This study aimed to evaluate the effectiveness of a group-based peer support intervention for individuals with type 2 diabetes, focusing on diabetes-related distress, self-care, well-being, and health-related quality of life. In this randomized controlled trial, participants were allocated to either a group-based peer support intervention—consisting of six sessions led by peer leaders and psychotherapists—or a single educational meeting. Outcomes were assessed at baseline, six months, and twelve months using self-reported questionnaires. Differences between the intervention and control groups were analyzed using linear multilevel models. Out of 1,404 individuals with type 2 diabetes who were invited, 269 (19.2%) expressed willingness to participate, and 225 (16.0%) completed the baseline questionnaire and were enrolled. Participants who consented generally had higher educational levels. Among those in the intervention group, 62.7% attended three or more sessions. The intervention led to improved well-being (0.99; 95%CI:-0.02–2.00) and higher frequency of foot care days per week (0.50; 95%CI 0.06–0.94). However, there were no differences between the groups regarding diabetes-related distress, health-related quality of life, self-efficacy, or the other self-care domains. The results showed only limited benefits for people with T2D, the findings suggest the need for better targeting of interventions and strategies to improve engagement and participation.

BACKGROUND:Medial arterial calcification (MAC) and increased arterial stiffness contribute to cardiovascular disease risk in type 2 diabetes mellitus (T2DM). Experimental studies suggest that magnesium supplementation may halt arterial calcification and improve arterial stiffness. OBJECTIVES:This study aimed to evaluate the effect of 6-mo oral magnesium citrate supplementation on calciprotein crystallization (T50) and carotid-femoral pulse wave velocity (cfPWV) in individuals with T2DM and peripheral MAC. METHODS:This double-blind, placebo-controlled trial randomly assigned 74 participants with T2DM [78% males, 72 (68-76) y] with peripheral MAC and cfPWV≥12.0 m/s to magnesium citrate (350 mg/d; n = 37) or placebo (n = 37). Nephelometry-based T50 measurements, cfPWV measurements, and 24-h urine collections were obtained at baseline, 3 and 6 mo. Longitudinal analysis of covariance adjusted for baseline T50 and cfPWV was used to study the treatment effects on T50 and cfPWV. RESULTS:Baseline mean T50 and cfPWV were similar between the magnesium group (T50 348 ± 54 min; cfPWV 15.9 ± 2.2 m/s) and the placebo group (362 ± 54 min; 15.6 ± 2.0 m/s). Magnesium in serum and in 24-h urine were lower in the magnesium group [0.74 (0.71-0.77) mmol/L and 3.30 (2.06-4.71) mmol/24 h] compared with the placebo group [0.81 (0.74-0.86) mmol/L and 4.31 (3.09-5.54) mmol/24 h]. Supplementation increased 24-h urine magnesium excretion (P < 0.001), but not serum magnesium concentration (P = 0.073) over time in the magnesium group relative to the placebo group. Magnesium supplementation did not increase T50 [ẞ = 6 min (-11, 22), P = 0.491] but did increase cfPWV [ẞ = 0.8 m/s (0.1, 1.5), P = 0.021] over 6 mo in the magnesium group relatively to the placebo group, but the statistical significance was lost after adjusting for clinically relevant baseline differences [T50: ẞ = 7 min (-12, 25), P = 0.482; cfPWV: ẞ = 0.5 m/s (-0.2, 1.3), P = 0.180]. CONCLUSIONS:Six-month magnesium citrate supplementation did not reduce calciprotein crystallization and arterial stiffness in older individuals with T2DM with peripheral MAC. Daily supplementation of 350 mg appears to be ineffective in this population, possibly attributable to normomagnesemia and preserved renal function. This study was registered at the Dutch Trial Register (CCMO) as NL81281.029.22 and at ISRCTN as 60460377.

Chronic kidney disease (CKD) is a common complication of type 2 diabetes, characterized by reduced kidney function and/or albuminuria, yet its progression varies widely among individuals. While sodium-glucose cotransporter-2 (SGLT2) inhibitors are known to protect against kidney decline, the molecular mechanisms underlying their renoprotective effects remain incompletely understood. Circulating small non-coding RNAs (sncRNAs), particularly microRNAs, have been linked to CKD but the contribution of other sncRNA classes is less explored. We profiled plasma sncRNAs in 263 participants with type 2 diabetes from the Hoorn DCS cohort without CKD at baseline, followed for ∼9 years (n control = 122, n case = 141). sncRNA profiling was also performed before and after treatment of SGLT2 inhibitors in three trials (n = 65, total) to assess drug-induced molecular changes in the circulation. Eleven sncRNAs were nominally associated with incident CKD, most strongly SNORD12C and SNORD105B. In an independent SGLT2 inhibitor trial, exploratory analyses identified 34 sncRNAs that changed following treatment, including SNORD105B. Preliminary analyses linked these snoRNAs to co-regulated proteins, suggesting potential functional relevance. Our results identify snoRNAs, particularly SNORD105B, as potential novel markers of CKD risk and SGLT2 inhibitor response in type 2 diabetes, revealing an unexplored sncRNA axis and providing a foundation for future functional studies into their mechanistic role in CKD progression.

The OMED2 (Optimization of Medication in Elderly with Diabetes) study addresses the effect and implementation of integrating a deprescribing programme (DPP) in general practice. The aim of the DPP is to reduce glucose-lowering medication (SU/insulin) in overtreated older patients. The protocol for this study has been published previously. This statistical analysis plan (SAP) contains a more elaborate outline of the (statistical) methods we plan to use for data analysis. The OMED2 study is a randomized mixed-methods study with a 2-year follow-up period that compares the effect of the implementation of a DPP in general practice to regular care (control). In this SAP, we report on the (statistical) approaches that we plan to use to address the study objectives. The main objective of the OMED2 study is to examine the effect of the implementation of the DPP on diabetes complications, whereby the total number of diabetes complications related to undertreatment and overtreatment will be summed. Generalized linear mixed models with a Poisson distribution and the DPP as the main determinant will be used to test whether the total number of diabetes complications occurring from the start of the 2-year follow-up until the end of follow-up differs between intervention and control. The incident rate of the number of diabetes complications will be calculated to correct for possible differences in follow-up duration. The model will also include a random effect variable to allow for possible clustering effects by general practice. We will perform intention-to-treat analyses, which include all patients eligible for deprescribing, as well as per protocol analyses, which omit patients who were not deprescribed in the intervention arm. Additionally, approaches to study the implementation of the DPP and the cost-effectiveness of the implementation are outlined in the SAP. ISRCTN Registry ISRCTN50008265. Registered on 1 November 2024.

BACKGROUND:Subclinical hyperthyroidism (SHT) has been associated with adverse cardiovascular outcomes, but the magnitude and consistency of these risks, particularly across demographic subgroups, remain unclear. METHODS:We conducted a retrospective cohort study using general practitioner (GP) data from the PHARMO Data Network in the Netherlands (2012-2021). Patients with biochemically confirmed SHT (suppressed thyrotropin [TSH] with normal fT4; n = 11,163) were compared with a matched euthyroid reference group (n = 46,058) based on age, sex, and GP practice. Incidence of atherosclerotic complications, atrial fibrillation (AF), heart failure (HF), and all-cause mortality were assessed. Multivariable-adjusted Cox regression models estimated hazard ratios (HRs), adjusting for relevant confounders. Due to data limitations, information on smoking and alcohol use was not available, and medical history concerning comorbid conditions could only be assessed for the one-year period prior to cohort entry. RESULTS:SHT was associated with a significantly increased risk of AF (HR: 1.37, 95% CI: 1.22-1.55), particularly in those with TSH < 0.1 mU/L (HR: 1.60, 1.32-1.94) and in individuals aged 30-49 years (HR 1.88, 1.05-3.36). HF risk was modestly elevated overall (HR: 1.21, 1.04-1.40), with stronger effects in individuals aged 30-49 years (HR: 3.74, 1.52-9.24) and women (HR: 1.31, 1.10-1.56). All-cause mortality was higher in the SHT group (HR: 1.51, 1.38-1.64), especially in men (HR: 1.75, 1.50-2.05) and individuals aged 30-49 years (HR: 2.95, 1.73-5.04). The association with atherosclerotic complications was weak-to-modest (HR: 1.12, 1.00-1.24). CONCLUSIONS:SHT is linked to increased risks of AF, HF, and all-cause mortality, with higher relative risks in younger patients. These findings challenge the traditional focus on older populations and underscore the need for individualized risk assessment in SHT.

In this meta-analysis of international cohorts, current smoking is confirmed as a significant BMD-independent predictor of future fracture with a stronger relationship in men than in women. A causative and reversible effect of smoking on fracture risk is suggested by past smoking having a significantly lower risk than current smoking. In this meta-analysis of international cohorts, the aim was to examine the relationship of current and past smoking with fracture risk to provide an update for future iterations of the FRAX tool. The risk of fracture associated with current and past smoking was estimated using an extended Poisson model applied separately to each of 58 prospective international cohort studies. Covariates included current time since start of follow up, current age, and in an additional model, BMD at the femoral neck. The results of the different studies were merged by using inverse-variance weighted β-coefficients. This analysis included a total of 1,691,024 participants (61.2

OBJECTIVE:To delineate organ-specific and systemic drivers of metabolic dysfunction-associated steatotic liver disease (MASLD), we applied integrative causal inference across clinical, imaging, and proteomic domains in individuals with and without type 2 diabetes (T2D). METHODS:Bayesian network analyses and complementary two-sample Mendelian randomization were used to quantify causal pathways linking adipose distribution, glycemia, and insulin dynamics with liver fat in the IMI-DIRECT prospective cohort study. Data included frequently sampled metabolic challenge tests, MRI-derived abdominal and hepatic fat content, serological biomarkers, and Olink plasma proteomics from 331 adults with new-onset T2D and 964 adults without diabetes, with harmonized protocols enabling replication. RESULTS:High basal insulin secretion rate (BasalISR), estimated via C-peptide deconvolution, emerged as the primary potential causal driver of liver fat accumulation in both cohorts. BasalISR, a clearance-independent measure of β-cell insulin output distinct from peripheral insulin levels, was independently linked to hepatic steatosis. Visceral adipose tissue exhibited bidirectional associations with liver fat, suggesting a self-reinforcing metabolic loop. Of 446 analyzed proteins, 34 mapped to these metabolic networks (27 in the non-diabetes network, 18 in the T2D network, and 11 shared). Key proteins directly associated with liver fat included GUSB, ALDH1A1, LPL, IGFBP1/2, CTSD, HMOX1, FGF21, AGRP, and ACE2. Sex-stratified analyses identified GUSB in females and LEP in males as the strongest protein predictors of liver fat. CONCLUSIONS:BasalISR may better capture early β-cell-driven disturbances contributing to MASLD. These findings outline a multifactorial, sex- and disease stage-specific proteo-metabolic architecture of hepatic steatosis and identify potential biomarkers or therapeutic targets.

Background In the Netherlands, community pharmacists (CPs) are required to conduct annual clinical medication reviews (CMRs) for older patients with polypharmacy. In practice, these reviews are insufficiently implemented, and opportunities to deprescribe inappropriate cardiovascular and antidiabetic medications are often missed. The LeMON study focused on deprescribing, enhancing CPs' awareness and ability to reduce unnecessary medication through close collaboration with general practitioners (GPs).Aim The aim of the study was to evaluate the experiences of patients and CPs who participated in the LeMON study.Methods Patient experiences and satisfaction were assessed using the Patient-Reported Experience Measure (PREM) and the Treatment Satisfaction Questionnaire for Medication (TSQM). Semistructured interviews with CPs were analysed using the extended normalization process theory (eNPT), covering potential, capability, capacity and contribution.Results Of 140 patients, 62 (44%) completed the questionnaires. Patients reported high satisfaction, felt their medication concerns were addressed andappreciated CP recommendations. TSQM scores were moderate to high across effectiveness, side effects, convenience andoverall satisfaction. CPs valued the online training and acknowledged the importance of deprescribing. Challenges included addressing patient concerns in the absence of symptoms and deprescribing medications initially prescribed by specialists, which could reduce CPs' confidence and patient trust.Conclusion Patient and CP experiences highlight the need for specific knowledge and training, shared clinical data andclose CP-GP collaboration to implement deprescribing-focused CMRs routinely. Addressing patient concerns and deprescribing specialist-initiated medications requires effective communication skills and structured local or regional protocols for multidisciplinary collaboration between primary and secondary care.

Diabetes distress (DD) refers to the emotional and psychological burden experienced by individuals living with diabetes. Randomized controlled trials (RCTs) have investigated the efficacy of interventions on DD among adults with type 1 diabetes or type 2 diabetes. We aimed to systematically identify, summarize and critically appraise all available evidence from RCTs assessing the efficacy of interventions for reducing DD (either as primary or secondary outcome) among adults with type 1 diabetes or type 2 diabetes. Four electronic databases (PubMed, Cochrane Database of Systematic Reviews, PsycINFO and CINAHL) were searched from inception until 23 September 2024. Retrieved papers were screened for eligibility by two independent reviewers, who also screened the reference lists of all included publications. Studies were included if the study was an RCT performed in an adult population (≥18 years), in which the efficacy of an active intervention on DD as primary or secondary outcome was described. Data were extracted using an a priori developed form. Two independent reviewers assessed the risk of bias of included studies using the Cochrane RoB 2 tool for RCTs. For each type of intervention, a narrative data synthesis was conducted, and, if possible, meta-analyses were conducted when two or more studies reported on the same outcome. Heterogeneity between studies was assessed using the I2 statistic and a certainty of evidence assessment (GRADE) was conducted. In case of substantial heterogeneity, subgroup analysis was conducted. Data regarding the efficacy of interventions on DD was summarized and discussed. Future implications and recommendations for clinical care were presented. This systematic review and meta-analysis served as the basis for a European Association for the Study of Diabetes (EASD) guideline on the management of DD. PROSPERO CRD42024598512.

BACKGROUND:Interpretation of blood leptin concentration in clinical practice and research is limited by a lack of comprehensive reference values. We aimed to establish reference ranges across the age and weight spectrum, taking into consideration important covariates age (0-75 years), pubertal status, and body weight status (normal to extreme obesity). METHOD:Data from 12 629 individuals across 16 European cohorts were pooled and extracted for weight, height, Tanner stage (TS), and serum leptin concentration via ELISA (Leptin ELISA kit). Generalized additive models for location, shape, and scale were used to render reference curves stratified by sex, TS, and weight status. RESULTS:In boys, serum leptin concentrations increased between ages 6 and 12, followed by a decline after age 12, while girls showed an increase until age 15, with body mass index (BMI) SD score (SDS) dependent trajectories thereafter. Leptin concentrations were generally higher in girls than boys, except in boys aged 9 to 15 years with a BMI-SDS of > 3. In adults, women consistently had higher leptin concentrations across all BMI categories. In men, leptin concentrations decreased until the mid-20s for a BMI of 30 kg/m2 and until age 50 for a BMI of 40 kg/m2, stabilizing thereafter. CONCLUSION:We present the first reference curves for leptin concentrations across the entire age and weight range. An online tool and an R package for calculating leptin z-scores that are specific to age, sex, TS, and BMI (or BMI-SDS) are now available for clinical and research use at https://leptin.science.

The relationship between bone mineral density (BMD) at the femoral neck and fracture risk was determined in a meta-analysis of primary data of 307205 men and women from 53 cohort studies. Low BMD was an important predictor of fracture risk, particularly for hip fracture. This study aimed to quantify the relationship between DXA-measured femoral neck BMD and fracture risk and examine the effect of age, sex, time since measurement, and initial BMD value on fracture risk, with a view to updating FRAX®. We studied 307,205 men and women from within 53 predominately population-based cohorts followed up for an average of 8.7 years and a total of 2,683,185 person-years. The association of BMD and fracture risk was examined using a Poisson model in each cohort separately by sex. Results were expressed as a gradient of risk (GR, hazard ratio/standard deviation decrease in BMD). The different studies were then merged using weighted coefficients. Most hip fractures arose in men and women with low bone mass or osteoporosis at baseline (73 = 0.12 for women and p = 0.89 for men). A significant decrease in GR for hip fracture was observed with increasing duration of follow-up, but the magnitude of the effect was modest compared with the effect of age. For other fracture outcomes, including non-hip major osteoporotic fracture, the gradient of risk was lower than for hip fracture. Femoral neck BMD is a risk factor for fracture of substantial importance, particularly for future hip fracture. The lower magnitude of association at older age is consistent with other non-skeletal factors contributing to hip fracture risk with advancing age. Its validation on an international basis supports its use in case finding strategies. Its use should, however, take account of the variations in predictive value of BMD with age, sex, length of follow-up, and BMD.

This narrative review provides a historical perspective on how observational research on type 2 diabetes has been developed and consolidated over the last 50 years and how well-designed cohort studies will provide us with knowledge for research and practice in the future and aid guideline development. We have included data from a large number of cohorts from every continent that have been used to study the development and/or progression of type 2 diabetes, including cohorts that are general population-based, disease-based, intervention-based and registry-based. We have structured the results from the past 50 years based on the following themes: diagnosis and screening, complications, risk factors and pathophysiology. We also discuss the strengths and weaknesses of observational research when compared with other research designs. Finally, we discuss the emerging and future directions for type 2 diabetes research using cohorts, which include novel developments, such as artificial intelligence, precision health and the exposome. We conclude that cohort research has significantly advanced our understanding of type 2 diabetes and aided guideline development, and complements experimental work, such as human randomised controlled trials and animal studies. Both approaches are essential and complementary in our pursuit to provide a more comprehensive understanding of the development and progression of type 2 diabetes, and to change dogma, practice and policies for better outcomes.

In the largest meta-analysis of international cohorts to date, a family history of fracture is confirmed as a significant BMD-independent predictor of future fracture risk. Parental and sibling histories of fracture carry the same significance for future fracture, including the impact of family hip fracture on future hip fracture risk. PURPOSE:We have undertaken a meta-analysis of international prospective cohorts to quantify the relationship between a family history of fracture and future fracture incidence. METHODS:The analysis dataset comprised 350,542 men and women from 42 cohorts in 29 countries followed for 2.8 million person-years. We investigated the relationship between family history of hip fracture or any fracture and the risk of any clinical fracture, any osteoporotic fracture, major osteoporotic fracture (MOF), and hip fracture alone using an extended Poisson model in each cohort. Models were adjusted for current age, sex, BMD, and follow-up time. RESULTS:As no difference in influence of family history of fracture was seen between genders, results are presented for men and women combined. A parental history of hip fracture was associated with a higher risk of incident fracture across all fracture outcome categories, with a stronger relationship with future hip fracture (hazard ratios (HR, 95% CI) for hip and MOF 1.37, 1.23-1.52 and 1.19, 1.12-1.27, respectively). Associations were slightly reduced but remained significant when additionally adjusted for BMD and did not vary by baseline offspring age, follow-up time, or parent affected. In a more limited analysis, parental history of any fracture or a sibling history of hip or any fracture showed similar associations to those observed with parental history of hip fracture. CONCLUSIONS:A family history of fracture is confirmed as a significant BMD-independent predictor of future fracture risk. While parental hip fracture appears the strongest factor for future hip fracture, a family history of other fractures might be appropriate for inclusion in future iterations of the FRAX tool.

Deprescribing inappropriate cardiovascular and antidiabetic medication has been shown to be feasible and safe. Healthcare providers often perceive the deprescribing of cardiovascular and antidiabetic medication as a challenge and therefore it is still not widely implemented in daily practice. The aim was to assess whether training focused on conducting a deprescribing-oriented clinical medication review (CMR) results in a reduction of the inappropriate use of cardiovascular and antidiabetic medicines. A cluster randomized controlled trial involving 20 community pharmacists, who conducted a clinical medication review in 10 patients. The intervention group received training on deprescribing. Patients 70 years or older with polypharmacy having a systolic blood pressure below 140 mmHg and using antihypertensive medication and/or an HbA1c level below 54 mmol/mol and using antidiabetic medication, were included. Follow-up took place within 4 weeks (T1) and after 3 months (T2). The primary outcome measure was the proportion of patients with one or more cardiovascular and antidiabetic medicine deprescribed within 3 months after the CMR (T2). A total of 71 patients in the intervention group and 69 patients in the control group were included. At T2, 32

INTRODUCTION:Ethnic minority populations may be disproportionally affected by unhealthy environmental exposures, increasing health inequities. This study aims to identify whether residential neighborhood exposures differ between ethnic groups in the Netherlands. METHODS:This cross-sectional study included all adult residents of the Netherlands registered in the national population register on 01/01/2022 (N = 13,926,871). Exposure data (physico-chemical, food and physical environment, socio-economic characteristics, health and social well-being) were obtained from Statistics Netherlands, GECCO and the Dutch Health Monitor, and linked to individuals based on geocoded home addresses. Ethnicity was based on country of birth of individuals and their parents. Estimated marginal means were calculated and ethnic differences in exposure determined using multiple linear regression, adjusted for age and sex, stratified by socio-economic status (SES) and population density. RESULTS:Compared to Dutch-origin, ethnic minority populations had less favorable physico-chemical exposures (e.g. 0.87 µg/m3 [95 %-CI: 0.86;0.88] higher PM2.5 exposure for Moroccans in "high SES-high population density"). Conversely, the food and physical activity environment was more favorable for ethnic minorities (e.g. 1.82 km/ha [95 %-CI 1.80;1.83] higher bike path density among Turks in the "low SES-low population" density category). Socio-economic characteristics of the environment were generally less favorable for ethnic minorities (e.g. difference between Dutch Caribbeans and Dutch-origin -4.23 % [95 %-CI -4.35;-4.11] in "high income-high population density"). Ethnic differences in health and social well-being varied. Neighborhood-level smoking was most prevalent among ethnic minorities, while excessive drinking was most prevalent among Dutch-origin. Exposure to vandalism and (sexual) violence was lowest among Dutch-origin and highest among Dutch Caribbean, Moroccans, Turks and Surinamese. CONCLUSION:Physico-chemical exposure, socio-economic characteristics of the environment and safety from crime were less favorable among ethnic minority populations compared to Dutch-origin. The food and physical activity environment was more favorable for ethnic minorities. Ethnic inequalities were most pronounced among Moroccans, Turks, Surinamese and Dutch Caribbeans compared to Dutch-origin.

Background: The effectiveness of COVID-19 vaccines appears to decline rapidly over time due to waning immunity and immune evasion by emerging variants of concern, and may be reduced in high-risk populations. We aimed to evaluate the rates of SARS-CoV-2 breakthrough infection or severe COVID-19, both in individuals who had completed their primary COVID-19 vaccination, and in those who had received their first booster vaccination. Specifically, we aimed to evaluate whether persons with certain risk factors, such as age, gender, socioeconomic status (SES), and specified comorbidities have an increased risk of either breakthrough infection or severe COVID-19, compared to those without the respective risk factors. Methods: Data on COVID-19 vaccinations, infections, hospitalizations, and deaths were collected from the PHARMO Data Network, consisting of health records from Dutch residents. Two cohorts were established: (1) all persons who have completed their primary COVID-19 vaccination regimen, and (2) those who have received their first booster vaccination. The outcomes were SARS-CoV-2 breakthrough infection, and severe COVID-19, defined as either hospitalization or death following SARS-CoV-2 infection. Incidence rates of these outcomes were calculated in both cohorts. The adjusted incidence rate ratios of these outcomes in persons with certain risk factors were calculated, using generalized linear models with a Poisson distribution. Results: In 2021, a total of 1,090,567 individuals received either two doses of BNT162b2, AZD1222, or mRNA-1273, or one dose of Ad26.COV2.S and were included in the primary vaccination cohort, of which 344,153 (31.6%) received a booster vaccination. Overall incidence rates of SARS-CoV-2 breakthrough infection and severe COVID-19 after primary vaccination were 29.9 and 3.1 per 1000 person-years, respectively, and after booster vaccination were 256.4 and 2.3, respectively. Male gender, older age, lower SES, history of COVID-19, and recent hospitalization were factors associated with a lower risk of breakthrough infection after primary vaccination, and a higher risk of severe COVID-19. The risk of severe COVID-19 after primary vaccination was increased in persons with several comorbidities, compared to those without, and remained elevated after booster vaccination in persons with diabetes or lung disease. Conclusions: Our study emphasizes the crucial role of boosters in reducing breakthrough infections, particularly in high-risk populations. The varied impact on severe outcomes in individuals with comorbidities underscores the need for ongoing surveillance and tailored vaccination strategies.

IntroductionOrganisational problems still prevent widespread implementation of clinical medication reviews. The Opti-Med2 method was developed to facilitate the process of performing clinical medication reviews. The method includes patient involvement by means of a questionnaire and expert teams of community pharmacists and general practitioners (GPs) to perform pharmacotherapeutic analyses, providing the patients' own GP with pharmacotherapeutic advice. There is a supporting role of community pharmacy technicians and general practice nurses/assistants in the process.AimTo gain insight into the implementation of the Opti-Med2 method within the framework of pharmacotherapeutic audit meeting groups in the Netherlands.MethodA mixed-methods implementation study in seven groups of primary care healthcare providers. Quantitative data were collected using study forms. Semi-structured interviews with 8 GPs, 5 community pharmacists and 2 community pharmacy technicians were held. Interviews were transcribed verbatim and were analysed using the extended Normalization Process Theory.ResultsOnly one group provided sufficient quantitative data for analysis. Of the pharmacotherapeutic advice given by the expert team, 72% was adopted by the GPs of which 85% resulted in an intervention with the patient. In general, the healthcare providers were satisfied with using the Opti-Med2 method. The use of expert teams was appreciated by most GPs and community pharmacists. All healthcare providers were very satisfied with the use of the patient questionnaire.ConclusionAlthough full implementation of Opti-Med2 method as a whole was not achieved, the structured organisation of conducting CMRs and the use of questionnaires was deemed successful.

AIMS:Adherence to an ideal cardiovascular health (CVH) might contribute to lower the burden of sudden cardiac death (SCD) in the community. We aimed to examine the association between the number of ideal CVH metrics at baseline and of its change over 10 years with the risk of SCD. METHODS AND RESULTS:The Copenhagen City Heart Study is a community-based prospective cohort study. The number of ideal CVH metrics (range 0-6; non-smoking and ideal level of body mass index, physical activity, untreated glucose, untreated systolic blood pressure, and untreated total cholesterol levels) at baseline in 1991-94 and its 10-year change thereof between 1981-83 and 1991-94 were evaluated. Definite SCD was defined as a death occurring within 1 h (eye-witnessed case) or within 24 h (non-eye-witnessed) of symptoms onset, with the presence of confirmed ventricular tachycardia and the exclusion of non-cardiac cause at autopsy. Fine and Gray sub-distribution HRs (sHRs) were calculated to account for competing risk. The study population includes 8837 participants (57% women; mean age 57 years, ±15 years) in 1991-94. After a median follow-up of 22.6 years from 1 January 1993 up to 31 December 2016, 56 definite SCD occurred. The risk of definite SCD decreased gradually with the number of ideal metrics in 1991-94 [sHR = 0.58; 95% confidence interval (CI): 0.44-0.75 per additional ideal metric] and with the change (i.e. improvement) in the number of ideal metrics between 1981-83 and 1991-94 (sHR = 0.68; 0.50-0.93 per change in the number of ideal metrics). Effect size was lower for coronary death, all-cause mortality, and coronary heart disease events. CONCLUSION:Adherence to a higher number of ideal cardiovascular health was related to a substantial lower risk of definite SCD.