Our Research:
Improvement of Care and Outcome
Improvement of Care and Outcome
An important goal for Diabeter is to optimize the outcome for every person with diabetes, and minimize the burden of the disease. Our use of an electronic disease management system developed in-house (VCare) for over 15 years means that we have collected a vast amount of data, as well as experience. Rigorous scientific analyses of our datasets makes it possible for us to identify factors associated with better outcomes, and improve the care that we deliver.
As new medicines and new technologies enter the real world, we can make use of the VCare system to continually evaluate their impact on the management of type 1 diabetes. We can provide useful data on usability, efficacy, safety, and cost-effectiveness.
Our work in the field of outcomes research has included:
- Identifying factors associated with the successful use of insulin pumps and continuous glucose sensors.
- Investigating the use, impact, and outcome of new forms of treatment and communication between people with diabetes and the health care professional, such as our ‘Ther@piemail’ (personalized e-mails with advice based on VCare-algorithms which is checked by health care professionals)
- Analyzing data for screening and treatment of concomitant diseases such as hypothyroidism and celiac disease.
- Testing new insulin analogues such as insulin degludec (Tresiba).
- Testing co-medications such as GLP-1 analogues.
- Intervention studies with vaccines (Diagnode study) or immune-modulators (Diabil study) that should inhibit beta-cell destruction in type 1 diabetes.
Through research such as this, we can help refine and optimize treatment and its outcomes, developing the most appropriate personalized care for each person with diabetes. You can find our projects on these topics by clicking here or on the Projects button.
Projects
FiAsp: Evaluation of a faster insulin analogue in adult people with diabetes with an insulin-pump (NovoNordisk).
Thyroid function and diagnostics in children with type 1 diabetes
The right diagnosis: is it type 1 or…?
Effect of bolus/basal rate settings on glucose regulation and weight
Factors of success in sensor-augmented pump treatment (SAPT)
Long-term improvement and sustainability of HbA1c outcome in children and youth with type 1 diabetes: the Diabeter experience
Publications
Mortality and diabetes in the Netherlands
Jessica Bak, Silvia de Vries, Erik H. Serné, Rolf Groenwold, Harold de Valk, Dick Mul, Theo Sas, Maurice Bizino, Max Nieuwdorp, Mark Kramer, Carianne Verheugt
Mortality patterns in Dutch diabetes outpatients. Diabetes Obes Metab. 2024 Jul 29
Diabetes registry in the Netherlands
Jessica Bak, Erik Serné, M Wouters, Harold de Valk, Dick Mul, Theo Sas, Mark Kramer, Max Nieuwdorp, Carianne Verheugt
Potency of quality indicators in Dutch and international diabetes registries. Diabetes Metab Syndr . 2024 Jan;18(1):102920.
Socioeconomic differences in diabetes care
Silvia de Vries, Theo Sas, Jessica Bak, Dick Mul, Max Nieuwdorp, Michel Wouters, Carianne Verheugt
Socio-economic disparities in hospital care among Dutch patients with diabetes mellitus. Diabetes Obes Metab. 2024 Jan 16. Online ahead of print.
Hospital size and T1D care
Silvia de Vries, Jessica Bak, Dick Mul, Michel Wouters, Max Nieuwdorp, Carianne Verheugt, Theo Sas.
Does size matter? Hospital volume and resource use in paediatric diabetes care. Diabet Med . 2023 Nov 28:e15260.
Diet and closed-loop systems in T1D
Sarah Koning
Dietary interventions in closed loop systems - Changing clinical nutrition approaches. Oral presentation at ISPAD 2023
Lipids & blood pressure in T1D
Rita Varkevisser, Dick Mul, Henk-Jan Aanstoot, Bruce Wolffenbuttel, Melanie van der Klauw
Differences in lipid and blood pressure measurements between individuals with type 1 diabetes and the general population: a cross-sectional study. BMJ Open 2023;13:e073690
Diabetes and use of hospital care in the Netherlands
Silvia de Vries, Jessica Bak, Vincent Stangenberger, Michel Wouters, Max Nieuwdorp, Theo Sas, Carianne Verheugt
Use of hospital care among Dutch diabetes patients. Diabetes Obes Metab . 2023 Aug;25(8):2268-2278.
Basal bolus ratio & treatment modality
Ferda Evin, Sascha R. Tittel, Barbara Piccini, Roque Cardona-Hernandez, Dick Mul, Nicole Sheanon, Thekla von dem Berge, Vit Neuman, Martin Tauschmann, Damla Gökşen
Basal and Bolus Insulin Distribution According to Treatment Modality: Data from SWEET Diabetes Registry. Pediatric Diabetes. 2023 Aug 9; 8837506.
Pediatric T1D care during COVID-19
Agata Chobot, Stefanie Lanzinger, Hessa Alkandari, Todd Alonso, Nicole Blauensteiner, Nicole Coles, Luisa De Sanctis, Dick Mul, Banshi Saboo, Carmel Smart, Meng-Che Tsai, Bedowra Zabeen, Klemen Dovc for the SWEET Study Group
Diabetes care practices and outcomes in 40.000 children and adolescents with type 1 diabetes from the SWEET registry during the COVID-19 pandemic. Diabetes Res Clin Pract. 2023 Jun 27;110809.
Insulin pump discontinuation
Ferda Evin, Sascha R. Tittel, Barbara Piccini, Roque Cardona-Hernandez, Dick Mul, Nicole Sheanon, Thekla von dem Berge, Vit Neuman, Martin Tauschmann, Damla Gökşen
Basal and Bolus Insulin Distribution According to Treatment Modality: Data from SWEET Diabetes Registry. Pediatric Diabetes. 2023 Aug 9; 8837506.
Cost and technology in pediactric diabetes
Silvia de Vries, Jessica Bak, Carianne Verheugt, Vincent Stangenberger, Dick Mul, Michel Wouters, Max Nieuwdorp, Theo Sas
Healthcare expenditure and technology use in pediatric diabetes care. BMC Endocr Disord. 2023 Apr 7;23(1):72.
Need for improvement in T1D management
Rita Varkevisser, Erwin Birnie, Dick Mul, Peter van Dijk, Henk-Jan Aanstoot, Bruce Wolffenbuttel, Melanie van der Klauw
Type 1 diabetes management: Room for improvement. J Diabetes. 2023 Mar;15(3):255-263.
Sex differences in paediatric T1D
Silvia de Vries, Carianne Verheugt, Dick Mul, Max Nieuwdorp, Theo Sas
Do sex differences in paediatric type 1 diabetes care exist? A systematic review. Diabetologia. 2023 Apr;66(4):618-630. Epub 2023 Jan 26.
Cardiovascular risk management in T1D
Rita Varkevisser, Erwin Birnie, Charlotte Vollenbrock, Dick Mul, Peter van Dijk, Melanie van der Klauw, Henk Veeze, Bruce Wolffenbuttel, Henk-Jan Aanstoot.
Cardiovascular risk management in people with type 1 diabetes: performance using three guidelines. BMJ Open Diabetes Res Care. 2022 Jul;10(4):e002765
Closing the loop part II: 780G system results after 6 months
D Mul, A. Arrieta, HJ Aanstoot, J Castañeda, J Da Silva
Durable high glucometric performance of the Minimed 780G advanced hybrid closed loop system in real-world evaluation in a value based diabetes center (Diabeter Netherlands). Diabetes Technology & Therapeutics.Apr 2022.A-1-A-237. Poster EP035
Glycemic control in T1D: International comparison
Regina Prigge, John A McKnight, Sarah H Wild et al. (including Henk Veeze, Henk-Jan Aanstoot and Dick Mul of Diabeter)
International comparison of glycaemic control in people with type 1 diabetes: an update and extension. Diabet Med. 2022 May;39(5):e14766.
COVID-19 and improved glucometrics in T1D
Namam Ali, Soumia El Hamdaoui, Giesje Nefs, Cornelis J Tack, Bastiaan E De Galan
Improved glucometrics in people with type 1 diabetes 1 year into the COVID-19 pandemic. BMJ Open Diabetes Res Care . 2022 May;10(3):e002789.
Consensus statement do-it-yourself automated insulin delivery systems
Katarina Braune, Rayhan A. Lal, Lenka Petruželková, Gary Scheiner, Per Winterdijk, Signe Schmidt, Linda Raimond, Korey K Hood, Michael C Riddell, Timothy Skinner, Klemens Raile, Sufyan Hussain on behalf of the OPEN International Healthcare Professional Network and OPEN Legal Advisory Group.
Open-source automated insulin delivery: international consensus statement and practical guidance for health-care professionals. Lancet Diabetes Endocrinol . 2022
SWEET: Benchmarking type 1 diabetes care in 19 countries
Peter Gerhardsson, Anke Schwandt, Michael Witsch, Olga Kordonouri, Jannet Svensson, Gun Forsander, Tadej Battelino, Henk Veeze, Thomas Danne, on Behalf of the SWEET Study Group
The SWEET Project 10-Year Benchmarking in 19 Countries Worldwide Is Associated with Improved HbA1c and Increased Use of Diabetes Technology in Youth with Type 1 Diabetes. 2021 Jul;23(7):491-499.
Remote care in COVID-19 times
G Nefs, P Winterdijk, P Dekker, M De Vries, T Sas, D Mul, H Veeze, HJ Aanstoot
Transition to remote diabetes care in COVID-19 times: experiences from a specialized type 1 diabetes clinic. 14th International Conference on Advanced Technologies and Treatments for Diabetes, 2-5 June 202, online. Abstract: #359.
Closing the loop: 780G system
HJ Aanstoot, P Winterdijk, S Bovenberg, P Dekker, M De Vries, T Sas, D Mul, I Bliek, S Huijbers, M Alkemade, L Olierook, H Veeze
Effect of remote education in switching to a new advanced hybrid closed-loop system: improved time in range, sustained auto mode and better average glucose levels. 14th International Conference on Advanced Technologies and Treatments for Diabetes, 2-5 June 2021, online. Abstract: #319.
Dutch National Diabetes Registry: DPARD
Jessica C. G. Bak, Dick Mul, Erik H. Serné, Harold W. de Valk, Theo C. J. Sas, Petronella H. Geelhoed-Duijvestijn, Mark H. H. Kramer, Max Nieuwdorp, Carianne L. Verheugt
DPARD: rationale, design and initial results from the Dutch national diabetes registry. BMC Endocr Disord. 2021 Jun 16;21(1):122.
Primary vs secondary patients: The Diabeter experience
P Dekker,D Mul, M De Vries, T Sas, HJ Aanstoot, H Veeze.
Glycaemic control in type 1 diabetes patients treated from clinical onset in a value-based care center vs. patients transferred from other centers: the DIABETER experience. 13th International Conference on Advanced Technologies and Treatments for Diabetes, 19-22 February 2020, Madrid. Abstract: #628.
Real-world data 670G hybrid closed-loop system
Dick Mul, Arcelia Arrieta, Pim Dekker, Henk-Jan Aanstoot, Martine de Vries, Theo Sas, Henk Veeze
Increased time in range and sustained Auto Mode use in 670G hybrid closed-loop system users: real world experience in DIABETER. 13th International Conference on Advanced Technologies and Treatments for Diabetes, 19-22 February 2020, Madrid, Spain. Abstract: #170.
Framework conditions for succesful use of technology in type 1 diabetes
Mul D, Aanstoot HJ, Dekker P, de Vries M, Sas T, Veeze HJ.
Improvement of A1C can be obtained in an optimal and enabling setting that combines technology and patient-HCP contacts through data-upload and eHealth. 45th Annual of the International Society for Pediatric and Adolescent Diabetes (ISPAD), Oct 30-Nov 2 2019, Abstract: #O23
To pump or not to pump: csii discontinuation among children and adolescents with type 1 diabetes
T Sas, C De Jong, M De Vries, P Dekker, HJ Aanstoot, H Veeze, D Mul.
Discontinuation of pump use in children and adolescents with type 1 diabetes. 12th International Conference on Advanced Technologies and Treatments for Diabetes, 20-23 February 2019, Berlin. Abstract: #279.
Incidence of pediatric type 1 diabetes doubles in 30 years
Spaans EA, Gusdorf LM, Groenier KH, Brand PL, Veeze HJ, Reeser HM, Bilo HJ, Kleefstra N.
The incidence of type 1 diabetes is still increasing in the Netherlands, but has stabilised in children under five (Young DUDEs-1). Acta Pediatr. 2015;104:626-9.
Global study compares glycemic control rates
McKnight JA, Wild SH, Lamb MJ, Cooper MN, Jones TW, Davis EA, Hofer S et al.
Glycaemic control of type 1 diabetes in clinical practice early in the 21st century: an international comparison. Diabet Med. 2015;32:1036-50.
Insulin dosing calculator for people with newly developed type 1 diabetes evaluated
Mul D, Aanstoot HJ, Simm D, Veeze HJ.
Initial insulin dosage in new onset pediatric diabetes: how to start? Presented at: 8th International Conference on Advanced Technologies and Treatments for Diabetes, 18-21 February 2015, Paris. Abstract: #286.
Thyroid peroxidase autoimmunity in type 1 diabetes – how prevalent is it?
D. Simm, E.Birnie, D. Mul, H.J. Veeze, H.J. Aanstoot.
Thyroid peroxidase autoimmunity and the effect on thyroid function in children and adolescents with type 1 diabetes. Presented at: 8th International Conference on Advanced Technologies and Treatments for Diabetes, 18-21 February 2015, Paris. Abstract: #376.
Family factors influence patient outcomes
Cameron FJ, Skinner TC, de Beaufort CE, Hoey H, Swift PG, Aanstoot H, Aman J, Martul P et al.
Are family factors universally related to metabolic outcomes in adolescents with type 1 diabetes? Diabet Med. 2008;25:463-8.