Phenotypic and Genotypic Characterization of Patients With Dysmetabolism in Greenland

Conditions studied

Diabetes Mellitus, Type 2, Obesity, Morbid, Obstructive Sleep Apnea, MODY, Diabetic Retinopathy, Diabetic Neuropathies

About this study

The goal of this clinical trial is to perform a detailed description of the feno- and genotype of people living with type 2 diabetes and severe obesity who are linked to care at Steno Diabetes Center Greenland. The main questions it aims to answer are: * Are monogenetic diabetes variants associated with the same risk of developing late diabetic complications as other types of diabetes? * Can genotyping and thereby personalized medicine be implemented in Greenland, and can personalized medicine lead to improved treatment? * What is the prevalence of sleep apnea among high-risk individuals in Greenland? * Is it possible to develop and implement a simple algorithm for the identification of sleep apnea in Greenland that can ensure treatment of severe sleep apnea? Participants will: * Answer WHO-5 and FOSQ-10 questionnaires regarding quality of life and functional outcomes of sleepiness * Perform VAGUS examinations for Cardiovasculare Autonomic Neuropathy * Clinical examination of height, weight, circumference of hip, waist and neck, Friedman tonsil and tongue score, nasal air flow, nasal septal deviation * Blood samples for full genome sequencing

Interventions

• Genetic: Whole genome sequencing — Screening for MODY diabetes. Diabetic treatment will be adjusted based on the participant's diabetic genotype.
• Diagnostic Test: VAGUS — To examine for Cardiovasculare Autonomic Neuropathy participants will be tested with the handheld Vagus device (Medicus Engineering, Aarhus, Denmark). Participants are instructed to perform three cardiovascular reflex tests (CARTs) after lying still in supine position for 5 minutes to record heart rate at rest. CARTs include supine-to-upright position, deep-breathing, and valsalva maneuver. From each CART the ratio based on the shortest and longest R-R-interval at predefined timepoints in the recording is used to assess the possibility of CAN
• Diagnostic Test: NightOwl — Participants will be examined for sleep apnea for 3 nights using the NightOwl (Ectosense, Belgium) device, which measuring Peripheral Arterial Tonometry (PAT) in the index finger. The results of the examination will is uploaded via the patient's smartphone to an online platform accessible to healthcare providers. Participants with signs of sleep apnea will receive a confirmatory cardiorespiratory monitoring using the Nox T3s (Noxturnal, ResMed), and the results will be compared.
• Device: CPAP — Participants with an Apnea-Hypoapnea-Index above 30, or above 15 with symptoms of sleep apnea, will be offered treatment with continuous positive airway pressure (CPAP).

Primary outcomes

• Number of participants with MODY diabetes and their complication status (Blood drawn at inclusion. Results for participants ready after approximately 6 months.)
• Number of participants with diabetic complication (Types and number of complications are available at inclusion. No follow-up screenings for complications are performed.)
• Number of participants with obstructive sleep apnea (Home sleep testing is performed for 3 nights after inclusion. Confirmatory home sleep examinations performed one day after the initial sleep examination. In total, four days examinations time.)

Eligibility information

Study locations

• Steno Diabetes Center Greenland, Queen Ingrids Hospital, Nuuk, Sermersooq 3900 Greenland