Age at diagnosis of Type 2 diabetes in Germany: a nationwide analysis based on claims data from 69 million people

The rat as an animal model in chronic wound research: An update

The increasing global prevalence of chronic wounds underscores the growing importance of developing effective animal models for their study. This review offers a critical evaluation of the strengths and limitations of rat models frequently employed in chronic wound research and proposes potential improvements. It explores these models in the context of key comorbidities, including diabetes, venous and arterial insufficiency, pressure-induced blood flow obstruction, and infections. Additionally, the review examines important wound factors including age, sex, smoking, and the impact of anesthetic and analgesic drugs, acknowledging their substantial effects on research outcomes. A thorough understanding of these variables is crucial for refining animal models and can provide valuable insights for future research endeavors.

Hailey-Hailey Disease is Associated with Diabetes: A Population-based Cohort Study, Clinical Cohort Study, and Pedigree Analysis

Hailey-Hailey disease is a rare hereditary skin disease caused by mutations in the ATP2C1 gene encoding the secretory pathway Ca2+/Mn2+-ATPase 1 (SPCA1) protein. Extracutaneous manifestations of Hailey-Hailey disease are plausible but still largely unknown. The aim of this study was to explore the association between Hailey-Hailey disease and diabetes. A population-based cohort study of 347 individuals with Hailey-Hailey  disease was performed to assess the risks of type 1  diabetes and type 2 diabetes, using Swedish nationwide registries. Pedigrees from 2 Swedish families with Hailey-Hailey disease were also investigated: 1 with concurrent type 1 diabetes and HLA-DQ3, the other with type 2 diabetes. Lastly, a clinical cohort with 23 individuals with Hailey-Hailey disease and matched healthy controls was evaluated regarding diabetes. In the register data males with Hailey-Hailey disease had a 70% elevated risk of type 2 diabetes, whereas no  excess risk among women could be confirmed. In both pedigrees an unusually high inheritance for diabetes was observed. In the clinical cohort, individuals with Hailey-Hailey disease displayed a metabolic phenotype indicative of type 2 diabetes. Hailey-Hailey disease seems to act as a synergistic risk factor for diabetes. This study indicates, for the first time, an association between Hailey-Hailey disease and diabetes and represents human evidence that SPCA1 and the Golgi apparatus may be implicated in diabetes pathophysiology.

Diabetes in a hospital cohort of persons living with HIV: a descriptive and comparative study in French Guiana

BACKGROUND

In French Guiana (population 294,000) the prevalence of type 2 diabetes (10%) and of HIV(1.1%) are very high. Our objective was to determine the prevalence of diabetes and its complications in a HIV cohort.

MATERIALS AND METHODS

We enrolled HIV-infected persons followed in Cayenne, Kourou, and Saint Laurent du Maroni hospitals between January 1, 1992 and December 31, 2021 in the French Hospital Database for HIV (FHDH) a national database compiling data from all French regions.

RESULTS

There was no difference of diabetes prevalence between men (8.2%) and women (8.8%), P = 0.4. Patients with diabetes were older (56 years ± 13.4) than those without diabetes (44.7 years ± 13.6) and prevalence increased with age. The proportion of persons with diabetes was greater among virologically suppressed persons (10%) than those with a detectable viral load under antiretroviral treatment (5.8%). Persons with diabetes had substantially greater CD4 counts at diagnosis than persons without diabetes. The majority of macro and microvascular complications were observed in people with diabetes. Persons with diabetes and HIV were significantly less likely to have had AIDS (1.6 versus 2.2 per 100 person-years, respectively). Overall, 374 persons living with HIV of 4167 had died (9%) the proportion of persons with diabetes among the dead was greater than those who did not die 11.7% versus 8.1%, respectively, p = 0.017. However, persons with diabetes were older and hence died older, 62.3 years (SD = 1.9) for deceased persons with diabetes versus 50.4 years (SD = 0.8), P < 0.0001. However, using Cox regression to adjust for age, initial CD4 count, country of birth there was no significant difference in the Hazard for death between persons with diabetes and persons without diabetes (aHR = 0.99, 95%CI = 0.65-1.5), P = 0.9.

CONCLUSIONS

The prevalence of diabetes in our HIV cohort was high. Persons with diabetes had greater CD4 counts, earlier care, and greater virological suppression than persons without diabetes. There were no significant differences between persons with diabetes and without diabetes in terms of survival.

Common procedures and conditions leading to inpatient hospital admissions in adults with and without diabetes from 2015 to 2019 in Germany : A comparison of frequency, length of hospital stay and complications

OBJECTIVE

To evaluate common surgical procedures and admission causes in inpatient cases with diabetes in Germany between 2015 and 2019 and compare them to inpatient cases without diabetes.

METHODS

Based on the German diagnosis-related groups (G-DRG) statistics, regression models stratified by age groups and gender were used to calculate hospital admissions/100,000 individuals, hospital days as well as the proportion of complications and mortality in inpatient cases ≥ 40 years with or without a documented diagnosis of diabetes (type 1 or type 2).

RESULTS

A total of 14,222,326 (21%) of all inpatient cases aged ≥ 40 years had a diagnosis of diabetes. More middle-aged females with vs. without diabetes/100,000 individuals [95% CI] were observed, most pronounced in cases aged 40-< 50 years with myocardial infarction (305 [293-319] vs. 36 [36-37], p < 0.001). Higher proportions of complications and longer hospital stays were found for all procedures and morbidities in cases with diabetes.

CONCLUSION

Earlier hospitalizations, longer hospital stays and more complications in inpatient cases with diabetes together with the predicted future increase in diabetes prevalence depict huge challenges for the German healthcare system. There is an urgent need for developing strategies to adequately care for patients with diabetes in hospital.

Living kidney donor evaluation is associated with early identification of life-changing diagnoses in potentially healthy donor candidates

BACKGROUND

In order to ensure eligibility for living kidney donation, donor candidates undergo a thorough medical evaluation. This process might reveal hitherto undetected medical conditions, leading to refusal of the kidney donor candidate. Detection of such conditions may, however, also have a lifesaving effect. We report on 13 years of data from our living donor transplantation program on kidney donor candidates who were diagnosed with major medical conditions during evaluation.

MATERIALS AND METHODS

We performed a retrospective analysis of living kidney donor candidates who attended our transplant center between January, 2007 and December, 2019. The main focus was on newly diagnosed medical conditions that required immediate medical attention and their prognostic significance.

RESULTS

Of the 436 donor candidates who were evaluated for living kidney donation at our transplant center, 192 (44%) were accepted, while 244 (56%) were excluded from donation. Interestingly, 81 (33.1%) of the ineligible donor candidates were newly diagnosed as having a medical condition that required immediate attention. While 45 (18.5%) candidates were newly diagnosed with diabetes or prediabetes, 12 (4.9%) candidates had hitherto undetected malignancies, 10 candidates (4.1%) cardiac disease, five (2.0%) hypertension with end-organ damage, and four (1.6%) suffered from kidney disease. The remaining four candidates (1.6%) were diagnosed with gastrointestinal diseases, and one candidate (.4%) had an endocrine disorder.

CONCLUSION

A comprehensive evaluation process for living kidney donation facilitates the identification of life-changing diagnoses in a significant proportion of candidates and secures immediate medical attention.

Cellular enlargement - A new hallmark of aging?

Years of important research has revealed that cells heavily invest in regulating their size. Nevertheless, it has remained unclear why accurate size control is so important. Our recent study using hematopoietic stem cells (HSCs) in vivo indicates that cellular enlargement is causally associated with aging. Here, we present an overview of these findings and their implications. Furthermore, we performed a broad literature analysis to evaluate the potential of cellular enlargement as a new aging hallmark and to examine its connection to previously described aging hallmarks. Finally, we highlight interesting work presenting a correlation between cell size and age-related diseases. Taken together, we found mounting evidence linking cellular enlargement to aging and age-related diseases. Therefore, we encourage researchers from seemingly unrelated areas to take a fresh look at their data from the perspective of cell size.

The association between the risk of developing type 2 diabetes mellitus and health-related quality of life: baseline results from the Dimini lifestyle intervention

PURPOSE

The aim of the study was to analyse health-related quality of life (HRQoL) and its determinants in individuals with an increased risk of developing type 2 diabetes mellitus (T2D).

METHODS

We used pseudonymized baseline data collected between 2018 and 2020 as part of the Dimini project in Hesse and Schleswig-Holstein. HRQoL was measured by the mental and the physical component score of the validated instrument Short Form 12 and descriptively analysed followed by multiple linear regression analysis.

RESULTS

The Dimini population (n = 662) showed an average physical component score of 42.12 (SD 10.56) and a mental component score of 47.12 (SD 11.13). While men demonstrated both significantly higher physical and mental component scores than women, differences based on migration background were not observed. Younger age was associated with a higher level of the physical component score, whereas mental component scores linearly increased with age. Regarding indicators of T2D-risk, a significant influence of HbA1c on HRQoL was not confirmed. However, physical component scores are negatively related to Findrisk scores and BMI. Finally, study participants living alone and those with a handicap reported lower levels of HRQoL.

CONCLUSION

Compared with a representative sample of the general German population (DEGS1), Dimini participants were characterized by a lower average HRQoL. The analysis showed a higher vulnerability to an impaired HRQoL within certain subgroups of the population and among participants with relatively higher levels of T2D-risk. As a result, tailored healthcare interventions are required to reach these target groups.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov ID NCT03482674.

Physical inactivity in healthy, obese, and diabetic adults in Germany: An analysis of related socio-demographic variables

BACKGROUND

Adults with diabetes or obesity are more likely to be physically inactive than healthy adults. Physical activity is essential in the management of both diseases, necessitating targeted interventions in these groups. This study analysed physical inactivity (defined as not taking part in leisure-time physical activity) in over 100,000 adults in Germany considering their body mass index and the presence of diabetes. Furthermore, the relationship between specific socio-demographic factors with physical inactivity was investigated, particularly focussing diabetic and obese people, to refine the identification of risk-groups for targeted interventions on physical activity promotion.

METHODS

Data from 13 population-based health surveys conducted in Germany from 1997 to 2018 were used. The relevant variables extracted from these datasets were merged and employed in the analyses. We included data from 129,886 individuals in the BMI analyses and 58,311 individuals in the diabetes analyses. Logistic regression analyses were performed to identify the importance of six socio-demographic variables (age, sex/gender, education, income, employment, and migration) for the risk of physical inactivity.

RESULTS

Obese and diabetic people reported a higher prevalence of physical inactivity than those who were not affected. Logistic regression analyses revealed advanced age, low education level, and low household income as risk factors for physical inactivity in all groups. A two-sided migration background and unemployment also indicated a higher probability of physical inactivity.

CONCLUSION

Similar socio-demographic barriers appear to be important determinants of physical inactivity, regardless of BMI status or the presence of diabetes. However, physical activity promoting interventions in obese and diabetic adults should consider the specific disease-related characteristics of these groups. A special need for target group specific physical activity programmes in adults from ethnic minorities or of advanced age was further identified.

Prevalence of insulin as a first-line therapy and associated factors in people with type 2 diabetes in German primary care practices

AIM

To evaluate how many people with type 2 diabetes receive a treatment regimen with insulin as a first-line therapy and the factors associated with this.

METHODS

This retrospective study was based on data from the Disease Analyzer database and included 10 497 people with type 2 diabetes with an initial prescription of anti-hyperglycaemic therapy from 859 general and diabetologist practices in Germany between January 2014 and December 2018. The main outcome of the study was the prevalence of insulin as a first-line therapy. A multivariable logistic regression model was performed to investigate the association between predefined variables and the probability of receiving insulin as a first-line therapy.

RESULTS

A total of 7.1% of participants received insulin as a first-line therapy. Diabetologist practice [odds ratio (OR) 2.71, 95% confidence interval (CI) 1.81-4.06], age > 80 years (OR 2.35, 95% CI 1.20-4.61) compared with age ≤ 40 years, HbA_1c ≥ 86 mmol/mol (10%) (OR 2.99, 95% CI 1.81-4.95) compared with HbA_1c < 48 mmol/mol (6.5%), renal complications (OR 1.91, 95% CI 1.29-2.81), peripheral artery disease (OR 1.94, 95% CI 1.30-2.81), neurological complications (OR 1.45, 95% CI 1.00-2.09), Charlson Comorbidity Index (OR 1.16, 95% CI 1.08-1.25) and higher number of different drugs prescribed within 12 months prior-the index date (OR 1.09, 95% CI 1.05-1.12) were significantly associated with the probability of receiving insulin as a first-line therapy.

CONCLUSION

Insulin is rarely used as a first-line therapy in people with type 2 diabetes. Furthermore, a person's likelihood of receiving insulin as a first-line therapy is significantly influenced by diabetologist practice, age, HbA_1c ≥ 86 mmol/mol (10%), renal, neurological and vascular complications, higher multimorbidity, and polypharmacy.

Development a clinical prediction model of the neurological outcome for patients with coma and survived 24 hours after cardiopulmonary resuscitation

Background

Cardiac arrest is still a global public health problem at present. The neurological outcome is the core indicator of the prognosis of cardiac arrest. However, there is no effective means or tools to predict the neurological outcome of patients with coma and survived 24 hours after successful cardiopulmonary resuscitation (CPR).

Hypothesis

Therefore, we expect to construct a prediction model to predict the neurological outcome for patients with coma and survived 24 hours after successful CPR.

Methods

A retrospective cohort study was used to construct a prediction model of the neurological function for patients with coma and survived 24 hours after successful CPR. From January 2007 to December 2015, a total of 262 patients met the inclusion and exclusion criteria.

Results

The predictive model was developed using preselected variables by a systematic review of the literature. Finally, we get five sets of models (three sets of construction models and two sets of internal verification models) which with similar predictive value. The stepwise model, which including seven variables (age, noncardiac etiology, nonshockable rhythm, bystander CPR, total epinephrine dose, APTT, and SOFA score), was the simplest model, so we choose it as our final predictive model. The area under the ROC curve (AUC), specificity, and sensitivity of the stepwise model were respectively 0.82 (0.77, 0.87), 0.72and 0.82. The AUC, specificity, and sensitivity of the bootstrap stepwise (BS stepwise) model were respectively 0.82 (0.77, 0.87), 0.71, and 0.82.

Conclusion

This new and validated predictive model may provide individualized estimates of neurological function for patients with coma and survived 24 hours after successful CPR using readily obtained clinical risk factors. External validation studies are required further to demonstrate the model's accuracy in diverse patient populations.

Endogenous Testosterone Levels Are Associated with Risk of Type 2 Diabetes in Women without Established Comorbidity

Purpose

The impact of endogenous androgen levels on the risk of type 2 diabetes in women remains uncertain. The objective was to investigate associations between endogenous androgen levels and risk of type 2 diabetes in young women without established comorbidity.

Methods

In this retrospective cohort study, women aged 18 to 50 years who underwent measurement of plasma testosterone, dehydroepiandrosterone-sulfate (DHEA-S), dihydrotestosterone (DHT), and sex hormone-binding globulin (SHBG) for the first time from January 2007 to December 2015 were included. Androgens were analyzed using tandem liquid chromatography mass spectrometry. Women with established comorbidity were excluded, using Danish healthcare registries. We calculated incidence rate ratios (IRRs, 95% confidence intervals) of type 2 diabetes according to quartiles of plasma androgens using multivariate Poisson regression models.

Results

A total of 8876 women, with a mean ± SD age of 38.5 ± 4.6 years and a median (interquartile range [IQR]) follow-up duration of 8.1 (6.6-9.4) years, were eligible for analyses. During 69 728 person-years, 69 women were diagnosed with type 2 diabetes. Women in the highest quartile of plasma total testosterone and calculated free testosterone displayed increased risk of type 2 diabetes compared with the lowest quartile: IRR 1.97 (1.01; 3.85), P = .048 and IRR 7.32 (2.84; 18.83), P < .001. SHBG was inversely associated with type 2 diabetes, Q4 versus Q1; IRR 0.06 (0.02; 0.21), P < .001. Plasma DHEA-S and DHT were not associated with incident type 2 diabetes.

Conclusions

Higher levels of plasma total and free testosterone were associated with increased risk of type 2 diabetes among women.