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Gensluckner S, Wernly B, Koutny F, Strebinger G, Zandanell S, Stechemesser L, Paulweber B, Iglseder B, Trinka E, Frey V, Langthaler P, Semmler G, Valenti L, Corradini E, Datz C, Aigner E. Prevalence and Characteristics of Metabolic Hyperferritinemia in a Population-Based Central-European Cohort. Biomedicines 2024; 12:207. [PMID: 38255312 PMCID: PMC10813305 DOI: 10.3390/biomedicines12010207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Hyperferritinemia (HF) is a common finding and can be considered as metabolic HF (MHF) in combination with metabolic diseases. The definition of MHF was heterogenous until a consensus statement was published recently. Our aim was to apply the definition of MHF to provide data on the prevalence and characteristics of MHF in a Central-European cohort. METHODS This study was a retrospective analysis of the Paracelsus 10,000 study, a population-based cohort study from the region of Salzburg, Austria. We included 8408 participants, aged 40-77. Participants with HF were divided into three categories according to their level of HF and evaluated for metabolic co-morbidities defined by the proposed criteria for MHF. RESULTS HF was present in 13% (n = 1111) with a clear male preponderance (n = 771, 69% of HF). Within the HF group, 81% (n = 901) of subjects fulfilled the metabolic criteria and were defined as MHF, of which 75% (n = 674) were characterized by a major criterion. In the remaining HF cohort, 52% (n = 227 of 437) of subjects were classified as MHF after application of the minor criteria. CONCLUSION HF is a common finding in the general middle-aged population and the majority of cases are classified as MHF. The new classification provides useful criteria for defining MHF.
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Affiliation(s)
- Sophie Gensluckner
- Department of Internal Medicine I, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (S.G.)
- Obesity Research Unit, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Bernhard Wernly
- Department of Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Paracelsusstraße 37, 5110 Oberndorf, Austria
| | - Florian Koutny
- Department of Internal Medicine 2, Gastroenterology and Hepatology and Rheumatology, University Hospital of St. Pölten, Karl Landsteiner University of Health Sciences, Dunant-Platz 1, Kremser Landstraße 40, 3100 St. Pölten, Austria
| | - Georg Strebinger
- Department of Internal Medicine I, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (S.G.)
- Obesity Research Unit, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Stephan Zandanell
- Department of Internal Medicine I, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (S.G.)
- Obesity Research Unit, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Lars Stechemesser
- Department of Internal Medicine I, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (S.G.)
- Obesity Research Unit, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Bernhard Paulweber
- Department of Internal Medicine I, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (S.G.)
| | - Bernhard Iglseder
- Department of Geriatric Medicine, Christian Doppler University Hospital, Paracelsus Medical University, Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Affiliated Member of the European Reference Network EpiCARE, Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria
| | - Vanessa Frey
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Affiliated Member of the European Reference Network EpiCARE, Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria
| | - Patrick Langthaler
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Affiliated Member of the European Reference Network EpiCARE, Ignaz-Harrer-Straße 79, 5020 Salzburg, Austria
| | - Georg Semmler
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Luca Valenti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Francesco Forza 35, 20122 Milan, Italy;
- Precision Medicine, Biological Resource Center Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy
| | - Elena Corradini
- Department of Medical and Surgical Sciences, Università degli Studi di Modena e Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy;
- Internal Medicine and Centre for Hemochromatosis and Hereditary Liver Diseases, Azienda Ospedaliero-Universitaria di Modena Policlinico, 41124 Modena, Italy
| | - Christian Datz
- Department of Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Paracelsusstraße 37, 5110 Oberndorf, Austria
| | - Elmar Aigner
- Department of Internal Medicine I, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; (S.G.)
- Obesity Research Unit, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
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2
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Parzer V, Resl M, Stechemesser L, Wakolbinger M, Itariu B, Brix JM. [Postoperative management]. Wien Klin Wochenschr 2023; 135:729-742. [PMID: 37821696 PMCID: PMC10567962 DOI: 10.1007/s00508-023-02272-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 10/13/2023]
Abstract
Bariatric surgery results in significant weight loss, reduction or even remission of obesity-associated comorbidities, reduced mortality, and improved quality of life in many patients; however, obesity is a chronic disease, thus follow-up care is required after bariatric surgery. Furthermore, specific issues, such as micronutrient deficiencies and subsequent complications, can arise both in the short-term and the long-term. Abdominal pain after bariatric surgery must always be regarded as a serious symptom. A further focus should be on the diagnosis and treatment of dumping syndrome. Patients with type 2 diabetes should be regularly screened for recurrent hyperglycemia as well as specific sequelae, even though blood glucose levels may be substantially improved or normalized. In addition to centers with multidisciplinary teams, primary care and, in particular, general practitioners will play an increasingly more important role in the follow-up care after bariatric surgery.
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Affiliation(s)
- Verena Parzer
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Klinik Landstraße, Wien, Österreich
- Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien, Österreich
| | - Michael Resl
- ICMR - Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz, Linz, Österreich
- Abteilung für Innere Medizin mit Diabetologie, Gastroenterologie und Hepatologie, Rheumatologie und Intensivmedizin, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich
| | - Lars Stechemesser
- Universitätsklinik für Innere Medizin I mit Gastroenterologie, Hepatologie, Nephrologie, Stoffwechsel und Diabetologie, Uniklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich
| | - Maria Wakolbinger
- Abteilung für Sozial- und Präventivmedizin, Zentrum für Public Health, Medizinische Universität Wien, Wien, Österreich
| | - Bianca Itariu
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.
| | - Johanna Maria Brix
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Klinik Landstraße, Wien, Österreich
- Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien, Österreich
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3
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Brix JM, Andersen B, Aydinkoc-Tuzcu K, Beckerhinn P, Brossard-Eitzinger A, Cavini A, Ciardi C, Clodi M, Eichner M, Erlacher B, Fahrnberger M, Felsenreich DM, Francesconi C, Göbel B, Hölbing E, Hoppichler F, Huber J, Huber SL, Itariu BK, Jandrasitz B, Kiefer FW, Köhler G, Kruschitz R, Ludvik B, Malzner A, Moosbrugger A, Öfferlbauer-Ernst A, Parzer V, Prager G, Resl M, Ress C, Schelkshorn C, Scherer T, Sourji H, Stechemesser L, Stulnig T, Toplak H, Wakolbinger M, Vonbank A, Weghuber D. [Overweight and obesity in adults: general principles of treatment and conservative management]. Wien Klin Wochenschr 2023; 135:706-720. [PMID: 37821694 PMCID: PMC10567802 DOI: 10.1007/s00508-023-02270-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 10/13/2023]
Abstract
The prevalence of overweight and obesity is steadily increasing in Austria as well as internationally. Obesity in particular is associated with multiple health risks, comorbidities, functional disability, and social stigma. Obesity is an independent, complex, chronic disease and should be treated as such by a multidisciplinary team of appropriately qualified personnel. In addition to recent international guidelines, this consensus paper outlines the overall principles of the management of overweight and obesity and provides guidance for the diagnosis and conservative treatment, focusing on lifestyle modifications and pharmacotherapy. Using the "5A" framework of behavioral health intervention, guidelines for a structured, pragmatic, and patient-centered medical care of adults with overweight or obesity are presented.
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Affiliation(s)
- Johanna Maria Brix
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien, Österreich
| | | | - Kadriye Aydinkoc-Tuzcu
- 5. Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Klinik Ottakring, Wien, Österreich
| | - Philipp Beckerhinn
- Abteilung für Chirurgie, Landesklinikum Hollabrunn, Hollabrunn, Österreich
| | - Agnes Brossard-Eitzinger
- Universitätsklinik für Innere Medizin I, mit Gastroenterologie Hepatologie, Nephrologie, Stoffwechsel und Diabetologie, Uniklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich
| | - Anna Cavini
- kokon – Reha für junge Menschen, Bad Erlach, Österreich
| | - Christian Ciardi
- Abteilung für Innere Medizin, Krankenhaus St. Vinzenz Zams, Zams, Österreich
| | - Martin Clodi
- ICMR – Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz, Linz, Österreich
- Abteilung für Innere Medizin mit Diabetologie, Gastroenterologie und Hepatologie, Rheumatologie und Intensivmedizin, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich
| | - Marlies Eichner
- 3. Medizinische Abteilung mit Stoffwechselerkrankungen und Nephrologie, Karl Landsteiner-Institut für Stoffwechselerkrankungen und Nephrologie, Klinik Hietzing, Wien, Österreich
| | - Brigitte Erlacher
- Abteilung Innere Medizin III, Krankenhaus Barmherzige Schwestern, Wien, Österreich
| | | | - Daniel Moritz Felsenreich
- Klinische Abteilung für Viszeralchirurgie, Universitätsklinik für Allgemeinchirurgie, Medizinische Universität Wien, Wien, Österreich
| | | | - Bettina Göbel
- 5. Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Klinik Ottakring, Wien, Österreich
| | - Elisabeth Hölbing
- Landeskrankenhaus Hochsteiermark, Standort Leoben, Leoben, Österreich
| | - Friedrich Hoppichler
- Abteilung für Innere Medizin, Krankenhaus der Barmherzigen Brüder Salzburg, Salzburg, Österreich
- Institut SIPCAN – Initiative für ein gesundes Leben, Salzburg, Österreich
| | - Joakim Huber
- Interne Abteilung mit Akutgeriatrie und Palliativmedizin, Franziskus Spital, Standort Landstraße, Wien, Österreich
| | - Simone Leonora Huber
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien, Österreich
| | - Bianca Karla Itariu
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Birgit Jandrasitz
- 3. Medizinische Abteilung mit Stoffwechselerkrankungen und Nephrologie, Karl Landsteiner-Institut für Stoffwechselerkrankungen und Nephrologie, Klinik Hietzing, Wien, Österreich
| | - Florian W. Kiefer
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Gerd Köhler
- Rehabilitationszentrum Aflenz für Stoffwechselerkrankungen mit Schwerpunkt Diabetes mellitus und hochgradige Adipositas, Aflenz, Österreich
| | - Renate Kruschitz
- Abteilung für Innere Medizin, Krankenhaus der Elisabethinen Klagenfurt, Klagenfurt, Österreich
| | - Bernhard Ludvik
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien, Österreich
| | - Andrea Malzner
- Abteilung für Innere Medizin I, Klinikum Wels Grieskirchen, Standort Wels, Wels, Österreich
| | - Alexander Moosbrugger
- Abteilung für Innere Medizin II, Konventhospital der Barmherzigen Brüder Graz-Marschallgasse, Graz, Österreich
| | - Anna Öfferlbauer-Ernst
- Universitätsklinik für Innere Medizin I, mit Gastroenterologie Hepatologie, Nephrologie, Stoffwechsel und Diabetologie, Uniklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich
| | - Verena Parzer
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien, Österreich
| | - Gerhard Prager
- Klinische Abteilung für Viszeralchirurgie, Universitätsklinik für Allgemeinchirurgie, Medizinische Universität Wien, Wien, Österreich
| | - Michael Resl
- ICMR – Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz, Linz, Österreich
- Abteilung für Innere Medizin mit Diabetologie, Gastroenterologie und Hepatologie, Rheumatologie und Intensivmedizin, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich
| | - Claudia Ress
- Department für Innere Medizin I, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | | | - Thomas Scherer
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Harald Sourji
- Klinische Abteilung für Endokrinologie und Diabetologie, Medizinische Universität Graz, Graz, Österreich
| | - Lars Stechemesser
- Universitätsklinik für Innere Medizin I, mit Gastroenterologie Hepatologie, Nephrologie, Stoffwechsel und Diabetologie, Uniklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich
| | - Thomas Stulnig
- 3. Medizinische Abteilung mit Stoffwechselerkrankungen und Nephrologie, Karl Landsteiner-Institut für Stoffwechselerkrankungen und Nephrologie, Klinik Hietzing, Wien, Österreich
| | - Hermann Toplak
- Klinische Abteilung für Endokrinologie und Diabetologie, Medizinische Universität Graz, Graz, Österreich
| | - Maria Wakolbinger
- Abteilung für Sozial- und Präventivmedizin, Zentrum für Public Health, Medizinische Universität Wien, Wien, Österreich
| | - Alexander Vonbank
- Abteilung für Innere Medizin I, Akademisches Lehrkrankenhaus Feldkirch, Feldkirch, Österreich
| | - Daniel Weghuber
- Universitätsklinik für Kinder- und Jugendheilkunde, Uniklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich
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4
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Wascher TC, Stechemesser L, Harreiter J. [Blood glucose self monitoring]. Wien Klin Wochenschr 2023; 135:143-146. [PMID: 37101035 PMCID: PMC10133076 DOI: 10.1007/s00508-023-02172-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/28/2023]
Abstract
Self monitoring of blood glucose contributes to the integrated management of diabetes mellitus. It, thus, should be available for all patients with diabetes mellitus. Self monitoring of blood glucose improves patients safety, quality of life and glucose control. The current article represents the recommendations of the Austrian Diabetes Association for the use of blood glucose self monitoring according to current scientific evidence.
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Affiliation(s)
| | - Lars Stechemesser
- Universitätsklinik für Innere Medizin I, Paracelsus Medizinische Privatuniversität - Landeskrankenhaus, Salzburg, Österreich
| | - Jürgen Harreiter
- Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Spitalgasse 23, 1090, Wien, Österreich.
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5
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Mader JK, Brix JM, Aberer F, Vonbank A, Resl M, Hochfellner DA, Ress C, Pieber TR, Stechemesser L, Sourij H. [Hospital diabetes management (Update 2023)]. Wien Klin Wochenschr 2023; 135:242-255. [PMID: 37101046 PMCID: PMC10133359 DOI: 10.1007/s00508-023-02177-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/28/2023]
Abstract
This position statement presents the recommendations of the Austrian Diabetes Association for diabetes management of adult patients during inpatient stay. It is based on the current evidence with respect to blood glucose targets, insulin therapy and treatment with oral/injectable antidiabetic drugs during inpatient hospitalization. Additionally, special circumstances such as intravenous insulin therapy, concomitant therapy with glucocorticoids and use of diabetes technology during hospitalization are discussed.
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Affiliation(s)
- Julia K Mader
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich.
| | - Johanna M Brix
- Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Klinik Landstraße, Wien, Österreich
| | - Felix Aberer
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich
| | - Alexander Vonbank
- Innere Medizin I mit Kardiologie, Angiologie, Endokrinologie, Diabetologie und Intensivmedizin, Akademisches Lehrkrankenhaus Feldkirch, Feldkirch, Österreich
| | - Michael Resl
- Abteilung für Innere Medizin, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich
| | - Daniel A Hochfellner
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich
| | - Claudia Ress
- Innere Medizin, Department I, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Thomas R Pieber
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich
| | - Lars Stechemesser
- Universitätsklinik für Innere Medizin I, Paracelsus Medizinische Privatuniversität - Landeskrankenhaus, Salzburg, Österreich
| | - Harald Sourij
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich
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6
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Clodi M, Abrahamian H, Brath H, Schernthaner G, Brix J, Ludvik B, Drexel H, Saely CH, Fasching P, Rega-Kaun G, Föger B, Francesconi C, Fröhlich-Reiterer E, Kautzky-Willer A, Harreiter J, Luger A, Resl M, Riedl M, Winhofer Y, Hofer SE, Hoppichler F, Huber J, Kaser S, Ress C, Lechleitner M, Aberer F, Mader JK, Sourij H, Toplak H, Paulweber B, Stechemesser L, Pieber T, Prager R, Stingl H, Stulnig T, Rami-Merhar B, Drexel H, Roden M, Schelkshorn C, Wascher TC, Weitgasser R, Zlamal-Fortunat S. [Antihyperglycemic treatment guidelines for diabetes mellitus type 2 (Update 2023)]. Wien Klin Wochenschr 2023; 135:32-44. [PMID: 37101023 PMCID: PMC10133357 DOI: 10.1007/s00508-023-02186-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 04/28/2023]
Abstract
Hyperglycemia significantly contributes to complications in patients with diabetes mellitus. While lifestyle interventions remain cornerstones of disease prevention and treatment, most patients with type 2 diabetes will eventually require pharmacotherapy for glycemic control. The definition of individual targets regarding optimal therapeutic efficacy and safety as well as cardiovascular effects is of great importance. In this guideline we present the most current evidence-based best clinical practice data for healthcare professionals.
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Affiliation(s)
- Martin Clodi
- ICMR - Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz JKU Linz, Altenberger Straße 69, 4040, Linz, Österreich.
- Abteilung für Innere Medizin mit Diabetologie, Gastroenterologie und Hepatologie, Rheumatologie und Intensivmedizin, , Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich.
| | - Heidemarie Abrahamian
- Privates Institut für Medizin & NLP, Wissenschaftliches Institut gemäß BundesstatistikG 2008 ÖNACE-CODE: 72.19-0, Wien, Österreich
| | - Helmut Brath
- Sigmund Freud Privatuniversität Medizin, Campus Prater, Wien, Österreich
- Diabetes- und Fettstoffwechselambulanz, Mein Gesundheitszentrum Favoriten, Wien, Österreich
| | | | - Johann Brix
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Krankenanstalt Rudolfstiftung, Wien, Österreich
| | - Bernhard Ludvik
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Krankenanstalt Rudolfstiftung, Wien, Österreich
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Österreich
| | - Christoph H Saely
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Österreich
- Abteilung für Innere Medizin I, Akademisches Lehrkrankenhaus Feldkirch, Feldkirch, Österreich
| | - Peter Fasching
- 5. Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Wilhelminenspital der Stadt Wien, Wien, Österreich
| | - Gersina Rega-Kaun
- 5. Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Wilhelminenspital der Stadt Wien, Wien, Österreich
| | - Bernhard Föger
- Abteilung für Allgemein Innere Medizin, Rottal Inn Kliniken, Pfarrkirchen, Deutschland
| | | | - Elke Fröhlich-Reiterer
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Österreich
| | - Alexandra Kautzky-Willer
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
- Gender Medicine Unit, Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Jürgen Harreiter
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Anton Luger
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Michael Resl
- ICMR - Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz JKU Linz, Altenberger Straße 69, 4040, Linz, Österreich
- Abteilung für Innere Medizin mit Diabetologie, Gastroenterologie und Hepatologie, Rheumatologie und Intensivmedizin, , Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich
| | - Michaela Riedl
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Yvonne Winhofer
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Sabine E Hofer
- Department für Pädiatrie 1, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Friedrich Hoppichler
- Abteilung für Innere Medizin, Krankenhaus der Barmherzigen Brüder Salzburg, Salzburg, Österreich
| | - Joakim Huber
- Interne Abteilung mit Akutgeriatrie und Palliativmedizin, Franziskus Spital, Standort Landstraße, Wien, Österreich
| | - Susanne Kaser
- Department für Innere Medizin I, Medizinische Universität Innsbruck, Innsbruck, Österreich
- Christian Doppler Labor für Insulinresistenz, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Claudia Ress
- Department für Innere Medizin I, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Monika Lechleitner
- Avomed - Arbeitskreis für Vorsorgemedizin zbd Gesundheitsförderung in Tirol, Innsbruck, Österreich
| | - Felix Aberer
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Julia K Mader
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Harald Sourij
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Hermann Toplak
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Bernhard Paulweber
- Universitätsklinik für Innere Medizin I, mit Gastroenterologie, Hepatologie, Nephrologie, Stoffwechsel und Diabetologie, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
| | - Lars Stechemesser
- Universitätsklinik für Innere Medizin I, mit Gastroenterologie, Hepatologie, Nephrologie, Stoffwechsel und Diabetologie, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
| | - Thomas Pieber
- Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Rudolf Prager
- 3. Medizinische Abteilung, Karl Landsteiner Institut für Stoffwechselerkrankungen und Nephrologie, Krankenhaus Hietzing der Stadt Wien, Wien, Österreich
- Karl-Landsteiner-Universität für Gesundheitswissenschaften, Krems, Österreich
| | - Harald Stingl
- Karl-Landsteiner-Universität für Gesundheitswissenschaften, Krems, Österreich
- Abteilung für Innere Medizin, Landeskliniken Baden-Mödling, Standort Baden, Baden, Österreich
| | - Thomas Stulnig
- 3. Medizinische Abteilung mit Stoffwechselerkrankungen und Nephrologie, Krankenhaus Hietzing Wien, Wien, Österreich
| | - Birgit Rami-Merhar
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
| | - Heinz Drexel
- Chair der ESC-Working Group "Cardiovascular Pharmacotherapy", Sophia Antipolis, Frankreich
- Drexel University College of Medicine, Philadelphia, PA, USA
- ESC-Working Group "Cardiovascular Pharmacotherapy", Sophia Antipolis, Frankreich
- Drexel University College of Medicine, Philadelphia, PA, USA
- Private Universität im Fürstentum Liechtenstein, Triesen, Liechtenstein
| | - Michael Roden
- Klinik für Endokrinologie und Diabetologie, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Deutschland
- Deutsches Zentrum für Diabetesforschung, DZD e. V., München-Neuherberg, Deutschland
- Institut für Klinische Diabetologie, Deutsches Diabetes-Zentrum (DDZ), Leibniz-Zentrum für Diabetesforschung, Düsseldorf, Deutschland
| | | | - Thomas C Wascher
- 1. Medizinische Abteilung, Mein Hanusch-Krankenhaus, Wien, Österreich
| | - Raimund Weitgasser
- Abteilung für Innere Medizin, Privatklinik Wehrle-Diakonissen, Salzburg, Österreich
- Universitätsklinik für Innere Medizin I, LKH Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich
| | - Sandra Zlamal-Fortunat
- Abteilung für Innere Medizin und Gastroenterologie, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Österreich
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7
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Abrahamian H, Salamon B, Lahnsteiner A, Schelkshorn C, Bräuer A, Stechemesser L, Köhler G, Clodi M. [Diabetes mellitus and road traffic-a position paper of the Austrian Diabetes Association (update 2023)]. Wien Klin Wochenschr 2023; 135:319-330. [PMID: 37101052 PMCID: PMC10133049 DOI: 10.1007/s00508-023-02193-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 04/28/2023]
Abstract
Public safety (prevention of accidents) is the primary objective in assessing fitness to drive a motor vehicle. However, general access to mobility should not be restricted if there is no particular risk to public safety. For people with diabetes mellitus, the Führerscheingesetz (Driving Licence Legislation) and the Führerscheingesetz-Gesundheitsverordnung (Driving Licence Legislation Health enactment) regulate important aspects of driving safety in connection with acute and chronic complications of the disease. Critical complications that may be relevant to road safety include severe hypoglycemia, pronounced hyperglycemia and hypoglycemia perception disorder as well as severe retinopathy and neuropathy, endstage renal disease and certain cardiovascular manifestations. If there is a suspicion of the presence of one of these complications, a detailed evaluation is required.In addition, the individual antihyperglycemic medication should be checked for existing potential for hypoglycemia. Sulfonylureas, glinides and insulin belong to this group and are therefore associated with the requirement of a 5-year limitation of the driver's license. Other antihyperglycemic drugs without potential for hypoglycemia such as Metformin, SGLT‑2 inhibitors (Sodium-dependent-glucose-transporter‑2 inhibitors, gliflozins), DPP-4-inhibitors (Dipeptidyl-Peptidase inhibitors, gliptins), and GLP‑1 analogues (GLP‑1 rezeptor agonists) are not associated with such a time limitation.The relevant laws which regulate driving safety give room for interpretation, so that specific topics on driving safety for people with diabetes mellitus are elaborated from a medical and traffic-relevant point of view. This position paper is intended to support people involved in this challenging matter.
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Affiliation(s)
- Heidemarie Abrahamian
- Wissenschaftliches Institut gemäß BundesstatistikG 2008 ÖNACE-CODE: 72.19-0, Privates Institut für Medizin & NLP, Wien, Österreich
| | - Birgit Salamon
- KFV (Kuratorium für Verkehrssicherheit), Wien, Österreich
| | - Angelika Lahnsteiner
- Fachbereich für Biowissenschaften und Medizinische Biologie, Universität Salzburg, Salzburg, Österreich
| | - Christian Schelkshorn
- Erste medizinische Abteilung, Schwerpunkt Stoffwechselmedizin, Landesklinikum Korneuburg/Stockerau, Stockerau, Österreich
| | - Alexander Bräuer
- Klinik Ottakring, Fünfte Medizinische Abteilung mit Endokrinologie, Rheumatologie und Akutgeriatrie, Wiener Gesundheitsverbund, Wien, Österreich
| | - Lars Stechemesser
- Landeskrankenhaus, Universitätsklinik für Innere Medizin 1 der PMU, Uniklinikum Salzburg, Salzburg, Österreich
| | - Gerd Köhler
- Klinische Abteilung für Endokrinologie und Diabetologie, Medizinische Universität Graz und Rehabilitation für Stoffwechselerkrankungen Aflenz, Graz, Aflenz, Österreich
| | - Martin Clodi
- Krankenhaus der Barmherzigen Brüder Linz und Institut for Cardiovascular and Metabolic Research JKU (ICMR), Johannes Kepler Universität Linz (JKU Linz), Altenberger Straße 69, 4040, Linz, Österreich.
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8
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Wascher TC, Stulnig TM, Saely CH, Stechemesser L. [Inhibition of platelet aggregation (Update 2023)]. Wien Klin Wochenschr 2023; 135:161-163. [PMID: 37101038 PMCID: PMC10133352 DOI: 10.1007/s00508-023-02168-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/28/2023]
Abstract
Acute thrombotic complications as a key feature of accelerated atherothrombotic disease typically precipitate cardiovascular events and therefore strongly contribute to cardiovascular morbidity and mortality in patients with diabetes. Inhibition of platelet aggregation can reduce the risk for acute atherothrombosis. The present article represents the recommendations of the Austrian Diabetes Association for the use of antiplatelet drugs in patients with diabetes according to current scientific evidence.
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Affiliation(s)
| | - Thomas M Stulnig
- 3. Medizinische Abteilung und Karl Landsteiner Institut für Stoffwechselerkrankungen und Nephrologie, Klinik Hietzing, Wien, Österreich
| | - Christoph H Saely
- Abteilung für Innere Medizin I, Akademisches Lehrkrankenhaus Feldkirch, VIVIT Institut, Feldkirch, Österreich
- Private Universität im Fürstentum Liechtenstein, Triesen, Liechtenstein
| | - Lars Stechemesser
- Universitätsklinik für Innere Medizin I, Paracelsus Medizinische Privatuniversität, Müllner Hauptstraße 48, 5020, Salzburg, Österreich.
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9
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Jansson Sigfrids F, Stechemesser L, Dahlström EH, Forsblom CM, Harjutsalo V, Weitgasser R, Taskinen MR, Groop PH. Apolipoprotein C-III predicts cardiovascular events and mortality in individuals with type 1 diabetes and albuminuria. J Intern Med 2022; 291:338-349. [PMID: 34817888 PMCID: PMC9298713 DOI: 10.1111/joim.13412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We studied apolipoprotein C-III (apoC-III) in relation to diabetic kidney disease (DKD), cardiovascular outcomes, and mortality in type 1 diabetes. METHODS The cohort comprised 3966 participants from the prospective observational Finnish Diabetic Nephropathy Study. Progression of DKD was determined from medical records. A major adverse cardiac event (MACE) was defined as acute myocardial infarction, coronary revascularization, stroke, or cardiovascular mortality through 2017. Cardiovascular and mortality data were retrieved from national registries. RESULTS ApoC-III predicted DKD progression independent of sex, diabetes duration, blood pressure, HbA1c , smoking, LDL-cholesterol, lipid-lowering medication, DKD category, and remnant cholesterol (hazard ratio [HR] 1.43 [95% confidence interval 1.05-1.94], p = 0.02). ApoC-III also predicted the MACE in a multivariable regression analysis; however, it was not independent of remnant cholesterol (HR 1.05 [0.81-1.36, p = 0.71] with remnant cholesterol; 1.30 [1.03-1.64, p = 0.03] without). DKD-specific analyses revealed that the association was driven by individuals with albuminuria, as no link between apoC-III and the outcome was observed in the normal albumin excretion or kidney failure categories. The same was observed for mortality: Individuals with albuminuria had an adjusted HR of 1.49 (1.03-2.16, p = 0.03) for premature death, while no association was found in the other groups. The highest apoC-III quartile displayed a markedly higher risk of MACE and death than the lower quartiles; however, this nonlinear relationship flattened after adjustment. CONCLUSIONS The impact of apoC-III on MACE risk and mortality is restricted to those with albuminuria among individuals with type 1 diabetes. This study also revealed that apoC-III predicts DKD progression, independent of the initial DKD category.
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Affiliation(s)
- Fanny Jansson Sigfrids
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Lars Stechemesser
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,First Department of Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Emma H Dahlström
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Carol M Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,National Institute for Health and Welfare, Helsinki, Finland
| | - Raimund Weitgasser
- First Department of Medicine, Paracelsus Medical University, Salzburg, Austria.,Department of Medicine, Diabetology, Wehrle-Diakonissen Hospital, Salzburg, Austria
| | | | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
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10
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Aziz F, Aberer F, Bräuer A, Ciardi C, Clodi M, Fasching P, Karolyi M, Kautzky-Willer A, Klammer C, Malle O, Pawelka E, Pieber T, Peric S, Ress C, Schranz M, Sourij C, Stechemesser L, Stingl H, Stöcher H, Stulnig T, Tripolt N, Wagner M, Wolf P, Zitterl A, Reisinger AC, Siller-Matula J, Hummer M, Moser O, von-Lewinski D, Eller P, Kaser S, Sourij H. COVID-19 In-Hospital Mortality in People with Diabetes Is Driven by Comorbidities and Age-Propensity Score-Matched Analysis of Austrian National Public Health Institute Data. Viruses 2021; 13:v13122401. [PMID: 34960670 PMCID: PMC8705658 DOI: 10.3390/v13122401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/22/2021] [Accepted: 11/27/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND It is a matter of debate whether diabetes alone or its associated comorbidities are responsible for severe COVID-19 outcomes. This study assessed the impact of diabetes on intensive care unit (ICU) admission and in-hospital mortality in hospitalized COVID-19 patients. METHODS A retrospective analysis was performed on a countrywide cohort of 40,632 COVID-19 patients hospitalized between March 2020 and March 2021. Data were provided by the Austrian data platform. The association of diabetes with outcomes was assessed using unmatched and propensity-score matched (PSM) logistic regression. RESULTS 12.2% of patients had diabetes, 14.5% were admitted to the ICU, and 16.2% died in the hospital. Unmatched logistic regression analysis showed a significant association of diabetes (odds ratio [OR]: 1.24, 95% confidence interval [CI]: 1.15-1.34, p < 0.001) with in-hospital mortality, whereas PSM analysis showed no significant association of diabetes with in-hospital mortality (OR: 1.08, 95%CI: 0.97-1.19, p = 0.146). Diabetes was associated with higher odds of ICU admissions in both unmatched (OR: 1.36, 95%CI: 1.25-1.47, p < 0.001) and PSM analysis (OR: 1.15, 95%CI: 1.04-1.28, p = 0.009). CONCLUSIONS People with diabetes were more likely to be admitted to ICU compared to those without diabetes. However, advanced age and comorbidities rather than diabetes itself were associated with increased in-hospital mortality in COVID-19 patients.
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Affiliation(s)
- Faisal Aziz
- Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (F.A.); (F.A.); (O.M.); (H.S.); (N.T.)
| | - Felix Aberer
- Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (F.A.); (F.A.); (O.M.); (H.S.); (N.T.)
| | - Alexander Bräuer
- Medical Division of Endocrinology, Rheumatology and Acute Geriatrics, Hospital Ottakring, 1160 Vienna, Austria; (A.B.); (P.F.)
| | - Christian Ciardi
- Clinical Division for Internal Medicine, Endocrinology, Diabetology and Metabolic Diseases, St. Vinzenz Hospital Zams, 6511 Zams, Austria;
| | - Martin Clodi
- Clinical Division for Internal Medicine, Konvent Hospital Barmherzige Brüder Linz, 4020 Linz, Austria; (M.C.); (C.K.)
| | - Peter Fasching
- Medical Division of Endocrinology, Rheumatology and Acute Geriatrics, Hospital Ottakring, 1160 Vienna, Austria; (A.B.); (P.F.)
| | - Mario Karolyi
- 4th Medical Division with Infectiology, SMZ Süd—KFJ-Hospital Vienna, 1100 Vienna, Austria; (M.K.); (E.P.)
| | - Alexandra Kautzky-Willer
- Division for Endocrinology and Metabolism, Medical University of Vienna, AKH, 1090 Vienna, Austria; (A.K.-W.); (P.W.)
| | - Carmen Klammer
- Clinical Division for Internal Medicine, Konvent Hospital Barmherzige Brüder Linz, 4020 Linz, Austria; (M.C.); (C.K.)
| | - Oliver Malle
- Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (F.A.); (F.A.); (O.M.); (H.S.); (N.T.)
| | - Erich Pawelka
- 4th Medical Division with Infectiology, SMZ Süd—KFJ-Hospital Vienna, 1100 Vienna, Austria; (M.K.); (E.P.)
| | - Thomas Pieber
- Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria;
| | - Slobodan Peric
- Department of Medicine III and Karl Landsteiner, Institute for Metabolic Diseases and Nephrology, Clinic Hietzing, Vienna Health Care Group, 1130 Vienna, Austria; (S.P.); (T.S.); (A.Z.)
| | - Claudia Ress
- Department for Internal Medicine I, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Michael Schranz
- Department for Inner Medicine, Paracelsus-Private Medical University, 5020 Salzburg, Austria; (M.S.); (L.S.)
| | - Caren Sourij
- Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (C.S.); (D.v.-L.)
| | - Lars Stechemesser
- Department for Inner Medicine, Paracelsus-Private Medical University, 5020 Salzburg, Austria; (M.S.); (L.S.)
| | - Harald Stingl
- Clinical Division for Internal Medicine, Hospital Melk, 3390 Melk, Austria; (H.S.); (M.W.)
| | - Hannah Stöcher
- Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (F.A.); (F.A.); (O.M.); (H.S.); (N.T.)
| | - Thomas Stulnig
- Department of Medicine III and Karl Landsteiner, Institute for Metabolic Diseases and Nephrology, Clinic Hietzing, Vienna Health Care Group, 1130 Vienna, Austria; (S.P.); (T.S.); (A.Z.)
| | - Norbert Tripolt
- Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (F.A.); (F.A.); (O.M.); (H.S.); (N.T.)
| | - Michael Wagner
- Clinical Division for Internal Medicine, Hospital Melk, 3390 Melk, Austria; (H.S.); (M.W.)
| | - Peter Wolf
- Division for Endocrinology and Metabolism, Medical University of Vienna, AKH, 1090 Vienna, Austria; (A.K.-W.); (P.W.)
| | - Andreas Zitterl
- Department of Medicine III and Karl Landsteiner, Institute for Metabolic Diseases and Nephrology, Clinic Hietzing, Vienna Health Care Group, 1130 Vienna, Austria; (S.P.); (T.S.); (A.Z.)
| | - Alexander Christian Reisinger
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (A.C.R.); (P.E.)
| | | | - Michael Hummer
- Austrian National Public Health Institute, 1010 Vienna, Austria;
| | - Othmar Moser
- Department of Exercise Physiology & Metabolism, Institute of Sports Science, University of Bayreuth, 95445 Bayreuth, Germany;
| | - Dirk von-Lewinski
- Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (C.S.); (D.v.-L.)
| | - Philipp Eller
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (A.C.R.); (P.E.)
| | - Susanne Kaser
- Department for Internal Medicine I, Medical University of Innsbruck, 6020 Innsbruck, Austria;
- Correspondence: (S.K.); (H.S.); Tel.: +43-512-504-81407 (S.K.); +43-316-385-81310 (H.S.)
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (F.A.); (F.A.); (O.M.); (H.S.); (N.T.)
- Correspondence: (S.K.); (H.S.); Tel.: +43-512-504-81407 (S.K.); +43-316-385-81310 (H.S.)
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11
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Eckert AJ, Plaumann M, Pehlke S, Beck C, Mühldorfer S, Weickert U, Laimer M, Pfeifer M, Stechemesser L, Holl R. Idiopathic Frozen Shoulder in Individuals with Diabetes: Association with Metabolic Control, Obesity, Antidiabetic Treatment and Demographic Characteristics in Adults with Type 1 or 2 Diabetes from the DPV Registry. Exp Clin Endocrinol Diabetes 2021; 130:468-474. [PMID: 34425597 DOI: 10.1055/a-1543-8559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIMS To examine the association of frozen shoulder (FS) with demographic and diabetes-related outcomes in individuals with type 1 (T1D) or type 2 (T2D) diabetes aged ≥30 years. MATERIALS AND METHODS Multivariable logistic regression models, adjusted for demographics were used to calculate the proportion of FS in association with age, gender, diabetes duration, body mass index (BMI), haemoglobin A1C (HbA1c) and diabetes treatment. RESULTS The unadjusted percentage of FS was higher in T1D compared to T2D (0.22% vs. 0.06%). In T1D, adjusted regression models revealed higher prevalence of FS in women than men (0.26 [0.20-0.34] % vs. 0.15 [0.11-0.21] %, p=0.010). No significant relationship of age and BMI with FS was found in both diabetes types. Longer diabetes duration was associated with a higher proportion of FS in T1D (p<0.001) and T2D (p=0.004). In T1D, HbA1c >7% was related to a higher proportion of FS compared to HbA1c ≤7% (0.25 [0.19-0.32] vs. 0.12 [0.08-0.20] %, p=0.007), while an inverse relationship was found in T2D (HbA1c ≤7%: 0.08 [0.07-0.10] vs. HbA1c >7%: 0.05 [0.04-0.06] %, p=0.001). CONCLUSIONS Different associations of FS with gender and HbA1c were observed for T1D and T2D; however, longer diabetes duration increases the risk for FS independent of diabetes type. Musculoskeletal diseases are still underreported in individuals with diabetes and awareness should be raised for FS as a specific diabetes complication.
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Affiliation(s)
- Alexander J Eckert
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Maike Plaumann
- Diabetologische Schwerpunktpraxis Hannover, Hannover, Germany
| | | | - Christof Beck
- Klinik für Innere Medizin 4, Klinikum Nürnberg Süd, Nürnberg, Germany
| | | | - Uwe Weickert
- Department of Medicine II, SLK Kliniken Heilbronn, University of Heidelberg, Germany
| | - Markus Laimer
- Universitätsklinik für Diabetologie, Endokrinologie, Ernährungsmedizin und Metabolismus, Universität Bern, Inselspital, Bern, Switzerland
| | | | - Lars Stechemesser
- Department of Internal Medicine I, Paracelsus Medical University, Salzburg, Austria
| | - ReinhardW Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
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12
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Eckert AJ, Zhou FL, Grimsmann JM, Pettus JH, Kerner W, Miller KM, Stechemesser L, Edelman SV, Spies C, Holl RW, Ibald-Mulli AM. Demographic characteristics and acute complications among adults with type 1 diabetes: Comparison of two multicentre databases from Germany and the United States. J Diabetes Complications 2021; 35:107812. [PMID: 33280985 DOI: 10.1016/j.jdiacomp.2020.107812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/27/2020] [Accepted: 11/11/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Studies on acute complications in adult T1D were previously reported from the United States (U.S.) and from Germany. The aim was to compare demographic characteristics and patterns of severe hypoglycaemia (SH) and diabetic ketoacidosis (DKA) between Germany and the U.S. METHODS Descriptive comparison on individuals aged ≥18 years, with T1D duration ≥2 years were made between the German diabetes-patient registry (DPV) and the U.S. electronic-health-record database (T1PCO). Individuals in both databases were divided into patients with haemoglobin A1c (HbA1c) <7% and HbA1c ≥7%. RESULTS 5190 (DPV) and 31,430 individuals (T1PCO) fulfilled the inclusion criteria. DPV patients were younger, more often male and had lower body-mass index. In both databases, more males than females had HbA1c <7%. Individuals had higher HbA1c in T1PCO compared to DPV. The relationship between HbA1c and DKA was similar in both databases. SH revealed a U-shaped curve in T1PCO, but no clear pattern was present in DPV. SH events increased with higher age in DPV, but not in T1PCO. CONCLUSION Patterns of SH differ between Germany and U.S. Differences in capture of SH among the databases cannot be excluded, but differences in health care including patient education and level of care by specialists are likely.
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Affiliation(s)
- Alexander J Eckert
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany; German Centre for Diabetes Research (DZD), Neuherberg, Germany.
| | | | - Julia M Grimsmann
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany; German Centre for Diabetes Research (DZD), Neuherberg, Germany
| | | | | | | | - Lars Stechemesser
- First Department of Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Steven V Edelman
- Veterans Affairs Medical Center, University of California San Diego, San Diego, CA, USA
| | - Carsten Spies
- Department of Gastroenterology, Hepatology, Diabetology and emergency medicine, St. Vincent Hospital Limburg, Limburg, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany; German Centre for Diabetes Research (DZD), Neuherberg, Germany
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13
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Sourij H, Aziz F, Bräuer A, Ciardi C, Clodi M, Fasching P, Karolyi M, Kautzky‐Willer A, Klammer C, Malle O, Oulhaj A, Pawelka E, Peric S, Ress C, Sourij C, Stechemesser L, Stingl H, Stulnig T, Tripolt N, Wagner M, Wolf P, Zitterl A, Kaser S. COVID-19 fatality prediction in people with diabetes and prediabetes using a simple score upon hospital admission. Diabetes Obes Metab 2021; 23:589-598. [PMID: 33200501 PMCID: PMC7753560 DOI: 10.1111/dom.14256] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/02/2020] [Accepted: 11/11/2020] [Indexed: 01/05/2023]
Abstract
AIM To assess predictors of in-hospital mortality in people with prediabetes and diabetes hospitalized for COVID-19 infection and to develop a risk score for identifying those at the greatest risk of a fatal outcome. MATERIALS AND METHODS A combined prospective and retrospective, multicentre, cohort study was conducted at 10 sites in Austria in 247 people with diabetes or newly diagnosed prediabetes who were hospitalized with COVID-19. The primary outcome was in-hospital mortality and the predictor variables upon admission included clinical data, co-morbidities of diabetes or laboratory data. Logistic regression analyses were performed to identify significant predictors and to develop a risk score for in-hospital mortality. RESULTS The mean age of people hospitalized (n = 238) for COVID-19 was 71.1 ± 12.9 years, 63.6% were males, 75.6% had type 2 diabetes, 4.6% had type 1 diabetes and 19.8% had prediabetes. The mean duration of hospital stay was 18 ± 16 days, 23.9% required ventilation therapy and 24.4% died in the hospital. The mortality rate in people with diabetes was numerically higher (26.7%) compared with those with prediabetes (14.9%) but without statistical significance (P = .128). A score including age, arterial occlusive disease, C-reactive protein, estimated glomerular filtration rate and aspartate aminotransferase levels at admission predicted in-hospital mortality with a C-statistic of 0.889 (95% CI: 0.837-0.941) and calibration of 1.000 (P = .909). CONCLUSIONS The in-hospital mortality for COVID-19 was high in people with diabetes but not significantly different to the risk in people with prediabetes. A risk score using five routinely available patient variables showed excellent predictive performance for assessing in-hospital mortality.
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Affiliation(s)
- Harald Sourij
- Clinical Division for Endocrinology and DiabetologyMedical University GrazGrazAustria
- Center for Biomarker Research in Medicine (CBMed)GrazAustria
| | - Faisal Aziz
- Clinical Division for Endocrinology and DiabetologyMedical University GrazGrazAustria
- Center for Biomarker Research in Medicine (CBMed)GrazAustria
| | - Alexander Bräuer
- Medical Division for Endocrinology, Rheumatology and Acute GeriatricsWilhelminen Hospital ViennaViennaAustria
| | - Christian Ciardi
- Clinical Division for Internal Medicine, Endocrinology, Diabetology and Metabolic Diseases, St. Vinzenz Hospital ZamsZamsAustria
| | - Martin Clodi
- Clinical Division for Internal MedicineKonventhospital Barmherzige Brüder LinzLinzAustria
| | - Peter Fasching
- Medical Division for Endocrinology, Rheumatology and Acute GeriatricsWilhelminen Hospital ViennaViennaAustria
| | - Mario Karolyi
- 4 Medical Division with InfectiologySMZ Süd – KFJ‐Hospital ViennaViennaAustria
| | - Alexandra Kautzky‐Willer
- Clinical Division for Endocrinology and Diabetology and Metabolic DiseasesAKH ViennaViennaAustria
| | - Carmen Klammer
- Clinical Division for Internal MedicineKonventhospital Barmherzige Brüder LinzLinzAustria
| | - Oliver Malle
- Clinical Division for Endocrinology and DiabetologyMedical University GrazGrazAustria
| | - Abderrahim Oulhaj
- Institute of Public Health, College of Medicine and Health SciencesUnited Arab Emirates UniversityAl AinUnited Arab Emirates
| | - Erich Pawelka
- 4 Medical Division with InfectiologySMZ Süd – KFJ‐Hospital ViennaViennaAustria
| | - Slobodan Peric
- 3rd Department and Karl Landsteiner Institute for Metabolic Diseases and Nephrology, Clinic HietzingVienna Health Care GroupViennaAustria
| | - Claudia Ress
- Department for Internal Medicine IMedical University InnsbruckInnsbruckAustria
| | - Caren Sourij
- Clinical Division for CardiologyMedical University GrazGrazAustria
| | - Lars Stechemesser
- Department for Internal Medicine IParacelsus Medical UniversitySalzburgAustria
| | - Harald Stingl
- Clinical Division for Internal MedicineHospital MelkMelkAustria
| | - Thomas Stulnig
- 3rd Department and Karl Landsteiner Institute for Metabolic Diseases and Nephrology, Clinic HietzingVienna Health Care GroupViennaAustria
| | - Norbert Tripolt
- Clinical Division for Endocrinology and DiabetologyMedical University GrazGrazAustria
| | - Michael Wagner
- Clinical Division for Internal MedicineHospital MelkMelkAustria
| | - Peter Wolf
- Clinical Division for Endocrinology and Diabetology and Metabolic DiseasesAKH ViennaViennaAustria
| | - Andreas Zitterl
- 3rd Department and Karl Landsteiner Institute for Metabolic Diseases and Nephrology, Clinic HietzingVienna Health Care GroupViennaAustria
| | - Susanne Kaser
- Department for Internal Medicine IMedical University InnsbruckInnsbruckAustria
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14
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Salem RM, Todd JN, Sandholm N, Cole JB, Chen WM, Andrews D, Pezzolesi MG, McKeigue PM, Hiraki LT, Qiu C, Nair V, Di Liao C, Cao JJ, Valo E, Onengut-Gumuscu S, Smiles AM, McGurnaghan SJ, Haukka JK, Harjutsalo V, Brennan EP, van Zuydam N, Ahlqvist E, Doyle R, Ahluwalia TS, Lajer M, Hughes MF, Park J, Skupien J, Spiliopoulou A, Liu A, Menon R, Boustany-Kari CM, Kang HM, Nelson RG, Klein R, Klein BE, Lee KE, Gao X, Mauer M, Maestroni S, Caramori ML, de Boer IH, Miller RG, Guo J, Boright AP, Tregouet D, Gyorgy B, Snell-Bergeon JK, Maahs DM, Bull SB, Canty AJ, Palmer CNA, Stechemesser L, Paulweber B, Weitgasser R, Sokolovska J, Rovīte V, Pīrāgs V, Prakapiene E, Radzeviciene L, Verkauskiene R, Panduru NM, Groop LC, McCarthy MI, Gu HF, Möllsten A, Falhammar H, Brismar K, Martin F, Rossing P, Costacou T, Zerbini G, Marre M, Hadjadj S, McKnight AJ, Forsblom C, McKay G, Godson C, Maxwell AP, Kretzler M, Susztak K, Colhoun HM, Krolewski A, Paterson AD, Groop PH, Rich SS, Hirschhorn JN, Florez JC. Genome-Wide Association Study of Diabetic Kidney Disease Highlights Biology Involved in Glomerular Basement Membrane Collagen. J Am Soc Nephrol 2019; 30:2000-2016. [PMID: 31537649 DOI: 10.1681/asn.2019030218] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/08/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although diabetic kidney disease demonstrates both familial clustering and single nucleotide polymorphism heritability, the specific genetic factors influencing risk remain largely unknown. METHODS To identify genetic variants predisposing to diabetic kidney disease, we performed genome-wide association study (GWAS) analyses. Through collaboration with the Diabetes Nephropathy Collaborative Research Initiative, we assembled a large collection of type 1 diabetes cohorts with harmonized diabetic kidney disease phenotypes. We used a spectrum of ten diabetic kidney disease definitions based on albuminuria and renal function. RESULTS Our GWAS meta-analysis included association results for up to 19,406 individuals of European descent with type 1 diabetes. We identified 16 genome-wide significant risk loci. The variant with the strongest association (rs55703767) is a common missense mutation in the collagen type IV alpha 3 chain (COL4A3) gene, which encodes a major structural component of the glomerular basement membrane (GBM). Mutations in COL4A3 are implicated in heritable nephropathies, including the progressive inherited nephropathy Alport syndrome. The rs55703767 minor allele (Asp326Tyr) is protective against several definitions of diabetic kidney disease, including albuminuria and ESKD, and demonstrated a significant association with GBM width; protective allele carriers had thinner GBM before any signs of kidney disease, and its effect was dependent on glycemia. Three other loci are in or near genes with known or suggestive involvement in this condition (BMP7) or renal biology (COLEC11 and DDR1). CONCLUSIONS The 16 diabetic kidney disease-associated loci may provide novel insights into the pathogenesis of this condition and help identify potential biologic targets for prevention and treatment.
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Affiliation(s)
- Rany M Salem
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
| | - Jennifer N Todd
- Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Programs in Metabolism and Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts.,Center for Genomic Medicine and
| | - Niina Sandholm
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine and
| | - Joanne B Cole
- Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Programs in Metabolism and Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts.,Center for Genomic Medicine and
| | - Wei-Min Chen
- Center for Public Health Genomics, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Darrell Andrews
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Marcus G Pezzolesi
- Division of Nephrology and Hypertension, Diabetes and Metabolism Center, University of Utah, Salt Lake City, Utah
| | - Paul M McKeigue
- Usher Institute of Population Health Sciences and Informatics and
| | - Linda T Hiraki
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Chengxiang Qiu
- Departments of Medicine and Genetics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Viji Nair
- Division of Nephrology, Department of Internal Medicine and
| | - Chen Di Liao
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jing Jing Cao
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Erkka Valo
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine and
| | - Suna Onengut-Gumuscu
- Center for Public Health Genomics, School of Medicine, University of Virginia, Charlottesville, Virginia
| | | | - Stuart J McGurnaghan
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Jani K Haukka
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine and
| | - Valma Harjutsalo
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine and.,The Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Eoin P Brennan
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Natalie van Zuydam
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK.,Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Emma Ahlqvist
- Department of Genomics, Diabetes and Endocrinology, Lund University Diabetes Centre, Malmö, Sweden
| | - Ross Doyle
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | | | - Maria Lajer
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Maria F Hughes
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Jihwan Park
- Departments of Medicine and Genetics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jan Skupien
- Joslin Diabetes Center, Boston, Massachusetts
| | | | | | - Rajasree Menon
- Division of Nephrology, Department of Internal Medicine and.,Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan
| | | | - Hyun M Kang
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan.,Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Robert G Nelson
- Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona
| | - Ronald Klein
- University of Wisconsin-Madison, Madison, Wisconsin
| | | | | | - Xiaoyu Gao
- The George Washington University, Washington, DC
| | | | - Silvia Maestroni
- Complications of Diabetes Unit, Division of Immunology, Transplantation and Infectious Diseases, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | | | | | - Rachel G Miller
- University of Pittsburgh Public Health, Pittsburgh, Pennsylvania
| | - Jingchuan Guo
- University of Pittsburgh Public Health, Pittsburgh, Pennsylvania
| | | | - David Tregouet
- INSERM UMR_S 1166, Sorbonne Université, UPMC Univ Paris 06, Paris, France.,ICAN Institute for Cardiometabolism and Nutrition, Paris, France
| | - Beata Gyorgy
- INSERM UMR_S 1166, Sorbonne Université, UPMC Univ Paris 06, Paris, France.,ICAN Institute for Cardiometabolism and Nutrition, Paris, France
| | | | - David M Maahs
- Department of Pediatrics-Endocrinology, Stanford University, Stanford, California
| | - Shelley B Bull
- The Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Angelo J Canty
- Department of Mathematics and Statistics, McMaster University, Hamilton, Ontario, Canada
| | - Colin N A Palmer
- Pat Macpherson Centre for Pharmacogenetics and Pharmacogenomics, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Lars Stechemesser
- First Department of Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Paulweber
- First Department of Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Raimund Weitgasser
- First Department of Medicine, Paracelsus Medical University, Salzburg, Austria.,Department of Medicine, Diakonissen-Wehrle Hospital, Salzburg, Austria
| | | | - Vita Rovīte
- Latvian Biomedical Research and Study Centre, Riga, Latvia
| | - Valdis Pīrāgs
- University of Latvia, Riga, Latvia.,Pauls Stradins University Hospital, Riga, Latvia
| | | | - Lina Radzeviciene
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rasa Verkauskiene
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Nicolae Mircea Panduru
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,2nd Clinical Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Leif C Groop
- Department of Genomics, Diabetes and Endocrinology, Lund University Diabetes Centre, Malmö, Sweden.,Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Mark I McCarthy
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK.,Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, UK.,Genentech, 1 DNA Way, South San Francisco, California
| | - Harvest F Gu
- Department of Clinical Science, Intervention and Technology and.,School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Anna Möllsten
- Division of Pediatrics, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Rolf Luft Center for Diabetes Research and Endocrinology, Karolinska Institutet, Stockholm, Sweden.,Department of Endocrinology, Diabetes and Metabolism, Karolinska University Hospital, Stockholm, Sweden
| | - Kerstin Brismar
- Department of Molecular Medicine and Surgery, Rolf Luft Center for Diabetes Research and Endocrinology, Karolinska Institutet, Stockholm, Sweden.,Department of Endocrinology, Diabetes and Metabolism, Karolinska University Hospital, Stockholm, Sweden
| | - Finian Martin
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Tina Costacou
- University of Pittsburgh Public Health, Pittsburgh, Pennsylvania
| | - Gianpaolo Zerbini
- Complications of Diabetes Unit, Division of Immunology, Transplantation and Infectious Diseases, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Michel Marre
- Department of Diabetology, Endocrinology and Nutrition, Bichat Hospital, DHU FIRE, Assistance Publique-Hôpitaux de Paris, Paris, France.,UFR de Médecine, Paris Diderot University, Sorbonne Paris Cité, Paris, France.,INSERM UMRS 1138, Cordeliers Research Center, Paris, France.,Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Samy Hadjadj
- Department of Endocrinology and Diabetology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.,INSERM CIC 1402, Poitiers, France.,L'institut du thorax, INSERM, CNRS, CHU Nantes, Nantes, France
| | - Amy J McKnight
- Centre for Public Health, Queens University of Belfast, Northern Ireland, UK
| | - Carol Forsblom
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine and.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine and
| | - Gareth McKay
- Centre for Public Health, Queens University of Belfast, Northern Ireland, UK
| | - Catherine Godson
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - A Peter Maxwell
- Centre for Public Health, Queens University of Belfast, Northern Ireland, UK
| | - Matthias Kretzler
- Division of Nephrology, Department of Internal Medicine and.,Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan
| | - Katalin Susztak
- Departments of Medicine and Genetics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Helen M Colhoun
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Per-Henrik Groop
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine and.,Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia; and
| | - Stephen S Rich
- Center for Public Health Genomics, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Joel N Hirschhorn
- Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Programs in Metabolism and Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts
| | - Jose C Florez
- Programs in Metabolism and Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts; .,Center for Genomic Medicine and.,Diabetes Unit, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
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15
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Lechleitner M, Clodi M, Abrahamian H, Brath H, Brix J, Drexel H, Fasching P, Föger B, Francesconi C, Fröhlich-Reiterer E, Harreiter J, Hofer SE, Hoppichler F, Huber J, Kaser S, Kautzky-Willer A, Ludvik B, Luger A, Mader JK, Paulweber B, Pieber T, Prager R, Rami-Merhar B, Resl M, Riedl M, Roden M, Saely CH, Schelkshorn C, Schernthaner G, Sourij H, Stechemesser L, Stingl H, Toplak H, Wascher TC, Weitgasser R, Winhofer-Stöckl Y, Zlamal-Fortunat S. [Insulin therapy of type 2 diabetes mellitus (Update 2019)]. Wien Klin Wochenschr 2019; 131:39-46. [PMID: 30980147 DOI: 10.1007/s00508-019-1492-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The present article is a recommendation of the Austrian Diabetes Association for the practical use of insulin in type 2 diabetes, including the various insulin regimens.
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Affiliation(s)
- Monika Lechleitner
- Interne Abteilung, Landeskrankenhaus Hochzirl - Natters, Hochzirl, 6170, Zirl, Österreich.
| | - Martin Clodi
- ICMR - Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz, Linz, Österreich.,Abteilung für Innere Medizin, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich
| | | | - Helmut Brath
- Diabetes Ambulanz, Gesundheitszentrum Wien-Süd, Wien, Österreich
| | - Johanna Brix
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Krankenanstalt Rudolfstiftung, Wien, Österreich
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Österreich.,Private Universität im Fürstentum Liechtenstein, Triesen, Liechtenstein.,Drexel University College of Medicine, Philadelphia, PA, USA.,Abteilung für Angiologie, Universitätsspital Bern, Bern, Schweiz.,Chair der ESC-Working Group "Cardiovascular Pharmacotherapy", Sophia Antipolis, Frankreich
| | - Peter Fasching
- 5. Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Wilhelminenspital der Stadt Wien, Wien, Österreich
| | - Bernhard Föger
- Interne Abteilung, Landeskrankenhaus Bregenz, Bregenz, Österreich.,AKS Gesundheit, Bregenz, Österreich
| | | | - Elke Fröhlich-Reiterer
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Österreich
| | - Jürgen Harreiter
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Sabine E Hofer
- Department für Pädiatrie 1, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Friedrich Hoppichler
- Abteilung für Innere Medizin, Krankenhaus der Barmherzigen Brüder Salzburg, Salzburg, Österreich
| | - Joakim Huber
- Interne Abteilung mit Akutgeriatrie und Palliativmedizin, Franziskus Spital, Standort Landstraße, Wien, Österreich
| | - Susanne Kaser
- Department für Innere Medizin I, Medizinische Universität Innsbruck, Innsbruck, Österreich.,Christian Doppler Labor für Insulinresistenz, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Bernhard Ludvik
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Krankenanstalt Rudolfstiftung, Wien, Österreich
| | - Anton Luger
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Julia K Mader
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Bernhard Paulweber
- Universitätsklinik für Innere Medizin I, mit Gastroenterologie, Hepatologie, Nephrologie, Stoffwechsel und Diabetologie, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
| | - Thomas Pieber
- Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Rudolf Prager
- 3. Medizinische Abteilung mit Stoffwechselerkrankungen und Nephrologie, Krankenhaus Hietzing, Wien, Österreich
| | - Birgit Rami-Merhar
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
| | - Michael Resl
- Abteilung für Innere Medizin, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich
| | - Michaela Riedl
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Michael Roden
- Klinik für Endokrinologie und Diabetologie, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Deutschland.,Institut für Klinische Diabetologie, Deutsches Diabetes-Zentrum (DDZ), Leibniz-Zentrum für Diabetesforschung, Düsseldorf, Deutschland.,Deutsches Zentrum für Diabetesforschung, DZD e. V., München-Neuherberg, Deutschland
| | - Christoph H Saely
- Abteilung für Innere Medizin I, Akademisches Lehrkrankenhaus Feldkirch, Feldkirch, Österreich
| | | | - Guntram Schernthaner
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Department für Nephrologie, Krankenanstalt Rudolfstiftung, Wien, Österreich
| | - Harald Sourij
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Lars Stechemesser
- Universitätsklinik für Innere Medizin I, mit Gastroenterologie, Hepatologie, Nephrologie, Stoffwechsel und Diabetologie, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
| | - Harald Stingl
- Abteilung für Innere Medizin, Landesklinikum Melk, Melk, Österreich
| | - Hermann Toplak
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Thomas C Wascher
- 1. Medizinische Abteilung, Hanusch-Krankenhaus, Wien, Österreich
| | - Raimund Weitgasser
- Abteilung für Innere Medizin, Privatklinik Wehrle-Diakonissen, Salzburg, Österreich.,Universitätsklinik für Innere Medizin I, LKH Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich
| | - Yvonne Winhofer-Stöckl
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Sandra Zlamal-Fortunat
- Abteilung für Innere Medizin und Gastroenterologie, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Österreich
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16
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Clodi M, Abrahamian H, Brath H, Brix J, Drexel H, Fasching P, Föger B, Francesconi C, Fröhlich-Reiterer E, Harreiter J, Hofer SE, Hoppichler F, Huber J, Kaser S, Kautzky-Willer A, Lechleitner M, Ludvik B, Luger A, Mader JK, Paulweber B, Pieber T, Prager R, Rami-Merhar B, Resl M, Riedl M, Roden M, Saely CH, Schelkshorn C, Schernthaner G, Sourij H, Stechemesser L, Stingl H, Toplak H, Wascher TC, Weitgasser R, Winhofer-Stöckl Y, Zlamal-Fortunat S. [Antihyperglycemic treatment guidelines for diabetes mellitus type 2 (Update 2019)]. Wien Klin Wochenschr 2019; 131:27-38. [PMID: 30980148 DOI: 10.1007/s00508-019-1471-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Hyperglycemia significantly contributes to complications in patients with diabetes mellitus. While lifestyle interventions remain cornerstones of disease prevention and treatment, most patients with type 2 diabetes will eventually require pharmacotherapy for glycemic control. The definition of individual targets regarding optimal therapeutic efficacy and safety as well as cardiovascular effects is of great importance. In this guideline we present the most current evidence-based best clinical practice data for healthcare professionals.
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Affiliation(s)
- Martin Clodi
- ICMR - Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz, 4040, Linz, Österreich. .,Abteilung für Innere Medizin mit Diabetologie, Gastroenterologie und Hepatologie, Rheumatologie und Intensivmedizin, Konventhospital der Barmherzigen Brüder Linz, Seilerstätte 2, 4021, Linz, Österreich.
| | | | - Helmut Brath
- Diabetes Ambulanz, Gesundheitszentrum Wien-Süd, Wien, Österreich
| | - Johanna Brix
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Krankenanstalt Rudolfstiftung, Wien, Österreich
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Österreich.,Chair der ESC-Working Group "Cardiovascular Pharmacotherapy", Sophia Antipolis, Frankreich.,Abteilung für Angiologie, Universitätsspital Bern, Bern, Schweiz.,Drexel University College of Medicine, Philadelphia, PA, USA.,Private Universität im Fürstentum Liechtenstein, Liechtenstein, Liechtenstein
| | - Peter Fasching
- 5. Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Wilhelminenspital der Stadt Wien, Wien, Österreich
| | - Bernhard Föger
- Interne Abteilung, Landeskrankenhaus Bregenz, Bregenz, Österreich.,AKS Gesundheit, Bregenz, Österreich
| | | | - Elke Fröhlich-Reiterer
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Österreich
| | - Jürgen Harreiter
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Sabine E Hofer
- Department für Pädiatrie 1, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Friedrich Hoppichler
- Abteilung für Innere Medizin, Krankenhaus der Barmherzigen Brüder Salzburg, Salzburg, Österreich
| | - Joakim Huber
- Interne Abteilung mit Akutgeriatrie und Palliativmedizin, Franziskus Spital, Standort Landstraße, Wien, Österreich
| | - Susanne Kaser
- Department für Innere Medizin I, Medizinische Universität Innsbruck, Innsbruck, Österreich.,Christian Doppler Labor für Insulinresistenz, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Monika Lechleitner
- Interne Abteilung, Landeskrankenhaus Hochzirl - Natters, Hochzirl, Österreich
| | - Bernhard Ludvik
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Krankenanstalt Rudolfstiftung, Wien, Österreich
| | - Anton Luger
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Julia K Mader
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Bernhard Paulweber
- Universitätsklinik für Innere Medizin I, mit Gastroenterologie, Hepatologie, Nephrologie, Stoffwechsel und Diabetologie, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
| | - Thomas Pieber
- Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Rudolf Prager
- 3. Medizinische Abteilung mit Stoffwechselerkrankungen und Nephrologie, Krankenhaus Hietzing Wien, Wien, Österreich
| | - Birgit Rami-Merhar
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
| | - Michael Resl
- ICMR - Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz, 4040, Linz, Österreich.,Abteilung für Innere Medizin mit Diabetologie, Gastroenterologie und Hepatologie, Rheumatologie und Intensivmedizin, Konventhospital der Barmherzigen Brüder Linz, Seilerstätte 2, 4021, Linz, Österreich
| | - Michaela Riedl
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Michael Roden
- Klinik für Endokrinologie und Diabetologie, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Deutschland.,Deutsches Zentrum für Diabetesforschung, DZD e. V., München-Neuherberg, Deutschland.,Institut für Klinische Diabetologie, Deutsches Diabetes-Zentrum (DDZ), Leibniz-Zentrum für Diabetesforschung, Düsseldorf, Deutschland
| | - Christoph H Saely
- Abteilung für Innere Medizin I, Akademisches Lehrkrankenhaus Feldkirch, Feldkirch, Österreich
| | | | - Guntram Schernthaner
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Krankenanstalt Rudolfstiftung, Wien, Österreich
| | - Harald Sourij
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Lars Stechemesser
- Universitätsklinik für Innere Medizin I, mit Gastroenterologie, Hepatologie, Nephrologie, Stoffwechsel und Diabetologie, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
| | - Harald Stingl
- Abteilung für Innere Medizin, Landesklinikum Melk, Melk, Österreich
| | - Hermann Toplak
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Thomas C Wascher
- 1. Medizinische Abteilung, Hanusch-Krankenhaus, Wien, Österreich
| | - Raimund Weitgasser
- Abteilung für Innere Medizin, Privatklinik Wehrle-Diakonissen, Salzburg, Österreich.,Universitätsklinik für Innere Medizin I, LKH Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich
| | - Yvonne Winhofer-Stöckl
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Sandra Zlamal-Fortunat
- Abteilung für Innere Medizin und Gastroenterologie, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Österreich
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Abstract
This position statement presents the recommendations of the Austrian Diabetes Association for diabetes management of adult patients during inpatient stay. It is based on the current evidence with respect to blood glucose targets, insulin therapy and treatment with oral antidiabetic drugs during inpatient hospitalization. Additionally, special circumstances such as intravenous insulin therapy, concomitant therapy with glucocorticoids and use of diabetes technology during hospitalization are discussed.
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Affiliation(s)
- Julia K Mader
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich.
| | - Johanna Brix
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Krankenanstalt Rudolfstiftung, Wien, Österreich
| | - Felix Aberer
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich
| | - Alexander Vonbank
- Innere Medizin I mit Kardiologie, Angiologie, Endokrinologie, Diabetologie und Intensivmedizin, Akademisches Lehrkrankenhaus Feldkirch, Feldkirch, Österreich
| | - Michael Resl
- Abteilung für Innere Medizin, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich
| | - Thomas R Pieber
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich
| | - Lars Stechemesser
- Universitätsklinik für Innere Medizin I, Paracelsus Medizinische Privatuniversität - Landeskrankenhaus, Salzburg, Österreich
| | - Harald Sourij
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich
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18
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Jirak P, Stechemesser L, Moré E, Franzen M, Topf A, Mirna M, Paar V, Pistulli R, Kretzschmar D, Wernly B, Hoppe UC, Lichtenauer M, Salmhofer H. Clinical implications of fetuin-A. Adv Clin Chem 2019; 89:79-130. [PMID: 30797472 DOI: 10.1016/bs.acc.2018.12.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Fetuin-A, also termed alpha2-Heremans-Schmid glycoprotein, is a 46kDa hepatocyte derived protein (hepatokine) and serves multifaceted functions.
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Affiliation(s)
- Peter Jirak
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Lars Stechemesser
- Department of Internal Medicine I, Divisions of Nephrology and Endocrinology, Paracelsus Medical University, Salzburg, Austria
| | - Elena Moré
- Department of Internal Medicine I, Divisions of Nephrology and Endocrinology, Paracelsus Medical University, Salzburg, Austria
| | - Michael Franzen
- Department of Internal Medicine I, Divisions of Nephrology and Endocrinology, Paracelsus Medical University, Salzburg, Austria
| | - Albert Topf
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Moritz Mirna
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Vera Paar
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Rudin Pistulli
- Department of Internal Medicine I, Division of Cardiology, Friedrich Schiller University Jena, Jena, Germany
| | - Daniel Kretzschmar
- Department of Internal Medicine I, Division of Cardiology, Friedrich Schiller University Jena, Jena, Germany
| | - Bernhard Wernly
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Uta C Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, Salzburg, Austria.
| | - Hermann Salmhofer
- Department of Internal Medicine I, Divisions of Nephrology and Endocrinology, Paracelsus Medical University, Salzburg, Austria
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19
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Denkmayr L, Feldman A, Stechemesser L, Eder SK, Zandanell S, Schranz M, Strasser M, Huber-Schönauer U, Buch S, Hampe J, Paulweber B, Lackner C, Haufe H, Sotlar K, Datz C, Aigner E. Lean Patients with Non-Alcoholic Fatty Liver Disease Have a Severe Histological Phenotype Similar to Obese Patients. J Clin Med 2018; 7:E562. [PMID: 30562976 PMCID: PMC6306845 DOI: 10.3390/jcm7120562] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 12/12/2018] [Accepted: 12/14/2018] [Indexed: 12/18/2022] Open
Abstract
A small proportion of lean patients develop non-alcoholic fatty liver disease (NAFLD). We aimed to report the histological picture of lean NAFLD in comparison to overweight and obese NAFLD patients. Biopsy and clinical data from 466 patients diagnosed with NAFLD were stratified to groups according to body mass index (BMI): lean (BMI ≤ 25.0 kg/m², n confirmed to be appropriate = 74), overweight (BMI > 25.0 ≤ 30.0 kg/m², n = 242) and obese (BMI > 30.0 kg/m², n = 150). Lean NAFLD patients had a higher rate of lobular inflammation compared to overweight patients (12/74; 16.2% vs. 19/242; 7.9%; p = 0.011) but were similar to obese patients (25/150; 16.7%). Ballooning was observed in fewer overweight patients (38/242; 15.7%) compared to lean (19/74; 25.7%; p = 0.014) and obese patients (38/150; 25.3%; p = 0.006). Overweight patients had a lower rate of portal and periportal fibrosis (32/242; 13.2%) than lean (19/74; 25.7%; p = 0.019) and obese patients (37/150; 24.7%; p = 0.016). The rate of cirrhosis was higher in lean patients (6/74; 8.1%) compared to overweight (4/242; 1.7%; p = 0.010) and obese patients (3/150; 2.0% p = 0.027). In total, 60/466; 12.9% patients were diagnosed with non-alcoholic steatohepatitis (NASH). The rate of NASH was higher in lean (14/74; 18.9% p = 0.01) and obese (26/150; 17.3%; p = 0.007) compared to overweight patients (20/242; 8.3%)). Among lean patients, fasting glucose, INR and use of thyroid hormone replacement therapy were independent predictors of NASH in a multivariate model. Lean NAFLD patients were characterized by a severe histological picture similar to obese patients but are more progressed compared to overweight patients. Fasting glucose, international normalized ratio (INR) and the use of thyroid hormone replacement may serve as indicators for NASH in lean patients.
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Affiliation(s)
- Lukas Denkmayr
- First Department of Medicine, Paracelsus Medical University, 5020 Salzburg, Austria.
| | - Alexandra Feldman
- First Department of Medicine, Paracelsus Medical University, 5020 Salzburg, Austria.
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria.
| | - Lars Stechemesser
- First Department of Medicine, Paracelsus Medical University, 5020 Salzburg, Austria.
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria.
| | - Sebastian K Eder
- First Department of Medicine, Paracelsus Medical University, 5020 Salzburg, Austria.
| | - Stephan Zandanell
- First Department of Medicine, Paracelsus Medical University, 5020 Salzburg, Austria.
| | - Michael Schranz
- First Department of Medicine, Paracelsus Medical University, 5020 Salzburg, Austria.
| | - Michael Strasser
- First Department of Medicine, Paracelsus Medical University, 5020 Salzburg, Austria.
| | - Ursula Huber-Schönauer
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, 5110 Oberndorf, Austria.
| | - Stephan Buch
- Department of Gastroenterology and Hepatology, Internal Medicine, University Hospital Dresden, 01307 Dresden, Germany.
| | - Jochen Hampe
- Department of Gastroenterology and Hepatology, Internal Medicine, University Hospital Dresden, 01307 Dresden, Germany.
| | - Bernhard Paulweber
- First Department of Medicine, Paracelsus Medical University, 5020 Salzburg, Austria.
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria.
| | - Carolin Lackner
- Institute of Pathology, Medical University of Graz, 8010 Graz, Austria.
| | - Heike Haufe
- Institute of Pathology, Paracelsus Medical University, 5020 Salzburg, Austria.
| | - Karl Sotlar
- Institute of Pathology, Paracelsus Medical University, 5020 Salzburg, Austria.
| | - Christian Datz
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria.
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, 5110 Oberndorf, Austria.
| | - Elmar Aigner
- First Department of Medicine, Paracelsus Medical University, 5020 Salzburg, Austria.
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria.
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20
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Feldman A, Eder SK, Felder TK, Paulweber B, Zandanell S, Stechemesser L, Schranz M, Strebinger G, Huber-Schönauer U, Niederseer D, Patsch W, Weghuber D, Tevini J, Datz C, Aigner E. Clinical and metabolic characterization of obese subjects without non-alcoholic fatty liver: A targeted metabolomics approach. Diabetes Metab 2018; 45:132-139. [PMID: 30266576 DOI: 10.1016/j.diabet.2018.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 09/04/2018] [Accepted: 09/10/2018] [Indexed: 01/14/2023]
Abstract
INTRODUCTION As a small proportion of obese individuals do not develop metabolic complications and non-alcoholic fatty liver disease (NAFLD), this study aimed to provide a comprehensive clinical, metabolic and genetic description of obese subjects with healthy livers. METHODS A total of 183 subjects were stratified, according to BMI, presence of metabolic syndrome, biochemical liver tests and hepatic steatosis on ultrasound, into: (i) lean controls (n = 69); (ii) obese healthy (n = 50); and (iii)obese NAFLD (n = 62) groups. Detailed clinical, genetic and metabolic evaluations were then performed. RESULTS Obese healthy subjects did not differ in glucose parameters from lean controls, and had a lower rate of minor TM6SF2 gene variants compared with obese NAFLD (2/49 vs. 11/60, respectively; P = 0.035) and lean controls (13/64; P = 0.035), but significantly higher leptin concentrations than lean controls (P < 0.001); they also higher adiponectin concentrations (P < 0.001), and lower TNF-α and IL-6 concentrations (P = 0.01 and P < 0.001, respectively), than obese NAFLD subjects. Also, metabolomic studies identified ether- and ester-containing phospholipids [PC ae C44:6, PC ae C42:5, PC aa C40:4; P < 0.001, corrected by the false discovery rate (FDR) method] and found that the amino-acids lysine, glycine and isoleucine (FDR < 0.001) differed between the two obese groups, but not between lean controls and obese healthy subjects. CONCLUSION Obese people with healthy livers are characterized by intact glucose homoeostasis, lower pro-inflammatory cytokine levels, and higher adiponectin and leptin concentrations compared with obese people with NAFLD. In addition, the major allele of TM6SF2, a set of phosphatidylcholines and several amino acids are associated with healthy livers in obesity.
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Affiliation(s)
- A Feldman
- First Department of Medicine, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; Obesity Research Unit, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - S K Eder
- First Department of Medicine, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; Obesity Research Unit, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - T K Felder
- Obesity Research Unit, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - B Paulweber
- First Department of Medicine, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; Obesity Research Unit, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - S Zandanell
- First Department of Medicine, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - L Stechemesser
- First Department of Medicine, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - M Schranz
- First Department of Medicine, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - G Strebinger
- Department of Internal Medicine, Hospital Oberndorf, Oberndorf, Austria
| | - U Huber-Schönauer
- Department of Internal Medicine, Hospital Oberndorf, Oberndorf, Austria
| | - D Niederseer
- Department of Internal Medicine, Hospital Oberndorf, Oberndorf, Austria; Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - W Patsch
- Department of Pharmacology and Toxicology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - D Weghuber
- Department of Pediatrics, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - J Tevini
- Obesity Research Unit, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - C Datz
- Obesity Research Unit, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; Department of Internal Medicine, Hospital Oberndorf, Oberndorf, Austria
| | - E Aigner
- First Department of Medicine, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; Obesity Research Unit, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria.
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21
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Stechemesser L, Eder SK, Wagner A, Patsch W, Feldman A, Strasser M, Auer S, Niederseer D, Huber-Schönauer U, Paulweber B, Zandanell S, Ruhaltinger S, Weghuber D, Haschke-Becher E, Grabmer C, Rohde E, Datz C, Felder TK, Aigner E. Metabolomic profiling identifies potential pathways involved in the interaction of iron homeostasis with glucose metabolism. Mol Metab 2016; 6:38-47. [PMID: 28123936 PMCID: PMC5220278 DOI: 10.1016/j.molmet.2016.10.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 10/17/2016] [Accepted: 10/24/2016] [Indexed: 02/06/2023] Open
Abstract
Objective Elevated serum ferritin has been linked to type 2 diabetes (T2D) and adverse health outcomes in subjects with the Metabolic Syndrome (MetS). As the mechanisms underlying the negative impact of excess iron have so far remained elusive, we aimed to identify potential links between iron homeostasis and metabolic pathways. Methods In a cross-sectional study, data were obtained from 163 patients, allocated to one of three groups: (1) lean, healthy controls (n = 53), (2) MetS without hyperferritinemia (n = 54) and (3) MetS with hyperferritinemia (n = 56). An additional phlebotomy study included 29 patients with biopsy-proven iron overload before and after iron removal. A detailed clinical and biochemical characterization was obtained and metabolomic profiling was performed via a targeted metabolomics approach. Results Subjects with MetS and elevated ferritin had higher fasting glucose (p < 0.001), HbA1c (p = 0.035) and 1 h glucose in oral glucose tolerance test (p = 0.002) compared to MetS subjects without iron overload, whereas other clinical and biochemical features of the MetS were not different. The metabolomic study revealed significant differences between MetS with high and low ferritin in the serum concentrations of sarcosine, citrulline and particularly long-chain phosphatidylcholines. Methionine, glutamate, and long-chain phosphatidylcholines were significantly different before and after phlebotomy (p < 0.05 for all metabolites). Conclusions Our data suggest that high serum ferritin concentrations are linked to impaired glucose homeostasis in subjects with the MetS. Iron excess is associated to distinct changes in the serum concentrations of phosphatidylcholine subsets. A pathway involving sarcosine and citrulline also may be involved in iron-induced impairment of glucose metabolism. This metabolomic study focuses on pathways linking iron status to insulin resistance. Metabolomic differences in Metabolic Syndrome with/without iron overload are shown. Phlebotomy changes methionine, glutamate and long-chain phosphatidylcholines levels. Phosphatidylcholines are involved in the interaction of iron and glucose homeostasis.
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Key Words
- +Fe, with iron overload
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- Akt/PKB, Akt/protein kinase B
- BMI, body mass index
- CDP, Cytidinediphosphat
- CRP, C-reactive protein
- DIOS, dysmetabolic iron overload syndrome
- FoxO1, forkhead transcription factor O1
- GGT, gamma-glutamyl transpeptidase
- GLUT1, glucose transporter 1
- GNMT, glycine N-methyltransferase
- GSK3β, glycogen synthase kinase 3β
- Glucose
- HDL, high density lipoproteins
- HIF1α, hypoxia-inducible factor 1α
- HOMA-IR, homeostatic model assessment-insulin resistance
- Hyperferritinemia
- IL, interleukin
- IR, insulin resistance
- Iron overload
- LDL, low density lipoproteins
- MRI, magnet resonance imaging
- MetS, metabolic syndrome
- Metabolic syndrome
- Metabolomics
- NAFLD, non-alcoholic fatty liver disease
- PC, phosphatidylcholine
- PCOS, polycystic ovary syndrome
- PC_E, plasmalogens
- PEMT, phosphatidylethanolamine N-methyltransferase
- RBC, red blood count
- T2D, type 2 diabetes mellitus
- TNF, tumor necrosis factor
- VLDL, very low-densitylipoproteins
- WHO, World Health Organization
- WHR, waist hip ratio
- oGTT, oral glucose tolerance test
- −Fe, without iron overload
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Affiliation(s)
- Lars Stechemesser
- First Department of Medicine, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Sebastian K Eder
- First Department of Medicine, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; Obesity Research Unit, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Andrej Wagner
- First Department of Medicine, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Wolfgang Patsch
- Department of Pharmacology and Toxicology, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Alexandra Feldman
- First Department of Medicine, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; Obesity Research Unit, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Michael Strasser
- First Department of Medicine, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Simon Auer
- Department of Laboratory Medicine, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - David Niederseer
- Department of Internal Medicine, Hospital Oberndorf, Paracelsusstrasse 37, 5110 Oberndorf, Austria; Department of Cardiology, University Heart Center Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Ursula Huber-Schönauer
- Department of Internal Medicine, Hospital Oberndorf, Paracelsusstrasse 37, 5110 Oberndorf, Austria
| | - Bernhard Paulweber
- First Department of Medicine, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Stephan Zandanell
- First Department of Medicine, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Sandra Ruhaltinger
- First Department of Medicine, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Daniel Weghuber
- Obesity Research Unit, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Elisabeth Haschke-Becher
- Department of Laboratory Medicine, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Christoph Grabmer
- Department of Blood Group Serology and Transfusion Medicine, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Eva Rohde
- Department of Blood Group Serology and Transfusion Medicine, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Christian Datz
- Obesity Research Unit, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; Department of Internal Medicine, Hospital Oberndorf, Paracelsusstrasse 37, 5110 Oberndorf, Austria
| | - Thomas K Felder
- Obesity Research Unit, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; Department of Laboratory Medicine, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Elmar Aigner
- First Department of Medicine, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria; Obesity Research Unit, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria.
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Wascher TC, Stechemesser L. Blutzuckerselbstkontrolle. Wien Klin Wochenschr 2016; 128 Suppl 2:S137-40. [DOI: 10.1007/s00508-015-0927-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Domhardt M, Tiefengrabner M, Dinic R, Fötschl U, Oostingh GJ, Stütz T, Stechemesser L, Weitgasser R, Ginzinger SW. Training of carbohydrate estimation for people with diabetes using mobile augmented reality. J Diabetes Sci Technol 2015; 9:516-24. [PMID: 25883165 PMCID: PMC4604528 DOI: 10.1177/1932296815578880] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Imprecise carbohydrate counting as a measure to guide the treatment of diabetes may be a source of errors resulting in problems in glycemic control. Exact measurements can be tedious, leading most patients to estimate their carbohydrate intake. In the presented pilot study a smartphone application (BE(AR)), that guides the estimation of the amounts of carbohydrates, was used by a group of diabetic patients. METHODS Eight adult patients with diabetes mellitus type 1 were recruited for the study. At the beginning of the study patients were introduced to BE(AR) in sessions lasting 45 minutes per patient. Patients redraw the real food in 3D on the smartphone screen. Based on a selected food type and the 3D form created using BE(AR) an estimation of carbohydrate content is calculated. Patients were supplied with the application on their personal smartphone or a loaner device and were instructed to use the application in real-world context during the study period. For evaluation purpose a test measuring carbohydrate estimation quality was designed and performed at the beginning and the end of the study. RESULTS In 44% of the estimations performed at the end of the study the error reduced by at least 6 grams of carbohydrate. This improvement occurred albeit several problems with the usage of BE(AR) were reported. CONCLUSIONS Despite user interaction problems in this group of patients the provided intervention resulted in a reduction in the absolute error of carbohydrate estimation. Intervention with smartphone applications to assist carbohydrate counting apparently results in more accurate estimations.
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Affiliation(s)
- Michael Domhardt
- Department of MultiMediaTechnology, Salzburg University of Applied Sciences, Puch, Austria
| | - Martin Tiefengrabner
- Department of MultiMediaTechnology, Salzburg University of Applied Sciences, Puch, Austria
| | - Radomir Dinic
- Department of MultiMediaTechnology, Salzburg University of Applied Sciences, Puch, Austria
| | - Ulrike Fötschl
- Department of Biomedical Sciences, Salzburg University of Applied Sciences, Puch, Austria
| | - Gertie J Oostingh
- Department of Biomedical Sciences, Salzburg University of Applied Sciences, Puch, Austria
| | - Thomas Stütz
- Department of MultiMediaTechnology, Salzburg University of Applied Sciences, Puch, Austria
| | - Lars Stechemesser
- First Department of Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Raimund Weitgasser
- Department of Internal Medicine, Diakonissen Hospital Salzburg, Salzburg, Austria First Department of Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Simon W Ginzinger
- Department of MultiMediaTechnology, Salzburg University of Applied Sciences, Puch, Austria
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Stechemesser L, Gürel F, Hofmann A, Pirich C, Gappmayer B, Weitgasser R. Steigert der Nachweis einer diabetischen kardialen autonomen Neuropathie (CAN) die Wahrscheinlichkeit eines Ischämienachweises mittels Myokardszintigrafie? DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1222066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stechemesser L, Hammerschmied A, Gappmayer B, Schreuer M, Weitgasser R. Zwei kontinuierliche Glukosemesssysteme im simultanen Vergleich bei Patienten mit Diabetes mellitus Typ 2. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1222048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stechemesser L, Gradenegger U, Hofmann M, Hasenöhrl G, Steiner H, Weitgasser R. Assoziation des HELLP-Syndroms mit pathologischer Glukosetoleranz und Autoantikörperbildung. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-943903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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