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Eckert AJ, Zimny S, Altmeier M, Dugic A, Gillessen A, Bozkurt L, Götz G, Karges W, Wosch FJ, Kress S, Holl RW. Factors associated with diabetic foot ulcers and lower limb amputations in type 1 and type 2 diabetes supported by real-world data from the German/Austrian DPV registry. J Diabetes 2024; 16:e13531. [PMID: 38403299 PMCID: PMC10894714 DOI: 10.1111/1753-0407.13531] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/09/2023] [Accepted: 12/27/2023] [Indexed: 02/27/2024] Open
Abstract
AIMS Diabetic foot ulcer (DFU) is a leading cause of lower limb amputations in people with diabetes. This study was aimed to retrospectively analyze factors affecting DFU using real-world data from a large, prospective central-European diabetes registry (DPV [Diabetes-Patienten-Verlaufsdokumentation]). MATERIALS AND METHODS We matched adults with type 1 (T1D) or type 2 diabetes (T2D) and DFU to controls without DFU by diabetes type, age, sex, diabetes duration, and treatment year to compare possible risk factors. Cox regression was used to calculate hazard ratios for amputation among those with DFU. RESULTS In our cohort (N = 63 464), male sex, taller height, and diabetes complications such as neuropathy, peripheral artery disease, nephropathy, and retinopathy were associated with DFU (all p < .001). Glycated hemoglobin (HbA1c) was related to DFU only in T1D (mean with 95% confidence interval [CI]: 7.8 [6.9-9.0] % vs 7.5 [6.8-8.5] %, p < .001). High triglycerides and worse low-density lipoprotein/high-density lipoprotein ratio were also associated with DFU in T1D, whereas smoking (14.7% vs 13.1%) and alcohol abuse (6.4% vs 3.8%, both p < .001) were associated with DFU in T2D. Male sex, higher Wagner grades, and high HbA1c in both diabetes types and insulin use in T2D were associated with increased hazard ratios for amputations. CONCLUSIONS Sex, body height, and diabetes complications were associated DFU risk in adults with T1D and T2D. Improvement in glycemic control and lipid levels in T1D and reduction of smoking and drinking in T2D may be appropriate interventions to reduce the risk for DFU or amputations.
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Affiliation(s)
- Alexander J Eckert
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
| | - Stefan Zimny
- Department of General Internal Medicine, Endocrinology and Diabetology, Helios Clinic Schwerin, Schwerin, Germany
| | - Marcus Altmeier
- Klinik für Diabetologie, Klinikum Dortmund, Dortmund, Deutschland
| | - Ana Dugic
- Medical Clinic I, Klinikum Bayreuth Friedrich-Alexander-University Erlangen-Nürnberg, Bayreuth, Germany
| | - Anton Gillessen
- Department of Internal Medicine, Herz-Jesu-Hospital, Muenster, Germany
| | - Latife Bozkurt
- Department of Internal Medicine III and Karl Landsteiner Institute for Metabolic Disorders and Nephrology, Clinic Hietzing, Vienna Health Care Group, Vienna, Austria
| | - Gabriele Götz
- Department of Internal Medicine, Diabetes, Gastroenterology, Tumor Medicine, and Palliative Care, Academic Teaching Hospital Nürtingen, Tübingen, Germany
| | - Wolfram Karges
- Clinic for Gastroenterology, Metabolic Disorders and Internal Intensive Medicine (Medical Clinic III), Department of Endocrinology and Diabetology, University Hospital Aachen, Aachen, Germany
| | | | - Stephan Kress
- Diabetes, Sport and Physical Activity Working Group of the DDG, Unna, Germany
- Department of Internal Medicine I, Vinzentius Hospital Landau, Landau, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
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Eckert AJ, Fritsche A, Icks A, Siegel E, Mueller-Stierlin AS, Karges W, Rosenbauer J, Auzanneau M, Holl RW. Common procedures and conditions leading to inpatient hospital admissions in adults with and without diabetes from 2015 to 2019 in Germany : A comparison of frequency, length of hospital stay and complications. Wien Klin Wochenschr 2023:10.1007/s00508-023-02153-z. [PMID: 36763137 PMCID: PMC9913003 DOI: 10.1007/s00508-023-02153-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/10/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To evaluate common surgical procedures and admission causes in inpatient cases with diabetes in Germany between 2015 and 2019 and compare them to inpatient cases without diabetes. METHODS Based on the German diagnosis-related groups (G-DRG) statistics, regression models stratified by age groups and gender were used to calculate hospital admissions/100,000 individuals, hospital days as well as the proportion of complications and mortality in inpatient cases ≥ 40 years with or without a documented diagnosis of diabetes (type 1 or type 2). RESULTS A total of 14,222,326 (21%) of all inpatient cases aged ≥ 40 years had a diagnosis of diabetes. More middle-aged females with vs. without diabetes/100,000 individuals [95% CI] were observed, most pronounced in cases aged 40-< 50 years with myocardial infarction (305 [293-319] vs. 36 [36-37], p < 0.001). Higher proportions of complications and longer hospital stays were found for all procedures and morbidities in cases with diabetes. CONCLUSION Earlier hospitalizations, longer hospital stays and more complications in inpatient cases with diabetes together with the predicted future increase in diabetes prevalence depict huge challenges for the German healthcare system. There is an urgent need for developing strategies to adequately care for patients with diabetes in hospital.
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Affiliation(s)
- Alexander J. Eckert
- grid.6582.90000 0004 1936 9748Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, 89081 Ulm, Germany ,German Centre for Diabetes Research (DZD), Neuherberg, Germany
| | - Andreas Fritsche
- German Centre for Diabetes Research (DZD), Neuherberg, Germany ,grid.10392.390000 0001 2190 1447Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University Tübingen, Tübingen, Germany ,grid.10392.390000 0001 2190 1447Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany
| | - Andrea Icks
- German Centre for Diabetes Research (DZD), Neuherberg, Germany ,grid.411327.20000 0001 2176 9917Institute of Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany ,grid.411327.20000 0001 2176 9917Institute for Health Services Research and Health Economics, German Diabetes Centre, Leibniz Centre for Diabetes Research at the Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Erhard Siegel
- Department of Gastroenterology, Diabetology, Endocrinology, and Nutritional Medicine, St. Josefskrankenhaus Heidelberg, Heidelberg, Germany
| | - Annabel S. Mueller-Stierlin
- grid.410712.10000 0004 0473 882XDepartment of Psychiatry and Psychotherapy II, University Hospital Ulm, Ulm, Germany
| | - Wolfram Karges
- grid.1957.a0000 0001 0728 696XDivision of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Joachim Rosenbauer
- German Centre for Diabetes Research (DZD), Neuherberg, Germany ,grid.411327.20000 0001 2176 9917Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich Heine University Dusseldorf, Dusseldorf, Germany
| | - Marie Auzanneau
- grid.6582.90000 0004 1936 9748Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, 89081 Ulm, Germany ,German Centre for Diabetes Research (DZD), Neuherberg, Germany
| | - Reinhard W. Holl
- grid.6582.90000 0004 1936 9748Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, 89081 Ulm, Germany ,German Centre for Diabetes Research (DZD), Neuherberg, Germany
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Welters A, Tittel SR, Reinehr T, Weghuber D, Wiegand S, Karges W, Freiberg C, Meissner T, Schloot NC, Holl RW. Clinical characteristics and cardiovascular risk profile in children and adolescents with latent autoimmune diabetes: Results from the German/Austrian prospective diabetes follow-up registry. Pediatr Diabetes 2022; 23:1602-1612. [PMID: 36334008 DOI: 10.1111/pedi.13450] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022] Open
Abstract
AIMS To characterize children and adolescents with latent autoimmune diabetes of the young (LADY), and to assess the utility of classifying individuals as LADYs regarding their cardiovascular (CV) risk factors. METHODS Data from 25,520 individuals (age at diagnosis <18 years) of the Prospective Diabetes Follow-up Registry Diabetes-Patienten Verlaufsdokumentation (DPV) were analyzed. LADY was defined as positivity of ≥one islet autoantibody (iAb+) and an insulin-free interval of ≥6 months upon diabetes diagnosis. LADYs were compared to iAb+ individuals immediately requiring insulin ("immunologically confirmed" type 1 diabetes, T1DM), iAb-/Ins- individuals ("classical" T2DM) and to those clinically defined as T2DM (iAbs not measured). RESULTS Clinical characteristics of LADYs (n = 299) fell in between those with T1DM (n = 24,932) and T2DM (iAb-/Ins-, n = 152) or suspected T2DM (iAB not measured, n = 137). Stratifying LADYs according to their clinical diagnosis however revealed two distinct populations, highly resembling either T1DM or T2DM. Particularly, CV risk profile, precisely prevalence rates of arterial hypertension and dyslipidemia, was significantly higher in LADYs clinically classified as T2DM compared to LADYs classified as T1DM, and did not differ from those with "classical" T2DM. CONCLUSIONS In terms of CV risk, classifying children and adolescents with diabetes as LADYs provides no additional benefit. Instead, clinical diagnosis seems to better assign individuals to appropriate risk groups for increased CV risk profiles.
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Affiliation(s)
- Alena Welters
- Department of General Paediatrics, Neonatology and Paediatric Cardiology, University Children's Hospital Düsseldorf, Dusseldorf, Germany
| | - Sascha R Tittel
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Thomas Reinehr
- Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten-Herdecke, Datteln, Germany
| | - Daniel Weghuber
- Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
| | - Susanna Wiegand
- Center for Social-Pediatric Care/Pediatric Endocrinology and Diabetology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfram Karges
- Division of Endocrinology and Diabetes, RWTH Aachen University, Aachen, Germany
| | - Clemens Freiberg
- Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Thomas Meissner
- Department of General Paediatrics, Neonatology and Paediatric Cardiology, University Children's Hospital Düsseldorf, Dusseldorf, Germany
| | - Nanette C Schloot
- Medizinische Fakultät der Heinrich-Heine Universität Düsseldorf, Dusseldorf, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
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Doppler CEJ, Meyer L, Seger A, Karges W, Weiss PH, Fink GR. Intranasal oxytocin attenuates the effects of monetary feedback on procedural learning. Psychoneuroendocrinology 2022; 143:105823. [PMID: 35689985 DOI: 10.1016/j.psyneuen.2022.105823] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/06/2022] [Accepted: 06/01/2022] [Indexed: 11/18/2022]
Abstract
Procedural learning is a vital brain function that allows us to acquire motor skills during development or re-learn them after lesions affecting the motor system. Procedural learning can be improved by feedback of different valence, e.g., monetary or social, mediated by dopaminergic circuits. While processing motivationally relevant stimuli, dopamine interacts closely with oxytocin, whose effects on procedural learning, particularly feedback-based approaches, remain poorly understood. In a randomized, double-blind, placebo-controlled trial, we investigated whether oxytocin modulates the differential effects of monetary and social feedback on procedural learning. Sixty-one healthy male participants were randomized to receive a placebo or oxytocin intranasally. The participants then performed a modified serial reaction time task. Oxytocin plasma concentrations were measured before and after applying the placebo or verum. Groups did not differ regarding general reaction times or measures of procedural learning. For the placebo group, monetary feedback improved procedural learning compared to a neutral control condition. In contrast, the oxytocin group did not show a differential effect of monetary or social feedback despite a significant increase in oxytocin plasma levels after intranasal application. The data suggest that oxytocin does not influence procedural learning per se. Instead, oxytocin seems to attenuate the effects of monetary feedback on procedural learning specifically.
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Affiliation(s)
- Christopher E J Doppler
- Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Germany.
| | - Linda Meyer
- Department of Psychiatry, Alexius/Josef Hospital, Neuss, Germany
| | - Aline Seger
- Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Germany
| | - Wolfram Karges
- Division of Endocrinology and Diabetes, University Hospital RWTH Aachen, Aachen, Germany
| | - Peter H Weiss
- Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Germany
| | - Gereon R Fink
- Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Germany
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Zaharia OP, Lanzinger S, Rosenbauer J, Karges W, Müssig K, Meyhöfer SM, Burkart V, Hummel M, Raddatz D, Roden M, Szendroedi J, Holl RW. Comorbidities in Recent-Onset Adult Type 1 Diabetes: A Comparison of German Cohorts. Front Endocrinol (Lausanne) 2022; 13:760778. [PMID: 35721726 PMCID: PMC9205191 DOI: 10.3389/fendo.2022.760778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 04/11/2022] [Indexed: 12/21/2022] Open
Abstract
AIMS Restrictive exclusion criteria from different study populations may limit the generalizability of the observations. By comparing two differently designed German cohorts, we assessed the prevalence of cardiovascular risk factors and diabetes-related complications in recent-onset adult type 1 diabetes. METHODS This study evaluated 1511 persons with type 1 diabetes of the prospective diabetes follow-up registry (DPV) and 268 volunteers of the prospective observational German Diabetes Study (GDS) with a known diabetes duration <1 year. Participants had similar age (36 years), sex distribution (41% female) and BMI (26 kg/m2) in both cohorts. RESULTS The average HbA1c was 6.4 ± 0.8% in the GDS and 7.0 ± 1.1% in the DPV. Prevalence of hypertension (24%) was similar, while more DPV participants had dyslipidemia and lipid-lowering medication than GDS participants (77% vs. 41% and 7% vs. 2%, respectively; p<0.05). Prevalence of retinopathy and nephropathy was higher in DPV compared to GDS participants (10% vs. 3% and 18% vs. 7%, respectively; p<0.001). CONCLUSIONS Diabetic nephropathy and retinopathy are the most frequent complications in type 1 diabetes, affecting up to every 10th patient within the first year after diagnosis, underlining the need for more stringent risk factor management already at the time of diagnosis of type 1 diabetes.
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Affiliation(s)
- Oana P. Zaharia
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Stefanie Lanzinger
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Epidemiology and Medical Biometry, Zentralinstitut für Biomedizinische Technik (ZIBMT), University of Ulm, Ulm, Germany
| | - Joachim Rosenbauer
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - Wolfram Karges
- Division of Endocrinology and Diabetes, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Aachen, Germany
| | - Karsten Müssig
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- Department of Internal Medicine/Gastroenterology, Franziskus-Hospital Harderberg, Georgsmarienhütte, Germany
| | - Sebastian M. Meyhöfer
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Endocrinology and Diabetes, University of Lübeck, Rosenheim, Lübeck, Germany
| | - Volker Burkart
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | | | - Dirk Raddatz
- Division of Gastroenterology and Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Julia Szendroedi
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Internal Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
- *Correspondence: Julia Szendroedi,
| | - Reinhard W. Holl
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Epidemiology and Medical Biometry, Zentralinstitut für Biomedizinische Technik (ZIBMT), University of Ulm, Ulm, Germany
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Tittel SR, Laubner K, Schmid SM, Kress S, Merger S, Karges W, Wosch FJ, Altmeier M, Pavel M, Holl RW. Immune-checkpoint inhibitor-associated diabetes compared to other diabetes types - A prospective, matched control study. J Diabetes 2021; 13:1007-1014. [PMID: 34275207 DOI: 10.1111/1753-0407.13215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/15/2021] [Revised: 06/15/2021] [Accepted: 07/14/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To describe checkpoint inhibitor-induced diabetes mellitus (CPI-DM) and to compare with regular type 1 (T1DM), type 2 (T2DM), and medication-induced diabetes mellitus (MI-DM). METHODS We included 88 177 adult patients from the Diabetes Patient Follow-Up (DPV) registry with diabetes manifestation between 2011 and 2020. Inclusion criteria were T1DM, T2DM, MI-DM, or CPI-DM. Because of the heterogeneity between the groups, we matched patients by age, sex, and diabetes duration using propensity scores. Patient data were aggregated in the respective first documented treatment year. RESULTS The matched cohort consisted of 24 164 patients; T1DM: 29, T2DM: 24000, MI-DM: 120, CPI-DM: 15 patients. Median age at manifestation of CPI-DM patients was 63.6 (57.2-72.8) years (53.3% male). Body mass index in CPI-DM patients was significantly lower (26.8 [23.9-28.1] kg/m2 ) compared with T2DM patients (29.8 [26.2-34.3] kg/m2 , P = 0.02). At manifestation, HbA1c was significantly higher in CPI-DM compared with MI-DM, but there was no difference during follow-up. Diabetic ketoacidosis (DKA) was documented in six CPI-DM patients (T1DM: 0%, T2DM: 0.4%, MI-DM: 0.0%). Fourteen CPI-DM patients were treated with insulin, and three received additional oral antidiabetics. The most common therapy in T2DM was lifestyle modification (38.8%), insulin in MI-DM (52.5%). Concomitant autoimmune thyroid disease was present in four CPI-DM patients (T1DM: 0.0%, T2DM: 1.0%, MI-DM: 0.8%). CONCLUSIONS The data from this controlled study show that CPI-DM is characterized by a high prevalence of DKA, autoimmune comorbidity, and metabolic decompensation at onset. Structured diagnostic monitoring is warranted to prevent DKA and other acute endocrine complications in CPI-treated patients.
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Affiliation(s)
- Sascha R Tittel
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Katharina Laubner
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Sebastian M Schmid
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute for Endocrinology and Diabetes, University of Luebeck, Luebeck, Germany
| | - Stefan Kress
- Medical Clinic I, Vinzentius-Krankenhaus, Landau, Germany
| | - Sigrun Merger
- Medical Clinic IV, Clinic for Endocrinology, Diabetology, Metabolism, and Nutrition Medicine, Clinic Coburg, Coburg, Germany
| | - Wolfram Karges
- Division of Endocrinology and Diabetes, RWTH Aachen University, Aachen, Germany
| | | | | | - Marianne Pavel
- Department of Medicine, Division of Endocrinology and Diabetology, Universitätsklinikum Erlangen, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Reinhard W Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
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Prinz N, Tittel SR, Bachran R, Birnbacher R, Brückel J, Dunstheimer D, Haberland H, Hess M, Karges W, Oeverink R, Veigel A, Holl RW. Characteristics of Patients with Type 1 Diabetes and Additional Autoimmune Disease in the DPV Registry. J Clin Endocrinol Metab 2021; 106:e3381-e3389. [PMID: 34061946 DOI: 10.1210/clinem/dgab376] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/19/2021] [Indexed: 12/20/2022]
Abstract
CONTEXT Autoimmune diseases affect ~8% of the population. Type 1 diabetes mellitus (T1DM) is linked to other autoimmune diseases (AIDs), such as autoimmune thyroid disease or Addison's disease (AD), that may impact diabetes therapy and outcome. OBJECTIVE To analyze demographic and clinical characteristics of other AIDs in T1DM from a large standardized registry, the Prospective Diabetes Follow-up Registry (DPV). METHODS We searched the registry for T1DM with the additional diagnosis of Hashimoto's thyroiditis (HT), Graves' disease (GD), and/or AD. T1DM with other AIDs (n = 6166, 5.4%) were compared with isolated T1DM (n = 107 457). For group comparisons, we used multivariable regression models with age, sex, diabetes duration, migration background, and type of insulin regimen as basic adjustments (microvascular endpoints: additionally adjusted for glycated hemoglobin). RESULTS Patients with additional AIDs were more often female (54.7 vs 32.0%, P < .001) and had a longer diabetes duration (7.9 [4.2-12.5] vs 6.7 [2.7-12.9] years, P < .001). After adjustment, daily insulin dosage was higher in AD and HT than in isolated T1DM (0.858 ± 0.032 and 0.813 ± 0.005 vs 0.793 ± 0.001 IU/kg per day). Retinopathy was less common in HT (1.5%), whereas it was more frequent in GD (3.1%) than in isolated T1DM (1.8%). In both GD and HT, microalbuminuria occurred less often (10.6% and 14.3% vs 15.5%) and neuropathy (2.1% and 1.8% vs 0.8%) was more common than in isolated T1DM. All P < .05. CONCLUSION T1DM with additional AIDs show heterogeneous differences compared with isolated T1DM. T1DM plus AD or HT requires more insulin. Further, the rate of neuropathy is higher in HT or GD, whereas the rate of microalbuminuria is lower.
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Affiliation(s)
- Nicole Prinz
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, Ulm University, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Sascha R Tittel
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, Ulm University, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | | | | | - Joachim Brückel
- Department of Internal Medicine, Westallgäu-Klinikum, Wangen, Germany
| | - Désirée Dunstheimer
- Paediatrics and Adolescent Medicine, University Hospital of Augsburg, Augsburg, Germany
| | - Holger Haberland
- Children's Hospital, Sana Klinikum Lichtenberg, Berlin, Berlin, Germany
| | - Melanie Hess
- Department of Pediatric Endocrinology and Diabetology, Children's Hospital, University of Basel, Basel, Switzerland
| | - Wolfram Karges
- Clinic for Gastroenterology, Metabolic Disorders and Internal Intensive Medicine (Medical Clinic III), Department of Endocrinology and Diabetology, University Hospital Aachen, Aachen, Germany
| | - Rudolf Oeverink
- Department of Pediatric Endocrinology and Diabetology, MVZ Medicover, Oldenburg, Germany
| | | | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, Ulm University, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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Auzanneau M, Fritsche A, Icks A, Siegel E, Kilian R, Karges W, Lanzinger S, Holl RW. Diabetes in the Hospital. Dtsch Arztebl Int 2021; 118:407-412. [PMID: 34369369 DOI: 10.3238/arztebl.m2021.0151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/14/2020] [Accepted: 02/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Comprehensive data on the frequency of diabetes mellitus among hospitalized patients in Germany have not been published to date. METHODS Among all inpatient cases aged ≥20 years that were documented in the German DRG statistics for 2015-2017, we analyzed the frequencies of five types of diabetes (type 1, type 2, other/pancreatic diabetes, "rare diabetes" with an ICD code of E12 or E14, gestational diabetes) and of prediabetes, stratified by sex and age group. The presence of any of these conditions was ascertained from the corresponding ICD-10 code among the main diagnoses (reasons for admission) or secondary diagnoses. We also compared the length of hospital stay, in-hospital mortality, and the frequency of various categories of main diagnosis in cases with and without diabetes in each age group. RESULTS In the period 2015-2017, approximately 18% of the 16.4 to 16.7 million inpatient cases carried a main or secondary diagnosis of diabetes (in 2017: type 2, 17.1%; type 1, 0.5%). Diabetes was more common in male cases than in female cases (in 2017: type 2, 19.7% vs. 14.8%; type 1, 0.5% vs. 0.4%). In 2017, the greatest difference in length of hospital stay between patients with and without diabetes was for patients with type 1 diabetes aged 40-49 (7.3 vs. 4.5 days), while the greatest difference in in-hospital mortality was for patients with type 2 diabetes aged 70-79 (3.7% vs. 2.8%). From the age of 30 (age category 30-39), diseases of the cardiovascular system, and from the age of 50 (age category 50-59), diseases of the respiratory or urogenital systems were more frequently listed as a reason for admission in cases with than in those without diabetes. CONCLUSION The fact that diabetes is twice as prevalent in hospitalized cases as in the general population underscores the high morbidity associated with the disease and the greater need of persons with diabetes for in-hospital care, as the population of multimorbid diabetes patients continues to grow older.
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Affiliation(s)
- Marie Auzanneau
- Institute of Epidemiology and Medical Biometry, ZIBMT, Medical Faculty of the University Ulm, Ulm, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany; Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Zentrum München at the University of Tübingen, Tübingen, Germany; Institute of Health Services Research and Health Economics, Center for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute of Health Services Research and Health Economics, German Diabetes Center (DDZ), Düsseldorf, Germany; Department of Gastroenterology, Diabetology, Endocrinology, and Nutritional Medicine, St. Josefskrankenhaus Heidelberg, Heidelberg, Germany; Department of Psychiatry and Psychotherapy II, University Hospital Ulm, Um, Germany; Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, Aachen, Germany
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9
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Siegel S, Unger N, Streetz-van der Werf C, Karges W, Schilbach K, Schröder B, Szybowicz J, Sauerwald J, Zopf K, Grzywotz A, Bidlingmaier M, Kirstein C, Sommer H, Strasburger CJ, Kreitschmann-Andermahr I. Adults' Adherence to Growth Hormone Replacement in Relation to Medication-Related Beliefs, Coping and Quality of Life - An Exploratory Analysis. Front Endocrinol (Lausanne) 2021; 12:680964. [PMID: 34108940 PMCID: PMC8181747 DOI: 10.3389/fendo.2021.680964] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/23/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Little is known about psychological reasons associated with adherence to growth hormone (GH) replacement therapy (GHRx) in adults. As in other chronic diseases, medication-related beliefs, coping strategies and disease impact on quality of life (QoL) might play an important role. We thus explored these psychological factors in relation to adherence in patients with GH deficiency (GHD) in order to find leverage points for the improvement of adherence. PATIENTS AND METHODS Cross-sectional analysis including 107 adult GHD patients on GHRx who completed self-assessment inventories on health-related QoL (Short-Form SF-36), coping style (Freiburg questionnaire on coping with illness, FKV-LIS) and medication beliefs (Beliefs about Medicine questionnaire, BMQ). Results were correlated to general and GH-specific adherence to medication. RESULTS In the BMQ, 92.5% of the patients (n=99) reported a strong belief in the need for their medication, which correlated significantly with general adherence (rs = 0.325). Active coping was significantly related to general (rs = 0.307) and GH-specific adherence (rs = 0.226). Better mental QoL (rs = 0.210) but worse physical QoL (rs = -0.198; all p < 0.05) were related to higher GH-specific adherence. Older age was associated with a higher degree of active coping, a higher belief in the necessity of medication and worse physical QoL. CONCLUSION We provide preliminary data that most GHD patients on GHRx are strongly convinced of their need for medication and that adherence to GHRx is influenced by coping strategies and QoL. Patients with impaired psychological QoL are less able to translate their convictions into good adherence, a phenomenon to be addressed in future research.
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Affiliation(s)
- Sonja Siegel
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Essen, Germany
| | - Nicole Unger
- Department of Endocrinology, Diabetology and Metabolism, University of Duisburg-Essen, Essen, Germany
| | - Christine Streetz-van der Werf
- Division of Endocrinology and Diabetes, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Hospital, Aachen, Germany
| | - Wolfram Karges
- Division of Endocrinology and Diabetes, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Hospital, Aachen, Germany
| | - Katharina Schilbach
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität (LMU) Klinikum, Munich, Germany
| | - Bernadette Schröder
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Essen, Germany
| | - Janine Szybowicz
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Essen, Germany
| | - Janina Sauerwald
- Department of Endocrinology, Diabetes and Nutritional Medicine, Charité Universitaetsmedizin, Berlin, Germany
| | - Kathrin Zopf
- Department of Endocrinology, Diabetes and Nutritional Medicine, Charité Universitaetsmedizin, Berlin, Germany
| | - Agnieszka Grzywotz
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Essen, Germany
| | - Martin Bidlingmaier
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität (LMU) Klinikum, Munich, Germany
| | - Cedric Kirstein
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Essen, Germany
| | | | - Christian J. Strasburger
- Department of Endocrinology, Diabetes and Nutritional Medicine, Charité Universitaetsmedizin, Berlin, Germany
| | - Ilonka Kreitschmann-Andermahr
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Essen, Germany
- *Correspondence: Ilonka Kreitschmann-Andermahr,
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10
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Kreitschmann-Andermahr I, Siegel S, Unger N, Streetz-van der Werf C, Karges W, Schilbach K, Schröder B, Szybowicz J, Sauerwald J, Zopf K, Grzywotz A, Bidlingmaier M, Sommer H, Strasburger CJ. Motivation for and adherence to growth hormone replacement therapy in adults with hypopituitarism: the patients' perspective. Pituitary 2020; 23:479-487. [PMID: 32441023 PMCID: PMC7426293 DOI: 10.1007/s11102-020-01046-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Indexed: 01/21/2023]
Abstract
INTRODUCTION While reasons for non-adherence in children requiring growth hormone (GH) replacement (GH-Rx) are well researched, few studies have investigated adherence in adult GH deficient patients. Against the background of the adverse medical sequelae of untreated severe GH deficiency (GHD) in adults, we explored adherence to GH-Rx and associated factors in this patient group. METHOD Cross-sectional analysis including 107 adult patients with severe GHD on GH-Rx, 15 untreated GDH patients and 19 who had discontinued therapy. Patients completed self-developed ad hoc surveys on adherence to medication and GH-Rx, specific beliefs about GH-Rx, side effects and burden of injection, reasons for never receiving or dropping out of therapy, respectively. RESULTS Adherence to GH-Rx was high (mean 15.8/18 points on the self-developed adherence score) and significantly correlated with general medication adherence. Higher age was significantly associated with better adherence to GH-Rx, while injection side effects, duration of treatment or device used were not. The most frequent reasons for not being on GH-Rx apart from medical reasons included fear of side effects, lack of belief in treatment effects and dislike of injections. In patients not on GH-Rx, the proportion of patients in employment was significantly smaller than in the treatment group, despite similar age and comorbidities. CONCLUSIONS Adherence to GH-Rx was high for those patients on therapy. Instead of focusing on improving adherence in those adults already on GH-Rx, efforts should be undertaken to ally fear of side effects and provide education on positive treatment effects for those eligible but not receiving therapy.
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Affiliation(s)
- Ilonka Kreitschmann-Andermahr
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Sonja Siegel
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Nicole Unger
- Department of Endocrinology, Diabetology and Metabolism, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | | | - Wolfram Karges
- Division of Endocrinology and Diabetology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Katharina Schilbach
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Bernadette Schröder
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Janine Szybowicz
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | | | - Kathrin Zopf
- Hexal AG, Industriestrasse 25, 83607, Holzkirchen, Germany
| | - Agnieszka Grzywotz
- Department of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Martin Bidlingmaier
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Heide Sommer
- Hexal AG, Industriestrasse 25, 83607, Holzkirchen, Germany
| | - Christian J Strasburger
- Department of Endocrinology, Diabetes and Nutritional Medicine, Campus Charité Mitte, Charité Universitaetsmedizin, Charitéplatz 1, 10117, Berlin, Germany
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11
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Shah VN, Grimsmann JM, Foster NC, Dost A, Miller KM, Pavel M, Weinstock RS, Karges W, Maahs DM, Holl RW. Undertreatment of cardiovascular risk factors in the type 1 diabetes exchange clinic network (United States) and the prospective diabetes follow-up (Germany/Austria) registries. Diabetes Obes Metab 2020; 22:1577-1585. [PMID: 32329127 DOI: 10.1111/dom.14069] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 12/15/2022]
Abstract
AIM To examine the control of cardiovascular risk factors in type 1 diabetes (T1D) registries from the United States and Germany/Austria. MATERIALS AND METHODS Data on individuals aged ≥12 years with T1D for ≥1 year, from the T1D Exchange Clinic Network (T1DX, United States) and the Prospective Diabetes Follow-up Registry (DPV, Germany/Austria) from 1 January 2016 to 31 March 2018 were analysed. Linear and logistic regression models adjusted for age groups, sex, duration of diabetes and minority status were used to compare clinical characteristics and achievement of diabetes management targets between registries. RESULTS The cohort consisted of 47 936 patients (T1DX, n = 19 442; DPV, n = 28 494). Achievement of HbA1c goals (<7.0%, ages 18-65 years; all others, <7.5%) was better in the DPV for those aged <65 years (all P < .001). However, more older adults (aged ≥65 years) in the T1DX achieved an HbA1c goal of <7.5% compared with DPV (70% vs. 50%, P < .001). The frequency of patients with overweight (53% vs. 51%, P < .001) and obesity (19% vs. 9%, P < .001) was higher in T1DX. The frequency of meeting blood pressure goals (84% vs. 66%, P < .001) and lipid goals (73% vs. 62%, P < .001) was higher in T1DX; this was observed across all age groups (all P < .001). Few young adults aged <26 years received antihypertensive and lipid-lowering medications, respectively, despite indications in both registries (T1DX: 5% and 3%, DPV: 3% and 1%). CONCLUSION A minority of patients with T1D achieve glycaemic targets and the majority are inadequately treated for hypertension and dyslipidaemia. This highlights the need for improved diabetes and cardiovascular risk management strategies in T1D.
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Affiliation(s)
- Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Julia M Grimsmann
- Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | | | - Axel Dost
- Department of Pediatrics, University Hospital Jena, Jena, Germany
| | | | - Marianne Pavel
- Department of Internal Medicine, University of Erlangen, Erlangen, Germany
| | - Ruth S Weinstock
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, SUNY Upstate Medical University, Syracuse, New York
| | - Wolfram Karges
- Department of Internal Medicine, University of Aachen, Aachen, Germany
| | - David M Maahs
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
- Stanford Diabetes Research Center, Stanford University, Stanford, California
| | - Reinhard W Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
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Lanzinger S, Karges W, Merger S, Laimer M, Lück U, Wagner C, Milek K, Holl RW. Comparing diabetes due to diseases of the exocrine pancreas to type 1 and type 2 diabetes using propensity score matching. Pancreatology 2020; 20:860-866. [PMID: 32620406 DOI: 10.1016/j.pan.2020.05.023] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/17/2020] [Accepted: 05/12/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To estimate the prevalence of diabetes due to diseases of the exocrine pancreas (DEP) using data of the multicentre diabetes patient follow-up registry. Moreover, we aimed at comparing individuals with diabetes due to DEP to individuals with type 1 and type 2 diabetes. METHODS Individuals with DEP, type 1 or type 2 diabetes ≥18 years of age were studied. We aggregated the most recent treatment year per patient and used propensity scores to match diabetes due to DEP to type 1 and type 2 diabetes. Matching was conducted one-to-one with sex, age, diabetes duration, migration background and the German index of socioeconomic deprivation as covariates. RESULTS We identified 7,093 (1.6%) individuals with diabetes due to DEP. In the matched cohort DEP-type 1 diabetes we observed a similar daily insulin dose (0.62 IU/kg (95% confidence interval:0.60-0.63), 0.60 IU/kg (0.58-0.62)) and significant differences regarding microvascular (41.0% (39.7-42.2), 45.3% (44.0-46.6)), and macrovascular disease (16.6% (15.7-17.6), 14.7% (13.8-15.6)). HbA1c (8.2% (8.1-8.3), 7.9% (7.8-8.0)), daily insulin dose (0.60 IU/kg (0.58-0.62), 0.56 IU/kg (0.54-0.58)) and event rates of severe hypoglycemia (23.9 events/100 PY (21.4-26.8), (9.5 events/100 PY (8.0-11.2)) were significantly higher in individuals with diabetes due to DEP compared to type 2 diabetes. CONCLUSIONS Using registry data, rare diabetes types such as diabetes due to DEP can be studied with a significant sample size. Our study identified differences and similarities between adult individuals with DEP related diabetes and type 1 or type 2 diabetes.
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Affiliation(s)
- Stefanie Lanzinger
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
| | - Wolfram Karges
- Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Aachen, Germany
| | - Sigrun Merger
- Medical Clinic IV, Clinic for Endocrinology, Diabetology, Metabolism, and Nutrition Medicine, Clinic Coburg, Coburg, Germany
| | - Markus Laimer
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Bern, Switzerland
| | - Ursula Lück
- Department for Children and Adolescent Medicine, State Hospital Baden-Mödling, Austria
| | | | | | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany
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Hermann JM, Miller KM, Hofer SE, Clements MA, Karges W, Foster NC, Fröhlich-Reiterer E, Rickels MR, Rosenbauer J, DeSalvo DJ, Holl RW, Maahs DM. The Transatlantic HbA 1c gap: differences in glycaemic control across the lifespan between people included in the US T1D Exchange Registry and those included in the German/Austrian DPV registry. Diabet Med 2020; 37:848-855. [PMID: 31557351 DOI: 10.1111/dme.14148] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2019] [Indexed: 01/09/2023]
Abstract
AIM To compare HbA1c levels across the lifespan in people with type 1 diabetes in the USA with those in Germany/Austria, and to examine potential differences in HbA1c levels between sexes, insulin delivery methods and minority status. METHODS Data were extracted from the US T1D Exchange Registry (n=18 381 participants from 73 sites) and from the German/Austrian Prospective Diabetes Follow-up Registry, the DPV (n=32 643 participants from 362 sites). Mean HbA1c was calculated for each year of age for individuals aged ≤25 years, and at 2-year age intervals for individuals aged >25 years. Curves for mean HbA1c by age were estimated using locally weighted scatterplot smoothing. HbA1c differences between registries, sexes, insulin delivery methods, and minority status were assessed by age group using multiple linear regression. RESULTS In both registries, mean HbA1c increased by ~11 mmol/mol (1.0%) between the ages of 9 and 18 years, although at quite different absolute levels: from 66 mmol/mol (8.2%) to 77 mmol/mol (9.2%) in the T1D Exchange Registry, and from 56 mmol/mol (7.3%) to 66 mmol/mol (8.2%) in the DPV. Sex differences were observed in the DPV only. In the T1D Exchange Registry, injection users had higher mean HbA1c than pump users across the lifespan, whereas in the DPV higher HbA1c levels in injection users were observed in the age groups 6 to <12 years, 12 to <18 years, and 30 to <50 years (P < 0.001). Minority status was significantly associated with higher HbA1c in most age groups in both registries. CONCLUSIONS Significant differences in HbA1c were noted between the USA and Germany/Austria, with disparities more pronounced in early childhood through to young adulthood. Further studies should identify causes for these disparities.
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Affiliation(s)
- J M Hermann
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
- German Centre for Diabetes Research, Munich-Neuherberg, Germany
| | - K M Miller
- Jaeb Centre for Health Research, Tampa, FL, USA
| | - S E Hofer
- Department of Paediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | | | - W Karges
- Division of Endocrinology and Diabetes, RWTH Aachen University, Aachen, Germany
| | - N C Foster
- Jaeb Centre for Health Research, Tampa, FL, USA
| | | | - M R Rickels
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - J Rosenbauer
- German Centre for Diabetes Research, Munich-Neuherberg, Germany
- German Diabetes Centre, Institute for Biometrics and Epidemiology, Leibniz Centre for Diabetes Research at Düsseldorf University, Düsseldorf, Germany
| | - D J DeSalvo
- Baylor College of Medicine, Houston, TX, USA
| | - R W Holl
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
- German Centre for Diabetes Research, Munich-Neuherberg, Germany
| | - D M Maahs
- Stanford University, Palo Alto, CA, USA
- Stanford Diabetes Research Centre, Stanford, CA, USA
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Johannsson G, Gordon MB, Højby Rasmussen M, Håkonsson IH, Karges W, Sværke C, Tahara S, Takano K, Biller BMK. Once-weekly Somapacitan is Effective and Well Tolerated in Adults with GH Deficiency: A Randomized Phase 3 Trial. J Clin Endocrinol Metab 2020; 105:5727871. [PMID: 32022863 PMCID: PMC7076631 DOI: 10.1210/clinem/dgaa049] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 02/04/2020] [Indexed: 01/09/2023]
Abstract
CONTEXT Growth hormone (GH) replacement requires daily GH injections, which is burdensome for some adult patients with GH deficiency (AGHD). OBJECTIVE To demonstrate efficacy and safety of somapacitan, a once-weekly reversible albumin-binding GH derivative, versus placebo in AGHD. DESIGN Randomized, parallel-group, placebo-controlled (double-blind) and active-controlled (open-label) phase 3 trial, REAL 1 (NCT02229851). SETTING Clinics in 17 countries. PATIENTS Treatment-naïve patients with AGHD (n = 301 main study period, 272 extension period); 257 patients completed the trial. INTERVENTIONS Patients were randomized 2:2:1 to once-weekly somapacitan, daily GH, or once-weekly placebo for 34 weeks (main period). During the 52-week extension period, patients continued treatment with somapacitan or daily GH. MAIN OUTCOME MEASURES Body composition measured using dual-energy x-ray absorptiometry (DXA). The primary endpoint was change in truncal fat percentage to week 34. Insulin-like growth factor 1 (IGF-I) standard deviation score (SDS) values were used to dose titrate. RESULTS At 34 weeks, somapacitan significantly reduced truncal fat percentage (estimated difference: -1.53% [-2.68; -0.38]; P = 0.0090), demonstrating superiority compared with placebo, and it improved other body composition parameters (including visceral fat and lean body mass) and IGF-I SDS. At 86 weeks, improvements were maintained with both somapacitan and daily GH. Somapacitan was well tolerated, with similar adverse events (including injection-site reactions) compared with daily GH. CONCLUSIONS In AGHD patients, somapacitan administered once weekly demonstrated superiority over placebo, and the overall treatment effects and safety of somapacitan were in accordance with known effects and safety of GH replacement for up to 86 weeks of treatment. Somapacitan may provide an effective alternative to daily GH in AGHD. A short visual summary of our work is available (1).
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Affiliation(s)
| | | | - Michael Højby Rasmussen
- Novo Nordisk A/S, Søborg, Denmark
- Correspondence and Reprint Requests: Michael Højby Rasmussen, MD, PhD, MSc, Novo Nordisk A/S, Vandtårnsvej 110–112, DK 2860 Søborg, Denmark. E-mail:
| | | | - Wolfram Karges
- Division of Endocrinology and Diabetes, RWTH Aachen University, Aachen, Germany
| | | | | | - Koji Takano
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University, Tokyo, Japan
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Hackert VH, Hoebe CJPA, Dukers-Muijrers N, Krafft T, Kauhl B, Henning K, Karges W, Sprague L, Neubauer H, Al Dahouk S. Q fever: Evidence of a massive yet undetected cross-border outbreak, with ongoing risk of extra mortality, in a Dutch-German border region. Transbound Emerg Dis 2020; 67:1660-1670. [PMID: 32027783 PMCID: PMC7383856 DOI: 10.1111/tbed.13505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 01/20/2020] [Accepted: 01/31/2020] [Indexed: 12/11/2022]
Abstract
Background Following outbreaks in other parts of the Netherlands, the Dutch border region of South Limburg experienced a large‐scale outbreak of human Q fever related to a single dairy goat farm in 2009, with surprisingly few cases reported from neighbouring German counties. Late chronic Q fever, with recent spikes of newly detected cases, is an ongoing public health concern in the Netherlands. We aimed to assess the scope and scale of any undetected cross‐border transmission to neighbouring German counties, where individuals unknowingly exposed may carry extra risk of overlooked diagnosis. Methods (A) Seroprevalence rates in the Dutch area were estimated fitting an exponential gradient to the geographical distribution of notified acute human Q fever cases, using seroprevalence in a sample of farm township inhabitants as baseline. (B) Seroprevalence rates in 122 neighbouring German postcode areas were estimated from a sample of blood donors living in these areas and attending the regional blood donation centre in January/February 2010 (n = 3,460). (C) Using multivariate linear regression, including goat and sheep densities, veterinary Q fever notifications and blood donor sampling densities as covariates, we assessed whether seroprevalence rates across the entire border region were associated with distance from the farm. Results (A) Seroprevalence in the outbreak farm's township was 16.1%. Overall seroprevalence in the Dutch area was 3.6%. (B) Overall seroprevalence in the German area was 0.9%. Estimated mean seroprevalence rates (per 100,000 population) declined with increasing distance from the outbreak farm (0–19 km = 2,302, 20–39 km = 1,122, 40–59 km = 432 and ≥60 km = 0). Decline was linear in multivariate regression using log‐transformed seroprevalence rates (0–19 km = 2.9 [95% confidence interval (CI) = 2.6 to 3.2], 20 to 39 km = 1.9 [95% CI = 1.0 to 2.8], 40–59 km = 0.6 [95% CI = −0.2 to 1.3] and ≥60 km = 0.0 [95% CI = −0.3 to 0.3]). Conclusions Our findings were suggestive of widespread cross‐border transmission, with thousands of undetected infections, arguing for intensified cross‐border collaboration and surveillance and screening of individuals susceptible to chronic Q fever in the affected area.
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Affiliation(s)
- Volker H Hackert
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, The Netherlands.,Department of Social Medicine and Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University/MUMC+, Maastricht, The Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, The Netherlands.,Department of Social Medicine and Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University/MUMC+, Maastricht, The Netherlands
| | - Nicole Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, The Netherlands.,Department of Social Medicine and Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University/MUMC+, Maastricht, The Netherlands
| | - Thomas Krafft
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Boris Kauhl
- Department III, Civil Engineering and Geoinformatics, Beuth University of Applied Sciences, Berlin, Germany
| | - Klaus Henning
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut (FLI), Federal Research Institute for Animal Health, Jena, Germany
| | - Wolfram Karges
- Department of Internal Medicine III, RWTH Aachen University Hospital, Aachen, Germany
| | - Lisa Sprague
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut (FLI), Federal Research Institute for Animal Health, Jena, Germany
| | - Heinrich Neubauer
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut (FLI), Federal Research Institute for Animal Health, Jena, Germany
| | - Sascha Al Dahouk
- Department of Internal Medicine III, RWTH Aachen University Hospital, Aachen, Germany.,Department of Biological Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany
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16
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Musholt TJ, Bockisch A, Clerici T, Dotzenrath C, Dralle H, Goretzki PE, Hermann M, Holzer K, Karges W, Krude H, Kussmann J, Lorenz K, Luster M, Niederle B, Nies C, Riss P, Schabram J, Schabram P, Schmid KW, Simon D, Spitzweg C, Steinmüller T, Trupka A, Vorländer C, Weber T, Bartsch DK. [Update of the S2k guidelines : Surgical treatment of benign thyroid diseases]. Chirurg 2019; 89:699-709. [PMID: 29876616 DOI: 10.1007/s00104-018-0653-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 12/31/2022]
Abstract
Thyroid resections represent one of the most common operations with 76,140 interventions in the year 2016 in Germany (source Destatis). These are predominantly benign thyroid gland diseases. Recommendations for the operative treatment of benign thyroid diseases were last published by the CAEK in 2010 as S2k guidelines (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V. [AWMF] 003/002) against the background of increasingly more radical resection procedures. Hemithyroidectomy and thyroidectomy are routinely performed for benign thyroid disease in practice. The operation-specific risks show a clear increase with the extent of the resection. Therefore, weighing-up of the risk-indications ratio between unilateral lobectomy or thyroidectomy necessitates an independent evaluation of the indications for both sides. This principle in particular has been used to update the guidelines. In addition, the previously published recommendations of the CAEK for correct execution and consequences of intraoperative neuromonitoring were included into the guidelines, which in particular serve the aim to avoid bilateral recurrent laryngeal nerve paralysis. Moreover, the recommendations for the treatment of postoperative complications, such as hypoparathyroidism and postoperative infections were revised. The updated guidelines therefore represent the current state of the science as well as the resulting surgical practice.
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Affiliation(s)
- T J Musholt
- Sektion Endokrine Chirurgie der Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg Universität Mainz, Langenbeckstr. 1, 55101, Mainz, Deutschland.
| | - A Bockisch
- Klinik für Nuklearmedizin, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - T Clerici
- Klinik für Chirurgie, Kantonsspital St. Gallen, 9007, St. Gallen, Schweiz
| | - C Dotzenrath
- Klinik für endokrine Chirurgie, Helios Universitätsklinikum Wuppertal, Heusnerstr. 40, 42283, Wuppertal, Deutschland
| | - H Dralle
- Sektion Endokrine Chirurgie, Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - P E Goretzki
- Chirurgische Klinik, Campus Charite Mitte/Campus Virchow Klinikum, Endokrine Chirurgie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - M Hermann
- 2. Chirurgische Abteilung, Krankenanstalt Rudolfstiftung, Märzstr. 80, 1150, Wien, Österreich
| | - K Holzer
- Sektion Endokrine Chirurgie der Viszeral‑, Thorax- u. Gefäßchirurgie, Universitätsklinikum Marburg, Baldingerstr., 35043, Marburg, Deutschland
| | - W Karges
- Sektion Endokrinologie und Diabetologie - Medizinische Klinik III, Universitätsklinikum Aachen, RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - H Krude
- Klinik für Pädiatrie mit Schwerpunkt Endokrinologie und Diabetologie, Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - J Kussmann
- Klinik für Endokrine Chirurgie, Schön Klinik Hamburg-Eilbeck, Dehnhaide 120, 22081, Hamburg, Deutschland
| | - K Lorenz
- Klinik u. Poliklinik f. Allgem.-, Viszeral- u. Gefäßchirurgie, Universitätsklinikum Halle, Ernst-Grube-Str. 40, 06120, Halle, Deutschland
| | - M Luster
- Nuklearmedizin, Universitätsklinikum Gießen und Marburg, GmbH, Standort Marburg, Baldingerstrass, 35041, Marburg, Deutschland
| | - B Niederle
- Sektion Endokrine Chirurgie, Franziskus Spital, Nikolsdorfergasse 32, 1050, Wien, Österreich
| | - C Nies
- Klinik für Allg.- u. Viszeralchirurgie, Marienhospital Osnabrück, Bischofsstr. 1, 49074, Osnabrück, Deutschland
| | - P Riss
- Chirurgische Universitätsklinik, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - J Schabram
- Klinik für Endokrine Chirurgie, Asklepios Klinik Lich, Goethestr. 4, 35423, Lich, Deutschland
| | - P Schabram
- Anwaltskanzlei Ratajczak & Partner, Heinrich-von-Stephan-Str. 25, 79100, Freiburg im Breisgau, Deutschland
| | - K W Schmid
- Pathologie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - D Simon
- Klinik f. Allg.- u. Viszeralchirurgie, Ev. Bethesda Krankenhaus Duisburg GmbH, Heerstr. 219, 47053, Duisburg, Deutschland
| | - Ch Spitzweg
- Medizinische Klinik und Poliklinik II, LMU Klinikum der Universität München - Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - Th Steinmüller
- Chirurgische Abteilung, Zentrum f. Allg.- u. Viszeralchirurgie, DRK-Kliniken Westend, Spandauer Damm 130, 14050, Berlin, Deutschland
| | - A Trupka
- Chirurgische Klinik, Klinikum Starnberg GmbH, Oßwaldstr. 1, 82319, Starnberg, Deutschland
| | - C Vorländer
- Endokrine Chirurgie, Bürgerhospital Frankfurt am Main, Nibelungenallee 37-41, 60318, Frankfurt am Main, Deutschland
| | - T Weber
- Klinik für Endokrine Chirurgie, Katholisches Klinikum Mainz, An der Goldgrube 11, 55131, Mainz, Deutschland
| | - D K Bartsch
- Klinik für Visceral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen und Marburg, GmbH, Standort Marburg, Baldingerstrass, 35041, Marburg, Deutschland
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17
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Kalscheuer H, Seufert J, Lanzinger S, Rosenbauer J, Karges W, Bergis D, Mader JK, Zimny S, Schmid SM, Hummel M, Kerner W, Holl RW. Event Rates and Risk Factors for the Development of Diabetic Ketoacidosis in Adult Patients With Type 1 Diabetes: Analysis From the DPV Registry Based on 46,966 Patients. Diabetes Care 2019; 42:e34-e36. [PMID: 30655381 DOI: 10.2337/dc18-1160] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 12/09/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Hannes Kalscheuer
- Department of Endocrinology, Diabetes and Metabolism, University of Lübeck, Lübeck, Germany
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefanie Lanzinger
- Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Joachim Rosenbauer
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - Wolfram Karges
- Section of Endocrinology and Diabetology, RWTH Aachen University, Aachen, Germany
| | - Dominik Bergis
- Department of Internal Medicine 1, Goethe University Hospital, Frankfurt, Germany
| | - Julia K Mader
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Stefan Zimny
- Department of General Internal Medicine, Endocrinology and Diabetology, Helios Clinic Schwerin, Schwerin, Germany
| | - Sebastian M Schmid
- Department of Endocrinology, Diabetes and Metabolism, University of Lübeck, Lübeck, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
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18
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Kruppa JA, Gossen A, Oberwelland Weiß E, Kohls G, Großheinrich N, Cholemkery H, Freitag CM, Karges W, Wölfle E, Sinzig J, Fink GR, Herpertz-Dahlmann B, Konrad K, Schulte-Rüther M. Neural modulation of social reinforcement learning by intranasal oxytocin in male adults with high-functioning autism spectrum disorder: a randomized trial. Neuropsychopharmacology 2019; 44:749-756. [PMID: 30390065 PMCID: PMC6372686 DOI: 10.1038/s41386-018-0258-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/06/2018] [Accepted: 10/15/2018] [Indexed: 01/05/2023]
Abstract
Reduced social motivation is a hallmark of individuals with autism spectrum disorders (ASDs). Although the exact neural mechanisms are unclear, oxytocin has been shown to enhance motivation and attention to social stimuli, suggesting a potential to augment social reinforcement learning as the central mechanism of behavioral interventions in ASD. We tested how reinforcement learning in social contexts and associated reward prediction error (RPE) signals in the nucleus accumbens (NAcc) were modulated by intranasal oxytocin. Male adults with a childhood diagnosis of ASD (n = 15) and healthy controls (n = 24; aged 18-26 years) performed a probabilistic reinforcement learning task during functional magnetic resonance imaging in a single-center (research center in Germany), randomized double-blind, placebo-controlled cross-over trial. The interventions were intranasal oxytocin (Syntocinon®, Novartis; 10 puffs = 20 international units (IUs) per treatment) and placebo spray. Using computational modeling of behavioral data, trial-by-trial RPE signals were assessed and related to brain activation in NAcc during reinforcing feedback in social and non-social contexts. The order of oxytocin/placebo was randomized for 60 participants. Twenty-one participants were excluded from analyses, leaving 39 for the final analysis. Behaviorally, individuals with ASD showed enhanced learning under oxytocin when the learning target as well as feedback was social as compared to non-social (social vs. non-social target: 87.09% vs. 71.29%, 95% confidence interval (CI): 7.28-24.33, p = .003; social vs. non-social feedback: 81.00% vs. 71.29%, 95% CI: 2.81-16.61, p = .027). Correspondingly, oxytocin enhanced the correlation of the RPE signal with NAcc activation during social (vs. non-social) feedback in ASD (3.48 vs. -1.12, respectively, 95% CI: 2.98-6.22, p = .000), whereas in controls, this effect was found in the placebo condition (2.90 vs. -1.14, respectively, 95% CI: 1.07-7.01, p = .010). In ASD, a similar pattern emerged when the learning target was social (3.00 vs. -0.64, respectively, 95% CI: -0.13 to 7.41, p = .057), whereas controls showed a reduced correlation for social learning targets under oxytocin (-0.70 vs. 2.72, respectively, 95% CI: -5.86 to 0.98, p = .008). The current data suggest that intranasal oxytocin has the potential to enhance social reinforcement learning in ASD. Future studies are warranted that investigate whether oxytocin can potentiate social learning when combined with behavioral therapies, resulting in greater treatment benefits than traditional behavior-only approaches.
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Affiliation(s)
- Jana A. Kruppa
- 0000 0000 8653 1507grid.412301.5Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany ,grid.494742.8JARA-Brain Institute II, Molecular Neuroscience and Neuroimaging (INM-11), RWTH Aachen and Jülich Research Center, Jülich, Germany ,Institute of Neuroscience and Medicine (INM-3), Jülich Research Center, Jülich, Germany
| | - Anna Gossen
- 0000 0000 8653 1507grid.412301.5Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany ,Institute of Neuroscience and Medicine (INM-3), Jülich Research Center, Jülich, Germany
| | - Eileen Oberwelland Weiß
- 0000 0000 8653 1507grid.412301.5Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany ,grid.494742.8JARA-Brain Institute II, Molecular Neuroscience and Neuroimaging (INM-11), RWTH Aachen and Jülich Research Center, Jülich, Germany ,Institute of Neuroscience and Medicine (INM-3), Jülich Research Center, Jülich, Germany
| | - Gregor Kohls
- 0000 0000 8653 1507grid.412301.5Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany
| | - Nicola Großheinrich
- 0000 0000 8653 1507grid.412301.5Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany ,Institute of Neuroscience and Medicine (INM-3), Jülich Research Center, Jülich, Germany
| | - Hannah Cholemkery
- 0000 0004 0578 8220grid.411088.4Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Christine M. Freitag
- 0000 0004 0578 8220grid.411088.4Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Wolfram Karges
- 0000 0000 8653 1507grid.412301.5Division of Endocrinology and Diabetes, University Hospital RWTH Aachen, Aachen, Germany
| | - Elke Wölfle
- 0000 0000 8653 1507grid.412301.5Division of Endocrinology and Diabetes, University Hospital RWTH Aachen, Aachen, Germany
| | - Judith Sinzig
- 0000 0000 9702 9846grid.491992.eDepartment of Child and Adolescent Psychiatry and Psychotherapy, LVR-Klinik Bonn, Bonn, Germany
| | - Gereon R. Fink
- Institute of Neuroscience and Medicine (INM-3), Jülich Research Center, Jülich, Germany ,0000 0000 8852 305Xgrid.411097.aDepartment of Neurology, University Hospital Cologne, Cologne, Germany
| | - Beate Herpertz-Dahlmann
- 0000 0000 8653 1507grid.412301.5Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany
| | - Kerstin Konrad
- 0000 0000 8653 1507grid.412301.5Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany ,grid.494742.8JARA-Brain Institute II, Molecular Neuroscience and Neuroimaging (INM-11), RWTH Aachen and Jülich Research Center, Jülich, Germany
| | - Martin Schulte-Rüther
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany. .,JARA-Brain Institute II, Molecular Neuroscience and Neuroimaging (INM-11), RWTH Aachen and Jülich Research Center, Jülich, Germany. .,Institute of Neuroscience and Medicine (INM-3), Jülich Research Center, Jülich, Germany.
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19
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Orfanos S, Toygar T, Berthold-Losleben M, Chechko N, Durst A, Laoutidis ZG, Vocke S, Weidenfeld C, Schneider F, Karges W, Beckmann CF, Habel U, Kohn N. Investigating the impact of overnight fasting on intrinsic functional connectivity: a double-blind fMRI study. Brain Imaging Behav 2019; 12:1150-1159. [PMID: 29071464 PMCID: PMC6063348 DOI: 10.1007/s11682-017-9777-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The human brain depends mainly on glucose supply from circulating blood as an energy substrate for its metabolism. Most of the energy produced by glucose catabolism in the brain is used to support intrinsic communication purposes in the absence of goal-directed activity. This intrinsic brain function can be detected with fMRI as synchronized fluctuations of the BOLD signal forming functional networks. Here, we report results from a double-blind, placebo controlled, cross-over study addressing changes in intrinsic brain activity in the context of very low, yet physiological, blood glucose levels after overnight fasting. Comparison of four major resting state networks in a fasting state and a state of elevated blood glucose levels after glucagon infusion revealed altered patterns of functional connectivity only in a small region of the posterior default mode network, while the rest of the networks appeared unaffected. Furthermore, low blood glucose was associated with changes in the right frontoparietal network after cognitive effort. Our results suggest that fasting has only limited impact on intrinsic brain activity, while a detrimental impact on a network related to attention is only observable following cognitive effort, which is in line with ego depletion and its reliance on glucose.
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Affiliation(s)
- Stelios Orfanos
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany. .,Jülich Aachen Research Alliance (JARA) - BRAIN Institute Brain Structure-Function Relationships: Decoding the Human Brain at systemic levels, Forschungszentrum Jülich GmbH and RWTH Aachen University, Jülich, Germany.
| | - Timur Toygar
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Department of Biology, RWTH Aachen University, 52074, Aachen, Germany
| | - Mark Berthold-Losleben
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Jülich Aachen Research Alliance (JARA) - BRAIN Institute Brain Structure-Function Relationships: Decoding the Human Brain at systemic levels, Forschungszentrum Jülich GmbH and RWTH Aachen University, Jülich, Germany
| | - Natalya Chechko
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Jülich Aachen Research Alliance (JARA) - BRAIN Institute Brain Structure-Function Relationships: Decoding the Human Brain at systemic levels, Forschungszentrum Jülich GmbH and RWTH Aachen University, Jülich, Germany
| | - Annette Durst
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Jülich Aachen Research Alliance (JARA) - BRAIN Institute Brain Structure-Function Relationships: Decoding the Human Brain at systemic levels, Forschungszentrum Jülich GmbH and RWTH Aachen University, Jülich, Germany
| | - Zacharias G Laoutidis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Department of Psychiatry and Psychotherapy, University of Düsseldorf, Bergische Landstrasse 2, 40629, Düsseldorf, Germany
| | - Sebastian Vocke
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Jülich Aachen Research Alliance (JARA) - BRAIN Institute Brain Structure-Function Relationships: Decoding the Human Brain at systemic levels, Forschungszentrum Jülich GmbH and RWTH Aachen University, Jülich, Germany
| | - Caren Weidenfeld
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Jülich Aachen Research Alliance (JARA) - BRAIN Institute Brain Structure-Function Relationships: Decoding the Human Brain at systemic levels, Forschungszentrum Jülich GmbH and RWTH Aachen University, Jülich, Germany
| | - Frank Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Jülich Aachen Research Alliance (JARA) - BRAIN Institute Brain Structure-Function Relationships: Decoding the Human Brain at systemic levels, Forschungszentrum Jülich GmbH and RWTH Aachen University, Jülich, Germany
| | - Wolfram Karges
- Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, 52074, Aachen, Germany
| | - Christian F Beckmann
- Department of Cognitive Neuroscience, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.,Centre for Functional MRI of the Brain (FMRIB), University of Oxford, Oxford, UK
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Jülich Aachen Research Alliance (JARA) - BRAIN Institute Brain Structure-Function Relationships: Decoding the Human Brain at systemic levels, Forschungszentrum Jülich GmbH and RWTH Aachen University, Jülich, Germany
| | - Nils Kohn
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Department of Cognitive Neuroscience, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
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20
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Merger S, Lanzinger S, Welp R, Jehle P, Schäfer C, Auer-Hackenberg L, Milek K, Karges W, Holl R. Patienten mit Diabetes mellitus Typ 2 zeigen bei niedrig-normalem TSH günstigere kardiovaskuläre Risikoprofile. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1657797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- S Merger
- Klinik für Endokrinologie und Diabetologie, Klinikum Coburg, Coburg, Germany
| | | | - R Welp
- Innere Medizin, Bottrop, Germany
| | - P Jehle
- Evangelisches Krankenhaus Paul Gerhardt Stift Klinik f.Innere Medizin I, Wittenberg, Germany
| | - C Schäfer
- Klinikum Neumarkt Medizinische Klinik II, Neumarkt, Germany
| | | | - K Milek
- Diabetes Praxis, Hohenmölsen, Germany
| | | | - R Holl
- Universität Ulm, Ulm, Germany
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21
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Lanzinger S, Karges W, Raddatz D, Merger S, Seufert J, Thon A, Staab D, Laimer M, Holl R. Pankreopriver Diabetes mellitus: Gibt es Unterschiede in pathogenetischen Untergruppen? – Ergebnisse aus dem DPV-Register. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- S Lanzinger
- Universität Ulm, Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Ulm, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | - W Karges
- Universitätsklinikum Aachen, Sektion Endokrinologie und Diabetologie – Medizinische Klinik III, RWTH Aachen, Germany
| | - D Raddatz
- Universitätsmedizin Göttingen, Klinik für Gastroenterologie und gastrointestinale Onkologie, Göttingen, Germany
| | - S Merger
- Klinikum Coburg, Klinik für Endokrinologie, Diabetologie, Stoffwechsel- und Ernährungsmedizin, Coburg, Germany
| | - J Seufert
- Universitätsklinikum und Medizinische Fakultät Freiburg, Abteilung Endokrinologie und Diabetologie, Klinik für Innere Medizin II, Freiburg, Germany
| | - A Thon
- Medizinische Hochschule Hannover, Klinik für Pädiatrische Pneumologie, Allergologie & Neonatologie, Hannover, Germany
| | - D Staab
- Charité – Universitätsmedizin Berlin, Klinik für Pädiatrie m. S. Pneumologie und Immunologie, Berlin, Germany
| | - M Laimer
- Universitätsspital Bern, Universitätsklinik für Diabetologie, Endokrinologie, Ernährungsmedizin & Metabolismus (UDEM), Bern, Switzerland
| | - R Holl
- Universität Ulm, Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Ulm, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
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22
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Zaharia OP, Lanzinger S, Rosenbauer J, Schmid SM, Burkart V, Hummel M, Raddatz D, Müssig K, Karges W, Roden M, Szendroedi J, Holl RW. Increased diabetes-related complications in patients with newly diagnosed type 1 diabetes with uncontrolled dyslipidemia. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- OP Zaharia
- German Diabetes Center (DDZ), Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - S Lanzinger
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- ZIBMT, Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - J Rosenbauer
- German Diabetes Center (DDZ), Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - SM Schmid
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Medicine 1, University of Lübeck, Lübeck, Germany
| | - V Burkart
- German Diabetes Center (DDZ), Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - M Hummel
- Diabetes Center, Rosenheim, Germany
- Technical University of Munich, Munich, Germany
| | - D Raddatz
- Division of Gastroenterology and Gastrointestinal Oncology, Göttingen, Germany
| | - K Müssig
- German Diabetes Center (DDZ), Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - W Karges
- Division of Endocrinology and Diabetes, RWTH Aachen University, Aachen, Germany
| | - M Roden
- German Diabetes Center (DDZ), Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - J Szendroedi
- German Diabetes Center (DDZ), Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - RW Holl
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- ZIBMT, Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
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23
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Deuse L, Wudarczyk O, Rademacher L, Kaleta P, Karges W, Kacheva S, Gründer G, Lammertz S. Peripheral Oxytocin Predicts Higher-Level Social Cognition in Men Regardless of Empathy Quotient. Pharmacopsychiatry 2018; 52:148-154. [DOI: 10.1055/a-0590-4850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Abstract
Introduction Pharmaceutical oxytocin (OT) administration is being tested as a novel treatment for social deficits in various psychiatric populations. However, little is known about how naturally occurring variation in peripheral OT relates to differences in social cognition. This study investigates whether healthy individuals with very high or very low levels of empathy differ in endogenous OT and whether OT plasma levels can predict performance in a mentalizing task.
Methods 40 healthy men were included based upon their score above the 85th or below the 15th percentile of the empathy quotient inventory 1. Participants’ abilities to interpret social information was assessed via the Social Detection Task 2. Plasma OT levels were analyzed using enzyme immunoassay.
Results OT plasma levels predicted mentalizing performance for more ambiguous social scenes (i. e., difficult items) for all participants. We found no group differences in OT plasma levels between subjects with high and low empathy.
Discussion These findings confirm a link between peripheral OT and the ability to read subtle nonverbal social cues in healthy individuals, which is independent of self-reported empathy.
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Affiliation(s)
- Lisa Deuse
- Universitatsklinikum RWTH Aachen, Psychiatry, Department of Psychotherapy and Psychosomatics, Aachen, Germany
| | - Olga Wudarczyk
- Universitatsklinikum RWTH Aachen, Psychiatry, Department of Psychotherapy and Psychosomatics, Aachen, Germany
| | - Lena Rademacher
- Department of Psychiatry and Psychotherapy, Social Neuroscience Lab, University of Lübeck, Lübeck, Germany
| | - Peter Kaleta
- Universitatsklinikum RWTH Aachen, Psychiatry, Department of Psychotherapy and Psychosomatics, Aachen, Germany
| | - Wolfram Karges
- Universitatsklinikum RWTH Aachen, Clinic for Gastroenterology, Metabolic Disorders and Internal Intensive Medicine, Aachen, Germany
| | - Stella Kacheva
- Universitatsklinikum RWTH Aachen, Clinic for Gastroenterology, Metabolic Disorders and Internal Intensive Medicine, Aachen, Germany
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Clinical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sarah Lammertz
- Universitatsklinikum RWTH Aachen, Psychiatry, Department of Psychotherapy and Psychosomatics, Aachen, Germany
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24
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Seufert J, Lanzinger S, Schmid S, Karges W, Bergis D, Kerner W, Hummel M, Zimny S, Mader JK, Rosenbauer J, Holl RW. Epidemiologie diabetischer Ketoazidosen im Verlauf des Typ-1-Diabetes bei Erwachsenen: Daten der DPV-Initiative bei 45.764 Patienten. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- J Seufert
- Universitätsklinikum Freiburg, Klinik für Innere Medizin II, Abteilung Endokrinologie und Diabetologie, Freiburg, Germany
| | - S Lanzinger
- Universität Ulm, Institut für Epidemiologie und Medizinische Biometrie, ZIBMT, Ulm, Germany
| | - S Schmid
- Universitätsklinikum Schleswig-Holstein – Campus Lübeck, Medizinische Klinik 1 – Endokrinologie, Diabetologie, Internistische Adipositasmedizin, Lübeck, Germany
| | - W Karges
- Universitätsklinikum Aachen, Medizinische Klinik III, Sektion Endokrinologie und Diabetologie, Aachen, Germany
| | - D Bergis
- Universitätsklinikum Frankfurt, Medizinische Klinik 1, Schwerpunkt Endokrinologie und Diabetologie, Frankfurt, Germany
| | - W Kerner
- Klinikum Karlsburg der Klinikgruppe Dr. Guth GmbH & Co. KG, Klinik für Diabetes & Stoffwechselkrankheiten, Karlsburg, Germany
| | - M Hummel
- Diabetes Schwerpunktpraxis, Rosenheim, Germany
| | - S Zimny
- HELIOS Kliniken Schwerin GmbH, Klinik für Allgemeine Innere Medizin, Endokrinologie und Diabetologie, Diabeteszentrum, Schwerin, Germany
| | - JK Mader
- Medizinische Universität Graz, Universitätsklinik für Innere Medizin, Klinische Abteilung für Endokrinologie und Diabetologie, Graz, Austria
| | - J Rosenbauer
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | - RW Holl
- Universität Ulm, Institut für Epidemiologie und Medizinische Biometrie, ZIBMT, Ulm, Germany
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25
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Hofer SE, Miller K, Hermann JM, DeSalvo DJ, Riedl M, Hirsch IB, Karges W, Beck RW, Holl RW, Maahs DM. Response to Comment on Hofer et al. International Comparison of Smoking and Metabolic Control in Patients With Type 1 Diabetes. Diabetes Care 2016;39:e177-e178. Diabetes Care 2017; 40:e37. [PMID: 28223449 PMCID: PMC6463579 DOI: 10.2337/dci16-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Sabine E Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Julia M Hermann
- ZIBMT, Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.,German Center for Diabetes Research, München-Neuherberg, Germany
| | | | - Michaela Riedl
- Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Wolfram Karges
- Division of Endocrinology and Diabetes, RWTH Aachen University, Aachen, Germany
| | - Roy W Beck
- Jaeb Center for Health Research, Tampa, FL
| | - Reinhard W Holl
- ZIBMT, Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.,German Center for Diabetes Research, München-Neuherberg, Germany
| | - David M Maahs
- Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA
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26
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Karges B, Kapellen T, Wagner VM, Steigleder-Schweiger C, Karges W, Holl RW, Rosenbauer J. Glycated hemoglobin A1c as a risk factor for severe hypoglycemia in pediatric type 1 diabetes. Pediatr Diabetes 2017; 18:51-58. [PMID: 26712064 DOI: 10.1111/pedi.12348] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/12/2015] [Accepted: 11/23/2015] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess the risk of severe hypoglycemia related to glycated hemoglobin A1c (HbA1c) levels in a population-based cohort of pediatric type 1 diabetes patients during two time periods since 1995. METHODS The association between HbA1c levels and severe hypoglycemia (defined as requiring assistance from another person) or hypoglycemic coma (loss of consciousness or seizures) was analyzed by multivariable regression analysis in children and adolescents with type 1 diabetes from the DPV Diabetes Prospective Follow-up in Germany and Austria in 1995-2003 (n = 15 221 patients) and 2004-2012 (n = 22 318 patients). RESULTS Mean adjusted rates of severe hypoglycemia and hypoglycemic coma decreased from 19.18 [95% confidence interval (CI), 17.95-20.48] and 4.36 (3.93-4.83) per 100 patient-years in 1995-2003 to 15.01 (14.18-15.88) and 2.15 (1.94-2.39) in 2004-2012, respectively (p < 0.001). From the first to the second period, the relative risk (RR) for severe hypoglycemia and hypoglycemic coma per 1% lower HbA1c decreased from 1.22 (1.15-1.30) to 1.06 (1.01-1.12) and from 1.27 (1.15-1.40) to 1.04 (0.94-1.16), respectively. Risk of severe hypoglycemia and coma declined most in patients with HbA1c levels of 6-6.9% (RR 0.70 and 0.43, respectively) and with HbA1c of 7-7.9% (RR 0.63 and 0.38, respectively). Mean HbA1c levels fell from 8.4% in 1995-2003 to 8.2% in 2004-2012, while the use of insulin pumps, short- and long-acting insulin analogs, and glucose monitoring increased (p < 0.001). CONCLUSIONS In contrast to 1995-2003, low HbA1c has become a minor risk factor for severe hypoglycemia and coma in pediatric patients with type 1 diabetes in the 2004-2012 period.
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Affiliation(s)
- Beate Karges
- Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Aachen, Germany.,Department of Gynecological Endocrinology and Reproductive Medicine, Medical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Aachen, Germany.,Department of Pediatrics, Bethlehem Hospital, Stolberg, Germany
| | - Thomas Kapellen
- Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Verena M Wagner
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | | | - Wolfram Karges
- Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Aachen, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, German Center for Diabetes Research (DZD), Ulm, Germany
| | - Joachim Rosenbauer
- Institute for Biometrics and Epidemiology, Leibniz Center at University of Düsseldorf, German Center for Diabetes Research (DZD), Düsseldorf, Germany
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27
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Kacheva S, Karges B, Göller K, Marx N, Mischke K, Karges W. QT prolongation caused by insulin-induced hypoglycaemia - An interventional study in 119 individuals. Diabetes Res Clin Pract 2017; 123:165-172. [PMID: 28024277 DOI: 10.1016/j.diabres.2016.11.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 05/11/2016] [Revised: 11/03/2016] [Accepted: 11/27/2016] [Indexed: 02/03/2023]
Abstract
AIMS Hypoglycaemia is associated with increased risk of cardiovascular events and mortality in patients with diabetes, but the extent and mechanisms of this link are ill defined. We here prospectively studied cardiac repolarization abnormalities during insulin-induced hypoglycaemia in humans. METHODS 119 individuals (69 males, age 47.5±13.4years, range 18-82years) were assessed during hypoglycaemia after the injection of 0.1-0.25units/kg human insulin. Corrected QT intervals (QTc) and QT dispersion (QTd) were calculated from serially recorded twelve lead electrocardiograms, and plasma glucose and other endocrine markers were studied. RESULTS QTc increased from 415.1±21.9ms (mean±standard deviation) at baseline to 444.9±26.5ms during hypoglycaemia (plasma glucose nadir, 1.6±0.5mmol/L, p=0.001), accompanied by an increase of QTd from 45.0±22.7ms to 64.1±40.0ms (p<0.001). Hypoglycaemia-induced abnormal QTc prolongation (defined as ⩾460ms in females and ⩾450ms in males) occurred in 17% (9/54) of females and 26% (17/65) of males. 97 of 119 of individuals (82%) developed transient hypokalaemia (K+ ⩽3.6mmol/L), and plasma epinephrine increased from 220.4±169.5pmol/L at baseline to 2945.6±2421.4pmol/L during hypoglycaemia. Baseline QTc, but not age or gender, was a significant predictor of hypoglycaemia-induced QTc prolongation (p=0.001). CONCLUSIONS Insulin-induced hypoglycaemia frequently causes abnormal QT prolongation and is associated with hypokalaemia and sympathoadrenal activation, thereby increasing the potential risk for ventricular arrhythmias, particularly in individuals with pre-existing high normal QTc.
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Affiliation(s)
- Stella Kacheva
- Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, Aachen, Germany.
| | - Beate Karges
- Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Katrin Göller
- Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Nikolaus Marx
- Department of Cardiology, Pneumology, Angiology and Internal Intensive Care Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Karl Mischke
- Department of Cardiology, Pneumology, Angiology and Internal Intensive Care Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Wolfram Karges
- Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, Aachen, Germany
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28
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Hofer SE, Miller K, Hermann JM, DeSalvo DJ, Riedl M, Hirsch IB, Karges W, Beck RW, Holl RW, Maahs DM. International Comparison of Smoking and Metabolic Control in Patients With Type 1 Diabetes. Diabetes Care 2016; 39:e177-8. [PMID: 27531951 DOI: 10.2337/dc16-0845] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 07/20/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Sabine E Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Julia M Hermann
- ZIBMT, Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany German Center for Diabetes Research, München-Neuherberg, Germany
| | | | - Michaela Riedl
- Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Wolfram Karges
- Division of Endocrinology and Diabetes, RWTH Aachen University, Aachen, Germany
| | - Roy W Beck
- Jaeb Center for Health Research, Tampa, FL
| | - Reinhard W Holl
- ZIBMT, Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany German Center for Diabetes Research, München-Neuherberg, Germany
| | - David M Maahs
- Barbara Davis Center for Childhood Diabetes, Aurora, CO
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29
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Bohn B, Schöfl C, Zimmer V, Hummel M, Heise N, Siegel E, Karges W, Riedl M, Holl RW. Achievement of treatment goals for secondary prevention of myocardial infarction or stroke in 29,325 patients with type 2 diabetes: a German/Austrian DPV-multicenter analysis. Cardiovasc Diabetol 2016; 15:72. [PMID: 27141979 PMCID: PMC4855873 DOI: 10.1186/s12933-016-0391-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 02/25/2016] [Accepted: 04/22/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To analyze whether medical care is in accordance with guidelines for secondary prevention of myocardial infarction (MI), or stroke in patients with type 2 diabetes from Germany and Austria. METHODS 29,325 patients (≥ 20 years of age) with type 2 diabetes and MI, or stroke, documented between 2006 and 2015 were selected from the Diabetes-Patienten-Verlaufsdokumentation database. We analyzed medication, clinical characteristics, and lifestyle factors according to national secondary prevention guidelines in patients with MI, or stroke, separately. RESULTS HbA1C <7.5 % was achieved in 64.9 % (MI), and in 61.1 % (stroke) of patients. LDL <100 mg/dl was documented in 56.2 % (MI), and in 42.2 % (stroke). Non-smoking was reported in 92.0 % (MI), and in 93.1 % (stroke), physical activity in 9.6 % (MI), and 5.5 % (stroke). Target values of blood pressure (<130/80 mmHg in MI, 120/70-140/90 in stroke) were reached in 67.0 % (MI), and in 89.9 % (stroke). Prescription prevalence of inhibitors of platelet aggregation (IPA) was 50.7 % (MI), and 31.7 % (stroke). 57.0 % (MI), and 40.1 % (stroke) used statins, 65.1 % (MI), and 65.8 % (stroke) used any type of antihypertensives, and ACE inhibitors were prescribed in 49.7 % (MI), and 41.3 % (stroke). A body mass index (BMI) <27 kg/m(2) and the use of beta blockers were only recommended in subjects with MI. Of the patients with MI, 32.0 % had a BMI <27 kg/m(2), and 59.5 % used beta blockers. CONCLUSIONS Achievement of treatment goals in secondary prevention of MI, or stroke in subjects with type 2 diabetes needs improvement. Target goals were met more frequently in patients with MI compared to subjects with stroke. Especially the use of IPA was very low in patients with stroke. There remains great potential to reduce the risk of repeated macrovascular events and premature death, as well as to increase patients' quality of life.
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Affiliation(s)
- Barbara Bohn
- />Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, 89081 Ulm, Germany
- />German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Christof Schöfl
- />Division of Endocrinology and Diabetes, Department of Medicine I, University Hospital Erlangen, Friedrich-Alexander-University, Erlangen-Nuremberg, Germany
| | - Vincent Zimmer
- />Department for Internal Medicine, Protestant Hospital Zweibrücken, Zweibrücken, Germany
- />Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Michael Hummel
- />Specialized Diabetes Practice Rosenheim & Institute of Diabetes Research, Helmholtz Center Munich, Munich, Germany
| | - Nikolai Heise
- />Alb Fils Kliniken, Helfenstein Clinic, Geislingen, Germany
| | - Erhard Siegel
- />Department of Internal Medicine, St. Josefs Hospital, Heidelberg, Germany
| | - Wolfram Karges
- />Division of Endocrinology and Diabetes, RWTH Aachen University, Aachen, Germany
| | - Michaela Riedl
- />Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Reinhard W. Holl
- />Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, 89081 Ulm, Germany
- />German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - On behalf of the DPV-initiative
- />Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, 89081 Ulm, Germany
- />Division of Endocrinology and Diabetes, Department of Medicine I, University Hospital Erlangen, Friedrich-Alexander-University, Erlangen-Nuremberg, Germany
- />Department for Internal Medicine, Protestant Hospital Zweibrücken, Zweibrücken, Germany
- />Department of Medicine II, Saarland University Medical Center, Homburg, Germany
- />Specialized Diabetes Practice Rosenheim & Institute of Diabetes Research, Helmholtz Center Munich, Munich, Germany
- />Alb Fils Kliniken, Helfenstein Clinic, Geislingen, Germany
- />Department of Internal Medicine, St. Josefs Hospital, Heidelberg, Germany
- />Division of Endocrinology and Diabetes, RWTH Aachen University, Aachen, Germany
- />Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- />German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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30
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Bohn B, Schöfl C, Zimmer V, Hummel M, Heise N, Siegel E, Karges W, Riedl M, Holl RW, -Initiative DPV. Unterschiede zwischen Typ 2 Diabetes Patienten mit und ohne Diabetisches Fußsyndrom. Eine multizentrische DPV-Analyse von 188.410 Patienten aus den letzten 10 Jahren. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580939] [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: 10/21/2022]
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31
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McKnight JA, Wild SH, Lamb MJE, Cooper MN, Jones TW, Davis EA, Hofer S, Fritsch M, Schober E, Svensson J, Almdal T, Young R, Warner JT, Delemer B, Souchon PF, Holl RW, Karges W, Kieninger DM, Tigas S, Bargiota A, Sampanis C, Cherubini V, Gesuita R, Strele I, Pildava S, Coppell KJ, Magee G, Cooper JG, Dinneen SF, Eeg-Olofsson K, Svensson AM, Gudbjornsdottir S, Veeze H, Aanstoot HJ, Khalangot M, Tamborlane WV, Miller KM. Glycaemic control of Type 1 diabetes in clinical practice early in the 21st century: an international comparison. Diabet Med 2015; 32:1036-50. [PMID: 25510978 DOI: 10.1111/dme.12676] [Citation(s) in RCA: 239] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2014] [Indexed: 11/29/2022]
Abstract
AIMS Improving glycaemic control in people with Type 1 diabetes is known to reduce complications. Our aim was to compare glycaemic control among people with Type 1 diabetes using data gathered in regional or national registries. METHODS Data were obtained for children and/or adults with Type 1 diabetes from the following countries (or regions): Western Australia, Austria, Denmark, England, Champagne-Ardenne (France), Germany, Epirus, Thessaly and Thessaloniki (Greece), Galway (Ireland), several Italian regions, Latvia, Rotterdam (The Netherlands), Otago (New Zealand), Norway, Northern Ireland, Scotland, Sweden, Volyn (Ukraine), USA and Wales) from population or clinic-based registries. The sample size with available data varied from 355 to 173 880. Proportions with HbA1c < 58 mmol/mol (< 7.5%) and ≥ 75 mmol/mol (≥ 9.0%) were compared by age and sex. RESULTS Data were available for 324 501 people. The proportions with HbA1c 58 mmol/mol (< 7.5%) varied from 15.7% to 46.4% among 44 058 people aged < 15 years, from 8.9% to 49.5% among 50 766 people aged 15-24 years and from 20.5% to 53.6% among 229 677 people aged ≥ 25 years. Sex differences in glycaemic control were small. Proportions of people using insulin pumps varied between the 12 sources with data available. CONCLUSION These results suggest that there are substantial variations in glycaemic control among people with Type 1 diabetes between the data sources and that there is room for improvement in all populations, especially in young adults.
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Affiliation(s)
- J A McKnight
- Metabolic Unit, Western General Hospital, Edinburgh and University of Edinburgh, UK
- Scottish Diabetes Research Network Epidemiology Group
| | - S H Wild
- Centre for Population Health Sciences, University of Edinburgh, UK
- Scottish Diabetes Research Network Epidemiology Group
| | - M J E Lamb
- Centre for Population Health Sciences, University of Edinburgh, UK
- Scottish Diabetes Research Network Epidemiology Group
| | - M N Cooper
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia
| | - T W Jones
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
| | - E A Davis
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
| | - S Hofer
- Department of Pediatrics, Medical University of Innsbruck, Austria
- German/Austria DPV database
| | - M Fritsch
- Department of Pediatrics, Medical University of Vienna, Austria
- German/Austria DPV database
| | - E Schober
- Department of Pediatrics, Medical University of Vienna, Austria
- German/Austria DPV database
| | - J Svensson
- Department of Pediatrics, Copenhagen University Hospital Herlev, Denmark
| | - T Almdal
- Department of Medicine F, Copenhagen University Hospital, Hellerup, Denmark
| | - R Young
- Salford Royal Foundation NHS Trust, Salford, UK
| | - J T Warner
- Children's Hospital for Wales, Cardiff, UK
- National Pediatric Diabetes Audit and the Royal College of Paediatrics and Child Health
| | - B Delemer
- Department of Endocrinology, Diabetes and Nutrition, American Memorial Hospital, University Hospital of Rheims, France
| | - P F Souchon
- Department of Pediatrics, American Memorial Hospital, University Hospital of Rheims, France
- CARéDIAB Network
| | - R W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Germany
- German/Austria DPV database
| | - W Karges
- Division of Endocrinology, RWTH Aachen University, Germany
- German/Austria DPV database
| | - D M Kieninger
- Diabetes Division, Department of Paediatrics, Universitätsmedizin Johannes Gutenberg Universität Mainz, Germany
- German/Austria DPV database
| | - S Tigas
- Department of Endocrinology, University of Ioannina, Greece
| | - A Bargiota
- Department of Endocrinology and Metabolic Diseases, University of Thessaly, Greece
| | - C Sampanis
- Second Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - V Cherubini
- Department of Women's and Children's Health, SalesiHospital, Ancona, Italy
- RIDI Study Group
| | - R Gesuita
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Italy
| | - I Strele
- Department of Public Health and Epidemiology, Riga Stradins University, Riga, Latvia
| | - S Pildava
- The Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - K J Coppell
- Edgar Diabetes and Obesity Research, Department of Medicine, University of Otago, Dunedin, New Zealand
| | - G Magee
- Daisy Hill Hospital, Newry, County Down, UK
| | - J G Cooper
- Norwegian Adult Diabetes Register, Noklus, Bergen, Norway
| | - S F Dinneen
- Galway University Hospitals, Galway, Ireland
- NUI Galway, Galway, Ireland
- Galway University Hospitals Department of Diabetes, Endocrinology and Metabolism
| | - K Eeg-Olofsson
- Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden
- National Diabetes Register in Sweden
| | - A-M Svensson
- Centre of Registers in Region VöstraGötaland, Göteborg, Sweden
- National Diabetes Register in Sweden
| | - S Gudbjornsdottir
- Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Göteborg, Sweden
- Centre of Registers in Region VöstraGötaland, Göteborg, Sweden
- National Diabetes Register in Sweden
| | - H Veeze
- Diabeter, National Centre for Pediatric and Adolescent Diabetes, Rotterdam, the Netherlands
| | - H-J Aanstoot
- Diabeter, National Centre for Pediatric and Adolescent Diabetes, Rotterdam, the Netherlands
| | - M Khalangot
- Shupyk National Medical Academy of Postgraduate Education and Komisarenko Institute of Endocrinology and Metabolism, Kiev, Ukraine
- Ukrainian Diabetes Register Team
| | - W V Tamborlane
- Yale University, New Haven, CT, USA
- T1D Exchange Clinic Network
| | - K M Miller
- Jaeb Centre for Health Research, Tampa, FL, USA
- T1D Exchange Clinic Network
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Streetz-van der Werf C, Karges W, Blaum M, Kreitschmann-Andermahr I. Addisonian Crisis after Missed Diagnosis of Posttraumatic Hypopituitarism. J Clin Med 2015; 4:965-9. [PMID: 26239458 PMCID: PMC4470209 DOI: 10.3390/jcm4050965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 04/30/2015] [Accepted: 05/06/2015] [Indexed: 11/18/2022] Open
Abstract
We report a case of a previously undiagnosed panhypopituitarism initially presenting as a full-blown Addisonian crisis with hypoglycemia, hyponatremia, hypotension and neuropsychological symptoms, more than 30 years after a severe traumatic brain injury (TBI). The patient also displayed clearly visible pathognomonic clinical signs of long-standing pituitary dysfunction. The case highlights the importance of being aware of endocrine sequelae even decades after serious TBI.
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Affiliation(s)
| | - Wolfram Karges
- Division of Endocrinology and Diabetes, RWTH Aachen University, 52062 Aachen, Germany.
| | - Marcus Blaum
- Department of Neuroradiology, RWTH Aachen University, 52062 Aachen, Germany.
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Kacheva S, Kolk K, Morgenthaler NG, Brabant G, Karges W. Gender-specific co-activation of arginine vasopressin and the hypothalamic-pituitary-adrenal axis during stress. Clin Endocrinol (Oxf) 2015; 82:570-6. [PMID: 25200793 DOI: 10.1111/cen.12608] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/21/2014] [Accepted: 09/01/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To study the interaction between copeptin and hypothalamic-pituitary-adrenal (HPA) activation in men and women during hypoglycaemic stress. DESIGN AND PATIENTS A prospective study in 118 patients (mean age 47·7 ± 13·6 years, n = 52 women) undergoing insulin tolerance testing for suspected pituitary dysfunction. MEASUREMENTS Serum copeptin was measured in serially collected blood samples and assessed in relation to ACTH, cortisol and other endocrine parameters. RESULTS Symptomatic hypoglycaemia (mean glucose nadir, 1·6 ± 0·5 mmol/l) resulted in a rapid significant increase of serum copeptin. Individuals with impaired pituitary function had lower stress-induced copeptin levels (median, 6·26 pmol/l) than patients with intact pituitary (8·46 pmol/l, P < 0·001). A weak overall correlation between stress-induced copeptin and cortisol levels was observed (rs = 0·31, P < 0·001). In female individuals, there was a positive correlation between stress-induced copeptin and ACTH (rs = 0·47, P < 0·001) or cortisol levels (rs = 0·42, P = 0·002), while in males, no correlation with ACTH levels (rs = 0·03, P = 0·75) and poor correlation with cortisol levels (rs = 0·24, P = 0·045) was observed. Patients with central diabetes insipidus showed lowest baseline (2·20 pmol/l) and stimulated copeptin levels (3·68 pmol/l). CONCLUSIONS The data from this study indicate that stress-induced release of AVP in women, but not in men, is linked to the co-activation of the hypothalamic-pituitary-adrenal system.
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Affiliation(s)
- S Kacheva
- Division of Endocrinology and Diabetes, University Hospital, RWTH Aachen University, Aachen, Germany
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Kohn N, Toygar T, Weidenfeld C, Berthold-Losleben M, Chechko N, Orfanos S, Vocke S, Durst A, Laoutidis ZG, Karges W, Schneider F, Habel U. In a sweet mood? Effects of experimental modulation of blood glucose levels on mood-induction during fMRI. Neuroimage 2015; 113:246-56. [PMID: 25795339 DOI: 10.1016/j.neuroimage.2015.03.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 03/09/2015] [Accepted: 03/10/2015] [Indexed: 01/21/2023] Open
Abstract
Glucose is the primary source of energy for the human brain. Previous literature has shown that varying blood glucose levels may have a strong impact on behaviour, subjective mood, and the intensity of the BOLD signal measured in fMRI. Therefore, blood glucose levels varying even within the normal range may interact with cognitive and emotional processing as well as BOLD signal. Here, in a placebo-controlled, double-blind crossover study on 20 healthy women, we show that overnight fasting, compared to an elevated glucose condition, influences brain activation and the affective state during mood induction. Results indicate that our brain may compensate for low glucose levels during fasting by stronger recruitment of the brain areas relevant to the task at hand. Additionally, we systematically tested the effect of prior cognitive effort on behavioural and neural patterns and found that elevated activation is only associated with maintained performance as long as no prior cognitively challenging task is administered. Prior cognitive effort leads to deteriorated performance and a further increase in emotion-associated brain activation in the pregenual anterior and posterior cingulate, the superior frontal gyrus, and the pre-SMA. These results are in line with the strength model of self-regulation. Our results corroborate the strength model of self-regulation and extend it to affect regulation processes. Additionally, our observations suggest that experimentally controlling for fasting state or glucose levels may be beneficial, especially when studying processes that involve self-regulation.
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Affiliation(s)
- N Kohn
- Institute of Neuroscience and Medicine (INM-6), Jülich Research Centre, Jülich, Germany; JARA Brain - Translational Brain Medicine, Jülich-Aachen, Germany.
| | - T Toygar
- Department of Psychiatry, Psychotherapy and Psychosomatics, Uniklinik RWTH Aachen, 52074 Aachen, Germany; Department of Biology, RWTH Aachen University, 52074 Aachen, Germany
| | - C Weidenfeld
- Department of Psychiatry, Psychotherapy and Psychosomatics, Uniklinik RWTH Aachen, 52074 Aachen, Germany; JARA Brain - Translational Brain Medicine, Jülich-Aachen, Germany
| | - M Berthold-Losleben
- Department of Psychiatry, Psychotherapy and Psychosomatics, Uniklinik RWTH Aachen, 52074 Aachen, Germany; JARA Brain - Translational Brain Medicine, Jülich-Aachen, Germany
| | - N Chechko
- Department of Psychiatry, Psychotherapy and Psychosomatics, Uniklinik RWTH Aachen, 52074 Aachen, Germany; JARA Brain - Translational Brain Medicine, Jülich-Aachen, Germany
| | - S Orfanos
- Department of Psychiatry, Psychotherapy and Psychosomatics, Uniklinik RWTH Aachen, 52074 Aachen, Germany; JARA Brain - Translational Brain Medicine, Jülich-Aachen, Germany
| | - S Vocke
- Department of Psychiatry, Psychotherapy and Psychosomatics, Uniklinik RWTH Aachen, 52074 Aachen, Germany; JARA Brain - Translational Brain Medicine, Jülich-Aachen, Germany
| | - A Durst
- Department of Psychiatry, Psychotherapy and Psychosomatics, Uniklinik RWTH Aachen, 52074 Aachen, Germany; JARA Brain - Translational Brain Medicine, Jülich-Aachen, Germany
| | - Z G Laoutidis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Uniklinik RWTH Aachen, 52074 Aachen, Germany; Department of Psychiatry and Psychotherapy, University of Düsseldorf, Bergische Landstrasse 2, 40629 Düsseldorf, Germany
| | - W Karges
- Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - F Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatics, Uniklinik RWTH Aachen, 52074 Aachen, Germany; JARA Brain - Translational Brain Medicine, Jülich-Aachen, Germany
| | - U Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Uniklinik RWTH Aachen, 52074 Aachen, Germany; JARA Brain - Translational Brain Medicine, Jülich-Aachen, Germany
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Kacheva S, Segiet H, Streetz-van der Werf C, Karges W. Human plasma oxytocin measured with a reliable ELISA assay. Exp Clin Endocrinol Diabetes 2015. [DOI: 10.1055/s-0035-1547665] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Dohrn MF, Othman A, Hirshman SK, Bode H, Alecu I, Fähndrich E, Karges W, Weis J, Schulz JB, Hornemann T, Claeys KG. Elevation of plasma 1-deoxy-sphingolipids in type 2 diabetes mellitus: a susceptibility to neuropathy? Eur J Neurol 2015; 22:806-14, e55. [DOI: 10.1111/ene.12663] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 11/28/2014] [Indexed: 12/31/2022]
Affiliation(s)
- M. F. Dohrn
- Department of Neurology; RWTH Aachen University; Aachen Germany
- Institute of Neuropathology; RWTH Aachen University; Aachen Germany
| | - A. Othman
- Institute of Clinical Chemistry; University Hospital Zürich; Zürich Switzerland
- Centre for Integrative Human Physiology; University of Zürich; Zürich Switzerland
| | - S. K. Hirshman
- Department of Neurology; RWTH Aachen University; Aachen Germany
| | - H. Bode
- Institute of Clinical Chemistry; University Hospital Zürich; Zürich Switzerland
- Centre for Integrative Human Physiology; University of Zürich; Zürich Switzerland
| | - I. Alecu
- Institute of Clinical Chemistry; University Hospital Zürich; Zürich Switzerland
- Centre for Integrative Human Physiology; University of Zürich; Zürich Switzerland
| | - E. Fähndrich
- Division of Endocrinology and Diabetes; RWTH Aachen University; Aachen Germany
| | - W. Karges
- Division of Endocrinology and Diabetes; RWTH Aachen University; Aachen Germany
| | - J. Weis
- Institute of Neuropathology; RWTH Aachen University; Aachen Germany
- JARA - Translational Brain Medicine; Aachen Germany
| | - J. B. Schulz
- Department of Neurology; RWTH Aachen University; Aachen Germany
- JARA - Translational Brain Medicine; Aachen Germany
| | - T. Hornemann
- Institute of Clinical Chemistry; University Hospital Zürich; Zürich Switzerland
- Centre for Integrative Human Physiology; University of Zürich; Zürich Switzerland
| | - K. G. Claeys
- Department of Neurology; RWTH Aachen University; Aachen Germany
- Institute of Neuropathology; RWTH Aachen University; Aachen Germany
- JARA - Translational Brain Medicine; Aachen Germany
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Kohn N, Wassenberg A, Toygar T, Kellermann T, Weidenfeld C, Berthold-Losleben M, Chechko N, Orfanos S, Vocke S, Laoutidis ZG, Schneider F, Karges W, Habel U. Prolonged fasting impairs neural reactivity to visual stimulation. Brain Struct Funct 2014; 221:147-58. [DOI: 10.1007/s00429-014-0898-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 09/19/2014] [Indexed: 10/24/2022]
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Laubner K, Molz K, Kerner W, Karges W, Lang W, Dapp A, Schütt M, Best F, Seufert J, Holl RW. Daily insulin doses and injection frequencies of neutral protamine hagedorn (NPH) insulin, insulin detemir and insulin glargine in type 1 and type 2 diabetes: a multicenter analysis of 51 964 patients from the German/Austrian DPV-wiss database. Diabetes Metab Res Rev 2014; 30:395-404. [PMID: 24302583 DOI: 10.1002/dmrr.2500] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 10/24/2013] [Accepted: 11/08/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND We performed a comparative analysis of the use of long-acting insulin (analogues) neutral protamine hagedorn (NPH), detemir (Det) and glargine (Gla), and quantified injection frequencies and daily insulin doses in patients with type 1 and 2 diabetes in daily practice. METHODS A total number of 51 964 patients from 336 centres in Germany and Austria with type 1 and 2 diabetes with exclusive insulin therapy were retrospectively analysed. RESULTS A total number of 42.1%/75.9% (type 1/type 2) of patients used NPH, 19.9%/6.7% Det and 38.0%/17.4% Gla, with similar glycaemic control and proportion of severe hypoglycaemia for NPH/Det/Gla in type 1 (Mean HbA(1c) 7.98%/7.98%/8.07%; mean proportion of severe hypoglycaemia 11.06%/11.93%/10.86%) and type 2 diabetes (Mean HbA(1c) 7.61%/7.78%/7.61%; mean proportion of severe hypoglycaemia 5.66%/4.48%/5.03%). In type 1 diabetes, the mean daily injection frequencies of NPH versus Det versus Gla were 1.9 vs 1.8 vs 1.1, and total daily insulin injections were 5.3 vs 5.6 vs 5.0. The adjusted mean daily basal insulin doses were 0.36, 0.39 and 0.31 IU/kg, mean daily total insulin dose was lowest for Gla (0.74 IU/kg), followed by NPH (0.76 IU/kg) and Det (0.81 IU/kg). In type 2 diabetes patients, mean daily injection frequencies were 1.6 for NPH, 1.4 for Det and 1.1 for Gla, total daily insulin injections were 4.0 vs 4.1 vs 3.6. The mean daily basal insulin dosages were 0.30 IU/kg (NPH), 0.33 IU/kg (Det) and 0.29 IU/kg (Gla), mean total insulin doses per day were 0.63 IU/kg (NPH), 0.77 IU/kg (Det) and 0.67 IU/kg (Gla). CONCLUSIONS In a 'real-world' setting, the injection frequencies and doses of basal and total insulin per day are lowest with the use of insulin glargine compared with NPH-insulin or insulin detemir at similar glycaemic control and rates of severe hypoglycaemia.
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Kreissl MC, Jacob C, Führer D, Karges W, Luster M, Lux MP, Mann K, Mittendorf T, Schott M, Spitzweg C, Schmoll HJ. Best supportive care from the conservative/non-surgical perspective and its costs in the treatment of patients with advanced medullary thyroid cancer: results of a Delphi panel. Oncol Res Treat 2014; 37:316-22. [PMID: 24903762 DOI: 10.1159/000362613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 03/26/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Medullary thyroid cancer (MTC) is a rare tumor entity. The contents of best supportive care (BSC) have not been defined in advanced MTC. The objective of this work is to describe the epidemiology, the treatment patterns with respect to symptom management, as well as palliative treatment and associated costs. METHOD A Delphi panel with 9 clinical experts experienced in treating MTC was conducted to obtain details on the epidemiology of MTC and to gain insights into the therapeutic options considered for BSC in advanced MTC in Germany. Unit costs were applied to the described resources from the perspective of the German National Healthcare System in 2011. RESULTS The annual incidence of MTC in Germany was estimated at about 220. 32% of all patients were estimated to have aggressive/symptomatic MTC, with an estimated mean survival of 36.7 months (median: 36 months). The core element of BSC is relief of symptoms to maintain quality of life. The total mean cost of BSC per patient/year was estimated at € 9,248, lifetime cost at € 28,283. CONCLUSION There was consistent agreement within the panel on the epidemiology of MTC and on the structure of the provided therapeutic measures for BSC in advanced MTC, also defining the management of symptoms as a crucial goal of treatment.
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Affiliation(s)
- Michael C Kreissl
- Department of Nuclear Medicine, University Hospital of Wuerzburg, Germany
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Karges B, Rosenbauer J, Kapellen T, Wagner VM, Schober E, Karges W, Holl RW. Hämoglobin A1C und Hypoglykämierisiko bei Typ 1 Diabetes: Ergebnisse einer Kohortenstudie (1995 – 2012) bei 37.539 Patienten. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1374874] [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: 10/25/2022]
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Kacheva S, Göller K, Marx N, Mischke K, Karges W. QTc-Prolongation als Folge der insulininduzierten Hypoglykämie: Resultate einer interventionellen Studie in 119 Patienten. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375009] [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: 10/25/2022]
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Kacheva S, Segiet H, Streetz-van der Werf C, Karges W. Development of an ELISA Assay suitable for measurement of human plasma Oxytocin. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372158] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
The aim of this study was to systematically assess health care utilisation, diagnostic delay and psychosocial impairment in patients with acromegaly in rural versus urban health care environments. 41 patients with acromegaly were questioned to time lapse of symptom onset, first seeking medical advice and time of acromegaly diagnosis. Quality of life (QoL), and psychosocial impairment (depression, daytime sleepiness, sleep disturbances, disturbances of body image) were measured by self-assessment questionnaires. Patients were grouped into living in rural health care environments (RHCE, n = 22 patients) or urban health care environments (UHCE, n = 19 patients) using data on population density from the German Federal Statistical Office. RHCE patients waited significantly longer (2.5 vs. 0.89 years; p = .025) after symptom onset before seeking medical advice, but diagnosis of acromegaly was established at least as quickly as in UHCE (1.45 vs. 2.74 years; n.s.). There was a consistent trend toward more psychosocial impairment in UHCE which reached significance for sleep disturbances (p = .004). For all patients significant correlations between time delay of diagnostic process (defined as first visit to the doctor because of acromegaly-related symptoms and establishment of acromegaly diagnosis) and psychological QoL, depression, daytime sleepiness, sleep disorders and body image emerged. Patients with acromegaly in UHCE experienced more psychosocial impairment than patients in RHCE. The correlation of significantly increased psychosocial impairment and delay of diagnosis by the physician may reflect long-lasting embitterment in patients with acromegaly and should be considered during psychosocial counselling.
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Affiliation(s)
- Sonja Siegel
- Department of Neurosurgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
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Kolk K, Kacheva S, Brabant G, Morgenthaler NG, Karges W. The contribution of insulin induced hypoglycaemia to interaction between arginine vasopressin and corticotrope axis. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336687] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kacheva S, Fähndrich E, Karges W. 27-years of treatment of ACTH-dependent Cushing's syndrome with mitotane. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336693] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Dralle H, Musholt TJ, Schabram J, Steinmüller T, Frilling A, Simon D, Goretzki PE, Niederle B, Scheuba C, Clerici T, Hermann M, Kußmann J, Lorenz K, Nies C, Schabram P, Trupka A, Zielke A, Karges W, Luster M, Schmid KW, Vordermark D, Schmoll HJ, Mühlenberg R, Schober O, Rimmele H, Machens A. German Association of Endocrine Surgeons practice guideline for the surgical management of malignant thyroid tumors. Langenbecks Arch Surg 2013; 398:347-75. [PMID: 23456424 DOI: 10.1007/s00423-013-1057-6] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 01/30/2013] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Over the past years, the incidence of thyroid cancer has surged not only in Germany but also in other countries of the Western hemisphere. This surge was first and foremost due to an increase of prognostically favorable ("low risk") papillary thyroid microcarcinomas, for which limited surgical procedures are often sufficient without loss of oncological benefit. These developments called for an update of the previous practice guideline to detail the surgical treatment options that are available for the various disease entities and tumor stages. METHODS The present German Association of Endocrine Surgeons practice guideline was developed on the basis of clinical evidence considering current national and international treatment recommendations through a formal expert consensus process in collaboration with the German Societies of General and Visceral Surgery, Endocrinology, Nuclear Medicine, Pathology, Radiooncology, Oncological Hematology, and a German thyroid cancer patient support organization. RESULTS The practice guideline for the surgical management of malignant thyroid tumors includes recommendations regarding preoperative workup; classification of locoregional nodes and terminology of surgical procedures; frequency, clinical, and histopathological features of occult and clinically apparent papillary, follicular, poorly differentiated, undifferentiated, and sporadic and hereditary medullary thyroid cancers, thyroid lymphoma and thyroid metastases from primaries outside the thyroid gland; extent of thyroidectomy; extent of lymph node dissection; aerodigestive tract resection; postoperative follow-up and surgery for recurrence and distant metastases. CONCLUSION These evidence-based recommendations for surgical therapy reflect various "treatment corridors" that are best discussed within multidisciplinary teams and the patient considering tumor type, stage, progression, and inherent surgical risk.
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Affiliation(s)
- Henning Dralle
- Department of General, Visceral and Vascular Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06097, Halle, Saale, Germany.
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Jansen J, Rosenkranz E, Overbeck S, Warmuth S, Mocchegiani E, Giacconi R, Weiskirchen R, Karges W, Rink L. Disturbed zinc homeostasis in diabetic patients by in vitro and in vivo analysis of insulinomimetic activity of zinc. J Nutr Biochem 2012; 23:1458-66. [PMID: 22402369 DOI: 10.1016/j.jnutbio.2011.09.008] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 08/17/2011] [Accepted: 09/19/2011] [Indexed: 02/04/2023]
Abstract
Disturbances of zinc homeostasis have been observed in several diseases, including diabetes mellitus. To further characterize the association between zinc and diabetes, we recruited 75 patients with type 1 or type 2 diabetes and 75 nondiabetic sex-/age-matched control subjects in order to analyze differences concerning human zinc transporter 8 (hZnT-8) expression, single nucleotide polymorphisms (SNPs) in the genes of hZnT-8 as well as metallothionein 1A and serum/intracellular zinc. Furthermore, we investigated the relation between insulin and zinc homeostasis in type 2 diabetic subjects and consolidated our results by in vitro analysis of the effect of insulin on cellular zinc status and by analysis of the modulation of insulin signal transduction by intracellular zinc homeostasis. Concerning the expression of hZnT-8 and the SNPs analyzed, we did not observe any differences between diabetic and control subjects. Serum zinc was significantly lower in diabetic patients compared to controls, and intracellular zinc showed the same tendency. Interestingly, type 2 diabetes patients treated with insulin displayed lower serum zinc compared to those not injecting insulin. In vitro analyses showed that insulin leads to an increase in intracellular zinc and that insulin signaling was enhanced by elevated intracellular zinc concentrations. In conclusion, we show that type 1 and type 2 diabetic patients suffer from zinc deficiency, and our results indicate that zinc supplementation may qualify as a potential treatment adjunct in type 2 diabetes by promoting insulin signaling, especially in zinc-deficient subjects.
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Affiliation(s)
- Judith Jansen
- Institute of Immunology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
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Karges B, Schnur D, Ellard S, Kentrup H, Karges W. Diabetes infolge ABCC8/SUR1 Gen-Mutation: effektive Therapie mit Glimepirid. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277399] [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: 10/18/2022]
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Musholt TJ, Clerici T, Dralle H, Frilling A, Goretzki PE, Hermann MM, Kußmann J, Lorenz K, Nies C, Schabram J, Schabram P, Scheuba C, Simon D, Steinmüller T, Trupka AW, Wahl RA, Zielke A, Bockisch A, Karges W, Luster M, Schmid KW. German Association of Endocrine Surgeons practice guidelines for the surgical treatment of benign thyroid disease. Langenbecks Arch Surg 2011; 396:639-49. [DOI: 10.1007/s00423-011-0774-y] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 03/01/2011] [Indexed: 01/31/2023]
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