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Kramer G, Kuniss N, Kloos C, Lehmann T, Müller N, Sämann A, Wolf G, Müller UA. Metabolic control and hypoglycaemia in people with type 2 diabetes on conventional or intensified insulin therapy: a 22 year retrospective single centre survey. Diabetes Metab Res Rev 2016; 32:652-8. [PMID: 26789274 DOI: 10.1002/dmrr.2783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 12/07/2015] [Accepted: 12/27/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Multiple insulin injection therapy can easily be adapted to the patient's needs. Therefore, it is supposed that more intensive insulin therapy is associated with better metabolic control and less hypoglycaemia compared with a conventional insulin strategy in patients with type 2 diabetes. METHODS HbA1c and incidence of non-severe and severe hypoglycaemia were analysed with regard to the strategy of insulin therapy [multiple insulin injection therapy with preprandial insulin with or without basal insulin or conventional insulin therapy with twice-daily premix insulin] from 20 943 visits of 1417 people treated with insulin with type 2 diabetes in a university outpatient department for endocrinology and metabolic diseases over a period of 22 years. RESULTS Multiple insulin injection therapy was used in 13 896 (66.4%) of all 20 942 visits. Compared with conventional insulin therapy, these patients were younger (62.0 vs 68.7 years; p < 0.001), had a slightly longer diabetes duration (16.5 vs 15.8 years; p < 0.001) and higher body mass index (32.8 vs 30.9 kg/m(2) ; p < 0.001), a higher insulin dose (76.4 vs 46.5 IU/day; p < 0.001), more frequent blood glucose monitorings/week (24.2 vs 14.8; p < 0.001), a slightly lower HbA1c [7.7 (61.2) vs 7.9% (62.9 mmol/mol); p < 0.001] but more non-severe hypoglycaemic incidences per week (0.3 vs 0.2; p = 0.01). Episodes of severe hypoglycaemia were rare and comparable (0.01/patient/year) with both insulin therapy strategies. CONCLUSIONS Multiple insulin injection therapy and conventional insulin therapy yielded comparable metabolic control with HbA1c below 8% (63.9 mmol/mol), but multiple insulin injection therapy is associated with higher body mass index and higher incidence of non-severe hypoglycaemia. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- G Kramer
- Department Internal Medicine III, Jena University Hospital, Jena, Germany
| | - N Kuniss
- Department Internal Medicine III, Jena University Hospital, Jena, Germany
| | - C Kloos
- Department Internal Medicine III, Jena University Hospital, Jena, Germany
| | - T Lehmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany
| | - N Müller
- Department Internal Medicine III, Jena University Hospital, Jena, Germany
| | - A Sämann
- Department Internal Medicine III, Jena University Hospital, Jena, Germany
| | - G Wolf
- Department Internal Medicine III, Jena University Hospital, Jena, Germany
| | - U A Müller
- Department Internal Medicine III, Jena University Hospital, Jena, Germany
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Kloos C, Müller N, Hartmann P, Lehmann T, Sämann A, Roth J, Wolf G, Müller UA. High Quality of Diabetes Care Based Upon Individualised Treatment Goals - A Cross Sectional Study in 4784 Patients in Germany. Exp Clin Endocrinol Diabetes 2016; 124:294-9. [PMID: 26824283 DOI: 10.1055/s-0035-1569380] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Recent guidelines recommend an individualized approach towards patients with diabetes mellitus. Data of a programme dealing with quality of diabetes care, "Diabetes TÜV" of the Deutsche BKK was reappraised in the light of recent evidence applying these recommendations. PATIENTS AND METHODS Data originates from a population-based study in primary diabetes care in Germany. Patients with diabetes mellitus insured by the Deutsche BKK were invited to participate. From 2000 to 2004 data of 4 784 patients participated. Double or multiple visits were not included. HbA1c was analysed in 0.5% categories and in age groups below and above 70 years. HbA1c was DCCT adjusted. RESULTS A total of 368 patients with diabetes mellitus type 1 (DM1) (42% women, HbA1c 54 mmol/mol (7.1%), BP 136/79 mmHg) and 4 416 patients with diabetes type 2 (DM2) (44% women, HbA1c 48.6 mmol/mol (6.6%), BP 142/81 mmHg) were included.). An HbA1c of 53 mmol/mol (7%) or less was found in 70%, less than 64 mmol/mol (8%) in 87% of all patients, and higher than 86 mmol/mol (10%) in 2.8%. The detailed analysis shows that an HbA1c of <=47.6 mmol/mol (6.5%) is achieved of 38% of people with DM1 and 56% with DM2, an HbA1c <=66 mmol/mol (8.0%) of 79% and 88%, respectively.The mean systolic blood pressure (BP) was 142 mmHg, the diastolic BP was 81 mmHg. Systolic BP increased with age (systolic BP: < 50 years 131 mmHg; 50-70 years 142 mmHg; > 70 years 144 mmHg/diastolic BP: < 50 years 81 mmHg; 50-70 years 82 mmHg; > 70 years 80 mmHg). Using WHO grading, BP is mainly mildly elevated (grade 1: 41% (n=1942); grade 2, 17% (n=820) grade 3 6% (n=281). In 10 patients (0.2%) HbA1c above 86 mmol/mol (10.0%) coincides with a BP WHO grade 3. CONCLUSIONS In recent years new evidence is available regarding treatment targets. The reappraisal of a cross sectional study of a quality assurance programme of a German health insurance in a differentiated way demonstrates that more than 2/3 of the people with diabetes mellitus meet their specific goals. Only very few patients are at imminent risk due to bad glycaemic control and high blood pressure. Old patients may be at risk of overtreatment. Strategies aiming at adapting pharmacological interventions in older patients must be conceived.
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Affiliation(s)
- C Kloos
- Endocrinology and Metabolic Diseases, University Hospital Jena, Jena, Germany
| | - N Müller
- Endocrinology and Metabolic Diseases, University Hospital Jena, Jena, Germany
| | | | - T Lehmann
- Computer Sciences and Documentation, Institute of Medical Statistics, University Hospital Jena, Jena, Germany
| | - A Sämann
- Practice for Dialysis, Saalfeld, Germany
| | - J Roth
- Endocrinology and Metabolic Diseases, University Hospital Jena, Jena, Germany
| | - G Wolf
- Endocrinology and Metabolic Diseases, University Hospital Jena, Jena, Germany
| | - U A Müller
- Endocrinology and Metabolic Diseases, University Hospital Jena, Jena, Germany
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Neumann T, Lodes S, Kästner B, Franke S, Kiehntopf M, Lehmann T, Müller UA, Wolf G, Sämann A. Osteocalcin, adipokines and their associations with glucose metabolism in type 1 diabetes. Bone 2016; 82:50-5. [PMID: 25888930 DOI: 10.1016/j.bone.2015.04.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 02/16/2015] [Revised: 03/27/2015] [Accepted: 04/08/2015] [Indexed: 01/26/2023]
Abstract
To determine osteocalcin (OC) and adipokines in type 1 diabetes (T1D) and healthy controls, and to explore possible associations between glucose and bone metabolism, body composition and adipokines. Serum levels of total OC, undercarboxylated (UC-OC), leptin, adiponectin, and other parameters of glucose and bone metabolism were measured in 128 patients with T1D (mean duration 21.2years) and in 77 healthy controls, matched for gender, age, and body mass index (BMI). Partial correlations (adjusted for age and gender) with parameters of body composition (BMI, fat body mass [derived from bone mineral density scans]), glycaemic control (hemoglobin A1c (HbA1c), daily insulin dose in T1D), skeletal homeostasis (osteoprotegerin (OPG), receptor activator of NF-κB ligand (RANKL), all measured in serum), and serum insulin-like growth factor 1 (IGF-1) were also examined. Independent predictors of total and UC-OC were then explored. Total OC was lower in males with T1D (16.3±6.4 vs. 22.2±9.9ng/ml; p=0.001), whereas UC-OC did not show group differences. Adiponectin was higher in T1D patients, both for males and females (8.9±6.6 vs. 5.7±2.5μg/ml; p=0.004 and 13.8±6.4 vs. 8.8±4.0μg/ml; p<0.001). IGF-1 was lower only in females with T1D (146.6±68.8 vs. 203.0±74.4ng/ml; p<0.001). BMI and fat body mass were similar in T1D and controls. In T1D patients, total OC was inversely correlated with BMI and HbA1c, and UC-OC inversely correlated with HbA1c. In T1D patients, leptin positively correlated with BMI, fat body mass and daily insulin dose, while adiponectin inversely correlated with BMI and daily insulin dose. Multivariate regression modelling showed that determinants of higher total OC levels were male gender (p=0.04, ß-coefficient=2.865) and lower HbA1c (p=0.04, ß-coefficient=-0.117), whereas determinants of UC-OC levels were T1D (p=0.016, ß-coefficient=2.015), higher IGF-1 (p=0.004, ß-coefficient=0.011) and lower HbA1c (p=0.011, ß-coefficient=- 0.061). Total OC and UC-OC are associated with good glycaemic control in T1D, with gender-specific differences for total-OC. The association of leptin and adiponectin with glycaemic control, as observed in controls, does not seem to be a feature in T1D, although both adipokines appear to be related to the insulin demand. This article is part of a Special Issue entitled "Bone and diabetes".
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Affiliation(s)
- T Neumann
- Department of Internal Medicine III, Jena University-Hospital, Jena, Germany.
| | - S Lodes
- Department of Internal Medicine III, Jena University-Hospital, Jena, Germany
| | - B Kästner
- Department of Internal Medicine III, Jena University-Hospital, Jena, Germany
| | - S Franke
- Department of Internal Medicine III, Jena University-Hospital, Jena, Germany
| | - M Kiehntopf
- Institute of Clinical Chemistry and Laboratory Diagnostics, Jena University-Hospital, Jena, Germany
| | - T Lehmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University-Hospital, Jena, Germany
| | - U A Müller
- Department of Internal Medicine III, Jena University-Hospital, Jena, Germany
| | - G Wolf
- Department of Internal Medicine III, Jena University-Hospital, Jena, Germany
| | - A Sämann
- Department of Internal Medicine III, Jena University-Hospital, Jena, Germany
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Neumann T, Lodes S, Kästner B, Lehmann T, Hans D, Lamy O, Müller UA, Wolf G, Sämann A. Trabecular bone score in type 1 diabetes--a cross-sectional study. Osteoporos Int 2016; 27:127-33. [PMID: 26187124 DOI: 10.1007/s00198-015-3222-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [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: 02/24/2015] [Accepted: 06/23/2015] [Indexed: 12/21/2022]
Abstract
UNLABELLED Trabecular bone score (TBS) seems to provide additive value on BMD to identify individuals with prevalent fractures in T1D. TBS did not significantly differ between T1D patients and healthy controls, but TBS and HbA1c were independently associated with prevalent fractures in T1D. A TBS cutoff <1.42 reflected prevalent fractures with 91.7 % sensitivity and 43.2 % specificity. INTRODUCTION Type 1 diabetes (T1D) increases the risk of osteoporotic fractures. TBS was recently proposed as an indirect measure of bone microarchitecture. This study aimed at investigating the TBS in T1D patients and healthy controls. Associations with prevalent fractures were tested. METHODS One hundred nineteen T1D patients (59 males, 60 premenopausal females; mean age 43.4 ± 8.9 years) and 68 healthy controls matched for gender, age, and body mass index (BMI) were analyzed. The TBS was calculated in the lumbar region, based on two-dimensional (2D) projections of DXA assessments. RESULTS TBS was 1.357 ± 0.129 in T1D patients and 1.389 ± 0.085 in controls (p = 0.075). T1D patients with prevalent fractures (n = 24) had a significantly lower TBS than T1D patients without fractures (1.309 ± 0.125 versus 1.370 ± 0.127, p = 0.04). The presence of fractures in T1D was associated with lower TBS (odds ratio = 0.024, 95 % confidence interval (CI) = 0.001-0.875; p = 0.042) but not with age or BMI. TBS and HbA1c were independently associated with fractures. The area-under-the curve (AUC) of TBS was similar to that of total hip BMD in discriminating T1D patients with or without prevalent fractures. In this set-up, a TBS cutoff <1.42 discriminated the presence of fractures with a sensitivity of 91.7 % and a specificity of 43.2 %. CONCLUSIONS TBS values are lower in T1D patients with prevalent fractures, suggesting an alteration of bone strength in this subgroup of patients. Reliable TBS cutoffs for the prediction of fracture risk in T1D need to be determined in larger prospective studies.
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Affiliation(s)
- T Neumann
- Department of Internal Medicine III, Erlanger Allee 101, Jena University Hospital, 07747, Jena, Germany.
| | - S Lodes
- Department of Internal Medicine III, Erlanger Allee 101, Jena University Hospital, 07747, Jena, Germany
| | - B Kästner
- Department of Internal Medicine III, Erlanger Allee 101, Jena University Hospital, 07747, Jena, Germany
| | - T Lehmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany
| | - D Hans
- Bone Disease Unit, University of Lausanne, Lausanne, Switzerland
| | - O Lamy
- Bone Disease Unit, University of Lausanne, Lausanne, Switzerland
| | - U A Müller
- Department of Internal Medicine III, Erlanger Allee 101, Jena University Hospital, 07747, Jena, Germany
| | - G Wolf
- Department of Internal Medicine III, Erlanger Allee 101, Jena University Hospital, 07747, Jena, Germany
| | - A Sämann
- Department of Internal Medicine III, Erlanger Allee 101, Jena University Hospital, 07747, Jena, Germany
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Neumann T, Lodes S, Kästner B, Franke S, Kiehntopf M, Lehmann T, Müller UA, Wolf G, Sämann A. High serum pentosidine but not esRAGE is associated with prevalent fractures in type 1 diabetes independent of bone mineral density and glycaemic control. Osteoporos Int 2014; 25:1527-33. [PMID: 24599273 DOI: 10.1007/s00198-014-2631-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [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: 11/13/2013] [Accepted: 01/28/2014] [Indexed: 12/12/2022]
Abstract
UNLABELLED Fracture risk in type 1 diabetes (T1D) is supposed to be underestimated by bone mineral density (BMD). Individuals with T1D had more prevalent fractures in a cross-sectional study. Serum levels of pentosidine, an advanced glycation end product, and poor glycaemic control were associated with prevalent fractures independent of BMD. INTRODUCTION Type 1 diabetes (T1D) is associated with increased fracture risk. Bone mineral density (BMD) underestimates the risk of fractures in some individuals. The accumulation of advanced glycation end products (AGEs) impairs bone matrix and reduces bone strength. METHODS In a cross-sectional study, 128 men and premenopausal women with T1D were evaluated. We compared traditional risk factors for fractures, BMD, parameters of bone metabolism and AGEs in individuals with and without prevalent fractures. An independent association of serum AGE levels with prevalent fractures was investigated. RESULTS Individuals with prevalent fractures exhibited a longer duration of T1D, higher HbA1c and more diabetic-related complications. BMD at the femoral neck (z-score -0.76 ± 0.94 vs. -0.23 ± 1.02; p = 0.031) and total hip (z-score -0.54 ± 0.93 vs. 0.11 ± 1.11; p = 0.017) was lower in those with prevalent fractures. Individuals with fractures had higher pentosidine levels (164.1 ± 53.6 vs. 133.2 ± 40.4; p = 0.002). The levels of N-ε-(carboxymethyl)-lysine (CML) and endogenous secretory receptor for AGEs (esRAGE) did not significantly differ. Multivariate logistic regression analysis adjusted for age, BMI, family history of fractures, smoking, vitamin D deficiency, BMD at lumbar spine, femoral neck and total hip identified pentosidine levels and HbA1c as independent factors associated with prevalent fractures (odds ratio 1.02, 95% CI 1.00-1.03/pmol/ml increase of pentosidine; p = 0.008 and odds ratio 1.93, 95% CI 1.16-3.20 per percentage increase of HbA1c; p = 0.011). CONCLUSIONS The pentosidine levels but not BMD are independently associated with prevalent fractures. Impaired bone quality in T1D may result from increased AGE formation.
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Affiliation(s)
- T Neumann
- Department of Internal Medicine III, Jena University Hospital, Erlanger Allee 101, 07747, Jena, Germany,
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Abstract
Diabetic nephropathy can impact on quality of life, morbidity and mortality of affected patients. The prognosis can be improved by early diagnosis and therapy. The association between renal insufficiency, cardiovascular morbidity and mortality is of importance. Annual nephropathy screening should involve the analyses of albuminuria and glomerular filtration rate (GFR). After having detected albuminuria or reduced GFR, renal ultrasound imaging and microscopic examination of the urine sediment is necessary. Patients with abnormal or ambiguous findings should be referred to a nephrologist and may require a renal biopsy. Patients with renal complications can benefit from a goal-orientated intervention involving an antidiabetic, antihypertensive and lipid-modifying therapy. The avoidance of potentially nephrotoxic prescriptions and a renal function dependent dose-adjustment of medications are of importance in patients with declining renal function.
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Affiliation(s)
- A Sämann
- Nephrologische Gemeinschaftspraxis, Rainweg 68, 07318, Saalfeld, Deutschland.
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Sämann A, Pofahl S, Lehmann T, Voigt B, Victor S, Möller F, Müller UA, Wolf G. Diabetic nephropathy but not HbA1c is predictive for frequent complications of Charcot feet - long-term follow-up of 164 consecutive patients with 195 acute Charcot feet. Exp Clin Endocrinol Diabetes 2012; 120:335-9. [PMID: 22421981 DOI: 10.1055/s-0031-1299705] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIMS To investigate the clinical characteristics, treatment and long-term outcome of patients with acute Charcot feet (CF). METHODS Single-center retrospective analysis. Treatment of CF: stage-dependent immobilization/weight-off therapy, orthopaedic/adjusted shoes, foot surgery. 164 consecutive participants (type 1 vs. type 2 diabetes): 12 vs. 150, non-diabetic peripheral neuropathy: n=2, presented with 195 (17 vs. 176) CF. Mean follow-up: 4.7 ± 2.5 (range 2.2-9.8) vs. 5.4 ± 2.9 (range 0.8-18.8) years, vital at follow-up: 100 vs. 88%. RESULTS Baseline characteristics: age: 43.7 ± 10.9 vs. 57.9 ± 8.9 years (p<0.001), male gender: 66.7 vs. 77.3%, diabetes duration: 19.2 ± 9.1 vs. 13 ± 8.6 years (p=0.018), GHb: 8.1 ± 2.4 vs. 7.6 ± 1.6%, BMI: 24 ± 5.3 vs. 33.7 ± 6.5 kg/m2 (p<0.001), Levine 1: 18.2 vs. 7.4%, Levine 2: 45.5 vs. 65.9%, Sanders 2: 58.3 vs. 68.5%, Sanders 3: 33.3 vs. 45%. THERAPY immobilization for 6 ± 4.2 vs. 5.4 ± 4.5 months, orthopaedic/adjusted shoes: 27.3 vs. 20.5%, foot surgery: 11.8 vs. 18.2%. Major complications: 50 vs. 56% (rocker bottom deformities: 23.5 vs. 46.3%, foot ulcerations: 17.6 vs. 24.6%, CF amputations: 0 vs. 6%), not CF amputations: 16.7 vs. 15.3%, second episodes of CF: 41.6 vs. 18.3% after 5-132 months. Diabetic nephropathy was associated with an increase, intensive antihypertensive therapy with a decrease of complications. CONCLUSIONS Patients with CF are middle-aged, overweight males with type 2 diabetes above 10 years. Patients with type 1 diabetes are younger, have normal BMI and longer diabetes duration. Major complications and second episodes of CF are frequent. Diabetic nephropathy could be a risk factor for CF related complications. The awareness for CF must be improved.The study was conducted due to the Declaration of Helsinki.
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Affiliation(s)
- A Sämann
- Clinic for Nephrology, Saalfeld, Germany.
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Neumann T, Sämann A, Lodes S, Kästner B, Franke S, Kiehntopf M, Hemmelmann C, Lehmann T, Müller UA, Hein G, Wolf G. Glycaemic control is positively associated with prevalent fractures but not with bone mineral density in patients with Type 1 diabetes. Diabet Med 2011; 28:872-5. [PMID: 21395677 DOI: 10.1111/j.1464-5491.2011.03286.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [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] [Indexed: 12/19/2022]
Abstract
AIM There are conflicting data regarding the risk of osteoporosis in patients with Type 1 diabetes. We investigated an association between diabetes, bone mineral density and prevalent fractures. METHODS A single-centre, cross-sectional study of men and pre-menopausal women with Type 1 diabetes (n = 128) and a matched control group (n = 77) was conducted. The primary outcome measure was bone mineral density and secondary measures were markers of bone metabolism and prevalent fractures. RESULTS Hip and total body bone mineral densities were significantly lower in women with diabetes compared with control subjects. In men, no difference in bone mineral density was found. A multivariate regression analysis in women with diabetes revealed higher BMI as the strongest predictor of higher total hip, femoral neck and total body bone mineral density, whereas previous fractures were inversely associated with total hip bone mineral density and C-terminal telopeptide of type I collagen with total body bone mineral density. Poor long-term glycaemic control was not associated with low bone mineral density. Fracture frequency was higher in patients with diabetes compared with control subjects (1.64 vs. 0.62 per 100 patient-years; P < 0.05). In a multivariable model, long-term HbA(1c) control was associated with increased clinical fracture prevalence (OR 1.92; 95% CI 1.09-2.75) in those with diabetes. CONCLUSIONS Type 1 diabetes contributes to low bone mineral density in women. Previous fractures and low BMI were strong predictors of impaired bone mineral density and should therefore be considered in risk estimation. Fractures are more frequent in Type 1 diabetes. Long-term hyperglycaemia may account for impaired bone strength, independently from bone mineral density.
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Affiliation(s)
- T Neumann
- Department of Medicine III, University-Hospital Jena, Jena, Germany.
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Sämann A, Lehmann T, Seeliger S, Kaiser J, Wolf G, Müller UA. HbA1c-Kartografierung – Evaluation eines neuartigen versorgungs-epidemiologischen Verfahrens zum Monitoring der Stoffwechselkontrolle von Patienten mit Diabetes mellitus. Gesundheitswesen 2009; 71:476-80. [DOI: 10.1055/s-0029-1202331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kloos C, Sämann A, Müller N, Müller UA. Der Behandlungserfolg von Patienten mit Diabetes mellitus Typ 2 nach Teilnahme an einem strukturieren Schulungs- und Behandlungsprogramm ändert sich nicht durch die Art der Weiterbetreuung. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1222102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rüster C, Sämann A, Wolf G. Nieren und Diabetes. Dtsch Med Wochenschr 2008; 133:1848-52. [DOI: 10.1055/s-0028-1082808] [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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Sämann A, Lehmann T, Kloos C, Braun A, Hunger-Dathe W, Wolf G, Müller UA. Flexible, intensive insulin therapy and dietary freedom in adolescents and young adults with Type 1 diabetes: a prospective implementation study. Diabet Med 2008; 25:592-6. [PMID: 18445173 DOI: 10.1111/j.1464-5491.2008.02406.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [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] [Indexed: 02/03/2023]
Abstract
AIMS To assess the outcome of a Diabetes Treatment and Teaching Programme (DTTP) on glycated haemoglobin (HbA1c), severe hypoglycaemia (SH) and severe ketoacidosis (SKA) in adolescents and young adults with Type 1 diabetes. METHODS Quality-assurance project with assessment of participants 1 year after participation in a DTTP (5-day inpatient course, groups < or = 10 patients, fixed curriculum of education/training, introduction of dietary freedom). Before-after analyses of participants aged 12-15, 15-18, 18-21 and 21-24 years. Main outcome measures were HbA1c, SH and SKA. RESULTS For the 1592 participants, aged 12 to 24 years, mean age at enrolment was 19 +/- 3 years, mean duration of diabetes was 7.3 +/- 5.4 (range 0.3-24) years, mean baseline HbA1c declined from 8.8 +/- 2.3% to 8.1 +/- 2.0%. The incidence of SH was 0.31 vs. 0.11 events/patient/year; the incidence of SKA 0.17 vs. 0.07 events/patient/year. In mixed effects models taking into account effects of centres, age and diabetes duration, the mean difference was -0.64%[P < 0.001, 95% confidence interval (CI) -0.79 to -0.5] for HbA1c, -0.2 events/patient/year (P < 0.0001, 95% CI -0.28 to -0.12) for SH and -0.1 events/patient/year (P < 0.0001, 95% CI -0.14 to -0.06) for SKA. CONCLUSIONS Adolescents and young adults with Type 1 diabetes benefit from participation in a standard DTTP for flexible, intensive insulin therapy and dietary freedom.
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Affiliation(s)
- A Sämann
- Department of Internal Medicine III, Friedrich-Schiller-University, Jena, Germany.
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Sämann A, Tajiyeva O, Müller N, Tschauner T, Hoyer H, Wolf G, Müller UA. Prevalence of the diabetic foot syndrome at the primary care level in Germany: a cross-sectional study. Diabet Med 2008; 25:557-63. [PMID: 18346154 DOI: 10.1111/j.1464-5491.2008.02435.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [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] [Indexed: 11/28/2022]
Abstract
AIMS The diabetic foot syndrome (DFS) is an important complication of diabetes mellitus resulting in amputations, disability and reduced quality of life. DFS is preventable. The aim was to investigate the prevalence of the DFS at the primary care level in Germany. METHODS This was a cross-sectional study of the prevalence of DFS, associated factors and glycaemic control at the primary care level in Germany. We examined an unselected sample of participants with known diabetes who were insured by Deutsche BKK, a large healthcare insurer. RESULTS Three hundred and forty-one general practitioners examined 4778 participants with diabetes mellitus: 366 (7.7%) participants (mean age 49 +/- 16 years) had Type 1 and 4412 participants (mean age 66 +/- 10 years) had Type 2 diabetes. DFS was diagnosed in 138 patients, resulting in a prevalence of 3.6%[95% confidence interval (CI) 1.9, 6.0] in Type 1 and 2.8% (95% CI 2.3, 3.4) in Type 2 diabetes. DFS was independently associated with age, duration of diabetes, height, current smoking and insulin therapy. There was no significant effect of glycaemic control on the risk of DFS. The prevalence of other abnormal foot findings was: peripheral neuropathy 9.7%, peripheral arterial disease 14.8% (absent dorsalis pedis), 12.4% (absent tibialis posterior), acute diabetic foot ulcer 0.8%, amputations of lower extremities 1.5%, and amputations limited to toes 0.5%. CONCLUSIONS The prevalence of the DFS at the primary care level in Germany is 2.9%. Almost 50% of patients with DFS had major or minor amputations. Common risk factors such as hyperkeratosis and poor glycaemic control can be modified. Effective therapeutic approaches in addition to methods for primary and secondary prevention of DFS should be used more widely.
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Affiliation(s)
- A Sämann
- Department of Internal Medicine III, Friedrich-Schiller-University Jena, Germany
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Kloos C, Sämann A, Müller N, Müller UA. Telefonische Datenerfassung kann bei Nachuntersuchung eine vergleichbare Datenqualität bei Evaluation einer Schulungsintervention bringen – eine Querschnittsanalyse von Mitgliedseinrichtungen der AKD* der Jahre 2005–2007 ein Jahr nach absolviertem strukturierten Schulungs- und Behandlungsprogramm. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076318] [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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Kloos C, Sämann A, Müller N, Müller UA. Patienten mit Diabetes mellitus Typ 2 und Migrationshintergrund profitieren weniger von der Teilnahme an einem strukturieren Schulungs- und Behandlungsprogramm – eine Querschnittsanalyse von Mitgliedseinrichtungen der AKD* der Jahre 2005–2007 *Arbeitsgemeinschaft Klinische Diabetologie der DDG. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076317] [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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Lodes S, Neumann T, Sämann A, Kästner B, Hemmelmann C, Kloos C, Hein G, Wolf G, Müller UA. Die Knochendichte bei Patienten mit Typ-1-Diabetes ist nicht assoziiert mit der Qualität der langfristigen Stoffwechselkontrolle. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076461] [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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Sämann A, Müller N, Müller UA. Die Prävalenz des diabetischen Fußsyndroms sowie spezifischer Risikofaktoren und Komplikationen auf hausärztlicher Ebene – versorgungsepidemiologische Daten des Diabetes-TÜV der Deutschen BKK 2004–2006. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076386] [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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Kloos C, Sämann A, Müller N, Müller U. Pumpentherapie (CSII) ist bei Patienten mit Diabetes mellitus Typ 2 ohne Benefit – eine Querschnittsanalyse von Evaluationen von Mitgliedskliniken der AKD* der Jahre 2005–2007 ein Jahr nach Teilnahme an einem strukturierten Schulungs- und Behandlungsprogramm. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076483] [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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Abstract
Insulinomas are the most common pancreatic islet cell tumours and are characterised by uncontrolled insulin secretion even in the presence of hypoglycaemia. Diagnosis is usually made by the detection of endogenous hyperinsulinism over a period of fasting. We report the case of a patient with insulinoma without hyperinsulinaemia. A secretion and overexpression of split insulin has to be discussed. The diagnosis was made by endoscopic ultrasound-guided fine-needle aspiration and the immunohistochemical detection of chromogranine. In conclusion, the present report demonstrates that insulinomas should be considered and searched for in every case of hypoglycaemia, even when associated with normal insulin levels. It also confirms the essential role of endoscopic ultrasonography in the diagnosis of insulin-secreting tumors.
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Affiliation(s)
- W Hunger-Dathe
- Klinik für Innere Medizin III, Friedrich-Schiller-Universität Jena, 07740, Jena, Deutschland.
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Kloos C, Sämann A, Müller N, Tessmann D, Müller U. Kombinationstherapie mit Metformin führt im Vergleich zu einem besseren HbA1c, bei geringerer Zunahme des BMI und geringerem Insulinbedarf, als die alleinige Therapie mit Insulin – eine Querschnittsanalyse von Evaluationen von Mitgliedskliniken der AKD+ der Jahre 2005–2006 ein Jahr nach Teilnahme an einem strukturierten Schulungs- und Behandlungsprogramm – (+Arbeitsgemeinschaft Klinische Diabetologie der DDG). DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982126] [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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Kloos C, Sämann A, Tessmann D, Müller N, Müller U. Insulinanaloga verbessern den HbA1c im Vergleich zu Humaninsulin nicht – eine Querschnittsanalyse von Evaluationen von Mitgliedskliniken der AKD+ der Jahre 2005–2006 ein Jahr nach Teilnahme an einem strukturierten Schulungs- und Behandlungsprogramm (SSBP) (+Arbeitsgemeinschaft Klinische Diabetologie der DDG). DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982237] [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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Sämann A, Schmidt P, Boettcher J, Kaiser WA, Wolf G, Müller UA. Kontinuierliche cerebrale diffusions-gewichtete MRT während insulin-induzierter Hypoglykämie. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982444] [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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Kloos C, Sämann A, Müller N, Tessmann D, Fischer H, Jecht M, Müller U. Strukturierte Schulungsprogramme (STP) sind hochwirksame Instrumente zur Verbesserung des Stoffwechsels bei jüngeren und älteren Patienten mit Diabetes mellitus Typ 2– eine Analyse von Evaluationen von Mitgliedskliniken der AKD der Jahre 2000–2006 ein Jahr nach Teilnahme an einem strukturierten Schulungs- und Behandlungsprogramm. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982105] [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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Abstract
AIM Prevalence of glucose metabolism disorders in women six years after gestational diabetes in the index pregnancy (GDM). METHOD 227 Caucasian women who developed GDM between 1995 and 1996 were investigated; 173 women (BMI 27.5+/-6.0 kg/m2) received 75 g oGGT on average 5.8+/-2.0 years after delivery. RESULTS Impaired glucose metabolism was found in 31.2%, IGT or IFG 19.1%, diabetes mellitus type 2 (DM2) 9.2%, diabetes mellitus type 1 (DM1) 2.3%, second GDM 0.6%. 27.2% (BMI 25-29.9 kg/m2) were overweight, 23.1% suffered from obesity (BMI 30-39.9 kg/m2) and 5.2% morbid obesity (BMI>or=40 kg/m2). In comparison to a healthy control group, women with DM2 at re-examination were: older in age (32.1+/-5.9 vs. 29.1+/-4.8 years, p<0.05), had higher BMI (29.4+/-6.9 vs. 24.6+/-4.8 kg/m2, p<0.05), higher fasting blood glucose (6.5+/-1.9 vs. 5.2+/-0.9 mmol/l, p<0.05), earlier diagnosis of GDM (25+/-8 vs. 29+/-5 SSW, p<0.05), more frequent insulin therapy during pregnancy (75 vs. 24%) and had significantly higher insulin- and C-peptide for all measures of the oGTT, whereas HbA1c was not different (4.9+/-0.5 vs. 4.8+/-0.3%, n. s.). CONCLUSION In an average of 5.8 years after the diagnosis of GDM, the majority of women still have chronic insulin resistance. One third has either IGT, IFG or diabetes mellitus. Therefore, a long term follow-up is strongly recommended for women diagnosed with GDM.
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Affiliation(s)
- W Hunger-Dathe
- Friedrich-Schiller University of Jena, Department of Internal Medicine III, Jena, and Hufeland-Hospital GmbH, Bad Langensalza, Germany.
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Sämann A, Nordmann S, Kaiser J, Hunger-Dathe W, Kloos C, Braun A, Müller UA. Evaluation der Diabetes-Karte für Thüringen – Ein Projekt zur kontinuierlichen Evaluierung und Optimierung der Behandlungsqualität in der primären Versorgung von Patienten mit Diabetes mellitus in Thüringen. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-944088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sämann A, Müller N, Kloos C, Tschauner T, Müller UA. Inzidenz sowie Begleitfaktoren schwerer Hypoglykämien bei Diabetes mellitus – versorgungsepidemiologischen Daten des Diabetes-TÜV der Deutschen BKK. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-944102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sämann A, Mühlhauser I, Bender R, Kloos C, Müller UA. Glycaemic control and severe hypoglycaemia following training in flexible, intensive insulin therapy to enable dietary freedom in people with type 1 diabetes: a prospective implementation study. Diabetologia 2005; 48:1965-70. [PMID: 16132954 DOI: 10.1007/s00125-005-1905-1] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.7] [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: 01/06/2005] [Accepted: 06/02/2005] [Indexed: 10/25/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to evaluate the implementation of a course teaching flexible, intensive insulin therapy on glycaemic control and severe hypoglycaemia in routine care. METHODS This is a continuous quality-assurance project involving hospital diabetes centres. Every third year each centre re-examines 50 consecutive patients (evaluation sample) 1 year after participation in the course. Ninety-six diabetes centres in Germany participated and 9,583 patients with type 1 diabetes (190 evaluation samples) were re-examined between 1992 and 2004. The intervention was a 5-day inpatient course for groups of up to ten patients with a fixed curriculum of education and training for dietary flexibility and insulin adjustment. The main outcome measures were HbA1c and severe hypoglycaemia. RESULTS Mean baseline HbA1c was 8.1%, and had decreased to 7.3% at follow-up; incidence of severe hypoglycaemia was 0.37 events per patient per year prior to intervention and 0.14 after intervention. In mixed-effects models adjusted for effects of centres, age and diabetes duration, the mean difference was -0.7% (95% CI -0.9 to -0.6%, p<0.0001) for HbA1c and -0.21 events per patient per year (95% CI -0.32 to -0.11, p=0.0001) for severe hypoglycaemia, with similar results for evaluation samples, with a maximum of 10% of patients lost to follow-up. Before intervention, the incidence of severe hypoglycaemia was three-fold higher in the lowest quartile than in the highest quartile of HbA1c, whereas the risk was comparable across the range of HbA1c values after intervention. CONCLUSIONS/INTERPRETATION Implemented as part of a continuous quality-assurance programme the self-management programme is effective and safe in routine care. Improvement of glycaemic control can be achieved without increasing the risk of severe hypoglycaemia.
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Affiliation(s)
- A Sämann
- Department of Internal Medicine III, Friedrich Schiller University, Erlanger Allee 101, D-07740, Jena, Germany.
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Hunger-Dathe W, Mosebach N, Sämann A, Schulz J, Müller UA, Wolf G. Prävalenz einer Glukosetoleranzstörung und Adipositas von Kindern im Alter von 6 Jahren nach Gestationsdiabetes der Mutter in der Indexgravidität. Geburtshilfe Frauenheilkd 2005. [DOI: 10.1055/s-2005-872865] [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] Open
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Hunger-Dathe W, Seewald J, Wolf G, Sämann A, Seewald HJ, Schleußner E, Müller UA, Stein G. Kohortenstudie zum prognostischen Stellenwert von Nierenfunktionsparametern bei Risikoschwangerschaften (Hypertonie, Diabetes mellitus Typ 1, Gestationsdiabetes). Geburtshilfe Frauenheilkd 2005. [DOI: 10.1055/s-2005-837614] [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] Open
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Hunger-Dathe W, Volk K, Braun A, Sämann A, Müller UA, Peiker G, Hüller M. Perinatal Morbidity in Women with Undiagnosed Gestational Diabetes in Northern Thuringia in Germany. Exp Clin Endocrinol Diabetes 2005; 113:160-6. [PMID: 15789275 DOI: 10.1055/s-2005-837517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Undiagnosed gestational diabetes mellitus (GDM) is associated with severe perinatal complications. PATIENTS AND METHODS Out of 970 women, infant and maternal morbidity was assessed in 114 mother-children-pairs with an infant birth weight over the 90th percentile (Voigt et al., 1996). It was the aim of this retrospective study to assess the number of mothers with undiagnosed GDM, who have born a macrosomic child. RESULTS The macrosomia rate in newborns was 12 % in this study excluding macrosomic infants of mothers with preexisting diabetes mellitus. Maternal data: Age 28.3 +/- 5.3 years, adipositas (body-mass-index > 30 kg/m) in 42.1 % vs. 30.4 % in the peer group (p < 0.02), increase in weight > 15 kg during pregnancy in 57.9 % of the mothers who have given birth to a macrosomic child vs. 30.9 % in the peer group (p < 0.0001), family history of diabetes mellitus (28.0 % vs. 11.3 % in the peer group, p = 0.006), preeclampsia in 8.8 % vs. 2.7 % in the peer group (p = 0.002), cervical insufficiency in 2.6 % vs. 0.4 % in the peer group (p = 0.02). After delivery HbA1c was elevated in 38.6 % of the women having born macrosomic infant (mean HbA1c: 5.0 % +/- 0.5). Infant data: neonatal jaundice 16.7 % vs. 4.5 % in the peer group, p < 0.0001. There were no statistically significant differences concerning perinatal condition and malformations. Neonatal hypoglycaemia occurred in 9.6 % of the macrosomic infants. Cord blood insulin levels were significantly elevated in comparison to the peer group of mothers without metabolic disorders and having born eutroph infants (8.4 mU/l [3.0 - 100.0] vs. 5.3 mU/l [3.0 - 30.7], p = 0.01). 11.4 % of all macrosomic infants had cord blood insulin levels above the normal range. CONCLUSION More than one third of the mothers having born one or more macrosomic infants had an impairment of glucose metabolism immediately after birth. The elevated prevalence of preeclampsia in this group confirms the relationship of hypertension and impaired glucose metabolism during pregnancy. The detection of hyperinsulinaemia, postnatal hypoglycaemia, elevated prevalence of neonatal jaundice with need of further therapy and diabetic fetopathy in macrosomic infants of mothers, whose metabolism was not monitored during pregnancy, pinpoint the need for a diagnostic screening for GDM.
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Affiliation(s)
- W Hunger-Dathe
- Department of Internal Medicine III, Friedrich-Schiller University of Jena, Jena, Germany.
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Sämann A, Kaiser J, Hunger-Dathe W, Schiel R, Müller UA. Population-Based Measurement of Quality of Diabetes Care Using HbA1c Values in the State of Thuringia/Germany. Exp Clin Endocrinol Diabetes 2004; 112:531-7. [PMID: 15505762 DOI: 10.1055/s-2004-821311] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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] [Indexed: 10/26/2022]
Abstract
INTRODUCTION/HYPOTHESIS There remains insufficient knowledge about the quality of diabetes therapy regarding structure, process and outcome given by primary care in Thuringia, and elsewhere in Germany. The project assesses a means of determining the quality of diabetes therapy in primary care by analysis of HbA1c values within a broad territory. METHODS HbA1c tests of Thuringian patients were analysed by 20 participating medical laboratories between January 1 and March 31, 2002; each HbA1c test was identified by the postal code of the Thuringian General Practitioner (GP) who ordered the test and adjusted by a standardisation procedure (mean normal of healthy subjects 5 %). The German state of Thuringia (population of 2,421,871) consists of 23 urban and rural districts. This format was also used in the present study. RESULTS Twenty participating laboratories contributed 59,702 HbA1c tests from diabetic patients in Thuringia. Adjusted mean HbA1c of entire Thuringia: 6.75 %, 36.4 % of all HbA1c tests were above 7.0 % and 3,0 % of all HbA1c values above 10.0 %. Regional percentage of HbA1c tests above 7.0 % ranged between 28.2 % and 47.3 %. Regional percentage of HbA1c tests above 10.0 % ranged between 1.8 % and 4.8 %. Subgroup analyses comparing urban vs. rural districts showed significantly lower mean HbA1c (6.72 % vs. 6.75 %, CI 0.01 - 0.06, p < 0.01) and percentage of HbA1c tests above 7 % (8.19 % vs. 8.24 %, CI 0.01 - 0.08, p < 0.01) in urban areas. CONCLUSIONS Mean HbA1c as an indicator of glycaemic control of diabetes patients in primary care in Thuringia was good. The percentage of patients who need immediate medical intervention to prevent acute complications varied between districts, which is indicative for differences in quality of diabetes care in Thuringia. However, the proposed method is still experimental and has not yet been evaluated. Consequently, considerable bias might influence the results.
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Affiliation(s)
- A Sämann
- Department of Internal Medicine III, Friedrich-Schiller-University of Jena, Jena, Germany.
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Sämann A, Fischbacher CH, Jagemann KU, Danzer K, Schüler J, Papenkordt L, Müller UA. Non-invasive blood glucose monitoring by means of near infrared spectroscopy: investigation of long-term accuracy and stability. Exp Clin Endocrinol Diabetes 2001; 108:406-13. [PMID: 11026754 DOI: 10.1055/s-2000-8137] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [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] [Indexed: 10/17/2022]
Abstract
Modern strategies in the treatment of Diabetes mellitus require frequent blood glucose tests. Near-infrared spectroscopy [NIR] is considered to be a method for non-invasive blood glucose testing. The present study evaluated the long-term accuracy and stability of the method. Spectra of 10 patients were recorded. An individual calibration models were calculated for each patient from spectra which were recorded at the beginning of the investigation. These models were then applied to calculate blood glucose values from spectra which were recorded 84 to 169 days later. The long-term accuracy and stability of the calibration models expressed as root mean squared error of prediction [RMSP] varied from 3.1 to 35.9 mmol/l and the error grid analysis [EGA] from 13 to 92% clinically acceptable values in zones A and B. The results of the investigation indicate that long-term monitoring of blood glocose by means of NIR-spectroscopy and individual calibration models over a period of 3 to 4 months is basically possible once long-term stability of the method will be improved. Further technological progress and a better understanding of the underlying physiological processes is necessary to achieve a level of accuracy, reliability and stability of the method as required for clinical application.
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Affiliation(s)
- A Sämann
- Department of Internal Medicine II, Medical School. Friedrich-Schiller-University, Jena, Germany.
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