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Stoyanova D, Stratmann B, Schwandt A, Heise N, Mühldorfer S, Ziegelasch H, Zimmermann A, Tschoepe D, Holl RW. Heart failure among people with Type 2 diabetes mellitus: real-world data of 289 954 people from a diabetes database. Diabet Med 2020; 37:1291-1298. [PMID: 30701607 PMCID: PMC7496405 DOI: 10.1111/dme.13915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2019] [Indexed: 01/14/2023]
Abstract
AIM Comparing people with Type 2 diabetes mellitus with and without heart failure in terms of metabolic control, therapeutic regimen and comorbidities. METHODS The Prospective Diabetes Registry (DPV) is a longitudinal documentation system for demographics, medical care and outcome in people with diabetes mellitus. It consists of follow-up data from people with diabetes mellitus who have agreed to be recorded in the registry. Clinical data are submitted by general practitioners, specialists and clinics throughout Germany and Austria. Some 289 954 people with Type 2 diabetes mellitus (years 2000 to 2015) were analysed using demographic statistics and adjustment for confounders based on linear and logistic regression analysis. RESULTS People with Type 2 diabetes mellitus (ICD code: E11) and heart failure (ICD code: I50) (N = 14 723) were older, more often women and presented with longer diabetes duration compared with those without heart failure. After adjustment for age, gender and diabetes duration, people with heart failure showed lower HbA1c , higher BMI and more intense insulin therapy. Analysis revealed that people with heart failure were more often treated with insulin, and more frequently received anti-hypertensives and lipid-lowering medication. They presented with lower systolic and diastolic BP. People with heart failure more frequently showed a history of comorbidities. CONCLUSION Heart failure is common in diabetes mellitus, but the prevalence in the DPV is lower frequent than expected. The reason for improved metabolic control in heart failure may be intensified therapy with insulin, lipid-lowering medication and anti-hypertensives in this cohort.
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Affiliation(s)
- D. Stoyanova
- Herz‐ und Diabeteszentrum NRW, Ruhr‐Universität Bochum, DiabeteszentrumBad Oeynhausen
| | - B. Stratmann
- Herz‐ und Diabeteszentrum NRW, Ruhr‐Universität Bochum, DiabeteszentrumBad Oeynhausen
| | - A. Schwandt
- Institut für Epidemiologie und medizinische Biometrie, ZIBMTUniversität UlmUlm
- Deutsches Zentrum für Diabetesforschung DZDMünchen‐Neuherberg
| | - N. Heise
- ALB FILS KLINIKENHelfenstein Klinik Geislingen, Medizinische KlinikGeislingen
| | - S. Mühldorfer
- Klinikum Bayreuth GmbH, Medizinische Klinik 1Klinik für GastroenterologieBayreuth
| | | | | | - D. Tschoepe
- Herz‐ und Diabeteszentrum NRW, Ruhr‐Universität Bochum, DiabeteszentrumBad Oeynhausen
- Stiftung DHD (“der herzkranke Diabetiker”) in der Deutschen Diabetes StiftungGermany
| | - R. W. Holl
- Institut für Epidemiologie und medizinische Biometrie, ZIBMTUniversität UlmUlm
- Deutsches Zentrum für Diabetesforschung DZDMünchen‐Neuherberg
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Rathmann W, Schwandt A, Hermann JM, Kuss O, Roden M, Laubner K, Best F, Ebner S, Plaumann M, Holl RW. Distinct trajectories of HbA 1c in newly diagnosed Type 2 diabetes from the DPV registry using a longitudinal group-based modelling approach. Diabet Med 2019; 36:1468-1477. [PMID: 31392761 DOI: 10.1111/dme.14103] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 01/09/2023]
Abstract
AIM To identify groups of heterogeneous HbA1c trajectories over time in newly diagnosed Type 2 diabetes. METHODS The study comprised 6355 adults with newly diagnosed Type 2 diabetes (55% men, median age 62 years, baseline BMI 31 kg/m2 ) from the Diabetes Patienten Verlaufsdokumentation (DPV) prospective multicentre diabetes registry (Germany, Austria). Individuals were assessed during the first 5 years after diabetes diagnosis if they had ≥ 3 aggregated HbA1c measurements during follow-up. Latent class growth modelling was used to determine distinct subgroups that followed similar longitudinal HbA1c patterns (SAS: Proc Traj). Multinomial logistic regression models were used to investigate which variables were associated with the respective HbA1c trajectory groups. RESULTS Four distinct longitudinal HbA1c trajectory (glycaemic control) groups were found. The largest group (56% of participants) maintained stable good glycaemic control (HbA1c 42-45 mmol/mol). Twenty-six percent maintained stable moderate glycaemic control (HbA1c 57-62 mmol/mol). A third group (12%) initially showed severe hyperglycaemia (HbA1c 97 mmol/mol) but reached good glycaemic control within 1 year. The smallest group (6%) showed stable poor glycaemic control (HbA1c 79-88 mmol/mol). Younger age at diabetes diagnosis, male sex, and higher BMI were associated with the stable moderate or poor glycaemic control groups. Insulin therapy was strongly associated with the highly improved glycaemic control group. CONCLUSIONS Four subgroups with distinct HbA1c trajectories were determined in newly diagnosed Type 2 diabetes using a group-based modelling approach. Approximately one-third of people with newly diagnosed Type 2 diabetes need either better medication adherence or earlier intensification of glucose-lowering therapy.
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Affiliation(s)
- W Rathmann
- Institute of Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
| | - A Schwandt
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
| | - J M Hermann
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
| | - O Kuss
- Institute of Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
| | - M Roden
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Clinical Diabetology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - K Laubner
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Centre, University of Freiburg, Germany
| | - F Best
- Diabetes Practice Dr. Best, Essen, Germany
| | - S Ebner
- Medical Campus III, Clinic for Internal Medicine 2, Kepler University Hospital, Linz, Austria
| | - M Plaumann
- Specialist Diabetes Practice Hannover, Hannover, Germany
| | - R W Holl
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
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Kosteria I, Schwandt A, Davis E, Jali S, Prieto M, Rottembourg D. Lipid profile is associated with treatment regimen in a large cohort of children and adolescents with Type 1 diabetes mellitus: a study from the international SWEET database. Diabet Med 2019; 36:1294-1303. [PMID: 30972800 DOI: 10.1111/dme.13963] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2019] [Indexed: 12/15/2022]
Abstract
AIMS To examine the effect of pump vs injection therapy on the lipid profile of children with Type 1 diabetes mellitus. METHODS A cross-sectional analysis of the lipid profile of children aged ≤ 18 years with Type 1 diabetes mellitus from SWEET, an international diabetes registry, was conducted with a focus on the effect of treatment regimen. Dyslipidaemia was defined as LDL cholesterol ≥2.6 mmol/l or non-HDL cholesterol ≥3.1 mmol/l. LDL and non-HDL cholesterol values among 14 290 children (52% boys, 51% receiving pump therapy) from 60 SWEET centres were analysed by linear and logistic regression analysis adjusted for sex, age, diabetes duration, HbA1c and BMI-standard deviation score group, region, and common interactions between age, sex, HbA1c and BMI. RESULTS This study confirmed the established associations of increased lipids with female sex, age, diabetes duration, HbA1c and BMI. LDL and non-HDL cholesterol levels were lower in the pump therapy group compared to the injection therapy group [LDL cholesterol: injection therapy 2.44 mmol/l (95% CI 2.42 to 2.46) vs pump therapy 2.39 mmol/l (95% CI 2.37-2.41), P<0.001; non-HDL cholesterol: injection therapy 2.88 mmol/l (95% CI 2.86 to 2.90) vs pump therapy 2.80 mmol/l (95% CI 2.78-2.82), both P<0.0001]. Similarly, the odds ratios for LDL cholesterol ≥2.6 mmol/l [0.89 (95% CI 0.82-0.97)] and non-HDL cholesterol ≥3.1 mmol/l [0.85 (0.78 to 0.93)] were significantly lower in the pump therapy group, even after all adjustments. CONCLUSIONS Our results indicate that pump therapy is associated with a better lipid profile.
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Affiliation(s)
- I Kosteria
- Diabetes Centre, Division of Endocrinology, Diabetes and Metabolism, First Department of Paediatrics, National and Kapodistrian University of Athens, Medical School, Aghia Sophia Children's Hospital, Athens, Greece
| | - A Schwandt
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
- German Centre for Diabetes Research, Munich-Neuherberg, Germany
| | - E Davis
- Centre for Child Health Research, Telethon Kids Institute, University of Western, Perth, Australia
| | - S Jali
- J. N. Medical College (KAHER) and the KLE Diabetes Centre, KLES Dr Prabhakar Kore Hospital, Belgaum, India
| | - M Prieto
- Hospital de Pediatria Garrahan, Buenos Aires, Argentina
| | - D Rottembourg
- Faculty of Medicine and Health Sciences, Sherbrooke University, Sherbrooke, Canada
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Kapellen TM, Müther S, Schwandt A, Grulich-Henn J, Schenk B, Schwab KO, Marg W, Holl RW. Transition to adult diabetes care in Germany-High risk for acute complications and declining metabolic control during the transition phase. Pediatr Diabetes 2018; 19:1094-1099. [PMID: 29691964 DOI: 10.1111/pedi.12687] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 12/19/2017] [Revised: 04/12/2018] [Accepted: 04/16/2018] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE There is evidence that transition from pediatric to adult health care is frequently associated with deterioration of health in youths with type 1 diabetes (T1D). The aim of this study was to compare metabolic control, acute complications and microvascular complications in adolescents and young adults before and after transfer to an adult treatment center with respect to the time between first visit in the adult center and last visit in pediatric treatment. METHODS All data were collected during routine care and retrieved from the German/Austrian DPV database. We analyzed data as of March 2017. RESULTS We found 1283 young adults with available data of the last pediatric treatment year and the first year after transition to adult care. HbA1c increased significantly from 8.95% (74 mmol/mol) before to 9.20% (77 mmol/mol) in the first year after transition. Frequency of DKA with hospitalization (0.10-0.191 per annum, P < .0001) and severe hypoglycemia (0.23-0.46 per annum, P = .013) doubled during transition. Microvascular complications increased dramatically depending on the time between first visit in adult treatment and last visit in pediatric care. We could not find a significant correlation of this rise of microvascular complications to the duration of transition (short or long). CONCLUSION This phase of life bears a high risk for detrimental outcome in young adults with T1D. Structured transition programs with case management are therefore needed to improve the transition process and outcomes.
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Affiliation(s)
- T M Kapellen
- Department of Women and Child Health, University of Leipzig, Leipzig, Germany
| | - S Müther
- Department of Pediatrics, DRK Kliniken Berlin, Berlin, Germany
| | - A Schwandt
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research, DZD, Munich, Germany
| | - J Grulich-Henn
- Department of Pediatrics, University of Heidelberg, Heidelberg, Germany
| | - B Schenk
- Department of Pediatrics, Helios Kliniken Schwerin, Schwerin, Germany
| | - K O Schwab
- Department of Pediatrics, University of Freiburg, Freiburg, Germany
| | - W Marg
- Childrens Hospital Bremen, Bremen, Germany
| | - R 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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5
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Schwandt A, Best F, Biester T, Grünerbel A, Kopp F, Krakow D, Laimer M, Wagner C, Holl RW. Both the frequency of HbA 1c testing and the frequency of self-monitoring of blood glucose predict metabolic control: A multicentre analysis of 15 199 adult type 1 diabetes patients from Germany and Austria. Diabetes Metab Res Rev 2017; 33. [PMID: 28544457 DOI: 10.1002/dmrr.2908] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 05/19/2016] [Revised: 04/10/2017] [Accepted: 05/02/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND The objective of this study was to examine the association between metabolic control and frequency of haemoglobin A1c (HbA1c ) measurements and of self-monitoring of blood glucose, as well as the interaction of both. METHODS Data of 15 199 adult type 1 diabetes patients registered in a standardized electronic health record (DPV) were included. To model the association between metabolic control and frequency of HbA1c testing or of self-monitoring of blood glucose, multiple hierarchic regression models with adjustment for confounders were fitted. Tukey-Kramer test was used to adjust P values for multiple comparisons. Vuong test was used to compare non-nested models. RESULTS The baseline variables of the study population were median age 19.9 [Q1; Q3: 18.4; 32.2] years and diabetes duration 10.4 [6.8; 15.7] years. Haemoglobin A1c was 60.4 [51.5; 72.5] mmol/mol. Frequency of HbA1c testing was 8.0 [5.0; 9.0] within 2 years, and daily self-monitoring of blood glucose frequency was 5.0 [4.0; 6.0]. After adjustment, a U-shaped association between metabolic control and frequency of HbA1c testing was observed with lowest HbA1c levels in the 3-monthly HbA1c testing group. There was an inverse relationship between self-monitoring of blood glucose and HbA1c with lower HbA1c associated with highest frequency of testing (>6 daily measurements). Quarterly HbA1c testing and frequent self-monitoring of blood glucose were associated with best metabolic control. The adjusted Vuong Z statistic suggests that metabolic control might be better explained by HbA1c testing compared to self-monitoring of blood glucose (P < .0001). CONCLUSION This research reveals the importance of quarterly clinical HbA1c monitoring together with frequent self-monitoring of blood glucose in diabetes management to reach and maintain target HbA1c .
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Affiliation(s)
- A Schwandt
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - F Best
- Outpatient Diabetes Center, Essen, Germany
| | - T Biester
- AUF DER BULT, Diabetes Centre for Children and Adolescents, Hannover, Germany
| | - A Grünerbel
- Outpatient Diabetes Center Munich South, Munich, Germany
| | - F Kopp
- Department of Internal Medicine, Diabetes Center, Clinical Center Augsburg, Augsburg, Germany
| | - D Krakow
- Diabetes Center Forchheim, Forchheim, Germany
| | - M Laimer
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Bern, Bern, Switzerland
| | - C Wagner
- Outpatient Diabetes Center, Surheim, Germany
| | - R W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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Schwandt A, Denkinger M, Fasching P, Pfeifer M, Wagner C, Weiland J, Zeyfang A, Holl RW. Welche der Formeln Cockcroft-Gault, MDRD und CKD-EPI schätzt die gemessene glomeruläre Funktion am besten? Ergebnisse einer multizentrischen Studie mit 36.507 erwachsenen Patienten mit Typ 1 oder Typ 2 Diabetes aus der DPV-Datenbank. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601602] [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)
- A Schwandt
- Universität Ulm, Institut für Epidemiologie und Medizinische Biometrie, ZIBMT, Ulm, Germany
| | - M Denkinger
- AGAPLESION Bethesda Klinik, Geriatrie der Universität Ulm, Ulm, Germany
| | - P Fasching
- Wilhelminenspital, 5. Medizinischen Abteilung, Wien, Austria
| | - M Pfeifer
- Klinik Tettnang, Diabeteszentrum, Tettnang, Germany
| | - C Wagner
- Diabeteszentrum, Saaldorf-Surheim, Germany
| | - J Weiland
- Klinik Bad Reichenhall, Insitut für Innere Medizin, Bad Reichenhall, Germany
| | - A Zeyfang
- Sana Klinik Bethesda, Stuttgart, Germany
| | - RW Holl
- Universität Ulm, Institut für Epidemiologie und Medizinische Biometrie, ZIBMT, Ulm, Germany
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Schwandt A, Rathmann W, Holl RW, Bramlage P, Altmeier M, Kaltheuer M, Ziegelasch HJ, Siegel E, Tytko A, Danne T. Serum-Lipidwerte bei Patienten mit Typ-2-Diabetes in der Routineversorgung: Gemeinsame Auswertung der Diabetes-Register DPV und DIVE. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580782] [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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Stoyanova D, Stratmann B, Schwandt A, Heise N, Mühldorfer S, Ziegelasch HJ, Tschöpe D, Holl RW. Herzinsuffizienz und Therapie bei Patienten mit Diabetes mellitus Typ 2 aus der Routineversorgung-Auswertung aus dem Diabetes-Patienten-Verlaufsdokumentation (DPV)-Register. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580748] [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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Danne T, Schwandt A, Bramlage P, Zimmermann A, Kaltheuner M, Welp R, Weber D, Wagner C, Reuter HM, Holl RW. Welche Patienten verwenden Glargin U300 in der Routinebetreuung? Gemeinsame Auswertung der Diabetes-Register DIVE und DPV. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580861] [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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Schwandt A, Best F, Biester T, Grünerbel A, Kopp F, Krakow D, Laimer M, Wagner C, Holl RW. Die Häufigkeit der HbA1c-Messungen und die Häufigkeit der Blutzuckerselbstmessungen beeinflussen die Stoffwechseleinstellung! Ergebnisse einer multizentrischen Studie mit 15.199 erwachsenen Typ-1-Diabetes Patienten aus der DPV-Datenbank. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580871] [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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Schwandt A, Köppen S, Ebner S, Zimny S, Risse A, Bergis D, Dapp A, Jehle PM, Wietholtz H, Holl RW. Ergebnisse einer multizentrischen Studie mit 222.078 Typ-2-Diabetespatienten aus der DPV-Datenbank: Psoriasis bei 232 Patienten mit Typ-2-Diabetes trägt zu einer hohen Rate an Depression bei. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549784] [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: 10/23/2022]
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Danne T, Bollow E, Schwandt A, Heidtmann B, Kordonouri O, Rami-Merhar B, Ziegler R, Holl RW. Charakteristika der 1279 Patchpumpen-Nutzer im deutsch-östereichischen DPV-Register*. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549734] [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: 10/23/2022]
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Hermann JM, Schwandt A, Rosenbauer J, Kapellen T, Prchla C, Warncke K, Raile K, Renner C, Wenzel S, Holl RW. Jugendliche sind verschieden! Gruppenbasierte Trajectory-Analyse des HbA1c-Verlaufes über die Pubertät – eine Analyse von 5.746 Patienten mit Diabetes mellitus Typ 1 mit follow-up vom 8. bis zum 19. Lebensjahr aus der DPV-Datenbank. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549703] [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: 10/23/2022]
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Schwandt A, Harris PJ, Hunsberger S, Deleporte A, Smith GL, Vulih D, Anderson BD, Ivy SP. The role of age on dose-limiting toxicities in phase I dose-escalation trials. Clin Cancer Res 2014; 20:4768-75. [PMID: 25028396 DOI: 10.1158/1078-0432.ccr-14-0866] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Elderly oncology patients are not enrolled in early-phase trials in proportion to the numbers of geriatric patients with cancer. There may be concern that elderly patients will not tolerate investigational agents as well as younger patients, resulting in a disproportionate number of dose-limiting toxicities (DLT). Recent single-institution studies provide conflicting data on the relationship between age and DLT. EXPERIMENTAL DESIGN We retrospectively reviewed data about patients treated on single-agent, dose-escalation, phase I clinical trials sponsored by the Cancer Therapy Evaluation Program (CTEP) of the National Cancer Institute. Patients' dose levels were described as a percentage of maximum tolerated dose, the highest dose level at which <33% of patients had a DLT, or recommended phase II dose (RP2D). Mixed-effect logistic regression models were used to analyze relationships between the probability of a DLT and age and other explanatory variables. RESULTS Increasing dose, increasing age, and worsening performance status (PS) were significantly related to an increased probability of a DLT in this model (P < 0.05). There was no association between dose level administered and age (P = 0.57). CONCLUSIONS This analysis of phase I dose-escalation trials, involving more than 500 patients older than 70 years of age, is the largest reported. As age and dose level increased and PS worsened, the probability of a DLT increased. Although increasing age was associated with occurrence of DLT, this risk remained within accepted thresholds of risk for phase I trials. There was no evidence of age bias on enrollment of patients on low or high dose levels.
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Affiliation(s)
- A Schwandt
- Case Western Reserve School of Medicine, Cleveland, Ohio
| | - P J Harris
- National Cancer Institute, Bethesda, Maryland
| | | | | | - G L Smith
- National Cancer Institute, Bethesda, Maryland
| | - D Vulih
- Theradex Systems, Inc, Princeton, New Jersey
| | | | - S P Ivy
- National Cancer Institute, Bethesda, Maryland.
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15
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MacKenzie MJ, Rini BI, Elson P, Schwandt A, Wood L, Trinkhaus M, Bjarnason G, Knox J. Temsirolimus in VEGF-refractory metastatic renal cell carcinoma. Ann Oncol 2010; 22:145-148. [PMID: 20595449 DOI: 10.1093/annonc/mdq320] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Temsirolimus is an i.v. administered inhibitor of mammalian target of rapamycin with activity in the first-line setting in poor-prognosis patients with metastatic renal cell carcinoma (RCC). The efficacy of this agent after failure of prior inhibitors of vascular endothelial growth factor (VEGF) is unknown. METHODS a retrospective review of patients with metastatic RCC treated at the Cleveland Clinic Taussig Cancer Institute and three regional cancer centers in Ontario, Canada, through the Torisel (temsirolimus) Compassionate Use Program was conducted. Demographic, toxicity and response data were collected. RESULTS a total of 87 patients with metastatic RCC were identified who had previously been treated with inhibitors of VEGF subsequently treated with temsirolimus. The majority of patients had either intermediate or poor-prognosis disease at baseline. Expected toxic effects including hyperglycemia and noninfectious pneumonitis were observed. The RECIST-defined objective response rate was 5% and the stable disease rate was 65%. The median time to progression (TTP) was 3.9 months (95% confidence interval 2.8-4.8 months), and median overall survival was 11.2 months. CONCLUSIONS in a cohort of pre-treated intermediate to poor-prognosis patients with metastatic RCC, weekly i.v. temsirolimus is associated with predictable, but manageable toxicity, and a TTP approaching 4 months.
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Affiliation(s)
- M J MacKenzie
- Department of Medical Oncology, London Regional Cancer Program, London, Ontario, Canada.
| | - B I Rini
- Department of Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - P Elson
- Department of Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - A Schwandt
- Department of Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - L Wood
- Department of Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - M Trinkhaus
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre
| | - G Bjarnason
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre
| | - J Knox
- Department of Medical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
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Schwandt A, Garcia JA, Elson P, Wyckhouse J, Finke JH, Ireland J, Triozzi P, Zhou M, Dreicer R, Rini BI. A translational phase II trial of celecoxib plus interferon-alpha (IFN-α2b) in metastatic renal cell carcinoma (RCC) patients (pts) with 3+ COX-2 tumor immunostaining. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5116] [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] [Indexed: 11/20/2022] Open
Abstract
5116 Background: Cyclooxygenase-2 (COX-2) has been correlated with RCC stage and grade, and overexpression can lead to dysregulation of dendritic cells (DC) and CD4+/CD25+/FOXP3+ regulatory T cells (Treg). A previous trial of celecoxib in combination with IFNα2b in RCC (Rini et al, Cancer. 2006) demonstrated an association between more intense COX-2 RCC tumor staining and clinical response. Methods: Pts with cytokine-naïve mRCC with at least 10% maximal COX-2 tumor staining received IFNα2b MU five times/week plus celecoxib 400 mg BID continuously. Baseline tumor tissue was stained for COX-2, CD4+ and CD8+ T cells, Treg and DC (s100 and CD208). Peripheral blood prostaglandin E2 (PGE2), DC and Treg number/function and intracellular T cell cytokine production were measured at baseline, at the end of cycles 2 and 4 and at end of treatment. Activation of DC was assessed by IL-12 and IL-10 mRNA and protein production by ELISA. The primary endpoint was objective response rate (ORR). Secondary endpoints were DC / Treg number and cytokine production changes with therapy. The trial tested a null hypothesis of ORR <20% vs. alternative hypothesis of ORR >40%; beta = 0.8 and alpha = 0.05 (n = 34). Immune parameters were analyzed using non-parametric methods. Results: Fourteen pts have been enrolled; 79% male, median age 62 (range, 43–74) and 64% ECOG performance status 0. All pts had prior nephrectomy and 36% had received prior tyrosine kinase inhibitors (TKI); MSKCC Risk Group was favorable 14%, intermediate 71%, and unfavorable 14%. The ORR was 21% and 69% of pts experienced tumor shrinkage. Median PFS is 4.4 months. Toxicity was as expected for IFN therapy. Baseline 3+ COX-2 staining was associated with elevated peripheral blood PGE2 levels (p = 0.02), reduced DC IL-12 expression (p = 0.04) and reduction in IFN gamma-producing CD3+CD4+ T-cells (p = 0.04) compared to a control group of RCC pts with <10% 3+ COX-2 staining (n = 21). No significant changes in immunomodulatory cells were observed with therapy. Conclusions: COX-2 inhibition in combination with IFNα2b in maximal COX-2-expressing mRCC pts has clinical activity. COX-2 RCC tumor expression promotes an immunosuppressive phenotype. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | - M. Zhou
- Cleveland Clinic, Cleveland, OH
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17
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Abstract
OBJECTIVE We performed a prospective trial to evaluate the feasibility, accuracy, and safety of a postoperative fever algorithm that is based on symptoms and physical examination in an attempt to decrease the random use of urine cultures, blood cultures, and chest radiographs. STUDY DESIGN Our fever algorithm consisted of assessing all febrile postoperative patients for signs and symptoms of infection. If none were present, no tests were ordered. RESULTS Twenty-eight of 105 consecutive patients (27%) had postoperative fever after major gynecologic surgery. Three of 28 febrile patients (11%) were evaluated with tests according to the algorithm. Two of 28 febrile patients (7%) were evaluated in violation of the algorithm. Four febrile patients (14%) had documented infections. Two patients had infections within the first 30 days after discharge. Compared with our previous retrospective review, significantly fewer febrile patients were evaluated with testing with a significantly increased yield of positive test results. CONCLUSIONS Our postoperative fever evaluation algorithm that is based on symptoms and physical examination is feasible, is safe, decreases random testing, and increases the yield of positive test results.
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Affiliation(s)
- A Schwandt
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Ohio, Toledo 43614-5809, USA
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18
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Affiliation(s)
- M S Cardoso
- German Red Cross Blood Transfusion Service of Baden-Württemberg, Ulm,
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19
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Cardoso MS, Koerner K, Hinz W, Lenz C, Prokein S, Rau B, Schwandt A, Kubanek B. Experiences in HCV-NAT screening prior to releasing cellular components by the German Red Cross Blood Transfusion Service of Baden-Württemberg. Biologicals 1999; 27:281-4. [PMID: 10686053 DOI: 10.1006/biol.1999.0221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In this report we present the accumulated data on nucleic acid testing (NAT) for hepatitis C virus (HCV) RNA of blood donations by the Blood Transfusion Service of Baden-Württemberg in the period between March 1997 and March 1999. An extra barcoded blood sample was collected from each donor. Samples were tested by NAT in mini-pools of maximally 96 samples. First-time and repeat donors were tested separately. RT/HCV-PCR was performed with the COBAS HCV Amplicortrade mark, versions 1.0 and 2.0 from Roche Diagnostic Systems. Many modifications have been introduced to the original protocol since the implementation of NAT screening aiming at an increase in the sensitivity and specificity of the assay. NAT positive pools containing serologically positive samples were detected. Initially, reactive pools were identified that could not be confirmed by secondary pooling and single testing procedures. So far, no serologically negative but NAT positive sample has been found.
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Affiliation(s)
- M S Cardoso
- German Red Cross Blood Transfusion Service of Baden-Württemberg and Department of Transfusion Medicine, University of Ulm, Ulm, Germany.
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20
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Abstract
CD45 is a family of transmembrane glycoproteins that function as protein tyrosine phosphatases. All isoforms exhibit common CD45 epitopes, whereas the restricted CD45 epitopes (RA, RB, and RO) are each limited to one or more isoforms. In prior studies, we showed that human Langerhans cells in normal epidermis express a novel CD45 phenotype. They express common CD45 epitopes but are characteristically RA- RB- RO-. This suggests that Langerhans cells can express a novel form of CD45. In order to clarify this issue further, mRNA extracted from enriched Langerhans cell preparations was reverse transcribed into cDNA. The 5' portion of CD45 cDNA was then amplified using polymerase chain reaction primers complementary to exon 2 and exons 9-10, which flank the CD45 variable exon region (exons 4-6). Cloning and sequencing of the dominant 441 bp polymerase chain reaction product revealed the following exon configuration for the 5' translated region of Langerhans cells CD45: exon 3/7/8/9/10. This is the same exon configuration associated with the 180 kd CD45 isoform expressed by memory T cells and monocytes/macrophages; however, these cell types are RO+ whereas normal Langerhans cells are RO-. The RO epitope is known to be an oligosaccharide with a terminal sialic acid moiety. Therefore, we determined the expression of a related epitope, OPD4, by Langerhans cells. This is another terminal sialic acid moiety expressed by the 180 kd CD45 isoform of memory T cells but not by monocytes/macrophages. Langerhans cells were OPD4-. Our data suggest that memory T cells, monocytes/macrophages, and Langerhans cells all express a common CD45 transcript lacking exons 4-6; however, this transcript appears to undergo lineage-specific, post-translational glycosylation to create three distinct CD45 glycoproteins: RO+ OPD4+, RO+ OPD4-, and RO- OPD4-, which are expressed typically by memory T cells, monocytes/macrophages, and Langerhans cells, respectively. Because these epitopes are located extracellularly, they are postulated to allow differential responses to extracellular stimuli by creating differential ligand specificity.
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Affiliation(s)
- G S Wood
- Department of Dermatology, and Skin Diseases Research Center, Case Western Reserve University, and the Veterans Affairs Medical Center, Cleveland, Ohio 44106, USA
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21
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Abstract
Tetrahymena thermophila mutants homozygous for the oad mutation become nonmotile when grown at the restrictive temperature, and axonemes isolated from nonmotile mutants lack approximately 90% of their outer dynein arms. Electrophoretic analyses of axonemes isolated from nonmotile mutants (oad axonemes) indicate they contain significantly fewer of the 22 S dynein heavy chains that axonemes isolated from wild-type cells (wild-type axonemes) contain. The 22 S dynein heavy chains that remain in axonemes isolated from nonmotile, oad mutants are assembled into 22 S dynein particles that exhibit wild-type levels of ATPase activity. Two-dimensional gel electrophoresis of oad axonemes show that they are deficient in no proteins other than those proteins thought to be components of 22 S dynein. This report is the first formal proof that outer dynein arms in Tetrahymena cilia are composed of 22 S dynein.
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Affiliation(s)
- S A Ludmann
- Department of Zoology, Miami University, Oxford, Ohio 45056
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Attwell GJ, Bricker CS, Schwandt A, Gorovsky MA, Pennock DG. A temperature-sensitive mutation affecting synthesis of outer arm dyneins in Tetrahymena thermophila. J Protozool 1992; 39:261-6. [PMID: 1533674 DOI: 10.1111/j.1550-7408.1992.tb01312.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We have characterized a novel, temperature-sensitive mutation affecting motility in Tetrahymena thermophila. Mutants grew and divided normally at the restrictive temperature (38 degrees C), but became nonmotile. Scanning electron microscopic analysis indicated that nonmotile mutants contained the normal number of cilia and that the cilia were of normal length. Transmission electron microscopic analysis indicated that axonemes isolated from nonmotile mutants lacked outer dynein arms, so the mutation was named oad 1 (outer arm deficient). Motile mutants shifted to 38 degrees C under conditions that prevent cell growth and division (starvation) remained motile suggesting that once assembled into axonemes at the permissive temperature (28 degrees C) the outer arm dyneins remain functional at 38 degrees C. Starved, deciliated mutants regenerated a full complement of functional cilia at 38 degrees C, indicating that the mechanism that incorporates the outer arm dynein into developing axonemes is not affected by the oad 1 mutation. Starved, nonmotile mutants regained motility when shifted back to 28 degrees C, but not when incubated with cycloheximide. We interpret these results to rule out the hypothesis that the oad 1 mutation affects the site on the microtubules to which the outer arm dyneins bind. Axonemes isolated from mutants grown for one generation at 38 degrees C had a mean of 6.0 outer arm dyneins, and axonemes isolated from mutants grown for two generations at 38 degrees C had a mean of 3.2 outer arm dyneins. Taken together, these results indicate that the oad 1 mutation affects the synthesis of outer arm dyneins in Tetrahymena.
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Affiliation(s)
- G J Attwell
- Department of Zoology, Miami University, Oxford, Ohio 45056
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