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Dehn-Hindenberg A, Saßmann H, Berndt V, Biester T, Heidtmann B, Jorch N, Kim-Dorner SJ, Konrad K, Lilienthal E, Nellen-Hellmuth N, Neu A, Ziegler R, Lange K. Long-term Occupational Consequences for Families of Children With Type 1 Diabetes: The Mothers Take the Burden. Diabetes Care 2021; 44:2656-2663. [PMID: 34697032 DOI: 10.2337/dc21-0740] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/26/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the occupational and financial consequences for parents following the onset of type 1 diabetes in their child. RESEARCH DESIGN AND METHODS A questionnaire assessing occupational and financial situations before and in the first year after the onset of diabetes was distributed to all families with a child ≤14 years of age at diagnosis with a diabetes duration of at least 12 months in nine German pediatric diabetes centers. RESULTS Data of 1,144 children (mean age at diagnosis 6.7 [3.6] years; 46.5% female) and their families were obtained. Mothers' occupational status reflected in paid working hours was significantly reduced in the first year after their child's diabetes diagnosis (P < 0.001). Overall, 15.1% of mothers stopped working, and 11.5% reduced working hours. Mothers of preschool children were particularly affected. Fathers' working status hardly changed (P = 0.75). Nearly half of the families (46.4%) reported moderate to severe financial losses. Compared with an earlier similar study in 2003, significant negative occupational consequences for mothers and financial burden on families remained unchanged in 2018 (P = 0.59 and 0.31, respectively). CONCLUSIONS Mothers of young children with newly diagnosed diabetes experienced negative consequences in their occupational situation. This inequality for mothers can have long-term negative consequences for their mental health and future economic situation. There is an urgent need for action to reduce the burden on families and to provide professional, social, and regulatory support, especially for mothers of young children with diabetes.
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Affiliation(s)
| | - Heike Saßmann
- Medical Psychology, Hannover Medical School, Hannover, Germany
| | - Verena Berndt
- Social-Pediatric Centre Lichtenberg, Sana Hospital Group Berlin-Brandenburg, Berlin, Germany
| | - Torben Biester
- Diabetes Centre for Children and Adolescents, Children's Hospital Auf der Bult, Hannover, Germany
| | | | - Norbert Jorch
- University Clinic for Pediatrics, Evangelisches Klinikum Bethel, Bielefeld University, Bielefeld, Germany
| | | | - Katja Konrad
- Pediatrics, Elisabeth-Hospital Essen, Essen, Germany
| | - Eggert Lilienthal
- University Clinic, University Children's Hospital, Ruhr-University Bochum, Bochum, Germany
| | | | - Andreas Neu
- Pediatric Endocrinology and Diabetes, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Ralph Ziegler
- Diabetes Clinic for Children and Adolescents Muenster, Muenster, Germany
| | - Karin Lange
- Medical Psychology, Hannover Medical School, Hannover, Germany
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2
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Rutagarama F, Muganga R, Konrad K, Teteli R, Semakula M, Musafili A, Laigong P, Mutesa L. Vitamin D Levels in Mother-Baby Pairs: A Cross-Sectional Prospective Study in a Rwandan Tertiary Hospital. J Trop Pediatr 2021; 67:6313138. [PMID: 34213539 DOI: 10.1093/tropej/fmab024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Exposure to the sunlight contributes largely to the production of vitamin D. However, vitamin D deficiency is a reality in tropical countries, despite enjoying enough sunlight, especially bearing women in their last trimester whose foetuses exclusively depend on their reserves. This work aimed at demonstrating the state of vitamin D in mother-baby pairs and associated factors in one of the University Hospitals in Rwanda. METHODS This cross-sectional prospective study was performed on mother-baby pairs at Kigali University Hospital. Mother's serum 25-hydroxyvitamin D levels were considered as outcomes compared with demographic, clinical and biological markers. Correlation analysis was conducted in order to assess the association between serum 25-hydroxyvitamin D levels for the couple mothers-babies. RESULTS Approximately 38% of women and 65% of neonates had deficiency in 25-hydroxyvitamin D (<20 ng/ml). The use of a vitamin D rich diet within 24 h recall (p < 0.01) or 1 week recall (p < 0.001) before delivery was associated with appropriate vitamin D levels in mothers. Interestingly, a strong positive correlation was found between maternal and neonatal serum 25-hydroxyvitamin D levels (r = 0.760). CONCLUSIONS There was a high rate of vitamin D deficiency in mothers and their babies. Babies born from women with deficiency were likely to develop low levels of vitamin D. This stresses on the need to strengthen the interventions for preventing vitamin D deficiency in the couple mothers-babies such as supplement in vitamin D before and after delivery, improving the quality of meals and regular contact with sunlight.
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Affiliation(s)
- Florent Rutagarama
- Department of Paediatrics, Rwanda Military Hospital, Kigali, Rwanda.,College of Medicine and Health Sciences, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | - Raymond Muganga
- College of Medicine and Health Sciences, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | - Katja Konrad
- Department of Pediatrics and Adolescents Medicine, University of Cologne, Elisabeth-Hospital Essen, Essen, Germany
| | - Raissa Teteli
- College of Medicine and Health Sciences, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | - Muhammed Semakula
- Research and Innovation Division, Rwanda Biomedical Centre, Ministry of Health Rwanda, Kigali, Rwanda
| | - Aimable Musafili
- Department of Paediatrics and Child Health, Butare University Teaching Hospital, Butare, Rwanda
| | - Paul Laigong
- Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya
| | - Leon Mutesa
- Center for Human Genetics, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Kamrath C, Tittel SR, Kapellen TM, von dem Berge T, Heidtmann B, Nagl K, Menzel U, Pötzsch S, Konrad K, Holl RW. Early versus delayed insulin pump therapy in children with newly diagnosed type 1 diabetes: results from the multicentre, prospective diabetes follow-up DPV registry. Lancet Child Adolesc Health 2020; 5:17-25. [PMID: 33253630 DOI: 10.1016/s2352-4642(20)30339-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/01/2020] [Accepted: 10/07/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although continuous subcutaneous insulin infusion therapy (ie, insulin pump therapy) is associated with improved metabolic control compared with multiple daily insulin injections in children with type 1 diabetes, it is unclear when it is best to start it after diagnosis. In this study, we aimed to compare the outcomes between early and delayed start of insulin pump therapy in young patients with type 1 diabetes. METHODS We based the current study on data from the multicentre, prospective diabetes follow-up registry (ie, Diabetes-Patienten-Verlaufsdokumentation [DPV]). The DPV registry comprises 501 diabetes centres from Germany, Austria, Switzerland, and Luxembourg. We included patients diagnosed with type 1 diabetes between 2004 and 2014, who were aged between 6 months and 15 years at the time of diagnosis, who had started insulin pump therapy either within the first 6 months (ie, the early treatment group) or in the second to third year (ie, the delayed treatment group) after diabetes diagnosis, and who were treated with insulin pump therapy for at least 1 year. The outcome parameters included the glycated haemoglobin (HbA1c) values, the cardiovascular risk profile, and rates of acute complications and diabetes-associated hospital admissions (ie, hospitalisation) during the most recent documented treatment year with insulin pump therapy. Statistical models were adjusted for age at diabetes diagnosis, year of diagnosis, sex, immigrant background, use of continuous glucose monitoring, centre size, and the German Index of Socioeconomic Deprivation 2012 terciles. FINDINGS Our study sample comprised 8332 patients from 311 diabetes centres in Germany, Austria, Switzerland, and Luxembourg. The early treatment group consisted of 4004 (48·1%) of 8332 patients, and the delayed treatment group consisted of 4328 (51·9%). The median diabetes duration during follow-up was 6·7 years (IQR 5·1-8·7 in the early group; 5·0-8·7 in the delayed group) in both groups. Patients with early initiation of insulin pump therapy compared with those with delayed initiation of insulin pump therapy had significantly lower estimated mean HbA1c values (7·9% [95% CI 7·8-7·9] and 62·6 mmol/mol [95% CI 62·1-63·2] vs 8·0% [8·0-8·1] and 64·1 mmol/mol [63·6-64·6]; p=0·0006), and lower rates of hypoglycaemic coma (incidence risk ratio 0·44 [95% CI 0·24-0·79]; p=0·0064) and hospitalisation (0·86 [95% CI 0·78-0·94]; p=0·0016). A better cardiovascular risk profile was observed in patients with early initiation of insulin pump therapy than in those with delayed initiation: an estimated mean systolic blood pressure of 117·6 mm Hg (95% CI 117·2-117·9) versus 118·5 mm Hg (118·2-118·9), p=0·0007; and HDL cholesterol of 62·8 mg/dL (95% CI 62·2-63·5) versus 60·6 mg/dL (60·0-61·2), p<0·0001; however, diastolic blood pressure; concentrations of LDL cholesterol, non-HDL cholesterol, and triglycerides; and estimated body-mass index standard deviation scores during follow-up did not differ significantly between both groups. INTERPRETATION Our findings provide evidence for improved clinical outcomes associated with the early initiation of insulin pump therapy in children with type 1 diabetes. FUNDING The German Center for Diabetes Research (Deutsches Zentrum für Diabetesforschung), German Robert Koch Institute, German Diabetes Association, and Diabetes Agenda 2010.
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Affiliation(s)
- Clemens Kamrath
- Division of Pediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany.
| | - Sascha R Tittel
- ZIBMT, Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; German Center for Diabetes Research, Munich, Germany
| | - Thomas M Kapellen
- Department of Women and Child Health, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Thekla von dem Berge
- Diabetes Center for Children and Adolescents, Children's Hospital Auf der Bult, Hannover, Germany
| | - Bettina Heidtmann
- Department of Pediatric Endocrinology and Diabetology, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
| | - Katrin Nagl
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Ulrike Menzel
- Department of Paediatric Endocrinology, AKK Altonaer Kinderkrankenhaus, Hamburg, Germany
| | - Simone Pötzsch
- Department for Children and Adolescent Medicine, Helios Vogtland Clinic Plauen, Plauen, Germany
| | - Katja Konrad
- Department of Pediatric and Adolescent Medicine, Elisabeth-Hospital Essen, Essen, Germany
| | - Reinhard W Holl
- ZIBMT, Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; German Center for Diabetes Research, Munich, Germany
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4
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Welters A, Meissner T, Konrad K, Freiberg C, Warncke K, Judmaier S, Kordonouri O, Wurm M, Papsch M, Fitzke G, Schmidt SC, Tittel SR, Holl RW. Diabetes management in Wolcott-Rallison syndrome: analysis from the German/Austrian DPV database. Orphanet J Rare Dis 2020; 15:100. [PMID: 32321554 PMCID: PMC7178620 DOI: 10.1186/s13023-020-01359-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/17/2020] [Indexed: 01/17/2023] Open
Abstract
Background Wolcott-Rallison syndrome (WRS) is characterized by permanent early-onset diabetes, skeletal dysplasia and several additional features, e.g. recurrent liver failure. This is the first multicentre approach that focuses on diabetes management in WRS. We searched the German/Austrian Diabetes-Patienten-Verlaufsdokumentation (DPV) registry and studied anthropometric characteristics, diabetes treatment, glycaemic control and occurrence of severe hypoglycaemia (SH) and diabetic ketoacidosis (DKA) in 11 patients with WRS. Furthermore, all local treatment centres were personally contacted to retrieve additional information on genetic characteristics, migration background and rate of consanguinity. Results Data were analysed at diabetes onset and after a median follow-up period of 3 (1.5–9.0) years (time from diagnosis to latest follow-up). Median age at diabetes onset was 0.2 (0.1–0.3) years, while onset was delayed in one patient (aged 16 months). Seventy percent of patients manifested with DKA. At follow-up, 90% of patients were on insulin pump therapy requiring 0.7 [0.5–1.0] IU of insulin/kg/d. More than two third of patients had HbA1c level ≥ 8%, 40% experienced at least one episode of SH in the course of the disease. Three patients died at 0.6, 5 and 9 years of age, respectively. To the best of our knowledge three patients carried novel mutations in EIF2AK3. Conclusion Insulin requirements of individuals with WRS registered in DPV appear to be comparable to those of preschool children with well-controlled type 1 diabetes, while glycaemic control tends to be worse and episodes of SH tend to be more common. The majority of individuals with WRS in the DPV registry does not reach glycaemic target for HbA1c as defined for preschool children (< 7.5%). International multicentre studies are required to further improve our knowledge on the care of children with WRS.
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Affiliation(s)
- Alena Welters
- Department of General Paediatrics, Neonatology and Paediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany.
| | - Thomas Meissner
- Department of General Paediatrics, Neonatology and Paediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
| | - Katja Konrad
- Department of Paediatric and Adolescent Medicine, Elisabeth-Hospital Essen, Essen, Germany
| | - Clemens Freiberg
- Department of Paediatrics, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Katharina Warncke
- Department of Paediatrics, Kinderklinik München Schwabing, Technical University of Munich School of Medicine, Munich, Germany
| | - Sylvia Judmaier
- Department of Paediatrics, LKH Hochsteiermark/Standort Leoben, Leoben, Austria
| | - Olga Kordonouri
- Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Germany
| | - Michael Wurm
- Department of Paediatrics, St. Hedwigs Campus, University Children's Hospital Regensburg, Regensburg, Germany
| | - Matthias Papsch
- Department of Paediatrics, Marienhospital, Gelsenkirchen, Germany
| | - Gisela Fitzke
- Department of Paediatrics, Ostalbklinikum Aalen, Aalen, Germany
| | | | - Sascha R Tittel
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
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5
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Kemmler W, Weissenfels A, Willert S, Fröhlich M, Ludwig O, Berger J, Zart S, Becker S, Backfisch M, Kleinöder H, Dörmann U, Wirtz N, Wegener B, Konrad K, Eifler C, Krug J, Zinner C, Müller S, Vatter J, Authenrieth S, Beisswenger T, Teschler M, von Stengel S. Recommended Contraindications for the Use of Non-Medical WB-Electromyostimulation. Dtsch Z Sportmed 2019. [DOI: 10.5960/dzsm.2019.401] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lanzinger S, Welters A, Thon A, Konrad K, Kapellen T, Grulich-Henn J, Raddatz D, Holl RW. Comparing clinical characteristics of pediatric patients with pancreatic diabetes to patients with type 1 diabetes: A matched case-control study. Pediatr Diabetes 2019; 20:955-963. [PMID: 31314155 DOI: 10.1111/pedi.12894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/10/2019] [Accepted: 07/08/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Only few studies have been conducted on pancreatic diabetes and data from large epidemiological studies are missing. Our main objective was to study the most important differences and similarities between pediatric individuals with pancreatic diabetes and type 1 diabetes (T1D). METHODS Patients <20 years of age were identified from the diabetes patient follow-up registry (DPV). Data of the most recent treatment year between January 2000 and March 2018 were aggregated. Propensity score was used to match individuals with pancreatic diabetes to individuals with T1D. Matching was conducted one-to-one by sex, age, diabetes duration, body mass index SD score (BMI-SDS), and migration background. RESULTS We studied 731 individuals with pancreatic diabetes and 74 460 with T1D. In the matched cohort of 631 pairs, HbA1c was significantly lower in pancreatic diabetes (7.4% [95% confidence interval: 7.2; 7.5%]) compared to T1D patients (8.7% [8.5; 8.8%]). Daily insulin dose (0.80 IU/kg [0.77; 0.84] vs 0.86 IU/kg [0.82; 0.90]) and insulin pump use (13.3% [10.7; 16.4] vs 22.1% [19.0; 25.6%]) were lower in patients with pancreatic diabetes. However, event rates of severe hypoglycemia were similar between pancreatic and T1D patients (8.8 [5.4; 14.2] vs 9.6 [5.9; 15.6] events per 100 patient years). CONCLUSIONS With the use of robust epidemiological data, our study improves the knowledge on clinical characteristics in pediatric individuals with pancreatic diabetes. Moreover, our results serve as a basis to reconsider treatment options and for discussing clinical practice guidelines for patients with this rare medical condition.
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Affiliation(s)
- Stefanie Lanzinger
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Alena Welters
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Angelika Thon
- Clinic for Pediatric Pneumology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Katja Konrad
- Department of Pediatric and Adolescent Medicine, Elisabeth-Hospital Essen, Essen, Germany
| | - Thomas Kapellen
- Department of Pediatrics, University of Leipzig, Hospital for Children and Adolescents, Leipzig, Germany
| | | | - Dirk Raddatz
- Clinic for Gastroenterology und Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
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Prinz N, Konrad K, Brack C, Hahn E, Herbst A, Icks A, Grulich-Henn J, Jorch N, Kastendieck C, Mönkemöller K, Razum O, Steigleder-Schweiger C, Witsch M, Holl RW. Diabetes care in pediatric refugees from Africa or Middle East: experiences from Germany and Austria based on real-world data from the DPV registry. Eur J Endocrinol 2019; 181:31-38. [PMID: 31075760 DOI: 10.1530/eje-18-0898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/10/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE With increasing migration to Europe, diabetes diagnosis and treatment of refugees became challenging. To describe the current experience with pediatric refugees in Germany and Austria. DESIGN AND METHODS 43,137 patients (<21 years) with type 1 diabetes from the diabetes patient follow-up registry (DPV) were studied and divided by refugee status into patients born in Middle East (n = 365) or Africa (n = 175) and native patients (child and parents born in Germany/Austria; G/A: n = 42,597). Groups were compared using multivariable regression adjusted for age, sex and diabetes duration (SAS 9.4). In refugees the first year after arrival was studied, and for native children the most recent year of care. RESULTS After adjustment, HbA1c was highest in refugees (1. ME and 2. AFR vs 3. G/A: 72.3 ± 1.0 and 75.0 ± 1.4 vs 66.0 ± 0.1 mmol/mol, 1 vs 3: P < 0.001 and 2 vs 3: P < 0.001) and microalbuminuria (9.9 and 13.6 vs 6.5%, 1 vs 3: P = 0.039 and 2 vs 3: P = 0.002) was more prevalent. African children experienced severe hypoglycemia (17.8 ± 4.3 and 25.4 ± 8.7 vs 11.5 ± 0.3 per 100 patient years, 1 vs 3: P > 0.05 and 2 vs 3: P = 0.045) significantly more often, whereas hypoglycemia with coma (5.1 ± 1.1 and 4.1 ± 1.6 vs 2.6 ± 0.1 per 100 patient years, 1 vs 3: P = 0.006 and 2 vs 3: P > 0.05) and retinopathy (2.1 and n/a vs 0.2%, 1 vs 3: P < 0.001) were significantly more common in children from Middle East compared to natives. Insulin pumps were used in a markedly larger proportion of native patients (7.4 and 13.2 vs 43.0%, 1 vs 3: P < 0.001 and 2 vs 3: P < 0.001). CONCLUSIONS A relevant number of pediatric refugees with type 1 diabetes are treated in German/Austrian diabetes clinics. Refugee children, parents and caregivers are faced with several problems in diabetes therapy and outcome that should be addressed more intensively by pediatric diabetes teams.
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Affiliation(s)
- Nicole Prinz
- Institute of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich Neuherberg, Germany
| | - Katja Konrad
- Department of Pediatric and Adolescent Medicine, University of Cologne, Cologne, Germany
- Department of Pediatric and Adolescent Medicine, Elisabeth-Hospital Essen, Essen, Germany
| | | | - Eva Hahn
- Department of Pediatrics and Adolescent Medicine, Protestant Hospital Oberhausen, Oberhausen, Germany
| | - Antje Herbst
- Department of Pediatric and Adolescent Medicine, Hospital Leverkusen gGmbH, Leverkusen, Germany
| | - Andrea Icks
- German Center for Diabetes Research (DZD), Munich Neuherberg, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Norbert Jorch
- Department of Pediatrics, Protestant Hospital Bielefeld gGmbH, Bielefeld, Germany
| | | | - Kirsten Mönkemöller
- Department of Pediatrics, Pediatric Hospital Amsterdamer Straße, Cologne, Germany
| | - Oliver Razum
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Claudia Steigleder-Schweiger
- Department of Pediatrics, University Hospital of Pediatrics, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Michael Witsch
- Department of Pediatric and Adolescent Medicine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Reinhard 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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8
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Prinz N, Zolin A, Konrad K, Nährlich L, Laubner K, Olesen HV, Bauer M, Jung A, Frischer T, Holl RW. Characteristics of cystic fibrosis-related diabetes: Data from two different sources the European cystic fibrosis society patient registry and German/Austrian diabetes prospective follow-up registry. Pediatr Diabetes 2019; 20:255-262. [PMID: 30761696 DOI: 10.1111/pedi.12831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 12/17/2018] [Accepted: 01/28/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Standardized patient registries provide a unique basis to get insight into cystic fibrosis (CF)-related diabetes (CFRD), the most common comorbidity in CF. METHODS A total of 3853 CFRD patients from the European CF Society Patient Registry (ECFSPR) and 752 from the German/Austrian diabetes prospective follow-up (diabetes patienten verlaufsdokumentation [DPV]) were studied. To adjust for age and sex, multivariable regression was used (SAS 9.4). RESULTS DPV subjects were younger (26.5 [20.2-32.6] vs 28.3 [21.7-36.0] years, P < 0.001) and more often female (59.6 vs 50.9%, P < 0.001). In both registries, F508del homozygotes were most frequent, with higher proportion in DPV (80.9 vs 57.8%, P = 0.003). After adjustment, lung-transplantation (LTX) was more common in ECFSPR (18.9 vs 4.9%, P < 0.001), although duration since LTX (4.8 ± 0.2 vs 5.5 ± 0.7 years, P = 0.33) did not differ. In DPV patients without LTX, a lower BMI (19.6 ± 0.1 vs 21.0 ± 0.1 kg/m2 , P < 0.001), higher proportion of underweight (41.2 vs 20.2%, P < 0.001) and a tendency towards worse lung function (%FEV1 : 42.3 ± 4.2 vs 48.3 ± 0.5%, P = 0.16) were observed. CONCLUSIONS Between both registries, demographic and clinical differences of CFRD were present. Besides different kind of data sources, diverse treatment structures between countries may play a role. The results may further indicate a more serious illness in patients treated in specialized diabetes clinics, documenting their data in DPV.
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Affiliation(s)
- Nicole Prinz
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Anna Zolin
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Katja Konrad
- Department of Pediatric and Adolescent Medicine, University of Cologne, Cologne, Germany.,Department of Pediatric and Adolescent Medicine, Elisabeth-Hospital Essen, Essen, Germany
| | - Lutz Nährlich
- Department of Pediatrics, Justus-Liebig-University Giessen, Giessen, Germany
| | - Katharina Laubner
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hanne V Olesen
- Department of Child and Adolescent Health, CF Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Maria Bauer
- Department of Children and Adolescent Medicine, Gynecological and Children Hospital, Linz, Austria
| | - Andreas Jung
- Division of Respiratory Medicine, University Children's Hospital, Zürich, Switzerland
| | - Thomas Frischer
- Department of Pediatrics, Wilhelminenspital, Vienna, Austria
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
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9
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Bechtold SM, Rohrer TR, Raile K, Hofer S, Thon A, Boettcher C, Konrad K, Pozza RD, Bollow E, Holl RW. Diabetes mellitus in pediatric solid organ recipients without and with cystic fibrosis: An analysis from the German-Austrian diabetes database (Diabetes Patienten Verlaufsdokumentation). Pediatr Diabetes 2018; 19:1191-1197. [PMID: 30070005 DOI: 10.1111/pedi.12725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/17/2018] [Accepted: 07/10/2018] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Posttransplantation diabetes mellitus (PTDM) increases the risk of cardiovascular disease, graft loss, and decreased survival. Follow-up treatment after solid organ transplantation (SOT) needs to focus on, inter alia, maintaining balanced glucose metabolism. This study aimed to ascertain the prevalence of PTDM and describe patient characteristics in the large DPV (Diabetes Patienten Verlaufsdokumentation) pediatric diabetes database. METHODS DPV data of 71 902 patients from the January 01, 1995 to January 04, 2015 period were analyzed for patients with and without cystic fibrosis (CF) after SOT (kidney, liver, heart, and lung). Multivariable analysis served to assess differences between SOT patient groups at risk for developing diabetes. RESULTS Out of 109 SOT patients, 51 had CF; 72.5% received steroids and 62% were additionally given tacrolimus. PTDM developed in 45% of CF patients and 12% of non-CF patients. SOT patients were older at diabetes onset (mean age, 12.50 ± 3.98 years), shorter (height z-score, -1.67 ± 1.25), and lighter (weight z-score, -1.59 ± 1.57) than non-SOT diabetes patients (P < 0.01). With transplantation, glycated hemoglobin (HbA1c) was significantly lower and treatment for hypertension and dyslipidemia was increased. Among SOT patients, weight and body mass index (BMI) z-scores were significantly lower in patients with CF-related diabetes (P < 0.05). CONCLUSIONS SOT was present in 6.6% of children with diabetes, and this might aggravate the risk of cardiovascular disease in populations with already increased rates of hypertension and dyslipidemia. Dystrophy and short stature were also present, particularly in transplant recipients with CF and diabetes. Comorbidities and long-term consequences call for multidisciplinary collaboration.
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Affiliation(s)
- Susanne M Bechtold
- Department of Pediatric Endocrinology and Diabetology, Ludwig-Maximilian's University Medicine Munich, Munich, Germany
| | - Tilman R Rohrer
- Department of Pediatrics, Saarland University Medical Center, Homburg/Saar, Germany
| | - Klemens Raile
- Department of Pediatric Endocrinology and Diabetology, Charité University Medicine Berlin, Berlin, Germany
| | - Sabine Hofer
- Department of Pediatrics, University Hospital Innsbruck, Innsbruck, Austria
| | - Angelika Thon
- Department of Pediatrics, Hannover Medical University, Hannover, Germany
| | - Claudia Boettcher
- Division of Pediatric Endocrinology & Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University Giessen, Gießen, Germany
| | - Katja Konrad
- Department of Pediatrics, Elisabeth Krankenhaus Essen, Essen, Germany.,Medical University of Cologne, Köln, Germany
| | - Robert Dalla Pozza
- Department of Pediatric Cardiology, Ludwig-Maximilian's University Medicine Munich, Munich, Germany
| | - Esther Bollow
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
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10
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Vloet TD, Konrad K, Herpertz-Dahlmann B. Psychische Erkrankungen im Kindes- und Jugendalter und ihre Auswirkungen auf das Erwachsenwerden. ACTA ACUST UNITED AC 2018. [DOI: 10.1055/s-0038-1669667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
ZusammenfassungEntwicklungsprozesse haben für die Entstehung und den Verlauf kinder- und jugendpsychiatrischer Störungen eine große Bedeutung. So manifestieren sich einige erst in bestimmten Altersphasen oder nehmen in der Häufigkeit mit zunehmender Reife wieder ab. Viele Entwicklungsverläufe reichen aber auch bis in das Erwachsenenalter hinein. Der vorliegende Artikel stellt zunächst eine Klassifikation kinder- und jugendpsychiatrischer Störungen in Abhängigkeit distinkter Entwicklungs- und Verlaufsaspekte dar. Anhand von drei Störungsbildern werden exemplarisch verschiedene Entwicklungsverläufe skizziert: Währen die Autismusspektrumsstörungen früh beginnen und oft zu lebenslangen Beeinträchtigungen führen, können Reifungsprozesse bei den Aufmerksamkeitsdefizit-/Hyperaktivitätsstörungen die Ausprägung der Symptomatik im Verlauf vermindern. Innerhalb der heterogenen Gruppe von Störungen des Sozialverhaltens bestehen erhebliche Unterschiede zwischen Entwicklungspfaden, die teilweise eine dauerhaft zunehmende Symptomatik von der Kindheit bis in das Erwachsenenalter hinein zeigen. Generell liegen z.T. bereits im Kindes- und Jugendalter übergreifende Beeinträchtigungen vor, die im Verlauf die Bewältigung notwendiger Entwicklungsaufgaben erschweren und zu umfangreichen Einschränkungen im Erwachsenenalter führen können. Es wird in diesem Zusammenhang die Bedeutung einer bereits im Kindes- und Jugendalter einsetzenden Therapie betont.
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11
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Weber P, John R, Konrad K, v. Livonius B, Lorenz B, Ruple B, Stock-Mühlnickel S, Karch D, Schroeder A. Erratum zu: Visuelle Wahrnehmungsstörungen. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0529-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Hilgard D, Konrad K, Meusers M, Bartus B, Otto KP, Lepler R, Schober E, Bollow E, Holl RW. Comorbidity of attention deficit hyperactivity disorder and type 1 diabetes in children and adolescents: Analysis based on the multicentre DPV registry. Pediatr Diabetes 2017; 18:706-713. [PMID: 27523391 DOI: 10.1111/pedi.12431] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/16/2016] [Accepted: 07/19/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The interaction between type 1 diabetes mellitus (T1DM) and attention deficit hyperactivity disorder (ADHD) in children and adolescents has been studied rarely. We aimed to analyse metabolic control in children and adolescents with both T1DM and ADHD compared to T1DM patients without ADHD. PATIENTS AND METHODS Auxological and treatment data from 56.722 paediatric patients (<20 years) with T1DM in the multicentre DPV (Diabetes Prospective Follow-up Initiative) registry were analysed. T1DM patients with comorbid ADHD were compared to T1DM patients without ADHD using multivariable mixed regression models adjusting for demographic confounders. RESULTS We identified 1.608 (2.83%) patients with ADHD, 80.8% were male. Patients with comorbid ADHD suffered twice as often from diabetic ketoacidosis compared to patients without ADHD [10.2; 9.7-10.8 vs [5.4; 5.3-5.4] (P < .0001). We also found significant differences in HbA1c [8.6% (7.3-9.4); 66.7 mmol/mol (56.3-79.4) vs 7.8% (7.0-9.0); 62.1 mmol/mol (53.2-74.7)], insulin dose/kg [0.9 IU/kg (0.7-1.1) vs 0.8 IU/kg (0.7-1.0)], body mass index-standard deviation score (BMI-SDS) [0.2 (-0.5 to 0.8) vs 0.3 (-0.3 to 0.9)], body weight-SDS [0.1 (-0.5 to 0.8) vs 0.3 (0.3 - 0.9)]; (all P < 0.0001), and systolic blood pressure after adjustment [mean: 116.3 vs 117.1 mm Hg)]; (P < 0.005). CONCLUSION Paediatric patients with ADHD and T1DM showed poor metabolic control compared to T1DM patients without ADHD. Closer cooperation between specialized paediatric diabetes teams and paediatric psychiatry/psychology seems to be necessary to improve diabetes care and metabolic control in this group of patients.
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Affiliation(s)
- Doerte Hilgard
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | - Katja Konrad
- Department of Pediatric and Adolescent Medicine, University of Cologne, Cologne, Germany.,Department of Pediatric and Adolescent Medicine, Elisabeth Hospital Essen, Essen, Germany
| | - Michael Meusers
- Department of Child and Adolescent Psychiatry, Gemeinschaftskrankenhaus, Herdecke, Germany
| | - Bela Bartus
- Department of Pediatrics, Filderklinik, Filderstadt, Germany
| | - Klaus-Peter Otto
- Department of Pediatrics, Medical Center Itzehoe, Itzehoe, Germany
| | - Rudolf Lepler
- Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
| | - Edith Schober
- Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Esther Bollow
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
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13
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Prinz N, Zolin A, Konrad K, Nährlich L, Laubner K, Olesen H, Bauer M, Jung A, Frischer T, Holl R. 414 Demographic and clinical aspects of cystic fibrosis-related diabetes (CFRD) – a registry comparison between the European CF Society Patient Registry (ECFSPR) and the German/Austrian/Luxembourg diabetes patient follow-up registry DPV. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30744-0] [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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Hermann JM, Rosenbauer J, Holterhus PM, Böckmann A, Hahn E, Meraner D, Thienelt M, Konrad K, Holl RW. Diabetes im Sommer, Diabetes im Winter: Gibt es saisonale Schwankungen beim HbA1c? Eine DPV-Analyse von 72,162 Patienten mit Typ-1-Diabetes. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601686] [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)
- JM Hermann
- Universität Ulm, Institut für Epidemiologie und Medizinische Biometrie, ZIBMT, Ulm, Germany
| | - J Rosenbauer
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | - PM Holterhus
- Christian-Albrechts Universität zu Kiel, Pädiatrische Endokrinologie und Diabetologie, Kiel, Germany
| | - A Böckmann
- Klinikum Konstanz, Klinik für Kinder und Jugendliche, Konstanz, Germany
| | - E Hahn
- Evangelisches Krankenhaus Oberhausen, Klinik für Kinder und Jugendliche, Oberhausen, Germany
| | - D Meraner
- Medizinische Universität Innsbruck, Department für Pädiatrie 1, Innsbruck, Austria
| | - M Thienelt
- Christophorus-Kliniken Coesfeld, Diabetes-Zentrum für Kinder, Coesfeld, Germany
| | - K Konrad
- Elisabeth-Krankenhaus Essen, Klinik für Kinder- und Jugendmedizin, Essen, Germany
| | - RW Holl
- Universität Ulm, Institut für Epidemiologie und Medizinische Biometrie, ZIBMT, Ulm, Germany
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Oberwelland E, Schilbach L, Barisic I, Krall SC, Vogeley K, Fink GR, Herpertz-Dahlmann B, Konrad K, Schulte-Rüther M. Young adolescents with autism show abnormal joint attention network: A gaze contingent fMRI study. Neuroimage Clin 2017; 14:112-121. [PMID: 28180069 PMCID: PMC5279905 DOI: 10.1016/j.nicl.2017.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/22/2016] [Accepted: 01/07/2017] [Indexed: 01/20/2023]
Abstract
Behavioral research has revealed deficits in the development of joint attention (JA) as one of the earliest signs of autism. While the neural basis of JA has been studied predominantly in adults, we recently demonstrated a protracted development of the brain networks supporting JA in typically developing children and adolescents. The present eye-tracking/fMRI study now extends these findings to adolescents with autism. Our results show that in adolescents with autism JA is subserved by abnormal activation patterns in brain areas related to social cognition abnormalities which are at the core of ASD including the STS and TPJ, despite behavioral maturation with no behavioral differences. Furthermore, in the autism group we observed increased neural activity in a network of social and emotional processing areas during interactions with their mother. Moreover, data indicated that less severely affected individuals with autism showed higher frontal activation associated with self-initiated interactions. Taken together, this study provides first-time data of JA in children/adolescents with autism incorporating the interactive character of JA, its reciprocity and motivational aspects. The observed functional differences in adolescents ASD suggest that persistent developmental differences in the neural processes underlying JA contribute to social interaction difficulties in ASD. Gaze-contingent fMRI task to study joint attention in a developmental sample with autism JA in the autism group elicited abnormal activation in social cognition related areas. The interaction partner's familiarity modulated brain activity in the autism group. In the autism group frontal activation is related to the severity of communication deficits.
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Affiliation(s)
- E Oberwelland
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital RWTH Aachen, Germany; Translational Brain Research in Psychiatry and Neurology, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Aachen, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Jülich Research Center, Germany
| | - L Schilbach
- Department of Psychiatry, University Hospital Cologne, Germany; Max Planck Institute of Psychiatry, Munich, Germany
| | - I Barisic
- Department of Psychiatry, University Hospital Cologne, Germany; Department of Humanities, Social and Political Science, ETH Zurich, Switzerland
| | - S C Krall
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital RWTH Aachen, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Jülich Research Center, Germany
| | - K Vogeley
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Jülich Research Center, Germany; Department of Psychiatry, University Hospital Cologne, Germany
| | - G R Fink
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Jülich Research Center, Germany; Department of Neurology, University Hospital Cologne, Germany
| | - B Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital RWTH Aachen, Germany
| | - K Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital RWTH Aachen, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Jülich Research Center, Germany
| | - M Schulte-Rüther
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital RWTH Aachen, Germany; Translational Brain Research in Psychiatry and Neurology, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Aachen, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Jülich Research Center, Germany
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16
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Plamper M, Gohlke B, Woelfle J, Konrad K, Rohrer T, Hofer S, Bonfig W, Fink K, Holl RW. Interaction of Pubertal Development and Metabolic Control in Adolescents with Type 1 Diabetes Mellitus. J Diabetes Res 2017; 2017:8615769. [PMID: 29238730 PMCID: PMC5697126 DOI: 10.1155/2017/8615769] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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] [Received: 06/22/2017] [Revised: 09/07/2017] [Accepted: 09/27/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In T1DM, delayed pubertal development and reduced final height are associated with inadequate metabolic control. OBJECTIVE To assess whether T1DM affects pubertal growth spurt and whether metabolic control during puberty is gender-related. METHODS Using a large multicentre database, longitudinal data from 1294 patients were analysed. Inclusion criteria: complete records of height and HbA1c from the age of seven to 16 years. Exclusion criteria: other significant chronic diseases and medications, T1DM duration less than three months, and initial BMI < 3rd or >97th percentile. RESULTS Growth velocity (GV) was impaired with a significant reduction of peak GV by 1.2 cm in boys. HbA1c increase during male puberty was lower except for a period of 1.5 years. The highest HbA1c increase in boys coincided with maximum growth spurt. In girls, the highest HbA1c increase was observed during late puberty. Even though there is impaired GV, both sexes reach a height at 16 years of age which corresponds to the background population height. CONCLUSION Worsening of metabolic control is sex-discordant and associated with gender-specific alterations of GV. However, the vast majority of boys and girls with T1DM seems to reach normal height at the age of 16 years.
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Affiliation(s)
- M. Plamper
- Pediatric Endocrinology Division, Children's Hospital, University of Bonn, Bonn, Germany
| | - B. Gohlke
- Pediatric Endocrinology Division, Children's Hospital, University of Bonn, Bonn, Germany
| | - J. Woelfle
- Pediatric Endocrinology Division, Children's Hospital, University of Bonn, Bonn, Germany
| | - K. Konrad
- Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
- Department of Pediatric and Adolescent Medicine, Elisabeth Hospital Essen, Essen, Germany
| | - T. Rohrer
- Department of Pediatrics, University of Saarland, Homburg, Germany
| | - S. Hofer
- Department of Pediatrics, University of Innsbruck, Innsbruck, Austria
| | - W. Bonfig
- Department of Pediatrics, Technical University Munich, Munich, Germany
- Department of Pediatrics, Klinikum Wels-Grieskirchen, Wels, Austria
| | - K. Fink
- Institute for Epidemiology and Medical Biometry, ZIBMT University of Ulm and German Center for Diabetes Research (DZD), Neuherberg, München, Germany
| | - R. W. Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT University of Ulm and German Center for Diabetes Research (DZD), Neuherberg, München, Germany
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17
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Warncke K, Konrad K, Kohne E, Hammer E, Ohlenschläger U, Herrlinger S, Jäger A, Holl RW. Diabetes in Patients with ß-thalassemia or other Hemoglobinopathies - Analysis from the DPV Database. Klin Padiatr 2016; 228:307-312. [PMID: 27846660 DOI: 10.1055/s-0042-111691] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Diabetes mellitus is a common endocrinopathy in patients with thalassemia major, but the occurrence of hemoglobinopathies is rare in Germany and Western Europe. The longitudinal German-Austrian DPV (Diabetes Patienten Verlaufsdokumentation) registry allows a comprehensive characterization of this group of patients. Patients/methods: Patients from the DPV-registry aged<30 years with thalassemia major or other hemoglobinopathies were compared to patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) using the statistical software SAS 9.4. Results: 94 patients (0.13% of patients) with hemoglobinopathies are registered in DPV. 82.4% of 17 patients with thalassemia major, 100% of 12 patients with sickle cell disease (SCD) and >90% of 65 patients with other hemoglobinopathies receive insulin treatment. In the majority of patients with thalassemia major, hemosiderosis is documented. Patients with thalassemia major developed diabetes at a median age of 14.6 [IQR 8.4-18.0] years (9.0 years [5.3-12.5] in T1D; 18.7 years [14.2-25.6] in TD2; both p<0.01). They show high HbA1c/fructosamine levels and frequent hypoglycemia, reflecting poor metabolic control. Conclusion: Diabetes in thalassemia major is probably caused by hemosiderosis due to polytransfusion, while patients with SCD/thalassemia minor are most likely affected by T1D. The high rate of hypoglycemia in patients with ß-thalassemia major may be caused by liver fibrosis and a lack of hepatic glycogen stores.
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Affiliation(s)
- K Warncke
- Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - K Konrad
- Department of Pediatric and Adolescent Medicine, University Children's Hospital Cologne, Cologne, Germany
| | - E Kohne
- Department of Pediatrics and Adolescents, Laboratory of Hemoglobinopathy, University of Ulm, Ulm, Germany
| | - E Hammer
- Department of Pediatrics, Children's Hospital Wilhelmstift, Hamburg, Germany
| | - U Ohlenschläger
- Department of Pediatrics, Goethe University Frankfurt, Frankfurt, Germany
| | - S Herrlinger
- Department of Pediatrics, Klinikum Bremen Nord, Bremen, Germany
| | - A Jäger
- Department of Pediatrics, Kaiser-Franz-Josef-Spital mit Gottfried von Preyer'schem Kinderspital, Wien, Austria
| | - R W Holl
- Central Institute for Biomedical Technology, ZIBMT, University of Ulm, Ulm, Germany
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18
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Konrad K, Vogel C, Bollow E, Fritsch M, Lange K, Bartus B, Holl RW. Current practice of diabetes education in children and adolescents with type 1 diabetes in Germany and Austria: analysis based on the German/Austrian DPV database. Pediatr Diabetes 2016; 17:483-491. [PMID: 26530288 DOI: 10.1111/pedi.12330] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 08/03/2015] [Accepted: 09/23/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Diabetes education of patients and/or parents is an essential part of diabetes care with effects on diabetes outcome. The objective of our study was to describe the current practice of diabetes education in Germany and Austria with regard to training frequency, patient age, migration background and diabetes therapy in a large cohort of pediatric patients with diabetes mellitus type 1 (T1DM). METHODS We analyzed data from pediatric T1DM patients with diabetes training in 2013 and complete data available for treatment year in the multicenter Diabetes Patienten Verlaufsdokumentation (DPV) registry using sas 9.4. RESULTS In 2013 21 871 pediatric patients with T1DM were documented [52.4% male, age: 12.70 (9.35-15.30) yr (median (interquartile range)], diabetes duration: 3.80 (1.45-7.00) yr, migration background: 21.4%, twice daily injections: 5.5%, multiple daily injections: 52.5%, insulin-pump therapy: 42%. Of these 32.31% were trained in 2013. Younger patients and their parents were trained more intensely and more frequently as inpatients compared with older patients (0-6 vs. 6-12 and 12-18 yr: teaching units: 13.07 vs. 12.05 and 9.79; inpatient: 79% vs. 72% and 70%). There was also a difference in training frequency with regard to migration background. Severe hypoglycemia or ketoacidosis resulted in intensification of training (4.0 vs. 2.0%; 7.8 vs. 3.1%). Centre-specific education tools were used frequently alone or in combination with published, standardized education programs. CONCLUSION Training frequency was highest in younger patients and during the first year of diabetes. Acute complications resulted in more frequent diabetes training, indicating that currently many education sessions take place in consequence to these complications.
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Affiliation(s)
- K Konrad
- Department of Pediatric and Adolescent Medicine, University of Cologne, Cologne, Germany. .,Department of Pediatric and Adolescent Medicine, Elisabeth-Hospital Essen, Essen, Germany.
| | - C Vogel
- Department of Pediatrics, Childrens Hospital Chemnitz, Chemnitz, Germany
| | - E Bollow
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, German Center for Diabetes Research (DZD), Ulm, Germany
| | - M Fritsch
- Department of Pediatric and Adolescent Medicine, University of Vienna, Vienna, Austria
| | - K Lange
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
| | - B Bartus
- Department of Pediatrics Filderstadt Hospital, Filderklinik, Filderstadt, Germany
| | - R W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, German Center for Diabetes Research (DZD), Ulm, Germany
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19
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Puetz VB, Parker D, Kohn N, Dahmen B, Verma R, Konrad K. Altered brain network integrity after childhood maltreatment: A structural connectomic DTI-study. Hum Brain Mapp 2016; 38:855-868. [PMID: 27774721 DOI: 10.1002/hbm.23423] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 09/09/2016] [Accepted: 09/26/2016] [Indexed: 11/08/2022] Open
Abstract
Childhood maltreatment is associated with alterations in neural architecture that potentially put these children at increased risk for psychopathology. Alterations in white matter (WM) tracts have been reported, however no study to date has investigated WM connectivity in brain networks in maltreated children to quantify global and local abnormalities through graph theoretical analyses of DTI data. We aimed for a multilevel investigation examining the DTI-based structural connectome and its associations with basal cortisol levels of 25 children with documented maltreatment experiences before age 3, and 24 matched controls (age: 10.6 ± 1.75 years). On the global and lobar level, maltreated children showed significant reductions in global connectivity strength, local connectivity and increased path length, suggesting deviations from the small-world network architecture previously associated with psychopathology. Reductions in global connectivity were associated with placement instability, attenuated cortisol secretion and higher levels of internalizing and externalizing behaviours. Regional measures revealed lower connectivity strength especially in regions within the ventromedial prefrontal cortex (vMPFC) in maltreated children. These findings show that childhood maltreatment is associated with systemic global neurodevelopmental alterations in WM networks next to regional alterations in areas involved in the regulation of affect. These alterations in WM organization could underlie global functional deficits and multi-symptom patterns frequently observed in children with maltreatment experiences. Hum Brain Mapp 38:855-868, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- V B Puetz
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - D Parker
- Section of Biomedical Image Analysis, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - N Kohn
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - B Dahmen
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital RWTH Aachen, Germany
| | - R Verma
- Section of Biomedical Image Analysis, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - K Konrad
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital RWTH Aachen, Germany.,JARA-Brain Institute II, Molecular Neuroscience and Neuroimaging, RWTH Aachen & Research Centre Juelich, Germany.,Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital RWTH Aachen, Germany
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Konrad K, Kapellen T, Lilienthal E, Prinz N, Bauer M, Thon A, Rietschel E, Wiemann D, Holl RW. Does β-Cell Autoimmunity Play a Role in Cystic Fibrosis-Related Diabetes? Analysis Based on the German/Austrian Diabetes Patienten Verlaufsdokumentation Registry. Diabetes Care 2016; 39:1338-44. [PMID: 27271187 DOI: 10.2337/dc16-0020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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] [Received: 01/05/2016] [Accepted: 05/03/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Research on β-cell autoimmunity in cystic fibrosis (CF)-related diabetes (CFRD) is still rare. We aimed to analyze the frequency of β-cell autoimmunity and the influence on age at diabetes onset, insulin requirement, type of insulin therapy, and hypoglycemic or ketoacidotic events in patients with CFRD compared with antibody-negative patients with CFRD in the Diabetes Patienten Verlaufsdokumentation (DPV) registry. RESEARCH DESIGN AND METHODS We analyzed data of 837 patients with CFRD in the German/Austrian DPV database by multivariable mixed-regression modeling. RESULTS In our cohort, 8.5% of patients with CFRD (n = 72) were found to be β-cell antibody positive. There was a female preponderance in this patient group: 65.3 vs. 57.6%. Diabetes onset (median [interquartile range]) was earlier (14.00 [10.15-15.90] vs. 16.10 [13.50-21.20] years; P < 0.005), and insulin dose/kg body weight was higher (0.95 [0.61-1.15] vs. 0.67 [0.33-1.04] IU/kg; P < 0.05). There were also differences in the type of insulin treatment. Insulin pump therapy was used significantly more often in patients with CFRD with β-cell autoimmunity (18.2 vs. 6.4%; P < 0.05). The differences for multiple daily injections (ICT) and conventional therapy (CT) were not significant (ICT: 67.7 vs. 79.0%; CT: 15.2 vs. 14.6). Oral antidiabetic agents were rarely used in both groups. Rate of severe hypoglycemia with coma and rate of ketoacidosis were higher in antibody-positive patients (hypoglycemia with coma: 8.0 vs. 1.4, P < 0.05; ketoacidosis: 9.3 vs. 0.9, P < 0.05). CONCLUSIONS Presence of β-cell autoantibodies in our cohort of patients with CFRD (8.5%) appeared to be greater than in the general population and was associated with female sex, earlier onset of diabetes, and higher insulin requirement. Insulin pump therapy was used significantly more often in patients with β-cell antibodies. Severe hypoglycemia and ketoacidosis were significantly more frequent in CFRD with β-cell autoimmunity compared with β-cell antibody-negative patients with CFRD.
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Affiliation(s)
- Katja Konrad
- Department of Pediatric and Adolescent Medicine, University of Cologne, Cologne, Germany Department of Pediatric and Adolescent Medicine, Elisabeth-Hospital Essen, Essen, Germany
| | - Thomas Kapellen
- Department of Pediatrics, University of Leipzig, Leipzig, Germany
| | | | - Nicole Prinz
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Maria Bauer
- Department of Pediatric and Adolescent Medicine, University of Linz, Linz, Austria
| | - Angelika Thon
- Department of Pediatrics, Hannover Medical School, Hannover, Germany
| | - Ernst Rietschel
- Department of Pediatric and Adolescent Medicine, University of Cologne, Cologne, Germany
| | - Dagobert Wiemann
- Department of Pediatrics, University of Magdeburg, Magdeburg, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany German Center for Diabetes Research, München-Neuherberg, Germany
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Wurm M, Konrad K, Kapellen T, Kieninger D, Laubner K, Lilienthal E, Prinz N, Martin S, Smaczny C, Wiemann D, Holl R. 266 The role of diabetes autoantibodies in cystic fibrosis related diabetes mellitus – a DPV registry analysis. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30504-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Seitz J, Herpertz-Dahlmann B, Konrad K. Brain morphological changes in adolescent and adult patients with anorexia nervosa. J Neural Transm (Vienna) 2016; 123:949-59. [DOI: 10.1007/s00702-016-1567-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 04/30/2016] [Indexed: 01/17/2023]
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Oberwelland E, Schilbach L, Barisic I, Krall SC, Vogeley K, Fink GR, Herpertz-Dahlmann B, Konrad K, Schulte-Rüther M. Look into my eyes: Investigating joint attention using interactive eye-tracking and fMRI in a developmental sample. Neuroimage 2016; 130:248-260. [PMID: 26892856 DOI: 10.1016/j.neuroimage.2016.02.026] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/19/2016] [Accepted: 02/09/2016] [Indexed: 12/19/2022] Open
Abstract
Joint attention, the shared attentional focus of at least two people on a third significant object, is one of the earliest steps in social development and an essential aspect of reciprocal interaction. However, the neural basis of joint attention (JA) in the course of development is completely unknown. The present study made use of an interactive eye-tracking paradigm in order to examine the developmental trajectories of JA and the influence of a familiar interaction partner during the social encounter. Our results show that across children and adolescents JA elicits a similar network of "social brain" areas as well as attention and motor control associated areas as in adults. While other-initiated JA particularly recruited visual, attention and social processing areas, self-initiated JA specifically activated areas related to social cognition, decision-making, emotions and motivational/reward processes highlighting the rewarding character of self-initiated JA. Activation was further enhanced during self-initiated JA with a familiar interaction partner. With respect to developmental effects, activation of the precuneus declined from childhood to adolescence and additionally shifted from a general involvement in JA towards a more specific involvement for self-initiated JA. Similarly, the temporoparietal junction (TPJ) was broadly involved in JA in children and more specialized for self-initiated JA in adolescents. Taken together, this study provides first-time data on the developmental trajectories of JA and the effect of a familiar interaction partner incorporating the interactive character of JA, its reciprocity and motivational aspects.
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Affiliation(s)
- E Oberwelland
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital RWTH Aachen, Germany; Translational Brain Research in Psychiatry and Neurology, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Aachen, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Jülich Research Center, Germany.
| | - L Schilbach
- Department of Psychiatry, University Hospital Cologne, Germany; Max Planck Institute of Psychiatry, Munich, Germany
| | - I Barisic
- Department of Psychiatry, University Hospital Cologne, Germany; Department of Humanities, Social and Political Science, ETH Zurich, Switzerland
| | - S C Krall
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital RWTH Aachen, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Jülich Research Center, Germany
| | - K Vogeley
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Jülich Research Center, Germany; Department of Psychiatry, University Hospital Cologne, Germany
| | - G R Fink
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Jülich Research Center, Germany; Department of Neurology, University Hospital Cologne, Germany
| | - B Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital RWTH Aachen, Germany
| | - K Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital RWTH Aachen, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Jülich Research Center, Germany
| | - M Schulte-Rüther
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital RWTH Aachen, Germany; Translational Brain Research in Psychiatry and Neurology, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Aachen, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Jülich Research Center, Germany
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Konrad K, Datz N, Engelsberger I, Grulich-Henn J, Hoertenhuber T, Knauth B, Meissner T, Wiegand S, Woelfle J, Holl RW. Current use of metformin in addition to insulin in pediatric patients with type 1 diabetes mellitus: an analysis based on a large diabetes registry in Germany and Austria. Pediatr Diabetes 2015; 16:529-37. [PMID: 25131985 DOI: 10.1111/pedi.12203] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 04/18/2014] [Revised: 07/11/2014] [Accepted: 07/21/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND With increasing obesity in childhood and adolescence, weight gain, and insulin resistance become also more frequent in patients with type 1 diabetes mellitus (T1DM). Especially during puberty, insulin therapy often has to be intensified and higher insulin doses are necessary. Some studies point to a beneficial effect of metformin in addition to insulin in these patients. In order to describe current practice and possible benefits, we compared pediatric T1DM patients with insulin plus metformin (n = 525) to patients with insulin therapy only (n = 57 487) in a prospective multicenter analysis. METHODS Auxological and treatment data from 58 012 patients aged <21 yr with T1DM in the German/Austrian Diabetes Patienten Verlaufsdokumentation (DPV) registry were analyzed by multivariable mixed regression modeling. RESULTS Patients with additional metformin were older [median (interquartile range)]: [16.1 (14.1-17.6) vs. 15.2 (11.5-17.5) yr] with female preponderance (61.0 vs. 47.2%, p < 0.01). They had higher body mass index-standard deviation score (BMI-SDS) [+2.03 (+1.29 to +2.56) vs. +0.51 (-0.12 to +1.15); p < 0.01] and glycated hemoglobin (HbA1c) (9.0 vs. 8.6%, p < 0.01). Hypertension (43.7 vs. 24.8%) and dyslipidemia (58.4 vs. 40.6%) were significantly more prevalent. Adjusted insulin dose was significantly higher (0.98 vs. 0.93 IU/kg bodyweight). In a subgroup of 285 patients followed-up longitudinally (average treatment period 1.42 yr), addition of metformin resulted in a slight reduction of BMI-SDS [-0.01 (-2.01 to +1.40)], but did not improve HbA1c or insulin requirement. CONCLUSION Additional metformin therapy in T1DM is primarily used in obese females. Additional therapy with metformin was associated with minor benefits.
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Affiliation(s)
- Katja Konrad
- Department of Pediatrics II, University Children's Hospital Essen, Essen, Germany
| | - Nicolin Datz
- Department of Pediatrics, ''Auf der Bult" Hannover, Hannover, Germany
| | - Ilse Engelsberger
- Department of Pediatrics, Childrens Hospital Munchen Schwabing, München, Germany
| | | | - Thomas Hoertenhuber
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Burkhild Knauth
- Department of Pediatrics, CJD Berchtesgaden, Berchtesgaden, Germany
| | - Thomas Meissner
- Department of Pediatrics, University of Düsseldorf, Düsseldorf, Germany
| | - Susanna Wiegand
- Department of Pediatrics, University Charite Berlin, Berlin, Germany
| | | | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
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Helmbold K, Zvyagintsev M, Dahmen B, Bubenzer-Busch S, Gaber TJ, Crockett MJ, Klasen M, Sánchez CL, Eisert A, Konrad K, Habel U, Herpertz-Dahlmann B, Zepf FD. Effects of serotonin depletion on punishment processing in the orbitofrontal and anterior cingulate cortices of healthy women. Eur Neuropsychopharmacol 2015; 25:846-56. [PMID: 25869157 DOI: 10.1016/j.euroneuro.2015.02.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 02/12/2014] [Revised: 01/27/2015] [Accepted: 02/21/2015] [Indexed: 11/30/2022]
Abstract
Diminished synthesis of the neurotransmitter serotonin (5-HT) has been linked to disrupted impulse control in aversive contexts. However, the neural correlates underlying a serotonergic modulation of female impulsivity remain unclear. The present study investigated punishment-induced inhibition in healthy young women. Eighteen healthy female subjects (aged 20-31) participated in a double-blinded, counterbalanced, placebo-controlled, within subjects, repeated measures study. They were assessed on two randomly assigned occasions that were controlled for menstrual cycle phase. In a randomized order, one day, acute tryptophan depletion (ATD) was used to reduce 5-HT synthesis in the brain. On the other day, participants received a tryptophan-balanced amino acid load (BAL) as a control condition. Three hours after administration of ATD/BAL, neural activity was recorded during a modified Go/No-Go task implementing reward or punishment processes using functional magnetic resonance imaging (fMRI). Neural activation during No-Go trials in punishment conditions after BAL versus ATD administration correlated positively with the magnitude of central 5-HT depletion in the ventral and subgenual anterior cingulate cortices (ACC). Furthermore, neural activation in the medial orbitofrontal cortex (mOFC) and the dorsal ACC correlated positively with trait impulsivity. The results indicate reduced neural sensitivity to punishment after short-term depletion of 5-HT in brain areas related to emotion regulation (subgenual ACC) increasing with depletion magnitude and in brain areas related to appraisal and expression of emotions (mOFC and dorsal ACC), increasing with trait impulsivity. This suggests a serotonergic modulation of neural circuits related to emotion regulation, impulsive behavior, and punishment processing in females.
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Affiliation(s)
- K Helmbold
- RWTH Aachen University, Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Germany; Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Germany
| | - M Zvyagintsev
- Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Germany; RWTH Aachen University, Department of Psychiatry, Psychotherapy and Psychosomatics, Germany
| | - B Dahmen
- RWTH Aachen University, Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Germany
| | - S Bubenzer-Busch
- RWTH Aachen University, Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Germany; Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Germany
| | - T J Gaber
- RWTH Aachen University, Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Germany; Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Germany
| | - M J Crockett
- Wellcome Trust Centre for Neuroimaging, University College London, United Kingdom
| | - M Klasen
- Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Germany; RWTH Aachen University, Department of Psychiatry, Psychotherapy and Psychosomatics, Germany
| | - C L Sánchez
- RWTH Aachen University, Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Germany; Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Germany
| | - A Eisert
- Department of Pharmacy, RWTH Aachen University, Aachen, Germany
| | - K Konrad
- RWTH Aachen University, Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Germany; Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Germany; Institute for Neuroscience and Medicine, Jülich Research Centre, Germany
| | - U Habel
- Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Germany; RWTH Aachen University, Department of Psychiatry, Psychotherapy and Psychosomatics, Germany
| | - B Herpertz-Dahlmann
- RWTH Aachen University, Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Germany; Jülich Aachen Research Alliance, JARA Translational Brain Medicine, Germany
| | - F D Zepf
- Department of Health in Western Australia, Specialised Child and Adolescent Mental Health Services (CAMHS), Perth, WA, Australia; Department of Child and Adolescent Psychiatry, School of Psychiatry & Clinical Neurosciences and School of Paediatrics & Child Health, The University of Western Australia, Perth, WA, Australia.
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Laubner K, Scheuing N, Bauer M, Konrad K, Lilienthal E, Lorenzen N, Poeplau T, Teeken A, Thon A, Seufert J, Holl RW, Schebek M. Association of CFTR mutations with Cystic Fibrosis related Diabetes (CFRD) in Germany and Austria: a multicentre analysis from the DPV registry. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549581] [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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Raile K, Schober E, Konrad K, Thon A, Grulich-Henn J, Meissner T, Wölfle J, Scheuing N, Holl RW. Treatment of young patients with HNF1A mutations (HNF1A-MODY). Diabet Med 2015; 32:526-30. [PMID: 25483937 DOI: 10.1111/dme.12662] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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: 12/02/2014] [Indexed: 12/15/2022]
Abstract
AIM Children and adolescents with a molecular diagnosis of HNF1A-MODY should be treated with oral sulfonylurea according to current International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines. METHODS We surveyed the German-Austrian DPV database of 50 043 people and included 114 patients with a confirmed molecular-genetic diagnosis of HNF1A mutation and diabetes onset at below age 18 years. We analysed hypoglycaemic episodes, metabolic control (HbA1c ) and other clinical variables according to treatment groups. RESULTS People with HNF1A-MODY were included and analysed according to treatment with insulin alone (n = 34), sulfonylurea (n = 30), meglitinides (n = 22) or lifestyle (n = 28). In those receiving any drug treatment (n = 86), severe hypoglycaemia did not occur with meglitinide and was highest (at 3.6 events per 100 patient-years) with insulin. HbA1c was highest with insulin treatment (insulin = 58 mmol/mol, 7.5%; sulfonylurea = 55 mmol/mol, 7.2%; meglitinides = 52 mmol/mol, 6.9%; P = 0.008), whereas weight (BMI SD score), serum lipids and blood pressure were not different. CONCLUSIONS Of note, 40% of people with HNF1A-MODY and medical treatment were receiving insulin alone and thus were not being treated in line with up-to-date International Society for Pediatric and Adolescent Diabetes/International Diabetes Federation guidelines, despite insulin treatment being associated with worse metabolic control and the risk of hypoglycaemia. The unlicensed use of oral drugs in patients below age 18 years and adherence by both doctors and patients to the initial insulin treatment might contribute to this finding.
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Affiliation(s)
- K Raile
- Experimental and Clinical Research Center, Charité, Berlin, Germany
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Scheuing N, Badenhoop K, Borkenstein M, Konrad K, Lilienthal E, Laubner K, Naeke A, Rami-Merhar B, Thon A, Wiemann D, Holl RW. Why is insulin pump treatment rarely used in adolescents and young adults with cystic fibrosis-related diabetes? Pediatr Diabetes 2015; 16:10-5. [PMID: 24984902 DOI: 10.1111/pedi.12158] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 12/20/2013] [Revised: 04/11/2014] [Accepted: 05/06/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In type 1 diabetes (T1D), the use of continuous subcutaneous insulin infusion (CSII) has increased steadily in the last years. Compared with conventional insulin injection regimes, major advantages might be a nearly physiological insulin secretion, lower rates of hypoglycemia, higher flexibility in daily life, and increased quality of life. Data on CSII in cystic fibrosis-related diabetes (CFRD) are scarce. OBJECTIVE To analyze current use of insulin pumps in CFRD and compare demographics of pump-treated patients between CFRD and T1D. METHODS Data from the prospective German/Austrian diabetes patient registry on insulin-treated patients with either CFRD (n = 515) or T1D (n = 43 165) aged >10 yr at manifestation of diabetes were analyzed. RESULTS A total of 4.1% (n = 21) of CFRD and 17.7% (n = 7647) of T1D patients received insulin pump treatment within the recent year of care (p < 0.001). Pump-treated patients with CFRD had a significantly shorter duration of diabetes [median (Q1 ; Q3 ): 5.8 (2.9; 9.5) vs. 7.8 (4.3; 20.4) yr, p = 0.026] and tended to be younger [22.0 (18.2; 30.1) vs. 24.9 (17.3; 45.9) yr] than pump-treated T1D patients. Age at initiation of CSII seemed to be lower in CFRD [19.2 (16.5; 29.2) vs. 23.3 (14.8; 43.5) yr]. Insulin pump therapy was used slightly more often in male CFRD patients than females (4.7 vs. 3.6%), whereas in T1D the opposite was observed (14.9 vs. 21.2%, p < 0.001). Discontinuation rate of CSII was higher in CFRD than T1D (30.0 vs. 12.7%, p = 0.005). CONCLUSIONS Despite potential advantages, insulin pump therapy was rarely used among adolescent and young adult CFRD patients.
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Affiliation(s)
- Nicole Scheuing
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
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Trippe H, Boukidis A, Hauffa B, Konrad K, Schara U. G.P.235. Neuromuscul Disord 2014. [DOI: 10.1016/j.nmd.2014.06.311] [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: 10/24/2022]
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Krall SC, Rottschy C, Oberwelland E, Bzdok D, Fox PT, Eickhoff SB, Fink GR, Konrad K. The role of the right temporoparietal junction in attention and social interaction as revealed by ALE meta-analysis. Brain Struct Funct 2014; 220:587-604. [PMID: 24915964 DOI: 10.1007/s00429-014-0803-z] [Citation(s) in RCA: 212] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 05/17/2014] [Indexed: 11/28/2022]
Abstract
The right temporoparietal junction (rTPJ) is frequently associated with different capacities that to shift attention to unexpected stimuli (reorienting of attention) and to understand others' (false) mental state [theory of mind (ToM), typically represented by false belief tasks]. Competing hypotheses either suggest the rTPJ representing a unitary region involved in separate cognitive functions or consisting of subregions subserving distinct processes. We conducted activation likelihood estimation (ALE) meta-analyses to test these hypotheses. A conjunction analysis across ALE meta-analyses delineating regions consistently recruited by reorienting of attention and false belief studies revealed the anterior rTPJ, suggesting an overarching role of this specific region. Moreover, the anatomical difference analysis unravelled the posterior rTPJ as higher converging in false belief compared with reorienting of attention tasks. This supports the concept of an exclusive role of the posterior rTPJ in the social domain. These results were complemented by meta-analytic connectivity mapping (MACM) and resting-state functional connectivity (RSFC) analysis to investigate whole-brain connectivity patterns in task-constrained and task-free brain states. This allowed for detailing the functional separation of the anterior and posterior rTPJ. The combination of MACM and RSFC mapping showed that the posterior rTPJ has connectivity patterns with typical ToM regions, whereas the anterior part of rTPJ co-activates with the attentional network. Taken together, our data suggest that rTPJ contains two functionally fractionated subregions: while posterior rTPJ seems exclusively involved in the social domain, anterior rTPJ is involved in both, attention and ToM, conceivably indicating an attentional shifting role of this region.
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Affiliation(s)
- S C Krall
- Institute of Neuroscience and Medicine (INM-3), Jülich Research Center, Jülich, Germany,
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Scheuing N, Berger G, Bergis D, Gohlke B, Konrad K, Laubner K, Lilienthal E, Moser C, Schütz-Fuhrmann I, Thon A, Holl RW. Adherence to clinical care guidelines for cystic fibrosis-related diabetes in 659 German/Austrian patients. J Cyst Fibros 2014; 13:730-6. [PMID: 24917115 DOI: 10.1016/j.jcf.2014.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 04/10/2014] [Accepted: 05/09/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND In Germany/Austria, data on medical care for cystic fibrosis-related diabetes (CFRD) is limited. METHODS Anonymized data from 659 CFRD patients were analyzed and compared to the latest ADA/CFF guidelines. RESULTS Specialized diabetes clinics were attended less frequently than recommended (3.1 vs. 4.0 times yearly). 7.9% of patients had a complete profile of examinations: diabetes education (44.9%), HbA1c (88.8%), blood pressure (79.5%), BMI (86.5%), lipid status (37.5%), retinopathy (29.9%), microalbuminuria (33.2%), and self-monitoring of blood glucose (71.6%). HbA1c and blood pressure were measured less frequently than recommended (2.3 and 2.0 vs. 4.0 times yearly). Overall, guidelines were followed more frequently in children than adults. Contrary to recommendations, not all patients were treated with insulin (77.2 vs. 100.0%). Insulin therapy was initiated earlier in children than adults, but there was still a substantial delay (0.9 vs. 2.7years after diagnosis, p<0.001). CONCLUSION In CFRD patients studied, adherence to care guidelines was suboptimal.
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Affiliation(s)
- Nicole Scheuing
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, D-89081 Ulm, Germany.
| | - Gabriele Berger
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Dominik Bergis
- Department of Internal Medicine I, Division of Endocrinology & Metabolism, Goethe University Hospital, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany
| | - Bettina Gohlke
- Pediatric Endocrinology Division, Children's Hospital, University of Bonn, Adenauerallee 119, D-53113 Bonn, Germany
| | - Katja Konrad
- Department of Pediatrics II, University Children's Hospital Essen, Hufelandstraße 55, D-45147 Essen, Germany
| | - Katharina Laubner
- Department of Internal Medicine II, Division of Endocrinology and Diabetology, University Hospital of Freiburg, Hugstetter Straße 49, D-79106 Freiburg, Germany
| | - Eggert Lilienthal
- Department of Pediatrics, University of Bochum, Alexandrinenstraße 5, D-44791 Bochum, Germany
| | - Christine Moser
- Department of Pediatrics I, Medical University of Innsbruck, Christoph Probst Platz 1, A-6020 Innsbruck, Austria
| | - Ingrid Schütz-Fuhrmann
- 3rd Medical Department, Hospital Hietzing, Wolkersbergenstraße 1, A-1130 Vienna, Austria
| | - Angelika Thon
- Department of Pediatrics, Hannover Medical School, Carl-Neuberg-Straße 1, D-30625 Hannover, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, D-89081 Ulm, Germany
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Scheuing N, Bauer M, Karsten C, Konrad K, Meissner T, Seufert J, Schoenau E, Schöfl C, Thon A, Woelfle J, Holl R. WS6.5 Body mass index, carbohydrate intake and insulin dosage per carbohydrate unit in 131 female and 77 male patients with cystic fibrosis-related diabetes. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60041-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Scheuing N, Hermann JM, Badenhoop K, Borkenstein M, Konrad K, Lilienthal E, Laubner K, Naeke A, Rami-Merhar B, Thon A, Holl RW. Flexibles Diabetesmanagement auch bei CF-Diabetes? Ein multizentrischer Vergleich der Insulinpumpentherapie zwischen CF-Diabetes und Typ 1 Diabetes basierend auf der deutsch/österreichischen DPV-Datenbank. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kirschner J, Schorling D, Hauschke D, Rensing-Zimmermann C, Wein U, Grieben U, Schottmann G, Schara U, Konrad K, Müller-Felber W, Thiele S, Wilichowski E, Hobbiebrunken E, Stettner GM, Korinthenberg R. Somatropin treatment of spinal muscular atrophy: a placebo-controlled, double-blind crossover pilot study. Neuromuscul Disord 2013; 24:134-42. [PMID: 24300782 DOI: 10.1016/j.nmd.2013.10.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/24/2013] [Accepted: 10/31/2013] [Indexed: 11/25/2022]
Abstract
In preclinical studies growth hormone and its primary mediator IGF-1 have shown potential to increase muscle mass and strength. A single patient with spinal muscular atrophy reported benefit after compassionate use of growth hormone. Therefore we evaluated the efficacy and safety of growth hormone treatment for spinal muscular atrophy in a multicenter, randomised, double-blind, placebo-controlled, crossover pilot trial. Patients (n = 19) with type II/III spinal muscular atrophy were randomised to receive either somatropin (0.03 mg/kg/day) or placebo subcutaneously for 3 months, followed by a 2-month wash-out phase before 3 months of treatment with the contrary remedy. Changes in upper limb muscle strength (megascore for elbow flexion and hand-grip in Newton) were assessed by hand-held myometry as the primary measure of outcome. Secondary outcome measures included lower limb muscle strength, motor function using the Hammersmith Functional Motor Scale and other functional tests for motor function and pulmonary function. Somatropin treatment did not significantly affect upper limb muscle strength (point estimate mean: 0.08 N, 95% confidence interval (CI:-3.79;3.95, p = 0.965), lower limb muscle strength (point estimate mean: 2.23 N, CI:-2.19;6.63, p = 0.302) or muscle and pulmonary function. Side effects occurring during somatropin treatment corresponded with well-known side effects of growth hormone substitution in patients with growth hormone deficiency. In this pilot study, growth hormone treatment did not improve muscle strength or function in patients with spinal muscular atrophy type II/III.
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Affiliation(s)
- J Kirschner
- Department of Neuropaediatrics and Muscle Disorders, University Medical Center, Freiburg, Germany.
| | - D Schorling
- Department of Neuropaediatrics and Muscle Disorders, University Medical Center, Freiburg, Germany
| | - D Hauschke
- Institute of Medical Biometry and Medical Informatics, University of Freiburg, Germany
| | - C Rensing-Zimmermann
- Department of Neuropaediatrics and Muscle Disorders, University Medical Center, Freiburg, Germany
| | - U Wein
- Department of Neuropaediatrics and Muscle Disorders, University Medical Center, Freiburg, Germany
| | - U Grieben
- Department of Neuropaediatrics, Charité University Medical School, Berlin, Germany
| | - G Schottmann
- Department of Neuropaediatrics, Charité University Medical School, Berlin, Germany
| | - U Schara
- Department of Paediatric Neurology, University Hospital Essen, Germany
| | - K Konrad
- Department of Paediatric Endocinology, University Hospital Essen, Germany
| | - W Müller-Felber
- Department of Paediatric Neurology and Developmental Medicine, Dr. Von Hauner Children's Hospital, München, Germany
| | - S Thiele
- Department of Paediatric Neurology and Developmental Medicine, Dr. Von Hauner Children's Hospital, München, Germany
| | - E Wilichowski
- Department of Paediatrics and Paediatric Neurology, Georg August University, Göttingen, Germany
| | - E Hobbiebrunken
- Department of Paediatrics and Paediatric Neurology, Georg August University, Göttingen, Germany
| | - G M Stettner
- Department of Paediatrics and Paediatric Neurology, Georg August University, Göttingen, Germany
| | - R Korinthenberg
- Department of Neuropaediatrics and Muscle Disorders, University Medical Center, Freiburg, Germany
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Konrad K, Scheuing N, Badenhoop K, Borkenstein MH, Gohlke B, Schöfl C, Seufert J, Thon A, Holl RW. Cystic fibrosis-related diabetes compared with type 1 and type 2 diabetes in adults. Diabetes Metab Res Rev 2013; 29:568-75. [PMID: 23704008 DOI: 10.1002/dmrr.2429] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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: 03/13/2013] [Accepted: 05/18/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND With increasing life expectancy of patients with cystic fibrosis (CF), secondary diabetes becomes more prevalent. It appears to be the most common co-morbidity in persons with cystic fibrosis. Therefore, the objective of our study was to describe characteristics of cystic fibrosis-related diabetes compared with type 1 and 2 diabetes (T1DM/T2DM) in adults. METHODS Data from 218 436 patients >18 years with cystic fibrosis (n = 401), T1DM (n = 32,409) or T2DM (n = 185 626) in the multicenter Diabetes-Patienten-Verlaufsdokumentation or prospective documentation of diabetes patients registry were analysed. RESULTS Diabetes onset [median (interquartile range)] in cystic fibrosis [18.70 (15.50-25.30) years] was between T1DM [16.40 (10.50-31.80) years] and T2DM [58.50 (48.80-68.00) years], with female preponderance. Body mass index (BMI) and glycosylated haemoglobin (HbA1c ) were lowest (19.6 [18.1-21.5] kg/m(2) )/50 mmol/mol (6.73%) versus T1DM (24.4 [22.1-27.4])/62 mmol/mol (7.83%) vs. T2DM (29.6 [26.1-33.9])/54 mmol/mol (7.06%); all p < 0.01. A total of 78.6% of cystic fibrosis patients with diabetes received insulin. Insulin dose (0.74 IE/kg bodyweight) was not significantly different from T1DM (0.73) and T2DM (0.76). Frequency of vascular complications, adjusted for confounding effects, across the groups was different: Hypertension (CFRD 16.1% vs. T1DM 24.0% vs. T2DM 32.2%; all p < 0.01), retinopathy (CFRD 10.7% vs. T1DM 10.4% vs. T2DM 10.5%, not significant), nephropathy (CFRD 25.2% vs. T1DM 17.2% vs. T2DM 24.7%; only T1DM/T2DM; p < 0.01). CONCLUSION CFRD is a uniquely complex entity with clear differences from T1DM and T2DM in adults.
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Affiliation(s)
- Katja Konrad
- Department of Pediatrics II, Pediatric Endocrinology and Diabetes, University Children's Hospital Essen, Essen, Germany
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Schimmelmann BG, Hinney A, Scherag A, Pütter C, Pechlivanis S, Cichon S, Jöckel KH, Schreiber S, Wichmann HE, Albayrak Ö, Dauvermann M, Konrad K, Wilhelm C, Herpertz-Dahlmann B, Lehmkuhl G, Sinzig J, Renner TJ, Romanos M, Warnke A, Lesch KP, Reif A, Hebebrand J. Bipolar disorder risk alleles in children with ADHD. J Neural Transm (Vienna) 2013; 120:1611-7. [DOI: 10.1007/s00702-013-1035-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 05/10/2013] [Indexed: 11/28/2022]
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Konrad K, Lilienthal E, Badenhoop K, Borkenstein M, Gohlke B, Scheuing N, Schöfl C, Seufert J, Thon A, Holl RW. Besonderheiten des Diabetes bei cystischer Fibrose (CFRD) im Vergleich zu Diabetes mellitus Typ 1 (T1DM) und Typ 2 (T2DM) bei erwachsenen Patienten des DPV-Registers. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341665] [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: 10/26/2022]
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Raile K, Konrad K, Thon A, Grulich-Henn J, Woelfle J, Schober E, Meissner T, Holl R. Glinidtherapie bei HNF1A-MODY (MODY3): Multizentrische Analyse (DPV-WISS) über Wirksamkeit und Komplikationsrate bei 133 Patienten mit HNF1A-MODY. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341675] [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: 10/26/2022]
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Konrad K, Thon A, Fritsch M, Fröhlich-Reiterer E, Lilienthal E, Wudy SA, Holl RW. Comparison of cystic fibrosis-related diabetes with type 1 diabetes based on a German/Austrian Pediatric Diabetes Registry. Diabetes Care 2013; 36:879-86. [PMID: 23238661 PMCID: PMC3609515 DOI: 10.2337/dc12-0807] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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] [Received: 04/29/2012] [Accepted: 09/07/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The prevalence of cystic fibrosis-related diabetes (CFRD) has increased with improved life expectancy of patients. Clinical and care characteristics were compared with type 1 diabetes mellitus (T1DM) in a multicenter analysis of pediatric data. RESEARCH DESIGN AND METHODS Auxological and treatment data from 47,227 patients aged younger than 21 years with CFRD or T1DM in the German/Austrian Diabetes Prospective Documentation Initiative registry were analyzed by multivariable mixed regression modeling. RESULTS Diabetes onset (mean [interquartile range]) occurred later in individuals with CFRD (14.5 [11.8-16.3] years) than in individuals with T1DM (8.5 [4.9-11.8] years), with female preponderance in CFRD (59.1% vs. 47.5%; P < 0.01). CFRD patients had lower BMI standard deviation scores (-0.85 [-1.59 to -0.12] vs. +0.52 [-0.10 to +1.16]; P < 0.01) and lower HbA(1c) (6.87% vs. 7.97%; P < 0.01). Self-monitoring of blood glucose was more frequent in patients with T1DM (4.5 vs. 3.5; P < 0.01); 72% of CFRD patients received insulin. In insulin-treated patients, insulin dosage adjusted for age, sex, and diabetes duration differed significantly (T1DM: 0.79 IE per kilogram of body weight; CFRD: 0.83 IE per kilogram of body weight). Use of short-acting and long-acting insulin analogs was significantly more frequent in T1DM (47% vs. 39% and 37% vs. 28%; both P < 0.05). Metabolic control in CFRD patients without insulin was better compared with CFRD on insulin (HbA(1c): 6.00 vs. 7.12; P < 0.01), but duration of disease was significantly shorter (0.8 years [0.1-2.4] compared with 2.4 years [0.6-4.6]). There was no significant difference for BMI standard deviations scores between CFRD patients with or without insulin treatment. CONCLUSIONS Pediatric patients with CFRD show clear auxological and metabolic differences from those with T1DM, with different treatment choices.
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Affiliation(s)
- Katja Konrad
- Department of Pediatrics II, University Children's Hospital Essen, Essen, Germany.
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Schulte-Rüther M, Mainz V, Fink GR, Herpertz-Dahlmann B, Konrad K. Reduced activation of brain networks underlying theory of mind is associated with treatment outcome in juvenile anorexia nervosa. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Konrad K, Pütz V, Dahmen B, Herpertz-Dahlmann B. How do early separation experiences impact on structural and functional brain development in children? KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301614] [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: 10/28/2022]
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Konrad K. Geschlechtsunterschiede und der Einfluss von Steroidhormonen auf das sich entwickelnde menschliche Gehirn. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1295376] [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: 10/15/2022] Open
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Mayrhauser U, Stiegler P, Stadlbauer V, Koestenbauer S, Leber B, Konrad K, Iberer F, Tscheliessnigg K. Cell to cell interactions influence sensitivity of liver cell lines during hyperthermia. Anticancer Res 2011; 31:3713-3717. [PMID: 22110191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Thermal cancer therapy is used for hepatocellular carcinoma treatment. In this study we investigated the effect of hyperthermia on liver cells and compared data of our different cell culture fibrosis models (transwell vs. co-culture model). MATERIALS AND METHODS The cell lines HepG2 and LX-1 were seeded in different numbers in transwells to simulate different grades of fibrosis and then heated from 55°C to 85°C for different time spans. Thereafter, metabolic activity was measured. RESULTS Heating at 65°C showed that the greater the number of LX-1 cells treated together with HepG2 cells the lower the metabolic activity of HepG2 cells was. Compared to our previous co-culture study, there were significantly different results in cell survival from 55°C to 75°C. CONCLUSION The co-culture fibrosis model is more physiological than the transwell model because it allows a higher seeding density and a higher degree of cell to cell interactions. Therefore, it is more efficient for investigating the effect of hyperthermia on liver cells.
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Affiliation(s)
- Ursula Mayrhauser
- Department of Surgery, Division for Transplantation Surgery, Medical University Graz, Auenbruggerplatz 29, 8036 Graz, Austria.
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Mayrhauser U, Stiegler P, Stadlbauer V, Koestenbauer S, Leber B, Konrad K, Iberer F, Portugaller RH, Tscheliessnigg K. Effect of hyperthermia on liver cell lines: important findings for thermal therapy in hepatocellular carcinoma. Anticancer Res 2011; 31:1583-1588. [PMID: 21617213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Hepatocellular carcinoma is the fifth most common malignant tumour, with a high mortality rate. This study aimed to investigate the effect of hyperthermia on HepG2 and LX-1 cell lines to gain more information on thermal treatment of liver tumours. MATERIALS AND METHODS The cell lines HepG2, LX-1 and their co-cultures were heated from 55°C to 85°C for different time spans. After heat exposure, metabolic activity was measured immediately, and after 24 h and 48 h using the 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium) (MTS) test to assess how many cells had survived heating. RESULTS Our results show highly significant differences between the temperature tolerance of HepG2 and LX-1 cells. Alone, HepG2 cells are most sensitive to heat-induced cell death, their sensitivity decreased with rising percentages of LX-1 cells in the co-culture. CONCLUSION Our results suggest that the outcome of thermal cancer therapy is dependent on the temperature and the grade of fibrosis in the treated livers.
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Affiliation(s)
- Ursula Mayrhauser
- Department of Surgery, Division of Transplantation Surgery, Medical University Graz, Austria.
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Greimel E, Schulte-Rüther M, Fink GR, Piefke M, Herpertz-Dahlmann B, Konrad K. Development of neural correlates of empathy from childhood to early adulthood: an fMRI study in boys and adult men. J Neural Transm (Vienna) 2010; 117:781-91. [PMID: 20411397 DOI: 10.1007/s00702-010-0404-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 03/27/2010] [Indexed: 11/28/2022]
Abstract
Although empathy is rooted early in life, the ability to understand and share the emotions of others continues to develop after childhood. Here, we aimed at exploring developmental changes in the neural mechanisms underlying empathy from childhood to early adulthood. Using functional magnetic resonance imaging, 47 healthy male subjects aged 8-27 years were investigated during an explicit empathy task. Emotional faces were presented and participants were either asked to infer the emotional state from the face (other-task) or to judge their own emotional response to the face (self-task). A perceptual decision on the width of faces was used as a control condition. Age-related activity increases were observed in the fusiform gyrus and inferior frontal gyrus, depending on whether subjects attributed emotions to self or other. During the self-task, activity in the right precuneus and right intraparietal sulcus decreased as a function of age. No age-related differences were observed in behavioral performance measures. Increased activity in the fusiform gyrus and in the frontal component of the human mirror neuron system with increasing age may be explained by greater experience and expertise accumulated during socio-emotional interactions. Greater recruitment of right parietal structures in younger as compared to older subjects might reflect developmental differences in the cognitive strategies to infer one's own emotional response. This study is the first to show developmental changes in the neural mechanisms supporting empathy. Our findings may have important implications for the development of novel therapeutic interventions in clinical conditions characterized by empathy deficits, such as autism spectrum disorder.
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Affiliation(s)
- E Greimel
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of the RWTH Aachen, 52074 Aachen, Germany.
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Abstract
Attention deficit hyperactivity disorder (ADHD) is one of the most common neuropsychiatric disorders in children. ADHD is often chronic persisting into adulthood in about 60% of patients. The disorder is frequently associated with co-occurring disruptive, anxiety, mood and personality disorders as well as substance abuse. The diagnosis of ADHD has to be based on careful assessment of symptoms and impairments in the different phases of life. Recent neuroimaging and genetic data support the neurobiological basis of the disorder. Multimodal treatment options including stimulants, antidepressants and behavioral therapy play a fundamental role in the management of ADHD across the life span.
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Affiliation(s)
- K Konrad
- LFG Klinische Neuropsychologie des Kindes- und Jugendalters, Klinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Universitätsklinikum, 52074 Aachen.
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Schimmelmann BG, Friedel S, Nguyen TT, Sauer S, Ganz Vogel CI, Konrad K, Wilhelm C, Sinzig J, Renner TJ, Romanos M, Palmason H, Dempfle A, Walitza S, Freitag C, Meyer J, Linder M, Schäfer H, Warnke A, Lesch KP, Herpertz-Dahlman B, Hinney A, Hebebrand J. Exploring the genetic link between RLS and ADHD. J Psychiatr Res 2009; 43:941-5. [PMID: 19223043 DOI: 10.1016/j.jpsychires.2009.01.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [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] [Received: 08/19/2008] [Revised: 01/13/2009] [Accepted: 01/13/2009] [Indexed: 01/27/2023]
Abstract
Attention deficit/hyperactivity disorder (ADHD) is a highly heritable neurodevelopmental disorder of childhood onset. Clinical and biological evidence points to shared common central nervous system (CNS) pathology of ADHD and restless legs syndrome (RLS). It was hypothesized that variants previously found to be associated with RLS in two large genome-wide association studies (GWA), will also be associated with ADHD. SNPs located in MEIS1 (rs2300478), BTBD9 (rs9296249, rs3923809, rs6923737), and MAP2K5 (rs12593813, rs4489954) as well as three SNPs tagging the identified haplotype in MEIS1 (rs6710341, rs12469063, rs4544423) were genotyped in a well characterized German sample of 224 families comprising one or more affected sibs (386 children) and both parents. We found no evidence for preferential transmission of the hypothesized variants to ADHD. Subsequent analyses elicited nominal significant association with haplotypes consisting of the three SNPs in BTBD9 (chi2 = 14.8, df = 7, nominal p = 0.039). According to exploratory post hoc analyses, the major contribution to this finding came from the A-A-A-haplotype with a haplotype-wise nominal p-value of 0.009. However, this result did not withstand correction for multiple testing. In view of our results, RLS risk alleles may have a lower effect on ADHD than on RLS or may not be involved in ADHD. The negative findings may additionally result from genetic heterogeneity of ADHD, i.e. risk alleles for RLS may only be relevant for certain subtypes of ADHD. Genes relevant to RLS remain interesting candidates for ADHD; particularly BTBD9 needs further study, as it has been related to iron storage, a potential pathophysiological link between RLS and certain subtypes of ADHD.
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Affiliation(s)
- B G Schimmelmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, LVR Klinikun Essen, Virchowstr. 174, 45147 Essen, Germany.
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Lampe K, Konrad K, Kroener S, Fast K, Kunert HJ, Herpertz SC. Neuropsychological and behavioural disinhibition in adult ADHD compared to borderline personality disorder. Psychol Med 2007; 37:1717-1729. [PMID: 17506923 DOI: 10.1017/s0033291707000517] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although attention-deficit/hyperactivity disorder (ADHD) is thought to be an inhibitory disorder, the question remains of how specific the inhibitory deficit is in adults and whether it distinguishes ADHD from borderline personality disorder (BPD), with which it shares several clinical features, particularly impulsiveness. METHOD The study assessed various motor and cognitive inhibitory functions (inhibition of prepotent, ongoing and interfering responses) in addition to working memory in adult ADHD patients with and without BPD, compared to subjects with BPD alone and controls. In addition, questionnaire data on various aspects of impulsiveness and anger regulation were assessed in all groups. RESULTS ADHD patients performed worse than BPD individuals and controls in two inhibitory tasks: the stop signal task and the conflict module of the Attentional Network Task (ANT). In addition, they exhibited longer reaction times (RTs) and higher intra-individual variance in nearly all attentional tasks. The co-morbid group exhibited poor performance on the stop signal task but not on the conflict task. The BPD group barely differed from controls in neuropsychological performance but overlapped with ADHD in some behavioural problems, although they were less severe on the whole. CONCLUSIONS Impaired inhibition is a core feature in adults with ADHD. In addition, slow RTs and high intra-individual variance in performance may reflect deficits in the regulation of activation and effort in ADHD patients. ADHD and BPD share some symptoms of behavioural dysregulation without common cognitive deficits, at least in the attentional realm.
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Affiliation(s)
- K Lampe
- Department of Psychiatry and Psychotherapy, RWTH Aachen, University Hospital, Rostock, Germany
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