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Koutny F, Wiemann D, Eckert A, Meyhöfer S, Fritsch M, Pappa A, Wiegand S, Weyer M, Wurm M, Weghuber D, Holl RW. Poorly controlled pediatric type 1 diabetes mellitus is a risk factor for metabolic dysfunction associated steatotic liver disease (MASLD): An observational study. J Pediatr Gastroenterol Nutr 2024; 78:1027-1037. [PMID: 38558281 DOI: 10.1002/jpn3.12194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/26/2024] [Accepted: 02/08/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES Recent studies have suggested a link between type 1 diabetes mellitus (T1D) and metabolic dysfunction associated steatotic liver disease (MASLD) in children and adolescent, but longitudinal evidence is lacking. This study aimed to investigate the potential association between poorly controlled T1D and elevated alanine aminotransferase (ALT), serving as a proxy for MASLD in children and adolescents over time. METHODS The study included 32,325 children aged 2-17 years with T1D from Germany, Austria, and Switzerland who had undergone at least one assessment of liver enzyme levels recorded in the Diabetes-Patienten- Verlaufsdokumentation registry. Multivariable logistic and Cox regression models were calculated to show possible associations between T1D and elevated ALT values (>26 U/L in males, >22 U/L in females) as a proxy for MASLD. RESULTS Children with poorly controlled T1D (HbA1c > 11%) exhibited increased odds of elevated ALT values, after adjustment for age, sex, diabetes duration and overweight (odds ratio [OR] 2.54; 95% confidence interval [CI], 2.10-3.10; p < 0.01). This finding is substantiated by a longitudinal analysis, which reveals that inadequately controlled T1D was associated with a higher hazard ratio (HR) of elevated ALT values compared to children with controlled T1D over an observation period extending up to 5.5 (HR: 1.54; 95% CI, 1.19-2.01; p < 0.01). CONCLUSION In conclusion, the current study strongly links poorly controlled T1D in children and adolescents to MASLD irrespective of overweight. This association is not only present cross-sectionally but also increases over time. The study underscores the critical role of effective diabetes management in reducing the risk of MASLD in this population.
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Affiliation(s)
- Florian Koutny
- Department of Human Medicine, PhD Medical Science, Paracelsus Medical University, Salzburg, Austria
- Department of Internal Medicine 2, Gastroenterology and Hepatology and Rheumatology, Karl Landsteiner University of Health Sciences, University Hospital of St. Pölten, St. Pölten, Austria
| | - Dagobert Wiemann
- Department of Pediatrics, University of Magdeburg, Magdeburg, Germany
| | - Alexander Eckert
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Germany, and German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Svenja Meyhöfer
- Institute for Endocrinology & Diabetes, University of Lübeck, Lübeck, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Department of Internal Medicine 1, Endocrinology & Diabetes, University of Lübeck, Lübeck, Germany
| | - Maria Fritsch
- Department of Pediatrics, Medical University of Graz, Austria
| | - Angeliki Pappa
- Department of Pediatric and Adolescent Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Susanna Wiegand
- Department of Pediatric Endocrinology and Diabetes, Center for social-pediatric care, Charité, Germany
| | - Marc Weyer
- Kamillus-Klinik Internal Medicine, Asbach, Germany
| | - Michael Wurm
- Department of Paediatrics, St. Hedwigs Campus, University Children's Hospital Regensburg, Regensburg, Germany
| | - Daniel Weghuber
- Department of Human Medicine, PhD Medical Science, Paracelsus Medical University, Salzburg, Austria
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Germany, and German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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Tittel SR, Sondern KM, Weyer M, Poeplau T, Sauer BM, Schebek M, Ludwig KH, Hammer F, Fröhlich-Reiterer E, Holl RW. Multicentre analysis of hyperglycaemic hyperosmolar state and diabetic ketoacidosis in type 1 and type 2 diabetes. Acta Diabetol 2020; 57:1245-1253. [PMID: 32488499 PMCID: PMC7496062 DOI: 10.1007/s00592-020-01538-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/18/2020] [Indexed: 02/06/2023]
Abstract
AIMS To compare diabetes patients with hyperglycaemic hyperosmolar state (HHS), diabetic ketoacidosis (DKA), and patients without decompensation (ND). METHODS In total, 500,973 patients with type 1 or type 2 diabetes of all ages registered in the diabetes patient follow-up (DPV) were included. Analysis was stratified by age (≤ / > 20 years) and by manifestation/follow-up. Patients were categorized into three groups: HHS or DKA-during follow-up according to the most recent episode-or ND. RESULTS At onset of diabetes, HHS criteria were met by 345 (68.4% T1D) and DKA by 9824 (97.6% T1D) patients. DKA patients had a lower BMI(-SDS) in both diabetes types compared to ND. HbA1c was higher in HHS/DKA. During follow-up, HHS occurred in 1451 (42.2% T1D) and DKA in 8389 patients (76.7% T1D). In paediatric T1D, HHS/DKA was associated with younger age, depression, and dyslipidemia. Pump usage was less frequent in DKA patients. In adult T1D/T2D subjects, metabolic control was worse in patients with HHS/DKA. HHS and DKA were also associated with excessive alcohol intake, dementia, stroke, chronic kidney disease, and depression. CONCLUSIONS HHS/DKA occurred mostly in T1D and younger patients. However, both also occurred in T2D, which is of great importance in the treatment of diabetes. Better education programmes are necessary to prevent decompensation and comorbidities.
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Affiliation(s)
- S R Tittel
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology (ZIBMT), Ulm University, Albert-Einstein-Allee 41, 89081, Ulm, Germany.
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | | | - M Weyer
- Kamillus-Klinik Internal Medicine, Asbach, Germany
| | - T Poeplau
- Clemenshospital, Ludgerus-Kliniken GmbH, Münster, Germany
| | - B M Sauer
- Medical Clinic Internal Medicine, Spaichingen, Germany
| | | | - K-H Ludwig
- Paediatric Clinic of the Borromeans, Trier, Germany
| | - F Hammer
- Cnopf Children's Clinic, Nuremberg, Germany
| | | | - R W Holl
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology (ZIBMT), Ulm University, Albert-Einstein-Allee 41, 89081, Ulm, Germany
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
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Hodeck K, Tittel SR, Dreyhaupt I, Beer R, Petermann S, Risse A, Weyer M, Hake K, Schiel R, Holl RW. Charakteristika von Diabetespatienten mit und ohne Pflegebedürftigkeit. DIABETOL STOFFWECHS 2020. [DOI: 10.1055/a-1207-9645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
ZusammenfassungIm Rahmen der vorliegenden multizentrischen Auswertung mit 6.424 Pflegepatienten unter 500.973 Menschen mit Diabetes aus dem DPV-Register wird die Erkrankungssituation der Pflegebedürftigen im Vergleich zu Patienten ohne Pflegebedürftigkeit, differenziert nach Altersgruppen und Diabetestyp, dargestellt.15 % der Pflegebedürftigen haben einen Typ-1-Diabetes, darunter fallen 99,0 % der Kinder, 9,5 % der 18- bis 75-Jährigen und 2,4 % der über 75-Jährigen. Pflegebedürftigkeit ist bei Erwachsenen und Senioren insbesondere mit den Krankheitsbildern Demenz, Depression, Herzinsuffizienz, Durchblutungsstörungen der Hirngefäße/Schlaganfall sowie mit dem diabetischen Fußsyndrom/Amputationen assoziiert. In der diabetologischen Therapie des Typ-2-DM wird bei 77 % der Pflegebedürftigen und damit deutlich häufiger als in der Vergleichsgruppe mit 55 % Insulin eingesetzt. Trotz höherer HbA1c-Werte und höherer Nüchternglukose als bei Typ-2-Patienten ohne Pflege treten unter Pflegebedürftigen gleichzeitig signifikant häufiger Hypoglykämien mit und ohne Koma auf. Stoffwechselbedingte Entgleisungen führten bei 15 % der Pflegepatienten mit Typ-2-DM gegenüber nur 6 % der Menschen mit Typ-2-DM ohne Pflegebedarf zu Klinikaufnahmen.Im Rahmen der Versorgung sollte verstärkt auf die Vermeidung von Stoffwechselentgleisungen geachtet und präventiv auf einen späteren Eintritt der assoziierten Krankheitsbilder hingewirkt werden. Die Versorgungsstrukturen sollten regional auf die Begleitung der Betroffenen spezialisiert werden. In der Aus- und Weiterbildung von Pflegepersonal und Ärzten sollten die Besonderheiten von jungen und alten Menschen mit Typ-1- und Typ-2-Diabetes stärker beachtet werden.
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Affiliation(s)
- Katja Hodeck
- Institut für Innovatives Gesundheitsmanagement GmbH, Berlin
| | - Sascha R. Tittel
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Universität Ulm und Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg
| | - Ines Dreyhaupt
- Kreisklinik Trostberg, Kliniken Südostbayern AG, Traunstein
| | - Renate Beer
- Diabetesberatung, HELIOS Klinikum Hildesheim
| | | | | | - Marc Weyer
- Innere Medizin, DRK Kamillus Klinik, Asbach
| | - Kathrin Hake
- Klinik für Kinder- und Jugendmedizin, MediClin Müritz-Klinikum, Waren
| | - Ralf Schiel
- MEDIGREIF Inselklinik Heringsdorf GmbH, Fachklinik für Kinder und Jugendliche, Haus Gothensee, Ostseebad Heringsdorf
| | - Reinhard W. Holl
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Universität Ulm und Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg
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Adjidé CC, De Meyer A, Weyer M, Obin O, Lamory F, Lesueur C, Trouillet L, Biendo M, Eb F, Ganry O. [Stenotrophomonas maltophilia and Pseudomonas aeruginosa water-associated microbiologic risk assessment in Amiens' University Hospital Centre]. ACTA ACUST UNITED AC 2009; 58:e1-5. [PMID: 19892487 DOI: 10.1016/j.patbio.2009.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 07/12/2009] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa (Psa) and Stenotrophomonas maltophilia (Smalto) are major opportunistic waterborne pathogens causing hospital-acquired infections. This study aimed to assess the biocontamination level of cold water used in Amiens' university hospital wards, from March to June 2008. METHODS We cultivated 122 pairs of cold water first jet and taps cotton-swabs on Cetrimide agar for Psa, on Stenotrophomonas maltophilia selective medium with coloured indicator (SM2i) for Smalto, on Mueller Hinton agar used as isolation medium reference for both, 48h at 30 degrees C. Data analysed with Epi-Info 6.04dFr were compared with chi(2) test, significant at p<.05. RESULTS Psa and Smalto were isolated in 26.2 and 14.8% of water samples and in 21.3 and 10.7% of swab samples respectively. They were associated in 11.5% of water samples and 5% of swab samples. Psa was alone in 13.1% of water samples and 7.4% of swab samples whereas Smalto was found in 6.6% of water and 2.5% of swabs. Psa and Smalto were isolated from 14.8% of water samples and 8.2% of swab samples of the same tap. Finally, respectively 35.2 and 17.2% of the cold water taps were biocontaminated by Psa and Smalto. In fact, microbiologic water taps contamination risk was two-fold higher for Psa than for Smalto, p<.001, without variation between wards. CONCLUSION Sm2i and Cetrimide are suited and efficient medium respectively for Smalto and Psa isolation. Cold-water samples are sufficient for waterborne pathogens biocontamination risk appraisal. Our results urged healthcare workers on efficient water fittings microbiologic risk control to prevent healthcare associated waterborne infections, notably due to Psa and Smalto.
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Affiliation(s)
- C C Adjidé
- Unité d'hygiène et épidémiologie hospitalière, service d'épidémiologie hygiène hospitalière et santé publique, CHU d'Amiens, 1, place Victor-Pauchet, 80054 Amiens cedex 01, France.
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Abstract
Examined stress and coping variables as predictors of divorce-related ruminations in children whose parents had recently divorced. Simultaneous multiple regression was used to analyze the cross-sectional data of 351 children of divorce. Divorce-related stressful events and threat appraisal were positively related to children's ruminations. A prospective longitudinal design was employed to predict rumination at Time 2 (T2) controlling for Time 1 (T1) rumination. Efficacy of coping was negatively related to T2 rumination after controlling for T1 rumination and all other predictors. This study also provided descriptive data on the frequency of children's divorce-related ruminations.
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Affiliation(s)
- M Weyer
- Department of Psychology, Arizona State University, Tempe 85287-1104, USA
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Abstract
OBJECTIVE This study sought to determine whether dawn simulation was superior to a shorter dimmer "placebo" dawn signal in treating winter depression. METHOD In a randomized, parallel design, 22 patients with winter depression were treated with either 1 week of a 2-hour dawn simulation peaking at 250 lux or 1 week of a 30-minute dawn simulation peaking at 0.2 lux. The subjects were told that they would receive either a "gradual" dawn or a "rapid" dawn reaching an intensity that would be dimmer than standard bright light treatment. At the end of both the baseline week and the treatment week, subjects were assessed in a blind manner with the Hamilton Rating Scale for Depression. Analysis of covariance was used to compare the two dawn treatments. RESULTS The 2-hour, 250-lux dawn simulation resulted in Hamilton depression scale scores that were significantly lower than scores after the 30-minute, 0.2-lux dawn simulation. CONCLUSIONS This study indicates that dawn simulation is an effective treatment for winter depression.
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Affiliation(s)
- D H Avery
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
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Feáux de Lacroix W, Weyer M, Schütt A, Lennartz KJ. Age-dependent change of the effect of a cytostatic drug on the proliferation kinetics of a solid tumor of the mouse. J Cancer Res Clin Oncol 1979; 94:29-37. [PMID: 468897 DOI: 10.1007/bf00405347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The aim of the present investigations was to study the effectiveness of a cytostatic drug (VCR) during different phases of tumor growth (1st, 7th, 14th days a.t.) and at the periphery and at the centre of the tumor (on the 14th day a.t.). Furthermore the inducement of a partial synchronization in the proliferation of tumor cells was attempted. It was found that the intensity of the cytostatic effect significantly decreased both with the passage of time after transplantation and within the tumor from the periphery to the centre. The changing cytostatic sensitivity probably is due to the diminishing vascular supply and the decreased rate of cell proliferation; especially the decline of the growth fraction. A partial synchronization of the proliferation of tumor cells could not be demonstrated.
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