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Hiermann P, Wendenburg J, von Sengbusch S, Mönkemöller K, Lindemann N, Paape D, Boß K, Griffig K, Hilgard D, Kapellen T. Wer schult die Betreuungspersonen von Kindern mit Typ-1-Diabetes in Kindertagesstätte und Schule und wer finanziert diese Schulungen? Ergebnisse und eine Stellungnahme zur Situation in Deutschland. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0042-116311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- P. Hiermann
- Hospital for children and adolescents, University of Leipzig, Germany
| | - J. Wendenburg
- Kinderdiabetologische Schwerpunktpraxis, Jena, Germany
| | - S. von Sengbusch
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein – Campus Lübeck, Germany
| | - K. Mönkemöller
- Pädiatrie, Kinderklinik Amsterdamer Straße, Köln, Germany
| | - N. Lindemann
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein – Campus Kiel, Germany
| | - D. Paape
- LV Bremen e.V., Deutsche Diabeteshilfe, Bremen, Germany
| | - K. Boß
- Sozialpädiatrisches Zentrum, Charité Universitätsmedizin Berlin, Germany
| | - K. Griffig
- Sozialpädiatrisches Zentrum, Charité Universitätsmedizin Berlin, Germany
| | - D. Hilgard
- Kinderklinik, Gemeinschaftskrankenhaus Herdecke, Germany
| | - T. Kapellen
- Hospital for children and adolescents, University of Leipzig, Germany
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Neu A, Bürger-Büsing J, Danne T, Dost A, Holder M, Holl R, Holterhus PM, Kapellen T, Karges B, Kordonouri O, Müller S, Raile K, Schweizer R, von Sengbusch S, Stachow R, Wagner V, Wiegand S, Ziegler R. Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0042-111213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - J. Bürger-Büsing
- Bund diabetischer Kinder und Jugendlicher e.V., Diabeteszentrum, Kaiserslautern
| | - T. Danne
- Kinder- und Jugendkrankenhaus Auf der Bult, Hannover
| | - A. Dost
- Universitätsklinikum Jena, Klinik für Kinder- und Jugendmedizin
| | | | - R. Holl
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Universität Ulm
| | - P.-M. Holterhus
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Allgemeine Pädiatrie
| | - T. Kapellen
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Kinder- und Jugendmedizin
| | - B. Karges
- RWTH Aachen, Universitätsklinikum, Sektion Endokrinologie und Diabetologie
| | - O. Kordonouri
- Kinder- und Jugendkrankenhaus Auf der Bult, Hannover
| | - S. Müller
- Praxis für Ernährungsberatung, Ennepetal
| | - K. Raile
- Charité, Universitätsmedizin Berlin, Virchow-Klinikum
| | - R. Schweizer
- Universitätsklinikum Tübingen, Klinik für Kinder- und Jugendmedizin
| | - S. von Sengbusch
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Klinik für Kinder- und Jugendmedizin
| | - R. Stachow
- Fachklinik Sylt für Kinder und Jugendliche, Westerland
| | - V. Wagner
- Gemeinschaftspraxis für Kinder- und Jugendmedizin, Rostock
| | - S. Wiegand
- Charité, Universitätsmedizin Berlin, Virchow-Klinikum
| | - R. Ziegler
- Praxis für Kinder- und Jugendmedizin, Diabetologische Schwerpunktpraxis, Münster
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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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Neu A, Bürger-Büsing J, Danne T, Dost A, Holder M, Holl R, Holterhus PM, Kapellen T, Karges B, Kordonouri O, Müller S, Raile K, Schweizer R, von Sengbusch S, Stachow R, Wagner V, Wiegand S, Ziegler R. Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter – AWMF-Registernummer 057–016. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0042-100779] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - J. Bürger-Büsing
- Bund diabetischer Kinder und Jugendlicher e.V., Diabeteszentrum, Kaiserslautern
| | - T. Danne
- Kinder- und Jugendkrankenhaus Auf der Bult, Hannover
| | - A. Dost
- Universitätsklinikum Jena, Klinik für Kinder- und Jugendmedizin
| | | | - R. Holl
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Universität Ulm
| | - P.-M. Holterhus
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Allgemeine Pädiatrie
| | - T. Kapellen
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Kinder- und Jugendmedizin
| | - B. Karges
- RWTH Aachen, Universitätsklinikum, Sektion Endokrinologie und Diabetologie
| | - O. Kordonouri
- Kinder- und Jugendkrankenhaus Auf der Bult, Hannover
| | - S. Müller
- Praxis für Ernährungsberatung, Ennepetal
| | - K. Raile
- Charité, Universitätsmedizin Berlin, Virchow-Klinikum
| | - R. Schweizer
- Universität Tübingen, Klinik für Kinder- und Jugendmedizin
| | - S. von Sengbusch
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Klinik für Kinder- und Jugendmedizin
| | - R. Stachow
- Fachklinik Sylt für Kinder und Jugendliche, Westerland
| | - V. Wagner
- Gemeinschaftspraxis für Kinder- und Jugendmedizin, Rostock
| | - S. Wiegand
- Charité, Universitätsmedizin Berlin, Virchow-Klinikum
| | - R. Ziegler
- Praxis für Kinder- und Jugendmedizin, Diabetologische Schwerpunktpraxis, Münster
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Herbst A, Kapellen T, Schober E, Graf C, Meissner T, Holl RW. Impact of regular physical activity on blood glucose control and cardiovascular risk factors in adolescents with type 2 diabetes mellitus--a multicenter study of 578 patients from 225 centres. Pediatr Diabetes 2015; 16:204-10. [PMID: 24888254 DOI: 10.1111/pedi.12144] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 09/15/2013] [Revised: 03/06/2014] [Accepted: 03/06/2014] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Regular physical activity (RPA) is a major therapeutic recommendation in children and adolescents with type 2 diabetes mellitus (T2DM). We evaluated the association between frequency of RPA and metabolic control, cardiovascular risk factors, and treatment regimes. METHODS The Pediatric Quality Initiative (DPV), including data from 225 centers in Germany and Austria, provided anonymous data of 578 patients (10-20 yr; mean 15.7 ± 2.1 yr; 61.9% girls) with T2DM. Patients were grouped by the frequency of their self-reported RPA per week: RPA 0, none; RPA 1, 1-2×/wk; RPA 2, >2×/wk. RESULTS The frequency of RPA ranged from 0 to 9×/wk (mean 1.1×/wk ±1.5). 55.7% of the patients reported no RPA (58.1% of the girls). Hemoglobin A1c (HbA1c) differed significantly among RPA groups (p < 0.002), being approximately 0.8 percentage points lower in RPA 2 compared to RPA 0. Body mass index (BMI-SDS) was higher in the groups with less frequent RPA (p < 0.00001). Multiple regression analysis revealed a negative association between RPA and HbA1c (p < 0.0001) and between RPA and BMI-SDS (p < 0.01). The association between RPA and high density lipoprotein (HDL)-cholesterol was positive (p < 0.05), while there was no association to total cholesterol, low density lipoprotein (LDL)-cholesterol or triglycerides. Approximately 80% of the patients received pharmacological treatment (oral antidiabetic drugs and/or insulin) without differences between RPA groups. CONCLUSION More than half of the adolescents with T2DM did not perform RPA. Increasing physical activity was associated with a lower HbA1c, a lower BMI-SDS, a higher HDL-cholesterol, but not with a difference in treatment regime. These results suggest that regular exercise is a justified therapeutic recommendation for children and adolescents with T2DM.
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Affiliation(s)
- A Herbst
- Department of Pediatrics, Hospital of Leverkusen, Leverkusen 51375, Germany
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Hermann JM, Schwandt A, Rosenbauer J, Kapellen T, Prchla C, Warncke K, Raile K, Renner C, Wenzel S, Holl RW. Jugendliche sind verschieden! Gruppenbasierte Trajectory-Analyse des HbA1c-Verlaufes über die Pubertät – eine Analyse von 5.746 Patienten mit Diabetes mellitus Typ 1 mit follow-up vom 8. bis zum 19. Lebensjahr aus der DPV-Datenbank. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kapellen T, Reimann R, Kiess W, Kostev K. Häufigkeit von ADHS bei Kindern und Jugendlichen mit Diabetes mellitus Typ 1 in Deutschland – Daten aus zwei repräsentativen Datenbanken. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549741] [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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Karges B, Rosenbauer J, Kapellen T, Wagner VM, Schober E, Karges W, Holl RW. Hämoglobin A1C und Hypoglykämierisiko bei Typ 1 Diabetes: Ergebnisse einer Kohortenstudie (1995 – 2012) bei 37.539 Patienten. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1374874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sonntag D, Trebst D, Kiess W, Kapellen T, Bertsche T, Kostev K. [Off-label drug prescriptions among outpatient children and adolescents in Germany--a database analysis]. Dtsch Med Wochenschr 2013; 138:2239-45. [PMID: 24150699 DOI: 10.1055/s-0033-1349609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Due to lack of respective studies children often receive medication that is applied beyond the approved indication. The consequence of this off-label use is often an increased risk of unexpected and undesirable side effects. This study deals with the amount of off-label drug prescriptions among children and adolescents receiving outpatient treatment in Germany. The aim is to outline age-, gender-, region-, and insurance specific differences and to determine risk factors for an off-label prescription. METHODS This is a retrospective study that has been conducted by means of the IMS Patient Database Disease Analyzer for the year 2010 considering three therapy classes (analgesics, antibiotics and antidepressants). The evaluation of the risk factors for an off-label prescription resulted from a multivariate logistic regression. Age- and dose-specific prescriptions were analyzed but not indication-specific prescriptions. RESULTS In total 189,285 children and adolescents with analgesics-, 147,089 with antibiotics-, and 15,405 with antidepressants prescriptions were identified. The percentage of patients with off-label prescriptions amounted to 0.9 % for analgesics, 2.5 % for antibiotics and 8.5 % for antidepressants. The off-label prescriptions made by general practitioners were significantly higher than those made by pediatricians and child psychiatrists. The number of off-label prescriptions in country sides was higher than in cities. In eastern states more off-label prescriptions were made than in western states of Germany. CONCLUSION The study shows that outpatient treatment of children and adolescents occurs widely with drugs corresponding to age and dosage. Off-label prescriptions not conform to indication were not determined. However, off-label drug use should be reduced further for outpatient treatment to ensure a safe and low-risk medical treatment for children and adolescents.
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Affiliation(s)
- D Sonntag
- Department für Frauen- und Kindermedizin, Klinik für Kinder- und Jugendmedizin, Universität Leipzig
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Wolf J, Rohrer T, Liptay S, Zimmer K, Fröhlich-Reiterer E, Marg W, Stern M, Kapellen T, Hauffa B, Wölfle J, Scheuing N, Holl R. Zöliakie als Risikofaktor für mikrovaskuläre Folgeerkrankungen bei Typ-1-Diabetes: Longitudinales Follow-up von 54488 Patienten aus Deutschland/Österreich im Rahmen der DPV-Initiative. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341676] [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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Kapellen T, Heidtmann B, Lilienthal E, Engler-Schmidt C, Bartelt H, Holl R. Insulinpumpentherapie bei Neugeborenen und Säuglingen. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341678] [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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Wolf J, Kapellen T, Stachow R, von Schütz W, Holl R. Morgenhyperglykämie bei Kindern und Jugendlichen mit Typ-1-Diabetes bei unterschiedlichen Therapieformen: Eine Auswertung des DPV-Datenpools. Klin Padiatr 2012; 224:471-5. [DOI: 10.1055/s-0032-1321899] [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] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- J. Wolf
- Klinik für Kinder- und Jugendmedizin, St. Vincenz-Krankenhaus, Paderborn
| | - T. Kapellen
- Klinik und Poliklinik für Kinder und Jugendliche, Universitätsklinik Leipzig, Leipzig
| | - R. Stachow
- Fachklinik für Kinder und Jugendliche, Fachklinik Sylt, Westerland
| | - W. von Schütz
- Kinderkrankenhaus auf der Bult, Pädiatrie III, Hannover
| | - R. Holl
- Institut für Epidemiologie und medizinische Biometrie, Universität Ulm
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Icks A, Razum O, Rosenbauer J, Bächle C, Hungele A, Mönkemöller K, Müller-Godeffroy E, Heidtmann B, Kapellen T, Moltz K, Holl RW. Pumpentherapie wird bei türkischstämmigen Kindern und Jugendlichen mit Typ 1-Diabetes deutlich seltener eingesetzt als bei Typ 1-diabetischen Kindern und Jugendlichen ohne Migrationshintergrund. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314461] [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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Dost AG, Molz E, Krebs A, Bechthold Della Pozza S, Kapellen T, Rohrer T, Raile K, Fritsch M, Schwab KO, Holl RW. Pulse Pressure bei Kindern und Jugendlichen mit Typ 1 Diabetes Mellitus in Deutschland und Österreich. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314489] [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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Schmidt F, Kapellen T, Wiegand S, Herbst A, Wolf J, Fröhlich-Reiterer E, Rabl W, Rohrer T, Holl R. Diabetes Mellitus in Children and Adolescents with Genetic Syndromes. Exp Clin Endocrinol Diabetes 2012; 120:579-85. [DOI: 10.1055/s-0032-1306330] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- F. Schmidt
- Department of Paediatrics, University of Halle-Wittenberg, Halle, Germany
| | - T. Kapellen
- Department of Paediatrics, University of Leipzig, Leipzig, Germany
| | - S. Wiegand
- Institute of Experimental Paediatric Endocrinology; Charité, Universitätsmedizin Berlin, Germany
| | - A. Herbst
- Department of Paediatrics, Hospital of Leverkusen, Leverkusen, Germany
| | - J. Wolf
- Department of Paediatrics, St. Vincenz-Hospital, Paderborn, Germany
| | | | - W. Rabl
- Department of Paediatrics, Technical University of Munich, Munich, Germany
| | - T. Rohrer
- Department of Paediatrics and Neonatology, Saarland University Hospital, Homburg/Saar, Germany
| | - R. Holl
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
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Kapellen T, Vogel C, Telleis D, Siekmeyer M, Kiess W. Treatment of diabetic ketoacidosis (DKA) with 2 different regimens regarding fluid substitution and insulin dosage (0.025 vs. 0.1 units/kg/h). Exp Clin Endocrinol Diabetes 2012; 120:273-6. [PMID: 22328113 DOI: 10.1055/s-0031-1299706] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Diabetic ketoacidosis (DKA) is still the most dangerous acute complication in type 1 diabetes. The aim of this study was to compare treatment of DKA with a regimen of a low insulin dose (0.025 units/kg/h) vs. a standard insulin dose (0.1 units/kg/h).We retrospectively analysed all cases of children and adolescents (age 0-18 years) with type 1 diabetes and DKA who needed treatment in the ICU in the time period of 1998-2005 in 2 pediatric diabetes centers. In a chart review of the first 48 h after onset of DKA the following parameters where evaluated: pH, blood glucose, sodium, potassium, and ketones in urine. Consciousness, neurological status and complications such as cerebral edema, hypoglycaemia or hypokalemia were also recorded.23 children were treated in center A (low insulin dose) whereas 41 where treated in center B (standard insulin dose). Mean age of the patients was 8.9 (range 1.58-17.7) and 13.5 years (1.25-17.7) respectively (p=0.134). Mean pH was 7.1 and HCO3 was 9.05 and 7.79 respectively (p=0.122). Initial blood glucose was 26 mmol/l (no difference between the 2 centres). Treatment with the standard insulin dose resulted in a slightly shorter duration of acidosis (8 h in center A, 6.5 h in center B) and a significantly faster normalization of blood glucose (18 h in A, vs. 10.5 h in B) (p<0.005). During the first day we found similar and very low rates of hypoglycaemia. In center B one case of suspected cerebral edema and cerebral infarction occurred.Low dose insulin substitution is as safe as the recommended standard dose in respect to the occurrence of acute complications. Acidosis is broken slightly earlier with the standard dose. Implications of this earlier normalisation of pH remain unclear.
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Affiliation(s)
- T Kapellen
- Hospital for Children and Adolescents, Department for Women and Child Health, University of Leipzig, Liebigstraße 20A, Leipzig, Germany.
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Kapellen T, Bartelt H, Prettin C, Marg W, Ziegler R, Grulich-Henn J, Hungele A, Labitzke B, Kiess W, Holl RW. Transition von Jugendlichen in die Erwachsenen-Diabetologie. Repräsentativer Survey in Deutschland. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277530] [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: 10/18/2022]
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Herbst A, Awa W, Meissner T, Dost A, Kapellen T, Holl RW. Einfluss von regelmäßigem Sport auf die Stoffwechseleinstellung und das kardiovaskuläre Risikoprofil bei Jugendlichen mit Diabetes mellitus Typ 2: Eine multizentrische Auswertung von 435 Patienten aus 153 Zentren. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kordonouri O, Hartmann R, Pankowska E, Rami B, Lange K, Remus K, Bläsig S, Marquardt E, Kapellen T, Coutant R, Danne T. Sensorunterstützte Pumpentherapie ab der Manifestation eines Typ 1 Diabetes: Ergebnisse des 2-jährigen Follow-up der pädiatrischen ONSET-Studie. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kordonouri O, Pankowska E, Rami B, Kapellen T, Coutant R, Hartmann R, Lange K, Knip M, Danne T. Sensor-augmented pump therapy from the diagnosis of childhood type 1 diabetes: results of the Paediatric Onset Study (ONSET) after 12 months of treatment. Diabetologia 2010; 53:2487-95. [PMID: 20711715 DOI: 10.1007/s00125-010-1878-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [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: 04/15/2010] [Accepted: 07/15/2010] [Indexed: 10/19/2022]
Abstract
AIMS/HYPOTHESIS The value of managing children with type 1 diabetes using a combination of insulin pump and continuous glucose monitoring starting from diagnosis for improving subsequent glycaemic control and preserving residual beta cell function was determined. METHODS A total of 160 children (aged 1-16 years, mean ± SD: 8.7 ± 4.4 years; 47.5% girls) were randomised to receive insulin pump treatment with continuous glucose monitoring or conventional self-monitoring blood glucose measurements. The primary outcome was the level of HbA(1c) after 12 months. Other analyses included fasting C-peptide, glycaemic variability, sensor usage, adverse events, children's health-related quality of life and parent's wellbeing. RESULTS HbA(1c) was not significantly different between the two groups, but patients with regular sensor use had lower values (mean 7.1%, 95% CI 6.8-7.4%) compared with the combined group with no or low sensor usage (mean 7.6%, 95% CI 7.3-7.9%; p=0.032). At 12 months, glycaemic variability was lower in the sensor group (mean amplitude of glycaemic excursions 80.2 ± 26.2 vs 92.0 ± 33.7; p=0.037). Higher C-peptide concentrations were seen in sensor-treated 12- to 16-year-old patients (0.25 ± 0.12 nmol/l) compared with those treated with insulin pump alone (0.19 ± 0.07 nmol/l; p=0.033). Severe hypoglycaemia was reported only in the group without sensors (four episodes). CONCLUSION/INTERPRETATION Sensor-augmented pump therapy starting from the diagnosis of type 1 diabetes can be associated with less decline in fasting C-peptide particularly in older children, although regular sensor use is a prerequisite for improved glycaemic control. TRIAL REGISTRATION ISRCTN.org ISRCTN05450731 FUNDING Medtronic International Trading Sàrl, Tolochenaz, Switzerland.
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Affiliation(s)
- O Kordonouri
- Bult Diabetes Centre for Children and Adolescents, Kinderkrankenhaus auf der Bult, Janusz-Korczak-Allee 12, D-30173 Hannover, Germany
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Awa WL, Boehm BO, Kapellen T, Rami B, Rupprath P, Marg W, Becker M, Holl RW. HLA-DR genotypes influence age at disease onset in children and juveniles with type 1 diabetes mellitus. Eur J Endocrinol 2010; 163:97-104. [PMID: 20371654 DOI: 10.1530/eje-09-0921] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [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: 11/08/2022]
Abstract
OBJECTIVE To investigate HLA-DR genotype in association with chronological age or calendar year of disease onset and the time trend of genotype frequencies from 1969 to 2009. Additionally, to examine genotype frequency in relation to B-cell-, islet cell antibodies (ICA)-, autoantibodies to insulin-, insulinoma antigen 2 (IA2)-, glutamic acid decarboxylase-antibody positivity, thyroid antibody positivity, thyroid diseases or coeliac antibody positivity. Genotype associations with gender and ethnicity are also analyzed. SUBJECTS AND METHODS HLA-typed children and juveniles (n=1445) aged <or=20 years at disease onset from the German/Austrian DPV-database were examined. chi(2) statistics and mixed hierarchical logistic regression models were used to compare genotype frequencies and establish associations with age at disease manifestation, autoimmune antibodies/diseases, ethnicity and time trend. RESULTS Subjects aged <6 years predominantly carried the genotype HLA-DR3/4 (25.2%), whereas in subjects aged >12 years the most prevalent HLA-DR genotype was X/X (18.1%). IA2 positivity was associated with HLA-DR4/X and HLA-DR3/4 positivity (P=0.011), and hypothyroidism was linked to HLA-DR4/4 (P=0.0103). More females carried the HLA-DR4/4 genotype (18.2 vs 12.7% P=0.0048) or were thyroid antibody positive (24.5 vs 14.7% P=0.0001). Larger numbers of <6 year olds were coeliac antibody positive than >12 year olds (14.8 vs 9.1% P=0.0037). No associations between migration background and B-cell-, thyroid- or coeliac-antibody positivity, and no time trend were found. CONCLUSION HLA-DR genotype associated with age at disease onset, ICA positivity and hypothyroidism; female gender with thyroid antibody positivity and low age of diabetes onset with coeliac antibody positivity.
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Affiliation(s)
- W L Awa
- Department of Epidemiology, Faculty of Medicine, Division of Endocrinology and Diabetes, Clinic for Internal Medicine I, University of Ulm, Ulm 89081, Germany.
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Hümer M, Scheller G, Kapellen T, Gebauer C, Schmidt H, Kiess W. [Use of herbal medicine in German children - prevalence, indications and motivation]. Dtsch Med Wochenschr 2010; 135:959-64. [PMID: 20446230 DOI: 10.1055/s-0030-1253683] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Herbal medicine (phytotherapy) is increasingly used by the German population. But its use for children has been rarely analysed. This study determined prevalence, motivations and indications for the use of herbal medicine use. It also investigated parent-related variables associated with its use. METHODS An anonymized questionnaire was filled in by parents of children and adolescents who attended the general pediatric out-patient department of two German university children's hospitals and the practice of two general pediatricians. RESULTS 413 of 600 parents (68.8%) completed the questionnaire. Mean age of the children was 6.7 +/- 4.7 years. 353 (85.5%) were given one or more herbal products, chamomile (85.5%), fennel (81.3%), eucalyptus (43.9%). Bronchipret 43.1%) (thyme and primrose [tablets] or thyme with ivy [syrup] and Prospan (43.1%) (a syrup of ivy leaf extract) were the most commonly used, in the treatment of cough. Parents who give phytotherapeuticals to their children were significantly more often women, living in a large city, of good education and financially better off (p< 0.05). CONCLUSION Herbal medicine is widely used in Germany during childhood and adolescence. To achieve high therapeutic safety it is important to ask parents explicitly about such use.
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Affiliation(s)
- M Hümer
- Klinik für Kinder und Jugendliche, Department für Frauen- und Kindermedizin des Universitätsklinikums Leipzig, Leipzig
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Molz K, Schober E, Wolf J, Raile K, Naeke A, Schütt M, Kapellen T, Karges B, Holl R. Vergleich von Injektionshäufigkeit und Tagesinsulindosis zwischen Detemir, Glargin und NPH bei 29253 Kindern, Jugendlichen und Erwachsenen mit Typ 1-Diabetes mellitus aus der DPV-Datenbank. DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1253748] [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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Karges B, Kapellen T, Neu A, Hofer SE, Rohrer T, Rosenbauer J, Wolf J, Holl RW. Langwirkende Insulinanaloga und Häufigkeit der diabetischen Ketoazidose bei Kindern und Jugendlichen mit Typ 1 Diabetes: Eine prospektive Studie in 10.682 Patienten von 271 Institutionen. DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1253745] [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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26
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Kordonouri O, Pankowska E, Rami B, Kapellen T, Coutant R, Hartmann R, Lange K, Remus K, Bläsig S, Marquardt E, Danne T. Ergebnisse der multizentrischen Pädiatrischen ONSET-Studie zur sensorunterstützten Pumpentherapie bei Typ 1 Diabetes im ersten Jahr der Erkrankung. DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1253860] [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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Lange K, Danne T, Coutant R, Kapellen T, Pankowska E, Rami B, Krug N, Aschemeier B, Remus K, Bläsig S, Marquardt E, Hartmann R, Kordonouri O. Gute kindliche Lebensqualität und psychisches Wohlbefinden der Mütter: 12 Monatsdaten der ONSET-Studie zur sensorunterstützten Insulinpumpentherapie. DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1253879] [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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Lange K, Coutant R, Danne T, Kapellen T, Pankowska E, Rami B, Aschemeier B, Bläsig S, Hartmann R, Krug N, Marquardt E, Walte K, Kordonouri O. Diabetesdiagnose bei Kindern: Beeinträchtigung der kindlichen Lebensqualität und affektive Anpassungsstörungen ihrer Mütter zu Beginn der Paediatric ONSET-Studie. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1221840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kapellen T, Wolf J, Rosenbauer J, Stachow R, Ziegler R, Szczepanski R, Holl R. Changes in the Use of Analogue Insulins in 37 206 Children and Adolescents with Type 1 Diabetes in 275 German and Austrian Centers during the Last Twelve Years. Exp Clin Endocrinol Diabetes 2009; 117:329-35. [DOI: 10.1055/s-0028-1103289] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Berghaeuser MA, Kapellen T, Heidtmann B, Haberland H, Klinkert C, Holl RW. Continuous subcutaneous insulin infusion in toddlers starting at diagnosis of type 1 diabetes mellitus. A multicenter analysis of 104 patients from 63 centres in Germany and Austria. Pediatr Diabetes 2008; 9:590-5. [PMID: 18503495 DOI: 10.1111/j.1399-5448.2008.00416.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- M A Berghaeuser
- Department of Paediatrics, University of Muenster, Muenster, Germany.
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Schmidt F, Herbst A, Wolf J, Kapellen T, Hofer S, Rabl W, Holl RW. Diabetes mellitus im Rahmen von genetischen Syndromen im Kindes- und Jugendalter – eine DPV-Wiss-Analyse. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lange K, Kleine T, Dunstheimer D, Etspüler J, Paape D, Lauterborn R, Jorch N, Kapellen T, Petersen M, Ludwig KH, Neu A, Danne T. Gute Lebensqualität von Kindern mit Typ 1 Diabetes und hohe Belastung der Eltern im ersten Jahr nach Diabetesdiagnose: Ergebnisse einer multizentrischen prospektiven Studie. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Heidtmann B, Hilgard D, Kapellen T, Schumacher A, Lepler R, Schober E, Holl R. Die Insulinpumpentherapie bei kleinen Kindern bis zum 6. Lebensjahr: Vergleich der Stoffwechselparameter vor und 6 bzw. 12 Monate nach CSII-Beginn. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-960522] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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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Wolf J, Kapellen T, Stachow R, Ziegler R, Szczepanski R, Holl RW. Die Anwendung von Analoginsulinen in der Pädiatrie – eine Bestandsaufnahme. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Galler A, Gelbrich G, Kratzsch J, Noack N, Kapellen T, Körner A, Kiess W. Erhöhte Adiponektinkonzentrationen im Serum bei Kindern und Jugendlichen mit Diabetes mellitus Typ 1. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kratzsch J, Knerr I, Galler A, Kapellen T, Raile K, Körner A, Thiery J, Dötsch J, Kiess W. Metabolic decompensation in children with type 1 diabetes mellitus associated with increased serum levels of the soluble leptin receptor. Eur J Endocrinol 2006; 155:609-14. [PMID: 16990661 DOI: 10.1530/eje.1.02261] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [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] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Type 1 diabetes mellitus (T1DM) leads to increased serum levels of the soluble leptin receptor (sOB-R) by an as yet unknown cellular mechanism. The aim of our study was to investigate potential metabolic factors that may be associated with the induction of the sOB-R release from its membrane receptor. MATERIALS AND METHODS Twenty-five children (aged between 1.5 and 17.0 years) were studied at the onset of T1DM. Blood samples were collected before (n = 25), during the first 18 h (mean +/- S.D. 11.1 +/- 4.3 h, n = 16) and 92 h (47.5 +/- 22.5 h; n = 14) after beginning insulin therapy. Serum sOB-R and leptin levels were determined by in-house immunoassays. RESULTS The sOBR-level and the molar sOB-R/leptin ratio were significantly higher before than after starting insulin treatment (P < 0.05). In contrast, leptin levels were significantly lower (P < 0.05) before insulin therapy. The correlation between sOB-R and blood glucose (r = 0.49; P < 0.05), as well as sOB-R with parameters of ketoacidosis, such as pH (r = -0.72), base excess (r = -0.70), and bicarbonate (r = -0.69) (P < 0.0001) at diagnosis of T1DM remained significant during the first 18 h of insulin treatment. Multiple regression analysis revealed that base excess predicted 41.0% (P < 0.001), age 16.4% (P < 0.05), and height SDS 13.9% (P < 0.01) of the sOB-R variance. CONCLUSIONS Metabolic decompensation in children with new onset T1DM is associated with dramatic changes of the leptin axis; serum levels of sOB-R are elevated and of leptin are reduced. The molar excess of sOB-R over leptin (median 11.3) in this condition may contribute to leptin insensitivity. Upregulation of the soluble leptin receptor appears to be a basic mechanism to compensate for intracellular substrate deficiency and energy-deprivation state.
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Affiliation(s)
- J Kratzsch
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Germany.
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Kapellen T. Fistel nach Gallensteinperforation in das Duodenum. Dtsch Med Wochenschr 2006. [DOI: 10.1055/s-2006-941756] [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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Kapellen T. Manifestation eines Morbus Addison im Sinne eines Autoimmun-Polyendokrinopathie-Syndroms Typ 2 (APS-Typ 2: Diabetes mellitus Typ 1, Autoimmunthyreoiditis, Morbus Addison). Dtsch Med Wochenschr 2006. [DOI: 10.1055/s-2006-941743] [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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Gundlach S, Würz J, Schmutzer G, Hiermann P, Kapellen T, Galler A, Wudy S, Hauschild M, Kiess W, Brähler E. Gesundheitsbezogene Lebensqualität von Geschwistern an Diabetes mellitus Typ 1 erkrankter Kinder und Jugendlicher. Dtsch Med Wochenschr 2006; 131:1143-8. [PMID: 16705535 DOI: 10.1055/s-2006-941741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND INFORMATION A chronic illness in childhood or adolescents constitutes a drastic event for the whole family, especially for the healthy siblings. This could impair their quality of life. PATIENTS AND METHODS We designed a case-control-study in three centres (Leipzig, Giessen and Augsburg) with questionaires sent to 72 diabetic children, 71 of their siblings and 63 children of neighbourhood (controls) aged between 8 and 16 years. KINDL-Questionnaire was used for the study of the health-related quality of life of children and adolescents, supplemented by other appropriate items. RESULTS The results indicate a positive health related quality of life of the healthy siblings of families with a child who has type 1 diabetes. Differences in the quality of life depend on factors such as age and gender of the children and relate to specific items of sibling relationship (e. g. "worried about sibling", "looked after sibling"). Generally, there was a great similarity with regard to the quality of life of healthy brothers and sisters from affected families compared with children of families without a child suffering from chronic illness. CONCLUSIONS The results indicate that the health related quality of life of healthy siblings of children with diabetes only differs insignificantly from brothers and sisters of "healthy" families.
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Affiliation(s)
- S Gundlach
- Universitätsklinik und Poliklinik für Kinder und Jugendliche, Leipzig
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Würz J, Brähler E, Kapellen T, Galler A, Kiess W. Dyadisches Coping (paarbezogene Stressbewältigung) bei Eltern von Kindern und Jugendlichen mit Diabetes mellitus Typ 1. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-943980] [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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41
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Lange K, Kleine T, Dunstheimer D, Etspüler J, Paape D, Lauterborn R, Jorch N, Kapellen T, Petersen M, Ludwig KH, Serra E, Danne T. Struktur und Ergebnisse der Initialschulung der Eltern von Kindern mit Typ 1 Diabetes: eine multizentrische Evaluation. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-943814] [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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Würz J, Gundlach S, Hiermann P, Kapellen T, Galler A, Wudy S, Hauschild M, Brähler E, Kiess W. „Vergessene“ Geschwister? – Lebensqualität von Geschwistern von an Diabetes mellitus Typ 1 erkrankten Kindern und Jugendlichen. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-943942] [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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Galler A, Kapellen T, Schulz M, Kiess W. Fallbericht: Hirnödem und Hirninfarkt der Arteria cerebri posterior bei Manifestation eines Diabetes mellitus Typ 1 bei einem 2½ Jahre altem Kleinkind. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-944122] [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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Kapellen T, Heidtmann B, Bachmann J, Ziegler R, Holl R. Die Insulinpumpe im Kindes- und Jugendalter: Unterschiede in den einzelnen Altersgruppen hinsichtlich der Therapieziele und deren Verwirklichung. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-943800] [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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Rohrer T, Grabert M, Holterhus PM, Kapellen T, Knerr I, Mix M, Holl R, Initiative DPV. Das Menarchealter ist abhängig von der relativen Diabetes-Dauer und der Qualität der Diabetes-Einstellung. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-943797] [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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Heidtmann B, Hilgard D, Kapellen T, Schumacher A, Holl RW. Die Insulinpumpentherapie bei kleinen Kindern bis zum 6. Lebensjahr: Vergleich der Stoffwechselparameter vor und 12 Monate nach CSII-Beginn. Auswertung der DPV-Wiss-Daten für die Insulinpumpen-AG und die DPV-Wiss-Initiative. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-943799] [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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Reinehr T, Andler W, Kapellen T, Kiess W, Richter-Unruh A, Schönau E, Seewi O, Heinze E, Wabitsch M. Clinical characteristics of type 2 diabetes mellitus in overweight European caucasian adolescents. Exp Clin Endocrinol Diabetes 2005; 113:167-70. [PMID: 15789276 DOI: 10.1055/s-2005-837522] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM To present the clinical features of Type 2 diabetes mellitus (T2DM) in overweight European Caucasian children and adolescents. METHODS We report the clinical characteristics of 16 non-syndromal overweight European Caucasian adolescents with T2DM (10 boys, 6 girls, SDS-BMI in median +2.8, range +1.6 to +3.4) treated in 5 specialised centres for obesity and diabetes. RESULTS None of the adolescents manifested with ketoacidosis. 13 were asymptomatic (3 adolescents with polyuria), 12 showed features of metabolic syndrome (dyslipidaemia or hypertension), 8 demonstrated acanthosis nigricans and 12 had relatives with T2DM. 11 adolescents were extremely obese and all patients were pubertal. Mean age at diagnosis was 14.2 years (range 11.0 - 16.9). Median insulin was 19 microU/ml, insulin resistance index (HOMA) 8.5, C-peptide 2.3 ng/ml, HbA1c 6.9 %, fasting blood glucose 176 mg/dl and blood glucose at 2 hours with the oGTT 229 mg/dl at manifestation. Fasting blood glucose and HBA1c were in the normal range in 4 and 6 adolescents respectively, while oGTT always fitted the diagnosis of T2DM. CONCLUSION Since T2DM occurred in Caucasian overweight adolescents and is frequently asymptomatic, it is essential that clinicians perform diagnostic procedures to identify T2DM in high-risk groups of overweight Caucasian adolescents (extreme obesity, features of metabolic syndrome, relatives with T2DM).
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Affiliation(s)
- T Reinehr
- Vestische Kinder- und Jugendklinik, University of Witten-Herdecke, Datteln, Germany.
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Kratzsch J, Deimel A, Galler A, Kapellen T, Klinghammer A, Kiess W. Increased serum soluble leptin receptor levels in children and adolescents with type 1 diabetes mellitus. Eur J Endocrinol 2004; 151:475-81. [PMID: 15476448 DOI: 10.1530/eje.0.1510475] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We investigated whether or not serum levels of the soluble leptin receptor (sOB-R) and leptin are related to anthropometric and metabolic changes during pubertal development of children and adolescents with type 1 diabetes mellitus. DESIGN AND METHODS Blood levels of sOB-R, leptin and HbA1C, as well as body-mass index (BMI), diabetes duration and daily insulin doses, were determined in 212 (97 girls; 115 boys) children with type 1 diabetes mellitus and compared with the sOB-R serum levels in 526 healthy children and adolescents. RESULTS OB-R serum levels and parallel values of the molar ratio between sOB-R and leptin were significantly higher in children with diabetes than in normal children (P<0.05) in almost all investigated Tanner stages. Furthermore, in the entire group of patients, we demonstrated statistically significant correlations (P<0.02) between sOB-R and the duration of diabetes (r=0.30), HbA1c levels (r=0.32) and the insulin dose (r=0.18). Multiple-regression analysis revealed that HbA1c (12.4%), height (7.9%) and duration of diabetes (8.7%) contributed to 29% variance of sOB-R in diabetic children. CONCLUSIONS Our data suggest that poor glycemic control in diabetes may lead to increased serum levels of sOB-R. This regulation of sOB-R appears to be independent of leptin, but may have an impact on leptin action. The consequently developing molar excess of sOB-R related to leptin could reduce leptin sensitivity and may, therefore, influence leptin-related anthropometric and metabolic abnormalities.
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Affiliation(s)
- J Kratzsch
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany.
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Kiess W, Böttner A, Raile K, Kapellen T, Müller G, Galler A, Paschke R, Wabitsch M. Type 2 diabetes mellitus in children and adolescents: a review from a European perspective. Horm Res Paediatr 2003; 59 Suppl 1:77-84. [PMID: 12566725 DOI: 10.1159/000067829] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Changes in food consumption and exercise are fueling a worldwide increase in obesity in children and adolescents. As a consequence of this dramatic development, an increasing rate of type 2 diabetes mellitus has been recorded in children and adolescents in the USA and, more recently, in many countries around the world. Both genetic and environmental factors contribute to the pathogenesis of type 2 diabetes. Lower susceptibility in white Caucasians and higher susceptibility in Asians, Hispanics and blacks have been noted. There is a high hidden prevalence and a lack of exact data on the epidemiology of the disease in Europe: in Germany only 70 patients below the age of 15 years were identified in the systematic, nationwide DPV (Diabetessoftware für prospektive Verlaufsdokumentation) diabetes survey, but our calculations suggest that more than 5000 young people in Germany at present would meet the diagnostic criteria of type 2 diabetes. In Australasia, the prevalence of type 2 diabetes is reportedly high in some ethnic groups and again is linked very closely to the obesity epidemic. No uniform and evidence-based treatment strategy is available: many groups use metformin, exercise programmes and nutritional education as a comprehensive approach to treat type 2 diabetes in childhood and adolescence. The lack of clear epidemiological data and a strong need for accepted treatment strategies point to the key role of preventive programmes. Prevention of obesity will help to counteract the emerging worldwide epidemic of type 2 diabetes in youth. Preventive programmes should focus on exercise training and reducing sedentary behaviour such as television viewing, encouraging healthy nutrition and supporting general education programmes since shorter school education is clearly associated with higher rates of obesity and hence the susceptibility of an individual to acquire type 2 diabetes.
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Affiliation(s)
- W Kiess
- Hospital for Children and Adolescents, University of Leipzig, Germany.
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Abstract
The level of fatness of a child at which morbidity acutely and/or later in life increases is determined on an acturial basis. Direct measurements of body fat content, e.g. hydrodensitometry, bioimpedance, or DEXA, are useful tools in scientific studies. However, body mass index (BMI) is easy to calculate and is generally accepted now to be used to define obesity in children and adolescents clinically. An increased risk of death from cardiovascular disease in adults has been found in subjects whose BMI had been greater than the 75th percentile as adolescents. Childhood obesity seems to substantially increase the risk of subsequent morbidity whether or not obesity persists into adulthood. The genetic basis of childhood obesity has been elucidated to some extent through the discovery of leptin, the ob gene product, and the increasing knowledge on the role of neuropeptides such as POMC, neuropeptide Y (NPY) and the melanocyte concentrating hormone receptors (for example, MC4R). Environmental/exogenous factors largely contribute to the development of a high degree of body fatness early in life. Twin studies suggest that approximately 50% of the tendency toward obesity is inherited. There are numerous disorders including a number of endocrine disorders (Cushing's syndrome, hypothyroidism, etc.) and genetic syndromes (Prader-Labhard-Willi syndrome, Bardet Biedl syndrome, etc.) that can present with obesity. A simple diagnostic algorithm allows for the differentiation between primary or secondary obesity. Among the most common sequelae of primary childhood obesity are hypertension, dyslipidemia, back pain and psychosocial problems. Therapeutic strategies include psychological and family therapy, lifestyle/behaviour modification and nutrition education. The role of regular exercise and exercise programmes is emphasized. Surgical procedures and drugs used in adult obesity are still not generally recommended in children and adolescents with obesity. As obesity is the most common chronic disorder in industrialized societies, its impact on individual lives as well as on health economics has to be recognized more widely. This review is aimed towards defining the clinical problem of childhood obesity on the basis of current knowledge and towards outlining future research areas in the field of energy homoesostasis and food intake in relation to child health. Finally, one should aim to increase public awareness of the ever increasing health burden and economic dimension of the childhood obesity epidemic that is present around the globe.
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Affiliation(s)
- W Kiess
- Children's Hospital, University of Leipzig, Oststr. 21-25, D 04317 Leipzig, Germany.
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