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Sourij C, Oulhaj A, Aziz F, Tripolt NJ, Aberer F, Pferschy PN, Postula M, Drexel H, Benedikt M, Kolesnik E, Pieber TR, Bugger H, von Lewinski D, Sourij H. Impact of glycaemic status on the cardiac effects of empagliflozin when initiated immediately after myocardial infarction: A post-hoc analysis of the EMMY trial. Diabetes Obes Metab 2024; 26:1971-1975. [PMID: 38287198 DOI: 10.1111/dom.15477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 01/31/2024]
Affiliation(s)
- Caren Sourij
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Abderrahim Oulhaj
- Department of Public Health and Epidemiology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Faisal Aziz
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Norbert J Tripolt
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Felix Aberer
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Peter N Pferschy
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Marek Postula
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - H Drexel
- VIVIT Institute, Feldkirch, Austria
| | - Martin Benedikt
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Ewald Kolesnik
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Thomas R Pieber
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Heiko Bugger
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | | | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
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Aziz F, Sternad C, Sourij C, Knoll L, Kojzar H, Schranz A, Bürger A, Sourij H, Aberer F. Glycated haemoglobin, HOMA2-B, C-peptide to glucose ratio and type 2 diabetes clusters as predictors for therapy failure in individuals with type 2 diabetes without insulin therapy: A registry analysis. Diabetes Obes Metab 2024; 26:1082-1089. [PMID: 38151754 DOI: 10.1111/dom.15409] [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: 10/24/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023]
Abstract
AIM Some people with type 2 diabetes mellitus (T2D) and declining β-cell function do require insulin over time. Various laboratory parameters, indices of glucose metabolism or phenotypes of T2D (clusters) have been suggested, which might predict future therapy failure (TF), indicating the need for insulin therapy initiation. This analysis evaluated glycated haemoglobin (HbA1c), homeostatic model assessment (HOMA)2-B, C-peptide to glucose ratio (CGR) and diabetes clusters as predictive parameters for the occurrence of glycaemic TF in individuals diagnosed with T2D without previous insulin therapy. MATERIALS AND METHODS In total, 159 individuals with T2D [41% female, median age 50 (IQR: 53-69) years, diabetes duration 9 (5-15) years], without insulin therapy were prospectively evaluated for the occurrence of a composite primary endpoint, including HbA1c increasing or remaining >8.0% (64 mmol/mol) 3 months after baseline on non-insulin glucose-lowering agents, insulin initiation or hospital admissions because of acute hyperglycaemic events. Diabetes clusters were formed according to previously described characteristics. Only severe autoimmune diabetes clusters were excluded because of a small amount of glutamate decarboxylase antibody-positive participants. The other clusters were distributed as mild age-related diabetes 33%; severe insulin-deficient diabetes 31%; mild obesity-related diabetes 20%; and severe insulin-resistant diabetes 15%. RESULTS During a median observation of 57 months, higher tertiles of HbA1c at baseline, HOMA2-B, as well as a lower CGR were significantly predictive for the occurrence of the primary endpoint. The probability of meeting the primary endpoint was the highest for mild obesity-related diabetes [hazard ratio 3.28 (95% confidence interval 1.75-6.2)], followed by severe insulin-deficient diabetes [hazard ratio 2.03 (95% confidence interval 1.1-3.7)], mild age-related diabetes and the lowest for severe insulin-resistant diabetes. The best performance to predict TF with an area under the curve (AUC) of 0.77 was HbA1c at baseline, followed by HOMA2-B (AUC 0.69) and CGR (AUC 0.64). CONCLUSION HbA1c, indices of insulin secretion capacity (HOMA2-B and CGR) and T2D clusters might be applicable tools to guide practitioners in the decision of whether insulin is required in people already diagnosed with T2D. These findings need to be validated in prospective studies.
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Affiliation(s)
- Faisal Aziz
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Christoph Sternad
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Caren Sourij
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Lisa Knoll
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Harald Kojzar
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Anna Schranz
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Alexandra Bürger
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Felix Aberer
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
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Sourij C, Aziz F, Tripolt NJ, Siller-Matula J, Pferschy PN, Kolesnik E, Wallner M, Eyileten C, Postula M, Oulhaj A, Sourij H, von Lewinski D. Effects of empagliflozin in women and men with acute myocardial infarction: An analysis from the EMMY trial. Hellenic J Cardiol 2024; 75:3-8. [PMID: 37236318 DOI: 10.1016/j.hjc.2023.05.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE Women have a higher comorbidity burden and a lower survival rate after acute myocardial infarction (AMI) than men. This analysis aimed to investigate the impact of sex on the effect of treatment with the sodium glucose cotransporter 2 inhibitor (SGLT2i) empagliflozin immediately after an AMI. METHODS Participants were randomized to either empagliflozin or placebo and followed for 26 weeks after initiating the treatment no later than 72 hours after a percutaneous coronary intervention following an AMI. We analyzed the impact of sex on the beneficial effects of empagliflozin observed for heart failure biomarkers as well as structural and functional cardiac parameters. RESULTS Women had higher NT-proBNP levels at baseline (median 2117pg/mL, IQR 1383-3267 pg/mL versus 1137 pg/mL, IQR 695-2050 pg/mL; p < 0.001) and were older than men (median 61y, IQR 56-65y versus 56y, IQR 51-64y, p = 0.005). The beneficial effects of empagliflozin on NT-proBNP levels (Pinteraction = 0.984), left ventricular ejection fraction (Pinteraction = 0.812), left ventricular end systolic volume (Pinteraction = 0.183), or left ventricular end diastolic volume (Pinteraction = 0.676) were independent of sex. CONCLUSIONS Empagliflozin exhibited similar benefits in women and men when administered immediately after an AMI.
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Affiliation(s)
- Caren Sourij
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Faisal Aziz
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Norbert J Tripolt
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Jolanta Siller-Matula
- Department of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20 1090 Vienna, Austria
| | - Peter N Pferschy
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Ewald Kolesnik
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Markus Wallner
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Ceren Eyileten
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, 61 Zwirki i Wigury Street, 02-091 Warsaw, Poland
| | - Marek Postula
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, 61 Zwirki i Wigury Street, 02-091 Warsaw, Poland
| | - Abderrahim Oulhaj
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, UAE P O Box 127788, United Arab Emirates
| | - Harald Sourij
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
| | - Dirk von Lewinski
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
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Müller A, Moser O, Sternad C, Aziz F, Unteregger C, Kojzar H, Mursic I, Sourij C, Pferschy P, Tripolt N, Aberer F, Sourij H. Effects of 8 weeks of aerobic endurance training on functional capacity and metabolic variables in people with type 1 diabetes: A secondary outcome analysis of the ULTRAFLEXI-1 study. Diabetes Obes Metab 2023; 25:3826-3830. [PMID: 37580976 DOI: 10.1111/dom.15245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/20/2023] [Accepted: 07/31/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Alexander Müller
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Othmar Moser
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Exercise Physiology & Metabolism, Institute of Sports Science, University of Bayreuth, Bayreuth, Germany
| | - Christoph Sternad
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Faisal Aziz
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Christina Unteregger
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Harald Kojzar
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ines Mursic
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Caren Sourij
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter Pferschy
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Norbert Tripolt
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Felix Aberer
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Harald Sourij
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Paar M, Cvirn G, Hoerl G, Reibnegger G, Sourij H, Sourij C, Kojzar H, Oettl K. Albumin of People with Diabetes Mellitus Is More Reduced at Low HbA1c. Int J Mol Sci 2023; 24:16256. [PMID: 38003446 PMCID: PMC10671031 DOI: 10.3390/ijms242216256] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
Oxidative stress is involved in the development, progression, and complications of diabetes mellitus (DM). Oxidative modification of human serum albumin's cysteine-34 is a marker for oxidative stress-related pathological conditions. We aimed to evaluate the redox state of albumin in patients with DM to investigate possible correlations with age, diabetes duration, and disease control status. Plasma aliquots were collected from 52 participants (26 type 1 and 26 type 2 DM). Patients were divided into two groups according to their glycated hemoglobin levels less than or equal to and greater than 58 mmol/L. Albumin redox state was assessed with high-performance liquid chromatography by fractionating it into human mercaptalbumin (HMA) and human nonmercaptalbumin 1 and 2 (HNA1 and HNA2). Albumin redox fractions were differently related to the age of study participants. In age-matched T1DM and T2DM groups, the albumin redox state was essentially the same. Irreversibly oxidized HNA2 was positively correlated with diabetes duration, especially in the T1DM group. HNA was increased in people with an increased HbA1c (>58 mmol/mol). Our results support the hypothesis that oxidative stress plays a crucial role in DM pathogenesis and emphasize the importance of diabetes control on systemic oxidative burden.
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Affiliation(s)
- Margret Paar
- Division of Medicinal Chemistry, Otto Loewi Research Center, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria; (M.P.); (G.C.); (G.H.); (G.R.)
| | - Gerhard Cvirn
- Division of Medicinal Chemistry, Otto Loewi Research Center, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria; (M.P.); (G.C.); (G.H.); (G.R.)
| | - Gerd Hoerl
- Division of Medicinal Chemistry, Otto Loewi Research Center, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria; (M.P.); (G.C.); (G.H.); (G.R.)
| | - Gilbert Reibnegger
- Division of Medicinal Chemistry, Otto Loewi Research Center, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria; (M.P.); (G.C.); (G.H.); (G.R.)
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (H.S.); (H.K.)
| | - Caren Sourij
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria;
| | - Harald Kojzar
- Division of Endocrinology and Diabetology, Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (H.S.); (H.K.)
| | - Karl Oettl
- Division of Medicinal Chemistry, Otto Loewi Research Center, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010 Graz, Austria; (M.P.); (G.C.); (G.H.); (G.R.)
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Sourij C, Aziz F, Krappinger S, Praschk A, Metzner T, Kojzar H, Zirlik A, Stojakovic T, Pätzold D, von Lewinski D, Zweiker R, Scharnagl H, Sourij H. Changes in Lipoprotein(a) Levels in People after ST Elevation Myocardial Infarction-The STEMI-Lipids Study. Int J Mol Sci 2023; 24:15531. [PMID: 37958516 PMCID: PMC10647358 DOI: 10.3390/ijms242115531] [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] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023] Open
Abstract
Lipoprotein(a) (Lp(a)) is considered an independent risk factor for cardiovascular diseases. The plasma concentration of Lp(a) is largely genetically determined but varies over a wide range within the population. This study investigated changes in Lp(a) levels after an acute myocardial infarction. Patients who underwent coronary angiography due to an ST elevation myocardial infarction were enrolled (n = 86), and Lp(a) levels were measured immediately after the intervention, one day, two days, and at a post-discharge follow-up visit at 3 to 6 months after the acute myocardial infarction. Median Lp(a) levels increased from a median of 7.9 mg/dL (3.8-37.1) at hospital admission to 8.4 mg/dL (3.9-35.4) on the following day, then to 9.3 mg/dL (3.7-39.1) on day two (p < 0.001), and to 11.2 mg/dL (4.4-59.6) at the post-discharge follow-up (p < 0.001). Lp(a) levels were the lowest during the acute myocardial infarction and started to increase significantly immediately thereafter, with the highest levels at the post-discharge follow-up. The moderate but significant increase in Lp(a) in people with acute myocardial infarction appears to be clinically relevant on an individual basis, especially when specific Lp(a) cut-off levels are supposed to determine the initiation of future treatment. Hence, a repeated measurement of Lp(a) after myocardial infarction should be performed.
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Affiliation(s)
- Caren Sourij
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria (A.P.); (D.P.)
| | - Faisal Aziz
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (F.A.); (S.K.)
| | - Sarah Krappinger
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (F.A.); (S.K.)
| | - Andreas Praschk
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria (A.P.); (D.P.)
| | - Thomas Metzner
- Department of Medical Affairs, Eli Lilly GmbH, Erdberger Lände 26A, 1030 Vienna, Austria
| | - Harald Kojzar
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (F.A.); (S.K.)
| | - Andreas Zirlik
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria (A.P.); (D.P.)
| | - Tatjana Stojakovic
- Clinical Institute of Medical- and Chemical Laboratory Diagnostics, University Hospital Graz, 8036 Graz, Austria; (T.S.); (H.S.)
| | - Dieter Pätzold
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria (A.P.); (D.P.)
| | - Dirk von Lewinski
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria (A.P.); (D.P.)
| | - Robert Zweiker
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria (A.P.); (D.P.)
| | - Hubert Scharnagl
- Clinical Institute of Medical- and Chemical Laboratory Diagnostics, University Hospital Graz, 8036 Graz, Austria; (T.S.); (H.S.)
| | - Harald Sourij
- Trials Unit for Interdisciplinary Metabolic Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (F.A.); (S.K.)
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Schweighofer N, Strasser M, Obermayer A, Trummer O, Sourij H, Sourij C, Obermayer-Pietsch B. Identification of Novel Intronic SNPs in Transporter Genes Associated with Metformin Side Effects. Genes (Basel) 2023; 14:1609. [PMID: 37628660 PMCID: PMC10454417 DOI: 10.3390/genes14081609] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Metformin is a widely used and effective medication in type 2 diabetes (T2DM) as well as in polycystic ovary syndrome (PCOS). Single nucleotide polymorphisms (SNPs) contribute to the occurrence of metformin side effects. The aim of the present study was to identify intronic genetic variants modifying the occurrence of metformin side effects and to replicate them in individuals with T2DM and in women with PCOS. We performed Next Generation Sequencing (Illumina Next Seq) of 115 SNPs in a discovery cohort of 120 metformin users and conducted a systematic literature review. Selected SNPs were analysed in two independent cohorts of individuals with either T2DM or PCOS, using 5'-3'exonucleaseassay. A total of 14 SNPs in the organic cation transporters (OCTs) showed associations with side effects in an unadjusted binary logistic regression model, with eight SNPs remaining significantly associated after appropriate adjustment in the discovery cohort. Five SNPs were confirmed in a combined analysis of both replication cohorts but showed different association patterns in subgroup analyses. In an unweighted polygenic risk score (PRS), the risk for metformin side effects increased with the number of risk alleles. Intronic SNPs in the OCT cluster contribute to the development of metformin side effects in individuals with T2DM and in women with PCOS and are therefore of interest for personalized therapy options.
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Affiliation(s)
- Natascha Schweighofer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (N.S.); (M.S.); (A.O.); (H.S.); barbar (B.O.-P.)
- Center for Biomarker Research in Medicine, CBmed, 8010 Graz, Austria
| | - Moritz Strasser
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (N.S.); (M.S.); (A.O.); (H.S.); barbar (B.O.-P.)
- Department of Health Studies, Institute of Biomedical, FH Joanneum University of Applied Sciences, 8020 Graz, Austria
| | - Anna Obermayer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (N.S.); (M.S.); (A.O.); (H.S.); barbar (B.O.-P.)
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, 8036 Graz, Austria
| | - Olivia Trummer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (N.S.); (M.S.); (A.O.); (H.S.); barbar (B.O.-P.)
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (N.S.); (M.S.); (A.O.); (H.S.); barbar (B.O.-P.)
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, 8036 Graz, Austria
| | - Caren Sourij
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria;
| | - Barbara Obermayer-Pietsch
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (N.S.); (M.S.); (A.O.); (H.S.); barbar (B.O.-P.)
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Moser O, Müller A, Aberer F, Aziz F, Kojzar H, Sourij C, Obermayer A, Abbas F, Birnbaumer P, Lenz J, Mursic I, Sternad C, Hönger L, Ziko H, Pferschy PN, Tripolt N, Sourij H. Comparison of Insulin Glargine 300 U/mL and Insulin Degludec 100 U/mL Around Spontaneous Exercise Sessions in Adults with Type 1 Diabetes: A Randomized Cross-Over Trial (ULTRAFLEXI-1 Study). Diabetes Technol Ther 2023; 25:161-168. [PMID: 36516429 DOI: 10.1089/dia.2022.0422] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aims: In the ULTRAFLEXI-1 study, we compared basal insulin Glargine 300 U/mL (IGlar U300) and insulin Degludec 100 U/mL (IDeg U100) for time below range <70 mg/dL (TBR<70; 3.9 mmol/L) in two different doses (100% and 75% of the regular dose) when used around spontaneous exercise sessions in adults with type 1 diabetes. Methods: A randomized, single-center, four-period, cross-over trial was performed and in each of the four 2-weeks-periods, participants attended six spontaneous 60 min moderate-intensity evening cycle ergometer exercise sessions. The basal insulin administered on the exercise days were IGlar U300 100% or 75% of the regular dose or IDeg U100 100% or 75%, respectively (morning injection). The primary outcome was the TBR<70 during the 24 h postexercise periods of the six spontaneous exercise sessions in the four trial arms and was analyzed in hierarchical order using the repeated measures linear mixed model. Results: Twenty-five people with type 1 diabetes were enrolled (14 males) with a mean age of 41.4 ± 11.9 years and an HbA1c of 7.5% ± 0.8% (59 ± 9 mmol/mol). The mean ± standard error of mean TBR<70 during the 24 h periods following the exercise sessions was 2.71% ± 0.51% for IGlar U300 (100%) and 4.37% ± 0.69% for IDeg U100 (100%) (P = 0.023) as well as 2.28% ± 0.53% for IGlar U300 and 2.55% ± 0.58% for IDeg U100 when using a 75% dose on exercise days (P = 0.720). Time in glucose range70-180 was the highest in the IDeg U100 (100%) group. Conclusions: TBR<70 within the first 24 h after spontaneous exercise sessions was significantly lower when receiving IGlar U300 compared to IDeg U100 when a regular basal dose was administered.
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Affiliation(s)
- Othmar Moser
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Exercise Physiology and Metabolism, Institute of Sports Science, University of Bayreuth, Bayreuth, Germany
| | - Alexander Müller
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Felix Aberer
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Faisal Aziz
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Harald Kojzar
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Caren Sourij
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Anna Obermayer
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Farah Abbas
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Philipp Birnbaumer
- Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
| | - Jacqueline Lenz
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ines Mursic
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Christoph Sternad
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Lukas Hönger
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Haris Ziko
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Peter N Pferschy
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Center for Biomarker Research in Medicine, CBmed, Graz, Austria
| | - Norbert Tripolt
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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9
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Obermayer A, Tripolt NJ, Pferschy PN, Kojzar H, Aziz F, Müller A, Schauer M, Oulhaj A, Aberer F, Sourij C, Habisch H, Madl T, Pieber T, Obermayer-Pietsch B, Stadlbauer V, Sourij H. Efficacy and Safety of Intermittent Fasting in People With Insulin-Treated Type 2 Diabetes (INTERFAST-2)-A Randomized Controlled Trial. Diabetes Care 2023; 46:463-468. [PMID: 36508320 PMCID: PMC9887629 DOI: 10.2337/dc22-1622] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the safety and feasibility of 3 nonconsecutive days of intermittent fasting (IF) per week over 12 weeks in participants with insulin-treated type 2 diabetes. RESEARCH DESIGN AND METHODS Forty-six people were randomized to an IF or control group. Dietary counseling and continuous glucose monitoring was provided. Coprimary end points were the change in HbA1c from baseline to 12 weeks and a composite end point (weight reduction ≥2%, insulin dose reduction ≥10%, and HbA1c reduction ≥3 mmol/mol). RESULTS The IF group showed a significant HbA1c reduction (-7.3 ± 12.0 mmol/mol) compared with the control group (0.1 ± 6.1 mmol/mol) over 12 weeks (P = 0.012). The coprimary end point was achieved by 8 people in the IF and none in the control group (P < 0.001). No severe hypoglycemia occurred. CONCLUSIONS IF is a safe and feasible dietary option to ameliorate glycemic control while reducing total daily insulin dose and body weight in insulin-treated people with type 2 diabetes.
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Affiliation(s)
- Anna Obermayer
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Norbert J. Tripolt
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter N. Pferschy
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- CBmed – Center for Biomarker Research in Medicine, Graz, Austria
| | - Harald Kojzar
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Faisal Aziz
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Alexander Müller
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Markus Schauer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Abderrahim Oulhaj
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
- Research and Data Intelligence Support Center, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Felix Aberer
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Caren Sourij
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Hansjörg Habisch
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Molecular Biology and Biochemistry, Medical University of Graz, Graz, Austria
| | - Tobias Madl
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Molecular Biology and Biochemistry, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Thomas Pieber
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- CBmed – Center for Biomarker Research in Medicine, Graz, Austria
| | - Barbara Obermayer-Pietsch
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Endocrinology Lab Platform, Division of Endocrinology and Diabetology, Department of Internal Medicine and Department of Gynecology and Obstetrics, Medical University of Graz, Graz, Austria
| | - Vanessa Stadlbauer
- CBmed – Center for Biomarker Research in Medicine, Graz, Austria
- Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Corresponding author: Harald Sourij,
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10
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Tripolt NJ, Hofer SJ, Pferschy PN, Aziz F, Durand S, Aprahamian F, Nirmalathasan N, Waltenstorfer M, Eisenberg T, Obermayer AMA, Riedl R, Kojzar H, Moser O, Sourij C, Bugger H, Oulhaj A, Pieber TR, Zanker M, Kroemer G, Madeo F, Sourij H. Glucose Metabolism and Metabolomic Changes in Response to Prolonged Fasting in Individuals with Obesity, Type 2 Diabetes and Non-Obese People-A Cohort Trial. Nutrients 2023; 15:511. [PMID: 36771218 PMCID: PMC9921960 DOI: 10.3390/nu15030511] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/21/2023] Open
Abstract
Metabolic regulation of glucose can be altered by fasting periods. We examined glucose metabolism and metabolomics profiles after 12 h and 36 h fasting in non-obese and obese participants and people with type 2 diabetes using oral glucose tolerance (OGTT) and intravenous glucose tolerance testing (IVGTT). Insulin sensitivity was estimated by established indices and mass spectrometric metabolomics was performed on fasting serum samples. Participants had a mean age of 43 ± 16 years (62% women). Fasting levels of glucose, insulin and C-peptide were significantly lower in all cohorts after 36 h compared to 12 h fasting (p < 0.05). In non-obese participants, glucose levels were significantly higher after 36 h compared to 12 h fasting at 120 min of OGTT (109 ± 31 mg/dL vs. 79 ± 18 mg/dL; p = 0.001) but insulin levels were lower after 36 h of fasting at 30 min of OGTT (41.2 ± 34.1 mU/L after 36 h vs. 56.1 ± 29.7 mU/L; p < 0.05). In contrast, no significant differences were observed in obese participants or people with diabetes. Insulin sensitivity improved in all cohorts after 36 h fasting. In line, metabolomics revealed subtle baseline differences and an attenuated metabolic response to fasting in obese participants and people with diabetes. Our data demonstrate an improved insulin sensitivity after 36 h of fasting with higher glucose variations and reduced early insulin response in non-obese people only.
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Affiliation(s)
- Norbert J. Tripolt
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria
| | - Sebastian J. Hofer
- Institute of Molecular Biosciences, NAWI Graz, University of Graz, Humboldtstraße 50, 8010 Graz, Austria
- BioTechMed Graz, 8010 Graz, Austria
- Field of Excellence BioHealth, University of Graz, 8010 Graz, Austria
- Inserm U1138, Equipe Labellisée par la Ligue Contre le Cancer, Centre de Recherche des Cordeliers, Institut Universitaire de France, Sorbonne Université, Université de Paris, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, 94805 Villejuif, France
| | - Peter N. Pferschy
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), 8010 Graz, Austria
| | - Faisal Aziz
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria
| | - Sylvère Durand
- Inserm U1138, Equipe Labellisée par la Ligue Contre le Cancer, Centre de Recherche des Cordeliers, Institut Universitaire de France, Sorbonne Université, Université de Paris, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, 94805 Villejuif, France
| | - Fanny Aprahamian
- Inserm U1138, Equipe Labellisée par la Ligue Contre le Cancer, Centre de Recherche des Cordeliers, Institut Universitaire de France, Sorbonne Université, Université de Paris, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, 94805 Villejuif, France
| | - Nitharsshini Nirmalathasan
- Inserm U1138, Equipe Labellisée par la Ligue Contre le Cancer, Centre de Recherche des Cordeliers, Institut Universitaire de France, Sorbonne Université, Université de Paris, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, 94805 Villejuif, France
| | - Mara Waltenstorfer
- Institute of Molecular Biosciences, NAWI Graz, University of Graz, Humboldtstraße 50, 8010 Graz, Austria
| | - Tobias Eisenberg
- Institute of Molecular Biosciences, NAWI Graz, University of Graz, Humboldtstraße 50, 8010 Graz, Austria
- BioTechMed Graz, 8010 Graz, Austria
- Field of Excellence BioHealth, University of Graz, 8010 Graz, Austria
| | - Anna M. A. Obermayer
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria
| | - Regina Riedl
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, 8010 Graz, Austria
| | - Harald Kojzar
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), 8010 Graz, Austria
| | - Othmar Moser
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria
- Department of Sport Science, Division of Exercise Physiology and Metabolism, University of Bayreuth, 95440 Bayreuth, Germany
| | - Caren Sourij
- Division of Cardiology, Medical University of Graz, 8010 Graz, Austria
| | - Heiko Bugger
- Division of Cardiology, Medical University of Graz, 8010 Graz, Austria
| | - Abderrahim Oulhaj
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University Abu Dhabi, Al-Ain P.O. Box 17666, United Arab Emirates
| | - Thomas R. Pieber
- BioTechMed Graz, 8010 Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), 8010 Graz, Austria
- Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria
| | - Matthias Zanker
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria
| | - Guido Kroemer
- Inserm U1138, Equipe Labellisée par la Ligue Contre le Cancer, Centre de Recherche des Cordeliers, Institut Universitaire de France, Sorbonne Université, Université de Paris, 75006 Paris, France
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, 94805 Villejuif, France
- Department of Biology, Institut du Cancer Paris CARPEM, Hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - Frank Madeo
- Institute of Molecular Biosciences, NAWI Graz, University of Graz, Humboldtstraße 50, 8010 Graz, Austria
- BioTechMed Graz, 8010 Graz, Austria
- Field of Excellence BioHealth, University of Graz, 8010 Graz, Austria
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria
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Sourij C, Aziz F, Kojzar H, Obermayer AM, Sternad C, Müller A, Tripolt NJ, Pferschy PN, Aberer F, Schlenke P, Kleinhappl B, Stradner M, Sareban N, Moritz M, Dominguez‐Villar M, Oliver N, Steinmetz I, Sourij H. Severe acute respiratory syndrome coronavirus 2 spike antibody level decline is more pronounced after the second vaccination, but response to the third vaccination is similar in people with type 1 and type 2 diabetes compared with healthy controls: The prospective COVAC-DM cohort study. Diabetes Obes Metab 2023; 25:314-318. [PMID: 36057945 PMCID: PMC9538806 DOI: 10.1111/dom.14855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/16/2022] [Accepted: 08/29/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Caren Sourij
- Division of CardiologyMedical University of GrazGrazAustria
- Interdisciplinary Metabolic Medicine Trials UnitMedical University of GrazGrazAustria
| | - Faisal Aziz
- Interdisciplinary Metabolic Medicine Trials UnitMedical University of GrazGrazAustria
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Harald Kojzar
- Interdisciplinary Metabolic Medicine Trials UnitMedical University of GrazGrazAustria
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Anna M. Obermayer
- Interdisciplinary Metabolic Medicine Trials UnitMedical University of GrazGrazAustria
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Christoph Sternad
- Interdisciplinary Metabolic Medicine Trials UnitMedical University of GrazGrazAustria
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Alexander Müller
- Interdisciplinary Metabolic Medicine Trials UnitMedical University of GrazGrazAustria
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Norbert J. Tripolt
- Interdisciplinary Metabolic Medicine Trials UnitMedical University of GrazGrazAustria
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Peter N. Pferschy
- Interdisciplinary Metabolic Medicine Trials UnitMedical University of GrazGrazAustria
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
- Centre for Biomarker Research in Medicine (CBmed)GrazAustria
| | - Felix Aberer
- Interdisciplinary Metabolic Medicine Trials UnitMedical University of GrazGrazAustria
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Peter Schlenke
- Department of Blood Group Serology and Transfusion MedicineMedical University of GrazGrazAustria
| | - Barbara Kleinhappl
- Institute of Hygiene, Microbiology and Environmental MedicineMedical University of GrazGrazAustria
| | - Martin Stradner
- Division of Rheumatology and ImmunologyMedical University of GrazGrazAustria
| | - Nazanin Sareban
- Department of Blood Group Serology and Transfusion MedicineMedical University of GrazGrazAustria
| | - Martina Moritz
- Department of Blood Group Serology and Transfusion MedicineMedical University of GrazGrazAustria
| | | | - Nick Oliver
- Department of Metabolism, Digestion and ReproductionImperial CollegeLondonUK
| | - Ivo Steinmetz
- Institute of Hygiene, Microbiology and Environmental MedicineMedical University of GrazGrazAustria
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials UnitMedical University of GrazGrazAustria
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
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12
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Paar M, Aziz F, Sourij C, Tripolt NJ, Kojzar H, Müller A, Pferschy P, Obermayer A, Banfic T, Di Geronimo Quintero B, Goswami N, Schlagenhauf A, Köstenberger M, Bärnthaler T, Wagner T, Hrzenjak A, Wonisch W, Reibnegger G, Raggam RB, Sourij H, Cvirn G. Only Subclinical Alterations in the Haemostatic System of People with Diabetes after COVID-19 Vaccination. Viruses 2022; 15:10. [PMID: 36680051 PMCID: PMC9867445 DOI: 10.3390/v15010010] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
People with diabetes have an increased risk of experiencing adverse COVID-19 outcomes. COVID-19 vaccination is, therefore, highly recommended. However, people with diabetes have an inherently elevated risk of thrombotic events and the impact of the vaccination on the coagulation system in this patient population remains to be elucidated. The aim of this study was to investigate the impact of COVID-19 vaccination on the haemostatic system in people with type 1 or type 2 diabetes. We evaluated the effects of COVID-19 vaccination (BioNTech Pfizer, Moderna, AstraZeneca) on standard coagulation parameters, whole blood coagulation (Thrombelastometry), platelet function (impedance aggregation), and thrombin generation (calibrated automated thrombography) in people with type 1 diabetes mellitus (n = 41) and type 2 diabetes mellitus (n = 37). Blood sampling points were prior to vaccination and two weeks after the respective vaccination. Thrombelastometry measurements indicated moderately increased clot formation post-vaccination in people with type 1, as well as with type 2, diabetes: "Clot formation times" were significantly shorter, and both "maximum clot firmness" and "alpha angles" were significantly higher, as compared to the respective pre-vaccination values. Therefore, TEM parameters were not altered after vaccination in patients receiving ASA. Moreover, platelet aggregation was enhanced in people with type 1 diabetes, and plasma levels of D-Dimer were increased in people with type 2 diabetes, following COVID-19 vaccination. All other standard coagulation parameters, as well as thrombin generation, were not affected by the vaccination. The coagulation responses of people with diabetes to COVID-19 vaccination were only subclinical and comparable to those observed in healthy individuals. Our findings suggest that people with diabetes do not face an increased activation of the coagulation post-vaccination.
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Affiliation(s)
- Margret Paar
- Division of Medicinal Chemistry, Otto Loewi Research Centre for Vascular Biology, Immunology and Inflammation, Medical University of Graz, 8010 Graz, Austria
| | - Faisal Aziz
- Division of Endocrinology and Diabetology, Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, 8010 Graz, Austria
| | - Caren Sourij
- Division of Cardiology, Medical University of Graz, 8010 Graz, Austria
| | - Norbert J. Tripolt
- Division of Endocrinology and Diabetology, Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, 8010 Graz, Austria
| | - Harald Kojzar
- Division of Endocrinology and Diabetology, Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, 8010 Graz, Austria
| | - Alexander Müller
- Division of Endocrinology and Diabetology, Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, 8010 Graz, Austria
| | - Peter Pferschy
- Division of Endocrinology and Diabetology, Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, 8010 Graz, Austria
| | - Anna Obermayer
- Division of Endocrinology and Diabetology, Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, 8010 Graz, Austria
| | - Tamara Banfic
- Division of Endocrinology and Diabetology, Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, 8010 Graz, Austria
| | - Bruno Di Geronimo Quintero
- Division of Medicinal Chemistry, Otto Loewi Research Centre for Vascular Biology, Immunology and Inflammation, Medical University of Graz, 8010 Graz, Austria
| | - Nandu Goswami
- Division of Physiology, Otto Loewi Research Centre for Vascular Biology, Immunology and Inflammation, Medical University of Graz, 8010 Graz, Austria
| | - Axel Schlagenhauf
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, 8010 Graz, Austria
| | - Martin Köstenberger
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, 8010 Graz, Austria
| | - Thomas Bärnthaler
- Division of Pharmacology, Otto Loewi Research Centre for Vascular Biology, Immunology and Inflammation, Medical University of Graz, 8010 Graz, Austria
| | - Thomas Wagner
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, 8010 Graz, Austria
| | - Andelko Hrzenjak
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, 8010 Graz, Austria
| | - Willibald Wonisch
- Division of Medicinal Chemistry, Otto Loewi Research Centre for Vascular Biology, Immunology and Inflammation, Medical University of Graz, 8010 Graz, Austria
| | - Gilbert Reibnegger
- Division of Medicinal Chemistry, Otto Loewi Research Centre for Vascular Biology, Immunology and Inflammation, Medical University of Graz, 8010 Graz, Austria
| | | | - Harald Sourij
- Division of Endocrinology and Diabetology, Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, 8010 Graz, Austria
| | - Gerhard Cvirn
- Division of Medicinal Chemistry, Otto Loewi Research Centre for Vascular Biology, Immunology and Inflammation, Medical University of Graz, 8010 Graz, Austria
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13
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Obermayer A, Tripolt NJ, Pferschy PN, Kojzar H, Jacan A, Schauer M, Aziz F, Oulhaj A, Aberer F, Sourij C, Obermayer‐Pietsch B, Stadlbauer V, Sourij H. INTERmittent FASTing in people with insulin-treated type 2 diabetes mellitus - the INTERFAST-2 study protocol. Diabet Med 2022; 39:e14813. [PMID: 35179802 PMCID: PMC9304224 DOI: 10.1111/dme.14813] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 02/07/2022] [Accepted: 02/16/2022] [Indexed: 12/04/2022]
Abstract
AIM Intermittent fasting, a dietary intervention of alternate eating and fasting, has gained popularity in people trying to lose weight. Intermittent fasting could provide an alternative to classic caloric restriction in people with type 2 diabetes mellitus. The aim of the study is to determine the impact of a 12-week intermittent fasting regimen compared with usual care in people with type 2 diabetes mellitus receiving insulin therapy. METHODS This open, single-centre, randomized controlled trial investigates participants with type 2 diabetes mellitus on insulin therapy and a glycated haemoglobin A1c (HbA1c) of ≥53 mmol/mol (≥7.0%) and a minimum insulin dose of 0.3 IU/kg body weight per day. Participants are randomized in a 1:1 ratio to either 12 weeks of intermittent fasting or the standard care group. All participants receive dietary counselling, continuous glucose monitoring, measurement of the resting metabolic rate, an oral glucose tolerance test, body composition measurement via dual-energy X-ray absorptiometry and stool samples for microbiome analyses at the beginning and at the end of the intervention. Two co-primary outcomes (analysed in hierarchical order) were chosen for the study: (i) the difference in the change of HbA1c from baseline to 12 weeks and (ii) the difference in the number of participants achieving a combined end point encompassing a body weight reduction of at least 2%, an insulin dose reduction of at least 10% and an absolute HbA1c reduction of at least 3 mmol/mol (0.3%) between the two groups.
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Affiliation(s)
- Anna Obermayer
- Interdisciplinary Metabolic Medicine Trials UnitDivision of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Norbert J. Tripolt
- Interdisciplinary Metabolic Medicine Trials UnitDivision of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Peter N. Pferschy
- Interdisciplinary Metabolic Medicine Trials UnitDivision of Endocrinology and DiabetologyMedical University of GrazGrazAustria
- CBmed – Center for Biomarker Research in MedicineGrazAustria
| | - Harald Kojzar
- Interdisciplinary Metabolic Medicine Trials UnitDivision of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Angela Jacan
- CBmed – Center for Biomarker Research in MedicineGrazAustria
| | - Markus Schauer
- Interdisciplinary Metabolic Medicine Trials UnitDivision of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Faisal Aziz
- Interdisciplinary Metabolic Medicine Trials UnitDivision of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Abderrahim Oulhaj
- Department of Epidemiology and Public HealthCollege of Medicine and Health SciencesKhalifa UniversityAbu DhabiUAE
- Institute of Public HealthCollege of Medicine and Health SciencesUnited Arab Emirates UniversityAl AinUAE
| | - Felix Aberer
- Interdisciplinary Metabolic Medicine Trials UnitDivision of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Caren Sourij
- Division of CardiologyMedical University of GrazGrazAustria
| | - Barbara Obermayer‐Pietsch
- Endocrinology Lab PlatformDivision of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Vanessa Stadlbauer
- CBmed – Center for Biomarker Research in MedicineGrazAustria
- Division of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials UnitDivision of Endocrinology and DiabetologyMedical University of GrazGrazAustria
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14
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Eyileten C, Wicik Z, Keshwani D, Aziz F, Aberer F, Pferschy PN, Tripolt NJ, Sourij C, Prietl B, Prüller F, von Lewinski D, De Rosa S, Siller-Matula JM, Postula M, Sourij H. Alteration of circulating platelet-related and diabetes-related microRNAs in individuals with type 2 diabetes mellitus: a stepwise hypoglycaemic clamp study. Cardiovasc Diabetol 2022; 21:79. [PMID: 35596173 PMCID: PMC9123651 DOI: 10.1186/s12933-022-01517-5] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In patients with type 2 diabetes mellitus (T2DM) an association between severe hypoglycaemic episodes and the risk of cardiovascular (CV) morbidity and mortality has been previously established. METHODS We aimed to investigate the influence of hypoglycaemia on several diabetes-related and platelet-related miRNAs selected based on bioinformatic analysis and literature search, including hsa-miR-16, hsa-miR-34a, hsa-miR-129-2, hsa-miR-15a, hsa-miR-15b, hsa-miR-106a, miR-223, miR-126. Selected miRNAs were validated by qRT-PCR in 14 patients with T2DM on metformin monotherapy, without established CV disease and antiplatelet therapy during a stepwise hypoglycaemic clamp experiment and a follow-up 7 days after the clamp event. In order to identify which pathways and phenotypes are associated with validated miRNAs we performed target prediction on genes expressed with high confidence in platelets. RESULTS Circulating levels of miR-106a-5p, miR-15b, miR-15a, miR-16-5p, miR-223 and miR-126 were increased after euglycaemic clamp followed by hypoglycaemic clamp, each with its distinctive time trend. On the contrary, miR-129-2-3p, miR-92a-3p and miR-34a-3p remained unchanged. MiR-16-5p was negatively correlated with interleukin (IL)-6, intercellular adhesion molecule (ICAM) and vascular cell adhesion molecule (VCAM) (p = 0.002, p < 0.001, p = 0.016, respectively), whereas miR-126 was positively correlated with VCAM (p < 0.001). There were negative correlations between miR-16-5p, miR-126 and coagulation factors, including factor VIII and von Willebrand factor (vWF). Among all studied miRNAs, miR-126, miR-129-2-3p and miR-15b showed correlation with platelet function. Bioinformatic analysis of platelet-related targets of analyzed miRNAs showed strong enrichment of IL-2 signaling. We also observed significant enrichment of pathways and diseases related to cancer, CV diseases, hyperglycemia, and neurological diseases. CONCLUSIONS Hypoglycaemia can significantly influence the expression of platelet-enriched miRNAs, with a time trend paralleling the time course of platelet activation. This suggests miRNAs could be exploited as biomarkers for platelet activation in response to hypoglycaemia, as they are probably released by platelets upon activation by hypoglycaemic episodes. Should they hold their promise in clinical endpoint studies, platelet-derived miRNAs might become helpful markers of CV risk in subjects with diabetes. Trial registration The study was registered at clinical trials.gov; Impact of Hypoglycaemia in Patients With DIAbetes Mellitus Type 2 on PLATElet Activation (Diaplate), trial number: NCT03460899.
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Affiliation(s)
- Ceren Eyileten
- Department of Experimental and Clinical Pharmacology, Center for Preclinical Research and Technology CEPT, Medical University of Warsaw, Banacha 1B str., 02-097, Warsaw, Poland.,Genomics Core Facility, Center of New Technologies (CeNT), University of Warsaw, Warsaw, Poland
| | - Zofia Wicik
- Department of Experimental and Clinical Pharmacology, Center for Preclinical Research and Technology CEPT, Medical University of Warsaw, Banacha 1B str., 02-097, Warsaw, Poland
| | - Disha Keshwani
- Department of Experimental and Clinical Pharmacology, Center for Preclinical Research and Technology CEPT, Medical University of Warsaw, Banacha 1B str., 02-097, Warsaw, Poland
| | - Faisal Aziz
- Division of Endocrinology and Diabetology, Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria.,Center for Biomarker Research in Medicine, CBmed, Graz, Austria
| | - Felix Aberer
- Division of Endocrinology and Diabetology, Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Peter N Pferschy
- Division of Endocrinology and Diabetology, Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria.,Center for Biomarker Research in Medicine, CBmed, Graz, Austria
| | - Norbert J Tripolt
- Division of Endocrinology and Diabetology, Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Caren Sourij
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Barbara Prietl
- Center for Biomarker Research in Medicine, CBmed, Graz, Austria
| | - Florian Prüller
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Dirk von Lewinski
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Jolanta M Siller-Matula
- Department of Experimental and Clinical Pharmacology, Center for Preclinical Research and Technology CEPT, Medical University of Warsaw, Banacha 1B str., 02-097, Warsaw, Poland.,Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Marek Postula
- Department of Experimental and Clinical Pharmacology, Center for Preclinical Research and Technology CEPT, Medical University of Warsaw, Banacha 1B str., 02-097, Warsaw, Poland.
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
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15
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Sourij C, Tripolt NJ, Aziz F, Aberer F, Forstner P, Obermayer AM, Kojzar H, Kleinhappl B, Pferschy PN, Mader JK, Cvirn G, Goswami N, Wachsmuth N, Eckstein ML, Müller A, Abbas F, Lenz J, Steinberger M, Knoll L, Krause R, Stradner M, Schlenke P, Sareban N, Prietl B, Kaser S, Moser O, Steinmetz I, Sourij H. Humoral immune response to COVID-19 vaccination in diabetes is age-dependent but independent of type of diabetes and glycaemic control: The prospective COVAC-DM cohort study. Diabetes Obes Metab 2022; 24:849-858. [PMID: 34984802 PMCID: PMC9303917 DOI: 10.1111/dom.14643] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/11/2021] [Accepted: 01/01/2022] [Indexed: 01/08/2023]
Abstract
AIMS To investigate the seroconversion following first and second COVID-19 vaccination in people with type 1 and type 2 diabetes in relation to glycaemic control prior to vaccination and to analyse the response in comparison to individuals without diabetes. MATERIALS AND METHODS This prospective, multicentre cohort study analysed people with type 1 and type 2 diabetes and a glycated haemoglobin level ≤58 mmol/mol (7.5%) or >58 mmol/mol (7.5%), respectively, and healthy controls. Roche's Elecsys anti-SARS-CoV-2 S immunoassay targeting the receptor-binding domain was used to quantify anti-spike protein antibodies 7 to 14 days after the first and 14 to 21 days after the second vaccination. RESULTS A total of 86 healthy controls were enrolled in the study, as well as 161 participants with diabetes, of whom 150 (75 with type 1 diabetes and 75 with type 2 diabetes) were eligible for the analysis. After the first vaccination, only 52.7% of participants in the type 1 diabetes group and 48.0% of those in the type 2 diabetes group showed antibody levels above the cut-off for positivity. Antibody levels after the second vaccination were similar in participants with type 1 diabetes, participants with type 2 diabetes and healthy controls after adjusting for age, sex and multiple testing (P > 0.05). Age (r = -0.45, P < 0.001) and glomerular filtration rate (r = 0.28, P = 0.001) were significantly associated with antibody response. CONCLUSIONS Anti-SARS-CoV-2 S receptor-binding domain antibody levels after the second vaccination were comparable in healthy controls and in participants with type 1 and type 2 diabetes, irrespective of glycaemic control. Age and renal function correlated significantly with the extent of antibody levels.
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Affiliation(s)
- Caren Sourij
- Division of CardiologyMedical University of GrazGrazAustria
| | - Norbert J. Tripolt
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Faisal Aziz
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Felix Aberer
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental MedicineMedical University of GrazGrazAustria
| | | | - Anna M. Obermayer
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Harald Kojzar
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | | | - Peter N. Pferschy
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Julia K. Mader
- Division of Physiological ChemistryMedical University of GrazGrazAustria
| | - Gerhard Cvirn
- Division of Physiology, Otto Loewi Research CenterMedical University of GrazGrazAustria
| | - Nandu Goswami
- Division of Exercise Physiology and MetabolismInstitute of Sport ScienceBayreuthGermany
| | - Nadine Wachsmuth
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental MedicineMedical University of GrazGrazAustria
| | - Max L. Eckstein
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental MedicineMedical University of GrazGrazAustria
| | - Alexander Müller
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Farah Abbas
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Jacqueline Lenz
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Michaela Steinberger
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Lisa Knoll
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Robert Krause
- Division for Infectious DiseasesMedical University of GrazGrazAustria
| | - Martin Stradner
- Division of Rheumatology and ImmunologyMedical University of GrazGrazAustria
| | - Peter Schlenke
- Department of Blood Group Serology and Transfusion MedicineMedical University of GrazGrazAustria
| | - Nazanin Sareban
- Department of Blood Group Serology and Transfusion MedicineMedical University of GrazGrazAustria
| | - Barbara Prietl
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Susanne Kaser
- Department for Internal Medicine IMedical University of InnsbruckInnsbruckAustria
| | - Othmar Moser
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental MedicineMedical University of GrazGrazAustria
| | - Ivo Steinmetz
- Center for Biomarker Research in Medicine (CBmed)GrazAustria
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
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16
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Aziz F, Reisinger AC, Aberer F, Sourij C, Tripolt N, Siller-Matula JM, von-Lewinski D, Eller P, Kaser S, Sourij H. Simplified Acute Physiology Score 3 Performance in Austrian COVID-19 Patients Admitted to Intensive Care Units with and without Diabetes. Viruses 2022; 14:v14040777. [PMID: 35458507 PMCID: PMC9025097 DOI: 10.3390/v14040777] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 03/29/2022] [Accepted: 04/06/2022] [Indexed: 02/01/2023] Open
Abstract
This study evaluated and compared the performance of simplified acute physiology score 3 (SAPS 3) for predicting in-hospital mortality in COVID-19 patients admitted to intensive care units (ICUs) with and without diabetes in Austria. The Austrian national public health institute (GÖG) data of COVID-19 patients admitted to ICUs (n = 5850) were analyzed. Three versions of SAPS 3 were used: standard equation, Central European equation, and Austrian equation customized for COVID-19 patients. The observed in-hospital mortality was 38.9%, 42.9%, and 37.3% in all, diabetes, and non-diabetes patients, respectively. The overall C-statistics was 0.69 with an insignificant (p = 0.193) difference between diabetes (0.70) and non-diabetes (0.68) patients. The Brier score was > 0.20 for all SAPS 3 equations in all cohorts. Calibration was unsatisfactory for both standard and Central European equations in all cohorts, whereas it was satisfactory for the Austrian equation in diabetes patients only. The SAPS 3 score demonstrated low discrimination and accuracy in Austrian COVID-19 patients, with an insignificant difference between diabetes and non-diabetes. All equations were miscalibrated particularly in non-diabetes patients, while the Austrian equation showed satisfactory calibration in diabetes patients only. Both uncalibrated and calibrated versions of SAPS 3 should be used with caution in COVID-19 patients.
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Affiliation(s)
- Faisal Aziz
- Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria
| | | | - Felix Aberer
- Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria
| | - Caren Sourij
- Division of Cardiology, Medical University of Graz, 8036 Graz, Austria
| | - Norbert Tripolt
- Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria
| | - Jolanta M Siller-Matula
- Division of Cardiology, Medical University of Vienna, AKH, 1090 Vienna, Austria
- Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharmacology, University of Warsaw, 02-672 Warsaw, Poland
| | - Dirk von-Lewinski
- Division of Cardiology, Medical University of Graz, 8036 Graz, Austria
| | - Philipp Eller
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Susanne Kaser
- Department of Internal Medicine I, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria
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17
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Aberer F, Moser O, Aziz F, Sourij C, Ziko H, Lenz J, Abbas F, Obermayer AM, Kojzar H, Pferschy PN, Müller A, Unteregger C, Leitner M, Banfic T, Eckstein ML, Wachsmuth N, Kaser S, Mader JK, Tripolt NJ, Sourij H. Impact of COVID-19 Vaccination on Glycemia in Individuals With Type 1 and Type 2 Diabetes: Substudy of the COVAC-DM Study. Diabetes Care 2022; 45:e24-e26. [PMID: 34848490 DOI: 10.2337/dc21-1563] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/01/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Felix Aberer
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.,Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Othmar Moser
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria.,Department of Exercise Physiology & Metabolism, Institute of Sports Science, University of Bayreuth, Bayreuth, Germany
| | - Faisal Aziz
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.,Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Caren Sourij
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Haris Ziko
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Jacqueline Lenz
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.,Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Farah Abbas
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.,Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Anna M Obermayer
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.,Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Harald Kojzar
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.,Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Peter N Pferschy
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.,Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria.,Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Alexander Müller
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.,Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Christina Unteregger
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.,Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Marlies Leitner
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.,Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Tamara Banfic
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.,Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Max L Eckstein
- Department of Exercise Physiology & Metabolism, Institute of Sports Science, University of Bayreuth, Bayreuth, Germany
| | - Nadine Wachsmuth
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.,Department of Exercise Physiology & Metabolism, Institute of Sports Science, University of Bayreuth, Bayreuth, Germany
| | | | - Julia K Mader
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Norbert J Tripolt
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.,Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.,Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
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18
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Aziz F, Aberer F, Bräuer A, Ciardi C, Clodi M, Fasching P, Karolyi M, Kautzky-Willer A, Klammer C, Malle O, Pawelka E, Pieber T, Peric S, Ress C, Schranz M, Sourij C, Stechemesser L, Stingl H, Stöcher H, Stulnig T, Tripolt N, Wagner M, Wolf P, Zitterl A, Reisinger AC, Siller-Matula J, Hummer M, Moser O, von-Lewinski D, Eller P, Kaser S, Sourij H. COVID-19 In-Hospital Mortality in People with Diabetes Is Driven by Comorbidities and Age-Propensity Score-Matched Analysis of Austrian National Public Health Institute Data. Viruses 2021; 13:v13122401. [PMID: 34960670 PMCID: PMC8705658 DOI: 10.3390/v13122401] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/22/2021] [Accepted: 11/27/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND It is a matter of debate whether diabetes alone or its associated comorbidities are responsible for severe COVID-19 outcomes. This study assessed the impact of diabetes on intensive care unit (ICU) admission and in-hospital mortality in hospitalized COVID-19 patients. METHODS A retrospective analysis was performed on a countrywide cohort of 40,632 COVID-19 patients hospitalized between March 2020 and March 2021. Data were provided by the Austrian data platform. The association of diabetes with outcomes was assessed using unmatched and propensity-score matched (PSM) logistic regression. RESULTS 12.2% of patients had diabetes, 14.5% were admitted to the ICU, and 16.2% died in the hospital. Unmatched logistic regression analysis showed a significant association of diabetes (odds ratio [OR]: 1.24, 95% confidence interval [CI]: 1.15-1.34, p < 0.001) with in-hospital mortality, whereas PSM analysis showed no significant association of diabetes with in-hospital mortality (OR: 1.08, 95%CI: 0.97-1.19, p = 0.146). Diabetes was associated with higher odds of ICU admissions in both unmatched (OR: 1.36, 95%CI: 1.25-1.47, p < 0.001) and PSM analysis (OR: 1.15, 95%CI: 1.04-1.28, p = 0.009). CONCLUSIONS People with diabetes were more likely to be admitted to ICU compared to those without diabetes. However, advanced age and comorbidities rather than diabetes itself were associated with increased in-hospital mortality in COVID-19 patients.
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Affiliation(s)
- Faisal Aziz
- Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (F.A.); (F.A.); (O.M.); (H.S.); (N.T.)
| | - Felix Aberer
- Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (F.A.); (F.A.); (O.M.); (H.S.); (N.T.)
| | - Alexander Bräuer
- Medical Division of Endocrinology, Rheumatology and Acute Geriatrics, Hospital Ottakring, 1160 Vienna, Austria; (A.B.); (P.F.)
| | - Christian Ciardi
- Clinical Division for Internal Medicine, Endocrinology, Diabetology and Metabolic Diseases, St. Vinzenz Hospital Zams, 6511 Zams, Austria;
| | - Martin Clodi
- Clinical Division for Internal Medicine, Konvent Hospital Barmherzige Brüder Linz, 4020 Linz, Austria; (M.C.); (C.K.)
| | - Peter Fasching
- Medical Division of Endocrinology, Rheumatology and Acute Geriatrics, Hospital Ottakring, 1160 Vienna, Austria; (A.B.); (P.F.)
| | - Mario Karolyi
- 4th Medical Division with Infectiology, SMZ Süd—KFJ-Hospital Vienna, 1100 Vienna, Austria; (M.K.); (E.P.)
| | - Alexandra Kautzky-Willer
- Division for Endocrinology and Metabolism, Medical University of Vienna, AKH, 1090 Vienna, Austria; (A.K.-W.); (P.W.)
| | - Carmen Klammer
- Clinical Division for Internal Medicine, Konvent Hospital Barmherzige Brüder Linz, 4020 Linz, Austria; (M.C.); (C.K.)
| | - Oliver Malle
- Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (F.A.); (F.A.); (O.M.); (H.S.); (N.T.)
| | - Erich Pawelka
- 4th Medical Division with Infectiology, SMZ Süd—KFJ-Hospital Vienna, 1100 Vienna, Austria; (M.K.); (E.P.)
| | - Thomas Pieber
- Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria;
| | - Slobodan Peric
- Department of Medicine III and Karl Landsteiner, Institute for Metabolic Diseases and Nephrology, Clinic Hietzing, Vienna Health Care Group, 1130 Vienna, Austria; (S.P.); (T.S.); (A.Z.)
| | - Claudia Ress
- Department for Internal Medicine I, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Michael Schranz
- Department for Inner Medicine, Paracelsus-Private Medical University, 5020 Salzburg, Austria; (M.S.); (L.S.)
| | - Caren Sourij
- Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (C.S.); (D.v.-L.)
| | - Lars Stechemesser
- Department for Inner Medicine, Paracelsus-Private Medical University, 5020 Salzburg, Austria; (M.S.); (L.S.)
| | - Harald Stingl
- Clinical Division for Internal Medicine, Hospital Melk, 3390 Melk, Austria; (H.S.); (M.W.)
| | - Hannah Stöcher
- Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (F.A.); (F.A.); (O.M.); (H.S.); (N.T.)
| | - Thomas Stulnig
- Department of Medicine III and Karl Landsteiner, Institute for Metabolic Diseases and Nephrology, Clinic Hietzing, Vienna Health Care Group, 1130 Vienna, Austria; (S.P.); (T.S.); (A.Z.)
| | - Norbert Tripolt
- Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (F.A.); (F.A.); (O.M.); (H.S.); (N.T.)
| | - Michael Wagner
- Clinical Division for Internal Medicine, Hospital Melk, 3390 Melk, Austria; (H.S.); (M.W.)
| | - Peter Wolf
- Division for Endocrinology and Metabolism, Medical University of Vienna, AKH, 1090 Vienna, Austria; (A.K.-W.); (P.W.)
| | - Andreas Zitterl
- Department of Medicine III and Karl Landsteiner, Institute for Metabolic Diseases and Nephrology, Clinic Hietzing, Vienna Health Care Group, 1130 Vienna, Austria; (S.P.); (T.S.); (A.Z.)
| | - Alexander Christian Reisinger
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (A.C.R.); (P.E.)
| | | | - Michael Hummer
- Austrian National Public Health Institute, 1010 Vienna, Austria;
| | - Othmar Moser
- Department of Exercise Physiology & Metabolism, Institute of Sports Science, University of Bayreuth, 95445 Bayreuth, Germany;
| | - Dirk von-Lewinski
- Division of Cardiology, Medical University of Graz, 8036 Graz, Austria; (C.S.); (D.v.-L.)
| | - Philipp Eller
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (A.C.R.); (P.E.)
| | - Susanne Kaser
- Department for Internal Medicine I, Medical University of Innsbruck, 6020 Innsbruck, Austria;
- Correspondence: (S.K.); (H.S.); Tel.: +43-512-504-81407 (S.K.); +43-316-385-81310 (H.S.)
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (F.A.); (F.A.); (O.M.); (H.S.); (N.T.)
- Correspondence: (S.K.); (H.S.); Tel.: +43-512-504-81407 (S.K.); +43-316-385-81310 (H.S.)
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Eckstein ML, Moser O, Tripolt NJ, Pferschy PN, Obermayer AAM, Kojzar H, Mueller A, Abbas F, Sourij C, Sourij H. Rapid glucose rise reduces heart rate variability in adults with type 1 diabetes: A prospective secondary outcome analysis. Diabetes Obes Metab 2021; 23:1681-1684. [PMID: 33283963 PMCID: PMC8247286 DOI: 10.1111/dom.14287] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/10/2020] [Accepted: 11/28/2020] [Indexed: 01/24/2023]
Abstract
To investigate differences in heart rate variability (HRV) during oral glucose tolerance tests (OGTTs) in response to the rate of change in glucose and to different glycaemic ranges in individuals with type 1 diabetes. This was a single-centre, prospective, secondary outcome analysis in 17 individuals with type 1 diabetes (glycated haemoglobin 53 ± 6.3 mmol/L), who underwent two OGTTs (after 12 and 36 hours of fasting) investigating differences in HRV in response to rapid glucose increases/decreases and different glycaemic ranges during OGTT. Based on the rate of change in glucose level, the variables heart rate (P < 0.001), square root of the mean standard difference of successive R-R intervals (P = 0.002), percentage of pairs of R-R intervals with >50 ms difference (P < 0.001) and corrected QT interval (P = 0.04) were significantly altered, with HRV particularly reduced during episodes of rapid glucose rises. Glycaemic ranges during OGTT had no impact on HRV (P < 0.05). Individuals with type 1 diabetes showed no changes in HRV in response to different glycaemic ranges. HRV was dependent on the rate of change in glucose, especially rapid increases in glucose level.
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Affiliation(s)
- Max L. Eckstein
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
- Division of Exercise Physiology and Metabolism, Department of Sport ScienceUniversity of BayreuthBayreuthGermany
| | - Othmar Moser
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
- Division of Exercise Physiology and Metabolism, Department of Sport ScienceUniversity of BayreuthBayreuthGermany
| | - Norbert J. Tripolt
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Peter N. Pferschy
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Anna A. M. Obermayer
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Harald Kojzar
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Alexander Mueller
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
- Exercise Physiology, Training & Training Therapy Research Group, Institute of Sports ScienceUniversity of GrazGrazAustria
| | - Farah Abbas
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Caren Sourij
- Division of Cardiology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Harald Sourij
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
- Center for Biomarker Research in Medicine, CBmedGrazAustria
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Obermayer A, Tripolt NJ, Aziz F, Högenauer C, Aberer F, Schreiber F, Eherer A, Sourij C, Stadlbauer V, Svehlikova E, Brunner M, Goswami N, Kojzar H, Pferschy PN, Pieber TR, Sourij H. EndoBarrier™ Implantation Rapidly Improves Insulin Sensitivity in Obese Individuals with Type 2 Diabetes Mellitus. Biomolecules 2021; 11:biom11040574. [PMID: 33919949 PMCID: PMC8070956 DOI: 10.3390/biom11040574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/05/2021] [Accepted: 04/12/2021] [Indexed: 12/16/2022] Open
Abstract
The EndoBarrier™ medical device is a duodenal-jejunal bypass liner designed to mimic the effects of gastric bypass surgery to induce weight loss and glycaemic improvement. In this study, 10 participants with type 2 diabetes mellitus (T2DM), a mean body mass index (BMI) of 43.3 ± 5.0 (kg/m2) and a mean glycated haemoglobin A1c (HbA1c) of 60.6 ± 8.6 mmol/mol were examined at baseline (before implantation of EndoBarrier™), 4 weeks after implantation, at 36 weeks (right before explantation) and 24 weeks after the removal of the device to explore the short and long-term effects on glucose metabolism. Besides a significant reduction in body weight and fat mass, EndoBarrier™ treatment significantly improved insulin sensitivity during Botnia clamp investigations after four weeks of implantation. The beneficial effects decreased over time but remained significant 24 weeks after removal of the device.
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Affiliation(s)
- Anna Obermayer
- Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria; (A.O.); (N.J.T.); (F.A.); (F.A.); (E.S.); (M.B.); (H.K.); (P.N.P.); (T.R.P.)
| | - Norbert J. Tripolt
- Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria; (A.O.); (N.J.T.); (F.A.); (F.A.); (E.S.); (M.B.); (H.K.); (P.N.P.); (T.R.P.)
| | - Faisal Aziz
- Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria; (A.O.); (N.J.T.); (F.A.); (F.A.); (E.S.); (M.B.); (H.K.); (P.N.P.); (T.R.P.)
| | - Christoph Högenauer
- Division of Gastroenterology and Hepatology, Medical University of Graz, 8010 Graz, Austria; (C.H.); (F.S.); (A.E.); (V.S.)
| | - Felix Aberer
- Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria; (A.O.); (N.J.T.); (F.A.); (F.A.); (E.S.); (M.B.); (H.K.); (P.N.P.); (T.R.P.)
| | - Florian Schreiber
- Division of Gastroenterology and Hepatology, Medical University of Graz, 8010 Graz, Austria; (C.H.); (F.S.); (A.E.); (V.S.)
| | - Andreas Eherer
- Division of Gastroenterology and Hepatology, Medical University of Graz, 8010 Graz, Austria; (C.H.); (F.S.); (A.E.); (V.S.)
| | - Caren Sourij
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, 8010 Graz, Austria;
| | - Vanessa Stadlbauer
- Division of Gastroenterology and Hepatology, Medical University of Graz, 8010 Graz, Austria; (C.H.); (F.S.); (A.E.); (V.S.)
- CBmed—Center for Biomarker Research in Medicine, 8010 Graz, Austria
| | - Eva Svehlikova
- Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria; (A.O.); (N.J.T.); (F.A.); (F.A.); (E.S.); (M.B.); (H.K.); (P.N.P.); (T.R.P.)
- CRC—Clinical Research Center, Medical University of Graz, 8010 Graz, Austria
| | - Martina Brunner
- Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria; (A.O.); (N.J.T.); (F.A.); (F.A.); (E.S.); (M.B.); (H.K.); (P.N.P.); (T.R.P.)
- CRC—Clinical Research Center, Medical University of Graz, 8010 Graz, Austria
| | - Nandu Goswami
- Otto Loewi Research Centre, Physiology Division, Medical University of Graz, 8010 Graz, Austria;
| | - Harald Kojzar
- Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria; (A.O.); (N.J.T.); (F.A.); (F.A.); (E.S.); (M.B.); (H.K.); (P.N.P.); (T.R.P.)
| | - Peter N. Pferschy
- Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria; (A.O.); (N.J.T.); (F.A.); (F.A.); (E.S.); (M.B.); (H.K.); (P.N.P.); (T.R.P.)
- CBmed—Center for Biomarker Research in Medicine, 8010 Graz, Austria
| | - Thomas R. Pieber
- Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria; (A.O.); (N.J.T.); (F.A.); (F.A.); (E.S.); (M.B.); (H.K.); (P.N.P.); (T.R.P.)
- CBmed—Center for Biomarker Research in Medicine, 8010 Graz, Austria
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria; (A.O.); (N.J.T.); (F.A.); (F.A.); (E.S.); (M.B.); (H.K.); (P.N.P.); (T.R.P.)
- CBmed—Center for Biomarker Research in Medicine, 8010 Graz, Austria
- Correspondence:
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21
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Aziz F, Aberer F, Moser O, Sourij C, von Lewinski D, Kaser S, Reichardt B, Sourij H. Impact of comorbidities on mortality in hospitalized influenza patients with diabetes - Analysis of the Austrian Health Insurance. Diabetes Res Clin Pract 2021; 174:108758. [PMID: 33744375 DOI: 10.1016/j.diabres.2021.108758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/24/2020] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 01/21/2023]
Abstract
AIMS To assess the impact of characteristics and comorbidities on the hospitalization rate and 30- and 90-days all-cause mortality after hospitalization for influenza-related illness (IRI) in individuals with diabetes. METHODS Data of 507,184 individuals with diabetes enrolled in the national Austrian Health Insurance database during 2013-2017 were analyzed. Hospitalization for IRI was defined as per International Classification of Disease 10 codes (J09, J10, J11). All-cause mortality was calculated for 30- and 90-days post-hospitalization. RESULTS Of the total diabetes population, 1994 (0.4%) were hospitalized for IRI during 2013-2017. The rate of comorbidities was higher in individiuals who were hospitalized due to IRI as compared with the general diabetes population. Overall 30-days cumulative mortality following hospitalization for IRI was 7.9% and 90-days mortality was 10.3%. The risk (adjusted Hazard Ratio, 95% Confidence Interval) of IRI related 90-days mortality increased with age (50-59: 3.00, 0.65-13.94; 60-69: 4.16, 0.99-17.55; 70-79: 4.79, 1.16-19.76; 80+: 7.15, 1.74-29.46), heart failure (1.97, 1.31-2.98), renal disease (1.50, 1.05-2.14), and Charlson comorbidity index (1.14, 1.08-1.19). CONCLUSIONS Older age, heart failure, renal disease, and Charlson comorbidity index were significant predictors of mortality following hospitalization for IRI in individuals with diabetes. These findings could help in improving the clinical management and performance of surveillance and health systems concerning IRI in Austria.
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Affiliation(s)
- Faisal Aziz
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Felix Aberer
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Othmar Moser
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria; Division of Exercise Physiology and Metabolism, University of Bayreuth, Bayreuth, Germany
| | - Caren Sourij
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | | | - Susanne Kaser
- Department for Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.
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22
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Sourij H, Aziz F, Bräuer A, Ciardi C, Clodi M, Fasching P, Karolyi M, Kautzky‐Willer A, Klammer C, Malle O, Oulhaj A, Pawelka E, Peric S, Ress C, Sourij C, Stechemesser L, Stingl H, Stulnig T, Tripolt N, Wagner M, Wolf P, Zitterl A, Kaser S. COVID-19 fatality prediction in people with diabetes and prediabetes using a simple score upon hospital admission. Diabetes Obes Metab 2021; 23:589-598. [PMID: 33200501 PMCID: PMC7753560 DOI: 10.1111/dom.14256] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/02/2020] [Accepted: 11/11/2020] [Indexed: 01/05/2023]
Abstract
AIM To assess predictors of in-hospital mortality in people with prediabetes and diabetes hospitalized for COVID-19 infection and to develop a risk score for identifying those at the greatest risk of a fatal outcome. MATERIALS AND METHODS A combined prospective and retrospective, multicentre, cohort study was conducted at 10 sites in Austria in 247 people with diabetes or newly diagnosed prediabetes who were hospitalized with COVID-19. The primary outcome was in-hospital mortality and the predictor variables upon admission included clinical data, co-morbidities of diabetes or laboratory data. Logistic regression analyses were performed to identify significant predictors and to develop a risk score for in-hospital mortality. RESULTS The mean age of people hospitalized (n = 238) for COVID-19 was 71.1 ± 12.9 years, 63.6% were males, 75.6% had type 2 diabetes, 4.6% had type 1 diabetes and 19.8% had prediabetes. The mean duration of hospital stay was 18 ± 16 days, 23.9% required ventilation therapy and 24.4% died in the hospital. The mortality rate in people with diabetes was numerically higher (26.7%) compared with those with prediabetes (14.9%) but without statistical significance (P = .128). A score including age, arterial occlusive disease, C-reactive protein, estimated glomerular filtration rate and aspartate aminotransferase levels at admission predicted in-hospital mortality with a C-statistic of 0.889 (95% CI: 0.837-0.941) and calibration of 1.000 (P = .909). CONCLUSIONS The in-hospital mortality for COVID-19 was high in people with diabetes but not significantly different to the risk in people with prediabetes. A risk score using five routinely available patient variables showed excellent predictive performance for assessing in-hospital mortality.
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Affiliation(s)
- Harald Sourij
- Clinical Division for Endocrinology and DiabetologyMedical University GrazGrazAustria
- Center for Biomarker Research in Medicine (CBMed)GrazAustria
| | - Faisal Aziz
- Clinical Division for Endocrinology and DiabetologyMedical University GrazGrazAustria
- Center for Biomarker Research in Medicine (CBMed)GrazAustria
| | - Alexander Bräuer
- Medical Division for Endocrinology, Rheumatology and Acute GeriatricsWilhelminen Hospital ViennaViennaAustria
| | - Christian Ciardi
- Clinical Division for Internal Medicine, Endocrinology, Diabetology and Metabolic Diseases, St. Vinzenz Hospital ZamsZamsAustria
| | - Martin Clodi
- Clinical Division for Internal MedicineKonventhospital Barmherzige Brüder LinzLinzAustria
| | - Peter Fasching
- Medical Division for Endocrinology, Rheumatology and Acute GeriatricsWilhelminen Hospital ViennaViennaAustria
| | - Mario Karolyi
- 4 Medical Division with InfectiologySMZ Süd – KFJ‐Hospital ViennaViennaAustria
| | - Alexandra Kautzky‐Willer
- Clinical Division for Endocrinology and Diabetology and Metabolic DiseasesAKH ViennaViennaAustria
| | - Carmen Klammer
- Clinical Division for Internal MedicineKonventhospital Barmherzige Brüder LinzLinzAustria
| | - Oliver Malle
- Clinical Division for Endocrinology and DiabetologyMedical University GrazGrazAustria
| | - Abderrahim Oulhaj
- Institute of Public Health, College of Medicine and Health SciencesUnited Arab Emirates UniversityAl AinUnited Arab Emirates
| | - Erich Pawelka
- 4 Medical Division with InfectiologySMZ Süd – KFJ‐Hospital ViennaViennaAustria
| | - Slobodan Peric
- 3rd Department and Karl Landsteiner Institute for Metabolic Diseases and Nephrology, Clinic HietzingVienna Health Care GroupViennaAustria
| | - Claudia Ress
- Department for Internal Medicine IMedical University InnsbruckInnsbruckAustria
| | - Caren Sourij
- Clinical Division for CardiologyMedical University GrazGrazAustria
| | - Lars Stechemesser
- Department for Internal Medicine IParacelsus Medical UniversitySalzburgAustria
| | - Harald Stingl
- Clinical Division for Internal MedicineHospital MelkMelkAustria
| | - Thomas Stulnig
- 3rd Department and Karl Landsteiner Institute for Metabolic Diseases and Nephrology, Clinic HietzingVienna Health Care GroupViennaAustria
| | - Norbert Tripolt
- Clinical Division for Endocrinology and DiabetologyMedical University GrazGrazAustria
| | - Michael Wagner
- Clinical Division for Internal MedicineHospital MelkMelkAustria
| | - Peter Wolf
- Clinical Division for Endocrinology and Diabetology and Metabolic DiseasesAKH ViennaViennaAustria
| | - Andreas Zitterl
- 3rd Department and Karl Landsteiner Institute for Metabolic Diseases and Nephrology, Clinic HietzingVienna Health Care GroupViennaAustria
| | - Susanne Kaser
- Department for Internal Medicine IMedical University InnsbruckInnsbruckAustria
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Moser O, Eckstein ML, Mueller A, Tripolt NJ, Yildirim H, Abbas F, Pferschy PN, Goswami N, Aberer F, Obermayer A, Pieber TR, Kojzar H, Sourij C, Brunner M, Niedrist T, Herrmann M, Sourij H. Impact of a Single 36 Hours Prolonged Fasting Period in Adults With Type 1 Diabetes - A Cross-Over Controlled Trial. Front Endocrinol (Lausanne) 2021; 12:656346. [PMID: 34295305 PMCID: PMC8292020 DOI: 10.3389/fendo.2021.656346] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/21/2021] [Indexed: 12/16/2022] Open
Abstract
UNLABELLED Prolonged fasting has shown beneficial effects in healthy individuals and in people with chronic diseases. In type 1 diabetes, the effect or even the feasibility of fasting is unclear. We aimed to assess the impact and safety of prolonged fasting in adults with type 1 diabetes. Glycemia was assessed during overnight fasting (12 hours) vs. prolonged fasting (36 hours) via an intermittently-scanned continuous glucose monitoring system. Anthropometric data, metabolic and hormonal markers were compared between both trial arms. After each fasting period, a 75 g oral glucose tolerance test was performed and plasma glucose levels and hormones were assessed. Data were compared via paired t-tests and mixed-model regressions (p ≤ 0.05). Twenty individuals with type 1 diabetes (7 females) with a mean ± SD age of 35 ± 11 years, body mass index (BMI) 24.8 ± 2.8 kg/m2 and HbA1c 54 ± 7 mmol/mol were included. Hypoglycemia/hour (70 mg/dL; <3.9 mmol/L) was similar in both trial arms (12 hrs: 0.07 ± 0.06 vs. 36 hrs: 0.05 ± 0.03, p=0.21). Glycemic excursions during the oral glucose tolerance test were not different after the two fasting periods. Beta-hydroxybutyrate levels were higher after prolonged fasting (p=0.0006). Our study showed that people with type 1 diabetes can safely perform a 36 hours fasting period with a low risk of hypoglycemia and ketoacidosis. CLINICAL TRIAL REGISTRATION DRKS.de, identifier DRKS00016148.
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Affiliation(s)
- Othmar Moser
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany
- *Correspondence: Othmar Moser, ; Harald Sourij,
| | - Max L. Eckstein
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany
| | - Alexander Mueller
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Exercise Physiology, Training & Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
- Austria Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Norbert J. Tripolt
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Hakan Yildirim
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Farah Abbas
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter N. Pferschy
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Nandu Goswami
- Division of Physiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Felix Aberer
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Anna Obermayer
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas R. Pieber
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Harald Kojzar
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Caren Sourij
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Martina Brunner
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Tobias Niedrist
- Austria Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Markus Herrmann
- Austria Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- *Correspondence: Othmar Moser, ; Harald Sourij,
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Aziz F, Reichardt B, Sourij C, Dimai HP, Reichart D, Köhler G, Brodmann M, Sourij H. Epidemiology of major lower extremity amputations in individuals with diabetes in Austria, 2014-2017: A retrospective analysis of health insurance database. Diabetes Res Clin Pract 2020; 170:108477. [PMID: 33002552 DOI: 10.1016/j.diabres.2020.108477] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/28/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
AIMS To describe the incidence, mortality, and trend of major lower extremity amputations (LEA) and to assess risk factors of all-cause mortality after major LEA in individuals with diabetes. METHODS Procedure codes of major LEA were extracted from the Austrian Health Insurance database (N = 507,180) during 2014-2017 to estimate crude and age-standardized rates per 100,000 population. Short- (30-day, 90-day) and long-term (1-year, 5-year) all-cause mortality after major LEA was estimated from the date of amputation till the date of death. RESULTS The age-standardized rate of major LEA was 6.44 with an insignificant annual change of 3% (p = 0.825) from 2014 to 2017. Cumulative 30-day mortality was 13.5%, 90-day 22.0%, 1-year 34.4%, and 5-year 66.7%. Age, male sex, above-knee amputation, Charlson index, and heart failure were significantly associated with both short- and long-term mortality. Cancer, dementia, heart failure, peripheral vascular disease, and renal disease were associated with long-term mortality. CONCLUSIONS The rate of major LEA in individuals with diabetes remained stable during 2014-2017 in Austria. Short- and long-term mortality rates were considerably high after major LEA. Old age, male sex, above-knee amputations, and Charlson Index were significant predictors of both short- and long-term mortality and comorbidities were significant predictors of long-term mortality only.
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Affiliation(s)
- Faisal Aziz
- Division of Endocrinology and Diabetology, Department of Medicine, Medical University of Graz, Graz, Austria; Center for Biomarker Research in Medicine, CBmed, Graz, Austria
| | | | - Caren Sourij
- Division of Cardiology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Hans-Peter Dimai
- Division of Endocrinology and Diabetology, Department of Medicine, Medical University of Graz, Graz, Austria
| | | | - Gerd Köhler
- Division of Endocrinology and Diabetology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Marianne Brodmann
- Division of Angiology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Department of Medicine, Medical University of Graz, Graz, Austria.
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Moser O, Mueller A, Eckstein ML, Ziko H, Aberer F, Treiber G, Unteregger C, Kojzar H, Mader JK, Sourij C, Pferschy P, Obermayer A, Tripolt N, Sourij H. Improved glycaemic variability and basal insulin dose reduction during a running competition in recreationally active adults with type 1 diabetes-A single-centre, prospective, controlled observational study. PLoS One 2020; 15:e0239091. [PMID: 32915897 PMCID: PMC7485886 DOI: 10.1371/journal.pone.0239091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/29/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION To investigate the glycaemic response, macronutrient intake and insulin management in people with type 1 diabetes (T1D) compared to healthy individuals around a running competition. MATERIAL AND METHODS This was a single-centre, prospective, controlled observational study performed in individuals with T1D and healthy people. 24 people (12 T1D) were included in this study (age: T1D 41±12 vs. healthy 38±6 years, females: 3 vs. 6, BMI: 25.53.0 vs. 22.9±2.8 kg/m2). Both groups received an intermittently scanned continuous glucose monitoring (isCGM; FreeStyle Libre 1, Abbott, USA) system to assess glycaemia 24 hours before, during and 24 hours after a running competition. During this period, participants recorded their food intake and insulin administration. Data were analysed via ANOVA and mixed model analyses with post-hoc testing (p≤0.05). RESULTS For overall glycaemic ranges in comparison of groups, significant differences were found for time in range (T1D 63±21% vs. healthy 89±13%, p = 0.001), time above range (TAR) 1 (T1D 21±15% vs. healthy 0±0%, p<0.001) and TAR 2 (T1D 8 [0-16%] vs. healthy 0±0%, p<0.001). When glycaemic variability was assessed, people with T1D had a higher glycaemic variability compared to healthy individuals (p<0.0001). Basal insulin dose was significantly reduced when compared against the regular pre-study basal insulin dose (pre-study 22±6 vs. pre-competition day 11±9 (-50±41%), p = 0.02; competition day 15±5 (-32± 1%)). CONCLUSION People with T1D have impaired glucose responses around a running competition compared to healthy individuals. However, basal insulin dose reductions were sufficient to prevent further dysglycaemia. CLINICAL TRIAL ID drks.de; DRKS00019886.
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Affiliation(s)
- Othmar Moser
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Alexander Mueller
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Exercise Physiology, Training & Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
| | - Max L. Eckstein
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Haris Ziko
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Felix Aberer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gerlies Treiber
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Christina Unteregger
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Harald Kojzar
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Julia K. Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Caren Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter Pferschy
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Anna Obermayer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Norbert Tripolt
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Aberer F, Pferschy PN, Tripolt NJ, Sourij C, Obermayer AM, Prüller F, Novak E, Reitbauer P, Kojzar H, Prietl B, Kofler S, Brunner M, Svehlikova E, Stojakovic T, Scharnagl H, Oulhaj A, Aziz F, Riedl R, Sourij H. Hypoglycaemia leads to a delayed increase in platelet and coagulation activation markers in people with type 2 diabetes treated with metformin only: Results from a stepwise hypoglycaemic clamp study. Diabetes Obes Metab 2020; 22:212-221. [PMID: 31595635 PMCID: PMC6972619 DOI: 10.1111/dom.13889] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 09/11/2019] [Accepted: 09/27/2019] [Indexed: 12/13/2022]
Abstract
AIMS To investigate the effect of hypoglycaemia on platelet and coagulation activation in people with type 2 diabetes. MATERIALS AND METHODS This monocentric, open, single-arm, mechanistic trial included 14 people with established type 2 diabetes (four women, 10 men, age 55 ± 7 years, glycated haemoglobin concentration 51 ± 7 mmol/mol) receiving metformin monotherapy. A stepwise hyperinsulinaemic-hypoglycaemic clamp experiment (3.5 and 2.5 mmol/L, for 30 minutes respectively) was performed, aiming to investigate platelet and coagulation activity during predefined plateaus of hypoglycaemia, as well as 1 day and 7 days later. RESULTS While platelet activation assessed by light transmittance aggregometry did not significantly increase after the hypoglycaemic clamp procedure, the more sensitive flow cytometry-based measurement of platelet surface activation markers showed hypoglycaemia-induced activation 24 hours (PAC1pos CD62Ppos , PAC1pos CD63Ppos and PAC1pos CD62Ppos CD63pos ; P < .01) and 7 days after the hypoglycaemic clamp (P < .001 for PAC1pos CD63pos ; P < .01 for PAC1pos CD62Ppos and PAC1pos CD62Ppos CD63pos ) in comparison to baseline. Coagulation markers, such as fibrinogen, D-dimer, plasminogen activator inhibitor-1, von Willebrand factor activity and factor VIII, were also significantly increased, an effect that was most pronounced 24 hours after the hypoglycaemic clamp. CONCLUSION A single event of insulin-induced hypoglycaemia led to an increase in markers of platelet activation and coagulation in people with early stages of type 2 diabetes on metformin therapy. However, the activation occurred with a delay and was evident 24 hours and 7 days after the actual hypoglycaemic episode.
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Affiliation(s)
- Felix Aberer
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Peter N. Pferschy
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
- CBmed GmbH, Centre for Biomarker Research in MedicineGrazAustria
| | - Norbert J. Tripolt
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Caren Sourij
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Anna M Obermayer
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
- CBmed GmbH, Centre for Biomarker Research in MedicineGrazAustria
| | - Florian Prüller
- Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory DiagnosticsGrazAustria
| | - Eva Novak
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Philipp Reitbauer
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Harald Kojzar
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
- CBmed GmbH, Centre for Biomarker Research in MedicineGrazAustria
| | - Barbara Prietl
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
- CBmed GmbH, Centre for Biomarker Research in MedicineGrazAustria
| | - Selina Kofler
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
- CBmed GmbH, Centre for Biomarker Research in MedicineGrazAustria
| | - Martina Brunner
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Eva Svehlikova
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
| | - Tatjana Stojakovic
- Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory DiagnosticsGrazAustria
| | - Hubert Scharnagl
- Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory DiagnosticsGrazAustria
| | - Abderrahim Oulhaj
- College of Medicine and Health SciencesUnited Arab Emirates University, Institute of Public HealthAl AinUAE
| | - Faisal Aziz
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
- CBmed GmbH, Centre for Biomarker Research in MedicineGrazAustria
| | - Regina Riedl
- Medical University of Graz, Institute for Medical Informatics, Statistics and DocumentationGrazAustria
| | - Harald Sourij
- Division of Endocrinology and DiabetologyMedical University of GrazGrazAustria
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Moser O, Eckstein ML, Mueller A, Birnbaumer P, Aberer F, Koehler G, Sourij C, Kojzar H, Holler P, Simi H, Pferschy P, Dietz P, Bracken RM, Hofmann P, Sourij H. Impact of physical exercise on sensor performance of the FreeStyle Libre intermittently viewed continuous glucose monitoring system in people with Type 1 diabetes: a randomized crossover trial. Diabet Med 2019; 36:606-611. [PMID: 30677187 DOI: 10.1111/dme.13909] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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] [Accepted: 12/05/2018] [Indexed: 01/10/2023]
Abstract
AIMS To evaluate the sensor performance of the FreeStyle Libre intermittently viewed continuous glucose monitoring system using reference blood glucose levels during moderate-intensity exercise while on either full or reduced basal insulin dose in people with Type 1 diabetes. METHODS Ten participants with Type 1 diabetes [four women, mean ± sd age 31.4 ± 9.0 years, BMI 25.5±3.8 kg/m2 , HbA1c 55±7 mmol/mol (7.2±0.6%)] exercised on a cycle ergometer for 55 min at a moderate intensity for 5 consecutive days at the clinical research facility, while receiving either their usual or a 75% basal insulin dose. After a 4-week washout period, participants performed the second exercise period having switched to the alternative basal insulin dose. During exercise, reference capillary blood glucose values were analysed using the fully enzymatic-amperometric method and compared with the interstitial glucose values obtained. Intermittently viewed continuous glucose monitoring accuracy was analysed according to median (interquartile range) absolute relative difference, and Clarke error grid and Bland-Altman analysis for overall glucose levels during exercise, stratified by glycaemic range and basal insulin dosing scheme (P<0.05). RESULTS A total of 845 glucose values were available during exercise to evaluate intermittently viewed continuous glucose monitoring sensor performance. The median (interquartile range) absolute relative difference between the reference values and those obtained by the sensor across the glycaemic range overall was 22 (13.9-29.7)%, and was 36.3 (24.2-45.2)% during hypoglycaemia, 22.8 (14.6-30.6)% during euglycaemia and 15.4 (9-21)% during hyperglycaemia. Usual basal insulin dose was associated with a worse sensor performance during exercise compared with the reduced (75%) basal insulin dose [median (interquartile range) absolute relative difference: 23.7 (17.2-30.7)% vs 20.5 (12-28.1)%; P<0.001). CONCLUSIONS The intermittently viewed continuous glucose monitoring sensor showed diminished accuracy during exercise. Absolute glucose readings derived from the sensor should be used cautiously and need confirmation by additional finger-prick blood glucose measurements.
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Affiliation(s)
- O Moser
- Diabetes Research Group, Medical School, Swansea University, Swansea, UK
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - M L Eckstein
- Diabetes Research Group, Medical School, Swansea University, Swansea, UK
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - A Mueller
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, Medical University of Graz, Graz, Austria
- Sport Science Laboratory, FH Joanneum University of Applied Science, Bad Gleichenberg, Austria
| | - P Birnbaumer
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, Medical University of Graz, Graz, Austria
| | - F Aberer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - G Koehler
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - C Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - H Kojzar
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - P Holler
- Sport Science Laboratory, FH Joanneum University of Applied Science, Bad Gleichenberg, Austria
| | - H Simi
- Sport Science Laboratory, FH Joanneum University of Applied Science, Bad Gleichenberg, Austria
| | - P Pferschy
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - P Dietz
- Department of Physical Activity and Public Health, Institute of Sports Science, Medical University of Graz, Graz, Austria
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre of the University of Mainz, Mainz, Germany
| | - R M Bracken
- Diabetes Research Group, Medical School, Swansea University, Swansea, UK
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - P Hofmann
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, Medical University of Graz, Graz, Austria
| | - H Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Moser O, Eckstein ML, Mueller A, Birnbaumer P, Aberer F, Koehler G, Sourij C, Kojzar H, Holler P, Simi H, Pferschy P, Dietz P, Bracken RM, Hofmann P, Sourij H. Reduction in insulin degludec dosing for multiple exercise sessions improves time spent in euglycaemia in people with type 1 diabetes: A randomized crossover trial. Diabetes Obes Metab 2019; 21:349-356. [PMID: 30221457 PMCID: PMC6587463 DOI: 10.1111/dom.13534] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/30/2018] [Accepted: 09/11/2018] [Indexed: 12/29/2022]
Abstract
AIMS To compare the time spent in specified glycaemic ranges in people with type 1 diabetes (T1D) during 5 consecutive days of moderate-intensity exercise while on either 100% or 75% of their usual insulin degludec (IDeg) dose. MATERIALS AND METHODS Nine participants with T1D (four women, mean age 32.1 ± 9.0 years, body mass index 25.5 ± 3.8 kg/m2 , glycated haemoglobin 55 ± 7 mmol/mol (7.2% ± 0.6%) on IDeg were enrolled in the trial. Three days before the first exercise period, participants were randomized to either 100% or 75% of their usual IDeg dose. Participants exercised on a cycle ergometer for 55 minutes at a moderate intensity for 5 consecutive days. After a 4-week wash-out period, participants performed the last exercise period for 5 consecutive days with the alternate IDeg dose. Time spent in specified glycaemic ranges, area under the curve and numbers of hypoglycaemic events were compared for the 5 days on each treatment allocation using a paired Students' t test, Wilcoxon matched-pairs signed-rank test and two-way ANOVA. RESULTS Time spent in euglycaemia over 5 days was greater for the 75% IDeg dose versus the 100% IDeg dose (4008 ± 938 minutes vs. 3566 ± 856 minutes; P = 0.04). Numbers of hypoglycaemic events (P = 0.91) and time spent in hypoglycaemia (P = 0.07) or hyperglycaemia (P = 0.38) was similar for both dosing schemes. CONCLUSIONS A 25% reduction in usual IDeg dose around regular exercise led to more time spent in euglycaemia, with small effects on time spent in hypo- and hyperglycaemia.
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Affiliation(s)
- Othmar Moser
- Diabetes Research Group, Medical School, Swansea University, Swansea, UK
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - Max L Eckstein
- Diabetes Research Group, Medical School, Swansea University, Swansea, UK
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - Alexander Mueller
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
- Sport Science Laboratory, Institute of Health and Tourism Management, FH Joanneum University of Applied Science, Bad Gleichenberg, Austria
| | - Philipp Birnbaumer
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
| | - Felix Aberer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gerd Koehler
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Caren Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Harald Kojzar
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter Holler
- Sport Science Laboratory, Institute of Health and Tourism Management, FH Joanneum University of Applied Science, Bad Gleichenberg, Austria
| | - Helmut Simi
- Sport Science Laboratory, Institute of Health and Tourism Management, FH Joanneum University of Applied Science, Bad Gleichenberg, Austria
| | - Peter Pferschy
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Pavel Dietz
- Department of Physical Activity and Public Health, Institute of Sports Science, University of Graz, Graz, Austria
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre of the University of Mainz, Mainz, Germany
| | - Richard M Bracken
- Diabetes Research Group, Medical School, Swansea University, Swansea, UK
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - Peter Hofmann
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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29
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Tripolt NJ, Aberer F, Url J, Högenauer C, Schreiber F, Eherer A, Sourij C, Obermayer AM, Stadlbauer V, Svehlikova E, Brunner M, Kojzar H, Pferschy PN, Pieber TR, Sourij H. Impact of Duodeno-Jejunal Bypass Liner (EndoBarrierTM) Implantation on Insulin Sensitivity in Patients with Type 2 Diabetes Mellitus (T2DM): A Study Protocol for a Pilot Trial. Diabetes Ther 2019; 10:299-309. [PMID: 30539524 PMCID: PMC6349299 DOI: 10.1007/s13300-018-0540-z] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION A 60-cm endoscopically implantable duodenal-jejunal bypass liner (Endobarrier™, GI Dynamics, Lexington, MA, USA) has been introduced as a therapeutic option to support weight loss for a selected group of obese subjects with type 2 diabetes mellitus (T2DM). The sleeve prevents contact between chyme and the intestinal mucosa of the upper gastrointestinal tract. The primary aim of this study is to elucidate the changes in insulin sensitivity and beta-cell function after EndoBarrier™ implantation in obese patients with T2DM; changes in gut permeability and gut microbiome are also to be examined. METHODS This is an open, single-center, prospective trial in which ten obese subjects with T2DM and suboptimal glycemic control (glycosylated hemoglobin A1c (HbA1c) level > 48 mmol/mol) are investigated with regards to EndoBarrier™ implantation. The Endobarrier™ is implanted shortly after baseline and left in situ for a period of 36 weeks. Dual-energy X-ray absorptiometry measurement, assessment of beta-cell function and insulin sensitivity as measured by a Botnia clamp procedure, and a mixed-meal tolerance test are performed prior to implantation and at 4, 36, and 64 weeks after implantation. The composition of the gut microbiota is characterized from stool using 454 pyrosequencing of 16S rRNA genes. Gut permeability is assessed by a differential sugar absorption method. PLANNED OUTCOME This study will give mechanistic insights in particulr into changes of insulin sensitivity, beta-cell function or microbiome changes over time in subjects implanted with an EndobarrierTM device. TRIAL REGISTRATION NCT02769728, Registered 12 May 2016. Current Protocol Date/Version: 04 September 2017/Version 1.9.
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Affiliation(s)
- Norbert Joachim Tripolt
- Divisions of Endocrinology and Diabetology, Division of Gastroenterology and Hepatology, Medizinische Universitat Graz, Graz, Austria
| | - Felix Aberer
- Divisions of Endocrinology and Diabetology, Division of Gastroenterology and Hepatology, Medizinische Universitat Graz, Graz, Austria
| | - Jasmin Url
- Divisions of Endocrinology and Diabetology, Division of Gastroenterology and Hepatology, Medizinische Universitat Graz, Graz, Austria
| | - Christoph Högenauer
- Divisions of Endocrinology and Diabetology, Division of Gastroenterology and Hepatology, Medizinische Universitat Graz, Graz, Austria
| | - Florian Schreiber
- Divisions of Endocrinology and Diabetology, Division of Gastroenterology and Hepatology, Medizinische Universitat Graz, Graz, Austria
| | - Andreas Eherer
- Divisions of Endocrinology and Diabetology, Division of Gastroenterology and Hepatology, Medizinische Universitat Graz, Graz, Austria
| | - Caren Sourij
- Divisions of Endocrinology and Diabetology, Division of Gastroenterology and Hepatology, Medizinische Universitat Graz, Graz, Austria
| | - Anna-Maria Obermayer
- Divisions of Endocrinology and Diabetology, Division of Gastroenterology and Hepatology, Medizinische Universitat Graz, Graz, Austria
| | - Vanessa Stadlbauer
- Divisions of Endocrinology and Diabetology, Division of Gastroenterology and Hepatology, Medizinische Universitat Graz, Graz, Austria
| | - Eva Svehlikova
- Divisions of Endocrinology and Diabetology, Division of Gastroenterology and Hepatology, Medizinische Universitat Graz, Graz, Austria
| | - Martina Brunner
- Divisions of Endocrinology and Diabetology, Division of Gastroenterology and Hepatology, Medizinische Universitat Graz, Graz, Austria
| | - Harald Kojzar
- Divisions of Endocrinology and Diabetology, Division of Gastroenterology and Hepatology, Medizinische Universitat Graz, Graz, Austria
| | - Peter Nikolaus Pferschy
- Divisions of Endocrinology and Diabetology, Division of Gastroenterology and Hepatology, Medizinische Universitat Graz, Graz, Austria
| | - Thomas Rudolf Pieber
- Divisions of Endocrinology and Diabetology, Division of Gastroenterology and Hepatology, Medizinische Universitat Graz, Graz, Austria
| | - Harald Sourij
- Divisions of Endocrinology and Diabetology, Division of Gastroenterology and Hepatology, Medizinische Universitat Graz, Graz, Austria.
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