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Outcome of Immunotherapy in Adrenocortical Carcinoma - A retrospective cohort study. Eur J Endocrinol 2023:7187724. [PMID: 37260092 DOI: 10.1093/ejendo/lvad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/13/2023] [Accepted: 04/18/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Clinical trials with immune checkpoint inhibitors (ICI) in adrenocortical carcinoma (ACC) have yielded contradictory results. We aimed to evaluate treatment response and safety of ICI in ACC in a real-life setting. DESIGN Retrospective cohort study of 54 patients with advanced ACC receiving ICI as compassionate use at six German reference centres between 2016 and 2022. METHODS Objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS) and treatment-related adverse events (TRAE) were assessed. RESULTS In 52 patients surviving at least 4 weeks after initiation of ICI, ORR was 13.5% (6-26) and DCR 24% (16-41). PFS was 3.0 months (95%CI 2.3-3.7). In all patients, median OS was 10.4 months (3.8-17). 17 TRAE occurred in 15 patients, which was associated with a longer PFS of 5.5 (1.9-9.2) vs. 2.5 (2.0- 3.0) months (HR 0.29, 95%CI 0.13-0.66, p=0.001) and OS of 28.2 (9.5-46.8) vs. 7.0 (4.1-10.2) months (HR 0.34, 95%CI 0.12-0.93). Positive tissue staining for programmed cell death ligand 1 (PD-L1) was associated with a longer PFS of 3.2 (2.6-3.8) vs. 2.3 (1.6-3.0, p<0.05) months. Adjusted for concomitant mitotane use, treatment with nivolumab was associated with lower risk of progression (HR 0.36, 0.15-0.90) and death (HR 0.20, 0.06-0.72) compared to pembrolizumab. CONCLUSIONS In the real-life setting we observe a response comparable to other second-line therapies and an acceptable safety profile in ACC patients receiving different ICI. The relevance of PD-L1 as a marker of response and the potentially more favourable outcome in nivolumab treated patients require confirmation.
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[COVID-19 associated pneumonia despite repeatedly negative PCR-analysis from oropharyngeal swabs]. Pneumologie 2020; 74:615-620. [PMID: 32916744 DOI: 10.1055/a-1178-7275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PATIENT HISTORY AND CLINICAL FINDINGS A 46-year old construction worker presented at the emergency department with two orthostatic syncopes. The patient complained of prolonged fever and coughs for 7 days which had not improved after oral treatment with sultamicillin for 5 days, prescribed by the patient's general practitioner. Physical examination showed high blood pressure due to previously known hypertension. Other vital signs without pathological findings. Pulmonary auscultation showed basal soft crackling noises of the left lung. FINDINGS AND DIAGNOSIS Laboratory examination showed increased values for LDH, pro-BNP and CRP and normal values for leucocytes and procalcitonin. Conventional X-Ray of the chest showed bipulmonal lateral atypical infiltrates. After the first PCR turned in negative another PCR-analysis for SARS-CoV-2 of a deep oral swab-sample was performed since the clinical, laboratory and radiological findings were typical for COVID-19. Again, SARS-CoV-2-RNA was not detected. A CT-scan of the chest showed bipulmonal lateral ground-glass attenuation, again typical for COVID-19 associated pneumonia. After a third attempt for a PCR-analysis of a deep oral swab-sample was negative, analysis of a sputum was performed which finally confirmed the diagnosis of COVID-19 associated pneumonia. THERAPY AND COURSE OF EVENTS The patient was admitted for evaluation of syncopes and suspect of COVID-19 associated pneumonia. The patient was prophylactically isolated while the result of SARS-CoV-2-PCR from a deep oral swab was pending. Suspecting a possible secondary bacterial infection at the beginning, intravenous antibiotic treatment with ampicillin/sulbactam was initiated. While further examinations showed no indication for bacterial infection, antibiotics were discontinued after 3 days. Due to clinical recovery antiviral therapy was not performed after confirming the diagnosis. The patient was discharged 17 days after onset of first symptoms without any requirements for further isolation. CONCLUSION This casuistic describes a case of COVID-19 associated pneumonia presenting with typical clinical features, laboratory and radiological findings. Detection of viral RNA was not successful from deep oral swab-samples despite repeated attempts. Finally, PCR-analysis of sputum confirmed the diagnosis. Analysis of deeper airway samples (sputum, bronchoalveolar lavage, tracheal secretions) or stool for SARS-CoV-2 should be performed in cases of evident clinical suspicion of COVID-19 and negative PCR results from deep oral swabs.
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Abstract
Seit Beginn der Coronaviruspandemie mit SARS-CoV‑2 („severe acute respiratory syndrome coronavirus 2“) im Januar 2020 wurden bereits mehr als 100 Fälle von chinesischen Schwangeren publiziert, darunter auch Fälle mit Gestationsdiabetes (GDM). In vorliegender Übersicht wird über die Klinik von COVID-19 sowie geburtshilfliche und neonatale Ergebnisdaten berichtet. Leitsymptome der insgesamt milder verlaufenden Infektion sind Fieber, Husten und Atembeschwerden. Es gibt bislang keine Beweise für eine intrauterine Transmission des Virus und auch keinen Beleg für einen Transfer in bzw. durch Muttermilch. Postnatale Infektionen von Säuglingen infizierter Mütter sind belegt, die Verläufe mild. Die vorliegenden Daten sind geeignet, Angehörige der Gesundheitsberufe auf die zu erwartenden Infektionen schwangerer Frauen mit der Komorbidität Diabetes mellitus vorzubereiten.
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Distinct trajectories of HbA 1c in newly diagnosed Type 2 diabetes from the DPV registry using a longitudinal group-based modelling approach. Diabet Med 2019; 36:1468-1477. [PMID: 31392761 DOI: 10.1111/dme.14103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 01/09/2023]
Abstract
AIM To identify groups of heterogeneous HbA1c trajectories over time in newly diagnosed Type 2 diabetes. METHODS The study comprised 6355 adults with newly diagnosed Type 2 diabetes (55% men, median age 62 years, baseline BMI 31 kg/m2 ) from the Diabetes Patienten Verlaufsdokumentation (DPV) prospective multicentre diabetes registry (Germany, Austria). Individuals were assessed during the first 5 years after diabetes diagnosis if they had ≥ 3 aggregated HbA1c measurements during follow-up. Latent class growth modelling was used to determine distinct subgroups that followed similar longitudinal HbA1c patterns (SAS: Proc Traj). Multinomial logistic regression models were used to investigate which variables were associated with the respective HbA1c trajectory groups. RESULTS Four distinct longitudinal HbA1c trajectory (glycaemic control) groups were found. The largest group (56% of participants) maintained stable good glycaemic control (HbA1c 42-45 mmol/mol). Twenty-six percent maintained stable moderate glycaemic control (HbA1c 57-62 mmol/mol). A third group (12%) initially showed severe hyperglycaemia (HbA1c 97 mmol/mol) but reached good glycaemic control within 1 year. The smallest group (6%) showed stable poor glycaemic control (HbA1c 79-88 mmol/mol). Younger age at diabetes diagnosis, male sex, and higher BMI were associated with the stable moderate or poor glycaemic control groups. Insulin therapy was strongly associated with the highly improved glycaemic control group. CONCLUSIONS Four subgroups with distinct HbA1c trajectories were determined in newly diagnosed Type 2 diabetes using a group-based modelling approach. Approximately one-third of people with newly diagnosed Type 2 diabetes need either better medication adherence or earlier intensification of glucose-lowering therapy.
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Abstract
BACKGROUND Inhibitors of sodium-glucose cotransporters type 2 (SGLT-2) are a class of oral antidiabetic drugs with a novel specific mode of action in the kidneys. OBJECTIVE The effects of SGLT-2 inhibitors on cardiovascular (CV) and renal endpoints in outcome trials with type 2 diabetes patients. MATERIAL AND METHODS Differential analysis and interpretation of the results of outcome trials with the SGLT-2 inhibitors empagliflozin, canagliflozin and dapagliflozin in type 2 diabetes mellitus. RESULTS In the EMPA-REG OUTCOME trial, empagliflozin demonstrated a significant reduction in major cardiac adverse events (MACE), hospitalization for heart failure (HHI), renal endpoints, CV and total mortality vs. placebo in >7000 patients with type 2 diabetes and established CV disease over 3.1 years. In the CANVAS program, canagliflozin demonstrated a significant reduction of MACE, HHI and renal endpoints vs. placebo in >10,000 patients with type 2 diabetes and high CV risk over 2.4 years. In the CREDENCE trial, canagliflozin demonstrated a significant reduction of a combined renal endpoint and CV endpoints vs. placebo in >4000 patients with type 2 diabetes and established kidney disease with albuminuria over 2.6 years. In the DECLARE-TIMI 58 trial, dapagliflozin demonstrated a significant reduction in a combined endpoint of CV death and HHI vs. placebo in >17,000 patients with type 2 diabetes and established CV disease or with multiple CV risk factors over 3.1 years. CONCLUSION Outcome trials with SGLT-2 inhibitors have collectively demonstrated cardioprotective and nephroprotective effects in patients with type 2 diabetes and high CV risk. The use of SGLT-2 inhibitors is recommended in current guidelines and consensus statements as primary combination partners for metformin in patients with type 2 diabetes and established CV disease, high CV risk, heart failure or kidney disease.
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The T risk allele of TCF7L2 rs 7903146 is associated with impaired insulin secretion rather than insulin resistance: A clinical pilot study in women with a history of gestational diabetes (GDM). DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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414 Demographic and clinical aspects of cystic fibrosis-related diabetes (CFRD) – a registry comparison between the European CF Society Patient Registry (ECFSPR) and the German/Austrian/Luxembourg diabetes patient follow-up registry DPV. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30744-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Efficacy and safety development and nutritive changes during one-year treatment with the duodenal-jejunal bypass liner (DJBL). DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Mesenchymal Stem Cell (MSC)-derived humoral factors promote survival of insulin producing pancreatic β-cells during intrinsic cellular stress via Akt and ERK1/2 signalling. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Exocrine AR42J acinar cells enhance viability of cocultured endocrine INS-1E beta cells. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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11
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Erhöhte Prävalenz depressiver Symptomatik bei Frauen mit Gestationsdiabetes. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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17q12 Recurrent Deletion Syndrome – a rare cause for diabetes mellitus type MODY5. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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266 The role of diabetes autoantibodies in cystic fibrosis related diabetes mellitus – a DPV registry analysis. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30504-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Insulinabgabegenauigkeiten von Patch-Pumpen versus Schlauchpumpen – Eine systematische Analyse unter Laborbedingungen. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mesenchymal stem cell (MSC)-mediated activation of ERK1/2 signaling does not contribute to maintained survival of cocultured alloxan-treated INS-1E beta cells. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Verbesserung der Nicht-alkoholischen Fettlebererkrankung (NAFLD) durch Implantation eines endoskopischen duodenalen Bypasses (EndoBarrier®) bei Patienten mit Typ 2 Diabetes (T2Dm) und Übergewicht. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Preserved insulin response of Nupr1-transgenic islets during diabetogenic injury is correlated with reduced secretion of IL-1beta and enhanced secretion of IL-1 receptor antagonist. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Effects of the gestational diabetes-risk polymorphism rs10501320 of MADD gene on metabolic phenotype and glucose homeostasis in women with history of gestational diabetes. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Association of CFTR mutations with Cystic Fibrosis related Diabetes (CFRD) in Germany and Austria: a multicentre analysis from the DPV registry. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Characteristics and outcomes of patients with type 2 diabetes mellitus (T2D) treated by bariatric surgery (BS) – a multicentre, descriptive analysis of 236,726 type 2 diabetic patients from the DPV registry. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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German EndoBarrier® Registry – conception, structure, and current status. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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The macrophage migration inhibitory factor (MIF)/CXCR4 axis regulates migration of bone marrow derived mesenchymal stem cells towards pancreatic ß-cells under lipotoxic conditions. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Are insulin analogues detemir or glulisine used preferentially in overweight/obese subjects? A German multicentre analysis of 38560 type 2 diabetic patients from the DPV registry. Exp Clin Endocrinol Diabetes 2014; 122:602-7. [PMID: 25054308 DOI: 10.1055/s-0034-1383646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Several studies suggest benefits of insulin analogues detemir or glulisine in overweight and obese patients with type 2 diabetes. The present multicentre study therefore examines, whether these insulin analogues are used more frequently in patients with increased body mass index. METHODS Data of 38 560 adult type 2 diabetic patients using insulin analogues, from 150 centres in Germany, registered in a standardized, prospective, computer-based documentation program (DPV), were included. Patients were classified into body mass index categories according to World Health Organization. Analysis was stratified by 3 time periods. To adjust for confounding effects, multivariable logistic regression models were created. RESULTS Detemir was preferentially used in overweight (OR 1.36, 95%-CI 1.20-1.53) and obese patients (OR 2.06, 95%-CI 1.84-2.31) compared to normal-weight patients. These effects remained significant after adjusting for sex, age, new/old federal state of Germany, size of centre, treatment in university clinic and clinic/specialized private practice. Models were additionally adjusted for time period and interaction of BMI category with age or sex. For glulisine, a minor effect was present when comparing obese to normal-weight patients (OR 1.26, 95%-CI 1.06-1.50). After adjustment, this finding was no longer significant. Stratified by obesity grade, class III obese patients more frequently used detemir or glulisine compared to class I obese patients. Comparing time periods, odds ratios did not differ, neither for detemir nor for glulisine. CONCLUSION Detemir is used more often in overweight and obese patients compared to normal-weight patients. For glulisine, the relationship is less pronounced.
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Impact of an acceptance facilitating intervention on diabetes patients' acceptance of Internet-based interventions for depression: a randomized controlled trial. Diabetes Res Clin Pract 2014; 105:30-9. [PMID: 24862240 DOI: 10.1016/j.diabres.2014.04.031] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 04/17/2014] [Accepted: 04/28/2014] [Indexed: 11/19/2022]
Abstract
AIMS To (1) determine diabetes patients' acceptance of Internet-based interventions (IBIs) for depression, to (2) examine the effectiveness of an acceptance facilitating intervention (AFI) and to (3) explore subgroup specific effects. METHODS 141 diabetes patients from two inpatient rehabilitation units and one outpatient clinic in Germany were randomly allocated to an intervention (IG) and a no-intervention control group (CG). The IG received an AFI consisting of a personal information session before filling-out a questionnaire on patients' acceptance of IBIs, predictors of acceptance (performance expectancy, effort expectancy, social influence, facilitating conditions, and Internet anxiety) as well as sociodemographic, depression-related and diabetes-related variables. The CG filled out the questionnaire immediately. Patients' acceptance of IBIs was measured with a four-item scale (sum-score ranging from 4 to 20). RESULTS The CG showed a low (50.7%) to medium (40.8%) acceptance with only 8.5% of all diabetes patients reporting a high acceptance of IBIs for depression. The AFI had no significant effect on acceptance (IG: M=10.55, SD=4.69, n=70; KG: M=9.65, SD=4.27, n=71; d=0.20 [95%-CI: -0.13;0.53]) and the predictors of acceptance. Yet, subgroup analyses yielded a trend for depressed, diabetes-related distressed, female and younger (<59) participants and for those who do not frequently use the Internet to profit from the AFI. CONCLUSION Diabetes patients show a rather low acceptance toward IBIs for depression. Findings indicate that the AFI is likely to be effective in the subgroup of depressed, diabetes-related distressed, female or younger diabetes patients, but not in the whole target population. Hence, AFIs might need to be tailored to the specific needs of subpopulations.
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Daily insulin doses and injection frequencies of neutral protamine hagedorn (NPH) insulin, insulin detemir and insulin glargine in type 1 and type 2 diabetes: a multicenter analysis of 51 964 patients from the German/Austrian DPV-wiss database. Diabetes Metab Res Rev 2014; 30:395-404. [PMID: 24302583 DOI: 10.1002/dmrr.2500] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 10/24/2013] [Accepted: 11/08/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND We performed a comparative analysis of the use of long-acting insulin (analogues) neutral protamine hagedorn (NPH), detemir (Det) and glargine (Gla), and quantified injection frequencies and daily insulin doses in patients with type 1 and 2 diabetes in daily practice. METHODS A total number of 51 964 patients from 336 centres in Germany and Austria with type 1 and 2 diabetes with exclusive insulin therapy were retrospectively analysed. RESULTS A total number of 42.1%/75.9% (type 1/type 2) of patients used NPH, 19.9%/6.7% Det and 38.0%/17.4% Gla, with similar glycaemic control and proportion of severe hypoglycaemia for NPH/Det/Gla in type 1 (Mean HbA(1c) 7.98%/7.98%/8.07%; mean proportion of severe hypoglycaemia 11.06%/11.93%/10.86%) and type 2 diabetes (Mean HbA(1c) 7.61%/7.78%/7.61%; mean proportion of severe hypoglycaemia 5.66%/4.48%/5.03%). In type 1 diabetes, the mean daily injection frequencies of NPH versus Det versus Gla were 1.9 vs 1.8 vs 1.1, and total daily insulin injections were 5.3 vs 5.6 vs 5.0. The adjusted mean daily basal insulin doses were 0.36, 0.39 and 0.31 IU/kg, mean daily total insulin dose was lowest for Gla (0.74 IU/kg), followed by NPH (0.76 IU/kg) and Det (0.81 IU/kg). In type 2 diabetes patients, mean daily injection frequencies were 1.6 for NPH, 1.4 for Det and 1.1 for Gla, total daily insulin injections were 4.0 vs 4.1 vs 3.6. The mean daily basal insulin dosages were 0.30 IU/kg (NPH), 0.33 IU/kg (Det) and 0.29 IU/kg (Gla), mean total insulin doses per day were 0.63 IU/kg (NPH), 0.77 IU/kg (Det) and 0.67 IU/kg (Gla). CONCLUSIONS In a 'real-world' setting, the injection frequencies and doses of basal and total insulin per day are lowest with the use of insulin glargine compared with NPH-insulin or insulin detemir at similar glycaemic control and rates of severe hypoglycaemia.
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The anti-inflammatory protein NUPR1 (p8) is a novel intracellular mediator of pancreatic β-cell protection during diabetogenic stress in vitro and in vivo. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1374962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Type 2 Diabetes mellitus genetic risk variant T in TCF7L2 rs 7903146 in women is associated with an increased risk for the development of gestational diabetes mellitus (GDM) with necessity of insulin therapy. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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The anti-inflammatory protein NUPR1 protects pancreatic islets from diabetogenic lipotoxic injury ex vivo. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1374927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Flexibles Diabetesmanagement auch bei CF-Diabetes? Ein multizentrischer Vergleich der Insulinpumpentherapie zwischen CF-Diabetes und Typ 1 Diabetes basierend auf der deutsch/österreichischen DPV-Datenbank. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gestationsdiabetes – Eine multizentrische Analyse von 9125 Patientinnen der multizentrischen DPV-Datenbank: Deskription und Veränderung über die letzten 14 Jahre. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1374936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Der mit einer gestörten Insulinbiosynthese assoziierte Polymorphismus rs10501320 im MADD Gen erhöht das Risiko für das Auftreten von Gestationsdiabetes. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1374938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Treatment of type 2 diabetes mellitus with the endoscopic duodenal-jejunal bypass liner (EndoBarrier®). DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Humoral factors by human bone marrow-derived MSC enhance beta cell proliferation via ERK1/2 signalling. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1374923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Diabetes insipidus and secondary hypogonadism due to vasculitis of the pituitary gland. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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35
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The anti-inflammatory protein p8 protects pancreatic islets from diabetogenic lipotoxic injury ex vivo. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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The insulin-biosynthesis-impairing MADD rs10501320 genetic polymorphism is associated with gestational diabetes in European populations. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Type 2 Diabetes mellitus genetic risk variant T in TCF7L2 rs7903146 in women is associated with an increased probability of insulin therapy in gestational diabetes mellitus (GDM). Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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p8 is a novel intracellular mediator of pancreatic β-cell protection that preserves insulin secretory function during inflammatory cell stress in vivo. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Humoral factors by human bone marrow-derived MSC enhance beta cell proliferation via ERK1/2 signalling. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Von Recklinghausen's disease of bone with multiple osteolyses and bone fractures due to malnutrition in an 83 years old patient. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Endoscopic Duodenal-Jejunal Bypass Liner (EndoBarrier®) for the treatment of type 2 diabetes mellitus. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Humoral factors by bone marrow-derived MSC enhance survival of injured β-cells by preserving AKT signalling. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Diabetes mellitus Typ 2 und hepatozelluläres Karzinom- Tumorcharakteristika und Prognose. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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p8 is a novel intracellular mediator of pancreatic beta cell protection that preserves insulin secretory function during inflammatory stress in vivo. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Influence of type 2 diabetes mellitus on tumour characteristics and outcomes in patients with hepatocellular carcinoma. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Der genetische Typ 2 Diabetes Risikomarker TCF7L2 rs7903146 ist differenziell assoziiert mit dem Auftreten eines Gestationsdiabetes bei deutschen und griechischen Frauen. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Differenzielle Regulation des humanen Insulinpromotors in β-Zellen und nicht-β-Zellen durch Interaktion von Krüppel-like factor 11 (KLF11) mit dem P300-PDX1-Transaktivierungskomplex. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Ectopic ACTH production causes 10% of Cushing's syndromes. The diagnostic workup is difficult, can last more than 6 months (> 50% of cases), and the underlying tumour is still frequently not located (12%). Carcinoid tumours of the appendix are frequent and are revealed in 0.3% of patients undergoing routine appendectomy. However, neuroendocrine tumours of the appendix with ACTH production are an extremely rare entity. Here we report the case of a female patient with clinically overt Cushing's syndrome due to ectopic ACTH-production from a carcinoid tumour of the appendix. During the diagnostic workup, repeated endocrine tests, multiple different imaging modalities and frequent and lengthy hospitalisations were necessary. Wrongly, even a neurosurgical pituitary exploration was performed. After 12 months from the initial admission, the tumour was finally detected by an ¹⁸F-fluoro-L-dihydroxyphenylalanine (¹⁸FDOPA PET) and an appendectomy followed by right hemicolectomy were performed. The patient recovered rapidly and the symptoms from the hypercortisolism were no more present.In this case, we discuss the multitude of problems, which may delay the diagnosis and the pitfalls, that should be avoided in order to locate the tumour and to initiate adequate therapy as early as possible. Furthermore, our case demonstrates the complexity of diagnostic procedures, which demand most of the times a multidisciplinary approach. In this setting, regular follow-ups in short time intervals and the use of novel imaging techniques can finally cut the diagnostic "Gordian knot".
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Abstract
Graves' orbitopathy (GO) is the most frequently observed extrathyroidal manifestation of Graves' disease occurring in up to 40% of patients. Most patients with Graves' orbitopathy are tested positive for TSH receptor autoantibodies (TRAb), which are pathognomonic for Graves' disease and also play a central pathogenetic role in the development of GO. For the diagnosis of Graves' disease, symptoms of hyperthyroidism, low TSH and high fT3 and/or fT4 levels and positive TRAbs are typical. All patients with Graves' disease must be regularly examined for extrathyroidal manifestations, especially for Graves' orbitopathy. For hyperthyroidism, treatment with antithyroidal drugs, such as thiamazole or propylthiouracil is initiated to quickly restore euthyroidism, which also frequently leads to improvement of Graves' orbitopathy. Smoking cessation is also heavily mandated. In cases of relapse or ineffective antithyroidal treatment, radioiodine therapy or thyroid surgery is a further definitive therapeutic option to treat hyperthyroidism. The management of Graves' orbitopathy remains clinically challenging and demands involvement of a multidisciplinary team including endocrinologists, ophthalmologists, surgeons, radiotherapists and nuclear medicine specialists.
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Polycystisches Ovarsyndrom (PCOS): 5-Jahres Follow up Metabolischer Parameter. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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