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Bad Aibling, Germany

Schutt M.,University of Lubeck | Zimmermann A.,Diabetes Schwerpunktpraxis | Hummel M.,Helmholtz Center Munich | Seufert J.,University Hospital Freiburg | And 3 more authors.
Experimental and Clinical Endocrinology and Diabetes | Year: 2015

Effects of diabetes treatment are strongly connected to individual factors, but the relevant role of gender has not been addressed so far. This observational study evaluates whether monotherapy with lifestyle, metformin or sulfonylurea has gender-specific effects on glycemic control and/or body weight. Data of 9 108 patients with type 2 diabetes from 129 German diabetes centers were assessed by a standardized, prospective, computer-based diabetes care and outcome documentation system (DPV-Wiss-database; age 63.1±12.8 years, diabetes duration 5.7±7.4 years, HbA1c 55±17.7 mmol/mol [7.2±1.6%], BMI 30.6±6.1 kg/m2, 49.3% female patients). Antidiabetic concepts included lifestyle intervention (n=5,787), metformin (n=2,180), sulfonylurea (n=943) or other antidiabetic drugs (n=198), respectively. HbA1c and body weight were compared before and after a stable monotherapeutical period of 0.8±0.4 years. Women had a significantly higher reduction of body weight after treatment with lifestyle (women-0.8±0.1 vs. men-0.2±0.1 kg; p<0.05), metformin (women-1.8±0.2 vs. men-1.2±0.2 kg; p<0.05) or sulfonylurea drugs (women-0.9±0.2 vs. men - 0.1±0.2 kg; p<0.05), whereas men displayed significantly higher HbA1c-reductions after treatment with lifestyle (women-6.9±0.2 mmol/mol [- 0.6±0.02%] vs. men-7.5±0.2 mmol/mol [0.7±0.02%]; p<0.05) and metformin only (women-6.3±0.3 mmol/mol [- 0.6±0.03%] vs. men - 7.4±0.3 mmol/mol [- 0.7±0.03%]; p<0.05). No differences were seen for sulfonylurea monotherapy concerning the HbA1c-reduction (women - 5.6±0.5 mmol/mol [- 0.5±0.05%] vs. men-6.4±0.4 mmol/mol [- 0.6±0.04%]; p=0.196). In summary, antidiabetic treatment concepts might result in gender-specific effects on body weight and HbA1c. Gender might therefore represent another important factor in the context of an individualized treatment management of type 2 diabetes. © J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart.

Kerr D.,Bournemouth Diabetes and Endocrine Center | Wizemann E.,Diabetes Schwerpunktpraxis | Senstius J.,Novo Nordisk AS | Zacho M.,Novo Nordisk AS | Ampudia-Blasco F.J.,University of Valencia
Journal of Diabetes Science and Technology | Year: 2013

Aim: We review and summarize the literature on the safety and stability of rapid-acting insulin analogs used for continuous subcutaneous insulin infusion (CSII) in patients with diabetes. Methods: Two predefined search strategies were systematically implemented to search Medline and the Cochrane Register of Clinical Trials for publications between 1996 and 2012. Results: Twenty studies were included in the review: 13 in vitro studies and 7 clinical studies. In vitro studies investigated the effects of extreme CSII conditions (high temperature and mechanical agitation) on the risk of catheter occlusions and insulin stability factors, such as potency, purity, high molecular weight protein content, pH stability, and preservative content (m-cresol, phenol). Under these conditions, the overall stability of rapid-acting insulin analogs was similar for insulin lispro, insulin aspart, and insulin glulisine, although insulin glulisine showed greater susceptibility to insulin precipitation and catheter occlusions. A limited number of clinical trials were identified; this evidence-based information suggests that the rate of catheter occlusions in patients with type 1 diabetes using CSII treatment may vary depending on the rapid-acting analog used. Conclusions: Based on a limited amount of available data, the safety, stability, and performance of the three available rapidacting insulin analogs available for use with CSII were similar. However, there is limited evidence suggesting that the risk of occlusion may vary with the insulin preparation under certain circumstances. © Diabetes Technology Society.

Schutt M.,University of Lubeck | Fach E.-M.,Diabetes Schwerpunktpraxis | Seufert J.,University Hospital Freiburg | Kerner W.,Heart and Diabetes Center Mecklenburg Vorpommern | And 4 more authors.
Diabetic Medicine | Year: 2012

Aim Elderly and old patients with Type1 diabetes represent a growing population that requires thorough diabetes care. The increasing relevance of this subgroup, however, plays only a minor role in the literature. Here, we describe elderly patients with Type1 diabetes on the basis of a large multi-centre database in order to point out special features of this population. Method Data of 64609 patients with Type1 diabetes treated by 350 qualified diabetes treatment centres were assessed and analysed by age group. Results Compared with the age group ≤60years, patients aged >60years (n=3610 61-80years and n=377 >80years old) were characterized by a longer diabetes duration (27.7 vs. 7.7years), an almost double risk for severe hypoglycaemia (40.1 vs. 24.3/100patient-years), a lower level of HbA 1c [60 vs. 67mmol/mol (7.6 vs. 8.3%)] and higher percentages of microalbuminuria (34.5 vs. 15.6%), diabetic retinopathy (45.2 vs. 8.3%), myocardial infarction (9.0 vs. 0.4%) or stroke (6.8 vs. 0.3%). Elderly patients used insulin pumps less frequently (12.2 vs. 23.8%), but more often used conventional premixed insulin treatment (10.8 vs. 3.8%). Differences between elderly and younger patient groups were significant, respectively. Conclusion Diabetes care of elderly patients with Type1 diabetes involves individualized treatment concepts. Increased hypoglycaemia risk and functional impairment attributable to diabetes-associated and/or age-related disorders must be taken into account. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

Schutt M.,University of Lbeck | Kern W.,Zentrum Fr Hormon und Stoffwechselerkrankungen | Zimmermann A.,Diabetes Schwerpunktpraxis | Busch P.,II. Medizinische Klinik | And 6 more authors.
Experimental and Clinical Endocrinology and Diabetes | Year: 2010

Glycemic and body weight control are two outstanding goals in the treatment of patients with type 2 diabetes that often are not appropriately achieved. This observational study evaluates whether treatment by quality controlled diabetes centers generates an improvement in this regard and focuses on associations with different therapies. Data of 9.294 type 2 diabetic patients (mean age 66.9±11.6 years, mean diabetes duration 12.4±9.2 years) from 103 German diabetes centers were assessed by a standardized, prospective, computer-based diabetes care and outcome documentation system (DPV-Wiss-database). Therapeutic concepts included lifestyle intervention (n=1.813), oral antidiabetics (OAD, n=1.536), insulin (n=4.504) and insulin plus OAD (n=1.441). HbA1c and body weight were compared before and after a stable therapeutical period of 1.07±0.3 years. Change in HbA1c (%): all patients 7.4±1.67.0±1.3, lifestyle intervention 7.5±1.96. 9±1.5, OAD 6.7±1.16.5±1.0, insulin 7.6±1.67. 2±1.4, insulin plus OAD 7.5±1.57.2±1.3; each p0.05. Change in body weight (kg): all patients +0.08±0.07, n.s.; lifestyle intervention 0.28±0.20, OAD 0.56±0.13, each p<0.05 [metfomin 0.77±0.21, sulfonylurea drugs 0.75±0.34, each p<0.05; glitazones +0.62±0.70, -glucosidase inhibitors 0.22±0.76, each n.s.], insulin +0.27±0.10, insulin plus OAD +0.63±0.14, each n.s. In summary, lifestyle, metformin or sulfonylurea drug treatment resulted in HbA1c-values below 7.0% plus a significant weight reduction. Insulin treatment-associated concepts resulted in HbA1c-values slightly above 7.0% without body weight alterations. These real life data underline that a specialised and quality controlled diabetes care is able to achieve significant treatment results even in patients with disease progression and a high proportion of insulin therapies. © J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart.

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