Tanudjaja T.,Diabetologische Schwerpunktpraxis |
Spraul M.,Diabetes Zentrum Rheine
Diabetologe | Year: 2015
Background: The number of scientific publications on the diabetic foot has significantly risen in the last 10 years. Materials and methods: The most important contributions published in 2014 dealing with the diabetic foot were selected. The backgrounds of several clinically relevant publications are presented together with the methods and results. Implications for daily practice are provided. Results: Based on the diagnosis-related group (DRG) system, the number of major amputations in Germany has decreased in recent years. In the last 20 years, the risk for amputation for people with diabetes has decreased more than for people without diabetes. There are indications that the cost of care for patients with diabetic foot have also declined. A long delay in treating a diabetic foot represents an increased risk for amputation and mortality. Intense patient education is essential to improve the self-assessment for the patient and to reduce the amputation rate in patients at high risk of diabetic foot. Chronic plantar ulcers are very common. One study concluded that appropriate footwear and treating nonulcerative skin lesions are effective measures to reduce this significant risk for chronic ulcers. Several studies investigated the selection of the antibiotic therapy for infected diabetic foot. Especially in view of the increasing number of cases with severe Clostridium difficile-associated diarrhea and increased development of resistance, strict hygiene and careful selection of the antibiotic are necessary. © 2015, Springer-Verlag Berlin Heidelberg.
Holstein A.,Lippe Detmold Hospital |
Patzer O.,Lippe Detmold Hospital |
Tiemann T.,Diabetologische Schwerpunktpraxis |
Vortherms J.,Diabetologische Schwerpunktpraxis |
Kovacs P.,University of Leipzig
Diabetic Medicine | Year: 2012
Objective To assess the number and sex ratio of children in individuals with Type1 diabetes mellitus and the influence of parental diabetes on age at onset of Type1 diabetes in our cohort. Methods In a cross-sectional study in a German region comprising 350000 inhabitants, 697 subjects with Type1 diabetes (364 women, 333 men) underwent a standardized assessment regarding the number and sex of their children and the family history of diabetes. Results Compared with 1.36 children per woman in the German background population, the total fertility rate in the calendar year of 2010 in our female cohort with Type1 diabetes (age 18-49years) was 0.88. Men with Type1 diabetes had a fertility rate of 0.65. More men (51.1%) than women (35.7%; P<0.0001) were childless. Twenty per cent of all women aged 41-45years in the background population were childless compared with 36.2% of all women and 52% of all men in this specific age group from our cohort. The sex ratio of female vs. male offspring of individuals with Type1 diabetes did not differ significantly from the expected 1:1 ratio. Maternal Type1 or Type2 diabetes increased the age at onset of Type1 diabetes from 22.9±13.7 (no maternal diabetes) to 28.6±16.8 and 30.1±15.1years (p<0.0001), respectively. Conclusions Compared with the German reference population, individuals with Type1 diabetes had significantly fewer children and were more often childless. The sex ratio female vs. male offspring of women and men with Type1 diabetes was unaffected. Maternal history of Type1 and Type2 diabetes was associated with a significant later onset of Type1 diabetes. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.
Fiesselmann A.,Diabetologische Schwerpunktpraxis |
Wiesner T.,MVZ Stoffwechselmedizin Leipzig |
Fleischmann H.,Sanofi S.A. |
Bramlage P.,Institute For Pharmakologie Und Praventive Medizin
Acta Diabetologica | Year: 2016
Aims: The addition of a single injection of insulin to the oral drugs (basal supported oral therapy; BOT) has been shown to greatly reduce blood glucose levels. The intermediate-acting NPH insulin (NPH) and the long-acting insulin glargine (Lantus®) have been compared for use in BOT in numerous clinical trials; however, their efficacy and safety in a real-life setting have not been described. Methods: TIP (therapeutic benefits of patients on insulin glargine vs. NPH insulin being poorly controlled on prior short-time basal-insulin supported therapy with NPH insulin or insulin glargine) is a non-interventional, multicentre, observational study over 24 weeks. A total of 2629 patients were enrolled and 1931 were fully evaluable (1614 insulin glargine, 303 NPH insulin). Propensity scoring (PSM) was used to match 570 patients into 2 similar cohorts of 285 patients. Results: In the PSM cohort, a slightly greater reduction in FBG and HbA1c levels was seen in the insulin glargine group compared to the NPH group. A weight loss, which was slightly more pronounced in insulin glargine patients despite receiving a lower insulin dose relative to the NPH group, was seen in both the groups. Additionally, hypoglycaemia, including nocturnal and severe events, was more prevalent in the patients receiving BOT with NPH. The occurrence of new micro- or macro-vascular complications and adverse events was low for both groups. A large proportion of patients changed from NPH therapy to insulin glargine therapy during the study, which was mainly attributable to insufficient glucose modulation. Improvements in quality of life and treatment satisfaction were found for both types of insulin. Conclusions: This observational study provides evidence from a real-life setting that BOT with insulin glargine provides slightly greater reductions in weight, FBG and HbA1c levels, with a lower risk of hypoglycaemia than patients receiving NPH. This conclusion indicates that insulin glargine may be preferable to NPH insulin for BOT. © 2016 Springer-Verlag Italia
Hermanns N.,FIDAM GmbH Forschungsinstitut Diabetes Akademie Bad Mergentheim |
Kaiser M.,Diabetologische Schwerpunktpraxis |
Reuter H.-M.,Diabetologische Schwerpunktpraxis |
Medding J.,Novo Nordisk AS |
And 2 more authors.
Diabetes, Stoffwechsel und Herz | Year: 2014
Introduction: Guidelines on type 2 diabetes recommend insulin treatment if oral anti-diabetics (OADs) fail. However, insulin treatment is often introduced rather late, which may be due to fear of injections and hypoglycaemia. Methods: DE-LIGHT was a six-month observational study on patients with type 2 diabetes initially on insulin for the first time after OAD treatment. The primary endpoint was treatment satisfaction (DTSQ); secondary parameters were: HbA 1c levels, hypoglycaemia frequency, fasting blood glucose, weight development, and diabetes-specific and general health-related quality of life (ADDQoL and EQ-5D, respectively). Results: The DE-LIGHT study followed 5498 patients on insulin detemir (IDet), and 2627 on NPH insulin (NPH). Treatment satisfaction at the end of the observation period was greater for IDet than for NPH (DTSQc/Treatment Satisfaction Scale Total: +10.7 vs. +9.0; p<0.0001), and the same was true for diabetes-related quality of life (p = 0.0053). Hypoglycaemic episodes occurred significantly less frequently in patients on IDet (0.61 vs. 0.85 episodes/patient year; p<0.0001), while HbA1c levels were similar between the two groups. Conclusion: Both insulin types showed an improvement in treatment satisfaction and diabetes-related quality of life in combination with oral anti-diabetics at around six months after the beginning of treatment; IDet showed significantly more pronounced improvement than did NPH.
Kolassa R.,Diabetologische Schwerpunktpraxis |
Siegmund T.,Stadtisches Klinikum Munich GmbH |
Thomas A.,Medtronic GmbH
Diabetes, Stoffwechsel und Herz | Year: 2013
Novel diabetes drugs and treatment technologies have improved diabetes treatment to match patient requirements, with insulin substitution close to physiological insulin secretion in type 1 diabetes (sensor-augmented pump therapy (SaP)). Continuous glucose monitoring (CGM) has played a major role in this development, as glucose regulation and therapeutic outcome used to rely on blood glucose and HbA1c measurement at intervals only; the former only allows limited interpretation with respect to glucose fluctuation, the latter does not allow any kind of interpretation. CGM, on the other hand, shows a complete record of glucose level fluctuation, raising the question as to whether non-physiological glucose fluctuation may pose a risk in acute and long-term complications. Unlike blood glucose measurement, CGM measures glucose levels in interstitial fluid leading to varying, though physiologically determined results in an increased glucose dynamic. Should this also play a role in future observation and intervention? Questions such as this may cause a paradigm shift in diabetology. The present contribution will address these considerations, its conclusions stemming from a large number of CGM profiles with comparable patterns that may provide a basis for discussion. Cellular measurements and experimental clinical studies should contribute further to answering the questions raised.
Kaiser M.,Diabetologische Schwerpunktpraxis
Arzneimitteltherapie | Year: 2010
Today, about 6% of the world population suffer from type 2 diabetes - with an increasing incidence. Since diabetes is a major cause for an enhanced mortality due to macro- and microangiopathic comorbidities, the effective treatment of glycemic goals has become a top priority of all available antidiabetic therapies. However, avoiding adverse events such as major hyperglycemia or strong weight gain is essential. Unfortunately, these are therapy limiting conditions that occur with most of the available treatment opportunities. Furthermore, most of the treatments cannot delay the two underlying pathophysiologic defects of the disease - the progressive β-cell dysfunction and the insulin resistance. Hence, many physicians and patients concentrate their attention on the recently approved incretin-based therapies, mainly the GLP-1-mimetics. Hitherto, exenatide has gained approval for its use in patients with type 2 diabetes. Another GLP-1 agonist is liraglutide which gained approval in June 2009. The results of the phase 3 LEAD program have been presented recently. The present publication wants to give a short overview of the new GLP-1-mimetics and tries to assess the risk-benefit ratio, based on the available data and the current recommendations of ADA and EASD.
Stephan U.D.,Diabetologische Schwerpunktpraxis
Journal fur Pharmakologie und Therapie | Year: 2014
Insufficient achievement of individualized treatment targets with type-2-diabetic treatment for more than 3 month is regarded as therapy failure. In such cases, an intensification of therapy is recommended according to national treatment guidelines, while a switch to another member within the same substance class is not intended. An ambulant observational study investigated 38 patients with type-2-diabetes, who did not adequately respond to a therapy with metformin and sitagliptin. Adaptation of therapy was done by switch to another DPP-4-inhibitor. Results show improvement in HbA1c in 81.6 [%] of patients with vildagliptin as add-on therapy to metformin.
PubMed | Institute For Pharmakologie Und Praventive Medizin, MVZ Stoffwechselmedizin Leipzig, Diabetologische Schwerpunktpraxis and Sanofi S.A.
Type: Journal Article | Journal: Acta diabetologica | Year: 2016
The addition of a single injection of insulin to the oral drugs (basal supported oral therapy; BOT) has been shown to greatly reduce blood glucose levels. The intermediate-acting NPH insulin (NPH) and the long-acting insulin glargine (Lantus()) have been compared for use in BOT in numerous clinical trials; however, their efficacy and safety in a real-life setting have not been described.TIP (therapeutic benefits of patients on insulin glargine vs. NPH insulin being poorly controlled on prior short-time basal-insulin supported therapy with NPH insulin or insulin glargine) is a non-interventional, multicentre, observational study over 24weeks. A total of 2629 patients were enrolled and 1931 were fully evaluable (1614 insulin glargine, 303 NPH insulin). Propensity scoring (PSM) was used to match 570 patients into 2 similar cohorts of 285 patients.In the PSM cohort, a slightly greater reduction in FBG and HbA1c levels was seen in the insulin glargine group compared to the NPH group. A weight loss, which was slightly more pronounced in insulin glargine patients despite receiving a lower insulin dose relative to the NPH group, was seen in both the groups. Additionally, hypoglycaemia, including nocturnal and severe events, was more prevalent in the patients receiving BOT with NPH. The occurrence of new micro- or macro-vascular complications and adverse events was low for both groups. A large proportion of patients changed from NPH therapy to insulin glargine therapy during the study, which was mainly attributable to insufficient glucose modulation. Improvements in quality of life and treatment satisfaction were found for both types of insulin.This observational study provides evidence from a real-life setting that BOT with insulin glargine provides slightly greater reductions in weight, FBG and HbA1c levels, with a lower risk of hypoglycaemia than patients receiving NPH. This conclusion indicates that insulin glargine may be preferable to NPH insulin for BOT.
PubMed | Universitatsklinikum Hamburg Eppendorf, The Interdisciplinary Center, Diabetologische Schwerpunktpraxis and Clinic of General
Type: Clinical Study | Journal: Obesity surgery | Year: 2016
The aim of this study was to demonstrate feasibility and safety of a new electric duodenal stimulation system (EDS, BALANCE) in humans. Secondary objectives were to evaluate the effect on glycemic control and weight loss in patients with obesity and type 2 diabetes mellitus (T2DM).In an open-labeled, prospective, single-arm, non-randomized multicenter study, 12 obese T2DM patients with a mean HbA1c of 8.0% received laparoscopic implantation of the BALANCE duodenal stimulating device. Adverse events, changes in glycemic control, cardiovascular parameters, and weight were collected. The follow-up period after implantation was 12 months.Device related severe adverse events did not occur. Mean HbA1c decreased by 0.8% (p=0.02) and mean fasting blood glucose level (FBG) was reduced by 19% (p=0.038) after the 12 months. Mean HDL level increased from 44 to 48 mg/dl (p=0.033).EDS is a feasible and safe procedure. Positive effects on T2DM and some cardiovascular parameters (HDL, weight) were seen. However, further prospective randomized blinded studies are needed in order to evaluate the potential of this new minimally invasive method.
PubMed | Hannover Medical School, Olgahospital, Diabetologische Schwerpunktpraxis, Forschungsinstitut Diabetes Akademie Bad Mergentheim and 6 more.
Type: | Journal: Journal of diabetes science and technology | Year: 2016
Optimal usage of continuous glucose monitoring (CGM) requires adequate preparation and training. Patients using a CGM system without special training often do not achieve their intended improvement of metabolic control or even stop using the system due to disappointing results. For this reason a structured training program called SPECTRUM was developed in Germany to ensure a high-quality standard for the use of CGM systems. This program is suitable for patients of all age groups and is applicable to all CGM systems and all forms of insulin therapy. Structured curricula (adults, parents of young children, adolescents) have been developed enabling diabetes centers with less experience to offer comprehensive CGM training. Key requirements of SPECTRUM were independency of manufacturers and product neutrality enabling certification for reimbursement after formal evaluation within the framework of a large clinical trial. SPECTRUM was published in January 2016 in German, and translations into other languages are planned.