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Bendas A.,University Hospital Dresden | Rothe U.,TU Dresden | Kiess W.,University of Leipzig | Kapellen T.M.,University of Leipzig | And 10 more authors.

Aims To estimate the national incidence rate and trend of type 1 diabetes (T1DM) in Germany from 1999 to 2008 and the national prevalence in 2008 in the age group 0-14 years. Methods Data were taken froma nationwide registry for incident cases of T1DM in the ages 0-4 years and 3 regional registries (North-Rhine-Westphalia, Baden-Wuerttemberg and Saxony) for incident cases of T1DM in the ages 0-14 years covering 41%of the child population in Germany. The degree of ascertainment was ≥ 97%in all registries. Incident and prevalent cases were grouped by region, sex, age (0-4, 5-9, 10-14 years), and, for incident data, additionally by two 5-year periods (1999-2003, 2004-2008). Poisson regression models were fitted to the data to derive national estimates of incidence rate trends and prevalence in the age groups 5-9, 10-14 and 0-14 years. We used direct age-standardization. Results The estimated national incidence rate in 0-14-year-olds increased significantly by 18.1% (95%CI: 11.6-25.0%, p<0.001) from 1999-2003 to 2004-2008, independent of sex, corresponding to an average annual increase of 3.4% (95%-CI: 2.2-4.6%). The overall incidence rate was estimated at 22.9 per 100,000 person-years and we identified a within-country west-east-gradient previously unknown. The national prevalence in the ages 0-14 years on 31/12/2008 was estimated to be 148.1 per 100,000 persons. Conclusions The national incidence rate of childhood T1DM in Germany is higher than in many other countries around the world. Importantly, the estimated trend of the incidence rate confirms the international data of a global increase of T1DM incidences. Copyright: © 2015 Bendas et al. Source

Ehehalt S.,University Hospital of Tuebingen | Neu A.,University Hospital of Tuebingen | Heinke P.,Institute of Diabetes Gerhardt Katsch Karlsburg | Willasch A.M.,Goethe University Frankfurt | Dietz K.,University of Tubingen
Experimental and Clinical Endocrinology and Diabetes

Objective: To examine the impact of rapidly changing environmental factors on the incidence of type 1 diabetes mellitus (T1D). Method: We compared the frequency of T1D in children before and after the reunification of Germany by means of the registries of the German Democratic Republic (GDR, 1960-1989) and of Baden-Wuerttemberg (BW, 1987-2006). The number of cases of diabetes onset in East Germany after the reunification was predicted by a mathematical model. The observed incidence rate in the Eastern part of Germany after the reunification was taken from the literature 1. Results: In Germany, the incidence rate of T1D in children aged 0-14 was 7.2/100000/year (95%-CI 6.9-7.5, GDR, 1980-1987), and 10.4/100000/year (95%-CI 9.5-11.4, BW, 1987-1994). For the whole observation period (1960-2006), the observed incidence rates y could be described by the square of a linear function [GDR: y=(1.86 + 0.040*(year - 1960)) 2; r2=0.85; BW: y=(3.03+0.085*(year - 1987)) 2, r2=0.89]. The mean rise in incidence before the reunification was less than half the mean rise after the reunification (mean slope: BW 0.085, 95%-CI 0.080-0.090 vs. GDR 0.040, 95% CI 0.036-0.044). The observed incidence for East Germany after 1989 was higher than the prediction on the basis of the GDR registry (GDR 12.3/100000/year vs. Saxony 15.7/100000/year, 95%-CI 14.2-17.3, n=412; 1999-2003). Conclusion: We conclude that the basis for the disease progress is a genetic predisposition. Environmental factors may modify changes in incidence of type 1 diabetes but do not determine the overall risk. © Georg Thieme Verlag KG Stuttgart · New York. Source

Salzsieder E.,Institute of Diabetes Gerhardt Katsch Karlsburg | Salzsieder E.,Diabetes Service Center | Augstein P.,Institute of Diabetes Gerhardt Katsch Karlsburg | Augstein P.,Walter and Eliza Hall Institute of Medical Research
Journal of Diabetes Science and Technology

Background: Several telemedicine-based eHealth programs exist, but patient-focused personalized decision support (PDS) is usually lacking. We evaluated the acceptance, efficiency, and cost-effectiveness of telemedicine-assisted PDS in routine outpatient diabetes care. Methods: Data are derived from the Diabetiva® program of the German health insurance company BKK TAUNUS. Diabetiva offers telemedicine-based outpatient health care in combination with PDS generated by the Karlsburg Diabetes Management System, KADIS®. This retrospective analysis is based on data from the first year of running KADIS-based PDS in routine diabetes care. Participants were insured persons diagnosed with diabetes and cardiovascular diseases. For final analysis, patients were grouped retrospectively as users or nonusers according to physician acceptance or not (based on questionnaires) of the KADIS-based PDS. Results: A total of 538 patients participated for more than one year in the Diabetiva program. Of these patients, 289 had complete data sets (two continuous glucose monitoring measurements, two or more hemoglobin A1c (HbA1c) values, and a signed questionnaire) and were included in the final data analysis. Of the physicians, 74% accepted KADIS-based PDS, a rate that was clearly related to HbA1c at the beginning of the observation. If KADIS-based PDS was accepted, HbA1c decreased by 0.4% (7.1% to 6.7%). In contrast, rejection of KADIS-based PDS resulted in an HbA1c increase of 0.5% (6.8% to 7.3%). The insurance company revealed an annual cost reduction of about 900 € per participant in the Diabetiva program. Conclusions: KADIS-based PDS in combination with telemedicine has high potential to improve the outcome of routine outpatient diabetes care. © Diabetes Technology Society. Source

Salzsieder E.,Institute of Diabetes Gerhardt Katsch Karlsburg | Vogt L.,Diabetes Service Center Karlsburg | Kohnert K.-D.,Institute of Diabetes Gerhardt Katsch Karlsburg | Heinke P.,Institute of Diabetes Gerhardt Katsch Karlsburg | Augstein P.,Institute of Diabetes Gerhardt Katsch Karlsburg
Computer Methods and Programs in Biomedicine

The model-based Karlsburg Diabetes Management System (KADIS®) has been developed as a patient-focused decision-support tool to provide evidence-based advice for physicians in their daily efforts to optimize metabolic control in diabetes care of their patients on an individualized basis. For this purpose, KADIS® was established in terms of a personalized, interactive in silico simulation procedure, implemented into a problem-related diabetes health care network and evaluated under different conditions by conducting open-label mono- and polycentric trials, and a case-control study, and last but not least, by application in routine diabetes outpatient care. The trial outcomes clearly show that the recommendations provided to the physicians by KADIS® lead to significant improvement of metabolic control. This model-based decision-support system provides an excellent tool to effectively guide physicians in personalized decision-making to achieve optimal metabolic control for their patients. © 2010 Elsevier Ireland Ltd. Source

Kohnert K.-D.,Institute of Diabetes Gerhardt Katsch Karlsburg | Freyse E.-J.,Institute of Diabetes Gerhardt Katsch Karlsburg | Salzsieder E.,Institute of Diabetes Gerhardt Katsch Karlsburg | Salzsieder E.,Diabetes Service Center Karlsburg
Current Diabetes Reviews

The importance of glycaemic variability (GV) as a factor in the pathophysiology of cellular dysfunction and late diabetes complications is currently a matter of debate. However, there is mounting evidence from in vivo and in vitro studies that GV has adverse effects on the cascade of physiological processes that result in chronic ß-cell dysfunctions. Glucose fluctuations more than sustained chronic hyperglycaemia can induce excessive formation of reactive oxygen (ROS) and reactive nitrogen species (RNS), ultimately leading to apoptosis related to oxidative stress. The insulinsecreting ß-cells are particularly susceptible to damage imposed by oxidative stress. Evidence from experiments, using isolated pancreatic islets or ß-cell lines, has linked intermittent high glucose, which mimicks GV under diabetic conditions, to significant impairment of ß-cell function. Several clinical studies reported a close association between GV and ß-cell dysfunction, although the deleterious effects are difficult to demonstrate. Notwithstanding, early therapeutic interventions in patients with type 1 as well as type 2 diabetes, using different strategies of optimising glycaemic control, have shown that favourable outcomes on recovery and maintenance of ß-cell function correlated with reduction of GV. The purpose of the present review is to discuss the detrimental effects of GV and associations with ß-cell function as well as upcoming therapeutic strategies directed towards minimising glucose excursions, improving ß-cell recovery and preventing progressive ß-cell loss. Measuring GV has importance for management of diabetes, because it is the only one component of the dysglycaemia that reflects the degree of dysregulation of glucose homeostasis. © 2012 Bentham Science Publishers. Source

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