MEDIGREIF Inselklinik Heringsdorf GmbH

Seebad Heringsdorf, Germany

MEDIGREIF Inselklinik Heringsdorf GmbH

Seebad Heringsdorf, Germany
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Schiel R.,MEDIGREIF Inselklinik Heringsdorf GmbH | Schiel R.,Health Science University | Thomas A.,Medtronic GmbH | Kaps A.,MEDIGREIF Inselklinik Heringsdorf GmbH | Bieber G.,Fraunhofer Institute for Computer Graphics Research
Experimental and Clinical Endocrinology and Diabetes | Year: 2011

To assess physical activity in patients with type 1 diabetes an innovative telemedical support system has been developed. The aim of the feasibility trial was to prove its use in a clinical setting. Patients/methods: 16 children/adolescents with type 1 diabetes mellitus aged 14.5±2.2 years (diabetes duration 6.5±3.6 years, HbA1c 8.8±1.0%) were included in the study. During a period of 13 days all the patients received a telemedical assessment system. It consists of a sensor for physical activity integrated into a mobile phone (DiaTrace). Additionally it is combined with a system for continuous blood glucose monitoring (CGM). Results: The technical system was highly accepted by all the 16 children and adolescents. Physical activity measured was 13.3±5.5AU/d, mean duration of total physical activity was 204.9±66.5min/d (walking 102.5±62.5, running 7.4±5.8, cycling 39.2±32.7, driving 36.0±18.6, non-specific physical activity 57.0±29.7min/d). Periods without activity lasted for 386.5±187.2min/d. Daily energy expenditure was 1964.1±185.5kcal/d. Correlations between physical activity (measured with DiaTrace) and blood glucose profiles (measured with CGM) were calculated. Pearson's correlation coefficients ranged between 0.59 and 0.99 (median 0.91). Hence, these good correlation coefficients show the high and direct association between blood glucose values and activity units. The wide ranges in correlation coefficients demonstrate a huge variability of individualized reactions. Conclusions: Use of innovative electronic health technology is highly accepted by patients. It reveals an accurate, real-time assessment of an individual's physical activity. These information can use for insulin dose-adjustment. © 2011 J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart. New York.


Schiel R.,MEDIGREIF Inselklinik Heringsdorf GmbH | Schiel R.,Health Science University | Kaps A.,MEDIGREIF Inselklinik Heringsdorf GmbH | Bieber G.,Fraunhofer Institute for Computer Graphics Research
Appetite | Year: 2012

Objective: It was the goal of the trial to study the impact of electronic healthcare technology into treatment. Methods: One hundred and twenty-four children/adolescents (females 56%, age 13.5±2.8years, height 1.64±0.13m, weight 85.4±23.0kg, body-mass index (BMI) 31.3±5.2kg/m 2, BMI-standard deviation score (SDS) 2.50±0.5) were included. To assess physical activity and eating habits, a mobile motion sensor integrated into a mobile phone with digital camera was used. Results: The children/adolescents had a significant weight reduction of 7.1±3.0kg. BMI/BMI-SDS decreased (p<0.01). Intensity (14.1±6.4 activity units) and duration of physical activity (290.4±92.6min/day) were assessed with sensors. Time walking: median 45.5 (range, 2.5-206.5), running 8.0 (range, 0-39.5), cycling 27.7 (range, 0-72.5), car driving 23.7 (range, 0-83.0) min/day. Comparing self-reported physical activity (walking 292.9 (range, 9.6-496.1), running 84.8 (range, 8.4-130.2) min/day) with assessment with sensors there were significant differences (p<0.01). Duration of physical activity documented by children/adolescents was higher than the assessment with motion sensors (walking 292.9 vs 45.5min, p<0.01, running 84.8 vs 8.0min, p<0.01). Sensor derived energy intake was higher than recommended (469.14±88.75kcal vs 489.03±108.25kcal, p=0.09). Performing multivariate analysis the following parameters showed associations with weight reduction (R-square=0.75): body weight (β=-0.95, p<0.01), C-reactive protein (CRP, β=0.15, p=0.07), physical activity, time spent in activities measured with sensors (β=-0.18, p=0.04), stress management (β=0.16, p=0.06), body fat mass at onset of the trial (β=0.45, p<0.01) and body shape (β=-0.25, p=0.01). Conclusion: The innovative mobile movement detection system is highly accepted by children and adolescents. The system is able to augment existing weight reduction and stabilization strategies. © 2011 Elsevier Ltd.


Schiel R.,MEDIGREIF Inselklinik Heringsdorf GmbH | Vahl T.,MEDIGREIF Inselklinik Heringsdorf GmbH | Bieber G.,Fraunhofer Institute for Computer Graphics Research
Diabetologie und Stoffwechsel | Year: 2015

Overweight and obesity are risk factors for a variety of long-term complications. An innovative strategy for therapy and long-term follow-up seem to be interactive, telemedical technologies. Such a technology was analyzed in theresent trial. Methods: N?=?34 children/adolescents (age 14.4?±?1.7 years, BMI-SDS 2.70?±?0.45) with overweight and obesity were randomised to an intervention group (application of InterLearn, a computer-based system for monitoring, information and training, Fraunhofer-Institut für Grafische Datenverarbeitung, Rostock). N?=?27 children/adolescents (age 13.0?±?3.1 years,?=?0.44 vs. intervention group, BMI-SDS 2.53?±?0.56,?=?0.19 vs. intervention group) were treated in a control group (established treatment without telemedical application). Analyses wereerformed at the end of a 6-week in-house rehabilitation and 12 months later. Results: Analyseser-intention to treat: 79?% (n?=?27) of theatients out of the intervention group were re-examined vs. 41?% (n?=?11) out of the control group.?During the in-house rehabilitation both groups reached a weight reduction (intervention group BMI 33.8?±?4.0 vs. 31.4?±?3.6?kg/m2,?


Schiel R.,MEDIGREIF Inselklinik Heringsdorf GmbH | Perenthaler T.J.,MEDIGREIF Inselklinik Heringsdorf GmbH | Steveling A.,University of Greifswald | Stein G.,Friedrich - Schiller University of Jena
Diabetes Research and Clinical Practice | Year: 2016

In a cohort of children and adolescents with type 1 diabetes mellitus the trial tested the hypothesis that copeptin levels are associated with kidney function, biometrical data and quality of diabetes control. Patients and methods A total of 141 subjects were recruited to participate in the trial: 80 patients with type 1 diabetes (13.0 ± 3.4 years, HbA1c 7.85 ± 1.42%) and 61 healthy controls (12.4 ± 2.8 years). Clinical and socio-economic data were assessed. A sandwich immunoassay (B.R.A.H.M.S. GmbH/Thermo Fisher Scientific, Hennigsdorf/Berlin, Germany) was used for measuring plasma copeptin levels. Results The mean concentration of copeptin in the diabetic patients was 4.75 ± 3.46 pmol/l. There was a strong inverse correlation between copeptin and GFR (r = −0.86, p = 0.021), as well as with total cholesterol (r = −0.23, p = 0.041), LDL-cholesterol (r = −0.24, p = 0.036), but not with serum creatinine, albuminuria, HbA1c, blood glucose, MAGE, CRP, systolic or diastolic blood pressure or age, diabetes duration, weight, height and BMI. Comparing patients with a diabetes duration of ⩾7 years (n = 45) with those with a diabetes duration <7 years (n = 35), patients with a longer duration of diabetes had higher copeptin levels (5.24 ± 2.26 vs 4.13 ± 2.86, p = 0.045). Performing multivariate analyses only GFR could be identified as a parameter associated with copeptin (R-square = 0.05, β = −0.23, p = 0.032). In the healthy controls mean copeptin concentration was 5.56 ± 3.15 pmol/l. The copeptin concentration and GFR were inversely correlated as well (r = −0.61, p = 0.034). However, other correlation and multivariate analyses revealed no further significant results. Comparing patients with type 1 diabetes mellitus with the healthy controls, the diabetes patients revealed no significant difference with respect to copeptin (p = 0.24), serum creatinine (49.8 ± 11.9 vs 50.4 ± 11.0 μmol/l, p = 0.53) or GFR (102.4 ± 23.3 vs 104.5 ± 19.1 ml/min, p = 0.47). On the other hand, patients with type 1 diabetes had lower concentrations of CRP (1.66 ± 3.91 vs 3.21 ± 3.04 μg/ml, p = 0,013), triglycerides (0.88 ± 0.53 vs 1.13 ± 0.60 mmol/l, p = 0.010), and a lower ratio of LDL-/HLD-cholesterol (1.73 ± 0.69 vs 2.32 ± 0.80, p < 0.001), as well as lower body weight (51.3 ± 18.0 vs 60.3 ± 15.7 kg, p = 0.002) and BMI (19.7 ± 3.8 vs 23.2 ± 2.9 kg/m2, p < 0.001). In contrast to the controls, the diabetes patients had higher blood glucose levels at the time of examination (8.2 ± 3.8 vs 4.7 ± 0.5 mmol/l, p < 0.001), higher HDL-cholesterol levels (1.59 ± 0.34 vs 1.26 ± 0.24 mmol/l, p < 0.001), as well as higher education and higher educational levels of the mothers. Conclusions The present trial revealed a clear association between GFR and copeptin in children and adolescents with type 1 diabetes mellitus. Hence, copeptin can be considered as a marker of renal function. © 2016 Elsevier Ireland Ltd


Schiel R.,MEDIGREIF Inselklinik Heringsdorf GmbH | Kaps A.,Fraunhofer Institute For Graphische Datenverarbeitung | Bieber G.,MEDIGREIF Inselklinik Heringsdorf GmbH | Kramer G.,MEDIGREIF Inselklinik Heringsdorf GmbH | And 2 more authors.
Journal of Telemedicine and Telecare | Year: 2010

We conducted a pilot trial of electronic technology integrated into the treatment of children and adolescents who are overweight or obese. A total of 30 patients (mean age 14 years, mean BMI 32.7 kg/m 2) were admitted to our hospital to participate in a structured treatment and teaching programme (STTP). To assess physical activity and eating habits, a mobile motion sensor board (MoSeBo) or a sensor for physical activity, integrated into a mobile phone with digital camera (DiaTrace) was used. Over an average period of four days of monitoring, the mean intensity (15.4 activity units) and duration of physical activity (267 min/d) were recorded with the mobile sensors. The mean time spent walking was 64 min/d, running 11 min/d, cycling 24 min/d and car driving 21 min/d. There were significant differences (P<0.001) between self-reported physical activity and objective assessment: in general the duration of physical activity documented by children and adolescents was much higher than the objective assessment. Similarly, the real caloric intake was higher than the self-estimates (P = 0.085). A multivariate analysis showed that the following variables were significantly associated with weight reduction in the hospital STTP (R-squared = 0.59): high motivation, intrafamilial conflicts, duration of physical activity assessed with the MoSeBo/DiaTrace system, and the body fat mass at onset of therapy. All children and adolescents included in the trial completed it. Although the MoSeBo/DiaTrace system was used for a relatively short period in each patient, the high acceptance demonstrated that it could be integrated into therapy easily.


Schiel R.,MEDIGREIF Inselklinik Heringsdorf GmbH | Kaps A.,MEDIGREIF Inselklinik Heringsdorf GmbH | Stein G.,Friedrich - Schiller University of Jena | Steveling A.,University of Greifswald
Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen | Year: 2016

Introduction: Worldwide, overweight and obesity are known as posing serious health risks. Successful methods for weight reduction have remained elusive. It was the aim of the present trial to identify parameters and determinants to guarantee long-term weight reduction. Patients and methods: A total of 143/159 overweight and obese children and adolescents (90 %) completed the prospective multicenter trial (age 13.9±2.4 years, BMI 31.2±5.4kg/m2, BMI-SDS 2.51±0.57). During a 6-week rehabilitation period the patients participated in a structured treatment and teaching program (STTP). Following in-patient treatment the children and adolescents were monitored over a period of 24 months (physical examination, measurements of BMI, BMI-SDS, body composition, carotid intima-media thickness, laboratory parameters, blood pressure, standardized questionnaires to assess socio-demographic, socio-economic parameters, eating behavior, well-being, quality of life, intelligence, intrafamilial conflicts, self-efficacy, resilience, sense of coherence, stress management, social support, actual body shape). Results: 66% of the children and adolescents had abnormal laboratory parameters as well as higher blood pressure and/or an increased carotid intima-media thickness. The mean carotid intima-media thickness was 0.53. ±. 0.09. mm (range 0.40 to 0.80); 15% of the patients showed normal range values (< 0.45. mm), 40% a slightly elevated (≥ 0.45 to ≤ 0.50. mm) and 45% an elevated (> 0.50. mm) thickness. After the inpatient treatment lasting 40.4. ±. 4.1 (range 28 to 49) days, children and adolescents reached a mean weight reduction of 5.52. ±. 3.94 (0.4 to 13.3) kg (p <. 0.01) that was accompanied by a reduction in body fat mass. Using multivariate analyses, the most important psychological factors associated with long-term weight reduction were identified (R-square = 0.53): well-being (β = -0.543), resilience (β = 0.434), and sense of coherence (β = 0.315). Conclusion: The different parameters (i. e., well-being, resilience, sense of coherence) have demonstrated their utility, and strategies should be developed allowing an adaption of these into the STTPs and the integration of intervention into the therapeutic setting. © 2016.


PubMed | University of Greifswald, MEDIGREIF Inselklinik Heringsdorf GmbH and Friedrich - Schiller University of Jena
Type: | Journal: Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen | Year: 2016

Worldwide, overweight and obesity are known as posing serious health risks. Successful methods for weight reduction have remained elusive. This multicenter non-randomised trial aimed to identify parameters and determinants of long-term weight reduction.A total of 143/159 overweight and obese children and adolescents (90%) completed the prospective multicenter trial (age 13.92.4 years, BMI 31.25.4kg/m66% of the children and adolescents had abnormal laboratory parameters as well as higher blood pressure and/or an increased carotid intima-media thickness. The mean carotid intima-media thickness was 0.530.09mm (range 0.40 to 0.80); 15% of the patients showed normal range values (<0.45mm), 40% a slightly elevated (0.45 to 0.50mm) and 45% an elevated (>0.50mm) thickness. After the inpatient treatment lasting 40.44.1 (range 28 to 49) days, children and adolescents reached a mean weight reduction of 5.523.94 (0.4 to 13.3) kg (p<0.01) that was accompanied by a reduction in body fat mass. Using multivariate analyses, the most important psychological factors associated with long-term weight reduction were identified (R-square=0.53): well-being (=-0.543), resilience (=0.434), and sense of coherence (=0.315).The different parameters (i.e., well-being, resilience, sense of coherence) have demonstrated their utility, and strategies should be developed allowing an adaption of these into the STTPs.


PubMed | University of Greifswald, MEDIGREIF Inselklinik Heringsdorf GmbH and Friedrich - Schiller University of Jena
Type: | Journal: Diabetes research and clinical practice | Year: 2016

In a cohort of children and adolescents with type 1 diabetes mellitus the trial tested the hypothesis that copeptin levels are associated with kidney function, biometrical data and quality of diabetes control.A total of 141 subjects were recruited to participate in the trial: 80 patients with type 1 diabetes (13.03.4years, HbA1c 7.851.42%) and 61 healthy controls (12.42.8years). Clinical and socio-economic data were assessed. A sandwich immunoassay (B.R.A.H.M.S. GmbH/Thermo Fisher Scientific, Hennigsdorf/Berlin, Germany) was used for measuring plasma copeptin levels.The mean concentration of copeptin in the diabetic patients was 4.753.46pmol/l. There was a strong inverse correlation between copeptin and GFR (r=-0.86, p=0.021), as well as with total cholesterol (r=-0.23, p=0.041), LDL-cholesterol (r=-0.24, p=0.036), but not with serum creatinine, albuminuria, HbA1c, blood glucose, MAGE, CRP, systolic or diastolic blood pressure or age, diabetes duration, weight, height and BMI. Comparing patients with a diabetes duration of 7years (n=45) with those with a diabetes duration <7years (n=35), patients with a longer duration of diabetes had higher copeptin levels (5.242.26 vs 4.132.86, p=0.045). Performing multivariate analyses only GFR could be identified as a parameter associated with copeptin (R-square=0.05, =-0.23, p=0.032). In the healthy controls mean copeptin concentration was 5.563.15pmol/l. The copeptin concentration and GFR were inversely correlated as well (r=-0.61, p=0.034). However, other correlation and multivariate analyses revealed no further significant results. Comparing patients with type 1 diabetes mellitus with the healthy controls, the diabetes patients revealed no significant difference with respect to copeptin (p=0.24), serum creatinine (49.811.9 vs 50.411.0mol/l, p=0.53) or GFR (102.423.3 vs 104.519.1ml/min, p=0.47). On the other hand, patients with type 1 diabetes had lower concentrations of CRP (1.663.91 vs 3.213.04g/ml, p=0,013), triglycerides (0.880.53 vs 1.130.60mmol/l, p=0.010), and a lower ratio of LDL-/HLD-cholesterol (1.730.69 vs 2.320.80, p<0.001), as well as lower body weight (51.318.0 vs 60.315.7kg, p=0.002) and BMI (19.73.8 vs 23.22.9kg/m(2), p<0.001). In contrast to the controls, the diabetes patients had higher blood glucose levels at the time of examination (8.23.8 vs 4.70.5mmol/l, p<0.001), higher HDL-cholesterol levels (1.590.34 vs 1.260.24mmol/l, p<0.001), as well as higher education and higher educational levels of the mothers.The present trial revealed a clear association between GFR and copeptin in children and adolescents with type 1 diabetes mellitus. Hence, copeptin can be considered as a marker of renal function.


PubMed | University of Greifswald, MEDIGREIF Inselklinik Heringsdorf GmbH and Friedrich - Schiller University of Jena
Type: Journal Article | Journal: Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association | Year: 2016

Today continuous subcutaneous insulin infusion (CSII) is frequently used in children and adolescents with type 1 diabetes mellitus. The present cross-sectional trial aimed to document current practice, quality of diabetes control and incidence of acute complications in different age-groups under CSII vs. multiple daily insulin injection therapy (MIT). Moreover the survey analyzed socio-demographic backgrounds of the patients.A total of 901 patients (age 11.54.0, diabetes duration 4.03.6 years) was entered in the database. Clinical data, laboratory parameters and, using a standardized questionnaire, socio-demographic data were assessed. For age-related analyses patients were allocated to 4 groups: pre-school children (<6 years), pre-adolescents (6 and<11 years), adolescents (11and<16 years) and young adults (16 and<22 years).Of the cohort n=194 had a CSII, n=707 had a MIT. Patients with CSII vs. MIT had a longer diabetes duration, they used more frequently insulin analogues, performed more frequently blood-glucose self-tests and had a lower insulin dosage per kilogram body weight. In respect of HbA1c, the mean amplitude of blood-glucose excursions, but also of lipids, creatinine, microalbuminuria and blood pressure, there were no differences in neither age-group between patients with CSII and MIT. In patients with CSII and MIT, there was a tendency (p<0.05) towards an increase in HbA1c in adolescents and young adults and there was a decrease (p<0.05 for tendency) in the frequency of hypoglycaemia from the age group of young adults to pre-school children. Adolescents and young adults with CSII had a higher educational level. Pre-adolescents, adolescents and young adults with CSII have also better diabetes-related knowledge. Moreover, in all age-groups, the parents of patients with CSII had mostly a lower unemployment rate and higher educational levels.The present analyses demonstrate that in all age-groups CSII provides convenient and flexible insulin delivery during routine treatment of type 1 diabetes. There is reasonable quality of diabetes control accompanied by a low incidence of hypoglycaemia and ketoacidosis. However, under CSII and MIT there is an increase of HbA1c towards adolescence. It must also highlighted that CSII seems to be expansive and that CSII is more frequently used in patients with better educational levels and deriving from higher social classes.


PubMed | University of Greifswald, MEDIGREIF Inselklinik Heringsdorf GmbH and Friedrich - Schiller University of Jena
Type: Journal Article | Journal: Healthcare (Basel, Switzerland) | Year: 2016

Worldwide, overweight and obesity are known as posing serious health risks. Successful methods of prevention and therapy for overweight and obesity have remained elusive. It was the aim of the present trial to identify parameters and determinants to guarantee long-term weight reduction.In total 143/159 children and adolescents (90%) with overweight and obesity completed the prospective, multicenter trial (age 13.9 2.4 years, BMI 31.2 5.4 kg/m, BMI-SDS 2.51 0.57). During a six-week rehabilitation patients participated in a structured treatment and teaching program (STTP). Following the inpatient treatment the children and adolescents were monitored over a period of 24 months (physical examination, measurements of BMI, BMI-SDS, body composition, carotid intima-media thickness, laboratory parameters, blood pressure, and standardized questionnaires to assess socio-demographic, socio-economic parameters, eating behavior, well-being, quality of life, intelligence, intrafamilial conflicts, self-efficacy, resilience, sense of coherence, stress-management, social support, and actual body shape).66% of the children and adolescents showed non-normal laboratory parameters as well as higher blood pressure and/or an increased carotid intima-media thickness. Mean thickness of carotid intima-media was 0.53 0.09 mm (range, 0.40-0.80); 15% of the patients showed a normal range (<0.45 mm), 40% slightly elevated (0.45-0.50 mm) and 45% an elevated (>0.50 mm) thickness. After an inpatient treatment lasting 40.4 4.1 (range, 28-49) days, children and adolescents reached a mean weight reduction of 5.52 3.94 (0.4-13.3) kg (p < 0.01) accompanied by a reduction of body fat mass. Performing multivariate analyses, the most important psychological factors associated with long-term weight reduction were identified (R-square = 0.53): Well-being ( = -0.543), resilience ( = 0.434) and intrafamilial conflicts ( = 0.315).The different parameters (i.e., resilience, intrafamilial conflicts, structured daily schedule) have demonstrated their utility and strategies should be developed allowing an adaption of these into the STTPs and the integration of intervention into the therapeutic setting.

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