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Hannover, Germany

People with diabetes are at increased risk of cognitive dysfunction and dementia. As potential risk factors chronic exposure to hyperglycemia, vascular complications, hypertension, depression and genetic factors are discussed. In addition for older patients with cognitive dysfunction there seems to be an association between the frequency of severe hypoglycemia and cognitive decline. Dementia as a severely limiting factor of diabetes self-management requires glycemic goals and therapeutic strategies which are individually customized to patient-specific risks and impairments. In patients with limited cognitive functioning, glycemic goals may be less intensive but hyperglycemia leading to symptoms or risk of acute hyperglycemic complications should be avoided. Patients with severe cognitive deficits require a wellcoordinated multidisciplinary geriatric and diabetic care. © Springer-Verlag 2012. Source


Zillmer S.,Helmholtz Center Munich | Warncke K.,Helmholtz Center Munich | Raab J.,Helmholtz Center Munich | Winkler C.,Helmholtz Center Munich | And 8 more authors.
Diabetes, Stoffwechsel und Herz | Year: 2016

Type 1 diabetes incidence has been increasing every year, especially in infants; the disease is often diagnosed at an advanced stage with diabetic ketoacidosis already present. Diagnosis at an early stage can prevent complications, and is one of the objectives in the Fr1da study, the first project of its kind worldwide that has screened more than 33000 infants - Aged two to five years for islet antibodies since January 2015. The first three cases that were diagnosed with an early stage of type 1 diabetes (positive for two or more islet autoantibodies) have already been included in a structured follow-up programme. The present contribution will cover these cases as examples for the process from positive screening result to individual prediabetes training. Source


Hussein R.J.,Institute For Epidemiologie | Schneller T.,Medizinische Psychologie | Dierks M.-L.,Institute For Epidemiologie | Walter U.,Institute For Epidemiologie
Gesundheitswesen | Year: 2013

Objective: Dentists' suggestions for the establishment of preventive care were investigated on 3 levels; dentist, dental associations and unions (DAU), and health care system (HCS). Associations between categories of suggestions and dentists' characteristics were explored. Methods: A postal survey was sent to 2 075 dentists practicing in Bremen and Lower Saxony. The answers on 3 open-ended questions were analysed in a qualitative manner based on the quality control protocol (QCP) of the Federal Joint Committee. Quantitative methods were used for exploring associations between categories of suggestions and gender as well as age. Results: Response rate was 33% (n=685). Dentists made 2 120 suggestions (dentist=752, DAU= 574, HCS= 794). The majority of dentists (90%) suggested educating and motivating patients. Dentists stated that support from DAU is needed in educating the public (50%), offering preventive-oriented training (35%), and in advertising for prophylaxis (18%). On the HCS level, about 60% of the suggestions concerned remunerating prophylaxis and expanding the existing bonus system. Significantly more female (p=0.010) and younger dentists (p=0.031) contributed to educating patients than male and older dentists. Conclusion: Education is the key message of this work. Essential topics such as prevention for elderly and risk groups were not a focal point. Education on the DAU and HCS levels can be realised through organising nation-wide health campaigns. Funding options for prevention and regulating multidisciplinary work between dentists and other health-care providers should be examined. These changes can contribute enormously to further establish prevention. © Georg Thieme Verlag KG Stuttgart. New York. Source


Gaul C.,Universitatsklinikum Essen | Gaul C.,Martin Luther University of Halle Wittenberg | Malcherczyk A.,Martin Luther University of Halle Wittenberg | Schmidt T.,Medizinische Psychologie | And 2 more authors.
Medizinische Klinik | Year: 2010

Background: Difficulties in recruiting patients for clinical trials lead to increasing costs, and prolonged implementation of evidences into medical practice. Knowledge about motivation and barriers in potential participants would be helpful to develop successful recruitment strategies. Currently, no systematic research of determining factors affecting the decision to participate in clinical studies is available from German samples. Methods: After been given details about a potential participation in a clinical or diagnostic study in nine study centers, patients were recruited for an additional structured questionnaire survey concerning motivation and barriers to participation. Results: 62 patients were included into the survey. 95.1% did not have any experience with clinical studies before. 66.1% met the physician explaining the study and asking for informed consent for the first time. Despite this, 96.6% judged the physician to be competent. Family and friends were important for decision-making about the participation in a study. Gender was only of marginal influence. The majority of patients (91.4%) expected advantages of the study for their own. 88% of the patients denominated potential advantages for other patients as an additional motivator. The possibility of adverse events was inferior for patients in decision-making about participation in a clinical trial. Conclusion: Physicians recruiting patients for clinical studies should be well prepared about details of the study and should have adequate time for an introductory conversation in a quiet environment. Including relatives into the introductory conversation may enhance the motivation and therefore the success of recruitment. Potential advantages of a participation for the own treatment and additionally for other patients should be highlighted. Possible side effects should be explained in a realistic manner. © 2010 Urban & Vogel, Muenchen. Source


Hevelke L.K.,Medizinische Psychologie | Albrecht C.,Klinik fur Kinder und Jugendliche | Busse-Widmann P.,Klinik fur Kinder und Jugendmedizin | Kranz J.,University of Tubingen | And 6 more authors.
PPmP Psychotherapie Psychosomatik Medizinische Psychologie | Year: 2016

Introduction: Published data on prevalence of disturbed eating behavior in youth with type 1 diabetes are heterogeneous. This study assesses the prevalence rate of disturbed eating behavior in a representative German sample of children and adolescents with type 1 diabetes. The prevalence rate is compared to the one published for a national sample of healthy peers. Furthermore prospects as well as limits of a generic screening tool used to identify disturbed eating behavior are compared to those of a diabetes specific screening tool. Material and Methods: A total of 246 children and adolescents (age: 11-19 years) with type 1 diabetes, from 6 pediatric diabetes centers in Germany, completed the generic SCOFF questionnaire and the diabetes specific Diabetes Eating Problem Survey-Revised (DEPS-R) to assess their eating behavior. Prevalence data were compared to representative data from a nationwide survey in Germany (KiGGS-study). Results: A total of 16.3% of the children and adolescents with type 1 diabetes scored above the SCOFF cut-off (≥ 2) (24.2% of the girls and 8.9% of the boys). The percentages in the healthy controls were 28.9% for girls and 15.2% for boys. Compared to this the prevalence of disturbed eating behavior was lower in the diabetes group (p=0.017 and p<0.001). According to the diabetes specific DEPS-R 11.2% of the boys and 13.2% of the girls with type 1 diabetes practiced insulin-purging. The association between SCOFF-scores and the items referring to insulin-purging in DEPS-R, was stronger for girls than for boys (r=0.437 vs. r=0.144). Among the young people with type 1 diabetes DEPS-R-scores showed stronger associations to the quality of metabolic control (HbA1c) than the SCOFF (boys: r=0.357 vs. r=0.217 and girls: r=0.368 vs. r=0.131). Discussion: Children and adolescents with type 1 diabetes are not more frequently affected by disturbed eating behavior than their healthy peers. Particularly boys with type 1 diabetes practicing insulin-purging, are not reliably detected by a generic screening tool. Conclusion: As part of long-term care a diabetes specific screening tool should be used to identify adolescents with type 1 diabetes and disturbed eating behavior more reliably. © Georg Thieme Verlag KG Stuttgart · New York. Source

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