This position statement reflects the opinion of the Austrian Diabetes Association concerning the perioperative management of patients with diabetes mellitus based on the available scientific ...evidence. The paper covers necessary preoperative examinations from an internal/diabetological point of view as well as the perioperative metabolic control by means of oral antidiabetics and/or insulin therapy.
Zusammenfassung
Das vorliegende Positionspapier beschreibt die Sicht der Österreichischen Diabetes Gesellschaft hinsichtlich des perioperativen Managements von Patienten mit Diabetes mellitus auf ...Basis der verfügbaren wissenschaftlichen Evidenz. Dabei wird Bezug genommen auf die präoperative Begutachtung und Vorbereitung sowie auf die perioperative Stoffwechselkontrolle mittels oraler Antidiabetika und/oder injektabler Therapie (Insulin-/GLP-1-RA-therapie).
Current means of diagnosis of acute kidney injury (AKI) based on serum creatinine have poor sensitivity and may miss possible therapeutic windows in subclinical kidney injury, especially in septic ...AKI. Kidney injury molecule-1 (KIM-1) may be a valuable biomarker to improve diagnostic algorithms for AKI. The understanding of septic AKI is still insufficient, knowledge about KIM-1 kinetics in inflammation is scarce. The aim of this study was to investigate the possible effect of lipopolysaccharide (LPS) on KIM-1 as a marker of structural kidney injury in healthy volunteers.
A single-blinded, placebo-controlled cross-over study using the Human Endotoxin Model (LPS administration) was performed in ten healthy men. KIM-1 and serum creatinine were measured repetitively over 48 hours.
We observed a significant elevation of serum KIM-1 levels following the administration of LPS (p < 0.001). Furthermore, LPS caused a significant elevation of serum creatinine at an early timepoint (p = 0.013) as compared with placebo.
Even a relatively small inflammatory stimulus is sufficient to cause subclinical structural kidney injury with elevated KIM-1 and serum creatinine in healthy volunteers. This outlines the insufficiency of the current diagnostic approach regarding acute kidney injury and the urgency to develop novel diagnostic algorithms including markers of kidney injury.Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03392701 (08/01/2018).
Zusammenfassung
Die Zusammenhänge zwischen Diabetes mellitus, koronarer Herzkrankheit und Herzinsuffizienz sind wechselseitig. Bei Erstmanifestation einer koronaren Herzkrankheit sollte aktiv auf ...Diabetes mellitus gescreent werden, während bei an Diabetes mellitus erkrankten Patient:innen die kardiovaskuläre Risikostratifizierung immer in Zusammenschau sämtlicher Risikofaktoren, Biomarker und dem klinischen Befinden des Patient:innen durchgeführt werden sollte. Eine bereits bekannte kardiovaskuläre Erkrankung wie auch das Vorliegen zahlreicher Risikofaktoren stellen wesentliche Kriterien für die Auswahl der individuellen Therapiestrategien dar.
Die Zusammenhänge zwischen Diabetes mellitus, koronarer Herzkrankheit und Herzinsuffizienz sind wechselseitig. Bei Erstmanifestation einer koronaren Herzkrankheit sollte aktiv auf Diabetes mellitus ...gescreent werden, während bei an Diabetes mellitus erkrankten Patient:innen die kardiovaskuläre Risikostratifizierung immer in Zusammenschau sämtlicher Risikofaktoren, Biomarker und dem klinischen Befinden des Patient:innen durchgeführt werden sollte. Eine bereits bekannte kardiovaskuläre Erkrankung wie auch das Vorliegen zahlreicher Risikofaktoren stellen wesentliche Kriterien für die Auswahl der individuellen Therapiestrategien dar.
There is a high prevalence of diabetes mellitus in the elderly population of industrial countries. The present article provides recommendations for the screening, prevention and treatment of elderly ...diabetic patients according to current scientific evidence.
Public safety (prevention of accidents) is the primary objective in assessing fitness to drive a motor vehicle. However, general access to mobility should not be restricted if there is no particular ...risk to public safety. For people with diabetes mellitus, the Führerscheingesetz (Driving Licence Legislation) and the Führerscheingesetz-Gesundheitsverordnung (Driving Licence Legislation Health enactment) regulate important aspects of driving safety in connection with acute and chronic complications of the disease. Critical complications that may be relevant to road safety include severe hypoglycemia, pronounced hyperglycemia and hypoglycemia perception disorder as well as severe retinopathy and neuropathy, endstage renal disease and certain cardiovascular manifestations. If there is a suspicion of the presence of one of these complications, a detailed evaluation is required.In addition, the individual antihyperglycemic medication should be checked for existing potential for hypoglycemia. Sulfonylureas, glinides and insulin belong to this group and are therefore associated with the requirement of a 5-year limitation of the driver's license. Other antihyperglycemic drugs without potential for hypoglycemia such as Metformin, SGLT‑2 inhibitors (Sodium-dependent-glucose-transporter‑2 inhibitors, gliflozins), DPP-4-inhibitors (Dipeptidyl-Peptidase inhibitors, gliptins), and GLP‑1 analogues (GLP‑1 rezeptor agonists) are not associated with such a time limitation.The relevant laws which regulate driving safety give room for interpretation, so that specific topics on driving safety for people with diabetes mellitus are elaborated from a medical and traffic-relevant point of view. This position paper is intended to support people involved in this challenging matter.
Diabetic ketoacidosis (DKA) and the hyperglycemic hyperosmolar state (HHS) represent potentially life-threatening situations in adults. Therefore, rapid comprehensive diagnostic and therapeutic ...measures with close monitoring of vital and laboratory parameters are required. The treatment of DKA and HHS is essentially the same and replacement of the mostly substantial fluid deficit with several liters of a physiological crystalloid solution is the first and most important step. Serum potassium concentrations need to be carefully monitored to guide its substitution. Regular insulin or rapid acting insulin analogues can be initially administered as an i.v. bolus followed by continuous infusion. Insulin should be switched to subcutaneous injections only after correction of the acidosis and stable glucose concentrations within an acceptable range.
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