Zusammenfassung
In den letzten beiden Jahren wurden neue Erkenntnisse zur Pathophysiologie und Prävention des Typ-2-Diabetes im Rahmen des Diabetes Updates präsentiert, die in dieser Übersichtsarbeit ...zusammengefasst werden. Zunehmend ergeben sich deutliche Hinweise, dass durch exogene und endogene Faktoren eine Hyperinsulinämie induziert wird, die nicht nur zur Insulinresistenz führt, sondern vermutlich auch der durch ungünstigen Lebensstil verursachten Adipositas zugrunde liegt. Dabei scheint, bedingt durch eine kohlenhydratreiche bzw. hyperkalorische Kost, die Insulinclearance in der Leber reduziert zu werden. Auch werden Antiinkretine diskutiert, die nahrungsbedingt eine Insulinresistenz auslösen. Weiterhin ergaben aktuelle mechanistische Studien, dass Personen mit Mutationen des SGLT-1-Rezeptor-Gens (SGLT: „sodium dependent glucose transporter“), die zu einer geringeren Glukoseaufnahme führen, eine niedrigere Prävalenz von Adipositas, Diabetes mellitus und Herzinsuffizienz sowie eine geringere Mortalitätsrate aufweisen. Obwohl sich die Forschung in den vergangenen Jahren eher der Primärprävention des Typ-2-Diabetes widmete, wurde dennoch eine Vielzahl an Arbeiten zur Sekundärprävention mit nichtmedikamentösen Ansätzen publiziert. Ganz im Vordergrund steht dabei die DiRECT-Studie (DiRECT: „diabetes remission clinical trial“), in der erstmals nachgewiesen wurde, dass durch ein radikales Gewichtsreduktionsprogramm mittels Formuladiät Remissionen des Typ-2-Diabetes erreichbar sind. Diese Ergebnisse führten dazu, dass Formuladiäten als Therapieoption bei der Lebensstilumstellung in den neuen Konsensusreport der „American Diabetes Association“ (ADA) und der „European Association for the Study of Diabetes“ (EASD) aufgenommen wurden.
The proportion of hospitalized patients with diabetes as a secondary diagnosis increases continuously. Therefore, we have developed a team-based interprofessional and telemedicine-based diabetes ...management system named TeDia ("Telemedical Diabetology") and implemented it in an inpatient setting. The aim of the retrospective real-world study was to show the clinical impact of TeDia following its implementation.
TeDia is characterized by an interpersonal and telemedicine-based exchange of hospital routine data between specially trained nurses ("diabetes managers") and external diabetologists. It was implemented in three acute hospitals of the Düsseldorf Catholic Hospital Group in Düsseldorf, Germany. Clinical awareness of diabetes, diabetes-related complications and diagnosis-related group (DRG)-based revenues were analyzed using ICD routine coding. Furthermore, the frequency of HbA1c determinations as well as hospitalization days were investigated.
Before (2010), during (2012) and after the implementation of TeDia (2014), the number of patients with ICD coding for diabetes, decompensated diabetes, diabetic neuropathy, diabetic nephropathy as well as complicated diabetes increased by +18%, +93%, +101%, +113% and +89%, respectively. Using the same DRG grouper, revenues increased by +53% (from 27 (2013) to 42 (2014) DRG points). Frequency of HbA1c determinations rose by +85%, whereas the time for an average length of stay decreased by -12% (-0, 91 days) in comparison to patients without diabetes.
TeDia improved clinical awareness for diabetes and its complications. This new treatment model increased revenues and reduced hospital days indicating enhanced treatment quality. Our findings emphasize the necessity of novel technologies in inpatient settings for the improvement of efficacy, safety and efficiency of diabetes care.
Ruff et al. (1994; Ruff, Camenzuli, & Mueller, 1996) hypothesized that some mild traumatic brain injury (MTBI) patients will suffer chronic symptomatic complaints and impairments, identifying this ...subgroup as the "miserable minority." However, several meta-analyses of the effects of MTBI have been published (e.g., Rohling et al., 2011) showing no significant cognitive impairments following recovery. Recently Pertab, James, and Bigler (2009) suggested that meta-analysis might be obscuring impairments in some MTBI patients, presenting a hypothetical score distribution to illustrate their claim. Our statistical analyses of their hypothetical figure and of several other potential distributions containing an impaired subgroup that varied as a function of effect size and base rate of occurrence did not support the existence of a miserable minority that is obscured in meta-analyses by the larger group of MTBI patients experiencing full recovery. Indeed, given our recent published MTBI effect size of −0.07 (Rohling et al., 2011), for an impaired subgroup to exist, the level of impairment would have to be just under a tenth of a standard deviation, equivalent to a WMS-IV Index score value of 1 point. At effect sizes this small, any cut score chosen on a test to diagnose patients would result in more false positives than true positives. This greatly increases the risk of misdiagnosis in persons who are susceptible to misattribution, expectancy effects, and "diagnosis threat," thereby increasing the risk of iatrogenic illness.
Purpose of Review
This review summarizes the current knowledge on the relationship of physical activity, exercise, and cardiorespiratory fitness (CRF) with cardiovascular autonomic neuropathy (CAN) ...based on epidemiological, clinical, and interventional studies.
Recent Findings
The prevalence of CAN increases with age and duration of diabetes. Further risk factors for CAN comprise poor glycemic control, dyslipidemia, abdominal obesity, hypertension, and the presence of diabetic complications. CAN has been also linked to reduced CRF. We recently showed that CRF parameters (e.g., maximal oxidative capacity or oxidative capacity at the anaerobic threshold) are associated with cardiac autonomic function in patients recently diagnosed with type 1 or type 2 diabetes. Exercise interventions have shown that physical activity can increase cardiovagal activity and reduce sympathetic overactivity. In particular, long-term and regularly, but also supervised, performed endurance and high-intense and high-volume exercise improves cardiac autonomic function in patients with type 2 diabetes. By contrast, the evidence in those with type 1 diabetes and also in individuals with prediabetes or metabolic syndrome is weaker.
Summary
Overall, the studies reviewed herein addressing the question whether favorably modulating the autonomic nervous system may improve CRF during exercise programs support the therapeutic concept to promote physical activity and to achieve physical fitness. However, high-quality exercise interventions, especially in type 1 diabetes and metabolic syndrome including prediabetes, are further required to better understand the relationship between physical activity, fitness, and cardiac autonomic function.
One of the basic tasks performed by a neuropsychologist is to identify the difference between current performance and the premorbid expected performance. Baseline expected performance for ...Intellectually Impaired (n = 21), Developmentally Delayed (n = 40), Attention Deficit Disorder (n = 98), Learning Disability (n = 42), and "Normal" groups (n = 75) were developed along with a demographically corrected prediction of premorbid functioning and a word reading based prediction of premorbid functioning. We utilized a subset of this data pool for development (n = 107) and validation (n = 108) of premorbid functioning estimates. Findings show that a combination of three methods (baseline, demographic, and reading) were superior to any individual method. The effect size (Cohen's d) calculations show that differences in the prediction of domain level performances were small and likely not clinically meaningful, indicating that the premorbid estimates would be usable as a prediction of expected performance at the domain level. However, the motor domains were not well predicted.
The incidence of diabetes mellitus and cardiovascular diseases is increasing worldwide and also in Germany. The aim of the study was to assess the health literacy regarding these diseases in ...childhood and adolescence.
Students of the 5
-12
grade (grammar school ("Gymnasium"), secondary school forms ("Realschule" and "Hauptschule")) were interviewed in 2007 (n = 4383) and 2019 (n = 572) about diabetes and secondary complications. In addition, questions about other cardiovascular risk factors were asked in 2019.
Diabetes-related questions were answered correctly by 56 % in 2007 as well as 53 % in 2019. Among others, 70 % (2007) as well as 75 % (2019) of the students stated "ate too much sugar" as a cause for type 1 diabetes. Further, questions about major risk factors for heart attack and stroke were answered correctly by only 33 % (for diabetes) and 43 %-53 % (for smoking) of students.Across all questions, a positive association indicated between the rate of correct answers and the educational level of the school institution; however, the differences remained marginal at 5-19 % between Gymnasium and Hauptschule or Realschule at both survey time points. A difference between genders was indicated in 2007 (girls: 59 % vs. boys: 52 %) and 2019 (girls: 56 % vs. boys: 51 %).
Changes in health literacy regarding diabetes and other cardiovascular risk factors among 5
-12
grade students over the past 12 years could not be observed. The assumed self-infliction of type 1 diabetes may be perceived as discrimination by those affected.
The primary purpose of this study was to determine the individual, family, and peer factors that correlate with adolescent gambling. High school students from three states ( N = 1,846) completed an ...anonymous questionnaire assessing the behavior of themselves, their parents, and their peers. Participants also reported on their gambling behavior via the SOGS-RA, which was used to create five adolescent gambling groups (i.e., Non-Gamblers, Non-Problem Gamblers, At-Risk Gamblers, Problem Gamblers, and Probable Pathological Gamblers). In a discriminant function analysis using demographic, individual, family, and peer factors as potential discriminators, two functions emerged that accounted for 94% of the variance between groups. The first function was linear, with the Probable Pathological Gamblers reporting the highest level of peer and parent gambling, susceptibility to peer pressure, conduct problems, binge drinking, suicide attempts, drug use, and being male. The second function highlighted three unique qualities of individuals in the two outlying groups: Probable Pathological Gamblers and Non-Gamblers. These findings suggest that demographic, individual, family, and peer variables are all important correlates of probable pathological gambling in adolescents. Results also support the utility of a five-group classification scheme based on the SOGS-RA. The clinical implications of these results are discussed.
Both impaired cardiorespiratory fitness (CRF) and heart rate variability (HRV) are predictors of mortality, but their relative roles in recent-onset diabetes are unknown. We determined to which ...extent CRF and HRV are reduced and interrelated in recent-onset diabetes.
Participants from the German Diabetes Study with type 1 (n = 163) or type 2 (n = 188) diabetes with known diabetes duration <1 year and two age-matched glucose-tolerant control groups (n = 40 each) underwent spiroergometry and HRV assessment during a hyperinsulinemic-euglycemic clamp.
Compared with control subjects, patients with type 2 diabetes showed reduced VO
(median 1st-3rd quartiles 19.3 16.5-22.9 vs. 25.6 20.7-29.9 mL/kg body weight/min; P < 0.05), diminished VCO
(23.0 19.1-26.8 vs. 30.9 24.5-34.4 mL/kg body weight/min; P < 0.05), blunted heart rate recovery after 2 min (-29.0 -35.0 to -23.0 vs. -36.0 -42.8 to -28.0 beats/min; P < 0.05), and reduced HRV in four of nine indices, whereas patients with type 1 diabetes had unaltered CRF but reduced HRV in three of nine indices (P < 0.05), indicating diminished vagal and sympathetic HRV modulation. HRV measures correlated with VO
in patients with type 1 diabetes (r >0.34; P < 0.05) but not in those with type 2 diabetes.
CRF is reduced in recently diagnosed type 2 diabetes but preserved in type 1 diabetes, whereas cardiac autonomic function is reduced in both diabetes types but is strongly associated with CRF only in type 1 diabetes. These results support the therapeutic concept of promoting physical fitness in the early course of diabetes.
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