[Show abstract][Hide abstract] ABSTRACT: Despite the efforts to control the epidemic of diabetes the total number of people living with diabetes is still steadily rising. In order to detect people at risk, cost-effective, convenient, and sensitive screening tools to assess the diabetes risk and to detect undiagnosed type 2 diabetes need to be developed and implemented in the primary care setting. To evaluate the combination of the well established FINDRISK questionnaire and HbA1c testing as a potential screening strategy the data obtained from 671 blood donors were analyzed for a potential correlation with the results of an oral glucose tolerance test. Based on the oral glucose tolerance test, 65 blood donors (9.7%) were newly diagnosed with diabetes, 336 (50.1%) with prediabetes, and 270 (40.2%) had a normal test result. Of the 401 blood donors diagnosed with prediabetes or diabetes 322 (80.3%) had a HbA1c between 5.7% and 6.4% and 27 (6.7%) with a HbA1c of 6.5% or greater. The majority of the blood donors newly diagnosed with diabetes or prediabetes (n=327) had a FINDRISK result of 12 points or higher. ROC analyses confirmed that the optimal cut off levels were for FINDRISK ≥ 12 points and for HbA1c ≥ 5.9%. Thus, a 3-step screening strategy applying the FINDRISK questionnaire followed by HbA1c testing and performing an oral glucose tolerance test on selected individuals could be a cost-saving approach for screening large populations and identifying people at risk for diabetes or undiagnosed diabetes.
Hormone and Metabolic Research 10/2011; 43(11):782-7. · 2.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Innerhalb des Sozialgesetzbuches (SGB)V ist die Forderung nach Qualitätsmanagement gesetzlich verankert. Dadurch wird die
Verpflichtung zu Transparenz der eigenen Leistung durch Dokumentation und Evaluation festgelegt. Die Ergebnisse der eigenen
Arbeit sollten regelmäßig innerhalb des Diabetesteams und in Qualitätszirkeln vor Ort diskutiert werden, um Verbesserungspotenziale
zu entdecken und in den medizinischen Alltag zu implementieren. Die wichtigste Grundlage im Qualitätsmanagement sind Offenheit
und Bereitschaft zur Kritikannahme und die Umsetzung von Verbesserungsmöglichkeiten. Struktur-, Prozess- und Ergebnisqualität
sind die wesentlichen Säulen des Qualitätsmanagements und beschreiben als Teilqualitäten die erreichte Qualität einer individuellen
Leistung, einer Allgemeinpraxis oder diabetologischen Schwerpunktpraxis, einer Abteilung oder einer gesamten Klinik. Die Diabetologie
bietet eine Vielzahl von Instrumenten an, die das Ziel einer verbesserten Qualität in der Betreuung und Versorgung umzusetzen
The requirement for quality management has been enshrined in law within the German Social CodeV. As a result, an obligation
to transparency in own services by means of documentation and evaluation has been stipulated. The results of own work should
be discussed regularly within the diabetes team and in on-site quality controls in order to identify where improvements could
be made and implement these improvements in clinical routine. The most important principle of quality management is openness
to and willingness to take criticism, as well as implement improvement possibilities. The quality of structures, processes
and results forms the main pillar of quality management and describes the achieved quality of an individual service, general
practice or specialized diabetes practice, a department or whole clinic as part qualities. Diabetology offers a wealth of
instruments to help achieve the goal of improved quality in medical treatment and care.
SchlüsselwörterQualitätsmanagement–Disease-Management-Programm–Evidenzbasierte Leitlinien–Gesundheitspass Diabetes–Diabetes-Qualitäts-Modell
KeywordsQuality management–Disease management programme–Evidence-based guidelines–Diabetes health pass–Diabetes quality model
Der Diabetologe 01/2011; 7(2):119-132. · 0.25 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The rising prevalence of type 2 diabetes is having an impact on limited medical and economic resources making increased efficiency and effectiveness of medical care and preventative strategies imperative. Quality management indicators that are fit for purpose will permit improvements and shortcomings to be identified in the strategies being employed and may provide information on how to better achieve objectives. This article considers two approaches to how indicators, which were developed by the Implementation of A European Guideline and training standards for diabetes prevention project, can be used in clinically applicable quality management, including benchmarking, in order to compare the quality of work among prevention managers and to develop an overall benchmark for preventive intervention.
The British Journal of Diabetes & Vascular Disease 01/2011; 11(4):217-222.
[Show abstract][Hide abstract] ABSTRACT: Die Pankreastransplantation wird meistens in Kombination mit einer Nierentransplantation bei Typ-1-Diabetes-Patienten durchgeführt.
Die Einjahres-/10-Jahres-Überlebensraten für die Simultantransplantation von Niere und Pankreas betragen laut internationaler
Statistik und großen Studien für Patienten 94–100%/79%, für die Nieren 89–92%/63% und für die Pankreas 85–87%/53%. Die hohe
Erfolgsrate mit langfristiger Normalisierung des Glukosestoffwechsels führt nicht nur zu einer Verbesserung der Lebensqualität
und zur Stabilisierung und/oder Verbesserung der Sekundärkomplikationen, sondern auch zu einer signifikanten Senkung der Mortalität,
die deutlich größer ist als bei alleiniger Nierentransplantation bei vergleichbaren Patienten. Die alleinige Pankreasverpflanzung
bei noch guter Nierenfunktion bleibt einer strengen Indikationsliste vorbehalten.
Pancreas grafting is mainly performed in combination with kidney transplantation in uremic type 1 diabetic patients. According
to international statistics and studies, the 1-year/10-year survival rates after simultaneous kidney/pancreas transplantation
are 94%–100%/79%, 89–92%/63% for kidneys and 85%–87%/53% for the pancreas. The high success rate with long-lasting normalization
of glucose metabolism leads to an improvement in quality of life and to a stabilization and/or amelioration of secondary complications,
as well as to a significant reduction in mortality, which is much higher compared to that of kidney graft recipients with
a comparable risk profile. Pancreas transplantation alone in patients with good kidney function or after successful renal
grafting (living-related donation) requires careful indication.
SchlüsselwörterDiabetes mellitus-Pankreastransplantation-Insel(zell-)Transplantation-Diabetische Folgekomplikationen-Patienten- und Organüberleben
KeywordsDiabetes mellitus-Pancreas transplantation-Islet transplantation-Diabetes complications-Patient and transplant survival
Der Diabetologe 09/2010; 6(6):451-459. · 0.25 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Zusammenfassung Ein nach Transplantation neu auftretender Diabetes mellitus ist ein häufiges Ereignis und führt häufiger zu Tod, Transplantatversagen
sowie im Langzeitverlauf zur Progression mikro- und makrovaskulärer Morbidität. Daher gilt es bereits zum Zeitpunkt der Evaluation
zur Aufnahme auf eine Transplantationswarteliste sowie im Posttransplantationsverlauf, ein standardisiertes prospektives Setting
zur frühzeitigen Detektion hyperglykämischer Stoffwechelsentgleisungen zu implementieren, welches die Durchführung eines oralen
Glukosetoleranztests (oGTT) einschließt. Im Hinblick auf eine gleichermaßen konsequente wie auch logistisch und ökonomisch
effiziente diagnostische und therapeutische Strategie bieten regionale Kooperationen von Transplantationsmedizinern und Diabetologen
mit ihrem Team dafür eine ideale Voraussetzung und sollten entsprechend gefördert werden. Nur dadurch wird eine rechtzeitige
therapeutische Intervention ermöglicht und der Gesamttransplantationserfolg hyperglykämischer Transplantatempfänger nachhaltig
Der Diabetologe 09/2010; 6(6):460-468. · 0.25 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: The prevalence and socioeconomic burden of type 2 diabetes (T2DM) and associated co-morbidities are rising worldwide.
Aims: This guideline provides evidence-based recommendations for preventing T2DM.
Methods: A European multidisciplinary consortium systematically reviewed the evidence on the effectiveness of screening and interventions for T2DM prevention using SIGN criteria.
Results: Obesity and sedentary lifestyle are the main modifiable risk factors. Age and ethnicity are non-modifiable risk factors. Case-finding should follow a step-wise procedure using risk questionnaires and oral glucose tolerance testing. Persons with impaired glucose tolerance and/or fasting glucose are at high-risk and should be prioritized for intensive intervention. Interventions supporting lifestyle changes delay the onset of T2DM in high-risk adults (number-needed-to-treat: 6.4 over 1.8–4.6 years). These should be supported by inter-sectoral strategies that create health promoting environments. Sustained body weight reduction by ≥ 5 % lowers risk. Currently metformin, acarbose and orlistat can be considered as second-line prevention options. The population approach should use organized measures to raise awareness and change lifestyle with specific approaches for adolescents, minorities and disadvantaged people. Interventions promoting lifestyle changes are more effective if they target both diet and physical activity, mobilize social support, involve the planned use of established behaviour change techniques, and provide frequent contacts. Cost-effectiveness analysis should take a societal perspective.
Conclusions: Prevention using lifestyle modifications in high-risk individuals is cost-effective and should be embedded in evaluated models of care. Effective prevention plans are predicated upon sustained government initiatives comprising advocacy, community support, fiscal and legislative changes, private sector engagement and continuous media communication.
Hormone and Metabolic Research 04/2010; 42 Suppl 1:S3-36. · 2.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The marked increase of type 2 diabetes necessitates active development and implementation of efficient prevention programs. A European level action has been taken by launching the IMAGE project to unify and improve the various prevention management concepts, which currently exist within the EU. This report describes the background and the methods used in the development of the IMAGE project quality indicators for diabetes primary prevention programs. It is targeted to the persons responsible for diabetes prevention at different levels of the health care systems.
Development of the quality indicators was conducted by a group of specialists representing different professional groups from several European countries. Indicators and measurement recommendations were produced by the expert group in consensus meetings and further developed by combining evidence and expert opinion.
The quality indicators were developed for different prevention strategies: population level prevention strategy, screening for high risk, and high risk prevention strategy. Totally, 22 quality indicators were generated. They constitute the minimum level of quality assurance recommended for diabetes prevention programs. In addition, 20 scientific evaluation indicators with measurement standards were produced. These micro level indicators describe measurements, which should be used if evaluation, reporting, and scientific analysis are planned.
We hope that these quality tools together with the IMAGE guidelines will provide a useful tool for improving the quality of diabetes prevention in Europe and make different prevention approaches comparable.
Hormone and Metabolic Research 04/2010; 42 Suppl 1:S56-63. · 2.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: When we ask people what they value most, health is usually top of the list. While effective care is available for many chronic diseases, the fact remains that for the patient, the tax payer and the whole of society: prevention is better than cure. Diabetes and its complications are a serious threat to the survival and well-being of an increasing number of people. It is predicted that one in ten Europeans aged 20-79 will have developed diabetes by 2030. Once a disease of old age, diabetes is now common among adults of all ages and is beginning to affect adolescents and even children. Diabetes accounts for up to 18 % of total healthcare expenditure in Europe. The good news is that diabetes is preventable. Compelling evidence shows that the onset of diabetes can be prevented or delayed greatly in individuals at high risk (people with impaired glucose regulation). Clinical research has shown a reduction in risk of developing diabetes of over 50 % following relatively modest changes in lifestyle that include adopting a healthy diet, increasing physical activity, and maintaining a healthy body weight. These results have since been reproduced in real-world prevention programmes. Even a delay of a few years in the progression to diabetes is expected to reduce diabetes-related complications, such as heart, kidney and eye disease and, consequently, to reduce the cost to society. A comprehensive approach to diabetes prevention should combine population based primary prevention with programmes targeted at those who are at high risk. This approach should take account of the local circumstances and diversity within modern society (e.g. social inequalities). The challenge goes beyond the healthcare system. We need to encourage collaboration across many different sectors: education providers, non-governmental organisations, the food industry, the media, urban planners and politicians all have a very important role to play. Small changes in lifestyle will bring big changes in health. Through joint efforts, more people will be reached. The time to act is now.
Hormone and Metabolic Research 04/2010; 42 Suppl 1:S37-55. · 2.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Self-monitoring of blood glucose (SMBG) has been considered one major breakthrough in diabetes therapy because, for the first time, patients were able to determine their blood glucose levels during daily life. It seems obvious that this must be of advantage to disease management and clinical outcome, but it has become a nightmare for those trying to provide evidence. Randomised controlled trials have yielded inconsistent results on a benefit of SMBG-based treatment strategies not only in type 2 but - surprisingly - also in type 1 and gestational diabetes. Despite this, SMBG is being considered indispensible in intensive insulin treatment, but is being debated for other clinical settings. When considering the non-RCT based reasons for recommending SMBG in type 1 and gestational diabetes it becomes apparent that the same reasons also apply to type 2 diabetes.
Diabetes research and clinical practice 11/2009; 87(2):150-6. · 2.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Bisher gibt es keine einheitlichen Empfehlungen zur Selbstmessung der Blutglukose (SMBG), zu deren Nutzung und zur Umsetzung
der Ergebnisse in praktisches Handeln. Unbestritten ist, dass SMBG als Bestandteil des Selbstmanagements den Patienten ermöglicht,
die Dosierung von Insulin entsprechend der Ernährung und der körperlichen Aktivität anzupassen. Zu den Maßnahmen, die individuell
für den einzelnen Patienten aufgrund der Messergebnisse zu ergreifen sind, gibt es bislang keine Algorithmen oder Richtlinien.
Eine SMBG ist nur dann sinnvoll, wenn sie therapeutische Konsequenzen nach sich zieht. Mit Hilfe von Schulungsprogrammen kann
das erforderliche Wissen vermittelt werden. Bei einer stabilen Stoffwechseleinstellung kann die SMBG-Messfrequenz auf ein
Minimum reduziert werden. Im vorliegenden Beitrag werden Handlungsempfehlungen, die aus der Diskussion einer Expertenkommission
hervorgegangen sind, vorgeschlagen, die in allgemein gültige Praxisempfehlungen münden sollen.
To date, there have been no standardised recommendations on self-monitoring of blood glucose (SMBG), its usefulness and how
to put the results to practical use. That SMBG is an integral part of patient self-management, enabling patients to adjust
the dosage of their insulin according to their food intake and physical activity, is undisputed. However, the measures to
be taken by individual patients on the basis of measurement results are not governed by any algorithms or guidelines. SMBG
is only helpful when it results in therapeutic consequences. The knowledge required for this can be gained by means of training
courses. SMBG measurement frequency can be reduced to a minimum in the presence of stable metabolic control. The current article
presents recommendations for action which arose from an expert commission, and which should be included in generally accepted
Der Diabetologe 09/2009; 5(6):460-470. · 0.25 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Epidemiological studies have shown that microalbuminuria is an important risk factor for arteriosclerosis, coronary heart disease and other vascular diseases in persons with type 2 diabetes. In the present study we examined the prevalence and risk factors for micro- and macroalbuminuria and examined glycemic control as well as treatment of modifiable cardiovascular risk factors in persons with known type 2 diabetes in Germany.
The presented data were derived from the 'KORA Augsburg Diabetes Family Study', conducted between October 2001 and September 2002. Participants were adults aged 29 years and older with previously diagnosed type 2 diabetes (n = 581). Microalbuminuria was defined as an albumin-creatinine ratio of 30 to 300 mg/g, and macroalbuminuria as an albumin-creatinine ratio of more than 300 mg/g.
Microalbuminuria was revealed in 27.2% and macroalbuminuria in 9.0% of the 581 included diabetic persons. Multivariable regression analysis identified HBA1c, duration of diabetes, systolic blood pressure, serum creatinine, smoking and waist circumference as independent risk factors associated with albuminuria (micro- or macroalbuminuria). Relatively few persons with type 2 diabetes achieved treatment targets of HbA1c < 7% (46.6%), total cholesterol < 200 mg/dl (44.1%), and LDL cholesterol < 100 mg/dl (16.0%). Optimal HDL cholesterol values (> 45 mg/dl in men, > 55 mg/dl in women) were found in 55.8%, and blood pressure values < 130 and < 85 mmHg in 31.3% of the persons
Albuminuria is common among German persons with known type 2 diabetes. Despite evidence-based guidelines, only a small proportion of type 2 diabetic persons achieved the recommended levels of glycemic control and control of cardiovascular risk factors.
BMC Health Services Research 12/2008; 8:226. · 1.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective was to describe the resource use and costs due to predefined stages of nephropathy in diabetic patients and to evaluate its economical impact in Germany.
In this retrospective, observational study information about socio-demographics, clinical characteristics and resource use on adult type 1 and type 2 patients with nephropathy in diabetic patients were collected from 23 general practitioners, 10 internists and 24 diabetologists, who were randomly selected from a physicians' database. Based on these results average costs per patient were evaluated for each complication stage from the societal perspective and the perspective of the health insurance.
The costs due to nephropathy in diabetic patients increase dramatically with the progression of the disease. The main cost drivers were dialysis and hospitalization which accounted for 68% of the total costs due to nephropathy in diabetic patients. The total estimated costs related to nephropathy in diabetic patients were euro1332 (from the perspective of the health insurance) and euro2019 from the societal perspective.
Patients at high risk should be identified as early as possible and intensive diabetic case management should be provided to them to prevent or decelerate the expensive complications of nephropathy in diabetic patients.
Diabetes research and clinical practice 05/2008; 80(1):34-9. · 2.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Simultaneous pancreas/kidney transplantation (SPK) should be the procedure of choice for (pre)uremic patients with type 1 diabetes. All standard immunosuppressive protocols for SPK include a calcineurin-inhibitor. Both calcineurin inhibitors, cyclosporine (CyA) and probably tacrolimus (FK506) too, are associated with the occurrence of cholelithiasis due to their metabolic side effects.
We evaluated the prevalence of cholelithiasis in 83 kidney/pancreas transplanted type I-diabetic patients (46 males, 37 females, mean age 42.8 +/- 7.5 years) by conventional B-mode ultrasound 5 years after transplantation. 56 patients received CyA (group 1) and 27 received tacrolimus (group 2) as first-line-immunosuppressive drug. Additional immunosuppression consisted of steroids, azathioprine or mycophenolate mofetil. Additionally, laboratory analyses of cholestasis parameters (gamma-GT and alcalic phosphatasis) were performed.
In total, 23 patients (28%) revealed gallstones and 52 patients (62%) revealed a completely normal gallbladder. In eight patients (10%) a cholecystectomy was performed before or during transplantation because of already known gallstones. No concrements in the biliary ducts (choledocholithiasis) could be detected. In group 2 the number of patients with gallstones was slightly lower (22%) compared with group 1 patients (30%), but without statistical significance. - Cholestasis parameters were not increased and HbA1c values were normal in both groups of patients.
The prevalence of biliary disease in kidney/pancreas transplanted type I-diabetic patients with 28% is increased in comparison to the general population (10-15%). Lithogenicity under tacrolimus seems to be lower as under cyclosporine based immunosuppressive drug treatment. We recommend regular sonographical examinations to detect an acute or chronic cholecystis as early as possible, which may develop occultly in these patients.
European journal of medical research 04/2008; 13(3):127-30. · 1.10 Impact Factor