Alexandra Kautzky-Willer

• Prof. Dr.
• Head of Department at Medical University of Vienna

Blood glucose is lower in mountain dwellers living under low partial oxygen pressure. We show that obese mice maintained under hypoxia exhibit a delayed but distinct decrease in blood glucose with improved insulin sensitivity, which is independent of changes in body weight. This effect of hypoxia is mediated by erythropoiesis and is a direct result...

Background: Bone fractures and vitamin deficiencies are potential long-term risks after metabolic/bariatric surgery (MBS). This study aimed to evaluate the health status of patients with an average follow-up of 15 years after MBS, focusing on vitamin deficiencies, patients’ satisfaction and bone fractures. Methods: A questionnaire-based cross-secti...

Objective Differences in cardiac parameters such as myocardial mass, left ventricular ejection fraction (LVEF), cardiac output, and brain natriuretic peptide (NT-proBNP) levels between cisgender men and women are well established. No evidence exists regarding changes in myocardial mass or cardiac function parameters in transgender individuals under...

ESC Guidelines provide best practice, evidence-based recommendations for diagnosing and treating patients with cardiovascular diseases. It is not always possible for best practices to be followed, however, particularly in low-resource settings. To address this issue, a set of guideline-related documents were created to identify key priorities for u...

Background: Body composition analysis is crucial in clinical practice, yet few methods are suitable for pediatric patients, and data on young children with obesity are limited. Methods: This study measured body fat percentage (BFP), fat mass (FM), and fat-free mass (FFM) in 26 pediatric patients with obesity (BMI: 35.6±6.9 kg/m²), using two bioelec...

While gendered psycho-socio-cultural factors are recognized as major determinants of cardiovascular health, their contribution to our understanding of their effect on hypertension (HTN) in each country is poorly understood. Therefore, we investigated the role of these factors in HTN prevalence, focusing on sex- and gender-specific differences acros...

Objectives Over the past few decades, knowledge of women’s health regarding sex and gender differences in health has increased but transfer of these new insights into medical education and clinical practice is lagging, resulting in substandard care for women compared with men. This study aimed to reach consensus on what all physicians taking care o...

OBJECTIVE To investigate the association of timing of commencing glucose management with glycemia, glycemic variability, and pregnancy outcomes among women with early gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS In this substudy among participants of a trial of immediate vs delayed treatment of early GDM diagnosed by 2013 World...

Objective To compare the prevalence and clinical characteristics of early gestational diabetes (eGDM) and associated birth outcomes amongst women of different ethnic groups. Research Design and Methods This is a secondary analysis of an international, multicentre randomized controlled trial of treating eGDM among pregnant women with GDM risk facto...

Purpose We aimed to assess the changes in body fat distribution, intraorgan lipid accumulation, and cardiometabolic risk factors after 6 months of gender-affirming hormone therapy (GAHT) in transgender men (TM) and transgender women (TW). Methods Conducted at the Medical University of Vienna between 2019 and 2022, the study included 15 TW and 20 T...

Aims Familial hypercholesterolaemia (FH) is a severely underdiagnosed, inherited disease, causing dyslipidaemia and premature atherosclerotic cardiovascular disease. In order to facilitate screening in a broad clinical spectrum, we aimed to analyse the current yield of routine genetic diagnostics for FH and to evaluate the performance of the Dutch...

Diabetes mellitus does not only double the risk to develop a cardiovascular disease (CVD) but also leads to a relative risk increase in coronary heart disease in females compared to males. Moreover, females with diabetes mellitus are more affected by cardiovascular diseases in terms of mortality and hospitalization rate than males. Although the inc...

Background: Stroke is a leading cause of long-term disability among survivors. Past literature already investigated the biological sex differences in stroke outcome, still limited work on gender differences is published. Therefore, the study aimed at investigating whether biological sex and sociocultural gender of survivors play a role as determina...

Background and aims: The FTO rs9939609 gene variant has been associated with adult obesity, increased added sugar intake and type 2 diabetes . In a set of Austro-Hungarian mother-neonate pairs we aimed to explore the effects of FTO gene variants, and hypothesized that fetal genotype could be associated with maternal blood glucose levels during OGTT...

Background Diabetes increases the risk of psychosocial health problems. Person-centred psychosocial care is therefore advocated. However, several barriers to implementation exist, including uncertainty about how to approach psychosocial problems in consultations. Objective We aimed to explore which psychosocial outcomes patients and healthcare pro...

Our aim is to investigate if sex and gender influence the association of hypertension and their comorbidities. We investigated how gender differences in five socioeconomic factors impact the relation between hypertension and ten comorbidities including diabetes mellitus, renal disease, and chronic pulmonary disease in European countries grouped by...

Objective To identify factors associated with neonatal respiratory distress (NRD) in early Gestational diabetes mellitus (eGDM). Design Nested case–control analysis of the TOBOGM trial. Setting Seventeen hospitals: Australia, Sweden, Austria and India. Population Pregnant women, <20 weeks' gestation, singleton, GDM risk factors. Methods Women w...

Background: Obesity in pregnancy is linked to adverse clinical outcomes such as gestational diabetes. Recently, a risk score calculated by different ceramide concentrations was recognized as a new way to investigate cardiovascular risk. The aim was to analyze if the ceramide risk score and cardiometabolic risk vary between normal-weight, obese, and...

Background Proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors have emerged as important therapeutic options for patients unable to achieve the low-density lipoprotein cholesterol (LDL-C) target or to tolerate alternative lipid-lowering agents. The aim of this study was to investigate the efficacy of PCSK9 inhibitor treatment in tertia...

Both mental and metabolic disorders are steadily becoming more prevalent, increasing interest in non-pharmacological lifestyle interventions targeting both types of disorders. However, the combined effect of diet and psychological interventions on the gut microbiome and mental health outcomes remains underexplored. Thus, in this study, we randomize...

Objectives This study aimed to assess the guideline recommended diagnostic tools NT-proBNP and NYHA classification, with a focus on sex-specific differences. Background Patients with Type 2 Diabetes (T2D) face a heart failure (HF) risk up to four times higher than those without T2D, particularly affecting women more than twice as much as men. Desp...

OBJECTIVE We evaluated associations between early-pregnancy oral glucose tolerance test (OGTT) glucose and complications in the Treatment of Booking Gestational Diabetes Mellitus (TOBOGM) cohort to inform prognostic OGTT thresholds. RESEARCH DESIGN AND METHODS Individuals with risk factors for hyperglycemia were recruited for an international, mul...

Aim: To compare glycemic test characteristics for predicting GDM at 24-28 weeks’ gestation (LGDM) among those with a normal OGTT <20 weeks’ gestation. Methods: Pregnant women with GDM risk factors were enrolled into a multicenter early GDM (EGDM) treatment trial. Women with EGDM are excluded from this analysis. A 2-h 75g OGTT with HbA1c occurred on...

Aim: To compare maternal glycemia and pregnancy outcomes with treatment initiation before 20 weeks’ versus after 24 weeks' gestation among women with early gestational diabetes mellitus (EGDM). Methods: This prospective study included participants enrolled in the Treatment of Booking Gestational Diabetes Mellitus randomized controlled trial. Women...

Background There is conflicting evidence whether prediabetes is associated with adverse clinical outcomes in patients with chronic coronary syndrome. We aimed to assess the effect of prediabetes in patients with chronic coronary syndrome on clinical outcomes. Methods This is a secondary analysis of data from the ISCHEMIA and ISCHEMIA-CKD trials, i...

STUDY QUESTION Are maternal levels of moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) in obese pregnant women associated with placental structural adaptations for facilitating oxygen delivery to the fetus? SUMMARY ANSWER Higher maternal MVPA and ST are associated with a higher density of villi, a proxy measure of placental su...

Purpose A high rate of lost to follow-up (LTFU) in patients with phenylketonuria (PKU) represents a main challenge. In this study, we investigated potential risk factors for becoming LTFU related to adolescence as a critical period of life. Methods We retrospectively analyzed longitudinal data collected from 1993 to 2019 of patients diagnosed with...

Background Case reports indicate a clinical connection between SARS-CoV-2 and thyroid dysfunctions. However, evidence from large population-based registry analyses is sparse, especially in Europe, where iodine deficiency is common. This study aimed to analyze the impact of the COVID-19 pandemic on healthcare provision for thyroid diseases in Austri...

Background Sex differences in diabetes, obesity, metabolic disorders and cardiovascular disease are well described, however, differences between women and men in intrahepatocellular (HCL) and intramyocardial (MYCL) lipids with increasing impairment of glucose metabolism and different BMI strata are controversial and yet not well investigated. Aim o...

Background A recently undertaken multicenter randomized controlled trial (RCT) “Treatment Of BOoking Gestational diabetes Mellitus” (TOBOGM: 2017–2022) found that the diagnosis and treatment of pregnant women with early gestational diabetes mellitus (GDM) improved pregnancy outcomes. Based on data from the trial, this study aimed to assess the cost...

OBJECTIVE To compare pregnancy outcomes among women with a normal oral glucose tolerance test (OGTT) before 20 weeks’ gestation (early) and at 24–28 weeks’ gestation (late) (no gestational diabetes mellitus, or No-GDM), those with early GDM randomized to observation with a subsequent normal OGTT (GDM-Regression), and those with GDM on both occasion...

We aim to comprehensively identify typical life-spanning trajectories and critical events that impact patients’ hospital utilization and mortality. We use a unique dataset containing 44 million records of almost all inpatient stays from 2003 to 2014 in Austria to investigate disease trajectories. We develop a new, multilayer disease network approac...

OBJECTIVE In most gestational diabetes mellitus (GDM) studies, cohorts have included women combined into study populations without regard to whether hyperglycemia was present earlier in pregnancy. In this study we sought to compare perinatal outcomes between groups: women with early GDM (EGDM group: diagnosis before 20 weeks but no treatment until...

Acetylcarnitine is an essential metabolite for maintaining metabolic flexibility and glucose homeostasis. The in vivo behavior of muscle acetylcarnitine content during exercise has not been shown with magnetic resonance spectroscopy. Therefore, this study aimed to explore the behavior of skeletal muscle acetylcarnitine during rest, plantar flexion...

Background Prolonged critical illness is often accompanied by an impairment of adrenal function, which has been frequently related to conditions complicating patient management. The presumed connection between hypoxia and the pathogenesis of this critical- illness- related corticosteroid insufficiency (CIRCI) might play an important role in patient...

Skeletal muscle plays a central role in the regulation of systemic metabolism during lifespan. With aging, this function is perturbed, initiating multiple chronic diseases. Our knowledge of mechanisms responsible for this decline is limited. Glycerophosphocholine phosphodiesterase 1 (Gpcpd1) is a highly abundant muscle enzyme that hydrolyzes glycer...

Post-transplantation diabetes mellitus (PTDM) remains a leading complication after solid organ transplantation. Previous international PTDM consensus meetings in 2003 and 2013 provided standardized frameworks to reduce heterogeneity in diagnosis, risk stratification and management. However, the last decade has seen significant advancements in our P...

Objective Standardised person‐reported outcomes (PRO) data can contextualise clinical outcomes enabling precision diabetes monitoring and care. Comprehensive outcome sets can guide this process, but their implementation in routine diabetes care has remained challenging and unsuccessful at international level. We aimed to address this by developing...

BACKGROUND A major hurdle in fully realizing the value of Patient-Reported Outcomes (PROs) concerns technology. To collect and use PROs in a useful manner, a healthcare application must be user-friendly and add value to all stakeholders. One of the most crucial components is an easeful, intuitive, and positive user experience (UX). Especially in pe...

Background Severe hypertriglyceridemia is commonly associated with pancreatitis and questionably atherosclerotic cardiovascular disease (ASCVD). However, while some patients develop those sequelae at relatively low levels, others with extreme levels remain spared from it. Purpose This study serves to validate, whether the distribution of triglycer...

Background Familial hypercholesterolemia (FH) is an autosomal dominant genetic disease, causing dyslipidemia and premature atherosclerotic cardiovascular disease (ASCVD), with currently ∼2,000,000 unidentified adult cases as well as ∼500,000 children cases in Europe. Purpose Aim of this study is to analyse the current yield of routine molecular ge...

(Abstracted from N Engl J Med 2023;388(23):2132–2144) Gestational diabetes mellitus is a common pregnancy complication. It is associated with adverse outcomes, including preeclampsia, obstetrical intervention, large-for-gestational-age neonates, shoulder dystocia, birth trauma, and neonatal hypoglycemia. Cohort studies have found that women with hy...

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM) and heart failure (HF). In consideration of emerging evidence that there are clinically relevant sex-related differences in the course of T2DM and subsequent cardiovascular outcomes, it is unknown if SGLT2i...

Objectives: The objective was to identify candidate patient reported outcomes with potential to inform individual patient care and service development for inclusion in a digital outcome set to be collected in routine care, as part of an international project to enhance care outcomes for people with diabetes. Methods: PubMed, COSMIN and COMET dat...

Introduction Gremlin-1 is a peptide that functions as an antagonist to bone morphogenic proteins and is overexpressed in obesity and type 2 diabetes mellitus. Gremlin-1 has not yet been investigated in pregnancy, pregnancy-related insulin resistance or gestational diabetes mellitus (GDM). Patients and methods Gremlin-1 levels were measured through...

Brain aging is a naturally occurring process resulting in the decline of cognitive functions and increased vulnerability to develop age‐associated disorders. Fluctuation in lipid species is crucial for normal brain development and function. However, impaired lipid metabolism and changes in lipid composition in the brain have been increasingly recog...

We aim to comprehensively identify typical life-spanning trajectories and critical events that impact patients' hospital utilization and mortality. We use a unique dataset containing 44 million records of almost all inpatient stays from 2003 to 2014 in Austria to investigate disease trajectories. We develop a new, multilayer disease network approac...

Background Both obesity and sleep disorders are common among women during pregnancy. Although prior research has identified a relationship between obesity and sleep disorders, those findings are from women later in pregnancy. Objective To explore the relationships between self‐reported sleep duration, insufficient sleep and snoring with body mass...

Undernutrition in early life associates with increased risk for type 2 diabetes in later life. Whether similar associations hold for other diseases remains unclear. We aim to quantify how perinatal exposure to famines relates to the risk of becoming incident with type 2 diabetes in later life. Using population-wide medical claims data for Austrians...

This study aims to quantify whether age and sex groups in Austrian regions are equally affected by the rise of type 2 diabetes. Population-wide medical claims data was obtained for citizens in Austria aged above 50 year, who received antihyperglycemic treatments or underwent HbA1c monitoring between 2012 and 2017. Diabetes incidence was measured us...

Roux-en-Y gastric bypass operations (RYGB-OP) and pregnancy alter glucose homeostasis and the adipokine profile. This study investigates the relationship between adipokines and glucose metabolism during pregnancy post-RYGB-OP. (1) Methods: This is a post hoc analysis of a prospective cohort study during pregnancy in 25 women with an RYGB-OP (RY), 1...

Simple Summary Cardiovascular diseases represent the leading cause of mortality and morbidity worldwide, and age is an important contributing factor. Preclinical models are crucial for exploring and understanding the physiology of the heart and age-related changes, as well as cardiac pathological aspects. In line with this, the Octodon degus (O. de...

Purpose Sodium-glucose cotransporter 2 inhibitor (SGLT2i) regulation, developed as treatment for patients with type 2 diabetes, can be imaged with the glucose analogue alpha-methyl-4-deoxy-4-[¹⁸F]fluoro-d-glucopyranoside (Me4FDG), a positron emission tomography (PET) tracer with a high affinity for SGLT1 and SGLT2 proteins. With regard to therapy e...

Background Non-alcoholic fatty liver disease (NAFLD) is one of the leading causes of liver-related morbidity and mortality. While data on acromegaly, a state of chronic growth hormone (GH)/Insulin-like growth factor I(IGF-I) excess, suggest an inverse relationship with intrahepatic lipid content (IHL), less is known about the impact of the GH/IGF-I...

Zusammenfassung Die vorliegende Leitlinie nimmt Bezug auf die Indikation und praktische Umsetzung der Injektionstherapie (GLP1-Rezeptor Agonisten und Insulin) bei Typ 2 Diabetes.

Zusammenfassung Bereits vor mehr als 30 Jahren forderte die St. Vincent Deklaration, dass Schwangere mit vorbestehendem Diabetes mellitus vergleichbare Schwangerschaftsergebnisse wie gesunde Frauen erreichen sollen. Dennoch bestehen bei Frauen mit konzeptionell manifestem Diabetes nach wie vor höhere Komplikationsraten und eine höhere perinatale Mo...

Zusammenfassung Je nach Diabetesform und -therapie sollen alle Menschen mit Diabetes eine individuelle ernährungsmedizinische Beratung und Schulung durch Fachpersonal erhalten. Im Vordergrund sollte eine patientinnen- und patientenzentrierte, individualisierte Beratung stehen, angepasst an die jeweiligen Bedürfnisse und Lebensumstände der Menschen...

Zusammenfassung Gestationsdiabetes (GDM) wird als Glukosetoleranzstörung definiert, die erstmals in der Schwangerschaft festgestellt wird. GDM ist mit einer erhöhten feto-maternalen Morbidität sowie Langzeitkomplikationen bei Mutter und Kind assoziiert. Frauen, die die Kriterien eines manifesten Diabetes mellitus bereits in der Frühschwangerschaft...

Zusammenfassung Die Leitlinie nimmt Bezug auf die Diagnostik, einschließlich begleitender Autoimmunerkrankungen, bei Typ 1 Diabetes mellitus, die Insulintherapie und die glykämischen Zielwerte.

Zusammenfassung Metabolische Erkrankungen beeinflussen das Leben von Männern und Frauen in den verschiedenen Lebensabschnitten in unterschiedlicher und vielfältiger Weise und stellen eine große Herausforderung für das Gesundheitssystem dar. Die behandelnden Ärztinnen und Ärzte sind mit den unterschiedlichen Bedürfnissen von Männern und Frauen im kl...

Zusammenfassung Diabetes mellitus und Osteoporose zählen zu den häufigsten chronischen Erkrankungen und kommen deshalb beide häufig in ein und demselben Individuum vor. Da die Prävalenz beider mit steigendem Alter zunimmt, wird in Anbetracht der Altersstruktur unserer Bevölkerung deren Häufigkeit zunehmen. Patient:innen mit Diabetes haben ein erhöh...

Zusammenfassung Diese Leitlinie repräsentiert die Empfehlungen der Österreichischen Diabetes Gesellschaft (ÖDG) zur Nutzung von Diabetes-Technologie (Insulinpumpentherapie; kontinuierliche Glukosemesssysteme, CGM; Hybrid Closed Loop Systeme, HCL; Automated Insulin Delivery Systeme, AID, Diabetes-Apps) und den Zugang zu diesen technologischen Innova...

Zusammenfassung Epidemiologische Untersuchungen zeigen, dass etwa 2–3 % aller Österreicher*innen einen Diabetes mellitus mit Nierenbeteiligung aufweisen. Dies betrifft somit in Österreich etwa 250.000 Menschen. Das Risiko des Auftretens und Fortschreitens der diabetischen Nierenerkrankung kann durch Lebensstilinterventionen und Optimierung des arte...

Zusammenfassung Diabetes mellitus ist häufig mit psychischen Erkrankungen assoziiert. Depressive Störungen kommen bei diabetischen Patient:innen doppelt so häufig vor wie in der nicht-diabetischen Population. Andere psychische Erkrankungen, die gehäuft mit Prädiabetes und Diabetes mellitus vorkommen, sind kognitive Dysfunktionen bis zur Demenz, auf...

Zusammenfassung Die Hyperglykämie ist wesentlich an der Entstehung der Spätkomplikationen bei an Diabetes mellitus Typ 2 erkrankten Patienten/Patientinnen beteiligt. Während Lebensstilmaßnahmen die Eckpfeiler jeder Diabetestherapie bleiben, benötigen im Verlauf die meisten Patienten/Patientinnen mit Typ 2 Diabetes eine medikamentöse Therapie. Bei d...

The prevalence of diseases often varies substantially from region to region. Besides basic demographic properties, the factors that drive the variability of each prevalence are to a large extent unknown. Here we show how regional prevalence variations in 115 different diseases relate to demographic, socio-economic, environmental factors and migrato...

Magnesium (Mg) has a vital role in the human body, and the kidney is a key organ in the metabolism and excretion of this cation. The objective of this work is to compile the available evidence regarding the role that Mg plays in health and disease, with a special focus on the elderly population with chronic kidney disease (CKD) and the eventual sex...

The prevalence of type 2 diabetes mellitus is increasing in both sexes, but men are usually diagnosed at a younger age and lower body fat mass than women. Worldwide, an estimated 17.7 million more men than women have diabetes mellitus. Women appear to bear a greater risk factor burden at the time of their type 2 diabetes diagnosis, especially obesi...

Background: Many cells adapt to hyperosmolal conditions by upregulation of organic osmolytes to maintain cell function and integrity. Glycerophosphocholine (GPC), a recognised osmolyte in renal medullary cells, is the major phosphodiester (PDE) in human skeletal muscle, wherefore we hypothesized muscular GPC to be associated with surrogate paramet...

Aims The aim of this study was to elucidate whether sex and gender factors influence access to health care and/or are associated with cardiovascular (CV) outcomes of individuals with diabetes mellitus (DM) across different countries. Methods Using data from the Canadian Community Health Survey (8.4% of respondent reporting DM) and the European Hea...

Background Combining mouse experiments with big data analysis of the Austrian population, we investigated the association between high-dose statin treatment and bone quality. Methods The bone microarchitecture of the femur and vertebral body L4 was measured in male and ovariectomized female mice on a high-fat diet containing simvastatin (1.2 g/kg)...