P T Sawicki's research while affiliated with University of Cologne and other places

Publications (170)

Article
Full-text available
Objective: To compare the proportions and trends in the distribution of research topics as presented during the annual meetings 2010-2013 of the European Association for the Study of Diabetes (EASD) to patients' preferences. Methods: Longitudinal evaluation of EASD research areas 2010-2013 divided into 9 main categories and compared with a cross-se...
Article
Retnakaran et al. (1) claim in their recent article that liraglutide preserves β-cell function in type 2 diabetes. We doubt whether their methodology and results prove that liraglutide independent of its effect on glucose and weight is β-cell protective. In their study, after stopping all antidiabetes medication in the prerandomization phase, gluco...
Article
To examine differences in conclusions, statistical significances, and quality of systematic reviews on preventive effects of different targets of blood glucose lowering on macrovascular events in patients with type 2 diabetes. We searched MEDLINE, the Cochrane Database of Systematic Reviews, and Embase until October 15, 2011. Systematic reviews usi...
Conference Paper
Hintergrund und Fragestellung: Mehrere Systematische Reviews zu kardiovaskulären Effekten verschiedener Ziele der Blutzuckersenkung bei Patienten mit Diabetes mellitus Typ 2 wurden in den letzten Jahren veröffentlicht. Ziel der vorliegenden Arbeit ist es, Unterschiede zwischen den Systematischen Reviews hinsichtlich der Ergebnisse und Schlussfolger...
Chapter
Hier wird es um eine Medizin gehen, die die Zunahme der Qualität der Patientenversorgung anstrebt, nicht um die Qualität des Wirtschaftsfaktors „Gesundheit„, nicht um die Ansprüche der Ärzte und Krankenhäuser, nicht um die Senkung der Ausgaben der Krankenkassen und auch nicht um die Steigerung des „Shareholder Value“ von börsennotierten Aktiengesel...
Article
Objective: To compare patients’ preferences in diabetes research to the current scientific research spectrum as presented during annual meetings of the European Association for the Study of Diabetes (EASD). Methods: After dividing all scientific activities in diabetes research into 9 main fields, a questionnaire was published in a popular German w...
Article
This commentary discusses whether screening for type 2 diabetes or earlier normalisation of blood glucose levels or initiation of non-antihyperglycaemic agents or any other diabetes-specific treatment can help reduce the excess associated risks for macrovascular morbidity and mortality. The available data indicate that screening with the sole aim o...
Article
Background: Disease management programmes (DMPs) were implemented in Germany in 2002. Their evaluation is required by law. Beyond the mandatory evaluation, a growing number of published studies evaluate the DMP for diabetes mellitus type 2 in a control-group design. As patients opt into the programme on a voluntary basis it is necessary to adjust...
Article
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Our objective was to examine the cost-effectiveness of disease management programs (DMPs) for type 2 diabetes mellitus (T2DM) taking into account their life prolonging effect. We compared real life costs in 19,888 propensity score matched pairs of T2DM DMP participants and T2DM patients in routine care (RC) according to sickness funds data. We esti...
Article
Disease management programs (DMPs) are complex interventions, and, like all medical interventions, they should undergo adequate scientific evaluation before being widely implemented into healthcare services, in order to find out their positive and negative effects and bear these in mind when treating patients. As the patients who are accepted into...
Article
Late in 2004, the German Health Ministry held a conference that aimed to improve outcomes and cost-benefit relations in the treatment of chronic diseases. The ministry was concerned that the increasing costs of treatment were not accompanied by an improvement in patient relevant outcomes. As a consequence, in 2005 the Joint Federal Committee—the to...
Article
Reitmeier’s correspondence poignantly illustrates the dissatisfaction we described in our article. We regard the first five causes as an expression of political opinion that we do not wish to comment on. However, it is not the case that “the concept of evidence based medicine (EBM) can thus far be applied only to narrow segments of primary care doc...
Article
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Olsson et al. (1) describe an association between high levels of education and an increased risk of autoimmune diabetes in adults. They propose “the hygiene hypothesis” as an explanation for their results indicating that childhood environment and a low prevalence of childhood infections might contribute to the evolution of autoimmune diabetes. We w...
Article
In 2009, the U.S. Commonwealth Fund conducted a survey of primary care physicians in a number of different countries to determine their views on aspects of their daily work and their perceptions of their countries' health care systems as a whole. A similar survey had been carried out in 2006. From February to July 2009, the survey was carried out b...
Article
Section 35b of the German Code of Social Law Book V (SGB V) mentions “expert approved international standards of evidence-based medicine” (EbM). An idea which started as a reform movement in and for clinical medicine more than twenty years ago is here, from a socio-legal perspective, being utilised as a normative concept in terms of a standard-crea...
Article
International health care systems of industrial countries show great differences in organization and financing. During 2008 the Commonwealth Fund interviewed sicker adult patients from eight countries to compare aspects of quality of health care. In total, 9633 randomly selected patients from Australia, Canada, France, Germany, The Netherlands, New...
Article
Section 35b of the German Code of Social Law Book V (SGB V) mentions "expert approved international standards of evidence-based medicine" (EbM). An idea which started as a reform movement in and for clinical medicine more than twenty years ago is here, from a socio-legal perspective, being utilised as a normative concept in terms of a standard-crea...
Article
Many German observers are bewildered over the U.S. health care reform debate. Most Europeans see affordable health insurance for everyone as a fundamental element of a stable and prosperous society — an element founded on the principle of communal responsibility. Like the United States, Germany is a wealthy, democratic society with strong nongovern...
Article
Einleitung Die Wahrnehmung, was mit wissenschaftlicher Evidenz gemeint ist, hat sich in den letzten Jahren deutlich verändert. Der Wechsel der Perspektive ist eng mit dem Begriff evidenzbasierte Medizin verbunden. Gemeint ist damit eine medizinische Betreuung von Patienten, die sich nicht alleine auf Meinungen und Übereinkünfte stützt, sondern wiss...
Article
Full-text available
The Institute for Quality and Efficiency in Health Care (IQWiG) was established in 2004 to provide Germany's Federal Joint Committee with evidence-based evaluations of the benefits and cost benefits of health services, and functions in an advisory role. IQWiG reviews available evidence and produces recommendations after an extensive process of cons...
Article
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The aim of this cohort study was to investigate the risk of malignant neoplasms and mortality in patients with diabetes treated either with human insulin or with one of three insulin analogues. Data were provided by the largest German statutory health insurance fund (time-frame: January 1998 to June 2005 inclusive), on patients without known malign...
Article
The discussion about improving the efficiency, quality, and long-term sustainability of the U.S. health care system is increasingly focusing on the need to provide better evidence for decision making through comparative effectiveness research (CER). In recent years, several other countries have established agencies to evaluate health technologies a...
Article
Full-text available
Mit der Gesundheitsreform des Jahres 2007 (GKV-WSG) wurden die Aufgaben des Instituts für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG) erweitert: Bislang konnte es Arzneimittel nur in Hinblick auf ihren medizinischen Nutzen bewerten. Künftig soll das Institut auch die Kosten in ein Verhältnis zu dem zuvor ermittelten Nutzen setzen. L...
Article
Eine wichtige Voraussetzung für hohe Qualität in einem Gesundheitssystem ist, dass medizinische Technologien ausschließlich da eingesetzt werden, wo sie notwendig sind. Dieser Beschränkung steht die Pflicht gegenüber, das was notwendig ist, für die gesamte Bevölkerung durch die Solidargemeinschaft abzusichern. Ein zweiter Aspekt der Qualität besteh...
Article
Das Institut für Qualität und Wirtschaflichkeit im Gesundheitswesen (IQWiG) ist ein unabhängiges wissenschaftliches Institut, das den Nutzen medizinischer Leistungen für den Patienten untersucht. Damit stehen Qualität und Wirtschaftlichkeit auf dem Prüfstand. Das Institut erforscht, was therapeutisch und diagnostisch möglich und sinnvoll ist und in...
Article
Zusammenfassung Mit der jüngsten Gesundheitsreform (GKV-WSG) wurden die Aufgaben des Instituts für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG) erweitert: Bislang konnte es Arzneimittel nur in Hinblick auf ihren medizinischen Nutzen bewerten. Künftig soll das Institut auch die Kosten in ein Verhältnis zu dem zuvor ermittelten Nutzen...
Article
Germany’s health system provides good access to care for all patients. But, as Peter Sawicki and Hilda Bastian explain, it is increasingly turning to science to determine what is good value
Article
In addition to the metrological quality of international normalized ratio (INR) monitoring devices used in patients' self-management of long-term anticoagulation, the effectiveness of self-monitoring with such devices has to be evaluated under real-life conditions with a focus on clinical implications. An approach to evaluate the clinical significa...
Article
Introduction: National health care systems differ markedly in organization and financing, in international comparison. In 2006 the Commonwealth Fund interviewed primary care doctors from 7 countries to compare aspects of daily work and quality of health care. Methods: In total 6 088 general and family physicians, pediatricians and general internist...
Article
In line with the application of evidence-based medicine as part of the day-to-day clinical practice of a community hospital internal guidelines concerning relevant diagnostic or therapeutic problems were developed. The authors retrospectively compared all data of patients with the tentative diagnosis of deep vein thrombosis (DVT), who underwent fur...
Article
To compare the effects of a cardioselective beta-blocker (nebivolol) with those of an angiotensin-converting enzyme inhibitor (enalapril) on parameters of insulin sensitivity, peripheral blood flow and arterial stiffness during one extended glucose clamp experiment. A randomized, double-blind crossover trial, consisting of two 12-week treatment pha...
Article
After the recall of rofecoxib (Vioxx), there was repeated national and international discussion on the potential number of patients harmed by causally related cardio- and cerebrovascular events. In individual cases, it cannot be determined whether a myocardial infarction or stroke that occurred during rofecoxib therapy was actually directly caused...
Article
Sicker adults in Germany suffer many of the same issues and concerns as do sicker adults in Australia, Canada, New Zealand, the United Kingdom, and the USA. However, quality of care in sicker adults in Germany stands out from the other countries in a few key areas: 1. DISSATISFACTION WITH THE HEALTH CARE SYSTEM Almost one in three sicker adults in...
Article
Patienten in Deutschland leiden unter vergleichbaren Unzulänglichkeiten und Defiziten des Gesundheitssystems wie jene in Australien, Kanada, Neuseeland, Großbritannien und den USA. Allerdings unterscheidet sich die Qualität der Versorgung von chronisch kranken Menschen in Deutschland von der in den übrigen Ländern in einigen wesentlichen Aspekten:...
Article
Smoking has repeatedly been associated with alterations in both insulin sensitivity and insulin absorption in type 2 diabetes, which should lead to differences in the pharmacokinetic (PK) and pharmacodynamic (PD) properties of regular insulin (RI). However, a direct comparison of the PK/PD-effects of RI has never been performed in these patients. T...
Article
The AD2000 study was a randomized placebo-controlled trial, the effects of donepezil, a cholinesterase inhibitor, in patients with Alzheimer's disease. It was the first long-term RCT not sponsored by the pharmaceutical industry. The study did not show any significant effect on patient-relevant outcomes. However, donepezil had a significant effect o...
Article
The AD2000 study was a randomized placebo-controlled trial, the effects of donepezil, a cholinesterase inhibitor, in patients with Alzheimer’s disease. It was the first long-term RCT not sponsored by the pharmaceutical industry. The study did not show any significant effect on patient-relevant outcomes. However, donepezil had a significant effect o...
Article
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This study aimed to compare the effect of treatment with short-acting insulin (SAI) analogues versus structurally unchanged short-acting insulin (regular insulin) on glycaemic control and on the risk of hypoglycaemic episodes in type 1 diabetic patients using different insulin treatment strategies. We performed a meta-analysis of 27 randomised cont...
Conference Paper
Full-text available
y mother is a walking miracle. I'm not the kind of person who tries to be cool or trendy, I'm definitely an individual. If you can do what you do best and be happy, you're further along in life than most people.
Article
Cardiovascular morbidity and mortality is a major and still unresolved threat to patients with reduced glucose tolerance and Type 2 diabetes mellitus. In epidemiological studies, in non-diabetic subjects, post-prandial glycaemia is positively associated with the risk of diabetes, hypertension and cardiovascular events. If this epidemiological assoc...
Article
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This work is aimed at assessing the evidence for the possible improvement of therapeutic control of anticoagulation, reduction of major bleedings, thromboembolism and improvement of treatment-related quality of life in patients with self-managed oral anticoagulation therapy versus oral anticoagulation patients on routine care. Randomised controlled...
Article
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Aerztliche Entscheidungen in der Praxis werden weniger durch eine kritische eigenständige Bewertung der wissenschaftlichen Literatur als vielmehr durch aufbereitete externe Informationen, die meist von der Pharmaindustrie über ihre Referenten vermittelt werden, determiniert. Somit haben die Werbeaussagen von Pharmareferenten eine entscheidende steu...
Article
Does antihypertensive treatment in normotensive patients with diabetic nephropathy alter the progression of kidney failure? We have evaluated studies of renal function which either assessed the effects of different therapeutic blood pressure (BP) goals, or the effects of antihypertensive therapy within the normotensive BP range. Need for renal repl...
Article
Does antihypertensive treatment in normotensive patients with diabetic nephropathy alter the progression of kidney failure? We have evaluated studies of renal function which either assessed the effects of different therapeutic blood pressure (BP) goals, or the effects of antihypertensive therapy within the normotensive BP range. Need for renal repl...
Article
Full-text available
To compare causes of death assessed by a clinical review committee, the information given on death certificates, and ICD-codes provided by the State Documentation Office in deceased persons with Type 1 (insulin-dependent) diabetes mellitus. A cohort of 3674 patients were monitored for 10+/-3 (mean +/- SD) years. Vital status and end-stage diabetic...
Article
Objective: Control of oral anticoagulation therapy has been reported to be often inadequate. Prospective controlled randomised short-term investigations suggest that patients' self-management of oral anticoagulation may lead to improved control. Prospective long-term studies of this intervention are not available. Design: Prospective, multicenter,...
Article
To examine the effects of a time-limited, problem-orientated psychotherapeutic intervention on self-defined psychological problems and metabolic control in Type 1 diabetic patients with microvascular complications. Randomized wait-list controlled trial with a follow-up of 6 months. Out-patient clinic of a university diabetes centre. Forty-six Type...
Article
The benefit of good blood pressure control in patients with arterial hypertension has been repeatedly demonstrated. In high risk patients, a good blood pressure control is one of the main prerequisites for the reduction in morbidity and mortality. However, as shown in population-based studies, the quality of blood pressure control both in patients...
Article
The benefit of good blood pressure control in patients with arterial hypertension has been repeatedly demonstrated. In high risk patients, a good blood pressure control is one of the main prerequisites for the reduction in morbidity and mortality. However, as shown in population-based studies, the quality of blood pressure control both in patients...
Article
The prescription rate of AT-II antagonists in diabetic patients is currently increasing. We have critically analysed available evidence on the impact of these agents on morbidity and mortality in diabetic patients with hypertension, heart failure, renal disease, or myocardial hypertrophy. When combined with beta blockers in patients with heart fail...
Chapter
Cardiovascular disease is the leading cause of mortality both in type 1 (insulin-dependent) and type 2 (non-insulin-dependent) patients. Reduction of this excessive cardiovascular mortality rate represents the main aim of diabetes care. However, some aspects of cardiovascular disease may differ between diabetic and non-diabetic patients. In this ar...
Article
To assess the prevalence of cardiac autonomic neuropathy (CAN) in Type 1 diabetic patients with and without nephropathy. Sixty-six consecutive patients without nephropathy (n = 24), with incipient (n = 26) or overt nephropathy (n = 16) and a diabetes duration between 21 and 31 years were examined. Heart rate variability (HRV) as measure for CAN was...
Article
Betablockers have been convincingly shown to reduce total and cardiovascular morbidity and mortality of hypertensive diabetic patients. In diabetic patients, after myocardial infarction, these agents confer a twice as high protective effect when compared to non-diabetic patients. However, most paradoxically, betablocking agents are used less freque...
Article
The benefit of good blood pressure control in patients with arterial hypertension has been repeatedly demonstrated. In high-risk patients, a good blood pressure control is one of the main prerequisites for the reduction of morbidity and mortality. However, as has been shown in population-based studies, the quality of blood pressure control both in...
Article
Full-text available
To quantify pharmacokinetic and pharmacodynamic properties of regular insulin and insulin lispro in type 1 diabetic patients with and without overt diabetic nephropathy. In this double-blind, two-way cross-over, euglycemic (5 mmol/l) glucose clamp study, we investigated the metabolic response to subcutaneous injections of regular insulin and insuli...
Article
Beta-blockers have been convincingly shown to reduce total and cardiovascular morbidity and mortality in hypertensive diabetic patients. After myocardial infarction these agents confer a twice as high protective effect when compared to non-diabetic patients. However, most paradoxically, beta-blocking agents are used less frequently in diabetes. A t...
Article
It is commonly accepted that strict blood pressure control with blood pressure values in or even below the normal range has to be achieved in patients with diabetes mellitus and hypertension, especially in patients with diabetic nephropathy. Many surveys, however, show that the quality of antihypetensive control in these patients in general is poor...
Article
To study the prognosis of persons with type 1 diabetes in relation to the degree of nephropathy at initiation of intensified insulin therapy. Ten years follow-up of a cohort of 3674 patients who had participated in a 5-day group treatment and teaching programme for intensification of insulin therapy between September 1978 and December 1994. Ten dia...
Article
In type 1 diabetic patients with nephropathy, tight blood pressure control has been shown to prevent the progression of the disease. Up until now, self-monitoring, ambulatory and office blood pressure values have not been compared in these patients. Thus, we have evaluated blood pressure values obtained in the office by a physician and at home by s...