Diabetic MedicineVolume 37, Issue 7 p. 1209-1210 Letter Comment on: Comparative characteristics of older people with type 1 diabetes treated with continuous subcutaneous insulin infusion or insulin injection therapy: data from the German/Austrian DPV registry. Reply to Rigalleau et al. J. Grammes, J. Grammes orcid.org/0000-0002-5894-6734 Health Psychology, Johannes Gutenberg University, MainzSearch for more papers by this authorE. Küstner, E. Küstner Health Psychology, Johannes Gutenberg University, MainzSearch for more papers by this authorA. Dapp, A. Dapp Medical Center, SpaichingenSearch for more papers by this authorM. Hummel, M. Hummel Diabetology Outpatient Clinic, RosenheimSearch for more papers by this authorJ.-C. Kämmer, J.-C. Kämmer Department of Gastroenterology, Cardiology, Diabetology, and Geriatrics, Vivantes Klinikum Berlin, BerlinSearch for more papers by this authorT. Kubiak, T. Kubiak orcid.org/0000-0003-0095-9265 Health Psychology, Johannes Gutenberg University, MainzSearch for more papers by this authorI. Schütz-Fuhrmann, I. Schütz-Fuhrmann Department of Internal Medicine, Krankenhaus Hietzing, Vienna, AustriaSearch for more papers by this authorS. Zimny, S. Zimny Department of Internal Medicine, Endocrinology and Diabetology, Helios Kliniken, SchwerinSearch for more papers by this authorE. Bollow, E. Bollow ZIBMT, Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm German Center for Diabetes Research (DZD), Munich, GermanySearch for more papers by this authorR. W. Holl, R. W. Holl ZIBMT, Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm German Center for Diabetes Research (DZD), Munich, GermanySearch for more papers by this authorfor the DPV Initiative, for the DPV InitiativeSearch for more papers by this author J. Grammes, J. Grammes orcid.org/0000-0002-5894-6734 Health Psychology, Johannes Gutenberg University, MainzSearch for more papers by this authorE. Küstner, E. Küstner Health Psychology, Johannes Gutenberg University, MainzSearch for more papers by this authorA. Dapp, A. Dapp Medical Center, SpaichingenSearch for more papers by this authorM. Hummel, M. Hummel Diabetology Outpatient Clinic, RosenheimSearch for more papers by this authorJ.-C. Kämmer, J.-C. Kämmer Department of Gastroenterology, Cardiology, Diabetology, and Geriatrics, Vivantes Klinikum Berlin, BerlinSearch for more papers by this authorT. Kubiak, T. Kubiak orcid.org/0000-0003-0095-9265 Health Psychology, Johannes Gutenberg University, MainzSearch for more papers by this authorI. Schütz-Fuhrmann, I. Schütz-Fuhrmann Department of Internal Medicine, Krankenhaus Hietzing, Vienna, AustriaSearch for more papers by this authorS. Zimny, S. Zimny Department of Internal Medicine, Endocrinology and Diabetology, Helios Kliniken, SchwerinSearch for more papers by this authorE. Bollow, E. Bollow ZIBMT, Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm German Center for Diabetes Research (DZD), Munich, GermanySearch for more papers by this authorR. W. Holl, R. W. Holl ZIBMT, Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm German Center for Diabetes Research (DZD), Munich, GermanySearch for more papers by this authorfor the DPV Initiative, for the DPV InitiativeSearch for more papers by this author First published: 22 April 2020 https://doi.org/10.1111/dme.14311Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume37, Issue7July 2020Pages 1209-1210 RelatedInformation

To compare clinical characteristics and outcomes in adults with type 1 diabetes aged ≥ 60 years using continuous subcutaneous insulin infusion (CSII) vs. insulin injection therapy. Further, to determine the percentage of older adults with type 1 diabetes using CSII.

Fragestellung: In unserer alternden Gesellschaft treten Demenz und Typ-2-Diabetes (T2D) immer häufiger auf. Ziel war es den Einfluss einer komorbiden Demenzdiagnose auf die Diabetestherapie und den Verlauf zu untersuchen.

Fragestellung: In der Literatur wurde wiederholt über eine Assoziation von Typ-2-Diabetes (T2D) und Psoriasis berichtet. Chronische Entzündungsreaktionen spielen sowohl bei T2D als auch bei Psoriasis eine Rolle. Ziel dieser Auswertung war die Untersuchung von T2D-Patienten mit und ohne komorbide Psoriasis.

BACKGROUND:We performed a comparative analysis of the use of long-acting insulin (analogues) neutral protamine hagedorn (NPH), detemir (Det) and glargine (Gla), and quantified injection frequencies and daily insulin doses in patients with type 1 and 2 diabetes in daily practice.METHODS:A total number of 51 964 patients from 336 centres in Germany and Austria with type 1 and 2 diabetes with exclusive insulin therapy were retrospectively analysed.RESULTS:A total number of 42.1%/75.9% (type 1/type 2) of patients used NPH, 19.9%/6.7% Det and 38.0%/17.4% Gla, with similar glycaemic control and proportion of severe hypoglycaemia for NPH/Det/Gla in type 1 (Mean HbA(1c) 7.98%/7.98%/8.07%; mean proportion of severe hypoglycaemia 11.06%/11.93%/10.86%) and type 2 diabetes (Mean HbA(1c) 7.61%/7.78%/7.61%; mean proportion of severe hypoglycaemia 5.66%/4.48%/5.03%). In type 1 diabetes, the mean daily injection frequencies of NPH versus Det versus Gla were 1.9 vs 1.8 vs 1.1, and total daily insulin injections were 5.3 vs 5.6 vs 5.0. The adjusted mean daily basal insulin doses were 0.36, 0.39 and 0.31 IU/kg, mean daily total insulin dose was lowest for Gla (0.74 IU/kg), followed by NPH (0.76 IU/kg) and Det (0.81 IU/kg). In type 2 diabetes patients, mean daily injection frequencies were 1.6 for NPH, 1.4 for Det and 1.1 for Gla, total daily insulin injections were 4.0 vs 4.1 vs 3.6. The mean daily basal insulin dosages were 0.30 IU/kg (NPH), 0.33 IU/kg (Det) and 0.29 IU/kg (Gla), mean total insulin doses per day were 0.63 IU/kg (NPH), 0.77 IU/kg (Det) and 0.67 IU/kg (Gla).CONCLUSIONS:In a 'real-world' setting, the injection frequencies and doses of basal and total insulin per day are lowest with the use of insulin glargine compared with NPH-insulin or insulin detemir at similar glycaemic control and rates of severe hypoglycaemia.

Fragestellung: Insbesondere bei älteren Menschen liegt zusätzlich zum Diabetes mellitus Typ 2 (T2DM) häufig ein Morbus Parkinson vor. Ziel dieser Auswertung war daher, Diabetesendpunkte sowie geriatrische Syndrome zwischen T2DM-Patienten mit und ohne Morbus Parkinson zu vergleichen.

Fragestellung: Anhand der DPV-Wiss-Daten soll die Häufigkeit einer Demenz in Abhängigkeit von Geschlecht, Alter, rel. Diabetesdauer, Behandlungsjahr, Gewicht, Stoffwechseleinstellung und Diabetesmedikation untersucht werden.

Glycemic and body weight control are two outstanding goals in the treatment of patients with type 2 diabetes that often are not appropriately achieved. This observational study evaluates whether treatment by quality controlled diabetes centers generates an improvement in this regard and focuses on associations with different therapies. Data of 9.294 type 2 diabetic patients (mean age 66.9±11.6 years, mean diabetes duration 12.4±9.2 years) from 103 German diabetes centers were assessed by a standardized, prospective, computer-based diabetes care and outcome documentation system (DPV-Wiss-database). Therapeutic concepts included lifestyle intervention (n=1.813), oral antidiabetics (OAD, n=1.536), insulin (n=4.504) and insulin plus OAD (n=1.441). HbA1c and body weight were compared before and after a stable therapeutical period of 1.07±0.3 years. Change in HbA1c (%): all patients 7.4±1.6-7.0±1.3, lifestyle intervention 7.5±1.9-6.9±1.5, OAD 6.7±1.1-6.5±1.0, insulin 7.6±1.6-7.2±1.4, insulin plus OAD 7.5±1.5-7.2±1.3; each p≤0.05. Change in body weight (kg): all patients +0.08±0.07, n. s.; lifestyle intervention -0.28±0.20, OAD -0.56±0.13, each p<0.05 [metfomin -0.77±0.21, sulfonylurea drugs -0.75±0.34, each p<0.05; glitazones +0.62±0.70, α-glucosidase inhibitors -0.22±0.76, each n. s.], insulin +0.27±0.10, insulin plus OAD +0.63±0.14, each n. s. In summary, lifestyle, metformin or sulfonylurea drug treatment resulted in HbA1c-values below 7.0% plus a significant weight reduction. Insulin treatment-associated concepts resulted in HbA1c-values slightly above 7.0% without body weight alterations. These "real life" data underline that a specialised and quality controlled diabetes care is able to achieve significant treatment results even in patients with disease progression and a high proportion of insulin therapies.

Fragestellung: Durch Verwendung langwirkender Analoginsuline soll sich die Anzahl täglicher Basalinsulingaben verringern. Die Injektionshäufigkeit und der Tagesinsulinbedarf unter Alltagsbedingungen von Typ 2-Diabetes Patienten wurden mit anonymisierten Verlaufsdaten zwischen den Basalinsulinen Detemir, Glargin und NPH verglichen.

Glycemic and body weight control are two outstanding goals in the treatment of patients with type 2 diabetes that often are not appropriately achieved. This observational study evaluates whether treatment by quality controlled diabetes centers generates an improvement in this regard and focuses on associations with different therapies. Data of 9.294 type 2 diabetic patients (mean age 66.9 +/- 11.6 years, mean diabetes duration 12.4 +/- 9.2 years) from 103 German diabetes centers were assessed by a standardized, prospective, computer-based diabetes care and outcome documentation system (DPV-Wiss-database). Therapeutic concepts included lifestyle intervention (n = 1.813), oral antidiabetics (OAD, n = 1.536), insulin (n = 4.504) and insulin plus OAD (n = 1.441). HbA1c and body weight were compared before and after a stable therapeutical period of 1.07 +/- 0.3 years. Change in HbA1c (%): all patients 7.4 +/- 1.6-7.0 +/- 1.3, lifestyle intervention 7.5 +/- 1.9-6.9 +/- 1.5, OAD 6.7 +/- 1.1-6.5 +/- 1.0, insulin 7.6 +/- 1.6-7.2 +/- 1.4, insulin plus OAD 7.5 +/- 1.5-7.2 +/- 1.3; each p <= 0.05. Change in body weight (kg): all patients +0.08 +/- 0.07, n.s.; lifestyle intervention -0.28 +/- 0.20, OAD-0.56 +/- 0.13, each p < 0.05 [metfomin -0.77 +/- 0.21, sulfonylurea drugs -0.75 +/- 0.34, each p < 0.05; glitazones +0.62 +/- 0.70, alpha-glucosidase inhibitors -0.22 +/- 0.76, each n.s.], insulin +0.27 +/- 0.10, insulin plus OAD +0.63 +/- 0.14, each n.s. In summary, lifestyle, metformin or sulfonylurea drug treatment resulted in HbA1c-values below 7.0% plus a significant weight reduction. Insulin treatment-associated concepts resulted in HbA1c-values slightly above 7.0 % without body weight alterations. These "real life " data underline that a specialised and quality controlled diabetes care is able to achieve significant treatment results even in patients with disease progression and a high proportion of insulin therapies.

Fragestellung: Adipositas gilt als eigenständiger kardiovaskulärer Risikofaktor. Neben einer guten Stoffwechselkontrolle stellt die Gewichtsreduktion bei Übergewicht ein wichtiges Ziel einer mikro- und makrovaskulär orientierten Diabetestherapie dar. Auf Basis der DPV-Wiss-Datenbank wurde untersucht, welchen Einfluss verschiedene Diabetestherapien auf den Stoffwechsel und auf das Gewicht haben.

Fragestellung: Die Adipositas spielt eine wesentliche Rolle bei der Entstehung makrovaskulärer Komplikationen des Menschen mit Typ 2 Diabetes. Das Erreichen einer Gewichtsreduktion ist deshalb neben der Normoglykämie ein wichtiges Ziel der Diabetestherapie. Auf Basis der DPV-Wiss-Datenbank wurde untersucht, welchen Einfluss verschiedene Diabetestherapien auf den Stoffwechsel und auf das Gewicht haben.

Hintergrund: Für Zigarettenrauchen als Risikofaktor für mikrovaskuläre Folgeerkrankungen bei Menschen mit Diabetes mellitus gibt es widersprüchliche Befunde. Rauchen als Risikofaktor für makrovaskuläre Folgeerkrankungen bei Menschen mit Diabetes mellitus ist dagegen gut belegt. Methodik: Mit Hilfe der DPV-Software wurden anonymisierte Verlaufsdaten von 10.397 erwachsenen Menschen mit Typ 1 Diabetes (Alter 16 - 60 Jahre) standardisiert erhoben und ausgewertet. Raucher und Nichtraucher wurden hinsichtlich bekannter Risikofaktoren für mikro- und makroangiopathische Komplikationen verglichen. Untersucht wurde zudem, ob das Rauchen ein unabhängiger Risikofaktor für mikroangiopathische Komplikationen ist. Ergebnisse: Es zeigt sich, das Raucher im Vergleich zu Nichtrauchern häufiger ein erhöhtes Cholesterin (11,68 vs. 7,8 %, p < 0,001) und einen erhöhten HbA1c Wert (9,71 % vs. 8,61 %, p < 0,001) haben. Zudem kann belegt werden, dass Rauchen das Risiko bei Menschen mit Typ 1 Diabetes für eine Retinopathie um das 2,4fache (1,78 - 3,30, p < 0,001), für eine Makroalbuminurie um das 5,9fache (2,04 - 16,97, p < 0,001) erhöht. Schlussfolgerung: Raucher haben ein höheres Risikoprofil für mikro- und makrovaskuläre Komplikationen als Nichtraucher. Außerdem ist aber Rauchen zusätzlich ein unabhängiger Risikofaktor für mikroangiopathische Komplikationen, d. h. alleine das Rauchen erhöht das Risiko für die diabetische Retinopathie und Makroalbuminurie.

Einleitung: BZSM und Insulin Dosisanpassung gelten als anerkannte Bestandteile eines modernen Diabetes Selbstmanagements. Ziele: Die Effektivität einer BZSM für die BZ Einstellung soll unter Alltagsbedingungen ermittelt werden.

Blood glucose measurements are generally accepted components of a modern diabetes self-management. The value of self-monitoring of blood glucose (SMBG) is, however, discussed controversially and only a few studies addressed the efficacy of SMBG under real-life conditions so far. In order to investigate whether the frequency of SMBG is related to long-term metabolic control, data from the DPV-Wiss-database, a standardized,prospective, computer-based documentation of diabetes care and outcome, were analyzed for patients with type 1(n = 19,491) and type 2 (n = 5,009) diabetes from 191 centers in Germany and Austria. Local HbA1c reference ranges were mathematically adjusted to the DCCT reference. For each patient, data from the most recent year of diabetes care were used. On average,patients with type 1 diabetes performed 4.4 blood glucose measurements/day. Corrected for age, gender, diabetes duration,on intensified (>or=4 daily injections or CSII) therapy (HbA1c reduction of 0.32% for one additional SMBG/day) compared to patients on conventional (1-3 daily injections) therapy(HbA1c-reduction of 0.16% for one additional SMBG/day). In 2,021 patients with insulin-treated type 2 diabetes (2.7 measurements/day), more frequent SMBG was associated with better metabolic control (HbA1c-reduction of 0.16% for one additionalSMBG/day, p < 0.0001), while in 2,988 patients on OAD or diet alone (2.0 measurements/day), more frequent blood glucose measurements were associated with higher HbA1c-levels(HbA1c-increase of 0.14% for one additional SMBG/day,p < 0.0001). These data indicate that more frequent SMBG are associated with better metabolic control in both, patients with type 1 and insulin-treated type 2 diabetes. Since no benefit ofSMBG on metabolic control was found in patients with type 2 diabetes on OAD or diet alone, SMBG should primarily be recommended for those patients with suboptimal metabolic control whereas the benefit of SHBG in non-insulin-treated patients with adequate HbA1c-levels remains uncertain.insulin therapy and center difference, the SMBG frequency was associated with better metabolic control (HbA1c-reduction of0.26% for one additional SMBG/day, p < 0.0001). HbA1c-reduction with higher frequency of SMBG was more pronounced in patients Blood glucose measurements are generally accepted components of a modern diabetes self-management. The value of self-monitoring of blood glucose (SMBG) is, however, discussed controversially and only a few studies addressed the efficacy of SMBG under real-life conditions so far. In order to investigate whether the frequency of SMBG is related to long-term metabolic control, data from the DPV-Wiss-database, a standardized,prospective, computer-based documentation of diabetes care and outcome, were analyzed for patients with type 1(n = 19,491) and type 2 (n = 5,009) diabetes from 191 centers in Germany and Austria. Local HbA1c reference ranges were mathematically adjusted to the DCCT reference. For each patient, data from the most recent year of diabetes care were used. On average,patients with type 1 diabetes performed 4.4 blood glucose measurements/day. Corrected for age, gender, diabetes duration,insulin therapy and center difference, the SMBG frequency wasassociated with better metabolic control (HbA1c-reduction of 0.26% for one additional SMBG/day, p < 0.0001). HbA1c-reduction with higher frequency of SMBG was more pronounced in patients on intensified (>or= 4 daily injections or CSII) therapy (HbA1c reduction of 0.32% for one additional SMBG/day) compared to patients on conventional (1-3 daily injections) therapy(HbA1c-reduction of 0.16% for one additional SMBG/day). In 2,021 patients with insulin-treated type 2 diabetes (2.7 measurements/day), more frequent SMBG was associated with better metabolic control (HbA1c-reduction of 0.16% for one additionalSMBG/day, p < 0.0001), while in 2,988 patients on OAD or diet alone (2.0 measurements/day), more frequent blood glucose measurements were associated with higher HbA1c-levels(HbA1c-increase of 0.14% for one additional SMBG/day, p < 0.0001). These data indicate that more frequent SMBG are associated with better metabolic control in both, patients with type 1 and insulin-treated type 2 diabetes. Since no benefit of SMBG on metabolic control was found in patients with type 2 diabetes on OAD or diet alone, SMBG should primarily be recommended for those patients with suboptimal metabolic control whereas the benefit of SHBG in non-insulin-treated patients with adequate HbA1c-levels remains uncertain.