ZUSAMMENFASSUNG Das diabetische Fußsyndrom umfasst komplexe pathologische Veränderungen am Fuß eines Menschen mit Diabetes mellitus. Schwerwiegende Manifestationen diabetischer Fußprobleme sind Ulzerationen, deformierende Veränderungen des Fußskeletts („Charcot-Fuß“) und immer noch zu oft Amputationen. Ulzera oder Nekrosen entwickeln sich meist als Folge von repetitiver Traumatisierung bei eingeschränktem Druck- und Schmerzempfinden im Rahmen einer diabetischen Polyneuropathie. Bei allen Menschen mit Diabetes sollten daher Füße und Schuhwerk regelmäßig untersucht werden. Wesentliche Komponenten der Behandlung diabetischer Fußulzera sind Stoffwechseloptimierung und Behandlung internistischer Grunderkrankungen, Infektionskontrolle, Debridement avitaler Gewebeanteile, effektive Druckentlastung, stadiengerechte lokale Wundbehandlung, Therapie von Gefäßerkrankungen, fußchirurgische Korrektur von Deformitäten und/oder Fehlstellungen sowie Patientenschulung. Durch ein frühzeitiges multidisziplinäres, multiprofessionelles und transsektorales Vorgehen bei der Behandlung von Fußulzera kann die Häufigkeit von Amputationen bedeutend gesenkt werden. Wichtigste präventive Maßnahme ist die rechtzeitige Identifikation von Risikofüßen und dann deren regelmäßige Selbst- und Fremdkontrolle, um trotz des Verlustes schützender Warnmechanismen im Rahmen der Neuropathie keine akuten Ereignisse zu erleiden.

Patienten mit Neuropathie und diabetischem Fußsyndrom stellen sich bei Behandlern mit rezidivierenden Ulzera vor, die theoretisch hätten vermieden werden können, wenn die Betroffenen besser auf ihre Füße geachtet und sich früher beim Arzt gemeldet hätten. Die Auswirkungen des Verlust des Schutzgefühls („loss of protective sensation“ [LOPS]) in den Füßen werden oft von Behandlern unterschätzt, woraufhin die Unerfahrenen mit Fassungslosigkeit, Hilflosigkeit und manchmal Ärger reagieren. Psychologische und anthropologische Kenntnisse sind hilfreich, um zu verstehen, wie diese scheinbar mangelnde Sorgfalt zustande kommt und warum es sich dabei nicht um mangelnde Sorgfalt handelt. Daraus ableitend empfehlen wir Kommunikationsmöglichkeiten, um Patienten mit Neuropathie besser auf ihrem Weg mit dieser schwierigen Krankheit zu unterstützen.

Objective To analyze the proportion of diabetes among all hospitalized cases in Germany between 2015 and 2020. Methods Using the nationwide Diagnosis-Related-Groups statistics, we identified among all inpatient cases aged ≥ 20 years all types of diabetes in the main or secondary diagnoses based on ICD-10 codes, as well all COVID-19 diagnoses for 2020. Results From 2015 to 2019, the proportion of cases with diabetes among all hospitalizations increased from 18.3% (3.01 of 16.45 million) to 18.5% (3.07 of 16.64 million). Although the total number of hospitalizations decreased in 2020, the proportion of cases with diabetes increased to 18.8% (2.73 of 14.50 million). The proportion of COVID-19 diagnosis was higher in cases with diabetes than in those without in all sex and age subgroups. The relative risk (RR) for a COVID-19 diagnosis in cases with vs without diabetes was highest in age group 40–49 years (RR in females: 1.51; in males: 1.41). Conclusions The prevalence of diabetes in the hospital is twice as high as the prevalence in the general population and has increased further with the COVID-19 pandemic, underscoring the increased morbidity in this high-risk patient group. This study provides essential information that should help to better estimate the need for diabetological expertise in inpatient care settings.

Diabetic foot syndrome is understood to be all pathological changes in the foot of a person with diabetes mellitus. These include pre-ulcerous lesions such as abnormal corneal callouses. Ulcers or necroses usually develop as a result of repetitive trauma with limited sensation of pressure and pain in the context of diabetic polyneuropathy (e. g. in the form of high pressure and shear stress, especially in foot and toe deformities). In Germany, more than 50 % of all cases are characterized by a relevant peripheral arterial occlusive disease (PAOD), whose symptoms (claudication, pain at rest) are often masked by the polyneuropathy.

Aktualisierungshinweis Die DDG-Praxisempfehlungen werden regelmäßig zur zweiten Jahreshälfte aktualisiert. Bitte stellen Sie sicher, dass Sie jeweils die neueste Version lesen und zitieren.

Aktualisierungshinweis Die DDG-Praxisempfehlungen werden regelmäßig zur zweiten Jahreshälfte aktualisiert. Bitte stellen Sie sicher, dass Sie jeweils die neueste Version lesen und zitieren.

Patients with chronic wounds are significantly impaired in their health‐related quality of life (HRQoL). The validated Wound‐QoL questionnaire allows assessing the impact of chronic wounds on different aspects of HRQoL including physical, psychological, and everyday life‐related impairments. The aim of our study was to investigate associations of these HRQoL dimensions with age, sex, and particularly wound genesis. In this retrospective, cross‐sectional, multicentre study, Wound‐QoL questionnaires from clinical routine of patients with venous leg ulcers, arterial leg ulcers, mixed leg ulcers, and diabetic foot ulcers (DFU) were evaluated. Effects of wound genesis, sex, and age were assessed with analysis of variance as well as correlation and multiple linear regression analyses. The completed questionnaires of 381 patients (f = 152/m = 229; mean age 68.9) were included. The wound genesis groups showed significantly different distributions of age and sex. We also found significant differences between those groups in everyday life‐related QoL, with the greatest impairments in patients with DFU. Physical QoL scores showed significant differences between men and women depending on diagnosis group: in patients with venous leg ulcers, women had greater impairment of physical QoL than men. Independent of the underlying diagnosis, women had significantly higher scores in the psychological subscale as well as in the Wound‐QoL sum scale. Within the subgroup of arterial leg ulcer patients, overall HRQoL sum score was significantly worse in older patients. Regression analyses supported negative effects of DFU diagnosis and female sex on HRQoL. Our data offer evidence that HRQoL shows clinically relevant differences between patients with chronic wounds of different genesis. Moreover, our data revealed that HRQoL is associated with age and sex, which should be considered when treating the patient groups. In order to be able to capture these important aspects and to offer individualised and patient‐oriented treatments, the Wound‐QoL should be implemented as a quick and uncomplicated standard instrument in daily routine. Patients with chronic wounds are significantly impaired in their health‐related quality of life. Validated Wound‐QoL questionnaire is a quick and easy‐to‐use instrument for daily practice. Wound‐related quality of life shows clinically relevant differences between patients with chronic wounds of different genesis. Wound‐related quality of life is associated with age and sex, which should be considered when treating these patient groups. Health‐related quality of life should be regularly objectified in all patients with chronic wounds with a validated measuring instrument.

Diabetologe 2021 · 17:192–200 https://doi.org/10.1007/s11428-021-00723-1 Angenommen: 12. Januar 2021 Online publiziert: 15. Februar 2021 © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2021 StephanMorbach · Ralf Lobmann · Michael Eckhard · Eckhard Müller · Heinrich Reike · Alexander Risse · Gerhard Rümenapf · Maximilian Spraul 1 Abteilung Diabetologie und Angiologie, Marienkrankenhaus gGmbH, Soest, Deutschland 2 Klinik für Endokrinologie, Diabetologie und Geriatrie, Klinikum Stuttgart, Standort Bad Cannstatt, Stuttgart, Deutschland Universitäres Diabeteszentrumund Interdisziplinäres Zentrum Diabetischer FußMittelhessen, UniversitätsklinikumGießen und Marburg GmbH, Gießen, Deutschland

In the present multicentre study with 6424 nursing patients among 500 973 diabetic patients of the DPV registry, the clinical characteristics in patients in need of nursing care compared to pa-tients without nursing care are presented stratified by age group and diabetes type. 15 % of people in need of care have type 1 diabetes, (99.0 % of the children), 9.5 % of 18-75-year-olds and 2.4 % of over 75-year-olds. Nursing care in adults and the elderly is associated with dementia, depression, heart failure, circulatory disorders, stroke, diabetic foot syndrome and amputations. Insulin is used in 77 % of those in need of nursing care and thus significantly more often than in the control group (55 %). Despite significantly higher HbA(1c)levels and higher fast-ing glucose compared to patients without nursing care, hypoglycemia with and without coma is significantly more frequent among those requiring care. Metabolic decompensation resulted in hospital admission for 15 % of nursing patients compared to only 6 % of diabetes patients with-out the need for nursing care. In the context of nursing care, more attention should be paid to the avoidance of decompensa-tions and measures should be taken to prevent later occurrence of the associated conditions. Nursing care structures should be regionally specialized in order to slow down further progres-sion in comorbid patients. In the education and training of doctors and nursing staff, the specific requirements of young and old patients as well as patients with type 1 and type 2 diabetes should be highlighted.

Zusammenfassung Im Rahmen der vorliegenden multizentrischen Auswertung mit 6.424 Pflegepatienten unter 500.973 Menschen mit Diabetes aus dem DPV-Register wird die Erkrankungssituation der Pflegebedürftigen im Vergleich zu Patienten ohne Pflegebedürftigkeit, differenziert nach Altersgruppen und Diabetestyp, dargestellt. 15 % der Pflegebedürftigen haben einen Typ-1-Diabetes, darunter fallen 99,0 % der Kinder, 9,5 % der 18- bis 75-Jährigen und 2,4 % der über 75-Jährigen. Pflegebedürftigkeit ist bei Erwachsenen und Senioren insbesondere mit den Krankheitsbildern Demenz, Depression, Herzinsuffizienz, Durchblutungsstörungen der Hirngefäße/Schlaganfall sowie mit dem diabetischen Fußsyndrom/Amputationen assoziiert. In der diabetologischen Therapie des Typ-2-DM wird bei 77 % der Pflegebedürftigen und damit deutlich häufiger als in der Vergleichsgruppe mit 55 % Insulin eingesetzt. Trotz höherer HbA1c-Werte und höherer Nüchternglukose als bei Typ-2-Patienten ohne Pflege treten unter Pflegebedürftigen gleichzeitig signifikant häufiger Hypoglykämien mit und ohne Koma auf. Stoffwechselbedingte Entgleisungen führten bei 15 % der Pflegepatienten mit Typ-2-DM gegenüber nur 6 % der Menschen mit Typ-2-DM ohne Pflegebedarf zu Klinikaufnahmen. Im Rahmen der Versorgung sollte verstärkt auf die Vermeidung von Stoffwechselentgleisungen geachtet und präventiv auf einen späteren Eintritt der assoziierten Krankheitsbilder hingewirkt werden. Die Versorgungsstrukturen sollten regional auf die Begleitung der Betroffenen spezialisiert werden. In der Aus- und Weiterbildung von Pflegepersonal und Ärzten sollten die Besonderheiten von jungen und alten Menschen mit Typ-1- und Typ-2-Diabetes stärker beachtet werden.

Non-adherence to treatment recommendations for patients with diabetes is widespread. This applies to medication as well as recommendations for a healthy lifestyle with appropriate physical activity, a healthy diet, and, if necessary, an end to smoking and weight control. Disregard of these recommendations has been shown to increase the risk of diabetes complications, morbidity and premature mortality. Physicians ' responses to this patient behavior include increased efforts to improve adherence to therapy and often result in a feeling of resignation in the long term. Research efforts focus on an increasing number of interventions to improve therapy adherence, with the results of meta-analyses indicating only moderate success. This position paper presents a practice-oriented approach for discussion that aims to improve the problems described. We reflect on the different roles and responsibilities of patients on the one hand and physicians and other professional groups (diabetes counsellors, nurses, and psychotherapists) on the other. A new classification of different types of non-adherence to therapy is proposed. These constitute the starting point for a practice-related algorithm for the medical handling of the different types of non-adherence, in which the roles and responsibilities of practitioners and patients are explicitly clarified. Thereby no adherence to therapy of patients is pushed. Rather, the aim is for patients to make an informed and responsible decision for or against a doctor's suggestion and for this to be accepted by the physician so that frustrations on both sides are avoided. Finally, theses regarding motivation problems in diabetes will be presented for discussion.

Letter to: Adhärenz: Wer wie an was?Diabetologie und Stoffwechsel 2019; 14(05): 365-366DOI: 10.1055/a-0969-0728

Non-adherence to treatment recommendations for patients with diabetes is widespread. This applies to medication as well as recommendations for a healthy lifestyle with appropriate physical activity, a healthy diet, and, if necessary, an end to smoking and weight control. Disregard of these recommendations has been shown to increase the risk of diabetes complications, morbidity and premature mortality. Physicians ' responses to this patient behavior include increased efforts to improve adherence to therapy and often result in a feeling of resignation in the long term. Research efforts focus on an increasing number of interventions to improve therapy adherence, with the results of meta-analyses indicating only moderate success. This position paper presents a practice-oriented approach for discussion that aims to improve the problems described. We reflect on the different roles and responsibilities of patients on the one hand and physicians and other professional groups (diabetes counsellors, nurses, and psychotherapists) on the other. A new classification of different types of non-adherence to therapy is proposed. These constitute the starting point for a practice-related algorithm for the medical handling of the different types of non-adherence, in which the roles and responsibilities of practitioners and patients are explicitly clarified. Thereby no adherence to therapy of patients is pushed. Rather, the aim is for patients to make an informed and responsible decision for or against a doctor's suggestion and for this to be accepted by the physician so that frustrations on both sides are avoided. Finally, theses regarding "motivation problems in diabetes" will be presented for discussion.

Hintergrund: Im Vergleich zur Allgemeinbevölkerung leiden Diabetiker häufiger an kardiovaskulären Erkrankungen, die in Kombination mit einer peripheren Neuropathie oft zu einem offenen Ulkus am Fuß (diabetisches Fußsyndrom) führen. Bei 85 % der Amputierten insgesamt liegt als Erstbefund ein diabetischer Fuß zugrunde. Damit stellt die Zuckerkrankheit einen großen Risikofaktor für nichttraumatische Amputationen dar, die wiederum mit einer deutlich erhöhten Mortalität einhergehen. Da sich in Dänemark infolge der nationalen Register sehr verlässlich medizinische Daten erheben lassen, prüften Rasmussen et al. die Veränderung von Amputationsraten von Patienten mit und ohne Diabetes mellitus.

Objective . This study aimed to investigate the association between psoriasis and disease outcome in type 2 diabetes (T2D). Methods . 222078 T2D patients (≥10 years old) from the prospective, multicenter diabetes patient registry were analyzed. Specific search items were used to identify psoriasis patients. Multiple regression models were fitted and adjusted for demographic confounder. Results . 232 T2D patients had comorbid psoriasis. After adjusting psoriasis patients revealed a higher BMI (31.8 [31.0; 32.6] versus 30.6 [30.5; 30.6] kg/m 2 ,p=0.004) and HbA1c (64.8 [62.1; 67.6] versus 59.0 [58.9; 59.1] mmol/mol,p<0.0001). Insulin was used more frequently (62.3 [55.7; 68.5] versus 50.9 [50.7; 51.1] %,p=0.001), only OAD/GLP-1 was similar, and nonpharmacological treatment was less common (13.3 [9.5; 18.3] versus 21.9 [21.7; 22.1] %,p=0.002). Severe hypoglycemia (0.31 [0.238; 0.399] versus 0.06 [0.057; 0.060] events per patient-year,p<0.0001), hypertension (86.1 [81.1; 90.0] versus 68.0 [67.8; 68.2] %,p<0.0001), and thyroid disease (14.0 [10.1; 19.2] versus 4.6 [4.5; 4.7] %,p<0.0001) were more prevalent. Depression occurred more often (10.5 [7.1; 15.2] versus 2.8 [2.7; 2.8] %,p<0.0001). Conclusions . Clinical diabetes characteristics in psoriasis T2D patients were clearly worse compared to patients without psoriasis. Comorbid conditions and depression were more prevalent, and more intensive diabetes therapy was required.

Germany is in the upper range of European countries with its rate of over 60 000 amputations per year. Approximately 70 % of all amputations are performed on patients with diabetes mellitus.