Background and aims: Nonobese patients with type 1 diabetes (T1D) can exhibit insulin resistance and have lower flux through muscular ATP synthase. Here, we examined the role of insulin resistance and hyperglycemia for hepatic energy metabolism in T1D.

The aim of this study was to compare the effect of our newly developed online evidence-based patient information (EBPI) vs. standard patient information about subthreshold elevated blood glucose levels and primary prevention of diabetes on informed patient decision-making. EBPI significantly improved knowledge about elevated glucose levels, but also increased decisional conflict and critical attitudes to screening and treatment options. The intention to undergo metabolic screening decreased as a result.

Fragestellung: Die Bedeutung von Biomarkern der subklinischen Inflammation für die Verschlechterung der glykämischen Kontrolle vor der Diagnose des Typ-2-Diabetes ist bislang kaum untersucht. Daher war es das Ziel dieser Studie, die Hypothese zu testen, dass erhöhte systemische Konzentrationen von proinflammatorischen Biomarkern und erniedrigte Adiponektin-Spiegel in nicht-diabetischen Personen mit Anstiegen des HbA1c über einen Zeitraum von 7 Jahren assoziiert sind.

Objective: This study compared the effects of obesity and pancreas fat on β-cell function, while non-invasively distinguishing between peripancreatic, interlobular, and parenchymal fat.

Diabet. Med. 30, 6569 (2013) Abstract Aims Cross-sectional studies have consistently reported evidence for an association between diabetes and depressive disorders. However, only limited prospective studies have examined this association, reporting conflicting results. In a population-based cohort study, we compared cumulative incidences of diabetes between participants with and without high depressive symptoms. Method We analysed the 5-year follow-up data from the German Heinz Nixdorf Recall study of 3547 participants without diabetes at baseline [mean age 58.8 (sd 7.6) years, 47.5% male]. Depressive symptoms were defined using the Centre for Epidemiologic Studies Depression scale (cut point = 17). Diabetes (diagnosed or previously undetected) was identified by self-reported physician-diagnosed diabetes, medication and high blood glucose levels. We estimated 5-year cumulative incidences with 95% confidence intervals and fitted multiple logistic regression models to calculate the odds ratios, adjusted for age, sex, physical activity, smoking, living with or without partner, and educational level. Results The cumulative incidence of diabetes was 9.2% (95% CI 6.312.8) in participants with high depressive symptoms at baseline and 9.0% (95% CI 8.010.0) in participants without these symptoms. The age- and sex-adjusted odds ratio of diabetes in participants with depressive symptoms compared with those without was 1.13 [95% CI 0.771.68; fully adjusted 1.11 (95% CI 0.741.65)]. These results did not substantially change in several additional sensitivity analyses. Conclusion Our study did not show a significantly increased risk of developing diabetes in individuals with high depressive symptoms compared with those without high depressive symptoms during a 5-year follow-up period. Diabet. Med. 30, 65-69 (2013)

AIM:To model the future costs of Type 2 diabetes in Germany, taking into account demographic changes, disease dynamics and undiagnosed cases. METHODS:Using a time-discrete Markov model, the prevalence of diabetes (diagnosed/undiagnosed) between 2010 and 2040 was estimated and linked with cost weights. Demographic, epidemiological and economic scenarios were modelled. Inputs to the model included the official population forecasts, prevalence, incidence and mortality rates, proportions of undiagnosed cases, health expenditure and cost ratios of an individual with (diagnosed/undiagnosed) diabetes to an individual without diabetes. The outcomes were the case numbers and associated annual direct medical excess costs of Type 2 diabetes from a societal perspective in 2010€. RESULTS:In the base case, the case numbers of diabetes will grow from 5 million (2.8 million diagnosed) in 2010 to a maximum of 7.9 million (4.6 million diagnosed) in 2037. From 2010 to 2040, the prevalence rate amonf individuals ≥40 years old will increase from 10.5 to 16.3%. The annual costs of diabetes will increase by 79% from €11.8 billion in 2010 to €21.1 billion in 2040 (€9.5 billion to €17.6 billion for diagnosed cases). CONCLUSIONS:The projected increase in costs will be attributable to demographic changes and disease dynamics, and will be enhanced by higher per capita costs with advancing age. Better epidemiological and economic data regarding diabetes care in Germany would improve the forecasting accuracy. The method used in the present study can anticipate the effects of alternative policy scenarios and can easily be adapted to other chronic diseases.

1 Zhang P, Zhang X, Brown J, Vistisen D, Sicree R, Shaw J et al. Economic Impact of Diabetes. Background paper of the IDF Diabetes Atlas. Brussels: International Diabetes Federation, 2009. 2 Bagust A, Hopkinson PK, Maslove L, Currie CJ. The projected healthcare burden of Type 2 diabetes in the UK from 2000 to 2060. Diabet Med 2002; 19: S1–5. 3 Jacobs P, Fassbender K. The measurement of indirect costs in the health economics evaluation literature. A review. Int J Technol Assess Health Care 1998; 14: 799–808. 4 Eddy DM, Hollingworth W, Caro JJ, Tsevat J, McDonald , Wong JB. DRAFT – Model Transparency and Validation: A Report of the ISPOR-SMDM Modeling Good Research Practices Task Force Working Group. Available at http://www.ispor.org/workpaper/modeling_methods/DRAFT-Modeling-Task-Force_Validation-andTransparency-Report.pdf Last accessed 13 November 2012.

AimsPatient time costs have been described to be substantial; however, data are highly limited. We estimated patient time costs attributable to outpatient and inpatient care in study participants with diagnosed diabetes, previously undetected diabetes, impaired glucose regulation and normal glucose tolerance.MethodsUsing data of the population-based KORAS4 study (55-74years, random sample of n=350), we identified participants' stage of glucose tolerance by oral glucose tolerance test. To estimate mean patient time costs per year (crude and standardized with respect to age and sex), we used data regarding time spent with ambulatory visits including travel and waiting time and with hospital stays (time valued at a 2011 net wage rate of Euro20.63/h). The observation period was 24weeks and data were extrapolated to 1year.ResultsEighty-nine to 97% of participants in the four groups (diagnosed diabetes, undetected diabetes, impaired glucose regulation and normal glucose tolerance.) had at least one physician contact and 4-14% at least one hospital admission during the observation period. Patient time [h/year (95%CI)] was 102.0 (33.7-254.8), 53.8 (15.0-236.7), 59.3 (25.1-146.8) and 28.6 (21.1-43.7), respectively. Age-sex standardized patient time costs per year (95%CI) were Euro2447.1 (804.5-6143.6), Euro880.4 (259.1-3606.7), Euro1151.6 (454.6-2957.6) and Euro589.2 (435.8-904.8).ConclusionsPatient time costs were substantialeven higher than medication costs in the same study population. They are higher in participants with diagnosed diabetes, but also in those with undetected diabetes and impaired glucose regulation compared with those with normal glucose tolerance. Research is needed in larger populations to receive more precise and certain estimates that can be used in health economic evaluation.

Nonalcoholic fatty liver disease (NAFLD) strongly associates with obesity and type 2 diabetes and may lead to cirrhosis and hepatocellular carcinoma. Fatty liver indices based on laboratory and anthropometric parameters are increasingly used to predict steatosis in clinical studies, which requires solid validation. To this end, we examined the accuracy of three recently published indices – NAFLD liver fat score, fatty liver index and hepatic steatosis index – by comparison with exact quantification of liver fat content (HCL) by 1H-magnetic resonance spectroscopy (1H-MRS) in 92 non-diabetic humans (58 ± 12 years, BMI 26 ± 4 kg/m2). A 4-point 75-g oral glucose tolerance test was performed to assess insulin sensitivity and β-cell function. Employing 1H-MRS, 17 out of 92 subjects had fatty liver. HCL ranged from 0.03 to 39.01% with a median of 2.5 [0.6;4.2] and correlated with insulin sensitivity (composite whole body insulin sensitivity index, ISIcomp; r =-0.46, p < 0.001) and β-cell function (Disposition Index, DI; r = 0.36, p < 0.001). The tested indices yielded areas under the receiver operating curve (AROCs) from 0.70 to 0.79 and correlated with HCL (r = 0.40, 0.50 and 0.46, all p < 0.001), ISIcomp (r =-0.70, -0.62 and -0.53, all p < 0.001) and DI (r = 0.56, 0.47 and 0.48, all p < 0.001). Even after adjustments for age, sex and HCL, the indices remained independently associated with insulin sensitivity (β=-0.33, -0.19 and -0.04, all p < 0.001) and β cell function (β= 0.23, 0.13 and 0.03, all p < 0.001).

To estimate medication costs in individuals with diagnosed diabetes, undetected diabetes, impaired glucose regulation and normal blood glucose values in a population-based sample by age and sex.Using the KORA F4 follow-up survey, conducted in 2006-2008 (n=2611, age 40-82 years), we identified individuals' glucose tolerance status by means of an oral glucose tolerance test. We assessed all medications taken regularly, calculated age-sex specific medication costs and estimated cost ratios for total, total without antihyperglycemic drugs, and cardiovascular medication, using multiple 2-part regression models.Compared to individuals with normal glucose values, costs were increased in known diabetes, undetected diabetes and impaired glucose regulation, which was more pronounced in participants aged 40-59 years than in those aged 60-82 years (cost ratios for all medications: 40-59 years: 2.85; 95%-confidence interval: 1.78-4.54, 2.00; 1.22-3.29 and 1.53; 1.12-2.09; 60-82 years: 2.04; 1.71-2.43, 1.17; 0.90-1.51 and 1.09; 0.94-1.28). Compared to individuals with diagnosed diabetes, costs were significantly lower among individuals with impaired glucose regulation across all age and sex strata, also when antihyperglycemic medication was excluded (40-59 years: 0.60; 0.36-0.98, 60-82 years: 0.74; 0.60-0.90; men: 0.72; 0.56-0.93; women: 0.72; 0.54-0.96).We could quantify age- and sex-specific medication costs and cost ratios in individuals with diagnosed diabetes, undetected diabetes and impaired glucose regulation compared to those with normal glucose values, using data of a population-based sample, with oral glucose tolerance test-based identification of diabetes states. These results may help to validly estimate cost-effectiveness of screening and early treatment or prevention of diabetes.

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Fragestellung: Um langfristige Komplikationen bei Typ-2-Diabetespatienten zu vermeiden, sollte eine normnahe Diabeteseinstellung erfolgen, bei der Hypoglykämien möglichst vermieden werden. DPP-4-Inhibitoren (DPP-4) und Sulfonylharnstoffe (SH) unterscheiden sich im Einfluss auf die Insulinsekretion. SU wirken glukoseunabhängig, sodass Hypoglykämien resultieren können, während DPP-4 über dass Darmhormon GLP-1 nur bei erhöhten Blutzuckerwerten wirken. Bisher gibt es keine Daten aus der Versorgungspraxis zur Inzidenz von Hypoglykämien bei primärztlich behandelten Typ-2-Diabetespatienten mit DDP-4 und SH.

Hintergrund: Insulin Aspart hat einen rascheren Wirkungseintritt und eine effektivere Senkung der postprandialen Blutzuckerwerte als kurzwirksames Humaninsulin, was einen günstigen Einfluss auf die Entstehung der diabetischen Spätkomplikationen haben könnte. Zielsetzung war es, die Inzidenz von makro- und mikrovaskulären Ereignissen bei Typ-2-Diabetespatienten in allgemeinmedizinischen Praxen mit Insulin Aspart und kurzwirkenden Humaninsulinen zu vergleichen.