TY  - JOUR
AB  - AIMS: Cost-effectiveness (CE) of lifestyle change programs (LCP) for type 2 diabetes (T2D) prevention is influenced by a participant's risk. We identified the risk threshold of developing T2D in the intervention population that was cost-effective for three formats of the LCP: delivered in-person individually or in groups, or delivered virtually. We compared the cost-effectiveness across program formats when there were more than one cost-effective formats. METHODS: Using the CDC-RTI T2D diabetes CE simulation model, we estimated CEs associated with three program formats in 8 population groups with an annual T2D incidence of 1% to 8%. We generated a nationally representative simulation population for each risk level using the 2011-2016 National Health and Nutrition Examination Survey data. We used an incremental cost-effectiveness ratio (ICER), cost per quality-adjusted life year (QALY) gained in 25-years, to measure the CEs of the programs. We took a health care system perspective RESULTS: To achieve an ICER of $50,000/QALY or lower, the annual T2D incidence of the program participant needed to be ≥5% for the in-person individual program, ≥4% for the digital individual program, and ≥3% for the in-person group program. For those with T2D risk of ≥4%, the in-person group program always dominated the digital individual program. The in-person individual program was cost-effective compared with the in-person group program only among persons with T2D risk of ≥8%. CONCLUSIONS: Our findings could assist decision-makers in selecting the most appropriate target population for different formats of lifestyle intervention programs to prevent T2D.
AU  - Park, J.*
AU  - Zhang, P.*
AU  - Shao, H.*
AU  - Laxy, M.
AU  - Imperatore, G.*
C1  - 64782
C2  - 52480
TI  - Selecting a target population for type 2 diabetes lifestyle prevention programs: A cost-effectiveness perspective.
JO  - Diabetic Med.
VL  - 39
IS  - 7
PY  - 2022
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - Aim To analyse the associations of area deprivation and urban/rural traits with the incidence of type 1 diabetes in the German federal state of North Rhine-Westphalia.Methods Data of incident type 1 diabetes cases in children and adolescents aged <20 years between 2007 and 2014 were extracted from a population-based diabetes register. Population data, indicators of area deprivation and urban/rural traits at the municipality level (396 entities) were obtained from official statistics. Area deprivation was assessed in five groups based on quintiles of an index of multiple deprivation and its seven deprivation domains. Poisson regression accounting for spatial dependence was applied to investigate associations of area deprivation and urban/rural traits with type 1 diabetes incidence.Results Between 2007 and 2014, 6143 incident cases were reported (99% completeness); the crude incidence was 22.3 cases per 100 000 person-years. The incidence decreased with increasing employment and environmental deprivation (relative risk of the most vs. the least deprived municipalities: 0.905 [95% CI: 0.813, 1.007] and 0.839 [0.752, 0.937], respectively) but was not associated with the composite deprivation index. The incidence was higher in more peripheral, rural, smaller and less densely populated municipalities, and the strongest association was estimated for the location trait (relative risk of peripheral/very peripheral compared with very central location: 1.231 [1.044, 1.452]).Conclusions The results suggest that the type 1 diabetes risk is higher in more remote, more rural, less densely populated and less deprived areas. Urban/rural traits were stronger predictors of type 1 diabetes risk than area deprivation indicators.
AU  - Castillo-Reinado, K.*
AU  - Maier, W.
AU  - Holle, R.
AU  - Stahl-Pehe, A.*
AU  - Baechle, C.*
AU  - Kuss, O.*
AU  - Hermann, J.*
AU  - Holl, R.W.*
AU  - Rosenbauer, J.*
AU  - The German Pediatric Surveillance Unit (ESPED*
C1  - 57968
C2  - 48073
CY  - 111 River St, Hoboken 07030-5774, Nj Usa
SP  - 2089-2097
TI  - Associations of area deprivation and urban/rural traits with the incidence of type 1 diabetes: Analysis at the municipality level in North Rhine-Westphalia, Germany.
JO  - Diabetic Med.
VL  - 37
IS  - 12
PB  - Wiley
PY  - 2020
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - Time spent on health-related activities is an essential resource in the production of health [1]. Time spent on health care or self-management in chronic diseases cannot be spent on alternative work and leisure activities, and can potentially affect a person's willingness to undertake an intervention [2].
AU  - Icks, A.*
AU  - Haastert, B.*
AU  - Arend, W.*
AU  - Konein, J.*
AU  - Thorand, B.
AU  - Holle, R.
AU  - Laxy, M.
AU  - Schunk, M.
AU  - Neumann, A.*
AU  - Wasem, J.*
AU  - Chernyak, N.*
AU  - Dintsios, C.M.*
C1  - 57629
C2  - 47940
CY  - 111 River St, Hoboken 07030-5774, Nj Usa
TI  - Patient time costs due to self-management in diabetes may be as high as direct medical costs: Results from the population-based KORA survey FF4 in Germany.
JO  - Diabetic Med.
PB  - Wiley
PY  - 2020
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - Aim To investigate the association between anxiety symptoms and the progression from prediabetes to type 2 diabetes.Methods A sample of 1708 participants aged 31-82 years from the population-based Cooperative Health Research in the Region of Augsburg F4 and the follow-up Cooperative Health Research in the Region of Augsburg FF4 studies was included. Prediabetes was defined as impaired fasting glucose and/or impaired glucose tolerance, and anxiety status was measured by the generalized anxiety disorder-7 questionnaire. Newly diagnosed type 2 diabetes cases were identified after 6.5 years (11 102 person-years) and confirmed by medical records. Multivariate logistic regression analyses were employed to estimate the effect of prediabetes and anxiety on the incidence of type 2 diabetes with different levels of adjustments for potential confounders. The population attributable risk of type 2 diabetes in participants with prediabetes and anxiety was estimated.Results Prediabetes at baseline was prevalent in 247 participants, of whom 77 developed diabetes after follow-up, accounting for a progression rate of 31%. In participants with prediabetes, high anxiety was associated with a 3-fold increased risk of progression to type 2 diabetes in comparison with low anxiety, even after accounting for socio-demographic, lifestyle and metabolic risk factors (OR = 2.82, 95% CI = 0.95-8.37, P = 0.06). A significant proportion of incident type 2 diabetes was attributed to having anxiety in addition to prediabetes (attributable risk proportion: 0.52; 95% CI = 0.004-1.04, P = 0.05).Conclusions Anxiety symptoms independently increase the progression risk of prediabetes to type 2 diabetes and should be routinely considered alongside the traditional risk factors in people with prediabetes.
AU  - Jiang, L.
AU  - Atasoy, S.
AU  - Johar, H.
AU  - Herder, C.*
AU  - Peters, A.
AU  - Kruse, J.*
AU  - Ladwig, K.-H.
C1  - 57853
C2  - 48104
CY  - 111 River St, Hoboken 07030-5774, Nj Usa
SP  - 1737-1741
TI  - Anxiety boosts progression of prediabetes to type 2 diabetes: Findings from the prospective Cooperative Health Research in the Region of Augsburg F4 and FF4 studies.
JO  - Diabetic Med.
VL  - 37
IS  - 10
PB  - Wiley
PY  - 2020
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - Aims: To select a core list of standard outcomes for diabetes to be routinely applied internationally, including patient-reported outcomes. Methods: We conducted a structured systematic review of outcome measures, focusing on adults with either type 1 or type 2 diabetes. This process was followed by a consensus-driven modified Delphi panel, including a multidisciplinary group of academics, health professionals and people with diabetes. External feedback to validate the set of outcome measures was sought from people with diabetes and health professionals. Results: The panel identified an essential set of clinical outcomes related to diabetes control, acute events, chronic complications, health service utilisation, and survival that can be measured using routine administrative data and/or clinical records. Three instruments were recommended for annual measurement of patient-reported outcome measures: the WHO Well-Being Index for psychological well-being; the depression module of the Patient Health Questionnaire for depression; and the Problem Areas in Diabetes scale for diabetes distress. A range of factors related to demographic, diagnostic profile, lifestyle, social support and treatment of diabetes were also identified for case-mix adjustment. Conclusions: We recommend the standard set identified in this study for use in routine practice to monitor, benchmark and improve diabetes care. The inclusion of patient-reported outcomes enables people living with diabetes to report directly on their condition in a structured way.
AU  - Nano, J.
AU  - Carinci, F.*
AU  - Okunade, O.*
AU  - Whittaker, S.*
AU  - Walbaum, M.*
AU  - Barnard-Kelly, K.*
AU  - Barthelmes, D.*
AU  - Benson, T.*
AU  - Calderon-Margalit, R.*
AU  - Dennaoui, J.*
AU  - Fraser, S.*
AU  - Haig, R.*
AU  - Hernández-Jimenéz, S.*
AU  - Levitt, N.*
AU  - Mbanya, J.C.*
AU  - Naqvi, S.*
AU  - Peters, A.L.*
AU  - Peyrot, M.*
AU  - Prabhaharan, M.*
AU  - Pumerantz, A.*
AU  - Raposo, J.*
AU  - Santana, M.*
AU  - Schmitt, A.*
AU  - Skovlund, S.E.*
AU  - Ulloa, A.C.G.*
AU  - Wee, H.L.*
AU  - Zaletel, J.*
AU  - Massi-Benedetti, M.*
C1  - 58504
C2  - 48218
CY  - 111 River St, Hoboken 07030-5774, Nj Usa
SP  - 2009-2018
TI  - A standard set of person-centred outcomes for diabetes mellitus: Results of an international and unified approach.
JO  - Diabetic Med.
VL  - 37
IS  - 12
PB  - Wiley
PY  - 2020
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - Aims Time needed for health-related activities in people with diabetes is assumed to be substantial, yet available data are limited. Time spent on self-management and associated factors was analysed using cross-sectional data from people with diagnosed diabetes enrolled in a population-based study. Methods Mean total time spent on self-management activities was estimated using a questionnaire for all participants with diagnosed diabetes in the KORA FF4 study (n = 227, 57% men, mean age 69.7, sd 9.9 years). Multiple two-part regression models were fitted to evaluate associated factors. Multiple imputation was performed to adjust for bias due to missing values. Results Some 86% of participants reported spending time on self-management activities during the past week. Over the entire sample, a mean of 149 (sd 241) min/week were spent on self-management-activities. People with insulin or oral anti-hyperglycaemic drug treatment, better diabetes education, HbA(1c) 48 to < 58 mmol/mol (6.5% to < 7.5%) or lower quality of life, spent more time on self-management activities. For example, people without anti-hyperglycaemic medication invested 66 min/week in self-management, whereas those taking insulin and oral anti-hyperglycaemic drugs invested 269 min/week (adjusted ratio 4.34, 95% confidence interval 1.85-10.18). Conclusions Time spent on self-management activities by people with diabetes was substantial and varied with an individual's characteristics. Because of the small sample size and missing values, the results should be interpreted in an explorative manner. Nevertheless, time needed for self-management activities should be routinely considered because it may affect diabetes self-care and quality of life.
AU  - Icks, A.*
AU  - Haastert, B.*
AU  - Arend, W.*
AU  - Konein, J.*
AU  - Thorand, B.
AU  - Holle, R.
AU  - Laxy, M.
AU  - Schunk, M.
AU  - Neumann, A.*
AU  - Wasem, J.*
AU  - Chernyak, N.*
C1  - 54430
C2  - 45553
CY  - 111 River St, Hoboken 07030-5774, Nj Usa
SP  - 970-981
TI  - Time spent on self-management by people with diabetes: Results from the population-based KORA survey in Germany.
JO  - Diabetic Med.
VL  - 36
IS  - 8
PB  - Wiley
PY  - 2019
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - Aim This cross-sectional study used a large nationwide claims data set to assess the excess medical costs of people with type 2 diabetes according to age group in 2015. Methods Data from 291 709 people with diabetes and 291 709 age- and sex-matched controls were analysed. Total costs (expressed as 2015 euros) of outpatient and inpatient services, medication, rehabilitation, and the provision of aids and appliances were examined. Overall and age-stratified excess costs of people with diabetes were estimated using gamma regression with a log-link. Results Overall, the estimated total direct costs of a person with type 2 diabetes are approximately double those of a person without diabetes: euro4727 vs. euro2196, respectively. Absolute excess costs were approximately the same in all age groups (around euro2500), however, relative excess costs of persons with diabetes were much higher in younger (similar to 334% for < 50 years) than in older age groups (similar to 156% for >= 80 years). Regional costs, both absolute and excess, partly differed from the national level. Conclusions This study complements and updates previous studies on the excess medical costs of people with diabetes in Germany. The results indicate the importance of preventing the development of type 2 diabetes, especially in younger age groups. Longitudinal and regional studies examining changes in prevalence and the development of excess costs in groups with different types of diabetes, and according to age, would be of interest to validate our findings and better understand the avoidable burden of having diabetes.
AU  - Kähm, K.
AU  - Stark, R.G.
AU  - Laxy, M.
AU  - Schneider, U.*
AU  - Leidl, R.
C1  - 57632
C2  - 47923
CY  - 111 River St, Hoboken 07030-5774, Nj Usa
TI  - Assessment of excess medical costs for persons with type 2 diabetes according to age groups: An analysis of German health insurance claims data.
JO  - Diabetic Med.
PB  - Wiley
PY  - 2019
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - Aims Children and adolescents with a family history of diabetes are at increased risk of overweight, but little is known about the potentially beneficial effects of physical activity on these children. The objective of this study was to investigate the association between moderate to vigorous physical activity (MVPA) and metabolic and inflammatory risks in children and adolescents with a family background of Type 1 diabetes or gestational diabetes. Methods Valid MVPA measurements, made with accelerometers, were available from 234 participants (median age, 10.2 years) who had a first-degree relative with either Type 1 or gestational diabetes. Anthropometric and metabolic measurements were made and cytokines measured, and were correlated with MVPA measurements, with stepwise adjustment for confounding factors, in a cross-sectional analysis. Results MVPA was negatively associated with insulin and C-peptide during challenge with an oral glucose tolerance test. MVPA was also significantly positively associated with the insulin sensitivity index, whereas no consistently significant associations were found between MVPA and BMI, blood pressure or cytokine levels. Discussion Our findings indicate that physical activity may have beneficial effects on insulin and C-peptide metabolism in children and adolescents with a family background of diabetes, but show no evidence of a protective association with other health-related outcomes.
AU  - Ungethüm, K.
AU  - Jolink, M.
AU  - Hippich, M.
AU  - Lachmann, L.
AU  - Haupt, F.
AU  - Winkler, C.
AU  - Hummel, S.
AU  - Pitchika, A.
AU  - Kordonouri, O.*
AU  - Ziegler, A.-G.
AU  - Beyerlein, A.
C1  - 54380
C2  - 45532
CY  - 111 River St, Hoboken 07030-5774, Nj Usa
SP  - 366-375
TI  - Physical activity is associated with lower insulin and C-peptide during glucose challenge in children and adolescents with family background of diabetes.
JO  - Diabetic Med.
VL  - 36
IS  - 3
PB  - Wiley
PY  - 2019
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - Aims: To investigate whether there has been further improvement in the risk of adverse outcomes in pregnancies in women with diabetes during 2008–2016 in Bavaria, Germany. Methods: Using cross-sectional data on all 1716 170 deliveries in Bavarian hospitals between 2001 and 2016, we assessed the risks of stillbirth, early neonatal death, preterm delivery, large for gestational age, malformations, low Apgar score and low umbilical cord pH by maternal group with diabetes (gestational, pre-gestational, or none) separately for 2001–2007 and 2008–2016. We also investigated the associations of specific risk factors such as maternal smoking with respect to early mortality and malformations in each group with diabetes during 2008–2016. Results: No further reduction in the risk for any adverse outcome in mothers with pre-gestational diabetes and their offspring during 2008–2016 was observed. Maternal smoking, multiple delivery and substandard antenatal care were the strongest additional predictors of both early perinatal mortality and malformations for mothers with pre-gestational diabetes. The respective risks were lower and also decreased over time for mothers with gestational diabetes. Conclusions: No significant improvement has been achieved in the management of pregnancies affected by pre-gestational diabetes during the last decade. The apparent risk reductions in women with gestational diabetes may partly be due to a change in diagnostic criteria over time. Women with pre-gestational diabetes who smoke, carry more than one child, or are not regularly seen during pregnancy, may need particular attention.
AU  - Beyerlein, A.
AU  - Lack, N.*
AU  - von Kries, R.*
C1  - 53607
C2  - 44699
SP  - 1420-1424
TI  - No further improvement in pregnancy-related outcomes in the offspring of mothers with pre-gestational diabetes in Bavaria, Germany, between 2001 and 2016.
JO  - Diabetic Med.
VL  - 35
IS  - 10
PY  - 2018
SN  - 0742-3071
ER  - 

TY  - JOUR
AU  - McCreight, L.J.*
AU  - Stage, T.B.*
AU  - Connelly, P.J.*
AU  - Lonergan, M.*
AU  - Brosen, K.*
AU  - Prehn, C.
AU  - Adamski, J.
AU  - Pearson, E.R.*
C1  - 53385
C2  - 44713
CY  - Hoboken
SP  - 22-22
TI  - Pharmacokinetic study of metformin: Insights into the mechanism of metformin intolerance.
JO  - Diabetic Med.
VL  - 35
PB  - Wiley
PY  - 2018
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - AimsTo investigate the association of high life satisfaction with incident Type 2 diabetes separately in men and women. MethodsA longitudinal analysis was conducted among the 7107 participants (3664 men, 51.5%; 3443 women, 48.5%) aged 25-74 years (mean sd age 47.8 13.7 years) of two population-based MONICA/KORA surveys conducted in 1989-1995 and followed up until 2009. Life satisfaction was assessed using a one-item instrument with a six-order response level, which was dichotomized into high vs medium or low. Sex-specific hazard ratios were estimated using Cox proportional hazards models. ResultsCrude incidence rates for Type 2 diabetes per 10 000 person-years were lower in participants with high than in those with medium or low life satisfaction (men: 57 vs 73; women: 37 vs 48). In men with high life satisfaction, there was a 27% risk reduction in incident Type 2 diabetes (hazard ratio 0.73, 95% CI 0.56-0.94; P=0.02) in a model adjusted for sociodemographic, behavioural and clinical risk factors. The association lost statistical significance after further adjusting for depressed mood (hazard ratio 0.79, 95% CI 0.61-1.03). Life satisfaction was not significantly associated with incident Type 2 diabetes in women. ConclusionLife satisfaction may be a valuable asset in assessing risk of Type 2 diabetes, especially in men, and in the development of more effective prevention strategies to deter onset of diabetes. More research is needed to investigate the underlying potential causal pathways that may link life satisfaction to the development of Type 2 diabetes.
AU  - Piciu, A.M.
AU  - Johar, H.
AU  - Lukaschek, K.
AU  - Thorand, B.
AU  - Ladwig, K.-H.
C1  - 52892
C2  - 44221
CY  - Hoboken
SP  - 323-331
TI  - Life satisfaction is a protective factor against the onset of Type 2 diabetes in men but not in women: Findings from the MONICA/KORA cohort study.
JO  - Diabetic Med.
VL  - 35
IS  - 3
PB  - Wiley
PY  - 2018
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - AIM: To compare clinical baseline data in individuals with Type 2 diabetes and normoalbuminuria, who are at high or low risk of diabetic kidney disease based on the urinary proteomics classifier CKD273. METHODS: We conducted a prospective, randomized, double-blind, placebo-controlled international multicentre clinical trial and observational study in participants with Type 2 diabetes and normoalbuminuria, stratified into high- or low-risk groups based on CKD273 score. Clinical baseline data for the whole cohort and stratified by risk groups are reported. The associations between CKD273 and traditional risk factors for diabetic kidney disease were evaluated using univariate and logistic regression analysis. RESULTS: A total of 1777 participants from 15 centres were included, with 12.3% of these having a high-risk proteomic pattern. Participants in the high-risk group (n=218), were more likely to be men, were older, had longer diabetes duration, a lower estimated GFR and a higher urinary albumin:creatinine ratio than those in the low-risk group (n=1559, P<0.02). Numerical differences were small and univariate regression analyses showed weak associations (R < 0.04) of CKD273 with each baseline variable. In a logistic regression model including clinical variables known to be associated with diabetic kidney disease, estimated GFR, gender, log urinary albumin:creatinine ratio and use of renin-angiotensin system-blocking agents remained significant determinants of the CKD273 high-risk group: area under the curve 0.72 (95% CI 0.68-0.75; P<0.01). CONCLUSIONS: In this population of individuals with Type 2 diabetes and normoalbuminuria, traditional diabetic kidney disease risk factors differed slightly between participants at high risk and those at low risk of diabetic kidney disease, based on CKD273. These data suggest that CKD273 may provide additional prognostic information over and above the variables routinely available in the clinic. Testing the added value will be subject to our ongoing study. (European Union Clinical Trials Register: EudraCT 2012-000452-34 and Clinicaltrials.gov: NCT02040441).
AU  - Tofte, N.*
AU  - Lindhardt, M.*
AU  - Adamova, K.*
AU  - Beige, J.*
AU  - Beulens, J.W.J.*
AU  - Birkenfeld, A.L.
AU  - Currie, G.*
AU  - Delles, C.*
AU  - Dimos, I.*
AU  - Francová, L.*
AU  - Frimodt-Møller, M.*
AU  - Girman, P.*
AU  - Göke, R.*
AU  - Havrdova, T.*
AU  - Kooy, A.*
AU  - Mischak, H.*
AU  - Navis, G.*
AU  - Nijpels, G.*
AU  - Noutsou, M.*
AU  - Ortiz, A.*
AU  - Parvanova, A.*
AU  - Persson, F.*
AU  - Ruggenenti, P.L.*
AU  - Rutters, F.*
AU  - Rychlík, I.*
AU  - Spasovski, G.*
AU  - Speeckaert, M.*
AU  - Trillini, M.*
AU  - von der Leyen, H.*
AU  - Rossing, P.*
C1  - 54992
C2  - 45966
SP  - 1375-1382
TI  - Characteristics of high- and low-risk individuals in the PRIORITY study: Urinary proteomics and mineralocorticoid receptor antagonism for prevention of diabetic nephropathy in Type 2 diabetes.
JO  - Diabetic Med.
VL  - 35
IS  - 10
PY  - 2018
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - Human adenovirus (HAdV) E1B-55K is a multifunctional regulator of productive viral replication and oncogenic transformation in nonpermissive mammalian cells. These functions depend on E1B-55K's posttranslational modification with the SUMO protein and its binding to HAdV E4orf6. Both early viral proteins recruit specific host factors to form an E3 ubiquitin ligase complex that targets antiviral host substrates for proteasomal degradation. Recently, we reported that the PML-NB associated factor Daxx represses efficient HAdV productive infection and is proteasomally degraded via a SUMO-E1B-55K-dependent, E4orf6-independent pathway, the details of which remained to be established. RNF4, a cellular SUMO-targeted ubiquitin ligase (STUbL), induces ubiquitinylation of specific SUMOy lated proteins and plays an essential role during DNA repair. Here, we show that E1B-55K recruits RNF4 to the insoluble nuclear matrix fraction of the infected cell to support RNF4/Daxx association, promoting Daxx PTM and thus inhibiting this antiviral factor. Removing RNF4 from infected cells using RNA interference resulted in blocking the proper establishment of viral replication centers and significantly diminished viral gene expression. These results provide a model for how HAdV antagonize the antiviral host responses by exploiting the functional capacity of cellular STUbLs. Thus, RNF4 and its STUbL function represent a positive factor during lytic infection and a novel candidate for future therapeutic antiviral intervention strategies.IMPORTANCE Daxx is a PML-NB-associated transcription factor that was recently shown to repress efficient HAdV productive infection. To counteract this antiviral measurement during infection, Daxx is degraded via a novel pathway including viral E1B-55K and host proteasomes. This virus-mediated degradation is independent of the classical HAdV E3 ubiquitin ligase complex, which is essential during viral infection to target other host antiviral substrates. To maintain a productive viral life cycle, HAdV E1B-55K early viral protein inhibits the chromatin-remodeling factor Daxx in a SUMO-dependent manner. In addition, viral E1B-55K protein recruits the STUbL RNF4 and sequesters it into the insoluble fraction of the infected cell. E1B-55K promotes complex formation between RNF4-and E1B-55K-targeted Daxx protein, supporting Daxx posttranslational modification prior to functional inhibition. Hence, RNF4 represents a novel host factor that is beneficial for HAdV gene expression by supporting Daxx counteraction. In this regard, RNF4 and other STUbL proteins might represent novel targets for therapeutic intervention.
AU  - Wyatt, R.C.*
AU  - Brigatti, C.*
AU  - Liberati, D.*
AU  - Grace, S.L.*
AU  - Gillard, B.T.*
AU  - Long, A.E.*
AU  - Marzinotto, I.*
AU  - Shoemark, D.*
AU  - Chandler, K.A.*
AU  - Achenbach, P.
AU  - Gillespie, K.M.*
AU  - Piemonti, L.*
AU  - Lampasona, V.*
AU  - Williams, A.J.K.*
C1  - 53322
C2  - 44684
CY  - 1752 N St Nw, Washington, Dc 20036-2904 Usa
SP  - 954-963
TI  - The first 142 amino acids of glutamate decarboxylase do not contribute to epitopes recognized by autoantibodies associated with Type 1 diabetes.
JO  - Diabetic Med.
VL  - 35
IS  - 7
PB  - Amer Soc Microbiology
PY  - 2018
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - Background: Familial partial lipodystrophies are rare monogenic disorders that are often associated with diabetes. In such cases, it can be difficult to achieve glycaemic control. Case report: We report a 34-year old woman with familial partial lipodystrophy type 2 (Dunnigan) and diabetes; her hyperglycaemia persisted despite metformin treatment. A combined intravenous glucose tolerance–euglycaemic clamp test showed severe insulin resistance, as expected, but also showed strongly diminished first-phase insulin secretion. After the latter finding, we added the glucagon-like peptide-1 receptor agonist liraglutide to the patient's treatment regimen, which rapidly normalized plasma glucose levels. HbA 1c values < 42 mmol/mol (6.0%) have now been maintained for over 4 years. Conclusion: This case suggests that a glucagon-like peptide-1 receptor agonist may be a useful component of glucose-lowering therapy in individuals with familial partial lipodystrophy and diabetes mellitus.
AU  - Banning, F.
AU  - Rottenkolber, M.
AU  - Freibothe, I.
AU  - Seissler, J.
AU  - Lechner, A.
C1  - 52407
C2  - 43955
SP  - 1792-1794
TI  - Insulin secretory defect in familial partial lipodystrophy Type 2 and successful long-term treatment with a glucagon-like peptide 1 receptor agonist.
JO  - Diabetic Med.
VL  - 34
IS  - 12
PY  - 2017
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - AIMS: Several psychosocial factors have been shown to increase the risk of Type 2 diabetes mellitus. This study investigated the association between structural social support and incidence of Type 2 diabetes mellitus in men and women. METHODS: Data were derived from three population-based MONICA/KORA surveys conducted in 1984-1995 in the Augsburg region (southern Germany) and followed up by 2009. The study population comprised 8952 participants (4669 men/4283 women) aged 30-74 years without diabetes at baseline. Structural social support was assessed using the Social Network Index. Sex-specific hazard ratios were estimated from Cox proportional hazard models. RESULTS: Within follow-up, 904 incident Type 2 diabetes mellitus cases (558 men, 346 women) were observed. Crude incidence rates for Type 2 diabetes mellitus per 10 000 person-years were substantially higher in poor compared with good structural social support (men: 94 vs. 69, women: 58 vs. 43). After adjustment for age, survey, parental history of diabetes, smoking status, alcohol intake, physical activity, hypertension, dyslipidaemia, BMI, education, sleep complaints and depressed mood, risk of Type 2 diabetes mellitus for participants with poor compared with good structural social support was 1.31 [95% confidence interval (CI) = 1.11-1.55] in men and 1.10 (95% CI = 0.88-1.37) in women. Stratified analyses revealed a hazard ratio of 1.50 (95% CI = 1.23-1.83) in men with a low level of education and 0.87 (95% CI = 0.62-1.22) in men with a high level of education (P for interaction: 0.0082). CONCLUSIONS: Poor structural social support is associated with Type 2 diabetes mellitus in men. This association is independent of risk factors at baseline and is particularly pronounced in men with a low level of education.
AU  - Altevers, J.
AU  - Lukaschek, K.
AU  - Baumert, J.J.
AU  - Kruse, J.*
AU  - Meisinger, C.
AU  - Emeny, R.T.
AU  - Ladwig, K.-H.
C1  - 46725
C2  - 37767
CY  - Hoboken
SP  - 47-54
TI  - Poor structural social support is associated with an increased risk of Type 2 diabetes mellitus: Findings from the MONICA/KORA Augsburg cohort study.
JO  - Diabetic Med.
VL  - 33
IS  - 1
PB  - Wiley-blackwell
PY  - 2016
SN  - 0742-3071
ER  - 

TY  - JOUR
AU  - Long, A.E.*
AU  - Wilson, I.*
AU  - Becker, D.J.*
AU  - Libman, I.M.*
AU  - Wong, F.S.*
AU  - Steck, A.K.*
AU  - Rewers, M.J.*
AU  - Achenbach, P.
AU  - Williams, A.J.K.*
AU  - Gillespie, K.M.*
C1  - 48257
C2  - 41009
CY  - Hoboken
SP  - 76-77
TI  - Is there regulation of the autoimmune response in slow progressors to type 1 diabetes?
JO  - Diabetic Med.
VL  - 33
PB  - Wiley-blackwell
PY  - 2016
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - AIMS: To investigate the hypothesis that high serum levels of omentin, an adipokine with anti-inflammatory, insulin-sensitizing and cardioprotective properties, may be related to a lower risk of diabetic sensorimotor polyneuropathy. METHODS: The association between serum omentin level and polyneuropathy was estimated in people aged 61-82 years with Type 2 diabetes (47 with and 168 without polyneuropathy) from the population-based KORA F4 study. The presence of clinical diabetic sensorimotor polyneuropathy was defined as bilateral impairment of foot vibration perception and/or foot pressure sensation. Omentin levels were determined by enzyme-linked immunosorbent assay. RESULTS: Serum omentin level was inversely associated with polyneuropathy after adjustment for age, sex, height, waist circumference, hypertension, total cholesterol, smoking, alcohol intake and physical activity [odds ratio 0.45 (95% CI 0.21-0.98); P = 0.043]. Although omentin was positively correlated with adiponectin (r = 0.55, P < 0.0001) and inversely with tumour necrosis factor-α (r = -0.30, P = 0.019), additional adjustment for adiponectin and tumour necrosis factor-α had little impact on the association. CONCLUSIONS: Serum levels of omentin are reduced in people with Type 2 diabetes and diabetic sensorimotor polyneuropathy, independently of established risk factors of polyneuropathy. This association is only partially explained by biomarkers of subclinical inflammation.
AU  - Herder, C.*
AU  - Bongaerts, B.W.*
AU  - Ouwens, D.M.*
AU  - Rathmann, W.*
AU  - Heier, M.
AU  - Carstensen-Kirberg, M.*
AU  - Koenig, W.*
AU  - Thorand, B.
AU  - Roden, M.*
AU  - Meisinger, C.
AU  - Ziegler, D.*
AU  - KORA Study Group (Gieger, C.
AU  - Grallert, H.
AU  - Heinrich, J.
AU  - Holle, R.
AU  - Leidl, R.
AU  - Peters, A.
AU  - Strauch, K.)
C1  - 45387
C2  - 37336
SP  - 1479-1483
TI  - Low serum omentin levels in the elderly population with type 2 diabetes and polyneuropathy.
JO  - Diabetic Med.
VL  - 32
IS  - 11
PY  - 2015
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - AIM: To analyse the association of neighbourhood unemployment with incident self-reported physician-diagnosed Type 2 diabetes in a population aged 45-74 years from five German regions. METHODS: Study participants were linked via their addresses at baseline to particular neighbourhoods. Individual-level data from five population-based studies were pooled and combined with contextual data on neighbourhood unemployment. Type 2 diabetes was assessed according to a self-reported physician diagnosis of diabetes. We estimated proportional hazard models (Weibull distribution) in order to obtain hazard ratios and 95% CIs of Type 2 diabetes mellitus, taking into account interval-censoring and clustering. RESULTS: We included 7250 participants residing in 228 inner city neighbourhoods in five German regions in our analysis. The incidence rate was 12.6 per 1000 person-years (95% CI 11.4-13.8). The risk of Type 2 diabetes mellitus was higher in men [hazard ratio 1.79 (95% CI 1.47-2.18)] than in women and higher in people with a low education level [hazard ratio 1.55 (95% CI 1.18-2.02)] than in those with a high education level. Independently of individual-level characteristics, we found a higher risk of Type 2 diabetes mellitus in neighbourhoods with high levels of unemployment [quintile 5; hazard ratio 1.72 (95% CI 1.23-2.42)] than in neighbourhoods with low unemployment (quintile 1). CONCLUSIONS: Low education level and high neighbourhood unemployment were independently associated with an elevated risk of Type 2 diabetes mellitus. Studies examining the impact of the residential environment on Type 2 diabetes mellitus will provide knowledge that is essential for the identification of high-risk populations.
AU  - Müller, G.*
AU  - Wellmann, J.*
AU  - Hartwig, S.*
AU  - Greiser, K.H.*
AU  - Moebus, S.*
AU  - Jöckel, K.-H.*
AU  - Schipf, S.*
AU  - Völzke, H.*
AU  - Maier, W.
AU  - Meisinger, C.
AU  - Tamayo, T.*
AU  - Rathmann, W.*
AU  - Berger, K.*
C1  - 43957
C2  - 36680
CY  - Hoboken
SP  - 1017-1022
TI  - Association of neighbourhood unemployment rate with incident type 2 diabetes mellitus in five German regions.
JO  - Diabetic Med.
VL  - 32
IS  - 8
PB  - Wiley-blackwell
PY  - 2015
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - AIMS: Patient 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. METHODS: Using data of the population-based KORA S4 study (55-74 years, 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 €20.63/h). The observation period was 24 weeks and data were extrapolated to 1 year. RESULTS: Eighty-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 €2447.1 (804.5-6143.6), €880.4 (259.1-3606.7), €1151.6 (454.6-2957.6) and €589.2 (435.8-904.8). CONCLUSIONS: Patient time costs were substantial-even 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.
AU  - Icks, A.*
AU  - Claessen, H.*
AU  - Strassburger, K.*
AU  - Waldeyer, R.*
AU  - Chernyak, N.*
AU  - Jülich, F.*
AU  - Rathmann, W.*
AU  - Thorand, B.
AU  - Meisinger, C.
AU  - Huth, C.
AU  - Rückert, I.-M.
AU  - Schunk, M.
AU  - Giani, G.*
AU  - Holle, R.
C1  - 25220
C2  - 31846
SP  - 1245-1249
TI  - Patient time costs attributable to healthcare use in diabetes: Results from the population-based KORA survey in Germany.
JO  - Diabetic Med.
VL  - 30
IS  - 10
PB  - Wiley-Blackwell
PY  - 2013
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - Aim Our objective was to test the hypothesis that the prevalence of Type2 diabetes increases with increasing regional deprivation even after controlling for individual socio-economic status. Methods We pooled cross-sectional data from five German population-based studies. The data set contained information on n=11688 study participants (men 50.1%) aged 4574years, of whom 1008 people had prevalent Type2 diabetes (men 56.2%). Logistic multilevel regression was performed to estimate odds ratios (OR) and 95% confidence intervals (CI) for diabetes prevalence. We controlled for sex, age and lifestyle risk factors, individual socio-economic status and regional deprivation, based on a new small-area deprivation measure, the German Index of Multiple Deprivation. Results Adjusted for sex, age, body mass index (BMI), physical activity, smoking status and alcohol consumption, the prevalence of Type2 diabetes showed a stepwise increase in risk with increasing area deprivation [OR1.88 (95%CI 1.163.04) in quintile4 and OR2.14 (95%CI 1.293.55) in quintile5 compared with the least deprived quintile1], even after controlling for individual socio-economic status. Focusing on individual socio-economic status alone, the risk of having diabetes was significantly higher for low compared with medium or high educational level [OR1.46 (95%CI 1.241.71)] and for the lowest compared with the highest income group [OR1.53 (95%CI 1.181.99)]. Conclusion Regional deprivation plays a significant part in the explanation of diabetes prevalence in Germany independently of individual socio-economic status. The results of the present study could help to target public health measures in deprived regions.
AU  - Maier, W.
AU  - Holle, R.
AU  - Hunger, M.
AU  - Peters, A.
AU  - Meisinger, C.
AU  - Greiser, K.H.*
AU  - Kluttig, A.*
AU  - Völzke, H.*
AU  - Schipf, S.*
AU  - Moebus, S.*
AU  - Bokhof, B.*
AU  - Berger, K.*
AU  - Mueller, G.*
AU  - Rathmann, W.*
AU  - Tamayo, T.*
AU  - Mielck, A.
C1  - 23512
C2  - 30912
SP  - 78-86
TI  - The impact of regional deprivation and individual socio-economic status on the prevalence of type 2 diabetes in Germany. A pooled analysis of five population-based studies.
JO  - Diabetic Med.
VL  - 30
IS  - 3
PB  - Wiley-Blackwell
PY  - 2013
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - Diabet. Med. 29, 10111020 (2012) Abstract Aims To compare the effect of our newly developed online evidence-based patient information vs. standard patient information about sub-threshold elevated blood glucose levels and primary prevention of diabetes on informed patient decision making. Methods We invited visitors to the cooperating health insurance company, Techniker Krankenkasse, and the German Diabetes Center websites to take part in a web-based randomized controlled trial. The population after randomization comprised 1120 individuals aged between 40 and 70 years without known diabetes, of whom 558 individuals were randomly assigned to the intervention group receiving evidence-based patient information, and 562 individuals were randomly assigned to the control group receiving standard information from the Internet. The primary endpoint was acquired knowledge of elevated blood glucose level issues and the secondary outcomes were attitude to metabolic testing, intention to undergo metabolic testing, decisional conflict and satisfaction with the information. Results Overall, knowledge of elevated glucose level issues and the intention to undergo metabolic testing were high in both groups. Participants who had received evidence-based patient information, however, had significantly higher knowledge scores. The secondary outcomes in the evidence-based patient information subgroup that completed the 2-week follow-up period yielded significantly lower intention to undergo metabolic testing, significantly more critical attitude towards metabolic testing and significantly higher decisional conflict than the control subgroup (n = 466). Satisfaction with the information was not significantly different between both groups. Conclusions Evidence-based patient information significantly increased knowledge about elevated glucose levels, but also increased decisional conflict and critical attitude to screening and treatment options. The intention to undergo metabolic screening decreased. Future studies are warranted to assess uptake of metabolic testing and satisfaction with this decision in a broader population of patients with unknown diabetes.
AU  - Genz, J.*
AU  - Haastert, B.*
AU  - Müller, H.*
AU  - Verheyen, F.*
AU  - Cole, D.*
AU  - Rathmann, W.*
AU  - Nowotny, B.*
AU  - Roden, M.*
AU  - Giani, G.*
AU  - Mielck, A.
AU  - Ohmann, C.*
AU  - Icks, A.*
C1  - 8297
C2  - 30069
SP  - 1011-1020
TI  - Blood glucose testing and primary prevention of type 2 diabetes - evaluation of the effect of evidence-based patient information: A randomized controlled trial.
JO  - Diabetic Med.
VL  - 29
IS  - 8
PB  - Wiley-Blackwell
PY  - 2012
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - Aim:  In Germany, regional data on the prevalence of Type 2 diabetes mellitus are lacking for health-care planning and detection of risk factors associated with this disease. We analysed regional variations in the prevalence of Type 2 diabetes and treatment with antidiabetic agents. Methods:  Data of subjects aged 45-74 years from five regional population-based studies and one nationwide study conducted between 1997 and 2006 were analysed. Information on self-reported diabetes, treatment, and diagnosis of diabetes were compared. Type 2 diabetes prevalence estimates (95% confidence interval) from regional studies were directly standardized to the German population (31 December 2007). Results:  Of the 11 688 participants of the regional studies, 1008 had known Type 2 diabetes, corresponding to a prevalence of 8.6% (8.1-9.1%). For the nationwide study, a prevalence of 8.2% (7.3-9.2%) was estimated. Prevalence was higher in men (9.7%; 8.9-10.4%) than in women (7.6%; 6.9-8.3%). The regional standardized prevalence was highest in the east with 12.0% (10.3-13.7%) and lowest in the south with 5.8% (4.9-6.7%). Among persons with Type 2 diabetes, treatment with oral antidiabetic agents was more frequently reported in the south (56.9%) and less in the northeast (46.0%), whereas treatment with insulin alone was more frequently reported in the northeast (21.6%) than in the south (16.4%). Conclusion:  The prevalence of known Type 2 diabetes mellitus showed a southwest-to-northeast gradient within Germany, which is in accord with regional differences in the distribution of risk factors for Type 2 diabetes. Furthermore, the treatment with antidiabetic agents showed regional differences.
AU  - Schipf, S.*
AU  - Werner, A.*
AU  - Tamayo, T.*
AU  - Holle, R.
AU  - Schunk, M.
AU  - Maier, W.
AU  - Meisinger, C.
AU  - Thorand, B.
AU  - Berger, K.*
AU  - Mueller, G.*
AU  - Moebus, S.*
AU  - Bokhof, B.*
AU  - Kluttig, A.*
AU  - Greiser, K.H.*
AU  - Neuhauser, H.*
AU  - Ellert, U.*
AU  - Icks, A.*
AU  - Rathmann, W.*
AU  - Völzke, H.*
C1  - 7226
C2  - 29573
SP  - E88-E95
TI  - Regional differences in the prevalence of known type 2 diabetes mellitus in 45-74 years old individuals: Results from six population-based studies in Germany (DIAB-CORE consortium).
JO  - Diabetic Med.
VL  - 29
IS  - 7
PB  - Diabetic Medicine
PY  - 2012
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - Aims To estimate population values of health-related quality of life (HRQL) in subjects with and without Type 2 diabetes mellitus across several large population-based survey studies in Germany. Systematic differences in relation to age and sex were of particular interest. Methods Individual data from four population-based studies from different regions throughout Germany and the nationwide German National Health Interview and Examination Survey (GNHIES98) were included in a pooled analysis of primary data (N = 9579). HRQL was assessed using the generic index instrument SF-36 (36-item Short Form Health Survey) or its shorter version, the SF-12 (12 items). Regression analysis was carried out to examine the association between Type 2 diabetes and the two component scores derived from the SF-36/SF-12, the physical component summary score (PCS-12) and the mental component summary score (MCS-12), as well as interaction effects with age and sex. Results The PCS-12 differed significantly by -4.1 points in subjects with Type 2 diabetes in comparison with subjects without Type 2 diabetes. Type 2 diabetes was associated with significantly lower MCS-12 in women only. Higher age was associated with lower PCS-12, but with an increase in MCS-12, for subjects with and without Type 2 diabetes. Conclusions Pooled analysis of population-based primary data offers HRQL values for subjects with Type 2 diabetes in Germany, stratified by age and sex. Type 2 diabetes has negative consequences for HRQL, particularly for women. This underlines the burden of disease and the importance of diabetes prevention. Factors that disadvantage women with Type 2 diabetes need to be researched more thoroughly.
AU  - Schunk, M.
AU  - Reitmeir, P.
AU  - Schipf, S.*
AU  - Völzke, H.*
AU  - Meisinger, C.
AU  - Thorand, B.
AU  - Kluttig, A.*
AU  - Greiser, K.H.*
AU  - Berger, K.*
AU  - Müller, G.*
AU  - Ellert, U.*
AU  - Neuhauser, H.*
AU  - Tamayo, T.*
AU  - Rathmann, W.*
AU  - Holle, R.
C1  - 7976
C2  - 29940
SP  - 646-653
TI  - Health-related quality of life in subjects with and without type 2 diabetes: Pooled analysis of five population-based surveys in Germany.
JO  - Diabetic Med.
VL  - 29
IS  - 5
PB  - Wiley-Blackwell
PY  - 2012
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - Aims: Limited data are available for European populations regarding the prevalence of diabetes and disturbed glucose metabolism in younger individuals. Our aim was to estimate the prevalence of diagnosed and undiagnosed diabetes, isolated impaired fasting glucose (i-IFG), isolated impaired glucose tolerance (i-IGT) and combined IFG/IGT in a population-based sample (n = 1653) from Southern Germany aged 35-59 years. Methods: Oral glucose tolerance tests were carried out in all non-diabetic participants of the KORA F4 Study (2006-2008). Diabetes, IGT and IFG were defined according to the 1999 World Health Organization diagnostic criteria. The original IFG criteria (6.1-6.9 mmol/l) were used as recommended by the European Diabetes Epidemiology Group. Results:The age-standardized prevalence was 2.2% for known diabetes, 2.0% for newly detected diabetes, 2.9% for i-IFG, 6.3% for i-IGT and 1.1% for combined IFG/IGT. About half of the cases with overt diabetes were undiagnosed in all age groups. The prevalence of i-IGT was approximately twice as high as that of i-IFG. The proportion of i-IGT varied between 3.2% (age group 35-44 years) and 11.8% (age group 55-59 years); the corresponding numbers for i-IFG were 1.1% and 5.9%. IFG/IGT was present in 1.2% of the total sample, and was most frequently found in the age group 55-59 years (2.4%). Overall, 16% of the study population had either diabetes or abnormalities of glucose metabolism. Conclusions: The study reveals for the first time a high prevalence of impaired glucose regulation in the younger and middle-aged German population. The detection of disturbed glucose metabolism or diabetes needs to be improved.
AU  - Meisinger, C.
AU  - Strassburger, K.*
AU  - Heier, M.
AU  - Thorand, B.
AU  - Baumeister, S.E.
AU  - Giani, G.*
AU  - Rathmann, W.*
C1  - 166
C2  - 27136
SP  - 360-362
TI  - Prevalence of undiagnosed diabetes and impaired glucose regulation in 35-59-year-old individuals in southern Germany: The KORA F4 study.
JO  - Diabetic Med.
VL  - 27
IS  - 3
PB  - Wiley-Blackwell Publishing
PY  - 2010
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - BACKGROUND: The aim was to derive Type 2 diabetes prediction models for the older population and to check to what degree addition of 2-h glucose measurements (oral glucose tolerance test) and biomarkers improves the predictive power of risk scores which are based on non-biochemical as well as conventional clinical parameters. METHODS: Oral glucose tolerance tests were carried out in a population-based sample of 1353 subjects, aged 55-74 years (62% response) in Augsburg (Southern Germany) from 1999 to 2001. The cohort was reinvestigated in 2006-2008. Of those individuals without diabetes at baseline, 887 (74%) participated in the follow-up. Ninety-three (10.5%) validated diabetes cases occurred during the follow-up. In logistic regression analyses for model 1, variables were selected from personal characteristics and additional variables were selected from routinely measurable blood parameters (model 2) and from 2-h glucose, adiponectin, insulin and homeostasis model assessment of insulin resistance (HOMA-IR) (model 3). RESULTS: Age, sex, BMI, parental diabetes, smoking and hypertension were selected for model 1. Model 2 additionally included fasting glucose, HbA(1c) and uric acid. The same variables plus 2-h glucose were selected for model 3. The area under the receiver operating characteristic curve significantly increased from 0.763 (model 1) to 0.844 (model 2) and 0.886 (model 3) (P<0.01). Biomarkers such as adiponectin and insulin did not improve the predictive abilities of models 2 and 3. Cross-validation and bootstrap-corrected model performance indicated high internal validity. CONCLUSIONS: This longitudinal study in an older population provides models to predict the future risk of Type 2 diabetes. The OGTT, but not biomarkers, improved discrimination of incident diabetes.
AU  - Rathmann, W.*
AU  - Kowall, B.*
AU  - Heier, M.
AU  - Herder, C.*
AU  - Holle, R.
AU  - Thorand, B.
AU  - Strassburger, K.*
AU  - Peters, A.
AU  - Wichmann, H.-E.
AU  - Giani, G.*
AU  - Meisinger, C.
C1  - 5540
C2  - 27577
SP  - 1116-1123
TI  - Prediction models for incident Type 2 diabetes mellitus in the older population: KORA S4/F4 cohort study.
JO  - Diabetic Med.
VL  - 27
IS  - 10
PB  - Diabetes UK
PY  - 2010
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - AIMS: Adipocyte-derived hormones seem to be involved in the development of Type 2 diabetes. Therefore, we assessed the association between the proinflammatory adipokine leptin and incident Type 2 diabetes, taking into account interactions between leptin and the anti-inflammatory adipokine adiponectin. METHODS: Using a case-cohort design, serum levels of adipokines were measured in 460 cases with incident Type 2 diabetes and 1474 non-cases selected from a source population of 7936 middle-aged subjects participating in the population-based Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA)/Cooperative Health Research in the Region of Augsburg (KORA) Augsburg cohort study between 1984 and 1995 and followed up until 2002 (mean follow-up 10.9+/-4.7 years). RESULTS: High leptin and low adiponectin levels were associated with an increased Type 2 diabetes risk. The multivariable adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) comparing tertile extremes were 1.71 (1.12-2.63) for leptin (top vs. bottom tertile) and 2.65 (1.88-3.76) for adiponectin (bottom vs. top tertile), respectively. There was a significant interaction between leptin and adiponectin, with highest diabetes risk being observed in individuals with high leptin and low adiponectin levels (P = 0.029 for interaction).While the addition of adiponectin to a basic risk factor model improved model prediction (Delta area under the curve 0.011), the change in model prediction was only marginal after the addition of leptin (Delta area under the curve 0.002). CONCLUSIONS: Our findings indicate that the two adipokines leptin and adiponectin interact in modulating Type 2 diabetes risk, but adiponectin is more strongly associated with Type 2 diabetes risk than leptin.
AU  - Thorand, B.
AU  - Zierer, A.
AU  - Baumert, J.J.
AU  - Meisinger, C.
AU  - Herder, C.*
AU  - Koenig, W.*
C1  - 4658
C2  - 27549
SP  - 1004-1011
TI  - Associations between leptin and the leptin/adiponectin ratio and incident Type 2 diabetes in middle-aged men and women: Results from the MONICA/KORA Augsburg study 1984-2002.
JO  - Diabetic Med.
VL  - 27
IS  - 9
PB  - Wiley-Blackwell Publishing Inc.
PY  - 2010
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - Aims: To determine the incidence of Type 2 diabetes in an elderly population in Germany and its association with clinical and lifestyle factors. - Methods: Oral glucose tolerance tests (OGTT, World Health Organization criteria) were carried out in a random sample of 1353 subjects (age group 55-74 years; 62% response) in Augsburg (Southern Germany) (1999-2001). The cohort was re-investigated in 2006-2008. Of those individuals without diabetes (baseline), 887 (74%) participated in the follow-up. - Results: Ninety-three (10.5%) developed diabetes during the 7-year follow-up period {standardized incidence rates [95% confidence interval (CI)] per 1000 person-years: total 15.5; 12.6, 19.1; men 20.2; 15.6, 26.1; women 11.3; 7.9, 16.1}. In both sexes, those who developed diabetes were slightly older, were more obese, had a more adverse metabolic profile (higher glucose values, HbA1c, fasting insulin, uric acid, and triglycerides) and were more likely to have hypertension at baseline than were participants remaining free of diabetes (P < 0.05). On stepwise logistic regression, age, parental diabetes, body mass index, uric acid, current smoking, HbA1c and fasting and 2-h glucose (OGTT) were strong predictors of diabetes incidence. The risk of diabetes was higher in subjects with isolated impaired glucose tolerance (odds ratio 8.8; 95% CI 5.0, 15.6) than in isolated impaired fasting glucose (4.7; 2.2, 10.0), although the difference did not reach statistical significance. - Conclusions: For the first time, we have estimated the incidence of Type 2 diabetes in an elderly German cohort and demonstrated that it is among the highest in Europe. The OGTT appears to be useful in identifying individuals with high Type 2 diabetes risk. Our results support a role of smoking in the progression to diabetes.
AU  - Rathmann, W.*
AU  - Strassburger, K.*
AU  - Heier, M.
AU  - Holle, R.
AU  - Thorand, B.
AU  - Giani, G.*
AU  - Meisinger, C.
C1  - 2241
C2  - 26906
SP  - 1212-1219
TI  - Incidence of type 2 diabetes in the elderly German population and the effect of clinical and lifestyle risk factors: KORA S4/F4 cohort study.
JO  - Diabetic Med.
VL  - 26
IS  - 12
PY  - 2009
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - AIMS: To estimate the association between depressive symptoms and Type 2 diabetes, as well as previously undetected diabetes, in a large population-based sample in Germany and to determine associated variables. METHODS: We used baseline data on 4595 participants (age 45-75 years, 50.2% women) from the German Heinz Nixdorf Recall study, a population-based, prospective cohort study which started in 2000. Diabetes mellitus was assessed by self report (physician diagnosis or medication), undiagnosed diabetes based on blood glucose levels. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale short form (cut-off >or= 15 points). We fitted multiple logistic regression models. RESULTS: The prevalence of diagnosed and previously undetected diabetes was 9.3% (95% confidence interval 8.2-11.6) and 7.6% (6.6-8.8) in men and 6.0% (5.1-7.1) and 3.2% (2.5-4.0) in women, respectively. Compared with non-diabetic women, the prevalence of depressive symptoms was not significantly different in diabetic women (age-adjusted odds ratio, 95% confidence interval 1.48; 0.98-2.24) and women with undiagnosed diabetes (0.67; 0.33-1.36). In men, the prevalence of depressive symptoms tended to be lower in diabetic than in non-diabetic subjects (0.62; 0.35-1.09), but the depressive symptoms were significantly less frequent in men with undiagnosed diabetes (0.30; 0.13-0.70). The pattern remained after further adjustment. Significant associations with depressive symptoms were found for co-morbidities and living without a partner in both women and in men, and for body mass index and activity level in women only. CONCLUSIONS: After adjustment for relevant covariates, the association between depressive symptoms and Type 2 diabetes was heterogenous in our population-based study. In subjects with undiagnosed diabetes, however, depressive symptoms were less frequent in men. Co-morbidities and psychosocial conditions are strongly associated with depressive symptoms.
AU  - Icks, A.*
AU  - Kruse, J.*
AU  - Dragano, N.*
AU  - Broecker-Preuss, M.*
AU  - Slomiany, U.*
AU  - Mann, K.*
AU  - Jöckel, K.-H.*
AU  - Erbel, R.*
AU  - Giani, G.*
AU  - Moebus, S.*
AU  - Heinz Nixdorf Recall Study Cohort (Löwel, H.)
C1  - 32349
C2  - 39107
SP  - 1330-1336
TI  - Are symptoms of depression more common in diabetes? Results from the Heinz Nixdorf Recall study.
JO  - Diabetic Med.
VL  - 25
IS  - 11
PY  - 2008
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - no Abstract
AU  - Rathmann, W.*
AU  - Strassburger, K.*
AU  - Giani, G.*
AU  - Döring, A.
AU  - Meisinger, C.
C1  - 2615
C2  - 25991
SP  - 1374-1375
TI  - Differences in height explain gender differences in the response to the oral glucose tolerance test.
JO  - Diabetic Med.
VL  - 25
IS  - 11
PB  - Blackwell
PY  - 2008
SN  - 0742-3071
ER  - 

TY  - JOUR
AB  - To analyse the clinical and cost-effectiveness of the primary prevention of Type 2 diabetes in a 'real world' routine healthcare setting using population-based data (KORA Survey in Augsburg, Germany, total population approximately 600,000). METHODS: Decision analytic model, time horizon 3 years. INTERVENTIONS: Staff education, targeted screening and lifestyle modification or metformin in people aged 60-74 years with a body mass index of > or = 24 kg/m(2) and prediabetic status (fasting glucose 5.3-6.9 mmol/l and 2-h post load glucose 7.8-11.0 mmol/l) (target population approximately 72,500), according to the Diabetes Prevention Program trial. MAIN OUTCOME MEASURES: Cases of Type 2 diabetes prevented, cost (Euro), incremental cost-effectiveness ratios (ICERs). RESULTS: Under model assumptions, 14 908 people in the target population would develop diabetes if there was no intervention, 184 cases would be avoided with lifestyle intervention and 42 cases with metformin intervention. From the perspective of statutory health insurance and society, costs for lifestyle modification were 856,507 euro (574,241 pounds) and 4,961,340 euro (3,326,307 pounds), respectively, and for metformin 797,539 euro (534,706 pounds) and 1,335,204 euro(895,181 pounds). Up to 5% of the costs were due to staff education and up to 36% to screening. Lifestyle was more cost effective than metformin. ICERs for lifestyle vs. 'no intervention' were 4664 euro (3127 pounds) and 27,015 euro (18,112 pounds) per case prevented from the statutory health insurance and societal perspective. CONCLUSIONS: Total cost and cost per case of diabetes avoided was high. Staff education and screening had a considerable impact. In view of the low participation in a routine healthcare setting, with both strategies only a small number of cases of diabetes would be prevented. Before implementing the programme, efforts should be made to improve patient participation in order to achieve better clinical and cost-effectiveness of the prevention of Type 2 diabetes in 'real world' clinical practice.
AU  - Icks, A.*
AU  - Rathmann, W.*
AU  - Haastert, B.*
AU  - Gandjour, A.*
AU  - Holle, R.
AU  - John, J.
AU  - Giani, G.*
AU  - KORA Study Group (Wichmann, H.-E.
AU  - Illig, T.
AU  - Meisinger, C.
AU  - Peters, A.
AU  - Holle, R.
AU  - John, J.)
C1  - 5890
C2  - 24669
SP  - 473-480
TI  - Clinical and cost-effectiveness of primary prevention of Type 2 diabetes in a 'real world' routine healthcare setting: Model based on the KORA Survey 2000.
JO  - Diabetic Med.
VL  - 24
IS  - 5
PB  - Blackwell
PY  - 2007
SN  - 0742-3071
ER  - 

TY  - JOUR
AU  - Stiegler, H.
AU  - Standl, E.
AU  - Schulz, K.
AU  - Roth, R.
AU  - Lehmacher, W.
C1  - 20445
C2  - 13651
SP  - 646-653
TI  - Morbidity, Mortality, and Albuminuria in Type 2 Diabetic Patients: a Three-year Prospective Study of a Random Cohort in General Practice.
JO  - Diabetic Med.
VL  - 9
PY  - 1992
SN  - 0742-3071
ER  - 

TY  - JOUR
AU  - The EURODIABETA Project
C1  - 18771
C2  - 11886
SP  - 639-650
TI  - Information Technology for Diabetes Care in Europe: the EURODIABETA Initiative.
JO  - Diabetic Med.
VL  - 7
PY  - 1990
SN  - 0742-3071
ER  -