Medical Antihyperglycaemic Treatment of Type 2 Diabetes Mellitus

Matthaei, S.; Bierwirth, R.; Fritsche, Andreas; Gallwitz, Baptist; Häring, Hans‐Ulrich; Joost, Hans‐Georg; Kellerer, Monika; Kloos, C.; Kunt, T.; Nauck, Michael A.; Schernthaner, Guntram; Siegel, Erhard; Thienel, Florian

doi:10.1055/s-0029-1239559

Cited by 78 publications

(45 citation statements)

References 48 publications

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“…Therefore, it might be that—according to the above-mentioned definition- we mis-classified some prediabetics to have a manifest DM. Nevertheless, as this prophylactic therapy is not recommended according to the Guidelines of the German Diabetes Association [38], we suppose that the number of prediabetic persons treated with off-label oral antidiabetic drugs was rather low. The results on the prevalence of DR in prediabetes have been published previously [39].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Cardiovascular Associations of Diabetic Retinopathy and Maculopathy: Results from the Gutenberg Health Study

et al. 2015

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ObjectiveDiabetic retinopathy (DR) is the leading cause of blindness in people of working age. The purpose of this paper is to report the prevalence and cardiovascular associations of diabetic retinopathy and maculopathy (DMac) in Germany.Research Design and MethodsThe Gutenberg Health Study (GHS) is a population-based study with 15,010 participants aged between 35 at 74 years from the city of Mainz and the district of Mainz-Bingen. We determined the weighted prevalence of DR and DMac by assessing fundus photographs of persons with diabetes from the GHS data base. Diabetes was defined as HbA1c ≥ 6.5%, known diagnosis diabetes mellitus or known diabetes medication. Furthermore, we analysed the association between DR and cardiovascular risk factors and diseases.ResultsOverall, 7.5% (1,124/15,010) of the GHS cohort had diabetes. Of these, 27.7% were unaware of their disease and thus were newly diagnosed by their participation in the GHS. The prevalence of DR and DMac was 21.7% and 2.3%, respectively among patients with diabetes. Vision-threatening disease was present in 5% of the diabetic cohort. In the multivariable analysis DR (all types) was associated with age (Odds Ratio [95% confidence interval]: 0.97 [0.955–0.992]; p = 0.006) arterial hypertension (1.90 [1.190–3.044]; p = 0.0072) and vision-threatening DR with obesity (3.29 [1.504–7.206]; p = 0.0029). DR (all stages) and vision-threatening DR were associated with duration of diabetes (1.09 [1.068–1.114]; p<0.0001 and 1.18 [1.137–1.222]; p<0.0001, respectively).ConclusionsOur calculations suggest that more than a quarter-million persons have vision-threatening diabetic retinal disease in Germany. Prevalence of DR was lower in the GHS compared to East-Asian studies. Associations were found with age, arterial hypertension, obesity, and duration of diabetes mellitus.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Cardiovascular Associations of Diabetic Retinopathy and Maculopathy: Results from the Gutenberg Health Study

et al. 2015

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“…The second part involved the practical application of the diagnostic algorithm in the treatment of patients with diabetes mellitus in case studies and included the processing of case studies according to the guidelines of the German Diabetes Association [18]. Case studies and the materials used were also identical for all groups.…”

Section: Methodsmentioning

confidence: 99%

Self-directed learning can outperform direct instruction in the course of a modern German medical curriculum - results of a mixed methods trial

2016

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BackgroundModernised medical curricula in Germany (so called “reformed study programs”) rely increasingly on alternative self-instructed learning forms such as e-learning and curriculum-guided self-study. However, there is a lack of evidence that these methods can outperform conventional teaching methods such as lectures and seminars.This study was conducted in order to compare extant traditional teaching methods with new instruction forms in terms of learning effect and student satisfaction.MethodsIn a randomised trial, 244 students of medicine in their third academic year were assigned to one of four study branches representing self-instructed learning forms (e-learning and curriculum-based self-study) and instructed learning forms (lectures and seminars). All groups participated in their respective learning module with standardised materials and instructions. Learning effect was measured with pre-test and post-test multiple-choice questionnaires. Student satisfaction and learning style were examined via self-assessment.ResultsOf 244 initial participants, 223 completed the respective module and were included in the study. In the pre-test, the groups showed relatively homogenous scores. All students showed notable improvements compared with the pre-test results. Participants in the non-self-instructed learning groups reached scores of 14.71 (seminar) and 14.37 (lecture), while the groups of self-instructed learners reached higher scores with 17.23 (e-learning) and 15.81 (self-study). All groups improved significantly (p < .001) in the post-test regarding their self-assessment, led by the e-learning group, whose self-assessment improved by 2.36.ConclusionsThe study shows that students in modern study curricula learn better through modern self-instructed methods than through conventional methods. These methods should be used more, as they also show good levels of student acceptance and higher scores in personal self-assessment of knowledge.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0679-0) contains supplementary material, which is available to authorized users.

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“…As of 2003, the German Diabetes Association defined a target HbA 1c of <6.5% for T2DM and HbA 1c values as low as possible for T1DM but explicitly avoiding severe hypoglycemia (8,9). In addition, the nationwide Disease Management Program (DMP)-Diabetes for T2DM and T1DM was progressively implemented from 2003 onward to optimize diabetes therapy (10).…”

Section: Discussionmentioning

confidence: 99%

Substantial Increase in Incidence of Severe Hypoglycemia Between 1997–2000 and 2007–2010

et al. 2012

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OBJECTIVETo compare the incidences of severe hypoglycemia and corresponding clinical circumstances in a German population between 2007–2010 and 1997–2000.RESEARCH DESIGN AND METHODSA screening for severe hypoglycemia was performed in the Lippe-Detmold area in Germany to sensitively detect severe hypoglycemia. This was defined as a symptomatic event requiring treatment with intravenous glucose and being confirmed by a blood glucose measurement of <50 mg/dL.RESULTSSevere hypoglycemia increased considerably from 264 events in 1997–2000 to 495 events in 2007–2010, which translated into an increase in frequency of severe hypoglycemia among all emergency admissions from 0.68 to 0.83% (P = 0.015). This was mostly related to intensification of antihyperglycemic therapy, particularly in the increasingly morbid group of hypoglycemic patients with type 2 diabetes indicated by lower HbA1c, more comedication (3.3 vs. 7.7 drugs), and more concomitant diseases (3.6 vs. 4.4) (all P values <0.001).CONCLUSIONSWithin a 10-year period, there was an intensification of antihyperglycemic therapy in increasingly comorbid subjects, leading to a considerably higher incidence of severe hypoglycemia.

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Medical Antihyperglycaemic Treatment of Type 2 Diabetes Mellitus

Cited by 78 publications

References 48 publications

Prevalence and Cardiovascular Associations of Diabetic Retinopathy and Maculopathy: Results from the Gutenberg Health Study

Prevalence and Cardiovascular Associations of Diabetic Retinopathy and Maculopathy: Results from the Gutenberg Health Study

Self-directed learning can outperform direct instruction in the course of a modern German medical curriculum - results of a mixed methods trial

Substantial Increase in Incidence of Severe Hypoglycemia Between 1997–2000 and 2007–2010

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