Antje Bergmann

The Finnish Diabetes Risk Score Is Associated with Insulin Resistance and Progression towards Type 2 Diabetes

OBJECTIVE The Finnish Diabetes Risk Score (FINDRISC) questionnaire is a practical screening tool to estimate the diabetes risk and the probability of asymptomatic type 2 diabetes. In this study we evaluated the usefulness of the FINDRISC to predict insulin resistance in a population at increased diabetes risk. DESIGN Data of 771 and 526 participants in a cross-sectional survey (1996) and a cohort study (1997-2000), respectively, were used for the analysis. Data on the FINDRISC and oral glucose tolerance test parameters were available from each participant. The predictive value of the FINDRISC was cross-sectionally evaluated using the area under the curve-receiver operating characteristics method and by correlation analyses. A validation of the cross-sectional results was performed on the prospective data from the cohort study. RESULTS The FINDRISC was significantly correlated with markers of insulin resistance. The receiver operating characteristics-area under the curve for the prediction of a homeostasis model assessment insulin resistance index of more than five was 0.78 in the cross-sectional survey and 0.74 at baseline of the cohort study. Moreover, the FINDRISC at baseline was significantly associated with disease evolution (P < 0.01), which was defined as the change of glucose tolerance during the 3 yr follow-up. CONCLUSIONS The results indicate that the FINDRISC can be applied to detect insulin resistance in a population at high risk for type 2 diabetes and predict future impairment of glucose tolerance.

A More Simplified Finnish Diabetes Risk Score for Opportunistic Screening of Undiagnosed Type 2 Diabetes in a German Population with a Family History of the Metabolic Syndrome

The aim of the present study was to evaluate the performance of the Finnish diabetes risk score (FINDRISC) for identifying undiagnosed type 2 diabetes in a German population and to develop a more simplified alternative model. We invited 921 individuals with a family history of the metabolic syndrome in a cross-sectional survey. Of these, 771 subjects completed the FINDRISC questionnaire and underwent an oral glucose tolerance test. The performance of the FINDRISC was assessed using the area under the receiver operating characteristics curve (ROC-AUC). The ROC-AUC of the FINDRISC was 0.81 (0.76-0.87). We detected no difference in diabetes prevalence between individuals with or without a family history of diabetes. Two logistic regression models (continuous- and categorical-model) were developed using the diagnosis of diabetes as the dependent variable, and age, body mass index (BMI), waist circumference, use of blood pressure medication, and history of high blood glucose as independent variables. After stepwise backward elimination of the insignificant variables, the following variables remained: age, BMI, and history of high blood glucose. The ROC-AUCs for the continuous- and categorical-models were 0.88 (0.85-0.92) and 0.86 (0.82-0.90), respectively, and were significantly larger than the ROC-AUC of the FINDRISC. There was no significant difference between the ROC-AUC of fasting plasma glucose and those of the two regression models. The FINDRISC questionnaire can be used to identify undetected diabetes in a German population. The simplified version, the categorical-model, may be a useful alternative for identifying asymptomatic type 2 diabetes.

Role of glycated hemoglobin in the prediction of future risk of T2DM.

AIM The aim of this study was to assess the predictive power of glycated hemoglobin (HbA1c) for future type 2 diabetes risk. RESEARCH DESIGN AND METHODS Six hundred eighty-seven subjects who were free of type 2 diabetes mellitus (T2DM) participated in the study. Each subject received a 75-g oral glucose tolerance test at baseline and 624 received a repeat oral glucose tolerance test after 3.5 ± 0.1 yr of follow-up. Anthropometric measurements, lipid profile, and HbA1c were measured during the baseline visit. Logistic multivariate models were created with T2DM status at follow-up as the dependent variable and other parameters as the independent variables. The receiver-operating characteristic (ROC) was used to assess the predictive discrimination of the various models. RESULTS HbA1c was a significant predictor of future T2DM risk (area under the ROC curve = 0.73, P < 0.0001). A HbA1c cut point of 5.65% had the maximal sum of sensitivity and specificity. Although the area under the ROC curve of HbA1c was smaller than the area under the ROC curve of both the 1-h plasma glucose concentration and a multivariate logistic model (including anthropometric parameters, lipid profile, and fasting plasma glucose), the addition of HbA1c to both the 1-h plasma glucose and the multivariate logistic model significantly increased their predictive power. CONCLUSION Although HbA1c alone is a weaker predictor of future T2DM risk compared with the 1-h plasma glucose, it provides additive information about future T2DM risk when added to previously published prediction models.

General practitioners’ views on polypharmacy and its consequences for patient health care

BackgroundMultimorbidity is defined as suffering from coexistent chronic conditions. Multimorbid patients demand highly complex patient-centered care which often includes polypharmacy, taking an average of six different drugs per day. Adverse drug reactions, adverse drug events and medication errors are all potential consequences of polypharmacy. Our study aims to detect the status quo of the health care situation in Saxony’s general practices for multimorbid patients receiving multiple medications. We will identify the most common clinical profiles as well as documented adverse drug events and reactions that occur during the treatment of patients receiving multiple medications. We will focus on exploring the motives of general practitioners for the prescription of selected drugs in individual cases where there is evidence of potential drug-drug-interactions and potentially inappropriate medications in elderly patients. Furthermore, the study will explore general practitioners’ opinions on delegation of skills to other health professions to support medical care and monitoring of patients receiving multiple medications.Methods/designThis is a retrospective cross sectional study using mixed methods. Socio-demographic data as well as diagnoses, medication regimens and clinically important events will be analyzed retrospectively using general practitioners documentation in patients’ records. Based on these data, short vignettes will be generated and discussed by general practitioners in qualitative telephone interviews.DiscussionTo be able to improve outpatient health care management for patients receiving multiple medications, the current status quo of care, risk factors for deficient treatment and characteristics of concerned patients must be investigated. Furthermore, it is necessary to understand the physicians’ decision making process regarding treatment.

Polymorphisms in Perilipin Gene (PLIN) are not Associated with Obesity and Weight Variation in People with High Risk of Type 2 Diabetes

Perilipins are hormonally regulated phosphorylated proteins that coat the intracellular lipid storage droplet . They are essential for the regulation of triglyceride deposition and mobilization . The human perilipin gene (PLIN) is located to 15q26.1, near the susceptibility loci for obesity, and insulin-dependent diabetes mellitus, and hypertriglyceridemia. Therefore, it is considered as a candidate gene for these diseases . Some studies shown that lower level of perilipin protein was displayed in obese than lean subjects and polymorphisms in PLIN were associated with obesity in American and Spanish white women as well as in Korean . But some other studies showed that, this association was not significant in Chinese and French . The aim of the current study was to examine whether the associations manifested in a German population with high risk of type 2 diabetes.

The A98V Single Nucleotide Polymorphism (SNP) in Hepatic Nuclear Factor 1 α (HNF-1α) is Associated with Insulin Sensitivity and β-Cell Function

OBJECTIVE Mutations in the hepatic nuclear factor-1-alpha ( HNF-1alpha) gene is considered as a candidate for the aetiology of type 2 diabetes. The aims of the study was to determine whether two single nucleotide polymorphisms (SNPs) ile27-to-leu and ala98-to-val in the HNF-1alpha gene associate with diabetes, insulin sensitivity as well as beta-cell function. RESEARCH DESIGN AND METHODS 1 479 subjects of a volunteer sample with increased risk of type 2 diabetes were investigated. They underwent a 75 g oral glucose tolerance test (OGTT) with measurements of plasma glucose, insulin and C-peptide at fasting and at 30, 60, 90 and 120 minutes after the glucose challenge. The HNF-1alpha SNPs, I27L and A98V were genotyped. RESULT Patients harbouring the V98 allele exhibited higher serum insulin and C-peptide levels. The heterozygote variant was also associated with decrease in beta-cell function but better insulin sensitivity. No significant differences of any clinical parameters were found for I27L gene variants. CONCLUSION Significant associations between the heterozygote A98V genotype and clinical parameters of insulin metabolism were reported but no relationship with type 2 diabetes was obtained. This may be explained by a balancing negative effect on insulin secretion and concomitant positive effect on insulin resistance in Val allele carriers.

Current vaccination status regarding measles among university students in Dresden, Germany.

Germany aimed to eliminate measles by 2015, but vaccination coverage is still insufficient, especially in respect to adolescents and young adults. A cross-sectional survey with 711 students studying a range of subjects showed a high acceptance regarding vaccination. Actual self-reported vaccination rates were lower; only 65.5% of medical students and 25.3%-39.4% of other student groups reported complete vaccination against measles. Of the students, 12.6%-45% did not know their vaccination status. Vaccination acceptance did not correlate with vaccination behavior: accessible vaccination opportunities at universities should be offered.

Perspectives and challenges to undertake diabetes prevention in clinical practice

The marked increase in newly diagnosed cases of type 2 diabetes is a major public health concern within the European Union. However, it has been shown that prevention programmes can significantly reduce the risk of developing diabetes. The challenge is to implement proven intervention methods effectively into clinical reality. To achieve this, action is needed in the field of policy development. Targeted intervention programmes, especially to address the needs of people at increased diabetes risk are required for clinical and community-based healthcare professionals and for the general population. Herein we try to address some of the questions arising during the implementation of a prevention management concept into clinical practice.Br J Diabetes Vasc Dis 2008; 8: 295—298

Facharztpräferenzen von Medizinstudierenden im Kontrast zum Bedarf an Allgemeinmedizinern in Sachsen

Aim of the study: Especially in the rural areas of Germany, there are not enough general practitioners (GPs) for primary care. Preferred medical specialties of medical students can help get an estimate of the number of future GPs. This study compares this estimate to the current need for GPs in Saxony. Methods: 587 medical students at the second, sixth and tenth semester were invited to take part in an anonymous cross-sectional study regarding their specialty preferences at the Technical University Dresden. Based on the data of the medical requirements for Saxony, 4 model calculations were generated for comparison of the estimated numbers of future GPs and the current need for GPs. Results: The most commonly preferred medical specialties were surgery (19.1%), internal medicine (12.9%), pediatrics (11.6%) and general practice (9.9%). A significant increase in specialist preference for GP was observed from the sixth (4.9%) to the tenth semester (14.0%). The model calculations show that approximately 29% to 111% of the open positions for GPs could be filled by the potential new GPs from Dresden. Conclusion: Currently, medical students planning to become GPs cannot meet the corresponding need for GPs. Future studies should include the points of view of students, continuing education assistants, GPs and patients.

Factors influencing sleep quality among nursing staff: Results of a cross sectional study

PURPOSE Given the intense physical and mental demands placed on nurses and other caregivers, getting sufficient sleep is essential to maintaining both individual health and professional performance. The goal of our study is to describe and analyze the self-reported sleep quality of nursing staff and identify which factors have an influence on it. METHODS The sample was comprised of 153 female nurses over the age of 20 years who completed written surveys regarding their health status and health behavior. Their responses were subjected to ANOVA analysis with post hoc follow-up tests and logit regression was used. RESULTS 33% of female nursing staff reported poor quality sleep. Lower quality of life, tachycardia and unequal distribution of work load were most strongly associated with poor sleep quality. CONCLUSION Our study indicates that reducing workplace stress is a good place to start in developing a proactive strategy. A comprehensive prevention strategy should include both behavioral and situational prevention elements. Future studies should focus on identifying causal factors and developing prevention strategies.