Search

ZUSAMMENFASSUNGDiabetes kann zu verschiedenen schwerwiegenden Komplikationen führen wie kardiovaskuläre Komorbiditäten, Neuropathie, Retinopathie, Nephropathie, nicht-alkoholische Fettlebererkrankungen (NAFLD) und auch Krebs. Um solche Folgen künftig vermeiden bzw. hinauszögern zu können, gilt es zu erkennen, welche Patienten ein besonders hohes Risiko für Komplikationen haben. Ziel des Forschungsschwerpunkts „Folgeerkrankungen des Diabetes“ ist es, neue Wege zur Prävention, zur verbesserten Behandlung oder sogar zur Heilung von Folgeerkrankungen von Typ-1- und Typ-2-Diabetes zu erforschen. Die DZD-Forschenden vermuten, dass häufige diabetische Langzeitkomplikationen auf einer dysfunktionalen Verstoffwechslung von Glukose und Lipiden in den frühen Stadien der Krankheitsmanifestation beruhen, was zur Bildung toxischer Metabolite und oxidativem Stress, Carbonyl-Stress und Entzündungsreaktionen führt. Dies kann wiederum die DNA schädigen und langfristig die Organfunktion beeinträchtigen.

Background The number of people using long-term care (LTC) is increasing steadily, hence, demand for adequate services is rising. The purpose of this exploratory study was to identify relevant gender-linked determinants for utilization of LTC in community-dwelling older adults. Methods We examined 4077 females (52.7%) and males ≥ 65 years old (range: 65–97 years) between 2011/12 (t1) and 2016 (t2). Data originated from the population-based Cooperative Health Research in the Region of Augsburg (KORA)-Age study in southern Germany. A descriptive analysis assessed the amount of LTC used. Cross-sectional generalized estimating equation logistic models identified determinants for utilization of (in)formal LTC. Determinants for transition to LTC between t1 and t2 were examined using a longitudinal logistic regression model. Potential determinants were chosen according to Andersen's Behavioral Model of Health Services Use. Results At t2, 820 (20.1%) were LTC users with 527 (64.3%) being female. The average amount of informal LTC was higher in males, whereas the amount of formal LTC was higher in females. In both genders, higher age, multimorbidity, and disability were associated with utilization of and transition to LTC. Living alone was significantly associated with utilization of LTC in both genders, but its effect was two times stronger in males. Thus, it is considered the essential gender-linked determinant. Conclusions Gender-linked determinants must be considered when establishing demand-oriented policies. Future health programs should specifically target older individuals, especially males, living alone to improve their capabilities in activities of daily living to allow them to remain living longer and independently within community settings.

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.

Aims: Interleukin-1β (IL-1β) represents a key proinflammatory cytokine in the development of atherosclerosis and coronary heart disease (CHD). The activity of IL-1β is counter-regulated by interleukin-1 receptor antagonist (IL-1ra), an endogenous inhibitor. Data on the relevance of circulating IL-1ra levels for cardiovascular risk are scarce and inconsistent. Therefore, this study aimed (i) to examine the association between serum IL-1ra and incident CHD in the general population and (ii) to test whether this association is explained by other inflammation-related biomarkers. Methods: This case-cohort study uses data from the population-based MONICA/KORA Augsburg cohort. During a follow-up time of 16.0 ± 5.8 years, 803 cases and 1942 non-cases were observed for the combined CHD endpoint (non-fatal myocardial infarction and coronary death before the age of 75 years). Associations between IL-1ra and incidence of CHD were assessed using Cox regression adapted for cases-cohort analyses. Results: Cases had higher IL-1ra serum levels than non-cases (geometric means [antilog of SE] 338.81 [1.02] vs. 352.59 [1.01] pg/ml; p < 0.001). The hazard ratio (95% CI) for incident CHD was 1.15 (1.02; 1.30) per standard deviation of log-transformed IL-1ra serum levels after adjustment for age, sex, anthropometric, metabolic and lifestyle factors (p = 0.022). The excess risk for CHD was attenuated by ≥10% after additional adjustment for high-sensitivity C-reactive protein, IL-6, myeloperoxidase or soluble adhesion molecules. Conclusion: Serum IL-1ra levels are positively associated with increased risk of CHD. This association may at least partially reflect a counter-regulation to subclinical inflammation, endothelial activation and oxidative stress.

SummaryPrevious studies reported a gender-specific association between plasma fibrinogen concentrations and incident hypertension. We systematically analysed polymorphisms and haplotypes across the fibrinogen gene cluster with fibrinogen levels and assessed their contribution to prevalent hypertension in 2,200 men and 2,159 women from the population-based MONICA/KORA Augsburg study. Eleven tagging single nucleotide polymorphisms (SNPs) were systematically selected in the three fibrinogen genes and haplotypes were reconstructed. The minor alleles of two SNPs, rs2227401 (FGB) and rs2070016 (FGA) and the haplotypes tagged by those variants, were significantly associated with higher fibrinogen concentrations in both, men and women, explaining 1% of the total variance of fibrinogen concentrations. In addition, a FGG haplotype, tagged by rs1049636, was associated with lower concentrations of fibrinogen in women, but not in men. Regarding hypertension, we detected a significant association with a FGA promoter variant (rs2070008) in women only, whereas fibrinogen haplotypes were not associated with hyper-tension after correction for multiple comparisons in either men or women. In conclusion, our results suggest that variants in all three fibrinogen genes are significantly associated with differences in fibrinogen concentrations with modest contribution to phenotypic variance. It is likely that other genetic variants outside the fibrinogen gene loci are involved in the regulation of fibrinogen concentrations. In addition, one FGA promoter variant was significantly associated with hypertension in women. Confirmation of these findings by future studies is warranted.

The SF-36 Health Survey and its 12-item abridged form is an instrument for the assessment of health related quality of life that can be used with healthy persons and patient populations. Its use has been recommended within a large German multicentre rehabilitation research programme. The paper examines missing data across all five study projects of the North German Network for Rehabilitation Research (NVRF) as well as psychometric properties of the instrument. In addition, data were compared to representative norm data using the SF-36 (SF-12) in the German National Health Survey. Results showed that there were few missing data in the SF-36. Examining the impact of age, gender and health status yielded effects of higher age and female gender on missing data. Psychometric analyses showed good to excellent results of the instrument in terms of scale fit and reliability. In terms of convergent validity, medium to high correlation of the SF-36 subscales with comparable instruments (e. g. SCL-90-R) could be found. Summarizing, the SF-36/SF-12 can be recommended for use in rehabilitation research. Analyses regarding sensitivity should be conducted in future studies.