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Aim: To compare HbA1c levels across the lifespan in people with type 1 diabetes in the USA with those in Germany/Austria, and to examine potential differences in HbA1c levels between sexes, insulin delivery methods and minority status. Methods: Data were extracted from the US T1D Exchange Registry (n=18 381 participants from 73 sites) and from the German/Austrian Prospective Diabetes Follow‐up Registry, the DPV (n=32 643 participants from 362 sites). Mean HbA1c was calculated for each year of age for individuals aged ≤25 years, and at 2‐year age intervals for individuals aged >25 years. Curves for mean HbA1c by age were estimated using locally weighted scatterplot smoothing. HbA1c differences between registries, sexes, insulin delivery methods, and minority status were assessed by age group using multiple linear regression. Results: In both registries, mean HbA1c increased by ~11 mmol/mol (1.0%) between the ages of 9 and 18 years, although at quite different absolute levels: from 66 mmol/mol (8.2%) to 77 mmol/mol (9.2%) in the T1D Exchange Registry, and from 56 mmol/mol (7.3%) to 66 mmol/mol (8.2%) in the DPV. Sex differences were observed in the DPV only. In the T1D Exchange Registry, injection users had higher mean HbA1c than pump users across the lifespan, whereas in the DPV higher HbA1c levels in injection users were observed in the age groups 6 to <12 years, 12 to <18 years, and 30 to <50 years (P < 0.001). Minority status was significantly associated with higher HbA1c in most age groups in both registries. Conclusions: Significant differences in HbA1c were noted between the USA and Germany/Austria, with disparities more pronounced in early childhood through to young adulthood. Further studies should identify causes for these disparities. What's new?: Data from the TID Exchange Registry (T1DX) have shown that only few individuals with type 1 diabetes meet HbA1c targets, and that glycaemic control has worsened in adolescents over recent years.Although a similar increase in HbA1c on reaching adolescence was observed, young people in the German/Austrian DPV registry had HbA1c levels that were ˜11 mmol/mol (1.0%) lower compared with young people included in the T1DX.Comparison of the two contemporary diabetes cohorts showed large discrepancies in glycaemic control between developed Western countries, and highlights the need for increased efforts to improve care and particularly to lower HbA1c in young people with type 1 diabetes, especially those included in the T1DX. [ABSTRACT FROM AUTHOR]

Aim: To identify groups of heterogeneous HbA1c trajectories over time in newly diagnosed Type 2 diabetes. Methods: The study comprised 6355 adults with newly diagnosed Type 2 diabetes (55% men, median age 62 years, baseline BMI 31 kg/m2) from the Diabetes Patienten Verlaufsdokumentation (DPV) prospective multicentre diabetes registry (Germany, Austria). Individuals were assessed during the first 5 years after diabetes diagnosis if they had ≥ 3 aggregated HbA1c measurements during follow‐up. Latent class growth modelling was used to determine distinct subgroups that followed similar longitudinal HbA1c patterns (SAS: Proc Traj). Multinomial logistic regression models were used to investigate which variables were associated with the respective HbA1c trajectory groups. Results: Four distinct longitudinal HbA1c trajectory (glycaemic control) groups were found. The largest group (56% of participants) maintained stable good glycaemic control (HbA1c 42–45 mmol/mol). Twenty‐six percent maintained stable moderate glycaemic control (HbA1c 57–62 mmol/mol). A third group (12%) initially showed severe hyperglycaemia (HbA1c 97 mmol/mol) but reached good glycaemic control within 1 year. The smallest group (6%) showed stable poor glycaemic control (HbA1c 79–88 mmol/mol). Younger age at diabetes diagnosis, male sex, and higher BMI were associated with the stable moderate or poor glycaemic control groups. Insulin therapy was strongly associated with the highly improved glycaemic control group. Conclusions: Four subgroups with distinct HbA1c trajectories were determined in newly diagnosed Type 2 diabetes using a group‐based modelling approach. Approximately one‐third of people with newly diagnosed Type 2 diabetes need either better medication adherence or earlier intensification of glucose‐lowering therapy. What's new?: Currently, data on HbA1c trajectories in newly diagnosed Type 2 diabetes are limited.This longitudinal study identified four distinct HbA1c trajectories during the first 5 years after Type 2 diabetes diagnosis. The largest group (56%) showed persistent good glycaemic control, whereas two smaller groups exhibited either stable moderate (26%) or poor (6%) glycaemic control, respectively. Twelve percent of people with Type 2 diabetes showed initial poor glycaemic control, which highly improved during the first year after diabetes diagnosis.A personalized medicine approach in the treatment of newly diagnosed Type 2 diabetes could be supported by identification of subgroups with specific HbA1c trajectories in response to glucose‐lowering therapy. [ABSTRACT FROM AUTHOR]

Objectives: In a contemporary cohort of youth with type 1 diabetes, we examined the interval between episodes of severe hypoglycemia (SH) as a risk factor for recurrent SH or hypoglycemic coma (HC). Methods: This was a large longitudinal observational study. Using the DPV Diabetes Prospective follow‐up data, we analyzed frequency and timing of recurrent SH (defined as requiring assistance from another person) and HC (loss of consciousness or seizures) in 14 177 youths with type 1 diabetes aged <20 years and at least 5 years of follow‐up. Results: Among 14 177 patients with type 1 diabetes, 72% (90%) had no, 14% (6.8%) had 1 and 14% (3.2%) >1 SH (HC). SH or HC in the last year of observation was highest with SH in the previous year (odds ratio [OR] 4.7 [CI 4.0‐5.5]/4.6 [CI 3.6‐6.0]), but remained elevated even 4 years after an episode (OR 2.0 [CI 1.6‐2.7]/2.2 [CI 1.5‐3.1]). The proportion of patients who experienced SH or HC during the last year of observation was highest with SH/HC recorded during the previous year (23% for SH and 13% for HC) and lowest in those with no event (4.6% for SH and 2% for HC) in the initial 4 years of observation. Conclusions: Even 4 years after an episode of SH/HC, risk for SH/HC remains higher compared to children who never experienced SH/HC. Clinicians should continue to regularly track hypoglycemia history at every visit, adjust diabetes education and therapy in order to avoid recurrences. [ABSTRACT FROM AUTHOR]

Aim: To compare HbA 1c levels across the lifespan in people with type 1 diabetes in the USA with those in Germany/Austria, and to examine potential differences in HbA 1c levels between sexes, insulin delivery methods and minority status., Methods: Data were extracted from the US T1D Exchange Registry (n=18 381 participants from 73 sites) and from the German/Austrian Prospective Diabetes Follow-up Registry, the DPV (n=32 643 participants from 362 sites). Mean HbA 1c was calculated for each year of age for individuals aged ≤25 years, and at 2-year age intervals for individuals aged >25 years. Curves for mean HbA 1c by age were estimated using locally weighted scatterplot smoothing. HbA 1c differences between registries, sexes, insulin delivery methods, and minority status were assessed by age group using multiple linear regression., Results: In both registries, mean HbA 1c increased by ~11 mmol/mol (1.0%) between the ages of 9 and 18 years, although at quite different absolute levels: from 66 mmol/mol (8.2%) to 77 mmol/mol (9.2%) in the T1D Exchange Registry, and from 56 mmol/mol (7.3%) to 66 mmol/mol (8.2%) in the DPV. Sex differences were observed in the DPV only. In the T1D Exchange Registry, injection users had higher mean HbA 1c than pump users across the lifespan, whereas in the DPV higher HbA 1c levels in injection users were observed in the age groups 6 to <12 years, 12 to <18 years, and 30 to <50 years (P < 0.001). Minority status was significantly associated with higher HbA 1c in most age groups in both registries., Conclusions: Significant differences in HbA 1c were noted between the USA and Germany/Austria, with disparities more pronounced in early childhood through to young adulthood. Further studies should identify causes for these disparities., (© 2019 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.)

Aim: To identify groups of heterogeneous HbA 1c trajectories over time in newly diagnosed Type 2 diabetes., Methods: The study comprised 6355 adults with newly diagnosed Type 2 diabetes (55% men, median age 62 years, baseline BMI 31 kg/m 2 ) from the Diabetes Patienten Verlaufsdokumentation (DPV) prospective multicentre diabetes registry (Germany, Austria). Individuals were assessed during the first 5 years after diabetes diagnosis if they had ≥ 3 aggregated HbA 1c measurements during follow-up. Latent class growth modelling was used to determine distinct subgroups that followed similar longitudinal HbA 1c patterns (SAS: Proc Traj). Multinomial logistic regression models were used to investigate which variables were associated with the respective HbA 1c trajectory groups., Results: Four distinct longitudinal HbA 1c trajectory (glycaemic control) groups were found. The largest group (56% of participants) maintained stable good glycaemic control (HbA 1c 42-45 mmol/mol). Twenty-six percent maintained stable moderate glycaemic control (HbA 1c 57-62 mmol/mol). A third group (12%) initially showed severe hyperglycaemia (HbA 1c 97 mmol/mol) but reached good glycaemic control within 1 year. The smallest group (6%) showed stable poor glycaemic control (HbA 1c 79-88 mmol/mol). Younger age at diabetes diagnosis, male sex, and higher BMI were associated with the stable moderate or poor glycaemic control groups. Insulin therapy was strongly associated with the highly improved glycaemic control group., Conclusions: Four subgroups with distinct HbA 1c trajectories were determined in newly diagnosed Type 2 diabetes using a group-based modelling approach. Approximately one-third of people with newly diagnosed Type 2 diabetes need either better medication adherence or earlier intensification of glucose-lowering therapy., (© 2019 Diabetes UK.)

In the present study, poets and cognitive scientists came together to investigate the construction of meaning in the process of reading normative, 3-line English-language haiku (ELH), as found in leading ELH journals. The particular haiku which we presented to our readers consisted of two semantically separable parts, or images, that were set in a 'tense' relationship by the poet. In our sample of poems, the division, or cut, between the two parts was positioned either after line 1 or after line 2; and the images related to each other in terms of either a context-action association (context-action haiku) or a conceptually more abstract association (juxtaposition haiku). From a constructivist perspective, understanding such haiku would require the reader to integrate these parts into a coherent 'meaning Gestalt', mentally (re-)creating the pattern intended by the poet (or one from within the poem's meaning potential). To examine this process, we recorded readers' eye movements, and we obtained measures of memory for the read poems as well as subjective ratings of comprehension difficulty and understanding achieved. The results indicate that processes of meaning construction are reflected in patterns of eye movements during reading (1st-pass) and re-reading (2nd- and 3rd-pass). From those, the position of the cut (after line 1 vs. after line 2) and, to some extent, the type of haiku (context-action vs. juxtaposition) can be 'recovered'. Moreover, post-reading, readers tended to explicitly recognize a particular haiku they had read if they had been able to understand the poem, pointing to a role of actually resolving the haiku's meaning (rather than just attempting to resolve it) for memory consolidation and subsequent retrieval. Taken together, these first findings are promising, suggesting that haiku can be a paradigmatic material for studying meaning construction during poetry reading.

Background: Seasonality at the clinical onset of type 1 diabetes (T1D) has been suggested by different studies, however, the results are conflicting. This study aimed to evaluate the presence of seasonality at clinical onset of T1D based on the SWEET database comprising data from 32 different countries., Methods: The study cohort included 23 603 patients (52% males) recorded in the international multicenter SWEET database (48 centers), with T1D onset ≤20 years, year of onset between 1980 and 2015, gender, year and month of birth and T1D-diagnosis documented. Data were stratified according to four age groups (<5, 5-<10, 10-<15, 15-20 years) at T1D onset, the latitude of European center (Northern ≥50°N and Southern Europe <50°N) and the year of onset ≤ or >2009., Results: Analysis by month revealed significant seasonality with January being the month with the highest and June with the lowest percentage of incident cases (P < .001). Winter, early spring and late autumn months had higher percentage of incident cases compared with late spring and summer months. Stratification by age showed similar seasonality patterns in all four age groups (P ≤ .003 each), but not in children <24 months of age. There was no gender or latitude effect on seasonality pattern, however, the pattern differed by the year of onset (P < .001). Seasonality of diagnosis conformed to a sinusoidal model for all cases, females and males, age groups, northern and southern European countries., Conclusions: Seasonality at T1D clinical onset is documented by the large SWEET database with no gender or latitude (Europe only) effect except from the year of manifestation., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Notes of 4,000 obstetric and neo-natal cases have been analysed. The role of non-specific fetal infection (which means excluding syphilis, toxoplasmosis and German measles) has been defined with the backing of histopathological, bacteriological and clinical findings. Its role in perinatal mortality and neo-natal morbidity has been outlined. Possibilities for prevention of the condition are suggested, dealing with premature rupture of the membranes and clear-cut maternal infection. "At risk of infection" is the term that has been defined for neonates by studying carefully obstetrical clinical parameters where they are isolated or associated with other conditions but relatively innocuous. When the condition has been defined in particular cases, intensive supervision of the children at risk must be carried out so that as a result of bacteriological findings therapy can be started earlier, better adjusted to the condition and promising a better prognosis.