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The REPRESENT study aims to examine whether participants enrolled in glucagon-like peptide 1 receptor agonist cardiovascular outcome trials (CVOTs) LEADER (liraglutide), REWIND (dulaglutide), and SUSTAIN-6 (injectable semaglutide) are representative of the Spanish population with type 2 diabetes (T2D).This retrospective observational study used the IQVIA Electronic Medical Records database in Spain to identify adults aged 18 years and older with T2D diagnosed before/between January 2013 and December 2015. Demographic and clinical characteristics were analyzed descriptively. The proportions of individuals in the Spanish cohort who met the key selection criteria of each CVOT were calculated from individuals with available database entries for estimated glomerular filtration rate and body mass index using proxies.A total of 24,268 adults with T2D were identified from the IQVIA database. The Spanish cohort was predominantly male (55.5%) and had a mean (± SD) age of 66.8 ± 12.5 years and HbA1c of 7.2 ± 1.5%, with 14.0% having established cardiovascular disease and 2.9% having prior myocardial infarction. The characteristics of the Spanish cohort were more similar to that of REWIND than LEADER or SUSTAIN-6. The proportions of subjects in the Spanish cohort who met the CVOTs key selection criteria were 10.1% for LEADER, 53.6% for REWIND, and 10.4% for SUSTAIN-6.Although none of the CVOTs was fully representative of the Spanish cohort, the REWIND population was found to be more representative of the real-world Spanish population with T2D than those of LEADER and SUSTAIN-6. These findings reinforce the applicability of the results of REWIND in clinical practice.

Background and objectives Volume overload is frequent in prevalent patients on kidney replacement therapies and is associated with outcome. This study was devised to follow-up volume status of an incident population on peritoneal dialysis (PD) and to relate this to patient-relevant outcomes. Design, setting, participants, & measurements This prospective cohort study was implemented in 135 study centers from 28 countries. Incident participants on PD were enrolled just before the actual PD treatment was started. Volume status was measured using bioimpedance spectroscopy before start of PD and thereafter in 3-month intervals, together with clinical and laboratory parameters, and PD prescription. The association of volume overload with time to death was tested using a competing risk Cox model. Results In this population of 1054 participants incident on PD, volume overload before start of PD amounted to 1.9±2.3 L, and decreased to 1.2±1.8 L during the first year. At all time points, men and participants with diabetes were at higher risk to be volume overloaded. Dropout from PD during 3 years of observation by transfer to hemodialysis or transplantation (23% and 22%) was more prevalent than death (13%). Relative volume overload >17.3% was independently associated with higher risk of death (adjusted hazard ratio, 1.59; 95% confidence interval, 1.08 to 2.33) compared with relative volume overload ≤17.3%. Different practice patterns were observed between regions with respect to proportion of patients on PD versus hemodialysis, selection of PD modality, and prescription of hypertonic solutions. Conclusions In this large cohort of incident participants on PD, with different treatment practices across centers and regions, we found substantial volume overload already at start of dialysis. Volume overload improved over time, and was associated with survival.

Fragestellung: Ist der Anstieg der Krankenhausbehandlungen Jugendlicher wegen einer Alkoholintoxikation ein Indikator für eine Zunahme riskanten Trinkverhaltens? Methodik: Durchgeführt wurden zwei Sekundäranalysen (Untersuchung der Straftaten und Unfälle unter Alkoholeinfluss von 10 – 20-jährigen Jugendlichen sowie der Blutalkoholkonzentrationen (BAK) von stationär behandelten Jugendlichen, n = 1 020) und eine Feldstudie (Bevölkerungsbefragung, n = 285). Ergebnisse: Die Zahl der Krankenhausbehandlungen korrelierte positiv mit den Straftaten, jedoch nicht mit den Unfällen unter Alkoholeinfluss. In einer Stadt mit hohen Behandlungszahlen würden mehr Studienteilnehmer in Notfallsituationen als Erstes den Rettungsdienst verständigen als in einer vergleichbaren Stadt mit geringen Behandlungszahlen. Die durchschnittlichen BAK sanken innerhalb eines Zweijahreszeitraums (2008 – 2009) kontinuierlich. Schlussfolgerungen: Die Entwicklung von Krankenhausbehandlungen und Straftaten unter Alkoholeinfluss sprechen für einen gestiegenen Risikokonsum. Die Zunahme der Behandlungen wegen Alkoholintoxikation ist jedoch mit einer erhöhten Sensibilisierung der Bevölkerung assoziiert und wird durch alkoholbezogene Unfallzahlen nicht unterstützt.