Multicentre analysis of hyperglycaemic hyperosmolar state and diabetic ketoacidosis in type 1 and type 2 diabetes.

AIMS: To compare diabetes patients with hyperglycaemic hyperosmolar state (HHS), diabetic ketoacidosis (DKA), and patients without decompensation (ND). METHODS: In total, 500,973 patients with type 1 or type 2 diabetes of all ages registered in the diabetes patient follow-up (DPV) were included. Analysis was stratified by age (≤ / > 20 years) and by manifestation/follow-up. Patients were categorized into three groups: HHS or DKA-during follow-up according to the most recent episode-or ND. RESULTS: At onset of diabetes, HHS criteria were met by 345 (68.4% T1D) and DKA by 9824 (97.6% T1D) patients. DKA patients had a lower BMI(-SDS) in both diabetes types compared to ND. HbA1c was higher in HHS/DKA. During follow-up, HHS occurred in 1451 (42.2% T1D) and DKA in 8389 patients (76.7% T1D). In paediatric T1D, HHS/DKA was associated with younger age, depression, and dyslipidemia. Pump usage was less frequent in DKA patients. In adult T1D/T2D subjects, metabolic control was worse in patients with HHS/DKA. HHS and DKA were also associated with excessive alcohol intake, dementia, stroke, chronic kidney disease, and depression. CONCLUSIONS: HHS/DKA occurred mostly in T1D and younger patients. However, both also occurred in T2D, which is of great importance in the treatment of diabetes. Better education programmes are necessary to prevent decompensation and comorbidities.

Antibacterial capacity of buccal epithelial cells from healthy donors and children with recurrent urinary tract infections.

The effect of buccal epithelial cells (BEC) on bacterial growth was investigated in healthy subjects as well as in patients with recurrent urinary tract infections (UTI) and compared to the antibacterial capacity of uroepithelial cells (UEC) of the same individuals. Epithelial cells were obtained from the following groups: healthy female controls; females without further UTI after reflux operation; females with asymptomatic bacteriuria (ABU); females with further UTI despite successful reflux operation; and patients with meningomyelocele (MMC) and recurrent UTI due to significant residual urinary volume. Cocultivation of Escherichia coli with BEC as well as UEC from healthy females or patients with MMC resulted in significant suppression of bacterial growth. However, neither type of epithelial cell showed an antibacterial effect when they were obtained from patients with recurrent UTI in the absence of urological abnormalities (ABU patients; reflux-corrected patients with further UTI). From these results it is concluded that a generalised epithelial defence defect is one important pathogeneic factor for recurrent idiopathic UTI.

[Clinical course and scar development in operated vesico-renal reflux in a long-term study]. / Klinischer Verlauf und Narbenentwicklung beim operierten vesico-renalen Reflux in einer Langzeitbeobachtung.

62 patients (14 boys, 48 girls) representing 85 refluxive renal units (Grade 2-4) were investigated after successful operation for the development of further urinary tract infections (UTI) and renal scars (RS). The mean follow-up was 9.3 years. With the exception of one boy, none of the male patients developed any UTI or new RS. A similar result was obtained for about 45% of the girls. These two groups of patients presented with high-grade reflux before surgery. The remaining female patients (about 55%), however, presenting with lower-grade reflux before surgical treatment, developed further UTI as well as new RS despite surgical correction of their reflux. Investigations on the capacity of uroepithelial cells (UEC) to suppress bacterial growth revealed a deficient antibacterial effect of UEC in these patients. Such an UEC defect has also been shown in patients with asymptomatic bacteriuria. In conclusion, different reasons seem to be responsible for recurrent UTI and the development of RS in patients with reflux.