Heart failure among people with Type 2 diabetes mellitus: real-world data of 289 954 people from a diabetes database.

AIM: Comparing people with Type 2 diabetes mellitus with and without heart failure in terms of metabolic control, therapeutic regimen and comorbidities. METHODS: The Prospective Diabetes Registry (DPV) is a longitudinal documentation system for demographics, medical care and outcome in people with diabetes mellitus. It consists of follow-up data from people with diabetes mellitus who have agreed to be recorded in the registry. Clinical data are submitted by general practitioners, specialists and clinics throughout Germany and Austria. Some 289 954 people with Type 2 diabetes mellitus (years 2000 to 2015) were analysed using demographic statistics and adjustment for confounders based on linear and logistic regression analysis. RESULTS: People with Type 2 diabetes mellitus (ICD code: E11) and heart failure (ICD code: I50) (N = 14 723) were older, more often women and presented with longer diabetes duration compared with those without heart failure. After adjustment for age, gender and diabetes duration, people with heart failure showed lower HbA1c , higher BMI and more intense insulin therapy. Analysis revealed that people with heart failure were more often treated with insulin, and more frequently received anti-hypertensives and lipid-lowering medication. They presented with lower systolic and diastolic BP. People with heart failure more frequently showed a history of comorbidities. CONCLUSION: Heart failure is common in diabetes mellitus, but the prevalence in the DPV is lower frequent than expected. The reason for improved metabolic control in heart failure may be intensified therapy with insulin, lipid-lowering medication and anti-hypertensives in this cohort.

Risk factors for myocardial infarction and death in newly detected NIDDM: the Diabetes Intervention Study, 11-year follow-up.

The Diabetes Intervention Study (DIS) is a prospective population-based multicentre trial of newly detected cases of non-insulin-dependent diabetes mellitus (NIDDM). This report analyses the risk factors for subsequent coronary heart disease and all-cause death during the 11-year follow-up. The prognostic significance of the categories of the NIDDM Policy Group was validated with respect to the incidence of coronary heart disease and mortality. At baseline 1139 subjects, aged 30-55 years at the time of diabetes detection and classified as diet controlled after a 6-week screening phase, were included. Of the patients 112 (15.2%) suffered from myocardial infarction, 197 (19.82%) of 994 had died. The odds ratio for all-cause mortality compared to the general population for males at the age of 36-45 years was 5.1 and for females 7.0. In multivariate analysis age, blood pressure and smoking were independent risk factors for myocardial infarction and male sex, age, blood pressure, triglycerides, postprandial blood glucose and smoking for death, respectively. The categories of the NIDDM Policy Group target parameters for blood glucose, triglycerides and blood pressure were significant predictors of both CHD and death. Thus, it appears that in NIDDM good control of blood glucose, blood pressure and triglycerides is associated with a lower incidence of coronary heart disease and death rate respectively.

[Selected social medicine problems of the diabetic patient]. / Ausgewählte sozialmedizinische Probleme des Diabetikers.

Corresponding publications above all consider social medical problems of the diabetic, which still is in occupation. As more than the half of all diabetics are recipients of pension, we have to engage in them, too. We examined 1397 diabetics. 72% of them were able to get alone in the consulting hour. The rest (28%) had a significantly longer duration of illness and were disabled workers very often. We refer to the insufficient insulin therapy in old diabetics. We demonstrate possibilities for enforcement of the insulin injection.

[Correlation of serum creatinine concentration, retinopathy and frequency of hypertension in relation to the age of long-term diabetics in a rural population]. / Beziehungen zwischen Serumkreatininkonzentration, Retinopathie- und Hypertoniefrequenz in Abhängigkeit vom Lebensalter bei Langzeitdiabetikern einer ländlichen Population.

274 diabetics with a duration of the disease between 15 and 54 years were examined regarding the relations between their renal function, the frequency of retinopathy and hypertension and their age. 41.6% of the patients showed an increased creatinine value, a retinopathy occurred in 59.5% of all diabetics. In the increase of creatinine as well as in the retinopathy there was a close correlation of the retinopathy and the duration of the disease, but the retinopathy was significantly more frequent in younger persons. It is nearly always accompanied by hypertension. The latter way found in 69.3% of the patients. The duration of diabetes seems to have no influence on the frequency of hypertension, but the level of creatinine in patients under 60 does. Increased creatinine values as well as a retinopathy and hypertension were preponderant in males of this age group. References to the reduction of the high frequency of hypertension, retinopathy and of increased creatinine are given.

[Incidence of invalidism and severe handicap in diabetics in an agrarian region]. / Häufigkeit von Invalidisierungen und Schwerbeschädigungen bei Diabetikern in einem Agrarkreis.

The 1,409 diabetics registered in the district department for diabetes Prenzlau on December 31st 1979 were questioned concerning the occurrence of invalidity, the causes of invalidity and the frequency of a present severely disabled persons's card. 34.1% of the female and 28.5% of the male diabetics were physical disability pensioners or old-age pensioners. This frequency was 4 to 6 times higher than in the total population of Prenzlau. Disease of the heart and the circulatory system were for the most part the causes of invalidity in the two groups, while the specific diabetic complications played a minor role in the diabetics. 15.1% of the female and 25.4% of the male diabetics had a severely disabled person's card. The recommendations for a uniform criticism of the body injury in diabetes mellitus published already in 1961 should be revised because of the frequent diminution of the earning capacity in diabetics.

[The cardiovascular risk profile in persons with normal glucose tolerance with reference to the familial occurrence of diabetes mellitus]. / Das Kardiovaskuläre Risikoprofil von Personen mit normaler Glukosetoleranz m Abhängigkeit von familiärem Diabetesvorkommen.

Of 96 persons each with normal glucose tolerance test (oral glucose tolerance test in all deviations "securely normal"), but different hereditary load with diabetes the cardiovascular risk factors overweight, hypertension, hypertriglyceridaemia, hypercholesterolaemia and hyperuricaemia were established and compared according to the principle of biostatistical twin formation. Persons with heredity of diabetes have significantly more frequently overweight (p less than 0.05) than persons without familial load with diabetes. Female test persons with close diabetic relatives are more frequently hypertensives (p less than 0.05) than females without heredity of diabetes. The authors recommend more than hitherto to take into consideration genetic viewpoints within the problems of arteriosclerosis.

[The cardiovascular risk profile in patients with disorders of glucose tolerance (borderline diabetes) dependent on the heredity of the diabetes]. / Das kardiovaskuläre Risikoprofil von Personen mit gestörter Glukosetoleranz (Borderline-Diabetes) in Abhängigkeit von der Diabetesheredität.

In the statement of the profile of the cardiovascular risk of 1,780 persons evaluable data on a probable heredity of diabetes of 1st degree were got. Taking into consideration the same age groups no differences could be found concerning the heredity of diabetes between persons with carbohydrate tolerance lying in the borderline region (oral glucose tolerance test in the modification of the European study group for epidemiology of diabetes) and newly detected diabetics, whereas normal persons showed significantly more infrequently an occurrence of diabetes in near relatives. Taking into consideration the same age and sex of the comparative couples (150 biostatistic twins each) borderline diabetics with and without heredity of diabetes had an identical profile of risk with restriction to 5 generally accepted cardiovascular sizes of influence (overweight, hypertension, hypertriglyceridaemia, hypercholesterolaemia and hyperuricaemia). An existing heredity of diabetes does not increase the signs of risk associated with the carbohydrate intolerance.

[Incidence of pathological ECG findings, hypertension and obesity in diabetic patients depending on their mode of therapy]. / Häufigkeit eines pathologischen Ekg-Befundes, einer Hypertonie und einer Fettsucht bei Diabetikern in Abhängigkeit von der Therapieart.

Of 1,164 (= 89.7%) of all diabetics established in the district department for diabetes Prenzlau the electrocardiograms in rest were evaluated and the frequency of hypertension, adiposity and left hypertrophy in the photofluorogram were registered. Altogether only 13% of all patients with an average age of 65 years had a normal ECG. In comparisons to the population with healthy metabolism the frequency of hypertension *84.0%), adiposity (62.7%) and in the ECG of repolarization disturbances (68.9%), myocardial infarction (6.4%), atrioventricular blockings (16.9%), absolute arrhythmia (4.4%), tachycardia (5.5%), a left hypertrophy (18.2%; in the photofluorogram 52.3%), of forms of bundle branch blocks (9.1% left-anterior hemiblock, 4.5% right bundle branch block and 3.1% left bundle branch block) and of an overturned left type (13.1%) were evident in diabetics. Pathological changes of the ECG could be proved no more infrequently in females with diabetes than in males with diabetes. The connection between the appearance of a coronary arteriosclerosis and the intake of tolbutamide supposed by the UGDP-study could be confirmed also for the intake of glibenclamide.

[The cardiovascular risk-profile of persons with normal, borderline disturbed and certain pathological glucose tolerance in dependence on the body-weight (author's transl)]. / Das kardiovaskuläre Risikoprofil von Personen mit normaler, grenzgestörter und sicher pathologischer Glukosetoleranz im Gewichtsbezug.

For a group of 218 persons with normal, borderline disturbed and certain pathological glucose tolerance (age and sex matched controls) the following risk factors were determined: - overweight (Broca-index greater than 1.1) - hypertension (WHO-criterions) - hypertriglyceridaemia (from 200 mg/dl) - hypercholesterolaemia (from 260 mg/dl) and - hyperuricaemia (from 6,5 mg/dl (male) respectively 6,0 mg/dl (female). These risk factors were compared in dependence on the bodyweight in each case. There were average values of 1.68 associated risk factors for normal persons, 2.55 for borderline diabetics and 2.72 for newly discovered but not yet treated diabetics. With growing bodyweight the part of hypertensions increases, with borderline diabetics stronger than with normal persons but weaker than with diabetics. The behaviour of the hypertriglyceridaemia frequency is the same. The frequency of hyperuricaemias surpasses with borderline diabetics those for normal persons and diabetics. The frequency of hyperuricaemia does not show the strong proportionality to the bodyweight with disturbed glucose tolerance as with normal persons. The average value of cardiovascular risk factors increases greater with low degree of glucose intolerance than with clearly disturbed glucose tolerance.

[The influence of diabetes heredity on cardiovasculary risk profile in patients with high age diabetes (author's transl)]. / Untersuchungen zum Diabetes mellitus im hohen Lebensalter. 2. Mitteilung: Der Einfluss der Diabetesheredität auf das kardiovaskuläre Risikoprofil von Altersdiabetikern.

The cardiovasculary risk profile of 105 newly detected, but still untreated, high age diabetics with an average of 69,1 years showing diabetes heredity in relatives of first degree was compared with a corresponding group (same age and same number of patients) without diabetes heredity. Taking into consideration exclusively the danger magnitudes overweight, hypertension, hypertriglyceridaemia, hypercholesterolaemia and hyperuricaemia, one sees an identical risk profile for both groups (the groups of patients were chosen according the principle of biostatistical gemini forming). For the showing of pathogenic magnitudes of influence within the metabolic syndrome the environmental factors seem to have a far greater importance than hereditary diabetogenic ones.

[Associated cardiovascular factors of risk in borderline-diabetes (author's transl)]. / Assoziierte kardiovaskuläre Risikofaktoren beim Borderline-Diabetes.

In 1288 persons with reduced glucose tolerance (borderline-diabetics, recently discovered diabetics, which were never before treated) the cardiovascular factors of risk overweight (Broca-weight greater than or equal to 110%), hypertension (RR greater than or equal to 160 and/or 95 Torr), hypertriglyceridaemia (greater than or equal to 200 mg/100 ml), hypercholesterolaemia (greater than or equal to 260 mg/100 ml) and hyperuricaemia (greater than or equal to 6,5 mg/100 ml in males and 6.0 mg/100 ml in females) were determined and compared with the frequency of the same danger indicators of 564 persons with normal glucose tolerance. The borderline-diabetic, which is still being in the forefield of the fixed diabetic, shows a large number of cardiovascular factors of risk already and differed from the normal case of the same age by a significant accumulated occurrence of overweight, hypertension, hypertriglyceridaemia and hyperuricaemia. The diagnosis "borderline-diabetes" engages to look for more cardiovascular factors, especially in the both first thirds of life. The differences of associated factors of risk diminish with advance in years between the three groups.

[The cardiovascular risk profile of subjects with normal, marginally disordered and proven pathological glucose tolerance]. / Das kardiovaskuläre Risikoprofil von Personen mit normaler, grenzgestörter und sicher pathologischer Glukosetoleranz.

In 1.035 persons with reduced glucose tolerance (borderline diabetics, diabetic biophan G test admissions, spontaneous admissions and diabetics treated already for a longer time) the cardiovascular factors of risk over-weight (Broca-weight greater than or equal to 110%), hypertension (RR greater than or equal to 160/and/or 95 Torr), hypertriglyceridaemia (greater than or equal to 200 mg/100 ml), hypercholesterolaemia (greater than or equal to 300 mg/100 ml) and hyperuricaemia (greater than or equal to 6.5 mg/100 ml in males and 6.0 mg/100 ml in females) were determined and compared with the frequency of the same danger indicators of 255 persons with certainly normal glucose tolerance. Taking into consiteration the reduction of the glucose tolerance as cardiovascular factor of risk the glucosuria test admissions with 3.48 factor of risk/proband had no less factors of risk than the spontaneous diabetic admissions (3.29 factor of risk/proband). Already the borderline diabetic differed in the frequency of overweight, hypertension and hypertriglyceridaemia significantly (p less than 0.01) from the normal case of the same age. Thus the glucose tolerance disturbed in its limit deserves increased consideration from the diabetological as well as from the cardiological point of view.