Prevalence, incidence and concomitant co-morbidities of type 2 diabetes mellitus in South Western Germany--a retrospective cohort and case control study in claims data of a large statutory health insurance.

BACKGROUND: Type 2 diabetes mellitus (T2DM) has become a world-wide epidemic. This chronic metabolic disease has a major impact on life expectancy and on quality of life. The burden of this disease includes a number of co-morbidities. However, estimates of prevalence, incidence and associated diseases as well as the current temporal development and regional differences are largely missing for South Western Germany. METHODS: Lifetime diagnosis-based prevalence, incidence and presence of concomitant co-morbidities were examined between the years 2007 and 2010 in the claims data set of all insured persons of the AOK Baden-Wuerttemberg, a large statutory health insurance. The analysis was based on the respective WHO-ICD-10 codes. Data were standardized for age and sex on the residential population of about 10 million inhabitants of South Western Germany. RESULTS: The total study cohort involved approximately 3.5 million persons each year. The standardized diagnosis-based prevalence (SDP) of T2DM rose from 6.6%, 7.4%, 8.0%, up to 8.6% in the years 2007 to 2010. Yearly SDP was between 14.0% and 18.9% at an age range of 60 to 64 years and between 26.7% and 31.8% at an age of 75 years or older. In the year 2010 the regional distributions of standardized diagnosis-based prevalence were between 7.6% and 11.6 %, respectively. Incidence rates were 8.3 in 2008, 7.8 in 2009, and 8.7 in 2010 (all rates per 1000). The excess disease risk (odds ratio) of T2DM was for adiposity 2.8 to 3.0, hypertension 2.4 to 3.7, coronary heart disease 1.8 to 1.9, stroke 1.7 to 1.8, renal insufficiency 2.8 to 3.4, and retinopathy 2.8 to 2.9 in the years 2007 to 2010. These co-morbidities appeared several years earlier compared to the non-diabetic population. CONCLUSIONS: T2DM is common and increasing in South Western Germany. In particular a quarter of the population in higher ages was afflicted by T2DM. Interestingly a region-specific pattern was observed as well as an increase in numbers during earlier years in life. Our data underline the need for diabetes awareness programmes including early diagnosis measures as well as structured and timely health surveys for major diseases such as T2DM and its concomitant co-morbidities.

A systematic review of assessments for identifying executive function impairment in adults with acquired brain injury.

PURPOSE: To synthesize quantitative findings concerning measures of executive function (EF) in adults with acquired brain injury (ABI). METHOD: Electronic databases were searched for studies of EF assessments in adults with ABI that reported any of 3 values: likelihood ratios (LRs), standardized group mean comparisons (ds), or correlations (rs) among EF tests. Forest plots were constructed for each value. RESULTS: Searches yielded 1,417 unique citations. Full texts of 129 articles were reviewed; 34 reported at least 1 value of interest. Nineteen positive and negative LRs were calculated from 8 studies of 8 EF measures; some point estimates were in the clinically informative range, but all confidence intervals extended beyond it. From 24 studies of 14 measures, 114 d values were calculated; d values for only 11 measures had lower bounds > 0.80. From 8 studies involving 10 EF measures, 104 correlations were reported; in only 5 cases were r(2) values > .5. CONCLUSIONS: Strong evidence concerning diagnostic accuracy and concurrent validity of EF measures for adults with ABI is lacking. Better specification of the construct of EF as well as research aimed at improving the quality of evidence concerning EF tests are needed.

Pilot clinical study of Adacolumn cytapheresis in patients with systemic lupus erythematosus.

The aim of this study is to investigate the clinical effects of cytapheresis using the Adacolumn system (selective removal of circulating monocytes and granulocytes by means of an extracorporeal type column) in patients with active systemic lupus erythematosus (SLE). An open uncontrolled multicenter pilot study was conducted in 18 SLE patients who were showing a SLEDAI score of 8 or more under conventional medication. Patients with lupus nephritis (>class 1, WHO classification) were excluded. Extracorporeal cytapheresis with the Adacolumn system was administered once a week for five consecutive weeks. The efficacy of the treatment was evaluated using the SLEDAI for 10 weeks after the first cytapheresis session. The median SLEDAI decreased from 16 at baseline to six at week 11 (10 weeks after the first apheresis) (p<0.001). Significant improvements in musculoskeletal and dermal systems were observed. Arthritis and alopecia were present in 14 and nine patients at baseline and this number decreased to five and one patients, respectively by week 11. Three mild and one moderate adverse events out of the 42 reported events were judged 'probably related' to the treatment; no serious adverse events were reported. Selective removal of monocytes and granulocytes from the blood in an extracorporeal circulation system was associated with clinical improvement in this small series of patients with SLE. Since this approach seems not to have the disadvantages of pharmacological immunosuppression, further controlled studies of Adacolumn cytapheresis are warranted in SLE.