Incidence of fractures in patients with type 1 diabetes mellitus-a retrospective study with 4420 patients.

This retrospective study investigated the incidence of fracture in 4420 type 1 diabetes (T1DM) patients. Our findings indicate that patients with T1DM have an increased incidence of fractures. Further studies and preventive measures are urgently needed. INTRODUCTION: The aim of this study was to investigate the incidence of fracture in patients with type 1 diabetes mellitus (T1DM). METHODS: This study is based on the German Disease Analyzer database and included 4258 adult individuals with a T1DM diagnosis documented between January 2000 and December 2015 in 1203 general practices in Germany. Individual matching of T1DM and non-diabetic patients was performed. The cumulative incidence of new fractures was shown for up to 10 years after the index date using Kaplan-Meier curves. Cox proportional hazard models (dependent variable: incident fracture) were used to estimate the effect of T1DM on fracture incidence, as well as the effect of predefined variables on fracture incidence. RESULTS: After 10 years of follow-up, the cumulative fracture incidence was 18.4% for T1DM patients and 9.9% for non-diabetic patients (p < 0.001). A strong association between T1DM and fractures was found (HR, 2.01 (95% CI, 1.70-2.38) p < 0.001) in both female and male patients. Significant differences between T1DM and non-diabetes patients were found in lower leg/ankle, foot and toe, shoulder/upper arm, and rib(s), sternum and thoracic spine fractures. A significant association between higher age and fracture incidence was observed in T1DM patients. CONCLUSIONS: In summary, we found that patients with T1DM have a twofold increased fracture rate compared with healthy controls. Furthermore, fractures were associated with increased age and high HbA1c values.

Prevalence of insulin as a first-line therapy and associated factors in people with type 2 diabetes in German primary care practices.

AIM: To evaluate how many people with type 2 diabetes receive a treatment regimen with insulin as a first-line therapy and the factors associated with this. METHODS: This retrospective study was based on data from the Disease Analyzer database and included 10 497 people with type 2 diabetes with an initial prescription of anti-hyperglycaemic therapy from 859 general and diabetologist practices in Germany between January 2014 and December 2018. The main outcome of the study was the prevalence of insulin as a first-line therapy. A multivariable logistic regression model was performed to investigate the association between predefined variables and the probability of receiving insulin as a first-line therapy. RESULTS: A total of 7.1% of participants received insulin as a first-line therapy. Diabetologist practice [odds ratio (OR) 2.71, 95% confidence interval (CI) 1.81-4.06], age > 80 years (OR 2.35, 95% CI 1.20-4.61) compared with age ≤ 40 years, HbA1c ≥ 86 mmol/mol (10%) (OR 2.99, 95% CI 1.81-4.95) compared with HbA1c < 48 mmol/mol (6.5%), renal complications (OR 1.91, 95% CI 1.29-2.81), peripheral artery disease (OR 1.94, 95% CI 1.30-2.81), neurological complications (OR 1.45, 95% CI 1.00-2.09), Charlson Comorbidity Index (OR 1.16, 95% CI 1.08-1.25) and higher number of different drugs prescribed within 12 months prior-the index date (OR 1.09, 95% CI 1.05-1.12) were significantly associated with the probability of receiving insulin as a first-line therapy. CONCLUSION: Insulin is rarely used as a first-line therapy in people with type 2 diabetes. Furthermore, a person's likelihood of receiving insulin as a first-line therapy is significantly influenced by diabetologist practice, age, HbA1c ≥ 86 mmol/mol (10%), renal, neurological and vascular complications, higher multimorbidity, and polypharmacy.

Diagnostic and therapeutic considerations for "mycotic" cerebral aneurysms: 2 case reports and review of the literature.

OBJECTIVE: Cerebral aneurysms of an infectious etiology, so-called "mycotic" aneurysms, are rare neurovascular pathologies. Primary treatment may be targeted on the aneurysm, but care has to be driven by the underlying pathology to prevent an often fatal clinical course with a mortality rate reaching 90%. 2 case reports are presented, and the diagnostic and therapeutic issues outlined by reviewing the literature. CASE REPORT: A 33-year-old female was admitted to our hospital with a sudden left-sided hemiparesis following a 3-week history of fever. An atypical intracerebral hemorrhage of the right parietal lobe due to a ruptured aneurysm of the distal middle cerebral artery (MCA) was diagnosed. Blood cultures containing Streptococcus sanguinus were the only finding for an infectious origin. Antibiotic therapy was started, followed by neurosurgical evacuation of the hematoma and clipping of the aneurysm. In a second case, endovascular coiling was the choice of treatment in a 38-year-old male presenting with a distal bifurcation aneurysm of the frontal MCA insular branch. An aortic valve replacement had been previously performed due to a congenital heart condition. The primary site of infection remained unclear and a 4-week course of broad-spectrum antibiotics was given intravenously. DISCUSSION: Cerebral aneurysms far distal to the usual sites of congenital aneurysms, organisms in blood chemistry, endocarditis, symptoms of infection, atypically located intracerebral hemorrhages, and young patients with immunodeficiency are strong factors for an infectious aneurysm. Cerebral angiography is mandatory to exclude aneurysms at other sites and early targeted antimicrobial treatment is crucial in these cases. Elimination of the aneurysm itself should be evaluated carefully because treating these aneurysms remains challenging compared to the ordinary group of cerebral aneurysms. Reconstructive procedures without sacrificing the parent artery often fail due to the fusiform and fragile aneurysm wall. CONCLUSION: Cerebral aneurysms of an infectious origin often have a disastrous clinical course in which morbidity and mortality can be reduced by early diagnosis, appropriate antimicrobial therapy, and aneurysm elimination by an experienced team. Apart from the initial treatment, major attention should be focused on a thorough follow-up to confirm complete cure of the primary site of infection.

Effects of the GABA(A) receptor antagonists bicuculline and gabazine on stimulus-induced sharp wave-ripple complexes in adult rat hippocampus in vitro.

Hippocampal sharp wave-ripple-complexes (SPW-Rs) are characterized by slow field potential transients superimposed by ripples with a frequency of approximately 200 Hz. In epileptic humans and rats frequencies of such transient network oscillations can reach up to 500 Hz potentially due to loss of functional inhibition. Therefore, we investigated whether GABA(A) receptor antagonists increased ripple frequency during SPW-Rs. Within area CA3, SPW-Rs were induced by repeated stimulation of stratum radiatum in area CA1 of adult Wistar rat hippocampal slices. Intracellular recordings showed that in approximately 50% of recorded CA3 pyramidal cells SPW-Rs were accompanied by compound excitatory postsynaptic potentials (EPSPs) of approximately 10 mV superimposed by up to four action potentials (APs). The remaining cells responded with a compound inhibitory postsynaptic potential (IPSP) during SPW-Rs. The GABA(A) receptor antagonists bicuculline (BMI) or gabazine (SR-95531) led to a transition of SPW-Rs into prolonged bursts with a significant increase in amplitude and duration reminiscent of recurrent epileptiform discharges (REDs). Ripple frequencies increased from approximately 190 Hz to approximately 300 Hz. In naïve slices SR-95531 and BMI also evoked REDs with similar incidence and high frequency ripple frequencies of approximately 240 Hz. Elevations in extracellular potassium concentration during REDs were approximately 20-fold higher than those observed during SPW-Rs. Intracellular recordings revealed bursts that were characterized by a large (> 25 mV) prolonged depolarization superimposed by up to 40 APs in close synchrony with extracellularly recorded ripples. Our results suggest that the generation of high frequency ripples, which are also observed in epileptic humans and rats, could indicate a loss of functional inhibition.