Incidence trend of type 2 diabetes from 2012 to 2021 in Germany: an analysis of health claims data of 11 million statutorily insured people.

AIMS/HYPOTHESIS: The aim of the study is to describe the time trend of type 2 diabetes incidence in the largest state of Germany, Bavaria, from 2012 to 2021, and to compare the incidence rates during the pandemic period (2020-2021) to the pre-pandemic period (2012-2019). METHODS: This secondary data analysis uses health claims data provided by the Bavarian Association of Statutory Health Insurance Physicians (KVB), covering approximately 11 million insurees, accounting for 85% of the total population of Bavaria, Germany. Newly diagnosed type 2 diabetes cases in adults (≥20 years) coded as E11 (Diabetes mellitus, Type 2) or E14 (Unspecified diabetes mellitus) under ICD-10, German modification (ICD-10-GM) for the study period 2012 to 2021 were included. Annual and quarterly age-standardised incidence rates (ASIR) stratified by sex, age and region were calculated using the European standard population. Sex-specific crude incidence rates (CIR) were calculated using 10-year age groups. Regression analyses adjusted for time trends, seasonal effects, and pandemic effects were used to analyse the incidence trend and to assess the effect of the pandemic. RESULTS: Overall, 745,861 new cases of type 2 diabetes were diagnosed between 2012 and 2021: 50.4% (376,193 cases) in women. The male/female ratio remained stable over the observation period, while the median age at diagnosis decreased from 61 to 58 years in men and from 66 years to 61 years in women. ASIR were consistently higher for men compared with women, with the yearly difference remaining stable over time (2012: 18%; 2021: 20%). An overall decreasing trend in ASIR was observed during the study period, with a strong decrease from 2012 to 2017, followed by a less pronounced decline from 2018 to 2021 for both sexes. For men, ASIR decreased from 1514 per 100,000 person-years in 2012 to 995 per 100,000 person-years in 2021 (4.6% average annual reduction), and for women from 1238 per 100,000 person-years in 2012 to 796 per 100,000 person-years in 2021 (4.8% average annual reduction). This downward trend was also observed for age groups above 50 years. Regression analyses showed no significant change in incidence rates during the pandemic period (2020 and 2021) compared with the pre-pandemic period. CONCLUSIONS/INTERPRETATION: For the first time, a 10-year incidence trend of type 2 diabetes is reported for Germany, showing a strong decline from 2012 to 2017, followed by a less pronounced decline from 2018 to 2021. The incidence trend of type 2 diabetes appears not to have been affected by the first 2 years of the COVID-19 pandemic. Despite an overall increasing prevalence, the incidence is decreasing, potentially resulting from robust screening by family physicians, reducing the median age at diagnosis by 3 to 5 years. However, further investigation is needed to fully identify the reasons for the declining incidence trend. Continued incidence monitoring is necessary to identify the long-term trend and the potential effect of the pandemic on diagnoses of type 2 diabetes.

Influence of Treadmill Design on Gait: Does Treadmill Size Affect Muscle Activation Amplitude? A Musculoskeletal Calculation With Individualized Input Parameters of Gait Analysis.

With increasing age, gait changes often occur, leading to mobility problems and thus a higher risk of falling. Interest in training at home or at retirement homes has led to the development of "mobile treadmills." A difference in treadmill surface length may influence walking parameters (i.e., step length) and therefore may affect muscle activation. This led to the question: Does the treadmill size affect the muscle activation, i.e., with the length of the walking surface. The study aimed to investigate the influence of treadmill size, i.e., length of the walking surface, on gait pattern and to determine differences in the amplitude of muscle activation using a participant-specific musculoskeletal model (AnyBody Technology A/S, Aalborg, Denmark). For a prospective, randomized study gait parameters were collected from 47 healthy participants (aged 50.19 ± 20.58 years) while walking on two different treadmills, a small mobile treadmill (walking surface length 100 cm) and a conventional treadmill (walking surface length 150 cm), at their preferred speed, 2 km/h, and 4 km/h. Muscle activation amplitude patterns were similar between treadmills (M. gastrocnemius medialis: rmean = 0.94, M. gastrocnemius lateralis: rmean = 0.92, M. gluteus medius rmean = 0.90, M. gluteus minimus rmean = 0.94). However, the gait analysis showed a decreased preferred velocity (p < 0.001, z = 4.54), reduced stride length (preferred velocity: p = 0.03, z = -2.17; 2 km/h: p = 0.36, z = 2.10; 4 km/h: p = 0.006, z = 2.76), shorter stride time (2 km/h: p < 0.001, z = 4.65; 4 km/h: p < 0.001, z = 4.15), and higher cadence (2 km/h: p < 0.001, z = -4.20; 4 km/h: p = 0.029, z = -2.18) on the mobile treadmill than on the conventional treadmill. Our observations suggest that the treadmill design (e.g., a 50 cm difference in walking surface length) may not influence muscle activity amplitude during walking. However, the design of the treadmill may influence gait characteristics (e.g., stride length, cadence) of walking.

Anticipatory and Reactive Grip Force Control in Patients with Alzheimer's Disease: A Pilot Study.

BACKGROUND: Alzheimer's disease (AD) affects several cognitive functions and causes altered motor function. Fine motor deficits during object manipulation are evident in other neurological conditions, but have not been assessed in dementia patients yet. OBJECTIVE: Investigate reactive and anticipatory grip force control in response to unexpected and expected load force perturbation in AD. METHODS: Reactive and anticipatory grip force was investigated using a grip-device with force sensors. In this pilot study, fifteen AD patients and fourteen healthy controls performed a catching task. They held the device with one hand while a sandbag was dropped into an attached receptacle either by the experimenter or by the participant. RESULTS: In contrast to studies of other neurological conditions, the majority of AD patients exerted lower static grip force levels than controls. Interestingly, patients who were slow in the Luria's three-step test produced normal grip forces. The timing and magnitude of reactive grip force control were largely preserved in patients. In contrast, timing and extent of anticipatory grip forces were impaired in patients, although anticipatory control was generally preserved. These deficits were correlated with decreasing Mini-Mental State Examination scores. Apraxia scores, assessed by pantomime of tool-use, did not correlate with performance in the catching task. CONCLUSION: We interpreted the decreased grip force in AD in the context of loss of strength and lethargy, typical for patients with AD. The lower static grip force during object manipulation may emerge as a potential biomarker for early stages of AD, but more studies with larger sample sizes are necessary.