Diabetes mellitus im Alter

Diabetes in old age is one of the most common chronical diseases by a prevalence of up to 25 % of the 70-year and older patients. Elderly with diabetes often suffer from functional or cognitive deficits that must be realized for therapeutic issues. These would include special geriatric syndromes like frailty, falls, immobility or higher vulnerability for drug interactions. Therefore the German Diabetes Association recommends to adjust therapeutic goals not only to patients’ goals but also to their individual functional status. Simple therapy regimens should be preferred to avoid polypharmacia and to preserve the patients’ independence as long as possible.

Where is the Hoechst Insulin?: The Role of Diabetics and Their Doctors as Consumers During the German Democratic Republic’s Autarkic Policy of ‘Making Free From Disturbance’, 1961–1966

Summary This article examines the treatment of the chronic disease, diabetes mellitus, during and immediately after the German Democratic Republic (GDR)’s autarkic policy of Störfreimachung, literally translated as ‘making free from disturbance’. I look specifically at an insulin favoured by East German diabetes specialists and their patients delivered from the West German pharmaceutical company, Hoechst AG, and the consequences of preventing this insulin from being imported. By using insulin as a case study, a medication necessary for the survival of insulin-dependent diabetics, the article offers a close analysis of the complex relationship between ordinary citizens, medical professionals and the ruling Socialist Unity Party (SED) following the building of the Berlin Wall. I argue that the intense focus on the issue of consumption in the competition between the GDR and West Germany shaped both the attitude of the SED and those responding to the policy of Störfreimachung. The SED regime and leading health officials espoused a highly ‘productionist’ medical ethos that was somewhat at odds with their growing desire to meet increasing consumer demands. This collision opened up ideological contradictions, which provided an opportunity for those on the receiving end of the policy to discredit it, and, by extension, justify the continued use of their preferred choice of insulin from Hoechst. I draw, in particular, on patient Eingaben (petitions) and reports by district diabetologists in order to uncover this trend.

Definition, Classification and Diagnosis of Diabetes Mellitus

Aim of recommendations like this one issued by the German Diabetes Association is to provide the GP and diabetologist and his team with information he needs for his daily practice. These recommendations are updated annually. They are written by a group of experts, but they are not evidence based guidelines. This specific recommendation for diabetes diagnosis briefly describes the diabetes types and the different options for diagnosis. Also the caveats and the practical procedure are presented.

Derivation and external validation of a clinical version of the German Diabetes Risk Score (GDRS) including measures of HbA1c

ObjectiveThe German Diabetes Risk Score (GDRS) is a diabetes prediction model which only includes non-invasively measured risk factors. The aim of this study was to extend the original GDRS by hemoglobin A1c (HbA1c) and validate this clinical GDRS in the nationwide German National Health Interview and Examination Survey 1998 (GNHIES98) cohort.Research design and methodsExtension of the GDRS was based on the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study with baseline assessment conducted between 1994 and 1998 (N=27 548, main age range 35–65 years). Cox regression was applied with the original GDRS and HbA1c as independent variables. The extended model was evaluated by discrimination (C-index (95% CI)), calibration (calibration plots and expected to observed (E:O) ratios (95% CI)), and reclassification (net reclassification improvement, NRI (95% CI)). For validation, data from the GNHIES98 cohort with baseline assessment conducted between 1997 and 1999 were used (N=3717, age range 18–79 years). Missing data were handled with multiple imputation.ResultsAfter 5 years of follow-up 593 incident cases of type 2 diabetes occurred in EPIC-Potsdam and 86 in the GNHIES98 cohort. In EPIC-Potsdam, the C-index for the clinical GDRS was 0.87 (0.81 to 0.92) and the overall NRI was 0.26 (0.21 to 0.30), with a stronger improvement among cases compared with non-cases (NRIcases: 0.24 (0.19 to 0.28); NRInon-cases: 0.02 (0.01 to 0.02)). Almost perfect calibration was observed with a slight tendency toward overestimation, which was also reflected by an E:O ratio of 1.07 (0.99 to 1.16). In the GNHIES98 cohort, discrimination was excellent with a C-index of 0.91 (0.88 to 0.94). After recalibration, the calibration plot showed underestimation of diabetes risk in the highest risk group, while the E:O ratio indicated overall perfect calibration (1.02 (0.83 to 1.26)).ConclusionsThe clinical GDRS provides the opportunity to apply the original GDRS as a first step in risk assessment, which can then be extended in clinical practice with HbA1c whenever it was measured.