Analysis of diabetes attitudes, wishes and needs in Switzerland, the Swiss DAWN2™ Study.

AIMS OF THE STUDY Swiss DAWN2™ aimed to evaluate the difficulties and unmet needs of individuals with diabetes and stakeholders, based on the assessments of diabetes care and self-management: the individual burden of disease, the perception of the quality of medical care, and the treatment satisfaction of individuals with diabetes living in the Canton of Bern. The results of the Swiss cohort were analysed and compared with the global DAWN2™ results. METHODS 239 adult individuals with diabetes were enrolled in a cross-sectional study at the Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism at the University Hospital of Bern between 2015 and 2017. The participants completed validated online questionnaires regarding health-related quality of life (EQ-5D-3L) and emotional distress (PAID-5), diabetes self-care activities (SDSCA-6), treatment satisfaction (PACIC-DSF), and health-related wellbeing (WHO-5). Eligibility criteria were as follows: participants were aged >18 years, had a diagnosis of diabetes type 1 or 2 since at least 12 months and gave written informed for the participation in the present study. RESULTS When compared globally, the Swiss cohort reported a higher quality of life (77.28 ± 16.73 vs. 69.3 ± 17.9 EQ-5D-3L score, p 7% correlated to emotional distress (PAID-5, 26.08 ± 23.37 vs. 18.80 ± 17.49, p = 0.024), unfavourable eating habits (4.28 ± 2.22 vs. 4.99 ± 2.15, p = 0.034) and decreased physical activity (3.95 ± 2.16 vs. 4.72 ± 1.92, p = 0.014). Sleeping problems were most commonly reported (35.6%). In total, 28.8% of respondents completed diabetes-related educational programs. CONCLUSION In global comparison, Swiss DAWN2™ showed a lower burden of disease and yet a higher level of treatment satisfaction in patients who were treated in Switzerland. Further studies are required to assess the quality of diabetes treatment and unmet needs in patients treated outside of a tertiary care center

Study protocol for a randomised, double-blind, placebo-controlled crossover trial assessing the impact of the SGLT2 inhibitor empagliflozin on postprandial hypoglycaemia after gastric bypass.

INTRODUCTION Postprandial hypoglycaemia after gastric bypass surgery (also known as postbariatric hypoglycaemia or PBH) is an increasingly encountered clinical problem. PBH is characterised by meal-induced rapid spikes and consequent falls in glycaemia, resulting in both hypoglycaemia burden and high glycaemic variability. Despite its frequency, there is currently no approved pharmacotherapy. The purpose of this investigation is to evaluate efficacy and safety of empagliflozin 25 mg, a sodium-glucose cotransporter 2-inhibitor, to reduce glucose excursions and hypoglycaemia burden in patients with PBH after gastric bypass surgery. METHODS AND ANALYSIS In a prospective, single-centre, randomised, double-blind, placebo-controlled, crossover trial, we plan to enrol 22 adults (≥18 years) with PBH after Roux-en-Y gastric bypass surgery (plasma or sensor glucose <3.0 mmol/L). Eligible patients will be randomised to receive empagliflozin 25 mg and placebo once daily, each for 20 days, in random order. Study periods will be separated by a 2-6 weeks wash-out period. The primary efficacy outcome will be the amplitude of plasma glucose excursion (peak to nadir) during a mixed meal tolerance test. Results will be presented as paired-differences±SD plus 95% CIs with p values and hypothesis testing for primary and secondary outcomes according to intention-to-treat. Secondary outcomes include continuous glucose monitoring-based outcomes, further metabolic measures and safety. ETHICS AND DISSEMINATION The DEEP-EMPA trial (original protocol title: Randomized, double-blind, placebo-controlled crossover trialassessing the impact of the SGLT2 inhibitor empagliflozin onpostprandial hypoglycaemia after gastric bypass) was approved by the Bern Ethics Committee (ID 2021-01187) and Swissmedic (Ref. Number: 102663190) in October and November 2021, respectively. First results are expected in the first quarter of 2023 and will be disseminated via peer-reviewed publications and presented at national and international conferences. The acronym DEEP was derived from an overarching project title (DEciphering the Enigma of Postprandial Hyperinsulinaemic Hypoglycaemia after Bariatric Surgery), the term EMPA stands for the drug empagliflozin. TRIAL REGISTRATION NUMBER NCT05057819

Type 1 diabetes mellitus and SARS-CoV-2 in pediatric and adult patients - Data from the DPV network.

BACKGROUND Data on patients with type 1 diabetes mellitus (T1DM) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections are sparse. This study aimed to investigate the association between SARS-CoV-2 infection and T1DM. METHODS Data from the Prospective Diabetes Follow-up (DPV) Registry were analyzed for diabetes patients tested for SARS-CoV-2 by polymerase chain reaction (PCR) in Germany, Austria, Switzerland, and Luxembourg during January 2020-June 2021, using Wilcoxon rank-sum and chi-square tests for continuous and dichotomous variables, adjusted for multiple testing. RESULTS Data analysis of 1855 pediatric T1DM patients revealed no differences between asymptomatic/symptomatic infected and SARS-CoV-2 negative/positive patients regarding age, new-onset diabetes, diabetes duration, and body mass index. Glycated hemoglobin A1c (HbA1c) and diabetic ketoacidosis (DKA) rate were not elevated in SARS-CoV-2-positive vs. -negative patients. The COVID-19 manifestation index was 37.5% in individuals with known T1DM, but 57.1% in individuals with new-onset diabetes. 68.8% of positively tested patients were managed as outpatients/telemedically. Data analysis of 240 adult T1MD patients revealed no differences between positively and negatively tested patients except lower HbA1c. Of these patients, 83.3% had symptomatic infections; 35.7% of positively tested patients were hospitalized. CONCLUSIONS Our results indicate low morbidity in SARS-CoV-2-infected pediatric T1DM patients. Most patients with known T1DM and SARS-CoV-2 infections could be managed as outpatients. However, SARS-CoV-2 infection was usually symptomatic if it coincided with new-onset diabetes. In adult patients, symptomatic SARS-CoV-2 infection and hospitalization were associated with age

Randomized, double-blind, placebo-controlled crossover trial of once daily empagliflozin 25 mg for the treatment of postprandial hypoglycaemia after Roux-en-Y gastric bypass.

Aims To investigate the effect of empagliflozin on glucose dynamics in individuals suffering from postbariatric hypoglycaemia (PBH) after Roux-en-Y gastric bypass (RYGB). Methods Twenty-two adults with PBH after RYGB were randomized to empagliflozin 25 mg or placebo once daily over 20 days in a randomized, double-blind, placebo-controlled, crossover trial. The primary efficacy outcome was the amplitude of plasma glucose excursion (peak to nadir) during a mixed meal tolerance test (MMTT). Outcomes of the outpatient period were assessed using continuous glucose monitoring (CGM) and an event-tracking app. Results The amplitude of glucose excursion during the MMTT was 8.1±2.4 mmol/L with empagliflozin vs 8.1±2.6 mmol/L with placebo (mean±SD, p=0.807). CGM-based mean amplitude of glucose excursion (MAGE) during the 20 day-period was lower with empagliflozin than placebo (4.8±1.3 vs 5.2±1.6. p=0.028). Empagliflozin reduced the time spent with CGM values >10.0 mmol/L (3.8±3.5 % vs. 4.7±3.8 %, p =0.009), but not the time spent with CGM values <3.0 mmol/L (1.7±1.6 % vs. 1.5±1.5 %, p=0.457). No significant difference was observed in the quantity and quality of recorded symptoms. Eleven adverse events occurred with empagliflozin (three drug-related) and six with placebo. Conclusions Empagliflozin 25 mg reduces glucose excursions but not hypoglycaemia in individuals with PBH

Горизонтальные классификаторы. Основы теории и расчета: моногр.

Приведены технологические схемы получения строительных песков при гидромеханизированной добыче, основные конструктивные схемы классификаторов, используемых при получении строительных песков. Особое внимание уделено изучению процесса взаимодействия проточной части горизонтального классификатора с совокупностью твердых частиц, расположенных в горизонтальном ускоренном потоке несущей среды. Выполнено математическое моделирование ускоренного движения горизонтального потока и твердых частиц в пределах разнонаклонных поверхностей горизонтального классификатора. Экспериментально изучено гравитационное осаждение твердых частиц, рассмотренное в виде вертикальной и горизонтальной составляющих, а также влияние стесненности движения и перемещения твердых частиц относительно несущего горизонтального потока. Приведена методика расчета и выбора параметров классификаторов, информация об опыте проектирования и внедрения горизонтальных классификаторов в составе добычных комплексов при освоении обводненных месторождений песков. Монография может быть полезна студентам, инженерно-техническим работникам, сотрудникам высших учебных заведений, научно-исследовательских институтов и проектных организаций горной промышленности

Bariatric surgery prevents carotid wall thickness progression.

BACKGROUND Bariatric surgery is a treatment option for patients with severe obesity and improves parameters of cardiovascular and/or metabolic disease. Carotid intima media thickness (C-IMT) is a surrogate measure of subclinical atherosclerosis. Previous studies showed short to mid-term arrest and even regression of C‑IMT progression following bariatric surgery. We aimed to investigate the long-term effect of weight loss on C‑IMT progression 10 years after bariatric surgery in comparison to a population-based control cohort. METHODS In total, 21 eligible patients were examined preoperatively, at 5 and 10 years after bariatric surgery. Anthropometric parameters, plasma triglycerides, total cholesterol, high-density lipoprotein cholesterol (HDL-C), insulin, and glucose were assessed at all three study visits. C‑IMT was measured via B‑mode scans of the common carotid artery. C‑IMT progression was measured in an age-matched and BMI-matched cohort selected from the population-based Bruneck study to compare with changes in C‑IMT progression after bariatric surgery. RESULTS C‑IMT remained stable over the 10-year observation period after bariatric surgery. The control cohort showed a significant C‑IMT progression over 10 years. The difference in C‑IMT progression over 10 years was significant (p < 0.01) between both cohorts. CONCLUSION Weight loss induced by bariatric surgery halts the natural progression of C‑IMT over a 10-year observation period

Randomized, Double-Blind, Placebo-Controlled Crossover Trial of Once Daily Empagliflozin 25 mg for the Treatment of Postprandial Hypoglycemia After Roux-en-Y Gastric Bypass

Aims: To investigate the effect of empagliflozin on glucose dynamics in individuals suffering from postbariatric hypoglycemia (PBH) after Roux-en-Y gastric bypass (RYGB). Methods: Twenty-two adults with PBH after RYGB were randomized to empagliflozin 25 mg or placebo once daily over 20 days in a randomized, double-blind, placebo-controlled, crossover trial. The primary efficacy outcome was the amplitude of plasma glucose excursion (peak to nadir) during a mixed-meal tolerance test (MMTT). Outcomes of the outpatient period were assessed using continuous glucose monitoring (CGM) and an event-tracking app. Results: The amplitude of glucose excursion during the MMTT was 8.1 ± 2.4 mmol/L with empagliflozin versus 8.1 ± 2.6 mmol/L with placebo (mean ± standard deviation, P = 0.807). CGM-based mean amplitude of glucose excursion during the 20-day period was lower with empagliflozin than placebo (4.8 ± 1.3 vs. 5.2 ± 1.6. P = 0.028). Empagliflozin reduced the time spent with CGM values >10.0 mmol/L (3.8 ± 3.5% vs. 4.7 ± 3.8%, P = 0.009), but not the time spent with CGM values <3.0 mmol/L (1.7 ± 1.6% vs. 1.5 ± 1.5%, P = 0.457). No significant difference was observed in the quantity and quality of recorded symptoms. Eleven adverse events occurred with empagliflozin (three drug-related) and six with placebo. Conclusions: Empagliflozin 25 mg reduces glucose excursions but not hypoglycemia in individuals with PBH

Evaluation of the glycoprotein Afamin in obesity, cardiovascular disease and cancer

Afamin, ein Glykoprotein und Mitglied der Albumin-Superfamilie, wurde 1994 erstmals beschrieben. Bindungs- und Affinitätsexperimente konnten eine physiologisch relevante Transportfunktion von Afamin für Vitamin E feststellen.In Untersuchungen an transgenen Mäusen, welche humanes Afamin überexprimierten, konnte festgestellt werden, dass sich deren Körperkomposition, deren Blutlipidkonzentrationen als auch deren Nüchtern-Glukosespiegel signifikant im Sinne einer jeweils deutlichen Erhöhung im Vergleich zu gesunden Wild-Typ Mäusen unterschieden, woraufhin die Hypothese aufgestellt wurde, dass Afamin eine Funktion in der Entwicklung des metabolischen Syndroms als auch kardiovaskulärer Erkrankung einnehmen könnte. Afamin wurde daraufhin in drei klinischen, prospektiven, populationsbasierten oder Kohortenstudien gemessen, namentlich der Bruneck Studie, der Salzburg Atherosclerosis Prevention Program in Subjects at High Individual Risk Studie und der “Kooperative Gesundheitsforschung in der Region Augsburg”. Es konnte in all diesen Studien gezeigt werden, dass ein signifikaner Zusammenhang zwischen (im Vergleich zu gesunder Normalbevölkerung) erhöhten Afamin Plasma-Konzentrationen und der Entwicklung und Prävalenz von Kriterien des metabolischen Syndroms besteht.Die vorliegende Arbeit fasst mehrere Studien zusammen, welche sich dem Zusammenhang zwischen Afamin, der Entwicklung und Prävalenz von Obesitas und assoziierten metabolischen Störungen, kardiovaskulärer Erkrankung als auch Krebserkrankungen im Menschen widmen. Afamin wurde hierzu in zwei weiteren Kohortenstudien, namentlich der “Northwick Park Heart Study II” und der „Ludwigshafen Risk and Cardiovascular Health“ Studie gemessen. Es wurde abermals gezeigt, dass ein starker Zusammenhang zwischen der Höhe der Afamin Plasmakonzentration und dem VorThe glycoprotein afamin, a member of the albumin-superfamily was discovered in 1994 and identified as a capable transport protein for vitamin E isomers. Due to preliminary findings in transgenic mice overexpressing afamin, which showed a significantly higher proportion of adipose tissue, blood lipids and plasma glucose compared to wild-type litter mates, afamin was presumed to play a possible role in the development of the metabolic syndrome. These findings were previously substantiated and expanded in three large-scale, prospective population-based and cohort studies including the Bruneck, the Salzburg Atherosclerosis Prevention Program in Subjects at High Individual Risk, Kooperative Gesundheitsforschung in der Region Augsburg study. These studies indicated a pronounced and positive correlation between afamin plasma concentrations and the presence and development of criteria of the metabolic syndrome. In the present study we subsume our work done on the identification of afamin as a possible factor in the development of obesity, metabolic disturbances, cardiovascular disease and cancer. We measured afamin in the Northwick Park Heart Study II, and Ludwigshafen Risk and Cardiovascular Health study to identify a possible association between afamin and criteria of the metabolic syndrome and cardiovascular disease. All of these studies showed a highly significant correlation between elevated afamin plasma concentrations and the prevalence of criteria of the metabolic syndrome and type 2 diabetes mellitus. The association between cardiovascular disease, gastric cancer and afamin was present but less obvious.By prospectively investigating afamin plasma concentration in 40 patients undergoing bariatric surgery, we were able to identify an association between afamin plasma concentrations and pronounced weight loss in a clinical prospective design. It was found that the decline in total body adipose tissue and visceral adiby Andreas MelmerAbweichender Titel laut Übersetzung der Verfasserin/des VerfassersEnth. u.a. 5 Veröff. d. Verf. aus den Jahren 2012 - 2013 . - Zsfassung in dt. SpracheInnsbruck, Med. Univ., Diss., 2014(VLID)12741

Treatment Goals in Diabetes.

The quality of glycaemic control in diabetes mellitus relies on accurate individualization of available treatment options. Treatment targets depend on the type and duration of diabetes, the patients' abilities and characteristics and the individual risk for acute and/or late-stage complications. These complications include hypoglycaemia, which can be severe and life threatening, hyperglycaemia, which is a main factor for the development of cardiovascular disease, and macrovascular and microvascular disease, both of which are hallmark features of diabetes-associated constraints. Moreover, other treatment goals in diabetic patients influence both glycaemic control and quality of life. Lipoproteins, blood pressure, weight control, mental health and lifestyle are important factors that contribute to the frequency of diabetes-associated complications