Evaluation des Krankheitsverlaufs von Patienten mit Diabetes mellitus Typ 2 der Diabetesambulanz der UMG anhand laborchemischer und klinischer Parameter – eine retrospektive Analyse des Zeitraums 2014 bis 2021

Evaluation of the disease progression of patients with type 2 diabetes at the diabetes outpatient department of UMG based on laboratory and clinical parameters – A retrospective analysis of the period 2014 to 2021

by Dennis Hörner
Doctoral thesis
Date of Examination:2025-02-12
Date of issue:2025-01-17
Advisor:Prof. Dr. Dirk Raddatz
Referee:PD Dr Reiner M. Wäschle
Referee:Prof. Dr. Margarete Schön
Persistent Address: http://dx.doi.org/10.53846/goediss-10989

 

 

Files in this item

Name:Hörner_Dennis_Dissertation_eDiss.pdf
Size:811.Kb
Format:PDF

The following license files are associated with this item:

Abstract

English

The aim of this doctoral thesis was to investigate the disease progression and treatment courses of patients with type 2 diabetes at the diabetes outpatient department of University Medical Center Göttingen between the periods 2014–2015 (t0) and 2019–03/2021 (t1). Since the mid-2010s, several major studies have been published showing the benefits of SGLT2 inhibitors (e.g. EMPA-REG OUTCOME for empagliflozin) and GLP-1 receptor agonists (GLP-1 RA) (e.g. LEADER for liraglutide) concerning key cardiovascular outcomes for patients with type 2 diabetes and elevated cardiovascular risk. Therefore, these drug classes gained increasing importance in guideline recommendations for type 2 diabetes. This thesis aimed to assess how the treatment regimens of patients in this outpatient department evolved in light of these new therapeutic recommendations over the aforementioned periods. In the second step, changes in key clinical and laboratory parameters (insulin requirements, BMI, HbA1c, renal values) were evaluated. A secondary aspect involved investigating cardiovascular risk and lipid-lowering therapy in the context of LDL cholesterol target levels. A total of 132 patients were included. In addition to a longitudinal analysis of the entire cohort, a subgroup analysis was also conducted. The subgroup classification was based on whether a patient received an SGLT2 inhibitor, a GLP-1 RA, a combination of both drug classes, or none of these medications over the course of treatment. Statistical analysis was conducted using IBM® SPSS (t-test, sign test, McNemar test). The results showed that, over time, more patients were treated with SGLT2 inhibitors and/or a GLP-1 RA (from 19 to 80 patients), while prescriptions of DPP-4 inhibitors decreased (from 54 to 23 patients). Average insulin requirements (from 76 to 57 IU) and BMI (from 32.7 to 31.5 kg/m²) decreased, with patients receiving the combined SGLT2 inhibitor and GLP-1-RA therapy showing the greatest reductions in both parameters. This combination therapy was also associated with a reduction in HbA1c levels (from 7.9 % to 7.3 %), whereas patients who were not treated with a SGLT2 inhibitor oder GLP-1 RA showed an increase in HbA1c levels (from 7.05 % to 7.41 %). HbA1c target levels were generally achieved. Renal function declined across all patient groups. The majority of patients in this cohort (124 patients) belonged to the "very-high-risk" group for cardiovascular events. Despite an improvement in lipid parameters (e.g. average LDL-C levels decreased from 99 to 86 mg/dL), only about 19 % of patients in the "very-high-risk" group achieved their individual LDL-C target levels.
Keywords: diabetes; typ 2 diabetes; sglt2 inhibitor; glp 1 ra; outpatient department; HbA1c; BMI; insulin; cardiovaskular risk; LDL cholesterol
 
Statistik