Skip to main content
Erschienen in: Diabetologia 6/2004

01.06.2004 | Article

11β-Hydroxysteroid dehydrogenase Type 1: genetic polymorphisms are associated with Type 2 diabetes in Pima Indians independently of obesity and expression in adipocyte and muscle

verfasst von: S. Nair, Y. H. Lee, R. S. Lindsay, B. R. Walker, P. A. Tataranni, C. Bogardus, L. J. Baier, P. A. Permana

Erschienen in: Diabetologia | Ausgabe 6/2004

Einloggen, um Zugang zu erhalten

Abstract

Aims/hypothesis

The enzyme 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) modulates tissue-specific glucocorticoid concentrations by generating active cortisol. We have shown that adipose tissue 11β-HSD1 mRNA levels were associated with adiposity and insulinaemia. Here we conducted further expression and genetic association studies in Pima Indians.

Methods

The 11β-HSD1 mRNA concentrations were measured in abdominal subcutaneous adipocytes (n=61) and skeletal muscle tissues (n=64). Single nucleotide polymorphisms in the HSD11B1 gene were genotyped in a larger group of full-blooded Pima Indians.

Results

Two representative SNPs (SNP1, n=706; SNP5, n=839) were associated with Type 2 diabetes mellitus (p=0.01), although neither SNP was associated with obesity. Among subjects with normal glucose tolerance, SNP1 (n=127) and SNP5 (n=159) were associated with insulin-mediated glucose uptake rates (p=0.03 and p=0.04), and SNP1 was further associated with fasting, 30-min, and 2-h plasma insulin concentrations (p=0.002, p=0.002 and p=0.03). Adipocyte 11β-HSD1 mRNA concentrations were correlated positively with adiposity and insulinaemia, and were additionally negatively correlated with insulin-mediated glucose uptake rates; nevertheless, the adipocyte 11β-HSD1 expression did not correlate with genotypes of the donors. The muscle 11β-HSD1 mRNA concentrations did not correlate with any anthropometric or metabolic variables.

Conclusions/interpretation

We confirmed that adipocyte 11β-HSD1 mRNA concentrations were associated with adiposity, and showed that genetic variations in the HSD11B1 gene were associated with Type 2 diabetes mellitus, plasma insulin concentrations and insulin action, independent of obesity. The variable adipose expression might not be a primary consequence of these HSD11B1 SNPs. Therefore, it is possible that the HSD11B1 gene is under tissue-specific regulation, and has tissue-specific consequences.
Literatur
1.
Zurück zum Zitat Bujalska IJ, Kumar S, Hewison M, Stewart PM (1999) Differentiation of adipose stromal cells: the roles of glucocorticoids and 11beta-hydroxysteroid dehydrogenase. Endocrinology 140:3188–3196PubMed Bujalska IJ, Kumar S, Hewison M, Stewart PM (1999) Differentiation of adipose stromal cells: the roles of glucocorticoids and 11beta-hydroxysteroid dehydrogenase. Endocrinology 140:3188–3196PubMed
2.
Zurück zum Zitat Napolitano A, Voice MW, Edwards CR, Seckl JR, Chapman KE (1998) 11Beta-hydroxysteroid dehydrogenase 1 in adipocytes: expression is differentiation-dependent and hormonally regulated. J Steroid Biochem Mol Biol 64:251–260CrossRefPubMed Napolitano A, Voice MW, Edwards CR, Seckl JR, Chapman KE (1998) 11Beta-hydroxysteroid dehydrogenase 1 in adipocytes: expression is differentiation-dependent and hormonally regulated. J Steroid Biochem Mol Biol 64:251–260CrossRefPubMed
3.
Zurück zum Zitat Ricketts ML, Verhaeg JM, Bujalska I, Howie AJ, Rainey WE, Stewart PM (1998) Immunohistochemical localization of type 1 11beta-hydroxysteroid dehydrogenase in human tissues. J Clin Endocrinol Metab 83:1325–1335CrossRefPubMed Ricketts ML, Verhaeg JM, Bujalska I, Howie AJ, Rainey WE, Stewart PM (1998) Immunohistochemical localization of type 1 11beta-hydroxysteroid dehydrogenase in human tissues. J Clin Endocrinol Metab 83:1325–1335CrossRefPubMed
4.
Zurück zum Zitat Whorwood CB, Donovan SJ, Wood PJ, Phillips DI (2001) Regulation of glucocorticoid receptor alpha and beta isoforms and type I 11beta-hydroxysteroid dehydrogenase expression in human skeletal muscle cells: a key role in the pathogenesis of insulin resistance? J Clin Endocrinol Metab 86:2296–2308CrossRefPubMed Whorwood CB, Donovan SJ, Wood PJ, Phillips DI (2001) Regulation of glucocorticoid receptor alpha and beta isoforms and type I 11beta-hydroxysteroid dehydrogenase expression in human skeletal muscle cells: a key role in the pathogenesis of insulin resistance? J Clin Endocrinol Metab 86:2296–2308CrossRefPubMed
5.
Zurück zum Zitat Seckl JR, Walker BR (2001) Minireview: 11beta-hydroxysteroid dehydrogenase type 1—a tissue-specific amplifier of glucocorticoid action. Endocrinology 142:1371–1376CrossRefPubMed Seckl JR, Walker BR (2001) Minireview: 11beta-hydroxysteroid dehydrogenase type 1—a tissue-specific amplifier of glucocorticoid action. Endocrinology 142:1371–1376CrossRefPubMed
6.
Zurück zum Zitat Rask E, Olsson T, Soderberg S et al. (2001) Tissue-specific dysregulation of cortisol metabolism in human obesity. J Clin Endocrinol Metab 86:1418–1421PubMed Rask E, Olsson T, Soderberg S et al. (2001) Tissue-specific dysregulation of cortisol metabolism in human obesity. J Clin Endocrinol Metab 86:1418–1421PubMed
7.
Zurück zum Zitat Rask E, Walker BR, Soderberg S et al. (2002) Tissue-specific changes in peripheral cortisol metabolism in obese women: increased adipose 11beta-hydroxysteroid dehydrogenase type 1 activity. J Clin Endocrinol Metab 87:3330–3336CrossRefPubMed Rask E, Walker BR, Soderberg S et al. (2002) Tissue-specific changes in peripheral cortisol metabolism in obese women: increased adipose 11beta-hydroxysteroid dehydrogenase type 1 activity. J Clin Endocrinol Metab 87:3330–3336CrossRefPubMed
8.
Zurück zum Zitat Paulmyer-Lacroix O, Boullu S, Oliver C, Alessi MC, Grino M (2002) Expression of the mRNA coding for 11beta-hydroxysteroid dehydrogenase type 1 in adipose tissue from obese patients: an in situ hybridization study. J Clin Endocrinol Metab 87:2701–2705PubMed Paulmyer-Lacroix O, Boullu S, Oliver C, Alessi MC, Grino M (2002) Expression of the mRNA coding for 11beta-hydroxysteroid dehydrogenase type 1 in adipose tissue from obese patients: an in situ hybridization study. J Clin Endocrinol Metab 87:2701–2705PubMed
9.
Zurück zum Zitat Lindsay RS, Wake DJ, Nair S et al. (2003) Subcutaneous adipose 11 beta-hydroxysteroid dehydrogenase type 1 activity and messenger ribonucleic acid levels are associated with adiposity and insulinemia in Pima Indians and Caucasians. J Clin Endocrinol Metab 88:2738–2744CrossRefPubMed Lindsay RS, Wake DJ, Nair S et al. (2003) Subcutaneous adipose 11 beta-hydroxysteroid dehydrogenase type 1 activity and messenger ribonucleic acid levels are associated with adiposity and insulinemia in Pima Indians and Caucasians. J Clin Endocrinol Metab 88:2738–2744CrossRefPubMed
10.
Zurück zum Zitat Wake DJ, Rask E, Livingstone DE, Soderberg S, Olsson T, Walker BR (2003) Local and systemic impact of transcriptional up-regulation of 11beta-hydroxysteroid dehydrogenase type 1 in adipose tissue in human obesity. J Clin Endocrinol Metab 88:3983–3988CrossRefPubMed Wake DJ, Rask E, Livingstone DE, Soderberg S, Olsson T, Walker BR (2003) Local and systemic impact of transcriptional up-regulation of 11beta-hydroxysteroid dehydrogenase type 1 in adipose tissue in human obesity. J Clin Endocrinol Metab 88:3983–3988CrossRefPubMed
11.
Zurück zum Zitat Westerbacka J, Yki-Jarvinen H, Vehkavaara S et al. (2003) Body fat distribution and cortisol metabolism in healthy men: enhanced 5beta-reductase and lower cortisol/cortisone metabolite ratios in men with fatty liver. J Clin Endocrinol Metab 88:4924–4931CrossRefPubMed Westerbacka J, Yki-Jarvinen H, Vehkavaara S et al. (2003) Body fat distribution and cortisol metabolism in healthy men: enhanced 5beta-reductase and lower cortisol/cortisone metabolite ratios in men with fatty liver. J Clin Endocrinol Metab 88:4924–4931CrossRefPubMed
12.
Zurück zum Zitat Tomlinson JW, Sinha B, Bujalska I, Hewison M, Stewart PM (2002) Expression of 11beta-hydroxysteroid dehydrogenase type 1 in adipose tissue is not increased in human obesity. J Clin Endocrinol.Metab 87:5630–5635CrossRefPubMed Tomlinson JW, Sinha B, Bujalska I, Hewison M, Stewart PM (2002) Expression of 11beta-hydroxysteroid dehydrogenase type 1 in adipose tissue is not increased in human obesity. J Clin Endocrinol.Metab 87:5630–5635CrossRefPubMed
13.
Zurück zum Zitat Masuzaki H, Paterson J, Shinyama H et al. (2001) A transgenic model of visceral obesity and the metabolic syndrome. Science 294:2166–2170PubMed Masuzaki H, Paterson J, Shinyama H et al. (2001) A transgenic model of visceral obesity and the metabolic syndrome. Science 294:2166–2170PubMed
14.
Zurück zum Zitat Andrews RC, Herlihy O, Livingstone DE, Andrew R, Walker BR (2002) Abnormal cortisol metabolism and tissue sensitivity to cortisol in patients with glucose intolerance. J Clin Endocrinol Metab 87:5587–5593CrossRefPubMed Andrews RC, Herlihy O, Livingstone DE, Andrew R, Walker BR (2002) Abnormal cortisol metabolism and tissue sensitivity to cortisol in patients with glucose intolerance. J Clin Endocrinol Metab 87:5587–5593CrossRefPubMed
15.
Zurück zum Zitat Stewart PM, Boulton A, Kumar S, Clark PM, Shackleton CH (1999) Cortisol metabolism in human obesity: impaired cortisone→cortisol conversion in subjects with central adiposity. J Clin Endocrinol Metab 84:1022–1027PubMed Stewart PM, Boulton A, Kumar S, Clark PM, Shackleton CH (1999) Cortisol metabolism in human obesity: impaired cortisone→cortisol conversion in subjects with central adiposity. J Clin Endocrinol Metab 84:1022–1027PubMed
16.
Zurück zum Zitat Walker BR, Connacher AA, Lindsay RM, Webb DJ, Edwards CR (1995) Carbenoxolone increases hepatic insulin sensitivity in man: a novel role for 11-oxosteroid reductase in enhancing glucocorticoid receptor activation. J Clin Endocrinol Metab 80:3155–3159PubMed Walker BR, Connacher AA, Lindsay RM, Webb DJ, Edwards CR (1995) Carbenoxolone increases hepatic insulin sensitivity in man: a novel role for 11-oxosteroid reductase in enhancing glucocorticoid receptor activation. J Clin Endocrinol Metab 80:3155–3159PubMed
17.
Zurück zum Zitat Andrews RC, Rooyackers O, Walker BR (2003) Effects of the 11 beta-hydroxysteroid dehydrogenase inhibitor carbenoxolone on insulin sensitivity in men with type 2 diabetes. J Clin Endocrinol Metab 88:285–291CrossRefPubMed Andrews RC, Rooyackers O, Walker BR (2003) Effects of the 11 beta-hydroxysteroid dehydrogenase inhibitor carbenoxolone on insulin sensitivity in men with type 2 diabetes. J Clin Endocrinol Metab 88:285–291CrossRefPubMed
18.
Zurück zum Zitat Whorwood CB, Donovan SJ, Flanagan D, Phillips DI, Byrne CD (2002) Increased glucocorticoid receptor expression in human skeletal muscle cells may contribute to the pathogenesis of the metabolic syndrome. Diabetes 51:1066–1075 Whorwood CB, Donovan SJ, Flanagan D, Phillips DI, Byrne CD (2002) Increased glucocorticoid receptor expression in human skeletal muscle cells may contribute to the pathogenesis of the metabolic syndrome. Diabetes 51:1066–1075
19.
Zurück zum Zitat Kotelevtsev Y, Holmes MC, Burchell A et al. (1997) 11beta-hydroxysteroid dehydrogenase type 1 knockout mice show attenuated glucocorticoid-inducible responses and resist hyperglycemia on obesity or stress. Proc Natl Acad Sci USA 94:14924–14929PubMed Kotelevtsev Y, Holmes MC, Burchell A et al. (1997) 11beta-hydroxysteroid dehydrogenase type 1 knockout mice show attenuated glucocorticoid-inducible responses and resist hyperglycemia on obesity or stress. Proc Natl Acad Sci USA 94:14924–14929PubMed
20.
Zurück zum Zitat Morton NM, Holmes MC, Fievet C et al. (2001) Improved lipid and lipoprotein profile, hepatic insulin sensitivity, and glucose tolerance in 11beta-hydroxysteroid dehydrogenase type 1 null mice. J Biol Chem 276:41293–41300PubMed Morton NM, Holmes MC, Fievet C et al. (2001) Improved lipid and lipoprotein profile, hepatic insulin sensitivity, and glucose tolerance in 11beta-hydroxysteroid dehydrogenase type 1 null mice. J Biol Chem 276:41293–41300PubMed
21.
Zurück zum Zitat Davani B, Khan A, Hult M et al. (2000) Type 1 11beta-hydroxysteroid dehydrogenase mediates glucocorticoid activation and insulin release in pancreatic islets. J Biol Chem 275:34841–34844PubMed Davani B, Khan A, Hult M et al. (2000) Type 1 11beta-hydroxysteroid dehydrogenase mediates glucocorticoid activation and insulin release in pancreatic islets. J Biol Chem 275:34841–34844PubMed
22.
Zurück zum Zitat Hanson RL, Ehm MG, Pettitt DJ et al. (1998) An autosomal genomic scan for loci linked to type II diabetes mellitus and body-mass index in Pima Indians. Am J Hum Genet 63:1130–1138PubMed Hanson RL, Ehm MG, Pettitt DJ et al. (1998) An autosomal genomic scan for loci linked to type II diabetes mellitus and body-mass index in Pima Indians. Am J Hum Genet 63:1130–1138PubMed
23.
Zurück zum Zitat World Health Organization (1980) WHO Expert Committee on Diabetes Mellitus: Second report. World Health Organization, Geneva, Technical Report Series No. 646 World Health Organization (1980) WHO Expert Committee on Diabetes Mellitus: Second report. World Health Organization, Geneva, Technical Report Series No. 646
24.
Zurück zum Zitat Tataranni PA, Ravussin E (1995) Use of dual-energy X-ray absorptiometry in obese individuals. Am J Clin Nutr 62:730–734PubMed Tataranni PA, Ravussin E (1995) Use of dual-energy X-ray absorptiometry in obese individuals. Am J Clin Nutr 62:730–734PubMed
25.
Zurück zum Zitat Lillioja S, Mott DM, Zawadzki JK et al. (1987) In vivo insulin action is familial characteristic in nondiabetic Pima Indians. Diabetes 36:1329–1335PubMed Lillioja S, Mott DM, Zawadzki JK et al. (1987) In vivo insulin action is familial characteristic in nondiabetic Pima Indians. Diabetes 36:1329–1335PubMed
26.
Zurück zum Zitat Steele R (1959) Influences of glucose loading and of injected insulin on hepatic glucose output. Ann NY Acad Sci 82:420–430 Steele R (1959) Influences of glucose loading and of injected insulin on hepatic glucose output. Ann NY Acad Sci 82:420–430
27.
Zurück zum Zitat Majer M, Mott DM, Mochizuki H et al. (1996) Association of the glycogen synthase locus on 19q13 with NIDDM in Pima Indians. Diabetologia 39:314–321PubMed Majer M, Mott DM, Mochizuki H et al. (1996) Association of the glycogen synthase locus on 19q13 with NIDDM in Pima Indians. Diabetologia 39:314–321PubMed
28.
Zurück zum Zitat Draper N, Echwald SM, Lavery GG et al. (2002) Association studies between microsatellite markers within the gene encoding human 11beta-hydroxysteroid dehydrogenase type 1 and body mass index, waist to hip ratio, and glucocorticoid metabolism. J Clin Endocrinol Metab 87:4984–4990CrossRefPubMed Draper N, Echwald SM, Lavery GG et al. (2002) Association studies between microsatellite markers within the gene encoding human 11beta-hydroxysteroid dehydrogenase type 1 and body mass index, waist to hip ratio, and glucocorticoid metabolism. J Clin Endocrinol Metab 87:4984–4990CrossRefPubMed
29.
Zurück zum Zitat Caramelli E, Strippoli P, Di Giacomi T, Tietz C, Carinci P, Pasquali R (2001) Lack of mutations of type 1 11beta-hydroxysteroid dehydrogenase gene in patients with abdominal obesity. Endocr Res 27:47–61CrossRefPubMed Caramelli E, Strippoli P, Di Giacomi T, Tietz C, Carinci P, Pasquali R (2001) Lack of mutations of type 1 11beta-hydroxysteroid dehydrogenase gene in patients with abdominal obesity. Endocr Res 27:47–61CrossRefPubMed
30.
Zurück zum Zitat Quervain DJ de, Poirier R, Wollmer MA et al. (2004) Glucocorticoid-related genetic susceptibility for Alzheimer’s disease. Hum Mol Genet 13:47–52CrossRefPubMed Quervain DJ de, Poirier R, Wollmer MA et al. (2004) Glucocorticoid-related genetic susceptibility for Alzheimer’s disease. Hum Mol Genet 13:47–52CrossRefPubMed
31.
Zurück zum Zitat Draper N, Walker EA, Bujalska IJ et al. (2003) Mutations in the genes encoding 11beta-hydroxysteroid dehydrogenase type 1 and hexose-6-phosphate dehydrogenase interact to cause cortisone reductase deficiency. Nat Genet 34:434–439CrossRefPubMed Draper N, Walker EA, Bujalska IJ et al. (2003) Mutations in the genes encoding 11beta-hydroxysteroid dehydrogenase type 1 and hexose-6-phosphate dehydrogenase interact to cause cortisone reductase deficiency. Nat Genet 34:434–439CrossRefPubMed
32.
Zurück zum Zitat Duplomb L, Lee Y, Wang MY et al. (2004) Increased expression and activity of 11beta-HSD-1 in diabetic islets and prevention with troglitazone. Biochem Biophys Res Commun 313:594–599CrossRefPubMed Duplomb L, Lee Y, Wang MY et al. (2004) Increased expression and activity of 11beta-HSD-1 in diabetic islets and prevention with troglitazone. Biochem Biophys Res Commun 313:594–599CrossRefPubMed
33.
Zurück zum Zitat Liu ML, Olson AL, Edgington NP, Moye-Rowley WS, Pessin JE (1994) Myocyte enhancer factor 2 (MEF2) binding site is essential for C2C12 myotube-specific expression of the rat GLUT4/muscle-adipose facilitative glucose transporter gene. J Biol Chem 269:28514–28521PubMed Liu ML, Olson AL, Edgington NP, Moye-Rowley WS, Pessin JE (1994) Myocyte enhancer factor 2 (MEF2) binding site is essential for C2C12 myotube-specific expression of the rat GLUT4/muscle-adipose facilitative glucose transporter gene. J Biol Chem 269:28514–28521PubMed
34.
Zurück zum Zitat Watada H, Kajimoto Y, Kaneto H et al. (1996) Involvement of the homeodomain-containing transcription factor PDX-1 in islet amyloid polypeptide gene transcription. Biochem Biophys Res Commun 229:746–751CrossRefPubMed Watada H, Kajimoto Y, Kaneto H et al. (1996) Involvement of the homeodomain-containing transcription factor PDX-1 in islet amyloid polypeptide gene transcription. Biochem Biophys Res Commun 229:746–751CrossRefPubMed
35.
Zurück zum Zitat Ornatsky OI, McDermott JC (1996) MEF2 protein expression, DNA binding specificity and complex composition, and transcriptional activity in muscle and non-muscle cells. J Biol Chem 271:24927–24933CrossRefPubMed Ornatsky OI, McDermott JC (1996) MEF2 protein expression, DNA binding specificity and complex composition, and transcriptional activity in muscle and non-muscle cells. J Biol Chem 271:24927–24933CrossRefPubMed
36.
Zurück zum Zitat Thai MV, Guruswamy S, Cao KT, Pessin JE, Olson AL (1998) Myocyte enhancer factor 2 (MEF2)-binding site is required for GLUT4 gene expression in transgenic mice. Regulation of MEF2 DNA binding activity in insulin-deficient diabetes. J Biol Chem 273:14285–14292CrossRefPubMed Thai MV, Guruswamy S, Cao KT, Pessin JE, Olson AL (1998) Myocyte enhancer factor 2 (MEF2)-binding site is required for GLUT4 gene expression in transgenic mice. Regulation of MEF2 DNA binding activity in insulin-deficient diabetes. J Biol Chem 273:14285–14292CrossRefPubMed
37.
Zurück zum Zitat Mora S, Yang C, Ryder JW, Boeglin D, Pessin JE (2001) The MEF2A and MEF2D isoforms are differentially regulated in muscle and adipose tissue during states of insulin deficiency. Endocrinology 142:1999–2004CrossRefPubMed Mora S, Yang C, Ryder JW, Boeglin D, Pessin JE (2001) The MEF2A and MEF2D isoforms are differentially regulated in muscle and adipose tissue during states of insulin deficiency. Endocrinology 142:1999–2004CrossRefPubMed
38.
Zurück zum Zitat Jonsson J, Carlsson L, Edlund T, Edlund H (1994) Insulin-promoter-factor 1 is required for pancreas development in mice. Nature 371:606–609PubMed Jonsson J, Carlsson L, Edlund T, Edlund H (1994) Insulin-promoter-factor 1 is required for pancreas development in mice. Nature 371:606–609PubMed
39.
Zurück zum Zitat Ohlsson H, Karlsson K, Edlund T (1993) IPF1, a homeodomain-containing transactivator of the insulin gene. EMBO J 12:4251–4259PubMed Ohlsson H, Karlsson K, Edlund T (1993) IPF1, a homeodomain-containing transactivator of the insulin gene. EMBO J 12:4251–4259PubMed
Metadaten
Titel
11β-Hydroxysteroid dehydrogenase Type 1: genetic polymorphisms are associated with Type 2 diabetes in Pima Indians independently of obesity and expression in adipocyte and muscle
verfasst von
S. Nair
Y. H. Lee
R. S. Lindsay
B. R. Walker
P. A. Tataranni
C. Bogardus
L. J. Baier
P. A. Permana
Publikationsdatum
01.06.2004
Verlag
Springer-Verlag
Erschienen in
Diabetologia / Ausgabe 6/2004
Print ISSN: 0012-186X
Elektronische ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-004-1407-6

Weitere Artikel der Ausgabe 6/2004

Diabetologia 6/2004 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Schadet Ärger den Gefäßen?

14.05.2024 Arteriosklerose Nachrichten

In einer Studie aus New York wirkte sich Ärger kurzfristig deutlich negativ auf die Endothelfunktion gesunder Probanden aus. Möglicherweise hat dies Einfluss auf die kardiovaskuläre Gesundheit.

Intervallfasten zur Regeneration des Herzmuskels?

14.05.2024 Herzinfarkt Nachrichten

Die Nahrungsaufnahme auf wenige Stunden am Tag zu beschränken, hat möglicherweise einen günstigen Einfluss auf die Prognose nach akutem ST-Hebungsinfarkt. Darauf deutet eine Studie an der Uniklinik in Halle an der Saale hin.

Klimaschutz beginnt bei der Wahl des Inhalators

14.05.2024 Klimawandel Podcast

Auch kleine Entscheidungen im Alltag einer Praxis können einen großen Beitrag zum Klimaschutz leisten. Die neue Leitlinie zur "klimabewussten Verordnung von Inhalativa" geht mit gutem Beispiel voran, denn der Wechsel vom klimaschädlichen Dosieraerosol zum Pulverinhalator spart viele Tonnen CO2. Leitlinienautor PD Dr. Guido Schmiemann erklärt, warum nicht nur die Umwelt, sondern auch Patientinnen und Patienten davon profitieren.

Zeitschrift für Allgemeinmedizin, DEGAM

Typ-2-Diabetes und Depression folgen oft aufeinander

14.05.2024 Typ-2-Diabetes Nachrichten

Menschen mit Typ-2-Diabetes sind überdurchschnittlich gefährdet, in den nächsten Jahren auch noch eine Depression zu entwickeln – und umgekehrt. Besonders ausgeprägt ist die Wechselbeziehung laut GKV-Daten bei jüngeren Erwachsenen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.