Skip to main content

2022 | OriginalPaper | Buchkapitel

23. Störungen der Glukosetoleranz und Diabetes mellitus Typ 2

verfasst von : Thomas Reinehr, Eberhard Heinze, Martin Wabitsch

Erschienen in: Adipositas bei Kindern und Jugendlichen

Verlag: Springer Berlin Heidelberg

Zusammenfassung

Der Diabestes mellitus Typ 2 (T2DM), der sogenannte „Altersdiabetes“ wird zunehmend häufiger bei adipösen Jugendlichen beobachtet wird. Der T2DM tritt v. a. bei Afroamerikaner, Hispanier, Asiaten und Indianern und weitaus seltener bei Kaukasiern auf. Die Manifestation des T2DM ist meist asymptomatisch, sodass ein Screening in Risikogruppen wie extreme Adipositas, erstgradige Verwandten mit T2DM, Zeichen einer Insulinresistenz (arterieller Bluthochdruck, Fettstoffwechselstörung, polyzystisches Ovarsyndrom oder Acanthosis nigricans) sinnvoll erscheint. Die Behandlung der Wahl besteht in einer Lebensstilintervention, gefolgt von einer Behandlung mit Metformin. Neue Medikamente sind DPP-IV-Hemmer und GLP-1-Mimetika, welche jedoch für das Jugendalter noch nicht zugelassen sind. Ein großes klinisches Problem stellt fehlende Therapieadhärenz von Jugendlichen mit T2DM dar.
Literatur
Zurück zum Zitat American Diabetes Association (2000) Type 2 diabetes in children and adolescents. Diabetes Care 23:381–389CrossRef American Diabetes Association (2000) Type 2 diabetes in children and adolescents. Diabetes Care 23:381–389CrossRef
Zurück zum Zitat Anonymous (2013) Diagnosis and classification of diabetes mellitus. Diabetes Care 36(Suppl 1):S67–S74 Anonymous (2013) Diagnosis and classification of diabetes mellitus. Diabetes Care 36(Suppl 1):S67–S74
Zurück zum Zitat Anonymous (2016) ISPAD clinical practice consensus guidelines 2014 Anonymous (2016) ISPAD clinical practice consensus guidelines 2014
Zurück zum Zitat Arslanian S (2002) Type 2 diabetes in children: clinical aspects and risk factors. Horm Res 57(Suppl 1):19–28PubMed Arslanian S (2002) Type 2 diabetes in children: clinical aspects and risk factors. Horm Res 57(Suppl 1):19–28PubMed
Zurück zum Zitat Arslanian SA (2000) Type 2 diabetes mellitus in children: pathophysiology and risk factors. J Pediatr Endocrinol Metab 13(Suppl 6):1385–1394CrossRef Arslanian SA (2000) Type 2 diabetes mellitus in children: pathophysiology and risk factors. J Pediatr Endocrinol Metab 13(Suppl 6):1385–1394CrossRef
Zurück zum Zitat Awa WL, Boehm BO, Rosinger S, Achenbach P, Ziegler AG, Krause S, Meissner T, Wiegand S, Reinehr T, Kapellen T, Karges B, Eiermann T, Schober E, Holl RW (2013) HLA-typing, clinical, and immunological characterization of youth with type 2 diabetes mellitus phenotype from the German/Austrian DPV database. Pediatr Diabetes Awa WL, Boehm BO, Rosinger S, Achenbach P, Ziegler AG, Krause S, Meissner T, Wiegand S, Reinehr T, Kapellen T, Karges B, Eiermann T, Schober E, Holl RW (2013) HLA-typing, clinical, and immunological characterization of youth with type 2 diabetes mellitus phenotype from the German/Austrian DPV database. Pediatr Diabetes
Zurück zum Zitat Dabelea D, Bell RA, D’Agostino RB Jr, Imperatore G, Johansen JM, Linder B, Liu LL, Loots B, Marcovina S, Mayer-Davis EJ, Pettitt DJ, Waitzfelder B (2007) Incidence of diabetes in youth in the United States. JAMA 297:2716–2724CrossRef Dabelea D, Bell RA, D’Agostino RB Jr, Imperatore G, Johansen JM, Linder B, Liu LL, Loots B, Marcovina S, Mayer-Davis EJ, Pettitt DJ, Waitzfelder B (2007) Incidence of diabetes in youth in the United States. JAMA 297:2716–2724CrossRef
Zurück zum Zitat Drake AJ, Smith A, Betts PR, Crowne EC, Shield JP (2002) Type 2 diabetes in obese white children. Arch Dis Child 86:207–208CrossRef Drake AJ, Smith A, Betts PR, Crowne EC, Shield JP (2002) Type 2 diabetes in obese white children. Arch Dis Child 86:207–208CrossRef
Zurück zum Zitat Ehehalt S, Wiegand S, Koerner A, Schweizer R, Liesenkoetter K, Partsch C, Blumenstock G, Spielau U, Denzer C, Wabitsch M, Ranke M, Neu A, Binder G, Kiess W, Reinehr T (2016) Diabetes screening in overweight and obese children and adolescents: choosing the right test. Eur J Pediatr. (im Druck) Ehehalt S, Wiegand S, Koerner A, Schweizer R, Liesenkoetter K, Partsch C, Blumenstock G, Spielau U, Denzer C, Wabitsch M, Ranke M, Neu A, Binder G, Kiess W, Reinehr T (2016) Diabetes screening in overweight and obese children and adolescents: choosing the right test. Eur J Pediatr. (im Druck)
Zurück zum Zitat Fagot-Campagna A, Narayan KM, Hanson RL, Imperatore G, Howard BV, Nelson RG, Pettitt DJ, Knowler WC (1997) Plasma lipoproteins and incidence of non-insulin-dependent diabetes mellitus in Pima Indians: protective effect of HDL cholesterol in women. Atherosclerosis 128:113–119CrossRef Fagot-Campagna A, Narayan KM, Hanson RL, Imperatore G, Howard BV, Nelson RG, Pettitt DJ, Knowler WC (1997) Plasma lipoproteins and incidence of non-insulin-dependent diabetes mellitus in Pima Indians: protective effect of HDL cholesterol in women. Atherosclerosis 128:113–119CrossRef
Zurück zum Zitat Fagot-Campagna A, Pettitt DJ, Engelgau MM, Burrows NR, Geiss LS, Valdez R, Beckles GL, Saaddine J, Gregg EW, Williamson DF, Narayan KM (2000) Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective. J Pediatr 136:664–672CrossRef Fagot-Campagna A, Pettitt DJ, Engelgau MM, Burrows NR, Geiss LS, Valdez R, Beckles GL, Saaddine J, Gregg EW, Williamson DF, Narayan KM (2000) Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective. J Pediatr 136:664–672CrossRef
Zurück zum Zitat Florez JC (2008) Clinical review: the genetics of type 2 diabetes: a realistic appraisal in 2008. J Clin Endocrinol Metab 93:4633–4642CrossRef Florez JC (2008) Clinical review: the genetics of type 2 diabetes: a realistic appraisal in 2008. J Clin Endocrinol Metab 93:4633–4642CrossRef
Zurück zum Zitat Hagman E, Reinehr T, Kowalski J, Ekbom A, Marcus C, Holl RW (2013) Impaired fasting glucose prevalence in two nationwide cohorts of obese children and adolescents. Int J Obes Hagman E, Reinehr T, Kowalski J, Ekbom A, Marcus C, Holl RW (2013) Impaired fasting glucose prevalence in two nationwide cohorts of obese children and adolescents. Int J Obes
Zurück zum Zitat Hagman E, Danielsson P, Brandt L, Ekbom A, Marcus C (2016) Association between impaired fasting glycaemia in pediatric obesity and type 2 diabetes in young adulthood. Nutr Diabetes 6:e227CrossRef Hagman E, Danielsson P, Brandt L, Ekbom A, Marcus C (2016) Association between impaired fasting glycaemia in pediatric obesity and type 2 diabetes in young adulthood. Nutr Diabetes 6:e227CrossRef
Zurück zum Zitat Han JC, Lawlor DA, Kimm SY (2010) Childhood obesity. Lancet 375:1737–1748CrossRef Han JC, Lawlor DA, Kimm SY (2010) Childhood obesity. Lancet 375:1737–1748CrossRef
Zurück zum Zitat Hood KK, Beavers DP, Yi-Frazier J, Bell R, Dabelea D, Mckeown RE, Lawrence JM (2014) Psychosocial burden and glycemic control during the first 6 years of diabetes: results from the SEARCH for Diabetes in Youth study. J Adolesc Health 55:498–504CrossRef Hood KK, Beavers DP, Yi-Frazier J, Bell R, Dabelea D, Mckeown RE, Lawrence JM (2014) Psychosocial burden and glycemic control during the first 6 years of diabetes: results from the SEARCH for Diabetes in Youth study. J Adolesc Health 55:498–504CrossRef
Zurück zum Zitat Kiess W, Bottner A, Raile K, Kapellen T, Muller G, Galler A, Paschke R, Wabitsch M (2003) Type 2 diabetes mellitus in children and adolescents: a review from a European perspective. Horm Res 59(Suppl 1):77–84PubMed Kiess W, Bottner A, Raile K, Kapellen T, Muller G, Galler A, Paschke R, Wabitsch M (2003) Type 2 diabetes mellitus in children and adolescents: a review from a European perspective. Horm Res 59(Suppl 1):77–84PubMed
Zurück zum Zitat Kleber M, Desousa G, Papcke S, Wabitsch M, Reinehr T (2010a) Impaired glucose tolerance in obese white children and adolescents: three to five year follow-up in untreated patients. Exp Clin Endocrinol Diabetes Kleber M, Desousa G, Papcke S, Wabitsch M, Reinehr T (2010a) Impaired glucose tolerance in obese white children and adolescents: three to five year follow-up in untreated patients. Exp Clin Endocrinol Diabetes
Zurück zum Zitat Kleber M, Lass N, Papcke S, Wabitsch M, Reinehr T (2010b) One-year follow-up of untreated obese white children and adolescents with impaired glucose tolerance: high conversion rate to normal glucose tolerance. Diabet Med 27:516–521CrossRef Kleber M, Lass N, Papcke S, Wabitsch M, Reinehr T (2010b) One-year follow-up of untreated obese white children and adolescents with impaired glucose tolerance: high conversion rate to normal glucose tolerance. Diabet Med 27:516–521CrossRef
Zurück zum Zitat Liese AD, D’Agostino RB Jr, Hamman RF, Kilgo PD, Lawrence JM, Liu LL, Loots B, Linder B, Marcovina S, Rodriguez B, Standiford D, Williams DE (2006) The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study. Pediatrics 118:1510–1518CrossRef Liese AD, D’Agostino RB Jr, Hamman RF, Kilgo PD, Lawrence JM, Liu LL, Loots B, Linder B, Marcovina S, Rodriguez B, Standiford D, Williams DE (2006) The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study. Pediatrics 118:1510–1518CrossRef
Zurück zum Zitat Lobstein T, Frelut ML (2003) Prevalence of overweight among children in Europe. Obes Rev 4:195–200CrossRef Lobstein T, Frelut ML (2003) Prevalence of overweight among children in Europe. Obes Rev 4:195–200CrossRef
Zurück zum Zitat May AL, Kuklina EV, Yoon PW (2012) Prevalence of cardiovascular disease risk factors among US adolescents, 1999–2008. Pediatrics 129:1035–1041CrossRef May AL, Kuklina EV, Yoon PW (2012) Prevalence of cardiovascular disease risk factors among US adolescents, 1999–2008. Pediatrics 129:1035–1041CrossRef
Zurück zum Zitat Moss A, Klenk J, Simon K, Thaiss H, Reinehr T, Wabitsch M (2012) Declining prevalence rates for overweight and obesity in German children starting school. Eur J Pediatr 171:289–299CrossRef Moss A, Klenk J, Simon K, Thaiss H, Reinehr T, Wabitsch M (2012) Declining prevalence rates for overweight and obesity in German children starting school. Eur J Pediatr 171:289–299CrossRef
Zurück zum Zitat Owada M, Hanaoka Y, Tanimoto Y, Kitagawa T (1990) Descriptive epidemiology of non-insulin dependent diabetes mellitus detected by urine glucose screening in school children in Japan. Acta Paediatr Jpn 32:716–724CrossRef Owada M, Hanaoka Y, Tanimoto Y, Kitagawa T (1990) Descriptive epidemiology of non-insulin dependent diabetes mellitus detected by urine glucose screening in school children in Japan. Acta Paediatr Jpn 32:716–724CrossRef
Zurück zum Zitat Reinehr T (2005) Clinical presentation of type 2 diabetes mellitus in children and adolescents. Int J Obes 29(Suppl 2):S105–S110CrossRef Reinehr T (2005) Clinical presentation of type 2 diabetes mellitus in children and adolescents. Int J Obes 29(Suppl 2):S105–S110CrossRef
Zurück zum Zitat Reinehr T (2013) Type 2 diabetes mellitus in children and adolescents. World J Diabetes 4:270–281CrossRef Reinehr T (2013) Type 2 diabetes mellitus in children and adolescents. World J Diabetes 4:270–281CrossRef
Zurück zum Zitat Reinehr T, Andler W, Kapellen T, Kiess W, Richter-Unruh A, Schonau E, Seewi O, Heinze E, Wabitsch M (2005) Clinical characteristics of type 2 diabetes mellitus in overweight European caucasian adolescents. Exp Clin Endocrinol Diabetes 113:167–170CrossRef Reinehr T, Andler W, Kapellen T, Kiess W, Richter-Unruh A, Schonau E, Seewi O, Heinze E, Wabitsch M (2005) Clinical characteristics of type 2 diabetes mellitus in overweight European caucasian adolescents. Exp Clin Endocrinol Diabetes 113:167–170CrossRef
Zurück zum Zitat Reinehr T, Schober E, Wiegand S, Thon A, Holl R (2006) Beta-cell autoantibodies in children with type 2 diabetes mellitus: subgroup or misclassification? Arch Dis Child 91:473–477CrossRef Reinehr T, Schober E, Wiegand S, Thon A, Holl R (2006) Beta-cell autoantibodies in children with type 2 diabetes mellitus: subgroup or misclassification? Arch Dis Child 91:473–477CrossRef
Zurück zum Zitat Reinehr T, Widhalm K, l’Allemand D, Wiegand S, Wabitsch M, Holl RW (2009) Two-year follow-up in 21,784 overweight children and adolescents with lifestyle intervention. Obesity (Silver Spring) 17:1196–1199CrossRef Reinehr T, Widhalm K, l’Allemand D, Wiegand S, Wabitsch M, Holl RW (2009) Two-year follow-up in 21,784 overweight children and adolescents with lifestyle intervention. Obesity (Silver Spring) 17:1196–1199CrossRef
Zurück zum Zitat Reinehr T, Kiess W, Kapellen T, Wiegand S, Holl RW (2010) Children with diabetes mellitus type 2 in Europe: an underserved population. Arch Dis Child 95:954CrossRef Reinehr T, Kiess W, Kapellen T, Wiegand S, Holl RW (2010) Children with diabetes mellitus type 2 in Europe: an underserved population. Arch Dis Child 95:954CrossRef
Zurück zum Zitat Reinehr T, Woelfle J, Wiegand S, Karges B, Meissner T, Nagl K, Holl RW (2015b) Leptin but not adiponectin is related to type 2 diabetes mellitus in obese adolescents. Pediatr Diabetes Reinehr T, Woelfle J, Wiegand S, Karges B, Meissner T, Nagl K, Holl RW (2015b) Leptin but not adiponectin is related to type 2 diabetes mellitus in obese adolescents. Pediatr Diabetes
Zurück zum Zitat Reinehr T, Wolters B, Knop C, Lass N, Holl RW (2015c) Strong effect of pubertal status on metabolic health in obese children: a longitudinal study. J Clin Endocrinol Metab 100:301–308CrossRef Reinehr T, Wolters B, Knop C, Lass N, Holl RW (2015c) Strong effect of pubertal status on metabolic health in obese children: a longitudinal study. J Clin Endocrinol Metab 100:301–308CrossRef
Zurück zum Zitat Reinehr T, Karges B, Meissner T, Wiegand S, Stoffel-Wagner B, Holl RW, Woelfle J (2016) Inflammatory markers in obese adolescents with type 2 diabetes and their relationship to hepatokines and adipokines. J Pediatr 173:131–135CrossRef Reinehr T, Karges B, Meissner T, Wiegand S, Stoffel-Wagner B, Holl RW, Woelfle J (2016) Inflammatory markers in obese adolescents with type 2 diabetes and their relationship to hepatokines and adipokines. J Pediatr 173:131–135CrossRef
Zurück zum Zitat Rodriguez BL, Fujimoto WY, Mayer-Davis EJ, Imperatore G, Williams DE, Bell RA, Wadwa RP, Palla SL, Liu LL, Kershnar A, Daniels SR, Linder B (2006) Prevalence of cardiovascular disease risk factors in U.S. children and adolescents with diabetes: the SEARCH for diabetes in youth study. Diabetes Care 29:1891–1896CrossRef Rodriguez BL, Fujimoto WY, Mayer-Davis EJ, Imperatore G, Williams DE, Bell RA, Wadwa RP, Palla SL, Liu LL, Kershnar A, Daniels SR, Linder B (2006) Prevalence of cardiovascular disease risk factors in U.S. children and adolescents with diabetes: the SEARCH for diabetes in youth study. Diabetes Care 29:1891–1896CrossRef
Zurück zum Zitat Rosenbloom AL, Silverstein JH, Amemiya S, Zeitler P, Klingensmith GJ (2008) ISPAD clinical practice consensus guidelines 2006–2007. Type 2 diabetes mellitus in the child and adolescent. Pediatr Diabetes 9:512–526CrossRef Rosenbloom AL, Silverstein JH, Amemiya S, Zeitler P, Klingensmith GJ (2008) ISPAD clinical practice consensus guidelines 2006–2007. Type 2 diabetes mellitus in the child and adolescent. Pediatr Diabetes 9:512–526CrossRef
Zurück zum Zitat Rotteveel J, Belksma EJ, Renders CM, Hirasing RA, Delemarre-Van de Waal HA (2007) Type 2 diabetes in children in the Netherlands: the need for diagnostic protocols. Eur J Endocrinol 157:175–180CrossRef Rotteveel J, Belksma EJ, Renders CM, Hirasing RA, Delemarre-Van de Waal HA (2007) Type 2 diabetes in children in the Netherlands: the need for diagnostic protocols. Eur J Endocrinol 157:175–180CrossRef
Zurück zum Zitat Schober E, Holl RW, Grabert M, Thon A, Rami B, Kapellen T, Seewi O, Reinehr T (2005) Diabetes mellitus type 2 in childhood and adolescence in Germany and parts of Austria. Eur J Pediatr 164:705–707CrossRef Schober E, Holl RW, Grabert M, Thon A, Rami B, Kapellen T, Seewi O, Reinehr T (2005) Diabetes mellitus type 2 in childhood and adolescence in Germany and parts of Austria. Eur J Pediatr 164:705–707CrossRef
Zurück zum Zitat Schober E, Rami B, Grabert M, Thon A, Kapellen T, Reinehr T, Holl RW (2009a) Phenotypical aspects of maturity-onset diabetes of the young (MODY diabetes) in comparison with Type 2 diabetes mellitus (T2DM) in children and adolescents: experience from a large multicentre database. Diabet Med 26:466–473CrossRef Schober E, Rami B, Grabert M, Thon A, Kapellen T, Reinehr T, Holl RW (2009a) Phenotypical aspects of maturity-onset diabetes of the young (MODY diabetes) in comparison with Type 2 diabetes mellitus (T2DM) in children and adolescents: experience from a large multicentre database. Diabet Med 26:466–473CrossRef
Zurück zum Zitat Schober E, Waldhoer T, Rami B, Hofer S (2009b) Incidence and time trend of type 1 and type 2 diabetes in Austrian children 1999–2007. J Pediatr 155:190–193CrossRef Schober E, Waldhoer T, Rami B, Hofer S (2009b) Incidence and time trend of type 1 and type 2 diabetes in Austrian children 1999–2007. J Pediatr 155:190–193CrossRef
Zurück zum Zitat Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K, Savoye M, Rieger V, Taksali S, Barbetta G, Sherwin RS, Caprio S (2002) Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med 346:802–810CrossRef Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K, Savoye M, Rieger V, Taksali S, Barbetta G, Sherwin RS, Caprio S (2002) Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med 346:802–810CrossRef
Zurück zum Zitat Springer SC, Silverstein J, Copeland K, Moore KR, Prazar GE, Raymer T, Shiffman RN, Thaker VV, Anderson M, Spann SJ, Flinn SK (2013) Management of type 2 diabetes mellitus in children and adolescents. Pediatrics 131:e648–e664CrossRef Springer SC, Silverstein J, Copeland K, Moore KR, Prazar GE, Raymer T, Shiffman RN, Thaker VV, Anderson M, Spann SJ, Flinn SK (2013) Management of type 2 diabetes mellitus in children and adolescents. Pediatrics 131:e648–e664CrossRef
Zurück zum Zitat Taksali SE, Caprio S, Dziura J, Dufour S, Cali AM, Goodman TR, Papademetris X, Burgert TS, Pierpont BM, Savoye M, Shaw M, Seyal AA, Weiss R (2008) High visceral and low abdominal subcutaneous fat stores in the obese adolescent: a determinant of an adverse metabolic phenotype. Diabetes 57:367–371CrossRef Taksali SE, Caprio S, Dziura J, Dufour S, Cali AM, Goodman TR, Papademetris X, Burgert TS, Pierpont BM, Savoye M, Shaw M, Seyal AA, Weiss R (2008) High visceral and low abdominal subcutaneous fat stores in the obese adolescent: a determinant of an adverse metabolic phenotype. Diabetes 57:367–371CrossRef
Zurück zum Zitat Wabitsch M, Hauner H, Hertrampf M, Muche R, Hay B, Mayer H, Kratzer W, Debatin KM, Heinze E (2004) Type II diabetes mellitus and impaired glucose regulation in Caucasian children and adolescents with obesity living in Germany. Int J Obes Relat Metab Disord 28:307–313CrossRef Wabitsch M, Hauner H, Hertrampf M, Muche R, Hay B, Mayer H, Kratzer W, Debatin KM, Heinze E (2004) Type II diabetes mellitus and impaired glucose regulation in Caucasian children and adolescents with obesity living in Germany. Int J Obes Relat Metab Disord 28:307–313CrossRef
Zurück zum Zitat Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, Allen K, Lopes M, Savoye M, Morrison J, Sherwin RS, Caprio S (2004) Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 350:2362–2374CrossRef Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, Allen K, Lopes M, Savoye M, Morrison J, Sherwin RS, Caprio S (2004) Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 350:2362–2374CrossRef
Zurück zum Zitat Wiegand S, l’Allemand D, Hubel H, Krude H, Burmann M, Martus P, Gruters A, Holl RW (2010) Metformin and placebo therapy both improve weight management and fasting insulin in obese insulin-resistant adolescents: a prospective, placebo-controlled, randomized study. Eur J Endocrinol 163:585–592CrossRef Wiegand S, l’Allemand D, Hubel H, Krude H, Burmann M, Martus P, Gruters A, Holl RW (2010) Metformin and placebo therapy both improve weight management and fasting insulin in obese insulin-resistant adolescents: a prospective, placebo-controlled, randomized study. Eur J Endocrinol 163:585–592CrossRef
Zurück zum Zitat Zeitler P, Hirst K, Pyle L, Linder B, Copeland K, Arslanian S, Cuttler L, Nathan DM, Tollefsen S, Wilfley D, Kaufman F (2012) A clinical trial to maintain glycemic control in youth with type 2 diabetes. N Engl J Med 366:2247–2256CrossRef Zeitler P, Hirst K, Pyle L, Linder B, Copeland K, Arslanian S, Cuttler L, Nathan DM, Tollefsen S, Wilfley D, Kaufman F (2012) A clinical trial to maintain glycemic control in youth with type 2 diabetes. N Engl J Med 366:2247–2256CrossRef
Metadaten
Titel
Störungen der und
verfasst von
Thomas Reinehr
Eberhard Heinze
Martin Wabitsch
Copyright-Jahr
2022
Verlag
Springer Berlin Heidelberg
DOI
https://doi.org/10.1007/978-3-662-59216-8_23

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Klinik aktuell Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Häufigste Gründe für Brustschmerzen bei Kindern

06.05.2024 Pädiatrische Diagnostik Nachrichten

Akute Brustschmerzen sind ein Alarmsymptom par exellence, schließlich sind manche Auslöser lebensbedrohlich. Auch Kinder klagen oft über Schmerzen in der Brust. Ein Studienteam ist den Ursachen nachgegangen.

Endlich: Zi zeigt, mit welchen PVS Praxen zufrieden sind

IT für Ärzte Nachrichten

Darauf haben viele Praxen gewartet: Das Zi hat eine Liste von Praxisverwaltungssystemen veröffentlicht, die von Nutzern positiv bewertet werden. Eine gute Grundlage für wechselwillige Ärztinnen und Psychotherapeuten.

Update Pädiatrie

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