J. Rosenbauer - Academia.edu (original) (raw)
Papers by J. Rosenbauer
Experimental and Clinical Endocrinology & Diabetes, 2004
Cost-of-illness study to evaluate diabetes-related direct costs for the care of diabetic children... more Cost-of-illness study to evaluate diabetes-related direct costs for the care of diabetic children and adolescents in Germany from the perspective of the statutory health insurance. For all continuously treated patients < 20 years of age from 89 pediatric departments (n = 6437, 52 % male, mean age 12.5 [SD 3.8], diabetes duration 5.2 [3.3] years), diabetes-related hospitalization, ambulatory care, insulin management, glucose self measurement, and treatment with antihypertensive drugs in 2000 were ascertained, as well as metabolic control (HbA1c). Costs per patient-year were calculated in Euros (EUR) based on year 2000 prices. Using multivariate regression, the associations between costs and age, sex, diabetes duration, and metabolic control were evaluated. Mean total costs per patient-year were EUR 2611 (interquartile range 1665 - 2807). Blood glucose self measurement, hospitalization, and insulin accounted for 37 %, 26 %, and 21 % of the costs, respectively, followed by ambulatory care (9 %), injection equipment and glucagon sets (7 %), and treatment with antihypertensive drugs (0.1 %). The total costs were significantly increased for higher age, longer diabetes duration, and higher HbA1c (p < 0.01). The costs for hospitalization were significantly associated with pubertal age (10 - 14 years) and poor metabolic control (HbA1c SDS > 5) (p < 0.001). Based on the present estimations, the total direct costs for the care of all diabetic subjects in Germany < 20 years would be EUR 66.8 (95 % CI 65.4 - 68.1) million in 2000. Among the direct medical costs of childhood diabetes, the highest economic burden was due to glucose self measurement, hospitalization, and insulin. The costs were considerably higher in adolescents with poor metabolic control, especially the costs for hospitalization. Outpatient education programs in pediatric diabetes care, in particular targeting children with poor metabolic control, should be encouraged, including their evaluation with respect to cost and effectiveness.
Diabetologie und Stoffwechsel, 2009
European Endocrinology, 2010
... E: Axel.Dost@med.uni-jena.de. ... Bulsara MK, Arcy CD, Holman J, et al., The impact of a deca... more ... E: Axel.Dost@med.uni-jena.de. ... Bulsara MK, Arcy CD, Holman J, et al., The impact of a decade of changing treatment on rates of severe hypoglycemia in a population-based cohort of children with type 1 diabetes, Diabetes Care, 2004;27:2293–8. ...
Der Diabetologe, 2010
Leitthema Weltweit wird über eine Zunahme der Neuerkrankungshäufigkeit des Typ-1-Diabetes im Kind... more Leitthema Weltweit wird über eine Zunahme der Neuerkrankungshäufigkeit des Typ-1-Diabetes im Kindes-und Jugendalter in den letzten 20 Jahren berichtet [5, 30]. Insbesondere aus den USA wird aber auch über eine starke Zunahme der Häufigkeit des Typ-2-Diabetes vor allem bei ethnischen Minderheiten berichtet [16, 31, 40]. Vor dem Hintergrund einer Zunahme von Übergewicht und Adipositas wird auch hierzulande das Auftreten des Typ-2-Diabetes bei jungen Menschen mit zunehmender Aufmerksamkeit verfolgt. Wie stellt sich nun die aktuelle Häufigkeit des Diabetes mellitus in Deutschland im Vergleich zu internationalen Daten dar? Typ-1-Diabetes im Kindesund Jugendalter Inzidenz (Neuerkrankungsrate) des Typ-1-Diabetes Internationale Daten Seit den 1990er Jahren untersuchen die beiden internationalen, kollaborativen, epidemiologischen Projekte EURODIAB [30] und DIAMOND [5] die Neuerkrankungsrate des Typ-1-Diabetes im Kindesalter auf der Basis von populationsbasierten Registern und unter Verwendung von standardisierten Erfassungsmethoden. Der 2009 von der "International Diabetes Federation" (IDF) vorgestellte Diabetes-Atlas [17] greift auf die Daten dieser beiden Netzwerke sowie auf ergänzende Einzelstudien zurück und präsentiert weltweite Schätzungen der Typ-1-Diabetes-Häufigkeit für 2010.
Archives of disease in childhood, 2014
Increased weight gain has been reported prior to disease onset (accelerator hypothesis) and as a ... more Increased weight gain has been reported prior to disease onset (accelerator hypothesis) and as a side effect of intensified insulin therapy in type 1 diabetes (T1D). Paediatric studies are complicated by the age-dependency and gender-dependency of BMI, and also by a trend towards obesity in the general population. The aim of this study was to evaluate factors related to the increase in BMI during the course of diabetes in children and adolescents with T1D in a large multicentre survey. Within the DPV database (Diabetespatienten Verlaufsdokumentation) a standardised, prospective, computer-based documentation programme, data of 53,108 patients with T1D, aged <20 years, were recorded in 248 centres. 12,774 patients (53% male, mean age 13.4±3.9, mean diabetes duration 4.7±3.0 years and mean age at diabetes onset 8.7±4.0 years) were included in this analysis. Population-based German reference data were used to calculate BMI-SDS and define overweight and obesity. 12.5% of T1D patients ...
Diabetologie und Stoffwechsel, 2009
Diabetologie und Stoffwechsel, 2012
Diabetologie und Stoffwechsel, 2011
The month of diagnosis in childhood type 1 diabetes shows seasonal variation. We describe the pat... more The month of diagnosis in childhood type 1 diabetes shows seasonal variation. We describe the pattern and investigate if year-to-year irregularities are associated with meteorological factors using data from 50 000 children diagnosed under the age of 15 yr in 23 population-based European registries during 1989-2008. Tests for seasonal variation in monthly counts aggregated over the 20 yr period were performed. Time series regression was used to investigate if sunshine hour and average temperature data were predictive of the 240 monthly diagnosis counts after taking account of seasonality and long term trends. Significant sinusoidal pattern was evident in all but two small centers with peaks in November to February and relative amplitudes ranging from ±11 to ±38% (median ±17%). However, most centers showed significant departures from a sinusoidal pattern. Pooling results over centers, there was significant seasonal variation in each age-group at diagnosis, with least seasonal variation in those under 5 yr. Boys showed greater seasonal variation than girls, particularly those aged 10-14 yr. There were no differences in seasonal pattern between four 5-yr sub-periods. Departures from the sinusoidal trend in monthly diagnoses in the period were significantly associated with deviations from the norm in average temperature (0.8% reduction in diagnoses per 1 °C excess) but not with sunshine hours. Seasonality was consistently apparent throughout the period in all age-groups and both sexes, but girls and the under 5 s showed less marked variation. Neither sunshine hour nor average temperature data contributed in any substantial way to explaining departures from the sinusoidal pattern.
Diabetologie Und Stoffwechsel - DIABETOL STOFFWECHS, 2007
Diabetologie Und Stoffwechsel - DIABETOL STOFFWECHS, 2010
The Journal of Pediatrics, 2009
Objective To relate self-reported smoking frequency to metabolic control and other cardiovascular... more Objective To relate self-reported smoking frequency to metabolic control and other cardiovascular risk factors in adolescents with type 1 diabetes.
Journal of Pediatric Endocrinology and Metabolism, 2000
Prospective population-based cost-of-illness study to evaluate diabetes mellitus (DM)-related dir... more Prospective population-based cost-of-illness study to evaluate diabetes mellitus (DM)-related direct costs in German pediatric DM care in the early course after onset (perspective: statutory health insurers). 573 patients with DM &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;15 years of age were followed for up to 2 years after onset. DM-related hospitalization and ambulatory care, insulin and self-testing regimen were ascertained. Costs per patient-year were estimated (2000 prices). Using multivariate regression, associations between costs and families&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; socioeconomic status was evaluated. Mean total costs per patient-year were 7,069 euro (interquartile range 5,414-8,127). Onset hospitalization accounted for the majority of costs (4,908 euro, 3,728-6,213). Within post-onset costs, most were attributable to blood glucose self measurement and hospitalization (36% and 32%). Costs were significantly higher in children from families with lower compared to highest educated parents and in children from non-German families (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). Among the direct medical costs of childhood DM in the early course after onset, the greatest economic burden was due to hospitalization, in particular at onset. Blood glucose self measurement accounted for the majority of the post-onset costs. Costs were associated with the socio-economic status. It is recommended to evaluate the cost-effectiveness of outpatient programs targeting children from families with lower social status.
Journal of Pediatric Endocrinology and Metabolism, 2000
Diabetic ketoacidosis is the most serious complication at the onset of type 1 diabetes mellitus (... more Diabetic ketoacidosis is the most serious complication at the onset of type 1 diabetes mellitus (DM). In Germany, population-based data on its occurrence at DM onset are not yet available. In a population-based study in a North Rhine-Westphalian region, Germany, during 1993-95, data on the clinical presentation at type 1 DM onset were obtained from hospital records for 262 patients under 15 years of age (81% of eligible patients). Information on social status was obtained from 148 families by a standardized questionnaire. The most frequently reported symptoms were polyuria (93.9%), fatigue (64.2%) and weight loss (59.4%). Mean duration of symptoms was 3.5 weeks. At diagnosis 18.3% of the children presented impaired consciousness and 3.5% coma. Mean glucose level was 25.1 mmol/l. Severe ketoacidosis (pH < or = 7.2) was present in 16.0% of the children. Metabolic derangement was more severe in children under 5 years. Low social status was significantly associated with increased risk of severe ketoacidosis (OR = 3.54, 95% CI: 1.10-11.35). Frequency of ketoacidosis at DM onset needs to be reduced through increased public and medical awareness of the presenting characteristics of childhood DM.
Journal of Pediatric Endocrinology and Metabolism, 2000
Fitting a Poisson model to national data on the incidence of type 1 diabetes mellitus (T1DM) unde... more Fitting a Poisson model to national data on the incidence of type 1 diabetes mellitus (T1DM) under 5 years (1993-95) and to age-specific incidence data from three different German regions (age groups 0-4, 5-9, 10-14, 15-19 years, 1988-1995), national age-specific incidences of T1DM in childhood were estimated. From these the age-standardized national incidence and prevalence were derived for age groups 0-15 and 0-19 years. In 1993-95 the age-standardized national incidences (95% CIs) in the age groups 0-14 and 0-19 years were 14.2 (12.9-15.5) and 17.0 (15.2-18.8) per 100,000 person-years, respectively. The respective national prevalences were 86.7 (83.4-90.0) and 140.2 (134.3-146.1) per 100,000 persons. These estimates of the national incidence and prevalence of T1DM for the mid-1990s were about twofold higher than estimates from the former Eastern Germany in the late 1980s. This striking high frequency of T1DM in Germany has an important impact on clinical and economic aspects of diabetes care in childhood and adolescence.
Journal of Epidemiology & Community Health, 2001
International Journal of Epidemiology, 2011
Background The incidence rates of childhood onset type 1 diabetes are almost universally increasi... more Background The incidence rates of childhood onset type 1 diabetes are almost universally increasing across the globe but the aetiology of the disease remains largely unknown. We investigated whether birth order is associated with the risk of childhood diabetes by performing a pooled analysis of previous studies.
Das Gesundheitswesen, 2010
Das Gesundheitswesen, 2010
Experimental and Clinical Endocrinology & Diabetes, 2004
Cost-of-illness study to evaluate diabetes-related direct costs for the care of diabetic children... more Cost-of-illness study to evaluate diabetes-related direct costs for the care of diabetic children and adolescents in Germany from the perspective of the statutory health insurance. For all continuously treated patients < 20 years of age from 89 pediatric departments (n = 6437, 52 % male, mean age 12.5 [SD 3.8], diabetes duration 5.2 [3.3] years), diabetes-related hospitalization, ambulatory care, insulin management, glucose self measurement, and treatment with antihypertensive drugs in 2000 were ascertained, as well as metabolic control (HbA1c). Costs per patient-year were calculated in Euros (EUR) based on year 2000 prices. Using multivariate regression, the associations between costs and age, sex, diabetes duration, and metabolic control were evaluated. Mean total costs per patient-year were EUR 2611 (interquartile range 1665 - 2807). Blood glucose self measurement, hospitalization, and insulin accounted for 37 %, 26 %, and 21 % of the costs, respectively, followed by ambulatory care (9 %), injection equipment and glucagon sets (7 %), and treatment with antihypertensive drugs (0.1 %). The total costs were significantly increased for higher age, longer diabetes duration, and higher HbA1c (p < 0.01). The costs for hospitalization were significantly associated with pubertal age (10 - 14 years) and poor metabolic control (HbA1c SDS > 5) (p < 0.001). Based on the present estimations, the total direct costs for the care of all diabetic subjects in Germany < 20 years would be EUR 66.8 (95 % CI 65.4 - 68.1) million in 2000. Among the direct medical costs of childhood diabetes, the highest economic burden was due to glucose self measurement, hospitalization, and insulin. The costs were considerably higher in adolescents with poor metabolic control, especially the costs for hospitalization. Outpatient education programs in pediatric diabetes care, in particular targeting children with poor metabolic control, should be encouraged, including their evaluation with respect to cost and effectiveness.
Diabetologie und Stoffwechsel, 2009
European Endocrinology, 2010
... E: Axel.Dost@med.uni-jena.de. ... Bulsara MK, Arcy CD, Holman J, et al., The impact of a deca... more ... E: Axel.Dost@med.uni-jena.de. ... Bulsara MK, Arcy CD, Holman J, et al., The impact of a decade of changing treatment on rates of severe hypoglycemia in a population-based cohort of children with type 1 diabetes, Diabetes Care, 2004;27:2293–8. ...
Der Diabetologe, 2010
Leitthema Weltweit wird über eine Zunahme der Neuerkrankungshäufigkeit des Typ-1-Diabetes im Kind... more Leitthema Weltweit wird über eine Zunahme der Neuerkrankungshäufigkeit des Typ-1-Diabetes im Kindes-und Jugendalter in den letzten 20 Jahren berichtet [5, 30]. Insbesondere aus den USA wird aber auch über eine starke Zunahme der Häufigkeit des Typ-2-Diabetes vor allem bei ethnischen Minderheiten berichtet [16, 31, 40]. Vor dem Hintergrund einer Zunahme von Übergewicht und Adipositas wird auch hierzulande das Auftreten des Typ-2-Diabetes bei jungen Menschen mit zunehmender Aufmerksamkeit verfolgt. Wie stellt sich nun die aktuelle Häufigkeit des Diabetes mellitus in Deutschland im Vergleich zu internationalen Daten dar? Typ-1-Diabetes im Kindesund Jugendalter Inzidenz (Neuerkrankungsrate) des Typ-1-Diabetes Internationale Daten Seit den 1990er Jahren untersuchen die beiden internationalen, kollaborativen, epidemiologischen Projekte EURODIAB [30] und DIAMOND [5] die Neuerkrankungsrate des Typ-1-Diabetes im Kindesalter auf der Basis von populationsbasierten Registern und unter Verwendung von standardisierten Erfassungsmethoden. Der 2009 von der "International Diabetes Federation" (IDF) vorgestellte Diabetes-Atlas [17] greift auf die Daten dieser beiden Netzwerke sowie auf ergänzende Einzelstudien zurück und präsentiert weltweite Schätzungen der Typ-1-Diabetes-Häufigkeit für 2010.
Archives of disease in childhood, 2014
Increased weight gain has been reported prior to disease onset (accelerator hypothesis) and as a ... more Increased weight gain has been reported prior to disease onset (accelerator hypothesis) and as a side effect of intensified insulin therapy in type 1 diabetes (T1D). Paediatric studies are complicated by the age-dependency and gender-dependency of BMI, and also by a trend towards obesity in the general population. The aim of this study was to evaluate factors related to the increase in BMI during the course of diabetes in children and adolescents with T1D in a large multicentre survey. Within the DPV database (Diabetespatienten Verlaufsdokumentation) a standardised, prospective, computer-based documentation programme, data of 53,108 patients with T1D, aged <20 years, were recorded in 248 centres. 12,774 patients (53% male, mean age 13.4±3.9, mean diabetes duration 4.7±3.0 years and mean age at diabetes onset 8.7±4.0 years) were included in this analysis. Population-based German reference data were used to calculate BMI-SDS and define overweight and obesity. 12.5% of T1D patients ...
Diabetologie und Stoffwechsel, 2009
Diabetologie und Stoffwechsel, 2012
Diabetologie und Stoffwechsel, 2011
The month of diagnosis in childhood type 1 diabetes shows seasonal variation. We describe the pat... more The month of diagnosis in childhood type 1 diabetes shows seasonal variation. We describe the pattern and investigate if year-to-year irregularities are associated with meteorological factors using data from 50 000 children diagnosed under the age of 15 yr in 23 population-based European registries during 1989-2008. Tests for seasonal variation in monthly counts aggregated over the 20 yr period were performed. Time series regression was used to investigate if sunshine hour and average temperature data were predictive of the 240 monthly diagnosis counts after taking account of seasonality and long term trends. Significant sinusoidal pattern was evident in all but two small centers with peaks in November to February and relative amplitudes ranging from ±11 to ±38% (median ±17%). However, most centers showed significant departures from a sinusoidal pattern. Pooling results over centers, there was significant seasonal variation in each age-group at diagnosis, with least seasonal variation in those under 5 yr. Boys showed greater seasonal variation than girls, particularly those aged 10-14 yr. There were no differences in seasonal pattern between four 5-yr sub-periods. Departures from the sinusoidal trend in monthly diagnoses in the period were significantly associated with deviations from the norm in average temperature (0.8% reduction in diagnoses per 1 °C excess) but not with sunshine hours. Seasonality was consistently apparent throughout the period in all age-groups and both sexes, but girls and the under 5 s showed less marked variation. Neither sunshine hour nor average temperature data contributed in any substantial way to explaining departures from the sinusoidal pattern.
Diabetologie Und Stoffwechsel - DIABETOL STOFFWECHS, 2007
Diabetologie Und Stoffwechsel - DIABETOL STOFFWECHS, 2010
The Journal of Pediatrics, 2009
Objective To relate self-reported smoking frequency to metabolic control and other cardiovascular... more Objective To relate self-reported smoking frequency to metabolic control and other cardiovascular risk factors in adolescents with type 1 diabetes.
Journal of Pediatric Endocrinology and Metabolism, 2000
Prospective population-based cost-of-illness study to evaluate diabetes mellitus (DM)-related dir... more Prospective population-based cost-of-illness study to evaluate diabetes mellitus (DM)-related direct costs in German pediatric DM care in the early course after onset (perspective: statutory health insurers). 573 patients with DM &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;15 years of age were followed for up to 2 years after onset. DM-related hospitalization and ambulatory care, insulin and self-testing regimen were ascertained. Costs per patient-year were estimated (2000 prices). Using multivariate regression, associations between costs and families&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; socioeconomic status was evaluated. Mean total costs per patient-year were 7,069 euro (interquartile range 5,414-8,127). Onset hospitalization accounted for the majority of costs (4,908 euro, 3,728-6,213). Within post-onset costs, most were attributable to blood glucose self measurement and hospitalization (36% and 32%). Costs were significantly higher in children from families with lower compared to highest educated parents and in children from non-German families (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). Among the direct medical costs of childhood DM in the early course after onset, the greatest economic burden was due to hospitalization, in particular at onset. Blood glucose self measurement accounted for the majority of the post-onset costs. Costs were associated with the socio-economic status. It is recommended to evaluate the cost-effectiveness of outpatient programs targeting children from families with lower social status.
Journal of Pediatric Endocrinology and Metabolism, 2000
Diabetic ketoacidosis is the most serious complication at the onset of type 1 diabetes mellitus (... more Diabetic ketoacidosis is the most serious complication at the onset of type 1 diabetes mellitus (DM). In Germany, population-based data on its occurrence at DM onset are not yet available. In a population-based study in a North Rhine-Westphalian region, Germany, during 1993-95, data on the clinical presentation at type 1 DM onset were obtained from hospital records for 262 patients under 15 years of age (81% of eligible patients). Information on social status was obtained from 148 families by a standardized questionnaire. The most frequently reported symptoms were polyuria (93.9%), fatigue (64.2%) and weight loss (59.4%). Mean duration of symptoms was 3.5 weeks. At diagnosis 18.3% of the children presented impaired consciousness and 3.5% coma. Mean glucose level was 25.1 mmol/l. Severe ketoacidosis (pH < or = 7.2) was present in 16.0% of the children. Metabolic derangement was more severe in children under 5 years. Low social status was significantly associated with increased risk of severe ketoacidosis (OR = 3.54, 95% CI: 1.10-11.35). Frequency of ketoacidosis at DM onset needs to be reduced through increased public and medical awareness of the presenting characteristics of childhood DM.
Journal of Pediatric Endocrinology and Metabolism, 2000
Fitting a Poisson model to national data on the incidence of type 1 diabetes mellitus (T1DM) unde... more Fitting a Poisson model to national data on the incidence of type 1 diabetes mellitus (T1DM) under 5 years (1993-95) and to age-specific incidence data from three different German regions (age groups 0-4, 5-9, 10-14, 15-19 years, 1988-1995), national age-specific incidences of T1DM in childhood were estimated. From these the age-standardized national incidence and prevalence were derived for age groups 0-15 and 0-19 years. In 1993-95 the age-standardized national incidences (95% CIs) in the age groups 0-14 and 0-19 years were 14.2 (12.9-15.5) and 17.0 (15.2-18.8) per 100,000 person-years, respectively. The respective national prevalences were 86.7 (83.4-90.0) and 140.2 (134.3-146.1) per 100,000 persons. These estimates of the national incidence and prevalence of T1DM for the mid-1990s were about twofold higher than estimates from the former Eastern Germany in the late 1980s. This striking high frequency of T1DM in Germany has an important impact on clinical and economic aspects of diabetes care in childhood and adolescence.
Journal of Epidemiology & Community Health, 2001
International Journal of Epidemiology, 2011
Background The incidence rates of childhood onset type 1 diabetes are almost universally increasi... more Background The incidence rates of childhood onset type 1 diabetes are almost universally increasing across the globe but the aetiology of the disease remains largely unknown. We investigated whether birth order is associated with the risk of childhood diabetes by performing a pooled analysis of previous studies.
Das Gesundheitswesen, 2010
Das Gesundheitswesen, 2010