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Oft wird die Gewinnung von Gastärzten aus dem Ausland als Möglichkeit zur kurz- und mittelfristigen Deckung des Ärztebedarfs in Kliniken in Erwägung gezogen. Die hohen Anforderungen von Landesprüfungsämtern, Arbeitsagenturen, Ausländerbehörden und Botschaften erweisen sich sowohl für Ärzte als auch Kliniken als schwer überwindbare Hürden. Insbesondere Sprachschwierigkeiten sowie mangelhafte fachliche und kulturelle Kenntnisse der internationalen Ärzte sind ohne professionelle Unterstützung kaum zu kompensieren.
Background: Type 2 diabetes mellitus is associated with increased cardiovascular risk. One laboratory marker for cardiovascular risk assessment is high-sensitivity C-reactive protein (hsCRP).
Methods: This cross-sectional study attempted to analyze the association of hsCRP levels with insulin resistance, β-cell dysfunction and macrovascular disease in 4270 non-insulin-treated patients with type 2 diabetes [2146 male, 2124 female; mean age ±SD, 63.9±11.1years; body mass index (BMI) 30.1±5.5kg/m2; disease duration 5.4±5.6years; hemoglobin A1c (HbA1c) 6.8±1.3%]. It consisted of a single morning visit with collection of a fasting blood sample. Observational parameters included several clinical scores and laboratory biomarkers.
Results: Stratification into cardiovascular risk groups according to hsCRP levels revealed that 934 patients had low risk (hsCRP <1mg/L), 1369 patients had intermediate risk (hsCRP 1–3mg/L), 1352 patients had high risk (hsCRP >3–10mg/L), and 610 patients had unspecific hsCRP elevation (>10mg/L). Increased hsCRP levels were associated with other indicators of diabetes-related cardiovascular risk (homeostatic model assessment, intact proinsulin, insulin, BMI, β-cell dysfunction, all p<0.001), but showed no correlation with disease duration or glucose control. The majority of the patients were treated with diet (34.1%; hsCRP levels 2.85±2.39mg/L) or metformin monotherapy (21.1%; 2.95±2.50mg/L hsCRP). The highest hsCRP levels were observed in patients treated with sulfonylurea (17.0%; 3.00±2.43mg/L).
Conclusions: Our results indicate that hsCRP may be used as a cardiovascular risk marker in patients with type 2 diabetes mellitus and should be evaluated in further prospective studies.
High-sensitivity C-reactive protein as cardiovascular risk marker in patients with diabetes mellitus
(2006)
Eine Suite für den Patienten
(2006)