Risk of severe hypoglycemia in sulfonylurea-treated patients from diabetes centers in Germany/Austria: how big is the problem? which patients are at risk?

BACKGROUND We investigated the rate of severe hypoglycemic events and confounding factors in patients with type-2-diabetes treated with sulfonylurea (SU) at specialized diabetes centers, documented in the German/Austrian DPV-Wiss-database. METHODS Data from 29,485 SU-treated patients were analyzed (median[IQR] age 70.8[62.2-77.8]yrs, diabetes-duration 8.2[4.3-12.8]yrs). The primary objective was to estimate the event-rate of severe hypoglycemia (requiring external help, causing unconsciousness/coma/convulsion and/or emergency.hospitalization). Secondary objectives included exploration of confounding risk-factors through group-comparison and Poisson-regression. RESULTS Severe hypoglycemic events were reported in 826(2.8%) of all patients during their most recent year of SU-treatment. Of these, n = 531(1.8%) had coma, n = 501(1.7%) were hospitalized at least once. The adjusted event-rate of severe hypoglycemia [95%CI] was 3.9[3.7-4.2] events/100 patient-years (coma: 1.9[1.8-2.1]; hospitalization: 1.6[1.5-1.8]). Adjusted event-rates by diabetes-treatment were 6.7 (SU + insulin), 4.9 (SU + insulin + other OAD), 3.1 (SU + other OAD), and 3.8 (SU only). Patients with ≥1 severe event were older (p < 0.001) and had longer diabetes-duration (p = 0.020) than patients without severe events. Participation in educational diabetes-programs and indirect measures of insulin-resistance (increased BMI, plasma-triglycerides) were associated with fewer events (all p < 0.001). Impaired renal function was common (N = 3,113 eGFR ≤30 mL/min) and associated with an increased rate of severe events (≤30 mL/min: 7.7; 30-60 mL/min: 4.8; >60 mL/min: 3.9). CONCLUSIONS These real-life data showed a rate of severe hypoglycemia of 3.9/100 patient-years in SU-treated patients from specialized diabetes centers. Higher risk was associated with known risk-factors including lack of diabetes-education, older age, and decreased eGFR, but also with lower BMI and lower triglyceride-levels, suggesting that SU-treatment in those patients should be considered with caution. This article is protected by copyright. All rights reserved.

The Forgotten Archduke: The Funeral Monument for Ernest of Austria in Brussels

Archduke Ernest of Austria (1553–1595), second son of Emperor Maximilian II and younger brother of Emperor Rudolf II, was in his youth a possible candidate for the thrones of the Empire or the Spanish Kingdom. Instead, he became Governor-General of the Netherlands in 1593 and relocated to Brussels in 1594 where he was welcomed with lavish festivities as the bearer of hope and prosperity. Unfortunately, Ernest died only thirteen months later without having achieved any political success. His brother and successor Albert of Austria commissioned the funeral monument for Ernest in 1600 after it was settled that he would be buried in Brussels and not Vienna. Focusing on this monument, which draws stylistically from various dynasty-related models, it will be shown that Albert intended to use this monument – and thus his brother’s memoria – to make the Brussels Cathedral the primary location of Habsburg dynastic memory in the Low Countries.

Multigrade teaching in primary education as a promising pedagogy for teacher education in Austria and Finland

This chapter focuses on teaching practices used in multigrade classes and the importance of them being incorporated in teacher education as promising pedagogies for future use. Multigrade classes - defined as classes in which two or more grades are taught together - are common worldwide. Hence, there is a need for teacher candidates to become familiar with how to teach in split grade classrooms. However, research on multigrade teaching as well as its development in teacher education studies has been neglected, even though multigrade teachers need special skills to organize instruction in their heterogeneous classrooms. We argue that in successful multigrade teaching practices, the heterogeneity of students is taken into account and cultivated. Based on content analysis of teacher interviews conducted in Austrian and Finnish primary schools, we recommend teaching practices such as spiral curricula, working plans, and peer learning as promising teacher education pedagogies for future multigrade class teaching. We also suggest that the professional skills required in high-quality teaching practices in multigrade teaching should be further studied by researchers and educators.

Present-day vegetation and the Holocene and recent development of Egelsee-Moor, Salzburg province, Austria

This paper describes the present-day vegetation, stratigraphy and developmental history of the mire of Egelsee-Moor (Salzburg, Austria; 45°45′N, 13°8.5′E, 700 m a.s.l., 15 ha in area) since the early Late Glacial on the basis of 4 transects with 14 trial borings across the peatland. We present a vegetation map of the mire, a longitudinal section through the peat body based on six cores showing the peat types, overview macrofossil diagrams of six cores showing the local mire development and two pollen diagrams covering the Late Glacial and Holocene. The chronology of the diagrams depends on biostratigraphic dating for the Late Glacial and early Holocene and radiocarbon dating for the remaining Holocene. The northern part of the mire originated through terrestrialisation of nutrient-rich, mostly inundated fen and the southern part through paludification of wet soils. The very small lake of today was a reservoir until recently for providing water-power for timber rafting (‘Holztrift’). The mire vegetation today is a complex of forested parts (mainly planted Pinus sylvestris and Thuja occidentalis, but also spontaneous Picea abies, Betula pubescens and Frangula alnus), reed-lands (Phragmites) and litter meadows (Molinietum, Schoenetum, etc.). The central part has hummock-hollow complexes with regionally rare species of transitional mires (Drosera anglica, D. intermedia, Lycopodiella inundata, Scorpidium scorpioides, Sphagnum platyphyllum, S. subnitens). The results indicate that some of the mid-Holocene sediments may have been removed by the timber-rafting practices, and that water extraction from the hydrological catchment since 1967 has resulted in a partial shift of transitional mire to ombrotrophic bog. The latter potentially endangers the regionally rare species and was used as an argument to stop further water extraction.