Case report: Uncovering hidden glucose patterns in medicated versus unmedicated bipolar disorder and comorbid type 1 diabetes mellitus

IntroductionType 1 diabetes mellitus is characterized by an absolute insulin deficiency requiring the lifetime intensive insulin therapy accompanied by daily self-monitoring, self-management, ongoing education, and complex diabetes care. Regular patient-clinician shared therapeutic decisions based on age, sex, comorbidities, medications, predicted impact of meals, physical activity, stress, hormonal changes, insulin therapy, and patterns of glycemic changes are key for achieving glycemic targets. The impact of various phases of bipolar disorder and their treatment on continuous glucose levels remains unexplored and calls for future assessments.Case presentationThe present case reports a 41-year-old Caucasian female with an established diagnosis of bipolar II disorder and type 1 diabetes mellitus who discontinued long-term mood-stabilizing pharmacotherapy with quetiapine. Real-time continuous glucose monitoring performed before and 6-months following the discontinuation of quetiapine revealed hidden glucose patterns in medicated versus unmedicated bipolar disorder. Despite the known adverse metabolic effects of quetiapine, the continuous glucose monitoring captured more stable and near-normal continuous glucose values during the antipsychotic treatment compared to unmedicated stages of bipolar disorder with considerably higher glucose values and glucose variability.ConclusionThe case report highlights the importance of the ongoing psychopharmacotherapy of bipolar disorder in comorbid type 1 diabetes mellitus to reduce mood-induced reactivity, emotional urgency, and non-emotional impulsivity that may contribute to dysglycemia. If not effectively treated, the “bipolar diabetes” is likely to progress to multiple psychiatric and somatic complications. The bidirectional links between the phases of bipolar disorder and the corresponding continuous glucose patterns can help advance clinical decision-making and yield innovative1 research that can translate into efficacious clinical practice

Self-reported health problems and patients’ preferences for non--pharmacological interventions in rheumatoid arthritis

Objective: There is promising evidence for the positive impact of non-pharmacological interventions (NPIs) such as physiotherapy and cognitive behavioural therapy (CBT) in patients with a chronic disease. To facili-tate the implementation of evidence-based NPIs, a first step is to understand patients’ self-reported health problems (SRHPs) and their preferences for NPIs. This study aimed to explore patients’ SRHPs and interests in NPIs in patients with rheumatoid arthritis (RA) undergoing biological treatment. Methods: We included 183 RA patients (80.9% females; mean age 55.6 ± 13.5 years) from the rheumatology outpatient department in Kosice, Slovakia. Open questions about SRHP and NPI preference, along with sociodemographic (age, gender, education, employment status, area where patient live) and environmental characteristics (home internet connection, distance from home to hospital, and companion on hospital visits) were collected through a telephone interview. Clinical characteristics of patients (HAQ-DI, DAS28, duration of disease and biologic therapy) were obtained from their medical records. Results: Physical health problems were reported by 63.9% of patients, and combined physical and mental health problems by an additional 33.3%. Patients with multiple SRHPs (χ2 = 9.091, p &lt; 0.01) and Internet users (χ2 = 14.380, p &lt; 0.001) were more likely to be interested in NPIs. We found no significant associations between a preference for a certain type of NPI and sociodemographic, clinical, or environmental characteristics. Conclusions: The majority of RA patients were open to NPIs as a new kind of additional treatment. Our results could benefit practice by helping to tailor interventions based on the patients’ most im-portant SRHPs.</p

The altered circadian pattern of basal insulin requirements – an early marker of autoimmune polyendocrine syndromes in type 1 diabetes mellitus

Objectives. The purpose of the present paper is to propose and introduce novel biomarkers of autoimmune polyendocrine syndromes that are relevant to the early diagnosis and optimal medical management of the patients who already suffer from type 1 diabetes mellitus

Reportované zdravotné problémy u pacientov s reumatoidnou artritídou a ich preferencie pre nefarmakologické intervencie

Objective: There is promising evidence for the positive impact of non-pharmacological interventions (NPIs) such as physiotherapy and cognitive behavioural therapy (CBT) in patients with a chronic disease. To facili-tate the implementation of evidence-based NPIs, a first step is to understand patients’ self-reported health problems (SRHPs) and their preferences for NPIs. This study aimed to explore patients’ SRHPs and interests in NPIs in patients with rheumatoid arthritis (RA) undergoing biological treatment. Methods: We included 183 RA patients (80.9% females; mean age 55.6 ± 13.5 years) from the rheumatology outpatient department in Kosice, Slovakia. Open questions about SRHP and NPI preference, along with sociodemographic (age, gender, education, employment status, area where patient live) and environmental characteristics (home internet connection, distance from home to hospital, and companion on hospital visits) were collected through a telephone interview. Clinical characteristics of patients (HAQ-DI, DAS28, duration of disease and biologic therapy) were obtained from their medical records. Results: Physical health problems were reported by 63.9% of patients, and combined physical and mental health problems by an additional 33.3%. Patients with multiple SRHPs (χ2 = 9.091, p < 0.01) and Internet users (χ2 = 14.380, p < 0.001) were more likely to be interested in NPIs. We found no significant associations between a preference for a certain type of NPI and sociodemographic, clinical, or environmental characteristics. Conclusions: The majority of RA patients were open to NPIs as a new kind of additional treatment. Our results could benefit practice by helping to tailor interventions based on the patients’ most im-portant SRHPs

Reportované zdravotné problémy u pacientov s reumatoidnou artritídou a ich preferencie pre nefarmakologické intervencie

Objective: There is promising evidence for the positive impact of non-pharmacological interventions (NPIs) such as physiotherapy and cognitive behavioural therapy (CBT) in patients with a chronic disease. To facili-tate the implementation of evidence-based NPIs, a first step is to understand patients’ self-reported health problems (SRHPs) and their preferences for NPIs. This study aimed to explore patients’ SRHPs and interests in NPIs in patients with rheumatoid arthritis (RA) undergoing biological treatment. Methods: We included 183 RA patients (80.9% females; mean age 55.6 ± 13.5 years) from the rheumatology outpatient department in Kosice, Slovakia. Open questions about SRHP and NPI preference, along with sociodemographic (age, gender, education, employment status, area where patient live) and environmental characteristics (home internet connection, distance from home to hospital, and companion on hospital visits) were collected through a telephone interview. Clinical characteristics of patients (HAQ-DI, DAS28, duration of disease and biologic therapy) were obtained from their medical records. Results: Physical health problems were reported by 63.9% of patients, and combined physical and mental health problems by an additional 33.3%. Patients with multiple SRHPs (χ2 = 9.091, p < 0.01) and Internet users (χ2 = 14.380, p < 0.001) were more likely to be interested in NPIs. We found no significant associations between a preference for a certain type of NPI and sociodemographic, clinical, or environmental characteristics. Conclusions: The majority of RA patients were open to NPIs as a new kind of additional treatment. Our results could benefit practice by helping to tailor interventions based on the patients’ most im-portant SRHPs

Autism and education-Teacher policy in Europe:Policy mapping of Austria, Hungary, Slovakia and Czech Republic

Background: This report maps autism and special education needs (SEN) policies, alongside teacher responsibilities in the education of children with SEN in Austria, Hungary, Czech Republic, and Slovakia. Methods and Procedure: A policy path analysis using a scoping review as an underlying methodological framework was performed. Outcomes and Results: The end of communism and accession to the European Union were critical for the countries under study. They passed crucial policies after international policies and adopted a three-stream approach towards providing education: (1) special schools; (2) special classes in mainstream schools; or (3) mainstream classes. Special schools remain for children that cannot participate in mainstream schools. Teachers are given high levels of responsibility. Conclusion and Implications: Changes in international guidance greatly impacted Austria, Hungary, Slovakia and the Czech Republic. The education systems aim for inclusion, though segregation remains for children that cannot thrive in mainstream schools. Teachers are pivotal in the education of children with SEN, more so than with typical children