Projekt „5000 metrów nad poziomem cukru”

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Diabetes as a risk factor of death in hospitalized COVID-19 patients – an analysis of a National Hospitalization Database from Poland, 2020

IntroductionDiabetes is one of the comorbidities associated with poor prognosis in hospitalized COVID-19 patients. In this nationwide retrospective study, we evaluated the risk of in-hospital death attributed to diabetes.MethodsWe analyzed data from discharge reports of patients hospitalized with COVID-19 in 2020 as submitted to the Polish National Health Fund. Several multivariate logistic regression models were used. In each model, in-hospital death was estimated with explanatory variables. Models were built either on the whole cohorts or cohorts matched with propensity score matching (PSM). The models examined either the main effects of diabetes itself or the interaction of diabetes with other variables.ResultsWe included 174,621 patients with COVID-19 who were hospitalized in the year 2020. Among them, there were 40,168 diabetic patients (DPs), and the proportion of DPs in this group was higher than in the general population (23.0% vs. 9.5%, p<0.001). In this group of COVID-19 hospitalizations, 17,438 in-hospital deaths were recorded, and the mortality was higher among DPs than non-diabetics (16.3% vs. 8.1%, p<0.001). Multivariate logistic regressions showed that diabetes was a risk factor of death, regardless of sex and age. In the main effect analysis, odds of in-hospital death were higher by 28.3% for DPs than for non-diabetic patients. Similarly, PSM analysis including 101,578 patients, of whom 19,050 had diabetes, showed that the risk of death was higher in DPs regardless of sex with odds higher by 34.9%. The impact of diabetes differed among age groups and was the highest for patients aged 60-69.ConclusionsThis nationwide study confirmed that diabetes was an independent risk factor of in-hospital death in the course of COVID-19 infection. However, the relative risk differed across the age groups

Circulating ghrelin level is higher in HNF1A-MODY and GCK-MODY than in polygenic forms of diabetes mellitus

Ghrelin is a hormone that regulates appetite. It is likely to be involved in the pathophysiology of varying forms of diabetes. In animal studies, the ghrelin expression was regulated by the hepatocyte nuclear factor 1 alpha (HNF1A). Mutations of the HNF1A gene cause maturity onset diabetes of the young (MODY). We aimed to assess the circulating ghrelin levels in HNF1A–MODY and in other types of diabetes and to evaluate its association with HNF1A mutation status. Our cohort included 46 diabetic HNF1A gene mutation carriers, 55 type 2 diabetes (T2DM) subjects, 42 type 1 diabetes (T1DM) patients, and 31 glucokinase (GCK) gene mutation carriers with diabetes as well as 51 healthy controls. Plasma ghrelin concentration was measured using the immunoenzymatic assay with polyclonal antibody against the C-terminal fragment of its acylated and desacylated forms. Ghrelin concentrations were 0.75 ± 0.32, 0.70 ± 0.21, 0.50 ± 0.20, and 0.40 ± 0.16 ng/ml in patients with HNF1A–MODY, GCK–MODY, T1DM, and T2DM, respectively. The ghrelin levels were higher in HNF1A–MODY and GCK–MODY than in T1DM and T2DM (p < 0.001 for all comparisons) but lower than in non-diabetic controls (1.02 ± 0.29 ng/ml, p < 0.001 for both comparisons). In the multivariate linear model, the differences between both MODY groups and common diabetes types remained significant. Analysis by a HNF1A mutation type indicated that ghrelin concentration is similar in patients with different types of sequence differences. Plasma ghrelin level is higher in HNF1A–MODY and GCK–MODY than in the common polygenic forms of diabetes

Physiological characteristics of type 1 diabetes patients during high mountain trekking

In this study, the aim was to provide observational data from an ascent to the summit of Mount Damavand (5670 meters above sea level (m.a.s.l), Iran) by a group of people with type 1 diabetes (T1DM), with a focus on their physiological characteristics. After a 3-day expedition, 18 T1DM patients, all treated with personal insulin pumps, successfully climbed Mount Damavand. Information was collected on their physiological and dietary behaviors, as well as medical parameters, such as carbohydrate consumption, glucose patterns, insulin dosing, and the number of hypo- and hyperglycemic episodes during this time frame. The participants consumed significantly less carbohydrates on day 3 compared to day 1 (16.4 vs. 23.1 carbohydrate units; p=0.037). Despite this, a gradual rise in the mean daily glucose concentration as measured with a glucometer was observed. Interestingly, the patients did not fully respond to higher insulin delivery as there was no significant difference in mean daily insulin dose during the expedition. There were more hyperglycemic episodes (≥180 mg/dL) per patient on day 3 vs. day 1 (p250 mg/dL) per patient on days 2 (p<0.05) and 3 (p<0.05) vs. day 1. In summary, high mountain trekking is feasible for T1DM patients with good glycemic control and no chronic complications. However, some changes in dietary preferences and an observable rise in glucose levels may occur. This requires an adequate therapeutic response

DNA methylation analysis of negative pressure therapy effect in diabetic foot ulcers

Objective: Negative pressure wound therapy (NPWT) has been used to treat diabetic foot ulcerations (DFUs). Its action on the molecular level, however, is only partially understood. Some earlier data suggested NPWT may be mediated th rough modification of local gene expression. As methylation is a key epigenetic regulatory mechanism of gene expression, we assessed the effect of NPWT on its profile in patients with type 2 diabetes (T2DM) and neuropathic non-infected DFUs. Methods: Of 36 included patients, 23 were assigned to NPWT and 13 to standard therapy. Due to ethical concerns, the assignment was non-randomized and based on wound characteristics. Tissue samples were obtained before and 8 ± 1 days after therapy initiation. DNA methylation patterns were checked by Illumina Methylation EPIC kit. Results: In terms of clinical characteristics, the groups presented typical features of T2DM; however, the NPWT group had significantly greater wound ar ea: 16.8 cm2 vs 1.4 cm2 (P = 0.0003). Initially only one region at chromosome 5 was differentially methylated. After treatment, 57 differentially methylated genes were found, mainly located on chromosomes 6 (chr6p21) and 20 (chr20p13); they were associated with DNA repair and autocrine signaling via retinoic acid receptor. We performed differential analyses pre treatment and post treatment. The analysis reveale d 426 differentially methylated regions in the NPWT group, but none in the control group. The enrichment analysis showed 11 processes significantly associated with NPWT, of which 4 were linked with complement system activation. All but one were hypermethylated after NPWT. Conclusion: The NPWT effect on DFUs may be mediated through epigenetic chan ges resulting in the inhibition of complement system activation

The association between the level of baseline daily physical activity and selected clinical and biochemical parameters during mountain trekking in patients with type 1 diabetes

Introduction. There is a general agreement that regular physical activity should be recommended for patients with type 1 diabetes mellitus (T1DM), as it positively affects blood pressure and lipid levels and diminishes the risk of T1DM complications. Aim of this study was to search for a correlation between lactate level, de­gree of fatigue, and patient-reported physical activity in T1DM patients while trekking up to 3000 meters above sea level (masl). Material and methods. Study group consisted of 19 participants (2 women) in mean age of 31 years with T1DM who summited 3000 masl in Alps. Clinical infor­mation was taken from patient questionnaire, personal insulin pumps and blood analysis (glucose, lactate level). Additionally patient self-assessment of physical activity and fatigue (Borg scale) was used. Results. Declared physical activity in the last six months correlated with the initial, second, and final ratings of fatigue according to the Borg Scale during the expedition day, p = 0.02, r = –0.65; p = 0.02, r = –0.54; p = 0.01, r = –0.61, respectively. Blood lactate levels tended to increase with duration of exercise and altitude. Also, the average level of lactate on the expedition correlated with the average level of fatigue (p = 0.02, r = 0.57). Conclusion. Before undertaking day-long mountain trekking, T1DM patients with a sedentary lifestyle should improve their fitness. The measurement of lactate levels can be a useful tool to predict fatigue as measured with the Borg Scale. (Clin Diabetol 2017; 6, 3: 77–80)Introduction. There is a general agreement that regular physical activity should be recommended for patients with type 1 diabetes mellitus (T1DM), as it positively affects blood pressure and lipid levels and diminishes the risk of T1DM complications. Aim of this study was to search for a correlation between lactate level, de­gree of fatigue, and patient-reported physical activity in T1DM patients while trekking up to 3000 meters above sea level (masl). Material and methods. Study group consisted of 19 participants (2 women) in mean age of 31 years with T1DM who summited 3000 masl in Alps. Clinical infor­mation was taken from patient questionnaire, personal insulin pumps and blood analysis (glucose, lactate level). Additionally patient self-assessment of physical activity and fatigue (Borg scale) was used. Results. Declared physical activity in the last six months correlated with the initial, second, and final ratings of fatigue according to the Borg Scale during the expedition day, p = 0.02, r = –0.65; p = 0.02, r = –0.54; p = 0.01, r = –0.61, respectively. Blood lactate levels tended to increase with duration of exercise and altitude. Also, the average level of lactate on the expedition correlated with the average level of fatigue (p = 0.02, r = 0.57). Conclusion. Before undertaking day-long mountain trekking, T1DM patients with a sedentary lifestyle should improve their fitness. The measurement of lactate levels can be a useful tool to predict fatigue as measured with the Borg Scale. (Clin Diabetol 2017; 6, 3: 77–80