Liczne przewlekłe powikłania jako rezultat niedostatecznej kontroli glikemii u pacjenta z cukrzycą typu 1 — opis przypadku

We present a case of a 54-year-old patient with type 1 diabetes affected by multiple microvascular and macrovascular complications. Over the course of the disease, he developed diabetic nephropathy that resulted in renal transplant, proliferative retinopathy of both eyes, and sensory polyneuropathy. He also suffered from arterial hypertension and diabetic foot syndrome, complicated by an amputation of fourth left toe. With the implementation of intensive insulin therapy (IIT), a decrease in prevalence of diabetic complications has been observed. Tight metabolic control, especially during early years of the disease, significantly reduces the risk of their development. However, there are patients who suffer from multiple complications, despite receiving IIT. One of the most important aspects of effective diabetes management is patients’ education and their active participation in the treatment.W pracy przedstawiono przypadek 54-letniego pacjenta chorującego na cukrzycę typu 1 z wieloma powikłaniami o charakterze mikroangiopatii i makroangiopatii. W przebiegu choroby u pacjenta rozwinęła się nefropatia cukrzycowa, która doprowadziła do przeszczepu nerki, retinopatia proliferacyjna obu oczu i polineuropatia czuciowa. Cierpiał też na nadciśnienie tętnicze oraz zespół stopy cukrzycowej, powikłany amputacją czwartego palca lewej stopy. Wprowadzenie intensywnej insulinoterapii (IIT) doprowadziło do zmniejszenia częstości powikłań o charakterze mikroangiopatii i makroangiopatii u pacjentów z cukrzycą typu 1. Ścisła kontrola metaboliczna, szcze­gólnie w pierwszych latach choroby, istotnie obniża ryzyko ich wystąpienia. Pomimo tego u części chorych poddanych IIT nadal rozwijają się liczne powikłania. Jednym z najistotniejszych aspektów opieki nad pacjentami z cukrzycą jest ich edukacja i aktywny udział w procesie leczenia

Body Composition, Serum Concentrations of Androgens and Insulin Resistance in Different Polycystic Ovary Syndrome Phenotypes

Insulin resistance and hyperandrogenemia observed in polycystic ovary syndrome (PCOS) are associated with metabolic disturbances and could be connected with body composition pattern. To date, several studies defining the parameters of body composition using dual energy X-ray absorptiometry (DXA) method in the group of PCOS patients have been published, however, without the analysis in different phenotypes. The aim of the present study was to investigate the relationships between serum androgens concentration, insulin resistance and distribution of fat mass using DXA method in various PCOS phenotypes according to the Rotterdam criteria. We examined 146 women: 34 (38%) had PCOS phenotype A, 20 (23%) phenotype B, 20 (23%) phenotype C and 15 (16%) phenotype D (with mean age of each phenotype 25 years), and 57 control subjects (mean age of 25.5 years). Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Serum concentrations of testosterone, androstenedione and dehydroepiandrosterone sulfate (DHEA-S) were assessed and free androgen index (FAI) was calculated. In phenotypes A, B and C, we observed higher FAI in comparison to the control group (all p < 0.01). Serum concentrations of androstenedione and DHEA-S were higher in phenotypes A and C in comparison to the control group (all p < 0.01). However, only in phenotype A we found higher visceral adipose tissue (VAT) mass and android/gynoid ratio (A/G ratio) in comparison to the control group (all p < 0.01). In phenotype A, we observed connection of VAT with FAI (r = 0.58, p < 0.01). Accordingly, A/G ratio was related with FAI in all phenotypes (all p < 0.05). Additionally, in phenotype C, A/G ratio was related to serum concentrations of DHEA-S and androstenedione (r = 0.46, p = 0.03; r = 0.53, p = 0.01, respectively). We also found connections of HOMA-IR with VAT and A/G ratio in all phenotypes (all p < 0.05). Women with phenotype A had higher amount of VAT and A/G ratio in comparison to the control group. Serum concentration of androgens and insulin resistance are connected with VAT and A/G ratio in normoandrogenic and hyperandrogenic PCOS phenotypes

Serum Concentrations of Betatrophin and Its Association with Indirect Indices of Insulin Resistance and Beta Cell Function in Women with Polycystic Ovary Syndrome

Introduction. Data underline the role of betatrophin in glucose homeostasis. Polycystic ovary syndrome (PCOS) is characterized by insulin resistance (IR). The aim of our study was to investigate the relationship of serum betatrophin concentrations with indirect indices of IR and insulin secretion in women with PCOS, compared to the control group. Methods. The study group comprised 43 women with PCOS and 16 controls. IR was assessed by HOMA-IR and Matsuda index. Insulin secretion was evaluated with HOMA-B. An oral glucose tolerance test (OGTT) with estimation of serum betatrophin concentrations was performed. Results. Glucose load resulted in an increase in serum betatrophin concentrations in the control group (p=0.02). Serum betatrophin concentrations at 120 min of OGTT were lower in women with PCOS than in the control group (p=0.02). We observed positive correlations between baseline serum betatrophin concentrations and HOMA-IR (r=0.39, p=0.008), negative correlations with Matsuda index (r=−0.31, p=0.004), and a positive relationship with HOMA-B (r=0.38, p=0.01) in women with PCOS. Multiple regression analysis revealed that HOMA-B (β=0.47, p=0.001) was an independent factor connected to serum betatrophin levels in PCOS. Conclusions. Serum concentrations of betatrophin are connected with insulin resistance and beta cell function and did not change after glucose load in women with PCOS

Serum Concentrations of Betatrophin and Its Association with Indirect Indices of Insulin Resistance and Beta Cell Function in Women with Polycystic Ovary Syndrome

Introduction. Data underline the role of betatrophin in glucose homeostasis. Polycystic ovary syndrome (PCOS) is characterized by insulin resistance (IR). The aim of our study was to investigate the relationship of serum betatrophin concentrations with indirect indices of IR and insulin secretion in women with PCOS, compared to the control group. Methods. The study group comprised 43 women with PCOS and 16 controls. IR was assessed by HOMA-IR and Matsuda index. Insulin secretion was evaluated with HOMA-B. An oral glucose tolerance test (OGTT) with estimation of serum betatrophin concentrations was performed. Results. Glucose load resulted in an increase in serum betatrophin concentrations in the control group (p=0.02). Serum betatrophin concentrations at 120 min of OGTT were lower in women with PCOS than in the control group (p=0.02). We observed positive correlations between baseline serum betatrophin concentrations and HOMA-IR (r=0.39, p=0.008), negative correlations with Matsuda index (r=−0.31, p=0.004), and a positive relationship with HOMA-B (r=0.38, p=0.01) in women with PCOS. Multiple regression analysis revealed that HOMA-B (β=0.47, p=0.001) was an independent factor connected to serum betatrophin levels in PCOS. Conclusions. Serum concentrations of betatrophin are connected with insulin resistance and beta cell function and did not change after glucose load in women with PCOS