Cukrzyca u chorego po przeszczepieniu nerki — spojrzenie nefrodiabetologiczne

A transplant physician often has under his care a kid­ney recipient with end-stage kidney disease due to diabetes mellitus (DM) or DM developed after trans­plantation (posttransplantation diabetes mellitus — PTDM). The presence of DM is associated with a de­terioration in quality of life and worse prognosis both for the transplanted kidney and the patient survival. Such patients should be provided with combined and coordinated nephrology/diabetes care. The diagnostic procedures for PTDM do not differ from those gen­erally accepted, the basic one being an oral glucose load test. An important role in the control of treatment is played by glycated haemoglobin, sometimes used as a diagnostic support tool. Until now, no unambigu­ous standards of therapeutic treatment in PTDM have been established and both in the diagnosis and the therapeutic regimens apply the guidelines established for diabetic patients without a transplanted organ. The basis of treatment should be a diet combined with ap­propriate physical exercise. There are many hypogly­cemic medications available, including new ones with wide spectrum pharmacokinetic and pharmacody­namic properties that vary in efficacy and safety pro­file. Graft function and also possible interactions with other medications, especially immunosuppressants, should be taken into account before implementing hy­poglycemic treatment in transplanted patients

Zbyt intensywne leczenie chorych na cukrzycę typu 2 w podeszłym wieku

  Wstęp. U starszych pacjentów z cukrzycą typu 2 (T2DM) oraz poważnymi chorobami współistniejącymi ryzyko wynikające ze ścisłej kontroli glikemii przewyższa jej korzyści. Cele niniejszej pracy obejmowały ocenę od­setka hemoglobiny glikowanej A1c (HbA1c) u chorych na T2DM ≥ 80. roku życia oraz porównanie odsetka HbA1c u chorych hospitalizowanych z powodu ciężkiej hipoglikemii (SH) i innych przyczyn internistycznych. Materiał i metody. Do badania włączono 166 chorych na T2DM powyżej 80. roku życia, hospitalizowanych w latach 2009–2013 z różnych przyczyn internistycznych. Wyniki. Średni wiek pacjentów wynosił 83,72 ± 3,19 roku, średni czas trwania cukrzycy 9,14 ± 5,88 roku, średni wskaźnik masy ciała (BMI) 27,87 ± 4,51 kg/m2 i średni współczynnik filtracji kłębuszkowej (GFR) 58,94 ± 25,87 ml/min/1,73 m². Średnia wartość HbA1c dla całej grupy wynosiła 7,61 ± 1,87% (59,77 ± 20,48 mmol/mol). Ścisłą kontrolę glikemii z HbA1c < 7,0% (53 mmol/mol) odnotowano u 77 chorych (46%). Ciężką hipoglikemię rozpoznano u 19 (11%) pacjentów. Chorzy z SH cechowali się istotnie niż­szym średnim odsetkiem HbA1c niż pacjenci hospi­talizowani z innych przyczyn (6,38 ± 1,22 vs. 7,77 ± 1,88% (46,31 ± 13,36 vs. 61,51 ± 20,63 mmol/mol); p = 0,002). Częstość występowania zawału serca i/lub udaru mózgu była prawie dwukrotnie wyższa u chorych na cukrzycę hospitalizowanych z powodu SH niż u pacjentów bez hipoglikemii (47 vs. 28%; c² = 3,03; p = 0,082). Ciężką hipoglikemię stwierdzono tylko u pacjentów otrzymujących insulinę (n = 10) lub pochodną sulfonylomocznika (SU) (n = 9). Wnioski. Mimo że u chorych na T2DM w starszym wieku ryzyko wynikające z intensywnego leczenia hi­poglikemizującego przewyższa jego korzyści, połowa badanych cechowała się ścisłą kontrolą glikemii. Co dziesiąty pacjent był hospitalizowany z powodu SH. U osób z SH odnotowano istotnie niższy średni odsetek HbA1c niż u osób hospitalizowanych z innych przyczyn. Ob­serwacje autorów sugerują, że znaczna część pacjentów z T2DM w wieku ≥ 80 lat może być leczona zbyt intensywnie

Diagnosis and management of hyperglycaemia in patients treated with antipsychotic drugs

Research results indicate the presence of an association between mental disorders, certain antipsychotics, and the risk of developing prediabetes (preDM) and specific type diabetes mellitus (DM). However, there are no precise recommendations for their diagnosis and treatment. The obtained data suggest the necessity to perform diagnostics of carbohydrate disorders at the onset of the first symptoms of psychosis, even before the implementation of antipsychotic drugs, and the oral glucose tolerance test (OGTT) seems to be the optimal tool. There is a lot of controversy regarding the timing of control tests addressing the development of dysglycaemia during the use of antipsychotic drugs. We suggest that it should be carried out during the first 4–8 weeks, and in the absence of disorders it should be repeated once a year or with a change in antipsychotic treatment. The diagnostic regimen should then include the need for OGTT supportedby routine determination of the percentage of glycated haemoglobin. If dysglycaemia is diagnosed, the therapeutic management should include non-pharmacological management and hypoglycaemic agents. These recommendations should be individually tailored to each patient and take into account the presence of obesity, which is often found in this group of patients. Weight reduction can be achieved with a properly balanced diet, physical effort, and in justified situations also with drugs effectively reducing body weight. For this reason, drugs are recommended that, if preDM and DM are diagnosed, simultaneously lower glucose levels and reduce body weight. So far, effectiveness in this area has been demonstrated for 2 incretinomimetics: exenatide and liraglutide. Due to the mechanism of preDM/DM development in patients using antipsychotics, the usefulness of other hypoglycaemic drugs with insulin-sensitizing potential — metformin and pioglitazone — has also been suggested. To date, there has been no research on the benefits of other hypoglycaemic drugs in this group of patients

Introduction of insulin therapy in patients with type 2 diabetes mellitus - is not it too late?

WSTĘP. Celem niniejszej pracy była analiza skuteczności dotychczasowego leczenia hipoglikemizującego ocenianego jako odsetek hemoglobiny glikowanej (HbA1c) u chorych na cukrzycę typu 2, hospitalizowanych z różnych przyczyn internistycznych, oraz ocena wiedzy pacjentów dotyczącej zasad monitorowania kontroli metabolicznej cukrzycy. MATERIAŁ I METODY. Do badania zakwalifikowano 86 chorych na cukrzycę typu 2, skierowanych do szpitala z innych przyczyn niż dekompensacja cukrzycy. W chwili przyjęcia do szpitala u każdego z nich oznaczano odsetek HbA1c. Ponadto wszyscy chorzy udzielali odpowiedzi na pytania ankietowe dotyczące między innymi czasu trwania cukrzycy typu 2, sposobu i kontroli jej leczenia oraz ostatniej wartości HbA1c. WYNIKI. Średni wiek pacjentów wynosił 65 &#177; 11,07 roku, najczęstszą przyczyną hospitalizacji były choroby układu sercowo-naczyniowego i przewodu pokarmowego. Czas trwania cukrzycy typu 2 wynosił 7,5 &#177; 6,4 roku, a średnia wartość HbA1c przy przyjęciu - 9,46% &#177; 1,92%. U żadnego chorego nie oznaczano HbA1c w ciągu ostatnich 3-6 miesięcy, a większość z nich nigdy nie słyszała o tym wskaźniku kontroli metabolicznej. Leczenie dietą prowadzono u 10 chorych. Monoterapię metforminą stosowano u 20 osób, a pochodnymi sulfonylomocznika (SU) - u 13 pacjentów. Połączeniem metforminą z SU leczono 39 chorych, skojarzeniem SU z akarbozą - 2 pacjentów, a jednego - połączeniem metforminy z akarbozą. Terapię trójlekową (metformina + SU + akarboza) otrzymywał również jeden chory. WNIOSKI. U wielu chorych na cukrzycę typu 2 nie wykonuje się pomiaru HbA1c zgodnie z rekomendacjami Polskiego Towarzystwa Diabetologicznego (PTD). Nie można wykluczyć, że jest to jedna z najważniejszych przyczyn opóźnienia insulinoterapii przez lekarzy. (Diabet. Prakt. 2010; 11, 4: 125-129)INTRODUCTION. The aim of the study was to determine the level of admission A1c in type 2 diabetes mellitus patients referred to the hospital due to various internal diseases. Moreover, the patient&#8217;s knowledge about the principle of type 2 diabetes mellitus management monitoring was evaluated. MATERIAL AND METHODS. Study population consisted of 86 type 2 diabetes mellitus patients referred to the hospital due to other reasons than diabetes decompensation. The admission A1c values were determined in all patients. In addition, all patients were asked to complete a questionnaire consisting of several questions including: duration of type 2 diabetes mellitus, mode of treatment and monitoring of type 2 diabetes mellitus management. RESULTS. The patients&#8217; mean age was 65 &#177; 11.07 years, mean duration of type 2 diabetes mellitus 7.5 &#177; 6.4 years and the mean A1c value 9.46% &#177; 1.92%. A1c value was > 9.5% in as many as 38% of patients. None of the patients have had A1c measured over the past 3-6 months and most of them have never heard about this glycemic control marker. Before hospitalisation type 2 diabetes was managed only with diet in 10 patients. Twenty patients received metformin and 13 sulphonylurea (SU) as monotherapy. Thirty nine patients were treated with metformin and SU, 2 with SU and acarbose, 1 with metformin and acarbose, and 1 subject received combination of metformin, SU and acarbose. CONCLUSIONS. These findings indicate that A1c is not regularly determined in type 2 diabetes mellitus patients as recommended by the Polish Diabetes Association. It may at least partially explained why the patients with type 2 diabetes mellitus are not switched by general practitioners on insulin therapy sooner. (Diabet. Prakt. 2010; 11, 4: 125-129

The coincidence of diabetes mellitus and asthma, their probable causal relationships and therapeutic opportunities

Both the epidemiological data and the everyday medical practice demonstrate the coincidence of various types of diabetes mellitus (DM) in patients with asthma. Specific correlations between the risk of DM in pregnancy, asthma and the consequences of these diseases to the mother and her baby are also explored. The discussion concerning, on the one hand, the impact of asthma-related inflammatory condition on the metabolism of carbohydrates, and, on the other, the presence of chronic hyperglycemia and inflammatory markers observed in patients with asthma, is still ongoing. In the case of asthma and type 1 diabetes mellitus (T1DM), a correlation with the dysfunction of the immune system and the genetic background has been suggested, and in the case of type 2 (T2DM), the vital role of obesity and insulin resistance (IR) to promote excessive proinflammatory immune response. The data indicate that both asthma and DM affect mutually their clinical presentations, including the prognostic values and therapeutic possibilities. The ongoing controversy concerning the effective and safe anti-asthma and hypoglycemizing therapy does not allow for a definitive therapeutic consensus in this group of patients, despite the suggested role of metformin and hyperglycemizing effects of glucocorticoids. Therefore, the objective of the presented paper is a review of the knowledge in the field of DM and asthma coincidence, their probable causal relationships and therapeutic opportunities

The association between affective temperaments and depressive symptoms in a population of medical university students, Poland

BackgroundCompared to their peers, medical students are more exposed to stress, and many present symptoms of depression, making them a group prone to experiencing mental illnesses.ObjectiveThis study investigates a potential link between the occurrence of symptoms of depression and the dominating type of affective temperament in young people studying at a medical university.MethodsOne hundred thirty-four medical students were surveyed using two validated questionnaires; the Polish versions of Beck’s Depression Inventory-II (BDI-II) and the Temperament Evaluation of the Memphis, Pisa, and San Diego Autoquestionnaire (TEMPS-A).ResultsThe data analysis revealed a significant link between symptoms of depression and affective temperaments, most significantly in subjects with an anxious temperament.ConclusionThis study confirms the role of various affective temperaments as a risk factor for mood disorders, specifically depression

The influence of metformin and the presence of type 2 diabetes mellitus on mortality and hospitalisation in patients with heart failure

Background: Metformin is one of the antihyperglycaemic drugs, reducing the risk of major cardiovascular events, including fatal ones. Although it is formally contraindicated in moderate and severe functional stages of heart failure (HF), it is commonly used in patients with concomitant type 2 diabetes mellitus (T2DM).Aim: We sought to evaluate the effect of metformin and T2DM on total mortality and hospitalisation rates in patients with HF.Methods: This retrospective analysis included 1030 adult patients (&gt; 18 years) with HF from the Polish section of the HF Long-Term Registry (enrolled between 2011 and 2014). Patients with T2DM (n = 350) were identified and divided into two groups: those receiving metformin and those not. Both groups were subjected to one-year follow-up.Results: Mean patient age was 65.3 ± 13.5 years, with the predominance of male sex (n = 726) and obesity (mean bodymass index 30.3 ± 5.5 kg/m2) and mean left ventricular ejection fraction was 34.3% ± 14.1%. Among patients with T2DM (n = 350) only 135 (38.6%) were treated with metformin. During one-year follow-up, 128 patients with HF died, of whom 53 had T2DM (15.1% vs. 10.9%, hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.87–0.91, p = 0.045). Metformin was associated with a lower mortality rate compared to other antihyperglycaemic agents (9.6% vs. 18.6%, HR 0.85; 95% CI 0.81–0.89, p = 0.023). There were no significant differences in the hospitalisation rate, including that due to HF decompensation, among patients treated with metformin and the remainder (53.5% vs. 40.0%, respectively HR 0.93, 95% CI 0.82–1.04, p = 0.433).Conclusions: Metformin treatment in patients with different degrees of HF and T2DM is associated with a reduction in mortality and does not affect the hospitalisation rate

Dietary Intake of Polyphenols or Polyunsaturated Fatty Acids and Its Relationship with Metabolic and Inflammatory State in Patients with Type 2 Diabetes Mellitus

Background: The aim of the study was to evaluate the relationship between polyphenol or polyunsaturated fatty acids (PUFAs) consumption and the selected metabolic and inflammatory markers in type 2 diabetes (T2DM) patients. Methods: The study enrolled 129 diabetics (49 men, mean age 64.1 &plusmn; 9.8 years) with different amounts of polyphenol and PUFAs consumption. Results: A significant effect of polyphenol or PUFAs omega-3 consumption on fasting glucose concentration (FG) or glycated haemoglobin fraction (HbA1c) was reported. A negative association was observed between FG and total polyphenol, flavonoid, flavan-3-ol and stilbene intake. In the group with high flavonoid intake, the FG was significantly lower compared to the group characterised by low flavonoid intake. Polyphenols, except stilbenes, did not modulate HbA1c. Additionally, higher consumption of PUFAs omega-3 significantly decreased HbA1c, and the intake of eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids negatively and significantly correlated with FG and HbA1c. Further analysis confirmed a significant association between EPA + DHA intake and HbA1c, with significant interactions with age and gender or with body mass index and waist-to-hip ratio. The dietary intake of polyphenols or PUFAs was independent of familial diabetes or diabetic diet application. Conclusions: Our study indicates a positive effect of high consumption of flavonoids, omega-3 PUFAs and stilbenes on the markers of carbohydrate metabolism balance and the absence of such an effect on other cardiometabolic markers and inflammatory conditions

Feelings of loneliness and meaning in life in subjects with Asperger’s syndrome: a pilot study

Abstract Subjects with Asperger’s syndrome without intellectual disabilities have significant difficulties in establishing social relationships despite their IQ being within the normal range. One of the effects of social deficit is depression. The question arises whether loneliness and dimensions of meaning in life correlate with the severity of depression and whether the average severity of depression, loneliness and dimensions of meaning in life differentiate the following groups: people with Asperger’s syndrome and depression, people with Asperger’s syndrome without depression, people with depression without Asperger’s syndrome and healthy subjects. The study was conducted on a total of 170 people, including: 43 people with Asperger’s syndrome and depression, 41 people with Asperger’s syndrome without depression, 40 people with depression without Asperger’s syndrome and 46 healthy people (without Asperger’s syndrome and without depression). All were administered a demographic survey, Beck Depression Inventory II (BDI-II), De Jong Gierveld Loneliness Scale, Life Attitude Profile-Revised. Asperger’s syndrome and depressive episodes were diagnosed on the basis of ICD-10 research criteria still applicable in Poland. In the group with Asperger’s syndrome and depression the highest levels of loneliness and the lowest values of the dimensions of the sense of meaning in life, except for the acceptance of death, were observed. This result was significantly different from the results obtained in the other study groups. Both in people with Asperger’s syndrome without depression and in people with depression without Asperger’s syndrome, the values of the dimensions of the sense of meaning in life and the level of loneliness differ significantly from the results obtained in the control group. The BDI-II scores correlated positively with the loneliness values and negatively with the sense of meaning in life values in all groups. The results indicate that both suffering from depression and having Asperger’s syndrome are associated with an increased sense of loneliness and a reduced sense of meaning in life. People with Asperger’s syndrome and depression have the highest values of loneliness and the lowest values of dimensions of the sense of meaning of life compared to the other groups studied. The limitation of the work is the deliberate selection of groups, because it would be interesting to answer the question whether Asperger’s syndrome is a risk factor for depression in the population

Norwegian scabies in a resident of a nursing home misdiagnosed as dermatologic lesions of type 2 diabetes mellitus

Introduction. Norwegian (crusted, hyperkeratotic) scabies is a relatively rare form of the disease, but it is highly contagious and easily transmitted. Although skin lesions are typical for that form of the disease, they differ substantially from those observed in typical infection with Sarcoptes scabiei. Objective. To present the difficulties in the diagnosis of Norwegian scabies. Case report. We describe a case of an elderly patient, a resident of a nursing home, with Norwegian scabies in whom itching and skin lesions were initially misdiagnosed as a dermatologic complication of type 2 diabetes mellitus. Additionally, in the nursing home, the results of the implemented therapy were not checked appropriately, which resulted in an outbreak of scabies in the institution as well as infection of several family members. Conclusions . Considering the fact that pharmacological treatment of Norwegian scabies does not differ from other forms of this disease, it seems that early diagnosis and appropriate treatment planning are crucial to prevent transmission of the infection