Efficacy and safety of insulin pump treatment in adult T1DM patients : influence of age and social environment

Introduction and objective. Continuous subcutaneous insulin infusion (CSII) via personal insulin pump is a valuable therapeutic tool in T1DM patients. However, adherence to recommended CSII- related behaviours may be of concern to young adults with intensive, variable daily activities (students, young professionals). The aim of this observational study was to estimate treatment outcomes in young adult patients with T1DM, and compare them with older individuals. Materials and methods. Overall, 140 adults with T1DM on CSII were examined, divided into 2 subgroups: 77 patients younger than 26 years of age (mean 20.6 years) and 63 older subjects (mean 39.0). We compared the glycaemic control in both groups of T1DM subjects and analyzed treatment attitudes to identify potentially modifiable behaviours influencing the efficacy of the treatment. Results. The younger individuals were characterized by significantly worse treatment outcomes, compared to the older ones: the mean HbA1c levels were 7.6 ± 1.3% and 6.9±1.3% (p=0.00001), while the mean glucose levels based on glucometer downloads were 161±33.6 mg/dL and 136±21.8 mg/dL (p=0.00001), respectively. The frequency of self-monitoring of blood glucose (SMBG) was lower in younger individuals (5.3±2.1 vs. 7.0±2.8 daily, p=0.0005, respectively); they were also less frequently used advanced pump functions, e.g. the bolus calculator (48% vs. 67% users, p=0.0014, respectively). Conclusions. The efficacy of CSII treatment observed in young T1DM adults was worse than in older patients. The reason for this phenomenon remains unclear, it may be due simply to age-dependend behaviours, to social environment, or both

Podaż węglowodanów w diecie i kontrola glikemii u pacjentów leczonych za pomocą mieszanek insuliny ludzkiej

  Introduction. The treatment with pre-mixed human insulins (PMHI) is globally one of the most popular models of insulin therapy. Achieving good glycaemic control on PMHI may, however, be difficult, mostly due to inconsistent calorie and carbohydrate intake. The aim of the study was to examine the impact of dietary modification on glucose levels in patients with type 2 diabetes mellitus (T2DM) treated with PMHI. Materials and methods. In this prospective cross-over analysis we studied 8 T2DM PMHI treated individuals (mean HbA1c 8.4%). We exposed patients to 2 diets, both based on steady calorie/carbohydrate content: „A” — 50% calories from carbohydrates, 30% from fat, 20% from protein, „B”— 40% from carbohydrates, 30% from fat and 30% from protein. The study was performed in home settings, all the meals were delivered to the patients. Each patient was exposed to diet A for 9 days, than after 7 days of wash-out to 9 days of diet B. Glucose patterns were assessed with continuous glucose monitoring system (CGMS, iPro, Medtronic, USA). Results. Switching from diet A to diet B resulted in a decrease in mean glucose levels (CGMS data) from 145 mg/dL to 133 mg/dL (p = 0.0001), SD reduction from 51 to 42 mg/dL (p = 0.0429), and a decrease in time spent above the target of 180 mg/dL from 18% to 11% (p = 0.0006). Conclusions. The study demonstrates that consistent and repeatable carbohydrate (CH) and calorie intake with moderate restriction of CHs helps to improve glycaemic control in this group of patients.    Wstęp. Leczenie mieszankami insuliny ludzkiej (PMHI, pre-mixed human insulin) jest na całym świecie jednym z najpopularniejszych modeli insulinoterapii. Jednak osiągnięcie dobrej kontroli glikemii u osób stosujących PMHI może być trudne, głównie ze względu na zmienne spożycie węglowodanów i podaż kalorii. Badanie przeprowadzono w celu oceny wpływu modyfikacji diety na stężenia glukozy u chorych na cukrzycę typu 2 (T2DM, type 2 diabetes mellitus) stosujących PMHI. Materiał i metody. Do tego prospektywnego badania przeprowadzonego w układzie naprzemiennym włączono 8 chorych na T2DM leczonych PMHI (średnie stężenie HbA1c 8,4%). U chorych zastosowano 2 diety, obie cechujące się stałą zawartością kalorii/węglowodanów: dieta A — 50% kalorii pochodzi z węglowodanów, 30% — z tłuszczów, 20% — z białek; dieta B — 40% kalorii pochodzi z węglowodanów, 30% — z tłuszczów i 30% — z protein. Badanie prowadzono w warunkach domowych, dostarczano chorym wszystkie posiłki. Każdy chory stosował dietę A przez 9 dni, a następnie po 7-dniowym okresie wypłukiwania przez 9 dni stosował dietę B. Profile glukozy oceniano przy użyciu systemu ciągłego monitorowania glikemii (CGMS, continuous glucose monitoring system, iPro, Medtronic, USA). Wyniki. Zmiana z diety A na dietę B spowodowała zmniejszenie średnich stężeń glukozy (dane z system CGMS) ze 145 mg/dl do 133 mg/dl (p = 0,0001), redukcję SD z 51 do 42 mg/dl (p = 0,0429) oraz skrócenie czasu, w którym glikemia utrzymywała się powyżej progowej wartości 180 mg/dl z 18% do 11% (p = 0,0006). Wnioski. W badaniu wykazano, że zapewnienie odpowiedniej i powtarzalnej podaży węglowodanów i kalorii z umiarkowanym ograniczeniem węglowodanów umożliwia poprawę kontroli glikemii u chorych na cukrzycę typu 2.

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

GTP cyclohydrolase I gene polymorphisms are associated with endothelial dysfunction and oxidative stress in patients with type 2 diabetes mellitus

Background: The genetic background of atherosclerosis in type 2 diabetes mellitus (T2DM) is complex and poorly understood. Studying genetic components of intermediate phenotypes, such as endothelial dysfunction and oxidative stress, may aid in identifying novel genetic components for atherosclerosis in diabetic patients.<p></p> Methods: Five polymorphisms forming two haplotype blocks within the GTP cyclohydrolase 1 gene, encoding a rate limiting enzyme in tetrahydrobiopterin synthesis, were studied in the context of flow and nitroglycerin mediated dilation (FMD and NMD), intima-media thickness (IMT), and plasma concentrations of von Willebrand factor (vWF) and malondialdehyde (MDA).<p></p> Results: Rs841 was associated with FMD (p = 0.01), while polymorphisms Rs10483639, Rs841, Rs3783641 (which form a single haplotype) were associated with both MDA (p = 0.012, p = 0.0015 and p = 0.003, respectively) and vWF concentrations (p = 0.016, p = 0.03 and p = 0.045, respectively). In addition, polymorphism Rs8007267 was also associated with MDA (p = 0.006). Haplotype analysis confirmed the association of both haplotypes with studied variables.<p></p> Conclusions: Genetic variation of the GCH1 gene is associated with endothelial dysfunction and oxidative stress in T2DM patients

Continuous glucose monitoring and insulin pump therapy in pregnant women with type 1 diabetes mellitus

Objectives: We examined the impact of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring systems (CGM) during pregnancy in women with pre-gestational type 1 diabetes (T1DM) on glycemic control and subsequent adverse outcomes.Material and methods: In this observational, one-center study we analyzed records of consecutive 109 T1DM pregnancies (2016–2017). The final analyzed group consisted of 81 singleton pregnancies who met inclusion and exclusion criteria. We searched for the association between the use of CSII with or without CGM and pregnancy planning with glycated hemoglobin A1c (HbA1c) through pregnancy and after delivery as well as maternal and infant outcomes.Results: Patients using CSII and CGM vs CSII without CGM and MDI (multiple daily injections) users had the lowest HbA1c levels during and after pregnancy (5.3%, 5.3%, 5.2% and 5,5% in the 1st, 2nd, 3rd trimester and postpartum visit, p = 0.003, p = 0.030, p = 0.039 and p = 0.002, respectively). Patients treated with insulin pumps with CGM and additional functions of automatic insulin delivery suspension on low glucose level (SLG) or predictive low glucose suspend (PLGS) during the third trimester and after pregnancy achieved a significantly lower HbA1c than the other CSII patients. We did not find any differences between the study groups in gestational age at delivery, preterm births, birth weight or macrosomia risk. Despite very good glycemic control, the risk of macrosomia remained high (19.7%).Conclusions: The use of pumps equipped with CGM, especially with automatic insulin delivery suspension, may improve glycemic control in pregnant T1DM women. The proportion of macrosomia remained high

Quality of life in the course of a one-year use of an advanced hybrid closed-loop system in adults with type 1 diabetes previously naïve to advanced diabetes technology

AimTo evaluate the effect of a one-year use of an advanced hybrid closed-loop (AHCL) system on the quality of life, level of anxiety, and level of self-efficacy in adults with type 1 diabetes (T1D) previously treated with multiple daily injections (MDI) and naïve to advanced diabetes technologyMethodsA total of 18 participants of a previously published 3-month randomized trial (10 men, 8 women; age 40.9 ± 7.6 years) who were switched directly from MDI/BMG to AHCL completed 12 months of MiniMed 780G™system use (a 3-month randomized trial followed by a 9-month follow-up phase). At month 6 of the study, patients were switched from the sensor GS3 (Continuous Glucose Monitoring) system, powered by Guardian™ Sensor 3) to GS4. Quality of life was assessed using the Polish validated version of the ‘QoL-Q Diabetes’ questionnaire. The level of anxiety was evaluated with the use of the State-Trait Anxiety Inventory (STAI). Self-efficacy was assessed with the General Self-Efficacy Scale (GSES). Results were obtained at baseline and at the end of the study.ResultsSignificant increase in QoL was reported in the global score (p=0.02, Cohen d=0.61) and in as many as 11 out of 23 analyzed areas of life: being physically active (p=0.02, Cohen d = 0.71); feeling well (p<.01, Cohen d = 0.73); feeling in control of my body (p<.01, Cohen d = 0.72); looking good (p<.01, Cohen d = 1.07); working (p<.01, Cohen d = 1.12); sleeping (p=0.01, Cohen d = 0.66); eating as I would like (p<.01, Cohen d = 0.79); looking after or being useful to others (p= 0.02, Cohen d = 0.65); being active with pets/animals (p<.01, Cohen d = 0.95); being spontaneous (p=0.02, Cohen d = 0.67); and doing “normal” things (p=0.02, Cohen d = 0.67). Both state (p=0.04, Cohen d = 0.56) and trait (p=0.02, Cohen d = 0.60) anxiety decreased while the general self-efficacy increased (p=0.03, Cohen d = 0.76). No participant stopped the use of the pump.ConclusionAdult patients with T1D previously treated with MDI and naïve to modern technologies experienced significant improvement in their psychological well-being after transitioning to the AHCL system after 12 months of treatment

Comparison of the clinical characteristics, glycemic control, and pregnancy outcomes between women with gestational diabetes mellitus in waves I and III of the COVID-19 pandemic: a reference center report

Objectives: The medical care of patients with gestational diabetes mellitus (GDM) during the COVID-19 pandemic was influenced by changing epidemiological conditions and government regulations. Aim — To compare the clinical pregnancy data of GDM women between waves I and III of the pandemic. Material and methods: We performed a retrospective analysis of medical records from the GDM clinic and compared the periods of March–May 2020 (wave I) and March–May 2021 (wave III). Results: Women with GDM during wave I (n = 119) compared to wave III (n = 116) were older (33.0 ± 4.7 vs 32.1 ± 4.8 years; p = 0.07), booked later (21.8 ± 8.4 vs 20.3 ± 8.5 weeks; p = 0.17), and had their last appointment earlier (35.5 ± 2.0 vs 35.7 ± 3.2 weeks; p < 0.01). Telemedicine consultations were used more frequently during wave I (46.8% vs 24.1%; p < 0.01), while insulin therapy was used less often (64.7% vs 80.2%; p < 0.01). Mean fasting self-measured glucose did not differ (4.8 ± 0.3 vs 4.8 ± 0.3 mmol/L; p = 0.49), but higher postprandial glucose was reported during wave I (6.6 ± 0.9 vs 6.3 ± 0.6 mmol/l; p < 0.01). Pregnancy outcome data were available for 77 wave I pregnancies and 75 wave III pregnancies. The groups were similar in terms of gestational week of delivery (38.3 ± 1.4 vs 38.1 ± 1.6 weeks), cesarean sections (58.4% vs 61.3%), APGAR scores (9.7 ± 1.0 vs 9.7 ± 1.0 pts), and birth weights (3306.6 ± 457.6 g vs 3243.9 ± 496.8 g) (p = NS for all). The mean wave I neonate length was slightly higher (54.3 ± 2.6 cm vs 53.3 ± 2.6 cm; p = 0.04). Conclusions: We identified differences between wave I and wave III pregnancies for several clinical characteristics. However, nearly all pregnancy outcomes were found to be similar

The role of some clinical risk factors on the pathogenesis of diabetc retinopathy in type 2 diabetic patients from a Polish population

WSTĘP. Retinopatia cukrzycowa jest najczęstszym przewlekłym powikłaniem mikronaczyniowym cukrzycy. W przypadku znacznego zaawansowania zmian prowadzi do zaburzeń widzenia, a nawet do utraty wzroku. Celami niniejszej pracy były ocena w badaniu przekrojowym częstości występowania retinopatii cukrzycowej u chorych na cukrzycę typu 2 w populacji polskiej oraz analiza związku wybranych cech klinicznych z retinopatią. MATERIAŁ I METODY. Badaniem objęto chorych na cukrzycę typu 2 leczonych w Poradni Diabetologicznej Katedry i Kliniki Chorób Metabolicznych CM UJ w Krakowie. Pacjenci wypełniali kwestionariusz dotyczący wywiadu chorobowego, chorób współtowarzyszących, leczenia, nałogów, wywiadu rodzinnego w kierunku cukrzycy. Wykonano badania biochemiczne, badanie okulistyczne, w tym badanie oftalmoskopowe dna oka po poszerzeniu źrenicy oraz fotografie dna oka. WYNIKI. W badaniu uczestniczyło 359 chorych na cukrzycę typu 2 - 198 kobiet (55,2%) i 161 mężczyzn (44,8%), w średnim wieku 60,8 ± 9,4 roku, BMI 31,3 ± 7,4 kg/m2, czasem trwania choroby 11,2 ± 7,0 lat oraz HbA1c 7,5 ± 1,5%. Retinopatię cukrzycową stwierdzono u 33,7% badanych. W przypadku, gdy choroba trwa do 10 lat, retinopatię wykazano u 18,3% pacjentów (n = 33), w okresie 10-20 lat - u 43,7% (n = 52), a jeśli cukrzyca trwała dłużej niż 20 lat - u 62,5% badanych (n = 35). W analizie wieloczynnikowej niezależnymi czynnikami ryzyka retinopatii okazały się: wiek rozpoznania cukrzycy (p = 0,01; OR: 0,96; 95% CI: 0,92-0,99), czas trwania choroby (p = 0,003; OR: 1,06; 95% CI: 1,02-1,10), HbA1c (p = 0,001; OR: 1,35; 95% CI: 1,13-1,63), niepalenie tytoniu (p = 0,001; OR: 0,41; 95% CI: 0,23-0,71) oraz stężenie mocznika (p = 0,009; OR: 1,19; 95% CI: 1,05-1,36). WNIOSKI. W badanej grupie wykazano dużą częstość retinopatii cukrzycowej (33,7%). Chorobowość zwiększała się wraz z czasem trwania schorzenia. Niezależnymi czynnikami ryzyka retinopatii były: wiek zachorowania, czas trwania choroby, stężenia HbA1c i mocznika oraz niepalenie tytoniu.BACKGROUND. Type 2 diabetes mellitus (T2DM) is a complex, multifactorial disease that is a consequence of the progressive insulin secretory defect and peripheral insulin resistance. In the course of disease the long-lasting hyperglycaemia leads to the chronic complications. Diabetic retinopathy is a highly specific microvascular complication of this disease. It is the most frequent cause of new cases of blindness among adults. The aim of the study was to define the prevalence of diabetic retinopathy in patients with T2DM from a Polish population and to analyze the clinical features associated with this complication in the examined group. MATERIAL AND METHODS. The study group consisted of 359 T2DM patients with age of diagnosis above 35 years. The diagnosis of DR was based on the ophthalmologic examination and ophthalmoscopy after the dilation of pupils. The photographic documentation was done. Potentially important clinical covariables such as gender, age, duration of diabetes, BMI, smoking status, the presence of hypertension and some biochemical factors were also measured. RESULTS. We examined 359 subjects, all European Caucasians, residents of Poland with T2DM. The examined group consisted of 198 (55.2%) female and 161 (44.8%) male T2DM patients (mean age at examination: 60.8 ± 9.4 years, age at T2DM diagnosis: 49.7 ± 9.2, T2DM duration: 11.2 ± 7.0 years, body mass index: 31.3 ± 7.4 kg/m2, HbA1c: 7.5 ± 1.5 %). Diabetic retinopathy of different stages was detected in one third of the examined diabetic group (33.7%). Proliferative retinopathy was diagnosed in 8 subjects, what constituted 2.2% of the entire T2DM group. The morbidity differed in the sub-groups defined based on the disease duration. Among the patients with diabetes duration below 10 years retinopathy was diagnosed in 18.3% (n = 33) patients, while in the sub-group with diabetes duration between 10 and 20 years retinopathy was present in 43.7% (n = 52) of T2DM individuals. In the group of patients with the longest history of diabetes (above 20 years), retinopathy was observed in 62.5% (n = 35) subjects. The multivariate analysis revealed that significant predictors of diabetic retinopathy were: age at diagnosis of diabetes (p = 0.01; OR: 0.96; 95% CI: 0.92-0.99), duration of diabetes (p = 0.003; OR: 1.06; 95% CI: 1.02-1.10), HbA1c level (p = 0.001; OR: 1.35; 95% CI 1.13-1.63), never-smoking status (p = 0.001; OR: 0.41; 95% CI 0.23-0.71), and urea serum level (p = 0.009; OR 1.19; 95% CI: 1.05-1.36). CONCLUSIONS. The prevalence of diabetic retinopathy was 33.7% in examined populations. We were able to confirm the role of some clinical risk factors in the pathogenesis of DR such as age at diagnosis of diabetes, duration of the disease, HbA1c level, never smoking status, urea serum level

Qualitative Parameters of the Colonic Flora in Patients with HNF1A-MODY Are Different from Those Observed in Type 2 Diabetes Mellitus

Background. Type 2 diabetes mellitus (T2DM) is determined by genetic and environmental factors. There have been many studies on the relationship between the composition of the gastrointestinal bacterial flora, T2DM, and obesity. There are no data, however, on the gut microbiome structure in monogenic forms of the disease including Maturity Onset Diabetes of the Young (MODY). Methods. The aim of the investigation was to compare the qualitative parameters of the colonic flora in patients with HNF1A-MODY and T2DM and healthy individuals. 16S sequencing of bacterial DNA isolated from the collected fecal samples using the MiSeq platform was performed. Results. There were significant between-group differences in the bacterial profile. At the phylum level, the amount of Proteobacteria was higher ( = 0.0006) and the amount of Bacteroidetes was lower ( = 0.0005) in T2DM group in comparison to the control group. In HNF1A-MODY group, the frequency of Bacteroidetes was lower than in the control group ( = 0.0143). At the order level, Turicibacterales was more abundant in HNF1A-MODY group than in T2DM group. Conclusions. It appears that there are differences in the gut microbiome composition between patients with HNF1A-MODY and type 2 diabetes. Further investigation on this matter should be conducted

Differential regulation of serum microRNA expression by HNF1β and HNF1α transcription factors.

We aimed to identify microRNAs (miRNAs) under transcriptional control of the HNF1β transcription factor, and investigate whether its effect manifests in serum.This article is freely available via Open Access. Click on the 'Additional Link' above to access the full-text via the publisher's site.Published (Open Access