Teletransmission system supporting intensive insulin treatment of out-clinic type 1 diabetic pregnant women. Technical assessment during 3 years' application.

A telematic system supporting intensive insulin treatment of pregnant type 1 diabetic out-clinic patients was implemented and technical efficiency of the system was evaluated over long-term ambulatory application. The system consists of a patient teletransmission module (PTM) and a central clinical control unit (CCU). The PTM contains a one-box blood glucose meter and electronic logbook, a modem and a dial-up or cellular phone set. The CCU consists of a PC computer with a modem and DIAPRET - an original program designed to monitor the intensive insulin treatment. The system was installed in the Clinic of Gastroenterology and Metabolic Disease, MA Warsaw and was tested for 166 +/- 24 days on 15 pregnant type 1 diabetic women. Telemonitoring of the patient data was done automatically. No major technical problems with proper operation or handling of the system was noted. Total effectiveness was 69.3 +/- 13.0% and technical effectiveness 91.5 +/- 6.1%. The efficacy of the system was not significantly influenced by patient intelligence level, education level or place of residence (p < 0.05). Significant improvement of metabolic control was noted during application of the system. In conclusion, the telematic system we developed and implemented should have a positive influence on the quality of diabetes treatment during pregnancy.

What we can really expect from telemedicine in intensive diabetes treatment: results from 3-year study on type 1 pregnant diabetic women.

Existing standards of the management of the diabetic patients are not efficient enough, and further improvement is needed. The major objective of this paper is to present and discuss the therapeutic effectiveness of an intensive care telematic system designed and applied for intensive treatment of pregnant type 1 diabetic women. The developed system operates automatically, every night transferring all the data recorded during the day in the patient's glucometer memory to a central clinical unit. In order to assess the efficiency of the designed and developed system, a 3-year randomized prospective clinical trial was conducted, using the study group and the control group, each consisting of 15 pregnant type 1 diabetic women. All patients were treated by the same diabetologist. In the presented analysis, two indices calculated weekly were used for the assessment of glycemic control: MBG represents mean blood glucose level, and the universal J-index is sensitive to the glycemic level and glycemic variations. The most important results from the study concern: (a) better glycemic control in the study group in comparison with the control group during the course of treatment, as assessed by the average differences of the MBG and J indices calculated weekly (n = 24) (deltaMBG = -3.2 +/- 4.3 mg/dL, p = 0.0016, deltaJ = -1.4 +/- 2.3, p = 0.0065); (b) much more similar results in glycemic control among members of the study group compared to each other, than among members of the control group compared to each other, as indicated by significantly lower variations of the applied glycemic control indices (SDMBG: 11.9 vs. 18.7 mg/dL, p = 0.0498; SDJ: 6.5 vs. 10.9, p = 0.0318); (c) the observed tendency of a better glycemic control for patients with a lower level of intelligence (IQ < 100) supported by the telematic system in comparison with all other assessed groups of patients. The last result was not statistically significant (p > 0.05). This telematic intensive care system improved the effectiveness of diabetes treatment during pregnancy. It also allows the diabetologist's strategy to be much more precise than if it were conducted without telematic support. This telematic system is inexpensive and simple in use.

[The influence of prenatal glucocorticoids on glycemic control among pregnant women with type I diabetes]. / Wplyw sterydoterapii stosowanej w profilaktyce zaburzen oddychania na gospodarke weglowodanowa ciezarnych z cukrzyca przedciazowa insulinozalezna.

The purpose of this study was to determine the impact of glucocorticoids treatment, administered for a severe risk of premature delivery. The study material consisted of 30 diabetic mothers treated with intensive insulin therapy. The effects of steroid treatment on glucose level two days prior, one day prior, during 1-, or 2-, or 3-days therapy and the first 2 days following treatment were determined. No case of ketoacidosis was reported.

[Risk factors for gestational diabetes mellitus and results of glucose tolerance tests]. / Czynniki ryzyka cukrzycy ciazowej a wyniki testów obciazenia glukoza.

The authors made an effort to verify the connection between the presence of risk factors for GDM and results of screening and diagnostic tests. Study group consisted 302 patients. Gestational diabetes was more frequently diagnosed when an excessive maternal weight and family history of diabetes occurred. Among women with gestational diabetes recognised on the basis of the tests results (screening or diagnostic), 1/3 of patients had no evidence of any risk factor. There is no correlation between the number of risk factors and the occurrence of gestational diabetes. The risk factors were present in half of the investigated patients.

[The effect of selected factors on the birthweight of the newborns in gestational diabetes]. / Wplyw wybranych czynników na mase urodzeniowa noworodków matek z cukrzyca ciezarnych.

Fetal macrosomia is commonly associated with gestational diabetes mellitus (GDM) which may lead to various complications. We attended to establish maternal constitutional and metabolic risk factors responsible for the genesis of macrosomia. 219 GDM mothers were divided into two groups treated by diet or insulin. This study shows that maternal glycemic status and maternal nutritional status before pregnancy are important determinants of fetal macrosomia.

[Pregnancy in women with diabetes complicated by nephropathy and proliferative retinopathy]. / Ciaza u kobiet chorych na cukrzyce powiklana nefropatia i retinopatia proliferacyjna.

Nephropathy and proliferative retinopathy are widely known as the most serious complications of diabetes. In the paper the analysis of the course of pregnancy, labour and neonatal complications among mothers with White class F, R, FR and T was made. The study group consisted of 44 patients. Primary hypertension was observed in 17 (38.6%) patients. The percentage of complications both maternal and neonatal was very high. Among maternal complications were pregnancy induced hypertension (43.2%), urinary tract infections (36%), anaemia (22.7%), threatened preterm labor (13.6%). Nearly 50% of patients has diurnal proteinuria in nearly 50% of patients exceed 3 g. In the opinion of the authors there is a strong need to establish the national supraregional centers designed specially to deal with the problems of pregnant women with diabetic nephropathy and retinopathy.

[Factors affecting birthweight in insulin-dependent diabetes mellitus pregnancy]. / Wplyw wybranych czynników na mase urodzeniowa noworodków matek z przedciazowa cukrzyca insulinozalezna.

Fetal growth is affected by various maternal factors. Metabolic disturbances often present in pregnancy complicated by insulin-dependent diabetes mellitus may have important effect on birthweight. The aim of this study was to evaluate the influence of maternal morphometric and metabolic factors on birthweight parameters in women with IDDM. Data were analyzed from 124 diabetic women who delivered in I Department of Obstetrics and Gynaecology University Medical School in Warsaw between 1989-1998. Maternal morphometric factors, glycemic control, insulin requirement, glycosylated hemoglobin and fructosamine levels were correlated with birthweight and birthweight ratios. Glycemic control in first weeks of second part of pregnancy as well as maternal height and weight gain during pregnancy affected birthweight in women with insulin-dependent diabetes mellitus.

[Influence of intelligence level of the type I diabetic patients handling hi-tech glycemia monitoring system on the effectiveness of intensive insulin treatment]. / Wplyw poziomu inteligencji pacjentów z cukrzyca typu 1 stosujacych wysokospecjalistyczny system monitorujacy glikemie na wyniki intensywnej insulinoterapii podczas ciazy.

An intensive care system designed and developed in IBBE PAS allows for electronic storage and automatic transmission of BG values and other parameters directly from a patient's BG meter and electronic logbook (Glucometer M+ Bayer) to central clinical computer by telematic connection. Despite effort made to keep the system as simple as possible, its proper handling still requires some additional skills from the patient. Thus, effectiveness of the intensive insulin treatment supported by the system may be influenced by the patient's intelligence level. The aim of this work was to evaluate influence of the intelligence level of type 1 diabetic patients equipped with designed system on effectiveness of a long-term intensive insulin treatment. The study group consisted of 17 type 1 diabetic pregnant women randomly divided in two sub-groups. Eight patients used the transmission system and the remaining 9 patients were treated classically. Patient's intelligence level was assessed according Wechsler scale. Analysis of variance indicated that intelligence level did not influence significantly on average result of the treatment (p > 0.05) in whole study group and in both subgroups. Generally, in patients with lower (93 +/- 2.0) and higher (114.1 +/- 1.2) intelligence level glycemic control indices were found to be similar and did not differ significantly. Performed analysis indicated that the designed system could be properly handled by diabetic patients within wide range of intelligence level. However, despite not statistically significant influence of the patients intelligence level on obtained glycemic control, tendency was observed to obtain better average long-term glycemic control in patients with lower intelligence level using telematic data transmission in comparison with the patients treated in classical way (SDWG = 7.0 +/- 0.4 vs. 8.1 +/- 1.0 mmol/l and J = 30.3 +/- 4.4 vs. 39.0 +/- 12.2).

[Glucose tolerance disorders in patients with cancer of the colon]. / Zaburzenia tolerancji weglowodanów u chorych na raka jelita grubego.

Relating to the Williams' report suggesting twofold higher incidence of diabetes mellitus in patients with the cancer of the colon, the study aiming at comparing an incidence of diabetes mellitus in patients with stomach, lung, and colon malignancies were carried out. Coexistence of the above listed neoplasms with diabetes mellitus type II was assessed in patients hospitalized at the Department of Gastroenterology and Metabolic Diseases, Institute of the Internal Diseases, Medical Academy in Warsaw within 1978-1986. Moreover, glycaemia and insulinemia curves were plotted following oral glucose load (75 g) in 16 patients with the cancer of the colon and 15 patients without malignancy. Only patients with body weight not exceeding 10% of the normal body weight, without history of diabetes mellitus and not treated with corticosteroids were classified for the study. Mean glycaemia and insulinemia values did not differ statistically in the investigated groups except statistically significantly higher serum insulin level in patients with cancer of the lung in the thirties minute of the test. Differences statistically significant were also not observed in retrospective analysis. However, an incidence of diabetes mellitus in patients with the cancer of the colon was 10.5% being higher than mean incidence of diabetes mellitus in this age group. Moreover, glucose load test has shown tolerance abnormalities in 4 patients with cancer of the colon, 1 patient with cancer of the lung, and 1 patient without malignancy. The obtained results indicate tendency to higher incidence of carbohydrate metabolism disorders in patients with cancer of the colon.