Analysis of National Health and Insurance Registers for All-Cause Mortality in Patients with Heart Failure with and without Diabetes Mellitus in Poland in 2012.

BACKGROUND This retrospective study aimed to analyze all-cause mortality in patients with heart failure with and without diabetes mellitus in 2012 in Poland using data from the National Health Fund [Narodowy Fundusz Zdrowia] (NFZ), the Central Register of the Insured [Centralna Baza Ubezpieczonych] (CBU), and the Polish Universal Electronic System for Registration of the Population (PESEL). MATERIAL AND METHODS Between 1st January 2012 and 31st December 2012, data were analyzed from the NFZ, CBU, and PESEL to include all patients with a primary diagnosis of heart failure, with and without diabetes mellitus and all-cause mortality data. Structured Query Language (SQL) was used to retrieve and manage data from NFZ, CBU, and PESEL. RESULTS In Poland, 32.58% of 201,586 patients with a primary diagnosis of heart failure who died in 2012 also had a diagnosis of diabetes mellitus. The overall mortality rate in men with heart failure and diabetes was eight times higher than for men with heart failure without diabetes. The overall mortality rate in women with diabetes and heart failure was 5.5 times higher compared with women with heart failure without diabetes. More than 90% of deaths in female patients with heart failure, with or without diabetes, occurred in women >60 years. For male patients with heart failure with or without diabetes, 70% of deaths occurred in men >60 years. CONCLUSIONS These findings support the need for continued prevention programs, early diagnosis, and treatment of diabetes, and highlight the increase in mortality for patients with heart failure and diabetes.

Gestational diabetes mellitus/hyperglycaemia during pregnancy in Poland in the years 2010-2012 based on the data from the National Health Fund.

OBJECTIVES: The incidence of gestational diabetes varies depending on a country and it is extremely difficult to analyse. The aim of the study was to assess the incidence of gestational diabetes in Polish population. MATERIAL AND METHODS: Based on the data from the National Health Fund (NHF) the authors analysed reports regarding deliveries performed and then, determined the rates of gestational diabetes/hyperglycaemia during pregnancy and pregestational diabetes in Poland in the years 2010-2012. RESULTS AND CONCLUSIONS: In Poland, the incidence of gestational diabetes was estimated to be 4.665% in 2010, 6.918% in 2011 and 7.489% in 2012. The incidence of pregestational diabetes was 1.067% in 2010, 1.116% in 2011 and 0.932% in 2012.

Clinical aspects of fungal infections in diabetes.

Diabetes mellitus is one of the main risk factors of fungal infections of oral cavity, lower part of gastrointestinal tract, skin, foot, urogenital system and blood. Mycosis is a serious diagnostic and therapeutic problem and cause of mortality in diabetes. Fungal infections are also an important problem among hemodialysis patients with diabetes or diabetic patients after pancreas or kidney transplantation This work briefly describes the etiology, symptoms, diagnosis and ways of prophylaxis and treatment of mycosis in diabetic population. There is also emphasized the great connection between effective treatment of mycosis and glycemic control.

Insulin replacement therapy in patients with type 1 diabetes by isolated pancreatic islet transplantation.

Diabetes mellitus is a metabolic disease characterized by chronic hyperglycemia which causes micro- and macrovascular complications. A significant increase in diabetes morbidity rate has been observed. It is estimated that in year 2030 there will be 552 million diabetics worldwide. Type 1 diabetes requires lifelong treatment with insulin. The only available treatment of diabetes restoring physiological glucose metabolism is transplantation of pancreatic beta cells in form of pancreas or isolated pancreatic islets transplantation. The treatment restores normoglycemia and reduces chances of complications of diabetes. Over the past 10 years there has been significant progress in the development of the islet transplantation procedure. Constant improvement of the method, in particular the development of islets isolation and sourcing techniques, shows promise. According to the Collaborative Islet Transplant Registry in 1999-2009, there have been performed 1,072 allotransplantations. This paper summarizes the indications and contraindications for the procedure, the transplantation process, as well as the surgical procedure and immunosuppressive treatment. The review presents problems related to pancreatic islet cells transplantation and standard scheme of immunosuppressive treatment, requiring a solution.

The association of diabetes with all-cause mortality in patients with end-stage renal disease compared to the general population in Poland - a comparative analysis.

Introduction: End-stage renal disease (ESRD) is an important complication of diabetes, which is the leading cause of ESRD worldwide. The aim of the study was a comparative analysis of all-cause mortality in patients with ESRD with diagnosed diabetes mellitus (DM) and no diagnosed DM. Material and methods: Data for the analysis were obtained from the resources of the Polish National Health Fund, and they concerned patients with end-stage renal disease from the entire population of Polish patients in the period from 1.01.2011 to 31.12.2013. In addition, the period from 1.01.2012 to 31.12.2012 was analysed for two subpopulations: diabetic and non-diabetic patients. Results: The all-cause mortality in patients with end-stage renal disease in Poland per 100,000 representatives of the general population was 17.7, 15.9, and 12.50 persons in 2011, 2012, and 2013, respectively. The all-cause mortality rates for patients with ESRD and diabetes in Poland in 2012 were more than 15 times higher, for both men and women, than the all-cause mortality rates for non-diabetic patients with ESRD. Mortality in the study group of diabetic men with ESRD amounted to 147.59 ±29.07/100,000 men, whereas in the study group of diabetic women with ESRD it was 105.13 ±26.77/100,000 women. Regarding non-diabetic men with ESRD and non-diabetic women with ESRD, mortality amounted to 9.58 ±6.29/100,000 and 6.87 ±2.27/100,000 men and women, respectively. Conclusions: The occurrence of diabetes in patients with ESRD significantly increases the risk of death compared to patients with ESRD without diabetes.

Monitoring of diabetic foot syndrome treatment: some new perspectives.

Diabetic foot syndrome (DFS) is one of the major complications of diabetes, and it can lead to foot amputations. It is very important to assure good medical care for diabetic patients not only during their stay at hospital but also at home. Telecare can be one good solution for extending medical care to patients' homes. There are some reports regarding the application of new technologies in this field. The standard current model of telecare of DFS includes experts at hospital who conduct clinical examinations and decision making at a distance, in close cooperation with a visiting nurse and the patient. In the present paper a new paradigm of the DFS's telecare is introduced, which eliminates the visiting nurse. The designed and developed TeleDiaFoS system consists of a traditional database and mobile patient's module (PM) allowing for documentation of the foot images as well as the results of blood glucose and blood pressure measurements taken by the patient himself at home. A 2-year validation of the TeleDiaFoS system on 10 DFS patients (3 months each) proved its usefulness and led to acceptance of this type of technical support by patients and physicians. The designed and developed system and proposed sterilization procedure of the PM have been found to be easy to use by the patient at home.

Diabetes mellitus and congestive heart failure: the prevalence of congestive heart failure in patients with and without diabetes in Poland.

INTRODUCTION: Diabetes mellitus is a systemic disease and has a negative effect on the cardiovascular system. This paper aimed to present a retrospective analysis of morbidity associated with heart failure in subgroups of patients with and without diabetes in Poland in 2012. MATERIAL AND METHODS: Data from the National Health Fund were used for the study. In general, 656,937 patients with heart failure, including 281,538 males and 375,354 females, were studied. In this population, additionally, 201,043 patients with heart failure (main diagnosis) and diabetes were studied, including 82,117 males and 118,926 females. RESULTS: The mean index of morbidity associated with heart failure in the whole subpopulation of diabetes patients was 9.03%; 8.42% for males and 9.50% for females. Morbidity associated with heart failure in the population of patients diagnosed with diabetes in Poland in 2012 was seven times higher compared to morbidity associated with heart failure in non-diabetes patients. Morbidity associated with heart failure in females was significantly higher compared to morbidity in males in the whole population, in both the subpopulations of patients with and without diabetes. CONCLUSIONS: Diabetes mellitus significantly increases risk of heart failure in both women and men. The risk is significantly high after the age of 60 years and higher in females.

Leptin in acute myocardial infarction and period of convalescence in patients with type 2 diabetes mellitus.

BACKGROUND: Leptin is a protein produced in adipose tissue and takes part in angiogenesis and atherogenesis. Leptin is associated with development of type 2 diabetes and cardiovascular disease. AIM: To evaluate leptin concentrations in acute myocardial infarction and in the period of convalescence in patients with type 2 diabetes mellitus. METHODS: Coronary angiography was performed in 58 patients with acute myocardial infarction. The study group comprised 35 patients with type 2 diabetes mellitus (DM) (25 men, 10 women, mean age 63.8 + or - 11.5 years) and 23 non-diabetic subjects (17 men, 6 women, mean age 58.6 + or - 9.9 years) - the control group. All patients underwent medical examination and body mass indices (BMI) as well as waist/hip ratios (WHR) were calculated. Venous blood was collected after 24 hours of admission (second day), on day 5 and three weeks after admission. RESULTS: Leptin level was significantly associated with BMI (DM: r = 0.46, p = 0.005; control group: r = 0.67, p < 0.01), and hip circumference (DM: r = 0.28, p = 0.09; control group: r = 0.41, p = 0.04). Plasma leptin levels in women with type 2 diabetes were higher than in men (32.1 + or - 11.7 microg/mL vs 12.7 + or - 11.2 microg/mL, p < 0.01). Plasma leptin levels were significantly lower in non-diabetics compared to diabetic patients. Plasma leptin levels in diabetic patients were significantly higher in the acute phase of myocardial infarction than in the period of convalescence (18.3 + or - 14.3 microg/mL, 16.1 + or - 12.8 microg/mL, 14.8 + or - + or - 11.2 microg/mL, p = 0.02) but not in the control group (10.6 + or - 8.2 microg/mL, 10.0 + or - 7.3 microg/mL, 9.6 + or - 7.0 microg/mL, NS). CONCLUSIONS: Plasma leptin levels in diabetic patients were significantly higher in the acute myocardial infarction than in the period of convalescence. These findings suggests that leptin may play an important role in the metabolic changes taking place during the first days of myocardial infarction.

Geographic variability of major non-traumatic lower limb amputations in diabetic and non-diabetic patients in Poland.

INTRODUCTION: High amputation of the lower limb not only causes immense physical disability but also the destruction of the patient's mental state, and helps to shorten life of patients with diabetes. The incidence of amputations in diabetic patients is 10 times higher in comparison to non-diabetic subjects (2.8% vs. 0.29%). The purpose of the study is an analysis of the geographic variability of major non-traumatic lower limb amputation in diabetic and non-diabetic patients in Poland. MATERIAL AND METHODS: All major non-traumatic lower limb amputations performed for the first time, in particular databetween 1 January 2013 - 31 December 2013, and between 1 January 2014 - December 2014, were identified in the National Health Fund (NHF) database. In the presented study, the patients were grouped in relevant provincial departments of the NHF according to their place of residence, and not according to the hospital where lower limb amputation was performed. RESULTS: In 2013 in Poland, 4,727 major non-traumatic lower limb amputation were performed in diabetic patients, and 4,350 in 2014. On the other hand, in non-diabetic patients, 3,469 major non-traumatic lower limb amputations were performed in 2013, and 3149 in 2014. The mean number indicator of major non-traumatic lower limb amputations in diabetic patients in Poland, compared to the average indicator of amputations in patients without diagnosed diabetes in Poland was 19.9-fold in 2013 and 19.4-fold higher in 2014. CONCLUSIONS: In populations of diabetic patients and individuals without diagnosed diabetes major non-traumatic lower limb amputations are performed over 19-fold more frequently.

Comparison of the incidence of new malignancies in diabetic patients in urban and rural populations in Poland in the years 2008-2014 based on the database of the National Health Fund.

INTRODUCTION: Many epidemiological studies show a correlation between the risk of cancer and type 2 diabetes mellitus in various populations. MATERIAL AND METHODS: The material was obtained from the database of the National Health Fund. This publication presents a comparison of the incidence of new malignancies in rural and urban populations of diabetic patients in Poland based on the database of the National Health Fund for the period between 1.05.2008 and 30.09.2014. RESULTS: Comparison of the mean incidence of selected malignancies in diabetic patients in the population analysed indicated significant differences between the incidence rate in the urban and rural populations (p < 0.001). The mean incidence of gastric cancer, colorectal cancer, kidney cancer, brain tumours and leukaemia in both sexes was significantly higher in rural areas compared to urban. The mean incidence of oesophageal cancer and pancreatic cancer in females was significantly higher among in the urban population compared to the rural areas (p < 0.001). No differences in the incidence rate of these neoplasms were observed in men (p > 0.05). CONCLUSIONS: The incidence of gastric cancer, colorectal cancer, laryngeal cancer, lung cancer, testicular cancer, kidney cancer, lung cancer, lymphocytic leukaemia and myeloid leukaemia is higher in diabetic males in rural areas than the incidence in the urban population. The incidence of the malignancies liver cancer, malignant skin melanoma, malignant skin, prostate cancer, urinary bladder cancer and multiple myeloma in male diabetic patients living in urban areas is higher than the incidence in rural areas.

Evaluation of the incidence of aortic aneurysms in patients with and without diabetes in Poland in 2012 based on the database of the National Health Fund.

INTRODUCTION: There are reports that diabetes mellitus reduces the risk of aortic aneurysms and many reports that diabetes mellitus reduces the risk of abdominal aortic aneurysms. In earlier years there were also studies that did not demonstrate any effects of diabetes on the rate of aortic aneurysms. MATERIAL AND METHODS: For the year 2012, between 1 January and 31 December, reports for services regarding treatment for aortic aneurysms were found. At the same time, the reports for services associated with diabetes with the main diagnosis of "diabetes mellitus" were found in National Health Fund databases for 2012 with the special determinants. RESULTS: In Poland in 2012 the mean incidence of aortic aneurysms in both sexes in the group of subjects with diabetes calculated per 100,000 subjects with diabetes was 167.78 ±49.10, and the mean incidence of aortic aneurysms in both sexes in the group of subjects without diabetes calculated per 100,000 of the general population after subtracting the number of subjects with diabetes was 27.72 ±9.40. The incidence of aortic aneurysms among subjects with diabetes was significantly higher (p < 0.001) than the incidence of aortic aneurysms among subjects without diabetes. CONCLUSIONS: Aortic aneurysms were more frequently observed in the group of patients with diabetes than in those without diabetes. Aortic aneurysms were observed three times more frequently in men than in women. In Poland in 2012, 27.20% of patients diagnosed with aortic aneurysms also had diabetes.

A novel intravenous iron formulation for treatment of anemia in inflammatory bowel disease: the ferric carboxymaltose (FERINJECT) randomized controlled trial.

BACKGROUND AIMS: Anemia is a common complication of inflammatory bowel diseases (IBD) This multicenter study tested the noninferiority and safety of a new intravenous iron preparation, ferric carboxymaltose (FeCarb), in comparison with oral ferrous sulfate (FeSulf) in reducing iron deficiency anemia (IDA) in IBD. METHODS: Two hundred patients were randomized in a 2:1 ratio (137 FeCarb:63 FeSulf) to receive FeCarb (maximum 1,000 mg iron per infusion) at 1-wk intervals until the patients' calculated total iron deficit was reached or FeSulf (100 mg b.i.d.) for 12 wk. The primary end point was change in hemoglobin (Hb) from baseline to week 12. RESULTS: The median Hb improved from 8.7 to 12.3 g/dL in the FeCarb group and from 9.1 to 12.1 g/dL in the FeSulf group, demonstrating noninferiority (P= 0.6967). Response (defined as Hb increase of >2.0 g/dL) was higher for FeCarb at week 2 (P= 0.0051) and week 4 (P= 0.0346). Median ferritin increased from 5.0 to 323.5 mug/L at week 2, followed by a continuous decrease in the FeCarb group (43.5 mug/L at week 12). In the FeSulf group, a moderate increase from 6.5 to 28.5 mug/L at week 12 was observed. Treatment-related adverse events (AEs) occurred in 28.5% of the FeCarb and 22.2% of the FeSulf groups, with discontinuation of study medication due to AEs in 1.5% and 7.9%, respectively. CONCLUSIONS: FeCarb is effective and safe in IBD-associated anemia. It is noninferior to FeSulf in terms of Hb change over 12 wk, and provides a fast Hb increase and a sufficient refill of iron stores.

Microdialysis technique as a monitoring system for acute complications of diabetes.

The objective of the study was to establish the quasi-continuous courses, using microdialysis technique, of glucose, lactate, and glycerol concentrations in interstitial fluid of abdominal adipose tissue during the standard treatment of acute diabetes complications. Clinical studies were carried out on 31 diabetic patients during the initial 48 h of the treatment. In all but two obese female patients with hyperglycemic hyperosmolar state (HHS) did glucose concentration in perfusion fluid (PF) reflect concentration in capillary blood. The recovery of glucose correlated with patients' body mass index (r = 0.55). It was significantly higher in lean and overweight patients (91 +/- 15%) than in obese patients (55 +/- 31%). The course of lactate concentration in PF coincided with the course in venous blood (2.1 +/- 0.3 mmol/L vs. 2.0 +/- 0.5 mmol/L, P = 0.35). Glycerol concentration was 267 +/- 41 micromol/L and 133 +/- 40 micromol/L in PF and venous blood, respectively (P = 0.004). The study indicated that microdialysis may be an effective tool to monitor concentration of different metabolites in interstitial fluid of the adipose tissue during treatment of the acute complications of diabetes. Applicability of the technique in the monitoring of HHS, especially in obese female patients, needs further investigation.

Assessment of the incidence rate of end-stage renal disease in patients with and without diabetes in Poland.

INTRODUCTION: Several studies have suggested, that diabetes is very important factor of the risk of the chronic a renal disease. The paper aims to present a retrospective analysis of incidence of end-stage renal disease in subgroups of patients with and without diabetes in Poland. MATERIAL AND METHODS: For assessing this problem an electronic search was performed using Polish National Health Fund data base from 01.01.2011 until 31.12.2013 in general population and from 01.01.2012 until 31.12.2012 in 2 populations: with diabetes and without diabetes mellitus. RESULTS: The 43.70 % patients with end-stage renal disease was diabetic. The incidence rate in 2012 was: 292.48 ± 90.97 diabetic men / 100,000 diabetic population; 203.10 ± 90.97 diabetic women / 100,000 diabetic population; 23.44 ± 6.34 non-diabetic men / 100,000 non-diabetic population; 17.88 ± 6.33 non-diabetic women / 100,000 non-diabetic population. CONCLUSIONS: The incidence rate of end-stage renal failure in diabetics was multiple times higher than the incidence rate in non-diabetics. The incidence rate of new ESRD cases in Poland estimated to be 36.17 per 100,000 of general populations in 2011, 35.28% in 2012 and 30.46 per 100,000 of general populations in 2013. In 2012, the incidence rate of new ESRD cases in male diabetics was 292.48 ± 90.97 per 100,000 of diabetes men population, and in women diabetics 203.10 ± 66.06 per 100,000 of diabetes women population. In the same 2012 year, the incidence of new ESRD cases in men non-diabetics was 3.44 ± 6.34 per 100,000 of non-diabetes, and in women non-diabetes 17.58 ± 6.33 per 100,000 of non-diabetes women population.

Comment to 'Regarding "Diabetes mellitus increases the risk of ruptured abdominal aortic aneurysms"'.

This publication is a commentary on the Letter to the Editor by Juliette Raffort and Fabien Lareyre. This article clarifies a number of concerns about the method of calculating the index of prevalence of ruptured abdominal aortic aneurysms (AAA). The method of qualifying patients for the study and the method of calculating the index of prevalence of ruptured AAA in cohorts of diabetic and non-diabetic patients was presented. Most researchers calculate the Index of Prevalence per 100,000 of the general population. This gives the misleading result that diabetes reduces the risk of AAA rupture.We used a method which calculated prevalence per 100,000 with diabetes mellitus and per 100,000 without diabetes mellitus. This method confirms that diabetes mellitus increases the risk of ruptured AAA.

Diabetes mellitus increases the risk of ruptured abdominal aortic aneurysms.

The publication is a polemical response to reports that present data that diabetes reduces the risk of rupture of abdominal aortic aneurysm (AAA). The study analyzed all cases of developing AAA in patients with and without diabetes in 2012 in Poland. Data for the analysis were obtained with a unique and complete resources of the National Health Fund (NFZ) and population data from the Central Statistical Office (GUS). In Poland during 2012 2,227,453 patients with diabetes were treated, 975,364 males and 1,252,089 females. The incidence of AAA without rupture in patients without diabetes calculated per 100,000 of the non-diabetes general population was 25.0 +/- 9.0 in males and 5.6 +/- 2.3 in females. The incidence of ruptured AAA in the general population without diabetes was 3.6 +/- 0.9 in males, and 0.6 +/- 0.3 in females calculated per 100,000 of inhabitants without diabetes. The incidence of AAA without rupture in patients with diabetes was 184.897 +/- 70.653 in males and 35.364 +/- 24.925 in females calculated per 100,000 of patients diagnosed with diabetes. The incidence of ruptured AAA in patients with diabetes was 21.090 +/- 6.050 in males and 5.170 +/- 3.053 in females calculated per 100,000 of patients diagnosed with diabetes. The incidence rate for ruptured AAA in 2012 in Poland is statistically higher both in females and males in the population with diabetes. The incidence rate for AAA without rupture in 2012 in Poland is statistically higher in patients diagnosed with diabetes.

Risk factors of diabetic foot of neuropathic origin in patients with type 2 diabetes.

INTRODUCTION: Diabetic foot is a diabetes mellitus complication leading to recurrent ulcerations, risk of osteomyelitis and tissue necrosis which may finally result in amputation. Diabetic foot of neuropathic origin manifesting as autonomic and sensory motor neuropathy is the most common type of this complication. The aim of this study was to identify risk factors of diabetic foot of neuropathic origin occurrence in patients with type 2 diabetes. MATERIAL AND METHODS: The study included 240 patients, 74 with diabetic foot of neuropathic origin and 166 with diabetes. Cases and controls were matched in terms of age structure. Patients with peripheral arterial disease were excluded from the study. The study was conducted in the Gastroenterology and Metabolic Diseases Department, Medical University of Warsaw, Poland. We used logistic regression models, χ2, U Mann-Whitney's and t-Student tests. RESULTS: Logistic regression analysis showed that diabetic foot of neuropathic origin risk factors were: male gender (OR = 6.63; 95% CI: 3.31-13.27; p = 0.00001), duration of diabetes (OR = 1.10; 95% CI: 1.06-1.14; p = 0.00001), height (OR = 1.09; 95% CI: 1.06-1.13; p = 0.00001), weight (OR = 1.04; 95% CI: 1.04-1.06; p = 0.00001) and waist circumference (OR = 1.05; 95% CI: 1.02-1.08; p = 0.001). Although there was a correlation between diabetic foot of neuropathic origin and BMI value, it had no impact on DF occurrence risk. CONCLUSION: It is possible to identify patients at risk of diabetic foot development by evaluating anthropometric features. The existence of specific factors increasing the odds of diabetic foot of neuropathic origin occurring may lead to the identification of patients at risk of its development.

Differences between cardiologists and internists in the management of heart failure. Medical guidelines compared with every-day practice.

BACKGROUND: A marked progress in the treatment of chronic heart failure (CHF) took place during the last decade. Large, randomised studies documented the role of angiotensin-converting enzyme inhibitors (ACE-I) and beta-blockers in the reduction of mortality and morbidity in CHF. AIM: To assess differences in the management of CHF patients between cardiologists and internists. METHODS: Medical records of 433 patients with CHF, aged 38-98 years, hospitalised between October 2000 and May 2002 in an academic centre, were retrospectively analysed. Cardiologists treated 241 patients, and internists - 192 patients. In addition, 12 randomly selected physicians who treated CHF patients, filled-in a questionnaire concerning CHF treatment. Next, the answers were compared with the actual treatment, documented in patients medical files. RESULTS: There were significant differences in the CHF treatment between cardiologists and internists. Cardiologists significantly more often prescribed ACE-I in NYHA class III patients (77% vs 58%, p=0.003), beta-blockers in all NYHA classes (80% vs 57%, p<0.001), loop diuretics in NYHA classes III and IV (76% vs 42%, p<0.001 and 91% vs 44%, p=0.005), and thiazides in NYHA class III patients (36% vs 11%, p<0.001). Internists more often used loop diuretics (37% vs 15%, p<0.001), digoxin (28% vs 7%, p<0.001) and aldosterone antagonists (24% vs 13%, p=0.022) in NYHA class II patients. All cardiologists and almost half of internists declared combined usage of ACE-I and beta-blockers at increasing dosages as the treatment was continued. The highest concordance between declared and actual medication concerned the concomitant use of ACE-I and beta-blockers. CONCLUSIONS: Cardiologists used more often ACE-I and beta-blockers than internists in the treatment of CHF patients. A satisfactory knowledge of treatment guidelines was not associated with widespread usage of ACE-I and beta-blockers in every-day practice.

Diabetic foot risk factors in type 2 diabetes patients: a cross-sectional case control study.

BACKGROUND: Diabetic foot is a serious condition in patients with a long lasting diabetes mellitus. Diabetic foot treated improperly may lead not only to delayed ulceration healing, generalized inflammation, unnecessary surgical intervention, but also to the lower limb amputation. The aim of this study was to compare diabetic foot risk factors in population with type 2 diabetes and risk factors for diabetes in healthy subjects. METHODS: The study included 900 subjects: 145 with diabetic foot, 293 with type 2 diabetes without diabetic foot and 462 healthy controls matched in terms of mean age, gender structure and cardiovascular diseases absence. Study was conducted in Gastroenterology and Metabolic Diseases Department, Medical University of Warsaw, Poland. In statistical analysis a logistic regression model, U Mann-Whitney's and t-Student test were used. RESULTS: The binomial logit models analysis showed that the risk of diabetic foot in patients with type 2 diabetes was decreased by patient's age (odds ratio [OR] = 0.94; 95% confidence interval [CI]: 0.92-0.96; p = 0.00001) and hyperlipidaemia (OR = 0.54; 95% CI: 0.36-0.81; p = 0.01). In contrast, male gender (OR = 2.83; 95% CI: 1.86-4.28; p = 0.00001) diabetes duration (OR = 1.04; 95% CI: 1.03-1.06; p = 0.0003), weight (OR = 1.04; 95% CI: 1.03-1.06; p = 0.00001), height (OR = 1.08; 95% CI: 1.05-1.11; p = 0.00001) and waist circumference (OR = 1.028; 95% CI: 1.007-1.050; p = 0.006) increase the risk of diabetic foot. The onset of type 2 diabetes in healthy subjects was increased by weight (OR = 1.035; 95% CI: 1.024-1.046; p = 0.00001), WC (OR = 1.075; 95% CI: 1.055-1.096; p = 00001), hip circumference (OR = 1.03; 95% CI: 1.01-1.05; p = 0.005), overweight defined with body mass index (BMI) above 24,9 kg/m(2) (OR = 2.49; 95% CI: 1.77-3.51; p = 0.00001) and hyperlipidaemia (OR = 3.53; 95% CI: 2.57-4.84; p = 0.00001). CONCLUSIONS: Risk factors for Type 2 diabetes and diabetic foot are only partially common. Study proved that patients who are prone to developing diabetic foot experience different risk factors than patients who are at risk of diabetes. Identification of relationship between diabetic foot and diabetes risk factors in appropriate groups may help clinicians to focus on certain factors in diabetic foot prevention.

Comparison of indicators of the use of insulin and oral diabetes medication in a Polish population of patients in urban and rural areas in the years 2008, 2011 and 2012.

INTRODUCTION: Diabetes is one of the 10 most important chronic diseases in the world. According to the data of the International Diabetes Federation, in Poland 9% of the population between the ages of 20-79 suffer from diabetes. OBJECTIVE: The aim of this study was to investigate the differences in the prevalence of diabetes in urban and rural areas in Poland, and the preparation of a model describing the phenomenon. MATERIALS AND METHOD: Differences between urban and rural areas were studied for the occurrence of patients treated with diabetes per 100,000 inhabitants, the number of patients, structure of treatment per the used products, and the costs of reimbursement of treatment products between 2008-2012. Urban and rural cases were compared using zip codes. The basis for classifying a patient as being an inhabitant of an urban or rural area was an urban zip code of the declared place of residence. RESULTS: Differences were observed both between various areas of Poland, as well as depending on whether the declared place of residence of the patient was urban or rural. Differences between urban and rural areas within the studied period have increased. The difference in the prevalence of diabetes among the inhabitants of Podlaskie, Slaskie or Swietokrzyskie provinces is striking. CONCLUSION: Differences between urban and rural areas which depend on morbidity and detection of patients in the earlier phase of illness, the structures of medical technologies used in the treatment process, the number of purchased pharmaceuticals, enable better monitoring of effectiveness and quality of politics on prevention and treatment of chronic diseases. It is important for the creation of a health policy to devise a system of indicators, which will enable a decrease in the existing differences between regions, and between the urban and rural areas within the provinces.