Adiponectin, leptin and IL-1 ß in elderly diabetic patients with mild cognitive impairment.

The aim of the study was to determine the serum levels of adiponectin, leptin and IL-1 ß in elderly diabetic patients with and without mild cognitive impairment (MCI) and to examine the associations of these markers with clinical and cognitive parameters. A biochemical evaluation was performed of 62 seniors with type 2 diabetes (T2DM) and MCI, and 132 seniors with T2DM but without MCI (controls). Serum leptin and IL-1 ß levels were higher and adiponectin concentration was lower in MCI patients than controls. In MCI subjects, adiponectin level was negatively correlated with leptin, IL-1 ß levels and BMI. Leptin concentration was correlated with IL-1 ß level. Univariate logistic regression models revealed that the factors which increased the likelihood of diagnosis of MCI in elderly patients with T2DM were higher levels of HbA1c, leptin, IL-1 ß and triglycerides, as well as lower levels of adiponectin and HDL cholesterol. Similarly, previous CVD, hypertension, hyperlipidemia, retinopathy, nephropathy, hypoglycemia, longer duration of diabetes, increased number of co-morbidities, older age, fewer years of formal education were found to be associated with MCI. The multivariable model indicated fewer years of formal education, previous CVD, hypertension, increased number of co-morbidities, higher HbA1c and IL-1 ß levels and lower adiponectin level. Elderly diabetic patients with MCI have higher levels of leptin and IL-1 ß and lower levels of adiponectin. Further prospective studies are needed to determine the role of these markers in the progression to dementia.

Plasma levels of thrombomodulin, plasminogen activator inhibitor-1 and fibrinogen in elderly, diabetic patients with depressive symptoms.

BACKGROUND: Diabetes, depression and aging have been associated with pro-inflammatory and prothrombotic state. AIM: The aim of the study was to determine the plasma levels of thrombomodulin, plasminogen activator inhibitor-1 (PAI-1) and fibrinogen in elderly diabetic patients with and without depressive symptoms and to examine factors (including thrombomodulin, PAI-1, fibrinogen levels) associated with depressive symptoms in elderly patients with type 2 diabetes (T2DM). METHODS: A total of 276 T2DM elders were evaluated: 82 subjects with depressive symptoms and 194 controls. Data were collected concerning biochemical parameters and biomarkers. RESULTS: Plasma thrombomodulin, PAI-1 and fibrinogen were elevated in patients with depressive symptoms compared to controls. Thrombomodulin level was correlated with fibrinogen and PAI-1 levels. All parameters were correlated with the Geriatric Depression Scale-30 score. The univariate logistic regression models revealed that variables which increased the likelihood of diagnosis of depressive symptoms in elderly patients with T2DM were: female sex, smoking habit, longer duration of T2DM, hyperlipidemia, neuropathy, increased number of co-morbidities, higher BMI, and higher levels of total and LDL cholesterol, thrombomodulin, PAI-1 and fibrinogen. In addition, the multivariable analysis indicated that female sex, smoking habit, increased number of co-morbidities, higher BMI, and higher levels of LDL cholesterol and thrombomodulin are the predisposing factors for depressive symptoms. CONCLUSIONS: Elderly diabetic patients with depressive symptoms have higher levels of thrombomodulin, PAI-1 and fibrinogen. Further prospective larger studies are needed to provide potential directions for the research, treatment and prevention of co-morbid depression and diabetes.

C-Reactive Protein, Advanced Glycation End Products, and Their Receptor in Type 2 Diabetic, Elderly Patients with Mild Cognitive Impairment.

OBJECTIVE: The aim of the study was to evaluate serum levels of advanced glycation end products (AGEs), receptor for advanced glycation end products (RAGE), and C-reactive protein (CRP) in elderly patients with type 2 diabetes mellitus with and without mild cognitive impairment (MCI) and to determine the predictors (including AGEs, RAGE, and CRP levels) of having MCI in elderly patients with type 2 diabetes. METHODS: Two hundred seventy-six diabetics elders were screened for MCI (using the Montreal Cognitive Assessment: MoCA score). Data of biochemical parameters and biomarkers were collected. RESULTS: Serum AGEs, RAGE, and CRP levels were significantly increased in MCI patients compared to controls. In group of patients with MCI, serum RAGE level was positively correlated with AGEs level and with CRP level. RAGE, AGEs, and CRP concentrations were positively correlated with HbA1c levels and negatively correlated with MoCA score. The univariate logistic regression models revealed that variables, which increased the likelihood of diagnosis of MCI in elderly patients with type 2 diabetes were higher levels of HbA1c, RAGE, AGEs, CRP, TG, lower level of HDL cholesterol, previous CVD, HA, or use of HA drugs, hyperlipidemia, retinopathy, nephropathy, increased number of co-morbidities, older age, and less years of formal education. HA or use of HA drugs, previous CVD, higher level of RAGE and CRP, older age and less years of formal education are the factors increasing the likelihood of having MCI in elderly patients with type 2 diabetes in multivariable model. CONCLUSION: In summary, serum AGEs, RAGE, and CRP are increased in the circulation of MCI elderly diabetic patients compared to controls. A larger population-based prospective study needs to be performed to further confirm the relationship between AGEs, RAGE, and the cognitive decline or progress to dementia.

Pneumococcal and seasonal influenza vaccination among elderly patients with diabetes.

Both seasonal influenza vaccination and pneumococcal vaccination are recommended for elderly diabetics. The aim of the study was to determine the rate of seasonal influenza vaccination over the previous twelve months, pneumococcal vaccination over a lifetime, and to identify predictors which affect likelihood of vaccination. 219 diabetics elders were detailed questioned 3 months after the end of 2012/2013 influenza season. 26.48% of patients have been vaccinated against influenza in the last year and only 9.13% of patients reported pneumococcal vaccination in the past. The logistic regression analysis revealed that variables which increased the likelihood of having been vaccinated against influenza were: higher number of anti-hyperglycemic medications, increased number of co-morbidities, higher patients' income, recommendation of vaccination from General Practitioners (GPs) and specialist. Significant predictors of pneumococcal vaccine uptake included increased number of co-morbidities and recommendation of vaccination received from GPs and specialist. The commonest reasons given by those unvaccinated were lack of information about immunization and low perceived benefits of vaccination. Of patients who were not treated with influenza vaccine 86.7% had never received recommendation from specialist and 71.4% had never been advised by GPs. Influenza vaccination was too expensive to 24.85% of patients. The vaccination rate among elderly diabetics in Poland is low. Lack of knowledge and patients' income are the main barriers. Increased awareness of healthcare professionals to educate and encourage vaccination and propagation of free vaccinations to all people at risk may increase the rate of vaccination against influenza and pneumococcal disease.

Serum Soluble Adhesion Molecules and Markers of Systemic Inflammation in Elderly Diabetic Patients with Mild Cognitive Impairment and Depressive Symptoms.

The aim of the study was to determine the serum levels of soluble adhesion molecules and hs-CRP in elderly diabetics with mild cognitive impairment (MCI) alone or with depressive symptoms. Methods. 219 diabetics elders were screened for psychiatric disorders and divided: group 1, MCI without depressive mood; group 2, MCI with depressive mood; group 3, controls. Data of biochemical parameters and biomarkers were collected. Results. In groups 1 and 2 levels of all biomarkers were significantly higher as compared to controls. The highest level of hs-CRP and sICAM-1 was detected in group 2. SVCAM-1 and sE-selectin levels were also the highest in group 2; however they did not significantly differ as compared to group 1. MoCA score was negatively correlated with all biomarkers in group 1. The logistic regression model showed that variables which increased the likelihood of having depressive syndrome in MCI patients were older age, stroke, neuropathy, increased number of comorbidities, and higher sICAM-1 level. Conclusions. We first demonstrated that elderly diabetic patients with MCI, particularly those with depressive mood have higher levels of soluble adhesion molecules and markers of low-grade systemic inflammation. Coexisting depressive syndrome in patients with MCI through common inflammatory pathways may result in augmentation of psychiatric disorders.

[Assessment of chronic glucose metabolism disorders coexisting with respiratory failure in non-critical ill patients hospitalized with lower respiratory tract infections]. / Wspólistnienie zaburzen metabolizmu glukozy z niewydolnoscia oddechowa u pacjentów hospitalizowanych z powodu zakazen dolnych dróg oddechowych.

Lungs are the target organ in chronic hyperglycemia, but its large reserves causes a subclinical course of these changes. Given the results of other researchers indicating reduced active surface of gas exchange and pulmonary capillary damage, it can be assumed that diabetes and other hyperglycemic states diminish these reserves and impair effectiveness of respiratory gas exchange during pneumonia. So it is plausible to observe coexistence of glucose metabolism disorders and respiratory failure in patients hospitalized with lower respiratory tract infection. An observational study was conducted on 130 patients hospitalized with bacteriologically confirmed pneumonia. 63 patients suffering from chronic glucose metabolism disorders (A) and 67 randomly selected patients in control group (B) were observed on laboratory and clinical findings. There was no significant difference in prevalence of acute respiratory failure, although in the study group a slightly greater number of patients diagnosed with acute respiratory failure was observed. There was a significantly greater number of patients with previously confirmed chronic respiratory failure using long-term oxygen theraphy in A group (p = 0.029). The B patients with average blood glucose level > 108 mg/dl had significantly lower partial pressure of oxygen (PaO2)(gIc ≤ 108: 58.6 +/- 9.8; glc > 108: 51.7 +/- 11.1; p = 0.042). There was a statistically significant negative correlation of the average blood glucose level and PaO2 in the control group (p = 0.0152) and a significant inverse association between the average blood glucose level and the partial pressure of oxygen in patients without COPD belonging to the control group (p = 0.049). Respiratory failure is frequent in patients hospitalized with pneumonia. In patients without chronic glucose metabolism disorders with blood glucose level rising the oxygen tension decreases The association is stronger in patients without COPD.

Serum levels of inflammatory markers in depressed elderly patients with diabetes and mild cognitive impairment.

OBJECTIVE: The aim of the study was to determine the serum levels of CRP, IL-6 and TNF-α in elderly diabetic patients with depressive syndrome alone or with coexisting mild cognitive impairment (MCI). METHODS: 276 diabetics elders were screened for depressive symptoms (using Geriatric Depression Scale: GDS-30) and MCI (using the Montreal Cognitive Assessment: MoCA score). Data of HbA1c, blood lipids and inflammatory markers levels were collected. RESULTS: In all groups of patients levels of CRP, IL-6 and TNF-α were significantly higher as compared to controls. The highest level of inflammatory markers was detected in group with depressive mood and coexisting MCI, however IL-6 level didn't significantly differ as compared to MCI group. We founded correlations between all inflammatory markers in group of patients with depressive mood and in group of subjects with depressive symptoms and coexisting MCI. GDS-30 score was correlated with levels of inflammatory markers in group with depressive mood, and with levels of CRP and TNF-α in group with depressive mood and coexisting MCI. In the group with depressive mood and coexisting MCI we founded that MoCA score was negatively correlated with CRP and TNF-α levels; and HbA1c level was positively correlated with all inflammatory markers. The univariate logistic regression models revealed that variables which increased the likelihood of having been diagnosed with MCI in depressed patients were: higher levels of HbA1c, CRP, IL-6 and TNF-α, previous CVD or stroke, increased number of co-morbidities and microvascular complications, older age, less years of formal education. The multivariable model showed that previous CVD, higher HbA1c and IL-6 levels are significant factors. CONCLUSIONS: We demonstrated that the presence of depressive syndrome is associated with higher levels of inflammatory markers in elderly patients with diabetes. The presence of MCI in these depressed subjects has additive effect on levels of inflammatory mediators.

Mild cognitive impairment and depressive symptoms in elderly patients with diabetes: prevalence, risk factors, and comorbidity.

The aim of the study was to estimate the prevalence of mild cognitive impairment (MCI), depressive syndrome cases, and its comorbidity, and to identify predictors of these conditions. Methods. 276 diabetics elders were screened for MCI and depressive symptoms. Detailed information of history of diabetes, and data of BMI, HbA1c, and blood lipids were collected. Results. The prevalence of MCI was 31.5%, depressive syndrome was 29.7%, and MCI with coexisting depressive mood was 9.1%. The logistic regression analysis revealed that variables which increased the likelihood of having been diagnosed with MCI were: higher HbA1c level, previous CVD, hypertension, retinopathy, increased number of comorbidities, and less years of formal education. Significant predictors of having a depressive mood included female gender, single marital status, current and past smoking status, lack of physical activity, higher BMI and total cholesterol level, increased number of comorbidities, history of hypoglycemia, and insulin treatment. Factors associated with both MCI and depressive syndrome were female gender, single marital status, past smoking status, retinopathy, previous CVD or stroke, increased number of comorbidities, and insulin treatment. Conclusions. Depressive symptoms, MCI, and its comorbidity are common in elderly subjects with type 2 diabetes. Systematic screening could result in the identification of high-risk patients.

Selected factors determining a way of coping with stress in type 2 diabetic patients.

OBJECTIVES: The aim of the study was to examine factors which determine stress coping styles in type 2 diabetic (T2D) patients, with regard to selected demographic variables, clinical diabetes-related variables and selected psychical variables (anxiety level and assessment of depressive disorders). METHODS: 50 T2D patients, aged 59.9 ± 10.2 years were assessed by Coping Inventory for Stressful Situations (CISS), Spielberger State-Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI). In the statistical analysis simple and multivariable logistic regression models were used. RESULTS: Variables significantly increasing the selection risk of stress coping style different from preferred task-oriented strategy in a simple logistic regression model are: hypoglycemia within three months prior to the research: odds ratio (OR) = 6.86 (95% confidence interval (CI) 1.25-37.61), taking antidepressants or neuroleptics: OR =15.42 (95% CI 2.42-98.33), severe depression in Beck's scale: OR = 84.00 (95% CI 6.51-1083.65), high state-anxiety level: OR = 9.60 (95% CI 1.08-85.16), and high trait-anxiety level: OR = 18.40 (95%CI 2.96-114.31), but in a multivariable model, diagnosed depression is the strongest factor: OR = 32.38 (95% CI 4.94-212.13). CONCLUSIONS: In T2D patients, the strategy to cope with stress appears to be mostly influenced by psychical predisposition.

Rosiglitazone treatment in nondiabetic subjects with nonalcoholic fatty liver disease.

INTRODUCTION: Pharmacological treatment options for nonalcoholic fatty liver disease (NAFLD) are limited. It has been suggested that thiazolidinediones may be useful in NAFLD treatment. OBJECTIVES: An open-label prospective study was conducted to assess the efficacy and safety of rosiglitazone treatment in nondiabetic subjects with NAFLD. PATIENTS AND METHODS: A total of 27 subjects (mean age 44 ± 11 years, body mass index 29.2 ± 3.1 kg/m2), with biopsy-confirmed NAFLD and no other complaints, were treated with rosiglitazone 4 mg daily for 6 months. RESULTS: No adverse events were observed during a 6-month treatment with rosiglitazone. Liver enzymes gradually decreased (alanine transaminase from 101 ± 59 to 58 ± 39 IU/l, aspartate transaminase from 52 ± 24 to 37 ± 15 IU/l; P <0.001). Plasma insulin levels decreased significantly by 30% to 50% in each time point of the oral glucose tolerance test. The homeostatic model assessment index decreased from 3.73 ± 1.89 to 2.06 ± 1.68 (P <0.001). No significant changes in plasma glucose were noted. Plasma adiponectin increased from 2198 ± 1853 to 5734 ± 1999 ng/ml (P <0.001). There were no statistically significant changes in body weight, glycated hemoglobin A1c, plasma lipids, or leptin. CONCLUSIONS: Rosiglitazone treatment in patients with NAFLD is safe, well-tolerated and leads to a significant improvement in liver function and insulin sensitivity, without adversely affecting the lipid profile.

Long-term results of gastric bypass surgery in morbidly obese type 1 diabetes patients.

BACKGROUND: Long-term effects of bariatric surgery in morbidly obese type 1 patients are unknown. Five to eight-year experience in the case series of type 1 diabetes subjects is presented. METHODS: Three poorly controlled type 1 diabetes patients, aged 19, 23, and 28 underwent Roux-en-Y gastric bypass surgery. RESULTS: Their maximum body weight reduction noted during the follow-up was between 27% and 31% of baseline body weight, insulin requirement decreased from 0.6-0.95 to 0.3-0.83 IU/kg, and absolute reduction in HbA(1c) was 3-4%. Significant improvement in blood pressure, plasma lipid profile, and microalbuminuria was noted. CONCLUSIONS: RYGB surgery in morbidly obese type 1 diabetes patients leads to a significant and maintained weight loss and results in remarkable improvement in blood glucose control and concomitant disorders. Bariatric surgery should be recommended to significantly obese type 1 diabetes patients as a means of reduction of vascular complications risk.

Circadian blood pressure variation in normotensive type 2 diabetes patients and angiotensin converting enzyme polymorphism.

BACKGROUND/AIMS: Loss of circadian blood pressure (BP) variation (i.e., lack of nocturnal BP dip by at least 10mmHg, 'non-dipping') is associated with increased mortality rate in subjects with diabetes. We studied whether angiotensin converting enzyme (ACE) insertion/deletion (I/D) gene polymorphism may play a role in 24-h BP rhythm control. METHODS: The study group was 38 normotensive normoalbuminuric type 2 diabetes patients with impaired BP variation, the controls were 51 well-matched type 2 diabetes subjects with normal 24-h BP rhythm. ACE I/D polymorphism, endothelial function and subclinical inflammation parameters (serum endothelin-1, sE-selectin, intercellular and vascular cell adhesion molecules, tumor necrosis factor-alpha) were assessed. RESULTS: ACE DD genotype was found in 20 (53%), ID genotype in 16 (42%), and II genotype in 2 (5%) study group subjects, while 5 (10%) control subjects had DD genotype, 30 (59%) - ID genotype, and 16 (31%) - II genotype (p<0.0001). Study group subjects presented with marked endothelial dysfunction. CONCLUSION: Impaired circadian blood pressure variation in normotensive normoalbuminuric type 2 diabetes patients is associated with ACE DD genotype and marked endothelial dysfunction when compared to diabetic subjects with normal blood pressure rhythm.

[Adiponectinemia, inflammatory process activity, and endothelial dysfunction in patients with type 2 diabetes and acute coronary syndrome with ST elevation in relation to the severity of lesions in the coronary arteries]. / Adiponektynemia oraz aktywnosc procesu zapalnego i dysfunkcja sródblonka u chorych na cukrzyce typu 2 i na ostry zespól wiencowy z uniesieniem ST w zaleznosci od stopnia zaawansowania zmian w tetnicach wiencowych.

INTRODUCTION: Metabolic disorders developing in diabetes are associated with impaired endothelial function and the presence of subclinical inflammation, in consequence leading to generalized atherosclerosis. Vasoprotective factors include adiponectin, a cytokine with a diverse antiatherosclerotic activity. OBJECTIVES: Evaluation of adiponectin concentrations and activity of the inflammatory process and endothelial dysfunction in patients with type 2 diabetes and acute coronary syndrome (ACS) with ST elevation (STEMI) in relation to the severity of lesions in the coronary arteries. PATIENTS AND METHODS: This study included 72 patients (24 women, 48 men) with type 2 diabetes, treated with sulphonylurea derivatives, diagnosed with STEMI, who underwent percutaneous coronary angioplasty. The treated group consisted of 41 patients, mean age (+/- standard deviation) was 64 +/-9.6 years, the Gensini score (GS) >32 points (more advanced lesions in the coronary vessels). The control group consisted of 31 patients, a mean age of 63 +/-10 years, GS <32 points (less advanced lesions). Within 12 hours after the ACS, serum troponin T activity (TnT), creatine kinase MB isoenzyme (CK-MB), C-reactive protein (CRP), fibrinogen, two adhesion molecules - soluble vascular adhesion molecule-1 (sVCAM-1) and soluble intercellular adhesive molecule-1 (sICAM-1) were evaluated in serum of the patients. Leucocytosis, glucose and insulin levels, and lipid profiles were obtained after overnight fast conditions. RESULTS: Patients in group I demonstrated a significantly higher TnT and CK-MB (1.39 +/-1.3 vs 0.83 +/-0.74 ng/ml, p <0.05; 139.6 +/-178.5 vs 57.48+/-52.1 IU/I p <0.05, respectively), higher concentrations of CRP (12.06 +/-14.3 vs 3.59 +/-4.1mg/l, p <0.05) fibrinogen (4.59 +/-1.93 vs 3.62 +/-1.36 g/l, p <0.05), sVCAM-1 (1393.4 +/-865.4 vs 863.9+/-425.2 ng/ml, p <0.05) and sICAM-1 (735.1+/-316.3 vs 573.3 +/-226.1 ng/ml, p <0.05), higher leucocytosis (11,430 +/-3680 vs 9750+/-3100/microl, p <0.05) and lower adiponectin concentrations (5.8 +/-5.2 vs 8.3 +/-2.9 8 microg/ml, p <0.05) as compared to the control group. CONCLUSIONS: Hypoadiponectinaemia, severity of the inflammatory process and endothelial dysfunction could be factors contributing to the progression of atherosclerotic lesions in the coronary arteries in patients with type 2 diabetes.

[Fosfomycin, co-trimoxazole and nitrofurantoin in the treatment of recurrent uncomplicated urinary tract infections in type 2 diabetes mellitus]. / Fosfomycyna, ko-trymoksazol i nitrofurantoina w leczeniu nawracajacych niepowiklanych zapalen dolnych dróg moczowych u chorych na cukrzyce typu 2.

UNLABELLED: The aim of this study was to comprise the efficacy of chronic therapy with fosfomycin, co-trimoxazole and nitrofurantoin in the treatment and prevention of recurrent urinary tract infections (UTI) in type 2 diabetic women. MATERIALS AND METHODS: The study comprised 90 women aged 50-70 years, who suffered from the UTI (isolated bacterial uropathogen sensitive to fosfomycin, co-trimoxazole and nitrofurantoin). Women were divided into 3 groups. Group I comprised patients, who have been treated with fosfomycin, group II with co-tromixazole and group III with nitrofurantoin. Observation period lasted 9 months and for the 6 months patients were treated with antimicrobial agents. Efficacy of antimicrobial treatment was estimated when both clinical cure and bacteriological eradication of uropathogens were achieved. RESULTS: There were no significant differences in the percentage of patients between study groups, who achieved therapeutic successes after 3 and 6 months of the antimicrobial treatment (NS). Three months after discontinuation of treatment episodes of UTI were observed significantly rarely in group treated with fosfomycin in comparison with the group treated with nitrofurantoin (p = 0.01) and co-trimoxazole (p = 0.02). CONCLUSION: Fosfomycin, co-trimoxazole and nitrofurantoin are safe and effective antimicrobial methods to cure and prevent UTI. Fosfomycin is associated with rarely recurrence of UTI than nitrofurantoin and co-trimoxazole in the period without its taking.

Circadian blood pressure variation and antihypertensive medication adjustment in normoalbuminuric type 2 diabetes patients.

BACKGROUND/AIMS: The aim of the study was to assess the effect of an antihypertensive treatment adjustment on 24-hour blood pressure variation in type 2 diabetes patients. METHODS: The study group included 59 hypertensive type 2 diabetes patients subjected to a single one-step antihypertensive agent dose adjustment (increase or decrease). Ambulatory blood pressure monitoring was performed at baseline and 4-6 weeks after the treatment modification. Controls were 41 matched patients, in whom antihypertensive treatment remained unchanged. RESULTS: At baseline, 45 (76%) study group patients and 29 (71%) controls were 'non-dippers'; a similar number of patients in both groups converted to 'dipping' or vice versa: 11 (19%) from the study group and 7 (17%) controls. 'Converters' from the study group were significantly younger (47.5 +/- 3.9 vs. 56.4 +/- 12.2 years; p < 0.05) and had lower 24-hour systolic blood pressure than 'non-converters': 113.7 +/- 7.2 vs. 127.7 +/- 20.3 mm Hg (p < 0.01). CONCLUSION: A single one-step antihypertensive medication adjustment does not affect 'dipping' status in type 2 diabetes patients. However, the assessment of blood pressure variation should be made with greater caution in younger type 2 diabetes subjects with low systolic blood pressure.

Predicting maximum Roux-en-Y gastric bypass-induced weight reduction--preoperative plasma leptin or body weight?

BACKGROUND: Weight loss after bariatric surgery varies between patients, and predicting the extent thereof is often inaccurate. The aim of this study was to assess the potential of preoperative plasma leptin and body weight in predicting the maximum weight loss within 2 years after Roux-en-Y gastric bypass (RYGBP). METHODS: The study comprised 68 subjects (39 women, 29 men; mean age 36.4 +/- 10.2 years, body weight 130.3 +/- 24.8 kg, BMI 44.4 +/-6.8 kg/m2) undergoing RYGBP who were followed for 2 years. Baseline and maximum follow-up plasma leptin and weight were assessed. RESULTS: Mean maximum weight reduction of 50.5 +/- 19.1 kg (38.0 +/- 9.0%, range 24-100 kg) was noted at 15 +/- 4 months after RYGBP. Baseline plasma leptin was 37.9 +/- 14.5 ng/ml, and decreased to 17.4 +/- 8.1 ng/ml (P < 0.001) at maximum weight reduction. No significant correlation between baseline plasma leptin and absolute or relative weight reduction or minimum body weight achieved was noted. No significant plasma leptin threshold which would be predictive for any consistent extent of weight loss was found. However, baseline body weight was a strong determinant of minimum body weight attained (r = 0.67; P < 0.01) and of maximum absolute weight reduction (r = 0.81; P < 0.01). CONCLUSION: Preoperative plasma leptin concentration cannot be used as a predictor of weight reduction following RYGBP. Preoperative body weight is a reliable predictor of post-RYGBP weight loss.

[Effect of short-term intensive insulin therapy on daily insulin requirement in poorly controlled type 2 diabetes patients]. / Wplyw krótkotrwalej intensywnej insulinoterapii na dobowe zapotrzebowanie na insuline u chorych w okresie dekompensacji cukrzycy typu 2.

Prompt metabolic control improvement and daily insulin requirement assessment are indications for short-term intensive insulin therapy in type 2 diabetes, applied as multiple daily subcutaneous insulin injections (MDI), continuous subcutaneous (CSII) and intravenous insulin infusion (IVII). The study aimed at assessing the mean daily insulin dosage before beginning and after finishing three methods of short-term intensive insulin therapy, discontinued upon achievement of good glycemic control. 90 poorly controlled type 2 diabetes patients, hospitalized in Diabetology Department of Medical University in Lódz, treated with insulin twice daily were enrolled into the study (age 52.8 +/- 6.7 years, mean daily insulin dosage 0.76 +/- 0.28 U.I./kg. of body weight, daily blood glucose profile values 271 +/- 76 mg/dl). The patients were randomized into three groups: the first group treated with MDI, the second with IVII and the third with CSII. Insulin dosage increased significantly after MDI therapy comparing with prehospital values (0.72 U.I./ kg-->0.84 U.I./kg, p = 0.007). No change in daily insulin requirement was noted in CSII and IVII groups. We concluded that CSII and IVII comparing with MDI are more efficient methods of achieving prompt glucose control improvement and they do not lead to the increase in the insulin dosage.

[Fosfomycin in the treatment of recurrent tract infections in type 2 diabetic patients]. / Ocena skutecznosci fosfomycyny w leczeniu nawracajacych zakazen dróg moczowych u chorych na cukrzyce typu 2.

UNLABELLED: The aim of this study was to evaluate the efficacy of chronic therapy with fosfomycin trometamol (TF) in the treatment and prevention of recurrent, uncomplicated urinary tract infections (NIDDM) in type 2 diabetic women. INVESTIGATED GROUP: The study comprised 45 type 2 diabetes women aged 50-70 years. All patients enrolled into the study suffered from the NIDDM presented with clinical signs of uroinfection and positive urine culture with bacterial uropathogen sensitive to TF. Study period lasted 12 months and during the first 9 months patients were treated with TF. The patients remained under regular medical supervision in diabetic outpatient clinic every 3 months. Efficacy of treatment was proved when both clinical cure and uropathogen eradication were achieved in 3, 6, 9 or 12th month from the study beginning. RESULTS: The difference in efficiency of fosfomycin treatment after 3 months of the study duration in comparison with duration before study beginning was statistically different (p<0.001). The differences in efficiency of fosfomycin treatment after 6 months of study duration in comparison with time before 3 months were statistically different (p=0.03). There was not statistically differences in efficiency of fosfomycin treatment between the 6th and 9th month of study duration (NS). CONCLUSION: Fosfomycin is the safe and effective antimicrobial method to cure and prevent NIDDM.

[Efficacy of nitrofurantoin in the treatment of chronic urinary tract infections in patients with type 2 diabetes mellitus]. / Ocena skutecznosci nitrofurantoiny w leczeniu przewleklych zakazen dróg moczowych u chorych na cukrzyce typu 2.

THE AIM: of this study was to comprise the efficacy of chronic therapy with nitrofuarntoin in the treatment and prevention of recurrent urinary tract infections (NIM) in type 2 diabetic women. MATERIALS AND METHODS: The study comprised 105 women aged 50-70 years, who suffered from the NIM (isolated bacterial uropathogen sensitive to nitrofurantoin and cotrimoxazole). Women were divided into two groups. Group 1 (n=55) consisted of patients, who have been treated with nitrofurantoin and group 2 - control group (n=50) with cotromixazole. Observation period lasted 12 months and for the 9 months patients were treated with antimicrobial agents. Efficacy of antimicrobial treatment was estimated when both clinical cure and bacteriological eradication of uropathogens were achieved. RESULTS: There were no significant differences in the percentage of patients between study groups, who achieved therapeutic successes after three, six and nine months of the antimicrobial treatment (NS). Three months after discontinuation of this treatment episodes of NIM were observed in similar frequency in two study groups (NS). CONCLUSION: Nitrofurantoin is the effective antimicrobial method to cure and prevent NIM.