Does concomitance of Hashimoto's disease and type 1 diabetes affect diabetes control and development of its complications?

INTRODUCTION: Autoimmune diseases concomitant with diabetes may complicate the treatment and adversely affect the prognosis. The most common is Hashimoto's disease (HD). We compared diabetes control and prevalence of chronic complications in type 1 diabetes patients differing in the coexistence of HD. MATERIAL AND METHODS: Medical records of 188 type 1 diabetics were analysed. Hashimoto's disease was diagnosed based on medical history, as well as determination of the levels of thyroid peroxidase antibodies, hormones and ultrasound examination. Statistical analysis was performed using Statistica 10PL. RESULTS: HD was diagnosed in 43 (23%) patients. The mean HbA1c was 8.8 ±1.5% in the group with HD, and 9 ±1.6% in the group without HD (ns). The prevalence of diabetes complications was similar in both groups: ischaemic heart disease was diagnosed in 19% of patients with HD and 19% without HD, cerebral vascular insufficiency - 8% and 7%, peripheral neuropathy - 14% and 12%, sensory polyneuropathy - 47% and 46%, diabetic foot - 7% and 8%, Charcot osteoarthropathy - 7% and 2%, cardiovascular neuropathy - 21% and 28%, neuropathy of the gastrointestinal tract - 5% and 6%, nephropathy - 12% and 19%, retinopathy - 42% and 43%, and cataract in 28% and 19%, respectively. Impaired hypoglycaemia perception was rarer in the group with HD: 9% vs. 25% (p ≈ 0.04). CONCLUSIONS: Hashimoto's disease does not significantly affect the level of type 1 diabetes control or the development of its complications. Only autonomic neuropathy in the form of impaired awareness of hypoglycaemia is rarer in patients with that thyroiditis.

Adipokine Profile in Patients with Type 2 Diabetes Depends on Degree of Obesity.

BACKGROUND The fast pace of life, promoting fast food consumption and low physical activity, has resulted in obesity and/or diabetes as being serious social problems. The aim of the present study was to evaluate concentrations of selected adipokines (leptin, adiponectin, resistin, and visfatin) and to assess the leptin/adiponectin ratio in plasma of type 2 diabetes (T2D) patients in relation to degree of obesity. MATERIAL AND METHODS The study comprised 92 T2D subjects divided into 4 groups according to BMI value - I (normal body weight), II (overweight), III (obesity), and IV (severe obesity) - and 20 healthy volunteers (control group). Each group was divided into male and female subgroups. Plasma concentrations of adipokines were determined by enzyme-linked immunosorbent assay. RESULTS In women, leptin concentration was significantly higher in group IV, whereas in men it was higher in groups III and IV than in the control group and groups I and II. Irrespective of sex, a significant decrease in adiponectin level was observed in group III vs. CONTROL: There was no significant difference in resistin levels. In women visfatin was markedly enhanced in group III, whereas in men in groups II, III and IV vs. CONTROL: Leptin/adiponectin ratio was increased in groups III and IV vs. control in women, whereas in men vs. both control and group I. CONCLUSIONS The obese type 2 diabetic patients presented a disturbed adipokine profile, which seems to be an important link between obesity and T2D. The future studies concerning the question if regulating of adipokines' concentrations could be a promising approach for managing metabolic disorders seem to be well-grounded.

Is There Any Relationship between Plasma 25-Hydroxyvitamin D3, Adipokine Profiles and Excessive Body Weight in Type 2 Diabetic Patients?

A growing interest in the role of vitamin D in metabolic diseases led us to study the relationships between 25-hydroxyvitamin D3 (25(OH)D3) and the profiles of selected adipokines in type 2 diabetic (T2DM) patients. The study comprised 92 type 2 diabetics divided into quartiles regarding 25(OH)D3 concentration. Each group was divided into male and female subgroups. All the studied patients had their anthropometric and biochemical parameters determined. Plasma 25-hydroxyvitamin D3 concentration was determined by HPLC, while the selected adipokines (leptin, adiponectin, resistin and visfatin) by ELISA methods. The ratio of leptin to adiponectin (L/A) was calculated for all the patients. In 85.3% of diabetics a full (<20 ng/mL) or moderate (20-30 ng/mL) vitamin D deficit was found. Irrespective of sex, plasma leptin concentration decreased across increasing quartiles of 25(OH)D3 level. In women, 25(OH)D3 was negatively correlated with BMI, leptin level as well as L/A ratio, and positively with adiponectin concentration. In men, 25(OH)D3 was positively correlated with HDL and negatively with systolic blood pressure (SBP), leptin level and L/A ratio. Considering all the patients, there ocurred a significant negative correlation between 25(OH)D3 and SBP, BMI, WHR, TG, leptin and L/A ratio and positive ones between 25(OH)D3 and both adiponectin and HDL. The results of the study support the existence of the relationship among vitamin D, obesity and leptin in type 2 diabetic patients.

Clinical analysis of 52 obstetric hysterectomies.

OBJECTIVES: Analysis of obstetric (peripartum and postpartum) hysterectomies with regard to their frequency, indications, complications, and risk factors. MATERIAL AND METHODS: The study included 52 women operated between 1985-2012. Obstetric hysterectomies were performed in 39 (75%) and 13 (25%) women, respectively. The results were statistically analyzed as arithmetic mean and standard deviation (SD). RESULTS: Peri- and postpartum hysterectomies accounted for 0.123% of all births (0.092% and 0.031%, respectively). Mean pa-tient age, length of pregnancy, and number of deliveries was 32.6 years [SD ± 6.2], 38.1 weeks [SD ± 7.0], and 3.2 [SD ± 2.4], respectively. In the study group, 92.31% of the women were multiparous, and 86.54% gave birth by cesarean section and had a history of CS. Placental pathology accounted for 44.4% of indications for hysterectomy. Blood transfusion was required in 94.2% of the cases, symptoms of hypovolemic shock were observed in 21.2%, and ICU admission was required in 15.4% of the patients. Relaparotomy was necessary in 4 (7.7%) cases. Intrauterine fetal death occurred in 4 (7.6%) cases and extremely poor neonatal status was observed in 4.1% of the newborns. CONCLUSIONS: Hemorrhage due to placental pathology was the most frequent indication for obstetric hysterectomy. Risk factors for obstetric hysterectomy included multiparity, history of CS, recent CS, and age > 35 years. Postpartum hysterec-tomy accounted for 25% of the obstetric surgeries.

Torsion of the uterus with myomas in a postmenopausal woman - case study and review of the literature.

INTRODUCTION: Torsion of the uterus is defined as a rotation of more than 45° around the long axis of the uterus; 2/3 of cases are dextrorotations. The extent of rotation usually ranges from 45° to 180°. OBJECTIVE: The purpose of the article was to present a case study of a postmenopausal woman with uterine torsion and myomas and to review the articles discussing the problem of rotated non-pregnant uterus. MATERIAL AND METHODS: The article analyses the course of an extremely uncommon pathology, i.e. uterine torsion in a 67-year-old patient. Laparotomy exposed the uterus with myomas and numerous hemorrhages, rotated by 180° to the right side, size of 350 × 300 × 200 mm and bilateral necrosis of the ovaries. Moreover, we present a review of articles discussing surgical management in case of rotated non-pregnant uterus. RESULTS AND DISCUSSION: The patient was operated on by a team of gynecologists and surgeons. The uterus was derotated and total hysterectomy with salpingoophorectomy was performed. A fragment of the hepatic oval ligament was excised and periumbilical hernioplasty was performed. The patient was released home on the 10(th) day following the operation. CONCLUSIONS: If women complain of pain located within the small pelvis and abdominal cavity it is necessary to remember that it might result from the torsion of reproductive organs which is an uncommon condition but poses a health or life threat to patients. Surgical treatment of uterine torsion is successful if promptly implemented; in certain cases it is even possible to spare the patient's fertility.

Are we helping or harming our insulin-treated diabetic patients during ambulatory treatment?

INTRODUCTION: Correctness of insulin treatment depends on both the experience and skills of the doctor and knowledge and behaviour of the patient. OBJECTIVE: Evaluation the adequacy of insulin doses administered to diabetes patients in ambulatory conditions. MATERIAL AND METHODS: The treatment of 59 patients hospitalized in the Diabetology Ward was evaluated at admission, discharge and 3 months after hospitalization. RESULTS: The mean daily doses of insulin significantly differed at times of evaluation and were: 53.90, 39.31 and 43.34 units, respectively (p≈0.000001). A significant reduction of body weight, 90.86 vs. 88.25 kg (p≈0.000001), was obtained only during hospitalization, and was maintained 3 months after discharge (87.86 kg). Significant differences were also noted in the body mass index (33.44 vs. 32.48 vs. 32.37 kg/m(2), p≈0.000001). The change in waist circumference was not statistically significant (107.87 vs. 104.89 cm; p≈0.06). A decrease in the number of hypoglycaemia episodes was observed, but were statistically insignificant (25 vs. 23; p≈0.7). Three months after hospitalization an insignificant decrease of HbA1c level was noted (8.41% vs. 8.03%; p≈0.07). CONCLUSIONS: During treatment in the Diabetology Ward the procedure of choice was more frequently a reduction than an increase in insulin doses. This management led to the reduction of the patients' body weight, improvement of glycaemia, without any significant effect on the diabetes control determined by the HbA1c level.

Is the advancement of diabetic angiopathy evaluated as ankle-brachial index directly associated with current glycaemic control?

INTRODUCTION AND OBJECTIVE: Diabetic patients are at high risk for peripheral arterial disease (PAD) characterized by symptoms of intermittent claudication or critical limb ischemia. Measurement of ankle-brachial index (ABI) has emerged as the diagnostic tool of choice, because it is relatively simple, non-invasive and inexpensive. It is also an independent marker of increased morbidity and mortality from cardiovascular diseases. The aim of the presented study was to assess the relationship between current glycemic control defined by glycated hemoglobin (HbA(1c)) level, and quantitative changes in the arteries of the lower limbs in patients with type 2 diabetes. MATERIALS AND METHODS: 175 patients with type 2 diabetes hospitalized in the Diabetology Ward were studied. VENO Doppler and a sphygmomanometer were used to assess blood flow. RESULTS: The average level of HbA(1c) was assessed at 8.48%. Although the average level of ABI indicator was 1.20 (normal), only 45% of evaluated patients had their individual index within the normal range. Signs of ischemia were found in 17.7% of examined subjects. There was no conclusive correlation between ABI and HbA(1c) levels. CONCLUSIONS: The current level of glycemic control evaluated as HbA(1c) has no direct impact on the advancement of diabetic angiopathy evaluated as ABI.

Current glycaemic control has no impact on the advancement of diabetic neuropathy.

UNLABELLED: The aim of the study was to assess the association between glycemic control understanding as a glycated haemoglobin level and indices of diabetic neuropathy. METHODS: We evaluated 204 patients with diabetes (type 1 - 29; type 2 - 175). Glycated haemoglobin was determined using The Diabetes Control and Complications Trial/ National Glycohemoglobin Standardization Program method. Evaluation of complaints from the lower extremities was based on the Neuropathy Syndrome Total Score questionnaire. We used a mono lament for evaluation of touch sensation (Semmes-Weinstein 5.07-10 g), a 128 Hz calibrated tune-fork for the vibration perception test, Tip-Therm to assess temperature sensation. RESULTS: The mean glycated haemoglobin level was assessed on 8.53±1.87%. The mean Neuropathy Syndrome Total Score: 11.45±6.37. Decreased sensation of touch on both sides was determined in 30% of cases, decreased sensation of temperature in 59% and decreased sensation of vibration in 30%. For Neuropathy Syndrome Total Score and glycated haemoglobin the Pearson's correlation test was 0.00910 (p≈0.99), Spearman's rank correlation test was 0.00523 (p≈0.95). Persons with sensation deficits and neuropathy symptoms had not significantly higher (Neuropathy Syndrome Total Score, temperature sensation disturbances) and not significantly lower (vibration and touch) glycated haemoglobin level compared to patients without neuropathy. CONCLUSION: There is no correlation between prevalence and advancement of sensorial neuropathy and current diabetes control in patients with long-term established diabetes.

Multidisciplinary treatment of a patient with type 2 diabetes and morbid obesity, or perhaps already a surgical diabetology.

UNLABELLED: Relationships between abdominal obesity and glucose tolerance disorders have been well documented. There are also many reports concerning body weight gain during insulin therapy. On the other hand, there are reports pertaining to the effectiveness of surgical treatment of obesity and related type 2 diabetes. The case is presented of a 39-year-old woman with morbid obesity (maximum weight - 141 kg, BMI - 48.8 kg/m(2)), who reported to the outpatient department for metabolic diseases in December 2009. The patient had suffered from diabetes for 8 years and was treated with insulin - a dose of 114 IU from the day of the first visit. The patient received education concerning the modification of lifestyle, diet and insulin therapy. A balanced diet of 1,200 kcal daily was recommended. The daily insulin dose was reduced to 56 units. The patient was considered as a potential candidate for bariatric surgery. During the preparation for this procedure she was hospitalized in the Diabetology Ward, where the doses of insulin were further reduced and then discontinued. In March 2010, gastric sleeve resection was performed. Within 18 months, the patient's body weight was reduced by 66 kg and normalization of glycaemia was obtained, despite the total discontinuation of anti-diabetic drugs. In addition, the remission of psoriatic changes was observed. CONCLUSIONS: In patients with type 2 diabetes and severe obesity, in whom a satisfactory metabolic control cannot be achieved with standard hypoglycaemic therapy, further intensification of insulin treatment does not have to be the method of choice, although it may lead to the normalization of glycaemia. In some patients there is the possibility of total remission of glucose intolerance due to bariatric surgery, irrespective of the previous method of treatment.

A comparative evaluation of waist circumference, waist-to-hip ratio, waist-to-height ratio and body mass index as indicators of impaired glucose tolerance and as risk factors for type-2 diabetes mellitus.

UNLABELLED: A number of anthropometric indices is used for evaluation of fat tissue accumulation. It is known, that together with increase of obesity increases prevalence of impaired glucose tolerance (IGT) and diabetes mellitus type 2 (DM 2). The aim of this study was to determine, which of following indices: body mass index (BMI), waist to hip ratio (WHR), waist to height ratio (WHtR) and waist circumference (WC) is the most suitable for the assessment of glucose tolerance disturbances' risk in clinical practice. MATERIAL AND METHODS: The research involved an examination of 1965 people aged > or = 35 years selected from the Lublin town population. Their body mass, height, waist and hip circumferences were measured. Fasting glicaemia and glucose concentration level in the 120th minute after 75 g glucose oral load were determined in full vein blood. DM 2 and IGT were diagnosed according to the 1985 WHO criteria. The evaluation of receiver operating characteristics (ROC) and Pearson's correlation test were used for statistical analysis. RESULTS: The increase of all the studied indices was correlated with the increase of glicaemia, especially after an oral glucose load. The weakest correlation was shown by WHR. WC showed the strongest correlation with fasting glicaemia (except for men, where closer relationship with BMI was observed). Glicaemia after the load was stronger correlated with BMI and WHtR. A comparison of indices made by the analysis of ROC proved that all of them are characterised by a similar relation with the studied diseases. The indices in question showed significantly weaker relation with IGT than with DM 2. WHtR proved to have the highest diagnostic value in the IGT risk assessment IGT and WC in the assessment of DM 2. Interval estimation demonstrated a presence of statistically significant differences between WHR and other indices in the ROC distribution for DM2. The best cut-off points suggested higher DM 2 risk we found were: BMI - 29,2 kg/m2, WC - 97 cm, WHtR - O,62, WHR - 0,91 for women and 27,9 kg/m2, WC - 99 cm, WHtR - O,57, WHR - 0,97 for men. CONCLUSIONS: All the studied indices have a similar value for DM 2 risk assessment. Waist circumference (WC) is especially noteworthy for the family doctor's practice both because of its high diagnostic precision and exceptional simplicity of its determination. The cut-off points of the studied indices should be differentiated according to sex.

Diabetes mellitus type-2 is unknown in 75% of cases--results of a population study in rural areas of the Lublin Region (Eastern Poland).

There are scare data concerning the prevalence of diabetes mellitus in rural population in Poland. Our study, performed in 1806 subjects from rural areas, showed that prevalence of diabetes mellitus in rural population is unexpectedly high (17.2%) and is higher than in urban population. The fact that 3/4 of the cases turned out to be the cases of previously undiagnosed diabetes mellitus is especially distressing. Thus, main efforts should be concentrated on the necessity of screening tests in the group which is not subjected to periodical medical examinations, the more so that the prevalence of obesity in women reached 40%. The family physician and an appropriate organisation of educational prophylaxis can play a major role in fighting this problem.

Cardiovascular risk factors in the Lublin Region population with and without type-2 diabetes mellitus.

In the 1998--2001 period we carried out a survey on a representative group of the Lublin Region inhabitants aged over 35. During the survey we found particularly high and so far underestimated prevalence of type 2 diabetes mellitus (DM 2) and impaired glucose tolerance (IGT). Ischaemic heart disease and sudden heart death, which is related to it, are the most frequent DM 2 complications. The aim of this study was to assess the prevalence of selected ischaemic heart disease risk factors--obesity, central obesity, arterial hypertension, lipid disorders and the smoking habit--in the Lublin Region inhabitants in groups with correct and impaired glucose tolerance (IGT) as well as newly diagnosed and known type 2 diabetes mellitus 2 (DM 2), and to compare them with each other. We found significantly higher prevalence of obesity, central obesity, arterial hypertension, hypo-HDL-cholesterolemia and hypertriglyceridemia in the group with IGT and DM 2 compared to the group without IGT and DM 2. We did not find significant differences between the groups in total hypercholesterolemia and hyper-LDL-cholesterolemia prevalence. Smoking percentage was significantly higher in persons without IGT and DM 2. Ischaemic heart disease risk factors related to the metabolic syndrome are significantly more frequent in persons with DM 2 and IGT. Diagnosis and treatment of these disorders should be a priority in diabetes care.