Assessment of speed distribution of red blood cells in the microvascular network in healthy volunteers and type 1 diabetes using laser Doppler spectra decomposition.

We applied a recently reported method of decomposition of laser Doppler power density spectra for in vivo monitoring of speed distributions of red blood cells (RBCs) in the microvascular network. The spectrum decomposition technique allows us to derive the distribution of RBC speed (in absolute units (mm s(-1))) versus RBC concentration (in arbitrary units). We carried out postocclusive reactive hyperaemia (PORH) test in 15 healthy volunteers and 21 diabetic patients in which the duration of type 1 diabetes was longer than 10 years. Measurements were carried out simultaneously with the use of a typical laser Doppler commercial instrument and speed resolved laser Doppler instrument utilizing the new technique based on decomposition of the laser Doppler spectra. We show that for the classical laser Doppler instrument, none of the PORH parameters revealed a statistical significance of difference between the groups analyzed. In contrast, the RBC speed distributions obtained from laser Doppler spectra during rest in the control group and type 1 diabetes are statistically significant. This result suggests that speed distribution measurements in the rest state (without any kind of stimulation test) allows for the assessment of microcirculation disorders. Measurements carried out in healthy subjects show that the first moment of speed distributions (mean speed of the distributions) is 2.32 ± 0.54 mm s(-1) and 2.57 ± 0.41 mm s(-1) for optodes located on the toe and finger of the hand, respectively. Respective values in type 1 diabetes were higher: 3.00 ± 0.36 mm s(-1) and 3.10 ± 0.48 mm s(-1).

Risk factors of charcot neuroarthropathy development in patients with type 2 diabetes.

AIM: Charcot neuroarthropathy is a very rare form of diabetic foot syndrome occurring among others in patients with diabetes mellitus. Charcot neuroarthropathy leads to bone tissue destruction and may result in foot amputation. The aim of the study was to identify risk factors of Charcot neuroarthropathy occurrence in patients with diabetic foot and type 2 diabetes. MATERIALS: The study included 144 patients with type 2 diabetes; 33 with Charcot neuroarthropathy and 111 with diabetic foot of neuropathic origin without neuroarthropathy. The study was perform in Gastroenterology and Metabolic Diseases Department, Medical University of Warsaw, Poland. RESULTS: The regression analysis showed that Charcot neuroarthropathy occurrence risk factors were: male gender (OR=4.94, 95% CI:1.63-15.03, p=0.003), age (OR=0.92, 95% CI:0.87-0.96, p=0.0001), diabetic foot duration (OR=1.19, 95% CI:1.08-1.32, p=0.00002) and height (OR=1.078, 95% CI:1.019-1.140, p=0.007). A positive effect on Charcot neuroarthropathy presence was exerted by body weight (OR=1.027, 95% CI:1.003-1.051, p=0.03) and hips circumference (OR=1.034, 95% CI:0.997-1.072, p=0.04). CONCLUSIONS: The existence of the specific factors influencing Charcot neuroarthropathy development may result in earlier identification of patients at risk of its development. There is a necessity to take special care for patients prone to develop Charcot neuroarthropathy in order to prevent its occurrence and severe complications.

Mobile telecare system for intensive insulin treatment and patient education. First applications for newly diagnosed type 1 diabetic patients.

The aim of the work was to develop and to evaluate the clinical efficiency of a mobile telecare system implementing teleconsultations based on the continuous transmission of patient-collected data directly to the physician and to the clinic. The developed TeleMed system consists of the patients' and the diabetologist's mobile units, the diabetologist's clinic and home workstations and the clinical server. The evaluation of the system was performed on a group of 13 newly diagnosed type 1 diabetic patients, during a single-arm study with 3-days run-in period, including a one-day intensive educational program, and 3-week study period, when the intensive insulin treatment was conducted without visits of patients to the clinic. The MBG dropped from 7.2 +/- 1.7 mmol/L before the study to 6.1 +/- 1.0 mmol/L in the third week of the study (P = 0.02) and the J-index from 30.2+/-19.2 to 19.7+/-7.7 (P = 0.04). Hemoglobin A1c decreased from 11.8 +/- 3.3% to 8.6 +/- 1.2% (P = 0.0002) in one month. The total daily insulin dose declined from 39.9 +/- 8.5 U to 20.0 +/- 9.6 U (P = 0.000006). The number of hypoglycemia episodes per patient per day decreased by 66% (P = 0.08) and the number of hyperglycemia episodes was reduced by 47% (P < 0.0001). The TeleMed facilitates not only efficient realization of the intensive insulin treatment but also successful remote patient training and education. No formal patient satisfaction study was done. However, some of the findings indicate that the application of the developed system increases patient self-confidence and quality of life.

Proinsulinemia in simultaneous pancreas and kidney transplant recipients.

It has been shown that lipid profiles do not differ between pancreas recipients with systemic and portal venous anastomosis. However, it is unclear whether venous drainage from the transplanted pancreas has an impact on recipient atherogenesis and if other factors should be considered. Increased concentration of proinsulin correlates with tachycardia and other risk factors for ischemic heart disease. The aim of this study was to compare proinsulin levels in different types of pancreatic graft venous drainage. Twenty-four simultaneous pancreas and kidney transplantation (SPK) recipients with systemic venous drainage (group S, n = 12) and portal venous drainage (group P, n = 12) under identical immunosuppressive treatment were prospectively observed during 24 months. Following transplantation, only recipients with normoglycemia, normal HbA1c, and normal serum creatine were evaluated. Proinsulin was assessed in fasting state; after glucagon stimulation (Delta-proinsulin), and during oral 75-g glucose tolerance test twice: between 3 and 6 months and 12 to 24 months posttransplantation. All SPK patients had higher proinsulin concentration in fasting state compared with age-matched healthy controls. After stimulation, proinsulin level did not significantly differ between groups; the type of the pancreas venous anastomosis did not change the release of proinsulin and should not have impact on cardiovascular risk factors.

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.

[Polish multicenter study on type I diabetes incidence in the age group 15-29 between 1998 and 1999]. / Wieloosrodkowe badania nad zapadalnoscia na cukrzyce typu 1 w grupie wiekowej 15-29 lat w Polsce w latach 1998-1999.

The increase in diabetes type 1 incidence observed in various centers in Poland and the need for a centralized study covering a large population have resulted in the construction of a standardized registry of type 1 diabetes in 1998 within the Polish Multicenter Study in Diabetes Epidemiology. The aim of the study was to evaluate the incidence of type 1 diabetes in the age group 15-29 in 5 distinct regions of Poland (Krakow, Warsaw, Bialystok, Rzeszow and Olsztyn centers) with over 15% of the Polish population at risk in 1998 and 1999. The data for the standardized registry were obtained prospectively from hospital departments and diabetes outpatient units. The incidence rates calculated in 1998 showed the highest value of 11.2/100,000 for Krakow and its region, and the lowest (4.4/100,000) for Bialystok and its region. In 1999 the highest value of 12.3/100,000 was noted in Olsztyn and its region and the lowest (3.4/100,000) in Warsaw. There were significant differences in the incidence rates between the study centers were found. Incidence rates in the whole study area were significantly higher among males as compared with females in 1998 and 1999 (8.9/100,000 vs. 4.9/100,000; p = 0.0001), marked in the age groups 15-19 and 20-24 (p = 0.001 and p = 0.002 respectively). A significant increase in diabetes type 1 incidence (from 4.6/100,000 to 6.9/100,000) was found as compared with results of the "Three Cities Study" (1986-1988).

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.

[Evaluation of efficacy, safety and tolerance of glimepiride (Amaryl) in patients with type 2 diabetes]. / Ocena skutecznosci, bezpieczenstwa i tolerancji glimepirydu (Amaryl) u pacjentów z cukrzyca typu 2.

UNLABELLED: Glimepiride is a new long-acting the third generation sulfonylurea given once daily. The aim of this study was to evaluate the efficacy, safety and tolerability of glimepiride given as monotherapy in type 2 diabetic patients. A total of 142 patients (65 women and 77 men; mean +/- SD: age 57 +/- 8.5 years, duration of diabetes 64.4 +/- 57.7 months, BMI 28.7 +/- 3.6 kg/m2) were treated during 12 weeks with glimepiride (Amaryl). Glimepiride was forced titrated 0.5-7.0 mg once daily based on efficacy. Statistical analysis our results showed significant (p < 0.001) decrease of average fasting blood glucose, twenty-four hour plasma glucose values and HbA1c significantly lower. Systolic and diastolic blood pressure was also significantly (p < 0.001; p < 0.03) lower. There was a trend to lower serum cholesterol and triglyceride levels. The other laboratory values did not change during this study. No differences were registered in body weight. Safety was assessed by evaluating vital signs, laboratory values and the occurrence of adverse events. The frequency of hypoglycaemic events was very rare (0.7%). The percentage of patients with adverse drug reactions was 6.3%. The tolerance of glimepiride was good. CONCLUSION: This study demonstrates that glimepiride is effective, safe and well tolerated in improving glycaemic control in patients with type 2 diabetes.

[Diabetic cardiomyopathy. Pathophysiology and clinical implications]. / Kardiomiopatia cukrzycowa. Patofizjologia i implikacje kliniczne.

The accumulating body of data indicate that the occurrence of diabetic cardiomyopathy is an independent phenomenon from macroangiographic changes in coronary arteries and hypertension. Results from animal studies, human histological results and clinical observations provided support for this phenomenon. Although the clinical symptoms have been identified, however, the pathogenesis of diabetic cardiomyopathy is uncertain. The definition of diabetic cardiomyopathy describes both specific defects in the myocytes from diabetics and associated changes in the heart which have developed during the course of diabetes. The following defects in myocytes have been identified and are postulated to contribute to diabetic cardiomyopathy: The changes in carbohydrates metabolism, in fatty-acid metabolism, calcium and potassium transport, microvascular narrowing and micro aneurysms, hypertrophy, defects in collagen structure, myocardial fibrosis and perivascular fibrosis, abnormalities in conducting system, the decrease in the function of autonomic nerves. The clinical presentation of diabetic cardiomyopathy lead to the description of two phases of the disease. First, asymptomatic diabetic subjects with subclinical abnormalities of the left-ventricular diastolic function, measured by Doppler echocardiography. In the second phase--clinically evident diabetic cardiomyopathy is described by congestive cardiac failure without evident arteriosclerotic changes in coronary arteries and hypertension. Diabetic cardiomyopathy can be diagnosed early after the onset of diabetes mellitus and is independent phenomenon from late diabetic complications. The main cause of mortality in diabetic subjects is largely due to macroangiopathic changes in the coronary arteries (evaluated by coronarography), not the heart failure.

[Clinical evaluation of glimepiride in treatment of type 2 diabetes. Results of a multicenter study]. / Kliniczna ocena glimepiridu w leczeniu cukrzycy typu 2. Wyniki badania wieloosrodkowego.

In a multicenter study 142 patients (from 8 centers) with type 2 diabetes (77 men and 65 women, mean age 57 +/- 8.5 (SD) yrs, mean duration of diabetes 64.4 +/- 57.7 months, mean BMI 28.7 +/- 3.6 kg/m2) received over 3 months as the only antidiabetic drug glymepiride (Amaryl) once daily before breakfast in the dose of 0.5-7.0 mg, but mostly 1-3 mg. The treatment was interrupted in one patient due to metabolic deterioration which needed insulin therapy, in an other one because of allergic eruption, and in two because of insufficient compliance. In all other patients the satisfactory decrease of glyceaemia in fasting state and over the day was obtained: the median value of the mean daily glycemia decreased from 8.8 mmol/l (158 mg/dl) to 7.2 mmol/l (129 mg/dl), p < 0.001, of the mean Mw index from 12 to 8.2, p < 0.001, also the median value of HbA1c diminished from 8.0 to 7.35%, p < 0.001. These effects were particularly evident in a subgroup of 28 patients with diabetes duration below 1.5 yrs: at the end of the study no one blood glucose value in the daily profile did exceed 7.7 mmol/l (140 mg/dl). No significant change of BMI, serum triglycerides and serum total cholesterol was observed, instead a significant decrease of mean systolic and diastolic blood pressure took place (from 143 +/- 20 to 136 +/- 17 mm Hg, p < 0.001, and from 85 +/- 10 to 83 +/- 9 mm Hg, p < 0.001, respectively). The tolerance of the drug was good. The verified hypoglycaemia developed in one patient (0.7%). No changes of the laboratory safety parameters were observed.

[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).

[Use of laser-doppler perfusion for evaluation of microcirculation in patients with diabetes type I]. / Zastosowanie metody laserowo-dopplerowskiej dla oceny mikrokrazenia u chorych z cukrzyca typu 1.

UNLABELLED: The purpose of this study was to investigate the foot skin microcirculation in type 1-diabetic patients. The study group comprised 67 patients divided into four subgroups: 13 women and 11 men healthy and had no family history of diabetes; 19 women and 24 men had type 1-diabetes. The studied measurements included 7 parameters determined during rest and post occlusive hyperaemia. They were performed with laser Doppler fluxmetry using surface probe localised in distal part of the lower limbs. The most significant data localised the probe in thumb. The maximum of hyperaemic response (MAX) was significantly lower in the diabetic patients as compared to the healthy subjects (p < 0.01). The time of peak flow (TM) was higher (p < 0.01) in diabetic patients as compared to the control subjects. The half time of hyperaemia (TH) was significant longer (p < 0.05) for diabetic groups. CONCLUSION: The laser Doppler method is helpful to identify patients with risk development diabetic complications. The most valuable data is MAX, TM and TH, the best localisation of the probe seems to be the most distal point of thumb.

[The effect of age on glucose tolerance and B cell secretion]. / Wplyw wieku na tolerancje glukozy i czynnosc wydzielnicza komórek B wysp trzustkowych.

The aim of the study was to evaluate glucose tolerance, B cell secretion and hepatic clearance of insulin during the process of aging. 100 subjects of both sexes, in age range of 17 to 92 years and with BMI < 27 kg/m2 were studied. All subjects were divided in 4 groups according to age: 18 patients were in age from 17 to 59 years (group I--mean 46 +/- 12 (SD) years, 23 patients in age from 60 to 69 years (group II--mean 64 +/- 3 years), 33 patients in age from 70 to 79 years (group III--mean 75 +/- 3 years), 26 patients in age from 80 to 92 years (group IV--mean 84 +/- 4 years). In all participants oral glucose tolerance test (75 g) and the i.v. glucagon test (1 mg) were carried out and blood glucose, serum insulin (IRI) and C-peptide (CP) were measured. Hepatic clearance of insulin was calculated from the serum CP/IRI ratio. With advanced age the increase in fasting glycaemia (group I 4.25 +/- 0.6, group IV 4.7 +/- 0.5 mM, p = 0.02) and after applied stimuli, and a decrease in fasting (group I 0.6 +/- 0.2, group IV 0.35 +/- 0.13 nM, p < 0.05) and stimulated serum CP with no differences in serum IRI concentrations between groups was observed. Consequently the serum CP/IRI ratio decreased from 10 +/- 3.8 in group I to 5.4 +/- 1.7 in group IV (p < 0.05) indicating reduced insulin clearance in liver, probably as a compensatory adaptation to the deterioration of B cell secretory activity.

[The fate of patients with diabetes mellitus after amputation of a lower limb as a consequence of gangrene]. / Losy chorych z cukrzyca po wykonanej amputacji konczyny dolnej w nastepstwie zgorzeli.

The aim of study was to analyse factors that modified the survival time of 125 patients with diabetes mellitus and 121 patients with normal tolerance glucose to whom amputations of a lower limb in consequence of gangrene were performed. The prospective study were started on 5th January 1989 and finished 31st December 1993. Among the examined patients with NIDDM were 66 men in the age from 53 to 88 years (mean age 66.8 +/- 8.5 (+/-SD) years) and 48 women in the age from 58 to 91 years (mean age 71.8 +/- 9.1 years). Among the examined patients with IDDM were 6 men in the age from 40 to 65 years (mean age 55.7 +/- 9.7 years) and 5 women in the age from 34 to 72 years (mean age 53.7 +/- 13.6 years). The mean duration of NIDDM among men was 14.1 +/- 8.6 years, among women - 13.6 +/- 10.2 years and the mean duration of IDDM among men was 26.1 +/- 6.7 years, among women-26.0 +/- 10.8 years. In that period among patients with diabetes mellitus 80 patients died (64 percent), and among patients with normal glucose tolerance-died 39 patients (32 percent). In the analysis of survival time of patients with diabetes mellitus after nontraumatic amputation of a lower limb the following factors were the essential predictors of death: age (p = 0.0001), duration of diabetes (p = 0.03), arterial hypertension (p = 0.006), peripheral arterial disease (p = 0.0007), diabetic nephropathy (p = 0.0065). Among patients with normal tolerance glucose only the age was the essential predictor of death (p = 0.0001). The necessity of performance of amputation of a lower limb among patients with diabetes mellitus provides information on unsuccessful course of disease.

[Sodium dichloroacetate decreases the size of experimental myocardial infarction in dogs]. / Dwuchlooroctan sodowy zmniejsza wielkosc doswiadczalnego zawalu serca u psów.

The effect of sodium dichloroacetate on the size of myocardial infarction and on the changes of blood lactate and pyruvate levels after coronary artery occlusion were studies in 5 dogs. Sodium dichloroacetate administrated during coronary artery occlusion in dogs limited the size of myocardial necrotic area, simultaneous decrease of lactate and pyruvate levels in peripheral blood was observed. An analysis of lactate levels in blood samples from the coronary sinus and left atrium during coronary artery occlusion and the administration of sodium dichloroacetate suggests that the utilization of lactate by left ventricular myocardium under these conditions is increased.