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INTRODUCTION Diabetic foot is a severe diabetic complication, which may result in ulcerations that are unresponsive to treatment and in lower limb amputation. Osteoprotegerin is a protein that is involved in the pathogenesis of diabetic foot. OBJECTIVES The aim of the study was to evaluate the frequency of alleles in the TNFRSF11B gene rs2073617, rs2073618, and rs3134069 polymorphisms in patients with diabetic foot, diabetes, and healthy controls. PATIENTS AND METHODS The study comprised 877 patients, including 122 with diabetic foot, 293 with type 2 diabetes without diabetic foot, and 462 healthy controls. RESULTS In the rs2073618 polymorphism, the C allele was a risk factor for diabetic foot in patients with diabetes in the allelic variants [CC] vs. [CG + GG] (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.03-2.86; P = 0.035), and in men in the following allelic variants: CC vs. GG (OR, 3.16; 95% CI, 1.27-7.87; P = 0.011), CC vs. CG (OR, 3.33; 95% CI, 1.47-7.54; P = 0.002), and [CC] vs. [CG + GG] (OR, 3.28; 95% CI, 1.48-7.24; P = 0.002). A similar association was observed between men with diabetic foot and those only with diabetes in the following allelic variants: CC vs. GG (OR, 2.30; 95% CI, 0.91-5.85; P = 0.076), CC vs. CG (OR, 2.69; 95% CI, 1.16-6.22; P = 0.018) and [CC] vs. [CG + GG] (OR, 2.56; 95% CI, 1.13-5.77; P = 0.02). For patients with neuropathic diabetic foot, the association was demonstrated in variant CC vs. CG (OR, 2.5; 95% CI, 1.00-6.23; P = 0.044) and only for men in the following allelic variants: [CC] vs. [CG + GG] (OR, 3.17; 95% CI, 1.07-9.38; P = 0.029) and CC vs. CG (OR, 3.49; 95% CI, 1.15-10.58; P = 0.02). The A allele of the rs2073617 polymorphism protected women in variant AA vs. AG against diabetic foot compared with controls (OR, 0.45; 95% CI, 1.00-4.92; P = 0.045). The rs3134069 polymorphism was not observed to be a risk factor for diabetic foot. CONCLUSIONS The analysis of the TNFRSF11B gene may be used to assess the risk of diabetic foot and neuropathic diabetic foot in patients with type 2 diabetes.

Introduction Lactic acidosis is a relatively rare complication diagnosed in patients with diabetes. Objectives The aim of this study was to identify causes of lactic acidosis in patients with diabetes and to measure the extent of metabolic disturbances based on the available laboratory test results. Patients and methods A total of 29 diabetic patients aged 20-87 years were admitted to the Intensive Diabetes Care Unit of the Warsaw Medical University in the years 2007-2012 with the diagnosis of lactic acidosis (lactate level >5 mmol/l). A detailed medical history was taken from all patients or their caregivers. Lactate levels, glycemia, acetonuria, and gasometry were measured on admission. Results Eight patients with type 1 diabetes, 18 patients with type 2 diabetes, and 3 patients with other types of diabetes were hospitalized with the diagnosis of lactic acidosis. Lactic acidosis (lactate levels, 5.2-27 mmol/l) was associated with increased glycemia (13.3-91.7 mmol/l) and low pH (6.73-7.28). Alcohol abuse was reported in 12 subjects based on medical history. In 3 women, acute diabetic complication was caused by psychogenic eating disorders. There were 5 fatal cases including 3 cases of metformin treatment. Conclusions Alcohol abuse and its effects on health seem to be the main cause of lactic acidosis in diabetic patients. Metformin-treated patients, especially elderly ones, are at a risk of sudden deterioration of renal function, which in turn may increase the risk of lactic acidosis.

Introduction Chronic pancreatitis predisposes to diabetes. Loss of endocrine function by beta-cells in the Langerhans islets is considered to be the main causative factor, although several studies have also suggested insulin resistance as a possible additional mechanism. Objectives The aim of the study was to estimate insulin sensitivity in chronic pancreatitis in view of the coexisting meta bolic syndrome components. Patients and methods The study involved 30 patients (mean age 50.83 +/-6.61 years; 23.33% women, 76.66% men) diagnosed with chronic pancreatitis (using imaging tests). Insulin sensitivity with regard to the coexistent obesity, dyslipidemia, and arterial hypertension was measured using the euglycemic clamp method. Results Diabetes was present in 22 patients, impaired glucose tolerance in 4, and no carbohydrate metabolism disturbances in 4. Insulin resistance was present in 22 patients (73.33%), in whom a higher prevalence of diabetes (77.27% vs. 62.5%) and prediabetes (13.63% vs. 12.5%) was observed. The analysis of anthropometric para meters revealed that individuals with a high index of central obesity had a statistically significantly lower tissue glucose utilization (TGU) (3.23 vs. 4.89 mg/kg/min; P = 0.02), although there were no obese patients in the study group according to the body mass index. No statistically significant differences in TGU were observed in relation to lipid disorders (total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides) and arterial hypertension. Conclusions In patients with chronic pancreatitis, lack of correlation between insulin sensitivity and meta bolic syndrome components may indicate that insulin resistance is related to primary disease or that an additional mechanism underlying pancreatic diabetes operates.