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PURPOSE: Diabetic foot is a complication of long-lasting diabetes mellitus affecting up to 15% of patients, both in type 1 and type 2 diabetes. Osteoprotegerin is involved in osteogenesis and calcification. The aim of the study was to assess the role of selected osteoprotegerin gene variants in diabetes patients with diabetic foot. METHODS: The study involved 300 patients with diabetes and diabetic foot and 968 healthy controls. The study group was formed by 243 patients with diabetic foot of neuropathic origin, 102 with diabetic foot of neuroischemic origin and 77 with Charcot neuroarthropathy. RESULTS: Compared to controls, rs1872426 and rs1485286 showed correlation with diabetic foot in diabetes subjects. Significant associations between rs2073618, rs1872426, rs7464496 and rs1485286 in men were reported. The aforementioned correlations were also present in type 2 diabetes patient subgroup. Variant rs1485286 was associated to diabetic foot of neuropathic origin. Sex-specificity for females was present for rs6993813 in patients with diabetic foot of neuropathic origin and type 1 diabetes. Variants rs1872426, rs2073617 and rs1485286 were correlated with CN. We found that age, body weight, body mass index, waist circumference, hip circumference and waist-hip ratio were among the basic risk factors of diabetic foot. CONCLUSIONS: The following variants TNFRSF11B (rs2073618, rs2073617, rs1872426, rs1032128, rs7464496, rs11573829 and rs1485286), COLEC10 (rs6993813, rs3134069) and TNFSF11 (rs9533156) present differences in allele frequencies in diabetic foot patients and show correlation with gender, diabetes type and diabetic foot etiology. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40200-018-0372-4) contains supplementary material, which is available to authorized users.

The aim of this review was to investigate existing guidelines and scientific evidence on determining insulin dosage in people with type 1 and type 2 diabetes, and in particular to check whether the prandial insulin dose should be calculated based on glycemia or the meal composition, including the carbohydrates, protein and fat content in a meal. By exploring the effect of the meal composition on postprandial glycemia we demonstrated that several factors may influence the increase in glycemia after the meal, which creates significant practical difficulties in determining the appropriate prandial insulin dose. Then we reviewed effects of the existing insulin therapy regimens on glycemic control. We demonstrated that in most existing algorithms aimed at calculating prandial insulin doses in type 1 diabetes only carbohydrates are counted, whereas in type 2 diabetes the meal content is often not taken into consideration. We conclude that prandial insulin doses in treatment of people with diabetes should take into account the pre-meal glycemia as well as the size and composition of meals. However, there are still open questions regarding the optimal way to adjust a prandial insulin dose to a meal and the possible benefits for people with type 1 and type 2 diabetes if particular parameters of the meal are taken into account while calculating the prandial insulin dose. The answers to these questions may vary depending on the type of diabetes.

Purpose The objective was to assess glucose, lactate, glycerol, and pyruvate concentrations in the interstitial fluid of the adipose tissue as well as the glucose relative recovery coefficient in reference to capillary blood (RC) during the first two days of the standard treatment of diabetic ketoacidosis (DKA) in patients with type 1 and type 2 diabetes. Materials and Methods The study group consisted of 19 patients (12 with type 1 diabetes and 7 with type 2 diabetes). The metabolic state of the patients was monitored using the microdialysis technique. The analysis of variance was used to investigate whether the type of diabetes and the duration of treatment influenced the assessed parameters. Results Concentrations of all the monitored components were stable after the initial 12 h of treatment. Glucose concentration was higher and concentrations of all the other components were lower (pConclusions The results suggest that the standard treatment of DKA is effective in stabilizing a concentration of the studied metabolic components in the interstitial fluid in patients with type 1 and type 2 diabetes despite differences in the glucose concentration at the beginning of the treatment.

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 Basal-bolus insulin therapy is a standard method of intensifying diabetes treatment. A common adverse effect of such treatment is hypoglycemia. Data on frequency of hypoglycemia when fast-acting insulin analogue is used in everyday clinical practice is scarce. OBJECTIVES The aim of the study was to investigate the risk of hypoglycemia after the use of insulin aspart in basal-bolus therapy in patients with type 1 and 2 diabetes. PATIENTS AND METHODS It was a multicenter, open-label, noninterventional study. It involved 950 patients with type 1 and 1332 patients with type 2 diabetes who started preprandial insulin aspart in basal-bolus regimen. Patients were followed for 13 weeks. The primary endpoint was the incidence of major daytime and nocturnal hypoglycemic events assessed on the basis of patients' self-reports during follow-up compared with a 4-week period before the baseline visit. Secondary endpoints were: incidence of minor daytime and nocturnal hypoglycemia, hemoglobin A1c (HbA1c), fasting and postprandial glycemia. RESULTS The rate of major hypoglycemia decreased in patients with type 1 diabetes--the incidence rate ratio (IRR) was 0.14 for daytime and 0.03 for nocturnal episodes (P

An effective application of insulin treatment in diabetic patients requires ability of the patient to select proper insulin doses, which compensate ingested meals. This is difficult, time consuming and in some cases outreach patient’s abilities.

Background: Glycated hemoglobin A1c (HbA1c) has been used as an index of glycemic control in the management, guidance, and clinical trials of diabetic patients for the past 35 years. The aim of this study was to validate the HbA1c model in patients with type 1 and type 2 diabetes and to use it to support interpretation of HbA1c in different clinical situations. Methods: The HbA1c model was identified in 30 patients (15 with type 1 diabetes and 15 with type 2 diabetes) by estimating the overall glycation rate constant (k), based on results of continuous glucose monitoring. The model was validated by assessing its ability to predict HbA1c changes in cultures of erythrocytes in vitro and to reproduce results of the A1C-Derived Average Glucose (ADAG) study. The model was used to simulate the influence of different glucose profiles on HbA1c. Results: The mean k was equal to 1.296±0.216×10 �9 lm mol �1 s �1 with no difference between type 1 and type 2 diabetes. The mean coefficient of variation of k was equal to 16.7%. The model predicted HbA1c levels in vitro with a mean absolute difference less than 0.3% (3.3 mmol/mol). It reproduced the linear relationship of HbA1c and mean glucose levels established in the ADAG study. The simulation experiments demonstrated that during periods of unstable glycemic control, glycemic profiles with the same mean glucose might result in much different HbA1c levels. Conclusions: Patients with type 1 and type 2 diabetes are characterized by the same mean value of k, but there is considerable interindividual variation in the relationship of HbA1c and mean glucose level. Results suggest that reciprocal changes in glycation rate and the life span of erythrocytes exist in a wide range of HbA1c values. Thus, for an average patient with diabetes, no modifications of parameters of the glycation model are required to obtain meaningful HbA1c predictions. Interpreting HbA1c as a measure of the mean glucose is fully justified only in the case of stable glycemia. The model and more frequent tests of HbA1c might be used to decrease ambiguity of interpreting HbA1c in terms of glycemic control.

The objectives were as follows: (1) estimating mean value of the overall hemoglobin glycation rate constant (k); (2) analyzing inter-individual variability of k; (3) verifying ability of the hemoglobin A1c (HbA1c) formation model to predict changes of HbA1c during red blood cells cultivation in vitro and to reproduce the clinical data. The mean k estimated in a group of 10 non-diabetic subjects was equal to 1.257 ± 0.114 × 10(-9) L mmol(-1) s(-1). The mean k was not affected by a way of estimation of glycemia. The mean k differed less than 20% from values reported earlier and it was almost identical to the mean values calculated on basis of the selected published data. Analysis of variability of k suggests that inter-individual heterogeneity of HbA1c formation is limited or rare. The HbA1c mathematical model was able to predict changes of HbA1c in vitro resulting from different glucose levels and to reproduce a linear relationship of HbA1c and average glucose obtained in the A1C-Derived Average Glucose Study. This study demonstrates that the glycation model with the same k value might be used in majority of individuals as a tool supporting interpretation of HbA1c in different clinical situations.

Diabetes is a group of metabolic diseases affecting more than 200 mln people worldwide, which is characterized by elevated blood glucose level. Diabetes causes a number of late complications among which diabetic foot syndrome (DFS) is one of the most dramatic as a major cause of the lower limb amputations. In IBBE PAS the TeleDiaFoS system aimed at monitoring of DFS treatment was developed. In the system, the Central Clinical Server is accessed by the Patient’s Module using a wireless internet connection to send the wound pictures, the blood glucose (BG) readings and the blood pressure (BP) values. Clinical verification of the TeleDiaFoS system has been organized as a randomized 90-days trial with the study and the control groups consisting of 10 type 2 diabetic patients, each. Currently, the evaluation of the first patient treated with multi-injection insulin delivery and antibiotic — dalacin therapies has been terminated. Home telecare therapy led to 12-fold reduction of the wound surface (from 356 mm2 to 29 mm2). During the whole 90-days period BP was controlled efficiently, however, acceptable BG level has not been maintained. In conclusion, application of the system leads to more effective realization of the DFS therapy and has a positive impact on the patient’s comfort.

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.

One of the most difficult current medical problems is the growing epidemics of diabetes mellitus. The contemporary treatment aims not only to secure the patients survival and to protect from the acute symptoms but also to avoid the occurrence of the chronic complications of the disease. This paper contains a review of the role that postprandial hyperglycemia plays in the treatment of diabetes mellitus especially type 2. Authors summarize findings of pathophysiological and epidemiological macroangiopathy studies that indicate the use of prandial glucose regulation in clinical practice. This review contains discussion of postulated mechanism in which short-lasting increases in plasma glucose concentration can damage vessel wall lead to atherosclerosis. Epidemiological studies showing the strong correlation between postprandial (and post-challenge) plasma glucose levels with cardiovascular endpoints are also discussed. Moreover, in this paper the reader may find a discussion on practical aspects of postprandial hyperglycemia monitoring in the treatment of diabetic patient, focusing at the relationship between prandial glycaemia and long term glycaemia control expressed by HbA(1c) measurements. The guidelines for monitoring postprandial glycaemia are also included. The modern therapeutic possibilities aiming post-prandial hyperglycaemia are also showed.

The influence of selected physiologic coreactants on current-voltage scans of a (Pt-pvc) Pt electrode (the working electrode of the amperometric glucose sensor) was tested. It was shown that the electrode is sufficiently sensitive to glucose even in a case when a strong interference of tested substances was observed. On the basis of the preliminary in vivo measurements it was concluded that after the proper pretreatment, the amperometric glucose sensor can be used for short-term blood glucose monitoring.

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. (Int J Artif Organs 2006; 29: 1074–81)