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Tabak AG, Kempler P, Guja C, Eldor R, Haluzik M, Klupa T, Papanas N, Stoian AP, Mankovsky B. Expert Opinion on Current Trends in the Use of Insulin in the Management of People with Type 2 Diabetes from the South-Eastern European Region and Israel. Diabetes Ther 2024; 15:897-915. [PMID: 38472626 PMCID: PMC11043254 DOI: 10.1007/s13300-024-01556-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/14/2024] [Indexed: 03/14/2024] Open
Abstract
Despite the availability of various antihyperglycaemic therapies and comprehensive guidelines, glycaemic control in diabetes management has not improved significantly during the last decade in the real-world clinical setting. Treatment inertia arising from a complex interplay among patient-, clinician- and healthcare-system-related factors is the prime reason for this suboptimal glycaemic control. Also, the key factor leading to inadequate glycaemic levels remains limited communication between healthcare professionals (HCPs) and people with type 2 diabetes (PwT2D). Early insulin administration has several advantages including reduced glucotoxicity, high efficacy and preserved β-cell mass/function, leading to lowering the risk of diabetes complications. The current publication is based on consensus of experts from the South-Eastern European region and Israel who reviewed the existing evidence and guidelines for the treatment of PwT2D. Herein, the experts emphasised the timely use of insulin, preferably second-generation basal insulin (BI) analogues and intensification using basal-plus therapy, as the most-potent glucose-lowering treatment choice in the real-world clinical setting. Despite an increase in the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), the experts urged timely insulin initiation for inadequate glycaemic control in PwT2D. Furthermore, the combination of BI and GLP-1 RA addressing both fasting plasma glucose and post-prandial excursions as a free- or fixed-ratio combination was identified to reduce treatment complexity and burden. To minimise discontinuation and improve adherence, the experts reiterated quality, regular interactions and discussions between HCPs and PwT2D/carers for their involvement in the diabetes management decision-making process. Clinicians and HCPs should consider the opinions of the experts in accordance with the most recent recommendations for diabetes management.
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Affiliation(s)
- Adam G Tabak
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, 2/a Korányi S. Str., 1083, Budapest, Hungary.
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
- UCL Brain Sciences, University College London, London, UK.
| | - Peter Kempler
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, 2/a Korányi S. Str., 1083, Budapest, Hungary
| | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Disease, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Roy Eldor
- Diabetes Unit, Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Martin Haluzik
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Tomasz Klupa
- Center for Advanced Technologies in Diabetes & Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Nikolaos Papanas
- Second Department of Internal Medicine, Diabetes Centre, Diabetic Foot Clinic, Democritus University of Thrace, Alexandroupolis, Greece
| | - Anca Pantea Stoian
- Department of Diabetes, Nutrition and Metabolic Disease, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Boris Mankovsky
- Department of Diabetology, National Healthcare University of Ukraine, Kiev, Ukraine
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Stoet G, Foster E, Kerr C, Jiang L, Thornhill MA, Cyranka K, Matejko B, Sarna-Palacz D, Płonka-Stępień M, Klupa T. Improving support for university students with type 1 diabetes. Lancet Diabetes Endocrinol 2024:S2213-8587(24)00107-4. [PMID: 38642571 DOI: 10.1016/s2213-8587(24)00107-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/04/2024] [Indexed: 04/22/2024]
Affiliation(s)
- Gijsbert Stoet
- Department of Psychology, University of Essex, Colchester CO4 3SQ, UK.
| | - Emily Foster
- Rowhedge & University of Essex Medical Centre, Rowhedge, UK
| | - Catherine Kerr
- School of Sport, Rehabilitation, and Exercise Sciences, University of Essex, Colchester CO4 3SQ, UK
| | - Lingqing Jiang
- Department of Economics, University of Essex, Colchester CO4 3SQ, UK
| | | | - Katarzyna Cyranka
- Department of Psychiatry, Jagiellonian University Medical College, Kraków, Poland; Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland; University Hospital in Krakow, Kraków, Poland
| | - Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland; University Hospital in Krakow, Kraków, Poland
| | | | - Magdalena Płonka-Stępień
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland; Doctoral School of Medical and Health Sciences, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland; University Hospital in Krakow, Kraków, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland; University Hospital in Krakow, Kraków, Poland
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Cyranka K, Klupa T, Pilecki M, Sarna-Palacz D, Juryk A, Storman D, Dudek D, Malecki MT, Matejko B. Diabetes distress and diabetes burnout explored in various areas of life in patients with type 1 diabetes: effect of short-term psychological intervention. Endocrine 2024:10.1007/s12020-024-03760-0. [PMID: 38448676 DOI: 10.1007/s12020-024-03760-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/24/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Diabetes distress (DD) and diabetes burnout (DB) are recognized psychological phenomena in patients with T1DM (type 1 diabetes mellitus). Still, there is an urgent need to create professional psychological intervention procedures to provide patients with adequate care. AIM The aim of the study was to assess the level of DD and DB in T1DM patients at baseline and after 5 of sessions psychological intervention in the group of participants who applied for help. METHODS 34 T1DM patients who requested psychological support (22 females, 12 males) and 30 patients in a control group (14 females, 16 males) participated in the study. At baseline clinical test results between groups were compared. Next, in the studied group measurements were repeated after a set of five psychological face-to-face individual interventions which lasted 30-60 min each. They were support sessions with elements of cognitive-behavioral interventions done by clinical psychologists. Session 1: introduction, interview and collection of test results; session 2-4: work on the indicated by the patient and test results most problematic aspect of diabetes, session 5: a summary and plan for further treatment if needed. The control group results were obtained only at baseline. Research tools: DDS; PAID, Diabetes Burnout test by Polonsky. RESULTS At the baseline, significant differences were observed between the studied group and control group: in DB/DD levels: DB (3.9 ± 1.7 vs 2.4 ± 1.6; p < 0.001); DDS (3.2 ± 1.0 vs 2.7 ± 1.0; p = 0.064); PAID (62.3 ± 14.1vs 34.4 ± 21.0; p < 0.001). There were also group differences in HbA1c levels (8.7 ± 2.4 vs 7.3 ± 1.5; p = 0.028). After psychological interventions, there was a significant improvement in DB (3.9 ± 1.7vs 2.9 ± 1.2; p < 0.001; DDS (3.2 ± 1 vs 3.0 ± 0.7; p = 0.03); PAID (62.3 ± 14.1 vs 51.8 ± 12.5; p < 0.001). CONCLUSIONS DD and DB constitute a significant problem in the group of T1DM patients, but providing appropriate specialist care may help them accept diabetes and improve life satisfaction, as well as regain control over their diabetes management.
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Affiliation(s)
- Katarzyna Cyranka
- Department of Psychiatry, Jagiellonian University Medical College, Kraków, Poland.
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.
- University Hospital in Krakow, Kraków, Poland.
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Kraków, Poland
| | - Maciej Pilecki
- Department of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Krakow, Kraków, Poland
| | | | - Andrzej Juryk
- Department of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Krakow, Kraków, Poland
| | - Dawid Storman
- University Hospital in Krakow, Kraków, Poland
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Polska
| | - Dominika Dudek
- Department of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Krakow, Kraków, Poland
| | - Maciej T Malecki
- University Hospital in Krakow, Kraków, Poland
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Kraków, Poland
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Gregorczyk-Maga I, Kania M, Dąbrowska M, Samborowska E, Żeber-Lubecka N, Kulecka M, Klupa T. The interplay between gingival crevicular fluid microbiome and metabolomic profile in intensively treated people with type 1 diabetes - a combined metagenomic/metabolomic approach cross-sectional study. Front Endocrinol (Lausanne) 2024; 14:1332406. [PMID: 38371896 PMCID: PMC10871129 DOI: 10.3389/fendo.2023.1332406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/31/2023] [Indexed: 02/20/2024] Open
Abstract
Aims This study aimed to assess the gingival crevicular fluid (GCF) microbiome and metabolome of adults with type 1 diabetes (T1D) treated with continuous subcutaneous insulin infusion (CSII). Methods In this cross-sectional study, the GCF of adults with T1D treated with CSII and non-diabetic controls were sampled, and metagenomic/metabolomic analyses were performed. Results In total, 65 participants with T1D and 45 healthy controls with a mean age of 27.05 ± 5.95 years were investigated. There were 22 cases of mild gingivitis (G) in the T1D group. There were no differences considering the Shannon and Chao indices and β-diversity between people with T1D and G, with T1D without G, and healthy controls. Differential taxa were identified, which were mainly enriched in people with T1D and G. Acetic acid concentration was higher in people with T1D, regardless of the presence of G, than in healthy controls. Propionic acid was higher in people with T1D and G than in healthy controls. Isobutyric and isovaleric acid levels were higher in individuals with T1D and G than in the other two subgroups. The concentration of valeric acid was lower and that of caproic acid was higher in people with T1D (regardless of gingival status) than in healthy controls. Conclusions The identification of early changes in periodontal tissues by targeting the microbiome and metabolome could potentially enable effective prevention and initial treatment of periodontal disease in people with T1D.
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Affiliation(s)
- Iwona Gregorczyk-Maga
- Institute of Dentistry, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Kania
- Chair of Metabolic Diseases and Diabetology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
- Doctoral School of Medicine and Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Michalina Dąbrowska
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Emilia Samborowska
- Mass Spectrometry Laboratory, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - Natalia Żeber-Lubecka
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Department of Gastroenterology, Hepatology and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Maria Kulecka
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Department of Gastroenterology, Hepatology and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Tomasz Klupa
- Center of Advanced Technologies in Diabetes, Chair of Metabolic Diseases, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
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Matejko B, Tota Ł, Morawska-Tota M, Pałka T, Malecki MT, Klupa T. Assessment of selected muscle damage markers and zonulin concentration after maximum-intensity exercise in men with type 1 diabetes treated with a personal insulin pump. Acta Diabetol 2023; 60:1675-1683. [PMID: 37481476 PMCID: PMC10587266 DOI: 10.1007/s00592-023-02157-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/11/2023] [Indexed: 07/24/2023]
Abstract
AIM Exercise-induced muscle damage depends on exercise intensity and duration and on individual susceptibility. Mechanical and metabolic stress may disturb the intestinal microflora. The study evaluated selected muscle damage markers and zonulin concentration after maximum-intensity exercise in type 1 diabetes (T1D) men compared with healthy controls. METHODS The study involved 16 T1D participants and 28 controls matched by age (22.7 [21.3-25.1] vs. 22.6 [20.9-26.3] years), body mass index (24.2 ± 1.6 vs. 24.2 ± 1.9 kg/m2), and body fat percentage (16.1 ± 5.2 vs. 14.9 ± 4.6%). The T1D group had 11.3 ± 5.1 years of diabetes duration and a suboptimal mean glycated haemoglobin level of 7.2 ± 1.1%. The subjects underwent a graded running treadmill test until exhaustion. Lactate concentration was assessed in arterialized blood at baseline and 3 and 20 min after the test. Cortisol, testosterone, tumour necrosis factor α, myoglobin, lactate dehydrogenase, zonulin, and vitamin D levels were evaluated in cubital fossa vein blood before and 60 min after the test. RESULTS T1D patients presented higher baseline zonulin, myoglobin concentration, testosterone/cortisol ratio, and lower maximal oxygen uptake. On adjusting for the baseline values, the groups differed in zonulin, lactate dehydrogenase, and myoglobin levels, testosterone/cortisol ratio, and lactate concentration determined 20 min after exercise (P < 0.05). CONCLUSION Maximum-intensity exercise increased muscle and intestinal damage in T1D participants. In patients with lower physical activity, very-high-intensity exercise should be recommended with caution. Observing the anabolic-catabolic index may help individualize effort intensity in T1D individuals.
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Affiliation(s)
- Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688, Krakow, Poland.
- University Hospital in Krakow, Krakow, Poland.
| | - Łukasz Tota
- Department of Physiology and Biochemistry, University of Physical Education in Krakow, Krakow, Poland
| | - Małgorzata Morawska-Tota
- Department of Sports Medicine and Human Nutrition, University of Physical Education in Krakow, Krakow, Poland
| | - Tomasz Pałka
- Department of Physiology and Biochemistry, University of Physical Education in Krakow, Krakow, Poland
| | - Maciej T Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
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Krzyżowska S, Matejko B, Cyranka K, Juza A, Kieć-Wilk B, Klupa T. Lack of major impact of implementation of the Advanced Hybrid Closed Loop System in technologically-naïve patients with Type 1 Diabetes mellitus on their food choices or weight - a one year follow-up. Ann Agric Environ Med 2023; 30:468-473. [PMID: 37772522 DOI: 10.26444/aaem/161289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
INTRODUCTION AND OBJECTIVE The purpose of this follow-up study on the implementation of advanced closed-loop hybrid insulin pumps in people with type 1 diabetes was to assess the impact of introducing this advanced technology on quantitative and qualitative parameters of diet. MATERIAL AND METHODS 18 patients (8 women and 10 men, mean age 40.9 years) patients using the CE-marked MiniMed 780G AHCL system who completed 1 year of follow-up were included into the study. The research tool was the KomPAN questionnaire with several own questions added, asked in three study periods, concerning the number of meals consumed, general and night snacking, carbohydrate counting, frequency of consumption of various groups of products that affect postprandial glycaemia. RESULTS Although the mean body weight of the examined group did not increase significantly (from 75.1 kg at the beginning to 75,9 kg at the end), five various individual scenarios of weight change were observed. The eating habits has not changed, but patients began to consume less products containing simple sugars, e.g. fruit preserves, milk chocolate or fish in sauces (p<0.05). No statistically significant correlation was found between the change in body weight at the end of the study and the average amount of carbohydrates entered into the pump from the entire 12 months (p = 0.460). CONCLUSIONS The implementation of AHCL system in technology naïve patients, despite offering more freedom of food choices due to better glycaemic control, did not have a significant impact on patients' dietary patterns, also did not result in weight gain. This is important since AHCL system offers more freedom of food choices due to better glycaemic control. However, the longer follow up and the study based on larger population is required to finally address the issue of the impact of AHCL on body mass.
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Affiliation(s)
| | - Bartłomiej Matejko
- University Hospital in Krakow, Poland
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Cyranka
- University Hospital in Krakow, Poland
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Juza
- Clinical Provincial Hospital of Frederic Chopin No. 1 in Rzeszów, Poland
- College of Medical Sciences, University of Rzeszów, Poland
| | - Beata Kieć-Wilk
- University Hospital in Krakow, Poland
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Klupa
- University Hospital in Krakow, Poland
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
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Cyranka K, Matejko B, Juza A, Kieć-Wilk B, Cohen O, Malecki MT, Klupa T. Quality of life in the course of a one-year use of an advanced hybrid closed-loop system in adults with type 1 diabetes previously naïve to advanced diabetes technology. Front Endocrinol (Lausanne) 2023; 14:1210756. [PMID: 37654566 PMCID: PMC10466125 DOI: 10.3389/fendo.2023.1210756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/25/2023] [Indexed: 09/02/2023] Open
Abstract
Aim To evaluate the effect of a one-year use of an advanced hybrid closed-loop (AHCL) system on the quality of life, level of anxiety, and level of self-efficacy in adults with type 1 diabetes (T1D) previously treated with multiple daily injections (MDI) and naïve to advanced diabetes technology. Methods A total of 18 participants of a previously published 3-month randomized trial (10 men, 8 women; age 40.9 ± 7.6 years) who were switched directly from MDI/BMG to AHCL completed 12 months of MiniMed 780G™system use (a 3-month randomized trial followed by a 9-month follow-up phase). At month 6 of the study, patients were switched from the sensor GS3 (Continuous Glucose Monitoring) system, powered by Guardian™ Sensor 3) to GS4. Quality of life was assessed using the Polish validated version of the 'QoL-Q Diabetes' questionnaire. The level of anxiety was evaluated with the use of the State-Trait Anxiety Inventory (STAI). Self-efficacy was assessed with the General Self-Efficacy Scale (GSES). Results were obtained at baseline and at the end of the study. Results Significant increase in QoL was reported in the global score (p=0.02, Cohen d=0.61) and in as many as 11 out of 23 analyzed areas of life: being physically active (p=0.02, Cohen d = 0.71); feeling well (p<.01, Cohen d = 0.73); feeling in control of my body (p<.01, Cohen d = 0.72); looking good (p<.01, Cohen d = 1.07); working (p<.01, Cohen d = 1.12); sleeping (p=0.01, Cohen d = 0.66); eating as I would like (p<.01, Cohen d = 0.79); looking after or being useful to others (p= 0.02, Cohen d = 0.65); being active with pets/animals (p<.01, Cohen d = 0.95); being spontaneous (p=0.02, Cohen d = 0.67); and doing "normal" things (p=0.02, Cohen d = 0.67). Both state (p=0.04, Cohen d = 0.56) and trait (p=0.02, Cohen d = 0.60) anxiety decreased while the general self-efficacy increased (p=0.03, Cohen d = 0.76). No participant stopped the use of the pump. Conclusion Adult patients with T1D previously treated with MDI and naïve to modern technologies experienced significant improvement in their psychological well-being after transitioning to the AHCL system after 12 months of treatment.
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Affiliation(s)
- Katarzyna Cyranka
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
- Department of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
| | - Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | - Anna Juza
- Clinical Provincial Hospital of Frederic Chopin No. 1 in Rzeszów, Rzeszów, Poland
- College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
| | - Beata Kieć-Wilk
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | | | - Maciej T. Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
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Kwiendacz H, Nabrdalik K, Czupryniak L, Klupa T, Małecki M, Myśliwiec M, Strojek K, Gumprecht J. The Wedding Bells Sound Really Good! iGlarLixi Fixed-Ratio Combination in the Treatment of Type 2 Diabetes: A Narrative Review. Adv Ther 2023; 40:3395-3409. [PMID: 37326901 PMCID: PMC10329951 DOI: 10.1007/s12325-023-02567-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
iGlarLixi is a fixed-ratio combination of insulin glargine 100 U/mL and lixisenatide used in the treatment of type 2 diabetes. iGlarLixi has proven clinical benefits in terms of glycemia, weight control, and safety, defined by the risk of hypoglycemia. It simultaneously targets many pathophysiologic abnormalities which are at the root of type 2 diabetes and thus presents a complementary mode of action. Finally, it may also address diabetes treatment burden, and, by decreasing the complexity of treatment, it may improve patient adherence and persistence and fight against clinical inertia. This article reviews the results of major randomized controlled trials in people with type 2 diabetes that compared iGlarLixi to other therapeutic regimens, representing different intensification strategies, such as basal supported oral therapy, oral antidiabetic drugs, and a combination of the latter with glucagon-like peptide 1 receptor agonists. Moreover, as a supplement to randomized trials, data from real-world evidence have also been included.
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Affiliation(s)
- Hanna Kwiendacz
- Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, 3 Maja Str. 41-800, Zabrze, Poland.
| | - Katarzyna Nabrdalik
- Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, 3 Maja Str. 41-800, Zabrze, Poland
| | - Leszek Czupryniak
- Diabetology and Internal Medicine Department, Warsaw Medical University, Warsaw, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Małecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Małgorzata Myśliwiec
- Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdańsk, Poland
| | - Krzysztof Strojek
- Department of Internal Diseases, Diabetology and Cardiometabolic Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Janusz Gumprecht
- Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, 3 Maja Str. 41-800, Zabrze, Poland
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Kania M, Koń B, Kamiński K, Hohendorff J, Witek P, Klupa T, Malecki MT. Corrigendum: Diabetes as a risk factor of death in hospitalized COVID-19 patients - an analysis of a National Hospitalization Database from Poland, 2020. Front Endocrinol (Lausanne) 2023; 14:1228521. [PMID: 37469983 PMCID: PMC10352313 DOI: 10.3389/fendo.2023.1228521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/20/2023] [Indexed: 07/21/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fendo.2023.1161637.].
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Affiliation(s)
- Michal Kania
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases and Diabetology, University Hospital, Krakow, Poland
| | - Beata Koń
- Department of Analysis and Innovation, National Health Fund, Warsaw, Poland
| | - Konrad Kamiński
- Department of Analysis and Innovation, National Health Fund, Warsaw, Poland
| | - Jerzy Hohendorff
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases and Diabetology, University Hospital, Krakow, Poland
| | - Przemysław Witek
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases and Diabetology, University Hospital, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases and Diabetology, University Hospital, Krakow, Poland
| | - Maciej T. Malecki
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases and Diabetology, University Hospital, Krakow, Poland
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10
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Klupa T, Czupryniak L, Dzida G, Fichna P, Jarosz-Chobot P, Gumprecht J, Mysliwiec M, Szadkowska A, Bomba-Opon D, Czajkowski K, Malecki MT, Zozulinska-Ziolkiewicz DA. Expanding the Role of Continuous Glucose Monitoring in Modern Diabetes Care Beyond Type 1 Disease. Diabetes Ther 2023:10.1007/s13300-023-01431-3. [PMID: 37322319 PMCID: PMC10299981 DOI: 10.1007/s13300-023-01431-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023] Open
Abstract
Application of continuous glucose monitoring (CGM) has moved diabetes care from a reactive to a proactive process, in which a person with diabetes can prevent episodes of hypoglycemia or hyperglycemia, rather than taking action only once low and high glucose are detected. Consequently, CGM devices are now seen as the standard of care for people with type 1 diabetes mellitus (T1DM). Evidence now supports the use of CGM in people with type 2 diabetes mellitus (T2DM) on any treatment regimen, not just for those on insulin therapy. Expanding the application of CGM to include all people with T1DM or T2DM can support effective intensification of therapies to reduce glucose exposure and lower the risk of complications and hospital admissions, which are associated with high healthcare costs. All of this can be achieved while minimizing the risk of hypoglycemia and improving quality of life for people with diabetes. Wider application of CGM can also bring considerable benefits for women with diabetes during pregnancy and their children, as well as providing support for acute care of hospital inpatients who experience the adverse effects of hyperglycemia following admission and surgical procedures, as a consequence of treatment-related insulin resistance or reduced insulin secretion. By tailoring the application of CGM for daily or intermittent use, depending on the patient profile and their needs, one can ensure the cost-effectiveness of CGM in each setting. In this article we discuss the evidence-based benefits of expanding the use of CGM technology to include all people with diabetes, along with a diverse population of people with non-diabetic glycemic dysregulation.
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Affiliation(s)
- Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.
| | - Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Dzida
- Department of Internal Diseases, Medical University of Lublin, Lublin, Poland
| | - Piotr Fichna
- Department of Pediatric Diabetes and Obesity, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Janusz Gumprecht
- Department of Internal Medicine, Diabetology and Nephrology, Medical University of Silesia, Katowice, Poland
| | - Malgorzata Mysliwiec
- Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdansk, Poland
| | - Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland
| | - Dorota Bomba-Opon
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Czajkowski
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Maciej T Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
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11
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Cyranka K, Juza A, Kwiendacz H, Nabrdalik K, Gumprecht J, Małecki M, Klupa T, Matejko B. Evaluation of Psychological Resources of Young Adults With Type 1 Diabetes Mellitus During the Transition From Pediatric to Adult Diabetes Clinics: Multicenter Cross-sectional Study. JMIR Form Res 2023; 7:e46513. [PMID: 37247225 DOI: 10.2196/46513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/31/2023] [Accepted: 04/10/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND The transition period of patients with type 1 diabetes from pediatric to adult-oriented health care is associated with poorer glycemic control and less frequent clinic attendance. Fears and anxiety about the unknown, care approach differences in adult settings, and sadness about leaving the pediatric provider all contribute to a patient's reluctance to transition. OBJECTIVE This study aimed to evaluate the psychological parameters of young patients with type 1 diabetes transitioning to an adult outpatient clinic during the first visit. METHODS We examined 50 consecutive patients (n=28, 56% female) transitioning from March 2, 2021, to November 21, 2022, into adult care (3 diabetes centers from 3 regions in southern Poland: A, n=16; B, n=21; and C, n=13) and their basic demographic information. They completed the following psychological questionnaires: State-Trait Anxiety Inventory (STAI), Generalized Self-Efficacy Scale, Perceived Stress Scale, Satisfaction with Life Scale, Acceptance of Illness Scale, Multidimensional Health Locus of Control Scale Form C, Courtauld Emotional Control Scale, and Quality of Life Questionnaire Diabetes. We compared their data with those for the general healthy population and patients with diabetes from Polish Test Laboratory validation studies. RESULTS During the first adult outpatient visit, patients' mean age was 19.2 (SD 1.4) years, with a diabetes duration of 9.8 (SD 4.3) years and BMI of 23.5 (SD 3.1) kg/m2. Patients came from diverse socioeconomic backgrounds: 36% (n=18) live in villages, 26% (n=13) live in towns with ≤100,000 inhabitants, and 38% (n=19) live in bigger cities. Regarding therapy type, 68% (n=34) were treated with insulin pump therapy, whereas 32% (n=16) were treated with multiple daily injections. Patients from center A had a mean glycated hemoglobin level of 7.5% (SD 1.2%). There was no difference regarding the level of life satisfaction, perceived level of stress, and state anxiety between the patients and reference populations. Patients had similar health locus of control and negative emotions control to the general population of patients with diabetes. Most patients (n=31, 62%) believe that control over their health depends on themselves, whereas 52% (n=26) believe that it depends mostly on others. Patients had higher levels of suppression of negative emotions-anger, depression, and anxiety-than the age-matched general population. Additionally, the patients were characterized by a higher acceptance of illness and higher level of self-efficacy compared to the reference populations: 64% (n=32) had a high level of self-efficacy and 26% (n=13) had a high level of life satisfaction. CONCLUSIONS This study indicated that young patients transitioning to adult outpatient clinics have good psychological resources and coping mechanisms, which might result in adequate adaptation and adult life satisfaction including future metabolic control. These result also disprove the stereotypes that young people with chronic disease have worse life perspectives when entering adulthood.
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Affiliation(s)
- Katarzyna Cyranka
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
- Clinic of Metabolic Diseases, University Hospital in Kraków, Kraków, Poland
- Department of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Juza
- Diabetes Outpatient Clinic, Clinical Provincial Hospital of Frederic Chopin No. 1 in Rzeszów, Rzeszów, Poland
- College of Medical Sciences, University of Rzeszow, Rzeszów, Poland
| | - Hanna Kwiendacz
- Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze Medical University of Silesia, Katowice, Poland
| | - Katarzyna Nabrdalik
- Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze Medical University of Silesia, Katowice, Poland
| | - Janusz Gumprecht
- Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze Medical University of Silesia, Katowice, Poland
| | - Maciej Małecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
- Clinic of Metabolic Diseases, University Hospital in Kraków, Kraków, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
- Clinic of Metabolic Diseases, University Hospital in Kraków, Kraków, Poland
| | - Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
- Clinic of Metabolic Diseases, University Hospital in Kraków, Kraków, Poland
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12
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Matejko B, Juza A, Kiec-Wilk B, Cyranka K, Krzyżowska S, Cohen O, Malecki MT, Klupa T. One-year follow-up of advance hybrid closed-loop system in adults with type 1 diabetes previously naive to diabetes technology: The effect of switching to a calibration-free sensor. Diabetes Technol Ther 2023. [PMID: 37184526 DOI: 10.1089/dia.2023.0059] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The aim of this study was to observe the one-year clinical outcomes of people with type 1 diabetes (T1D) who switched from Multiple Daile Injection + Blood Glucose Meter to an advanced hybrid closed-loop (AHCL) system (Medtronic MiniMedTM 780G system (MM 780G). Additionally, the effect of changing at month 6 to a calibration free sensor (GuardianTM 4 Sensor (G4S) was evaluated. 18 participants (10 men, age 40.9±7.6 years) completed 1 year of MM 780G use. Time in range (70-180 mg/dL) (TIR) remained stable and ranged from 83.2% in month 9 to 84.8% in month 3. There was no difference between TIR at 3 months before switching vs 3 months after switching to G4S (p=0.614). AHCL system in adults significantly improves glycemic outcomes. This improved glycemic control was maintained over the 12 months. Switching to a calibration free sensor (G4S) did not affect outcomes but required less patient involvement.
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Affiliation(s)
- Bartlomiej Matejko
- Jagiellonian University Medical College, 49573, Krakow, Poland
- University Hospital in Krakow Metabolic Diseases and Diabetology Clinical Department, 574410, Krakow, Małopolskie, Poland;
| | - Anna Juza
- Specialist Voivodship Hospital Frederic Chopin in Rzeszow, 206088, ul. Saska 61/6, Rzeszów, Poland, 35-615;
| | - Beata Kiec-Wilk
- Jagiellonian University Medical College, 49573, Department of Metabolic Diseases, Krakow, Małopolskie, Poland
- University Hospital in Krakow Metabolic Diseases and Diabetology Clinical Department, 574410, Krakow, Małopolskie, Poland;
| | - Katarzyna Cyranka
- Jagiellonian University Medical College, 49573, Department of Metabolic Diseases, Krakow, Małopolskie, Poland
- University Hospital in Krakow Metabolic Diseases and Diabetology Clinical Department, 574410, Krakow, Małopolskie, Poland;
| | - Sabina Krzyżowska
- University Hospital in Krakow Metabolic Diseases and Diabetology Clinical Department, 574410, Department of Metabolic Diseases, Krakow, Małopolskie, Poland;
| | - Ohad Cohen
- Medtronic International Trading Sàrl, Toluchenaz, Tolochenaz, Switzerland, 46733;
| | - Maciej Tadeusz Malecki
- Jagiellonian University Medical College, 49573, Department of Metabolic Diseases, Krakow, Małopolskie, Poland
- University Hospital in Krakow Metabolic Diseases and Diabetology Clinical Department, 574410, Krakow, Małopolskie, Poland;
| | - Tomasz Klupa
- Jagiellonian University Medical College, 49573, Department of Metabolic Diseases, Krakow, Małopolskie, Poland
- University Hospital in Krakow Metabolic Diseases and Diabetology Clinical Department, 574410, Krakow, Małopolskie, Poland;
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Kania M, Koń B, Kamiński K, Hohendorff J, Witek P, Klupa T, Malecki MT. Diabetes as a risk factor of death in hospitalized COVID-19 patients - an analysis of a National Hospitalization Database from Poland, 2020. Front Endocrinol (Lausanne) 2023; 14:1161637. [PMID: 37214252 PMCID: PMC10194032 DOI: 10.3389/fendo.2023.1161637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/06/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction Diabetes is one of the comorbidities associated with poor prognosis in hospitalized COVID-19 patients. In this nationwide retrospective study, we evaluated the risk of in-hospital death attributed to diabetes. Methods We analyzed data from discharge reports of patients hospitalized with COVID-19 in 2020 as submitted to the Polish National Health Fund. Several multivariate logistic regression models were used. In each model, in-hospital death was estimated with explanatory variables. Models were built either on the whole cohorts or cohorts matched with propensity score matching (PSM). The models examined either the main effects of diabetes itself or the interaction of diabetes with other variables. Results We included 174,621 patients with COVID-19 who were hospitalized in the year 2020. Among them, there were 40,168 diabetic patients (DPs), and the proportion of DPs in this group was higher than in the general population (23.0% vs. 9.5%, p<0.001). In this group of COVID-19 hospitalizations, 17,438 in-hospital deaths were recorded, and the mortality was higher among DPs than non-diabetics (16.3% vs. 8.1%, p<0.001). Multivariate logistic regressions showed that diabetes was a risk factor of death, regardless of sex and age. In the main effect analysis, odds of in-hospital death were higher by 28.3% for DPs than for non-diabetic patients. Similarly, PSM analysis including 101,578 patients, of whom 19,050 had diabetes, showed that the risk of death was higher in DPs regardless of sex with odds higher by 34.9%. The impact of diabetes differed among age groups and was the highest for patients aged 60-69. Conclusions This nationwide study confirmed that diabetes was an independent risk factor of in-hospital death in the course of COVID-19 infection. However, the relative risk differed across the age groups.
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Affiliation(s)
- Michal Kania
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases and Diabetology, University Hospital, Krakow, Poland
| | - Beata Koń
- Department of Analysis and Innovation, National Health Fund, Warsaw, Poland
| | - Konrad Kamiński
- Department of Analysis and Innovation, National Health Fund, Warsaw, Poland
| | - Jerzy Hohendorff
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases and Diabetology, University Hospital, Krakow, Poland
| | - Przemysław Witek
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases and Diabetology, University Hospital, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases and Diabetology, University Hospital, Krakow, Poland
| | - Maciej T. Malecki
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases and Diabetology, University Hospital, Krakow, Poland
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Ucieklak D, Mrozińska S, Wojnarska A, Małecki MT, Klupa T, Matejko B. Type 1 Diabetes Mellitus and Lipohypertrophy - Impact of the Intervention on Glycemic Control via Patient's Examination and Retraining on Change of Infusion Set. Endocr Pract 2023; 29:174-178. [PMID: 36581082 DOI: 10.1016/j.eprac.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/18/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Lipohypertrophy (LH) is a common complication of insulin therapy in type 1 diabetes mellitus (T1DM). We examined whether an intervention consisting of LH assessment and retraining on insulin infusion set use improves glycemic control on subcutaneous insulin infusion (CSII) in patients with T1DM. METHODS The intervention was conducted in 79 consecutive patients with T1DM. Data on glucose levels, glycated hemoglobin (HbA1c), and insulin doses were collected at baseline and after a median of 22 weeks (20-31.75 weeks). RESULTS A total of 46 patients with T1DM (23 [50%] women) participating in the follow-up were characterized by a median age of 29 years (25-33.8 years), body mass index of 24.6 ± 3.3 kg/m2, T1DM duration of 16.5 years (8.3-20 years), and subcutaneous insulin infusion duration of 7 years (4-10.8 years). Patients' median HbA1c fell from 7.4% (6.7%-8.2%) to 7.05% (6.4%-7.6%) (P < .001), daily insulin dose/kg decreased (0.7 ± 0.20 vs 0.68 ± 0.15 IU/kg; P = .017) together with the total daily insulin dose (50.3 [40.5-62.7] vs 47.6 [39.8-62.1] IU; P = .019]. Furthermore, the percentage of basal insulin dose increased (43.0% [36-50] vs 44.0% [39.0-50.0]; P = .010], whereas the percentage of bolus dose decreased (57% [50-64] vs 56% [50-61], P = .010). CONCLUSIONS The structured LH-related intervention in patients with T1DM on insulin pumps resulted in better glycemic control and a decrease in total daily insulin dose.
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Affiliation(s)
- Damian Ucieklak
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland; Department of Metabolic Diseases, University Hospital, Krakow, Poland
| | - Sandra Mrozińska
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland; Department of Metabolic Diseases, University Hospital, Krakow, Poland; Department of Pathophysiology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Aleksandra Wojnarska
- Department of Metabolic Diseases, University Hospital, Krakow, Poland; Department of Radiology, Jagiellonian University Medical College, Krakow, Poland
| | - Maciej T Małecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland; Department of Metabolic Diseases, University Hospital, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland; Department of Metabolic Diseases, University Hospital, Krakow, Poland
| | - Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland; Department of Metabolic Diseases, University Hospital, Krakow, Poland.
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15
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Gregorczyk-Maga I, Fiema M, Kania M, Jachowicz-Matczak E, Romaniszyn D, Gerreth K, Klupa T, Wójkowska-Mach J. Oral Microbiota-One Habitat or Diverse Niches? A Pilot Study of Sampling and Identification of Oral Bacterial and Fungal Biota in Patients with Type I Diabetes Mellitus Treated with Insulin Pump. Int J Environ Res Public Health 2023; 20:2252. [PMID: 36767617 PMCID: PMC9914992 DOI: 10.3390/ijerph20032252] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE The oral microbiota is a very complex and dynamic microbial ecosystem. Alterations of its balance can result in oral and systemic diseases. We aimed to characterize the microbiota in particular niches of the oral cavity in adult type 1 diabetes patients treated with continuous infusion of insulin with insulin pump (IP). In addition, we aimed to determine optimal sites of oral microbiota sampling in studies of large research groups of patients with DM I. DESIGN In this pilot study, we sampled the buccal and soft palate mucosa, tongue, palatal and buccal dental surfaces and gingival pockets of adult DM I patients treated with IP. RESULTS In total, 23 patients were recruited. The oral microbiota was dominated by Streptococus and Neisseria, with a low incidence of cariogenic S. mutans and Lactobacillus, as well as periodontal pathogens such as Prevotella. There were significant differences in overall CFU counts of all strains, Gram-positive, Staphylococci, Streptococci and S. oralis strains between mucosal and dental surface sites. The overall CFU counts of all strains and Gram-positive strains were higher in dental sites vs. mucosal sites (both p < 0.001). CFU counts of S. oralis were significantly higher in dental sites vs. gingival pocket sites (p = 0.013). Candida species were rare. The mucosal sites on the buccae presented lower diversity and bacterial counts. CONCLUSIONS In the study group of adult DM I patients treated with IP, the microbiota in particular niches of the oral cavity was significantly different. Three distinct and optimally appropriate sampling sites for oral microflora were identified: buccal and palatal mucosa, dental surface and gingival pockets. The results of this study may be the basis for further studies of large groups of patients with DM I.
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Affiliation(s)
- Iwona Gregorczyk-Maga
- Institute of Dentistry, Faculty of Medicine, Jagiellonian University Medical College, 31-155 Krakow, Poland
| | - Mateusz Fiema
- Department of Endocrinology, University Hospital, 30-688 Krakow, Poland
| | - Michal Kania
- Doctoral School of Medicine and Health Sciences, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Department of Metabolic Diseases, Center of Advanced Technologies in Diabetes, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Estera Jachowicz-Matczak
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, 31-121 Krakow, Poland
| | - Dorota Romaniszyn
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, 31-121 Krakow, Poland
| | - Karolina Gerreth
- Department of Risk Group Dentistry, Chair of Pediatric Dentistry, Poznan University of Medical Sciences, 60-812 Poznan, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Center of Advanced Technologies in Diabetes, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Jadwiga Wójkowska-Mach
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, 31-121 Krakow, Poland
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16
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Mavragani A, Matejko B, Juza A, Kieć-Wilk B, Krzyżowska S, Cohen O, Da Silva J, Lushchyk M, Malecki MT, Klupa T. Improvement of Selected Psychological Parameters and Quality of Life of Patients With Type 1 Diabetes Mellitus Undergoing Transition From Multiple Daily Injections and Self-Monitoring of Blood Glucose Directly to the MiniMed 780G Advanced Hybrid Closed-Loop System: Post hoc Analysis of a Randomized Control Study. JMIR Form Res 2023; 7:e43535. [PMID: 36692945 PMCID: PMC9906310 DOI: 10.2196/43535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND While introducing new technologies and methods of treatment for type 1 diabetes mellitus (T1DM), it seems essential to monitor whether modern technologies in diabetes treatment may improve the psychological and emotional status of patients. OBJECTIVE This study aims to assess the baseline psychological parameters of patients with T1DM during investigation of the direct transition from multiple daily injections (MDI) and self-monitoring of blood glucose (SMBG) to the MiniMed 780G advanced hybrid closed-loop (AHCL) system and to evaluate changes in the psychological well-being and quality of life (QoL) after the transition in these individuals versus the control group. METHODS The trial was a 2-center, randomized controlled, parallel group study. In total, 41 patients with T1DM managed with MDI or SMBG were enrolled and randomized either to the AHCL or the MDI+SMBG group. Of these, 37 (90%) participants (mean age 40.3 years, SD 8.0 years; mean duration of diabetes 17.3, SD 12.1 years; mean hemoglobin A1c [HbA1c] 7.2%, SD 1.0%) completed the study (AHCL: n=20, 54%; MDI+SMBG: n=17, 46%). Psychological parameters (level of stress, coping mechanisms, level of anxiety, self-efficacy level, acceptance of illness, locus of control of illness, life satisfaction, QoL) were measured at baseline and at the end of the study using 10 psychological questionnaires. RESULTS At baseline, the general level of stress of the examined patients was higher than in the general healthy Polish population (P=.001), but coping strategies used in stressful situations were significantly more effective and the level of self-efficacy (P<.001) was much higher than in the general population. The patients in this study accepted their illness more than patients with diabetes from the general Polish population (P<.001), but they felt that their health does not depend on them compared to the general population (P<.001). The overall life satisfaction was similar to that of the general population (P=.161). After 3 months from transition, the AHCL group reported an increase in 4 scales of the QoL-feeling well (P=.042), working (P=.012), eating as I would like (P=.011), and doing normal things (P=.034)-in comparison to the control group, where no significant change occurred. The level of both state anxiety and trait anxiety decreased in the AHCL group: State-Trait Anxiety Inventory (STAI) X1 scores (P=.009), STAI X1 stens (P=.013), and STAI X2 scores (P=.022). The AHCL group became more emotion oriented in stressful situations (Coping Inventory for Stressful Situations [CISS] E; P=.043) and significantly less self-blaming after 3 months of the study (P=.020). CONCLUSIONS The results indicate that the patients who decided to take part in the transition study were characterized by higher levels of stress than the general healthy population but had better coping strategies and self-efficacy. Furthermore, transitioning from MDI+SMBG treatment to the AHCL in patients naive to technology may significantly improve psychological well-being and QoL within 3 months. The rapidity of these changes suggests that they may be related to the significant improvement in glycemic outcomes but also significantly less burdened diabetes self-management. TRIAL REGISTRATION ClinicalTrials.gov NCT04616391; https://clinicaltrials.gov/ct2/show/NCT04616391.
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Affiliation(s)
| | - Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,Hospital University in Krakow, Krakow, Poland
| | - Anna Juza
- Clinical Provincial Hospital of Frederic Chopin No 1 in Rzeszów, Rzeszów, Poland.,College of Medical Sciences, University of Rzeszow, Rzeszow, Poland
| | | | | | - Ohad Cohen
- Medtronic, Northridge, California, CA, United States
| | - Julien Da Silva
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Maxim Lushchyk
- Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus
| | - Maciej T Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,Hospital University in Krakow, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,Hospital University in Krakow, Krakow, Poland
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17
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Cyranka K, Matejko B, Chrobak A, Dudek D, Kieć-Wilk B, Cyganek K, Witek P, Lushchyk M, Krzyżowska S, Małecki MT, Klupa T. Assessment of the spectrum of depression and bipolarity in patients with type 1 diabetes. Diabetes Metab Res Rev 2023; 39:e3583. [PMID: 36270020 DOI: 10.1002/dmrr.3583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 07/08/2022] [Accepted: 09/23/2022] [Indexed: 01/10/2023]
Abstract
AIMS The aim of the study was to check the prevalence of unipolarity (depression), bipolarity, as well as the quality of sleep and temperament traits in patients with type 1 diabetes (T1DM) who are provided with optimal conditions of diabetes care and to identify possible risk factors connected with affective traits. MATERIALS AND METHODS Out of the 107 T1DM patients, 78 (54 females, 24 males) were included for the analysis (HbA1c [%] 7.11 ± 1.0, BMI [kg/m2 ] 25.3 ± 5.6; Years of disease duration [N] 13.7 ± 8.3). The patients filled in a set of questionnaires during their regular visit to the outpatient clinic. Three patients from the whole group were on intensive insulin therapy with Multiple Daily Injections (MDI) and Self-Monitoring of Blood Glucose (SMBG), all the rest were on various types of personal insulin pumps (years on insulin pump [N] 9.1 ± 4.5). All the patients were on regular diabetologist care, with regular visits in a Centre for Advanced Technologies in Diabetes (at least every 6 months). RESULTS In QIDS-S (full explanation and abbreviation 26 patients (33.8%) were screened positive for depression, in PHQ (full explanation and ab 57.7% of the patients (45 patients) had symptoms of depression (age was negatively correlated with PHQ score [r = -0.26; p = 0.023]). In CES-D 16 (20%) of the patients assessed their present affect as depressed. None of the analysed clinical variables correlated with depression scores. In the Mood Disorder Questionnaire (MDQ), 16 patients reported having symptoms of bipolarity (20.5% vs. 79.5%). Hypomania Checklist (HCL) analysis indicated 10 patients with bipolar traits (>14) (14.9% vs. 85.1%). None of the analysed clinical variables correlated with HCL results. 11.5% of patients were indicated to be of morning type. Morningness was more often seen in younger patients (r = 0.39; p = 0.001). As many as 46.6% declared that they had poor sleep quality. The temperament traits analysis correlated with clinical parameters: Cyclothymic temperament trait was negatively correlated with age (r = -0.30; p = 0.007) and positively with HbA1c level (r = 0.30; p = 0.025). Hyperthymic temperament was positively correlated with (BMI r = 0.28; p = 0.016). Quality of sleep was highly correlated with depressive symptoms CESD (r = 0.61, p = 0.001), PHQ Score (r = 0.62; p = 0.001), QISD (r = 0.68; p = 0.001) and bipolarity MDQ (p = 0.50, p = 0.001) and HCL (r = 0.42, p = 0.001). In addition, QIDS was shown to be correlated with the following features of temperament: depressive factor (r = 0.41; p = 0.001), irritable factor (r = 0.53; p = 0.001), cyclothymic factor (r = 0.59; p = 0.001), anxious factor (r = 0.58, p = 0.001). CONCLUSIONS The prevalence of affective disorders and poor sleep quality in the examined T1DM patients was much higher than in the general population. Even if the patients have in general good glycaemic control, their mental health condition should not be neglected. Well organised cooperation between patients, diabetologists, psychiatrists and psychotherapists is needed (Clinical Trials Identifier: NCT04616391).
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Affiliation(s)
- Katarzyna Cyranka
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Adult Psychiatry, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Krakow, Kraków, Poland
| | - Bartlomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Kraków, Poland
| | - Adrian Chrobak
- Department of Adult Psychiatry, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Krakow, Kraków, Poland
| | - Dominika Dudek
- Department of Adult Psychiatry, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Krakow, Kraków, Poland
| | - Beata Kieć-Wilk
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Kraków, Poland
| | - Katarzyna Cyganek
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Kraków, Poland
| | - Przemysław Witek
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Kraków, Poland
| | - Maxim Lushchyk
- Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus
| | | | - Maciej Tadeusz Małecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Kraków, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Kraków, Poland
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18
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Kania M, Suduł P, Mazur K, Chaykivska Z, Fiema M, Kopka M, Kostrzycka M, Wilk M, Hohendorff J, Kieć-Wilk B, Klupa T, Witek P, Katra B, Malecki MT. Type 1 diabetes outpatient care and treatment effectiveness during COVID-19: A single-center cohort study. J Diabetes Complications 2023; 37:108379. [PMID: 36525904 PMCID: PMC9721371 DOI: 10.1016/j.jdiacomp.2022.108379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE COVID-19 has brought many challenges for providing quality healthcare for type 1 diabetes (T1DM). We evaluated the impact of the COVID-19 pandemic on the medical care, glycemic control, and selected outcomes in T1DM patients. METHODS We retrospectively analyzed medical records from 357 T1DM adults enrolled in the Program of Comprehensive Outpatient Specialist Care at the University Hospital in Krakow, and assessed differences in patient data from before the COVID-19 period (March 2019-February 2020) and after it started COVID-19 (March 2020-February 2021). RESULTS The median HbA1c levels and the percentage of patients within the HbA1c target of <7 % (53 mmol/mol) were similar in both periods: before and after the beginning of the pandemic (6.86 % [51.5 mmol/mol], IQR 6.23-7.58 % [44.6-59.3 mmol/mol] vs. 6.9 % [51.9 mmol/mol], IQR 6.2-7.61 % [44.3-59.7 mmol/mol]; p = 0.50 and 56.3 % vs. 57.1 %, p = 0.42, respectively). However, we observed a rise in BMI and body weight (median 24.25, IQR 21.97-27.05 vs. 24.82, IQR 22.17-27.87 and median weight 71.0 IQR 61-82 vs. 72.55, IQR 55-85; p < 0.001 for both comparisons). There was no reduction in the numbers of total diabetes-related visits (median 4, IQR 4-5 vs. 5, IQR 4-5; p = 0.065), but the frequency of other specialist consultations decreased (2, IQR 0-2 vs. 1, IQR 0-2). During the pandemic, telehealth visits constituted of 1191 out of 1609 (71.6 %) total visits. CONCLUSIONS In this single-center observation, the COVID-19 pandemic did not have a negative impact on glycemic control in T1DM patients, but the patients' weight did increase. Telemedicine proved to be a valuable tool for T1DM care.
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Affiliation(s)
- Michał Kania
- University Hospital, Krakow, Poland; Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Paulina Suduł
- University Hospital, Krakow, Poland; Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | | | | | | | - Marianna Kopka
- University Hospital, Krakow, Poland; Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | | | - Magdalena Wilk
- University Hospital, Krakow, Poland; Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy Hohendorff
- University Hospital, Krakow, Poland; Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Beata Kieć-Wilk
- University Hospital, Krakow, Poland; Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Klupa
- University Hospital, Krakow, Poland; Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Przemysław Witek
- University Hospital, Krakow, Poland; Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Barbara Katra
- University Hospital, Krakow, Poland; Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Maciej T Malecki
- University Hospital, Krakow, Poland; Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.
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19
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Kania M, Mazur K, Terlecki M, Matejko B, Hohendorff J, Chaykivska Z, Fiema M, Kopka M, Kostrzycka M, Wilk M, Klupa T, Witek P, Katra B, Klocek M, Rajzer M, Malecki MT. Characteristics, Mortality, and Clinical Outcomes of Hospitalized Patients with COVID-19 and Diabetes: A Reference Single-Center Cohort Study from Poland. Int J Endocrinol 2023; 2023:8700302. [PMID: 36844106 PMCID: PMC9949948 DOI: 10.1155/2023/8700302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/21/2023] [Accepted: 01/31/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Diabetes is a risk factor for a severe course of COVID-19. We evaluated the characteristics and risk factors associated with undesirable outcomes in diabetic patients (DPs) hospitalized due to COVID-19. MATERIALS AND METHODS The data analysis of patients admitted between March 6, 2020, and May 31, 2021, to the University Hospital in Krakow (Poland), a reference center for COVID-19, was performed. The data were gathered from their medical records. RESULTS A total number of 5191 patients were included, of which 2348 (45.2%) were women. The patients were at the median age of 64 (IQR: 51-74) years, and 1364 (26.3%) were DPs. DPs, compared to nondiabetics, were older (median age: 70 years, IQR: 62-77 vs. 62, IQR: 47-72, and p < 0.001) and had a similar gender distribution. The DP group had a higher mortality rate (26.2% vs. 15.7%, p < 0.001) and longer hospital stays (median: 15 days, IQR: 10-24 vs. 13, IQR: 9-20, and p < 0.001). DPs were admitted to the ICU more frequently (15.7% vs. 11.0%, p < 0.001) and required mechanical ventilation more often (15.5% vs. 11.3%, p < 0.001). In a multivariate logistic regression, factors associated with a higher risk of death were age >65 years, glycaemia >10 mmol/L, CRP and D-dimer level, prehospital insulin and loop diuretic use, presence of heart failure, and chronic kidney disease. Factors contributing to lower mortality were in-hospital use of statin, thiazide diuretic, and calcium channel blocker. CONCLUSION In this large COVID-19 cohort, DPs constituted more than a quarter of hospitalized patients. The risk of death and other outcomes compared to nondiabetics was higher in this group. We identified a number of clinical, laboratory, and therapeutic variables associated with the risk of hospital death in DPs.
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Affiliation(s)
- Michał Kania
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | | | - Michał Terlecki
- University Hospital in Krakow, Krakow, Poland
- Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Bartłomiej Matejko
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | - Jerzy Hohendorff
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | | | | | | | | | - Magdalena Wilk
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | - Przemysław Witek
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | - Barbara Katra
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
| | - Marek Klocek
- University Hospital in Krakow, Krakow, Poland
- Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Marek Rajzer
- University Hospital in Krakow, Krakow, Poland
- Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Maciej T. Malecki
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Krakow, Poland
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20
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Ucieklak D, Mrozińska S, Wojnarska A, Małecki MT, Klupa T, Matejko B. Habits related to the use of insulin infusion set in patients with type 1 diabetes on pump therapy - the effect of the educational intervention. Folia Med Cracov 2022; 62:5-23. [PMID: 36854083 DOI: 10.24425/fmc.2022.144079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
INTRODUCTION Proper use of insulin infusion sets (IIS) plays an important role in pump therapy of patients with type 1 diabetes mellitus (T1DM). We assessed the habits associated with the use of IIS in patients with T1DM treated with insulin pump. MATERIALS AND METHODS This study included 79 T1DM patients who were examined for the presence of lipohypertrophy (LH) and retrained for proper IIS use. They completed a standard questionnaire regarding IIS at the time of study entry and at the follow-up. R e s u l t s: At baseline, most of the patients declared to have been using a plastic cannula (n = 68; 86.1%), changing the infusion set regularly (n = 65; 82.3%), and placing the infusion sets on the abdomen wall (n = 68; 86.1%). The most common rotation habit was the "curve pattern" on both sides of the umbilicus (n = 16; 20.3%). After a median of 23 weeks (IQR 20-34), 58 patients were available for the follow-up. A rise in the proportion of patients who declared to change IIS regularly (n = 48; 82.8% vs. n = 57; 98.3%, p = 0.016), change IIS every 2 to 3 days (n = 27; 46.6% vs. n = 35; 60.3%, p = 0.043), use "crisscross" rotation (n = 5; 8.8% vs. n = 12; 21.4%, p = 0.027) was observed. There were less patients reporting not having repeatable rotation manner (n = 15; 26.3% vs. n = 2; 5.4%, p = 0.009). C o n c l u s i o n s: A substantial proportion of T1DM patients on pump therapy declare that they do not follow the recommended principles of IIS use. The intervention consisting of LH assessment and retrain- ing of proper use of IIS might be effective in improving patient compliance.
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Affiliation(s)
- Damian Ucieklak
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland; University Hospital, Kraków, Poland
| | - Sandra Mrozińska
- Department of Metabolic Diseases; Department of Pathophysiology, Jagiellonian University Medical College; University Hospital, Kraków, Poland
| | - Aleksandra Wojnarska
- University Hospital; Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej T Małecki
- Department of Metabolic Diseases, Jagiellonian University Medical College; University Hospital, Kraków, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College; University Hospital, Kraków, Poland
| | - Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College; University Hospital, Kraków, Poland.
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21
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Cyranka K, Dudek D, Pilecki M, Matejko B, Krzyżowska S, Małecki M, Klupa T. Coexistence of type 1 diabetes mellitus, autism and blindness – narrative review and
case report. Arch Psych Psych 2022. [DOI: 10.12740/app/154752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The paper presents a case of 25 female patient, who is a clinical example of a triple
comorbidity – she was a preterm child in which at the age of 2 autism spectrum disorder (ASD) was diagnosed, and at the age of 3 type 1 diabetes mellitus (T1DM). The described case is special because autism coincides not only with diabetes, but also with blindness due to retinopathy of prematurity. In such a situation, the choice of the right treatment method has become a clinical challenge.
Considering the patients’ health status and life conditions (comorbidity of T1DM, autism and blindness, abusive, not engaged father, difficult financial situation) very good treatment results as far as T1DM is concerned were achieved: her HbA1c values available from last 3 years ranged from 6.5-7.3% Also, regardless of many obstacles and life crises, the patient maintains possibly the best in her conditions, psychological well-being.
The paper can be a source of knowledge and inspiration, presenting challenges and possibilities in treatment of people with T1DM, autism, and other comorbidities. From the therapeutic point of view, it indicates that well planned, individualized therapy may be the basis for creating optimal conditions for the development and improvement of the quality of life of patients.
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22
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Matejko B, Juza A, Kieć-Wilk B, Cyranka K, Krzyżowska S, Chen X, Cohen O, Da Silva J, Malecki MT, Klupa T. Transitioning of People With Type 1 Diabetes From Multiple Daily Injections and Self-Monitoring of Blood Glucose Directly to MiniMed 780G Advanced Hybrid Closed-Loop System: A Two-Center, Randomized, Controlled Study. Diabetes Care 2022; 45:2628-2635. [PMID: 35972259 PMCID: PMC9862281 DOI: 10.2337/dc22-0470] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the outcomes of transitioning to the MiniMed 780G advanced hybrid closed-loop (AHCL) system in adult individuals with type 1 diabetes mellitus (T1DM) naive to continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) technologies. RESEARCH DESIGN AND METHODS This was a two-center, randomized, controlled, parallel-group trial with evaluation of individuals with T1DM aged 26-60 years managed with multiple daily injections (MDI) and self-monitoring of blood glucose (BGM) with HbA1c <10%. RESULTS A total of 41 participants were recruited and randomized to either the AHCL (n = 20) or the MDI+BGM (n = 21) group, and 37 participants (mean ± SD age 40.3 ± 8.0 years, duration of diabetes 17.3 ± 12.1 years, BMI 25.1 ± 3.1 kg/m2, HbA1c 7.2 ± 1.0%) completed the study. Time spent with glucose levels in target range increased from 69.3 ± 12.3% at baseline to 85.0 ± 6.3% at 3 months in the AHCL group, while remaining unchanged in the control group (treatment effect 21.5% [95% CI 15.7, 27.3]; P < 0.001). The time with levels below range (<70 mg/dL) decreased from 8.7 ± 7.3% to 2.1 ± 1.7% in the AHCL group and remained unchanged in the MDI+BGM group (treatment effect -4.4% [95% CI -7.4, -2.1]; P < 0.001). Participants from the AHCL group also had significant improvements in HbA1c levels (treatment effect -0.6% [95% CI -0.9, -0.2]; P = 0.005) and in quality of life (QoL) in specific subscales compared with the MDI+BGM group. CONCLUSIONS People with T1DM naive to CSII and CGM technologies initiating AHCL significantly and safely improved their glycemic control, as well as their QoL and psychological well-being.
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Affiliation(s)
- Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| | - Anna Juza
- Clinical Provincial Hospital of Frederic Chopin No. 1 in Rzeszów, Rzeszów, Poland.,College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
| | - Beata Kieć-Wilk
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| | - Katarzyna Cyranka
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland.,Department of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
| | | | | | - Ohad Cohen
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Julien Da Silva
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Maciej T Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
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23
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Ludwig-Słomczyńska AH, Seweryn MT, Radkowski P, Kapusta P, Machlowska J, Pruhova S, Gasperikova D, Bellanne-Chantelot C, Hattersley A, Kandasamy B, Letourneau-Freiberg L, Philipson L, Doria A, Wołkow PP, Małecki MT, Klupa T. Variants influencing age at diagnosis of HNF1A-MODY. Mol Med 2022; 28:113. [PMID: 36104811 PMCID: PMC9476297 DOI: 10.1186/s10020-022-00542-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/06/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND HNF1A-MODY is a monogenic form of diabetes caused by variants in the HNF1A gene. Different HNF1A variants are associated with differences in age of disease onset, but other factors are postulated to influence this trait. Here, we searched for genetic variants influencing age of HNF1A-MODY onset. METHODS Blood samples from 843 HNF1A-MODY patients from Czech Republic, France, Poland, Slovakia, the UK and the US were collected. A validation set consisted of 121 patients from the US. We conducted a genome-wide association study in 843 HNF1A-MODY patients. Samples were genotyped using Illumina Human Core arrays. The core analysis was performed using the GENESIS package in R statistical software. Kinship coefficients were estimated with the KING and PC-Relate algorithms. In the linear mixed model, we accounted for year of birth, sex, and location of the HNF1A causative variant. RESULTS A suggestive association with age of disease onset was observed for rs2305198 (p = 2.09E-07) and rs7079157 (p = 3.96E-06) in the HK1 gene, rs2637248 in the LRMDA gene (p = 2.44E-05), and intergenic variant rs2825115 (p = 2.04E-05). Variant rs2637248 reached nominal significance (p = 0.019), while rs7079157 (p = 0.058) and rs2825115 (p = 0.068) showed suggestive association with age at diabetes onset in the validation set. CONCLUSIONS rs2637248 in the LRMDA gene is associated with age at diabetes onset in HNF1A-MODY patients.
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Affiliation(s)
| | - Michał T. Seweryn
- grid.5522.00000 0001 2162 9631Center For Medical Genomics OMICRON, Jagiellonian University Medical College, Kraków, Poland ,grid.261331.40000 0001 2285 7943Department of Pharmacogenomics, The Ohio State University, Columbus, OH USA
| | - Piotr Radkowski
- grid.5522.00000 0001 2162 9631Center For Medical Genomics OMICRON, Jagiellonian University Medical College, Kraków, Poland
| | - Przemysław Kapusta
- grid.5522.00000 0001 2162 9631Center For Medical Genomics OMICRON, Jagiellonian University Medical College, Kraków, Poland
| | - Julita Machlowska
- grid.5522.00000 0001 2162 9631Center For Medical Genomics OMICRON, Jagiellonian University Medical College, Kraków, Poland
| | - Stepanka Pruhova
- grid.4491.80000 0004 1937 116XDepartment of Pediatrics, Charles University in Prague, Second Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - Daniela Gasperikova
- grid.419303.c0000 0001 2180 9405Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | | | | | - Balamurugan Kandasamy
- grid.170205.10000 0004 1936 7822Kovler Diabetes Center, University of Chicago, Chicago, IL USA
| | | | - Louis Philipson
- grid.170205.10000 0004 1936 7822Kovler Diabetes Center, University of Chicago, Chicago, IL USA
| | - Alessandro Doria
- grid.38142.3c000000041936754XJoslin Diabetes Center, Harvard Medical School, Boston, MA USA
| | - Paweł P. Wołkow
- grid.5522.00000 0001 2162 9631Center For Medical Genomics OMICRON, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej T. Małecki
- grid.5522.00000 0001 2162 9631Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Klupa
- grid.5522.00000 0001 2162 9631Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
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24
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Czupryniak L, Danne T, Szymańska-Garbacz E, Zozulińska-Ziółkiewicz D, Gumprecht J, Klupa T. Sodium-glucose co-transporter-2 inhibitors for type 1 diabetes: Not any more? Diabetes Obes Metab 2022; 24:764-765. [PMID: 34931428 DOI: 10.1111/dom.14631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Thomas Danne
- Diabetes Center AUF DER BULT, Hannover Medical School, Hannover, Germany
| | | | | | - Janusz Gumprecht
- Department of Internal Medicine, Diabetology and Nephrology, Medical University of Silesia, Zabrze, Poland
| | - Tomasz Klupa
- Unit on Advanced Technologies in Diabetes, Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
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Czupryniak L, Dzida G, Fichna P, Jarosz-Chobot P, Gumprecht J, Klupa T, Mysliwiec M, Szadkowska A, Bomba-Opon D, Czajkowski K, Malecki MT, Zozulinska-Ziolkiewicz DA. Ambulatory Glucose Profile (AGP) Report in Daily Care of Patients with Diabetes: Practical Tips and Recommendations. Diabetes Ther 2022; 13:811-821. [PMID: 35278195 PMCID: PMC8991298 DOI: 10.1007/s13300-022-01229-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/08/2022] [Indexed: 12/01/2022] Open
Abstract
The ambulatory glucose profile (AGP) is now established as the standardised, practical one-page report for graphically presenting a summary of glycaemic control status in patients with diabetes who use continuous glucose monitoring (CGM) systems as part of their daily diabetes care. The AGP report provides both a visual and a statistical summary of the glucose metrics that, as agreed in the 2019 international consensus for assessing glycaemic control, should be analysed in all people with diabetes who are using CGM systems. The AGP report can be analysed in a systematic fashion to understand current glycaemic control and to monitor, in real time, the impact of adjustments to therapy in both type 1 diabetes and type 2 diabetes. Here we provide a practical guide to the glycaemic measures that are summarised in the AGP Report and illustrate the essential components of an AGP review in a series of hypothetical, real-world, patient-centred case studies (see Supplementary Materials).
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Affiliation(s)
- Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Dzida
- Department of Internal Diseases, Medical University of Lublin, Lublin, Poland
| | - Piotr Fichna
- Department of Pediatric Diabetes, Auxology and Obesity, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Janusz Gumprecht
- Department of Internal Medicine, Diabetology and Nephrology, Medical University of Silesia, Katowice, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Malgorzata Mysliwiec
- Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdansk, Poland
| | - Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland
| | - Dorota Bomba-Opon
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Czajkowski
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Maciej T Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
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Matejko B, Morawska M, Tota Ł, Flakus M, Cyranka K, Kieć-Wilk B, Lushchyk M, Małecki M, Klupa T. Association of short- and long-term metabolic control parameters with personality traits in adult type 1 diabetes treated with personal insulin pumps. Psychiatr Pol 2022:1-12. [DOI: 10.12740/pp/onlinefirst/145647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Surowiec P, Matejko B, Kopka M, Filemonowicz-Skoczek A, Klupa T, Cyganek K, Romanowska-Dixon B, Malecki MT. Low prevalence of diabetic retinopathy in patients with long-term type 1 diabetes and current good glycemic control - one-center retrospective assessment. Endocrine 2022; 75:427-436. [PMID: 34542802 PMCID: PMC8816752 DOI: 10.1007/s12020-021-02871-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 09/05/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Despite progress in type 1 diabetes (T1DM) therapy, diabetic retinopathy (DR) is still a common complication. We analysed predictors and prevalence of DR in patients with T1DM lasting 10 years or more. All of the patients were considered to be currently in excellent glycemic control and treated using modern therapies. METHODS Study included 384 (80.7% women) T1DM patients participating in the Program of Comprehensive Outpatient Specialist Care at the University Hospital in Krakow between the years 2014 and 2020. A retrospective analysis of medical records was conducted. RESULTS The patients were on average 34 ± 9.2 years old, had a BMI 25.0 ± 3.9 and a T1DM duration of 20.5 ± 7.9 years. The mean level of HbA1c throughout the follow-up (mean duration 4.9 ± 1.4 years) was 6.9 ± 1%. The group included 238 (62.0%) patients treated with insulin pumps and 99 (25.8%) on multiple daily injections, 47 (12.2%) used both methods; almost all patients were on insulin analogues. DR was confirmed in 150 (39.1%) patients, from which 109 (28.4%) were diagnosed de novo. Severe DR was occurred in just 31 cases (8.1%). In the multivariate logistic regression, independent risk factors for the presence of DR were T1DM duration (OR 1.13; 95% CI, 1.09-1.19), HbA1c level (OR 1.41; 95% CI, 1.08-1.84), LDL level (OR 1.79; 95% CI, 1.16-2.87), and the combined presence of non-DR micro- and macrovascular chronic complications (OR 1.86; 95% CI, 1.16-3.03). CONCLUSIONS In this highly-selected group of T1DM patients, mostly female, the prevalence of both DR at any stage and severe DR was lower than earlier reported results from other cohorts. Independent risk factors for the DR cohort did not differ from previously reported studies.
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Affiliation(s)
- Paulina Surowiec
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Marianna Kopka
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | | | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Katarzyna Cyganek
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Bożena Romanowska-Dixon
- University Hospital, Krakow, Poland
- Department of Ophthalmology, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej T Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.
- University Hospital, Krakow, Poland.
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Wolnik B, Hryniewiecki A, Pisarczyk-Wiza D, Szczepanik T, Klupa T. Switching from Neutral Protamine Hagedorn (NPH) Insulin to Insulin Glargine 300 U/mL in Older and Younger Patients with Type 2 Diabetes: A Post Hoc Analysis of a Multicenter, Prospective, Observational Study. Diabetes Ther 2022; 13:301-310. [PMID: 35034328 PMCID: PMC8873339 DOI: 10.1007/s13300-021-01199-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Older age and longer disease duration are key risk factors for hypoglycemia in patients with type 2 diabetes (T2D) who receive insulin. Previous studies have shown that insulin glargine 300 U/mL (Gla-300) improves glycemic control and reduces the risk of hypoglycemia, but whether this effect is observed in older patients switching from neutral protamine Hagedorn (NPH) insulin is unclear. METHODS In this multicenter, observational study involving patients with T2D aged ≥ 18 years with glycated hemoglobin (HbA1c) ≥ 8%, we compared the safety and effectiveness of switching from NPH insulin to Gla-300 in subgroups of patients differing by age (< 65 vs. ≥ 65 years) and duration of diabetes (≤ 13 vs. > 13 years). RESULTS A total of 469 participants were included in the study. From baseline to 6 months after switching to Gla-300, mean HbA1c decreased from 9.23% to 8.13% (p < 0.001) among patients aged ≤ 65 years (224 patients), and from 9.15% to 8.20% (p < 0.001) among those aged > 65 years (245 patients). The proportion of patients with ≥ 1 episodes of hypoglycemia decreased from 19.1% to 13.6% (p = 0.11) among those aged ≤ 65 years, and from 26.9% to 13.0% (p < 0.001) among those aged > 65 years; the reduction was significantly greater in those aged > 65 years (p = 0.001). The reduction in HbA1c was greater in those with a disease duration ≤ 13 years (p = 0.007), but the reduction in hypoglycemia was greater in those with a disease duration > 13 years (p < 0.0003). CONCLUSION The switch from NPH insulin to Gla-300 improved glycemic control in older patients with T2D and in those with a longer disease duration. Older patients with T2D and those with a longer disease duration benefited even more from the switch to Gla-300 than younger patients and those with a shorter disease duration, with significantly greater reductions in the risk of hypoglycemia.
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Affiliation(s)
- B Wolnik
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdansk, Poland
| | - A Hryniewiecki
- Diabetes Division, Sanofi-Aventis Poland, Warsaw, Poland
| | - D Pisarczyk-Wiza
- Department of Internal Diseases and Diabetology, Medical University of Poznan, Poznan, Poland
| | - T Szczepanik
- Zaglebie Oncology Center, Starkiewicz Hospital, Dabrowa Gornicza, Poland
| | - T Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.
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Hohendorff J, Witek P, Kania M, Sudol M, Hajduk K, Stepien A, Cyganek K, Kiec-Wilk B, Klupa T, Malecki MT. Higher scanning frequency is correlated with less fear of hypoglycemia in type 1 diabetes patients using isCGM. Front Endocrinol (Lausanne) 2022; 13:996933. [PMID: 36277730 PMCID: PMC9582341 DOI: 10.3389/fendo.2022.996933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/15/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Frequent scanning of intermittently scanned continuous glucose monitoring (isCGM) devices is associated with improvements in glycemic indices. Limited data is available for its correlation with fear of hypoglycemia (FOH), an established factor affecting quality of life and glycemic control in type 1 diabetes (T1DM). AIM The aim of the study was to analyze the association of sensor scanning frequency with FOH and glycemic indices in T1DM patients using isCGM. SUBJECTS AND METHODS T1DM patients using isCGM were eligible. Clinical data and Ambulatory Glucose Profile (AGP) reports were obtained from medical records. At outpatient visits, AGP of last 14 days prior to visit were analyzed and FOH was assessed using Hypoglycemia Fear Survey II (HFS II). RESULTS We included 77 consecutive T1DM patients (58 females, 19 males). Mean age was 34.1 ± 10.2 years and mean T1DM duration was 14.7 ± 12.0 years. Baseline mean glycemic indices were as follows: mean glucose - 155.8 ± 29.8 mg/dL; GMI - 53.3 ± 7.5 mmol/mol; TIR - 66.4 ± 17.8%; TBR70 - 4.5 ± 4.1%; TBR54 - 0.6 ± 1.2%; TAR180 - 29.2 ± 17.9%; TAR250 - 9.6 ± 10.4%; %CV - 36.7 ± 8.3. Average scanning frequency was 13.8 ± 7.8 scans/day. Mean HFS II scores were 16.1 ± 7.2 and 18.7 ± 12.2 in behavior and worry subscale, respectively. Correlation was confirmed between scanning frequency and mean glucose, GMI, TIR, TBR70, TAR180, TAR250, %CV and HFS II total, and HFS II - B (p<0.05 for all statistics). CONCLUSIONS For the first time, we report that higher scanning frequency is associated not only with better glycemic indices but also with less FOH in T1DM adult patients using isCGM.
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Affiliation(s)
- Jerzy Hohendorff
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Krakow, Poland
| | - Przemyslaw Witek
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Krakow, Poland
| | - Michal Kania
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Krakow, Poland
| | - Maria Sudol
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Hajduk
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Adam Stepien
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Cyganek
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Krakow, Poland
| | - Beata Kiec-Wilk
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Krakow, Poland
- Unit of Rare Metabolic Diseases, Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Krakow, Poland
| | - Maciej T. Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases and Diabetology, University Hospital in Krakow, Krakow, Poland
- *Correspondence: Maciej T. Malecki,
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Holt RIG, DeVries JH, Hess-Fischl A, Hirsch IB, Kirkman MS, Klupa T, Ludwig B, Nørgaard K, Pettus J, Renard E, Skyler JS, Snoek FJ, Weinstock RS, Peters AL. Correction to: The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2022; 65:255. [PMID: 34851428 PMCID: PMC8895052 DOI: 10.1007/s00125-021-05600-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
[Image: see text]
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Affiliation(s)
- Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
- Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - J Hans DeVries
- Amsterdam UMC, Internal Medicine, University of Amsterdam, Amsterdam, the Netherlands
- Profil Institute for Metabolic Research, Neuss, Germany
| | - Amy Hess-Fischl
- Kovler Diabetes Center, University of Chicago, Chicago, IL, USA
| | - Irl B Hirsch
- UW Medicine Diabetes Institute, Seattle, WA, USA
| | - M Sue Kirkman
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Tomasz Klupa
- Department of Metabolic Diseases, Center for Advanced Technologies in Diabetes, Jagiellonian University Medical College, Kraków, Poland
| | - Barbara Ludwig
- University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | | | - Eric Renard
- Montpellier University Hospital, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, Inserm, Montpellier, France
| | - Jay S Skyler
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Frank J Snoek
- Amsterdam UMC, Medical Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | | | - Anne L Peters
- Keck School of Medicine of USC, Los Angeles, CA, USA
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Ucieklak D, Mrozinska S, Wojnarska A, Malecki MT, Klupa T, Matejko B. Insulin-induced Lipohypertrophy in Patients with Type 1 Diabetes Mellitus Treated with an Insulin Pump. Int J Endocrinol 2022; 2022:9169296. [PMID: 35111222 PMCID: PMC8803446 DOI: 10.1155/2022/9169296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Lipohypertrophy (LH) of subcutaneous tissue is an insulin-induced complication occurring in patients with diabetes. We aimed to define the prevalence of LH and identify its risk factors in type 1 diabetes (T1DM) patients treated with continuous subcutaneous insulin infusion (CSII). MATERIALS AND METHODS The study included 79 consecutive CSII-treated T1DM patients. The diagnose of LH was based on ultrasonography (US) as a reference method, physical examination was also performed. Clinical characteristics were available from the medical records. RESULTS The median age of patients was 28 years (interquartile range [IQR], 24-30.5) with a body mass index (BMI) of 24.5 ± 3.5 kg/m2, HbA1c 7.1% (IQR, 6.7-8.1), T1DM duration 15 (9-20) years, and CSII use duration of 8 year (IQR, 5-11). LH was detected by US in 75 (94.9%) patients. This value was much higher than this obtained by visual assessment (n = 39, 49.4%) or palpation (n = 59, 74.7%). In univariate analyses, the following risk factors for occurrence of 5 and more LH lesions were identified: the ratio of insulin dose to body mass exceeding 0.7 IU/kg (OR, 3.69; 95% CI, 1.43-10.01) and the total daily insulin dose (OR, 1.05; 95% CI, 1.02-1.09). A higher dose of insulin per kg remained a significant risk factor of LH amount in multivariate analysis. CONCLUSION This selected T1DM cohort treated with CSII had a very high prevalence of LH. US assessment should be considered as a reference method for LH screening in T1DM patients. The identified risk factors for the number of LH lesions were related to insulin dosing.
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Affiliation(s)
- Damian Ucieklak
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Sandra Mrozinska
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Aleksandra Wojnarska
- University Hospital, Krakow, Poland
- Department of Radiology, Jagiellonian University Medical College, Krakow, Poland
| | - Maciej T. Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
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Janez A, Battelino T, Klupa T, Kocsis G, Kuricová M, Lalić N, Stoian AP, Prázný M, Rahelić D, Šoupal J, Tankova T, Zelinska N. Hybrid Closed-Loop Systems for the Treatment of Type 1 Diabetes: A Collaborative, Expert Group Position Statement for Clinical Use in Central and Eastern Europe. Diabetes Ther 2021; 12:3107-3135. [PMID: 34694585 PMCID: PMC8586062 DOI: 10.1007/s13300-021-01160-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/18/2021] [Indexed: 01/23/2023] Open
Abstract
In both pediatric and adult populations with type 1 diabetes (T1D), technologies such as continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring (CGM), or sensor-augmented pumps (SAP) can consistently improve glycemic control [measured as glycated hemoglobin (HbA1c) and time in range (TIR)] while reducing the risk of hypoglycemia. Use of technologies can thereby improve quality of life and reduce the burden of diabetes management compared with self-injection of multiple daily insulin doses (MDI). Novel hybrid closed-loop (HCL) systems represent the latest treatment modality for T1D, combining modern glucose sensors and insulin pumps with a linked control algorithm to offer automated insulin delivery in response to blood glucose levels and trends. HCL systems have been associated with increased TIR, improved HbA1c, and fewer hypoglycemic events compared with CSII, SAP, and MDI, thereby potentially improving quality of life for people with diabetes (PwD) while reducing the costs of treating short- and long-term diabetes-related complications. However, many barriers to their use and regional inequalities remain in Central and Eastern Europe (CEE). Published data suggest that access to diabetes technologies is hindered by lack of funding, underdeveloped health technology assessment (HTA) bodies and guidelines, unfamiliarity with novel therapies, and inadequacies in healthcare system capacities. To optimize the use of diabetes technologies in CEE, an international meeting comprising experts in the field of diabetes was held to map the current regional access, to present the current national reimbursement guidelines, and to recommend solutions to overcome uptake barriers. Recommendations included regional and national development of HTA bodies, efficient allocation of resources, and structured education programs for healthcare professionals and PwD. The responsibility of the healthcare community to ensure that all individuals with T1D gain access to modern technologies in a timely and economically responsible manner, thereby improving health outcomes, was emphasized, particularly for interventions that are cost-effective.
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Affiliation(s)
- Andrej Janez
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia.
| | - Tadej Battelino
- University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Kraków, Poland
| | - Győző Kocsis
- Department of Medicine and Oncology, Semmelweis University Budapest, Budapest, Hungary
| | - Miriam Kuricová
- Pediatric Department, National Institute of Endocrinology and Diabetology, Ľubochňa, Slovakia
- Department of Children and Adolescents, Jessenius Faculty of Medicine, Comenius University Bratislava, Martin, Slovakia
| | - Nebojša Lalić
- Faculty of Medicine of the University of Belgrade, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Belgrade, Serbia
| | - Anca Pantea Stoian
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Martin Prázný
- Third Department of Internal Medicine, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czechia
| | - Dario Rahelić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Jan Šoupal
- Third Department of Internal Medicine, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czechia
| | - Tsvetalina Tankova
- Department of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - Nataliya Zelinska
- Ukrainian Scientific and Practical Center of Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of the Ministry of Health of Ukraine, Kyiv, Ukraine
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Holt RIG, DeVries JH, Hess-Fischl A, Hirsch IB, Kirkman MS, Klupa T, Ludwig B, Nørgaard K, Pettus J, Renard E, Skyler JS, Snoek FJ, Weinstock RS, Peters AL. The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2021; 64:2609-2652. [PMID: 34590174 PMCID: PMC8481000 DOI: 10.1007/s00125-021-05568-3] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a writing group to develop a consensus statement on the management of type 1 diabetes in adults. The writing group has considered the rapid development of new treatments and technologies and addressed the following topics: diagnosis, aims of management, schedule of care, diabetes self-management education and support, glucose monitoring, insulin therapy, hypoglycaemia, behavioural considerations, psychosocial care, diabetic ketoacidosis, pancreas and islet transplantation, adjunctive therapies, special populations, inpatient management and future perspectives. Although we discuss the schedule for follow-up examinations and testing, we have not included the evaluation and treatment of the chronic microvascular and macrovascular complications of diabetes as these are well-reviewed and discussed elsewhere. The writing group was aware of both national and international guidance on type 1 diabetes and did not seek to replicate this but rather aimed to highlight the major areas that healthcare professionals should consider when managing adults with type 1 diabetes. Though evidence-based where possible, the recommendations in the report represent the consensus opinion of the authors. Graphical abstract.
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Affiliation(s)
- Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
- Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - J Hans DeVries
- Amsterdam UMC, Internal Medicine, University of Amsterdam, Amsterdam, the Netherlands
- Profil Institute for Metabolic Research, Neuss, Germany
| | - Amy Hess-Fischl
- Kovler Diabetes Center, University of Chicago, Chicago, IL, USA
| | - Irl B Hirsch
- UW Medicine Diabetes Institute, Seattle, WA, USA
| | - M Sue Kirkman
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Tomasz Klupa
- Department of Metabolic Diseases, Center for Advanced Technologies in Diabetes, Jagiellonian University Medical College, Kraków, Poland
| | - Barbara Ludwig
- University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | | | - Eric Renard
- Montpellier University Hospital, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, Inserm, Montpellier, France
| | - Jay S Skyler
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Frank J Snoek
- Amsterdam UMC, Medical Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | | | - Anne L Peters
- Keck School of Medicine of USC, Los Angeles, CA, USA
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Holt RIG, DeVries JH, Hess-Fischl A, Hirsch IB, Kirkman MS, Klupa T, Ludwig B, Nørgaard K, Pettus J, Renard E, Skyler JS, Snoek FJ, Weinstock RS, Peters AL. The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2021; 44:2589-2625. [PMID: 34593612 DOI: 10.2337/dci21-0043] [Citation(s) in RCA: 180] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a writing group to develop a consensus statement on the management of type 1 diabetes in adults. The writing group has considered the rapid development of new treatments and technologies and addressed the following topics: diagnosis, aims of management, schedule of care, diabetes self-management education and support, glucose monitoring, insulin therapy, hypoglycemia, behavioral considerations, psychosocial care, diabetic ketoacidosis, pancreas and islet transplantation, adjunctive therapies, special populations, inpatient management, and future perspectives. Although we discuss the schedule for follow-up examinations and testing, we have not included the evaluation and treatment of the chronic microvascular and macrovascular complications of diabetes as these are well-reviewed and discussed elsewhere. The writing group was aware of both national and international guidance on type 1 diabetes and did not seek to replicate this but rather aimed to highlight the major areas that health care professionals should consider when managing adults with type 1 diabetes. Though evidence-based where possible, the recommendations in the report represent the consensus opinion of the authors.
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Affiliation(s)
- Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, U.K. .,Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, U.K
| | - J Hans DeVries
- Amsterdam UMC, Internal Medicine, University of Amsterdam, Amsterdam, the Netherlands.,Profil Institute for Metabolic Research, Neuss, Germany
| | | | | | - M Sue Kirkman
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Tomasz Klupa
- Department of Metabolic Diseases, Center for Advanced Technologies in Diabetes, Jagiellonian University Medical College, Kraków, Poland
| | - Barbara Ludwig
- University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | | | - Eric Renard
- Montpellier University Hospital, Montpellier, France.,Institute of Functional Genomics, University of Montpellier, CNRS, Inserm, Montpellier, France
| | - Jay S Skyler
- University of Miami Miller School of Medicine, Miami, FL
| | - Frank J Snoek
- Amsterdam UMC, Medical Psychology, Vrije Universiteit, Amsterdam, the Netherlands
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Szadkowska A, Baranowska-Jaźwiecka A, Michalak A, Jarosz-Chobot P, Myśliwiec M, Głowińska-Olszewska B, Szypowska A, Nazim J, Mazur A, Szalecki M, Skowrońska B, Kucharska-Zubkiewicz A, Beń-Skowronek I, Walczak M, Klupa T, Wolnik B, Zozulińska-Ziółkiewicz D, Młynarski W. Above 40% of Polish children and young adults with type 1 diabetes achieve international HbA1c target - results of a nationwide cross-sectional evaluation of glycemic control: The PolPeDiab HbA1c study. Pediatr Diabetes 2021; 22:1003-1013. [PMID: 34351670 DOI: 10.1111/pedi.13250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Youth with type 1 diabetes (T1D) (16-18 y.o.) present worst disease control of all age groups and need structured interventions. Those should be based on unbiased, national-scale outcomes, which have not yet been successfully assessed in Poland. OBJECTIVE To evaluate the glycemic control in young patients with T1D in Poland. METHOD All pediatric diabetes care centers and the nine largest centers for adults with T1D were invited to this cross-sectional study, conducted in March 2018. Eligibility was defined as age ≤ 30 years and diabetes duration ≥1 year. Blinded samples of capillary blood and clinical questionnaires were sent to coordinating center, where HbA1c was measured by high-pressure liquid chromatography. RESULTS Nine adult and 25/28 pediatric centers participated, providing data for 1255 patients (50.8% males), mean age 12.3 years (95%CI:12.1-12.6) for children and 23.2 years (22.9-23.6) for adults; mean diabetes duration 7.1 years (6.8-7.3). This covered ~8% of pediatric population and 2% of 18-30-years-olds with T1D. Mean HbA1c was comparable between children and adults (57 mmol/mol [7.4%], 95%CI:56-57 mmol/mol [7.3-7.4%] vs. 57 mmol/mol [7.4%], 95%CI:56-60 mmol/mol [7.3-7.6%], p = 0.1870). Overall, 45.2% of patients achieved ISPAD target (<53 mmol/mol [<7.0%]). During the month preceding the study, 0.9% of patients experienced severe hypoglycemia and 0.4% suffered ketoacidosis. HbA1c was related to the method of insulin therapy, continuous glucose monitoring use and body weight (p < 0.0001). CONCLUSIONS In Polish children and young adults with T1D glycemic control expressed as HbA1c is promising in the light of ISPAD guidelines. Our results confirm the known associations between better glycemic control and the use of new technologies and maintaining optimal body weight.
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Affiliation(s)
- Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Łódź, Poland
| | - Anna Baranowska-Jaźwiecka
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Łódź, Poland
| | - Arkadiusz Michalak
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Łódź, Poland.,Department of Biostatistics and Translational Medicine, Medical University of Lodz, Łódź, Poland
| | | | - Małgorzata Myśliwiec
- Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdańsk, Poland
| | - Barbara Głowińska-Olszewska
- Department of Pediatrics, Endocrinology, Diabetology With Cardiology Division, Medical University of Bialystok, Białystok, Poland
| | | | - Joanna Nazim
- Department of Pediatric and Adolescent Endocrinology, Jagiellonian University Medical College, Kraków, Poland
| | - Artur Mazur
- Pediatric Department, University of Rzeszow, Rzeszów, Poland
| | - Mieczysław Szalecki
- Children's Memorial Health Institute, Department of Endocrinology and Diabetology, Warsaw, Poland and The Faculty of Medicine and Health Sciences, Jan Kochanowski University in Kielce, Kielce, Poland
| | - Bogda Skowrońska
- Department of Pediatric Diabetes and Obesity, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Iwona Beń-Skowronek
- Department of Pediatric Endocrinology and Diabetology, Medical University of Lublin, Lublin, Poland
| | - Mieczysław Walczak
- Clinic of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Bogumił Wolnik
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | | | - Wojciech Młynarski
- Department of Pediatrics, Oncology and Hematology, Medical University of Łódź, Łódź, Poland
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Tota Ł, Matejko B, Morawska-Tota M, Pilch W, Mrozińska S, Pałka T, Klupa T, Malecki MT. Changes in Oxidative and Nitrosative Stress Indicators and Vascular Endothelial Growth Factor After Maximum-Intensity Exercise Assessing Aerobic Capacity in Males With Type 1 Diabetes Mellitus. Front Physiol 2021; 12:672403. [PMID: 34426731 PMCID: PMC8379017 DOI: 10.3389/fphys.2021.672403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/06/2021] [Indexed: 10/26/2022] Open
Abstract
In type 1 diabetes mellitus (T1DM), chronic hyperglycemia causes reactive oxygen and nitrogen species production. Exercise alters the oxidant-antioxidant balance. We evaluated the aerobic capacity and oxidant-antioxidant balance changes after maximum-intensity exercise in T1DM patients. The study involved 30 T1DM participants and 23 controls. The patients' average age was 23.4 ± 5.1 years, with a body mass index of 24.3 ± 3.1 kg m-2 and with satisfactory glycemic control. Among the controls, the respective values equaled 24.7 ± 2.9 years and 22.9 ± 2.1 kg m-2. Aerobic capacity was assessed with a treadmill test. Peak minute oxygen uptake was significantly lower in T1DM compared with the controls (44.7 ± 5.7 vs. 56.0 ± 7.3 mL kg-1 min-1). The total oxidant capacity measured by total oxidative status/total oxidative capacity (TOS/TOC) equaled 321.5 ± 151 μmol L-1 before and 380.1 ± 153 μmol L-1 after exercise in T1DM, and 164.1 ± 75 and 216.6 ± 75 μmol L-1 in the controls (p < 0.05 for all comparisons). A significant difference in the ratio of total antioxidant status/total antioxidant capacity (TAS/TAC) between the groups after the treadmill test was observed (p < 0.05). Nitrosative stress indicators where significantly higher in the T1DM group both before and after the exercise. In conclusion, diabetic patients demonstrated a lower aerobic capacity. The TOS/TOC and nitrosative stress indicators were significantly higher in T1DM before and after the test.
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Affiliation(s)
- Łukasz Tota
- Department of Physiology and Biochemistry, University of Physical Education in Krakow, Krakow, Poland
| | - Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| | - Małgorzata Morawska-Tota
- Department of Sports Medicine and Human Nutrition, University of Physical Education in Krakow, Krakow, Poland
| | - Wanda Pilch
- Institute of Basic Research, Department of Chemistry and Biochemistry, University of Physical Education in Krakow, Krakow, Poland
| | - Sandra Mrozińska
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| | - Tomasz Pałka
- Department of Physiology and Biochemistry, University of Physical Education in Krakow, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| | - Maciej T Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
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Cyranka K, Dudek D, Małecki MT, Matejko B, Klupa T. Psychological Crisis Intervention for COVID-19 Lockdown Stress in Patients With Type 1 Diabetes Mellitus: Survey Study and Qualitative Analysis. JMIR Ment Health 2021; 8:e28097. [PMID: 33852411 PMCID: PMC8274678 DOI: 10.2196/28097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/29/2021] [Accepted: 04/14/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has challenged the worldviews of most people. Social isolation after the COVID-19 lockdown has not only led to economic difficulties but also resulted in adverse psychological reactions. As in most countries, including Poland, this situation has been very challenging for patients with type 1 diabetes mellitus (T1DM). In Poland, a crisis intervention team for patients with T1DM was established. The goal of the team was to provide psychological support for these patients, if needed, and to present information concerning how these patients may obtain medical consultations and prescriptions. OBJECTIVE We aimed to analyze the psychological parameters and main emotional reactions of patients with T1DM during the COVID-19 lockdown. METHODS An email with information concerning the possibility of having a web-based consultation with psychologists and psychiatrists and an attached set of psychological tests was sent to all patients with T1DM who were under the care of an outpatient diabetes clinic. The consultations were performed by licensed clinical psychologists and psychologists. This study was approved by the Bioethics Committee of the Jagiellonian University in Krakow, Poland. RESULTS The patients who decided to use psychological support had statistically higher levels of anxiety (state P=.043; trait P=.022), stress (P=.001) than those of patients from the group who did not seek support. CONCLUSIONS The presented intervention team may be perceived as an example of important and successful cooperation and communication between specialists of different fields of medicine (diabetology, psychiatry, and psychology) in a crisis situation.
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Affiliation(s)
- Katarzyna Cyranka
- Department of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
| | - Dominika Dudek
- Department of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
| | - Maciej Tadeusz Małecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
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Cyranka K, Matejko B, Klupa T, Małecki M, Cyganek K, Kieć-Wilk B, Dudek D. Type 1 Diabetes and COVID-19: the level of anxiety, stress and the general mental health in comparison to healthy control. Psychiatr Pol 2021; 55:511-523. [PMID: 34460878 DOI: 10.12740/pp/onlinefirst/133356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Assessment of mental state of patients with T1DM - the level of anxiety, stress and general mental health in the stressful conditions of an epidemic. Moreover, it was checked whether the stress response to the epidemic in the T1DM group differed from that in the control group. This is the first study to address these questions in the type 1 diabetes population in Poland. METHODS An e-mail was sent to all T1DM patients under the care of a diabetes clinic with information about the possibility of online consultation with a psychologist / psychiatrist, with a set of psychological tests attached. The study included 49 patients with T1DM who responded within the first month and agreed to participate in the study. 38 people from the control group were randomly recruited. Each person completed a set of psychological tools. RESULTS In both groups, the level of stress was higher than typical for the general population in the situation without stressor. T1DM patients who have been ill for over 10 years more often cope with stress through a task-oriented approach. Patients who have been ill for less than 10 years use avoidance strategies. In the first phase of the epidemic,women with T1DM used avoidance strategies. Patients with diabetes and mental disorders react more anxiously and thus require special care in coping with diabetes. CONCLUSIONS In a situation of stress such as a epidemic, patients suffering from T1DM require optimization of treatment and cooperation of specialists in the field of diabetes and psychology / psychiatry.
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Affiliation(s)
- Katarzyna Cyranka
- Uniwersytet Jagielloński Collegium Medicum, Wydział Lekarski, Katedra Psychiatrii
| | - Bartłomiej Matejko
- Uniwersytet Jagielloński Collegium Medicum, Wydział Lekarski, Katedra Chorób Metabolicznych
| | - Tomasz Klupa
- Uniwersytet Jagielloński Collegium Medicum, Wydział Lekarski, Katedra Chorób Metabolicznych
| | - Maciej Małecki
- Uniwersytet Jagielloński Collegium Medicum, Wydział Lekarski, Katedra Chorób Metabolicznych
| | - Katarzyna Cyganek
- Uniwersytet Jagielloński Collegium Medicum, Wydział Lekarski, Katedra Chorób Metabolicznych
| | - Beata Kieć-Wilk
- Uniwersytet Jagielloński Collegium Medicum, Wydział Lekarski, Katedra Chorób Metabolicznych
| | - Dominika Dudek
- Uniwersytet Jagielloński Collegium Medicum, Wydział Lekarski, Katedra Psychiatrii
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Araszkiewicz A, Bandurska-Stankiewicz E, Borys S, Budzyński A, Cyganek K, Cypryk K, Czech A, Czupryniak L, Drzewoski J, Dzida G, Dziedzic T, Franek E, Gajewska D, Gawrecki A, Górska M, Grzeszczak W, Gumprecht J, Idzior-Waluś B, Jarosz-Chobot P, Kalarus Z, Karczewska-Kupczewska M, Klupa T, Koblik T, Kokoszka A, Korzon-Burakowska A, Kowalska I, Krętowski A, Majkowska L, Małecki M, Mamcarz A, Mirkiewicz-Sieradzka B, Młynarski W, Moczulski D. 2021 Guidelines on the management of patients with diabetes. A position of Diabetes Poland. Clinical Diabetology 2021. [DOI: 10.5603/dk.2021.0001] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Klupa T. How to use 780G advanced hybrid closed loop system most effectively and avoid disappointments? Some practical tips from first experiences. Clinical Diabetology 2021. [DOI: 10.5603/dk.a2021.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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41
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Matejko B, Tota Ł, Mrozińska S, Morawska M, Pałka T, Kieć-Wilk B, Klupa T, Malecki MT. Predictors of the maximal oxygen consumption in adult patients with type 1 diabetes treated with personal insulin pumps. J Diabetes Investig 2021; 12:1377-1385. [PMID: 33378577 PMCID: PMC8354502 DOI: 10.1111/jdi.13490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/24/2020] [Accepted: 12/27/2020] [Indexed: 12/31/2022] Open
Abstract
Aims/Introduction Regular physical activity for adults with type 1 diabetes mellitus improves cardiorespiratory fitness (CF) and quality of life. The aim of our study was to evaluate clinical and biochemical features that might be associated with CF in a homogenous group of adults with type 1 diabetes mellitus who are all treated with a personal insulin pump (continuous subcutaneous insulin infusion). Materials and Methods We assessed CF in 62 patients (74.2% of whom were men) who fulfilled the eligibility criteria. To determine maximal oxygen consumption, the march‐running test on the treadmill was carried out. Two hours before the test, the patients consumed a defined meal covered by a dose of rapid acting insulin analog that was reduced by 25% from their regular dose. Basal insulin infusion was reduced by 50% for an hour. Additionally, the Perceived Stress Scale‐10 questionnaire was used to measure the perception of stress. Results There was no episode of severe hypoglycemia during or after the test. In the final model, independent predictors of maximal oxygen consumption were sex, body fat percentage, lactate at 20 min after CF test and Perceived Stress Scale‐10 score. Of interest, neither short‐term (continuous glucose monitoring) nor long‐term (glycosylated hemoglobin) metabolic control parameters were predictors of CF. Conclusions In our selected homogenous group of patients with type 1 diabetes mellitus treated with personal insulin pumps, higher CF was associated with a lower percentage of body fat, male sex, higher lactate level after the CF test and the Perceived Stress Scale‐10 score. The proposed protocol in our cohort proved to be safe with regard to glycemic control.
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Affiliation(s)
- Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital, Krakow, Poland
| | - Łukasz Tota
- Department of Physiology and Biochemistry, Faculty of Physical Education and Sport, University of Physical Education in Krakow, Krakow, Poland
| | | | - Małgorzata Morawska
- Department of Sports Medicine and Human Nutrition, Faculty of Physical Education and Sport, University of Physical Education in Krakow, Krakow, Poland
| | - Tomasz Pałka
- Department of Physiology and Biochemistry, Faculty of Physical Education and Sport, University of Physical Education in Krakow, Krakow, Poland
| | - Beata Kieć-Wilk
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital, Krakow, Poland
| | - Maciej T Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital, Krakow, Poland
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Cyranka K, Dudek D, Małecki MT, Klupa T. "Fighting spirit": specific personality traits as one of the key factors for sport championship in type 1 diabetes mellitus. Diabetol Int 2021; 12:317-323. [PMID: 33457163 PMCID: PMC7804577 DOI: 10.1007/s13340-020-00488-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/22/2020] [Indexed: 11/18/2022]
Abstract
There is ample evidence that sport is a protective factor against a number of health risks, across all ages, in the general population. An in-depth understanding of energy metabolism has reasonably entailed exercise as a cornerstone in the lifestyle of almost all subjects with type 1 diabetes mellitus (T1DM). Nevertheless, individuals with T1DM often fail in accomplishing exercise guidelines and they are often less active than their peer without diabetes. Two major obstacles are feared: management of blood glucose control and hypoglycemia. Nowadays, strategies, including glucose monitoring technology and insulin pump therapy, have significantly contributed to the participation in regular physical activity, and even in competitive sports, for T1DM people. The case report presents an analysis of specific personality traits and psychological parameters of 20 years old female Polish multiple champion in weightlifting with excellent T1DM control.
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Affiliation(s)
- Katarzyna Cyranka
- Department of Psychiatry, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| | - Dominika Dudek
- Department of Psychiatry, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| | - Maciej T Małecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
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Czupryniak L, Gawrecki A, Gierczyński J, Jarosz-Chobot P, Klupa T, Małecki M, Mianowska B, Myśliwiec M, Szadkowska A, Szypowska A, Wolnik B, Zozulińska-Ziółkiewicz D. Insulin pump therapy and continuous systems use in adult type 1 diabetes patients — Experts’ Opinion. Clinical Diabetology 2020. [DOI: 10.5603/dk.2020.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Matejko B, Krzyżowska S, Kieć-Wilk B, Malecki MT, Klupa T. Efficacy and safety of long-term insulin pump treatment in patients with type 1 diabetes aged over 50 years. Endocr J 2020; 67:367-371. [PMID: 32023570 DOI: 10.1507/endocrj.ej19-0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Continuous subcutaneous insulin infusion (CSII) therapy using insulin pumps has become widely used in the treatment of type 1 diabetes mellitus (T1DM). This retrospective study aimed to assess the efficacy and safety of long-term insulin pump treatment in patients with T1DM aged ≥50 years. The study included patients aged ≥50 years, who had a diagnosis of T1DM based on clinical criteria and/or presence of autoantibodies characteristic of autoimmune diabetes, and had received ≥5 years of recent and uninterrupted treatment with a personal insulin pump. We analyzed records on HbA1c levels across the entire observation period. The cohort comprised 17 patients, of whom 6 (35%) were men and 11 (65%) were women. The mean duration of observation was 6.6 years, during which patients had a mean of 8.4 HbA1c measurements. Mean HbA1c level over the entire observation period was 6.7% (range, 5.3-7.4%). Overall, 11 patients (65%) had mean HbA1c levels at the ADA-recommended target of <7% and 5 patients (29%) had mean HbA1c <6.5%. Mean HbA1c level was significantly lower at the end of the observation period than at the start (6.52% versus 6.91%; difference, -0.39%; p < 0.01), indicating an improvement in glycaemic control over time. On average, patients experienced one level 1 hypoglycaemia episode every 2.4 days. This retrospective analysis of at least 5 years of follow-up of selected patients with T1DM aged ≥50 years at the start of observation, showed that CSII is a safe and effective treatment option in this age group.
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Affiliation(s)
- Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
- Department of Metabolic Diseases, University Hospital, Kraków, Poland
| | - Sabina Krzyżowska
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Beata Kieć-Wilk
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
- Department of Metabolic Diseases, University Hospital, Kraków, Poland
| | - Maciej Tadeusz Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
- Department of Metabolic Diseases, University Hospital, Kraków, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
- Department of Metabolic Diseases, University Hospital, Kraków, Poland
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Mrozinska S, Gosiewski T, Sroka-Oleksiak A, Szopa M, Bulanda M, Malecki MT, Klupa T. The effect of linagliptin treatment on gut microbiota in patients with HNF1A-MODY or type 2 diabetes — a preliminary cohort study. Clinical Diabetology 2020. [DOI: 10.5603/dk.2019.0024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Matejko B, Gawrecki A, Wróbel M, Hohendorff J, Benbenek-Klupa T, Zozulińska-Ziółkiewicz D, Malecki MT, Klupa T. Physiological Characteristics of Type 1 Diabetes Patients during High Mountain Trekking. J Diabetes Res 2020; 2020:8068710. [PMID: 33015195 PMCID: PMC7519997 DOI: 10.1155/2020/8068710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/17/2020] [Accepted: 08/25/2020] [Indexed: 12/24/2022] Open
Abstract
In this study, the aim was to provide observational data from an ascent to the summit of Mount Damavand (5670 meters above sea level (m.a.s.l), Iran) by a group of people with type 1 diabetes (T1DM), with a focus on their physiological characteristics. After a 3-day expedition, 18 T1DM patients, all treated with personal insulin pumps, successfully climbed Mount Damavand. Information was collected on their physiological and dietary behaviors, as well as medical parameters, such as carbohydrate consumption, glucose patterns, insulin dosing, and the number of hypo- and hyperglycemic episodes during this time frame. The participants consumed significantly less carbohydrates on day 3 compared to day 1 (16.4 vs. 23.1 carbohydrate units; p = 0.037). Despite this, a gradual rise in the mean daily glucose concentration as measured with a glucometer was observed. Interestingly, the patients did not fully respond to higher insulin delivery as there was no significant difference in mean daily insulin dose during the expedition. There were more hyperglycemic episodes (≥180 mg/dL) per patient on day 3 vs. day 1 (p < 0.05) and more severe hyperglycemic episodes (>250 mg/dL) per patient on days 2 (p < 0.05) and 3 (p < 0.05) vs. day 1. In summary, high mountain trekking is feasible for T1DM patients with good glycemic control and no chronic complications. However, some changes in dietary preferences and an observable rise in glucose levels may occur. This requires an adequate therapeutic response.
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Affiliation(s)
- Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Andrzej Gawrecki
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marta Wróbel
- Department of Internal Medicine, Diabetology and Cardiometabolic Diseases, Silesian Center of Heart Diseases, Zabrze, Poland
| | - Jerzy Hohendorff
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | | | | | - Maciej T. Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital, Krakow, Poland
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Wolnik B, Wiza D, Szczepanik T, Syta A, Klupa T. Switching from Neutral Protamine Hagedorn Insulin to Insulin Glargine 300 U/mL Improves Glycaemic Control and Reduces Hypoglycaemia Risk: Results of a Multicentre, Prospective, Observational Study. J Diabetes Res 2020; 2020:8751348. [PMID: 32337298 PMCID: PMC7168722 DOI: 10.1155/2020/8751348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/28/2020] [Indexed: 11/17/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a major cause of morbidity and mortality worldwide and is an important public health issue. A significant proportion of insulin-treated patients with T2DM do not reach target glycated haemoglobin (HbA1c) values, which ultimately increases their risk of long-term microvascular and macrovascular complications. One potential option to improve diabetes control in these patients may be the use of new insulin formulations including second-generation basal insulin analogues such as insulin glargine 300 U/mL (Gla-300). Several published randomised controlled trials have assessed the clinical effectiveness of Gla-300, mostly versus insulin glargine 100 U/mL as well as insulin degludec. However, there is limited information about the real-world effectiveness of Gla-300 when patients are transitioned directly from neutral protamine Hagedorn (NPH) human basal insulin. The primary objective of this study was to evaluate the effectiveness of Gla-300, defined as the percentage of participants with an HbA1c reduction of ≥0.5%, 6 months after switching from NPH insulin, in participants with T2DM. Secondary objectives included the safety assessment based on the percentage of patients experiencing ≥1 episodes and the number of hypoglycaemic episodes by category: severe, symptomatic, symptomatic confirmed, diurnal or nocturnal, change in body weight, and insulin dose. A total of 469 participants completed the 6-month observation period. Mean baseline HbA1c was 9.19%. The percentage of participants with a ≥0.5% improvement in HbA1c from baseline was 71.7% at 6 months. Mean HbA1c decreased at 3 and 6 months by 0.77% (±0.98) and 1.01% (±1.12), respectively (p < 0.00001 versus baseline), while fasting glycaemia decreased by 32 mg/dL and 37 mg/dL, respectively (p < 0.00001 versus baseline). There were moderate increases in the doses of both Gla-300 and, if used, short-acting insulins during the 6 months of observation. The percentage of participants with ≥1 hypoglycaemia event during the preceding 4 weeks decreased significantly from baseline to 3 and 6 months, as did the proportion with symptomatic hypoglycaemia at night (p < 0.00001 versus baseline). No participants had severe hypoglycaemia after a switch to Gla-300. Body mass, waist and hip circumferences, and waist : hip ratio did not change significantly. In conclusion, this large, prospective, observational study demonstrated that switching from NPH insulin to Gla-300 resulted in a significant improvement in HbA1c, with only a moderate increase in insulin dose, a decreased risk of hypoglycaemia, and no increase in body weight.
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Affiliation(s)
- B. Wolnik
- Medical University of Gdansk, Department of Hypertension and Diabetology, Gdansk, Poland
| | - D. Wiza
- Poznan University of Medical Sciences, Department of Internal Medicine and Diabetology, Poznan, Poland
| | - T. Szczepanik
- Starkiewicz Hospital, Zaglebie Oncology Center, Dabrowa Gornicza, Poland
| | - A. Syta
- Sanofi-Aventis Poland, Medical Affairs, Warszawa, Poland
| | - T. Klupa
- Jagiellonian University Medical College, Department of Metabolic Diseases, Kraków, Poland
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Hohendorff J, Ucieklak D, Skupien J, Matejko B, Di Giacomo A, Malecki MT, Klupa T. Risk factors of hypoglycaemia in type 1 diabetes individuals during intensive sport exercise-Data from the SPORTGIVECHANCE event. Int J Clin Pract 2019; 73:e13411. [PMID: 31456268 DOI: 10.1111/ijcp.13411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/23/2019] [Accepted: 08/23/2019] [Indexed: 11/29/2022] Open
Abstract
AIMS Fear of hypoglycaemia seems to be one of the strongest barrier to physical activity for individuals with type 1 diabetes mellitus (T1DM).The aim of the study was to describe clinical characteristics of participants with T1DM in the intense sporting event of runs and bike rides"SPORTGIVECHANCE-Diabetic runners and cyclists for more sport for all in Europe", and investigate factors associated with self-reported hypoglycaemia episodes during the competition, in particular the use of continuous and flash glucose monitoring systems (CGM/FGM). METHODS The sporting event took place in Spoleto, Italy from 30 August 2018 to 2 September 2018. An online survey was distributed among 150 participants with diabetes. Only T1DM patients were invited to complete the survey that included questions on baseline clinical characteristics as well as glucose control and meal related issues during the competition. Logistic regression was used to determine factors associated with reported hypoglycaemia. RESULTS There were 35 T1DM individuals who completed the questionnaire: eight subjects were continuous glucose monitoring system (CGM) users, 10 used flash glucose monitoring systems (FGM), while the others performed self-measured blood glucose measurements (SMBG) on glucose meters. Mild hypoglycaemia episodes during the competition were reported by four CGM/FGM users and six non-users (OR: 0.73, CI: 0.34-1.53). No severe hypoglycaemic episode was reported. Body mass index (BMI) (OR: 1.47, CI: 1.01-2.13) and subjectively very hard or maximal intensity of the competition (OR: 4.90, CI: 1.51-15.89) were associated with a higher risk of hypoglycaemia. CONCLUSIONS Data obtained from the self-selected sample of T1DM patients suggests that T1DM individuals can participate in intense sport competitions with moderate risk of mild hypoglycaemia regardless of CGM/FGM or SMBG use.
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Affiliation(s)
- Jerzy Hohendorff
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases, University Hospital in Krakow, Krakow, Poland
| | - Damian Ucieklak
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases, University Hospital in Krakow, Krakow, Poland
| | - Jan Skupien
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases, University Hospital in Krakow, Krakow, Poland
| | - Bartlomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases, University Hospital in Krakow, Krakow, Poland
| | | | - Maciej T Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases, University Hospital in Krakow, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases, University Hospital in Krakow, Krakow, Poland
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Klupa T, Hohendorff J, Benbenek-Klupa T, Matejko B, Malecki MT. Insulin pump settings and glucose patterns during a 1008-km non-stop bicycle race in a patient with type 1 diabetes mellitus. Acta Diabetol 2019; 56:593-595. [PMID: 30443779 PMCID: PMC6451704 DOI: 10.1007/s00592-018-1254-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/06/2018] [Indexed: 01/26/2023]
Affiliation(s)
- Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, 15 Kopernika Street, 31-501, Kraków, Poland
- University Hospital, Kraków, Poland
| | - Jerzy Hohendorff
- Department of Metabolic Diseases, Jagiellonian University Medical College, 15 Kopernika Street, 31-501, Kraków, Poland
- University Hospital, Kraków, Poland
| | | | - Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, 15 Kopernika Street, 31-501, Kraków, Poland.
- University Hospital, Kraków, Poland.
| | - Maciej T Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, 15 Kopernika Street, 31-501, Kraków, Poland
- University Hospital, Kraków, Poland
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Szopa M, Klupa T, Kapusta M, Matejko B, Ucieklak D, Glodzik W, Zapala B, Sani CM, Hohendorff J, Malecki MT, Skupien J. A decision algorithm to identify patients with high probability of monogenic diabetes due to HNF1A mutations. Endocrine 2019; 64:75-81. [PMID: 30778899 PMCID: PMC6453873 DOI: 10.1007/s12020-019-01863-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/05/2019] [Indexed: 11/09/2022]
Abstract
PURPOSE To investigate the utility of biomarkers of maturity-onset diabetes of the young (MODY), high-sensitivity C-reactive protein (hsCRP), and 1,5-anhydroglucitol (1,5-AG) in conjunction with other clinical and laboratory features to improve diagnostic accuracy and provide a diagnostic algorithm for HNF1A MODY. METHODS We examined 77 patients with HNF1A MODY, 88 with GCK MODY mutations, 99 with type 1 diabetes, and 92 with type 2 diabetes. In addition to 1,5-AG and hsCRP, we considered body mass index (BMI), fasting glucose, and fasting serum C-peptide as potential biomarkers. Logistic regression and receiver operating characteristic curves were used in marker evaluation. RESULTS Concentration of hsCRP was lowest in HNF1A MODY (0.51 mg/l) and highest in type 2 diabetes (1.33 mg/l). The level of 1,5-AG was lowest in type 1 diabetes and HNF1A MODY, 3.8 and 4.7 μg/ml, respectively, and highest (11.2 μg/ml) in GCK MODY. In the diagnostic algorithm, we first excluded patients with type 1 diabetes based on low C-peptide (C-statistic 0.98) before using high BMI and C-peptide to identify type 2 diabetes patients (C-statistic 0.92). Finally, 1,5-AG and hsCRP in conjunction yielded a C-statistic of 0.86 in discriminating HNF1A from GCK MODY. We correctly classified 92.9% of patients with type 1 diabetes, 84.8% with type 2 diabetes, 64.9% HNF1A MODY, and 52.3% GCK MODY patients. CONCLUSIONS Plasma 1,5-AG and serum hsCRP do not discriminate sufficiently HNF1A MODY from common diabetes types, but could be potentially useful in prioritizing Sanger sequencing of HNF1A gene.
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Affiliation(s)
- Magdalena Szopa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Maria Kapusta
- Department of Clinical Biochemistry, Jagiellonian University Medical College, Krakow, Poland
| | - Bartlomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Damian Ucieklak
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | | | - Barbara Zapala
- Department of Clinical Biochemistry, Jagiellonian University Medical College, Krakow, Poland
| | - Cyrus Maurice Sani
- School of Medicine in English, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy Hohendorff
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Maciej T Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Jan Skupien
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.
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