Learning Curve for Starting a Successful Single-Centre TAVR Programme with Multiple Devices: Early and Mid-Term Follow-Up

Aims: We report 30-day, 1-year, and 3-year outcomes for a new TAVR programme that used five different transcatheter heart valve (THV) systems. Methods: From 2014 to 2020, 122 consecutive patients with severe aortic stenosis (AS) received TAVR based on the Heart Team decision. Outcomes were analysed for the whole study population and in addition the first 63 patients (Cohort A, 2014 to 2019) were compared to the last 59 patients (Cohort B, 2019 to 2020). Outcomes included VARC-2 definitions and device performance assessed via transthoracic echocardiography by independent high-volume investigators. Results: The mean patient age was 77.9 ± 6.1 years old, and 48 (39.3%) were male. The mean logistic Euroscore II was 4.2 ± 4.5, and the mean STS score was 6.9 ± 4.68. The systems used were as follows: Medtronic Corevalve Evolute R/PRO (82 patients-67.2%); Abbott Portico (13-10.6%); Boston Scientific Lotus (10-8.2%); Meril Myval (11-9%); and Boston Scientific Neo Accurate (6-5%). Access was transfemoral (95.9% of patients); surgical cut down (18% vs. percutaneous 77.8%); subclavian (n = 2); trans-axillary (n = 2); and direct aorta (n = 1). VARC-2 outcomes were as follows: device success rate 97.5%; stroke rate 1.6%; major vascular complication 3.3%; permanent pacemaker implantation 12.4%. At discharge, the incidences of grade I and II aortic regurgitation were 39.95 and 55.5%, respectively. At one year, all-cause mortality was 7.4% without admissions for valve-related dysfunction. The 3-year all-cause mortality and all-stroke rates were 22.9% and 4.1%, respectively. Between the 1-year and 3-year follow-ups, valve-related dysfunction was detected in three patients; one had THV system endocarditis that led to death. There was a remarkable but statistically non-significant decrease in mortality from Cohort A to Cohort B [four (6.3%) vs. one patient (1.7%), p = 0.195] and major vascular complications occurred at a significantly higher rate in the Cohort B [zero (0%) vs. four (6.8% patient, p = 0.036)]. Overall, we found that using multiple devices was safe and allowed for a learning team to achieve a high device success rate from the beginning (97.5%). Conclusions: TAVR with different THV systems showed acceptable early and mid-term outcomes for survival, technical success, and valve-related adverse events in high-risk patients with significant AS, even in the learning curve phase.

Single-Center Experience with the Balloon-Expandable Myval Transcatheter Aortic Valve System in Patients with Bicuspid Anatomy: Procedural and 30-Day Follow-Up

Aims: To report our single-center data regarding the initial 52 consecutive patients with a bicuspid aortic valve who underwent a Transcatheter Aortic Valve Implantation (TAVI) procedure using the new balloon-expandable MYVAL system. The focus is on reporting procedural details and outcomes over the 30-day postoperative period. Methods: From December 2019 to July 2023, 52 consecutive patients underwent a TAVI procedure with bicuspid anatomy. All patients had moderate to-high surgical risk or were unsuitable for surgical aortic valve replacement based on the Heart Team's decision. Outcomes were analyzed according to the VARC-2 criteria. The results of bicuspid patients were compared to patients with tricuspid anatomy in the overall study group, and further analysis involved a comparison between 52 pairs after propensity score matching. The device performance was evaluated using transthoracic echocardiography. Data collection was allowed by the Local Ethical Committee. Results: The mean age was 71 ± 7.1 years, and 65.4% were male. The mean Euroscore II and STS score were 3.3 ± 3.2 and 5.2 ± 3.3, respectively. Baseline characteristics and echocardiographic parameters were well balanced even in the unmatched comparison. Procedures were significantly longer in the bicuspid group and resulted in a significantly higher ARI index. All relevant anatomic dimensions based on the CT scans were significantly higher in bicuspid anatomy, including a higher implantation angulation, a higher rate of horizontal aorta and a higher proportion of patients with aortopathy. In the unmatched bicuspid vs. tricuspid comparison, postprocedural outcomes were as follows: in-hospital mortality 0% vs. 1.4% (p = 0.394), device success 100% vs. 99.1% (p = 0.487), TIA 1.9% vs. 0% (p = 0.041), stroke 1.9% vs. 0.9% (p = 0.537), major vascular complication 3.8% vs. 2.3% (p = 0.530), permanent pacemaker implantation 34% vs. 30.4% (p = 0.429), and cardiac tamponade 0% vs. 0.5% (p = 0.624). In the propensity-matched bicuspid vs. tricuspid comparison, postprocedural outcomes were as follows: in-hospital mortality 0% vs. 0%, device success 100% vs. 100%, TIA 1.9% vs. 0% (p = 0.315), stroke 1.9% vs. 0.9% (p = 0.315), major vascular complication 3.8% vs. 0% (p = 0.475), permanent pacemaker implantation 34% vs. 24% (p = 0.274), and cardiac tamponade 0% vs. 0%. There was no annular rupture nor need for second valve or severe aortic regurgitation in both the unmatched and matched comparison. The peak and mean aortic gradients did not differ at discharge and at 30-day follow-up between the two groups regardless of whether the comparison was unmatched or matched. There were no paravalvular leakages (moderate or above) in the bicuspid patients. Intermediate and extra sizes of the Myval THV system used a significantly higher proportion in bicuspid anatomy with a significantly higher oversize percentage in tricuspid anatomy. Conclusions: The TAVI procedure using the Myval THV system in patients with significant aortic stenosis and bicuspid aortic valve anatomy is safe and effective. Hemodynamic parameters do not differ between tricuspid and bicuspid patients. However, the permanent pacemaker implantation rate is higher than expected; its relevance on long-term survival is controversial.

Single center experience with the balloon-expandable Myval transcatheter aortic valve system with the first 100 patients: 30-day and 1-year follow-up

AIMS

To report our single-center data, regarding the first 100 patients who underwent TAVR procedure with the new balloon-expandable MYVAL system. We report 30-day and 1-year outcomes in low to high-risk TAVR patient population.

METHODS

From November 2019 to July 2021, 100 consecutive patients underwent TAVR procedure. Patient outcome was classified according to the VARC-2 definitions. The device performance was assessed using transthoracic echocardiography. Data collection was allowed by the Local Ethical Committee.

RESULTS

The mean age was 74.7 years, 63 (63%) were male. The mean Euroscore II and STS score were 4.8 ± 4.9 and 5.6 ± 3.9, respectively. Transfemoral access was the most frequent (surgical vs. percutaneous 2% vs. 97%) and in one patient surgical subclavian access was used. VARC-2 outcomes were as follows: device success 99%, STROKE 1%, major and minor vascular complication was 1% and 11%, respectively, the rate of new permanent pacemaker implantation was 30.7%. At discharge, the incidence of grade I, grade II aortic regurgitation was 39% and 1%, respectively, without relevant PVL. In-hospital mortality was only 1%. These results included a high proportion (17%) of patients with bicuspid aortic valves. At 1 year, the all-cause mortality rate was 7% (only two due to cardiac event) and only a single patient had valve-related dysfunction requiring surgical aortic replacement.

CONCLUSIONS

TAVR procedure with MYVAL transcatheter heart valve system shows excellent 30-day and 1-year outcomes regarding patient survival, technical success, and valve-related adverse events. The limitations of our study comprise a single-center study with retrospective data collection.

How Much Is Winning a Matter of Luck? A Comparison of 3 × 3 and 5v5 Basketball

BACKGROUND

The comparison of team sports based on luck has a long tradition and remains unsolved. A contrast between the new Olympic format three-on-three (3 × 3) and five-on-five (5v5) forms of basketball has never been analyzed and provides a comparison within the same form of sports.

METHODS

We developed a new method to calculate performance indicators for each team and invented the Relative Score Difference Index, a new competitive balance indicator that allows the comparison of luck in the two basketball forms for both men and women. We collected game-level data about 3 × 3 and 5v5 from the World Cups held between 2010 and 2019 (N = 666). Luck was defined as the difference between the expected and the actual outcomes of games. Using the basketball World Cup data, we applied the Surprise Index, ran probit regression models, and compared the basketball forms on the goodness-of-fit of the models.

RESULTS

As we predicted, there are differential effects of luck between game formats and sex, such that the 3 × 3 form depends more on luck and women's games are less influenced by luck when compared to men's games.

CONCLUSION

Coaches may better understand the differences between the two forms and sexes regarding luck if they are aware that the 3 × 3 and men's competitions are usually more influenced by luck. The findings provide a leverage point for testing new performances and competition balance indicators and will acknowledge the number of games we enjoy watching.

One-year safety and efficacy results of insulin treatment simplification with IDegLira in type 2 diabetes

INTRODUCTION

This study aimed to investigate the sustained safety and efficacy of insulin treatment simplification with IDegLira in patients with type 2 diabetes and an HbA1c ≤ 7.5% (58 mmol/mol) during a 12-month follow-up.

METHODS

Seventy-two adults with type 2 diabetes and an HbA1c ≤ 7.5% (58 mmol/mol) treated with multiple daily insulin injections (MDI) participated in the trial (age 63.8 ± 9.5 years, HbA1c 6.4 ± 0.7%, [46 ± 8 mmol/mol] body weight 92.95 ± 18.83 kg, total daily insulin dose: 43.21 ± 10.80 units; mean ± SD). Previous insulins were stopped, and once daily IDegLira was started. IDegLira was titrated by the patients to achieve a self-measured prebreakfast plasma glucose concentration of ≥5 mmol/L to ≤6 mmol/L.

RESULTS

After 12 months, good glycaemic control was maintained, while body weight decreased significantly. Mean HbA1c changed to 6.2 ± 0.8% (44 ± 9 mmol/mol) (p = .109) and body weight changed by -3.89 kg to 89.06 ± 18.61 kg (p < .0001). The simplified treatment was safe and well-tolerated. Percentage of patients experiencing at least one episode of hypoglycaemia was 49% during the month before simplification and 17% during the last 3 months of the follow-up.

CONCLUSIONS

Insulin treatment simplification with IDegLira in selected patients with type 2 diabetes is safe, maintains adequate glycaemic control and is associated with weight loss over 12 months.

Simplifying Complex Insulin Regimens While Preserving Good Glycemic Control in Type 2 Diabetes

INTRODUCTION

Type 2 diabetic patients suffering from severe hyperglycemia are often assigned a regimen involving multiple daily injections (MDI) of insulin. If the glucose toxicity resolves, the regimen can potentially be simplified, but there are no guidelines for this, and many patients are left on the MDI regimen. We aimed to prospectively examine the safety and efficacy of switching from MDI to once-daily IDegLira, a fixed-ratio combination of insulin degludec and liraglutide, in relatively well controlled (HbA1c ≤ 7.5%) subjects with type 2 diabetes on a low total daily insulin dose (TDD).

METHODS

62 adults with type 2 diabetes (baseline age 64.06 ± 10.24 years, HbA_1c 6.42 ± 0.68%, BMI 33.53 ± 6.90 kg/m², body weight 93.81 ± 19.26 kg, TDD 43.31 ± 10.99 IU/day, insulin requirement 0.47 ± 0.13 IU/kg, duration of diabetes 10.84 ± 7.50 years, mean ± SD) treated with MDI ± metformin were enrolled in our study. Previous insulins were stopped and once-daily IDegLira was started. IDegLira was titrated by the patients to achieve a self-measured pre-breakfast blood glucose concentration of < 6 mmol/L.

RESULTS

After a mean follow-up period of 99.2 days, mean HbA_1c had decreased by 0.30% to 6.12 ± 0.65% (p < 0.0001), body weight had decreased by 3.11 kg to 90.70 ± 19.12 kg (p < 0.0001), and BMI had reduced to 32.39 ± 6.71 kg/m² (p < 0.0001). After 3 months of treatment, the mean dose of IDegLira was 20.76 ± 6.60 units and the mean insulin requirement had decreased to 0.23 ± 0.08 IU/kg. IDegLira ± metformin combination therapy was found to be safe and generally well tolerated. During the month before the baseline visit, 28 patients (45%) had at least one episode of documented or symptomatic hypoglycemia, while only 6 (9.67%) patients reported a total of 13 documented episodes during the follow-up.

CONCLUSION

In everyday clinical practice, switching from low-dose MDI to IDegLira in patients with well-controlled type 2 diabetes is safe, may result in weight loss and similar or better glycemic control, and substantially reduces the insulin requirement. Simplifying complex treatment regimens decreases treatment burden and may improve adherence to therapy.

CLINICAL TRIAL NUMBER

NCT04020445.

Improvement in glycemic control, cardiovascular risk factors and anthropometric data in type 2 diabetic patients after the switch from biphasic human insulin to biphasic premix analog insulin aspart

A nagyszámú 2-es típusú diabeteses beteg bevonásával végzett, hosszú távú vizsgálatok eredményei egyértelműen bizonyították, hogy a tartósan jó anyagcserehelyzettel megelőzhetők a késői (micro- és macrovascularis) szövődmények. Jelen felmérésben a szerzők beavatkozással nem járó, úgynevezett obszervációs vizsgálat során Magyarország 50 cukorbeteg-szakellátó helyén 2007–2008-ban humán premix készítményről analóg premix inzulinra [bifázisos aszpart inzulin (BIAsp) – NovoMix® 30] átállított betegek adatait elemzik retrospektív módon. Az analízisbe bevont 2898 beteg átlagéletkora 66,20 ± 10,10 év, a diagnózistól eltelt idő az esetek 43%-ában több mint 10 év volt. A NovoMix® 30-kezelés hatodik hónapjának végén a HbA 1c jelentős, statisztikailag szignifikáns javulását észlelték: a kiinduláskor mért 9,10 ± 1,44%-os szint 7,62 ± 1,00%-ra csökkent ( p < 0,001). A lipidprofil is előnyösen változott (bár a célértéket az esetek többségében nem sikerült elérni). A szisztolés és diasztolés vérnyomás átlaga alacsonyabb lett, a testsúly 84,2 ± 14,9 kg-ról 82,6 ± 13,9 kg-ra ( p < 0,01) csökkent. Mindez a kiinduláshoz képest alacsonyabb napi inzulinadag (49,0 ± 17,4 IE versus 48,4 ± 17,6 IE, p < 0,001) és a hypoglykaemiás epizódok előfordulásának szignifikáns csökkenése mellett alakult ki. Az eredmények igazolták, hogy NovoMix® 30-kezeléssel a szénhidrát-anyagcsere jelentősen javul, ami részben az alacsonyabb HbA 1c -szintben és a célértéket elérők szignifikánsan magasabb számában, másrészt a ritkábban előforduló hypoglykaemiás reakciókban nyilvánult meg. Az egyéb cardiovascularis tényezők szignifikáns javulása szintén fontos eredmény, de ennek magyarázata egyelőre hiányzik, és kontrollált, prospektív tanulmányok elvégzését igényli.

Cardiometabolic risk and educational level in adult patients with type 1 diabetes

A low educational level and a poor socioeconomic status could be associated with increased risk for chronic diseases. The aim of the study was to evaluate the relationship between the educational level and cardiometabolic risk in adult patients with type 1 diabetes (n = 437; age: 38.0 +/- 10.4 years, duration of diabetes: 19.2 +/- 11.1 years; x +/- SD). Educational levels were classified as low [primary school, n = 56 (12.8%)], middle [high school, n = 251 (57.4%)] or high [university, n = 130 (29.7%)]. The prevalence rate of the metabolic syndrome proved to be higher in patients with low versus high educational levels (ATP-III criteria: 42.9 vs. 21.5%, P = 0.0006). Antihypertensive treatment and cardiovascular diseases were more prevalent in patients with low versus high educational level (46.4 vs. 26.2%, P = 0.01; 12.5 vs. 2.3%, P = 0.02; respectively). Overall glycemic control was worse in patients with low versus high educational level (HbA(lc): 8.8 +/- 1.6 vs. 7.9 +/- 1.4%; P = 0.0006). Patients with low versus high educational level differed significantly regarding smoking habits (smokers: 28.6 vs. 11.6%; P = 0.01) and regular physical activity (5.4 vs. 33.1%; P = 0.0001). Higher prevalence rate of certain cardiometabolic risk factors was associated with low educational level in middle-aged type 1 diabetic patients with relatively long duration of diabetes; therefore, these patients should have priority when preventing cardiovascular complications.

Cardiometabolic goal attainment during regular care of adult patients with type 1 diabetes mellitus

A kardiometabolikus kockázati tényezők csökkentésével visszaszoríthatók a cardiovascularis események. A kardiometabolikus kockázati tényezők befolyásolásának eredményességéről 1-es típusú diabetes mellitusban szenvedő felnőtt cukorbetegek körében csak kevés adat áll rendelkezésre. Célkitűzés: Diabetes-szakrendelésen ellenőrzés céljából megjelenő, 1-es típusú diabetes mellitusban szenvedő felnőtt (életkor ≥ 18 év) cukorbetegek körében adatokat gyűjtöttünk a kardiometabolikus kockázati tényezők előfordulásáról és kezelésük eredményességéről. Módszerek: Fél év alatt az ország 11 diabetescentrumában egymást követően megjelent 1-es típusú cukorbetegségben szenvedők (n = 533; 256 férfi, 277 nő; életkor 35,6 ± 11,6 év; diabetestartam 18,0 ± 11,1 év; x ± SD) ellenőrzésekor, az előzményi adatok felvételén túl, antropometriai és laboratóriumi adatokat regisztráltunk. A kardiometabolikus kockázati tényezők kezelési célértékeként a III. Magyar Cardiovascularis Konszenzuskonferencia ajánlásában szereplő adatokat tekintettük mérvadónak. Eredmények: A testtömegindex célértékét (< 25 kg/m 2 ) a betegek 55,3%-a (férfi: 45,7%, nő: 64,3%) érte el. A haskörfogat nők körében megkívánt értékét (< 80 cm) a betegek 50,5%-a, a férfiak esetében mérvadó értéket (< 94 cm) 63,7% érte el. A HbA 1c értéke a betegek 8,4%-ában volt 6,5% alatt (20,5%-ban 7,0% alatt). Lipidcsökkentő kezelésben részesült 130 beteg (24,4%), e csoportban a betegek 53,1%-a érte el a triglicerid, 71,5% a HDL-koleszterin és 27,8% az LDL-koleszterin kezelési célértékét. A lipidek szintjére vonatkozó célérték együttes elérése a betegek 17,7%-ában volt sikeres. Hypertonia miatt kezelésben részesült 173 beteg (32,5%), e betegcsoportban a < 130 Hgmm-es szisztolés vérnyomást a betegek 29,5%-a, a diasztolés célértéket (< 80 Hgmm) pedig 34,7% érte el. A betegek 17,7%-a a vizsgálat időpontjában dohányzónak vallotta magát, 19,2% leszokott a dohányzásról, és 63,2% sohasem dohányzott. Következtetések: Felnőtt, 1-es típusú diabetes mellitusban szenvedők körében a kardiometabolikus kockázati tényezők napjainkban ajánlott kezelési célértékeit a cukorbeteg-gondozás keretein belül nehéz elérni. További erőfeszítéseket kell tenni a cukorbetegek kardiometabolikus kockázati tényezőinek hatékonyabb csökkentése érdekében.

[Acarbose, an unduly neglected antidiabetic drug]

The long-term benefit of acarbose treatment was studied prospectively 20 NIDDM patients on diet, and 20 IDDM patients were treated with acarbose and followed for six years. 5 NIDDM patients and 7 IDDM patients were dropped-out due to side-effects or planned pregnancy or price of the drug. In the NIDDM group, acarbose treatment had to be supplemented with sulfonylureas in six patients, and a conversion to insulin had to be carried out in two patients. At the end of the study, all of NIDDM patients had a significantly lowered fasting blood-glucose level as compared to the baseline value. In the IDDM group, the postprandial blood-glucose level (at 90 minutes after meal) was significantly decreased, whereas the fasting glucose level remained unchanged versus the baseline level. In both groups, the values of HbA1c and serum lipids were significantly better than before acarbose treatment. The frequency of hypoglycaemic episodes was decreased, the body weight was without significant change. In addition, five NIDDM patients with late sulfonylurea-resistance were also treated with acarbose and followed for two years. After six months of treatment, however, four out of the five patients had to be converted to insulin.

CONCLUSIONS

1. in both types of diabetes, acarbose is an effective drug and decreases the frequency of hypoglycaemic episodes, 2. NIDDM patients having diet in effectivity require sulfonylureas or insulin late if acarbose administered and 3. in IDDM patients acarbose subsides the postprandial hyperglycaemia and smoothes the daily blood-sugar profile.

[Six-year follow up on recently diagnosed NIDDM patients]

The six-year prospective data on 100 newly detected NIDDM patients aged 40-69 years were analysed. After careful and controlled dietetic training, the carbohydrate metabolism parameters (glycohaemoglobin, mean blood sugar level and glycosuria), the physical status, fundus picture and laboratory data (lipids and renal function) were examined yearly and the alterations of the treatment were registered. 24 patients dropped out during six years. 10 patients died. The carbohydrate status was also favourable and a moderate weight reduction was reached. After two years 59% of the patients proved well controlled. At the end of six years 41% of the patients were still well controlled merely by dietary means. The data were compared with those on 100 similarly detected new NIDDM patients whose education and control were provided by family physicians. There were non essential differences between the two groups in specific complications, BMI and lipids. The level of carbohydrate metabolism control was significantly better in the diabetic clinic-controlled patients; the proportion of sulfanylurea-treated patients was only 40.5% after six years compared with 73% among family physicians-controlled patients. The importance of a correct and controlled diet, good education and continuous control is emphasized.

[Diabetic ketoacidosis (169 episodes in 131 patients in the course of 10 years)]

Diabetic patient material--presenting hyperglycaemic ketoacidotic episode--observed in Gyula and Szekszárd County Hospitals in period 1980-89, was reviewed by authors. 131 patients were admitted with 169 ketoacidotic episodes (among them 23 patients had 62 recurrences). The mean age of patients were 49.4 years (14-84 years), duration of diabetes 9.5 years (from one month to 45 years). The common cause of diabetic ketoacidosis was respiratory (26 per cent) and enteral (35.5 per cent) infection. The consciousness of patients had shown close correlation with the increase of blood sugar and urea nitrogen level as well as with the decreasing of the pH value of capillary blood. The first step of the therapy was the parenteral fluid intake with isotonic solution (in the first hour the average 1351 ml). In 18 patients fast-acting insulin (Novo Actrapid MC) was given by constant infusion, in the remaining cases intravenous or intramuscular low doses of the same insulin were administered. The importance of early potassium replacement, and the dangers of forced and rapid correction of acidosis is emphasized. Lethality related to episodes was 10 per cent, related to the patients 12.9 per cent. The number of ketoacidotic cases did not decrease parallel with the improvement of therapeutic possibilities, as it was experienced by their earlier evaluations. The importance of the prevention of acute metabolic disorders is outlined might be resulted from increasing the efficacy of patients education and better knowledge of GP's, as well.

Role of emotional factors in diabetes

As an approach to the emotional attitude of diabetic patients, the attitude examination devised by Dunn et al. in 1986 (ATT39 test) was applied. Thirty-nine points were analyzed on the basis of 6 factors in order to assess the stress relating to the diabetes, the adaptation, the guilt feelings, the alienation, the awareness of the disease and the tolerance on the Likert scale. Analysis of the results of 128 diabetic patients demonstrated that, besides the appearance of stress, the emotional attitude of the subject to diabetes is characterized by good ability to cooperate, appropriate awareness of the disease, adaptive tolerance and slight guilt feelings. The data were also evaluated with respect to the quality of metabolic control, age, sex, duration of disease, educational level and type of diabetes. Contrary to expectations, quality of control and duration of disease did not influence the emotional attitude towards diabetes, but this attitude was correlated to type of diabetes, complications and sex of the patients. The results of the attitude examination of 34 type I diabetic patients were compared with the data from other pyschological surveys (personality and performance tests), and a good correlation was found between emotional characteristics and results of the personality tests. It was concluded that the attitude examination can readily be carried out, and provides a basis that can be appropriately utilized in the care of diabetic patient.

[Insulin-induced lipoatrophy--caused by monocomponent insulin?]

Authors give case history of two patients for type II diabetes treated with insulin by whom with monocomponent insulin lipoatrophy developed on the region of insulin administration. In the case of one of them the problem was solved by elimination of technical fault, the local reaction of other patient ceased only by converting to human insulin into the lipoatrophic region. In the latter case dynamics of contemporaneous psoriatic change raises immunological connections.

Personality examinations in individuals with insulin-dependent diabetes mellitus

Assessment of the question of the 'diabetic personality' in the literature is not completely unambiguous. For the first time in Hungary, personality examinations were performed in 53 young (average age 24.9 years) insulin-dependent patients; 20 young patients with ulcers served as controls. Three different psychological tests were carried out, and data were also obtained on the treatment, knowledge concerning the disease and way of life by means of questionnaires and interviews. On the basis of the results, it was concluded that there is no special 'diabetic personality'. Psycho-emotional factors exert an influence in all stages of the disease, in exactly the same way as in subjects with other chronic diseases. The need is emphasized for individual psychotherapy.