HbA1c Screening for Diabetes in Patients with Acute Coronary Syndrome: A Worthwhile Test or a Pitfall?

BACKGROUND: Diagnostic concordance between HbA1c and other glucose-based tests is imperfect, and data on this problem in acute coronary syndrome (ACS) are still lacking. The aim of this study was to identify undiagnosed glucose abnormalities in ACS patients, and to compare the effectiveness and consistency of the diagnostic screening based on HbA1c to the oral glucose tolerance test (OGTT). METHODS: The study group consisted of 121 ACS patients, mean age 62.3 ± 11.6 years, without known glucose abnormalities. HbA1c, admission and fasting plasma glucose in the first days of hospitalization were assessed and referred to the results of OGTT performed two weeks after discharge. RESULTS: OGTT identified normoglycemia in 45%, pre-diabetes in 39.4%, and diabetes in 15.6%, while HbA1c revealed these categories in 39.7%, 51.2%, and 9.1%, respectively. With an HbA1c cut-off ≥6.5% (48 mmol/mol) diagnostic for diabetes, the sensitivity of the method was 41%, while specificity was 98%, compared to the OGTT. The optimal HbA1c cut-off value at the crossing of sensitivity and specificity curves was 5.9%. The HbA1c value recommended for the diagnosis of pre-diabetes and optimal cut-off point were the same (5.7%). CONCLUSIONS: Using HbA1c without OGTT in an early but stable phase of ACS may result in a significant underdiagnosis of diabetes.

High-Protein or Low Glycemic Index Diet-Which Energy-Restricted Diet Is Better to Start a Weight Loss Program?

BACKGROUND: To date, no crossover studies have compared the effects of high-protein (HP) and low glycemic index (LGI) diets applied as starting energy-restricted diets. METHODS: Thirty-five overweight or obese volunteers with sedentary lifestyles aged 41.4 ± 11.0 years, with body mass index (BMI) of 33.6 ± 4.2 kg/m2, without diabetes, completed an 8-week randomized crossover study of an energy-restricted diet (reduction of 30%; approximately 600 kcal/day). The anthropometric parameters, body composition, 24 h blood pressure, and basic metabolic profile were measured at baseline and after completing the two 4-week diets; i.e., the HP (protein at 30% of the daily energy intake) or LGI diet, followed by the opposite diet. All subjects maintained food diaries and attended six counselling sessions with a clinical dietitian. RESULTS: The final weight loss was not significantly different when the HP diet was used first but was associated with a greater loss of fat mass: 4.6 kg (5.8; 3.0 kg) vs. 2.2 (4.5; 0.8); p < 0.025, preserved muscle mass, and reduced LDL-cholesterol. CONCLUSIONS: A short-term HP diet applied as a jump-start diet appeared to be more beneficial than an LGI diet, as indicated by the greater fat mass loss, preservation of muscle mass, and better effects on the lipid profile.

Assessment of diabetes control in insulin pump therapy in late adolescentsand young adults with type 1 diabetes.

OBJECTIVES: The aim of the study was to evaluate metabolic control in insulin pump therapy (IPT) in late adolescents and young adults with type 1 diabetes mellitus. MATERIAL AND METHODS: The study was conducted in 86 subjects with type 1 diabetes, and included 45 patients aged 16-19 years (mean 17.6±1.2) treated in a pediatric outpatient clinic and 41 subjects aged 19-26 years (mean 22.8±2.2) treated in an adult outpatient clinic of the same university hospital, who received the same refund of IPT. RESULTS: Late adolescents had a lower BMI (22.7±2.9 kg/m2 vs. 24.2±3.2 kg/m2; P<0.05), higher HbA1c (69.4±15.1 mmol/mol vs. 58.5±11.8 mmol/mol; P<0.001) and mean blood glucose levels (10.4±2.6 mmol/l vs. 9.2±1.4 mmol/l, P<0.05), and received higher insulin doses per day (0.85±0.23 IU/kg vs. 0.65±0.13 IU/kg; P<0.001). The mean diabetes and IPT duration, number of visits, basal/bolus insulin ratio, number of insulin boluses, blood glucose tests and the episodes of hypoglycemia were similar. CONCLUSIONS: Metabolic control in late adolescents with type 1 diabetes on IPT is significantly worse than in young adults, despite higher doses of insulin and very similar way of treatment and self-control. This may be related to the patients age or the less rigorous approach to therapeutic recommendations resulting from pediatric diabetes care.

Level of knowledge concerning diet in type 2 diabetic patients and nurses.

Introduction: Among patients with diabetes, there are many myths concerning food products which are believed to lower or not influence the blood glucose (BG) level. The aim of this study was to assess the knowledge of patients with diabetes and hospital nurses concerning popular food products and their impact on BG levels. Materials and methods: The study group consisted of 250 patients with diabetes (DM), members of the Polish Diabetes Association; the other group consisted of 123 healthy nurses (N) from 3 hospitals in Szczecin, Poland. Participants were asked to complete a questionnaire on products common in diabetic diet (grapefruit, honey, coffee substitute, diabetic chocolate, milk soup, pork neck) and their influence on BG levels. Results: The highest percentage of wrong answers was given for pork (DM 71%; N 83%, NS) and grapefruit (DM 51%; N 77%, p < 0.01), while the most correct answers were for honey (DM 69%; N 80%; p < 0.05) and milk soup (DM 64%; N 67%, NS). Negative correlation was found between the number of correct answers and the age of patients (r(s) = −0,14; p < 0.01;) and no correlation between the number of correct answers and the duration of diabetes mellitus (NS). Patients treated with insulin provided correct answers significantly more frequently than patients on oral medication only (44% vs 34.8%; p < 0.01). Conclusions: 1. The level of knowledge concerning products commonly used in diabetic diet among patients with diabetes and hospital nurses is low. 2. Both groups, patients and hospital nurses, need education about diabetic diet.

False diagnosis of type 1 diabetes mellitus and its complications in Wolfram syndrome--is it the reason for the low number of reported cases of this abnormality?

Wolfram syndrome (WS), also known as DIDMOAD (Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness), is a rare autosomal recessive syndrome (1/770,000 in the United Kingdom), characterised by juvenile onset of diabetes mellitus, optic nerve atrophy, diabetes insipidus, sensorineural deafness, renal tract and neurological abnormalities, and primary gonadal atrophy. WS is caused mainly by biallelic mutations in the WFS1 gene, which encodes wolframin. Wide tissue distribution of wolframin and many mutations in the wolframin gene resulting in Wolfram syndrome may contribute to different phenotypes and the unusual combinations of clinical features. We describe a female patient with Wolfram syndrome diagnosed at the age of 25, with a previous false diagnosis of type 1 diabetes mellitus and misdiagnosed diabetic complications. The patient was found to be a compound heterozygote for two novel mutations in exon 8 of WFS1 gene: a 2-bp deletion AT at nt 1539 leading to a frameshift (Y513fs) and a single-base substitution 1174C > T resulting in a stop codon (Q392X). A detailed analysis of the patient's medical history and a review of the literature suggest that many cases of Wolfram syndrome may remain undiagnosed due to misdiagnosis as type 1 diabetes mellitus and incorrect interpretation of clinical symptoms of neurodegenerative abnormalities, especially in their early stages.

Thoracic spine fracture in the course of severe nocturnal hypoglycemia in young patients with type 1 diabetes mellitus--the role of low bone mineral density.

Thus far, only a few spine fracture cases related to severe nocturnal hypoglycemia in type 1 diabetes patients have been reported. Due to the relatively young age of these subjects, osteoporosis was not taken into consideration and bone mineral density was not assessed. We report three type 1 diabetes cases in young patients with durations of 2, 4, and 19 years. These patients had severe hypoglycemic attacks during night sleep with subsequent compression thoracic vertebrae fractures. Laboratory parameters for diabetes control, calcium, phosphate metabolism and celiac-specific antibodies were assessed. Moreover, kidney, thyroid, and parathyroid gland functions were also measured. Bone mineral density was assessed by dual energy x-ray absorptiometry. Lumbar spine x-ray absorptiometry revealed very low bone mineral density in all three patients. In all subjects, metabolic control was good, no chronic diabetes complications were found and other laboratory parameters were within a normal range. For the first time, it was demonstrated that low bone mineral density in young type 1 diabetes patients may contribute to an increased compression fracture risk of the dorsal spine during severe nocturnal hypoglycemia courses. The possibility of osteoporosis in young patients with short diabetes durations suggests it might be advisable to perform bone mineral density testing during diabetes diagnoses. Spinal pain occurrences in young patients after severe nocturnal hypoglycemia should be investigated using procedures for the diagnosis of vertebral compression fracture, even if there is no evident trauma.

Difficulties in interpreting HbA(1c) results.

Glycated hemoglobin (HbA(1c)) is a parameter broadly employed in the assessment of glycemic control in diabetes. The 2010 "Standards of medical care in diabetes", published by the American Diabetes Association (ADA), recommended performing the HbA(1c) test at least every 6 months in patients in whom disease is clinically stable, while subjects after modifications of therapy or in whom glycemic goals have not been met should be tested every 3 months. Moreover, the ADA suggested the HbA(1c) assay be implemented in the diagnosis of diabetes and in the detection of an increased risk of developing this disease. Among various approaches employed to measure the concentration of HbA(1c), high-pressure liquid chromatography is considered to be a reference method. HbA(1c) tests might not be clinically reliable in some circumstances. In cases when HbA(1c) levels do not correlate with glycemia and clinical symptoms, the results should be interpreted with caution, several conditions known to influence the measurement should be taken into account, and use of another diagnostic method, or even testing another marker of glycemic control, e.g., fructosamine or 1,5-anhydroglucitol, should be considered.

[Diabetes control in type 2 diabetic subjects treated in primary health care--how far is from life to standards?]. / Wyrównanie cukrzycy typu 2 u chorych pozostajacych pod wylaczna opieka lekarzy rodzinnych--jak daleko od zycia do standardów?

UNLABELLED: In Poland, as in many other countries, majority of type 2 diabetics subjects (80%) is treated by general practitioners (GPs). Aim of the study was to assess control of type 2 diabetic subjects treated by GPs in one of the big cities in Poland. Achievement of treatment goals was assessed according to recommendations of European Diabetes Policy Group (EDPG) published in 1998-1999 and used in Poland till 2004 and according to more rigorous criteria recommended in 2005 by Polish Diabetological Association (PDA). Study was conducted in 2004 year in 355 consecutive type 2 diabetic subjects coming for a visit to GPs in one of the primary health care centries. Group consisted of 205 women and 150 men, mean age 65.7 +/- 10.3 years, mean diabetes duration 9.2 +/- 7.3 years, mean BMI 29.9 +/- 4.9 kg/m2. In all patients blood pressure measurements were performed in sitting position and blood samples for HbA1c, fasting glycaemia, total cholesterol, LDL, HDL and triglicerides were taken. Mean HbA1c was 7.2 +/- 1.3%; HbA1c < or = 6.5% recommended by EDPG was found in 34,6% of patients, HbA1c < or = 6.1% recommended by PDA was achieved in 19.7% of subjects. Mean fasting glycaemia was 144 +/- 48 mg/dl; glycaemia < or = 110 mg/dl recommended by EDPG and PDA was present in 24% of patients. Dyslipidaemia was present in 62% of diabetics. Mean total cholesterol was 203.7 +/- 45 mg/dl, LDL 118 +/- 33 mg/dl, HDL 51 +/- 13 mg/dl. LDL cholesterol < 100 mg/dl recommended by EDPG and PDA was observed in 28.7% of subjects. HDL cholesterol > 46 mg/dl (EDPG criteria) was found in 61% of patients. HDL cholesterol > 40 mg/dl in men and > 50 mg/dl in women ( PDA criteria) was present 64.5% of subjects. Mean triglycerides level was 182 +/- 108 mg/dl; concentrations < 150 mg/dl (EDPG and PTD criteria) were observed in 46.2% of subjects. Hypertension was present in 81.4% of patients. Mean systolic blood pressure (SPB) was 146.1 +/- 20.4 mmHg, diastolic (DBP) 83.0 +/- 11.1 mmHg. Recommended by EDPG, SPB < 140 mmHg was observed in 47,9%, DBP < 85 mmHg--in 69.9%. Recommended by PTD, SBP < 130 mmHg was found in 16.1%, DBP < 80 mmHg--in 24.5%, and both values only in 8.2% of diabetics. All treatment goals recommended by EDPG-1998-1999 were achieved only in 2 patients. No one person achieved all goals of treatment recommended by PDA-2005. CONCLUSIONS: Great majority of type 2 diabetic subjects treated in primary health care failed to attain treatment goals recommended by EDPG 1998-1999 and by PDA 2005.

Diabetes care and self-monitoring of type 2 diabetic patients in a rural district of West-Pomeranian Province.

INTRODUCTION: Few surveys conducted in diabetic patients from rural regions show that in these subjects monitoring of diabetes is worse than in patients from urban areas. OBJECTIVES: To assess methods of diabetes care provided for type 2 diabetic patients residing in a rural region and methods of the patient self-monitoring of glycemia, blood pressure and foot self-care. PATIENTS AND METHODS: The survey was conducted in a rural district of West-Pomeranian province, in the primary health care center, where 279 type 2 diabetic patients were registered. Out of all patients invited to participate in a questionnaire survey, 168 were enrolled. The mean age of subjects was 67.2 +/- 9.9 years (range 46-91 years), diabetes duration of 8.2 +/- 6.6 years, and body mass index of 32.6 +/- 6.3 kg/m2. Data concerning diabetes care and methods of the patient self-control of glycemia, blood pressure and foot self-care were collected. RESULTS: The majority of patients (62%) were treated only by general practitioners, but 80% reported that they visited their doctors for diabetes treatment once a month. For 90% of subjects the term ,HbA1c" was unknown. Only 40% of patients performed self-monitoring of glycemia, 55%--of blood pressure and 34% examined their feet. CONCLUSIONS: The vast majority of patients from a rural region in West-Pomeranian province is treated only by general practitioners. Despite quite frequent medical visits related to diabetes, education of patients is still unsatisfactory, which was demonstrated by patients' lack of knowledge concerning the basic parameter of laboratory monitoring, HbA1c, as well as insufficient self-management of glycemia, blood pressure and infrequent foot exam.

[Postprandial glycemia--review of current pathophysiological, epidemiological and clinical aspects]. / Glikemia poposilkowa--przeglad zagadnien patofizjologicznych, epidemiologicznych i klinicznych.

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

[Relationship between I/D polymorphism of angiotensin I converting enzyme gene and microvascular complications in type 2 diabetic patients]. / Zaleznosc miedzy polimorfizmem I/D genu enzymu konwertujacego angiotensyne I a powiklaniami o typie mikroangiopatii u chorych na cukrzyce typu 2.

BACKGROUND: Type 2 diabetes mellitus is an increasing problem in developed countries. Microvascular diabetic complications can lead to worsening of the quality of life and lifespan shortening of diabetic patients. The renin-angiotensin system (RAS) seems to play an important role in microvascular blood flow. I/D polymorphism of angiotensin I converting enzyme (ACE) affecting activity of RAS may contribute to development of microvascular diabetic complications. AIM: The aim of the study was to evaluate association between I/D polymorphism of ACE gene and presence of microangiopathic complications in type 2 diabetic patients. MATERIAL AND METHODS: 108 type 2 diabetic patients (70 men and 38 women), mean age 60.0 +/- 9.1 years with mean duration of diabetes 9.1 +/- 6.7 years were assessed for presence of microvascular complications (nephropathy, retinopathy, peripheral neuropathy). Subjects were examined for metabolic control of diabetes, lipid profile and degree of insulin resistance based on HOMA rate. I/-D ACE gene polymorphism was evaluated using polymerase chain reaction (PCR). RESULTS: Diabetic nephropathy was diagnosed in 44 patients (42.7%), retinopathy in 34 patients (31.8%), and peripheral neuropathy in 58 patients (53.7%). Microvascular complications were found (at least one complication) in 83 patients (76.9%). Patients with microangiopathy and without microangiopathy were characterized by similar distribution of I/D ACE gene polymorphism. In carriers of DD ACE genotype blood pressure and HDL-cholesterol serum concentrations were higher than in patients with II polymorphism. CONCLUSIONS: 1. The ACE genotype is not associated with the presence of microvascular complications in type 2 diabetic patients. 2. In type 2 diabetic patients there is an association between DD genotype and higher blood pressure and serum HDL-cholesterol level.

[Multilevel blockade of the renin-angiotensin-aldosterone system in the treatment of diabetic nephropathy]. / Wielopoziomowa blokada ukladu renina-angiotensyna-aldosteron w leczeniu nefropatii cukrzycowej.

Diabetic nephropathy is a leading cause of end-stage renal disease. In this paper the role of renin-angiotensin-aldosterone system (RAA) in the pathogenesis of diabetic nephropathy is discussed and clinical effects of multilevel pharmacological blockade of RAA system by combined treatment with ACE inhibitors, angiotensin receptor blockers (ARB) and aldosterone antagonists is described.

[I/D polymorphism of angiotensin I converting enzyme gene and arterial hypertension in patients with type 2 diabetes mellitus]. / Polimorfizm I/D genu enzymu konwertujacego angiotensyne I a nadcisnienie tetnicze u chorych na cukrzyce typu 2.

UNLABELLED: Type 2 diabetes mellitus and arterial hypertension coexist very frequently. About 80% patients with type 2 diabetes suffer for hypertension, which is connected with higher morbidity and mortality from cardiovascular diseases. There are evidences that activation of the renin-angiotensin system (RAS), one of the most potent factors in blood pressure regulation, can decrease insulin sensitivity of tissues. As I/D polymorphism of angiotensin converting enzyme (ACE) gene can influence the activity of RAS, it may also influence both carbohydrate metabolism and blood pressure. AIM OF THE STUDY: To assess the relationship between the I/D polymorphism of ACE gene and frequency of hypertension and values of blood pressure in type 2 diabetic patients. MATERIAL AND METHODS: Examined group: 108 type 2 diabetic patients (38 women and 70 men), with mean duration of disease 9.07 +/- 6.68 years, mean age 59.98 +/- 9.10 years. We assessed following parameters: body mass index (BMI), waist/hip ratio (WHR), arterial blood pressure. Laboratory tests: concentration of the glucose, glycosylated hemoglobin (HbA1c), creatinine and urinary albumin excretion rate (UAER). Insulin resistance was calculated by the HOMA rate. I/D ACE gene polymorphism was evaluated by polymerase chain reaction (PCR). RESULTS: DD genotype carriers had significant higher systolic and diastolic blood pressure (147.8 +/- 19.8 vs 138.2 +/- 16.5 mm Hg, p = 0.03; 89.2 +/- 9.6 vs 81.7 +/- 8.6 mm Hg p = 0.004; respectively) than II patients. Groups with II, ID and DD genotype were not different in age, BMI, WHR, duration of diabetes, the prevalence and duration of arterial hypertension, degree of metabolic control of diabetes and insulin resistance assessed by HOMA rate. CONCLUSION: In type 2 diabetic patients the DD genotype of ACE gene is not connected with higher prevalence of hypertension, but it is associated with higher systolic and diastolic blood pressure.

Insertion/deletion polymorphism of angiotensin I converting enzyme gene and left ventricular hypertrophy in patients with type 2 diabetes mellitus.

INTRODUCTION: Left ventricular hypertrophy (LVH) is a well known risk factor of death from cardiovascular causes. Patients with type 2 diabetes mellitus are at particularly high risk of developing cardiovascular disease, which accounts for 80% of deaths in this group. Type 2 diabetes mellitus is probably related to increased left ventricular mass (LVM). Existing data show that the renin-angiotensin-aldosterone (RAA) system may play a role in the development of LVH. Since the I/D polymorphism of angiotensin-converting enzyme (ACE) gene influences the activity of RAA, it is likely that it could also have an impact on LVH. AIM: To assess the relationship between I/D polymorphism of the ACE gene and the severity of LVH assessed by echocardiography (Echo) in patients with type 2 diabetes mellitus. METHODS: The study group consisted of 103 patients (37 women and 66 men; mean age 60.1+/-9.1 years) suffering from type 2 diabetes mellitus with a mean duration of 9.0+/-6.5 years. BMI, waist-to-hip ratio (WHR), arterial blood pressure, LVM and LVM index (LVM indexed for body surface area [g/m(2)] or height raised to the power 2.7 [g/m(2.7)]) were evaluated. I/D polymorphism of the ACE gene was determined using polymerase chain reaction (PCR). RESULTS: Distribution of I/D polymorphism of the ACE gene in the study group was as follows: genotype II--32.0%, ID--42.7%, DD--25.2% of patients. LVH was diagnosed in 43-71% of patients (depending on criteria used). Distribution of individual genotypes was similar in patients with and without LVH. Genotypes II, ID and DD were observed in 37.3%, 31.4% and 31.4% of patients without LVH (according to the Levy criteria) and in 26.9%, 53.9%, 19.2% in the LVH group, respectively. In persons with DD genotype, when compared to group II, significantly higher values of systolic and diastolic blood pressure were noted (147.7+/-20.2 vs 138.2+/-16.7 mmHg, p=0.03 and 89.4+/-9.7 vs 81.9+/-8.7 mmHg, p=0.004, respectively). CONCLUSIONS: In patients with type 2 diabetes mellitus there is no relationship between I/D polymorphism of the ACE gene and LVH.

Lack of association between the Pro12Ala polymorphism in PPAR-gamma2 gene and body weight changes, insulin resistance and chronic diabetic complications in obese patients with type 2 diabetes.

BACKGROUND: It is generally accepted that the Pro12Ala polymorphism in peroxisome proliferator-activated receptor-gamma2 (PPAR-gamma2) is associated with an increased risk of type 2 diabetes. However, studies on an association between the polymorphism and obesity have yielded inconsistent findings. Also, a role of PPAR-gamma receptors in development of chronic diabetic complications cannot be excluded. The aim of this study was to investigate an association between Pro12Ala polymorphism and body weight changes, insulin resistance, insulin secretion and incidence of diabetic complications in obese patients with long-lasting type 2 diabetes. METHODS: In 216 obese patients with at least a 10-year history of type 2 diabetes, a detailed medical history was taken and a physical examination with assessment of diabetic complications was performed as well as evaluation of insulin resistance (homeostatic model assessment-HOMA), insulin secretion and other biochemical parameters. PCR-RFLP was used to assess Pro12Ala polymorphism. Two subgroups of patients were compared: homozygotic Pro/Pro and Ala allele carriers (Ala/Ala + Ala/Pro). RESULTS: No differences between the analyzed groups in body weight changes, insulin resistance and insulin secretion were found, but Ala allele was significantly more frequent in males than in females. There was no difference in incidence and progression of diabetic complications with only a trend towards higher incidence of diabetic retinopathy in patients with Ala allele. CONCLUSIONS: There is no association between Pro12Ala PPAR-gamma2 polymorphism and body mass changes observed during a course of type 2 diabetes, differences in peripheral insulin resistance and incidence and progression of diabetic complications in obese patients with long-lasting type 2 diabetes.

[Diabetes control in type 2 diabetic subjects treated in primary health care]. / Wyrównanie cukrzycy typu 2 u chorych leczonych przez lekarzy podstawowej opieki zdrowotnej.

Aim of the study was to assess control of type 2 diabetes in subjects treated by general practitioners. Study was conducted in one of the primary health care centers in a big city, in which health care was provided for 27 900 inhabitants. Control of diabetes was assessed in 355 of all 936 type 2 diabetic subjects registered in the center. None of them was seen by diabetologist in the preceeding year. Mean age was 65,7 +/- 10,3 lat, diabetes duration 9,2 +/- 7,3 lat, BMI 29,9 +/- 4,9 kg/m2. Normal body weight was found in 15%, overweight in 39%, obesity in 46% of subjects. Hypertension was present in 81%, dyslipidaemia in 62% of patients. Mean HbAlc was 7,2 +/- 1,3%, fasting serum glycaemia 144 +/- 48 mg/dl, total cholesterol 204 +/- 45 mg/dL, LDL - 119 +/- 33 mg/dL, HDL - 51 +/- 13 mg/dl, triglicerides 182 +/- 108 mg/dL. Mean systolic blood pressure was 146 +/- 20 mmHg, diastolic 83 +/- 11 mmHg. Treatment goals recommended by Polish Diabetological Association in 2005 were attained as follows: HbAlc < or = 6,1% - 19,7% of subjects, fasting glycaemia < or =110 mg/dl - 24%, total cholesterol < 175 mg/dl - 26%, LDL < 100 mg/dl - 29%, triglicerides < 150 mg/dl - 46%, cholesterol HDL > 40 mg/dl in men and > 50 mg/dl in women - 65% of subjects. Recommended systolic blood pressure < 130 mmHg was found in 16 %, diastolic blood pressure < 80 mmHg - in 24%, and both values - in 8% of diabetics. In no one subject all recommended treatment goals were met. Conclusions 1. Recommended treatment goals are perceived in unacceptably low number of type 2 diabetic subjects treated by general practitioners. 2. Medical care of type 2 diabetic subjects performed in primary health care is unsatisfactory and should be essentially improved or changed.

[Prevalence of diabetes, antidiabetic treatment and chronic diabetic complications reported by general practitioners]. / Ocena czestosci wystepowania cukrzycy, sposobu jej leczenia oraz czestosci powiklan o typie mikroangiopatii u osób pozostajacych pod opieka lekarzy podstawowej opieki zdrowotnej.

INTRODUCTION: Prevalence of type 2 diabetes has increased greatly over the past decade and focus of care for people with diabetes has shifted from specialists to general practitioners (GPs). Because of lack of the central registry, a real number of diagnosed diabetes in Poland is unknown, as unknown is the prevalence of diabetes in patients attending primary health care, provided treatment and a prevalence of chronic diabetic complications registered by GPs. AIM OF STUDY: Assessment of the prevalence of diabetes registered in primary health care, recommended antidiabetic treatment and prevalence of microangiopathic diabetic complications diagnosed by GPs. MATERIAL AND METHODS: Study was performed in Szczecin, a city of 450 000 inhabitants, located in North-West part of Poland. Data were obtained in year 2002 from one of the primary health care centers, in which health care was provided by 12 GPs for 27 932 inhabitants (15655 females and 12277 males), aged 0-98 years (average 38.3 +/- 23.2 years). Data were extracted from medical records and provided by GP doctors. RESULTS: Number of diagnosed and registered diabetics was 993 (prevalence--3.56%), age 3-95 years (mean 65.4 +/- 13.6 years). The diabetic group consisted of 611 females (mean age 67.5 +/- 12.4)--prevalence--3.90% and 382 males (mean age 62.0 +/- 14.7)--prevalence--3.11% (p = 0.003). Mean duration of diabetes was 7.4 +/- 6.9 years and it was similar for males and females. Type 2 diabetes was diagnosed in 94.4%, type 1 diabetes in 4.5%, other types of diabetes in 1.1% of all patients. Prevalence of registered diabetes in the group of 0-10 years old was 0.08%, in the group 11-20 years--0.33%, 21-30 years--0.25%, 31-40 years--0.44%, 41-50 years--1.93%, 51-60 years--5.03%, 61-70 years--9.88% and in the group over 70 years old--14.37%. Prevalence of diabetes in the group over 14 years old was 4.38%, in the group over 20 years--4.86%, and in subjects older than 35 years--6.84%. Elderly patients, over 60 years account for 74% of all diabetic subjects and subjects over 70 years--for 45% of them. Reported treatment of type 2 diabetes: diet alone--9%, oral agents--68%, oral agents combined with insulin--10.5%, insulin alone--12.5%. Mean HbA1c value measured in 307 type 2 diabetic subjects was 7.25 +/- 1.28%. According to GPs' opinion chronic microangiopathic diabetes complications were present in 36.6% of type 2 diabetic subjects. Retinopathy was reported in 24.8% of patients, polyneuropathy in 2.4%, nephropathy in 1.5%, diabetic foot in 0.5%, and combination of different complications in 7.4% of them. In type 1 diabetes chronic diabetic complications were stated in 42.2% of subjects--retinopathy--in 15.6%, polyneuropathy--in 2.2%, nephropathy--in 2.2%, diabetic foot--in 2.2%, and combination of them--in 20.0%. Average number of registered diabetics was 83 per physician, however 6 doctors took care of 107-158 diabetic subjects. In the past year diabetologist consultation or hospitalisation in internal medicine unit was provided for 47% of type 2 diabetics and for 98% of type 1 diabetics. CONCLUSIONS: 1. The prevalence of diabetes registered in primary health care in Szczecin is higher than expected on the basis of European data. 2. Low number of type 2 diabetics is treated with diet alone and quite high number is treated with insulin. 3. Low number of chronic diabetic complications reported by GPs, despite long duration of disease, indicates the necessity of special training in delivering care for diabetic people, diagnosis of diabetic complications, increased access to secondary care and better cooperation between primary and secondary care.

[I/D polymorphism of angiotensin I converting enzyme gene and insulin resistance and some parameters of metabolic syndrome in patients with type 2 diabetes]. / Polimorfizm I/D genu enzymu konwertuj cego angiotensyne I a insulinoopornosc i niektóre elementy zespolu metabolicznego u chorych z cukrzyca typu 2.

Insulinresistance is a component of the metabolic syndrome and important pathogenetic factor of type 2 diabetes mellitus. There are evidences that activation of the renin-angiotensin system (RAS) can decrease insulin sensitivity of tissues. As I/D polymorphism of angiotensin converting enzyme (ACE) gene can influence the activity of RAS, it may also influence insulin resistance. Aim. To assess the relationship between the I/D polymorphism of ACE gene and degree of insulin resistance and intensity of metabolic syndrome in type 2 diabetic patients. Study group and methods. Examined group: 108 type 2 diabetic patients (38 women and 70 men), with mean duration of disease 9.07 +/- 6.68 years, mean age 59.98 +/- 9.10 years. Assessed parameters: body mass index (BMI), waist/hip ratio (WHR), arterial blood pressure. Laboratory tests: concentration of the glycosylated hemoglobin (HbA 1c), glucose, insulin, total cholesterol, HDL and LDL cholesterol, triglycerides, creatinine, uric acid. Insulin resistance was calculated by the HOMA rate. Criterion of insulin resistance was rate > or = 2.5. The diagnosis and assessment of intensity of metabolic syndrome was performed according to criteria of National Education Cholesterol Adult Treatment Program the Panel III. I/D ACE gene polymorphism was evaluated by polymerase chain reaction (PCR). Results. Groups with 11, ID and DD genotype were not different in age, BMI, WHR, duration of diabetes, the prevalence and duration of arterial hypertension, degree of metabolic control and insulinresistance assessed by HOMA rate and intensity of metabolic syndrome. DD genotype carriers had significant higher systolic and diastolic blood pressure (147.8 +/- 19.8 mmHg vs 138.2 +/- 16.5 mmHg, p = 0,02; 89.2 +/- 9.6 mmHg vs 81.7 +/- 8.6, p = 0,003, respectively) than II patients. Conclusion. In type 2 diabetic patients the I/D genotype of ACE gene is not associated with the increased insulin resistance assessed by HOMA rate and intensity of metabolic syndrome.

[Assessment of the quality of ambulatory care in type 2 diabetes mellitus]. / Ocena poziomu ambulatoryjnej opieki nad chorymi na cukrzyce typu 2.

INTRODUCTION: Long asymptomatic course of diabetes and insufficient treatment lead to many chronic complications. AIM OF STUDY: Assessment of the quality of ambulatory diabetes care in Szczecin and nearest region. MATERIAL AND METHODS: In year 2001 patients with previously diagnosed diabetes hospitalized in 35 wards of several hospitals in Szczecin were inquired for data concerning ambulatory care before hospitalization. STUDY GROUP: 120 subjects (60 women and 60 men), aged 65 +/- 13 years, diabetes duration 9.1 +/- 7.1 years. Type 2 diabetes--104 cases, type 1-10 cases, other types of diabetes--6 cases. RESULTS: Health care was provided by general practitioners (GPs) for 63% of patients, by diabetologist for 31% of them; 6% stayed out of control. In the proceeding month 49% of subjects attended visit related to diabetes; in 10% such a visit was reported in the period longer than 6 months. Glucose measurement performed every day was reported by 28% of subjects, once a month--by 36%, rarely--by 15%. Blood pressure measurements were performed by doctors in 43% of subjects, self control was performed by 42% of them and in 10% blood pressure was not measured at all. In the proceeding year eyes examination related to diabetes was performed in 63% of patients; in 26% such examination was never done. Foot examination was never done in 66% of diabetics. ECG examination was done in 57% of subjects last year, in 39% it was never done. Cholesterol serum level was measured last year in 52% of subjects. CONCLUSIONS: 1. Quality of ambulatory diabetes care is highly unsatisfactory and insufficient. 2. To improve health care for diabetics obligatory training in practical diabetology was conducted for all GPs from north-west region of Poland in 2002 y.