Diet-Related Knowledge and Physical Activity in a Large Cohort of Insulin-Treated Type 2 Diabetes Patients: PROGENS ARENA Study.

There is no doubt that behavioral intervention is crucial for type 2 diabetes mellitus (T2DM) prevention and management. We aimed to estimate dietary habits and diet-oriented knowledge as well as the level of physical activity in 2500 insulin-treated Polish type 2 diabetes mellitus (T2DM) patients (55.4% women). The mean age of the study participants was 64.9 ± 9.3 years, mean BMI was 31.4 kg/m2 ± 4.5, mean diabetes duration was 12.4 ± 6.9 years, and mean baseline HbA1c was 8.5% ± 1.2. At the study onset, all the patients completed a questionnaire concerning health-oriented behavior. Results showed a significant lack of diet-related knowledge. For example, only 37.5% recognized that buckwheat contains carbohydrates; the percentage of correct answers in questions about fruit drinks and pasta was 56.4% and 61.2%, respectively. As for the physical activity, only 57.4% of examined T2DM patients declared any form of deliberate physical activity. To conclude, the cohort of poorly controlled insulin-treated T2DM patients studied by us is characterized by insufficient diet-related knowledge and by a very low level of physical activity. Further studies on other populations of insulin-treated T2DM patients are required to confirm these findings.

The effect of melatonin on circadian blood pressure in patients with type 2 diabetes and essential hypertension.

INTRODUCTION: The aim of this study was to evaluate the effect of melatonin on blood pressure in patients with essential hypertension receiving medical treatment and with type 2 diabetes in good metabolic control. MATERIAL AND METHODS: The study lasted 8 weeks. Patients were equipped with a 24-hour ambulatory blood pressure monitor and took melatonin (3 mg a day in the evening) for 4 weeks. The patients were divided into four groups: group 1 (n = 32) including dippers, group 2 (n = 34) non-dippers treated with melatonin; and two control groups: group 3 (n = 28) including dippers and group 4 (n = 30) non-dippers treated without melatonin. After 4 weeks patients took melatonin for the next 4 weeks (5 mg a day). In each visit were analyzed: systolic, diastolic and mean blood pressure in both day and night time. RESULTS: We observed that 29.5% non-dippers (n = 10) treated with melatonin in a dose of 3 mg/day achieved features of dippers compared to control group (p < 0.05). Five mg of melatonin per day restored normal diurnal blood pressure rhythm in 32.4% non-dippers (n = 11, p < 0.05). In non-dippers treated with melatonin significant decreases of diastolic, systolic and mean night blood pressure values (p < 0.05) were observed. CONCLUSIONS: More than 30% of non-dippers with type 2 diabetes treated with melatonin were restored to the normal circadian rhythm of blood pressure. The effect of melatonin in both doses (3 mg and 5 mg) was significant for non-dippers only and included nocturnal systolic, diastolic and mean arterial pressure.

[Is prevalence of the "white coat effect" correlated with a high risk of late diabetic complications in type 2 diabetic patients?]. / Czy wystepowanie "efektu bialego fartucha" u chorych na cukrzyce typu 2 wiaze sie z wiekszym ryzykiem wystepowania póznych powiklan cukrzycy?

BACKGROUND: On the ground of existing hitherto reports it is suggested that the "white coat effect" is not correlated with a high risk of cardiovascular diseases. Conducted studies did not ascertain a correlation between the value of the "white coat effect" and late diabetic complications. The aim of this study was to evaluate the risk of late diabetic complications: polyneuropathy, retinopathy and nephropathy in type 2 diabetic, hypertensive patients, in which the "white coat effect" was detected. MATERIAL AND METHODS: The study comprised 67 type 2 diabetic, hypertensive patients. In all cases blood count, creatinine and urea serum concentration, urine examination, kidney ultrasonography were performed as well as neurological and ophtalmological examinations. Blood pressure values were measured with the use of mercurial sphygmomanometer during clinic visits. In all patients ambulatory blood pressure measurements (ABPM) were conducted. The "white coat effect" was detected when mean "systolic office blood pressure" values were > 10 mmHg higher than mean systolic blood pressure in ABPM-day and mean "diastolic office blood pressure" values were > 5 mmHg higher than mean diastolic blood pressure in ABPM-day. RESULTS: The patients were devided into two groups depending on the presence of the "white coat effect". Group 1 (n = 41) consisted of patients with the "white coat effect" and the second group (n = 26) without this phenomen. There were differences between the studied groups in systolic and diastolic blood pressure values estimated by traditional blood pressure measurement during clinic visits (p < 0.05). Systolic and diastolic blood pressure values estimated in ambulatory conditions with the use of ABPM were comparable in both groups (p > 0.05). The number of late diabetic complications in patients did not differ in both of the studied groups (p > 0.05). CONCLUSION: The "white coat effect" has not got an influence on polyneuropathy, retinopathy and nephropathy in type 2 diabetic patients with arterial hypertension.

[Fosfomycin, co-trimoxazole and nitrofurantoin in the treatment of recurrent uncomplicated urinary tract infections in type 2 diabetes mellitus]. / Fosfomycyna, ko-trymoksazol i nitrofurantoina w leczeniu nawracajacych niepowiklanych zapalen dolnych dróg moczowych u chorych na cukrzyce typu 2.

UNLABELLED: The aim of this study was to comprise the efficacy of chronic therapy with fosfomycin, co-trimoxazole and nitrofurantoin in the treatment and prevention of recurrent urinary tract infections (UTI) in type 2 diabetic women. MATERIALS AND METHODS: The study comprised 90 women aged 50-70 years, who suffered from the UTI (isolated bacterial uropathogen sensitive to fosfomycin, co-trimoxazole and nitrofurantoin). Women were divided into 3 groups. Group I comprised patients, who have been treated with fosfomycin, group II with co-tromixazole and group III with nitrofurantoin. Observation period lasted 9 months and for the 6 months patients were treated with antimicrobial agents. Efficacy of antimicrobial treatment was estimated when both clinical cure and bacteriological eradication of uropathogens were achieved. RESULTS: There were no significant differences in the percentage of patients between study groups, who achieved therapeutic successes after 3 and 6 months of the antimicrobial treatment (NS). Three months after discontinuation of treatment episodes of UTI were observed significantly rarely in group treated with fosfomycin in comparison with the group treated with nitrofurantoin (p = 0.01) and co-trimoxazole (p = 0.02). CONCLUSION: Fosfomycin, co-trimoxazole and nitrofurantoin are safe and effective antimicrobial methods to cure and prevent UTI. Fosfomycin is associated with rarely recurrence of UTI than nitrofurantoin and co-trimoxazole in the period without its taking.

"White coat hypertension" in type 2 diabetic patients.

INTRODUCTION: "White coat hypertension" is a phenomenon in which patients exhibit elevated blood pressure in clinical setting, but not recorded by themselves at home. OBJECTIVES: The aim of this study was to evaluate frequency of "white coat hypertension" in type 2 diabetic patients, in which high blood pressure values in clinical setting were observed for the first time. PATIENTS AND METHODS: The study comprised 52 type 2 diabetic patients with newly diagnosed high blood pressure values in measurements with the use of mercurial sphygmomanometer during ambulatory visit (mean "office blood pressure" values > or =140/90 mmHg). In all patients ambulatory blood pressure measurements (ABPM) were conducted. "White coat hypertension" was detected when the mean blood pressure value in ABPM during the day was <135/85 mmHg and the mean "office blood pressure" was > or =140/90 mmHg. Arterial hypertension was detected when the mean "office blood pressure" values were > or =140/90 mmHg and the mean blood pressure value in ABPM during the day were > or =135/85 mmHg. RESULTS: In forty-four percent of the studied patients "white coat hypertension" was diagnosed (group 1). Group 2 consisted of patients with arterial hypertension (56% of all studied patients). Blood pressure values estimated on the ambulatory basis with the use of ABPM were lower in group 1 than in group 2 (p <0.05). There were no differences between the study groups in blood pressure values estimated by traditional method with the use of mercurial sphygmomanometer during clinic visit (p >0.05). CONCLUSIONS: In above 2/5 of type 2 diabetic patients with newly detected high blood pressure during clinic visits, "white coat hypertension" was diagnosed.

[Effect of short-term intensive insulin therapy on daily insulin requirement in poorly controlled type 2 diabetes patients]. / Wplyw krótkotrwalej intensywnej insulinoterapii na dobowe zapotrzebowanie na insuline u chorych w okresie dekompensacji cukrzycy typu 2.

Prompt metabolic control improvement and daily insulin requirement assessment are indications for short-term intensive insulin therapy in type 2 diabetes, applied as multiple daily subcutaneous insulin injections (MDI), continuous subcutaneous (CSII) and intravenous insulin infusion (IVII). The study aimed at assessing the mean daily insulin dosage before beginning and after finishing three methods of short-term intensive insulin therapy, discontinued upon achievement of good glycemic control. 90 poorly controlled type 2 diabetes patients, hospitalized in Diabetology Department of Medical University in Lódz, treated with insulin twice daily were enrolled into the study (age 52.8 +/- 6.7 years, mean daily insulin dosage 0.76 +/- 0.28 U.I./kg. of body weight, daily blood glucose profile values 271 +/- 76 mg/dl). The patients were randomized into three groups: the first group treated with MDI, the second with IVII and the third with CSII. Insulin dosage increased significantly after MDI therapy comparing with prehospital values (0.72 U.I./ kg-->0.84 U.I./kg, p = 0.007). No change in daily insulin requirement was noted in CSII and IVII groups. We concluded that CSII and IVII comparing with MDI are more efficient methods of achieving prompt glucose control improvement and they do not lead to the increase in the insulin dosage.

[Fosfomycin in the treatment of recurrent tract infections in type 2 diabetic patients]. / Ocena skutecznosci fosfomycyny w leczeniu nawracajacych zakazen dróg moczowych u chorych na cukrzyce typu 2.

UNLABELLED: The aim of this study was to evaluate the efficacy of chronic therapy with fosfomycin trometamol (TF) in the treatment and prevention of recurrent, uncomplicated urinary tract infections (NIDDM) in type 2 diabetic women. INVESTIGATED GROUP: The study comprised 45 type 2 diabetes women aged 50-70 years. All patients enrolled into the study suffered from the NIDDM presented with clinical signs of uroinfection and positive urine culture with bacterial uropathogen sensitive to TF. Study period lasted 12 months and during the first 9 months patients were treated with TF. The patients remained under regular medical supervision in diabetic outpatient clinic every 3 months. Efficacy of treatment was proved when both clinical cure and uropathogen eradication were achieved in 3, 6, 9 or 12th month from the study beginning. RESULTS: The difference in efficiency of fosfomycin treatment after 3 months of the study duration in comparison with duration before study beginning was statistically different (p<0.001). The differences in efficiency of fosfomycin treatment after 6 months of study duration in comparison with time before 3 months were statistically different (p=0.03). There was not statistically differences in efficiency of fosfomycin treatment between the 6th and 9th month of study duration (NS). CONCLUSION: Fosfomycin is the safe and effective antimicrobial method to cure and prevent NIDDM.

[Efficacy of nitrofurantoin in the treatment of chronic urinary tract infections in patients with type 2 diabetes mellitus]. / Ocena skutecznosci nitrofurantoiny w leczeniu przewleklych zakazen dróg moczowych u chorych na cukrzyce typu 2.

THE AIM: of this study was to comprise the efficacy of chronic therapy with nitrofuarntoin in the treatment and prevention of recurrent urinary tract infections (NIM) in type 2 diabetic women. MATERIALS AND METHODS: The study comprised 105 women aged 50-70 years, who suffered from the NIM (isolated bacterial uropathogen sensitive to nitrofurantoin and cotrimoxazole). Women were divided into two groups. Group 1 (n=55) consisted of patients, who have been treated with nitrofurantoin and group 2 - control group (n=50) with cotromixazole. Observation period lasted 12 months and for the 9 months patients were treated with antimicrobial agents. Efficacy of antimicrobial treatment was estimated when both clinical cure and bacteriological eradication of uropathogens were achieved. RESULTS: There were no significant differences in the percentage of patients between study groups, who achieved therapeutic successes after three, six and nine months of the antimicrobial treatment (NS). Three months after discontinuation of this treatment episodes of NIM were observed in similar frequency in two study groups (NS). CONCLUSION: Nitrofurantoin is the effective antimicrobial method to cure and prevent NIM.

[Personal insulin pumps--from experiment research till recommended method of diabetes treatment]. / Osobiste pompy insulinowe--od eksperymentu badawczego do rekomendowanej metody leczenia cukrzycy.

Diabetes treatment with continuous insulin infusion with the use of personal insulin pumps secures strict metabolic control in diabetes--patients and can minimize a number of complications of diabetes. According to American Diabetes Association (2001), diabetes therapy with continuous insulin infusion is recommended for each person, who accept this therapy method. Personal insulin pump is well tolerated device, which enables to conduct a comfortable continuous insulin infusion. The patients, who comply with medical instruction and perform self-monitoring are fit for diabetes treatment with personal insulin pump. According to present recommendation, there is not necessary to hospitalize patients to initiate continuous insulin infusion. Treatment with personal insulin pump takes up in Poland only in wards of Diabetology and Diabetes outpatient clinics. The main indications of personal insulin pump use are: unstable course of diabetes despite of the another intensive insulin methods used before, often hypoglycemic episodes in anamnesis, active, changing patient's life-style. Little daily insulin requirement < 20 U.l./24 hours, pregnancy. The essential advantages in personal insulin pump use are: prompt metabolic control improvement, a considerable liberty in meal consumption (in its time and amount) and intensity of effort, decrease in number of hypoglycemia and exactly insulin dosage establishment.

[Usefulness of continuous glucose monitoring system in detection of hypoglycaemic episodes in patients with diabetes in course of chronic pancreatitis]. / Przydatnosc systemu ciaglego monitorowania glikemii w wykrywaniu niedocukrzen u chorych na cukrzycf powstala w przebiegu przewleklego zapalenia trzustki.

BACKGROUND: Recently introduced method of glucose monitoring--Continuous Glucose Monitoring System (CGMS, Medtronic MiniMed) now offers new possibilities of assessing metabolic control of diabetes as it records blood glucose values 288 times per day. CGMS is particularly helpful in pancreatogenic diabetes, which is associated with essentially poor metabolic control and higher number of hypoglycemic events. AIM: The study aimed at assessing number of hypoglycemic episodes, including symptom-free hypoglycemic episodes detected with CGMS and glucose meter (GM). TURESTIGALED GROUP AND METHODS: The study comprised 60 diabetic out-patients, treated with insulin in age mean 53.8 +/- 5.1 years, with chronic pancreatitis lasting mean 10.6 +/- 4.6 years and diabetes mellitus-- 4.9 +/- 2.4 years. Serum glucose concentration values were measured with the use of CGMS. Ten measurements of capillary blood glucose concentration with GM were performed daily during the period of CGMS use. Observation period of hypoglycemic episodes lasted 3 days. Hypoglycemic event was detected when glucose value decreased below 60 mg/dl. The number of hypoglycemic episodes, including symptom-free hypoglycemic episodes detected with CGMS and GM was compared. RESULTS: Number of hypoglycemic events detected with CGMS was five times higher than in GM measurements (p < 0.001). Episodes of symptom--free hypoglycemia were noted in CGMS six times higher than in GM measurements (p < 0.001). Hypoglycemia was found in twice as many patients when diagnosed upon CGMS results as when found upon GM results (p < 0.01). Episodes of symptom-free hypoglycemia were detected in six times as many patients when diagnosed upon CGMS as when analysed upon GM measurements (p < 0.001). CONCLUSION: CGMS offers more complete data on low blood glucose incidents, including symptom-free hypoglycemia, than intensive blood glucose monitoring with the use of glucose meter.

[Accuracy of blood glucose concentration values outcome performed at various skin sites with personal glucose meters]. / Wiarygodnosc wartosci stezen glukozy we krwi uzyskanych z róznych okolic ciala za pomoca indywidualnych mierników glikemii.

AIM: The aim of this study was the comparison of capillary blood glucose values performed at different skin sites with various glucose meters. PATIENTS AND METHODS: 50 type 2 - diabetic patients were enrolled into the study. At the first part of study - in stable glucose phase, measurements were performed with four various glucose meters at four skin sites: finger, forearm, abdomen, big toe. At the second part of the study all the subjects underwent one hyperglycemic challenge (after intravenous 40% glucose load) and hypoglycemic challenge (after intravenous 6 I.U.dose of short-acting human insulin). All of those capillary glucose values were compared between the venous blood and the interstitial glucose values. RESULTS: No significant differences in performed glucose values were observed between the four types of glucose meters (p>0.05). Only the glucose values at finger were similar to the venous and the interstitial glucose levels in stable glycaemic and rapid glucose change phase as well (p>0.05). CONCLUSION: 1. Glucose meters are precise and reliable tool for capillary glucose measurement. 2. Capillary glucose measurements can differ depend on various skin sites. 3. Capillary glucose measurements at finger are reliable and comparable with the suitable venous and the interstitial glucose levels.

[Effectiveness of selected methods of the short-term intensive insulin therapy in patients with poorly controlled type 2 diabetes mellitus]. / Porównanie skutecznosci róznych metod krótkotrwalej intensywnej insulinoterapii stosowanych u chorych hospitalizowanych z powodu dekompensacji cukrzycy typu 2.

Poorly controlled type 2 diabetes mellitus can be an indication for hospitalisation and short-term intensive insulin therapy. There are different forms of such therapy i.e. multiple daily injections (MDI), continuous subcutaneous insulin infusion (CSII) or continuous intravenous insulin infusion (IVII). The aim of our study was to compare the efficacy of these methods of intensive insulin therapy. The following parameters were measured: 1) time period needed for "near normoglycaemia" establishment and 2) mean daily glucose values reduction as a result of the treatment applied. 60 patients with poorly controlled type 2 diabetes (daily blood glucose profile values > 250 mg/dl) treated with insulin twice daily were enrolled into the study. Patients were randomly divided into three groups: CSII, IVII and MDI. CSII as realized through subcutaneous insulin pump model MiniMed 508, IVII through intravenous pump model Duet standard 50-Kwapisz and MDI was based on four insulin injections per day in bolus--basal fashion. Intensive insulin therapy was continued until satisfying daily glucose profile achievement (80-180 mg/dl). After "near normoglycaemia" attainment, a conventional insulin therapy was introduced through subcutaneous insulin dosage. Significant reduction of mean daily glucose values as result of applied treatment was observed in all the groups examined. The degree of glycaemia reduction amounted 60 mg/dl for CSII and 85 mg/dl for IVII. There was no statistical significant difference between treated groups. Mean duration of intensive insulin therapy until "near normoglycaemia" establishment was significantly longer in MDI as compared to CSII and IVII groups (6 days vs. 4.45 and 5.2 respectively). Short-term intensive insulin therapy by MDI, CSII and IVII gives good glycemic control and significantly reduces mean daily glucose values, but this aim can be achieved most quickly using CSII and IVII.