[Myocardial infarction in a 26-year-old patient with diabetes type 1]. / Zawal serca u 26-letniej kobiety z cukrzyca typu 1.

A case of a 26-year-old patient with acute myocardial infarction and hypertension, hyperlipidaemia as well as type 1 diabetes from 18 years complicated by background retinopathy and nephropathy in the state of proteinuria is described. State of metabolic compensation of the diabetes was poor. The patient did not perform regular self-monitoring of glycaemia, smoked, and used oral contraception. Early diagnosis of vascular lesions in young persons with long-lasting of type 1 diabetes as well as the introduction of proper preventive and treatment methods may improve prognosis in these high-risk patients.

[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.

[The role of matrix metalloproteinases in the development of vascular complications of diabetes mellitus--clinical implications]. / Znaczenie metaloproteinaz i ich inhibitorów w progresji naczyniowych powiklan cukrzycy--mozliwosci terapeutyczne.

Cardiovascular complications are the leading cause of increasing and premature mortality in diabetic patients. Matrix metalloproteinases (MMPs) play an important role in the development and progression of vascular lesions. Matrix metalloproteinases are members of endopeptidases and are capable of degrading many extracellular matrix components. Results of recent studies indicated that non-pharmacological and pharmacological treatment of diabetes influenced disturbed system of metalloproteinases and their inhibitors. Clinical trials are being performed in hope that the selective MMP inhibitors reduce the progression of pathological vascular remodeling in diabetes. Further basic and clinical research is required to confirm hypothesis.

[Quality of life in patients with diabetes]. / Jakosc zycia chorych na cukrzyce.

Quality of life (QoL) has been recognized as an important health outcome in treatment of chronic diseases. Quality of life is measured as perceived physical and social functioning, and mental wellbeing. Reviews of research findings indicate that QoL may be adversely affected by diabetes. Although assessing QoL is methodologically complex, valid and reliable tools are available and can be used with diabetes patients. Measurement of quality of life as part of a monitoring procedure should be routinely included in clinical practice and clinical research in the field of diabetes care.

[The role of inflammation in the pathogenesis of late diabetic complications]. / Rola zapalenia w patogenezie przewleklych powikán cukrzycy.

Chronic inflammation plays an important role in the development of diabetes and its late complications. Over nutrition, physical inactivity, stress, truncal obesity, dyslipidaemia, hypertension and smoking directly and indirectly activate the family of nuclear factor kappa B, the principal factor of inflammatory response. Hiperglycaemia and especially brittle diabetes affect not only metabolic abnormalities but also modulate cell and humoral immune response. There is good evidence that looking for novel risk factors for development and progression of late diabetic complications among inflammatory markers are needed. Progress in the study on etiopathogenesis of micro- and macro-angiopathy have clinical implications.

[Atherogenic dyslipidaemia in type 2 diabetes]. / Aterogenna dyslipidemia w cukrzycy typu 2.

This paper presents an opinion about disturbances of lipids characteristic of impaired metabolism induced by obesity and insulin resistance. In these conditions dyslipidaemia, especially with hyperglycaemia, plays a key role in the aetiopathogenesis of cardiovascular diseases. Atherogenic dyslipidaemia consists of a reduction in HDL cholesterol, elevations of triglycerides and apo B and arising of small and dense LDL and HDL particles modified by oxidation and glycation. The fundamental approach is weight reduction, increased physical activity and drug treatment leading to regression of these disturbances.

[Does the optimal diet for the prevention of cardiovascular disease exist?]. / Czy istnieje dieta optymalna w prewencji chorób ukladu sercowo-naczyniowego?

Cardiovascular disease (CVD) is still the leading cause of mortality in general as well as in diabetic population. The metabolic syndrome is a cluster of risk factors for CVD. The life style plays a crucial role in the primary and secondary prevention of them. Discussion about optimal diet has been holding for years. The low-fat diet is commonly recommended as an antiatherogenic diet. This article reviews the current literature on the influence of diet on ingredients of metabolic syndrome.

[Assessment of antineutrophil-cytoplasmic autoantibodies (ANCA) in type 1 diabetic patients]. / Ocena wystepowania przeciwcial przeciwko cytoplazmie granulocytów obojetnochlonnych (ANCA) u chorych na cukrzye typu 1.

Polymorphonuclear neutrophils and inflammatory process play a key role in the development of late diabetic vascular complications. Antineutrophil-cytoplasmic autoantibodies (ANCA) are considered important serological markers for vasculitis. The aim of study was the assessment of prevalence ANCA in type 1 diabetic patients and evaluation of the relationship between ANCA and diabetic microangiopathy. 94 type 1 diabetic subjects, 47 male and 47 female, aged 30.7 +/- 9.6 years, with mean duration of diabetes 9.5 +/- 6.8 years and HbA1c 7.9 +/- 1.3% were included to this study. ANCA were detected by the indirect immunofluorescence test and the specificity was evaluated by ELISA test. The significantly positive result of ANCA was noticed in 11 subjects (12%), anti-myeloperoxidase (anti-MPO) in 9 and anti-proteinase 3 (anti-Pr-3c) in 2 subjects. It was not observed any differences in sex, parameters of metabolic control, duration of diabetes, C-reactive protein levels and diabetic retinopathy and nephropathy between group with ANCA and without ANCA (p>0.05). Moreover, we did not notice relationship between ANCA and the risk of late diabetic complications (retinopathy: OR 1.64; 95% CI 0.46-5.82, p = 0.52 and nephropathy: OR 0.16; 95% CI 0.02-1.35, p = 0.10). The obtained results do not fully confirm hypothesis that ANCA are connected with the development of diabetic microangiopathy.

[Effect of pregnancy on diabetic vascular complications]. / Wplyw ciazy na przebieg cukrzycy typu 1.

OBJECTIVES: There are still controversies referring to pregnancy influence on the development of vascular complications in type 1 diabetes. MATERIALS AND METHODS: 227 diabetic women were taken into the study (109 who gave at least one birth (GB) and 118, who never were pregnant (NB)). All of patients started to be diabetic before the 15 years of age. We compared the development of vascular complications (VC) (hypertension-RR, proteinuria (P), retinopathy (R) and the age of patients, HbA1C, serum creatinine (Cr), creatinine clearance (CrCl) between the GB and NB groups. We also compared the development of VC in relation to risk factors (RF): HbA1c and duration of diabetes. RESULTS: Women who gave birth were significantly older and developed diabetes earlier than childless women. We didn't find any significant difference in duration of diabetes, HbA1c, mean blood pressure (BP), Cr and CrCl between these two groups. In the GB group in comparison to NB we noticed higher frequency of RR (11.1% vs 6.8%, OR 1.7), proliferative retinopathy (9% vs 6.8%, OR 1.4) and laser therapy (5.5% vs 3.4%, OR 1.6). In the next step we analyzed the development of VC in relation to risk factors: duration of diabetes (less or more than 20 years) and HbA1c levels (below and above 8.0%). Patients, who developed diabetes before 20 years of age were significantly older (36.3 vs 31.2 years p < 0.001), duration of diabetes in this group was longer (26 vs 14 years p < 0.001), Cr was higher (0.9 mg/dl vs 0.8 mg/dl p < 0.05)and CrCl was lower (73 mg/ml vs 86 mg/ml p < 0.05). In this group the frequency of proteinuria as well as retinopathy were higher (18.2% vs 7.9%, OR 2.59) (52% vs 9.2%, OR 10.6). We didn't find the difference in HbA1c concentration between the groups with different duration of diabetes. Higher HbA1c presented no relation to the age of patients, but correlated with lower frequency of patients without retinopathy (60.3% vs 66% OR 0.68). In this group laser therapy had to be performed more frequent (6.8% vs 1.8% OR 6.1). CONCLUSIONS: Pregnancy in diabetic patients with good metabolic control doesn't seem to be a risk factor for developing vascular complications. These complications are still strongly correlated with duration of diabetes.

[Is intensive functional insulin therapy the method of choice in newly diagnosed type-1 diabetes mellitus?]. / Czy intensywna czynnosciowa insulinoterapia jest metoda z wyboru u osób ze swiezo wykryta cukrzyca typu 1?

The aim of our study was a prospective evaluation of type 1 diabetic patients treated with intensive insulin therapy. We recruited 100 patients (62 males and 38 females) aged 24.3+/-6.2 years with newly diagnosed type 1 diabetes. The mean observation period was 5.2+/-1.5 years. Parameters of diabetes metabolic balance, occurrence of chronic complications and patients' knowledge about the disease and the methods of its treatment were evaluated. 68% of the patients controlled their glycaemia regularly before main meals and 53% of them had a diabetic diary. In the knowledge test 20% of the subjects reached < or = 11 points, 62% 11-17 points and 18% > 17 points (mean 14.4+/-3.2 points of maximal 20 to achieve). The mean result in the questionnaire of knowledge about the disease was 28.1+/-4.9 points. Fasting glycaemia was 7.2+/-3.4 mmol/l, 2h postprandial glycaemia 9.4+/-3.6 mmol/l, HbA1c 7.5+/-1.4%, the mean C-peptide level 0.9+/-0.4 ng/ml and the number of hypoglycaemic episodes was 6/individual/month. We observed a statistically significant correlation between the level of patients' knowledge and HbA1c (r=-0.31, p<0.05). Retinopathy and nephropathy were detected in 8 (9%) and 6 (6.8%) subjects respectively. The risk of microangiopathy was connected with low knowledge (RR: 5.67; 95% CI: 2.02-15.82, p<0.0002). The study confirms the crucial role of intensive insulin therapy and systematic patients' education concerning the disease in maintaining a good metabolic control and thus reducing the risk of diabetic vascular complications.