[Quality of treatment in children with type 1 diabetes based on the Polish Prospective Pump Programme]. / Jakosc leczenia dzieci z cukrzyca typu 1 w oparciu o ogolnopolski prospektywny program leczenia przy uzyciu pomp insulinowych.

BACKGROUND: In pediatric patients with type 1 diabetes mellitus, the value of HbA1c is a predictor of the risk of late systemic complications in adulthood. In the last years significant changes in the method of treatment in pre-pubertal children with T1DM have taken place. However, there is lack of precise data concerning the results of metabolic control of this group of patients. THE AIM: was to assess the impact of the Polish Prospective Insulin Pump Programme (OPPLP) on the quality of metabolic control in prepubertal children with T1DM. The OPPLP included also education for diabetological staff (HPC) from the Polish Diabetic Centres as well as standardization of continuous subcutaneous insulin infusion (CSII) implementation procedures. MATERIAL AND METHODS: Population studies were conducted in the years: 2005-2008. 920 patients were enrolled at age from 1.2 to 14.6 years (median 8.5 years). 71.75 % of patients were in pre-pubertal age. 734 patients received CSII therapy. The cross sectional, prospective study, conducted according to the protocol of the OPPLP with clinical data collection from 2005 to 2008. We analyzed the data obtained during 1657 visits and assessed 1657 blood samples for HbA1c value in the Central Laboratory. The clinical data were recorded in the electronic net-database. RESULTS: In whole group the median of HbA1c was 7.46 % (min. 5% - max. 12.1%); 60.1% patients has HbA1c below 7.5%. The quality of treatment was comparable among the centres: med. HbA1c ranged from min. 6.5% to max. 8.0%. During the period from 2005 to 2008 effective results were obtained in glycemic control: med. HbA1c: 2005 - 7.6%, 2006 - 7.2%, 2007 - 7.0% and 2008 - 7.5%. Slightly higher HbA1c was observed in children with longer duration of diabetes (r=0.17, p<0.005). CONCLUSIONS: The OPPLP, including HCP education, enabled optimalization of metabolic control in the prepubertal children switched pump therapy. Moreover, the programme brought about an even level of treatment between the Polish Diabetic Centres irrespective of their size. It is important to continue the programme and to develop a country level register of children with T1DM.

[Metabolic syndrome in young adults type 1 diabetic patients]. / Zespól metaboliczny u mlodych doroslych chorych na cukrzyce typu 1.

AIM: The aim of the study was to estimate the prevalence of metabolic syndrome (MS) in type 1 diabetic patients and to assess the relationship between the scores of MS components and body mass and metabolic control. MATERIAL AND METHODS: 165 patients aged 18-32 years with diabetes duration 8-26 years were included into the study. The height, weight, waist circumference and blood pressure were measured. HbA1c and plasma lipids concentrations were examined. Body mass index (BMI), waist/hip ratio (WHR) and daily dose of insulin were calculated. MS was diagnosed according to the definition of National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP) and International Diabetes Federation (IDF). RESULTS: The prevalence of individual components of MS was 10.3% for high triglycerides, 7.3% for low HDL, 27.9% for high blood pressure, and 10.3% for abnormal waist circumference according to NGEP and 18.8% according to IDF definition. After assuming that all type 1 diabetic patients fulfilled criteria for hyperglycemia, the prevalence of MS diagnosed according to NCEP was 10.9% (95% CI 6.1-15.7) and according to IDF was the same 10.9% (95% CI 6.1-15.7). In 14 patients MS was diagnosed according to both definitions, whereas 4 met only the NCEP, and another 4 met only the IDF criteria. Rrelationships between the scores of MS components and BMI (p < 0.0001) and HbA1c (p = 0.002) were found. Patients with MS were older than the patients without MS (p = 0.003) and needed higher insulin doses (p = 0.028). CONCLUSIONS: According to the NCEP and IDF criteria similar prevalence of MS is recognized in type 1 diabetic patients. Only in 2/3 of them MS is diagnosed according to both definitions. The most frequently occurring component of MS is elevated blood pressure. The scores of MS components are related to the presence of overweight and to poor metabolic control.

[Tissue-specific autoimmunity in patients with idiopathic diabetes]. / Analiza tkankowo swoistej odpowiedzi humoralnej u chorych z cukrzyca idiopatyczna typu 1.

INTRODUCTION: According to the WHO classification, type 1 diabetes is divided into type 1A - autoimmune and type 1B - idiopathic. The pathogenesis of the latter remains unknown. Clinical observations confirm that type 1 diabetes is often associated with the presence of other organ-specific autoantibodies. Besides, the idiopathic type 1 diabetes is suggested as resulted form immune-related beta cell destruction with the defect of humoral response. THE AIM: of the study was to verify the above-mentioned hypothesis by an evaluation of the prevalence of thyroid and coeliac antibodies in children with idiopathic diabetes. MATERIAL AND METHODS: The study groups consisted of 37 patients with idiopathic diabetes (group 1B) and 108 patients with autoimmune diabetes (1A). The examined groups were chosen from 569 children with newly diagnosed type 1 diabetes. Anti-islet antibodies (ICA) and antibodies to endomysium were detected by indirect immunofluorescence. Antibodies to tissue transglutaminase were measured by the immunoenzymatic method, whereas the measurement of autoantibodies to insulin, to tyrosine phosphatase and to glutamic acid decarboxylase was determined by radioimmunoassay. RESULTS: Thyroid antibodies were detected in 5.9% of the examined patients from group 1B and 14.7% from group 1A. The frequency of the presence of tissue transglutaminase autoantibodies in both groups was similar (9.4% in 1B and 8.3% in 1A) and in case of endomysial antibodies it was slightly higher in group 1B (9.4% vs 4.8%, p=0.39). CONCLUSION: Since the prevalence of tissue specific autoantibodies is similar in both presentations of type 1 diabetes it is unlikely that a humoral defect of immune response in idiopathic diabetes is observed in this group of patients.

[Insulin glargine improves fasting blood glucose levels in prepubertal children with unsatisfactorily controlled type 1 diabetes]. / Glargina obniza stezenie glukozy na czczo u dzieci z niezadowalajaco wyrównana metabolicznie cukrzyca typu 1.

UNLABELLED: The aim of this prospective cross-over study was to compare glycemic control on NPH insulin (NPH) and on glargine in unsatisfactorily controlled type 1 diabetic prepubertal children. MATERIAL AND METHODS: 14 patients, aged 6-12 years, on multiple insulin injections regimen were included. The study protocol: (i) a 6-month therapy with NPH as basal insulin and (ii) a 6-month therapy with glargine as basal insulin, in a random order. RESULTS: After 4 and 6 months mean blood glucose levels were similar on glargine and on NPH. After 6 months on NPH fasting blood glucose levels were similar to baseline (9.3+/-1.5 and 9.8+/-1.6 mmol/l respectively), while on glargine they were significantly lower compared to baseline (8.0+/-1.4 vs. 9.8+/-1.6 mmol/l, p=0.04) and markedly lower than after 6 months on NPH (8.0+/-1.4 vs. 9.3+/-1.5 mmol/l, p=0.077). HbA1c was lower on glargine compared to NPH, but only after 4 months the difference was statistically significant (7.1+/-0.16 vs. 7.74+/-0.25%, p=0.007). No severe hypoglycemia or ketoacidosis occurred. CONCLUSION: In preadolescent children with unsatisfactorily controlled type 1 diabetes glargine constitutes a useful and safe alternative to NPH, providing better early morning and good total glycemic control, not increasing the risk of severe hypoglycemia; taking it into account the health care systems should participate in its costs for those who can not afford or tolerate an insulin pump.

[Prehypertension risk factors in children and adolescents with type 1 diabetes]. / Czynniki ryzyka stanu przednadcisnieniowego u dzieci i mlodziezy chorej na cukrzyce typu 1.

AIM: Higher blood pressure is a marker of increased risk for development of diabetic angiopathy. The aim of the study was to evaluate the selected factors influencing the prevalence of prehypertension in T1DM children and adolescents. METHODOLOGY: 113 T1DM patients (62 male), aged 12-19 years, with diabetes duration from 0.5 to 17.3 years, without evidence of arterial hypertension during routine examination were recruited. In patients 24-hour automatic blood pressure (BP) monitoring was performed. Prehypertension was diagnosed SBP>120 mmHg and < 95pc and/or DBP>80 mmHg and < 95pc. Among metabolic factors body mass index (BMI), lipids profile, HbA1c and insulin sensitivity index glucose disposal rate (euglycemic hiperinsulinemic clamp) were estimated. As an early marker of autonomic neuropathy heart rate variation was measured. RESULTS: None of the study patients had hypertension. In 35 individuals (31%) prehypertension was diagnosed. The prehypertension group had older age (17.4 vs. 15.8 years, p<0.001), longer duration of disease (6.6 vs. 4.3 years, p=0.003), greater BMI (23.8 vs. 22.0 kg/m2, p=0.01) and lower insulin sensitivity index (5.9 vs. 7.0 mg/kg/min., p=0.04) as compared with the group with normal value of blood pressure. There were no differences between groups in lipids profile and HbA1c. In the patients with prehypertension the greater activity of sympathetic activation was observed (LF/HF--1. 0 vs. 0.82, p=0.02). CONCLUSIONS: Prehypertension is common feature in children and adolescents with type 1 diabetes. The prevalence of prehypertension is associated with older age, longer duration of disease, greater BMI, lower insulin sensitivity and the shift of the sympathovagal balance toward sympathetic activation.

[Prehypertension in type 1 diabetic children and adolescents]. / Stan przednadcisnieniowy u dzieci i mlodziezy chorej na cukrzyce typu 1.

BACKGROUND: The elevated blood pressure is one of the most important risk factors of diabetic micro- and macroangiopathy. AIM OF THE STUDY: Evaluation of the prevalence of prehypertension and relationship between prehypertension, metabolic control and chronic complications in children and adolescents with type 1 diabetes mellitus. MATERIALS AND METHODS: 83 patients aged 12.0-18.9 years, with a duration of diabetes 0.5-17.3 years, without evidence of arterial hypertension were recruited. In all patients 24-hour automatic blood pressure monitoring was performed with oscillometric device. The individuals with >40% of systolic and/or diastolic blood pressure >120/80 mmHg were defined as prehypertensive. HbA(1)c was measured by HPLC, plasma lipid levels--by an enzymatic method and urinary albumin excretion rate by chemiluminescent enzyme immunoassay method. Body mass index (BMI) and daily dose of insulin were calculated. Ophthalmoscopic examination and power spectral analysis of heart rate variation were performed. RESULTS: In 30 individuals (36.1%) prehypertension was diagnosed. The prehypertension group had older age (17.5+/-1.1 vs. 15.9+/-2.3 years; p<0.001) and longer duration of the disease (7.3+/-4.7 vs. 4.7+/-3.4 years; p=0.005) as compared with the group with normal blood pressure. There were no significant differences between groups in HbA1c, daily dose of insulin, BMI-SDS, lipids profile, prevalence of microalbuminuria and retinopathy. In the patients with prehypertension the a greater activity of sympathetic activation was observed (LF/HF: 1.00+/-0.06 vs. 0.78+/-0.04, p=0.018). CONCLUSIONS: Prehypertension is frequently recognized in type 1 diabetic children and adolescents. The prevalence of prehypertension is associated with older age, longer duration of diabetes and the shift of the sympatho-vagal balance toward sympathetic activation. There is no relationship between prehypertension and metabolic control or the prevalence of microvascular complications.

[Prevalence of thyroid antibodies (TPO and ATG) at the onset of type 1 diabetes mellitus in children treated in two diabetes centres in Lódz and Kielce]. / Wystepowanie przeciwcial przeciwtarczycowych (TPO i ATG) u dzieci ze swiezo rozpoznana cukrzyca typu 1 leczonych w dwóch osrodkach diabetologicznych: lódzkim i kieleckim. (Doniesienie wstepne.)

Patients with autoimmune type 1 diabetes mellitus have often, besides immune diabetes markers, also other organ-specific antibodies, particularly thyroid autoantibodies (antithyreoglobulin antibodies - ATG and/or thyroid peroxidase antibodies - TPO). In many of these patients autoimmune thyroid diseases, i.e. Hashimoto thyroiditis and Grave's disease, with silent clinical course can be diagnosed. The aim of this study was to evaluate the prevalence of TPO and ATG antibodies in children with newly diagnosed type 1 diabetes treated in two diabetes centres, in Lodz and in Kielce. Elevated ATG and/or TPO antibodies were found in 17,8% (15/84) of children: in 19,2% (11/57) in Lodz centre and in 14,8% (4/27) in Kielce centre. Children with elevated thyroid autoantibodies were significantly older than those without thyroid autoantibodies. Daily insulin requirement did not differ between both groups.