Quality of life after simultaneous pancreas-kidney transplantation.

Even recipients with satisfactory function of transplanted pancreas and kidney may show physical and/or social disability due to diabetic complications. Our aims were to evaluate diabetic complications influencing recipient quality of life and to assess patients' psychosociological status. Nineteen patients with functioning grafts who consented to take part in the study, underwent clinical evaluation and answered questions regarding their quality of life. Results showed excellent endocrine pancreatic function in 17 patients. In most recipients, insulin activity and C-peptide levels were elevated owing to systemic venous drainage. Opthalmological examination revealed blindness in 7 patients (in 4 cases with onset following SPKTx) and retinopathy in 13 patients (in 5 cases it appeared after SPKTx). Assessment of the cardiovascular system revealed satisfactory cardiac function in 16 of 19 patients; 4 patients underwent amputation of a lower limb following SPKTx. All 19 recipients admitted to a great benefit of transplantation; most patients declared ability to organize their life activity and social functions and 4 had regular employment. Conversely, most patients were afraid of graft loss, and half were often sad and even depressed.

Retrospective analysis of cardiovascular outcomes in patients with type 2 diabetes mellitus after the first acute myocardial infarction.

We retrospectively analyzed survival in patients with type 2 diabetes mellitus (DM) after first acute myocardial infarction (AMI). The study was conducted in 5 sites in Poland and involved 521 patients who survived more than 30 days after AMI. In the 5-year period after the acute event, we investigated the following cardiovascular (CV) outcomes: death (overall mortality), next MI, stroke, hospitalization due to acute coronary symptoms (HACS), and composite outcomes (whichever occurred first). We also assessed: age, smoking habit, obesity, hypertension, dyslipidemia and coronary artery disease (CAD) diagnosed before AMI, and gender. 269 patients (52%) suffered one of the outcomes from the composite CV endpoint. HACS was the first event in 164 cases, MI in 59, death in 32, and stroke in 14 patients. Analyzing the prevalence of individual CV events, we found: HACS in 184 patients (35%), next MI in 79 patients (15%), death in 59 patients (11%), and stroke in 30 patients (6%). Only dyslipidemia, arterial hypertension, and CAD were independent risk factors with an impact on composite CV endpoint. Other analyzed risk factors like smoking and obesity did not have independent effects on the CV risk. In the retrospective analysis, we found that HACS was the most frequent CV event in individuals with type 2 DM after AMI. The CV risk in type 2 diabetics who suffered at least one myocardial infarction was further increased in those with coexisting dyslipidemia, arterial hypertension or CAD. These findings support the current guidelines which recommend aggressive management of CV risk factors including hypertension, dyslipidemia and CAD before a first myocardial infarction.

How recombinant insulin analogs improve insulin therapy of diabetes mellitus: pathophysiology, clinical practice and recommendations.

According to the latest prognoses, 300 million people are expected to suffer from diabetes (particularly type 2) in 2025; diabetes will become a new epidemics of the coming century. Therefore it is so important to get acquainted with the pathomechanism of diabetes-related disorders and the possibilities of effective treatment. During the last decade, numerous prospective epidemiological studies have been completed, which have considerably extended our knowledge of the pathomechanism of disturbances and their effect on late complications of diabetes. Resistance to insulin has an important role in the etiology of type 2 diabetes. However, there is substantial evidence indicating that impairment or regression of rapid insulin secretion phase at the early stage of the disease is a factor of no lesser importance. The lack of appropriate insulin concentration after the stimulation by food ingestion (first 30 min after the meal), leads to permanent, treatment-resistant hyperglycemia. The postulated attempts to obtain a 'nearly normoglycemic' condition, as well as the results of prospective epidemiological studies proving that achieving this aim improves the prognosis of diabetic patients, prompt the researchers to search for the drugs or treatment schedules, which could effectively restore the impaired insulin secretion, and its early phase in particular, in type 2 diabetes. Human insulin analogs and their pre-formulated commercially available mixtures seem very promising in this respect.

[Influence of pre-conception pregnancy planning in women with diabetes mellitus I on the number of spontaneous abortions and major congenital malformations in their children]. / Wplyw planowania ciazy u kobiet z cukrzyca typu 1 na liczbe poronien naturalnych i duzych wad wrodzonych u noworodków.

OBJECTIVE: The study assesses the relationship between pre-conception pregnancy planning and number of spontaneous abortions and major congenital malformations in their children. MATERIALS AND METHODS: 138 pregnancies in women with type 1 diabetes without complications or only with simple retinopathy (White B, C, D) were analyzed. Women were treated in the Outpatient Family Planning Center in Warsaw between 1988 and 1998. Thirty women were planning the pregnancy prior to conception, 108 registered already when pregnant. The groups compared did not differ statistically in age, duration of diabetes or diabetic angiopathy. Mean values of HbA1C in consecutive trimesters were: 6.40%, 5.84%, 5.67% in the group of patients planning the pregnancy and 6.99%, 6.29%, 6.15% in the non-planning group. The differences were statistically significant (p < 0.05, p < 0.05, p < 0.01). RESULTS: In the pre-conception group there were no spontaneous abortions and no and major congenital malformations. Mean value of HbA1C in early pregnancy was significantly higher in women with spontaneous abortions than in the remaining women in the non-planning group (respectively 7.9% and 6.9%). Also, mean value of HbA1C in early pregnancy was significantly higher in women who gave birth to children with major congenital malformations than in women had healthy children (respectively 8.23% and 6.81%, p < 0.05). CONCLUSION: Pre-conception pregnancy planning improves metabolic control during pregnancy and decreases the rate of spontaneous abortions and major congenital malformations.

[Prospective studies of diabetic retinopathy in a cohort of patients with type II diabetes mellitus]. / Prospektywne badania retinopatii cukrzycowej w kohorcie chorych na cukrzyce typu II.

To gain current data about epidemiology of diabetic retinopathy in a population of type 2 diabetics a long-term prospective study was started. The study included 1334 patients with type 2 diabetes mellitus registered in Warsaw regional Diabetes Center. The prevalence of any form of diabetic retinopathy in this group was 31.4% and proliferative retinopathy-1.3%. It was found that the patients with retinopathy had diabetes mellitus of longer duration, higher fasting and postprandial levels of glycemia and higher daily proteinuria in comparison with diabetics without retinopathy. Apart from that, a frequency of ischemic heart disease and lower extremity ischemic disease was higher in diabetics with retinopathy. 109 new cases of retinopathy were diagnosed during 3-year follow-up. The study allowed us to determine the current epidemiological parameters concerning diabetic retinopathy in type 2 diabetics and a set of parameters characterizing people at highest risk of a development of retinopathy.

[Microcirculatory evaluation of the early diabetic foot syndrome using laser doppler]. / Badania mikrokrazenia w zespole wczesnej stopy cukrzycowej za pomoca dopplera laserowego.

UNLABELLED: Recognition of early microcirculatory disturbances in feet of diabetics may facilitate the pathogenic interpretation of the diabetic foot syndrome, selection of the patients at risk of developing clinical problems and serve as the base for designing the preventive measures. This could be particularly true in diabetics with peripheral neuropathy. Therefore the study aimed at the assessment of functional parameters of the foot microcirculation in IDDM patients presenting signs of peripheral neuropathy but without any symptoms of the diabetic foot syndrome was undertaken. For comparison 20 IDDM subjects with the signs of peripheral neuropathy and 10 IDDM subjects without this complication were studied both clinically and metabolically. All of them underwent the examination of microcirculation of the feet with the use of Laser Doppler Flowmeter. The parameters measured were: resting blood flow, post-occlusive, hyperemic response, flow change after heating to 44 degrees C and the flow on dependency. In IDDM subjects with peripheral neuropathy the following functional microcirculatory abnormalities were found: delay and decrease in post-occlusive, hyperemic response (4.5 +/- 1.8 s in neuropathic vs 0.5 +/- 2.4 s in non-neuropathic IDDM patients), decrease of the peak flow (36 +/- 7.0 PU in non neuropathic vs 18 +/- 5.0 PU in neuropathic IDDM patients) and also impairment of the response of the skin flow to focal heating peak flow at 44 degrees C (48 +/- 7.0 PU vs 12 +/- 3.0 PU in non neuropathic IDDM patients). Also the venoarteriolar reflex measured as the ratio of resting to standing flow in the feet skin was significantly decreased (80% in non-neuropathic versus 35% in neuropathic IDDM patients). CONCLUSION: Laser Doppler Flowmetry discovers the very early functional abnormalities in the microcirculation of the skin in the feet of IDDM with peripheral neuropathy, when none of the typical symptoms of the diabetic foot syndrome is present. It points to the significance of the relation between neuropathic and microcirculatory disturbances in the early pathogenesis of diabetic foot syndrome.