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IIntroduction Because dopaminergic signaling pathways are one of the regulators of autoimmunity, we hypothesize that the -521C>T DRD4 gene polymorphism may correlate with the risk of diabetes mellitus type 1 (DM1) and its comorbidities. Methods The connection of the -521C>T DRD4 gene polymorphism with the DM1 and its comorbidities as well as the levels of serum pro- and anti-inflammatory markers, lipid profiles and values of monocyte subsets was evaluated. Results The key results of our study are as follows: 1) CC genotype and C allele are associated with a reduced risk of DM1 development (OR = 0.593, p = 0.005 and OR = 0.725, p = 0.003; resp.) whereas TT genotype and T allele are associated with a higher risk of DM1 (OR = 1.408, p = 0.04 and OR = 1.380, p = 0.003; resp.); 2) CC genotype is associated with an increased risk of dyslipidemia and retinopathy in diabetic patients (OR = 2.376, p = 0.001 and OR = 2.111, p = 0.01; resp.); 3) CC genotype and C allele carriers had the highest frequency of pro-inflammatory CD16+ monocytes (p = 2*10-4 and 0.04 resp.); 4) the DRD4 -521C>T polymorphism modifies the inflammatory status as well as lipid profile in DM1 patients. Discussion/Conclusion Our data imply that the dopaminergic signaling pathways may play an important role in the etiology of DM1 as well as its comorbidities and will provide a new insight into the DM1 risk management. The -521C>T DRD4 gene polymorphism could be considered a genetic marker to predict susceptibility to DM1 as well as retinopathy and dyslipidemia progress in patients with already established disease.

The paper’s main research aim is to verify the assumption that the way the Spanish Constitution was amended in 2011 means a rupture with the over 40-year-old political principle of including all parties represented in the Cortes Generales in this process. It is also indicated what disruptions it might cause in the operation of the Spanish political system. The source material selected for analysis consists of Spanish official journals and press from 2011. The applied research methods are the legal-institutional analysis and the comparative approach.

Therapy for type 1 diabetes (T1DM) focuses on maintaining optimal blood glucose levels, achieved with intensive insulin treatment, proper nutrition, and physical activity. The aim of this study was to investigate postprandial glycemic changes under low (30%) and standard (50%) carbohydrate diets in adolescents with T1DM. A single-center cross-over nutritional study was conducted, during which 26 adolescent patients provided 220 continuous glucose-monitored (CGM) meals data from the two consecutive 3-day nutritional plans. Overall, the 50% carbohydrate diet was associated with higher postprandial glucose variability in the small meals (afternoon snacks, second breakfast) and greater postprandial peaks for other meals (breakfast, dinner, supper). Nevertheless, after the adjustment of a patient’s individual clinical variables (age, Tanner classification, glucose disposal rate), we observed that mean postprandial glucose was higher for afternoon snacks and lower for suppers in the 30% carbohydrate diet. Although a 30% carbohydrate diet seems to offer better postprandial glycemia, it requires additional attention from the physician and patient when it comes to modifying daily carbohydrate intake. Increased fat/protein content and size of the main meal lead to a prolonged postprandial glycemic response, which may affect the insulin treatment and result in suboptimal glycemic control.

Monotherapy with autologous expanded CD4We conducted a three-arms clinical trial to explore the efficacy and safety of the combined treatment with Tregs and rituximab in paediatric patients with T1DM. The patients were allocated to three groups: Tregs only (n = 13), Tregs + rituximab (n = 12) and control (n = 11). The key primary efficacy analyses were C-peptide levels (mixed meal tolerance test) and the proportion of patients in remission at 12 and 24 months.At month 24, as compared with the control, both treatment groups remained superior in the area under the curve of C-peptide mixed meal tolerance test, whereas in the analysis of all visits only the combined therapy improved area under the curve at 12 and 24 months. The proportion of patients in remission was significantly higher in the combined group than in the control group at 3, 6, 9 and 21 months but not at 18 and 24 months. There was no significant difference between the Tregs only group and control group. Adverse events occurred in 80% patients, mostly in the combined group and Tregs only group. No adverse events led to the withdrawal of the intervention or death. All comparisons were performed with alpha level of 5%.Over 2 years, combined therapy with Tregs and rituximab was consistently superior to monotherapy in delaying T1DM progression in terms of C-peptide levels and the maintenance of remission.

Abstract As the KL-VS haplotype alters secretion and activity of KLOTHO and uric acid (UA) is associated with endothelial dysfunction and inflammation, their mutual links may contribute to microalbuminuria (MA) in patients with type 1 diabetes (T1D). Therefore, we hypothesize that KL-VS polymorphism could be associated with the prevalence of MA in T1D patients, and KL-VS polymorphism could modify physiological functions and pathogenic potential of UA. We have examined 350 patients with T1D. The analysis concerned KL-VS polymorphism along with the concentrations of serum inflammatory markers, indicators of renal function, blood pressure, and lipid profile. The incidence of KL-VS genotype was lower in a group with MA in comparison to patients without this condition. Moreover, KL-VS carriers had improved indicators of renal function, lower concentrations of pro-inflammatory cytokines, and higher levels of anti-inflammatory markers. Simultaneously, among KL-VS carriers serum UA was negatively correlated with HbA1c, albumin excretion rate, ACR, CRP, TNF-α, total cholesterol, LDL-C and triglycerides, and positively correlated with HDL-C. Moreover, among wild-type KLOTHO carriers serum, UA was in positive correlation with creatinine, blood pressure, IL-12 and MCP-1, and in negative correlation with IL-10 and eGFR. Findings of our study suggest that the functional KL-VS polymorphism is independently associated with MA and the KL-VS genotype protects from the development of MA, and KL-VS polymorphism may modify physiological functions and pathogenic potential of UA by altering the levels of HbA1c, inflammatory biomarkers, indicators of renal function, blood pressure, and lipid profile. Key messages • We analyzed the KL-VS polymorphism and the UA serum level in patients with T1D. • The KL-VS polymorphism is independently associated with microalbuminuria. • The KL-VS alleles protect from the development of microalbuminuria. • KL-VS polymorphism may modify physiological functions and pathogenic potential of uric acid.

From year to year, we observe constantly growing revenue from the sale of supplements and functional food for athletes. The increased interest in their use raises many questions concerning the choice of products, portions, in addition in the case of athletes with type 1 diabetes - how they affect the level of glycaemia. In the group of people under 18 with diagnosed type 1 diabetes, the properly selected supplementation, which will not cause undesirable effects, is even more important. This publication aims to summarize the current reports on nutrients that come from: the present scientific knowledge, information on the labels, and information available on the websites of the most popular companies producing nutrients on the Polish market.Z roku na rok obserwuje się stale rosnące przychody ze sprzedaży suplementów i żywności funkcjonalnej dla sportowców. Rosnące zainteresowanie ich zastosowaniem rodzi wiele pytań dotyczących wyboru produktów, porcji, a także w przypadku sportowców z cukrzycą typu 1 – w jaki sposób wpływają one na poziom glikemii. W grupie osób poniżej 18. roku życia z rozpoznaną cukrzycą typu 1 odpowiednio dobrana suplementacja, która nie spowoduje niepożądanych skutków, jest jeszcze ważniejsza. Niniejsza publikacja ma na celu podsumowanie bieżących raportów na temat odżywek, które pochodzą z: aktualnej wiedzy naukowej, informacji na etykietach oraz informacji dostępnych na stronach internetowych najpopularniejszych firm produkujących odżywki na polskim rynku.

Childhood obesity is a complex problem that requires a multidimensional approach. The constantly increasing prevalence of childhood obesity should be of interest not only to pediatricians but also government bodies. Parental awareness of how excess body weight influences a child's health is one of the aspects that should be considered.Our main goal was to assess the awareness and opinions on possible adverse effects of excess body weight of parents of children attending several primary schools in the Pomeranian, Lubelskie and Świętokrzyskie Voivodships in Poland.The questionnaire-based survey was conducted in 2019 during parent-teacher meetings in public schools in the Pomeranian, Lubelskie and Świętokrzyskie Voivodeships Statistical analysis was then performed on the 277 received questionnaires using Statistica 13.3 software package and spreadsheet editor Microsoft Excel 2018.Inhabitants of urban areas perceived a stronger link between obesity and its influence on health. Similar results were observed in the group consisting of parents with higher education. Gender had no significant effect on the opinion concerning complications of obesity.Overall, most of the parents recognized the influence of obesity on health. The degree of awareness among respondents was the weakest in relation to the influence of obesity and diet on carcinogenesis.Otyłość u dzieci jest złożonym problemem, który wymaga wielowymiarowego podejścia. Stale rosnąca częstość występowania otyłości wśród dzieci powinna zainteresować nie tylko pediatrów, lecz także organy rządowe. Świadomość rodziców, w jaki sposób nadmierna masa ciała wpływa na zdrowie dziecka, jest jednym z aspektów, które należy wziąć pod uwagę.Naszym głównym celem była ocena świadomości i opinii na temat możliwych negatywnych skutków nadmiernej masy ciała rodziców dzieci uczęszczających do kilku szkół podstawowych w województwach pomorskim, lubelskim i świętokrzyskim w Polsce.Badanie ankietowe przeprowadzono w 2019 r. podczas zebrań z rodzicami w szkołach publicznych w województwach pomorskim, lubelskim i świętokrzyskim. Następnie przeprowadzono analizę statystyczną 277 otrzymanych kwestionariuszy przy użyciu pakietu oprogramowania Statistica 13.3 i edytora arkuszy kalkulacyjnych Microsoft Excel 2018.Mieszkańcy obszarów miejskich dostrzegli silniejszy związek między otyłością i jej wpływem na zdrowie. Podobne wyniki zaobserwowano w grupie rodziców z wyższym wykształceniem. Płeć nie miała istotnego wpływu na opinię dotyczącą powikłań otyłości.Większość rodziców dostrzegła wpływ otyłości na zdrowie. Poziom świadomości wśród respondentów był najsłabszy w odniesieniu do wpływu otyłości i diety na kancerogenezę.

Overweight and obesity rates in children and adolescents increase worldwide for over 30 years, what leads to an increased risk of de-veloping metabolic diseases.Protocol description and preliminary results of the largest to-date obesity management programme for children in Poland - "PoZdro!"The Programme is based on three main steps: screening, parental engagement and long-term behavioral intervention (medical, dietetic, psychological, physical activity intervention panels) and education activities in secondary schools. Over 30.000 children were screened in four big Polish cities and over 2.000 engaged in the programme.Preliminary results from the first city show that, since 2014, 3998 of the 6346 (63%) eligible students from 24 schools (first grade of the secondary school) were screened. 16% of the children were overweight (body mass index - BMI ≥ 85th95th centile) and 4.7% were obese (BMI ≥95th centile). 603 children fulfilling the qualification (QUA) criteria (BMI90th centile) were offered the Individual Integrated Care (IIC). 470 (77.94% of QUA) began and 253 (41.96% of QUA, 53.82% of IIC) finished the full interventional pro-gramme with the mean BMI centile decrease of 3.04 in two following years."PoZdro!" is a unique obesity prevention and management programme in Poland operating simultaneously in several Polish big cities. The programme incorporates parental engagement and long-term behavioral intervention. Preliminary results show that it may result in meaningful decrease in BMI in two following years. Further data analyses are necessary to show the influence of the programme on metabolic risk in studied group.Od ponad 30 lat obserwuje się rosnący trend otyłości wśród dzieci i młodzieży na całym świecie, co skutkuje zwiększeniem ryzyka rozwoju chorób metabolicznych.Opis protokołu oraz wstępne wyniki dotychczas największego programu profilaktyki oraz walki z otyłością u dzieci w Polsce „Po-Zdro!”.Program oparty jest na trzech filarach: skriningu, zaangażowaniu opiekunów podczas długotrwałej interwencji behawioralnej (panele lekarza, dietetyka, psychologa, specjalisty aktywności fizycznej) oraz zajęciach edukacyjnych w szkołach średnich. Program zapewnia skoordynowaną pomoc dla nastolatków z nadwagą lub otyłością oraz ich rodzin w 4 dużych polskich miastach. W skriningu uczestni-czyło ponad 30 000, a w Programie ponad 2000 dzieci.Wstępne wyniki z Gdyni pokazują, iż od 2014 r. przebadano 3998 spośród 6346 (63%) kwalifikujących się uczniów z 24 szkół (pierw-sza klasa szkoły średniej). U 16% dzieci stwierdzono nadwagę (wskaźnik masy ciała; body mass index – BMI ≥ 85. centyla95. cen-tyla) a u 4.7% otyłość (BMI ≥ 95. centyla). Dzieciom spełniającym kryteria włączenia do programu (603 dzieci z BMI90. centyla) zaproponowano udział w zintegrowanej opiece indywidualnej (ZOI). Z tego 470 (77,94% z zakwalifikowanych) rozpoczęło, a 253 (41,96% zakwalifikowanych, 53,82% z ZOI) ukończyło program interwencyjny ze średnim obniżeniem centyla BMI o 3,04 po 2 latach.„PoZdro!” jest jedynym programem zapobiegania oraz walki z otyłością w Polsce przeprowadzanym jednocześnie w kilku dużych mia-stach. Program łączy zaangażowanie opiekunów z długotrwałą interwencją behawioralną. Wyniki wstępne pokazują, że skoordynowana, wielodyscyplinarna interwencja może przyczynić się do znacznego zmniejszenia BMI na przestrzeni 2 lat. Dalsze analizy danych po-zwolą na ocenę wpływu programu na ryzyko rozwoju chorób metabolicznych w badanej grupie.

Children with severe central nervous system (CNS) impairment are at risk of developing various degrees of nutritional deficit that require long-term nutritional intervention. Interventions are most often implemented through enteral nutrition (EN) using commercially manufactured feeds administered via gastro/jejunostomy or nasogastric or nasojejunal tubes. The modality of feeding—continuous feeding or bolus feeding—is dependent on the function of the gastrointestinal tract, particularly the efficiency of gastric emptying. In the literature, the relationship between this type of nutrition and the occurrence of hyperglycaemia is often discussed. In addition, children with chronic neurological diseases are vulnerable to disorders of many mechanisms of neurohormonal counter-regulation related to carbohydrate management, and due to limited verbal and logical contact, it is difficult to recognise the symptoms of hypoglycaemia in such patients. We aimed to assess the carbohydrate metabolism in children with severe CNS impairment, with enteral nutrition delivered via nasogastric, nasoenteral, or percutaneous tubes, based on continuous glycaemic monitoring (CGM) and the measurement of glycated haemoglobin (HbA1c) levels. Materials and methods: This prospective, observational study included nineteen patients (median (25–75 pc) age: 12.75 (6.17–15.55) years) with permanent CNS damage (Gross Motor Function Classification System V) receiving long-term tube enteral feeding, recruited from two paediatric university nutritional treatment centres. Patients with acute conditions and diagnosed diabetes were excluded. The nutritional status and nutritional support were analysed in all the inpatients in accordance with a uniform protocol. Using the CGM system (Medtronic iPro2), glycaemic curves were analysed, and in addition, HbA1C levels were determined in fourteen patients. CGM results were analysed using GlyCulator2.0. Statistical analysis was performed using the Statistica version 11 software (StatSoft Inc. Tulsa, OK, USA). Results: More than half (11/19; 58%) of the patients were undernourished (BMI < 3 pc for age and gender), with the stature age being significantly lower than calendar age (5 (4.5–9) vs. 12.75 (6.17–15.55) years; p = 0.0010). The actual caloric intake was 50 (37.7–68.8) kcal/kg (median; 25–75 pc). In patients fed using the bolus method, the number of calories consumed per day was statistically significantly higher than in children subjected to a continuous feeding supply (56.00 (41.00–75.00) vs. 33.40 (26.70–50.00) kcal/kg BW (body weight; p = 0.0159). Decreases in blood glucose levels below the alarm level ( 140 mg/dL (TAR 140) recorded overnight in children with BMI ≥ 3 amounted to 1.6% vs. 0% in undernourished patients (TAR 140: 0.0 (0.00–1.6%) vs. 0% (0.00–0.0%; p = 0.0375); the percentage of glycaemic concentrations

Monogenic diabetes caused by mutation in the glucokinase gene (GCK-MD) is a rare disorder manifesting in childhood as mild, prevalent hyperglycemia. By consensus, it is managed by dietary supervision and infrequent consultations. However, its impact on the mental health of the affected children is largely unknown.To estimate the prevalence of psychiatric comorbidities in children with monogenic glucokinase-related diabetes (GCK-MD) and evaluate their association with quality of life (QoL).The study invited children with GCK-MD aged 5-18 years identified in the Central National Registry and treated in 3 pediatric diabetes centers in Poland. The control group comprised children with type 1 diabetes (T1D, the most common diabetes type in youth) matched for age and family history of diabetes. Participants underwent a semistructured clinical interview diagnostic for psychiatric comorbidities, questionnaires assessing behavioral problems, depressive symptoms, parental stress, and measuring general and diabetes-related QoL (PedsQl).We included 35 patients with GCK-MDMD and 199 with T1D. Eight (22.9%) GCK-MD patients were diagnosed with psychiatric disorder in their lifetime, compared with 16 (8.1%) in the T1D group (odds ratio 3.4 [95% confidence interval: 1.3-8.7]). Patients with GCK-MD showed better parent-reported general QoL (87.1 ± 11.9 vs 82.0 ± 14.0, P = 0.0060) and higher diabetes-related QoL in both parental (84.5 ± 13.8 vs 74.1 ± 15.2, P0.0001) and child's perspective (87.6 ± 10.9 vs 77.3 ± 13.9, P0.0001). Psychiatric disorders (+P) were associated with worse child-reported diabetes QoL (T1D+P 66.6 ± 16.7, T1D-P 78.2 ± 13.3, GCK-MD+P 79.6 ± 16.3, GCK-MD-P 90.1 ± 7.5, P = 0.0002).High prevalence of psychiatric disorders in children with GCK-MD and lower QoL emphasizes the need for psychologic surveillance in those otherwise mildly-treated patients.

Aim: The aim of the study was to investigate the relationship between the concentration of psychrophilic bacteria, mesophilic bacteria and mold fungi in bioaerosols, and the number of new cases of type 1 diabetes mellitus (T1DM) in children. Methods: Air samples from the Lubelskie and Pomeranian voivodeships in Poland were collected from January 2015 to December 2016 in winter, spring, summer and autumn. Thirty-three samples were collected in the Pomeranian and 27 in the Lubelskie voivodeship. The air samples were collected on the first day of each month at 1:00 pm for 10 mins at a height of 1.5 m above the ground. The number of mesophilic bacteria was detected after 24–48 hrs incubation at 37°C on tryptone soya agar (TSA; Merck, Darmstadt, Germany). The number of psychrophilic bacteria was detected after 72 hrs incubation at 22°C on TSA. The number of fungi was detected by a 5-day long incubation at 28°C on chloramphenicol yeast glucose agar. Results: In the Lubelskie voivodeship, the mean concentration of psychrophilic bacteria was significantly higher than in the Pomeranian voivodeship (2739 vs 608 CFU/m3, respectively), the mean concentration of mesophilic bacteria was significantly higher (2493 vs 778/m3, respectively) and the concentration of fungi was significantly higher (3840 vs 688 CFU/m3, respectively). We also showed a statistically significant relationship between the number of children with recently diagnosed T1DM and the mean concentration of psychrophilic and mesophilic bacteria in the Pomeranian and Lubelskie voivodeships (P

Background The impairment of endothelial function in type 1 diabetes mellitus (DM1) is considered as the basis of microvascular complications. In DM1 patients autoimmune thyroiditis is a frequent comorbidity which may be responsible for further deterioration of microcirculation function. In studies investigating the relationship between cardiovascular risk factors and microvascular function, skin microcirculation is widely used. The aim of our study was to evaluate the impact of coexisting autoimmune thyroiditis on skin microcirculation in children with type I diabetes mellitus. Subjects The study group consisted of 25 pediatric DM1 patients, 25 pediatric patients with type 1 diabetes and autoimmune thyroiditis (DM1 + AIT) and 29 control subjects matched for age and gender. The DM1 and DM1 + AIT patients were also matched for age at onset of DM and diabetes duration. Methods Performed capillaroscopy studies employed non-selective stimuli such as post-occlusive reactive hyperemia (PORH) and venous occlusion (VO) tests. The relative area covered by capillaries (coverage) and the distance between capillaries were assessed. These measurements were performed before tests as well as after PORH and VO. Results Coverage at baseline, after PORH and VO and distance after VO differ significantly between control subjects and the group DM1 + AIT. The coverage at baseline, after PORH and VO were significantly smaller in DM1 + AIT compared with the control group. Post-hoc analysis after controlling for lipids levels showed that differences between the DM1 + AIT and control group were remained only for coverage at baseline and after VO. Significant differences between DM1 + AIT and DM1 and control group for coverage after VO were also presented. Conclusions Coexisting autoimmune thyroiditis significantly deteriorates skin microcirculation function in pediatric non-complicated type 1 diabetic patients. This process is independent of patient age, diabetes duration and age of diabetes onset.

Alternatively activated macrophages (M2) exert anti-inflammatory effects and are crucial for keeping balance between protective and destructive cell-mediated immunity in healing phase of inflammation. Two members of the interferon regulatory factors family, IRF5 and IRF4, are known to promote M1 or M2 phenotype, respectively. Our study aimed to analyse the effectiveness of the M2 differentiation process in vitro (achieved by IL-4 stimulation) and its relationship to the stage of type 1 diabetes mellitus (DM1) in juvenile patients. To identify the basic changes in M2 phenotype, we examined the expression of the surface CD206, CD14, CD86 molecules, intracellular IRF4 and IRF5 transcription factors as well as IL-10 and TNFα intracellular production. Ten newly diagnosed (ND-DM1) and ten long-standing (LS-DM1) patients were enrolled into the study. The control group consisted of six children. We observed a significantly higher number of unpolarised CD206+CD14+ cells in the M2 cultures of DM1 subjects when compared to healthy ones. Examined cells presented common features with M1 macrophages (high levels of the CD14/CD86/IRF5 markers); however, they were weak TNFα producers in ND-DM1 patients. For the first time, we have revealed dysregulated IRF4/IRF5 axis in the analysed subpopulation derived from diabetic patients. Additionally, monocytes of ND-DM1 children were still able to differentiate into regulatory IL-10+ M2 macrophages, while this process was highly limited in LS-DM1 patients. Summarising, we suggest that the M2 polarisation process is less effective in DM1 patients than in healthy subjects and it may vary depending on the stage of disease. It can be concluded that in vitro differentiated M2 macrophages may be used in the future as inflammatory inhibitors for adoptive therapy experiments in ND-DM1 subjects.

The CD83 molecule is a known marker of dendritic cell differentiation process, and its soluble form (sCD83) exerts immunosuppressive functions. In our research, we examined whether the sCD83 plasma concentration is impaired in DM1 children and if the expected changes are in line with the disturbed process of monocyte’s transformation into mCD83+ monocyte-derived cells. 28 newly diagnosed (ND-DM1) and 30 long-standing (LS-DM1) patients were enrolled into our study. We revealed that the examined cells show a high mCD83 expression level in ND-DM1, which was significantly downregulated by the TNF-α stimulation. The results were in line with those from healthy controls. We also observed that monocyte differentiation process into CD83+ cells was much defective in LS-DM1 children and the mCD83 expression level seems not to be controlled by TNF-α. Moreover, the sCD83 level was significantly decreased in plasma from LS-DM1 children and it was negatively related to HbA1c levels, while no correlations were observed between TNF-α plasma concentration or disease duration. Summarizing, our results suggest that reduced sCD83 levels may correspond with a poor metabolic control in LS-DM1 patients and therapeutic administration of this molecule may indicate a new therapy approach in the chronic phase of diabetes.

In the currently available literature there are no works investigating the correlation between CCR5-Δ32 polymorphism and dyslipidemia in children with type 1 diabetes mellitus (T1D). Therefore, we have decided to explore the potential role played by this polymorphic locus in the incidence of dyslipidemia as an important risk factor for cardiovascular disease (CVD) in patients with T1D.A total of 380 patients with T1D were selected. Patients were divided into two groups: 180 patients with diabetic dyslipidemia and 200 controls without dyslipidemia. Characterization of CCR5-Δ32 genotypes was analyzed by polymerase chain reaction. Logistic regression model was used to examine the association between CCR5-Δ32 polymorphism and dyslipidemia.When participants were analyzed according to CCR5-Δ32 polymorphism, Δ32 carriers presented higher levels of: HbA1c (p 0.001), fasting plasma glucose (p 0.001), LDL (p = 0.02) as well as TG (p = 0.01) and lower levels of HDL (p = 0.01) than noncarriers. Moreover, the minor allele Δ32 was more frequent in dyslipidemic subjects than controls (p 0.001) and conferred an increased individual risk for dyslipidemia (OR = 2.327; 95% CI = 11.241-4.365; p = 0.009).The findings of our study suggest that the CCR5-Δ32 polymorphism is associated with elevated plasma lipid levels and the Δ32 allele increases the risk of dyslipidemia in patients with T1D. Identification of the functional variant underlying these associations may potentially lead to the development of a novel and adjunctive approach for the treatment of dyslipidemia and CVD.

Health care provision for patients with diabetes mel­litus is a considerable challenge to health policy due to the increasing number of its new cases, both in adults and in children. In Poland, hospital care for children with diabetes mellitus is centralized and most services are provided by university and provincial hospitals. In spite of the above the structure of the services provided varies widely from province to province, both in terms of the number of hospitalizations per 100,000 children, net migration rate, length of hospital the stay, and percentage of hospitalizations for acute complications. It is necessary to improve the societal and medi­cal awareness regarding the signs and symptoms of diabetes in order to reduce the number of acute complications, including those at the time of diagno­sis. Furthermore, it is crucial to make every effort to provide equal access to specialist diabetes care, thus to make it consistent with the standards. The high number and differences in the numbers, duration of hospitalizations of children with diabetes require further monitoring at a coordinated system of pediatric care.

Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease characterised by a destruction of pancreatic  cells, which leads to absolute insulin deficiency. Persistently high glycaemia causes vascular damage throughout the body. Microvascular complications com-prise the following: nephropathy, retinopathy, and neuropathy. Macrovascular complications include coronary heart disease (CHD), which may result in myocardial infarction, cerebrovascular disease (leading to strokes), and peripheral vascular disease. The pathogene-sis of vascular complications is multifactorial and is probably the combination of direct glucose-mediated endothelial damage, oxidative stress, production of sorbitol, and advanced glycation end-products. Precise understanding of these mechanisms could help clinicians to identify diabetic complications earlier and subsequently implement indispensable therapy on time. It is vital to determine biomarkers of microvascular and macrovascular complications in children affected with T1DM. Advanced glycation end-products and their receptors, adhesive molecules, pro- and anti-inflammatory cytokines, enzymes such as N-acetyl-β-D-glucosaminidase, and growth factors are the subject of ongoing studies. Numerous biomarkers of diabetic microangiopathy are already known and may constitute therapeutic targets in the future. Unfortunately, despite substantial progress in the understanding of the processes by which microvascular and macrovascu-lar complications develop, much effort still needs to be devoted to the matter, and further investigations are required.Cukrzyca typu 1 jest przewlekłą chorobą charakteryzującą się dysfunkcją komórek  wysp trzustki, co prowadzi do całkowitego braku wydzielania insuliny. Trwale podwyższona glikemia powoduje uszkodzenie naczyń w całym organizmie. Do powikłań mikronaczynio-wych cukrzycy należą: retinopatia, nefropatia i neuropatia. Do powikłań makroangiopatycznych można zaliczyć chorobę niedokrwienną serca prowadzącą do zawału mięśnia sercowego, chorobę naczyń mózgowych mogącą skutkować udarem i chorobę naczyń obwodo-wych. Patogeneza powikłań naczyniowych jest wieloczynnikowa i prawdopodobnie jest wynikiem bezpośredniego działania uszkadza-jącego glukozy na śródbłonek naczyniowy, stresu oksydacyjnego, produkcji sorbitolu i końcowych produktów glikacji. Dokładne zro-zumienie tych mechanizmów mogłoby pomóc klinicystom we wcześniejszym rozpoznawaniu powikłań cukrzycowych i następnie we wprowadzeniu wymaganej terapii w odpowiednim czasie. Określenie markerów cukrzycowych powikłań mikro- i makronaczyniowych u dzieci chorych na cukrzycę typu 1 jest niezwykle istotne. Produkty końcowej glikacji i ich receptory, cytokiny pro- i antyzapalne, en-zymy, takie jak N-acetyl-β-D-glukozaminidaza oraz czynniki wzrostu, są obiektem nieustannych badań. Liczne markery mikroangiopatii cukrzycowej są już poznane i w przyszłości mogą stanowić potencjalny cel terapeutyczny. Niestety, mimo znacznego postępu w zrozu-mieniu procesów, które prowadzą do powstawania powikłań mikro- i makronaczyniowych cukrzycy, wciąż dalsze badania są konieczne.

Overweight and obesity in children is becoming an increasingly common problem due to the increased access to processed food, overly high energy density diet, and limitation of physical activity in children. Such trends in today's society lead to health consequences that can be observed in the early stages of carbohydrate metabolism disorders. Reduction of body weight and changes in eating habits can prevent the onset of type 2 diabetes. Recently, the benefits of consuming products containing resistant starch, which has the main advantage of influencing the metabolic pathway of glucose, have been increasingly underlined. To date, no recommendations have been made for the daily intake of resistant starch or its content in individual products available on the food market. However, in the medical literature, there are an increasing number of reported cases of the beneficial effect of consuming resistant starch as a factor that supports glycaemic control in children with carbohydrate disorders. Unfortunately, the above topic requires further research in this direction, especially in the developmental age population, which will allow the formulation of precise conclusions regarding its use in the prevention of overweight, obesity, carbohydrate metabolism disorders, and the development of diabetes.Nadwaga i otyłość u dzieci staje się coraz częstszym problemem ze względu na zwiększony dostęp do przetworzonej żywności, zbyt dużą gęstość energetyczną diety oraz ograniczoną aktywność fizyczną u dzieci. Takie trendy dzisiejszego społeczeństwa prowadzą do występowania konsekwencji zdrowotnych, które na samym początku można zaobserwować w zaburzeniach gospodarki węglowodanowej. Redukcja masy ciała oraz zmiana nawyków żywieniowych mogą zapobiec wystąpieniu cukrzycy typu 2. Ostatnio coraz częściej podkreśla się korzyści ze spożywania produktów zawierających skrobię oporną, której główną zaletą jest wpływ na szlak metaboliczny glukozy. Do dnia dzisiejszego nie stworzono zaleceń dotyczących dziennego spożycia skrobi opornej ani nie uwzględniono jej zawartości w poszczególnych produktach dostępnych na rynku spożywczym. Mimo to w literaturze pojawia się coraz więcej doniesień o korzystnym wpływie spożywania skrobi opornej jako czynnika, który wspomaga kontrolę glikemii u dzieci z zaburzeniami gospodarki węglowodanowej. Niestety, powyższa tematyka wymaga dalszych badań w tym kierunku, szczególnie w populacji wieku rozwojowego, które pozwolą na sformułowanie precyzyjnych wniosków dotyczących jej stosowania w profilaktyce nadwagi, otyłości, zaburzeń gospodarki węglowodanowej i rozwoju cukrzycy.

Purpose Genetically predisposed individuals may develop several autoimmune diseases—autoimmune polyendocrine syndromes (APS). APS types 2–4, are complex disorders, which combine various organ-specific autoimmune conditions. Recent reports support the considerable role of the BACH2 gene in immune cell differentiation and shifting the T-cell balance towards regulatory T-cells. BACH2 polymorphisms are associated with autoimmune disorders, including Addison’s disease (AD), Graves’ disease (GD), and probably type 1 diabetes (T1D). Our study was aimed to investigate the BACH2 variant, rs3757247, in endocrine autoimmunity in the Polish population. Methods The analysis comprised 346 individuals with APS, 387 with T1D only, and 568 controls. Genotyping was performed using TaqMan chemistry. Results APS type 2 was found in 219 individuals, type 3 in 102, and type 4 in 25 subjects. Overall, AD was diagnosed in 244 subjects, Hashimoto’s thyroiditis—in 238, T1D—in 127, GD—in 58, vitiligo and chronic gastritis each in 40 patients, celiac disease—in 28, premature menopause in 18, and alopecia in 4 patients. Minor T allele at rs3757247 was found in 56.4% APS vs. 44.1% control alleles (OR 1.59; 95%CI: 1.30–1.95, p p p-values > 0.05). Conclusions These results provide evidence of the association between BACH2 polymorphism and polyglandular autoimmunity. Since carriers of rs3757247 display increased risk for additional autoimmune conditions, this variant could identify individuals prone to develop APS.

Autoimmune thyroiditis (AIT) frequently coexists with type 1 diabetes (DM1) and additionally increases the extent of microcirculatory complications due to DM1. We hypothesized that in pediatric patients with DM1, impairment of macrocirculation could be further augmented by a coexisting autoimmune process. Therefore, we investigated the influence of AIT on large arteries in DM1 pediatric patients. Our group consisted of 19 DM1, 19 DM1 + AIT patients and 29 control subjects. The groups were comparable regarding age and gender. The DM1 and DM1 + AIT patients were matched for age at onset of DM1 and diabetes duration. Macrocirculation was described using pulsatility indices (PIs) determined for common carotid (CCA) and peripheral arteries of upper and lower limbs. CCA resistance index (RI) and ABI were also assessed. Children with DM1 + AIT had only significantly lower CCA_PI and CCA_RI in comparison with controls whereas in the absence of AIT such difference was not found. The diabetes duration and age of onset did not correlate with carotid indices. Total cholesterol level was higher both in DM1 + AIT and DM1 groups than in the control group. For low density lipoproteins cholesterol, a significant difference was found between DM1 + AIT and control groups. Age‐independent impact of AIT on CCA_PI was confirmed by multivariate analysis. Common carotid pulsatility is deteriorated by autoimmune thyroiditis independently of age in children with type 1 diabetes mellitus., Autoimmune thyroiditis frequently coexist with type 1 diabetes and additionally increases the extent of microcirculatory complications due to type 1 diabetes mellitus, but its impact on large arteries has been rarely studied. We investigated the influence of autoimmune thyroiditis on large arteries in type 1 diabetes mellitus pediatric patients. It was concluded that common carotid pulsatility is deteriorated by autoimmune thyroiditis independently of age in children with type 1 diabetes mellitus.

Skin microcirculation is recognized as an appropriate model to use when investigating the relationship between cardiovascular risk factors and microvascular function. It is currently a matter of debate whether studies on skin microcirculation in young type 1 diabetic patients without existing microangiopathy may be helpful in identifying subjects with impaired endothelial function.To evaluate the potential changes in skin microcirculation of patients up age of 18 years using capillaroscopy, post reactive hyperaemia (PORH) and venous occlusion (VO) tests, and to establish the relationship between those changes and disease duration and metabolic control in patients with type 1 diabetes.Study group consisted of 112 pediatric patients aged 8.4-18.0 years, with a median age of 14.95 years. The median diabetes duration and age at onset were 5 years and 9.6 years, respectively. The median HbA1c in the studied group was 7.6% at the time when the microcirculation was being examined. Capillaroscopy studies were focused on type 1 diabetic patients and employed non-selective stimuli such as the PORH and VO tests. The relative area covered by capillaries (coverage) was measured before the testing and again after the PORH and VO tests.The analysis revealed that none of the skin microcirculation indices correlated significantly with patient age, diabetes duration or metabolic control.In young patients with uncomplicated type 1 diabetes mellitus skin microcirculation function is not dependent on age, disease duration or metabolic control.Mikrokrążenie skóry jest uznawane za odpowiedni model do badania zależności między czynnikami ryzyka sercowo-naczyniowego a czynnością mikrokrążenia. Trwa dyskusja, czy badania mikrokrążenia skórnego u młodych pacjentów z cukrzycą typu 1 bez mikroangiopatii mogą być odpowiednie w identyfikacji osób z upośledzoną funkcją śródbłonka.Ocena potencjalnych zmian mikrokrążenia skórnego pacjentów w wieku poniżej 18 lat za pomocą kapilaroskopii, testu przekrwienia czynnego (PORH) i okluzji żylnej (VO) oraz ustalenie związku między tymi zmianami a czasem trwania choroby i kontrolą metaboliczną u pacjentów z cukrzycą typu 1.Grupę badaną stanowiło 112 pacjentów pediatrycznych w wieku 8,4–18,0 lat, z medianą 14,95 roku. Mediana czasu trwania cukrzycy wynosiła 5 lat, a wieku wystąpienia choroby 9,6 roku. Mediana HbA1c w grupie badanej w czasie badania mikrokrążenia skórnego wynosiła 7,6%. Wykonano badania kapilaroskopowe łącznie z zastosowaniem bodźców nieselektywnych, takich jak testy PORH i VO. Względny obszar pokryty kapilarami (pokrycie) mierzono przed badaniem, po testach PORH i VO.Analiza wykazała, że żaden z parametrów charakteryzujących mikrokrążenie skórne nie korelował istotnie z wiekiem pacjentów, czasem trwania cukrzycy i kontrolą metaboliczną.U młodych niepowikłanych pacjentów z cukrzycą typu 1 funkcja mikrokrążenia skórnego nie zależy od wieku, czasu trwania choroby i kontroli metabolicznej.

Background While in the general paediatric population the presence of abnormal lipid values is estimated at 8–20%, depending on the population, accepted norms and age, it was shown that in the population of lean children the prevalence of dyslipidemia is lower than in obese children, in whom it ranges from 20 to over 40%. Until now, however, no results of similar studies on a large sample of children form a Central or Eastern European country have been published. The aim of this study was to evaluate the prevalence of lipid disorders in overweight and obese children and adolescents participating in an integrated weight reduction programme. Methods According to the “6-10-14 for Health” programme implementation schedule, the programme accepted patients living in Gdańsk, aged 6, 9–11 and 14 years old, with BMI above the 85th percentile for age and sex, according to the Polish percentile charts. During the first visit, each of the participants underwent basic anthropometric examinations - body weight, body height, waist and hip circumference, blood pressure and body composition by bioelectrical impedance were measured. Blood samples were taken to assess lipid, glucose and insulin levels as well as alanine transaminase (ALT) and thyroid stimulating hormone (TSH) activity. Results 1948 patients underwent full anthropomethric and blood work measurements. At least one of the lipid disorders occurred in 38.23% of girls and 40.51% of boys with overweight and obesity. The most common lipid disorderswere decreased high-density lipoprotein cholesterol (HDL-C) levels (present in 20.55% of the girls and 23.79% of the boys) and elevated low-density lipoprotein cholesterol (LDL-C) (present in 15.31% of the girls and 14.25% of the boys). There was no strong association between lipid disorders and age, sex, birth weight, gestational age at birth or body composition. Conclusions Such a frequent occurrence of lipid disorders in the population of children and adolescents should be an important warning signal both at the individual and population level. Not only effective screening methods for overweight and obese children should be implemented from an early age but also therapeutic measures are required. Trial registration The trial is registered under the Local Ethics Committee at Medical University of Gdańsk, decision No. NKBBN/228/2012 from 25 June 2012.

Adolescent obesity persists as a major concern, especially in Central and Eastern Europe, yet evidence gaps exist regarding the pivotal early adolescent years. Our objective was to provide a comprehensive picture using a holistic approach of measured anthropometry in early adolescence, including body composition, cardiorespiratory fitness (CRF), and reported lifestyle characteristics. We aimed to elucidate potential sex/gender differences throughout and associations to biomarkers of disease risk for obese adolescents. Methods: Trained nurses measured 19,634 early adolescents (12–14-year-olds), we collected parental reports, and, for obese adolescents, fasting blood samples in four major Polish cities using a cross-sectional developmental design. Results: 24.7% boys and 18.6% girls were overweight/obese, and 2886 had BMI ≥ 90th percentile. With increasing age, there was greater risk of obesity among boys (p for trend = 0.001) and a decreasing risk of thinness for girls (p for trend = 0.01). Contrary to debate, we found BMI (continuous) was a useful indicator of measured fat mass (FM). There were 38.6% with CRF in the range of poor/very poor and was accounted for primarily by FM in boys, rather than BMI, and systolic blood pressure in girls. Boys, in comparison to girls, engaged more in sports (t = 127.26, p < 0.0001) and consumed more fast food (t = 188.57, p < 0.0001) and sugar-sweetened beverages (167.46, p < 0.0001). Uric acid, a potential marker for prediabetes, was strongly related to BMI in the obese subsample for both boys and girls. Obese girls showed signs of undernutrition. Conclusion: these findings show that overweight/obesity is by far a larger public health problem than thinness in early adolescence and is characterized differentially by sex/gender. Moreover, poor CRF in this age, which may contribute to life course obesity and disease, highlights the need for integrated and personalized intervention strategies taking sex/gender into account.

Aim: Estimation of the ocular status in adolescents with diabetes mellitus type 1 (DM1) treated with continuous subcutaneous insulin infusion (CSII), assessment of the development of the diabetic retinopathy (DR) and nephropathy (DN) within 10 years. Methods: 37 patients (74 eyes) aged 16-33 years, treated with CSII were enrolled to the study. Baseline, and a 10- year follow-up evaluation included: best corrected visual acuity (BCVA), tonometry, slit lamp exam and fluorescein angiography (FLA). Additionally, spectral-domain optical coherence tomography (SD-OCT) was done in the 7th year of observation to assess the thickness of the retinal nerve fiber (RNFL) and the ganglion cellinner plexiform layers (GCL-IPL) complex thickness. Glycated haemoglobin (HbA1) and albuminuria were also analysed. Results: During the 10-year observation period DR (non-proliferative - NPDR, proliferative - PDR, diabetic macular edema - DME) was diagnosed in 3 (8%) patients. In the DR group: BCVA was significantly lower, intraocular pressure (IOP) levels and albuminuria were higher. There were no differences in HbA1 in both groups. The thinning of RNFL was observed in both groups. Macular RNFL, GCL-IPL complex thickness assessment showed a significantly higher number of borderline results in the group with DR. Conclusions: Diabetic patients treated with CSII are at a lower risk of developing vascular complications even with poor metabolic control. Increased albuminuria may be a predictive sign for early ocular complications, and requires intense observation. Diagnosis of RNFL and GCL-IPL decreased values is crucial prior to diabetic retinopathy development. SD-OCT is a non-invasive, easy-to-perform, relatively inexpensive procedure, and can be a useful tool to monitor neuropathy progression.

One of the principal aspects of comprehensive medical care for patients with diabetes mellitus, especially paediatric patients, is the accessibility to personal insulin pumps. In Poland, the National Health Fund secures personal insulin pumps for children by means of a separately commissioned service. The structure of the provided services varies greatly from province to province in terms of accessibility to insulin pumps.

Presented recommendations are an extended and actualized version of paediatric recommendations of Polish Society of Hypertension published in 2015. Since then, new studies have appeared on this subject, introducing a new classification of hypertension, newly described principles of management in risk groups and methods of assessing hypertensive target organ damage. The presented updated recommendations included changes introduced in the 2016 European Society of Hypertension recommendation and Recommendations of Children’s Memorial Health Institute in Warsaw. Recently published guidelines of American Academy of Paediatrics have been discussed. In the presented issue of guidelines, epidemiological information on the occurrence and incidence of hypertension in developmental age was added and classification of blood pressure values was updated. Subchapters on diagnosis and organ damage assessment, principles of diagnosis and treatment of hypertension in children with diabetes, chronic kidney disease and a subsection discussing diagnostic and therapeutic difficulties with setting blood pressure targets were revised. In addition, the principles of early diagnosis of arterial hypertension in post-hospital care in children born before 33 weeks of gestation published in 2018 as recommendations of the Polish Neonatal Society have been also taken into account.

Background and aims KLOTHO is an anti-ageing circulating hormone involved in insulin signaling, inflammation and vascular homeostasis through its protective effects on the endothelium and antioxidant actions. The common functional “KL-VS” variant of the KLOTHO gene is reproducibly associated with longevity in humans. Large number of studies have evaluated close relationship between KLOTHO protein and diabetes but the association between KL-VS variant and retinopathy in type 1 diabetes mellitus (T1D) is unknown. Therefore, in the present study we examined the association between the KL-VS polymorphism and the risk of diabetic retinopathy (DR) in patients with T1D. Methods We examined 400 patients with T1D and 350 healthy age-matched controls. The analysis concerned KL-VS polymorphism along with the levels of serum inflammatory (CRP, TNF-α) and anti-inflammatory (IL-10) markers, pro-angiogenic (angiogenin) and anti-angiogenic interferon gamma-induced protein 10 (IP-10) factors as well as adhesion molecules (ICAM-1, ICAM-3). Results We did not find significant association between T1D and KL-VS alleles. However, we observed that the incidence of KL-VS genotype is lower in a group with retinopathy in comparison to diabetic patients without this complication. Moreover, we established that KL-VS carriers had the lowest levels of inflammatory markers, pro-angiogenic factors and adhesion molecules. Simultaneously, the KL-VS carriers had increased serum levels of anti-inflammatory and anti-angiogenic cytokines than holders bearing wild type genotype. Conclusions In conclusion, the findings of our studies suggest that the functional KL-VS variant of the KLOTHO gene protects against the development of retinopathy in patients with T1D.

Gestational diabetes is one of the most common medical disorders and may cause numerous of maternal and foetal complications, such as: preterm births, congenital defects, hypertrophic cardiomyopathy, metabolic changes, and macrosomia in neonates. One of the types of diabetes that may clinically manifest in pregnancy is GCK-MODY, caused by mutations in the glucokinase (GCK) gene.The aim of the study was to assess the impact of diabetes during pregnancy in women with GCK-MODY on their children's health outcome and to determine the clinical and biochemical characteristics of children delivered by patients with GCK-MODY.Study was multicentre, involving 50 children from paediatric diabetology departments in Gdansk, Katowice, Bialystok, and Lodz. The risk of GCK-MODY was evaluated on the basis of the medical history of the patient, the clinical course of the disease, and laboratory tests performed during diagnostic procedures. Data concerning family history, mothers' health status, course of pregnancy, and perinatal period was collected.The study showed that among children with glucokinase mutation, born by mothers affected with GCK-MODY, 62% received 10 points in Apgar score in the first minute of life, whereas 92% (n = 46) obtained 10 points in Apgar score in the fifth minute of life. The average age of diagnosis of GCK-MODY in children was 8.25 ±4.76 years, and the average HbA1c during diagnosis was 6.43 ±0.71%. Statis-tically significant difference between the absence of macrosomia (birth weight91st percentile) in children with GCK-MODY diabetes in comparison to the general paediatric population (p = 0.0229) was observed.According to the presented study, possible consequences of GCK-MODY during pregnancy on foetal development are generally less severe and may differ from those characteristic for other types of diabetes. Children born by mothers with diabetes should be followed up regarding glucose disorders. Further investigation of particular phenotypes of GCK-MODY, depending on the type of inherited mu-tation in mothers and their children, is required.Cukrzyca ciążowa stanowi jeden z najczęstszych problemów zdrowotnych w trakcie ciąży i może prowadzić do wielu powikłań, takich jak: poród przedwczesny, wady wrodzone, kardiomiopatia przerostowa, zmiany metaboliczne i makrosomia u noworodka. Jednym z rodzajów cukrzycy, który może objawiać się klinicznie w ciąży, jest GCK-MODY, wywołana mutacjami w genie glukokinazą (GCK).Ocena wpływu cukrzycy w czasie ciąży u kobiet dotkniętych GCK-MODY na wyniki zdrowotne ich dzieci oraz ustalenie klinicznych i biochemicznych cech dzieci urodzonych przez pacjentki z GCK-MODY.Badanie było wieloośrodkowe, do badania włączono 50 dzieci z oddziałów diabetologii dziecięcej w Gdańsku, Katowicach, Białymsto-ku i Łodzi. Ryzyko wystąpienia GCK-MODY oceniano na podstawie wywiadu medycznego pacjenta, przebiegu klinicznego choroby oraz badań laboratoryjnych. Zebrano dane dotyczące wywiadu rodzinnego, stanu zdrowia matek, przebiegu ciąży i okresu okołoporo-dowego.Badanie wykazało, że wśród dzieci z mutacją glukokinazy, urodzonych przez matki dotknięte GCK-MODY, 62% otrzymało 10 punktów w skali Apgar w pierwszej minucie życia, natomiast 92% (n = 46) uzyskało 10 punktów w skali Apgar w piątej minucie życia. Średni wiek rozpoznania GCK-MODY u dzieci wynosił 8,25 ±4,76 roku, a średni poziom hemoglobiny glikowanej (HbA1c) podczas diagno-zy 6,43 ±0,71%. Zaobserwowano statystycznie istotną różnicę między brakiem makrosomii (masa urodzeniowa91. percentyla) u dzieci z cukrzycą GCK-MODY w porównaniu z ogólną populacją pediatryczną (p = 0,0229).Według przedstawionych badań, możliwe konsekwencje GCK-MODY podczas ciąży na rozwój płodu są mniej poważne i mogą różnić się od charakterystycznych dla innych typów cukrzycy. Dzieci urodzone przez matki chore na cukrzycę powinny być monitorowane w odniesieniu do zaburzeń glukozy. Konieczne są dalsze badania poszczególnych fenotypów GCK-MODY, w zależności od rodzaju odziedziczonej mutacji u matek i ich dzieci.

Hypoglycaemia unawareness, defined at the onset of neuroglycopenia before the appearance of autonomic warning symptoms, is an serious problem in type 1 diabetes mellitus. It is often caused by recurrent or severe hypoglycaemia, which leads to the failure of the autonomic nervous system (hypoglycaemia-associated autonomic failure - HAAF). The hypoglycaemia awareness can be restored by avoiding episodes of hypoglycaemia. Management of hypoglycaemia unawareness is complex, and can only be achieved by a multifactorial intervention of clinical care and structured patient education. In patients in whom functional intensive insulin therapy with insulin analogue, continuous subcutaneous insulin infusion using insulin pumps are ineffective in the prevention of hypoglycaemia the implementation of continuous glucose monitoring (CGM) is advisable. CGM systems equipped with low glucose alarms and prediction alarms not only significantly reduce the risk of severe hypoglycaemia, but also significantly reduce the fear of hypoglycaemia and improve the quality of life of patients and their families. The insulin pumps integrated with CGM automatically suspending insulin infusion when glucose is predicted to soon be low (PLGS) should be preferred in patient with hypoglycaemia unawareness. Hypoglycaemia management is complex and should also include structural education. Particular attention should be paid to the management of hypoglycaemia and appropriate use of modern therapy. The hypoglycaemia unawareness is very common among children under the age of 6 years who are unable to observe the early symptoms of hypoglycemia by themselves. This induces a high risk of frequent and severe hypoglycaemia, which can lead to structural changes in the brain, cognitive dysfunctions, poor mental abilities and behavioral disorders later in life.Nieświadomość hipoglikemii, definiowana jako brak możliwości rozpoznania objawów hipoglikemii przez pacjenta, stanowi istotny problem kliniczny wśród chorych na cukrzycę typu 1. Najczęściej jest spowodowana nawracającymi niedocukrzeniami, które prowadzą do wystąpienia niewydolności autonomicznego układu nerwowego związanej z hipoglikemią (hypoglycaemia-associated autonomic failure – HAAF). Unikanie hipoglikemii może przywrócić zdolność do jej odczuwania. U pacjentów, u których zastosowanie funkcjonalnej intensywnej insulinoterapii z użyciem insulin analogowych oraz ciągłego podskórnego wlewu insuliny za pomocą pomp insulinowych jest nieskuteczne, wskazane jest wdrożenie ciągłego monitorowania glikemii. Systemy ciągłego monitorowania wyposażone w alarmy niskich glikemii i alarmy predykcyjne nie tylko znacznie redukują ryzyko wystąpienia ciężkich hipoglikemii, lecz także istotnie zmniejszają lęk przed hipoglikemią oraz poprawiają jakość życia zarówno pacjentów, jak i ich rodzin. Pompy insulinowe połączone z ciągłym monitorowaniem glikemii (continuous glucose monitoring – CGM), automatycznie wstrzymujące infuzję insuliny w przypadku zagrożenia niskim poziomem glikemii (predictive low-glucose insulin suspend – PLGS), powinny być preferowane u pacjentów z nieświadomością hipoglikemii. Leczenie nieświadomości hipoglikemii jest złożone, a jego integralną częścią jest edukacja zdrowotna. Szczególną uwagę należy zwrócić na postępowanie w hipoglikemii i odpowiednie wykorzystanie nowoczesnych metod terapii. Nieświadomość hipoglikemii jest bardzo częsta wśród dzieci poniżej 6. roku życia, które nie są w stanie same zaobserwować wczesnych objawów niedocukrzeń. Wiąże się to z dużym ryzykiem występowania częstych i ciężkich hipoglikemii, które mogą prowadzić do strukturalnych zmian w mózgu, upośledzenia funkcji poznawczych i rozwoju zaburzeń zachowania w późniejszym życiu.

Thyroid cancer is a rare pathology in childhood and adolescence, being responsible for 1.5-3% of all carcinomas in this age group. Differentiated thyroid carcinoma is the most commonly found variant, especially papillary carcinoma of the thyroid (PCT). Currently available data support the hypothesis that growth hormone (GH) as well as insulin-like growth factor 1 (IGF-1) can facilitate carcinogenesis. There is a confirmed role of the GH/IGF-1 axis in cancer progression as an initiator of tumorigenesis and neoplastic transformation, metastasis, and resistance to chemotherapy and radiotherapy. Presently, application of recombinant GH is an acceptable method to treat female patients with growth failure during the course of Turner syndrome (TS). This article reports the case of a fourteen-year-old female patient with Turner syndrome, Hashimoto thyroiditis, and papillary thyroid carcinoma diagnosed during GH treatment. The immunochemical analysis of tumour tissue in our patient revealed intensive brown reaction that labelled expression of the IGF-1R vs. traced reaction or its lack in normal thyroid tissue. A significant role is played by IGF-1 in the pathogenesis of invasion of thyroid cancer; however, this effect is complex, and how it works is not well established.Rak tarczycy jest rzadko rozpoznawany u dzieci i nastolatków i stanowi 1,5–3% nowotworów w tej grupie wiekowej. Najczęściej mamy do czynienia ze zróżnicowanym rakiem tarczycy, głównie rakiem brodawkowatym. Obecnie leczenie hormonem wzrostu pacjentek z zespołem Turnera jest ogólnie akceptowaną metodą leczenia niskorosłości. Istniejące doniesienia popierają hipotezę, że zarówno hormon wzrostu, jak i duże stężenia insulinopodobnego czynnika wzrostu 1 (insulin-like growth factor 1 – IGF-1) mogą sprzyjać nowotworzeniu. Bierze sie pod uwagę rolę osi GH/IGF-1 w progresji procesu nowotworowego, jako inicjatora kancerogenezy, przerzutów nowotworowych, oporności na chemioterapię i radioterapię oraz transformację nowotworową. W pracy przedstawiono pacjentkę z zespołem Turnera i chorobą Hashimoto, u której podczas leczenia rekombinowanym hormonem wzrostu rozpoznano raka brodawkowatego tarczycy. Badanie immunohistochemiczne tkanki nowotworowej u pacjentki wykazało intensywną reakcję wskazującą na obecność receptorów dla IGF-1 oraz bardzo słabą reakcję lub jej brak w zdrowej tkance tarczycy. Dotychczasowe doniesienia wskazują na bardzo ważną rolę IGF-1 w patogenezie i inwazyjności nowotworów złośliwych tarczycy. Jest ona złożona i jeszcze nie do końca poznana.

The effect of estrogens is mediated by activation of estrogen receptors (ERs). Because ER-α gene polymorphisms may exert different effects in childhood, we analyzed the associations between the IVS1 −397T>C (PvuII) polymorphism and systemic inflammatory state, proangiogenic factors, frequency of monocyte subsets, lipid profile, blood pressure, and vascular complications in girls with type 1 diabetes mellitus (DM1). We examined 180 young girls with DM1 and 120 healthy age-matched controls. The analysis concerned PvuII polymorphism of the ER-α gene as well as the levels of serum inflammatory markers (CRP, IL-6, TNF-α), proangiogenic factors (VEGF, angiogenin), 17β-estradiol, values of monocyte subsets (CD14++CD16− and CD14+CD16+), lipid profile, and blood pressure. In our study, girls with CC genotype had lower level of inflammatory and angiogenic factors and lower frequencies of CD14+CD16+ monocytes in comparison to CT or TT carriers. Simultaneously, the CC carriers had a greater population of CD14++CD16− monocytes, increased blood pressure, and serum levels of: estrogen, total cholesterol, triglycerides, and low-density lipoprotein cholesterol than girls bearing CT or TT genotype. Our study suggests a pleiotropic effect of PvuII polymorphic CC variant on diabetic vasculopathies. Although the CC genotype carriers demonstrate less inflammatory and angiogenic activity, they seem to display less favorable cardiometabolic features. Based on our study, we cannot distinguish PvuII ER-α genotype that could be useful in identification of DM1 girls that are more prone to develop of late vascular complications, before the occurrence of first clinical symptoms.

Aims The presented study was aimed to analyze the influence of IL-33 on regulatory T cells (Tregs) suppressive potential in patients with type 1 diabetes. Methods We analyzed the ability of IL-33 treated Tregs to inhibit the production of IFN-γ by effector T lymphocytes in an in vitro co-culture. The study group consisted of 22 patients with type 1 diabetes and 12 age and sex-matched healthy individuals. Results Our findings revealed that in vitro IL-33 treatment of Tregs derived from patients with type 1 diabetes resulted in quantitative as well as qualitative changes in this cell population, confirming immunoregulatory features of IL-33. Conclusion IL-33 could be considered as a potential therapeutic tool in adoptive therapies of type 1 diabetes.

Background Estimated monogenic diabetes (MD) prevalence increases as screening programs proceeds. Objective To estimate prevalence of MD among Polish children. Subjects Patients and their family members suspected of suffering from MD (defined as causative mutation in one of the Maturity Onset Diabetes of the Young or permanent neonatal diabetes mellitus genes) were recruited between January 2005 and December 2015. Methods Nationwide prevalence was estimated based on data from 6 administrative provinces (out of 16 in Poland) with high referral rates of patients (>10 per 100 000 children). Results During the analysis, probands from 322 of 788 screened families tested positive yielding a total of 409 children and 299 family members with MD. An average of 70 probands/year were referred. Screening success rate reached 40% over the study period. We estimated the prevalence of MD in 2015 to 7.52/100 000 children (1 in 13 000). The most frequent MODY in this group was GCK- MODY (6.88/100 000). The prevalence estimates increased nearly 2-fold since our report in 2011 (4.4/100 000). However, the figure reached a plateau because of screening saturation in 2014 what was also proven by lowering of the median age of diagnosis lowered in time (R = −0.73, P = .0172) along with shortening of the delay between clinical and genetic diagnosis (R = −0.65, P = .0417). Conclusions The screening for childhood MD in Poland reached a plateau phase after 10 years showing a stable prevalence estimate. The true frequency of MD in the overall population may be higher given later onset of reportedly more frequent types of MD than GCK -MODY.

In this study, we compare the prevalence of alcohol and cigarette use among Polish adolescents with type 1 diabetes mellitus (T1DM) (n = 209), aged 15-18 years, with that of a large cohort of their healthy peers, using standardized questionnaire used in the European School Survey Project on Alcohol and Drugs (ESPAD). The lifetime, previous year, and past 30-day prevalence of alcohol consumption was high among adolescents with T1DM but lower than in the controls (82.8 vs 92.0%, 71.7 vs 85.6%, and 47.5 vs 69.7%, respectively, p 10Although alcohol and cigarette consumption is lower than in controls, it is common among teenagers with type 1 diabetes, effecting metabolic control and causing the risk of acute diabetes complications. Better prevention strategies should be implemented in this group of patients in their early teen years. What is Known: • Substance use remains a significant cause of morbidity and mortality among teenagers with type 1 diabetes. • Current medical literature contains inconsistent data on the prevalence of alcohol and cigarette use among adolescents with type 1 diabetes, mostly due to methodological problems with conducting such surveys. What is New: • Methodological approach: we used a validated questionnaire from the European School Survey Project on Alcohol and Other Drugs (ESPAD) and compared the results to a large national control group of 12,114 healthy students who took part in ESPAD in 2011.

Two forms of diabetes can be distinguished during pregnancy: gestational diabetes and pregestational diabetes, which exists prior to pregnancy. In young women, the most common form of pregestational diabetes is type 1 diabetes (T1D). Regarding the decreasing age of sexual initiation and health risks for the mother and child related to hyperglycemia, it is essential that adolescents with T1D possess proper knowledge of pregnancy planning and diabetes management in case of pregnancy. Preconception counseling in adolescent patients with T1D remains a challenge for the whole therapeutic team.Assessing the awareness of consequences of uncontrolled diabetes on the course of pregnancy and fetal development among patients with T1D.The study was carried out in the group of 70 patients with T1D, aaged 15-18 years. The survey was consisted of 25 questions regarding health status, lifestyle, the knowledge of self-management of diabetes and the impact of diabetes on pregnancy and fetal development. Respondents were asked to indicate the sources of information from which they had gianed knowledge about the aforesaid issues. The data obtained were statistically analyzed.20% (n=14) of respondents declared sexual activity. In the group of sexually active patients, in 50% (n=7) last HbA1c level, reported by subjects, was between 7.5-9%, and in 21.4% (n=3)9%. The patients were aware of the consequences of uncontrolled diabetes on fetal development, however their knowledge was unsatisfactory. Surveyed adolescents indicated metabolic disorders (61.4 %, n=43), central nervous system malformations (55.7%, n=39) and heart defects (47.1%, n=33) as the most frequent complications. The respondents gathered knowledge mainly from a diabetologist (40%, n=28) and the Internet (40%, n=28). The majority of patients stated that preconception care should be provided by a diabetologist (88.6%, n=62) or a gynecologist (70%, n=49).In spite of continuous diabetes care, adolescents with T1D do not possess sufficient knowledge regarding the consequences of hyperglycemia during pregnancy. This study has emphasized the need for including reproductive health issues in diabetes education addressed to adolescent patients.Wstęp. W trakcie ciąży możemy wyróżnić cukrzycę ciążową i przedciążową, rozpoznaną przed zajściem w ciążę. U młodych kobiet najczęstszą postacią cukrzycy przedciążowej jest cukrzyca typu 1 (T1D). Z uwagi na stale obniżający się wiek inicjacji seksualnej oraz zagrożenia zdrowotne dla matki i dziecka, mogące wynikać z hiperglikemii, ważne jest, aby nastolatki z cukrzycą typu 1 posiadały odpowiednią wiedzę dotyczącą planowania ciąży i postępowania w jej przebiegu. Opieka prekoncepcyjna u nastoletnich pacjentek z cukrzycą typu 1 stanowi wyzwanie dla całego zespołu terapeutycznego sprawującego opiekę nad tą grupą pacjentek. Cel badania. Określenie świadomości wpływu niewyrównania metabolicznego cukrzycy na przebieg ciąży i rozwój płodu u nastolatek z cukrzycą typu 1. Materiał i metody. Anonimowe badanie ankietowe zostało przeprowadzone w grupie 70 pacjentek z T1D w wieku 15–18 lat. Ankieta składała się z 25 pytań sprawdzających wiedzę w zakresie samokontroli cukrzycy, wpływu cukrzycy na przebieg ciąży i rozwój płodu oraz pytań dotyczących stanu zdrowia i stylu życia, a także źródeł pozyskiwanej wiedzy. Odpowiedzi poddano analizie statystycznej. Wyniki. 20% (n=14) ankietowanych deklarowało aktywność seksualną. W grupie aktywnych seksualnie nastolatek u 50% (n=7) deklarowany poziom HbA1c wynosił 7,5–9%, a u 21,4% (n=3)9%. Badane pacjentki były świadome negatywnego wpływu źle kontrolowanej cukrzycy na płód, jednakże ich wiedza była niepełna. Jako najczęstsze powikłania wskazywały zaburzenia metaboliczne (61,4%, n=43) oraz wady mózgu (55,7%, n=39) i serca (47,1%, n=33). Wiedzę czerpały głównie od diabetologa (40%, n=28) i z internetu (40%, n=28). Większość pacjentek uważa, że informacji o ciąży powinni udzielać diabetolog (88,6%, n=62) oraz ginekolog (70%, n=49). Wnioski. Pomimo stałej opieki diabetologicznej poziom wiedzy nastolatek z cukrzycą typu 1 na temat powikłań hiperglikemii w ciąży jest niewystarczający. Przeprowadzone badanie wykazało konieczność poszerzenia edukacji diabetologicznej w okresie adolescensji o tematykę koncepcyjną.

Background X-linked immunodysregulation syndrome with polyendocrinopathy and enteropathy (IPEX) is caused by FOXP3 gene mutations that block the generation of regulatory T lymphocytes. We report an 18-month-old boy with classic IPEX who underwent 2 hematopoietic stem cell transplantations (HSCTs). Methods The first HSCT from an unrelated 8/10 HLA-matched umbilical cord blood donor (UCB) was performed after a conditioning regimen consisting of treosulfan, fludarabine, thiotepa, and thymoglobulin. Due to complete rejection of the UCB transplant, a second transplantation from a 6/10 HLA-matched mother was performed after alpha-beta T-cell depletion. The second conditioning regimen consisted of busulfan, fludarabine, a single dose of cyclophosphamide 1 g/m2, and Grafalon (Neovii Pharmaceuticals, Rapperswil, Switzerland). The T-cell depletion product contained 15.06 x 106 CD34+ cells per kilogram body weight (BW) and 4.19 x 105 alpha-beta T lymphocytes per kilogram BW. Due to acute graft rejection, the boy was treated with thymoglobulin, and full donor chimerism in both T lymphocytes and mononuclear cells was achieved. The immunosuppressive therapy was stopped 1 year after transplantation. To date, the patient remains free from graft-vs-host disease (GVHD) and immunosuppression. Conclusions HSCT after busulfan-based reduced-toxicity conditioning in patients with IPEX syndrome is feasible and well tolerated and can result in full donor engraftment. Monitoring of chimerism and aggressive therapy in cases of graft rejection are warranted due to the high reactivity of residual autologous T lymphocytes. T-cell depletion reduces the risk of GVHD and the need for steroid therapy, which is especially challenging in patients with diabetes.

Alternatively activated macrophages (M2) exert anti-inflammatory effects and are crucial for keeping balance between protective and destructive cell-mediated immunity in healing phase of inflammation. Two members of the interferon regulatory factors family, IRF5 and IRF4, are known to promote M1 or M2 phenotype, respectively. Our study aimed to analyse the effectiveness of the M2 differentiation process in vitro (achieved by IL-4 stimulation) and its relationship to the stage of type 1 diabetes mellitus (DM1) in juvenile patients. To identify the basic changes in M2 phenotype, we examined the expression of the surface CD206, CD14, CD86 molecules, intracellular IRF4 and IRF5 transcription factors as well as IL-10 and TNFα intracellular production. Ten newly diagnosed (ND-DM1) and ten long-standing (LS-DM1) patients were enrolled into the study. The control group consisted of six children. We observed a significantly higher number of unpolarised CD206

Aim: The aim of the study was to investigate the relationship between the concentration of psychrophilic bacteria, mesophilic bacteria and mold fungi in bioaerosols, and the number of new cases of type 1 diabetes mellitus (T1DM) in children. Methods: Air samples from the Lubelskie and Pomeranian voivodeships in Poland were collected from January 2015 to December 2016 in winter, spring, summer and autumn. Thirty-three samples were collected in the Pomeranian and 27 in the Lubelskie voivodeship. The air samples were collected on the first day of each month at 1:00 pm for 10 mins at a height of 1.5 m above the ground. The number of mesophilic bacteria was detected after 24–48 hrs incubation at 37°C on tryptone soya agar (TSA; Merck, Darmstadt, Germany). The number of psychrophilic bacteria was detected after 72 hrs incubation at 22°C on TSA. The number of fungi was detected by a 5-day long incubation at 28°C on chloramphenicol yeast glucose agar. Results: In the Lubelskie voivodeship, the mean concentration of psychrophilic bacteria was significantly higher than in the Pomeranian voivodeship (2739 vs 608 CFU/m3, respectively), the mean concentration of mesophilic bacteria was significantly higher (2493 vs 778/m3, respectively) and the concentration of fungi was significantly higher (3840 vs 688 CFU/m3, respectively). We also showed a statistically significant relationship between the number of children with recently diagnosed T1DM and the mean concentration of psychrophilic and mesophilic bacteria in the Pomeranian and Lubelskie voivodeships (P

Steroid-induced diabetes is a rare disease in the paediatric population. High doses of corticosteroids are used in diseases such as acute lymphoblastic leukaemia (ALL), lymphomas, or connective tissue diseases. Post-steroid hyperglycaemia arises as a result of increased gluconeogenesis and increased glycogen synthesis. Steroid-induced diabetes most often is asymptomatic; therefore it is important to monitor the glycaemic level in patients receiving systemic glucocorticoids. So far, no separate guidelines for steroid-induced diabetes have been developed, so the criteria for diagnosing drug-related diabetes mellitus do not differ from the criteria for diagnosing type 2 diabetes. Hyperglycaemia adversely affects the immune system: it impairs the function of granulocytes, immunoglobulins, and also causes T-lymphocyte apoptosis. A hyperglycaemic environment favours the development of bacterial and fungal infections. Numerous studies confirm that hyperglycaemia increases the risk of infection and severity of infection. There have also been reports of adverse effects of steroid-induced hyperglycaemia in the course of treatment for the underlying disease in the adult population. Reports related to the paediatric population are not as numerous. There are studies that have proven an increased risk of infection in paediatric patients with ALL and steroid-induced diabetes, as well as studies that proved an unfavourable effect of diabetes on survival in children with ALL and as well the studies that proved that risk of life-threatening infection and survival does not differ statistically in the group of patients with hyperglycaemia and in the group of patients who did not develop diabetes.Cukrzyca posteroidowa to rzadkie schorzenie w populacji pediatrycznej. Należy do grupy cukrzyc polekowych. Wysokie dawki kortykosteroidów stosuje się w takich schorzeniach, jak ostra białaczka limfoblastyczna (acute lymphoblastic leukemia – ALL), chłoniaki czy choroby tkanki łącznej. Hiperglikemia posteroidowa powstaje wskutek wzmożenia glukoneogenezy oraz wzmożenia syntezy glikogenu. Cukrzyca posteroidowa najczęściej przebiega bezobjawowo, dlatego ważne jest monitorowanie stężenia glikemii u pacjentów otrzymujących glikokortykosteroidy ogólnoustrojowo. Dotychczas nie opracowano oddzielnych wytycznych dla cukrzycy polekowej, zatem kryteria rozpoznania cukrzycy posteroidowej nie różnią się od kryteriów rozpoznania cukrzycy typu 2. Leczeniem z wyboru cukrzycy posteroidowej w populacji pediatrycznej jest insulinoterapia. Ponadto należy wdrożyć odpowiednią dietę oraz wyedukować pacjenta i jego opiekunów. Hiperglikemia wpływa niekorzystnie na działanie układu immunologicznego: upośledza funkcje granulocytów, immunoglobulin, a także powoduje apoptozę limfocytów T. Środowisko hiperglikemiczne sprzyja rozwojowi infekcji bakteryjnych i grzybiczych. Liczne badania potwierdzają, że hiperglikemia zwiększa ryzyko infekcji oraz powoduje ich cięższy przebieg. Opublikowano również doniesienia o niekorzystnym wpływie hiperglikemii posteroidowej na przebieg leczenia choroby podstawowej w populacji dorosłych. Doniesienia odnoszące się do populacji pediatrycznej nie są tak liczne i istnieją zarówno badania, w których udowodniono zwiększone ryzyko infekcji u onkologicznych pacjentów pediatrycznych z ALL z rozpoznaną cukrzycą posteroidową, oraz niekorzystny wpływ cukrzycy posteroidowej na przeżywalność u dzieci z ALL, jak i badania, w których udowodniono, że ryzyko wystąpienia infekcji zagrażającej życiu oraz przeżywalność nie różnią się statystycznie w grupie pacjentów z rozpoznaną hiperglikemią posteroidową oraz w grupie pacjentów, u których powikłanie to się nie rozwinęło.

In the recent years we have been observing an increased incidence of type 1 diabetes in children and adolescents. This leads to a more frequent acute complication of type 1 diabetes among children with hyperglycemia. The most common of these is diabetic ketoacidosis (DKA), while cerebral edema is the most dangerous. In children with DKA, cerebral edema most often presents with clinical symptoms but may also appear in the so-called “subclinical” form. That is why the search continues for new methods of assessing and monitoring cerebral edema in the course of DKA treatment. Ultrasonographic optic nerve sheath diameter (US ONSD) assessment is performed in various clinical scenarios when cerebral edema is suspected. It is most often performed in adult patients but increasingly often in children. US ONSD assessment is useful in the treatment of DKA in children with type 1 diabetes. This manuscript provides an overview of research results available in PubMed and other available databases on the course of treatment of DKA in children with type 1 diabetes.

Background: Peritoneal dialysis (PD) solutions with reduced sodium content may have advantages for hypertensive patients; however, they have lower osmolarity and solvent drag, so the achieved Kt/V-urea may be lower. Furthermore, the increased transperitoneal membrane sodium gradient can influence sodium balance with consequences for blood pressure (BP) control.Study Design: Prospective, randomized, double-blind clinical trial to prove the noninferiority of total weekly Kt/V-urea with low-sodium versus standard-sodium PD solution, with the lower confidence limit above the clinically accepted difference of 0.5. Setting & Participants: Hypertensive patients (1 antihypertensive drug, including diuretics, or office systolic BP 130 mm Hg) on continuous ambulatory PD therapy from 17 sites.Intervention: 108 patients were randomly assigned (1:1) to 6-month treatments with either low-sodium (125 mmol/L of sodium; 1.5%, 2.3%, or 4.25% glucose; osmolarity, 338-491 mOsm/L) or standard-sodium (134 mmol/L of sodium; 1.5%, 2.3%, or 4.25% glucose; osmolarity, 356-509 mOsm/L) PD solution.Outcomes: Primary end point: weekly total KtNurea; secondary outcomes: BP control, safety, and tolerability. Measurements: Total KtNurea was determined from 24-hour dialysate and urine collection; BP, by office measurement.Results: Total Kt/Vurea after 12 weeks was 2.53 +/- 0.89 in the low -sodium group (n = 40) and 2.97 +/- 1.58 in the control group (n = 42). The noninferiority of total KtNurea could not be confirmed. There was no difference for peritoneal KtNurea (1.70 +/- 0.38 with low sodium, 1.77 +/- 0.44 with standard sodium), but there was a difference in renal KtNurea (0.83 +/- 0.80 with low sodium, 1.20 +/- 1.54 with standard sodium). Mean daily sodium removal with dialysate at week 12 was 1.188 g higher in the low-sodium group (P Limitations: Broader variability of study population than anticipated, particularly regarding residual kidney function.Conclusions: The noninferiority of the low -sodium PD solution for total Kt/Vurea could not be proved; however, it showed beneficial clinical effects on sodium removal and BP. Am J Kidney Dis. 67(5):753-761. 2016 Fresenius Medical Care. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.orgIlicenses/by-nc-nd14.01).