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Publikacja recenzowana / Peer-reviewed publication Witamina D3 (kalcytriol) pełni wiele ważnych funkcji w organizmie. Pozyskiwana z diety lub syntetyzowana w skórze pod wpływem promieni ultrafioletowych bierze udział nie tylko w utrzymaniu gospodarki wapniowo-fosforanowej, ale także korzystnie wpływa na układ kostno-mięśniowy, układ immunologiczny i układ sercowo-naczyniowy. W ostatnich latach podjęto znaczną liczbę badań dotyczących wpływu witaminy D na ludzki organizm, i co najważniejsze, wykazano, że niedobory tej witaminy są najpowszechniejszą awitaminozą. Niedobór witaminy D szacuje się u blisko miliarda ludzi na świecie. Konsekwencje deficytu kalcytriolu dotyczą już dzieci i objawiają się nieprawidłową masą kostną i zaburzeniami mineralizacji kości, prowadząc do licznych deformacji szkieletu. U dorosłych rozwija się osteopenia. Zaobserwowano, że ryzyko chorób nowotworowych, takich jak rak piersi, jajników, prostaty, płuc, przełyku i trzustki zwiększa się proporcjonalnie w zależności od odległości względem równika, im dalej, tym malejąca ekspozycja na światło słoneczne i tym samym ograniczona zdolność produkcji witaminy. Badania pokazują wyraźną zależność niedoboru witaminy D i zwiększonego ryzyka chorób, takich jak cukrzyca typu 2, choroby układu sercowo-naczyniowego, częste infekcje górnych dróg oddechowych, zaburzenia poznawcze, zaburzenia psychiczne, alergie oraz schorzenia autoimmunologiczne. Badania wykazują, że odpowiednia dawka i czas suplementacji witaminą D, ma korzystny wpływ na stan zdrowia człowieka. Oznaczenie we krwi 25(OH)D jest najlepszą metodą do sprawdzenia poziomu witaminy, a badanie jest ogólnie dostępne. Zwiększenie świadomości społeczeństwa odnośnie ryzyka związanego z niedoborami witaminy D oraz badań i możliwości łatwo dostępnej suplementacji, a także rozpowszechnianie informacji wśród personelu medycznego, są warunkiem poprawy stanu zdrowia całej populacji. Vitamin D (calcitriol) plays a significant role in many processes. Obtained from diet or synthesized in the skin under UV radiation, it is used not only in calcium homeostasis, but also beneficially affects systems such as the muscoskeletal, immune, and cardiovascular. In recent years, a lot of research have been done regarding the influence of Vitamin D on the human organism and, more importantly, it has been revealed that Vitamin D defi ciency is the most common avitaminosis. It is assumed, that about one million people have Vitamin D deficiency globally. Calcitriol deficit is manifested in children by abnormal bone mass and impaired bone mineralization, leading to numerous deformities of the skeleton and in adults by osteopenia. It has been observed that the risk of cancers such as breast, ovarian, prostate, lung, esophagus and pancreas increases proportionally depending on the distance from the equator, as reduced exposure to sunlight limits the ability to produce this vitamin. Studies show a clear dependence of vitamin D deficiency and increased risk of diseases such as type 2 diabetes, cardiovascular diseases, frequent infections of the upper respiratory tract, cognitive disorders, mental disorders, allergies and autoimmune diseases. Studies show that the appropriate dose and timing of supplementation with vitamin D has a clear beneficial effect on health. Determination of blood 25(OH)D is the best method to measure the level of vitamin, and the test is publicly available. To improve the health of the population it is important to raise public awareness about the risks associated with vitamin D deficiency and the possibility of easily accessible supplementation, as well as disseminating information to medical personnel.

Metformin is widely used for the treatment of type 2 diabetes mellitus. Although this biguanide derivative has been used for more than 50 years, its mechanism of action has not been fully elucidated. In this article we describe the latest achievements concerning the mechanisms of antihyperglycemic action of metformin. They include: decrease of glucose absorption in the small intestine, increase of glucose transport into cells, decrease in the plasma free fatty acid concentrations and inhibition of gluconeogenesis. Activation of AMP-activated protein kinase (AMPK) plays an important role in these processes. The latest discoveries have revealed mechanisms of anti-atherosclerotic, hypotensive and anticancer action of metformin and its impact on vein endothelial function. The pleiotropic actions of metformin include impact on plasma lipid profile, decrease of oxidative stress, and increase in plasma fibrinolytic activity. Although metformin is not metabolized, the latest research has shown that it is actively transported into hepatocytes and renal tubular epithelium, by OCT1 (organic cation transporter 1, encoded by the SLC22A1 gene) and OCT2 (organic cation transporter 2, encoded by the SLC22A2 gene), respectively. However, MATE1 transporter (multidrug and toxin extrusion 1 protein) is encoded by the SLC47A1 gene and facilitates metformin excretion from these cells into bile and urine. Metformin transporter gene polymorphisms may contribute to significant variation in drug response. Further studies of mechanisms of metformin action could contribute to its wider use for the prevention of type 2 diabetes mellitus, cancer, and Alzheimer’s disease, and for the treatment of type 1 diabetes mellitus, and polycystic ovary syndrome (PCOS).

INTRODUCTION There is a paucity of Polish data describing the characteristics of and assessing treatment goals in patients with relatively newly diagnosed type 2 diabetes. OBJECTIVES The aim of the study was to describe the baseline characteristics of patients with newly diagnosed type 2 diabetes, who participated in the ARETAEUS1 study, and to assess to what degree diabetic control criteria recommended by the Polish Diabetes Association clinical practice guidelines are met. PATIENTS AND METHODS This cross-sectional questionnaire-based study was conducted from January to April 2009. It involved patients of any age and gender, diagnosed with type 2 diabetes after January 1, 2007, and recruited by randomly selected physicians, both diabetologists and non-diabetologists. RESULTS We analyzed 1714 valid questionnaires from 333 physicians: 1150 from non-diabetologists and 564 from diabetologists. Mean age of patients was 60 years, mean body mass index -- 30.6 kg/m2, proportion of females -- 50%. The levels of median glycated hemoglobin (HbA1c), total cholesterol and triglycerides, mean low-density lipoprotein (LDL) cholesterol, as well as blood pressure were above the thresholds recommended in the guidelines (i.e.

The plague of obesity afflicts an increasing group of people. Moreover type 2 diabetes, which is the most serious illness accompanying excessive weight, is becoming more and more common. Traditional methods of obesity treatment, such as diet and physical exercise, fail. This applies especially to people with class III obesity. The only successful way of treating obesity in their case is bariatric surgery. There are three types of bariatric surgery: restrictive procedures (reducing stomach volume), malabsorptive procedures, and mixed procedures, which combine both methods. In spite of the risk connected with the surgery and complications after it, bariatric procedures are advised to patients with class III obesity and class II with an accompanying illness which increases the probability of death. It has been proved that bariatric surgery not only eliminates obesity but also very frequently (in 90�0of cases) leads to the remission of type 2 diabetes. Moreover, the remission occurs very fast – it takes place a long time before the patients reduce their weight, even within a few days after surgery. Detailed studies have shown that the remission of diabetes is caused mostly by the change of the gastro-intestinal hormones’ profile, resulting from the surgery. These hormones include GLP-1, GIP, peptide YY, ghrelin and oxyntomodulin. Additionally, the change of the amount of adipose tissue after the surgery influences the level of adipokines, i.e. the hormones of the adipose tissue, among which the most important are leptin, adiponectin and resistin. Thus, bariatric surgery not only changes the shape of the gastrointestinal tract but it also modulates the hormonal activity. Bariatric surgery is considered as therapy not only for the obese but also for diabetic patients.