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Background. As diabetes affects multiple spheres of life the aim of this study was to explore the pain points of diabetes management as perceived by persons with type 2 diabetes and to identify their expectations towards new technologies. Methods. Patients with type 2 diabetes treated with oral hypoglycemic agents and/or insulin were surveyed. Respondents were asked to rate (i) the impact of diabetes on their daily life and (ii) their needs for improvements in different aspects of diabetes management on a five level Likert-type scale. Results. One hundred and fifty-four persons with type 2 diabetes were included. Most frequently reported challenges were: fear of diabetes complications development or progression (98.7% of patients), presence of diabetes complications (65.6%), frequent hyperglycemia (53.2%), and diabetes limiting one’s daily activities (50%). Most frequently expressed needs were: to evaluate glucose concentrations without finger pricking (98.1%), contact with a physician using mobile solutions and/or telemedicine (98.1%), and automation of insulin dosing (91.6%) and of calories/carbohydrates’ evaluation in meals (84.4%). Needs for telemedicine development, automation of insulin dosing and that the others help patients with diabetes management were more frequently reported by persons with: higher HbA1c, positive severe hypoglycemia history, concomitant chronic complications or diseases, and by those who were on insulin therapy. Conclusions. Although many diabetes technologies which meet the needs of patients with type 2 diabetes are already available, the study uncovers a high requirement for integrating them into disease management. The challenge pertains to implementation of the right technological solutions fulfilling needs of particular groups of patients and to helping them to embrace novelties into their daily lives.

Background. Diabetic ketoacidosis (DKA) is a life-threatening complication of newly diagnosed type 1 diabetes (T1DM) and is associated with severe dehydration. The aim of the study was to evaluate the changes in hematological parameters (RBC, Hct, Hb, MCV, PLT, WBC) and their correlations with acidosis level and dehydration during ketoacidosis treatment. Methods. The study group consisted of 262 children with newly diagnosed type 1 diabetes. Clinical data were collected from hospital discharge charts. Data considering hematological parameters were collected from two timepoints: first at admission and second up to 6 days since admission. Results. Ketoacidosis was present in 76 patients (29.01%). The DKA group had significantly higher values of baseline RBC (p = 0.0026), Hct (p = 0.0019), Hb (p = 0.0235), PLT (p = 0.0427) and WBC count (p 0.3 and all p values < 0.05) in DKA group but not in no-DKA group. However, weak, positive correlations at the margin of statistical significance with pH were observed for changes in PLT (p = 0.0609) and WBC (p = 0.0811) in no-DKA group. Conclusion. Monitoring dynamics of hematological parameters at T1DM diagnosis may be useful in esti­mating patients’ hydration status.

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.

Recommendations of the Polish Society of Hypertension Experts: Marcin Adamczak, Ludwina Szczepaniak-Chichel, Marzena Chrostowska, Danuta Czarnecka, Grzegorz Dzida, Krzysztof J. Filipiak, Jerzy Gąsowski, Jerzy Gluszek, Stefan Grajek, Tomasz Grodzicki, Kalina Kawecka-Jaszcz, Beata Wozakowska-Kaplon, Beata Begier-Krasinska, Jacek Manitius, Malgorzata Myśliwiec, Anna Niemirska, Aleksander Prejbisz, Danuta Pupek-Musialik, Grazyna Brzezinska-Rajszys, Katarzyna Stolarz-Skrzypek, Agnieszka Szadkowska, Tomasz Tomasik, Krystyna Widecka, Andrzej Wiecek, Adam Windak, Jacek Wolf, Tomasz Zdrojewski, Aleksandra Żurowska

Background and aims. Dipping profile in ambulatory blood pressure monitoring (ABPM) may be a good predictor of target organ damage in patients with type 1 diabetes. The aim of the study was to analyze the correlation between the blood pressure profile in ABPM and other predictors of early kidney damage in type 1 diabetes. Material and methods. We examined 132 type 1 diabetes patients with normal blood pressure and 22 type 1 diabetes patients treated with antihypertensive drugs. ABPM was performed in each patient. Urine albumin to creatinine ratio (UACR) was assessed and estimated glomerular filtration rate (eGFR) was estimated based on serum cystatin C concentration. The association between blood pressure profile in ABPM and renal function was analyzed. Results. In normotensive patients dipper status did not have any impact on renal function. Non-dippers had lower day systolic and diastolic blood pressure and higher night systolic and diastolic blood pressure than dippers. Day systolic blood pressure was negatively correlated with eGRF estimated with cystatin C. In hypertensive patients non-dippers had higher urine albumine to creatinine ratio than dippers. Conclusions. In normotensive type 1 diabetic patients non-dipping status does not seem to be good predictor of early renal complications. However, in type 1 diabetics treated for hypertension, non-dipping could reflect probable kidney damage. GFR estimated with cystatin C could be more sensitive than albuminuria predictor of early kidney damage in type 1 diabetes.

Introduction: Wolfram syndrome (WFS) is the most frequent syndromic form of monogenic diabetes coexisting with optic atrophy and many other disorders. The aim of this study was to estimate the prevalence of Wolfram syndrome among children with diabetes in Poland. Material and methods: These calculations were performed among Polish diabetic children, aged 0–18 years, from three administrative regions between January 2005 and December 2011. Epidemiological data was obtained by matching the results from the EURO-WABBPoland Project and the PolPeDiab Registry. Results: Throughout the study period, we confirmed genetic diagnosis of Wolfram syndrome in 13 patients from Poland. Three patients originated from the studied regions with complete epidemiological data on paediatric diabetes. The total number of patients with diagnosed diabetes in the study equalled 2,568 cases. The prevalence of Wolfram syndrome among Polish children with diabetes is 0.12% (95% Confidence Interval 0.04–0.34%). Conclusions: We estimate that Wolfram syndrome is 26 to 35 times less frequent than monogenic diabetes (MODY and neonatal diabetes) in the Polish paediatric population. (Endokrynol Pol 2014; 65 (4): 295–297)