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Copyright of Pediatric Endocrinology, Diabetes & Metabolism is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Polish Journal of Wound Management / Leczenie Ran is the property of Evereth Publishing Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Pediatric Endocrinology, Diabetes & Metabolism is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background. The aim of study was to evaluate clinical features in adults with metabolic syndrome at diagnosis of diabetes, depending on the exponents of absolute insulin deficiency. Material and methods. The study included 122 adults consecutively hospitalized in the Department of Internal Medicine and Diabetology in 2007-2010 who met the inclusion criteria: age under 50 years, newly diagnosed diabetes, the presence of metabolic syndrome. The study group was divided into two subgroups depending on the presence diabetic ketoacidosis. Results. Adults with the metabolic syndrome, with newly diagnosed diabetes and markers of absolute insulin deficiency, had at diagnosis significantly higher glycaemia (p = 0.009) and HbA1c (p = 0.001), and significantly lower C-peptide levels (p = 0.007) than that observed in the group without diabetic ketoacidosis. People with newly diagnosed diabetes with metabolic syndrome were generally classified as type 2 disease. The diagnosis that was significantly more often placed in the group without ketones (p = 0.002). However, regardless of the presence ketoacidosis, some patients were classified as type 2 diabetes or without specifying the type of diabetes. Study groups differed in the prevalence of ICA antibodies characteristic of type 1 diabetes (p = 0.005). Conclusions. Occurrence of ketoacidosis in adults with newly diagnosed diabetes and metabolic syndrome is not a prerequisite for the diagnosis of type 1 diabetes, nor the need for further treatment with insulin. In patients with newly diagnosed diabetes with ketoacidosis and a phenotype characteristic of type 2 diabetes to assess β cell function and autoantibodies may be useful when deciding how to treat. [ABSTRACT FROM AUTHOR]

Copyright of Experimental & Clinical Diabetology / Diabetologia Doswiadczalna i Kliniczna is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Objectives: The aim of the study was to evaluate the concentration of interleukin 12 (IL-12), the activity of phospholipase A2 (PLA2), and platelet-activating factor acetylhydrolase (PAF-AH) in type 1 diabetes (DM1) patients treated with intensive insulin therapy. Design and methods: Studied parameters were measured in 81 patients, who were subdivided according to the HbA1c value, hsCRP concentration, and presence or absence of late complications. Results: PAF-AH activity was higher in the DM1 patients versus the control group (P =0.042). IL-12 concentration was the highest in subgroup with ≥3 mg/L hsCRP (P <0.05). Negative correlations were found for the IL-12 and age of patients and for apo A–I in the subgroup with poor metabolic control. In addition, positive correlation for hsCRP and PAF-AH activity in the subgroup with ≥3 mg/L CRP (P <0.05) was also found. Conclusions: PAF-AH and IL-12 appear to be implicated in the development of a chronic inflammation in DM1. In addition, our results emphasize a protective role of apo A–I against an increase in IL-12 production. [Copyright &y& Elsevier]

Introduction: An essential process affecting the course of type 1 diabetes (DM1) is the appearance and duration of clinical remission. One of the most important factors promoting the occurrence of remission is physical activity, due to increased activity of antioxidants, reduces insulin resistance and improves glucose transport. Maximal oxygen capacity (VO 2 max) is an objective measure of the body's aerobic capacity. To assess VO 2 max, oxygen uptake should be measured directly during the exercise test. The aim of the study was to evaluate the physical capacity in adults with DM1 and its relationship with the occurrence of partial clinical remission (pCR) during 2 years follow-up., Methods: The pCR was assessed by the following mathematical formula: A1c (%) + [4 × insulin dose (U/kg/d)]. The result ⩽9 indicates pCR. VO 2 max was assessed between 6th and 24th month of diabetes duration using an ergospirometer (COSMED K5 System), during an exercise test carried out on a cycloergometer (RAMP incremental exercise test)., Results: The study group consisted of 32 adults with DM1. People with pCR were proved to have higher VO 2 max level [36.0 (33.0-41.5) vs 30.9 (26.5-34.4) ml/min/kg, P  = .009. Univariate and multivariate regression confirmed a significant association between VO 2 max and presence of pCR [AOR 1.26 (1.05-1.52), P  = .015]. Duration of remission was longer among group with higher VO 2 max results [15 (9-24) vs 9 (0-12) months, P  = .043]. The positive relationship was observed between diabetes duration and VO 2 max (rs = 0.484, P  = .005). Multivariate linear regression confirms a significant association between remission duration and VO 2 max (ml/min/kg) (β = 0.595, P  = .002)., Conclusion: The higher VO 2 max, the better chance of partial clinical remission at 2 years of DM1 and longer duration of remission., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: The article aims to present the most popular methods of assessing physical capacity. Moreover, the article sheds light on the beneficial impact of improving physical capacity in people with Diabetes Mellitus type 1 (DM1)., Methods: A computer-based literature search of PubMed, SCOPUS and Web of Science included studies up to September 2022., Results: The significant role of regular physical exertion could be observed in the group of people suffering from DM1, which implicates a positive correlation between the activity and the remission time. A suitable and objective indicator of sport influence on the organism is physical capacity (PC), which describes the efficiency of the cardiovascular system and its correlation between BMI, sex, and age. PC is mostly shown as VO 2max . Well metabolically controlled DM1 is not a contraindication to stress test. Even though physical activity is closely related to human history, the range of research into the importance of PC is still limited to particular groups of patients, which presents an opportunity for further research and future conclusions., Conclusions: Undertaking physical activities has a multidirectional influence on the organism. According to up-to-date knowledge, various methods of PC assessment are available. Patients can choose more easily accessible, simpler, and cheaper options like CRT, RT, and HST which do not need specialized equipment and skills. They can also decide on more advanced examinations like ergospirometry, where direct measurements of VO2max and other cardiorespiratory parameters are made., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background The association between common carotid artery intima-media thickness (CCA-IMT) and incident carotid plaque has not been characterized fully. We therefore aimed to precisely quantify the relationship between CCA-IMT and carotid plaque development. Methods and Results We undertook an individual participant data meta-analysis of 20 prospective studies from the Proof-ATHERO (Prospective Studies of Atherosclerosis) consortium that recorded baseline CCA-IMT and incident carotid plaque involving 21 494 individuals without a history of cardiovascular disease and without preexisting carotid plaque at baseline. Mean baseline age was 56 years (SD, 9 years), 55% were women, and mean baseline CCA-IMT was 0.71 mm (SD, 0.17 mm). Over a median follow-up of 5.9 years (5th-95th percentile, 1.9-19.0 years), 8278 individuals developed first-ever carotid plaque. We combined study-specific odds ratios (ORs) for incident carotid plaque using random-effects meta-analysis. Baseline CCA-IMT was approximately log-linearly associated with the odds of developing carotid plaque. The age-, sex-, and trial arm-adjusted OR for carotid plaque per SD higher baseline CCA-IMT was 1.40 (95% CI, 1.31-1.50; I 2 =63.9%). The corresponding OR that was further adjusted for ethnicity, smoking, diabetes, body mass index, systolic blood pressure, low- and high-density lipoprotein cholesterol, and lipid-lowering and antihypertensive medication was 1.34 (95% CI, 1.24-1.45; I 2 =59.4%; 14 studies; 16 297 participants; 6381 incident plaques). We observed no significant effect modification across clinically relevant subgroups. Sensitivity analysis restricted to studies defining plaque as focal thickening yielded a comparable OR (1.38 [95% CI, 1.29-1.47]; I 2 =57.1%; 14 studies; 17 352 participants; 6991 incident plaques). Conclusions Our large-scale individual participant data meta-analysis demonstrated that CCA-IMT is associated with the long-term risk of developing first-ever carotid plaque, independent of traditional cardiovascular risk factors.

Introduction: Some patients with type 1 diabetes (T1DM) are free from advanced complications despite long‑standing disease. These patients may be carriers of gene mutations responsible for maturity‑onset diabetes of the young and may have been misdiagnosed with T1DM., Objectives: We aimed to determine the clinical characteristics of patients with long‑term T1DM, without advanced microvascular complications, and with well‑preserved kidney function. A search for mutations in monogenic diabetes genes was performed., Patients and Methods: Patients were recruited at 2 Polish university centers based on the following criteria: T1DM duration of 40 years or longer and absence of advanced complications defined as chronic kidney disease (estimated glomerular filtration rate [eGFR] <60 ml/min/1.73 m2 ), overt proteinuria, blindness, and diabetic foot syndrome. Mutations in the 7 most frequent monogenic diabetes genes were identified using next‑generation sequencing., Results: We enrolled 45 patients with T1DM (mean [SD] age at examination, 59.2 [8.0] years; mean [SD] age at T1DM diagnosis, 14.6 [6.7] years). Mean (SD) hemoglobin A1c levels were 7.6% (1.4%); daily insulin dose, 0.48 (0.17) U/kg; high‑density lipoprotein (HDL) cholesterol levels, 1.9 (0.6) mmol/l; body mass index (BMI), 26.4 (5.0) kg/m2 ; and eGFR, 82.2 (12.1) ml/min/1.73 m2 . Albuminuria and retinopathy were reported in 7 and 39 patients, respectively. We were not able to assign a causative role to any of 10 genetic variants identified by next‑generation sequencing in this cohort., Conclusions: Patients with long‑term T1DM and preserved kidney function have good glycemic control, elevated HDL cholesterol levels, low insulin requirements, near ‑normal BMI, and a rare occurrence of mutations in monogenic diabetes genes.

Background  Erectile dysfunction (ED) affects approximately 38% of individuals with type 1 diabetes (T1DM). Skin autofluorescence (AF) reflects skin advanced glycation end product (AGE) deposits and is a marker of long-term glycemia control. Objective  The study investigates the relationship between ED and diabetes control in patients with T1DM. Methods  Adult patients with T1DM visiting the Diabetology Department were cross-sectionally investigated. Medical history, anthropometric features, and laboratory findings were collected. All individuals filled the International Index of Erectile Function (IIEF-5). IIEF-5 total score < 22 represented the presence of ED. AF was measured on the volar aspect of the forearm using AGE Reader. Insulin resistance (IR) was assessed by the estimated glucose disposal rate. Descriptive statistics and multivariate logistic regression analyses were performed. The adjusted covariates were general risk factors of ED. Results  Of a total of n  = 70 patients, n  = 30 (42.9%) suffered from ED. The presence of ED was associated with higher glycated hemoglobin level (OR, 95% CI; 1.62, 1.02-2.60; p  = 0.043), presence of at least one diabetic complication (3.49, 1.10-11.03; p  = 0.03), and skin AF (9.20, 1.60-52.94; p  = 0.01), but not with IR (0.78, 0.57-2.60; p  = 0.12). Skin AF values ≥ 2.2 indicates presence of ED with a sensitivity of 70.0% and a specificity of 77.5%. Area under the curve was equal to 0.72 (95% CI: 0.60-0.85). Conclusions  The presence of ED in individuals with T1DM is associated with HbA1c, the presence of at least one diabetic complication, and skin AF., Competing Interests: Conflict of Interest None declared., (International College of Angiology. This article is published by Thieme.)

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Competing Interests: Maciej Banach has received grant/research support from Amgen, Sanofi, Mylan/Viatris, and has worked as a consultant/received lecture fees from: Amgen, Daichii Sankyo, Esperion, Freia Pharmaceuticals, Herbapol, Kogen, KRKA, Mylan/Viatris, Novo Nordisk, Novartis, Polfarmex, Polpharma, Sanofi, Teva, Zentiva; works as CMO in Nomi Biotech Corporation Ltd.; Dariusz Dudek has received honoraria and grant/research support from: Amgen, Astra Zeneca, Cardinal Health, Gedeon Richter, Sanofi Piotr Jankowski has received honoraria and research grants from: Amgen, Sanofi, Novartis, Servier, Zentiva; Jacek Jóźwiak has received grant/research support from Valeant and has worked as a consultant/received lectures from: Amgen, Boehringer Ingelheim, Teva, Zentiva, Celgene, Servier, Bioton, ALAB; works as ADMO in Synexus; Irina Kowalska worked as consultant/received lecture fees from: Ascensia Diabetes Care, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, Sanofi; Bogdan Solnica has received lecture fees from Abbott Laboratories Poland, Argenta, Beckman Coulter, Euroimmun, Roche Diagnostics, Siemens Healthcare; Tomasz Tomasik declares cooperation with Boehringer Ingelheim, Novartis, Shire, Biofarm, Eli Lilly, and AstraZeneca; Dorota Zozulińska-Ziółkiewicz has received grant/research support from Novo Nordisk and worked as a consultant/received lecture fees from: Abbott, Astra Zeneca, Bioton, Boehringer Ingelheim, Dexcom, Eli Lilly, Medtronic, Mundipharma, Novo Nordisk, Roche, Sanofi, Zentiva; other experts report no conflict of interest.

Background and Aims: Cholesteryl ester transfer protein (CETP) and phospholipid transfer protein (PLTP) are crucial proteins in reverse cholesterol transport. There are insufficient data on regulating these proteins by insulin therapy in type 1 diabetes mellitus (T1DM). We aimed to assess prospectively the impact of insulin therapy initiation on transfer proteins serum levels in adults with newly diagnosed T1DM., Methods and Results: 57 adults with newly diagnosed T1DM were enrolled in the InLipoDiab1 Study. All participants were treated with subcutaneous insulin in the model of intensive insulin therapy since the diagnosis of diabetes. Serum PLTP and CETP concentrations were measured at diagnosis, after three weeks, six months, and after one year of insulin treatment, using the immunoenzymatic method ELISA. A significant decrease in PLTP and CETP concentrations were demonstrated during twelve months of insulin therapy in newly diagnosed T1DM. The dynamics of changes in the level of these proteins varied depending on the occurrence of remission after a year of the disease. In the group without remission, a significant decrease in PLTP and CETP levels appeared after six months of follow-up. The remission group was characterized by a decrease in proteins concentration only after one year of treatment. In the non-remission group, significant negative correlations were found between the daily dose of insulin and levels of PLTP and CETP., Conclusion: Exogenous insulin is an inhibitor of lipid transfer proteins involved in high-density lipoprotein cholesterol metabolism in the first year of treatment., Competing Interests: Declaration of competing interest None declared., (Copyright © 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Long-term insulin treatment can slow the growth process and decrease physical fitness level in children. In diabetic children, these two developments should be constantly monitored. The aim of the present study was to examine differences in somatic and physical fitness characteristics between soccer-training boys with type 1 diabetes and healthy boys of the same age (reference values based on Polish population norms for somatic and motor parameters). The participants were 94 boys (8-17 years), diagnosed with diabetes, who participated in soccer training on a regular basis and received routine medical care. The study involved (a) anthropometric and body composition measurements, (b) general motor ability assessments, and (c) comparison of those characteristics with the healthy Polish population. The diabetic boys were found to have lower levels of almost all somatic traits and motor abilities as compared with the healthy boys ( p ≤ 0.05). Handgrip strength was a variable with the smallest difference between the two groups. The observed differences indicate the necessity to design an appropriate control and assessment system based on simple medical and fitness field tests for diabetic children and adolescents. It will allow optimizing advanced training as well as minimize health risks before, during, or after exercise.

Introduction: Protein profiling allows the determination of the presence of proteins marking various stages of the disease, and differentiates between people at risk of various diseases. In type 1 diabetes, protein profiling had been previously used to find blood markers other than islet autoantibodies to indicate the pancreatic beta cell destruction process and to reflect the progression of type 1 diabetes mellitus (T1DM). However, T1DM is an auto-immune disease and its clinical presentation changes in time of its duration., The Aim of the Study: To find differences in protein profiles in patients with type 1 diabetes according to diabetes control (HbA1c > 7%) and with presence of diabetic complications or obesity. It may help to identify subgroups of patients who may need a better clinical supervision and individualized treatment., Material and Methods: A group of 103 patients with auto-immunologically confirmed T1DM, and meeting the following inclusion criteria: Caucasian race, duration of diabetes >5 years, were used in the study. Criteria of exclusion: past or present cancer (treated with chemo-/radiotherapy), diseases of the liver (ALT > 3 × ULN) except for people with simple hepatic steatosis, chronic renal disease (eGFR < 30 mL/1.73 m 2 /min), and acute inflammation (CRP > 5 mg/dL). The study group was divided in terms of the presence of chronic complications, obesity, or poor metabolic control (HbA1c > 7%). Protein profiling was completed by using the MALDI-TOF MS (matrix-assisted laser desorption/ionization-time of flight mass spectrometry) analyzer., Results: Differentiating proteins were identified in all of the groups. The groups burdened with complications, obesity, and poor metabolic control were characterized by increased levels of fibrinogen, complement C4 and C3., Conclusion: The groups of type 1 diabetes patients burdened with complications, obesity, and poor metabolic control were characterized by increased levels of fibrinogen, complement C4 and C3. Further detailed studies are necessary to determine more subtle changes in the proteomic profile of patients with type 1 diabetes., Competing Interests: The authors declare no conflict of interest.

Introduction: Apolipoprotein complement is a critical determinant of lipoprotein function and metabolism. The relation between exogenous insulin and apolipoproteins (apos) in newly diagnosed type 1 diabetes mellitus (T1DM) has not yet been studied extensively. The aim of this study was to prospectively observe the changes in serum apos AI (apo AI) and AII (apo AII) in patients with newly diagnosed T1DM and their association with the daily insulin requirement., Material and Methods: Thirty-four participants of the InLipoDiab1 study aged 26 (IQR: 22-32) were enrolled in this analysis. Apolipoprotein AI and AII concentrations were assessed at diagnosis and at follow-up after 3 weeks, 6 months, and 1 year of insulin treatment. The daily dose of insulin (DDI) was calculated as the amount of short- and long-acting insulin at discharge from the hospital and at follow-up visits., Results: The changes in apo AI concentration were observed after 3 weeks of insulin treatment ( p = 0.04), with the largest increase between 3 weeks and 6 months of observation ( p < 0.001). Apolipoprotein AII level did not change significantly after 3 weeks, while a significant increase was observed between 3 weeks and 6 months of treatment ( p < 0.001). The correlations between DDI and apo concentration were not statistically significant., Conclusions: In the first year of T1DM, there is a significant increase in apos concentration. Due to the significant deviation of apos concentration from accepted norms, changes in the recommendations of lipid control criteria in T1DM may be considered., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2020 Termedia & Banach.)

The prevalence of diabetes mellitus is increasing worldwide, including the nation of Poland. The aim of this prospective and observational study was to determine risk factors and the predictors of diabetes incidence in elderly women, and to calculate the diabetes incidence ratio in this population. Two-hundred women, aged 65-74, who were non-diabetic at baseline in 2012 were followed for 6.5 years. All women were checked for incident diabetes. In non-diabetic subjects, diagnostic procedures for diabetes were performed according to Poland's Diabetes recommendations. Between April 2012 and September 2018, 25 women developed diabetes and the next 11 cases were diagnosed based on FPG or oral glucose tolerance test. Women with incident diabetes had significantly higher baseline FPG, triglycerides (TG), TG/HDL cholesterol ratio and visceral adiposity index (VAI) score, and lower abdominal aorta diameter (AAD), HDL cholesterol and eGFR. In the Cox proportional hazard regression analysis, only AAD < 18 mm and VAI score ≥ 3.8 were independently associated with diabetes risk, hazard ratio (HR) 2.47 (95% confidence interval 1.21-5.02), P = 0.013 and HR 2.83 (1.35-5.94), P = 0.006 respectively. In the backward stepwise regression analysis including all variables, diabetes incidence could be predicted from a linear combination of the independent variables: AAD < 18 mm (P = 0.002), VAI score ≥ 3.8 (P < 0.001) and FPG ≥ 5.6 mmol/L (P = 0.011). The calculated incidence of diabetes was 2769.2 new cases/100,000 persons per year. AAD below 18 mm seem to be a novel, independent marker of diabetes risk in elderly women, and AAD assessment during routine abdomen ultrasound may be helpful in identifying females at early elderliness with high risk of diabetes incidence.

Atherosclerosis - the pathophysiological mechanism shared by most cardiovascular diseases - can be directly or indirectly assessed by a variety of clinical tests including measurement of carotid intima-media thickness, carotid plaque, -ankle-brachial index, pulse wave velocity, and coronary -artery calcium. The Prospective Studies of Atherosclerosis -(Proof-ATHERO) consortium (https://clinicalepi.i-med.ac.at/research/proof-athero/) collates de-identified individual-participant data of studies with information on atherosclerosis measures, risk factors for cardiovascular disease, and incidence of cardiovascular diseases. It currently comprises 74 studies that involve 106,846 participants from 25 countries and over 40 cities. In summary, 21 studies recruited participants from the general population (n = 67,784), 16 from high-risk populations (n = 22,677), and 37 as part of clinical trials (n = 16,385). Baseline years of contributing studies range from April 1980 to July 2014; the latest follow-up was until June 2019. Mean age at baseline was 59 years (standard deviation: 10) and 50% were female. Over a total of 830,619 person-years of follow-up, 17,270 incident cardiovascular events (including coronary heart disease and stroke) and 13,270 deaths were recorded, corresponding to cumulative incidences of 2.1% and 1.6% per annum, respectively. The consortium is coordinated by the Clinical Epidemiology Team at the Medical University of Innsbruck, Austria. Contributing studies undergo a detailed data cleaning and harmonisation procedure before being incorporated in the Proof-ATHERO central database. Statistical analyses are being conducted according to pre-defined analysis plans and use established methods for individual-participant data meta-analysis. Capitalising on its large sample size, the multi-institutional collaborative Proof-ATHERO consortium aims to better characterise, understand, and predict the development of atherosclerosis and its clinical consequences., (© 2020 S. Karger AG, Basel.)

Aims: To analyze physical performance and diabetes-related outcomes in adolescents with type 1 diabetes (T1DM) during two semi-competitive football matches utilising precise physical activity monitoring., Methods: The study was conducted during an annual summer camp for adolescents with T1DM. After physical examination and glycated hemoglobin measurement, 16 adolescent players completed Cooper's 12-min running test and, in the following days, took part in two football matches while wearing heart rate (HR) monitors coupled with global positioning system (GPS) tracking., Results: Both matches were comparable in terms of covered distances, number of sprints, achieved velocities and heart rate responses. During both games, capillary blood lactate increased significantly (Match 1: 1.75 ± 0.16-6.13 ± 1.73 mmol/l; Match 2: 1.77 ± 0.18-3.91 ± 0.63 mmol/l, p = 0.004). No significant differences in blood glucose were observed between the matches (p = 0.83) or over each match (p = 0.78). Clinically significant hypoglycemia (< 54 mg/dl) occurred in two children during the first match. None of the players experienced severe hypoglycemia. Despite similar workloads, players consumed significantly less carbohydrates during Match 2 [median difference: - 20 g (25-75%: - 40 to 0), p = 0.006]., Conclusions: HR monitoring and GPS-based tracking can effectively parameterize physical activity during a football match. In T1DM patients, exercise workload and glycemic changes during similar matches are comparable, which provides an opportunity to develop individual recommendations for players with T1DM.

Purpose: To assess glycemic control and safety of children and adolescents with type 1 diabetes participating in a 2-day football tournament., Methods: In total, 189 children with type 1 diabetes from 11 diabetes care centers, in Poland, participated in a football tournament in 3 age categories: 7-9 (21.2%), 10-13 (42.9%), and 14-17 (36%) years. Participants were qualified and organized in 23 football teams, played 4 to 6 matches of 30 minutes, and were supervised by a medical team. Data on insulin dose and glycemia were downloaded from personal pumps, glucose meters, continuous glucose monitoring, and flash glucose monitoring systems., Results: The median level of blood glucose before the matches was 6.78 (4.89-9.39) mmol/L, and after the matches, it was 7.39 (5.5-9.87) mmol/L (P = .001). There were no episodes of severe hypoglycemia or ketoacidosis. The number of episodes of low glucose value (blood glucose ≤3.9 mmol/L) was higher during the tournament versus 30 days before: 1.2 (0-1.5) versus 0.7 (0.3-1.1) event/person/day, P < .001. Lactate levels increased during the matches (2.2 [1.6-4.0] mmol/L to 4.4 [2.6-8.5] mmol/L after the matches, P < .001)., Conclusions: Large football tournaments can be organized safely for children with type 1 diabetes. For the majority of children, moderate mixed aerobic-anaerobic effort did not adversely affect glycemic results and metabolic safety.

Aims: To assess the prevalence of ZnT8-ab and its correlation to other autoimmune markers and diabetic ketoacidosis occurrence in children and adults with T1DM onset., Methods: The study included 367 patients (218 children; 149 adults) at the T1DM onset. Selected diabetes-related autoantibodies such as GAD-ab, IA2-ab, ZnT8-ab were tested before the initiation of insulin therapy. Diabetic ketoacidosis was defined as glucose concentration > 13.9 mmol/l, pH < 7.30, concentration of HCO 3  < 15 mmol/l, presence of ketone bodies in the blood and urine., Results: The autoantibodies pattern differs in both study groups. Children were mostly positive for two (37.8%) and three (49.5%) autoantibodies, whereas adults for one (32.2%) and two (30.7%). The most frequently detected autoantibodies in youth were ZnT8-ab (81.1%) and IA2-ab (80.7%), while in adults GAD-ab (74.8%). ZnT8-ab (p < 0.0001) titers were significantly higher in children, but adults had higher titer of GAD-ab (p < 0.0001) and IA2-ab (p < 0.0001). Children developed more frequently diabetic ketoacidosis (28.4 vs. 10.7%, p = 0.0002). ZnT8-ab (p = 0.002) and IA2-ab (p = 0.008) were reported mostly in individuals with ketoacidosis. A correlation between the number of positive antibodies and the severity of ketoacidosis was observed (R s - 0.129 p = 0.014). ZnT8-ab were associated with a greater risk of ketoacidosis independent of gender, age group and the autoantibodies number [OR = 2.44 (95% CI 1.0-5.94), p = 0.04]., Conclusions: Children are at greater risk of ketoacidosis at the diagnosis of diabetes. ZnT8-ab and IA2-ab are commonly detected in children, while adults have frequently higher titer of GAD-ab. ZnT8-ab are associated with more acute diabetes onset.

Changes in sensitivity to insulin occur in the course of a number of endocrine disorders. Most of the hormones through their antagonistic action to insulin lead to increased hepatic glucose output and its decreased utilisation in peripheral tissues. Carbohydrate disorders observed in endocrine diseases result from the phenomenon of insulin resistance, and in some cases also a reduction in insulin secretion is present. Abnormalities of glucose metabolism are observed in acromegaly, but also in growth hormone deficiency, hypercortisolism in the course of Cushing's syndrome, hyper- or hypothyroidism, primary hyperparathyroidism, aldosteronism, pheochromocytoma, congenital hypertrophy of the adrenal glands, polycystic ovaries syndrome, hypogonadism, or other hormonally active neuroendocrine tumours. They are of a secondary nature in relation to impaired hormonal balance. Hyperglycaemia is therefore often reversible, and the most effective method of treatment of impaired insulin sensitivity is successful therapy of specific endocrinopathies. Insulin sensitisers, also with a good effect, are used. Most experiences to date can be attributed to metformin therapy. Attempts have been made at treatment with other agents that are also effective in reducing insulin resistance as incretins or glitazones. In the presented paper, the authors reviewed endocrine diseases in which there is a clinically significant change in insulin sensitivity. Moreover, methods of therapy of concomitant disturbed glucose metabolism were presented.

INTRODUCTION Advanced glycation end products (AGEs) play a crucial role in the pathogenesis of diabetic peripheral neuropathy (DPN). OBJECTIVES The aim of the study was to assess the skin accumulation of AGEs in patients with long‑lasting type 1 diabetes in relation to the presence of DPN. PATIENTS AND METHODS We evaluated 178 patients with type 1 diabetes (99 men; age, 43 years [interquartile range [IQR], 34-54 years]; disease duration, 25 years [IQR, 18-31 years]). DPN was diagnosed if 2 or more of the following 5 abnormalities were present: symptoms of neuropathy, lack of ankle reflexes, and impaired sensation of touch, temperature, and/or vibration. PGP 9.5‑immunoreactive nerve fibers were counted to assess intraepidermal nerve fiber density (IENFD) in skin biopsy. The accumulation of AGEs in the skin was assessed on the basis of skin autofluorescence (AF).  RESULTS Patients with DPN (45%), compared with those without neuropathy, had higher skin AF (2.6 AU [IQR, 2.3-3.1 AU] vs 2.1 AU [IQR, 1.8-2.5 AU]; P <0.001) and lower IENFD (10 fibers/mm [IQR, 7-14 fibers/mm] vs 12 fibers/mm [IQR, 8-16 fibers/mm]; P = 0.005). We found a positive correlation between skin AF and patients' age (Rs = 0.44; P <0.001), diabetes duration (Rs = 0.32; P <0.001), and a negative correlation between skin AF and the estimated glomerular filtration rate (Rs = -0.26, P <0.001) and IENFD (Rs = -0.22; P = 0.004). In a multiple linear regression analysis, skin AF was independently associated with age (β = 0.45; P <0.001), glycated hemoglobin level (β = 0.19; P = 0.007), and IENFD (β = - 0.14; P = 0.04) (R2 = 0.27; P <0.001). In multivariate logistic regression, the presence of DPN was independently associated with skin AF (odds ratio, 4.16; 95% confidence interval, 1.88-9.20; P <0.001). CONCLUSIONS The presence of DPN, and particularly small fiber neuropathy, is associated with a higher accumulation of AGEs in the skin of patients with type 1 diabetes.

INTRODUCTION    Lipoprotein-associated phospholipase A2 (Lp-PLA2) and cholesteryl ester lipase (CEL) may oxidize low-density lipoproteins (oxLDL). OBJECTIVES    The aim of the study was to determine the influence of metformin on the metabolism of atherogenic lipid fractions in relation to Lp-PLA2 and CEL levels, as well as assess consequent improvement in the intima-media thickness (IMT) of the common carotid artery in young type 1 diabetes patients with excess body fat. PATIENTS AND METHODS    It was an open-label randomized clinical trial that lasted 6 months. It included a total of 84 people with metabolic decompensation (glycated hemoglobin >7.5%, >58.5 mmol/mol) of diabetes. Adjunctive metformin therapy (in addition to insulin) was administered in 42 patients, and the remaining 42 patients received insulin alone. Glycated low-density lipoproteins (LDLs), oxLDL, Lp-PLA2, and CEL were assessed by commercially available enzyme-linked immunosorbent assay kits. Cartoid IMT was measured using the Carotid Analyser for Research tool. Biochemical analyses were performed using routine laboratory techniques. RESULTS    The reduction of mean carotid IMT was observed in young type 1 diabetic adults treated additionally with metformin (0.6 ±0.1 cm vs 0.53 ±0.1 cm; P = 0.002). This effect was probably due to weight reduction (90 ±16 kg vs 87 ±15 kg, P = 0.054) and the decrease in atherogenic glycated LDL levels (1.5 ±0.5 mg/dl vs 1.6 ±1.046 mg/dl, P = 0.006). No such correlations were observed in patients treated with insulin alone. Additionally, in patients receiving metformin, glycated LDL levels were inversely correlated with Lp-PLA2 levels (r = -0.31, P <0.05). CONCLUSIONS    Additional use of metformin in young type 1 diabetic patients with excess body fat leads to a significant reduction of mean IMT in the common carotid artery. Concentrations of CEL and Lp-PLA2 were significantly increased in both study arms despite improved glucose metabolism.

INTRODUCTION Gastrointestinal symptoms may occur in 50% to 70% of patients with diabetes. OBJECTIVES The aim of this study was to evaluate the prevalence of small intestinal bacterial overgrowth (SIBO) in patients with diabetes, as well as the relationship between SIBO and metabolic control of diabetes and the presence of chronic complications of the disease. PATIENTS AND METHODS The study group included 148 patients with type 1 diabetes, treated in the years 2013-2015. The control group consisted of 41 healthy volunteers. The presence of SIBO was assessed with a noninvasive breath test using 20 g of lactulose suspended in 200 ml of water, with the assessment of exhaled hydrogen concentrations. The measurements were performed at 15-minute intervals in the first hour and at 30-minute intervals in the second hour of the test. A positive result was considered as the output value of exhaled hydrogen of 20 parts per million (ppm) or higher or an increase in the output value of the exhaled hydrogen of 12 ppm during the first 60 minutes of the test.  RESULTS We observed a lower prevalence of SIBO in the study group in comparison with controls (56 patients [37.8%] vs 30 healthy volunteers [73%]; P = 0.006). In the logistic regression model, this association was independent of age, sex, body mass index, cigarette smoking, serum C-reactive protein concentrations, and estimated glomerular filtration rate (odds ratio, 0.26; 95% confidence interval, 0.10-0.68; P = 0.006). CONCLUSIONS The prevalence of SIBO in patients with type 1 diabetes is lower than that in healthy subjects. One of the possible causes might be the beneficial effect of nutritional therapy in patients with diabetes.

Autoimmune Addison's disease (AAD) associates with exceptional susceptibility to develop other autoimmune conditions, including type 1 diabetes (T1D), marked by positive serum autoantibodies to insulin (IAA), glutamic acid decarboxylase (GADA) and insulinoma-associated protein 2 (IA-2A). Zinc transporter 8 (ZnT8) is a new T1D autoantigen, encoded by the SLC30A8 gene. Its polymorphic variant rs13266634C/T seems associated with the occurrence of serum ZnT8 antibodies (ZnT8A). This study was designed to determine the prevalence of serum ZnT8A and their clinical implication in 140 AAD patients. Other beta cell and thyroid-specific autoantibodies were also investigated, and ZnT8A results were confronted with the rs13266634 genotype. ZnT8A were detectable in 8.5 %, GADA in 20.7 %, IA-2A in 5.7 %, IAA in 1.6 % and various anti-thyroid antibodies in 7.1-67.8 % individuals. Type 1 diabetes was found in 10 % AAD patients. ZnT8A were positive in 57.1 % of T1D patients and 3.4 % non-diabetic AAD. Analysis of ZnT8A enabled to identify autoimmunity in two (14.3 %) T1D individuals previously classified as autoantibody-negative. ZnT8A-positive patients revealed significantly higher number of autoimmune conditions (p < 0.001), increased prevalence of T1D (p < 0.001) and other beta cell-specific autoantibodies. Carriers of the rs13266634 T-allele displayed increased frequency (p = 0.006) and higher titres of ZnT8A (p = 0.002). Our study demonstrates high incidence of ZnT8A in AAD patients. ZnT8A are associated with coexisting T1D and predictive of T1D in non-diabetic subjects. Moreover, positive ZnT8A in AAD indicate elevated risk for additional autoimmune conditions. Autoantibodies to beta cell antigens, comprising ZnT8, could be included in routine screening panels in AAD.

Chronic microvascular complications of type 1 diabetes relate to small and medium-sized vessels and clinically manifest as retinopathy, nephropathy and neuropathy as well as periodontitis. Cigarette smoking significantly modifies the course of inflammation in subjects without diabetes. The aim of the study was to assess the periodontal status in smoking and non-smoking subjects with type 1 diabetes., Materials and Methods: 115 subjects with type 1 diabetes, median age 32 years (IQR 25-38), median HbA1c 8.3% (7.4-9.4) were included. Assessed gingival indices comprised API, SBI, GI., Results: Smoking cigarettes was more frequent among men compared to women (p = 0.03). API was lower among women compared to men (p = 0.004). There was no correlation between HbA1c and gingival indexes, however, people achieving good metabolic control (HbA1c≤6.5%) had a lower API (p = 0.039). Smokers presented lower SBI compared to non- -smokers (p = 0.03)., Conclusions: People with type 1 diabetes smoking cigarettes present lower gingival bleeding compared to non-smokers. In people with poor metabolic control of type 1 diabetes there is an increased accumulation of dental plaque in comparison with well-controlled type 1 diabetic patients.

Nowadays, self-management of diabetes is more and more often based on continuous and flash glucose monitoring systems. In addition to measuring current glucose levels, both systems provide blood glucose levels from the past few hours in the form of a graph, as well as an indication of glucose trends via arrows. This information adds a new dimension to the self-management of diabetes, and should result in the modification of diabetes therapy. The paper presents proposals for modifications of treatment decisions based on glucose trends in patients with type 1 diabetes. By considering glucose trends, it is hoped that glycemic variability and numbers of hypoglycemia and hyperglycemia episodes will be reduced., (© Polish Society for Pediatric Endocrinology and Diabetology.)