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Background and aims A healthy diet has been inversely associated with endothelial dysfunction (ED) and low-grade inflammation (LGI). We investigated the association between nutrient consumption and biomarkers of ED and LGI in type 1 diabetes. Methods and results We investigated 491 individuals. Nutrient consumption and lifestyle risk factors were measured in 1989 and 1997. Biomarkers of ED (von Willebrand factor, soluble vascular cell adhesion molecule-1 and soluble endothelial selectin) and LGI (C-reactive protein, interleukin 6 and tumour necrosis factor α) were measured in 1997 and averaged into Z-scores. The nutrient residual method was used to adjust individual nutrient intake for energy intake. Data were analysed with generalised estimation equations. We report increments/decrements in nutrient consumption, averaged over time, per +1 standard deviation (SD) of 1997 ED or LGI Z-scores, after adjustment for sex, age, duration of diabetes, investigation centre, body mass index, energy intake, smoking behaviour, alcohol consumption, and each of the other nutrients. One SD elevation in ED Z-score was associated with a diet lower in fibre [β(95%CI);−0.09(−0.18;−0.004)], polyunsaturated fat [−0.18(−0.31;−0.05)] and vegetable protein [−0.10(−0.20;−0.001)]. For the LGI Z-score results showed associations with fibre [−0.09(−0.17;−0.01)], polyunsaturated fat [−0.14(−0.24;−0.03)] and cholesterol [0.10(0.01; 0.18)]. Conclusion In type 1 diabetes, consumption of less fibre, polyunsaturated fat and vegetable protein, and more cholesterol over the study period was associated with more ED and LGI. Following dietary guidelines in type 1 diabetes may reduce cardiovascular disease risk by favourably affecting ED and LGI.

Background/objectives - Individuals with type 1 diabetes have a high risk of developing cardiovascular diseases, and it has been reported that they consume a high atherogenic diet. We examined how nutrient intake and adherence to current European nutritional recommendations evolved in a large cohort of European individuals with type 1 diabetes over a period of 7 years. Subjects/methods - We analysed data from the EURODIAB Prospective Complications Study, a European multicentre prospective cohort study. Standardized 3-day dietary records were employed in individuals with type 1 diabetes. One thousand one hundred and two patients (553 men, 549 women, baseline age 33 ± 10 years, duration 15 ± 9 years) had complete nutritional data available at baseline and after 7 years. We calculated mean differences in reported nutrients over time and adjusted these for age, gender, HbA1c and BMI with ANOVA models. Results - Compared to baseline, there were minor changes in nutrients. Reported protein (-0.35 % energy (en), fat (-1.07 % en), saturated fat (-0.25 % en) and cholesterol (-7.42 mg/1000 kcal) intakes were lower, whereas carbohydrate (+1.23 % en) and fibre (+0.46 g/1000 kcal) intakes were higher at the 7-year follow-up. European recommendations for adequate nutrient intakes were followed in individuals with type 1 diabetes for protein (76 % at baseline and 78 % at follow-up), moderately for fat (34, 40 %), carbohydrate (34, 41 %) and cholesterol (39, 47 %), but poorly for fibre (1.4, 2.4 %) and saturated fat (11, 13 %). Conclusion - European individuals with type 1 diabetes consume a high atherogenic diet as few patients met recommendations for dietary fibre and saturated fat. This study showed minor changes in dietary nutrients and energy intakes over a period of 7 years. Nutrition education needs particular focus on strategies to increase dietary fibre and reduce saturated fat to exploit their potential benefit.

W pracy przedstawiono wyniki badania ACCORD Lipid, dotyczącego skuteczności klinicznej w prewencji angiopatii i bezpieczeństwa leczenia skojarzonego dyslipidemii cukrzycowej za pomocą statyny i fibratu w porównaniu z monoterapią statyną. Badaniem objęto 5518 chorych na cukrzycę typu 2, leczonych simwastatyną i fenofibratem, w porównaniu z simwastatyną i placebo. Po średnio 4,7 roku trwania badania nie obserwowano istotnych różnic w zakresie punktów końcowych (zgonów sercowo-naczyniowych, zawałów serca i udarów mózgu) pomiędzy porównywanymi grupami. Korzystny trend terapii skojarzonej w zestawieniu z monoterapią statyną w postaci 31-procentowej redukcji incydentów sercowo-naczyniowych obserwowano w podgrupie chorych z obniżonym stężeniem cholesterolu frakcji HDL i podwyższonym stężeniem triglicerydów - profilem typowym dla aterogennej dyslipidemii. Wyniki badania ACCORD Lipid sugerują stosowanie terapii skojarzonej u pacjentów z odpowiednim profilem lipidowym. n this article ACCORD Study results, concerning clinical efficacy in preventing cardiovascular disease and safety of combined statin and fibrate treatment in patients with type 2 diabetes in comparison to statin monotherapy are presented. Study included 5518 patients with type 2 diabetes, treated with simvastatin and fenofibrate in comparison to simvastatin and placebo. After 4.7 years of treatment no significant differences in primary end points (cardiac death, myocardial infarction and stroke) were observed between compared groups. However, favourable trend of combined therapy in comparison to statin monotherapy in the subgroup of patients with low HDL-cholesterol and high triglycerides - lipid profile typical for atherogenic dyslipidemia - 31% decrease of cardiovascular end-points was observed. The results of ACCORD Lipid Study suggest combined therapy according to patients’ lipid profile

WSTĘP. W ostatnio opublikowanych badaniach wykazano istotną rolę czynników wzrostowych i cytokin prozapalnych w rozwoju nefropatii cukrzycowej. Celem pracy była ocena wpływu wybranych czynników wzrostowych i markerów stanu zapalnego na rozwój zmian w nerkach u pacjentów z nefropatią cukrzycową. MATERIAŁ I METODY. Badaniami objęto 50 chorych z nefropatią w przebiegu cukrzycy typu 2, w tym 25 poddano obserwacji prospektywnej trwającej 36 miesięcy. U wszystkich pacjentów oznaczono stężenie czynników zapalnych i wzrostowych we krwi oraz parametry wydolności nerek. WYNIKI. Chorzy z nefropatią cukrzycową charakteryzowali się istotnie wyższym stężeniem fibrynogenu, hsCRP, IL-6 i sTNF-RII w porównaniu z wartościami referencyjnymi. W badaniu wyjściowym stwierdzono, że podwyższone stężenia IL-6 i sTNF-RII wiązały się ze spadkiem wartości GFR (r = –0,3; p = 0,01 oraz r = –0,7; p < 0,0001). Po 36 miesiącach obserwacji wykazano związek stężenia hsCRP, sTNF-RII z albuminurią (r = 0,5; p = 0,008 i r = 0,5; p = 0,02) oraz VEGF z wartością GFR (r = –0,4; p = 0,03). WNIOSKI. W niniejszej pracy wykazano, że u chorych z nefropatią cukrzycową, w stosunku do wartości referencyjnych, występują istotnie wyższe stężenia markerów zapalnych. W badaniu prospektywnym wzrost wartości stężeń markerów zapalnych wiązał się z progresją nefropatii - obniżeniem GFR i wzrostem albuminurii. BACKGROUND. Presently published research points to an essential role of growth and pro-inflammatory cytokines in the development of diabetic nephropathy. The aim of the study was to evaluate influence of certain growth factors and inflammatory markers on the progression of kidney changes in patients with diabetic nephropathy. MATERIAL AND METHODS. Material included 50 patients with diabetic nephropathy, 25 out of them re-evaluated after 36 months. Inflammatory and growth factors were measured along with renal parameters in all patients. RESULTS. Patients with diabetic nephropathy were characterized with significantly higher values of fibrinogen, hsCRP, IL-6 and sTNF-RII in comparison to reference values. In the initial examination, increased concentrations of IL-6 and sTNF-RII were associated with decreased values of GFR (r= –0.3; p = 0.01, as well as r = –0.7; p < 0.0001). After 36 months of observation - an association was found between concentrations of hsCRP, sTNF-RII and albuminuria (r = 0.5; p = 0.008 and r = 0.5; p = 0.02); as well as between VEGF and GFR values (r = –0.4; p = 0.03). CONCLUSIONS. Research showed that patients with diabetic nephropathy in comparison to reference values had significantly higher concentrations of inflammatory markers. In the prospective examination - changes of inflammatory markers were associated with progression of nephropathy (decrease of GFR and increase of albuminuria).

W niniejszej pracy omówiono zasady postępowania w dyslipidemii u chorych na cukrzycę typu 2. Istotną rolę odgrywa obniżenie stężenia cholesterolu frakcji LDL, należy jednak dążyć do normalizacji całego profilu lipidowego. Modyfikacja stylu życia i ścisłe wyrównanie glikemii, a także kontrola stężenia lipidów i dostosowywanie dawek leków w celu uzyskania stężeń docelowych mają istotne znaczenie w uzyskaniu dobrego efektu terapeutycznego. In this paper we described the practical guidelines of diagnosis and treatment of diabetic dyslipidemia. The primary treatment goal is to decrease LDL-cholesterol concentration, however, normalization of the whole lipid profile is recommended. Life style modification, strict glycemic control, as well as serum lipids control and adjusting drugs dose to obtain goal levels is important in achieving good therapeutic effect.