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Wstęp. Rejestr Kliniczny Fundacji ORKIESTRA był badaniem prospektywnym, wieloośrodkowym, obserwacyjnym, postmarketingowym, w którym badano stosowanie pompy insulinowej z systemem ciągłego monitorowania glikemii (CGM) lub bez CGM [tj. pompy wzbogaconej o system ciągłego monitorowania glikemii (SAP) lub pompy zintegrowanej z systemem ciągłego monitorowania glikemii (SIP)] u kobiet z cukrzycą typu 1 (T1DM). Materiał i metody. Rekrutacja kobiet do badania była prowadzona w 24 ośrodkach w Polsce, w których zbierano dane dotyczące dawkowania insuliny i obserwacji przez okres do 22 miesięcy (tj. do 12 miesięcy przed koncepcją, w trakcie ciąży i 6 tygodni po porodzie). Kobiety, które były już w ciąży, zostały włączone do 16. tygodnia ciąży. Badane wyniki obejmowały stężenie HbA1c przed ciążą i w czasie ciąży oraz poważne działania niepożądane (np. ciężka hipoglikemia, kwasica ketonowa, poronienie i hospitalizacja z powodu jakichkolwiek krwawień lub objawów sugerujących przedwczesny poród). Rejestrowano także rutynowe dane kliniczne, takie jak masa ciała kobiet ciężarnych, wskaźnik masy ciała (BMI) oraz dzienne zużycie insuliny. Urządzenia podające insulinę wykorzystane w badaniu to pompa insulinowa MiniMed™ Paradigm™ REAL-Time z funkcją ciągłego monitorowania glikemii (CGM) (za pomocą sensora MiniMed Sof-sensor™) lub bez CGM oraz MiniMed Paradigm Veo™ z funkcją CGM (za pomocą sensora Enlite™). Wyniki. Rekrutację do badania rozpoczęto w maju 2013 roku, a ostatnia pacjentka ukończyła badanie w sierpniu 2017 roku. Wnioski. Rejestr Kliniczny Fundacji ORKIESTRA pozwoli ocenić wyniki zautomatyzowanej podaży insuliny u kobiet w ciąży z T1DM przy użyciu pomp insulinowych z funkcją ciągłego monitorowania glikemii lub bez takiej funkcji. Background. The ORCHESTRA FOUNDATION Registry study was a prospective, multicenter, observational, post-market study investigating the use of an insulin pump with or without continuous glucose monitoring (CGM) [i.e., sensor-augmented pump (SAP) or sensor-integrated insulin pump (SIP)]; before, during, and after pregnancy, in women with type 1 diabetes mellitus (T1DM). Methods. Study participants enrolled in 24 centers, in Poland, and contributed intake and follow-up data for up to 22 months (i.e., up to 12 months pre-conception, throughout pregnancy, and 6 weeks after delivery). Participants who were already pregnant were enrolled up to the 16th week of pregnancy. Investigated outcomes included HbA1c before and during pregnancy, and serious adverse events (e.g., severe hypoglycemia, diabetic ketoacidosis, miscarriage, and hospitalization due to any bleeding or any symptoms suggesting premature delivery). Routine clinical data including maternal weight, body mass index, and daily insulin use were also recorded. The insulin delivery devices used in the study were the MiniMed™ Paradigm™ REAL-Time insulin pump with CGM (via the MiniMed Sof-sensor™ sensor) or without CGM, and the MiniMed Paradigm Veo™ with CGM (via the Enlite™ sensor). Results. Study enrollment began in May 2013 and the last patient completed the study in August 2017. Conclusions. The ORCHESTRA FOUNDATION Registry study provides an opportunity to assess the effects of automated insulin delivery in pregnant women with T1DM using insulin pumps with or without continuous glucose monitoring.

Background: ARETAEUS 1 study showed that a great majority of patients with type 2 dia­betes mellitus (T2DM) of short duration did not meet all of the treatment goals. Since then the treatment goals in T2DM have been changed. The aim of the ARETAEUS 2-Grupa Study was to assess cardiovascular (CV) risk management and meeting treatment goals in the population of T2DM of more than 10-year duration. Methods: ARETAEUS2-Grupa was a cross-sectional questionnaire-based study conducted in Poland in 2012. Randomly selected physicians recruited 1,740 patients with T2DM diag­nosed more than 10 years before the study. Results: Lipid treatment goals were met respectively: for total cholesterol in 34.5% of all patients, triglycerides in 53.8%, low density lipoprotein cholesterol (LDL-C) in 26.5% and high density lipoprotein cholesterol (HDL-C) in 38.2%. Most of patients with and without coronary artery disease were receiving aspirin (90.3% and 60%, respectively) and statins (84.4% and 67.7%, respectively). The current blood pressure (BP) goal (140/90 mm Hg) was met in 43.5% of pa­tients and the previous goal (< 130/80 mm Hg) in 12.4%. The patients were mainly treated with ≥ 3 antihypertensive drugs. All treatment goals (for HbA1c, BP and LDL-C) were reached only by 8.2% of patients, any two goals by 26.3% of patients, one goal by 39.8% of patients, none by 25.6% of patients. Conclusions: The new less restrictive treatment goals are reached more frequently but still much is to be done in the field of clinical practice guidelines implementation and CV prevention in T2DM population.

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.

Mieszanki insulinowe odgrywają ważną rolę w leczeniu cukrzycy typu 2 po wystąpieniu nieskuteczności leków doustnych. Przy rozpoczynaniu leczenia insuliną, po krótkim okresie postępowania skojarzonego lekami doustnymi i insuliną NPH, często konieczne jest przejście do stosowania mieszanek. Akceptowane jest także rozpoczynanie insulinoterapii od stosowania mieszanek dwa razy dziennie. Nie wykazano istotnych różnic w efektach leczenia między mieszankami insulin ludzkich i analogowych. Przy wprowadzeniu mieszanek insulin ludzkich obserwowano poprawę jakości życia. W niektórych sytuacjach bardziej przydatne są mieszanki insulin ludzkich niż analogowych, na przykład przy gastroparezie albo u chorych preferujących dodatkowe przekąski między posiłkami. Premixed insulins have a very important role in the therapy of type 2 diabetes after fail of the oral treatment. In initiation of insulin therapy, after short period of combined therapy with oral drugs and NPH insulin, introduction of premixed insulins is necessary. Often the initiation of insulin therapy with two daily injections of premixed insulins is also accepted. There are no serious differences in effects of therapy between human and analog premixed insulins. After introduction of human premixed insulins the improvement in quality of life was observed. In some circumstances there is superiority of human premixed insulins in comparison to analog premixed insulins, eg. in gastroparesis or in patients preferring snacks between main meals.

W pracy opisano budowę i działanie akarbozy, jak i jej wpływ na glikemię poposiłkową. Akarboza jest ważnym lekiem hamującym powstanie jawnej cukrzycy i zmniejszającym ryzyko sercowo-naczyniowe u osób ze stanem przedcukrzycowym. Zarówno działanie, jak i charakter skutków ubocznych akarbozy jest bardzo zbliżony do leków inkretynowych. Być może mechanizm działania tego leku częściowo wiąże się z osią jelitowo-trzustkową. Głównymi beneficjentami akarbozy są pacjenci z cukrzycą typu 2 z wysoką glikemią poposiłkową i osoby ze stanem przedcukrzycowym. Podsumowując, akarboza może być przepisywana na każdym etapie leczenia cukrzycy typu 2. The structure and mechanism of action of acarbose as well as ist role in normalization of postprandial hiperglycaemia is described. Acarbose is very important drug in reduction of risk of development of overt diabetes and in reduction of cardiovascular risk among persons with prediabetes state. The action as well as character of additional effects of acarbose is very similar to its described by incretins. Perhaps the mechanism of action of acarbose is partially connected with its effect on intestine-pancreatic axis. The beneficients of acarbose are patients with type 2 diabetes with high postprandial glycaemia as well persons with prediabetes. In summary, acarbose can be prescribed in every stage of treatment of type 2 diabetes.

Metformina ma znaczenie na wszystkich etapach leczenia cukrzycy typu 2. Wśród mechanizmów jej działania istotne miejsce zajmuje mechanizm inkretynowy. Działanie inkretynowe metforminy najprawdopodobniej polega na redukcji oporności komórki beta na GLP-1, co jest defektem uwarunkowanym genetycznie. The role of metformin is very important on every stage of therapy of type 2 diabetes. Among mechanismas of its action important is inkretin-like effect. This effect bases on reduction of the resistance of beta cell against GLP-1, what is probably determined genetically.

Neuropatia autonomiczna przewodu pokarmowego jest jednym z poważnych powikłań cukrzycy wpływających na stopień wyrównania choroby. Opóźnienie opróżniania żołądkowego zaburza relacje między absorpcją substratów pokarmowych a czasem działania insuliny. Opóźnienie szczytu działania insuliny, charakterystyczne dla insuliny ludzkiej, w porównaniu z analogami szybkodziałającymi, może być korzystne w odtworzeniu właściwych relacji czasowych między wchłanianiem pokarmu a działaniem hipoglikemicznym insuliny. Gastrointestinal autonomic neuropathy is one of the serious complications of diabetes influencing the degree of compensation of disease. Delay of stomach emptying disregulates relations between absorption of energy fuels and time of insulin action. Some delay of the peak of insulin action characteristic for human insulin in comparison with short acting insulin analogs may be beneficial in restoring proper relation in timing of meal absorption and hypoglycaemic effect of injected insulin.