Barbara Głowińska-Olszewska

Publications of Barbara Głowińska-Olszewska

• [Endothelial progenitor cells as a new marker of endothelial function with respect to risk of cardiovascular disorders].

  Authors: Barbara Głowińska-Olszewska, Włodzimierz Luczyński, Artur Bossowski

  Postȩpy higieny i medycyny doświadczalnej (Online). 01/2011; 65:8-15.

  The discovery of endothelial progenitor cells (EPC), over a decade ago, has refuted the previous belief that vasculogenesis only occurs during embryogenesis. The results of several studies revealedThe discovery of endothelial progenitor cells (EPC), over a decade ago, has refuted the previous belief that vasculogenesis only occurs during embryogenesis. The results of several studies revealed altered number and impaired function of EPC in hyperlipidemia, hypertension, diabetes, obesity as well as in rheumatoid arthritis. The population of developmental age is characterized by higher counts of EPC compared to adults. However, among young patients with chronic disorders that affect the vascular system, the number of EPC decreases. The reduced circulating concentration of EPC has become a surrogate marker of endothelial function and has been implicated in the pathogenesis of many vascular diseases. This article aims to review the biology and pathophysiology of EPC in the conditions of cardiovascular risk factors. The potential possibilities of increasing EPC number and function as well as the use of EPC in the treatment of vascular pathology will also be discussed.

• [Generation of T regulatory cells in children with type 1 diabetes mellitus].

  Authors: Włodzimierz Luczyński, Natalia Wawrusiewicz-Kurylonek, Agnieszka Szypowska, Elżbieta Iłendo, Artur Bossowski, Adam Krętowski, Barbara Głowińska-Olszewska, Marek Hryszko, Maria Górska, Anna Stasiak-Barmuta

  Pediatric endocrinology, diabetes, and metabolism. 01/2011; 17(2):64-70.

  In spite of intensive research the pathogenesis of type 1 diabetes mellitus is not thoroughly understood. One of the ideas which currently has a great number of supporters is the theory of theIn spite of intensive research the pathogenesis of type 1 diabetes mellitus is not thoroughly understood. One of the ideas which currently has a great number of supporters is the theory of the participation of T regulatory cells in the mechanism of insufficient suppression of the immune response against pancreatic self -antigens. According to some authors, the infusion of T regulatory cells in autoimmune diseases could lead to long -term remission or even a complete cure. Aim of the study: The aim of our present study was to achieve T regulatory cells from conventional T lymphocytes isolated from a small amount of peripheral blood in children with type 1 diabetes mellitus and their comparison to the Tregs generated from the blood of control children. Additionally, we assessed the changes in the expression of selected genes essential for the function of these cells during Tregs generation. The examined group consisted of 20 children with type 1 diabetes mellitus, the control group consisted of 20 non -diabetic children. From the peripheral blood CD4+CD25 - cells were separated and cultured with T -reg expander and interleukin (IL) 2. Before and after the culture the cells were analysed according to the expression of transcription factor FoxP3 and other molecules/cytokines: OX40, 4 -1BB, GITR, ICOS -1, CTLA -4 and IFN -γ, IL -10 and TGF -β. We observed a significantly higher percentage of T regulatory cells after the culture (with no difference between diabetic and control children). Moreover, we observed a lower expression of mRNA for GITR molecule and a higher IL -10 expression in the cultures of diabetic children compared to the control ones. The cells cultured from the blood of control children were characterised by a higher increase in the expression of mRNA for ICOS -1 and a lower expression of mRNA for TGF -β in comparison to the cultures from diabetic children. The results of our investigations confirm the possibility of generating T regulatory cells from conventional T lymphocytes from peripheral blood of children with newly recognised type 1 diabetes mellitus.

• Overweight, obesity and features of metabolic syndrome in children with diabetes treated with insulin pump therapy.

  Authors: Włodzimierz Łuczyński, Agnieszka Szypowska, Barbara Głowińska-Olszewska, Artur Bossowski

  European journal of pediatrics. 12/2010; 170(7):891-8.

  There has been no specific evaluation of atherogenic risk factors in children with type 1 diabetes mellitus (T1DM) treated with continuous subcutaneous insulin infusion (CSII). We, therefore, studiedThere has been no specific evaluation of atherogenic risk factors in children with type 1 diabetes mellitus (T1DM) treated with continuous subcutaneous insulin infusion (CSII). We, therefore, studied the prevalence of overweight/obesity and metabolic syndrome among these patients. Five hundred children with T1DM treated with CSII and multiple daily insulin (MDI) regimen were included in the study. Anthropometric data/physical examination, data concerning diabetes, and a lipid profile were assessed in this group, and compared with respect to treatment method (CSII vs. MDI). Almost one-third (30.2%) of the children were overweight/obese. The body mass index (BMI) values at the time of the present evaluation were significantly higher in comparison with the BMI values 3-6 months after the diagnosis. Dyslipidemia was recognized in 51.6%, hypertension in 4.8%, and the metabolic syndrome in 3.2%. of the subjects. The overweight/obese children differed from their normal-weight counterparts with respect to metabolic control, the incidence of hypertension, dyslipidemia, and metabolic syndrome. The girls showed higher prevalence of overweight/obesity and higher BMI values compared to the boys. The children treated with CSII had the same prevalence of overweight/obesity, but a lower incidence of dyslipidemia, and a better metabolic control compared to the children treated with MDI regimen. Our study shows a high prevalence of overweight/obesity and dyslipidemia in children with T1DM including those treated with an insulin pump.

• [Higher percentages of T regulatory cells in children at risk for developing type 1 diabetes mellitus].

  Authors: Włodzimierz Luczyński, Anna Stasiak-Barmuta, Małgorzata Myśliwiec, Agnieszka Nikołajuk, Agnieszka Brandt, Remigiusz Urban, Justyna Kos, Agnieszka Juchniewicz, Jolanta Jabłońska, Agnieszka Otocka, Barbara Głowińska-Olszewska, Bozena Florys, Mirosława Urban, Maria Górska, Anna Balcerska

  Pediatric endocrinology, diabetes, and metabolism. 01/2010; 16(1):7-10.

  The natural history of type 1 diabetes is concerned with the appearance of autoantibodies against antigens of pancreatic beta cells. The last decade revealed some evidence of the participation of TThe natural history of type 1 diabetes is concerned with the appearance of autoantibodies against antigens of pancreatic beta cells. The last decade revealed some evidence of the participation of T regulatory lymphocytes - cells which suppress immune response - in the pathogenesis of type 1 diabetes and prediabetes. was the assessment of T regulatory cells in the blood of children at risk for developing type 1 the diabetes mellitus. 85 subjects, siblings of children with type 1 diabetes, were enrolled into the study. The presence of anti-GAD65 antibodies was assessed. With the use of flow cytometry the following cell subpopulations were noted: CD4+, CD4+CD25high and CD4+CD25highCD127low with the coexpression of: CD28, CD45RO, CD54, CD62L and CD134 molecules. We did not observe any differences in white blood cell count, lymphocyte (including CD4+) count and the percentage between the examined and control groups. We noted higher percentages of T regulatory cells: CD4+CD25high, CD4+CD127low and CD4+CD25highCD127low in children with the presence of anti-GAD65 antibodies as compared to the control children. Higher percentages of T regulatory cells in the blood of children with the presence of anti-GAD65 antibodies may suggest an intensive regulatory response present in patients at risk for developing type 1 diabetes.

• [Asymmetric dimethylarginine (ADMA) in children with diabetes type 1].

  Authors: Barbara Głowińska-Olszewska, Włodzimierz Luczyński, Jolanta Jabłońska, Agnieszka Otocka, Bożena Florys, Artur Bossowski

  Pediatric endocrinology, diabetes, and metabolism. 01/2010; 16(3):137-41.

  Asymmetric dimethylarginine (ADMA), a naturally occurring product of asymmetric methylation of proteins, is an endogenous inhibitor of endothelial nitric oxide synthase. ADMA is now recognized as anAsymmetric dimethylarginine (ADMA), a naturally occurring product of asymmetric methylation of proteins, is an endogenous inhibitor of endothelial nitric oxide synthase. ADMA is now recognized as an independent marker of endothelial dysfunction and atherosclerosis. Data concerning ADMA level in type 1 diabetes (DM1) are controversial. The aim of the study was to evaluate ADMA level in children with DM1, without clinical evidence of vascular complications, with particular attention to additional cardiovascular risk factors (hypertension, obesity, hyperlipidemia). The study group included 72 children with DM1, aged mean 15±3 yrs (8-20 yrs), 33 boys and 39 girls, with diabetes duration time mean 6.6±3.5 yrs (1-14 yrs), HBA1c mean level 8.2±2.3% (5.6-15%). The control group consisted of 41 (19 boys and 22 girls) healthy children, aged mean--14.8±2.6 yrs, from 8 to 18 yrs, gender matched, with no family history of cardiovascular disease. ADMA level was determined in plasma using ELISA kit (DLD Diagnostica, Hamburg, Germany) ADMA level was similar in children with diabetes and in the control group: 0.69±0.33 vs. 0.7±0.27 μmol/L, ns. We did not find differences in ADMA level in diabetic children with the presence of additional diseases being cardiovascular risk factors. In the group of 13 children with hypertension ADMA level was the highest: 0.79±0.25 μmol/L, but the difference was statistically insignificant in comparison to children with diabetes without hypertension and in comparison to healthy controls. Children with DM1, without clinically evident vascular complications, have ADMA levels similar to healthy children. A possible relationship between ADMA and hypertension in these patients requires further investigation.

• [The role of T-regulatory cells in the pathogenesis of immunological disturbances accompanying obesity and atherosclerosis].

  Authors: Włodzimierz Luczyński, Artur Bossowski, Barbara Głowińska-Olszewska, Justyna Kos, Anna Stasiak-Barmuta

  Postȩpy higieny i medycyny doświadczalnej (Online). 01/2010; 64:156-60.

  Obesity and atherosclerosis, and their consequences, including cardiovascular disease, are plagues of the 21st century. Chronic inflammation, whose mechanism is not well understood, underlies theObesity and atherosclerosis, and their consequences, including cardiovascular disease, are plagues of the 21st century. Chronic inflammation, whose mechanism is not well understood, underlies the pathophysiological bases of both processes. T lymphocytes, macrophages, and the proinflammatory cytokines produced by these cells play key roles in the immunological disturbances accompanying obesity and atherosclerosis. It was recently shown that T-regulatory cells can play a role in these processes. T-regulatory cells are a small subpopulation of T cells which are responsible for inhibition of the immune response. In this review, experiments conducted in mice and human models on the role of diminished number and/or function of T-regulatory lymphocytes in the pathogenesis of immune disturbances accompanying obesity and atherosclerosis are discussed. The results of studies using T-regulatory cells to stabilize and decrease atherosclerotic lesions in blood vessel walls are also summarized. The results of experiments performed so far are encouraging and give some hope for the future use of T-regulatory cells in the therapy of obesity and atherosclerosis.

• [Overweight, obesity and metabolic syndrome in children with type 1 diabetes melllitus].

  Authors: Włodzimierz Luczyński, Agnieszka Szypowska, Artur Bossowski, Anna Ramotowska, Przemysław Rećko, Małgorzata Rembińska, Magdalena Tercjak, Bernadetta Blecharczyk, Urszula Lachowska, Paweł Suchoń, Karolina Wiśniewska, Paweł Bernatowicz, Barbara Głowińska-Olszewska

  Pediatric endocrinology, diabetes, and metabolism. 01/2010; 16(2):83-8.

  Obesity can be an additional risk factor for developing cardiovascular diseases in patients with diabetes. Aim of the study was the assessment of overweight, obesity and other elements of theObesity can be an additional risk factor for developing cardiovascular diseases in patients with diabetes. Aim of the study was the assessment of overweight, obesity and other elements of the metabolic syndrome in children with type 1 diabetes mellitus. 300 children treated with insulin at least one year were enrolled in the study. In the examined group anthropometric data, data concerned with diabetes and additional laboratory tests including risk factors for cardiovascular diseases were assessed. The median age of the examined group was 13.7 years. The body mass deficiency was noted in 0.66%, normal body mass in 71.6%, overweight in 15.3% and obesity in 12.3%. The abdominal obesity was noted in 16.0% of children. The rise in the body weight between 3-6 months from the beginning of the insulin therapy and the present assessment was statistically significant. Children with normal weight had a better metabolic control in comparison to children with overweight/obesity. Girls had a higher rise in body mass index values between the time of diagnosis and the present investigation compared to boys. Higher values of blood pressure or hypertension were noted in 16.6% of children. Altogether in 25.3% of children some dyslipidemia was observed. The metabolic syndrome criteria were noted in: 28.0% - one criterion, 13.0% - two criteria, and 0.3% - three criteria. The population of children with type 1 diabetes is characterized by high frequency of overweight/obesity, abdominal obesity, dyslipidemia and hypertension. The features of metabolic syndrome are less frequent. It is worthwhile to monitor the risk for development of cardiovascular diseases in this group of children.

• [The assessment of T regulatory cells in the peripheral blood of children with metabolic syndrome].

  Authors: Włodzimierz Łuczyński, Anna Stasiak-Barmuta, Barbara Głowińska-Olszewska, Wojciech Szczepański, Mirosława Urban, Karolina Buczyńska, Małgorzata Rembińska, Magdalena Tercjak, Przemysław Rećko

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 12/2009; 27(162):453-7.

  The metabolic syndrome is defined as the co-existence of risk factors for the development of cardio-vascular disease: obesity, hypertension, insulin resistance and dyslipidemia. For a few years thereThe metabolic syndrome is defined as the co-existence of risk factors for the development of cardio-vascular disease: obesity, hypertension, insulin resistance and dyslipidemia. For a few years there has been a growing interest in immune-inflammatory aspects of obesity and metabolic syndrome. According to many authors the disturbances in the number and(or) function of T regulatory cells are responsible for autoimmune diseases. It is possible that they play a role in a pathogenesis of chronic inflammation accompanying obesity. THE AIM OF THE STUDY was to determine the percentages of T regulatory cells in children with metabolic syndrome. Fourty seven children with metabolic syndrome were prospectively enrolled into the study according to the IDF criteria (central obesity and two of: hypertension, hypertriglycerydemia, low HDL, hyperglycemia/glucose intolerance/diabetes). With the use of five-colour flow cytometry the following percentages of T cells in the peripheral blood were assessed: CD4(+), CD4(+)CD25(high), CD4(+)CD25(high)FoxP3(+), CD4(+)CD25(high)CD127(low), CD4(+)CD25(high)FoxP3(+)CD127(low). In the group of children with metabolic syndrome we noted lower percentages of CD4(+)CD25(high) cells compared to control children: 1.7 vs. 3.7% (p = 0.01). The differences in CD4(+)CD127(low) cells were not statistically significant: 15.7 vs. 17.6% (p = 0.1). We did not observe the differences between examined and control group in the percentages of CD4(+)CD25(high)CD127(low) and CD4(+)CD25(high)FoxP3(+) cells (respectively: 0.54% vs. 0.58%, 0.49 vs. 0.59%, p > 0.05). Results of our investigation suggest the lower percentages of CD4(+)CD25(high) but not other Tregs subpopulation cells in children with metabolic syndrome. The further research concerning the role of Tregs in the pathogenesis of immunologic disturbances accompanying metabolic syndrome will continue.

• [Identification of the CD40 (CD154) ligand expression on the surface of conglomerate platelet-monocyte in children with the metabolic syndrome.]

  Authors: Mirosława Urban, Remigiusz Urban, Irena Krasowska, Barbara Głowińska-Olszewska, Anna Stasiak-Barmuta, Artur Bossowski, Alicja Koput

  Endokrynologia, diabetologia i choroby przemiany materii wieku rozwojowego : organ Polskiego Towarzystwa Endokrynologów Dziecięcych. 01/2008; 14(2):71-5.

  Introduction: The increased expression of the transmembrane protein CD40 on macrophages, endothelium, smooth muscle cells, platelet-monocyte conglomerate is connected with an enlarged risk of theIntroduction: The increased expression of the transmembrane protein CD40 on macrophages, endothelium, smooth muscle cells, platelet-monocyte conglomerate is connected with an enlarged risk of the occurrence of diseases of the cardiovascular system in the metabolic syndrome. The aim of the study was to establish whether metabolic syndrome in children can already be a precursor of cardiovascular diseases. Material and methods: The study was carried out on 35 children aged 10-18 years with the metabolic syndrome recognized according to the National Cholesterol Educational Program Adult Treatment Panel III (ATP III) criteria. The control group consisted of 26 healthy children without risk factors. In the examined children we evaluated BMI, the blood pressure, lipids, hsCRP, and the HOMA index. The analysis of the expression CD 40L (CD154) was performed with a three-color flow cytometer. The identification surrendered 104 cells. Statistical analysis was performed with use of U-Mann-Whitney test, for correlation analysis we used Spearman and Pearson tests. Results: We observed an elevated expression of CD40 ligand on the surface on platelet-monocyte conglomerate in patients with the metabolic syndrome compared to healthy children (12.7 vs. 4.95%, p=0.0036). In addition, we found a statistically significant correlation between the expression of the CD40L and HOMA index (r = -0.33, p<0.028). Conclusions: Enlarged expression of the transmembrane protein CD40L not only initiates and influences the progression of the atherosclerosis, but modulates the architecture of atherosclerotic plaque as well.

• Relationship between endothelial dysfunction, carotid artery intima media thickness and circulating markers of vascular inflammation in obese hypertensive children and adolescents.

  Authors: Barbara Głowińska-Olszewska, Joanna Tołwińska, Mirosława Urban

  Journal of pediatric endocrinology & metabolism : JPEM. 11/2007; 20(10):1125-36.

  BACKGROUND: Adhesion molecules released by dysfunctional endothelium are considered as markers of vascular inflammation in early atherosclerosis. Non-invasive ultrasound methods are now available toBACKGROUND: Adhesion molecules released by dysfunctional endothelium are considered as markers of vascular inflammation in early atherosclerosis. Non-invasive ultrasound methods are now available to detect first preclinical signs of the disease. AIM: To investigate the relationship between selected adhesion molecules and ultrasound indicators of early atherosclerosis: endothelial function measured by flow-mediated dilatation (FMD) and intima media thickness (IMT). PATIENTS: The study group consisted of 85 children, mean age 14.6 years, of whom 22 were obese, 31 were hypertensive, and 32 obese and hypertensive. The control group included 26 healthy children. METHODS: Adhesin concentrations were determined by ELISA. FMD and IMT were evaluated by ultrasound. RESULTS: A positive correlation was found between sICAM-1 (soluble intercellular adhesion molecule 1) and IMT (r = 0.32, p = 0.013, 95% CI: 0.11 to 0.49) and a negative correlation between IMT and FMD (r = -0.26, p = 0.04, 95% CI: -0.43 to -0.04) in the whole study group. In the particular groups, we found significant correlations only in obese hypertensive children. sICAM-1 correlated positively with IMT (r = 0.52, p = 0.001, 95% CI: 0.2 to 0.72) and negatively with FMD (r = -0.31, p = 0.027, 95% CI: -0.6 to -0.2). sE-selectin correlated positively with IMT (r = 0.41, p = 0.012). In regression models, IMT correlated with sICAM-1 (beta = 0.37, p = 0.03) and body mass index (beta = 0.55, p = 0.02), and FMD correlated negatively with sICAM-1 (beta = -0.47, p = 0.04). CONCLUSIONS: The association between inflammatory markers of the endothelium with impaired vasodilatation activity and the first atherosclerotic structural changes in the common carotid arteries were found in obese hypertensive children and adolescents. The coexistence of obesity and hypertension predisposes these young patients to closely related disturbances connected with early atherosclerosis.

• Elevated matrix metalloproteinase 9 and tissue inhibitor of metalloproteinase 1 in obese children and adolescents.

  Authors: Barbara Głowińska-Olszewska, Mirosława Urban

  Metabolism: clinical and experimental. 07/2007; 56(6):799-805.

  Matrix metalloproteinases (MMPs) have been implicated in the atherosclerotic process and risk factors for the disease such as hypertension, hyperlipidemia, or diabetes mellitus in adults. So far,Matrix metalloproteinases (MMPs) have been implicated in the atherosclerotic process and risk factors for the disease such as hypertension, hyperlipidemia, or diabetes mellitus in adults. So far, circulating levels of MMPs and their tissue inhibitors (TIMPs) have not been assessed in children and adolescents with obesity, a known risk factor for cardiovascular disease. Plasma levels of MMP-9 and TIMP-1 were measured immunoenzymatically in 45 obese children and adolescents, aged 15 +/- 1.8 years. The control group consisted of 28 healthy children, aged 14.5 +/- 2.5 years. MMP-9 and TIMP-1 concentrations were higher in obese children than in the control group (MMP-9: 553.5 +/- 311 vs 400.4 +/- 204 ng/mL, respectively; P = .02; TIMP-1: 161.2 +/- 32 vs 143.1 +/- 20.1 ng/mL, respectively; P = .03). We found significantly higher levels of MMP-9 in obese children with coexisting hypertension than in obese normotensive patients (635 +/- 308 vs 450 +/- 289 ng/mL, respectively; P = .04). MMP-9 correlated with body mass index (BMI) (r = 0.33, P = .005) and fasting insulin (r = 0.3, P = .013); TIMP-1 correlated with BMI (r = 0.35, P = .006). In the group of obese hypertensive children (n = 25), MMP-9 correlated with BMI (r = 0.41, P = .001), systolic blood pressure (r = 0.41, P = .002), fasting insulin (r = 0.37, P = .006), and homeostasis model assessment index of insulin resistance (r = 0.27, P = .03). TIMP-1 correlated with BMI (r = 0.33, P = .025) and systolic (r = 0.38, P = .008) and diastolic (r = 0.47, P = .001) blood pressure. In the regression models, MMP-9 was found to be dependent on fasting insulin (R(2) = 0.16, P = .04), and TIMP-1 on BMI (R(2) = 0.14, P = .04). In the obese hypertensive group, TIMP-1 was dependent on diastolic blood pressure (R(2) = 0.18, P = .04). Obese children and adolescents have elevated plasma concentrations of MMP-9 and TIMP-1. Coexistence of hypertension may exacerbate alterations of extracellular matrix turnover in these patients. It might be hypothesized that elevated MMP and TIMP concentrations may be related to increased cardiovascular risk in obese and particularly in obese hypertensive children and adolescents.

• [hsCRP protein in children and adolescents with diabetes type 1]

  Authors: Barbara Głowińska-Olszewska, Mirosława Urban, Jadwiga Peczyńska, Alicja Koput

  Endokrynologia, diabetologia i choroby przemiany materii wieku rozwojowego : organ Polskiego Towarzystwa Endokrynologów Dziecięcych. 02/2007; 13(2):79-84.

  INTRODUCTION: HsCRP protein is known as a novel marker of low grade inflammatory state, which characterises an atherosclerotic process in its early stages. Contrary to a large amount of data onINTRODUCTION: HsCRP protein is known as a novel marker of low grade inflammatory state, which characterises an atherosclerotic process in its early stages. Contrary to a large amount of data on inflammatory markers in diabetes type 2 and metabolic syndrome in adults, little is known so far about the inflammatory process in diabetes type 1, especially in children. The aim of the study was to estimate the level of hsCRP protein in children and adolescents with diabetes type 1 depending on coexisting additional risk factors for atherosclerosis and microvascular complications. MATERIAL AND METHODS: 127 children and adolescents with diabetes duration 6.7+/-3.3 years, aged 14.9+/-3.1, were studied. The control group consisted of 52 healthy children aged 14.9+/-2.8 years, matched acc. to gender. HsCRP level was assessed with use of immunoturbidymetric, latex augmented method (Tina-quant CRP (Latex) HS, Roche). RESULTS: HsCRP in the whole study group was nearly significantly higher compared to control group: 0.17+/-0.2 vs. 0.078+/-0.1 mg/dl, p=0.072. In diabetic hypertensive children (n=38) we found significantly higher levels of hsCRP compared to controls (0.27+/-0.3 vs. 0.07 mg/dl, p=0.008) and compared to diabetic normotensive children (0.13+/-0.22 mg/dl; p=0.024). Diabetic obese patients (n=23) had significantly higer hsCRP compared to controls (0.24+/-0.3 vs. 0.07+/-0.1 mg/dl, p=0.04). In 14 studied diabetic children we found coexisting hypertension and obesity, and we found further increase in hsCRP level - 0.28+/-0.3 mg/dl. In diabetic children with microangiopathy hsCRP level was 0.22+/-0.2 mg/dl, and it was insignificantly higher compared to controls and to diabetic children without complications. Correlation analysis showed interrelations between hsCRP and systolic blood pressure (r=0.2; p=0.04) and HbA1c (r=0.25; p=0.015). In stepwise regression analysis hsCRP was related to systolic blood pressure, HbA1c and the triglycerides level (R=0.37; p=0.003). CONCLUSIONS: In children and adolescents with diabetes type 1 we proved significantly higher levels of hsCRP in case of a coexistence of hypertension and/or obesity. Elevated hsCRP in children with diabetes type 1 and hypertension and/or obesity reflects low grade inflammatory state in the course of metabolic syndrome.

• [Evaluation of central corneal thickness in children and adolescents with type I diabetes mellitus]

  Authors: Beata Urban, Jadwiga Peczyńska, Barbara Głowińska-Olszewska, Mirosława Urban, Alina Bakunowicz-Lazarczyk, Małgorzata Kretowska

  Klinika oczna. 02/2007; 109(10-12):418-20.

  PURPOSE: To evaluate corneal thickness in diabetic and nondiabetic patients. MATERIALS AND METHODS: The central corneal thickness (CCT) was investigated in 100 eyes of 100 patients with diabetes typePURPOSE: To evaluate corneal thickness in diabetic and nondiabetic patients. MATERIALS AND METHODS: The central corneal thickness (CCT) was investigated in 100 eyes of 100 patients with diabetes type I and in 99 nondiabetic patients (99 eyes). The mean diabetic patients age was 15.31 +/- 3.18 years. The mean age in control group was 14.3 +/- 2.2 years. Corneal thickness was measured by non-contact microscope Topcon SP-2000P Statistical analysis was performed to assess systemic factors (patient age, sex, duration of diabetes mellitus, hemoglobin A1c value, diabetes control) related to CCT. SAS STAT (Release 8.2) program, the independent t-test, Kolmogorow-Smirnow test and Bartlett test were used to compare differences between the diabetic and control group. RESULTS: In our study the mean CCT in diabetic eyes was 0.54 +/- 0.03 mm and was significantly increased, compared to control group (0.525 +/- 0.037 mm). None of systemic factors was correlated with CCT. CONCLUSIONS: Our findings indicate that diabetes mellitus affects thickness of cornea in adolescents. Evaluation of endothelium in specular microscope should be performed in the diabetic patients.

• [Interrelationship between endothelial dysfunction, IMT of the carotid arteries and adhesion molecules in obese hypertensive children and adolescents]

  Authors: Barbara Głowińska-Olszewska, Joanna Tołwińska, Mirosława Urban

  Endokrynologia, diabetologia i choroby przemiany materii wieku rozwojowego : organ Polskiego Towarzystwa Endokrynologów Dziecięcych. 01/2007; 13(1):7-14.

  INTRODUCTION: Adhesion molecules released by dysfunctional endothelial cells are markers of an early atherosclerotic process. Ultrasonography of the brachial arteries (flow mediated dilatation - FMD)INTRODUCTION: Adhesion molecules released by dysfunctional endothelial cells are markers of an early atherosclerotic process. Ultrasonography of the brachial arteries (flow mediated dilatation - FMD) is used to detect an impairment of endothelial vasodilation, whereas the examination of intima-media thickness complex (IMT) of the common carotid arteries detects the earliest structural changes of the vessels. The aim of the study was to define the correlations between biochemical markers of endothelial dysfunction (sICAM-1, sVCAM-1, sE-selectin), vasodilatatory function (FMD) and early atherosclerotic changes (IMT) in children and adolescents with obesity and hypertension. MATERIAL AND METHODS: The study group consisted of 85 patients aged 14,6+/-2,4; of whom 22 obese children, 31 hypertensive children and 32 obese hypertensive children were distinguished. The control group included 26 healthy children. Adhesins concentrations were determined by an immunoenzymatic method (R&D Systems). FMD was assessed via the measurement of flow-mediated dilation of the brachial artery by ultrasound (Hewlett Packard Sonos 1000) according to the method worked out by Celermajer, whereas IMT was evaluated by means of Pignolie's method. RESULTS: Linear correlation analysis proved a significant positive correlation between sICAM-1 and IMT (r=0,32, p=0,013) and a marked negative correlation between IMT and FMD (r=-0,26; p=0,04) in the whole study group. Analysis carried out in particular groups showed significant correlations only in the group of obese hypertensive children. sICAM-1 concentration correlated markedly positively with IMT (r=0,52; p=0,001) and negatively with FMD (r=-0,37; p=0,027). sE-selectin concentration correlated significantly positively with IMT (r=0,41; p=0,012). In regression models, IMT correlated with sICAM-1 (p=0,03) and BMI (p=0,02), whereas FMD correlated negatively with sICAM-1 (p=0,04). CONCLUSIONS: The association between adhesion molecules (sICAM-1, sE-selectin) with impaired vasodilation activity and the early atherosclerotic structural changes in the common carotid arteries were found in obese hypertensive children and adolescents. The coexistence of both risk factors may predispose these young patients to closely related disturbances connected with early atherosclerosis.

• [Does autonomic diabetic neuropathy influence microcirculation reactivity in adolescents with diabetes type 1?]

  Authors: Mirosława Urban, Jadwiga Peczyńska, Marek Kowalewski, Barbara Głowińska-Olszewska

  Endokrynologia, diabetologia i choroby przemiany materii wieku rozwojowego : organ Polskiego Towarzystwa Endokrynologów Dziecięcych. 01/2007; 13(1):23-6.

  INTRODUCTION: Microcirculation is known to be disturbed in many organs of diabetic patients. Retinopathy, nephropathy and neuropathy might be considered as the cause of the functional andINTRODUCTION: Microcirculation is known to be disturbed in many organs of diabetic patients. Retinopathy, nephropathy and neuropathy might be considered as the cause of the functional and morphological changes at the level of microcirculation. The aim of the study was to assess by means of dynamic capillaroscopy the influence of autonomic diabetic nephropathy (CAN) in adolescents with type 1 diabetes mellitus on capillary blood flow (CBV) in skin microcirculation. MATERIAL AND METHODS: The study group consisted of 18 patients with type 1 diabetes mellitus (mean age 15+/-2 years). In 9 of them the diagnosis of CAN was made on the basis of Ewing tests. The control group consisted of 10 healthy persons aged 15+/-1.5 years. CBV was measured in capillars of the nailfold of the fourth finger during rest and after 2 minutes of arterial occlusion (the occlusion pressure - above 20 mmHg systolic blood pressure - was obtained by the occlusion of brachial artery using sphygnomanometer cuff). RESULTS: The resting CBV did not differ between patients with CAN, without CAN and healthy controls (0.39+/-0.06, 0.41+0.05 i 0.42+/-0.07). The values of the peak CBV significantly differ between the examined groups (CAN: 0.75+0.1; without CAN: 0.86+/-0.11; control group: 0.98+/-0.09, p<0.01). CONCLUSIONS: The obtained results indicate that the presence of the autonomic diabetic neuropathy significantly influences the regulatory function of microcirculation, which may predispose to occurrence of different late diabetic complications.

• [Ultrasonographic evaluation of selected parameters of the endothelial function in brachial arteries and IMT measurements in carotid arteries in children with diabetes type 1 using personal insulin pumps--preliminary report]

  Authors: Joanna Tołwińska, Barbara Głowińska-Olszewska, Mirosława Urban, Bozena Florys, Jadwiga Peczyńska

  Endokrynologia, diabetologia i choroby przemiany materii wieku rozwojowego : organ Polskiego Towarzystwa Endokrynologów Dziecięcych. 02/2006; 12(3):200-4.

  INTRODUCTION: Type 1 diabetes is a known risk factor for arterial atherosclerosis. The first symptoms can be found even in childhood. The ultrasonographic measurements of intimal plus medialINTRODUCTION: Type 1 diabetes is a known risk factor for arterial atherosclerosis. The first symptoms can be found even in childhood. The ultrasonographic measurements of intimal plus medial thickness in carotid arteries (IMT) and flow mediated dilatation (FMD) evaluated in brachial arteries, play a known role in the detection in these cases. The diabetes treatment intensification is an important factor in delaying early atherosclerotic changes. Currently, intensive treatment of children's diabetes with use of continuous subcutaneous insulin infusion with personal insulin pumps is gaining more and more popularity. THE AIM OF THIS STUDY was the evaluation of IMT and FMD indexes in children suffering from type 1 diabetes in the context of treatment intensification (multidose insulin injections v. personal insulin pumps). MATERIAL AND METHODS: We examined 64 children (29 boys and 35 girls) in the mean age 15.5 years treated with the multidose insulin injections method and 10 children using personal insulin pumps (4 girls and 6 boys) in the mean age 14.5 years. Using high resolution ultrasonography we evaluated IMT values in carotid arteries and FMD parameters in brachial arteries. In our analysis we estimated the blood concentration of lipid parameters, values of systolic and diastolic blood pressure, the age of diabetes onset, duration time of the illness and the values of HbA1c as a marker of metabolic control. RESULTS: We noticed significantly higher FMD values in patients treated with personal insulin pumps (13.7 vs. 5.5%, p=0.001). IMT values were similar in both groups (0.52 vs. 0.5 mm, p=0. 41). The level of HDL cholesterol was higher and triglycerides lower in the group with treatment intensification. The metabolic control was the same in both groups. In patients treated by the multidose insulin injections IMT correlated with systolic blood pressure values. We didn't notice any correlation between IMT and FMD in any group. CONCLUSIONS: 1. Treatment intensification (personal insulin pumps) influences better vascular endothelial function in type 1 diabetic children and seems to be a significant tool in delaying the atherosclerotic process. 2. We need more examinations to explain the role of treatment intensification in common carotid arteries wall morphology in type 1 diabetic children. 3. The ultrasonographic detection of atherosclerotic changes in arterial vessels can help in the evaluation of the changes due to different methods of diabetes treatment.

• [Correlation analysis between diabetic retinopathy and early atherosclerotic changes in adolescents with type 1 diabetes -- preliminary report]

  Authors: Barbara Głowińska-Olszewska, Mirosława Urban, Beata Urban, Joanna Tołwińska

  Endokrynologia, diabetologia i choroby przemiany materii wieku rozwojowego : organ Polskiego Towarzystwa Endokrynologów Dziecięcych. 02/2006; 12(2):96-102.

  OBJECTIVE: Recent studies have shown a correlation between advanced diabetic retinopathy and late stages of atherosclerosis. There are no findings on a possible relation between diabetic retinopathyOBJECTIVE: Recent studies have shown a correlation between advanced diabetic retinopathy and late stages of atherosclerosis. There are no findings on a possible relation between diabetic retinopathy and diseases of the cardiovascular system at their earliest stage in young people with diabetes type 1. The purpose of the study was to analyze a correlation between diabetic retinopathy and early atherosclerotic changes in adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS: The study included 28 adolescents aged 17.6+/-1.4 years suffering from type 1 diabetes mellitus for 7.9+/-3.1 years, the mean age of the disease onset - 9.5+/-3.7 years, a mean level of HbA1c - 8.6+/-1.9%. Eight patients with developing simple retinopathy, were separated from the whole group of young people. First control group consisted of the remaining patients with type 1 diabetes chosen with regard to age and sex, without disease complications. Second control group consisted of 11 healthy young people. The function of endothelium by measuring the brachial artery dilatation -- FMD and the intima-media complex thickness of the common carotid arteries were evaluated ultrasonographically. RESULTS: Young people with retinopathy had higher systolic pressure: 133+/-19 mmHg in comparison with patients without complications: 117+/-14 mmHg (p<0.05) and healthy people: 115+/-8 mmHg (p<0.05). All patients with diabetes showed significantly lower FMD (7.6+/-5.1%, p<0.05). In the group with retinopathy, FMD equaled 7.8+/-4.1% (p=0.04) and in the group without retinopathy - 7.6+/-5.5% (p<0.05) in comparison with 12.1+/-5.1% in healthy volunteers. Significantly higher IMT was found in all patients with diabetes in comparison with healthy young people: 0.49+/-0.06 vs. 0.42+/-0.03 mm (p<0.001). Patients with retinopathy had a significantly higher value of IMT in comparison not only with controls but also with patients without complications: 0.56+/-0.06 vs. 0.47+/-0.03 mm (p<0.001). CONCLUSIONS: 1. Young people with type 1 diabetes had a significantly impaired function of endothelium and higher IMT in comparison with healthy young people. 2. Adolescents with retinopathy were characterized by significantly higher values of systolic arterial blood pressure when compared to patients without complications 3. Higher IMT was found in patients with diabetic retinopathy in comparison with patients without complications, which may suggest that macrovascular changes are more advanced in case of complications than in patients without retinopathy.

• [Selected matrix metalloproteinases (MMP-2, MMP-9) in obese children and adolescents]

  Authors: Barbara Głowińska-Olszewska, Mirosława Urban, Bozena Florys

  Endokrynologia, diabetologia i choroby przemiany materii wieku rozwojowego : organ Polskiego Towarzystwa Endokrynologów Dziecięcych. 01/2006; 12(3):179-83.

  INTRODUCTION: In the last years it has been proved that matrix metalloproteinases participate in the development of all stages of atherosclerotic process. It has been suggested that plasma levels ofINTRODUCTION: In the last years it has been proved that matrix metalloproteinases participate in the development of all stages of atherosclerotic process. It has been suggested that plasma levels of metalloproteinases can be a novel, inflammatory marker of atherosclerosis. THE AIM OF THE STUDY was to evaluate plasma levels of selected matrix metalloproteinases (MMP-2 and MMP-9) in obese children and adolescents. MATERIAL AND METHODS: We studied 45 children and adolescents with simple obesity aged 15+/-1.8 years. The control group comprised 28 healthy, slim children aged 14.5 years. The obese children were studied according to coexistence of hypertension, hyperlipidemia, positive family history of cardiovascular diseases and insulin resistance. Levels of matrix metalloproteinases were assessed by use of ready ELISA kits (R&D Systems). RESULTS: MMP-9 level in the study group equaled 553.5+/-311 ng/ml and was significantly higher compared to the control group: 400.4+/-204 ng/ml, p=0.02. MMP-2 level in the study group was significantly lower compared to the control group: 211+/-37 ng/ml vs. 258+/-56 ng/ml, p<0,0001. In obese children with coexisting hypertension we found higher levels of MMP-9 when compared to children with obesity only: 635+/-308 ng/ml vs. 450+/-289 ng/ml (p=0,04), MMP-2 levels remained similar in both groups. CONCLUSIONS: Different levels of plasma matrix metalloproteinases in obese and hypertensive children compared to healthy, slim controls can indicate an altered metabolism of the extracellular matrix (ECM) of vessels and heart muscle. Changed metabolism of ECM may be of significant importance in enhancing the atherosclerotic process in this young patients.

• [Correlation analysis between biochemical and biophysical markers of endothelium damage in children with diabetes type 1]

  Authors: Barbara Głowińska-Olszewska, Mirosława Urban, Joanna Tołwińska, Jadwiga Peczyńska, Bozena Florys

  Endokrynologia, diabetologia i choroby przemiany materii wieku rozwojowego : organ Polskiego Towarzystwa Endokrynologów Dziecięcych. 02/2005; 11(4):221-7.

  Endothelial damage is one of the earliest stages in the atherosclerosis process. Adhesion molecules, secreted from dysfunctional endothelial cells are considered as early markers of atheroscleroticEndothelial damage is one of the earliest stages in the atherosclerosis process. Adhesion molecules, secreted from dysfunctional endothelial cells are considered as early markers of atherosclerotic disease. Ultrasonographic evaluation of brachial arteries serves to detect biophysical changes in endothelial function, and evaluation of carotid arteries intima-media thickness allows to evaluate the earliest structural changes in the vessels. The aim of the study was to the evaluate levels of selected adhesion molecules (sICAM-1, sVCAM-1, sE-selectin, sP-selectin) and endothelial function with use of brachial artery dilatation study (flow mediated dilation--FMD, nitroglycerine mediated dilation--NTGMD) and IMT in carotid arteries in children and adolescents with diabetes type 1, as well as the correlation analysis between biochemical and biophysical markers of endothelial dysfunction. MATERIAL AND METHODS: We studied 76 children and adolescents, with mean age--15.6+/-2.5 years, suffering from diabetes mean 7.8+/-2.8 years, mean HbA1c--8.4+/-1.5%. Control group consisted of 33 healthy children age and gender matched. Adhesion molecules levels were estimated with the use of immunoenzymatic methods (R&D Systems). Endothelial function was evaluated by study of brachial arteries dilation--FMD, NTGMD, with ultrasonographic evaluation (Hewlett Packard Sonos 4500) after Celermajer method, and IMT after Pignoli method. RESULTS: In the study group we found elevated levels of sICAM-1: 309.54+/-64 vs. 277.85+/-52 ng/ml in the control group (p<00.05) and elevated level of sE-selectin: 87.81+/-35 vs. 66.21+/-22 ng/ml (p<00.05). We found significantly impaired FMD in brachial arteries in the study group--7.51+/-4.52 vs. 12.61+/-4.65% (p<00.05) and significantly higher IMT value: 0.51+/-0.07 vs. 0.42+/-0.05 mm (p<00.001). Correlation analysis revealed a significant negative correlation between sE-selectin and FMD - r=-0.33 (p=0.004), and a positive correlation between E-selectin and IMT: r=0.32 (p=0.005). CONCLUSIONS: 1. In children and adolescents with diabetes type 1 we found elevated levels of adhesion molecules sICAM-1 and sE-selectin, what can confirm an endothelial dysfunction in these patients. 2. Significant negative correlation between sE-selectin level and FMD, and positive correlation between sE-selectin and IMT were found. 3. Biophysical proof of this damage is impaired brachial artery dilatation--FMD, and increased IMT values provide information about structural changes in the vessels.

• [Usefulness of continuous glucose monitoring system (CGMS) in monitoring glycaemic profile in small children with diabetes type 1]

  Authors: Barbara Głowińska-Olszewska, Mirosława Urban, Jadwiga Peczyńska, Bozena Florys, Marek Kowalewski

  Endokrynologia, diabetologia i choroby przemiany materii wieku rozwojowego : organ Polskiego Towarzystwa Endokrynologów Dziecięcych. 02/2005; 11(4):237-43.

  BACKGROUND: Improved methods of diabetes therapy result in a near normoglycaemic state in many patients. This leads however unfortunately to more frequent hypoglycaemic incidents. Particularly smallBACKGROUND: Improved methods of diabetes therapy result in a near normoglycaemic state in many patients. This leads however unfortunately to more frequent hypoglycaemic incidents. Particularly small children, whose nervous system is not fully mature, are at high risk of central nervous system damage in case of hypoglycaemia. A new method of detail monitoring of glycaemia provides CGMS system. OBJECTIVES: The aim of the study was to compare the glycaemic profile, with high attention to hypoglycaemia in groups of young and older children with diabetes type 1, using CGMS and routine glucose meter. MATERIAL AND METHODS: We studied 32 children with diabetes type 1. Children were divided into groups: group I--small children, n=17 (<7 yrs of age), mean age 5,8 years, with disease duration--2,46 years, with mean HbA1c level--7,22%, and group II--older children, n=15 (>10 years of age), mean age--12 years, with disease duration--3 years, with HbA1c level--7,21%. Continuous glucose monitoring system (CGMS), by MiniMed, was applied in outpatient or hospital conditions, after short training of patient and parents; together with routine glucose meter measurements, 4-8 times/24 hours. In 9 patients from small children group CGMS was repeated after 2 months. RESULTS: Hypoglycaemic incidents detected with CGMS were similar in both groups: 4,6 in I group vs. 4,2 in II group (ns). Hypoglycaemic incidents found with meter were lower in I group--1,6 vs. 2,3 in II group (ns). Mean hypoglycaemic time/24 hour was longer in small children group: 101 min vs. 74 min in group II (p<00,05). In I group we found higher number of hypoglycaemic incidents during the night compared to group II--1,7 vs. 0,8 (p<00,05) and longer duration of night hypoglycaemia: in I group--56 min vs. 32 min in group II (p<00,05). Repeated CGMS study in 9 children from I group revealed decreased mean time of hypoglycaemia/24 hours from 134 min/24 h to 90 min/24 h (p<00,05) and decreased time of night hypoglycaemia from 65 min to 40 min (p<00,05), with a comparable number of hypoglycaemic incidents. Hypoglycaemic incidents found with routine meter measurements in small children were 1,6 vs. 4,6 hypoglycaemia found with CGMS (p<00,05), in the older children group routine measurement found 2,3 hypoglycaemia vs. 4,2 detected with CGMS (ns). CONCLUSIONS: 1. CGMS can be particularly usefull in monitoring glucose profile and detecting hypoglycaemia incidents, mainly nocturnal in small children. 2. CGMS allows to verify meal dose of insulin and to decrease postprandial hyperglycaemia. 3. Modification of insulin therapy on the base of CGMS helps to decrease the time of hypoglycaemia and hyperglycemia, particularly during the night.