A Sledziewski

Medical University of Bialystok, Belostok, Podlasie, Poland

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Publications (14)18.88 Total impact

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    ABSTRACT: The aim of our study was to compare the secretion of amylin, as well as glucose, insulin and C-peptide at baseline and in response to glucagon stimulation in 26 lean women with gestational diabetes mellitus (GDM) and in 19 age- and BMI-matched pregnant women with normal glucose tolerance (NGT). Intravenous 1-mg glucagon stimulation test was performed 6 weeks after delivery. Fasting and stimulated glucose levels were significantly higher in GDM patients than in subjects with NGT ( p<0.01 at 0 and 6 min; glucose area under the curve (AUC), 604.8+/-41.8 mg/6 min vs. 572.4+/-52.4 mg/6 min, p<0.05). Insulin AUC was also markedly higher in GDM subjects than in healthy controls (373.9+/-144.2 micro IU/6 min vs. 283.7+/-139.1 micro IU/6 min, p<0.05). There was no difference in fasting C-peptide levels between the groups studied, but stimulated concentrations, as well as C-peptide AUC were significantly higher in patients with GDM ( p<0.01 at 1 min and p<0.005 at 6 min; AUC, 27.4+/-11.3 pmol/6 min vs. 18.4+/-6.9 pmol/6 min, p<0.01). Amylin levels were higher in GDM group in comparison to healthy subjects ( p<0.005 at 1 and 6 min; amylin AUC, 113.3+/-51.2 pg/6 min vs. 72.5+/-15.7 pg/6 min; p=0.14), but in contrast to the other hormones, did not rise in response to glucagon injection. In conclusion, our results provide evidence that in patients with GDM in the post-partum period, the levels of amylin, as well as the secretion of insulin and C-peptide remain elevated, when compared to women with NTG. Further investigations are needed to clarify the significance of this elevation as a predictive factor for the development of late maternal type 2 diabetes.
    Acta Diabetologica 03/2004; 41(1):1-4. · 4.63 Impact Factor
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    ABSTRACT: Leptin is a protein hormone mainly produced by the adipocytes. Apart from its autocrine role within the placenta in humans, plasma circulating leptin contributes to the endocrine function. Leptin levels may serve as an index of metabolic and energy balance in pregnancy. Recent reports have shown a positive correlation between leptin concentrations and plasma levels of glycated haemoglobin (HbA(1c)) in patients with gestational diabetes mellitus (GDM). The aim of the present study was to evaluate leptin levels after delivery in GDM and normal glucose tolerance (NGT) women. Plasma leptin concentration and insulin, c-peptide and glycated haemoglobin were measured in both. NGT women and in patients with a history of GDM in all patients total LDL - and HDL cholesterol concentrations were estimated. We also calculated the anthropometric parameters of the mother and birth weight in both groups. The plasma leptin concentration after delivery was not different in patients with GDM in comparison with the NGT individuals. We concluded that in patients with GDM and normal BM1 the postpartum leptin level was not different in comparison with the NGT patients.
    Medycyna wieku rozwojowego 01/2004; 8(3 Pt 2):703-10.
  • Maciej Kinalski, Adam Sledziewski, Adam Kretowski
    Polskie archiwum medycyny wewnȩtrznej 08/2002; 108(1):687-93. · 2.05 Impact Factor
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    ABSTRACT: Amylin (Islet Amyloid Pancreatic Polypeptide - IAPP) is a hormone cosecreted with insulin by pancreatic beta cells in a pulsatile pattern. Recent reports point to its essential part in glucose homeostasis. Postpartum evaluation of IAPP release in Gestational Diabetes Mellitus (GDM) patients was performed. Our data were compared to insulin and peptide-C secretion patterns. We were not able to demonstrate a dynamic increase of IAPP in response to glucagon stimuli. However, related to GDM, puerperal IAPP levels were significantly higher than in normal controls. Lack of postpartum amylin response to glucagon stimulation might be interpreted as a primary result of previously reported increases in circulatory levels of IAPP during pregnancy complicated by GDM. Post partum elevated IAPP may be a useful marker to identify patients with high risk of type 2 diabetes mellitus.
    Medycyna wieku rozwojowego 01/2002; 6(1):75-80.
  • M Kinalski, A Sledziewski, A Kretowski
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    ABSTRACT: This paper reviews current literature on strategic policy in gestational diabetes (GDM). Emphasis is placed on early identification of carbohydrate intolerance. Definitive guidelines related to screening procedures, diagnostic criteria, glucose monitoring with threshold for insulin therapy in GDM were briefly described. Pregnancy termination and delivery management have been discussed. The importance of postpartum follow-up is pointed out. Special attention is paid to the association with increased antenatal risk of subsequent diabetes and consequently raised perinatal morbidity and/or mortality. For appropriate health-care a cooperation between patients, obstetricians and diabetologists is suggested.
    Ginekologia polska 12/2001; 72(11):899-907. · 0.79 Impact Factor
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    ABSTRACT: Pregnancy complicated by poor control of diabetes is associated with a higher risk of embryopathies, spontaneous abortions and perinatal mortality. A number of authors suggest an involvement of reactive oxygen species (ROS) in diabetic pregnancy. Determining lipid peroxidation products (LP), scavenging enzyme activities and the umbilical cord blood's acid-base balance may contribute to an adequate diagnosis of the neonate at birth. Nevertheless, such measurements seem to have limited value in practical clinical routine. The present study evaluates LP, antioxidant defence and acid-base status related to diabetic pregnancy. Twenty-eight women with type 1 diabetes (PGDM), 19 with gestational diabetes (GDM) and 13 control cases were investigated. An additional control group consisted of 15 healthy patients with negative diabetic history; all women underwent vaginal delivery. Immediately after delivery cord blood samples and placental tissue were collected for malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione (GSH) determination. Additionally, pH, pCO2, pO2 and base excess were measured in both vessels and compared to identify and exclude double venous samples. MDA levels in both cord blood and placental homogenates were significantly higher in both pregestational and gestational diabetic groups, but SOD activity was significantly diminished. Cord blood GSH was markedly elevated in PGDM and GDM. We have also shown significant differences in acid-base parameters in infants of PGDM group. Statistical analysis was performed using the Mann-Whitney U-test. These findings indicate an excessive oxidative stress in pregnancy complicated by diabetes mellitus. Evaluating LP products and scavenging enzyme activities may be valuable, sensitive indexes of fetal/neonatal threat in diabetic pregnancy in humans. Since oxidative stress is an important pathway for fetal injury, we believe that obtaining adequate measurements at the time of birth would contribute to clarifying the fetal/neonatal status in a medical and legal context and might be of value in altering therapy in newborn infants.
    Hormone and Metabolic Research 05/2001; 33(4):227-31. · 2.15 Impact Factor
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    ABSTRACT: The purpose of our study was to evaluate lipid peroxidation products and scavenging enzyme activity in placenta and cord blood as well as the estimation of acid-base status and blood gases. Seventy five pregnant patients and their newborns were investigated. Twenty eight had pre-gestational diabetes mellitus (PGDM) and 19 gestational diabetes mellitus (GDM). The following parameters were measured: malondialdehyde (MDA) concentrations, glutathione (GSH) levels, the activity of CuZn dismutase (SOD) (Bioxytech, France). Base excess, pO2, pCO2 and pH were measured in arterial and venous samples. Statistical analysis was performed using Mann-Whitney U test. MDA levels and GSH content increased significantly, while SOD activities declined in diabetic group. Newborns of PDGM mothers had essentially diminished pH and rised both, pCO2 and base deficit. There were no any significant differences in parameters of acid-base balance in newborns of patients with GDM as compared with healthy patients. Our results suggest, that in diabetic patients the fetuses are exposed to increased oxidative stress. The evaluation of antioxidant defence and lipid peroxidation, apart from routine measurement of acid-base balance, might serve as a useful marker of fetal distress in diabetic patients.
    Przegla̧d lekarski 02/2001; 58(3):120-3.
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    ABSTRACT: The aim of this study was to evaluate lipid peroxidation and scavenging enzyme activity in streptozotocin-induced diabetes, and then to establish whether moderate doses of nonenzymatic antioxidant vitamin E play a role in the antioxidant defence system in diabetic pregnant rats and their offspring. The study group consisted of 30 normal female Wistar rats, which were given a single dose of streptozotocin (40 mg/kg) and were mated 7 days later. Subsequently, the diabetic animals were divided into two matched groups: the first supplemented with vitamin E (30 mg/100 g chow), and the other fed with a standard diet lacking vitamin E. Controls consisted of 15 pregnant rats. On the first day after delivery, the rats were decapitated and homogenates of maternal liver and uterus as well as neonatal lungs and liver were prepared. Then the following parameters were measured: malondialdehyde (MDA) concentrations in the homogenates and blood serum, glutathione (GSH) levels, the activity of CuZn-superoxide dismutase (SOD) and glutathione peroxidase (GPx), and glycaemia. The neonates of diabetic rats were smaller than the healthy ones and serum glucose concentration was markedly higher in the diabetic animals. MDA levels were significantly increased, whereas GSH, SOD and GPx were markedly diminished in the diabetic adult rats and their offspring in comparison to the control group. In the animals supplemented with alpha-tocopherol, MDA concentrations were significantly lower, GSH content and SOD activities were markedly elevated most tissues studied, whereas GPx remained unchanged. We conclude that, by monitoring the activity of selected scavenging enzymes, information on ongoing biological oxidative stress and thereby on the fetus/neonate status may be obtained. Our results suggest that diabetic pregnant rats and their neonates are exposed to an increased oxidative stress and that vitamin E supplementation may reduce its detrimental effects.
    Acta Diabetologica 02/2000; 37(4):179-83. · 4.63 Impact Factor
  • M Kinalski, A Sledziewski, A Kretowski
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    ABSTRACT: The use of perinatal steroid therapy, first introduced in 1972 is effective in precocious maturation of human lungs. Antenatal corticosteroid therapy results in reduction of fetal mortality, respiratory distress syndrome, intraventricular hemorrhage in preterm babies. These benefits extend to a broad range of gestational age. They comprise the interval between 24 and 34 weeks of human pregnancy and are not limited by the infant's gender or race. The beneficial effects of corticosteroids are the best pronounced after more than 24 hours from the beginning of the treatment. Noteworthy is that therapy less than 24 hours of duration may also improve outcomes. In the presence of premature rupture of membranes, or better with intact membranes, antenatal corticosteroids reduce frequency of RDS, IVH and finally mortality and morbidity. Review of meta-analyses based on randomized trials supports general option that premature infants whose mothers received corticosteroids before delivery are less likely to develop RDS and its complications. Recent data showed that benefits derived from ANS are additive to those of surfactant therapy, rendering the latter more effective. Followup of children up to 12 years of age indicate that ANS do not impair physical growth or psychomotor development. Short-term adverse effects including maternal infection, maternal pulmonary edema were not clearly demonstrated. Pulmonary edema has not been reported when ANS were used alone (i.e. not in combination with betamimetic tocolytics). No long-term unwanted effects on maternal adrenal function have been observed. There is no serious maternal risk resulting from immunosuppressive effect of corticosteroid therapy on maternal immune system. Although glucocorticoid therapy is likely to provoke insulin resistance, and thereby deterioration in diabetic control, and potentially causes cortisol resistance in the fetal lung, the results of scarce randomized trials are not conclusive. In any rate strict control of maternal diabetes mellitus reduces incidence of RDS. Current available data are not indicative of higher risk of fetal mortality in association with maternal hypertensive disease and ANS. In conclusion, most randomized trials of ANS has provided a positive evidence of efficacy and safety of this highly cost effective therapy in most common clinical situations. However, further trials and more precise estimates are justified on ANS treatment specifically related to blood glucose control and evidence concerning the promotion of fetal lung maturity in babies of women with diabetes mellitus. Although benefits of the corticosteroid therapy are beyond any doubts, more experience is needed to assess the effect of ANS on maternal and/or fetal infection in presence of premature rupture of membranes. And finally, further assessments are required on antenatal corticosteroids with dose regimens in patients with multifetal gestation, more common after wide use of techniques of the assisted human reproduction.
    Wiadomości lekarskie (Warsaw, Poland: 1960) 02/2000; 53(9-10):538-45.
  • A Sledziewski, M Kinalski, A Kretowski
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    ABSTRACT: Preterm delivery is still a major cause of infant morbidity and mortality. Premature infants develop numerous complications including respiratory distress syndrome, intraventricular hemorrhage, patent ductus arteriosus, necrotising enterocolitis, etc. Respiratory distress syndrome is the leading problem in perinatology. The incidence of RDS accounts for 70% of all infants delivered before 30 week's gestation and about 20% neonates born between 32-37 week of pregnancy. Our paper presents current opinions and is a critical review of relevant literature on antenatal treatment before anticipated preterm deliveries. Recently performed meta-analysis prove that glucocorticoid therapy is effective in reducing aforementioned pathologies of prematurity. After brief account on effects of several hormones on fetal pulmonary maturity some beneficial interactions for enhanced fetal maturity are pointed out. Glucocorticoid mechanism of action in target cells and its biochemical implications are reviewed. The use of antenatal corticoids for fetal maturation and possible adverse maternal effects follow. Finally both short-term and long-term benefits of ANS are discussed. Thus there are convincing data to support the use of ANS in fetal pulmonary maturation. The current findings suggest that the improvement of respiratory outcome may depend on enhanced expression of phospholipids and proteins of the surfactant system and enzymes of antioxidant systems. We believe that use of antenatal corticosteroids for fetal maturation results in improvement of neonatal outcome and yields substantial savings in health care costs.
    Przegla̧d lekarski 02/2000; 57(3):171-7.
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    ABSTRACT: The aim of our study was to analyse the effect of chronic hyperglycaemia on lipid peroxidation and scavenging enzyme activity in pregnant animals and their offspring supplemented and not supplemented with vitamin E - a natural antioxidant. Thirty pregnant female Wistar rats were used in our experiments. Diabetes was induced on day 7 of pregnancy using a single does of streptozotocin (40 mg/kg). Diabetic animals were divided into two equal groups: vitamin E supplemented and those fed with standard diet. Our controls consisted of 15 healthy rats. On day 1 after delivery homogenates of maternal liver and uterus as well as neonatal lungs and liver were prepared. Then the following parameters were measured: malondialdehyde (MDA) concentrations in the homogenates and blood serum, glutathione (GSH) levels, the activity of CuZn superoxide dismutase (SOD) and glutathione peroxidase (GPx) (Bioxytech, France). Statistical analysis was performed using Mann-Withney U test. The neonates of diabetic rats were smaller than those from healthy rats and serum glucose concentration was markedly higher in diabetic animals, both in mothers and neonates. MDA levels increased significantly, whereas GSH content and SOD as well as GPx activities were markedly diminished in diabetic pregnant rats and their offspring in comparison with the control group. In animals supplemented with tocopherol, MDA concentrations declined significantly, GSH contents and SOD activities were markedly elevated in almost all types of tissues studied, whereas glutathione peroxidase remained suppressed. Our results suggest that diabetic pregnant rats and their neonates are exposed to oxidative stress (OS), but vitamin E supplementation could in part reduce the imbalance between uncontrolled reactive oxygen species generation and scavenging enzyme activity, and may potentially serve as a useful prophylactic factor against OS development:
    Acta Diabetologica 10/1999; 36(3):113-7. · 4.63 Impact Factor
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    ABSTRACT: This paper is a review of recent reports on autoimmune aspects of gestational diabetes mellitus (GDM). In a subgroup of GDM patients distinct phenotypic and genotypic features could be distinguished. Islet autoantibodies with variable frequency are present in samples of sera taken from women with GDM. Beta-cell destruction may follow different time course patterns. For this reasons GDM patients may develop variable forms of autoimmune DM. We believe that women who experienced autoimmune GDM are at risk of type l DM and simultaneously, they are candidates for possible immunomodulatory preventive therapy in the future.
    Medycyna wieku rozwojowego 8(3 Pt 2):711-8.
  • M Kinalski, A Sledziewski
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    ABSTRACT: Current views and opinions on pregnancy in diabetic mothers are presented. Special attention is paid to carbohydrate metabolism, pregestational diabetes mellitus (PGDM), gestational diabetes mellitus (GDM) and unclear heterogenous etiology of gestational diabetes mellitus (GDM). Suggestions for identification, diagnosis and treatment of GDM with an emphasis on early screening strategy are given. Obstetrical management and possible perinatal complications are discussed.
    Medycyna wieku rozwojowego 5(1):65-76.
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    ABSTRACT: Interdisciplinary team work and recommendations of diabetologist and obstetrician is the condition of success of antenatal care and consequently perinatal outcome in pregnancy complicated by diabetes. Careful insight into the metabolic, haemodynamic and vascular disturbances is the basic of contemporary surveillance in diabetic pregnancy. The authors emphasise that a diabetic pregnant woman must not only pay attention to adequate nutrition and balanced exercise, but also be aware of and cope with characteristic, momentary swings in glycemia in order to overcome them by appropriate insulin therapy. Continuous supervision for several other complications associated with diabetic pregnancy, viz. hypertension, retinopathy, thyroid dysfunction, nephropathy and the threat of in utero foetal death is justified. Briefly, rigorous measures to sustain normoglycemia and normal blood pressure, examination of the retina, thyroid and renal functions as well as foetal status evaluation are paramount in appropriate management of major common diabetic complications in pregnancy.
    Medycyna wieku rozwojowego 8(3 Pt 2):691-701.

Publication Stats

106 Citations
18.88 Total Impact Points

Institutions

  • 1999
    • Medical University of Bialystok
      • Department of Endocrinology, Diabetology and Internal Medicine
      Belostok, Podlasie, Poland