Bogna Wierusz-Wysocka

Poznan University of Medical Sciences, Posen, Greater Poland Voivodeship, Poland

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Publications (133)163.15 Total impact

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    ABSTRACT: Introduction. Gastrointestinal symptoms are present in 50-70% of patients with diabetes. Small intestinal bacterial overgrowth (SIBO) is expansion of microorganisms colonizing the large intestine into the small intestine, leading to disorders of digestion and absorption. Material and methods. The study included 200 patients (91 with type 1 and 109 with type 2 diabetes hospitalized in years 2013-2015 in the Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences. The control group consisted of 20 healthy volunteers. Hydrogen breath tests with Gastro+ Gastrolyzer (Bedfont) were used to assess SIBO. After drinking 20 g of lactulose we checked exhaled hydrogen concentration. The result was considered positive when exhaled hydrogen of first breath was ≥ 20 ppm (parts per milion) or an increase in the output value of the exhaled hydrogen was 12 ppm during the first 60 minutes of the test. Results. We observed lower prevalence of SIBO in the test group as compared to controls [82 patients (41%) vs. 15 patients (75%); p = 0.0043]. Moreover, patients with type 1 diabetes as well as type 2 diabetes had lower incidence of SIBO as compared to controls [accordingly, 42% vs. 75%, p=0.008, 40% vs. 75%, p=0.006]. In the logistic regression model this relation-ship was independent of age, gender and BMI (OR: 5,57, 95% CI: 1,78-17,47; p = 0,003). Conclusion. The prevalence of microbial proliferation of the small intestine in patients with diabetes is lower than in healthy subjects. One possible cause might be the beneficial effect of nutritional therapy in patients with diabetes.
    No preview · Article · Dec 2015
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    ABSTRACT: The aim of this study was to evaluate the prevalence of chronic complications in patients with type 1 diabetes with more than 30 years of history of the disease, depending on the age of onset of diabetes. The criterion for inclusion in the study was over 30-year history of type 1 diabetes. The study group was divided into two subgroups according to the age of diagnosis of type 1 diabetes (either before or after 18 years of age). Anthropometric parameters, degree of metabolic control and the presence of markers of chronic diabetic micro- and macrovascular complications were assessed. The study was performed in 215 type 1 diabetic patients with more than 30 years history of the disease, aged 54±10 years, 98 men, 117 women. In 110 patients (group I), type 1 diabetes was diagnosed before age of 18 years, in 105 patients (group II) after 18 years of age. Patients in group I were younger, with a longer duration of the disease, more often treated with intensive functional insulin. There were no differences in terms of metabolic control between the assessed groups. Patients in group I were significantly more often diagnosed with chronic diabetic kidney disease, in group II hypertension was more often observed. Conclusions: The diagnosis of type 1 diabetes before or after the age of 18 had no significant effect on the lack of chronic complications. Patients with diabetes diagnosed in childhood, after 30 years of disease, presented a higher incidence of diabetic kidney disease.
    No preview · Article · Nov 2015 · Pediatric endocrinology
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    ABSTRACT: The use of exogenous insulin and incorrect nutritional habits are conducive to obesity and excess weight. This leads to the development of insulin resistance, even in patients with type 1 diabetes mellitus. The aim of this study was to assess the effects of metformin as adjunctive therapy on anthropometric parameters and metabolic control in patients with type 1 diabetes mellitus. The study included a group 45 patients with elevated adipose tissue content as measured by electrical bioimpedance. Thirty-nine patients (11 males and 28 females) of the group fulfill the study protocol. The mean age was 33.5 ± 11.9 years and duration of diabetes 12.6 ± 7.4 years. Metformin was administered for at least 6 months at a mean dose of 1032 ± 718 mg/day. Application of metformin resulted in a statistically significant reduction in total adipose tissue (4.8 ± 4.0 vs. 2.9 ± 4.4 kg, p = 0.03), waist circumference (96.4 ± 9.5 vs. 89.1 ± 11.1 cm, p = 0.003), and VAI (4.1 ± 2.4 vs. 2.5 ± 1.8, p = 0.006). Reduction in insulin requirement (0.7 ± 0.1 vs. 0.6 ± 0.2 units/kg/day, p = 0.02), fasting glycemia (166.5 ± 52.5 vs. 135.7 ± 48 mg/dl, p = 0.01), and postprandial glycemia (196.9 ± 74.3 vs. 137.1 ± 37.5 mg/dl, p = 0.00002) was also observed. In addition, decrease in triglyceride serum concentration (128.2 ± 52.9 vs. 94.0 ± 32.1 mg/dl, p = 0.002) and non-HDL cholesterol (154.5 ± 41.3 vs. 130.0 ± 39.7 mg/dl, p = 0.01) was achieved. Addition of metformin to insulin therapy of patients with type 1 diabetes mellitus and elevated adipose tissue content is safe and may lead to measurable clinical benefits.
    No preview · Article · Nov 2015 · International Journal of Diabetes in Developing Countries

  • No preview · Article · Oct 2015 · Diabetologia Kliniczna
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    ABSTRACT: The aim of this study was to assess microvascular function associated with the occurrence of Charcot neuroarthropathy (CN) in patients with diabetes. We evaluated 70 diabetic patients (54 men) with Charcot neuroarthropathy (CN-DM), median age 59 (IQR: 51-62), mean disease duration 16±8years. The control group were 70 subjects with diabetes and without Charcot neuroarthropathy (DM), 54 men, median age 60 (54-62), mean diabetes duration 15±7years. We assessed metabolic control of diabetes, serum C-reactive protein concentration (CRP) and cardiovascular autonomic neuropathy (CAN). We used AGE-Reader to measure skin autofluorescence (AF) associated with accumulation of advanced glycation end products that reflects long lasting metabolic control. Microvascular function was examined by laser Doppler flowmetry (PERIFLUX 5000) with thermal hyperemia (TH) and postocclusive reactive hyperemia (PORH). CN-DM patients as compared to DM subjects had lower HbA1c level [7.6 (6.6-8.4) vs 8.4 (7.3-9.7)%, p<0.001], lower eGFR [75.9±24.1 vs 86.6±17.8ml/min/1.73m(2), p=0.003], higher CRP serum concentration [3.8 (2.3-10.1) vs 1.9 (0.8-4.4)mg/l, p<0.001] and higher skin autofluorescence [2.8 (2.5-3.1) vs 2.6 (2.3-2.9)AU, p=0.03]. The cardiovascular autonomic neuropathy (CAN) was more frequently diagnosed in CN-DM subjects [59 vs 27%, p<0.001]. The peak flow during thermal hyperemia (THmax) was lower in CN-DM subjects as compared to DM group [156 (93-240) vs 235 (155-300)PU, p=0.001]. We found negative correlation between THmax and CRP concentration (Rs=-0.34, p=0.003), TG concentration (Rs=-0.37, p=0.002) and skin AF (Rs=-0.32, p=0.04) and positive correlation between THmax and HDL cholesterol level (Rs=0.42, p<0.001) in CN-DM patients. There was also a positive correlation between PORHpeak and HDL cholesterol level (Rs=-0.23, p=0.04). Deterioration of microvascular function and autonomic system dysfunction are present in Charcot neuroarthropathy. Impaired microvascular reactivity is associated with worse long lasting metabolic control of diabetes and low grade inflammatory process. Copyright © 2015. Published by Elsevier Inc.
    No preview · Article · Jul 2015 · Microvascular Research
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    Preview · Article · May 2015
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    ABSTRACT: Genetic factors are indicated in the development of type 1 diabetes (DM1). Recently, nucleotide variants of BACH2 and SOD2 have been associated with this chronic condition. Therefore, the purpose of the present study was to investigate the contribution of BACH2 rs3757247 and SOD2 rs4880 (Ala16Val) polymorphisms to the risk of DM1 and diabetes long-term complications. Selected polymorphic variants of BACH2 and SOD2 were investigated in a group of 141 patients with DM1 and in a group of age, gender-matched healthy subjects (n=369) using a high-resolution melting curve method. There was no evidence for either allelic or genotypic association with the risk of DM1 and diabetes chronic complications for analysed polymorphisms. In addition, no interaction between BACH2 and SOD2 variants in the development of this condition was observed. However, the frequency of BACH2 rs3757247 AG and AA genotypes was statistically different between DM1 patients with retinopathy and healthy individuals (odds ratio, 2.455; 95% confidence interval, 0.999-6.035; P=0.044), but this result did not survive multiple testing corrections. The present study did not confirm the involvement of BACH2 rs3757247 and SOD2 rs4880 polymorphisms in the development of DM1 and diabetes long-term complications. Further studies in a larger population sample are required.
    Full-text · Article · May 2015
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    ABSTRACT: Clinical remission of type 1 diabetes reflects the transient recovery of β-cell function and improvement in insulin sensitivity, occurring after introduction of insulin therapy. The aim of the study was to identify factors associated with early beginning of partial remission phase in patients with newly diagnosed type 1 diabetes. One hundred and sixteen patients (41 women and 75 men), aged 18-34 (mean age 23.8 ± 8.7 years), were included into the study. Mean hospitalization time was 7 ± 2 days. Early remission was defined as reaching total daily insulin dose
    No preview · Article · Feb 2015 · International Journal of Diabetes in Developing Countries
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    ABSTRACT: Our aim was to assess the association between skin autofluorescence (AF) related to advanced glycation end products (AGEs) accumulation and long-term metabolic control, microvascular complications and carotid intima-media thickness (IMT) in an observational cohort of type 1 diabetes (DM1). The analysis included 77 patients with DM1 (28 women and 49 men) aged 38 (IQR: 34-41), diabetes duration 15 (14-17), participating in Poznan Prospective Study (PoProStu). Skin AF was measured with AGE Reader (DiagnOptics). We found 50% of any microvascular complication; 37% of retinopathy, 37% of diabetic kidney disease and 22% of distal symmetrical neuropathy. Median carotid IMT was 0.57 (0.52-0.67)mm and skin AF 2.2 (IQR: 1.9-2.6). We found positive correlation between skin AF and patients' age (r=0.31, p=0.006), mean HbA1c from the observation time (r=0.35, p=0.001) and IMT (r=0.39, p<0.001). In multivariate logistic regression presence of microvascular complications was independently associated with skin AF: for retinopathy (OR 3.49; 95%CI:1.08-11.28, p=0.03), for diabetic kidney disease (OR 3.62; 95%CI:1.16-11.28, p=0.02), for neuropathy (OR 5.01; 95%CI:1.21-20.77, p=0.02) and for any microangiopathy (OR 3.13; 95%CI: 1.06-9.18, p=0.03). Skin AF is a reliable marker of past glycaemic control of diabetes. Increased accumulation of AGEs is related to the presence of diabetic microangiopathy as well as subclinical macroangiopathy in patients with type 1. Copyright © 2015. Published by Elsevier Inc.
    Full-text · Article · Jan 2015 · Microvascular Research
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    ABSTRACT: Introduction and objective. Diabetic ketoacidosis (DKA) is one of the most serious and potentially life-threatening, acute metabolic complications of diabetes, resulting from absolute deficiency of insulin. This condition requires hospitalization and intensive treatment. Despite the recommendations of Polish Diabetes Association (PTD) for treatment of DKA, the derogation from the protocol are observed in clinical practice. The Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, is a referral medical center for Wielkopolska, where patients with DKA are admitted directly or transferred from other hospitals. The duration of ketosis treatment is of prognostic importance. The aim of the study was to compare the time of treatment of patiens hospitalised in the referral medical center from the beginning with patients transferred from other hospitals. Material and methods. We analyzed the duration of DKA treatment in 124 patients with type 1 diabetes (n = 119) and class 3 (n = 5), hospitalized in the Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences in years 2008-2011. We compared the duration of treatment of patients hospitalized in the Department from the beginning (n = 70) and transferred from other medical centers (n = 54). The achievement of acid-base balance was regarded as the end of treatment of diabetic ketoacidosis. Results. The mean duration of treatment of the whole group of patients with DKA was 35 ± 18 h. Patients transferred to a referral center and immediately treated at the Department did not differ significantly in severity of diabetic ketoacidosis. Duration of recovering from DKA in the group of patients hospitalized in the referral center from the beginning was 32 ± 19 h. The duration of treatment of patients transferred from other hospitals was 38 ± 18 h (p = 0.03). There was a significant difference in the frequency of administration of bicarbonate in the group of patients transferred from other medical centers [7 (12.9%) vs. 2 (2.8%), p = 0.03]. Conclusions. Immediate hospitalization of patients with diabetic ketoacidosis in the referral center, which is experienced in treatment of patients with acute hyperglycaemic complications, is associated with shorter duration of treatment.
    No preview · Article · Jan 2015
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    ABSTRACT: Purpose The cardiovascular diseases (CVD) are the leading cause of mortality in type 1 diabetes (DM1). Carotid intima-media thickness (IMT) has been approved as a marker of subclinical atherosclerosis. The aim of this prospective study was to evaluate the relationship between baseline diabetic knowledge after five-day teaching program and IMT in patients with (DM1) treated with intensive functional insulin therapy (IFIT) from the onset of the disease. Material/methods The analysis included 79 subjects aged 23.4 ± 5.1 years with newly diagnosed DM1, participating in Poznan Prospective Study (PoProStu). The patients attended a five-day structured training program in IFIT at diagnosis, followed by a test consisting of 20 questions. After follow-up period of 11 years we evaluated the presence of microangiopathy and subclinical macroangiopathy. IMT of the right common carotid artery was determined using high resolution ultrasonography and calculated automatically with the Carotid Analyzer for Research program. Results After 11-year follow-up median intima-media thickness was 560 (IQR: 520–630) μm. We found a negative correlation between diabetes knowledge at baseline and IMT at the end of follow-up (r = −0.27, p = 0.017). In multivariate linear regression model baseline diabetic knowledge test result was associated with IMT at follow-up, independently from sex, age, smoking status, presence of hypertension and diabetic kidney disease (all at follow-up) and from mean follow-up LDL-cholesterol concentrations and HbA1c results (β = −8, 95% CI −16, −1, p = 0.037). Conclusions Baseline diabetic knowledge after 5-day teaching program is an independent predictor of subclinical macroangiopathy in patients with DM1.
    No preview · Article · Sep 2014 · Advances in Medical Sciences
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    ABSTRACT: Objectives: The aim of study was to evaluate the relationship between serum cystatin C and insulin resistance (IR) in type 1 diabetic patients being the participants of Poznan Prospective Study. Design and methods: The study was performed on 71 Caucasian patients (46 men); with type 1 diabetes, who were recruited into the Poznan Prospective Study, at the age of 39±6.1 meanly, and treated with intensive insulin therapy since the onset of the disease. The follow-up period and diabetes duration were 15±1.6 years. Insulin resistance (IR) was assessed by estimated glucose disposal rate (eGDR) calculation with cut-off point 7.5 mg/kg/min. Patients were divided into two groups, according to the presence or absence of IR. Results: From among 71 patients, 31 patients (43.7%) presented decreased sensitive to insulin with eGDR below 7.5 mg/kg/min. Patients who had eGDR <7.5 mg/kg/min (insulin resistant), compared with subjects with eGDR >7.5 mg/kg/min (insulin sensitive), had higher level of serum cystatin C [0.59 (IQR:0.44-0.84) vs 0.46 (IQR:0.37-0.55) mg/L, p=0.009]. A significant negative correlation between cystatin C and eGDR was revealed (Rs=-0.39, p=0.001). In regression model cystatin C was related to insulin resistance, adjusted for sex, BMI, eGFR and duration of diabetes [OR 0.03 (0.001-0.56), p=0.01]. Conclusions: Higher level of serum cystatin C is related to decreased insulin sensitivity in patients with type 1 diabetes. This relationship seems to have an important clinical implication.
    Full-text · Article · Jun 2014 · Clinical Biochemistry

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  • No preview · Article · Apr 2014
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    ABSTRACT: INTRODUCTION One of the reasons of impaired antioxidant response in patients with type 1 diabetes (DM1) could be decreased expression of mitochondrial superoxide dismutase (MnSOD). OBJECTIVES The purpose of this study was to evaluate expression of MnSOD at both transcript and protein level in polymorphonuclear leukocytes (PMNLs) from DM1 patients and analyzed their relation with presence of microvascular complications. PATIENTS AND METHODS MnSOD expression was assessed in PMNLs from 46 DM1 patients and age and gender matched 12 healthy subjects. The study group was divided into two subgroups according to the absence (DM) or presence (DMC) of microvascular complications. MnSOD expression on transcript level was evaluated by quantitative PCR (RQ-PCR), whereas MnSOD expression on protein level was measured by western blot technique. RESULTS A significant increase in MnSOD transcript level was found in all DM1 patients regardless to the presence of microvascular complications (p=0.013, p=0.024, respectively). Interestingly, MnSOD protein level was higher in DM group compared with DMC group and the control group (p=0.049, p=0.029, respectively). MnSOD expression at both transcript and protein level positively correlated with fasting plasma glucose (FPG) level and total cholesterol (TCH) concentrations (r=0.400, r=0.389, r=0.310, r=0.391, n=46, p<0.05, respectively) in all DM1 patients. CONCLUSIONS Even though increased MnSOD transcript level in DM1 patients suggests enhanced antioxidant mobilization in all diabetic patients, decreased level of MnSOD protein in PMNLs from DMC patients in comparison with DM patients could indicate that DM1 patients with microvascular complications display impaired antioxidant response.
    Full-text · Article · Apr 2014 · Polskie archiwum medycyny wewnȩtrznej
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    ABSTRACT: The diagnosis of autoimmune diabetes in non-obese adults is based on detection of autoantibodies to glutamic acid decarboxylase autoantibodies (GADA), islet cells antibodies (ICA), antibodies to tyrosine phosphatase (IA-2A). Zinc transporter 8 (ZnT8) was identified as a new auto-antigen in diabetes type 1. The coincidence of autoimmune thyroiditis with diabetes is common, therefore screening of thyroid stimulating hormone (TSH) and thyroid peroxidase antibodies (ATPO) is recommended at diagnosis of diabetes. We address the question whether occurrence of islet autoantibodies is associated with positive titre of ATPO in newly diagnosed adult onset autoimmune diabetes. DESIGN AND METHODS STUDY INVOLVED 80 NON-OBESE ADULTS AGED 44 [INTERQUARTILE RANGE (IQR): 37-51] years, body mass index (BMI) 24.0 (IQR: 22.2- 26.0) kg/m2, with new onset diabetes. Markers of autoimmune diabetes [GADA, ICA, IA-2A and ZnT8A], TSH and thyroid peroxidase antibodies (ATPO) were evaluated. 70% (n=56) subjects had positive at least 1 of 4 assessed markers of autoimmune diabetes (83.9% GADA, 62.5% ICA, 42.8% anty-IA2 and 33% ZnT8A), 37,5% patients were ATPO positive. ZnT8A positive patients had higher ATPO titre in comparison to ZnT8A negatives [(172.7 (IQR: 0.36-410.4) vs 92.4 (IQR: 0-23.7) IU/ml p=0,001)]. From the marked islet autoantibodies, occurrence of positive ZnT8A and GADA was related to positive titre of ATPO using logistic regression: OR=5.48 95%CI: 1.65-18.14 p=0.006 and OR=3.42 95%CI: 1.09-10.71 p=0.03 respectively.Conclusions In non-obese adults with new onset diabetes presence of glutamic acid decarboxylase autoantibodies and especially zinc transporter 8 autoantibodies increases the risk of autoimmune thyroiditis.
    Full-text · Article · Jan 2014 · European Journal of Endocrinology
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    ABSTRACT: The association of inflammation with cardiovascular (CV) complication in diabetes is still a matter of considerable debate. Arterial stiffness and enhanced wave reflection play an important role in CV complication. Therefore we address the question whether markers of inflammation are correlated with parameters of wave reflection in type 1 diabetes. We included 145 type 1 diabetic patients, median age 32 years, disease duration 10 years, HbA1c 8.2%. Serum high sensitive C-reactive protein (hsCRP), matrix metalloproteinase-9 (MMP-9), soluble intracellular adhesion molecule-1 (sICAM-1) and myeloperoxidase (MPO) concentrations were estimated as markers of inflammation. Parameters of pulse wave reflection (central- CAIx and peripheral augmentation index- PAIx ) were assessed with the use of Pulse Wave Analysis. In the study group CAIx and PAIx were associated with serum concentration of hsCRP [1.838 (95% CI: 0.336 - 3.339), p=0.017; 2.041 (95% CI: 0.683 - 3.400), p=0.004)] and sICAM-1 [0.073 (95% CI: 0.015 - 0.131) p=0.014; 0.066 (95 % CI: 0.013 - 0.119), p=0.016] in multivariate linear regression analysis after adjustment for age, BPmean,, HbA1c, LDL cholesterol and presence of at least one microangiopathic complication of diabetes. In type 1 diabetes parameters of wave reflection are related to markers of inflammation.
    No preview · Article · Jan 2014 · Journal of Diabetes
  • M. Mackiewicz-Wysocka · A. Araszkiewicz · B. Wierusz-Wysocka
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    ABSTRACT: Skin is one of the largest organs in the body. It is composed of epidermis, dermis and subcutaneous tissue. Skin changes in diabetes are similar to accelerated aging process. This paper presents the changes in the skin cells functions in the presence of hyperglycemia. We also describe the mechanisms of assessment of glycation of skin proteins, and the impact of the formation of advanced glycation end products on the properties of the skin. The variety of skin cells, glucose dependence, and their easy availability should make changes in the skin an equivalent of late diabetic complications.
    No preview · Article · Jan 2014
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    ABSTRACT: Introduction. Dysfunction of the sweat glands is an early clinical manifestation of diabetic neuropathy. SUDOSCAN+ is a device used to noninvasively assess the function of the sweat glands on the basis of the electrochemical reaction of chlorine ions secreted in sweat due to low voltage current. The aim of the study was to evaluate the electrochemical skin conductance with the device SUDOSCAN+ in the diagnosis of neuropathy in patients with type 1 diabetes. Material and methods. The study included 203 patients with type 1 diabetes (95 women and 108 men) aged 39 years (IQR: 31-50), with disease duration of 22 years (IQR: 17-30) hospitalized in the Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, between years 2013-2014. The study group was subdivided into two groups depending on the presence of peripheral neuropathy identified by standard methods. In the study group we performed analysis of electrochemical skin conduction (ESC) measured with SUDOSCAN+ on the hands and feet with estimation of Risk of Autonomic Neuropathy. We also evaluated the accumulation of advanced glycation end products in the skin on the basis of the autofluorescence skin ratio (AGE Reader device). Results. We diagnosed peripheral neuropathy in 45.3% of patients. Patients with peripheral neuropathy, compared to those without clinical neuropathy, had lower Feet ESC [70.5 (IQR: 51.5-83) vs. 83 μS (IQR: 78-87), p < 0.001], Hands ESC [58.5 (IQR: 47.5-71.5) vs. 70 μS (IQR: 61-78), p < 0.001] and a higher Risk of Autonomic Neuropathy [24.5 (IQR: 13-35) vs. 11% (IQR: 1-20), p < 0.001]. We found a negative correlation between the result of the Feet ESC and patients age (Rs = -0.40, p < 0.001), duration of diabetes (Rs = -0.32, p < 0.001), skin autofluorescence (Rs = -0.38, p < 0.001) and positive correlation with the eGFR (Rs = 0.32, p < 0.001). Conclusions. Electrochemical skin conductance is reduced in patients with type 1 diabetes and diabetic neuropathy. Sudomotor dysfunction is related to longer duration of diabetes, chronic metabolic uncontrolled diabetes, and worse renal function.
    No preview · Article · Jan 2014
  • A. Juruc · D. Pisarczyk-Wiza · B. Wierusz-Wysocka
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    ABSTRACT: Modern diabetic treatment of diabetes requires implementation of lifestyle changes, including modification of dietary habits. Nowadays there is a significant progress in therapies for patients with, that may favor greater liberty in eating behaviors. Diets that were used in order to improve metabolic control were changed. Modern treatment of diabetes by intensive functional insulin therapy allows much greater flexibility in eating habits and increases the variety in acceptable food products in comparison to more conventional insulin therapies. Thanks to this therapy, the change in patient's lifestyle caused by diabetes can be less visible and unpleasant. In spite of the progress in diabetic treatment, reaching a proper metabolic control is still a very difficult problem for a large number of patients. On the other hand, however, changing eating habits, including greater amount of fiber and low glycaemic index, is widely recommended in order to prevent the rate of development of chronic complications of diabetes. The aim of this article is to review current knowledge about diet and eating behaviors and its role in metabolic control and prevention of long term complications in type 1 diabetic patients.
    No preview · Article · Jan 2014