Monika Lenart-Lipinska

Serum fibroblast growth factor 21 is predictive of combined cardiovascular morbidity and mortality in patients with type 2 diabetes at a relatively short-term follow-up

AIMSnWe hypothesised that serum fibroblast growth factor 21 (FGF-21), a novel adipokine with postulated insulin-sensitizing effects, may be predictive of cardiovascular (CV) events in patients with type 2 diabetes (DM2) at a relatively short-term follow-up.nnnMETHODSnSerum FGF-21 levels were assessed in 87 DM2 patients, aged 57-66 years, with the median duration of diabetes of 10 years, who were referred to the Department of Endocrinology for routine annual metabolic assessment. During a follow-up of 24 months, overall mortality, CV mortality and CV nonfatal events were registered. Cox proportional hazards regression assessed adjusted differences in CV morbidity and mortality risk.nnnRESULTSnPatients stratified according to serum FGF-21 levels ≤ and > the median value of 240.7 pg/mL showed no significant differences at baseline in gender distribution, diabetes duration, insulin therapy, BMI, biochemical profiles and previous CV events. At 24-month follow-up, 21 (24.1%) patients experienced a nonfatal CV event. A significantly (P=0.0013) higher incidence of the combined end point of CV morbidity and mortality was observed in the FGF-21>240.7 pg/mL group. In the multivariate Cox proportional hazards regression model, the presence of FGF-21>the median value was associated with a significant increase in the risk of the combined end point of CV morbidity and mortality (HR: 4.7, 95% CI 1.67-13.24).nnnCONCLUSIONSnThe obtained results support the prognostic value of FGF-21 in DM2 and may provide a useful tool for stratification of CV prognosis in DM2 patients.

Increased serum insulin-like growth factor-1 levels in women with gestational diabetes.

BACKGROUNDnInsulin-like growth factor-1 (IGF-1), which has effects similar to insulin, reduces blood glucose level, improves insulin sensitivity and may play an important role in the pathogenesis of gestational diabetes (GDM).nnnOBJECTIVEnThe aim of the study was to estimate the concentration of IGF-1 in pregnant women with GDM and 3 months after delivery and find relationships between IGF-1 and clinical and biochemical parameters.nnnMATERIALS AND METHODSn67 women between 24th - 28th week of pregnancy were enrolled in the study (46 with GDM and 21 as a control group). All women underwent clinical and biochemical examinations. Concentrations of IGF-1, adiponectin, fasting glucose, insulin, lipids, CRP, fibrinogen were measured during pregnancy, additionally IGF-1 concentration was determined 3 months after delivery.nnnRESULTSnIGF-1, glucose, insulin, CRP, fibrinogen, lipids concentrations and HOMA-IR were significantly higher in women with GDM than in the control group (p<0.05). A significant decrease in IGF-1 concentration was observed in both groups after delivery. In the GDM group significant correlations between IGF-1 and BMI (r=0.370, p<0.05), insulin (r=0.469, p<0.01) and HOMA-IR (r=0.439, p<0.01) were observed. Regression analysis with IGF-1 as a dependent parameter showed that only BMI and insulin remained as predictors, explaining 32% of plasma IGF-1 variation. Re-evaluation after delivery revealed impaired glucose tolerance in 9% of the population studied.nnnCONCLUSIONSnIncreased IGF-1 concentrations in pregnancy complicated with GDM may partly reflect metabolic disturbances, especially insulin resistance and hyperinsulinemia, and may be one of possible compensatory reactions of the organism in response to these disturbances.

Clinical implications of vitamin D deficiency.

Vitamin D deficiency is a common medical problem worldwide and its prevalence rises along with latitude, obesity, sedentary lifestyle, limited sunlight exposure and aging. A great body of evidence has shown that patients with vitamin D deficiency have increased cardiovascular risks and total mortality. Conversely, the presence of comorbidities progressive with age such as abdominal obesity, insulin resistance, type 2 diabetes and hypertension places the patients at an increased risk of vitamin D deficiency. The multidirectional effect of vitamin D deficiency is present in different phases of the aging process. Based on the literature review, the risk factors for vitamin D insufficiency most often found in post-menopausal women include limited sun exposure and time spent outdoors, inadequate dietary vitamin D intake, winter season and increased age. Vitamin D supplementation in this group might offer prevention of falls and fractures and may be beneficial for cardiovascular health, what may be especially important in osteoporotic and elderly populations. Prevention and treatment processes involve education regarding sunlight exposure and pharmacological cholecalciferol supplementation according to the recommendations for Central Europe. This manuscript reviews the role of vitamin D and its deficiency and considers their clinical implications, with particular regard to peri- and postmenopausal women.

The pharmacological and hormonal therapy of hot flushes in breast cancer survivors.

The side effects of oncological treatment, which appear during or after therapy, are sometimes very annoying for patients and are not adequately treated by physicians. Among the symptoms experienced by breast cancer patients are hot flushes, which result from a natural or cancer therapy-induced menopause. The intensity of hot flushes in breast cancer patients may be more severe than those experienced by women undergoing a natural menopause. Taking into account the incidence of breast cancer and long-lasting hormone-suppression therapies, the problem of hot flushes will affect many women. Hormonal replacement therapy, the most effective therapeutic means for alleviating hot flushes, is usually contraindicated for breast cancer patients. For intense and severe hot flushes, pharmacological treatment using agents from a group of selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors such as venlafaxine or citalopram may be introduced. Other agents from different pharmacological groups, such as clonidine, gabapentin, or pregabalin, have also proved to be effective in treating hot flushes. The efficacy of phytoestrogens has not been proven in randomized clinical trials. The importance of the placebo effect in decreasing vasomotor symptoms has also been reported in many research papers. Educating breast cancer patients in lifestyle changes which decrease the frequency and intensity of vasomotor symptoms can offer significant help too. This paper reviews the current state of research in order to assess the options for the treatment of hot flushes in breast cancer survivors.

Postpartum adiponectin changes in women with gestational diabetes

INTRODUCTION AND OBJECTIVEnCurrent literature provides contradictory information on the role of adiponectin (AdipoQ) in the course of gestational diabetes mellitus (GDM) and the changes after delivery. The aim of the study was to measure AdipoQ concentration in blood of women with GDM, and to conduct a comparative analysis of AdipoQ concentrations in gestation at 3 and 12 months after delivery.nnnMATERIAL AND METHODSnThe study group consisted of 50 women diagnosed with GDM between 24 and 28 weeks of gestation. Three months after delivery, 41 women underwent further tests, while 12 months after delivery 30 patients. All patients underwent clinical and laboratory evaluation at GDM diagnosis at 3 and 12 months after delivery. Laboratory evaluation included fasting glucose, fasting insulin, OGTT and lipid parameters in serum. Serum AdipoQ concentration was measured at GDM diagnosis as well as at 3 and 12 months after delivery.nnnRESULTSnAdipoQ concentrations did not differ significantly between the groups during gestation (p=0.7054) and 3 months after delivery (p=0.9732), while a significant rise was observed 12 months after delivery, compared to the values during pregnancy (p=0.0006). AdipoQ in the GDM group 12 months after delivery inversely correlated with fasting glucose and 2-hour post-load plasma glucose after a 75-g oral glucose tolerance test (r=-0.37*; p<0.05 and r=-0.42, p<0.05, respectively).nnnCONCLUSIONSnAn increased level of AdipoQ after delivery in the comparison to women with GDM may be a marker for reversibility of carbohydrate metabolism disorders, while a negative correlation between AdipoQ and glucose levels suggests that this parameter may be a predictor In the future of disturbances in glucose tolerance in women with GDM.

Polycystic ovary syndrome: clinical implication in perimenopause.

Polycystic ovary syndrome (PCOS), a hyperandrogenic disorder, is the commonest endocrinopathy in premenopausal women. This syndrome is associated with fertility problems, clinical manifestations of hyperandrogenism and metabolic disturbances, particularly insulin resistance and obesity. There is a great body of evidence that patients with PCOS present multiple cardiovascular risk factors and cluster components of metabolic syndrome from early ages. The presence of comorbidities such as abdominal obesity, insulin resistance, type 2 diabetes, hypertension places these females at an increased risk of future cardiovascular events. However, the extent to which PCOS components are present in perimenopausal women and the degree to which PCOS increases various risk factors in addition to the known risk of the perimenopausal period have not been fully determined. The perimenopausal period per se is associated with weight gain and an increased cardiovascular risk, which may be additionally aggravated by the presence of metabolic disturbances connected with PCOS. The phenotype of PCOS may improve with aging and it is still uncertain whether the presence of PCOS significantly increases the cardiovascular risk later in womens life. Most recent data suggest that the prevalence of cardiovascular diseases and the related long-term consequences in females with PCOS seem to be lower than expected. This manuscript reviews long-term consequences of PCOS and considers their clinical implications in perimenopause.

Exenatide twice daily versus insulin glargine for the treatment of type 2 diabetes in Poland — subgroup data from a randomised multinational trial GWAA

INTRODUCTIONnWe explored the safety and efficacy of exenatide BID v. insulin glargine in a subgroup of Polish patients with type 2 diabetes sub-optimally controlled with metformin plus a sulfonylurea, participating in a 26-week randomised, controlled open-label trial.nnnMATERIAL AND METHODSnIn Poland, 80 patients (HbA1c 7-10%, BMI 25-45 kg/m(2)) were randomised to exenatide 10 μg BID (n = 40) or insulin glargine once daily (n = 40). We present exploratory analyses on HbA1c, glucose profiles, body weight, hypoglycaemia and adverse events (AEs).nnnRESULTSnMean (SD) baseline HbA1c was 7.9% (0.86) for exenatide and 7.8% (1.02) for insulin glargine. At Week 26, LS mean (SEM) HbA1c decreased in both groups (exenatide -0.72% [0.12]; glargine -0.64% [0.12]), as did fasting glucose. Postprandial glucose excursions after breakfast and dinner were smaller in patients treated with exenatide. LS mean (SEM) body weight decreased by -1.9 (0.48) kg with exenatide and increased by 1.6 (0.48) kg with glargine (group difference [95%CI]: -3.5 kg [-4.9 to -2.2]). Hypoglycaemia was low in both groups; nocturnal hypoglycaemia was reported for three v. seven patients (three v. 24 episodes) in the exenatide and glargine groups, respectively. Adverse events were more common with exenatide (nausea n = 22 v. n = 1, vomiting n = 5 v. n = 0, headache n = 8 v. n = 2).nnnCONCLUSIONnThis exploratory analysis confirms that findings from the global study apply to patients treated with exenatide BID and glargine in Poland, showing that exenatide BID was as effective as insulin glargine. Data suggested that changes in HbA1c were similar, with fasting glucose changes greater in the glargine group and postprandial changes greater in the exenatide BID group. Exenatide BID was associated with weight reduction, less nocturnal hypoglycaemia, but more gastrointestinal events compared to glargine.

A new diagnostic perspective – hyperglycemia in pregnancy – as of the year, 2014

Abstract Gestational Diabetes Mellitus (GDM) is a growing epidemiological problem, and it is currently the most common metabolic disorder in pregnancy, as it affects approximately 2-6% of all pregnant women. In 2014, the Polish Diabetic Association introduced significant changes in the diagnosis of hyperglycemia as first diagnosed in pregnancy, based on the recommendations of the IADPSG of 2010 and WHO of 2013. There are now two categories: diabetes in pregnancy, and GDM. These involve different degrees of severity of metabolic complications for the mother and the growing fetus. Establishing a new diagnostic criterion is significant because of the negative impact of hyperglycemia on the fetus (especially in the first trimester), the increased prevalence of malformations or the possibility of spontaneous abortions in early pregnancy.

Hypopituitarism in the course of secondary hemochromatosis in a patient with Diamond-Blackfan anemia

Diamond-Blackfan anemia (DBA) is a rare, genetically determined disorder which is manifested with selective deficiency of erythrocyte line in bone marrow. Patients with DBA are diagnosed with a hypocellular bone marrow with a significant absence of erythroid precursors typically in early childhood. They require chronic treatment with corticosteroids and frequent blood transfusions, stem cell transplantation is also possible. For those., who don’ t respond to corticosteroids therapy, survival depends on blood transfusions. The most common complications of transfusional hemochromatosis are hepatic cirrhosis, cardiomiopathy and endocrinopathies such as hypopitiutarism, hypogonadism, hypothyreosis or diabetes mellitus. DBA patients, therefore, require longterm chelation therapy to avoid these complications.