Paweł Niedźwiecki

Are zinc transporter type 8 antibodies a marker of autoimmune thyroiditis in non-obese adults with new-onset diabetes?

OBJECTIVE The diagnosis of autoimmune diabetes in non-obese adults is based on the detection of glutamic acid decarboxylase autoantibodies (GADA), islet cell antibodies (ICA) and antibodies to tyrosine phosphatase (IA-2A). Zinc transporter 8 (ZnT8) has been identified as a new autoantigen in patients with type 1 diabetes mellitus. The coincidence of autoimmune thyroiditis (AITD) with diabetes is common; therefore, screening of TSH and thyroid peroxidase antibodies (ATPO) is recommended during the diagnosis of diabetes. In this study, we determined whether the occurrence of islet autoantibodies is associated with a positive titre of ATPO in newly diagnosed adult-onset autoimmune diabetic patients. DESIGN AND METHODS THE STUDY INVOLVED 80 NON-OBESE ADULTS AGED 44 (INTERQUARTILE RANGE (IQR): 37-51) years with a BMI of 24.0 (IQR: 22.2-26.0) kg/m(2) and new-onset diabetes. The markers of autoimmune diabetes (GADA, ICA, IA-2A and ZnT8A), TSH and thyroid peroxidase antibodies (ATPO) were evaluated. RESULTS IN THE STUDY POPULATION, 70% (N=56) OF THE SUBJECTS WERE POSITIVE FOR AT LEAST ONE OF THE FOUR ASSESSED MARKERS OF AUTOIMMUNE DIABETES (83.9% GADA, 62.5% ICA, 42.8% IA-2A AND 33% ZNT8A) AND 37.5% OF THE SUBJECTS WERE POSITIVE FOR ATPO. THE ZNT8A-POSITIVE SUBJECTS HAD HIGHER ATPO TITRES THAN THE ZNT8A-NEGATIVE SUBJECTS (172.7 (IQR: 0.36-410.4) vs 92.4 (IQR: 0-23.7) IU/ml, P=0.001). Based on the assessed islet autoantibodies, the occurrence of positive ZnT8A and GADA was found to be related to a 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, the presence of GADA and especially ZnT8 autoantibodies increases the risk of AITD.

Assessment of adherence to the dietary recommendations concerning the amount of carbohydrates intake in type 1 diabetic patients treated with continuous subcutaneous insulin infusion during pregnancy and 8 weeks after the delivery

Introduction . Pregnancy in type 1 diabetic women isa special period requiring intensified care performedby the multidisciplinary therapeutic team. Maintainingthe recommended rigorous glycemic control is crucialcondition for the correct development of the foetus,and the mother’s health. The menu of pregnant diabeticpatients should provide them with all essentialdiet nutrients. Among them, carbohydrates affectblood glucose level the most strongly. Not only theiramount, but also type and distribution are important. Material and methods . The study group consisted of32 pregnant women with type 1 diabetes. All patientswere treated with intensive insulin therapy with theuse of continuous subcutaneous insulin infusion (CSII).In all cases we evaluated: glycated hemoglobin (HbA1c),body weight, daily intake of carbohydrates, the adherenceto the dietary recommendations concerning theamount of carbohydrates intake (per day) — at thetime of diagnosis of pregnancy, in 24th and 36th weekof pregnancy as well as 8 weeks after childbirth. Therecommended carbohydrate intake was calculated individuallyfor each patient and accounted for 40–45%of the daily energy demand. The consumption of therecommended amount of carbohydrates was assessedas 100% adherence. The information about carbohydrateintake in each trimester and after childbirth,was obtained from the computer program used toread data from the personal insulin pump and frompatients self-monitoring diaries. Results . Recommended daily carbohydrate intake forthe entire study group was approx. 205.6 ± 34.2 g ofcarbohydrates. The adherence to the recommendationsassessed in 1st, 2nd and 3rd trimester and 8 weeks afterchildbirth was: 82.8 ± 28.3%, 91.1 ± 29.7%, 97.3 ±± 34.8%, 69.9 ± 32.6%, respectively (p < 0.00001).After birth, breastfeeding subjects consumed 60.2 ±± 24.5% of the recommended carbohydrate intake,while for non-breastfeeding subjects it was 91.4 ±± 38.9% (p = 0.01). Subjects with normal body weightbefore pregnancy followed the recommendation inthe 1st, 2nd and 3rd trimester and 8 weeks after birthin 73.4 ± 19.9%, 83.4 ± 23.7%, 91.2 ± 30.2%, 63.4 ±± 25.3%, respectively, while overweight subjects in111.0 ± 32.1%, 114.5 ± 34.9%, 115.8 ± 42.9%, 89.8 ±± 44.7%, respectively. Conclusion . Pregnant type 1 diabetic women withnormal body weight before pregnancy consumedless carbohydrates than recommended. Complianceconcerning dietary recommendations significantly differedin particular trimesters and 8 weeks after birth.We observed a statistically significant decrease in theadherence to the recommendation after pregnancy.Breastfeeding subjects consumed less carbohydratesthan non-breastfeeding. Overweight subjects consumedmore carbohydrates than recommended.

Krótszy czas wyprowadzania z cukrzycowej kwasicy ketonowej podczas leczenia w ośrodku referencyjnym u osób z cukrzycą typu 1 i innymi specyficznymi typami cukrzycy

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.