Piotr Ładyżyński

Home telecare during intensive insulin treatment – metabolic control does not improve as much as expected

We examined the influence of the increased frequency of data reporting on metabolic control in patients with diabetes. Data reporting was via a home telecare system that stored blood glucose values and was integrated with a simple electronic logbook. The data collected by the patient were automatically transmitted via the telephone network every night. The study population consisted of 30 patients with type I diabetes, who were randomly allocated to the home telecare group or the control group. The control group was treated based on clinical examinations performed every three weeks. In the home telecare group, the patient-collected data were transmitted to hospital daily, enabling more frequent interventions by the doctor. The average study period was 180 days (SD 22) in the home telecare group and 176 days (SD 16) in the control group. The mean level of metabolic control and the insulin dose adjustment patterns were very similar in both groups regardless of the much higher (15 times) reporting frequency in the home telecare group. The patient-collected data were not fully utilized, mainly because of too high within-day variability in glycaemic control and the high workload connected with daily data analysis.

A Randomized Controlled Study of an Insulin Dosing Application That Uses Recognition and Meal Bolus Estimations

Background: Throughout the insulin pump therapy, decisions of prandial boluses programming are taken by patients individually a few times every day, and, moreover, this complex process requires numerical skills and knowledge in nutrition components estimation. The aim of the study was to determine the impact of the expert system, supporting the patient’s decision on meal bolus programming, on the time in range of diurnal glucose excursion in patients treated with continuous subcutaneous insulin infusion (CSII). Methods: The crossover, randomized study included 12 adults, aged 19 to 53, with type 1 diabetes mellitus, duration ranging from 7 to 30 years. Patients were educated in complex food counting, including carbohydrate units (CU) and fat-protein units (FPU). Subsequently, they were randomly allocated to the experimental group (A), which used the expert software named VoiceDiab, and the control group (B), using a manual method of meal-bolus estimation. Results: It was found that 66.7% of patients within the A group statistically reported a relevant increase in the percentage (%) of sensor glucose (SG) in range (TIR 70-180 mg/dl), compared to the B group. TIR (median) reached 53.9% in the experimental group (A) versus 44% within the control group (B), P < .05. The average difference in the number of hypoglycemia episodes was not statistically significant (–0.2%, SD 11.6%, P = .93). The daily insulin requirement in both groups was comparable—the average difference in total daily insulin dose between two groups was 0.26 (SD 7.06 IU, P = .9). Conclusion: The expert system in meal insulin dosing allows improvement in glucose control without increasing the rates of hypoglycemia or the insulin requirement.

The First Use of Bolus Calculator With Speech Analyzer: The Patients’ Perspective

Background: The insulin therapy in type 1 diabetes involves a wide array of restrictions in patients and their families. One of those is a difficulty in estimation of the insulin dose programmed for each meal. The purpose of the study is an assessment of functionalities related to the expert system VoiceDiab—a calculator of meal boluses. Methods: The sample group composed of 54 patients, aged 3-52, all suffering from type 1 diabetes, treated with the insulin pump, taking part in the clinics RCT (for adults and a pediatrician), with a randomized allocation to a surveyed group and cross-over. The research methodology was based upon questionnaires and open-ended questions. Results: 40% of respondents recognized the application’s usefulness as high (18 of 47), giving it 10 points, and easy to use (70%). Disadvantages of this app comprised lack of some products in the application database (n = 23), troubles with the mobile range ( n = 4), and no option of a manual data input for processing purposes (n = 23). Advantages, that have been mentioned the most frequently included facilitation of measurements (n = 7), enhanced life quality of the patient (n = 8), and a guarantee of prompt and thorough calculations (n = 22). Of the surveyed individuals, 50% reached their diet, while 100% gave a top grade to the application, claiming it had contributed to a more efficient metabolic control. Conclusion: The pilot scheme of the expert system VoiceDiab has potential to become an application, facilitating dosing of the meal insulin and improving the comfort and safety of insulin administering. However, it needs to be modified, as mentioned by the users who have tested the system.

Preventive systems for the late complications of diabetes

Aim of this work is to review and characterize methods and systems that are used to prevent onset and to slow down the progression of the late complications of diabetes. Two groups of methods and systems that might be used to prevent or to slow down the progression of the late complications of diabetes are characterized in this paper. Each of these two groups serves a different purpose. The first group is composed of the systems that facilitate a maintenance of strict metabolic control in diabetic patients, i.e. the systems which are used for monitoring and treatment of diabetes. The second group contains systems that are aimed at screening/monitoring or treatment of the risk factors or the early signs of the late complications. Obesity increases risk of diabetes and its complications. Thus, body mass monitoring and control systems are examples of the tools that belong to this group. Other examples include the diabetic retinopathy telescreening systems and the systems for monitoring of the diabetic foot syndrome.

System for Calculating of Compensating Insulin Dose from Voice Description of Meal

An effective application of insulin treatment in diabetic patients requires ability of the patient to select proper insulin doses, which compensate ingested meals. This is difficult, time consuming and in some cases outreach patient’s abilities.

Transmembrane Pressure as an Indicator of a Density of Endothelial Cells Cultured Inside Capillaries of a Membrane Bioreactor under Dynamic Conditions

The main objective of this study was to asses usefulness of usage of transmembrane pressure changes measurements for monitoring of cells culture in the closed construction of bioreactor with semipermeable capillary membranes. Two simultaneous HUVECs’ cultures in bioreactors with an assumed cells densities of 20,000 and 60,000 cells/cm2 were carried out. Obtained results indicated that the transmembrane pressure rise time of 30 mmHg after locking up the capillaries exit depend on the quantity of cells introduced for seeding to inner part of capillaries and may be a good marker of cells quantity cultured on the inside surface of capillary membranes. However microscopy analysis of the inner part of membranes after end of cultures showed that cells shapes and sizes differed from those for cells cultured without monitoring of transmembrane pressure changes. The further studies are necessary aimed at selection of the value of the transmembrane pressure rise which does not influence on the cells morphology, cytoskeletal organization and does not disturb physiological behavior of the cells.

A Multiple Treatments Meta-Analysis of a Response to the First-Line Treatment of the Chronic Lymphocytic Leukemia

The chronic lymphocytic leukemia (CLL) is the most common blood cancer in adult patients. We performed a multiple treatments meta-analysis using the evidence found in reports of randomized controlled trials (RCTs) identified in the PubMed database to compare a response to available first-line treatments of CLL. Twenty three trials involving 7,507 patients were included in the analysis comparing the complete remission (CR) and the partial remission (PR) rates of different therapy options. A Bayesian framework was applied using a Markov Chain Monte-Carlo technique. Chlorambucil was considered to be the reference treatment. All the analyzed treatments ensured higher CR and PR than the reference treatment. The obtained results suggest that bendamustine has the highest probability of being the most efficacious treatment in terms of CR and PR in patients with previously untreated CLL.

An Analysis of the Hemoglobin Glycation Rate in the A1C-Derived Average Glucose Study Population Applying a Monte Carlo Method

Diabetes is a huge and growing problem, and the costs to society are consistently increasing. The glycated hemoglobin A1c (HbA1c) concentration is a frequently used marker of the metabolic control. In 2008 the results of the A1c-Derived Average Glucose (ADAG) Study were reported establishing a linear relationship between HbA1c and the preceding glycemia. The aim of this study was to analyze the overall hemoglobin glycation rate constant (k) in the ADAG population applying a Monte Carlo method. We reproduced the distribution of HbA1c and plasma glucose concentrations in the ADAG population and we obtained an estimate of k equal to 1.239 ± 0.175×10− 9 L/(mmol s) assuming that red blood cells’ (RBCs) life span was equal to 120 days. The k value estimated in this study is in a good agreement with values of this parameter reported earlier. It was also demonstrated that a normal distribution of RBCs’ life span with the standard deviation of 14 days is sufficient to explain the inter-subject variability of the hemoglobin glycation rate. The obtained distribution of RBCs’ life spans is even less scattered around the mean than previously reported distributions for healthy individuals and for patients with diabetes. However, an assumption that k is the same for all the individuals implies a positive correlation of RBCs’ life span and HbA1c concentration, which was inconsistent with earlier reports. This result suggests that the hemoglobin glycation rate might increase with a deterioration of the metabolic control.