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Take Action to Prevent Diabetes – The IMAGE Toolkit for the Prevention of Type 2 Diabetes in Europe

When we ask people what they value most, health is usually top of the list. While effective care is available for many chronic diseases, the fact remains that for the patient, the tax payer and the whole of society: prevention is better than cure. Diabetes and its complications are a serious threat to the survival and well-being of an increasing number of people. It is predicted that one in ten Europeans aged 20-79 will have developed diabetes by 2030. Once a disease of old age, diabetes is now common among adults of all ages and is beginning to affect adolescents and even children. Diabetes accounts for up to 18 % of total healthcare expenditure in Europe. The good news is that diabetes is preventable. Compelling evidence shows that the onset of diabetes can be prevented or delayed greatly in individuals at high risk (people with impaired glucose regulation). Clinical research has shown a reduction in risk of developing diabetes of over 50 % following relatively modest changes in lifestyle that include adopting a healthy diet, increasing physical activity, and maintaining a healthy body weight. These results have since been reproduced in real-world prevention programmes. Even a delay of a few years in the progression to diabetes is expected to reduce diabetes-related complications, such as heart, kidney and eye disease and, consequently, to reduce the cost to society. A comprehensive approach to diabetes prevention should combine population based primary prevention with programmes targeted at those who are at high risk. This approach should take account of the local circumstances and diversity within modern society (e.g. social inequalities). The challenge goes beyond the healthcare system. We need to encourage collaboration across many different sectors: education providers, non-governmental organisations, the food industry, the media, urban planners and politicians all have a very important role to play. Small changes in lifestyle will bring big changes in health. Through joint efforts, more people will be reached. The time to act is now.

Technetium-99m-sestamibi subtraction scintigraphy vs. ultrasonography combined with a rapid parathyroid hormone assay in parathyroid aspirates in preoperative localization of parathyroid adenomas and in directing surgical approach.

Objective  To determine the sensitivity and positive predictive value (PPV) of subtraction scintigraphy (SS) vs. ultrasonography (US) of the neck combined with rapid intact parathyroid hormone (iPTH) assay in US‐guided fine‐needle parathyroid aspirates in preoperative localization of parathyroid adenomas and in directing surgical approach.

Cancer consequences of the Chernobyl accident in Europe outside the former USSR : A review

The accident which occurred during the night of April 25–26, 1986 in reactor 4 of the Chernobyl nuclear power plant in the Ukraine released considerable amounts of radioactive substances into the environment. Outside the former USSR, the highest levels of contamination were recorded in Bulgaria, Austria, Greece and Romania, followed by other countries of Central, Southeast and Northern Europe. Studies of the health consequences of the accident have been carried out in these countries, as well as in other countries in Europe. This report presents the results of a critical review of cancer studies of the exposed population in Europe, carried out on the occasion of the 10th anniversary of the Chernobyl accident. Overall, there is no evidence to date of a major public health impact of the Chernobyl accident in the field of cancer in countries of Europe outside the former USSR.

Prevention of type 2 diabetes by lifestyle intervention in primary health care setting in Poland: Diabetes in Europe Prevention using Lifestyle, physical Activity and Nutritional intervention (DE-PLAN) project:

Aim To find out whether diabetes prevention via a lifestyle intervention programme is feasible in a primary healthcare setting in Poland. Methods The intervention (Diabetes in Europe: Prevention using Lifestyle, physical Activity and Nutritional intervention; DE-PLAN project) was completed by 175 middle-aged, slightly obese participants in nine primary healthcare centres in Krakow, Poland. The inclusion criterion was diabetes risk (Finnish Diabetes Risk score (FRS) >14). The nurse-delivered intervention consisted of 10 group

Increased prevalence of hyperthyroidism as an early and transient side-effect of implementing iodine prophylaxis

OBJECTIVE To assess the prevalence of hyperthyroidism just after implementation of iodine prophylaxis among adults from an area with iodine deficiency. STUDY DESIGN AND SUBJECTS A total of 1648 adults (age 16 years and older) were sampled from an area of southern Poland during two nationwide epidemiological surveys. Of these, 1424 adults with negative medical history for thyroid disorders qualified for final analysis. The authors compared thyroid dysfunction in participants prior to (1989-1990) and after implementation of iodine prophylaxis (1997-1999). SETTING The southern part of Poland. RESULTS We found an increase in the serum concentration of anti-thyroid microsomal antibodies from 4.9% in the years 1989-1990 to 12.1% after introduction of iodised household salt (P < 0.0001). The prevalence of hyperthyroidism (defined as thyroid-stimulating hormone < 0.4 microU ml- 1) significantly increased in the equivalent period from 4.8 to 6.5% (P = 0.009). CONCLUSIONS We concluded that a sudden rise in iodine intake after implementation of iodine prophylaxis among adults from the area with iodine deficiency may lead to an increase in thyroid autoimmunity and prevalence of hyperthyroidism. Those possible early side-effects appear to be only temporary and are acceptable when compared with the evident benefits of adequate iodine intake.

Iodine, Selenium, and Other Trace Elements in Urine of Pregnant Women

The purpose of this work was to determine trace element levels in urine and evaluate possible associations between urinary iodine concentration (UIC), other trace elements (Cr, Cu, Fe, Mn, Na, Se, Zn), toxic elements (Cd, Pb), anthropometrical measures (body weight and height), glycemic indices (serum insulin and glucose), and several parameters related to thyroid function (thyroid stimulating hormone, free thyroxine, antithyroid peroxidase antibodies, thyroid volume, and thyroid echogenicity) in pregnant women. One hundred sixty-nine participants were recruited. The whole study group, originating from Krakow region, comprised three subgroups belonging to three trimesters: I trimester (n = 28), II trimester (n = 83), and III trimester (n = 58). Trace elements were determined using inductively coupled plasma mass/(atomic emission) spectrometry. Partial least square model was used to reveal correlation structure between parameters investigated, as well as a possible causal relationship between dependent parameters and potentially explanatory parameters. Results obtained for trace and toxic elements in urine were comparable with results of other authors, although the study group was not homogenous. We confirmed (1) low iodine excretion in pregnant women, (2) the existence of statistically significant correlation between UIC and urinary selenium, and (3) lack of correlation between latter parameter and typical indices of thyroid function. Urinary selenium correlated with other urinary trace elements, but physiological significance of this finding remains uncertain. The fact that a large number of pregnant women fail to meet dietary recommendations for iodine is the major reason for concern.

Effectiveness of the iodine prophylaxis model adopted in Poland

Objective: Most of the Polish territory has been classified as an iodine-deficient and endemic goiter area according to the International Council for Control of Iodine Deficiency (ICCIDD) criteria. In 1997 the obligatory model of iodine prophylaxis was implemented. Our investigations were aimed at the effectiveness of iodine prophylaxis in Poland. Methods: We assessed urinary iodine excretion and goiter prevalence in 5663 children aged 6–12 yr. The population of children from the same 27 schools was investigated from 1992 to 1994 (1406 girls and 1244 boys) and from 1999 to 2005 (1563 girls and 1450 boys) using identical laboratory and ultrasound methods. Results: We found significant increase in iodine urinary concentration (median 52 μg/l vs 93 ug/l, p<0.001) with accompanying drop in goiter prevalence (29.6% vs 5.2%, p<0.001) after implementation of iodine prophylaxis. Iodine excretion distribution changed significantly after 1997 with an increase in the percentage of children with iodine urinary concentration above 100 μg/l from 10.8% to 45.4%, respectively. A significantly higher iodine urinary concentration was observed in lowlands compared to uplands both before and after implementation of iodine prophylaxis (median, 50 νg/l vs 57 μg/l and 86 μg/l vs 114 μg/l, respectively, p<0.001). The goiter prevalence did not differ between girls and boys from 1992 to 1994 (28.8% vs 30.5%, p=0.35) and 1999 to 2005 (5.5% vs 4.9%, p=0.45). Conclusions: Implementation of the new model of iodine prophylaxis in Poland in 1997 has led to significant increase in iodine urinary concentration and decrease in goiter prevalence among Polish schoolchildren. In the youngest group of children (6–8 yr olds), prevalence of goiter decreased to 3.2% — i.e. below endemic levels.

Iodine concentration in Polish consumer milk.

Abstract The aim of this study was monitoring the iodine concentration in Polish consumer milk in the years 2011-2012. The test material used in this study consisted of consumer UHT pasteurized milk with extended shelf life. Six randomly selected cartons of milk with different fat content (from 0.5% to 3.2%) were each purchased from large-sized stores located in 16 cities during the summer and in 13 cities during the cow’s winter feeding period. In total, 167 milk samples were collected. During the summer season, the milk’s iodine content averaged 143 μg iodine kg-1 and ranged from 103 to 196 μg iodine kg-1 (n=96 samples), with a standard deviation (SD) of ±31 and coefficient variability (CV) of 44%. During the winter season, the milk’s iodine content averaged 183 μg iodine kg-1 and ranged from 141 to 236 μg iodine kg-1 (n=77 samples), with a standard deviation (SD) of ±5 and coefficient of variability (%) (CV) of 26%. Iodine levels in Polish consumer milk increased from the last monitoring (2007-2008) from 100 to 143 μg iodine kg-1 in the summer season, and from 147 to 183 μg iodine kg-1 in the winter season (increases of 47% and 24%, respectively).

Performance characteristics of a rapid method for iodine determination in milk.

Streszczenie Badania powtarzalności i odtwarzalności przeprowadzono na 72 próbkach. Określono najważniejsze parametry walidacji, w tym składowe niepewności. Wyniki analiz porównano z wartościami referencyjnymi. Powtarzalność i odtwarzalność metody nie przekraczały 8 i 10%, odpowiednio. LOQ w oznaczanym roztworze próbki mleka wynosił 14 μg/L. Zakres roboczy krzywej kalibracji wynosił od 7 do 200 μg/L. Niepewność metody (P≤0,05) uwzględniająca błędy odtwarzalności wewnątrzlaboratoryjnej, odzysku, czystości wzorca oraz błędy szkła miarowego wynosiła (%) 17.8 i 22.8 (n = 2 i n = 1). Podczas wykonywania rutynowych analiz powinien być sprawdzany współczynnik zmienności dla powtarzalności, który nie powinien przekraczać granicy powtarzalności wynoszącej 16%. Metoda cechuje się wystarczającą wiarygodnością, co zostało potwierdzone wynikami walidacji. Procedura jest szybka, prosta i ma niską wartość LOQ. Metodę akredytowano zgodnie z normą ISO/IEC 17025:2005. Abstract The repeatability and within-laboratory reproducibility were tested on 72 samples. The most important validation parameters were determined, including the components of uncertainty. The results of the analyses were compared with reference values. The repeatability and within-laboratory reproducibility of the method did not exceed 8% and 10%, respectively. The limit of quantification (LOQ) in the milk sample solution was 14 μg/L. The working range of the calibration curve was 7 to 200 μg/L. The uncertainty of the method (P≤0.05), which accounts for the errors of within-laboratory reproducibility, recovery and standard purity as well as the errors of volumetric glassware, was (%) 17.8 and 22.8 (n = 2 and n = 1), respectively. The coefficient of variation for repeatability should also be determined during routine analysis; it should not exceed the repeatability limit of 16%. The method has sufficient reliability, as confirmed by the validation results. The procedure is rapid, simple and has a low LOQ. The method was accredited according to ISO/IEC 17025:2005 international standard.

Association of coronary atherosclerosis with insulin resistance in patients with impaired glucose tolerance.

Objectives — The purpose of the study was to evaluate the role of insulin resistance (IR) in the development of coronary atherosclerosis in patients with impaired glucose tolerance. Methods and results — The study group consisted of 42 patients with impaired glucose tolerance. Based upon coronary angiography the patients were divided into group A – with prior myocardial infarction and critical coronary stenosis (n = 20) and group B – without prior myocardial infarction and without critical coronary stenosis (n = 22). In each patient glucose disposal rate (GDR) during metabolic clamp, insulinaemia in the fasting state and during the clamp, glycaemia during oral glucose tolerance test (OGTT), BMI and body mass composition were measured.The groups did not differ in age, BMI, percent fat content and distribution, and blood pressure. Fasting insulinaemia (56.7 mU/ml) was higher in group A than in group B (22.3 μU/ml). GDR in group A (2.96 mg/kg b.m./min) was lower than in group B (5.36 mg/kg b.m./min).There was a negative correlation between the number of critically narrowed coronary vessels and GDR in group A. GDR below 3.97 mg/kg b.m./min was found, based on regression analysis, to be a powerful risk factor for myocardial infarction. Conclusions — The relationship between IR and severity of coronary atherosclerosis implies its unfavourable role in the development of atherosclerosis. The present findings indicate a negative role of IR in the development of myocardial infarction and suggest that it is an independent risk factor, which identifies high-risk patients requiring treatment that would increase tissue insulin sensitivity.