Wladyslaw Grzeszczak

Self-Monitoring of Blood Glucose in Type 2 Diabetes: Recent Studies

The increasing role for structured and personalized self-monitoring of blood glucose (SMBG) in management of type 2 diabetes has been underlined by randomized and prospective clinical trials. These include Structured Testing Program (or STeP), St. Carlos, Role of Self-Monitoring of Blood Glucose and Intensive Education in Patients with Type 2 Diabetes Not Receiving Insulin, and Retrolective Study Self-Monitoring of Blood Glucose and Outcome in Patients with Type 2 Diabetes (or ROSSO)-in-praxi follow-up. The evidence for the benefit of SMBG both in insulin-treated and non-insulin-treated patients with diabetes is also supported by published reviews, meta-analyses, and guidelines. A Cochrane review reported an overall effect of SMBG on glycemic control up to 6 months after initiation, which was considered to subside after 12 months. Particularly, the 12-month analysis has been criticized for the inclusion of a small number of studies and the conclusions drawn. The aim of this article is to review key publications on SMBG and also to put them into perspective with regard to results of the Cochrane review and current aspects of diabetes management.

Effects of Naloxone Administration on Endocrine Abnormalities in Chronic Renal Failure

In 72 patients with end-stage renal failure and 70 healthy subjects, the influence of blockade of opioid receptors by naloxone on secretion of prolactin, lutropin (LH), follitropin (FSH), adrenocorticotropin (ACTH), somatotropin (HGH), insulin (IRI), glucagon (IR-G), parathyroid hormone (PTH) and calcitonin (CT) was studied. Administration of naloxone stimulated luliberin-induced LH and FSH secretion quantitatively equally in patients and controls. Blockade of opioid receptors was followed by a less marked suppression of chlorpromazine-induced prolactin secretion but by a higher response of hypoglycemia-induced ACTH secretion in uremic patients than in controls. In addition, a less marked suppressive effect of naloxone was noted on hypoglycemia-induced HGH secretion in chronic renal failure as compared with controls. Blockade of opioid receptors improved significantly glucose tolerance and glucose-induced insulin secretion in uremic patients and suppressed nearly completely glucagon secretion response during the second phase of a glucose tolerance test. Finally, administration of naloxone was followed by a blunted response of Ca-induced CT secretion and suppression of PTH. Data presented in this paper suggest the existence of hyperendorphinism in end-stage renal failure.

Efficacy of acarbose in different geographical regions of the world: analysis of a real-life database†

Alpha‐glucosidase inhibitors are recommended in some international guidelines as first‐line, second‐line and third‐line treatment options but are not used worldwide due to perceived greater effectiveness in Asians than Caucasians.

The Role of Self-Monitoring of Blood Glucose in Glucagon-Like Peptide-1-Based Treatment Approaches: A European Expert Recommendation

The role of glucagon-like peptide (GLP)-1-based treatment approaches for type 2 diabetes mellitus (T2DM) is increasing. Although self-monitoring of blood glucose (SMBG) has been performed in numerous studies on GLP-1 analogs and dipeptidyl peptidase-4 inhibitors, the potential role of SMBG in GLP-1-based treatment strategies has not been elaborated. The expert recommendation suggests individualized SMBG strategies in GLP-1-based treatment approaches and suggests simple and clinically applicable SMBG schemes. Potential benefits of SMBG in GLP-1-based treatment approaches are early assessment of treatment success or failure, timely modification of treatment, detection of hypoglycemic episodes, assessment of glucose excursions, and support of diabetes management and diabetes education. Its length and frequency should depend on the clinical setting and the quality of metabolic control. It is considered to play an important role for the optimization of diabetes management in T2DM patients treated with GLP-1-based approaches.

An age-related decrease in factor V Leiden frequency among Polish subjects.

Factor V Leiden (G1691AFV mutation) is a widely acknowledged risk factor of deep vein thrombosis, including pulmonary embolism as the most serious complication. However, its high prevalence of ∼5% in the Caucasian population might be related to an unknown evolutionary advantage. It might exert a beneficial effect on the carrier, e. g. protecting women from excessive bleeding during labour or allowing increased survival in severe sepsis or with other inflammatory diseases. The aim of our study was to verify or contradict the hypothesis of a favourable association between the A allele (A1691) and longevity in the Polish population. For this purpose, the G1691A mutation was analyzed by PCR-RFLP in 1016 Poles: 400 neonates (187 female and 312 male), 184 healthy adults (129 female and 55 male), and 432 long-lived individuals (age ≥ 95 years: 343 women and 89 men). Frequencies of G1691A carriers and the A1691 allele in long-lived individuals (0.2% and 0.1%, respectively) were significantly lower than in neonates (4.2% and 2.2%, respectively) and adults (3.3% and 1.6%). The frequency of the G1691A factor V Leiden mutation decreased with age, which indicates a shorter survival time among A1691 allele carriers in the Polish population.

Acarbose reduces body weight irrespective of glycemic control in patients with diabetes: results of a worldwide, non-interventional, observational study data pool

OBJECTIVE The objective of this study is to examine the effect of acarbose, an alpha-glucosidase inhibitor, on body weight in a real-life setting by pooling data from post-marketing surveillance. METHODS Data from 10 studies were pooled (n=67,682) and the effect of acarbose on body weight was analysed taking into account baseline body weight, glycemic parameters and other baseline characteristics. RESULTS The mean relative reduction in body weight was 1.45 ± 3.24% at the 3-month visit (n=43,510; mean baseline 73.4 kg) and 1.40 ± 3.28% at the last visit (n=54,760; mean baseline 73.6 kg) (both p<0.0001). These reductions were dependent on baseline body weight (overweight: -1.33 ± 2.98% [n=13,498; mean baseline 71.6 kg]; obese: -1.98 ± 3.40% [n=20,216; mean baseline 81.3 kg]). When analysed by baseline glycemic parameter quartiles, the reduction was independent of fasting plasma glucose (FPG), postprandial plasma glucose (PPG), glycated hemoglobin (HbA1c) and postprandial glucose excursion (PPGE). A bivariate analysis of covariance identified female sex, South East Asian and East Asian ethnicity, younger age, higher body mass index, short duration of diabetes, and no previous treatment as factors likely to impact positively on body weight reduction with acarbose. CONCLUSIONS This post-hoc analysis showed that acarbose treatment reduces body weight independent of glycemic control status but dependent on baseline body weight.

Is Analgesic Nephropathy a Problem in the South-West Region of Poland?

Prof. F. Kokot, Department of Nephrology, Silesian University School of Medicine, ul. Francuska 20/24, PL-40-027 Katowice (Poland) Dear Sir, The prevalence of analgesic nephropathy (AN) in hemodialyzed patients in Poland has been established as extremely low [1]. On the other hand, the existence of an inverse correlation between prevalence of AN and nephropathy of unknown etiology was shown [2]. Thus, it seems to be likely that at least in some patients with end-stage renal failure (ESRF) of unknown origin chronic uremia may be caused by the chronic abuse of analgesics. As diagnostic criteria of AN in patients with ESFR were specified only recently [3], it seemed interesting to reassess based on new diagnostic criteria the prevalence of AN in the population of the same region on which there was a previous report [1]. The present study was a part of a multi-center one coordinated by the University of Antwerp (Analgesic Nephropathy Network Europe – ANNE). In 83 patients (58 males and 25 women) admitted for the first time for dialysis treatment in 10 centers of Southern Poland from January 1991 to December 1992 the causes of chronic renal failure were analyzed. Special attention was paid to AN. In order to identify analgesic abuse we investigated regular medication during the preceding year, drug consumption for relieve of complaints such as headache or joint pains and consumption of analgesics using a book containing color photographs of analgesics sold in Poland. In all patients renal sonography and tomography were performed and searched for the presence of renal papillary calcifications, bumpy contours and decreased renal mass [3]. The mean age of examined patients was 37 years (10-60). The causes of ESRF were the following: chronic glomerulonephritis 54.3%, pyelonephritis 18.1%, polycystic disease 6%, renal vascular disease 4.8%, diabetic nephropathy 1.2%, systemic diseases 1.2% and other causes 2.4%. In 18.1% of patients the cause of chronic renal failure was unknown. In no patient could the presence of AN be proven. From results of this study it follows that AN is a rare cause of ESRF in dialyzed patients in South-West Poland. These results are concordant with those reported previously [1,4]. The reason of such low prevalence of AN in the examined population seem to be a low consumption of analgesics per capita as already reported in 1989 [1] or the relative young age of the dialysis population caused by the fact that at present only about 40% patients with ESRF are treated with renal replacement therapy in Poland. Therefore, rather young patients with a better prognosis are

1936A→G (I646 V) Polymorphism in the AKAP10 Gene Encoding A-Kinase-Anchoring Protein 10 in Very Long-Lived Poles is Similar to that in Newborns

Background/Study Context: The common 1936A→G transition (rs203462) in the AKAP10 gene encoding the A-kinase-anchoring protein 10 has been recently associated with negative prognosis in the aging European American population (60 to 79 years old). The aim of this study was to see the effects of this transition on allele frequency in very long-lived Poles. Methods: AKAP10 genotype and allele distributions were analyzed in Polish subjects: 148 nonagenarians (95 to 103 years old) and 200 healthy newborn controls, using polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP). Distributions were separated according to gender and χ2 tests used to analyze possible differences. Results: No significant differences were found in genotype or allele distribution between the age groups, for either gender. Percentages of GG AKAP10 homozygotes were slightly greater in the very old subjects than in the newborns (12.2% vs. 9.0%, respectively), and the G allele percentages were very similar (males, 30.7% and 33.0%; females, 34.1% and 35.8%; respectively). Conclusion: The authors conclude that differences in study results between European Americans (60 to 79 years old) and Poles (≥95 years old) result from either (1) geographical location; or (2) the influence of this polymorphism on groups of people differing in genetic background or environmental history; or (3) the time window affected, including extreme age. Further studies with full age-frequency distributions are needed to clarify these results.