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EN
Diabetes mellitus (DM) is a multifactorial disease characterized by hyperglycemia. The type 1 and type 2 DM are two different conditions with insulin deficiency and insulin resistance, respectively. It may cause atherosclerosis, stroke, myocardial infarction and other relevant complications. It also features neurological degeneration with autonomic dysfunction to meet metabolic demand. The autonomic balance controls the physiological variables that exhibit nonlinear dynamics. Thus, in current work, nonlinear heart rate variability (HRV) parameters in prognosis of diabetes using artificial neural network (ANN) and support vector machine (SVM) have been demonstrated. The digital lead-I electrocardiogram (ECG) was recorded from male Wister rats of 10–12 week of age and 200 ± 20 gm of weight from control (n = 5) as well as from Streptozotocin induced diabetic rats (n = 5). A total of 526 datasets were computed from the recorded ECG data for evaluating thirteen nonlinear HRV parameters and used for training and testing of ANN. Using these parameters as inputs, the classification accuracy of 86.3% was obtained with an ANN architecture (13:7:1) at learning rate of 0.01. While relatively better accuracy of 90.5% was observed with SVM to differentiate the diabetic and control subjects. The obtained results suggested that nonlinear HRV parameters show distinct changes due to diabetes and hence along with machine learning tools, these can be used for development of noninvasive low-cost real-time prognostic system in predicting diabetes using machine learning techniques.
EN
The present work aimed to develop and validate a simple, rapid, sensitive, accurate, and precise method for simultaneous determination of metformin hydrochloride and vildagliptin in tablet and biological samples. Isocratic elution of both the analytes was performed at 35 °C by injecting 20 μL into Thermo Hypersil ODS C18 column (5 μm, 4.6 mm× 250 mm), while the flow rate was set to 0.8 mL/min. The mobile phase comprised of methanol, acetonitrile, and phosphate buffer (5:30:65, v/v, pH 3.5), and wavelength was selected at 212 nm. The overall run time per sample was 7.0 min with a retention time of 3.36 and 5.41 min for metformin hydrochloride and vildagliptin, respectively. The calibration curve was linear from 10–140 μg/mL for metformin and 1–14 μg/mL for vildagliptin with a coefficient of determination (R2) ≤ 0.9919, while repeatability and reproducibility (expressed as relative standard deviation) were lower than 1.13 and 0.97%, respectively. Force degradation studies indicated a complete separation of the analytes in the presence of their degradation products providing a high degree of method specificity. The proposed reversed-phase high-performance liquid chromatography (RP-HPLC) method was demonstrated to be simple and rapid for the determination of metformin hydrochloride and vildagliptin in commercially available tablet and biological samples providing recoveries ranged between 100.13–100.29%.
3
Content available The insulin activity model based on insulin profiles
EN
The purpose of the research was to propound an insulin activity model in a human body after a subcutaneous injection. A deterministic model in the form of a mathematical function was formulated. The research was based on pharmaceutic publicly available drug information published by the manufactures. The paper presents in detail the model. The obtained results can be used in computer simulations of diabetes mellitus therapy. They suggest that activity models may be assigned to types of insulin instead of separate products.
PL
Celem badań było opracowanie modelu aktywności insuliny w organizmie człowieka po wstrzyknięciu podskórnym. Sformułowano model deterministyczny w postaci funkcji matematycznej. Badanie oparto na publicznie dostępnych informacjach farmaceutycznych opublikowanych przez producentów. Artykuł szczegółowo przedstawia model. Uzyskane wyniki mogą być wykorzystane w komputerowych symulacjach terapii cukrzycy. Sugerują one również, że modele aktywności mogą dotyczyć grup insulin zamiast konkretnych preparatów.
4
Content available remote Modern noninvasive methods for monitoring glucose levels in patients: a review
EN
This paper presents the current state of the art of noninvasive glucose monitoring. In recent years, we can observe constant increase in the incidence of diabetes. About 40% of all performed blood tests apply to the glucose tests. Formerly, this lifestyle disease occurred mainly in rich countries, but now it is becoming more common in poorer countries. It is related to the increase in life expectancy, unhealthy diet, lack of exercise, and other factors. Untreated diabetes may cause many complications or even death. For this reason, daily control of glucose levels in people with this disorder is very important. Measurements with a traditional glucometer are connected with performing finger punctures several times a day, which is painful and uncomfortable for patients. Therefore, researches on other methods are ongoing. A method that would be fast, noninvasive and cheap could also enable testing the state of the entire population, which is necessary because of the number of people currently living with undiagnosed type 2 diabetes. Although the first glucometer was made in 1966, the first studies on glucose level measurement in tear film were documented as early as 1937. This shows how much a noninvasive method of diabetes control is needed. Since then, there have been more and more studies on alternative methods of glucose measurement, not only from tear fluid, but also from saliva, sweat, or transdermally.
EN
This overview will discuss the smart polymers as drug nanocarries, their construction and shapes showing their using for controlled insulin release. The report will focus on diabetes mellitus as a disease unit, its etiology and treatment by injection and by using smart polymers. The ingredients described in this article are: poly- (methacrylic acid-g-ethylene glycol), hyaluronic acid, G-CSF-transferrin conjugate in cultured enterocyte-like Caco-2 monolayers, poly(hydroxybutyrate-co-hydroxyhexanoate) and chitosan. Such “intelligent” polymers and their use in a controlled insulin release in diabetic therapy are immensely promising.
PL
Cukrzyca to „epidemia XXI wieku”, szacuje się, że w 2011 roku na cukrzycę chorowało 6,7% populacji Polski, z czego jedna czwarta nie miała świadomości choroby. Tak duże rozpowszechnienie cukrzycy sprawia, że coraz więcej lekarzy staje przed problemem prawidłowej kwalifikacji pacjenta z cukrzycą do amatorskiego uprawiania sportu, w tym nurkowania. W niniejszej publikacji przedstawiono najważniejsze informacje dotyczące oceny ryzyka, dopuszczenia do amatorskiego nurkowania pacjentów z cukrzycą oraz proponowanych protokołów postępowania przed i podczas uprawiania tego sportu.
EN
Diabetes is an "epidemic of the 21st century" and it is estimated that in 2011 6.7% of Poland's population suffered from diabetes, one quarter of which was unaware of the disease. Such a high prevalence of diabetes mellitus results in an increasing number of physicians being confronted with the problem of qualifying patient with diabetes to partake in amateur sports, including diving. This publication presents the most important information concerning risk assessment, admission of diabetic patients to amateur diving and some proposed protocols of management before and during sport practice.
7
EN
In theory, the continuous subcutaneous insulin infusion (CSII) has a few advantages over the multiple daily insulin injections (MDI) that should lead to improved glycemic control and lower risk of hypoglycemia. In practice, both treatment regimens allow for adequate control of glycemia. The objective of this review is to discuss the most important factors contributing to this situation. We made a comprehensive evidence-based review of the factors affecting effectiveness of CSII and MDI, with a special attention to algorithms for insulin dose adjustments and the automatic bolus calculators. Regardless of the treatment regimen that is used a few different interdependent factors influence the final result of the intensive insulin therapy. These factors comprise: patients' education, attitude, emotional stability and compliance, and careful analysis of the treatment results by a physician establishing the appropriate rate of basal insulin infusion or the basal dose of insulin and adjusting insulin doses to: the meals, the planned physical activity and the actual and target glucose levels. Our study implies that good glycemic control in patients with type 1 diabetes requires not only a thorough patient education and complying with medical recommendations, but also an individual determination of therapy goals and ways of achieving them. That is why, regardless of the treatment method that is applied, it is the choice of appropriate algorithms and adjusting them to the patient's way of life what allow for achieving pre-specified therapeutic goals. Technical means such as automatic bolus calculators might supplement but they cannot replace patients education and compliance.
EN
Diabetic foot is one of the most severe complications of diabetes. Early diagnosis of this syndrome can ensure proper medical care and adequate treatment. Various image analysis methods can be used to speed up the diagnosis process, and automated diagnosis can be applied as a screening technique to reduce its cost. Introducing auxiliary diagnostic parameters may help to detect polyneuropathy or neuropathy, both of which often precede the appearance of diabetic foot syndrome. The present paper describes a study performed on a group of diabetic patients by analyzing plantar pressure distribution images. As part of this study, 2D discrete cosine transform (DCT) is computed for the forefoot and rearfoot regions of each diabetic subject in a group of 37 patients. Three new DCT-based parameters are introduced to help to detect polyneuropathy or at least indicate that the patient may have polyneuropathy without a time-consuming examination. The results indicate a certain relationship between these parameters and the presence of polyneuropathy. This information could be used in further diagnosis to prevent foot ulcers from developing in patients with diabetes.
EN
This paper presents the usefulness of perfusion computed tomography (pCT) in the diagnosis of diabetic pulmonary microangiopathy. Our previous works have shown that perfusion parameters are useful in the diagnosis of diabetic pulmonary microangiopathy. We are looking for such measurements and perfusion parameters that provide the most accurate diagnosis. Two types of comparison were made based on the results of clinical trials: non-diabetic vs. diabetic and diabetes without microangiopathy vs. diabetes with microangiopathy. Our studies have shown that PS (permeability surface) is only perfusion parameter statistically significant. In certain regions of interest logistic regression as a classifier produces very good results in diagnosing lung microangiopathy: sensitivity Sens = 89% and excellent specificity Spec = 100%. The results were obtained on the base of measurements taken from 23 subjects. These results were compared with results reported in the literature and based on diffusion capacity and spirometry measurements and modeling. None of the previous results was as good as those obtained using the PS and logistic regression for binary classification.
EN
The disease of diabetes mellitus has spread in recent years across the world, and has thus become an even more important medical problem. Despite numerous solutions already proposed, the problem of management of glucose concentration in the blood of a diabetic patient still remains as a challenge and raises interest among researchers. The data-driven models of glucose-insulin interaction are one of the recent directions of research. In particular, a data-driven model can be constructed using the idea of sequential patterns as the knowledge representation method. In this paper a new hierarchical, template-based approach for mining sequential patterns is proposed. The paper proposes also to use functional abstractions for the representation and mining of clinical data. Due to the experts knowledge involved in the construction of functional abstractions and sequential templates, the discovered underlying template-based patters can be easily interpreted by physicians and are able to provide recommendations of medical therapy. The proposed methodology was validated by experiments using real clinical data of juvenile diabetes.
11
Content available remote Preventive systems for the late complications of diabetes
EN
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.
12
Content available remote Comparison of the wound area assessment methods in the diabetic foot syndrome
EN
The paper presents results of comparison of the wound area assessment methods in the diabetic foot syndrome (DFS). Wound size is a basic parameter that is used to evaluate efficacy of the applied treatment. Four measurement methods were used: the rulers, the planimetric Visitrak (Smith & Nephew, England), the Silhouette (Aranz Medical, New Zealand) applying lasers, digital photography and planimetry as well as the patient's module of TeleDiaFoS telecare system with the foot scanning capabilities. Study group consisted of 18 DFS patients. Nineteen wounds were successfully measured with all 4 methods. The results of the Visitrak and the Silhouette can be used interehangeably (r = 0.994, slope = 1.01, intercept = 0.154 cm2). For the other systems strong linear relationships exist that can be used to convert the wound area measured with one method to the corresponding value of another method. The correlation coefficients higher than 0.985 were obtained in ease of 3 systems: Visitrak, Silhouette and TeleDiaFoS. The TeleDiaFoS system can provide a physician with the patient-self-taken wound images that can be used for reliable assessment of the wound healing process during home tele-monitoring of the DFS patients.
PL
Na świecie notuje się coraz więcej zachorowań na cukrzycę, której częstym następstwem jest choroba wieńcowo-naczyniowa. Wyniki przezskórnej interwencji wieńcowej (PCI), a także operacji pomostowania aortalno-wieńcowego (CABG) u pacjentów chorych na cukrzycę typu 2 są w tym przypadku mniej korzystne. Implementacja stentów wieńcowych uwalniających leki pozwoliła poprawić efekty kliniczne, głównie dzięki zminimalizowaniu stopnia restenozy. Celem pracy jest podsumowanie aktualnego stanu wiedzy, dotyczącego efektywności oraz bezpieczeństwa stosowania stentów uwalniających leki antyproliferacyjne u pacjentów chorych na cukrzycę typu 2.
EN
Cardiovascular disease is a major consequence of this chronic condition. Outcomes after percutaneous coronary interventions (PCI) and coronary artery bypass grafting (CABG) are worse in patients with diabetes mellitus (DM) compared with those without DM. Drugs eluting stents implantation has improved the clinical outcomes of diabetic patients, especially the reduction of restenosis rate. The purpose of this review is to summarize the current achievements relating to the effectiveness and safety of drug eluting stents in diabetic patients.
14
EN
This study describes the changes in serum glycoproteins from type 2 diabetic and non-diabetic patients with and without cataract. A total of 85 subjects were selected for the study and divided into four groups. The first group consisted of 21 healthy subjects, the second group consisted of 21 diabetic patients with no chronic complications, the third group consisted of 20 diabetic patients with cataract, and the fourth group had 23 non-diabetic patients with age related cataract. The patients with and without cataract were selected on clinical grounds from the Ziauddin University and Jinnah Postgraduate Medical Centre in Karachi, Pakistan. As expected diabetic patients with and without cataract had significantly higher levels of fasting plasma glucose, glycated haemoglobin, glycated plasma proteins and serum fructosamine. In addition to these parameters, the levels of hexosamine, sialic acid and serum total protein were higher in diabetic compared to non-diabetic subjects with age related cataract and healthy subjects. Analysis of the protein fractions showed that alpha-1-globulins and alpha-2-globulins were higher in diabetic patients without complications compared to non-diabetic subjects with age related cataract and healthy subjects. Serum alpha-1-globulin, alpha-2-globulin, beta globulins and gamma globulins were all significantly higher in diabetic patients with cataract compared to healthy subjects but not serum albumin. In conclusion, the levels of beta globulins and gamma globulins were significantly higher in diabetic patients with cataract and non-diabetic age related patients with cataract compared to healthy subjects. Thus, mechanisms other than hyperglycaemia are responsible for the development of cataract in these patients.
15
Content available remote Application of telemedicine technique in screening for diabetic retinopathy
EN
Diabetic retinopathy is one of the most serious long-term microvascular complications of diabetes. It is a sight-threatening, chronic ocular disorder, which is currently the most common cause of blindness in people of working age in western societies. Slit lamp biomicroscopy and seven-field stereoscopic 30o fundus photography (with dilated pupil) represent the current gold standard techniques for detecting diabetic retinopathy. These methods are too expensive for widespread use in the screening process, even in the most developed countries. At present, retinopathy is usually detected by the direct ophthalmoscopic examination. Simple wide angle color fundus photography is another much more accurate and widely used method. The introduction of digital imaging cameras made the application of the telemedicine technique possible. First feasibility studies concerning application of the telemedicine technique in screening for diabetic retinopathy were reported in the late 1990s. These early systems used mobile fundus cameras or e-mail messages for transmission of digital fundus photographs between distant locations in a store–and–forward mode. Then, more advanced systems followed, which either based on proprietary software solutions or on the latest advances of the internet technology. One of such systems has been developed in co-operation between NAIST and IBBE PAS. The developed DRWeb system consists of the image acquisition station, the database and communication server and the image grading station. Two modes of operation are possible: telediagnosis – when all the mentioned above stages are conducted independently, one after another and teleconsultation – when real time interaction between the physician and the expert is possible. The system is supplemented by an algorithm ensuring that the quality of the transmitted digital images is good enough for a successful making of the diagnosis.
EN
Insulin sensitivity (IS) is one of the important diagnostic parameters used in treatments of diabetes, hypertension and other diseases as well as during evaluation of new drug therapies. Euglycaemic glucose clamp is the most accurate method of the IS measurement. Effectiveness of this procedure depends on accuracy of the tissue glucose utilization measurements (GU) and proper realization of the insulin infusion. Application of the accurate glucose control algorithm, sampling site, sampling frequency, duration of the procedure are also very important factors. Possible technical realization includes manual, semi-automatic and automatic modes. Recently the computerized semi-automatic system realizing this type of measurement has been designed and developed in the IBBE PAS. A developed system consist of control unit, infusion unit, glycaemia measurement unit and printer. Endogenous glucose secretion is suppressed by insulin infusion, which is determined according to individual patients parameters. The newest version of the measurement procedure allows to realize euglycaemic or normoglycaemic clamp studies. TISS system is inexpensive and easily operated by one person from middle medical staff. Till now GU measurements using TISS system were performed on over 200 patients in 4 Polish clinical centers. Developed and clinically tested TISS system seems to provide satisfying quality of the GU measurement in men.
17
Content available remote Continuous glucose monitoring and automated insulin infusion
EN
Continuous glucose monitoring is necessary for an automated glucose controlled insulin infusion system in diabetes therapy. We developed a glucose sensor for continuous on-line tissue glucose measurement based on microdialysis and enzymatic amperometric glucose sensing. A microdialysis probe is inserted in the abdominal subcutaneous tissue and perfused with saline at a constant flow rate. The glucose concentration in the dialysate is determined ex-vivo in a portable device, and the glucose value is transmitted telemetrically to a wrist watch. Glucose is measured continuously over a time period of up to three days without recalibration. In order to close the loop with an insulin pump we have to develop algorithms for feed-back control. Despite of new fast acting insulin analogues the pharmacodynamic of insulin is the limiting factor for glucose controlled insulin infusion. External disturbances like carbohydrate intake and physical exercise have to be included in the algorithms. Mathematical models and computer simulations can help to predict glucose levels. With the development of the continuous tissue glucose sensor it is possible to prove the feasibility of tissue glucose controlled subcutaneous insulin infusion in diabetes therapy. The final goal is the artificial endocrine pancreas for use under daily life conditions.
PL
Ciągłe monitorowanie stężenia glukozy jest niezbędne do realizacji automatycznego, kontrolowanego stężeniem glukozy, systemu dozowania insuliny w leczeniu cukrzycy. Autorzy opracowali czujnik glukozy przeznaczony do ciągłego on-line pomiaru tkankowego stężenia glukozy oparty na zjawisku mikro dializy i enzymatycznego amperometrycznego pomiaru stężenia glukozy. Przez sondę mikrodializacyjną wprowadzoną w tkankę podskórną brzucha jest pompowana ze stałą szybkością sól fizjologiczna. Stężenie glukozy w dializacie określa się ex-vivo za pomocą miniaturowego urządzenia, które następnie przesyła zmierzoną wartość telemetrycznie do czytnika zbudowanego w postaci ręcznego zegarka. Stężenie glukozy mierzone jest w sposób ciągły, w okresie do trzech dni, bez konieczności ponownej kalibracji urządzenia. W celu zamknięcia pętli sprzężenia zwrotnego za pomocą pompy insulinowej, konieczne jest opracowanie algorytmu kontrolującego wlew insuliny. Pomijając nowe, szybko działające odpowiedniki insuliny, farmakodynamika insuliny jest czynnikiem ograniczającym realizację kontrolowanego stężeniem glukozy wlewu insuliny. Opracowywany algorytm musi również uwzględniać wpływ zakłóceń zewnętrznych; takich jak spożywane w posiłkach węglowodany czy też wysiłek fizyczny. Modele matematyczne i symulacje komputerowe mogą pomóc w przewidywaniu stężenia glukozy. Posiadając czujnik do ciągłego pomiaru tkankowego stężenia glukozy, możliwe jest przeprowadzenie, kontrolowanego stężeniem glukozy, podskórnego wlewu insuliny w leczeniu cukrzycy. Celem ostatecznym jest sztuczna trzustka stosowana w warunkach życia codziennego.
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