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EN
Background: Paraoxonase-1 is an HDL-associated esterase that acts as an anti-atherogenic agent by protecting LDL from oxidation. This study investigates paraoxonase-1 activities in children and adolescents with type 1 diabetes mellitus and possible associations with other biochemical markers. Patients and methods: The study enrolled 82 children and adolescents with type 1 diabetes mellitus and 41 controls with similar age and gender distribution. Serum paraoxonase-1 arylesterase and salt-stimulated paraoxonase activities were assessed by measuring the rates of phenyl acetate and paraoxon hydrolysis, respectively; paraoxonase-1 lactonase activity and oxidized LDL were assessed by a pH-sensitive colorimetric assay and ELISA, respectively. Glycated haemoglobin HbA1c and lipid profile were assayed with an immunoturbidimetric method and commercially available kits, respectively. Results: We found lower paraoxonase-1 activities in diabetics when compared to controls. The decrease was statistically significant only for the lactonase activity, the difference being higher when referring to the subgroup with poor glycaemic control. The lactonase activity/HDL ratio was also lower in diabetics vs. controls, but without statistical significance. Both lactonase and arylesterase activities were negatively correlated with HbA1c in diabetics, but only the latter was statistically significant (ρ = -0.21, P = 0.055; ρ = -0.24, P = 0.03, respectively). A correlation coefficient of ρ = 0.196 (P = 0.078) was found between oxidized LDL and HbA1c. Conclusion: All paraoxonase-1 activities were lower in diabetic children and adolescents, but only the decrease in the lactonase activity was statistically significant. Although lipid profile and glycaemic control were altered in diabetics, no differences were observed between groups regarding oxidized LDL level.
EN
Introduction The correlation between physical activity and the level of HbA1c in children and adolescents with type 1 diabetes mellitus is poorly understood. This study sought to assess the effects of physical activity on the level of HbA1c. The results draw attention to the benefits of physical activity regarding general metabolism and HbA1c levels. Decreased HBA1c levels are associated with health benefits in patients with diabetes patients and result in a lower risk for a variety of potential health complications. Material and methods The research was carried out in 2014 and included 92 patients with type 1 diabetes mellitus (50 girls and 42 boys) aged 7-20 with a mean disease duration of 6.5 years who were being treated in a diabetes clinic in Olsztyn. To assess physical activity the International Health Behaviour in School-Aged Children (HBSC) survey was administered. Physical activity level was determined using both minutes of moderate/vigorous physical activity (MVPA) and vigorous physical activity (VPA). The study participants were divided into the following groups: A – physically active boys and girls (3 days a week or more) and B – physically inactive boys and girls (less than 3 days a week). Results The analysis of correlations between MVPA, VPA and HbA1c revealed that there were no statistically significant differences between physically active and inactive girls. However, there were slight differences in HbA1c levels in favour of active girls. The results of boys regarding MVPA and HbA1c demonstrated statistically significant differences between active and inactive boys, in favour of the active group. While analysing the results concerning the correlation between VPA and HbA1c in boys, no statistically significant differences were noted; however, the level of HbA1c was lower in active boys. Conclusions Contrary to boys, the majority of girls manifested reluctance to do physical activity. Girls and boys who were active had a slightly lower level of HbA1c than inactive individuals. Physical activity of the study participants did not reduce the level of HbA1c significantly.
EN
This paper presents an artificial pancreas algorithm implemented with a discrete-time sliding-mode method combined with a nonlinear block controllable form using a unidirectional control law and a discrete adaptive observer. The algorithm is both unidirectional, using insulin as unique input, and hybrid with a percentage of the pre-meal bolus administered in advance to complement the control action. Personalisation combines patient clustering and individual gain calculation after analysing glucose time-in-range. The stability of the complete closed-loop system involving the observer bounds is tested using the Lyapunov methodology. The performance of the algorithm is evaluated with 256 patients, simulated using Hovorka’s model. The evaluation defines two scenarios (closed-loop and open loop with continuous subcutaneous insulin infusion, CSII), divided into three 1- week intervals, to respectively compare the impact of glucose control under the expected meal plan as a result of changes in carbohydrates quantities and meal schedule, and in response to more extreme events. The performance of time-in-range in each period obtained with CSII is improved by hybrid closed-loop in all cases, i.e., with the expected meals (weekdays 74.9 vs 78.4; weekends 71.5 vs 73.4), with meal variability (weekdays 74.3 vs 77.6; weekend 71.6 vs 72.7), and in the presence of transgressions (forgetting meal announcement: 50.1 vs 63.4; meal omission: 78.2 vs 82.03; copious meal: 60.1 vs 63.4). Compared to CSII, the personalised nonlinear block controller was able to increase the time-in-range without glucose presence in time below range level 2 for 98 % of the cohort for expected meals, meal variability, and transgressions.
EN
Diabetes mellitus (DM), being a chronic and essentially incurable disease, is associated with a significant risk of mental disorders in persons affected. The aim of this paper was to answer the following questions: 1) do young people afflicted with type 1 DM are more depressive than healthy peers?; 2) is there a correlation between severity of depression and quality of diabetes control? The study encompassed a group of 100 patients (50 boys and 50 girls) aged 16-22.2 years (mean age 17.8 years; SD=1.6 years) with type 1 DM and 100 healthy age-matched peers. Symptoms of depression were assessed using the Beck Depression Inventory; quality of management of diabetes was assessed by measuring the level of glycosylated haemoglobin (HbA1c), a generally accepted indicator of quality of metabolic control. HbA1c level was a criterion used to assign each patient to one of three subgroups, depending on quality of DM control attained in his or her case: 1) poor, 2) acceptable, 3) good. Results obtained indicate, that patients with DM are significantly more depressive than their healthy peers (p<0.05). Analysis of gender-dependent differences revealed a significantly higher level of depression in diabetic boys as compared with healthy boys (p<0.05). Significant differences in the level of depression were noticed among subgroups depending on quality of metabolic control. Diabetics who have their DM better controlled, present significantly less depressive symptoms (p<0.01). These findings relate to the entire study population and to the girls’ group. DM may constitute one of risk factors for development of depression. Depression may result in inadequate metabolic control. Ineffective management of DM may contribute to the development of depressive symptoms in young diabetics.
PL
Cukrzyca jako choroba przewlekła i nieuleczalna niesie ryzyko występowania zaburzeń psychicznych u osób na nią chorujących. Celem niniejszej pracy była odpowiedź na pytania: 1) czy młodzi pacjenci chorujący na cukrzycę typu 1 są bardziej depresyjni od zdrowych rówieśników?; 2) czy istnieje związek między nasileniem depresji a efektywnością leczenia cukrzycy? Do badania włączono 100-osobową grupę pacjentów (50 dziewcząt i 50 chłopców) w wieku 16-22,2 roku (średnia: 17,8; s=1,6) z cukrzycą typu 1 oraz 100 zdrowych rówieśników. Objawy depresyjne badano Inwentarzem depresji Becka, za wskaźnik efektywności leczenia przyjęto stężenie hemoglobiny glikozylowanej (HbA1c) określające stopień kontroli metabolicznej. HbA1c była kryterium przyporządkowania każdego pacjenta do jednej z trzech grup efektywności leczenia cukrzycy: 1) niewystarczająca; 2) do akceptacji; 3) dobra. Wyniki badań dowiodły, że pacjenci z cukrzycą są istotnie bardziej depresyjni niż zdrowi rówieśnicy (p<0,05). Analiza różnic w obrębie płci wskazała na istotnie wyższy poziom depresji u chorych chłopców w porównaniu z chłopcami zdrowymi (p<0,05). Między pacjentami o różnym stopniu efektywności leczenia cukrzycy występują istotne różnice w poziomie depresji. Diabetycy o lepszym wyrównaniu metabolicznym cukrzycy mają istotnie mniej objawów depresyjnych (p<0,01). Takie wyniki odnoszą się do ogółu badanych oraz grupy chorych dziewcząt. Cukrzyca może stanowić jeden z czynników ryzyka występowania depresji. Depresja może wpływać na niedostateczną kontrolę cukrzycy. Słabe wyniki leczenia cukrzycy mogą przyczyniać się do pojawiania się objawów depresyjnych u młodych diabetyków.
PL
Cel i założenia: badanie miało na celu ustalenie związku między lękiem przed hipoglikemią a lękiem przed wysiłkiem fizycznym w grupie młodzieży z cukrzycą typu 1. Założenia: 1) u młodzieży z cukrzycą typu 1 występuje wyższy poziom lęku jako stanu i lęku jako cechy, które związane są z lękiem przed hipoglikemią. 2) lęk przed hipoglikemią oraz dyskomfort fizyczny spowodowany chorobą powodują wycofywanie się pacjentów z cukrzycą z aktywności fizycznej. Materiał: zbadano 50 pacjentów z cukrzycą typu 1 (średnia wieku - 16 lat) oraz 30 osób zdrowych. Metoda badawcza: wykorzystano Kwestionariusz STAI Spielbergera, Kwestionariusz KAS, Skalę Hd z MMPI, autorskie kwestionariusze. Wnioski: lęk przed hipoglikemiąjest związany z lękiem przed aktywnością fizyczną, lękiem jako cechą oraz tendencją do somatyzacji u młodzieży z cukrzycą typu 1. Wiąże się raczej z utrzymywaniem, dla bezpieczeństwa, wyższej glikemii niż z wycofywaniem się z aktywności fizycznej. Większy dyskomfort fizyczny spowodowany chorobą sprzyja podejmowaniu przez młodzież aktywności fizycznej.
EN
Aims: the study aimed at establishing the interdependency between the fear of hypoglycaemia and the fear of physical activity in adolescents with type 1 diabetes mellitus. Adolescents with diabetes mellitus type 1 exhibit higher trait and state anxiety which is linked to fear of hypoglycaemia. Anxiety of hypoglycaemia and psychological discomfort induced by the illness cause withdrawal from physical activity. Material: fifty patients with type 1 diabetes mellitus (average age - 16) and 30 control subjects were tested. Methods: state and Trait Anxiety Inventory, Social Approval Questionnaire, Hypochondria Scale from Minnesota Multiphasic Personality Inventory and the authors' questionnaires were employed. Conclusions: fear of hypoglycaemia is connected to fear of physical activity, trait anxiety and somatisation tendency in adolescents with type 1 diabetes mellitus. Fear of hypoglycaemia is related to maintaining higher glycaemia, not to withdrawing from physical activity. Discomfort caused by the illness favours physical activity.
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