Background. Correction of glucose levels is one of the main goals of antidiabetic treatment. Patients with type 2 diabetes whose disease in uncontrolled with oral antidiabetic drugs (OADs) require insulin. While the current guidelines recommend that insulin therapy should be initiated with long- acting preparations, they also take into account the necessity to individualise the treatment. We present the Progens-first- step study, which was a multicentre observational study conducted in the outpatient setting whose aim was to evaluate the efficacy of treatment with Gensulin M30. Material and methods. The study involved a follow-up of 464 patients (age 61 ± 9.1 years, duration of diabetes 63 ± ± 54 months, BMI 29.4 ± 3.75 kg/m2) receiving Gensulin M30. We evaluated glycaemic control (4-point selfmonitoring profile, HbA1c), body mass, episodes of hypoglycaemia and the quality of life (questionnaire) at baseline and at 13 and 26 weeks. Results. HbA1c decreased significantly from 8.7 ± 1.3% at baseline to 7.7 ± 0.9% and 7.1 ± 0.7% at 13 and 26 weeks, respectively (P < 0.001 for both time points), which was paralleled by a reduction in self-recorded glucose levels (fasting and postprandial). No episodes of severe hypoglycaemia were observed. There was a significant increase in body mass from baseline by 0.17 ± 0.18 kg at 13 weeks (P < 0.05) and by 0.36 ± 0.56 kg at 26 weeks (P < 0.01). The use of insulin resulted in an improvement of the quality of life and treatment satisfaction (P < 0.001 for all the comparisons). Conclusions. Gensulin M30 in patients with type 2 diabetes with secondary failure to oral antidiabetic drugs affects the treatment efficacy by: (1) improving glycaemic control reflected by a reduction in HbA

Background. Diabetes and its complications are still unresolved problems of diabetology. Many studies showed, that intensive therapy allows for reduction of chronic diabetic complications. Recently, considerable attention has been directed to the role of postprandial hyperglycaemia in the pathogenesis of chronic diabetic complications. The aim of the study was to evaluate the impact of daily glycaemic excursions on presence of the atheroslerosis assessed by intima-media thickness (IMT) in common carotid artery in type 2 diabetic patients. Material and methods. 29 diabetic patients divided into 2 groups: 1 — 12 patients with IMT > 0.8 mm; 2 — 17 patients with IMT £ 0.8 mm. Glucose by means of glucometer, HbA1c, lipid profile, body mass index (BMI), waist to hip ratio (WHR) were examined. 48 hours measurement of glycaemia using MiniMed CGMS was performed. Mean amplitude of glycaemic excursions (MAGE) was calculated from CGMS data. IMT in common carotid artery was measured using Color Doppler Duplex ultasonography. The t-Student and Mann-Whitney U tests were calculated. Results. There were no significant differences in age, diabetes duration, HbA1c, postprandial glycaemia (1 h and 2 h after meal), BMI and WHR between the groups. Lipid concentrations were increased in both groups. In group with IMT > 0.8 mm, fasting plasma glucose was greater (P = 0.0019) and average glucose obtained from CGMS was lower (P = 0.0002) in comparison with group 2. The differences between MAGE were not observed.

Background. Modern management of diabetes mellitus, which enables patients to avoid disability, requires full glycaemic control. Achievement of normal glucose levels is only possible with the help of self-monitoring of blood glucose (SMBG) and adjusting the treatment depending on the measured values. The aim of the study was to assess the way in which glucose meters are used based on the evaluation of test strip coding, diet adjustments and dosage of medications depending on the measured blood glucose values. Material and methods. A total of 510 consecutive patients (including 99 patients with type 1 diabetes mellitus) managed at the Provincial Diabetes Clinic in Zabrze, Poland, were included in the study. The mean age was 60 ± 19 years, duration of diabetes was 12 ± ± 9 years and the mean body mass index was 29.1 ± ± 5.63 kg/m 2 (24.4 ± 4.3 kg/m 2 and 30.2 ± 4.9 kg/m 2 in patients with type 1 and type 2 diabetes mellitus, respec- tively). The questionnaire contained general details and the patient's declarations regarding the glucose meter coding, self-monitoring and treatment adjustment. Data on glucose meter use were verified on the basis of the glucose meter evaluation (programmed dates and times as well as the numbers of measurements in the memory, correctness of the code). Results. Twenty-eight (5.4%) out of the 510 patients declared not having changed the code. Based on the glucose meter evaluation we found that 25 (4.9%) subjects had entered a wrong code (including 4 subjects who had not been informed) and 234 (63%) subjects had not programmed the date and time. Based on the evaluation of glucose levels 135 (27%) subjects declared no diet adjustment (85/355 (36%) of patients managed with insulin and 50/185 (39%) managed with oral antidiabetic drugs). Of the 326 patients managed with insulin 233 (72%) declared dosage adjustment with 58% declaring no more than two injections and 85% no more than 3 injections (P < 0.001). Conclusions. The recommendation to perform SMBG requires effective patient education on the technique of measurements, including the coding of glucose meters. A significant group of patients performing SMBG does not adjust their treatment despite abnormal glucose values. It seems that patient education on how to use the information obtained during SMBG may improve glycaemic control.

Background. Behavioural therapy, which includes reduced food intake and increased physical exercise, is the mainstay of treatment in type 2 diabetes mellitus. Monitoring of dietary habits and increasing physical activity in patients suffering from diabetes improve metabolic control and reduces the risk of complications. Patient education is the key element in this therapy. Material and methods. A group of 29 patients with type 2 diabetes mellitus (mean duration of diabetes, 9 ± 8 years; body mass index (BMI) 30.1 ± 4.4 kg/m2; glycated haemoglobin (HbA1c), 7.3 ± 1.7%; fasting blood glucose, 7.88 ± 2.05 mmol/L) was asked to complete a physical activity questionnaire. We collected data on anthropometric parameters, HbA1c and blood glucose. Based on a 24-hour measurement performed with the use of a stepometer we calculated the distance walked during the study. Results. In patients declaring intermediate and high physical activity no differences were found in the level of physical activity, as measured by the distance walked over the 24 hours, or in the number of consumed calories and body mass between the groups. We found a significant negative correlation between the declared calorie consumption and BMI. We observed no correlations between the 24-hour distance walked and the declared calorie consumption or BMI or between HbA 1c and the distance walked and the energy value of the consumed meals. Conclusions. The level of physical activity perceived by diabetic patients is not reflected by their actual level of physical activity. The negative correlation between the declared calorie consumption and BMI suggests a lack of correct estimation of the effects energy value of meals has on one's body mass. Our results suggest the need to modify educational programmes paying more attention to everyday execution of the recommended lifestyle changes. Diabet Dośw Klin 2009; 9, 2: 77-80