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Abstract

Introduction: Proper use of insulin infusion sets (IIS) plays an important role in pump therapy of patients with type 1 diabetes mellitus (T1DM). We assessed the habits associated with the use of IIS in patients with T1DM treated with insulin pump.
Materials and Methods: This study included 79 T1DM patients who were examined for the presence of lipohypertrophy (LH) and retrained for proper IIS use. They completed a standard ques-tionnaire regarding IIS at the time of study entry and at the follow-up.
Results: At baseline, most of the patients declared to have been using a plastic cannula (n = 68; 86.1%), changing the infusion set regularly (n = 65; 82.3%), and placing the infusion sets on the abdomen wall (n = 68; 86.1%). The most common rotation habit was the “curve pattern” on both sides of the umbilicus (n = 16; 20.3%). After a median of 23 weeks (IQR 20–34), 58 patients were available for the follow-up. A rise in the proportion of patients who declared to change IIS regularly (n = 48; 82.8% vs. n = 57; 98.3%, p = 0.016), change IIS every 2 to 3 days (n = 27; 46.6% vs. n = 35; 60.3%, p = 0.043), use “crisscross” rotation (n = 5; 8.8% vs. n = 12; 21.4%, p = 0.027) was observed. There were less patients reporting not having repeatable rotation manner (n = 15; 26.3% vs. n = 2; 5.4%, p = 0.009).
Conclusions: A substantial proportion of T1DM patients on pump therapy declare that they do not follow the recommended principles of IIS use. The intervention consisting of LH assessment and retrain-ing of proper use of IIS might be effective in improving patient compliance.
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Authors and Affiliations

Damian Ucieklak
1 2
Sandra Mrozińska
1 2 3
Aleksandra Wojnarska
2 4
Maciej T. Małecki
1 2
Tomasz Klupa
1 2
Bartłomiej Matejko
1 2

  1. Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
  2. University Hospital, Kraków, Poland
  3. Department of Pathophysiology, Jagiellonian University Medical College, Kraków, Poland
  4. Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
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Abstract

A i m s: Gestational diabetes mellitus (GDM) is an emerging worldwide problem. Changes in clinical characteristics of women affected by GDM in a long-term perspective are still not properly investigated. We aimed to examine such changes over a decade in a retrospective single-center analysis.
M e t h o d s: The medical documentation from Department of Metabolic Diseases, Krakow, Poland was analyzed. We included 633 women consecutively diagnosed with GDM in one of three time intervals: 2007–2008 (N = 157), 2012–2013 (N = 272), 2016–2017 (N = 234). Statistical analyses were performed.
R e s u l t s: Comparison of the three groups identified differences in the mean age of women at the GDM diagnosis (30.7 ± 5.0 years vs. 31.2 ± 4.7 vs. 32.5 ± 4.7, respectively, starting from the earliest 2007–2008 group), pregnancy week at GDM diagnosis (28.0 ± 5.3 wks. vs. 25.9 ± 4.9 vs. 23.4 ± 6.8), the proportion of women diagnosed before the 24th week of pregnancy (12.8% vs. 16.5% vs. 31.3%), and gestational weight gain (12.4 ± 5.0 kg vs. 10.4 ± 5.2 vs. 10.0 ± 5.7); (p = 0.001 or less for all comparisons). We also found differences for glucose values on fasting and at 2 hours with the highest (0 min) and lowest level (120 min) in the 2016–2017, respectively. Finally, a borderline difference for the weight, but not for BMI, was found (64.1 ± 14.1 kg vs. 66.2 ± 13.1 vs. 67.8 ± 15.6; p = 0.04). Differences were also identified in the post hoc analysis between cohorts.
C o n c l u s i o n: This retrospective analysis illustrates changes in characteristics of women with GDM occurring over the period of decade in Poland. They likely result from both epidemiological trends and modifications of the WHO criteria for the GDM diagnosis.
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Bibliography

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2. Lowe L.P., Metzger B.E., Dyer A.R., et al.: Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: associations of maternal A1C and glucose with pregnancy outcomes. Diabetes Care. 2012; 35: 574–580.
3. Gortazar L., Flores-Le Roux J.A., Benaiges D., et al.: Trends in prevalence of gestational diabetes and perinatal outcomes in Catalonia, Spain, 2006 to 2015: the Diagestcat Study. Diabetes Metab Res Rev. 2019; 35: e3151.
4. Cade T.J., Polyakov A., Brennecke S.P.: Implications of the introduction of new criteria for the diagnosis of gestational diabetes: a health outcome and cost of care analysis. BMJ Open. 2019; 9: e023293.
5. Mack L.R., Tomich P.G.: Gestational Diabetes: Diagnosis, Classification and Clinical Care. Obstet. Gynecol. Clin. North Am. 2017; 44: 207–217.
6. Egan A.M., Vellinga A., Harreiter J., et al.: Epidemiology of gestational diabetes mellitus according to IADPSG/WHO 2013 criteria among obese pregnant women in Europe. Diabetologia. 2017; 60: 1913– 1921.
7. Lean S.C., Derricott H., Jones R.L., et al.: Advanced maternal age and adverse pregnancy outcomes: A systematic review and meta-analysis. PLoS One. 2017; 12: e0186287.
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Authors and Affiliations

Magdalena Wilk
1 2
Katarzyna Cyganek
1 2
Bartłomiej Matejko
1 2
Sabina Krzyżowska
1 2
Izabela Lasoń
1 2
Barbara Katra
1 2
Joanna Zięba-Parkitny
2
Przemysław Witek
1 2
Maciej T. Małecki
1 2

  1. Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
  2. University Hospital, Kraków, Poland
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Abstract

The complex course of the COVID-19 and the distant complications of the SARS-CoV-2 infection still remain an unfaded challenge for modern medicine. The care of patients with the sympto-matic course of COVID-19 exceeds the competence of a single specialty, often requiring a multispecialist approach. The CRACoV-HHS (CRAcow in CoVid pandemic — Home, Hospital and Staff) project has been developed by a team of scientists and clinicians with the aim of optimizing medical care at hospital and ambulatory settings and treatment of patients with SARS-CoV-2 infection. The CRACoV project integrates 26 basic and clinical research from multiple medical disciplines, involving different populations infected with SARS-CoV-2 virus and exposed to infection.
Between January 2021 and April 2022 we plan to recruit subjects among patients diagnosed and treated in the University Hospital in Cracow, the largest public hospital in Poland, i.e. 1) patients admitted to the hospital due to COVID-19 [main module: ‘Hospital’]; 2) patients with signs of infection who have been confirmed as having SARS-CoV-2 infection and have been referred to home isolation due to their mild course (module: ‘Home isolation’); 3) patients with symptoms of infection and high exposure to SARS- CoV-2 who have a negative RT-PCR test result. In addition, survey in various professional groups of hospital employees, both medical and non-medical, and final-fifth year medical students (module: ‘Staff’) is planned.
The project carries both scientific and practical dimension and is expected to develop a multidisciplinary model of care of COVID-19 patients as well as recommendations for the management of particular groups of patients including: asymptomatic patient or with mild symptoms of COVID-19; symptomatic patients requiring hospitalization due to more severe clinical course of disease and organ complications; patient requiring surgery; patient with diabetes; patient requiring psychological support; patient with undesirable consequences of pharmacological treatment.
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Bibliography

1. Duszyński J., Afelt A., Ochab-Marcinek A., Owczuk R., Pyrć K., Rosińska M., Rychard A., Smiatacz T.: Zrozumieć Covid-19. 2020. Polska Akademia Nauk. https://pan.pl/images/2020/opracowanie-covid19-14-09-2020/ZrozumiecCovid19_opracowanie_PAN_interactive.pdf
2. Sydor W.: COVID-19 a zaburzenia krzepnięcia. Medical Research Reviews. ISBN 978–83–65515–97–1.
3. Hu B., Guo H., Zhou P., Zheng-Li S.: Characteristics of SARS-CoV-2 and COVID-19. Nat Rev Microbiol. 2021; 19: 141–154. https://doi.org/10.1038/s41579-020-00459-7.
4. Levi M., Thachil J., Iba T., Levye J.H.: Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020; 7: e438–e440.
5. Terlecki M., Wojciechowska W., Klocek M., Olszanecka A., Stolarz-Skrzypek K., Grodzicki T., et al.: Association between cardiovascular disease, cardiovascular drug therapy, and in-hospital outcomes in patients with COVID-19: data from a large single-center registry in Poland. Kardiologia Polska. 2021.
6. Undas A., Podolak-Dawidziak M., Pruszczyk P., Windyga J.: Tromboprofilaktyka i leczenie przeciwkrzepliwe u dorosłych chorych hospitalizowanych z powodu COVID-19. 30 marca 2020. https://nil.org.pl/aktualnosci/5395-tromboprofilaktyka-i-leczenie-przeciwkrzepliwe-u-doroslych- chorych-hospitalizowanych-z-powodu-covid-19.
7. Flisiak R., Horban A., Jaroszewicz J., et al.: Zalecenia postępowania w zakażeniach SARS-CoV-2 Polskiego Towarzystwa Epidemiologów i Lekarzy Chorób Zakaźnych, na dzień 26 kwietnia 2021. http://www.pteilchz.org.pl/wp-content/uploads/2021/04/REKOMENDACJE-pl-w-C19-2021-26-04- 2021b.pdf.
8. Lo Bianco G., Di Pietro S., Mazzuca E., et al.: Multidisciplinary Approach to the Diagnosis and In- Hospital Management of COVID-19 Infection: A Narrative Review. Front Pharmacol. 2020 Dec 9; 11: 572168. https://doi.org/10.3389/fphar.2020.572168.
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Authors and Affiliations

Wojciech Sydor
1 2
Barbara Wizner
3
Magdalena Strach
2
Monika Bociąga-Jasik
4 5
Krzysztof Mydel
6
Agnieszka Olszanecka
7
Marek Sanak
8 5
Maciej Małecki
9 5
Jadwiga Wójkowska-Mach
10
Robert Chrzan
11
Aleksander Garlicki
4 5
Tomasz Gosiewski
12 5
Marcin Krzanowski
13 5
Jarosław Surowiec
14 5
Stefan Bednarz
15 5
Marcin Jędrychowski
16 5
Tomasz Grodzicki
3 5
The CraCoV-HHS Investigators

  1. Center for Innovative Therapies, Clinical Research Coordination Center, University Hospital in Cracow, Poland
  2. Department of Rheumatology and Immunology, Jagiellonian University Medical College, Cracow, Poland
  3. Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Cracow, Poland
  4. Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, Cracow, Poland
  5. Steering Committee of the CRACoV-HHS
  6. Deputy Director for Coordination and Development, University Hospital in Cracow, Poland
  7. Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Cracow, Poland
  8. 2nd Department of Internal Medicine, Jagiellonian University Medical College, Cracow, Poland
  9. Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Cracow, Poland
  10. Chair of Microbiology, Medical Faculty, Jagiellonian University Medical College, Cracow, Poland
  11. Department of Radiology, Jagiellonian University Medical College, Cracow, Poland
  12. Department of Molecular Medical Microbiology, Chair of Microbiology, Medical Faculty, Jagiellonian University Medical College, Cracow, Poland
  13. Department of Nephrology and Dialysis Unit, Jagiellonian University Medical College; Deputy Medical Director, University Hospital in Cracow, Poland
  14. Head of Quality, Hygiene and Infection Control Section at University Hospital in Cracow, Poland
  15. Head of Primary Care Unit at University Hospital in Cracow, Poland
  16. Director of University Hospital in Cracow, Poland

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