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Changes in the clinical characteristics of women with gestational diabetes mellitus — a retrospective decade-long single center analysis

Magdalena Wilk Katarzyna Cyganek Bartłomiej Matejko Sabina Krzyżowska Izabela Lasoń Barbara Katra Joanna Zięba-Parkitny Przemysław Witek Maciej T. Małecki
Folia Medica Cracoviensia | 2020 | Vol. 60 | No 4 | 19-29 | DOI: 10.24425/fmc.2020.136201
Keywords diabetes diabetes mellitus gestational diabetes mellitus GDM hyperglycemia
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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

1. McIntyre H.D., Catalano P., Zhang C., Desoye G., Mathiesen E.R., Damm P.: Gestational diabetes mellitus. Nat Rev Dis Primers. 2019; 5: 47. JAMA 1967; 200: 1129–1131.
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.
8. Chiefari E., Arcidiacono B., Foti D., et al.: Gestational diabetes mellitus: an updated overview. J Endocrinol Invest. 2017; 40:.899–909.
9. Skupień J., Cyganek K., Małecki M.T.: Diabetic pregnancy: an overview of current guidelines and clinical practice. Curr Opin Obstet Gynecol. 2014; 26: 431–417.
10. Behboudi-Gandevani S., Amiri M., Bidhendi Yarandi R., et al.: The impact of diagnostic criteria for gestational diabetes on its prevalence: a systematic review and meta-analysis. Diabetol Metab Syndr. 2019; 11: 11.
11. HAPO Study Cooperative Research Group, Metzger B.E., Lowe L.P., et al.: Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008; 358: 1991–2002.
12. World Health Organization: Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization guideline. Diabetes Res Clin Pract. 2014; 103: 341–363.
13. 2020 Guidelines on the management of diabetic patients. A position of Diabetes Poland. Clinical Diabetology, supplement A, 2014.
14. Rybińska A.: Motherhood after the age of 35 in Poland. Studia Demogr. 2014; 1: 7–15.
15. Molina-García L., Hidalgo-Ruiz M., Cocera-Ruíz E.M., et al.: The delay of motherhood: Reasons, determinants, time used to achieve pregnancy, and maternal anxiety level. PLoS One. 2019; 14: e0227063.
16. Matthews T.J., Hamilton B.E.: First births to older women continue to rise. NCHS Data Brief. 2014; 152: 1–8.
17. Hammarberg K., Clarke V.E.: Reasons for delaying childbearing — a survey of women aged over 35 years seeking assisted reproductive technology. Aust Fam Physician. 2005; 34 (3): 187–206.
18. Kim M., Park J., Kim S.H., et al.: The trends and risk factors to predict adverse outcomes in gestational diabetes mellitus: a 10-year experience from 2006 to 2015 in a single tertiary center. Obstet Gynecol Sci. 2018; 61: 309–318.
19. Wender-Ożegowska E., Bomba-Opoń D., Brązert J., et al.: The Polish Society of Gynaecologists and Obstetricians standards for the management of patients with diabetes. Ginekologia i Perinatologia Praktyczna. 2017; 2: 215–229.
20. Egan A.M., Dunne F.P.: Epidemiology of Gestational and Pregestational Diabetes Mellitus. In: Lapolla A., Metzger B.E. (eds.): Gestational Diabetes. A Decade after the HAPO Study. Front Diabetes. Basel, Karger, 2020; 28: 1–10.
21. Egan A.M., Dennedy M.C., Al-Ramli W., et al.: ATLANTIC-DIP: excessive gestational weight gain and pregnancy outcomes in women with gestational or pregestational diabetes mellitus. J Clin Endocrinol Metab. 2014; 99: 212–219.
22. Ferreira L.A.P., Piccinato C.A., Cordioli E., et al.: Pregestational body mass index, weight gain during pregnancy and perinatal outcome: a retrospective descriptive study. Einstein (Sao Paulo). 2019; 18: eAO4851.
23. Brown J., Kapurubandara S., McGee T.M.: Confounding effect of ethnic diversity on booking-in body mass index and prevalence of gestational diabetes and hypertensive disorders in pregnant women in western Sydney 1997–2016. Aust N Z J Obstet Gynaecol. 2020; 60: 369–375.
24. Lavery J.A., Friedman A.M., Keyes K.M., et al.: Gestational diabetes in the United States: temporal changes in prevalence rates between 1979 and 2010. BJOG. 2017; 124: 804–813.
25. Fitzpatrick K.E., Tuffnell D., Kurinczuk J.J., et al.: Pregnancy at very advanced maternal age: a UK population-based cohort study. BJOG. 2017; 124: 1097–1106.
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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

Counting three million diabetics

Roman Topór-Mądry Tomasz Zdrojewski
ACADEMIA. The magazine of the Polish Academy of Sciences | 2016 | Nr 2 (46) Emotions | 4-9
Keywords diabetics data-gathering techniques
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Abstract

We talk to Roman Topór-Mądry, MD, chairman of the PAS Committee on Public health, and Tomasz Zdrojewski, MD, from the Jagiellonian University’s Public Health Institute, coauthors of the first Report on Diabetes in Poland, about counting the number of diabetics and data-gathering techniques.

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Authors and Affiliations

Roman Topór-Mądry
Tomasz Zdrojewski

Playing cops vs.outlaws

Natalia Marek-Trzonkowska Piotr Trzonkowski
ACADEMIA. The magazine of the Polish Academy of Sciences | 2018 | Nr 1 (57) 2018 Consumption | 50-57
Keywords blood glucose levels diabetes
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Abstract

Natalia Marek-Trzonkowska and Piotr Trzonkowski of the Medical University of Gdańsk talk about trust, coordination, and creative conflicts – in the first of a series of interviews with scientists who are partners both at work and in life.

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Authors and Affiliations

Natalia Marek-Trzonkowska
Piotr Trzonkowski

Retinopathy severity correlates with RANTES concentrations and CCR5-positive microvesicles in diabetes

Aleksandra Tokarz Magda Konkolewska Beata Kuśnierz-Cabala Barbara Maziarz Patryk Hanarz Aleksander Żurakowski Iwona Szuścik Ewa Łucja Stępień
Folia Medica Cracoviensia | 2019 | vol. 59 | No 3 | 95-112 | DOI: 10.24425/fmc.2019.131139
Keywords biomarkers diabetic retinopathy ectosomes microangiopathy
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Abstract

I n t r o d u c t i o n: RANTES regulates leukocyte recruitment to areas affected by the inflammatory process. Microvesicles (MVs) belong to a subpopulation of extracellular vesicles and show proangiogenic potential by transferring bioactive molecules to target cells.

Obj e c t i v e s: The aim of this study was to determine the relationship between circulating proangiogenic factors (MVs and RANTES) and diabetes complications in patients with different severities of diabetic retinopathy (DR). CCR5 (CD195) receptors transported by annexin V-labeled MVs were also investigated. Patients and Methods: Diabetic patients (n = 61), among whom 35 had confirmed DR classified according to guidelines, and controls (n = 25) were included. MVs were isolated by centrifugation and analyzed using flow cytometry, RANTES was assessed by ELISA.

R e s u l t s: T h e study group diff ered from the control group with respect to BMI, age, heart rate and systolic blood pressure. Additionally, glucose and creatinine concentrations were signifi cantly increased: 5.30 [5.09–5.62] vs. 9.38 [7.48–11.55] (p<0.0001) mmol/l and 74.59 [64–84] vs. 89.00 [77.11–105.44] μmol/l (p = 0.0005), respectively. RANTES concentrations were significantly increased in diabetic patients compared to those of controls (15.5 (9.7–18.1) vs. 8.9 (0.9–14.6) μg/ml (p = 0.011)), and RANTES concentration significantly increased with respect to nonproliferative DR progression. Moreover, the number of CCR5-positive MVs was significantly increased in patients with heavy nonproliferative diabetic retinopathy (HNPDR) compared to those with soft nonproliferative DR (SNPDR): 1178 [836–2254] vs. 394 [275–799] counts/μl.

C o n c l u s i o n s: Correlation of RANTES concentrations with the stage of nonproliferative DR and the statistically significant dependence of CCR5-positive MVs with disease progression suggest that MVs and RANTES can be considered new biomarkers.

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Authors and Affiliations

Aleksandra Tokarz
Magda Konkolewska
Beata Kuśnierz-Cabala
Barbara Maziarz
Patryk Hanarz
Aleksander Żurakowski
Iwona Szuścik
Ewa Łucja Stępień

Robustness of closed-loop glucose control systems

Artur Wyciślok Jarosław Śmieja
Archives of Control Sciences | 2023 | vol. 33 | No 3 | 681–705 | DOI: 10.24425/acs.2023.146964
Keywords artificial pancreas closed-loop control insulin pump type 1 diabetes
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Abstract

The main purpose of this work is to provide an extensive, simulation-based comparison of robustness of PID and MPC algorithms in control of blood glucose levels in patients with type 1 diabetes and thus answer the question of their safety. Cohort testing, with 1000 simulated, randomized patients allowed to analyze specific control quality indicators, such as number of hypoglycemic events, and length of hypo- and hyperglycemia periods. Results show that both algorithms provide a reasonable safety level, taking into account natural changes of patients’ physiological parameters. At the same time, we point out drawbacks of each solution, as well as general problems arising in close-loop control of blood glucose level.
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Authors and Affiliations

Artur Wyciślok
1
ORCID: ORCID
Jarosław Śmieja
1
  1. Department of Biology and Systems Engineering, Silesian University of Technology, Gliwice, Poland

Effect of cold atmospheric plasma/NO gas application with different exposure times on healing in wounds with tissue loss in diabetic rats

G. Tatlıcıoğlu A. Çürükoğlu G. Akan G. Yeşilovalı G. Öğütçü R. Aktaş A. Kükner M. Temizel Z.K. Sarıtaş F.E. Özgencil
Polish Journal of Veterinary Sciences | 2023 | vol. 26 | No 3 | 441–447 | DOI: 10.24425/pjvs.2023.145051
Keywords cold atmospheric plasma diabetic wound healing nitric oxide rat
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Abstract

Applications of cold atmospheric plasma/nitric oxide (CAP/NO) gas have recently garnered popularity when treating impaired wound healing in patients with diabetes. In this study, we aimed to investigate the effects of NO gas application for 60 and 120 s on wound healing in diabetic rats. A dorsal excision 3 cm in diameter was performed in 15 diabetic rats; these rats were categorized into the following 3 groups: DC (untreated diabetic control); DNO/60 (exposure to 200 ppm NO gas for 60 s/day); and DNO/120 (exposure to 200 ppm NO gas for 120 s/day). Wound contraction on days 0, 3, 7, 11, and 14 and wound contraction rate between days 0 and 14 were evaluated. On day 14, tissue samples were collected for histopathologic assessment of inflammation, epithelial regeneration, angiogenesis congestion, and collagen fiber organization. Normality of distribution was assessed using the Shapiro-Wilk test, and intergroup comparisons were performed using the Mann-Whitney U test (NPar Test) and the Kruskal-Wallis test (non-parametric ANOVA). Wound contraction during treatment days 7-14 was significantly greater in the NO-treatment groups than in the DC group (p<0.05). The NO60 s and NO120 s groups showed a significantly higher wound contraction rate than the DC group (p=0.033, p=0.049, respectively). Significant differences were noted between the control and NO groups in terms of inflammation (p<0.05) and between the control group and DNO/60 and DNO/120 groups in terms of collagen organization (p<0.05, p<0.01, respectively). Evaluation of epithelialization revealed significant intergroup differences between the control and NO treatment groups (p<0.01). In this study, the application of NO once a day for 60 seconds and 120 seconds in diabetic wounds contributed equally to wound healing.
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Bibliography

  1. Ahmed R, Augustine R, Chaudhry M, Akhtar UA, Zahid AA, Tariq M, Falahati M, Ahmad IS, Hasan A (2022) Nitric oxide-releasing biomateri-als for promoting wound healing in impaired diabetic wounds: State of the art and recent trends. Biomed Pharmacother 149: 112707.
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Authors and Affiliations

G. Tatlıcıoğlu
1
A. Çürükoğlu
1
G. Akan
2
G. Yeşilovalı
1
G. Öğütçü
3
R. Aktaş
1
A. Kükner
3
M. Temizel
4
Z.K. Sarıtaş
5
F.E. Özgencil
1
  1. Surgery Department, Near East University, Faculty of Veterinary Medicine, Yakın Doğu St, VIC: 99138 Nicosia / TRNC Mersin 10 – Turkey
  2. DESAM Institute, Near East University, Yakın Doğu St, VIC: 99138 Nicosia / TRNC Mersin 10 – Turkey
  3. Histology Department, Near East University, Faculty of Medicine, Yakın Doğu St, VIC: 99138 Nicosia / TRNC Mersin 10 – Turkey
  4. Experimental Animal Research Center, Near East University Faculty of Veterinary Medicine, Yakın Doğu St, VIC: 99138 Nicosia / TRNC Mersin 10- Turkey
  5. Surgery Department, Afyon Kocatepe University, Faculty of Veterinary Medicine, ANS Campus, Erenler, Afyonkarahisar/Turkey

Hyperglycemia induced C2C12 myoblast cell cycle arrest and skeletal muscle atrophy by modulating sirtuins gene expression in rats

P. Surinlert T. Thitiphatphuvanon W. Khimmaktong C. Pholpramool C. Tipbunjong
Polish Journal of Veterinary Sciences | 2021 | vol. 24 | No 4 | 563-572 | DOI: 10.24425/pjvs.2021.139981
Keywords diabetic mellitus hyperglycemia muscle atrophy sirtuins skeletal muscle
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Abstract

Diabetes is characterized by high blood glucose level termed hyperglycemia affecting skeletal muscle structure and function by an unclear molecular mechanism. This study aimed to investigate the effect and underlying mechanism(s) of hyperglycemia on skeletal muscle both in vitro and in vivo. Treatment with hyperglycemic condition (25 mM) for 48 h significantly inhibited C2C12 myoblast proliferation detected by MTT assay whilst flow cytometry revealed an interruption of the cell cycle at subG1 and G2/M phases. An exposure to hyperglycemic condition significantly decreased the myosin heavy chain (MHC) protein expression in the differentiated myotube and tibialis anterior (TA) muscle of Wistar rats. In addition, the muscle cross-section area (MCA) of TA muscle in diabetic rats were significantly decreased compared to the non-diabetic control. Western blotting analysis of C2C12 myoblasts and differentiated myotubes revealed the increased expressions of cleaved-caspase-9 and cleaved-caspase-3, but not cleaved-caspase-8. Of note, these caspases in the TA muscles were not changed under hyperglycemic condition. Quantitative real-time polymerase chain reaction (qRT-PCR) of the hyperglycemic myoblasts and TA muscles revealed modulation of the gene expression of sirtuins (SIRTs). In C2C12 myoblasts, the expressions of SIRT1, SIRT2 and SIRT4 were upregulated whilst SIRT7 was downregulated. Meanwhile, the expressions of SIRT1, SIRT2 in TA muscles were upregulated whilst SIRT4 was downregulated. Taken together, this study showed that hyperglycemia induced cell cycle arrest and apoptosis in myoblasts, and protein degradation and atrophy in skeletal muscle most likely via modulation of SIRTs gene expression.
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Authors and Affiliations

P. Surinlert
1
T. Thitiphatphuvanon
2
W. Khimmaktong
3
C. Pholpramool
4
C. Tipbunjong
3 5
  1. Chulabhorn International College of Medicine, Thammasat University, Pathum-Thani 12120, Thailand
  2. Faculty of Medicine, Siam University, Bangkok 10160, Thailand
  3. Department of Anatomy, Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Songkhla 90110, Thailand
  4. Department of Physiology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand
  5. Gut Biology and Microbiota Research Unit, Prince of Songkla University, Songkhla 90110, Thailand

Habits related to the use of insulin infusion set in patients with type 1 diabetes on pump therapy — the effect of the educational intervention

Damian Ucieklak Sandra Mrozińska Aleksandra Wojnarska Maciej T. Małecki Tomasz Klupa Bartłomiej Matejko
Folia Medica Cracoviensia | 2022 | Vol. 62 | No 4 | 5-23 | DOI: 10.24425/fmc.2022.144079
Keywords type 1 diabetes pump therapy insulin infusion set
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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

Novel antidiabetic drugs in diabetic kidney disease accompanying type 2 diabetes — a minireview

Ewa Wieczorek-Surdacka Andrzej Surdacki Jolanta Świerszcz Bernadeta Chyrchel
Folia Medica Cracoviensia | 2020 | Vol. 60 | No 4 | 97-101 | DOI: 10.24425/fmc.2020.136207
Keywords sodium-glucose cotransporter-2 inhibitors glucagon-like peptide-1 receptor agonists renoprotection diabetic kidney disease type 2 diabetes cardiovascular outcome trials clinical practice guidelines
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Abstract

Intensive hypoglycemic treatment is the strongest preventive strategy against the development of microvascular complications of type 2 diabetes (T2DM), including diabetic nephropathy. However, some antidiabetic drugs, i.e. sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA) have an additional renoprotective effect beyond glucose control by itself. Similar, both SGLT-2i and GLP1-RA have been demonstrated to decrease the risk of adverse cardiovascular (CV) events in CV outcome trials. Nevertheless, there are relevant differences in CV and renal effects of SGLT-2i and GLP1-RA. First, SGLT2i reduced the incidence and progression of albuminuria and prevented loss of kidney function, while predominant renal benefits of GLP1-RA were driven by albuminuria outcomes. Second, the risk of heart failure (HF) hospitalizations decreased on SGLT2i but not on GLP1-RA, which gives priority to SGLT2i in T2DM and HF, especially with depressed EF. Third, either GLP1-RA (reducing predominantly atherosclerosis-dependent events) or SGLT-2i, should be used in T2DM and established atherosclerotic CV disease (ASCVD) or other indicators of high CV risk. In this review, we have briefly compared clinical practice guidelines of the American Diabetes Association (2020 and 2021 versions), Polish Diabetes Association (2020) and the European Society of Cardiology/European Association for the Study of Diabetes (2019), with a focus on the choice between SGLT-2i and GLP1-RA in patients with diabetic kidney disease.
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Authors and Affiliations

Ewa Wieczorek-Surdacka
1
Andrzej Surdacki
2
Jolanta Świerszcz
3
Bernadeta Chyrchel
4
  1. Chair and Department of Nephrology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
  2. Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
  3. Department of Medical Education, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
  4. Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland

Maximizing performance of linear model predictive control of glycemia for T1DM subjects

Martin Dodek Eva Miklovicová
Archives of Control Sciences | 2022 | vol. 32 | No 2 | 305-333 | DOI: 10.24425/acs.2022.141714
Keywords diabetes mellitus artificial pancreas glycemia control predictive control constrained optimization control feasibility
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Abstract

The primary objective of this paper is the custom design of an effective, yet relatively easyto- implement, predictive control algorithm to maintain normoglycemia in patients with type 1 diabetes. The proposed patient-tailorable empirical model featuring the separated feedback dynamics to model the effect of insulin administration and carbohydrate intake was proven to be suitable for the synthesis of a high-performance predictive control algorithm for artificial pancreas.Within the introduced linear model predictive control law, the constraints were applied to the manipulated variable in order to reflect the technical limitations of insulin pumps and the typical nonnegative nature of the insulin administration. Similarly, inequalities constraints for the controlled variable were also assumed while anticipating suppression of hypoglycemia states during the automated insulin treatment. However, the problem of control infeasibility has emerged, especially if one uses too tight constraints of the manipulated and the controlled variable concurrently. To this end, exploiting the Farkas lemma, it was possible to formulate the helper linear programming problem based on the solution of which this infeasibility could be identified and the optimality of the control could be restored by adapting the constraints. This adaptation of constraints is asymmetrical, thus one can force to fully avoid hypoglycemia at the expense of mild hyperglycemia. Finally, a series of comprehensive in-silico experiments were carried out to validate the presented control algorithm and the proposed improvements. These simulations also addressed the control robustness in terms of the intersubject variability and the meal announcements uncertainty.
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Authors and Affiliations

Martin Dodek
1
Eva Miklovicová
1
  1. Institute of Robotics and Cybernetics, Faculty of Electrical Engineering and Information Technology, Slovak University of Technology in Bratislava, Slovakia

Female mouse model of diabetes mellitus induced by streptozotocin and high-carbohydrate high-fat diet

R. Guo J. Dong D.Q. Wang Y.F. Gu
Polish Journal of Veterinary Sciences | 2022 | vol. 25 | No 4 | 547-555 | DOI: 10.24425/pjvs.2022.142042
Keywords diabetes mellitus female mouse pathological analysis streptozotocin high-carbohydrate high-fat diet
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Abstract

With the improvement of people’s living standards and rapid economic development, the incidence of diabetes mellitus (DM) is increasing in most parts of the world. DM presents an important potential threat to human health. In the present study, a model of diabetes in female mice was established, and fasting blood glucose was detected at week 4, after which the biochemical profiles were evaluated by histopathological analysis. The success rate of modeling in the normal control (NC) group and the low/ middle/high-dose streptozotocin (STZ) group were 0, 0, 25% and 60%, respectively. In the middle-dose and high-dose STZ groups, the liver index was increased significantly compared with the NC group (p<0.05). The blood biochemical indicators of total cholesterol and low density lipoprotein cholesterol in three STZ injection groups were as follows: alanine aminotransferase and aspartate transaminase in middle- and high-dose STZ groups, high-density lipoprotein cholesterol and serum creatinine in the high-dose STZ group, and blood urea nitrogen in the middle-dose STZ group were significantly increased (p<0.05). The level of total triglycerides was lower, obviously, in the high-dose STZ group than in the NC group (p<0.05). The mice showed marked steatosis, green-dyed fiber tissue coloring in varying degrees, and the contour of the hepatic lobules basically disappeared in STZ injection groups. The results suggest that to establish a diabetes model for female ICR mice, the optimum dose of STZ is 100 mg/kg.
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Authors and Affiliations

R. Guo
1 2
J. Dong
3
D.Q. Wang
3
Y.F. Gu
1 2
  1. State Key Laboratory for Diagnosis and Treatment of Infectious Disease, National Clinical Research Center for Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
  2. Jinan Microecological Biomedicine Shandong Laboratory, No. 3716 Qingdao Road, Huaiyin District, Jinan City, Shandong Province, Solutia City Light West Building, 21F, Shandong Laboratory of Microecological Biomedicine, Jinan 250117, China
  3. Institute of Animal Husbandry and Veterinary Science, Zhejiang Academy of Agricultural Sciences, Hangzhou 310021, China

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