Premixed insulins are an important tool for glycemic control in persons with diabetes. Equally important in diabetes care is the selection of the most appropriate insulin regimen for a particular individual at a specific time. Currently, the choice of insulin regimens for initiation or intensification of therapy is a subjective decision. In this article, we share insights, which will help in rational and objective selection of premixed formulations for initiation and intensification of insulin therapy. The glycemic status and its variations in a person help to identify the most appropriate insulin regimen and formulation for him or her. The evolution of objective glucometric indices has enabled better glycemic monitoring of individuals with diabetes. Management of diabetes has evolved from a ‘glucocentric’ approach to a ‘patient-centered’ approach; patient characteristics, needs, and preferences should be evaluated when considering premixed insulin for treatment of diabetes.Funding: Novo Nordisk, India.

Background While introducing new technologies and methods of treatment for type 1 diabetes mellitus (T1DM), it seems essential to monitor whether modern technologies in diabetes treatment may improve the psychological and emotional status of patients. Objective This study aims to assess the baseline psychological parameters of patients with T1DM during investigation of the direct transition from multiple daily injections (MDI) and self-monitoring of blood glucose (SMBG) to the MiniMed 780G advanced hybrid closed-loop (AHCL) system and to evaluate changes in the psychological well-being and quality of life (QoL) after the transition in these individuals versus the control group. Methods The trial was a 2-center, randomized controlled, parallel group study. In total, 41 patients with T1DM managed with MDI or SMBG were enrolled and randomized either to the AHCL or the MDI+SMBG group. Of these, 37 (90%) participants (mean age 40.3 years, SD 8.0 years; mean duration of diabetes 17.3, SD 12.1 years; mean hemoglobin A1c [HbA1c] 7.2%, SD 1.0%) completed the study (AHCL: n=20, 54%; MDI+SMBG: n=17, 46%). Psychological parameters (level of stress, coping mechanisms, level of anxiety, self-efficacy level, acceptance of illness, locus of control of illness, life satisfaction, QoL) were measured at baseline and at the end of the study using 10 psychological questionnaires. Results At baseline, the general level of stress of the examined patients was higher than in the general healthy Polish population (P=.001), but coping strategies used in stressful situations were significantly more effective and the level of self-efficacy (P<.001) was much higher than in the general population. The patients in this study accepted their illness more than patients with diabetes from the general Polish population (P<.001), but they felt that their health does not depend on them compared to the general population (P<.001). The overall life satisfaction was similar to that of the general population (P=.161). After 3 months from transition, the AHCL group reported an increase in 4 scales of the QoL—feeling well (P=.042), working (P=.012), eating as I would like (P=.011), and doing normal things (P=.034)—in comparison to the control group, where no significant change occurred. The level of both state anxiety and trait anxiety decreased in the AHCL group: State-Trait Anxiety Inventory (STAI) X1 scores (P=.009), STAI X1 stens (P=.013), and STAI X2 scores (P=.022). The AHCL group became more emotion oriented in stressful situations (Coping Inventory for Stressful Situations [CISS] E; P=.043) and significantly less self-blaming after 3 months of the study (P=.020). Conclusions The results indicate that the patients who decided to take part in the transition study were characterized by higher levels of stress than the general healthy population but had better coping strategies and self-efficacy. Furthermore, transitioning from MDI+SMBG treatment to the AHCL in patients naive to technology may significantly improve psychological well-being and QoL within 3 months. The rapidity of these changes suggests that they may be related to the significant improvement in glycemic outcomes but also significantly less burdened diabetes self-management. Trial Registration ClinicalTrials.gov NCT04616391; https://clinicaltrials.gov/ct2/show/NCT04616391

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Introduction: Recently, radiofrequency ablation (RFA) has been increasingly used for the treatment of thyroid nodules. However, immediate morphological changes associated with bipolar devices are poorly shown. Aims: To present the results of analysis of gross and microscopic alterations in human thyroid tissue induced by RFA delivered through the application of the original patented device. Materials and methods: In total, there were 37 surgically removed thyroid glands in females aged 32–67 at presentation: 16 nodules were follicular adenoma (labelled as ‘parenchymal’ solid benign nodules) and adenomatous colloid goitre was represented by 21 cases. The thyroid gland was routinely processed and the nodules were sliced into two parts – one was a subject for histological routine processing according to the principles that universally apply in surgical pathology, the other one was used for the RFA procedure. Results: No significant difference in size reduction between parenchymal and colloid nodules was revealed (p>0.1, t-test) straight after the treatment. In addition, RFA equally effectively induced necrosis in follicular adenoma and adenomatous colloid goitre (p>0.1, analysis of variance test). As expected, tumour size correlated with size reduction (the smaller the size of the nodule, the greater percentage of the nodule volume that was ablated): r=-0.48 (p<0.0001). Conclusion: The results make it possible to move from ex vivo experiments to clinical practice.

Cel pracyCelem naszego badania obserwacyjnego było określenie , czy wybrane cechy osobowości są skorelowane ze stopniem wyrównania metabolicznego/czasem trwania cukrzycy u dorosłych pacjentów z T1DM.MetodaDane zebrano od 56 dorosłych pacjentów (40 mężczyzn) z T1DM leczonych w ośrodku o trzecim stopniu referencyjności. Cechy osobowości „Wielkiej Piątki” oceniano za pomocą kwestionariusza “NEO-Five Factor Inventory”. Kilka zmiennych uzyskano po sczytaniu osobistych pomp insulinowych, glukometrów i zaślepionego systemu ciągłego monitorowania glikemii (CGM).WynikiWszystkie cechy osobowości oprócz neurotyczności (niski poziom cechy) wykazywały przeciętne nasilenie. Ugodowość była skorelowana z większością zmiennych uzyskanych z systemu CGM. Większa sumienność wiązała się z dłuższym czasem trwania cukrzycy. Większa neurotyczność korelowała z większą zmiennością glikemii (GV), podczas gdy wysoka ekstrawersja wiązała się z niższym wskaźnikiem GV. Niższa Otwartość była związana z wydłużeniem czasu klinicznie istotnej hipoglikemiiWnioskiNasze badanie sugeruje, że cechy osobowości przejawiają się w indywidualnym podejściu do leczenia cukrzycy i regulacji emocji, co przekłada się również na stosunek do leczenia. Z drugiej strony, ogólne wyniki cech pacjentów z T1DM były zgodne z normami niepsychiatrycznymi dla osób zdrowych, co obala mity i stereotypy sugerujące, że choroba przewlekła jest zwykle związana z psychopatologią.