Biomedical subjects

E Janczewska

Publications and source records attributed to E Janczewska.

At least 19 recordsLinked to original sources

PubMed2001

What we can really expect from telemedicine in intensive diabetes treatment: results from 3-year study on type 1 pregnant diabetic women.

Existing standards of the management of the diabetic patients are not efficient enough, and further improvement is needed. The major objective of this paper is to present and discuss the therapeutic effectiveness of an intensive care telematic system designed and applied for intensive treatment of pregnant type 1 diabetic women. The developed system operates automatically, every night transferring all the data recorded during the day in the patient's glucometer memory to a central clinical unit. In order to assess the efficiency of the designed and developed system, a 3-year randomized prospective clinical trial was conducted, using the study group and the control group, each consisting of 15 pregnant type 1 diabetic women. All patients were treated by the same diabetologist. In the presented analysis, two indices calculated weekly were used for the assessment of glycemic control: MBG represents mean blood glucose level, and the universal J-index is sensitive to the glycemic level and glycemic variations. The most important results from the study concern: (a) better glycemic control in the study group in comparison with the control group during the course of treatment, as assessed by the average differences of the MBG and J indices calculated weekly (n = 24) (deltaMBG = -3.2 +/- 4.3 mg/dL, p = 0.0016, deltaJ = -1.4 +/- 2.3, p = 0.0065); (b) much more similar results in glycemic control among members of the study group compared to each other, than among members of the control group compared to each other, as indicated by significantly lower variations of the applied glycemic control indices (SDMBG: 11.9 vs. 18.7 mg/dL, p = 0.0498; SDJ: 6.5 vs. 10.9, p = 0.0318); (c) the observed tendency of a better glycemic control for patients with a lower level of intelligence (IQ < 100) supported by the telematic system in comparison with all other assessed groups of patients. The last result was not statistically significant (p > 0.05). This telematic intensive care system improved the effectiveness of diabetes treatment during pregnancy. It also allows the diabetologist's strategy to be much more precise than if it were conducted without telematic support. This telematic system is inexpensive and simple in use.

Adult↗

PubMed2001

Teletransmission system supporting intensive insulin treatment of out-clinic type 1 diabetic pregnant women. Technical assessment during 3 years' application.

A telematic system supporting intensive insulin treatment of pregnant type 1 diabetic out-clinic patients was implemented and technical efficiency of the system was evaluated over long-term ambulatory application. The system consists of a patient teletransmission module (PTM) and a central clinical control unit (CCU). The PTM contains a one-box blood glucose meter and electronic logbook, a modem and a dial-up or cellular phone set. The CCU consists of a PC computer with a modem and DIAPRET - an original program designed to monitor the intensive insulin treatment. The system was installed in the Clinic of Gastroenterology and Metabolic Disease, MA Warsaw and was tested for 166 +/- 24 days on 15 pregnant type 1 diabetic women. Telemonitoring of the patient data was done automatically. No major technical problems with proper operation or handling of the system was noted. Total effectiveness was 69.3 +/- 13.0% and technical effectiveness 91.5 +/- 6.1%. The efficacy of the system was not significantly influenced by patient intelligence level, education level or place of residence (p < 0.05). Significant improvement of metabolic control was noted during application of the system. In conclusion, the telematic system we developed and implemented should have a positive influence on the quality of diabetes treatment during pregnancy.

Adult↗

PubMed1999

[Results of screening tests for gestational diabetes mellitus at Medical University in Warsaw].

Our purpose was to determine the incidence of screening for gestational diabetes among the population of women delivering at I and II Departments of the First Faculty of Medical University in Warsaw. A retrospective review of 647 pregnancies was performed. The incidence of gestational diabetes mellitus screening was determined and the rate of occurrence of GDM analyzed. 310 (48%) pregnancies were screened for gestational diabetes mellitus with a 1-hour, 50 gm oral glucose challenge test. 49 (16.07%) of the screens had positive results at a plasma glucose level of > 139 mg/dl. Two-hour 75 gm oral glucose tolerance tests (according to the 1994 World Health Organization panel recommendations) were performed on screen-positive women, eleven of whom (22.45%) were diagnosed with gestational diabetes mellitus. Despite of positive oral 50 gm glucose test, (plasma glucose level 140-179 mg/l) 15 women (30%) haven't had the 75 gm oral glucose test. The incidence of GDM among analyzed population is 4% and when GDM screening is carried out, exceeds 7%. Early gestational glucose screening, if performed, may be beneficial in detecting gestational diabetes. Consideration should be given to fulfill it more frequently and for sure, repeat glucose testing in patients with positive one-hour screening tests.

Academic Medical Centers↗

PubMed1999

[Risk factors for gestational diabetes mellitus and results of glucose tolerance tests].

The authors made an effort to verify the connection between the presence of risk factors for GDM and results of screening and diagnostic tests. Study group consisted 302 patients. Gestational diabetes was more frequently diagnosed when an excessive maternal weight and family history of diabetes occurred. Among women with gestational diabetes recognised on the basis of the tests results (screening or diagnostic), 1/3 of patients had no evidence of any risk factor. There is no correlation between the number of risk factors and the occurrence of gestational diabetes. The risk factors were present in half of the investigated patients.

Adult↗

PubMed1999

[The effect of selected factors on the birthweight of the newborns in gestational diabetes].

Fetal macrosomia is commonly associated with gestational diabetes mellitus (GDM) which may lead to various complications. We attended to establish maternal constitutional and metabolic risk factors responsible for the genesis of macrosomia. 219 GDM mothers were divided into two groups treated by diet or insulin. This study shows that maternal glycemic status and maternal nutritional status before pregnancy are important determinants of fetal macrosomia.

Adult↗

PubMed1999

[Factors affecting birthweight in insulin-dependent diabetes mellitus pregnancy].

Fetal growth is affected by various maternal factors. Metabolic disturbances often present in pregnancy complicated by insulin-dependent diabetes mellitus may have important effect on birthweight. The aim of this study was to evaluate the influence of maternal morphometric and metabolic factors on birthweight parameters in women with IDDM. Data were analyzed from 124 diabetic women who delivered in I Department of Obstetrics and Gynaecology University Medical School in Warsaw between 1989-1998. Maternal morphometric factors, glycemic control, insulin requirement, glycosylated hemoglobin and fructosamine levels were correlated with birthweight and birthweight ratios. Glycemic control in first weeks of second part of pregnancy as well as maternal height and weight gain during pregnancy affected birthweight in women with insulin-dependent diabetes mellitus.

Adult↗

PubMed1999

[Pregnancy in women with diabetes complicated by nephropathy and proliferative retinopathy].

Nephropathy and proliferative retinopathy are widely known as the most serious complications of diabetes. In the paper the analysis of the course of pregnancy, labour and neonatal complications among mothers with White class F, R, FR and T was made. The study group consisted of 44 patients. Primary hypertension was observed in 17 (38.6%) patients. The percentage of complications both maternal and neonatal was very high. Among maternal complications were pregnancy induced hypertension (43.2%), urinary tract infections (36%), anaemia (22.7%), threatened preterm labor (13.6%). Nearly 50% of patients has diurnal proteinuria in nearly 50% of patients exceed 3 g. In the opinion of the authors there is a strong need to establish the national supraregional centers designed specially to deal with the problems of pregnant women with diabetic nephropathy and retinopathy.

Adult↗

PubMed1999

[Influence of intelligence level of the type I diabetic patients handling hi-tech glycemia monitoring system on the effectiveness of intensive insulin treatment].

An intensive care system designed and developed in IBBE PAS allows for electronic storage and automatic transmission of BG values and other parameters directly from a patient's BG meter and electronic logbook (Glucometer M+ Bayer) to central clinical computer by telematic connection. Despite effort made to keep the system as simple as possible, its proper handling still requires some additional skills from the patient. Thus, effectiveness of the intensive insulin treatment supported by the system may be influenced by the patient's intelligence level. The aim of this work was to evaluate influence of the intelligence level of type 1 diabetic patients equipped with designed system on effectiveness of a long-term intensive insulin treatment. The study group consisted of 17 type 1 diabetic pregnant women randomly divided in two sub-groups. Eight patients used the transmission system and the remaining 9 patients were treated classically. Patient's intelligence level was assessed according Wechsler scale. Analysis of variance indicated that intelligence level did not influence significantly on average result of the treatment (p > 0.05) in whole study group and in both subgroups. Generally, in patients with lower (93 +/- 2.0) and higher (114.1 +/- 1.2) intelligence level glycemic control indices were found to be similar and did not differ significantly. Performed analysis indicated that the designed system could be properly handled by diabetic patients within wide range of intelligence level. However, despite not statistically significant influence of the patients intelligence level on obtained glycemic control, tendency was observed to obtain better average long-term glycemic control in patients with lower intelligence level using telematic data transmission in comparison with the patients treated in classical way (SDWG = 7.0 +/- 0.4 vs. 8.1 +/- 1.0 mmol/l and J = 30.3 +/- 4.4 vs. 39.0 +/- 12.2).

Adult↗

PubMed1991

Evaluation of dementia in subcortical arteriosclerotic encephalopathy (Binswanger's disease).

Sixteen patients with a clinical diagnosis of subcortical arteriosclerotic encephalopathy (Binswanger's disease) were studied. Mild or moderate dementia was found in 14 cases, with characteristic disturbances of concentration, and psychic retardation with apathy. Neuropsychological studies revealed that signs of diffuse lesions in the frontal lobes dominated. Impairment of memory was significant in all cases. Although intellectual impairment in subcortical arteriosclerotic encephalopathy resembled subcortical dementia, some significant differences were found.

Activities of Daily Living↗

PubMed1983