GLUCAGON-LIKE PEPTIDE-1 AFFECTS TASTE PERCEPTION DIFFERENTLY IN WOMEN: A RANDOMIZED, PLACEBO-CONTROLLED CROSSOVER STUDY.

Gastrointestinal tract is an important connector between food intake and body weight, it senses basic tastes in a similar manner as the tongue. The aim of the study was to find out how gut hormone glucagon-like peptide-1 (GLP-1) influences taste preference. Fourteen healthy participants (six male and eight female) were included in this double-blind, placebo-controlled crossover study. After overnight fast and salty fluid (oral sodium load), participants were randomized to receive placebo (500 mL of 0.9% saline) or GLP-1 infusion (1.5 pmol/kg/min) over a 3-hour period. At the end of infusion, participants chose food preferences from illustrations of food types representing 5 tastes. After 7 days, the protocol was repeated, this time those that had received placebo first got GLP-1 infusion, and those having received GLP-1 first got placebo. Change of taste preference after GLP-1 infusion but not after placebo was reported as response, and non-response was reported in case of taste persistence. A statistically significant difference in response type was found between genders, with women being more likely to change their taste preference after GLP-1 than men. The change of taste upon GLP-1 infusion observed in women might be ascribed to estrogen weight-lowering effects accomplished by receptor-mediated delivery.

Glucagon-Like Peptide-1 Infusion Suppresses Aldosterone Levels in Healthy Normal-Weight Individuals: Double-Blind, Placebo-Controlled Crossover Study.

INTRODUCTION: Glucagon-like peptide-1 (GLP-1) has many effects on the human body, but its glucose-lowering effect through its stimulation of insulin secretion is the most significant. GLP-1 also acts on renal function and hemodynamics. The antihypertensive and renoprotective effects of GLP-1 receptor agonists are partly explained by their vasoactive effect and increased natriuresis, but their positive influences on blood pressure and the development and progression of kidney disease are attributed to many effects beyond glycemic control. The aim of this study was to determine how the native gut hormone GLP-1 influences the renin-angiotensin-aldosterone system (RAAS). METHODS: Fourteen healthy participants (6 males and 8 females) were included in a double-blind, placebo-controlled crossover study. After overnight fasting and oral sodium loading, participants were randomly assigned to receive either placebo (500 ml of 0.9% saline) or GLP-1 infusion (1.5 pmol/kg/min dissolved in 500 ml of 0.9% saline) over a 3-h period. After 3 and 6 h, the following parameters were measured: glucose, insulin, plasma renin activity, aldosterone, GLP-1, and antidiuretic hormone. After 7 days, the protocol was repeated, except that those who had previously received placebo now received GLP-1 infusion, and those who had previously received GLP-1 now received placebo. RESULTS: Three hours after GLP-1 infusion, aldosterone had decreased by a statistically significant amount (p < 0.008) compared to the baseline level. CONCLUSION: The present study showed that native GLP-1 can decrease aldosterone secretion in a group of healthy individuals, supporting the idea of beneficial outcomes of GLP-1-activating agents on blood pressure and the RAAS. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02130778.

Type 1 diabetes from adolescence to adulthood: is there a permanent need for nutrition education and re-education?

BACKGROUND: The transition for type 1 diabetes patients from pediatric to adult diabetology care is challenging process for both medical team and patients. Adult diabetology usually insists on stricter goals and focuses on increased empowerment and self-care. We set to find a more practical and effective way to determine patient knowledge and skills during the transition. The aim of the study was to identify screening questions which best represent knowledge in management of type 1 diabetes and to explore the differences in the effect of a structured educational program for type 1 diabetes patient diagnosed in childhood versus adulthood. METHODS: It was an observational study exploring effect of a structured educational program for 39 participants diagnosed with type 1 diabetes in childhood (group 1) vs. 20 patients diagnosed in adulthood (group 2). Main outcome measures were A1C and knowledge questionnaire results change before and after education. RESULTS: The effect of education was equal in both groups, with higher basal level of knowledge in group 1. There was a significant correlation between questions regarding carbohydrate counting and A1C after 3 and 6-12 months in group 1. We found that questions regarding carbohydrate counting may predict glycemic control and represent general knowledge. CONCLUSIONS: Carbohydrate counting is crucial in predicting glycemic control and representing general knowledge about diabetes. Patients diagnosed in childhood may be more knowledgeable in diabetes management, but their practical skill in matching insulin dose and carbohydrate content is poor. Both groups improved their knowledge in similar proportion with same educational program.

Prevalence of gestational diabetes mellitus according to IADPSG and NICE criteria.

OBJECTIVE: To investigate the impact of the International Association of Diabetic Pregnancy Study Group (IADPSG) diagnostic criteria on the prevalence of gestational diabetes mellitus (GDM) and overt diabetes as compared with the UK National Institute for Health and Care Excellence (NICE) criteria, and to evaluate the prevalence of maternal and perinatal outcomes among pregnant women with fasting plasma glucose (FPG) levels of 5.1-5.5 mmol/L. METHODS: A retrospective study was undertaken of data for women who underwent a 2-hour 75-g oral glucose tolerance test at 24-32 weeks of a singleton pregnancy at a center in Croatia between January 2012 and December 2014. RESULTS: Among 4646 included women, 1074 (23.1%) had GDM according to IADPSG criteria, 826 (17.8%) would be diagnosed according to NICE criteria, and 50 (1.1%) had overt diabetes. FPG levels were 5.1-5.5 mmol/L for 409 (8.8%) women. Compared with a control group (n=3391), these women had higher odds of large-for-gestational-age newborns (odds ratio 3.7, 95% CI 2.0-4.6) and cesarean delivery (odds ratio 1.8, 95% CI 1.3-2.3). CONCLUSION: Women with FPG levels of 5.1-5.5 mmol/L have an increased risk of adverse maternal and perinatal outcome, although they would not be diagnosed with GDM according to NICE criteria.

[Guidelines for the management of hyperglycaemia in hospitalised adult patients]. / Smjernice za zbrinjavanje hiperglikemije u odraslih hospitaliziranih bolesnika.

INTRODUCTION: The aim was to prepare guidelines for the management of in-hospital hyperglycaemia in adult patients in intensive care units and regular wards. CONTRIBUTORS: Working group led by two coordinators consists of repre- sentatives of professional societies within the Croatian Medical Association. EVIDENCE: These guidelines are derived from the guidelines of international professional societies. Level of evidence and strength of recommendation are evaluated according to GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system. Decision making process: Working group produced Guidelines draft by a consensus. The draft has been delivered to professional societies for review. Final document is accepted by all included societies. CONCLUSION: Hyperglycaemia is a frequent, serious and demanding complication in hospitalized patients. Results of published studies suggest that its regulation decreases morbidity and mortality. Implementation of locally developed standardized protocols promoting basal-bolus insulin regimen is regarded as the most important measure for management of hyperglycaemia in hospital. Present guidelines are a set of practical, rational and feasible recommendations and suggestions.

Obesity in type 2 diabetes: prevalence, treatment trends and dilemmas.

This retrospective observational study investigated the prevalence of obesity in persons with type 2 diabetes, trends in obesity resulting from the duration and treatment of diabetes, and treatment-related changes in HbA1c and body mass index (BMI). Data on 1773 type 2 diabetics (802 men and 971 women) were obtained from the CroDiabNET registry. Follow-up included the analysis of patients' age, disease duration, diabetes treatment, BMI and HbA1c values. A significantly higher rate of overweight and obesity was found in persons with type 2 diabetes as compared to the general population. A significant decrease in BMI was observed in the groups treated by diet, and in those treated by oral hypoglycaemic agents (p < 0.05), regardless of their pharmacotherapeutic group, in contrast to a significant increase in BMI observed in the groups treated with insulin (alone or in combination with oral hypoglycaemic agents) (p < 0.05). Persons with type 2 diabetes lost weight only during the first years of the disease, while with diabetes duration and insulin treatment they regained weight. A significant increase in HbA1c was observed in the groups treated with sulfonylureas (p < 0.05), whereas all other groups revealed either a significant decrease (p < 0.05) or no change in HbA1c. Our findings suggest the necessity of an integrated approach to managing type 2 diabetic patients that would simultaneously address both diabetes and obesity. Good glycaemic control is imperative and diabetes treatment should not be postponed. Because of a possible concomitant weight gain, aggressive weight control measures should be applied concurrently in order to achieve maximum treatment benefit.

[Management of adrenal incidentaloma: the position statement of the Croatian referral center for adrenal gland disorders]. / Dijagnostika i lijecenje incidentaloma nadbubrezne zlijezde: preporuke referentnog centra ministarstva zdravstva za bolesti nadbubrezne zlijezde.

Adrenal incidentalomas are tumours of adrenal glands discovered during diagnostic workup for other clinical condition unrelated to adrenal glands. Improvement in imaging techniques and their widespread use in everyday practice have increased detection of adrenal incidentalomas making their management one of the most important challenges of modern endocrinology. Based on the relevant medical literature and guidelines of other international societies a panel of Croatian leading experts in adrenal gland disorders provide practical recommendations for the diagnostics and treatment of adrenal incidentaloma.

Prevalence of diabetes mellitus in Croatia.

The aim of this study was to obtain an accurate estimate of diabetes prevalence in Croatia and additional estimates of impaired fasting glucose (IFG), undiagnosed diabetes, and insulin resistance. The study was part of the First Croatian Health Project. Field work included a questionnaire, anthropological measurements, and blood sampling. A nationally representative sample of 1653 subjects aged 18-65 years was analyzed. A total of 100 participants with diabetes were detected, among them 42 with previously unknown diabetes. The prevalence was 6.1% (95% CI: 4.59-7.64), with a significant difference by age. IFG prevalence (WHO-criteria) was 11.3%. The ratio of undiagnosed/diagnosed diabetes was 72/100, unevenly distributed by the regions. HOMA-IR was >1 in 40.4% of the subjects. This survey revealed a higher prevalence of diabetes than previously estimated, whereas that of IFG was as expected. A significant difference in the proportion of undiagnosed diabetes among the regions warrants attention.

[Metabolic syndrome: what, why, how and who?]. / Metabolicki sindrom: sto, zasto, kako i u koga.

Although first knowledge on the joint onset of cardiovascular risk factors had been gained earlier, the first systematic review of this condition was made by G. Reaven in 1988 with his thesis on syndrome X, today known as the metabolic syndrome, with insulin resistance as the common denominator. Four elements have been identified: central obesity, dyslipoproteinemia (increased triglycerides, reduced HDL cholesterol), hypertension and glucose intolerance. There are two most influential definitions: one by the National Cholesterol Education Program (NCEP) and the other by the International Diabetes Federation (/IDF). NCEP requires the presence of at least three of the following factors: abdominal obesity as assessed by waist circumference >102 cm (m) or >88 cm (f), dyslipoproteinemia defined as triglyceridemia > or =1.7 mmol/L and/or HDL cholesterol <1.03 mmol/L (m); <1.29 mmol/L (f), hypertension (blood pressure > or =30/85 mmHg) and fasting glycemia > or =5.6 mmol/L (previously 6.1). IDF focuses on central obesity defined as waist circumference, taking into consideration sex and ethnic group specificities, with the presence of at least two additional factors (dyslipoproteinemia, hypertension, or increased fasting glycemia - all criteria virtually the same as in NCEP definition). Both IDF and NCEP define abdominal obesity by waist circumference, taking account of sex differences, and, in case of IDF, ethnic ones as well. The idea is to identify the simplest measure to indirectly determine the accumulation of visceral fat, which is, contrary to subcutaneous fat, a significant cardiovascular risk factor. However, waist circumference as the only criterion seems to be less specific than the waist-to-hip circumference ratio, which defines the risk more specifically and also better reflects insulin resistance. There is broad discussion as to whether the term metabolic syndrome contributes to the identification of persons at risk of cardiovascular disease better than its components, and, if so, which is the right set of components. It is being recommended that the discussion on the metabolic syndrome be limited to persons without diabetes or already diagnosed cardiovascular disease, as the primary goal for these individuals is to prevent these diseases. It has already been shown that this was possible, primarily by intensive change in lifestyle - healthy diet and exercise. In conclusion, further basic research is necessary to explain the pathophysiologic mechanisms, which might serve to develop new therapies. Moreover, epidemiological and public health aspects are extremely important in the creation of a prevention program. Preliminary results of the Croatian Health Survey (2003) indicate that the metabolic syndrome according to the IDF criteria is present even in the youngest age group, with expected age-dependent increase in both men and women. This is even an underestimate since in this survey only blood pressure and waist circumference were actually measured, and data on dislipidemia and blood glucose were based on a questionnaire. It is already obvious that a wide action with two main goals aimed primarily at the youngest population is necessary: an increase in regular physical activity and the promotion of healthy and energy-adequate diet in the population at large.

[CroDiab NET--electronic diabetes registry]. / CroDiab NET--registar osoba sa secernom bolesti.

INTRODUCTION AND AIM: National diabetes registry has been an important aim of Croatian diabetology for a long time. Currently, efforts are made to define a national registry based upon Cro Diab NET, a computer software designed as a patient record form and suitable for automatic extraction of data for the registry. METHODS: Diagnostic entities captured are defined by the International Classification of Diseases and Related Health Problems, 10th rev. (E10--E14, G63.2, and H36) and ICF (b540, b279, b298, b2108). Central CroDiabNET module is BIS (Basic Informatic Sheet), recognized by the international diabetology community as optimal data collection form for the follow-up and improvement of diabetes care. There are several ways of data collection: secondary and tertiary health centers with diabetes care within their scope of activities send BIS on their patients to the central base by a modem, other secondary and tertiary health centers as well as primary health care will send data on their diabetic patients either via the Internet or by mail (interactive BIS will be available on the registry www page). The preferred method of data collection is the electronic one. The central base automatically links records of uniquely identified patients. Other records are checked separately, compared with the existing records and linked manually. Data confidentiality is ensured by double password protection of excess at the level of both users and registry. Unauthorised access is highly unlikely. RESULTS: So far, most of the secondary and tertiary health centers dealing with diabetology have been active in data collection. Inclusion of primary care (family physicians) is in progress. The last report covered data from 13 centers. Besides data on the number of patients, the reports contained analyses of BIS patient data availability. This is a tool for the analysis of the quality of registry and it can also provide basic data for planned actions aimed at quality of care improvement. Regular data collection from all levels of health care with concomitant connection of the registry to the national death registry started in 2004. With complete implementation of these processes a unique national diabetes database will be defined. CONCLUSION: Results of the use of CroDiabNET so far confirm its potency as a valuable tool for population registry of diabetes as well as for improvement of diabetes health care. Regular periodic reports reveal an increasing number of centers involved. With continuation of this trend the registry will become a national, population-based database.

Effects of an empowerment-based psychosocial intervention on quality of life and metabolic control in type 2 diabetic patients.

This study was aimed at determining impact of an empowerment-based psychosocial intervention on the patients' quality of life and glycemic control as compared to patients in standard care. Consecutively recruited type 2 diabetic patients, scheduled for their regular medical check-ups, were individually acquainted with empowerment-based principles and invited to participate in an empowering psychosocial course. The response rate was 35% giving a number of 73 patients who were treated in eight separate groups. The treated patients reported their quality of life to be improved after the course regarding its psychological and social aspects. Their glycemic control also improved and remained so after 3- and 6-month follow-up periods, still being in a category of poor control. Empowerment-based psychosocial intervention in type 2 diabetic patients was shown to favourably affect their quality of life and to improve their metabolic control, the latter in a modest degree. Better educated patients believing in internal health control and efficacy of diabetes treatment seemed to benefit the most. Further research is needed in order to highlight individual preferences for different educational approaches, as well as social and cultural factors affecting them.

[Prandial regulation of glycemia]. / Prandijalna regulacija glikemije.

The most striking feature of diabetes is hyperglycemia. Maintaining glycemia within certain levels can prevent the development of chronic complications. We researched today's possibilities of diabetes treatment with special emphasis on prandial glucose regulation, searching the Medline with keywords: diabetes mellitus/therapy, hyperglycemia, postprandial period.