Risk factors in diabetic nephropathy progression at present.

Diabetic nephropathy is becoming an increasingly important cause of morbidity and mortality worldwide as a consequence of increasing prevalence of type 2 diabetes and obesity. The glomeruli of patients with diabetes are characterized by glomerular hypertrophy, widening of the glomerular basement membrane, mesangial expansion, podocytopenia leading to nodular (Kimmelstiel-Wilson) glomerulosclerosis. Many studies have reported the initiation and progression of incipient nephropathy in type 1 diabetes patients, but only limited data are available in type 2 diabetes patients. The information on the risk factors and conversion rate of normal renal function to proteinuria in type 2 diabetes patients is sparse. In this report, we review risk factors of diabetic nephropathy progression in type 2 diabetes patients (Ref. 50).

Monitoring of glycation, oxidative stress and inflammation in relation to the occurrence of vascular complications in patients with type 2 diabetes mellitus.

The study aimed to evaluate if the monitoring of advanced glycation end products (AGEs), advanced oxidation protein products (AOPP), lipoperoxides (LPO) and interleukin-6 (IL-6) in plasma could help to predict development of diabetic complications (DC). Clinical and biochemical parameters including AGEs, AOPP, LPO and IL-6 were investigated in patients with type 2 diabetes mellitus (DM2) with (+DC) and without (-DC) complications. AGEs were significantly higher in both diabetic groups compared to controls. AGEs were also significantly higher in group +DC compared to -DC. AGEs significantly correlated with HbA1c. We observed significantly higher AOPP in both diabetic groups in comparison with controls, but the difference between -DC and +DC was not significant. LPO significantly correlated with BMI. IL-6 were significantly increased in both diabetic groups compared to controls, but the difference between -DC and +DC was not significant. There was no significant correlation between IL-6 and clinical and biochemical parameters. These results do not exclude the association between IL-6 and onset of DC. We suggest that the measurement of not only HbA1c, but also AGEs may be useful to predict the risk of DC development in clinical practice. Furthermore, the measurement of IL-6 should be studied as adjunct to HbA1c monitoring.

Vasculitides as a rare cause of intermittent claudication.

Intermittent claudication of the lower extremities is a common symptom described in older patients with atherosclerotic peripheral arterial disease. Peripheral arterial disease due to atherosclerosis is known to be associated with a higher risk of myocardial infarction, stroke and all-cause mortality. However, if intermittent claudication appears in a younger group of patients or older patients in absence of traditional risk factors for atherosclerosis such as smoking, dyslipidemia, arterial hypertension and diabetes mellitus other causes than atherosclerosis must be considered. These conditions include vasculitides, fibromuscular dysplasia, cystic adventitial disease, excentric vascular compression by tumor, popliteal artery entrapment syndrome, trauma or dissection. Vasculitides present a heterogenous group of disorders characterized by inflammatory destruction of blood vessels. Although often not a leading symptom intermittent claudication could be a part of a clinical picture in giant-cell arteritis, Takayasu´s arteritis, Buerger´s disease, polyarteritis nodosa or Behçet disease. Limb claudication is usually of rapid onset, progressive and bilateral. Each of the mentioned vasculitides is specific in ethiology and clinical manifestation with a variable prognosis for the patient. Increased awareness of the presence of different causes of limb claudication and their early diagnosis with a prompt initiation of appropriate treatment may help to avoid clinical progression that can lead to vascular surgery or even limb loss (Ref. 37).

Influence of infection on clinical picture of diabetic foot syndrome.

The aim of our study was to analyse the foot infections in diabetic patients. We analysed foot ulcerations in 124 diabetics who attended outpatient foot clinic, or were hospitalized in the period from 1996 to 2006. Basic neuropathy screening examination was made with cotton wisp, pin-prick, tuning fork, and monofilament. For evaluation of leg ischemia, besides the evaluation of the presence of pedal pulses, the ankle-brachial pressure index was measured. If the infection of foot ulceration was clinically present, bacteriology examinations was performed. In the case of deep wound infection, x-ray examination was made. If bone destruction was present, osteomyelitis was diagnosed by technecium bone scanning and by technecium-labelled leukocyte scan. Deformation and destruction of the bone without infection was appoited as Charcot neuroarthropathy. Foot ulcer infection was found in 58 % diabetic patients, wounds were more often deep (80 %). Infection was not associated with special location of foot ulcer. Two-third of the total infected wounds were associated with leg ischemia and 30.6 % of infected ulcer ended with leg amputation. More foot ulcer infections were found in the diabetics with HbAlc over 8 %. Infection was coupled with diabetic retinopathy (in 63 % patients) (p=0.023), and also with diabetic nephropathy (in 66 % patients) (p=0.012). Bacteriology examination revealed most often Staphylococci (45.8 %), antibiotic therapy was made most often with chinolones. Osteomyelitis was present in 34.7 % of foot ulcer infections. In 14 diabetics (56 %) after antibiotic therapy it was not necessary to perform a leg amputation. HbAlc seems to be a significant predictor of osteomyelitis (p<0.02; OR=1.76). In conclusion, we confirmed that diabetic foot infections, especially on ischemic leg, in diabetics with poor metabolic control and chronic diabetic microvascular complications, are associated with a higher risk of leg amputations. Further, it is possible to cure osteomyelitis successfully without surgery in more than half the cases (Tab. 1, Ref. 24). Full Text in free PDF www.bmj.sk.

[Arterial hypertension with orthostatic hypotension]. / Artériová hypertenzia spojená s ortostatickou hypotenziou.

Arterial hypertension (AH) with orthostatic hypotension (OH) is quite important clinical problem, present especially in older age and in various forms of autonomic nervous system (ANS) failure. ANS damage may be primary, or secondary, most offen in diabetes mellitus. In older age OH occurrence is about 30% and postprandial hypotension is also possible. Various antihypertensive drugs, also tricyclic antidepressants, alpha1-adrenergic receptors antagonists and diuretics may provoke OH. Diagnostic value has simple screening bedside orthostatic test, respectively head up tilt table test and cardiovascular reflex tests. Therapy is non-medicamentous with enough fluids, compression of legs and higher head and neck position in the night. AH with OH can be treated with short-acting antihypertensive drugs, eventually with transdermal nitroglycerin. OH can be treated with clonidine, midodrine, fludrocortisone or beta1-blocker.

[Obesity and arterial hypertension]. / Obezita a artériová hypertenzia.

Obesity is an independent risk factor for the development and progression of hypertension, cardiovascular disease and chronic kidney disease. There is growing evidence that obesity and associated metabolic abnormalities may induce and accelerate renal complications in essential hypertension. The clustering of obesity and other features of the metabolic syndrome might have important implications for prevention, particularly with regard to whether interventions targeted at visceral obesity would have beneficial effects on cardiovascular and renal morbidity.

[Obesity--the risk factor of cardiovascular disease in patients with chronic kidney disease?]. / Obezita--rizikový faktor kardiovaskulárnych ochorení u pacientov s chronickým ochorením obliciek?

In general population obesity is regarded as a predisposing factor for chronic disease such as type 2 diabetes and cardiovascular disease. Obesity increases the risk of kidney disease and adversely affects the progress of kidney disease among patients with diagnosed kidney disease. The main reason of mortality in chronic kidney disease patients is cardiovascular disease, however, the real meaning of obesity as a risk factor of cardiovascular diseases is still uncertain. While in a general population obesity causes higher cardiovascular mortality, many studies reflect inverse association in chronic kidney disease patients. Obesity is associated with better survival, contrary to general population obesity appears to be a protective factor of cardiovascular disease. The name of this phenomenon is "reverse epidemiology" or "obesity paradox", in dialysis patients known as a "risk-factor-paradox". Some studies do not confirm this paradox association in patients with chronic kidney disease.

[Continuous monitoring of tissue glucose]. / Kontinuálne monitorovanie tkanivovel glukózy.

Continuous glucose monitoring is technology revolution in diabetology similar to holter ECG monitoring in cardiology. With goal of the diabetes treatment to achieve almost normal glucose concentration in blood, continuous glucose monitoring can help in hypoglycemia risk reduction. Continuous glucose monitoring offers actual value of glycemia longitudinal whole day, with possibility of analyzing records and signalization when programmed thresholds are exceeded. It offers immediate patients reaction by modification of insulin treatment, food intake or physical activity, and also retrospective analysis of records. Subsequently it is possible to improve long-term treatment. Special contribution of continuous glucose monitoring is in recognizing undetectable hypoglycemias, especially during sleep.

[Purtscher-like retinopathy in acute alcoholic pancreatitis: fluorescein angiography and optical coherence tomography findings]. / Purtscher-like retinopatia pri akútnej alkoholovej pankreatitíde: nález na fluoresceínovej angiografii a optickej koherentnej tomografii.

27 year old patient with a history of alcohol abuse after consumption of fat meal and wine following epigastric pain noticed sudden bilateral visual loss: right eye logMAR 0, 94, left eye logMAR 1, 22. Retinal examination revealed massive edema in the central part of the retina, multiple cotton wool spots in the posterior pole peripapillary and flame-shaped hemorrhages. On the OCT, there was edema most of all in the inner part of the retina, but also subretinal, hyperreflectivity in the nerve fibre layers corresponding to massive cotton wool spots. Fluorescein angiography in the early phases showed hypofluorescent ischemic areas of the retina subsequently leakage developed in the late phases. Immediately after antibiotic and spasmoanalgetic treatment of the pancreatitis visual acuity improved and 2 months after beginning of the therapy visual acuity is logMAR 0 bilateraly. We proposed that the most suspected cause of Purtscher-like retinopathy in this case is fat embolism.

[Characteristics of foot ulcers in diabetic patients]. / Charakteristika ulcerácií na nohách u diabetikov.

INTRODUCTION: Diabetic foot syndrome is often presented as a skin lesion in diabetics. The aim of our study was to analyse foot ulcerations in diabetics, together with ethiopatogenesis, location and grade of impairment. METHODS: We analysed foot ulcerations in 124 diabetics who attended outpatient foot clinic, or were hospitalized in the period from 1996 to 2006. Basic neuropathy screening examination was made with cotton wisp, pin-prick, tuning fork, and monofilament. Beside the evaluation of the presence of pedal pulses, the ankle-brachial pressure index was measured. If the infection of foot ulceration was present, bacteriology examinations was performed. Wagner and University of Texas classifications of foot ulcerations were applied, moreover, location of ulcerations was analysed. RESULTS: Neuropathic ulcer was diagnosed in 46 patients of the total number of 124 (37%), neuroischemic in 76 patients (61%) and pure ischemic ulcer only in 2 patients (2%). Neuropathy was present in 122 (98%) patients with diabetic foot, limb ischemia in 78 patients (63%). Fifty four per cent of foot ulcers were located on toes and 43% ulcers on plantar surface. Foot ulcer infection was detected in 72 patients (58%). We found 48 superficial ulcers (38.7%) and 76 deep ulcers (61.3%). In diabetics without foot ischemia and infection 39% deep ulcers were present whereas in the group with ischemia and infection the proportion amounted to 80% (p < 0.05). CONCLUSION: Diabetic foot syndrom was present more often in type-2 diabetics with longer disease duration, in those on insulin treatment, in men of older age, further in the diabetics with pure glycemic control and/or with chronic microvascular diabetic complications.

[Purtscher-like retinopathy--a rare complication of acute pancreatitis]. / Purtscher-like retinopatia--zriedkavá komplikácia akútnej pankreatitídy: kazuistika.

The article reports the case of a 27-year old woman hospitalised in the internal medicine ward for acute pancreatitis after eating fat food and drinking alcohol. In addition to acute pancreatitis, the patient complained of vision problems. The ophthalmologist detected bilateral occurrence of large whitish nidi located primarily around the optic disc, intraretinal hemorrhage and a massive retinal oedema in the central field and diagnosed Purtscher-like retinopathy. After a month of treatment of acute pancreatitis, the clinical picture improved, the patient's vision sharpness improved and the laboratory parametres returned to normal. The finding on the ocular fundus also improved. Even though similar cases are rare, more patients with acute pancreatitis should be checked for eventual vision disorders. Ocular fundus examination should be included in the set of tests performed for acute pancreatitis, similarly to the practice in arterial hypertension or diabetes mellitus patients.

[The prevalence of abdominal obesity in Slovakia. The IDEA Slovakia study]. / Prevalencia abdominálnei obezity na Slovensku. Stúdia IDEA Slovakia.

Abdominal obesity represents an independent risk factor for subsequent severe cardiovascular events. It is one of the important diagnostic criteria for Metabolic Syndrome whose predictive value for severe cardiovascular events is similar to that of elevated LDL-cholesterol levels. The prevalence of abdominal obesity in the context of Metabolic Syndrome still has not been systematically monitored in Slovakia. The IDEA program evaluated a sample of 4183 patients in 103 centres in Slovakia. It has shown that only one in three adult inhabitants of Slovakia has a normal body weight. Almost every second inhabitant of Slovakia has intraabdominal obesity (by ATP III criteria). Obesity was recorded in every third woman (34.7 %) and in every fourth man (27.0 %). The prevalence of the principal risk factors (hypertension, hyperlipoproteinemia and diabetes mellitus) grew in proportion to the increase in waist circumference.

Effect of vitamin E supplementation on microalbuminuria, lipid peroxidation and blood prostaglandins in diabetic patients.

BACKGROUND: Oxidative stress is an important pathogenic factor in the development of diabetic vascular complications. AIMS: To study the effect of vitamin E supplementation on microalbuminuria, plasma levels of malondialdehyde (MLD) and metabolites of prostaglandins TXA2 (TXB2) and PGI2 (6-keto-PGF1alpha) and to evaluate the relation between plasma MLD and thromboxane B2 (TXB2) in diabetic patients. PATIENTS AND METHODS: Diabetic microalbuminuric patients were supplemented with vitamin E 1200 IU daily (EVIT, Rodisma, Germany) and measurements of microalbuminuria, MLD, TXB2 and 6-ketoPGF1alpha were repeated after 4 months of treatment. RESULTS: Vitamin E supplementation lowered microalbuminuria (93.8 +/- 45.6 vs 67.95 +/- 28.4 microg/min, p < 0.05), MLD (0.55 +/- 0.26 vs 0.32 +/- 0.16 micromol/l, p < 0.001) and also TXB2 level (115.14 +/- 22.7 vs 15.32 +/- 14.7 ng/l, p < 0.001) in diabetic microalbuminuric patients. The changes of 6-keto-PGF1alpha after treatment were not significant. CONCLUSIONS: Our results did not show any significant relationship between levels of MLD and TXB2. Vitamin E supplementation significantly lowered microalbuminuria, MLD and TXB2. (Tab. 2, Fig. 2, Ref. 35).

Does diabetic autonomic neuropathy influence the clinical manifestations of reflux esophagitis?

Diabetic autonomic neuropathy is a common complication of diabetes mellitus and affects every segment of the gastrointestinal tract. Gastrointestinal problems tend to be more common and severe in diabetics compared with the nondiabetic population. In the literature, the prevalence of reflux esophagitis is not known. The aim of this study was to analyze esophagoscopic findings, compare them with esophageal symptoms, and evaluate reflux esophagitis in relationship with autonomic neuropathy. We examined 54 diabetics (15 type 1, 39 type II), 28 males and 26 females, average age 55.4 (95% confidence intervals 52.1-58.8), with duration of diabetes more than 5 (average 15.0; 12.4-17.6) years. All patients completed a structured questionnaire. After overnight fasting, gastroesophageal endoscopy was performed in the morning to establish the presence of reflux esophagitis, using the Los Angeles classification. Cardiovascular autonomic neuropathy was diagnosed with the help of cardiovascular autonomic reflexes (deep breathing, active orthostasis, Valsalva's maneuver) and spectral analysis of heart rate variation. Endoscopic esophagitis was present in 22 (40.7%) diabetics and 10 of them (45 %) also complained of reflux symptoms. Sensitivity of symptoms was 45.5% and specificity was 72%. We found the presence of symptoms of reflux esophagitis in 21 (38.9%) diabetics, but of this group only 10 (47.6%) had endoscopic changes. Autonomic neuropathy was present in 29 patients, 16 (55%) of them had reflux esophagitis and 18 (62%) were positive for reflux symptoms. In the diabetics without autonomic neuropathy, esophagitis was noted in 6 (24%), which reflects a significant difference (p < 0.05). Reflux symptoms were present in 10 (40%) diabetics without autonomic neuropathy, and in comparison with patients who had autonomic neuropathy, the difference was not statistically significant. Thus, reflux eosophagitis is common in diabetic patients, with a prevalence of 40.7%. Reflux symptoms do not have a great diagnostic value in establishing reflux esophagitis. We confirmed a relationship between autonomic neuropathy and the clinical manifestations of reflux esophagitis, but no association with accompanying reflux symptoms. (Tab. 2, Ref. 27.)

[Effect of vitamin E therapy on progression of diabetic nephropathy]. / Vplyv liecby vitamínom E na progresiu diabetickej nefropatie.

Pathogenesis of diabetic nephropathy, which belongs to most serious microangiopathic complications of diabetes, is still not completely clear. Thromboxan A2 and increased oxidation stress are new factors apparently associated with pathogenesis of diabetic nephropathy. It was the aim of the contribution to verify the participation of thromboxan A2 and oxidation stress in the pathogenesis of diabetic nephropathy, as well as to follow the effects of treatment with vitamin E on its progression. In 19 diabetic subjects with microalbuminemia (MA) (age 55.2 +/- 7.6 years), 10 diabetic subjects with normoalbuminemia (NA) (age 54.4 +/- 6.1 years) and in 10 healthy subjects (age 53.6 +/- 9.4) the authors examined the level of malondialdehyde (MLDA) in serum, metabolites of thromboxan A2 (thromboxan B2-TXB2) and prostacyclin PGI2 (6-keto-PGF1 alpha) in urine by means of an RIA method (Isotop, Hungary). The diabetic patients with microalbuminemia were subsequently administered natural vitamin E (EVIT, Rodisna, FRG) at the daily dose of 1200 IU for the period of four months. After two and four months, respectively, MA, MLDA, TXB2 and 6-keto-PGF1 alpha) were examined. The age of the subjects in the two groups was not significantly different. In diabetic subjects with MA, the authors observed significantly higher MLDA levels in serum than in the control individuals (0.55 +/- 0.26 vs. 0.22 +/- 0.02 mumol/l, P < 0.001) and a significant difference occurred also in TBX2 in urine (134.7 +/- 113.8 vs. 27.7 +/- 10.1 ng/12 h, P < 0.001). Increased levels of TXB2 in urine were already present in diabetic subjects with NA as compared with healthy individuals (69.1 +/- 38.8 vs. 27.7 +/- 10.1 ng/12 h, P < 0.05). The treatment with vitamin E caused a significant decrease of MA (93.8 +/- 45.6 vs. 67.95 +/- 28.4 micrograms/min, P < 0.05), MLDA in serum (0.55 +/- 0.26 vs. 0.32 +/- 0.16 mumol/l, P < 0.001). On the basis of our results it is possible to suppose the role of oxidation stress and increased level of thromboxan A2 in the pathogenesis of diabetic nephropathy. The authors also confirmed that the treatment with vitamin E favorably decreases microalbuminemia, while the nephroprotective effect is apparently mediated not only by the antioxidant action, but also the decrease of thromboxan A2 production.

The effect of cardiovascular autonomic neuropathy on resting ECG in type 1 diabetic patients.

BACKGROUND: Cardiovascular autonomic neuropathy (CAN) is a common complication of diabetes mellitus. AIM: To assess the manifestations of CAN on ECG at rest. SUBJECTS AND METHODS: 100 type I diabetic patients, mean age 36.5 (range 17-62) years, mean duration of diabetes 14.6 (range 0-49) years were examined. The control group consisted of 88 healthy subjects, mean age 37 (range 15-65) years. Cardiovascular reflexes (respiration sinus arrhythmia, orthostatic test and Valsalva's maneuvre) were examined, and ECG at rest was analysed. RESULTS: In 35 (35%) diabetics CAN was established. In comparison to diabetic patients without neuropathy, patients with CAN had a higher heart rate (94, 89-99 vs. 79, 75-82 heart beats.min-1, p < 0.001), higher P wave voltage (0.13, 0.12-0.15 vs 0.11, 0.09-0.12 mV, p < 0.001), as well as QTc interval length (422, 410-433 vs 396, 388-404 ms, p < 0.001), but they had a lower voltage of R wave (0.83, 0.72-0.94 vs. 1.0, 0.91-1.09 mV, p < 0.05) and lower T wave voltage (0.18, 0.15-0.21 vs 0.23, 0.19-0.27 mV, p < 0.05). CONCLUSIONS: The higher voltage of P wave, lower voltage of T wave, shorter PQ interval and prolonged QTc interval with tachycardia may be the manifestation of relative sympatheticotonia. Lower R wave voltage and the prolonged QRS complex are the possible signs of cardiomyopathy. (Tab. 4, Ref. 31.)

[Incidence of risk factors and vascular complications in patients with newly diagnosed type 2 diabetes mellitus]. / Výskyt rizikových faktorov a vaskulárnych komplikácií u novodiagnostikovaných pacientov s diabetes mellitus 2. typu.

UNLABELLED: The objective of the investigation was early detection of risk factors of diabetes and/or atherosclerosis and the prevalence of vascular complications of diabetes in newly diagnosed patients with type 2 diabetes in the Slovak Republic. PATIENTS AND METHODS: In the Slovak detection programme of vascular complications participated 40 diabetological out-patient departments. In the course of one year (from the beginning of June 1999 to the end of May 2000) in a total of 3424 newly diagnosed patients with type 2 diabetes, aged under 70 years the case-history was recorded, focused on risk factors of diabetes and atherosclerosis, on the patients' lifestyle, on vascular complications of diabetes and their treatment. Moreover a detailed clinical and laboratory examination was made. The authors made in addition to assessment of the blood sugar level also biochemical examinations focused on indicators of the lipid metabolism and microalbuminuria. All patients had an ophthalmological examination, and the electrocardiogram was recorded. RESULTS: As to risk factors of diabetes as many as 3259 patients (95.2%) reported a low physical activity (exercise lasting less than the minimum of 3 x 30 minutes per week) and 3001 (87.6%) had an elevated body weight, whereby 43.9% patients had a BMI of 25 to 30 kg/m2 and 43.8% were obese (BMI > 30 kg/m2). Diabetes mellitus in a first grade relative was reported by 1521 patients (44.7%). As to risk factors of atherosclerosis, the most frequent finding was hyprcholesterolaemia (values > 5.2 mmol/l) in 2262 patients (67.3%), and hypertriglyceridaemia (values > 1.7 mmol/l) in 2194 patients (66.5%). Arterial hypertension (values of systolic and/or diastolic pressure > 140/90 Hg) were recorded in 2326 (67.9%) patients. The most frequent microvascular complication of diabetes was microalbuminuria was in 20.5% patients. Ischaemic heart disease was recorded in 22.80 diabetics. Risk factors of atherosclerosis and vascular complications in newly diagnosed type 2 diabetics are closely related to the patients' body weight. CONCLUSION: The authors provided evidence of a high incidence of risk factors of diabetes and atheroscleosis in newly diagnosed patients with type 2 diabetes mellitus, and in practically every fifth patient the presence of ischaemic heart disease. Obesity is a significant adverse metabolic and vascular factor.

[Effect of vitamin C and E on nonenzymatic glycation and physico- chemical properties of isolated erythrocyte membranes in diabetic patients]. / Vplyv vitamínu C a E na neenzýmovú glykáciu a fyzikálno-chemické vlastnosti izolovaných membrán erytrocytov u diabetických pacientov.

Non-enzymatic glycation, accompanied by the formation of free radicals, represents a serious problem in diabetes mellitus. It is supposed to be the cause of the development of long-term diabetic complications. The aim of this work was to estimate the effect of treatment with vitamin C (1 g per day) and E (600 mg per day) on selected biochemical parameters as well as to determine the physicochemical state of erythrocyte membranes in diabetics. The paper also compares the physicochemical state of diabetic and control erythrocyte membranes. The changes in the values of glycaemia, glycated haemoglobin, and fructosamine were insignificant after three months of treatment. This points out that the doses used could be low or that the patient compliance was poor. An anionic fluorescent probe merocyanine 540 (MC540) was used to monitor possible changes in the physicochemical properties of isolated diabetic erythrocyte membranes. Significantly higher affinity of MC540 monomers to the membrane in diabetics treated with vitamin E was observed, which can be the result of the antioxidative effect of the vitamin (p < 0.02). A comparison of absorption spectra of MC540 in diabetic and control membranes revealed significant changes in the position of the bands and in their absorbances (p < 0.01 and less). They result from substantial alterations in the structure, surface charge, and the fluidity of erythrocyte membranes in diabetes mellitus. (Tab. 2, Fig. 3, Ref. 22.)

[Diabetic neuropathy]. / Diabetická neuropatia.

Author in his article shortly describe pathogenetic mechanisms, clinical manifestations, diagnostic procedures and screening possibilities (which are very easy to perform), and also therapeutic methods of diabetic neuropathy.

Decreased fluidity of isolated erythrocyte membranes in type 1 and type 2 diabetes. The effect of resorcylidene aminoguanidine.

Changes in the physico-chemical properties of erythrocyte membranes induced by nonenzymatic glycation as well as the possible prevention of their rise were studied. Using the fluorescent probe 1,6-diphenyl-1,3,5-hexatriene (DPH), fluorescence anisotropy values were determined in erythrocyte membranes isolated from type 1 and type 2 diabetic patients with and without complications. The mean anisotropy values for the groups of diabetic patients were significantly higher than those for the control group (p < 0.01). This indicated pathologically decreased fluidity in cell membranes in the diabetics regardless of the type of diabetes or the presence of complications. The fluorescence anisotropy positively correlated (p < 0.01) with clinical parameters, such as glycohaemoglobin and plasma cholesterol content, which are important for the monitoring of the compensation status of the diabetic patient. Our results support the suggestion that protein crosslinking and oxidative stress induced by nonenzymatic glycation contribute to changes in the physico-chemical properties of erythrocyte membranes. In vitro testing of a new potential drug resorcylidene aminoguanidine (RAG) showed its ability to increase significantly (p < 0.001), to various extent (p < 0.01), the fluidity of both diabetic and control erythrocyte membranes. Upon the administration of RAG, reduced fluorescence anisotropy values for the groups of diabetic patients approached the normal values obtained for the controls. This may play an important role in the improvement of impaired cell functions found in diabetes that are controlled by the cell membrane.