Vitamin D supplementation in inflammatory bowel disease: the role of dosage and patient compliance.

OBJECTIVES: Vitamin D substitution is recommended in patients with inflammatory bowel disease. Specific guidelines are lacking. The aim of this study was to assess the effect of vitamin D supplementation with respect to dosage and patient compliance. METHODS: A prospective cohort study of 167 Crohn disease/ulcerative colitis outpatients. Patients were screened for serum vitamin D (25OHD2+3) at the end of summer and in late winter. Demographic data, history of vitamin D supplementation were recorded and matched with prescription records. RESULTS: A total of 57 subjects used vitamin D supplementation (mean dose 1104 IU/day). 25OHD2+3 levels were lower (p < 0.001) in winter both in substituted and unsubstituted group, without any differences between groups within the same season. 25OHD2+3 levels did not correlate with the substitution dose. 52.1 % of subjects were fully compliant with substitution. 25OHD2+3 and prevalence of vitamin D deficit in this group were comparable with unsubstituted subjects except a higher prevalence of vitamin D insufficiency (p < 0.02). CONCLUSION: Fixed dosage of 1100 IU/day of vitamin D was insufficient to correct the deficiency. Patient compliance with vitamin D supplementation was low, however this fact did not significantly contribute to the degree of vitamin D deficiency in this dosage (Tab. 3, Fig. 1, Ref. 21).

[Up to day trends in insulin therapy]. / Moderní trendy v inzulinoterapii.

Patients with type 2 diabetes mellitus have a double risk of development of cardiovascular diseases than patients without diabetes. Two thirds of patients with type 2 diabetes mellitus can die from heart attack or a cerebrovascular accident if it is not possible to influence these risks by procedures such as decreasing the blood pressure, cholesterol level, glycemia and to stop smoking. The recommendations of ADA/ EASD for therapy of type 2 diabetes mellitus emphasizes that the therapy should be conducted in such a manner as to decrease the risk of cardiovascular complications and undesirable effects, primarily hypoglycemic events. A whole line of clinical studies, e. g. DCCT EDIC, UKPDS have documented the importance of intensive insulin therapy for achievement of normoglycemia, decreasing risk of microangiopathic complications and in followup observation, also decreasing of cardiovascular risk. An ORIGIN study with insulin glargine documented the safety of therapy of longacting insulin analog and also reduction of development of new diabetes from prediabetes. Insulin therapy with respect to the positive outcomes of study with insulin analogs moved up to the second line in algorithm therapy, immediately after metformin therapy and change of life style.

Serum adipocyte fatty acid binding protein levels in patients with type 2 diabetes mellitus and obesity: the influence of fenofibrate treatment.

Recent studies have demonstrated that adipocyte fatty acid binding proteins (FABP) may play a role in the etiopathogenesis of insulin resistance. The aim of our study was to assess serum FABP levels in obese patients with type 2 diabetes mellitus (T2DM) before and after 3 months of treatment with PPAR-alpha agonist fenofibrate (F) and to explore the relationship of FABP to biochemical parameters and measures of insulin sensitivity assessed by hyperinsulinemic-isoglycemic clamp. We measured biochemical parameters by standard laboratory methods, insulin sensitivity by hyperinsulinemic-isoglycemic clamp and serum concentrations of FABP by commercial ELISA kit in 11 obese females with T2DM before and after three months of treatment with PPAR-alpha agonist fenofibrate and in 10 lean healthy control women (C). Serum FABP levels were 2.5-fold higher in T2DM group relative to C and were not affected by fenofibrate treatment (C: 20.6+/-2.1 microg/l, T2DM before F: 55.6+/-5.7 microg/l, T2DM after F: 54.2+/-5.4 microg/l, p 0.0001 for C vs. T2DM before F). Hyperinsulinemia during the clamp significantly suppressed FABP levels in both C and T2DM group. FABP levels positively correlated with BMI, triglyceride levels, blood glucose, glycated hemoglobin, atherogenic index and insulin levels. An inverse relationship was found between FABP and HDL levels, metabolic clearance rate of glucose, M/I and MCR(glc)/I sensitivity indexes. We conclude that FABP levels are closely related to BMI, parameters of insulin sensitivity, HDL levels and measures of diabetes compensation. This combination makes FABP a valuable marker of metabolic disturbances in patients with type 2 diabetes mellitus.

Levels of adhesion molecules bear a relationship to triglyceride levels in type 2 diabetic subjects with proven silent ischemia.

AIM: The aim of the study was to examine the levels of adhesion molecules, high-sensitivity C-reactive protein (hs-CRP) and lipid spectrum of type 2 diabetic subjects with proven silent myocardial ischemia. METHODS: We included in the study 19 patients with ischemia (Group 1) and 16 patients without ischemia (Group 2). We documented silent ischemia by an exercise-myocardial single photon emission computed tomography. We examined the levels of total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, vascular cell adhesion molecule 1, intercellular adhesion molecule 1, E-selectin, HbA1c, microalbuminuria (MAU), hs-CRP and carotid intima-media thickness. RESULTS: The differences among the values of lipids, adhesion molecules, HbA1c, hs-CRP, MAU between the groups were not statistically significant. E-selectin levels positively correlated with triglyceride levels in the group 1 (Spearman correlation, P<0.05). This correlation was not proven in the Group 2. CONCLUSION: Statistically differences between the study groups were not significant. Levels of E-selectin positively correlated with high triglyceride levels in type 2 diabetic subjects with silent ischemia. This correlation documents a disturbance of the reverse cholesterol transport system.

[Incidence and developmental interdependence of peripheral nerve disorders in type 1 diabetics]. / Výskyt a závislosti vzniku postizení periferní nervové soustavy u diabetu I. typu.

In 1987-1988 the authors subjected to comprehensive neurological examination 79 type I diabetics. The group comprised subjects under 60 years and patients with other possible neurotoxic influences were eliminated. After a detailed clinical examination in 75.9% diabetics clinical signs of affection of the peripheral nervous system were revealed, incl. 45.6% clinical diabetic neuropathies were detected. In all instances it was symmetrical distal sensory or sensomotor polyneuropathy and in four instances moreover the carpal tunnel syndrome was detected. The most frequent neurological disorder was panhypaesthesia on the acra of the lower extremities. The most frequent subjective complaint were paraesthesias of the feet and subsequent cramps. The authors investigated moreover parameters of the long-term compensation of diabetes, the duration of diabetes and the biological age of diabetics. They assessed the statistical significance of these parameters for the development of diabetic neuropathy which was proved only for the parameter of the duration of the disease and the biological age of type I diabetics (p less than 0.05).

[Incidence and developmental interdependence of peripheral nerve disorders in type 2 diabetics]. / Výskyt a závislosti vzniku postizení periferní nervové soustavy u diabetiku II. typu.

In 1987-1988 160 type 2 diabetics, dispensarized in diabetological out-patient departments of the medical clinic of the Institute for Postgraduate training were subjected to neurological examinations. The selection of the group was governed by an effort to reduce to a minimum the association of other neurotoxic influences. The group therefore comprised subjects under 60 years of age; diabetics with other diseases with a possible neurotoxic action, drug abuse, alcohol abuse, etc. were eliminated. After a detailed neurological examination signs of affection of the peripheral nervous system were detected in 87.5%, clinically manifest diabetic neuropathy was found in 78 diabetics (48.75%); 12 had moreover mononeuropathy of the median nerve. The clinical picture was uniform: impaired perception of vibrations on the acra of the lower extremities with ascendent propagation, reduction to disappearance tendinous-muscular reflexes on the lower extremities. Subjectively more frequently cramps of the feet than paraesthesias were reported. The authors revealed that long-term compensation of diabetes, the duration of diabetes and the biological age of the diabetics were statistically significant for the manifestation of diabetic neuropathy. This significance was proved for the factor of biological age (p less than 0.05); there was also a significant correlation between the long-term state of compensation of type 2 diabetes and the manifestation of neuropathy (p = 0.06).

[The carotid drainage system--a "window" into the atherosclerosis process in diabetics?]. / Karotické povodí-"okno" aterosklerotického procesu u diabetiku?

Macrovascular complications present from the viewpoint of morbidity and mortality the biggest risk in type 2 diabetics. An aim of this work is to show ways of detecting clinical and preclinical phases of atherosclerosis with special regard to carotid system. In our paper we have been presenting a sample of 239 patients with cardiovascular incidents and findings on their extracranial carotid systems detected by duplex sonography. 88 patients (36.8%) in the sample had type 2 diabetes, their average age was 68.2 +/- 8.5. 35 were on a diet, 34 were treated with peroral antidiabetics, and 19 with insulin. Findings on extracranial carotid systems were normal in 27.3% of diabetics, in stenoses up to 50% was lumen in 50%, in stenoses 51-70% was lumen in 15.9%, and in stenoses 71-95% was lumen in 6.8% (compared to 3.9 in nondiabetics). Intimomedial thickness (IMT) in a group with positive microalbuminuria was 0.9 +/- 0.3 mm and in a group with negative microalbuminuria 0.87 +/- 0.18 mm. Intimomedial thickness (IMT) and microalbuminuria (MAU) are the markers of risk for atherosclerosis and enable to detect preclinical stages of atherosclerosis. Another enzyme indicated in the process of atherosclerosis is PAPP-A, an indicator of plaque instability. Early detection and early intervention of the atherosclerotic process can prevent growth of atherosclerosis, especially during epidemic increase of type 2 diabetes.

[Problems in the diagnosis of gestational diabetes]. / Problematika diagnostiky gestacního diabetu.

The standard of care of mother and child is in the foreground of interest of the lay public. Gestational diabetes is associated with an increased mortality and morbidity of the foetus, unless diagnosed in time and adequately treated. The screening test for detection of gestational diabetes (according to O'Sullivan) is made in all pregnant women of the Zlín district since 1985. Within 4 months (September-December 2000) it was made in more than 700 women. Of these 58 positive screenings were referred to our out-patient department. Supplemented by oGTT (75 g, WHO). 19 patients with gestational diabetes were detected, 6 with impaired glucose tolerance and 18 with renal glycosuria. During the investigation no patient was detected with negative screening and subsequently confirmed gestational diabetes. In three instances of gestational diabetes insulin treatment was administered, in three cases of renal glyosuria based on the blood sugar level the condition was re-evaluated as gestational diabetes. Gestational diabetes is associated with obesity of the mother. With regard to the increasing incidence of obesity in the population the risk of a higher incidence of diabetes is increasing. Women in fertile age should be tested for hyperglycaemia not only during pregnancy but already before conception.

[Protective special shoes for diabetics. Personal experience with a group of high risk diabetics during a 2 and 1/2 year period]. / Protektivní specializovaná obuv vhodná pro diabetiky. Vlastní zkusenosti u rizikové skupiny diabetiku za 2,5leté období.

A group of 60 type II diabetics with the risk of development of ulceration of the feet was provided with protective specialized footwear. In the course of 2.5 years in 45 patients who could be evaluated the frequency of relapses of previous ulcerations, the development of first ulcerations and the effect on indicators of immediate high risk of a defect (formation of decubital ulcers, blisters) was investigated, as well as the general biomechanical comfort. In 10 patients with relapsing defects relapses developed twice (20%), no primary ulceration developed. As compared with common footwear, the protective footwear had a favourable effect on the formation of sores and blisters 25 patients (55.5%/ 45/100%) reported improvement of the general comfort when walking. 28 (62.2%) patients make use of the favourable experience with the specialized footwear when selecting shoes or when modifiying standard footwear. A surprising finding was delayed fatigue when walking reported by 35 (77.8%) patients, mitigation of dysaesthesias by 23 (51%), pain in the joints by 14 (31.1%), improved stability by 35 (77.8%) of the patients. With regard of the improvement of some subjective complaints the use of protective footwear can be considered a symptomatic-therapeutic element. According to clinical results specialized footwear has a favourable and protective effect on already damaged feet with a reduced tolerance for combined (mechanical, ischaemic, neurotrophic, infectious) insults. Consistent with data of authors from abroad after a 2-5-year follow-up there was a cca 50% reduction in the number of relapses of ulcerations and amputations as compared with common not modified footwear.

[Treatment of insulin-dependent diabetics during delivery]. / Problematika péce o inzulindependentní diabeticku behem porodu.

The authors discuss the care of an insulin-dependent diabetic woman during delivery. Due to the introduction of modern procedures in diabetology, obstetrics and neonatology the perinatal mortality in diabetic pregnancies is close to that in healthy women. In the Zlín region there was in 1997 a total of 2301 deliveries, incl. 8 IDDM patients (0.34%) and 32 patients with gestational diabetes (0.72%). The perinatal mortality in diabetic pregnancies was 0 pro mille and in non-diabetic ones 5.14 pro mille.

[Angiologic findings in type 1 diabetics who have had diabetes longer than 25 years]. / Angiologické nálezy u diabetiku I. typu s trváním diabetu více jak 25 let.

The authors present a group of type 1 diabetics with duration of IDDM longer than 25 years (15 men and 10 women), mean age 53.8 years, mean duration from diagnosis of IDDM 35.0 years. The authors performed angiologic examination by using noninvasive methods with focus on affections of extracranial carotid arteries and peripheral arteries by using ultrasonographic methods and by measuring skin perfusion pressure by the photocell of the plethysmograph on the fingers of lower extremities. The authors investigated the subsequent risk factors--obesity, smoking, hypertension, hyperlipoproteinaemias, ischaemic heart disease, strokes. Macroangiopathy of lower extremities was detected in 28.5%, hemodynamically nonsevere stenosis of the extracranial carotid arteries in 20% of patients. As a result, the authors emphasize the need for regular control of arterial changes in diabetics of type 1.

[Prevention of venous thrombosis and pulmonary embolism. Scoring system of the risk of TEN development]. / Prevence zilní trombózy a plicní embolie. Bodovací systém rizikovosti vzniku TEN.

The authors summarize hitherto used patterns of thromboprophylaxis. They attempted to quantify the risk of development of thromboembolism by means of a "Scoring system of the risk of development of TEN" which facilitates the decision on the intensity of prophylaxis of thromboembolic disease.

[New aspects of pharmacologic and general prophylactic care of the diabetic foot]. / Nové aspekty farmakologické a obecne protektivní péce o diabetickou nohu.

Ischaemia, neuropathies and infections are predisposing factors for the development of ulceration of the diabetic foot. Diabetics have evidently a disposition for affections of the peripheral circulation and impaired regulation of the microcirculation as a result of autonomic neuropathy. The lower the driving pressure (in critical ischaemia), the more important are rheological factors and drugs which can influence them. These preparations include e.g. Trental (pentoxiphilline), Prostavasin (prostaglandin E1), Vessel due F (sulodexide). In advanced stages of ischaemic extremities oedema is a very adverse factor. Non-cardiac oedema can be very effectively handled by manual lymphatic drainage combined with intermittent one-segment pneumatic compression which was successfully used by the authors in ulcerations of the diabetic foot. One of the main general protective measures is adequate care of the foot and protective footwear for diabetics. After 3.5 years' use of protective footwear the authors recorded, consistent with data in the literature, a 50% reduction of relapses of ulcerations (and amputations). By examination on an EMED II apparatus abnormally high local pressures on the sole of risk patients can be detected and at the some time the protective effect of materials used for protective insoles can be tested. Active pharmacological and generally protective care of diabetic foot leads to a reduced number of amputations, in particular supracondylar ones by 50 or more per cent.

[Physical training in type 1 diabetics]. / Fyzický trénink u diabetika I. typu.

The objective of the investigation was to follow the response of type 1 diabetics to a load and subsequently elaborate simple recommendations which can be used in out-patient practice and to provide thus the diabetologist in the field and his patient with practical recommendations for physical exercise.

[Clinical features and therapy of giant cell temporal arteritis]. / Klinický obraz a terapie obrovskobunecné temporální arteriitidy.

Giant-cell temporal arteritis is an urgent condition in ophthalmology as successful treatment depends on early diagnosis and effective therapy before the development of ophthalmological symptoms. The authors investigated on a long-term basis five patients. In the first one complete regression of general and ocular symptoms occurred and vision was preserved. The second patient was admitted already with loss of vision of one eye and despite intensive treatment it did not prove possible to save vision of the second eye. The third patient developed, after clinical recovery, a relapse which was again brought under control. In another patient of relatively younger age it proved possible to arrest the progress of the disease without loss of vision. In the last patient visual acuity improved after treatment.