[CROATIAN GUIDELINES FOR THE PHARMACOTHERAPY OF TYPE 2 DIABETES]. / HRVATSKE SMJERNICE ZA FARMAKOLOSKO LIJECENJE SECERNE BOLESTI TIPA 2.

INTRODUCTION: The Croatian Association for Diabetes and Metabolic Disorders of the Croatian Medical Association has issued in 2011 the first national guidelines for the nutrition, education, self-control, and pharmacotherapy of diabetes type 2. According to the increased number of available medicines and new evidence related to the effectiveness and safety of medicines already involved in the therapy there was a need for update of the existing guidelines for the pharmacotherapy of type 2 diabetes in the Republic of Croatia. PARTICIPANTS: as co-authors of the Guidelines there are listed all members of the Croatian Association for Diabetes and Metabolic Diseases, as well as other representatives of professional societies within the Croatian Medical Association, who have contributed with comments and suggestions to the development of the Guidelines. EVIDENCE: These guidelines are evidence-based, according to the GRADE system (eng. Grading of Recommendations, Assessment, Development and Evaluation), which describes the level of evidence and strength of recommendations. CONCLUSIONS: An individual patient approach based on physiological principles in blood glucose control is essential for diabetes' patients management. Glycemic targets and selection of the pharmacological agents should be tailored to the patient, taking into account the age, duration of disease, life expectancy, risk of hypoglyce- mia, comorbidities, developed vascular and other complications as well as other factors. Because of all this, is of national interest to have a practical, rational and applicable guidelines for the pharmacotherapy of type 2 diabetes.

From cellulite to smooth skin: is Viagra the new dream cream?

In this article, we provide a hypothesis considering the potential effect of phosphodiesterase 5a inhibitors on cellulite. Cellulite is a significant cosmetic problem for many post-adolescent women. Its pathophysiology is complex and involves the presence of excess subcutaneous fat, the microcirculatory system, lymphatics and the extracellular matrix. Many diverse treatments have been tested to treat cellulite like iontophoresis, ultrasound, thermotherapy, pressotherapy, lymphatic drainage and electrolipophoresis which all enhance skin microcirculation. There have been several attempts to treat cellulite with drugs, but results were insufficient. Phosphodiesterases (PDE) are a superfamily of enzymes degrading adenosine monophosphate (cAMP) and cyclic guanosine monophoshpate (cGMP). Human fat cell lipolysis is mediated by both cAMP- and cGMP-dependent protein kinases. Indeed, high dose sildenafil pretreatment led to increased lipolysis in adipocyte cultures. That effect could not be attributed exclusively to either PDE3b or PDE5a inhibition, since sildenafil inhibited about 50% of the PDE3b activity in pretreated adipocytes. Sildenafil has a potential beneficial effect on skin microcirculation, as well as on tissue hypoxia. Transdermal or local route of administration should be considered.