WHICH FACTORS MAY AFFECT THE QUALITY OF LIFE IN PATIENTS WITH TYPE 1 DIABETES MELLITUS USING THE MEDTRONIC VEO CONTINUOUS SUBCUTANEOUS INSULIN INFUSION PUMP?

Continuous Subcutaneous Insulin Infusion (CSII) is considered an effective therapeutic approach to the treatment of patients with Type 1 Diabetes Mellitus (T1DM). Literature offers limited information regarding the quality of life (QoL) in patients using CSII. The aim of the study was to investigate the impact of diabetes related factors on the QoL of patients with T1DM on CSII treatment, in a Greek urban population. A cross-sectional study was conducted on 80 patients with T1DM using CSII. [(Mean±SD) age: 35.9±11.4 years, duration of diabetes: 24.2±10.3 years, BMI: 24.6±3.5kg/m2, duration of Insulin pump use: 7.1±3.9 years, HbA1c: 7.7±1.1%, gender: 37 males-43 females)]. QoL was assessed using the patient self-administered EuroQol EQ 5D validated in Greek. Correlation and regression analyses were performed to examine the relationship between EQ index - EQ VAS scores and diabetes related factors. Hypoglycemia Awareness was measured using Clarke and Gold Score questionnaires, Hypoglycemic Episodes were expressed as number of episodes per week and the Fear of Hypoglycemia was measured using the worry subscale of the Hypoglycemia Fear Survey (HFS-W). Results were as follows: Gold score: 2.8±1.5, Clarke score: 2.8±2.1, Hypoglycemia Fear Score: 20.6±11.2, Number of hypoglycemic Episodes per week: 4.3±2.9, VAS score: 68.7±18.1, EQ index: 0.79±0.24. In univariate analyses QoL was negatively correlated with Hypoglycemic episodes, HbA1c, Hypoglycemia Fear Score and Hypoglycemia Awareness status. After regression analysis, only HbA1c and the number of hypoglycemic episodes per week remained independently related to QoL scores. Prevention of hypoglycemia and glycemic control should be emphasized in order to improve QoL in patients with T1DM with CSII.

The role of the osteoprotegerin/RANKL/RANK system in diabetic vascular disease.

Over the last years our knowledge on the mechanisms involved in the pathogenesis of cardiovascular disease has been enriched by the discovery of new molecules emerging as novel risk factors. Osteoprotegerin (OPG) is a soluble glycoprotein, member of the tumor necrosis factor (TNF)-related superfamily, involved in bone resorption. It was first described as a key regulator of bone homeostasis and vascular calcification in mice. Clinical studies have suggested that serum OPG is associated with vascular calcification in humans. The role of OPG in the development of macroangiopathy in diabetes is not yet clear. It is possible that the increased OPG levels in diabetes reflect a compensatory response to arterial injury and that it is not involved in the pathogenesis of atherosclerosis. Whether harmful or not, determination of serum OPG levels has been suggested as a prognostic biomarker of cardiovascular disease. In addition, increased OPG levels have been reported in diabetic patients with microvascular complications. The potential of OPG administration for therapeutic reasons is challenging for future investigators. This review summarizes the current knowledge on the association between OPG and macrovascular as well microvascular complications of diabetes.

[Effect of induced hyperglycemia on contrast sensitivity function in insulin-dependent diabetic patients]. / Effekt von provozierter Hyperglykämie auf die Kontrastempfindlichkeitsfunktion bei insulinpflichtigen Diabetikern.

Acute hyperglycemia in diabetes mellitus is often associated with transient subjective visual disturbances that have not yet been objectively evaluated. We used a contrast sensitivity (CS) test to assess functional visual disturbances in provoked hyperglycemia in 20 patients with well-controlled insulin-dependent diabetes (40 eyes) with no evidence of diabetic retinopathy and with intact visual acuity (age: 32 +/- 8.2 years, duration of diabetes: 11.4 +/- 7.3 years). The CS function was measured by using the CSV-1000 CS test, which is rapid and easily comprehended by the patient and encompasses four spatial frequencies, 3 (A), 6 (B), 12 (C) and 18 (D) cycles/degree. At each frequency, eight pairs of circular targets differing stepwise in contrast were presented simultaneously. The number of targets seen by each patient in the four spatial frequencies at euglycemic (116 +/- 14.7 mg/dl) and hyperglycemic (274 +/- 52 mg/dl) levels, expressed as the CS score, was recorded and afterwards analyzed. The differences in mean CS scores at the individual frequencies at euglycemic versus hyperglycemic levels were statistically significant (p < 0.001). Visual acuity remained stable during hyperglycemia. There was no significant difference in the amount of CS reduction between the group of patients that had had diabetes for a duration of more than 10 years and the group who had had diabetes for less than 10 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Biologic activities of biosynthetic human insulin in healthy volunteers and insulin-dependent diabetic patients monitored by the artificial endocrine pancreas.

This study investigates and compares biosynthetic human insulin (BHI) and purified pork insulin, in healthy volunteers and in insulin-dependent diabetic patients, in terms of biologic action, capacity for controlling diabetic patients, and the requirements of the patients on each insulin. The possible importance of this new insulin in the improved long-term control of diabetic patients led to the experimental design of this protocol.

The validity of C-peptide measurement in the diagnosis of factitious hypoglycemia.

The case is presented of a 32-year-old obese diabetic nurse, with a history of recent hypoglycemic episodes. Estimation of immunologically measurable insulin during hypoglycemia after an overnight fast revealed high values, while simultaneous determination of serum C-peptide failed to show an increase. This combination is considered pathognomonic for factitious hyperinsulinism. After the hidden vial was discovered and presented to her, the patient finally admitted that she had been surreptitiously injecting insulin.

The use of artificial beta cell in diagnosis and treatment of insulinoma.

The glucose-controlled insulin infusion system (GCIIS), the socalled artificial beta-cell, is an important and useful device for detecting and treating hypoglycemic reactions. The dangers of several diagnostic tests such as the tolbutamide or the insulin response test may successfully be avoided. Patients suffering from severe hypoglycemia are kept in normoglycemia by the feedback-controlled dextrose infusion before and during operation.

[A field study with the combination of Pindolol and Clopamid in antihpertensive therapy (author's transl)]. / Der Kombinationstyp Betarezeptorenblocker/Diuretikum in der antihypertensiven Therapie.

In a field study comprising 678 patients with arterial hypertension efficacy and tolerance of the stable combination VKB 105 consisting of 10 mg Pindolol (Visken) and 5 mg Clopamid (Brinaldix) were investigated. Treatment with 1--2 tablets of VKB per day resulted in a successful therapy in 94% of all patients corresponding on the average to a reduction in blood pressure to 145/85 mm Hg within 14 days. In mean arterial pressures ranging between 120 and 170 mm Hg a positive linear relationship between the individual initial value and the hypotensive effect of the combination could be observed. A controlled omission trial disclosed qualitatively the respective contribution to the effect of the two components Pindolol and Clopamid. With a systematic case control of the serum potassium under the combined therapy with VKB 105 and during a monotherapy with Clopamid and antihypokalaemic effect of Pindolol could be demonstrated diminishing the tendency for potassium loss. The result revealed a far-reaching potassium neutrality of diuresis-depending stimulation of renin by the beta-receptor blocker. In 61 patients altogether subjective side-effects could be recorded, such as vertigo (5%), palpitations (2.8%), fatigue (2%), insomina (1.9%), nausea (1.7%) and vomiting (0.8%). Laboratory controls gave no indication for clinically relevant changes.