Tesaglitazar, a dual peroxisome proliferator-activated receptor alpha/gamma agonist, improves apolipoprotein levels in non-diabetic subjects with insulin resistance.

AIM: To determine the effects of the peroxisome proliferator-activated receptor (PPAR) alpha/gamma agonist tesaglitazar on serum levels of apolipoprotein (apo) A-I, apoB, and apoCIII in non-diabetic insulin-resistant subjects. METHODS: This randomized, double-blind, multicentre, placebo-controlled trial examined the effect of tesaglitazar (0.1, 0.25, 0.5, and 1mg) once daily for 12 weeks on apolipoprotein levels in 390 abdominally obese subjects with hypertriglyceridaemia. RESULTS: Tesaglitazar dose-dependently increased serum concentrations of apoA-I (p<0.009) and decreased concentrations of apoB (p<0.0001), the apoB/apoA-I ratio (p<0.0001), and apoCIII (p<0.0001). Similar improvements were observed in all subgroups of subjects, where individuals were grouped according to age, gender, baseline body mass index, serum triglycerides and high-density lipoprotein cholesterol levels. Low-density lipoprotein particle concentrations were also dose-dependently reduced by tesaglitazar (p<0.0001). CONCLUSION: Although tesaglitazar is no longer in clinical development, these data indicate that dual PPARalpha/gamma agonism may be a useful pharmacological approach to improve the atherogenic dyslipidaemia associated with insulin resistance.

A comparative evaluation of waist circumference, waist-to-hip ratio, waist-to-height ratio and body mass index as indicators of impaired glucose tolerance and as risk factors for type-2 diabetes mellitus.

UNLABELLED: A number of anthropometric indices is used for evaluation of fat tissue accumulation. It is known, that together with increase of obesity increases prevalence of impaired glucose tolerance (IGT) and diabetes mellitus type 2 (DM 2). The aim of this study was to determine, which of following indices: body mass index (BMI), waist to hip ratio (WHR), waist to height ratio (WHtR) and waist circumference (WC) is the most suitable for the assessment of glucose tolerance disturbances' risk in clinical practice. MATERIAL AND METHODS: The research involved an examination of 1965 people aged > or = 35 years selected from the Lublin town population. Their body mass, height, waist and hip circumferences were measured. Fasting glicaemia and glucose concentration level in the 120th minute after 75 g glucose oral load were determined in full vein blood. DM 2 and IGT were diagnosed according to the 1985 WHO criteria. The evaluation of receiver operating characteristics (ROC) and Pearson's correlation test were used for statistical analysis. RESULTS: The increase of all the studied indices was correlated with the increase of glicaemia, especially after an oral glucose load. The weakest correlation was shown by WHR. WC showed the strongest correlation with fasting glicaemia (except for men, where closer relationship with BMI was observed). Glicaemia after the load was stronger correlated with BMI and WHtR. A comparison of indices made by the analysis of ROC proved that all of them are characterised by a similar relation with the studied diseases. The indices in question showed significantly weaker relation with IGT than with DM 2. WHtR proved to have the highest diagnostic value in the IGT risk assessment IGT and WC in the assessment of DM 2. Interval estimation demonstrated a presence of statistically significant differences between WHR and other indices in the ROC distribution for DM2. The best cut-off points suggested higher DM 2 risk we found were: BMI - 29,2 kg/m2, WC - 97 cm, WHtR - O,62, WHR - 0,91 for women and 27,9 kg/m2, WC - 99 cm, WHtR - O,57, WHR - 0,97 for men. CONCLUSIONS: All the studied indices have a similar value for DM 2 risk assessment. Waist circumference (WC) is especially noteworthy for the family doctor's practice both because of its high diagnostic precision and exceptional simplicity of its determination. The cut-off points of the studied indices should be differentiated according to sex.

Usefulness of glucose levels determination with glucometer in epidemiologic research.

A decentralised health care system based on family doctors implies a certain return to a traditional model, that is to the performance of simple diagnostic tests by the doctor himself. This tendency is getting stronger. In such situation, the approach towards the results obtained with the glucometer should be revised. Carrying out our comparative study on determining 131 patients' glucose concentration levels in capillary blood, whole vein blood (Roche's Glucotrend glucometer), and vein blood serum by means of the laboratory method (the Cobas DP 25 semi automatic method, glucose concentration level tests produced by Cormay) we come to the conclusion that these tests are equally useful.

Metabolic syndrome.

The authors present the history of selecting and understanding the essence of the metabolic syndrome (X syndrome, Reaven's syndrome) related to insulin resistance as well as its contemporary working definition allowing diagnosing affected individuals. They describe the cycle of their own study investigating the prevalence of metabolic syndrome elements in patients treated because of their thyrotoxicosis. It has been observed that 4 weeks after thyrostatic treatment is started, many of these patients are affected by the growth of their body mass and total cholesterol level (mostly at the cost of LDL-cholesterol). After 2 years the growth of body mass is significant, many patients develop arterial hypertension. After 15 years of obesity, diabetes type 2 (DM-2), arterial hypertension, dyslipidemia, hyperinsulinaemia and full metabolic syndrome are found much more frequently than in the control group. In the research carried in the 1987--1989 period, we found the following in 11,546 subjects from the Lublin region (villagers aged over 18): overweight in 36% women and 34% of men, and obesity in 30% of women and 10% of men, and arterial hypertension in 24.2% and DM 2 in 2.7% of the whole examined group. Within the research carried out between 1998 and 2000 we examined 3,782 persons (63%) out of 6,000 persons aged over 35 carefully selected from the Lublin town and the Lublin region villages. DM 2 was found in 17.6% of the examined in the countryside and in 14.1% from the town (newly diagnosed diabetes--75% and 56% respectively). Obesity (BMI > or = 30 kg/m2) was found in 30.8% of the examined from villages and 30.1% town dwellers, arterial hypertension (RR > or = 140/90 mmHg) was found in 69.4% villagers and 68.6% subjects from the town. Total serum cholesterol > or = 5.2 mmol/l (200 mg/dl) was found in 66.4% of the examined from the countryside and in 60% from the town, LDL-cholesterol > or = 3.5 mmol/l (135 mg/dl) was found in 57.3% and 52.6% respectively, and triglycerides > or = 1.7 mmol/l (150 mg/dl) in 33,3% and 44.8 respectively. Hypo-HDL-cholesterolaemia was found in 21.7% of the examined from villages and in 31.4% of the examined from Lublin. 76.5% of the examined from the countryside and 72.7% from the town had a raised WHR index.

Clinically evident thyroid gland disorders in Lublin Region.

The authors tried to assess the prevalence of thyroid gland pathology in Lublin and the Lublin Region population over 35 years old. The study was performed a few years after introduction of iodine prophylaxis in Poland. In our study we still found high prevalence of goitre--about 12% in town and rural population. A very low rate of diagnosed and treated patients with clinically evident thyroid gland pathology was observed in countryside area. Our data confirm the known phenomenon of considerably higher prevalence of thyroid gland diseases in females. Decrease of prevalence of hyperthyroidism in recent years but still low prevalence of overt hypothyroidism are characteristic of a temporary period from moderate iodine deficiency to sufficient iodine intake.

Diabetes mellitus type-2 is unknown in 75% of cases--results of a population study in rural areas of the Lublin Region (Eastern Poland).

There are scare data concerning the prevalence of diabetes mellitus in rural population in Poland. Our study, performed in 1806 subjects from rural areas, showed that prevalence of diabetes mellitus in rural population is unexpectedly high (17.2%) and is higher than in urban population. The fact that 3/4 of the cases turned out to be the cases of previously undiagnosed diabetes mellitus is especially distressing. Thus, main efforts should be concentrated on the necessity of screening tests in the group which is not subjected to periodical medical examinations, the more so that the prevalence of obesity in women reached 40%. The family physician and an appropriate organisation of educational prophylaxis can play a major role in fighting this problem.

Cardiovascular risk factors in the Lublin Region population with and without type-2 diabetes mellitus.

In the 1998--2001 period we carried out a survey on a representative group of the Lublin Region inhabitants aged over 35. During the survey we found particularly high and so far underestimated prevalence of type 2 diabetes mellitus (DM 2) and impaired glucose tolerance (IGT). Ischaemic heart disease and sudden heart death, which is related to it, are the most frequent DM 2 complications. The aim of this study was to assess the prevalence of selected ischaemic heart disease risk factors--obesity, central obesity, arterial hypertension, lipid disorders and the smoking habit--in the Lublin Region inhabitants in groups with correct and impaired glucose tolerance (IGT) as well as newly diagnosed and known type 2 diabetes mellitus 2 (DM 2), and to compare them with each other. We found significantly higher prevalence of obesity, central obesity, arterial hypertension, hypo-HDL-cholesterolemia and hypertriglyceridemia in the group with IGT and DM 2 compared to the group without IGT and DM 2. We did not find significant differences between the groups in total hypercholesterolemia and hyper-LDL-cholesterolemia prevalence. Smoking percentage was significantly higher in persons without IGT and DM 2. Ischaemic heart disease risk factors related to the metabolic syndrome are significantly more frequent in persons with DM 2 and IGT. Diagnosis and treatment of these disorders should be a priority in diabetes care.

[Association of the renin-angiotensin system gene polymorphism with nephropathy in type II diabetes]. / Zwiazek polimorfizmów genów ukladu renina-angiotensyna z nefropatia w przebiegu cukrzycy typu 2.

Diabetic nephropathy is the most frequent cause of end-stage renal failure. One of the crucial factors in a development of renal and cardiovascular complications of diabetes is genetic predisposition. The genes of the renin-angiotensin system are important group of candidate genes involved in pathogenesis of chronic renal diseases. The purpose of our study was the evaluation of a possible role of genetic polymorphisms of some of the RAS system genes in the nephropathy in type 2 diabetes. The study was performed in 117 patients with diabetic nephropathy, compared with 200 healthy subjects as a control group. The following polymorphisms: insertion/deletion (I/D) of the angiotensin-converting enzyme gene (ACE), M235T of the angiotensinogen gene (AGT) and A1166C of the angiotensin II type 1 receptor gene (AT1R) were evaluated by polymerase chain reaction (PCR). No statistically significant differences between groups were found in the allele frequency and genotype distribution for ACE and AGT polymorphisms. The results for the AT1R gene polymorphism revealed significant differences in allele and genotype frequencies. The homozygous CC genotype was more frequent in patients with diabetic nephropathy than in control group. Both genotypes with the C allele (AC + CC) were found in 56% of patients compared to 38% in control group. These results suggest increased susceptibility to diabetic nephropathy in individuals carrying the CC genotype. Therefore, the A1166C polymorphism of the AT1R gene could be a potential genetic marker for increased susceptibility to renal complications in type 2 diabetes.

Insulin resistance, parameters of carbohydrate metabolism, anthropometric parameters, interactions in diabetic patients.

The aim of the study was to investigate relationships between insulin resistance index and basic parameters of carbohydrate metabolism and anthropometric values. We investigated patients with diabetes mellitus t.2 (n = 36) treated with oral hypoglycemic agents. The control group represented patients with normal glucose tolerance (n = 37). Both, the group with diabetes and control had similar values of anthropometric parameters. The insulin resistance index showed significant correlations with fasting plasma insulin and glucose concentrations and HbA1C level in both groups. In the group with normal glucose tolerance we showed significant correlations between insulin resistance index and anthropometric parameters (waist circumference, BMI, body weight, WHR). We did not find any significant relationships between insulin resistance and anthropometric parameters in the diabetic group.

Allergy to house dust mites in primary health care subjects with chronic or recurrent inflammatory states of respiratory system.

Chronic and recurrent respiratory tract disorders are a frequent problem in general practice. The purpose of the study was to investigate the role of hypersensitivity to house dust mites in respiratory tract diseases in general practice patients. We tried to assess the influence of determined risk factors exposure on development of respiratory tract allergy. Patients from family practitioners surgeries with chronic or recurrent respiratory tract symptoms who had no diagnosis of allergy were recruited to the study (n = 89). All patients responded to a questionnaire focused on history of symptoms, atopic conditions in family and exposure to determined environmental factors like dwelling conditions, obstetrician history, diet in the first year of life. All patients underwent skin prick test with common inhalant allergens. Families of the patients were asked to participate in the study. Families who agreed to take part also responded to the questionnaire and underwent skin tests. In patients and their families blood samples were taken to determine total IgE and specific IgE antibodies to mites allergens. Dust samples were collected by vacuuming of patients' bedroom carpets and mattresses to determine house dust mites allergens concentration. Data on 30 complete patients family sets of their brotherhood, mother and father were collected. Total and specific serum IgE antibodies were determined by disc enzyme-immunoassay (Analco). Mites allergens concentration in dust was measured by simple Acarex strip test (Nexter). The results of the assays (positive skin tests and/or elevated levels of specific IgE) showed allergy to house dust mites in 24 of 89 study patients from general practitioners surgeries (27%). The prevalence of chronic rhinitis, recurrent bronchitis, chronic or recurrent cough, wheezing, dyspnoea was higher in allergic than in nonallergic subjects. Patients with the diagnosis of allergy to house dust mites had usually worse dwelling conditions. Especially the influence of dampness in flats on several respiratory symptoms was observed. Subjects who had been found to be allergic were more frequently exposed to higher concentrations of house dust mites allergens in bedroom carpets and in mattresses. In allergic children early introducing of sensitizing components into the diet in infancy related to shorter breast feeding was observed.

Primary and specialist diabetes care three years after introduction of health care system reform in Poland.

The authors discuss epidemics of diabetes in the world and in Poland. In the Lublin region (eastern Poland), for instance, they found type 2 diabetes (DM 2) in 15.6% of the examined aged over 35 (according to the WHO criteria of 1985). The health care system reform in Poland has made more difficult the access of the diabetic to a specialist that treats this disease. Therefore doctors and nurses of primary health care have become more responsible for diabcare than before. The authors believe that the systematic education of primary health care doctors by specialists so that they can treat patients according to the modern standards of practical diabetology as well as sharing of tasks and responsibilities between primary and specialist diabetologic care, are very important. Primary health care would be in charge of prevention and early diagnosis of DM 2 as well as prevention and early diagnosis of concomitant complications of the disease. Specialists would have consultation on the patients at the moment of diagnosis and then at least once a year. They would also take care of search for and diagnosis of remote diabetes complications. Primary health care doctors would still treat most of diabetics with DM 2; specialist centres doctors would treat most of diabetics with DM type 1, patients with complications and from special risk groups (e.g. women with gestational diabetes).