Metabolic Syndrome and Serum Liver Enzymes Level at Patients with Type 2 Diabetes Mellitus.

OBJECTIVES: The aim of this study was to evaluate liver function in patients with type 2 diabetes mellitus (T2DM) with and without metabolic syndrome (MS) by determining serum levels of gamma glutamyltransferase (GGT), alanine aminotransferase (ALT) and aspartate aminotransferase (AST). We also investigated correlation between levels of liver enzymes and some components of MS in both groups of patients. METHODS: This cross-sectional study included 96 patients (age 47-83 years) with T2DM. All patients were divided according to the criteria of the National Cholesterol Education Program (NCEP) in two groups: 50 patients with T2 DM and MS (T2DM-MS) and 46 patients with T2DM without MS (T2DM-Non MS). The analysis included blood pressure monitoring and laboratory tests: fasting blood glucose (FBG), total lipoprotein cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), fibrinogen and liver enzymes: GGT, ALT and AST. T2DM-MS group included patients which had FBG ≥ 6,1 mmol/L, TG ≥ 1,7 mmol/L and blood pressure ≥ 130/85 mm Hg. RESULTS: T2DM-MS patients had significant higher values of systolic blood pressure, diastolic blood pressure and medium arterial pressure compared to T2DM-Non MS patients. Serum levels of TC, TG, LDL-C, VLDL-C and FBG were significantly higher in the T2DM-MS group compared to the T2DM-Non MS group. Serum fibrinogen level and GGT level were significantly higher in patients with T2DM-MS compared to the serum fibrinogen level and GGT level in T2DM-Non MS patients. Mean serum AST and ALT level were higher, but not significantly, in patients with T2DM and MS compared to the patients with T2DM without MS. Significant negative correlations were observed between TC and AST (r= -0,28, p<0,05), as well as between TC and ALT level (r= -0,29, p<0,05) in T2DM-MS group of patients. CONCLUSION: These results suggest that patients with T2DM and MS have markedly elevated liver enzymes. T2DM and MS probably play a role in increasing the risk of liver injury.

Effects of aggressive approach to the multiple risk factors for diabetic nephro-pathy on proteinuria reduction in diabetes type 2 patients.

Dietary interventions with protein and salt restriction, good glucose control, smoking cessation, aggressive blood pressure control, good control of cholesterol and triglycerides, use of ACE inhibitors and ARBs can delay the progression of diabetic nephropathy. The aim of this study was to present the effects of aggressive treatment of the multiple risk factors for diabetic nephropathy on proteinuria in patients with type 2 diabetes. In this study we included 15 patients with diabetes type 2 and insufficient regulation of glycaemia. The patients were followed for three months period. Glycated haemoglobin (HbA1c), fasting plasma glucose (FPG), postprandial plasma glucose (PPG), blood pressure, cholesterol and triglycerides and proteinuria were followed prior and after the study. Prior the study patients were treated with premix insulin divided in two daily doses + metformin after the lunch and they had insufficient regulation of glycaemia. During the study patients were treated with one daily dose of basal insulin, three doses of metformin (2550 mg), one daily dose of atorvastatin (20 mg) and one daily dose of ramipril (5 to 10 mg). Doses of insulin were titrated separately for each patients (0,7-1,0 IU/kg). Patients were advised to start with lifestyle modification, increased physical activity and dietary interventions with protein and salt restriction, energy restricted diet and smoking cessation. A total of 20 patients (male 12 and female 8) with diabetes type 2 were studied. The mean age of the subjects was 53+/-5,25 years. The mean diabetes duration was 4,05+/-1,96 years. The mean body mass index decreased from 28,1+/-1,67 kg/m2 to 25,9 +/-1,22 kg/m2 after the study. Mean HbA1c decreased from 8,82 +/- 0,53 % to 7,15 +/- 0,23 % (p<0,05). Mean fasting glycemia decreased from 8,79+/-0,58 mmol/dm3 to 7,03+/-0,18 mmol/dm3 (p < 0,05). Mean postmeal glycemia decreased from 9,93 +/- 0,77 mmol/dm3 to 7,62 +/- 0,42 mmol/dm3 (p<0,05). The mean cholesterol level decreased from 7,99 +/-0,64 mmol/dm3 to 5,93 +/- 0,65 mmol/dm3 (p<0,05). The mean triglicerides level decreased from 4,05 +/- 0,97 mmol/dm3 to 1,96 +/- 0,24 mmol/dm3 (p<0,05). The significant decrease of proteinuria was recorded, prior the study the mean albuminuria was 1,05 +/- 0,31 g/dm3 and after the study was 0,07 +/- 0,145 g/dm3 (p<0,05). Mean blood pressure prior the study was 153+/-8,69/91,5 +/- 3,78 mm Hg (p<0,05), after the study was 125 +/- 6,32/ 79,25+/-3,26 mmHg. Effective control of glycaemia, blood pressure, cholesterol and triglycerides, use of ACE inhibitors, dietary interventions with protein and salt restriction, smoking cessation, can delay the progression of nephropathy in type 2 diabetes.

Effects of basal insulin analog and metformin on glycaemia control and weight as risk factors for endothelial dysfunction.

Obese patients with type 2 diabetes and impaired glucose tolerance are at increased risk of development of cardiovascular diseases. Endothelial dysfunction may be a reason for development of atherosclerosis and cardiovascular diseases. Lifestyle modification, increased physical activity, weight reduction, energy restricted diet and good glycaemia control can be useful for the endothelial function improvement and may decrease the risk of cardiovascular diseases. The aim of this study was to evaluate the effects of basal insulin analog and metformin on glycaemia control and weight as risk factors of endothelial dysfunction. Total of 15 patients (9 male and 6 female) with type 2 diabetes were studied. The patients were monitored over six months period. Glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), postprandial plasma glucose (PPG), and body mass index (BMI) were observed. Mean age of the subjects was 53,4 +/- 6,27 years. Mean diabetes duration was 3,71 +/- 1,89 years. At the end of the study mean body mass index decreased from 27,5 +/- 1,45 kg/m2 to 25,7 +/-1,22 kg/m2. In this study we included diabetic patients with fasting glycaemia over 7 mmol/dm3, postmeal glycaemia over 7,8 mmol/dm3 and glycated hemoglobin over 7%. Prior to the study, the patients were treated with premix insulin divided in two daily doses and metformin after the lunch, which did not result in sufficient regulation of glycaemia. We started treatment with one daily insulin basal analog and three daily doses of metformin and monitored the above mentioned parameters. We advised patients to change their lifestyle, to practice energy restricted diet and to increase their daily physical activity. Insulin doses were titrated separately for each patient (0,7-1 IU/kg). Weight reduction was recorded after the study. Mean fasting glycaemia decreased from 8,6+/-0,49 mmol/dm3 to 7,04+/-0,19 mmol/dm3 (p < 0,05). Mean postmeal glycaemia decreased from 9,74 +/- 0,79 mmol/dm3 to 7,6 +/- 0,43 mmol/dm3 (p<0,05). Mean HbA1c decreased from 8,80 +/- 0,59 % to 7,11 +/- 0,22 % (p<0,05). Treatment with one daily doses of basal insulin analog and three daily doses of metformin with lifestyle modification and weight reduction, in obese patients with type 2 diabetes can be useful for the endothelial function improvement and may decrease the risk of cardiovascular diseases.

Effect of biphasic insulin aspart 30 combined with metformin on glycaemic control in obese people with type 2 diabetes.

Combination therapy consisting of biphasic insulin aspart 30 bid with metformin provide better glycaemic control in obese patients with diabetes mellitus type 2. In our study, patients who were treated with 2550 mg of metformin, administered in three daily doses had poor glycaemic control. Three months after switching from metformin therapy to treatment with biphasic insulin aspart 30 + metformin twice a day, glycaemic control improved with significant reduction in hemoglobin HbA1c, fasting blood glucose and postprandial blood glucose levels. Biphasic insulin aspart 30 in combination with metformin administered twice a day may be recommended as a starting insulin treatment in obese diabetic persons whose glycaemic control remained poor while on oral metformin therapy alone.

The effects of combined insulin and metformin therapy in obese patients with diabetes mellitus type 2 in the early stage of the disease.

Combination of insulin and metformin has been shown to improve glycaemic control in clinical trials, particularly in obese patients with diabetes type 2. Insulin therapy can improve function of pancreatic beta cells and periphery insulin activity in target cells in order to enhance glycaemic homeostasis (1, 2, 3). In our study we included obese patients with diabetes type 2 in the early stage of the disease. The study is partially retrospective and partially prospective. The study encompassed 40 patients split in two groups. The first group of 20 patients received insulin therapy combined with metformin, while the patients of the second group were treated with oral antidiabetic drugs, sulfonylureas and metformin. Three months later, the group treated with insulin and metformin showed improvement in the monitored parameters, namely significant reduction in HbA1c (p = 0.003), MFBG (p = 0.0009), PPG (p = 0.028). Insulin therapy administered together with metformin, in obese patients with diabetes type 2, in the early stage of the disease, resulted in well regulated fasting blood glycaemia, as well as post challenge glycaemia and HbA1c.

[Vaccine for prevention of type 1 diabetes mellitus]. / Vakcina za prevenciju diabetesa tipa 1.

Diabetes mellitus type 1, known as insulin dependent diabetes mellitus (IDDM), results from a chronic autoimmune destruction of the insulin secreting pancreatic beta cells. This autoimmune process is marked by circulating auto antibodies to beta cell antigens. GAD 65 (Glutamic Acid Decarboxylase) auto antibodies are present in 70-80% of newly diagnosed patients with type 1 diabetes, and it can be detected many years before clinical onset of the disease. New knowledge in the imunopathogenesis have given expectation that imunotherapy will become routine manner for cure of diabetes mellitus type 1.

Effects of hyperglycemia and iron deficiency on kidney and heart function in type 2 diabetes disease.

Untreated anemia can caused significant cardiac and kidney damage. The aim of this study was to investigate the efficiency of anemia and hyperglycemia treatment in type 2 diabetes and their impact on kidney and heart impairment. The study is clinical retrospective and prospective and it was conducted in Clinic of Endocrinology, Diabetes Mellitus and Metabolic Diseases, University Clinical Center of Sarajevo. Prior to the study all patients were taking oral hypoglycemic drugs included sulfonylureas and biguanides. These subjects were put on 2 times daily fix mix insulin and biguanides after lunch. Each day, subjects received Iron tab 1 x 100 mg/ day, and C vitamin 1 x 100 mg/day. The results of our study are showing that effective treatment of glycaemia and anemia in patients with diabetes, reduces blood pressure, urine albumin secretion and pulse rate, diminishing cardiovascular damage and improving kidney function.

Cystatin C as a marker for detection of early renal failure in diabetes type 2 patients.

UNLABELLED: The epidemiological studies have show dramatic increase and prevalence of end stage renal disease in patients with type 2 diabetes therefore early markers of diabetic nephropathy need to be identified (1). During the treatment of patients at the Clinic of endocrinology, diabetes mellitus and metabolic diseases in Sarajevo, we observed a necessity of application of new markers in assessment of early renal failure. Serum cystatin C level is another marker of renal function. Cystatin C is freely filtered at the level of the glomerulus and virtually all is re-absorbed and metabolized by the proximal tubular cells. Serum cystatin C is a screening test and an early indicator and predictor of the development of renal failure. AIM OF THE STUDY: To estimate correlation among cystatin C, serum creatinine and albuminuria in diabetes type 2 patients for assessment of early renal failure. Serum cystatin C as a screening test has to be considered in the treatment of diabetes type 2 patients for assessment of early renal failure.

[Contemporary methods of prevention and treatment diabetic kidney disease]. / Savremene metode prevencije i tretmana dijabeticne bubrezne bolesti.

The number of people with diabetes is increasing worldwide. Diabetes is the leading cause of end-stage renal disease. Diabetic kidney disease has been reported to occur in 25-40% of people with type 1 or type 2 diabetes. Recent studies have demonstrated that the onset and course of diabetic nephropathy can be significantly improved by intervention in early stage of the development of this complication. In this article we will review the current recommendations regarding the prevention and treatment of diabetic nephropathy.

[Unilateral pheochromocytoma and adrenal gland hyperplasia]. / Unilateralni feohromocitom i hiperplazija nadbubrega.

Woman, forty two years old, has been hospitalized because of frequent headache, palpitation and tremor of lips with paroxysmal increase of blood pressure. The adrenals have examined. The status of the hormones has checked many times but showed increased values of VMA and 17-OH steroids only once. There is no possibility to measure the catcholamines. Analysis of other hormones has showed normal values except of paradoxal hGH increase during suppressive hGH test and hypoglycemia in OGTT test. The changes of the left adrenal, which size was 25x18 and 30x25 mm, have diagnosed by MRI of adrenals. It has been suspected microadenoma by MRI of pituitary gland. The left adrenalectomy has been done. During the surgery hypertension and tachyarrhythmia has occurred and treated by fentolamin and propranolol. No complications have been noticed after the surgery. The status of the adrenals hormones are in the normal range. Patohystological analysis has proved phcochromocytoma and hyperplasy.

[Amylin--a partner hormone to insulin]. / Amylin partner hormon inzulinu.

This article will provide an overview of some of the known functions of a recently discovered hormone, amylin, a partner hormone to insulin. Studies indicate that amylin has a role in the postmeal glucose regulation through effects on glucagon secretion, nutrient delivery and food intake. Three hormones--amylin, glucagon and insulin--are a critical part of postmeal glucose regulation. The interaction of these hormones and their role in the regulation of postmeal glucose concentrations is the subject of this article.