The differential influence of glimepiride and glibenclamide on insulin resistance and adiponectin levels in patients with type 2 diabetes.

Several studies have demonstrated the decreased insulin resistance (IR) in persons with type 2 diabetes mellitus (T2DM) treated with glimepiride. Those suggest this might be associated with observed higher concentrations of adiponectin. We assessed if there is a difference in IR and metabolic syndrome components between glimepiride and glibenclamide treatment as well as adiponectin concentration in T2DM. Our research observed 20 T2DM patients treated with glibenclamid and 20 switched to glimepiride (n = 20) treatment for 24 weeks. Anthropometric measurements and laboratory analysis were performed at the beginning and at the end of treatment while IR was accessed by homeostasis model assessment of insulin resistance (HOMA-IR). The glimepiride group revealed better glycaemic control compared to glibenclamide group. Moreover, the adiponectin concentration increased (23.9 ± 17.3 to 29.1 ± 12.2 ng/mL, p = 0.087) whereas it decreased in the glibenclamide group (34.3 ± 22.6 to 20.3 ± 11.3 ng/mL, p = 0.011) following 24 weeks of treatment. The serum adiponectin and HOMA-IR were inversely correlated within the group of glibenclamide (r = -0.667, p = 0.009). The present study demonstrates that glimepiride might have beneficial effect on IR compared to glibenclamide, as suggested. However, this observation needs further study investigation among other formulations of SU.

[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.

Ganglioside GT1b protects human spermatozoa from hydrogen peroxide-induced DNA and membrane damage.

We have reported previously that various gangliosides, the sialic acid containing glycosphingolipids, provide protection against sperm injury caused by reactive oxygen species (ROS). In this study, we investigated the effect of treatment of human spermatozoa with ganglioside GT1b on hydrogen peroxide (H(2)O(2))-induced DNA fragmentation and plasma membrane damage. Single-cell gel electrophoresis (Comet assay) used in the assessment of sperm DNA integrity showed that in vitro supplemented GT1b (100 microm) significantly reduced DNA damage induced by H(2)O(2) (200 microm) (p < 0.05). Measurements of Annexin V binding in combination with the propidium iodide vital dye labelling demonstrated that the spermatozoa pre-treated with GT1b exhibited a significant increase (p < 0.05) in the percentage of live cells with intact membrane and decreased phosphatidylserine translocation after exposure to H(2)O(2). Flow cytometry using the intracellular ROS-sensitive fluorescence dichlorodihydrofluorescein diacetate dye employed to investigate the transport of the extracellularly supplied H(2)O(2) into the cell interior revealed that ganglioside GT1b completely inhibited the passage of H(2)O(2) through the sperm membrane. These results suggest that ganglioside GT1b may protect human spermatozoa from H(2)O(2)-induced damage by rendering sperm membrane more hydrophobic, thus inhibiting the diffusion of H(2)O(2) across the membrane.

Lifestyle habits of Croatian diabetic population: observations from the Croatian Adult Health Survey.

The aim of this study was to assess the behavioural risk factors in Croatian diabetic population and to compare them with the lifestyle habits of individuals with no known history of diabetes. The study was a part of the Croatian Adult Health Survey (CAHS), a cross-sectional survey that provided comprehensive health assessment of the Croatian adult population. Risk factors were defined as an unhealthy nutritional regimen, excessive alcohol consumption, smoking and lack of physical activity. Physical inactivity was the most prevalent risk factor observed in a significant number of both diabetic and non-diabetic subjects (44.8% and 29.1%). It was also the only behavioural risk factor that was more prevalent in the diabetic individuals as compared to those without diabetes. Alcohol consumption did not vary significantly between the two groups (5.8% vs. 6.3%), while unhealthy dietary pattern and smoking were less frequent in respondents with diabetes (10.0% vs. 16.5% and 14.3% vs. 23.2%, respectively). Among diabetic patients, a significantly larger proportion of men than women reported smoking (19.2% vs. 10.0%), whereas no such sex-related differences were observed in other behavioural risk factors. Although the most prominent risk factor in diabetic patients was physical inactivity, a significant proportion of respondents with diabetes also reported the presence of other risk factors investigated in this survey. Since the majority of diabetic patients do not reach their treatment goals, there is a substantial need for curative and preventive interventions. Given the importance of physical activity in the treatment and prevention of diabetes and the high proportion of inactive diabetic patients, any future preventive programme in Croatia should address that risk as well.

[Recommendations of Croatian societies on treatment of macrovascular and microvascular complications in patients with metabolic syndrome and diabetes type 2--treatment of residual risk]. / Preporuke Hrvatskih strucnih drustava o lijecenju makrovaskularnih i mikrovaskularnih komplikacija u bolesnika s metabolickim sindromom i secernom bolesti tipa 2--lijecenje preostalog kardiovaskularno [corrected] rizika.

Quite a number of studies have shown that despite achieving targets for total and LDL cholesterol, blood pressure and glycemia according to the guidelines, many patients remain at high residual risk for cardiovascular diseases (CVD), both macrovascular and microvascular. This is particularly true for patients with established CVD, type 2 diabetes, obesity and/or metabolic syndrome who have very often atherogenic dyslipidemia characterized by decreased plasma concentrations of HDL cholesterol and increased triglycerides. To address this issue a working group of experts has been established to produce this document in order to recommend therapeutic interventions for reducing this residual risk. This document has been endorsed by relevant Croatian scientific and professional societies (Croatian atherosclerosis socitey, Croatian hypertension society, Croatian cardiac society, Croatian diabetes society, Croatian endocrinology society, Croatian obesity society, Croatian internal medicine society and Croatian society for clinical pharmacology).

[Incretins in the treatment of diabetes]. / Inkretini u lijecenju secerne bolesti.

Nowadays, diabetes affects about 200 million people worldwide, and represents the sixth-leading cause of death. Approximately 90 to 95% of those affected have type 2 diabetes, caused by two main mechanisms: insulin deficiency or peripheral insulin resistance. Early in the approach, diabetic patients are encouraged to make healthy lifestyle modifications including changes in diet, exercise patterns, and weight control. However, in most of patients, as the disease progresses, pharmacologic treatment becomes necessary. Despite the many pharmacological treatment modalities currently available, glucose control remains unsatisfactory in the type 2 diabetes population as evidenced by average hemoglobin A1c (HbA1c). The incretin mimetics and DPP-IV inhibitors are the new class of medications available for treating patients with diabetes type 2. The glycemic profiles of patients after administrations of incretin mimetics and DPP-IV inhibitors show improvement in postprandial glucose levels and ultimately in HbA1c. Therefore, incretin mimetics and DPP-IV inhibitors may play a clinically significant role in the treatment of patients with type 2 diabetes.

Humoral methylglyoxal level reflects glycemic fluctuation.

OBJECTIVES: According to the nonenzymatic glycation hypothesis, excessive production of toxic alpha-oxoaldehydes is associated with diabetes tissue damage. The aim of this study was to examine the hypothesis that methylglyoxal overproduction is affected by glycemic fluctuation. DESIGN AND METHODS: Methylglyoxal was measured by HPLC in 41 patients with diabetes, and correlated with 9-point daily glucose profiles, fasting glucose level, as well as early (HbA1c) and advanced glycation products. The 24-h glycemia variability was expressed as the M value, a quantitative index of diurnal glucose fluctuation. RESULTS: Methylglyoxal was, in parallel, analyzed in the whole blood and the plasma of the same individual. Significantly higher concentrations were measured in plasma samples of both, patients with diabetes (n=41) (742+/-141 vs. 409+/-131 nmol/L; P=0.000001) and normoglycemic controls (n=10) (520+/-42 vs. 338+/-62 nmol/L; P=0.0002). Difference between plasma and whole blood methylglyoxal (DeltaMG) in the same individual showed higher DeltaMG values in patients with diabetes (346+/-165 vs. 167+/-86 nmol/L; P=0.0027). Elevated methylglyoxal production was observed in patients with M values>20, yielding a significant correlation between M values and methylglyoxal levels. A significant negative correlation between methylglyoxal and creatinine clearance was observed (r=-0.38, P=0.019). CONCLUSIONS: Methylglyoxal was demonstrated to be a parameter characterized by high sensitivity to glycemic fluctuation. The difference between plasma and whole blood concentrations, in the diabetic population versus control subjects might be associated with increased biogenesis, less efficient endogenous detoxification and/or decreased elimination.

Takayasu's arteritis and chronic autoimmune thyroiditis in a patient with type 1 diabetes mellitus.

Takayasu's arteritis is a rare, chronic inflammatory disease of unknown origin, affecting the walls of the aorta and its main branches, as well as coronary and pulmonary arteries. The inflammation of the arteries may lead to stenosis, occlusions, dilatations, and aneurysms of involved vessels. It is relatively common in Asia and the Far East but is rare in the Western Hemisphere. We present the case of a 36-year-old white woman with a history of type 1 diabetes mellitus and chronic autoimmune thyroiditis who complained of easy fatigability in the upper limbs, with absent arterial pulses in the upper limbs and audible bruits over both subclavian and left common carotid arteries. Intra-arterial digital subtraction angiography revealed complete or subtotal obliteration of the aortic arch's branches, with the brain supplied with blood only by the left vertebral artery originating directly from the aortic arch. We diagnosed Takayasu's arteritis with abnormal origin of the left vertebral artery. To the best of our knowledge, our case of Takayasu's arteritis and chronic autoimmune thyroiditis in a type 1 diabetic patient with abnormal origin of the left vertebral artery is the first one ever described.

Impact of a guide dog on glycemia regulation in blind/visually impaired persons due to diabetes mellitus.

The aim was to assess glycemia regulation in a blind diabetic patient after getting a guide dog. Glycosylated hemoglobin (HbA1c) results of a blind patient before and after getting the guide dog were retrospectively collected. The paired t-test results yielded a two-tailed P value of 0.0925, a difference considered not statistically significant; the 95% confidence interval of this difference varied from -0.2494 to 1.889. An improvement of glycemia regulation was observed with the guide dog compared to previous glycemia regulation, however, the difference was not statistically significant. The moderate improvement could probably be attributed to the mobility of the blind person having a guide dog. Standard quality of life tests should be included in the evaluation of diabetic blind persons, especially the impact of a guide dog on glycemic control or other chronic complications of diabetes.

Lipoprotein(a) predicts progression of carotid artery intima-media thickening in patients with type 2 diabetes: A four-year follow-up.

BACKGROUND: The aim of the study was to establish whether increased levels of serum lipoprotein(a) significantly contribute to an increase in intima-media thickness and the number of carotid artery plaques, and consequently to cardiovascular risk in patients with type 2 diabetes mellitus. METHODS: Lipoprotein(a) levels, intima-media thickness and the number of carotid artery plaques were determined at the beginning of the study in 146 patients with type 2 diabetes. Patients were divided into two groups according to serum lipoprotein(a) levels (> or 30 mg/dl had more cardiovascular events, the difference was not statistically significant. CONCLUSIONS: These results indicate that lipoprotein(a) is an independent, genetically determined risk factor closely associated with progression of intima-media thickness in type 2 diabetes.