[show abstract][hide abstract] ABSTRACT: Diabetes mellitus (DM) is considered to be an epidemic, chronic and progressive disease. The treatment of DM reqiures substantial effort from both the diabetes treatment team and a patient. Patient education is one of the treatment elements. The most efficacious form and content of education has not yet been established. However, every DM education must include introduction to a substantial number of facts about diabetes. The aim of our study was to estimate the levels of DM knowledge and glycemic control in Serbian patients with DM type 2 as well as to estimate the effects of education using printed material on the levels of glycemic control and knowledge about DM. Also, the effects of education on glycemic control and the level of knowledge in differently treated patients were estimated.
The patients with DM type 2 (n = 364), aged 40 to 65 years, from three regional health centers, were randomized for the study. After informed consent, patients filled out the questionnaire, and were checked for HbA1c and fasting blood glucose. Finally, booklet "Healthy lifestyle with diabetes mellitus type 2" was given to them. The same procedure was repeated after 3, 6 and 18 months.
There was a significant improvement in HbA1c levels after 3 months (8.00 +/- 1.66% vs 9.06 +/- 2.23%, p < 0.01) and after 6 months (7.67 +/- 1.75% vs 9.06 +/- 2.23%, p < 0.01). There was no further improvement in HbA1c levels after 18 months (7.88 +/- 1.46% vs 7.67 +/- 1.75%, p > 0.05). There was a significant improvement in the average test score (percent of correct answers per test sheet) after three monts (64.6% vs 55.6%, p < 0.01). There were no further statistically significant changes in the general level of DM knowledge after 6 months (65.0 +/- 32.5% vs 64.5 +/- 33.7%, p > 0.05) and after 18 months (64.8 +/- 32.7 vs 64.5 +/- 33.7%, p > 0.05). There was a significant diffrence in educational intervention response in DM type 2 patients on different therapeutic regimens.
Education with printed material led to improvement in glycemic control and level of DM knowledge in our patients. Education with printed material may be a useful adjunct to DM treatment and should be structured according to the treatment modality.
[show abstract][hide abstract] ABSTRACT: Diabetes mellitus is associated with an increased risk for neonatal morbidity and mortality. One of the most important goals in treating pregnancies complicated with diabetes is keeping glucose level within the normal range, especially in the first trimester. A portable insulin pump for continuous subcutaneous insulin infusion (CSII) represents the best form of therapy for patients with type 1 diabetes mellitus during pregnancy. The aim of our study was to evaluate the effects of therapy with a portable insulin pump for continuous subcutaneous insulin infusion during the first trimester of pregnancy on the quality of glycoregulation and pregnancy outcome in women with type 1 diabetes mellitus.
A total of 17 newly diagnosed pregnant women with type 1 diabetes mellitus were treated with CSII therapy for three months. The parameters of glycoregulation (hemoglobin A, glycosylated--HbAlc, mean blood glucose value in daily profiles--MBG, daily requirement for insulin--IJ/kg BM), lipid levels, blood preassure and renal function were estimated before and after the therapy. These parameters were correlated with parameters of pregnancy outcome: fetal weight, APGAR score, duration of pregnancy.
There was a significant improvement in HbA1c (8.94 +/- 1.62 vs. 6.90 +/- 1.22 %,p < 0.05), MBG (9.23 +/- 2.22 vs. 6.41 +/- 1.72 mmol/l, p < 0.01), and daily requirement for insulin (0.66 +/- 0.22 vs. 0.55 +/- 0.13 IJ/kg BM, p < 0.05) during the CSII therapy. There were significant correlations between fetal weight and HbAlc (r = -0.60, p < 0.05), triglyceride levels (r = -0.63, p < 0.01), and the number of pregnancies (r = -0.62, p < 0.01), as well as between APGAR score and MBG (r = -0.52, p < 0.05) and cholesterol levels (r = -0.65, p < 0,01) before a portable insulin pump was applicated.
There was a significant improvement in the quality of glycoregulation during CSII therapy in the pregnant women with type 1 diabetes mellitus. The quality of glycoregulation in the moment of conception was the important factor for pregnancy outcome.
[show abstract][hide abstract] ABSTRACT: Controversial data were reported on GH response to different provocative stimuli in obese patients with polycystic ovary syndrome (PCOS). The objective of our study was to assess the effect of short-term fasting on GH response to combined stimulus with GHRH+GH-releasing peptide-6 (GHRP-6) in obese patients with PCOS and possible relation with leptin and insulin changes during fasting. Twelve obese PCOS women and nine obese control women participated in 3-day fasting. GH response, IGF-I, insulin and leptin were measured after GHRH+ GHRP-6, before and after short-term fasting. Obese PCOS patients had significantly greater GH peak after GHRH+GHRP-6 before fasting. Enhanced response to GH stimulation was found after fasting without substantial differences between obese PCOS and obese controls. Insulin and leptin significantly decreased, while insulin sensitivity significantly improved in both groups during fasting. In conclusion, obese PCOS patients have peculiar type of GH response to GHRH+GHRP-6 before fasting, possibly due to enhanced sensitivity of somatotrophs. Observed changes in insulin and leptin may participate in modulation of enhanced GH response after short-term fasting to GHRH+GHRP-6 in PCOS and obese controls.
Journal of endocrinological investigation 05/2003; 26(4):333-40. · 1.65 Impact Factor
[show abstract][hide abstract] ABSTRACT: The growth hormone (GH) response to GH-releasing hormone (GHRH) in patients with non-insulin-dependent diabetes mellitus (NIDDM) was found to be either decreased or normal. The recent introduction of a new and potent GH stimulus, GH-releasing peptide-6 (GHRP-6), allowed further investigation of the functional properties of somatotropes in a variety of metabolic diseases. The aim of the present study was to investigate the response of GH to GHRP-6, GHRH, and GHRP-6 + GHRH in NIDDM patients. Twenty-one patients with NIDDM were divided into two groups: group A, normal weight (body mass index [BMI], 23.31+/-0.62 kg/m2); and group B, overweight (BMI, 27.62+/-0.72 kg/m2). Eight normal-weight control subjects (group C) were studied. Each subject received GHRP-6 (90 microg intravenously [i.v.]), GHRH (100 microg i.v.), and GHRP-6 + GHRH on three separate occasions. There was no difference between the GH response after GHRP-6 in groups A, B, and C in terms of the GH peak (50.95+/-11.55, 51.96+/-7.71, and 70.07+/-15.59 mU/L, P>.05) and the area under the curve (AUC) for GH (2,340.06+/-617.36, 2,684.54+/-560.57, 3,462.78+/-1,223.53 mU/L/120 min, P>.05). A decreased GH response to GHRH was found in group B in comparison to group A (B v A: peak GH response, 8.25+/-1.90 v 22.19+/-8.81, P<.05; AUC GH, 479.62+/-84.0 v 1,443.21+/-743.76, P<.05). There was no difference in the GH response between group A and group C (peak GH response, 22.19+/-8.81 v 26.42+/-6.71, P>.05; AUC, 1,443.21+/-743.76 v 1,476.51+/-386.56, P>.05). There was a significant difference between the same parameters in group B versus group C (8.25+/-1.90 v 26.42+/-6.71, P<.05; AUC, 479.62+/-84.0 v 1,476.51+/-386.56, P<.05). The combined administration of GHRP-6 + GHRH elicited a synergistic GH response in NIDDM patients and controls. There was a significant difference between groups A and B for the GH peak (96.49+/-9.80 v 68.38+/-8.25, P<.05), whereas there was no difference for the AUC (5,111.13+/-703.77 v 3,425.95+/-459.67, P>.05). There was no difference in the peak GH after the combined test between group A and group C (96.49+/-9.80 v 139.82+/-24.16, P>.05), whereas the peak GH in the same test was significantly decreased in group B in comparison to group C (68.38+/-8.25 v 139.82+/-24.16, P<.05). The AUC for GH after combined GHRP-6 + GHRH in group A versus group C was not significantly different (5,111.13+/-703.77 v 9,274.71+/-1,541.46, P>.05), whereas there was a significant difference for the same test between group B and group C (3,425.95+/-459.67 v 9,274.71+/-1,541.46, P<.05). Our results demonstrate that normal-weight NIDDM patients have a preserved GH response to GHRP-6, GHRH, and GHRP-6 + GHRH, and overweight NIDDM patients have a blunted response to GHRH and GHRP-6 + GHRH. The preserved GH response to GHRP-6 in both diabetic groups suggests that the secretory potential of somatotropes is preserved in NIDDM patients. The impairment of the GH response to GHRH in overweight NIDDM patients could be a functional defect due to the obesity, since it could be overridden by administration of GHRP-6.
[show abstract][hide abstract] ABSTRACT: The study was conducted to assess leptin levels and insulin sensitivity in obese and non-obese patients with polycystic ovary syndrome (PCOS). Twenty-two women with PCOS and 19 control healthy women were included in the study, divided into obese and non-obese groups. Leptin was determined using Linco Research radio-immunoassay while insulin sensitivity was calculated from intravenous glucose tolerance tests with frequent blood sampling using MINMOD analysis. Significantly higher basal leptin levels were found in obese compared to non-obese PCOS (31.76 +/- 3.06 vs. 10.42 +/- 2.31 ng/ml; p < 0.05) as well as in obese in comparison to non-obese controls (29.16 +/- 5.06 vs 8.51 +/- 0.88 ng/ml; p < 0.05). A negative correlation was found between insulin sensitivity and leptin levels in both obese (r = -0.2480; p > 0.05) and non-obese PCOS groups (r = -0.4620; p > 0.05). In conclusion, high serum leptin, insulin and testosterone levels together with reduced insulin sensitivity were found in obese PCOS women, suggesting that high leptin levels could be a characteristic of the obese PCOS phenotype.
[show abstract][hide abstract] ABSTRACT: Growth hormone (GH) response to dexamethasone (DEX) in 10 poorly controlled insulin dependent diabetic patients (IDDM) without clinical evidence of diabetic complications and in 10 healthy controls, was studied. GH responses to DEX were compared with pituitary GH response to growth hormone releasing hormone (GHRH). Fasting GH values were not significantly higher in IDDM in comparison with the controls. The peak GH responses to GHRH and DEX were similar in the controls and IDDM patients (23.8 +/- 6.49 vs 38.87 +/- 7.26, p > 0.05 in GHRH test and 13.71 +/- 3.59 vs 17.33 +/- 5 23, p > 0.05 in DEX test). No significant difference between area under curve during GHRH (1386. +/- 490.69 vs 1966.89 +/- 561.46, p > 0.05) and during DEX test (1085.8 +/- 239 856 vs 501.87 +/- 847.16, p > 0 05) in the controls and IDDM patients, were established There was no significant correlation between basal and peak GH values and AUC during both tests, and HbA1C and duration of diabetes It is concluded that GH response to GHRH was normal and that our patients had preserved the integrity of the hypothalamo-pituitary axis, thanks to the suggested mechanism of dexamethasone action via somatostatin.
Srpski arhiv za celokupno lekarstvo 01/1995; 123(1-2):1-4. · 0.23 Impact Factor
[show abstract][hide abstract] ABSTRACT: Hypothalamo-hypophyseal metastases are still a relatively unfamiliar entity. Mostly they are confirmed by autopsy. Rear clinical manifestations are presented by diabetes insipidus. In general, patients with endocrine breast carcinoma metastases are young, premenopausal women, with great tumour burden and widely disseminated tumor. We report 54-year-old woman with diabetes insipidus caused by solitary breast carcinoma metastasis, eight years after primary tumour was diagnosed. The operative and radiation therapy were effective.
Srpski arhiv za celokupno lekarstvo 119(1-2):43-6. · 0.23 Impact Factor