[Show abstract][Hide abstract] ABSTRACT: Acute coronary syndrome (ACS) is the main cause of mortality in diabetics. Acute myocardial infarction (AMI) in diabetics is much more often than in non-diabetics. MMP-9 activity could ease the formation of atherosclerosis, destabilization and plaque rupture as well as thrombocyte aggregation. THE AIM OF THIS STUDY IS TO EXAMINE: MMP-9 defining in serum in diabetics; the impact of diabetes mellitus on atherosclerosis and MMP-9 level; relation between serum values of MMP-9 and markers of glycoregulation and lipid status, respectively. RESULTS: The greatest concentration of both total and active MMP-9 serum has been noted in diabetics group with ACS. Both total and active MMP-9 values, in group with diabetes and ACS showed significantly important difference regarding the values in control group. Total and active MMP-9 showed statistically important correlation between the values of glycated hemoglobine A1c (HbA1c) and inverse correlations with values of subfraction HDL3.Active MMP-9 showed statistically important inverse correlation with value of HDL cholesterol. IN CONCLUSION: According to the results, it has been thought that active MMP-9 shows a certain degree of atherosclerotic changes on blood vessels better than total MMP-9. MMP-9, active one, could present an early marker of atherosclerosis, especially on coronary blood vessels, in diabetics with type 2.
[Show abstract][Hide abstract] ABSTRACT: AIM: To evaluate the correlation between metabolic control and the presence and severity level of diabetic retinopathy (DR)
in patients with diabetes type 2. METHODS: This cross-sectional study included 80 patients divided into four groups according
to the duration of the disease: de novo; up to 10 years; from 11 to 20 years; and over 20 years. In order to evaluate the metabolic control each patient was tested
for: glycosylated hemoglobin (HbA1c), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides
(TG). According to eye fundus changes patients were classified following the American Academy of Ophthalmology classification.
RESULTS: The patients with DR had significantly increased values of HbA1c. (9.5 ± 1.83%) and decreased values of HDL-C (1.1 ± 0.21 mmol/L) compared to patients without DR (6.9 ± 1.29%, t = 5.088;
p < 0,001) and (1.3 ± 0.25 mmol/L, t = 3.022; p < 0.01) respectively. The presence and severity level of DR correlated positively
with HbA1c values (p < 0.001) and poor glycaemic control (p < 0.001) while HDL-C values correlated inversely with the presence (p <
0.01) and severity level of DR (p < 0.05). CONCLUSION: Poor metabolic control determined by the increased values of HbA1c and decreased values of HDL-C correlates with the presence and severity of DR.
ZIELSETZUNG: Die Bewertung der Korrelation zwischen Wechselstoffkontrolle und Präsenz und Schweregrad der diabetischen Retinopathie
(DR) bei Patienten mit Typ-2-Diabetes. METHODEN: Diese Querschnittstudie umfasste 80 Patienten, die in vier Gruppen eingeordnet
wurden, nach der Dauer der Krankheit: de novo; bis zu 10 Jahren; 11 bis 20 Jahre; und über 20 Jahre. Um die Stoffwechselkontrolle zu bewerten wurden bei jedem Patient
die folgenden Parameter getestet: glycosiliertes Hämoglobin (HbA1c), Gesamtcholesterinspiegel (TC), High-Density Lipoprotein Cholesterin (HDL-C), Low-Density Lipoprotein Cholesterin (LDL-C)
und Triglyceride (TG). Abhängig von der Änderung an der Netzhaut wurden die Patienten nach der Klassifizierung der Amerikanischen
Akademie für Augenheilkunde eingeordnet. ERGEBNISSE: Patienten mit DR hatten deutlich erhöhte HbA1c-Werte (9,5 ± 1,83%) und verringerte HDL-C-Werte (1,1 ± 0,21 mmol/L) im Vergleich zu Patienten ohne DR (6,9 ± 1,29%, t = 5,088;
p < 0,001 und 1,3 ± 0,25 mmol/L, t = 3,022; p < 0,01). Die Präsenz und der Schweregrad der DR standen in positiver Wechselwirkung
mit HbA1c-Werten (p < 0,001) und schlechter glykämischer Kontrolle (p < 0,001), während sich HDL-C Werte umgekehrt proportional zur
Präsenz (p < 0,01) und zum Schweregrad der DR (p < 0,05) verhielten. SCHLUSSFOLGERUNG: Schlechte Stoffwechselkontrolle, gemessen
anhand erhöhter HbA1c-Werte und verringerter HDL-C-Werte, steht in Wechselwirkung mit der Präsenz und dem Schweregrad der DR.
KeywordsMetabolic control-Diabetic retinopathy-Diabetes type 2-Glycosylated hemoglobin-High-density lipoprotein cholesterol
SchlüsselwörterStoffwechselkontrolle-Diabetische Retinopathie-Typ-2-Diabetes-Glykosiliertes Hämoglobin-High-Density Lipoprotein Cholesterin
Spektrum der Augenheilkunde 01/2010; 24(3):157-161. · 0.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Measurement of intima-media thickness (IMT) of carotid artery by ultrasound, is well known method. Using this noninvasive method in various risck factors such as diabetes mellitus, dislipidemia, hypertension, smoking, age, obesity could be very usefull in pathophisiology studies of atherosklerosis.
The aim of this study was to measure intima media thickness (IMT) of carotid artery, as an early indicator for development of atherosclerosis, and too estemate if there is any significant differences between investigated groups of pts (diabetics pts, pts with glucose intolerance and obese pts without diabetes an older than 45 years).
110 pts were devided in five groups: three groups of diabetics pts: type 1 DM (25) pts, type 2 (25) pts and type 2 DM de novo (20), and (20) pts with glucose intolerance, and 20 pts obese without diabetes, older than 45 years of age. Correlation of metabolic parameters (body mass index (BMI), hip circumference (OS), lipid status) with IMT was performed as well as hipertension, age, sex, smoking and alcohol abuse.
The authors used 2 test and Spearman's correlation.
Intima media ticknes (IMT) was highly statisticly significant in groups of DM type 2 and DM tipe 2 de novo. IMT was stat. sig. in pts with high values of BMI and hip circumference according to those pts with normal values. It was also stat. sig. in pts with smoking hiperlipoproteinemia and hipertension. There was no stat. sig. correlation of IMT with sex, age and alcohol abuse.
This study showed that diabetics pts have frequent patological changes on arteri vessels and these changes are difuse and frequently with complicated wall leasens. The influence of these risck factors is very important because their sinergetic effects may augment clinical manifestation of atherosclerosis.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to examine prothrombogenic factors and antioxidative defense in obese children and adolescents with pre-metabolic and metabolic syndrome, and to analyze insulin secretion and resistance, early glycoregulation disorders and lipid status.
Insulin sensitivity was determined using the homeostasis model assessment for insulin resistance (HOMA-IR), while insulin secretion was determined using the homeostasis model assessment beta (HOMA-beta). Prothrombogenic factors analyzed were plasma plasminogen activator inhibitor-1 (PAI-1) and fibrinogen. Superoxide dismutase and glutathione peroxidase were measured as markers of antioxidative defense.
Patients with metabolic syndrome were characterized with increased body mass index (BMI), waist circumference, and HOMA-IR and HOMA-beta levels, and all had increased blood pressure and triglyceride levels, low high-density lipoprotein cholesterol levels, increased PAI-1 levels and reduced antioxidative defense levels. Patients with pre-metabolic syndrome had higher levels of basal and mean insulinemia during an oral glucose tolerance test, higher levels of HOMA-beta and lower levels of antioxidative defense compared to patients with metabolic syndrome.
Negative correlations between antioxidative defense parameters and BMI, abdominal obesity, insulin secretion, systolic blood pressure and atherogenic lipid factors, as well as correlations between PAI-1 and insulin resistance and basal glycemia in the metabolic syndrome group contribute to accelerated atherosclerosis. Positive correlations between PAI-1 and waist circumference and BMI, and negative correlations between BMI and antioxidative defense in the pre-metabolic syndrome patients show that this early stage preceding the metabolic syndrome is also characterized by atherosclerotic complication risks and evident hyperinsulinism and insulin resistance.
Clinical Chemistry and Laboratory Medicine 02/2007; 45(9):1140-4. · 3.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Previous studies have suggested that the multiple transplants might be equally metabolically efficient to a single regimen for human adult islets. The aim of this study was to compare immunological and metabolic parameters after each of the two regimens of human fetal islets (HFI). Group A single transplants (n = 9) had 180 +/- 20 x 1000 HFI equivalents (IEQs) implanted via a single intramuscular injection. In group B multiple transplants (n = 8) islets were implanted by three consecutive injections of 60 +/- 10 x 1000 IEQs at 7-day intervals. We analyzed the immunological parameters of CD4/CD8 T lymphocyte ratios; islet cell antibodies (ICAs) and insulin antibodies (IAs). We estimated insulin secreting capacity (ISC) as the metabolic parameter. We observed that the CD4+/CD8+ T-cell ratio increased, peaking on day 90, in similar fashion in both groups: day -1: A = 1.18 +/- 0.03 versus B = 1.19 +/- 0.04; on day 90: A = 1.79 +/- 0.09, versus B = 1.75 +/- 0.08 (P = NS) immediately before the decrease in C-peptide levels. Thereafter the ratios rapidly decreased without statistical differences. The levels of ICAs did not change. The levels of IAs, which were increased before transplant, then decreased without statistical differences between the groups. The values of ISC increased after transplant and then decreased similar to the T-cell ratio. Our results demonstrated that regimens of multiple and single HFIs did not show differences in the kinetics of the immunological response presumably mediating graft destruction. The CD4/CD8 ratio increased as the C-peptide level decreased, peaking on day 90 at the time of a decrease in C-peptide. These results may be useful for clinical studies of HFIs for type 1 diabetic patients.
[Show abstract][Hide abstract] ABSTRACT: A 45-year-old female patient with diabetes was on corticosteroid therapy for a year due to pulmonary sarcoidosis. During the last six years she was treated with oral antidiabetic drugs, but during the last couple of months, she required insulin therapy due to impaired glycoregulation. After corticosteroid therapy was discontinued, glycoregulation improved and insulin therapy was discontinued as well. SECOND CASE: a 32-year-old male patient was on prednisolone therapy due to pulmonary and extrapulmonary sarcoidosis. A few weeks later diabetes mellitus (de novo) was established. During the treatment of sarcoidosis with corticosteroids, short-term insulin therapy was due to impaired glycoregulation. Insulin therapy has improved the glycoregulation.
There is no certain evidence about the incidence of diabetes mellitus under the influence of corticosteroids, due to increase of hepatic glucose production, insulin resistance and exhaustion of pancreatic beta-cells because of stimulated endogenous secretion. During treatment of sarcoidosis, corticosteroid therapy may cause deterioration of glycoregulation and occurrence of clinically manifested diabetes mellitus in patients with impaired glycose tolerance or predisposition to diabetes.
Diabetic patients with sarcoidosis who need corticosteroid therapy, should control glycoregulation Patients with sorcoidosis, treated with corticosteroid therapy need regular control in order to diagnose early diabetes.
[Show abstract][Hide abstract] ABSTRACT: There is a relationship between sarcoidosis and endocrine diseases: hypothalamus, hypophysis, thyroid gland, parathyroid gland, adrenal gland and calcium metabolism disorder.
Neurological disorders, obesity, secondary hypogonadism, and thirst as a result of diabetes insipidus, dominate the clinical picture of hypothalanmic sarcoidosis. Diseases of adenohypophysis present with gonadotropic insufficiency and prolactin increase. They may cause disorders in menstruation and ovulation. Disorders of neurohypophysis manifest with moderate polyuria and polydipsia. Disorders of thyroid gland function in systemic sarcoidosis present with hyperthyroidism, hypothyroidism or thyroiditis. Sarcoidosis of the parathyroid gland is rare. Sarcoidosis of adrenal cortex may cause primary insufficiency of the suprarenal gland The secondary insufficiency of the suprarenal gland is caused by hypothalamic and pituitary sarcoidosis. In sarcoidosis, calcium metabolism disorder and hypercalcemia are frequent. Vitamin 1.25(OH)2D has an important role since it is increasingly produced in renal and extra renal regions. Hypercalcemia leads to hypercalciuria and nephrolithiasis, while the level of parathyroid hormone usually decreases. Increased levels of serum angiotensin converting enzyme (ACE) are also important markers in the diagnosis of sarcoidosis.
Clinical manifestations of endocrine disorders depend on the localization of sarcoid lesions. The treatment of disorders is directed to the treatment of structure and functional disorders of glands involved, as well as to sarcoidosis. Successful treatment of sarcoidosis may cause regression of granulomatous lesions in the involved glands.