Glycemic and Extraglycemic Effects of Metformin in Patients with Diabetes

For several decades, metformin has been the mainstay of treatment of type 2 diabetes (T2D), not only due to its remarkable efficacy in both monotherapy and combination therapy regimens, but also due to its favorable safety profile, weight neutrality, and low cost. Other advantages have been reported, including improvements in lipid profile and inflammatory markers and reports of cardioprotective effects, albeit with scant evidence. The modification of the cellular energy metabolism is the core of metformin’s mode of action. Metformin works to lower serum glucose concentration by inhibiting hepatic gluconeogenesis and countering the action of glucagon. Secondarily, it enhances glucose uptake in peripheral tissues, predominantly in the muscles. Long-term and widespread use of metformin has shed light on its other potential uses mediated by its effects on deranged metabolic pathways. Moreover, metformin is gaining research interest by demonstrating its potential in the treatment of multiple disorders other than diabetes and has been proven to have anti-cancer, immunoregulatory, and anti-aging properties. As a result, metformin is currently being researched as a potential treatment option for various diseases

The Jubilees of the Discovery of Insulin & Glycemic Index: Where Conventional meets Complementary Medicine in the Management of Diabetes Mellitus

This year we marked two important jubilees in the management of diabetes mellitus: one is the discovery of insulin 90 years ago and the other one is the introduction of the Glycemic Index, 60 years later, both originated at the University of Toronto, Canada. Both discoveries can help to improve diabetes tremendously and thus have contributed to the advancement of management of this troubling disease the incidence of which continues to climb at a staggering rate

Efficacy of a fixed combination of insulin degludec and GLP-1 receptor agonist liraglutide (Xultophy) in patient with type 2 diabetes

The fixed combination of insulin degludec and liraglutide- Xultophy is a newer therapy available for treatment of type 2 diabetes (DM2). Insulin degludec is an ultralong-basal insulin analogue and liraglutide is a glucagon-like peptide-1 receptor agonist. In this case we monitor values of HbA1c as a marker of glycemia regulation and predictor of vascular incidents, but also fasting glucose, HDL, LDL and triglycerides were observed

Telemedicine for Diabetic Retinopathy Screening in Croatia: A Dream That Could Become a Reality

Diabetic retinopathy (DR) is the leading cause of preventable blindness in working-age adults associated with devastating personal and socioeconomic consequences. The increasing use of anti-vascular endothelial growth factor (anti-VEGF) agents over the past decade and telemedicine implementation in systematic DR screening resulted in a decliningtrend of new blindness due to diabetes in several countries. Telemedicine is the remote delivery of healthcare services over the telecommunications infrastructure. It allows healthcare providers to evaluate, diagnose, and treat patients without the need for an in-person visit. Teleophthalmology is a telemedicine branch, mostly focused on diabetic retinopathy and retinopathy of prematurity. Screening for DR in Croatia is commonly performed annually, only by ophthalmologists using dilated slit-lamp biomicroscopic fundus examination. Due to the insufficient number of ophthalmologists and the lack of a formal call system, many diabetic patients do not perform annual screening. In an ideal DR screening model in Croatia, each diabetes center in university or general hospitals throughout Croatia (17 centers) would have one small digital fundus camera and an educated nurse who would perform dilated fundus photography. Electronic images from diabetes centers would be transferred for remote grading to the same hospitals’ ophthalmology departments or a central grading center for DR screening in Croatia. Grading for DR would be performed by an ophthalmologist, medical retina specialist. Patients would be annually invited by mail from the National Diabetes Registry to come to the nearest diabetes center for a fundus photographing and DR screening. Each patient with a positive result would be promptly referred to the medical retina specialist at the closest ophthalmology department for further examination and treatment

Dermatoglyphics in Patients with Hypothyreosis

About 15% of all females and 3% of all males suffers from hypothyreosis. The thyroid disease is the most frequent cause of hypothyreosis, and among people in Croatia who are suffering from that disease 90% have been affected by its autoimmune form. The thyroid diseases are supposed to be caused by the influence of various genetic and external factors and some forms of genetic influences have not yet been studied. Analysis of digito-palmar dermatoglyphics has been used in the research of the role of genetic predisposition in many various diseases. We have analyzed correlation of qualitative and quantitative traits between the group of 50 females suffering from hypothyreosis and a control group of 100 phenotypically healthy females. Quantitative statistical analysis using t-test has indicated only few significantly different variables, while the discriminant analysis has shown 76.9% correctly classified samples. The factor analysis has shown a high percentage of total variance within patients suffering from hypothyreosis, as well as the different structure of individual factors. Qualitative analysis has shown the heterogeneity between the two examined groups. The results of the research have proved that the qualitative characteristics are more unstable than the quantitative ones and they have also shown the instability of genes taking part in hypothyreosis development implying genetic predisposition of the disease

Dermatoglyphics in Patients with Hypothyreosis

About 15% of all females and 3% of all males suffers from hypothyreosis. The thyroid disease is the most frequent cause of hypothyreosis, and among people in Croatia who are suffering from that disease 90% have been affected by its autoimmune form. The thyroid diseases are supposed to be caused by the influence of various genetic and external factors and some forms of genetic influences have not yet been studied. Analysis of digito-palmar dermatoglyphics has been used in the research of the role of genetic predisposition in many various diseases. We have analyzed correlation of qualitative and quantitative traits between the group of 50 females suffering from hypothyreosis and a control group of 100 phenotypically healthy females. Quantitative statistical analysis using t-test has indicated only few significantly different variables, while the discriminant analysis has shown 76.9% correctly classified samples. The factor analysis has shown a high percentage of total variance within patients suffering from hypothyreosis, as well as the different structure of individual factors. Qualitative analysis has shown the heterogeneity between the two examined groups. The results of the research have proved that the qualitative characteristics are more unstable than the quantitative ones and they have also shown the instability of genes taking part in hypothyreosis development implying genetic predisposition of the disease

Bubrežna funkcija je povezan s razvojem katarakte u bolesnika sa šećernom bolešću tipa 2

In this study, we investigated the impact of renal function, metabolic risk factors, and duration of diabetes on cataract development in patients with type 2 diabetes (T2DM). This study was cross-sectional and included 107 T2DM (67 male/40 female). Renal function was estimated with a creatinine-based formula (eGFR) and with albumin/creatinine (A/C) ratio. Patients were divided into three groups according to the LOCSIII classification: group 1 represents patients with clear crystalline lens (n=16), group 2 represent patients with initial cataract (n=74), and group 3 represents patients with immature cataract (n=17). Compared to group 1, group 3 had significantly longer diabetes duration (17.12±6.38 vs. 10.81±4.09 years; p=0.004) and marginally higher HbA1c (7.11±1.41 vs. 6.38±0.83%; p=0.057). Diastolic blood pressure (DBP) was also significantly higher (90.94±15.41 vs. 76.47±6.32 mmHg; p=0.002) while eGFR was significantly lower (53 ± 18 vs. 72 ± 12 ml/min- 11.73m-2; p=0.014). In logistic regression analysis, DBP (AOR=1.06, 95%CI 1.00-1.12, p=0.039) and eGFR (AOR=3.02, 95%CI 1.07-8.49, p=0.034) had a significant influence on cataract development even after adjustment for well-known risk factors HbA1c and duration of diabetes. The results of the study suggest a connection between renal function and cataract development in T2DM.Cilj istraživanja bio je istražiti utjecaj trajanja šećerne bolesti (ŠB), metaboličkih rizičnih čimbenika i bubrežne funkcije na razvoj katarakte u bolesnika sa šećernom bolešću tipa 2 (ŠB2). Ovo presječno istraživanje je uključilo 107 bolesnika sa ŠB2 (67 muškaraca/40 žena). Bubrežna funkcija je procijenjena određivanjem glomerularne filtracije (GF) i omjerom albumin/ kreatinin (A/K) u urinu. Bolesnici su prema LOCS III bili podijeljeni u tri skupine: sk. 1 - bolesnici s prozirnom očnom lećom (n=16), sk. 2 - bolesnici s početnom kataraktom (n=74) i sk. 3 - bolesnici s nezrelom kataraktom (n=17). Bolesnici u sk. 3 imali su značajno duže trajanje ŠB (17.12±6.38 vs. 10.81±4.09 godina; p=0.004) i granično viši HbA1c (7.11±1.41 vs. 6.38±0.83%; p=0.057) nego oni u sk. 1. Dijastolički krvni tlak (DKT) bio je značajno viši (90.94±15.41 vs. 76.47±6.32 mmHg; p=0.002), a procijenjena GF značajno niža (53±18 vs. 72±12 mlmin-11.73m-2; p=0.017) u sk. 3 nego u sk. 1. Logistička regresija je utvrdila da su DKT (AOR=1.06, 95%CI 1.00-1.12, p=0.039) i GF (AOR=3.02, 95%CI 1.07-8.49, p=0.034) povezani s razvojem katarakte u ŠB2 čak i nakon standardizacije rezultata za trajanje ŠB i HbA1c. Rezultati ovog istraživanja su pokazali da bubrežna funkcija ima važnu ulogu u razvoju katarakte u ŠB2

Obilježavanje stote godišnjice prve primjene inzulina

The year 2022 marked the one-hundredth anniversary of the first application of insulin. November 14th, the birth date of one of its main discoverers, Frederick Banting, was designated as World Diabetes Day. This paper comprises a narrative review of the history of the discovery of diabetes and insulin, progress in insulin development, important breakthroughs in insulin production and delivery, and a short commentary regarding potential future developments in insulin treatment. Diabetes, as one of the earliest recorded illnesses in medical writings, has been a focus of research for almost the entire written human history. Groundbreaking discoveries during the early 20th century have resulted in type 1 diabetes mellitus becoming a treatable, chronic condition. The relationship between good glycemic control and reduced occurrence of diabetes complications was established, which has enticed further development and refinements in insulin treatment, ranging from the purification and increased quality of insulin itself, as well as various inventions in its administration. Despite great achievements in insulin therapy so far, future research aims to avoid the need for subcutaneous administration and to create non-invasive means of insulin application.Godine 2022. obilježena je stota godišnjica prve primjene inzulina. Četrnaesti studenog, datum rođenja Fredericka Bantinga, jednog od izumitelja inzulina, proglašen je Svjetskim danom dijabetesa. U ovom radu pružamo narativni pregled povijesti otkrića šećerne bolesti i inzulina, napretka u razvoju inzulina, važnih otkrića u proizvodnji i isporuci inzulina te kratak komentar o potencijalnom budućem razvoju u inzulinskoj terapiji. Šećerna bolest, kao jedna od najranijih zabilježenih bolesti u medicinskim spisima, bila je tema istraživanja tijekom gotovo cijele pisane ljudske povijesti. Revolucionarna otkrića ranog 20. stoljeća dovela su do toga da šećerna bolest tip 1 postane lječivo, kronično stanje. Kada je utvrđen odnos između dobre kontrole glikemije i smanjene pojave komplikacija šećerne bolesti, potaknuti su daljnji razvoj i usavršavanje inzulinske terapije, uključujući pročišćavanje i unapređenje kvalitete samog inzulina, kao i razne izume u njegovoj primjeni. Unatoč velikim postignućima u inzulinskoj terapiji do sada, budućim istraživanjima cilj je izbjeći potrebu za potkožnom primjenom i stvoriti neinvazivne načine primjene inzulina

Glycemic Control in Diabetes Type 2 Patients in Foster Families of Brod-Posavina County During the COVID-19 Pandemic

COVID-19 pandemic has changed everyday life and medical supervision of chronically ill patients. Epidemiological measures, social distancing, and limited access to medical care impair glycemic control in patients with diabetes. Also, type 2 diabetes is a risk factor for more severe form of coronavirus disease. A large proportion of diabetic patients are placed in foster families who also adapt to the new situation. The purpose of this study was to examine the manner and frequency of glycemic control in patients with type 2 diabetes who are placed in foster families in the region of Brod- Posavina County. We established contact with patients suffering from type 2 diabetes situated in foster families and their caregivers. Measurement of glycemia was performed several times a day with regular notes and the data were supplemented by an insight into the medical documentation of patients in the hospital information system. The study included 33 patients with type 2 diabetes. The relationship between HbA1C with fasting and postprandial glycemia was linear. There were no statistically significant differences in HbA1C regulation by type of therapy. There was a significant difference in the number of complications according to the level of HbA1C (Hi square test = 25.982, p <.001). The number of complications generally increased as HbA1C regulation was poorer. During current COVID-19 pandemic, care for patients with type 2 diabetes is significantly limited. Improved medical care for patients can be achieved by establishing cooperation and daily communication between caregivers, family physicians and, if necessary, diabetologists, especially through the use of online platforms and telephone communication, all with the aim of early detection of diabetes complications and adequate treatment of patients in current conditions

Obilježavanje stote godišnjice prve primjene inzulina

The year 2022 marked the one-hundredth anniversary of the first application of insulin. November 14th, the birth date of one of its main discoverers, Frederick Banting, was designated as World Diabetes Day. This paper comprises a narrative review of the history of the discovery of diabetes and insulin, progress in insulin development, important breakthroughs in insulin production and delivery, and a short commentary regarding potential future developments in insulin treatment. Diabetes, as one of the earliest recorded illnesses in medical writings, has been a focus of research for almost the entire written human history. Groundbreaking discoveries during the early 20th century have resulted in type 1 diabetes mellitus becoming a treatable, chronic condition. The relationship between good glycemic control and reduced occurrence of diabetes complications was established, which has enticed further development and refinements in insulin treatment, ranging from the purification and increased quality of insulin itself, as well as various inventions in its administration. Despite great achievements in insulin therapy so far, future research aims to avoid the need for subcutaneous administration and to create non-invasive means of insulin application.Godine 2022. obilježena je stota godišnjica prve primjene inzulina. Četrnaesti studenog, datum rođenja Fredericka Bantinga, jednog od izumitelja inzulina, proglašen je Svjetskim danom dijabetesa. U ovom radu pružamo narativni pregled povijesti otkrića šećerne bolesti i inzulina, napretka u razvoju inzulina, važnih otkrića u proizvodnji i isporuci inzulina te kratak komentar o potencijalnom budućem razvoju u inzulinskoj terapiji. Šećerna bolest, kao jedna od najranijih zabilježenih bolesti u medicinskim spisima, bila je tema istraživanja tijekom gotovo cijele pisane ljudske povijesti. Revolucionarna otkrića ranog 20. stoljeća dovela su do toga da šećerna bolest tip 1 postane lječivo, kronično stanje. Kada je utvrđen odnos između dobre kontrole glikemije i smanjene pojave komplikacija šećerne bolesti, potaknuti su daljnji razvoj i usavršavanje inzulinske terapije, uključujući pročišćavanje i unapređenje kvalitete samog inzulina, kao i razne izume u njegovoj primjeni. Unatoč velikim postignućima u inzulinskoj terapiji do sada, budućim istraživanjima cilj je izbjeći potrebu za potkožnom primjenom i stvoriti neinvazivne načine primjene inzulina