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

The Prevalence of Depression and Anxiety in Seafarers Type 2 Diabetic Patients

Depression and anxiety are co-morbid condition in diabetes as disease-related psychological reactions on this chronic metabolic illness. This study was aimed to determine the occurrence of depression and anxiety in seafarer’s type 2 diabetic patients. A random sample of 52 diabetic seafarers treated with diet and oral glucose lowering agents, and 56 healthy seafarers were screened for depression with The Beck Depression Inventory (BDI) and for anxiety with State- -Trait Anxiety Inventory (STAI 1, STAI 2). Depression (BDI>18.5) and anxiety (STAI<28.5) was significantly higher in the group of diabetic seafarers than in control group (more than 30%). Significant correlation was noted between depression and duration of diabetes mellitus, degree of obesity and poor glycaemic control (HbA1C>8%) and longer duration of shipping routes (over 6 months). The proportion of depression and anxiety was found higher in seafarer’s type 2 diabetic patients than in the healthy seafarers

The Role of Inflammation and Endothelial Dysfunction in the Pathogenesis of Diabetic Retinopathy

The pathogenesis of diabetic retinopathy (DR) is insufficiently understood and presumed to possibly involve inflammation and endothelial dysfunction. The aim of the study was to investigate the relationship between inflammation markers, other markers of endothelial dysfunction and anthropometric parameters and their association with DR in patients with type 2 diabetes, divided into three groups: no retinopathy (N=65), mild / moderate nonproliferative diabetic retinopathy (NPDR; N=19) and severe NPDR / proliferative diabetic retinopathy (PDR; N=23). The groups did not differ in the levels of inflammation markers, other markers of endothelial dysfunction and anthropometric parameters. C-reactive protein was correlated with fibrinogen, HbA1c, LDL-cholesterol, BMI, WC, WHR and C index. HbA1c was correlated with cholesterol, LDL-cholesterol, BMI and WC. Logistic regression analysis showed that diabetes duration and HbA1cmedian were the main predictors of retinopathy. The study demonstrated that the association between obesity, inflammation and other risk factors plays an important role in endothelial impairment involved in the pathogenesis of DR

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

Krvni tlak je povezan s dijabetičkom retinopatijom kod bolesnika s tipom 1, ali ne i kod tipa 2 šećerne bolesti

The aim of this study was to investigate the role of systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the development of diabetic retinopathy (DR) in type 1 and type 2 diabetes and to determine the differences between these two types of diabetes. This cross-sectional study included 84 patients with type 1 diabetes (T1DM) and 107 patients with type 2 diabetes (T2DM). Ophthalmologic retinal examination included indirect slit-lamp fundoscopy, color fundus photography according to EURODIAB (EUROpe and DIABetes) protocol and optical coherence tomography. Blood pressure was measured with a mercury sphygmomanometer after a 10-minute rest period. In T1DM, DR was positively associated with SBP (p = 0.035), HbA1cmedian (p < 0.001) and hypertensive retinopathy (p < 0.001), while in T2DM DR was positively related only to HbA1cmedian (p = 0.021). Binary logistic regression analysis (no DR/DR) showed that diabetes duration and HbA1cmedian were the main predictors of DR in both types of diabetes. In contrast, SBP (OR = 1.05, p = 0.045) and hypertensive retinopathy (OR = 3.75, p < 0.001) were the main predictors/indicators of DR only in T1DM. In conclusion, blood pressure is associated with DR in type 1 but not in type 2 diabetes.Cilj ovog istraživanja bio je istražiti povezanost sistoličkog krvnog tlaka (SKT) i dijastoličkog krvnog tlaka (DKT) te dijabetičke retinopatije (DR) kod šećerne bolesti tipa 1 i tipa 2 te utvrditi razlike između ova dva tipa šećerne bolesti. Ova presječna studija uključila je 84 bolesnika sa šećernom bolešću tipa 1 (ŠB1) i 107 bolesnika sa šećernom bolešću tipa 2 (ŠB2). Oftalmološki pregled uključivao je neizravnu fundoskopiju, fotografiju fundusa u boji prema EURODIAB (EUROpe and DIABetes) protokolu i optičku koherentnu tomografiju. Krvni tlak izmjeren je živinim tlakomjerom nakon 10-minutnog mirovanja. Kod ŠB1 DR je bila pozitivno povezana sa SKT (p = 0,035), HbA1cmedijanom (p < 0,001) i hipertenzivnom retinopatijom (p < 0,001), dok je u ŠB2 DR bila pozitivno povezana samo s HbA1cmedijanom (p = 0,021). Analiza binarne logističke regresije (bez i sa DR) pokazala je da su trajanje šećerne bolesti i HbA1cmedijan glavni prediktori DR u oba tipa šećerne bolesti. Međutim, SKT (OR = 1,05, p = 0,045) i hipertenzivna retinopatija (OR = 3,75, p < 0,001) bili su glavni prediktori/indikatori DR samo u ŠB1. Zaključno, krvni tlak je povezan s DR kod tipa 1, ali ne i kod tipa 2 šećerne bolesti

The Prevalence of Depression and Anxiety in Seafarers Type 2 Diabetic Patients

Depression and anxiety are co-morbid condition in diabetes as disease-related psychological reactions on this chronic metabolic illness. This study was aimed to determine the occurrence of depression and anxiety in seafarer’s type 2 diabetic patients. A random sample of 52 diabetic seafarers treated with diet and oral glucose lowering agents, and 56 healthy seafarers were screened for depression with The Beck Depression Inventory (BDI) and for anxiety with State- -Trait Anxiety Inventory (STAI 1, STAI 2). Depression (BDI>18.5) and anxiety (STAI<28.5) was significantly higher in the group of diabetic seafarers than in control group (more than 30%). Significant correlation was noted between depression and duration of diabetes mellitus, degree of obesity and poor glycaemic control (HbA1C>8%) and longer duration of shipping routes (over 6 months). The proportion of depression and anxiety was found higher in seafarer’s type 2 diabetic patients than in the healthy seafarers

Dijabetički makularni edem: tradicionalni i novi pristup liječenju

Diabetes is one of the leading public health problems worldwide. Diabetic macular edema (DME) is the main cause of vision loss in patients with diabetes. Ideal metabolic control of diabetes is the primary goal of treatment and the basic way of preventing and stopping the progression of DME. Although laser photocoagulation has been the standard treatment of DME for nearly three decades, superior outcomes can be achieved with novel, intravitreal anti-VEGF and steroid therapy. Novel treatment option for DME depends on visual acuity and location/extent of macular thickening based on optical coherence tomography scans. According to the International Clinical Classification Scale, DME is divided into no center-involving DME and center-involving DME (CI-DME). New guidelines recommend intravitreal treatment as the treatment of choice for patients with CI-DME and moderate visual impairment. Patients with no CI-DME and mild visual impairment should be treated with modified ETDRS laser photocoagulation and closely observed. Vitrectomy is the treatment of choice for patients with a tractional component of DME. Nowadays, traditional treatment goal of preventing blindness in patients with DME has been changed by the new goal aiming to restore impaired vision, prevent further vision loss and improve visual function. Therefore, many trials addressing this new concept have been underway worldwide.Dijabetes je jedan od vodećih svjetskih javnozdravstvenih problema. Dijabetički makularni edem (DME) je glavni uzrok sljepoće u osoba oboljelih od dijabetesa. Idealna metabolička regulacija bolesti je primarni cilj liječenja i osnovni način sprječavanja i zaustavljanja progresije DME-a. Iako je laserska fotokoagulacija u posljednja tri desetljeća smatrana standardnim načinom liječenja DME-a, bolji ishod moguće je postići primjenom nove intravitrealne anti-VEGF ili steroidne terapije. Novi pristup liječenju DME-a ovisi o vidnoj oštrini i smještaju/veličini makularnog zadebljanja utvrđenog optičkom koherentnom tomografijom. Prema Međunarodnoj kliničkoj klasifikaciji DME se dijeli na DME koji ne zahvaća centar makule (ne CI-DME) i DME sa zahvaćenim centrom (CI-DME). Nove smjernice preporučuju intravitrealno liječenje kao prvi izbor liječenja za bolesnike s CI-DME i umjerenim padom vidne oštrine, dok bolesnike s ne CI-DME i blagim padom vidne oštrine treba liječiti modificiranom ETDRS laserskom fotokoagulacijom i pažljivo pratiti. Operativni zahvat vitrektomija izbor je liječenja bolesnika s trakcijski izazvanim DME-om. U današnje vrijeme je sprječavanje sljepoće kao tradicionalni cilj liječenja DME-a zamijenjen novim ciljevima, a to su oporavak oštećene vidne oštrine, sprječavanje daljnjeg slabljenja vida i poboljšanje vidne funkcije pa se danas u tu svrhu provode brojna znanstvena i klinička istraživanja širom svijeta

Validation of Point-of-Care Glucose Testing for Diagnosis of Type 2 Diabetes

Point-of-care (POC) glucose technology is currently considered to be insufficiently accurate for the diagnosis of diabetes. The objective of this study was to investigate the diagnostic accuracy of an innovative, interference-resistant POC glucose meter (StatStrip glucose hospital meter, Nova Biomedical, USA) in subjects with a previous history of dysglycaemia, undergoing a 75 g diagnostic oral glucose tolerance test (oGTT). Venous and capillary blood sampling for the reference laboratory procedure (RLP) and POC-glucose measurement was carried out at fasting and 2 h oGTT, and categories of glucose tolerance were classified according to 2006 WHO diagnostic criteria for the respective sample type. We found an excellent between-method correlation at fasting (r=0.9681, P<0.0001) and 2 h oGTT (r=0.9768, P<0.0001) and an almost perfect diagnostic agreement (weighted Kappa = 0.858). Within a total of 237 study subjects, 137 were diagnosed with diabetes with RLP, and only 6 of them were reclassified as having glucose intolerance with POC. The diagnostic performance of POC-fasting glucose in discriminating between the normal and any category of disturbed glucose tolerance did not differ from the RLP (P=0.081). Results of this study indicate that StatStrip POC glucose meter could serve as a reliable tool for the diabetes diagnosis, particularly in primary healthcare facilities with dispersed blood sampling services

Diabetic Macular Edema: Traditional and Novel Treatment

Diabetes is one of the leading public health problems worldwide. Diabetic macular edema (DME) is the main cause of vision loss in patients with diabetes. Ideal metabolic control of diabetes is the primary goal of treatment and the basic way of preventing and stopping the progression of DME. Although laser photocoagulation has been the standard treatment of DME for nearly three decades, superior outcomes can be achieved with novel, intravitreal anti-VEGF and steroid therapy. Novel treatment option for DME depends on visual acuity and location/extent of macular thickening based on optical coherence tomography scans. According to the International Clinical Classification Scale, DME is divided into no center-involving DME and center-involving DME (CI-DME). New guidelines recommend intravitreal treatment as the treatment of choice for patients with CI-DME and moderate visual impairment. Patients with no CI-DME and mild visual impairment should be treated with modified ETDRS laser photocoagulation and closely observed. Vitrectomy is the treatment of choice for patients with a tractional component of DME. Nowadays, traditional treatment goal of preventing blindness in patients with DME has been changed by the new goal aiming to restore impaired vision, prevent further vision loss and improve visual function. Therefore, many trials addressing this new concept have been underway worldwide