Gestacijski dijabetes (GDM) najčešći je metabolički poremećaj u trudnica povezan s neželjenim ishodima trudnoće i dugoročnim zdravstvenim rizicima za majke i njihovo potomstvo. Prevalencija GDM-a u ...svijetu raste zbog epidemije debljine, sve starije dobi trudnica i strožih dijagnostičkih kriterija. Promjena životnog stila temeljena na uravnoteženoj prehrani i prirast tjelesne mase unutar poželjnih okvira imaju vodeću ulogu u liječenju GDM-a. Ako glikemijske ciljeve nije moguće ostvariti samo dijetom, indicirana je terapija inzulinom s obzirom na to da za oralne antihiperglikemike još nema dovoljno podataka o dugoročnoj sigurnosti. Budući da žene s GDM-om imaju doživotni rizik za razvoj šećerne bolesti tipa 2, potrebno je redovito praćenje i probir na šećernu bolest 4 do 12 tjedana nakon poroda te potom svake 1 do 3 godine. Cilj ovog članka je prikazati novosti u liječenju gestacijskog dijabetesa.
Gestational diabetes (GDM) is the most common metabolic disorder in pregnant women associated with adverse pregnancy outcomes and long-term maternal and offspring health risks. Worldwide GDM prevalence is increasing in the setting of the obesity epidemic, advanced maternal age, and tighter diagnostic criteria. Lifestyle interventions that promote healthy eating behaviours and healthy weight gain play a key role in the management of GDM. If glycemic targets are not achieved with diet alone, insulin therapy is recommended since oral antihyperglycemic agents lack long-term safety data. Because GDM is associated with an increased lifetime maternal risk for type 2 diabetes women should be followed up regularly and screened for diabetes 4- to 12-weeks postpartum and every 1–3 years thereafter. The aim of this article is to present an update on treatment of gestational diabetes.
Kortikosteroidi izazivaju pojavu steroidnog oblika šećerne bolesti mnogobrojnim mehanizmima. Kortikosteroidi povećavaju otpornost na inzulin u stanicama jetre i stanicama drugih tkiva kao što su ...masno i mišićno tkivo. Imaju štetno djelovanje na beta-stanice gušterače, smanjenja unosa glukoze u stanice i indukcije apoptoze. Čimbenici rizika za razvoj steroidne šećerne bolesti su doza i dugotrajnost primjene kortikosteroida, dob, obiteljska anamneza šećerne bolesti, debljina, rasa i prethodno postojanje šećerne bolesti. Pristup pacijentima sa steroidnom šećernom bolešću je dijeta, tjelovježba i samokontrola glukoze u plazmi. Ako glikemija natašte ili nakon obroka naraste preko 11,1 mmol/l preporučena je primjena inzulina.
Metabolic syndrome (MetS) is a chronic, multi-component disease characterised by central obesity, hyperglycaemia, dyslipidaemia, and hypertension. Since MetS leads to type 2 diabetes, cardiovascular ...disease, development of certain cancers, and eventually to premature death, it is not surprising that it draws the attention of scientists around the world. The aetiopathology of MetS is complex and still not fully understood. This review focuses on the role of endocrine factors such as cortisol and insulin in the development of MetS. It also takes a look at some of the contributing lifestyle and genetic factors as well as at the current knowledge about its treatment.
Metabolički sindrom (MetS) kronična je višekomponentna bolest, koju karakteriziraju abdominalna debljina, hiperglikemija, dislipidemija i hipertenzija. Kako MetS dovodi do razvoja šećerne bolesti tipa 2, kardiovaskularnih i nekih malignih bolesti te posljedično do prerane smrti, ne čudi da MetS privlači pozornost znanstvenika diljem svijeta. Etiopatologija MetSa je kompleksna te još nije u potpunosti razjašnjena. Cilj je ovoga rada dati literaturni pregled uloge nekih endokrinih poremećaja, kao što su poremećaj kortizola i inzulina, u razvoju MetSa. Također, razmatrani su i neki faktori načina života/životnog stila te genetički faktori koji pridonose razvoju MetSa. Na kraju su spomenuta trenutačna saznanja u liječenju MetSa i njegovih komponenti.
Sindrom policističnih jajnika Pentz, Ivana
Medicus (Zagreb, Croatia : 1992),
06/2010, Letnik:
19, Številka:
1_Adolescencija_2
Journal Article
Recenzirano
Odprti dostop
Sindrom policističnih jajnika (PCOS) endokrinološki je poremećaj karakteriziran kroničnom anovulacijom, kliničkim i/ili biokemijskim hiperandrogenizmom i/ili policističnim izgledom jajnika. Većinom ...se smatra da je hiperandrogenemija glavna karakteristika PCOS-a. Više je teorija o nastanku PCOS- -a. Zadnjih 20-ak godina više je dokaza da je defekt inzulinskog djelovanja ključan u patogenezi ovog sindroma. Većina žena s ovim sindromom ima inzulinsku rezistenciju, što zbog genetske predispozicije što zbog debljine. Učestalost PCOS-a iznosi 15 do 25% i češća je u adolescentica, oko 25%. Za dijagnozu PCOS-a potrebna su dva od tri gore navedena kriterija. Uz anamnezu i fizikalni pregled, rade se biokemijski testovi te ultrazvučni pregled jajnika. Liječenje PCOS-a ovisi o dobi pacijentice, simptomima i znakovima ovog sindroma te reprodukcijskim željama. U tu svrhu daju se hormonski pripravci, inzulin-senzitirajući lijekovi i kirurško liječenje. Međutim, prva je mjera zdrav način života i smanjenje tjelesne težine pretilih pacijentica kojom se u kombinaciji s ostalim terapijskim postupcima postiže optimalan učinak liječenja, smanjuje rizik od razvoja nekih carcinoma i osigurava kvalitetan život.
Insulin resistance, defined as a reduced biological action of insulin, has emerged as a major factor in the development and progression of a number of common non-communicable diseases in man. The ...role of insulin resistance in the aetiology of type 2 diabetes is particularly well-established. However, insulin resistance has also come to be regarded as a key component of a broader syndrome of common metabolic defects that conspire to increase the risk of atherosclerotic coronary heart disease. The ramifications of insulin resistance now embrace many different medical specialties.
The objective of this book is to summarize the current state of knowledge about insulin resistance. Section 1 (Pathophysiology of Insulin Resistance) considers the development of current concepts of insulin resistance. This is followed by a critical review of techniques for the assessment of insulin action in humans. The section concludes with an outline of current hypotheses concerning the molecular defects responsible for insulin resistance. Section 2 (Insulin Resistance in Clinical Medicine) broadens the discussion to include physiological and pathological conditions with which insulin resistance is associated; the effects of drug treatment on insulin sensitivity are also considered. Section 3 (Management of Insulin Resistance and Associated Conditions) focuses on the avoidance and treatment of insulin resistance in its clinical manifestations. A discussion of the potential benefits of non-pharmacological measures prefaces a review of the range of drugs used in the treatment of type 2 diabetes and related disorders. References are confined to key articles at the end of each section.
Improved nutrition allied to increased levels of physical exercise are of crucial importance in the battle to stem the increasing incidence and prevalence of insulin resistance; however, translation of such advice into action has proved difficult in practice. Thus, other approaches have been explored. Recent years have witnessed considerable progress in the pharmacological management of insulin resistance. In particular, the thiazolidinediones (and other insulin-sensitizing drugs) appear to provide a more specific assault on insulin-resistance. Clinical experience with these agents remains relatively limited and serious hepatotoxicity has clouded the first agent in this class - troglitazone. With its introduction into the USA in 1995 and driven by the publication of the United Kingdom Prospective Diabetes Study, metformin has enjoyed a renaissance. This well-established agent is finding application for new clinical indications. In parallel, the development of anti-obesity drugs continues apace. The molecular and genetic mechanisms underlying some forms of insulin resistance are being revealed.
Original intellectual concepts such as the fetal origins hypothesis are challenging traditional views about the aetiology of insulin resistance and its clinical sequelae. These exciting scientific advances notwithstanding, the evolving global epidemic of obesity and type 2 diabetes represents an enormous public health challenge. Now more than ever, research must focus on identifying solutions that are applicable on the level of entire populations. By definition, these must also be practical and cost-effective.
Inzulinová léčba je základním terapeutickým přístupem u diabetiků 1. typu a také u řady diabetiků 2. typu zejména s delším trváním onemocnění. U pacientů s diabetem 2. typu je však inzulinová terapie ...často zahajována později, než by bylo optimální, což je mimo jiné dáno také suboptimálními farmakokinetickými vlastnostmi dostupných inzulinů. Stále proto pokračuje vývoj nových inzulinů, jejichž charakteristiky by byly výhodnější než inzulinů v současné době používaných. Cílem tohoto článku je shrnout stávající poznatky týkající se nových inzulinů, které byly nedávno uvedeny na trh nebo se uvedení na trh přibližují. Zaměříme se rovněž na perspektivy inzulinové terapie v dlouhodobém horizontu včetně alternativních možností aplikace inzulinu mimo jeho klasické podávání subkutánní injekcí. Klíčová slova: alternativní možnosti aplikace inzulinu – diabetes mellitus – hypoglykemie – inzulin – inzulinová analoga
Insulin therapy is a therapeutic cornerstone in patients with type 1 diabetes and also in numerous patients with type 2 diabetes especially with longer history of diabetes. The initiation of insulin therapy in type 2 diabetes patients is often delayed which is at least partially due to suboptimal pharmacokinetic characteristics of available insulins. The development of novel insulins with more favorable characteristics than those of current insulins is therefore still ongoing. The aim of this paper is to review current knowledge of novel insulins that have been recently introduced to the market or are getting close to routine clinical use. We will also focus on the perspectives of insulin therapy in the long-term run including the alternative routes of insulin administration beyond its classical subcutaneous injection treatment. Key words: alternative routes of insulin administration – diabetes mellitus – hypoglycemia – insulin – insulin analogues
Martin Haluzík
Tip 1 šećerna bolest u dječjoj dobi Severinski, Srećko; Butorac Ahel, Ivona; Božinović, Ivana
Medicina fluminensis,
12/2016, Letnik:
52., Številka:
4.
Journal Article
Recenzirano
Odprti dostop
Tip 1 šećerna bolest (ŠB) je najčešća endokrinološka bolest dječje dobi. Karakterizirana je deficitom inzulina koji nastaje zbog autoimunog uništenja β stanica gušterače. Javlja se u genetski ...predisponiranih osoba, a može biti potaknuta provocirajućim čimbenicima iz okoliša. Incidencija tip 1 ŠB u djece je u porastu, u prvom redu u djece mlađe od 5 godina. Znakovi i simptomi bolesti se razvijaju brzo, obično u periodu kroz nekoliko tjedana. Tipični simptomi su poliurija, polidipsija, polifagija i gubitak na tjelesnoj težini. U nekih pacijenata inicijalni simptom početka tip 1 ŠB je dijabetička ketoacidoza, po život opasno metaboličko stanje. Liječenje tip 1 ŠB tijekom djetinjstva i adolescencije je kompleksno i zahtjevno. Osnova liječenja bolesnika s tip 1 ŠB je inzulin. Postoji više različitih pripravaka inzulina i načina aplikacije inzulina. Intenzivirana terapija inzulinom u usporedbi s konvencionalnom terapijom poboljšava kontrolu glikemije i smanjuje dugoročne komplikacije ŠB. Važna komponenta u liječenju djece s tip 1 ŠB je pravilna prehrana. Glavni terapijski cilj je dobra kontrola glikemije (glikolizirani hemoglobin <7.5%) kako bi se spriječile kratkoročne i dugoročne komplikacije bolesti. Najčešće komplikacije bolesti u djece su hipoglikemija, hiperglikemija i dijabetička ketoacidoza.
Úvod: Projekt PROROK (Prospektivní observační projekt významu diference glykemie nalačno a postprandiální glykemie pro odhad úspěšnosti terapie diabetu 2. typu) měl charakter neintervenčního, ...prospektivního, multicentrického observačního projektu s délkou trvání 6 měsíců, jehož cílem byla kvantifikace významu rozdílu mezi glykemií nalačno a postprandiálně pro úspěšnost léčby agonisty pro GLP1 resp. léčby inzulinem bazálním, premixovaným, nebo kombinací bazálního a bolusového inzulinu. Lékaři vybírali léčbu pro neuspokojivě kompenzované pacienty dle vlastního uvážení, zařazeno bylo celkem 4 972 pacientů. Cíl: Cílem práce bylo zhodnocení rozdílů v základních antropometrických a biochemických parametrech mezi skupinami pacientů zařazených do projektu PROROK se zřetelem k volbě terapie ošetřujícím diabetologem. Metodika a výsledky: Pacienti léčení agonisty receptoru GLP1 byli významně mladší, trpí diabetem kratší dobu a zároveň byli obéznější a měli nejvyšší koncentraci triacylglycerolů. Pacienti, u nichž byla volena terapie bazálním inzulinem, měli nejvyšší glykemii nalačno. Pacienti, u nichž byla volena terapie premixovaným inzulinem nebo režimem bazálního a bolusového inzulinu, měli nejvyšší glykemii postprandiálně, pacienti s režimem bazálního a bolusového inzulinu měli nejvyšší vstupní glykovaný hemoglobin. Rozdíl mezi glykemií nalačno a postprandiálně byl nejmenší ve skupině, u níž byla volena terapie bazálním inzulinem a nejvyšší ve skupině vybrané k terapii premixovaným inzulinem resp. kombinací bazálního a bolusového inzulinu. Průměrné zlepšení glykovaného hemoglobinu bylo v celém souboru 1,6 %, medián výsledného glykovaného hemoglobinu byl 5,9 % resp. 5,8 % (léčení agonisty receptoru pro GLP1). Všechny rozdíly p < 0,001. Závěr: Při vědomí skutečnosti, že rozdíly nalezené v parametrech popisujících soubory jsou sice statisticky významné, ale klinicky jsou méně relevantní, považujeme za důležitou skutečnost, že výběr terapie je v konkordanci se základními poznatky o patofyziologii diabetu 2. typu a možnostmi individuálně volené cílené intervence antidiabetickou terapií. Lékaři účastnící se v projektu PROROK tedy volí většinou terapii racionálně.
Introduction: The PROROK project (A prospective observation project to assess the relevance of the difference between fasting glycemia and postprandial glycemia to estimation of success of type 2 diabetes therapy) had a character of a non-interventional, prospective, multicentric observation project conducted for a period of 6 months, whose aim was to quantify the relevance of the difference between fasting and postprandial glycemia to the success of GLP1 receptor agonist treatment, or insulin therapy with basal or premixed insulin, or a combination of basal and bolus insulin. Physicians chose therapy for inadequately compensated patients at their own discretion, with 4 972 patients included. Aim: The study aimed at the assessment of the differences in basic anthropometric and biochemical parameters between the patient cohorts included in the PROROK project with regard to the therapy selected by the treating diabetologist. Methodology and results: The patients treated with GLP1 receptor agonists were quite young, they have suffered from diabetes for a shorter period of time and at the same time were more obese and had the highest concentration of triacylglycerols. The patients who underwent basal insulin therapy, had the highest fasting glycemia. The patients for whom premixed insulin therapy or basal/bolus insulin regimen were chosen, manifested the highest postprandial glycemia, those with basal/bolus insulin regimen had the highest initial glycated haemoglobin. The difference between fasting and postprandial glycemia was the smallest in the cohort for which basal insulin therapy was chosen and the greatest in the cohort chosen for the therapy with premixed insulin, or with the basal/bolus insulin combination. Average improvement in glycated haemoglobin values reached 1.6 % within the whole cohort, a median of the resulting glycated haemoglobin reached 5.9 % or 5.8 % (GLP1 receptor agonist treatment). All the differences amounted to p < 0.001. Conclusion: Bearing in mind that the differences established in the parameters describing the cohorts, although statistically relevant, are of smaller clinical relevance, we regard as an important finding that the choice of therapy is in accordance with the basic knowledge about the pathophysiology of type 2 diabetes and possibilities of an individually chosen targeted intervention with antidiabetic therapy. We may conclude that most of the physicians participating in the PROROK project choose their therapy in a rational manner.
Denisa Janíčková Žďarská, Pavlína Piťhová, Tomáš Pavlík, Milan Kvapil
Pozadina istraživanja. Primjena biljaka i njihovih ekstrakata u liječenju kroničnih bolesti nadaleko je poznata u tradicionalnoj medicini. Svrha je ovoga rada bila utvrditi utjecaj desetodnevne ...konzumacije ekstrakta cvijeta trnine na koncentraciju glukoze u krvi, glikemijsko opterećenje, aktivnost α-amilaze i koncentraciju inzulina u serumu normoglikemijskih i hiperglikemijskih (induciranih aloksanom) miševa.
Eksperimentalni pristup. Normoglikemijski i hiperglikemijski (inducirani s 150 mg aloksana po kg tjelesne mase) C57BL/6 miševi tretirani su tijekom 10 dana ekstraktom cvijeta trnine. Koncentracija šećera u ekstraktu određena je HPLC analizom, a koncentracija glukoze u krvi i oralna podnošljivost glukoze (oralni glukoza tolerans test) ispitane su glukometrom. Koncentracija inzulina u serumu određena je ELISA testom, a aktivnost α-amilaze kolorimetrijskom metodom.
Rezultati i zaključci. Ekstrakt cvijeta trnine povećao je koncentraciju glukoze u krvi u normoglikemijskom mišu za 30 % nakon prvog i petog dana, te za 17 % nakon desetog dana konzumacije. To je bila posljedica prisustva slobodnih šećera, što je potvrđeno analizom njihovog sastava, kojom je utvrđeno da ekstrakt sadržava 59,8 mg/L monosaharida, uglavnom fruktoze (55,7 mg/L) i glukoze (24,3 mg/L). Suprotno tome, tretman ekstraktom cvijeta trnine je nakon 10 dana smanjio koncentraciju glukoze u krvi hiperglikemijskog miša za 29 %. Oralni glukoza tolerans test potvrdio je da se u hiperglikemijskoj skupini tretiranoj ekstraktom poboljšala podnošljivost glukoze te da je brže uspostavljena njezina homeostaza. Koncentracija inzulina u serumu povećala se za 49 %, a aktivnost α-amilaze za 46 % nakon desetodnevnog tretmana hiperglikemijske skupine ekstraktom cvijeta trnine. Može se zaključiti da ekstrakt cvijeta trnine poboljšava podnošljivost glukoze, potiče lučenje inzulina te smanjuje aktivnost serumske α-amilaze.
Novina i znanstveni doprinos. Dobiveni rezultati prvi put pokazuju mogućnost primjene ekstrakta cvijeta trnine u regulaciji hiperglikemije.
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