Diabetic gastroparesis (DGP), a delay in gastric emptying without obstruction to outflow as a complication of diabetes, typically develops after at least 10 years of diabetes. Cardinal symptoms ...include nausea, vomiting, early satiety, bloating, and upper abdominal pain. The aim of DGP treatment is to alleviate the severity and frequency of symptoms, improve the level of gastric emptying, ameliorate the patient's nutritional status and to optimize glycemic control. In the treatment of chronic drug-refractory nausea and vomiting secondary to DGP, gastric electrical stimulation (GES) such as Enterra Therapy System (Medtronic Inc., Minneapolis, MN, USA) can be considered. It is well established that diabetic nephropathy is the most common cause of end-stage renal disease (ESRD) requiring renal replacement therapy. The exact prevalence of patients with severe DGP and ESRD is not known; however, finding a therapeutic approach to these patients, particularly those whose gastroparesis symptoms preclude them from undergoing kidney transplant procedure, represents a huge challenge. Our experience suggests that GES implantation can be an effective treatment modality for type 1 diabetic patients on peritoneal dialysis (PD) who are simultaneous pancreas-kidney transplantation candidates, by improving the severity and frequency of gastroparesis symptoms and eventually ensuring their optimal nutritional and fluid intake.
Hitna stanja u endokrinologiji predstavljaju skupinu po život opasnih stanja koja često,
unatoč dijagnostičkim i terapijskim dostignućima suvremene medicine, i dalje ostaju često
neprepoznata. ...Nepravovremena dijagnoza i odgođeni početak liječenja dodatno pridonose
ionako visokoj smrtnosti koja karakterizira ova stanja. Iako se najčešće javljaju u osoba
s otprije poznatim endokrinopatijama, hitno stanje može biti i prva manifestacija bolesti endokrinog
sustava, što dodatno otežava pravovremeno postavljanje dijagnoze. U ovom preglednom
članku iznosimo prikaz najčešćih hitnih stanja u endokrinologiji i dijabetologiji u
okrilju medicine zasnovane na dokazima. Dijabetička ketoacidoza (DKA) i hiperglikemijsko
hiperosmolarno stanje (HHS) dvije su najčešće akutne komplikacije šećerne bolesti koje
ujedno predstavljaju i najčešća hitna stanja u endokrinologiji. Tireotoksična kriza, miksedemska
koma i adrenalna kriza nisu stanja s kojima se često susrećemo u kliničkoj praksi, no
važno je prepoznati ih na vrijeme i započeti sa specifičnim liječenjem jer u protivnom rezultiraju
ozbiljnim komplikacijama i visokom smrtnošću. Poznavajući činjenicu da su hitna stanja
u endokrinologiji često posljedica drugih bolesti ili stanja, sve precipitirajuće poremećaje
treba prepoznati i liječiti.
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.
Obesity remains a tremendous public health, clinical, and scientific challenge globally. Conventional approaches in the management of obesity offer limited potential for sustained weight loss. ...Bariatric surgery, although it represents the most effective weight loss treatment, has its own risks and is associated with substantial costs and limited patient applicability. Endoscopic weight loss procedures are considered as the major breakthrough in the management of obesity. Endoluminal interventions performed entirely through the gastrointestinal tract have evolved as a result of an attempt to replicate some of the anatomical features and the physiological effects of the traditional weight loss surgery while being reversible, less invasive, and more cost-effective. Restrictive procedures act to decrease gastric volume by space-occupying devices and/or by suturing or stapling techniques that alter gastric anatomy, whereas malabsorptive procedures tend to create malabsorption by preventing food contact with the duodenum and proximal jejunum. Other procedures act by influencing gastric function (gastric botulinum injections, gastric pacing, and vagal nerve blocking) or by gastric aspiration. It is important to underline that the majority of endoscopic weight loss procedures are still being evaluated and are not yet available routinely. Even though some of the techniques and devices that have recently emerged have demonstrated promising short-term results, evidence on their safety and long-term efficacy from well-designed and well-conducted research should be given before they can become an inherent part of everyday clinical practice. Given the rapid development of endoscopic weight loss procedures, this review considers the current state and recent trends in endoscopic management of obesity.
Over the last few decades obesity has become a major health issue worldwide. Although dietary and lifestyle changes are the cornerstone of obesity management, it still poses a huge challenge for the ...majority of patients to permanently change their eating habits. Bariatric endoscopy represents an evolving filed of minimally invasive techniques and procedures for weight loss trying to respond to these challenges by developing new methods with the increasing role of endoscopists in the management of obesity. Areas covered: The aim of this article is to review the role and the advantages of bariatric endoscopy in the management of obesity by providing a comprehensive reference source and evaluating the currently available and emerging endoscopic devices and techniques for weight loss. Expert commentary: Endoscopic methods for weight loss represent a useful armamentarium in the management of obesity by providing improved effectiveness compared with medications, with a lower risk profile than traditional bariatric surgery. Although preliminary results of recently introduced methods are encouraging, many questions remain regarding the safety and efficacy of such interventions. Combining scientific background with advancements in technology is the key strategy for the further development of bariatric endoscopy.
This observational study aimed to assess the effectiveness of lixisenatide as add on therapy to basal insulin in diabetic type 2 patients previously treated with different insulin regimes.
Patients ...with diabetes type 2, prescribed with lixisenatide and basal insulin were divided in three groups (premixed insulin, basal bolus insulin and basal oral therapy (BOT). Difference in mean change in HbA1c, body mass index, total insulin doses, fasting blood glucose (FPG) and prandial blood glucose (PPG) were assessed after 3-6-months of follow-up.
The primary outcomes were assessed in 111 patients. Lixisenatide added to basal insulin, reduced HbA1c and body weight significantly in all three groups of patients (p < 0.001 for all), with the most prominent reduction in the basal bolus group of patients which had the highest baseline HbA1c compared to premix and BOT treatment groups. Regarding a difference in total insulin dose the reduction was statistically significant in the basal bolus (p = 0.006) and premix group (p < 0.001). FPG and PPG were also significantly reduced over time in all three groups (p < 0.001 for all). A composite outcome (reduction of HbA1c below 7% (53 mmol/mol) with any weight loss) was achieved in 27% of total patients included in the study, reduction of HbA1c below 7% was observed in 30% of patients, while 90% of patients experienced weight reduction.
These results indicate that lixisenatide add on basal insulin treatment (BIT) can improve glycemic control in a population with long-standing type 2 diabetes and previously uncontrolled on other insulin therapy.
In this study, we investigated the effectiveness of FreeStyle Libre Flash Glucose Monitoring (FGM) implementation in a real life clinical setting with the emphasis on the effect of initial education ...on the use of the FGM system.
This prospective observational study included 425 diabetes type 1 subjects followed up for 3 to 12 months (320 were followed up to 3 months, 267 up to 6 months and 147 up to period of one year). An FGM sensor was placed at study entry and all participants were educated through a period of 5 days on sensor usage and self-management of glycemia with follow up visits every 3 months.
HbA1c values significantly decreased from baseline (T0) to 3 months (T3) (
< 0.001), with a drop from 7.48% ± 0.1% to 7.30 ± 0.1%. There was no change in time spent in hypoglycemia from T3 to T12, although there was a decreasing trend present. The change in HbA1c values in the entire cohort was driven by change in the subgroup of patients with HbA1c ≥7% with a drop from 8.22% ± 1.14% to 7.68% ± 1.26% (
< 0.0001) in the first 3 months. Also, in individuals performing SMBG less than 5 times per day, there was a steady decrease in HbA1c levels up to 6 months (
< 0.05 and
< 0.001, respectively) as opposed to those who performed SMBG ≥5 times per day.
The improvement in HbA1c was mainly driven by the increase in the number of scans per day. The subjects with poorer glycemic control and those who seldom performed SMBG benefited the most.
Osteoporoza je metabolička bolest kosti karakterizirana gubitkom koštane mase i poremećenom
mikroarhitekturom koštanog tkiva, što za posljedicu ima povećanu krhkost kostiju i povećan rizik za ...nastanak prijeloma. Osnovni mehanizam nastanka osteoporoze je gubitak ravnoteže između koštane razgradnje i stvaranja nove kosti. Dijagnostički kriterij za osteoporozu
je smanjena mineralna gustoća kosti za 2,5 standardne devijacije u odnosu na vršnu gustoću
kosti (zdrave 30-godišnjakinje), utvrđeno denzitometrijom. Iako preventivne mjere, kao što su primjena kalcija, vitamina D, tjelovježba i reduciranje čimbenika rizika, trebaju biti sastavni dio pristupa bolesniku s osteoporozom, kako bi se postigla primjerena zaštita od prijeloma, u većine bolesnika potrebno je primijeniti i farmakološku terapiju. Nekoliko je lijekova dostupno za terapiju osteoporoze. Prema osnovnom mehanizmu djelovanja na kost klasificiraju se kao antiresorptivni ili osteoanabolički lijekovi. Antiresorptivni lijekovi u prvom redu smanjuju koštanu
resorpciju, dok anabolici potiču stvaranje nove kosti. Ovaj članak donosi pregled lijekova koji se trenutno primjenjuju u liječenju osteoporoze, kao i budućih terapijskih opcija.
Prehrana je najvažniji promjenjivi čimbenik uključen u razvojni proces kronične upale niskog intenziteta na razini visceralnog masnog tkiva. Proupalni/protuupalni potencijali glavnine namirnica i ...nutritivnih komponenti određeni su, vrednovani te prikazani kao DII (eng. dietary inflammatory index). DII je nutricionistički alat dizajniran na temelju opsežnog pregleda literature o učincima konzumacije pojedinih prehrambenih parametara na biomarkere upalnog procesa. Obrascu prehrane pridružen ukupni DII može se nalaziti u rasponu od 7.98 (maksimalni proupalni) do -8.87 (maksimalni protuupalni). Integrativni protuupalni pristup potencijalna je prekretnica u suočavanju s preuhranjenosti/debljinom, kroničnom upalom niskog intenziteta i njoj pridruženim kroničnim bolestima.
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