Cilj: Procijeniti učinkovitost strukturirane edukacije za osobe sa šećernom bolešću po pitanju napretka u znanju i redukcije glikiranog hemoglobina HbA1c. Ispitanici i metode: Istraživanje je ...obuhvatilo ukupno 102 pacijenta (20 sa šećernom bolesti tipa 1 i 82 sa šećernom bolesti tipa 2), prosječne dobi 60 godina (20 – 80 godina), koji su u periodu od srpnja 2017. do siječnja 2018. bili upućeni u Dnevnu bolnicu za endokrinologiju, dijabetes i bolesti metabolizma Kliničkog bolničkog centra Rijeka s ciljem provođenja grupne strukturirane edukacije za osobe sa šećernom bolešću. Polaznici su zamoljeni da ispune upitnik prije početka edukacije te po njenu završetku. Upitnik se sastojao od 12 pitanja, od kojih je 11 bilo po principu točnog/netočnog odgovora, dok se posljednje pitanje iz upitnika odnosilo na pacijentovu samoprocjenu educiranosti o šećernoj bolesti (Tablica 1). Vrijednost glikiranog hemoglobina HbA1c mjerena je inicijalno te 3 mjeseca po provedenoj edukaciji. Za statističku obradu podataka korišteni su Microsoft Excel (Microsoft Office), MedCalc v12.1.3 (MedCalc Software bvba, Ostend, Belgium) i Statistica v13.3 (StatSoft Inc., Tulsa, Oklahoma, United States), a razina statističke značajnosti procijenjena je na P < 0,05. Rezultati: Po završenoj edukaciji značajno se povisio broj postignutih točnih odgovora (4,1 ± 2,3 vs 9,3 ± 1,6, P < 0,001), snizila se vrijednost glikiranog hemoglobina HbA1c (8,0 ± 1,8 % vs 7,1 ± 1,3 %, P < 0,001) te utrostručio broj polaznika koji su za sebe smatrali da su adekvatno educirani o šećernoj bolesti (28,4 % vs 84,3 %, P < 0,001). Zaključci: Po provedenoj edukaciji zabilježen je značajan napredak u znanju, popraćen redukcijom glikiranog hemoglobina HbA1c od 0,9 %, čime je dokazana učinkovitost strukturirane edukacije.
Aim: To evaluate the effect of diabetes structured education on knowledge and glycemic control. Patients and methods: The study included 102 patients with diabetes mellitus (20 patients with type 1 diabetes and 82 patients with type 2 diabetes), aged 20-80 years (median age 60 years), consecutively referred to Diabetes outpatient clinic structured education program at Clinical Hospital Centre Rijeka, within a six month period. Patients were asked to complete 12-item questionnaire before the education program and immediately after its completion. The maximum possible score was 11 (1 point for each correctly answered item), since the last item of the questionnaire was knowledge self-assessment (Table 1). Glycated hemoglobin A1c was measured initially and 3 months after the education program. Data were analyzed using Microsoft Excel (Microsoft Office), MedCalc v12.1.3 (MedCalc Software bvba, Ostend, Belgium) and Statistica v13.3 (StatSoft Inc., Tulsa, Oklahoma, United States). Criterion for statistical significance was estimated on P<0,05. Results: Significant improvement in knowledge was noticed after completion of the education program (4,1 ± 2,3 vs 9,3 ± 1,6, P < 0,001), followed by a significant reduction in glycated hemoglobin A1c levels (8,0 ± 1,8% vs 7,1 ± 1,3%, P<0,001). Moreover, the education program resulted in threefold increase in the number of patiens who perceive themselves to be adequately educated on diabetes (28,4% vs 84,3%, P<0,001). Conclusions: The overall increase in knowledge and self-confidence followed by reduction of glycated hemoglobin A1c by 0,9%, confirmed the efficacy of diabetes structured education.
The sodium/glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like-1 receptor agonists (GLP-1RA) are antidiabetic agents effective both in hemoglobin A1c (HbA1c) reduction (with a low risk of ...hypoglycemia) and cardiovascular event prevention. In patients with type 2 diabetes, the add-on value of combination therapy of GLP-1RA and an SGLT-2i seems promising.
To investigate whether the efficacy of GLP-1RA and SGLT-2i combination observed in randomized controlled trials translates into therapeutic benefits in the Croatian population during routine clinical practice and follow-up.
We included 200 type 2 diabetes patients with poor glycemic control and analyzed the effects of treatment intensification with (1) GLP-1RA on top of SGLT-2i, (2) SGLT-2i on top of GLP-1RA compared to (3) simultaneous addition of both agents. The primary study endpoint was the proportion of participants with HbA1c < 7.0% and/or 5% bodyweight reduction. Secondary outcomes included changes in fasting plasma glucose (FPG), prandial plasma glucose, low-density lipoprotein cholesterol, estimated glomerular filtration rate (eGFR), and cardiovascular (CV) incidents assessment over a follow-up period of 12 mo.
The majority of patients were over 65-years-old, had diabetes duration for more than 10 years. The initial body mass index was 39.41 ± 5.49 kg/m
and HbA1c 8.32 ± 1.26%. Around half of the patients in all three groups achieved target HbA1c below 7%. A more pronounced decrease in the HbA1c seen with simultaneous SGLT-2i and GLP-1RA therapy was a result of higher baseline HbA1c and not the effect of initiating combination therapy. The number of patients achieving FPG below 7.0 mmol/L was significantly higher in the SGLT-2i group (
= 0.021), and 5% weight loss was dominantly achieved in the simultaneous therapy group (
= 0.044). A composite outcome (reduction of HbA1c below 7% (53 mmol/mol) with 5% weight loss) was achieved in 32.3% of total patients included in the study. Only 18.2% of patients attained composite outcome defined as HbA1c below 7% (53 mmol/mol) with 5% weight loss and low-density lipoprotein cholesterol < 2.5 mmol/L. There were no significant differences between treatment groups. No differences were observed regarding CV incidents or eGFR according to treatment group over a follow-up period.
Combination therapy with GLP-1RA and SGLT-2i is effective in terms of metabolic control, although it remains to be determined whether simultaneous or sequential intensification is better.
Intragastric balloon (IGB) and cognitive-behavioral therapy (CBT) are possible options for weight reduction. The aim of our study was to compare their effectivness in inducing weight loss and ...metabolic changes accompanying weight loss in non-morbidly obese patients.
Subjects were required to be between 18 and 55 years old and to have a BMI between 30 and 45 to be eligible. Exclusion criteria, besides those for IGB placement, were the presence of diabetes, depression, binge-eating disorder and the use of medications that affect body weight. Anthropometric, biochemical and blood pressure measurements were performed at baseline and after 6 months. A total of 114 subjects were recruited to the study and assigned to IGB (n = 60) or CBT group (n = 54). All patients completed the study.
After 6 months, patients treated with IGB lost significantly (P < 0.01) more weight (%EWL = 44.6 ± 23.9) than patients who participated in CBT (%EWL = 24.3 ± 16.0). In IGB group 75% of patients achieved ≥ 10% loss of initial weight, and 42.6% of patients in CBT group respectively. A significant improvement in all indices of metabolic syndrome except HDL cholesterol was seen in both treatment groups but much more in subjects treated with IGB.
Our results confirmed that intragastric balloon is useful method for promoting weight loss. Due to improvement of metabolic parameters and substantial benefit on liver function, obese people with metabolic syndrome appear to be the best candidates for IGB placement. Combining intragastric balloon treatment with cognitive-behavioral approach might prove valuable for even greater weight loss.
Obesity is a worldwide health problem associated with substantial morbidity and cost. Lifestyle modification and pharmacotherapy for obesity have limited benefit. Bariatric surgery is effective but ...with substantial risks, considerable cost and limited patient applicability. Endoscopic approach to obesity has evolved as a result of an attempt to replicate some of the anatomical manipulations and the physiological effects of the traditional weight loss surgery in a minimally invasive manner. Endoscopic interventions performed entirely through the GI tract offer the potential for an ambulatory weight loss procedure that is more cost-effective compared with current surgical approaches. There are two main endoscopic weight loss modalities - restrictive and malabsorptive. Restrictive procedures act to decrease gastric volume by space-occupying prosthesis and/or by suturing or stapling devices that alter gastric anatomy while malabsorptive procedures tend to create malabsorption by preventing food contact with the duodenum and proximal jejunum. Restrictive endoscopic procedures include intragastric balloon treatment, endoluminal vertical gastroplasty, transoral gastroplasty (TOGA) and transoral endoscopic restrictive implant system (TERIS). The duodenojejunal bypass sleeve (DJBS) is a malabsorptive device that mimics such surgical procedure. Gastroduodenojejunal bypass sleeve is a combination of both procedures. Except for intragastric balloon all mentioned procedures are rather novel, tested on a small number of subjects and with limited knowledge on safety and long-term efficacy. Owing to evolving field of evidence-based medicine with demand for rigorous evaluation of the scientific evidence these therapies need to be carefully tested in a randomized controlled manner to determine their safety and efficacy in the short and long-term. This review is aimed to compare endoscopic bariatric interventions with each other and with other weight loss modalities including conventional treatment and surgical procedures.
The aim of this study was to assess the relationship between beliefs about the causes of illness, glycaemic control, and affective status of overweight and obese women and men with type 2 diabetes. ...The clinical sample included 88 patients (46 males), aged from 31 to 79 years. Patients were examined in the Outpatient Clinic for Endocrinology, Diabetes and Metabolic Diseases in the Clinical Medical Centre Rijeka. Psychological measurements included the Revised Illness Perception Questionnaire and the Hospital Anxiety and Depression Scale. Patients' body weight, height and glycaemic control (HbA1c) were also obtained.The results show that body mass index (BMI) is not significantly correlated with the level of HbA1c, nor with measured psychological variables (psychological attributions of illness, anxiety and depressive symptoms). A stronger belief that illness was caused by psychological factors is correlated with more symptoms of anxiety and depression in patients. There was a significant main effect of patients' sex on psychological attributions and anxiety symptoms. Women reported stronger beliefs that psychological factors might have been the cause of their illness and showed higher levels of anxiety symptoms than men. There was no significant main effect of glycaemic control on measured psychological variables. The results suggest that in working with T2DM patients it is important to pay attention to psychological aspects of illness, taking into account the patient's sex. Inquiring about diabetes causation beliefs and emotional status may be a way of recognizing possible barriers towards providing care.
Obesity is a chronic disease with a marked impact on health and the prevalence of obesity in Croatia is rapidly rising. Since obesity plays a significant role in the etiology of cardiovascular ...diseases, diabetes mellitus type 2 and of some cancers, it is an obvious target of public health activities. Weight-reducing drugs, like sibutramine, in combination with diet, exercise and behavioral changes have a role in the management of obesity. Sibutramine acts centrally as a serotonergic and noradrenergic reuptake inhibitor. It reduces body weight by enhancing satiety and stimulating thermogenesis. The aim of this multicenter prospective study was to evaluate the efficacy, tolerability and safety profile of sibutramine in the treatment of overweight patients in Croatia. Patients received 10 mg of sibutramine daily for 12 weeks. The main outcome measures were changes in body weight, BMI, waist and hip circumferences, laboratory assessments (serum triglicerida, cholesterol, glucose, HbA1c), blood pressure and heart rate profile. Of 461 patients included (mean BMI = 35.81+/-6.48 kg/m2, mean age = 43.65+/-10.90 years), 392 completed the study. Three months of sibutramine treatment lead to a significant reduction in body weight, BMI, waist and hip circumferences and improvement in metabolic parameters. Loss of over 5% of their initial body weight was found in 359 patients (91.58%), while 179 patients (45.66%) achieved weight loss over 10%. A decrease of both systolic (-3.39%) and diastolic (-3.75%) blood pressure was noted, while the pulse rate rose slightly (+0.13%). Adverse events were reported by 124 (26.90%) patients, but they precipitated only 17 (3.69%) withdrawals. Results of our study confirmed that sibutramine is an effective and safe weight-reducing drug.
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. Key words: insulin; diabetes; discovery; type 1 diabetes mellitus; type 2 diabetes mellitus Godine 2022. obiljezena je stota godisnjica prve primjene inzulina. Cetrnaesti studenog, datum rodenja Fredericka Bantinga, jednog od izumitelja inzulina, proglasen je Svjetskim danom dijabetesa. U ovom radu pruzamo narativni pregled povijesti otkrica secerne bolesti i inzulina, napretka u razvoju inzulina, vaznih otkrica u proizvodnji i isporuci inzulina te kratak komentar o potencijalnom buducem razvoju u inzulinskoj terapiji. Secerna bolest, kao jedna od najranijih zabiljezenih bolesti u medicinskim spisima, bila je tema istrazivanja tijekom gotovo cijele pisane ljudske povijesti. Revolucionarna otkrica ranog 20. stoljeca dovela su do toga da secerna bolest tip 1 postane ljecivo, kronicno stanje. Kada je utvrden odnos izmedu dobre kontrole glikemije i smanjene pojave komplikacija secerne bolesti, potaknuti su daljnji razvoj i usavrsavanje inzulinske terapije, ukljucujuci prociscavanje i unapredenje kvalitete samog inzulina, kao i razne izume u njegovoj primjeni. Unatoc velikim postignucima u inzulinskoj terapiji do sada, buducim istrazivanjima cilj je izbjeci potrebu za potkoznom primjenom i stvoriti neinvazivne nacine primjene inzulina. Kljucne rijeci: inzulin, secerna bolest, otkrice, secerna bolest tip 1, secerna bolest tip 2
PDF
