Glycemic Variability and Vascular Complications in Patients with Type 2 Diabetes Mellitus.

Background: Presence of macro- and microvascular complications in patients with diabetes mellitus (DM) is not only related to chronic hyperglycemia represented by glycated hemoglobin (HbA1c) but also to acute glycemic fluctuations (glycemic variability, GV). The association between GV and DM complications is not completely clear. Aim of our study was to evaluate GV by MAGE index in patients with type 2 DM and to verify association of MAGE index with presence of macro- and microvascular DM complications.

[Specifics of using ambulatory blood pressure monitoring in the elderly].

Arterial hypertension is a chronic disease which represents a major risk factor for damage of cardiovascular system. Insufficient control of elevated blood pressure is associated with the development of target organ damage, increased cardiovascular morbidity and mortality with a adverse prognostic value. Using ambulatory blood pressure monitoring (ABPM) we can improve the overall management of elderly patients at which the prevalence of arterial hypertension is particularly high.

[Specifics of using ambulatory blood pressure monitoring in the elderly].

Unlabelled: Arterial hypertension is a chronic disease which represents a major risk factor for damage of cardiovascular system. Insufficient control of elevated blood pressure is associated with the development of target organ damage, in-creased cardiovascular morbidity and mortality with a adverse prognostic value. Using ambulatory blood pressure monitoring (ABPM) we can improve the overall management of elderly patients at which the prevalence of arterial hypertension is particularly high.

Orthostatic hypotension in diabetic patients-10-year follow-up study.

Introduction: Cardiovascular autonomic neuropathy in diabetics is a common but often underestimated and underdiagnosed complication of diabetes mellitus. One of the most clinical apparent forms of cardiovascular autonomic neuropathy is orthostatic hypotension.

Objectives: To retrospectively assess the association of the orthostatic hypotension (OH) with macrovascular and microvascular complications of diabetes mellitus and to determine its effect on mortality.

Risk factors in diabetic nephropathy progression at present.

Diabetic nephropathy is becoming an increasingly important cause of morbidity and mortality worldwide as a consequence of increasing prevalence of type 2 diabetes and obesity. The glomeruli of patients with diabetes are characterized by glomerular hypertrophy, widening of the glomerular basement membrane, mesangial expansion, podocytopenia leading to nodular (Kimmelstiel-Wilson) glomerulosclerosis. Many studies have reported the initiation and progression of incipient nephropathy in type 1 diabetes patients, but only limited data are available in type 2 diabetes patients.

Monitoring of glycation, oxidative stress and inflammation in relation to the occurrence of vascular complications in patients with type 2 diabetes mellitus.

The study aimed to evaluate if the monitoring of advanced glycation end products (AGEs), advanced oxidation protein products (AOPP), lipoperoxides (LPO) and interleukin-6 (IL-6) in plasma could help to predict development of diabetic complications (DC). Clinical and biochemical parameters including AGEs, AOPP, LPO and IL-6 were investigated in patients with type 2 diabetes mellitus (DM2) with (+DC) and without (-DC) complications. AGEs were significantly higher in both diabetic groups compared to controls.

Vasculitides as a rare cause of intermittent claudication.

Intermittent claudication of the lower extremities is a common symptom described in older patients with atherosclerotic peripheral arterial disease. Peripheral arterial disease due to atherosclerosis is known to be associated with a higher risk of myocardial infarction, stroke and all-cause mortality. However, if intermittent claudication appears in a younger group of patients or older patients in absence of traditional risk factors for atherosclerosis such as smoking, dyslipidemia, arterial hypertension and diabetes mellitus other causes than atherosclerosis must be considered.

Influence of infection on clinical picture of diabetic foot syndrome.

The aim of our study was to analyse the foot infections in diabetic patients. We analysed foot ulcerations in 124 diabetics who attended outpatient foot clinic, or were hospitalized in the period from 1996 to 2006. Basic neuropathy screening examination was made with cotton wisp, pin-prick, tuning fork, and monofilament.

[Purtscher-like retinopathy in acute alcoholic pancreatitis: fluorescein angiography and optical coherence tomography findings].

27 year old patient with a history of alcohol abuse after consumption of fat meal and wine following epigastric pain noticed sudden bilateral visual loss: right eye logMAR 0, 94, left eye logMAR 1, 22. Retinal examination revealed massive edema in the central part of the retina, multiple cotton wool spots in the posterior pole peripapillary and flame-shaped hemorrhages. On the OCT, there was edema most of all in the inner part of the retina, but also subretinal, hyperreflectivity in the nerve fibre layers corresponding to massive cotton wool spots.

[Arterial hypertension with orthostatic hypotension].

Arterial hypertension (AH) with orthostatic hypotension (OH) is quite important clinical problem, present especially in older age and in various forms of autonomic nervous system (ANS) failure. ANS damage may be primary, or secondary, most offen in diabetes mellitus. In older age OH occurrence is about 30% and postprandial hypotension is also possible.

[Obesity--the risk factor of cardiovascular disease in patients with chronic kidney disease?].

In general population obesity is regarded as a predisposing factor for chronic disease such as type 2 diabetes and cardiovascular disease. Obesity increases the risk of kidney disease and adversely affects the progress of kidney disease among patients with diagnosed kidney disease. The main reason of mortality in chronic kidney disease patients is cardiovascular disease, however, the real meaning of obesity as a risk factor of cardiovascular diseases is still uncertain.

[Obesity and arterial hypertension].

Obesity is an independent risk factor for the development and progression of hypertension, cardiovascular disease and chronic kidney disease. There is growing evidence that obesity and associated metabolic abnormalities may induce and accelerate renal complications in essential hypertension. The clustering of obesity and other features of the metabolic syndrome might have important implications for prevention, particularly with regard to whether interventions targeted at visceral obesity would have beneficial effects on cardiovascular and renal morbidity.

[Complications of obesity--pathogenesis].

Author discuss possible pathogenetic mechanisms of obesity complications. He separates metabolic complications, especially risk factors of atherosclerosis collected in syndrome of insulin resistance. Here can be added also hyperuricaemia and nonalcoholic fatty liver disease.

[Continuous monitoring of tissue glucose].

Continuous glucose monitoring is technology revolution in diabetology similar to holter ECG monitoring in cardiology. With goal of the diabetes treatment to achieve almost normal glucose concentration in blood, continuous glucose monitoring can help in hypoglycemia risk reduction. Continuous glucose monitoring offers actual value of glycemia longitudinal whole day, with possibility of analyzing records and signalization when programmed thresholds are exceeded.

[Characteristics of foot ulcers in diabetic patients].

Introduction: Diabetic foot syndrome is often presented as a skin lesion in diabetics. The aim of our study was to analyse foot ulcerations in diabetics, together with ethiopatogenesis, location and grade of impairment.

Methods: We analysed foot ulcerations in 124 diabetics who attended outpatient foot clinic, or were hospitalized in the period from 1996 to 2006.

[Purtscher-like retinopathy--a rare complication of acute pancreatitis].

The article reports the case of a 27-year old woman hospitalised in the internal medicine ward for acute pancreatitis after eating fat food and drinking alcohol. In addition to acute pancreatitis, the patient complained of vision problems. The ophthalmologist detected bilateral occurrence of large whitish nidi located primarily around the optic disc, intraretinal hemorrhage and a massive retinal oedema in the central field and diagnosed Purtscher-like retinopathy.

[The prevalence of abdominal obesity in Slovakia. The IDEA Slovakia study].

Abdominal obesity represents an independent risk factor for subsequent severe cardiovascular events. It is one of the important diagnostic criteria for Metabolic Syndrome whose predictive value for severe cardiovascular events is similar to that of elevated LDL-cholesterol levels. The prevalence of abdominal obesity in the context of Metabolic Syndrome still has not been systematically monitored in Slovakia.

Effect of vitamin E supplementation on microalbuminuria, lipid peroxidation and blood prostaglandins in diabetic patients.

Background: Oxidative stress is an important pathogenic factor in the development of diabetic vascular complications.

Aims: To study the effect of vitamin E supplementation on microalbuminuria, plasma levels of malondialdehyde (MLD) and metabolites of prostaglandins TXA2 (TXB2) and PGI2 (6-keto-PGF1alpha) and to evaluate the relation between plasma MLD and thromboxane B2 (TXB2) in diabetic patients.

Patients And Methods: Diabetic microalbuminuric patients were supplemented with vitamin E 1200 IU daily (EVIT, Rodisma, Germany) and measurements of microalbuminuria, MLD, TXB2 and 6-ketoPGF1alpha were repeated after 4 months of treatment.

Comparison of pioglitazone and gliclazide in sustaining glycemic control over 2 years in patients with type 2 diabetes.

Objective: The hypothesis that pioglitazone treatment is superior to gliclazide treatment in sustaining glycemic control for up to 2 years in patients with type 2 diabetes was tested.

Research Design And Methods: This was a randomized, multicenter, double-blind, double-dummy, parallel-group, 2-year study. Approximately 600 patients from 98 centers participated.

Does diabetic autonomic neuropathy influence the clinical manifestations of reflux esophagitis?

Diabetic autonomic neuropathy is a common complication of diabetes mellitus and affects every segment of the gastrointestinal tract. Gastrointestinal problems tend to be more common and severe in diabetics compared with the nondiabetic population. In the literature, the prevalence of reflux esophagitis is not known.

[Effect of vitamin E therapy on progression of diabetic nephropathy].

Pathogenesis of diabetic nephropathy, which belongs to most serious microangiopathic complications of diabetes, is still not completely clear. Thromboxan A2 and increased oxidation stress are new factors apparently associated with pathogenesis of diabetic nephropathy. It was the aim of the contribution to verify the participation of thromboxan A2 and oxidation stress in the pathogenesis of diabetic nephropathy, as well as to follow the effects of treatment with vitamin E on its progression.

[Incidence of risk factors and vascular complications in patients with newly diagnosed type 2 diabetes mellitus].

Unlabelled: The objective of the investigation was early detection of risk factors of diabetes and/or atherosclerosis and the prevalence of vascular complications of diabetes in newly diagnosed patients with type 2 diabetes in the Slovak Republic.

Patients And Methods: In the Slovak detection programme of vascular complications participated 40 diabetological out-patient departments. In the course of one year (from the beginning of June 1999 to the end of May 2000) in a total of 3424 newly diagnosed patients with type 2 diabetes, aged under 70 years the case-history was recorded, focused on risk factors of diabetes and atherosclerosis, on the patients' lifestyle, on vascular complications of diabetes and their treatment.

The effect of cardiovascular autonomic neuropathy on resting ECG in type 1 diabetic patients.

Background: Cardiovascular autonomic neuropathy (CAN) is a common complication of diabetes mellitus.

Aim: To assess the manifestations of CAN on ECG at rest.

Subjects And Methods: 100 type I diabetic patients, mean age 36.

Decreased fluidity of isolated erythrocyte membranes in type 1 and type 2 diabetes. The effect of resorcylidene aminoguanidine.

Changes in the physico-chemical properties of erythrocyte membranes induced by nonenzymatic glycation as well as the possible prevention of their rise were studied. Using the fluorescent probe 1,6-diphenyl-1,3,5-hexatriene (DPH), fluorescence anisotropy values were determined in erythrocyte membranes isolated from type 1 and type 2 diabetic patients with and without complications. The mean anisotropy values for the groups of diabetic patients were significantly higher than those for the control group (p < 0.

[Diabetic neuropathy].

Author in his article shortly describe pathogenetic mechanisms, clinical manifestations, diagnostic procedures and screening possibilities (which are very easy to perform), and also therapeutic methods of diabetic neuropathy.