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Absztrakt: Az inzulinrezisztencia (IR) fennállásának megerősítése vagy kizárása a hazai diabetes-szakrendelésekre irányított nem cukorbetegek egyik leggyakoribb beutalási indoka. A közlemény áttekinti az IR fogalmát, kórélettani jelentőségét, kórismézési lehetőségeit és kezelési vonatkozásait. Kiemeli, hogy az inzulinhatás csökkenése számos betegség kísérőjelensége, s önmagában, más tünetek nélkül nem igényli részletes kivizsgálását. Ha mégis felmerül, tájékozódó céllal elegendő a HOMA-IR-érték számítása, valamint az éhomi vércukor- és széruminzulinszint meghatározása. Ha valamely társbetegség részeként igazolódik, annak komplex kezelése szükséges. Orv Hetil. 2020; 161(26): 1088–1093.

Abstract: Glucagon-like peptide-1 (GLP1) and their receptor agonists – beside their blood glucose lowering and central effects- affect also the gastrointestinal function in many respects. They slow down the stomach emptying, the motility of the small bowel and colon – this is the explanation for the “ileal brake” terminology –, stimulate the function of exocrine pancreatic acinar cells and increase amylase production. GLP1 receptor agonists belong to the defining tools of the blood glucose lowering therapy in type 2 diabetes. Their long- and short-acting derivatives have different influence on the fasting and the postprandial blood glucose, respectively. By introducing the term non-prandial and prandial type analogues – which seems to be forced in light of the newer data – the potential slowdown in gastric emptying is the center of interest, lately, however, especially in the case of long-acting GLP1 variants, at least such attention should be paid to controlling bowel function. The article reviews the physiological effects of GLP1 on the gastrointestinal tract and draws attention to the potential for the prevention of possible side effects through detailed patient information and dietary advises. Orv Hetil. 2019; 160(49): 1927–1934.

Objective The objective of this study was to develop a long-term economic model for type 2 diabetes to describe the entire spectrum of the disease over a wide range of healthcare programmes. The model evaluates a public health, risk-based screening programme in a country specific setting. Methods The lifespan of persons and important phases of the disease and related interventions are recorded in a Markov model, which first simulates the effect of screening, then replicates important complications of diabetes, follows the progression of individuals through physiological variables and finally calculates outcomes in monetary and naturalistic units. Results The introduction of the screening programme nearly doubled the proportion of diagnosed patients at the age of 50 and prolonged life expectancy. Three-yearly screening gained 0.0229 quality adjusted life years for an additional €83 per person compared with no screening and resulted an incremental cost-effectiveness ratio of €3630/quality adjusted life years. Conclusion From the economic perspective introduction of the 3-yearly screening programme is justifiable and it provides a good value for money. Copyright © 2016 John Wiley & Sons, Ltd.

The introduction of insulin in type 2 diabetes is often too late, though the immediate as well as late consequences of inadequate metabolic control are well known. That is the reason, why a special attention is given in recent therapeutic guidelines for the importance of early, at least timely insulinisation. This review article summarizes the advantages (mitigation of the beta-cell dysfunction, long lasting good metabolic control) and potential risks (hypoglycemia, weight gain, possible deteriorating patient compliance) of early or timely insulin therapy. It is pointed out that the introduction of insulin is effective and safe therapeutic option during the whole course of type 2 diabetes, the use of different regimes is suitable to reach and maintain the individual glycemic target and, with a structured patient education, it does not disturb the quality of life and the compliance of patients.Tapasztalatok szerint az inzulin bevezetése 2-es típusú diabetesben gyakran késik, jóllehet a kívánttól elmaradó anyagcserekontroll azonnali és hosszú távú következményei jól ismertek. Ez a magyarázata, hogy a korai, de legalább az időben megkezdett inzulinadás kezelési útmutatásokban mind nagyobb hangsúlyt kap. A közlemény áttekinti a betegség korai – első kezelésként alkalmazott −, illetve későbbi szakaszában indított inzulinadás lehetséges előnyeit (béta-sejt-diszfunkció mérséklése, a progresszió lassítása, tartósabb és hosszú távon kedvezőbb anyagcserekontroll), valamint potenciális korlátozó tényezőit (nem kívánt vércukoresések gyakoribb előfordulása, súlygyarapodás, romló beteg-együttműködés). Rámutat arra, hogy inzulin adása megfelelő kezelésválasztással a 2-es típusú diabetes minden szakaszában biztonságos terápiás alternatíva, jól igazítható az individuális glykaemiás célhoz és körültekintő betegoktatással nem rontja az érintettek életminőségét és nem hátráltatja hosszú távú kezelési együttműködésüket sem. Orv. Hetil., 2014, 155(7), 255–261.

Hyponatremia is the most frequent eletrolyte imbalance in hospitalized geriatric patient. The accompanying signs and symptoms can run a wide range and, therefore, these patients are usually admitted to various departments, i.e. neurology and/or traumatology first. Directed laboratory investigations demonstrate severe hyponatremia. Differential diagnosis can be very difficult and complex in the clinical settings. Firstly, spurious forms of hyponatremia have to be excluded, then the underlying cause should elucidated based on the patients hydration status and serum osmolarity. Hyponatremia can be divided into hyper-, hypo- and normovolemic forms. Moreover, it can be further classified as hypo-, iso- and hyperosmolar hyponatremias. The differentiation between renal and extrarenal salt wasting forms is hinged on the urine sodium concentration. Syndrome of inappropriate antidiuretic hormone secretion is the most common cause of normovolemic, hypoosmolar forms (named also as Schwartz–Bartter syndrome). The authors aimed to shed light on the often insurmountable difficulties of the diagnosis, differential diagnosis and appropriate treatment of this very frequent electrolyte imbalance by presenting a clinical case report. Their purported aim reflects upon the wide array of ethiopathogenesis of hyponatremia: various endocrine, renal diseases, inappropriateness of antidiuretic hormone secretion as well as the role of different medications (e.g. diuretics). This fine-tuned and intricate physiology of sodium metabolism could fortuitously be overturned by these mechanisms. Orv. Hetil., 2013, 154, 1235–1241.

Discovery of physiological and pharmacological characteristics of incretins (glucagon-like peptide-1 and glucose-dependent insulinotrop polypeptide), and the introduction of various products of those into the clinical practice has fundamentally changed blood glucose lowering therapy in type 2 diabetes. In addition to the antidiabetic properties more attention is paid to their favourable pleiotropic effects independent from the blood glucose lowering such as cardio-, vaso- and renoprotectiv, blood pressure lowering effects, as well as beneficial changes on blood lipid values and hepatic steatosis. These preferential changes prevail in slightly different way when incretin mimetics applied and dipeptidyl peptidase-4 inhibitors, furthermore, prolonged action of peptides metabolised by this enzyme may serve additional benefits in this latter mentioned group. The article overviews the currently known most important pleiotropic effects of incretins from the point of view of cardiorenal risk accompanying type 2 diabetes. Orv. Hetil., 2013, 154, 248–255.

Insul(in)oma is a usually solitary or, in some cases, multifocal tumor of pancreatic beta cells. It may be a component of multiple endocrine neoplasia type 1. or von Hippel-Lindau syndrome. In typical forms the diagnosis – based on the Whipple triad – is simple, however, it may be difficult to recognize in cases with near normal or only slightly elevated serum insulin levels, as well as in patients with known convulsive episodes. With the case presentation of an 81-year-old woman the authors draw attention to the pitfalls of the correct diagnosis. A special feature of the presented case is that convulsions persisted after surgical removal of the pancreatic neuroendocrine tumor verified with functional and imaging methods. Recurrant or residual tumor was not found, and morphological damage of the brain was absent. In the background of the continuing convulsions cerebrovascular alterations as well as the cytotoxic effect of the hypoglycemia-induced excessive glutamate production can be postulated. Orv. Hetil., 2013, 154, 69–73.

To estimate and compare the prevalence of self-reported diabetes based on nationally representative surveys of the Hungarian adult population in 2002 (published data - Hungarostudy) and a survey in 2012.A cross-sectional computer-assisted telephone interview survey on a stratified representative sample of community-dwelling adults (n=1000) in 2012. To describe self-reported diabetes prevalence and its temporal changes generalized linear models were used and results were compared to figures from Hungarostudy.Age standardized prevalence of self-reported type 2 diabetes was 11.7% (95%CI 10.0-13.8%) without gender or rural-urban differences in 2012. People with self-reported diabetes were older than controls (mean [SE]: 63.9 [0.9] vs. 45.9 [0.3] years, p0.0001). The prevalence of diabetes sharply increased after 40 years of age and peaked at age 70 (27.7% [2.5], pWe reported an alarming increase in the prevalence of self-reported type 2 diabetes in the last decade that mostly affects working age people. If this trend continues, a major public health crisis in Hungary can be envisaged.

A cukorbetegséghez társuló idegrendszeri károsodás kialakulásának mechanizmusa ma sem teljes mértékben tisztázott, bár az utóbbi évtizedben számos, részben terápiás konzekvenciával járó adat vált ismertté. Az endoneuralis véráramlás csökkenése részben a primer haemostasis károsodásának, a koagulációs rendszer trombogén irányú elmozdulásának következménye. A hyperglykaemia a szuperoxid-anion fokozott képződése révén a glikolízisben kulcsszerepet játszó glicerin-aldehid-3-foszfát-dehidrogenáz aktivitásának csökkenéséhez, alternatív anyagcsereutak (poliol-, hexóz-amin-, diacil-glicerol-, proteinkináz-C anyagcsereút, fehérjeglikáció) aktiválódásához vezet. A végglikációs fehérjék fokozzák a nukleáris faktor κ-B aktivitását, vazoaktív tényezők és citokinek (interleukin-1, -6, tumornekrózis-faktor-α) termelődését. A patogenetikai alapon nyugvó oki kezelés célja a neuropathiás károsodás progressziójának lassítása, megállítása vagy visszafordítása. Az oki kezelés legfontosabb összetevői: a szénhidrátanyagcsere-helyzet optimális beállítása, a rizikófaktorok kezelése, valamint benfotiamin és alfa-liponsav adása. A transzketoláz-aktivátor benfotiamin egyrészt gátolja a hyperglykaemia következményeként előtérbe kerülő legfontosabb alternatív anyagcsereutak (fehérjeglikáció, diacil-glicerol-, proteinkináz-C-aktiváció, poliol- és hexóz-amin-anyagcsereút) aktivitását, másrészt fokozza a pentóz-foszfát-sönt aktivitását. A benfotiamin klinikai hatékonyságát számos hazai és nemzetközi tanulmány igazolta. Az antioxidáns hatású alfa-liponsav az oxidatív stressz csökkentése révén elősegíti a glicerin-aldehid-3-foszfát-dehidrogenáz aktivitásának fokozódását. Az alfa-liponsav mind infúzióban, mind per os adagolva csökkenti a neuropathiával összefüggő tüneteket és mérsékli a neuropathiás károsodást. Összességében a neuropathia diabetica jól illusztrálja, hogy a patomechanizmussal kapcsolatos ismereteink bővülése számottevően hozzájárulhat a terápia sikeréhez is.

A cukorbetegség − különösen 2-es típusú formája − előfordulása világszerte fokozatosan nő, ezt tükrözik a hazai adatok is. A késői prognózis szempontjából meghatározó jelentőségű érszövődmények megelőzésének, illetve késleltetésének egyik előfeltétele az anyagcserezavar időben történő kórismézése. Ezt segítheti a célzott szűrés, költség-hatékonysági szempontokat szem előtt tartva elsősorban a diabetesre fokozott kockázattal rendelkezők körében. A Magyar Diabetes Társaság, a 77 Elektronika Kft. támogatásával, az országban először, kockázatalapú szűrővizsgálatot indított az alapellátásban dolgozók bevonásával. A szűrés két lépésben történt. Első fázisában a nemzetközileg validált FINDRISC kérdőív magyar változatának kitöltésére került sor, a kérdésekre adott válaszokat pontozási rendszerrel értékeltük (maximálisan elérhető pontszám 26). A ≥12 pontértékkel rendelkező személyek esetében az Egészségügyi Világszervezet előírásait követve éhomi vércukorvizsgálat, kétes értéke esetén 75 grammos glükózterhelés történt, vénás plazmából történő, laboratóriumban végzett vércukormérésekkel. A szűrővizsgálatban 2008. április 1.–2009. március 31. között 8921 személy (59,7% nő, 40,3% férfi) vett részt. A ≥12 pontszámmal rendelkező 4286 személy [életkor: 53,4±11,4 év, testtömegindex (BMI): 29,9±4,9 kg/m 2 , haskörfogat: 101,1±12,7 cm] közül 3733 (87,1%) az éhomi vércukor meghatározása alapján normális glükóztoleranciájúnak bizonyult, míg 283 főnél (6,6%) IFG, 122 esetben (2,85%) IFG, 19 személynél (0,44%) izolált IGT volt megállapítható. Manifeszt, de a szűrés megtörténtéig nem ismert diabetest ismertünk fel 129 személy (3,01%) esetében. Ha a laboratóriumi vizsgálat szükségességét jelentő ponthatárt magasabb értékben (≥15, illetve ≥20 pont) határoztuk meg, nőtt a glükózintoleranciában szenvedők aránya. Az antropometriai paraméterek közül legkifejezettebben a BMI növelte a kóros pontszám-kategóriába kerülés esélyét [egységnyi (1 kg/m 2 ) BMI-növekedés a kockázatot 24,7%-kal növelte (95%-os megbízhatósági tartomány: 23,3–26,2%)]. A kockázatalapú diabetesszűrés egyszerű és hatékony módszer a szénhidrátanyagcsere-zavarok korai felismerésére, ezért annak szélesebb körű, egészségbiztosítói támogatással történő bevezetése indokolt.

A zsírszövetben az inzulinreceptor jelátviteli folyamatait auto-, para- és endokrin hatásokkal szabályozó számos fehérje termelődik és szekretálódik. Ezek közül több, így a tumornekrózis-faktor-α és szolúbilis receptor formái, az sTNFR1 és sTNFR2, a rezisztin, retinolkötő fehérje-4, plazminogénaktivátor-inhibitor, lipokain-1 gátolja az inzulin jelátviteli folyamatait és inzulinrezisztenciát okoz, elsősorban a zsírszövetben, a májban, az izomszövetben, az agyban, az endothelsejtekben, valamint a hasnyálmirigy β-sejtjeiben. Más fehérjék, így az adiponektin, visfatin, vaspin, omentin, apelin és chemerin pedig javítják az inzulinreceptor jelátvitelét. Az összefoglalás áttekinti az inzulinreceptor jelátviteli folyamatainak főbb részleteit és kitér az elhízásban, valamint a 2-es típusú cukorbetegségben észlelhető inzulin- és citokinrezisztenciák patomechanizmusában a közelmúltban megismert molekuláris tényezőkre (például a suppressor of cytokine signaling fehérje család).

A low educational level and a poor socioeconomic status could be associated with increased risk for chronic diseases. The aim of the study was to evaluate the relationship between the educational level and cardiometabolic risk in adult patients with type 1 diabetes (n = 437; age: 38.0 +/- 10.4 years, duration of diabetes: 19.2 +/- 11.1 years; x +/- SD). Educational levels were classified as low [primary school, n = 56 (12.8%)], middle [high school, n = 251 (57.4%)] or high [university, n = 130 (29.7%)]. The prevalence rate of the metabolic syndrome proved to be higher in patients with low versus high educational levels (ATP-III criteria: 42.9 vs. 21.5%, P = 0.0006). Antihypertensive treatment and cardiovascular diseases were more prevalent in patients with low versus high educational level (46.4 vs. 26.2%, P = 0.01; 12.5 vs. 2.3%, P = 0.02; respectively). Overall glycemic control was worse in patients with low versus high educational level (HbA(lc): 8.8 +/- 1.6 vs. 7.9 +/- 1.4%; P = 0.0006). Patients with low versus high educational level differed significantly regarding smoking habits (smokers: 28.6 vs. 11.6%; P = 0.01) and regular physical activity (5.4 vs. 33.1%; P = 0.0001). Higher prevalence rate of certain cardiometabolic risk factors was associated with low educational level in middle-aged type 1 diabetic patients with relatively long duration of diabetes; therefore, these patients should have priority when preventing cardiovascular complications.

A kardiometabolikus kockázati tényezők csökkentésével visszaszoríthatók a cardiovascularis események. A kardiometabolikus kockázati tényezők befolyásolásának eredményességéről 1-es típusú diabetes mellitusban szenvedő felnőtt cukorbetegek körében csak kevés adat áll rendelkezésre. Célkitűzés: Diabetes-szakrendelésen ellenőrzés céljából megjelenő, 1-es típusú diabetes mellitusban szenvedő felnőtt (életkor ≥ 18 év) cukorbetegek körében adatokat gyűjtöttünk a kardiometabolikus kockázati tényezők előfordulásáról és kezelésük eredményességéről. Módszerek: Fél év alatt az ország 11 diabetescentrumában egymást követően megjelent 1-es típusú cukorbetegségben szenvedők (n = 533; 256 férfi, 277 nő; életkor 35,6 ± 11,6 év; diabetestartam 18,0 ± 11,1 év; x ± SD) ellenőrzésekor, az előzményi adatok felvételén túl, antropometriai és laboratóriumi adatokat regisztráltunk. A kardiometabolikus kockázati tényezők kezelési célértékeként a III. Magyar Cardiovascularis Konszenzuskonferencia ajánlásában szereplő adatokat tekintettük mérvadónak. Eredmények: A testtömegindex célértékét (< 25 kg/m 2 ) a betegek 55,3%-a (férfi: 45,7%, nő: 64,3%) érte el. A haskörfogat nők körében megkívánt értékét (< 80 cm) a betegek 50,5%-a, a férfiak esetében mérvadó értéket (< 94 cm) 63,7% érte el. A HbA 1c értéke a betegek 8,4%-ában volt 6,5% alatt (20,5%-ban 7,0% alatt). Lipidcsökkentő kezelésben részesült 130 beteg (24,4%), e csoportban a betegek 53,1%-a érte el a triglicerid, 71,5% a HDL-koleszterin és 27,8% az LDL-koleszterin kezelési célértékét. A lipidek szintjére vonatkozó célérték együttes elérése a betegek 17,7%-ában volt sikeres. Hypertonia miatt kezelésben részesült 173 beteg (32,5%), e betegcsoportban a < 130 Hgmm-es szisztolés vérnyomást a betegek 29,5%-a, a diasztolés célértéket (< 80 Hgmm) pedig 34,7% érte el. A betegek 17,7%-a a vizsgálat időpontjában dohányzónak vallotta magát, 19,2% leszokott a dohányzásról, és 63,2% sohasem dohányzott. Következtetések: Felnőtt, 1-es típusú diabetes mellitusban szenvedők körében a kardiometabolikus kockázati tényezők napjainkban ajánlott kezelési célértékeit a cukorbeteg-gondozás keretein belül nehéz elérni. További erőfeszítéseket kell tenni a cukorbetegek kardiometabolikus kockázati tényezőinek hatékonyabb csökkentése érdekében.

In type 2 diabetes mellitus the decreased catabolism of triglyceride-rich lipoproteins as a consequence of mainly the decreased lipoprotein lipase activity results in hypertriglyceridaemia and other lipoprotein alterations promoting atherosclerosis. The high-density lipoprotein-associated enzyme, paraoxonase, prevents the oxidation of low-density lipoprotein, which is an antiatherogenic effect.to examine the relation between the activities of enzymes influencing HDL remodelling- LPL and PON- in type 2 diabetes mellitus.56 newly diagnosed type 2 diabetic patients and 39 healthy controls were involved in the study. The serum PON activity was measured spectrophotometrically using paraoxone as substrate. PON phenotype was determined by the dual substrate method, PON mass was measured by ELISA. The determination of lipoprotein lipase activity was performed using 3H-triolein.We noticed smaller PON activity decrease in our newly diagnosed diabetic subjects compared to the previous studies which investigated the alteration of enzyme activity after a longer duration of diabetes mellitus. The lipoprotein lipase activity showed a positive correlation with PON activity (r=0.43; P0.02). Interestingly, the PON activity of the homozygous-low activity group did not correlate with the LPL activity, while in the heterozygous and homozygous-high activity groups there was a significantly positive correlation (r=0.51; P0.05) between PON and LPL activity.Besides lipid alterations, the metabolic changes of type 2 diabetes mellitus influence the reduction of the antioxidant capacity of HDL by remodelling HDL and decreasing PON activity via modification of lipoprotein lipase activity, which might contribute to accelerated atherosclerosis.

OBJECTIVE: Malignant tumors of the thyroid gland exhibit a variety of histopathologies and clinical behavior. Immune markers are gaining more and more importance in diagnostic pathology, especially in the differential diagnostics and in the grading of thyroid gland tumors. DESIGN: The Authors investigated the immunohistochemical reaction of galectin-3 (gal3) in patients with various thyroid gland diseases. They tested the diagnostic value of gal3 in determining the benign or malignant nature of various lesions, especially in lesions of follicular origin, because previous results have indicated nearly 100% specificity and sensitivity in this regard. METHODS: Gal3 immunoperoxidase reaction was carried out on 91 sections of thyroid gland samples fixed in formalin and embedded in paraffin. RESULTS: While gal3 expressed itself strongly and diffusely in papillary carcinomas (19 of 20 cases), in other malignant lesions it showed weaker, focal or variable positivity. Focal positivity was found in four of 19 follicular adenomas, and negativity was found in three of 10 follicular carcinomas. In all cases of inflammation a focal positivity was observed (eight of eight cases). All nodular goiter and normal thyroid tIssue were negative (25 of 25 cases). CONCLUSIONS: Based on our results, the gal3 immunohistochemical reaction seems to be reliable in the diagnosis of papillary carcinomas. However, in the case of solitary thyroid nodules and follicular lesions, although it is still a useful supplementary marker, it is not of absolute value (as stated in previous studies) in determining whether a tumor is benign or malignant.

OBJECTIVE: The aim of the study was to evaluate the expression of tumor necrosis factor (TNF)-alpha protein in the subcutaneous and visceral adipose tIssue in correlation with adipocyte cell Volume, serum TNF-alpha, soluble TNF-receptor-2 (sTNFR-2) and indirect parameters of insulin resistance in overweight/obese and lean healthy persons. DESIGN: A cross-sectional case-control study was used. PATIENTS: Twenty-eight overweight/obese probands with normal glucose tolerance (BMI>27 kg/m(2)) and 15 lean people (BMI

Background. We studied the contribution of the tumor necrosis factor system and leptin to insulin resistance during the course of normal pregnancy. Methods. Forty-five healthy pregnant women (15 in the 1 st , 15 in the 2nd 2 and 15 in the 3rd 3 trimester) and 25 age-matched healthy nonpregnant women as controls. Twenty-three newborns delivered by women followed in the 2nd and 3rd trimesters were also investigated. Fasting serum immunoreactive tumor necrosis factor-α, soluble tumor necrosis factor receptor-1, soluble tumor necrosis factor receptor-2, leptin (by enzyme-linked immunoassay) and C-peptide (by radioimmunoassay) concentrations in the patients and controls were measured. Body weight, length and head circumference of the newborns were analyzed in connection with the measured maternal parameters. Results. Significantly elevated tumor necrosis factor-α, tumor necrosis factor receptor-1 and -2, leptin, and C-peptide levels were found in the 3rd 3 trimester as compared with the 1st 1 and 2nd 2 trimest...

OBJECTIVE: Human fetuin/alpha(2)-HS-glycoprotein (AHSG) is a 49 kDa serum and tissue protein which is a natural inhibitor of insulin receptor signaling. We investigated serum AHSG levels during pregnancy and whether the protein is involved in insulin resistance observed in healthy pregnant women and patients with gestational diabetes. DESIGN: One hundred and four healthy pregnant women and 23 of their neonates, 30 patients with gestational diabetes and their neonates and 30 healthy age-matched non-pregnant females as a control group were investigated in a case-control cross-sectional study. METHODS: Serum AHSG was determined by radial immunodiffusion. RESULTS: We observed an increase of serum AHSG concentration in the second and third trimesters. Gestational diabetes patients had significantly higher AHSG levels than healthy pregnant women and non-pregnant controls. There was a highly significant positive correlation between serum AHSG concentration and indirect parameters of insulin resistance, i.e. tumor necrosis factor-alpha (TNF-alpha), leptin, C-peptide and C-peptide/blood glucose ratio. There was also a negative correlation between maternal AHSG, TNF-alpha, leptin levels and head circumference, body length and body weight of newborns. CONCLUSION: AHSG, TNF-alpha and leptin may contribute to insulin resistance during normal pregnancy and gestational diabetes. AHSG along with these cytokines may also negatively regulate neonatal skeletal development.

The aim of the study was to investigate the pathophysiological role of the tumor necrosis factor (TNF) system in insulin resistance in patients with gestational diabetes (GDM) and during the course of normal pregnancy.Thirty women with GDM (16-39 gestational weeks), 35 healthy pregnant women (15 first, nine second and 11 third trimester) and 25 healthy age-matched non-pregnant women were studied. Serum TNF-alpha, and its soluble receptors 1 and 2 (sTNFR-1 and -2) were measured.In non-diabetic pregnant women in the third trimester all measures were significantly higher (P0.05 or less) than in the first trimester and in non-pregnant women (BMI 27.6 +/- 4.1 (+/- S.D.), 24.1 +/- 2.6, 22.4 +/- 2.4 kg/m(2)), serum TNF-alpha (4.6 +/- 0.6, 4.1 +/- 0.4, 4.1 +/- 0.4 ng/l), sTNFR-1 (2.7 +/- 0.9, 2.0 +/- 0.5, 2.0 +/- 0.1 microg/l), sTNFR-2 (5.6 +/- 2.6, 4.6 +/- 2.1, 3.3 +/- 0.2 microg/l), C-peptide (3.1 +/- 1.7, 1.1 +/- 0.7, 1.1 +/- 0.8 microg/l), and C-peptide:blood glucose ratio (0.6 +/- 0.2, 0.2 +/- 0.1, 0.2 +/- 0.1 microg/mmol). In GDM these measures were even higher than in any subgroup of healthy pregnant women (BMI) (33.4 +/- 6.4 kg/m(2), TNF-alpha) (6.3 +/- 0.6 microg/l), sTNFR-1 (3.0 +/- 0.5 microg/l), sTNFR-2 (10.0 +/- 6.9 microg/l, C-peptide 6.0 +/- 2.7 microg/l, C-peptide:blood glucose ratio: 1.2 +/- 0.5 microg/mmol, P0.01). Significant (P0.01) positive linear correlations were found in gestational diabetic and non-diabetic women between serum TNF-alpha, C-peptide levels, and BMI. In gestational diabetic women, in multivariate analysis studying the dependency of C-peptide only BMI remained significant (r(2)=0.67, P=0.01).Our observation emphasizes the obesity-related component of insulin resistance driven by adipocytokines, such as TNF-alpha and its receptors during the course of normal pregnancy and GDM.

The contribution of the tumor necrosis factor (TNF) system and leptin was studied in insulin resistance and neonatal development during the course of normal pregnancy and gestational diabetes mellitus (GDM). Thirty patients with GDM and their neonates (n = 30), 35 healthy pregnant women (15 in the first, nine in the second and 11 in the third trimester) and their neonates (n = 20), and 25 healthy matched non-pregnant women participated in the study. Significantly elevated levels of maternal TNF-alpha, sTNF receptor (R)-1 and R-2, leptin (detected by enzyme-linked immunosorbent assay) and fasting C-peptide (measured by radioimmunossay and raised body mass index (BMI) were found in GDM patients and in the third trimester of normal pregnancies. TNF-alpha, sTNFR-2, C-peptide, leptin concentrations and BMI positively correlated with each other in GDM. An inverse relationship between the body length, head circumference and body weight of the newborns, and maternal TNF-alpha, leptin and C-peptide concentrations was shown in GDM. In healthy pregnancies the maternal serum leptin level was in a negative linear correlation with the head circumference of the newborns. In conclusion, increased TNF-alpha and leptin levels may contribute to insulin resistance in GDM and in the third trimester of normal pregnancy and may negatively influence the anthropometric parameters of the newborns.

Principles of glycemic treatment of type 2 diabetes are well outlined for a long time, however, emphasis of therapeutic strategies and treatment guidelines are continuously changing partially due to the continuous expansion of the available antihyperglycemic drugs. This article overviews the modifications of the drug selection arising from the broadening of the pathogenetic knowledge and recent therapeutic guidelines. It presents the role of the patient-centered approach in the therapeutic choice, highlights occasional contradictions between recent international and national guidelines and financing rules in Hungary. While consideration of the different antidiabetics by the same criteria and the choice of the most appropriate drug characterize international practice, prescription of certain compounds is often restricted by financial rules in Hungary.A 2-es típusú diabetes vércukorcsökkentő kezelésének alapelvei hosszú ideje jól körvonalazottak, a készítményválaszték folyamatos bővülése mellett azonban a kezelés hangsúlyai és a terápiás stratégiák is időről időre változnak. A közlemény áttekinti a patogenetikai ismeretek bővülésének és a kezelési irányelvek módosulásainak a készítményválasztást befolyásoló hatását. Kitér a betegközpontú kezelési szemlélet terápiás stratégiát befolyásoló szerepére, s rámutat a szakmai szempontok és a hazai finanszírozási szabályok esetenkénti ellentmondásaira. Míg a nemzetközi gyakorlatot a választható készítmények azonos szempontok szerinti mérlegelése és az adott esetben legtöbb előnyt kínáló gyógyszercsoport(ok) alkalmazása jellemzi, a hazai lehetőségeket finanszírozási megfontolások korlátozzák. Orv. Hetil., 2014, 155(31), 1215–1220.

Wernicke encephalopathy (or Wernicke-Korsakoff encephalopathy) is a rarely diagnosed neurological disorder, which is caused by vitamin B1 deficiency. In the classical form it is characterized by a typical triad (confusion, oculomotor disturbance and ataxia), however, in the majority of the cases only confusion is present. It can be frequently observed in subjects with chronic alcohol consumption, but it may accompany different pathological states of which end stage malignant diseases are the most importants, where confusion may have different backgrounds. The authors present the case of an old male patient with advanced gastric cancer recognised and treated vitamin B1 deficiency, and they draw attention to difficulties of the diagnosis of Wernicke's disease.A Wernicke-encephalopathia (vagy más leírásokban: Wernicke–Korsakoff-encephalopathia) a belgyógyászati gyakorlatban ritkán felismert kórkép, amit B1-vitamin-hiány okoz. Típusos formáját jellegzetes triász kíséri (zavartság, szemmozgászavar, ataxia), gyakoribb azonban, hogy e tünetekbol csak a zavartság van jelen. Leggyakrabban krónikus alkoholfogyasztókon figyelheto meg, de társulhat – más kórképek mellett - végstádiumú tumoros betegségekhez is, ahol a zavart viselkedésnek számtalan egyéb oka is lehet. A szerzok idos, elorehaladott gyomortumorban szenvedo férfi betegen észlelt Wernicke-encephalopathiás esetüket ismertetik, felhívva a figyelmet a kórismézés és a differen­ciáldiagnosztika nehézségeire. Orv. Hetil., 2014, 155(1), 30–33.

Oxidative stress plays a key role in the pathogenesis of diabetes mellitus, contributing not only to the development, but also to the progression of diabetes and its related complications. Both immunosuppressive and antioxidant effects of resveratrol in attenuating the increased oxidative stress due to responses of β-cells to leukocyte activation have been implicated in the prevention of type 1 diabetes mellitus. Resveratrol affords advantageous effects by decreasing the oxidative injury and the recruitment of the nutritive precapillary arterioles in the context of disease states associated with insulin resistance, such as metabolic syndrome, pre-diabetes, and type 2 diabetes mellitus. The antioxidant properties of resveratrol could result from its direct effects by acting as a free radical scavenger, as well as its ability to indirectly activate antioxidant enzymes, and other mechanisms. These indirect effects could be conferred either via increased expression/activation/translocation of sirtuin 1, nuclear factor erythroid 2-related factor 2, superoxide dismutase, catalase, heme oxygenase-1, and glyoxalase or the suppression of inducible nitric oxide synthase and p47phox translocation/expression with the resultant inhibition of nicotinamide adenine dinucleotide (phosphate) oxidase. In addition to reducing oxidative stress, resveratrol could also improve the carbohydrate metabolism by promoting similar beneficial metabolic processes to those found in caloric restriction via the activation of sirtuin 1, as well as by increasing the level of glucagon-like peptide 1, by exerting an estrogen-like effect, or by stimulating the peroxisome proliferator-activated receptor-γ activity. In our preliminary human study we examined the effects of resveratrol in type 2 diabetic patients. In agreement with animal studies, we found that resveratrol treatment markedly decreased the insulin resistance and blood glucose levels, whereas we could not detect increases in insulin secretion. We also found that the onset of the postprandial glucose peak was manifested after a longer lag time in the postprandial period with resveratrol treatment, while there were no changes in amylin, glucagon-like peptide 1, and gastric inhibitory polypeptide levels; hormones that prolong gastric emptying. Additionally, we found decreased urinary excretion rates of ortho-tyrosine with resveratrol treatment, indicating a lowered degree of the hydroxyl free radical production in these patients. These findings support the notion that resveratrol decreases oxidative stress through its broad direct and indirect antioxidant effects, and this could be a promising approach for the prevention and treatment of diabetes mellitus. Further studies are undoubtedly warranted to better comprehend the effects of resveratrol in humans, since there is very limited data from human observations.

Background and aims: In vivo and in vitro experiments show the protective role of calcium ions (Ca2+) against colorectal cancer. The calcium-sensing receptor (CaSR) detects extracellular Ca2+ concentration. An association between the CaSR A986S polymorphism and serum calcium in healthy adults has been reported. Subjects with AA genotype had lower serum concentrations of Ca2+ than other genotypes. The expression of erbB-2, epidermal growth factor receptor (EGFR), p53, and ras in colorectal cancer has been suggested to have diagnostic and prognostic significance. Patients and methods: We investigated the relationship between the CaSR A986S polymorphism and the expression of erbB-2, EGFR, p53, and ras as well as the UICC stage in 56 patients with rectal cancer. Results: The occurrence of the genotype AA was not different in cancer patients and in 112 controls. In the presence of the coexpression of major oncogenes, patients with genotype AA were in significantly higher UICC stages than in the case of AS genotype. During the follow-up period AA genotype showed a tendency for poor prognosis. Conclusions: Our observation raises the possibility that genetic alterations of CaSR influence the pathogenesis of rectal cancer.

Apart from the regulation of calcium metabolism, 1,25-dihydroxyvitamin D3 plays an essential role in cell proliferation and differentiation in several tissues. The vitamin D receptor (VDR) gene shows polymorphisms in humans that appear to be clinically significant in some pathological conditions. In the present study, the BsmI polymorphism of the VDR gene was studied in 59 Caucasian patients with rectal cancer (mean follow-up: 48 months). The relationship between VDR genotypes and the expression of oncogenes as well as their influence on survival were also investigated. VDR polymorphism was examined in tumor and normal mucosa cells by PCR technique. The expression of erbB-2/HER-2, p53, ras and epidermal growth factor receptor (EGFR) was also detected by immunohistochemistry and protein blotting. The presence of the VDR B allele significantly correlated with the overexpression of the erbB-2 oncogene. There was no difference in the VDR genotype between cancer and normal mucosal cells. Coexpression of erbB-2, pan-ras, p53 and EGFR internal and external domains was significantly higher in cancer cells than in normal mucosa. There was no significant correlation between VDR genotypes and age, gender, tumor infiltration depth, number and site of lymph node metastases and lymphatic or blood vessel infiltration. The VDR genotype alone did not influence survival. Overexpression of erbB-2 and EGFR was associated with a poor prognosis. In patients expressing only one oncogene in cancer cells, the presence of the VDR B allele showed a tendency to a poor prognosis. In conclusion, VDR gene BsmI polymorphism might affect the development and prognosis of rectal cancer by influencing erbB-2 oncogene expression.

Az inkretinek, a glukagonszerű peptid (GLP)-1, illetve a glukozdependens inzulinotrop peptid (GIP) felfedezese, hatastani sajatossagaik megismerese, majd az inkretinhatason alapulo vercukorcsokkentők forgalomba kerulese jelentős előrelepest hozott a 2-es tipusu cukorbetegseg kezeleseben. Az alapkutatasok folytatodasa szamos reszlet tekinteteben modositotta e hormonok elettanaval kapcsolatos eddigi ismereteinket, atertekelődott a GIP anyagcsere-folyamatokban jatszott szerepe, s megalapozottabba valt a GLP-1 hatas terapias hasznositasa is. A kozlemeny a legujabb adatok bemutatasaval az inkretinek termelődesenek es hatasainak elettani sajatossagait es azok cukorbetegsegben megfigyelhető eltereseit tekinti at, ramutatva a meg pontosabb tisztazast igenylő reszletekre es a terapias alkalmazas jovőbeni lehetősegeire is. Orv. Hetil., 2011, 152, 1922–1930.

Type 2 diabetes is making up to 90% of the all diabetic cases. In addition to insulin resistance, insufficient B-cell function also plays an important role in the pathogenesis of the disease. The insufficient production and secretion of insulin can be increased by secretagogue drugs, like sulfonylureas and incretin mimetics/enhancers. In recent years growing number of genetic failures of the B-cells has been detected. These genetic variants can influence the efficacy of secretagogue drugs. Some of these gene polymorphisms were identified in the genes encoding the KATP channel (KCNJ11 and ABCC8). These mutations are able either to reduce or increase the insulin secretion and can modify the insulin response to sulfonylurea treatment. Other polymorphisms were found on genes encoding enzymes or transcription factors. In the recent years the genetic variants of TCF7L2 and its clinical importance have been intensively studied. Authors give a summary of the above gene polymorphisms and their role in the insulin secretion. Orv. Hetil., 2011, 152, 1651–1660.

A 2-es típusú diabetes kórfejlődése jellemző módon időben elhúzódó és lappangó, olykor a manifeszt betegség kezdeti stádiuma is meglehetősen tünetszegény. Ez megteremti az alapját a szűrővizsgálattal történő betegségfelismerésnek. Szűrővizsgálattal nemcsak a 2-es típusú diabetes, hanem kórmegelőző állapota (összefoglaló néven praediabetes) is felismerhető. A szűrővizsgálat céljára napjainkban az úgynevezett kockázatalapú, kétlépcsős módszer a leginkább elfogadott: az első lépcsőben kérdőív segítségével azonosíthatók a fokozott kockázatú egyének, a második lépcsőben ez utóbbiak körében vércukor-meghatározásra kerül sor. A kérdőívek közül a FINDRISC (Finnish Diabetes Risk Score) használata terjedt el a legtöbb országban, az első hazai tapasztalatok is kedvezőek alkalmazásával kapcsolatban. A szűrővizsgálat megteremti a korai diabetesesetek azonosítását, illetve a primer prevenció lehetőségét. Mindez végül elvezethet a 2-es típusú diabetes előfordulási gyakoriságának csökkenéséhez. Helyes lenne, ha ez az egészségügyi-társadalmi aktivitás hazánkban is – más országokhoz hasonlóan – nemzeti diabetesprogram keretei között valósulna meg.

Inkretineknek az emésztőtraktus speciális sejtjeiben termelődő, peptid természetű hormonokat nevezzük, amelyek a táplálék összetevői, elsősorban szénhidrátkomponensei hatására elválasztódva, közvetett módon, összetett hatásmechanizmussal – döntően a postprandialis vércukorszint csökkentésével – részt vesznek a glükózhomeosztázis biztosításában. Az összefoglaló közlemény a két legfontosabb inkretin, a glükagonszerű peptid (GLP)-1 és a glükózdependens inzulinotróp polipeptid (GIP) élettani termelődésének áttekintése mellett részletesen foglalkozik a szénhidrát-anyagcsere tekintetében meghatározó jelentőségű tényező, a GLP-1 hatástani sajátosságaival és ezek farmakológiai hasznosításának, a 2-es típusú diabétesz kezelésében való felhasználásának lehetőségeivel. A humán GLP-1 rövid felezési ideje folytán a napi gyakorlatban nem alkalmazható. A lebontását végző szerin-peptidáz típusú enzim, a dipeptidil-peptidáz (DPP) IV gátlásával azonban hatástartama megnyújtható. Sikerült is előállítani e hatással rendelkező vegyületeket, amint kifejlesztésre kerültek DPP IV-rezisztens, a GLP-1-től eltérő szerkezetű, de receptorán agonista hatást kifejtő származékok is. Előbbiek az incretin (GLP-1) hatásfokozók („enhancers”), utóbbiak az ún. mimetikumok. Mindkét csoport képviselői törzskönyvezésre is kerültek. Az inkretin hatásfokozók, az ún. „gliptinek” közül a sita- és vildagliptinnel ismertek hosszabb távú klinikai megfigyelések. Az inkretinomimeticumok egy képviselője, az exenatid – szintetikus exendin-4 – került eddig klinikai forgalomba, több mint egy éves alkalmazásáról ugyancsak ismertek tapasztalatok. A rendelkezésre álló adatok alapján mindegyik felsorolt származék a 2-es típusú diabétesz vércukorcsökkentő kezelésének új, hatékony alternatívája lehet. A terápialáncban képviselt helyük ma még egyértelműen nem körvonalazható. Bár érvek sorakoztathatók fel monoterápiában történő korai adásuk mellett is, elsősorban más antidiabetikumokkal kombinált alkalmazásuk látszik reális indikációnak.

To study fasting biologically active serum ghrelin (RIA) and resistin (ELISA) levels in different trimesters of pregnancy (HP, n=45, 15 in each) and in gestational diabetes mellitus (GDM, n=30) compared to non-pregnant healthy women (NP, n=40) in correlation with TNF-alpha, soluble (s)TNF-receptor (R)-1, -2, leptin (ELISA), C-peptide (Cp, RIA) and Cp/blood glucose ratio (bg).Cross-sectional case control study.Acylated ghrelin levels were significantly increased (p0.0001) in the 2nd (377+/-38pg/ml, X+/-S.D.) and decreased in the 3rd trimester (252+/-36) and in GDM (226+/-21) compared to NP controls (309+/-20) and HP women in the 1st trimester (314+/-41). Serum resistin levels were higher in the 1st (8.5+/-2.6ng/ml), 2nd (10.2+/-2.1) and 3rd (13.1+/-3.6) trimesters of pregnancy and in GDM (15.7+/-3.5) than in NP controls (6.5+/-2.3). Significant (p0.01) negative linear correlations were found among fasting serum ghrelin and body mass index (BMI), the fasting C-peptide (Cp) level, C-peptide/blood glucose (Cp/bg) ratio, TNF-alpha, soluble (s)TNFR-2, leptin and resistin concentrations in both, HP and GDM groups. Significant positive correlations were observed between serum acylated ghrelin and adiponectin, and between BMI and fasting Cp, Cp/bg, TNF-alpha, sTNFR-1, -2 and leptin levels in both pregnant groups.Increased fasting serum acylated ghrelin concentrations in the 2nd trimester may associate with weight gain during pregnancy. Hyperresistinemia may also be associated with the pregnancy-induced insulin resistance. A negative regulatory feed-back mechanism between resistin, TNF-alpha and ghrelin may be hypothesized.

Background and aim Previous studies have demonstrated that oxidative stress is increased in obese patients. The high-density lipoprotein (HDL) associated human paraoxonase 1 (PON1) can inhibit low-density lipoprotein oxidation and has an antiatherogenic effect. Our objective was to assess the effects of orlistat therapy combined with diet on body mass index (BMI), waist circumference, lipid parameters, blood pressure, serum glucose level and PON1 activity. Methods and results A longitudinal, multicenter, randomized study with and without orlistat treatment was performed. One hundred thirty nine otherwise healthy, obese subjects were divided in to two groups: 78 persons received orlistat (120 mg three times a day) combined with diet while 61 persons were kept on diet only. Anthropometrical parameters, serum lipid levels and PON1 activity were measured at baseline and after 6 months of treatment. BMI and waist circumference were reduced more pronouncedly in the orlistat group than in the control group. Patients receiving orlistat also had significantly greater improvements in fasting blood glucose levels and blood pressure. The orlistat-treated group showed a greater reduction in total cholesterol and triglyceride levels. In addition, the serum PON1 activity in these patients was significantly increased compared to the diet-only group. Conclusions The 6-month treatment with orlistat had a beneficial effect on the lipid profile and improved the antioxidant status by increasing serum PON1 activity. However, because of the limited therapeutic effectiveness, obese patients with hypercholesterolemia should receive additional lipid lowering medications.

Exposure to certain mycotoxins has been proved to contribute to fertility problems in pigs. Although ochratoxin A (OA) is one of the most common naturally occurring mycotoxins, there is little data concerning the possible effects of this toxin on sperm quality of boars. After a 4-week control period, animals were given 20 μg OA per os daily for 6 weeks, followed by a 9-week withdrawal period. Serum and seminal plasma were monitored for OA with enzyme-linked immunosorbent assay (ELISA). Spermatozoal motility was measured at 0, 24, 48, 72 and 96 h, and ejaculation volume, initial viability and progressive motility were recorded. Samples of testis and epidydimidis were evaluated histologically. Viability, initial forward motility, and motility after 24 h storage were significantly reduced in the experimental group in the withdrawal period only. There were no major histological differences in number and morphology of Leydig cells and epydidimal structures between experimental and control boars. Results of the present study demonstrate that OA may affect sperm production and boar semen quality only after a lag period. Further research is required to elucidate the possibility of a direct or indirect interaction between the toxin and germ cells (spermatogonia).

Role of tumour necrosis factor-alpha (TNF-alpha) was studied in insulin resistance during pregnancy.Serum TNF-alpha (ELISA) and fasting C-peptide (Cp) (RIA) concentrations were measured in 40 healthy pregnant women (15, 12 and 13 of them in the 1st, 2nd and 3rd trimesters, respectively) and in 25 healthy non-pregnant women in a case-control study.TNF-alpha (X+/-S.D.: 5.33+/-0.46 pg/ml) and Cp levels (3.37+/-1.30 ng/ml) were significantly higher in the 3rd trimester as compared with matched healthy controls (TNF: 4.07+/-0.26, Cp: 1.05+/-0.36) and to the pregnant women in 1st (TNF: 4.04+/-0.26, Cp: 1.34+/-0.59) and 2nd (TNF: 4.35+/-0.32, Cp: 1.11+/-0.35) trimesters. Significant positive linear correlation was calculated among TNF-alpha, Cp, Cp/blood glucose ratio (indirect parameters of insulin resistance) and body mass indexes (BMIs) of pregnant women (P0.01).TNF-alpha may contribute to the insulin resistance during the course of normal pregnancy.

OBJECTIVE: We studied the significance of BsmI restriction enzyme polymorphism of the vitamin D receptor (VDR) gene and the XbaI and PvuII polymorphisms of the estrogen receptor (ER) gene in patients with type 2 diabetes (n=49), android type obesity with normal carbohydrate metabolism (n=29) and healthy controls (n=138). METHODS: The distribution of genotypes in the study groups, as well as their relationship to fasting and 1 h postprandial serum C-peptide levels were analyzed. RESULTS: Postprandial serum C-peptide levels of BB genotypes were significantly higher in the diabetes and obese groups (6.18+/-5.09 ng/ml) compared with other genotypes (2.71+/-2.45 vs. 1.72+/-1.97 ng/ml, respectively, P=0.05). Among patients with type 2 diabetes and obese subjects, the XX allelic variant of the ER gene was more frequent (P=0.00015). Postprandial C-peptide levels of subjects exhibiting XX genotype were significantly lower compared with those with Xx genotype (1.67+/-2.16 vs. 3.8+/-3.72 ng/ml, P=0.021). The BBXx allelic combination of the VDR/ER receptor genes was less frequent in diabetic patients than in healthy subjects or in obese patients. The BBXx genotype was associated with significantly elevated postprandial C-peptide levels in all subjects compared with other combinations (9.65+/-3.14 vs. 1.35+/-2.82 ng/ml, P=0.003). No difference was found in the distribution of the PvuII polymorphism of the ER gene or in the association with the C-peptide levels among study groups. CONCLUSION: Polymorphisms of the VDR/ER receptor genes might play a role in the pathogenesis of type 2 diabetes by influencing the secretory capacity of beta-cells.

The role of tumor necrosis factor-alpha in insulin resistance has been studied in 59 patients with Type 2 diabetes, 28 with android type obesity and 35 healthy lean controls. Immunoreactive concentrations and bioactivity of serum tumor necrosis factor-alpha have repeatedly been determined in 8 weeks intervals for 12 months, five times per patients, by using ELISA and L929 cell cytotoxicity bioassay. Significantly higher immunoreactive tumor necrosis factor-alpha concentrations and bioactivity have been found in both, the Type 2 diabetic and obese groups as compared to the healthy persons. Tumor necrosis factor-alpha concentrations and bioactivity have showed a significant positive linear correlation with the elevated basal serum C-peptide levels and body mass indexes in both groups of patients. According to these data the cytokine might play a role in insulin resistance in obesity as well in Type 2 diabetes.

Objective: To study the influence of diabetes on the endothelium-dependent vasodilation in the coronary arterial bed. Methods: The effects of acetylcholine (ACh 2–36 pmol·kg−1; 18 nmol·l−1–9.8 μmol·l−1; 0.1–10 μmol·l−1), l-arginine (1 mmol·l−1) and sodium nitroprusside (1 nmol·l−1–100 μmol·l−1) were measured on coronary conductivity, vascular tone and cGMP release (RIA) in healthy and diabetic dogs. Results: ACh-mediated (in cumulative intra-arterial infusion) increase in coronary conductivity was reduced ( P

Lindsay et al. (1) recently published an article in Diabetes Care that claims adiponectin is present in the cord blood of the offspring of diabetic and nondiabetic pregnant mothers and that its level does not correlate with their birth weight and skinfold thickness. Our data, obtained from a case-control study of nondiabetic women and women with gestational diabetes mellitus (GDM), further support the role of adiponectin in insulin resistance. We observed significantly decreased plasma adiponectin levels (7.55 ± 2.04 μg/ml [means ± SD]) using radioimmunoassay (Linco Research, St. Charles, MO) (intra-assay precision coefficient of variation [CV] 3.86%, interassay CV 8.47%) in 30 women with GDM, all of whom were treated with insulin (aged 28.12 ± 2.71 years, gestational age 27.35 ± 6.15 weeks), compared with 40 nondiabetic pregnant women tested with oral glucose tolerance test (OGTT) (total group 9.91 ± 3.32, P < 0.01, Mann-Whitney, aged 26.91 ± 2.65 years, gestational age …

Growth hormone (hGH) reserve following arginine administration and the paradoxical hGH response to thyrotropin-releasing hormone (TRH) were studied in 30 diabetics without evidence of vascular complications. The diabetics were divided into 4 groups according to the type of their disease and to the metabolic condition within the IDDM group (insulin-dependent: IDDM, in acceptable response and in poor metabolic control; non-insulin-dependent: NIDDM, and juvenile diabetics not requiring insulin at least for two years after diagnosing their disease: NIDDY). The results were compared with controls of identical age and normal weight. A paradoxical hGH response to TRH stimulation was found only in IDDM patients in poor metabolic control. In this group the hGH reserve revealed by arginine was significantly larger than in the others. It was shown that the induced hGH release was independent of the sex distribution of the groups and of the basal hGH values. Magnitude of the hGH reserve and appearance of the paradoxical hGH response were not necessarily correlated but the substantial reserve was frequently associated with a paradoxical response. It can be assumed that the unfavorable metabolic condition is of decisive importance in giving rise to these anomalies. Our observations seem to confirm the need for good metabolic control if the pathological hGH secretion in diabetics is to be prevented.