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Background and aims: Depressive symptoms and diabetes-related distress may adversely interact with patients' effectiveness in the learning process during diabetes self-management education. This study was aimed at comparing baseline and follow-up indicators of diabetes knowledge and glycaemic control in patients with and without these symptoms who attended an educational course. Patients and methods: One hundred and sixty-six patients (aged 48± 15 years, 52% female, 38% type 1, with diabetes duration of 10± 8 yrs, 78% insulin treated) who participated in a 5-day educational course were assessed for depression and diabetes-related distress using the Center for Epidemiological Studies-Depression scale (CES-D) and the Problem Areas in Diabetes (PAID) scale. The CES-D score ≥ 16 and the PAID score ≥ 40 were considered indicative of severe depressive symptoms and high distress caused by diabetes. Diabetes knowledge was assessed at the beginning and at the end of the course using parallel forms of the Diabetes Knowledge Test (DKT). Indicators of glycaemic control as measured by HbA1C were assessed at the beginning of the course and after 3, 6 and 12 months. Baseline and follow-up indicators of diabetes knowledge and glycaemic control were compared in the subgroups of depressed-distressed, depressed, distressed and symptom-free individuals using the Kruskal-Wallis ANOVA. Results: Thirty-two percent of patients attending the educational course reported elevated depressive symptoms and high diabetes-related distress, 9% expressed elevated depressive symptoms, 10% high diabetes distress and 49% reported none of these symptoms. The four subgroups differed with respect to diabetes knowledge assessed at the beginning of the course (H=11.2 p=0.01), with depressed-distressed individuals having poorer knowledge as compared to the symptom-free individuals (p=0.02). Diabetes knowledge did not differ across the subgroups after the course (H=6.2 p=0.10), indicating comparable improvement in all participants. Depressed-distressed, depressed, distressed and symptom-free individuals had comparable baseline HbA1C values (H=3.6 p=0.31), which improved correspondingly after 3 and 6 months (H=3.2 p= 0.36 and H= 6.7 p=0.08 respectively). Differences in HbA1C values across the subgroups were observed at 12-month follow-up assessment (H=7.7 p=0.05), indicating poorer control in depressed-distressed vs depressed individuals (p=0.04). Conclusions: The benefits of a five-day educational course defined as improvements in diabetes knowledge and long-term diabetes control were shown to be comparable in patients reporting depressive symptoms and diabetes-related distress as compared to patients without these symptoms. Patients with double symptoms have greater difficulties in maintaining an acceptable long-term glycemic control, suggesting a need for a more intensive follow-up.

The purpose of this essay is to review available evidence on lifestyle, pharmacological and herbal remedies influence on the prevention or delay of the onset of type 2 diabetes and adapting these lessons from clinical trials to clinical practice. A Medline literature search from 1997-2006 was performed to identify articles on the prevention or delay of type 2 diabetes in adults. The limits were practical guidelines, systematic reviews, randomized controlled trials (meta-analyses), as full text articles or abstracts, and with no limits for the period searched. Different trials and systematic reviews have revealed that pharmacological and lifestyle interventions can reduce the rate of progression to type 2 diabetes in people with impaired glucose tolerance. The overall goal for diabetes prevention is to reach and maintain an active, healthy weight with a tendency toward a hypo-caloric diet. Pharmacological interventions also reduced diabetes risk. However, lifestyle changes were more effective and are recommended as first-line strategy. For pharmacological interventions adverse effects need to be fully understood to enable the potential harms and benefits to be assessed. Therefore, better approach to patients for lifestyle changes should be achieved through a structured program in order to delay or prevent type 2 diabetes. Multidisciplinary healthcare teams may provide more intensive counseling and increase the contact the patient has with the overall healthcare system.

Madelung’ s disease is an extremely rare disorder of unknown etiology, characterized by prominent, symmetric masses of adipose tissue on the neck, shoulders, arms and upper parts of the trunk. Although benign in its nature, tongue or mediastinal involvement can cause compression syndromes of the trachea and superior vena cava leading to dyspnea, dysphagia and dysphonia. It predominantly affects men between the ages of 30 and 60 years, of Mediterranean origin and with a history of alcohol abuse. The disorder can also be associated with hyperlipoproteinemia, hyperuricemia, diabetes mellitus and hypothyroidism. The only effective treatment is surgical removal or liposuction, but recurrences are common. A case of a 51-year-old man with unusual pseudoathletic appearance, history of excessive alcohol consumption and subcutaneous fat tissue biopsy is presented and typical features of Madelung’ s disease are discussed.

Inzulinsko liječenje provodi se, između ostalog, primjenom supkutanih insulinskih injekcija. Dnevna doza individualno je varijabilna. Cilj: Ustanoviti broj aplikacija i dnevnu prosječnu dozu inzulina, a nakon 5 godina to ponoviti u istih bolesnika.

Primjena inzulinskih pumpi sve je više zastupljena u liječenju tipa 1 i 2 šećerne bolesti. Cilj liječenja inzulinskom pumpom uz postizanje normoglikemije i odgode razvoja kroničnih komplikacija je i poboljšanje kvalitete života dijabetičkih bolesnika. Uključeno je 25 bolesnika tipa 1 šećerne bolesti, zbog prekoncepcijske regulacije, jakih neprepoznatih hipoglikemija i izrazito loše metaboličke regulacije, gdje se uz primjenu svih dosadašnjih načina liječenja nije uspjela postići zadovoljavajuća regulacija.

Aim: The aim of the study was to investigate the role of statin, aspirin and angiotensin-converting enzyme (ACE) inhibitor therapy in the development of atherosclerosis via their effect on the reduction in C-reactive protein (CRP) and homocysteine (HCY). Methods: A total of 243 type 2 diabetic patients were studied during a 1-year follow-up period. Patients were randomized to receive atorvastatin (n = 59), simvastatin (n = 64), pravastatin (n = 38), or ACEinhibitor lisinopril (n = 43). The control group included 39 patients. CRP, HCY, atherogenic index of plasma (AIP), body mass index (BMI), pulse pressure (PP) and albumin excretion rate (AER) were determined. The patients were assigned to groups based on AER/mg/24 h/ (300), PP (65) and BMI (30). Results: ANOVA revealed significant differences in initial CRP and AIP (P = 0.01 and P = 0.041, respectively) according to AER and BMI (both P < 0.001), and in HCY and AIP (both P < 0.001) according to PP. Multiple linear regression for CRP, HCY, age, diabetes duration, BMI, AIP, AER and PP was significant (P < 0.01) and showed BMI and AIP to be independent predictors of CRP, and age, AER and BMI independent predictors of HCY (P < 0.05). CRP was significantly reduced in the groups treated with atorvastatin (P < 0.001), simvastatin (P = 0.049) and lisinopril (P = 0.012). HCY was significantly reduced in the simvastatinand pravastatin-treated groups (P = 0.015 vs. P = 0.002), and AIP and PP were significantly reduced in the simvastatin- and atorvastatin-treated groups (both P < 0.01). A significant reduction (P < 0.005) in AER and PP was revealed in the lisinopril group. Conclusions: BMI was an independent predictor of inflammatory markers, whereas ACE-inhibitors and statins had a beneficial effect on blood pressure and lipid profile. The latter can attenuate inflammation by reducing CRP and HCY and, consequently, together with body weight reduction, delay the development of atherosclerosis.

Background:To determine if a reduced nocturnal fall in blood pressure increases the risk of microvascular complications in normoalbuminuric and normotensive type 1 diabetics. Patients and Methods: One hundred thirty nine type 1 diabetic patients with 24h urinary albumin excretion < 30 mg/24h and casual BP 0.9 as dippers and nondippers. Results:Between the dippers (n=113) and nondippers (n=26) according to diastolic blood pressure ratio, a significant difference in 24h urinary albumin excretion (12.21 &plusmn ; 5.45 ; 18.78&plusmn ; 4.73, p= 0.001) and prevalence of nonproliferative retinopathy (44.24% ; 76.9%, p= 0.03) was found. Between the dippers (n=76) and nondippers (n=63) according to systolic blood pressure ratio, a significant difference in 24h urinary albumin excretion (10.63 &plusmn ; 4.33 ; 16.76&plusmn ; 5.8 p= 0.001), prevalence of nonproliferative retinopathy (28.9% ; 66.6%, p= 0.04) and duration of diabetes was found (9.55 &plusmn ; 8.84 ; 14 &plusmn ; 9.41, p=0.004). Night/day diastolic blood pressure ratio was related to 24h urinary albumin excretion and retinopathy (r=0.406, r=0.23). In a stepwise multiple regression analysis urinary albumin excretion was significantly associated with night/day diastolic blood pressure ratio (β =0.794), retinopathy was significantly associated with night/day diastolic blood pressure ratio (β =0.949) and duration of diabetes (β =0.04). Conclusion: An impaired night diastolic blood pressure fall is associated with high normal urinary albumin excretion and retinopathy in normoalbuminuric and strictly normotensive type 1 diabetic patients and may be relevant to the long-term development of microvascular complications.

The paper deals with the role of angiotensin receptors and angiotensin converting enzymes in the progression of diabetic nephropathy.

In diabetic patients, the presence of hypertension amplifies an increased risk in cardiovascular disease. Approximately two- thirds of them die from cardiovascular complications. Over the last decade extensive randomised trials showing a clinically significant benefit in outcomes with lowering of blood pressure levels, led to the revision of the definition of hypertension in diabetic population. According to recent guidelines, a target blood pressure goal of < 130/80 mmHg is recommended. The diagnosis of hypertension should be made based on three or more separate measurements, after 5 minutes rest in the supine and standing position. A wider cuff should be used if the mid-arm circumference is greater than 33 cm. Non-invasive ambulatory blood pressure measurement (ABMP) is becoming more widely used in diabetic patients due to some advantages over the standard sphygmomanometer, particularly due to a close relation to a range of target organ damage. Pharmacological therapy needs to be individualised to fit patients' needs and combinations of drugs are often necessary to achieve target levels of blood pressure control. ACE inhibitors, ARBs, diuretics, calcium channel blockers and ß-blockers have all been documented to be effective pharmacological treatment. Because of the proven beneficial effects on progression of nephropathy, the established practice of choosing ACE inhibitor or AT antagonists as first-line agent in type 1 and type 2 diabetics is reasonable. Beta-blockers, diuretics and Ca channel-blockers should be used as second-line agents, and alpha-blockers, under specific indications.

Many reports show a 20% decrease in the risk of coronary disease in people taking small amounts of alcohol (5-14 drinks per week), i.e. less than 30 g alcohol per day for men and 15 g alcohol per day for women. On the other hand, diabetes mellitus is associated with the highest rate and earlier development of atherosclerotic changes as compared with the general population, diabetes mellitus being one of the risk factors for coronary disease. Alcohol has an antiatherogenic effect, the possible mechanisms implying alcohol metabolism into acetaldehyde that inhibits the formation of glycosylation endproducts and lipoprotein oxidation, reduces platelet aggregation, and influences vascular relaxation depending on the endothelium mediated by the NO-cyclic guanosine 5- monophosphate system. Thus, moderate alcohol consumption in diabetics does not interfere with normotriglyceridemia if taken at meals. The recommended alcohol intake is 1-2 drinks daily or 5- 14 drinks weekly.

Intensive diabetes management can be achieved in children, adolescents and adults either with the use of continuous subcutaneous insulin infusion or with multiple daily injections. The goals of intensive diabetes management established by the Diabetes Control and Complications Trial are to achieve near normal glycemia, to avoid short-term crises such as hypoglycemia requiring third part assistance or intervention, to minimize longterm complications, and to improve the quality and length of life in persons suffering from diabetes. The importance of tight metabolic control in patients with diabetes was also demonstrated by the results of United Kingdom Prospective Diabetes Study, and emphasized in the Saint Vincent Declaration. Disadvantages of multiple daily injections are the need for patients to take three or even more injections per day by syringe or pen, resulting in poor compliance, and to use modified insulins, intermediate or long-acting insulins (NPH, Lente, Ultra-lente) that must be injected to reach basal concentration of insulin to keep blood glucose within normal limits between meals. It has been clearly shown that absorption of modified insulins vary from 19% to 55% in the same individual, which could be the reason for blood glucose variability. Conversely, the absorption of soluble, short-acting insulins that are used in continuous subcutaneous insulin infusion varies by less than 3% daily. As the result of continuous subcutaneous insulin infusion – insulin pump therapy and use of a continuous glucose sensor, achievement of the main goals in diabetes treatment could rather become a matter of fact. During recent years continuous subcutaneous insulin infusion has reached widespread recognition, as it has become the mode of intensive diabetes treatment for more than 200 000 diabetic patients worldwide.

It is known that type 1 diabetes mellitus and celiac disease have a similar genetic background associated with HLA DQ2 or 8, and similar trigger mechanisms for autoimmune process. Celiac disease typically presents with malabsorption but in recent years there is an increasing number of atypical or silent form. Untreated celiac disease may be associated with long-term health risks. The institution of gluten-free diets may result in rapid and often dramatic improvement of symptoms. Extended monitoring is needed due to documentation of the clinical benefits of screening and treatment in diabetic patients.

To order to investigate factors related to the development of retinopathy in 122 normotensive and normoalbuminuric patients 24 h blood pressure (BP) measurement and autonomic tests based on standard, vector and spectral analysis of heart rate variation (HRV) were performed. Retinopathy was found in 47 patients with significantly higher duration of diabetes and incidence of autonomic neuropathy ( 9, 5&plusmn ; ; ; ; 5, 5 ; 59, 6%) in comparison with 75 patients without retinopathy (5.29&plusmn ; ; ; ; 4.9 ; 16%), (p

In numerous studies, asymptomatic hyperglycemia has been shown to be a risk factor for cardiovascular and coronary disease, with a higher risk of dying from coronary disease. Hyperglycemia may develop during severe diseases (e.g., acute myocardial infarction) in people who have not previously suffered from diabetes. The aim of the study was to determine the number of patients with acute myocardial infarction (AMI) in whom hyperglycemia was detected for the first time during AMI. The study included 412 nondiabetic patients treated for AMI at the Department for Medicine, Cantonal Hospital in Zenica, during 1991, 1993 and 1996. The 1993 European standards were used to make the diagnosis of hyperglycemia. Out of 412 nondiabetics with AMI, 113 (27.43%) had hyperglycemia during their hospital stay. According to year of treatment, there were 29 (22.83%), 50 (34.97%) and 34 (23.94%) patients in 1991, 1993 and 1996, respectively. According to year of hospitalization, a statistically significantly higher percentage of nondiabetics with first-ever detected hyperglycemia during AMI were recorded in the war year 1993 as compared with 1991 and 1996 (p

Risk factors for coronary disease, apart from some others, are cigarette smoking, excessive consumption of alcohol, overweight and obesity. The aim of the study was to evaluate the frequency of these three risk factors of coronary disease among diabetics and nondiabetics treated for acute myocardial infarction (AMI) before the war in 1991, during the war in 1993, and after the war in 1996. The aim was also to establish whether there were differences in the frequency of these three factors in diabetics treated for AMI among the three study years. The study included diabetic and nondiabetic patients with AMI hospitalized at the Department of Medicine, Cantonal Hospital in Zenica during the mentioned period. According to study years, there were 163 AMI patients in 1991, 36 (22.09%) of them diabetic and 127 (77.91%) nondiabetic ; 174 AMI patients in 1993, 31 (17.82%) of them diabetic and 143 (82.18%) nondiabetic ; and 169 AMI patients in 1996, 27 (15.98%) of them diabetic and 142 (84.02%) nondiabetic. Patient data were obtained from medical files of the Department of Medicine, Cantonal Hospital in Zenica, and a few missing data directly from the patients or their close relatives through a questionnaire. The study was retrospective in design. Statistical analysis was done by use of chi2-test and t-test. Data are shown in tables and figures. There were significantly fewer smokers and alcohol users among diabetic compared to nodiabetic AMI patients in all three study years. On the other hand, there was a significantly higher percent of overweight and obese patients among diabetic compared to nondiabetic AMI patients. A significantly higher percent of smokers and alcohol abuse patients were recorded among diabetic AMI patients in 1991 and 1993 compared to 1996. However, there was a statistically significantly higher percent of overweight and obese patients among diabetic AMI patients in 1991 and 1996 than in 1993. In conclusion, we found a statistically lower percent of smokers and alcohol abusers but a higher percent of overweight and obese patients among diabetic as compared to nondiabetic AMI patients. Among diabetic AMI patients there was a statistically higher percent of smokers and alcohol abusers in 1991 and 1993 than in 1996, and a statistically lower percent of overweight and obese patients in 1993 compared to 1991 and 1996.

The effect of diabetic pregnancy on fuel metabolism is one of underutilization of exogenous fuel in the fed state (facilitated anabolism reduced) and over- production from endogenous source in the fasted state (hyperaccelerated starvation). The first sign of preg- nancy in a diabetic (particularly in type 1 diabetes) as early as the first week of gestation and even before nausea or vomiting sets in may be early morning fasting ketonuria. A minor proportion of women lack the necessary B-cell reserve to maintain euglycemia during pregnancy, and develop impaired glucose tolerance (IGT). They have significantly lower insulin responses at 30 and 60 min after oral glucose load compared with glucose-tolerant controls, while insulin sensitivity is similarly reduced in the second trimester.

Emergencies in diabetes can be fatal if not attended promptly. Moreover, successful treatment of patients with diabetes depends on regular contact with the caring physician. There are thousands of villages in India where people have to walk or travel by bullock cart for miles together to obtain even a simple medical aid. A more challenging problem is the scarcity in rural areas of lavatory facilities, which are essential for proper care of diabetes patients. In India, facilities for even ordinary clinical and biochemical investigations are available only in large towns and cities but not in small towns or villages. Remedies for diabetes prescribed by native medical men include neem tree leaves, bitter gourd juice, honey, etc. Some quacks have made fortunes selling wooden tumblers made from a particular tree, claiming that cold water kept in a tumbler for a few hours has an antidiabetic action. From the above description it is evident that there are many major problems and challenges in diabetic health care in India. Today, the position of India is unique in that it shares all health and economic problems of developing countries, and at the same time the incidence of diabetes, atherosclerosis and ischemic heart disease is not very low. A comprehensive approach is necessary for planning and implementing prevention and control programs for noncommunicable diseases including diabetes with common underlying risk factors.

In diabetic patients with proteinuria the relative mortality is about 40 times higher than in diabetics without proteinuria. Renal damage is a serious complication of diabetes mellitus (DM). It is estimated that death due to renal disease is 17 times more common in diabetics than in nondiabetics. Diabetic nephropathy is the most important cause of death in type 1 diabetic patients, of whom 30%-40% eventually develop end-stage renal failure. Death due to diabetic nephropathy with renal failure is less common in type 2 DM. The relative risk of renal mortality in diabetic patients diagnosed after the age of 45 years is estimated to be twofold that in nondiabetic patients. However, proteinuria as an indicator of renal involvement is not uncommon in patients with type 2 DM. It is now established that in both type 1 and 2 DM, urinary excretion of small amounts of albumin (microalbuminuria) is predictive of morbidity and mortality due to renal complications and cardiovascular disease.

The paper describes the frequency of most common diabetic complications and its influence on development of subsequent complications.

It is widely held that urinary tract infection (UTI) is more common in subjects with diabetes mellitus. Although there are relatively few recently published data, there is evidence suggesting that bacteriuria is more common in females but not in males with diabetes. Certain renal tract infections, including emphysematous pyelonephritis and cystitis, perinephric abscess, and candidiasis, show close association with diabetes mellitus. These, together with renal papillary necrosis, form the basis of UTI. Urinary tract is the most important and most common site of infection in diabetic patients. Diabetic patients have been found to have 5-fold frequency of acute pyelonephritis at autopsy than nondiabetics. The incidence of bacteriuria in diabetic men with good control of blood sugar is reported to be similar as in nondiabetic men, however, in pregnant diabetic women it is 2-4 times as common as in control groups.

The paper describes methods and frequency of HbA1c measurement in health care centers in Croatia.

The paper describes the most common conditions associated with acidosis in persons with diabetes mellitus.

The paper describes the relationship between AMBP and albuminuria in patients with type 1 diabetes mellitus with normal blood pressure.

The paper deals with new approaches in education of type 1 diabetics and their needs in modern social environment.

The poster presents correlations between late complications in diabetic patients in Croatia.

Diabetic foot is a common problem in diabetic patients and contributes to morbidity and mortality in this population. About 15% of diabetic population are affected. The problems associated with foot ulcers (inflammation, amputation) result in a reduced quality of life, and significant morbidity and mortality in diabetic patients. The major contributing factors for diabetic foot development are diabetic neuropathy leading to foot deformities, elevated peak plantar pressure and callus formation ; penetrating trauma ; and ill-fitting shoes. Peripheral neuropathy has a central role, being present in over 80% of diabetic patients with foot lesions, but ischemia is also a frequent contributing factor. An interdisciplinary approach is mandatory in the treatment of diabetic foot, especially once neuropathic ulcers or inflammation have developed. Hyperbaric oxygen therapy has been used with the aim to improve diabetic foot oxygenation and accelerate healing. The role and place of hyperbaric oxygen in the management of diabetic foot are reviewed.

At the Department of Obstetrics and Gynecology, Perinatal Unit for Diabetes and Fetal Growth, Zagreb University School of Medicine, perinatal care of diabetes-complicated pregnancies has been practiced for more than 36 years now. The purpose of this paper is to present results of a study of diabetic pregnancies and latest clinical advances in the perinatal care of such pregnancies. Pregnancy complicated with diabetes is at risk for a number of maternal, fetal, and neonatal complications. Recent advances in medicine, especially in diabetology and perinatology, help the clinician avoid or lessen antenatal or perinatal complications in diabetic pregnancies. The main result of improved perinatal care is that today, the fetal and neonatal mortality in diabetic pregnancy is almost equal to that in the healthy pregnant population. Intensive preconceptional care and optimal regulation of insulin dependent diabetes have resulted not only in decreased perinatal mortality but also in a decreased rate of congenital malformations. On the other hand, tight glycemia control during pregnancy has an impact on fetal growth. Intensive control of fetal growth, verification of lung maturation at term by amniocentesis, and surveillance of fetal oxygenation will result in giving birth to a mature, eutrophic newborn with the lowest rate of neonatal complications possible. Perinatal mortality of less than 2% in diabetic pregnancy can be achieved by planned delivery between week 38 and 39 of gestation, either by the vaginal route or by cesarean section, depending on the indication. After delivery, intensive care of the newborn is required.

A 56-year-old man was admitted to surgical department for bilateral thromboembolisms of the femoral and popliteal arteries. A year before, he had chest pains and two months before he suffered temporary episodes of occipital headache. Paroxysmal jumps of blood pressure with profuse sweating were observed, and pheochromocytoma was suspected. The patient also had elevated values of blood glucose, with no history of diabetes mellitus. High values of catecholamines and vanilmandelic acid were found in 24-hour urine. Computed tomography revealed a tumor of the right adrenal gland. After preoperative treatment with alpha and beta blockers, the tumor was removed. Pathohistologically, it was a benign tumor. The levels of blood pressure and blood glucose normalized after the surgery. While diabetes is not uncommonly associated with pheochromocytoma, there are no published reports on peripheral embolisms in patients with pheochromocytoma. The etiology and pathophysiologic mechanisms of embolisms in our patient remained unknown. Transthoracic echosonography and aortography did not reveal thrombotic masses. Transesophageal echosonography was not performed ; therefore, a thrombus in the left atrium auricle could not be excluded with certainty as a possible cause of embolisms.

The safety, efficacy, and pharmacokinetics of glimepiride were investigated in a multiple-dose, open study in subjects with non-insulin dependent diabetes mellitus (NIDDM) and renal impairment. Glimepiride was given to 19 patients over a 3-month period. NIDDM patients were divided into two groups with creatinine clearance of 30-60 and 10-30 mL/min. The initial daily dose of 1 mg glimepiride was adjusted within the range of 1-8 mg to achieve good glucose control. Safety evaluation and tests were performed before, and 1, 2 and 3 months after start of the trial. Standard safety parameters were observed: vital signs, standard clinical biochemistry and hematology determinations, etc. Adverse events were monitored and recorded throughout the study. Glimepiride was well tolerated and there were no drug-related adverse events other than recurrent hypoglycemia episodes in one patient (she did not require further antidiabetic drug treatment thereafter). Three of 19 subjects were not eligible for efficacy and pharmacokinetic evaluation, two of them due to inadequate glycemic control and one due to his decision to withdraw from the study. The therapeutic goal of a fasting blood glucose level of

Appropriate diet and physical exercise followed by selfmonitoring and selfmanagement remain the main forms of therapy in NIDDM patients, but about 20% of patients need insulin to achieve acceptable glycemic control. This study was aimed to show whether basal insulin alone could ensure satisfactory control of blood glucose levels in NIDDM. We selected a group of twelve patients with type II diabetes in whom the treatment with oral hypoglycemic agents failed. The treatment with glibenclamide was discontinued, and one evening dose of long-acting insulin was introduced. Mean fasting glucose declined significantly six months after insulin introduction (from 13.08± 1.85 to 7.31± 2.95 mM/L ; p=0.00002), and so did HbA1c (from 10.61± 2.34% to 7.38± 1.37% ; p=0.0005). A slight, nonsignificant rise in body weight was observed (from 83.25± 13.76 to 83.33± 13.28 kg ; p=0.47). Only three mild hypoglycemic episodes were reported. We conclude that imitating basal insulin secretion in NIDDM patients who require insulin enables nearly as smooth a glycemic control as in healthy persons, without any major risk of hypoglycemia or weight gain.

Apolipoprotein E (apo E) polimorfizam jedna je od glavnih čimbenika koji utječu na metabolizam lipoproteina. Tri izoforme apo E (E2, E3, E4) određuju šest različitih genotipova. Svaka izovorma je kodirana s tri različita alela na apo E lokusu kromosoma...

Rad se bavi procjenom obuhvaćenosti i učinkovitosti mjerenja glikoziliranog hemoglobina u Republici Hrvatskoj.

Članak se bavi novostima u područkju dijabetologije prezentiranim na skupovima održanim u ljeto 1997. godine.

Uvodnik govori o aktualnoj temi broja.

Opisuje se ustroj "Hrvatskog modela" zdravstvene zaštite bolesnika sa šećernom bolesti te pokazuje njegovo funkcioniranje u zadanim uvjetima današnjeg vremena.

The study was carried out to determine whether patients with poorly controlled diabetes mellitus had a higher rate of vaginal candidiasis than control subjects, and whethere there was a relationship between the duration of diabetes and rate of vaginal candidiasis. Sixty-five women with insulin dependent diabetes mellitus were matched by 59 diabetes-free control women. Vaginal samples were obtained on gynecologic examination and cultured on Sabouraud agar at 27 and 35 °C. Colonies of Candida albicans grew after 3-15 days. Candida albicans was isolated in 20.9% of all women, i.e. in 18.6% of control women and 23.1% of diabetic women. The women with poor glycemia control showed a higher rate of vaginal candidiasis than those with acceptable glycemia (32.3% vs. 14.7%), but the difference was not statistically significant. There was no significant correlation between Candida albicans isolation and duration of diabetes mellitus. No significant relationship was found between previous and present vaginal infection either.

The current diagnostic criteria for diabetes were recommended by the National Diabetes Data Group in 1979 and World Health Organization in 1980. This review covers the epidemiological basis of these diagnostic criteria which have been chosen to reflect the risk of diabetic complications. In the past sixteen years, the new knowledge has raised the question of the need of new criteria. OGTT and 2-hour post-load plasma glucose have been considered the gold standard, however, current knowledge indicates it to be equivalent to fasting plasma glucose values and glycated haemoglobin.

The role of menopausal status in vaginal infections was studied in IDDM patients and healthy women. Relationship between chronic diabetic complications and vaginal candidiasis in diabetics was also investigated. Study group of 65 women with IDDM were matched by 59 healthy control women. Vaginal swabs were cultured on Sabouraud agar at 27 and 35 °C. Candida albicans colonies grew after 3-15 days. In the control group, there were 20% and 17.2% of pre- and postmenopausal women with candidiasis, respectively. There was no significant difference between these two subgroups. In the study group, a higher rate of vaginal candidiasis (24%) was recorded in postmenopausal women. There was no significant relationship between the menopausal status and vaginal candidiasis. Neither was any significant difference observed when the rate of vaginal candidiasis was compared between IDDM patients with concurrent nephropathy and neuropathy, and patients with at least one of other diabetic complications. Each diabetic patient with vaginal candidiasis had at least one diabetic complication. There was no significant difference between the patients with and without diabetic complications according to vaginal candidiasis.

Opisuju se smjernice u dijagnostici i liječenju inzulin-neovisnog oblika šećerne bolesti.

Diabetic patients develop chronic complications which are difficult to control and treat: diabetic foot, somatic neuropathy, diabetic osteopenia, connective tissue structural and functional damage, and limited joint mobility. The medicamentous or surgical modes of treatment have varying success. Physiotherapy employs various effective but noninvasive methods of treatment. It removes pain, decreases swelling and inflammation, increases local circulation and facilitates bone and soft tissue healing. Electrotherapy, hydrotherapy, helium-neon laser and ultrasound are the main types of, in some cases, single therapy or often adjuvant therapy when the usual medication proves inadequate. In connective tissue and joint diseases, physiotherapy has the crucial role in the treatment of nondiabetic and diabetic patients.

The nature and composition of glycohemoglobin are discussed. Glycohemoglobin (particularly HbA1c) is a useful indicator of glucose levels during the recent patient's history, since it has a half-life of about 120 days and gets "tagged" by blood glucose. It has been shown, however, that the proportion of different variants of glycohemoglobin varies in different conditions and diseases, so that caution must be exercised when using the results of HbA1c in clinical work. In spite of numerous shortcomings, it is a useful diagnostic tool. Various measurement methods and their properties are presented. Furthermore, the question of standardization is discussed in order to optimize practical unification of analysis results.

Impotence is the inability of achieving an erection sufficient for vaginal penetration in 50 or more percent of attempts at coitus. Various researchers have found 35%-75% of men with diabetes to have problems with erection. In 1798, Rollo was the first to report on impotence in persons with diabetes, and in 1906 Naunyn observed it to be the most frequent complication of diabetes in males. McCulloch et al. have reported that 9% of diabetic men aged 20-29 years, and 95% of those aged more than 70 years have erectile impairment. Impotence occurs in patients with IDDM as well as in those with NIDDM. According to our observations, it is somewhat more frequent in insulin-dependent patients. Some authors have reported an association of diabetes duration and impotence, while others did not find this association. Erectile dysfunction in men with diabetes mellitus can occur as: 1. a consequence of diabetes, i.e. as its complication ; 2. impotence as the first sign of diabetes ; or 3. transitory erectile dysfunction as a sign of insufficient regulation of carbohydrate metabolism. Making the diagnosis of erectile dysfunction in persons with diabetes requires team work including a diabetologist-endocrinologist, psychologist, neurologist, angiologist and urologist. Upon making the diagnosis, the patient is given appropriate treatment depending on the cause. In the treatment of erectile dysfunction in persons with diabetes, numerous vasoactive substances as well as various types of prostheses and blood vessel surgery are available today.

Rad opisuje utjecaj intenzivirane terapije na učestalost razvoja, odnosno progresije kroničnih komplikacija šećerne bolesti.

The EURODIAB Insulin Dependent Diabetes (IDDM) Complications Study was a cross-sectional study of a stratified random sample of IDDM patients attending 31 clinics in 16 European countries. The findings in Zagreb (140 patients) were compared with those of the study group as a whole (3, 250 patients). The Zagreb patients had worse glycemia control, without more frequent episodes of hypoglycemia or ketoacidosis. Consequently, the prevalence of microvascular complications was significantly higher in Zagreb than in the total EURODIAB population. The prevalence of cardiovascular disease was similar to the EURODIAB average, probably reflecting similar prevalences of some risk factors for macrovascular disease (smoking, dyslipidemia, hypertension). To reduce morbidity and premature death in Croatian IDDM patients, efforts should be intensified to improve glycemia control and reduce the proportion of hypertensive IDDM patients.

The hypoglycemic activity of single dose benzoic acid derivative (AG-EE 388, 3.0 mg) was compared to glibenclamide 3.5 mg open, and to placebo double blind, in 12 non-insulin dependent diabetics in a three-time cross-over trial. The pharmacokinetic features of AG-EE 388 were determined during a 24-hour period. The mean maximal glucose level after AG-EE 388 was 12.5± 4.0 mM/l in the morning, 10.1± 3.0 mM/l in the afternoon and 12.5± 4.0 mM/l during the night. Glucose levels were not significantly different after the administration of glibenclamide (12.7± 3.1, 9.8± 2.9 and 11.9± 3.7 mM/l, respectively). Accordingly, both were significantly lower during the morning and afternoon than after placebo (14.4± 3.2, 12.2± 4.1 and 13.2± 3.6 mM/l, respectively) (Table 1). The mean value of serum insulin concentration after AG-EE 388 in the morning (57.8± 33.6 mU/l) corresponded to the value obtained after glibenclamide (59.7± 28.9 mU/l) and was significantly higher than after placebo (47.3± 31.0 mU/l). In the afternoon, serum insulin concentration remained elevated after glibenclamide (36.0± 14.6 mU/l), and decreased significantly after AG-EE 388 and placebo (29.1± 11.6 and 27.5± 10.7 mU/l, respectively). During the night, there were no significant difference in serum insulin concentration among the three treatments (27.9± 11.8, 25.1 ± 8.5 and 29.9± 12.8 mU/l, respectively). The maximal plasma concentration of 118± 42 ng/ml was achieved 1.4± 1.2 h after the administration of a single oral dose of 3.0 mg AG-EE 388. Terminal biologic half-time = 2.5± 1.4 h. Conclusion: As a potential oral antidiabetic, AG-EE 388 showed promising pharmacokinetic characteristics: fast resorption and short biologic half-time, with a significantly shorter betacyto- tropic activity compared to glibenclamide and insignificant difference in hypoglycemic activity.