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Komić L, Kruljac I, Mirošević G, Gaćina P, Pećina HI, Čerina V, Gajski D, Blaslov K, Rotim K, Vrkljan M. SPONTANEOUS RESOLUTION OF A NONFUNCTIONING PITUITARY ADENOMA OVER ONE-MONTH PERIOD: A CASE REPORT. Acta Clin Croat 2021; 60:317-322. [PMID: 34744285 PMCID: PMC8564843 DOI: 10.20471/acc.2021.60.02.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/12/2021] [Indexed: 11/24/2022] Open
Abstract
Spontaneous resolution of nonfunctioning pituitary adenoma after hemorrhagic apoplexy is a rare clinical entity of unknown etiology and is defined as disappearance of a tumor without any specific treatment. Here we present a 54-year-old male patient who presented with acute onset of severe headache, vomiting, photophobia, and sonophobia. He was referred to brain computed tomography, which showed a 16x12x16 mm tumor mass located in the sellar region with signs of hemorrhage. Endocrinologic evaluation was consistent with under-function of pituitary gonadotropic cells. Magnetic resonance imaging (MRI) performed ten days later was consistent with hemorrhagic apoplexy of the pituitary adenoma. The patient’s symptoms resolved after conservative treatment with dexamethasone, but he was scheduled for elective pituitary surgery. Preoperative MRI was performed one month after the first one and disclosed normal pituitary gland without any signs of adenoma. Our case is remarkable due to the fact that spontaneous remission of pituitary adenoma occurred within the first month, which is the shortest interval reported to date. Our case highlights the importance of conservative therapy as the first-line treatment for pituitary apoplexy in the absence of neurological impairment, since spontaneous remission may occur in a short time interval.
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Affiliation(s)
| | - Ivan Kruljac
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Gorana Mirošević
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Petar Gaćina
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Hrvoje Ivan Pećina
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Vatroslav Čerina
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Domagoj Gajski
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Kristina Blaslov
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Krešimir Rotim
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Milan Vrkljan
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
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Blaslov K, Gajski D, Vucelić V, Gaćina P, Mirošević G, Marinković J, Vrkljan M, Rotim K. THE ASSOCIATION OF SUBCLINICAL INSULIN RESISTANCE WITH THYROID AUTOIMMUNITY IN EUTHYROID INDIVIDUALS. Acta Clin Croat 2020; 59:696-702. [PMID: 34285440 PMCID: PMC8253084 DOI: 10.20471/acc.2020.59.04.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/23/2020] [Indexed: 11/24/2022] Open
Abstract
Hashimoto thyroiditis is characterized by anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies that gradually lead to thyroid cell destruction. As hypothyroidism has been associated with insulin resistance (IR), we aimed to investigate whether IR is associated with thyroid antibody presence and whether the degree of IR correlates with their concentration in euthyroid individuals. A total of 164 non-diabetic, euthyroid individuals, average age 34 years, were included in the study, divided into two groups according to Hashimoto thyroiditis and underwent 5-hour oral glucose tolerance test. The degree of IR was evaluated by the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). The Hashimoto thyroiditis group had higher HOMA-IR (p=0.003) and lower glucose levels (p=0.04). HOMA-IR correlated positively with anti-TPO (p<0.001). Linear logistic regression revealed that anti-TPO concentration increased by 18.13 (p=0.001) with each HOMA-IR unit. IR might trigger thyroid antibody production and Hashimoto thyroiditis development, which needs to be evaluated in further larger scale follow up studies.
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Affiliation(s)
| | - Domagoj Gajski
- 1Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4University of Applied Health Sciences, Zagreb, Croatia; 5Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6School of Medicine, University of Zagreb, Zagreb, Croatia; 7Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia
| | - Vesna Vucelić
- 1Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4University of Applied Health Sciences, Zagreb, Croatia; 5Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6School of Medicine, University of Zagreb, Zagreb, Croatia; 7Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia
| | - Petar Gaćina
- 1Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4University of Applied Health Sciences, Zagreb, Croatia; 5Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6School of Medicine, University of Zagreb, Zagreb, Croatia; 7Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia
| | - Gorana Mirošević
- 1Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4University of Applied Health Sciences, Zagreb, Croatia; 5Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6School of Medicine, University of Zagreb, Zagreb, Croatia; 7Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia
| | - Jelena Marinković
- 1Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4University of Applied Health Sciences, Zagreb, Croatia; 5Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6School of Medicine, University of Zagreb, Zagreb, Croatia; 7Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia
| | - Milan Vrkljan
- 1Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4University of Applied Health Sciences, Zagreb, Croatia; 5Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6School of Medicine, University of Zagreb, Zagreb, Croatia; 7Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia
| | - Krešimir Rotim
- 1Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3School of Dental Medicine, University of Zagreb, Zagreb, Croatia; 4University of Applied Health Sciences, Zagreb, Croatia; 5Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6School of Medicine, University of Zagreb, Zagreb, Croatia; 7Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia
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Ahola AJ, Radzeviciene L, Zaharenko L, Bulum T, Skrebinska S, Prakapiene E, Blaslov K, Roso V, Rovite V, Pirags V, Duvnjak L, Sokolovska J, Verkauskiene R, Forsblom C. Association between symptoms of depression, diabetes complications and vascular risk factors in four European cohorts of individuals with type 1 diabetes - InterDiane Consortium. Diabetes Res Clin Pract 2020; 170:108495. [PMID: 33058955 DOI: 10.1016/j.diabres.2020.108495] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 09/18/2020] [Accepted: 10/02/2020] [Indexed: 11/17/2022]
Abstract
AIMS To investigate the association between depressive symptomatology and health markers in type 1 diabetes. METHODS Four countries from the InterDiane Consortium had adopted the Finnish Diabetic Nephropathy Study protocol, including the Beck Depression Inventory (BDI). Associations between depression symptomatology, diabetes complications (diabetic nephropathy, proliferative retinopathy, major adverse cardiovascular events [MACE]) and vascular risk factors (metabolic syndrome, body mass index, glycaemic control) were investigated. RESULTS In a sample of 1046 participants (Croatia n = 99; Finland n = 314; Latvia n = 315; Lithuania n = 318), 13.4% displayed symptoms of depression (BDI score ≥ 16) with no statistically significant difference in the prevalence of depression among the cohorts. The highest rates of diabetic nephropathy (37.1%) and proliferative retinopathy (36.3%) were observed in Lithuania. The rates of MACE and metabolic syndrome were highest in Finland. In joint analyses, individuals exhibiting depression symptomatology had higher HbA1c (79 vs. 72 mmol/mol, p < 0.001) and higher triglyceride concentration (1.67 vs. 1.28 mmol/l, p < 0.001), than those without. In the multivariable model, BDI score was positively associated with the presence of diabetic nephropathy, proliferative retinopathy, MACE, and metabolic syndrome and its triglyceride component. Moreover, BDI score was positively associated with the number of metabolic syndrome components, triglyceride concentration, and HbA1c. CONCLUSIONS Comorbid depression should be considered a relevant factor explaining metabolic problems and vascular outcomes. Causality cannot be inferred from this cross-sectional study.
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Affiliation(s)
- Aila J Ahola
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Abdominal Center, Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland
| | - Lina Radzeviciene
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Linda Zaharenko
- Latvian Biomedical Research and Study Centre, Rātsupītes Street 1, Riga LV1067, Latvia
| | - Tomislav Bulum
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, School of Medicine, Zagreb, University of Zagreb, Croatia
| | - Sabīne Skrebinska
- University of Latvia, Faculty of Medicine, Jelgavas Street 3, LV 1004 Riga, Latvia
| | - Edita Prakapiene
- Department of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kristina Blaslov
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Clinical Hospital Center, Zagreb, Croatia
| | - Vinko Roso
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, School of Medicine, Zagreb, University of Zagreb, Croatia
| | - Vita Rovite
- Latvian Biomedical Research and Study Centre, Rātsupītes Street 1, Riga LV1067, Latvia
| | - Valdis Pirags
- Latvian Biomedical Research and Study Centre, Rātsupītes Street 1, Riga LV1067, Latvia; University of Latvia, Faculty of Medicine, Jelgavas Street 3, LV 1004 Riga, Latvia; Pauls Stradins Clinical University Hospital, Pilsoņu Street 13, LV1002 Riga, Latvia
| | - Lea Duvnjak
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, School of Medicine, Zagreb, University of Zagreb, Croatia
| | | | - Rasa Verkauskiene
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Abdominal Center, Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland.
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Kruljac I, Dabelić N, Marjan D, Blaslov K, Perić B, Mirošević G, Vagić D, Vrkljan M. Cushing's Disease in a Patient with MEN 2B Syndrome. Am J Med 2020; 133:e46-e47. [PMID: 31421068 DOI: 10.1016/j.amjmed.2019.07.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Ivan Kruljac
- Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso," University Hospital Center "Sestre Milosrdnice," University of Zagreb School of Medicine, Croatia.
| | - Nina Dabelić
- Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Domagoj Marjan
- Department of Radiology, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Kristina Blaslov
- Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso," University Hospital Center "Sestre Milosrdnice," University of Zagreb School of Medicine, Croatia
| | - Božidar Perić
- Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso," University Hospital Center "Sestre Milosrdnice," University of Zagreb School of Medicine, Croatia
| | - Gorana Mirošević
- Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso," University Hospital Center "Sestre Milosrdnice," University of Zagreb School of Medicine, Croatia
| | - Davor Vagić
- Department of Otorinolaringology and Head and Neck Surgery, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia; University of Zagreb School of Medicine, Croatia
| | - Milan Vrkljan
- Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso," University Hospital Center "Sestre Milosrdnice," University of Zagreb School of Medicine, Croatia; University of Zagreb School of Medicine, Croatia
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Emini-Sadiku M, Car N, Begolli L, Blaslov K, Haliti E, Bahtiri E. The differential influence of glimepiride and glibenclamide on insulin resistance and adiponectin levels in patients with type 2 diabetes. Endocr J 2019; 66:915-921. [PMID: 31292311 DOI: 10.1507/endocrj.ej18-0493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Several studies have demonstrated the decreased insulin resistance (IR) in persons with type 2 diabetes mellitus (T2DM) treated with glimepiride. Those suggest this might be associated with observed higher concentrations of adiponectin. We assessed if there is a difference in IR and metabolic syndrome components between glimepiride and glibenclamide treatment as well as adiponectin concentration in T2DM. Our research observed 20 T2DM patients treated with glibenclamid and 20 switched to glimepiride (n = 20) treatment for 24 weeks. Anthropometric measurements and laboratory analysis were performed at the beginning and at the end of treatment while IR was accessed by homeostasis model assessment of insulin resistance (HOMA-IR). The glimepiride group revealed better glycaemic control compared to glibenclamide group. Moreover, the adiponectin concentration increased (23.9 ± 17.3 to 29.1 ± 12.2 ng/mL, p = 0.087) whereas it decreased in the glibenclamide group (34.3 ± 22.6 to 20.3 ± 11.3 ng/mL, p = 0.011) following 24 weeks of treatment. The serum adiponectin and HOMA-IR were inversely correlated within the group of glibenclamide (r = -0.667, p = 0.009). The present study demonstrates that glimepiride might have beneficial effect on IR compared to glibenclamide, as suggested. However, this observation needs further study investigation among other formulations of SU.
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Affiliation(s)
- Merita Emini-Sadiku
- Department of Internal Diseases, Faculty of Medicine, University of Prishtina, Prishtinë 10 000, Kosovo
- Clinic of Endocrinology, University Clinical Center of Kosovo, Pristina 10 000, Kosovo
| | - Nikica Car
- University Clinic of Diabetes, Endocrinology and Metabolism "Vuk Vrhovac", University Hospital "Merkur", Zagreb 10 000, Croatia
| | - Luljeta Begolli
- Institut of Biochemistry, Faculty of Medicine, University of Prishtina, Pristina 10 000, Kosovo
| | - Kristina Blaslov
- Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso", University Clinical Hospital Center "Sestre Milosrdnicev", Zagreb 10 000, Croatia
| | - Edmond Haliti
- Department of Internal Diseases, Faculty of Medicine, University of Prishtina, Prishtinë 10 000, Kosovo
- Clinic of Cardiology, University Clinical Center of Kosovo, Pristina 10 000, Kosovo
| | - Elton Bahtiri
- Department of Pharmacology, Faculty of Medicine, University of Prishtina, Pristina 10 000, Kosovo
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Blaslov K, Kruljac I, Mirošević G, Gaćina P, Kolonić SO, Vrkljan M. The prognostic value of red blood cell characteristics on diabetic retinopathy development and progression in type 2 diabetes mellitus. Clin Hemorheol Microcirc 2019; 71:475-481. [PMID: 30103306 DOI: 10.3233/ch-180422] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUNDAlthough it is considered that the pathogenesis of diabetic retinopathy (DR) in type 2 diabetes mellitus (T2DM) is primarily due to chronic hyperglycemia resulting in vascular changes and retinal ischemia, the red blood cells (RBCs) disorders might also represent an important pathophysiological risk factor.OBJECTIVETo evaluate whether the RBC properties contribute to DR development and progression in T2DM.METHODSThis prospective observational study comprised 247 persons with T2DM free of DR or with non proliferative DR without any signs of anaemia. The patients were reacessed after 60-months.RESULTSThe mean age of our study population was 56 years, 54.9% males with diabetes duration of 11,18±1,28 years. During the follow up, 16 (5.84%) participants developed non proliferative DR and 9 (3.64%) progressed to PDR while the mean corpuscular volume (MCV) and red cell distribution width (RDW) MCV rose. Both MCV and RDW correlated positively with HbA1c (r = 0,468, p = 0.003 and r = 0.521, p < 0.001), while Cox regression analysis revealed that besides age, diabetes duration, HbA1c, hypertension and dyslipidemia presence, MCV and RDW are also associated with the risk of DR development and progression (HR 1.057 and 1.237, p < 0.001).CONCLUSIONSWe clearly demonstrated that RBC's characteristics might represent a risk factor for DR development and progression.
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Affiliation(s)
- Kristina Blaslov
- Department of Endocrinology, Diabetology and Metabolic Diseases "Mladen Sekso", University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivan Kruljac
- Department of Endocrinology, Diabetology and Metabolic Diseases "Mladen Sekso", University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Gorana Mirošević
- Department of Endocrinology, Diabetology and Metabolic Diseases "Mladen Sekso", University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia
| | - Petar Gaćina
- Department of Haematology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia.,School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Slobodanka Ostojić Kolonić
- Department of Haematology, University Hospital Merkur, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Milan Vrkljan
- Department of Endocrinology, Diabetology and Metabolic Diseases "Mladen Sekso", University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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Režić T, Blaslov K, Kruljac I, Rahelić D, Vrkljan M, Renar IP. The possible synergistic action of sex hormones and glucagon-like peptide-1 (GLP-1) agonists on body mass decline in patients with type 2 diabetes mellitus. Med Hypotheses 2019; 131:109308. [PMID: 31443779 DOI: 10.1016/j.mehy.2019.109308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/07/2019] [Accepted: 07/12/2019] [Indexed: 10/26/2022]
Abstract
Adiposity is a chronic disease and one of the major modifiable risk factors for the development of type 2 diabetes mellitus (T2DM). Its prevalence in the world could be considered epidemic with 80% of patients with T2DM being obese. Novel antidiabetic drugs, such as glucagone-like peptide-1 (GLP-1) agonists have demonstrated benefitial effect on weight reduction. Nevertheless, in the last decades the need for new therapeutic strategies in the management of adiposity have emerged. Both adiposity and T2DM have negative effect on hypothalamic-pituitary-gonadal axis. Conversely, it has been known that sex hormone replacement therapy improves metabolic parameters in hypogonadal subjects. Recent research has found potential therapeutic effect of combination therapies with sex hormones and GLP-1 agonists in reducing body weight. Based on the aforementioned, we hypothesize that there is a possible synergistic effect of GLP-1 agonists and sex hormones on body mass reduction in patients with type 2 diabetes. The possible additional effect of sex hormones on weight loss could contribute to more effective treatment of T2DM and its complications.
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Affiliation(s)
- T Režić
- Department of Endocrinology, Diabetes and Clinical Pharmacology, Dubrava University Hospital, Zagreb, Croatia.
| | - K Blaslov
- Department of Endocrinology, Diabetes and Metabolic Diseases ''Mladen Sekso'', University Hospital Centre ''Sestre Milosrdnice'', Zagreb, Croatia; University of Zagreb School of Medicine, Zagreb, Croatia
| | - I Kruljac
- Department of Endocrinology, Diabetes and Metabolic Diseases ''Mladen Sekso'', University Hospital Centre ''Sestre Milosrdnice'', Zagreb, Croatia; University of Zagreb School of Medicine, Zagreb, Croatia
| | - D Rahelić
- University of Zagreb School of Medicine, Zagreb, Croatia; Department of Diabetes and Endocrinology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
| | - M Vrkljan
- Department of Endocrinology, Diabetes and Metabolic Diseases ''Mladen Sekso'', University Hospital Centre ''Sestre Milosrdnice'', Zagreb, Croatia; University of Zagreb School of Medicine, Zagreb, Croatia
| | - I P Renar
- University of Zagreb School of Medicine, Zagreb, Croatia
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Blaslov K, Naranđa FS, Kruljac I, Renar IP. Treatment approach to type 2 diabetes: Past, present and future. World J Diabetes 2018; 9:209-219. [PMID: 30588282 PMCID: PMC6304295 DOI: 10.4239/wjd.v9.i12.209] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/20/2018] [Accepted: 11/26/2018] [Indexed: 02/05/2023] Open
Abstract
Type 2 diabetes mellitus (DM) is a lifelong metabolic disease, characterized by hyperglycaemia which gradually leads to the development and progression of vascular complications. It is recognized as a global burden disease, with substantial consequences on human health (fatality) as well as on health-care system costs. This review focuses on the topic of historical discovery and understanding the complexity of the disease in the field of pathophysiology, as well as development of the pharmacotherapy beyond insulin. The complex interplay of insulin secretion and insulin resistance developed from previously known "ominous triumvirate" to "ominous octet" indicate the implication of multiple organs in glucose metabolism. The pharmacological approach has progressed from biguanides to a wide spectrum of medications that seem to provide a beneficial effect on the cardiovascular system. Despite this, we are still not achieving the target treatment goals. Thus, the future should bring novel antidiabetic drug classes capable of acting on several levels simultaneously. In conclusion, given the raising burden of type 2 DM, the best present strategy that could contribute the most to the reduction of morbidity and mortality should be focused on primary prevention.
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Affiliation(s)
- Kristina Blaslov
- Department of Endocrinology, Diabetes and Metabolic Diseases Mladen Sekso, University Hospital Center Sestre Milosrdnice, Zagreb 10000, Croatia
| | | | - Ivan Kruljac
- Department of Endocrinology, Diabetes and Metabolic Diseases Mladen Sekso, University Hospital Center Sestre Milosrdnice, Zagreb 10000, Croatia
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Kruljac I, Vurnek I, Maasberg S, Kust D, Blaslov K, Ladika Davidović B, Štefanović M, Demirović A, Bišćanin A, Filipović-Čugura J, Marić Brozić J, Pape UF, Vrkljan M. A score derived from routine biochemical parameters increases the diagnostic accuracy of chromogranin A in detecting patients with neuroendocrine neoplasms. Endocrine 2018; 60:395-406. [PMID: 29633144 DOI: 10.1007/s12020-018-1592-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/02/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Chromogranin A (CgA) is a valuable biomarker for detection and follow-up of patients with neuroendocrine neoplasms (NENs). However, various comorbidities may influence serum CgA, which decreases its diagnostic accuracy. We aimed to investigate which laboratory parameters are independently associated with increased CgA in real-life setting and to develop a scoring system, which could improve the diagnostic accuracy of CgA in detecting patients with NENs. METHODS This retrospective study included 55 treatment naïve patients with NENs and160 patients with various comorbidities but without NEN (nonNENs). Scoring system (CgA-score) was developed based on z-scores obtained from receiver operating curve analysis for each parameter that was associated with elevated serum CgA in nonNENs. RESULTS CgA correlated positively with serum BUN, creatinine, α2-globulin, red-cell distribution width, erythrocyte sedimentation rate, plasma glucose and correlated inversely with hemoglobin, thrombocytes and serum albumin. Serum CgA was also associated with the presence of chronic renal failure, arterial hypertension and diabetes and the use of PPI. In the entire study population, CgA showed an area under the curve of 0.656. Aforementioned parameters were used to develop a CgA-score. In a cohort of patients with CgA-score <12.0 (N = 87), serum CgA >156.5 ng/ml had 77.8% sensitivity and 91.5% specificity for detecting NENs (AUC 0.841, 95% CI 0.713-0.969, P < 0.001). Serum CgA had no diagnostic value in detecting NENs in patients with CgA-score >12.0 (AUC 0.554, 95% CI 0.405-0.702, P = 0.430). CONCLUSIONS CgA-score encompasses a wide range of comorbidities and represents a promising tool that could improve diagnostic performance of CgA in everyday clinical practice.
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Affiliation(s)
- Ivan Kruljac
- Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso", University Hospital Center "Sestre Milosrdnice", University of Zagreb School of Medicine, Zagreb, Croatia.
| | - Ivan Vurnek
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Sebastian Maasberg
- Department of Hepatology and Gastroenterology, ENETS Center of Excellence for Neuroendocrine Tumors, Charité Campus Mitte and Virchow Clinic, Charité University Medicine, Berlin, Germany
| | - Davor Kust
- Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Kristina Blaslov
- Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso", University Hospital Center "Sestre Milosrdnice", University of Zagreb School of Medicine, Zagreb, Croatia
| | - Blaženka Ladika Davidović
- Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Mario Štefanović
- Clinical Institute of Chemistry, University Hospital Center "Sestre Milosrdnice", University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Alma Demirović
- Department of Pathology, University Hospital Center "Sestre Milosrdnice", University of Zagreb School of Medicine, Zagreb, Croatia
| | - Alen Bišćanin
- Department of Gastroenterology and Hepatology, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | | | - Jasmina Marić Brozić
- Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Ulrich-Frank Pape
- Department of Hepatology and Gastroenterology, ENETS Center of Excellence for Neuroendocrine Tumors, Charité Campus Mitte and Virchow Clinic, Charité University Medicine, Berlin, Germany
| | - Milan Vrkljan
- Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso", University Hospital Center "Sestre Milosrdnice", University of Zagreb School of Medicine, Zagreb, Croatia
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Blaslov K, Kruljac I, Mirošević G, Kirigin Biloš LS, Vrkljan M. The possible role of stress induced hormonal disbalance in the patophysiology of insulin resistane in lean individuals. Med Hypotheses 2018; 114:8-10. [PMID: 29602470 DOI: 10.1016/j.mehy.2018.02.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 02/25/2018] [Indexed: 12/19/2022]
Abstract
Insulin resistance (IR) is a common denominator of metabolic and hemodynamic disorders simultaneously present in one person and responsible for elevated risk of developing type 2 diabetes (T2DM) and cardiovascular incidents. According to the latest research, IR is present in 25-45% of the general population. Therefore, the mechanism of its development is in the center of scientific and professional interest. Established or acquired factors, or combinations thereof, which disturb any step of the physiological insulin action mechanism: its binding to the cellular receptor, through the complex cascade of intracellular signaling pathways might cause IR. Although the adiposity and its underlying risk factors are considered to be the primary cause of IR, it is present in a great porportion in lean individuals as well. There are insights of the possible role of psychological factors: exposure to stress and deprssion to IR development, although the mechanism of this relationship has not been comperhensively studied. Data driven from cell cultures and experimental animal models suggest that there is an elevated level of counter-regulatory insulin hormones: growth hormone, prolactin and cortisol due to acute stress exposure. However, the relationship between these psychological disorders with the hyperreactivity of the axis of the hypothalamic-pituitaryadrenal axis as the underlying mechanism in the patophysiology of IR in lean individuals has not been systematically investigated. Based on the aforementioned, we hypothesise that this mechanism would be responsible for the formation of IR, and consequently, T2DM in lean individuals. The possible effect of the amount of stress in conjunction with the serum concentration of growth hormone, cortisol, prolactin and dehydroepiandrostendone to the abnormal 5-h oral glucose tollerance test results could contribute to the primary prevention of diabetes and its complications.
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Affiliation(s)
- K Blaslov
- Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso", University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia; University of Zagreb School of medicine, Zagreb, Croatia.
| | - I Kruljac
- Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso", University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia; University of Zagreb School of medicine, Zagreb, Croatia
| | - G Mirošević
- Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso", University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Lora S Kirigin Biloš
- Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso", University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - M Vrkljan
- Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso", University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia; University of Zagreb School of medicine, Zagreb, Croatia
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Kruljac I, Vičić I, Blaslov K, Kolak Z, Benković M, Kust D, Ladika Davidović B, Tometić G, Penavić I, Dabelić N, Vazdar L, Pavić T, Vrkljan M. The Role of the Acute Octreotide Suppression Test in Detecting Patients with Neuroendocrine Neoplasms. Neuroendocrinology 2018; 107:284-291. [PMID: 30114698 DOI: 10.1159/000492934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 08/16/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Serum chromogranin A (CgA) is routinely used as a biomarker in patients with neuroendocrine neoplasms (NENs). Several conditions and comorbidities may be associated with falsely elevated CgA, often leading to extensive diagnostic evaluation, which may be costly and harmful. The aim of this study was to analyze the effectiveness of the acute octreotide suppression test (AOST) in differentiating falsely elevated serum CgA. METHODS Our prospective study enrolled 45 patients from two different patient cohorts: (1) 29 patients with suspicion or presence of NENs (extensive workup and subsequent biopsy confirmed 16 NENs); (2) 16 consecutive patients admitted via the Emergency Department without NENs (non-NENs). AOST was performed after an overnight fast. Baseline CgA was measured, after which 0.25 mg of octreotide was administered subcutaneously. CgA was measured 3 and 6 h after administration. RESULTS Baseline CgA levels were similar in NENs and non-NENs. At the end of the AOST, CgA decreased by a median of 83.3% (41.0-127.4) in non-NENs and 13.8% (0.0-43.6) in NENs (p < 0.001). In patients with increased baseline CgA, a decrease in CgA at the 6th hour of < 51.3% had 90.0% sensitivity and 88.9% specificity in detecting NENs. In patients with normal baseline serum CgA, a decrease in CgA at the 3rd hour of < 17.6% had 83.3% sensitivity and 81.8% specificity in detecting patients with NENs. The diagnostic accuracy of the AOST in the entire study population was 86.7%. CONCLUSIONS AOST is a promising tool to increase the diagnostic accuracy of serum CgA.
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Affiliation(s)
- Ivan Kruljac
- Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso", University Hospital Center "Sestre Milosrdnice", University of Zagreb School of Medicine, Zagreb,
| | - Ivan Vičić
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Kristina Blaslov
- Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso", University Hospital Center "Sestre Milosrdnice", University of Zagreb School of Medicine, Zagreb, Croatia
| | - Zorica Kolak
- Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso", University Hospital Center "Sestre Milosrdnice", University of Zagreb School of Medicine, Zagreb, Croatia
| | - Martina Benković
- Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso", University Hospital Center "Sestre Milosrdnice", University of Zagreb School of Medicine, Zagreb, Croatia
| | - Davor Kust
- Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Blaženka Ladika Davidović
- Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Gordan Tometić
- Department of Oncological Surgery, Clinic for Clinic for Tumors, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Ivan Penavić
- Department of Oncological Surgery, Clinic for Clinic for Tumors, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Nina Dabelić
- Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Ljubica Vazdar
- Department of Radiotherapy and Medical Oncology, Clinic for Tumors, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Tajana Pavić
- University of Zagreb School of Medicine, Zagreb, Croatia
- Department of Gastroenterology and Hepatology, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Milan Vrkljan
- Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso", University Hospital Center "Sestre Milosrdnice", University of Zagreb School of Medicine, Zagreb, Croatia
- University of Zagreb School of Medicine, Zagreb, Croatia
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Kokic V, Kokic S, Krnic M, Petric M, Liberati AM, Simac P, Milenkovic T, Capkun V, Rahelic D, Blaslov K. Prediabetes awareness among Southeastern European physicians. J Diabetes Investig 2017; 9:544-548. [PMID: 28853223 PMCID: PMC5934258 DOI: 10.1111/jdi.12740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/04/2017] [Accepted: 08/20/2017] [Indexed: 01/03/2023] Open
Abstract
AIMS/INTRODUCTION Prediabetes (PD) represents a transitional state where the glucose levels are higher than normal, but not enough for diabetes mellitus diagnosis. As there is a growing number of the population with PD, its early detection and treatment could prevent the development of diabetes mellitus and its complications. We aimed to assess the overall knowledge of PD among medical professionals of different varieties. MATERIALS AND METHODS A questionnaire-based study addressing PD and type 2 diabetes mellitus knowledge among Southeastern European general practitioners, postgraduates, physicians and superior specialists was carried out. RESULTS A total of 397 physicians completed the questionnaire. The total rate of correct answers from diabetologists, non-diabetologist internists, residents and general practitioners was 69, 56.1, 54 and 53%, respectively. Questions related to the PD definition achieved a total of 46.6% correct answers. Correct responses considering the numerical definition of impaired fasting glucose and impaired glucose tolerance were 46.3 and 46.8%, respectively. Younger physicians had better knowledge of numerical values regarding PD and type 2 diabetes mellitus criteria (P < 0.001). CONCLUSIONS The present results show that overall knowledge of PD is poor among Southeastern European physicians, which necessitates adequate educational programs on PD in this region.
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Affiliation(s)
- Visnja Kokic
- School of Medicine, University of Split, Split, Croatia
- Department of Endocrinology, Diabetes and Metabolic Disease, Clinical Hospital Center Split, Split, Croatia
| | - Slaven Kokic
- School of Medicine, University of Split, Split, Croatia
| | - Mladen Krnic
- School of Medicine, University of Split, Split, Croatia
- Department of Endocrinology, Diabetes and Metabolic Disease, Clinical Hospital Center Split, Split, Croatia
| | - Marin Petric
- School of Medicine, University of Split, Split, Croatia
- Department of Rheumatology and Clinical Immunology, Clinical Hospital Center Split, Split, Croatia
| | - Ana Marija Liberati
- Department of Endocrinology, Diabetes and Metabolic Disease, Clinical Hospital "Sveti Duh", Zagreb, Croatia
| | - Petra Simac
- School of Medicine, University of Split, Split, Croatia
- Department of Rheumatology and Clinical Immunology, Clinical Hospital Center Split, Split, Croatia
| | - Tatjana Milenkovic
- University St. Cyril and Methodius - University Clinic of Endocrinology, Skopje, Macedonia
| | - Vesna Capkun
- School of Medicine, University of Split, Split, Croatia
| | - Dario Rahelic
- Department of Endocrinology, Diabetes and Clinical Pharmacology, Clinical Hospital "Dubrava", Zagreb, Croatia
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Lovrenčić MV, Biljak VR, Blaslov K, Božičević S, Duvnjak LS. Impact of creatinine methodology on glomerular filtration rate estimation in diabetes. World J Diabetes 2017; 8:222-229. [PMID: 28572883 PMCID: PMC5437620 DOI: 10.4239/wjd.v8.i5.222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 12/20/2016] [Accepted: 03/02/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate the influence of creatinine methodology on the performance of chronic kidney disease (CKD)-Epidemiology Collaboration Group-calculated estimated glomerular filtration rate (CKD-EPI-eGFR) for CKD diagnosis/staging in a large cohort of diabetic patients.
METHODS Fasting blood samples were taken from diabetic patients attending our clinic for their regular annual examination, including laboratory measurement of serum creatinine and eGFR.
RESULTS Our results indicated an overall excellent agreement in CKD staging (kappa = 0.918) between the Jaffé serum creatinine- and enzymatic serum creatinine-based CKD-EPI-eGFR, with 9% of discordant cases. As compared to the enzymatic creatinine, the majority of discordances (8%) were positive, i.e., associated with the more advanced CKD stage re-classification, whereas only 1% of cases were negatively discordant if Jaffé creatinine was used for eGFR calculation. A minor proportion of the discordant cases (3.5%) were re-classified into clinically relevant CKD stage indicating mildly to moderately decreased kidney function (< 60 mL/min per 1.73 m2). Significant acute and chronic hyperglycaemia, assessed as plasma glucose and HbA1c levels far above the recommended glycaemic goals, was associated with positively discordant cases. Due to a very low frequency, positive discordance is not likely to present a great burden for the health-care providers, while intensified medical care may actually be beneficial for the small number of discordant patients. On the other hand, a very low proportion of negatively discordant cases (1%) at the 60 mL/min per 1.73 m2 eGFR level indicate a negligible possibility to miss the CKD diagnosis, which could be the most prominent clinical problem affecting patient care, considering high risk of CKD for adverse patient outcomes.
CONCLUSION This study indicate that compensated Jaffé creatinine procedure, in spite of the glucose-dependent bias, is not inferior to enzymatic creatinine in CKD diagnosis/staging and therefore may provide a reliable and cost-effective tool for the renal function assessment in diabetic patients.
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Duvnjak L, Perković MN, Blaslov K. Dipeptidyl peptidase-4 activity is associated with urine albumin excretion in type 1 diabetes. J Diabetes Complications 2017; 31:218-222. [PMID: 27625045 DOI: 10.1016/j.jdiacomp.2016.08.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/14/2016] [Accepted: 08/22/2016] [Indexed: 02/09/2023]
Abstract
AIMS The inability of kidneys to prevent urinary protein leakage represents the earliest sign of renal damage in diabetic kidney disease (DKD). Recent data suggest the possible nephroprotective role of the dipeptidyl peptidase-4 (DPP-4) inhibitors. We aimed to investigate whether serum DPP-4 activity is associated with urine albumin excretion (UAE) in patients with type 1 diabetes (type 1 DM). METHODS DPP-4 activity and UAE measurement were performed in 113 patients with type 1 DM and glomerular filtration rate (GFR) within normal range. They were divided into three groups according to UAE tertiles. RESULTS Worse lipid profile and higher waist circumference were observed in the group with highest DPP-4 activity. Patients within lowest UAE tertile group had lowest DPP-4 activity value (p<0.001) compared to group within second and third tertile of UAE. DPP-4 activity correlated with systolic blood pressure (ρ=0.142; p=0.001), HbA1c (ρ=0.133; p=0.013) and UAE (ρ=0.349; p<0.001). In the linear regression analysis when DPP-4 activity was adjusted for age, gender, disease duration, HbA1c, waist circumference, the use of ACEI and hypolipemic agents the association remained significant; UAE increased for 8.136mg/24h by each increase of DPP-4 activity of 1U/L (p<0.008). CONCLUSION Our results indicate that serum DPP-4 activity is associated with albuminuria in type 1 diabetes. This arises the question whether the use of DPP-4 inhibitors might serve as an additional therapeutic strategy to prevent proteinuria in patients with DKD.
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Affiliation(s)
- Lea Duvnjak
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, 10000 Zagreb, Croatia; University of Zagreb, School of Medicine, 10000 Zagreb, Croatia
| | - Matea Nikolac Perković
- Rudjer Boskovic Institute, Division of Molecular Medicine, Laboratory for Molecular Neuropsychiatry, 10000 Zagreb, Croatia
| | - Kristina Blaslov
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, 10000 Zagreb, Croatia.
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Duvnjak L, Blaslov K, Vučić Lovrenčić M, Knežević Ćuća J. Persons with latent autoimmune diabetes in adults express higher dipeptidyl peptidase-4 activity compared to persons with type 2 and type 1 diabetes. Diabetes Res Clin Pract 2016; 121:119-126. [PMID: 27693949 DOI: 10.1016/j.diabres.2016.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/04/2016] [Accepted: 09/13/2016] [Indexed: 12/12/2022]
Abstract
AIMS We aimed to determine serum dipeptidyl peptidase-4 (DPP-4) activity in a group of persons with latent autoimmune diabetes in adults (LADA) and to compare it with persons with type 1, type 2 diabetes and healthy controls. METHODS DPP-4 activity measurement was performed in 67 persons (21 with type 1, 26 type 2 and 19 with LADA) and 13 healthy age and gender matched controls. RESULTS Persons with LADA showed highest DPP-4 activity among the study groups (32.71±3.55 vs 25.37±2.84 vs 18.57±2.54 vs 18.57±2.61U/L p<0.001). Mean glutamic acid autoantibody in persons with LADA was 164.32±86.28IU/mL. It correlated with DPP-4 activity (r=0.484, p=0.013). Furthermore, DPP-4 activity correlated with waist circumference (r=0.279, p=0.034) and glycated haemoglobin A1c (r=0.483, p<0.001), as well as with LDL cholesterol (r=0.854, p<0.001) and total daily insulin dose (r=0.397, p=0.001). In the multinomial regression analysis DPP-4 activity remained associated with both LADA (prevalence ratio 1.058 (1.012-1.287), p=0.001) and type 1 diabetes (prevalence ratio 1.506 (1.335-1.765), p<0.001) while it did not show an association with type 2 diabetes (prevalence ratio 0.942 (0.713-1.988), p=0.564). CONCLUSIONS Persons with LADA express higher DPP-4 activity compared to persons with both type 1 and type 2 diabetes. The possible pathophysiological role of DPP-4 in the LADA pathogenesis needs to be further evaluated.
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Affiliation(s)
- L Duvnjak
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, Zagreb, Croatia; School of Medicine Zagreb, Croatia
| | - K Blaslov
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, Zagreb, Croatia.
| | - M Vučić Lovrenčić
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, Zagreb, Croatia
| | - J Knežević Ćuća
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, Zagreb, Croatia
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Duvnjak L, Blaslov K, Perković MN, Ćuća JK. Dipeptidyl peptidase-4 activity might be a link between tumour necrosis factor alpha and insulin resistance in type 1 diabetes. Endocrine 2016; 53:453-8. [PMID: 26906712 DOI: 10.1007/s12020-016-0899-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/11/2016] [Indexed: 11/28/2022]
Abstract
Tumour necrosis factor alpha (TNF α) leads to β cell damage in type 1 diabetes (T1DM) but also causes insulin resistance (IR). It modulates dipeptidyl peptidase-4 (DPP-4) activity, adipokine linked with both IR and T1DM. We were interested if there is an association of TNF α in conjunction with DPP-4 and IR in T1DM. DPP-4 activity, TNF α concentration measurements, and insulin sensitivity calculation using estimated glucose disposal rate (eGDR) equation were performed in 70 T1DM patients. They were divided into two groups according to eGDR median. The group with higher IR had higher value of DPP-4 activity (27.57 ± 1.77 vs. 18.33 ± 1.14, p < 0.001) and TNF α concentration (12.91 ± 0.83 vs. 6.72 ± 0.36, p < 0.001). TNF α concentration and DPP-4 activity negatively correlated with eGDR (r = -0.616, p < 0.001 and r = -0.643, p < 0.001) while correlating positively with each other (r = 0.422; p = 0.001). The linear regression showed that eGDR decreases for 0.166 mg kg(-1) min(-1) by TNF α concentration increase of 1 pg/mL (p < 0.001) and for 0.090 mg kg(-1) min(-1) by DPP-4 activity increase of 1 U/L (p = 0.001) when adjusted for age, gender disease duration, glycated haemoglobin, body mass index and waist-to-hip ratio. eGDR decreased by additional 0.60 mg kg(-1) min(-1) (B = -0.150, p < 0.001) when DPP-4 activity was additionally adjusted for TNF α. TNF α concentration is associated with IR, correlates with its severity and increases the drop in insulin sensitivity modulated by DPP-4 activity. Whether TNF α involvement in the insulin signalling pathway is mediated by DPP-4 activity needs to be further evaluated.
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Affiliation(s)
- Lea Duvnjak
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, 10000, Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000, Zagreb, Croatia
| | - Kristina Blaslov
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, 10000, Zagreb, Croatia.
| | - Matea Nikolac Perković
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000, Zagreb, Croatia
| | - Jadranka Knežević Ćuća
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, 10000, Zagreb, Croatia
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Bulum T, Blaslov K, Duvnjak L. The Use of Anthropometric Measurements of Obesity in Prediction of Microvascular Complications in Obese Type 2 Diabetic Patients. Acta Clin Croat 2016; 55:217-23. [PMID: 28394108 DOI: 10.20471/acc.2016.55.02.06] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) are superior to body mass index (BMI) in predicting type 2 diabetes mellitus (T2DM) development. The aim of this study was to investigate the predictive power of BMI, WC, WHR and WHtR for microvascular (chronic kidney disease (CKD), retinopathy and peripheral neuropathy) prevalence in obese (BMI ≥35 kg/m2) T2DM patients. This cross-sectional study included 125 T2DM patients of both genders. The validity of each test was assessed by Receiver Operating Characteristic (ROC) curves; the area under the curve (AUC) was calculated for each anthropometric parameter and microvascular complication. AUCs for WHtR were significantly higher than AUCs for WC with respect to CKD. Optimal cut-off for WHtR was >0.593 and WC >112 cm regarding CKD. The AUC for peripheral neuropathy was significant only for WHR and optimal cut-off for WHR was >1.409 with low sensitivity and high specificity. Our study demonstrated that WHtR, WC and WHR might be used as simple and noninvasive methods for detection of CKD and peripheral neuropathy in obese T2DM population.
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Affiliation(s)
- Tomislav Bulum
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Kristina Blaslov
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
| | - Lea Duvnjak
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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Duvnjak L, Tomić M, Blaslov K, Vučković Rebrina S. Autonomic nervous system function assessed by conventional and spectral analysis might be useful in terms of predicting retinal deterioration in persons with type 1 diabetes mellitus. Diabetes Res Clin Pract 2016; 116:111-6. [PMID: 27321325 DOI: 10.1016/j.diabres.2016.04.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/01/2016] [Accepted: 04/21/2016] [Indexed: 01/29/2023]
Abstract
AIMS To determine whether cardiac autonomic dysfunction represents a risk factor for diabetic retinopathy (DR) development and progression in persons with type 1 diabetes mellitus (T1DM). METHODS The study comprised 154 normoalbuminuric persons with T1DM divided into two groups according to the DR presence: with and without DR. Cardiovascular autonomic functioning was measured at baseline using conventional and spectral analysis. Participants were re-examined for the DR presence 18months after. RESULTS The group with DR had longer disease duration compared to the group without DR (20 vrs 11.5years, p<0.001), heart rate coefficient of variation (HRV-CV) at rest and during deep breathing were lower in participants with DR (p=0.001 and 0.004), as well did spectral indices of HRV: low frequency (LF) band, high frequency (HF) band (p=0.003 and 0.022) while LF/HF ratio indicating sympathovagal balance was higher (p=0.037). No difference in glycaemic control or blood pressure value were observed. Twenty-one (13.36%) participants developed non proliferative DR or progressed to proliferative DR. Cox proportional regression showed that the 18months risk from retinal deterioration was reduced by 33.4% by each increase in the HRV-CV of 1%, 12.7% for the same HRV-CV increase during deep breathing while LF band of 1ms(2) results in 8.6% risk reduction. CONCLUSIONS This study provides evidence that DR should not be considered merely a metabolic control manifestation and that HRV-CV as well as spectral indices of HRV might serve as a practical tool to identify a subgroup of T1DM patients with higher risk of retinal deterioration.
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Affiliation(s)
- L Duvnjak
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, Zagreb, Croatia; School of Medicine Zagreb, Croatia
| | - M Tomić
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, Zagreb, Croatia
| | - K Blaslov
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, Zagreb, Croatia.
| | - S Vučković Rebrina
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, Zagreb, Croatia
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Duvnjak L, Blaslov K. Statin treatment is associated with insulin sensitivity decrease in type 1 diabetes mellitus: A prospective, observational 56-month follow-up study. J Clin Lipidol 2016; 10:1004-1010. [PMID: 27578133 DOI: 10.1016/j.jacl.2016.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/20/2016] [Accepted: 04/29/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Statins are effective in the primary and secondary prevention of cardiovascular events in individuals with and without diabetes. Emerging evidence, however, suggests that statins might reduce insulin sensitivity and secretion in healthy population and in type 2 diabetes. OBJECTIVE We aimed to investigate the effect of statin therapy introduction on insulin sensitivity in patients with type 1 diabetes mellitus (T1DM). METHODS This prospective observational 56-month long study included 832 randomly selected T1DM patients aged 25 to 61 years. Uncontrolled dyslipidemia and clinician-perceived need for treatment, rather than randomization, were basis for individuals being started on either atorvastatin or simvastatin (10-40 mg); N = 345, 41.47%. Patients on statin treatment were compared with those unexposed to statin. Insulin sensitivity was assessed using equation derived from euglycemic-hyperinsulinemic clamp studies-estimated glucose disposal rate. RESULTS Patients who started statin therapy (N = 345, 59.42% atorvastatin and 40.58% simvastatin) experienced a greater decrease in insulin sensitivity (19.27% vs 12.82% P < .001) and metabolic control deterioration compared with statin-free group. The risk of decrease in insulin sensitivity attributable to statin use was 36.7% (hazard ratio 1.36; 95% confidence interval 1.31-1.43) after adjustment for age, gender, disease duration, smoking status, and the concomitant antihypertensive therapy. CONCLUSION Although there is still a lack of a clear molecular explanation on the adverse effects of statin therapy on insulin sensitivity, we showed that it deteriorates insulin sensitivity in T1DM. The cardiovascular benefits of statin treatment might outweigh the risk of developing insulin resistance, but, the possible metabolic control worsening merits to be considered.
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Affiliation(s)
- Lea Duvnjak
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Kristina Blaslov
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia.
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Duvnjak L, Blaslov K. Dipeptidyl peptidase-4 inhibitors improve arterial stiffness, blood pressure, lipid profile and inflammation parameters in patients with type 2 diabetes mellitus. Diabetol Metab Syndr 2016; 8:26. [PMID: 27006706 PMCID: PMC4802883 DOI: 10.1186/s13098-016-0144-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/09/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This uncontrolled open label study evaluated the effect of dipeptidyl peptidase-4 inhibitors (DPP-4i): sitagliptin and vildagliptin on augmentation index standardized for 75 beats per minute (cAiX@75), blood pressure (BP), lipid profile and high-sensitivity C-reactive protein (hsCRP) in patients with type 2 diabetes mellitus (T2DM). METHODS Fifty-one well-regulated T2DM patients were randomly assigned to either sitagliptin or vildagliptin (100 mg/day) for 3 months continuing their previous treatment. Lipid profile, cAiX@75, hsCRP, glycated hemoglobin (HbA1c) were measured at baseline at 4, 8 and 12th week were accessed. cAiX@75 and pulse wave velocity (PWV) were determined by SphygmoCor device. RESULTS Following DPP-4 treatment there was a significant reduction in total serum cholesterol (5.18 vs 4.62 mmol/L), low-density lipoprotein (2.89 vs 2.54 mmol/L), hsCRP (3.21 vs 1.95 mg/L), cAiX@75 (24.5 vs 22.3) and central systolic BP (131.8 vs 119.5 mmHg). The sitagliptin treated group reached cAiX@75 reduction earlier in the study period while neither sitagliptin or vildagliptin use resulted in the significant HbA1c reduction. CONCLUSION The treatment with DPP-4i: sitagliptin and vildagliptin provides favorable metabolic and vascular effects beyond glucose-control. Further studies are required to elucidate their implication in metabolic pathways.
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Affiliation(s)
- Lea Duvnjak
- />Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic diseases, Merkur University hospital, Dugi dol 4a, Zagreb, Croatia
- />School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Kristina Blaslov
- />Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic diseases, Merkur University hospital, Dugi dol 4a, Zagreb, Croatia
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Katalinić L, Blaslov K, Đanić-Hadžibegović A, Gellineo L, Kes P, Jelaković B, Basić-Jukić N. METABOLIC ACIDOSIS--AN UNDERESTIMATED PROBLEM AFTER KIDNEY TRANSPLANTATION? Acta Clin Croat 2015; 54:486-491. [PMID: 27017724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Despite prolonged survival and better quality of life as compared to dialysis, kidney transplantation frequently presents with a complex set of medical issues that require intensive management to protect graft function. Metabolic acidosis has an impact on several metabolic complications such as mineral and muscle metabolism, nutritional status and anemia. It may also have an effect on graft function, possibly through the stimulation of adaptive mechanisms aimed at maintaining acid-base homeostasis. We investigated current practice in the evaluation of metabolic acidosis at one of the largest transplant centers in the Eurotransplant region. Adult renal transplant recipients having received allograft from January 2011 to August 2012 were included in the investigation. We recorded the frequency of measuring the parameters of venous blood gas analysis, as well as creatinine and urea levels, creatinine clearance, proteinuria, calcium, phosphate and potassium blood levels, body mass index and the time spent on dialysis prior to kidney transplantation. Out of 203 patients who had received renal allograft at our institution during the observed period, 191 (124 males and 67 females, age range from 18 to 77 years) were enrolled in the study. Of these, only 92 (48.167%) patients had parameters of venous blood gas analysis measured at some time after kidney transplantation. Acid-base status was determined more often in males (77 males vs. 22 females, p = 0.001). Patients with pH/blood gas analysis performed were found to have significantly higher creatinine and urea levels and significantly lower creatinine clearance (p < 0.001 both). Serum calcium levels were also significantly lower in this group of patients (p < 0.001). Metabolic acidosis is a very important clinical issue that needs to be monitored in every transplant recipient. Its effects on graft function, nutritional status, anemia and bone mass are complex but can be successfully managed. Our study showed metabolic acidosis to be linked with significantly higher creatinine and urea levels, decreased creatinine clearance and lower calcium levels. Nevertheless, metabolic acidosis still stays a highly underestimated problem among nephrologists dealing with transplant recipients. We suggest regular determination of the acid-base status in renal transplant recipients.
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Blaslov K, Bulum T, Duvnjak L. The role of endothelial dysfunction driven by adipocitokines in the development and progression of microvascular complications in patients with type 1 and type 2 diabetes. Med Hypotheses 2015; 84:593-5. [DOI: 10.1016/j.mehy.2015.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 03/02/2015] [Accepted: 03/04/2015] [Indexed: 11/24/2022]
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Bulum T, Blaslov K, Prkacin I, Zibar K, Duvnjak L. PP.19.08. J Hypertens 2015. [DOI: 10.1097/01.hjh.0000468287.70331.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bulum T, Blaslov K, Prkačin I, Zibar K, Duvnjak L. SP474TREATMENT WITH A GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONIST LIRAGLUTIDE DECREASES ALBUMINURIA IN OVERWEIGHT TYPE 2 DIABETIC PATIENTS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv195.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Blaslov K, Bulum T, Zibar K, Duvnjak L. Relationship between metabolic syndrome and meal-induced glucagon like peptide-1 response in type 1 diabetic patients1-1. J Diabetes 2015; 7:340-6. [PMID: 25042812 DOI: 10.1111/1753-0407.12194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 06/03/2014] [Accepted: 06/25/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MS) is found in approximately% 30-40% of patients with type 1 diabetes mellitus (T1DM). Meal-induced glucagon-like peptide-1 (GLP-1) secretion in T1DM patients with MS is yet to be clarified. The aim of the present study was to analyse the relationship between total fasting GLP-1 concentrations and the meal-induced GLP-1 response with MS prevalence in T1DM patients compared with lean, normal glucose tolerance (NGT), control subjects. METHODS The study included 77 T1DM patients (61% male), 26 (34%) with MS, who had a mean age of 45.08 years, mean body mass index (BMI) of 25.42 kg/m(2) , and median diabetes duration of 21 years. Ten age-, gender, and BMI-matched NGT control subjects were also included in the study. Circulating GLP-1 concentrations ere measured before and 30 min after a meal by ELISA. The difference between the 30-min postprandial and fasting GLP-1 concentration (ΔGLP-1) was calculated by subtracting fasting GLP-1 concentrations from postprandial GLP-1 concentrations. RESULTS The NGT group had significantly higher total fasting, postprandial, and meal-induced GLP-1 concentrations than the T1DM groups. The T1DM patients without MS had a higher increase in circulating GLP-1 concentrations compared with the T1DM group with MS. After adjustment for age, gender, disease duration, and meal caloric value, GLP-1 response levels were inversely correlated with MS prevalence in binary logistic regression analysis. CONCLUSION A higher meal-induced GLP-1 response is associated with lower MS prevalence, but whether GLP-1 has a protective role in MS development is yet to be determined. This may provide further insight into the implementation of GLP-1-based therapies in the T1DM population.
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Affiliation(s)
- Kristina Blaslov
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, University of Zagreb, School of Medicine, Zagreb, Croatia
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Blaslov K, Bulum T, Duvnjak L. Circulating dipeptidyl peptidase-4 activity is associated with insulin resistance in type 1 diabetic patients. J Diabetes Complications 2015; 29:390-4. [PMID: 25641023 DOI: 10.1016/j.jdiacomp.2014.12.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 12/19/2014] [Accepted: 12/29/2014] [Indexed: 02/07/2023]
Abstract
AIM The pathophysiology of insulin resistance (IR) comprises a complex adipokine mediated cross-talk between white adipose tissue and other organs. Dipeptidyl peptidase-4 (DPP4) is protease recently proposed as a novel adipokine linked to IR. We aimed to assess the relationship between fasting serum DPP4 activityand IR in type 1 diabetic (T1DM) patients. METHODS A cross-sectional study comprised 44 T1DM patients aged >18 and <65years. IR was esimated using the equation for insulin sensitivity derived from euglycemic-hyperinsulinemic clamp studies-estimated glucose disposal rate (eGDR). DPP4 serum activity was determined spectrophotometrically as a rate of cleavage of 7-Amino-4-Methyl Coumarin (AMC) from H-Gly-Pro-AMC. RESULTS Patients were divided according to DPP4 activity tertiles (<25.40; ≥36.54 U/L). Fasting serum DPP4 activity was related to disease duration (p=0.012), systolic (p=0.009) and diastolic (p=0.047) blood pressure, waist circumference (p=0.037), urine albumin excretion (p=0.022) and conversely related to eGDR (p=0.004). The linear regression has shown that eGDR decreases for 0.203 mgkg(-1)min(-1) by each increase of serum DPP4 activity of 1 U/L (p<0.001) after adjustment for adjusted for age, gender, disease duration, albuminuria and the use of antihypertensives and statins. CONCLUSION Serum DPP4 activity is associated with IR in T1DM patients and it might play an important role in its pathophysiology.
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Affiliation(s)
- K Blaslov
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, School of Medicine Zagreb, Croatia.
| | - T Bulum
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, School of Medicine Zagreb, Croatia
| | - L Duvnjak
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, School of Medicine Zagreb, Croatia
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Zibar K, Blaslov K, Bulum T, Ćuća JK, Smirčić-Duvnjak L. Basal and postprandial change in serum fibroblast growth factor-21 concentration in type 1 diabetic mellitus and in healthy controls. Endocrine 2015; 48:848-55. [PMID: 25194937 DOI: 10.1007/s12020-014-0413-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 08/30/2014] [Indexed: 12/12/2022]
Abstract
Fibroblast growth factor-21 (FGF-21) appears to have an important role in glucose and lipid metabolism. FGF-21 secretion is mainly determined by nutritional status. The aim of this study was to measure basal and postprandial FGF-21 and postprandial change of FGF-21 concentration in type 1 diabetes mellitus (T1DM) patients and in healthy controls, and to investigate the differences between the groups. The cross-sectional study included 30 C-peptide negative T1DM patients, median age 37 years (20-59), disease duration 22 years (3-45), and nine healthy controls, median age 30 years (27-47). Basal and postprandial FGF-21 concentrations were measured by ELISA. The associations of FGF-21 with glucose, lipids, and insulin were analyzed. Individuals with T1DM showed significantly lower basal FGF-21 concentration (P=0.046) when compared with healthy controls (median value 28.2 vs 104 pg/mL) and had significantly different postprandial change (∆ 30'-0') of FGF-21 (P=0.006) in comparison with healthy controls (median value -1.1 vs -20.5 pg/mL). The glucose and lipid status did not correlate with FGF-21. In healthy controls, postprandial insulin level correlated with basal FGF-21 (ρ=0.7, P=0.036). Multiple regression analysis showed that they are independently associated after adjustment for confounding factors (β=1.824, P=0.04). We describe the pathological pattern of basal and postprandial change of FGF-21 secretion not associated with glucose, lipid levels, or insulin therapy in patients with T1DM. Since FGF-21 has numerous protective metabolic effects in the experimental model, the lower basal FGF-21 concentration in T1DM patients opens the question about the potential role of recombinant FGF-21 therapy.
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Affiliation(s)
- Karin Zibar
- Department of Endocrinology and Metabolic Diseases, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Dugi Dol 4a, 10000, Zagreb, Croatia,
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Blaslov K, Bulum T, Knežević-Ćuća J, Duvnjak L. Relationship between autoantibodies combination, metabolic syndrome components and diabetic complications in autoimmune diabetes in adults. Endocrine 2015; 48:551-6. [PMID: 24968736 DOI: 10.1007/s12020-014-0331-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 06/05/2014] [Indexed: 01/03/2023]
Abstract
The aim of our study was to establish the possible association between double or triple antibody positivity and latent autoimmune diabetes (LADA) phenotype in the context of metabolic syndrome (MS) prevalence and its individual components. This cross-sectional study population comprised 69 islet cell antibody-positive patients coming for their comprehensive annual review. They were divided into three groups according to antibody positivity. Twenty-five (36.2 %) were male, mean age of 51 years with disease duration of 8 years. Twenty-eight (40.58 %) were positive only for GAD Abs, 26 (37.68 %) were positive for ICA and GAD Abs and 15 (21.74 %) were positive for GAD, ICA, and IA2 Abs. The lowest value of waist circumference, MS, and artherial hypertension prevalence was found in the group positive for all three antibodies. In the multinomial multivariate logistic regression model, MS was negatively associated with triple Abs positivity compared to single Ab positivity and double Abs positivity. Our results highlight the importance of inverse association between simultaneous Abs positivity for ICA, GAD, and IA2 with the MS and its components present in LADA patients. This inverse relationship might implicate that LADA patients are phenotypically closer to T1DM. The contribution of IA2 Ab positivity merits is to be considered in the determination of LADA phenotypes, while its diagnostic value needs to be clarified in future follow-up studies.
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Affiliation(s)
- Kristina Blaslov
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, School of Medicine, University of Zagreb, 10000, Zagreb, Croatia,
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Abstract
OBJECTIVE Chronic kidney disease (CKD) is one of the most serious complications in obesity-induced type 2 diabetes mellitus (T2DM). Body mass index (BMI), waist-to-hip ratio (WHR), waist circumference (WC) and waist-to-height ratio (WHtR) are recognised as sensitive obesity measures. We aimed to investigate the association of BMI, WC, WHR and WHtR with CKD prevalence in overweight T2DM patients. DESIGN, SUBJECTS AND METHODS We obtained 125 overweight T2DM patients coming for their in-patient annual visit. Metabolic profiles and anthropometric indices were measured and calculated. Urine albumin excretion (UAE) was determined as the mean of 24-h urine from two consecutive days. Serum creatinine was measured from fasting blood sample in order to calculate the estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration formula. Patients were divided into two groups according to CKD prevalence. RESULTS Thirty-six (28.8%) patients met diagnostic criteria for CKD. The WHtR and WC were higher in the group with CKD. WHtR correlated positively with UAE (r = 0.828, p < 0.001) and negatively with eGFR (r = -0.262, p = 0.015). No significant correlation was observed with WC in relation to UAE (p = 0.335) nor eGFR (p = 0.121). WHtR yielded the significant and great OR in association with nephropathy after adjustment for all confounding risk factors. CONCLUSION WHtR might be of a greater importance in association to CKD compared to other anthropometric parameters that indicate central obesity. Whether it is a best measure of central obesity and its exact role in CKD pathology is yet to be investigated.
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Affiliation(s)
- Kristina Blaslov
- a Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, University of Zagreb, School of Medicine , Zagreb , Croatia
| | - Tomislav Bulum
- a Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, University of Zagreb, School of Medicine , Zagreb , Croatia
| | - Lea Duvnjak
- a Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, University of Zagreb, School of Medicine , Zagreb , Croatia
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Bulum T, Blaslov K, Duvnjak L. Risk factors for development and progression of nonproliferative retinopathy in normoalbuminuric patients with type 1 diabetes. Diabetes Res Clin Pract 2014; 106:555-9. [PMID: 25451889 DOI: 10.1016/j.diabres.2014.09.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/19/2014] [Accepted: 09/14/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study was to evaluate risk factors for development and progression of nonproliferative retinopathy (NPR) in normoalbuminuric patients with type 1 diabetes mellitus (T1DM). METHODS A total of 223 T1DM with normal renal function and normoalbuminuria were included in this study and followed for 48 months. Photodocumented retinopathy status was made according to the EURODIAB protocol. Urinary albumin excretion rate (UAE) was measured from at least two 24-h urine samples. Possible risk factors for development or progression of NPR were examined in backward stepwise Cox's multiple regression analysis. RESULTS The majority of patients (70%) had no retinopathy while 67 (30%) had NPR at baseline. Patients with NPR were older, had longer duration of diabetes, higher systolic blood pressure, BMI, resting heart rate, UAE and lower estimated glomerular filtration rate (p ≤ 0.04 for all). After 48 months 24 patients (10.7%) developed NPR or progressed to proliferative retinopathy. Systolic blood pressure (HR 1.03, CI 1.01-1.05, p=0.02), UAE (HR 1.14, CI 1.07-1.21, p<0.001), and resting heart rate (HR 1.05, CI 1.01-1.09, p=0.006) were significantly associated with development or progression of NPR. CONCLUSIONS Our results suggest that retinopathy is present and may progress in T1DM even when coexisting renal disease is excluded. Normoalbuminuric T1DM requires close monitoring for the early detection of retinopathy, especially if they have a higher UAE, systolic blood pressure and resting heart rate.
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Affiliation(s)
- Tomislav Bulum
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, Medical School, University of Zagreb, Zagreb, Croatia.
| | - Kristina Blaslov
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, Medical School, University of Zagreb, Zagreb, Croatia
| | - Lea Duvnjak
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, Medical School, University of Zagreb, Zagreb, Croatia
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Zibar K, Ćuća JK, Blaslov K, Bulum T, Smirčić-Duvnjak L. Difference in glucagon-like peptide-1 concentrations between C-peptide negative type 1 diabetes mellitus patients and healthy controls. Ann Clin Biochem 2014; 52:220-5. [DOI: 10.1177/0004563214544709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The role of glucagon-like peptide-1 (GLP-1) has become a new scientific interest in the field of pathophysiology of type 1 diabetes mellitus (T1DM), but the results of the published studies were contradictory. The aim of our study was therefore to measure fasting and postprandial GLP-1 concentrations in T1DM patients and in healthy controls and to examine the difference in those concentrations between the two groups of subjects. Methods The cross-sectional study included 30 C-peptide negative T1DM patients, median age 37 years (20–59), with disease duration 22 years (3–45), and 10 healthy controls, median age 30 years (27–47). Fasting and postprandial total and active GLP-1 concentrations were measured by ELISA (ALPCO, USA). The data were statistically analysed by SPSS, and significance level was accepted at P < 0.05. Results Both fasting total and active GLP-1 concentrations were significantly lower in T1DM patients (total 0.4 pmol/L, 0–6.4 and active 0.2 pmol/L, 0–1.9) compared with healthy controls (total 3.23 pmol/L, 0.2–5.5 and active 0.8 pmol/L, 0.2–3.6), P = 0.008 for total GLP-1 and P = 0.001 for active GLP-1. After adjustment for age, sex and body mass index, binary logistic regression showed that both fasting total and active GLP-1 remained significantly independently lower in T1DM patients (total GLP-1: OR 2.43, 95% CI 1.203–4.909 and active GLP-1: OR 8.73, 95% CI 1.472–51.787). Conclusions T1DM patients had independently lower total and active GLP-1 fasting concentrations in comparison with healthy people, which supports the potential therapeutic role of incretin therapy, along with insulin therapy, in T1DM patients.
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Affiliation(s)
- Karin Zibar
- Department of Endocrinology and Metabolic Diseases, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
| | - Jadranka Knežević Ćuća
- Department of Clinical Chemistry and Laboratory Medicine, Merkur University Hospital, Zagreb, Croatia
| | - Kristina Blaslov
- Department of Endocrinology and Metabolic Diseases, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
| | - Tomislav Bulum
- Department of Endocrinology and Metabolic Diseases, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
| | - Lea Smirčić-Duvnjak
- Department of Endocrinology and Metabolic Diseases, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- Medical School University of Zagreb, Zagreb, Croatia
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Blaslov K, Bulum T, Zibar K, Duvnjak L. Incretin based therapies: A novel treatment approach for non-alcoholic fatty liver disease. World J Gastroenterol 2014; 20:7356-7365. [PMID: 24966606 PMCID: PMC4064081 DOI: 10.3748/wjg.v20.i23.7356] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 12/07/2013] [Accepted: 01/08/2014] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease is considered a hepatic manifestation of metabolic syndrome (MS). The current treatment of non-alcoholic fatty liver disease (NAFLD) principally includes amelioration of MS components by lifestyle modifications but the lack of success in their implementation and sustainment arises the need for effective pharmacological agent in fatty liver treatment. Incretins are gut derived hormones secreted into the circulation in response to nutrient ingestion that enhances glucose-stimulated insulin secretion. Glucagon-like peptide-1 (GLP-1) is the most important incretin. Its receptor agonist and inhibitors of dipeptidyl peptidase-4 (DPP-4) are used in treatment of type 2 diabetes mellitus. DPP-4 serum activity and hepatic expression are shown to be elevated in several hepatic diseases. There are several experimental and clinical trials exploring the efficacy of incretin based therapies in NAFLD treatment. They suggest that GLP-1 analogues might have beneficial effect on hepatic steatosis acting as insulin sensitizers and directly by stimulating GLP-1 receptors expressed on hepatocytes. The use of DPP-4 inhibitors also results in hepatic fat reduction but the mechanism of action remains unclear. There is growing evidence that incretin based therapies have beneficial effects on hepatocytes, however further study analysis are needed to assess the long term effect of incretin based therapies on NAFLD.
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Blaslov K, Zibar K, Bulum T, Duvnjak L. Effect of exenatide therapy on hepatic fat quantity and hepatic biomarkers in type 2 diabetic patients. Clin Res Hepatol Gastroenterol 2014; 38:e61-3. [PMID: 24315013 DOI: 10.1016/j.clinre.2013.10.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 10/30/2013] [Indexed: 02/04/2023]
Affiliation(s)
- Kristina Blaslov
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, University of Zagreb, School of Medicine, Dugi Dol 4a, Zagreb, Croatia.
| | - Karin Zibar
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, University of Zagreb, School of Medicine, Dugi Dol 4a, Zagreb, Croatia
| | - Tomislav Bulum
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, University of Zagreb, School of Medicine, Dugi Dol 4a, Zagreb, Croatia
| | - Lea Duvnjak
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, University of Zagreb, School of Medicine, Dugi Dol 4a, Zagreb, Croatia
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Abstract
INTRODUCTION Previous cross-sectional studies suggested that plasma total homocysteine (tHcy) is associated with retinopathy in patients with type 1 diabetes (T1DM) only in cases of impaired renal function. The objective of this study was to examine whether there is an independent relationship between tHcy and retinopathy in normoalbuminuric T1DM patients with normal estimated glomerular filtration rate (eGFR). METHODS The study included 163 normoalbuminuric patients with T1DM and normal renal function (eGFR >60 ≤ 125 ml min(-1) 1.73 m(-2)). Urinary albumin excretion rate (UAE) was measured from at least two 24 h urine samples. Photodocumented retinopathy status was made according to the EURODIAB protocol. tHcy level was measured with the chemiluminescent immunoassay. RESULTS Retinopathy was present in 48% of normoalbuminuric patients. Patients with retinopathy were older (49 vs 42 years, p = 0.001), had higher systolic blood pressure (130 vs 120 mmHg, p = 0.001), triglycerides (0.89 vs 0.77 mmol/L, p = 0.01), tHcy (9.8 vs 9.1 µmol/L, p = 0.04), and lower eGFR (100 vs 106 ml min(-1) 1.73 m(-2), p = 0.03). In multivariate logistic regression analysis, after adjustment for variables that reached statistical significance in the univariate analysis, only tHcy was significantly associated with a risk of retinopathy in our subjects (p = 0.02), with odds ratios of 1.02 to 1.43. CONCLUSION These data suggest that tHcy is independently associated with retinopathy in normoalbuminuric T1DM with normal eGFR. The mechanisms relating tHcy and retinopathy in T1DM are not clear. Prospectives studies are needed to confirm whether higher tHcy in normoalbuminuric T1DM patients has predictive value for development of retinopathy.
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Affiliation(s)
- Tomislav Bulum
- a Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, University of Zagreb , Zagreb , Croatia
| | - Kristina Blaslov
- a Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, University of Zagreb , Zagreb , Croatia
| | - Lea Duvnjak
- a Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, University of Zagreb , Zagreb , Croatia
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Vanikar AV, Trivedi HL, Dave SD, Kute VB, Rawal MN, Patel HV, Gumber MR, Afghahi H, Pirouzifard M, Svensson AM, Eliasson B, Svensson MK, Dumann K, Horrmann B, Lammert A, Rheinberger M, Gorski M, Kramer BK, Heid IM, Boger CA, Demirtas L, Akbas EM, Timuroglu A, Ozcicek F, Turkmen K, Fernandez-Fernandez B, Sanchez-Nino MD, Martin-Cleary C, Izquierdo MC, Elewa U, Ortiz A, Petrica L, Vlad A, Gluhovschi G, Gadalean F, Dumitrascu V, Gluhovschi C, Velciov S, Bob F, Vlad D, Popescu R, Petrica M, Jianu DC, Milas O, Izvernari O, Ursoniu S, Makino Y, Konoshita T, Nyumura I, Babazono T, Yoshida N, Uchigata Y, Handisurya A, Kerscher C, Tura A, Werzowa J, Heinzl H, Ristl R, Kautzky-Willer A, Pacini G, Saemann M, Schmidt A, Halbesma N, Metcalfe W, Bulum T, Prka in I, Blaslov K, Zibar K, Duvnjak L, Idorn T, Knop FK, Jorgensen MB, Christensen M, Holst JJ, Hornum M, Feldt-Rasmussen B, Naess H, Hartmann A, Jenssen TG, Holdaas H, Horneland R, Grzyb K, Bitter J, Midtvedt K, Yoshida N, Babazono T, Uchigata Y, Timar R, Gluhovschi G, Gadalean F, Velciov S, Petrica L, Timar B, Gluhovschi C, Soro-Paavonen A, Fleming T, Forsblom C, Gordin D, Tolonen N, Harjutsalo V, Nawroth PP, Groop PH, Tsuda A, Ishimura E, Uedono H, Yasumoto M, Nakatani S, Ichii M, Ohno Y, Ochi A, Mori K, Fukumoto S, Emoto M, Inaba M, Rheinberger M, Hormann B, Lammert A, Dumann K, Gorski M, Heid IM, Kramer BK, Boger CA, Siddaramaiah NH, Tez DK, Linker NJ, Bilous M, Winship S, Marshall SM, Bilous RW, Lampropoulou IT, Papagianni A, Stangou M, Didangelos T, Iliadis F, Efstratiadis G, Esposito P, Debarbieri G, Mereu R, Ditoro A, Montagna F, Groop PH, Bernardi L, Dal Canton A, Garland JS, Holden R, Morton R, Ross R, Adams M, Pruss C, Akbas EM, Demirtas L, Timuroglu A, Ozcicek F, Turkmen K, Bulum T, Prka in I, Blaslov K, Zibar K, Duvnjak L, Theodoridis M, Panagoutsos S, Bounta T, Roumeliotis S, Kantartzi K, Pouloutidis G, Passadakis P, Polaina Rusillo M, Borrego Utiel FJ, Ortega Anguiano S, Liebana Canada A, Gaber EW, Abdel Rehim WM, Ibrahim NA, Mahmoud BF, Silva AP, Fragoso A, Tavares N, Silva C, Santos N, Camacho A, Neves P, Rodriguez R, Porrini E, Gonzalez-Rinne A, De Vries A, Torres A, Salido E, Kato S, Makino H, Uzu T, Koya D, Nishiyama A, Imai E, Ando M, Jorgensen MB, Knop FK, Idorn T, Holst JJ, Hornum M, Feldt-Rasmussen B, Vaduva C, Popa S, Mitrea A, Mota M, Mota E, Theodoridis M, Panagoutsos S, Roumeliotis S, Bounta T, Kriki P, Roumeliotis A, Passadakis P, Ogawa T, Okazaki S, Hatano M, Hara H, Inamura M, Kiba T, Iwashita T, Shimizu T, Tayama Y, Kanozawa K, Kato H, Matsuda A, Hasegawa H, Elewa U, Fernandez B, Egido J, Ortiz A, Rottembourg J, Guerin A, Diaconita M, Dansaert A, Chakraborty J, Prabhu R, Nagaraju SP, Bairy M, Satyamoorthy K, Kosuru S, Parthasarathy R, Tomilina N, Zhilinskaya T, Stolyarevich E, Silva AP, Fragoso A, Guilherme P, Silva C, Santos N, Rato F, Camacho A, Neves P, Pasko N, Strakosha A, Toti F, Dedej T, Marku N, Petrela E, Zekollari E, Kacorri V, Thereska N, Roumeliotis SK, Roumeliotis AK, Theodoridis M, Tavridou A, Panagoutsos S, Passadakis P, Vargemezis V, Kim IY, Lee SB, Lee DW, Kim MJ, Shin MJ, Rhee H, Yang BY, Song SH, Seong EY, Kwak IS, Celebi K, Sengul E, Cekmen MB, Yilmaz A, Sonikian M, Dona A, Skarakis J, Miha T, Trompouki S, Karaitianou A, Spiliopoulou C, Dimas GG, Iliadis FS, Tegos TJ, Spiroglou SG, Kanellos IE, Fotiadis SD, Didaggelos TP, Savopoulos CG, Hatzitolios AI, Grekas DM, Hsu YH, Huang MC, Chang HY, Shin SJ, Wahlqvist ML, Chang YL, Hsu KC, Hsu CC, Miarka P, Grabowska-Polanowska B, Faber J, Skowron M, Pietrzycka A, Walus-Miarka M, Sliwka I, Sulowicz W. DIABETES CLINICAL. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Davids MR, Marais N, Jacobs J, Cohen E, Krause I, Goldberg E, Garty M, Krause I, Dursun B, Sahan Y, Tanriverdi H, Rota S, Uslu S, Senol H, Minutolo R, Gabbai FB, Agarwal R, Chiodini P, Borrelli S, Stanzione G, Nappi F, Bellizzi V, Conte G, De Nicola L, Van De Walle J, Johnson S, Fremeaux-Bacchi V, Ardissino G, Ariceta G, Beauchamp J, Cohen D, Greenbaum LA, Ogawa M, Schaefer F, Licht C, Scalzotto E, Nalesso F, Zaglia T, Corradi V, Neri M, Martino F, Zanella M, Brendolan A, Mongillo M, Ronco C, Chinnappa S, Mooney A, El Nahas AM, Tu YK, Tan LB, Jung JY, Kim AJ, Ro H, Lee C, Chang JH, Lee HH, Chung W, Clarke AL, Young HM, Hull KL, Hudson N, Burton JO, Smith AC, Marx S, Petrilla A, Filipovic I, Lee WC, Meijers B, Poesen R, Storr M, Claes K, Kuypers D, Evenepoel P, Aukland M, Clarke AL, Hull KL, Burton JO, Smith AC, Betriu A, Martinez-Alonso M, Arcidiacono MV, Cannata-Andia J, Pascual J, Valdivielso JM, Fernandez-Giraldez E, Kingswood JC, Zonnenberg B, Sauter M, Zakar G, Biro B, Besenczi B, Varga A, Pekacs P, Pizzini P, Pisano A, Leonardis D, Panuccio V, Cutrupi S, Tripepi G, Mallamaci F, Zoccali C, Arnold J, Baharani J, Rayner H, So BH, Blackwell S, Jardine AG, Macgregor MS, Cunha C, Barreto P, Pereira S, Ventura A, Mota M, Seabra J, Sakaguchi T, Kobayashi S, Yano T, Yoshimoto W, Bancu I, Bonal Bastons J, Cleries Escayola M, Vela Vallespin E, Bustins Poblet M, Magem Luque D, Pastor Fabregas M, Chen JH, Chen SC, Chang JM, Hwang SJ, Chen HC, Ahbap E, Kara E, Basturk T, Sahutoglu T, Koc Y, Sakaci T, Sevinc M, Akgol C, Ozagari AA, Unsal A, Minami S, Hesaka A, Yamaguchi S, Iwahashi E, Sakai S, Fujimoto T, Sasaki K, Fujita Y, Yokoyama K, Marks A, Fluck N, Prescott G, Robertson L, Smith WC, Black C, Ohsawa M, Fujioka T, Omori S, Isurugi T, Tanno K, Onoda T, Omama S, Ishibashi Y, Makita S, Okayama A, Garland JS, Simpson CS, Metangi MF, Parfrey B, Johri AM, Sloan L, McAuley J, Cunningham R, Mullan R, Quinn M, Harron C, Chiu H, Murphy-Burke D, Werb R, Jung B, Chan-Yan C, Duncan J, Forzley B, Lowry R, Hargrove G, Carson R, Levin A, Karim M, Reznik EV, Storozhakov GIV, Rollino C, Troiano M, Bagatella M, Liuzzo C, Quarello F, Roccatello D, Blaslov K, Bulum T, Prka In I, Duvnjak L, Heleniak Z, Ciepli ska M, Szychli ski T, Pryczkowska M, Bartosi ska E, Wiatr H, Kot owska H, Tylicki L, Rutkowski B, Song YR, Kim SGK, Kim HJ, Noh JW, Tong A, Jesudason S, Craig JC, Winkelmayer WC, Hung PH, Huang YT, Hsiao CY, Sung PS, Guo HR, Tsai KJ, Wu CC, Su SL, Kao SY, Lu KC, Lin YF, Lin WH, Lee HM, Cheng MF, Wang WM, Yang LY, Wang MC, Vukovic Lela I, Sekoranja M, Poljicanin T, Karanovic S, Abramovic M, Matijevic V, Stipancic Z, Leko N, Cvitkovic A, Dika Z, Kos J, Laganovic M, Grollman AP, Jelakovic B, Dryl-Rydzynska T, Prystacki T, Malyszko J, Trifiro G, Sultana J, Giorgianni F, Ingrasciotta Y, Muscianisi M, Tari DU, Perrotta M, Buemi M, Canale V, Arcoraci V, Santoro D, Rizzo M, Iheanacho I, Van Nooten FE, Goldsmith D, Grandtnerova B, Berat ova Z, ErvenOva M, cErven J, Markech M, tefanikova A, Engelen W, Elseviers M, Gheuens E, Colson C, Muyshondt I, Daelemans R. CKD GENERAL AND CLINICAL EPIDEMIOLOGY 2. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Katalinić L, Blaslov K, Pasini E, Kes P, Bašić-Jukić N. [Acid-base status in patients treated with peritoneal dialysis]. Acta Med Croatica 2014; 68:85-90. [PMID: 26012143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
When compared to hemodialysis, peritoneal dialysis is very simple yet low cost method of renal replacement therapy. Series of studies have shown its superiority in preserving residual renal function, postponing uremic complications, maintaining the acid-base balance and achieving better post-transplant outcome in patients treated with this method. Despite obvious advantages, its role in the treatment of chronic kidney disease is still not as important as it should be. Metabolic acidosis is an inevitable complication associated with progressive loss of kidney function. Its impact on mineral and muscle metabolism, residual renal function, allograft function and anemia is very complex but can be successfully managed. The aim of our study was to evaluate the efficiency in preserving the acid-base balance in patients undergoing peritoneal dialysis at Zagreb University Hospital Center. Twenty-eight patients were enrolled in the study. The mean time spent on the treatment was 32.39 ± 43.43 months. Only lactate-buffered peritoneal dialysis fluids were used in the treatment. Acid-base balance was completely maintained in 73.07% of patients; 11.54% of patients were found in the state of mild metabolic acidosis, and the same percentage of patients were in the state of mild metabolic alkalosis. In one patient, mixed alkalosis with respiratory and metabolic component was present. The results of this study showed that acid-base balance could be maintained successfully in patients undergoing peritoneal dialysis, even only with lactate-buffered solutions included in the treatment, although they were continuously proclaimed as inferior in comparison with bicarbonate-buffered ones. In well educated and informed patients who carefully use this method, accompanied by the attentive and thorough care of their physicians, this method can provide quality continuous replacement of lost renal function as well as better quality of life.
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Blaslov K, Bulum T, Duvnjak L. [Pathophysiological factors in the development of diabetic nephropathy--new insights]. Acta Med Croatica 2014; 68:135-140. [PMID: 26012151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Diabetic nephropathy (DN), also known as Kimmelstiel-Wilson syndrome, is a progressive kidney disease characterized by nephrotic syndrome and diffuse glomerulosclerosis. It affects about 30% of patients with diabetes mellitus and is a prime indication for dialysis in many Western countries as well as in Croatia. Moreover, it takes a high fourth place in total disease cost, thus it is a very important public health problem. Hyperglycemia, dyslipidemia and hypertension are well established risk factors for the disease development and progression. However, nowadays, the knowledge about the pathophysiology of the disease is expanded and recently focused on the role of growth factors. Well balanced local and plasma concentration of growth factors is important for achievement and maintenance of glomerular integrity and function, so any disturbances could be a contributing factor to the development of DN. There is a growing body of literature suggesting that bone morphogenic protein 7 (BMP7), fibroblast growth factor 23 (FGF23) and fibroblast growth factor 21(FGF21) may play an important role in the DN development and progression. BMP7 possesses antifibrotic and proteolytic activity, so it could diminish the action of profibrotic factors and play an inhibitory role in the disease pathogenesis. It has been demonstrated that plasma concentration of BMP7 is decreasing in parallel to the drop in glomerular filtration rate (GFR) and albumin excretion increase. The plasma concentration of FGF21 and FGF23 has been shown to increase in parallel to DN progression. Moreover, they are linked with hyperinsulinemia and insulin resistance as well as with other diabetic complications such as cardiovascular events and endothelial dysfunction and retinopathy conditions closely related to DN. However, the background of the disturbances is not well established; it is not clarified whether GFR lowering causes increase of FGF21 and FGF23 or the increase in FGF21 and FGF23 concentration causes GFR lowering. The loop is yet to be clarified in order to develop a possible novel therapeutic approach in the treatment of this disease with serious consequences for the individual as well as for the entire population.
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Blaslov K, Katalinic L, Kes P, Spasovski G, Smalcelj R, Basic-Jukic N. What is the impact of immunosuppressive treatment on the post-transplant renal osteopathy? Int Urol Nephrol 2013; 46:1019-24. [PMID: 24217803 DOI: 10.1007/s11255-013-0596-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022]
Abstract
Although glucocorticoid therapy is considered to be the main pathogenic factor, a consistent body of evidence suggests that other immunosuppressants might also play an important role in the development of the post-transplant renal osteopathy (PRO) through their pleiotropic pharmacological effects. Glucocorticoids seem to induce osteoclasts' activity suppressing the osteoblasts while data regarding other immunosuppressive drugs are still controversial. Mycophenolate mofetil and azathioprine appear to be neutral regarding the bone metabolism. However, the study analyzing any independent effect of antimetabolites on bone turnover has not been conducted yet. Calcineurin inhibitors (CNIs) induce trabecular bone loss in rodent, with contradictory results in renal transplant recipients. Suppression of vitamin D receptor is probably the underlying mechanism of renal calcium wasting in renal transplant recipients receiving CNI. In spite of an increased 1,25(OH)2 vitamin D level, the kidney is not able to reserve calcium, suggesting a role of vitamin D resistance that may be related to bone loss. More efforts should be invested to determine the role of CNI in PRO. In particular, data regarding the role of mammalian target of rapamycin inhibitors (mTORi), such as sirolimus and everolimus, in the PRO development are still controversial. Rapamycin markedly decreases bone longitudinal growth as well as callus formation in experimental models, but also lowers the rate of bone resorption markers and glomerular filtration in clinical studies. Everolimus potently inhibits primary mouse and human osteoclast activity as well as the osteoclast differentiation. It also prevents the ovariectomy-induced loss of cancellous bone by 60 %, an effect predominantly associated with a decreased osteoclast-mediated bone resorption, resulting in a partial preservation of the cancellous bone. At present, there is no clinical study analyzing the effect of everolimus on bone turnover in renal transplant recipients or comparing sirolimus versus everolimus impact on bone, so only general conclusions could be drawn. Hence, the use of mTORi might be useful in patients with PRO due to their possible potential to inhibit osteoclast activity which might lead to a decreased rate of bone resorption. In addition, it should be also emphasized that they might inhibit osteoblast activity which may lead to a decreased bone formation and adynamic bone disease. Further studies are urgently needed to solve these important clinical dilemmas.
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Affiliation(s)
- Kristina Blaslov
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
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Blaslov K, Zibar K, Bulum T, Duvnjak L. Relationship of vascular complications and exenatide therapy failure in type 2 diabetic patients. Acta Clin Croat 2013; 52:328-336. [PMID: 24558765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Exenatide is an incretin mimetic that acts through glucagon-like peptide 1 receptor accepted as a successful novel glucose-lowering agent in type 2 diabetes. The aim of this study was to explore the possible predictive factors for exenatide efficacy among baseline characteristics of type 2 diabetic patients. We observed basic anthropometric measurements, laboratory findings and diabetic complications in ninety-one type 2 diabetic patients starting exenatide therapy. There were forty-six (50.5%) male and forty-five (49.5%) female patients, median age 58 (31-76) years, body mass index 38.95 +/- 4.35 kg/m2, duration of diabetes 10 (1-30) years and HbAlc level 8.3 +/- 1.4%. Thirty (33%) patients stopped therapy because of glycemic dysregulation during 105 (21-390) days on therapy. These patients differed statistically significantly from those that continued therapy according to the following seven variables: higher fasting glucose blood concentration (11.5 mmol/L (5.6-20) vs. 10.2 mmol/L (5-19), higher serum creatinine concentration (93 micromol/L (44-149) vs. 72 micromol/L (44-124), more frequent diabetic complications including retinopathy (56.7% vs. 27.9%), chronic kidney disease (43.7% vs. 24.7%), coronary artery disease (53.3% vs. 31.1%) and peripheral artery disease (60% vs. 34.4%), and less often concomitant metformin and exenatide therapy (62% vs. 82%). Bivariate logistic regression identified peripheral artery disease, coronary artery disease, retinopathy, and chronic kidney disease as risk factors for glycemic dysregulation on exenatide therapy. We found reasonable to consider that a higher rate of microvascular and macrovascular complications may indicate failure of exenatide therapy in the majority of patients.
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Affiliation(s)
- Kristina Blaslov
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, School of Medicine, University of Zagreb, Zagreb, Croatia.
| | - Karin Zibar
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tomislav Bulum
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Lea Duvnjak
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, School of Medicine, University of Zagreb, Zagreb, Croatia
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Bulum T, Prkacin I, Blaslov K, Zibar K, Duvnjak L. Association between red blood cell count and renal function exist in type 1 diabetic patients in the absence of nephropathy. Coll Antropol 2013; 37:777-782. [PMID: 24308216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Anemia is a prevalent finding in patients with type 1 diabetes, particularly in those with albuminuria or reduced renal function. We investigated the relationship between red blood cell count (RBC) and renal function in type 1 diabetic patients with normal or mildly impaired renal function and urinary albumin excretion rate (UAE) < 30 mg/24 h. Study included 313 type 1 diabetic patients with estimated glomerular filtration rate (eGFR) > 60 mL min(-1) 1.73 m(-2), and before any interventions with statins, ACE inhibitors or angiotensin II receptor blockers. UAE was measured from at least two 24-h urine samples. Hemoglobin (Hb), hematocrit (Hct), erythrocytes (E), serum iron and ferritin levels were significantly lower in subjects in the highest quartile of serum creatinine compared to those in lowest quartile (132 vs 148 g/L, 0.39 vs 0.42 L/L, 4.5 vs 4.8 x 10(12)/L, 13 vs 18 micromol/L, and 25 vs 103 microg/L, respectively, for all p < 0.001). Hb and Hct levels were significantly lower in subjects in the highest quartile of UAE compared to those in lowest quartile (135 vs 140 g/L, and 0.40 vs 0.41 L/L, respectively, for all p = 0.03). Finally, those with mildly impaired eGFR had significantly lower levels of Hb, Hct and E compared to those with normal eGFR or hyperfiltrating subjects (133 vs 140 g/L, 0.38 vs 0.41 L/L, and 4.4 vs 4.7 x 10(12)/L, respectively, for all p = 0.01). We have detected that interplay between RBC and renal function parameters occurs even in type 1 diabetic patients with normal or mildly impaired renal function.
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Affiliation(s)
- Tomislav Bulum
- University of Zagreb, School of Medicine, University Hospital "Merkur", "Vuk Vrhovac" Clinic for Diabetes, Endocrinology and Metabolic Diseases, Zagreb, Croatia.
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Bulum T, Blaslov K, Duvnjak L. Resting heart rate is associated with nonproliferative retinopathy in normoalbuminuric type 1 diabetic patients. J Clin Hypertens (Greenwich) 2013; 15:579-83. [PMID: 23889721 DOI: 10.1111/jch.12130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 04/06/2013] [Accepted: 04/14/2013] [Indexed: 11/27/2022]
Abstract
Previous studies have reported that retinopathy might be already present in the normoalbuminuric state in type 1 diabetic patients. The aim of this study was to evaluate the prevalence and predictors of nonproliferative retinopathy in normoalbuminuric type 1 diabetic patients. The study included 312 normoalbuminuric type 1 diabetic patients with normal renal function before any interventions with statins, angiotensin-converting enzyme inhibitors, or angiotensin II receptor blockers. Diagnosis of nonproliferative retinopathy was made by fundoscopy after pupillary dilatation. Urinary albumin excretion (UAE) rate was measured from at least two 24-hour urine samples. Nonproliferative retinopathy was present in 36% of normoalbuminuric patients. Patients with nonproliferative retinopathy were older and had longer duration of diabetes, higher hemoglobin A1c , daily insulin dose, and higher resting heart rate (RHR) (P≤.01 for all). Patients in the 4th quartile of RHR were older and had longer duration of diabetes, higher hemoglobin A1c , daily insulin dose, serum creatinine, UAE, and a significantly higher prevalence of nonproliferative retinopathy compared with subjects in the 2nd, 3rd, and 4th quartiles (P<.05). In logistic regression analysis, after adjustment for risk factors, higher RHR was significantly associated with risk of nonproliferative retinopathy in patients (P<.001), with odds ratios of 1.02 to 1.08. These data suggest that RHR is independently associated with nonproliferative retinopathy in normoalbuminuric type 1 diabetic patients.
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Affiliation(s)
- Tomislav Bulum
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, Medical School, University of Zagreb, Zagreb, Croatia.
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Blaslov K, Bulum T, Zibar K, Duvnjak L. Relationship between Adiponectin Level, Insulin Sensitivity, and Metabolic Syndrome in Type 1 Diabetic Patients. Int J Endocrinol 2013; 2013:535906. [PMID: 23956744 PMCID: PMC3730225 DOI: 10.1155/2013/535906] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 07/01/2013] [Indexed: 01/30/2023] Open
Abstract
Objective. Adiponectin is known to be decreased in insulin resistance (IR) and metabolic syndrome (MS) which can be present in patients with type 1 diabetes mellitus (T1DM). The aim of this study was to evaluate the relationship between adiponectin level, MS, and insulin sensitivity in T1DM. Research Design and Methods. The study included 77 T1DM patients divided into two groups based on the total plasma adiponectin median value. Insulin sensitivity was calculated with the equation for eGDR, and MS was defined according to International Diabetes Federation criteria. Results. Patients with higher adiponectin level (n = 39) had significantly lower waist circumference (P < 0.002), fasting venous glucose levels (P < 0.001), higher HDL3-cholesterol (P = 0.011), and eGDR (P = 0.003) in comparison to the group with lower adiponectin who showed higher prevalence of MS (P = 0.045). eGDR increased for 1.09 mg/kg(-1) min(-1) by each increase of 1 µ g/mL total fasting plasma adiponectin (P = 0.003). In the logistic regression model, adiponectin was inversely associated with the presence of MS (P = 0.014). Conclusion. Higher adiponectin concentration is associated with lower prevalence of MS in T1DM. Whether higher adiponectin concentration has a protective role in the development of the MS in T1DM needs to be clarified in future follow-up studies.
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Affiliation(s)
- Kristina Blaslov
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tomislav Bulum
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, School of Medicine, University of Zagreb, Zagreb, Croatia
- *Tomislav Bulum:
| | - Karin Zibar
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Lea Duvnjak
- Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic Diseases, University Hospital Merkur, School of Medicine, University of Zagreb, Zagreb, Croatia
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