LAM Extra for General Practicioners

[ANTIDIABETIC THERAPY OF PATIENTS WITH TYPE 2 DIABETES - THE PLACE OF ADMINISTRATION OF ACARBOSE]

KEMPLER Péter

FEBRUARY 20, 2012

LAM Extra for General Practicioners - 2012;4(01)

[Administration of the alpha-glucosidase enzyme inhibitor acarbose leads to a prolonged absorption of carbohydrates, which has a smoothing effect on blood glucose excursions, and results in a more even daily blood glucose profile. The glucose lowering effect is mainly due to the reduction of postprandial blood glucose levels. Non-glycaemic effects of acarbose, including those on blood pressure, lipids and the coagulation system are also clearly beneficial. According to the available data, the preparation also reduces cardiovascular risk. If used as a monotherapy, acarbose does not cause hypoglycaemia. Flatulence and diaorrhea represent the main side effects. From a professional point of view, acarbose should be given if postprandial blood glucose excursions exceed 2.2 mmol/l.]

COMMENTS

0 comments

Further articles in this publication

LAM Extra for General Practicioners

[PAIN MANAGEMENT IN RHEUMATOLOGY]

NAGY Katalin

[Pain is the most common symptom in rheumatology, which can be of mechanical or inflammatory origin, acute and chronic, nociceptive, neuropathic and psychogenic. Pain can be relieved by analgesics, nonsteroidal anti-inflammatory drugs, opioids, adjuvants and special drugs depending on the etiology, for example a gout attack can be stopped by colchicine. For pain relief, we use therapeutic guidelines of the World Health Organization (WHO), which recommends the use of analgesics, NSAIDs and adjuvants as the first step, weaker opioids as the second, and strong opioids as the third step. In rheumatology, the first step's drugs are generally used. If possible, NSAIDs should be administered briefly, potentially combined with analgesics and muscle relaxants. If pain management is insufficient, tramadol should be given. Pain relief in rheumatology also include the use of local and intraarticular injections, physiotherapy, TENS and balneotherapy. Complex therapies that combine the above mentioned methods is often more effective than the use of medications only.]

LAM Extra for General Practicioners

[PYCNOGENOL IN THE CLINICAL PRACTICE]

KISS István, TAVASZY Mariann, FARSANG Csaba

[Polyphenols, which belong to the group of flavonoids, can be found in a number of plants, and are present in a high concentration in the French maritime pine bark. The authors summarise results of large-scale experimental and clinical studies on pycnogenol, the standardised extract of French maritime pine bark. Pycnogenol decreases production and effects of free radicals (antioxidant effect). It has antiinflammatory properties, and, by the stimulation of eNOSsynthesis, it increases the production of vasodilatory compounds (e.g. NO, prostacyclin) and decreases that of vascoconstrictor compounds (endothelin-1, thromboxane) materials. These changes lead to vasodilation, which results in increased tissue perfusion and decreased blood pressure. Pycnogenol also decreases platelet aggregation and LDL-cholesterol level and increases HDL-cholesterol level. Its antidiabetic effect has also been shown. Consequently, it may substantially decrease cardiovascular risk. In addition to these results, pycnogenol has been also found to have antibacterial and antiviral effects. It has been successfully used in children with attention deficit hyperactivity disorder, as well as in adults with dysmenorrhea, climacterial disturbances, glaucoma or asthma bronchiale.]

LAM Extra for General Practicioners

[HOW DIABETOGENIC IS STATIN THERAPY?]

CSÁSZÁR Albert

[According to the latest guidelines, the goal in cardiovascular prevention is to achieve an LDL-cholesterol level no higher than 1.8 mmol/l in the high risk and extra high risk groups. According to international recommendations, statin should be used at the highest tolerable dose rather than any combination treatments. In a number of cases, higher doses are associated with increased side effects, which rarely affect liver enzymes and CK-parameters. A metaanalysis published in 2011 made it clear that higher statin doses compared with low-medium doses can increase the occurence of newonset diabetes by about 12%. This is presumably a class effect, which is not significant according to the guidelines, and which is much lesser than the benefits of this therapy in the prevention of cardiovascular events, thus, it obviously does not question the justification of statin treatment. However, the observed association implies that during statin therapy of nondiabetic patients, blood glucose control should be performed every year, and, if needed, an oral glucose tolerance test should be performed to detect the potential development of diabetes.]

LAM Extra for General Practicioners

[FAIR-HF]

MATOS Lajos

All articles in the issue

Related contents

Hypertension and nephrology

[Association between cyclothymic affective temperament and hypertension]

NEMCSIK János, BATTA Dóra, KŐRÖSI Beáta, RIHMER Zoltán

[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]

Clinical Neuroscience

Positive airway pressure normalizes glucose metabolism in obstructive sleep apnea independent of diabetes and obesity

KABELOĞLU Vasfiye, SENEL Benbir Gulçin, KARADENIZ Derya

The relationship among obstructive sleep apnea syndrome (OSAS), type 2 diabetes mellitus (DM2) and obesity is very complex and multi-directional. Obesity and increased visceral fat are important perpetuating factors for DM2 in patients with OSAS. On the other hand, OSAS itself leads to obesity by causing both leptin and insulin resistance as a consequence of activation of the sympathetic nervous system. Risk for developing DM2 further increases in patients with OSAS and obesity. Data regarding effects of positive airway pressure (PAP) therapy, gold standard treatment for OSAS, on glycemic control were inconsistent due to variability in duration of and adherence to PAP therapy. In our cohort study we investigated effects of PAP treatment on glucose metabolism in normal-weighted non-diabetic OSAS patients, in obese non-diabetic OSAS patients, and in OSAS patients with DM2. We prospectively analyzed 67 patients diagnosed with OSAS and documented to be effectively treated with PAP therapy for three months. Apnea-hypopnea index was highest in the diabetic group, being significantly higher than in the normal-weighted group (p=0.021). Mean HOMA values were significantly higher in obese (p=0.002) and diabetic group (p=0.001) than normal-weighted group; the differences were still significant after PAP therapy. HbA1c levels were significantly higher in diabetic group compared to those in normal-weighted (p=0.012) and obese (p=0.001) groups. After PAP treatment, decrease in HbA1c levels were significant in normal-weighted (p=0.008), obese (p=0.034), and diabetic (p=0.011) groups. There was no correlation with the change in HbA1c levels and age (p=0.212), BMI (p=0.322), AHI (p=0.098) or oxygen levels (p=0.122). Our study showed that treatment of OSAS by PAP therapy offers beneficial effect on glucose metabolism, not only in diabetic patients, but also in obese and normal-weighted OSAS patients. Although data regarding overall effects of PAP therapy on glycemic control present contradictory results in the literature, it should be emphasized that duration and adherence to PAP therapy were main determinants for beneficial outcome of treatment.

Hypertension and nephrology

[The importance of assessing subclinical organ damage in risk prediction of hypertensive patients]

GODINA Gabriella, JÁRAI Zoltán

[As the cardiovascular risk influences the quality and intensity of blood pressure lowering therapy, the goal blood pressure values and the frequency of medical control of hypertensive patients, as well as global risk assessment has an important role in the management of hypertension. In the last couple of years many data have been accumulated showing the poor prognostic value of traditional cardiovascular risk factors. This is the reason why recent Hungarian and international guidelines on the management of hypertension advise the screening for subclinical organ damage. Our goal was to summarize the importance of subclinical organ damage by discussing recently published literature on this topic. An overview has been made on the markers of vascular subclinical damage, like carotid atherosclerosis proved with carotid ultrasonography, peripheral arterial disease assessed with ankle-brachial pressure index measurements and vascular rigidity defined with pulse wave velocity measurements. The prognostic values of myocardial hypertrophy assessed with ECG and/or echocardiography and renal damage proved with decreased estimated glomerular filtration rate and proteinuria are also discussed. Summing up what has been said so far, the assessment of subclinical organ damage has a role in cardiovascular risk prediction, however more randomized and prospective studies have to be performed to define the most suitable (i.e. the most reliable and the most cost-effective) markers for this purpose.]

Lege Artis Medicinae

[INSULIN ASPART IN THE CLINICAL PRACTICE]

JERMENDY György

[Insulin aspart (B28 Asp-insulin), which is produced by recombinant DNA technology, is a fast-acting insulin analogue. Due to the aspartate for proline substitution at position 28 of the Bchain, the insulin molecule's tendency for selfassociation is diminished, therefore, insulin aspart rapidly dissociates into dimeric and monomeric forms and absorbs quickly and easily after subcutaneous administration. Compared to human regular insulin, insulin aspart has a faster onset of activity, a higher plasma peak and a shorter duration of action. Overall, the pharmacokinetic profile of insulin aspart better mimics the physiological postprandial insulin secretion. Therefore, insulin aspart can be used for prandial insulin substitution in order to decrease postprandial blood glucose excursion. It should be administered immediately before meals, but some observations suggest that it can also be used after finishing meal. This allows a more flexible lifestyle for patients. Insulin aspart can be used in both type 1 and type 2 diabetes. Compared to regular human insulin, a moderate decrease in the HbA1c values and fewer nocturnal hypoglycaemic events are expected from insulin aspart use. Insulin aspart is appropriate for pump treatment as well. It has recently been approved for use in pregnancy, whereas for children and adolescents the expected benefits should be weighed against the more modest clinical experience available. Similarly to other insulin analogues, results of long-term clinical investigations with insulin aspart with regard to the development of complications are not yet available.]

Image challenge

What do you see on the feet of the diabetic patient?