Lege Artis Medicinae

[Antidiabetic therapy of patients with type 2 diabetes - The role of incretin mimetics]

GERŐ László

JANUARY 20, 2012

Lege Artis Medicinae - 2012;22(01)

[Incretin mimetics represent a new group of antidiabetic drugs. They bind to their own receptor on the beta-cell membrane and increase insulin secretion in a glucosedependent manner. Thus, they rarely cause hypoglycaemia. Furthermore, they significantly reduce body weight and other cardiovascular risk factors. Accordingly, they can be considered as an optimal group of antidiabetic drugs. The author reviews the clinical efficacy and safety of currently available incretin mimetics.]

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[How do physicians sleep and dream?]

SUSÁNSZKY Éva, SZÁNTÓ Zsuzsa

[INTRODUCTION - Satisfying sleep is especially important for physicians. Our study analyses physicians’ sleep and dream from the point of view of continuous nightand- day duty. SAMPLE AND METHOD - Questionnaires were completed by 125 physicians among whom the proportion of night shift taking and only day-time working persons was equal. The questionnaire contained the Athens Insomnia Scale and the Dream Quality Questionnaire as well as questions about demographical characteristics and work circumstances. RESULTS - Almost each doctor mentioned sleep problems, principally daytime sleepiness (78%) and sleep deprivation (70%). Long sleep latency is reported more often by women doctors; the frequency of night awakenings increases, while daytime sleepiness decreases by age. The feeling of performance-loss is more prevalent among night shift takers. Dream characteristics differ significantly neither along demographical characteristics nor by work shifts. CONCLUSION - Although sleep problems are more frequent among physicians when comparing to the Hungarian general population, the frequency of clinical level insomnia is not higher. On the other hand, physicians can recall their dreams more often (25% vs 7%) and the emotional load of their dreams influence their daytime mood more commonly.]

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Lege Artis Medicinae

[Efficiency and safety of the vaccination against H1N1 influenza virus in inflammatory bowel disease]

FARKAS Klaudia, JANKOVICS István, MELLES Márta, NAGY Ferenc, SZEPES Zoltán, WITTMANN Tibor, MOLNÁR Tamás

[INTRODUCTION - Inactivated influenza and H1N1 vaccination is recommended yearly for patients with inflammatory bowel disease receiving immunosuppressive therapy; however, immunomodulator and biological therapy might impair the immune response to the vaccination. In our study, we assessed whether immunity can develop in response to H1N1 influenza vaccination in patients receiving immunomodulator and/or biological therapy. We also assessed the occurrence of side effects after the immunisation in these patients. PATIENTS AND METHODS - In our prospective study, blood samples were obtained from 24 patients (12 Crohn’sdisease, 12 ulcerative colitis) one month after immunisation against influenza A/California/ 07/2009 (H1N1) virus. At the time of vaccination, all patients have been receiving immunomodulator and/or biological therapy for at least three month. Antiviral antibodies were detected by using microneutralisation assay. The safety of the vaccination was assessed by questionnaires. RESULTS - Every patient developed complete immunity against influenza A (H1N1) virus, independently from the type of immunosuppressive therapy. Regarding side effects, local symptoms occurred in six patients and systemic symptoms in another six patients. Mild diarrhea occurred in five patients. Moderate exacerbation of the disease was observed in 2 patients with Crohn’s disease and in one patient with ulcerative colitis. CONCLUSIONS - According to our results, immunocompromised patients with IBD can be safely advised to receive the vaccination. In our study, all patients developed adequate immunity according to microneutralisation titers.]

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[Farewell to rosiglitazone: where to go?]

TAMÁS GYULA, KERÉNYI ZSUZSA

[The European Medicines Agency concluded that the marketing authorisation for all rosiglitazonecontaining medicines (Avandia, Avandamet, Avaglim) should be suspended across the European Union. The National Health Insurance Fund Administration in Hungary in a circular letter called the attention of GP’s to the necessity in getting the medical proposal (of an internist, endocrinologist or diabetologist) for substituting rosiglitazone to arrange a smooth modification of their treatment regimen. The review taking into account updated recommendations of the ADA-EASD and the Hungarian Diabetes Association summarises the potential drugs. The first line therapy of choice has to be starting with insulin. Pioglitazone might also be administered, with all known side effects of the glitazone family, e.g. congestive heart failure and bone fractures. Further alternatives are choosing the newer drugs of the incretin principle: the incretin mimetics (exenatid, liraglutid) and the incretin enhancers (sitagliptin, vildagliptin, saxagliptin). Beside their favourable profile of effect they do not have longterm follow up outcome studies and evidences for cardiovascular safety.]

LAM KID

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[Objectives: Was to evaluate 10-year probability of hip fracture and a major osteoporotic fracture using the FRAX algorithm, vitamin D status, bone mineral density (BMD) and biochemical markers of bone turnover in men over 50 years of age with type 2 diabetes (T2DM). We compared FRAX-predicted 10-year fracture probability, levels of 25-hydroxyvitamin D (25-OH-D), markers of bone turnover and bone mineral density at L1-L4 (LS) and femur neck (FN) in 68 men with T2DM with an age- and gender-matched group (n=68). The mean (range) age of the T2DM group was 61.4 (51-78) years. The prevalence of hypovitaminosis D (25-OH-D <75 nmol/L) was 59%. The mean (range) FRAX hip fracture and FRAX major osteoporotic fracture was 0.7 (0-2.8)% and 3.2 (0-8.5)%, respectively. BMD at the FN (0.974 gm/cm2 vs. 0.915 gm/cm2; p = 0.008) and LS (1.221 gm/cm2 vs. 1.068 gm/cm2; p < 0.001) was significantly higher in the T2DM cohort as compared to the healthy age matched males. 25-OH-vitamin D (67.7 nmol/L vs.79.8 nmol/L; p < 0.001), crosslaps (0.19 μg/L vs. 0.24 μg/L; p = 0.004) and osteocalcin (13.3 μg/L vs. 15.7 μg/L; p = 0.004) were significantly lower in the T2DM group. There was no difference in FRAX-related fracture probability between the two groups. The increased BMD in T2DM and the lack of inclusion of T2DM as a risk factor in the FRAX algorithm are probable explanations for the discordance between literature-observed and FRAX-related fracture probabilities.]

LAM Extra for General Practicioners

[THE PLACE OF SULPHONYLUREA COMPOUNDS IN THE BLOOD GLUCOSE LOWERING THERAPY OF TYPE 2 DIABETES]

WINKLER Gábor

[The mechanism of blood glucose lowering action of sulphonylureas, their advantages and potencial risks are overviewd in the article. The author delineates the present place of the sulphonylurea group in the antihyperglycemic therapy of type 2 diabetes, listing possibilities of monotherapeutic as well as combined applications. It is emphasized that traditional insulin-secretagogue compounds have their place in the therapy of type 2 diabetes even beside of the new, incretin-type secretagogues.]

Lege Artis Medicinae

[THE ROLE OF SIMVASTATIN IN THE TREATMENT OF DIABETIC DYSLIPIDAEMIA]

BALOGH Zoltán, PARAGH György

[Patients with type 2 diabetes have markedly increased cardiovascular morbidity and mortality. Type 2 diabetes is typically associated with atherogenic dyslipidaemia, which is characterized by elevated triglycerides, low plasma levels of high-density lipoprotein cholesterol, and an increased ratio of small, dense lowdensity lipoprotein particles. Current treatment guidelines stress the importance of lipidlowering therapy in reducing cardiovascular risk in diabetic patients. Statins currently represent the cornerstone of dyslipidaemia management, based on their ability to efficiently reduce cardiovascular risk through lowering low-density lipoprotein cholesterol. They have, however, a relatively modest effect on the components of atherogenic dyslipidaemia, since they reduce triglycerides by only 15 to 35% and elevate high-density lipoprotein cholesterol by less than 10%. This raises the need for combining statins with other lipid-lowering drugs (ezetimibe, nicotinic acid, fibrate) at an early stage of type 2 diabetes. Authors review the role of simvastatin monotherapy in the treatment of diabetic dyslipidaemia and summarize the results of studies on simvastatin as part of a combined lipid-lowering treatment.]

Image challenge

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