Lege Artis Medicinae



FEBRUARY 22, 2007

Lege Artis Medicinae - 2007;17(02)

[Sulfonylureas, used as base therapy in type 2 diabetes, specifically block ATP-dependent potassium channels (K+ ATP). While in pancreatic beta cells these channels have an essential role in insulin release, they are also involved in cardiovascular adaptive mechanisms. Ion channels with similar morphology may have different pathophysiological effects in the human body. This raises the question, is it necessary to count with some damage to the cardiovascular protective mechanism when using sulfonylurea to induce insulin secretion. Is this indeed a relevant clinical problem today? The answer may lay in the different organ-specific effects of sulfonylureas.]



Further articles in this publication

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[Zoonoses in focus]

LAKOS András

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[The Sides of the Coin]


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[INTRODUCTION - Among the primary malignant tumours of the liver, hepatoblastoma is extremely rare in adults in contrast to its frequency in children. Only 23 such cases have been published to date. Mixed tumour of the liver and carcinosarcoma of the liver are used as synonyms for adult hepatoblastoma. The tumours have both mesenchymal and epithelial components (hepatocellular or cholangiocellular carcinoma) with focal bone and/or cartilage formation. CASE REPORT - A 78-year-old woman was admitted to the surgery department with increasing anaemia and persistent abdominal pain. An emergency operation was performed. Her peritoneal cavity was filled with blood due to the rupture of a tumour that occupied the right lobe of the liver. The neoplasm could only be removed partially. Despite an intensive care, the patient's state could not be stabilized and she died a day after the operation. The histological diagnosis was carcinosarcoma of the liver with an AFP- and cytokeratin-positive epithelial component and a spindle cell component positive for vimentin. The osteogen sarcoma found in the tumour was strongly positive for the S-100 protein. DISCUSSION - The authors review the hypotheses for the formation of adult primary hepatoblastoma, a combined tumour, they describe their various types and the immunohistochemical tests that are used in their identification.]

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[That Place in the World... A Discussion with Zsolt Bugarszki, General Manager of Soteria Foundation and Professional Lead Ibolya Hegedűs]

GYIMESI Ágnes Andrea

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NAGY Viktor

[Diuretics are essential therapeutic tools. They effectively reduce blood pressure and have been shown in numerous hypertension clinical trials to reduce both cardiovascular and cerebrovascular morbidity and mortality. In addition, they are important components of the treatment of heart failure with apparent signs of congestion. While thiazides are recommended in mild forms, loop diuretics are used in the severe stages of congestive heart failure. Loop diuretics and thiazides often induce hypokalaemia, which has been demonstrated to be not as benign as thought before. Diuretic-induced hypokalaemia seems to be aldosterone dependent. Aldosterone levels increase during diuretic therapy. Aldosterone antagonists are unique among diuretics in that they improve survival of patients with heart failure independent of their effect on sodium metabolism. Because of this, diuretic treatment lives its renaissance in cardiology.]

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Related contents

Hypertension and nephrology

[Summary of guidelines for American, European and International Companies in diabetes mellitus type 2 associated with hypertonia]

KÉKES Ede, DOLGOS Szilveszter

[The importance of hypertension in type 2 diabetes mellitus, the method of continuous blood pressure control and patient’s careas well as the forms of non-drug and drug therapy have been disclosed by presenting therapeutical recommendations from American, European scientific societies and international organizations. It has been established that the principles of care and treatment of hypertonia have basically remained unchanged in diabetes all over the world, despite the recent widespread debate over the interpretation of normal blood pressure and the consideration of the benefits of intensive or standard treatment.]

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[Biosimilar insulins on the horizon]


[Nowadays human insulins and insulin analogues are exclusively used in the clinical practice, when insulin therapy is needed. The patents of human insulins are expired and will expire soon for glargine, the first long-acting, basal insulin analogue preparation. The reliable production of biosimilar insulins is a new challenge for the pharmaceutical industry. Independently developed insulins with appreciable clinical efficacy have already become available in some countries where the quality criteria of regulatory process in place are less strict than in the European Union. The first approval for true biosimilar insulin, i.e. for biosimilar glargine was given in Europe in 2014. In this article, the characteristics of biosimilar insulins, especially the difficulties in the manufacturing process are reviewed in comparison with generic drugs. It is of note that potential efficacy and safety differences may occur due to even minor changes in the production, formulation and storage of the biological drugs. Therefore, biosimilarity should be investigated by detailed comparative pharmacokinetic and pharmacodynamic studies. Moreover, similar clinical efficacy and safety should be documented by randomized, comparative clinical trials. The potential impact of altered immunologic profile of biosimilar insulins should also be carefully monitored. ]

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[Direct health care costs of diabetes mellitus in Hungary]

VOKÓ Zoltán, NAGYJÁNOSI László, KALÓ Zoltán

[INTRODUCTION - Diabetes mellitus is responsible for a huge burden of disease all over the world, including Hungary, as well. The object of our study was to estimate the direct health care costs of treating patients with diabetes, in order to characterize this aspect of the burden of disease, and to facilitate the use of this information in further analyses. METHODS - We used the data of the National Health Fund. Diabetic patients were defined as persons who filled in a prescription of oral antidiabetics (OAD) or insulin in the second half of 2007. We divided this study population into two groups depending on whether they were or were not hospitalised for major complications of diabetes in 2007-2008. The group that was not hospitalised was further divided into three subgroups according to the use of drugs (only OAD, only insulin, OAD and insulin). In all study groups, we estimated the mean, the standard deviation, and the median of health care costs for each cost item by age group in the whole study group and among those who actually used a particular service. Additionally, we took samples of patients who were hospitalised for specific complications, and estimated the health care costs for the first and for the second year after the occurrence of the complication. RESULTS - The mean health care cost of the 521,545 diabetic patients involved in the analysis was 335 thousand HUF. It was 633 thousand HUF for those who were hospitalised for complications, 242 thousand for OAD users without complications, and 449 thousand for insulin users without complications. 53% of the total cost covered drug treatment and 27% acute hospital treatment. 26% of the total drug cost was spent on OADs and on insulin. The acute hospital cost and the drug cost had multiplied within the first year of complication. The latter remained high or further increased in the second year. CONCLUSION - The healthcare cost of diabetes is already very high in Hungary, especially the care for its complications. Considering the burden of disease that manifests in premature mortality, reduction in quality of life, and high cost, and the epidemiological trends, diabetes mellitus should be a public health priority in Hungary.]

Hypertension and nephrology

[Comparison of HbA1c levels of diabetic and non diabetic patients at a nephrology outpatient department]

MÁCSAI Emília, SZABÓ Emília, KIRÁLY Mónika, BENKE Attila, LAKATOS László

[Introduction: The role of HbA1c in the diagnostic criteria of diabetes has been more emphasized in the american medical literature. The prevalence of disturbed glucose tolerance in adult population is considered significant. In primary care, in case of identified diabetics the regular HbA1c measurement is not used generally. We screened our proteinuric patients on the spot HbA1c measurement selecting the patients with metabolic syndrome and known diabetes. Patients and methods: During the three week period 51 consecutive patients fulfilled the inclusion criteria, we measured HbA1c along with registration of other laboratory and clinical data. Results: In the non-diabetic group five patients showed HbA1c below 5%, 12 patients between 5.1-5.5%, 19 patients in the range of 5.6-6%, and 6 patients above 6%. The rate of proven diabetes was 14% (6/42 patients) by confirmatory laboratory examination. In the diabetic group the HbA1c values were around 6.7% (median; and range 5.2- 7.9%). Conclusion: We do suggest on the spot HbA1c measurement as screening test in patients with high risk of diabetes at the nephrological outpatient department, further laboratory HbA1c analysis and glucose tolerance test can demonstrate the diagnosis. In patients with overt type 2 diabetes it can help to identify those, who should be sent to diabetological consultation.]

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[Incretins are hormone-like peptides secreted by specific cells of the small intestine mucosa. Their two main representatives are the glucagon-likepeptide- 1 (GLP-1 and the glucose-dependent insulinotropic peptide, (GIP) the release of which is stimulated by meals. The main action of incretins is to enhance insulin secretion following meals. They are rapidly metabolized in the circulation by the enzyme dipeptidyl peptidase IV (DPP-IV). Patients with type 2 diabetes have markedly impaired incretin-mediated insulin secretion mainly due to decreased secretion of GLP-1. Research in the last years has opened up a new therapeutic option to treat patients with type 2 diabetes. Continuous intravenous use of GLP-1 cannot be widely used in clinical practice; however, GLP-1-mimetics that have an agonist effect on the receptors but are resistant to degradation by DPP-IV have been developed. The GLP-1 agonist xenatide, due to its incretin mimetic property, stimulates postprandial insulin secretion, suppresses glucagon secretion, delays gastric emptying and increases sense of fullness thus resulting in weight reduction. In experimental settings, exenatide has a documented beta-cell protecting property. Its disadvantages include the fact that it can only be administered subcutaneously and that it has a well characterized side effect profile. On the contrary, the DPP-IV inhibiting incretin enhancers (sitagliptin, vildagliptin) can be used orally and are well tolerated. Exenatide, sitagliptin and vildagliptin are the first representatives of incretin mimetics and incretin enhancers. Sitagliptin has been available in Hungary since August, 2008. Their effect to reduce blood glucose and HbA1c should mainly be exploited in combination therapy, preferably with metformin. The availability of incretin mimetics and incretin enhancers will offer new therapeutic options for treating patients with type 2 diabetes. Nevertheless, the final assessment of these new drugs will require long-term experience in the clinical practice.]