[Investigation of skin microcirculation in diabetes mellitus by laser Doppler flowmetry]
KOLOSSVÁRY Endre, FARKAS Katalin, STELLA Péter, FARSANG Csaba
MAY 20, 2003
Lege Artis Medicinae - 2003;13(04)
KOLOSSVÁRY Endre, FARKAS Katalin, STELLA Péter, FARSANG Csaba
MAY 20, 2003
Lege Artis Medicinae - 2003;13(04)
[The prognosis of patients with diabetes mellitus is mainly influenced by vascular complications which is partly due to the deterioration of the microcirculation. Laser Doppler flowmetry is a suitable method to investigate the complex disturbance that characteristic for diabetic microcirculation. This review gives a summary of the anatomical, physiological and theoretical backgrounds and the possibilities in diagnosis given by Laser Doppler flowmetry.]
Lege Artis Medicinae
[Human adult-onset lactase decline, characterised by a decrease in intestinal lactase enzyme activity is a biologic feature characteristic of the maturing intestine in the majority of the world's population. It demonstrates an autosomal recessive pattern of inheritance and it is regulated primarily by the rate of lactase gene transcription. Ingestion of high quantities of lactose-containing foods by patients with adultonset lactase decline results in intestinal symptoms, including bloating, distension, cramps, flatulence and diarrhoea. Due to the differences in the rates of gastric emptying and intestinal transit as well as the abundance of lactosemetabolising bacteria in the colon, the symptoms of lactose intolerance are often quite variable from persons to person. Lactose intolerance usually leads to self-imposed dietary restriction of dairy products, the main source of calcium intake, therefore it appears to be a risk factor for development of osteoporosis. Consumption of milk with solid foods can reduce symptoms in many individuals. Yoghurt containing active cultures are useful substitute for whole milk. Prehydrolized milk and lactase enzyme containing tablets are also available in the treatment.]
Lege Artis Medicinae
Lege Artis Medicinae
Lege Artis Medicinae
Lege Artis Medicinae
Lege Artis Medicinae
[It is no exaggeration to say that there is a paradigm shift in the diabetes care. Since 2015, the driving force behind are primarily the widely spreading sensor technologies instead of the new insulin products and treatment regimens. The rapidly spreading sensor technologies are applied in more and more countries financially supported in type 1 diabetes since 2015. The use of Continuous Glucose Monitoring (CGM, tissue glucose sensor, simplified as sensor), which includes both real-time CGM (RT-CGM) and intermittently scanned CGM (isCGM), has grown rapidly over the past few years by improving sensor accuracy, greater convenience and ease of use, and expanding support of reimbursement. Numerous studies have demonstrated the significant clinical benefits of using CGM in diabetic patients, regardless of the type of insulin treatment. In this summary, we review the practical aspects of glucose monitoring, the optimal frequency of monitoring, the effectiveness, reliability, and role of continuous glucose monitoring systems.]
Hypertension and nephrology
[Results of cardiovascular safety studies with SGLT-2 inhibitors have shown that in addition to their hypoglycaemic and beneficial cardiovascular effects, they are renoprotective. A number of mechanisms underlying the renoprotective effects of SGLT-2 inhibitors have been shown to reduce albuminuria and deterioration of renal function. Their nephroprotective effects extend over a very wide range of eGFR and albuminuria categories. In the DAPA-CKD study, dapagliflozin was shown to exert its nephroprotective effect regardless of the presence of diabetes and a baseline eGFR, while also having a beneficial effect on cardiovascular endpoints and mortality. Following the confirmation of favourable renal results for SGLT-2 inhibitors, it is no coincidence that they have been included in national and international recommendations for the treatment of chronic kidney disease.]
Lege Artis Medicinae
[Therapeutic patient education is a lifelong educational activity. As an approach focused on the needs, values and therapeutic strategies of patients, it promotes an increase in patients’ knowledge and skills according to the disease, results in a better quality of life, increased therapeutic compliance and a decrease of complications. Patients become partners and health care providers become coaches. Many type-2 diabetes patients refuse insulin therapy, even when this modality of treatment is indicated. This paper aims to explore diabetic patients’ reasons of accepting insulin therapy and the initial barriers to its use, as well as related education requirements.]
[INTRODUCTION - Data on bone mineral density (BMD) in diabetes mellitus are contradictory in the literature. Early studies described a decreased bone mineral density in type 1 diabetes mellitus (T1DM), but recent studies report no osteopenia in T1DM.The BMD may depend on the quality of treatment for diabetes mellitus and on the presence of chronic complications. In type 2 diabetes mellitus (T2DM) the BMD is not decreased, occasionally it can even be increased. PATIENTS AND METHODS - Bone mineral density was measured in 122 regularly controlled diabetic patients (T1DM: n=73, mean age: 43.6±11.1 years,T2DM: n=49, mean age: 61.8±9.8 years) by dual energy X-ray absorptiometry at the lumbar spine and at the femur. Results were compared to those of 40 metabolically healthy control persons with a mean age of 47.5±11.9 years.The patients’ carbohydrate metabolism was assessed by the average HbA1c level of the last three years.These values were 7.9±1.4 % in T1DM, and 7.5±1.7 % in T2DM. BMDs were classified based on the T-score and Z-score using the WHO criteria. RESULTS - There was no significant difference in T1DM or in T2DM compared to the reference group in the prevalence of either osteoporosis or of osteoporosis and osteopenia combined. CONCLUSION - BMD was not found to be decreased in patients with well-controlled metabolism compared to healthy controls.]
Hypertension and nephrology
[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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