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Biomedical subjects

Z Metelko

Publications and source records attributed to Z Metelko.

At least 19 recordsLinked to original sources
PubMed2003

Relationship between autonomic neuropathy, 24-hr blood pressure and retinopathy in normoalbuminuric and normotensive type 1 diabetic patients.

In order to investigate factors related to the development of retinopathy in 122 normotensive and normoalbuminuric patients 24 hr-blood pressure (BP) measurement and autonomic tests based on standard, vector and spectral analysis of heart rate variation (HRV) were performed. Retinopathy was found in 47 patients with significantly longer duration of diabetes and prevalence of autonomic neuropathy (9.5 +/- 5.5; 59.6%) in comparison with 75 patients without retinopathy (5.29 +/- 4.9; 16%), (p < 0.05). Patients were matched according to age, gender, HbA1c and 24-hr urinary albumin excretion rate. Maximal night systolic, mean night and day diastolic BPs were significantly higher in patients with retinopathy (118.94 +/- 11; 62.94 +/- 8.1; 74.3 +/- 7.2 mmHg) as compared to patients without it (115.03 +/- 8.9; 59.65 +/- 7.1; 71.75 +/- 5.7) (p = 0.03). Maximal night systolic BP was inversely related to power high frequency (HF; r = -0.28, p = 0.05) and deep breathing CV (r = -0.23, p = 0.02). Mean night diastolic BP was inversely related to power mid frequency (r = -0.21, p = 0.03), HF (r = -0.32, p = 0.005), CV deep breathing (r = -0.27, p = 0.005) and mean circular resultant deep breathing (r = -0.24, p = 0.003); mean day diastolic BP to power HF (r = -0.22, p = 0.02). In multiple regression analysis retinopathy was associated with the duration of diabetes (beta = 0.53) and autonomic neuropathy (beta = 0.28) (p < 0.001). Autonomic neuropathy was related to BP elevation and retinopathy in normotensive and normoalbuminuric Type 1 diabetic patients.

Adult↗
PubMed2002

Effects of a fixed mixture of 25% insulin lispro and 75% NPL on plasma glucose during and after moderate physical exercise in patients with type 2 diabetes.

OBJECTIVE: To compare the plasma glucose (PG) response with a fixed mixture of 25% insulin lispro and 75% NPL (Mix25), prior to a meal and 3 h before exercise, to human insulin 30/70 (30/70) in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: Thirty-seven patients were treated in a randomized, open-label, 8-week, two-period crossover study. Mix25 was injected 5 min before breakfast and dinner throughout the study, as was 30/70 on inpatient test days and on outpatient dose titration days. Following the 4-week outpatient phase, patients were hospitalized, and exercised at a heart rate of 120 beats/min on a cycle ergometer two times for 30 min, separated by 30 min rest, starting 3 h after a 339 kcal breakfast. RESULTS: The 2-h postprandial PG was significantly lower with Mix25 ((mean +/- SEM) 10.5 +/- 0.4 mmol/l vs 11.6 +/- 0.4 mmol/l; p = 0.016). Maximum decrease in PG from onset of exercise to end of exercise was significantly less with Mix25 (-3.6 +/- 0.29 mmol/l vs -4.7 +/- 0.31 mmol/l; p = 0.001). The maximum decrease in PG over 6 h, after exercise onset, was significantly less with Mix25 (-4.3 +/- 0.4 mmol/l vs -5.9 +/- 0.4 mmol/l; p < 0.001). The frequency of hypoglycemia (blood glucose (BG) < 3 mmol/l or symptoms) during the inpatient test was not different between treatments. During the outpatient phase, the frequency of patient-recorded hypoglycemia was significantly lower with Mix25 (0.7 +/- 0.2 episodes/30 d vs 1.2 +/- 0.3 episodes/30 d; p = 0.042). CONCLUSIONS: Mix25 resulted in better postprandial PG control without an increase in exercise-induced hypoglycemia. The smaller decrease in PG during the postprandial phase after exercise may suggest a lower risk of exercise-induced hypoglycemia with Mix25 than with human insulin 30/70, especially for patients in tight glycemic control.

Adult↗
PubMed2001

Intramuscular injection of insulin lispro or soluble human insulin: pharmacokinetics and glucodynamics in Type 2 diabetes.

AIM: The aim of the study was to compare the pharmacokinetics and glucodynamics of insulin lispro and soluble human insulin following intramuscular (i.m.) injection in patients with Type 2 diabetes with secondary failure of sulphonylureas. METHODS: Single 15-U i.m. doses of insulin lispro or soluble human insulin were administered to 16 patients in a two-way, randomized, crossover design. Glucodynamic and pharmacokinetic parameters were determined over 6 h after insulin injection using clamp techniques. RESULTS: Insulin C(max) was significantly higher (971 +/- 217 vs. 659 +/- 141 pmol/l, P < 0.001) and T(max) was significantly shorter (46.9 +/- 27 vs. 94.7 +/- 50.1 min, P = 0.002) with insulin lispro. Glucose infusion rate (GIR) curves showed clear separation 20 min after injection and were significantly greater for insulin lispro during the 40-60, 60-80 and 80-100-minute time intervals. Total glucose infused was only approximately 5% larger with insulin lispro during the 6-h follow-up, due to lower insulinaemia at later time points. The glucose R(max) and TR(max) were not statistically different between insulin treatments. CONCLUSION: This study shows that i.m. injection of insulin lispro is followed by its more rapid absorption, which results in stronger metabolic effect in the first 2 h when compared with soluble human insulin under the same test conditions. Diabet. Med. 18, 562-566 (2001)

Blood Glucose↗
PubMed2000

Different risk factors of microangiopathy in patients with type I diabetes mellitus of short versus long duration. The EURODIAB IDDM Complications Study.

AIMS/HYPOTHESIS: To identify factors associated with early development of and late protection from microvascular complications in subjects with Type I (insulin-dependent) diabetes mellitus. METHODS: The frequency of microvascular complications and their relation to risk factors were studied in 300 Type I diabetic subjects with short duration of disease (< or = 5 years) compared with 1062 subjects with long duration (> or = 14 years). Microvascular disease was defined as the presence of either retinopathy (assessed from centrally-graded retinal photographs) or urinary albumin excretion rate of more than 20 micrograms/min. RESULTS: The prevalence of microvascular disease was 25% in the short duration group. In the long duration group 18% had no evidence of microvascular complications. In the short duration group factors associated with early development of complications were cigarette smoking and a family history of hypertension. Subjects free of microvascular complications in spite of long duration of diabetes had better glycaemic control, lower blood pressure, better lipid profile and lower von Willebrand factor levels. CONCLUSION/INTERPRETATION: At the early stages of Type I diabetes, cigarette smoking and genetic susceptibility to hypertension are important risk factors for microvascular complications. At a later stage, additional risk factors are poorer glycaemic control, higher blood pressure, and an unfavourable lipid profile possibly associated with endothelial dysfunction. Many of these factors are amenable to long-term intervention which should be started as soon as possible in the course of the disease.

Cohort Studies↗
PubMed1999

[The diabetic foot. The Croatian model--national consensus (clinical recommendations for diagnosis, prevention and therapy)].

Diabetic foot occurs due to the loss of protective sense and circulation disorder and a marked proneness to infections. Mechanical stress of bone growths frequently leads to ulcerations. The prevention and timely treatment of diabetic foot requires the participation of both patients and all health care levels. This consensus is given for the purpose of procedure standardization. Education is the basis of prevention and should be carried out with every patient suffering from diabetes mellitus and those with a sensory defect in particular. Appropriate footwear significantly contributes to prevention and treatment of ulcers. As regards the treatment, the necessity of surgical approach with a long term and often manifold antibiotic therapy should be pointed out. Infections are usually mixed. The deeper the ulceration, the more likely the infection with anaerobes and Gram-negative bacteria occurs in addition to Gram-positive ones which are normally present in surface lesions. Strict metabolic control is a precondition for successful treatment. In conclusion, diabetic foot is a major health problem which requires multidisciplinary approach with permanent patient education as its essential part, and a specific cooperation of all levels and different health care specialties.

Diabetic Foot↗
PubMed1999

Changes of autoantibodies against oxidatively modified low density lipoproteins during long-term LDL-apheresis.

The oxidation of low-density lipoproteins (LDL) is considered a key event in the initiation of atherosclerosis. The aim of this study was to follow-up the biological marker of in vivo LDL oxidation (oxidatively modified LDL autoantibody titres) during long-term LDL-apheresis treatment. A patient suffering from severe combined hyperlipidaemia underwent LDL-apheresis biweekly and was followed for two years. The significant reduction of baseline total cholesterol (58%), total triglycerides (80%), LDL-cholesterol (48%), apoprotein B (50%) and apolipoprotein (a) (61%) may be considered as a good response to the treatment. The titre of autoantibodies (IgG) against oxidatively modified LDL (malondialdehyde-derived LDL) was followed throughout the study and showed dynamic changes. The measured values were multiple compared as mean+/-SD over each semester of apheresis application: I semester 70.0+/-8.3 U/ml, n = 12; II semester 58.0+/-13.8 U/ml, n = 12; III semester 37.6+/-6.0 U/ml, n=12; IV semester 34.3+/-7.0 U/ml, n = 12; ANOVA: I vs. II semester p<0.083, II vs. III semester p<0.00053, III vs. IV semester p<0.248. In parallel to the changes in this biochemical parameter, regression of numerous xanthomas was clinically observed. In spite of this, the presence of oxidised-LDL (oxLDL) antibodies was enhanced in comparison to antibody titre detected in a group of age-matched normolipaemic healthy controls (n = 15; 19.4+/-8.6; p<0.01). Classical lipoprotein parameters were correlated with the titre of autoantibodies against oxLDL and showed low correlation coefficients: total cholesterol vs. oxLDLab, r = 0.36; triglycerides vs. oxLDLab, r = 0.43; LDL cholesterol vs. oxLDLab, r = 0.14; HDL cholesterol vs. oxLDLab, r = -0.33; apo B vs. oxLDLab, r = 0.25; apo (a) vs. oxLDLab, r = -0.05. Our study showed an additional benefit of LDL-apheresis therapy. The production of autoantibodies against oxLDL was reduced during the treatment, indicating a lower level of the atherogenic antigen.

Adult↗
PubMed1998

Reduction of diffusion capacity for carbon monoxide in diabetic patients.

Diabetes can cause the development of pulmonary complications due to collagen and elastin changes, as well as microangiopathy. This study demonstrates the relationship between pulmonary complications and other chronic complications in diabetes. Twenty-seven patients with diabetes, aged 21 to 62 years, who had had the disease from 3 to 32 years, were included in this study. The protein excretion rate (PER) and the diffusion capacity of the lung for carbon monoxide (DLCO) were included as parameters of the severity of complications. PER was determined by the Biuret method. DLCO was measured by the single-breath method and was corrected by the measurement of alveolar volume (VA). The values of DLCO as corrected by VA (DLCO/VA) were included in the statistical evaluation of the results. The variables of age, duration of diabetes, and complication parameters were included in a multiple regression model with forward, stepwise selection to assess their value in predicting DLCO/VA. The variables were found to be significant predictors of DLCO/VA (R2 = 0.46, adjusted R2 = 0.32, p < 0.022). However, proteinuria was the only significant independent predictor of DLCO/VA. This finding indicates that both renal and pulmonary complications of diabetes share a similar microangiopathic background.

Adult↗
PubMed1998

Quality of life following a change in therapy for diabetes mellitus.

OBJECTIVE: The study objective was to evaluate and compare quality-of-life (QOL) parameters between patients with type 2 (non-insulin-dependent) diabetes mellitus who changed therapy from an oral hypoglycaemic agent (OHA) to insulin and those who remained on an OHA. DESIGN: The World Health Organization Quality of Life Questionnaire (WHOQOL) was used to assess quality of life among 2 groups of patients with type 2 diabetes mellitus at baseline and after a 2-month follow-up period. SETTING: The study was conducted in the outpatient department of the Vuk Vrhovac Clinic, a referral centre for registration, treatment and follow-up of patients with diabetes mellitus in Zagreb, Croatia. PARTICIPANTS AND INTERVENTIONS: 32 consecutively recruited patients with type 2 diabetes mellitus who were switched from an OHA to insulin therapy (group 1) were compared with 28 patients who remained on OHA (group 2) with respect to QOL issues. The patient groups were comparable in terms of gender, age, duration of disease, education and family status. However, patients in group 1 had glycosylated haemoglobin (HbA1c) values greater than 9.5% on average during a period of approximately 6 months, which was the criterion used for switching to insulin therapy. MAIN OUTCOME MEASURES AND RESULTS: At baseline, various QOL ratings were higher among patients in group 2 than group 1, indicating better quality of life with respect to overall quality of life (t = -2.31, p = 0.03), physical health (t = -2.36, p = 0.02), psychological state (t = -2.01, p = 0.05) and level of independence (t = -2.75, p = 0.001), while no differences were found between groups with respect to the social domain, personal beliefs and environmental QOL aspects. After the follow-up period, the groups were comparable in all QOL aspects other than overall quality of life (t = -2.18, p = 0.03) and level of independence (t = -3.49, p = 0.001), both of which remained higher for patients in group 2. No changes in QOL parameters were detected within group 2 from baseline to the end of the 2-month follow-up period, whereas patients in group 1 showed significant improvement in psychological QOL determinants (t = -2.14, p = 0.04). CONCLUSION: Results of the study indicate that introducing insulin therapy in patients with type 2 diabetes mellitus and sustained elevated HbA1c levels might positively affect their quality of life.

Adult↗
PubMed1997

Total plasma antioxidants in first-degree relatives of patients with insulin-dependent diabetes.

Insulin-dependent diabetes mellitus (IDDM) is a chronic disorder that results from autoimmune destruction of the pancreatic beta-cells. Recent evidence suggests that oxidative damage, resulting from both cytokine-induced production of toxic free radicals and low antioxidant capacity of the beta-cell plays a significant role in the pathogenesis of IDDM. Islet cell antibodies (ICA) have been the best validated marker of risk for the development of IDDM in predisposed individuals, i.e. first-degree relatives of patients with IDDM. We investigated the total plasma antioxidant status (TAS) in both ICA-positive and ICA-negative first-degree relatives of patients with IDDM, to assess the level of overall protection against oxidative damage. TAS was significantly lowered in ICA-positive when compared to both ICA-negative and healthy subjects (p < 0.001), while no significant difference was found in comparison to recently diagnosed patients with IDDM. TAS values were not significantly influenced by gender, age and smoking habits in all groups, as well as by ICA titers in the group of ICA-positive subjects. Results indicate that prediabetic condition, apart from well-established immunological and metabolic alterations, could be associated with biochemical changes revealing complex disturbances of the antioxidative defence system. Although TAS is a functional rather than specific marker, its measurement is likely to be a valuable tool for understanding the mechanisms of specific beta-cell injury.

Adolescent↗
PubMed1996

Pharmacokinetics and safety of glimepiride at clinically effective doses in diabetic patients with renal impairment.

The pharmacokinetics, efficacy and safety of glimepiride were investigated in a single- and a multiple-dose open study in patients with non-insulin-dependent diabetes mellitus and renal impairment and an initial creatinine clearance above 10 ml/ min. Patients were divided into three groups with creatinine clearance above 50 ml/min, 20-50 ml/min and under 20 ml/min. Fifteen fasting patients received a single dose of 3 mg glimepiride and serial blood and urine samples were taken over 24 h for pharmacokinetic and efficacy analyses. A further 16 patients received glimepiride over a 3-month period, an initial dose of 1 mg glimepiride being adjusted within the range 1 to 8 mg to achieve good glucose control. Pharmacokinetic evaluation was done on day 1 and after 3 months. Mean relative total clearance and mean volume of distribution of both single (41.6 ml/ min and 8.47 litres, respectively, when creatinine clearance was above 50 ml/min) and multiple doses of glimepiride increased in proportion to the degree of renal impairment (to 91.1 ml/min and 14.98 litres, respectively, when creatinine clearance was below 20 ml/min, single dose), whereas the terminal halflife and mean time remained unchanged. Lower relative total clearance and renal clearance of both glimepiride metabolites correlated significantly with lower creatinine clearance values. Of the 16 patients 12 required between 1 and 4 mg glimepiride to stabilize their fasting blood glucose. Glimepiride was well-tolerated and there were no drug-related adverse events. In conclusion glimepiride is safe, effective and has clearly-definable pharmacokinetics in diabetic patients with renal impairment. The increased plasma elimination of glimepiride with decreasing kidney function is explainable on the basis of altered protein binding with an increase in unbound drug.

Administration, Oral↗
PubMed1996

Emotional adjustment and metabolic control in newly diagnosed diabetic persons.

Emotional reactions to diagnosis were examined in a random sample of newly detected diabetic patients (n = 71) and compared with the indicators of glycemic control in a one-year-follow-up period. The social and emotional factors subscale of the diabetes care profile was used to determine the subjectively experienced burden, negative feelings and positive coping abilities. The initial struggle against the disease indicated three characteristic emotional patterns. Feelings of being able to cope with the disease predominated in group 1 (n = 36), negative emotional reactions, but with the ability to cope were observed in group 2 (n = 17) and negative feelings combined with weak coping abilities in group 3 (n = 18). The long-term indicators of glycemic control were shown to be worst in group 3 and best in group 1. Subjective perception of the disease was not associated with sociodemographic variables, with the exception of perceived coping abilities which were better in more educated persons and those with more familial support.

Adaptation, Psychological↗
PubMed1995

Incidence of IDDM during 1988-1992 in Zagreb, Croatia.

The objective of this study was to determine the incidence of insulin-dependent diabetes mellitus (IDDM) in the population of Zagreb, Croatia, during 1988-1992. A centralized diabetes registry was the primary source of data, while secondary sources were used to assess ascertainment. A total of 282 new cases of IDDM were diagnosed in the study period, the primary and secondary sources identifying annually 93-100% of the cases. The annual incidence rate ranged from 5.6 per 100,000 to 6.6 per 100,000. Early fatality in persons older than 50 years was the major cause of underascertainment. The incidence peaked in the 10-14 years age group (12.4 per 100,000), and remained stable after age 24 years. Males had a significantly higher incidence in the 5-9 and 24-44 years age groups. In the 45-54 years age group, females had a significantly higher incidence. No seasonality was observed. Despite the war conditions in Croatia, the low overall IDDM incidence rates did not change significantly during the study period.

Adolescent↗
PubMed1993

War-induced prolonged stress and metabolic control in type 2 diabetic patients.

Sound evidence that psychological stress may significantly worsen metabolic control in diabetic patients in lacking. The stressful effects of war on glycaemia control have not been assessed as yet. A randomly selected sample of displaced Type 2 diabetic persons (N = 44) was compared to a matched group of diabetic persons who had not been forced to leave their homes. The self-reported stress, depression level, fasting and post-prandial blood glucose, glycosylated haemoglobin and serum lipids were compared. The two groups were found to be significantly different in scores for self-reported stress and depression levels (P < 0.001). The proportion of subjects belonging to the category of clinically significant depression was larger in the group of displaced persons (P < 0.001), as well as the proportion of extreme scores for self-reported stress (P < 0.001). No significant differences between the groups were found for variables measuring metabolic control (P > 0.05), except for the serum triglycerides which were found to be significantly higher in the group of displaced persons (P < 0.01). This is assumed to be the result of differences in nutrition. The results do not demonstrate an association between prolonged stress and glycaemic control in Type 2 diabetic patients. The variability of data measuring stress and depression level in two extreme groups with respect to HbA1c values suggests that individual factors which determine the response to stressors need to be explored.

Adaptation, Psychological↗
PubMed1993

Effect of war-induced prolonged stress on cortisol of persons with type II diabetes mellitus.

The study was designed to assess the impact of protracted, war-induced stress on cortisol levels and glycemic control in persons with Type II diabetes mellitus. A randomly selected sample of 44 displaced Type II diabetic persons was compared with a group of diabetic persons matched for sex, age, weight, duration of diabetes, and type of treatment who had not been forced to leave their homes. The self-reported stress, depression level, serum cortisol, fasting blood glucose, and glycosylated hemoglobin were compared. The two groups were found to be significantly different in scores for self-reported stress and depression level. Passive coping patterns prevailed in the displaced group. The serum cortisol levels correlated positively with self-reported stress, negatively with active coping patterns, and were significantly higher in the displaced persons group. No significant differences were found between the group on the variables measuring glycemic control. The results indicate that prolonged stress need not worsen glycemic control in Type II diabetic patients.

Adaptation, Psychological↗
PubMed1993

Effect of war on glycemic control in type II diabetic patients.

OBJECTIVE: To determine the effect of war-related, protracted stress on glycemic control in type II diabetic patients. RESEARCH DESIGN AND METHODS: We examined 35 patients with type II diabetes as part of their routine control in October 1990. We reexamined them in October 1991, 3 mo after the war in Croatia began. We also administered a questionnaire to assess the patients' exposure to stress and changes in diet and exercise. RESULTS: The patients were exposed to considerable stressors. The wartime diet differed from the prewar diet. We found significant changes in total serum cholesterol and TG values (P < 0.01), but we observed no significant changes in body weight, FBG, postprandial blood glucose, and HbA1c values. Insulin and glibenclamide dosages did not change. CONCLUSIONS: We detected no significant impact of stress on glycemic control, probably because of differences in individual stress responsiveness. Changes in the lipid status probably were attributable to changes in dietary habits caused by specific circumstances.

Adult↗
PubMed1992

Diabetes in time of armed conflict: the Croatian experience.

During the summer of 1991, armed conflict broke out in the Republic of Croatia. This resulted in many deaths and the displacement of many persons, with population loss in some communities and additional population burden in others. Registration of diabetic persons has been compulsory in Croatia since 1975 and from available statistics compiled by the Vuk Vrhovac Institute for Diabetes in Zagreb it was known that in 1991 there were 111,096 diabetic persons in Croatia, 16% requiring insulin, 46% treated with oral agents and 38% using dietary treatment only. This information helped to plan adequate supplies during the emergency. Contacts with international organizations and friends were of value in overcoming shortages, the most useful gifts being battery-operated blood glucose measuring devices. A study in Zagreb failed to demonstrate an association between the stress of displacement and metabolic control. Somewhat unexpectedly, diabetes and its complications did not present a major public health problem during the first 8 months of the armed conflict, but the long-term effects of these events remain to be seen.

Adolescent↗
PubMedDate not supplied

The application of insulin using the jet injector DG-77.

UNLABELLED: To avoid soreness and psychic stress following insulin injections by needle and syringe, the new jet injector DG-77 was used. It is a portable percutaneous pressure device with a spring, simple to operate which can be used to apply two different types of insulin. Thirty type 1 and type 2a diabetic patients participated in the study (10 females, 20 males). Insulin was applied using a needle and the DG-77 device in the same region of the body. A standardized questionnaire was compiled concerning simplicity of application, soreness, wish to possess the device and the possibility of acquiring it. The results obtained regarding the type of application were as follows: traditional way: glycemia: at 07(00)-8.5, 10(00)-10.5, 13(00)-7.4 mmol/l; insulinemia: at 07(00)-7.5, 10(00)-20.2, 13(00)-21.0 mU/l; jet injector: glycemia - at 07(00)-8.4, 10(00)-10.4, 13(00)-8.4 mmol/l; insulinemia: at 07(00)-2.8, 10(00)-12.3, 13(00)-20.0 mU/l, which was not statistically significant; for glycemia: at 10(00), t = 0.110, p greater than 0.05, at 13(00), t = 1.88, p greater than 0.05, and for insulinemia at 10(00), t = 0.82, p greater than 0.05, and at 13(00), t = 1.23, p greater than 0.05. IN CONCLUSION: 1) blood glucose and insulin control with the jet injector administration of insulin was equally successful as with the standard insulin application; 2) incidence of hematoma was not significant; 3) eighty-five percent of patients prefer the injector due to its simplicity of application, reduced soreness and would wish to possess the device.

Adult↗