Somatostatin: beneficial effects on remission in young adult patients with newly diagnosed diabetes mellitus type 1.

To assess a possible influence of short-term administration of somatostatin on remission development in adult patients with newly diagnosed diabetes mellitus type 1, the somatostatin analog octreotide was given for two weeks after the establishment of the diagnosis at the daily dose of 150 microg subcutaneously in addition to the regular insulin and metabolic therapy. When compared to the control group, the remission was achieved earlier in the octreotide group (6+/-4 weeks vs. 11+/-12 weeks in the control group, p 0.05) and its duration was longer (99+/-49 weeks vs. 49+/-31 weeks in the control group, p 0.05). Moreover, remission also appeared in patients from the octreotide group with lower endogenous residual secretion of insulin (basal C peptide at the time of diagnosis in patients who later entered remission was 0.23+/-0.16 nmol/l vs. 0.34+/-.18 nmol/l in the control group, p<0.05). The increase of 24-h urine excretion of C-peptide after the therapy with octreotide was predictive for remission development. It can thus be concluded that octreotide administration in adults with newly diagnosed diabetes mellitus type 1 positively influences both the onset and duration of remission.

[Importance of short-term administration of low doses of somatostatin analog in the development and remission of type 1 diabetes mellitus in adult patients]. / Význam krátkodobého podání malých dávek analogu somatostatinu pro vznik a vývoj remise u dospelých nemocných s cerstvým diabetem I. typu.

The objective of the presented work was to evaluate the short-term administration of octreotide on the development, onset and persistence of remission in recent insulin-dependent diabetics. The importance of remission means for the patient a clinically favourable condition with satisfactory metabolic compensation and a greater metabolic stability during the subsequent course of the disease. The period of remission is important from the aspect of prevention of late organ complications. Two-week treatment with octreotide, 150 micrograms/day, administered during the first month after establishment of the diagnosis was not associated with serious undesirable effects. Treatment with octreotide led to more frequent development of remission, partial and complete, as compared with a control group. In the majority of diabetics in the intervened group remission started immediately after administration of octreotide. The serum value of peptide-C as part of the glucagon test made at the time of diagnosis had a predictive value for the development of induced and spontaneous remission. Octreotide administration increased the probable development of remission even in patients with a substantially lower peptide C value at the time of diagnosis as compared with controls. The preliminary results indicate also a protraction of the remission period.

[Thyroglobulin and microsome autoantibodies and their clinical significance in adult type I diabetics]. / Výskyt protilátek proti tyreoglobulinu a proti mikrosomum u dospelých diabetiku I. typu a jejich mozný klinický význam.

In 34 patients with type 1 diabetes manifested in postadolescent age (mean age at time of diagnosis 25 years, 18 women and 16 men) after the establishment of the diagnosis perspectively the presence of antibodies against thyroglobulin and the microsomal fraction and their relation to affection of the thyroid gland was investigated. During an investigation of 20% of the patients the authors provided repeatedly evidence of the presence of both antibodies, in 23% repeatedly only against microsomes. In 21% some antibodies were detected only once. In the course of the investigation in 65% of the patients thyroid antibodies were found. The clinically most serious affection of the thyroid gland (from the sonographic an functional aspect) was found in groups 1 an 2, while in groups 3 and 4 in the majority of patients the thyroid gland was not affected. A different pathogenesis of the disease in the above groups is suggested in the areas of DR and DQ during HLA typing, the behaviour of other antibodies and differences in dermatoglyphic examinations. Moreover there is a high ratio of women in the first two groups (61%) and conversely of men in groups 3 and 4. In the discussion attention is drawn to the different course of diabetes in patients with thyroid autoimmunity.

[Comparison of basic somatometric characteristics in randomly selected populations from Prague and Vsetín]. / Porovnání základních somatometrických charakteristik u náhodne vybraných osob prazské a vsetínské oblasti.

In 1991-1992 in the Czech Republic an epidemiological survey was conducted focused on prevention of iodine deficiency and the incidence of some thyropathies. The authors examined samples of the Prague and Vsetín population selected at random. The clinical examination comprised also somatometric assessment. In a group of 1,100 subjects from Prague and Vsetín anthropometry of basic somatometric characteristics was performed (height, body weight, BMI and four skinfolds). From comparison of the two groups ensues that the Vsetín population is shorter, as compared with the Prague population, the BMI values are significantly higher and so is the percentage of subcutaneous body fat.

[Iodine status and incidence of thyropathies in the Czech population]. / Stav zásobení jodem a výskyt tyreopatií v nasí populaci.

Based on clinical experience on the rising incidence of some thyropathies in our population, the authors examined a random sample of the Prague population. They assessed and evaluated iodinuria, the sonographic finding of the thyroid gland, the palpation finding of the thyroid and a clinical examination which comprised a detailed case-history (a questionnaire checked during the examination) and a clinical and anthropometric examination. The results indicate that iodinuria (which reflects the iodine intake) reaches the recommended optimum (above 150 micrograms iodine/l) only in 11.4% of boys, 14% men, 6.3% girls and 5.4% women. A quite inadequate intake (less than 50 g iodine/l) was recorded in 13.2% boys, 15.2% men, 17% girls and 33.1% women. When evaluating the thyroid volume, an enlarged volume is found in 20.4-58.3% and on evaluation by palpation pathological changes are found in a considerable proportion of the examined population. The findings suggest that the iodine supply of the Prague population is inadequate and the incidence of abnormal findings on the thyroid gland is high. It will be necessary to verify these findings in other random population samples from other localities. If the adverse position will be confirmed, this will call for an urgent solution, i.e. a better iodine supply of the population.

[Manifestations and early course of type I diabetes mellitus--a decisive period from the viewpoint of controlling the further development of the disease]. / Manifestace a casný prubeh diabetes mellitus I. typu--rozhodující období z hlediska moznosti ovlivnení dalsího vývoje onemocnení.

The autoimmune process focused on B-cells of the islets of Langerhans and leading gradually to their destruction is latent before the manifestation of diabetic symptoms. The detection of this preclinical stage in particular in sporadic cases is in common clinical practice, due to the low prevalence of the disease in the population and pretentious character as regards applied methods, unreal. Therefore attention is focused on the period of clinical manifestation of the diabetic syndrome and its early stages when by early diagnosis and intensive insulin or immunosuppressive treatment it is still possible to preserve a substantial proportion of functional B-cells and influence in an effective manner the onset and duration of remission. The authors summarize experience assembled during the eighties, incl. therapeutic procedures and problems of active immunomodulation in the prehyperglycaemic stage of the disease.