Cardiovascular risk factors characteristic for the metabolic syndrome in adult patients with type 1 diabetes.

UNLABELLED: The prevalence rate and clinical significance of the metabolic syndrome in type 1 diabetic patients are not well established. The aim of this study was to estimate the prevalence rate of the metabolic syndrome in adult patients with type 1 diabetes. Patients with type 1 diabetes (n=533; age: 35.6+/-11.6 years; duration of diabetes: 18.0+/-11.1 years; x+/-SD) were consecutively enrolled from 11 diabetes outpatient departments. Data on medical history, actual treatment, anthropometric and laboratory parameters as well as actual blood pressure were registered while eating habits and physical activity were evaluated by standardized questionnaires. The prevalence rate of the metabolic syndrome according to the ATP-III criteria was 31.1% (29.7% in men, 32.7% in women; p>0.05). Using the IDF criteria a higher overall prevalence rate of the metabolic syndrome (36.2%; [32,8% in men, 39.4% in women; p>0.05]) was observed. Comparing type 1 diabetic patients to the general population, the prevalence rate of the metabolic syndrome proved to be significantly higher in each age-group of patients with type 1 diabetes. According to the stepwise logistic regression analysis the metabolic syndrome in type 1 diabetic patients was associated in a decreasing ranking order of significance with waist circumference, serum triglycerides, female gender, antihypertensive medication, HDL-cholesterol, diastolic blood pressure and serum creatinine. CONCLUSIONS: The metabolic syndrome can frequently be detected and is predominantly associated with higher waist circumference in adult patients with type 1 diabetes in Hungary.

Cardiometabolic risk and educational level in adult patients with type 1 diabetes.

A low educational level and a poor socioeconomic status could be associated with increased risk for chronic diseases. The aim of the study was to evaluate the relationship between the educational level and cardiometabolic risk in adult patients with type 1 diabetes (n = 437; age: 38.0 +/- 10.4 years, duration of diabetes: 19.2 +/- 11.1 years; x +/- SD). Educational levels were classified as low [primary school, n = 56 (12.8%)], middle [high school, n = 251 (57.4%)] or high [university, n = 130 (29.7%)]. The prevalence rate of the metabolic syndrome proved to be higher in patients with low versus high educational levels (ATP-III criteria: 42.9 vs. 21.5%, P = 0.0006). Antihypertensive treatment and cardiovascular diseases were more prevalent in patients with low versus high educational level (46.4 vs. 26.2%, P = 0.01; 12.5 vs. 2.3%, P = 0.02; respectively). Overall glycemic control was worse in patients with low versus high educational level (HbA(lc): 8.8 +/- 1.6 vs. 7.9 +/- 1.4%; P = 0.0006). Patients with low versus high educational level differed significantly regarding smoking habits (smokers: 28.6 vs. 11.6%; P = 0.01) and regular physical activity (5.4 vs. 33.1%; P = 0.0001). Higher prevalence rate of certain cardiometabolic risk factors was associated with low educational level in middle-aged type 1 diabetic patients with relatively long duration of diabetes; therefore, these patients should have priority when preventing cardiovascular complications.

Experiences with functional insulin substitution: a follow-up study on control and patient compliance.

Functional insulin substitution, an insulin regimen made up of two daily injections of intermediate-acting insulin and prandial boluses of regular insulin, was to be introduced in 49 type 1 diabetic patients, as previous regimens consisting of two or three daily injections proved to be inefficient due to the patients lifestyle or inherent metabolic lability. Forty-five patients were treated with human insulin injected by NovoPen. In 38 cases therapy was changed in the frame of a one-week, small-group, inpatient, structured educational course. After a mean 14 months of follow-up metabolic status improved in 33 cases while there was further derangement in 16. Eighteen patients were practising true functional therapy, i.e. doing blood glucose tests before each injection. Further 22 diabetics were trying to achieve better metabolic control through 2-3 daily blood glucose tests and insulin dose corrections. The metabolic status was not affected by the frequency of blood glucose testing, rather by raising of the daily dose of short acting insulin in conjunction with the switch in therapy acting beneficially. All patients insisted on using NovoPen further on.

[Experience with functional insulin therapy: metabolic follow up and patient cooperation]. / Funkcionális inzulinkezeléssel szerzett tapasztalatok: az anyagcserehelyzet és a páciens-együttmüködés alakulása.

Functional insulin substitution, an insulin regimen made up of two daily injections of intermedier acting insulin and prandial boluses of regular insulin, was to be introduced in 49 type 1 diabetic patients, as previous regimens consisting of two or three daily injections proved to be inefficient due to the patients' lifestyle or inherent metabolic lability. 45 patients were treated with human insulin injected by NovoPen. In 38 cases therapy was changed in the frame of a one-week, small-group, inpatient, structured educational course. After a mean 14 months of follow-up metabolic status improved in 33 cases while there was further derangement in 16. 18 patients were practicing true functional therapy ie. doing blood glucose tests before each injection. Another 22 diabetics were trying to achieve better metabolic control through 2-3 daily blood glucose tests and insulin dose corrections. Metabolic status was not affected by the frequency of blood glucose testing, rather by the raising of the daily dose of Actrapid insulin in conjunction with the switch in therapy acting beneficially. All patients insisted on using NovoPen further on.

Non-specific cellular immunity in type I and type II diabetes.

Antibody-dependent cellular cytotoxicity (ADCC) against human erythrocytes was investigated in 39 type I and 63 type II diabetic patients in comparison to 177 healthy blood donors. The cytotoxic capacity of lymphocytes from diabetics was significantly increased. The highest values were measured in insulin-treated type II diabetics (after secondary failure of a previous sulfonylurea therapy).--It is suggested that in certain cases of type II diabetes an increased unspecific K cell-and/or antibody-dependent cellular cytotoxicity plays a pathogenetic role in the development of the disease. The latter might possibly be directed against insulin receptors.