Effect of special types of bread with select herbal components on postprandial glucose levels in diabetic patients.

BACKGROUND: Nutrition recommendations in patients with type 2 diabetes mellitus (T2DM) are to consume rye or integral bread instead of white bread. A positive effect on glucoregulation has been achieved by enriching food with various biologically active substances of herbal origin, so we formulated an herbal mixture that can be used as a supplement for a special type of bread (STB) to achieve better effects on postprandial glucose and insulin levels in patients with T2DM. AIM: To compare organoleptic characteristics and effects of two types of bread on postprandial glucose and insulin levels in T2DM patients. METHODS: This trial included 97 patients with T2DM. A parallel group of 16 healthy subjects was also investigated. All participants were given 50 g of rye bread and the same amount of a STB with an herbal mixture on 2 consecutive days. Postprandial blood glucose and insulin levels were compared at the 30th, 60th, 90th and 120th min. A questionnaire was used for subjective estimation of the organoleptic and satiety features of the two types of bread. RESULTS: Compared to patients who consumed rye bread, significantly lower postprandial blood glucose and insulin concentrations were found in T2DM patients who consumed STB. No relevant differences were found among the healthy subjects. Subjectively estimated organoleptic and satiety characteristics are better for STB than for rye bread. CONCLUSION: STB have better effects than rye bread on postprandial glucoregulation in T2DM patients. Subjectively estimated organoleptic and satiety characteristics are better for STB than for rye bread. Therefore, STB can be recommended for nutrition in T2DM patients.

Coronary Microvascular Dysfunction and Hypertension: A Bond More Important than We Think.

Coronary microvascular dysfunction (CMD) is a clinical entity linked with various risk factors that significantly affect cardiac morbidity and mortality. Hypertension, one of the most important, causes both functional and structural alterations in the microvasculature, promoting the occurrence and progression of microvascular angina. Endothelial dysfunction and capillary rarefaction play the most significant role in the development of CMD among patients with hypertension. CMD is also related to several hypertension-induced morphological and functional changes in the myocardium in the subclinical and early clinical stages, including left ventricular hypertrophy, interstitial myocardial fibrosis, and diastolic dysfunction. This indicates the fact that CMD, especially if associated with hypertension, is a subclinical marker of end-organ damage and heart failure, particularly that with preserved ejection fraction. This is why it is important to search for microvascular angina in every patient with hypertension and chest pain not associated with obstructive coronary artery disease. Several highly sensitive and specific non-invasive and invasive diagnostic modalities have been developed to evaluate the presence and severity of CMD and also to investigate and guide the treatment of additional complications that can affect further prognosis. This comprehensive review provides insight into the main pathophysiological mechanisms of CMD in hypertensive patients, offering an integrated diagnostic approach as well as an overview of currently available therapeutical modalities.

Homeostatic microbiome disruption as a cause of insulin secretion disorders. Candida albicans, a new factor in pathogenesis of diabetes: A STROBE compliant cross-sectional study.

The study aimed to test the hypothesis that homeostatic microbiome (HM) disorders lead to the increased indirect influence of certain microorganisms (MO) in the gastrointestinal tract, causing a disorder of insulin secretion, insulin resistance, and diabetes. We highlighted Candida and certain types of bacteria since previous in vitro research showed they significantly affect insulin secretion and can cause insulin resistance in obese patients with metabolic syndrome. After determining the type of MO present in the throat swab and the stool, the oral glucose tolerance test (OGTT) test, and analysis of glucose and insulin secretion were performed in patients (n = 38) who were positive for certain types of MO compared to negative patients. Finally, all patients were divided into two groups: overweight patients (body mass index [BMI] < 30) and obese patients (BMI > 30). These two groups were compared for the percentage of certain types of MO to determine which MO can affect an increase in obesity and BMI. The presence of Diphtheroids in the throat (60.5%) reduces insulin secretion in patients compared with the negative group (194.5: 332.4) and the difference was statistically significant (P = .030). The presence of Candida in the throat (10%) increases insulin secretion, but the difference was statistically insignificant. The presence of Candida in the stool (28.9%) also increases insulin secretion and the difference was statistically significant (P = .038). Cumulative results (throat + stool) were similar (180: 332, P = .022). Analysis of BMI showed that the percentage of Diphtheroids in the throat decreases with increased body weight (53.8: 75%) while the percentage of Candida (38.5: 8.3%) and Enterobacter (61.5: 25%) increases, but these differences were statistically insignificant (P > .05). Diphtheroids in the throat can reduce insulin secretion by synthesizing their metabolites. Candida albicans is a conditional pathogen and as a significant indirect factor induces increased insulin secretion and insulin resistance. There are indications that elevated levels of Candida in the intestinal system can cause increased body weight of patients. C albicans should be considered a new factor in the pathogenesis of diabetes.

Matrix metalloproteinase-9 index as a possible parameter for predicting acute coronary syndrome in diabetics.

BACKGROUND/AIM: Matrix metalloproteinase-9 (MMP-9) index is the ratio of active MMP-9 and total MMP-9 levels. It reflects the importance of MMP-9 in acute coronary syndrome (ACS). METHODS: The study included 3 groups of patients (n = 87): the group 1 - non-diabetic subjects without ACS (control); the group 2 - diabetic patients with ACS [subgroups with unstable angina pectoris (UAP), myocardial infarction (MI) or reinfarction]; and the group 3 non-diabetics patients with ACS. Total and active MMP-9 were measured and used to create MIP-9 index. RESULTS: MMP-9 index, as a marker showed good sensitivity and specificity, of ACS in diabetics, with a cut-off value over 58.2. MMP-9 was higher in the study groups than in the control one. MMP-9 correlated with ACS occurrence and type of cardiovascular event. A statistically significant difference was found among the groups according to active MMP-9 (p < 0.001). The same was found with active MMP-9 between the control and the group with MI (p < 0.001). The control was highly statistically significantly different from the group of patients with UAP (p < 0.01). Statically significant differences in MMP-9 index was found between the control and the diabetics with ACS (P < 0.001). Statistically significant difference of MMP-9 index was also found in the controls compared to the value in non-diabetic patients with ACS (p < 0.01). CONCLUSION: MMP-9 index may be a possible marker of atheromatous plaque rupture in diabetics.

Prothrombogenic factors and reduced antioxidative defense in children and adolescents with pre-metabolic and metabolic syndrome.

BACKGROUND: The aim of this study was to examine prothrombogenic factors and antioxidative defense in obese children and adolescents with pre-metabolic and metabolic syndrome, and to analyze insulin secretion and resistance, early glycoregulation disorders and lipid status. METHODS: Insulin sensitivity was determined using the homeostasis model assessment for insulin resistance (HOMA-IR), while insulin secretion was determined using the homeostasis model assessment beta (HOMA-beta). Prothrombogenic factors analyzed were plasma plasminogen activator inhibitor-1 (PAI-1) and fibrinogen. Superoxide dismutase and glutathione peroxidase were measured as markers of antioxidative defense. RESULTS: Patients with metabolic syndrome were characterized with increased body mass index (BMI), waist circumference, and HOMA-IR and HOMA-beta levels, and all had increased blood pressure and triglyceride levels, low high-density lipoprotein cholesterol levels, increased PAI-1 levels and reduced antioxidative defense levels. Patients with pre-metabolic syndrome had higher levels of basal and mean insulinemia during an oral glucose tolerance test, higher levels of HOMA-beta and lower levels of antioxidative defense compared to patients with metabolic syndrome. CONCLUSIONS: Negative correlations between antioxidative defense parameters and BMI, abdominal obesity, insulin secretion, systolic blood pressure and atherogenic lipid factors, as well as correlations between PAI-1 and insulin resistance and basal glycemia in the metabolic syndrome group contribute to accelerated atherosclerosis. Positive correlations between PAI-1 and waist circumference and BMI, and negative correlations between BMI and antioxidative defense in the pre-metabolic syndrome patients show that this early stage preceding the metabolic syndrome is also characterized by atherosclerotic complication risks and evident hyperinsulinism and insulin resistance.

Effect of tadalafil on erectile dysfunction in male patients with diabetes mellitus.

BACKGROUND/AIM: [corrected] During the first 10 years over 50% of diabetes patients develop erectile dysfunction (ED). It is more severe and resistant to therapy than in male patients with normal glucoregulation. The purpose of this pilot study was to estimate the tadalafil (Cialis) efficacy and safety in male patients with diabetes mellitus (DM), together with moderate to severe ED. METHODS: The study included 30 male patients with diagnozed type 1 or type 2 DM together with ED. ED was estimated through the International Index of Erectile Function (IIEF-6), Sexual Encounter Profile (SEP) questionnaire and prostaglandin test, at the beginning of the research and three months after the 20 mg tadalafil therapy initiation, once a week (on Fridays). Glycosylated haemoglobin in blood (HbAlc) values were also monitored. According to the ED severity (IIEF values at the beginning of the therapy) the patients were divided into 2 groups. The previous experience with sildenafil citrate (Viagra) and prostaglandin E1 intracavernous therapy was recorded. RESULTS: Tadalafil significantly improved ED (p < 0.001) for 7.40 points of the IIEF score, i.e. for 58% and 60% towards SEP2 and SEP3 questionnaire, respectively. Compared to the previous ED therapy subjectively better tadalafil experience was recorded. Each group experienced a significant improvement in IIEF score (p < 0.001), more significantly in the group 2 (8.26+/-1.49 points) compared with the medium improvement in the group 1 (6.27+/-1.35 points). After three months HbA1c values decreased for 2.26+/-1.62 (p < 0.001). CONCLUSION: Tadalafil is an effective tool for treating ED in diabetes patients. In some situations tadalafil application could replace prostaglandin test. The sexual sphere motivation leads to the improvement of glucoregulation in DM patients.

[Sarcoidosis localized in endocrine glands].

INTRODUCTION: There is a relationship between sarcoidosis and endocrine diseases: hypothalamus, hypophysis, thyroid gland, parathyroid gland, adrenal gland and calcium metabolism disorder. DISCUSSION: Neurological disorders, obesity, secondary hypogonadism, and thirst as a result of diabetes insipidus, dominate the clinical picture of hypothalanmic sarcoidosis. Diseases of adenohypophysis present with gonadotropic insufficiency and prolactin increase. They may cause disorders in menstruation and ovulation. Disorders of neurohypophysis manifest with moderate polyuria and polydipsia. Disorders of thyroid gland function in systemic sarcoidosis present with hyperthyroidism, hypothyroidism or thyroiditis. Sarcoidosis of the parathyroid gland is rare. Sarcoidosis of adrenal cortex may cause primary insufficiency of the suprarenal gland The secondary insufficiency of the suprarenal gland is caused by hypothalamic and pituitary sarcoidosis. In sarcoidosis, calcium metabolism disorder and hypercalcemia are frequent. Vitamin 1.25(OH)2D has an important role since it is increasingly produced in renal and extra renal regions. Hypercalcemia leads to hypercalciuria and nephrolithiasis, while the level of parathyroid hormone usually decreases. Increased levels of serum angiotensin converting enzyme (ACE) are also important markers in the diagnosis of sarcoidosis. CONCLUSION: Clinical manifestations of endocrine disorders depend on the localization of sarcoid lesions. The treatment of disorders is directed to the treatment of structure and functional disorders of glands involved, as well as to sarcoidosis. Successful treatment of sarcoidosis may cause regression of granulomatous lesions in the involved glands.

[Chronic sarcoidosis].

INTRODUCTION: According to available literature data, chronic pulmonary and extrapulmonary sarcoidosis occurs in 10-30% of all sarcoidosis patients. Unpredictable course of the disease is a great challenge for scientists and researchers. Clinical and biological parameters for evaluation and prediction of the course of the disease are still the topic of different scientific investigations all over the world. According to an American case control study on sarcoidosis, unique diagnostic criteria have been established in order to simplify the diagnosis of sarcoidosis. The aim of this study was to present the morbidity and the clinical course of sarcoidosis in our patients. MATERIALS AND METHODS: We analyzed 370 sarcoidosis patients and confirmed the diagnosis of sarcoidosis by biopsy of the suspected granuloma, and by excluding any other possible cause of granulomatous inflammation. In our analyzed patients with sarcoidosis, chronic form was diagnosed in about 30%. An extremly unpredictable, chronic form of the disease was established in patients with extrapulmonary localisations (heart, CNS, liver and bones). CONCLUSION: Follow-up criteria and control examinations of sarcoidosis patients are suggested as well.

[Sarcoidosis and diabetes: therapeutic aspects].

FIRST CASE: A 45-year-old female patient with diabetes was on corticosteroid therapy for a year due to pulmonary sarcoidosis. During the last six years she was treated with oral antidiabetic drugs, but during the last couple of months, she required insulin therapy due to impaired glycoregulation. After corticosteroid therapy was discontinued, glycoregulation improved and insulin therapy was discontinued as well. SECOND CASE: a 32-year-old male patient was on prednisolone therapy due to pulmonary and extrapulmonary sarcoidosis. A few weeks later diabetes mellitus (de novo) was established. During the treatment of sarcoidosis with corticosteroids, short-term insulin therapy was due to impaired glycoregulation. Insulin therapy has improved the glycoregulation. DISCUSSION: There is no certain evidence about the incidence of diabetes mellitus under the influence of corticosteroids, due to increase of hepatic glucose production, insulin resistance and exhaustion of pancreatic beta-cells because of stimulated endogenous secretion. During treatment of sarcoidosis, corticosteroid therapy may cause deterioration of glycoregulation and occurrence of clinically manifested diabetes mellitus in patients with impaired glycose tolerance or predisposition to diabetes. CONCLUSION: Diabetic patients with sarcoidosis who need corticosteroid therapy, should control glycoregulation Patients with sorcoidosis, treated with corticosteroid therapy need regular control in order to diagnose early diabetes.

[Application of measuring instruments--quality of life questionnaires in patients with chronic sarcoidosis].

INTRODUCTION: Health-related quality of life in interstitial lung diseases, especially in sarcoidosis, has hardly received appropriate attention in clinical studies due to lack of validated methods of measurement. Until now, in patients with sarcoidosis and interstitial lung diseases, several generic and respiratory specific quality-of-life instruments were used in order to discover the most valid and reliable quality-of-life instrument. Sarcoidosis is a multi-system disease that affects quality of life in many different ways. MATERIAL AND METHODS: In this study the Sarcoidosis Health Questionnaire was used to evaluate the quality of life in sarcoidosis patients. 89 biopsy positive sarcoidosis patients were analyzed (16 male, 73 female); their mean age 46.15 +/- 11.11 years. 34 (39%) patients presented with acute sarcoidosis, 53 (61%) with chronic sarcoidosis and 46 patients (51.7%) had extrapulmonary disease. In regard to treatment, 51 (57%) patients were treated with corticosteroids 18 (20%) with methotrexate and in 20 (23%) spontaneous remission was reported. All analyses were performed using the Statistical Package for Social Science Software: A probability value less than 0.01 considered being statistically significant. RESULTS: Statistically significant correlation was found between the sarcoidosis health questionnaire scores and chronic sarcoidosis. daily 0.001, emotional 0.014 and total 0.01. In regard to treatment, significant difference between groups was found in the domain of physical (sig 0.006) emotional (sign 0.005) and total (sign 0.001) scores. CONCLUSION: The first sarcoidosis specific questionnaire shows perfect correlation with the possible clinical course in patients with sarcoidosis.