[Cyproterone acetate improves beta-cell function in postmenopausal women with diabetes mellitus type 2]. / Cyproterone acetate podobriava beta-kletuchnata funktsiia pri postmenopauzalni zheni sus zakharen diabet tip 2

Menopause is associated with two main risk factors for the development of type 2 diabetes mellitus--impaired beta-cell insulin secretion and insulin resistance. Physiologically estrogens improve carbohydrate metabolism, but this is not the case with different progestogens. The aim of the present study was to evaluate the effect of Cyproterone acetate (a progestogen with antiandrogenic activity) on insulin secretion, peripheral insulin sensitivity, lipid parameters and parameters of oxidative stress. Seven type 2 diabetic females, of mean age 55.4 +/- 4.7 years and mean BMI 30.8 +/- 9.39 kg/m2, in menopause for average 5 years, in good borderline glycaemic control (mean HbAic 7.8%), with dyslipidaemia, normal parameters of calcium and phosphate metabolism and with osteopenia (T-score < 88%) were enrolled in the study. They were treated with Estradiol valerate + Cyproterone acetate (Climen, Schering) for three months. Phases of insulin secretion--first phase (FPIS), second phase (SPIS) and AUC for FPIS and SPIS were assessed during IVGTT. Insulin sensitivity was determined with the manual method of euglycaemic hyperinsulinaemic clamp technique. The postmenopausal diabetic women in the present study were with overweight and obesity; they did not increase their body weight during HRT and even decreased it by mean 0.7%. Insulin secretion improved after Climen--FPIS increased by 16% and SPIS by 44%. Insulin sensitivity increased by 15%; triglycerides decreased by 16% and HDL-cholesterol increased by 27%. Total antioxidant capacity of the serum (TAOK) increased by 7%. The favourable effect on the pathophysiological mechanisms improved metabolic control--HbAic was reduced by mean 3% after 3 months. In conclusion, our results suggest that HRT with the progestogen Cyproterone acetate (Climen) should be preferred in postmenopausal type 2 diabetic females with predominant beta-cell insulin secretion defect.

Effect of hormone replacement therapy on insulin secretion and insulin sensitivity in postmenopausal diabetic women.

The aim of the present study was to evaluate the effect of three different combinations of hormone replacement therapy (HRT) on insulin secretion, peripheral insulin sensitivity, serum lipid levels and parameters of oxidative stress. Seven type II diabetic women of mean age 55.4 +/- 4.7 years, who had been menopausal for an average of 5 years, were enrolled in the study. Phases of insulin secretion--first (FPIS) and second (SPIS)--and the area under the curve (AUC) for insulin secretion were studied during an intravenous glucose tolerance test (IVGTT). Insulin sensitivity was determined using the manual euglycemic-hyperinsulinemic clamp technique. Three different HRT combinations were applied consecutively for 3-month periods: estradiol valerate plus cyproterone acetate (Climen); transdermal 17 beta-estradiol (System TTS 50) plus dydrogesterone (Duphaston) 10 mg daily for 10 days a month; oral 17 beta-estradiol plus dydrogesterone (Femoston) for 14 days a month. A group of nine women with normal glucose tolerance (according to World Health Organization criteria during a 75-g oral glucose tolerance test (OGTT)), of mean age 50.1 +/- 8.2 years and mean body mass index 24.60 +/- 2.01 kg/m2, were also studied, and served as a control group. Insulin secretion improved significantly after Climen: FPIS increased by 16% and SPIS by 44%. Insulin sensitivity increased by 50% after Systen TTS 50 + Duphaston; fasting hyperinsulinemia was normalized and total antioxidant capacity of the serum (TAOCS) was significantly raised (p < 0.01). Femoston led to an increase in insulin sensitivity (by 23%) and in TAOCS (p < 0.05), while fasting hyperinsulinemia remained unchanged. HRT should be prescribed in type II diabetic postmenopausal women because of its favorable effect on existing pathophysiological defects. Cyproterone acetate should be preferred in cases with a predominant beta-cell insulin secretion defect, while dydrogesterone in combination with a transdermal estrogen should be recommended in cases with leading insulin resistance.

[Catecholamine excretion in insulin-treated diabetic patients]. / Katecholaminausscheidung bei insulinbehandelten Diabetikern.

The urine excretion of the catecholamines adrenalin, noradrenalin and dopamine as well as the serum levels of cortisol and STH were determined with the aim to establish objective criteria for a "latent" hypoglycaemia in diabetics. The altogether 45 insulin-requiring diabetics had no hypoglycaemia (n = 28) and the decrease of blood sugar, respectively, occurred during the daytime (n = 6) or at night (n = 11). From the results no significance for the catecholamines as parameters of a hypoglycaemia that happened long ago can be derived. Deviation in the circadian rhythms of the cortisol levels in diabetics with hypoglycaemias need the securing by further investigations.

[Treatment of patients with postmenopausal and steroid-induced osteoporosis using sodium fluoride combined with vitamin D2 and calcium gluconate]. / Lechenie na bolni s postmenopauzalna i steroidindutsirana osteoporoza s natriev fluorid v kombinatsiia s vitamin D2 i kaltsiev gliukonat.

9 patients with postmenopausal and 5 patients with steroid-induced osteoporosis, mean age 57.9 +/- 7.76 years, were treated in the course of one year with sodium fluoride (Fluosen) in a dose of 45 mg/24 h in combination with calcium gluconate (2 g/24 h) and oil solution of vit D2 (2 mg/week). In the course of the treatment a considerable easing of the pains in the most affected parts of the skeleton was found and the height remained at the same level before and after the treatment. This correlates with the statistically significant increase of the serum levels of the total alkaline phosphatase and its bone isoenzyme by keeping a normal kalium phosphorous balance as well as with the x-ray data for retaining the bone changes liked with the osteoporosis.

[Catecholamine excretion in diabetics on insulin treatment]. / Katekholaminova ekskretsiia pri diabetno bolni na insulinolechenie.

In order to find out objective indices for "hidden" hypoglycemia in diabetic patients the urine excretion of the catecholamines adrenaline, noradrenaline, dopamine and the serum levels of cortisol and somatotrophic hormone (STH) were followed up. 45 diabetics on insulin treatment were included in the study: 32 patients with type I diabetes mellitus and 13 patients with diabetes mellitus type II with secondary resistance to sulfanilurea drugs and insulin. The patients were classified into the following groups: I. without hypoglycemia--28 patients; 2. with diurnal hypoglycemia--6 patients and 3. with nocturnal hypoglycemia--II patients. In the patients with hypoglycemia the 24 h adrenaline urine excretion was higher than in the patients without hypoglycemia. No such differences were found for noradrenaline and dopamine. The separate examination of the diurnal and nocturnal catecholamines excretion showed in all groups that they cannot serve as an objective index for determination of hypoglycemia. The STH showed no differences in all groups of diabetics. Disturbances in the circadian rhythm of cortisol secretion in diabetics were found. This could be a good and available marker for detecting "hidden" hypoglycemia in diabetics.