Chicken eggshell powder more effectively alleviates bone loss comparted to inorganic calcium carbonate: an animal study performed on ovariectomized rats.

This study aimed to evaluate the effects of chicken eggshell powder rich in calcium and the inorganic form of calcium carbonate on osteoporotic bone structure using an animal model of ovariectomized rats. Animals were divided into four groups: sham-operated rats (SHAM group); ovariectomized rats untreated (OVX group); OVX rats treated with eggshell powder (Biomin H® OVX + ECa group; total Ca content 1.5%); and OVX rats receiving inorganic calcium carbonate (calcium carbonate precipitated, total Ca content 1.5%; OVX + ICa group) during 8 weeks. Ovariectomy increased total body weight, plasma alkaline phosphatase activity, cortical bone thickness, periosteal bone apposition, and considerably worsened the trabecular bone microarchitecture. Calcium supplementation in both OVX + ECa and OVX + ICa groups elevated blood supply in the cortical bone when compared to OVX rats. Treatment with eggshell powder, unlike the OVX + ICa group, significantly lowered bone resorption, increased plasma calcium level, relative volume of trabecular bone, and secondary osteon population density, which together contributes to the enhanced bone strength. In addition, sizes of Haversian canals and secondary osteons in OVX + ECa group reached the values of SHAM group. Our results suggest that chicken eggshell powder more effectively ameliorates bone loss in ovariectomized rats than precipitated calcium carbonate.

Insulin lispro improves postprandial glucose control in patients with diabetes mellitus.

Insulin lispro was compared with regular human insulin with respect to glycaemic control in patients with diabetes mellitus on intensive insulin treatment. Sixty-two patients (55 type 1; 7 type 2) from eight study centres in the Czech Republic, Slovenia and the Slovak Republic participated in a 4-month, open-label, randomized, crossover study. Patients administered insulin lispro immediately before meals or regular human insulin 30 min before meals. A test meal (220-400 kcal), based on local and individual dietary habits and consistent for each patient throughout the study was given at baseline and at the end of each treatment. At each test meal visit HbA1c, fasting blood glucose, 1-hour and 2-hour postprandial blood glucose levels were measured. The level of HbA1c (7.6% +/- 1.5% versus 7.4% +/- 1.5%), incidence of hypoglycaemia (41-66% of patients--versus 39-63%) and daily insulin dose (0.67 +/- 0.11 U/kg versus 0.65 +/- 0.11 U/kg) did not differ between treatment groups at endpoint (insulin lispro versus regular human insulin, respectively). Mean 2-hour postprandial blood glucose excursion for the insulin lispro group (0.0 +/- 3.7 mmol/L) was significantly lower (p = 0.035) when compared with the regular human insulin group (1.3 +/- 3.7 mmol/L) at endpoint. Therapy with insulin lispro was therefore associated with a significant improvement in postprandial blood glucose excursion control when compared with regular human insulin, without an increase in rate of hypoglycaemia.

[Incidence of risk factors and vascular complications in patients with newly diagnosed type 2 diabetes mellitus]. / Výskyt rizikových faktorov a vaskulárnych komplikácií u novodiagnostikovaných pacientov s diabetes mellitus 2. typu.

UNLABELLED: The objective of the investigation was early detection of risk factors of diabetes and/or atherosclerosis and the prevalence of vascular complications of diabetes in newly diagnosed patients with type 2 diabetes in the Slovak Republic. PATIENTS AND METHODS: In the Slovak detection programme of vascular complications participated 40 diabetological out-patient departments. In the course of one year (from the beginning of June 1999 to the end of May 2000) in a total of 3424 newly diagnosed patients with type 2 diabetes, aged under 70 years the case-history was recorded, focused on risk factors of diabetes and atherosclerosis, on the patients' lifestyle, on vascular complications of diabetes and their treatment. Moreover a detailed clinical and laboratory examination was made. The authors made in addition to assessment of the blood sugar level also biochemical examinations focused on indicators of the lipid metabolism and microalbuminuria. All patients had an ophthalmological examination, and the electrocardiogram was recorded. RESULTS: As to risk factors of diabetes as many as 3259 patients (95.2%) reported a low physical activity (exercise lasting less than the minimum of 3 x 30 minutes per week) and 3001 (87.6%) had an elevated body weight, whereby 43.9% patients had a BMI of 25 to 30 kg/m2 and 43.8% were obese (BMI > 30 kg/m2). Diabetes mellitus in a first grade relative was reported by 1521 patients (44.7%). As to risk factors of atherosclerosis, the most frequent finding was hyprcholesterolaemia (values > 5.2 mmol/l) in 2262 patients (67.3%), and hypertriglyceridaemia (values > 1.7 mmol/l) in 2194 patients (66.5%). Arterial hypertension (values of systolic and/or diastolic pressure > 140/90 Hg) were recorded in 2326 (67.9%) patients. The most frequent microvascular complication of diabetes was microalbuminuria was in 20.5% patients. Ischaemic heart disease was recorded in 22.80 diabetics. Risk factors of atherosclerosis and vascular complications in newly diagnosed type 2 diabetics are closely related to the patients' body weight. CONCLUSION: The authors provided evidence of a high incidence of risk factors of diabetes and atheroscleosis in newly diagnosed patients with type 2 diabetes mellitus, and in practically every fifth patient the presence of ischaemic heart disease. Obesity is a significant adverse metabolic and vascular factor.

[The prevalence of undiagnosed type 2 diabetes mellitus in consulting rooms of general practitioners]. / Prevalencia nediagnostikovaných pacientov s diabetes mellitus 2. typu v ambulancii obvodného lekára.

UNLABELLED: The aim of study was to estimate the prevalence of newly detected type 2 diabetic patients and compare it with prevalence of registered type 2 diabetic patients in the Slovak republic. The second aim was to improve the cooperation between general practitioners and diabetologists in the detection of unrecognized diabetes. PATIENTS AND METHODS: Seventy-six general practitioners were involved in Slovak Diabetologic Detection Program. Randomly taken capillary glucose (glucometer One-Touch, Lifescan) was measured in 18,942 probands over 40 years of age with one or more risk factors for type 2 diabetes in nine regions of Slovakia during a 6-month period. When capillary glucose was over 6 mmol/l the proband was referred to one of the nine diabetologic outpatient clinics for further evaluation. The history, physical examination and fasting capillary glucose or oGTT were performed in these patients. After exclusion of previously registered diabetic patients, noncompliant patients and insufficient examinations the data were evaluated in 15,387 probands. This data were compared with the Slovak National Registry, which is based on yearly collected and evaluated data from all diabetologic outpatient clinics. RESULTS: Newly detected (undiagnosed) type 2 diabetes was found in 444 (2.9%) and impaired fasting glucose and/or impaired glucose tolerance in 347 (2.3%) out of 15,387 probands. Data from Slovak National Registry show 9.5% type 2 diabetic patients over 40 years of age. In our detection program the number of undiagnosed type 2 diabetic patients over the age of 40 years was 2.9%. Therefore authors estimated the overall prevalence of type 2 diabetes in Slovakia over the age of 40 on 12.3% of general population in this age category (population ca 2.2 million people). When is compared prevalence of undiagnosed and registered type 2 diabetic patients it can be claimed that on three registered diabetic patients, there is one undiagnosed and one other with impaired fasting glucose and/or impaired glucose tolerance. The patients with undiagnosed diabetes and ones with impaired fasting glucose and/or impaired glucose tolerance had significantly higher body mass index and significantly higher occurrence of arterial hypertension and positive family history of diabetes compared to non-diabetic probands. Authors also achieved the second aim by establishing the collaboration between general practitioners and diabetologists in the selected nine regions of Slovakia. This relationship is essential for detection the undiagnosed diabetic patients by general practitioners and confirmation of diagnosis of diabetes as well as initiation of introductory education by diabetes specialists. Authors conclude that it is essential to actively screen for disturbances of glucose metabolism in population over 40 years old in general practice.

24-h ambulatory blood pressure, daytime and nighttime urinary albumin and retinol-binding protein excretion in type I diabetic patients.

We studied 24-h ambulatory blood pressure (SBP, DBP), actual glycemic control assessed from seven blood glucose measurements, 16-h daytime and 8-h nighttime urinary excretion of albumin (UAE) and retinol-binding protein (URBP) in 20 normoalbuminuric (group A, nighttime UAE < 20 micrograms/min) and 20 microalbuminuric and low-proteinuric type I diabetic patients (group B, nighttime UAE 20-500 micrograms/min) matched for age and diabetes duration. Glycemic control was similar in the two groups. Daytime and nighttime SBP and DBP were higher in group B compared to group A (p < 0.01). Nighttime decrease in SBP and DBP correlated with nighttime decrease in UAE in group B (p < 0.05, p < 0.001), but not in group A. There was no correlation between BP and actual glycemic control in either group. We found higher daytime and nighttime URBP in group B compared to group A (p < 0.05). We conclude that, in microalbuminuric and low-proteinuric patients, daytime and nighttime BP was elevated but still in the normal or borderline range, and nighttime decrease in BP correlated with nighttime decrease in UAE but not with actual glycemic control. Increased URBP in these patients suggests slightly impaired proximal tubular function in early stages of diabetic nephropathy.

[Insulin resistance and combined therapy with sulfonylurea and insulin in non-insulin dependent diabetics]. / Inzulínová rezistencia a kombinovaná liecba sulfonylureou a inzulínom u non-inzulíndependentných diabetikov.

The author explains the mechanisms of insulin resistance and impaired insulin secretion which are the main signs in the pathogenesis of non-insulin-dependent diabetics. Both reasons are the basis of secondary failure of sulphonylurea treatment or the necessity to administer large doses of insulin to achieve a normal blood sugar level in these patients. By combined treatment, i.e. by adding small amounts of insulin to the original treatment with sulphonylurea antidiabetics or by adding sulphonylurea to large insulin doses, it is possible to compensate the patient as effectively as with insulin treatment alone. The author analyzes the procedure of changing over to combined treatment which should be implemented during hospitalization of the patient. Finally the author evaluates the effect of combined treatment from data in the literature as well as his own experience which indicate that to achieve equal metabolic compensation combined treatment with sulphonylurea and insulin requires substantially lower insulin doses, as compared with insulin treatment only.

[A 2-month period of physical training in insulin-dependent diabetics]. / Dvojmesacný telesný tréning u inzulín-dependentných diabetikov.

Twenty type 1 diabetics participated after previous individual instructions in a 8-week physical training programme. The latter comprised three training units per week. One training unit started by 10-minute warming up exercise, then the patients pedalled on a bicycle ergometer 2 x 10 minutes with a 5-minute break with a load amounting to 80% of the oxygen consumption during the maximum tolerated load. The final part was formed by swimming in a swimming pool, covering a distance of at least 200 m. After the termination of the programme the authors did not observe significant changes in the carbohydrate and lipid metabolism nor in physical performance, however, the maximal oxygen consumption increased as a result of training by 17% and the maximum achieved load by 25 W (i.e. one step). Throughout the investigation period the authors did not record any serious complications. The patients enjoyed the physical activity and reported improvement of the quality of life. Therefore the authors recommend physical training in the treatment of insulin-dependent diabetic patients.

[Catecholamines and changes in blood pressure during stress tests in type 1 diabetics]. / Katecholamíny a zmeny krvného tlaku pocas zát'azových testov u diabetikov 1. typu.

The influence of metabolic control on catecholamine secretion and blood pressure during upright posture, mental stress and physical exercise was studied in 34 normotensive normoalbuminuric type 1 (insulin-dependent) diabetic patients without autonomic neuropathy. A poor metabolic control did not induce different changes in blood pressure and plasma catecholamines as compared to a good metabolic control, except for an exaggerated rise in plasma adrenaline in patients with asymptomatic hypoglycemia. The lack of correlation between plasma catecholamines and blood pressure suggest that some other factors are also involved in the hemodynamic reaction to mental stress and physical exercise in diabetic patients. (Fig. 2, Tab. 3, Ref. 25.).

[Multicenter study with gliquidone in type 2 diabetes mellitus]. / Multicentrová stúdia s gliquidonom pri diabetes mellitus 2. typu.

The effectiveness and tolerance of the new sulphonyl urea antidiabetic gliquidone (commercial name Glurenorm) was tested by three-month administration of this preparation in a group of 39 type 2 diabetics. Gliquidone proved a medium-strength beta-cytotropic antidiabetic preparation. As to side-effects, the authors noted only dyspepsia in one patient (2.5%). Symptomatic hypoglycaemia did not develop in any of the patients. In the subgroup of six patients with diabetic nephropathy the indicators of renal functions did not deteriorate. In a sub-group of 6 patients with concurrent hepatopathy the originally elevated gamma-glutamyl transpeptidase activity receded. The authors confirmed thus the good tolerance of gliquidone in diabetes associated with nephropathy and diabetes with hepatopathy.

[The importance of albuminuria in the detection of diabetic nephropathy and its relation to the development of retinopathy and autonomic neuropathy in type I diabetes]. / Význam albuminúrie pre urcenie diabetickej nefropatie a ich vzt'ah k vývoju retinopatie a autonómnej neuropatie u diabetikov I. typu.

A series of 72 type I diabetics was grouped according to the mean value of 24-h albuminuria (AU) determined from three 24-h urine collections: group A (n = 49, normoalbuminuria, AU less than or equal to 26 mg/24 h), group B (n = 16, microalbuminuria, AU less than or equal to 26 mg/24 h), group C (n = 7, clinically significant proteinuria, AU greater than 260 mg/24 h). Glycosylated hemoglobin (GHb) was examined five times in three-month intervals. Systolic and diastolic blood pressure (BPs and BPD) were determined from four values taken in the course of one year. Glomerular filtration (GF) was established a single examination of 24-h creatinine clearance. Fluorescent angiography was used to examine the fundus of the eye. The function of the cardiovascular autonomic nervous system was assessed on the basis of three tests: variation of heart rate during deep respiration, response of heart rate to upright position, Valsalva's maneuver. Group C had the longest duration of diabetes, the highest GHb, the lowest GF, and the highest BPS and BPD values. The number of diabetics with different findings on the fundus of the eye (normal finding/simple retinopathy/preproliferative and proliferative retinopathy) was as follows: group A--15/31/3, group B--9/6/1, group C--0/3/4. Group C exhibited the most pronounced derangement of the cardiovascular autonomic nervous system, whose extent depended on the length of diabetes duration and on the quality of metabolic compensation. Between the groups A and B no significant differences were found in any of the parameters studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Relationship between nephropathy, retinopathy, and autonomic neuropathy in patients with type I diabetes.

Seventy-two Type I diabetic patients were divided into three groups according to 24 hour urinary albumin excretion (UalbV, mean of three urine collections): normoalbuminuric group 1 (n = 49, UalbV less than or equal to 26 mg/24 h), microalbuminuric group 2 (n = 16, 26 less than UalbV less than or equal to 250 mg/24 h), proteinuric group 3 (n = 7, UalbV greater than 250 mg/24 h). Fluorescein angiography and three cardiovascular autonomic tests were performed. Relative frequencies of ocular findings (no retinopathy/simplex retinopathy/preproliferative and proliferative retinopathy) were determined in each group: group 1 (0.31/0.63/0.06), group 2 (0.56/0.38/0.06), and group 3 (0/0.43/0.57). The most severely affected autonomic function was observed in group 3 (p less than 0.01 vs. group 1). Significant partial correlations were found between UalbV and retinopathy (p less than 0.01), UalbV, and autonomic neuropathy (p less than 0.05), retinopathy and autonomic neuropathy (p less than 0.01), and blood pressure and UalbV and/or autonomic neuropathy (p less than 0.01). No correlation was found between the variables and the previous 15 months' metabolic control. The results suggest that nephropathy, retinopathy, and autonomic neuropathy are signs of a generalized diabetic microangiopathic process whose progression may be influenced by factors other than diabetes duration and metabolic control.

[Lipid composition of the myometrium during labor]. / Lipidické zlozky myometria pocas pôrodnej cinnosti.

Lipids represent one of the basic components of each cellular and subcellular membrane of the myometrium and their fluidity has a strong influence upon membrane function. Human myometrium was obtained at cesarean sections. Lipids were separated by one-dimensional thin layer chromatography. The chromatoplates were determined on the densitometer Shimadzu CS 930. Lipid profile of the myometrium was studied before the 37th week of pregnancy, at term without contractile activity, further during at term labor with normal contractile activity and at failure of myometrial contractility. Analysis of the obtained data showed changes in lipid fluidity, namely a decrease before the 37th week of pregnancy and at failure of myometrial contractions during at term labor. The decrease of fluidity was caused by a higher content of total cholesterol and a lower content of total phospholipids in the myometrium.

Effect of the exercise test on albuminuria, blood pressure and blood glucose in type I (insulin-dependent) diabetic patients.

Twenty-nine male type I diabetic patients (age range 16-46 years) and thirteen healthy men (age range 18-43 years) were exercised on a cycling ergometer at 75 W and 100 W after having achieved a steady state of water diuresis. Diabetic patients were subdivided into Group A (n = 19, resting urinary albumin excretion rate - UAER less than or equal to 16 micrograms/min) and Group B (n = 10, 16 less than resting UAER less than 126 micrograms/min). The groups were comparable in weight, serum creatinine, duration of diabetes and glycosylated hemoglobin. Group B showed the highest elevation of UAER at the work load of 100 W, with no correlation between increase in UAER and increase in systolic blood pressure (SBP) at both work loads. The only correlation between these parameters was found in Group A at the work load of 100 W (p less than 0.05). No correlation was found between exercise UAER and actual blood glucose in either group. The difference in UAER between healthy subjects and Group B patients (p less than 0.001) remained on the same level during exercise as at rest, but the difference between Group A and Group B (p less than 0.001) decreased with increasing work load (p less than 0.05). The highest exercise-induced systolic and diastolic blood pressure (DBP) was found in Group B, although there was no difference between the diabetic groups in pre-exercise blood pressure and in mean SBP and DBP from previous outpatient check-ups. Blood glucose did not change significantly during exercise in either diabetic group. Working capacity of diabetic patients was lower than that of healthy subjects. The test revealed some diabetic patients with strong elevation of UAER and with abnormally raised systolic and diastolic BP during exercise. The value of the findings reported is to be clarified in a further longitudinal study.

Vitamin C in the control of hypercholesterolemia in man.

The activity of the cholesterol 7 alpha-hydroxylating system containing cyto-chrome P-450 is depressed in the liver of guinea-pigs with chronic marginal vitamin C deficiency. Slowing-down of this rate-limiting reaction of cholesterol transformation to bile acids causes cholesterol accumulation in the liver, blood plasma and arteries, increase in the index total: HDL cholesterol, prolongation of plasma cholesterol half-life, increase in the index cholesterol: bile acids in the gall-bladder bile, cholesterol gallstone formation and atheromatous changes on coronary arteries in guinea-pigs with long-lasting marginal vitamin C deficiency. The most effective means for preventing these changes are vitamin C doses ensuring maximal steady-state levels of ascorbate in the tissues. In most of hypercholesterolemic persons with a low vitamin C status, the administration of ascorbic acid in doses 500-1000 mg per day lowers total cholesterol concentration in blood plasma. This effect may be reinforced through a simultaneous administration of bile acids sequestrants, such as cholestyramine or pectin. In every form of hypercholesterolemia therapy (dietary and/or pharmacological), an adequate vitamin C supply should be ensured in doses capable of creating maximal steady-state levels of ascorbate in human tissues.