Starting insulin therapy in type 2 diabetes: twice-daily biphasic insulin Aspart 30 plus metformin versus once-daily insulin glargine plus glimepiride.

AIM: To compare the efficacy and safety of two analog insulins as starting regimens in insulin-naïve Type 2 diabetes patients. METHODS: In this randomized, open-label parallel study, twice-daily biphasic insulin aspart 30 (30% soluble and 70% protaminated insulin aspart; BIAsp 30) plus metformin (met) was compared with once-daily insulin glargine (glarg) plus glimepiride (glim) in 255 insulin-naïve patients (131 male; mean+/-SD age, 61.2+/-9.1 years). Mean baseline HbA (1c) (+/-SD) was 9.2+/-1.4% and 8.9+/-1.3% for BIAsp 30 plus met ( N=128) and glarg plus glim ( N=127), respectively ( P=0.0747). Primary endpoint was the difference in absolute change in HbA (1c) between groups after 26 weeks of treatment. RESULTS: HbA (1c) change was significantly greater in the BIAsp 30 plus met group than the glarg plus glim group (between-group difference: -0.5% (95% CI: -0.8; -0.2); P=0.0002). Mean prandial plasma glucose increment was significantly lower for BIAsp 30 plus met compared with glarg plus glim: 1.4+/-1.4 mmol/l vs. 2.2+/-1.8 mmol/l; P=0.0002. During the maintenance phase (weeks 6-26), one major hypoglycemic episode occurred in each group; 20.3% and 9% of patients experienced minor hypoglycemic episodes in the BIAsp 30 plus met and glarg plus glim groups, respectively ( P=0.0124). At end-of-trial, mean daily insulin doses were 0.40 U/kg BIAsp 30 and 0.39 U/kg glarg. Glarg plus glim-treated patients experienced significant weight gain of 1.5 kg (95% CI: 0.84; 2.19; P<0.0001). Weight change with BIAsp 30 plus met of +0.7 kg was not statistically significant (95% CI: -0.07; 1.42; P=0.0762). CONCLUSIONS: Starting insulin in Type 2 diabetes patients with twice-daily BIAsp 30 plus met can reduce HbA (1c) and mean prandial plasma glucose increment to a greater extent than once-daily glarg plus glim.

[The effect of walking exercise on aerobic capacity and serum lipids in type 2 diabetics]. / Vliv tréninku chuzí na aerobní kapacitu a krevní lipidy u diabetiku 2. typu.

Regular physical activity can have a favourable impact on other risk factors of ischaemic heart disease (IHD) and associated diabetes (DM), such as obesity, hypertension, dyslipidaemia, insulin resistance and others. This important part of treatment of diabetes is frequently difficult to implement because of the lack of willingness ("adherence") of type 2 diabetics to practice regular exercise, and unequivocal data are lacking on the intensity of exercise which will influence effectively these risk factors and be at the same time safe, readily available and psychologically acceptable. The objective of the work was to find out whether walking, i.e. locomotor activity with a low to medium intensity can effectively influence parameters of aerobic capacity and blood lipids. The authors submit the results of two groups of type 2 diabetics. The experimental group B (n = 10, age 57 +/- 7 years, BMI 31 +/- 3, duration of DM 8 +/- 5 years) participated in a 12-week training programme of walking; at the beginning and at the end of this period indicators of aerobic capacity at the level of the anaerobic threshold (VO2ANP) were evaluated as well as at the level of the symptom limited maximum (VO2SL, TepO2SL), and the blood lipid levels. In the control group A (n = 6, age 58 +/- 7 years, BMI 32 +/- 4) indicators of aerobic capacity and blood lipids were assessed after a 12-week period of the usual habitual physical activity. In group B the 12-week walking training led to significant improvement of parameters of aerobic capacity at the level of the anaerobic threshold (ANP), oxygen pulse at the level of the symptom limits maximum (SL) and a significant reduction of total and LDL cholesterol. In the control group no significant changes occurred in aerobic capacity nor blood lipid values. The training programme where walking was selected as physical activity with a low to medium intensity can be considered suitable for everyday life of motivated patients with type 2 diabetics, preferably in the form of a domestic training programme. The prerequisite of success is its regular and frequent evaluation by health professionals.

[Therapeutic use of acetylsalicylic acid in diabetics]. / Lécba kyselinou acetylsalicylovou u diabetiku.

Aterosclerosis is a leading cause of morbidity and mortality in diabetics. Macrovascular diseases--myocardial infarction, cerebral vascular accident, ischemic lower extremities--start in persons with diabetes earlier and in a bigger scope then in non-diabetics. Development of these changes is determined by diabetic vasculopathy which is connected with endothelial dysfunction, hypercoagulation state, and platelet abnormalities. Treatment of a patient with diabetes is based on compensation of diabetes and management of hypertension and dyslipidaemia. Drugs that inhibit platelets constitute an important part of prevention of cardiovascular disabilities in diabetics.

[Antihypertensives and their metabolic effects in diabetics]. / Antihypertenziva a jejich metabolické úcinky u diabetiku.

Due to its frequent occurrence in diabetics, hypertension is a serious problem from the aspect of its effect on cardiovascular morbidity and mortality. Evaluation of metabolic and clinical effects of treatment of hypertension in diabetics should precede considerations on the selection of suitable antihypertensive treatment.