1,721,055 research outputs found
A Modern Approach to the Treatment of Dyslipidemia
No full textDislipidemije su heterogena skupina poremećaja karakterizirana abnormalnostima u koncentraciji lipida u krvi. Predstavljaju jedan od vodećih faktora rizika za razvoj KVB stoga je njihovo liječenje važan dio prevencije ovih bolesti. Klinički najznačajnija je hiperkolesterolemija, a terapijske mjere, farmakološke i nefarmakološke, naglašavaju važnost snižavanja LDL-K s obzirom na njegovu glavnu ulogu u progresiji ateroskleroze. Nefarmakološke mjere, koje podrazumijevaju redovitu tjelesnu aktivnost, redukciju tjelesne težine, prilagođenu prehranu, umjerenu konzumaciju alkohola te prestanak pušenja, preporučuju se svim bolesnicima s abnormalnim lipidnim profilom kao prvi korak u liječenju. Individualizirani pristup svakom pacijentu ključan je za postizanje optimalnih rezultata, a odabir odgovarajuće farmakoterapije temelji se na lipidnom profilu bolesnika, KV riziku i prisutnosti komorbiditeta. Smjernice preporučuju terapiju statinima visokog intenziteta do maksimalno podnošljive doze kao prvi korak usmjeren ka postizanju ciljnih vrijednosti LDL-K. Ciljne vrijednosti definirane su za svaku kategoriju KV rizika. Ako ciljni LDL-K nije postignut terapija se intenzivira najčešće dodavanjem ezetimiba i/ili PCSK9 inhibitora. Kombinacije različitih lijekova mogu se koristiti kako bi se postigao optimalan rezultat u smanjenju KV rizika.Dyslipidemias are a heterogeneous group of disorders characterized by abnormalities in blood lipid concentrations. They represent one of the leading risk factors for the development of cardiovascular disease (CVD), which makes their treatment an important part of CVD prevention. Among dyslipidemias, hypercholesterolemia is clinically the most significant. Therapeutic measures, both pharmacological and non-pharmacological, emphasize the importance of LDL-C reduction due to its central role in the progression of atherosclerosis. Non-pharmacological measures, including regular physical activity, weight reduction, appropriate diet, moderate alcohol consumption and smoking cessation, are recommended for all patients with an abnormal lipid profile as the initial step in the treatment. An individualized approach to each patient is crucial for achieving optimal results and the selection of appropriate pharmacotherapy is based on the patient's lipid profile, cardiovascular risk (CV risk) and presence of comorbidities. Guidelines recommend high-intensity statin therapy up to the maximum tolerated dose as the first step towards achieving target LDL-C levels. Different target values are defined for each CV risk category. If the target LDL-C is not achieved, therapy is intensified, most commonly by adding ezetimibe and/or PCSK9 inhibitors. Combinations of different drugs can be used to achieve optimal results in reducing CV risk
INTEGRATIVE APPROACH TO TREATMENT OF HASHIMOTO S DISEASE
No full textHashimotov tireoiditis je kronična autoimuna upala štitne žlijezde koja se najčešće javlja u žena srednje i starije životne dobi, a smatra se za najčešću autoimunu bolest i jedan od najučestalijih endokrinih poremećaja.
Najčešće se prezentira simptomima hipotireoze kao što su umor, suhoća kože, konstipacija, grčevi u mišićima i povećana osjetljivost na hladnoću, a vrlo se često javlja zajedno s drugim AI bolestima te tada govorimo o poliautoimunosti. Takva povezanost objašnjava se pojačanom imunosenzitivnošću kod pacijenata s deficijencijom mikronutrijenata te s postojanjem autoantitijela protiv različitih tkiva.
U početnoj fazi liječenja potrebno nadomjestiti hormone štitnjače koji su u manjku, a nakon toga je potrebno pristupiti liječenju tako da pacijent uzima svu potrebnu suplementaciju: selen, cink, jod, probiotike, vitamin D, vitamine B, omega 3 i dr. Pacijente treba motivirati i poticati na promjenu životnog stila kroz promjenu prehrane u smislu konzumacije protuupalnih namirnica te bezglutenske prehrane, što je i najznačajnije u samom terapijskom pristupu.
Da bi se to sve ostvarilo potrebno je pacijentu pružati podršku u životnoj promjeni, koja je prijeko potrebna da bi uopće moglo doći do zadovoljavajuće kontrole bolesti i smanjenja simptoma. Preporuča se korištenje više pravaca u psihološkom pristupu da se u pacijentu probudi motivacija i želja za promjenom koja će moguće dovesti do značajnog poboljšanja, ako ne i do izlječenja od Hashimotove bolesti.Hashimoto's thyroiditis is a chronic autoimmune inflammation of the thyroid gland which most commonly occurs in the middle-aged and elderly women, being considered the most common autoimmune disease and one of the most common endocrine disorders in general.
Most often HT presents with symptoms of hypothyroidism such as fatigue, dry skin, constipation, muscle cramps and increased sensitivity to coldness. Very often it occurs together with other AI diseases, which is known as polyautoimmunity. Such an association is explained by increased immunosensitivity in patients with micronutrient deficiency and the presence of autoantibodies against various tissues.
In the initial phase of treatment it is important to replace the deficient thyroid hormones with levothyroxine. Furthermore, the therapeutic approach should be upgraded with all necessary supplements: selenium, zinc, iodine, probiotics, vitamin D, vitamins B, omega 3, etc. The patients have to be motivated to change their lifestyle through dietary modifications and encouraged to follow the anti-inflammatory and gluten-free diet, representing the most important part of the therapeutic approach .
Moreover, it is necessary to insist in developing patient’s ability to achieve better control of the disease and reduction of symptoms. It is recommended to use multiple directions in the psychological approach to achieve motivation and desire to change that will possibly lead to significant improvement, if not the complete healing from Hashimoto’s disease
COVID-19 AND DIABETES MELLITUS : graduation thesis
No full textThe incidence of COVID-19 in DM2 ranged from 10.8-22%. Due to a constant chronic inflammation, as is seen in DM2 patients, they present with increased susceptibility towards SARS-CoV-2 infections. Acute COVID-19 infections are associated with a massive release of pro-inflammatory cytokines and hyperglycemic hormones, which trigger cytokine storms and potential MOF, severe pneumonia, and death. Consequences of long-standing DM2 predispose those patients to pulmonary embolisms, ARDS, sepsis, cardiovascular diseases, heart failure, and AKI, altogether resulting in higher rates of hospitalization, ICU admission, mechanical ventilation, prolonged hospitalization duration, and 2-3-times higher fatal outcomes in comparison to nondiabetic patients. The foremost risk factor for severe outcomes in DM2 patients is glycemic control. During the COVID-19 pandemic, increased incidences of DKA and hyperosmolar hyperglycemic states are detected in conjunction with elevated amylase and lipase levels. Many cases of new-onset hyperglycemia are described, whereby the specific phenotype currently isn´t defined. There is a suspicion that SARS-CoV-2 can rather directly target pancreatic tissue or induce systemic infection resulting in pancreatic -cells apoptosis. For managing COVID-19 in diabetic patients, prevention in terms of optimal glycemic management and a healthy diet is crucial. Based on the individual case, antidiabetic therapy should be carried out using metformin, DPP4is, GLP-1-RA, SGLT2i, and insulin. In new-onset hyperglycemia, insulin in combination with long-term surveillance is the therapy of choice
Endokrini uzroci hipertenzije
No full textArterijsku hipertenziju možemo podijeliti na primarnu i sekundarnu. Endokrini uzroci
hipertenzije pripadaju skupini sekundarnih hipertenzija. Iako čine samo manji dio u
ukupnoj prevalenciji hipertenzije nužno ih je pravovremeno prepoznati jer su
potencijalno izlječivi. Najpovoljnije liječenje endokrine hipertenzije je upravo
rješavanje same endokrinološke patologije, posebno kirurškim pristupom. U tu
skupinu ulaze primarni aldesteronizam, Cushingov sindrom, feokromocitom,
akromegalija, hipo/hipertireoza i sl. Primarni aldosteronizam je najčešći oblik
endokrine hipertenzije s prevalencijom 5-13% u hipertoničara. To je skupina
poremećaja karakterizirana visokom sekrecijom aldosterona, hipertenzijom,
hipokalijemijom, hipernatrijemijom, metaboličkom acidozom. Hipersekrecija
aldosterona izaziva hipertenziju djelovanjem na više organskih sustava. Metoda
liječenja unilateralnog PA je laparoskopska ekstirpacija adenoma ili žlijezde žlijezde, a
bilateralnog antagonistima mineralokortikoidnih receptora. U Cushingovom sindrom
nalazimo previsoke koncentracije hormona kore nadbubrežne žlijezde. Karakteristični
simptomi hiperkortizolizma su purpurne strije, atrofija kože, okruglo lice, proksimalna
mišićna slabost. Arterijska hipertenzija složene je etiologije i javlja se u oko 80%
pacijenata sa Cushingovim sindromom. Liječenje je u prvom redu kirurško.
Feokromocitomi su rijetki tumori kromafinih stanica koji luče katekolamine. Klasični trijas simptoma sastoji se od glavobolje, pojačanog znojenja i palpitacija. Trećina
pacijenata ima paroksizmalnu hipertenziju, polovina perzistentnu, ostali mogu biti
normotenzivni. Liječenje je kirurško, medikamentna terapija prije same operacije ima
veliku važnost kako bi se izbjegle potencijalno fatalne hipertenzivne krize.
Akromegalija je rijedak uzrok hipertenzije, to je kronična bolest karakterizirana ekscesivnom sekrecijom hormona rasta. Arterijska hipertenzija javlja su u 40%
bolesnika, dominatno je povišen dijastolički tlak.Hypertension can be divided into primary and secondary. The endocrine causes of
hypertension are primary aldosteronism, Cushing's syndrome, pheochromocytoma,
acromegaly, hypo/hyperthyroidism etc. They are classed as secondary hypertension.
Although they account for only a small part of the overall prevalence of hypertension
it is very important to diagnose them because they are potentally curable. The best
treatment approach for endocrine hypertension is treating its cause (endocrine
pathology), especially by surgery. Primary aldosteronism is the most common form
with prevalence of 5-13% in hypertensive patients. It is a group of disorders
characterized by excessive aldosterone secretion, hypertension, hypokalemia,
hypernatremia and metabolic acidosis. Aldosterone hypersecretion induces
hypertension by affecting several organ systems. Laparoscopic removal of adenoma
or entire gland represents the elective treatment in unilateral PA variants. Patients
with bilateral autonomous aldosterone production should be treated with mineralocorticoid receptor blockers. Cushing's syndrome is characterized by
excessive secretion of hormones produced in the adrenal cortex. Characteristic
symptoms of hypercortisolism are stretch marks, skin atrophy, moon face and
proximal muscle weakness. The etiology of arterial hypertension is complex and it
occurs in approximately 80% of patients with Cushing's syndrome.
Pheochromocytomas are rare catecholamine-secreting tumors. The classic triad of
symptoms consist of headaches, excessive sweating and palpitations. One third of
patients have paroxysmal hypertension, half have persistent, and others may be
normotensive. Surgical resection of the tumor is the treatment of choice. Careful
preoperative management is required to control blood pressure and prevent
intraoperative hypertensive crises. Acromegaly is a rare cause of hypertension, it is a chronic disease characterized by excessive secretion of growth hormone.
Hypertension occurs in 40% of patients with predominantly elevated diastolic
pressure
Endokrini disruptori i debljina
No full textPovećana incidencija debljine postaje ozbiljan globalni javnozdravstveni problem. Osim nezdrave prehrane i smanjene tjelesne aktivnosti razni kemijski spojevi koji se nalaze svuda oko nas mogu biti jedan od etioloških čimbenika razvoja debljine i njene povećane incidencije. Kemijski spojevi koji ometaju rad hormonalnog sustava čovjeka nazivaju se endokrini disruptori. U skupinu endokrinih disruptora spadaju obezogeni koji ometaju normalan razvoj i ravnotežu metabolizma lipida.
Razdoblje ranog razvoja (in utero, novorođenčad) je najosjetljiviji period i izloženost ploda obezogenima tijekom tog razdoblja putem mlijeka ili preko posteljice može biti predisponirajući čimbenik za razvoj debljine u odrasloj dobi. Obezogeni su sastavni dio kozmetike, elektronike, plastike, ali se nalaze i u zraku, vodi i hrani koju svakodnevno konzumiramo. Trenutno je u svijetu poznato dvadeset spojeva za koje se zna da utječu na razvoj debljine.
Iako je trenutno znanje o endokrinim disruptorima usporedivo s „vrhom sante leda“, endokrini disruptori se smatraju novim globalnim problemom današnjice. S aspekta suočavanja s epidemijom debljine posebno je važno uspostaviti kontrolu nad obezogenima i pokušati spriječiti ili barem ograničiti izloženost ljudi, posebice djece i trudnica tim opasnim spojevima.The increasing incidence of obesity is a global public health problem. In addition to unhealthy diet and reduced physical activity various chemical compaunds that are found all around us may be one of the etiological factors of obesity development and its increased incidence. Endocrine disruptors are chemicals that can interfere with the endocrine system and disrupt hormonally regulated metabolic processes. Obesogens are subclass of endocrine disruptors that can disrupt normal development and homeostasis of lipid metabolism.
Early development (in utero, newborns) is the most vulnerable period for obesogen exposure. Developmental exposure to obesogens occurs through maternal diet and interaction with products that can cross the placental barrier or transmitted through breast milk. Obesogens can be found in cosmetics, electronics, plastic, but also in air, water and food that people consume. There are twenty confirmed compounds that increase obesity risk in adulthood.
Although current knowledge about endocrine disruptors is comparable with the „top of the iceberg“, endocrine disruptors are considered as a new global problem. In terms of dealing with the epidemic of obesity, it is of particular importance to establish control over obesogens and try to prevent or at least limit the exposure of people, especially children and pregnant women, to these dangerous compounds
ASSESSMENT OF DIETARY HABITS AND NUTRITIONAL KNOWLEDGE OF PEOPLE WITH OSTEOPOROSIS
No full textOsteoporoza je kronična bolest povezana s visokim rizikom prijeloma kosti. Zajedno s primjenom lijekova koji usporavaju gubitak koštane mase ili potiču stvaranje nove kosti, dijetoterapija ima vrlo važnu ulogu u liječenju osteoporoze. Mediteranska prehrana uz poseban naglasak na dovoljnom unosu namirnica bogatih kalcijem i vitaminom D predstavlja zlatni standard prehrane za osobe s osteoporozom. Cilj ovog istraživanja bio je procijeniti znanje o prehrani i prehrambene navike bolesnika s osteoporozom. U istraživanju je sudjelovalo 100 ispitanika, 50 iz Opće bolnice „Dr. Josip Benčević“ u Slavonskom Brodu i 50 iz Kliničkog Bolničkog Centra Rijeka. Od ukupnog broja ispitanih bolesnika 95 je ženskog spola, a 5 ispitanika je muškog spola. Prosječna dob ispitanika iznosi 62 godine, a prosječni indeks tjelesne mase 26.4 kg/m2. Znanje bolesnika o prehrani u kontekstu liječenja osteoporoze može se ocijeniti kao nedostatno. Većina ispitanika ne zna da dnevne potrebe za kalcijem osoba oboljelih od osteoporoze iznose 1200 mg, a za vitaminom D 800 do 1000 IU. Jednako tako većina ispitanika ne zna koje namirnice su najznačajniji izvor kalcija u prehrani. Utvrđeno je da gotovo polovica bolesnika uzima dodatke prehrani koji sadrže kalcij. U ispitivanom uzorku samo polovica bolesnika uzima dodatke prehrani koji sadrže vitamin D što je nedostatno. I ovo istraživanje potvrđuje da su pojedini aspekti prehrane i ponašanja poput konzumacije gaziranih pića, kave i duhanskih proizvoda koji imaju nepovoljan učinak na kost još uvijek u prevelikoj mjeri zastupljeni u osoba s osteoporozom. Čak trećina ispitanika konzumira gazirana pića barem nekoliko puta tjedno, a kavu svakodnevno. Također, gotovo trećina ispitanika konzumira duhanske proizvode. Zadatak nutricionista je sudjelovati u osmišljavanju i provođenju ne samo individualne dijetoterapije osteoporoze već i edukativnih akcija u široj zajednici s ciljem osvještavanja mlađih dobnih skupina o važnosti uravnotežene prehrane, zadovoljavajućeg unosa kalcija, optimalnog statusa vitamina D i zdravih životnih navika kako bi se postigla i očuvala optimalna koštanu masa i spriječio razvoj osteoporoze, bolesti koja predstavlja tihu epidemiju, a koja je povezana s visokom smrtnošću i visokim troškovima liječenja.Osteoporosis is a chronic disease that is related with high risk of bone fractures. Together with the use of drugs that slow bone loss or encourage the formation of new bone, diet therapy has a very important role in the osteoporosis treatment. Mediterranean diet with special emphasis on the intake of food that is rich in calcium and vitamin D is the golden standard of nutrition for patients with osteoporosis. The main goal of this research was to assess the nutritional knowledge and eating habits of patients with osteoporosis. Overall one hundred patients participated in this research, 50 from General hospital „Dr. Josip Benčević“ in Slavonski Brod and 50 from Clincal Hospital Centar Rijeka. There were 95 female and 5 male participants. Average age of participants is 62 years, and avarage body mass index 26.4 kg/m2 . Nutritional knowlage of patients with osteoporosis can be reated as insufficient. Most participants do not know that daily needs for calcium of people with osteoporosis is 1200 mg, and for vitamin D 800 to 1000 I.U. Likewise most participants do not know which food is the most important source of calcium. It has been found that almost half of the patients take calcium-containing dietary supplements. In the examined sample, only half of the patients take dietary supplements that contain vitamin D, which is insufficient. This research confirms that certain aspects of diet and behavior such as consumption of carbonated beverages, coffee and tobacco products that have an adverse effect on bone are still overrepresented in patients with osteoporosis. As many as a third of respondents consume carbonated beverages at least several times a week, and coffee on a daily basis. Also, almost a third of respondents consume tobacco products. The task of nutritionists is to participate in designing and implementing not only individual diet therapy for osteoporosis but also educational actions in the wider community with the aim of raising awareness of younger age groups about the importance of a balanced diet, satisfactory calcium intake, optimal vitamin D status and healthy lifestyle to achieve and preserve the optimal bone mass and prevent the development of osteoporosis, a disease that represents a silent epidemic, and which is associated with high mortality and high treatment costs
Impact of the FreeStyle Libre flash glucose monitoring system use on glycemic control - experiences of Clinical Hospital Center of Rijeka
No full textCilj: Cilj ovog diplomskog rada bio je istražiti utjecaj korištenja FreeStyle Libre sustava za kontinuirano mjerenje glukoze na pojedine parametre glukoregulacije osoba oboljelih od šećerne bolesti tip 1 u razdoblju od godine dana nakon početka korištenja sustava, a koje su prethodno samokontrolu provodile mjerenjem glukoze iz kapilarne krvi pomoću klasičnog glukometra i trakica.
Ispitanici i postupci: U istraživanje su uključene odrasle osobe sa šećernom bolešću tipa 1 koje se kontroliraju u Dijabetološkoj ambulanti Kliničkog bolničkog centra Rijeka, a koje koriste FreeStyle Libre sustav za kontinuirano mjerenje glukoze najmanje godinu dana te su bile uključene u sustav praćenja 1, 3, 6 i 12 mjeseci od početka korištenja uređaja. Ispitivane su sljedeće varijable – prosječna glukoza, HbA1c, vrijeme unutar ciljnog raspona (TIR), vrijeme iznad ciljnog raspona (TAR), vrijeme ispod ciljnog raspona (TBR), broj hipoglikemija, prosječni broj skeniranja dnevno, prosječni broj korištenih trakica dnevno.
Rezultati: Ispitivani uzorak sastojao se od 127 ispitanika, prosječne dobi 29 godina, prosječnog trajanja dijabetesa 18 godina. Iako vrijednosti HbA1c pokazuju jasan trend redukcije, od vrijednosti na početku praćenja koja je iznosila 8,06% do vrijednosti nakon 12 mjeseci koja je iznosila 7,37%, navedeno nije doseglo razinu statističke značajnosti. Prosječni TIR 12 mjeseci nakon početka korištenja sustava iznosio je 64,37% što ukazuje na suboptimalnu glukoregulaciju. Unatoč zamijećenom trendu povećanja TIR-a kroz period praćenja nije dosegnuta razina statističke značajnosti. Vrijeme provedeno ispod ciljnog raspona bilo je statistički značajno reducirano, dok smanjenje ukupnog broja hipoglikemija nije doseglo razinu statističke značajnosti. Prosječni broj skeniranja u našem uzorku iznosi 13 dnevno i ostaje održan kroz čitav period praćenja što ukazuje na ustrajnost u provođenju samokontrole.
Zaključak: Ovim istraživanjem pokazalo se kako kontinuirano mjerenje glukoze pomoću FreeStyle Libre sustava zaslužuje svoje mjesto u liječenju osoba oboljelih od šećerne bolesti tip 1. Rezultati bi zasigurno bili još uvjerljiviji da je uzorak ispitanika bio veći s potpunijim podacima kontrolnih praćenja.Objective: The aim of this thesis was to investigate the impact of using FreeStyle Libre system for continuous glucose measurement on certain parameters of glucoregulation of persons with type 1 diabetes over a period of one year after starting the system, and who previously conducted self-monitoring using a classic glucometer and strips.
Subjects and procedures: The study includes adults with type 1 diabetes who are monitored in the Diabetic Clinic of the Clinical Hospital Center in Rijeka, and who use FreeStyle Libre system for continuous glucose measurement for at least a year and were included in the monitoring system 1, 3, 6 and 12 months since they started using the device. The following variables were examined - average glucose, HbA1c, time within the target range (TIR), time above the target range (TAR), time below the target range (TBR), number of hypoglycemia, average number of scans per day, and average number of strips used per day.
Results: The sample consisted of 127 subjects, with the average age of 29 years and average duration of diabetes of 18 years. Although HbA1c values show a clear trend of reduction, from the value at the beginning of the monitoring which was 8.06% to the value after 12 months which was 7.37%, it did not reach the level of statistical significance. The average TIR 12 months after the start of use of the system was 64.37% indicating suboptimal glucoregulation. Despite the observed trend of increasing TIR during the monitoring period, the level of statistical significance was not reached. Time spent below the target range was statistically significantly reduced, while the reduction in total number of hypoglycemia did not reach the level of statistical significance. The average number of scans in our sample is 13 per day and remains maintained during the monitoring period, which indicates persistence in conducting self-monitoring.
Conclusion: This study showed that continuous glucose measurement using the FreeStyle Libre system deserves its place in the treatment of people with type 1 diabetes. The results would have been even more convincing if the study sample had been larger with more comprehensive monitoring data
Diabetic kidney disease: diagnosis and treatment
No full textDijabetes melitus predstavlja kompleksni, kronični poremećaj koji sa sobom nosi čitav niz komplikacija te predstavlja vodeći javnozdravstveni izazov 21. stoljeća, s obzirom na nepovoljnu epidemiološku statistiku s rastućom prevalencijom i povećanim stopama morbiditeta i mortaliteta među svjetskim stanovništvom. DBB predstavlja najčešću mikrovaskularnu komplikaciju DM-a. Dijabetes je odgovoran za preko 40% novih slučajeva razvoja ESRD-a te kao takav predstavlja vodeći faktor razvoja KBB-a. Dijabetičku bolest bubrega obilježava prisutnost KBB-a (s perzistentnom albuminurijom i/ili trajnim smanjenjem glomerularne filtracije) u trajanju od najmanje tri mjeseca, u osoba oboljelih od dijabetesa. Pri tom, iznimno je važno prepoznati potencijalne čimbenike rizika, kako u svrhu prevencije i odgađanja daljnje progresije, tako i u svrhu liječenja DBB-a. Složeni metabolički mehanizmi uključeni u patogenezu DBB-a obuhvaćaju hiperglikemiju uz stvaranje završnih produkata glikacije, glomerularnu hiperfiltraciju, ishemiju, hipoksiju, ekspresiju raznih citokina, stvaranje slobodnih radikala kisika te brojne druge koji se još istražuju. Dijagnoza DBB-a se postavlja klinički, odnosno mjerenjem albuminurije i glomerularne filtracije, dok se u nejasnim slučajevima izvodi biopsija bubrega. Glavne strategije liječenja DBB-a su regulacija glikemije i kontrola krvnog tlaka. Antihiperglikemici iz skupine SGLT-2 inhibitora, posebice dapagliflozin i empagliflozin, zahvaljujući dokazanim renoprotektivnim svojstvima, iskazuju izniman terapijski potencijal sa svrhom sprječavanja daljnje progresije KBB-a. Zahvaljujući poboljšanoj skrbi i liječenju, prognoza pacijenata oboljelih od DBB-a se znatno poboljšala, no i dalje se traga za inovativnijim strategijama u vidu prevencije, dijagnostike i liječenja DBB-a.Diabetes mellitus is a complex chronic disease that involves a whole range of complications and represents the leading public health challenge of the 21st century, given the unfavorable epidemiological statistics of rising prevalence and increased morbidity and mortality rates in the world population. Diabetic kidney disease is the most common microvascular complication of DM. Diabetes accounts for more than 40% of new cases of ESRD, making it the most important factor in the development of CKD. Diabetic kidney disease is characterized by the presence of CKD (with persistent albuminuria and/or a permanent reduction in glomerular filtration rate) lasting at least three months in diabetic patients. At the same time, it is extremely important to identify potential risk factors, both to prevent and delay further progression and to treat CKD. The complex metabolic mechanisms involved in the pathogenesis of DKK include hyperglycemia with formation of glycation end products, glomerular hyperfiltration, ischemia, hypoxia, expression of various cytokines, reactive oxygen species, and many others that are still being explored. DKK is diagnosed clinically by measuring albuminuria and glomerular filtration, while renal biopsy is performed in uncertain cases. Key treatment strategies for DKK include glycemic and blood pressure control. Antihyperglycemic agents from the group of SGLT-2 inhibitors, particularly dapagliflozin and empagliflozin, have extraordinary therapeutic potential to prevent further progression of CKD due to their proven renoprotective effects. Thanks to improved care and treatment, the prognosis of DKK patients has improved significantly, but further innovative strategies for the prevention, diagnosis and treatment of DKK are still being sought
Metabolic control in patients with type 2 diabetes mellitus in the clinical hospital centre rijeka: a cross-sectional study : graduation thesis
No full textDiabetes mellitus is a disease that is defined as impaired glycemic control due to insulin
resistance or impaired pancreatic insulin production. The prevalence is rising worldwide with
Croatia not being an exception. It effects patient’s lipid metabolism which is one of the main
causes of morbidity and mortality.
The aim of this study was to investigate the state of metabolic control in patients being treated
for T2DM in the CHC Rijeka. The data of 104 patients was used that were admitted for a
counseling program of the daily hospital in the period from the 16th of March 2022 until the
29th of March 2023. Parameters included the age at the time of examination, age at the time of
diagnosis, hemoglobin A1c, fasting plasma glucose, body mass index, total cholesterol, lowdensity lipoprotein, high-density lipoprotein, and triglycerides.
The median age of participants at the time of examination was 62 years and the mean BMI was
30.19 kg/m2
. The mean value of HbA1c was 8.2% and the mean of LDL was 2.74 mmol/L,
respectively. HbA1c values were higher in patients with a long-term diagnosis compared to
those that have been recently diagnosed with T2DM. Target value of HbA1c < 7% was reached
by only 26.9% of participants. LDL threshold values were reached by slightly more than a fifth
of the participants (20.2%). Overall excellent metabolic control, considering LDL, HDL and
TG values were only reached by 16.3 % of all participants.
The study showed the metabolic control off the participants wasn’t satisfactory however, it was
to be expected since they were all referred to the daily hospital to be educated on how to manage
their disease. Reasons for referral were either evidence of long-term neglect of glycemic control
or a recent diagnosis of T2DM
KARDIOVASKULARNE KOMPLIKACIJE ŠEĆERNE BOLESTI
No full textŠećerna bolest je kronična metabolička bolest praćena čitavim nizom komplikacija čija je pojavnost na globalnoj razini u stalnom porastu posljednjih nekoliko desetljeća. Navedeno zabrinjava ne samo zbog negativnog utjecaja na kvalitetu života i visokih troškova liječenja već i visokog rizika smrtnosti uslijed komplikacija šećerne bolesti. Upravo kardiovaskularne komplikacije (koronarna bolest srca, cerebrovaskularna bolest, periferna vaskularna bolest) predstavljaju vodeći uzrok smrtnosti među oboljelima od šećerne bolesti. Šećerna bolest se smatra stanjem ubrzane ateroskleroze. Inzulinska rezistencija, kronična upala niskog stupnja, endotelna disfunkcija i protrombotičko stanje kao temeljne značajke metaboličkog sindroma osnova su razvoja ne samo šećerne bolesti tipa 2 već i kardiovaskularne bolesti. S obzirom na pritajeni tijek nerijetko su već u trenutku postavljanja dijagnoze šećerne bolesti razvijene makrovaskularne komplikacije. Stoga je od izuzetne važnosti pravodobno dijagnosticirati i od početka ozbiljno shvatiti i liječiti šećernu bolest s ciljem ne samo kontrole glikemije već i svih pridruženih čimbenika KV rizika, uključujući arterijsku hipertenziju i dislipidemiju. Od presudne su važnosti nefarmakološke mjere i promjena stila života s ciljem postizanja i održavanja poželjne tjelesne mase s obzirom da je gotovo 90% osoba sa šećernom bolešću tipa 2 preuhranjeno ili pretilo. Također potrebno je ograničiti unos soli i savjetovati prestanak pušenja. Prilikom odabira medikamentne terapije u svjetlu novih spoznaja o benefitima novijih skupina antihiperglikemika za koje je utvrđeno da povrh regulacije glikemije ostvaruju dodatna djelovanja s povoljnim učinkom na kardiovaskularne ishode izdvajaju se agonisti GLP-1 receptora i SGLT2 inhibitori.Diabetes is a chronic metabolic disease accompanied by a series of complications whose prevalence at the global level is constantly increasing over the last few decades. This is worrying not only because of the negative impact on quality of life and high treatment costs but also the high risk of mortality due to diabetes related complications. Cardiovascular complications (coronary heart disease, cerebrovascular disease, peripheral vascular disease) are the leading cause of death among individuals with diabetes. Diabetes appears to be a condition of accelerated atherosclerosis. Insulin resistance, low-grade chronic inflammation, endothelial dysfunction, and prothrombotic state as the fundamental features of metabolic syndrome are the underlying conditions for the development of both type 2 diabetes and also cardiovascular disease. Given the latent course of the disease, it is not uncommon that diabetic complications are already present at the time of initial diagnosis of type 2 diabetes. Therefore, timely diagnosis and profound understanding and treatment of diabetes are extremely important not only in terms of glycemic control but also of other associated comorbidities, including arterial hypertension and dyslipidemia which contribute substantially to overall CV risk. Non-pharmacological measures and lifestyle changes aiming at achieving and maintaining a healthy body weight are crucial given that almost 90% of people with type 2 diabetes are overweight or obese. Additionally, dietary salt reduction and smoking cessation should be recommended. In the light of new findings on the beneficial effects on cardiovascular outcomes, when choosing between antihyperglycemic agents, GLP-1 receptor agonists and SGLT2 inhibitors stand out for their favourable CV effects in addition to glycemic control
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