NEW METHODS OF TREATMENT OF DIABETES AND ITS COMPLICATIONS
Main researcher
: GRANIĆ, MATE (14180) Assistants
KERUM, GORAZD (169432)
COCE, FRANJO (6993)
MRZLJAK, VLADIMIR (32604)
BOŽIKOV, VELJKO (5053)
CAR, NIKICA (48525)
UGRINOVIĆ, NIKOLA (51032)
KNEŽEVIĆ-ĆUĆA, JADRANKA (169454)
ŠESTAN-CRNEK, SANDRA (900671)
Type of research: developmental Duration from: 01/01/91. to 12/31/95. Papers on project (total): 44
Papers on project quoted in Current Contents: 4
Institution name: Institut za dijabetes, endokrinologiju i bolesti metabolizma "Vuk Vrhovac", Zagreb (45) Department/Institute: Clinical Department Address: Institut "Vuk Vrhovac", Dugi dol 4 a City: 10000 - Zagreb, Croatia
Communication
Phone: 385 (0)41-231-532
Fax: 385 (0)41-231-515
Summary: Chronic diabetic complications represent a major problem
both for individual patients and for the whole community. They may develop
on almost all systems of organism as a consequence of differenct
biochemical processes, which may appear especially in the organism of an
uncontrolled diabetic patient. a) During the last 12 years implantable
pumps have been tested in the treatment of diabetes mellitus for the
purpose of achieving better metabolic control because they more closely
imitate physiological insulin delivery. The aim of the study was to
evaluate the effectiveness and safety of continuous intravenous isnulin
infusion using constant rate implantanble pumps combined with preprandial
s.c. insulin boluses using pen injectors. Metabolic control improved
significantly and HbA1c values reached normal levels. Combined with s.c.
preprandial insulin boluses it may improve metabolic control in insulin
dependent diabetics. b) One of the most serious complications is the
diabetic foot. At our Institute, 437 diabetic patients were hospitalized
due to diabetic foot during a six-year period. Diabetic foot infections are
of polymicrobic etiology. The causative agents most frequently isolated are
gram-positive cocci: Staphylococcus aureus, Streptococcus, Entrococcus and
gram-negative bacilli: Proteus, Enterobacteria, and Escherichia coli. Due
to polymicrobic infection, treatment is directed at aerobic and anaerobic
bacteria. The most commonly used drugs are clindamycin and aminoglycoside.
Such therapy yielded quite good results. c) Diabetic gastroenteropathy is
primarily a functional disorder in food passage through the
gastrointestinal system. The purpose of the study was to determine the
relationship between changes in gastrin levels in the serum of insulin
dependent diabetics and diabetic gastroenteropathy and the effect of the
prokinetic medicament (Cisaprid). Damage to the autonomous nervous system
was found to exist in all patients with diabetic gastroenteropathy, but
this was found not to directly correlate with serum gastrin levels.
Cisaprid significantly lowered gastrin levels in the serum of patients with
diabetic gastroenteropathy. d) Cardiovascular complicatins are the most
often cause of morbidity and mortality of diabetics with renal
insufficiency who are on dialysis. Two small groups of patients were
compared, one group on dialysis and the other one treated with paired
filtration dialysis (PFD). Both groups consist of patients with
remarkablyunstabilized cardiovascular system (miocardial infarction, CHD,
hypothension). During the period of follow-up (1992-1994) there was no
cardiovascular incidents. e) The aim was to estimate whether the
fotocoagulation can slowed the progress of diabetic retinopathy and
development of visual acuity and how important is good regulation of
glycemia for the achievement of good results. Monitoring of visual acuity
and morphologic changes on retina in 1500 patients proved that
fotocoagulation significantly slowed the development of non-proliferative
into proliferative retinopathy.
Research goals: The main goal of this study is to establish the
methods of better metabolic control and diminish development of the chronic
diabetic complications. The specific aims: a) To evaluate the effectiveness
and safety of continuous intravenous insulin infusion using constant rate
implantable pumps combined with preprandial s.c. insulin boluses using pen
injectors. b) To determine to what degree each particular pathological
microorganism is present in the diabetic foot syndrome, asses response to
antibiotic treatment and evaluate the therapy of this complex clinical
problem. c) To determine the relationship between changes in gastrin levels
in the serum of patients with insulin dependent diabetes mellitus and
gastroenteropathy considering: 1. changes in body weight, 2. damage to the
autnomous nervous system and, 3. the effect to the prokinetic substance
Cisaprid. d) The aim of the study was the evaluation of different
hemodialysis procedures regarding the risk of cardiovascular complications.
Normal left ventricular function was observed by the use of noninvasive
echocardiographic evaluation was observed in 9 dialysis patients with ESRD.
Abnormalities in basal hemodynamic parameters were possibly the reason for
periodical circulatory instability in 2 patients. Important productin of
C3a and C5a at 15th min of PFD accompanied with important reduction of
granulocytes concentrations (58+-34%) indicated less biocompatible
properties of the combined membranes in used hemodiafilter. Quantified
estimation of PFD adequacy showed acceptable results (index Kt/V>1.0). e)
The goal of the study was to establish how much the fotocoagulation can
slowed the progress of diabetic retinopathy and development of visual
acuity and how important is the good regulation of glycemia for the success
of fotocoagulation.