SVIBOR - Project code: 3-01-146

MINISTRY OF SCIENCE AND TECHNOLOGY

Strossmayerov trg 4, HR - 10000 ZAGREB
tel.: +385 1 459 44 44, fax: +385 1 459 44 69
E-mail: ured@znanost.hr

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Project code: 3-01-146


NEW METHODS OF TREATMENT OF DIABETES AND ITS COMPLICATIONS


Main researcher: GRANIĆ, MATE (14180)


Assistants
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.

Keywords: Diabetes Mellitus, constant rate implantable pumps, diabetic foot, infections, antibiotics, diabetic gastroenteropathy, diabetic retinopathy, fotocoagulation, diabetic nephropathy, dialysis

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.

COOPERATION - INSTITUTIONS


  1. Name of institution: Institut "Ruđer Bošković"
    Type of institution: University/Faculty
    City: 10000 - Zagreb, Croatia
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