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Absztrakt: Az inzulinrezisztencia (IR) fennállásának megerősítése vagy kizárása a hazai diabetes-szakrendelésekre irányított nem cukorbetegek egyik leggyakoribb beutalási indoka. A közlemény áttekinti az IR fogalmát, kórélettani jelentőségét, kórismézési lehetőségeit és kezelési vonatkozásait. Kiemeli, hogy az inzulinhatás csökkenése számos betegség kísérőjelensége, s önmagában, más tünetek nélkül nem igényli részletes kivizsgálását. Ha mégis felmerül, tájékozódó céllal elegendő a HOMA-IR-érték számítása, valamint az éhomi vércukor- és széruminzulinszint meghatározása. Ha valamely társbetegség részeként igazolódik, annak komplex kezelése szükséges. Orv Hetil. 2020; 161(26): 1088–1093.

Abstract: Glucagon-like peptide-1 (GLP1) and their receptor agonists – beside their blood glucose lowering and central effects- affect also the gastrointestinal function in many respects. They slow down the stomach emptying, the motility of the small bowel and colon – this is the explanation for the “ileal brake” terminology –, stimulate the function of exocrine pancreatic acinar cells and increase amylase production. GLP1 receptor agonists belong to the defining tools of the blood glucose lowering therapy in type 2 diabetes. Their long- and short-acting derivatives have different influence on the fasting and the postprandial blood glucose, respectively. By introducing the term non-prandial and prandial type analogues – which seems to be forced in light of the newer data – the potential slowdown in gastric emptying is the center of interest, lately, however, especially in the case of long-acting GLP1 variants, at least such attention should be paid to controlling bowel function. The article reviews the physiological effects of GLP1 on the gastrointestinal tract and draws attention to the potential for the prevention of possible side effects through detailed patient information and dietary advises. Orv Hetil. 2019; 160(49): 1927–1934.

Metformin is the basic drug of antihyperglycemic therapy in type 2 diabetes: according to actual therapeutic guidelines, it should be given in the absence of contraindications or intolerance during the whole course of the disease even after the initiation of insulin therapy. Recently more and more details have been explored regarding the molecular background of its effects, however, in parallel with the enormous growing knowledge, the number of questions still waiting to be answered has also grown. This review article deals with data already crystallized as well as with details not definitely cleared up. Genetic polymorphisms as well as potential drug interactions influencing the effects of metformin are also briefly summarized. Orv. Hetil., 2016, 157(23), 882–891.

Objective The objective of this study was to develop a long-term economic model for type 2 diabetes to describe the entire spectrum of the disease over a wide range of healthcare programmes. The model evaluates a public health, risk-based screening programme in a country specific setting. Methods The lifespan of persons and important phases of the disease and related interventions are recorded in a Markov model, which first simulates the effect of screening, then replicates important complications of diabetes, follows the progression of individuals through physiological variables and finally calculates outcomes in monetary and naturalistic units. Results The introduction of the screening programme nearly doubled the proportion of diagnosed patients at the age of 50 and prolonged life expectancy. Three-yearly screening gained 0.0229 quality adjusted life years for an additional €83 per person compared with no screening and resulted an incremental cost-effectiveness ratio of €3630/quality adjusted life years. Conclusion From the economic perspective introduction of the 3-yearly screening programme is justifiable and it provides a good value for money. Copyright © 2016 John Wiley & Sons, Ltd.

Objective The aim of this study was to derive a function that can map the Nottingham Health Profile (NHP) questionnaire onto a utility measure, the EuroQol five-dimensional (EQ-5D) questionnaire index, for diabetic patients. Methods A cross-sectional study was performed on diabetic patients in Hungary with different complications in which quality of life was measured by using both the NHP questionnaire and the EQ-5D questionnaire. Ordinary stepwise-backward least-squares regression was used to develop a mapping function. Adjusted R 2 , Akaike's information criterion, and root mean square error were used to assess the performance of the model. The robustness of the models was tested using 10-fold cross-validation and bootstrapping. Results The best-fitting models were those that contained all the NHP statements as predictors and a stepwise reduced version that contained only 19 statements. The latter model, however, showed considerable variability in the selection of predictors. The adjusted R 2 of the former model was 0.68, the root mean square error was 174, and the Akaike's information criterion was −559.9. Conclusions The expected value of the EQ-5D questionnaire can be reasonably predicted on the basis of results of the NHP in patients with diabetes mellitus. The mapping function of the NHP onto the EQ-5D questionnaire is capable of estimating the expected EQ-5D questionnaire utility values in a group of patients with diabetes. The function's applicability for individual-level predictions, however, is limited. Further research is needed to find out whether mapping functions developed in Central-Eastern European countries are transferable to Western European countries.

Both the prevalence and incidence of type 2 diabetes are increasing worldwide and over 60% of people with T2DM develop cardiovascular disease. There are many data supporting the view that glycaemic control plays a role in reducing cardiovascular complications. The relationship between hyperglycaemia and cardiovascular disease is complex with evidence suggesting that an acute increase of glycaemia, particularly after a meal, may have a direct detrimental effect on cardiovascular disease. Although control of fasting hyperglycaemia is necessary, it is usually insufficient to obtain optimal glycaemic control. A growing body of evidence suggests that reducing post meal plasma glucose excursions is as important, or perhaps more important for achieving HbA1c goals. New classes of therapies for managing post meal plasma glucose in people with diabetes (glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors) have shown significant benefits in reducing post meal plasma glucose excursions andlowering HbA1c. The individual properties of the various GLP‑1 receptor agonists might enable incretin-based treatment of type 2 diabetes mellitus to be tailored to the needs of each patient.

Sulfonylurea compounds have been basic elements of antidiabetic treatment in type 2 diabetes for a long time. However, with the introduction of incretin type insulin secretagogues it is often arises, whether is still there a place for sulfonylureas in the today's therapy. To answer this question the author overviews general pharmaceutical characteristics of the sulfonylurea compounds as well as individual particularities of the second generation derivatives used at present in Hungary. The author details also the most important differences between incretin type drugs - first of all dipeptidyl peptidase-4 inhibitors - and sulfonylureas. On the basis of available data it can be concluded in accordance with the latest international guidelines, that sulfonylureas have still role in the blood glucose lowering therapy of type 2 diabetes, though they became somewhat pushed back among insulin secretagogue type drugs. If a sulfonylurea compound is the drug of choice, it is important to select the appropriate molecule (in case of normal renal function gliclazide or glimepiride). It is also important to re-educate the patient, as well as to apply the minimal dose providing the desired glycaemic effect.A szulfanilureavegyületek hosszú ideje a 2-es típusú diabetes vércukorcsökkentő kezelésének alapgyógyszerei. Az inkretin mechanizmusú antidiabetikumok megjelenésével azonban időről időre felmerül, van-e helye továbbra is e gyógyszercsoportnak napjaink terápiájában. A szerző áttekinti a szulfanilureák általános hatástani jellemzőit, s a Magyarországon forgalomban lévő második generációs származékok főbb sajátosságait. Kitér az inkretin hatású szerek, elsősorban a dipeptidil-peptidáz-gátlók és a szulfanilureák különbségeire. Megállapítja, hogy amint azt a legújabb kezelési irányelvek is tükrözik, a szulfanilureáknak ma is helye van a vércukorcsökkentő kezelésben, bár az inzulinszekretagóg szerek között a korábbinál hátrébb szorultak. Rendelésük esetén fontos a megfelelő készítményválasztás – rendezett vesefunkció esetén elsősorban gliclazid vagy glimepirid adása −, a cukorbeteg megfelelő edukálása, valamint a kívánt anyagcserehatást biztosító legkisebb dózis választása. Orv. Hetil., 2015, 156(13), 511–515.

In addition to the common blood glucose lowering effect, sulfonylurea compounds are different in many aspects from each other. Based on earlier findings the second generation gliclazide has special advantages within this group. Although the number of experimental and clinical observations on gliclazide is continuously increasing, these novel findings are not in the focus anymore due to the appearance of new antidiabetics. The article overviews recent experimental (receptorial effect, the absence of Epac2 activation, antioxidant properties, possible incentive of factors participating in beta-cell differentiation) and pharmacogenomic data, and compares them with clinical observations obtained from gliclazide treatment (hypoglycaemias, parameters of cardiovascular outcome). The data underline the advantages of gliclazide, the highly pancreas-selective nature, preservation of the ischemic precondition, favourable hemodynamic properties and potential reduction of the beta-cell loss as compared to other compounds of the group. However, gliclazide is not free from disadvantages characteristic to sulfonylureas in general (blood glucose independent insulin stimulation, beta-cell depletion). Comparing gliclazide with other derivatives of the group, the above data indicate individual benefits for the application when sulfonylurea compound is the drug of choice. Orv. Hetil., 2014, 155(14), 541–548.

Inflammatory disorders of the thyroid gland are divided into three groups according to their duration (acute, subacute and chronic). De Quervain's thyroiditis (also termed giant cell or granulomatous thyroiditis) is a subacute inflammation of the thyroid, which accounts for 5% of thyroid disorders. The etiology is unknown, it usually appears two weeks after an upper viral respiratory infection. The clinical feature includes neck pain, which is aggravated during swallowing, and radiates to the ear. On palpation, the thyroid is exquisitely tender. The erythrocyte sedimentation rate is markedly elevated, the leukocyte count, C-reactive protein are normal or slightly elevated. The natural history of granulomatous thyroiditis involves four phases: the destructive inflammation results temporarily in hyperthyroidism followed by euthyroidism. After a transient hypothyroidism the disease becomes inactive and the thyroid function is normalised. Ultrasonographic findings are diffuse hypoechogenic structures, but nodules may also occur. The disease often remains unrecognised, or the first phase of the disease is diagnosed and treated as hyperthyroidism. The diagnosis can be confirmed by the presence of the thyroid autoantibodies, radioiodine uptake and fine needle aspiration cytology. There is no special treatment, non-steroid anti-inflammatory drugs or steroid should be given to relieve the pain. The aim of the authors is to shed light the key points of diagnosis and differential diagnosis by the presentation of four slightly different cases.A pajzsmirigy gyulladásos megbetegedései klinikai megjelenésük alapján heveny, szubakut és krónikus formákba oszthatók. A de Quervain- (más néven óriássejtes vagy granulomatosus) thyreoiditis a szubakut csoportba sorolható, a pajzsmirigy betegségeinek mintegy 5%-át teszi ki. Eredete pontosan még nem tisztázott, rendszerint két héttel a felső légúti virális infekciót követően jelentkezik. A klinikai képet típusos esetben nyelési, illetve a fül felé sugárzó fájdalom uralja, a pajzsmirigy kifejezett tapintási érzékenységével. Jellemző a jelentősen gyorsult süllyedés, amely nem feltétlenül társul leukocytosissal és a C-reaktív fehérje emelkedésével. Lefolyásában négy fázis figyelhető meg: a destruktív gyulladásos folyamat átmeneti hyperthyreosissal jár, majd annak mérséklődése, illetve megszűnése euthyreoid állapotot eredményez. Utóbbit átmeneti hypothyreoid fázis követi, végül, a regeneráció beindulását követően, ismét normofunkció észlelhető. Az ultrahangos képen diffúz hypoechogen szerkezet látható, nem ritka azonban göbök előfordulása sem. A kórkép gyakran felismeretlen marad, vagy kezdeti szakaszát tévesen, hyperthyreosisként véleményezik és kezelik. Antitestvizsgálatok, pajzsmirigy-szcintigráfia, göbök fennállása esetén finomtű-aspirációs citológiai mintavétel segíthet a kórisme felállításában. Speciális kezelést általában nem igényel, a fájdalom enyhítésére átmenetileg nem szteroid gyulladáscsökkentő, esetleg szteroid adható. A szerzők négy, részben eltérő klinikai megjelenésű esetük bemutatásával a kórismézés és az elkülönítő diagnózis sarokpontjaira kívánják felhívni a figyelmet. Orv. Hetil., 2014, 155(17), 676–680.

The introduction of insulin in type 2 diabetes is often too late, though the immediate as well as late consequences of inadequate metabolic control are well known. That is the reason, why a special attention is given in recent therapeutic guidelines for the importance of early, at least timely insulinisation. This review article summarizes the advantages (mitigation of the beta-cell dysfunction, long lasting good metabolic control) and potential risks (hypoglycemia, weight gain, possible deteriorating patient compliance) of early or timely insulin therapy. It is pointed out that the introduction of insulin is effective and safe therapeutic option during the whole course of type 2 diabetes, the use of different regimes is suitable to reach and maintain the individual glycemic target and, with a structured patient education, it does not disturb the quality of life and the compliance of patients.Tapasztalatok szerint az inzulin bevezetése 2-es típusú diabetesben gyakran késik, jóllehet a kívánttól elmaradó anyagcserekontroll azonnali és hosszú távú következményei jól ismertek. Ez a magyarázata, hogy a korai, de legalább az időben megkezdett inzulinadás kezelési útmutatásokban mind nagyobb hangsúlyt kap. A közlemény áttekinti a betegség korai – első kezelésként alkalmazott −, illetve későbbi szakaszában indított inzulinadás lehetséges előnyeit (béta-sejt-diszfunkció mérséklése, a progresszió lassítása, tartósabb és hosszú távon kedvezőbb anyagcserekontroll), valamint potenciális korlátozó tényezőit (nem kívánt vércukoresések gyakoribb előfordulása, súlygyarapodás, romló beteg-együttműködés). Rámutat arra, hogy inzulin adása megfelelő kezelésválasztással a 2-es típusú diabetes minden szakaszában biztonságos terápiás alternatíva, jól igazítható az individuális glykaemiás célhoz és körültekintő betegoktatással nem rontja az érintettek életminőségét és nem hátráltatja hosszú távú kezelési együttműködésüket sem. Orv. Hetil., 2014, 155(7), 255–261.

Hyponatremia is the most frequent eletrolyte imbalance in hospitalized geriatric patient. The accompanying signs and symptoms can run a wide range and, therefore, these patients are usually admitted to various departments, i.e. neurology and/or traumatology first. Directed laboratory investigations demonstrate severe hyponatremia. Differential diagnosis can be very difficult and complex in the clinical settings. Firstly, spurious forms of hyponatremia have to be excluded, then the underlying cause should elucidated based on the patients hydration status and serum osmolarity. Hyponatremia can be divided into hyper-, hypo- and normovolemic forms. Moreover, it can be further classified as hypo-, iso- and hyperosmolar hyponatremias. The differentiation between renal and extrarenal salt wasting forms is hinged on the urine sodium concentration. Syndrome of inappropriate antidiuretic hormone secretion is the most common cause of normovolemic, hypoosmolar forms (named also as Schwartz–Bartter syndrome). The authors aimed to shed light on the often insurmountable difficulties of the diagnosis, differential diagnosis and appropriate treatment of this very frequent electrolyte imbalance by presenting a clinical case report. Their purported aim reflects upon the wide array of ethiopathogenesis of hyponatremia: various endocrine, renal diseases, inappropriateness of antidiuretic hormone secretion as well as the role of different medications (e.g. diuretics). This fine-tuned and intricate physiology of sodium metabolism could fortuitously be overturned by these mechanisms. Orv. Hetil., 2013, 154, 1235–1241.

Introduction: Early diagnosis and adequate care of gestational diabetes is of great importance for both the mother and her fetus. Although several national and international guidelines are known on the methodology for screening gestational diabetes, a not negligible part of the cases remain unrecognized when applying even the most widely used criteria recommended by the World Health Organization (1st recommendation). A connection has been found between the maternal blood glucose values and the prevalence of still-birth, preeclampsia and large for gestational age neonates in several studies, from which the Hyperglycaemia and Adverse Pregnancy Outcomes study has come into prominence. According to conclusions of this study the International Association of Diabetic Pregnancy Study Groups suggested new numeric criteria for the evaluation of the 75-gramm oral glucose tolerance test (2nd rercommendation), which differs from the evaluation used in the afore mentioned screening system. Aims: The aim of the study was to compare the effectiveness of the two screening systems by evaluation of the pregnancy outcomes. Methods: By following non-twin pregnancies of 1107 pregnant mothers (831 with normal glucose tolerance, 276 with gestational diabetes based on any of the applied screening methods) the maternal (pre- and postterminal birth, caesarean section, toxaemia) and newborns pregnancy outcomes (infants small and large for gestational age, hypoglycaemia) were analysed. Results: With the exception of the prevalence of large for gestational age infants – which was higher among women screened by the new evaluation – no substantial difference in the efficacy of the two investigated methods was found. Conclusion: The decision whether the screening of gestational diabetes using the new criteria results in safer recognition of the disturbances of glucose metabolism during pregnancy requires further investigations including a large number of cases. Orv. Hetil., 2013, 154, 776–783.

Discovery of physiological and pharmacological characteristics of incretins (glucagon-like peptide-1 and glucose-dependent insulinotrop polypeptide), and the introduction of various products of those into the clinical practice has fundamentally changed blood glucose lowering therapy in type 2 diabetes. In addition to the antidiabetic properties more attention is paid to their favourable pleiotropic effects independent from the blood glucose lowering such as cardio-, vaso- and renoprotectiv, blood pressure lowering effects, as well as beneficial changes on blood lipid values and hepatic steatosis. These preferential changes prevail in slightly different way when incretin mimetics applied and dipeptidyl peptidase-4 inhibitors, furthermore, prolonged action of peptides metabolised by this enzyme may serve additional benefits in this latter mentioned group. The article overviews the currently known most important pleiotropic effects of incretins from the point of view of cardiorenal risk accompanying type 2 diabetes. Orv. Hetil., 2013, 154, 248–255.

BACKGROUND: The prevalence of type 2 diabetes mellitus is rapidly increasing, worldwide and also in Hungary. Timely diagnosis and early treatment could be aided by targeted screening. Recognizing this, the Hungarian Diabetes Association initiated a risk-stratified screening with the involvement of primary care physicians. MATERIAL/METHODS: In the first phase of screening, the FINDRISC questionnaire was completed, followed by an oral glucose tolerance test (OGTT) for those with a score of ≥12. Between September 1, 2010 and March 31, 2011, 70,432 non-diabetic adults, who visited their general practitioners for any reason, were involved in the screening. Of these, 68,476 questionnaires proved to be suitable for processing. RESULTS: From the questionnaires, 28,077 (41.0%) had a score of ≥12. A valid OGTT was performed in 22,846 cases; of this group 3,217 subjects (14.1%) had elevated fasting glucose levels, 5,663 (24.8%) had impaired glucose tolerance, and 1,750 (7.6%) had manifest, previously undiagnosed, diabetes mellitus. Overall, from the valid OGTT group, 46.5% subjects had some degree of glucose intolerance. CONCLUSIONS: Based on the FINDRISC questionnaire, the risk-stratified screening for diabetes mellitus proved to be simple and cost-effective method for the early detection of carbohydrate metabolism disorders. Using this method, the prevalence rate of previously undiagnosed abnormal glucose tolerance was high in adult patients cared for by general practitioners in Hungary.

Insul(in)oma is a usually solitary or, in some cases, multifocal tumor of pancreatic beta cells. It may be a component of multiple endocrine neoplasia type 1. or von Hippel-Lindau syndrome. In typical forms the diagnosis – based on the Whipple triad – is simple, however, it may be difficult to recognize in cases with near normal or only slightly elevated serum insulin levels, as well as in patients with known convulsive episodes. With the case presentation of an 81-year-old woman the authors draw attention to the pitfalls of the correct diagnosis. A special feature of the presented case is that convulsions persisted after surgical removal of the pancreatic neuroendocrine tumor verified with functional and imaging methods. Recurrant or residual tumor was not found, and morphological damage of the brain was absent. In the background of the continuing convulsions cerebrovascular alterations as well as the cytotoxic effect of the hypoglycemia-induced excessive glutamate production can be postulated. Orv. Hetil., 2013, 154, 69–73.

Bariatric surgery managing/preventing complications of severe overweight is nowdays widely accepted as a mainstay in the treatment of morbid obesity. Its role is particularly important in type 2 diabetes developing on the base of long-standing significant overweight. The glycemic control improves within days-weeks after these surgeries, when weight loss and reduction of the visceral fat mass is barely detectable. This short term effect is probably due to an increased secretion of glucagon-like peptide and, as a consequence, an improvement in hepatic insulin sensitivity as wel as the whole body glucose uptake. Besides the prolonged glucagon-like peptide effects, the favourable long term effect of these operations – lasting for 10 years even after surgery – is the decrease of visceral fat mass and elimination of harmful influence of cytokines produced by the fatty tissue. The article overviews the metabolic effects of these procedures, their undoubted advantages and potential risks. Orv. Hetil., 2013, 154, 3–9.

To estimate and compare the prevalence of self-reported diabetes based on nationally representative surveys of the Hungarian adult population in 2002 (published data - Hungarostudy) and a survey in 2012.A cross-sectional computer-assisted telephone interview survey on a stratified representative sample of community-dwelling adults (n=1000) in 2012. To describe self-reported diabetes prevalence and its temporal changes generalized linear models were used and results were compared to figures from Hungarostudy.Age standardized prevalence of self-reported type 2 diabetes was 11.7% (95%CI 10.0-13.8%) without gender or rural-urban differences in 2012. People with self-reported diabetes were older than controls (mean [SE]: 63.9 [0.9] vs. 45.9 [0.3] years, p0.0001). The prevalence of diabetes sharply increased after 40 years of age and peaked at age 70 (27.7% [2.5], pWe reported an alarming increase in the prevalence of self-reported type 2 diabetes in the last decade that mostly affects working age people. If this trend continues, a major public health crisis in Hungary can be envisaged.

The objective of this position paper is to review the current medical evidence andguidelines regarding the treatment of type 2 diabetes (T2DM) and to issue medicalrecommendations strengthening the timely use of insulin in patients with T2DMuncontrolled on noninsulin therapy. When noninsulin therapy fails to achieve or tomaintain HbA1c targets, insulin therapy is required. Timely insulin therapy couldprovide proper metabolic control that might prevent complications, lead toimprovement of life expectancy and quality of life.

A cukorbetegséghez társuló idegrendszeri károsodás kialakulásának mechanizmusa ma sem teljes mértékben tisztázott, bár az utóbbi évtizedben számos, részben terápiás konzekvenciával járó adat vált ismertté. Az endoneuralis véráramlás csökkenése részben a primer haemostasis károsodásának, a koagulációs rendszer trombogén irányú elmozdulásának következménye. A hyperglykaemia a szuperoxid-anion fokozott képződése révén a glikolízisben kulcsszerepet játszó glicerin-aldehid-3-foszfát-dehidrogenáz aktivitásának csökkenéséhez, alternatív anyagcsereutak (poliol-, hexóz-amin-, diacil-glicerol-, proteinkináz-C anyagcsereút, fehérjeglikáció) aktiválódásához vezet. A végglikációs fehérjék fokozzák a nukleáris faktor κ-B aktivitását, vazoaktív tényezők és citokinek (interleukin-1, -6, tumornekrózis-faktor-α) termelődését. A patogenetikai alapon nyugvó oki kezelés célja a neuropathiás károsodás progressziójának lassítása, megállítása vagy visszafordítása. Az oki kezelés legfontosabb összetevői: a szénhidrátanyagcsere-helyzet optimális beállítása, a rizikófaktorok kezelése, valamint benfotiamin és alfa-liponsav adása. A transzketoláz-aktivátor benfotiamin egyrészt gátolja a hyperglykaemia következményeként előtérbe kerülő legfontosabb alternatív anyagcsereutak (fehérjeglikáció, diacil-glicerol-, proteinkináz-C-aktiváció, poliol- és hexóz-amin-anyagcsereút) aktivitását, másrészt fokozza a pentóz-foszfát-sönt aktivitását. A benfotiamin klinikai hatékonyságát számos hazai és nemzetközi tanulmány igazolta. Az antioxidáns hatású alfa-liponsav az oxidatív stressz csökkentése révén elősegíti a glicerin-aldehid-3-foszfát-dehidrogenáz aktivitásának fokozódását. Az alfa-liponsav mind infúzióban, mind per os adagolva csökkenti a neuropathiával összefüggő tüneteket és mérsékli a neuropathiás károsodást. Összességében a neuropathia diabetica jól illusztrálja, hogy a patomechanizmussal kapcsolatos ismereteink bővülése számottevően hozzájárulhat a terápia sikeréhez is.

A cukorbetegség − különösen 2-es típusú formája − előfordulása világszerte fokozatosan nő, ezt tükrözik a hazai adatok is. A késői prognózis szempontjából meghatározó jelentőségű érszövődmények megelőzésének, illetve késleltetésének egyik előfeltétele az anyagcserezavar időben történő kórismézése. Ezt segítheti a célzott szűrés, költség-hatékonysági szempontokat szem előtt tartva elsősorban a diabetesre fokozott kockázattal rendelkezők körében. A Magyar Diabetes Társaság, a 77 Elektronika Kft. támogatásával, az országban először, kockázatalapú szűrővizsgálatot indított az alapellátásban dolgozók bevonásával. A szűrés két lépésben történt. Első fázisában a nemzetközileg validált FINDRISC kérdőív magyar változatának kitöltésére került sor, a kérdésekre adott válaszokat pontozási rendszerrel értékeltük (maximálisan elérhető pontszám 26). A ≥12 pontértékkel rendelkező személyek esetében az Egészségügyi Világszervezet előírásait követve éhomi vércukorvizsgálat, kétes értéke esetén 75 grammos glükózterhelés történt, vénás plazmából történő, laboratóriumban végzett vércukormérésekkel. A szűrővizsgálatban 2008. április 1.–2009. március 31. között 8921 személy (59,7% nő, 40,3% férfi) vett részt. A ≥12 pontszámmal rendelkező 4286 személy [életkor: 53,4±11,4 év, testtömegindex (BMI): 29,9±4,9 kg/m 2 , haskörfogat: 101,1±12,7 cm] közül 3733 (87,1%) az éhomi vércukor meghatározása alapján normális glükóztoleranciájúnak bizonyult, míg 283 főnél (6,6%) IFG, 122 esetben (2,85%) IFG, 19 személynél (0,44%) izolált IGT volt megállapítható. Manifeszt, de a szűrés megtörténtéig nem ismert diabetest ismertünk fel 129 személy (3,01%) esetében. Ha a laboratóriumi vizsgálat szükségességét jelentő ponthatárt magasabb értékben (≥15, illetve ≥20 pont) határoztuk meg, nőtt a glükózintoleranciában szenvedők aránya. Az antropometriai paraméterek közül legkifejezettebben a BMI növelte a kóros pontszám-kategóriába kerülés esélyét [egységnyi (1 kg/m 2 ) BMI-növekedés a kockázatot 24,7%-kal növelte (95%-os megbízhatósági tartomány: 23,3–26,2%)]. A kockázatalapú diabetesszűrés egyszerű és hatékony módszer a szénhidrátanyagcsere-zavarok korai felismerésére, ezért annak szélesebb körű, egészségbiztosítói támogatással történő bevezetése indokolt.

A zsírszövetben az inzulinreceptor jelátviteli folyamatait auto-, para- és endokrin hatásokkal szabályozó számos fehérje termelődik és szekretálódik. Ezek közül több, így a tumornekrózis-faktor-α és szolúbilis receptor formái, az sTNFR1 és sTNFR2, a rezisztin, retinolkötő fehérje-4, plazminogénaktivátor-inhibitor, lipokain-1 gátolja az inzulin jelátviteli folyamatait és inzulinrezisztenciát okoz, elsősorban a zsírszövetben, a májban, az izomszövetben, az agyban, az endothelsejtekben, valamint a hasnyálmirigy β-sejtjeiben. Más fehérjék, így az adiponektin, visfatin, vaspin, omentin, apelin és chemerin pedig javítják az inzulinreceptor jelátvitelét. Az összefoglalás áttekinti az inzulinreceptor jelátviteli folyamatainak főbb részleteit és kitér az elhízásban, valamint a 2-es típusú cukorbetegségben észlelhető inzulin- és citokinrezisztenciák patomechanizmusában a közelmúltban megismert molekuláris tényezőkre (például a suppressor of cytokine signaling fehérje család).

A low educational level and a poor socioeconomic status could be associated with increased risk for chronic diseases. The aim of the study was to evaluate the relationship between the educational level and cardiometabolic risk in adult patients with type 1 diabetes (n = 437; age: 38.0 +/- 10.4 years, duration of diabetes: 19.2 +/- 11.1 years; x +/- SD). Educational levels were classified as low [primary school, n = 56 (12.8%)], middle [high school, n = 251 (57.4%)] or high [university, n = 130 (29.7%)]. The prevalence rate of the metabolic syndrome proved to be higher in patients with low versus high educational levels (ATP-III criteria: 42.9 vs. 21.5%, P = 0.0006). Antihypertensive treatment and cardiovascular diseases were more prevalent in patients with low versus high educational level (46.4 vs. 26.2%, P = 0.01; 12.5 vs. 2.3%, P = 0.02; respectively). Overall glycemic control was worse in patients with low versus high educational level (HbA(lc): 8.8 +/- 1.6 vs. 7.9 +/- 1.4%; P = 0.0006). Patients with low versus high educational level differed significantly regarding smoking habits (smokers: 28.6 vs. 11.6%; P = 0.01) and regular physical activity (5.4 vs. 33.1%; P = 0.0001). Higher prevalence rate of certain cardiometabolic risk factors was associated with low educational level in middle-aged type 1 diabetic patients with relatively long duration of diabetes; therefore, these patients should have priority when preventing cardiovascular complications.

A kardiometabolikus kockázati tényezők csökkentésével visszaszoríthatók a cardiovascularis események. A kardiometabolikus kockázati tényezők befolyásolásának eredményességéről 1-es típusú diabetes mellitusban szenvedő felnőtt cukorbetegek körében csak kevés adat áll rendelkezésre. Célkitűzés: Diabetes-szakrendelésen ellenőrzés céljából megjelenő, 1-es típusú diabetes mellitusban szenvedő felnőtt (életkor ≥ 18 év) cukorbetegek körében adatokat gyűjtöttünk a kardiometabolikus kockázati tényezők előfordulásáról és kezelésük eredményességéről. Módszerek: Fél év alatt az ország 11 diabetescentrumában egymást követően megjelent 1-es típusú cukorbetegségben szenvedők (n = 533; 256 férfi, 277 nő; életkor 35,6 ± 11,6 év; diabetestartam 18,0 ± 11,1 év; x ± SD) ellenőrzésekor, az előzményi adatok felvételén túl, antropometriai és laboratóriumi adatokat regisztráltunk. A kardiometabolikus kockázati tényezők kezelési célértékeként a III. Magyar Cardiovascularis Konszenzuskonferencia ajánlásában szereplő adatokat tekintettük mérvadónak. Eredmények: A testtömegindex célértékét (< 25 kg/m 2 ) a betegek 55,3%-a (férfi: 45,7%, nő: 64,3%) érte el. A haskörfogat nők körében megkívánt értékét (< 80 cm) a betegek 50,5%-a, a férfiak esetében mérvadó értéket (< 94 cm) 63,7% érte el. A HbA 1c értéke a betegek 8,4%-ában volt 6,5% alatt (20,5%-ban 7,0% alatt). Lipidcsökkentő kezelésben részesült 130 beteg (24,4%), e csoportban a betegek 53,1%-a érte el a triglicerid, 71,5% a HDL-koleszterin és 27,8% az LDL-koleszterin kezelési célértékét. A lipidek szintjére vonatkozó célérték együttes elérése a betegek 17,7%-ában volt sikeres. Hypertonia miatt kezelésben részesült 173 beteg (32,5%), e betegcsoportban a < 130 Hgmm-es szisztolés vérnyomást a betegek 29,5%-a, a diasztolés célértéket (< 80 Hgmm) pedig 34,7% érte el. A betegek 17,7%-a a vizsgálat időpontjában dohányzónak vallotta magát, 19,2% leszokott a dohányzásról, és 63,2% sohasem dohányzott. Következtetések: Felnőtt, 1-es típusú diabetes mellitusban szenvedők körében a kardiometabolikus kockázati tényezők napjainkban ajánlott kezelési célértékeit a cukorbeteg-gondozás keretein belül nehéz elérni. További erőfeszítéseket kell tenni a cukorbetegek kardiometabolikus kockázati tényezőinek hatékonyabb csökkentése érdekében.

In type 2 diabetes mellitus the decreased catabolism of triglyceride-rich lipoproteins as a consequence of mainly the decreased lipoprotein lipase activity results in hypertriglyceridaemia and other lipoprotein alterations promoting atherosclerosis. The high-density lipoprotein-associated enzyme, paraoxonase, prevents the oxidation of low-density lipoprotein, which is an antiatherogenic effect.to examine the relation between the activities of enzymes influencing HDL remodelling- LPL and PON- in type 2 diabetes mellitus.56 newly diagnosed type 2 diabetic patients and 39 healthy controls were involved in the study. The serum PON activity was measured spectrophotometrically using paraoxone as substrate. PON phenotype was determined by the dual substrate method, PON mass was measured by ELISA. The determination of lipoprotein lipase activity was performed using 3H-triolein.We noticed smaller PON activity decrease in our newly diagnosed diabetic subjects compared to the previous studies which investigated the alteration of enzyme activity after a longer duration of diabetes mellitus. The lipoprotein lipase activity showed a positive correlation with PON activity (r=0.43; P0.02). Interestingly, the PON activity of the homozygous-low activity group did not correlate with the LPL activity, while in the heterozygous and homozygous-high activity groups there was a significantly positive correlation (r=0.51; P0.05) between PON and LPL activity.Besides lipid alterations, the metabolic changes of type 2 diabetes mellitus influence the reduction of the antioxidant capacity of HDL by remodelling HDL and decreasing PON activity via modification of lipoprotein lipase activity, which might contribute to accelerated atherosclerosis.

OBJECTIVE: Malignant tumors of the thyroid gland exhibit a variety of histopathologies and clinical behavior. Immune markers are gaining more and more importance in diagnostic pathology, especially in the differential diagnostics and in the grading of thyroid gland tumors. DESIGN: The Authors investigated the immunohistochemical reaction of galectin-3 (gal3) in patients with various thyroid gland diseases. They tested the diagnostic value of gal3 in determining the benign or malignant nature of various lesions, especially in lesions of follicular origin, because previous results have indicated nearly 100% specificity and sensitivity in this regard. METHODS: Gal3 immunoperoxidase reaction was carried out on 91 sections of thyroid gland samples fixed in formalin and embedded in paraffin. RESULTS: While gal3 expressed itself strongly and diffusely in papillary carcinomas (19 of 20 cases), in other malignant lesions it showed weaker, focal or variable positivity. Focal positivity was found in four of 19 follicular adenomas, and negativity was found in three of 10 follicular carcinomas. In all cases of inflammation a focal positivity was observed (eight of eight cases). All nodular goiter and normal thyroid tIssue were negative (25 of 25 cases). CONCLUSIONS: Based on our results, the gal3 immunohistochemical reaction seems to be reliable in the diagnosis of papillary carcinomas. However, in the case of solitary thyroid nodules and follicular lesions, although it is still a useful supplementary marker, it is not of absolute value (as stated in previous studies) in determining whether a tumor is benign or malignant.

OBJECTIVE: The aim of the study was to evaluate the expression of tumor necrosis factor (TNF)-alpha protein in the subcutaneous and visceral adipose tIssue in correlation with adipocyte cell Volume, serum TNF-alpha, soluble TNF-receptor-2 (sTNFR-2) and indirect parameters of insulin resistance in overweight/obese and lean healthy persons. DESIGN: A cross-sectional case-control study was used. PATIENTS: Twenty-eight overweight/obese probands with normal glucose tolerance (BMI>27 kg/m(2)) and 15 lean people (BMI

Background. We studied the contribution of the tumor necrosis factor system and leptin to insulin resistance during the course of normal pregnancy. Methods. Forty-five healthy pregnant women (15 in the 1 st , 15 in the 2nd 2 and 15 in the 3rd 3 trimester) and 25 age-matched healthy nonpregnant women as controls. Twenty-three newborns delivered by women followed in the 2nd and 3rd trimesters were also investigated. Fasting serum immunoreactive tumor necrosis factor-α, soluble tumor necrosis factor receptor-1, soluble tumor necrosis factor receptor-2, leptin (by enzyme-linked immunoassay) and C-peptide (by radioimmunoassay) concentrations in the patients and controls were measured. Body weight, length and head circumference of the newborns were analyzed in connection with the measured maternal parameters. Results. Significantly elevated tumor necrosis factor-α, tumor necrosis factor receptor-1 and -2, leptin, and C-peptide levels were found in the 3rd 3 trimester as compared with the 1st 1 and 2nd 2 trimest...

OBJECTIVE: Human fetuin/alpha(2)-HS-glycoprotein (AHSG) is a 49 kDa serum and tissue protein which is a natural inhibitor of insulin receptor signaling. We investigated serum AHSG levels during pregnancy and whether the protein is involved in insulin resistance observed in healthy pregnant women and patients with gestational diabetes. DESIGN: One hundred and four healthy pregnant women and 23 of their neonates, 30 patients with gestational diabetes and their neonates and 30 healthy age-matched non-pregnant females as a control group were investigated in a case-control cross-sectional study. METHODS: Serum AHSG was determined by radial immunodiffusion. RESULTS: We observed an increase of serum AHSG concentration in the second and third trimesters. Gestational diabetes patients had significantly higher AHSG levels than healthy pregnant women and non-pregnant controls. There was a highly significant positive correlation between serum AHSG concentration and indirect parameters of insulin resistance, i.e. tumor necrosis factor-alpha (TNF-alpha), leptin, C-peptide and C-peptide/blood glucose ratio. There was also a negative correlation between maternal AHSG, TNF-alpha, leptin levels and head circumference, body length and body weight of newborns. CONCLUSION: AHSG, TNF-alpha and leptin may contribute to insulin resistance during normal pregnancy and gestational diabetes. AHSG along with these cytokines may also negatively regulate neonatal skeletal development.

The aim of the study was to investigate the pathophysiological role of the tumor necrosis factor (TNF) system in insulin resistance in patients with gestational diabetes (GDM) and during the course of normal pregnancy.Thirty women with GDM (16-39 gestational weeks), 35 healthy pregnant women (15 first, nine second and 11 third trimester) and 25 healthy age-matched non-pregnant women were studied. Serum TNF-alpha, and its soluble receptors 1 and 2 (sTNFR-1 and -2) were measured.In non-diabetic pregnant women in the third trimester all measures were significantly higher (P0.05 or less) than in the first trimester and in non-pregnant women (BMI 27.6 +/- 4.1 (+/- S.D.), 24.1 +/- 2.6, 22.4 +/- 2.4 kg/m(2)), serum TNF-alpha (4.6 +/- 0.6, 4.1 +/- 0.4, 4.1 +/- 0.4 ng/l), sTNFR-1 (2.7 +/- 0.9, 2.0 +/- 0.5, 2.0 +/- 0.1 microg/l), sTNFR-2 (5.6 +/- 2.6, 4.6 +/- 2.1, 3.3 +/- 0.2 microg/l), C-peptide (3.1 +/- 1.7, 1.1 +/- 0.7, 1.1 +/- 0.8 microg/l), and C-peptide:blood glucose ratio (0.6 +/- 0.2, 0.2 +/- 0.1, 0.2 +/- 0.1 microg/mmol). In GDM these measures were even higher than in any subgroup of healthy pregnant women (BMI) (33.4 +/- 6.4 kg/m(2), TNF-alpha) (6.3 +/- 0.6 microg/l), sTNFR-1 (3.0 +/- 0.5 microg/l), sTNFR-2 (10.0 +/- 6.9 microg/l, C-peptide 6.0 +/- 2.7 microg/l, C-peptide:blood glucose ratio: 1.2 +/- 0.5 microg/mmol, P0.01). Significant (P0.01) positive linear correlations were found in gestational diabetic and non-diabetic women between serum TNF-alpha, C-peptide levels, and BMI. In gestational diabetic women, in multivariate analysis studying the dependency of C-peptide only BMI remained significant (r(2)=0.67, P=0.01).Our observation emphasizes the obesity-related component of insulin resistance driven by adipocytokines, such as TNF-alpha and its receptors during the course of normal pregnancy and GDM.

The contribution of the tumor necrosis factor (TNF) system and leptin was studied in insulin resistance and neonatal development during the course of normal pregnancy and gestational diabetes mellitus (GDM). Thirty patients with GDM and their neonates (n = 30), 35 healthy pregnant women (15 in the first, nine in the second and 11 in the third trimester) and their neonates (n = 20), and 25 healthy matched non-pregnant women participated in the study. Significantly elevated levels of maternal TNF-alpha, sTNF receptor (R)-1 and R-2, leptin (detected by enzyme-linked immunosorbent assay) and fasting C-peptide (measured by radioimmunossay and raised body mass index (BMI) were found in GDM patients and in the third trimester of normal pregnancies. TNF-alpha, sTNFR-2, C-peptide, leptin concentrations and BMI positively correlated with each other in GDM. An inverse relationship between the body length, head circumference and body weight of the newborns, and maternal TNF-alpha, leptin and C-peptide concentrations was shown in GDM. In healthy pregnancies the maternal serum leptin level was in a negative linear correlation with the head circumference of the newborns. In conclusion, increased TNF-alpha and leptin levels may contribute to insulin resistance in GDM and in the third trimester of normal pregnancy and may negatively influence the anthropometric parameters of the newborns.

Principles of glycemic treatment of type 2 diabetes are well outlined for a long time, however, emphasis of therapeutic strategies and treatment guidelines are continuously changing partially due to the continuous expansion of the available antihyperglycemic drugs. This article overviews the modifications of the drug selection arising from the broadening of the pathogenetic knowledge and recent therapeutic guidelines. It presents the role of the patient-centered approach in the therapeutic choice, highlights occasional contradictions between recent international and national guidelines and financing rules in Hungary. While consideration of the different antidiabetics by the same criteria and the choice of the most appropriate drug characterize international practice, prescription of certain compounds is often restricted by financial rules in Hungary.A 2-es típusú diabetes vércukorcsökkentő kezelésének alapelvei hosszú ideje jól körvonalazottak, a készítményválaszték folyamatos bővülése mellett azonban a kezelés hangsúlyai és a terápiás stratégiák is időről időre változnak. A közlemény áttekinti a patogenetikai ismeretek bővülésének és a kezelési irányelvek módosulásainak a készítményválasztást befolyásoló hatását. Kitér a betegközpontú kezelési szemlélet terápiás stratégiát befolyásoló szerepére, s rámutat a szakmai szempontok és a hazai finanszírozási szabályok esetenkénti ellentmondásaira. Míg a nemzetközi gyakorlatot a választható készítmények azonos szempontok szerinti mérlegelése és az adott esetben legtöbb előnyt kínáló gyógyszercsoport(ok) alkalmazása jellemzi, a hazai lehetőségeket finanszírozási megfontolások korlátozzák. Orv. Hetil., 2014, 155(31), 1215–1220.

Background and aims: In vivo and in vitro experiments show the protective role of calcium ions (Ca2+) against colorectal cancer. The calcium-sensing receptor (CaSR) detects extracellular Ca2+ concentration. An association between the CaSR A986S polymorphism and serum calcium in healthy adults has been reported. Subjects with AA genotype had lower serum concentrations of Ca2+ than other genotypes. The expression of erbB-2, epidermal growth factor receptor (EGFR), p53, and ras in colorectal cancer has been suggested to have diagnostic and prognostic significance. Patients and methods: We investigated the relationship between the CaSR A986S polymorphism and the expression of erbB-2, EGFR, p53, and ras as well as the UICC stage in 56 patients with rectal cancer. Results: The occurrence of the genotype AA was not different in cancer patients and in 112 controls. In the presence of the coexpression of major oncogenes, patients with genotype AA were in significantly higher UICC stages than in the case of AS genotype. During the follow-up period AA genotype showed a tendency for poor prognosis. Conclusions: Our observation raises the possibility that genetic alterations of CaSR influence the pathogenesis of rectal cancer.

Wernicke encephalopathy (or Wernicke-Korsakoff encephalopathy) is a rarely diagnosed neurological disorder, which is caused by vitamin B1 deficiency. In the classical form it is characterized by a typical triad (confusion, oculomotor disturbance and ataxia), however, in the majority of the cases only confusion is present. It can be frequently observed in subjects with chronic alcohol consumption, but it may accompany different pathological states of which end stage malignant diseases are the most importants, where confusion may have different backgrounds. The authors present the case of an old male patient with advanced gastric cancer recognised and treated vitamin B1 deficiency, and they draw attention to difficulties of the diagnosis of Wernicke's disease.A Wernicke-encephalopathia (vagy más leírásokban: Wernicke–Korsakoff-encephalopathia) a belgyógyászati gyakorlatban ritkán felismert kórkép, amit B1-vitamin-hiány okoz. Típusos formáját jellegzetes triász kíséri (zavartság, szemmozgászavar, ataxia), gyakoribb azonban, hogy e tünetekbol csak a zavartság van jelen. Leggyakrabban krónikus alkoholfogyasztókon figyelheto meg, de társulhat – más kórképek mellett - végstádiumú tumoros betegségekhez is, ahol a zavart viselkedésnek számtalan egyéb oka is lehet. A szerzok idos, elorehaladott gyomortumorban szenvedo férfi betegen észlelt Wernicke-encephalopathiás esetüket ismertetik, felhívva a figyelmet a kórismézés és a differen­ciáldiagnosztika nehézségeire. Orv. Hetil., 2014, 155(1), 30–33.

Az inkretinek, a glukagonszerű peptid (GLP)-1, illetve a glukozdependens inzulinotrop peptid (GIP) felfedezese, hatastani sajatossagaik megismerese, majd az inkretinhatason alapulo vercukorcsokkentők forgalomba kerulese jelentős előrelepest hozott a 2-es tipusu cukorbetegseg kezeleseben. Az alapkutatasok folytatodasa szamos reszlet tekinteteben modositotta e hormonok elettanaval kapcsolatos eddigi ismereteinket, atertekelődott a GIP anyagcsere-folyamatokban jatszott szerepe, s megalapozottabba valt a GLP-1 hatas terapias hasznositasa is. A kozlemeny a legujabb adatok bemutatasaval az inkretinek termelődesenek es hatasainak elettani sajatossagait es azok cukorbetegsegben megfigyelhető eltereseit tekinti at, ramutatva a meg pontosabb tisztazast igenylő reszletekre es a terapias alkalmazas jovőbeni lehetősegeire is. Orv. Hetil., 2011, 152, 1922–1930.

Type 2 diabetes is making up to 90% of the all diabetic cases. In addition to insulin resistance, insufficient B-cell function also plays an important role in the pathogenesis of the disease. The insufficient production and secretion of insulin can be increased by secretagogue drugs, like sulfonylureas and incretin mimetics/enhancers. In recent years growing number of genetic failures of the B-cells has been detected. These genetic variants can influence the efficacy of secretagogue drugs. Some of these gene polymorphisms were identified in the genes encoding the KATP channel (KCNJ11 and ABCC8). These mutations are able either to reduce or increase the insulin secretion and can modify the insulin response to sulfonylurea treatment. Other polymorphisms were found on genes encoding enzymes or transcription factors. In the recent years the genetic variants of TCF7L2 and its clinical importance have been intensively studied. Authors give a summary of the above gene polymorphisms and their role in the insulin secretion. Orv. Hetil., 2011, 152, 1651–1660.

Metabolic characteristics of physiological and diabetic pregnancies are discussed. The basic factor of these changes is the increasing insulin resistance throughout pregnancy, which in case of diabetes may result in hyperglycemia with undesirable clinical consequences and complications for both the mother and the fetus. Prevention of these complications by maintaining physiological metabolic state of diabetic pregnant women is possible, which is similar to that of healthy women. The aim of treatment of pregnant diabetics is to achieve normoglycemic state during the whole gestation that is possible by early diagnosis in case of gestational diabetes and by an adequate preconceptional care in case of pregestational diabetes. To obtain desirable glycemic conditions insulin treatment is necessary in most of the cases together with an adequate, quantitative nutrition therapy, while oral antidiabetic drugs during pregnancy and lactation are to be avoided. For adequate care of the cases with diabetes and pregnancy interdisciplinary diabetes centers with well-trained experts are required. Orv. Hetil., 2011, 152, 1635–1640.

Buschke-Löwenstein tumor (verrucous carcinoma, giant condylomata) of the anal margin is a locally invasive, destructively growing carcinoma that does not metastasize. The lesions are rare despite the increased incidence of anal condylomata and anal carcinomas. Authors report a case of a 63-year-old woman suffering from verrucous carcinoma (Buschke-Löwenstein tumor) of the anal margin. The tumor invaded the rectal sphincter and extended beyond the muscle, infiltrating the lower abdomen. Infiltration of the perivesical soft tissue caused bilateral hydronephros. Because both under- and overdiagnosis of anal cancer and precancer may lead to inappropriate treatment, it is important to perform adequate sampling for histology. Non-representative superficial biopsies may result underdiagnosis of the disease. Orv. Hetil., 2011, 152, 344–348.

Authors present the case of a 65 year-old man without any remarkable previous illness, hospitalized because of having prolonged fever caused probably by an infection due to a tick bite. Tularaemia and bartonellosis based on serological results as well as neoplasm of the sigma with multiple metastases to the liver raised by ultrasonography and abdominal CT could be excluded with detailed investigations. Multiple abscesses of the liver were diagnosed, followed by a percutaneuos ultrasonography directed aspiration of one of the abscesses which resulted in 150 ml buffy pus. Microbiological examination evaluated the presence of Actinomyces meyeri. Instead of neoplasm, diverticulosis and diverticulitis of the sigma could be clarified with perforation of one of the diverticuli causing peridiverticulitis, retroperitoneal abscess and probably abscesses in the liver by haematogenous dissemination. Surgical intervention, resection of the liver and the sigma resulted in recovery of the patient. Difficulties of diagnosis are discussed in the article pointing out the importance of interdisciplinary collaboration, involving also infectologist. Diverticulosis of the sigma as presumably origin of hepatic actinomycosis is a literary curiosity. This was the cause of the case presentation. Orv. Hetil., 2011 152, 268–272.

A 2-es típusú diabetes kórfejlődése jellemző módon időben elhúzódó és lappangó, olykor a manifeszt betegség kezdeti stádiuma is meglehetősen tünetszegény. Ez megteremti az alapját a szűrővizsgálattal történő betegségfelismerésnek. Szűrővizsgálattal nemcsak a 2-es típusú diabetes, hanem kórmegelőző állapota (összefoglaló néven praediabetes) is felismerhető. A szűrővizsgálat céljára napjainkban az úgynevezett kockázatalapú, kétlépcsős módszer a leginkább elfogadott: az első lépcsőben kérdőív segítségével azonosíthatók a fokozott kockázatú egyének, a második lépcsőben ez utóbbiak körében vércukor-meghatározásra kerül sor. A kérdőívek közül a FINDRISC (Finnish Diabetes Risk Score) használata terjedt el a legtöbb országban, az első hazai tapasztalatok is kedvezőek alkalmazásával kapcsolatban. A szűrővizsgálat megteremti a korai diabetesesetek azonosítását, illetve a primer prevenció lehetőségét. Mindez végül elvezethet a 2-es típusú diabetes előfordulási gyakoriságának csökkenéséhez. Helyes lenne, ha ez az egészségügyi-társadalmi aktivitás hazánkban is – más országokhoz hasonlóan – nemzeti diabetesprogram keretei között valósulna meg.

Inkretineknek az emésztőtraktus speciális sejtjeiben termelődő, peptid természetű hormonokat nevezzük, amelyek a táplálék összetevői, elsősorban szénhidrátkomponensei hatására elválasztódva, közvetett módon, összetett hatásmechanizmussal – döntően a postprandialis vércukorszint csökkentésével – részt vesznek a glükózhomeosztázis biztosításában. Az összefoglaló közlemény a két legfontosabb inkretin, a glükagonszerű peptid (GLP)-1 és a glükózdependens inzulinotróp polipeptid (GIP) élettani termelődésének áttekintése mellett részletesen foglalkozik a szénhidrát-anyagcsere tekintetében meghatározó jelentőségű tényező, a GLP-1 hatástani sajátosságaival és ezek farmakológiai hasznosításának, a 2-es típusú diabétesz kezelésében való felhasználásának lehetőségeivel. A humán GLP-1 rövid felezési ideje folytán a napi gyakorlatban nem alkalmazható. A lebontását végző szerin-peptidáz típusú enzim, a dipeptidil-peptidáz (DPP) IV gátlásával azonban hatástartama megnyújtható. Sikerült is előállítani e hatással rendelkező vegyületeket, amint kifejlesztésre kerültek DPP IV-rezisztens, a GLP-1-től eltérő szerkezetű, de receptorán agonista hatást kifejtő származékok is. Előbbiek az incretin (GLP-1) hatásfokozók („enhancers”), utóbbiak az ún. mimetikumok. Mindkét csoport képviselői törzskönyvezésre is kerültek. Az inkretin hatásfokozók, az ún. „gliptinek” közül a sita- és vildagliptinnel ismertek hosszabb távú klinikai megfigyelések. Az inkretinomimeticumok egy képviselője, az exenatid – szintetikus exendin-4 – került eddig klinikai forgalomba, több mint egy éves alkalmazásáról ugyancsak ismertek tapasztalatok. A rendelkezésre álló adatok alapján mindegyik felsorolt származék a 2-es típusú diabétesz vércukorcsökkentő kezelésének új, hatékony alternatívája lehet. A terápialáncban képviselt helyük ma még egyértelműen nem körvonalazható. Bár érvek sorakoztathatók fel monoterápiában történő korai adásuk mellett is, elsősorban más antidiabetikumokkal kombinált alkalmazásuk látszik reális indikációnak.

To study fasting biologically active serum ghrelin (RIA) and resistin (ELISA) levels in different trimesters of pregnancy (HP, n=45, 15 in each) and in gestational diabetes mellitus (GDM, n=30) compared to non-pregnant healthy women (NP, n=40) in correlation with TNF-alpha, soluble (s)TNF-receptor (R)-1, -2, leptin (ELISA), C-peptide (Cp, RIA) and Cp/blood glucose ratio (bg).Cross-sectional case control study.Acylated ghrelin levels were significantly increased (p0.0001) in the 2nd (377+/-38pg/ml, X+/-S.D.) and decreased in the 3rd trimester (252+/-36) and in GDM (226+/-21) compared to NP controls (309+/-20) and HP women in the 1st trimester (314+/-41). Serum resistin levels were higher in the 1st (8.5+/-2.6ng/ml), 2nd (10.2+/-2.1) and 3rd (13.1+/-3.6) trimesters of pregnancy and in GDM (15.7+/-3.5) than in NP controls (6.5+/-2.3). Significant (p0.01) negative linear correlations were found among fasting serum ghrelin and body mass index (BMI), the fasting C-peptide (Cp) level, C-peptide/blood glucose (Cp/bg) ratio, TNF-alpha, soluble (s)TNFR-2, leptin and resistin concentrations in both, HP and GDM groups. Significant positive correlations were observed between serum acylated ghrelin and adiponectin, and between BMI and fasting Cp, Cp/bg, TNF-alpha, sTNFR-1, -2 and leptin levels in both pregnant groups.Increased fasting serum acylated ghrelin concentrations in the 2nd trimester may associate with weight gain during pregnancy. Hyperresistinemia may also be associated with the pregnancy-induced insulin resistance. A negative regulatory feed-back mechanism between resistin, TNF-alpha and ghrelin may be hypothesized.

Background and aim Previous studies have demonstrated that oxidative stress is increased in obese patients. The high-density lipoprotein (HDL) associated human paraoxonase 1 (PON1) can inhibit low-density lipoprotein oxidation and has an antiatherogenic effect. Our objective was to assess the effects of orlistat therapy combined with diet on body mass index (BMI), waist circumference, lipid parameters, blood pressure, serum glucose level and PON1 activity. Methods and results A longitudinal, multicenter, randomized study with and without orlistat treatment was performed. One hundred thirty nine otherwise healthy, obese subjects were divided in to two groups: 78 persons received orlistat (120 mg three times a day) combined with diet while 61 persons were kept on diet only. Anthropometrical parameters, serum lipid levels and PON1 activity were measured at baseline and after 6 months of treatment. BMI and waist circumference were reduced more pronouncedly in the orlistat group than in the control group. Patients receiving orlistat also had significantly greater improvements in fasting blood glucose levels and blood pressure. The orlistat-treated group showed a greater reduction in total cholesterol and triglyceride levels. In addition, the serum PON1 activity in these patients was significantly increased compared to the diet-only group. Conclusions The 6-month treatment with orlistat had a beneficial effect on the lipid profile and improved the antioxidant status by increasing serum PON1 activity. However, because of the limited therapeutic effectiveness, obese patients with hypercholesterolemia should receive additional lipid lowering medications.

Role of tumour necrosis factor-alpha (TNF-alpha) was studied in insulin resistance during pregnancy.Serum TNF-alpha (ELISA) and fasting C-peptide (Cp) (RIA) concentrations were measured in 40 healthy pregnant women (15, 12 and 13 of them in the 1st, 2nd and 3rd trimesters, respectively) and in 25 healthy non-pregnant women in a case-control study.TNF-alpha (X+/-S.D.: 5.33+/-0.46 pg/ml) and Cp levels (3.37+/-1.30 ng/ml) were significantly higher in the 3rd trimester as compared with matched healthy controls (TNF: 4.07+/-0.26, Cp: 1.05+/-0.36) and to the pregnant women in 1st (TNF: 4.04+/-0.26, Cp: 1.34+/-0.59) and 2nd (TNF: 4.35+/-0.32, Cp: 1.11+/-0.35) trimesters. Significant positive linear correlation was calculated among TNF-alpha, Cp, Cp/blood glucose ratio (indirect parameters of insulin resistance) and body mass indexes (BMIs) of pregnant women (P0.01).TNF-alpha may contribute to the insulin resistance during the course of normal pregnancy.

The therapeutic effectiveness of a benfotiamine (CAS 22457-89-2)-vitamin B combination (Milgamma-N), administered in high (4 x 2 capsules/day, = 320 mg benfotiamine/day) and medium doses (3 x 1 capsules/day), was compared to a monotherapy with benfotiamine (Benfogamma) (3 x 1 tablets/day, = 150 mg benfotiamine/day) in diabetic patients suffering from painful peripheral diabetic neuropathy (DNP). In a 6-week open clinical trial, 36 patients (aged 40 to 70 yrs) having acceptable metabolic control (HbA1c < 8.0%) were randomly assigned to three groups, each of them comprising 12 participants. Neuropathy was assessed by five parameters: the pain sensation (evaluated by a modified analogue visual scale), the vibration sensation (measured with a tuning fork using the Riedel-Seyfert method) and the current perception threshold (CPT) on the peroneal nerve at 3 frequencies: 5, 250 and 2000 Hz). Parameters were registered at the beginning of the study and at the end of the 3rd and 6th week of therapy. An overall bneneficial therapeutic effect on the neuropathy status was observed in all three groups during the study, and a significant improvement in most of the parameters studied appeared already at the 3rd week of therapy (p < 0.01). The greatest change occurred in the group of patients receiving the high dose of benfotiamine (p < 0.01 and 0.05, resp., compared to the othr groups). Metabolic control did not change over the study. It is concluded that benfotiamine is most effective in large doses, although even in smaller daily dosages, either in combination or in monotherapy, it is effective.

The role of tumor necrosis factor-alpha in insulin resistance has been studied in 59 patients with Type 2 diabetes, 28 with android type obesity and 35 healthy lean controls. Immunoreactive concentrations and bioactivity of serum tumor necrosis factor-alpha have repeatedly been determined in 8 weeks intervals for 12 months, five times per patients, by using ELISA and L929 cell cytotoxicity bioassay. Significantly higher immunoreactive tumor necrosis factor-alpha concentrations and bioactivity have been found in both, the Type 2 diabetic and obese groups as compared to the healthy persons. Tumor necrosis factor-alpha concentrations and bioactivity have showed a significant positive linear correlation with the elevated basal serum C-peptide levels and body mass indexes in both groups of patients. According to these data the cytokine might play a role in insulin resistance in obesity as well in Type 2 diabetes.

Objective: To study the influence of diabetes on the endothelium-dependent vasodilation in the coronary arterial bed. Methods: The effects of acetylcholine (ACh 2–36 pmol·kg−1; 18 nmol·l−1–9.8 μmol·l−1; 0.1–10 μmol·l−1), l-arginine (1 mmol·l−1) and sodium nitroprusside (1 nmol·l−1–100 μmol·l−1) were measured on coronary conductivity, vascular tone and cGMP release (RIA) in healthy and diabetic dogs. Results: ACh-mediated (in cumulative intra-arterial infusion) increase in coronary conductivity was reduced ( P