Search

MaroszSzymon, BorkowskaAleksandra, MikulskaPaulina,BorkowskaKatarzyna, Kowieska Jolanta. The treatment of diabetes with new generation drugs. Journal of Education, Health and Sport.2020;10(9):690-696. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2020.10.09.083 https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/JEHS.2020.10.09.083 https://zenodo.org/record/4048524 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2020; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 10.09.2020. Revised: 24.09.2020. Accepted: 24.09.2020. The treatment of diabetes with new generation drugs Szymon Marosz1,Aleksandra Borkowska1, Paulina Mikulska2, Katarzyna Borkowska2, Jolanta Kowieska2 1Chair and Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin 2Mazovian Regional Hospital of St. John Paul II in Siedlce Sp. z o.o. Corresponding author: Aleksandra Borkowska: borkowska.ola231@gmail.com ORICID ID: Szymon Marosz: https://orcid.org/0000-0003-4774-8449 Aleksandra Borkowska: https://orcid.org/0000-0002-0950-2176 Katarzyna Borkowska: https://orcid.org/0000-0002-2090-7887 Paulina Mikulska: https://orcid.org/0000-0003-0876-6150 Jolanta Kowieska: https://orcid.org/0000-0001-5257-686X Abstract Introduction:Diabetes is a global problem, affecting nearly 422 million people around the world. Pathogenesis includes a defect in secretion or insulin activity. This results in an increase in the glucose level, which is associated with the development of complications. These include changes in peripheral vessels and nerves that lead to their damage. It is necessary to introduce appropriate treatment in the earliest stages of the disease to prevent these effects. Materials and methods:The aim of this work is to present knowledge about the treatment based on the recommendations of the Polish Diabetes Association, American Diabetes Association, as well as a literature review and analysis of publications published on PubMed and Google Scholar platforms. Results:Over the years, the recommendations and recommendations for treatment change. Recently, a greater role has been given to the latest antidiabetic drugs. This group includes SGLT-2 inhibitors as well as incremental drugs, the main representatives of which are GLP-1 analogues. These drugs affect the level of glycemia, but also have a beneficial effect on weight reduction and reduce the risk of cardiovascular events. Recently, Poland has introduced reimbursement of some new generation antidiabetic drugs such as dapaglyphosin, empaglyphosin and canaglyphosin. Conclusions:Dynamic development of diabetes treatment helps to slow down the course of the disease and postpones the introduction of insulin therapy as the final treatment method. Reimbursement of some antidiabetic drugs enables patients to have better access to drugs that have not been within their reach so far. The changes introduced are, in a way, groundbreaking in the treatment of diabetes. Key words: diabetes, GLP-1 analogues, SGLT-2 inhibitors.

Small intestinal bacterial overgrowth (SIBO) is a frequent cause of chronic abdominal complaints. So far, a lot information has been gathered on its pathogenesis but are still doubts that raise question why its causes chronic diarrhea in some and constipation in other patients.The aim of the study was to assess the number of endothelial lymphocytes (IELs) in the duodenal and ileum mucosa in patients with SIBO with dominant diarrhea (SIBO-D) and dominant constipation (SIBO-C).The study was performed in 30 healthy patients (group I) and 40 patients with SIBO and diarrhoea (group II), and in 4o patients with constipation (group III). To diagnose SIBO the lactulose hydrogen breath test (LHBT) was performed. To determine the number of intraepithelial lymphocytes in duodenal and jejunal mucosa the histological assessment was performed using haematoxylin-eosin staining. Moreover, immunochistochemical method was used to assess the number of enterochromatoffin cells (EC, chromogranin A - LK-2H10) in these some parts of the gut.The results of LHBT were similar in group II and III - 75,6±18,1 ppm and 66,9±16,2 ppm(p0,05). The number of IELs in duodenal mucosa in controls was 14,6±4,1/100 EN, in group II - 28,3±6,8/100 EN (p0.01), and in group III - 23,0±9,9/100 EN (p0,05), and similar differences were in jejunal mucosa. The number of EC in both parts of the gut was higher in SIBO compared to controls. Furthermore, in patients with SIBO-D the number of IELs in duodenum, as well as in jejunum, was positively correlated with the number of EC cells ( p0,05, p=0,056, respectively).In patients with SIBO, particularly with SIBO-D, increased number of IELs I EC cells may be a cause of diverse abdominal symptoms.

The pathogenesis of functional dyspepsia is remains unknown. The diagnosis is based on subjective symptoms. However, many effort are being made in searching for the causes and objective indices which could facilitate the diagnosis and the treatment of this disease.The aim of study was to evaluate the indices of serotonin synthesis and metabolism in patients with functional dyspepsia in relation to psychosomatic symptoms.The study comprised 30 healthy subjects (group I - control) and 30 patients with functional dyspepsia(group II) as postprandial distress syndrome (PDS), according to Rome Criteria IV. Assessment of the severity of dyspeptic symptoms was performed using a 10-point visual-analogue scale(VAS). All patients completed the Hamilton Depression Scale. Serum serotonin and 5-hydroxyindoleacetic acid (5-HIAA) concentration in urine were measured by ELISA method using IBL antibodies (catalog numbers- RE-59121, RE-59131).Serum serotonin concentration in the control group was 205.1±34.1 ng/ml, and in dyspeptic patients - 154.2±52.9 ng/ml (p0.001). Significant differences were also found in daily urinary 5-HIAA excretion: 6.88±0.79 mg/24h vs 5.06±1.25 mg/24h, respectively ( p0.001). Moreover, a negative correlation was found between serotonin concentration as well as urinary 5-HIAA excretion and severity of depressive symptoms. The correlation between severity of dyspeptic and psychic symptoms was poorly positive.These results indicate that in patients with functional dyspepsia homeostasis of serotonin is disturbed, and it is in relation to psychosomatic symptoms.

Small intestinal bacterial overgrowth (SIBO) is a frequent cause of chronic abdominal complaining.The aim of this study was to assess the prevalence of the functional disorders in this group patients.The study was conducted in a group of 426 subjects, aged 22-65, including 294 women and 132 men with intestinal functional diseases, as defined in Rome IV Criteria. Small intestinal bacterial overgrowth was evaluated using the Gastrolyzer (Bedfont), assuming an increase of hydrogen concentration in the breath samples over 20 ppm in relation to the baseline value within 90 minutes after consumption of 10 g lactulose (LHBT test). In 185 subjects (group I) results of this test was negative, and in 241 patients (group II) was positive.On the whole the prevalence of functional disorders are similar in both groups (p0,05). However, in the group with a positive LHBT score, the diarrheal form of the irritable bowel syndrome was more often diagnosed (21,1% vs 28,2%; OR -1,47, 95% Cl - 0,94-2,31) as well as functional diarrhea (22,1% vs 17,8%; OR - 1,22; Cl 95% - 0,78-1,92). Less differences were determined in evaluation of the constipation and bloatedness.The LHBT is useful in the diagnosis of functional disorders of the gastrointestinal tract.