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The author presents an account of combined treatment with insulin and sulphonylurea derivatives in 46 diabetics type 2 for a period of three years. In all patients satisfactory metabolic compensation was achieved which persisted throughout the whole period at a level of HbA1c values of 8.0-8.5%. The author considers combined treatment indicated in secondary failure of oral antidiabetics with preserved C peptide secretion of 0.8-0.24 ng/ml. Combined treatment may be also a solution for some metabolically unbalanced diabetes type 2 with obesity and hyperinsulinaemia. Combined treatment is useful, does not burden the patient with large insulin doses and proves useful also in long-term satisfactory compensation as it reduces the risk of development of complications. Combined treatment fails in 9.6% of the patients, usually during the first year.

Hundred and ten type 2 diabetics with complications, mean age 58.1 years, were treated intensively with insulin for a 12-month period using CSII in an attempt to stabilize the development of specific complications. During 12 months of treatment their long-term compensation corresponded to a value of 7.8 HbA1c. It proved possible to influence in a favourable way complications in 48 patients, i.e. in 43.6%. The greatest improvement was recorded in peripheral sensory neuropathy, less frequently sensorimotor neuropathy. In patients with nephropathy in 33% quantitative proteinuria dropped below 500 mg/24 hr. Retinopathies were not affected, on the contrary, deterioration was recorded in 18.6% of the patients. Forty-eight diabetics whose condition improved proceeded with intensive insulin therapy (using IKT) for another two years, 62 diabetics whose condition did not improve were treated with insulin in the standard was (1-2 doses per 24 hr.). Evaluation of treatment after two years revealed less progression of complications in the intensively treated group. Intensive insulin treatment leading to close compensation is effective also in type 2 diabetics when specific complications progress.

Free oxygen radicals (FOR) are one of the factors which participate via lipoperoxides in the development of atherosclerosis. Atherosclerosis complications affect a large part of diabetic patients. The objective of the present work was to test whether in diabetic patients there is, as compared with healthy subjects, a difference in the FOR activity and in the lipoperoxide blood level. A total of 30 patients with insulin non-dependent diabetes and a control group of 31 healthy subjects were examined. The FOR formation in blood, the concentration of malondialdehyde (MDA) as a marker of lipid paroxidation and serum lipid concentrations were assessed. In patients with diabetes a statistically significant increase in the FOR formation in blood (p < 0.01) and an increased MDA serum concentration (p < 0.01) were found. The mean serum lipid concentrations in the two groups did not differ significantly. The results suggest a significant participation role of highly reactive oxygen species in the development of vascular atherosclerosis complications.

The authors revealed during dispensarization of pregnant women suffering from essential hypertension that the disease is relatively frequently associated with some metabolic disorders, i. e. obesity, gestational diabetes or impaired glucose tolerance. They draw attention to a similarity with Reaven's syndrome in non-pregnant women. The authors recommend to screen for diabetes all obese pregnant women and those with hypertension to detect an impaired glucose metabolism and prevent foetopathies in neonates of thus affected mothers. The authors consider obesity one of the subsidiary criteria in the differential diagnosis of essential hypertension and preeclampsia.

The authors examined in 134 type 2 diabetics under the age of 60 years (mean age 54.5 years) the number of circulating endothelia. The results were compared with the number of circulating endothelia in 12 type 1 diabetics who were in a compensated state. The number of circulating endothelial increased with the degree of metabolic decompensation, the limital value of glycosylated haemoglobin (HbA1c) was 12%. In patients with a lower HbA1c value the number of circulating endothelia was still at the upper range of normal values. The highest values were recorded in diabetics with ketosis. The elevated number of circulating endothelia does not depend on the duration of diabetes, on the method of treatment or the patient's age. The finding of an elevated number of circulating endothelia correlates also with a higher cholesterol and triacylglycerol level. The authors consider the raised number of circulating endothelia a marker of endothelial damage and thread of the development of macroangiopathy.

The authors evaluate the effect of two years intense individual education on the metabolic compensation of diabetics. They evaluate it in 611 patients with regard to the blood concentration of glycosylated haemoglobin (HbA1c). The improved compensation was most marked in diabetics treated by a combination of insulin and oral antidiabetics (by 2.3%); in the remaining groups treated with insulin alone, with diet alone and derivatives of sulphonyl urea by 1.0-1.4%. Individual education of diabetics, of sufficiently intense, contributes substantially to compensation and should be the basic working method in all diabetological surgeries. The prerequisite of success is a well trained diabetological nurse and dietitian.

The authors treated 20 diabetics (14 men and 6 women) in an open clinical trial with indapamide (Arifon, Zorka Co.) for a period of three months, using a morning dose of 2.5 mg. In 10 patients with hypertension stage I in all normalization of the systolic pressure below 18.6 kPa and diastolic pressure below 12 kPa was achieved. Treatment of patients with hypertension stage II was not adequate in 6 patients. In the course of treatment metabolic compensation of diabetes (type 1 or type 2) did not deteriorate. No changes in the blood lipid spectrum and mineral metabolism were recorded. Indapamide is an antihypertensive drug suitable for treatment of mild hypertension in diabetics as monotherapy.

The authors evaluate treatment by a combination of insulin and gliquidone (Glurenorm) in 29 type 2 diabetics where long-term treatment with oral antidiabetics alone had failed. Within four months all patients were completely compensated from the metabolic aspect. HbA1c declined from 10.8 to 6.5, C peptide, on the other hand, increased from the original value of 1.2 ng/ml to 1.8 ng/ml. The authors did not observe any undesirable effects or hypoglycaemic states. Gliquidone is suitable for combined treatment because of its short-term effect; stimulation of endogenous secretion has a pulsed character and imitates an intensified regime. The prerequisite of success is a low dose of intermediary insulin to prevent inhibition of the central action of gliquidone.

The author treated since 1985 on a long-term basis (for more than one year) 228 diabetic patients with an insulin pump. She gives an account for her experience of three years' treatment of 32 diabetics type 1 and 2, incl. 5 treated already for a period of 5 years. Eight type 1 diabetics treated on account of a great lability of the disease are free from specific complications. In 10 type 1 diabetics treated on account of developing nephropathy and neuropathy the condition has stabilized and does not develop further. In 14 type 2 diabetics progression of complications which led to the indication of pump treatment did not occur. Treatment had the most favourable effect on sensitive neuropathy and incipient nephropathy where a reduction of proteinuria was recorded. From the total number of 228 patients treated on a long-term basis in 31, on failure of the pump, decompensation occurred. Five of these patients developed ketosis which called for hospitalization. Clinically severe hypoglycaemia was observed only once.

The authors assessed the antihypertensive effect of guanfacine (Estulic Sandoz) in 28 stage II hypertensive patients with a pronounced pressure response to the isometric test. Over a period of 4.3 months on the average, they managed to normalise both resting and exercise blood pressure in 89% of subjects. In another study, the authors administered guanfacine to 30 I- and II- type diabetics with essential, primarily stage I, hypertension. Over an average of 6 months, blood pressure normalised in 81% and, when using a guanfacine-saluretic combination, in additional 11%, that is, in a total of 92% of patients. It has been demonstrated that guanfacine has no adverse metabolic action. By contrast, the level of compensation of diabetes mellitus improved allowing 50% of patients to decrease their doses of oral antidiabetic drugs and insulin as well. The authors believe that, in diabetics with hypertension, guanfacine can be rightly regarded as the drug of first choice since it is effective in single-drug therapy and can be used with advantage in patients with whatever complication of diabetes mellitus.

The author treated for prolonged periods 179 diabetics type I and II using an insulin pump. The shortest period of treatment was 6 months, the longest three years. Treatment failed only in six patients, i.e. in 3.3%, in all instances because they were incapable of adhering to the dietetic regime or to control the function of the pump. Complications had also mainly technical reasons, in 43 patients the pump failed and had to be replaced. Indicators of metabolic compensation reached normal levels in 173 patients and the triacylglycerol and cholesterol blood levels declined significantly. Laboratory hypoglycaemia was recorded in all patients, hypoglycaemia with clinical symptoms only in 17 patients. As to specific complications of diabetes, proteinuria and neuropathy were influenced most favourably. Long-term treatment with an insulin pump is useful in type I diabetes with metabolic lability and in obese type II diabetics where weight reduction is essential because of insulin resistance. So far the effectiveness of treatment with a pump to suppress permanently progression of specific complications is controversial.