Biomedical subjects
Publications and source records attributed to J Rybka.
A review on the lipid metabolism in IDDM and NIDDM. The paper deals with quantitative and qualitative lipid changes and their relationship with macrovascular diseases. Part of the paper is devoted also to practical problems of dietetic and medicamentous treatment of lipid disorders in diabetes and different hypolipidaemic agents are discussed in detail.
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Ischaemia, neuropathies and infections are predisposing factors for the development of ulceration of the diabetic foot. Diabetics have evidently a disposition for affections of the peripheral circulation and impaired regulation of the microcirculation as a result of autonomic neuropathy. The lower the driving pressure (in critical ischaemia), the more important are rheological factors and drugs which can influence them. These preparations include e.g. Trental (pentoxiphilline), Prostavasin (prostaglandin E1), Vessel due F (sulodexide). In advanced stages of ischaemic extremities oedema is a very adverse factor. Non-cardiac oedema can be very effectively handled by manual lymphatic drainage combined with intermittent one-segment pneumatic compression which was successfully used by the authors in ulcerations of the diabetic foot. One of the main general protective measures is adequate care of the foot and protective footwear for diabetics. After 3.5 years' use of protective footwear the authors recorded, consistent with data in the literature, a 50% reduction of relapses of ulcerations (and amputations). By examination on an EMED II apparatus abnormally high local pressures on the sole of risk patients can be detected and at the some time the protective effect of materials used for protective insoles can be tested. Active pharmacological and generally protective care of diabetic foot leads to a reduced number of amputations, in particular supracondylar ones by 50 or more per cent.
Insulin resistance which is the typical sign of NIDDM and the metabolic "X" syndrome is the basic problem of successful treatment of NIDDM. The author discusses therapeutic possibilities--biguanides, some new perspective pharmaceutical preparations and possibilities of combined treatment with PAD and insulin. Although it is not quite clear so far which treatment is the best, prevention of late diabetic complications, intensive NIDDM treatment must be focused on perfect control of the blood sugar level as well as on correction of associated metabolic abnormalities, as much as possible.
The Diabetes Control and Complications Trial--DCCT--is the longest and largest perspective study in the history of diabetes which provides evidence that reduction of the blood sugar level delays or prevents the development of late diabetic complications. The main conclusions of DCCT proved that correct metabolic control reduces the risk of late diabetes, and to the majority of patients with IDDM intensified treatment should be recommended. DCCT confirmed also the correctness of therapeutic recommendations given in the Saint Vincent declaration.
Although NIDDM is by far the most frequent form of diabetes, the pathogenesis is less clear and even more controversial than in IDDM. There is a heterogeneity of IDDM and NIDDM and there are reasons why the two types should be considered different diseases although we do not know exactly why. NIDDM is the result of a disbalance between insulin sensitivity and insulin secretion. Fully developed NIDDM syndrome calls for the concurrent existence of both main defects, i.e. insulin resistance and deteriorated B-cell function. It is important that the two defects must occur simultaneously, only then marked glucose intolerance develops. Concurrent hyperglycaemia and hyperinsulinaemia on fasting suggest severe insulin resistance. Investigations provide evidence that hyperinsulinaemia is a predictor of the final development of IGT and IDDM and it was demonstrated that hyperglycaemia is a predictor of development of NIDDM in Caucasians.
Diabetes mellitus type II-NIDDM--is characterized by insulin insufficiency and insulin resistance. The main therapeutic aim is to mitigate symptoms, achieve and maintain desirable body weight, achieve a normal blood sugar level and treat complications. The main principle of NIDDM therapy remains an adequate dietary programme with reduction of the total energy intake. The greatest problem of successful therapy remains dietary non-compliance of the patient. Oral antidiabetics--in particular sulphonyl urea, have been the basis of therapy for more than 30 years. But even on this point there are some controversial views. The author discusses some problems of the pharmacodynamics and pharmacokinetics of SU, clinical effectiveness, reasons for primary and secondary failure and presents a list of sulphonyl urea derivatives of the second generation.
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The authors investigated visually evoked potentials in 27 patients with diabetes mellitus type I and II. In 77.8% of the patients abnormal values of visually evoked responses were found. The authors did not find a significant relationship between the degree of diabetic retinopathy and the disorder of visually evoked potentials.
Diabetes and hypertension are independent risk factors of coronary heart disease as well as of other cardiovascular diseases, and their combination substantially enhances the risk. Hypertension is twice to four times as frequent in diabetics than in the non-diabetic population. The most frequent form is essential hypertension which affects the relatively most numerous group of the II diabetics but may occur also in type I diabetics. Insulin dependent diabetics suffer more frequently from "renal diabetic hypertension" and tend to develop hyporeninaemic hypoaldosteronism. Other types of hypertension found in diabetics are systolic hypertension and hypertension with orthostatic hypotension. In an effort to improve the adverse prognosis of diabetics with hypertension it is essential to pay systematic attention to early detection of high blood pressure, its differential diagnosis and treatment, and to detect, and if possible eliminate, other risk factors of cardiovascular diseases.
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