The aim of this study was to examine the effects of hypoglycaemic drug-agonists of PPAR-gama receptors-rosiglitazone (Avandia,4 mg - Glaxo Smith Kline) on values of wide-spread risk - markers-fibrinogen, C-reactive protein and uric acid and glicolysated haemoglobin HbA1C as parameter of metabolic control .We included fourty patients with criteria for metabolic syndrome and evaluated results into groups of diabetic and prediabetic patients according to criteria of IDF (International Diabetic Federation)These risk markers and glicolysated haemoglobin HbA1C were observed at the start of therapy, then after four, eight and twelve weeks and results were compared and statistically calculated. Three months initial therapy with rosiglitazone significantly reduced values of HbA1C, fibrinogen and CRP but not uric acid in prediabetic patients.Rosiglitazone initial three months therapy significantly reduced HbA1C, fibrinogen and uric acid, but not CRP in diabetic patients.

UNLABELLED We aimed to determine whether the administration of statins to type 2 diabetics without pre-existing CHD reduced the incidence of CHD and their effects on cholesterol and CRP levels. All the participants were carefully interviewed, clinically examined, and laboratory tested to exclude conditions likely to provoke an inflammatory response that was an exclusion criterion. EXCLUSION CRITERIA Serious heart, liver or kidney problems, history of renal transplant, recent history of drug or alcohol abuse, HbA1c>10%, blood pressure >140/90 mmHg, BMI >35 kg/m2, triglycerides >3,0 mmol/dm3. 95 obese diabetics (mean age 60,9 years and BMI=31,59 kg/m2, diabetes duration more than 10 years) without pre-existing CHD, were included in the analysis and were randomized to simvastatin (25 female and 20 male used 40 mg simvastatin daily) or placebo (30 female and 20 male) group. After six months, simvastatin significantly lowered CRP levels by 19%, (p<0,01), cholesterol levels by 18%, TG levels by 8%, LDL levels by 20% and VLDL levels by 17%, whereas there was no change with placebo. After one year the difference sustained between groups. Coronary events were rarely in the simvastatin group (6,6%) than in the placebo group (14%). Coronary revascularizations were 4 in the placebo group and 1 in the simvastatin group. Rate of stroke was more often in the placebo group (18%) than in the simvastatin group (8,8%). So, reduction of acute CHD events is for 7,4% in the simvastatin group. Positive correlation was between CRP and CVD (r=0,29). Statin therapy reduced the risk of coronary heart disease in diabetics without CHD.

The incidence of cardiovascular diseases (CVD) in women, although lower than in men, increases dramatically after the menopause. Diabetes mellitus is a more powerful predictor of CHD risk and prognosis in women than in men. The aim of this study was to promote diet and physical activity (PA) regimen in order to decrease coronary risk in next years in postmenopausal women with impaired glucose tolerance. Methodological approach of this research is to compare data gathered trough prospective and retrospective analysis of anamnestic data, clinical research, diagnostic tests and biochemical parameters of 100 examinees, regarding the glycoregulation, lipid status, body mass indexes, incidence of hypertension, uric acid and fibrinogen level. The SCORE (Systematic Coronary Risk Evaluation) assessment system is derived from a large dataset of prospective European studies and predicts any kind of fatal CVD events over a ten-year period. It was documented that the then year risk of fatal CVD exerted a shift toward the lower percent value in postmenopausal women after proposed diet/PA regimen. In pre-menopausal women the estimated ten year risk of fatal CVD by SCORE was shifted toward the level below 1%. The risk of 15% and above was not documented after diet/physical activity regimen. The prevalence of the atherogenic lipid markers at the beginning and the end of the assay decreased for all investigated lipid parameters in the group of pre-menopausal women what was more than in postmenopausal ones. Presented data indicate that dietary regimen and physical activity are crucial factors in CVD prevention throughout menopause and beyond. Behavioral changes aimed at decreasing food intake and increasing energy expenditure, should be implemented in pre-menopausal period of life.

Elevated C-reactive protein (CRP) in association with hyperinsulinemia is a significant risk factor for cardiovascular diseases and that plays a key role in the development of the PCOS. We evaluated serum CRP level, before and after metformin therapy in obese women with polycystic ovarian syndrome (PCOS). Thirty five obese women with PCOS [BMI=28,2+/-1,84 kg/m2, aged 20-35 years] were studied. Patients received metformin orally the dose of 850 mg per day. The patients were carefully interviewed, clinically examined, and laboratory tested to eliminate conditions, probable to provoke an inflammatory response which was an exclusion criterion. Subjects were excluded if there was clinical or electrocardiographic evidence of coronary artery disease, a family history of coronary artery disease, a history of smoking, or concurrent oestrogen, antihypertensive, or lipid lowering medication. At all patients we determined CRP, insulin, C-peptide, luteinising hormone, follicle stimulating hormone, oestradiol, testosterone, prolactin, TSh, T3, T4, glucose, fibrinogen and lipid profile, before and after metformin treatment. Mean serum C-RP levels significantly decreased after metformin treatment ((6,37+/-1,72 vs. 1,67+/-0,73 mg/l; p<0,05). Level of insulin reduced for 37% after metformin treatment (234+/-68 vs. 148+/-39 pmol/l). Total cholesterol and low-density lipoprotein cholesterol levels decreased as well. Mean total testosterone levels decreased after metformin treatment too (3,21+/-0,91, vs. 2,31+/-0,72 nmol/l). Elevated serum CRP level significantly correlated to the hyperinsulinaemia (r=0,54). Metformin therapy in PCOS women reduces CRP level, hyperinsulinaemia and cardiovascular risk.

We examined the effects of treatment of subclinical hypothyroidism (SH) on metabolic control and hyperinsulinemia. The study included 53 patients ages 53.42+/-3.11 years, BMI = 28.43+/-1.67 kg/m2, with SH. Laboratory evaluation included serum free T3, free T4, TSH, thyroid antibodies, TGL, insulin, C-peptide and glucose during OGTT, HbA1c, CRP and level of lipids. Twelve SH patients (37.7 %) had diabetes mellitus (DM), 14 patients (26.4 %) had glucose intolerance (GI) and 35 patients were obese (66 %). All patients were treated with L-thyroxin (25-50 microg). Patients with DM and GI were treated with diabetic diet, physical activity and previously antidiabetics without change of doses. After the six months of treatment, patients had normal or limited TSH (8.43+/-2.14 vs. 4.22+/-1.23 ulU/ml), level of fasting insulin (176+/-42 vs. 119+/-30 pmol/l) significantly decreased, level of HbA1c (7.2+/-1.3 vs. 5.8+/-0.6 %) decreased as well. The level of fasting and postprandial glucose significantly decreased, level of CRP decreased as well. The level of total cholesterol, as well as triglycerides, HDL and LDL cholesterol were changed. The correlation between TSH and HbA1c was positive and significant. These data support an important role of treatment of SH in support metabolic control and insulin sensitivity.

LEAP is multicentric study in phase IV. The first aim was to affirm Lantus efficacy and safety in every day practice, in local conditions. The second aims were to verify therapy successful by measuring fast blood glucose (FBG) and HbA1c and to estimate patients' pleasure. Duration of study was 2 months. Lantus was administrated subcutaneously daily. Doses were individual. HbA1c was measured at the begining of therapy and at the last control. Blood glucose was measured every day. The study included patients who did not reach the control of glycemy, or patients with frequent hypoglycemic crysis, older then 6 year. LEAP study in Sarajevo included 114 patients. Fifty four patients (47%) were men, and 60 (53%) were women. 46% diabetics have type 1 of diabetes mellitus and 54% have type 2 diabetes mellitus. The results of study demonstrated statistically significant decreasing of FBG and HbA1c in both groups (I group--patients younger than 18 years and II group--patients older than 18 years), p<0.05. FBG in I group on the start of Lantus therapy was 9.9+/-3.9 mmol/l but on ending control was 8.7+/-4.4 mmol/l (p<0.05). HbA1c on start of therapy was 9.4+/-1.9%, but on end control was 8.0+/-1.8% (p<0.05). FBG in II group on start was 13.6+/-4.7 mmol/l but on finish was 7.3+/-2.9 mmol/l (p<0.01). HbA1c on start was 9.3+/-1.8% and on end was 7.2+/-1.2% (p<0.01). These results showed that the Lantus is very efficacious for good glycoregulation. Just for two months, HbA1c decreased for 2%. Undesirable effects were not registered. We concluded that Lantus is very safe. Most patients (89%) were satisfied with therapy.

Valsartan as angiotensin-II receptor antagonist in normotensive diabetic may provide kidney and heart protection. It also increases insulin receptor sensitivity. The aim of this study was to investigate the effect of valsartan on lipid profile in normotensive type 2 diabetic patients. Fifteen normotensive patients with type 2 diabetes mellitus, mean age 58.6+/-5.6 years, with mean BMI 28.6+/-2.5 kg/m2, were treated with valsartan in doses 20-80 mg per day. After a year of treatment with valsartan we witnessed significant decrease in total cholesterol level (6.8+/-1.4 to 5.4+/-0.9 mmol/l, p<0.05) and low density lipoprotein (LDL) from 4.5 to 2.7 mmol/l. Triglycerides were not affected significantly. Albumin excretion in urine significantly decreased. Level of basal insulin (from 256 to 78 pmol/l) has, also, decreased. In type 2 diabetes mellitus, the use of angiotensin-II receptor antagonists reduces the progression from micro to macro albuminuria. These results suggest that the angiotensin-II receptor antagonist decreases lipid serum levels in normotensive diabetes mellitus type 2 patients.