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UNLABELLED: The prevalence rate and clinical significance of the metabolic syndrome in type 1 diabetic patients are not well established. The aim of this study was to estimate the prevalence rate of the metabolic syndrome in adult patients with type 1 diabetes. Patients with type 1 diabetes (n=533; age: 35.6+/-11.6 years; duration of diabetes: 18.0+/-11.1 years; x+/-SD) were consecutively enrolled from 11 diabetes outpatient departments. Data on medical history, actual treatment, anthropometric and laboratory parameters as well as actual blood pressure were registered while eating habits and physical activity were evaluated by standardized questionnaires. The prevalence rate of the metabolic syndrome according to the ATP-III criteria was 31.1% (29.7% in men, 32.7% in women; p>0.05). Using the IDF criteria a higher overall prevalence rate of the metabolic syndrome (36.2%; [32,8% in men, 39.4% in women; p>0.05]) was observed. Comparing type 1 diabetic patients to the general population, the prevalence rate of the metabolic syndrome proved to be significantly higher in each age-group of patients with type 1 diabetes. According to the stepwise logistic regression analysis the metabolic syndrome in type 1 diabetic patients was associated in a decreasing ranking order of significance with waist circumference, serum triglycerides, female gender, antihypertensive medication, HDL-cholesterol, diastolic blood pressure and serum creatinine. CONCLUSIONS: The metabolic syndrome can frequently be detected and is predominantly associated with higher waist circumference in adult patients with type 1 diabetes in Hungary.

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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.

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UNLABELLED: The long-term benefit of acarbose treatment was studied prospectively 20 NIDDM patients on diet, and 20 IDDM patients were treated with acarbose and followed for six years. 5 NIDDM patients and 7 IDDM patients were dropped-out due to side-effects or planned pregnancy or price of the drug. In the NIDDM group, acarbose treatment had to be supplemented with sulfonylureas in six patients, and a conversion to insulin had to be carried out in two patients. At the end of the study, all of NIDDM patients had a significantly lowered fasting blood-glucose level as compared to the baseline value. In the IDDM group, the postprandial blood-glucose level (at 90 minutes after meal) was significantly decreased, whereas the fasting glucose level remained unchanged versus the baseline level. In both groups, the values of HbA1c and serum lipids were significantly better than before acarbose treatment. The frequency of hypoglycaemic episodes was decreased, the body weight was without significant change. In addition, five NIDDM patients with late sulfonylurea-resistance were also treated with acarbose and followed for two years. After six months of treatment, however, four out of the five patients had to be converted to insulin. CONCLUSIONS: 1. in both types of diabetes, acarbose is an effective drug and decreases the frequency of hypoglycaemic episodes, 2. NIDDM patients having diet in effectivity require sulfonylureas or insulin late if acarbose administered and 3. in IDDM patients acarbose subsides the postprandial hyperglycaemia and smoothes the daily blood-sugar profile.

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The six-year prospective data on 100 newly detected NIDDM patients aged 40-69 years were analysed. After careful and controlled dietetic training, the carbohydrate metabolism parameters (glycohaemoglobin, mean blood sugar level and glycosuria), the physical status, fundus picture and laboratory data (lipids and renal function) were examined yearly and the alterations of the treatment were registered. 24 patients dropped out during six years. 10 patients died. The carbohydrate status was also favourable and a moderate weight reduction was reached. After two years 59% of the patients proved well controlled. At the end of six years 41% of the patients were still well controlled merely by dietary means. The data were compared with those on 100 similarly detected new NIDDM patients whose education and control were provided by family physicians. There were non essential differences between the two groups in specific complications, BMI and lipids. The level of carbohydrate metabolism control was significantly better in the diabetic clinic-controlled patients; the proportion of sulfanylurea-treated patients was only 40.5% after six years compared with 73% among family physicians-controlled patients. The importance of a correct and controlled diet, good education and continuous control is emphasized.

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Diabetic patient material--presenting hyperglycaemic ketoacidotic episode--observed in Gyula and Szekszárd County Hospitals in period 1980-89, was reviewed by authors. 131 patients were admitted with 169 ketoacidotic episodes (among them 23 patients had 62 recurrences). The mean age of patients were 49.4 years (14-84 years), duration of diabetes 9.5 years (from one month to 45 years). The common cause of diabetic ketoacidosis was respiratory (26 per cent) and enteral (35.5 per cent) infection. The consciousness of patients had shown close correlation with the increase of blood sugar and urea nitrogen level as well as with the decreasing of the pH value of capillary blood. The first step of the therapy was the parenteral fluid intake with isotonic solution (in the first hour the average 1351 ml). In 18 patients fast-acting insulin (Novo Actrapid MC) was given by constant infusion, in the remaining cases intravenous or intramuscular low doses of the same insulin were administered. The importance of early potassium replacement, and the dangers of forced and rapid correction of acidosis is emphasized. Lethality related to episodes was 10 per cent, related to the patients 12.9 per cent. The number of ketoacidotic cases did not decrease parallel with the improvement of therapeutic possibilities, as it was experienced by their earlier evaluations. The importance of the prevention of acute metabolic disorders is outlined might be resulted from increasing the efficacy of patients education and better knowledge of GP's, as well.

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As an approach to the emotional attitude of diabetic patients, the attitude examination devised by Dunn et al. in 1986 (ATT39 test) was applied. Thirty-nine points were analyzed on the basis of 6 factors in order to assess the stress relating to the diabetes, the adaptation, the guilt feelings, the alienation, the awareness of the disease and the tolerance on the Likert scale. Analysis of the results of 128 diabetic patients demonstrated that, besides the appearance of stress, the emotional attitude of the subject to diabetes is characterized by good ability to cooperate, appropriate awareness of the disease, adaptive tolerance and slight guilt feelings. The data were also evaluated with respect to the quality of metabolic control, age, sex, duration of disease, educational level and type of diabetes. Contrary to expectations, quality of control and duration of disease did not influence the emotional attitude towards diabetes, but this attitude was correlated to type of diabetes, complications and sex of the patients. The results of the attitude examination of 34 type I diabetic patients were compared with the data from other pyschological surveys (personality and performance tests), and a good correlation was found between emotional characteristics and results of the personality tests. It was concluded that the attitude examination can readily be carried out, and provides a basis that can be appropriately utilized in the care of diabetic patient.

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Authors give case history of two patients for type II diabetes treated with insulin by whom with monocomponent insulin lipoatrophy developed on the region of insulin administration. In the case of one of them the problem was solved by elimination of technical fault, the local reaction of other patient ceased only by converting to human insulin into the lipoatrophic region. In the latter case dynamics of contemporaneous psoriatic change raises immunological connections.

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In the treatment of patients suffering from therapy-resistant hypertension the angiotensin converting enzyme inhibitor captopril seems to be one of the most promising drugs of the past decade. The authors examined and followed the effect of captopril (Tensiomin) for one year in 13 severe therapy-resistant hypertensive patients. The average arterial blood pressure of 12 patients suffering from essential hypertension and 1 patient with renal hypertension was, before the introduction of captopril therapy, 215/120 mmHg (SD +/- 23/18). At the end of the one-year examination period the average blood pressure was 186/111 mmHg (SD +/- 25/19). The acute effect of captopril was found to be very favourable, and the required blood pressure fall could be obtained during its long-term use even in cases of renal failure. Except for one case multiple combination therapy had to be applied in all patients for the moderation of blood pressure (in 5 cases 4, in 2 cases 5, in 1 case 6 drugs). The long-term use of the drug did not influence notably the serum potassium-carbamide-creatinine and SGOT values or the white blood cell count. On the basis of their results the authors emphasize that the therapeutic effectivity of captopril monotherapy is not sufficient in severe therapy-resistant hypertension cases, its adjuvant action may be expected in drug combinations. With daily doses lower than 200 mg demonstrable side-effects did not occur.

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Assessment of the question of the 'diabetic personality' in the literature is not completely unambiguous. For the first time in Hungary, personality examinations were performed in 53 young (average age 24.9 years) insulin-dependent patients; 20 young patients with ulcers served as controls. Three different psychological tests were carried out, and data were also obtained on the treatment, knowledge concerning the disease and way of life by means of questionnaires and interviews. On the basis of the results, it was concluded that there is no special 'diabetic personality'. Psycho-emotional factors exert an influence in all stages of the disease, in exactly the same way as in subjects with other chronic diseases. The need is emphasized for individual psychotherapy.

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