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BACKGROUND: Metabolic syndrome occurs more often among people living in poorer social conditions. The health status of the largest minority ethnic group in Hungary lags in many aspects behind that of the general population. METHODS: To estimate the prevalence of metabolic syndrome a screening was initiated in the city of Gyor among subjects aged 20-70 years who declared themselves as Gypsy. Subjects with known diabetes and cardiovascular disease were excluded. The diagnosis of metabolic syndrome was based on the ATP-III criteria. RESULTS: Among the 77 individuals screened (35 men, 42 women, age 46.9 ± 10.6 years, x ± SD) diabetes mellitus was found in 14 cases (18.2 %), and pre-diabetes (impaired fasting blood glucose (IFG) or impaired glucose tolerance (IGT) could be diagnosed in further 14 cases (18.2 %). Individual components of the metabolic syndrome occurred as follows: hypertension in 47 subjects (61.0 %), abnormal waist circumference in 40 individuals (51.9 %), abnormal HDL-cholesterol in 39 cases (50.6 %), abnormal triglycerides in 35 individuals (45.5 %) and abnormal fasting blood glucose in 15 subjects (19.5 %). Within the cohort metabolic syndrome could be diagnosed in 39 individuals (50.6 %) without a significant gender difference (males 20/35 = 57.1 %; women: 19/42 = 45.2 %, p>0.05). CONCLUSION: The occurrence of metabolic syndrome and that of glucose intolerance is high among adult Gypsy people in Hungary. In order to recognise cardio-metabolic risks and to prevent their cardiovascular consequences, continuous health promotion and adequate medical care should be provided for the Gypsy population in Hungary (Tab. 5, Ref. 32).

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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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The importance of measuring microalbuminuria is well established; however, controversy still exists regarding the type of urine specimen to be used for detecting early renal impairment of diabetic patients. To evaluate practical aspects, albumin concentration and albumin/creatinine ratio of first void urine samples as well as urinary albumin excretion in timed specimens were determined by immunoturbidimetric method 3 times within 3 weeks in 192 adult diabetic patients (136 men, 56 women; Type 1/Type 2 diabetes: 90/102; age: 51.4+/-10.8 yr; duration of diabetes: 15.3+/-9.1 yr; body mass index: 27.9+/-4.6 kg/m2; HbA1c: 8.54+/-1.46%; actual blood pressure: 138+/-14/82+/-8 mmHg; serum creatinine: 94+/-20 pmol/l; x+/-SD). According to the urinary albumin excretion values one-third of patients (31.2%-30.7%-34.4%) were normoalbuminuric (<30 mg/24 hr), more than half of the patients (55.8%-57.3%-53.6%) proved to be microalbuminuric (30-300 mg/24 hr), while the remaining group of patients (13.0%-12.0%-12.0%) was macroalbuminuric (>300 mg/24 hr). Comparing the results of successive measurements, good correlation was found between the same laboratory values (urinary albumin excretion: kappa=0.64, kappa=0.67; urinary albumin concentration: kappa=0.60, kappa=0.62; albumin/creatinine ratio: kappa=0.54, kappa=0.61; first vs second and second vs third measurements, respectively). The percentage of patients being in the same range of albuminuria (ie normo-, micro- or macroalbuminuria) at successive measurements was 79.7-81.2% with urinary albumin excretion values, 77.1-77.6% with urinary albumin concentration and 74.5-78.6% with albumin/creatinine ratio. Good correlation was found between urinary albumin excretion and urinary albumin concentration (kappa=0.54; 0.54; 0.57) and nearly the same correlation was observed between urinary albumin excretion and albumin/creatinine ratio (kappa=0.49; 0.47; 0.54) at the three consecutive measurements (n=192). Using values of urinary albumin excretion for comparison at all measurements, 79.3% sensitivity and 69.5% specificity were found for urinary albumin concentration, whereas 74.6% sensitivity and 68.8% specificity were documented for albumin/creatinine ratio. Beside the standard measurement of urinary albumin excretion in timed urine samples, the use of the more convenient morning urinary spot collection could also provide useful results (urinary albumin concentration or albumin/creatinine ratio) for detecting early renal involvement in diabetic patients.

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The medical history of a 14-year-old diabetic adolescent female patient is presented. The patient has been exclusively treated by human insulin since the manifestation of diabetes at age of 11. As a clinical curiosity lipoatrophy developed at different sites of insulin injections (upper arm, thigh, abdominal wall, buttock). The insulin administration technique by pen-devices was correct. The patient proved to be non-atopic without signs of insulin allergy on intracutan tests. On histological examination, "lipoblastoma-like" alterations without signs of local immune mechanisms and no inflammatory cell infiltrates were found at the site of lipoatrophy. The histological findings suggested dedifferentiation of adipose tissue mediated probably by elevated local tumor necrosis factor-alpha. Immunological consequences of previous human insulin treatment were documented by high insulin-specific IgG and IgE antibody titer, however, no clinical signs of immunogenic insulin resistance were found. Switching to insulin analogue (insulin lispro) before main meals no further lipoatrophic areas were observed despite of using human NPH-insulin for basal insulin supplementation. Insulin analogue (insulin lispro) may be useful for treating diabetic patients with lipoatrophy secondary to previous human insulin treatment.

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To assess the long-term metabolic control, immunochemical method was used for hemoglobin A1c (HbA1c) determinations in diabetic patients. The use of DCA 2000 device (Bayer) resulted in immediate (< 6 min) HbA1c values. The reproducibility of this method was acceptable (within-run coefficients of variations were 3.48% and 4.80%). A close, linear correlation (r = 0.974; p < 0.001; n = 106) between HbA1c-values measured simultaneously by DCA 2000 and DIAMAT (Bio-Rad, method: high pressure liquid chromatography) was observed in diabetic patients. The new immunochemical method proved to be simple and reliable. The immediate (within 6 min) result makes the therapeutic decision easier during the care of diabetic patients.

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In order to assess the characteristics of day-night blood pressure (BP) variation in normotensive and hypertensive non-insulin-dependent diabetic (NIDDM) patients with asymptomatic autonomic neuropathy, 54 NIDDM patients and 13 healthy control subjects were studied by casual BP measurements and 24-h ambulatory blood pressure monitoring. Signs but not symptoms of autonomic neuropathy were documented by results of standard cardiovascular function tests in each patient. Daytime (06:00-22:00) and nighttime (22:00-06:00) BP values were separately analyzed and delta day-night BP values and diurnal index were determined. Patients were classified as being normotensive or having hypertension according to the casual BP values and medical history. In normotensive NIDDM patients (n = 30), nighttime systolic BP was significantly higher, whereas delta day-night systolic and delta day night diastolic BP values as well as diurnal index were considerably lower than those in control subjects (n = 13). In hypertensive NIDDM patients (n = 24), similar alterations were found at higher BP levels. No significant difference was found in BP values if normoalbuminuric and microalbuminuric NIDDM patients were compared. 'Non-dipper' phenomenon could be found in normotensive and hypertensive NIDDM patients with asymptomatic autonomic neuropathy, suggesting that relative sympathetic overdrive due to incipient and predominantly parasympathetic impairment of cardiovascular innervation might play a role in early alterations of circadian BP variation.

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