1
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Winkler G, Folyovich A, Kis JT, Dancs T, Schandl L. [Cardio- and neuroprotective role of glucagon-like receptor-1 agonists in reducing the incidence of ischemic stroke accompanying type 2 diabetes]. Orv Hetil 2024; 165:489-498. [PMID: 38555568 DOI: 10.1556/650.2024.33012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/12/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Gábor Winkler
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
- 3 Miskolci Egyetem, Egészségtudományi Kar, Elméleti Egészségtudományi Intézet Miskolc Magyarország
| | - András Folyovich
- 2 Észak-budai Szent János Centrumkórház, Neurológiai Osztály - Stroke Centrum Budapest Magyarország
| | - János Tibor Kis
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
| | - Tamara Dancs
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
| | - László Schandl
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
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Arapovicsné Kiss K, Tóth A, Schandl L, Kiss Z, Winkler G, Kis JT. [Immunotherapy of type 1 diabetes mellitus]. Orv Hetil 2024; 165:363-369. [PMID: 38461453 DOI: 10.1556/650.2024.33000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 01/14/2024] [Indexed: 03/12/2024]
Abstract
Az 1-es típusú diabetes mellitus krónikus lefolyású, progrediáló természetű
autoimmun betegség. A genetikai, immunológiai és a kezdeti anyagcsere-eltérések
jóval megelőzik a klinikai tünetek jelentkezését, ami már régóta felvetette
annak lehetőségét, hogy a betegség kialakulását késleltessük, megakadályozzuk,
esetleg visszafordítsuk. Sajnos a prevenciót célzó klinikai vizsgálatok sokáig
nem hoztak átütő sikert. A közelmúltban azonban az immunológiai kezelés elérte
azt a stádiumot, amelyben az intervenció előnyei meghaladják a kezeléssel járó
kockázatot. E lehetőségek napi gyakorlatba ültetése, az inzulinkezelés
késleltetésének lehetősége át fogja formálni a betegség kezelésének, illetve az
1-es típusú cukorbetegség tekintetében a nagy kockázatú betegek felkutatásának
eddigi stratégiáját. A szerzők összefoglalják az e kórforma immunterápiájával
kapcsolatos legfontosabb ismereteket. Orv Hetil. 2024; 165(10): 363–369.
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Affiliation(s)
- Krisztina Arapovicsné Kiss
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
| | - Anna Tóth
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
| | - László Schandl
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
| | - Zsófia Kiss
- 2 Betegápoló Irgalmas Rend, Budai Irgalmasrendi Kórház, Allergológia és Immunológia Budapest Magyarország
| | - Gábor Winkler
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
- 3 Miskolci Egyetem, Egészségtudományi Kar, Elméleti Egészségtudományi Intézet Miskolc Magyarország
| | - János Tibor Kis
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
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Winkler G, Kis JT, Arapovicsné Kiss K, Schandl L. [From GLP1 receptor agonists to triple hormone receptor activation supplemented with glucagon receptor agonism.]. Orv Hetil 2023; 164:1656-1664. [PMID: 37865924 DOI: 10.1556/650.2023.32894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/05/2023] [Indexed: 10/24/2023]
Abstract
Following the introduction of mono- and then dual hormone (incretin) receptor agonists into therapy, attention was turned to multiple receptor stimulation, with the additional activation of the glucagon receptor, as a new option for the pharmaceutical treatment of type 2 diabetes and obesity. In addition to its role in carbohydrate metabolism, the article reviews the other important physiological tasks of glucagon, especially its participation in intrainsular paracrine regulation, energy expenditure and the shaping of appetite and food consumption. It covers the potential benefits of the triple combination and briefly touches data on the efficacy and safety of the first triple receptor agonist drug, retatrutide, in preclinical human studies. Further confirmation of the promising results may represent progress in the treatment of these forms of disease and their accompanying conditions, such as steatosis hepatis. Orv Hetil. 2023; 164(42): 1656-1664.
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Affiliation(s)
- Gábor Winkler
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
- 2 Miskolci Egyetem, Egészségtudományi Kar, Elméleti Egészségtudományi Intézet Miskolc Magyarország
| | - János Tibor Kis
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
| | - Krisztina Arapovicsné Kiss
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
| | - László Schandl
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
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Tomasics G, Schandl L, Polyák A, Winkler G. [Diabetes mellitus and the intestinal microbiome]. Orv Hetil 2023; 164:981-987. [PMID: 37356017 DOI: 10.1556/650.2023.32788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/30/2023] [Indexed: 06/27/2023]
Abstract
The intestinal microbiome plays an important role in the body's physiological processes. One of its most decisive roles is the production of short-chain fatty acids, which has crucial importance in the maintenance of an intact intestinal barrier and immune homeostasis. Dysbiosis in the microbiome caused by dietary habits, regular medication use, and other factors can result in damage to the barrier function, which triggers the translocation of lipopolysaccharides into the portal circulation. By maintaining subclinical inflammation, these can lead to the development of obesity, insulin resistance, and fatty liver. The entry of pathogenic bacteria into the portal circulation can cause beta cell destruction through molecular mimicry and consequent autoimmunity. Both mechanisms can lead to diabetes mellitus. The paper reviews the changes in the intestinal microbiome in type 1 and type 2 diabetes mellitus, detailing experimental and clinical data. It points out that even though our knowledge is not yet sufficient to help daily clinical practice, the expansion of data can help the prognostic use of some results. All this, however, requires further investigations and observations. Orv Hetil. 2023; 164(25): 981-987.
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Affiliation(s)
- Gyula Tomasics
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
| | - László Schandl
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
| | - Annamária Polyák
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
| | - Gábor Winkler
- 1 Észak-budai Szent János Centrumkórház, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
- 2 Miskolci Egyetem, Egészségtudományi Kar, Elméleti Egészségtudományi Intézet Miskolc Magyarország
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Winkler G, Kis JT, Schandl L. [The "other" incretin - the therapeutic rediscovery of the glucose-dependent insulinotropic polypeptide]. Orv Hetil 2023; 164:210-218. [PMID: 36774634 DOI: 10.1556/650.2023.32710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 02/13/2023]
Abstract
Among the two incretins that strongly stimulate insulin secretion and are also involved in its physiological regulation in type 2 diabetes, glucagon-like peptide-1 (GLP1) has been the focus of interest for a long time, due to its retained - although reduced - secretagogue nature also in type 2 diabetes. Its receptor agonists were also included in the antidiabetic treatment toolkit. In the light of more recent studies, however, the "other" incretin, the glucose-dependent insulinotropic polypeptide (GIP) has also come into a different light. It turned out that by regulating glucagon and insulin production according to blood sugar levels, it acts as a bifunctional blood sugar stabilizing factor in type 2 diabetes as well. The article reviews new data on the physiology of GIP, its verifiable effects in type 2 diabetes and obesity, the so-called "twincretin" effect as well as the benefits of the double stimulation of the GIP and the GLP1 receptor. It describes the pharmacology of the first dual receptor agonist, tirzepatide, already incorporated in therapeutic recommendations, and the first clinical trials related to its use. In the light of the data so far, the molecule may open new horizons in the treatment of type 2 diabetes and obesity. Orv Hetil. 2023; 164(6): 210-218.
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Affiliation(s)
- Gábor Winkler
- 1 Észak-Közép-budai Centrum, (ÉKC) Új Szent János Kórház és Szakrendelő, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország.,2 Miskolci Egyetem, Egészségtudományi Kar, Elméleti Egészségtudományi Intézet Miskolc Magyarország
| | - János Tibor Kis
- 1 Észak-Közép-budai Centrum, (ÉKC) Új Szent János Kórház és Szakrendelő, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
| | - László Schandl
- 1 Észak-Közép-budai Centrum, (ÉKC) Új Szent János Kórház és Szakrendelő, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország
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6
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Winkler G, Wittmann I. [Fat tissue as the primary target organ of insulin resistance in diabetes mellitus.]. Orv Hetil 2023; 164:3-10. [PMID: 36617350 DOI: 10.1556/650.2023.32680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/30/2022] [Indexed: 01/09/2023]
Abstract
Insulin resistance is a pathological condition in which the effect of endogenous or externally administered (exogenous) insulin to promote tissue glucose uptake and utilization falls short of that observed in metabolically healthy individuals. It affects the entire organism, but the pathogenetic and underlying molecular biological processes of its selected target tissues - the liver, muscle and adipose tissue - are partially different. Recently, knowledge about the role of adipose tissue has expanded significantly, and it increasingly seems that dysfunctional adipose tissue is the central player in these pathological events. The manuscript reviews the structure of adipose tissue, the regulation of adipogenesis and lipolysis, data on the relationship between the microbiome and adipose tissue, the typical differences of the acute and chronic insulin resistance as well as the therapeutic tools currently available to reduce adipose tissue insulin resistance. It may well be that a molecule with a selective adipose tissue attack point and enabling safe long-term use in humans is not yet within the hoped-for proximity, the first animal experimental observations related to the first "adipeuticum" being under development outline the promise of a new treatment option. Orv Hetil. 2023; 164(1): 3-10.
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Affiliation(s)
- Gábor Winkler
- 1 Észak-Közép-budai Centrum, Új Szent János Kórház és Szakrendelő, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1-3., 1125 Magyarország.,2 Miskolci Egyetem, Egészségtudományi Kar, Elméleti Egészségtudományi Intézet Miskolc Magyarország
| | - István Wittmann
- 3 Pécsi Tudományegyetem, Általános Orvostudományi Kar, II. Belgyógyászati Klinika, Nephrológiai és Diabetológiai Centrum Pécs Magyarország
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7
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Winkler G, Kis JT, Schandl L. Indokolt-e a klasszifikáció módosítása diabetesben? Orv Hetil 2022; 163:1909-1916. [DOI: 10.1556/650.2022.32639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/22/2022] [Indexed: 12/02/2022]
Abstract
A diabetes mellitus heterogén etiopatogenezisű és klinikai viselkedésű kórforma.
Egyes eseteinek pontos típusba sorolása, „klasszifikációja” meghatározó
jelentőségű az optimális kezelésválasztás tekintetében. A tipizálás azonban a
rendelkezésre álló, egyre szélesedő eszközpark és a rohamosan bővülő ismeretek
ellenére még mindig nem teljesen megoldott. Ezért újabb ajánlások születnek a
csoportba sorolás pontosítására. A közlemény áttekinti a nemzetközi konszenzus
alapján, az Egészségügyi Világszervezet (WHO) koordinálásával 1965 és 2019
között született klasszifikációs irányelveket, valamint az újabb vizsgálatok,
megfigyelések alapján született javaslatokat. Megállapítja, hogy a napi
gyakorlat számára továbbra is a WHO hatályos útmutatása a legorientálóbb,
hozzátéve, hogy bizonytalan besorolású esetekben elengedhetetlen a betegek
követése és a vizsgálatok szükség szerinti ismétlése mindaddig, amíg az adott
kórforma természete nem tisztázódik. Orv Hetil. 2022; 163(48): 1909–1916.
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Affiliation(s)
- Gábor Winkler
- Észak-Közép-budai Centrum, Új Szent János Kórház és Szakrendelő, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1–3., 1125 Magyarország
- Miskolci Egyetem, Egészségtudományi Kar, Elméleti Egészségtudományi Intézet Miskolc Magyarország
| | - János Tibor Kis
- Észak-Közép-budai Centrum, Új Szent János Kórház és Szakrendelő, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1–3., 1125 Magyarország
| | - László Schandl
- Észak-Közép-budai Centrum, Új Szent János Kórház és Szakrendelő, II. Belgyógyászat-Diabetológia Budapest, Diós árok 1–3., 1125 Magyarország
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Winkler G, Helleberg N. Nudging – die gesunde und nachhaltigere
Ernährung einfacher machen. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- G Winkler
- Hochschule Albstadt-Sigmaringen, Life Sciences, Sigmaringen,
Deutschland
| | - N Helleberg
- Ernährungsinstitut KinderLeicht, München,
Deutschland
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9
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Winkler G. GLP1-receptor-agonisták a 2-es típusú diabetes vércukorcsökkentő kezelésében. Orv Hetil 2022; 163:1144-1151. [DOI: 10.1556/650.2022.32547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/23/2022] [Indexed: 11/21/2022]
Abstract
A glükagonszerű peptid-1 receptorának agonistái napjainkban a 2-es típusú
diabetes vércukorcsökkentő kezelésének meghatározó készítményei. Mára
kikristályosodtak adásuk lehetőségei: a fel- (step-up) és a leépítő (step-down),
vagy elterjedt új keletű kifejezéssel, a deeszkalációs antidiabetikumkezelésben
való részvételük, a már hozzáférhető oralis változatnak a parenteralis
készítményformával szemben mutatkozó előnyei és potenciális hátrányai, valamint
a bázisinzulinnal kombinált, fix összetételű változataik lehetséges
differenciálási lehetőségei. E kérdéseket tekinti át munkánk, de kitér a
gyógyszercsoporttal kapcsolatos újabb kutatásokra, a fejlesztés alatt álló új,
részben kombinációs készítményekre is. Felhívja a figyelmet e csoport képviselői
– elsősorban hosszú hatású származékai − korai alkalmazásának jelentőségére,
cardiorenalis védőhatására és a még szélesebb körű használatuk érdekében
szükséges folyamatos orvosszakmai tájékoztatás, valamint betegedukáció
fontosságára. Orv Hetil. 2022; 163(29): 1144–1151.
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Affiliation(s)
- Gábor Winkler
- Észak-Közép-budai Centrum, Új Szent János Kórház és Szakrendelő Budapest, Diós árok 1–3., 1125 Magyarország
- Miskolci Egyetem, Egészségtudományi Kar, Elméleti Egészségtudományi Intézet Miskolc Magyarország
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10
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Winkler G, Perner LW, Truong GW, Zhao G, Bachmann D, Mayer AS, Fellinger J, Follman D, Heu P, Deutsch C, Bailey DM, Peelaers H, Puchegger S, Fleisher AJ, Cole GD, Heckl OH. Mid-infrared interference coatings with excess optical loss below 10 ppm. Optica 2021; 8:10.1364/OPTICA.405938. [PMID: 36578655 PMCID: PMC9793494 DOI: 10.1364/optica.405938] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/22/2021] [Indexed: 05/23/2023]
Abstract
We present high-reflectivity substrate-transferred single-crystal GaAs/AlGaAs interference coatings at a center wavelength of 4.54 μm with record-low excess optical loss below 10 parts per million. These high-performance mirrors are realized via a novel microfabrication process that differs significantly from the production of amorphous multilayers generated via physical vapor deposition processes. This new process enables reduced scatter loss due to the low surface and interfacial roughness, while low background doping in epitaxial growth ensures strongly reduced absorption. We report on a suite of optical measurements, including cavity ring-down, transmittance spectroscopy, and direct absorption tests to reveal the optical losses for a set of prototype mirrors. In the course of these measurements, we observe a unique polarization-orientation-dependent loss mechanism which we attribute to elastic anisotropy of these strained epitaxial multilayers. A future increase in layer count and a corresponding reduction of transmittance will enable optical resonators with a finesse in excess of 100 000 in the mid-infrared spectral region, allowing for advances in high resolution spectroscopy, narrow-linewidth laser stabilization, and ultrasensitive measurements of various light-matter interactions.
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Affiliation(s)
- G Winkler
- Christian Doppler Laboratory for Mid-IR Spectroscopy and Semiconductor Optics, Faculty Center for Nano Structure Research, Faculty of Physics, University of Vienna, Boltzmanngasse 5, 1090 Vienna, Austria
| | - L W Perner
- Christian Doppler Laboratory for Mid-IR Spectroscopy and Semiconductor Optics, Faculty Center for Nano Structure Research, Faculty of Physics, University of Vienna, Boltzmanngasse 5, 1090 Vienna, Austria
| | - G-W Truong
- Crystalline Mirror Solutions, Santa Barbara, CA and Vienna, Austria
- Thorlabs Crystalline Solutions, 114 E Haley St., Suite G, Santa Barbara, CA 93101 USA
| | - G Zhao
- Material Measurement Laboratory, National Institute of Standards and Technology, 100 Bureau Drive, Gaithersburg, MD 20899 USA
| | - D Bachmann
- Crystalline Mirror Solutions, Santa Barbara, CA and Vienna, Austria
| | - A S Mayer
- Christian Doppler Laboratory for Mid-IR Spectroscopy and Semiconductor Optics, Faculty Center for Nano Structure Research, Faculty of Physics, University of Vienna, Boltzmanngasse 5, 1090 Vienna, Austria
| | - J Fellinger
- Christian Doppler Laboratory for Mid-IR Spectroscopy and Semiconductor Optics, Faculty Center for Nano Structure Research, Faculty of Physics, University of Vienna, Boltzmanngasse 5, 1090 Vienna, Austria
| | - D Follman
- Crystalline Mirror Solutions, Santa Barbara, CA and Vienna, Austria
- Thorlabs Crystalline Solutions, 114 E Haley St., Suite G, Santa Barbara, CA 93101 USA
| | - P Heu
- Crystalline Mirror Solutions, Santa Barbara, CA and Vienna, Austria
| | - C Deutsch
- Crystalline Mirror Solutions, Santa Barbara, CA and Vienna, Austria
| | - D M Bailey
- Material Measurement Laboratory, National Institute of Standards and Technology, 100 Bureau Drive, Gaithersburg, MD 20899 USA
| | - H Peelaers
- Department of Physics & Astronomy, University of Kansas, 1251 Wescoe Hall Dr., Lawrence, KS 66045 USA
| | - S Puchegger
- Faculty Center for Nano Structure Research, Faculty of Physics, University of Vienna, Boltzmanngasse 5, 1090 Vienna, Austria
| | - A J Fleisher
- Material Measurement Laboratory, National Institute of Standards and Technology, 100 Bureau Drive, Gaithersburg, MD 20899 USA
| | - G D Cole
- Crystalline Mirror Solutions, Santa Barbara, CA and Vienna, Austria
- Thorlabs Crystalline Solutions, 114 E Haley St., Suite G, Santa Barbara, CA 93101 USA
| | - O H Heckl
- Christian Doppler Laboratory for Mid-IR Spectroscopy and Semiconductor Optics, Faculty Center for Nano Structure Research, Faculty of Physics, University of Vienna, Boltzmanngasse 5, 1090 Vienna, Austria
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Abstract
Confirming or ruling out the presence of insulin resistance (IR) is one of the most common reasons for referral to non-diabetics in Hungary for diabetes outpatient units. The article overviews the concept of IR, its importance in pathophysiology, the diagnostic capabilities, and its treatment implications. It emphasizes that the decline in insulin activity is a co-morbidity of many diseases and does not, in itself, require detailed examination without other symptoms. If this occurs, it is sufficient to calculate the HOMA-IR value and determine fasting blood glucose and serum insulin levels for information purposes. If it is confirmed as part of a comorbid condition, complex treatment is required. Orv Hetil. 2020; 161(26): 1088-1093.
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Affiliation(s)
- Gábor Winkler
- Új Szent János Kórház és Szakrendelő, II. Belgyógyászat-Diabetológia,Észak-Közép-budai Centrum Budapest, Diós árok 1-3., 1125.,Egészségügyi Kar,Miskolci Egyetem Miskolc
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12
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Winkler G, Hajós P, Kiss JT. [Glucagon-like peptide-1 (GLP1) and the gastrointestinal tract. GLP1 receptor agonists: overemphasized gastric, forgotten intestinal ("ileal brake") effect?]. Orv Hetil 2019; 160:1927-1934. [PMID: 31786941 DOI: 10.1556/650.2019.31615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Glucagon-like peptide-1 (GLP1) and their receptor agonists - beside their blood glucose lowering and central effects- affect also the gastrointestinal function in many respects. They slow down the stomach emptying, the motility of the small bowel and colon - this is the explanation for the "ileal brake" terminology -, stimulate the function of exocrine pancreatic acinar cells and increase amylase production. GLP1 receptor agonists belong to the defining tools of the blood glucose lowering therapy in type 2 diabetes. Their long- and short-acting derivatives have different influence on the fasting and the postprandial blood glucose, respectively. By introducing the term non-prandial and prandial type analogues - which seems to be forced in light of the newer data - the potential slowdown in gastric emptying is the center of interest, lately, however, especially in the case of long-acting GLP1 variants, at least such attention should be paid to controlling bowel function. The article reviews the physiological effects of GLP1 on the gastrointestinal tract and draws attention to the potential for the prevention of possible side effects through detailed patient information and dietary advises. Orv Hetil. 2019; 160(49): 1927-1934.
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Affiliation(s)
- Gábor Winkler
- II. Belgyógyászat-Diabetológia, Észak-Közép-budai Centrum, Új Szent János Kórház és Szakrendelő Budapest, Diós árok 1-3., 1125.,Elméleti Egészségtudományi Intézet, Miskolci Egyetem, Egészségügyi Kar Miskolc
| | - Péter Hajós
- II. Belgyógyászat-Diabetológia, Észak-Közép-budai Centrum, Új Szent János Kórház és Szakrendelő Budapest, Diós árok 1-3., 1125
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Truong GW, Winkler G, Zederbauer T, Bachmann D, Heu P, Follman D, White ME, Heckl OH, Cole GD. Near-infrared scanning cavity ringdown for optical loss characterization of supermirrors. Opt Express 2019; 27:19141-19149. [PMID: 31503677 DOI: 10.1364/oe.27.019141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 05/09/2019] [Indexed: 06/10/2023]
Abstract
A cavity ringdown system for probing the spatial variation of optical loss across high-reflectivity mirrors is described. This system is employed to examine substrate-transferred crystalline supermirrors and to quantify the effect of manufacturing process imperfections. Excellent agreement is observed between the ringdown-generated spatial measurements and differential interference contrast microscopy images. A 2-mm diameter ringdown scan in the center of a crystalline supermirror reveals highly uniform coating properties with excess loss variations below 1 ppm.
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Smith A, Guenther P, Winkler G, McKnight R. Note on the Prompt-Fission-Neutron Spectra of Uranium-233 and -235 and Plutonium-239 and -240 Relative to That of Californium-252. NUCL SCI ENG 2017. [DOI: 10.13182/nse80-a21327] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- A. Smith
- Argonne National Laboratory, Applied Physics Division 9700 South Cass A venue, Argonne, Illinois 60439
| | - P. Guenther
- Argonne National Laboratory, Applied Physics Division 9700 South Cass A venue, Argonne, Illinois 60439
| | - G. Winkler
- Argonne National Laboratory, Applied Physics Division 9700 South Cass A venue, Argonne, Illinois 60439
| | - R. McKnight
- Argonne National Laboratory, Applied Physics Division 9700 South Cass A venue, Argonne, Illinois 60439
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Winkler G, Spiegel V, Eisenhauer CM, Smith DL. Measurement of the Average Activation Cross Section for the Reaction 63Cu(n, α)60Co in the Spontaneous Fission Neutron Field of Californium-252. NUCL SCI ENG 2017. [DOI: 10.13182/nse81-a21377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- G. Winkler
- Institut für Radiumforschung und Kernphysik Boltzmanngasse 3, A-1090 Vienna, Austria
| | - V. Spiegel
- National Bureau of Standards, Center for Radiation Research Washington, D. C 20234
| | - C. M. Eisenhauer
- National Bureau of Standards, Center for Radiation Research Washington, D. C 20234
| | - D. L. Smith
- Argonne National Laboratory, Applied Physics Division 9700 South Cass Avenue, Argonne, Illinois 60439
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Affiliation(s)
- G. Winkler
- Institut für Radiumforschung und Kernphysik A-I090 Wien, Boltzmanngasse 3, Austria
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17
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Affiliation(s)
- G. Winkler
- Argonne National Laboratory, Applied Physics Division 9700 South Cass Ave., Argonne, illinois 60439
| | - Donald L. Smith
- Argonne National Laboratory, Applied Physics Division 9700 South Cass Ave., Argonne, illinois 60439
| | - James W. Meadows
- Argonne National Laboratory, Applied Physics Division 9700 South Cass Ave., Argonne, illinois 60439
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Affiliation(s)
- A. Pavlik
- Institut fur Radiumforschung und Kernphysik der Universitat Wien und der Osterreichischen Akademie der Wissenschaften, Boltzmanngasse 3, A-1090 Vienna, Austria
| | - G. Winkler
- Institut fur Radiumforschung und Kernphysik der Universitat Wien und der Osterreichischen Akademie der Wissenschaften, Boltzmanngasse 3, A-1090 Vienna, Austria
| | - M. Uhl
- Institut fur Radiumforschung und Kernphysik der Universitat Wien und der Osterreichischen Akademie der Wissenschaften, Boltzmanngasse 3, A-1090 Vienna, Austria
| | - A. Paulsen
- Commission of the European Communities, Joint Research Center, Central Bureau for Nuclear Measurements, Steenweg op Retie, B-2440 Geel, Belgium
| | - H. Liskien
- Commission of the European Communities, Joint Research Center, Central Bureau for Nuclear Measurements, Steenweg op Retie, B-2440 Geel, Belgium
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Herr C, Brenner B, Thekoke J, Nehr S, Winkler G. Erfahrung mit dem LAI Leitfaden bei der Bewertung von Bioaerosoleemissionen aus Anlagen. Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1602110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- C Herr
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, München
| | - B Brenner
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, München
| | - J Thekoke
- Verein Deutscher Ingenieure, Düsseldorf
| | - S Nehr
- Verein Deutscher Ingenieure, Düsseldorf
| | - G Winkler
- Bayerisches Landesamt für Umwelt, Augsburg
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Domján BA, Ferencz V, Tänczer T, Szili-Janicsek Z, Barkai L, Hidvégi T, Jermendy G, Kempler P, Winkler G, Gerő L, Tabák AG. Large increase in the prevalence of self-reported diabetes based on a nationally representative survey in Hungary. Prim Care Diabetes 2017; 11:107-111. [PMID: 27669637 DOI: 10.1016/j.pcd.2016.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 08/22/2016] [Accepted: 09/03/2016] [Indexed: 11/19/2022]
Abstract
AIMS To estimate and compare the prevalence of self-reported diabetes based on nationally representative surveys of the Hungarian adult population in 2002 (published data - Hungarostudy) and a survey in 2012. METHODS A cross-sectional computer-assisted telephone interview survey on a stratified representative sample of community-dwelling adults (n=1000) in 2012. To describe self-reported diabetes prevalence and its temporal changes generalized linear models were used and results were compared to figures from Hungarostudy. RESULTS Age standardized prevalence of self-reported type 2 diabetes was 11.7% (95%CI 10.0-13.8%) without gender or rural-urban differences in 2012. People with self-reported diabetes were older than controls (mean [SE]: 63.9 [0.9] vs. 45.9 [0.3] years, p<0.0001). The prevalence of diabetes sharply increased after 40 years of age and peaked at age 70 (27.7% [2.5], page*age<0.0001). The prevalence of self-reported diabetes increased by 89% (OR 1.89, 95%CI 1.53-2.32) from 6.2 to 11.7% between the two surveys with the most pronounced increase in the age group 55-64 years (from 11.6 to 24.4%). CONCLUSIONS We reported an alarming increase in the prevalence of self-reported type 2 diabetes in the last decade that mostly affects working age people. If this trend continues, a major public health crisis in Hungary can be envisaged.
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Affiliation(s)
- Beatrix A Domján
- 1st Department of Medicine, Semmelweis University Faculty of Medicine, Korányi S. u. 2/a, Budapest H-1083, Hungary.
| | - Viktória Ferencz
- 1st Department of Medicine, Semmelweis University Faculty of Medicine, Korányi S. u. 2/a, Budapest H-1083, Hungary.
| | - Tímea Tänczer
- 1st Department of Medicine, Semmelweis University Faculty of Medicine, Korányi S. u. 2/a, Budapest H-1083, Hungary.
| | - Zsófia Szili-Janicsek
- 1st Department of Medicine, Semmelweis University Faculty of Medicine, Korányi S. u. 2/a, Budapest H-1083, Hungary.
| | - László Barkai
- Institute of Theoretical Health Sciences, Faculty of Health Care, University of Miskolc, Egyetem út, Miskolc H-3515, Hungary; Velkey László Center for Child Health, Borsod County University Hospital, Szentpéteri kapu 72-76, Miskolc H-3526, Hungary; Postgraduate Institute of Pediatrics, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen H-4032, Hungary.
| | - Tibor Hidvégi
- Department of Internal Medicine, Aladár Petz County Hospital, Vasvári Pál utca 2-4, Győr H-9023, Hungary.
| | - György Jermendy
- Department of Medicine, Bajcsy-Zsilinszky Hospital, Maglódi út 89-91, Budapest H-1106, Hungary.
| | - Péter Kempler
- 1st Department of Medicine, Semmelweis University Faculty of Medicine, Korányi S. u. 2/a, Budapest H-1083, Hungary.
| | - Gábor Winkler
- Institute of Theoretical Health Sciences, Faculty of Health Care, University of Miskolc, Egyetem út, Miskolc H-3515, Hungary; Department of Medicine and Diabetology, Saint John's Hospital, Diós árok 1, Budapest H-1125, Hungary.
| | - László Gerő
- 1st Department of Medicine, Semmelweis University Faculty of Medicine, Korányi S. u. 2/a, Budapest H-1083, Hungary.
| | - Adam G Tabák
- 1st Department of Medicine, Semmelweis University Faculty of Medicine, Korányi S. u. 2/a, Budapest H-1083, Hungary; Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
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Sander K, Winkler G, Hofer N, Hunatschek S, Doerr R. [Improvement of Psychosomatic Rehabilitation after Prestationary Intervention]. REHABILITATION 2016; 55:388-394. [PMID: 27923244 DOI: 10.1055/s-0042-120083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Aim of the study: Improvement of psychosomatic rehabilitation efforts with prestationary intervention. Method: The study is designed as a prospective and randomisized interventon study including 317 in patients. Result: Most of the patients were women (69.4 %), the mean age was 50.2 years. As measured with the BDI-II patients with prestationary intervention improved more than patients without intervention. The motivation has not been changed significantly in both treatment arms. Various independent cofactors like long duration of unemployment, disablement and patients who apply to pension were identified. Conclusion: Finally a prestationary telephon interview improves the results of psychosomatic rehabilitation measured with BDI.
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Affiliation(s)
- K Sander
- Klinik für Psychiatrie, Psychosomatik und Stationäre Psychotherapie der Universitätsklinik Salzburg
| | - G Winkler
- Psychosomatische Klinik Schön Klinik Berchtesgadener Land
| | - N Hofer
- Psychosomatische Klinik Schön Klinik Berchtesgadener Land
| | - S Hunatschek
- Psychosomatische Klinik Schön Klinik Berchtesgadener Land
| | - R Doerr
- Psychosomatische Klinik Schön Klinik Berchtesgadener Land
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Nagy B, Zsólyom A, Nagyjánosi L, Merész G, Steiner T, Papp E, Dessewffy Z, Jermendy G, Winkler G, Kaló Z, Vokó Z. Cost-effectiveness of a risk-based secondary screening programme of type 2 diabetes. Diabetes Metab Res Rev 2016; 32:710-729. [PMID: 26888326 DOI: 10.1002/dmrr.2791] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 11/25/2015] [Accepted: 02/09/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The objective of this study was to develop a long-term economic model for type 2 diabetes to describe the entire spectrum of the disease over a wide range of healthcare programmes. The model evaluates a public health, risk-based screening programme in a country specific setting. METHODS The lifespan of persons and important phases of the disease and related interventions are recorded in a Markov model, which first simulates the effect of screening, then replicates important complications of diabetes, follows the progression of individuals through physiological variables and finally calculates outcomes in monetary and naturalistic units. RESULTS The introduction of the screening programme nearly doubled the proportion of diagnosed patients at the age of 50 and prolonged life expectancy. Three-yearly screening gained 0.0229 quality adjusted life years for an additional €83 per person compared with no screening and resulted an incremental cost-effectiveness ratio of €3630/quality adjusted life years. CONCLUSION From the economic perspective introduction of the 3-yearly screening programme is justifiable and it provides a good value for money. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Balázs Nagy
- Syreon Research Institute, Budapest, Hungary.
- Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary.
| | - Adriána Zsólyom
- Syreon Research Institute, Budapest, Hungary
- Faculty of Social Sciences, Social Policy Ph.D. Programme, Eötvös Loránd University, Budapest, Hungary
| | - László Nagyjánosi
- Health Sciences Doctoral School, University of Debrecen, Debrecen, Hungary
| | | | - Tamás Steiner
- Faculty of Social Sciences, Social Policy Ph.D. Programme, Eötvös Loránd University, Budapest, Hungary
- 2nd Department of Internal Medicine-Diabetology, St. John's Hospital and North-Buda United Institutions, Budapest, Hungary
- Department of Endocrinology, St. Christopher's Clinic, Budapest, Hungary
| | - Eszter Papp
- National Institute of Pharmacy and Nutrition, Budapest, Hungary
| | | | - György Jermendy
- 3rd Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Gábor Winkler
- 2nd Department of Internal Medicine-Diabetology, St. John's Hospital and North-Buda United Institutions, Budapest, Hungary
- Faculty of Health Care, Institute of Theoretical Sciences, University of Miskolc, Miskolc, Hungary
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary
- Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary
| | - Zoltán Vokó
- Syreon Research Institute, Budapest, Hungary
- Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary
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Abstract
Metformin is the basic drug of antihyperglycemic therapy in type 2 diabetes: according to actual therapeutic guidelines, it should be given in the absence of contraindications or intolerance during the whole course of the disease even after the initiation of insulin therapy. Recently more and more details have been explored regarding the molecular background of its effects, however, in parallel with the enormous growing knowledge, the number of questions still waiting to be answered has also grown. This review article deals with data already crystallized as well as with details not definitely cleared up. Genetic polymorphisms as well as potential drug interactions influencing the effects of metformin are also briefly summarized.
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Affiliation(s)
- Gábor Winkler
- II. Belgyógyászat-Diabetológia, a Semmelweis Egyetem, Általános Orvostudományi Kar Oktató Osztálya, Szent János Kórház Budapest, Diós árok 1-3., 1125.,Elméleti Egészségtudományi Intézet, Miskolci Egyetem, Egészségügyi Kar Miskolc
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Winkler G. [Sulfonylureas in today's blood glucose lowering therapy. New data on advantages and potential barriers of an "old" antidiabetic group]. Orv Hetil 2015; 156:511-5. [PMID: 25796278 DOI: 10.1556/oh.2015.30114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Sulfonylurea compounds have been basic elements of antidiabetic treatment in type 2 diabetes for a long time. However, with the introduction of incretin type insulin secretagogues it is often arises, whether is still there a place for sulfonylureas in the today's therapy. To answer this question the author overviews general pharmaceutical characteristics of the sulfonylurea compounds as well as individual particularities of the second generation derivatives used at present in Hungary. The author details also the most important differences between incretin type drugs - first of all dipeptidyl peptidase-4 inhibitors - and sulfonylureas. On the basis of available data it can be concluded in accordance with the latest international guidelines, that sulfonylureas have still role in the blood glucose lowering therapy of type 2 diabetes, though they became somewhat pushed back among insulin secretagogue type drugs. If a sulfonylurea compound is the drug of choice, it is important to select the appropriate molecule (in case of normal renal function gliclazide or glimepiride). It is also important to re-educate the patient, as well as to apply the minimal dose providing the desired glycaemic effect.
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Affiliation(s)
- Gábor Winkler
- Fővárosi Szent János Kórház II. Belgyógyászat-Diabetológia Budapest Diós árok 1-3. 1125 Miskolci Egyetem, Egészségügyi Kar Elméleti Egészségtudományi Intézet Miskolc
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Barkai L, Hâncu N, Jermendy G, Konstantinova M, Lichiardopol R, Moţa M, Tankova C, Temelkova N, Winkler G. The Importance of Postprandial Hyperglycemia Position Statement of the Danube Mco Experts. Romanian Journal of Diabetes Nutrition and Metabolic Diseases 2015. [DOI: 10.1515/rjdnmd-2015-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Both the prevalence and incidence of type 2 diabetes are increasing worldwide and over 60% of people with T2DM develop cardiovascular disease. There are many data supporting the view that glycaemic control plays a role in reducing cardiovascular complications. The relationship between hyperglycaemia and cardiovascular disease is complex with evidence suggesting that an acute increase of glycaemia, particularly after a meal, may have a direct detrimental effect on cardiovascular disease. Although control of fasting hyperglycaemia is necessary, it is usually insufficient to obtain optimal glycaemic control. A growing body of evidence suggests that reducing post meal plasma glucose excursions is as important, or perhaps more important for achieving HbA1c goals. New classes of therapies for managing post meal plasma glucose in people with diabetes (glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors) have shown significant benefits in reducing post meal plasma glucose excursions andlowering HbA1c. The individual properties of the various GLP‑1 receptor agonists might enable incretin-based treatment of type 2 diabetes mellitus to be tailored to the needs of each patient.
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Affiliation(s)
- László Barkai
- University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj Napoca
| | - Nicolae Hâncu
- University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj Napoca
| | - György Jermendy
- 3rd Teaching Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | | | | | - Maria Moţa
- University of Medicine and Pharmacy Craiova
| | | | | | - Gábor Winkler
- 2nd Department of Internal Medicine-Diabetology, St. John's Hospital, Budapest, University of Miskolc, Faculty of Health Care, Institute of Theoretical Health Sciences, Hungary
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Gruber DP, Winkler G, Resch K. Comprehensive study on the light shielding potential of thermotropic layers for the development of new materials. Appl Opt 2015; 54:150-156. [PMID: 25967611 DOI: 10.1364/ao.54.000150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 11/23/2014] [Indexed: 06/04/2023]
Abstract
In recent years thermotropic overheating protection glazings have been the focus for both solar thermal collector technology and architecture. A thermotropic glazing changes its light transmittance from highly transparent to light diffusing upon reaching a certain threshold temperature autonomously and reversibly. In thermotropic systems with fixed domains (TSFD) the scattering domains are embedded in a polymer matrix, which exhibits a sudden change of the refractive index upon reaching a threshold temperature. The aim of the present study was to comprehensively investigate the light shielding characteristics and potential of TSFD materials by applying simulation of light scattering in particle-filled layers. In random walk simulations a variety of parameters were varied systematically, and the effect on the light transmission behavior of TSFD was studied. The calculation steps of the simulation process are shown in detail. The simulations demonstrate that there is great potential for the production of functional materials with high overheating protection efficiency.
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Winkler G. [Is there any progress in the blood glucose lowering therapy of type 2 diabetes?]. Orv Hetil 2014; 155:1215-20. [PMID: 25095281 DOI: 10.1556/oh.2014.29979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Principles of glycemic treatment of type 2 diabetes are well outlined for a long time, however, emphasis of therapeutic strategies and treatment guidelines are continuously changing partially due to the continuous expansion of the available antihyperglycemic drugs. This article overviews the modifications of the drug selection arising from the broadening of the pathogenetic knowledge and recent therapeutic guidelines. It presents the role of the patient-centered approach in the therapeutic choice, highlights occasional contradictions between recent international and national guidelines and financing rules in Hungary. While consideration of the different antidiabetics by the same criteria and the choice of the most appropriate drug characterize international practice, prescription of certain compounds is often restricted by financial rules in Hungary.
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Affiliation(s)
- Gábor Winkler
- Szent János Kórház II. Belgyógyászat-Diabetológia Budapest Diós árok 1-3. 1125 Miskolci Egyetem, Egészségügyi Kar Elméleti Egészségtudományi Tanszék Miskolc
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28
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Szűcs A, Barcs G, Winkler G, Soós Z, Folyovich A, Kelemen A, Várallyay P, Kamondi A. Anti glutamate-decarboxylase antibodies: a liaison between localisation related epilepsy, stiff-person syndrome and type-1 diabetes mellitus. Ideggyogy Sz 2014; 67:269-271. [PMID: 25509368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We present two patients with partial epilepsy, type-1 diabetes and stiff person syndrome associated with high serum auto-antibody levels to glutamate-decarboxylase (anti-GAD). Both patients were or have suffered from additional autoimmune conditions. The presence of stiff person syndrome and elevated anti-GAD levels have to make clinicians look for additional autoimmune conditions including type-1 diabetes. On the other hand, the co-morbidity of partial epilepsy with autoimmune conditions in patients with elevated serum anti-GAD suggests an autoimmune mechanism of partial epilepsy in these cases.
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Vokó Z, Németh R, Nagyjánosi L, Jermendy G, Winkler G, Hídvégi T, Kalotai Z, Kaló Z. Mapping the Nottingham Health Profile onto the Preference-Based EuroQol-5D Instrument for Patients with Diabetes. Value Health Reg Issues 2014; 4:31-36. [PMID: 29702803 DOI: 10.1016/j.vhri.2014.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aim of this study was to derive a function that can map the Nottingham Health Profile (NHP) questionnaire onto a utility measure, the EuroQol five-dimensional (EQ-5D) questionnaire index, for diabetic patients. METHODS A cross-sectional study was performed on diabetic patients in Hungary with different complications in which quality of life was measured by using both the NHP questionnaire and the EQ-5D questionnaire. Ordinary stepwise-backward least-squares regression was used to develop a mapping function. Adjusted R2, Akaike's information criterion, and root mean square error were used to assess the performance of the model. The robustness of the models was tested using 10-fold cross-validation and bootstrapping. RESULTS The best-fitting models were those that contained all the NHP statements as predictors and a stepwise reduced version that contained only 19 statements. The latter model, however, showed considerable variability in the selection of predictors. The adjusted R2 of the former model was 0.68, the root mean square error was 174, and the Akaike's information criterion was -559.9. CONCLUSIONS The expected value of the EQ-5D questionnaire can be reasonably predicted on the basis of results of the NHP in patients with diabetes mellitus. The mapping function of the NHP onto the EQ-5D questionnaire is capable of estimating the expected EQ-5D questionnaire utility values in a group of patients with diabetes. The function's applicability for individual-level predictions, however, is limited. Further research is needed to find out whether mapping functions developed in Central-Eastern European countries are transferable to Western European countries.
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Affiliation(s)
- Zoltán Vokó
- Faculty of Social Sciences, Department of Health Policy & Health Economics, Institute of Economics, Eötvös Loránd University; Syreon Research Institute.
| | - Renáta Németh
- Faculty of Social Sciences, Department of Statistics, Eötvös Loránd University
| | | | - György Jermendy
- 3rd Department of Internal Medicine, Bajcsy-Zsilinszky Hospital
| | - Gábor Winkler
- 2nd Department of Internal Medicine - Diabetology, Saint John Hospital, Budapest, Hungary; Faculty of Health Care, Institute of Theoretical Health Sciences, University of Miskolc, Miskolc, Hungary
| | - Tibor Hídvégi
- Department of Metabolic Disorders, Endocrinology and Diabetology, Petz Aladár County Teaching Hospital, Győr, Hungary
| | | | - Zoltán Kaló
- Faculty of Social Sciences, Department of Health Policy & Health Economics, Institute of Economics, Eötvös Loránd University; Syreon Research Institute
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Winkler G. The history of the chapel of the (New) St. John’s Hospital in Budapest. Orv Hetil 2014; 155:1039-43. [DOI: 10.1556/oh.2014.ho2494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Gábor Winkler
- Szent János Kórház és Észak-budai Egyesített Kórházai II. Belgyógyászat-Diabetológia Budapest Diós árok 1. 1125
- Miskolci Egyetem, Egészségügyi Kar Elméleti Egészségtudományi Intézet Miskolc
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Soós Z, Salamon M, Erdei K, Kaszás N, Folyovich A, Szücs A, Barcs G, Arányi Z, Skaliczkis J, Vadasdi K, Winkler G. LADA type diabetes, celiac diasease, cerebellar ataxia and stiff person syndrome. A rare association of autoimmune disorders. Ideggyogy Sz 2014; 67:205-209. [PMID: 25087381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Celiac disease--in its typical form--is a chronic immune-mediated enteropathy with typical clinical symptoms that develops against gliadin content of cereal grains, and is often associated with other autoimmune diseases. In cases of atypical manifestation classic symptoms may be absent or mild, and extra-intestinal symptoms or associated syndromes dominate clinical picture. The authors present a longitudinal follow-up of such a case. A 63-years old woman was diagnosed with epilepsy at the age of 19, and with progressive limb ataxia at the age of 36, which was initially thought to be caused by cerebellar atrophy, later probably by stiff person syndrome. At the age 59, her diabetes mellitus manifested with type 2 diabetic phenotype, but based on GAD positivity later was reclassified as type 1 diabetes. Only the last check-up discovered the celiac disease, retrospectively explaining the entire disease course and neurological symptoms. By presenting this case, the authors would like to draw attention to the fact that one should think of the possibility of celiac disease when cerebellar ataxia, progressive neurological symptoms and diabetes are present at the same time. An early diagnosis may help to delay the progression of disease and help better treatment.
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Abstract
In addition to the common blood glucose lowering effect, sulfonylurea compounds are different in many aspects from each other. Based on earlier findings the second generation gliclazide has special advantages within this group. Although the number of experimental and clinical observations on gliclazide is continuously increasing, these novel findings are not in the focus anymore due to the appearance of new antidiabetics. This article reviews recent experimental (effect on receptors, the absence of Epac2 activation, antioxidant properties, possible incentive of factors participating in beta-cell differentiation) and pharmacogenomic data, and compares them with clinical observations obtained from gliclazide treatment (hypoglycemias, parameters of cardiovascular outcome). The data underline the advantages of gliclazide, the highly pancreas-selective nature, preservation of the ischemic precondition, favourable hemodynamic properties and potential reduction of the beta-cell loss as compared to other compounds of the group. However, gliclazide is not free from disadvantages characteristic to sulfonylureas in general (blood glucose independent insulin stimulation, beta-cell depletion). Comparing gliclazide with other derivatives of the group, the above data indicate individual benefits for the application when sulfonylurea compound is the drug of choice.
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Affiliation(s)
- Gábor Winkler
- Szent János Kórház II. Belgyógyászat-Diabetológia Budapest Diós árok 1-3. 1125 Miskolci Egyetem, Egészségügyi Kar Elméleti Egészségtudományi Intézet Miskolc
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Abstract
Inflammatory disorders of the thyroid gland are divided into three groups according to their duration (acute, subacute and chronic). De Quervain’s thyroiditis (also termed giant cell or granulomatous thyroiditis) is a subacute inflammation of the thyroid, which accounts for 5% of thyroid disorders. The etiology is unknown, it usually appears two weeks after an upper viral respiratory infection. The clinical feature includes neck pain, which is aggraviated during swallowing, and radiates to the ear. On palpation, the thyroid is exquisitely tender. The erythrocyte sedimentation rate is markedly elevated, the leukocyte count, C-reactive protein are normal or slightly elevated. The natural history of granulomatous thyroiditis involves four phases: the destructive inflammation results temporarily in hyperthyroidism followed by euthyroidism. After a transient hypothyroidism the disease becomes inactive and the thyroid function is normalised. Ultrasonographic findings are diffuse hypoechogenic structures, but nodules may also occur. The disease often remains unrecognised, or the first phase of the disease is diagnosed and treated as hyperthyroidism. The diagnosis can be confirmed by the presence of the thyroid autoantibodies, radioiodine uptake and fine needle aspiration cytology. There is no special treatment, non-steroid anti-inflammatory drugs or steroid should be given to relieve the pain. The aim of the authors is to shed light the key points of diagnosis and differential diagnosis by the presentation of four slightly different cases. Orv. Hetil., 2014, 155(17), 676–680.
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Affiliation(s)
- Roland Oláh
- Szent János Kórház II. Belgyógyászat-Diabetológia Budapest Diós árok 1–3. 1125
| | - Péter Hajós
- Szent János Kórház II. Belgyógyászat-Diabetológia Budapest Diós árok 1–3. 1125
| | - Zsuzsanna Soós
- Szent János Kórház II. Belgyógyászat-Diabetológia Budapest Diós árok 1–3. 1125
| | - Gábor Winkler
- Szent János Kórház II. Belgyógyászat-Diabetológia Budapest Diós árok 1–3. 1125
- Miskolci Egyetem, Egészségügyi Kar Elméleti Egészségtudományi Tanszék Miskolc
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Dessovic P, Mohn P, Jackson RA, Winkler G, Schreitl M, Kazakov G, Schumm T. 229Thorium-doped calcium fluoride for nuclear laser spectroscopy. J Phys Condens Matter 2014; 26:105402. [PMID: 24553189 DOI: 10.1088/0953-8984/26/10/105402] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The (229)thorium isotope presents an extremely low-energy isomer state of the nucleus which is expected around 7.8 eV, in the vacuum ultraviolet (VUV) regime. This unique system may bridge between atomic and nuclear physics, enabling coherent manipulation and precision spectroscopy of nuclear quantum states using laser light. It has been proposed to implant (229)thorium into VUV transparent crystal matrices to facilitate laser spectroscopy and possibly realize a solid-state nuclear clock. In this work, we validate the feasibility of this approach by computer modelling of thorium doping into calcium fluoride single crystals. Using atomistic modelling and full electronic structure calculations, we find a persistent large band gap and no additional electronic levels emerging in the middle of the gap due to the presence of the dopant, which should allow direct optical interrogation of the nuclear transition.Based on the electronic structure, we estimate the thorium nuclear quantum levels within the solid-state environment. Precision laser spectroscopy of these levels will allow the study of a broad range of crystal field effects, transferring Mössbauer spectroscopy into the optical regime.
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Affiliation(s)
- P Dessovic
- Center for Computational Materials Science, Vienna University of Technology, Gusshausstrasse 25/134, A-1040, Vienna, Austria
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Winkler G. [Timely commencement of insulin in type 2 diabetes: benefits and risks]. Orv Hetil 2014; 155:255-61. [PMID: 24509354 DOI: 10.1556/oh.2014.29828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The introduction of insulin in type 2 diabetes is often too late, though the immediate as well as late consequences of inadequate metabolic control are well known. That is the reason, why a special attention is given in recent therapeutic guidelines for the importance of early, at least timely insulinisation. This review article summarizes the advantages (mitigation of the beta-cell dysfunction, long lasting good metabolic control) and potential risks (hypoglycemia, weight gain, possible deteriorating patient compliance) of early or timely insulin therapy. It is pointed out that the introduction of insulin is effective and safe therapeutic option during the whole course of type 2 diabetes, the use of different regimes is suitable to reach and maintain the individual glycemic target and, with a structured patient education, it does not disturb the quality of life and the compliance of patients.
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Affiliation(s)
- Gábor Winkler
- Szent János Kórház II. Belgyógyászat-Diabetológia Budapest Diós árok 1-3. 1125 Miskolci Egyetem, Egészségügyi Kar Elméleti Egészségtudományi Intézet Miskolc
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Soós Z, Salamon M, Oláh R, Czégeni A, Salamon F, Folyovich A, Winkler G. [Wernicke encephalopathy accompanying linitis plastica]. Orv Hetil 2014; 155:30-3. [PMID: 24379094 DOI: 10.1556/oh.2014.29800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Wernicke encephalopathy (or Wernicke-Korsakoff encephalopathy) is a rarely diagnosed neurological disorder, which is caused by vitamin B1 deficiency. In the classical form it is characterized by a typical triad (confusion, oculomotor disturbance and ataxia), however, in the majority of the cases only confusion is present. It can be frequently observed in subjects with chronic alcohol consumption, but it may accompany different pathological states of which end stage malignant diseases are the most importants, where confusion may have different backgrounds. The authors present the case of an old male patient with advanced gastric cancer recognised and treated vitamin B1 deficiency, and they draw attention to difficulties of the diagnosis of Wernicke's disease.
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Affiliation(s)
- Zsuzsanna Soós
- Szent János Kórház II. Belgyógyászat-Diabetológia Budapest Diós árok 1-3. 1125
| | - Mónika Salamon
- Szent János Kórház II. Belgyógyászat-Diabetológia Budapest Diós árok 1-3. 1125
| | - Roland Oláh
- Szent János Kórház II. Belgyógyászat-Diabetológia Budapest Diós árok 1-3. 1125
| | - Anna Czégeni
- Szent János Kórház II. Belgyógyászat-Diabetológia Budapest Diós árok 1-3. 1125
| | - Ferenc Salamon
- Szent János Kórház II. Belgyógyászat-Diabetológia Budapest Diós árok 1-3. 1125
| | | | - Gábor Winkler
- Szent János Kórház II. Belgyógyászat-Diabetológia Budapest Diós árok 1-3. 1125 Miskolci Egyetem, Egészségügyi Kar Elméleti Egészségtudományi Intézet Miskolc
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Steiner T, Oláh R, Németh A, Winkler G. Difficulties in the differential diagnosis of hyponatremia presenting with severe neuropsychiatric symptoms – case presentation. Orv Hetil 2013; 154:1235-41. [DOI: 10.1556/oh.2013.29677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Hyponatremia is the most frequent eletrolyte imbalance in hospitalized geriatric patient. The accompanying signs and symptoms can run a wide range and, therefore, these patients are usually admitted to various departments, i.e. neurology and/or traumatology first. Directed laboratory investigations demonstrate severe hyponatremia. Differential diagnosis can be very difficult and complex in the clinical settings. Firstly, spurious forms of hyponatremia have to be excluded, then the underlying cause should elucidated based on the patients hydration status and serum osmolarity. Hyponatremia can be divided into hyper-, hypo- and normovolemic forms. Moreover, it can be further classified as hypo-, iso- and hyperosmolar hyponatremias. The differentiation between renal and extrarenal salt wasting forms is hinged on the urine sodium concentration. Syndrome of inappropriate antidiuretic hormone secretion is the most common cause of normovolemic, hypoosmolar forms (named also as Schwartz–Bartter syndrome). The authors aimed to shed light on the often insurmountable difficulties of the diagnosis, differential diagnosis and appropriate treatment of this very frequent electrolyte imbalance by presenting a clinical case report. Their purported aim reflects upon the wide array of ethiopathogenesis of hyponatremia: various endocrine, renal diseases, inappropriateness of antidiuretic hormone secretion as well as the role of different medications (e.g. diuretics). This fine-tuned and intricate physiology of sodium metabolism could fortuitously be overturned by these mechanisms. Orv. Hetil., 2013, 154, 1235–1241.
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Affiliation(s)
- Tamás Steiner
- Szent János Kórház és Észak-budai Egyesített Kórházak II. Belgyógyászat-Diabetológia Budapest Diós árok 1–3. 1125
| | - Roland Oláh
- Szent János Kórház és Észak-budai Egyesített Kórházak II. Belgyógyászat-Diabetológia Budapest Diós árok 1–3. 1125
| | - Attila Németh
- Szent János Kórház és Észak-budai Egyesített Kórházak II. Belgyógyászat-Diabetológia Budapest Diós árok 1–3. 1125
| | - Gábor Winkler
- Szent János Kórház és Észak-budai Egyesített Kórházak II. Belgyógyászat-Diabetológia Budapest Diós árok 1–3. 1125
- Miskolci Egyetem, Egészségügyi Kar Elméleti Egészségtudományi Tanszék Miskolc
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Salamon M, Soós Z, Oláh R, Hazai M, Sóvágó L, Kovács D, Pál B, Baranyi E, Lintner F, Winkler G. [Comparison of the effectiveness of two internationally recommended screening methods for the diagnosis of gestational diabetes]. Orv Hetil 2013; 154:776-83. [PMID: 23666024 DOI: 10.1556/oh.2013.29615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Early diagnosis and adequate care of gestational diabetes is of great importance for both the mother and her fetus. Although several national and international guidelines are known on the methodology for screening gestational diabetes, a not negligible part of the cases remain unrecognized when applying even the most widely used criteria recommended by the World Health Organization (1st recommendation). A connection has been found between the maternal blood glucose values and the prevalence of still-birth, preeclampsia and large for gestational age neonates in several studies, from which the Hyperglycaemia and Adverse Pregnancy Outcomes study has come into prominence. According to conclusions of this study the International Association of Diabetic Pregnancy Study Groups suggested new numeric criteria for the evaluation of the 75-gram oral glucose tolerance test (2nd recommendation), which differs from the evaluation used in the aforementioned screening system. AIMS The aim of the study was to compare the effectiveness of the two screening systems by evaluation of the pregnancy outcomes. METHODS By following non-twin pregnancies of 1107 pregnant mothers (831 with normal glucose tolerance, 276 with gestational diabetes based on any of the applied screening methods) the maternal (pre- and post-term birth, caesarean section, toxaemia) and newborns pregnancy outcomes (infants small and large for gestational age, hypoglycaemia) were analysed. RESULTS With the exception of the prevalence of large for gestational age infants - which was higher among women screened by the new evaluation - no substantial difference in the efficacy of the two investigated methods was found. CONCLUSION The decision whether the screening of gestational diabetes using the new criteria results in safer recognition of the disturbances of glucose metabolism during pregnancy requires further investigations including a large number of cases.
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Affiliation(s)
- Mónika Salamon
- Szent János Kórház II. Belgyógyászat-Diabetológia Budapest Diós árok 1-3. 1125
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Leithäuser B, Zerm T, Raji A, Winkler G. Kognition und kardiovaskuläre Erkrankungen: eine komplexe Beziehung. Aktuel Kardiol 2013. [DOI: 10.1055/s-0032-1328148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - T. Zerm
- Neuro-Kardiologie im Zentrum, Hamburg
| | - A. Raji
- Neuro-Kardiologie im Zentrum, Hamburg
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Abstract
Discovery of physiological and pharmacological characteristics of incretins (glucagon-like peptide-1 and glucose-dependent insulinotrop polypeptide), and the introduction of various products of those into the clinical practice has fundamentally changed blood glucose lowering therapy in type 2 diabetes. In addition to the antidiabetic properties more attention is paid to their favourable pleiotropic effects independent from the blood glucose lowering such as cardio-, vaso- and renoprotectiv, blood pressure lowering effects, as well as beneficial changes on blood lipid values and hepatic steatosis. These preferential changes prevail in slightly different way when incretin mimetics applied and dipeptidyl peptidase-4 inhibitors, furthermore, prolonged action of peptides metabolised by this enzyme may serve additional benefits in this latter mentioned group. The article overviews the currently known most important pleiotropic effects of incretins from the point of view of cardiorenal risk accompanying type 2 diabetes. Orv. Hetil., 2013, 154, 248–255.
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Affiliation(s)
- Gábor Winkler
- Szent János Kórház és Észak-budai Egyesített Intézményei II. Belgyógyászat-Diabetológia Budapest Diós árok 1–3. 1125
- Miskolci Egyetem, Egészségügyi Kar Elméleti Egészségtudományi Tanszék Miskolc
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Winkler G, Hidvégi T, Vándorfi G, Balogh S, Jermendy G. Prevalence of undiagnosed abnormal glucose tolerance in adult patients cared for by general practitioners in Hungary. Results of a risk-stratified screening based on FINDRISC questionnaire. Med Sci Monit 2013; 19:67-72. [PMID: 23344680 PMCID: PMC3629009 DOI: 10.12659/msm.883747] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 08/02/2012] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The prevalence of type 2 diabetes mellitus is rapidly increasing, worldwide and also in Hungary. Timely diagnosis and early treatment could be aided by targeted screening. Recognizing this, the Hungarian Diabetes Association initiated a risk-stratified screening with the involvement of primary care physicians. MATERIAL/METHODS In the first phase of screening, the FINDRISC questionnaire was completed, followed by an oral glucose tolerance test (OGTT) for those with a score of ≥12. Between September 1, 2010 and March 31, 2011, 70,432 non-diabetic adults, who visited their general practitioners for any reason, were involved in the screening. Of these, 68,476 questionnaires proved to be suitable for processing. RESULTS From the questionnaires, 28,077 (41.0%) had a score of ≥12. A valid OGTT was performed in 22,846 cases; of this group 3,217 subjects (14.1%) had elevated fasting glucose levels, 5,663 (24.8%) had impaired glucose tolerance, and 1,750 (7.6%) had manifest, previously undiagnosed, diabetes mellitus. Overall, from the valid OGTT group, 46.5% subjects had some degree of glucose intolerance. CONCLUSIONS Based on the FINDRISC questionnaire, the risk-stratified screening for diabetes mellitus proved to be simple and cost-effective method for the early detection of carbohydrate metabolism disorders. Using this method, the prevalence rate of previously undiagnosed abnormal glucose tolerance was high in adult patients cared for by general practitioners in Hungary.
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Affiliation(s)
- Gábor Winkler
- Department of Medicine and Diabetology, Saint John’s Hospital, Budapest, Hungary
- Department of Health Sciences, Faculty of Health Care, University of Miskolc, Miskolc, Hungary
| | - Tibor Hidvégi
- Department of Medicine, Petz County Teaching Hospital, Győr, Hungary
| | - Győző Vándorfi
- Centre for Medicine, Diabetology and Metabolism, Veszprém County Csolnoky Hospital, Veszprém, Hungary
| | - Sándor Balogh
- National Institute for Primary Health Care, Budapest, Hungary
| | - György Jermendy
- Department of Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
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Soós Z, Czégeni A, Salamon F, Salamon M, Kenessey I, Folyovich A, Tihanyi T, Winkler G. [A case of glucose-sensitive insulinoma accompanied by slightly elevated serum insulin levels and persisting convulsions after the surgically removed neuroendocrine tumor]. Orv Hetil 2013; 154:69-73. [PMID: 23291205 DOI: 10.1556/oh.2013.29522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Insul(in)oma is a usually solitary or, in some cases, multifocal tumor of pancreatic beta cells. It may be a component of multiple endocrine neoplasia type 1. or von Hippel-Lindau syndrome. In typical forms the diagnosis - based on the Whipple triad - is simple, however, it may be difficult to recognize in cases with near normal or only slightly elevated serum insulin levels, as well as in patients with known convulsive episodes. With the case presentation of an 81-year-old woman the authors draw attention to the pitfalls of the correct diagnosis. A special feature of the presented case is that convulsions persisted after surgical removal of the pancreatic neuroendocrine tumor verified with functional and imaging methods. Recurrent or residual tumor was not found, and morphological damage of the brain was absent. In the background of the continuing convulsions cerebrovascular alterations as well as the cytotoxic effect of the hypoglycemia-induced excessive glutamate production can be postulated.
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Affiliation(s)
- Zsuzsanna Soós
- Szent János Kórház II. Belgyógyászat-Diabetológia Budapest Diós árok 1-3. 1125
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Abstract
Bariatric surgery managing/preventing complications of severe overweight is nowadays widely accepted as a mainstay in the treatment of morbid obesity. Its role is particularly important in type 2 diabetes developing on the base of long-standing significant overweight. The glycemic control improves within days-weeks after these surgeries, when weight loss and reduction of the visceral fat mass is barely detectable. This short term effect is probably due to an increased secretion of glucagon-like peptide and, as a consequence, an improvement in hepatic insulin sensitivity as well as the whole body glucose uptake. Besides the prolonged glucagon-like peptide effects, the favourable long term effect of these operations - lasting for 10 years even after surgery - is the decrease of visceral fat mass and elimination of harmful influence of cytokines produced by the fatty tissue. The article overviews the metabolic effects of these procedures, their undoubted advantages and potential risks.
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Affiliation(s)
- Gábor Winkler
- Szent János Kórház II. Belgyógyászat-Diabetológia Budapest.
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Wegert K, Monakhova YB, Kuballa T, Reusch H, Winkler G, Lachenmeier DW. Regulatory Control of Energy Drinks Using1H NMR Spectroscopy. ACTA ACUST UNITED AC 2012. [DOI: 10.1002/lemi.201290113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Winkler G. Doctors, druggists and the ones who seem to be – on the musical stage. Orv Hetil 2012; 153:632-4. [DOI: 10.1556/oh.2012.ho2406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Brenner B, Herr C, Winkler G. Umweltmedizinische Bewertung von Bioaerosolen aus Tierhaltungsanlagen auf Basis des Gründrucks VDI 4250 Blatt 1. Gesundheitswesen 2012. [DOI: 10.1055/s-0032-1307316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Type 2 diabetes is making up to 90% of the all diabetic cases. In addition to insulin resistance, insufficient B-cell function also plays an important role in the pathogenesis of the disease. The insufficient production and secretion of insulin can be increased by secretagogue drugs, like sulfonylureas and incretin mimetics/enhancers. In recent years growing number of genetic failures of the B-cells has been detected. These genetic variants can influence the efficacy of secretagogue drugs. Some of these gene polymorphisms were identified in the genes encoding the KATP channel (KCNJ11 and ABCC8). These mutations are able either to reduce or increase the insulin secretion and can modify the insulin response to sulfonylurea treatment. Other polymorphisms were found on genes encoding enzymes or transcription factors. In recent years, the genetic variants of TCF7L2 and its clinical importance have been intensely studied. Authors give a summary of the above gene polymorphisms and their role in insulin secretion.
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Affiliation(s)
- Gábor Winkler
- Fővárosi Szent János Kórház és Észak-budai Egyesített Intézményei II. Belgyógyászat-Diabetológia Budapest
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Abstract
The discovery of incretins − glucagon-like peptide (GLP)-1 and glucose-dependent insulinotrop peptide (GIP) −, clarification of their physiological properties as well as therapeutic application of incretin-based blood glucose lowering drugs opened new perspectives in the medical management of type 2 diabetes. New results of basic research investigations led to revaluation of the role of GIP in metabolic processes and a more established use of GLP-1 action. The article overviews the most relevant data of production and effects of incretins, as well as future possibilities of their therapeutic use. Orv. Hetil., 2011, 152, 1922–1930.
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Affiliation(s)
- Gábor Winkler
- Fővárosi Szent János Kórház és Észak-budai Egyesített Intézményei II. Belgyógyászat-Diabetológia Budapest Diósárok út 1–3. 1125
- Miskolci Egyetem Egészségügyi Kar Elméleti Egészségtudományi Tanszék Miskolc
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Waizenegger J, Winkler G, Kuballa T, Ruge W, Kersting M, Alexy U, Lachenmeier DW. Analysis and risk assessment of furan in coffee products targeted to adolescents. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2011; 29:19-28. [PMID: 22035212 DOI: 10.1080/19440049.2011.617012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
The aim of this work was to analyse the furan concentrations in coffee products targeted to adolescents and to estimate the health risk for those consumers by using the consumption data of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study (DONALD). Three different kinds of coffee beverages were analysed: 'coffee ready to drink' (i.e. industrially manufactured and packaged products available in cans or plastic cups), 'coffee instant' (i.e. soluble coffee in powder form) and 'coffee from coffee chains' (i.e. freshly prepared coffee sampled on-site). Furan was analysed according to the US Food and Drug Administration (USFDA) method using headspace-GC-MS and quantification with standard addition. The lowest furan concentrations were found within the category 'coffee instant', with an average of 4.6 µg kg(-1), followed by the category 'coffee ready to drink', with an average of 41.3 µg kg(-1), while the products from the coffee chains showed the highest concentrations, on average 100.5 µg kg(-1). According to the obtained furan contents, it seems that the highest furan exposure for adolescents is generally given in the consumption of products within the category 'coffee from coffee chains', while the lowest is given in the category 'coffee instant'. Risk assessment based on the margin of exposure (MOE) approach showed that in different consumption scenarios except for consumers of instant coffee, the MOE lay below 10,000, a range that is judged to be of public health relevance. The lowest MOE was found for consumers in the age group 10-12 years (especially females) and for both sexes in the age group 16-18 years.
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Affiliation(s)
- J Waizenegger
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, Germany
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Abstract
Metabolic characteristics of physiological and diabetic pregnancies are discussed. The basic factor of these changes is the increasing insulin resistance throughout pregnancy, which in case of diabetes may result in hyperglycemia with undesirable clinical consequences and complications for both the mother and the fetus. Prevention of these complications by maintaining physiological metabolic state of diabetic pregnant women is possible, which is similar to that of healthy women. The aim of treatment of pregnant diabetics is to achieve normoglycemic state during the whole gestation that is possible by early diagnosis in case of gestational diabetes and by adequate preconception care in case of pregestational diabetes. To obtain desirable glycemic conditions insulin treatment is necessary in most of the cases together with adequate, quantitative nutrition therapy, while oral antidiabetic drugs during pregnancy and lactation are to be avoided. For adequate care of the cases with diabetes and pregnancy interdisciplinary diabetes centers with well-trained experts are required.
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Affiliation(s)
- Eva Baranyi
- Honvédkórház-Állami Egészségügyi Központ Diabetológiai Szakrendelés Budapest Róbert Károly krt. 44. 1134.
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