Ivona Risovic

Introduction: Obesity is a central pathophysiological factor that links reduced lung function and the severity of obstructive sleep apnea. The aim: To analyze the association between obesity, lung function, and the severity of obstructive sleep apnea (OSA). Methods: A retrospective study was conducted in 28 hospitalized patients at the Clinic for pulmonary diseses of the University Clinical Center of the Republic of Srpska with suspected sleep-disordered breathing. Lung function was assessed by spirometry (forced exiratory volume in 1 second (FEV1), forced vital capacity FVC, FEV1/FVC ratio), while sleep-disordered breathing was diagnosed by nocturnal polygraphy with determination of apnea-hypopnea index (AHI) and oxygen desaturation index (ODI). Results: The subjects were of average age 50 years, predominantly male (68%), with a high average body mass index (BMI) of 40.4 kg/m². The results showed statistically significant positive correlation between BMI and AHI (r = 0.38), as well as a very strong correlation between AHI and ODI (r = 0.91). Negative correlations were observed between AHI and FEV1 (r = -0.45) and FVC (r = -0.40), as well as between BMI and spirometric parameters. Conclusion: Obesity significantly contributes to the reduction of lung function and the severity of OSA.

Background/Aim: Secondary failure of oral therapy occurs after a long period of successful use of oral antidiabetic drugs. The exact mechanism of its occurrence is not known. Recent data suggest heterogeneity of this phenomenon, analogous that of type 2 diabetes pathogenesis. Research objective was to assess glucoregulation and insulin secretory function before, three months after the use of insulin therapy and three months after the exclusion and re-introduction of oral antidiabetic therapy. Methods: Forty-nine patients with unsatisfactory glycaemic control were selected and insulin therapy in four daily doses (basal-bolus regimen) was subsequently initiated. Glycaemic regulation and beta cell function (C-peptide and insulinemia) were monitored at three time points: before starting insulin therapy, three months after initiating insulin and three months after discontinuing insulin and resuming the previously used oral antidiabetics. Results: After the introduction of insulin therapy, there was a significant improvement in glycaemic regulation parameters (p < 0.001). Improvements in beta-cell function and reductions in insulin resistance were confirmed during the period after insulin therapy (p < 0.001). However, a certain deterioration in these parameters was observed following the discontinuation of insulin therapy. Additionally, there was a slight decrease in C-peptide and an increase in insulinemia, though these changes were not statistically significant. Conclusion: Application of intensified insulin therapy for three months leads to improvement of glucoregulation and partial recovery of the secretory function of the endocrine pancreas. The reintroduction of oral antidiabetic therapy led to a slight worsening of the observed parameters, although this change was not statistically significant.

Fixed ratio combination of basal insulin and a glucagon-like peptide-1 receptor agonist (GLP-1RA) offers another option to patients with type 2 diabetes (T2DM) with inadequate glycemic control, especially for those desiring simplified method of treatment intensification in order to improve adherence. There are two types of fixed-ratio combinations: insulin degludec/liraglutide (iDergLira) and insulin glargine/lixisenatide (iGlarLixi). The aim of this study was to evaluate efficacy of intesifying the treatment with fixed ratio combination basal insulin and GLP-1 RA in patients inadequatly controlled on different therapeutic regimen. The study included 200 patients with uncontrolled T2DM, who were divided into four equal groups based on the therapeutic regimen before study: oral diabetic agents or metformin and basal insulin or metformin and GLP 1RA or premix insulin. Our results showed that fixed ratio combination showed better efficiency of on glycemic control in patients previously treated with oral agents and premix insulin, while patients previously treated with premix insulin have had the greatest benefit regarding weight change. We found no difference in glycemic control between iDegLira and iGlarLixi, but significant difference in weight reduction between iDegLira and iGlarLixi.

Background: Two types of fixed-ratio combinations of basal insulin and a glucagon-like peptide-1 receptor agonist (GLP-1RA) have been approved for use in type 2 diabetes. One is insulin degludec/liraglutide (iDergLira), and the other is insulin glargine/lixisenatide (iGlarLixi). Direct comparisons between these two combination is not available. Methods: The retrospective study included 186 patients with type 2 diabetes mellitus (DM) with inadequate glycemic control on metformin and basal insulin (degludec, glargine 100, glargine 300) who were switched to fixed-ratio combination GLP-1 RA and basal insulin. Patients were divided into two groups based on the basal insulin before study: group I (n = 86) treated with degludec were switched to iDegLira and patients group II (n = 99), treated with glargine were switched to iGlarLixi. The aim of this study was to directly compare the effects between two fixed – ratio combination on glycemic parameters and non glycemic parameters. Follow up was 6 months. Results: Mean HbA1c decreased similarly (− 1.2% vs.-1.1%). Higher percentage patients in iDegLira group had reached the HbA1c < 7% after 6 months (22% vs. 18.2%, p < 0.05). The mean change in fasting plasma glucose (FPG) was comparable for the two groups, while mean decrease postprandial plasma glucose (PPG) level were lower in iGlarLixi group (2 vs 1.8 mmol/l, p > 0.05). Change in body weight was significant in iDegLira group (1.8 kg vs. 0.7 kg, p < 0.001). At the end of the study patients showed decrease in total cholesterol (TC) and low-density lipoprotein (LDL) for 0.2 mmol/L in iDegLira, 0.1 mmol/l in iGlarLixi, triglycerides decreased 0.3 mmol/l in both groups, high-density lipoprotein(HDL) increased 0.1 mm/l in iGlarLixi. Conclusion: Our results showed that more patients with iDegLira had HbA1c less than 7% and these combination had better effect on weight loss. There was no difference observed in FPG and PPG, lipid profile and rate of hypoglycemia.

Leptin is a protein hormone secreted by adipocytes. Its role in malnutrition-inflammation complex syndrome (MICS) in hemodialysis (HD) patients has not been fully resolved yet. We aimed to assess the predictive role of serum leptin in MICS in maint...

Background. Two types of fixed-ratio combinations of basal insulin and a glucagon-like protein-1 receptor agonist (GLP-1RA) have been approved for use in type 2 diabetes. One is insulin degludec/liraglutide(iDergLira), and the other is insulin glargine/lixisenatide (iGlarLixi). Direct comparisons between these two combination is not available. Methods. The retrospective study included 186 patients with type 2 DM with inadequate glycemic control on metformin and basal insulin (degludec, glargin 100, glargin 300) who were switched fixed-ratio combination GLP-1 RA and basal insulin.Patients were divided into two groups based on the basal insulin before study: group I ( n = 86) treated with degludec were switched to iDegLira and patients group II ( n = 99), 48 treated with glargin were switched to iGlarLixi. The aim of this study was to direct compare the effect between two fixed – ratio combination on glycemic parameters and non glycemic parameters. Follow up was 6 months. Results . Mean HbA1c decreased similarly (-1.2% vs.-1.1%). Higher percentage patients in iDegLira group had reached the HbA1c < 7% after 6 months ( 22% vs. 18.2%, p < 0.05). The mean change in FPG was comparable for the two groups, while mean decrease PPG level were lower in iGlarLixi group (2 vs 1.8 mmol/l, p > 0.05). Change in body weight were significant difference in iDegLira group (1.8 kg vs. 0.7 kg, p < 0.001). At the end of the study patients showed decreased in total cholesterol and LDL for 0.2 mmol/L in iDegLira, 0.1 mmol/l in iGlarLixi, triglycerids for 0.3 mmol/l in both groups, increase HDL for 0.1 mm/l in iGlarLixi. Conclusion . Our results showed that more patients with iDegLira had HbA1c less than 7% and these combination had better effect on weight loss. There were no difference on FPG and PPG, lipid profile and rate of hypoglycemia.

Background: Diabetes mellitus (DM) is one of the most common comorbidities in people with COVID-19 infection. Inadequate glycemic control is related to high inflammation, hypercoagulability, and mortality in COVID-19 patients. Patients admitted to hospital for COVID-19 might need modifications to their diabetes therapy. The study was aimed at evaluating the association of clinical presentation and glycemic management in patients with type 2 diabetes and COVID-19. Methods: This retrospective study included 60 patients with type 2 DM and COVID-19, distributed into three groups: group 1 oral agents — 32 patients, group 2 oral agents and basal insulin — 15 patients, group 3 intensive insulin treatment — 13 patients. We measured laboratory parameters, evaluated clinical presentation, and followed glycemic treatment during hospitalization. Results: Patients on oral antidiabetic drugs had better glycemic control before hospitalization, shorter duration of DM, and normal weight according to BMI compared with the other two groups. The most common symptoms of COVID -19 were: fever, cough, and fatigue. For better glycemic control we added basal insulin in 15 patients in group 1 (50%) and 9 patients need intensive insulin treatment in group 2 (60%). We discounted metformin in two patients in group 1 and three patients in group 2. A total of 7 patients died (11.6 %) during hospitalization, including 3 deaths in group 2 (5%), and 4 deaths in group 3 (6.6%). Conclusions: Poorer glycemic control before COVID -19 is associated with higher inflammation parameters, worse outcomes, and required modification of their treatment during hospitalization. Background: Diabetes mellitus (DM) is one of the most common comorbidities in people with COVID-19 infection. Inadequate glycemic control is related to high inflammation, hypercoagulability, and mortality in COVID-19 patients. Patients admitted to hospital for COVID-19 might need modifications to their diabetes therapy. The study was aimed at evaluating the association of clinical presentation and glycemic management in patients with type 2 diabetes and COVID-19. Methods: This retrospective study included 60 patients with type 2 DM and COVID-19, distributed into three groups: group 1 oral agents — 32 patients, group 2 oral agents and basal insulin — 15 patients, group 3 intensive insulin treatment — 13 patients. We measured laboratory parameters, evaluated clinical presentation, and followed glycemic treatment during hospitalization. Results: Patients on oral antidiabetic drugs had better glycemic control before hospitalization, shorter duration of DM, and normal weight according to BMI compared with the other two groups. The most common symptoms of COVID -19 were: fever, cough, and fatigue. For better glycemic control we added basal insulin in 15 patients in group 1 (50%) and 9 patients need intensive insulin treatment in group 2 (60%). We discounted metformin in two patients in group 1 and three patients in group 2. A total of 7 patients died (11.6 %) during hospitalization, including 3 deaths in group 2 (5%), and 4 deaths in group 3 (6.6%). Conclusions: Poorer glycemic control before COVID -19 is associated with higher inflammation parameters, worse outcomes, and required modification of their treatment during hospitalization.

Maintenance hemodialysis (HD) patients often experience fluctuations of volume status. Although hypervolemia possibly induces systemic inflammation, the relationship between volume status and leptin has not yet been well defined. The aims of this study were to determine the levels of leptin, C‐reactive protein (CRP), and ferritin in relation to volume status and to assess the relationship between leptin and volume and inflammatory status in chronic HD patients. This prospective study included 93 HD patients divided, based on evaluation using the body composition monitor, into normovolemic and hypervolemic groups (overhydration/extracellular water [OH/ECW] ≤ 15% and OH/ECW > 15%, respectively). The levels of leptin and inflammatory markers (CRP, ferritin) were determined during a mid‐week dialysis session in all patients. There were more hypervolemic patients after 12 months of follow up than at baseline (41% vs. 38%). Hypervolemic patients had significantly lower leptin levels (11.42 ± 19.24 ng/mL vs. 34.53 ± 40.32 ng/mL at baseline and 13.41 ± 22.04 ng/mL vs. 41.54 ± 21.78 ng/mL at 12 months), longer time on dialysis, and poorer nutritional status than normovolemic patients. Inflammation was present regardless of the volume status, but hypervolemic patients had significantly higher CRP and ferritin than normovolemic patients. A statistically significant reverse correlation was found between leptin level, hyperhydration index, and OH/ECW. No significant correlation was found between leptin and inflammatory markers CRP and ferritin.

INTRODUCTION AND AIMS: The malnutrition and inflammation complex syndrome (MICS) play important role in morbidity and mortality in chronic hemodialysis patients. Leptin is a protein hormone, which primary role is in the regulation of food intake and energy consumption. The role of leptin in MICS in hemodialysis patients has not yet been well defined. The aim of the study was to examine the impact of MICS on the leptin level and the predictive value of leptin for MICS