Most researchers support the important role of incretins, particularly glucagon-like peptide-1 in improving metabolic control in patients with type 2 diabetes after bariatric operations, mostly involving shunting. A positive effect of bariatric surgery for type 2 diabetes is known from numerous publications on the results of surgical treatment of morbid obesity and in this review we try to analyze the mechanisms of this effect.

The growing interest to metformin in areas beyond the limits of diabetology serves as a stimulus for further evaluation of its effectiveness as a potential modulator of cancer morbidity and obesity epidemic. Gradually detectable differences in the intensity of these effects of the drug can be explained by an insufficient number of randomized trials, differences in the control groups (reference points), gender, age, pharmacogenetic and other factors, the study of which collectively promised to increase the likelihood of more favorable clinical effects of metformin and other antidiabetic biguanides in discussed areas.

Metabolic syndrome (MS) is a combination of impaired glucose metabolism, abdominal obesity, dyslipidemia, and hypertension and is associated with the development of type 2 diabetes (T2D) and cardiovascular disease (CVD). Despite numerous studies on this subject, the terminology and the definition of MS as well as borderline values for its criteria are not defined. From the standpoint of public health and clinical practice, the early detection of MS is highly important in order to prevent the development of CVD and T2D. This review article reflects the stages of development of the concept of MS, expresses the opinion of the authors with respect to the modern view of the problem and analyzes of contemporary arguments "for" and "against" the use of MS diagnosis in clinical practice.

Vitamin D is essential for a vast number of physiologic processes, and thus adequate levels are necessary for optimal health. During childhood and adolescence, an adequate vitamin D status is needed due to its important role in cell growth, skeletal development and growth. Vitamin D is a fat-soluble vitamin that is naturally found in very few foods, is added to others, and is available as a dietary supplement. It is produced endogenously when ultraviolet light strikes the skin. The adequate intake and status of vitamin D greatly depends on age, concomitant diseases and the use of some medications that are covered in-depth in the article. Recent epidemiologic and experimental evidence has suggested that low vitamin D concentrations seem to be significantly associated with all-cause mortality, cardiovascular disease, cancer (mainly breast, prostate and colorectal), hypertension, metabolic syndrome, diabetes mellitus type 1 and type 2. However, the data supporting protective effects of vitamin D supplementation on conditions other than skeletal diseases like rickets, osteoporosis and osteomalacia are very weak, and the large, controlled clinical trials that are in progress now should resolve this issue.

We examined 292 patients (mean age 37,5±9,1 years) with morbid obesity (initial BMI 47,3±7,0 kg/m2), from which 72 patients had type 2 diabetes, before and after biliopancreatic diversion in Hess-Marceau modification, conducted from 2003 to 2010. Along with a significant and steady weight loss, the most important advantage of surgery is its high efficiency in treatment of disturbances in carbohydrate and lipid metabolism in patients with morbid obesity and associated type 2 diabetes and severe atherogenic dyslipidemia.

69 young men with obesity manifesting at puberty have been examined. The average age was 19,22±0,26. 17 healthy young men, whose average age was 22 ± 0,72 years old, constituted a control group. The examined were divided according to their blood pressure (BP): the first subgroup included 36 young men with normal blood pressure, the other subgroup included 33 young men with arterial hypertension. Levels of blood lipid spectrum, levels of leptin, resistin, adiponectin, insulin in serum, urinary metanephrine excretion were measured. We obtained the following results: young men with obesity identified atherogenic changes in lipid metabolism, insulin resistance and compensatory hyperinsulinemia. Regardless of the level of blood pressure they showed a significant increase in leptin levels. In the subgroup of patients with hypertension we found increased urinary excretion of metanephrine, indicating increased activity of the sympathoadrenal system and its involvement in the formation of hypertension. The level of adiponectin in the surveyed tended to decrease, more pronounced in the combination of obesity and hypertension.

Aim: to study the role and relationship of lipid metabolism and levels of proinflammatory cytokines in patients with type 2 diabetes mellitus (DM2) with diabetic nephropathy (DN), depending on the stage of chronic kidney disease (CKD). Materials and Methods: a total of 240 patients with type 2 diabetes in the early stages of DN and CKD were studied. Results: in patients with type 2 diabetes development of DN was associated with an increased level of proinflammatory cytokines and lipid abnormalities (hypertriglyceridemia). We found a negative correlation between the level of triglycerides (TG) and glomerular filtration rate (GFR) (r = -0,43) and a direct correlation between the level of IL-6 and TG (r = 0,48). Conclusions: increased levels of proinflammatory cytokines and triglycerides increase the risk of development and progression of DN and CKD.

Hypercortisolism is a severe endocrine disorder that leads to all types of metabolic disturbances. The most frequent symptom of hypercortisolism is a specific weight gain and body fat distribution - "cushingoid" obesity which clinically reflects the pathological changes in protein, carbohydrate and lipids metabolism. We provide a clinical case of a patient with Cushing's disease. This clinical case represents challenges in the differential diagnosis of this rare endocrine disorder and metabolic syndrome, and specific approach in further evaluation and treatment of Cushing's disease that requires all the latest technology in this field to be employed.

Comments on: Vaag A, Gluud C, Lund SS, Almdal T.Comparison of metformin and insulin versus insulin alone for type 2 diabetes: systematic review of randomised clinical trials with meta-analyses and trial sequential analyses. BMJ. 2012 Apr 19;344:e1771

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Stevens JE, Horowitz M, Deacon CF, Nauck M, Rayner CK, Jones KL. The effects of sitagliptin on gastric emptying in healthy humans - a randomised, controlled study. Aliment Pharmacol Ther. 2012 Jun 28. doi: 10.1111/j.1365-2036.2012.05198.x

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Harte AL, Varma MC, Tripathi G, McGee KC, Al-Daghri NM, Al-Attas OS, Sabico S, O'Hare JP, Ceriello A, Saravanan P, Kumar S, McTernan PG. High fat intake leads to acute postprandial exposure to circulating endotoxin in type 2 diabetic subjects. Diabetes Care. 2012 Feb; 35(2): 375-82

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Qaseem A., Humphrey L.L., Sweet D.E., Starkey M., Shekelle P. Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2012 Feb 7;156(3):218-31.

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Wong TY, Simó R, Mitchell P. Fenofibrate – a potential systemic treatment for diabetic retinopathy? Am J Ophthalmol. 2012 Jul;154(1):6-12