SEMNIFICAIA SCORULUI REAVEN N CAZUL PACIENILOR CU DIABET ZAHARAT NOU DIAGNOSTICAT A. Nicoar, C. Pencea, D. Licroiu, R. Nafornita, R.

Lichiardopol Institutul de Diabet, Nutriie i Boli Metabolice N. Paulescu, Bucureti, Romnia

Obiectiv: Obiectivul acestui studiu a fost acela de a identifica relaia dintre Scorul Reaven i caracteristicile clinice si metabolice ale pacienilor nou descoperii cu diabet zaharat tip 1 (DZ tip 1) si diabet zaharat tip 2 (DZ tip 2). Material si metod: Lotul studiat a inclus 200 pacieni cu DZ tip 1 si DZ tip 2, nou descoperii, nregistrai n ultimele 2 luni la Institutul de Diabet, Nutriie si Boli Metabolice N.Paulescu, Bucureti, dintre care 98 au fost barbai (49%) si 102 au fost femei (51%). Pe lotul studiat, pacienii au fost grupai n funcie de tipul de diabet zaharat (DZ) n 2 loturi : lotul 1 incluznd pacienii cu DZ tip 1 (n=13) i lotul 2 incluznd pacienii cu DZ tip 2 (n=187). Pentru fiecare lot au fost colectate date clinice si antropometrice (nalime, greutate, indexul masei corporale-IMC, circumferina abdominal i valorile tensiunii arteriale sistolice i diastolice), dar i parametrii metabolici (HbA1c i profilul lipidic), date privind statusul de fumtor/nefumtor i antecedente heredocolaterale de DZ.Pentru interpretarea rezultatelor, am utilizat criteriile ATP III pentru definirea parametrilor sindromului metabolic i Scorul Reaven (raportul TG/HDLcol3) pentru estimarea insulinorezistenei.Analiza statistic a datelor s-a efectuat utiliznd SPSS 15.0. Rezultate: Prevalena obezitii abdominale a fost de 30.7% n cazul lotului de pacieni cu DZ tip 1 i de 47.05% n cazul lotului de pacieni cu DZ tip 2. Valori crescute ale tensiunii arteriale sistolice s-au constatat la 74.2% dintre subieci, 23.1% dintre acetia aparinnd lotului 1 de pacieni cu DZ tip 1, iar 77.2% aparinnd lotului 2 de pacieni cu DZ tip 2. Valoarea medie a HbA1c a fost de 10.62.84% la pacienii cu DZ tip 1, respectiv 9.082.54% la pacienii cu DZ tip 2. Valoarea medie a Scorului Reaven a fost de 2.591.35 la lotul de pacieni cu DZ tip 1 i respectiv 6.443.98 la lotul de pacieni cu DZ tip 2. Valorile medii ale IMC au fost 23.76kg/m la pacienii cu DZ tip 1, respectiv 30.16kg/m la pacienii cu DZ tip 2.La pacienii cu DZ tip 1 nou diagnosticat, raportul TG/HDLcol s-a corelat direct i puternic cu circumferina taliei (rs=0.670, p=0.012, CD=44.89), astfel c 44% dintre subieci au prezentat o corelaie pozitiv ntre cei doi parametri.La pacienii cu DZ tip 2 nou diagnosticat, Scorul Reaven s-a corelat pozitiv cu circumferina abdominal (rs=0.740, p=0.001, CD=54.76%), cu valorile HbA1c (rs=0.552, p=0.006, CD=30.47%) i cu tensiunea arteriala (p=0.001). Nu am constatat diferene statistic semnificative ntre pacienii din cele 2 loturi n ceea ce privete stratificarea lor n funcie de sex, antecedente de DZ i statusul de fumtor. Concluzii: In cazul DZ tip 1 nou diagnosticat, Scorul Reaven se asociaz cu circumferina taliei pacienilor. n cazul DZ tip 2, Scorul Reaven se asociaz cu circumferina taliei, cu majoritatea parametrilor sindromului metabolic i cu gradul de

control metabolic al DZ. Circumferina taliei, fiind un parametru uor de msurat, poate fi uzitat ca punct de plecare n screeningul insulinorezistenei.

THE SIGNIFICANCE OF REAVENS SCORE IN PATIENTS WITH DIABETES MELLITUS NEWLY DIAGNOSED A.Nicoara, C.Pencea, D. Licaroiu, G. Stan, R. Lichiardopol N.Paulescu Institute of Diabetes, Nutrition and Metabolic Disease, Bucharest, Roumania

Background and Aims: The objective of this study was to identify the relationship between the Reaven`s Score which is an indicator for insulin resistance and the clinical and metabolic features of patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) newly diagnosed. Materials and Methods: The study group included two hundred patients newly diagnosed T1DM and T2DM registrated at N. Paulescu Institute of Diabetes, Nutrition and Metabolic Disease, Bucharest during the last two month, 98 men (49%) and 102 women (51%). Depending on the type of diabetes mellitus (DM), the subjects were selected in two groups: group 1 included the patients with T1DM newly diagnosed (n=13) and group 2 included the patients with T2DM newly diagnosed (n=187). In each group, we assessed the clinical and a few anthropometric data (heigh, weight, body mass index - BMI, waist circumference and sistolic and diastolic blood pressure) as well as metabolic parameters (HbA1c and lipid profiles), history of DM data and smoking/no smoking status data.The ATP III criteria for metabolic syndrome (MetS), Reaven`s Score (TG/HDL chol) 3 for estimation of insulin resistance have been used to interpret the results.Statistical analysis was carried out using SPSS 15.0. Results: The prevalence of large waist was 30.77% for T1DM group and 47.05% for T2DM group. High sistolic blood pressure was found in 74.2% of the subjects, in 23.1% of the patients with T1DM and in 77.2% of the patients with T2DM. The mean HbA1c level was 10.62.84% in T1DM patients group and 9.082.54% in T2DM patients group. The mean values of Reaven`s Score was 2.591.35 in T1DM patients and 6.443.98 in T2DM patients. The mean values of BMI was 23.76kg/m in newly diagnosis T1DM patients and 30.16kg/m in newly diagnosis T2DM patients. In patients with newly diagnosed T1DM there was proved the existence of a positive correlation between Reaven`s Score and waist circumference (rs=0.670, p=0.012, CD=44.89): in 44% of the patients with newly diagnosed T1DM has been shown a positive correlation between the TG/HDL chol. ratio values and the waist circumference values. In patients with newly diagnosed T2DM there was proved the existence of a positive correlation between Reaven`s Score and waist circumference values (rs=0.740, p=0.001, CD=54.76%) as well as between Reaven`s Score and HbA1c values (rs=0.552, p=0,006, CD=30.47%) and 2

between the Reaven`s Score and high blood pressure (p=0,001). We have not found semnificative statistical differences between the patients of the two groups regarding the sex stratification (p=0.832), history of DM (p=0.267) and smoking status (p=0.225). Conclusions: The Reaven`s Score is related to waist circumference in newly diagnosed T1DM patients. In T2DM, The Reaven`s Score is related to anthropometric and most parameters of metabolic syndrome and with the degree of metabolic control. Based on the frequency and easy-to-determine waist circumference, it could be use as starting point to screen for insulin resistance.

INSTRUMENT INFORMATIC APLICAT IN EDUCATIA PENTRU O ALIMENTATIE SANATOASA Calinici M.A.*, Pavel N.**, Pavel C.**, Calinici T.*** *Spitalul Judetean de Urgenta Zalau **SC. Alfasoftware. SA Zalau *** Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj Napoca

In conditiile in care excesul ponderal ameninta sa dobandeasca proportii epidemice, am considerat util sa testam eficienta utilizarii instrumentelor informatice in educatia pentru o alimentatie sanatoasa. Obiectivul aplicatiei este sensibilizarea persoanelor sanatoase cu privire la importanta unei ratii calorice rezonabile si a unei structuri armonioase in principii nutritive. Grupul tinta e definit ca alcatuit din navigatori pe internet, grup caracterizat printr-un anume segment de varsta, coeficient intelectual si preocupari specifice. Site-ul www.anchetainfarfurie.ro are incorporata o aplicatie de tip Flash, ce permite alcatuirea unui jurnal alimentar prin intermediul unui site web (internet). Colectand date de la utilizator, aplicatia calculeaza I.M.C. si ratia calorica ideala si cea realizata. In serverul aplicatiei este inregistrata o baza de date cuprinzand peste 7500 de alimente, cu parametrii acestora. Aceste alimente se pot include in jurnalul fiecarui untilizator printr-o interfata simpla si prietenoasa. Serverul ce ruleaza aplicatia este in incinta Societatii Romane de Informatica Medicala Aplicata (SRIMA), baza de date cuprinzand alimentele provine de la The Nutricut Data Laboratory si este recomandata de catre Center for Food Safety and Applied Nutrition, din cadrul U.S. Food and Drink Administration. Programul Ancheta in farfurie este agreat de Societatea de Nutritie din Romania.

INFORMATICAL INSTRUMENT APPLIED IN THE EDUCATION FOR A HEALTHY NUTRITION Calinici M.A.*, Pavel N.**, Pavel C.**, Calinici T.*** *The Emergency County Hospital Zalau **SC Alfasoftware SA, Zalau ***The Iuliu Hatieganu University of Medicine and Pharmacy, , Cluj Napoca

In the circumstances in which excessive ponderosity threatens to gain epidemical proportions, we considered it usefull to test the eficiency of some informatical instruments in the education for a healthy nutrition. The aim of the application is to make healthy people more sensitive to the importance of a reasonable caloric intake and of a structure that is harmonious in what concerns the nutritive principles. The target group is defined as being made of internet navigators. The group is characterized by a certain age segment, IQ or specific concerns. The site www. Anchetainfarfurie.ro has incorporated a FLASH application that allows the creation of an alimentary diary through a web (internet) site. Gathering data from the user, the application calculates the B.M.I. and the ideal and the achieved caloric intake. A database is registered inside the application server, containig over 7500 aliments and their parameters. These aliments can be included in each and every users diary, through a simple and friendly interface. The server that supports the application is inside The Romanian Society for Applied Medical Informatics (RSAMI), the database containing the aliments coming from The Nutricut Data Laboratory and is recommended by The Center for Food Safety and Applied Nutrition in the U.S. Food and Drink Administration. The program Ancheta in farfurie (investigation in your plate) is supported by The Romanian Society For Nutrition.

EDUCATIA TERAPEUTICA IN ROMANIA Adina Snpetreanu, Gina Vrnceanu Centrul Clinic de DNBM Cluj-Napoca, Centrul Clinic de DNBM Iai

Lucrarea de fata isi propune sa prezinte structura organizatorica a centrelor de diabet din tara in ceea ce priveste numarul existent de educatori specializati in diabet , dieteticieni , precum si organizarea programului educational .Metodele de abordare a educatiei pacientilor cu diabet zaharat sunt de asemenea parte importanta a acestei lucrari.

TERAPEUTIC EDUCATION IN ROMANIA Adina Snpetreanu, Gina Vrnceanu

Diabetes demographic and epidemic data. Diabetes care network in Romania. Therapeutic Education in Romania; network, methods , achievements , barriers.

FACTORI DE RISC AI EXCESULUI PONDERAL LA COPIL SI ADOLESCENT Adriana Cosmescu, Doina Felea, Liliana Barbacariu, Antoneta Petroaie, Ana-Maria Slnin, Otilia Novac, Mihaela Manole Disciplina Medicin de Familie U.M.F. "Gr. T. Popa" Iai

Introducere: Obezitatea la copil reprezint o problem de sntate major deoarece studiile efectuate au artat ca 20 25% din populaie devine supraponderal nainte de vrsta de 20 de ani. Scopul acestui studiu a fost prezentarea aspectelor epidemiologice, clinico-anamnestice i etiologice n apariia excesului ponderal la copil. Material i metod: Studiul a fost efectuat pe un lot de 33 de copii i adolesceni dignosticai cu suprapondere sau obezitate ntr-un cabinet de pediatrie din cadrul Ambulatoriului de Specialitate al Spitalului "Sf. Spiridon" din Iai, n perioada ianuarieiunie 2008. La aceti pacieni, examenul clinic general i msurtorile antropometrice au fost completate cu o anamnez amanunit privind antecedentele heredo-colaterale, antecedentele personale fiziologice i patologice, ancheta alimentar, activitatea fizic efectuat, afeciunile asociate. Rezultate: Din cei 33 de pacieni, 23 de copii i adolesceni, reprezentnd 69,7%, au fost diagnosticai cu obezitate ( IMC peste percentila 95 dup vrsta i sex) i 10 cazuri cu supraponderalitate ( IMC peste percentila 85 ). Repartiia dup sex a artat o predominen a sexului feminin (19 fete, respectiv 57,6%), fa de sexul masculin ( 14 baieti 42,4% ). Mediul de provenien a fost urban n 66,7% din cazuri i rural la 33,3% dintre pacieni. Istoric familial pozitiv la unul sau ambii prini ( obezitate, diabet zaharat de tip 2 ) s-a ntlnit la 14 pacieni. n ce privete greutatea la natere, la 3 pacieni a fost peste 4000 de grame i n 3 cazuri sub 2700 de grame ( subponderalitate ). n toate cazurile, principala cauza a excesului ponderal a fost dieta dezechilibrat, 5

hipercaloric, pe baza surplusului de dulciuri, fainoase i grsimi. Doar 8 dintre pacieni practicau o activitate fizic corespunztoare, respectiv orele de educaie fizic dar i un sport n afara colii. n celelalte cazuri, copiii fie erau scutii de sport, fie se prezentau la orele de educaie fizic dar fr a participa efectiv. Dintre afeciunile asociate menionam: diabetul de tip 2 ntr-un caz, HTA la 2 pacieni, scderea toleranei la glucoz n 4 cazuri i dislipidemie la 10 pacieni. Concluzii Obezitatea copilului este o problem de sntate public att prin creterea prevalenei ct i prin efectele pe termen lung asupra sntii. Prevenirea obezitii se realizeaz prin diet adecvat, activitate fizic i modificarea stilului de via. Depistarea supraponderii i obezitii precum i factorii de risc ai acestora reprezint cel mai important rol profilactic al medicului de familie.

RISK FACTORS OF OVERWEIGHT IN CHILDREN AND TEENAGERS Adriana Cosmescu, Doina Felea, Liliana Barbacariu, Antoneta Petroaie, Ana-Maria Slanina, Otilia Novac, Mihaela Manole Discipline Family Medicine U.M.F. Gr. T. Popa Iasi

Introduction: Obesity in children is a major condition of health as the carried out studies have shown that 20 25% of people become overweight before they reach 20. The purpose of this study was to present the epidemiological, clinical, anamnestic and etiological aspects in the occurrence of overweight in children. Material and method: The study was performed on 33 overweight or obese children and teenagers in a pediatrics office of the Out-patient Clinic of Sf. Spiridon Hospital from January to June 2008. In these patients, the general clinical exam and the anthropometric measuring were completed by a minute anamnesis with respect to the heredo-collateral history, the pathological and physiological personal history, the food survey and the carried out physical activity. Results: Of the 33 patients, 23 children and teenagers, i.e. 69,7% were diagnosed with obesity (IMC over 95 percentile according to age and sex) and 10 cases of overweight (IMC over 85 percentile). The division according to sex showed a predominance of the female sex (19 girls, i.e. 57,6%) as opposed to the male sex (14 boys 42,4%). Their environment was an urban one in 66,7% of the cases and a rural one in 33,3% of the patients. The positive family history with one or both affected parents (obesity, type 2 diabetes mellitus) was discovered in 14 patients. The birth weight was over 4000 grams in 3 patients and below 2700 grams in 3 cases. In all cases, the main cause of overweight was an unbalanced hyper caloric diet based on excessive sweets, pastry and fats. Only 8

of the patients were practicing an extra sport and were participating at the physical education hours at school. The other children were exempted from physical education classes or they were present without taking any part in the activities. From the associated diseases, we mention the following: type 2 diabetes mellitus in one case, hypertension in 2 patients, impaired glucose tolerance in 4 cases and dyslipidemia in 10 patients. Conclusions Children obesity is a public health matter both due to the increase of prevalence and the long term effects on health. Obesity prevention is achieved by an adequate diet, physical activity and change of the life style. The diagnoses of overweight and obesity along with their risk factors are the most prophylactic role of the family medicine. INFLUENTA HIPERGLICEMIEI POSTPRANDIALE ASUPRA INTERVALULUI QT LA PACIENTII CU DIABET ZAHARAT TIP 2 Adriana Rusu1, Cristina Ni1,2, Ramona tefan2, Adriana Filimon2, Ildiko Kicsi Matyus2, Nicolae Hncu1,2
1 2

Universitatea de Medicin i FarmacieIuliu Haieganu, Cluj Napoca Centrul de Diabet , Nutriie i Boli Metabolice, Cluj-Napoca

Introducere i obiective. Intervalul QT prelungit reflect alungirea repolarizrii isau creterea heterogenitii repolarizrii miocardice, situaii asociate cu un risc crescut de aritmii i moarte subit. Studii recente au confirmat valoarea intervalului QT ca predictor al mortalitii att n cazul pacienilor cu diabet zaharat, ct i n cazul persoanelor fr diabet. Obiectivul acestei cercetri a fost investigarea relaiei ntre glicemia postprandial i durata intervalului QT, precum i identificarea valorii glicemiei postprandiale de la care crete riscul de apariie a intervalului QT prelungit. Subieci i Metod. Au fost analizate date provenite de la 47 de pacieni cu diabet zaharat tip 2 (66% femei), cu vrste cuprinse ntre 30 i 79 ani. S-au nregistrat istoricul personal, caracteristicile clinice i antropometrice, precum i rezultatele determinrilor de laborator: A1c, profil lipidic. De asemeanea, a fost nregistrat electrocardiograma (ECG) n repaus, att preprandial ct i la 2h postprandial, fr controlul frecvenei i profunzimii respiraiei. Intervalul QT a fost msurat n derivaiile II, V2, V5, iar valoarea medie a fost corectat pentru frecvena cardiac utiliznd formula lui Hodges. Prelungirea intervalului QTc > 440 ms a fost considerat patologic. Rezultate. Postprandial, durata intervalului QTc a fost semnificativ mai mare dect n condiii preprandiale (410.727.1ms vs. 403.323.03ms, p=0.03). n 59.6% din cazuri s-a constatat creterea postprandial a duratei intervalului QTc, iar dintre aceti pacieni

(14.9%) au prezentat prelungirea intervalului QTc > 440 ms. Pentru predicia prezenei intervalului QTc prelungit, utiliznd ROC, s-a determinat c o valoare a glicemiei postprandiale de 173.5 mg/dl poate detecta prezena intervalului QTc prelungit cu o sensibilitate de 86% i o specificitate de 51%. Valoarea predictiv negativ (VPN) a fost de 95%, iar valoarea predictiv pozitiv (VPP) de 24%. Concluzii. Alungirea intervalului QTc este frecvent asociat cu hiperglicemia postprandial i poate reprezenta un factor de risc adiional pentru evenimentele cardiovasculare. Reducerea excursiilor glicemice postprandiale ar putea preveni prelungirea intervalului QTc i ulterior apariia unor aritmii potenial fatale.

THE INFLUENCE OF POSTPRANDIAL HYPERGLYCEMIA ON QT INTERVAL IN PATIENTS WITH TYPE 2 DIABETES Adriana Rusu1, Cristina Ni1,2, Ramona tefan2, Adriana Filimon, Ildiko Kicsi Matyus2, Nicolae Hncu1,2
1 2

Iuliu Haieganu University of Medicine and Pharmacy, Cluj Napoca Clinical Center of Diabetes, Nutrition, Metabolic Diseases, Cluj-Napoca

Background and Aims. Ventricular myocardial depolarization and repolarization are reflected in QT interval. Prolonged QTc reflects cardiac repolarization prolongation and/or increased repolarization inhomogenity known to be associated with increased risk of arrhythmias and sudden death. In recent years, studies have confirmed the value of QT interval as a predictor of total mortality in both diabetic and non-diabetic subjects. The objective of this study was to investigate the relationship between postprandial glycemia and the duration of QT interval and to identify cutoff values of postprandial glycemia from which QT interval is prolonged. Subjects and Methods. A number of 47 persons (66% women) with type 2 diabetes, aged between 30-79 years were included in the study. A complete medical history and physical examination was performed. Blood samples were collected in the overnight fasting state, and A1c, total cholesterol, HDL-cholesterol, triglycerides were assessed. Pre- and 2 h-postprandial 12-lead resting ECG were recorded without controlling for depth and rate of respiration. QT interval was measured in II, V2, V5, and the mean value was corrected for heart rate using the Hodges` formula. QTc >440 ms was considered as abnormally prolonged. Results. In postprandial state QTc duration was significantly longer than preprandial (410.727.1 ms vs. 403.323.03 ms, p=0.03). 28 patients (59.6%) presented a

prolongation of QTc interval in the postprandial state compared with preprandial QTc duration. From these patients, 7 (14.9%) had a QTc interval > 440 ms. A cut-off point of 173.5 mg/dl for postprandial glycemia detected the presence of prolonged QTc interval with a sensitivity of 86% and a specificity of 51%. Negative predictive value (NPV) was 95%, and positive predictive value (PPV) was 24% when referring to the presence of prolonged QTc interval. Conclusions. Prolongation of QTc occurs frequently during postprandial state in type 2 diabetes. Postprandial hyperglycemia alters myocardial ventricular repolarization in patients with type 2 diabetes and might be an additional risk factor for cardiovascular events. Limiting meal related glucose excursions over 173.5 mg/dl could prevent QTc prolongation and possible could prevent the occurrence of arrhythmias.

COGNIII DEZADAPTATIVE DESPRE TRATAMENTUL CU INSULIN. CONSTRUCIA I VALIDAREA UNEI SCALE CARE S ORIENTEZE INTERVENIILE CARE VIZEAZ SCDEREA REZISTENEI PSIHOLOGICE LA INSULIN.
1, 2 1 2

Drd. Psih. Amfiana Gherman, 2Prof. Univ. Dr. Daniel David

Centrul Clinic de Diabet, Nutriie i Boli Metabolice Catedra de Psihologie Clinic i Psihoterapie, Universitatea Babe-Bolyai

ASPECTE TEORETICE. Rezistena psihologic la insulin se refer la refuzul din partea pacientului sau a medicului de a iniia insulino-terapia atunci cnd ar fi necesar n controlul diabetului de tip 2. n literatura de specialitate nu sunt disponibile instrumente validate tiinific care s msoare acest concept din punct de vedere psihologic. Cu alte cuvinte, nu exist instrumente care s aib n spate o teorie validat tiinific pentru factorii psihologici implicai n refuzul tratamentului cu insulin i care s aib n acelai timp caliti psihometrice bune. Astfel, este nevoie de un asemenea instrument care s ghideze interveniile psihologilor clinicieni pentru scderea rezistenei psihologice la insulin. Pornind de la teoria cognitiv a emoiilor, la baza consecinelor emoionale i comportamentale dezadaptative (cum ar fi refuzul tratamentului cu insulin sau emoiile disfuncionale de tip anxietate, deprimare, frustrare, furie) stau procese cognitive de tip evaluativ, cum ar fi cerinele absolutiste fa de sine, lume i via, catastrofarea unui eveniment, tolerana sczut la frustrare, evaluarea global negativ a propriei persoane sau a altora. OBIECTIVE: Construirea i validarea unei scale care s msoare cogniiile dezadaptative specifice n rezistena psihologic la insulin.

METODOLOGIE: Participani 50 de pacieni cu diabet zaharat de tip 2 din evidena Centrului de Diabet, Nutriie i Boli Metabolice, Cluj-Napoca. Instrumente: Scala de cogniii despre insulin (SCI), Scala de atitudini i convingeri II (ABS II DiGiuseppe, Leaf, Exner i Robin, 1988), Chestionarul gndurilor automate (ATQ Hollon i Kendal, 1980) i Profilul distresului afectiv (Opri i Macavei, 2005), Interviu clinic pentru investigarea tulburrilor de tip depresiv sau anxios. Procedur: S-a construit (prin consultul experilor i al pacienilor) scala care msoar cogniiile dezadaptative despre tratamentul cu insulin (SCI), iar apoi scalele de mai sus s-au aplicat participanilor la studiu pentru a aduna date legate de fidelitatea i validitatea acestei scale. Rezultate: Analiza datelor a evideniat faptul c SCI are o consisten intern ridicat; validitatea de coninut a fost analizat de un grup de experi n teoriile cognitiv-comportamentale ale emoiilor. SCI a fost astfel construit nct coninutul su s reflecte principiile teoriei raional-emotive i cognitiv-comportamentale, iar forma sa s fie asemntoare altor teste similare deja existente i care i-au dovedit utilitatea. Validitatea de construct se refer la msura n care scala reflect constructul pe care l msoar; astfel, s-au corelat itemii acestui nou instrument cu itemii altor scale existente care i-au dovedit deja validitatea i fidelitatea (ABS II, ATQ i PDA). Datele arat o bun validitate de construct a acestei scale. n ceea ce privete validitatea convergent, cogniiile evaluative dezadaptative coreleaz cu emoiile negative disfuncionale, iar cele adaptative cu emoiile negative funcionale i cu cele pozitive. CONCLUZII: SCI are coeficieni de fidelitate i validitate ridicai, putnd discrimina cu succes ntre persoanele care refuz i cele care accept tratamentul cu insulin. Aceast scal este un instrument de tip evidence-based n evaluarea factorilor cognitivi care influeneaz refuzul/acceptarea insulino-terapiei.

MALADAPTIVE BELIEFS ABOUT INSULIN THERAPY. THE CONSTRUCTION AND VALIDATION OF A SCALE USEFUL FOR THE INTERVENTIONS THAT AIM TO DECREASE THE PSYCHOLOGICAL INSULIN RESISTANCE.
1,2 1 2

Amfiana Gherman, M.A., PhD candidate, 2 Univ. Prof. Daniel David, PhD

Clinic of Diabetes, Nutrition and Metabolic Diseases Department of Clinical Psychology and Psychotherapy, Babe-Bolyai University

THEORETICAL ASPECTS. The psychological insulin resistance refers to the reluctance of both patients and medical staff to initiate insulin therapy when it would be beneficial for the control of the type 2 diabetes. In the literature there arent available evidence-based instruments to measure this concept from a psychological point of view. Therefore, there are no instruments based on an empirical theory for the psychological factors involved in the refusal of the insulin treatment and that has good psychometric 10

qualities at the same time. Therefore, we need such an instrument to guide the interventions of the clinical psychologists to decrease the psychological insulin resistance. Starting from the cognitive theory of emotions, at the basis of the maladaptive emotional and behavioral consequences (such as the refusal of the insulin treatment or the dysfunctional emotions such as anxiety, depression, anger) there are evaluative cognitive mechanisms, such as demandingness towards self, life and others, awfulinsing the negative character of an event, low frustration tolerance and negative global evaluation. OBJECTIVES: The development and the validation of a scale that measures the maladaptive believes about insulin treatment. METHOD: Participants 50 patients with type 2 diabetes from the Clinic of Diabetes, Nutrition and Metabolic Diseases, Cluj-Napoca. Instruments The Insulin Beliefs Scale (IBS), The Attitudes and Beliefs Scale II(ABS II DiGiuseppe, Leaf, Exner & Robin, 1988), Automatic Thoughts Questionnaire (ATQ Hollon & Kendal, 1980) and Emotional Distress Profile (Opri i Macavei, 2005), SCID (Semistructured Clinical Interview after DSM-IV) for investigating depressive or anxiety disorders. Procedure: The scale was constructed with the agreement of the experts and of the patients (IBS), and then all the other scales were applied in order to compute the psychometric coefficients of the scale. Results: The data analysis showed that IBS has a good intern consistency; the content validity was analyzed by a group of experts in the rationalemotional and cognitive behavioral theories of emotions. IBS was constructed so that its content reflects the cognitive theories of emotion and its wording is similar to other tests that already prove their utility. Its construct validity was measured by correlating the IBS items with the items of other scales that already prove their validity (ABS II, ATQ and EDP). The data show good construct validity. In what the convergent validity is concerned, the maladaptive evaluative cognitions correlate with the negative dysfunctional beliefs, and the adaptive ones with the negative and positive adaptive emotions. CONCLUSIONS: IBS has high fidelity and validity coefficients, being able to discriminate between the persons that refuse and those who accept the treatment with insulin. This scale is an evidence-based instrument in the evaluation of the cognitive factors that influence the refusal or the acceptance of the insulin therapy.

PROPUNEREA UNUI GHID CLINIC PENTRU PSIHOLOGII CLINICIENI CARE LUCREAZ CU PACIENI CU DIABET SAU OBEZITATE
1,2 1 2

Drd. Psih. Gherman Amfiana, 1 Psih. Andreia Mocan, 2 Prof. Univ. Dr. Daniel David

Centrul Clinic de Diabet, Nutriie i Boli Metabolice Catedra de Psihologie Clinic i Psihoterapie, Universitatea Babe-Bolyai

11

Pentru a oferi cele mai bune i cele mai eficiente tratamente pacienilor, ne bazm pe principiul interveniilor validate tiinific (evidence-based). Astfel, pentru ca o intervenie s fie validat tiinific, este nevoie ca att teoria care st n spatele ei s fie validat, ct i procedura de intervenie n sine. De aceea, se propune un ghid de intervenie pentru psihologii clinicieni, consilieri psihologici i psihoterapeuii care lucreaz cu persoane cu diabet care s satisfac n primul rnd acest principiu, att ct este posibil avnd n vedere cercetrile existente n literatura de specialitate. Ghidul va urma elementele principale ale unei proceduri de intervenie: psihodiagnostic i evaluare clinic, conceptualizare clinic, relaie terapeutic i tehnici de intervenie. Psihodiagnostic i evaluare clinic: utilizarea interviului clinic semi-structurat dup DSM-IV sau IDC-10, utilizarea de scale care s msoare mecanismele psihologice etiopatogenetice generale i specifice i care au caliti psihometrice bune (evidencebased). Scopul evalurii este acela de a stabili un diagnostic nosologic, ali factori psihologici care influeneaz condiia medical, precum i stabilirea unei liste de probleme specifice pentru situaia de consiliere psihologic sau de psihoterapie specific. Conceptualizarea clinic trebuie s rspund la urmtoarele ntrebri: (1) Ce probleme de natur psihologic sunt (care influeneaz factorii medicali)?; (2) De ce au aprut aceste probleme? i (3) Ce se poate face pentru a remedia aceste probleme? Relaia terapeutic este unul din factorii foarte importani, care explic pn la 30% din mecanismele schimbrii psihologice i presupune cteva caracteristici majore pe care trebuie s le aib psihologul: empatie, congruen, acceptare necondiionat i colaborare. Tehnicile de intervenie recomandate vor fi n funcie de categoriile de probleme psihologice care se pot regsi la pacienii cu diabet sau obezitate. Acestea vor fi abordate din perspectiva modelelor validate tiinific ABC cognitiv i comportamental; n acelai timp, se vor avea n vedere aspectele pozitive i punctele forte ale pacienilor. De asemenea, n ceea ce privete tulburrile psihologice cuprinse n manualele de diagnostic (DSM-IV sau ICD), cum ar fi tulburrile depresive, de tip anxios, tulburrile de comportament alimentar ghidul va oferi trimiterile necesare spre cele mai eficiente (evidence-based) protocoale de intervenie existente.

THE PROPOSAL OF A CLINICAL GUIDE FOR THE CLINICAL PSYCHOLOGISTS THAT WORK WITH DIABETIC OR OBESE PATIENTS
1,2

Amfiana Gherman, M.A., PhD candidate, 1 Psih. Andreia Mocan 2 Univ. Prof. Daniel David, PhD
1 2

Clinic of Diabetes, Nutrition and Metabolic Diseases Chair of Clinical Psychology and Psychotherapy, Babe-Bolyai University

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In order to offer the best and the most efficient treatments, we are based on the principle of evidence-based interventions. Therefore, in order to be scientifically based, a psychological intervention needs to have its theory as well as the intervention protocol tested. As a consequence, we propose an intervention guide for the clinical psychologists, counselors and psychotherapists that work with diabetic and obese persons, that satisfies this criterion, according to the literature. The guide will follow the principal elements of an intervention procedure: the psycho-diagnosis and clinical evaluation, the clinical conceptualization, the therapeutic relationship and the intervention techniques. Psycho-diagnosis and clinical evaluation: the use of the SCID (Semistructured Clinical Interview after DSM-IV) for investigating depressive, anxiety disorders, and others, the use of scales that measure the general and specific ethio-pathogenetic mechanisms, scales that have good psychometric qualities (are evidence-based). The goal of the evaluation is to establish a nosologic diagnosis, the factors that influence the medical condition and a list of specific problems. The clinical conceptualization must answer to the following questions: (1) What are the psychological problems that influence the medical factors? (2) Why did these problems appear? (3) What can be done in order to solve these problems? The therapeutic relationship is one of the most important factors that explain 30% of the psychological mechanisms of change and that implies a few characteristics that the psychologist must have: empathy, congruence, unconditional acceptance and collaboration. The intervention techniques will be recommended according to the specific psychological problems of the diabetic or obese patients. These problems will be approached with the cognitive and behavioral ABC models; at the same time, the positive characteristics of the patients will be used and reinforced. Regarding the ICD-10 psychological disorders, such as the depressive or anxious disorders, the guide will make the necessary references to the most efficicent (evidence-based) intervention protocols.

CUM ESTE APRECIAT PROGRAMUL GUVERNAMENTALCORNUL I LAPTELE" DE CTRE ELEVII DE GIMNAZIU DINTR-O COAL DIN MEDIUL RURAL Crciun Anca-Elena*, Streulea Ioana*, Crciun Cristian-Ioan**, Costiuc Cristina Valentina***, Anca Todoran *- medic rezident an III diabet zaharat, nutriie, boli metabolice, Centrul Clinic de Diabet i Nutriie Cluj-Napoca; **- medic rezident an IV farmacologie clinic, ClujNapoca; ***- medic rezident an III sntate public i management, Cluj-Napoca

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Introducere: Programul guvernamental Cornul i laptele a fost lansat n 16 septembrie 2002. Iniial au beneficit de el doar elevii claselor primare. De curnd de acest program beneficiaz i elevii de gimnaziu. Material i metod: Pentru a afla ct de apreciat este programul guvernamental Cornul i laptele n rndul elevilor de gimnaziu, am aplicat un chestionar elevilor claselor V-VIII ai colii Generale nr.1 din comuna Cricior, judeul Hunedoara. Chestionarul a fost aplicat n ultima or de Educaie pentru sntate din anul colar 2007-2008. Rezultate: Au rspuns la chestionar 85 de elevi, dintre care 27 (31,8%) au fost n clasa a Va, 18 (21,2%) n clasa a VIa, 18 (21,2%) n clasa a VIIa i 22 (25,8%) n clasa a VIIIa. Dintre acetia, 39 (45,9%) au fost fete i 46 (54,1%) au fost biei. 60,2% dintre elevii chestionai nu mannc deloc cornul primit prin programul guvernamental, iar 63,8% nu beau laptele sau iaurtul. n ciuda acestor rezultate, mai bine de jumtate dintre elevii chestionai (59,5%) sunt ncntai de ideea de a primi corn i lapte la coal, iar la 3,6% dintre respondeni le displace aceast msur. Mai bine de o treime (37%) ar dori s primeasc i altceva pe lng corn i lapte sau acestea s fie nlocuite. Dintre propuneri fac parte fructele, eugeniile, biscuiii, coca-cola, brnza topit, iar n lunile de var, ngheata. Aproape 85% dintre copii au zilnic, sau aproape zilnic, pachet la coal, iar aproape 88% dintre ei primesc bani s-i cumpere ce doresc de mncat sau de but. Concluzii: n coala din mediul rural unde am aplicat chestionarul, 60,2% dintre elevi nu mnnc deloc cornul primit prin programul guvernamental, iar 63,8% nu beau laptele sau iaurtul. Cu toate acestea, majoritatea copiilor doresc n continuare s primeasc corn i lapte la coal.

THE EXTENT TO WHICH COUNTRYSIDE SECONDARY SCHOOL CHILDREN APPRECIATE THE GOVERNMENTAL PROGRAM CROISSANT AND MILK Craciun Anca-Elena*, Streulea Ioana*, Craciun Cristian-Ioan**, Costiuc Cristina Valentina***, Anca Todoran *resident doctor in Sugar Diabetes, Nutrition and Metabolic Diseases, 3rd year, at the Clinical Centre of Diabetes and Nutrition, Cluj-Napoca;**resident doctor in Clinical Pharmacology, 4th year, Cluj-Napoca; ***resident doctor in Public Health and Management, 3rd year , Cluj-Napoca

Introduction: The governmental program Croissant and Milk was launched on September 16, 2002. Initially, only the primary school children benefited from it, but recently, it was introduced to secondary school pupils as well. Materials and methods: In order to determine the extent to which the governmental program Croissant and Milk is appreciated among the secondary school children, we have applied a questionnaire to pupils of 5th-8th grade from the No.1 Secondary School, in Criscior, the district of Hunedoara. The questionnaire was applied during the last Education for Health class, at the end of the school year 2007-2008. 14

Results: From a total of 85 students who answered the questionnaire, 27(31.8%) were in the 5th grade, 18(21.2%) in the 6th grade, 18(21.2%) in the 7th grade, and 22(25.8%) were in the 8th grade. Among all these 39(45.9%) were girls, and 46(54.1%) were boys. 60.2% from the questioned pupils never eat the croissant given to them through this governmental program, and 63.8% dont drink the milk or the yoghurt. Despite these results, more than a half of the students who were questioned (59.5%) were delighted by the idea of receiving milk and croissants at school, and 3.6% from those who answered were discontented with this practice. More than one third of the pupils (37%) expressed their wish to get other products together with the milk and the croissant, or, to replace these with something else. Among the suggestions we encountered fruit, Eugenia biscuits, crackers, Coca-Cola, processed cheese, and, during the warm season, ice-cream. Almost 85% of the children have a daily, or almost daily home-packed lunch with them, and almost 88% receive money from their parents in order to buy anything they wish to eat or drink. Conclusions: In the countryside school where the questionnaire was applied, 62.2% of the pupils never eat the croissant given to them through this governmental program, and 63.8% dont drink the milk. Despite this fact, the majority of children are still in favor of receiving milk and croissants at school.

DIMENSIUNEA PSIHOLOGIC I PSIHOPATOLOGIC A SINDROMULUI METABOLIC I A DIVERSELOR SALE COMPONENTE Anca Frunz*, Radu L. Dumitru**, Prof.Dr. C-tin Ionescu-Trgovite* *Institutul de Diabet, Nutriie i Boli Metabolice Prof. Dr. N.C. Paulescu **Institutul Clinic Fundeni

Scop: Studiul de fa i propune construirea unui profil al pacientului cu sindrom metabolic care s conin caracteristicile de ordin psihologic i psihopatologic ale acestuia, profil care s furnizeze datele necesare unui management eficient al bolii i care s vin n sprijinul abordrii terapeutice de ctre medicii practicieni. De asemenea, studiul ii dorete stabilirea gradului n care fiecare component a sindromului metabolic contribuie la caracteristicile de ordin psihologic i psihopatologic ale bolnavilor cu sindrom metabolic, n special gradul n care hipertensiunea arterial este implicat n existena acestor caracteristici. Material i metod: 30 de pacieni diagnosticai cu sindrom metabolic, internai n Institutul de Diabet, Nutriie i Boli Metabolice Prof. Dr. N.C. Paulescu au fost comparai cu 60 de pacieni hipertensivi i cu 40 de pacieni normotensivi. Datele demografice i clinice, comorbiditile la momentul internrii i tratamentul urmat au fost obinute prin anamnez, examen clinic i investigaii paraclinice. Pentru evaluarea statusului psihologic am utilizat Symptom Checklist 90, Scala de Evaluare a Depresiei Hamilton, Scala funcionalitii globale i Scala funcionalitii sociale. 15

Rezultate:26% dintre subiecii inclui n studiu au fost diagnosticai cu sindrom metabolic. Pacienii hipertensivi cu sau fr sindrom metabolic au nregistrat scoruri crescute la parametrii psihologici studiai, cu rezultate statistic semnificative( pvalue<0.05) pentru somatizarea medie, manifestrile obsesiv-compulsive i depresia uoar. Pacienii cu sindrom metabolic au demonstrat o funcionalitate social i global redus. Dintre diversele componente, hipertensiunea arterial a fost cel mai puternic asociat cu caracteristicile psihologice studiate( B-value ntre 0.87 i 3.17; pvalue<0.05).Hiperglicemia a fost semnificativ statistic asociat cu anxietatea, somatizarea, depresia i senzitivitatea. Nivelul HDL-Colesterolului a fost asociat invers proporional cu anxietatea i depresia (B= - 2.31 ;i, respectiv B= - 2.52; p<0.05). Concluzii: Sindromul metabolic reprezint o patologie ale crei implicaii de ordin psihologic sunt importante i demne de luat n considerare. Hipertensiunea arterial este principalul determinant al caracteristicilor de ordin psihologic. PSYCHOLOGICAL AND PSYCHOPATOLOGICAL DIMENSION OF METABOLIC SYNDROME AND ITS COMPONENTS Anca Frunz*, Radu L. Dumitru**, Prof. Dr. C-tin Ionescu-Trgovite* *Diabetes, Nutrition and Metabolic Disease Prof. Dr. N.C.Paulescu Institute **Fundeni Clinical Institute

Aim: The aim of our study was to build a psychological and psychopatological profile of hypertensive patients, a profile that can provide imperative data and information for an eficient management of the disease and that is useful to the therapeutical approach. Another aim of this study was to determine the contribution of each metabolic syndrome component to psychological and psychopatological characteristics, particularly the contribution of hypertension. Method: 30 patients hospitalised in the Prof. Dr. N.C Paulescu Diabetes, Nutrition and Metabolic Disease Institute were compared to 60 hypertensive patients and 40 normotensive patients. Demographic and clinical data, comorbidities and medical treatment before hospitalisation had been obtained through case history, clinical exam and medical investigations. So as to evaluate the psychological status we used Symptom Checklist 90, Hamilton Depression Rating Scale, Global Asset Functioning Scale, Social Functioning Scale. Results: Of the sample, 26% had metabolic syndrome. Hypertensive patients with or without metabolic syndrome had greater scores for the studied psychological factors, with statistical significance ( p- value<0.05) for medium somatization, obssesive-compulsive symptoms and low depression symptoms. Patients with metabolic syndrome had lower social and global functionality. Of the individual components, hypertension was strongly associated with psychological characteristics ( B-value = 0.87 - 3.17; p-value<0.05). Hyperglycemia was associated with anxiety, somatization, sensitivity and depression.

16

HDL-Cholesterol levels were negatively associated with anxiety and depression(B=- 2.31 ; B= - 2.52; p<0.05). Conclusions: Patients diagnosed with metabolic syndrome often develop depression symptomes and anxiety, but have no particularly psychopatological characteristics. Hypertension is the main contributor to psychological characteristics.

ASOCIEREA DINTRE NIVELUL ACIDULUI URIC I COMPONENTELE SINDROMUL METABOLIC LA PACIENII CU DIABET ZAHARAT DE TIP 2 Andrada Mihai1, Iuliana Filip2, Daniela Drgoescu3, Maria Vldic1, Constantin Ionescu-Trgovite1
1

Institutul de Diabet, Nutriie i Boli Metabolice N. Paulescu, Bucureti; 2Secia Diabet zaharat, Nutriie i Boli Metabolice, Spitalul Judeean Ploieti, PH; 3Spitalul Clinic CF Witing, Bucureti

Introducere: Sindromul metabolic (Metsd) reprezint o agregare de tulburri metabolice interrelaionate care apar mai frecvent la persoanele insulinorezistente sau hiperinsulinemice i semnific risc crescut pentru bolile cardiovasculare. Hiperuricemia este consecina unor tulburri metabolice i se asociaz cu hipertensiune arterial, insulinorezisten, obezitate i dislipidemie, ns despre asocierea cu sindromul metabolic exist nc multe dezbateri. Obiective: am examinat asocierea acidului uric seric cu componentele Metsd i particularitile acestor asocieri n funcie de sex la pacieni cu diabet zaharat de tip 2 (DZ2) i Metsd (definiia Adult Treatment Panel III). Material i metod: am analizat, dup mprirea n quartile pentru acidul uric, 310 pacieni cu DZ2 i Metsd (194 f/116 b), internai n IDNBM N. Paulescu cu urmtoarele caracteristici medie (deviaie standard): Caracteristica IMC (kg/m2) Circumferin abdominal (cm) Vrsta (ani) TAS (mmHg) Total 30.16 (5.11) 102.43 (12.01) 62.16 (9.30) 137.21 Q1 28.48 (4.71) 97.43 (12.61) 61.91 (8.67) 130.90 Q2 30.23 (5.00) 101.54 (9.90) 62.55 (9.51) 138.44 Q3 30.62 (4.86) 103.74 (12.31) 61.21 (9.37) 141.56 Q4 31.30 (5.49) 107.01 (11.16) 62.97 (9.71) 138.01

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(22.71) HbA1c (%) Colesterol total (mg/dl) HDL colesterol (mg/dl) Trigliceride (mg/dl) Acid uric (mg/dl) 9.86 (2.50) 210.15 (55.14) 38.43 (9.16) 197.53 (168.44) 5.52 (1,93)

(21.69) 10.42 (2.41) 197.96 (46.03) 39.31 (9.51) 180.81 (139.82) 3.44 (0.56)

(22.23) 9.82 (2.37) 208.40 (48.67) 38.99 (9.48) 199.23 (203.47) 4.6 (0.27)

(25.03) 9.97 (2.61) 215.25 (64.80) 37.39 (8.95) 191.60 (109.98) 5.81 (0.42)

(20.79) 9.22 (2.50) 219.05 (57.77) 38.01 (8.74) 218.42 (201.86) 8.14 (1.49)

De asemenea, am mprit pacienii n trei grupe n funcie de numrul de componente ale Metsd ndeplinite i am comparat nivelul mediu al acidului uric ntre aceste grupe. Am utilizat Students t-test i Pearson correlation. Nivele ale acidului uric peste 7 mg/dl la brbai si, respectiv, peste 6 mg/dl au fost considerate hiperuricemie. Rezultate: 26,77% (24,74% f; 30,17% b) din pacieni au prezentat hiperuricemie. n funcie de numrul de componente ale Metsd ndeplinite, la cei cu 5 criterii, hiperuricemia a fost mai frecvent (37,23% vs 20,59% la cei cu 3 criterii), dar valoarea medie a acidului uric a fost semnificativ mai mare doar n cazul femeilor (5,74 vs 4,23; p<0,0001). Nivelul acidului uric s-a corelat cel mai bine cu circumferina abdomninal i cu greutatea corporal (r=0.3). Analiznd datele pe quartile, diferene semnificative statistic s-au nregistrat ntre prima i ultima quartil pentru: circumferina abdominal i greutate (p<0,0001), IMC (p=0,0003), HbA1c (p=0,0014), colesterol total (p=0,006), numrul de criterii ATP III ndeplinite (p=0,03), LDL colesterol (p=0,02), TAS (p=0,01) i vechimea diabetului (p=0,018). Concluzii: hiperuricemia este frecvent la pacienii cu DZ2 i Metsd. Cel mai adesea se ntlnete la femeile care ntrunesc toate criteriile de definire a sindromului metabolic. Hiperuricemia se coreleaz puternic cu tulburrile metabolice i hemodinamice prezente la pacienii cu DZ2 i Metsd i poate fi considerat un alt component al Metsd ce necesit mai mult atenie n viitor.

ASSOCIATION BETWEEN SERUM URIC ACID LEVELS AND THE METABOLIC SYNDROME COMPONENTS IN TYPE 2 DIABETIC PATIENTS Andrada Mihai1, Iuliana Filip2, Daniela Drgoescu3, Maria Vldic1, Constantin Ionescu-Trgovite1 18

1 2

Institute of Diabetes, Nutrition and Metabolic Disease N. Paulescu Bucharest; Dept. of Diabetes, County Hospital Ploieti; 3Clinical Hospital CF Witing, Bucharest

Background: Metabolic syndrome (MetS) is defined as a cluster of interrelated metabolic disorders more frequently found in persons with insulin resistence or hyperinsulinemia and represents an increased risk for cardiovascular disease. Hyperuricemia is associated with hypertension, insulin resistance, obesity and hyperlipidemia, but the association with the syndrome is still under debate. Aims: We examined the associations of serum uric acid (UA) with MetS components and the sex-differences of these associations in type 2 diabetic patients with metabolic syndrome (Adult Treatment Panel III criteria). Material and methods: the study is cross-sectional comprising 310 in-patients with T2DM and MetS (194 w/116 m), with the characteristics - mean ( standard deviation) presented in table.

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Characteristic BMI (kg/m2) Waist circumference (cm) Age (years) SBP (mmHg) HbA1c (%) Total cholesterol (mg/dl) HDL cholesterol (mg/dl) Triglycerides (mg/dl)

Total 30.16 (5.11) 102.43 (12.01) 62.16 (9.30) 137.21 (22.71) 9.86 (2.50) 210.15 (55.14) 38.43 (9.16) 197.53 (168.44)

Q1 28.48 (4.71) 97.43 (12.61) 61.91 (8.67) 130.90 (21.69) 10.42 (2.41) 197.96 (46.03) 39.31 (9.51) 180.81 (139.82) 3.44 (0.56)

Q2 30.23 (5.00) 101.54 (9.90) 62.55 (9.51) 138.44 (22.23) 9.82 (2.37) 208.40 (48.67) 38.99 (9.48) 199.23 (203.47) 4.6 (0.27)

Q3 30.62 (4.86) 103.74 (12.31) 61.21 (9.37) 141.56 (25.03) 9.97 (2.61) 215.25 (64.80) 37.39 (8.95) 191.60 (109.98) 5.81 (0.42)

Q4 31.30 (5.49) 107.01 (11.16) 62.97 (9.71) 138.01 (20.79) 9.22 (2.50) 219.05 (57.77) 38.01 (8.74) 218.42 (201.86) 8.14 (1.49)

Uric acid (mg/dl) 5.52 (1,93)

Different components of MetS were compared by quartiles of UA. We also compared mean UA levels among 3 groups defined on number of MetS components. Students t-test, Pearson correlation were used. Hyperuricemia was defined as >7 mg/dl in men and >6 mg/dl in women. Results: 26.77% (24.74% w; 30.17% m) of patients presented hyperuricemia. Analyzing data for the number of MetS components fulfilled, in those with 5 criteria hyperuricemia was more frequent (37.23% vs. 20.59% in those with 3 criteria), but the mean UA value was significantly higher only in women (5.74 vs. 4.23; p<0.0001). UA levels correlated best with waist circumference and body weight (r=0.3). When analyzing data for UA quartiles, significant statistical differences were recorded between the first and the last quartile for: waist circumference and body weight (p<0.0001), BMI (p=0.0003), HbA1c (p=0.0014), total cholesterol (p=0.006), the number of ATP III criteria that were fulfilled (p=0.03), LDL cholesterol (p=0.02), SBP (p=0.01) and diabetes duration (p=0.018). Conclusions: hyperuricemia is frequent in patients with type 2 diabetes and MetS. Women fulfilling all MetS criteria were most likely to have hyperuricemia. 20

Hyperuricemia is strongly correlated with metabolic and hemodynamic disorders found in T2DM and MetS and might be a considered another component of MetS that needs more attention in the future.

RELAIA DINTRE DEPRESIE, ANXIETATE I CREDINELE RAIONALE I IRAIONALE PRIVIND MENINEREA CONTROLULUI ASUPRA VALORII GLICEMICE A.S. Mocan Centrul de Diabet, Nutriie i Boli Metabolice Cluj-Napoca Obiectivul acestui studiu este analiza relaiei existente ntre credinele raionale i iraionale privind meninerea glicemiei ntre valorile normale recomandate de medici i apariia depresiei i a anxietii. Astfel a fost elaborata o scal de 8 itemi conform modelului teoriei raionalemotive al lui Albert Ellis. Din totalul de 8 itemi ai scalei, 4 itemi vizeaz credinele iraionale ce privesc evaluarea globala a propriei persoane sau a altora, catastofarea situaiei, toleranta sczut la frustrare i trebuie cu necesitate, iar 4 itemi ofer varianta raional a acestor gnduri. In ceea ce privete depresia s-a utilizat Chestionarul Depresiei (BDI) elaborat de A.T.Beck, iar pentru anxietate s-a folosit chestionarul STAI cu cele dou forme ale sale, de evaluare a anxietii persoanei n momentul completrii i de evaluarea a anxietii generalizate. Subiecii, in numr de 30, au fost selectai pe baza de voluntariat din cadrul ambulatorului i a seciei cu persoane internate a Centrului de Diabet si Boli de Nutriie Cluj. Pe lng datele demografice am fost interesai i dac persoana se automonitorizeaz, frecvena acestui comportament, care a fost valoarea ultimei glicemii i a ultimei glicemii glicozicate, precum i de tipul tratamentului pe care persoana l urmeaz (terapie orala sau terapie cu insulin). Din analiza datelor reiese existena unei corelaii ntre depresie i gndurile iraionale pe de-o parte i ntre gndurile iraionale i anxietate pe de alt parte. Cuvinte cheie: credine iraionale, credine raionale, depresie, anxietate

RELATIONSHIP BETWEEN DEPRESSION, ANXIETY AND RATIONAL, IRRATIONAL BELIEFS ABOUT CONTROLLING THE GLYCAEMIC VALUES A.S. Mocan Diabetes, Nutrition and Metabolic Clinic-Napoca

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The aim of this study is to analyze the relationship between rational and irrational beliefs about controlling the glycaemic values recommended by the physicians and the their influence regarding depression and anxiety. An 8-item scale was elaborated based on A. Elliss rational-emotional model. From this 8 items, 4 of them refer to irrational beliefs (global evaluation, low frustration tolerance, self downing and awfulising) and four of them refer to rational beliefs. Depression was evaluated with The Beck Depression Inventory and for anxiety was used the State and Trait Anxiety Inventory. The subjects, 30 of them, were selected from outpatient department and inpatient department of Diabetes, Nutrition and Metabolic Clinic. We used demographical and personal data like the frequency of glycaemic recording, last glycemia and HbA1c, type of treatment (insulin therapy or oral therapy). The data analysis revealed a correlation between depression and irrational beliefs and one between anxiety and irrational beliefs. Key words: irrational beliefs, rational beliefs, depression, anxiety.

INTERVENIE PRIVIND MENINEREA CONTROLULUI VALORII GLICEMICE A.S.Mocan, A.Gherman Centrul de Diabet, Nutriie i Boli Metabolice Cluj-Napoca

Scopul acestei intervenii este controlul valorilor glicemice prin modificarea stilului de via. Astfel intervenia dureaz o perioad de o lun i jumtate, cu 9 ntlniri, cu caracter sptmnal. Fiecare edin de terapie dureaz ntre 60 - 90 de minute, mai puin prima edin, care este de cunoatere a pacientului i care dureaz dou ore. La aceast intervenie pot participa persoanele cu diabet, indiferent de tratamentul pe care-l urmeaz, intervenia fiind de fapt o optimizare a stilului de via. Intervenia se desfoar pe module. Astfel n funcie de nevoile pacientului se poate renuna la unul din module. Modulul I se refer la regularizarea meselor i la un regim alimentar sntos. Modulul II este adresat creterii exerciiului fizic. Modulul III este adresat persoanelor care doresc s reduc numrul igrilor sau s renune definitiv la fumat. Pe tot parcursul interveniei se automonitorizeaz glicemia dorindu-se creterea numrului de msurtori a acesteia. De asemenea, pacientul este nvat s-i stabileasc scopuri reale i posibile, s aib ateptri realiste de la modificrile pe care le dorete. Pe lng strategiile comportamentale sunt folosite i tehnici de restructurare cognitiv care s ajute pacientul n depirea barierelor mentale pe care le are referitoare la modificrile ce urmeaz a fi fcute.

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La finalul interveniei se urmrete introducerea unei modificri pe termen lung a stilului de via mai degrab dect o modificare de moment. Cuvinte cheie: monitorizare glicemic, alimentar, reducerea fumatului, intensificarea activitii fizice.

INTERVENTION REGARDING THE CONTROL OF THE GLYCAEMIC VALUES A.S.Mocan, A.Gherman Diabetes, Nutrition and Metabolic Clinic Cluj-Napoca

The aim of this intervention is to control the glaycaemic values through changing the life style. The intervention is scheduled for 9 weekly sessions. Each session lasts between 60 and 90 minutes except the first one, which lasts for two hours. At this intervention there can participate diabetes patients with no regard of the treatment they are following (insulin or oral therapy); in fact this intervention aims a change in the patients life style. The therapy is modular so, regarding the needs of the patient, we can skip a module. Module I targets a healthier eating behavior, module II targets the increase of the physical activity and module III referrs to smoking cessation. During the intervention we encourage the patients to record their glycaemias and to increase the frequency of this behavior. The patient learns to establish real and touchable objectives and to have realistic expectations from the life style modifications. Beside behavioral strategies the patient learns also cognitive techniques to overcome the possible mental obstacles regarding the changes from his life. In the end of the intervention we try to establish a long-term change in the life style.

Key words: glaycaemia and food records, smoking cessation, increasing physical activity.

STATUSUL ACTUAL AL GLUCOZEI LA PERSOANELE CU DIABET ZAHARAT TIP 1 I TIP 2

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Andreea Moroanu1, Gabriela Roman1,2, Mihaela Gribovschi1,3, Cristina Ni1,2, Nicolae Hncu1,2,3
1

Centrul Clinic de Diabet, Nutriie i Boli metabolice Cluj-Napoca, 2Universitatea de Medicin i Farmacie Iuliu Haieganu Cluj-Napoca, 3 Centrul Medical Moilor Cluj-Napoca

Introducere. Monitorizarea continu a glucozei (MCG) este o metod recent care furnizaz date extensive privind statusul actual al glucozei la persoanele investigate, prin determinarea procentului ariei de sub curb (%ASC) care definete expunerea glicemic - i a mediei valorilor glucozei (MVG) att pentru valorile ncadrate n limitele stabilite, ct i pentru cele situate n afara obiectivelor. De asemenea, MCG permite cuantificarea variabilitii glucozei exprimat prin amplitudinea medie a excursiilor glucozei (MAGE), parametru care influeneaz stresul oxidativ i riscul de complicaii cronice ale diabetului. Obiectiv. Scopul acestui studiu a fost evaluarea comparativ prin MCG a statusului glucozei la persoanele cu diabet zaharat (DZ) tip 1, comparativ cu persoanele cu DZ tip 2. Material i metod. Studiul a cuprins 55 de persoane: 24 cu DZ tip 1, 31 cu DZ tip 2, cu vrsta medie 43.69 ani (11-88), cu durata medie a diabetului de 9.86 ani (0-31), 29 femei i 26 brbai; 16 persoane au urmat tratament cu antidiabetice orale, iar 39 persoane au fost tratate cu insulin. Distribuia valorilor glucozei fost evaluat prin determinarea %ASC i a MVG pe domenii glicemice (< 70 mg/dl, > 180 mg/dl, 70-180 mg/dl i 90130 mg/dl). De asemenea, am evaluat variabilitatea glucozei prin intermediul MAGE, calculat pe baza datelor MCG i am dozat hemoglobina glicat A1c (A1c), n vederea comparaiei cu datele MCG. MCG a fost efectuat prin intermediul Continuous Glucose Monitoring System (CGMS, Minimed Medtronic) Analiza statistic a fost efectuat cu programul SPSS 13.0.Semnificaia statistic a fost atins pentru p<0.05. Rezultate. A1c a fost 8.33 1.75% (medie deviaie standard,DS) - ntregul grup studiat, 8.69 1.84% - DZ tip 1 i 8.05 1.65% - DZ tip 2 (p>0.05 DZ tip 1 vs. DZ tip 2). MAGE a fost 122.55 47.22 mg/dl ntregul grup, 156.38 34.00 mg/dl - DZ tip 1 i 96.38 38.79 mg/dl - DZ tip 2, diferen care a fost semnificativ statistic (p<0.001, DZ tip 1 vs DZ tip 2). Distribuia valorilor glucozei a fost urmtoarea (*p<0.05, DZ tip 1 vs.DZ tip 2): Distribuia valorilor glucozei (medieDS) Total DZ tip 1 DZ tip 2 %ASC %ASC %ASC < 70 mg/dl 1.60 3.04 >180 mg/dl 46.88 29.99 70-180 mg/dl 90-130 mg/dl 51.50 29.37 21.42 22.00

2.43 3.95* 57.42 20.16* 40.15 18.59* 13.24 8.98 0.97 1.96* 38.74 33.91* 60.29 33.25* 27.77 26.72

24

Total DZ tip 1 DZ tip 2

MVG (mg/dl) 60.39 5.00 226.77 27.01 132.63 17.67 112.48 4.98 MVG (mg/dl) 58.85 4.59* 235.43 25.91* 132.12 15.26 111.90 4.22 MVG (mg/dl) 62.73 4.86* 219.09 26.07* 133.06 19.65 112.98 5.59

A1c a fost corelat direct cu MAGE per total i n DZ tip 2, ns nu i n DZ tip 1. A1c a fost direct corelat cu ASC total, %ASC > 180 mg/dl, MVG total, MVG > 180 mg/dl. A1c a fost invers corelat cu %ASC ntre 70-180 mg/dl, % ASC ntre 90-130 mg/dl att pentru ntregul grup, ct i pe subgrupurile cu DZ tip 1 i tip 2 (p<0.05). MAGE a fost corelat direct cu ASC total, %ASC > 180 mg/dl, MVG total, MVG > 180 mg/dl i a fost invers corelat cu % ASC 70-180 mg/dl i % AUC 90-130 mg/dl per total i n DZ tip 2 (p<0.05). n DZ tip 1, MAGE a fost corelat direct cu %ASC > 180 mg/dl i MVG > 180 mg/dl (p<0.05). Acurateea senzorului de glicemie a fost 94,44% pentru toate cazurile studiate. Discuii. MAGE a fost mai mare dect valoarea normal de 40 mg/dl pentru tot grupul studiat, dar i pe subgrupuri. Subiecii cu DZ tip 1 au avut MAGE semnificativ mai mare dect cei cu DZ tip 2 (p<0.001), chiar dac grupurile nu au fost diferite din punctul de vedere al A1c. Persoanele cu DZ tip 1 au avut expunerea glicemic la hipoglicemie i hiperglicemie semnificativ mai mari dect persoanele cu DZ tip 2. Media valorilor hipoglicemice a fost semnificativ mai mic, n timp ce media valorilor hiperglicemice a fost semnificativ mai mare n DZ tip 1 comparativ cu DZ tip 2, fapt explicat i de variabilitatea glicemic mai mare n DZ tip 1. Subiecii cu DZ tip 2 au avut o expunere semnificativ mai mare la normoglicemie fa de cei cu DZ tip 1. A1c a fost corelat cu MAGE, indicnd o relaie direct liniar ntre dezechilibrul glicemic i variabilitatea valorilor glucozei, per total i n DZ tip 2. A1c i MAGE au fost corelate direct cu expunerea i amplitudinea hiperglicemiei (per total i separat pentru DZ tip 1 i tip 2) i invers cu expunerea i amplitudinea normoglicemiei n DZ tip 1 (numai pentru A1c), n DZ tip 2 i per total (A1c i MAGE). Nu s-a observat o relaie semnificativ ntre A1c, MAGE i expunerea i amplitudinea hipoglicemiei. Concluzii. La acelai nivel al A1c, echilibrul glicemic al persoanelor cu DZ tip 1 este mai precar, necesitnd o intervenie intensiva att din partea medicului cat si a persoanei cu diabet. MCG a facilitat evidenierea unor diferene semnificative ale statusului glicemic la persoanele cu DZ tip 1 i tip 2 oferind oportunitatea identificrii msurilor terapeutice adecvate n vederea optimizrii controlului glicemic. Studiul actual a fost finanat prin Grantul CNCSIS Td 472/2006-2007.

CURRENT GLUCOSE STATUS IN PERSONS WITH TYPE 1 AND TYPE 2 DIABETES

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Andreea Moroanu1, Gabriela Roman1,2, Mihaela Gribovschi1,3, Cristina Ni1,2, Nicolae Hncu1,2,3
1

Clinical Center of Diabetes, Nutrition and Metabolic Diseases Cluj-Napoca, 2Iuliu Haieganu University of Medicine and Pharmacy Cluj-Napoca, 3 Moilor Medical Center Cluj-Napoca

Background. Continuous glucose monitoring is a recent evaluation method of glucose excursions that provides comprehensive data about current glucose status, measuring parameters like percent of area under the curve (%AUC) defining glucose exposure and mean glucose values (MGV) below, above and between target limits. It also allows the quantification of glucose variability expressed by mean amplitude of glucose excursions (MAGE) known to directly influence oxidative stress and further diabetes chronic complications. Aims. We aimed to investigate the differences in current glucose status between type 1 diabetes (T1D) and type 2 diabetes (T2D) persons evaluated by continuous monitoring of interstitial glucose values (CGM). Material and Methods: We assessed 55 persons: 24 with type 1 diabetes (T1D), 31 with type 2 diabetes (T2D), with mean age of 43.69 years (11-88), with mean diabetes duration of 9.86 years (0-31); 29 women, 26 men; 16 orally treated; 39 insulin treated. Glucose distribution was assessed by %AUC and MGV on glucose domains (< 70 mg/dl, > 180 mg/dl, 70-180 mg/dl and 90-130 mg/dl); glucose variability was assessed by MAGE. We evaluated glycated haemoglobin A1c (A1c) for all study subjects, for comparison with CGM data. CGM was performed by Continuous Glucose Monitoring System (CGMS, Minimed Medtronic). Statistical analysis was effectuated with SPSS 13.0 program. Statistical significance was reached for p<0.05. Results: HbA1c was 8.33 1.75% (mean SD) - the entire group, 8.69 1.84% -T1D and 8.05 1.65% -T2D (p>0.05, T1D vs. T2D). MAGE was 122.55 47.22 mg/dl (mean SD) - the entire group, 156.38 34.00 mg/dl -T1D and 96.38 38.79 mg/dl - T2D (p<0.001 T1D vs. T2D). Glucose values distribution was:

Glucose values distribuiton < 70 mg/dl (meanSD) All T1D T2D All %AUC %AUC %AUC MGV (mg/dl) 1.60 3.04

>180 mg/dl

70-180 mg/dl

90-130 mg/dl

46.88 29.99

51.50 29.37

21.42 22.00

2.43 3.95* 57.42 20.16* 40.15 18.59* 13.24 8.98 0.97 1.96* 38.74 33.91* 60.29 33.25* 27.77 26.72 60.39 5.00 226.77 27.01 132.63 17.67 112.48 4.98

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T1D T2D

MGV (mg/dl) MGV (mg/dl)

58.85 4.59* 235.43 25.91* 132.12 15.26 111.90 4.22 62.73 4.86* 219.09 26.07* 133.06 19.65 112.98 5.59

*P<0.05 (T1D vs.T2D)

HbA1c was positively correlated with MAGE in the entire group and in T2D, but not in T1D. HbA1c was positively correlated with total AUC, with % AUC > 180 mg/dl, total MGV, MGV >180 mg/dl. HbA1c was inversely correlated with %AUC 70-180 mg/dl, %AUC 90-130 mg/dl in the entire group as well as in T1D and T2D subgroups. (p<0.05) MAGE was positively correlated with total AUC, with %AUC > 180 mg/dl, total MGV, MGV >180 mg/dl and inversely correlated with %AUC 70-180 mg/dl and %AUC 90-130 mg/dl in the entire group and in T2D (p<0.05). MAGE was positively correlated with %AUC > 180 mg/dl and MGV > 180 mg/dl in T1D. Sensor overall accuracy was 94.44% for all the study cases. Discussions. A1c showed a poor glucose control in both T1D and T2D persons. MAGE was higher than normal value (40 mg/dl), in the whole group and in T1D and T2D subgroups. T1D subjects had significantly higher MAGE than those with T2D (p<0.001), even if A1c did not differ between the two subgroups. T1D persons had significantly higher exposure to hypoglycemia and hyperglycemia than T2D subjects. MGV for hypoglycemia was significantly lower and MGV for hyperglycemia was significantly higher in T1D persons compared with T2D ones, this fact being explained by the higher glucose variability in T1D individuals. Conversely, T2D subjects had significantly higher exposure to normoglycemia. A1c was correlated with MAGE which showed a direct linear relation between poor glucose control and glucose variability in T2D and per total. A1c and MAGE were directly correlated with hyperglycemic exposure and amplitude (in the entire group and in T1D and T2D subgroups) and inversely correlated with normoglycemic exposure and amplitude in T1D subgroup (only for A1c) and in T2D and the whole group (for A1c and MAGE). It wasnt evident any relation between A1c, MAGE and hypoglycemic exposure and amplitude. Conclusions. At a similar A1c level, T1D persons had a poorer glucose control emphasizing the need for more intensive approach from both physician and patient sides. CGM marked out significant differences in glucose status between T1D and T2D persons allowing further identification of the specific therapeutic changes for optimizing glucose control Acknowledgements: Current Research was supported by a Romanian Grant for Young Researchers: Grant CNCSIS Td 472/2006-2007.

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OBEZITATEA FACTOR DE PROTECIE N OSTEOPOROZ Andreescu Georgeta*, Dinc Mihaela Eugenia*, Petrisor C.A.**, Petrisor Iuliana Eugenia*** *U.M.F. Craiova Disciplina Boli Nutritie si Metabolism **U.M.F. Craiova Disciplina Medicin Intern *** Medic rezident endocrinologie Spital Universitar de Urgent Craiova Obezitatea i osteoporoza sunt dou boli frecvente i complexe. Amndou au etiologie multifactorial, incluznd factori genetici i de mediu cu potenial de interaciune. Existena unei relaii ntre obezitate i densitatea masei osoase a fost studiat n numeroase studii epidemiologice, cu rezultate pro i contra asupra obezitii ca factor de protecie fa de osteoporoz. Cteva mecanisme par a fi implicate , cum ar fi: efectul mecanic al greutii suportate de musculatur, creterea transformrii androgenilor n estrogeni la nivelul esutului adipos, scderea legrii hormonilor sexuali de globulin cu o rat mai mare a formelor libere a hormonilor sexuali, creterea nivelului de leptin seric, scderea sintezei de IGF la nivelul ficatului i scheletului, hiperinsulinemia i insulinorezistena. Estrogenul este un hormon activ pe sistemul osos care crete n obezitate. esutul adipos transform androstendionul n estron prin aromatizare i acesta reprezint principala surs a estrogenului la femeia aflat n postmenopauz, mai degrab dect secreia ovarian sau adrenal. Activitatea de aromatizare de la nivelul celulelor stromale adipoase este crescut n funcie de vrst, fiind mai mare la femeia aflat n postmenopauz fa de premenopauz. Astfel, creterea produciei de estrogen al femeilor aflate n postmenopauz este datorat numrului mare de celule adipose i activitii crescute de aromatizare. Exist studii care au demonstrat c androgenul adrenal DHEA este convertit la estron la nivelul osteoblatilor de ctre aromataza P450, iar acest fapt contribuie la meninerea masei osoase n decada a asea i a aptea de via. La femeia obez aflat n postmenopauz scade riscul de fractur datorit ritmului mai sczut de pierdere osoas. Consecina acestui fapt este o rat mai mic a fracturilor osteoporotice, n special la nivelul capului femural.

OBESITY PROTECTION FACTOR IN OSTEOPOROSIS Obesity and osteoporosis are two frecvent and complex diseases. Both have a multifactorial etiology, including genetic and environmental factor with interaction potential. An existing relationship between obesity and bone mass density was studied in several epidemiological studies, with different results regarding obesity as a protection factor for osteoporosis. Several mechanisms seems to be responsible: the mechanic effect of weight supported by muscles, the rise of transformation from androgen to estrogen hormones in adipous tissue, the decline of binding of sexual hormones to globuline, with a higher rate of free sexual hormones development, the rise of seric leptin levels, decline of IGF synthesis in liver and bones, hyperinsulinemia and insulin resistance. The estrogen

28

is an active hormone on bone tissue and rises in obesity. The adipose tissue transform androstendion in estrone through aromatization and this is the main source of estrogen at the postmenopause women, rather than ovarian or adrenal secretion. The aromatization activity from stromal adipous cells depends on age, being higher at the postmenopausal women then premenopausal ones. Thus, the rise of estrogen production at postmenopausal women is due to the increased number of adipous cells and aromatization activity. There are studies that demonstrated that DHEA adrenal androgen is converted to estrone in osteoblasts by P450 aromatase making possible the conservation of bone mass at women in sixth and seventh decade. At obese postmenopausal women the risk of fracture is lower due to decreased rate of bone loss. The result is a lower rate of osteoporothyc fractures specially at the femoural head. ROLUL OSTEOPROTEGERINEI N REMODELAREA OSOAS Dinc Mihaela Eugenia*, Andreescu Georgeta*, Petrisor C.A.**, Petrisor Iuliana Eugenia*** *U.M.F. Craiova Disciplina Boli Nutritie si Metabolism **U.M.F. Craiova Disciplina Medicin Intern *** Medic rezident endocrinologie Spital Universitar de Urgent Craiova

Integritatea sistemului osos necesit numeroase mecanisme de reglare. Recent, sau evideniat date noi despre remodelarea osoas i cauzele care conduc la apariia celei mai comune boli metabolice osoase, osteoporoza, a crei incidena este n cretere marcat. Dezvoltarea osteoclastelor mature depind de interaciunea corespunzatoare cu celulele liniei osteoblastice. Astfel, este necesar interaciunea RANKL (Receptor Activator of Nuclear Factor Kappa B Ligand) secretat de osteoblaste cu RANK (Receptor Activator of NFkB) de pe suprafaa precursorilor osteoclastici. Aceast interaciune poate fi blocat de osteoprotegerina (OPG), o glicoprotein membr a superfamiliei TNF receptor. OPG funcioneaz ca un receptor capcan pentru RANKL, competiionnd cu RANK pentru legarea de RANKL i dovedindu-se astfel un inhibitor important al maturrii i activrii osteoclastelor in vivo i in vitro Mai multe studii au dovedit c nivelurile serice ale OPG cresc semnificativ cu vrsta att la brbai, ct i la femei, fiind un mecanism protectiv al scheletului menit s compenseze creterea resorbiei osoase i a pierderii de os. OPG poate preveni reducerea osoas, fiind o valoare potenial n tratamentul osteoporozei.

THE ROLE OF OSTEOPROTEGERIN IN BONE REMODELATION

29

The integrity of the bone tissue depends on numerous regulation mechanisms. Recently, new data about the bone remodelling and also new causes of the most common bone metabolic disease are available. The development of mature osteoclasts depend on the right interaction with the osteoblastic cell line. Thus, the interaction of RANKL (Receptor Activator of Nuclear Factor Kappa B Ligand)secreted by RANK osteoblasts (Receptor Activator of NFkB)is necessary. This interaction can be blocked by osteoprotegerin (OPG), a glycoprotein from the TNF receptor family. OPG works like a trap receptor for RANKL, competing with RANK for the binding with RANKL and proving to be an important inhibitor of osteoclasts maturation and activation in visvo and in vitro. Many studies showed that seric levels of OPG rise significantly with age at men and woman, this being a protective mechanism of the skeleton, meant to compensate the growth of bone resorbtion and bone loss. OPG can prevent bone loss, with potential value in osteoporosis treatment.

DIABETUL ZAHARAT, MODEL DE BOALA PSIHOSOMATICA Bianca Andreica1, Mariana Andreica2 1- Clinica Psihiatrie Pediatrica 2- Clinica Pediatrie II Cluj-Napoca

Diabetul zaharat este o boal cronic metabolic, cauzat de deficiena absolut sau relativ de insulin. Cei mai muli cercettori au gsit urmtoarele variabile psihosociale ca fiind implicate n apectele psihosomatice ale diabetului :1) depresia, anxietatea, frica de hipoglicemie 2) deficitul cognitiv, 3) stresul, evenimente stresante de via, 4) mecanisme de coping, 5) percepia personal asupra bolii, 6) trsturi de personalitate, 7) suport social, incluznd familia, 8) calitatea relaiei medic-pacient, 9)variabile socio-demografice, venit, educaia, dizabilitile date de diabet. Lucrarea prezenta este un studiu de caz al unei adolescente in varsta de 18 ani, aflata in ultimul an de liceu, afectata de examenul de bacalaureat care o asteapta si de iminenta plecarii mamei in strainatate. Stresul generat de aceste doua evenimente, coroborat cu despartirea de prietenul sau au determinat aparitia unui tablou clinic caracterizat prin fatigabilitate, senzatia de lesin. Examinarile paraclinice au depistat hiperglicemie si testul de toleranta la glucoza crescut. Cazul a fost interpretat ca si Diabet zaharat tip 2 si s-a impus urmarea unei diete si tratament medicamentos specific. Aflarea acestui diagnostic si consecintele sale au determinat dezvoltarea la adolescenta a unui Sindrom posttraumatic de stres. A refuzat medicatia, chiar si pe cea homeopata. A urmat inconstant sedinte de psihoterapie

30

cognitive comportamentala si a inceput sa participe mai des la slujbe religioase. Dupa o luna, la control s-a depistat normalizarea parametrilor biochimici. Cuvinte cheie: diabet zaharat, factori psihosociali, PTSD

DIABETTES MELLITUS MODEL FOR PSYCHOSOMATIC DISEASE

Diabetes mellitus is a chronic metabolic disorder caused by an absolute or relative deficiency of insulin. The most frequent psychosocial variables found in diabetes are: 1) depression, anxiety, 2) cognitive deficits, 3) stress, 4) coping mechanisms, 5) temperament and character, 6) family and friends support, 7) socio-demographic variables. The present paper is a case study of a 18 years old girl, in the last high-school year, affected by the forthcoming graduation exam and by the imminence of her mothers departure abroad. The stress generated by these two events, corroborated with the separation from her boyfriend determined the apparition of a simptomatology, caracterised by fatigability, and the sensation of faint. The paraclinical examinations discovered hyperglycemia and the glucose tolerance test increased. The case was interpreted as diabetes mellitus type 2, and a diet and specific drug cure was imposed. This diagnosis and its consequences determined the onset of a posttraumatic stress syndrome. The patient refused medication, even if it was homeopathic. She followed inconstant behavioral cognitive psychotherapy sessions and began to attend more often religious masses. Two months after the examination, the normalization of biochemical parameters was discovered. Key words: diabetes, psychosocial factors, PTSD

EVALUAREA AFECTRII RENALE LA PACIENII CU DIABET ZAHARAT TIP 1 DIN CENTRUL CLINIC DE DIABET, NUTRIIE, BOLI METABOLICE IAI Bogdan Mihai1,2, Cristina Lctuu1,2, Roxana tefan2, Laura Mihalache1,2, Delia Vtc2, Mariana Graur1,2
1 2

Universitatea de Medicin i Farmacie Gr. T. Popa Iai Centrul Clinic de Diabet, Nutriie, Boli Metabolice Iai

Scopul lucrrii: am efectuat un studiu retrospectiv, observaional, transversal, pentru a aprecia prevalena i severitatea afectrii renale la pacienii cu diabet zaharat tip 1 aflai n evidena Centrului Clinic de Diabet, Nutriie, Boli Metabolice Iai.

31

Material i metod: am evaluat toi pacienii aduli cu diabet zaharat tip 1 aflai n evidena centrului nostru pn la data de 01.01.2007. Din analiza fielor de monitorizare, lund n considerare doar datele din ultimii doi ani, am selectat informaiile referitoare la vrst, sex, vechimea bolii, eliminrile urinare de proteine i clearance-ul de creatinin, care au fost nregistrate ntr-o baz de date Microsoft Office Excel i supuse ulterior prelucrrii statistice folosind programele SPSS. Rezultate i discuii: Din totalul de 1072 pacieni, dup excluderea celor cu vrsta sub 18 ani i a celor cu patologie terminal de organ (care ar fi putut falsifica analiza statistic a datelor de laborator), am selectat un lot de 994 pacieni. Am constatat o preponderen a sexului masculin (553 cazuri 55,6%) i o vrst medie de 43,5813,66 ani, cu variaii ntre 18 i 84 de ani. Vechimea diabetului zaharat tip 1 a variat ntre 1 i 49 de ani, cu o medie de 11,029,05 ani. 305 pacieni (30,7% din totalul cazurilor) aveau determinate semicantitativ sau cantitativ eliminrile urinare de proteine n ultimii 2 ani; dintre acetia, majoritatea erau normoalbuminurici (48,2%), 24,6% prezentau microalbuminurie i 27,2% macroalbuminurie. La 817 pacieni (82,2% din totalul cazurilor) au fost disponibile datele necesare pentru calculul clearance-ului de creatinin (ClCr) conform formulei Cockcroft-Gault; 39,8% dintre aceti pacieni prezentau afectare renal (ClCr < 90 ml/min): 29,99% ClCr = 60-90 ml/min, 7,22% ClCr = 30-60 ml/min, 0,86% ClCr = 15-30 ml/min, 1,71% ClCr < 15 ml/min. Valoarea clearance-ului de creatinin a fost semnificativ statistic mai mic la pacienii cu macroalbuminurie comparativ cu cei cu normoalbuminurie i cu microalbuminurie. S-a constatat o preponderen a sexului masculin n grupul cu eliminri urinare crescute de proteine (65,1% brbai vs. 34,9% femei cu macroalbuminurie), ns fr a atinge pragul semnificaiei statistice. Pacienii cu o vechime mai mare a bolii prezentau mai frecvent eliminri urinare crescute de proteine i valori sczute ale clearance-ului de creatinin, cu diferene semnificative statistic ntre grupurile menionate. Concluzii: Peste 50% din cazurile evaluate aveau eliminri urinare crescute de proteine i aproximativ 40% dintre pacieni prezentau o rat sczut de filtrare glomerular evideniat prin determinarea clearance-ului de creatinin. Valoarea clearance-ului de creatinin a fost semnificativ statistic mai mic la pacienii cu macroalbuminurie comparativ cu cei cu normoalbuminurie i cu microalbuminurie. n grupul cu eliminri urinare crescute de proteine s-a constatat o prevalen crescut a sexului masculin. Pacienii cu o vechime mai mare a bolii prezentau mai frecvent eliminri urinare crescute de proteine i valori sczute ale clearance-ului de creatinin.

RENAL FUNCTION IN TYPE 1 DIABETIC PATIENTS IN CLINICAL CENTRE OF DIABETES, NUTRITION, METABOLIC DISEASES IAI Bogdan Mihai1,2, Cristina Lctuu1,2, Roxana tefan2, Laura Mihalache1,2, Delia Vtc2, Mariana Graur1,2
1

The University of Medicine and Pharmacy Gr. T. Popa Iai

32

The Clinical Centre of Diabetes, Nutrition, Metabolic Diseases Iai

Aim of study: we performed a retrospective, observational, transversal study in order to appreciate the prevalence and severity of renal disease in type 1 diabetic patients in Clinical Centre of Diabetes, Nutrition, Metabolic Diseases Iai. Material and method: we evaluated all adult patients diagnosed with type 1 diabetes mellitus in our centre before January 1st 2007. We analyzed the record files, by considering only data available in the last two years. We searched information about age, sex, duration of disease, urinary albumin excretion rate and creatinine clearance, which were registered in a Microsoft Office Excel data base and afterwards undergone statistic analysis by using SPSS programs. Results and discussions: Out of all 1072 patients, after excluding those under 18 years old and those with terminal organ pathology (that might have falsified the statistical analysis of laboratory data), we selected a group of 994 patients. We observed a predominance of male patients (553 cases 55.6%) and a mean age of 43.5813.66 years, with extremes of 18 and 84 years. The duration of type 1 diabetes mellitus varied between 1 and 49 years, with a mean value of 11.029.05 years. 305 patients (30.7% of all cases) had semiquantitative or quantitative urinary albumin excretion rate evaluation in the last 2 years; most of them had normal albuminuria values (48.2%), 24.6% had microalbuminuria and 27.2% had macroalbuminuria. 817 patients (82.2% of all cases) had available data as to calculate the creatinine clearance (ClCr) by Cockcroft-Gault equation; 39.8% of these patients had chronic kidney disease (ClCr < 90 ml/min): 29.99% ClCr = 60-90 ml/min, 7.22% ClCr = 30-60 ml/min, 0.86% ClCr = 15-30 ml/min, 1.71% ClCr < 15 ml/min. The creatinine clearance value was lower (with statistical significance) in patients with macroalbuminuria compared to those with normoalbuminuria and microalbuminuria. We noticed a predominance of male patients in the group with high urinary albumin excretion rate (65.1% males vs. 34.9% females with macroalbuminuria), but without reaching the level of statistical significance. Patients with a longer duration of diabetes had more often high urinary albumin excretion rates and low values of creatinine clearance, with statistically significant differences between the already mentioned groups. Conclusions: More than 50% of the evaluated cases had high urinary albumin excretion rates and approximately 40% of the patients had low glomerular filtration rate as shown by the creatinine clearance value. The creatinine clearance value was statistically significant lower in patients with macroalbuminuria compared to those with normoalbuminuria and microalbuminuria. In the group with high urinary albumin excretion rates we noticed a higher prevalence of males. Patients with a longer duration of the disease had more often high urinary albumin excretion rates and low values of creatinine clearance.

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SENSIBILITATEA PERIFERIC LA PACIENI CU DIABET ZAHARAT TIP 2 NOU DIAGNOSTICAT UTILIZND TESTAREA SENZORIAL CANTITATIV COMPUTERIZAT CORELAIE CU SCORUL CLINIC NSS C.Constantin2,3, C.Ioni 1, I.N.Gal 1, G.Stan 2,4, D.Chea1,2 1) Universitatea de Medicin i Farmacie Carol Davila Bucureti 2) Institutul Naional de Diabet i Boli de Nutriie Prof. N Paulescu Bucureti 3) Spitalul Clinic de Urgen Militar Central Carol Davila Bucureti 4) Fundaia Pentru Alimentaie Sntoas, Bucureti

Background: Pacienii cu diabet zaharat tip 2 (DZ2) nou diagnosticat pot prezenta concomintent i modificarea sensibilitii periferice, evaluarea acesteia fiind descris discordant n literatur. Obiectiv: Studiul i-a dorit evaluarea pragului sensibilitii periferice (la rece) a pacienilor cu DZ tip 2 nou diagnosticat utiliznd sistemul CASE IV i corelarea cu prezena simptomelor de neuropatie (scorul NSS). Materiale i metode: Studiul transversal a fost realizat pe un lot selectat dintre pacienii internai n cadrul Institutului N. Paulescu diagosticai cu diabet zaharat tip 2 nou descoperit (DZ2) i au fost evaluai utiliznd testarea senzorial cantitativ (QTS) i scorul simptomelor de neuropatie (NSS). Parametrii urmrii au fost: HbA1c, BMI, pragul sensibilitii la rece (PSR), simptomele de neuropatie. Testarea senzorial cantitativ s-a realizat folosind sistemul CASE IV (Computer-Assisted Sensory Examination IV) la nivelul membrului superior drept (MS) i al membrului inferior drept (MI), iar ncadrarea privind pragul sensibilitii s-a facut n trei categorii: hiperestezic 7,5 JND, limite normale - LN ntre 7,5 i 12,5 JND i hipoestezic 12,5 JND. Dup NSS mprirea pacienilor s-a realizat astfel: 0 pentru absena simptomelor, 3-4 simptome uoare, 5-6 simptome moderate, 7-9 simptome severe. Rezultate i discuii: A fost realizat un lot de 37 de pacieni cu o vrst medie de 54 13,3 de ani. HbA1c a avut o valoare medie de 12,3% 2,4% la prima determinare. BMI a avut o valoare medie la internare de 26,65,1kg/m2, 54,1% dintre pacieni fiind supraponderali. La MS, PSR este alterat la 62,2% (23) din pacieni, 37,8% (14) prezentnd alterare de tip hiperestezie. La MI, PSR este alterat la 64,9% (24) din pacieni, 37,8% (14) prezentnd alterare de tip hiperestezie. n ceea ce privete scorul NSS, 37,8% (14) din pacieni nu aveau simptomatologie sugestiv de neuropatie, dar 71,4% (10) dintre ei prezentau alterri ale PSR la nivelul MS, respectiv 92,8% (13) la nivelul MI. 62,2% (21) dintre pacieni aveau simptome de neuropatie uoare (16,2%, NSS = 4) sau moderate (45,9%, NSS 5 sau 6), chiar dac PSR era n limite normale la MS la 47,6%

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(10) dintre pacieni, respectiv la MI la 57,14 % (12) dintre pacieni. Nici unul dintre pacienii luai n studiu nu a prezentat simptome severe de neuropatie (NSS = 7-9). Concluzii: La pacienii cu DZ2 nou diagnosticat alterarea pragului sensibilitii la rece este att de tip hipoestezic, ct i de tip hiperestezic, fr a fi prezent o simptomatologie clinic n direct corelaie cu modificrile evideniate. Neuropatia diabetic poate evolua subclinic, fiind necesar o metod obiectiv de evaluare a sensibitii periferice. Finanare: Studiu realizat n cadrul proiectului CEEX 92/2006, PNCDI2 52164/2008.

PERIPHERAL SENSITIVITY IN NEWLY DIAGNOSED TYPE 2 DIABETES MELLITUS PATIENTS USING COMPUTERIZED QUANTITATIVE SENSORY TESTING - CORRELATION WITH CLINICAL SCORE NSS C.Constantin,; C. Ioni ; I.N.Gal ; G.Stan,4; D.Chea,. 1) Carol Davila University of Medicine and Pharmacy, Bucharest; 2) National Institute of Diabetes, Nutrition and Metabolic Diseases N.Paulescu, Bucharest; 3) Carol Davila Central Military Emergency Hospital, Bucharest 4). Healthy Nutrition Foundation, Bucharest

Background: Abnormal peripheral sensitivity could be identified at newly diagnosed type 2 diabetes mellitus patients (T2DM), but evaluation of diabetic neuropathy at T2DM having a controversial literature. Objective: Evaluation of cold threshold sensitivity of newly diagnosed type 2 diabetes mellitus patients using the CASE IV System and correlation with the symptoms of neuropathy (NSS score). Materials and methods: This cross-sectional study was conducted on a lot of patients selected within the Institute "N. Paulescu " with newly diagnosed type 2 diabetes mellitus (T2DM) and were assessed using quantitative sensory testing (QTS) and neuropathy symptoms score (NSS). We recorded the next parameters: HbA1c, BMI, cooling detection threshold (CDT), symptoms of neuropathy (NSS). Quantitative sensory testing was performed using the CASE IV System (Computer-Assisted Sensory Examination IV) in the superior limb (SL) and inferior limb (IL) of each patient, and they were characterized in three categories: hyperesthesic 7.5 JND, normal - between 7.5 and 12.5 JND, hypoaesthetic 12.5 JND. After NSS the patients were divided as follows: 0 for no symptoms, 3-4 light symptoms, 5-6 moderate symptoms, 7-9 severe symptoms. Results and discussion: The lot of 37 patients with an average age of 54.0013.3- years was studied. HbA1c had an average value of 12.3% 2.4%. BMI had an average value of

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26.65.1kg/m2, 56.1% of patients being overweight. In the SL, CDT is altered in 62.2% (23) of patients, 37.8% (14) presenting alteration type hyperesthesia. In the IL, CDT is altered in 64.9% (24) of patients, 37.8% (14) presenting alteration type hyperesthesia. Regarding NSS, 37.8% (14) of patients had no symptoms of neuropathy, but 71.4% (10) of these patients had alteration of the CDT at the SL, and 92.8% (13) at the IL. 62.2% (21) of patients had symptoms of light peripheral neuropathy (16.2% NSS=4) or moderate peripheral neuropathy (45.9% NSS 5 or 6), even if CDT was normal in the SL in 47.6% (10) of this patients, respectively in the IL in 57.14 % (12) of patients. Conclusions: In newly diagnosed type 2 diabetes mellitus patients abnormal CDT is both hypoaesthesia and hyperesthesia, without a direct correlation between clinical symptoms and the alteration of peripheral sensitivity. Neuropathy may have a subclinical evolution, being necessary an objective method to evaluate the peripheral sensitivity. Supported by: Grant CEEX 92/2006, PNCDI2 52164/2008 from the Romanian Research Ministry.

EVALUAREA PRAGULUI SENSIBILITII VIBRATORII LA PACIENII CU DIABET ZAHARAT TIP 2 NOU DIAGNOSTICAT C. Constantin 1, 2, I. Gal3, C. Ionita3, G. Stan1,4, D. Cheta1,3 1. Institutul Naional de Diabet, Nutriie i Boli Metabolice Prof. NC Paulescu 2. Spitalul Clinic de Urgen Militar Central Carol Davila 3. Universitatea de Medicin i Farmacie Carol Davila 4. Fundaia Pentru Alimentaie Sntoas Bucureti

Obiectiv Obiectivul acestui studiu a fost s evalueze evoluia pragului sensibilitii vibratorii la pacienii cu diabet zaharat tip 2 (DZ2) nou diagnosticat. Material i metode Sistemul computerizat de determinare a sensibiliti vibratorii (CASE IV System) este un instrument de calitate pentru evaluarea componentei vibratorii a polineuropatiei diabetice. Acesta este un studiu deschis, prospectiv, desfurat pe durata a 3 luni. Au fost alctuite dou grupuri de 12 pacieni cu DZ2 nou diagnosticat urmrind un tratament intensiv cu insulin i diet adecvat. Comorbiditile neurologice au fost exluse la nceputul i pe durata studiului. Criteriile de includere si de excludere din studiu au fost urmate cu strictee.

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Rezultate Caracteristicile la momentul includerii n studiu au fost: pentru grupul A vrsta medie a fost de 45,343,5ani, greutatea medie 89,712,25kg, HbA1c 12,711,27%, pentru grupul B vrsta este de 64,236,54ani (p<0,05), greutatea medie 85,89,23kg (p>0,05) HbA1c 11,92,21% (p>0,05). Pe parcursul perioadei studiate s-au nregistrat: HbA1c, evenimentele hipogicemice, greutatea i indicele de mas corporal. Sistemul CASE IV a nregistrat valori ale pragului sensibilitii vibratorii la intrarea n studiu, la o lun, dou i trei luni. La trei luni: pentru grupul A s-a nregistrat un plus n greutate de 4,181,21kg i o scdere a valorii HbA1c pn la 7,90,8%, pentru grupul B s-a nregistrat un plus n greutate de 5,022,03 kg (A vs. B, p>0,05), o descretere a HbA1c la 8.020.27% (A vs. B, p>0,05). Numrul evenimentelor hipoglicemice a fost similar pentru cele dou loturi: 4,121,03 vs. 3,961,22/lun, p>0,05). Evoluia pragului sensibilitii vibratorii este descris n Tabelul 1, cu valori diferite semnificativ statistic la 3 luni (p<0.05). Concluzii Acesta este unul dintre primele studii care demonstreaz o mbuntire a pragului sensibilitii vibratorii la pacienii cu DZ2 nou diagnosticat dup tratament intensiv cu insulin i intervenie susinut asupra stilului de viat. mbuntirea pragului sensibilitii vibratorii a fost semnificativ mai bun pentru partipanii mai tineri. S-a constatat prezena unui dezechilibru metabolic major (HbA1c>12%) nsoit fiind de semne ale deficitului insulinic.

Timp/ Unit. JND

Grup A

Grup B

Grup A Signf* (MS Vib T*) p<0,05 8,340,84 p>0,05 7,283,19 p<0,05 6,001,22 p<0,05 6,371,51

Grup B (MS Vib T) 8,722,10 7,482,57 7,882,64 8,122,12 Signf* p<0,05 p>0,05 p<0,05 p<0,05

(MI Vib T*) (MI Vib T) 12,122,10 10,102,57 10,802,64 10,262,52

Baseline 11,920,23 1 lun 2 luni 3 luni 9,344,23 8,402,33 8,102,26

*MI Vib T Determinarea sensibilitii vibratorii la nivelul membrului inferior, *MS Vib T Determinarea sensibilitii vibratorii la nivelul membrului superior, *Signf - Semnificaia statistic folosid testul T Student

Tabelul 1. Evoluia pragului sensibilitii vibratorii

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Finanare: Studiu realizat n cadrul proiectului CEEX 92/2006.

EVALUATION OF VIBRATORY DETECTION THRESHOLD IN NEWLY DIAGNOSED TYPE 2 DIABETES MELLITUS PATIENTS C. Constantin 1,2, I. Gal3, C. Ionita3, G. Stan1,4, D. Cheta1,3 1. Prof. NC Paulescu Diabetes Institute Bucharest 2. Carol Davila Emergency Military Hospital Bucharest 3. Carol Davila University of Medicine and Pharmacy Bucharest 4. Healthy Nutrition Foundation Bucharest

Objective The objective of this study was to evaluate the evolution of vibratory threshold in newly diagnosed type 2 diabetes mellitus patients. Material and methods Computed vibratory detection threshold (CASE IV System) is a valuable instrument to evaluate diabetic sensory polyneuropathy. This is a 3 months open prospective study. We have two groups of 12 subjects each, with type 2 newly diagnosed DM following intensive insulin treatment and adequate diet. Common neurological disorders were excluded at start and during the study. Inclusion Criteria: Patients must fulfill all of the following criteria to be eligible for this study: 1.Newly diagnosed Type 2 diabetes mellitus, 2.Able to follow the protocol and willing to participate in the study as confirmed by signed consent to release information, 3.Currently treated with (EASD protocols): Life style intervention, Insulin (with or without oral agents), Different drugs for co-morbidities, 4. No anamnestic stories or clinical signs about nervous impairement. Results Baseline characteristics: The group A has the mean age 45.343.5years and the other one 64.236.54years. Baseline characteristics (mean) BMI, weight, systolic blood pressure-sBP, HbA1c were similar for two groups. Data for HbA1c, hypoglicemic events, weight and BMI were recorded. Computed vibratory detection threshold was monitored at the baseline and after 1, 2 and 3 months. For the Group A mean weight at baseline was 89.712.25kg and weight gain at 3 months was 4.181.21 kg. Mean HbA1c at baseline was 12.711.27% and decreased to 7.90.8% at 3 months. For Group B mean weight at baseline was 85.89.23kg and weight gain at 3 months was 5.022.03 kg (A vs. B, 38

p>0.05). Mean HbA1c at baseline was 11.92.21% and decreased to 8.020.27% (A vs. B, p>0.05) at 3 months. The hypoglicemic events are similar in the 2 lots during the treatment (4.121.03 vs. 3.961.22/months, p>0.05). At baseline the computed vibratory threshold was 11.920.23JND Units for Group A and 2.122.10JND Units for Group B (Foot Vibration Test) (p>0.05). After three monts the computed vibratory threshold was 8.102.26JND Units for Group A and 10.262.52JND Units for Group B(p<0.05). Table 1. Conclusions This is one of the first studies were we can see an improvement of vibratory threshold after an intensive insulin treatment and lifestyle modifications in newly diagnosed type 2 DM patients. The improvement vibratory threshold is significantly better at younger participants (p<0.05).High metabolic disturbances (HbA1c%>12) were present at the beginning of the study with signs of insulin deficit. Low power level of study only 24 participants had finished the program.

Time/ JND Units

Group A

Group B

Group A

Group B

(Foot Vib T*) (Foot Vib T) Signf* (Hand Vib T*) (Hand Vib T) Signf* 12.122.10 p<0.05 8.340.84 8.722.10 p<0.05

Baseline 11.920.23 1 month 9.344.23

10.102.57 10.802.64 10.262.52

p>0.05 7.283.19 p<0.05 6.001.22 p<0.05 6.371.51

7.482.57 7.882.64 8.122.12

p>0.05 p<0.05 p<0.05

2 months 8.402.33 3 months 8.102.26

*Foot Vib T Foot Vibration Test, *Hand Vib T Hand Vibration Test, *Signf - statistical significance using t Student test

Table 1. The evolution of vibratory threshold Supported by: Grant CEEX 92/2006 from the Romanian Research Ministry.

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ROLUL ALELELOR HLA-B N SUSCEPTIBILITATEA GENETIC PENTRU DZ TIP 1 PENTRU POPULAIA DIN ROMNIA C. Guja1, L Guja1, A. Clin1, S. Nutland2, J. Howson2, H. Rance2 i J.A. Todd2 i C. Ionescu-Trgovite1 1 Clinica 1 de Diabet, Institutul N. Paulescu, Bucureti, Romnia 2 JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Cambridge Institute for Medical Research, Cambridge, UK

Introducere: Diabetul Zaharat de tip 1 (DZ tip 1) este o boal cronic cu patogenie autoimun, caracterizat prin distrugerea mediat de limfocite T a celulelor beta pancreatice. Principalele gene diabetogene descrise pn n prezent sunt localizate la nivelul regiunii HLA de clasa a II-a, fiind reprezentate n special de unele alele ale HLA DQB1 i DRB1. Exist ns i date privind implicarea unor alele de clasa I, HLA-A i HLA-B. Pentru a evalua efectul diabetogen al unor alele HLA-B pentru populaia din Romnia (ar cu una din cele mai mici incidene ale DZ tip 1 din Europa), am realizat o tipare HLA-B complet pe un numr de 423 familii cu DZ tip 1. Scop: Evaluarea implicrii unor alele HLA-B n patogenia DZ tip 1 pentru populaia din Romnia. Materiale i Metode: Lotul studiat a cuprins 1515 subieci dintre care 439 pacieni DZ tip 1 (208 brbai/231 femei) i 1076 rude de gradul 1 nediabetice. Tiparea a fost fcut prin metoda PCR-SSOP. Datele au fost analizate prin Transmission Disequilibrium Test (TDT) i AFBAC folosind programul Stata 8.1 (http://www.stata.com). Pentru a stabili dac efectele alelelor HLA-B sunt independente, datele au fost analizate prin metoda regresiei logistice condiionate, folosind genotipurile DQB1 i DRB1 ale subiecilor inclui n studiu. Rezultate: Am identificat o transmisie semnificativ crescut la diabetici a alelelor HLA B8 (71.3% transmitere, pTDT = 6.5x10-7), B15 (69.2% transmitere, pTDT = 0.005), B41 (74.1% transmitere, pTDT = 0.0002), B50 (85.7% transmitere, pTDT = 0.00002) i Bw6 (65.7% transmitere, pTDT = 2.35x10-8). Am identificat de asemenea o transmitere semnificativ sczut a alelei HLA B52 la diabetici (25.8% transmitere, pTDT = 0.007). Transmisia acelorai alele la fraii neafectai ai probanzilor diabetici nu a fost diferit semnificativ de 50%, procent ateptat prin ans. Rezultatele sunt susinute i de frecvena mai mare a acelorai alele la diabetici comparativ culotul pseudocontrol (16.6% vs. 7,2% pentru B8; 6% vs. 2.6% pentru B15; 6.7% vs. 1.9% pentru B41; 4.8% vs. 1.1% pentru B50, 69.25% vs. 54.4% pentru Bw6 i 1.24% vs. 3% pentru B52). Analiza prin conditional logistic regression a artat ns c asocierea alelelor HLA B cu DZ tip 1 nu este independent de influena alelelor HLA DQ i DR (Prob > chi2 = 0.1023).

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Discuii: Rezultatele noastre indic un posibil efect diabetogen al alelelor HLA B8, B15, B41, B50 i Bw6 precum i un efect protector al alelei HLA B52. Totui aceste asocieri par a nu fi independente, cel mai probabil fiind datorate unui fenomen de linkage disequilibrium cu alelele demonstrat diabetogene/protectoare aparinnd locilor HLA de clasa a IIa DQ i DR.

THE ROLE OF HLA B ALLELES ON TYPE 1 DIABETES GENETIC SUSCEPTIBILITY IN THE ROMANIAN POPULATION. C. Guja1, L Guja1, A. Clin1, S. Nutland2, J. Howson2, H. Rance2 i J.A. Todd2 i C. Ionescu-Trgovite1 1 Institute of Diabetes, Nutrition and Metabolic Diseases N. Paulescu, Bucharest, Romania; 2 Juvenile Diabetes Research Foundation/Wellcome Trust Diabetes and Inflammation Laboratory, Cambridge Institute for Medical Research, Cambridge, UK;

Introduction: Type 1 diabetes (T1DM) is a chronic autoimmune disease conditioned by multiple genetic and environmental factors. The main diabetes genes reported so far belong to the HLA class II region, DQB1 and DRB1 loci. However, multiple reports exists regarding the independent effect of some class I HLA A and B alleles. In order to assess the diabetogenic role of HLA B alleles for the Romanian population (with one of the lowest reported incidence of T1D in Europe), we performed a full HLA B typing in 423 nuclear families. Aim: Our aim was to assess the potential involvement of HLA-B alleles in the pathogenesis of T1DM in Romanian families. Materials and Methods: The study group comprised 1,515 individuals with 439 T1D patients (206 male/224 female) and 1,076 unaffected first degree relatives. Genotyping was done by PCR-SSOP. Data were analysed using the Transmission Disequilibrium Test (TDT) and AFBAC using Stata 8.1 (http://www.stata.com). To establish if the effects of B alleles are independent, data were analysed by conditional logistic regression using the complete DQB1 and DRB1 genotypes for the entire study group. Results: We found a significant increased transmission to diabetics of HLA B8 (71.3% transmission, pTDT = 6.5x10-7), B15 (69.2% transmission, pTDT = 0.005), B41 (74.1% transmission, pTDT = 0.0002), B50 (85.7% transmission, pTDT = 0.00002) and Bw6 alleles (65.7% transmission, pTDT = 2.35x10-8). We also found a significant decreased transmission of HLA B52 allele to diabetics (25.8% transmission, pTDT = 0.007). The

41

transmission of the same alleles to unaffected sibs was not significant different from 50%. The results were supported by the higher frequency of these alleles in cases in comparison with pseudocontrols (16.6% vs. 7,2% for B8; 6% vs. 2.6% for B15; 6.7% vs. 1.9% for B41; 4.8% vs. 1.1% for B50, 69.25% vs. 54.4% for Bw6 and 1.24% vs. 3% for B52). Conditional logistic regression analysis showed that these associations are not independent of the effect of DQ and DR alleles neither for HLA B (Prob > chi2 = 0.0577) nor for HLA Bw (Prob > chi2 = 0.1023) alleles. Discussion: Our results indicate a possible diabetogenic effect for HLA B8, B15, B41, B50 and Bw6 alleles and a protective effect for HLA B52 allele. However, the conditional logistic regression analysis showed that these effects are not independent but most likely due to the strong linkage disequilibrium with diabetogenic/protective class II DQ and DR alleles.

PARTICULARITATI ALE DIABETULUI ZAHARAT LA COPILUL MIC Banarescu Carmen Spitalul de Copii Sfanta Maria Iasi

1.Introducere Diabetul zaharat insulino-dependent la copilul mic ridica greutati in redarea unui diagnostic rapid si correct , deseori in prezenta simptomatologiei atipice varstei. 2.Obiective -studiul particularitatilor clinico-evolutive ale DID la copilul mic -posibilitatile terapeutice si aspecte particulare ale insulinoterapiei la copilul mic 3.Metode Si Materiale De Lucru Studiul a fost efectuat in Clinica a-III-a Pediatrie , Spitalul clinic de urgenta de copii Sf. Maria Iasi in perioada 1-01-2005 si 1-01-2008 pe 10 copii. 4.Concluzii Diabetul zaharat la copii mici prezinta: -instabilitate metabolica

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-obtinerea controlului glicemic este greu de mentinut -familia joaca un rol important in imbunatatirea echilibrului metabolic cu prevenirea complicatiilor tardive.

PARTICULARITIES OF THE DIABETES MELLITUS IN THE SMALL CHILD Banarescu Carmen Spitalul de Copii Sfanta Maria Iasi

1. Introduction:

The insulin dependent diabetes mellitus in the small child raises several issues related to establishing an accurate and rapid diagnosis in the presence, often, of atypical symptoms as well as high instability specific to age.
2. Objectives:

study of the chemical-evolutive particularities of the insulin-dependent diabetes in the infant and in the small child - therapeutic possibilities and particular issues of the insulinotherapy in the infant and in the small child 3. Method And Working Material: The study was conducted in Clinics 3 of Pediatrics January 1st 2005 through January 1st 2008 on 10 children
4. Conclusions: The diabetes mellitus in the small child shows:

- metabolic instability - obtaining of a metabolic control, difficult to achieve - the family plays an important role in obtaining a glycemic control which allows for the improvement of the metabolic equilibrium by preventing tardive complications.

PERTURBARILE METABOLISMULUI GLUCIDIC IN MUCOVISCIDOZA CONSIDERATII PE MARGINEA UNUI CAZ

43

Carmen Oltean, Laura Bozomitu, Dana Anton, D. Moraru Clinica a III-a Pediatrie, U.M.F. Gr.T.Popa Iasi

Mucoviscidoza reprezinta cea mai frecventa boala AR intalnita la populatia caucaziana, caracterizata prin afectare pluriorganica si cu consecinte severe asupra celor trei tipuri de metabolism. Afectarea metabolismului glucidic apare, in general, dupa o evolutie de mai lunga durata a bolii, avand grade diferite de severitate, de la hiperglicemii izolate, scaderea tolerantei la glucoza pana la diabet zaharat. Obiectiv: prezentarea cazului unui copil cu mucoviscidoza - forma completa la care scaderea tolerantei la glucoza a aparut precoce, la varsta de 11 ani. Material si metoda: autorii descriu cazul unui baiat diagnosticat tardiv, la varsta de 10 ani, cu fibroza chistica forma completa, la care scaderea tolerantei la glucoza s-a instalat precoce, in absenta unei simptomatologii de hiperglicemie. Rezultate si discutii: pacientul S.V., 12 ani, cu repetate infectii respiratorii cu evolutie trenanta in antecedente, s-a internat pentru prima data in Clinica a III-a Pediatrie la varsta de 10 ani. La internare prezenta deficit staturo-ponderal sever (- 3,4 DS pentru T si 3DS pentru G), cu semne patente de insuficienta respiratorie cronica, scaune nedigerate cu steatoree, anemie feripriva, hipoproteinemie cu hiposerinemie, hipolipemie, aspect de fibroza pulmonara si hepatica, testul sudorii pozitiv. S-a stabilit diagnosticul de mucoviscidoza forma completa fiind instituit tratamentul dietetic si medicamentos specific bolii. Urmarirea bolnavului a evidentiat ameliorarea deficitului nutritional si a insuficientei respiratorii dar evolutia a fost grevata de suprainfectii bacteriene pulmonare si perturbarea metabolismului lipidic (hipolipemie, hipocolesterolemie). La aproximativ un an de la diagnostic s-au decelat initial hiperglicemii postprandiale izolate (180-220 mg %) in absenta unei simptomatologii caracteristice. Efectuarea TTGO a stabilit diagnosticul de toleranta scazuta la glucoza. Avand in vedere afectiunea de baza, pacientului i s-a recomandat o restrictie relativa la glucide cu absorbtie rapida (consumarea lor impreuna cu alte alimente pentru scaderea vitezei de absorbtie), dieta hipercalorica,hiperlipidica, hiperproteica si monitorizare bisaptamanala a glicemiei. Concluzie: aparitia precoce a perturbarilor metabolismului glucidic in mucoviscidoza este consecinta evolutiei naturale a bolii (in absenta unei terapii specifice), cu extinderea rapida a leziunilor de fibroza, la care se adauga infectiile respiratorii repetate. Dieta glucidica este partial restrictiva, respectand necesitatile hipercalorice specifice bolii.

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CARBOHYDRATE METABOLISM PERTURBATIONS IN CYSTIC FIBROSISCASE CONSIDERATIONS Carmen Oltean, Laura Bozomitu, Dana Anton, D. Moraru Clinica a III-a Pediatrie, U.M.F. Gr.T.Popa Iasi

Cystic fibrosis is the most frequent AR disease in caucasians, characterized by multiorganic involvement and with severe consequences on the three types of metabolism. The carbohydrate metabolism is generally impaired after a long-term evolution of the disease, with different stages of severity, from isolated hyperglycemia episodes, glucose intolerance, to diabetes mellitus. Aim: to present the case of a 10 years old child with cystic fibrosis-complete form in whom the glucose intolerance has occurred early, at the age of 11. Material and method: authors describe the case of a boy who was lately diagnosed with cystic fibrosis-complete form- at the age of 10, in whom the glucose intolerance has early occurred, without any symptoms due to hyperglycemia. Results,discussions: the patient SV, aged 12, with recurrent, persistent respiratory infections in the history, was first admitted in the 3rd Pediatric Cclinic at the age of 10. At admittance he had severe growth retardation (-3,4 SD for H and -3 SD for W), with patent signs of chronic respiratory failure, steatorrhea, iron deficiency anemia, hypoproteinemia with hyposerinemia, hypolipemia, liver and lung fibrosis, positive sweat test. The diagnosis of cystic fibrosis-complete form was made and the diet and medical treatment specific to disease was begun. The follow up remarked the improvement of the nutritional impairment and of the respiratory failure but the outcome was subsequently poor, by pulmonary bacterial infections and lipidic metabolism perturbations (hypolipemia, hypocholesterolemia). After approximately one year after diagnosis there were initially detected only isolated postprandial hyperglycemias (180-220 mg%), without any characteristic symptom. After the oral glucose tolerance test was made (OGTT) the diagnosis was glucose intolerance. Considering the main diagnosis (CF), it was recommended for the patient a relative restriction of rapidly absorbed carbohydrates (their intake together with other food in order to decrease the absorption time), a hypercaloric, hyperlipidic, hyperproteic diet and twice a week glycemic monitoring. Conclusion: the early occurrence of the carbohydrate metabolism troubles in cystic fibrosis is due to natural evolution of the disease (without any specific therapy), with rapid extension of fibrotic lesions, and also with further occurrence of recurrent respiratory infections. The carbohydrate intake is partially restricted, with respect to hypercaloric requirements specific for this disease.

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EPIDIAB 2008 IN JUDEUL CLUJ Mirela Florea, Cristina Nita, Adriana Rusu, Nicolae Hancu Centrul Clinic de Diabet, Nutriie i Boli Metabolice Cluj Napoca

Introducere: Numrul persoanelor cu diabet a crescut alarmant n ntreaga lume,fr nici o tendin de atenuare a ritmului de cretere. Diabetul zaharat tip 2 este considerat n momentul de fa una dintre cele mai ingrijortoare, costisitoare i serioas problem de sntate. Programul EPIDIAB are ca scop analiza epidemiologica si a calitatii ingrijirii persoanelor cu diabet zaharat nou depistat. Scopul lucrarii: Este de a analiza aspectele referitoare la datele demografice,antropometrice, prevalenta factorilor de risc cardiometabolici,prevalenta complicatiilor cronice , precum si structura terapeutica a persoanelor cu diabet diagnosticate in perioada ianuarieseptembrie 2008 in judetul Cluj. Metoda: Au fost preluate datele din fisele de consultatie ale persoanelor diagnosticate si luate in evidenta cu diabet zaharat in perioada ianuarie-septembrie 2007 la Centrul Clinic de Diabet, Nutritie si Boli Metabolice Cluj Napoca, la care s-au adaugat datele comunicate de celelalte cabinet de Diabet din judetul Cluj. Rezultate: In perioada 1 ianuarie-30 septembrie 2008, au fost inregistrat 3705 persoane cu diabet zaharat nou depistat, dintre care diabet zaharat tip 2:99,1%, diabet zaharat tip 1: 0,5 %, diabet gestational: 0,16%, diabet secundar: 0,24%. Raportul barbati:femei a fost de 1:1,01 ;76 % provin din mediul urban, majoritatea(64,75%) se situeaza in grupa de varsta 41-65 de ani. Din punct de vedere antropometric 10,82 % din persoanele nou diagnosticate sunt normoponderale, 35,9% cu suprapondere si 53,28% cu obezitate; 93,87% din persoane au talia peste 80 cm la femei sau peste 94 cm la barbati. Prevalenta hipertensiunii arteriale a fost de 64,63%, a dislipidemiei de 57%, iar 21% din persoanele nou depistate cu diabet zaharat prezinta deja o complicatie macrovasculara(cardiopatie ischemica 45,64%,angina pectorala 29,61 %, infarct miocardic14,98 %, boala cerebrovasculara16,02 %, arteriopatie periferica 7,32%). Structura terapeutica in diabetul zaharat nou depistat a fost urmatoarea: 24,09% optimizarea stilului de viata, 44,74% metformin in monoterapie, 8,88% sulfonilureice,

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11,33% metformin sulfonilureice, 6,49% insulina, 3,75% insulina-terapie orala, 0,72% alte clase. Concluzii: Incidenta diabetului zaharat inregistreaza in judetul Cluj o crestere semnificativa, fiind de aproximativ 44,83% mai mare comparativ cu aceeasi perioada a anului 2007 si de aproximativ 182,82% comparativ cu anul 2006. Diferentele semnificative comparativ cu anul 2006 sunt in parte explicate prin derularea Programului National de Evaluare a Starii de Sanatate a Populatiei din iulie 2007.Din punct de vedere terapeutic se remarca o crestere a numarului de pacienti aflati pe modulul de terapie metformin in comparatie cu anii precedenti.

EPIDIAB 2008 IN CLUJ COUNTY Mirela Florea, Cristina Nita, Adriana Rusu, Nicolae Hancu Clinical Center of Diabetes, Nutrition, Metabolic Diseases Cluj Napoca

Introduction: The number of individuals with diabetes has increased alarmingly through-out the world and the rate of increase shows no signs of slowing. Type 2 diabetes is currently one of the most costly and worrying chronic diseases and represents a serious health care problem worldwide. The objective of EPIDIAB Program is to provide epidemiological data as well as the quality care of newly-diagnosed diabetes. Aim: To analyze the demographic, anthropometric data, the prevalence of cardiometabolic risk factors and chronic complications and the therapeutic structure of persons with newlydiagnosed diabetes, between January-September 2008, in Cluj County. Method: We analyzed data from the medical records of persons with newly-diagnosed diabetes between January-September 2008 and registered in the Diabetes Clinics from Cluj County. Results: In January-September 2008, 3705 persons with newly-diagnosed diabetes were registered,99,1 % with type 2, 0,5% type 1, 0,16% gestational diabetes and 0,24% with other specific types of diabetes; the ratio men: women is 1:1,01 ; 76% of the persons come from urban areas, the majority (64,75%) being in the 41-65 years group of age. 47

10,82 % of type 2 newly-diagnosed diabetes have normal weight, 35,9% overweight and 53,28%obesity;93,87 % have the abdominal circumference over 80 cm in women or over 94 cm in men. The prevalence of hypertension is 64,63%, of dyslipidemia 57%; 21 % of newly-diagnosed diabetes has already a macrovascular complications at diagnosis ( ischemic heart disease 45,64%, angina 29,61 %, myocardial infarction14,98%, cerebrovascular disease 16,02%, peripheral vascular disease7,32%). The therapeutic structure for newly diagnosed diabetes is as follows:24,09% lifestyle intervention only,44,74 % metformin, 8,88 % sulphonylurea, 11,33% metformin plus sulphonylurea, 6,49% insulin, 3,75%insulin plus oral therapy and 0,72% other drugs. Conclusion: The incidence of diabetes mellitus in the county of Cluj registers a significant increasing about 44,83% more than the same period in 2007 and 182,82% more than 2006. Increased diagnostic activity by initiation of National Population Health Assessment Program in 2007 might generate a significant increase in the incidence of diabetes in 2007 and 2008 as compared with 2006. When treatment is considered, there are significant increased as compared with the previous years for metformin therapy.

CARACTERISTICI GENERALE ALE PACIENILOR CU DIABET ZAHARAT TIP 1 DIN CENTRUL CLINIC DE DIABET, NUTRIIE, BOLI METABOLICE IAI Cristina Lctuu1,2, Bogdan Mihai1,2, Roxana tefan2, Laura Mihalache1,2, Delia Vtc2, Mariana Graur1,2
1 2

Universitatea de Medicin i Farmacie Gr. T. Popa Iai Centrul Clinic de Diabet, Nutriie, Boli Metabolice Iai

Scopul lucrrii: am efectuat un studiu retrospectiv, observaional, transversal, pentru a aprecia caracteristicile generale ale pacienilor cu diabet zaharat tip 1 aflai n evidena Centrului Clinic de Diabet, Nutriie, Boli Metabolice Iai. Material i metod: am evaluat toi pacienii aduli cu diabet zaharat tip 1 aflai n evidena centrului nostru pn la data de 01.01.2007. Din analiza fielor de monitorizare, lund n considerare doar datele din ultimii doi ani, am selectat informaiile referitoare la vrst, sex, vechimea bolii, greutate, nlime, circumferina abdominal, circumferina fesier i prezena complicaiilor cronice ale diabetului, care au fost nregistrate ntr-o baz de date Microsoft Office Excel i supuse ulterior prelucrrii statistice folosind programele SPSS.

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Rezultate i discuii: Din totalul de 1072 pacieni, dup excluderea celor cu vrsta sub 18 ani i a celor cu patologie terminal de organ (care ar fi putut falsifica analiza statistic a datelor antropometrice), am selectat un lot de 994 pacieni. S-a constatat o preponderen a sexului masculin (553 cazuri 55,6%) i o vrst medie de 43,5813,66 ani, cu variaii ntre 18 i 84 de ani. Vechimea diabetului zaharat tip 1 a variat ntre 1 i 49 de ani, cu o medie de 11,029,05 ani. Indicele de mas corporal a variat ntre 14,88 kg/m2 i 46,22 kg/m2, cu o medie de 25,624,50 kg/m2; a existat o preponderen net a pacienilor normoponderali (46,34%) i supraponderali (33,95%). Utiliznd valorile circumferinei abdominale (CA) i ale indicelui abdomino-fesier (IAF), am constatat c 45,8% i respectiv 39,1% dintre pacieni depeau valorile normale, cu diferene statistic semnificative ntre cele dou sexe n ambele cazuri (CA 57,8% dintre femei i 35% dintre brbai; IAF 47,3% dintre femei i 31,8% dintre brbai). 46,4% dintre pacienii evaluai n ultimii 2 ani au fost diagnosticai cu retinopatie diabetic (RD): 35% RD neproliferativ form uoar/medie, 1,7% RD neproliferativ form sever/foarte sever, 9,7% RD proliferativ. Din cei 305 pacieni la care fuseser recent evaluate eliminrile urinare de proteine, 48,2% erau normoalbuminurici, 24,6% prezentau microalbuminurie i 27,2% macroalbuminurie. La cei 860 pacieni la care fusese evaluat neuropatia, 68,7% prezentau forma periferic i 13,15% forma vegetativ. Macroangiopatia era prezent la un numr mai mic de cazuri (12,7% din cei 106 pacieni evaluai prezentau boal coronarian, 2,82% din totalul pacienilor aveau sechele de accident vascular cerebral, 5,3% din cei 851 pacieni evaluai prezentau AOMI). Concluzii: Preponderena crescut a sexului masculin este o particularitate a pacienilor cu diabet zaharat tip 1 din centrul nostru, tiut fiind c n rile cu o prevalen sczut a bolii (printre care i Romnia) exist o tendin de predominan feminin. Aproximativ 40% dintre pacieni prezentau o dispoziie abdominal a esutului adipos, mai ales n cazul sexului feminin (circa jumtate din cazuri). Peste 50% din cazurile evaluate aveau eliminri urinare crescute de proteine i aproape jumtate aveau retinopatie diabetic. Peste dou treimi din cazuri prezentau neuropatie periferic. Comparativ cu celelalte complicaii, macroangiopatia era prezent ntr-un numr mai redus de cazuri.

GENERAL FEATURES OF TYPE 1 DIABETIC PATIENTS IN CLINICAL CENTRE OF DIABETES, NUTRITION, METABOLIC DISEASES IAI Cristina Lctuu1,2, Bogdan Mihai1,2, Roxana tefan2, Laura Mihalache1,2, Delia Vtc2, Mariana Graur1,2
1 2

The University of Medicine and Pharmacy Gr. T. Popa Iai The Clinical Centre of Diabetes, Nutrition, Metabolic Diseases Iai

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Aim of study: we performed a retrospective, observational, transversal study in order to appreciate the general features of type 1 diabetic patients in Clinical Centre of Diabetes, Nutrition, Metabolic Diseases Iai. Material and method: we evaluated all adult patients diagnosed with type 1 diabetes mellitus in our centre before January 1st 2007. We analyzed the record files, by considering only data available in the last two years. We searched information about age, sex, duration of disease, weight, height, waist circumference, hip circumference and the chronic complications of diabetes, which were registered in a Microsoft Office Excel data base and afterwards undergone statistic analysis by using SPSS programs. Results and discussions: Out of all 1072 patients, after excluding those under 18 years old and those with terminal organ pathology (that might have falsified the statistical analysis of anthropometric data), we selected a group of 994 patients. We observed a predominance of male patients (553 cases 55.6%) and a mean age of 43.5813.66 years, with extremes of 18 and 84 years. The duration of type 1 diabetes mellitus varied between 1 and 49 years, with a mean value of 11.029.05 years. The body mass index varied between 14.88 kg/m2 and 46.22 kg/m2, with a mean value of 25.624.50 kg/m2; most patients were of normal weight (46.34%) or overweight (33.95%). By referring to waist circumference and waist-hip ratio, we noticed that 45.8% and respectively 39.1% of patients had abnormal values, with statistically significant differences between genders in both cases (waist circumference 57.8% of women and 35% of men; waist-hip ratio 47.3% of women and 31.8% of men). 46.4% of the patients evaluated in the last 2 years were diagnosed with diabetic retinopathy (DR): 35% nonproliferative incipient/moderate DR, 1.7% nonproliferative severe/very severe DR, 9.7% proliferative RD. In the 305 patients who had recent evaluation of urinary albumin excretion rate, 48.2% had normoalbuminuria, 24.6% had microalbuminuria i 27.2% macroalbuminuria. In the 860 patients who had been evaluated for neuropathy, 68.7% had the peripheral form and 13.15% had the autonomic form. Macrovascular disease was present in a smaller amount of cases (12.7% of the 106 patients that were evaluated had coronary disease, 2.82% of all patients had a stroke history, 5.3% of the 851 patients who were evaluated had peripheral arterial disease). Conclusions: High prevalence of male gender is an uncommon feature of type 1 diabetic patients in our centre, as we know that in countries with low prevalence of the disease (which include Romania) there is a tendency towards female predominance. Approximately 40% of patients had abdominal deposition of the fat mass, found especially in females (about half of cases). More than 50% of the evaluated cases had high urinary albumin excretion rates and almost half of patients had diabetic retinopathy. More than two thirds of cases had peripheral neuropathy. By comparison to other complications, macrovascular disease was present in a more reduced number of cases.

PREDICTORII HIPERGLICEMIEI POSTPRANDIALE LA PACIENII CU DIABET ZAHARAT TIP 2

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Cristina Ni1,2, Adriana Rusu1, Cornelia Bala1,2, N. Hncu1,2

1 2

Universitatea de Medicin i FarmacieIuliu Haieganu, Cluj Napoca Centrul de Diabet , Nutriie i Boli Metabolice, Cluj-Napoca

Introducere i Obiective Evidenele actuale sugereaza c toate aspectele metabolismului glucozei -hemoglobina glicat (A1C), glicemia bazal(GB) i glicemia postprandial(GPP)- sunt parametrii clinic relevani pentru a fi monitorizai. Glicemia postprandiala(GPP), n particular, pare s fie corelat cu boala cardiovascular (BCV). Obiectivul acestui studiu a fost determinarea factorilor asociai cu excursiile glicemice postprandiale n cazul pacienilor cu diabet zaharat tip 2 (DZ2). Material i metod Au fost evaluai factorii asociai cu hiperglicemia postprandial (>140mg/dl la 2 ore dup mas) corectai n funcie de sex i tratament, la 122 de pacieni care s-au prezentat la controlul periodic, n Centrul de Diabet i Boli de Nutriie Cluj Napoca, Romnia. Aceti pacieni au fost invitai s participe la un studiu epidemiologic privind evaluarea impactului glicemiei postprandiale asupra riscului cardiovascular, la persoanele cu DZ. S-a efectuat o evaluare medical complet a acestor pacieni, cu istoric personal i examen obiectiv (greutate, nlime, circumferin abdominal i tensiune arterial). De asemenea s-a determinat n condiii bazale nivelul glicemiei plasmatice, A1C, colesterol total, HDL-colesterol i trigliceride. Fiecare pacient a efectuat un profil glicemic n 6 puncte (preprandial i la 2h postprandial) i a completat un chestionar alimentar. Rezultate Vrsta medie a pacienilor inclusi n studiu a fost de 58 ani (minim 28, maxim 77 ani), ntre care 59.8% au fost de sex masculin. n medie, vechimea diabetului la pacienii inclui n studiu a fost de 6 ani ( minim 0, maxim 37 ani). Prin analiza factorial s-au determinat patru factori care explic 73% din variaia glicemiei postprandiale [ Factorul 1 cu ncrcare pozitiv pentru greutate, IMC, Factorul 2 cu ncrcare pozitiv pentru colesterol total i LDL colesterol, Factorul 3 cu ncrcare pozitiv pentru vechimea diabetului i vrst, Factorul 4 cu ncrcare pozitiv pentru trigliceride i HDLcolesterol]. Factorii determinai cu ajutorul analizei factoriale au fost inclui ca variabile independente ntr-un model de regresie liniar, avnd glicemia postprandial ca variabil dependent. Acest model a fost semnificativ asociat cu valoarea medie a glicemiei postprandiale ( p=0.002). n cadrul acestei analize Factorul 2 nu a atins nivelul semnificaiei statistice ( p=0.593) i a fost exclus din analiz. Al doilea model de regresie care a inclus numai Factorii 1, 2, 4 a fost semnificativ statistic (p=0.001, F change=6.123, semnificaia F change= 0.001). n urma ajustrii modelului de

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regresie pentru sexul pacienilor i tratamentul hipoglicemiant urmat, numai Factorul 1 i Factorul 4 au rmas semnificativ asociai cu glicemia postprandial (p=0.025 i 0.004). Concluzii Rezultatele studiului arat c greutatea, indicele de mas corporal, nivelul trigliceridelor i al HDL-colesterolului sunt asociate independent cu variaiile glicemice postprandiale.

PREDICTORS OF POSTPRANDIAL HYPERGLYCEMIA IN PATIENTS WITH TYPE 2 DIABETES Cristina Nita1,2, Adriana Rusu1, Cornelia Bala1,2, N. Hancu1,2
1 2

Iuliu Haieganu University of Medicine and Pharmacy, Cluj Napoca Clinical Center of Diabetes, Nutrition, Metabolic Diseases, Cluj-Napoca

Background and Aims: Growing evidence suggests that all aspects of glucose metabolism - glycated hemoglobin (A1c), fasting plasma glucose (FPG) and postprandial glycemia (PPG)- are clinically relevant parameters to be monitored. PPG, in particular, appears to be related to the cardiovascular disease (CVD). The objective of this study was to investigate the factors associated with postprandial glucose excursions in patients with type 2 diabetes (T2DM). Materials and Methods: We have evaluated the factors associated with postprandial hyperglycemia (>140 mg/dl at 2 hours after the meal), corrected for sex and treatment in 122 consecutive patients with T2DM attending the outpatient clinic from Clinical Center of Diabetes, Nutrition and Metabolic Diseases Cluj-Napoca, Romania. These patients were included in a larger epidemiological study aiming to assess the impact of postprandial hyperglycemia on cardiovascular risk in persons with type 2 diabetes. A complete medical history, physical examination (weight, height, waist circumference, and blood pressure) was performed. Blood samples were collected in the overnight fasting state, and A1c, total cholesterol, HDL-cholesterol and triglycerides were assessed. A six points blood glucose profile (before and 2 h after meals) measured by patients at home, together with a meal questionnaire was performed for each patient. To determine variables associated with higher postprandial glycemic levels, factor analysis followed by linear regression model was performed. Results: The study group had a median age of 58 years (min 29, max 77 years), 59.8% were males. The median duration of diabetes was 6 years (min 0, max 37 years). By factor analysis we have extracted 4 factors that explained 73% of the variance of postprandial glycemia [Factor 1 with positive loadings of weight and body mass index, Factor 2 with positive loadings of total cholesterol and LDL-cholesterol, Factor 3 with

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positive loadings of diabetes duration and age, Factor 4 with positive loadings of triglycerides and HDL-cholesterol]. In an unadjusted linear regression, model which included the four factors identified was significantly associated with postprandial glycemia (p=0.002).Within the model, Factor 2 displayed a p value of 0.593 and was removed from the analysis. A second regression included Factor 1, 3 and 4, and the model remained statistically significant (p=0.001, F change=6.123, significance of F change= 0.001). After adjustment for the sex and treatment, only Factor 1 and Factor 4 remained significantly associated with postprandial glycemic values (p=0.025, and 0.004) Conclusion The results of our study shows that weight, body mass index, triglyceride level and HDL-cholesterol are independently associated with postprandial glucose excursion.

RISCUL DEZVOLTARII NASH LA PACIENTII DIABETICI E.C. Rezi1, R. Mihil2, L. Nedelcu3, O. Fril4, C. Domnariu5, M. Deac2
1 2 3 4 5

Spitalul Clinic Judetean de Urgenta, Sibiu Facultatea de Medicina, Universitatea Lucian Blaga Sibiu Facultatea de Medicina, Universitatea Transilvania, Brasov Facultatea de Medicina, Universitatea Oradea Centru de Sanatate publica, Sibiu

Introducere: Stetohepatitta non-alcoolica se asociaz frecvent cu sindromul metabolic, un grup de tulburri metabolice - obezitate central, diabet zaharat tip 2, rezisten la insulin, dislipidemie, hipertensiune arterial. Scopul studiului nostru a fost de a determina riscul dezvoltarii NASH la pacientii diabetici si posibilele corelatii ale nivelului glicemiei cu gradul fibrozei hepatice. Material si metoda: Au fost luai n studiu toi bolnavii deplasabili internai n clinicile medicale ale Spitalelor Judeene din Braov, Oradea i Sibiu n perioada 15.10.2006 31.12.2006, care au fost examinai ecografic. Cei fr ficat hiperecogen i fr citoliz hepatic au constituit lotul martor (812 pacienti) iar lotul de studiu a fost format din toti pacientii (68) la care s-a pus diagnosticul de steatohepatita non-alcoolica (NASH). Fibroza hepatica a fost evaluata prin scorul Forns. Rezultatele au fost analizate statistic folosind testul Pearson, testul t Student i riscul relativ (RR).

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Rezultate: Repartitia pe genuri a pacientilor cu NASH a fost de 41.17% femei fata de 58.83% barbati. Varsta medie a lotului a fost de 54.47 12.84 ani. Glicemia medie a pacinetilor cu NASH a fost de 132.85 mg/dl fata de 100.13 mg/dl la pacientii din lotul martor, diferenta fiind inalt semnificativa statistica (p=0.00000008). Riscul relativ de a dezvolta NASH la pacientii cu diabet zaharat a fost de 3.33. Indicele de corelatie Pearson intre nivelul glicemiei si scorul Forns de fibroza hepatica a fost r = -0.005; deci nu s-au gasit corelatii intre nivelul glicemiei si scorul fibrozei hepatice. De asemenea, nivelul glicemiei nu s-a corelat cu gradul de citoliza (r = 0.007, pentru TGO, respectiv r = -0.0003 pentru TGP). Concluzii:Valorile glicemice sunt semnificativ mai mari la pacientii cu NASH decat la cei din lotul martor. Pacientii cu diabet zaharat de tip 2 sunt de trei ori mai expusi riscului de a dezolta steatohepatita non-alcoolica decat restul populatiei. Nu exista corelatii intre nivelul mediu al glicemiei si nivelul citolizei hepatice sau gradul fibrozei.

THE RISK OF DEVELOPING NASH AT THE DIABETIC PATIENTS E.C. Rezi1, R. Mihil2, L. Nedelcu3, O. Fril4, C. Domnariu5, M. Deac2
1 2 3 4 5

Spitalul Clinic Judetean de Urgenta, Sibiu Facultatea de Medicina, Universitatea Lucian Blaga Sibiu Facultatea de Medicina, Universitatea Transilvania, Brasov Facultatea de Medicina, Universitatea Oradea Centru de Sanatate publica, Sibiu

Introduction: Non-alcoholic steatohepatitis (NASH) is frequently associated with the metabolic syndrome, a group of metabolic disorders like central obesity, diabetes mellitus type 2, insuline resistance, dyslipidemy and arterial hypertension. Our aim was to determine the risk of developing NASH at the diabetic patients and the possible correlations between the level of glycemia and the degree of liver fibrosis. Material and method:We took in consideration a group formed by the patients who were hospitalize in the Medical Departments of the Clinical Hospitals from Brasov, Oradea and Sibiu during 15.10.2006 31.12.2006, who were ultrasonografically examined. The ones without hyperecougenous liver and without liver cytolysis formed 54

the controlled group (812 patients) and 68 patients to whom the NASH diagnosis was established formed the studied group. The liver fibrosis was evaluated using the Forns index of correlation. Results:The gender repartition of the NASH patients was 41.17% women and 58,83% men. The medium age of the lot was 54.47 12.84 years of age. The medium level of glycemia at the NASH patients was 132.85 mg/dl comparing with 100.13 mg/dl at the patients from the control group, the difference being very statistically significant (p=0.00000008). The relative risk of developing NASH at the diabetic patients was 3.33. The Pearson index of correlation between the glicemic level and the Forns index of liver fibrosis was r =-0.005; so there were no correlations found between the glycemic level and the liver fibrosis index. No correlations were found between the level of glycemia and the level of transaminases (r =0.007 for TGO and r =-0.0003 for TGP). Conclusions:The values of gycemia are significantly higher at the patients with NASH comparing with the control group. The patients with diabetes mellitus are three times more likely to develop NASH than the rest of the population. There are no correlations between the medium level of glycemia and the degree of liver cytolysis of liver fibrosis.

CORELAII CLINICO-BIOLOGICE N HEPATOPATIA ADIPOAS NONALCOOLIC :DIABETUL ZAHARAT TIP 2 SI INSULINOREZISTENA COMORBIDITAI OMIPREZENTE ALE ACESTEI PATOLOGII DASCLU DACIANA NICOLETA - medic specialist medicina interna Spital Gen. CF Sibiu

Ficatul gras non-alcoolic (FGNA) sau hepatopatia adipoasa non-alcoolica se ncadreaza intr-un spectru de boli hepatice caracterizate in principal prin degenerescenta grasoasa macroveziculara ce apare in lipsa consumului semnificativ de alcool , respectiv sub 20-30 g alcool pur/zi sau sub 200g alcool pur/saptamana. Cu toate dificultatile in interpretarea rezultatelor studiilor privind prevalenta FGNA, aceasta pare a fi cea mai frecventa afectare hepatica in populatia generala, estimarile cele mai recente si elaborate apreciind o prevalenta hepatopatiei adipoase de 20% si a steatohepatitei non-alcoolice de 2-3%. In contextul importantei majore ca problema de sanatate publica mai ales prin prisma comorbiditatilor si complicatiilor pe care le implica hepatopatia adipoasa nonalcoolica , scopul lucrarii este acela de a evidentia corelatiile clinico-biologice dar mai ales particularitatile afectiunii in randul pacientilor din aria noastra geografica . Am realizat un studiu-ancheta prospectiv pe pacienti care prezinta aspect ecografic de steatoza hepatica , fara consum semnificativ de alcool si neinfectati cu virus hepatitic B

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sau C. Am urmarit gradul steatozei hepatice , afectiunile asociate, prezenta afectiunilor considerate clasic ca fiind premegatoare sau concomitente cu aparitia ficatului gras nonalcoolic (insulinorezistenta , diabetul zaharat de tip 2 , sindromul metabolic , obezitatea abdominala, etc.) incercand evidentierea unor posibile corelatii intre aspectele clinice si examinarile paraclinice . Datele obtinute au fost analizate comparativ cu un lot martor de pacienti . Am realizat calcule de semnificatii statistice si indice de corelatie intre valorile obtinute la cele doua loturi si am constatat existenta de corelatii pozitive intre valorile IL6 si taliei , PCR talie, TNF-IMC , IL6-TNF , IL6 -PCR si PCR-TNF la pacientii cu FGNA. Din analiza rezultatelor partiale prezentate mai sus se desprind cateva concluzii referitoare la pacientii studiati cum ar fi procentul important dintre subiecti care prezinta patologie cardiovasculara ( HTA , CIC ) fiind astfel clasificabili ca pacienti cu mare risc cardio-vascular , valorile medii ale IMC , indice talie/sold si circum-ferinta taliei care sunt mult crescute fata de limitele maxim admise , valorile medii calculate ale TNF , PCR , IL6 si IL8 fiind si ele mai mari decat limitele maxim normale (semnificand implicarea acestor citokine in procesul inflamator care produce si insoteste boala). Calculul FLI (Fibrosis Liver Index) confirma aplicabilitatea acestui test bazat pe valorile trigliceridelor , IMC , GGT si circumf. taliei in predictia steatozei hepatice .Calculul noninvaziv gradului de fibroza hepatica utilizand formule brevetate pentru alte patologii hepatice cronice a avut rezultate usor diferite functie de formula utilizata: APRI , FIB-4 scor Forns , raport ASAT/ALAT , ASPRI. Aceste concluzii confirma datele din literatura de specialitate conform carora ficatul gras non-alcoolic este o boala mult mai frecvent intalnita in populatia adulta decat se credea initial , fiind insotita de multiple comorbiditati, sindromul metabolic fiind cea mai importanta constelatie de patologie intalnita la acesti pacienti, iar hepatopatia adipoasa componenta hepatica a acestui sindrom.

CLINICAL CORRELATIONS CONCERNING NON-ALCOHOLIC FATTY LIVER DISEASE- DIABETES MELLITUS AND INSULINRESISTANCE AS OMNIPRESENT CO-MORBIDITIES

Non-alcoholic fatty liver disease (NAFLD) is a broad spectrum liver disease produced in the absence of alcohol ingestion and described as a macrovesicular fatty degenerescence of the hepatocites , with a prevalence of 20% in the general population. We present a prospective study on pts. with NAFLD comparing them with a set of healthy people concerning the weight , body mass index (BMI) , waist circumference, waist to hip ratio , IL6 , TNF , PCR , and searching for co-morbidities

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like DM , insulinresistance , metabolic syndrome , ischemic heart disease , high blood pressure or obesity. We also calculated the grade of liver fibrosis using non-invasives formulas like Forns score , APRI , ASPRI , FIB-4 , FLI (Fibrosis Liver Index) , ASAT/ALAT. The conclusions are not optimistic since we proved a high correlation of NAFLD with cardio-vascular diseases , DM and Metabolic syndrome , a moderate degree of liver fibrosis in pts. with normal transaminases and positive correlations between IL6 -waist , PCR waist, TNF-BMI , IL6-TNF , IL6 -PCR si PCR-TNF in patients with non-alcoholic fatty liver disease. Metabolic syndrome is a broad constellation of pathologies with a high prevalence in the general population, NAFLD being just the hepatic branch of this dangerous syndrome.

PROFILUL LIPIDIC LA DZ TIP 1 I 2 NOU DESCOPERIT COHORTA 2007 Daniela Licroiu,Elena Ungurau, Alexandra Secrieru, C. Ionescu Trgovite INDNBM N.C. Paulescu Bucureti

Scop: Analiza elementelor profilului lipidic la pacienii nou diagnosticai cu diabet i relaia acestora cu parametrii controlului glicemic (glicemie a jeun i HbA1c) i IMC. Material si metoda: n studiu au fost nrolai 2787 pacieni nou diagnosticai cu DZ n perioada ianuarie decembrie 2007, grupai n dou loturi n funcie de tipul DZ: a) 204 pacieni cu DZ tip I - 117 brbai (57.4%) i 87 femei (42.6%), cu vrsta medie 31.09 ani (limite 4-76 ani) i b) 2583 pacieni cu DZ tip II, din care 1272 brbai (49.2%) i 1311 femei (50.8%), cu vrsta medie de 58.86 ani (limite 1487 ani). Datele studiului (vrst, sex, IMC, glicemie a jeun, HbA1c, colesterol total, HDL-colesterol i TG) provin din fiele CAD ale pacienilor, prelucrarea statistic realizndu-se cu S.P.S.S 15.0, folosind testele: 2, Mann-Whitney, KruskalWallis i coeficientul de corelaie Sperman, cu un prag de semnificaie statistic p 0.05. Rezultate: media (min max) IMC (kg/m2) Glicemie a jeun (mg/dl) DZ tip I 22.32 (13.5 39.45) 275.11 (43 990) 57 DZ tip II 30.30 (15.62 55.86) 223.54 (120 p P = 0.0001 P = 0.0001

1332) HbA1c (%) Colesterol total (mg/dl) HDL-colesterol (mg/dl) TG (mg/dl) 11.93 (5.10 18.20) 197.06 (100 604) 39.13 (20 98) 209.63 (39 3380) 9.28 (4 20.3) 220.76 (190 1936) 41.42 (30 216) 222.68 (90 4611) P = 0.0001 P = 0.0001 NS P = 0.0001

Prezena hipercolesterolemiei (colesterol total > 200 mg/dl) a fost la pacienii cu DZ tip 1 de 23.5% i la DZ tip 2 de 41,6 %. S-a gsit corelaie semnificativ statistic ntre valoarea colesterolului, IMC (rs1 = 0.229, rs2 = 0.073) i glicemie (rs1=0.215, rs2=0.100). Hipertrigliceridemia ( TG>150 mg/dl ) a fost prezent la 23% din pacienii cu DZ tip 1 i la 45.2% din pacienii cu DZ tip 2. La ambele loturi, valorile TG au fost corelate direct cu valorile IMC (rs1=0.515, rs2=0.179) i ale glicemiei (rs1=0.242, rs2=0.174), doar la pacienii cu DZ tip 2 acestea fiind corelate i cu valorile HbA1c (rs2 = 0.105). Semnificativ statistic, s-a ntlnit corelaie negativ la HDLc, unde la femeile cu DZ tip 1 HDLc a fost corelat invers proporional cu valorile IMC (rs1=0.529) i HbA1c (rs1=0.414), iar la femeile cu DZ tip 2, HDLc a fost corelat invers proporional cu valorile HbA1c (rs2=-0.121) i ale glicemiei (rs2=-0.115). La pacienii de sex masculin, HDLc a fost corelat invers proporional cu valorile IMC, att la cei cu DZ tip 1 (rs1=-0.326), ct i la cei cu DZ tip 2 (rs2=- 0.087) unde a fost corelat i cu valorile HbA1c (rs2=-0.160). Concluzii: La pacienii nou diagnosticai cu DZ tip 2, factorii de risc pentru bolile cardiovasculare ca: dislipidemia cu hipercolesterolemie i/sau hipertrigliceridemie, au fost mai frecvent prezente dect la pacienii cu DZ tip1 (p=0.0001), deoarece pacientii cu DZ tip 2 sunt mai in varsta si cu comorbiditati ( obezitate, HTA, IMA,, BCI, insulinoresistenta) .

LIPID PROFILE AT NEWLY DIAGNOSED T1DM AND T2DM, COHORT(2007) Daniela Licroiu, Elena Ungurau, Alexandra Secrieru, C. Ionescu Trgovite (National Institute of Diabetes, Nutrition and Metabolic Diseases N.C. Paulescu, Bucharest, Romania Background and Aims: To analyze lipid profile at newly diagnosed T1DM and T2DM and the correlation of the lipid profile with fasting blood glucose, HbA1C and BMI. Material and Methods: A cohort of 2787 diabetic patients was analyzed between January December, 2007 in Bucharest: 1389 (49.8 %) man, 1398 (50.2 %) woman 58

average age was 56, 82 years; BMI average was 29, 9Kg/m2. The two groups 204 (7, 3%) T1DM, 117(57.4%) men and 87 (41.6%) women and 2583 (92.7%) T2DM, 1272 (49.2%) men and 1311 (50.8%) women, average age 58.86 were studied depending on T1DM and T2DM.The following parameters were recorded: age, sex, BMI, fasting blood glucose, HbA1C, cholesterol, triglycerides, HDLc. The statistic program was SPSS 15.0; we used 2, Mann-Whitney, Kruskal Wallis, Spearman coefficient, with statistical significant p 0.05. Results: T1DM Parameters Mean (min max) 22.32 (13.5 39.45) 275.11 (43 990) 11.93 (5.10 18.20) 197.06 (100 604) 39.13 (20 98) 209.63 (39 3380) T2DM Mean (min max) 30.30 (15.62 55.86) 223.54 (120 1332) 9.28 (4 20.3) 220.76 (190 1936) 41.42 (30 216) 222.68 (90 4611) P for difference between T1 and T2 P = 0.0001 P = 0.0001 P = 0.0001 P = 0.0001 NS P = 0.0001

BMI (kg/m2) Fasting blood glucose (mg/dl) HbA1c (%) Cholesterol (mg/dl) HDL-c (mg/dl) Triglycerides

Hypercholesterolemia (cholesterol>200mg/dl) was presented in 23.5% patients with T1DM and 41.6% patients with T2DM. We found a positive correlation between the following parameters: total cholesterol and BMI and fasting blood glucose with total cholesterol. Hypertriglyceridemia (triglyceride>150mg/dl) was present in 23% patients with T1DM and 45.2% patients with T2DM. In both groups was positive correlation between TG level, BMI and glycemia, at T2DM was correlated also with HbA1C. In T1DM female patients, there was significant negative correlation with HDLc and inversely proportional with BMI, HbA1c and glycemia. In male patients, HDLc was correlated inversely proportional with BMI in T1DM and in T2DM patients. HDLc also correlated with HbA1C. Conclusions: In newly diagnosed T2DM patients, risk factors for cardiovascular diseases such as dyslipidemia with hypercholesterolemia +/- hypertriglyceridemia were more frequently present than in T1DM patients (p=0.0001) because T2DM patients are older

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with more co morbidities (obesity, hypertension, heart attack, cardiovascular diseases, insulin resistance).

COMPLICATIILE CRONICE ALE DZ TIP 1 SI 2 NOU DESCOPERIT COHORTA 2007 Daniela Licaroiu, Elena Ungurasu, Luminita Dospinoiu, Corina Nedelcu, C. Ionescu-Trgoviste INDNBM N.Paulescu, Bucuresti

Scop : De obicei la descoperire diabetul este asimptomatic, dar cteodata pot fi prezente complicaii micro i macrovasculare. Scopul acestui studiu a fost s evalueze prevalena complicaiilor cronice la pacienii cu DZ nou descoperit n 2007, nregistrai n INDNBM N. Paulescu. Materiale i metode: In studiu au fost nrolai 2787 de pacieni nou diagnosticai cu DZ n perioada ianuarie decembrie 2007: 1389 (49.8%) brbai i 1398 (50.2 %) femei, cu vrsta medie de 56.82 ani (limite ntre 4 i 87 ani), i un IMC mediu de 29.9Kg/m2 (limite ntre 13 si 56 kg/m2). Cele 2 loturi au fost studiate n funcie de tipul DZ: 204 pacieni (7.3%) cu DZ tip 1, barbati 117 (57.4%) si 87 (42.6%) femei i respectiv 2583 pacieni (92.7%) cu DZ tip 2, 1272 (49.2%) barbati si 1311 (50.8%) femei; prezena/absena complicaiilor diabetului. Datele folosite n studiu provin din fiele CAD ale pacienilor, prelucrarea lor statistic realizndu-se cu ajutorul softului SPSS 15.0, semnificaia statistic a diferenelor dintre cele dou loturi realizndu-se pe baza testului Chi-patrat pentru un prag de semnificaie p 0.05.

Rezultate : Nr. Total pacieni Complicaii microvasculare Complicaii macrovasculare IMA 1 (0.1%) 53 (1.8%) 54 AVC 1 (0.1%) 97 (3.4%) 98

Retinopatie Neuropatie Arteriopatie T1DM T2DM Total 204 (7,3%) 2583 (92.7) 2787 3 (0.1%) 50 (1.8%) 53 (1.9%) 9 (0.2%) 137 (5%) 146 (5.2%) 4 (0.1%) 92 (3.3%) 96 (3.4%)

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(100%)

(1.9%)

(3.5%)

Majoritatea pacienilor 2370 (84,1%), din care 187 (5,8%) cu DZ tip 1 i 2183 (78.3%) cu DZ tip 2, nu au prezentat complicaii, acestea fiind evideniate numai la 417 pacieni (15,9%), din care 17 pacieni (0,6%) cu DZ tip I si 400 pacieni cu DZ tip 2 (15,3%).

Concluzii : Pacienii nou diagnosticai cu DZ tip 1 i DZ tip 2 cel mai frecvent nu au complicaii, dar sunt mai frecvente la pacientii cu DZ tip 2, datorita factorilor de risc vasculari prezenti, cum ar fi: HTA, dislipidemia, hiperinsulinismul, obezitatea. Cel mai frecvent complicaiile macrovasculare afecteaza un singur teritoriu vascular, acesta fiind fie teritoriul cerebral, fie cel periferic, aceste teritorii fiind de aproximativ 4 ori mai frecvent afectate dect teritoriul coronarian. La pacienii cu complicaii microvasculare, neuropatia este mai frecvent dect retinopatia (p = 0.0001). Complicaiile cronice ale diabetului nou descoperit sunt mai frecvente la DZ tip 2 fa de DZ tip 1 datorita perioadei mai mari de prediagnostic (p= 0.038).

CHRONIC COMPLICATIONS AT NEWLY DIAGNOSED T1DM AND T2DM, COHORT 2007 Daniela Licaroiu, Elena Ungurasu, Luminita Dospinoiu, Corina Nedelcu, C. Ionescu-Trgoviste National Institute of Diabetes, Nutrition and Metabolic Diseases N.C. Paulescu, Bucharest, Romania

Background and Aims: Diabetes mellitus usually is asymptomatic at diagnosed, but sometimes micro- and macrovascular complications might be present. The aim of this study was to evaluate the prevalence of chronic diabetes complications in newly diagnosed diabetic patients registered in the outpatient Department of Institute N. Paulescu in 2007. Material and Methods: A cohort of 2787 diabetic patients was analyzed between January December, 2007 in Bucharest: 1389 (49.8 %) man, 1398 (50.2 %) woman average age was 56, 82 years; BMI average was 29, 9Kg/m2. The two groups 204 (7, 3%) T1DM, 117 (57.4%) man and 87 (41.6%) woman, 2583 (92.7%) T2DM 1272 (49.2%) man and 1311 (50.8%) woman were studied depending on present/absent off diabetic complications. The statistic program was SPSS 15.0; we used Chi-Square tests with statistical significant p 0.05.

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Results: Total patient s Microvascular complications Retinopath y 3 (0.1%) 50 (1.8%) 53 (1.9%) Neuropath y 9 (0.2%) 137 (5%) 146 (5.2%) Macrovascular complications Miocardica l infarction 1 (0.1%) 53 (1.8%) 54 (1.9%)

Arteriopathy 4 (0.1%) 92 (3.3%) 96 (3.4%)

Stroke 1 (0.1%) 97 (3.4%) 98 (3.5%)

T1DM T2DM Total

204 (7,3%) 2583 (92.7) 2787 (100%)

Most patients 2370 (84.1 %) had no complications: 187 (6.7%) T1DM and 2183 (78.3%) T2DM, only 417 patients (15.9 %) had complications, from which 17 patients T1DM (0. 6 %) and 400 patients T2DM (15.3%). Conclusions: Obviously at diagnosis T1DM patients and T2DM patients are mostly free of complications, but if they have it, the most common ones are macrovascular complications in T2DM patients due to the presence of additional vascular risk factors as: hypertension, dyslipidemia, hyperinsulinism, obesity. Most frequent diabetic macrovascular complications affects only one vascular territory, this is the cerebral territory or peripheral territories, affected 4 times more frequent than coronaries territory (p = 0.0001). The lower frequencies of cardiac lesions are probably due to different diagnosis criteria. In patients with microvascular complications neuropathy is more frequent then retinopathy (p= 0.0001). Newly diagnosed chronic complications are higher in T2DM than in T1DM patients (p = 0.038) due to a longer pre diagnosis period.

PREVALENTA COMPLICATIILOR MICROVASCULARE LA PACIENTII CU DZ TIP 1 SI TIP 2 CU SINDROM METABOLIC Dovan D, Institutul de Diabet, Nutritie si Boli MetaboliceProf. N.C. PaulescuBucuresti, Romania

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Introducere : Sindromul metabolic reprezinta un important factor de risc pentru diabet zaharat tip 2, putine date exista insa, despre importanta acestuia la pacientii cu diabet zaharat tip 1. Obiective : Evaluarea prevalentei complicatiilor microvasculare la pacientii cu diabet zaharat tip 1(DZ1) si tip 2(DZ2) cu sindrom metabolic(SM). Material si metoda : Au fost inclusi in studiu 1429 pacienti, internati in perioada 01.01.2006-31.12.2006 la IDNBM N.Paulescu,dintre care 270 cu DZ1 (136 barbati, 134 femei, varsta medie 42,5414,36 ani), iar 1159 cu DZ2 (518 barbati, 641 femei, varsta medie 60,1710,48 ani). SM a fost prezent la 50 (18,51%) dintre pacientii cu DZ1, respectiv 970 (83,69%) dintre cei cu DZ2, restul pacientilor nu au intrunit criteriile de diagnostic . S-au analizat urmatorii parametri prezenti in fisele de observatie ale pacientilor : varsta, sex, talie, HbA1c, istoric de HTA, colesterol total (CT), HDL, LDL, trigliceride (TG), raport TG/HDL, complicatii microvasculare: neuropatie diabetica (neuropatie diabetica senzitiva periferica, neuropatie vegetativa), retinopatie diabetica (retinopatie diabetica proliferativa, retinopatie diabetica neproliferativa). SM a fost definit conform criteriilor IDF. La pacientii cu DZ tip 1, glicemia nu a constituit citeriu de diagnostic. Rezultate : Pacientii cu DZ1 si SM, fata de cei cu DZ2 si SM au avut valori medii ale varstei semnificativ mai mici (49.1613.24vs.60.2510.33, p<0.001) si ale vechimii bolii semnificativ mai mari (12.589.63vs.9.398.21, p<0.01), relatii ce s-au mentinut si atunci cand s-a efectuat diferentierea pe sexe . De asemenea, pacientii cu DZ1 si SM au avut fata de cei cu DZ2 si SM un nivel semnificativ mai mare al HbA1c (10.522.23 vs.9.512.40, p<0.01), relatie ce s-a pastrat doar la barbati (10.752.76vs.9.062.43, p<0.01) atunci cand s-au analizat diferentele barbati-femei. Au existat diferente semnificativ statistic in lotul cu DZ1 si SM fata de lotul cu DZ2 si SM in ceea ce priveste prevalenta neuropatiei vegetative (OR 3.27; 95%CI:1.39-7.67), retinopatiei diabetice (OR 2.39; 95%CI:1.35-4.23) si retinopatiei diabetice neproliferative (OR 2.26;95%CI:1.254.08), diferente ce s-au mentinut pentru retinopatia diabetica (OR 3.08;95%CI:1.47-6.46) si retinopatia diabetica neproliferativa (OR 2.71;95%CI:1.27-5.80) doar la femei atunci cand s-a efectuat analiza pe sexe. Pacientii cu DZ1 si SM au avut fata de cei fara SM o prevalenta semnificativ mai mare a retinopatiei diabetice (OR 2.03; 95% CI: 1.09-3.78), fara diferente semnificative in ceea ce priveste neuropatia diabetica. La pacientii cu DZ2 si SM fata de cei fara SM nu au existat diferente semnificativ statistic in ceea ce priveste complicatiile microvasculare.In urma analizei tertilelor de distributie ale HbA1c si raportului TG/HDL nu au existat diferente semnificativ statistic intre pacientii cu DZ tip 1 si tip 2 din tertila superioara de distributie comparativ cu cei din tertila inferioara.In urma analizei tertilelor de distributie ale taliei, pacientii cu DZ1 din tertila superioara comparativ cu cei din tertila inferioara au avut o prevalenta mai mare a retinopatiei diabetice (OR 2.72; 95% CI: 1.07-6.90), fara diferente la pacientii cu DZ2. Concluzii: Sindromul metabolic reprezinta un factor de risc pentru afectarea microvasculara la pacientii DZ tip1.

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THE PREVALENCE OF MICROVASCULAR COMPLICATIONS IN TYPE I AND TYPE II DIABETES PATIENTS WITH METABOLIC SYNDROME Dovan D., Popescu L.D., Ionescu I., Lichiardopol R. Clinic of Diabetes, Nutrition and Metabolic Diseases, N.C. Paulescu Institute, Bucharest, Romania

Introduction: The metabolic syndrome is an important cardiovascular risk factor for type 2 diabetes mellitus (DM2), there are though few data regarding its importance in type I diabetes mellitus patients (DM1). Aim: The evaluation of microvascular complications in DM1 and DM2 patients with metabolic syndrome (SM). Methods: In the study there were included 1429 patients, which were admitted in 2006 in the diabetes department of the institute., of which 270 with DM1 (136 men, 134 women, mean age 42.54+14.36 years) and 1159 with DM2 (518 men, 641 women, mean age 60.17+10.48). SM was present in 50 (18.51%) of the DM1 patients, respectively 970 (83.69%) of the DM2 patients, the rest of the patients not meeting the diagnostic criteria. The following parameters in the patients file were analyzed: age, sex, waist circumference, hypertension history, HbA1c, total cholesterol (CT), HDL cholesterol (HDL), LDL cholesterol (LDL), triglycerides (TG), triglyceride/HDL cholesterol ratio, presence of microvascular complications: diabetic neuropathy, (peripheral diabetic neuropathy, autonomic neuropathy), diabetic retinopathy, (proliferating diabetic retinopathy, non-proliferating diabetic neuropathy). SM was defined according to the IDF criteria. In DM1 patients, glucose blood level was not a diagnostic criterion. Results: Patients with DM1 and SM had lower mean age (49.1613.24vs.60.2510.33, p<0.001) compare to patients with DM2 and SM (p<0.001) and a significantly longer disease duration (12.589.63vs.9.398.21, p<0.01), relation that maintained in the sex difference also. Also patients with DM1 and SM had a significantly higher level of HbA1c (10.522.23 vs.9.512.40, p<0.01), compared to the patients with DM2 and SM , relationship that maintained only in men (10.752.76vs.9.062.43, p<0.01) when menwomen differences were analyzed. There were statistically significant differences regarding autonomic neuropathy (OR 3.27; 95%CI:1.39-7.67, p<0.01), diabetic retinopathy (OR 2.39; 95%CI:1.35-4.23, p<0.01) and non-proliferating diabetic retinopathy (OR 2.26;95%CI:1.25-4.08, p<0.01) between the patients with DM1 and SM compare with patients with DM2 and SM, difference that maintained for diabetic retinopathy (OR 3.08;95%CI:1.47-6.46, p<0.01) and non-proliferating diabetic retinopathy (OR 2.71;95%CI:1.27-5.80, p<0.01) only in women when sex differences were analyzed.

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Patients with DM1 and SM had a significantly higher prevalence of diabetic retinopathy (OR 2.03; 95% CI: 1.09-3.78) compared to the patients without SM, with no significant differences regarding diabetic neuropathy. In patients with DM2 and SM there were no statistically significant differences regarding microvascular complications compared to the patients with DM2 and without SM. There were not significant differences in microvascular complication prevalence across the tertiles of HbA1c and TG/HDL distribution. When analyzing waist distribution tertiles, patients with DM1 in the superior tertile had a higher prevalence of diabetic retinopathy (OR 2.72; 95% CI: 1.07-6.90) compared to the patients in the lower terile, with no differences in patients with DZ2. Conclusions: Metabolic syndrome represents a risk factor for microvascular complications in patients with DZ1.

PREVALENA COMPLICATIILOR MACROVASCULARE LA PACIENTII CU DIABET ZAHARAT TIP 1 CU VECHIME A BOLII DE PESTE 25 ANI Diana Clenciu1, Mihaela Vladu2, Sigina Gargavu1, Nicoleta Mitroi1, Eva Toma1, Maria Mota2
1 2

Spitalul Clinic Judetean de Urgenta Craiova Clinica Diabet Nutritie Boli Metabolice; UMF Craiova Departamentul de Diabet Nutritie Boli Metabolice

Scopul studiului: Evaluarea prevalentei complicatiilor macrovasculare la un lot de pacienti cu diabet zaharat tip 1 cu vechime a bolii de peste 25 ani Material si metoda: Lotul studiat a cuprins 44 pacienti cu DZ tip 1 cu vechime a bolii de peste 25 ani aflati in evidenta Centrului Clinic de Diabet Nutritie Boli Metabolice al Spitalului Clinic Judetean de Urgenta Craiova. Ca metoda de lucru am utilizat urmatoarele date anamnestice, clinice si paraclinice: vechimea diabetului, antecedente personale, tensiunea arteriala, palparea pulsului la nivelul arterelor pedioase, tibiale posterioare, poplitee, femurale; auscultatia vaselor de la baza gatului, glicemie, colesterol total, HDL-colesterol, LDL-colesterol, trigliceride, electrocardiograma, examen cardiologic, ecocardiografie si coronarografie la indicatia medicului cardiolog, Eco Doppler vascular periferic si vase baza gatului, examen neurologic, CT si RMN la recomandarea medicului neurolog. Rezultate: Din cei 44 pacieti, 14 (31,81%) au fost de sex feminin si 30 (68,19%) de sex masculin. Cu privire la varsta acestora, 2 pacienti (4,54%) se aflau in decada de varsta 30-40 ani, 12 pacienti (27,27%) in decada 41-50 ani, 15 pacienti (34,09%) in decada 5160 ani si 15 pacienti (34,09%) peste 60 ani. Studiind parametrul complicatii macrovasculare s-a remarcat o frecventa crescuta a arteriopatiei diabetice obliterante, 26 65

pacienti (59,09%), dar si a cardiopatiei ischemice cronice 16 pacienti (36,36%). Un numar de 14 pacienti (31,81%) prezentau atat arteriopatie diabetica obliteranta cat si cardiopatie ischemica cronica. Din pacientii luati in studiu 4 pacienti (9,09%) au prezentat accident vascular cerebral pe parcursul evolutiei DZ. Debutul arteriopatiei diabetice a fost inregistrat la 2 pacienti (7,69%) la mai putin de 5 ani de evolutie ai DZ, la 2 pacienti (7,69%) intre 5-10 ani, la 3 pacienti (11,53%) intre 11-15 ani, la 4 pacienti (15,38%) intre 16-20 ani, la 5 pacienti (19,23%) intre 21-25 ani si la 10 pacienti (38,46%) la mai mult de 25 ani de evolutie ai DZ. Dislipidemia a fost evidentiata la 32 pacienti (72,72%). Hipertensiunea arteriala s-a intalnit la 36 pacienti (81,81%). Dintre pacientii hipertensivi, 28 pacienti (77,77%) prezentau HTA si neuropatie, 27 pacienti (75%) prezentau HTA si retinopatie, 17 pacienti (47,22%) prezentau HTA si arteriopatie, 15 pacienti (41,67%) prezentau HTA si nefropatie, iar 13 pacienti (36,11%) prezentau atat HTA cat si neuropatie, retinopatie, arteriopatie si nefropatie. Concluzii: Se remarca o frecventa crescuta a complicatiilor macrovasculare dupa o evolutie de peste 25 de ani ai DZ tip 1, prevalenta complicatiilor creste paralel cu vechimea diabetului zaharat. Arteriopatia diabetica obliteranta a membrelor inferioare este cea mai frecventa complicatie macrovasculara, care poate sa apara precoce, dar a carei incidenta crescuta se inregistreaza dupa 25 ani de evolutie ai DZ tip 1. Cardiopatia ischemica cronica se identifica ca o complicatie macrovasculara frecventa comparativ cu accidentul vascular cerebral care s-a intalnit in procent mai mic. Dislipidemia si hipertensiunea arteriala sunt intalnite frecvent la pacientul cu diabet cu o vechime de peste 25 ani si se asociaza mai frecvent cu complicatiile diabetului .

THE PREVALENCE OF MACROVASCULAR COMPLICATIONS IN TYPE 1 DIABETES MELLITUS WITH DURATION OF DIABETES MORE THAN 25 YEARS Diana Clenciu1,, Sigina Gargavu1, Mihaela Vladu2, Nicoleta Mitroi1, Eva Toma1, Maria Mota2 ,
1

Clinic County Emergency Hospital Craiova, Diabetes Clinic; 2 UMF Craiova

Background: To analyze the frequency of macrovascular complications in patients with duration of T1DM more than 25 years. Material and method: We studied a group of 44 patients with duration of T1DM more than 25 years, hospitalized in the Clinic of Diabetes Nutrition & Metabolic Diseases (Clinic County Emergency Hospital Craiova). We analised history of disease, clinical and paraclinical dates: the duration of diabetes mellitus, personal history, blood pressure, palpation of pulse at the level of dorsal artery of foot, posterior tibial artery, popliteal artery and femoral artery, the vessels auscultation from the base of the neck, glycemia, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, ECG, cardiologic 66

examination, ecocardiography and coronarography at the indication of the cardiologist, vascular Eco Doppler, neurologic examination, CT and NMR at the indication of the neurologist. Results and discussions: From the 44 patients included in the study, 14 patients (31,81%) were female and 30 patients (68,19) male. Concerning the age of patients, 2 patients (4,54%) were between 30-40 years, 12 patients (27,27%) were between 41-50 years, 15 (34,09%) patients were between 51-60 years and 15 patients (34,09%) over 60 years. Regarding macrovascular complications, 26 patients (59,09%) presented peripheral arterial disease and 16 patients (36,36%) presented ischemic heart disease. From the patients included in the study 4 patients (9,09%) presented stroke. Diabetic arteriopathy developed before 5 years of evolution in 2 patients (7,69%), between 5-10 years at 2 patients (7,69%), between 11-15 years at 3 patients (11,53%), between 16-20 ani in 4 patients (15,38%), between 21-25 years in 5 patients (19,23%) and 10 patients (38,46%) presented the developement of diabetic arteriopathy after 25 years of evolution. 32 patients (72,72%) had dyslipidaemia and 36 patients (81,81%) suffered of arterial hypertension. From hypertensive patients, 28 patients (77,77%) presented after 25 years arterial hypertension and diabetic neuropathy, 27 patients (75%) arterial hypertension and diabetic retinopathy, 17 patients arterial hypertension and diabetic arteriopathy, 15 patients arterial hypertension and diabetic nefropathy and 13 patients (36,11%) presented arterial hypertension, neuropathy, retinopathy, arteriopathy and nefropathy. Conclusions: This study showed that macrovascular complications appered with a big frequence after 25 years of evolution, the complications prevalence grows with the oldness of diabetes mellitus. Peripheral arterial disease is the most frequent macrovascular complication which can earlier appears, but its highest incidence is also after 25 years of duration of diabetes. Ischemic heart disease is more frequent than stroke, which was met in a smaller percentage. Also, dyslipidaemia and arterial hypertension are frequently met after 25 years of diabetes and they are associated frequently with diabetes complications.

EPIDIAB IN MUNICIPIUL CHISINAU: REZULTATELE PRIMELOR 9 LUNI. Elena Mornealo, Natalia Baltag, Olga Baranov, Silvia Bodean, Angela Dmitriev, Dorina Caraman, Chisinau.

Introducere: Diabetul zaharat este unanim acceptat ca o problema medico-sociala de extrema actualitate, prezentind o extindere epidemiologica in intreaga lume. Impactul negativ al bolii este conditionat in mare parte de dezvoltarea complicatiilor grave

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invalidizante, precum si de cresterea majora a riscului cardiovascular. Datorita unei perioade lungi de hiperglicemie asimptomatica, complicatiile cronice frecvent sunt prezente deja la momentul diagnosticarii diabetului. Din toate acestea reesa necesitatea unei abordari specifice a persoanelor cu diabet zaharat nou depistat. Obiectiv: Analiza epidemiologica a cazurilor noi de diabet zaharat, inregistrate in perioada ianuarie-septembrie 2008 in municipiul Chisinau, determinarea prezentei complicatiilor si a comorbiditatilor la momentul depistarii, evaluarea optiunillor terapeutice initiale si a calitatii ingrijirii persoanelor cu diabet zaharat nou depistat. Material si metode: S-au luat in studiu 507 cazuri de diabet zaharat nou depistat in perioada ianuarie-septembrie 2008, la care au fost analizate: aspectele epidemiologice legate de tipul de diabet, sex, varsta; datele antropometrice; screening-ul complicaiilor cronice; asocierea cu alte entitati ale sindromului metabolic si bolii cardiovasculare; structura terapeutica. Rezultate: Lotul de studiu a cuprins 507 de persone, dintre care 489 au prezentat diabet tip 2; repartitia pe sexe a fost aproape identica, raportul barbati:femei constituind 1:1,08. Varsta medie la momentul diagnosticarii a pacientilor cu tip1 de diabet 29,40 ani, tip 2 58,72 ani. Doar 14% din persoane cu tip 2 de diabet sunt normoponderale, 45,6% prezinta suprapondere si 40,2% obezitate. 69,3% din persoane au talia peste 80 cm la femei sau peste 94 cm la brbati. Prevalenta altor factori de risc cardio-vasculari este: hipertensiunea arteriala 63,8%, dislipidemia 62,7%. Un anumit numar de persoane au fost diagnosticate cu patologia cardio-vasculara deja la momentul depistarii diabetului: 5,53% au prezentat cardiopatie ischemica, 1,95% - boala cerebrovasculara, 3,25% -arteriopatie periferica, 2,28% - infarct miocardic. Screening-ul si diagnosticul complicatiilor microvasculare specifice releva: 42,3% din persoanele nou depistate cu diabet au fost scrinate pentru decelarea retinopatiei diabetice si la 20,7% a fost confirmata prezenta acestei complicatii la momentul diagnosticului.. Screening-ul pentru nefropatie diabetica s-a efectuat doar la 13,6 % din pacienti, 9,5% din cei examinati prezentind un grad de nefropatie. Screening-ul pentru polineuropatie diabetica si picior diabetic s-a efectuat la 41,36% din nou depistati, procentul celor diagnosticati pozitiv fiind de 24,4%. Consideram importanta analiza modului in care a fost depistata prezenta diabetului: doar 9,52% s-au adresat de sine statator cu careva acuze, la majoritatea 57,47% - hiperglicemia a fost descoperita in procesul examinarii cu ocazia altei patologii si inca 33,10% dintre persoane au fost diagnosticate in mod activ. Structura terapeutica in diabet zaharat nou depistat a fost urmatoarea: 14,98% numai optimizarea stilului de viata, 6,51% sulfonilureice, 56,67% - biguanide, 4,56% asociere sulfonilureice cu metformin, 10,09% insulina, 2,28 % asociere insulina cu metformin, 4,88% alte clase. Concluzii: Magnitudinea problemei diabetului zaharat este prezentata nu doar de prevalenta si incidenta crescute a bolii per se, ci si de asocierea sa cu obezitatea si factori de risc cardio-vasculari, in particular dislipidemie si hipertensiunea arteriala. Adresabilitatea foarte joasa justifica aplicarea examinarilor active pentru depistarea precoce a patologiei. Exista limite in examinarea persoanelor nou diagnosticate, in depistarea complicatiilor, conditionate in mare parte de deficiente organizatorice si de 68

costuri. Se impune necesitatea acuta elaborarii si implemintarii unor programe nationale, care vor contribui la ameliorarea calitatii ingrijirii persoanelor cu diabet zaharat.

EPIDIAB IN CHISINAU: RESULTS FROM THE FIRST 9 MONTHS. Elena Mornealo, Natalia Baltag, Olga Baranov, Silvia Bodean, Angela Dmitriev, Dorina Caraman, Chisinau.

Introduction: Diabetes mellitus is universally accepted as a medical and social problem of extreme relevance, presenting epidemiological extension (spread) in the whole world. The negative influence (impact) of the disease is caused in major portion by the development of severe complications and by the great increase of the cardiovascular risk as well. Because of the long period of asymptomatic hyperglycemia, the chronic complications are present frequently just at the moment of diagnosis. It follows that persons with new diagnosed diabetes need a specific management. Aim: epidemiological analysis of newly-diagnosed cases of diabetes mellitus that have been registered in Chisinau in the period January-September 2008, determination of the presence of complications and co morbidities at the time of diagnosis, evaluation of the therapeutic options and the quality of care. Material and method: Study involved 507 cases of newly-diagnosed diabetes in period January-September 2008, which were analyzed in the following: epidemiological aspects such as type of diabetes, sex, age; anthropometric data, screening for chronic complications, association with others features of metabolic syndrome; therapeutic structure. Results: from the 507 examined persons 489 presented type 2 diabetes; the distribution on sexes was nearly identical, ratio men: women being 1:1,08. The medium age at the moment of diabetes identification was 29,40 years for type 1 and 58,72 for type 2. Only 14% of type 2 newly-diagnosed diabetes have normal weight, 45,6% overweight and 40,2% obesity, though the share of abdominal obesity constitute 69,3%. The prevalence of other the cardiovascular risk factors is: hypertension 63,8%, dyslipidemia 62,7%. A certain number patients have been diagnosed with cardiovascular diseases already at the moment of diabetes identification: 5,53% presented ischemic cardiac disease, 1,95% cerebrovascular accident, 3,25% peripheral vascular disease, 2,28% myocardial infarction. Screening and diagnose of microvascular specific complications reveals: 42,3% of newly-diagnosed persons was screened for diabetic retinopathy and in 20,7% cases the presence of this was confirmed; screening for nephropathy was performed only in 13,6% of patients and 9,5% from examined had some grade of diabetic nephropathy; ; the screening for diabetic neuropathy and diabetic foot was done in 41,36%, the percentage of positives being 24,4%. Therapeutic structure of newly-diagnosed cases of diabetes was: lifestyle modification only in 14,36%, 56,67% - metformin, 6,51% 69

sulphonnylurea, 4,56% - sulphonnylurea plus metformin, 10,09% - insulin in monotherapy, 2,28% combination of insulin with metformin, 4,88% other therapies. Conclusions: The magnitude of diabetes mellitus problem is determined not only by high incidence and prevalence of the disease per se, but also by the association with obesity and cardiovascular risk factors, particularly dyslipidemia and hypertension. Low grade of addressability justifies active examinations for early identification of pathology. Certain limits exist in newly-diagnosed persons examination, in identification of complications, caused for the most part by organization deficient and costs. It is an acute necessity in elaboration and implementation of national programs, which will ameliorate the quality of diabetic patients care.

FICATUL GRAS NONALCOOLIC UN FACTOR DE RISC PENTRU BOALA RENALA CRONICA LA PACIENTUL DIABETIC F. Casoinic 1, Catalina Badau 2, D. Sampeleanu 1, D. Constantinescu 1, Luchiana Pruna 3 1. UMF Cluj Napoca. Spitalul Universitar CFR. Clinica Medicala IV 2. Insitutul Inimii Niculae Stancioiu, Cluj Napoca 3. Spitalul Judetean Baia Mare. Centrul deDiabet, Nutritie si Boli metabolice

Introducere si obiective La pacientii diabetici, studii observationale au sugerat faptul ca prezenta ficatului gras nonalcoholic (FGNA), poate creste riscul de microalbuminurie si astfel de boala cronica renala (BCR). Veriga patogenetica intre aceste doua conditii poate fii reprezentata de citokinele proinflamatorii secretate de ficat. Scopul studiului de fata consta din evaluarea prezentei microalbuminuriei la pacientii diabetici cu FGNA comparativ cu cei fara FGNA si corelarea acesteia cu markeri ai inflamatiei cum este proteina Creactiva cu sensibilitate inalta. Material si metoda Studiul a fost desfasurat pe un grup de 75 de pacienti diabetici cu FGNA diagnosticat ultrasonografic, la care s-au exclus consumul de alcool precum si alte cause de boala cronica hepatica, fumatul, hipertensiunea arteriala si boala renala preexistenta. Grupul de control a consistat din 70 de pacienti diabetici, fara dovezi ecografice de FGNA.. La toti pacientii s-au determinat parametrii antropometrici, glicemia a jeun, HbA1c, colesterolul total, LDL si HDL colesterolul, trigliceridele, transaminazele serice, hs PCR si microalbuminuria. Analiza statistica a fost efectuata cu SPSS11.0. O valoare a p<0,05 a fost considerata semnificativ statistica.

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Rezultate Microalbuminuria a fost a fost semnificativ mai frecventa la subiectii cu FGNA decat la grupul de control (12,7% vs 7,8%, p<0,05). Microalbuminuria s-a corelat pozitiv cu IMC, HbA1c, trigliceridele serice, hsCRP si respectiv negative cu nivele HDL la pacientii diabetici cu FGNA. Concluzii FGNA se coreleaza cu microalbuminuria- marker de boala cronica renala stadium precoce la pacientii diabetici. Aceasta pare a se datora unor nivele crescute de citokine proinflamatorii eliberate de ficat, cum este hsCRP. Pacientii diabetici cu FGNA au nivele semnificativ mai crescute ale HbA1c, relevand un control slab pe termen lung al valorilor glicemice.

NONALCOHOLIC FATTY LIVER DISEASE A RISK FACTOR FOR CHRONIC KIDNEY DISEASE IN DIABETIC PATIENTS F. Casoinic 1, Catalina Badau 2, D. Sampeleanu 1, D. Constantinescu 1, Luchiana Pruna 3 1. UMF Cluj Napoca. CFR University Hospital. IVth Medical Clinic 2. Heart Insitute Niculae Stancioiu, Cluj Napoca 3. County Hospital Baia Mare Diabetes departament

Background In diabetic patients observational studies have suggested that nonalcoholic fatty liver disease-NAFLD may increase the risk of microalbuminuria and thus that of chronic kidney disease (CKD). The pathogenetic link between these conditions could be proinflammatory cytokines secreted by the liver. The aim of our study was to assess the presence of microalbuminuria in diabetic subjects with nonalcoholic fatty liver disease (NAFLD) compared with diabetic patients without NAFLD and to correlate this with inflammatory markers such as high sensitive C- reactive protein (hsCRP). Material and methods The study was conducted on a group of 75 diabetic subjects with ultrasonographical NAFLD, in which alcohol consumption and other causes of chronic liver disease have been excluded. The exclusion criteria also included smoking, arterial hypertension, known renal disease. The control group consisted of 70 diabetic patients, matched for age and gender, without ultrasonographical evidence of NAFLD. In all subjects we measured height, weight, BMI, fasting glucose, HbA1c, total cholesterol, LDL and HDL cholesterol, triglycerides, serum transaminases, hsC-reactive 71

protein and microalbuminuria. Statistical analysis was performed using SPSS11.0. A pvalue<0,05 was considered statistically significant. Results Microalbuminuria was significantly more frequent in subjects with NAFLD than in controls (12,7% vs 7,8%, p<0,05). Microalbuminuria was positively correlated with waist to hip ratio, HbA1c levels, serum triglycerides, hsCRP levels and negatively correlated with HDL levels in subjects with NAFLD. Conclusion NAFLD is correlated with microalbuminuria- marker of early stage CKD, in diabetic patients. This seems to be related to higher levels of proinflammatory factors released by the liver, such as hsCRP. Diabetic patients with NAFLD had significantly higher levels of HbA1c, witnessing a poorer glycemic control.

IMPORTANTA DIETOTERAPIEI LA PACIENTII OBEZI CU DIABET ZAHARAT TIP II G Radulian,1,2, A.Dragomir,1,2, M Posea2 UMF Carol Davila, Bucuresti IDNBM N.Paulescu, Bucuresti

I. Scop: Dietoterapia si intensificarea efortului fizic sunt parte importanta in tratamentul diabetului zaharat tip 2. Acest studiu a fost conceput pentru a evalua eficacitatea unei diete hipoglucidice (45%), hipolipemiante (25%) si hiperproteice (30%) la pacientii obezi cu diabet zaharat tip 2. II. Material si metode: Un lot de 69 de pacienti diabetici , 33 barbati (47.8%) si 36 femei (52.2%), cu varsta medie de 51.3 8.7, in tratament cu antidiabetice orale, cu dislipidemie mixta si obezitate (IMC>30 kg/m2) au fost inclusi intr-un program bazat pe dieta hipoglucidica (45%), hipolipemianta (25%) si hiperproteica (30%) si exercitii fizice (3 ore/saptamana). Hb A1c, colesterolul total, trigliceridele, ureea, creatinina si greutatea fiecarui pacient au fost evaluate la inceput si la 3, si respectiv 6 luni. III.Rezultate: Greutatea medie la inceput a fost de 89,7 kg ( 72.5 121.5 kg ) iar la o luna, 3 si respectiv 6 luni s-a constatat o scadere in greutate de 3.3kg, 7.5kg, respectiv 9.1kg. Hb A1c medie a inregistrat valori initiale de 8.8% ( 6.6% -11.2% ) iar la evaluarile urmatoare a fost de 7.8%, respectiv 6.9%. Valorile colesterolului total au fost de 263 20.3 mg/dl iar la 3 si 6 luni au fost 249 21.5 mg/dl, respectiv 240 25.5 mg/dl. S-a 72

constatat o scadere a nivelului trigliceridelor de 26% dupa 6 luni. Nici un pacient nu a fost inclus in studiu daca functia renala, masurata prin uree si creatinina, era afectata. Clearence-ul la creatinina si microalbuminuria nu au fost modificate dupa 6 luni. IV. Concluzii: Dieta hipoglucidica, hipolipemianta si hiperproteica poate imbunatati controlul metabolic la pacientii obezi cu diabet zaharat tip 2. Dieta hiperproteica poate ajuta in pierderea greutatii si in obtinerea unui control glicemic mai bun, fara a avea efecte adverse asupra functiei renale. Acest tip de dieta poate fi o optiune de tratament la anumiti pacienti obezi cu diabet zaharat tip 2.

EFFICACY OF DIET CHANGES IN OBESE PATIENTS WITH TYPE 2 DIABETES Gabriela Radulian,1,2 A. Dragomir,1,2 M.Posea2 1 University of Medicine C. Davila Bucharest 2 Institute of Diabetes, Nutrition & Metabolic Disease, Bucharest.

I. Objective: Diet and exercise are considered important treatment strategies of type 2 diabetes. The objective of this study is to assess the efficacy of low carbohydrate (45%) and lipid (25% ), high protein ( 30% ) diet, as an alternative dietary treatment for obese patients with type 2 diabetes. II. Methods: A total of 69 obese patients with type 2 diabetes , 33 male ( 47,8% ) and 36 female ( 52,2% ), with a mean age of 51,3 8,7 years old, receiving oral hypoglicaemic agents, who had hypercholesterolemia ( total cholesterol > 200 mg/dl), hypertriglyceridemia and obesity ( BMI >30 kg/m2), were allocated to a low carbohydrate ( 45% ) and lipid ( 25% ), high protein ( 30% ) diet and each patient had 3 hour/week regular physical activity. Their HbA1c, cholesterol, triglycerides and weight loss were monitored at the start of the study and again at 3 and 6 months. III. Results: Mean weight at baseline was 89,7 kg ( 72,5 - 121,5 kg ) and weight loss at 1, 3 and 6 month respectively, were 3,3 kg, 7,5 kg, 9,1 kg. Mean HbA1c at baseline was 8,8% ( 6,6% -11,2% ) and mean results at 3 and 6 month were 7,8% and 6,9%. Mean total cholesterol at baseline was 263 20,3 mg/dl and at 3 and 6 month was 249 21,5 mg/dl, respectively 240 25,5 mg/dl . Triglyceridemia decreased with 26% after 6 month. Renal function as measured by serum creatinine and urea was assessed at the start of study, no patient with renal impairment was commenced on the diet. Urinary microalbumin and creatinine clearence were not different after 6 month.

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IV. Conclusions: A low carbohydrate and lipid, high protein diet may help to improve the metabolic control in type 2 obese diabetic patients. A high protein diet can generate weight loss, a better glycaemic control, without adverse effects on the renal function. This type of diet have a place in management of obese - type 2 diabetes in selected patients.

EPIDIAB 2008 6 LUNI: 1 IANUARIE-30 IUNIE 2008 Spitalul Judetean Sf.Ioan cel Nou Suceava Secia Diabet- Nutriie-Boli Metabolice R.Caziuc, C.Lazr, V.Rcaru, G.Creeanu

Obiectiv: Evaluare incidenei diabetului zaharat nou diagnosticat (n cursul anului 2008) la Centrul Antidiabetic Judeean Suceava i analizarea prezenei complicaiilor la momentul diagnosticului. Material i metod: S-au luat n studiu un numr de 1468 cazuri noi cu diabet zaharat dintre care: -83 pacieni cu diabet zaharat insulinodependent. -1385 pacieni cu diabet zaharat tip II, la care au fost analizate datele antropometrice(nlime, greutate,perimetrul taliei), clinice(tensiune arterial sistolic i diastolic,examenul piciorului diabetic i chestionar DN4), paraclinice(glicemie,profil lipidic,examen de urin,creatinin) i examen oftalmologic. Rezultate: Distribuia pe sexe la pacienii cu diabet zaharat tip I a fost de 41% femei i 59% brbai,n timp ce la tipul II,procentul de femei a fost de 51%. 61% dintre pacienii cu diabet zaharat tip I erau din mediul urban, iar la tipul II procentul a fost de 84%. Pe grupe de vrst,situaia a fost urmtoarea: -la pacienii cu diabet zaharat tip I 74

-8,9% au avut vrsta sub 30 ani, 64% ntre 30-65 ani,27% peste 65 ani. -la pacienii cu diabet zaharat tip II -64% au avut vrsta intre 30-65 ani, 36% peste 65 ani. n privina indexului masei corporale,datele au fost: -Diabet zaharat tip I: -47% dintre pacieni cu IMC < 25; -30% dintre pacieni cu IMC =25-29; -23% dintre pacieni cu IMC > 30. -Diabet zaharat tip II: -18% dintre pacieni cu IMC < 25; -27% dintre pacieni cu IMC =25-29; -55% dintre pacieni cu IMC > 30. La msurarea talie, datele au fost: 64% dintre femeile cu diabet zaharat tip I au avut talia peste 80cm, n timp ce numai 22% dintre brbai au avut talia peste 94cm; la pacienii cu diabet zaharat tip II 66% dintre femei au avut talie peste 80cm, i respective 60% dintre brbai au msurat n talie peste 90cm. Complicaiile la momentul diagnosticului:
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24% dintre pacieni au fost hipertensivi; 22% cu valori patologice ale profilului lipidic; 0,8% cu diagnostic de retinopatie; 14% prezena neuropatiei diabetice; 0,9% prezena nefropatiei diabetice. Structura terapeutic a fost: -83 pacienti n tratament cu insulin; -21% dintre pacieni au primit numai recomandare de diet; -62% tratament cu Metformin; -2% au primit recomandarea de asociere a dou antidiabetice orale; -15 % pacieni in tratament cu sulfoniluree sau alte antidiabetice orale.

Concluzii: Numrul de pacieni cu diabet zaharat nou diagnosticat este semnificativ mai mare n urma depistrii active prin analizele recomandate de ctre medicii de

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familie,ridicndu-se n aceste condiii problema volumului de munc la nivelul Unitii Judeene, necesitatea educrii acestor pacieni, precum i monitorizarea acestora periodic.( innd cont de faptul c pacientul cu diabet zaharat tip II n tratament cu ADO nu beneficiaz de automonitorizare).

EPIDIAB 2008 6 MONTHS: JANUARY 1ST JUNE 30TH, 2008 R. Caziuc, C. Lazar, V. Racaru, G. Creteanu Sf. Ioan cel Nou Suceava County Hospital Department of Diabetes Nutrition Metabolic Diseases Objective: To assess the incidence of newly diagnosed diabetes mellitus (during year 2008) at the Suceava County Anti-Diabetic Centre and to analyze the presence of complications at the moment of diagnosis. Material and Method: There were studied 1468 new cases with diabetes mellitus among which: - 83 patients with insulin-dependent diabetes mellitus - 1385 patients with type 2 diabetes mellitus, in whose case there were analyzed the anthropometric data (height, weight, waist measurement), clinical data (systolic and diastolic arterial blood pressure, exam of the diabetic leg and questionnaire DN4), paraclinical data (blood glucose level, lipid profile, urine test, creatinine) and ophthalmologic exam. Results: The distribution according to sexes, at the patients with type 1 diabetes mellitus, was 41% women and 59% men, while at type 2, the percentage of women was 51%. 61% of the patients with type 1 diabetes mellitus came from the urban environment, and at type 2 the percentage was 84%. According to age groups, the situation was the following: - at the patients with type 1 diabetes mellitus - 8.9% were under 30 years old, 64% between 30-65 years old, 27% over 65 years old - at the patients with type 2 diabetes mellitus - 64% were between 30-65 years old, 36% over 65 years old. With respect to the body weight index, the data were: - Type 1 diabetes mellitus: - 47% of patients with body weight index < 25 - 30% of patients with body weight index = 25-29 - 23% of patients with body weight index > 30 - Type 2 diabetes mellitus: - 18% of patients with body weight index <25

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- 27% of patients with body weight index = 25-29 - 55% of patients with body weight index >30. In the case of waist measurement, the data were: 64% of women with type 1 diabetes mellitus had the waist over 80 cm, while only 22% of the men had the waist over 94 cm; at the patients with type 2 diabetes mellitus, 66% of women had the waist over 80 cm, and 60% of men measured in waist over 90 cm. Complications at the moment of diagnosis: - 24% of patients had high blood pressure; - 22% with pathologic values of the lipid profile; - 0.8% with diagnosis of retinopathy; - 14% with presence of diabetic neuropathy; - 0.9% with presence of diabetic nephropathy. The therapeutic structure was: - 83 patients in treatment with insulin; - 21% patients received only a diet recommendation; - 62% treatment with Metformin; - 2% received the recommendation to associate two oral anti-diabetic drugs; - 15% patients in treatment with sulfonylurea or other oral anti-diabetic drugs. Conclusions: The number of patients with newly diagnosed diabetes mellitus is significantly higher as a result of the active discovery through the tests recommended by the family physicians, in these conditions being raised the question of the work amount at the level of the County Unit, the necessity to educate these patients, as well as their periodical surveillance (taking into account the fact that the patient with type 2 diabetes mellitus in treatment with oral anti-diabetic drugs does not benefit from self-surveillance).

EVALUAREA RISCULUI DE DIABET NTR-UN GRUP POPULATIONAL DIN ROMANIA Gabriela Ghimpeteanu*, Andreea Tocan*, Mihaela Gribovschi*, Ramona Stefan*, Andreea Morosanu*, Dana Birsan*, M.S. Ghimpeteanu, Gabriela Roman*
*

Centrul Clinic de Diabet, Nutritie si Boli Metabolice Cluj-Napoca

Introducere: Prezenta unor factori de risc precum hipertensiunea arteriala, disglicemia, supraponderea/obezitatea asociate cu sedentarismul, obiceiurile alimentare nesanatoase si istoricul familial de diabet zaharat, are valoare predictiva pentru aparitia pe termen lung a diabetului zaharat in populatia generala. Material si metoda: Au fost inclusi 368 subiecti neselectati, fr diabet zaharat din 6 orase mari din Romania (Brasov, Buzau, Piatra Neamt, Arad, Sibiu, Tg. Mures) . Acestora li s-a aplicat un chestionar pentru evaluarea riscului de a dezvolta diabet zaharat in urmatorii 10 ani. Chestionarul a inclus date generale (varsta, sex, mediu) , date antropometrice (circumferinta abdominala, greutate, inaltime, IMC) precum si date 77

referitoare la nivelul de activitate fizica, obiceiuri alimentare, prezenta hipertensiunii arteriale, a disglicemiei si a agregarii familiale a diabetului zaharat. La finalul testului s-a calculat un scor de risc conform unui sistem de punctaj standardizat in cadrul studiului FINDRISK, in functie de care participantii au fost incardati in mai multe categorii de risc (scazut, usor crescut, moderat crescut, crescut si foarte crescut). Rezultate: Din cei 368 subiecti, 80,2% au fost femei si 19,8%brbati, 85,9 % au provenit din mediul urban si 14,1% din mediul rural. Din punct de vedere antropometric s-au obtinut urmatoarele rezultate: 40,2% au avut circumferinta abdominal (CA)<80cm la femei si <94cm la brbati, 17,7% au avut CA ntre 80-88cm la femei si intre 90-94 cm la brbati si 42,1 %au avut CA>88cm la femei si >102cm la barbati. Din punctul de vedere al indicelui de mas corporal (IMC), 47,83% din subiecti au fost normoponderali, 34,51% au fost supraponderali si 17,66% au fost obezi, pe sexe, repartitia fiind in procente relativ apropiate (normoponderali sex F- 48,5%, sex M-45,2%; supraponderalisex F-32,88% si sex M-41,1%; obezi-sex F-18,64% si sex M-13,7%). Dupa repartitia pe categorii de scor, s-au evidentiat urmatoarle rezultate: scor de risc <7 (risc sczut 1 subiect din 100 va dezvolta diabet in urmatorii 10 ani) -50,54%, respectiv 186 subiecti; scor 7-11(usor crescut, 1din 25): 27,71%-102 subiecti; scor 12-14(moderat crescut, 1 din 6): 14,67%-54 persoane; scor 15-20(risc crescut, 1 din 3): 6,25%-23persoane; scor >20(risc foarte crescut, 1 din 2): 0,81%-3 subiecti. Aproximativ 25% din subiecti au un stil de viata nesntos (sunt sedentari, nu consum zilnic fructe si legume proaspete) si au hipertensiune arteriala si/sau urmeaza tratament medicamentos pentru aceasta. Aproximativ 75% din participantii la studiu nu prezinta istoric familial de diabet zaharat, un sfert avnd rude cu diabet zaharat iar 15% au rude de gradul I cu diabet. Aproximativ 15% din participanti prezint valori ale glicemiei bazale peste 110mg/dl. La studiu au participat persoane din mai multe grupe de varst, jumatate fiind inclusi n categoria de varst sub 45 de ani. Discutii si concluzii: Jumatate 50,54% din lotul studiat a prezentat un risc scazut de aparitie a diabetului zaharat n urmtorii 10 ani, 43,2% au prezentat un risc intermediar, in timp ce doar 7,06% au fost identificati la risc crescut de a prezenta diabet zaharat tip 2 n urmtorii 10 ani. Lotul studiat a fost format preponderent din persoane tinere, active, sub 55 ani, din care in medie jumatate normoponderali si jumatate supraponderali si obezi cu predominanta net a sexului feminin. Chestionarul aplicat poate fi utilizat ca instrument de identificare a persoanelor cu risc crescut de a dezvolta diabet zaharat tip 2( mai ales pentru rudele pacientilor cu diabet zaharat), facnd posibil initierea precoce a OSV pentru a preveni/ntrzia aparitia bolii. Datele obtinute sunt asemntoare cu cele rezultate din analizele obligatorii cerute de Ministerului Sntii.

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DIABETES RISK ASSESSMENT WITHIN A ROMANIAN POPULATION GROUP Gabriela Ghimpeteanu*, Andreea Tocan*, Mihaela Gribovschi*, Ramona Stefan*, Andreea Morosanu*, Dana Birsan*, M.S. Ghimpeteanu, Gabriela Roman*

Introduction: The presence of risk factors such as hypertension, disglycemia, overweight/obesity, associated with sedentary lifestyle, unhealthy dietary habits and family history of diabetes, has predictive value for the long term development of diabetes within the general population. Material and method: 368 unselected subjects without diabetes from six Romanian cities (Brasov, Buzau, Piatra Neamt, Arad, Sibiu, Tg. Mures) were included. A questionnaire was applied to the study group in order to evaluate the risk of develping diabetes within the next ten years. The questionnaire included general data( age, sex, environment), anthropometric data (waist cirumference, weight, height, BMI), as well as data regarding physical activity, dietary habits, the presence of arterial hypertension, disglycemia and family history of diabetes. At the end of the test , a risc score was calculated, according to a standardized scoring system within the FINDRISK study, which divided the patients into a few risk categories (low, slightly elevated, moderate, high, very high). Results: From the 368 participants, 80,2% were women and 19,8% men, environment: 85,9 % urban and 14,1% rural, and from anthropometric point of view the following aspects were noticed: 40,2% had a waist circumference < 80cm in women and <94cm in men, 17,7% had a waist circumference 80-88cm in women and between 90-94 cm inmen and 42,1 % had a waist circumference >88cm in women and >102cm in men. As regarding the BMI, 47,83% of subjects had a normal weight, 34,51% were overweight and 17,66% were obese, sex repartition consisting of very close percents (normal weight females- 48,5%, males-45,2%; overweight- females -32,88% and males M-41,1%; obese: females-18,64% and males M-13,7%). The following risk categories came out when calculating risk scores: <7 (low risk- 1 subject in 100 will develop diabetes during the next 10years) -50,54%-186 subjects; score 7-11(slightly elevated, 1in 25): 27,71%-102 subjectsi; score 12-14(moderate, 1 in 6): 14,67%-54 persons; score 15-20 (high risk, 1 in 3): 6,25%-23persons; score >20 (very high risk, 1 din 2): 0,81%-3 subjects. On average, 25% have an unhealthy lifestyle ( sedentary, they dont eat fruits and vegetables daily), and they suffer from hypertension and/or they are under medication for this condition. 75% of the questioned dont have a family history of diabetes, 25% have relatives with diabetes of which, 15% first degree relatives. 15% of the study group have a fasting glycemia>110mg/dl. The study participants belong to different age groups, half of them being included in the < 45years. Discussion and conclusions: Half-50,54%fo the study group had a low risk of developing diabetes within the next 10 years, 43,2% had a moderate risk, while only 7,06% were identified as being at high risk. The study group consisted mainly of young,

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active subjects, below 55years of age, from which half having a normal weight and half overweight and obese, with the clear predominance of females. The questionnaire we applied could be used as an instrument of identifying people at increased risk of developing type 2 diabetes (especially realtives of people with diabetes), having the opportunity of an early initiation of lifestyle optimization, in order to prevent/delay the onset of this disease. The data we collected are much alike the ones published by the Ministery of Health from the compulsory investigationsprogramme.

NUTRIIA PACIENILOR CU DIABET ZAHARAT Conf. Dr. Gabriela Negrianu, UMF Victor Babe Timioara Dr. Raluca Memu, Spitalul Judeean Drobeta Turnu Severin

Introducere De-a lungul timpului, recomandrile alimentare pentru pacienii cu diabet zaharat (DZ) sau dovedit destul de restrictive n privina hidrailor de carbon (HC). Regimul alimentar (dieta) n DZ a trecut prin mai multe etape: restricia total a regimul bogat n lipide i legume, dieta convenional, hipoglucidic. Din 1980 s-a estimat c raia glucidic n DZ poate fi de 55-60% din necesarul caloric (NC), lipidele maxim 30%, iar proteinele maxim 20%. ADA subliniaz rolul individualizrii regimului alimentar prin aplicarea terapiei medicale nutriionale (medical nutritional therapy-MNT) Coninut Modificarea obiceiurilor alimentare joac un rol major n tratamentul i managementul DZ. Obiectivele MNT pentru pacienii cu DZ sunt: obinerea i meninerea glicemiei la niveluri normale/apropiate de normal, a profilului lipidic i lipoproteic ce asigur un risc cardiovascular redus, a TA la niveluri normale/apropiate de normal, prevenirea/ncetinirea ratei de dezvoltare a complicaiilor cronice ale DZ, asigurarea necesitilor nutriionale individuale. Obiectivele MNT pentru tinerii cu DZ 1, DZ 2, gravidele i femeile care alpteaz, vrstnicii cu DZ sunt asigurarea necesitilor nutriionale, iar pentru cei tratai cu insulin sau secretagoge, asigurarea autocontrolului i tratamentul DZ n bolile acute. Este ncurajat consumul de HC din fructe, cereale integrale, legume, leguminoase i produse lactate degresate. Trebuie limitat aportul de grsimi saturate la sub 7% din NC, cu evitarea consumului de grsimi trans cu un aport de colesterol alimentar sub 200mg/zi i consumul a cel puin 2 porii de pete sptmnal. Sunt dovezi insuficiente care s indice modificarea aportului proteic obinuit (15-20% din NC) la diabeticii cu funcie

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renala normal. Numeroase studii au ncercat s stabileasc proporia optim a macronutrienilor n dieta diabeticilor. Individualizarea compoziiei n macronutrieni se va realiza n funcie de statusul metabolic al pacientului. Aportul zilnic de alcool trebuie limitat la o cantitate moderat. Nu exist dovezi clare ale beneficiului suplimentrii cu vitamine i minerale la pacienii cu DZ care nu prezint deficite. Insulinoterapia trebuie integrat ntr-un plan individual de diet i activitate fizic. Pacienii cu DZ tip 2 sunt ncurajai s implementeze modificarea stilului de via. Pentru femeile gravide i cele care alpteaz cu DZ, trebuie asigurat aportul energetic adecvat care s asigure greutatea corporal corespunztoare. Vrstnicii obezi cu DZ pot avea unele beneficii n urma unei restricii calorice modeste i a creterii nivelului de activitate fizic. Se recomand reducerea aportului proteic la 0,8-1 g/kgc/zi la diabeticii care prezint stadii incipiente de boal cronic renal i la 0,8 g/kgc/zi la cei cu boal cronic renal. Pentru diabeticii cu risc cardiovascular, dietele bogate n fructe, legume, cereale integrale, oleaginoase pot reduce riscul cardiovascular. Tratamentul obinuit al hipoglicemiei este reprezentat de ingestia a 15-20 g de glucoz. Aplicarea terapiei medicale nutriionale presupune parcurgerea a 4 etape: evaluarea statusului iniial, stabilirea obiectivelor, intervenia nutriional, evaluarea periodic.

NUTRITION OF DIABETIC PATIENTS Ass. Prof. Dr. Gabriela Negrisanu, University of Medicine and Pharmacy Victor Babes, Timisoara Dr. Raluca Memu, County Hospital, Drobeta Turnu Severin

Introduction Nutritional recommendations for diabetic patients were restrictive regardless carbohydrates for a long time. The diet has passed some periods: total restrictive in carbohydrates, a diet rich in fat and legumes, conventional diet period. From 1980 was accepted that carbohydrate may represent 55-60% from caloric necessary, fat 30% or less and protein 20% or less. ADA pointed out the role of individualization of the diet and the role of medical nutritional therapy-MNT. Content Dietary habits modification plays an important role in treatment and management of diabetes mellitus.Goals of MNT that apply to individuals with diabetes are: achieve and maintain blood glucose levels in the normal range, lipid and lipoprotein profile that reduces the risk for vascular disease, blood pressure levels in the normal range, to prevent/slow the rate of development of the chronic complications of diabetes. Goals of MNT that apply to youth with diabetes, pregnant and lactating women, and older adults 81

with diabetes are: to meet the nutritional needs and for individuals treated with insulin or insulin secretagogues, to provide self-management training and diabetes treatment during acute illness. In diabetes management, are recommended carbohydrate from fruits, vegetables, whole grains, legumes, and low-fat milk, to limit saturated fat intake to 0.7% of total calories, to minimized intake of trans fat, to limit dietary cholesterol to 0.200 mg/day. For individuals with diabetes and normal renal function, there is insufficient evidence to suggest that usual protein intake (1520% of energy) should be modified. Numerous studies have attempted to identify the optimal mix of macronutrients for the diabetic diet. The best mix of carbohydrate, protein, and fat appears to vary depending on individual circumstances. Individualization of the macronutrient composition will depend on the metabolic status of the patient. Alcohol daily intake should be limited to moderate amount. There is no clear evidence of benefit from vitamin or mineral supplementation in people with diabetes who do not have underlying deficiencies. Insulin therapy should be integrated into an individuals dietary and physical activity pattern. Individuals with type 2 diabetes are encouraged to implement lifestyle modifications. For pregnancy and lactation with diabetes adequate energy intake that provides appropriate weight gain is recommended. Obese older adults with diabetes may benefit from modest energy restriction and an increase in physical activity. Reduction of protein intake to 0.81.0 g/kg body wt/day in individuals with diabetes and the earlier stages of chronic kidney disease (CKD) and to 0.8 g/kg body wt/day in the later stages of CKD may improve measures of renal function and is recommended. For patients with diabetes at risk for CVD, diets high in fruits, vegetables, whole grains, and nuts may reduce the risk. Ingestion of 1520 g glucose is the preferred treatment for hypoglycemia. For the implementation of MNT it is necessary to run through 4 steps: evaluation of initial status, establishment of the goals, nutritional intervention, periodical evaluation.

FACTORII DE RISC CARDIOVASCULAR I STAREA POSTPRANDIAL N DIABETUL ZAHARAT TIP 2 Gabriela Roman1,2, Andreea Moroanu2, Delia Roman2, Mariana Coca2, N. Hncu1,2
1

Universitatea Iuliu Haieganu; 2Centrul Clinic de Diabet, Nutriie, Boli metabolice, Cluj-Napoca

Background. Factorii de risc cardiovascular se asociaz prin mecanisme etioptaogenice interdependente n cadrul sindromului metabolic i al diabetului zaharat tip 2. Statusul postprandial este considerat un important factor de risc cardiometabolic, prin

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hiperglicemie, hiperlipidemie, inflamaie, adipokine aterogene. Obiectiv. Studiul de fa a avut ca obiectiv evaluarea implicrii adiponectinei, visfatinei i a markerilor inflamatori n statusul postprandial n dibetul zaharat tip 2. Design i metode. n studiu au fost incluse 40 persoane cu DZ tip 2 i obezitate i 5 persoane normoponderale fr diabet ca i control. Probele biochimice au fost prelevate n condiii bazale, la 2 i 4 ore postprandial: glicemia, lipide, adiponectin, visfatin, TNF-alpha, interleukin-6, high sensitive C-Reactive protein, fibrinogen. Resultate. n condiii bazale au fost evideniate diferene semnificative ntre lotul de personae cu diabet zaharat i lotul de control n ce privete visfatina (26 18,3 vs. 12.5 3 ng/ml; p = 0.02) i high sensitive C-Reactive protein (4.7 3.7 vs. 0.38 0.35 mg/L; p=0.001). n statusul postprandial, o cretere semnificativ a fost observat n cazul visfatinei (p=0.03), interleukinei-6 (p=0.012) i high sensitive C-Reactive protein (p=0.017). n cadrul grupului cu diabet zaharat, la 2 ore postprandial s-a constatat o cretere semnificativ a glicemiei i la 4 ore postprandial a TNF-alpha i C-Reactive protein. Concluzii. Creteri semnificative la persoanele cu diabet zaharat tip 2 comparativ cu lotul de control au fost constatate n cazul visfatinei i high sensitive C-Reactive protein. Adiponectina a fost sczut la cei cu diabet zaharat, fr diferen semnificativ cu lotul de control. n grupul cu diabet, TNF-alpha, CReactive protein i glicemia au fost crescute postprandial, ceea ce demonstreaz c n diabetul zaharat tip 2 acioneaz multiplii factori de risc cardiovascular. Keywords: risc cardiometabolic, adiponectin, visfatin, status postprandial

CARDIOVASCULAR RISK FACTORS AND POSTPRANDIAL STATUS IN TYPE 2 DIABETES MELLITUS Gabriela Roman1,2, Andreea Moroanu2, Delia Roman2, Mariana Coca2, N. Hncu1,2
1

Iuliu Hatieganu University of Medicine and Pharmacy; 2Clinical Center of Diabetes, Nutrition, Metabolic diseases, Cluj-Napoca, Romania

Background: The cardiometabolic risk factors are clustered by interdependent ethiopathogenetic mechanisms, within the metabolic syndrome and type 2 diabetes. Due to hyperglycemia and hyperlipidemia, postprandial state is now recognized an important factor that increases the cardiovascular risk. Also other atherogenetic risk factors may be associated with postprandial state: inflammation, adipokynes. Objective: The aim of the study was to evaluate the involvement of adiponectin, visfatin and inflammatory markers in the postprandial state in people with type 2 diabetes. Design and method: A number of 40 persons with type 2 diabetes and obesity have been included. Five normoponderal persons without diabetes have provided the control. Blood test have been performed fasting and at 2 and 4 hours postprandial: glycemia, lipids, adiponectin, visfatin, inflammatory markers (TNF-alpha, interleukin-6, high sensitive C-Reactive protein, fibrinogen). Results: In basal conditions, significant differences have been found between the persons with obesity and type 2 diabetes and the control group in terms of 83

visfatine (26 18,3 vs. 12.5 3 ng/ml; p = 0.02) and high sensitive C-Reactive protein (4.7 3.7 vs. 0.38 0.35 mg/L; p=0.001). In postprandial state, significant increase of visfatine (p=0.03), interleukin-6 (p=0.012) and high sensitive C-Reactive protein (p=0.017) have been found in diabetes group compare to control. Within diabetes group, a significant 2-hour postprandial glycemia and 4-hour postprandial increase of TNF-alpha and C-Reactive protein has been found. Conclusions. A significant difference between diabetes and control has been found in terms of visfatin and high sensitive C-Reactive protein that are increased in diabetes. Adiponectin was lower in diabetes group, but not statistically significant compare to control group. In diabetes group, TNF-alpha, C-Reactive protein and glycemia have been found to be increased in the postprandial state, which demonstrates that in diabetes, multiple factors act to increase cardiovascular risk. Keywords: cardiometabolic risk, adiponectin, visfatin, postprandial state

ROLUL LDL COLESTEROLULUI IN CADRUL SINDROMULUI METABOLIC Georgeta Inceu1, Nicolae Hancu1,2
1 2

Centrul Clinic de Diabet Zaharat, Nutritie si Boli Metabolice, Cluj-Napoca Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj-Napoca

Introducere si obiective Diabetul zaharat este considerat echivalent de boala cardiovasculara, astfel incat tintirea agresiva a tuturor factorilor ce alcatuiesc riscul cardiometabolic constituie un obiectiv major in cadrul managementului pacientilor cu diabet zaharat. LDL colesterolul este un important factor de risc cardiovascular, dar implicatiile sale in cadrul sindromului metabolic constituie inca o controversa. Lucrarea de fata isi propune analiza unei posibile corelatii intre sindromul metabolic si LDL colesterol la pacientii cu diabet zaharat tip 2. Material si metoda Am efectuat un studiu retrospectiv la pacientii cu diabet zaharat tip 2 (DZ tip 2) internati in Centrul de Diabet Cluj in perioada ianuarie-martie 2008. Am analizat date clinice si demografice, prezenta sindromului metabolic (conform criteriilor IDF 2005), a bolii cardiovasculare, schemele de tratament folosite, precum si corelatia dintre LDL colesterol (luand ca si obiectiv tinta valoarea de 100mg/dl) si diversi factori de risc cardiovascular (in particular sindromul metabolic). Datele au fost prelucrate si analizate cu programul SPSS 10. Rezultate

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Intreg lotul analizat a inclus 200 de pacienti cu DZ tip 2, cu varsta medie de 589,25 ani, 41,5% barbati, cu o durata medie a diabetului de 10,27,03 (1-31) ani. Referitor la tratament, 1,1% erau sub monoterapie orala, 11,2% cu terapie orala combinata, 42% au beneficiat de asocierea insulina-antihiperglicemiante orale, 45,7% erau numai sub insulinoterapie, in timp ce 45,9% din intreg lotul aveau metformin in schema terapeutica. Dintre pacienti, 88,8% erau hipertensivi, 92,6% intruneau criteriile sindromului metabolic, 42% erau diagnosticati cu boala cardiovasculara si 79,3% aveau complicatii microvasculare prezente. Dintre pacientii cu sindrom metabolic 54,5% aveau LDL colesterol 100 mg/dl si 62,6% erau cu trigliceride 150mg/dl. Dintre pacientii cu boala cardiovasculara prezenta 49,4% erau cu LDL colesterol 100mg/dl si 65,8% cu trigliceride 150mg/dl. Analizand separat pacientii cu LDL cholesterol100mg/dl (acestia reprezinta 50,35% din intreg lotul ) am constatat ca 87,4% sunt hipertensivi, 40% au fost diagnosticati cu boala cardiovasculara si o majoritate covarsitoare (94,7%) intrunesc criteriile de diagnostic ale sindromului metabolic. Concluzii Rezultatele acestei analize observationale ilustreaza inca o data rolul fundamental al LDL colesterolului la pacientii cu sindrom metabolic si diabet zaharat. Faptul ca peste 90% dintre pacientii cu LDL cholesterol 100mg/dl intruneau criteriile de diagnostic ale sindromului metabolic, fac plauzibila ipoteza ca aceasta formatiune lipidica cu rol central in aterogeneza ar putea deveni parte integranta in cadru conceptului de sindrom metabolic.

LDL CHOLESTEROL AND ITS ROLE IN METABOLIC SYNDROME Georgeta Inceu1, Nicolae Hancu1,2
1 2

Clinical Center of Diabetes, Nutrition, Metabolic diseases, Cluj-Napoca, Romania Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca

Introduction and objective Diabetes mellitus is considered cardiovascular disease equivalent, so aggressive targeting of all cardiometabolic risk factors is a major objective in the management of diabetic patients. LDL cholesterol is an important cardiovascular risk factor, but its implications in the metabolic syndrome are still a controversy. This paper aims to analyze a possible correlation between metabolic syndrome and LDL cholesterol in patients with type 2 diabetes. Material and method We conducted a retrospective study in patients with type 2 diabetes admitted in Cluj Diabetes Center during January to March 2008. We analyzed demographic and clinical 85

data, the presence of metabolic syndrome (defined according to the IDF 2005 criteria), cardiovascular disease, treatment schemes used, as well as the relationship between LDL cholesterol (taking as objective target value of 100mg/dl) and various cardiovascular risk factors (in particular metabolic syndrome). The data were processed and analyzed with the SPSS 10. Results The entire batch analyzed included 200 patients with type 2 diabetes, with an average age of 58 9.25 years, 41.5% men, with an average duration of diabetes 10.2 7.03 (1-31) years. Regarding the treatment, 1.1% were under oral monotherapy, 11.2% received combined oral therapy, 42% benefited from the combination of oral therapy and insulin, 45.7% were under insulin therapy, while 45.9% of all patients had metformin in their treatment regimen. 88.8% of the patients were hypertensive, 92.6% meet the metabolic syndrome criteria, 42% were diagnosed with cardiovascular disease and 79.3% had microvascular complications. Among patients with metabolic syndrome 54.5% had LDL cholesterol 100 mg / dl and 62.6% had triglycerides 150mg/dl. Among patients with this cardiovascular disease 49.4% had LDL cholesterol 100mg/dl and 65.8% had triglycerides 150mg/dl. When separately analyzed patients with LDL cholesterol 100mg/dl (this represents 50.35% of the entire lot) we found that 87.4% are hypertensive, 40% were diagnosed with the cardiovascular disease and an absolute majority (94.7%) meet metabolic syndrome diagnosis criteria. Conclusions Observed results of this paper illustrate once again the fundamental role of LDL cholesterol in patients with metabolic syndrome and diabetes. The fact that over 90% of patients with LDL cholesterol 100mg/dl meet the diagnostic criteria for metabolic syndrome, make plausible the assumption that this lipoprotein components with a central role in atherogenesis could become an integral part of the metabolic syndrome concept.

RAPORTARE DE CAZ: HIPOGLICEMII REPETATE LA O PACIENT DIABETIC IN PROGRAM DE DPCA N TRATAMENT CU SOLUII DE ICODEXTRIN G. Ioni1, D. Pencu2, A. Cirjan2, C. Ionescu2, M. Voiculescu2 1 Institutul National de Diabet, Nutriie i Boli Metabolice N. C. Paulescu , Bucuresti, Romania 2Institutul Clinic Fundeni Centrul de Medicin Intern- Bucureti, Romania Centrul Bucureti,

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Din ce n ce mai muli pacienii cu IRC stadiul uremic sunt inclui n programul de dializ peritoneal continu ambulatorie. Dintre acetia, pacienii cu diabet zaharat sunt o categorie aparte ce implic o serie de probleme suplimentare n ceea ce privete interferena ntre tratamentul insulinic i soluiile de dializ peritoneal. Se prefer folosirea soluiilor peritoneale de Icodextrin (Extraneal), un polimer al glucozei derivat din porumb care presupune o absorbie sczut a carbohidrailor, permind astfel un mai bun control al glicemiei i care poate mbunti ultrafiltrarea i clearance-ul creatininei la pacienii cu PET HighAverage sau High.(transport peritoneal nalt sau naltMediu). Dei Icodextrinul nu este metabolizat n peritoneu, poate fi absorbit prin sistemul limfatic n circulaia sistemic, unde este hidrolizat de ctre amilaz n oligozaharide(maltoz, maltotrioz). Multe glucometre folosesc in benzile teste glucozdehidrogenaza cu coenzima piroloquinolinequinone, pentru a cataliza conversia glucozei la acidul gluconic i a reduce acidul adenin dinucleotid nicotinamidic (NADH). Cantitatea de NADH msurat de glucometru este direct proporional cu concentraia glucozei din mostra de snge. Glucoz-dehidrogenaza cu coenzima piroloquinolinequinone (PQQ) poate reaciona cu radicalul liber al glucozei localizat la captul moleculei de maltoz, producnd o cantitate adiional de NADH, contribuind la supraestimarea nivelului glicemiei. (3). Vom prezenta cazul unei paciente cu DZ tip I i IRC std V n program DPCA, n tratament cu Icodextrin, care a suferit repetate hipoglicemii datorit msurtorilor inadecvate a glicemiilor msurate cu glucometru pe baz de glucoz-dehidrogenaz. Pacienta, n vrst de 43 ani, cunoscut cu diabet zaharat tip 1 din 1994 n tratament cu insulina aspart:10U(ora8)-10U(ora14)-10U(ora20) i insulina glargina: 10U(ora22), nefropatie diabetic din 2006, HTA secundara renoparenchimatoas, dislipidemie mixt, insuficien renal cronic din 2006 n program de DPCA din 07.06.2007 se interneaz pentru sindrom febril 38-39 C i sughi de aproximativ 24ore, stare confuzional( iniial agitaie psihomotorie, ulterior refuz alimentar i verbal de cca 48ore). Menionm c la domiciliu pacienta a prezentat numeroase episoade hipoglicemice (non-complian la regimul alimentar i tratament antidiabetic, non-complian la indicaia de neutilizare pt determinarea glicemiei a glucometrelor- test de glucoz-dehidrogenaz) i nu a mai urmat medicaia antidepresiv n ultimele 2 luni (non-complian la tratament). Obiectiv: stare general mediocr, contient, febril (38C), agitaie psihomotorie, dezorientat temporo-spaial, areactiv la stimuli verbali, reactiv la stimuli dureroi; redoare de ceaf, opistotonus; tegumente i mucoase palide, uscate; fara edeme; ap respirator MV prezent bilateral, fara raluri; ap cardiovascular TA 230/100 mmHg , AV-90/ min, ritm regulat, fara sufluri supraadugate, artere periferice pulsatile; ap digestiv abdomen suplu, uor sensibil la palpare n epigastru, mobil cu micrile respiratorii, ficat i splina n limite normale, tranzit intestinal normal; ap urinar loje renale libere, Giordano (-) bilateral, diureza=500ml, UF=1000ml/24ore, efluent limpede.

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Paraclinic: sdr anemic(Hb 10.7-8.8 g/dl, Ht 33.1-27.1%), sdr inflamator: Leucocitoz(15600-22600/mmc), Fbg=564mg/dl, hipoalbuminemie, hipoproteinemie, coagulare, Na, K n limite normale, hipocalcemie, sdr de retenie azotat: creatinina=6.96.1mg/dl, uree=163-213mg/dl, oscilaii hipo-hiperglicemice cu valori ntre 44-559 mg/dl) (determinri pe laborator). Consultul neurologic a infirmat suspiciunea de menigit(Puncia lombar- LCR limpede, fr celule, proteinorahie normala) sau de AVC (CT cerebral fr acumulri hemoragice cu caracter recent intracerebrale) i a pus diagnosticul de Encefalopatie metabolic cu febra de origine central. Pe parcursul internrii pacienta a prezentat crize convulsive cu debut membre drepte i generalizare secundar, remise dup administrare de diazepam iv; s-a repetat puncia lombar- cu proteinorahie normal. Consultul psihiatric a confirmat ntreruperea tratmanetului antidepresiv i a pus diagnosticul de depresie reactiv. S-a efectuat RMN cerebral care a decelat leziuni demielinizante supratentoriale bilaterale de mici dimensiuni, minim proces inflamator mastoidian bilateral i sfenoidal i moderat atrofie cerebral. n timpul internrii pacienta a primit tratament de echilibrare hidroelectrolitica i acido-bazic, insulinoterapie, hipotensoare, anticonvulsivante i antidepresive cu evoluie lent favorabil, cu remiterea convulsiilor i a sdr febril , remiterea sindromului de agitaie psiho-motorie i creterea gradului de complian la regimul alimentar i medicamentos n condiiile controlului glicemic i normalizarea calcemiei. Am considerat simptomatologia de la internare i din cursul spitalizrii secundar unor episoade repetate de hipoglicemie i agravrii tulburrii depresive reactive prin noncompliana la diet i insulino-terapie, prin utilizarea nepermis a glucometrelor pe baz de dehidrogenaz n contextul dializei peritoneale cu Icodextrin i prin non-compliana la terapia antidepresiv. S-au fcut studii comparative ntre diferite metode de msurare a glicemiei pe baz de glucometre- prin glucoz-dehidrigenaz, prin glucoz-oxireductaz, prin glucozoxidaz comparativ cu valorile msurate prin metoda de laborator din sngele venos(hexokinaz) la diabeticii aflai n DPCA cu soluii cu Icodextrin. Toate glucometrele supraestimeaz valorile glicemiei, cele mai mici diferene fa de valorile obinute prin laborator au fost nregistrate cu glucometrele pe baz de glucoz-oxidaz. Inclusiv firma producatoare de Icodextrin avertizeaz asupra supraestimrii valorilor glicemiei determinate cu glucometre pe baz de GDH PQQ i glucoz-oxidoreductaz la pacienii diabetici in program de DPCA cu soluii de Icodextrin.(2). Cu toate acestea nc se mai observ cazuri de hipoglicemii din cauza folosirii acestor glucometre.

CASE REPORT: REPEATED HYPOGLICEMIC EPISODES IN A DIABETIC PATIENT WITH ESRD AND PERITONEAL DYALISES WITH ICODEXTRIN SOLUTION

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G. Ioni1, D. Pencu2, A. Cirjan2, C. Ionescu2, M. Voiculescu2 Institute of Diabetes, Nutrition and Metabolic Diseases "N. C. Paulescu", Bucharest Romania
1

2 Fundeni Clinical Institute - Center of Internal Medicine, Bucharest, Romania Bucharest,

More and more patients suffering from ESRD are included in peritoneal dialyses programes. Diabetic patients with ESRD and CCDP have to be carefully monitorised because of the interferences between insulin treatment and dialyses solutions. Icodextrin (Extraneal) peritoneal dialysis solution is a glucose polimer derived from cornstarch wich has a low carbohydrates absobtion and is prefered in diabetic patients because of a better glicemic control and because it can improve long-dwell ultrafiltration and clearance of creatinine for patients with High-average or High PET. These glucose polymers are absorbed via the peritoneal route and metabolised to oligosaccharides (mainly maltose), which interfere with glucose. Many glucometers are using the glucose dehydrogenase, an enzyme of the pyrroloquinolinequinone class, for catalysing the conversion of glucose to gluconic acid and reducing Nicotinamide adenine dinucleotide Acid (NADH). The quantity of NADH is in direct proportion with the glicemia. The glucose dehydrogenase reacts with the free reducing group of the glucose molecule located at the end of each saccharide chain and this aditional quantity of NADH is leading to an overestimation of the glicemia. We will present the case of a patient with diabetes mellitus type I and ESRD in dialysis peritoneal program with Icodextrin, that presented several hypoglicemic episodes because of the inadequacy measurements of glycemia using glucose dehydrogenase pyrroloquinolinequinone glucometers. The patient, a woman of age 43 years, with diabetes mellitus type I from 1994 in treatment with aspart insulin: 10U( at 8 a.m.)- 10U( at 14 a.m.)- 10U( at 8 p.m.) and glargina insulin: 10U( at 10 p.m.); diabetic nephropathy(2006); renal hypertension; dyslipidemia; ESRD in dialysis peritoneal program from 07.06.2008. She presented for fever (38-39 C), hiccup (for the last 24 hours), confusional state (initially anxiety, then she refused to speak and to eat for the last 48 hours). The patient presented several hypoglicemic episodes (noncompliance at the diet and medical treatment, noncompliance at the indication of not using glucose-dehydrogenase glucometers) and she has stopped the antidepressive medication for the last two months. Physical examination: fever(38C), anxiety, confusion; nonreactive to verbal stimuli but reactive to pain; nuchal rigidity to passive flexion, opisthotonus; pale skin and mucous membranes; no edema; pulmonar exam normal; cardiovascular exam: TA230/100mmHg, HR-90/min; mild epigastric tenderness ; no hepatosplenomegaly; Giordano (-) bilateral, diuresis -500ml/day, ultrafiltrate -1000ml/day, clear peritoneal effluent.

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Paraclinical: anemic sindrom (Hb 10.7-8.8 g/dl, Ht 33.1-27.1%), inflamatory sindrom (WBC-15600-22600/mmc, Fbg=564mg/dl, hypoalbuminemia, hypoproteinemia, hypocalcemia, coagulation, Na, K normal, chronic renal disease(creatininemia=6.96.1mg/dl, BUN=163-213mg/dl, hypo-hyperglicemic values between 44-559 mg/dl. Neurology specialist infirmed the suspicion of meningitis(lombar puncture clear cephalorahidian liquid, normal proteinorahia) or of stroke (cerebral tomography- no hemoragy ) and diagnosed the patient with Metabolic Encephalophaty and fever of central origin.During the hospitalisation she presented two partial seizures with secondary generalization remited after Diazepam i.v. A lombar puncture was repeated and was normal. The Psychiatrist confirmed that the patient stoped her antidepressive treatment and diagnosed the Reactive Depression. The cerebral RMI found small supratentorial demyelinization lesions, minimal inflamatory process at the mastoid et sfenoid and moderate cerebral atrophy. During the hospitalization the patient received hydratation and acid-alkali equilibration treatament, insulin, antihypertensives, anticonvulsivants and antidepressives with seizures, fever and anxiety remission, with a better compliance to the diet and medical treatment, with a better glicemic control and normalization of the calcemia. We c We considered the simptomatology as a consequence of the hypoglicemic episodes and of the agravation of the reactive depression due to noncompliance to the diet and insulin treatment and utilisation of the glucose dehydrogenase glucometers while peritoneal dyalises with Icodextrin solution and noncompliance to the antidepressive therapy. There are comparative studies between different methods of glycemia measurement at diabetics in peritoneal dyalise with Icodextrin using glucose dehydrogenase, glucose dehydrogenase nicotinamide adenine dinucleotide, or glucose oxidase glucometers and in venous blood using the laboratory reference method (hexokinase). All glucometers overestimate real blood glucose concentration; the minimal errors were obtained using glucose oxidase glucometers. Even the producers of Icodextrin warn about overestimation of glicemic values using glucose dehydrogenase or glucose oxidoreductase glucometers, but there are still cases of severe hypoglicemia because of the use of this glucometer.

ASPECTE EPIDEMIOLOGICE IN DIABETUL ZAHARAT TIP 2 - CAD ( CENTRUL ANTIDIABETIC) SIBIU, 1975 2007 Dr. Ghise Ghe.*, Dr. Strugariu Minola*, Dr. Mot Alina*, Dr. Natea Carmen Narcisa *, **; *Spitalul Clinic Jud. de Urgenta Sibiu Clinica Diabet, Nutritie si Boli Metabolice ;

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** Facultatea de Medicina Victor Papilian Sibiu, ULBS

Introducere si obiective: Incidenta diabetului zaharat tip 2 este in crestere in intreaga lume, DZ fiind considerat ca boala endemica; din pacate, complicatiile cronice ale DZ au consecinte devastatoare privind calitatea vietii, speranta de viata a pacientilor, presupunand mari costuri atat pentru individ cat si pentru societate. Autorii si-au propus analiza catorva aspecte epidemiologice ale DZ tip 2 in teritoriul arondat CAD Sibiu cu intentia de a dsprinde particularitatile locale ale acestei probleme pentru ca astfel sa poata gasi metodele necesare imbunatatirii calitatii ingrijirii. Material si metoda: Studiul s-a realizat printr-o metoda retrospectiva, datele fiind obtinute de la Centrul Judetean de Statistica si Centrul de diabet in perioada 1975 2007. In studiul noastre am urmarit: 1) Prevalenta si incidenta DZ; 2) Rata complicatiilor in momentul diagnostic; 3) Evolutia ratei mortalitatii; 4) Perioada de supravietuire si speranta de viata. Rezultate: Prevalenta DZ in teritoriul arondat orasului Sibiu a crescut de la 1577 ( 1,6%) in 1975, la 6,2% - in 2007; incidenta a crescut de la 77,59 1975 la 253,16 in 2007 ; rata mortalitatii la persoanele diabetice s-a mentinut relativ stabil 5,5% ; repartitia pe sexe a fost : barbati : 51, 63%, femei 48,36% ; in raport de tipul de DZ : DZ tip I 20, 38%, tip II 79, 61% ; durata medie a evolutiei aparente a DZ a fost de 16,3 ani ; ponderea cea mai mare a deceselor a fost inregistrata la cei cu o durata a diabetului cuprinsa intre 6 10 ani si fiind aproape dubla fata de cei cu evolutia DZ cuprinsa intre 1-5 ani si 11 -15 ani ; mortalitatea cea mai mare a fost inregistrata la grupele de varsta 60- 69 ani si 70 -79 ani, fiind de 2,5 ori mai mare fata de grupa de varsta 50-59 ani. Cauzele principale de deces au fost : boli cardiace- 61, 33%, AVC 8,42%, tumori 12, 74%, boli ale ap. respirator 9,8%. altele 7,7%. Concluzii :

1) Prevalenta si incidenta DZ are aceeasi tendinta cu cea inregistrata in intreaga lume

si in Romania ; 2) Incidenta mult crescuta din ultimii ani este data nu numai de evolutia naturala a DZ , cat si de depistarea activa ; 3) Incidenta complicatiilor cronice in momentul diagnostic este fals redusa din lipsa investigatiilor specifice ; 4) Nu dispunem de date referitoare la diabetul getational ; acest aspect va putea fi corectat doar prin colaborare eficienta cu medicii de familie si medicii ginecologi. 91

TYPE 2 DIABETES MELLITUS SOME EPIDEMIOLOGYCAL ASPECTS SIBIU COUNTY, 1975 2007 Dr. Ghise Ghe.*, Dr. Strugariu Minola*, Narcisa *, **; Dr. Mot Alina*, Dr. Natea Carmen

*Spitalul Clinic Jud. de Urgenta Sibiu Clinica Diabet, Nutritie si Boli Metabolice ; ** Facultatea de Medicina Victor Papilian Sibiu, ULBS

Introduction and aims: The type 2 diabetes incidence is increasing throughout the world, it has being considerated an endemic disease. Unfortunately the cronic complications of diabetes have devastating consequences on the life quality, life expectancy and impose a great burden to individuals and society. The authors proposed to analyse some epidemiological aspects of type 2 diabetes in Sibiu District in order to know the local particularities of this problem and so to prove the specific measures to improve the quality of care. Material and method: The study was done by a retrospective method, the informations were collected from the Statistic Departamental Center and Diabetes Center of Sibiu County in the period 1975 2007; in our study we had a view: 1) the prevalence and incidence of diabetes; 2) the rate of complications at the moment of diagnostics; 3) the evolution of the rate of mortality; 4) survive period and expectancy of life. Results: The prevalence of DM in Sibiu Conty was increased from 1577 ( 1,6%) 1975 to 6,2% - 2007; the incidence was increased from 77, 59 - 1975 to 253 -2007; the dynamic of mortality rate in diabetic population was in linear rate about 5,5% of all cases; men subjects - 51,63%, female subjects 48,36; mortality and type of diabetes: type 120,38%, type 2 79,61%; the overage of apparent evolution of diabetes was 16,3 years; the most frequent rate of death was registred to those with length of DM between 6-10 years being almost double given those with DM evolution between 1-5 years and 11- 15 years; the highrst rate of death was registrated at the group of age 60- 69 years and 70 -79 years, being 2,5 times higher than the group of age 50 59 years; the main causes of death were heart diseases 61,33%, stroke 8,42%, tumors 12, 74%, respiratory diseases 9,8%, others 7,70%. Conclusions:

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1) The prevalence and incidence of diabetes followed the world and Romanian tendency ; 2) The higher increase in the last years was due not only by the natural evolution of diabetes as well an active manner of diagnosis; 3) The incidence of chronic complications at the moment of diagnosis is false decrease by the lack of investigations; 4) We have no data about gestational diabetes this aspect will be effective and efficient by a strong collaboration with GP and gynaecologists.

MANIFESTARI AUTOIMUNE LA COPILUL CU DIABET-CELIACHIA Gina GHENGHEA Spitalului de Copii ,, Sfanta Maria IASI Clinica a III-a

DEFINITIE Boala celiaca (numita si celiachie, intoleranta la gluten) este o boala digestiva cronica, cauzata de ingestia la gluten, ce implica absorbtia nutrientilor, vitaminelor si mineralelor de catre intestin. INTRODUCERE Aceasta lucrare are ca scop scoaterea in evidenta a relatiei diabet celiachie, celiachia pare a fi frecventa la persoanele ce sufera de o boala autoimuna-diabet tip I. MATERIAL SI METODA Copii S-a luat in studiu un caz internat in clinica a III a Spitalului Clinic de ,,Sfanta Maria de la varsta de 3 ani. REZULTATE S-a urmarit: - diagnosticul de baza pe baza examenelor clinice si de laborator; - stare clinica: evolutie, complicatii, tratament, prognostic; - complianta familiei in acceptarea dignosticului si tratamentului. CONCLUZII 1. Dificultatea diagnosticarii sindromului celic la copilul cu diabet, medicul trebuind sa elimine posibilitatea unei alte probleme digestive

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2. 3.

mai frecvente (sindromul intestinului iritabil, o intoleranta alimentara sau o boala inflamatorie a intestinului). Necesitatea colaborarii pacient-mama-medic-asistenta. Adoptarea unei diete fara gluten.

AUTOIMMUNE MANIFESTATIONS AT A DIABETIC CHILD CELIAKIE Gina GHENGHEA Spitalului de Copii Sfanta Maria IASI Clinica a III a

Definition Celiac disease/illness ( also called celiac, immobility to tolerate gluten) is a chronic digestive disease, caused by the intolerance of gluten, which prevents the absorption of the nutrients, the vitamins and the minerals by the intestine. Introduction This paper work is meant to illustrate the relationship between diabetsand celiac. Celiakie appears more frequently to the persons who suffer from an autoimmune diseasediabetes type I. Material And Method It was studied the case of a child in the third class of St. Mary Clinic Hospital since the age of three. Results Objectives: - Diagnosis based on clinical, paraclinical and lab examinations; - Clinical state. Course of disease, complications, treatment, prognosis; - The family capacity of accepting the diagnosis and treatments. Conclusions 1. Difficulty in diagnosing the celiac syndrome at a diabetic child, the doctor having to eliminate the possibility of another frequent digestive illness ( the irritable intestine syndrome, on alimental intolerance or an inflammatory disease of the intestine). 2. The necessary relationship between patient-mother-doctor-nurse.

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3. Choose a diet without gluten.

SUFERINA VASCULAR N STEATOZA HEPATIC DR. I.L. LASCU, Cabinet Medicina Familiei (CMF ) DR. LASCU, Zalu

SCOPUL STUDIULUI Suferina vascular n steatoza hepatic (S.H.) este complex: arterial, venoas, limfatic i arteriocapilar, ca expresie a tulburrilor metabolice complexe cu care se asociaz S.H. MATERIAL I METOD Au fost studiai 104 bolnavi: 60 femei (F) i 44 brbai (B) cu vrste cuprinse ntre 30 i 60 ani. Din 44 B: 8 erau cu diabet zaharat (DZ) tip 1, 24 cu DZ tip 2 i 12 cu scderea toleranei la glucoz (STG), 28 prezentau boal varicoas manifest clinic i toi prezentau retinopatie. Din 60 F: 4 aveau DZ tip 1, 26 cu DZ tip 2 i 30 cu scderea toleranei la glucoz (STG), 48 prezentau boal varicoas manifest clinic, retinopatie diagosticat oftalmoscopic la 46. Studiul s-a bazat pe datele clinice, ecografie abdominal, oftalmoscopie. Observaiile noastre ne-au permis urmtoarele concluzii: 1. 2. 3. 4.
5.

Steatoza hepatic (SH) este o tulburare metabolic complex cu repercursiuni asupra circulaiei arteriale, venoase, arterio-capilare i limfatice; SH se asociaz frecvent cu tulburri ale mecanismului glucidic, ndeosebi, DZ tip 2 i STG; SH reprezint o cauz frecvent ce precipit tulburrile de circulaie venoas - boala varicoas; ntr-un procent important al cazurilor SH se asociaz cu retinopatie i posibile tulburri ale circulaiei cerebrale observate clinic; SH reprezint un factor important ce precipit apariia ascitei ce pledeaz pentru afectarea circulaiei limfatice.

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VASCULAR INVOLVMENT IN LIVER STEATOSIS DR. I.L. LASCU, Family Doctor Practice, Zalu

Goal: The vascular involvment in Liver Steatosis (LS) is very complex: arterial, venous, lymphatic and arterio-capillary, due to the complex metabolic changes associated with LS. The study was done on 104 patients, 60 females (F) and 44 males (M), with ages between 30 and 60 years old. From 44 M: 8 had Diabetes Mellitus (DM) type 1 and 22 had DM type 2, 12 presented with glucose intolerance (IGT) and 28 presents with varicose disease and all of these patiens had retinopathy. From 60 F, 4 presented with DM type 1, 26 presented DM type 2, 48 presented with varicose disease manifested and 30 IGT, 46 with retinopathy siagnosed by ophtalmoscope. The study was based on clinical data, abdominal ultra-sound and ophtalmoscopic examination of the retina. After examinations we draw the following conclusions: 1. 2. 3. 4. 5. LS is a complex metabolic change with repercussion on the arterial, venous, arterio-capillaryand limphatic circulation; LS is frecquent associated with changes in glucose starch metabolism, specially in type 2 DM; LS represents a frequent cause that precipitates venous circulatory involvement varicose disease; Significant percentage of LS cases is associated with retinopathy and possible cerebral circulation, clinical observation; LS represents an important cause that precipitates ascites, meaning the lymphatic circulation is impaired.

EXISTA IN PRACTICA FACTORI PREDICTIVI PENTRU DURATA DINTRE DIAGNOSTICUL DIABETULUI ZAHARAT TIP 2 SI INITIEREA INSULINOTERAPIEI? Ilinca Lenta, Adrian Copcea, Dana Simu, Silvia Stefania Iancu Centrul Clinic de Diabet, Nutritie si Boli Metabolice Cluj-Napoca

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INTRODUCERE: Diabetul zaharat tip 2, caracterizat prin doua mecanisme interdependente: deficitul insulinosecretor si insulinorezistenta, are o evolutie progresiva, potential influentata de factori precum glucotoxicitatea, lipotoxicitatea, folosirea anumitor clase de antidiabetice orale. Putini dintre parametrii folositi in practica clinica au fost citati ca asociindu-se cu durata pana la esecul terapiei orale. OBIECTIVE: Am urmarit sa identificam, dintre parametrii folositi curent in urmarirea ambulatorie a pacientilor, posibilii factori asociati cu durata dintre diagnosticul diabetului zaharat si initierea insulinoterapiei. MATERIAL SI METODE: S-au selectat 90 de pacienti cu diabet zaharat tip 2 insulinotratat, urmariti in ambulatorul Centrului de Diabet Cluj. Criteriul de includere a fost prezenta unei perioade de minim 6 luni de tratament non-insulinic, criteriul de excludere a fost initierea insulinei din alte motive decat esecul terapiei orale (ex. insuficienta hepatocelulara sau renala). Un numar de 30 de parametri disponibili din fisele de ambulator au fost documentati pentru fiecare caz in parte (parametri clinicobiologici, antropometrici, socio-demografici, durata tratamentului cu fiecare dintre antidiabeticele orale folosite). S-a studiat legatura dintre durata de la diagnostic la initierea insulinei si fiecare dintre acesti factori. REZULTATE: Durata medie de la diagnosticul diabetului la initierea insulinei [DD] a fost de 8.1 ani (min 0.9 max 22.4). Lotul a fost constituit din 31 barbati si 59 femei, varsta medie la initierea insulinei a fost de 59.4 ani. IMC mediu in lot a fost de 30.0 kg/m2, glicemia medie la initiere: 256 mg/dl, HbA1c medie 9.3% (parametru disponibil la 25% dintre pacienti). DD s-a corelat pozitiv cu greutatea la initierea insulinoterapiei, nu si la debutul diabetului (R=0.26 respectiv 0.16). A existat o asociere negativa nesemnificativa intre DD si glicemia la debut. Impactul tratamentului cu metformin, sulfoniluree si, respectiv, tiazolidindione asupra DD (R=0.77, R=0.75, R= -0.31) se explica prin administrarea frecventa a acestora din urma ca ultima intensificare inaintea insulinoterapiei. Nu s-au constatat corelatii semnificative intre DD si valoarea maxima documentata pentru colesterol, trigliceride, TA. Intre persoanele care au refuzat insulina la cel putin 3 vizite medicale (23.3%), a predominat sexul feminin (85.7%). DD a fost semnificativ mai mica la persoanele la care s-au efectuat cel putin 2 intensificari ale tratamentului in primii 2 ani de la debut, fata de cele la care tratamentul initial s-a mentinut minim 2 ani (6.3 vs 16.0 ani, p<0.05). Persoanele cu studii superioare au avut o initiere mai precoce a insulinei (DD medie = 5.4 ani). CONCLUZII: Durata dintre diagnosticul diabetului tip 2 si initierea insulinei nu s-a corelat semnificativ cu niciun parametru antropometric sau de laborator dintre cei determinati de rutina. Sexul feminin si nivelul de educatie par a influenta acest interval, probabil prin mecanisme psihologice. In studiul nostru, numarul de intensificari ale tratamentului in primii 2 ani de la diagnostic a fost singurul factor predictiv pentru intervalul de timp pana la insulinoterapie.

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COULD WE FIND IN OUR CLINICAL PRACTICE PREDICTIVE FACTORS FOR THE DURATION BETWEEN THE DIAGNOSIS OF TYPE 2 DIABETES AND INSULIN INITIATION? Ilinca Lenta, Adrian Copcea, Dana Simu, Silvia Stefania Iancu Centrul Clinic de Diabet, Nutritie si Boli Metabolice Cluj-Napoca

INTRODUCTION Type 2 diabetes, characterized by two interdependent mechanisms: -cell dysfunction and insulin resistance, has a progressive evolution, potentially influenced by factors like glucotoxicity, lipotoxicity, use of different antidiabetic drugs. Few of the parameters used currently in clinical practice were quoted as related to the duration between diagnosis of T2DM and insulin initiation. OBJECTIVES We aimed to identify, among the parameters documented in an outpatient setting, possible factors associated with the duration between diagnosis of T2DM and insulin initiation. METHODS 90 insulin treated type 2 diabetic patients were randomly selected from the outpatient offices of our clinic, using as an inclusion criterion the presence of at least 6 months of non-insulinic therapy, and as an exclusion criterion the initiation of insulin for other reasons than failure of oral therapy (i.e. renal or hepatic insufficiency). A number of 30 different parameters available from the medical files were included in the analysis for each case (clinical, biological, anthropometrical, socio-demographical parameters, as well as duration of treatment with each antidiabetic drug). Statistical evaluation of the relations between the time interval to insulin initiation and each of these parameters was performed. RESULTS The mean duration from the diagnosis of T2DM and insulin initiation [DD] was 8.1 years (min 0.9, max 22.4). The group consisted of 31 men and 59 women, having a mean age of 59.4 years at the time of insulin initiation. The mean BMI was 30.0 kg/m2, the mean fasting blood glucose (FBG) at insulin initiation was 256 mg/dl, mean HbA1c 9.3% (available in 25% of the patients). DD was positively correlated with the weight at the time of insulin initiation, but not at diagnosis (R=0.26 respectively R=0.16). There was a negative, non-significant association between DD and FBG at the time of diagnosis. The impact of metformin, sulfonylurea and, respectively, tiazolidindione use on DD (R=0.77, R=0.75, R= -0.31) is justified by the frequent use of the latter as a last intensification before insulin. There were no significant correlations between DD and the highest documented serum level of total cholesterol and triglycerides, neither with the maximum blood pressure values. Among the persons who refused at least at 3 visits the initiation of insulin (23.3%), 85.7% were females. DD was significantly lower in persons who had at least 2 treatment intensifications in the first 2 years, compared to those in

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whom the initial treatment was maintained (6.3 vs 16.0 years, p<0.05). The patients with the highest education level had the earliest insulin initiation (mean DD=5.4 years). CONCLUSIONS There were no significant correlations between the duration from diagnosis of type 2 diabetes to insulin initiation and any anthropometrical or laboratory parameters used in current practice. The education level and the female gender seem to influence this interval. In our study, the number of treatment intensifications in the first 2 years following diagnosis was the only predictive factor for the time interval to insulin initiation.

EPIDIAB 2008: ANALIZ 01.01.2008 - 30.09.2008 Dr. Carmen Crian, Dr. Adriana Cif, Dr. Marton Reka Ambulatoriul de Diabet Tg. Mure Introducere : Programul EPIDIAB (Epidemia Diabetului) este un studiu prospectiv, avnd ca obiective obinerea de date epidemiologice, clinico-biologice ale persoanelor cu DZ nou depistat, permind analiza calitii ngrijirii acestora. Scopul lucrrii : evaluarea rezultatelor pe primele 9 luni ale anului 2008 i compararea lor cu date din 2000-2007. Metod : rezultatele au fost obinute prelucrnd datele demografice, antropometrice, de prevalen a complicaiilor cronice i bolilor asociate precum i a tratamentului persoanelor cu DZ nou depistat n perioada ianuarie - septembrie 2008. Rezultate : n perioada studiat au fost nregistrate 2758 persoane cu DZ nou depistat. Distribuia pe tipuri de DZ a fost urmtoarea : 1,38 % tip 1; 98,62 % tip 2. Prevalena factorilor de risc cardiovasculari este: HTA 64,97 %; obezitate - 37,02 %; suprapondere -45,03%; dislipidemii - 61,20 % (din totalul celor 89,38 % screenai); boal cardiovascular ( la momentul depistrii ) : 25,13 %. Screening-ul i diagnosticul complicaiilor microvasculare specifice relev: 86 % din persoanele nou depistate cu DZ au fost screenate pentru decelarea retinopatiei diabetice i 10,15 % au prezentat de la diagnostic aceast complicaie. Screening -ul pentru nefropatie diabetic s-a efectuat la 43,03 % din pacieni i 7,03 % au fost diagnosticai ca avnd aceast complicaie. Screening-ul pentru polineuropatie diabetic i picior diabetic s-a efectuat la 42,35 % din nou depistai, fiind identificai 21,36 % cu acest diagnostic. Structura pe grupe terapeutice a fost urmtoarea : diet - 12,98 % ; sulfonilureice -19,9 % ; metformin 32,85 % ; sulfonilureic plus metformin - 24,76 % ; insulin - 5,98 %; altele-3,51 %. Discuii i concluzii : incidena DZ se menine ridicat, remarcndu-se o important cretere fa de anii anteriori. Prevalena factorilor de risc cardiovascular i a complicaiilor cronice cunoate o uoar cretere fa de anii anteriori, verosimil datorit unui screening mai atent i mai frecvent aplicat indicnd deci o calitate a actului medical sporit.

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EPIDIAB 2008: ANALYSIS 01.01.2008 - 30.09.2008 Dr. Carmen Crisan, Dr. Adriana Cif, Dr. Marton Reka Diabetes Ambulatory Tg. Mures INTRODUCTION: EPIDIAB Program is a prospective study, in order to provide epidemiological, clinical and biological data of persons with newly-diagnosed diabetes (NDD). METHOD: The demographic and anthropometric data, the prevalence of chronic complications and therapeutic structure of persons with NDD was analised in period January- September 2008. AIM: to evaluate the results on the first 9 months - 2008 and to compare with data from 2000 - 2007 period. RESULTS: In January - September 2008, 2758 persons with newly - diagnosed diabetes (NDD) were registered, 1,38 % with type 1; 98,62 % with type 2. The prevalence of cardiovascular risk factors is: hypertension - 64,97 %, obesity - 37,02 %, overweight 45,03%, dyslipidemia - 61,20 %, (screening was perform for 89,38 % of patients), cardiovascular disease - 25,13 % at the moment of screening. Microvascular complications screening and diagnostic: for retinopathy was performed for 86 % of patients, 10,15 % have some grade of diabetic retinopathy; the screening for diabetic nephropathy was performed in 43,03 % of patients, 7,03 % being positive; the screening for diabetic neuropathy and diabetic foot was performed in 42,35 %, the percentage of positives being 21,36%. The therapeutic structure was: diet - 12,98%, sulphonylurea 19,9 %, biguanides 32,85 %; sulphonylurea and biguanides 24,76 %; insulin - 5,98 % ; another 3,5 % CONCLUSION: The incidence of diabetes mellitus increased in 2008 comparative with the previous years. Cardiovascular risk factors and chronic complications prevalence is increasing versus previous years.

STUDIU PRELIMINAR ASUPRA MODIFICARILOR GLICEMICE REZULTATE DIN PROGRAMUL NATIONAL DE EVALUARE A STARII DE SANATATE Ioana Micle, Monica Marazan, Ramona Giurescu, Elena Pop, Angela Dumitrescu, Remus Laslau, Simona Raicu, Carmen Patap Clinica Pediatrie 1 Timisoara Spitalul Clinic de Urgenta pentru CopiiLouis Turcanu 100

Scopul lucrarii. Autorii isi propun obiectivarea modificarilor glicemice depistate, la varsta copilariei, prin programul national de evaluare a starii de sanatate a populatiei. Materialul de studiu. Grupul de studiu este format din 27 copii cu varsta cuprinsa intre 2-18 ani . Criteriul de selectie al copiilor indrumati in clinica Pediatrie 1 Timisoara a fost reprezentat de valoarea glicemiei bazale 100mg% obtinuta la doua determinari succesive.Metoda de studiu. Datele ananmnestice cu privire la antecedentele heredocolaterale de diabet si boli metabolice au fost obtinute din foile de observatie. S-a calculat IMC (Kg/mp) si s-a raportat cu nomogramele varstei. Bilantul biologic s-a efectuat etapizat, astfel: glicemia bazala, profilul glicemic, TTGO si HbA1c, apoi insulinemia (U/ml) ) si calculul indicelui de insulinorezistenta - HOMA si la cazurile selectionate - in functie de insulinemie - s-au determinat anticorpii anti GAD. Rezultate Din cei 27 copii, 5 (18,5%) au fost depistati cu diabet zaharat (DZ). Dintre acestia 4/27 (14,8%) sunt diagnosticati cu DZ tip 1 (la prima determinare a glicemiei) si 1/27 (3,7%) a fost diagnosticat cu DZtip 2 (dupa efectuarea profilului glicemic si a TTGO). Restul de 22/27 (81,48%)) au avut urmatoarele modificari: 9/27 (33.33%) scaderea tolerantei la glucoza (SGT -glicemie la 2 h 140 mg%) si 13/27 (48,14%) normoglicemie bazala si TTGO normal. Indicele de insulinorezistenta HOMA a fost crescut la 2 copii care aveau concomitent obezitate si semne de insulinorezistenta. Insulinemia bazala a fost scazuta la un copil cu Dztip 1 si crescuta la doi copii (dintre care unul a fost diagnosticat cu DZtip 2).Conduita terapeutica a fost diferentiata in functie de diagnosticul stabilit, astfel: la cei 4 copii cu DZ tip 1 s-a initiat insulinoterapia bazala la 3 copii si bazal-bolus terapie(BBT) la un copil;la copilul cu DZ tip 2 s-au administrat antidiabetice orale (ADO) metformin; 9 copii cu STG au ramas in expectativa terapeutica cu recomandari dietetice in STG, 13 copii urmand sa fie reevaluati periodic - trimestrial sau la simptome minore. Concluzii. Determinarea glicemica - ca screening - in cadrul programului national de evaluare a starii de sanatate ofera posibilitatea decelarii precoce a modificarilor glicemice, a depistarii populatiei infantile cu hiperglicemie bazala si diagnosticul precoce al DZ. Simptomatologia clasica de debut a DZ poate fi uneori nesesizata de familie si astfel, orice glicemie peste limitele normale necesita explorari suplimentare. La copil, o glicemie singulara peste limita normala nu inseamna intotdeauna DZ intrucat, chiar actul medical de prelevare a sangelui este un stress, dar nu trebuie neglijata ci, reconsiderata si repetata.

A PRELIMINARY STUDY ON THE GLYCEMIC ALTERATIONS DETECTED BY THE NATIONAL HEALTH SCREENING PROGRAM Authors: Ioana Micle, Monica Marazan, Ramona Giurescu, Elena Pop, Angela Dumitrescu, Remus Laslau, Simona Raicu, Carmen Patap 1 Pediatric Clinic, Louis Turcanu Childrens Emergency Hospital Timisoara Purpose: The authors aim to emphasize the glycemic alterations detected in children through the national health screening program. 101

Material: The study comprised 27 patients, aged between 2 and 18 years old. The selection criterion for referring the patients to our clinic was the value of the basal glycemia over 100mg% in two separate determinations. Methods: The anamnestic data about the presence of diabetes and other metabolic diseases in the families of the patients was gathered from the observation charts. We calculated the BMI (kg/m2) and compared with reference charts for age. The biological investigations were performed in the following order: basal glycemia, glycemic profile, OGTT and HbA1, insulinemia (ui/ml), the insulino-resistance index HOMA and, in selected cases, depending on the insulinemia, the anti-GAD antibody levels were determined. Results: From a total of 27 patients, 5 (18,5%) were diagnosed with diabetes, 4/27 (14,8%) were diagnosed with diabetes type 1 (at the first determination of glycemia) and 1/17 (3,7%) was diagnosed with diabetes type 2 (after performing a glycemic profile and OGTT). The rest 22/27 (81,48%) were diagnosed with the following alteration: 9/27 (33.33%) decreased glucose tolerance (DGT glycemia at 2h>140mg%) and 13/27 (48,14%)had normal basal glycemia an OGTT. The insulin resistance index HOMA was elevated in 2 children who presented simultaneously obesity and signs of insulin resistance. The basal level of insulin was decreased in one patient with diabetes type 1 and elevated in two patients (one of which was diagnosed with diabetes type 2). The therapeutic approach differed depending on the diagnosis: for the 4 patients diagnosed with type 1 diabetes we initiated basal insulin therapy in 3 and basal bolus therapy (BBT) in 1 patient, the patient diagnosed with type 2 diabetes was treated with an oral antidiabetic agent (metformin), 9 patients with decreased glucose tolerance remain in observation with special diet recommendations, 13 patients with minor symptoms are going to be evaluated periodically. Conclusions: The screening of the glycemic value in the national program for evaluation of populational health offers the possibility of early detection of glycemic alterations, early detection of the infantile population who presents basal hyperglycemia and arly diagnosis of diabetes. The classic symptoms at the onset of diabetes can be, sometimes, ignored by the family, therefore any glycemic value above norm needs further exploration. In children, one single value above normal does not always imply diabetes because even the prelevation of a blood sample cand bring a significant amount of stress in apatient. But still, a glycemic value above nomal must not be ignored and needs a second determination.

STUDIU COMPARATIV DE ADMINISTRARE MATINALA SAU VESPERALA A INSULINEI GLARGINE LA COPIL SI ADOLESCENT Ioana Micle, Monica Marazan, Ramona Giurescu, Elena Pop, Oana Domnitei, Cristina Damacus, Mihaela Zbarcea, Daniela Chiru 102

Clinica Pediatrie 1 Timisoara Spitalul Clinic de Urgenta pentru Copii Louis Turcanu Scopul lucrarii: Lucrarea i propune prezentarea comparativ a echilibrului glicemic realizat prin administrare de Glargine (Lantus) dimineata (ora 7) sau seara (ora 19; 23). Material de studiu: Au fost introdui n studiu 47 copii cu diabet zaharat tip 1 (DZ1), cu insulinoterapie bazal-bolus(BBT) , cu vrsta cuprins ntre 4 -18 ani care utilizeaza Glargine. Dintre acestia 41/47 (87,2%) isi injecteaza glargine seara si 6/47 (12,8%) dimineata. Criteriul de selecie pentru modificarea orei de injectare a insulinei glargine a fost numarul de hipoglicemii nocturne si valoarea glicemiei bazale. Metoda de studiu: S-au efectuat profile glicemice i media orar a glicemiilor n mod comparativ n terapia cu glargine administrat dimineata si seara. De asemenea, s-au evaluat numarul hipoglicemiilor diurne si nocturne, echilibrul glicemic prin valoarea HbA1c. Rezultate si discutii: S-a optat pentru administarea glarginului dimineata la copiii mici si prescolari aflati in perioada de remisiune labila si in perioada de stare, deoarece numarul hipoglicemiilor nocturne la acestia era mare de 4 - 5episoade/saptamana. Media glicemiilor din cadrul profilului glicemic a fost comparativa in administrarea de dimineata 13565mg% si in administrarea de seara 138 25 mg%. Cu toate acestea, media glicemiilor bazale este comparativ sczut la administrarea de glargine dimineata 117 31 mg% fa de 146 68 mg% la administrare seara. Aceasta se poate explica prin faptul ca la pubertate, secretia hormonului de crestere determina consecutiv cresterea rezistentei la insulina (fenomenul dawn). Majoritatea copiilor cu DZ 1 aflati la varsta pubertara au analog cu actiune prelungita in administrare vesperala sau inainte de culcare. Concluzii: Decizia momentului zilei (ora) de administrare a insulinei glargine depinde de valoarea glicemiei bazale. Glargine in administrare matinala este o opiune terapeutic pentru copiii mici si prescolari cu DZ aflati in perioada de remisiune parial sau in perioada de stare. La pubertate insulina glargine se administreaza seara sau inainte de culcare.

A COMPARATIVE STUDY ON MORNING VERSUS EVENING ADMINISTRATION OF GLARGINE INSULIN IN CHILDREN AND TEENAGERS Authors: Ioana Micle, Monica Marazan, Ramona Giurescu, Elena Pop, Oana Domnitei, Cristina Damacus, Mihaela Zbarcea, Daniela Chiru

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Pediatric Clinic nr 1. Louis Turcanu emergency chiledrens hospital, Timisoara Purpose: the study aims to present a comparison between the glycemic response and balance accomplished by treatment with Glargine (Lantus) administered in the morning (07 A.M.) versus evening (19, 23 P.M.) Material: the study comprised 47 children with diabetes mellitus type 1, treated with insulin (BBT therapy), aged between 4 and 18 years who use Glargine. Of the 47 patients, 41 (87,2%) inject glargine in the evening and 6 (12,8%) in the morning. The selection criteria for changing the hour of the glargine injection was the number of nocturnal hypoglycemias and the value of the basal glycemia. Method: we studied the glycemic profile for all the patients, evaluated the hourly average of the glycemic values for the glargine administered in the morning and in the evening. We also evaluated the number of morning and evening hypoglycemic values, the glycemic balance determined through the value of the HbA1. Results and discussion: we decided to administer glargine in the morning for the children under 6 years with temporary remission and those with longstanding diabetes, because the frequency of nocturnal hypoglycemia was higher than 4-5 episodes a week. The average of the glycemic values from the glycemic profile was relatively similar for the morning administration 135+/-65mg% and evening administration 138+/-25mg%. Still, the average of the basal glycemic values for the morning administration of glargine is comparatively low 117=/-31mg% compared to 146+/-68mg% for the evening administration. This is explained by the fact that at puberty, the growth hormone causes an increased resistance to insulin (dawn fenomenon). Most of the pubertal patients are treated with late action insulin analogue in the evening or before sleep. Conclusions: The decision towards morning or evening administration of glargine is influenced by the values of the basal glycemia. The morning administration of glargine is the therapeutic option for young children with diabetes type 1 in temporary remission or with longstanding diabetes. At puberty, glargine is best administered in the evening or before sleep.

HIPOGONADISMUL LA PACIENTII CU DIABET ZAHARAT Iulia Calota, Crina Filisan, Carmen Dobjanschi Spitalul Clinic N. Malaxa - Clinica Diabet, Nutritie, Boli Metabolice Bucuresti Premise: Hormonii steroidieni sunt cunoscuti a fi reglatori importanti ai metabolismului glucidic si lipidic. Nivele scazute ale testosteronului (T) sau ale SHBG (sex hormone binding globuline) au fost raportate la barbatii cu diabet zaharat tip 2. Hipoandrogenismul

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ramane deseori nediagnosticat si netratat deoarece simptomatologia este nespecifica si multifactoriala. Scopul studiului: evidentierea corelatiilor intre deficienta hormonilor androgeni si diabetul zaharat la barbat. Material si metoda: In acest studiu s-au determinat concentratiile serice ale SHBG si ale testosteronului liber la 12 barbatii cu diabet zaharat tip 1 ( media de varsta 36,45+/- 1.2 ani) si 34 cu diabet zaharat tip 2 ( media de varsta 56.8+/-1.9 ani) internati in Spitalul Clinic N. Malaxa. Testosteronul liber s-a calculat in functie de testosteronul total, SHBG si concentratia albuminei serice. Probele s-au recoltat a jeun, intre orele 08.00 si 10.00 am. Au fost luate in calcul durata de evolutie a diabetului, prezenta sindromului metabolic, tratamentul specific pentru diabet. S-a determinat prin bioimpedanta procentul de tesut adipos din masa corporala. S-au determinat markerii de inflamatie (Proteina C reactiva si fibrinogenul), profilul lipidic, hematocritul si hemglobina glicata. Rezultate: Valoarea medie a BMI a pacientilor cu diabet zaharat tip 1 si diabet zaharat tip 2 a fost de 27.56+/- 1.3 , respectiv 38,68+/- 2.34 kg/m2. Concentratia medie a testosteronului total la pacientii cu diabet zaharat tip 1 a fost de 20.69 +/- 1.23 respectiv 13.54+/- 1.99 nmol/l ( P<0,001) la cei cu diabet zaharat tip 2. Concentratia medie a testosteronului liber a fost de 0.576+/- 0.08 pentru pacientii cu diabet zaharat tip 1, respectiv de 0.264+/- 0.06 nmol/l la pacientii cu diabet zaharat tip 2. Hipogonadismul nu s-a asociat cu diabetul zaharat tip 1. Valorile scazute ale SHBG si testosteronului total sau asociat cu prezenta componentelor sindromului metabolic, in timp ce valorea testosteronului liber s-a corelat doar cu circumferinta abdominala. Nu s-au observat o corelatie intre hipogonadism si valoarea hemoglobinei glicate sau durata diabetului. Valorile scazute ale testosteronului sunt, de asemenea, corelate cu un procent crescut de tesut adipos din masa corporala. Valoarea proteinei C-reactive a fost crescuta la pacientii cu hipogonadism si s-a observat o corelatie inversa intre aceasta si concentratia testosteronului plasmatic. Corelatia inversa intre valoarea proteinei C-reactive si a testosteronului liber la pacientii cu diabet zaharat tip 2 sugereaza ca inflamatia poate avea un rol important in patogeneza hipogonadismului. Concluzii: Relatia intre diabet, sindromul metabolic si deficienta hormonilor androgeni este complexa. Hipogonadismul poate fi prezent in cazul unui numar semnificativ de pacienti cu diabet zaharat tip 2, dar nu si la cei cu diabet zaharat tip 1. Prevalenta hipogonadismului biochimic este mai mare in cazul determinarii testosteronului liber. Medicii diabetologi trebuie sa-si indrepte mai mult atentia asupra acestei afectiuni pentru a-si putea sfatui si indruma pacientii spre alte consulturi interdisciplinare.

THE RELATIONSHIP BETWEEN MALE HYPOGONADISM AND DIABETES MELLITUS

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Iulia Calota, Crina Filisan, Carmen Dobjanschi N. Malaxa Hospital, Diabetes Clinic Bucharest Background: Sex steroid hormones are known to be important regulators of the lipid and glucose metabolism. Lower levels of testosterone (T) or sex hormone-binding globulin (SHBG) have been reported in men with type 2 diabetes. The diagnosis of male hypoandrogenism often goes undiagnosed and untreated because the symptomatology is multifactorial and not specific. The aim of the study: is to describe relationship between androgen deficiency and diabetes in men. Design and Methods: In this study we assessed serum concentrations of SHBG, total and free testosterone in 12 type 1 diabetic (mean age 36.45 +/- 1.2 years) and 34 type 2 diabetic (mean age 56.8 +/- 1.9 years) subjects hospitalized in N.Malaxa Hospital. Calculation of free testosterone has been made from total testosterone, SHBG and albumin concentration. Blood samples have been taken between 08.00 and 10.00 h in the fasting state. Diabetes treatment, the presence of metabolic syndrome and subcutaneous fat mass measured by bioimpedance were noticed. HbA1c values, duration of diabetes, hemathocrit, lipid profile, inflammatory markers (the level of C-reactive protein and fibrinogen) were collected. Results: The mean BMI of type 1 and type 2 diabetic patients was 27.56 +/- 1.3 and 38.68 +/- 2.34 kg/m(2), respectively. The mean total testosterone concentration of type 1 and type 2 diabetic patients was 20.69 +/- 1.23 and 13.54 +/- 1.99 nmol/l, respectively (P < 0.001). The mean free testosterone concentration of type 1 and type 2 diabetic patients was 0.576 +/- 0.08 and 0.264 +/- 0.06 nmol/l, respectively (P < 0.001). Hypogonadism is not associated with type 1 diabetes. SHBG and total testosterone were associated with components of metabolic syndrome and free testosterone was associated only with waist circumference and triglycerides. The duration of diabetes or HbA1c are not related to hypogonadism. Low testosterone concentrations are also related to an increase in adiposity. C-reactive protein concentrations have been shown to be elevated in patients with hypogonadism and are inversely related to plasma testosterone concentrations. This inverse relationship between plasma free testosterone and C- reactive protein concentrations in patients with type 2 diabetes suggests that inflammation may play an important role in the pathogenesis of hypogonadism. Conclusions: The relationship between diabetes, the metabolic syndrome and androgen deficiency is complex. Male hypogonadism is a clinical condition that affects a significant number of men diagnosed with type 2 diabetes but not with type 1 diabetes. The prevalence of biochemical hypogonadism is greater if we use free testosterone. Diabetologists need to have a better understanding of this disease state to provide advice for their patients and to coordinate care with other clinicians.

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RELATIA DINTRE PROTEINELE ALIMENTARE SI GLICEMIA POSTPRANDIALA LA UN GRUP DE COPII CU DZ TIP 1 DIN ORADEA Larisa Dumbrava, Floare Husar, Elena Drambarean, Claudia Cladovan, Danuta Grebenisan, Bea Nilgesz, Iolanda Miklos Spitalul Clinic Municipal Oradea

Introducere. Aminoacizii sunt utilizati atat la sinteza si degradarea edificiului macromolecular proteic din celule cat si la furnizarea de energie, in lipsa unor cantitati suficiente de glucide sau lipide. Gluconeogeneza si o parte a cetogenezei presupun conversia aminoacizilor in hidrocarbonate. Scop. Lucrarea isi propune investigarea gluconeogenezei la copiii cu DZ tip 1 comparativ cu copiii fara diabet, la meniuri cu continut exclusiv proteic din surse diferite, respectiv carne de pui si peste oceanic. Material si Metoda. Un grup de 15 copii, 9 fete si 6 baieti, de 14+/-4 ani cu DZ tip 1 echilibrat (HbA1c=7+/-0.38) impreuna cu grupul control relativ omogen compus din 15 copii 7 fete si 8 baieti, de 15+/-2 ani fara diabet, consuma in prima zi un pranz din 200 g piept de pui la gratar, iar a 2-a zi un pranz din 200 g peste oceanic la gratar. Se determina la toti copiii glicemia pre- si postprandial la 1 si 2 ore, in acelasi ambient si conditii de repaus, fara administrirea dozei de insulina la copiii cu diabet. Rezultatele evidentiaza: o curba glicemica concav crescatoare dupa masa cu pui si o curba glicemica concav descrescatoare dupa cea cu peste, la copiii cu DZ. Dupa masa cu pui, scaderea glicemiei la o ora este nesemnficativa (p>0,05), iar la 2 ore glicemia crete semnificativ fa de de cea nregistrat preprandial sau la 1 or (p<0,05). Dup masa cu pete, glicemia scade semnificativ (p<0,001) la o or postprandial, iar la 2 ore crete semnificativ (p<0,05) fata de valoarea de la 1 ora. Iar la copiii fara diabet, evoluia glicemiei pe parcursul celor 2 evaluri a urmat o curb concav cresctoare dup masa cu pui i o linie discret ascendent dupa masa cu pete. Dup masa cu pui, la o or postprandial valoarea glicemiei scade nesemnificativ (p>0,05), iar la 2 ore crete semnificativ fa de de cea nregistrat preprandial sau la 1 or (p<0,04). Dup masa cu pete, atat la o or cat si la 2 ore glicemia crete nesemnificativ (p>0,05). Concluzii: Un meniu exclusiv proteic determina cresterea glicemiei postprandiale la 2 ore atat la pacientii cu DZ tip 1 cat si la non-diabetici, demonstrand conversia proteinelor in glucide. Scaderea glicemiei la 1 ora postprandial dupa ambele meniuri este probabil datorata timpului necesar pentru gluconeogeneza. Scaderea semnificativa a glicemiei la 1 ora dupa masa de peste se poate datora si proprietatilor protective ale acizilor polinesaturati din pestele oceanic, inclusiv in bolile autoimune. Cresterea glicemica semnificativa la 2 ore postprandial dupa masa de pui vs peste, atat la copiii cu cat si la cei fara DZ, evidentiaza un indice glicemic mai inalt la pui decat la peste. Cresterea usoara si liniara a glicemiei copiiilor fara diabet dupa masa de peste, vs curba 107

concav crescatoare dupa masa de pui, poate recomanda consumul de peste in profilaxia afectiunilor metabolice.

THE RELATIONSHIP BETWEEN FOOD PROTEIN AND POSTPRANDIAL GLYCAEMIA IN A GROUP OF TYPE 1 DIABETES CHILDREN FROM ORADEA Larisa Dumbrava, Floare Husar, Elena Drambarean, Claudia Cladovan, Danuta Grebenisan, Bea Nilgesz, Iolanda Miklos Municipal Clinic Hospital Oradea

Background. Amino acids are used both in synthesis and degradation of macromolecular protein building from the cells and also for supplying energy in lack of carbohydrates or fats. Gluconeogenesis and a part of ketogenesis suppose the conversion from amino acids in carbohydrates. The Aim is to investigate gluconeogenesis in type 1 diabetes children vs children without diabetes, after they ate an exclusive different protein meal, from chicken respectively ocean fish. Material and Methods. 15 children ( 9 girls and 6 boys, 14+/-4 years with type 1 diabetes (HbA1c=7+/-0.38) together with control group (15 children 7 girls and 8 boys, from 15+/-2 years without diabetes, ate in first day 200 g of white meat from grilled chicken and in the second day 200 g of grilled ocean fish. We measured glycaemia before and 1 and 2 hour after meal, in seam condition of ambient, without exercise and in children with diabetes without taking insulin. The results show an increase concave glycemic curve after chicken meal and decrease concave glycaemic curve after fish one, in children with diabetes. After chiken meal glycemia decrease insignificant (p>0,05) at 1 hour but increase significant at 2 hour vs both fasting and 1 hour postprandial glycemia (p<0,05). After fish meal, glycemia decrease significant (p<0,001) at 1 hour postprandial, but increase significant at 2 hour (p<0,05) vs 1 hour glycemia. In children without diabetes, glycemia draw an increase concave curve after chicken meal and a slowly increase line after the fish meal. After chiken meal glycemia decrease insignificant (p>0,05) at 1 hour but increase significant at 2 hour vs both fasting and 1 hour postprandial glycemia (p<0,04). After fish meal, glycemia increase insignificant both at 1 and 2 hour postprandial (p>0,05). In Conclusion: An exclusive protein meal leads to the increasing of 2 hours postprandial glycemia both in type 1 diabetes and non-diabetes children, proving conversion of proteins in carbohydrates. Significant decreasing of glycemia at 1 hour 108

after fish meal could be also determined by protective properties of polyunsaturated acids from ocean fish, inclusively in autoimmune diseases. Significant increasing of glycemia at 2 hours postprandial after chicken meal vs fish meal, both in diabetes and non-diabetes children, proves a higher glycemic index in chicken vs fish. Slowly and ruling increasing of glycemia in non-diabetes children after fish meal vs concave increasing curve after chicken meal, could recommended fish meals in prevention of metabolic diseases.

PREVALENTA COMPLICATIILOR MACROVASCULARE LA PACIENTII CU DZ TIP 1 SI TIP 2 CU SINDROM METABOLIC Popescu L.D., Ionescu I., Dovan D., Lichiardopol R.

Introducere : Sindromul metabolic reprezinta un important factor de risc pentru diabet zaharat tip 2 si boala cardiovasculara, putine date exista insa, despre importanta acestuia la pacientii cu diabet zaharat tip 1. Obiective : Evaluarea prevalentei complicatiilor macrovasculare la pacientii cu diabet zaharat (DZ) tip 1 si tip 2 cu sindrom metabolic. Material si metoda : Au fost inclusi in studiu 1429 pacienti, internati in perioada 01.01.2006-31.12.2006 la IDNBM N.Paulescu, dintre care 270 cu DZ tip 1 (136 barbati, 134 femei, varsta medie 42,5414,36 ani), iar 1159 cu DZ tip 2 (518 barbati, 641 femei, varsta medie 60,1710,48 ani). Sindromul metabolic a fost prezent la 50 (18,51%) dintre pacientii cu DZ tip 1, respectiv 970 (83,69%) dintre cei cu DZ tip 2, restul pacientilor nu au intrunit criteriile de diagnostic . S-au analizat urmatorii parametri prezenti in fisele de observatie ale pacientilor : varsta, sex, talie, indice de masa corporala (IMC), statusul de fumator, istoric de boala hipertensiva (HTA), hemoglobina glicata (HbA1c), colesterol total (CT), HDL-colesterol (HDL), LDL-colesterol (LDL), trigliceride (TG), raport TG/HDL, prezenta complicatiilor macrovasculare : boala cardiaca ischemica (BCI), infarct miocardic (IM), accident vascular cerebral (AVC), arteriopatie obliteranta membre inferioare (AOMI). Sindromul metabolic (SM) a fost definit conform criteriilor IDF. Rezultate : Pacientii cu SM si DZ tip 1, fata de cei cu SM si DZ tip 2 au avut o vechime semnificativ mai mare a bolii (p<0.01), relatie ce s-a mentinut si atunci cand s-a efectuat diferentierea pe sexe . De asemenea, pacientii cu SM si DZ tip1 au avut fata de cei cu DZ tip 2 si SM un nivel semnificativ mai mare al HbA1c (p<0.01), CT (p<0.05), LDL (p<0.05) si TG (p<0.05). Difrente semnificative au fost si in ceea ce priveste fumatul (p<0.01) si HTA (p<0.05), la cei cu DZ tip 2 si SM, fata de cei cu DZ tip 1 si SM. Barbatii cu SM si DZ tip 1 au avut fata de cei DZ tip 2 un nivel semnificativ mai mare al

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HbA1c (p<0.01), CT (p<0.05), TG (p<0.001) si al raportului TG/HDL (p<0.01). Femeile cu SM si DZ tip 1 fata de cele cu DZ tip 2 au avut un nivel seric al LDL semnificativ mai mare (p<0.05) si un nivel semnificativ mai mic al HDL (p<0.05), fara diferente semnificative statistic in ceea ce priveste HbA1c, CT, TG. Nu au existat diferente semnificative statistic intre cele doua grupuri analizate in ceea ce priveste prezenta compicatiilor macrovasculare (BCI, IM, AVC, AOMI), relatie ce s-a pastrat si atunci cand s-au analizat diferentele barbati, femei. Pacientii cu DZ tip 1 si SM au avut fata de cei fara SM o prevalenta semnificativ mai mare a BCI (OR 3.09; 95% CI: 1.30-7.34) si HTA (OR 5.21; 95% CI: 2.71-10.00). Pacientii cu DZ tip 2 au avut, de asemenea, o prevalenta semnificativ mai mare in ceea ce priveste BCI (OR 1.74; 95% CI: 1.26-2.41), respectiv HTA (OR 5.53; 95% CI: 3.98-7.69).Nu au fost diferente semnificative statistic intre grupurile analizate in ceea ce priveste prevalenta IM, AVC, AOMI. In urma analizei tertilelor de distributie ale taliei, pacientii cu DZ tip 1 din tertila superioara de distributie au avut o prevalenta mai mare a BCI (OR 0.10; 95% CI: 0.040.27) si HTA (OR 0.12; 95% CI: 0.04-0.34), iar cei cu DZ tip 2 o prevalenta mai mare a HTA (OR 0.35; 95% CI: 0.25-0.49). Concluzii : Sindromul metabolic reprezinta un factor de risc pentru afectarea cardiovasculara atat la pacientii cu DZ tip 1, cat si la pacientii cu DZ tip 2.

THE PREVALENCE OF MACROVASCULAR COMPLICATIONS IN TYPE I AND TYPE II DIABETES PATIENTS WITH METABOLIC SYNDROME Popescu L.D., Ionescu I., Dovan D., Lichiardopol R. Clinic of Diabetes, Nutrition and Metabolic Diseases, N.C. Paulescu Institute, Bucharest, Romania

Introduction: The metabolic syndrome groups numerous cardiovascular risk factors and frequently associates type II diabetes mellitus (DM2). There are though few data regarding its importance and frequency in type I diabetes mellitus patients (DM1). Aim: Comparative evaluation of prevalence of macrovascular complications in DM1 and DM2 patients with metabolic syndrome (SM). Methods: In the study there were included 1429 patients, which were admitted in 2006 in the diabetes department of the institute., of which 270 with DM1 (136 men, 134 women, mean age 42.54+14.36 years) and 1159 with DM2 (518 men, 641 women, mean age 60.17+10.48). SM was present in 50 (18.51%) of the DM1 patients, respectively 970 (83.69%) of the DM2 patients, the rest of the patients not meeting the diagnostic criteria.

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The following parameters in the patients file were analyzed: age, sex, waist circumference, hypertension history, HbA1c, total cholesterol (CT), HDL cholesterol, LDL cholesterol, triglycerides (TG), triglyceride/HDL cholesterol ratio, coronary heart disease (CHD), myocardial infarction (MI), stroke, peripheral arteriopathy disease (PAD). SM was defined according to the IDF criteria, with the specification that in DM1 patients, glucose blood level was not considered as diagnostic criterion. Results: Patients with DM1 and SM had lower mean age (49.1613.24vs.60.2510.33, p<0.001) compare to patients with DM2 and SM (p<0.001) and a significantly longer disease duration (12.589.63vs.9.398.21, p<0.01), relation that maintained in the sex difference also. The first group, compared to the second group, had significantly higher HbA1c (10.522.23vs.9.512.40, p<0.01), CT (223.5661.53vs.206.4355.05, p<0.05), LDL cholesterol (144.1045.71vs.126.9743.06, p<0.05) and TG (294.45311.79 vs. 199.25p170.72, p<0.05) levels. There were significant differences in hypertension history (HTA, OR 2.09;95% CI:1.15-3.81) in patients with DM2 and SM compared to patients with DM1 and SM. There were no significant differences between the two groups regarding CHD, stroke, PAD. In exchange patients with DM1 and values of waist circumference in the superior distribution tertile compared to the values in the lower distribution tertile, had a significantly higher prevalence of CHD (OR 10.18;95% CI: 3.76-27.56). Both DM1 and DM2, in the superior distribution tertile of waist circumference compared with those in the lower distribution tertile had a higher prevalence of HTA (OR 8.43;95% CI: 2.92-24.33, OR 2.89; 95% CI: 2.06-4.04). After analyzing TG/HDL distribution tertiles, patients with DM1 in the superior tertile compared with the patients in the lower tertile had a higher prevalence of CHD (OR 2.36; 95% CI: 1.02-5.46), hypertension history (OR 2.26; 95% CI: 1.07-4.77) and the patients with DM2 had a higher prevalence of CHD (OR 1.66; 95% CI: 1.22-2.27), PAD (OR 1.65; 95% CI: 1.05-2.59), MI (OR 3.43; 95% CI: 1.56-7.55) and hypertension (OR 2.34; 95% CI: 1.65-3.31). Patients with SM (DM1 or DM2) compared with patients without SM had a significantly higher prevalence of CHD (OR 3.09; 95% CI: 1.30-7.34), (OR 1.74; 95% CI: 1.26-2.41). There were no statistically significant differences between the analyzed groups regarding the prevalence of stroke and PAD. Conclusions: Metabolic syndrome represents a risk factor for cardiovascular disease and is associated with a higher prevalence of macrovascular complications both in type I and type II diabetes mellitus patients.

DIABETUL ZAHARAT SI SARCINA Asistent educator. Macavei Lidia Asistent educator. Cont Loredana Euromedica Hospital Baia Mare

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INTRODUCERE: Gravidele cu diabet zaharat tip 1 sau tip 2 sunt supuse unor riscuri extreme de ridicate in ceea ce priveste sanatatea lor si a copiilor ( risc de fat macrosom , malformatii intrauterine ale fatului , posibilitate de polihidroamnios , hipoxia fatului la nastere ,intreruperea de sarcina) SCOPUL LUCRARII: Am vrut sa determinam in ce masura educatia pacientelor cu diabet zaharat pe parcursul sarcinii ajuta la evitarea cresterii excesive in greutate a gravidei , a dezechilibrului glicemic si a altor complicatii care pot aparea pe parcursul sarcinii MATERIAL SI METODE : In colaborare cu Cabinetul de Obstetrica Ginecologie din cadrul clinicii am selectionat un grup de 16 paciente cu diabet zaharat (5 cu tip1 si 11 cu tip 2 ) in perioada 01.01.2006 01.09.2008 . Am facut ancheta nutritionala , chestionar alimentar cu privire la tipul alimentatiei (din punct de vedere calitativ si cantitativ ), continutul in macronutrienti si micronutrienti, ajustarea dozelor de insulina , determinarea hipoglicemiilor , monitorizarea greutatii . REZULTATE : Am constatat ca 6 paciente proveneau din mediul rural si 10 din mediul urban cu varste cuprinse intre 20 respectiv 36 ani .Dintre acestea 60% la prima sarcina , 30% la a2a sarcina si 10% la a-3a sarcina. Am observat : la pacientele din mediul rural 67% consuma excesiv slanina , untura si mamaliga evitand fructele - 70% au luat foarte mult in greutate (aprox.60kg) - 72% prezinta dezechilibru glicemic la pacientele din mediul urban 80 % au un regim alimentar mai echilibrat cu 2 3 mese /zi - 62% prezinta o greutate adecvata perioadei de gestatie - 84% au un profil glicemic mai bun

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CONCLUZIE: Am constatat lipsa de informare si dezinteres al pacientelor din mediul rural cu privire la educatia specifica diabetului zaharat in perioada sarcini

DIABETS MELLITUS AND PREGNANCY Asistent Educator: Macavei Lidia Asistent Educator: Cont Loredana Euromedica Hospital Baia Mare

INTRODUCTION: Pregnant women with type 1 diabet mellitus and type 2 are subject to extremely high risks in tems of their health an children (risk of macrosomia , intrauterine malformations of the fetus , possibly polihidroamnios , fetal hypoxia at birth , the interruption of pregnancy). AIMS: I wanted to determine to what extent education for patients with diabetes during pregnancy help prevent excessive weight increase of pregnant women , the imbalance in blood gloucose and other complications that can occur during pregnancy. MATERIALS AND METHODS: In collaboration with the Cabinet of Obstetric Gynecology in our clinic we selected 16 pacients with diabetes (5 with type 1 and 11 with type 2), between 01.01.2006 01.09.2008. I did nutritional survey ,questionnaires food on the type of food (in qualitative and quantitative) , cotent macronutrienti and micronutrients , adjustment of insulin , the hypo , monitoring weight. RESULTS : I found that 6 pacients were from rural and 10 urban , aged between 20 an 36 years of these 60% - 1 of pregnancy , 30% in the 2-d pregnang and 10% in the 3-rd task. I obsverved in pacients from rural area 67% consume excessive slanina , larg and polenta avoiding fruits 70% they took so mucht weight (aprox60kg) 72% the imbalance in blood glucose

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- in pacients from urban area 80% balance diet with 2 -3 meals/day - 62% presents a weight appropriate period of gestation - 84% a better glycemic profile CONCLUSION: I found the lack of information and carelessness on the port of patients from rural area on education specify diabetes during pregnancy

INTENSIFICAREA INSULINOTERAPIEI CU HUMALOG MIX 50 LA PACIENII CU DIABET ZAHARAT TIP 2 Autori: Dr. Livia Duma1; Dr. Anca Colda2; Dr. Cristina Ni1.
1

Centrul Medical de Diabet Cluj; 2Institutul Naional de Diabet, Nutriie i Boli Metabolice Prof. N. Paulescu Premize: Diabetul zaharat de tip 2 (DZ tip 2) reprezint o problem de sntate public din ce n ce mai important datorit asocierii unei morbiditi i mortaliti crescute. Din acest motiv, ghidurile internaionale de bun practic medical recomand obinerea unor valori int sczute pentru parametrii echilibrului metabolic la pacienii cu DZ tip 2. n ciuda multiplelor opiuni terapeutice disponibile, un procent redus de pacieni se nscriu n limitele recomandate de ghidurile internaionale. Obiectiv: n vederea obinerii unui control metabolic mai bun se poate opta pentru intensificarea insulinoterapiei cu Humalog Mix 50 n 3 prize, ca soluie alternativ n condiiile n care terapia cu 2 prize de insulin premixat nu mai poate asigura eficiena scontat. Material i metod: Se prezint cazurile a trei pacieni cu DZ de tip 2 din dou centre universitare au primit tratament intensificat cu Humalog Mix 50 n 3 prize n condiiile unui control metabolic insuficient. S-au nregistrat parametrii clinici i biologici nainte i dup intensificarea insulinoterapiei cu Humalog Mix 50. Acetia au fost: greutatea corporal (Kg), circumferina abdominal (cm), valorile glicemice determinate prin monitorizare continu a glicemiei (CGMS) i profile glicemice cu 7 puncte, HbA1c i profil lipidic complet. Rezultate: HbA1c a sczut de la o valoare medie de 9.03% la 7.23% dup 3 luni de la intensificarea insulinoterapiei cu Humalog Mix 50. Valorile glicemice nregistrate prin CGMS au demonstrat scderea glicemiei a jeun ct i a glicemiei postprandiale. n ceea ce privete greutatea corporal s-a nregistrat o reducere cu 1.5 Kg la unul dintre pacieni.

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Concluzii: Humalog Mix 50 n 3 prize prandiale reprezint o soluie de atingere a obiectivelor glicemice la pacienii cu DZ tip 2 necontrolai n regim cu 2 prize de insulin premixat. Aceasta nou abordare terapeutic determin creterea calitii vieii i a complianei pacienilor la tratament printr-un regim relativ comod i sigur.

INTENSIVE INSULIN TREATMENT WITH HUMALOG MIX 50 TID IN TYPE 2 DIABETES PATIENTS Authors: Livia Duma1; Anca Colda2; Cristina Ni1
1

Cluj Diabetes Medical Center, Cluj-Napoca; 2National Institute of Diabetes, Nutrition and Metabolic Disease Prof. N. Paulescu, Bucharest Background: Type 2 diabetes (T2DM) is a growing public health problem due to increased mortality and mobidity. Therefore international guidelines recommend lower targets for metabolic control. Despite many therapeutic options a small percentage of patients meet the recommended goals. Objective: Humalog Mix 50 TID is a solution for intensive insulin treatment in order to achieve better glycemic control when premixed insulins twice daily no longer provide adequate control. Method: We report three cases of T2DM patients with poor metabolic control in two academic centers who were treated with Humalog Mix 50 TID. Clinical and biological measurements were performed before and after insulin therapy intensification with Humalog Mix 50. Body weight (Kg) and waist circumference (cm) were measured. Continous blood glucose monitoring (CGMS), 7 points glycemic profiles, lipid profiles were performed. Results: Mean HbA1c value decreased from 9.03% la 7.23% within 3 months of Humalog Mix 50 TID treatment. CGMS showed improved glycemic control with both decreased fasting and postprandial blood glucose. A decrease in body weight of 1.5 Kg was reported for one patient. Conclusions: Humalog Mix 50 TID provides improved glycemic control for T2DM patients treated with two injections of premixed insulin daily. This new therapeutic approach increases quality of life and compliance with treatment in a safe and convenient way.

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IMPORTANTA COMUNICARII IN INGRIJIREA COPILULUI DIABETIC As.med. Luminita Ursache, licentiata in Comunicare Sociala si Relatii Publice Spitalul de Copii "Sf Maria Iasi, Clinica III Sanatatea este bunul suprem al omului, care nu are pret, iar viata este valoarea cea mai mare a lumii materiale. Ingrijire medicala fara constiinta nu se poate si uneori nu e deajuns doar buna intentie si multa munca . Mai este nevoie ca ceea ce facem sa fie realizat in asa fel incat sa fim pe deplin intelesi de toti cei implicati in aceasta relatie de interdependenta: echipa medicala , copilul bolnav, familia acestuia. In domeniul nostru de activitate orice interventie verbala: intrebare , remarca , subliniere, mai apoi manevra medicala are un scop bine stabilit , bine cunoscut de cei din interiorul sistemului sanitar , insa greu de inteles uneori , de acceptat , iar mai apoi de cooperat- de catre cei din afara. De aceea este atat de important ca personalul din sistemul sanitar sa stie sa comunice in situatiile speciale in care isi desfasoara activitatea , sa invete sa asculte si sa vorbeasca cat mai bine , mai mult decat in orice alta profesie . Aceasta comunicare specifica este utilizata de personalul spitalului ca modalitate de lucru. Ingrijirea copilului cu diabet pune probleme deosebite personalului nostru . Este important ca familia copilului diabetic sa fie capabila sa faca fata schimbarilor intervenite odata cu aparitia bolii . Copiii de varsta scolara pana la adolescenta accepta mai usor informatiile legate de boala si tratament . Problemele copilului cu diabet sunt si de natura emotionala , de adaptare , deoarece situatia lor este neobisnuita- tuturor copiilor le este teama de spital , de injectii ,iar ei incep sa inteleaga ca viata lor se schimba iremediabil odata ce au fost confirmati cu diabet . Nu mai sunt liberi ca inainte , nu mai pot manca ce isi doresc si de obicei este greu de acceptat aceasta decizie. Pot simti frustrare , pot deveni ostili si se pot razvrati: De ce eu? De ce mi s-a intamplat mie? Din aceasta perspectiva trebuie vazuta importanta comunicarii cu micii diabetici . Familia poate avea o atitudine asemanatoare in momentul confirmarii diabetului pentru ca starea de boala este o situatie pentru care nimeni nu este pregatit. De aceea prima reactie este de negare , a doua de culpabilitate si in cele din urma , de adaptare . Vor invata impreuna sa se impace si sa traiasca cu aceasta boala. Se stabileste astfel o perioada indelungata de colaborare cu copilul diabetic si cu familia acestuia in care personalul spitalului sa confirme profesionalismul , compasiunea , speranta .

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THE IMPORTANCE OF C OMUNICATION IN CARRYING FOR DIABETIC CHILD Luminita Ursache- licentiate in Social Comunicatioon and Public Relation Healts represents the priceless supreme humansassetand life is the biggest value in the material word. There is not medical care without any consciousness and sometimes just good intention and hard work are not enough . We need to do things in such way so we could be fully understood by all the people involved in this interdependent relationship: medical team , ill child and this family . In our field any verbal intervention: a question , a remark , an emphasis , and after that any medical intervention have a purpose: well known by those from medical system but harder to be understood or accepted and then to cope with by those outside this system . Thats why its so important for the medical staff to know how to communicate in special situations , to learn how to listen and talk as good as possible . And this needed in this profession more than others . This specific communication is used by the medical team as a working tool. Carrying for the diabetic child raises up special problems for our staff. It is important that the family of child with diabetes to be able to deal with the changes in their life brought by the disease. Young children cope better with the disease and treatment related information . The diabetic childrens problems are of emotional or adaptation nature because they find themselves in an unusual situations. All the kids are afraid to go the hospital , all of them are afraid of shots and then they start to understand that once they got this diagnosis their life changes for good . They dont feel free as before , they cantt eat what they want and this restriction is hard to accept. They feel frustration and could get hostile . They ask:Why me? , Why this happened to me?. The importance of communication with diabetic children has to be seen from this perspective. The family can have the same attitudine when they have the confirmation of the diagnosis . Being iil is usually a situation you are not ready for . They will learn together to deal and live with this disease. A long period of collaboration with the sick child and his family is needed and the medical team has to act professionally and show compassion and hope.

IMPACTUL BOLII CRONICE DE RINICHI ASUPRA PACIENTILOR CU DIABET ZAHARAT: EXPERIENTA UNUI CENTRU DE DIABET DIN ROMANIA Munteanu M., Schiller Ad., Ionutiu L., Mihaescu A., Olariu N., Cocos O., Tarta L.

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Universitatea de Medicina si Farmacie Timisoara, Spitalul Judetean Timisoara, Centrul de Diabet Timisoara Prevalenta DZ in Romania este in jur de 6-8% in populatia generala; ea este in crestere si, potrivit unor date recente, riscul relativ al acestor pacienti este de 1.5 (Collins Am. J Adv. Stud. Med. 2003, 3 (3C) S 194-197). DZ a fost considerat un factor de risc pentru aparitia BCR din 2002, nu numai datorita nefropatiei diabetice, ci si HTA, nefritelor interstitiale, leziunilor vasculare (cu prevalenta crescuta in DZ). In populatia cu risc cardiovascular crescut, prevalenta BCR a fost mai mare la pacientii diabetici, comparativ cu cei fara DZ ( 39.54% vs 22.40%)(Tonelli et al JASN 2005, 16: 37483754). Riscul relativ pentru BCR este 2, insa atunci cand se asociaza DZ, el creste la 2.4. Asadar, BCR asociata DZ necesita o atentie speciala. In centrul nostru, prevalenta BCR asociata DZ a fost foarte ridicata comparativ cu datele publicate : 45.82%, iar in lucrarea de fata ne-am propus sa analizam posibilele cauze ale acestui rezultat. Atat BCR cat si DZ, sunt factori de risc pentru boala cardiovasculara (BCV). In analizele combinate ale studiilor WOSCOPS, CARE si LIPID, rata evenimentelor cardiovasculare a fost semnificativ mai mare atat la pacientii cu DZ, cat si la cei cu BCR comparativ cu pacientii fara DZ si fara BCR- 25.2% si 21.2% vs. 16.7%. Rata evenimentelor CV a crescut la 31.7% in cazul asocierii BCR si DZ. In centrul nostru, prevalenta BCV (boala coronariana-BC, insuficienta cardiaca congestiva -ICC , boala vasculara priferica-BVP si boala vasculara cerebrala-BVC) a fost semnificativ mai crescuta la pacientii cu BCR comparativ cu cei fara BCR (BC-49.65% vs. 27.68% p<0.0005, ICC-23.12% vs. 5.93% p<0.0005, BVP-21.08% vs. 10.73% p=0.0006 si BVC7.14% vs. 3.67% p=0.036). Dislipidemia este un factor de risc cunoscut atat pentru BCV, cat si pentru progresia BCR. Pe de alta parte, aproape toti pacientii cu BCR dezvolta o forma intens aterogena de dislipidemie. In centrul nostru, dislipidemia a fost identificata la 68.13% dintre pacientii cu DZ (hipercolesterolemie 18.73%, hipertrigliceridemie 19.50%, dislipidemie mixta 30.34%) fara ca prevalenta sa difere semnificativ intre cele doua grupuri (cu BCR , respectiv fara BCR). RFG a pacientilor cu DZ si BCR a corelat negativ cu valorile colesterolului total. Prevalenta cea mai mare a BCR s-a observat la grupul cu dislipidemie mixta, iar prevalenta BCV a fost maxima la grupul cu hipercolesterolemie. Abordarea terapeutica este discutabila. La urmaririle ulterioare, prevalenta si severitatea BCR la pacienii cu DZ a crescut. Dupa 4 ani de urmarire, prevalenta BCR in centrul nostru a crescut de la 45.82% la 54.60%, la fel ca si severitatea BCR. Pe perioada de urmarire, mortalitatea de toate cauzele a fost semnificativ mai crescuta la pacientii cu BCR (17.85%) comparativ cu cei fara BCR (4.83%). Mortalitatea de toate cauzele s-a corelat pozitiv cu varsta, HbA1c, colesterolul total si negativ cu RFG. BCR asociata DZ necesita o atentie speciala dintr-o perspectiva multidisciplinara , in scopul de a-i reduce severitatea si prognosticul infaust.

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THE IMPACT OF CHRONIC KIDNEY DISEASE ON DIABETES MELLITUS PATIENTS THE EXPERIENCE OF A SINGLE ROMANIAN DIABETES CENTRE Munteanu M., Schiller Ad., Ionutiu L., Mihaescu A., Olariu N. Cocos O. Tarta L. University of Medicine and Pharmacy Timisoara, County Hospital Timisoara, Diabetes Care Centre Timisoara The prevalence of DM in Romania is about 6-8% of the general population and rising and according to recent data the relative risk of these patients is considered 1.5 (Collins Am. J Adv. Stud. Med. 2003, 3 (3C) S 194-197). Since 2002 DM is considered risk factor for the development of chronic kidney disease (CKD) not only related to diabetic nephropathy but to hypertension, interstitial nephritis, vascular lesions (highly prevalent in DM) also. In the high cardiovascular risk population the prevalence of CKD was reported higher in DM patients as compared to no DM patients (39.54% vs. 22.40%) (Tonelli et al JASN 2005, 16: 3748-3754). The relative risk of CKD is 2 but associated to DM is 2.4. So CKD associated to DM needs a special attention. In our centre the prevalence of CKD associated to DM was found to be very high 45.82% as compared to published data and in our paper we discus the possible causes. Both CKD and DM are risk factors for cardiovascular disease (CVD). The CV event rate was found to be significantly higher in both DM and CKD as compared to no DM no CKD in the combined analysis of WOSCOPS, CARE and LIPID trials (25.2% and 21.2% vs. 16.7%). When associated (DM and CKD) the event rate vas even higher 31.7%. In our centre the prevalence of CVD (i.e. coronary artery disease CAD, congestive heart failure CHF, peripheral vascular disease PVD and cerebral vascular disease CEVD) was found significantly higher in CKD patients as compared to no CKD ones (CAD - 49.65% vs. 27.68% p<0.0005, CHF - 23.12% vs. 5.93% p<0.0005, PVD 21.08% vs. 10.73% p=0.0006 and of CEVD - 7.14% vs. 3.67% p=0.036). Dyslipidemia is known to be a risk factor for CVD and it was found to be a risk factor for the progression of CKD. On the other hand almost all CKD patients develop a severely atherogenic form of dyslipidemia. In our centre dyslipidemia was identified in 68.13% of DM patients (18.73% hypercholesterolemia, 19.50 % hypertriglyceridemia and 30.34% mixed dyslipidemia) but the prevalence did not significantly differ in the two groups (CKD, no CKD). The GFR of DM patients with CKD correlated negatively with total cholesterolemia. The highest prevalence of CKD was found in the mixed dyslipidemia and of CVD was in the hypercholesterolemia group. The issue of therapy is discussed. On follow up, the prevalence and severity of CKD increases in DM patients. In a 4 years follow up, in our centre the prevalence of CKD significantly increased from 45.82% to 54.60% and the same was true for severity of CKD. During the follow up period the all cause mortality was significantly higher in CKD patients as compared to no 119

CKD ones (17.85% vs. 4.83%). All cause mortality was positively correlated with age, HbA1c and cholesterol levels and negatively with eGFR CKD associated to DM needs special attention from a multidisciplinary team in order to improve severity and poor prognosis.

PARTICULARITI DE EVOLUIE A DIABETULUI ZAHARAT TIP 1 ASOCIAT CU ALTE BOLI AUTOIMUNE - PREZENTARE DE CAZ Autori: Mdlina Punescu1, Aura Reghin1,2, Alice Albu1, Daniela Voicu3, Tudor Arbna1,2 ,Simona Fica1,2 1 Spitalul Universitar de Urgen Elias Bucureti, 2 UMF Carol Davila Bucureti, 3 Institutul Naional de Hematologie Transfuzional Prof Dr C.T. Nicolau Bucureti Introducere: Contextul autoimun de apariie a diabetului zaharat de tip 1 determin asocierea acestuia cu alte boli autoimune: anemie pernicioas, boal celiac, tiroidit autoimun, alopecie, insuficien gonadal, vitiligo, boal Addison i altele. Pacienii sunt n majoritate femei si cea mai frecvent asociere este cu tiroidita Hashimoto. In peste jumtate din cazuri, diabetul zaharat de tip 1 precede boala autoimun cu civa ani. Scopul: Lucrarea i propune prezentarea unui caz de diabet de tip 1 care, n evoluie, asociaz mai multe afeciuni autoimune. . Material i metod: Pacienta I.E n vrst de 68 de ani, a fost diagnosticat iniial cu diabet zaharat tip 1 i tiroidit Hashimoto cu hipotiroidie iar dup 3 ani asociaz anemie Biermer. Diagnosticul a fost stabilit pe baza examenului clinic, a analizelor de laborator (glicemie, hemoglobin glicozilat, anticorpi antitiroperoxidaz ATPO, TSH, hemogram, frotiu de snge periferic, anticorpi anticelul parietal gastric) i investigaii: ecografie tiroidian, endoscopie digestiv superioar. Ulterior, pacienta prezint anticorpi antinucleari i transaminaze dublu fa de normal n absena makerilor virali hepatici, stabilindu-se diagnosticul de hepatit autoimun. Rezultate: Sub tratament cu insulin, hormoni tiroidieni i vitamin B12, evoluia pacientei a fost favorabil cu ameliorarea manifestrilor clinice i mbuntirea parametrilor paraclinici. S-a constatat c la fiecare asociere de boal autoimun controlul metabolic (exprimat prin hemoglobina glicozilat) s-a deteriorat, necesarul de insulin a crescut, schema de

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insulin a trebuit intensificat. Prin tratarea bolii autoimune asociate s-a reuit ameliorarea controlului glicemic. Concluzii: Din cauza frecventei asocieri a diabetului de tip 1 cu alte afeciuni autoimune trebuie avut n vedere investigarea acestor pacieni (mai ales cnd debutul bolii este la vrsta adult) pentru depistarea precoce a posibilelor boli autoimune. Tratarea acestora permite obinerea unui control metabolic mai bun i prevenirea apariiei complicaiilor pe termen lung.

CHARACTERISTIC FEATURES OF EVOLUTION OF TYPE 1 DIABETES ASSOCIATED WITH SEVERAL AUTOIMMUNE DISEASES - case presentation Introduction: Type 1 diabetes mellitus is an autoimmune disease and it is frequently associated with other autoimmune diseases: pernicious anemia, celiac disease, autoimmune thyroiditis, alopecia, gonadal failure, vitiligo, Addison disease. Patients are mainly women and the most frequent association is Hashimoto`s disease. In over 50% of cases, type 1 diabetes mellitus precedes autoimmune disease with several years. Aim: to present the evolution of type 1 diabetes in a patient who developed several autoimmune diseases. Methods: Patient I.E, aged 68, was initially diagnosed with type 1 diabetes mellitus and Hashimoto`s thyroiditis and 3 years later, she associated Biermer`s anemia. The diagnosis was based on the clinical examination, laboratory tests (glycemia, glycosylated hemoglobin, thyroid peroxidase antibody - TPOAb, TSH, hemogram, peripheral smear, anti-gastric parietal cell antibodies) and investigations such as: thyroid ultrasound, upper gastrointestinal endoscopy. Further, the presence of antinuclear antibodies and raised transaminases, in the absence of hepatic viral markers, confirmed the diagnosis of autoimmune hepatitis. Results: The patient received insulin, thyroid hormones and cyanocobalamin treatment, and the symptomatology and paraclinic tests were significantly improved. Each time a new autoimmune disease was diagnosed, a deterioration of metabolic control was noticed (high glycosylated hemoglobin), and the patient needed to increase the daily dose of insulin. The improvement of glycemic control was possible with adequate treatment of the associated autoimmune diseases.

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Conclusions: Due to the frequent association of type 1 diabetes mellitus with other autoimmune diseases, functional screening for autoimmune diseases in these patients must be done, especially in those with type 1 diabetes onset at advanced age. The treatment of associated diseases allows a better metabolic control and prevention of long-term complications.

EVALUAREA DIABETULUI ZAHARAT NOU DESCOPERIT N JUDEUL GALAI N PERIOADA IANUARIE IUNIE 2008 Magdalena Moroanu1, Marta Aganencei2
1

Spitalul Judeean de Urgen Galai, 2Spitalul Municipal Tecuci

Introducere. Diabetul zaharat (DZ) prin frecvena i caracterul evolutiv de lung durat constituie o problem major i o preocupare continu pentru depistarea bolii, pentru evaluarea clinico biologic i prevenirea complicaiilor cronice micro i macroangiopatice. Scop. Analiza cazurilor noi de diabet n perioada 01.01.2008 30.06.2008 conform protocolului studiului EPIDIAB, pentru a evalua: - incidena bolii - frecvena complicaiilor cronice la diagnosticarea bolii - comorbiditi prezente - structura terapeutic Material i metod. un total de 1987 subieci au fost diagnosticai cu diabet zaharat in perioada 01 ianuarie- 30 iunie 2008 s-au analizat: - aspectele epidemiologice legate de tipul de diabet, sex, vrst; - screening-ul complicaiilor cronice; - asocierea cu alte entiti ale sindromului metabolic i bolii cardiovasculare; - structura terapeutic.

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Rezultate. Numr total nou depistai DZ tip 1 Numr total tip 1 14 0 14

Sex % 0,9 0 0,7 M 10 0 10 F 4 0 4

Galai Tecuci TOTAL

1564 423 1987

DZ diabet zaharat, % - procent din totalul persoanelor cu diabet zaharat nou depistate, M masculin, F feminin, DZ tip 2 (ADO, insulin i ADO, insulin, diet) Numr total nou depistai Sex Numr total tip 2 1550 423 1973 M F ADO Insulina / Insulina +ADO Diet

Galai Tecuci Total

1564 423 1987

767 203 970

783 220 1003

889 271 1160

57 12 69

514 129 643

DZ diabet zaharat, ADO antidiabetice orale, M masculin, F feminin,

DLP HTA (%) Galai Tecuci TOTAL 1383 (89,2%) 184 (43,4%) 1567 (78,8%) BCV (%) 128 (8,26%) 115 (27,1%) 243 (12,2%) Efectuat Nr. (%) 1122 (72,4%) 311 (73%) 1433 (72,1%) Pozitiv Nr. (%) 839 (54,1%) 186 (43,9%) 1025 (51,5%)

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HTA hipertensiune arterial, BCV boal cardiovascular, DLP dislipidemie, Nr. Retinopatie Nefropatie Neuropatie Efectuat Nr. Pozitiv Nr. Efectuat Nr. Pozitiv Nr. Efectuat Nr. Pozitiv Nr. (%) (%) (%) (%) (%) (%) Galai Tecuci Total 114 (7,35%) 58 (13,7%) 172 (8,6%) 18 (1,16%) 2 (0,47%) 20 (1.0%) 927 (59,8%) 176 (41%) 1103(55,5 %) 24 (1,55%) 3 (1,76%) 27 (1,3%) 702 (44,8%) 198 (46,8%) 900 (45,2%) 104 (6,6%) 84 (19,8%) 188(9,4 %)

numr, % - procent Nr. numr, % - procent Educaie 1987 cazuri (100%); automonitorizare - 276 diabetici (13,43%).

Concluzii. 1. n primele 6 luni ale anului 2008 s-au nregistrat 1987 cazuri noi de diabet, cu 852 cazuri mai mult fa de anul precedent. 2. La diagnosticare se constat complicaii cronice n procente relativ crescute precum i asocierea frecvent a hipertensiunii arteriale, bolii cardiovasculare i dislipidemiei. 3. Screening-ul complicaiilor cronice i al comorbiditilor necesit a fi mai activ pentru depistarea mai precoce a acestora n scopul mbuntirii managementului clinic i reducerii riscului cardiovascular. 4. Iniierea terapiei cu metformin la debutul DZ tip 2 n 2008 s-a realizat ntr-un procent apreciabil mai mare dect n anul precedent. 5. Extinderea epidemiologic a diabetului zaharat impune elaborarea unor programe mai active de depistare la grupele cu risc crescut, folosirea celor mai adecvate metode de educaie i popularizarea aspectelor legate de complicaii i comorbiditi.

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THE ANALYSIS OF NEWLY DIAGNOSED DIABETES MELLITUS IN GALATI COUNTY BETWEEN JANUARY-JUNE 2008 Magdalena Moroanu1, Marta Aganencei2
1

Emergency Clinical County Hospital Galai, 2City Hospital Tecuci

Background. Diabetes mellitus (DM) represents a progressive long-term disease with a high prevalence in general population. Diagnosing diabetes constitutes a major problem and causes continuous concern for appropriate clinical and biological evaluation and the prevention of diabetes microvascular and macrovascular chronic complications. Aims. The analysis of newly diagnosed cases of diabetes between January ,1st June, 30th 2008 according to EPIDIAB Study protocol, in order to evaluate: - the incidence of the disease - the frequency of chronic complications at disease at onset - concomitant comorbidities - therapeutic regimens Material and method.

A total of 1987 subjects were newly diagnosed with diabetes between January ,1 June, 30th 2008 We analyzed: - epidemiological aspects regarding diabetes type, age, sex - the screening of chronic complications - the association with other disorders included in metabolic syndrome - therapeutic structure
st

Results.

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Total no. newly diagnosed

Type 1 diabetes Total no. type 1 % 14 0 14 0,9 0 0,7

Sex M 10 0 10 F 4 0 4

Galai Tecuci TOTAL

1564 423 1987

No. number, % - percent from total number of newly diagnosed persons, M masculin, F - feminin

Total no. newly diagnosed Total no. type 2 Galai Tecuci Total 1564 423 1987 1550 423 1973

Type 2 diabetes (OAD, insulin and OAD, insulin, diet) Sex M F OAD Insulin / Insulin +OAD Diet

767 203 970

783 220 1003

889 271 1160

57 12 69

514 129 643

No. number, OAD oral antidiabetic drugs, M masculin, F - feminin

DLP HT (%) Galai Tecuci TOTAL 1383 (89,2%) 184 (43,4%) 1567 (78,8%) CVD (%) 128 (8,26%) 115 (27,1%) 243 (12,2%) Screened No. (%) 1122 (72,4%) 311 (73%) 1433 (72,1%) Pozitive No. (%) 839 (54,1%) 186 (43,9%) 1025 (51,5%)

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HT Hypertension, CVD cardiovascular disease, DLP dyslipidemia, no. number, % Retinopathy Nephropathy Neuropathy Screened No. Pozitive No. Screened No. Pozitive No. Screened No. Pozitive No. (%) (%) (%) (%) (%) (%) Galai Tecuci Total 114 (7,35%) 58 (13,7%) 172 (8,6%) 18 (1,16%) 2 (0,47%) 20 (1.0%) 927 (59,8%) 176 (41%) 1103(55,5 %) 24 (1,55%) 3 (1,76%) 27 (1,3%) 702 (44,8%) 198 (46,8%) 900 (45,2%) 104 (6,6%) 84 (19,8%) 188(9,4 %)

- percent No. number, % - percent

Education performed in 1987 cases (100%); self-monitoring performed by 276 persons with diabetes (13,43%).

Conclusions.

1. In first 6 months of 2008 we recorded 1987 cases of newly diagnosed diabetes, with 852 cases exceeding last year report for the same period. 2. We found relatively high percentages of chronic complications, as well as frequent association of hypertension, cardiovascular disease and dyslipidemia at diagnose. 3. We need a more active screening of chronic complications and comorbidities for an early diagnose, to improve clinical management and reduce cardiovascular risk. 4. The initiation of metformin therapy (percent of total cases) in newly diagnosed type 2 diabetes patients in 2008 was appreciably higher than in the previous year.

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5. The epidemiologic extent of diabetes impose elaboration of more active screening programs in high risk population groups, use of most adequate educational methods and largely discuss and disseminate the aspects regarding complications and comorbidities.

ACTIVITATEA FIZIC N RELAIE CU FACTORI INDIVIDUALI, EXTERNI I CU STATUSUL PONDERAL N POPULAIA GENERAL A JUDEULUI GALAI Magdalena Moroanu1, Andreea Moroanu2, Octavian Alexe3
1

Spitalul Clinic de Urgen Galai, 2Centrul Clinic de Diabet, Nutriie i Boli Metabolice Cluj-Napoca, 3Facultatea de Kinetoterapie, Universitatea Dunrea de JosGalai

Introducere. Stilul de via sedentar are o influen important n creterea ponderal. Obezitatea i supraponderea sunt favorizate de reducerea activitii fizice, care a devenit o caracteristic a stilului de via n societatea actual. Promovarea i stimularea activitii fizice au beneficii importante n reducerea ponderal, n prevenia creterii ponderale, n reducerea riscului cardiovascular (prin reducerea insulinorezistenei) i n terapia obezitii i a supraponderii. Obiective. Evaluarea activitii fizice n funcie de factori individuali, externi (sex, vrst, domiciliu, anotimp) i a relaiei acesteia cu starea ponderal n populaia judeului Galai. Material i metod. Lotul de studiu de 311 persoane a fost selecionat pe baza reprezentativitii generale pentru populaia adult a judeului Galai n funcie de grupe de vrst, sex i domiciliu (urban, rural). Activitatea fizic a fost cuantificat ca frecven (3 ori/sptmn) i ca durat ( 30 minute) (rspuns cotat cu da i nu) conform fiei de screening a obezitii a Asociaiei Romne pentru Studiul Obezitii (ARSO). Datele antropometrice s-au obinut prin msurarea greutii, nlimii, circumferinei abdominale (CA) i calculul indicelui de mas corporal (IMC). Categoriile strii ponderale n funcie de IMC au fost subpondere, normopondere, suprapondere, obezitate, adaptate dupa clasificarea OMS. Categoriile de risc ale obezitii abdominale au fost : risc sczut (CA < 80 cm la femei, < 94 cm la brbai), risc mediu (CA 80-88 cm la femei, 94-102 cm la brbai) i risc crescut (CA > 88 cm la femei, > 102 cm la brbai). Categoriile de risc mediu i crescut indic obezitatea abdominal (visceral). Prelucrarea statistic a datelor s-au realizat n programul SPSS 13.0. Nivelul semnificaiei statistice a fost realizat pentru p<0.05.

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Rezultate. Analiza activitii fizice n grupul studiat a artat c 59,16% din persoane efectueaz activitate fizic mai mult de 3 ori pe sptmn i mai mult de 30 minute. Barbaii fac activitate fizic n procent mai mare (61.82%) dect femeile (58.0%) (p>0.05). n general, ambele sexe n ambele medii efectueaz activitate fizic n proporie mai mare de 50%. S-a remarcat o pondere mai mare a efectuarii activitii fizice la brbai n mediul urban (65.67%) fa de mediul rural (55.81%), n timp ce la femei activitatea fizic este efectuat comparabil n mediul urban (58.87%) i rural (56.58%) (uor mai crescut n mediul urban). S-a constatat o prevalena a efecturii activitii fizice mai mare la grupele de vrst 20-29 ani (77.14%), 50-59 ani (67.39%) i 60-65 ani (57.89%) fa de grupele de vrst 30-39 ani (52.05%), 40-49 ani (51.78%) i peste 65 ani (44.68%), precum i n timpul verii (67.34%) fa de perioada de iarn (51.82%). Aceste diferene au fost semnificative statistic (p<0.05). Relaia activitate fizic stare ponderal. Persoanele care fac activitate fizic au IMC semnificativ mai mic (25.82 5.48 kg/m2) fa de cele care nu fac activitate fizic (28.40 6.19 kg/m2). Persoanele care fac activitate fizic sunt normoponderale, subponderale i supraponderale ntr-un procent semnificativ mai mare dect cele care nu fac activitate fizic (acestea sunt ntr-un procent mai mare incluse n categoria de obezitate) (p<0.05). Persoanele care fac activitate fizic au CA semnificativ mai mic (89.98 15.49 cm) fa de cele care nu fac activitate fizic (94.48 17.17 cm) i sunt, ntr-un procent mai mare, incluse n categoriile de risc sczut i mediu (p<0.05). Concluzii. Activitatea fizic este efectuat n procent mai crescut de ctre brbai, n special n mediul urban, la tineri (20-29 ani) i ntre 50-65 ani i mai mult n timpul verii. Persoanele care fac activitate fizic sunt frecvent normo- i supraponderale i asociaz CA cu risc sczut i mediu, n timp ce persoanele sedentare sunt asociate mai frecvent cu obezitatea i cu obezitatea abdominal cu risc crescut. Identificarea i evaluarea factorilor care influeneaz activitatea fizic constituie parte integrant din programele de management i prevenie a obezitii.

PHYSICAL ACTIVITY IN RELATION WITH INDIVIDUAL AND EXTERNAL FACTORS AND WITH PONDERAL STATUS IN GENERAL POPULATION OF GALATI COUNTY Magdalena Moroanu1, Andreea Moroanu2, Octavian Alexe3
1

Emergency Clinical County Hospital Galai, 2Clinical Center of Diabetes, Nutrition and Metabolic Diseases Cluj-Napoca, 3Kinetotherapy Faculty, Dunrea de Jos University Galai

Background. Sedentary lifestyle is an important factor in weight gain. The decrease of physical activity which became a lifestyle feature in nowadays society 129

induces the appearance of obesity and overweight. Promoting and stimulating the increase of physical effort bring important benefits in losing weight, in preventing weight gain, in reducing cardiovascular risk (by decreasing insulinresistance) and in obesity and overweight management. Aims. The assessment of physical activity in relation with individual and external factors and with ponderal status in general population of Galati County. Method and study group. Study group included 311 persons selected based on general representativity for age, sex and residence (urban, rural) in adult population of Galati County. Physical activity was quantified by yes/no answer regarding carrying out of exactly or more than 30 minutes of physical effort at least 3 times a week according to Obesity Screening Record form Romanian Association for the Study of Obesity. We assessed anthropometric parameters: weight, height, waist circumference (WC) and calculated body mass index (BMI). We adapted OMS criteria for quantifying ponderal categories based on BMI values: underweight, normalweight, overweight and obesity. The risk categories of WC were as following: low risk ( WC < 80 cm in women and < 94 cm in men), medium risk (WC between 80-88 cm in women and between 94-102 cm in men) and high risk (WC > 88 cm in women and > 102 cm in men). Medium and high risk categories indicate abdominal (visceral) obesity. Statistical analysis was performed with SPSS 13.0 program. Statistical significance was reached for p<0.05. Results. The analysis of physical activity level showed that 59.16% of the subjects perform physical effort more than 30 minutes of physical effort at least 3 times a week. Men carry out physical activity in a higher extent (61.82%) than women (58.0%) (p>0.05). Generally, more than 50% of both men and women performed physical activity. We noticed a higher percent of affirmative answers in men from urban area (65.67%) than from rural area (55.81%), while women had comparable affirmative answers in urban (58.87%) and rural areas (56.58%) (slightly higher for urban residence). We noticed a higher prevalence of physical activity for age between 20-29 years (77.14%), 50-59 years (67.39%) and 60-65 years (57.89%) than for age between 30-39 years (52.05%), 40-49 years (51.78%) and over 65 years (44.68%) as well as during summer time. These differences were statistically significant (p<0.05). The relation between physical activity and ponderal status. Persons who carry out physical effort had significantly lower BMI (25.82 5.48 kg/m2) than those who do not carry out physical effort (28.40 6.19 kg/m2). The persons who perform physical activity are normalweight and overweight in a significantly higher extent, while persons who do not carry out physical effort as required are more frequently obese (p<0.05). WC is significantly lower (89.98 15.49 cm) and is included more in low and medium risk categories in subjects who perform physical activity as needed than in those who do not (94.48 17.17 cm) which are included more in high risk category (p<0.05). Conclusions. Men perform more frequent physical activity, especially in urban area. Persons with age between 20-29 years and between 50-65 years, as well as during summer time carry out physical effort more frequently. Active persons are more often normalweight and overweight and are included in low and medium risk categories of WC, while sedentary persons are more often obese and have high risk of WC values 130

(abdominal obesity). Identification and assessment of factors which influence physical activity are important tools in the prevention and management of obesity.

DETERMINAREA COMPOZITIEI CORPULUI LA PACIENTI CU SINDROM METABOLIC, PRIN METODA BIOIMPEDANTEI, UTILIZAND APARATELE IN BODY 3.0, OMRON BF500, BCM Fresenius Medical Care Autori: M. Ispas, N. State, C. Serafinceanu , C. Constantin ,D. Cheta Afiliatia autorilor: 1)UMF Carol Davila 2)Institutul de Diabet Prof N. Paulescu 3)Spitalul Clinic de Urgenta Militar Central Carol Davila

Introducere. Studiul compozitiei corporale prin bioimpedanta este o metoda frecvent utilizata, folosind aparate de productie diferita. Rezultatele pot influenta decizia terapeutica. Materiale si metode. Pentru 68 de pacienti cu sindrom metabolic (IDF 2005), selectati dintre cei admisi in Institutul N.Paulescu, (33b/35f), cu varsta medie de 55,1710,98 ani, s-a examinat compozitia corporala cu ajutorul a trei aparate diferite (In Body 3.0, Omron BF 500, BCM-Fresenius Medical Care). Dintre acestia, 51 (22b/29f) au fost inclusi in studiu. Au fost exclusi pacienti care nu au urmat tot protocolul, cu amputatii sau cu dispozitive electronice implantate. Au fost determinati parametri: greutatea, IMC, volumele lichidiene intra- si extracelular, precum si masa, respectiv procentul de tesut adipos. Datele obtinute au fost prelucrate statistic cu SPSS 13.0 folosind testul T student modificat. Rezultate. S-au luat drept referinta rezultatele obtinute de la aparatul In Body 3.0, unde media volumului total de lichid (VTL) a fost de 42,128,38l, cu distributia 28,215,52 (lichid intracelular LIC) si 13,892,98 (lichid extracelular LEC) (rezultate diferite pentru p<0,05 fata de referinta). Rezultatele BCM Fresenius au fost: volumul total de lichid de 37,477.76 l , distribuit astfel: 20,44,23 l (LIC), respectiv 17,43,26l (LEC). IMC (kg/m) a fost diferit: 30,414,55 (In Body) vs. 30,484,55 (Omron) (pentru p<0,05). Greutatea totala determinata: 84,214,54 kg (In Body) si 84,4214,56 kg (Omron) (p<0,05). Procentul de tesut adipos a fost de 31,997,67% (In Body) vs. 35,1410,03% (Omron) (p<0,05), respectiv, vs. 38,298,05% (Fresenius) (p<0,05), cu o valoare mai mare la sexul feminin vs. sexul masculine. Pentru sexul feminin rezultatele au fost 40,827,48 (Omron) vs. 35,316,46% (In Body) (p<0,05). Pentru sexul masculin rezultatele au fost 27,287,12% (Omron) vs. 27,346,69 (In Body) (p<0,05). Raportul talie-sold: 0,990,06 (masculin) vs. 0,980,09 (feminin). 131

Aparatele In Body si Omron au furnizat date diferite si despre metabolismul bazal: 1452,94211,25, respectiv 1653,52241,82 kcal/zi (p<0,05).

Concluzii. Cntrirea sub ap i DEXA (dual-energy x-ray absorptiometry) sunt exemple de metode validate tiinific si desi costisitoare i inaccesibile, raman a fi standardele de aur n determinarea compoziiei corporale;. Majoritatea diferentelor obtinute pe lotul studiat sunt semnificative statistic, sugerand ca metoda bioimpedantei utilizata de diversi producatori necesita imbunatatirea tehnicii folosite. Discutii. Datele furnizate servesc pentru aprecierea compozitiei corporale a pacientilor cu sindrom metabolic, bioimpedanta fiind o metoda simpla, neinvaziva si usor de folosit, dar alegerea oricarui aparat dintre cele folosite, va influenta conduita terapeutica in practica. Finanare: Studiu realizat in cadrul proiectului PNCDI2 52164/2008

DETERMINATION OF BODY COMPOSITION IN PATIENTS WITH METABOLIC SYNDROME, BY BIO-IMPEDANCE METHOD, using In Body3.0, Omron BF 500, BCM Fresenius Medical Care devices Authors: M. Ispas, N. State, C. Serafinceanu , C. Constantin , D. Cheta Authors affiliation: 1) Carol Davila University of Medicine and Pharmacy; 2) N. Paulescu National Institute of Diabetes; 3) Carol Davila Central Military Emergency Clinical Hospital.

Introduction. The study of body composition by bio-impedance is a frequently used method, using different devices. The results may influence the therapeutic choice. Materials and methods. 68 patients (33m/35w) with metabolic syndrome (IDF2005) were selected from patients admitted in the N. Paulescu Institute. Their mean age was of 55.1710.98years. Their body composition was examined, using three different devices: In Body 3.0, Omron BF 500, BCM-Fresenius Medical Care. 51 patients (22m / 29w) were included in the study. Patients with amputation, implanted electronic devices or incomplete determinations were excluded. Weight, BMI, intra- and extracellular liquid volumes, fat tissue were also determined. All data were statistically processed using T Student test in SPSS 13.0.

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Results. As reference the results of In Body 3.0 were used, where total body water (TBW) was of 42.128.38L, distributed as following: 28.215.52L IBW (intracellular body water) and 13.892.98L EBW (extracellular body water) (results different for p<0.05 than reference). The results of BCM Fresenius were: 37.477.76L, distributed in 20.44.23L (IBW) and 17.43.26 L(EBW). The results for BMI (kg/m) were different: 30.414.55(In Body) and 30.484.55(Omron) (p<0.05). Determined weight was similar: 84.214.54 kg(In Body) and 84.4214.56 kg(Omron) (p<0.05). The percentage of fat tissue was different 31.997.67%(In Body) vs. 35.1410.03%(Omron) (p<0.05), respectively 38.298.05%(Fresenius) (p<0.05), with a higher value for women than men: 35.316.46%(In Body), 40.827.48%(Omron) (p<0.05) (women) vs. 27.346.69% (In Body), 27.287.12% (Omron) (p=0.054) (men). Were also recorded different information regarding Resting Metabolism Rate: 1452.94211.25 kcal/day (In Body) and 1653.52241.82 kcal/day (Omron) (statistically different for p<0.05). Conclusions. Under water weighting and DEXA (dual-energy-x-ray absorptiometry) remain the gold standard procedures for determining body composition, but they are inaccessible and expensive. The majority of obtained results are statistically different.

Discussions. The obtained data are helpful in determining body composition in patients with metabolic syndrome, as bio-impedance is a simple, noninvasive, easy to use method, but choosing any of the devices above will influence the therapeutic behavior in clinical practice. Supported by: Grant PNCDI2 52164/2008 from the Romanian Research Ministry.

STUDIU ASUPRA AUTOIMUNITATII ASOCIATE IN DIABETUL ZAHARAT TIP 1 LA COPIL SI ADOLESCENT

Mariana Andreica, Nicolae Miu, Simona Cainap, Bogdan Lucian, Lucia Slavescu, Claudia Bolba, Rodica Cornean, Tudor L. Pop Clinica Pediatrie II, UMF "Iuliu Hatieganu", Cluj-Napoca

Asocierile autoimune la pacientii cu DZ sunt bine cunoscute si pot apare fie individual, fie incadrate in sindroame. Aceste asocieri implica gene ale complexului major de histocompatibilitate(MHC) de tipul HLA DR si DQ. Cele mai frecvente asocieri

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sunt reprezentate, in ordinea incidentei, de tiroidita autoimuna, boala celiaca, boala Addison si alte autoimunitai ca artrita cronica idiopatica sau vitiligo. S-au luat in studiu un numar de 49 de copii si adolescenti internati in Clinica Pediatrie II, Cluj- Napoca, in perioada 2005-2007. S-a efectuat screening pentru tiroidita autoimuna prin masurarea anticorpilor antitireoperoxidaza(TPO), antitireoglobulina(TG), a TSH si a fT4. Screeningul pentru boala celiaca s-a realizat prin masurarea anticorpilor antiendomisium(AEM) si antitransglutaminaza tisulara(ATGt). Screeningul pentru boala Addison s-a efectuat prin masurarea cortizolemiei bazale si ulterior prin determinarea anticorpilor antiadrenali. De asemenea s-a realizat si screening pentru artrita cronica idiopatica si alte colagenoze prin detectarea factorului reumatoid, a anticorpilor antinucleari si a anticorpilor antiADN ds. In paralel s-a efectuat monitorizarea metabolica a tuturor pacientilor. Tiroidita autoimuna a fost descoperita la 3 pacienti(6,1%). Din acestia , un pacient a prezentat forma hipertiroidiana(b. Basedow-Graves), unul a prezentat asociat boala celiaca iar unul a prezentat sindrom poliendocrin autoimuin tip II. Boala celiaca a fost prezenta la 4 pacienti(8,1%). Boala Addison a fost prezenta la 1 pacient(2%) in contextul sindromului poliendocrin autoimun tip II. Doi pacienti au prezentat artrita cronica idiopatica(4%) si 1 pacient a prezentat leziuni de vitiligo(2%). In concluzie, autoimunitatile asociate diabetului zaharat tip I la copil si adolescent impune efectuarea unor teste screening dupa protocoale bine standardizate, atat pentru ameliorarea controlului bolii cat si pentru prevenirea precocitatii complicatiilor micro si macrovasculare ulterioare.

STUDY OF ASSOCIATED AUTOIMMUNITY AND TYPE 1 DIABETES MELLITUS IN CHILDREN AND ADOLESCENTS

Mariana Andreica, Nicolae Miu, Simona Cainap, Bogdan Lucian, Lucia Slavescu, Claudia Bolba, Rodica Cornean, Tudor L. Pop 2nd Pediatric Clinic, University of Medicine and Pharmacy Iuliu Hatieganu, ClujNapoca Associated autoimmunity and type 1 diabetes mellitus(T1DM) is well known and can exist individually or combined in syndromes. This association implicates the involvement of different genes of the major histocompatibility complex(MHC) such as human leukocyte antigen(HLA) DR and DQ. The most common autoimmune associations are represented by autoimmune thyroid disease, celiac disease, Addisons disease and others such as chronic idiopathic arthritis or vitiligo.

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We have studied 49 children and adolescents admitted in The 2nd Pediatric Clinic in Cluj-Napoca between 2005 and 2007. We have performed screening tests for autoimmune thyroid disease by measuring thyroid peroxidase and thyroglobulin autoantibodies, TSH and free T4. The celiac disease screening has been made by antiendomysial and trans-glutaminase autoantibodies and Addisons disease screening has been made by basal cortisol and antiadrenal antibodies. We have also performed screening for chronic idiopathic arthritis and other collagen diseases by determining rheumatoid factor and antinuclear and anti DNA antibodies. Autoimmune thyroid disease was discovered in 3(6,1%) patients of which 1 had hyperthyroid function(Basedow-Graves disease), one associated celiac disease and one had autoimmune polyendocrine syndrome type II. Celiac disease was revealed in 4 patients(8,1%). Addisons disease was revealed in one patient(2%) and was associated in the autoimmune polyendocrine syndrome type II. Two patients(4%) had had chronic idiopathic arthritis and one of them had vitiligo lesions. As a conclusion, associated autoimmunity and T1DM should emphasize the important role of screening in this patients, by well standardized protocols, in order to ameliorate the natural history of T1DM and to prevent the precocity of developing micro and macro- vascular complications of the disease.

CORELAIA DINTRE CIRCUMFERINA ABDOMINAL (CA) I RAPORTUL TG/HDL>3 CA MARKERI AI INSULINOREZISTENEI CU PERTURBRILE METABOLISMULUI GLUCIDIC Autori: Mihaela L. Bcu, Simona G. Popa, R.I. Dinu, Camelia Pnu, Maria Moa Spitalul Clinic Judeean de Urgen Craiova, Clinica Diabet Nutriie Boli Metabolice Premise i scop. Scopul studiului a fost de a urmri corelaia existent ntre dou modaliti de evaluare a insulinorezistenei: 1. circumferina abdominal (CA); 2. raportul TG/HDL > 3 i perturbrile metabolismului glucidic. Material i metod. Am luat n studiu 119 subieci internai n Clinic n perioada iunie 2008 -septembrie 2008, cu suspiciune de diabet zaharat (DZ), cu vrsta medie dev st de 54,50 13,68 ani (limite 20-80 ani), dintre care 60 brbai (50,4%) i 59 femei (49,6%). Menionm c au fost exclui subiecii cu suspiciune de perturbri secundare ale metabolismului glucidic. Parametrii investigai au fost: vrsta, sex, date antropometrice (nlime, greutate, indexul masei corporale - IMC, CA), test de toleran oral la glucoz TTGO cu 75 g glucoz (glicemie a jeun, glicemie la 1or, glicemie la 2 ore), trigliceride (TG), colesterol total, HDL colesterol.

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Rezultate i discuii. Din cei 119 subieci, 15 (12,60%) au prezentat toleran normal la glucoz (TNG), restul 104 subieci (87,40%) prezentnd modificri ale metabolismului glucidic, astfel: 46 subieci (38,65%) au fost diagnosticai cu diabet zaharat (DZ), 24 ( 20,16%) subieci cu alterarea glicemiei a jeun (IFG), 3 (2,52%) subieci cu scderea toleranei la glucoz (IGT), 23 (19,32%) subieci cu intoleran combinata la glucoz (CGI= IFG+IGT) i 8 (6,72%) subieci cu disglicemie. Corelaia dintre circumferina abdominal (CA) i raportul TG/HDL>3 ca markeri ai insulinorezistenei si perturbrile metabolismului glucidic Caracteristica Brbai (numr 60) CA (cm) Numr (%) TG/ HD L >3 TNG DZ IFG IGT CGI disglicemi e TG/ HD L <3 TNG DZ IFG <94 16 (26,66%) 4 (25%) 0 (0%) 1 (25%) 2 (50%) 0 (0%) 1 (25%) 0 (0%) 12 (75%) 2 (16,66%) 4 (33,33%) 4 (33,33%) 94-101 11 (18,33%) 8 (72,72%) 1 (12,5%) 2 (25%) 2 (25%) 0 (0%) 2 (25%) 1 (12,5%) 3 (27,27%) 0 (0%) 0 (0%) 2 (66,66%) 102 33 (55%) 22 (66,66%) 1 (4,54%) 7 (31,81%) 4 (18,18%) 1 (4,54%) 7 (31,81%) 2 (9,09%) 11 (33,33%) 1 (9,09%) 4 (36,36%) 2 (18,18%) <80 6 (10,16%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 6 (100%) 5 (83,33%) 0 (0%) 1 (16,66%) Femei (numr 59) 80-87 8 (13,55%) 2 (25%) 0 (0%) 1 (50%) 0 (0%) 0 (0%) 0 (0%) 1 (50%) 6 (75%) 1 (16,66%) 1 (16,66%) 2 (33,33%) 88 45 (76,27%) 14 (31,11%) 2 (14,28%) 5 ( 35,71%) 2 (14,28%) 0 (0%) 4 (28,57%) 1 (7,14%) 31 (68,88%) 2 (6,45%) 21 (67,74%) 3 (9,67%)

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IGT CGI disglicemi e

0 (0%) 1 (8,33%) 1 (8,33%)

1 (33,33%) 0 (0%) 0 (0%)

0 (0%) 3 (27,27%) 1 (9,09%)

0 (0%) 0 (0%) 0 (0%)

1 (16,66%) 1 (16,66%) 0 (0%)

0 (0%) 4 (12,9%) 1 (3,22%)

Dintre brbaii cu CA 102 cm, 66,66% au prezentat raport TG/HDL > 3, spre deosebire de femei, la care nu am observat corelaie ntre CA i raportul TG/HDL > 3 (31,11%). Att la brbai ct i la femei, am observat corelaie ntre CA 102 cm, respectiv CA 88 cm i perturbrile metabolismului glucidic, indiferent ns de valoarea raportului TG/HDL. Concluzii. Prezena obezitii abdominale i implicit a perturbrilor metabolismului lipidic, impun investigarea metabolismului glucidic prin efectuarea TTGO-ului, n vederea depistrii perturbarilor metabolismului glucidic n stadii precoce.

THE CORRELATION BETWEEN WAIST CIRCUMFERENCE (WC) AND TG/HDL>3 RATIO AS INSULINRESISTANCE MARKERS WITH THE DISTURBANCES OF GLYCEMIC METABOLISM Autors: Mihaela L. Bicu, Simona G. Popa, R.I. Dinu, Camelia Panus, Maria Mota Department of Diabetes Nutrition Metabolic Diseases, Clinical County Emergency Hospital Craiova Background and aim. The objective of this study was the assessment of the correlation between waist circumference (WC) and TG/HDL>3 ratio as insulinresistance markers with the disturbances of glycemic metabolism. Material and method. The study was performed 119 subjects which were admitted in Diabetes Clinical in June 2008 - September 2008 period, in observation for Diabetes Mellitus (DM), with an average age stdev of 54,50 13,68 (limits 20-80) years, from which 60 men (50,4%) and 59 women (49,6%). We mentioned that were excluded the subjects with suspicion on secundary disturbances of glycemic metabolism. The following parameters were analyzed: age, gender, anthropometric parameters (height, weight, body mass index-BMI, WC), oral glucose tolerance test (OGTT) using 75g glucose (fasting glycemia, glycemia at 1 hour, glycemia at 2 hours), tryglicerides (TG), total cholesterol, HDL cholesterol. Results and discussions. From the 119 subjects studied, 15 (12,60%) subjects have a normal glucose tolerance (NGT), the rest of 104 (87,40%) subjects presented

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disturbances of glycemic metabolism hereby: 46 subjects (38,65%) was diagnosed with DM, 24 subjects (20,16%) with impaired fasting glucose (IFG), 3 subjects (2,52%) with impaired glucose tolerance (IGT), 23 subjects (19,32%) with combined glucose intolerance (CGI=IFG+IGT) and 8 subjects (6,72%) with dysglycemia. The correlation between waist circumference (WC) and TG/HDL>3 ratio as insulinresistance markers with the disturbances of glycemic metabolism Characteristics Men ( 60 subjects) WC (cm) Number (%) TG/ HD L >3 TNG DZ IFG IGT CGI disglicemi e TG/ HD L <3 TNG DZ IFG IGT <94 16 (26,66%) 4 (25%) 0 (0%) 1 (25%) 2 (50%) 0 (0%) 1 (25%) 0 (0%) 12 (75%) 2 (16,66%) 4 (33,33%) 4 (33,33%) 0 (0%) 94-101 11 (18,33%) 8 (72,72%) 1 (12,5%) 2 (25%) 2 (25%) 0 (0%) 2 (25%) 1 (12,5%) 3 (27,27%) 0 (0%) 0 (0%) 2 (66,66%) 1 102 33 (55%) 22 (66,66%) 1 (4,54%) 7 (31,81%) 4 (18,18%) 1 (4,54%) 7 (31,81%) 2 (9,09%) 11 (33,33%) 1 (9,09%) 4 (36,36%) 2 (18,18%) 0 (0%) <80 6 (10,16%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 6 (100%) 5 (83,33%) 0 (0%) 1 (16,66%) 0 (0%) Women ( 59 subjects) 80-87 8 (13,55%) 2 (25%) 0 (0%) 1 (50%) 0 (0%) 0 (0%) 0 (0%) 1 (50%) 6 (75%) 1 (16,66%) 1 (16,66%) 2 (33,33%) 1 (16,66%) 88 45 (76,27%) 14 (31,11%) 2 (14,28%) 5 ( 35,71%) 2 (14,28%) 0 (0%) 4 (28,57%) 1 (7,14%) 31 (68,88%) 2 (6,45%) 21 (67,74%) 3 (9,67%) 0 (0%)

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(33,33%) CGI dysglicem ia 1 (8,33%) 1 (8,33%) 0 (0%) 0 (0%) 3 (27,27%) 1 (9,09%) 0 (0%) 0 (0%) 1 (16,66%) 0 (0%) 4 (12,9%) 1 (3,22%)

From the men with WC 102 cm, 66,66% showed TG/HDL > 3 ratio, comparative with the women, on which have not observed the correlation between WC and TG/ HDL > 3 ratio (31,11%). Both women and men we observed the correlation between WC 102 cm, respectively WC 88 cm with the disturbances of glycemic metabolism, no matter the value on TG/HDL ratio. Conclusions. The presence of abdominal obesity and implicitly of the disturbances of lipidic metabolism, makes necessary the investigation of the glycemic metabolism through effectuation of the OGTT, with a view to early tracking of the disturbances of glycemic metabolism.

COMPARAREA VARIABILITII GLICEMICE LA SUBIECI CU I FR MODIFICRI ALE METABOLISMULUI GLUCIDIC Autori: Mihaela L. Bcu, Simona G. Popa, Sigina R. Grgavu, R.I. Dinu, Maria Moa Spitalul Clinic Judeean de Urgen Craiova, Clinica Diabet Nutriie Boli Metabolice

Premise i scop: Variabilitatea glicemic la persoanele fr diabet zaharat este corelat cu rspunsul metabolic postprandial. n vederea cuantificrii exacte a variabilitii glicemice se pot calcula indici specifici: MAGE (Mean Amplitude Glycemic Excursion=Amplitudinea Medie a Excursiilor Glicemice), MODD (Mean of Daily Differences = Media Diferenelor Zilnice), MIME (Mean Indices of Meal Excursions = Indicele Mediu Al Excursiilor Glicemice Postprandiale). MAGE evalueaz excursiile glicemice majore din cursul unei zile, excluznd excursiile glicemice minore. MODD apreciaz variaiile glicemice n acelai moment din zile diferite, la acelai subiect. MIME evalueaz excursiile glicemice corelate cu ingestia de alimente. Scopul studiului este de a compara: 1.variabilitatea glicemic la doi subieci cu diet fr restricie de hidrai de carbon (HC), unul cu toleran normal la glucoz (NGT normal glucose tolerance) i unul cu alterarea glicemiei a jeun (IFG impaired fasting glucose); 2. variabilitatea glicemic la subiectul cu IFG - diet fr restricie de HC versus diet cu restricie de HC (200g HC/zi).

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Material i metod: Am calculat cinci indici specifici de evaluare a variabilitii glicemice (MG, DS, MAGE, MODD, MIME) la cei 2 subieci, cu diet fr restricie de HC: unul cu NGT i unul cu IFG, de acelai sex, comparabili ca vrst, IMC, condiii de stress; de asemenea, am calculat cei cinci indici la subiectul cu IFG, cu diet cu 200 g HC/zi. La cei doi subieci s-a montat CGMS (continuous glucose monitoring system = sistem de monitorizare continu a glicemiei) pe o perioad de 72 ore. Menionm c subiectul cu IFG a avut montat CGMS de 2 ori, timp de 72 ore, o dat cu dieta fr restricie de HC, i o dat cu dieta cu 200 g HC/zi. n ziua a doua a montrii CGMS-ului am efectuat test de toleran la glucoz pe cale oral (TTGO) la cei doi subieci, cu 75 g glucoz pulvis. Pentru calculul MG, SD i MAGE au fost analizate nregistrrile CGMS obinute n a doua zi, n timp ce pentru calculul MODD nregistrrile din ziua a doua i a treia. Pentru calculul MIME am evaluat excursiile glicemice postprandiale dup masa cu 75g HC, ct i dup TTGO (cu 75 g glucoz). Evaluarea indicilor de variabilitate glicemic: MAGE media aritmetic a excursiilor glicemice ascendente majore pe 24 ore. MODD media diferenelor absolute ntre glicemii determinate n acelai moment, la un interval de 24 ore. MIME s-a calculat n funcie de 3 elemente: G (diferena dintre valoarea glicemic maxim postprandial i valoarea preprandial a glucozei); T (timpul n care se obine peak-ul glicemic postprandial); - G (diferena dintre glicemia la 1 or dup atingerea peak-ului glicemic i valoarea glicemic maxim postprandial). MG (media glicemic) i DS (deviaia standard a glicemiilor). Rezultate i discuii: Subiect MG DS (mg/dl ) MAG E (mg/dl ) MOD D (mg/dl ) MIME (mg/dl) dup masa cu 75g HC G (mg/dl ) 39 T min G (mg/dl ) 13 MIME (mg/dl) dup TTGO cu 75 g glucoza G (mg/dl ) 61 T min - G (mg/dl ) 62

IFGdieta 107,53 42,71 fara restrictie 19,68 de HC NGTdieta 100,21 fara restrictie 11,5 de HC 8 IFG- dieta cu 978 200g HC 21

22,58

40

50

11,15

22

25

12

13

20

13

23

17,08

29

50

20

Subiectul cu IFG prezint excursii glicemice zilnice mai numeroase si mai ample (MAGE crescut) i reproductibilitate de la o zi la alta a profilului glicemic mai redus

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(MODD crescut) comparativ cu subiectul cu NGT. Comparnd MIME dup TTGO (cu 75g glucoz) i dup masa cu 75g HC, am observat valori mai mari ale celor 3 elemente (G, T,- G) dup TTGO, la subiectul cu IFG. La subiectul cu IFG s-au observat valori semnificativ mai mici ale indicilor variabilitii glicemice pe perioada dietei cu 200g HC/zi, fa de perioada dietei fr restricie de HC. Concluzii: Analiza profilului excursiilor glicemice la persoanele cu i fr modificri ale metabolismului glucidic poate fi util n definirea valorilor diagnostice i a celor int pentru diabet.

THE COMPARISON OF GLYCEMIC INSTABILITY IN SUBJECTS WITH AND WITHOUT DISTURBANCES OF GLUCOSE METABOLISM Autors: Mihaela L. Bcu, Simona G. Popa, Sigina R. Grgavu, R.I. Dinu, Maria Moa Department of Diabetes Nutrition Metabolic Diseases, Clinical County Emergency Hospital Craiova

Background and aim. The glycaemic variations observed in non diabetic subjects are primarily related to the postprandial metabolic responses. In order to exactly quantify glycemic variability, specific tools of calculation can be used: MAGE (Mean Amplitude Glycemic Excursion), MODD (Mean Of Daily Differences), MIME (Mean Indices of Meal). The MAGE index evaluate the intra-day major glycemic excursions, ignoring minor glycemic excursions. MODD index appreciate the glycemic variation in the same moment from different day, at the same patient. MIME evaluate the meal-related glycemic excursions. The objective of this study is to compare: 1. glycemic instability at 2 subjects with diet without restriction of carbohydrates (CH), one of them with normal glucose tolerance (NGT) and the other with impaired fasting glucose (IFG); 2. glycemic instability in subject with IFG diet without restriction of CH versus diet with restriction of CH (200g CH/day). Material and method: There were calculated five specific index of glycemic instability (MBG, SD, MAGE, MODD, MIME) in two subjects, with diet without restriction of CH: one NGT subject and one IFG subject, both women, comparable to age, BMI (body mass index), stress; also, we calculated five specific index at subject with IFG, with diet with 200g CH /day. These subjects were observed with continuous glucose monitoring system (CGMS) for 72 hours. To mention that subject with IFG was observed with CGMS for two times, for 72 hours, once with diet without restriction of CH, and once diet with restriction of CH (200g CH/day). In the second day of CGMS, we perform oral glucose

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tolerance test (OGTT) using 75g glucose at the two subjects. MBG, SD and MAGE were calculated using CGMS glycemic records from the second day, in time of MODD was measured using CGMS glycemic records from the second and third days. For the MIME measurement was evaluated postprandial glycemic excursion at meal with 75g CH, both at OGTT ( 75g glucose). Glycemic instability index calculation: MAGE major ascending glucose excursion average on 24 hours. MODD mean of absolute difference between glycemic values on the same moment from different days. MIME was calculated on the basis of three elements: G (difference between maxim postprandial glycemic value and preprandial glycemic value); T (necessary time for reach postprandial glycemic peak); - G (difference between glycemic value at 1 hour after reach postprandial glycemic peak and maxim postprandial glycemic). Mean level of blood glucose (MBG) and blood glucose standard deviation (SD). Results and discussion: Subject MBG SD (mg/dl) MAGE (mg/dl) MODD (mg/dl) MIME (mg/dl) at meal with 75g CH G (mg/dl) 42,71 22,58 39 T min 40 MIME (mg/dl) at OGTT with 75 g glucose G G (mg/dl) (mg/dl) 13 61 T min 50 - G (mg/dl) 62

IFGdiet 107,53 without 19,68 restriction of CH NGT- diet 100,21 without 11,58 restriction of CH IFGwith CH diet 978 200g

21

11,15

22

25

12

13

20

13

23

17,08

29

50

20

Subject with IFG presented numerous and more ample intra-day glucose excursions (high MAGE) and reduced day-to-day reproducibility of blood glucose values (high MODD), comparative with subject with NGT. At the subject with IFG we observed higer values for the three elements (G, T,- G) of MIME at OGTT (75g glucose), comparative with meal with 75g CH. The subject with IFG was present values significant lower of the glycemic instability index during diet with 200g CH/day, comparative with period of diet without restriction of CH.

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Conclusions: The profile of glycemic excursion in subjects with and without disturbances of glucose metabolism may have an important significance in defining the diagnostic cutoff-points and targets for glycemic control on diabetes mellitus.

RISCUL CARDIOVASCULAR LA PERSOANELE CU DIABET ZAHARAT TIP 2 Mihaela Gribovschi, Anca Frca, Edghiun Ismail, Nicolae Hncu4 Centrul Medical Moilor, Cluj-Napoca; Clinica Medicala I, Cluj-Napoca; Universitatea de Medicin i Farmacie Iuliu Hatieganu, Cluj-Napoca; Clinic de Diabet, Nutrite i Boli Metabolice Cluj-Napoca
4

Centrul

Premise si Obiective:n prezent, ne confruntm cu o adevrat epidemie de diabet zaharat (DZ), afeciune cu un puternic impact asupra morbiditii i mortalitii cardiovasculare. Diabetul zaharat asociaz un complex de factori de risc cardiovascular, fapt demonstrat de numeroase studii. Lucrarea de fa are ca i obiectiv cuantificarea riscului cardiovascular la persoanele cu DZ tip 2, precum i analiza diverilor factori de risc. Material si Metode: S-au studiat un numr de 120 pacieni cu diabet zaharat tip 2, care au fost investigai complet n cadrul Centrului Medical Moilor din Cluj Napoca. S-au colectat date referitoare la istoricul personal, caracteristicile antropometrice (greutate corporal, nlime, IMC, circumferin abdominal), evaluarea compoziiei corporale (esut adipos total, esut adipos visceral, mas muscular scheletic) cu ajutorul analizorului corporal InBody 720, statusul biochimic (glicemie bazal, HbA1c, profil lipidic), statusul glicemic (utiliznd monitorizarera glicemic continu pe o perioad de 72 ore), examen cardiovascular complet (inclusiv determinarea grosimii intim-medie la nivel carotidian bilateral) n vederea evalurii ct mai complete a statusului metabolic i a factorilor de risc cardiovascular (RCV) asociai. RCV al fiecrui pacient a fost calculat pe baza programelor UKPDS Risk Engine, PROCAM i Framingham. Rezultate: Persoanele studiate au avut o durat medie a DZ de 5,56 ani, o vrst medie de 51,81 ani, 40,35% au fost femei. S-a constatat c masa muscular este mai mare la persoanele cu DZ avnd nivele ale HbA1c6.5% comparativ cu persoanele insuficient controlate din punct de vedere glicemic (41,985,5kg vs 32,57,6kg, p=0,003). Cantitatea de esut adipos visceral a fost crecut la persoanele studiate, semnificativ mai mare la cele avnd un control glicemic nesatisfctor fa de persoanele avand un DZ bine echilibrat (HbA1c6.5%) (18726,9 vs 153,837, p=0.028). Pe de alt parte, masa total a esutului adipos a fost mai mare la persoanele bine controlate din punct de vedere glicemic (435,5kg vs de 32,57,6kg), dar fr semnificaie statistic (p=0,059). Masa muscular schelectic a fost semnificativ mai mare n rndul persoanelor cu HbA6.5% (41,95,5kg vs. 32,57,6kg, p= 0,003). Nivelul HbA1c se coreleaz cu RCV cuantificat prin UKPDS Risk Engine (boal coronarian non-fatal si fatal: 0,4 vs 0,377, p=0.000; 143

accident vascular cerebral non-fatal i fatal: 0,169 vs 0,177, p=0,03). Identificarea riscului cardiovascular de a dezvolta un eveniment coronarian n urmtorii 10 ani, prin diferite programe (UKPDS Risk Engine, PROCAM i Framingham) arat existena unei diferene n sensul c programul PROCAM este mai precis n aprecierea RCV la persoanele cu DZ dect aplicarea scorului Framingham (p<0.05). Toate cele trei programe de apreciere a RCV ofer date corelabile. Statusul hiperglicemic (glicemii>180mg/dl) se coreleaz cu RVC evaluat prin programul PROCAM si UKPDS Risk Engine. Am constatat, de asemenea, efectul protectiv al activitii fizice pentru dezvoltarea unui AVC fatal sau nonfatal (UKPRS Risk Engine). n mod surprinztor, grosimea intim-medie (GIM) nu s-a corelat cu durata DZ i nici cu controlul glicemic, n schimb s-au evideniat corelaii cu nivelul trigliceridelor serice. Concluzie Evaluare RCV prin cele 3 programe ne-a permis o mai bun cuantificare a contribuiei fiecrui factor de risc prezent la persoana cu DZ tip 2. Investigarea statusului glicemic prin aplicarea monitorizrii glicemice continue, precum i determinarea compoziiei corporale aduc date suplimentare deosebit de valoroase n evaluarea RCV al persoanei cu DZ cu att mai mult cu ct sunt cuantificai parametrii corectabili printrun management terapeutic adecvat.

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CARDIOVASCU

Background and strong impact upo a complex of car study was to dete
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NEFROPATIA DIABETICA Manolache Mihaela Clinica III Pediatrie Iasi Introducere Diabetul zaharat este afectiunea endocrina si metabolica cea mai frecventa in copilarie, caracterizata printr-o crestere permanenta a glicemiei, insotita sau nu de semne clinice, fiind cauzata de alterarea secretiei de insulina sau perturbarii actiunii sale. Aceasta afecteaza ambele sexe, aproximativ in egala masura, cu o usoara predominanta a sexului masculin. Nefropatia diabetica este o complicatie a diabetului care este determinata de concentratii mari de glucoza in sange. Hiperglicemia tulbura functionarea unitatii de filtrare a rinichiului (nefronul). In timp, aceasta poate duce la insuficienta renala. Prevenirea sau incetinirea leziunii renale este cel mai important pas in managementul bolii. care se efectueaza dializa renala. sau albuminurie), la care se adauga, in timp, edeme, hipertensiune arteriala etc. Obiective Scopul lucrarii este de a investiga frecventa afectarii renale la copiii diabetici si consecintelem acestei complicatii Material si metoda Studiul a fost efectuat in perioada 1 02 2008-1 09 2008,in clinica a IIIa pediatrie,pe un lot de 20 de bolnavi cu diabet Rezultate Ca umare a investigatiilor efectuate s-a constatat ce un numar mare de bolnavii cronici de diabet prezinta afectare renala. Din acesta cauza managementul corect al diabetului si a nefropatiei diabetice este foarte important.Un management defectuos putind duce pana la insuficienta renala. Concluzii Afectarea renala, prin nefropatie diabetica (complicatie tardiva a diabetului zaharat), determina prognosticul vital al copilului,motiv pentru care trebuie monitorizarea corecta si frecventa a copiilor cu diabet este o prioritate majora.

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NEPHRITIC DIABETES Introduction Diabetes is the endocrine and metabolic disease most frequent in childhood, which is characterized by a permanent growth of glucose that can be accompanied or not by clinical signs, and which is caused by the alteration of the insulin secretion or by the perturbation of its action. This disease affects both sexes equally, being just a bit predominant at the male sex. Nephritic diabetes is a complication of diabetes that is determined by high dosages of glucose in blood. Hyperglycemia disturbs the function of the filtering unit in the kidney. In time, this may cause kidney failure. The prevention or the slowing of kidney failure is the most important step in managing the disease, which is obtained by dialysis. Objectives The purpose of this paper is to investigate the frequency of renal affection at the diabetic children and the consequences of this complication. Material And Metodes The study was conducted on 20 children with diabetes admitted in the Clinic III Pediatrics, in the period of time 1.02.2008 1.09.2008. Results As a follow-up of the investigations, a large number of children suffering of diabetes also present kidney related affections. This is why the correct manage of diabetes and nephritic diabetes is very important. If the treatment is not correct, then the kidney failure may appear. Conclusion Kidney related affections, especially nephritic diabetes, determine the vital prognosis of the child, reason for which the correct and constant monitoring of the diabetic child is the major priority.

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VARIATIA NECESARULUI INSULINIC LA PACIENTII CU DIABET ZAHARAT TIP 1 CU VECHIME A BOLII DE PESTE 25 ANI Mihaela Vladu2, Sigina Gargavu1, Diana Clenciu1, Nicoleta Mitroi1, Daniela Braicu1, Maria Mota2
1 2

Spitalul Clinic Judetean de Urgenta Craiova Clinica de Diabet Nutritie Boli Metabolice; UMF Craiova - Departamentul de Diabet Nutritie Boli Metabolice

SCOPUL STUDIULUI: Analizarea variatiei necesarului insulinic la un lot de pacienti cu diabet zaharat tip 1 cu vechimea diabetului de peste 25 ani. MATERIAL SI METODA: Lotul studiat a cuprins 44 pacienti cu DZ tip 1 cu vechimea diabetului de peste 25 ani, aflati in evidenta Centrului Clinic de Diabet Nutritie Boli Metabolice al Spitalului Clinic Judeean de Urgenta Craiova. Informaiile retroactive au provenit din fisele acestor pacienti. S-au analizat urmatorii parametrii: vechimea diabetului, doza initiala de insulina, la 15 ani de la debutul DZ si doza actuala de insulina. De asemenea, am analizat tipul de tratament: conventional si intensiv (clasic i modern). REZULTATE: Necesarul de insulina la pacientii luati in studiu a evoluat pe parcursul timpului astfel:

INITIAL Sub 20 UI 21-40 UI 41-60 UI Peste 60 UI 2 (4,54%)

LA 15 ANI 1 (2,27%) 1

ACTUAL (2,27%) (45,45%) (34,09%) (18,18%)

21 (47,72%) 20 (45,45%) 1 (2,27%)

18 (40,90%) 17 (38,63%) 8 (18,18%)

20 15 8

Media calculata a necesarului de insulina la momentul debutului a fost de 31,54 UI, la 15 ani de evolutie a DZ 45, 86 UI, iar la momentul actual s-a situat la o valoare de 39, 15 UI. Regimul de insulinoterapie a fost un alt parametru urmarit. Astfel initial 86,36% pacienti se aflau sub tratament conventional (2 prize), 13,63% intensiv clasic (3prize). La 15 ani de la debut 59,09% se aflau pe tratament conventional, 40,91% pe tratament intensiv clasic. In ceea ce priveste momentul actual tratamentul conventional a fost intalnit in procent de 27,27%, tratamentul intensiv clasic la 70,44% pacienti, iar tramentul intensiv modern cu insulina (pompa de insulina) la un pacient (2,27%). Analizand comparativ necesarul de insulina de la 15 ani de evolutie a DZ fata de cel de la debut, am inregistrat urmatoarele date: la 56,81% dintre pacienti necesarul de insulina a 148

crescut, la 22,72% a scazut, iar la 20,45% s-a mentinut comparabil cu cel initial. Referitor la doza de insulina actuala comparativ cu doza la 15 ani de evolutie a DZ: la 45,45% dintre pacienti s-a evidentiat cresterea necesarului de insulina, la 50% necesarul a scazut, iar la 4,55% nu s-au inregistrat modificari ale acestuia. La pacientii la care s-a inregistrat actual scaderea dozei de insulina nefropatia s-a intalnit in procent 59,09%. Coma hipoglicemica s-a inregistrat la 18,18% din pacientii aflati actual pe tratament conventional, 29,54% pe tratament intensificat (3 prize de insulin/zi), 52,27% pe tratament intensiv. Concluzii: Se remarca o evolutie oscilanta a necesarului de insulina pe parcursul evolutiei DZ; dupa o vechime de 15 ani la majoritatea pacientilor s-a inregistrat cresterea necesarului de insulina, probabil datorit epuizrii rezervei secretorii pancretice restante; dupa 25 ani de evolutie a diabetului s-a nregistrat o scdere a dozelor de insulin, probabil datorit afectrii renale; la 59% dintre pacienii cu scaderea necesarului de insulina s-a asociat nefropatia diabetic. Comele hipoglicemice s-au inregistrat mai frecvent la pacientii cu tratament intensiv bazal-bolus. Tratamentul conventional este regasit i actual intr-un procent relativ mare la pacientii luati in studiu, din motive legate de pacieni, n cea mai mare parte.

THE INSULIN NECESSARY VARIATION IN PATIENTS WITH DURATION OF TYPE 1 DIABETES MELLITUS MORE THAN 25 YEARS Mihaela Vladu2, Sigina Gargavu1, Diana Clenciu1,, Nicoleta Mitroi1, Daniela Braicu, Maria Mota2 ,
1

Clinic County Emergency Hospital Craiova, Diabetes Clinic; 2 UMF Craiova

Background: To analyze the insulin necessary variation in patients with duration of T1DM more than 25 years. Material and method: We studied a group of 44 patients with duration of T1DM more than 25 years, hospitalized in the Clinic of Diabetes Nutrition & Metabolic Diseases (Clinic County Emergency Hospital Craiova). We used the informations arised from the patients files and we analized the duration of diabetes mellitus, the initial dose of insulin, after 15 years of evolution and the actual dose. Also, we studied the conventional and intensiv (clasic and modern) type of treatment. Results: The insulin necesary developed during the evolution of diabetes mellitus in the following way:

INITIAL Under 20 UI 21-40 UI 2 (4,54%)

AFTER 15 YEARS 1 (2,27%) 1

ACTUAL (2,27%) (45,45%)

21 (47,72%)

18 (40,90%)

20

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41-60 UI Over 60 UI

20 (45,45%) 1 (2,27%)

17 (38,63%) 8 (18,18%)

15 8

(34,09%) (18,18%)

Calculated mean of insulin necessary in the begining was 31,54 UI, after 15 years became 45,86 UI and in the present is 39,15 UI. The type of insulin therapy was another parameter which we had in view. Thus, at the begining 86,36% patients had a conventional treatment (2 injections/day) and 13,63% a clasic intensiv one (3 injections/day). After 15 years 59,09% patients had a conventional treatment, 40,91% a clasical intensiv treatment a. In the present the conventional treatment is used in 27,27% patients, clasical intensiv treatment in 70,44% patients and modern intensive treatment (insulin pomp) is found only in one patient (2,27%). Comparatively analizing the insulin necessary after 15 years of evolution with the necessary from the begining we obtained the following dates: in 56,81% of patients the insulin necessary increased, in 22,72% the necessary decreased and in 20,45% of cases the necessary was preserved. Regarding the actual insulin dose by comparison with the dose after 15 years of evolution in 45,45% of patients we had an increase of insulin necessary, in 50% patients the necessary decreased and in 4,55% patients didnt change. The nefropathy was met in 59,09% cases with insulin dose decreased. Hipoglicemic coma was recorded in 18,18% patients actually conventional treated (2 injections/day), 29,54% treated with 3 injections/day) and 52,27% actually on intensiv treatement (4 injections/day). Conclusions: This study showed an oscilatory development of insulin necessary during the evolution of T1DM; after 15 years most patients need much more insulin maybe because of exhausting pancreatic secretory storage but after 25 years the necessary decreased maybe through the development of diabetic nefropathy. In 59% patients with the decrease of insulin necessary diabetic nefropathy is associated. Hipoglicemic coma was frequently met in patients on intensiv treatment. Conventional treatment is actual found in a considerable percentage many times from reasons that regard the patients.

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STUDIUL CORELATIILOR INTRE NIVELUL AMPUTATIEI, VARSTA SI FACTORII DE RISC ASOCIATI LA PACIENTII CU AMPUTATII ALE MEMBRELOR INFERIOARE Nicoleta Mitroi1, Maria Mota2, Sigina Gargavu1, Mihaela Vladu2, Diana Clenciu1
1

Spitalul Clinic Judetean de Urgenta CraiovaClinica Diabet Nutritie Boli Metabolice; 2 UMF Craiova- Diabet Nutritie Boli Metabolice Introducere. Mai mult de 60% dintre amputatiile netraumatice ale membrelor inferioare sunt cauzate de diabetul zaharat, diabeticii prezentand un risc de 10 pana la de 40 de ori mai mare pentru astfel de interventii chirugicale. La fiecare 30 de secunde undeva in lume se realizeaza o amputatie la nivelul membrelor inferioare cauzata de diabet. Scopul studiului. Au fost analizate amputatiile realizate intr-o clinica chirurgicala la pacientii cu si fara DZ si au fost realizate corelatii intre anumiti parametrii urmarindu-se definirea metodelor de prevenire si/sau reducere a numarului de amputatii. Material si metoda. Au fost evaluati pacientii internatii intr-o clinica chirurgicala (Spitalul de Urgenta Craiova) intr-o perioada de 5 ani care au suferit amputatii ale membrelor inferioare. Dintr-un total de 222 de pacienti, 31 au avut mai multe amputatii si au fost analizati separat. Au fost urmariti mai multi parametrii, realizandu-se apoi corelatii intre prezenta si vechimea DZ, nivelul amputatiei, varsta, HTA, dislipidemie, fumat, prezenta altor amputatii in antecedente. Rezultate, discutii. 71 de pacienti (37.17%) au avut DZ si 120 (62.83%) nu au avut DZ. Nu a fost posibila evidentierea unei corelatii intre vechimea DZ si nivelul amputatiei, deoarece nu a putut fi stabilita cu exactitate data debutului DZ, ci numai momentul diagnosticarii acestuia. Varsta medie in momentul amputatiei a fost cu 4.3 ani mai mica la pacientii diabetici comparativ cu cei fara DZ (59.83 respectiv 64.17 ani). In ceea ce priveste corelatia dintre HTA, nivelul amputatiei si varsta la care s-a intervenit chirurgical, la pacientii cu DZ s-a constatat ca amputatia are loc la o varsta mai mica in cazul bolnavilor hipertensivi comparativ cu cei cu valori normale ale tensiunii arteriale (in medie cu 3.9 ani). Nu au fost observate corelatii intre prezenta HTA si varsta la amputatie la pacientii fara DZ. Referitor la prezenta dislipidemiei, nu au existat informatiile necesare pentru a putea fi analizata corelatia cu ceilalti factori evaluati.Varsta la amputatie a fost mai mica la pacientii fumatori (cu si fara DZ), indiferent de sediul amputatiei (cu 5.83 si respectiv 18.5 ani). Dintre pacientii cu DZ care au fost amputati, 25% au avut cel putin inca o alta amputatie in 5 ani, comparativ cu 8.65% in cazul celor fara DZ. Concluzii: numarul pacientilor cu DZ amputati reprezinta 40% din totalul de pacienti amputati, desi prevalenta DZ la populatia din Dolj este <5 %; prezenta HTA (ca factor de risc cardiovascular) a influentat varsta la amputatie numai la pacientii cu DZ in studiul nostru; fumatul a condus la scaderea varstei la amputatie atat la pacientii diabetici, cat si la cei fara DZ; prezenta unei amputatii in antecedente a determinat cresterea riscului de noi amputatii, in special in DZ; abordarea multidisciplinara a patologiei piciorului diabetic si interventia concomitenta asupra factorilor de risc asociati au ca rezultat prevenirea/reducerea numarului de amputatii.

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CORRELATIONS BETWEEN THE LEVEL OF THE AMPUTATION, THE AGE AND THE ASSOCIATED RISK FACTORS IN PATIENTS WITH LOWER LIMBS AMPUTATIONS Nicoleta Mitroi1, Maria Mota2 , Sigina Gargavu1, Mihaela Vladu2, Diana Clenciu1
1

Clinical County Emergency Hospital Craiova, Diabetes Clinic; 2 UMF Craiova

Background. More than 60% of the non traumatic amputations of the lower limbs are caused by diabetes, the diabetic patients being up to 40 times more likely to suffer one of this surgical intervention than people without diabetes. Every 30 seconds a lower limb is lost to diabetes somewhere in the world. The aim of the study. We evaluated the amputations realized in a surgical clinic in patients with and without DM and we made correlations between some parameters; the aim was to define the procedure to prevent/decrease the number of the amputations. Methodology and materials. We evaluated the patients hospitalized in a surgical clinic (Emergency Hospital Craiova) who suffered amputations of lower limbs during a 5 years period. From 222 patients, 31 suffered several amputations and were studied separately. Many parameters were analized, and then we made correlations between the presence and the oldness of DM, the level of the amputation, the age, HBP, dyslipidaemia, smoke, the presence of other amputations. Results and discussions. 71 of the patients (37.17%) presented DM and 120 (62.83%) did not. It was not possible to highlight any correlation between the age of DM and the level of amputation as could not precisely determines the exact moment when DM began, but only the moment of its diagnosis. The average age at amputation was with 4.3 years smaller in patients with DM comparing with those without DM (59.83, respective 64.17 years). Regarding the correlation between HBP, the level of the amputation and the age at amputation, in diabetic patients we noticed that the average age at amputation was smaller in those with HBP comparing with patients with normal blood pressure (with 3.9 years). In patients without DM we didnt observed correlations between these parameters. Yet regarding the presence of dyslipidaemia, there was no information that could help us identify its relationship with the additional factors analyzed. The average age at amputation was smaller in smokers (in both patients with and without DM) regardless of the level of the amputation (with 5.83 respective 18.5 years). Among the diabetic patients that suffered an amputation, 25% of them had at least another amputation in 5 years, comparing with 8.65% of the patient without DM. Conclusions. The patients with DM represent 40% of the total that suffered an amputation, even if the frequency of DM for the population of Dolj district is lower than 5%; the presence of HBP influenced the age at amputation only in diabetic patients in this study; smoking proved that diminishes the age at amputation in both patients with and without DM; the presence of another amputation was associated with a high risk of a new one, especially in patients with DM; the multilaterally approach of the pathology of the diabetic foot and of the associated risk factors will prevent/decrease the number of the amputations.

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INFECTIA CU HELICOBACTER PYLORI LA COPIII CU DIABET Aioane Norina Clinica a-III-a Pediatrie Iasi Rezumat Diabetul zaharat are drept principala caracteristica incapacitatea organismului de a produce si/sau utiliza hormonal pancreatic-insulina, cu instalarea unei hiperglicemii cronice. Infectiile produc hiperglicemie la acesti pacienti . Infectia cu Helicobacter Pylori are un rol important in manifestarile gastrointestinale la copiii diabetici si poate avea implicatii in controlul glicemic. Scopul lucrarii este de a investiga frecventa infectiei cu H. Pylori la copiii cu diabet si consecintele acestei infectii asupra controlului glicemic. Studiul a fost efectuat in Clinica III Pediatrie , in perioada 1-01-2007 1-10-2007 , pe un lot de 40 de copii diabetici ce prezentau simptome gastrointestinale. Infectia cu H. Pylori a fost diagnosticata la 20 de copii cu diabet. Grupa preponderant afectata a fost cea de 10-13 ani (12 cazuri). Leziunea histopatologica cea mai frecventa asociata cu infectia cu H. Pylori a fost gastrita nodulara antrala . Eradicarea infectiei a determinat o ameliorare a simptomatologiei gastrointestinale dar nu s-au constatat diferente semnificative in ce priveste HbA1C si dozele de insulina. Infectia cu H. Pylori a fost cea mai frecventa cauza la copii cu diabet , eradicarea acestei infectii permitand o inbunatatire a controlului glicemic.

THE INFECTIONS WHITH H.PYLORI AT DIABETIC CHILDREN Aioane Norina Clinica III Pediatrie SF.MARIA IASI Diabetess main characteristic is the incapacity of the organism to produce and /or use the pancreatic hormone insulin-with the installation of a chronic hyperglycemia. At this type of patients , the infections produce hyperglycemia. The infection with H. Pylori has an important role in the gastro-intestinal symptoms to the children who have diabetes and may have implications in the glucose control. The purpose of this paper is to investigate the frequency of the H.Pylori infection at the children with diabetes and the consequences of this infection in the glucose control. The study was conducted on 40 children with diabetes with gastro-intestinal symptoms in 3-rd Pediatric Clinic in the period of time 1-01-20071-10-2007. The H.Pylori infection was found in 20 of the diabetics children. Most of the infection cases were in the 10-13 age group(12 cases) . The histological lesion most frequently associated with H. Pylori infection was nodular antral gastritis.

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The eradication of the infection determined an amelioration of the gastro-intestinal symptomatology but there were no major differences in regard to the HbA1C and insulin dosage. The H.Pylori infection was the most frequent cause of gastritis among children with diabetes, the eradication of which permitted an improved glucose control.

STATUSUL HIPOGONADIC LA PACIENII CU DIABET ZAHARAT Olivia Georgescu 1 , Sorina Martin 1,2, Mihaela Ursache 1, Simona Fica 1,2 1. Spitalul Universitar de Urgen Elias Secia de Endocrinologie, Diabet, Boli de nutriie 2. UMF. Carol Davila Bucureti Scopul studiului a fost evaluarea statusului hipogonadic la pacienii de sex masculin cu diabet zaharat de tip 1 i 2, precum i determinarea unor posibile asocieri cu elemente definitorii ale echilibrului metabolic.

Material i metod : Pentru 68 brbati cu diabet zaharat (12 cu diabet zaharat tip 1 i 56 cu diabet zaharat tip 2), cu vrste cuprinse ntre 19 i 76 ani a fost evaluat statusul hipogonadic prin nregistrarea simptomelor i semnelor clinice, prin determinarea seric a testosteronului total, SHBG, DHEA-S, cu calcularea ulterioar a testosteronului liber. Au fost considerai hipogonadici pacienii cu testosteron seric total sub 300ng/dl. Au fost urmrii de asemenea parametrii echilibrului metabolic: HbA1c, profil lipidic .

Rezultate: 22% dintre pacienii evaluai au prezentat hipogonadism (16,6% dintre cei cu diabet zaharat tip1 i 23,2% dintre cei cu diabet zaharat tip 2). Pacienii diabetici hipogonadici , comparativ cu restul pacienilor diabetici au prezentat n medie o valoare mai mare a circumferinei abdominale( p= 0,05) i o valoare mai mic a HDL-colesterolului ( p= 0,03) .Scderea libidoului i a forei musculare s-a corelat direct proporional cu valoarea sczut a DHEA-S ( p= 0,006 ) i invers proporional cu HbA1c (p= 0,05) .Scderea frecvenei brbieritului i scderea pilozitii corporale s-a corelat cu valoarea sczut a testosteronului liber, independent de vrst. Alopecia s-a nregistrat mai frecvent la pacienii cu valori sczute ale SHBG ( p =0,03) . Concluzii: Statusul hipogonadic s-a regsit mai frecvent n rndul pacienilor cu diabet zaharat tip 2, fiind asociat cu unele componente ale sindromului metabolic.

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Hipogonadismul simptomatic s-a corelat cu valoarea DHEA-S i HbA1c, iar semnele clinice sugestive au fost asociate cu nivelul testosteronului liber i SHBG, independent de vrst.

THE HYPOGONADIC STATUS IN DIABETES MELLITUS PATIENTS Olivia Georgescu 1, Sorina Martin 1,2, Mihaela Ursache 1, Simona Fica 1,2 1. Elias University Emergency Hospital- Department of Endocrinology, Diabetes and Metabolic Diseases 2. UMF Carol Davila Bucharest The aim of this study was to assess the hypogonadic status in male patients with type 1 and type 2 diabetes mellitus and to estimate the possible correlation with metabolic balance.

Material and methods: For 68 male patients: 12 T1DM/ 56 T2DM, aged between 19-76 years we evaluate the gonadic status based on both symptoms and biochemical measures on total and free testosterone value, SHBG, DHEA-S. The patients with total testosterone under 300 ng/dl were considered hypogonadic. We also evaluate the metabolic balance ( HbA1c, lipid profile).

Results: Hypogonadism was present in 22% of patients (16,6% in T1DM and 23,2% in T2DM). The hypogonadic diabetic patients had higher waist ( p=0,05) and respectively lower HDL-cholesterol (p=0,03), compared with the other diabetic patients. The decrease of libido and muscular force was positve corelated with lower DHEA-S value and negative with HbA1c (p=0,05). The decrease of shaving frequency was positive corelated with lower free testosterone value, not related with age. Alopecia was more frequently observed in diabetic patients with lower SHBG value (p=0,03).

Conclusions: In our study, the hypogonadic status was most common defect in T2DM, in association with some components of metabolic syndrome criteria. The hypogonadic symptoms was corelated with DHEA-S and HbA1c, since clinical signs were associated with free testosterone and SHBG value, not related with age.

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PROTEINA C- REACTIV I TULBURRILE METABOLICE LA PACIENII OBEZI NOU DEPISTAI CU DIABET ZAHARAT Olivia Georgescu 1, Lavinia oav 2, Mihaela Ursache 1, Aura Reghin 1 1. Spitalul Universitar Elias , Secia de Endocrinologie, Diabet i Boli de Nutriie Bucureti 2. Spitalul Clinic Sf. Constantin i Elena Bucureti

Obiectiv: Este cunoscut faptul c proteina C-reactiv (PCR) poate prezice riscul de apariie al diabetului zaharat n rndul populaiei sntoase. Ne-am propus s determinm posibilele corelaii ntre PCR i modificrile metabolice ntr-o populaie nou diagnosticat cu diabet zaharat.

Material i metod: Pentru 40 de pacieni nou depistai cu diabet zaharat (25 obezi i 15 normoponderali),cu vrste cuprinse ntre 30-70 ani (media 54,2 ani) am efectuat msurtorile antropometrice, am evaluat statusul metabolic (HbA1c, profilul lipidic, tensiunea arterial) i inflamator (PCR) . Analiza statistic s-a efectuat cu ajutorul t-test, considerndu-se semnificativ statistic valoarea p=sub 0,05.

Rezultate: Am gsit o corelaie semnificativ statistic ntre valoarea PCR i HbA1c numai pentru populaia obez ( p=0,008) .n lotul studiat, PCR s-a asociat cu valoarea crescut a circumferinei abdominale (peste 94 cm) la pacienii de sex masculin 2,04 vs.2,94 mg l (p=0,04). La pacientele diabetice PCR s-a corelat negativ cu valoarea sczut a HDL-colesterolului (sub 50mg/dl) 3,25 vs. 1,96 mg/l. Nu s-au observat corelaii ntre PCR- hipertensiune, sau PCR-hipertrigliceridemie. Prevalena sindromului metabolic n lotul studiat a fost mai mare n rndul pacienilor cu valori crescute ale PCR (quartila superioar) , fr a fi ns semnificativ statistic (p=0,15) .

Concluzii: PCR poate fi considerat un marker al modificrilor metabolice aprute n rndul pacienilor obezi cu diabet zaharat nou depistat, dar nivelul su plasmatic se coreleaz diferit n funcie de sex cu componentele sindromului metabolic.

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C- REACTIVE PROTEIN AND METABOLIC DISTURBANCES IN OBESE NEW DIAGNOSED TYPE 2 DIABETICS Olivia Georgescu 1 ,Lavinia oav 2, Mihaela Ursache 1, Aura Reghin 1 1. Elias Emergency Universitary Hospital Department of Endocrinology, Diabetes and Nutrition - Bucharest 2. Sf.Constantin si Elena Clinical Hospital - Bucharest Background and aims: It is known that C-reactive protein (CRP) predicts future risk for diabetes in healthy caucasian population. We determined which are the corelations between CRP and metabolic disturbances in a new onset type 2 diabetes mellitus population. Material and methods: for 40 patients with new onset type 2 diabetes mellitus (25 obese / 15 with normal weight), aged between 30-70 years (mean 54,2 years) we performed anthropometric measures and we evaluated metabolic ( HbA1c, lipid profile, blood pressure) and inflammatory status (CRP level). Results: We found a statistically significant corelation between CRP-level and HbA1c only for obese population ( p = 0,008 ). In the whole study group, CRP level was associated with higher waist (over 94 cm) in male subjects (2,04 vs. 2,94 mg/l, p=0,04). In female diabetics patients CRP value was negative corelated with lower HDL- cholesterol (under 50 mg/dl) 3,25 vs. 1,96 mg/l. We did not found corelation between CRP- hypertension and also CRP- triglyceridemia. The prevalence of metabolic syndrome in our study group increase in whose patients with CRP levels in a top quartile but not statistically significant ( p = 0,15 ). Conclusions: CRP could be considered a new marker of metabolic disturbances in obese type 2 diabetes mellitus population, but his plasma level is different corelated according to sex with components of metabolic syndrome.

EFECTELE SCADERII IN GREUTATE ASUPRA FICATULUI GRAS NONALCOOLIC LA SUBIECTII CU SINDROM METABOLIC. R. Vasilescu, Silvi Ifrim Spital Clinic Colentina Bucuresti Sectia Diabet, Nutritie, Boli Metabolice Introducere: Boala ficatului gras non-alcoolic este una dintre cele mai frecvente cauze de afectare hepatica, care poate progresa de la steatoza simpla, la steatohepatita, ciroza hepatica si hepatocarcinom. In prezent boala ficatul gras non-alcoolic este considerata componenta hepatica a sindromului metabolic.

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Material si metoda: Studiul a inclus un numar de 20 subiecti de sex masculin, cu varsta medie de 38.5 ani (limite 25 54 ani), cu sindrom metabolic (definit conform criteriilor IDF), nediabetici, cu o valoare medie a IMC de 35.08 kg/m2 (limite 31kg/m2 40 kg/m2), la care s-a diagnosticat ultrasonografic prezenta steatozei hepatice. Pacientii au urmat o dieta hipocalorica de 1200 kcal timp de 24 saptamani. La subiectii inclusi in studiu s-au masurat greutatea, talia, circumferinta abdominala si s-au dozat alanin-aminotrasferaza (ALAT), aspartat-aminotrasferaza (ASAT), -glutamiltranspeptidaza (GGT), LDL colesterol, HDL colesterol, trigliceride, glicemia a jeun. Pentru analiza statistica a datelor obtinute la 12 saptamani si 24 saptamani s-a folosit testul t-student. Rezultate: Initial 12 saptamani 99.6716.46 33.434.52 11216.06 42.516.3 6334.22 72.541.75 13918.8 32.254.11 151.2518.0 8 86.57.59 24 saptamani 96.8316.56 32.274.59 108.515.55 36.259.54 39.7517.58 47.2520.7 125.7514.8 6 34.754.03 136.7519.6 2 84.56.45 Initial vs. Initial vs. 12 24 saptaman saptamani i p=0.003 P=0.001 P<0.001 P<0.001 P<0.001 P<0.001 P=0.02 p=0.03 p=0.05 p<0.001 NS p=0.01 p=0.04 P=0.02 p=0.02 p=0.03 p<0.001 NS p=0.005 p=0.004

Greutate IMC (kg/m2) Corcumferint a abdominala (cm) ASAT (TGO) ALAT (TGP) GGT LDLcolesterol HDLcolesterol Trigliceride Glicemie

10417.1 35.084.43 116.2516.5 6537.09 123.7570.0 8 97.2569.76 149.524.3 31.53.51 19229.23 9511.63

Prezenta ficatului gras non-alcoolic se asocieaza cu valori crescute ale concentratiilor plasmatice ale aminotransferazelor. La toti subiectii inclusi in studiu ALAT > 1.5xN si raportul ALAT/ASAT > 2. La 3 luni s-au obtinut scaderea greutatii cu 4.67 Kg (limite 26 kg), scaderea ALAT cu 60.75 U/l , scaderea ASAT cu 22.5 U/l, scaderea GGT cu 24.75 U/l, scaderea trigliceridelor cu 40.75 mg/dl, scaderea LDL colesterol cu 15.5 mg/dl, scaderea glicemiei a jeun cu 8.5 mg/dl si cresterea HDL colesterol cu 0.75 mg/dl. La 6 luni s-au obtinut scaderea greutatii cu 7.33 kg (limite 4-9 kg), scaderea concentratiei plasmatice a ALAT cu 84 U/l, scaderea ASAT cu 28.75 U/l, scaderea GGT cu 50 U/l, scaderea trigliceridelor cu 55.25 mg/dl, scaderea LDL-colesterol cu 23.75 mg/dl, scaderea glicemiei a jeun cu 10.5 mg/dl si cresterea HDL-colesterol cu 3.25 mg/dl. Concluzii: Scaderea in greutate este principala atitudine terapeutica la subiectii cu boala ficatului gras non-alcoolic. Scaderea in greutate la subiectii cu SM si boala ficatului gras

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nonalcoolic se insoteste de scaderea importanta a concentratiei plasmatice a transaminazelor. De asemenea, scaderea in greutate se insoteste de imbunatatirea semnificativa a profilului lipidic si a glicemiei a jeun.

EFFECTS OF WEIGHT REDUCTION ON NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) IN PATIENTS WITH METABOLIC SYNDROME R. Vasilescu, Silvi Ifrim Clinical Hospital Colentina Bucharest Departement of Diabetes, Nutrition, Metabolic Diseases Introduction: Non-alcoholic fatty liver disease (NAFLD) is a major cause of liver related morbidity and mortality. NAFLD may progress from simple stetosis to nonalcoholic steatohepatitis (NASH) and cirrohosis, that may be complicated by hapatocellular carcinoma. In recent years NAFLD is considered as a hepatic manifestation of metabolic syndrome (MS). Methods and patients: We studied 20 subjects (males), mean age 38.5 years (range 2554 years) with MS (IDF criteria), non-diabetic, mean BMI 35.08 kg/m2 ( range 31kg/m2 40 kg/m2), with hepatic steatosis (confirmed by liver ultrasound). All patients have been treated with a low caloric diet (1200 kcal) for 24 weeks. Weight, waist circumference, ALT, AST, GGT, triglycerides, LDL cholesterol, HDL cholesterol, fasting glucose were measured. T-student test was used to compare variables variations between baseline and 12 weeks and 24 weeks. Results: Week 0 Weight (Kg) BMI (kg/m2) Waist circumference AST (TGO) ALT (TGP) GGT LDLcholesterol HDLcholesterol Triglycerides 10417.1 35.084.43 116.2516.5 6537.09 123.7570.08 97.2569.76 149.524.3 31.53.51 19229.23 Week 12 99.6716.46 33.434.52 11216.06 42.516.3 6334.22 72.541.75 13918.8 32.254.11 15118.08 159 Week 24 96.8316.56 32.274.59 108.515.55 36.259.54 39.7517.58 47.2520.7 125.7514.86 34.754.03 136.7519.62 Week 0 Week 0 vs. Week vs. Week 12 24 p=0.003 P=0.001 P<0.001 P<0.001 P<0.001 P<0.001 P=0.02 p=0.03 p=0.05 p<0.001 NS p=0.01 P=0.02 p=0.02 p=0.03 p<0.001 NS p=0.005

(mg/dl) Glucose (mg/dl)

9511.63

86.57.59

84.56.45

p=0.04

p=0.004

Patients with MS and NAFLD have high serum transaminases. All patients had ALT>1.5xN and ALT/AST>2. Mean 12 weeks weight loss was 4.67 kg (range 2-6 kg), ALT decreased with 60.75 U/l, AST decreased with 22.5 U/l, GGT decreased with 24.75 U/l, triglycerides decreased with 40.75 mg/dl, LDL cholesterol decreased with 15.5 mg/dl, fasting glucose decreased with 8.5 mg/dl and HDL cholesterol increased with 0.75 mg/dl. Mean 24 weeks weight loss was 7.33 kg (range 4-9 kg), ALT decreased with 84 U/l, AST decreased with 28.75 U/l, GGT decreased with 50 U/l, triglycerides decreased with 55.25 mg/dl, LDL cholesterol decreased with 23.75 mg/dl, fasting glucose decreased with 10.5 mg/dl and HDL cholesterol increased with 3.25 mg/dl. Conclusion: Weight loss is the main therapy in patients with NAFLD. Reduction in body weight in patients with MS and NAFLD is associated with a pronounced decrease in serum transaminases. In addition weight loss resulted in significant improvements in the lipoprotein profile and fasting glucose.

PREVALENTA COMPLICATIILOR MICROVASCULARE LA PACIENTII CU DIABET ZAHARAT TIP 1 CU VECHIME A BOLII DE PESTE 25 ANI

Sigina Gargavu1, Mihaela Vladu2, Diana Clenciu1, Nicoleta Mitroi1, Camelia Panus1, Maria Mota2,
1 2

Spitalul Clinic Judetean de Urgenta Craiova Clinica Diabet Nutritie Boli Metabolice; UMF Craiova - Departamentul de Diabet Nutritie Boli Metabolice

Scopul studiului: Evaluarea prevalentei complicatiilor microvasculare la un lot de pacienti cu diabet zaharat tip 1 cu vechime a bolii de peste 25 ani. Material si metoda: Lotul studiat a cuprins 44 pacienti cu DZ tip 1 cu vechime a bolii de peste 25 ani aflati in evidenta Centrului Clinic de Diabet Nutritie Boli Metabolice al Spitalului Clinic Judetean de Urgenta Craiova. Ca metoda de lucru am utilizat urmatoarele date anamnestice, clinice si paraclinice: vechimea diabetului, antecedentele personale, determinarea tensiunii arteriale, glicemie, uree, creatinina, colesterol total, trigliceride, examen sumar urina, microalbuminurie repetata de 3 ori la pacientii cu uroculturi negative, examen oftalmologic, examen neurologic.

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Rezultate: Din cei 44 pacienti, 14 (31,81%) au fost de sex feminin si 30 (68,19%) de sex masculin. Cu privire la varsta acestora, 2 pacienti (4,54%) se aflau in decada de varsta 30-40 ani, 12 pacienti (27,27%) in decada 41-50 ani, 15 pacienti (34,09%) in decada 5160 ani si 15 pacienti (34,09%) peste 60 ani. Studiind parametrul complicatii microvasculare s-a remarcat o frecventa crescuta a neuropatiei diabetice 95,45% si a retinopatiei diabetice 88,63%. Nefropatie diabetica au prezentat 40,90% din pacientii cu vechime de peste 25 ani. Dintre pacientii cu neuropatie diabetica, 84,09% au avut neuropatie periferica si 11,36% atat neuropatie periferica cat si vegetativa. Din cei cu retinopatie diabetica 50% s-au aflat in stadiul neproliferativ; 11,36% in stadiul preproliferativ si 27,27% in stadiul proliferativ. La 31,05% dintre acestia s-a intalnit cecitatea ca si complicatie a retinopatiei diabetice. Nefropatia diabetica s-a intalnit in 33,33% in stadiul 3; 61,11% in stadiul 4 si 5,55% in stadiul 5. Dintre cei cu retinopatie diabetica 43,59% prezentau si nefropatie. Dislipidemia a fost evidentiata la 32 pacienti (72,72%). Hipertensiunea arteriala s-a intalnit la 36 pacienti (81,81%). Dintre pacientii hipertensivi, 28 pacienti (77,77%) prezentau HTA si neuropatie, 27 pacienti (75%) prezentau HTA si retinopatie, 17 pacienti (47,22%) prezentau HTA si arteriopatie, 15 pacienti (41,67%) prezentau HTA si nefropatie, iar 13 pacienti (36,11%) prezentau atat HTA cat si neuropatie, retinopatie, arteriopatie si nefropatie. Mentionam ca nu s-a putut stabili o corelatie intre echilibrul glicemic si complicatiile microvasculare datorita lipsei hemoglobinei glicozilate din evidentele pacientilor de-a lungul perioadei de evolutie a DZ. Concluzii : Se remarca o frecventa alarmanta a complicatiilor microvasculare dupa o vechime a DZ tip 1 de peste 25 ani. Neuropatia diabetica este cea mai frecventa complicatie intalnita, dar si cea mai precoce. Retinopatia diabetica este de asemenea o complicatie frecventa, dar este rara in primii ani de evolutie. Gradul mic de corelatie al retinopatiei diabetice cu nefropatia diabetica sugereaza posibila participare a unor factori individuali implicati in aparitia acestora, cum ar fi factorii genetici. Dislipidemia si hipertensiunea arteriala sunt frecvent intalnite la pacientii cu DZ de peste 25 ani. Ambele sexe sunt vulnerabile pentru complicatiilor microvasculare.

THE PREVALENCE OF MICROVASCULAR COMPLICATIONS IN TYPE 1 DIABETES MELLITUS WITH DURATION OF DIABETES MORE THAN 25 YEARS

Sigina Gargavu1, Mihaela Vladu2, Diana Clenciu1,, Nicoleta Mitroi1, Camelia Panus1, Maria Mota2 ,
1

Clinical County Emergency Hospital Craiova, Diabetes Clinic; 2 UMF Craiova

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Background: To analyze the frequency of microvascular complications in patients with duration of T1DM more than 25 years. Material and method: We studied a group of 44 patients with duration of T1DM more than 25 years, hospitalized in the Clinic of Diabetes Nutrition & Metabolic Diseases (Clinic County Emergency Hospital Craiova). We analized the following history, clinical and paraclinical dates: the duration of diabetes mellitus, personal history, blood pressure, glycemia, urea, creatine, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, urinary examination, microalbuminuria (repeted for 3 times), ophtalmological examination, neurological examination. Results and discussions: From the 44 patients included in the study, 14 patients (31,81%) were female and 30 patients (68,19) were male. Concerning the age of patients, 2 patients (4,54%) were between 30-40 years, 12 patients (27,27%) were between 41-50 years, 15 (34,09%) patients were between 51-60 years and 15 patients (34,09%) over 60 years. Regarding microvascular complications, 95,45% patients presented diabetic neuropathy and 88,63% presented diabetic retinopathy. Diabetic nefropathy presented 40,90% of patients with duration of T1DM more than 25 years. From the patients with diabetic neuropathy, 84,09% had peripheral neuropathy and 11,36% both peripheral and vegetative neuropathy. From the patients with diabetic retinopathy, nonproliferative DR (NPDR) was encountered in 50% of patients, preproliferative DR in 11,36% while 27,27% had proliferative DR (PDR). As a complication of DR, blindness was met in 31,05% patients. Regarding diabetic nefropathy, 33,33% of the cases presented 3rd stage, 61,11% presented 4th stage and only one patient (5,55%) presented 5th stage. From the patients with retinopathy 43,59% presented nefropathy too. 32 patients (72,72%) had dyslipidaemia and 36 patients (81,81%) suffered of arterial hypertension. From hypertensive patients, 28 patients (77,77%) presented after 25 years arterial hypertension and diabetic neuropathy, 27 patients (75%) arterial hypertension and diabetic retinopathy, 17 patients arterial hypertension and diabetic arteriopathy, 15 patients arterial hypertension and diabetic nefropathy and 13 patients (36,11%) presented arterial hypertension, neuropathy, retinopathy, arteriopathy and nefropathy. We can not established a corelation between glycemic control and microvascular complications because the missing of HbA1c during the diabetes mellitus evolution. Conclusions: This study showed that microvascular complications appeared with an alarming frequency after 25 years of evolution. Diabetic neuropathy is the most frequent and precocious microvascular complication. Also DR is a frequent complication too. Its smaller degree of corelation with diabetic nefropathy sugests the possibility of participation of others individuals factors, like genetic ones. Dyslipidemia and arterial hypertension were met after 25 years of type 1 diabetes mellitus evolution, even more frequently in patients with chronic complications. Both male and female are vulnerable for microvascular complications.

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CERCETRI PRIVIND OPTIMIZAREA CONSULTULUI DE DIABET N AMBULATORIUL DE SPECIALITATE Sorin Ioacara, Clin Tiu Policlinica Medis Cmpina, Romnia

Scop. Analiza modului de desfurare a consultului de diabet n sistem ambulator i optimizarea lui pentru a permite creterea calitii pentru acelai interval de timp folosit. Material i metod. Policlinica Medis a pus la dispoziie spaiul i dotrile necesare implementrii unui program de management conceput i realizat local, folosind experiena Spitalului General Salzburg, Austria. Pacientul se prezint prin programare, ateapt n medie 20, intr n cabinetul asistentei, unde se noteaz DOAR n calculator datele demografice, antropometrice (inclusiv circumferina abdominal), tensiune arteriala, fumat, etc. Urmeaz ultimile analize, inclusiv cu data, pentru glicemie, HbA1c, colesterol total, HDLc, trigliceride, uree, creatinin. Urmeaz rspunsul la ntrebri intite privind debutul diabetului, glaucom, cataracta, furnicturi picioare, etc. Sunt calculate automat: vrsta, greutatea ideal, IMC actual, IMC maxim n cursul vieii, LDLc, rata filtrrii glomerulare (formula MDRD). Timpul mediu necesar: 4 minute. Pacientul revine n sala de ateptare i intr apoi n cabinetul medicului, care preia consultaia din punctul lsat de asistent i introduce DOAR n calculator prin clic n csua potrivit date legate de complicaii oculare, renale, nervoase, dislipidemie, arteriopatie, hipertensiune, cardiopatie ischemic, infarct, accident vascular cerebral, insuficien cardiac, fibrilaie atrial. Se genereaz n mod automat diagnosticul complet (lung), care poate fi modificat (practic doar adugri) i validat. Urmeaz pagina 3 alocat recomandrilor, unde se aleg medicamentele din liste scurte, mprirea ntr-o zi i perioada prescrierii. Se genereaz automat date de regim alimentar (extins). Urmeaz momentul generrii documentelor medicale prin clic pe butonul corespunztor. Reetele gratuite sunt printate pe imprimante matriciale (trei). Calculatorul mai genereaza automat bilet de consult, identic cu biletul de externare (o pagina A4 plin, la font de 10), ce cuprinde pe lng diagnostic absolut toate informaiile existente n calculator, sub form de fraze automate, modificabile. Similar, sunt generate scrisoare medical, referat medical, referat justificare medicamente, etc., care sunt printate laser. Timpul mediu necesar: 4 minute, din care 5-10 secunde generarea tuturor documentelor medicale. Un exemplar din biletul de externare este pus n fia pacientului pentru a consemna consultul. Calculatorul mai genereaz registrul de consultaii i raportarea lunar ctre Casa de Sntate. Rezultate. n perioada 15/03/2008-30/09/2008 s-au efectuat 2450 consultaii diabet folosind managementul descris anterior, cu un timp mediu total (inclusiv asistenta!) de ingrijire medical de 8 minute / pacient, ceea ce corespunde la 15 pacieni / ora (4 minute/pacient x 2 cabinete). Pacienii sunt studiai prospectiv sub diverse aspecte (inclusiv mortalitate), cu generarea automat a bazei de date. Concluzii. Folosind un management performant se poate externaliza complet birocraia prezent i viitoare, cu realizarea a 80-90 consultaii / 6 ore. Dac toate documentele

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medicale sunt tampilate i semnate n prealabil, se elimin total folosirea pixului i a tampilei n timpul consultaiei. Timpul ctigat poate fi transferat ctre activiti de educaie, cercetare, etc. Un eventual Registru National de Diabet poate fi usor alimentat cu informatii in acest fel.

RESEARCH REGARDING THE OPTIMIZATION OF DIABETES CONSULTATION IN OUTPATIENT CLINIC Sorin Ioacara, Calin Tiu Medis Outpatient Clinic, Campina, Romania

Aim. To analyze the diabetes consultation and its optimization for increasing the quality without any expense of time. Materials and methods. Medis Outpatient Clinic offered the space and materials required for implementation of a management plan designed locally, using the experience of Salzburg General Hospital, Austria. The patient comes only by appointment, he waits around 20, he enters the nurses cabinet, where data are recorded only in computer regarding demographic, anthropometry (including waist circumference), blood pressure, smoking ... Then, the newest blood analysis data are recorded, including date, for glycaemia, HbA1c, total and HDL cholesterol, triglycerides, urea and creatinine. Then, the patient answers some questions regarding diabetes onset, glaucoma, cataract... Automated generated data include: age, ideal weight, present and maximum (during life) BMI, LDLc, glomerular filtration rate (MDRD formula). Mean time: 4 minutes. The patient returns in the waiting room and then he enters the doctors cabinet, who continues the consultation from the point left by the nurse. He records only in the computer data regarding ocular, renal, nervous complications, dyslipidemia, arteriopathy, hypertension, ischemic heart disease, myocardial infarction, stroke, heart insufficiency, atrial fibrillation. The diagnosis is generated automated, modified (generaly by completion) and validated. Page three deals with recommendations, where medications are chosen from small lists, dayly and the total period for prescription. The general diet is computer generated. Then, the medical discharge documents are automatically generated. Receipts are printed on matricial printers (three). The computer generates an discharge letter very similar with the one used in hospital (one A4 page, font: 10), which contains the diagnosis and all the information from computer, but in long phrases, which are modifiable. In a similar manner are automatically generated other documents like letter for the GP, medical note, notes for prescription justification ... they are laser printed. The doctors mean time: 4 minutes, from which 5-10 seconds for documents generation. One discharge letter goes to the patient medical file as a source document. The computer also generates the consultations registry and the monthly report to the Health Insurance Company.

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Results. During 15/03/2008-30/09/2008 period, there were 2450 diabetes consultations, all using the management plan described above, with a mean time of medical care (nurse+doctor) of 8 minutes / patient, which coresponds to 15 consultations / hour (4 minutes / patient x two cabinets). The patients are prospectively studied from diffrent aspects (including mortality), with the automatically generation of the database. Conclusions. If a top management plan is used, it is possible to completely externalise the present and future birocracy, with the result of 80-90 consultations / 6 hours. If all medical documents are signed and stamped before, there is no need for pen and stamping during the consultation. The gained time can be transfered to activities for education, research. Any future National Diabetes Registry can be easily fed with information.

INDICII MOLECULARE SI GENETICE DE REVERSIBILIZARE A DIABETULUI ZAHARAT TIP 2 Silvia Stefania Iancu Centrul Clinic de Diabet, Nutritie si Boli Metabolice, Cluj-Napoca

Prezentam o trecere in revista a directiilor de cercetare actuale care au ca scop reversibilizarea diabetului zaharat de tip 2, reversibilitate demonstrata si reproductibila prin tratamentul chirurgical al obezitatii si care necesita a fi extinsa la alte subgrupe de pacienti cu diabet zaharat tip 2. Acest lucru este posibil prin cautarea si identificarea genelor de risc, a cailor de semnalizare in care se implica produsii acestor gene. Aceste abordari se focalizeaza pe: gena TCF7l2, cea mai frecvent asociata cu riscul de diabet la multe populatii si implicarea in calea wnt de semnalizare, legata de metabolismul lipidic si de homeostazia glucozei si influenteaza numarul si functia celulelor beta; calea PPAR, rezistenta la insulina si semnalizarea insulinica redusa la nivel de receptor si postreceptor, statusul inflamator.

MOLECULAR AND GENETIC CLUES TO REVERSE TYPE 2 DIABETES MELLITUS Silvia Stefania Iancu Clinical Centre for Diabates Nutrition and Metabolic Diseases, Cluj-Napoca

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We present an overview of the research directions aiming at reversal of type 2 diabetes mellitus that was demonstrated and is reproducible in the surgical treatment of obesity. This fact should be extended to other subgroups of type 2 diabetes patients and this is possible through searching for the risk genes, the signalling pathways in which their action is involved. These approaches are focused on: TCF7l2 gene, the gene most frequently associated with the risk for diabetes in many populations and its implications in the wnt signalling pathway that is connected with the lipid metabolism and glucose homeostasis influences beta cells number and fuction; the PPAR pathway, insulin resistance and defects of insulin signalling reduced receptor and postreceptor activity, the inflammatory status.

NEUROPATIA VEGETATIVA CARDIACA ESTE SUBDIAGNOSTICATA IN DIABETUL ZAHARAT DE TIP 1 Silvia S Iancu (1), Mariana Coca (1), Ion Iancu (2), Ioana Streulea (1) 1 2 Centrul Clinic de Diabet, Nutritie si Boli Metabolice Cluj-Napoca Sectia de neurologie, Clinica Medicala IV, Cluj-Napoca

Scop Neuropatia cardiaca vegetativa se asociaza (NCV) cu risc cardiovascular crescut si cu moarte subita la pacientii cu diabet, din acest motiv am initiat studiul epidemiologei acestei afectiuni si asocierile ei cu alte complicatii cronice ale diabetului zaharat. Pacienti: Am inclus pacienti cu diabet zaharat tip 1, 50 barbati, 48 femei, cu varsta medie 35+ 8 ani, cu o durata a diabetului cuprinsa intre 9,5-23 ani, fara insuficienta renala. Metode: Pentru diagnosticul NCV am folosit rata variabilitatii frecventei cardiace in cursul respiratiei profunde si ca raspuns la ortostatism, Raspunsul presional la contractia mainii si la ortostatism din bateria de teste Ewing. Am diagnosticat NCV daca doua din testele mentionate anterior au fost pozitive. Am realizat screeningul prezentei complicatiilor cronice ale diabetului zaharat, am evaluat TA de repaus, IMC, HbA1C, profilul lipidic, creatinina, hemoleucograma, sideremia, EEG s-a realizat doar la 31 din pacienti pana la data respectiva Rezultate: Am aflat ca 5 din 25 (20%) din barbatii cu durata diabetului (dd) intre 10-15 ani si 11 din 25 (44%) din cei cu dd peste 15 ani au fost pozitivi pentru NCV, in timp ce la femei, 4 din 24 (16,6%) cu dd intre 10-15 ani si 10 din 24 (41,6%) cu dd>15 ani aveau NCV. Am gasit asocieri semnificative ale NCV cu hipoglicemiile severe/nerecunoscute OR=2,33, cu prezenta retinopatiei, OR= 1,82, cu tensiunea arteriala, OR=2,01, cu neuropatia periferica simptomatica OR=1,65, cu gastropareza sau diareea diabetica OR=4,03 dar nu am decelat deocamdata nici o asociere cu aspectele EEG. Doar 12,4%

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din pacienti au avut acuze de simptome sugestive pentru neuropatia autonoma la prezentare.. Concluzie: Am gasit o prevalenta crescuta a NCV la persoanele cu diabet zaharat tip 1 cu durata diabetului peste 10 ani, prevalenta care creste cu varsta si cu durata bolii. Recomandam efectuarea screening-ului acestei complicatii la pacientii cu diabet zaharat tip 1 mai ales cu peste peste 10 ani vechime a bolii

UNDERDIAGNOSED CARDIAC AUTONOMIC NEUROPATHY IN TYPE 1 DIABETIC PATIENTS Silvia S Iancu (1), Mariana Coca (1), I.. Iancu (2), Ioana Streulea (1) 1 2 Clinical centre for diabetes, nutrition and metabolic diseases Cluj-Napoca Neurology Department, Medical Clinic IV Cluj-Napoca

Aim: Cardiac autonomic neuropathy (CAN) is associated with highly increased cardiovascular risk and sudden death in diabetic patients. We studied the epidemiology of the condition and its associations with other diabetic complications. Patients: We included 98 type 1 diabetes patients, 50 males, 48 females, aged 35+ 8 years, with a diabetes duration between 9.5-23 years without renal insufficiency. Methods: For the CAN we assessed the heart rate (HR) variability during deep breath, HR response to standing, BP response to handgrip and BP response to standing, from the Ewing battery of tests. We diagnosed CAN if two of the tests previously mentioned were ositive. We screened the presence of chronic diabetes complications, we evaluated resting BP, BMI, HbA1C, lipid profile, creatinine, hemoleucogram, iron, EEG was performed in only 31 of the patients to date. Results: We found that 5 of 25 (20%) males with diabetes duration (dd) between 10-15 years and 11 of 25 (44%)with dd over 15 years were positive for CAN, whereas in females, 4 out of 24 (16,6%) with diabetes duration between 10-15 years and 10 out of 24 (41,6%) with dd>15 years had CAN. We found significant associations of CAN with unrecognized severe hypoglycemias OR=2,33, with presence of retinopathy OR= 1,82, with blood pressure OR=2,01, with symptomtic peripheral neuropathy OR=1,65, with diabetic gastropathy or diarrhea OR=4,03 but no association could be found with EEG aspects..Only 12,4% of the patients complained of symptoms usually suggestive of autonomic neuropathy at presentation. Conclusion: We found a high prevalence of CAN in type 1 diabetic patients, increasing with age and disease duration, and due to the high CV risk attributable to this condition

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We strongly recommend the inclusion of the CAN screening in the annual evaluation of the type 1 diabetes patients, after 10 years of disease duration...

ASPECTE ALE COMEI HIPOGLICEMICE Stefanita PETREA, Andreea SERBAN, Viviana ELIAN, Prof .Dr CONST. IONESCU TARGOVISTE Institutul de Diabet,Nutritie,Boli Metabolice N.PaulescuBucuresti

Coma hipoglicemica este manifestarea extrema a hipoglicemiei, insotita de pierderea starii de constiinta, cu incapacitatea pacientului de a actiona adecvat pentru a iesi din hipoglicemie fara interventia altor persoane. SCOP STUDIULUI:urmarirea cazurilor de coma hipoglicemica internate la I.D.N.B.M.PAULESCUin perioada martie 2007-februarie 2008. MATERIAL SI METODA:au fost analizate 106 pacienti,pe baza foii de observatie completate in serviciul de terapie intensiva.S-au urmarit parametrii fiziologici la internare,etiologia episodului hipoglicemic si raspunsul la tratament. REZULTATE:in perioada martie 2007-februarie 2008 au fost internati in sectia de terapie intensiva a spitalului .I.D.N.B.MPAULESCU 106 cazuri,din care 50 barbati,si 56 femei cu varsta medie de 60,1 ani ,cu o vechime medie a diabetului de 12.79 ani.La internare,pacientii au avut o valoare glicemica medie de 32,85 mg/dl,Hba1c medie de 8.6%,un scor glasgow mediu de 9.78,TAS medie 138,15 mmHg ,TAD medie 73,4 mmHg,AV-90,52 bpm,un procent de 29,78 %din pacienti au prezentat hipertonie,23,45 % semnul babinski si 65,95% transpiratii.Cauza cea mai frecventa a comei hipoglicemice a fost aportul alimentar inadecvat la 66,03%din pacienti.15,09%din cazuri au survenit pe fondul IRC,9.43% pe fondul consumului excesiv de alcool,4.71% in urma efortului fizic intens,,3.77% au survenit la persoane cu neoplazii.A fost inregistrat si un caz de coma hipoglicemica pe fondul administrarii excesive de insulina in scop suicidal la o tanara de 28 ani.Majoritatea pacientilor erau pe terapie cu insulina umana 62,26%,un procent de 23,58 % urmau tratament cu sulfoniluree si 14,15% urmau terapie cu analogi de insulina.Raspunsul la terapie a survenit in principal la 2 ore de la tratament ,cu o glicemie medie de 143 mg/dl,un singur deces a fost semnalat la o persoana de 48 ani,cu neoplasm mamar operat ,cu metastaze cerebrale si meningeale. CONCLUZII:coma a survenit mai frecvent la persoane care urmau tratament cu insulina umana,indeosebi pe schema cu 3 prize de insulina,iar aportul inadecvat de hidrati a fost principala cauza declansatoare .Acest fapt subliniaza importanta educatiei

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terapeutice a pacientului atat in ceea ce priveste administrarea de insulina cat mai ales importanta regimului igieno-dietetic si ajustarea dozelor in functie de stilului de viata

CONSIDERATIONS ON HYPOGLYCEMIC COMA Stefanita PETREA, SERBAN Andreea ,Viviana ELIAN, PROF.C.IONESCU TARGOVISTE Institute of diabetes, Nutrition and Metabolic Diseases "N. Paulescu" Hypoglycemic coma is the extreme manifestation of hypoglycemia,consecutive to the loss of consciousness,with the incapacity of the patient to act accordingly to get off the hypoglicemic status,without outside assistance. Objective-the evaluation of the patients with hypoglycemic coma who have been hospitalized in the Institute of Diabetes,Nutrition and Metabolic Diseases N.Paulescu, Bucharest, between march 2007- february 2008. Research design and methods- a group of 106 patients with hypoglycemic coma has been analysed using the medical records filled in the intensive care unit. It has been recorded the physical examination, vital signs, the etiology of the hypoglicemic event and the response at treatment. Results: between march 2007- february 2008 , in the intensive care unit of the Institute of Diabetes,Nutrition and Metabolic Diseases ,106 patients have been hospitalized ,50 men and 56 women ,average age of 60,1 years, with an average of 12,79 years of diabetes. At the hospitalisation moment,the patients had the following average parameters:glycemia of 32,85 mg/dl ,HbA1c of 8,6 %,the Glasgow coma scale of 9,78,the sistolic blood pressure of 138,15 and the diastolic blood pressure of 73,4, the heart rate of 92,52 beats per minute .29,78% of patients had hypertonia,23,45% had a positive Babinski sign and 65,95 % perspiration. The most common cause for hypoglycemic coma was the inadequate nourishment,present at 66,03 % of patients.15.09 % of cases resulted from chronic renal failure,9.43% from the alcoholic abuse ,4.71% from increased physical activity and 3,77 % of patients had as concomitant illness cancer.It has been recorded one case of hypoglycemic coma due to an insulin overdose administrated as a suicidal attempt by a 28 years old woman .Most of the patients were on human insulin treatment( 62,26%),meanwhile 23,58% were treated with sulfonylurea and 14,15 % with insulin analogs.The patients recovered mainly within 2 hours after the begining of the treatment, with an average of glycemic level of 143 mg/dl,with one exception , a 48 years woman ,with breast cancer and brain disemination ,who died .

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Conclusions: the incidence of coma has been higher to the patients treated with human insulin, especially with 3 doses per day, and the inadequate nourishment has been the primary trigger. This underlines the importance of the patients training regarding not only the administration of insulin but dietary and insulins dosage as well, accordingly to ones lifestyle.

DIABETUL ZAHARAT IN JUDETUL SATU MARE 01 01 2008 01 07 2008 PRELUCRAREA DATELOR CONFORM PROGRAMULUI EPIDIAB REFERIRI LA DATELE EPIDIAB DE LA INITIERE PANA IN PREZENT Dr Szilagyi Iosif* , Dr Bzduch Marta* , Dr Bzduch Zsolt Arpad** , Dr Ciorba Alina*** * Spital Judetean de Urgenta Satu Mare

** Centrul Medical CARITAS Satu Mare *** Cabinet Medical Individual Dr Szilagyi

REZUMAT Judetul Satu Mare face parte din acele judete care au fost integrate de la inceput in programul EPIDIAB. De la initierea programului si pana la 01 07 2008 numarul diabeticilor in evidenta a crescut cu aproape 10 000. Conform protocolului initial au fost inregistrati pacienti in functie de tipul diabetului,, domiciliu, sex, varsta,IMC, circumferinta abdominala, comorbiditati si complicatii (HTA, dislipidemie,cardiopatia ischemica,IM,AVC,arteriopatie diabetica, retinopatie , nefropatie diabetica, neuropatie). De asemenea a fost urmarita structura terapeutica (mod de viata, tratament oral, insulinoterapie de diverse tipuri, terapie combinata). In anul 2008 primul semestru au fost depistate 1372 cazuri noi din care 11 tip 1, 1343 tip 2, 1 diabet gestational, 15 alte forme.Repartitia in funtie de sex, varsta, domiciliu a fost sensibil egala. La tipul 2 o prevalenta net superioara se regaseste la supraponderali si obezi. La tipul 2 peste 70% au HTA, 69% dislipidemie, , 61% afectare vasculara de diverse tipuri, 19% retinopatie, 2,13% nefropatie clinic manifesta, 7,22% neuropatie in momentul depistarii. In ceea ce priveste structura terapeutica predomina cu 34,70% cei cu tratament cu regim+ metformin,33,45% deocamdata beneficiaza doar de regim alimentar , 15,93% au

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tratament cu sulfonilureice 8,04% tratament oral combinat, 4,1% insulinoterapie de diverse tipuri. In concluzie putem afirma faptul ca in continuare se mentine tendinta de crestere rapida a cazurilor de diabet zaharat , dar si faptul ca urmarirea active a acestora poate duce la prevenirea sau intarzierea complicatiilor , ceea ce justifica desfasurarea in continuare a programului.

DIABETES IN SATU-MARE COUNTY 01.01.2008 01.07.2008 DATA ANALYSIS ACCORDING TO EPIDIAB PROGRAM EPIDIAB DATA FROM START TO PRESENT DAYS Dr Szilagyi Iosif; Dr Bzduch Marta; Dr Bzduch Zsolt; Dr Ciorba Alina

ABSTRACT Satu-Mare County has been involved in The EPIDIAB Program from its beginning. The number of the registered diabetic patients has been raised with 10.000 since EPIDIAB started until 01.07.2008. According to the initial protocol the patients have been registered related to the diabetes type, residence, sex, age, BMI, waist circumference, co-morbidities and complications (arterial hypertension, dislipidemia, coronary arterial disease, myocardial infarction, stroke, diabetes vascular disease, retinopathy, diabetes nephropathy, and diabetes neuropathy). In the same time the therapeutically structure has been monitored(life style, oral therapy, different types of insulinoteraphy and combination therapy). In the first semester of 2008 there have been reported 1372 new cases of diabetes from witch 11cases of type 1 diabetes, 1343 type 2 diabetes, 1 gestational diabetes and 15 other types. There was a quite similar split based on sex, age and residency. Most of the type 2 diabetes patients are over-weighted and obese. Among the type 2 diabetes patients there are over 70% who suffered from arterial hypertension, 69% with dislipidemia, 61% with different kind of vascular disease and 19% with retinopathy, 2,13% with nephropathy and 7,22% with neuropathy at the moment of registration. Regarding the therapeutical structure there are 34,70% of the patients on metformin+ life style optimization measures, 33,45% on diet , 15,93% on SU and 8,04% combinated OADs and 4,1% on insulin. In conclusion we could state the fact that there is a continuous and rapid increasing tendency of the diabetes mellitus cases and also the fact that an active follow-up of this

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cases prevents or delay complications, all of this being a good argument to continue the program.

CORELATII INTRE NIVELUL SERIC AL TNF-ALFA SI GROSIMEA INTIMAMEDIE LA PACIENTII CU DIABET ZAHARAT TIP 2 COMPLICAT CU RETINOPATIE Autori: V.Negrean, T. Alexescu, M. Adam, S. Tarmure, N. Leach, C. Vinteler, D. Todea, L. Rosca, 1- Clinica Medicala IV, UMF Iuliu Hatieganu, Spitalul Clinic CF Cluj-Napoca 2- Clinica Dermatologie, Spitalul Clinic Judetean de Urgenta Cluj-Napoca 3- Clinica Pneumoftiziologie, UMF Iuliu Hatieganu Cluj-Napoca Obiectiv: Evaluarea relatiei intre indicele intima-medie(IIM) si valoarea serica a alfaTNF la pcientii cu diabet zaharat tip 2 si retinopatie diabetica. Material si Metoda: Studiul a inclus 40 de pacienti cu diabet zaharat tip 2 si retinopatie diabetica internati in Spitalul Clinic CF Cluj-Napoca in perioada 1.12.2007-30.03.2008. Fiecarui pacient i s-a intocmit o fisa ce cuprindea statusul metabolismului glucidic, lipidic si porteic, precum si markerii endoteliali inflamatori ( CRP, TNF-alfa). Indicele intima-medie a fost evaluat ultrasonografic la nivelul arterei carotide comune, bilateral, inregistrandu-se valoarea medie. Rezultate: 9 pacineti au avut niveluri crescute de TNF-alfa ( 22,5%) , iar indicele intimamedie a fost semnificativ crescut la 22 de pacienti (55%). S-a observat ca toti pacientii cu niveluri crescute de alfa-TNF au avut un indice intima-medie crescut. Concluzii: Indicele intima-medie masurat ultrasonografic reprezinta un semn precoce de ateroscleroza. Cresterea nivelurilor de TNF-alfa se coreleaza cu boala diabetica macrovasculara. Relatia intre semnele ultrasonografice de boala aterosclerotica subclinica si nivelurile serice ale mediatorilor inflamatiei nu este pe deplin certa, dar vom cauta noi factori predictivi de dezvoltare a aterosclerozei la pacientii cu diabet zaharat.

TNF-ALFA AND INTIMA-MEDIA THICKNESS (IMT) IN PATIENTS WITH RETINOPATHYS TYPE 2 DIABETES MELLITUS

Author Block V. Negrean1, T. Alexescu1, M. Adam1, S. Tarmure1, N. Leach, C. Vinteler2, D. Todea3, L. Rosca3;

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1 2

Medicala IV, Clinical Hospital CF cluj-Napoca, Cluj-napoca, Romania, Dermatology, Clinical Hospital of Urgency Cluj-Napoca, Cluj-napoca, Romania, 3 Pneumology, Clinical Hospital of Pneumology Cluj-Napoca, Cluj-napoca, Romania. Background and aims: Evaluation of the relationship between ITM and TNF-alfa in patients with diabetes mellitus type 2 and diabetes retinopathy. Materials and methods: The study included 40 patients with diabetes mellitus and retinopathy from diabetes mellitus causes, registered at Universitary Hospital ClujNapoca between 1.12.2007 and 30.03.2008. Each patient had a record of research where included the status of glucidic metabolism, lipidic metabolism and proteic metabolism and seric inflammatory markers ( CRP, TNF-alfa). ITM was evaluated using the ultrasonography of the common carotidal artery, on each side, and the medium value was recorded. Results: 9 patients had increased level of TNF-alfa ( 22,5%) and ITM was significant increased in 22 patients (55%). It was observed that all patients with high levels of TNFalfa had significant increased ITM. Conclusion: The ITM measured by ultrasonography represents early sign in the development of atherosclerosis. The raising of TNF-alfa levels correlates with macrovascular disease in patients with diabetes retinopathy. The relationship between ultrasonographic signs of sub-clinical atherosclerosis and the plasma levels of chemical mediators of inflammation is not certain yet, but we are looking for a new prediction factors of sub-clinical atherosclerosis in patients with diabetes mellitus and its systemic complications.

EVALUAREA MASEI DE ESUT ADIPOS DUP SUBSTITUIE TESTOSTERONIC LA BARBAII CU SINDROM METABOLIC I DISFUNCIE ERECTIL: EXPERIENA CLINIC A CENTRULUI CLINIC DE DIABET, NUTRIIE, BOLI METABOLICE, CLUJ-NAPOCA V. COCA, MD1, Georgiana NICOLESCU, MD2, Mariana C. COCA, MD, PHD3, Ildiko KICSI-MATYUS, MD2
1

Cabinet Andrologie si Medicina Sexualitii, 2Cabinet Obezitate i Dislipidemii, 3 Departament Laborator Clinic, Centrul de Diabet, Nutritie, Boli Metabolica, ClujNapoca.

Obiective: Am urmrit evoluia adipozitii generale, a adipozitii intra-abdominale, a taliei i a raportului talie/old dup tratament cu testosteron cu absorbie prelungit la persoane cu sindrom metabolic (MetS) cu disfuncie erectil (DE) i activitate gonadic diminuat.

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Metoda: La un grup de 18 brbai cu MetS (IMC: 32.671.08 kg/m2; T=1175.09 cm; glicemie=116.76.3 mg%; Grup A) funcie gonadic sczut (testosteron total [Tt] = 9.83.6 nmol/L, testosteron liber [free T] = 0.290.062) i DE ( ejaculare precoce alterare de libidou) am evaluat distribuia adipozitii (impedan [InBody]; V1): adipozitatea general (AG): 40.74.1%; adipozitatea visceral (AP): 108.412.3 cm2; talia (T): 119.528.8 cm; raport talie/old (T/S): 1.160.063. Pentru revigorare sexual am prescris testosteron injectabil i.m. cu absorbie prelungit (NEBIDO 1000, 4 ml, 250 mg/ml) combinat cu PDE5i. Am evaluat participanii din punct de vedere sexual (Indice Internaional al Funciei Erectile: IIEF), androgenic i prostatic (ecografie i PSA) naintea fiecrei injectri (la 2-3 luni) i respectiv antropometric dup 32 de sptmni (V2) plus profilul lipidic, cel hematologic i enzimele hepatice comparativ cu un lot de 20 de brbai (Grup B) cu MetS, DE i activitate testosteronic diminuat, tratai fr testosteron, doar cu PDE5i.

Rezultate: La V2: AG = 34.41.09% (7.6%), P<0.05. AP = 112.1510.7 cm2 (16.4 cm2, 14.6%), P<0.08. T = 99.66.09 cm (9 cm, 8.33%), P<0.05. T/S = 0.980.079 ( 0.08), P<0.01. Comparaia cu lotul de control (V2) a relevat urmtoarele semnificaii statistice: AG (vs. 43.453.02%): P < 0.05 (=0.058); AP (vs. 130.16.6 cm2): P < 0.06 (=0.067); T (vs. 120.025.01 cm): P < 0.05 (=0.056); T/S (vs. 1.10.03): P < 0.9. Parametrii lipidici, hematologici i enzimele hepatice nu au registrat ascensiuni valorice fa de V1. Testosteronemia postterapeutic nu a depit nivelul superior al normalului (medie Gr. A=18.663.09 nmol/L) i nu s-au nregistrat nici alterri ale PSA (medie Gr. A=0.1960.022 g/L).

Concluzie: Substituia testosteronic la brbaii obezi cu sindrom metabolic reduce masa adipocitar pe seama scderii semnificative a grsimii abdominale i a taliei. Acest beneficiu, alturat profilului lipidic nealterat dup testosteron, sugereaz un potenial de ameliorare a riscului cardiovascular.

BODY FAT MASS EVALUATION IN METABOLIC SYNDROME WITH ERECTILE DYSFUNCTION AFTER TESTOSTERONE SUBSTITUTION THERAPY: CLINICAL EXPERIENCE OF THE CLINICAL CENTER OF DIABETES, NUTRITION AND METABOLIC DISEASE, CLUJ-NAPOCA. V. COCA, MD1, Georgiana NICOLESCU, MD2, Mariana C. COCA, MD, PHD3, Ildiko KICSI-MATYUS, MD2,
1

Sexual Medicine and Andrology Office, 2Obesity and Dislipidemia Office, 3Laboratory Investigations Department, Diabetes Clinical Center, County Emergency Hospital, Cluj-Napoca, Romania

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Objective: To assess total body fat mass, abdominal fat, waist and waist to hip ratio in long acting testosterone therapy in men having non-diabetic metabolic syndrome (MetS), erectile dysfunction (ED) and low androgenic activity. Method: A group of 18 men with MetS (BMI: 32.671.08 kg/m2; W=1175.09 cm), low/low normal androgenic activity (testosterone [T] = 9.83.6 nmol/L and free T = 0.290.062 nmol/L) and ED ( premature ejaculation, low libido) has been selected (Group A). Body fat distribution (impedance method: In Body) characteristics at V1 were: general fat mass (GF): 40.74.1%; visceral adipose tissue (VA): 108.412.3 cm2; waist (W): 119.528.8 cm; waist to hip ratio (W/H): 1.160.063. For sexual reestablishement long acting testosterone (Nebido 1000) associated to phosphodiesteraze 5 inhibitors (PDE5i) were prescribed. Sexual (International Index of Erectile function: IIEF), serum testosterone and prostate (PSA, ultrasound) evaluation before every testosterone injection (2-3 month) were measured. Body fat parameters after 32 weeks injected long acting testosterone were also noted (V2) together with lipid profile, hematology and liver enzymes. Results were compared to those of a control group with MetS, ED and testosterone low activity, treated only with PDE5i (Gr. B). Results: At V2: GF = 34.41.09% (7.6%), P<0.05. VA = 112.1510.7 cm2 (16.4 cm2, 14.6%), P<0.08. W = 99.66.09 cm (9 cm, 8.33%), P<0.05. W/H = 0.980.079 (0.08), P<0.01. Comparing to the control group (also at V2) offered the following statistical significances: GF (vs. 43.453.02%): P < 0.05 (=0.058); VA (vs. 130.16.6 cm2): P < 0.06 (=0.067); W (vs. 120.025.01 cm): P < 0.05 (=0.056); W/H (vs. 1.10.03): P < 0.9. Lipid and hematological profile and liver enzymes also at V2 did not enhanced from normal patterns. Testosterone serum levels remained in normal interval values after the treatment (average Gr. A=18.663.09 nmol/L); PSA levels either (average Gr. A=0.1960.022 g/L).

Conclusions: Testosterone substitution therapy in metabolic syndrome men having ED decrease total body fat by reducing abdominal fat and waist. These benefits and the unaltered lipid profile suggest a possible lowering in cardiovascular risk of long acting testosterone admission.

EVALUAREA FUNCIEI SEXUALE DUP SUBSTITUIE TESTOSTERONIC LA PERSOANE CU SINDROM METABOLIC I DISFUNCIE ERECTIL: EXPERIENA CLINIC A CENTRULUI CLINIC DE DIABET, NUTRIIE, BOLI METABOLICE, CLUJ-NAPOCA V. COCA, MD1, D. PORAV, MD2, Ildiko KICSI-MATYUS, MD1, Georgiana NICOLESCU, MD1
1

Centrul de Diabet, Spital Judeean de Urgen, Cluj-Napoca.

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Secia Urologic, Spital Municipal, Cluj-Napoca.

Obiective: Evaluarea parametrilor de funcie sexual (funcie erectil, dorin sexual, satisfacie a penetrrii, satisfacie orgasmic i satisfacie general) dup substituie testosteronic, n sin-dromul metabolic (MetS) cu disfuncie erectil (DE) i cu activitate gonadic diminuat.

Metoda: La 18 brbai cu MetS (BMI: 32.671.08 kg/m2; W=1175.09 cm; Grup A), testosteron seric sczut (testosteron total [Tt] = 9.83.6 nmol/L, testosteron liber [free T) = 0.290.062) i DE ( ejaculare precoce alterare de libidou) am asociat terapeutic testosteron cu absorbie prelungit (testosterone undecanoat 250 mg/ml: Nebido 1000) i inhibitori de fosfodiesteraz 5 (PDE5i: sildenafil 50 mg, tadalafil 20 mg). Comparaia s-a facut cu un lot de control de 20 de brbai (Grup B) cu MetS i DE, tratai doar cu PDE5i, fr testosteron. Evaluarea sexual s-a fcut prin calcularea scorului total al Indexului Internaional de Funcie Erectil (IIEF) i al domeniilor acestuia: funcia erectil (FE): Q1 5, 15; satisfacia penetrrii (SP): Q6 8; satisfacia orgasmic (SO): Q9 10; dorina sexual (DS): Q11 12; satisfacia general (SG): Q13 14. Evaluarile s-au facut la nrolare (V1) i dup 32 de sptmni de testosteron (3 injecii i.m.; V2).

Rezultate: Scorul IIEF. Gr. A, V1 vs. V2: 41,87.2 vs. 68.45.9 (P=0.0016); la V2, Gr. A vs. Gr. B: 68.45.9 vs. 57.36.6 (P=0.037). Scor FE. Gr. A, V1 vs. V2: 14.23.1 vs. 26.52.2 (P=0.003); la V2, Gr. A vs. Gr. B: 26.52.2 vs. 22.62.4 (P=0.056). Scor SP. Gr. A, V1 vs. V2: 8.70.2 vs. 14.00.8 (P=0.074); la V2, Gr. A vs. Gr. B: 14.00.8 vs. 11.70.4 (P=0.021). Scor SO. Gr. A, V1 vs. V2: 8.30.08 vs.8.90.7; la V2 Gr. A vs. Gr. B: 8.90.7 vs. 8.60.1 (P=0,15). Scor DS. Gr. A, V1 vs. V2: 5.30.5 vs.8.80.04 (P=0.0012); la V2 Gr. A vs. Gr. B: 8.80.04 vs. 6.070.2 (P=0.072). Scor SG. Gr. A, V1 vs. V2: 4.70.3 vs.8.90.1 (P=0.008); la V2 Gr. A vs. Gr. B: 8.90.1 vs. 6.30.5 (P=0.061). Discuii: Lund n considerare semnificaia statistic de P<0.05, diferene semnificative fa de lotul martor au aprut la ameliorarea funciei erectile, a dorinei sexuale (libido) i a satisfaciei generale. Nu s-au putut face corelaii cu tipul de PDE5i asociat, din cauza inconstantei utilizrii a aceleiai forme de PDE5i pe durata studiului.

Concluzii: Substituia testosteronic cu preparate cu absorbie prelungit amelioreaz calitatea vieii, mbuntind funcia sexual la brbaii cu sindrom metabolic i disfuncie erectil i crescnd totodat i eficiena PDE5i la aceste persoane.

SEXUAL FUNCTION ASSESSMENT AFTER TESTOSTERONE SUBSTITUTION THERAPY IN MEN HAVING ERECTILE DYSFUNCTION AND METABOLIC SYN-DROME: CLINICAL EXPERIENCE OF THE

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CLINICAL CENTER OF DIABETES, NUTRITION AND META-BOLIC DISEASE, CLUJ-NAPOCA V. COCA, MD1, I. COMAN, MD2, Ildiko KICSI-MATYUS, MD3, Georgiana NICOLESCU, MD3
1

Sexual Medicine-Andrology Office, Diabetes Clinical Center, County Emergency Hospital, Cluj-Napoca, Romania
2

Sexual Medicine-Andrology Office, Urology Department, Municipal Hospital, ClujNapoca, Romania

3

Diabetes Clinical Center, County Emergency Hospital, Cluj-Napoca, Romania

Objective: To watch sexual items (erectile function, sexual desire, intercourse satisfaction, orgasmic satisfaction and overall satisfaction) after testosterone substitution therapy in men with metabolic syndrome having erectile dysfunction with low gonadic activity. Method: A group of 18 men with MetS (BMI: 32.671.08 kg/m2; W=1175.09 cm), low/low normal androgenic activity (testosterone [T] = 9.83.6 nmol/L and free T = 0.290.062 nmol/L) and ED ( premature ejaculation, low libido) has been selected (Group A). They were treated with long acting testosterone (testosterone undecanoat 1000 mg) associated to phosphodiesteraze 5 inhibitors (PDE5i: sildenafil 50 mg, tadalafil 20 mg) and compared to a 20 men control group (B) treated only with PDE5i and (also having MetS, ED and testosterone low activity). Sexual function has been evaluated by the International Index of Erectile Dysfunction (IIEF) score and its domains: Erectile Function (EF): Q1 - 5, Q15; Sexual Desire (SD): Q6 8; Intercourse Satisfaction (IS): Q9 10; Orgasmic Satisfaction (OS): Q11 12; and Overall Satisfaction (OVS): Q13 14. Results: IIEF score. Gr. A, V1 vs. V2: 41.87.2 vs. 68.45.9 (P=0.0016); la V2, Gr. A vs. Gr. B: 68.45.9 vs. 57.36.6 (P=0.037). EF score. Gr. A, V1 vs. V2: 14.23.1 vs. 26.52.2 (P=0.003); la V2, Gr. A vs. Gr. B: 26.52.2 vs. 22.62.4 (P=0.056). IS score. Gr. A, V1 vs. V2: 8.70.2 vs. 14.00.8 (P=0.074); la V2, Gr. A vs. Gr. B: 14.00.8 vs. 11.70.4 (P=0.021). OS score. Gr. A, V1 vs. V2: 8.30.08 vs.8.90.7; la V2 Gr. A vs. Gr. B: 8.90.7 vs. 8.60.1 (P=0.15). SD score. Gr. A, V1 vs. V2: 5.30.5 vs.8.80.04 (P=0.0012); la V2 Gr. A vs. Gr. B: 8.80.04 vs. 6.070.2 (P=0.072). OVS score. Gr. A, V1 vs. V2: 4.70.3 vs.8.90.1 (P=0.008); la V2 Gr. A vs. Gr. B: 8.90.1 vs. 6.30.5 (P=0.061). Considering as statistic significance the P<0.05, a better improve-ment in erectile function domain, sexual desire (libido component) and overall satisfaction, for the testosterone + PDE5i treated group has been registered. It could not been done correlations to each prescribed PDE5i because the participants varied it during the study. Conclusions: In men with erectile dysfunction and metabolic syndrome long acting testosterone therapy improves their sexual function (erection and desire), also enhancing PDE5i pharmacological effect and basically improving their quality of life. 177

HIPERGLICEMIA CRONICA USOARA IN TREI GENERATII: FORMA MONOGENICA DE DIABET ZAHARAT - MODY 2 (?) Dr. Victoria Cret (Clinica Pediatrie I Cluj) Ipoteza: Diabetul zaharat monogenic, rezultat al unor mutatii la nivelul unei singure gene, se poate transmite autosomal dominant, autosomal recesiv sau mutatia poate fi de novo. La copil, aproape toate formele de diabet monogenic sunt rezultatul mutatiilor la nivelul genelor care regleaza functia celulelor beta-pancreatice, mai frecvente fiind mutatiile (peste 200) genei glucokinazei (GCK) care determina MODY 2, majoritatea fiind mutatii inactivatoate in stare heterozigota, responsabile de hiperglicemia cronica usoara, neprogresiva. Prezentam cazul unei paciente cu hiperglicemie cronica, modificare biochimica prezenta si la mama, unchiul si bunicul matern, la care suspectam o forma monogenica, autosomal dominanta de diabet zaharat - MODY 2. Pacienta, in varsta de 12 ani, s-a prezentat pentru hiperglicemii usoare in ultimii ani, greutatea la nastere fiind normala. Evaluarea clinica releva hipostatura, IMC normal, dezvoltare neuropsihica si pubertara normala. Explorarile diagnostice au aratat: glicemia bazala: 182 mg/dl; TTGO: 312 mg/dl la 2 ore; HbA1c = 6,19%; peptidul C: 1,16 ng/ml (VN: 1,14,4); insulinemia bazala: 10,0 /ml (VN: 26, dup Ranke); HOMA-IR: 4,86 U (VN < 4); nu a prezentat cetonurie; evaluarea axei endocrine a cresterii a relevat valori normale ale IGF1 si STH stimulat. Mama pacientei, in varsta de 39 ani, prezenta hiperglicemie bazala, TTGO: 202 mg/dl la 2 ore si HbA1c: 6,64%. Unchiul matern, in varsta de 30 ani, a fost recent diagnosticat cu DZ tip 2, ca si bunicul matern, in varsta de 59 ani (ambii cu forme usoare de hiperglicemie: ntre 130 150 mg/dl). In evolutie, pacienta a prezentat valori ale glicemiei intre 80 170 mg/dl, controlate cu dieta. Diagnosticul diferential a inclus diabetul zaharat tip 2 si alte forme monogenice sau specifice de diabet zaharat Concluzii: Am interpretat cazul ca o forma familiala de hiperglicemie cronica usoara - o forma monogenica de diabet zaharat cu transmitere autosomal dominanta si anume MODY 2; pentru confirmarea diagnosticului se impune analiza moleculara cu precizarea mutatiei la nivelul genei glucokinazei. Importanta cunoasterii mutatiei rezida din faptul ca, in familiile cu risc, mutatiile in stare homozigota sau de heterozigot compus determina deficitul total de GCK, cu aparitia diabetului zaharat neonatal pernament iar mutatiile activatoare heterozigote sunt asociate cu hiperinsulinismul congenital.

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MILD CHRONIC HYPERGLICEMIA IN THREE GENERATIONS: MONOGENIC DIABETES MELLITUS - MODY 2 (?) Dr. Victoria Cret (First Pediatric Clinic, Cluj) Monogenic diabetes mellitus, as a result of one or more mutations in a single gene, could be transmited in an autosomal dominant / autosomal recesiv manner or the muation could be de novo. In children, almost all monogenic diabetes mellitus cases result from mutations in genes which regulate pancreatic beta-cells function, the glucokinase gene mutations (over 200), most of them being heterozigous and inactivating mutations, clinically expressed as MODY 2 - mild chronic hyperglicemia. We present here a female patient with mild hyperglicemia, biochemical mark present also in her mother, maternal grandfather and maternal uncle (diagnosed as type 2 diabetes mellitus), family who are under our susspicion to have monogenic diabetes mellitus, probably MODY 2. The patient, 12 years old girl, with normal birth wheight, recognised mild hyperglicemia years before but no records available. Clinical evaluations showed: short stature, normal BMD, normal pubertal and mental development. Laboratory tests revealed: fasting glycemia: 182 mg/dl; OGTT: 312 mg/dl at 2 hours; HbA1c: 6,19%; C peptide: 1,16 ng/ml (normal value: 1,14,4); fasting insulinemia: 10,0 U/ml (normal value: 26, after Ranke); HOMA-IR: 4,86 (normal value < 4); no ketonuria; normal value for IGF1 and stimulated GH. Her mother, 39 years old, presents fasting hyperglicemia (mild), OGTT: 202 mg/dl at 2 hours and HbA1c: 6,64%. Maternal uncle, 30 years of age, has been recently diagnosed with type 2 diabetes mellitus, as well as the maternal grandfather, 59 years of age (both with mild, chronic hyperglicemia: betveen 130 150 mg/dl). Our patient presented glycemia values arround 80 170 mg/dl on diet only. We discussed differential diagnosis with type 2 diabetes mellitus and other monogenic or specific forms of diabetes mellitus. In conclusion: This family, who show mild chronic hyperglicemia, seems to have a monogenic form of diabetes mellitus, an autosomal dominant one, more probably MODY 2. Molecular analysis sould be perform in order to identify the GCK mutations. This is important because, in family at risk, a total deficiency of GCK due to homogenous or compound heterozigous GCK mutations causes permanent neonatal diabetes mellitus and the heterozigous activating mutations are associated with congenital hyperinsulinemia o infancy.

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EVALUAREA PERFORMANEI DISPOZITIVELOR DE ADMINISTRARE A INSULINEI UTILIZATE FRECVENT LA PACIENII CU DIABET ZAHARAT TIP 2 N AMBULATOR Viorel erban1 , Mirela Tache 2, Gabriela Teodorescu3, Helmut Petto4, Jacek Kiljanksi4
1

Spitalul Clinic Judeean Timioara, Romnia; 2Spitalul Clinic N. Malaxa Bucureti, Romnia; 3Eli Lilly Romnia SRL, Bucureti, Romnia; 4Centrul Medical Regional Viena, Eli Lilly and Company, Austria

Context: Dispozitivele de administrare a insulinei (DAI) au fost dezvoltate pentru a reduce dificultile de ordin practic, social i emoional asociate cu insulinoterapia. Mici diferene tehnice ntre aceste dispozitive pot influena preferina pacienilor i pot afecta acurateea dozrii insulinei. Obiective: Evaluarea erorilor de dozare a insulinei la pacienii cu diabet zaharat tip 2 (DZ tip 2) insulinonecesitant, a timpului pe care personalul medical l petrece instruind pacienii s utilizeze DAI cele mai frecvent folosite (Optipen Pro1, Optiset, NovoPen 3, NovoLet i HumaPen Ergo). Pacieni i metode: Un studiu prezent, observaional, multicentric, deschis, a fost efectuat n 42 de centre din Romnia n anul 2005, pe parcursul a 6 luni. Au fost nrolai 609 pacieni cu DZ tip 2 dintre care 348 (57%) pacieni care nu se aflau n tratament anterior cu insulin Insulin Nave Patients INP (58% femei, vrsta medie 59 ani, durata medie a DZ 7,9 ani) i 261 (43%) pacieni care se aflau deja n tratament cu insulin Non Insulin Nave Patients - NINP (61% femei, vrsta medie 60 ani, durata medie a DZ 8,8 ani, doza zilnic medie de insulin a fost 38 U cu un interval de ncredere [CI 26, 48] administrat n 2 injecii pe zi.). Pentru administrarea insulinei s-au folosit seringi, Optipen Pro1, Optiset, NovoPen 3, NovoLet sau HumaPen Ergo care au putut fi schimbate ntre ele. Statistica ilustreaz valorile medii raportate fie cu intervalele de ncredere (CI 95%), fie cu valori minime i maxime. Testul Kruskal Wallis a fost utilizat pentru a calcula valorile p bilateral ale valorilor diferite dintre DAI. Rezultate: Scorul pentru dozarea corect (SDC) a fost diferit ntre DAI doar la nceput pentru pacienii INP (p=0.03). Pentru toate IDS combinate s-a demonstrat o cretere n timp a dozrilor corecte, de la valoarea iniial 93% (CI 91.4, 94.4) la 99% (CI 98.5, 99.5) dup 6 luni. Global, timpul necesar pentru instruirea pacienilor a sczut n timp de la 8.5 ore (CI 7.9, 9.1) la 1.9 ore (CI 1.9, 1.3). SDC a fost diferit ntre DAI att iniial (p=0.03) ct i dup cele 6 luni (p=0.006) la pacienii INNP. Pentru toate IDS combinate s-a demonstrate creterea n timp a dozrilor corecte de la valoarea iniial 95% (IC 93.0, 96,1) la >99% (IC 99.4, 100.0) dup 6 luni. Timp pentru reinstruire nu a fost disponibil la aceast grup. Concluzii: n pofida preciziei ridicate de dozare a insulinei, ndeplinit de toate DAI individual, la nceputul tratamentului se observ diferene ale acurateei dozrii la pacienii INP i INNP. Precizia dozrii crete cu timpul, diferenele dispar n cursul 180

primelor 6 luni de utilizare a DAI, iar la acei pacieni care dozeaz greit unitile de insulin, valoarea erorii scade. Cuvinte cheie: diabet zaharat tip 2, dispozitive de administrare a insulinei, pen pentru insulin, studiu comparativ i observaional. Finanare: Acest studiu (B5K-VI-B005) a fost finanat de Eli Lilly and Company. Conflicte de interese: G. Teodorescu, H. Petto i J. Kiljanski sunt salariai ai Eli Lilly and Company.

ASSESSMENT OF PERFORMANCE OF COMMONLY USED INSULIN DELIVERY SYSTEMS IN PATIENTS WITH TYPE 2 DIABETES IN AN OUTPATIENT SETTING Viorel erban1 on behalf of METCON investigators, Mirela Tache 2, Gabriela Teodorescu3, Helmut Petto4, Jacek Kiljanksi4
1

County Clinical Emergency Hospital Timioara, Romania; 2N. Malaxa Clinical Hospital Bucharest, Romania; 3Eli Lilly Romania SRL, Bucharest, Romania; 4Area Medical Center Vienna, Eli Lilly and Company, Austria

Background: Insulin delivery systems (IDS) are developed to reduce practical, social and emotional burden associated with insulin injections. Slight technical differences between these devices may be relevant for patients preference and affect accuracy of insulin dosing. Objectives: To assess the number and size of dosing mistakes and the time Health Care Professionals (HCPs) spent training patients on commonly used IDS (Optipen Pro1, Optiset, NovoPen 3, NovoLet and HumaPen Ergo ) in a standard clinical setting in patients with type 2 diabetes requiring insulin therapy. Patients and Methods: This was a 6-month observational, multi-center, open-label study conducted in 42 sites in Romania in 2005. 609 patients with Type 2 diabetes were enrolled: 348 (57%) insulin nave patients (INPs; 58% female, mean age 59 years, mean diabetes duration 7.9 years) who started insulin therapy and 261 (43%) non-insulin nave patients (NINPs; 61% female, mean age 60 years, mean diabetes duration 8.8 years, mean number of insulin injection - 2 per day; daily mean insulin dose - 38 [CI 26, 48] U). Insulin was delivered by syringes, Optipen Pro1, Optiset, NovoPen 3, NovoLet, or HumaPen Ergo and there could be switch among these devices. As summary statistics mean values were reported either with parametric 95% confidence intervals or with

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minimum and maximum values. Kruskal Walis tests were used to calculate two-sided pvalues for differences between insulin delivery systems. Results For INP patients only at baseline the correct dosing score (CDS) was different between IDS (p=0.03). All IDS combined showed an increased correct dosing over time from 93% (CI 91.4, 94.4) at baseline to 99% (CI 98.5, 99.5) after 6 months. Overall the time to train patients decreased over 6 months from 8.5 (CI 7.9, 9.1) to 1.9 (CI 1.9, 1.3) hours. For NINPs, at baseline and after 6 months CDS was different between IDS (p=0.03 and p=0.006, respectively). All IDS combined showed an increased correct dosing over time from 95% (CI 93.0, 96.1) at baseline to >99% (CI 99.4, 100) after 6 months. Time to retrain was not available for this group. Conclusions: These results indicate that despite of high dosing precision achieved with all the individual IDS, differences in dose accuracy are observed in the beginning of treatment for insulin nave and insulin non-nave patients. The accuracy of insulin dosing increased within 6 months of IDS use and in those patients who dosed incorrectly the range of the error became smaller. Keywords: type 2 diabetes, insulin delivery systems, insulin pen, observational and comparative study Funding: This study (B5K-VI-B005) was funded by Eli Lilly and Company. Conflicts of interests: G. Teodorescu, H. Petto and J. Kiljanski are employees of Eli Lilly and Company.

IGF SYSTEMS AT DIAGNOSIS IN PUBERTAL ADOLESCENT WITH TYPE I DIABETES MELLITUS. Simona I. Chisalita 1, 2, 4, J. Ludvigsson 4, 5 and H J. Arnqvist 1, 3, 4
1 2 3 4 5

Institution of Clinical and Experimental Medicine, Department of Cell Biology, Emergency Clinic, Division of Internal Medicine, Department of Medicine and Care, Diabetes Research Centre, Division of Paediatrics,

Faculty of Health Sciences, Linkping University, Linkping, Sweden.

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Background. Type 1 diabetes in pubertal adolescent is associated with alterations in the IGF-system probably due to both a deranged metabolism and insulinopenia in the portal vein. Aim. To study in pubertal adolescents with pubertal onset of type 1 diabetes mellitus how levels of IGF-I and IGFBP-1 are affected by the deteriorating endogenous insulin secretion. Methods. Ten girls and ten boys with type I diabetes, age 13.5 1.35 (mean SEM) years at diagnosis took part in the study. Blood samples were drawn at diagnosis, and after 3, 9 18 month, and after 3 and 5 years from the debut. HbA1c, total IGF-I, IGFBP-1 and Cpeptide were measured. Results. At diagnosis the patients had high HbA1c, low IGF-I and measurable C-peptide. After start of insulin treatment glycaemic control and IGF-I improved but C-peptide decreased and after 4 years almost all patients were C-peptide negative. C-peptide was correlated to IGF-I and IGFBP-1 at the diagnosis (p<0.05). HbA1c was correlated to IGF-I after 3 months of insulin treatment whereas IGFBP-1 was not correlated to HbA1c. Conclusions. In newly diagnosed adolescents with type I diabetes mellitus IGF-I levels but not IGFBP-1 is related to glycaemic control. Endogenous insulin secretion is also of importance for IGF-I and IGFBP-1.

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