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 etabolice !N. Paulescu!, Bucureti,
Ro"#nia
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)
Mateia! "i #et$%&! "otul studiat a inclus 2## pacieni cu DZ tip 1 si DZ tip 2$ nou
descoperii$ %nre&istrai %n ultimele 2 luni la 'nstitutul de Diabet$ (utriie si )oli
*etabolice +(,aulescu-$ )ucureti$ dintre care ./ au fost barbai (0.1) si 1#2 au fost
femei (211) ,e lotul studiat$ pacienii au fost &rupai %n funcie de tipul de diabet zaharat
(DZ) %n 2 loturi ! lotul 1 incluz3nd pacienii cu DZ tip 1 (n415) i lotul 2 incluz3nd
pacienii cu DZ tip 2 (n41/6) ,entru fiecare lot au fost colectate date clinice si
antropometrice (%nalime$ &reutate$ inde7ul masei corporale8'*9$ circumferina
abdominal: i valorile tensiunii arteriale sistolice i diastolice)$ dar i parametrii
metabolici (;b<1c i profilul lipidic)$ date privind statusul de fum:tor=nefum:tor i
antecedente heredocolaterale de DZ,entru interpretarea rezultatelor$ am utilizat criteriile
<>, ''' pentru definirea parametrilor sindromului metabolic i Scorul Reaven (raportul
>?=;D"col@5) pentru estimarea insulinorezistenei<naliza statistic: a datelor s8a
efectuat utiliz3nd S,SS 12#
Re'(!tate: ,revalena obezit:ii abdominale a fost de 5#61 %n cazul lotului de
pacieni cu DZ tip 1 i de 06#21 %n cazul lotului de pacieni cu DZ tip 2 Aalori crescute
ale tensiunii arteriale sistolice s8au constatat la 6021 dintre subieci$ 2511 dintre
acetia aparin3nd lotului 1 de pacieni cu DZ tip 1$ iar 6621 aparin3nd lotului 2 de
pacieni cu DZ tip 2 Aaloarea medie a ;b<1c a fost de 1#BC2/01 la pacienii cu DZ
tip 1$ respectiv .#/C2201 la pacienii cu DZ tip 2 Aaloarea medie a Scorului Reaven a
fost de 22.C152 la lotul de pacieni cu DZ tip 1 i respectiv B00C5./ la lotul de
pacieni cu DZ tip 2 Aalorile medii ale '*9 au fost 256BD&=mE la pacienii cu DZ tip 1$
respectiv 5#1BD&=mE la pacienii cu DZ tip 2"a pacienii cu DZ tip 1 nou dia&nosticat$
raportul >?=;D"col s8a corelat direct i puternic cu circumferina taliei (rs4#B6#$
p4##12$ 9D400/.)$ astfel c: 001 dintre subieci au prezentat o corelaie pozitiv: %ntre
cei doi parametri"a pacienii cu DZ tip 2 nou dia&nosticat$ Scorul Reaven s8a corelat
pozitiv cu circumferina abdominal: (rs4#60#$ p4###1$ 9D4206B1)$ cu valorile
;b<1c (rs4#222$ p4###B$ 9D45#061) i cu tensiunea arteriala (p4###1) (u am
constatat diferene statistic semnificative %ntre pacienii din cele 2 loturi %n ceea ce
privete stratificarea lor %n funcie de se7$ antecedente de DZ i statusul de fum:tor
C$)c!('ii: 'n cazul DZ tip 1 nou dia&nosticat$ Scorul Reaven se asociaz: cu
circumferina taliei pacienilor Fn cazul DZ tip 2$ Scorul Reaven se asociaz: cu
circumferina taliei$ cu maGoritatea parametrilor sindromului metabolic i cu &radul de
1
control metabolic al DZ 9ircumferina taliei$ fiind un parametru uor de m:surat$ poate
fi uzitat ca punct de plecare %n screenin&ul insulinorezistenei
THE SIGNIFICANCE OF REAVEN*S SCORE IN PATIENTS +ITH
DIABETES MELLITUS NE+L, DIAGNOSED
A.Nicoara, C.Pencea, D. Licaroiu, $. %tan, R. Lichiardopol
!N.Paulescu& Institute of Diabetes, Nutrition and etabolic Disease, Bucharest,
Rou"ania
Bac-.$()% a)% Ai#": >he obGective of this studH Ias to identifH the relationship
betIeen the ReavenJs Score Ihich is an indicator for insulin resistance and the clinical
and metabolic features of patients Iith tHpe 1 diabetes mellitus (>1D*) and tHpe 2
diabetes mellitus (>2D*) neIlH dia&nosed
Mateia!" a)% Met/$%": >he studH &roup included tIo hundred patients neIlH
dia&nosed >1D* and >2D* re&istrated at +( ,aulescu- 'nstitute of Diabetes$ (utrition
and *etabolic Disease$ )ucharest durin& the last tIo month$ ./ men (0.1) and 1#2
Iomen (211) Dependin& on the tHpe of diabetes mellitus (D*)$ the subGects Iere
selected in tIo &roups! &roup 1 included the patients Iith >1D* neIlH dia&nosed
(n415) and &roup 2 included the patients Iith >2D* neIlH dia&nosed (n41/6) 'n each
&roup$ Ie assessed the clinical and a feI anthropometric data (hei&h$ Iei&ht$ bodH mass
inde7 8 )*'$ Iaist circumference and sistolic and diastolic blood pressure) as Iell as
metabolic parameters (;b<1c and lipid profiles)$ historH of D* data and smoDin&=no
smoDin& status data>he <>, ''' criteria for metabolic sHndrome (*etS)$ ReavenJs Score
(>?=;D" chol) @ 5 for estimation of insulin resistance have been used to interpret the
resultsStatistical analHsis Ias carried out usin& S,SS 12#
Re"(!t": >he prevalence of lar&e Iaist Ias 5#661 for >1D* &roup and 06#21 for
>2D* &roup ;i&h sistolic blood pressure Ias found in 6021 of the subGects$ in 2511
of the patients Iith >1D* and in 6621 of the patients Iith >2D* >he mean ;b<1c
level Ias 1#BC2/01 in >1D* patients &roup and .#/C2201 in >2D* patients &roup
>he mean values of ReavenJs Score Ias 22.C152 in >1D* patients and B00C5./ in
>2D* patients >he mean values of )*' Ias 256BD&=mE in neIlH dia&nosis >1D*
patients and 5#1BD&=mE in neIlH dia&nosis >2D* patients 'n patients Iith neIlH
dia&nosed >1D* there Ias proved the e7istence of a positive correlation betIeen
ReavenJs Score and Iaist circumference (rs4#B6#$ p4##12$ 9D400/.)! in 001 of the
patients Iith neIlH dia&nosed >1D* has been shoIn a positive correlation betIeen the
>?=;D" chol ratio values and the Iaist circumference values 'n patients Iith neIlH
dia&nosed >2D* there Ias proved the e7istence of a positive correlation betIeen
ReavenJs Score and Iaist circumference values (rs4#60#$ p4###1$ 9D4206B1) as Iell
as betIeen ReavenJs Score and ;b<1c values (rs4#222$ p4#$##B$ 9D45#061) and
2
betIeen the ReavenJs Score and hi&h blood pressure (p4#$##1) Ke have not found
semnificative statistical differences betIeen the patients of the tIo &roups re&ardin& the
se7 stratification (p4#/52)$ historH of D* (p4#2B6) and smoDin& status (p4#222)
C$)c!("i$)": >he ReavenJs Score is related to Iaist circumference in neIlH
dia&nosed >1D* patients 'n >2D*$ >he ReavenJs Score is related to anthropometric
and most parameters of metabolic sHndrome and Iith the de&ree of metabolic control
)ased on the freLuencH and easH8to8determine Iaist circumference$ it could be use as
startin& point to screen for insulin resistance
INSTRUMENT INFORMATIC APLICAT IN EDUCATIA PENTRU O
ALIMENTATIE SANATOASA
Calinici .A.', Pa(el N.'', Pa(el C.'', Calinici ).'''
'%pitalul *udetean de +r,enta -alau
''%C. Alfasoft.are. %A -alau
''' +ni(ersitatea de edicina si /ar"acie Iuliu 0atie,anu, Clu1 Napoca
'n conditiile in care e7cesul 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 ?rupul tinta e definit ca alcatuit din navi&atori
pe internet$ &rup caracterizat printr8un anume se&ment de varsta$ coeficient intelectual si
preocupari specifice Site8ul IIIanchetainfarfuriero are incorporata o aplicatie de tip
Mlash$ ce permite alcatuirea unui Gurnal alimentar prin intermediul unui site Ieb
(internet) 9olectand date de la utilizator$ aplicatia calculeaza '*9 si ratia calorica
ideala si cea realizata 'n serverul aplicatiei este inre&istrata o baza de date cuprinzand
peste 62## de alimente$ cu parametrii acestora <ceste alimente se pot include in Gurnalul
fiecarui untilizator printr8o interfata simpla si prietenoasa Serverul ce ruleaza aplicatia
este in incinta Societatii Romane de 'nformatica *edicala <plicata (SR'*<)$ baza de
date cuprinzand alimentele provine de la >he (utricut Data "aboratorH si este
recomandata de catre 9enter for Mood SafetH and <pplied (utrition$ din cadrul NS Mood
and DrinD <dministration ,ro&ramul O <ncheta in farfurie P este a&reat de Societatea de
(utritie din Romania
5
INFORMATICAL INSTRUMENT APPLIED IN THE EDUCATION
FOR A HEALTH, NUTRITION
Calinici .A.', Pa(el N.'', Pa(el C.'', Calinici ).'''
')he 2"er,enc3 Count3 0ospital -alau
''%C Alfasoft.are %A, -alau
''')he !Iuliu 0atie,anu& +ni(ersit3 of edicine and Phar"ac3, , Clu1 Napoca
'n the circumstances in Ihich e7cessive ponderositH threatens to &ain epidemical
proportions$ Ie considered it usefull to test the eficiencH of some informatical
instruments in the education for a healthH nutrition >he aim of the application is to maDe
healthH people more sensitive to the importance of a reasonable caloric intaDe and of a
structure that is harmonious in Ihat concerns the nutritive principles >he tar&et &roup
is defined as bein& made of internet navi&ators >he &roup is characterized bH a certain
a&e se&ment$ 'Q or specific concerns >he site III <nchetainfarfuriero has
incorporated a M"<S; application that alloIs the creation of an alimentarH diarH throu&h
a Ieb (internet) site ?atherin& data from the user$ the application calculates the )*'
and the ideal and the achieved caloric intaDe < database is re&istered inside the
application server$ containi& over 62## aliments and their parameters >hese aliments can
be included in each and everH userRs diarH$ throu&h a simple and friendlH interface >he
server that supports the application is inside >he Romanian SocietH for <pplied *edical
'nformatics (RS<*')$ the database containin& the aliments comin& from >he (utricut
Data "aboratorH and is recommended bH >he 9enter for Mood SafetH and <pplied
(utrition in the NS Mood and DrinD <dministration >he pro&ram +<ncheta in farfurie-
(investi&ation in Hour plate) is supported bH >he Romanian SocietH Mor (utrition
EDUCATIA TERAPEUTICA IN ROMANIA
Adina %#npetreanu, $ina 4r#nceanu
Centrul Clinic de DNB Clu15Napoca,
Centrul Clinic de DNB Iai
"ucrarea de fata isi propune sa prezinte structura or&anizatorica a centrelor de diabet
din tara in ceea ce priveste numarul e7istent de educatori specializati in diabet $
dieteticieni $ precum si or&anizarea pro&ramului educational *etodele de abordare a
educatiei pacientilor cu diabet zaharat sunt de asemenea parte importanta a acestei
lucrari
0
TERAPEUTIC EDUCATION IN ROMANIA
Adina %#npetreanu, $ina 4r#nceanu
Diabetes demo&raphic and epidemic data Diabetes care netIorD in Romania
>herapeutic Sducation in RomaniaT netIorD$ methods $ achievements $ barriers
FACTORI DE RISC AI E0CESULUI PONDERAL LA COPIL SI ADOLESCENT
Adriana Cos"escu, Doina /elea, Liliana Barbacariu, Antoneta Petroaie, Ana5aria
%lnin, 6tilia No(ac, ihaela anole
Disciplina edicin de /a"ilie 7 +../. 8$r. ). Popa8 Iai
I)t$%(cee! Obezitatea la copil reprezint: o problem: de s:n:tate maGor: deoarece
studiile efectuate au ar:tat ca 2# U 221 din populaie devine supraponderal: %nainte de
v3rsta de 2# de ani
Sc$1(! acestui studiu a fost prezentarea aspectelor epidemiolo&ice$ clinico8anamnestice
i etiolo&ice %n apariia e7cesului ponderal la copil
Mateia! 2i #et$%&: Studiul a fost efectuat pe un lot de 55 de copii i adolesceni
di&nosticai cu suprapondere sau obezitate %ntr8un cabinet de pediatrie din cadrul
<mbulatoriului de Specialitate al Spitalului VSf SpiridonV din 'ai$ %n perioada ianuarie8
iunie 2##/ "a aceti pacieni$ e7amenul clinic &eneral i m:sur:torile antropometrice au
fost completate cu o anamnez: amanunit: privind antecedentele heredo8colaterale$
antecedentele personale fiziolo&ice i patolo&ice$ ancheta alimentar:$ activitatea fizic:
efectuat:$ afeciunile asociate
Re'(!tate: Din cei 55 de pacieni$ 25 de copii i adolesceni$ reprezent3nd B.$61$ au fost
dia&nosticai cu obezitate ( '*9 peste percentila .2 dup: v3rsta i se7) i 1# cazuri cu
supraponderalitate ( '*9 peste percentila /2 ) Repartiia dup: se7 a ar:tat o
predominen: a se7ului feminin (1. fete$ respectiv 26$B1)$ fa: de se7ul masculin ( 10
baieti U 02$01 ) *ediul de provenien: a fost urban %n BB$61 din cazuri i rural la
55$51 dintre pacieni 'storic familial pozitiv la unul sau ambii p:rini ( obezitate$ diabet
zaharat de tip 2 ) s8a %nt3lnit la 10 pacieni Fn ce privete &reutatea la natere$ la 5
pacieni a fost peste 0### de &rame i %n 5 cazuri sub 26## de &rame ( subponderalitate )
Fn toate cazurile$ principala cauza a e7cesului ponderal a fost dieta dezechilibrat:$
2
hipercaloric:$ pe baza surplusului de dulciuri$ fainoase i &r:simi Doar / dintre pacieni
practicau o activitate fizic: corespunz:toare$ respectiv orele de educaie fizic: dar i un
sport %n afara colii Fn celelalte cazuri$ copiii fie erau scutii de sport$ fie se prezentau la
orele de educaie fizic: dar f:r: a participa efectiv Dintre afeciunile asociate
menionam! diabetul de tip 2 %ntr8un caz$ ;>< la 2 pacieni$ sc:derea toleranei la
&lucoz: %n 0 cazuri i dislipidemie la 1# pacieni
C$)c!('ii
Obezitatea copilului este o problem: de s:n:tate public: at3t prin creterea prevalenei c3t
i prin efectele pe termen lun& asupra s:n:t:ii ,revenirea obezit:ii se realizeaz: prin
diet: adecvat:$ activitate fizic: i modificarea stilului de via:
Depistarea supraponderii i obezit:ii precum i factorii de risc ai acestora reprezint: cel
mai important rol profilactic al medicului de familie
RIS3 FACTORS OF OVER+EIGHT IN CHILDREN AND TEENAGERS
Adriana Cos"escu, Doina /elea, Liliana Barbacariu, Antoneta Petroaie, Ana5aria
%lanina, 6tilia No(ac, ihaela anole
Discipline /a"il3 edicine 7 +../. !$r. ). Popa& Iasi
I)t$%(cti$)! ObesitH in children is a maGor condition of health as the carried out studies
have shoIn that 2# U 221 of people become overIei&ht before theH reach 2#
T/e 1(1$"e of this studH Ias to present the epidemiolo&ical$ clinical$ anamnestic and
etiolo&ical aspects in the occurrence of overIei&ht in children
Mateia! a)% #et/$%! >he studH Ias performed on 55 overIei&ht or obese children and
teena&ers in a pediatrics office of the Out8patient 9linic of +Sf Spiridon- ;ospital from
WanuarH to Wune 2##/ 'n these patients$ the &eneral clinical e7am and the anthropometric
measurin& Iere completed bH a minute anamnesis Iith respect to the heredo8collateral
historH$ the patholo&ical and phHsiolo&ical personal historH$ the food surveH and the
carried out phHsical activitH
Re"(!t": Of the 55 patients$ 25 children and teena&ers$ ie B.$61 Iere dia&nosed Iith
obesitH ('*9 over .2 percentile accordin& to a&e and se7) and 1# cases of overIei&ht
('*9 over /2 percentile) >he division accordin& to se7 shoIed a predominance of the
female se7 (1. &irls$ ie 26$B1) as opposed to the male se7 (10 boHs U 02$01) >heir
environment Ias an urban one in BB$61 of the cases and a rural one in 55$51 of the
patients >he positive familH historH Iith one or both affected parents (obesitH$ tHpe 2
diabetes mellitus) Ias discovered in 10 patients >he birth Iei&ht Ias over 0### &rams
in 5 patients and beloI 26## &rams in 5 cases 'n all cases$ the main cause of overIei&ht
Ias an unbalanced hHper caloric diet based on e7cessive sIeets$ pastrH and fats OnlH /
B
of the patients Iere practicin& an e7tra sport and Iere participatin& at the phHsical
education hours at school >he other children Iere e7empted from phHsical education
classes or theH Iere present Iithout taDin& anH part in the activities Mrom the associated
diseases$ Ie mention the folloIin&! tHpe 2 diabetes mellitus in one case$ hHpertension in
2 patients$ impaired &lucose tolerance in 0 cases and dHslipidemia in 1# patients
C$)c!("i$)"
9hildren obesitH is a public health matter both due to the increase of prevalence and the
lon& term effects on health ObesitH prevention is achieved bH an adeLuate diet$ phHsical
activitH and chan&e of the life stHle
>he dia&noses of overIei&ht and obesitH alon& Iith their risD factors are the most
prophHlactic role of the familH medicine
INFLUENTA HIPERGLICEMIEI POSTPRANDIALE ASUPRA
INTERVALULUI 4T LA PACIENTII CU DIABET ZAHARAT TIP 5
Adriana Rusu
9
,

Cristina Ni
9,:
, Ra"ona ;tefan
:
, Adriana /ili"on
:
, Ildi<o =icsi
at3us
:
, Nicolae 0#ncu
9,:
9
+ni(ersitatea de edicin i /ar"acie>Iuliu 0aie,anu&, Clu1 Napoca
:
Centrul de Diabet , Nutriie i Boli etabolice, Clu15Napoca
I)t$%(cee 2i $biective6 'ntervalul Q> prelun&it reflect: alun&irea repolariz:rii iXsau
creterea hetero&enit:ii repolariz:rii miocardice$ situaii asociate cu un risc crescut de
aritmii i moarte subit: Studii recente au confirmat valoarea intervalului Q> ca predictor
al mortalit:ii at3t %n cazul pacienilor cu diabet zaharat$ c3t i %n cazul persoanelor f:r:
diabet
Obiectivul acestei cercet:ri a fost investi&area relaiei %ntre &licemia postprandial: i
durata intervalului Q>$ precum i identificarea valorii &licemiei postprandiale de la care
crete riscul de apariie a intervalului Q> prelun&it
S(biec7i 2i Met$%& <u fost analizate date provenite de la 06 de pacieni cu diabet
zaharat tip 2 (BB1 femei)$ cu v3rste cuprinse %ntre 5# i 6. ani S8au %nre&istrat istoricul
personal$ caracteristicile clinice i antropometrice$ precum i rezultatele determin:rilor de
laborator! <1c$ profil lipidic De asemeanea$ a fost %nre&istrat: electrocardio&rama (S9?)
%n repaus$ at3t preprandial c3t i la 2h postprandial$ f:r: controlul frecvenei i
profunzimii respiraiei 'ntervalul Q> a fost m:surat %n derivaiile ''$ A2$ A2$ iar valoarea
medie a fost corectat: pentru frecvena cardiac: utiliz3nd formula lui ;od&es ,relun&irea
intervalului Q>c Y 00# ms a fost considerat: patolo&ic:
Re'(!tate6 ,ostprandial$ durata intervalului Q>c a fost semnificativ mai mare dec3t %n
condiii preprandiale (01#6C261ms vs 0#55C25#5ms$ p4##5) Fn 2.B1 din cazuri s8a
constatat creterea postprandial: a duratei intervalului Q>c$ iar dintre aceti pacieni
6
(10.1) au prezentat prelun&irea intervalului Q>c Y 00# ms ,entru predicia prezenei
intervalului Q>c prelun&it$ utiliz3nd RO9$ s8a determinat c: o valoare a &licemiei
postprandiale de 1652 m&=dl poate detecta prezena intervalului Q>c prelun&it cu o
sensibilitate de /B1 i o specificitate de 211 Aaloarea predictiv: ne&ativ: (A,() a fost
de .21$ iar valoarea predictiv: pozitiv: (A,,) de 201
C$)c!('ii6 <lun&irea intervalului Q>c este frecvent asociat: cu hiper&licemia
postprandial: i poate reprezenta un factor de risc adiional pentru evenimentele
cardiovasculare Reducerea e7cursiilor &licemice postprandiale ar putea preveni
prelun&irea intervalului Q>c i ulterior apariia unor aritmii potenial fatale
THE INFLUENCE OF POSTPRANDIAL H,PERGL,CEMIA ON 4T
INTERVAL IN PATIENTS +ITH T,PE 5 DIABETES
Adriana Rusu
9
,

Cristina Ni
9,:
, Ra"ona ;tefan
:
, Adriana /ili"on, Ildi<o =icsi
at3us
:
, Nicolae 0#ncu
9,:
9
>Iuliu 0aie,anu& +ni(ersit3 of edicine and Phar"ac3, Clu1 Napoca
:
Clinical Center of Diabetes, Nutrition, etabolic Diseases, Clu15Napoca
Bac-.$()% a)% Ai#"6 Aentricular mHocardial depolarization and repolarization are
reflected in Q> interval ,rolon&ed Q>c reflects cardiac repolarization prolon&ation
and=or increased repolarization inhomo&enitH DnoIn to be associated Iith increased risD
of arrhHthmias and sudden death 'n recent Hears$ studies have confirmed the value of Q>
interval as a predictor of total mortalitH in both diabetic and non8diabetic subGects
>he obGective of this studH Ias to investi&ate the relationship betIeen postprandial
&lHcemia and the duration of Q> interval and to identifH cutoff values of postprandial
&lHcemia from Ihich Q> interval is prolon&ed
S(b8ect" a)% Met/$%"6 < number of 06 persons (BB1 Iomen) Iith tHpe 2 diabetes$
a&ed betIeen 5#86. Hears Iere included in the studH < complete medical historH and
phHsical e7amination Ias performed )lood samples Iere collected in the overni&ht
fastin& state$ and <1c$ total cholesterol$ ;D"8cholesterol$ tri&lHcerides Iere assessed
,re8 and 2 h8postprandial 128lead restin& S9? Iere recorded Iithout controllin& for
depth and rate of respiration Q> interval Ias measured in ''$ A2$ A2$ and the mean value
Ias corrected for heart rate usin& the ;od&esJ formula Q>c Y00# ms Ias considered as
abnormallH prolon&ed
Re"(!t"6 'n postprandial state Q>c duration Ias si&nificantlH lon&er than preprandial
(01#6C261 ms vs 0#55C25#5 ms$ p4##5) 2/ patients (2.B1) presented a
/
prolon&ation of Q>c interval in the postprandial state compared Iith preprandial Q>c
duration Mrom these patients$ 6 (10.1) had a Q>c interval Y 00# ms < cut8off point of
1652 m&=dl for postprandial &lHcemia detected the presence of prolon&ed Q>c interval
Iith a sensitivitH of /B1 and a specificitH of 211 (e&ative predictive value ((,A) Ias
.21$ and positive predictive value (,,A) Ias 201 Ihen referrin& to the presence of
prolon&ed Q>c interval
C$)c!("i$)" ,rolon&ation of Q>c occurs freLuentlH durin& postprandial state in tHpe 2
diabetes ,ostprandial hHper&lHcemia alters mHocardial ventricular repolarization in
patients Iith tHpe 2 diabetes and mi&ht be an additional risD factor for cardiovascular
events "imitin& meal related &lucose e7cursions over 1652 m&=dl could prevent Q>c
prolon&ation and possible could prevent the occurrence of arrhHthmias
COGNIII DEZADAPTATIVE DESPRE TRATAMENTUL CU INSULIN96
CONSTRUCIA :I VALIDAREA UNEI SCALE CARE S9 ORIENTEZE
INTERVENIILE CARE VIZEAZ9 SC9DEREA REZISTENEI
PSIHOLOGICE LA INSULIN96
9, :
Drd. Psih. A"fiana $her"an,
:
Prof. +ni(. Dr. Daniel Da(id
9
Centrul Clinic de Diabet, Nutriie i Boli etabolice
:
Catedra de Psiholo,ie Clinic i Psihoterapie, +ni(ersitatea Babe5Bol3ai
ASPECTE TEORETICE6 Rezistena psiholo&ic: la insulin: se refer: la refuzul din
partea pacientului sau a medicului de a iniia insulino8terapia atunci c3nd ar fi necesar: %n
controlul diabetului de tip 2 Fn literatura de specialitate nu sunt disponibile instrumente
validate tiinific care s: m:soare acest concept din punct de vedere psiholo&ic 9u alte
cuvinte$ nu e7ist: instrumente care s: aib: %n spate o teorie validat: tiinific pentru
factorii psiholo&ici implicai %n refuzul tratamentului cu insulin: i care s: aib: %n acelai
timp calit:i psihometrice bune <stfel$ este nevoie de un asemenea instrument care s:
&hideze interveniile psiholo&ilor clinicieni pentru sc:derea rezistenei psiholo&ice la
insulin: ,ornind de la teoria co&nitiv: a emoiilor$ la baza consecinelor emoionale i
comportamentale dezadaptative (cum ar fi refuzul tratamentului cu insulin: sau emoiile
disfuncionale de tip an7ietate$ deprimare$ frustrare$ furie) stau procese co&nitive de tip
evaluativ$ cum ar fi cerinele absolutiste fa: de sine$ lume i via:$ catastrofarea unui
eveniment$ tolerana sc:zut: la frustrare$ evaluarea &lobal: ne&ativ: a propriei persoane
sau a altora
OBIECTIVE! 9onstruirea i validarea unei scale care s: m:soare co&niiile
dezadaptative specifice %n rezistena psiholo&ic: la insulin:
.
METODOLOGIE! ,articipani U 2# de pacieni cu diabet zaharat de tip 2 din evidena
9entrului de Diabet$ (utriie i )oli *etabolice$ 9luG8(apoca 'nstrumente! Scala de
co&niii despre insulin: (S9')$ Scala de atitudini i convin&eri '' (<)S '' U Di?iuseppe$
"eaf$ S7ner i Robin$ 1.//)$ 9hestionarul &3ndurilor automate (<>Q U ;ollon i Zendal$
1./#) i ,rofilul distresului afectiv (Opri i *acavei$ 2##2)$ 'nterviu clinic pentru
investi&area tulbur:rilor de tip depresiv sau an7ios ,rocedur:! S8a construit (prin
consultul e7perilor i al pacienilor) scala care m:soar: co&niiile dezadaptative despre
tratamentul cu insulin: (S9')$ iar apoi scalele de mai sus s8au aplicat participanilor la
studiu pentru a aduna date le&ate de fidelitatea i validitatea acestei scale Rezultate!
<naliza datelor a evideniat faptul c: S9' are o consisten: intern: ridicat:T validitatea de
coninut a fost analizat: de un &rup de e7peri %n teoriile co&nitiv8comportamentale ale
emoiilor S9' a fost astfel construit: %nc3t coninutul s:u s: reflecte principiile teoriei
raional8emotive i co&nitiv8comportamentale$ iar forma sa s: fie asem:n:toare altor teste
similare deGa e7istente i care i8au dovedit utilitatea Aaliditatea de construct se refer: la
m:sura %n care scala reflect: constructul pe care %l m:soar:T astfel$ s8au corelat itemii
acestui nou instrument cu itemii altor scale e7istente care i8au dovedit deGa validitatea i
fidelitatea (<)S ''$ <>Q i ,D<) Datele arat: o bun: validitate de construct a acestei
scale Fn ceea ce privete validitatea conver&ent:$ co&niiile evaluative dezadaptative
coreleaz: cu emoiile ne&ative disfuncionale$ iar cele adaptative cu emoiile ne&ative
funcionale i cu cele pozitive
CONCLUZII! S9' are coeficieni de fidelitate i validitate ridicai$ put3nd discrimina cu
succes %ntre persoanele care refuz: i cele care accept: tratamentul cu insulin: <ceast:
scal: este un instrument de tip evidence8based %n evaluarea factorilor co&nitivi care
influeneaz: refuzul=acceptarea insulino8terapiei
MALADAPTIVE BELIEFS ABOUT INSULIN THERAP,6 THE
CONSTRUCTION AND VALIDATION OF A SCALE USEFUL FOR THE
INTERVENTIONS THAT AIM TO DECREASE THE PS,CHOLOGICAL
INSULIN RESISTANCE6
9,:
A"fiana

$her"an, .A., PhD candidate,
:
+ni(. Prof. Daniel Da(id, PhD
9
Clinic of Diabetes, Nutrition and etabolic Diseases
:
Depart"ent of Clinical Ps3cholo,3 and Ps3chotherap3, Babe5Bol3ai +ni(ersit3
THEORETICAL ASPECTS >he psHcholo&ical insulin resistance refers to the
reluctance of both patients and medical staff to initiate insulin therapH Ihen it Iould be
beneficial for the control of the tHpe 2 diabetes 'n the literature there arenRt available
evidence8based instruments to measure this concept from a psHcholo&ical point of vieI
>herefore$ there are no instruments based on an empirical theorH for the psHcholo&ical
factors involved in the refusal of the insulin treatment and that has &ood psHchometric
1#
Lualities at the same time >herefore$ Ie need such an instrument to &uide the
interventions of the clinical psHcholo&ists to decrease the psHcholo&ical insulin
resistance
Startin& from the co&nitive theorH of emotions$ at the basis of the maladaptive emotional
and behavioral conseLuences (such as the refusal of the insulin treatment or the
dHsfunctional emotions such as an7ietH$ depression$ an&er) there are evaluative co&nitive
mechanisms$ such as demandin&ness toIards self$ life and others$ aIfulinsin& the
ne&ative character of an event$ loI frustration tolerance and ne&ative &lobal evaluation
OB;ECTIVES: >he development and the validation of a scale that measures the
maladaptive believes about insulin treatment
METHOD: ,articipants U 2# patients Iith tHpe 2 diabetes from the 9linic of Diabetes$
(utrition and *etabolic Diseases$ 9luG8(apoca 'nstruments U >he 'nsulin )eliefs Scale
(')S)$ >he <ttitudes and )eliefs Scale ''(<)S '' U Di?iuseppe$ "eaf$ S7ner [ Robin$
1.//)$ <utomatic >hou&hts Questionnaire (<>Q U ;ollon [ Zendal$ 1./#) and
Smotional Distress ,rofile (Opri i *acavei$ 2##2)$ S9'D (Semistructured 9linical
'ntervieI after DS*8'A) for investi&atin& depressive or an7ietH disorders ,rocedure!
>he scale Ias constructed Iith the a&reement of the e7perts and of the patients (')S)$
and then all the other scales Iere applied in order to compute the psHchometric
coefficients of the scale Results! >he data analHsis shoIed that ')S has a &ood intern
consistencHT the content validitH Ias analHzed bH a &roup of e7perts in the rational8
emotional and co&nitive behavioral theories of emotions ')S Ias constructed so that its
content reflects the co&nitive theories of emotion and its Iordin& is similar to other tests
that alreadH prove their utilitH 'ts construct validitH Ias measured bH correlatin& the ')S
items Iith the items of other scales that alreadH prove their validitH (<)S ''$ <>Q and
SD,) >he data shoI &ood construct validitH 'n Ihat the conver&ent validitH is
concerned$ the maladaptive evaluative co&nitions correlate Iith the ne&ative
dHsfunctional beliefs$ and the adaptive ones Iith the ne&ative and positive adaptive
emotions
CONCLUSIONS: ')S has hi&h fidelitH and validitH coefficients$ bein& able to
discriminate betIeen the persons that refuse and those Iho accept the treatment Iith
insulin >his scale is an evidence8based instrument in the evaluation of the co&nitive
factors that influence the refusal or the acceptance of the insulin therapH
PROPUNEREA UNUI GHID CLINIC PENTRU PSIHOLOGII
CLINICIENI CARE LUCREAZ9 CU PACIENI CU DIABET SAU OBEZITATE
9,:
Drd. Psih. $her"an A"fiana,
9
Psih. Andreia ocan,
:
Prof. +ni(. Dr. Daniel Da(id
9
Centrul Clinic de Diabet, Nutriie i Boli etabolice
:
Catedra de Psiholo,ie Clinic i Psihoterapie, +ni(ersitatea Babe5Bol3ai
11
,entru a oferi cele mai bune i cele mai eficiente tratamente pacienilor$ ne baz:m pe
principiul i)teve)7ii!$ va!i%ate 2tii)7i<ic =evi%e)ce>ba"e%? <stfel$ pentru ca o
intervenie s: fie validat: tiinific$ este nevoie ca at3t teoria care st: %n spatele ei s: fie
validat:$ c3t i procedura de intervenie %n sine De aceea$ se propune un &hid de
intervenie pentru psiholo&ii clinicieni$ consilieri psiholo&ici i psihoterapeuii care
lucreaz: cu persoane cu diabet care s: satisfac: %n primul r3nd acest principiu$ at3t c3t
este posibil av3nd %n vedere cercet:rile e7istente %n literatura de specialitate ?hidul va
urma elementele principale ale unei proceduri de intervenie! psihodia&nostic i evaluare
clinic:$ conceptualizare clinic:$ relaie terapeutic: i tehnici de intervenie
P"i/$%ia.)$"tic 2i eva!(ae c!i)ic&: utilizarea interviului clinic semi8structurat dup:
DS*8'A sau 'D981#$ utilizarea de scale care s: m:soare mecanismele psiholo&ice
etiopato&enetice &enerale i specifice i care au calit:i psihometrice bune (evidence8
based) Scopul evalu:rii este acela de a stabili un dia&nostic nosolo&ic$ ali factori
psiholo&ici care influeneaz: condiia medical:$ precum i stabilirea unei liste de
probleme specifice pentru situaia de consiliere psiholo&ic: sau de psihoterapie specific:
C$)ce1t(a!i'aea c!i)ic& trebuie s: r:spund: la urm:toarele %ntreb:ri! (1) 9e probleme
de natur: psiholo&ic: sunt (care influeneaz: factorii medicali)\T (2) De ce au ap:rut
aceste probleme\ i (5) 9e se poate face pentru a remedia aceste probleme\
Re!a7ia tea1e(tic& este unul din factorii foarte importani$ care e7plic: p3n: la 5#1 din
mecanismele schimb:rii psiholo&ice i presupune c3teva caracteristici maGore pe care
trebuie s: le aib: psiholo&ul! empatie$ con&ruen:$ acceptare necondiionat: i colaborare
Te/)ici!e %e i)teve)7ie recomandate vor fi %n funcie de cate&oriile de probleme
psiholo&ice care se pot re&:si la pacienii cu diabet sau obezitate <cestea vor fi abordate
din perspectiva modelelor validate tiinific <)9 co&nitiv i comportamentalT %n acelai
timp$ se vor avea %n vedere aspectele pozitive i punctele forte ale pacienilor De
asemenea$ %n ceea ce privete tulbur:rile psiholo&ice cuprinse %n manualele de dia&nostic
(DS*8'A sau '9D)$ cum ar fi tulbur:rile depresive$ de tip an7ios$ tulbur:rile de
comportament alimentar &hidul va oferi trimiterile necesare spre cele mai eficiente
(evidence8based) protocoale de intervenie e7istente
THE PROPOSAL OF A CLINICAL GUIDE FOR THE CLINICAL
PS,CHOLOGISTS THAT +OR3 +ITH DIABETIC OR OBESE PATIENTS
9,:
A"fiana

$her"an, .A., PhD candidate,
9
Psih. Andreia ocan
:
+ni(. Prof. Daniel
Da(id, PhD
9
Clinic of Diabetes, Nutrition and etabolic Diseases
:
Chair of Clinical Ps3cholo,3 and Ps3chotherap3, Babe5Bol3ai +ni(ersit3
12
'n order to offer the best and the most efficient treatments$ Ie are based on the principle
of evidence8based interventions >herefore$ in order to be scientificallH based$ a
psHcholo&ical intervention needs to have its theorH as Iell as the intervention protocol
tested <s a conseLuence$ Ie propose an intervention &uide for the clinical psHcholo&ists$
counselors and psHchotherapists that IorD Iith diabetic and obese persons$ that satisfies
this criterion$ accordin& to the literature >he &uide Iill folloI the principal elements of
an intervention procedure! the psHcho8dia&nosis and clinical evaluation$ the clinical
conceptualization$ the therapeutic relationship and the intervention techniLues
P"@c/$>%ia.)$"i" a)% c!i)ica! eva!(ati$) ! the use of the S9'D (Semistructured 9linical
'ntervieI after DS*8'A) for investi&atin& depressive$ an7ietH disorders$ and others$ the
use of scales that measure the &eneral and specific ethio8patho&enetic mechanisms$ scales
that have &ood psHchometric Lualities (are evidence8based) >he &oal of the evaluation is
to establish a nosolo&ic dia&nosis$ the factors that influence the medical condition and a
list of specific problems
T/e c!i)ica! c$)ce1t(a!i'ati$) must ansIer to the folloIin& Luestions! (1) Khat are the
psHcholo&ical problems that influence the medical factors\ (2) KhH did these problems
appear\ (5) Khat can be done in order to solve these problems\
T/e t/ea1e(tic e!ati$)"/i1 is one of the most important factors that e7plain 5#1 of
the psHcholo&ical mechanisms of chan&e and that implies a feI characteristics that the
psHcholo&ist must have! empathH$ con&ruence$ unconditional acceptance and
collaboration
T/e i)teve)ti$) tec/)iA(e" Iill be recommended accordin& to the specific
psHcholo&ical problems of the diabetic or obese patients >hese problems Iill be
approached Iith the co&nitive and behavioral <)9 modelsT at the same time$ the positive
characteristics of the patients Iill be used and reinforced Re&ardin& the '9D81#
psHcholo&ical disorders$ such as the depressive or an7ious disorders$ the &uide Iill maDe
the necessarH references to the most efficicent (evidence8based) intervention protocols
CUM ESTE APRECIAT PROGRAMUL GUVERNAMENTALBCORNUL :I
LAPTELEC DE C9TRE ELEVII DE GIMNAZIU DINTR>O :COAL9 DIN
MEDIUL RURAL
Crciun Anca52lena', %treulea Ioana', Crciun Cristian5Ioan'', Costiuc Cristina
4alentina''', Anca )odoran
'5 "edic re?ident an III diabet ?aharat, nutriie, boli "etabolice, Centrul Clinic de
Diabet i Nutriie Clu15Napoca@ ''5 "edic re?ident an I4 far"acolo,ie clinic, Clu15
Napoca@ '''5 "edic re?ident an III sntate public i "ana,e"ent, Clu15Napoca
15
I)t$%(cee: ,ro&ramul &uvernamental ] 9ornul i laptele- a fost lansat %n 1B
septembrie 2##2 'niial au beneficit de el doar elevii claselor primare De cur3nd de acest
pro&ram beneficiaz: i elevii de &imnaziu Mateia! 2i #et$%&: ,entru a afla c3t de
apreciat este pro&ramul &uvernamental ]9ornul i laptele- %n r3ndul elevilor de &imnaziu$
am aplicat un chestionar elevilor claselor A8A''' ai ^colii ?enerale nr1 din comuna
9ricior$ Gudeul ;unedoara 9hestionarul a fost aplicat %n ultima or: de ]Sducaie pentru
s:n:tate- din anul colar 2##682##/ Re'(!tate: <u r:spuns la chestionar /2 de elevi$
dintre care 26 (51$/1) au fost %n clasa a Aa$ 1/ (21$21) %n clasa a A'a$ 1/ (21$21) %n
clasa a A''a i 22 (22$/1) %n clasa a A'''a Dintre acetia$ 5. (02$.1) au fost fete i 0B
(20$11) au fost b:iei B#$21 dintre elevii chestionai nu man3nc: deloc cornul primit
prin pro&ramul &uvernamental$ iar B5$/1 nu beau laptele sau iaurtul Fn ciuda acestor
rezultate$ mai bine de Gum:tate dintre elevii chestionai (2.$21) sunt %nc3ntai de ideea de
a primi corn i lapte la coal:$ iar la 5$B1 dintre respondeni le displace aceast: m:sur:
*ai bine de o treime (561) ar dori s: primeasc: i altceva pe l3n&: corn i lapte sau
acestea s: fie %nlocuite Dintre propuneri fac parte fructele$ eu&eniile$ biscuiii$ coca8cola$
br3nza topit:$ iar %n lunile de var:$ %n&heata <proape /21 dintre copii au zilnic$ sau
aproape zilnic$ pachet la coal:$ iar aproape //1 dintre ei primesc bani s:8i cumpere ce
doresc de m3ncat sau de b:ut C$)c!('ii: Fn coala din mediul rural unde am aplicat
chestionarul$ B#$21 dintre elevi nu m:n3nc: deloc cornul primit prin pro&ramul
&uvernamental$ iar B5$/1 nu beau laptele sau iaurtul 9u toate acestea$ maGoritatea
copiilor doresc %n continuare s: primeasc: corn i lapte la coal:
THE E0TENT TO +HICH COUNTR,SIDE SECONDAR, SCHOOL
CHILDREN APPRECIATE THE GOVERNMENTAL PROGRAM DCROISSANT
AND MIL3E
Craciun Anca52lena', %treulea Ioana', Craciun Cristian5Ioan'', Costiuc Cristina
4alentina''', Anca )odoran
'resident doctor in %u,ar Diabetes, Nutrition and etabolic Diseases, A
rd
3ear, at the
Clinical Centre of Diabetes and Nutrition, Clu15Napoca@''resident doctor in Clinical
Phar"acolo,3, B
th
3ear, Clu15Napoca@ '''resident doctor in Public 0ealth and
ana,e"ent, A
rd
3ear , Clu15Napoca
I)t$%(cti$): >he &overnmental pro&ram +9roissant and *ilD- Ias launched on
September 1B$ 2##2 'nitiallH$ onlH the primarH school children benefited from it$ but
recentlH$ it Ias introduced to secondarH school pupils as Iell
Mateia!" a)% #et/$%": 'n order to determine the e7tent to Ihich the &overnmental
pro&ram +9roissant and *ilD- is appreciated amon& the secondarH school children$ Ie
have applied a Luestionnaire to pupils of 2
th
8/
th
&rade from the (o1 SecondarH School$ in
9riscior$ the district of ;unedoara >he Luestionnaire Ias applied durin& the last
+Sducation for ;ealth- class$ at the end of the school Hear 2##682##/
10
Re"(!t": Mrom a total of /2 students Iho ansIered the Luestionnaire$ 26(51/1) Iere in
the 2
th
&rade$ 1/(2121) in the B
th
&rade$ 1/(2121) in the 6
th
&rade$ and 22(22/1) Iere
in the /
th
&rade <mon& all these 5.(02.1) Iere &irls$ and 0B(2011) Iere boHs B#21
from the Luestioned pupils never eat the croissant &iven to them throu&h this
&overnmental pro&ram$ and B5/1 donRt drinD the milD or the Ho&hurt Despite these
results$ more than a half of the students Iho Iere Luestioned (2.21) Iere deli&hted bH
the idea of receivin& milD and croissants at school$ and 5B1 from those Iho ansIered
Iere discontented Iith this practice *ore than one third of the pupils (561) e7pressed
their Iish to &et other products to&ether Iith the milD and the croissant$ or$ to replace
these Iith somethin& else <mon& the su&&estions Ie encountered fruit$ Su&enia
biscuits$ cracDers$ 9oca89ola$ processed cheese$ and$ durin& the Iarm season$ ice8cream
<lmost /21 of the children have a dailH$ or almost dailH home8pacDed lunch Iith them$
and almost //1 receive moneH from their parents in order to buH anHthin& theH Iish to
eat or drinD
C$)c!("i$)": 'n the countrHside school Ihere the Luestionnaire Ias applied$ B221 of
the pupils never eat the croissant &iven to them throu&h this &overnmental pro&ram$ and
B5/1 donRt drinD the milD Despite this fact$ the maGoritH of children are still in favor of
receivin& milD and croissants at school
DIMENSIUNEA PSIHOLOGIC9 :I PSIHOPATOLOGIC9 A SINDROMULUI
METABOLIC :I A DIVERSELOR SALE COMPONENTE
Anca /run?', Radu L. Du"itru'', Prof.Dr. C5tin Ionescu5)Cr,o(ite'
'Institutul de Diabet, Nutriie i Boli etabolice >Prof. Dr. N.C. Paulescu&
''Institutul Clinic /undeni
Sc$1: Studiul de fa: %i propune construirea unui profil al pacientului cu sindrom
metabolic care s: conin: caracteristicile de ordin psiholo&ic i psihopatolo&ic ale
acestuia$ profil care s: furnizeze datele necesare unui mana&ement eficient al bolii i care
s: vin: %n spriGinul abord:rii terapeutice de c:tre medicii practicieni De asemenea$
studiul ii dorete stabilirea &radului %n care fiecare component: a sindromului metabolic
contribuie la caracteristicile de ordin psiholo&ic i psihopatolo&ic ale bolnavilor cu
sindrom metabolic$ %n special &radul %n care hipertensiunea arterial: este implicat: %n
e7istena acestor caracteristici
Mateia! 2i #et$%&: 5# de pacieni dia&nosticai cu sindrom metabolic$ internai %n
'nstitutul de Diabet$ (utriie i )oli *etabolice ],rof Dr (9 ,aulescu- au fost
comparai cu B# de pacieni hipertensivi i cu 0# de pacieni normotensivi Datele
demo&rafice i clinice$ comorbidit:ile la momentul intern:rii i tratamentul urmat au fost
obinute prin anamnez:$ e7amen clinic i investi&aii paraclinice ,entru evaluarea
statusului psiholo&ic am utilizat Symptom Checklist 90$ Scala de Evaluare a Depresiei
Hamilton$ Scala funcionalitii globale i Scala funcionalitii sociale
12
Re'(!tate:2B1 dintre subiecii inclui %n studiu au fost dia&nosticai cu sindrom
metabolic ,acienii hipertensivi cu sau f:r: sindrom metabolic au %nre&istrat scoruri
crescute la parametrii psiholo&ici studiai$ cu rezultate statistic semnificative( p8
value_##2) pentru somatizarea medie$ manifest:rile obsesiv8compulsive i depresia
uoar: ,acienii cu sindrom metabolic au demonstrat o funcionalitate social: i &lobal:
redus: Dintre diversele componente$ hipertensiunea arterial: a fost cel mai puternic
asociat: cu caracteristicile psiholo&ice studiate( )8value %ntre #/6 i 516T p8
value_##2);iper&licemia a fost semnificativ statistic asociat: cu an7ietatea$
somatizarea$ depresia i senzitivitatea (ivelul ;D"89olesterolului a fost asociat invers
proporional cu an7ietatea i depresia ()4 8 251 Ti$ respectiv )4 8 222T p_##2)
C$)c!('ii: Sindromul metabolic reprezint: o patolo&ie ale c:rei implicaii de ordin
psiholo&ic sunt importante i demne de luat %n considerare ;ipertensiunea arterial: este
principalul determinant al caracteristicilor de ordin psiholo&ic
PS,CHOLOGICAL AND PS,CHOPATOLOGICAL DIMENSION OF
METABOLIC S,NDROME AND ITS COMPONENTS
Anca /run?', Radu L. Du"itru'', Prof. Dr. C5tin Ionescu5)Cr,o(ite'
'Diabetes, Nutrition and etabolic Disease >Prof. Dr. N.C.Paulescu& Institute
''/undeni Clinical Institute
Ai#: >he aim of our studH Ias to build a psHcholo&ical and psHchopatolo&ical profile of
hHpertensive patients$ a profile that can provide imperative data and information for an
eficient mana&ement of the disease and that is useful to the therapeutical approach
<nother aim of this studH Ias to determine the contribution of each metabolic sHndrome
component to psHcholo&ical and psHchopatolo&ical characteristics$ particularlH the
contribution of hHpertension
Met/$%: 5# patients hospitalised in the ],rof Dr (9 ,aulescu- Diabetes$ (utrition and
*etabolic Disease 'nstitute Iere compared to B# hHpertensive patients and 0#
normotensive patients Demo&raphic and clinical data$ comorbidities and medical
treatment before hospitalisation had been obtained throu&h case historH$ clinical e7am
and medical investi&ations So as to evaluate the psHcholo&ical status Ie used Symptom
Checklist 90 Hamilton Depression !ating Scale "lobal #sset $unctioning Scale Social
$unctioning Scale%
Re"(!t": Of the sample$ 2B1 had metabolic sHndrome ;Hpertensive patients Iith or
Iithout metabolic sHndrome had &reater scores for the studied psHcholo&ical factors$ Iith
statistical si&nificance ( p8 value_##2) for medium somatization$ obssesive8compulsive
sHmptoms and loI depression sHmptoms ,atients Iith metabolic sHndrome had loIer
social and &lobal functionalitH Of the individual components$ hHpertension Ias stron&lH
associated Iith psHcholo&ical characteristics ( )8value 4 #/6 8 516T p8value_##2)
;Hper&lHcemia Ias associated Iith an7ietH$ somatization$ sensitivitH and depression
1B
;D"89holesterol levels Iere ne&ativelH associated Iith an7ietH and depression()48 251
T )4 8 222T p_##2)
C$)c!("i$)": ,atients dia&nosed Iith metabolic sHndrome often develop depression
sHmptomes and an7ietH$ but have no particularlH psHchopatolo&ical characteristics
;Hpertension is the main contributor to psHcholo&ical characteristics
ASOCIEREA DINTRE NIVELUL ACIDULUI URIC :I COMPONENTELE
SINDROMUL METABOLIC LA PACIENII CU DIABET ZAHARAT DE TIP 5
Andrada ihai
9
, Iuliana /ilip
:
, Daniela Dr,oescu
A
, aria 4ldic
9
, Constantin
Ionescu5)Cr,o(ite
9
9
Institutul de Diabet, Nutriie i Boli etabolice >N. Paulescu&, Bucureti@
:
%ecia
Diabet ?aharat, Nutriie i Boli etabolice, %pitalul *udeean Ploieti, P0@
A
%pitalul
Clinic C/ Ditin,, Bucureti
I)t$%(cee! Sindromul metabolic (*etsd) reprezint: o a&re&are de tulbur:ri
metabolice interrelaionate care apar mai frecvent la persoanele insulinorezistente sau
hiperinsulinemice i semnific: risc crescut pentru bolile cardiovasculare ;iperuricemia este
consecina unor tulbur:ri metabolice i se asociaz: cu hipertensiune arterial:$
insulinorezisten:$ obezitate i dislipidemie$ %ns: despre asocierea cu sindromul metabolic
e7ist: %nc: multe dezbateri
Obiective! am e7aminat asocierea acidului uric seric cu componentele *etsd i
particularit:ile acestor asocieri %n funcie de se7 la pacieni cu diabet zaharat de tip 2
(DZ2) i *etsd (definiia <dult >reatment ,anel ''')
Mateia! 2i #et$%&! am analizat$ dup: %mp:rirea %n Luartile pentru acidul uric$
51# pacieni cu DZ2 i *etsd (1.0 f=11B b)$ internai %n 'D()* ]( ,aulescu- cu
urm:toarele caracteristici U medie (Cdeviaie standard)!
9aracteristica >otal Q1 Q2 Q5 Q0
'*9 (D&=m
2
)
5#1B
(C211)
2/0/
(C061)
5#25
(C2##)
5#B2
(C0/B)
515#
(C20.)
9ircumferin:
abdominal:
(cm)
1#205
(C12#1)
.605
(C12B1)
1#120
(C..#)
1#560
(C1251)
1#6#1
(C111B)
A3rsta (ani)
B21B
(C.5#)
B1.1
(C/B6)
B222
(C.21)
B121
(C.56)
B2.6
(C.61)
><S (mm;&) 15621 15#.# 15/00 1012B 15/#1
16
(C2261) (C21B.) (C2225) (C22#5) (C2#6.)
;b<1c (1) ./B (C22#)
1#02
(C201)
./2
(C256)
..6
(C2B1)
.22
(C22#)
9olesterol total
(m&=dl)
21#12
(C2210)
1.6.B
(C0B#5)
2#/0#
(C0/B6)
21222
(CB0/#)
21.#2
(C2666)
;D" colesterol
(m&=dl)
5/05
(C.1B)
5.51
(C.21)
5/..
(C.0/)
565.
(C/.2)
5/#1
(C/60)
>ri&liceride
(m&=dl)
1.625
(C1B/00)
1/#/1
(C15./2)
1..25
(C2#506)
1.1B#
(C1#../)
21/02
(C2#1/B)
<cid uric
(m&=dl)
222 (C1$.5)
500
(C#2B)
0B
(C#26)
2/1
(C#02)
/10
(C10.)
De asemenea$ am %mp:rit pacienii %n trei &rupe %n funcie de num:rul de
componente ale *etsd %ndeplinite i am comparat nivelul mediu al acidului uric %ntre
aceste &rupe <m utilizat StudentRs t8test i ,earson correlation (ivele ale acidului uric
peste 6 m&=dl la b:rbai si$ respectiv$ peste B m&=dl au fost considerate hiperuricemie
Re'(!tate! 2B$661 (20$601 fT 5#$161 b) din pacieni au prezentat hiperuricemie
Fn funcie de num:rul de componente ale *etsd %ndeplinite$ la cei cu 2 criterii$
hiperuricemia a fost mai frecvent: (56$251 vs 2#$2.1 la cei cu 5 criterii)$ dar valoarea
medie a acidului uric a fost semnificativ mai mare doar %n cazul femeilor (2$60 vs 0$25T
p_#$###1) (ivelul acidului uric s8a corelat cel mai bine cu circumferina abdomninal: i
cu &reutatea corporal: (r4#5) <naliz3nd datele pe Luartile$ diferene semnificative
statistic s8au %nre&istrat %ntre prima i ultima Luartil: pentru! circumferina abdominal: i
&reutate (p_#$###1)$ '*9 (p4#$###5)$ ;b<1c (p4#$##10)$ colesterol total (p4#$##B)$
num:rul de criterii <>, ''' %ndeplinite (p4#$#5)$ "D" colesterol (p4#$#2)$ ><S (p4#$#1)
i vechimea diabetului (p4#$#1/)
C$)c!('ii! hiperuricemia este frecvent: la pacienii cu DZ2 i *etsd 9el mai
adesea se %nt3lnete la femeile care %ntrunesc toate criteriile de definire a sindromului
metabolic ;iperuricemia se coreleaz: puternic cu tulbur:rile metabolice i
hemodinamice prezente la pacienii cu DZ2 i *etsd i poate fi considerat: un alt
component al *etsd ce necesit: mai mult: atenie %n viitor
ASSOCIATION BET+EEN SERUM URIC ACID LEVELS AND THE
METABOLIC S,NDROME COMPONENTS IN T,PE 5 DIABETIC PATIENTS
Andrada ihai
9
, Iuliana /ilip
:
, Daniela Dr,oescu
A
, aria 4ldic
9
, Constantin
Ionescu5)Cr,o(ite
9
1/
9
Institute of Diabetes, Nutrition and etabolic Disease !N. Paulescu& Bucharest@
:
Dept. of Diabetes, Count3 0ospital Ploieti@
A
Clinical 0ospital C/ Ditin,, Bucharest
Bac-.$()%: *etabolic sHndrome (*etS) is defined as a cluster of interrelated
metabolic disorders more freLuentlH found in persons Iith insulin resistence or
hHperinsulinemia and represents an increased risD for cardiovascular disease ;Hperuricemia
is associated Iith hHpertension$ insulin resistance$ obesitH and hHperlipidemia$ but the
association Iith the sHndrome is still under debate
Ai#": Ke e7amined the associations of serum uric acid (N<) Iith *etS
components and the se78differences of these associations in tHpe 2 diabetic patients Iith
metabolic sHndrome (<dult >reatment ,anel ''' criteria)
Mateia! a)% #et/$%"! the studH is cross8sectional comprisin& 51# in8patients
Iith >2D* and *etS (1.0 I=11B m)$ Iith the characteristics 8 mean (C standard
deviation) presented in table
1.
Different components of *etS Iere compared bH Luartiles of N< Ke also
compared mean N< levels amon& 5 &roups defined on number of *etS components
StudentRs t8test$ ,earson correlation Iere used ;Hperuricemia Ias defined as Y6 m&=dl
in men and YB m&=dl in Iomen
Re"(!t"! 2B661 (20601 IT 5#161 m) of patients presented hHperuricemia
<nalHzin& data for the number of *etS components fulfilled$ in those Iith 2 criteria
hHperuricemia Ias more freLuent (56251 vs 2#2.1 in those Iith 5 criteria)$ but the
mean N< value Ias si&nificantlH hi&her onlH in Iomen (260 vs 025T p_####1) N<
levels correlated best Iith Iaist circumference and bodH Iei&ht (r4#5) Khen analHzin&
data for N< Luartiles$ si&nificant statistical differences Iere recorded betIeen the first
and the last Luartile for! Iaist circumference and bodH Iei&ht (p_####1)$ )*'
(p4####5)$ ;b<1c (p4###10)$ total cholesterol (p4###B)$ the number of <>, '''
criteria that Iere fulfilled (p4##5)$ "D" cholesterol (p4##2)$ S), (p4##1) and
diabetes duration (p4##1/)
C$)c!("i$)"! hHperuricemia is freLuent in patients Iith tHpe 2 diabetes and *etS
Komen fulfillin& all *etS criteria Iere most liDelH to have hHperuricemia
9haracteristic >otal Q1 Q2 Q5 Q0
)*' (D&=m
2
)
5#1B
(C211)
2/0/
(C061)
5#25
(C2##)
5#B2
(C0/B)
515#
(C20.)
Kaist
circumference
(cm)
1#205
(C12#1)
.605
(C12B1)
1#120
(C..#)
1#560
(C1251)
1#6#1
(C111B)
<&e (Hears)
B21B
(C.5#)
B1.1
(C/B6)
B222
(C.21)
B121
(C.56)
B2.6
(C.61)
S), (mm;&)
15621
(C2261)
15#.#
(C21B.)
15/00
(C2225)
1012B
(C22#5)
15/#1
(C2#6.)
;b<1c (1) ./B (C22#)
1#02
(C201)
./2
(C256)
..6
(C2B1)
.22
(C22#)
>otal cholesterol
(m&=dl)
21#12
(C2210)
1.6.B
(C0B#5)
2#/0#
(C0/B6)
21222
(CB0/#)
21.#2
(C2666)
;D" cholesterol
(m&=dl)
5/05
(C.1B)
5.51
(C.21)
5/..
(C.0/)
565.
(C/.2)
5/#1
(C/60)
>ri&lHcerides
(m&=dl)
1.625
(C1B/00)
1/#/1
(C15./2)
1..25
(C2#506)
1.1B#
(C1#../)
21/02
(C2#1/B)
Nric acid (m&=dl) 222 (C1$.5)
500
(C#2B)
0B
(C#26)
2/1
(C#02)
/10
(C10.)
2#
;Hperuricemia is stron&lH correlated Iith metabolic and hemodHnamic disorders found
in >2D* and *etS and mi&ht be a considered another component of *etS that needs
more attention in the future
RELAIA DINTRE DEPRESIEF AN0IETATE :I CREDINELE RAIONALE :I
IRAIONALE PRIVIND MENINEREA CONTROLULUI ASUPRA VALORII
GLICEMICE
A.%. ocan
Centrul de Diabet, Nutriie i Boli etabolice Clu15Napoca
Obiectivul acestui studiu este analiza relaiei e7istente %ntre credinele raionale i
iraionale privind meninerea &licemiei %ntre valorile normale recomandate de medici i
apariia depresiei i a an7iet:ii
<stfel a fost elaborata o scal: de / itemi conform modelului teoriei raional8
emotive al lui <lbert Sllis Din totalul de / itemi ai scalei$ 0 itemi vizeaz: credinele
iraionale ce privesc evaluarea &lobala a propriei persoane sau a altora$ catastofarea
situaiei$ toleranta sc:zut: la frustrare i trebuie cu necesitate$ iar 0 itemi ofer: varianta
raional: a acestor &3nduri 'n ceea ce privete depresia s8a utilizat 9hestionarul Depresiei
()D') elaborat de <>)ecD$ iar pentru an7ietate s8a folosit chestionarul S><' cu cele
dou: forme ale sale$ de evaluare a an7iet:ii persoanei %n momentul complet:rii i de
evaluarea a an7iet:ii &eneralizate
Subiecii$ in num:r de 5#$ au fost selectai pe baza de voluntariat din cadrul
ambulatorului i a seciei cu persoane internate a 9entrului de Diabet si )oli de (utriie
9luG ,e l3n&: datele demo&rafice am fost interesai i dac: persoana se
automonitorizeaz:$ frecvena acestui comportament$ care a fost valoarea ultimei &licemii
i a ultimei &licemii &licozicate$ precum i de tipul tratamentului pe care persoana %l
urmeaz: (terapie orala sau terapie cu insulin:)
Din analiza datelor reiese e7istena unei corelaii %ntre depresie i &3ndurile
iraionale pe de8o parte i %ntre &3ndurile iraionale i an7ietate pe de alt: parte
C(vi)te c/eie! credine iraionale$ credine raionale$ depresie$ an7ietate
RELATIONSHIP BET+EEN DEPRESSIONF AN0IET, AND RATIONALF
IRRATIONAL BELIEFS ABOUT CONTROLLING THE GL,CAEMIC VALUES
A.%. ocan
Diabetes, Nutrition and etabolic Clinic5Napoca
21
>he aim of this studH is to analHze the relationship betIeen rational and irrational
beliefs about controllin& the &lHcaemic values recommended bH the phHsicians and
the their influence re&ardin& depression and an7ietH
<n /8item scale Ias elaborated based on < SllisRs rational8emotional model
Mrom this / items$ 0 of them refer to irrational beliefs (&lobal evaluation$ loI
frustration tolerance$ self doInin& and aIfulisin&) and four of them refer to rational
beliefs Depression Ias evaluated Iith >he )ecD Depression 'nventorH and for
an7ietH Ias used the State and >rait <n7ietH 'nventorH
>he subGects$ 5# of them$ Iere selected from outpatient department and inpatient
department of Diabetes$ (utrition and *etabolic 9linic Ke used demo&raphical and
personal data liDe the freLuencH of &lHcaemic recordin&$ last &lHcemia and ;b<1c$
tHpe of treatment (insulin therapH or oral therapH)
>he data analHsis revealed a correlation betIeen depression and irrational beliefs
and one betIeen an7ietH and irrational beliefs
ZeH Iords! irrational beliefs$ rational beliefs$ depression$ an7ietH
INTERVENIE PRIVIND MENINEREA CONTROLULUI VALORII
GLICEMICE
A.%.ocan, A.$her"an
Centrul de Diabet, Nutriie i Boli etabolice Clu15Napoca
Scopul acestei intervenii este controlul valorilor &licemice prin modificarea
stilului de via: <stfel intervenia dureaz: o perioad: de o lun: i Gum:tate$ cu . %nt3lniri$
cu caracter s:pt:m3nal Miecare edin: de terapie dureaz: %ntre B# 8 .# de minute$ mai
puin prima edin:$ care este de cunoatere a pacientului i care dureaz: dou: ore "a
aceast: intervenie pot participa persoanele cu diabet$ indiferent de tratamentul pe care8l
urmeaz:$ intervenia fiind de fapt o optimizare a stilului de via:
'ntervenia se desf:oar: pe module <stfel %n funcie de nevoile pacientului se
poate renuna la unul din module *odulul ' se refer: la re&ularizarea meselor i la un
re&im alimentar s:n:tos *odulul '' este adresat creterii e7erciiului fizic *odulul '''
este adresat persoanelor care doresc s: reduc: num:rul i&:rilor sau s: renune definitiv la
fumat ,e tot parcursul interveniei se automonitorizeaz: &licemia dorindu8se creterea
num:rului de m:sur:tori a acesteia De asemenea$ pacientul este %nv:at s:8i stabileasc:
scopuri reale i posibile$ s: aib: atept:ri realiste de la modific:rile pe care le dorete ,e
l3n&: strate&iile comportamentale sunt folosite i tehnici de restructurare co&nitiv: care
s: aGute pacientul %n dep:irea barierelor mentale pe care le are referitoare la modific:rile
ce urmeaz: a fi f:cute
22
"a finalul interveniei se urm:rete introducerea unei modific:ri pe termen lun& a
stilului de via: mai de&rab: dec3t o modificare de moment
C(vi)te c/eie: monitorizare &licemic:$ alimentar:$ reducerea fumatului$ intensificarea
activit:ii fizice
INTERVENTION REGARDING THE CONTROL OF THE GL,CAEMIC
VALUES
A.%.ocan, A.$her"an
Diabetes, Nutrition and etabolic Clinic Clu15Napoca
>he aim of this intervention is to control the &laHcaemic values throu&h chan&in& the
life stHle >he intervention is scheduled for . IeeDlH sessions Sach session lasts
betIeen B# and .# minutes e7cept the first one$ Ihich lasts for tIo hours <t this
intervention there can participate diabetes patients Iith no re&ard of the treatment theH
are folloIin& (insulin or oral therapH)T in fact this intervention aims a chan&e in the
patientRs life stHle
>he therapH is modular so$ re&ardin& the needs of the patient$ Ie can sDip a module
*odule ' tar&ets a healthier eatin& behavior$ module '' tar&ets the increase of the
phHsical activitH and module ''' referrs to smoDin& cessation Durin& the intervention
Ie encoura&e the patients to record their &lHcaemias and to increase the freLuencH of
this behavior >he patient learns to establish real and touchable obGectives and to have
realistic e7pectations from the life stHle modifications )eside behavioral strate&ies the
patient learns also co&nitive techniLues to overcome the possible mental obstacles
re&ardin& the chan&es from his life
'n the end of the intervention Ie trH to establish a lon&8term chan&e in the life
stHle
3e@ G$%"! &laHcaemia and food records$ smoDin& cessation$ increasin& phHsical
activitH
STATUSUL ACTUAL AL GLUCOZEI LA PERSOANELE CU DIABET
ZAHARAT TIP H :I TIP 5
25
Andreea oroanu
9
, $abriela Ro"an
9,:
, ihaela $ribo(schi
9,A
, Cristina Ni
9,:
,
Nicolae 0#ncu
9,:,A
9
Centrul Clinic de Diabet, Nutriie i Boli "etabolice Clu15Napoca,
:
+ni(ersitatea de
edicin i /ar"acie !Iuliu 0aie,anu& Clu15Napoca,
A
Centrul edical oilor
Clu15Napoca
I)t$%(cee6 *onitorizarea continu: a &lucozei (*9?) este o metod: recent: care
furnizaz: date e7tensive privind statusul actual al &lucozei la persoanele investi&ate$ prin
determinarea procentului ariei de sub curb: (1<S9) U care definete e7punerea
&licemic: 8 i a mediei valorilor &lucozei (*A?) at3t pentru valorile %ncadrate %n limitele
stabilite$ c3t i pentru cele situate %n afara obiectivelor De asemenea$ *9? permite
cuantificarea variabilit:ii &lucozei e7primat: prin amplitudinea medie a e7cursiilor
&lucozei (*<?S)$ parametru care influeneaz: stresul o7idativ i riscul de complicaii
cronice ale diabetului
Obiectiv6 Scopul acestui studiu a fost evaluarea comparativ: prin *9? a statusului
&lucozei la persoanele cu diabet zaharat (DZ) tip 1$ comparativ cu persoanele cu DZ tip
2
Mateia! 2i #et$%&6 Studiul a cuprins 22 de persoane! 20 cu DZ tip 1$ 51 cu DZ tip 2$ cu
v3rsta medie 05B. ani (118//)$ cu durata medie a diabetului de ./B ani (#851)$ 2. femei
i 2B b:rbaiT 1B persoane au urmat tratament cu antidiabetice orale$ iar 5. persoane au
fost tratate cu insulin: Distribuia valorilor &lucozei fost evaluat: prin determinarea
1<S9 i a *A? pe domenii &licemice (_ 6# m&=dl$ Y 1/# m&=dl$ 6#81/# m&=dl i .#8
15# m&=dl) De asemenea$ am evaluat variabilitatea &lucozei prin intermediul *<?S$
calculat pe baza datelor *9? i am dozat hemo&lobina &licat: <1c (<1c)$ %n vederea
comparaiei cu datele *9? *9? a fost efectuat: prin intermediul 9ontinuous ?lucose
*onitorin& SHstem (9?*S$ *inimed *edtronic) <naliza statistic: a fost efectuat: cu
pro&ramul S,SS 15#Semnificaia statistic: a fost atins: pentru p_##2
Re'(!tate6 <1c a fost /55 C 1621 (medie C deviaie standard$DS) 8 %ntre&ul &rup
studiat$ /B. C 1/01 8 DZ tip 1 i /#2 C 1B21 8 DZ tip 2 (pY##2 DZ tip 1 vs DZ tip
2) *<?S a fost 12222 C 0622 m&=dl U %ntre&ul &rup$ 12B5/ C 50## m&=dl 8 DZ tip 1
i .B5/ C 5/6. m&=dl 8 DZ tip 2$ diferen: care a fost semnificativ: statistic (p_###1$
DZ tip 1 vs DZ tip 2) Distribuia valorilor &lucozei a fost urm:toarea (`p_##2$ DZ tip 1
vsDZ tip 2)!
Distribuia valorilor
&lucozei (medieCDS)
_ 6# m&=dl Y1/# m&=dl 6#81/# m&=dl .#815# m&=dl
>otal 1<S9 1B# C 5#0 0B// C 2... 212# C 2.56 2102 C 22##
DZ tip 1 1<S9 56IJ K J6LMN MO6I5 K 5P6HQN IP6HM K HR6MLN 1520 C /./
DZ tip 2 1<S9 P6LO K H6LQN JR6OI K JJ6LHN QP65L K JJ65MN 2666 C 2B62
20
>otal *A? (m&=dl) B#5. C 2## 22B66 C 26#1 152B5 C 16B6 1120/ C 0./
DZ tip 1 *A? (m&=dl) MR6RM K I6MLN 5JM6IJ K 5M6LHN 15212 C 122B 111.# C 022
DZ tip 2 *A? (m&=dl) Q56OJ K I6RQN 5HL6PL K 5Q6PON 155#B C 1.B2 112./ C 22.
<1c a fost corelat: direct cu *<?S per total i %n DZ tip 2$ %ns: nu i %n DZ tip 1
<1c a fost direct corelat: cu <S9 total$ 1<S9 Y 1/# m&=dl$ *A? total:$ *A? Y 1/#
m&=dl <1c a fost invers corelat: cu 1<S9 %ntre 6#81/# m&=dl$ 1 <S9 %ntre .#815#
m&=dl at3t pentru %ntre&ul &rup$ c3t i pe sub&rupurile cu DZ tip 1 i tip 2 (p_##2)
*<?S a fost corelat: direct cu <S9 total$ 1<S9 Y 1/# m&=dl$ *A? total:$
*A? Y 1/# m&=dl i a fost invers corelat: cu 1 <S9 6#81/# m&=dl i 1 <N9 .#815#
m&=dl per total i %n DZ tip 2 (p_##2) Fn DZ tip 1$ *<?S a fost corelat: direct cu
1<S9 Y 1/# m&=dl i *A? Y 1/# m&=dl (p_##2) <curateea senzorului de &licemie a
fost .0$001 pentru toate cazurile studiate
Di"c(7ii6 *<?S a fost mai mare dec3t valoarea normal: de 0# m&=dl pentru tot &rupul
studiat$ dar i pe sub&rupuri Subiecii cu DZ tip 1 au avut *<?S semnificativ mai mare
dec3t cei cu DZ tip 2 (p_###1)$ chiar dac: &rupurile nu au fost diferite din punctul de
vedere al <1c
,ersoanele cu DZ tip 1 au avut e7punerea &licemic: la hipo&licemie i
hiper&licemie semnificativ mai mari dec3t persoanele cu DZ tip 2 *edia valorilor
hipo&licemice a fost semnificativ mai mic:$ %n timp ce media valorilor hiper&licemice a
fost semnificativ mai mare %n DZ tip 1 comparativ cu DZ tip 2$ fapt e7plicat i de
variabilitatea &licemic: mai mare %n DZ tip 1 Subiecii cu DZ tip 2 au avut o e7punere
semnificativ mai mare la normo&licemie fa: de cei cu DZ tip 1
<1c a fost corelat: cu *<?S$ indic3nd o relaie direct: liniar: %ntre dezechilibrul
&licemic i variabilitatea valorilor &lucozei$ per total i %n DZ tip 2 <1c i *<?S au fost
corelate direct cu e7punerea i amplitudinea hiper&licemiei (per total i separat pentru DZ
tip 1 i tip 2) i invers cu e7punerea i amplitudinea normo&licemiei %n DZ tip 1 (numai
pentru <1c)$ %n DZ tip 2 i per total (<1c i *<?S) (u s8a observat o relaie
semnificativ: %ntre <1c$ *<?S i e7punerea i amplitudinea hipo&licemiei
C$)c!('ii6 "a acelai nivel al <1c$ echilibrul &licemic al persoanelor cu DZ tip 1 este
mai precar$ necesit3nd o intervenie intensiva at3t din partea medicului cat si a persoanei
cu diabet *9? a facilitat evidenierea unor diferene semnificative ale statusului
&licemic la persoanele cu DZ tip 1 i tip 2 oferind oportunitatea identific:rii m:surilor
terapeutice adecvate %n vederea optimiz:rii controlului &licemic
Studiul actual a fost finanat prin Ga)t(! CNCSIS T% IO5S5PPQ>5PPO
CURRENT GLUCOSE STATUS IN PERSONS +ITH T,PE H AND T,PE 5
DIABETES
22
Andreea oroanu
9
, $abriela Ro"an
9,:
, ihaela $ribo(schi
9,A
, Cristina Ni
9,:
,
Nicolae 0#ncu
9,:,A
9
Clinical Center of Diabetes, Nutrition and etabolic Diseases Clu15Napoca,
:
!Iuliu
0aie,anu& +ni(ersit3 of edicine and Phar"ac3 Clu15Napoca,
A
oilor edical
Center Clu15Napoca
Bac-.$()%6 9ontinuous &lucose monitorin& is a recent evaluation method of &lucose
e7cursions that provides comprehensive data about current &lucose status$ measurin&
parameters liDe percent of area under the curve (1<N9) U definin& &lucose e7posure 8
and mean &lucose values (*?A) beloI$ above and betIeen tar&et limits 't also alloIs
the Luantification of &lucose variabilitH e7pressed bH mean amplitude of &lucose
e7cursions (*<?S) DnoIn to directlH influence o7idative stress and further diabetes
chronic complications
Ai#"6 Ke aimed to investi&ate the differences in current &lucose status betIeen tHpe 1
diabetes (>1D) and tHpe 2 diabetes (>2D) persons evaluated bH continuous monitorin& of
interstitial &lucose values (9?*)
Mateia! a)% Met/$%": Ke assessed 22 persons! 20 Iith tHpe 1 diabetes (>1D)$ 51 Iith
tHpe 2 diabetes (>2D)$ Iith mean a&e of 05B. Hears (118//)$ Iith mean diabetes
duration of ./B Hears (#851)T 2. Iomen$ 2B menT 1B orallH treatedT 5. insulin treated
?lucose distribution Ias assessed bH 1<N9 and *?A on &lucose domains (_ 6# m&=dl$
Y 1/# m&=dl$ 6#81/# m&=dl and .#815# m&=dl)T &lucose variabilitH Ias assessed bH
*<?S Ke evaluated &lHcated haemo&lobin <1c (<1c) for all studH subGects$ for
comparison Iith 9?* data 9?* Ias performed bH 9ontinuous ?lucose *onitorin&
SHstem (9?*S$ *inimed *edtronic) Statistical analHsis Ias effectuated Iith S,SS
15# pro&ram Statistical si&nificance Ias reached for p_##2
Re"(!t"! ;b<
1c
Ias /55 C 1621 (mean C SD) 8 the entire &roup$ /B. C 1/01 8>1D
and /#2 C 1B21 8>2D (pY##2$ >1D vs >2D) *<?S Ias 12222 C 0622 m&=dl (mean
C SD) 8 the entire &roup$ 12B5/ C 50## m&=dl 8>1D and .B5/ C 5/6. m&=dl 8 >2D
(p_###1 >1D vs >2D) ?lucose values distribution Ias!
?lucose values distribuiton
(meanCSD)
_ 6# m&=dl Y1/# m&=dl 6#81/# m&=dl .#815# m&=dl
<ll 1<N9 1B# C 5#0 0B// C 2... 212# C 2.56 2102 C 22##
>1D 1<N9 56IJ K J6LMN MO6I5 K 5P6HQN IP6HM K HR6MLN 1520 C /./
>2D 1<N9 P6LO K H6LQN JR6OI K JJ6LHN QP65L K JJ65MN 2666 C 2B62
<ll *?A (m&=dl) B#5. C 2## 22B66 C 26#1 152B5 C 16B6 1120/ C 0./
2B
>1D *?A (m&=dl) MR6RM K I6MLN 5JM6IJ K 5M6LHN 15212 C 122B 111.# C 022
>2D *?A (m&=dl) Q56OJ K I6RQN 5HL6PL K 5Q6PON 155#B C 1.B2 112./ C 22.
NPTP6PM =THD v"6T5D?
;b<
1c
Ias positivelH correlated Iith *<?S in the entire &roup and in >2D$ but
not in >1D ;b<
1c
Ias positivelH correlated Iith total <N9$ Iith 1 <N9 Y 1/# m&=dl$
total *?A$ *?A Y1/# m&=dl ;b<
1c
Ias inverselH correlated Iith 1<N9 6#81/#
m&=dl$ 1<N9 .#815# m&=dl in the entire &roup as Iell as in >1D and >2D sub&roups
(p_##2)
*<?S Ias positivelH correlated Iith total <N9$ Iith 1<N9 Y 1/# m&=dl$ total
*?A$ *?A Y1/# m&=dl and inverselH correlated Iith 1<N9 6#81/# m&=dl and 1<N9
.#815# m&=dl in the entire &roup and in >2D (p_##2) *<?S Ias positivelH correlated
Iith 1<N9 Y 1/# m&=dl and *?A Y 1/# m&=dl in >1D Sensor overall accuracH Ias
.0001 for all the studH cases
Di"c(""i$)"6 <1c shoIed a poor &lucose control in both >1D and >2D persons *<?S
Ias hi&her than normal value (0# m&=dl)$ in the Ihole &roup and in >1D and >2D
sub&roups >1D subGects had si&nificantlH hi&her *<?S than those Iith >2D (p_###1)$
even if <1c did not differ betIeen the tIo sub&roups
>1D persons had si&nificantlH hi&her e7posure to hHpo&lHcemia and
hHper&lHcemia than >2D subGects *?A for hHpo&lHcemia Ias si&nificantlH loIer and
*?A for hHper&lHcemia Ias si&nificantlH hi&her in >1D persons compared Iith >2D
ones$ this fact bein& e7plained bH the hi&her &lucose variabilitH in >1D individuals
9onverselH$ >2D subGects had si&nificantlH hi&her e7posure to normo&lHcemia
<1c Ias correlated Iith *<?S Ihich shoIed a direct linear relation betIeen
poor &lucose control and &lucose variabilitH in >2D and per total <1c and *<?S Iere
directlH correlated Iith hHper&lHcemic e7posure and amplitude (in the entire &roup and in
>1D and >2D sub&roups) and inverselH correlated Iith normo&lHcemic e7posure and
amplitude in >1D sub&roup (onlH for <1c) and in >2D and the Ihole &roup (for <1c and
*<?S) 't IasnRt evident anH relation betIeen <1c$ *<?S and hHpo&lHcemic e7posure
and amplitude
C$)c!("i$)"6 <t a similar <1c level$ >1D persons had a poorer &lucose control
emphasizin& the need for more intensive approach from both phHsician and patient sides
9?* marDed out si&nificant differences in &lucose status betIeen >1D and >2D persons
alloIin& further identification of the specific therapeutic chan&es for optimizin& &lucose
control
Ac-)$G!e%.e#e)t": 9urrent Research Ias supported bH a Romanian ?rant for aoun&
Researchers! Ga)t CNCSIS T% IO5S5PPQ>5PPO
26
OBEZITATEA U FACTOR DE PROTECIE N OSTEOPOROZ9
Andreescu $eor,eta', Dinc ihaela 2u,enia', Petrisor C.A.'', Petrisor Iuliana
2u,enia'''
'+../. Craio(a 7 Disciplina Boli Nutritie si etabolis"
''+../. Craio(a 7 Disciplina edicin Intern
''' edic re?ident endocrinolo,ie 7 %pital +ni(ersitar de +r,ent Craio(a
Obezitatea i osteoporoza sunt dou: boli frecvente i comple7e <m3ndou: au
etiolo&ie multifactorial:$ incluz3nd factori &enetici i de mediu cu potenial de
interaciune S7istena unei relaii %ntre obezitate i densitatea masei osoase a fost studiat:
%n numeroase studii epidemiolo&ice$ cu rezultate pro i contra asupra obezit:ii ca factor
de protecie fa: de osteoporoz: 93teva mecanisme par a fi implicate $ cum ar fi! efectul
mecanic al &reut:ii suportate de musculatur:$ creterea transform:rii andro&enilor %n
estro&eni la nivelul esutului adipos$ sc:derea le&:rii hormonilor se7uali de &lobulin: cu o
rat: mai mare a formelor libere a hormonilor se7uali$ creterea nivelului de leptin: seric:$
sc:derea sintezei de '?M la nivelul ficatului i scheletului$ hiperinsulinemia i
insulinorezistena Sstro&enul este un hormon activ pe sistemul osos care crete %n
obezitate besutul adipos transform: androstendionul %n estron: prin aromatizare i acesta
reprezint: principala surs: a estro&enului la femeia aflat: %n postmenopauz:$ mai de&rab:
dec3t secreia ovarian: sau adrenal: <ctivitatea de aromatizare de la nivelul celulelor
stromale adipoase este crescut: %n funcie de v3rst:$ fiind mai mare la femeia aflat: %n
postmenopauz: fa: de premenopauz: <stfel$ creterea produciei de estro&en al femeilor
aflate %n postmenopauz: este datorat: num:rului mare de celule adipose i activit:ii
crescute de aromatizare S7ist: studii care au demonstrat c: andro&enul adrenal D;S<
este convertit la estron: la nivelul osteoblatilor de c:tre aromataza ,02#$ iar acest fapt
contribuie la meninerea masei osoase %n decada a asea i a aptea de via:
"a femeia obez: aflat: %n postmenopauz: scade riscul de fractur: datorit: ritmului mai
sc:zut de pierdere osoas: 9onsecina acestui fapt este o rat: mai mic: a fracturilor
osteoporotice$ %n special la nivelul capului femural
OBESIT, UPROTECTION FACTOR IN OSTEOPOROSIS
ObesitH and osteoporosis are tIo frecvent and comple7 diseases )oth have a
multifactorial etiolo&H$ includin& &enetic and environmental factor Iith interaction
potential <n e7istin& relationship betIeen obesitH and bone mass densitH Ias studied in
several epidemiolo&ical studies$ Iith different results re&ardin& obesitH as a protection
factor for osteoporosis Several mechanisms seems to be responsible! the mechanic effect
of Iei&ht supported bH muscles$ the rise of transformation from andro&en to estro&en
hormones in adipous tissue$ the decline of bindin& of se7ual hormones to &lobuline$ Iith
a hi&her rate of free se7ual hormones development$ the rise of seric leptin levels$ decline
of '?M sHnthesis in liver and bones$ hHperinsulinemia and insulin resistance >he estro&en
2/
is an active hormone on bone tissue and rises in obesitH >he adipose tissue transform
androstendion in estrone throu&h aromatization and this is the main source of estro&en at
the postmenopause Iomen$ rather than ovarian or adrenal secretion >he aromatization
activitH from stromal adipous cells depends on a&e$ bein& hi&her at the postmenopausal
Iomen then premenopausal ones >hus$ the rise of estro&en production at
postmenopausal Iomen is due to the increased number of adipous cells and
aromatization activitH >here are studies that demonstrated that D;S< adrenal andro&en
is converted to estrone in osteoblasts bH ,02# aromatase maDin& possible the
conservation of bone mass at Iomen in si7th and seventh decade
<t obese postmenopausal Iomen the risD of fracture is loIer due to decreased rate of
bone loss >he result is a loIer rate of osteoporothHc fractures speciallH at the femoural
head
ROLUL OSTEOPROTEGERINEI N REMODELAREA OSOAS9
Dinc ihaela 2u,enia', Andreescu $eor,eta', Petrisor C.A.'', Petrisor
Iuliana 2u,enia'''
'+../. Craio(a 7 Disciplina Boli Nutritie si etabolis"
''+../. Craio(a 7 Disciplina edicin Intern
''' edic re?ident endocrinolo,ie 7 %pital +ni(ersitar de +r,ent Craio(a
'nte&ritatea sistemului osos necesit: numeroase mecanisme de re&lare Recent$ s8
au evideniat date noi despre remodelarea osoas: i cauzele care conduc la apariia celei
mai comune boli metabolice osoase$ osteoporoza$ a c:rei incidena este %n cretere
marcat: Dezvoltarea osteoclastelor mature depind de interaciunea corespunzatoare cu
celulele liniei osteoblastice <stfel$ este necesar: interaciunea R<(Z" (Receptor
<ctivator of (uclear Mactor Zappa ) "i&and) secretat de osteoblaste cu R<(Z (Receptor
<ctivator of (MD)) de pe suprafaa precursorilor osteoclastici <ceast: interaciune poate
fi blocat: de osteoprote&erina (O,?)$ o &licoprotein: membr: a superfamiliei >(M
receptor O,? funcioneaz: ca un receptor capcan: pentru R<(Z"$ competiion3nd cu
R<(Z pentru le&area de R<(Z" i dovedindu8se astfel un inhibitor important al
matur:rii i activ:rii osteoclastelor in vivo i in vitro *ai multe studii au dovedit c:
nivelurile serice ale O,? cresc semnificativ cu v3rsta at3t la b:rbai$ c3t i la femei$ fiind
un mecanism protectiv al scheletului menit s: compenseze creterea resorbiei osoase i a
pierderii de os O,? poate preveni reducerea osoas:$ fiind o valoare potenial: %n
tratamentul osteoporozei
THE ROLE OF OSTEOPROTEGERIN IN BONE REMODELATION
2.
>he inte&ritH of the bone tissue depends on numerous re&ulation mechanisms
RecentlH$ neI data about the bone remodellin& and also neI causes of the most common
bone metabolic disease are available >he development of mature osteoclasts depend on
the ri&ht interaction Iith the osteoblastic cell line >hus$ the interaction of R<(Z"
(Receptor <ctivator of (uclear Mactor Zappa ) "i&and)secreted bH R<(Z osteoblasts
(Receptor <ctivator of (MD))is necessarH >his interaction can be blocDed bH
osteoprote&erin (O,?)$ a &lHcoprotein from the >(M receptor familH O,? IorDs liDe a
]trap- receptor for R<(Z"$ competin& Iith R<(Z for the bindin& Iith R<(Z" and
provin& to be an important inhibitor of osteoclasts maturation and activation in visvo and
in vitro *anH studies shoIed that seric levels of O,? rise si&nificantlH Iith a&e at men
and Ioman$ this bein& a protective mechanism of the sDeleton$ meant to compensate the
&roIth of bone resorbtion and bone loss O,? can prevent bone loss$ Iith potential value
in osteoporosis treatment
DIABETUL ZAHARATF MODEL DE BOALA PSIHOSOMATICA
Bianca Andreica
9
, ariana Andreica
:
95 Clinica Psihiatrie Pediatrica
:5 Clinica Pediatrie II
Clu15Napoca
Diabetul zaharat este o boal: cronic: metabolic:$ cauzat: de deficiena absolut: sau
relativ: de insulin:
9ei mai muli cercet:tori au &:sit urm:toarele variabile psihosociale ca fiind implicate %n
apectele psihosomatice ale diabetului !1) depresia$ an7ietatea$ frica de hipo&licemie 2)
deficitul co&nitiv$ 5) stresul$ evenimente stresante de via:$ 0) mecanisme de copin&$ 2)
percepia personal: asupra bolii$ B) tr:s:turi de personalitate$ 6) suport social$ incluz3nd
familia$ /) calitatea relaiei medic8pacient$ .)variabile socio8demo&rafice$ venit$ educaia$
dizabilit:ile date de diabet
"ucrarea prezenta este un studiu de caz al unei adolescente in varsta de 1/ ani$ aflata in
ultimul an de liceu$ afectata de e7amenul de bacalaureat care o asteapta si de iminenta
plecarii mamei in strainatate
Stresul &enerat de aceste doua evenimente$ coroborat cu despartirea de prietenul sau au
determinat aparitia unui tablou clinic caracterizat prin fati&abilitate$ senzatia de lesin
S7aminarile paraclinice au depistat hiper&licemie si testul de toleranta la &lucoza crescut
9azul a fost interpretat ca si Diabet zaharat tip 2 si s8a impus urmarea unei diete si
tratament medicamentos specific <flarea acestui dia&nostic si consecintele sale au
determinat dezvoltarea la adolescenta a unui Sindrom posttraumatic de stres < refuzat
medicatia$ chiar si pe cea homeopata < urmat inconstant sedinte de psihoterapie
5#
co&nitive comportamentala si a inceput sa participe mai des la sluGbe reli&ioase Dupa o
luna$ la control s8a depistat normalizarea parametrilor biochimici
9uvinte cheie! diabet zaharat$ factori psihosociali$ ,>SD
DIABETTES MELLITUS U MODEL FOR PS,CHOSOMATIC DISEASE
Diabetes mellitus is a chronic metabolic disorder caused bH an absolute or relative
deficiencH of insulin
>he most freLuent psHchosocial variables found in diabetes are! 1) depression$ an7ietH$ 2)
co&nitive deficits$ 5) stress$ 0) copin& mechanisms$ 2) temperament and character$ B)
familH and friendsR support$ 6) socio8demo&raphic variables
>he present paper is a case studH of a 1/ Hears old &irl$ in the last hi&h8school Hear$
affected bH the forthcomin& &raduation e7am and bH the imminence of her motherRs
departure abroad >he stress &enerated bH these tIo events$ corroborated Iith the
separation from her boHfriend determined the apparition of a simptomatolo&H$
caracterised bH fati&abilitH$ and the sensation of faint >he paraclinical e7aminations
discovered hHper&lHcemia and the &lucose tolerance test increased >he case Ias
interpreted as diabetes mellitus tHpe 2$ and a diet and specific dru& cure Ias imposed
>his dia&nosis and its conseLuences determined the onset of a posttraumatic stress
sHndrome >he patient refused medication$ even if it Ias homeopathic She folloIed
inconstant behavioral co&nitive psHchotherapH sessions and be&an to attend more often
reli&ious masses >Io months after the e7amination$ the normalization of biochemical
parameters Ias discovered
ZeH Iords! diabetes$ psHchosocial factors$ ,>SD
EVALUAREA AFECT9RII RENALE LA PACIENII CU DIABET ZAHARAT
TIP H DIN CENTRUL CLINIC DE DIABETF NUTRIIEF BOLI METABOLICE
IA:I
Bo,dan ihai
9,:
, Cristina Lctuu
9,:
, RoEana ;tefan
:
, Laura ihalache
9,:
, Delia
4Ctc
:
, ariana $raur
9,:
9
+ni(ersitatea de edicin i /ar"acie >$r. ). Popa& Iai
:
Centrul Clinic de Diabet, Nutriie, Boli etabolice Iai
Sc$1(! !(c&ii: am efectuat un studiu retrospectiv$ observaional$ transversal$ pentru a
aprecia prevalena i severitatea afect:rii renale la pacienii cu diabet zaharat tip 1 aflai
%n evidena 9entrului 9linic de Diabet$ (utriie$ )oli *etabolice 'ai
51
Mateia! 2i #et$%&: am evaluat toi pacienii aduli cu diabet zaharat tip 1 aflai %n
evidena centrului nostru p3n: la data de #1#12##6 Din analiza fielor de monitorizare$
lu3nd %n considerare doar datele din ultimii doi ani$ am selectat informaiile referitoare la
v3rst:$ se7$ vechimea bolii$ elimin:rile urinare de proteine i clearance8ul de creatinin:$
care au fost %nre&istrate %ntr8o baz: de date *icrosoft Office S7cel i supuse ulterior
prelucr:rii statistice folosind pro&ramele S,SS
Re'(!tate 2i %i"c(7ii: Din totalul de 1#62 pacieni$ dup: e7cluderea celor cu v3rsta sub
1/ ani i a celor cu patolo&ie terminal: de or&an (care ar fi putut falsifica analiza statistic:
a datelor de laborator)$ am selectat un lot de ..0 pacieni <m constatat o preponderen: a
se7ului masculin (225 cazuri U 22$B1) i o v3rst: medie de 05$2/C15$BB ani$ cu variaii
%ntre 1/ i /0 de ani Aechimea diabetului zaharat tip 1 a variat %ntre 1 i 0. de ani$ cu o
medie de 11$#2C.$#2 ani 5#2 pacieni (5#$61 din totalul cazurilor) aveau determinate
semicantitativ sau cantitativ elimin:rile urinare de proteine %n ultimii 2 aniT dintre acetia$
maGoritatea erau normoalbuminurici (0/$21)$ 20$B1 prezentau microalbuminurie i
26$21 macroalbuminurie "a /16 pacieni (/2$21 din totalul cazurilor) au fost
disponibile datele necesare pentru calculul clearance8ului de creatinin: (9l
9r
) conform
formulei 9ocDcroft8?aultT 5.$/1 dintre aceti pacieni prezentau afectare renal: (9l
9r
_
.# ml=min)! 2.$..1 U 9l
9r
4 B#8.# ml=min$ 6$221 U 9l
9r
4 5#8B# ml=min$ #$/B1 U 9l
9r
4
1285# ml=min$ 1$611 U 9l
9r
_ 12 ml=min Aaloarea clearance8ului de creatinin: a fost
semnificativ statistic mai mic: la pacienii cu macroalbuminurie comparativ cu cei cu
normoalbuminurie i cu microalbuminurie S8a constatat o preponderen: a se7ului
masculin %n &rupul cu elimin:ri urinare crescute de proteine (B2$11 b:rbai vs 50$.1
femei cu macroalbuminurie)$ %ns: f:r: a atin&e pra&ul semnificaiei statistice ,acienii cu
o vechime mai mare a bolii prezentau mai frecvent elimin:ri urinare crescute de proteine
i valori sc:zute ale clearance8ului de creatinin:$ cu diferene semnificative statistic %ntre
&rupurile menionate
C$)c!('ii: ,este 2#1 din cazurile evaluate aveau elimin:ri urinare crescute de proteine
i apro7imativ 0#1 dintre pacieni prezentau o rat: sc:zut: de filtrare &lomerular:
evideniat: prin determinarea clearance8ului de creatinin: Aaloarea clearance8ului de
creatinin: a fost semnificativ statistic mai mic: la pacienii cu macroalbuminurie
comparativ cu cei cu normoalbuminurie i cu microalbuminurie Fn &rupul cu elimin:ri
urinare crescute de proteine s8a constatat o prevalen: crescut: a se7ului masculin
,acienii cu o vechime mai mare a bolii prezentau mai frecvent elimin:ri urinare crescute
de proteine i valori sc:zute ale clearance8ului de creatinin:
RENAL FUNCTION IN T,PE H DIABETIC PATIENTS IN CLINICAL CENTRE
OF DIABETESF NUTRITIONF METABOLIC DISEASES IA:I
Bo,dan ihai
9,:
, Cristina Lctuu
9,:
, RoEana ;tefan
:
, Laura ihalache
9,:
, Delia
4Ctc
:
, ariana $raur
9,:
9
)he +ni(ersit3 of edicine and Phar"ac3 >$r. ). Popa& Iai
52
:
)he Clinical Centre of Diabetes, Nutrition, etabolic Diseases Iai
Ai# $< "t(%@: Ie performed a retrospective$ observational$ transversal studH in order to
appreciate the prevalence and severitH of renal disease in tHpe 1 diabetic patients in
9linical 9entre of Diabetes$ (utrition$ *etabolic Diseases 'ai
Mateia! a)% #et/$%: Ie evaluated all adult patients dia&nosed Iith tHpe 1 diabetes
mellitus in our centre before WanuarH 1st 2##6 Ke analHzed the record files$ bH
considerin& onlH data available in the last tIo Hears Ke searched information about a&e$
se7$ duration of disease$ urinarH albumin e7cretion rate and creatinine clearance$ Ihich
Iere re&istered in a *icrosoft Office S7cel data base and afterIards under&one statistic
analHsis bH usin& S,SS pro&rams
Re"(!t" a)% %i"c(""i$)": Out of all 1#62 patients$ after e7cludin& those under 1/ Hears
old and those Iith terminal or&an patholo&H (that mi&ht have falsified the statistical
analHsis of laboratorH data)$ Ie selected a &roup of ..0 patients Ke observed a
predominance of male patients (225 cases U 22B1) and a mean a&e of 052/C15BB
Hears$ Iith e7tremes of 1/ and /0 Hears >he duration of tHpe 1 diabetes mellitus varied
betIeen 1 and 0. Hears$ Iith a mean value of 11#2C.#2 Hears 5#2 patients (5#61 of
all cases) had semiLuantitative or Luantitative urinarH albumin e7cretion rate evaluation
in the last 2 HearsT most of them had normal albuminuria values (0/21)$ 20B1 had
microalbuminuria and 2621 had macroalbuminuria /16 patients (/221 of all cases)
had available data as to calculate the creatinine clearance (9l
9r
) bH 9ocDcroft8?ault
eLuationT 5./1 of these patients had chronic DidneH disease (9l
9r
_ .# ml=min)! 2...1
U 9l
9r
4 B#8.# ml=min$ 6221 U 9l
9r
4 5#8B# ml=min$ #/B1 U 9l
9r
4 1285# ml=min$
1611 U 9l
9r
_ 12 ml=min >he creatinine clearance value Ias loIer (Iith statistical
si&nificance) in patients Iith macroalbuminuria compared to those Iith
normoalbuminuria and microalbuminuria Ke noticed a predominance of male patients in
the &roup Iith hi&h urinarH albumin e7cretion rate (B211 males vs 50.1 females Iith
macroalbuminuria)$ but Iithout reachin& the level of statistical si&nificance ,atients Iith
a lon&er duration of diabetes had more often hi&h urinarH albumin e7cretion rates and loI
values of creatinine clearance$ Iith statisticallH si&nificant differences betIeen the
alreadH mentioned &roups
C$)c!("i$)": *ore than 2#1 of the evaluated cases had hi&h urinarH albumin e7cretion
rates and appro7imatelH 0#1 of the patients had loI &lomerular filtration rate as shoIn
bH the creatinine clearance value >he creatinine clearance value Ias statisticallH
si&nificant loIer in patients Iith macroalbuminuria compared to those Iith
normoalbuminuria and microalbuminuria 'n the &roup Iith hi&h urinarH albumin
e7cretion rates Ie noticed a hi&her prevalence of males ,atients Iith a lon&er duration
of the disease had more often hi&h urinarH albumin e7cretion rates and loI values of
creatinine clearance
55
SENSIBILITATEA PERIFERIC9 LA PACIENI CU DIABET ZAHARAT TIP 5
NOU DIAGNOSTICAT UTILIZVND TESTAREA SENZORIAL9
CANTITATIV9 COMPUTERIZAT9 U CORELAIE CU SCORUL CLINIC NSS
C.Constantin
:,A
, C.Ioni
9
, I.N.$al
9
, $.%tan
:,B
, D.Chea
9,:
9F +ni(ersitatea de edicin i /ar"acie !Carol Da(ila& Bucureti
:F Institutul Naional de Diabet i Boli de Nutriie ! Prof. N Paulescu&
Bucureti
AF %pitalul Clinic de +r,en ilitar Central &Carol Da(ila& Bucureti
BF /undaia Pentru Ali"entaie %ntoas, Bucureti
Bac-.$()%: ,acienii cu diabet zaharat tip 2 (DZ2) nou dia&nosticat pot prezenta
concomintent i modificarea sensibilit:ii periferice$ evaluarea acesteia fiind descris:
discordant %n literatur:
Obiectiv: Studiul i8a dorit evaluarea pra&ului sensibilit:ii periferice (la rece) a
pacienilor cu DZ tip 2 nou dia&nosticat utiliz3nd sistemul 9<SS 'A i corelarea cu
prezena simptomelor de neuropatie (scorul (SS)
Mateia!e 2i #et$%e! Studiul transversal a fost realizat pe un lot selectat dintre pacienii
internai %n cadrul 'nstitutului ]( ,aulescu- dia&osticai cu diabet zaharat tip 2 nou
descoperit (DZ2) i au fost evaluai utiliz3nd testarea senzorial: cantitativ: (Q>S) i
scorul simptomelor de neuropatie ((SS) ,arametrii urm:rii au fost! ;b<1c$ )*'$
pra&ul sensibilit:ii la rece (,SR)$ simptomele de neuropatie >estarea senzorial:
cantitativ: s8a realizat folosind sistemul 9<SS 'A (9omputer8<ssisted SensorH
S7amination 'A) la nivelul membrului superior drept (*S) i al membrului inferior drept
(*')$ iar %ncadrarea privind pra&ul sensibilit:ii s8a facut %n trei cate&orii! hiperestezic c
6$2 W(D$ limite normale 8 "( %ntre 6$2 i 12$2 W(D i hipoestezic@ 12$2 W(D Dup: (SS
%mp:rirea pacienilor s8a realizat astfel! # pentru absena simptomelor$ 580 simptome
uoare$ 28B simptome moderate$ 68. simptome severe
Re'(!tate 2i %i"c(7ii! < fost realizat un lot de 56 de pacieni cu o v3rst: medie de 20 C
15$5 de ani ;b<1c a avut o valoare medie de 12$51 C 2$01 la prima determinare )*' a
avut o valoare medie la internare de 2B$BC2$1D&=m2$ 20$11 dintre pacieni fiind
supraponderali "a *S$ ,SR este alterat la B2$21 (25) din pacieni$ 56$/1 (10)
prezent3nd alterare de tip hiperestezie "a *'$ ,SR este alterat la B0$.1 (20) din pacieni$
56$/1 (10) prezent3nd alterare de tip hiperestezie Fn ceea ce privete scorul (SS$ 56$/1
(10) din pacieni nu aveau simptomatolo&ie su&estiv: de neuropatie$ dar 61$01 (1#)
dintre ei prezentau alter:ri ale ,SR la nivelul *S$ respectiv .2$/1 (15) la nivelul *'
B2$21 (21) dintre pacieni aveau simptome de neuropatie uoare (1B$21$ (SS 4 0) sau
moderate (02$.1$ (SS 2 sau B)$ chiar dac: ,SR era %n limite normale la *S la 06$B1
50
(1#) dintre pacieni$ respectiv la *' la 26$10 1 (12) dintre pacieni (ici unul dintre
pacienii luai %n studiu nu a prezentat simptome severe de neuropatie ((SS 4 68.)
C$)c!('ii! "a pacienii cu DZ2 nou dia&nosticat alterarea pra&ului sensibilit:ii la rece
este at3t de tip hipoestezic$ c3t i de tip hiperestezic$ f:r: a fi prezent: o simptomatolo&ie
clinic: %n direct: corelaie cu modific:rile evideniate (europatia diabetic: poate evolua
subclinic$ fiind necesar: o metod: obiectiv: de evaluare a sensibit:ii periferice
Fi)a)7ae! Studiu realizat %n cadrul proiectului 9SSd .2=2##B$ ,(9D'2 221B0=2##/
PERIPHERAL SENSITIVIT, IN NE+L, DIAGNOSED T,PE 5 DIABETES
MELLITUS PATIENTS USING COMPUTERIZED 4UANTITATIVE SENSOR,
TESTING > CORRELATION +ITH CLINICAL SCORE NSS
C.ConstantinG
,
H@ C. Ioni I@ I.N.$al I@ $.%tanG
,B
@ D.CheaI
,
G.
9F !Carol Da(ila& +ni(ersit3 of edicine and Phar"ac3, Bucharest@
:F National Institute of Diabetes, Nutrition and etabolic Diseases
!N.Paulescu&, Bucharest@
AF >Carol Da(ila& Central ilitar3 2"er,enc3 0ospital, Bucharest
BF. 0ealth3 Nutrition /oundation, Bucharest
Bac-.$()%! <bnormal peripheral sensitivitH could be identified at neIlH dia&nosed
tHpe 2 diabetes mellitus patients (>2D*)$ but evaluation of diabetic neuropathH at >2D*
havin& a controversial literature
Ob8ective! Svaluation of cold threshold sensitivitH of neIlH dia&nosed tHpe 2 diabetes
mellitus patients usin& the 9<SS 'A SHstem and correlation Iith the sHmptoms of
neuropathH ((SS score)
Mateia!" a)% #et/$%"! >his cross8sectional studH Ias conducted on a lot of patients
selected Iithin the 'nstitute V( ,aulescu V Iith neIlH dia&nosed tHpe 2 diabetes mellitus
(>2D*) and Iere assessed usin& Luantitative sensorH testin& (Q>S) and neuropathH
sHmptoms score ((SS) Ke recorded the ne7t parameters! ;b<1c$ )*'$ coolin&
detection threshold (9D>)$ sHmptoms of neuropathH ((SS) Quantitative sensorH testin&
Ias performed usin& the 9<SS 'A SHstem (9omputer8<ssisted SensorH S7amination 'A)
in the superior limb (S") and inferior limb ('") of each patient$ and theH Iere
characterized in three cate&ories! hHperesthesic c 62 W(D$ normal 8 betIeen 62 and 122
W(D$ hHpoaesthetic @ 122 W(D <fter (SS the patients Iere divided as folloIs! # for no
sHmptoms$ 580 li&ht sHmptoms$ 28B moderate sHmptoms$ 68. severe sHmptoms
Re"(!t" a)% %i"c(""i$)! >he lot of 56 patients Iith an avera&e a&e of 20##C1558 Hears
Ias studied ;b<1c had an avera&e value of 1251 C 201 )*' had an avera&e value of
52
2BBC21D&=m2$ 2B11 of patients bein& overIei&ht 'n the S"$ 9D> is altered in B221
(25) of patients$ 56/1 (10) presentin& alteration tHpe hHperesthesia 'n the '"$ 9D> is
altered in B0.1 (20) of patients$ 56/1 (10) presentin& alteration tHpe hHperesthesia
Re&ardin& (SS$ 56/1 (10) of patients had no sHmptoms of neuropathH$ but 6101 (1#)
of these patients had alteration of the 9D> at the S"$ and .2/1 (15) at the '" B221
(21) of patients had sHmptoms of li&ht peripheral neuropathH (1B21 (SS40) or
moderate peripheral neuropathH (02.1 (SS 2 or B)$ even if 9D> Ias normal in the S"
in 06B1 (1#) of this patients$ respectivelH in the '" in 2610 1 (12) of patients
C$)c!("i$)"! 'n neIlH dia&nosed tHpe 2 diabetes mellitus patients abnormal 9D> is both
hHpoaesthesia and hHperesthesia$ Iithout a direct correlation betIeen clinical sHmptoms
and the alteration of peripheral sensitivitH (europathH maH have a subclinical evolution$
bein& necessarH an obGective method to evaluate the peripheral sensitivitH
S(11$te% b@! ?rant 9SSd .2=2##B$ ,(9D'2 221B0=2##/ from the Romanian Research
*inistrH
EVALUAREA PRAGULUI SENSIBILIT9II VIBRATORII LA
PACIENII CU DIABET ZAHARAT TIP 5 NOU DIAGNOSTICAT
C. Constantin
9, :
, I. $al
A
, C. Ionita
A
, $. %tan
9,B
, D. Cheta
9,A
9. Institutul Naional de Diabet, Nutriie i Boli etabolice !Prof. NC
Paulescu&
:. %pitalul Clinic de +r,en ilitar Central !Carol Da(ila&
A. +ni(ersitatea de edicin i /ar"acie !Carol Da(ila&
B. /undaia Pentru Ali"entaie %ntoas Bucureti
Obiectiv
Obiectivul acestui studiu a fost s: evalueze evoluia pra&ului sensibilit:ii
vibratorii la pacienii cu diabet zaharat tip 2 (DZ2) nou dia&nosticat
Mateia! 2i #et$%e
Sistemul computerizat de determinare a sensibilit:i vibratorii (9<SS 'A SHstem)
este un instrument de calitate pentru evaluarea componentei vibratorii a polineuropatiei
diabetice <cesta este un studiu deschis$ prospectiv$ desf:urat pe durata a 5 luni <u fost
alc:tuite dou: &rupuri de 12 pacieni cu DZ2 nou dia&nosticat urm:rind un tratament
intensiv cu insulin: i diet: adecvat: 9omorbidit:ile neurolo&ice au fost e7luse la
%nceputul i pe durata studiului 9riteriile de includere si de e7cludere din studiu au fost
urmate cu strictee
5B
Re'(!tate
9aracteristicile la momentul includerii %n studiu au fost! pentru &rupul < v3rsta
medie a fost de 02$50C5$2ani$ &reutatea medie /.$6C12$22D&$ ;b<1c 12$61C1$261$
pentru &rupul ) v3rsta este de B0$25CB$20ani (p_#$#2)$ &reutatea medie /2$/C.$25D&
(pY#$#2) ;b<1c 11$.C2$211 (pY#$#2) ,e parcursul perioadei studiate s8au %nre&istrat!
;b<1c$ evenimentele hipo&icemice$ &reutatea i indicele de mas: corporal: Sistemul
9<SS 'A a %nre&istrat valori ale pra&ului sensibilit:ii vibratorii la intrarea %n studiu$ la o
lun:$ dou: i trei luni "a trei luni! pentru &rupul < s8a %nre&istrat un plus %n &reutate de
0$1/C1$21D& i o sc:dere a valorii ;b<1c p3n: la 6$.C#$/1$ pentru &rupul ) s8a
%nre&istrat un plus %n &reutate de 2$#2C2$#5 D& (< vs )$ pY#$#2)$ o descretere a ;b<1c
la /#2C#261 (< vs )$ pY#$#2) (um:rul evenimentelor hipo&licemice a fost similar
pentru cele dou: loturi! 0$12C1$#5 vs 5$.BC1$22=lun:$ pY#$#2) Svoluia pra&ului
sensibilit:ii vibratorii este descris: %n >abelul 1$ cu valori diferite semnificativ statistic la
5 luni (p_##2)
C$)c!('ii
<cesta este unul dintre primele studii care demonstreaz: o %mbun:t:ire a pra&ului
sensibilit:ii vibratorii la pacienii cu DZ2 nou dia&nosticat dup: tratament intensiv cu
insulin: i intervenie susinut: asupra stilului de viat: Fmbun:t:irea pra&ului
sensibilit:ii vibratorii a fost semnificativ mai bun: pentru partipanii mai tineri S8a
constatat prezena unui dezechilibru metabolic maGor (;b<1cY121) %nsoit fiind de
semne ale deficitului insulinic
Ti#1S
U)it6
;ND
$rup A
JI 4ib )'F
$rup B
JI 4ib )F %i,nf'
$rup A
J% 4ib )'F
$rup B
J% 4ib )F %i,nf'
&aseline 11$.2C#$25 12$12C2$1# p_#$#2 /$50C#$/0 /$62C2$1# p_#$#2
' lun .$50C0$25 1#$1#C2$26 pY#$#2 6$2/C5$1. 6$0/C2$26 pY#$#2
( luni /$0#C2$55 1#$/#C2$B0 p_#$#2 B$##C1$22 6$//C2$B0 p_#$#2
) luni /$1#C2$2B 1#$2BC2$22 p_#$#2 B$56C1$21 /$12C2$12 p_#$#2
`*' Aib > U Determinarea sensibilit:ii vibratorii la nivelul membrului inferior$
`*S Aib > U Determinarea sensibilit:ii vibratorii la nivelul membrului superior$
`Si&nf 8 Semnificaia statistic: folosid testul > Student
>abelul 1 Svoluia pra&ului sensibilit:ii vibratorii
56
Fi)a)7ae: Studiu realizat %n cadrul proiectului 9SSd .2=2##B
EVALUATION OF VIBRATOR, DETECTION THRESHOLD IN
NE+L, DIAGNOSED T,PE 5 DIABETES MELLITUS PATIENTS
C. Constantin
9,:
, I. $al
A
, C. Ionita
A
, $. %tan
9,B
, D. Cheta
9,A
9. !Prof. NC Paulescu& Diabetes Institute Bucharest
:. !Carol Da(ila& 2"er,enc3 ilitar3 0ospital Bucharest
A. !Carol Da(ila& +ni(ersit3 of edicine and Phar"ac3 Bucharest
B. 0ealth3 Nutrition /oundation Bucharest
Ob8ective
>he obGective of this studH Ias to evaluate the evolution of vibratorH threshold in
neIlH dia&nosed tHpe 2 diabetes mellitus patients
Mateia! a)% #et/$%"
9omputed vibratorH detection threshold (9<SS 'A SHstem) is a valuable
instrument to evaluate diabetic sensorH polHneuropathH >his is a 5 months open
prospective studH Ke have tIo &roups of 12 subGects each$ Iith tHpe 2 neIlH dia&nosed
D* folloIin& intensive insulin treatment and adeLuate diet 9ommon neurolo&ical
disorders Iere e7cluded at start and durin& the studH 'nclusion 9riteria! ,atients must
fulfill all of the folloIin& criteria to be eli&ible for this studH! 1(eIlH dia&nosed >Hpe 2
diabetes mellitus$ 2<ble to folloI the protocol and Iillin& to participate in the studH as
confirmed bH si&ned consent to release information$ 59urrentlH treated Iith (S<SD
protocols)! "ife stHle intervention$ 'nsulin (Iith or Iithout oral a&ents)$ Different dru&s
for co8morbidities$ 0 (o anamnestic stories or clinical si&ns about nervous impairement
Re"(!t"
)aseline characteristics! >he &roup < has the mean a&e 0250C52Hears and the
other one B025CB20Hears )aseline characteristics (mean) )*'$ Iei&ht$ sHstolic blood
pressure8s),$ ;b<1c Iere similar for tIo &roups Data for ;b<1c$ hHpo&licemic events$
Iei&ht and )*' Iere recorded 9omputed vibratorH detection threshold Ias monitored
at the baseline and after 1$ 2 and 5 months Mor the ?roup < mean Iei&ht at baseline Ias
/.6C1222D& and Iei&ht &ain at 5 months Ias 01/C121 D& *ean ;b<1c at baseline
Ias 1261C1261 and decreased to 6.C#/1 at 5 months Mor ?roup ) mean Iei&ht at
baseline Ias /2/C.25D& and Iei&ht &ain at 5 months Ias 2#2C2#5 D& (< vs )$
5/
pY##2) *ean ;b<1c at baseline Ias 11.C2211 and decreased to /#2C#261 (< vs
)$ pY##2) at 5 months >he hHpo&licemic events are similar in the 2 lots durin& the
treatment (012C1#5 vs 5.BC122=months$ pY##2) <t baseline the computed vibratorH
threshold Ias 11.2C#25W(D Nnits for ?roup < and 212C21#W(D Nnits for ?roup )
(Moot Aibration >est) (pY##2) <fter three monts the computed vibratorH threshold Ias
/1#C22BW(D Nnits for ?roup < and 1#2BC222W(D Nnits for ?roup )(p_##2)
>able 1
C$)c!("i$)"
>his is one of the first studies Iere Ie can see an improvement of vibratorH
threshold after an intensive insulin treatment and lifestHle modifications in neIlH
dia&nosed tHpe 2 D* patients >he improvement vibratorH threshold is si&nificantlH
better at Houn&er participants (p_##2);i&h metabolic disturbances (;b<1c1Y12) Iere
present at the be&innin& of the studH Iith si&ns of insulin deficit "oI poIer level of
studH U onlH 20 participants had finished the pro&ram
Ti#eS
;ND
U)it"
$roup A
J/oot 4ib )'F
$roup B
J/oot 4ib )F %i,nf'
$roup A
J0and 4ib )'F
$roup B
J0and 4ib )F %i,nf'
&aseline 11.2C#25 1212C21# p_##2 /50C#/0 /62C21# p_##2
'
month .50C025 1#1#C226 pY##2 62/C51. 60/C226 pY##2
(
months /0#C255 1#/#C2B0 p_##2 B##C122 6//C2B0 p_##2
)
months /1#C22B 1#2BC222 p_##2 B56C121 /12C212 p_##2
`Moot Aib > U Moot Aibration >est$ `;and Aib > U ;and Aibration >est$
`Si&nf 8 statistical si&nificance usin& t Student test
>able 1 >he evolution of vibratorH threshold
S(11$te% b@! ?rant 9SSd .2=2##B from the Romanian Research *inistrH
5.
ROLUL ALELELOR HLA>B N SUSCEPTIBILITATEA GENETIC9 PENTRU
DZ TIP H PENTRU POPULAIA DIN ROMVNIA
C. $u1a
9
, L $u1a
9
, A. Clin
9
, %. Nutland
:
, *. 0o.son
:
, 0. Rance
:
i *.A. )odd
:
i C.
Ionescu5)Cr,o(ite
9
9 Clinica 9 de Diabet, Institutul !N. Paulescu&, Bucureti, Ro"#nia
: *DR/KDellco"e )rust Diabetes and Infla""ation Laborator3, Ca"brid,e Institute
for edical Research, Ca"brid,e, +=
I)t$%(cee: Diabetul Zaharat de tip 1 (DZ tip 1) este o boal: cronic: cu pato&enie
autoimun:$ caracterizat: prin distru&erea mediat: de limfocite > a celulelor beta
pancreatice ,rincipalele &ene diabeto&ene descrise p3n: %n prezent sunt localizate la
nivelul re&iunii ;"< de clasa a ''8a$ fiind reprezentate %n special de unele alele ale ;"<
DQ)1 i DR)1 S7ist: %ns: i date privind implicarea unor alele de clasa '$ ;"<8< i
;"<8) ,entru a evalua efectul diabeto&en al unor alele ;"<8) pentru populaia din
Rom3nia (ar: cu una din cele mai mici incidene ale DZ tip 1 din Suropa)$ am realizat o
tipare ;"<8) complet: pe un num:r de 025 familii cu DZ tip 1
Sc$1: Svaluarea implic:rii unor alele ;"<8) %n pato&enia DZ tip 1 pentru populaia din
Rom3nia
Mateia!e 2i Met$%e: "otul studiat a cuprins 1212 subieci dintre care 05. pacieni DZ
tip 1 (2#/ b:rbai=251 femei) i 1#6B rude de &radul 1 nediabetice >iparea a fost f:cut:
prin metoda ,9R8SSO, Datele au fost analizate prin >ransmission DiseLuilibrium >est
(>D>) i <M)<9 folosind pro&ramul Stata
e
/1 (http!==IIIstatacom) ,entru a stabili
dac: efectele alelelor ;"<8) sunt independente$ datele au fost analizate prin metoda
re&resiei lo&istice condiionate$ folosind &enotipurile DQ)1 i DR)1 ale subiecilor
inclui %n studiu
Re'(!tate: <m identificat o transmisie semnificativ crescut: la diabetici a alelelor ;"<
)/ (6151 transmitere$ p
>D>
W B271#
86
)$ )12 (B.21 transmitere$ p
>D>
W ###2)$ )01
(6011 transmitere$ p
>D>
W ####2)$ )2# (/261 transmitere$ p
>D>
W #####2) i )IB
(B261 transmitere$ p
>D>
W 25271#
8/
) <m identificat de asemenea o transmitere
semnificativ sc:zut: a alelei ;"< )22 la diabetici (22/1 transmitere$ p
>D>
W ###6)
>ransmisia acelorai alele la fraii neafectai ai probanzilor diabetici nu a fost diferit:
semnificativ de 2#1$ procent ateptat prin ans: Rezultatele sunt susinute i de
frecvena mai mare a acelorai alele la diabetici comparativ culotul pseudocontrol (1BB1
vs 6$21 pentru )/T B1 vs 2B1 pentru )12T B61 vs 1.1 pentru )01T 0/1 vs 111
pentru )2#$ B.221 vs 2001 pentru )IB i 1201 vs 51 pentru )22) <naliza prin
conditional lo&istic re&ression a ar:tat %ns: c: asocierea alelelor ;"< ) cu DZ tip 1 nu
este independent: de influena alelelor ;"< DQ i DR (,rob Y chi2 4 #1#25)
0#
Di"c(7ii: Rezultatele noastre indic: un posibil efect diabeto&en al alelelor ;"< )/$ )12$
)01$ )2# i )IB precum i un efect protector al alelei ;"< )22 >otui aceste asocieri
par a nu fi independente$ cel mai probabil fiind datorate unui fenomen de linDa&e
diseLuilibrium cu alelele demonstrat diabeto&ene=protectoare aparin3nd locilor ;"< de
clasa a ''a DQ i DR
THE ROLE OF HLA B ALLELES ON T,PE H DIABETES GENETIC
SUSCEPTIBILIT, IN THE ROMANIAN POPULATION6
C. $u1a
9
, L $u1a
9
, A. Clin
9
, %. Nutland
:
, *. 0o.son
:
, 0. Rance
:
i *.A. )odd
:
i C.
Ionescu5)Cr,o(ite
9
9 Institute of Diabetes, Nutrition and etabolic Diseases !N. Paulescu&, Bucharest,
Ro"ania@
: *u(enile Diabetes Research /oundationKDellco"e )rust Diabetes and Infla""ation
Laborator3, Ca"brid,e Institute for edical Research, Ca"brid,e, +=@
I)t$%(cti$): >Hpe 1 diabetes (>1D*) is a chronic autoimmune disease conditioned bH
multiple &enetic and environmental factors >he main diabetes &enes reported so far
belon& to the ;"< class '' re&ion$ DQ)1 and DR)1 loci ;oIever$ multiple reports
e7ists re&ardin& the independent effect of some class ' ;"< < and ) alleles 'n order to
assess the diabeto&enic role of ;"< ) alleles for the Romanian population (Iith one of
the loIest reported incidence of >1D in Surope)$ Ie performed a full ;"< ) tHpin& in
025 nuclear families
Ai#: Our aim Ias to assess the potential involvement of ;"<8) alleles in the
patho&enesis of >1D* in Romanian families
Mateia!" a)% Met/$%": >he studH &roup comprised 1$212 individuals Iith 05. >1D
patients (2#B male=220 female) and 1$#6B unaffected first de&ree relatives ?enotHpin&
Ias done bH ,9R8SSO, Data Iere analHsed usin& the >ransmission DiseLuilibrium >est
(>D>) and <M)<9 usin& Stata
e
/1 (http!==IIIstatacom) >o establish if the effects of
) alleles are independent$ data Iere analHsed bH conditional lo&istic re&ression usin& the
complete DQ)1 and DR)1 &enotHpes for the entire studH &roup
Re"(!t": Ke found a si&nificant increased transmission to diabetics of ;"< )/ (6151
transmission$ p
>D>
W B271#
86
)$ )12 (B.21 transmission$ p
>D>
W ###2)$ )01 (6011
transmission$ p
>D>
W ####2)$ )2# (/261 transmission$ p
>D>
W #####2) and )IB alleles
(B261 transmission$ p
>D>
W 25271#
8/
) Ke also found a si&nificant decreased
transmission of ;"< )22 allele to diabetics (22/1 transmission$ p
>D>
W ###6) >he
01
transmission of the same alleles to unaffected sibs Ias not si&nificant different from
2#1 >he results Iere supported bH the hi&her freLuencH of these alleles in cases in
comparison Iith pseudocontrols (1BB1 vs 6$21 for )/T B1 vs 2B1 for )12T B61 vs
1.1 for )01T 0/1 vs 111 for )2#$ B.221 vs 2001 for )IB and 1201 vs 51 for
)22) 9onditional lo&istic re&ression analHsis shoIed that these associations are not
independent of the effect of DQ and DR alleles neither for ;"< ) (,rob Y chi2 4 ##266)
nor for ;"< )I (,rob Y chi2 4 #1#25) alleles
Di"c(""i$): Our results indicate a possible diabeto&enic effect for ;"< )/$ )12$ )01$
)2# and )IB alleles and a protective effect for ;"< )22 allele ;oIever$ the
conditional lo&istic re&ression analHsis shoIed that these effects are not independent but
most liDelH due to the stron& linDa&e diseLuilibrium Iith diabeto&enic=protective class ''
DQ and DR alleles
PARTICULARITATI ALE DIABETULUI ZAHARAT LA
COPILUL MIC
Banarescu Car"en
%pitalul de Copii %fanta aria Iasi
1'ntroducere
Diabetul zaharat insulino8dependent la copilul mic ridica &reutati in redarea unui
dia&nostic rapid si correct $ deseori in prezenta simptomatolo&iei atipice varstei
2Obiective
8studiul particularitatilor clinico8evolutive ale D'D la copilul mic
8posibilitatile terapeutice si aspecte particulare ale insulinoterapiei la copilul mic
5*etode Si *ateriale De "ucru
Studiul a fost efectuat in 9linica a8'''8a ,ediatrie $ Spitalul clinic de ur&enta de copii
Sf *aria 'asi in perioada 18#182##2 si 18#182##/ pe 1# copii
09oncluzii
Diabetul zaharat la copii mici prezinta!
8instabilitate metabolica
02
8obtinerea controlului &licemic este &reu de mentinut
8familia Goaca un rol important in imbunatatirea echilibrului metabolic cu prevenirea
complicatiilor tardive
PARTICULARITIES OF THE DIABETES MELLITUS IN THE SMALL CHILD
Banarescu Car"en
%pitalul de Copii %fanta aria Iasi
1. I)t$%(cti$)!
>he insulin U dependent diabetes mellitus in the small child raises several issues
related to establishin& an accurate and rapid dia&nosis in the presence$ often$ of atHpical
sHmptoms as Iell as hi&h instabilitH specific to a&e
2. Ob8ective"!
8 studH of the chemical8evolutive particularities of the insulin8dependent diabetes in
the infant and in the small child
8 therapeutic possibilities and particular issues of the insulinotherapH in the infant
and in the small child
3. Met/$% A)% +$-i). Mateia!!
>he studH Ias conducted in 9linics 5 of ,ediatrics WanuarH 1
st
2##2 throu&h WanuarH
1
st
2##/ on 1# children
4. C$)c!("i$)"!
>he diabetes mellitus in the small child shoIs!
8 metabolic instabilitH
8 obtainin& of a metabolic control$ difficult to achieve
8 the familH plaHs an important role in obtainin& a &lHcemic control Ihich alloIs for the
improvement of the metabolic eLuilibrium bH preventin& tardive complications
PERTURBARILE METABOLISMULUI GLUCIDIC IN MUCOVISCIDOZA U
CONSIDERATII PE MARGINEA UNUI CAZ
05
Car"en 6ltean, Laura Bo?o"itu, Dana Anton, D. oraru
Clinica a III5a Pediatrie, +../. !$r.).Popa& Iasi
*ucoviscidoza reprezinta cea mai frecventa boala <R intalnita la populatia caucaziana$
caracterizata prin afectare plurior&anica si cu consecinte severe asupra celor trei tipuri de
metabolism <fectarea metabolismului &lucidic apare$ in &eneral$ dupa o evolutie de mai
lun&a durata a bolii$ avand &rade diferite de severitate$ de la hiper&licemii izolate$
scaderea tolerantei la &lucoza pana la diabet zaharat
Obiectiv: prezentarea cazului unui copil cu mucoviscidoza 8 forma completa la care
scaderea tolerantei la &lucoza a aparut precoce$ la varsta de 11 ani
Mateia! "i #et$%a: autorii descriu cazul unui baiat dia&nosticat tardiv$ la varsta de 1#
ani$ cu fibroza chistica forma completa$ la care scaderea tolerantei la &lucoza s8a instalat
precoce$ in absenta unei simptomatolo&ii de hiper&licemie
Re'(!tate "i %i"c(tii: pacientul SA$ 12 ani$ cu repetate infectii respiratorii cu evolutie
trenanta in antecedente$ s8a internat pentru prima data in 9linica a '''8a ,ediatrie la varsta
de 1# ani "a internare prezenta deficit staturo8ponderal sever (8 5$0 DS pentru > si U 5DS
pentru ?)$ cu semne patente de insuficienta respiratorie cronica$ scaune nedi&erate cu
steatoree$ anemie feripriva$ hipoproteinemie cu hiposerinemie$ hipolipemie$ aspect de
fibroza pulmonara si hepatica$ testul sudorii pozitiv S8a stabilit dia&nosticul de
mucoviscidoza forma completa fiind instituit tratamentul dietetic si medicamentos
specific bolii Nrmarirea bolnavului a evidentiat ameliorarea deficitului nutritional si a
insuficientei respiratorii dar evolutia a fost &revata de suprainfectii bacteriene pulmonare
si perturbarea metabolismului lipidic (hipolipemie$ hipocolesterolemie) "a apro7imativ
un an de la dia&nostic s8au decelat initial hiper&licemii postprandiale izolate (1/#822# m&
1) in absenta unei simptomatolo&ii caracteristice Sfectuarea >>?O a stabilit
dia&nosticul de toleranta scazuta la &lucoza
<vand in vedere afectiunea de baza$ pacientului i s8a recomandat o restrictie relativa la
&lucide cu absorbtie rapida (consumarea lor impreuna cu alte alimente pentru scaderea
vitezei de absorbtie)$ dieta hipercalorica$hiperlipidica$ hiperproteica si monitorizare
bisaptamanala a &licemiei
C$)c!('ie: aparitia precoce a perturbarilor metabolismului &lucidic in mucoviscidoza
este consecinta evolutiei +naturale- a bolii (in absenta unei terapii specifice)$ cu
e7tinderea rapida a leziunilor de fibroza$ la care se adau&a infectiile respiratorii repetate
Dieta &lucidica este partial restrictiva$ respectand necesitatile hipercalorice specifice
bolii
00
CARBOH,DRATE METABOLISM PERTURBATIONS IN C,STIC FIBROSIS>
CASE CONSIDERATIONS
Car"en 6ltean, Laura Bo?o"itu, Dana Anton, D. oraru
Clinica a III5a Pediatrie, +../. !$r.).Popa& Iasi
9Hstic fibrosis is the most freLuent <R disease in caucasians$ characterized bH
multior&anic involvement and Iith severe conseLuences on the three tHpes of
metabolism >he carbohHdrate metabolism is &enerallH impaired after a lon&8term
evolution of the disease$ Iith different sta&es of severitH$ from isolated hHper&lHcemia
episodes$ &lucose intolerance$ to diabetes mellitus
Ai#! to present the case of a 1# Hears old child Iith cHstic fibrosis8complete form in
Ihom the &lucose intolerance has occurred earlH$ at the a&e of 11
Mateia! a)% #et/$%! authors describe the case of a boH Iho Ias latelH dia&nosed Iith
cHstic fibrosis8complete form8 at the a&e of 1#$ in Ihom the &lucose intolerance has earlH
occurred$ Iithout anH sHmptoms due to hHper&lHcemia
Re"(!t"$%i"c(""i$)"! the patient SA$ a&ed 12$ Iith recurrent$ persistent respiratorH
infections in the historH$ Ias first admitted in the 5rd ,ediatric 9clinic at the a&e of 1#
<t admittance he had severe &roIth retardation (85$0 SD for ; and 85 SD for K)$ Iith
patent si&ns of chronic respiratorH failure$ steatorrhea$ iron deficiencH anemia$
hHpoproteinemia Iith hHposerinemia$ hHpolipemia$ liver and lun& fibrosis$ positive sIeat
test >he dia&nosis of cHstic fibrosis8complete form Ias made and the diet and medical
treatment specific to disease Ias be&un >he folloI up remarDed the improvement of the
nutritional impairment and of the respiratorH failure but the outcome Ias subseLuentlH
poor$ bH pulmonarH bacterial infections and lipidic metabolism perturbations
(hHpolipemia$ hHpocholesterolemia) <fter appro7imatelH one Hear after dia&nosis there
Iere initiallH detected onlH isolated postprandial hHper&lHcemias (1/#822# m&1)$
Iithout anH characteristic sHmptom <fter the oral &lucose tolerance test Ias made
(O?>>) the dia&nosis Ias &lucose intolerance 9onsiderin& the main dia&nosis (9M)$ it
Ias recommended for the patient a relative restriction of rapidlH absorbed carbohHdrates
(their intaDe to&ether Iith other food in order to decrease the absorption time)$ a
hHpercaloric$ hHperlipidic$ hHperproteic diet and tIice a IeeD &lHcemic monitorin&
C$)c!("i$)! the earlH occurrence of the carbohHdrate metabolism troubles in cHstic
fibrosis is due to +natural- evolution of the disease (Iithout anH specific therapH)$ Iith
rapid e7tension of fibrotic lesions$ and also Iith further occurrence of recurrent
respiratorH infections >he carbohHdrate intaDe is partiallH restricted$ Iith respect to
hHpercaloric reLuirements specific for this disease
02
EPIDIAB 5PPR IN ;UDEUL CLU;
irela /lorea, Cristina Nita, Adriana Rusu, Nicolae 0ancu
Centrul Clinic de Diabet, Nutriie i Boli etabolice Clu1 Napoca
I)t$%(cee!
(um:rul persoanelor cu diabet a crescut alarmant %n %ntrea&a lume$f:r: nici o
tendin: de atenuare a ritmului de cretere Diabetul zaharat tip 2 este considerat %n
momentul de fa: una dintre cele mai in&riGor:toare$ costisitoare i serioas: problem: de
s:n:tate ,ro&ramul S,'D'<) are ca scop analiza epidemiolo&ica si a calitatii in&riGirii
persoanelor cu diabet zaharat nou depistat
Sc$1(! !(caii!
Sste de a analiza aspectele referitoare la datele demo&rafice$antropometrice$
prevalenta factorilor de risc cardiometabolici$prevalenta complicatiilor cronice $ precum
si structura terapeutica a persoanelor cu diabet dia&nosticate in perioada ianuarie8
septembrie 2##/ in Gudetul 9luG
Met$%a!
<u fost preluate datele din fisele de consultatie ale persoanelor dia&nosticate si
luate in evidenta cu diabet zaharat in perioada ianuarie8septembrie 2##6 la 9entrul 9linic
de Diabet$ (utritie si )oli *etabolice 9luG (apoca$ la care s8au adau&at datele
comunicate de celelalte cabinet de Diabet din Gudetul 9luG
Re'(!tate!
'n perioada 1 ianuarie85# septembrie 2##/$ au fost inre&istrat 56#2 persoane cu
diabet zaharat nou depistat$ dintre care diabet zaharat tip 2!..$11$ diabet zaharat tip 1!
#$2 1$ diabet &estational! #$1B1$ diabet secundar! #$201 Raportul barbati!femei a fost
de 1!1$#1 T6B 1 provin din mediul urban$ maGoritatea(B0$621) se situeaza in &rupa de
varsta 018B2 de ani
Din punct de vedere antropometric 1#$/2 1 din persoanele nou dia&nosticate sunt
normoponderale$ 52$.1 cu suprapondere si 25$2/1 cu obezitateT .5$/61 din persoane
au talia peste /# cm la femei sau peste .0 cm la barbati
,revalenta hipertensiunii arteriale a fost de B0$B51$ a dislipidemiei de 261$ iar
211 din persoanele nou depistate cu diabet zaharat prezinta deGa o complicatie
macrovasculara(cardiopatie ischemica 02$B01$an&ina pectorala 2.$B1 1$ infarct
miocardic10$./ 1$ boala cerebrovasculara1B$#2 1$ arteriopatie periferica 6$521)
Structura terapeutica in diabetul zaharat nou depistat a fost urmatoarea! 20$#.1
optimizarea stilului de viata$ 00$601 metformin in monoterapie$ /$//1 sulfonilureice$
0B
11$551 metformin U sulfonilureice$ B$0.1 insulina$ 5$621 insulina8terapie orala$ #$621
alte clase
C$)c!('ii!
'ncidenta diabetului zaharat inre&istreaza in Gudetul 9luG o crestere semnificativa$
fiind de apro7imativ 00$/51 mai mare comparativ cu aceeasi perioada a anului 2##6 si
de apro7imativ 1/2$/21 comparativ cu anul 2##B Diferentele semnificative comparativ
cu anul 2##B sunt in parte e7plicate prin derularea ,ro&ramului (ational de Svaluare a
Starii de Sanatate a ,opulatiei din iulie 2##6Din punct de vedere terapeutic se remarca o
crestere a numarului de pacienti aflati pe modulul de terapie metformin in comparatie cu
anii precedenti
EPIDIAB 5PPR IN CLU; COUNT,
irela /lorea, Cristina Nita, Adriana Rusu, Nicolae 0ancu
Clinical Center of Diabetes, Nutrition, etabolic Diseases Clu1 Napoca
I)t$%(cti$)!
>he number of individuals Iith diabetes has increased alarmin&lH throu&h8out the Iorld
and the rate of increase shoIs no si&ns of sloIin& >Hpe 2 diabetes is currentlH one of the
most costlH and IorrHin& chronic diseases and represents a serious health care problem
IorldIide >he obGective of S,'D'<) ,ro&ram is to provide epidemiolo&ical data as
Iell as the LualitH care of neIlH8dia&nosed diabetes
Ai#!
>o analHze the demo&raphic$ anthropometric data$ the prevalence of cardiometabolic risD
factors and chronic complications and the therapeutic structure of persons Iith neIlH8
dia&nosed diabetes$ betIeen WanuarH8September 2##/$ in 9luG 9ountH
Met/$%!
Ke analHzed data from the medical records of persons Iith neIlH8dia&nosed diabetes
betIeen WanuarH8September 2##/ and re&istered in the Diabetes 9linics from 9luG
9ountH
Re"(!t"!
'n WanuarH8September 2##/$ 56#2 persons Iith neIlH8dia&nosed diabetes Iere
re&istered$..$1 1 Iith tHpe 2$ #$21 tHpe 1$ #$1B1 &estational diabetes and #$201 Iith
other specific tHpes of diabetesT the ratio men! Iomen is 1!1$#1 T 6B1 of the persons
come from urban areas$ the maGoritH (B0$621) bein& in the 018B2 Hears &roup of a&e
06
1#$/2 1 of tHpe 2 neIlH8dia&nosed diabetes have normal Iei&ht$ 52$.1 overIei&ht and
25$2/1obesitHT.5$/6 1 have the abdominal circumference over /# cm in Iomen or over
.0 cm in men >he prevalence of hHpertension is B0$B51$ of dHslipidemia 261T 21 1 of
neIlH8dia&nosed diabetes has alreadH a macrovascular complications at dia&nosis
( ischemic heart disease 02$B01$ an&ina 2.$B1 1$ mHocardial infarction10$./1$
cerebrovascular disease 1B$#21$ peripheral vascular disease6$521)
>he therapeutic structure for neIlH dia&nosed diabetes is as folloIs!20$#.1 lifestHle
intervention onlH$00$60 1 metformin$ /$// 1 sulphonHlurea$ 11$551 metformin plus
sulphonHlurea$ B$0.1 insulin$ 5$621insulin plus oral therapH and #$621 other dru&s
C$)c!("i$)!
>he incidence of diabetes mellitus in the countH of 9luG re&isters a si&nificant increasin&
about 00$/51 more than the same period in 2##6 and 1/2$/21 more than 2##B
'ncreased dia&nostic activitH bH initiation of (ational ,opulation ;ealth <ssessment
,ro&ram in 2##6 mi&ht &enerate a si&nificant increase in the incidence of diabetes in
2##6 and 2##/ as compared Iith 2##B Khen treatment is considered$ there are
si&nificant increased as compared Iith the previous Hears for metformin therapH
CARACTERISTICI GENERALE ALE PACIENILOR CU DIABET ZAHARAT
TIP H DIN CENTRUL CLINIC DE DIABETF NUTRIIEF BOLI METABOLICE
IA:I
Cristina Lctuu
9,:
, Bo,dan ihai
9,:
, RoEana ;tefan
:
, Laura ihalache
9,:
, Delia
4Ctc
:
, ariana $raur
9,:
9
+ni(ersitatea de edicin i /ar"acie >$r. ). Popa& Iai
:
Centrul Clinic de Diabet, Nutriie, Boli etabolice Iai
Sc$1(! !(c&ii: am efectuat un studiu retrospectiv$ observaional$ transversal$ pentru a
aprecia caracteristicile &enerale ale pacienilor cu diabet zaharat tip 1 aflai %n evidena
9entrului 9linic de Diabet$ (utriie$ )oli *etabolice 'ai
Mateia! 2i #et$%&: am evaluat toi pacienii aduli cu diabet zaharat tip 1 aflai %n
evidena centrului nostru p3n: la data de #1#12##6 Din analiza fielor de monitorizare$
lu3nd %n considerare doar datele din ultimii doi ani$ am selectat informaiile referitoare la
v3rst:$ se7$ vechimea bolii$ &reutate$ %n:lime$ circumferina abdominal:$ circumferina
fesier: i prezena complicaiilor cronice ale diabetului$ care au fost %nre&istrate %ntr8o
baz: de date *icrosoft Office S7cel i supuse ulterior prelucr:rii statistice folosind
pro&ramele S,SS
0/
Re'(!tate 2i %i"c(7ii: Din totalul de 1#62 pacieni$ dup: e7cluderea celor cu v3rsta sub
1/ ani i a celor cu patolo&ie terminal: de or&an (care ar fi putut falsifica analiza statistic:
a datelor antropometrice)$ am selectat un lot de ..0 pacieni S8a constatat o
preponderen: a se7ului masculin (225 cazuri U 22$B1) i o v3rst: medie de 05$2/C15$BB
ani$ cu variaii %ntre 1/ i /0 de ani Aechimea diabetului zaharat tip 1 a variat %ntre 1 i
0. de ani$ cu o medie de 11$#2C.$#2 ani 'ndicele de mas: corporal: a variat %ntre 10$//
D&=m
2
i 0B$22 D&=m
2
$ cu o medie de 22$B2C0$2# D&=m
2
T a e7istat o preponderen: net: a
pacienilor normoponderali (0B$501) i supraponderali (55$.21) Ntiliz3nd valorile
circumferinei abdominale (9<) i ale indicelui abdomino8fesier ('<M)$ am constatat c:
02$/1 i respectiv 5.$11 dintre pacieni dep:eau valorile normale$ cu diferene statistic
semnificative %ntre cele dou: se7e %n ambele cazuri (9< U 26$/1 dintre femei i 521
dintre b:rbaiT '<M U 06$51 dintre femei i 51$/1 dintre b:rbai) 0B$01 dintre pacienii
evaluai %n ultimii 2 ani au fost dia&nosticai cu retinopatie diabetic: (RD)! 521 U RD
neproliferativ: form: uoar:=medie$ 1$61 U RD neproliferativ: form: sever:=foarte
sever:$ .$61 U RD proliferativ: Din cei 5#2 pacieni la care fuseser: recent evaluate
elimin:rile urinare de proteine$ 0/$21 erau normoalbuminurici$ 20$B1 prezentau
microalbuminurie i 26$21 macroalbuminurie "a cei /B# pacieni la care fusese evaluat:
neuropatia$ B/$61 prezentau forma periferic: i 15$121 forma ve&etativ:
*acroan&iopatia era prezent: la un num:r mai mic de cazuri (12$61 din cei 1#B pacieni
evaluai prezentau boal: coronarian:$ 2$/21 din totalul pacienilor aveau sechele de
accident vascular cerebral$ 2$51 din cei /21 pacieni evaluai prezentau <O*')
C$)c!('ii: ,reponderena crescut: a se7ului masculin este o particularitate a pacienilor
cu diabet zaharat tip 1 din centrul nostru$ tiut fiind c: %n :rile cu o prevalen: sc:zut: a
bolii (printre care i Rom3nia) e7ist: o tendin: de predominan: feminin: <pro7imativ
0#1 dintre pacieni prezentau o dispoziie abdominal: a esutului adipos$ mai ales %n
cazul se7ului feminin (circa Gum:tate din cazuri) ,este 2#1 din cazurile evaluate aveau
elimin:ri urinare crescute de proteine i aproape Gum:tate aveau retinopatie diabetic:
,este dou: treimi din cazuri prezentau neuropatie periferic: 9omparativ cu celelalte
complicaii$ macroan&iopatia era prezent: %ntr8un num:r mai redus de cazuri
GENERAL FEATURES OF T,PE H DIABETIC PATIENTS IN CLINICAL
CENTRE OF DIABETESF NUTRITIONF METABOLIC DISEASES IA:I
Cristina Lctuu
9,:
, Bo,dan ihai
9,:
, RoEana ;tefan
:
, Laura ihalache
9,:
, Delia
4Ctc
:
, ariana $raur
9,:
9
)he +ni(ersit3 of edicine and Phar"ac3 >$r. ). Popa& Iai
:
)he Clinical Centre of Diabetes, Nutrition, etabolic Diseases Iai
0.
Ai# $< "t(%@: Ie performed a retrospective$ observational$ transversal studH in order to
appreciate the &eneral features of tHpe 1 diabetic patients in 9linical 9entre of Diabetes$
(utrition$ *etabolic Diseases 'ai
Mateia! a)% #et/$%: Ie evaluated all adult patients dia&nosed Iith tHpe 1 diabetes
mellitus in our centre before WanuarH 1st 2##6 Ke analHzed the record files$ bH
considerin& onlH data available in the last tIo Hears Ke searched information about a&e$
se7$ duration of disease$ Iei&ht$ hei&ht$ Iaist circumference$ hip circumference and the
chronic complications of diabetes$ Ihich Iere re&istered in a *icrosoft Office S7cel data
base and afterIards under&one statistic analHsis bH usin& S,SS pro&rams
Re"(!t" a)% %i"c(""i$)": Out of all 1#62 patients$ after e7cludin& those under 1/ Hears
old and those Iith terminal or&an patholo&H (that mi&ht have falsified the statistical
analHsis of anthropometric data)$ Ie selected a &roup of ..0 patients Ke observed a
predominance of male patients (225 cases U 22B1) and a mean a&e of 052/C15BB
Hears$ Iith e7tremes of 1/ and /0 Hears >he duration of tHpe 1 diabetes mellitus varied
betIeen 1 and 0. Hears$ Iith a mean value of 11#2C.#2 Hears >he bodH mass inde7
varied betIeen 10// D&=m
2
and 0B22 D&=m
2
$ Iith a mean value of 22B2C02# D&=m
2
T
most patients Iere of normal Iei&ht (0B501) or overIei&ht (55.21) )H referrin& to
Iaist circumference and Iaist8hip ratio$ Ie noticed that 02/1 and respectivelH 5.11 of
patients had abnormal values$ Iith statisticallH si&nificant differences betIeen &enders in
both cases (Iaist circumference U 26/1 of Iomen and 521 of menT Iaist8hip ratio U
0651 of Iomen and 51/1 of men) 0B01 of the patients evaluated in the last 2 Hears
Iere dia&nosed Iith diabetic retinopathH (DR)! 521 U nonproliferative
incipient=moderate DR$ 161 U nonproliferative severe=verH severe DR$ .61 U
proliferative RD 'n the 5#2 patients Iho had recent evaluation of urinarH albumin
e7cretion rate$ 0/21 had normoalbuminuria$ 20B1 had microalbuminuria i 2621
macroalbuminuria 'n the /B# patients Iho had been evaluated for neuropathH$ B/61
had the peripheral form and 15121 had the autonomic form *acrovascular disease Ias
present in a smaller amount of cases (1261 of the 1#B patients that Iere evaluated had
coronarH disease$ 2/21 of all patients had a stroDe historH$ 251 of the /21 patients Iho
Iere evaluated had peripheral arterial disease)
C$)c!("i$)": ;i&h prevalence of male &ender is an uncommon feature of tHpe 1 diabetic
patients in our centre$ as Ie DnoI that in countries Iith loI prevalence of the disease
(Ihich include Romania) there is a tendencH toIards female predominance
<ppro7imatelH 0#1 of patients had abdominal deposition of the fat mass$ found
especiallH in females (about half of cases) *ore than 2#1 of the evaluated cases had
hi&h urinarH albumin e7cretion rates and almost half of patients had diabetic retinopathH
*ore than tIo thirds of cases had peripheral neuropathH )H comparison to other
complications$ macrovascular disease Ias present in a more reduced number of cases
PREDICTORII HIPERGLICEMIEI POSTPRANDIALE LA PACIENII CU
DIABET ZAHARAT TIP 5
2#
Cristina Ni
9,:
, Adriana Rusu
9
, Cornelia Bala
9,:
, N. 0#ncu
9,:
9
+ni(ersitatea de edicin i /ar"acie>Iuliu 0aie,anu&, Clu1 Napoca
:
Centrul de Diabet , Nutriie i Boli etabolice, Clu15Napoca
I)t$%(cee 2i Obiective
Svidenele actuale su&ereaza c: toate aspectele metabolismului &lucozei 8hemo&lobina
&licat: (<19)$ &licemia bazal:(?)) i &licemia postprandial:(?,,)8 sunt parametrii
clinic relevani pentru a fi monitorizai ?licemia postprandiala(?,,)$ %n particular$ pare
s: fie corelat: cu boala cardiovascular: ()9A)
Obiectivul acestui studiu a fost determinarea factorilor asociai cu e7cursiile &licemice
postprandiale %n cazul pacienilor cu diabet zaharat tip 2 (DZ2)
Mateia! 2i #et$%&
<u fost evaluai factorii asociai cu hiper&licemia postprandial: (Y10#m&=dl la 2 ore dup:
mas:) corectai %n funcie de se7 i tratament$ la 122 de pacieni care s8au prezentat la
controlul periodic$ %n 9entrul de Diabet i )oli de (utriie 9luG (apoca$ Rom3nia <ceti
pacieni au fost invitai s: participe la un studiu epidemiolo&ic privind evaluarea
impactului &licemiei postprandiale asupra riscului cardiovascular$ la persoanele cu DZ
S8a efectuat o evaluare medical: complet: a acestor pacieni$ cu istoric personal i
e7amen obiectiv (&reutate$ %n:lime$ circumferin: abdominal: i tensiune arterial:) De
asemenea s8a determinat %n condiii bazale nivelul &licemiei plasmatice$ <19$ colesterol
total$ ;D"8colesterol i tri&liceride Miecare pacient a efectuat un profil &licemic %n B
puncte (preprandial i la 2h postprandial) i a completat un chestionar alimentar
Re'(!tate
A3rsta medie a pacienilor inclusi %n studiu a fost de 2/ ani (minim 2/$ ma7im 66 ani)$
%ntre care 2./1 au fost de se7 masculin Fn medie$ vechimea diabetului la pacienii
inclui %n studiu a fost de B ani ( minim #$ ma7im 56 ani) ,rin analiza factorial: s8au
determinat patru factori care e7plic: 651 din variaia &licemiei postprandiale f Mactorul 1
cu %nc:rcare pozitiv: pentru &reutate$ '*9$ Mactorul 2 cu %nc:rcare pozitiv: pentru
colesterol total i "D" colesterol$ Mactorul 5 cu %nc:rcare pozitiv: pentru vechimea
diabetului i v3rst:$ Mactorul 0 cu %nc:rcare pozitiv: pentru tri&liceride i ;D"8
colesterolg Mactorii determinai cu aGutorul analizei factoriale au fost inclui ca variabile
independente %ntr8un model de re&resie liniar:$ av3nd &licemia postprandial: ca variabil:
dependent: <cest model a fost semnificativ asociat cu valoarea medie a &licemiei
postprandiale ( p4###2) Fn cadrul acestei analize Mactorul 2 nu a atins nivelul
semnificaiei statistice ( p4#2.5) i a fost e7clus din analiz: <l doilea model de re&resie
care a inclus numai Mactorii 1$ 2$ 0 a fost semnificativ statistic (p4###1$ M
]chan&e-4B125$ semnificaia M ]chan&e-4 ###1) Fn urma aGust:rii modelului de
21
re&resie pentru se7ul pacienilor i tratamentul hipo&licemiant urmat$ numai Mactorul 1 i
Mactorul 0 au r:mas semnificativ asociai cu &licemia postprandial: (p4##22 i ###0)
C$)c!('ii
Rezultatele studiului arat: c: &reutatea$ indicele de mas: corporal:$ nivelul tri&liceridelor
i al ;D"8colesterolului sunt asociate independent cu variaiile &licemice postprandiale
PREDICTORS OF POSTPRANDIAL H,PERGL,CEMIA IN PATIENTS +ITH
T,PE 5 DIABETES
Cristina Nita
9,:
, Adriana Rusu
9
, Cornelia Bala
9,:
, N. 0ancu
9,:
9
>Iuliu 0aie,anu& +ni(ersit3 of edicine and Phar"ac3, Clu1 Napoca
:
Clinical Center of Diabetes, Nutrition, etabolic Diseases, Clu15Napoca
Bac-.$()% a)% Ai#": ?roIin& evidence su&&ests that all aspects of &lucose
metabolism 8 &lHcated hemo&lobin (<1c)$ fastin& plasma &lucose (M,?) and postprandial
&lHcemia (,,?)8 are clinicallH relevant parameters to be monitored ,,?$ in particular$
appears to be related to the cardiovascular disease (9AD)
>he obGective of this studH Ias to investi&ate the factors associated Iith postprandial
&lucose e7cursions in patients Iith tHpe 2 diabetes (>2D*)
Mateia!" a)% Met/$%": Ke have evaluated the factors associated Iith postprandial
hHper&lHcemia (Y10# m&=dl at 2 hours after the meal)$ corrected for se7 and treatment in
122 consecutive patients Iith >2D* attendin& the outpatient clinic from 9linical 9enter
of Diabetes$ (utrition and *etabolic Diseases 9luG8(apoca$ Romania >hese patients
Iere included in a lar&er epidemiolo&ical studH aimin& to assess the impact of
postprandial hHper&lHcemia on cardiovascular risD in persons Iith tHpe 2 diabetes <
complete medical historH$ phHsical e7amination (Iei&ht$ hei&ht$ Iaist circumference$ and
blood pressure) Ias performed )lood samples Iere collected in the overni&ht fastin&
state$ and <1c$ total cholesterol$ ;D"8cholesterol and tri&lHcerides Iere assessed < si7
points blood &lucose profile (before and 2 h after meals) measured bH patients at home$
to&ether Iith a meal Luestionnaire Ias performed for each patient >o determine
variables associated Iith hi&her postprandial &lHcemic levels$ factor analHsis folloIed bH
linear re&ression model Ias performed
Re"(!t": >he studH &roup had a median a&e of 2/ Hears (min 2.$ ma7 66 Hears)$ 2./1
Iere males >he median duration of diabetes Ias B Hears (min #$ ma7 56 Hears) )H
factor analHsis Ie have e7tracted 0 factors that e7plained 651 of the variance of
postprandial &lHcemia fMactor 1 Iith positive loadin&s of Iei&ht and bodH mass inde7$
Mactor 2 Iith positive loadin&s of total cholesterol and "D"8cholesterol$ Mactor 5 Iith
22
positive loadin&s of diabetes duration and a&e$ Mactor 0 Iith positive loadin&s of
tri&lHcerides and ;D"8cholesterolg 'n an unadGusted linear re&ression$ model Ihich
included the four factors identified Ias si&nificantlH associated Iith postprandial
&lHcemia (p4###2)Kithin the model$ Mactor 2 displaHed a p value of #2.5 and Ias
removed from the analHsis < second re&ression included Mactor 1$ 5 and 0$ and the
model remained statisticallH si&nificant (p4###1$ M chan&e4B125$ si&nificance of M
chan&e4 ###1) <fter adGustment for the se7 and treatment$ onlH Mactor 1 and Mactor 0
remained si&nificantlH associated Iith postprandial &lHcemic values (p4##22$ and ###0)
C$)c!("i$) >he results of our studH shoIs that Iei&ht$ bodH mass inde7$ tri&lHceride
level and ;D"8cholesterol are independentlH associated Iith postprandial &lucose
e7cursion
RISCUL DEZVOLTARII NASH LA PACIENTII DIABETICI
2.C. Re?i
9
, R. ihil
:
, L. Nedelcu
A
, 6. /ril
B
, C. Do"nariu
L
, . Deac
:
9
%pitalul Clinic *udetean de +r,enta, %ibiu
:
/acultatea de edicina, +ni(ersitatea Lucian Bla,a %ibiu
A
/acultatea de edicina, +ni(ersitatea )ransil(ania, Braso(
B
/acultatea de edicina, +ni(ersitatea 6radea
L
Centru de %anatate publica, %ibiu
I)t$%(cee:
Stetohepatitta non8alcoolica se asociaz: frecvent cu sindromul metabolic$ un &rup de
tulbur:ri metabolice 8 obezitate central:$ diabet zaharat tip 2$ rezisten: la insulin:$
dislipidemie$ hipertensiune arterial: Scopul studiului nostru a fost de a determina riscul
dezvoltarii (<S; la pacientii diabetici si posibilele corelatii ale nivelului &licemiei cu
&radul fibrozei hepatice
Mateia! "i #et$%a:
<u fost luai %n studiu toi bolnavii deplasabili internai %n clinicile medicale ale Spitalelor
Wudeene din )raov$ Oradea i Sibiu %n perioada 121#2##B U 51122##B$ care au fost
e7aminai eco&rafic 9ei f:r: ficat hipereco&en i f:r: citoliz: hepatic: au constituit lotul
martor (/12 pacienti) iar lotul de studiu a fost format din toti pacientii (B/) la care s8a pus
dia&nosticul de steatohepatita non8alcoolica ((<S;) Mibroza hepatica a fost evaluata
prin scorul Morns Rezultatele au fost analizate statistic folosind testul ,earson$ testul ]t-
Student i riscul relativ (RR)
25
Re'(!tate:
Repartitia pe &enuri a pacientilor cu (<S; a fost de 01161 femei fata de 2//51
barbati Aarsta medie a lotului a fost de 2006 C 12/0 ani ?licemia medie a pacinetilor
cu (<S; a fost de 152/2 m&=dl fata de 1##15 m&=dl la pacientii din lotul martor$
diferenta fiind inalt semnificativa statistica (p4########/) Riscul relativ de a dezvolta
(<S; la pacientii cu diabet zaharat a fost de 555 'ndicele de corelatie ,earson intre
nivelul &licemiei si scorul Morns de fibroza hepatica a fost r 4 8###2T deci nu s8au &asit
corelatii intre nivelul &licemiei si scorul fibrozei hepatice De asemenea$ nivelul &licemiei
nu s8a corelat cu &radul de citoliza (r 4 ###6$ pentru >?O$ respectiv r 4 8####5 pentru
>?,)
C$)c!('ii:Aalorile &licemice sunt semnificativ mai mari la pacientii cu (<S; decat la
cei din lotul martor ,acientii cu diabet zaharat de tip 2 sunt de trei ori mai e7pusi riscului
de a dezolta steatohepatita non8alcoolica decat restul populatiei (u e7ista corelatii intre
nivelul mediu al &licemiei si nivelul citolizei hepatice sau &radul fibrozei
THE RIS3 OF DEVELOPING NASH AT THE DIABETIC PATIENTS
2.C. Re?i
9
, R. ihil
:
, L. Nedelcu
A
, 6. /ril
B
, C. Do"nariu
L
, . Deac
:
9
%pitalul Clinic *udetean de +r,enta, %ibiu
:
/acultatea de edicina, +ni(ersitatea Lucian Bla,a %ibiu
A
/acultatea de edicina, +ni(ersitatea )ransil(ania, Braso(
B
/acultatea de edicina, +ni(ersitatea 6radea
L
Centru de %anatate publica, %ibiu
I)t$%(cti$):
(on8alcoholic steatohepatitis ((<S;) is freLuentlH associated Iith the metabolic
sHndrome$ a &roup of metabolic disorders liDe central obesitH$ diabetes mellitus tHpe 2$
insuline resistance$ dHslipidemH and arterial hHpertension Our aim Ias to determine the
risD of developin& (<S; at the diabetic patients and the possible correlations betIeen
the level of &lHcemia and the de&ree of liver fibrosis
Mateia! a)% #et/$%!Ke tooD in consideration a &roup formed bH the patients Iho
Iere hospitalize in the *edical Departments of the 9linical ;ospitals from )rasov$
Oradea and Sibiu durin& 121#2##B U 51122##B$ Iho Iere ultrasono&raficallH
e7amined >he ones Iithout hHperecou&enous liver and Iithout liver cHtolHsis formed
20
the controlled &roup (/12 patients) and B/ patients to Ihom the (<S; dia&nosis Ias
established formed the studied &roup >he liver fibrosis Ias evaluated usin& the Morns
inde7 of correlation
Re"(!t":>he &ender repartition of the (<S; patients Ias 01161 Iomen and 2/$/51
men >he medium a&e of the lot Ias 2006 C 12/0 Hears of a&e >he medium level of
&lHcemia at the (<S; patients Ias 152/2 m&=dl comparin& Iith 1##15 m&=dl at the
patients from the control &roup$ the difference bein& verH statisticallH si&nificant
(p4########/) >he relative risD of developin& (<S; at the diabetic patients Ias 555
>he ,earson inde7 of correlation betIeen the &licemic level and the Morns inde7 of liver
fibrosis Ias r 48###2T so there Iere no correlations found betIeen the &lHcemic level
and the liver fibrosis inde7 (o correlations Iere found betIeen the level of &lHcemia
and the level of transaminases (r 4###6 for >?O and r 48####5 for >?,)
C$)c!("i$)":>he values of &Hcemia are si&nificantlH hi&her at the patients Iith (<S;
comparin& Iith the control &roup >he patients Iith diabetes mellitus are three times
more liDelH to develop (<S; than the rest of the population >here are no correlations
betIeen the medium level of &lHcemia and the de&ree of liver cHtolHsis of liver fibrosis
CORELAII CLINICO>BIOLOGICE N HEPATOPATIA ADIPOAS9 NON>
ALCOOLIC9 :DIABETUL ZAHARAT TIP 5 SI INSULINOREZISTENA U
COMORBIDITAI OMIPREZENTE ALE ACESTEI PATOLOGII
DA%CML+ DACIANA NIC6L2)A 5 "edic specialist "edicina interna
%pital $en. C/ %ibiu
Micatul &ras non8alcoolic (M?(<) sau hepatopatia adipoasa non8alcoolica se
%ncadreaza intr8un spectru de boli hepatice caracterizate in principal prin de&enerescenta
&rasoasa macroveziculara ce apare in lipsa consumului semnificativ de alcool $ respectiv
sub 2#85# & alcool pur=zi sau sub 2##& alcool pur=saptamana 9u toate dificultatile in
interpretarea rezultatelor studiilor privind prevalenta M?(<$ aceasta pare a fi cea mai
frecventa afectare hepatica in populatia &enerala$ estimarile cele mai recente si elaborate
apreciind o prevalenta hepatopatiei adipoase de 2#1 si a steatohepatitei non8alcoolice
de 2851
'n conte7tul importantei maGore ca problema de sanatate publica mai ales prin
prisma comorbiditatilor si complicatiilor pe care le implica hepatopatia adipoasa non8
alcoolica $ scopul lucrarii este acela de a evidentia corelatiile clinico8biolo&ice dar mai
ales particularitatile afectiunii in randul pacientilor din aria noastra &eo&rafica
<m realizat un studiu8ancheta prospectiv pe pacienti care prezinta aspect eco&rafic de
steatoza hepatica $ fara consum semnificativ de alcool si neinfectati cu virus hepatitic )
22
sau 9 <m urmarit &radul steatozei hepatice $ afectiunile asociate$ prezenta afectiunilor
considerate clasic ca fiind preme&atoare sau concomitente cu aparitia ficatului &ras non8
alcoolic (insulinore?istenta , diabetul ?aharat de tip : $ sindro"ul "etabolic $ obezitatea
abdominala$ etc) incercand evidentierea unor posibile corelatii intre aspectele clinice si
e7aminarile paraclinice Datele obtinute au fost analizate comparativ cu un lot martor
de pacienti <m realizat calcule de semnificatii statistice si indice de corelatie intre
valorile obtinute la cele doua loturi si am constatat e7istenta de corelatii pozitive intre
valorile '"B si taliei $ ,9R Utalie$ >(M8'*9 $ '"B8>(M $ '"B 8,9R si ,9R8>(M la
pacientii cu M?(<
Din analiza rezultatelor partiale prezentate mai sus se desprind cateva concluzii
referitoare la pacientii studiati cum ar fi procentul important dintre subiecti care prezinta
patolo&ie cardiovasculara ( ;>< $ 9'9 ) fiind astfel clasificabili ca pacienti cu mare risc
cardio8vascular $ valorile medii ale '*9 $ indice talie=sold si circum8ferinta taliei care
sunt mult crescute fata de limitele ma7im admise $ valorile medii calculate ale >(Mh $
,9R $ '"B si '"/ fiind si ele mai mari decat limitele ma7im normale (semnificand
implicarea acestor citoDine in procesul inflamator care produce si insoteste boala)
9alculul M"' (Mibrosis "iver 'nde7) confirma aplicabilitatea acestui test bazat pe valorile
tri&liceridelor $ '*9 $ ??> si circumf taliei in predictia steatozei hepatice 9alculul non8
invaziv &radului de fibroza hepatica utilizand formule brevetate pentru alte patolo&ii
hepatice cronice a avut rezultate usor diferite functie de formula utilizata! <,R' $ M')80
scor Morns $ raport <S<>=<"<> $ <S,R'
<ceste concluzii confirma datele din literatura de specialitate conform carora ficatul &ras
non8alcoolic 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 patolo&ie intalnita la acesti pacienti$ iar hepatopatia adipoasa U
componenta hepatica a acestui sindrom
CLINICAL CORRELATIONS CONCERNING NON>ALCOHOLIC FATT,
LIVER DISEASE> DIABETES MELLITUS AND INSULINRESISTANCE AS
OMNIPRESENT CO>MORBIDITIES
(on8alcoholic fattH liver disease ((<M"D) is a broad spectrum liver disease
produced in the absence of alcohol in&estion and described as a macrovesicular fattH
de&enerescence of the hepatocites $ Iith a prevalence of 2#1 in the &eneral population
Ke present a prospective studH on pts Iith (<M"D comparin& them Iith a set
of healthH people concernin& the Iei&ht $ bodH mass inde7 ()*') $ Iaist
circumference$ Iaist to hip ratio $ '"B $ >(M h $ ,9R $ and searchin& for co8morbidities
2B
liDe D* $ insulinresistance $ metabolic sHndrome $ ischemic heart disease $ hi&h blood
pressure or obesitH
Ke also calculated the &rade of liver fibrosis usin& non8invasives formulas liDe
Morns score $ <,R' $ <S,R' $ M')80 $ M"' (Mibrosis "iver 'nde7) $ <S<>=<"<>
>he conclusions are not optimistic since Ie proved a hi&h correlation of (<M"D
Iith cardio8vascular diseases $ D* and *etabolic sHndrome $ a moderate de&ree of
liver fibrosis in pts Iith normal transaminases and positive correlations betIeen '"B
8Iaist $ ,9R U Iaist$ >(M8)*' $ '"B8>(M $ '"B 8,9R si ,9R8>(M in patients Iith
non8alcoholic fattH liver disease
*etabolic sHndrome is a broad constellation of patholo&ies Iith a hi&h
prevalence in the &eneral population$ (<M"D bein& Gust the hepatic branch of this
dan&erous sHndrome
PROFILUL LIPIDIC LA DZ TIP H :I 5 NOU DESCOPERIT U COHORTA 5PPO
Daniela Licroiu,2lena +n,urau, AleEandra %ecrieru, C. Ionescu 7)Cr,o(ite
INDNB !N.C. Paulescu& Bucureti
Sc$1: <naliza elementelor profilului lipidic la pacienii nou dia&nosticai cu diabet i
relaia acestora cu parametrii controlului &licemic (&licemie a Geun i ;b<1c) i '*9
Mateia! "i #et$%a: Fn studiu au fost %nrolai 26/6 pacieni nou dia&nosticai cu DZ %n
perioada ianuarie U decembrie 2##6$ &rupai %n dou: loturi %n funcie de tipul DZ! a) 2#0
pacieni cu DZ tip ' 8 116 b:rbai (2601) i /6 femei (02B1)$ cu v3rsta medie 51#. ani
(limite 086B ani) i b) 22/5 pacieni cu DZ tip ''$ din care 1262 b:rbai (0.21) i 1511
femei (2#/1)$ cu v3rsta medie de 2//B ani (limite 10U/6 ani) Datele studiului (v3rst:$
se7$ '*9$ &licemie a Geun$ ;b<1c$ colesterol total$ ;D"8colesterol i >?) provin din
fiele 9<D ale pacienilor$ prelucrarea statistic: realiz3ndu8se cu S,SS 12#$ folosind
testele! i
2
$ *ann8KhitneH$ ZrusDalUKallis i coeficientul de corelaie Sperman$ cu un
pra& de semnificaie statistic: p c ##2
Re'(!tate:
media *min + ma,- DZ ti1 I DZ ti1 II 1
IMC =-.S#
5
? 2252 (152 U 5.02)
5#5# (12B2 U
22/B)
, 4 ####1
G!ice#ie a 8e() =#.S%!? 26211 (05 U ..#) 22520 (12# U , 4 ####1
26
1552)
HbAHc =X? 11.5 (21# U 1/2#) .2/ (0 U 2#5) , 4 ####1
C$!e"te$! t$ta! =#.S%!? 1.6#B (1## U B#0)
22#6B (1.# U
1.5B)
, 4 ####1
HDL>c$!e"te$! =#.S%!? 5.15 (2# U ./) 0102 (5# U 21B) (S
TG =#.S%!? 2#.B5 (5. U 55/#)
222B/ (.# U
0B11)
, 4 ####1
,rezena hipercolesterolemiei (colesterol total Y 2## m&=dl) a fost la pacienii cu DZ tip 1
de 2521 i la DZ tip 2 de 01$B 1 S8a &:sit corelaie semnificativ statistic: %ntre
valoarea colesterolului$ '*9 (rs1 4 #22.$ rs2 4 ##65) i &licemie (rs14#212$
rs24#1##)
;ipertri&liceridemia ( >?Y12# m&=dl ) a fost prezent: la 251 din pacienii cu DZ tip 1 i
la 0221 din pacienii cu DZ tip 2 "a ambele loturi$ valorile >? au fost corelate direct cu
valorile '*9 (rs14#212$ rs24#16.) i ale &licemiei (rs14#202$ rs24#160)$ doar la
pacienii cu DZ tip 2 acestea fiind corelate i cu valorile ;b<1c (rs2 4 #1#2)
Semnificativ statistic$ s8a %nt3lnit corelaie ne&ativ: la ;D"c$ unde la femeile cu DZ tip 1
;D"c a fost corelat invers proporional cu valorile '*9 (rs14#22.) i ;b<1c (rs148
#010)$ iar la femeile cu DZ tip 2$ ;D"c a fost corelat invers proporional cu valorile
;b<1c (rs248#121) i ale &licemiei (rs248#112) "a pacienii de se7 masculin$ ;D"c a
fost corelat invers proporional cu valorile '*9$ at3t la cei cu DZ tip 1 (rs148#52B)$ c3t
i la cei cu DZ tip 2 (rs248 ##/6) unde a fost corelat i cu valorile ;b<1c (rs248#1B#)
C$)c!('ii: "a pacienii nou dia&nosticai cu DZ tip 2$ factorii de risc pentru bolile
cardiovasculare ca! dislipidemia cu hipercolesterolemie i=sau hipertri&liceridemie$ au
fost mai frecvent prezente dec3t la pacienii cu DZ tip1 (p4####1)$ deoarece pacientii cu
DZ tip 2 sunt mai in varsta si cu comorbiditati ( obezitate$ ;><$ '*<$$ )9'$
insulinoresistenta)
LIPID PROFILE AT NE+L, DIAGNOSED THDM AND T5DMF COHORT=5PPO?
Daniela Licroiu, 2lena +n,urau, AleEandra %ecrieru, C. Ionescu 7 )Cr,o(ite
JNational Institute of Diabetes, Nutrition and etabolic Diseases !N.C. Paulescu&,
Bucharest, Ro"ania
Bac-.$()% a)% Ai#": >o analHze lipid profile at neIlH dia&nosed >1D* and >2D*
and the correlation of the lipid profile Iith fastin& blood &lucose$ ;b<19 and )*'
Mateia! a)% Met/$%": < cohort of 26/6 diabetic patients Ias analHzed betIeen
WanuarH U December$ 2##6 in )ucharest! 15/. (0./ 1) man$ 15./ (2#2 1) Ioman
2/
avera&e a&e Ias 2B$ /2 HearsT )*' avera&e Ias 2.$ .Z&=m2 >he tIo &roups 2#0 (6$
51) >1D*$ 116(2601) men and /6 (01B1) Iomen and 22/5 (.261) >2D*$ 1262
(0.21) men and 1511 (2#/1) Iomen$ avera&e a&e 2//B Iere studied dependin& on
>1D* and >2D*>he folloIin& parameters Iere recorded! a&e$ se7$ )*'$ fastin& blood
&lucose$ ;b<19$ cholesterol$ tri&lHcerides$ ;D"c >he statistic pro&ram Ias S,SS 12#T
Ie used i
2
$ *ann8KhitneH$ ZrusDal U Kallis$ Spearman coefficient$ Iith statistical
si&nificant p c##2
Re"(!t":
.arameters
THDM
/ean *min + ma,-
T5DM
/ean *min +
ma,-
P <$ %i<<ee)ce
betGee) TH a)%
T5
)*' (D&=m
2
) 2252 (152 U 5.02)
5#5# (12B2 U
22/B)
, 4 ####1
Mastin& blood &lucose
(m&=dl)
26211 (05 U ..#)
22520 (12# U
1552)
, 4 ####1
;b<1c (1) 11.5 (21# U 1/2#) .2/ (0 U 2#5) , 4 ####1
9holesterol (m&=dl) 1.6#B (1## U B#0)
22#6B (1.# U
1.5B)
, 4 ####1
;D"8c (m&=dl) 5.15 (2# U ./) 0102 (5# U 21B) (S
>ri&lHcerides 2#.B5 (5. U 55/#)
222B/ (.# U
0B11)
, 4 ####1
;Hpercholesterolemia (cholesterolY2##m&=dl) Ias presented in 2521 patients Iith
>1D* and 01B1 patients Iith >2D* Ke found a positive correlation betIeen the
folloIin& parameters! total cholesterol and )*' and fastin& blood &lucose Iith total
cholesterol
;Hpertri&lHceridemia (tri&lHcerideY12#m&=dl) Ias present in 251 patients Iith >1D*
and 0221 patients Iith >2D* 'n both &roups Ias positive correlation betIeen >?
level$ )*' and &lHcemia$ at >2D* Ias correlated also Iith ;b<19
'n >1D* female patients$ there Ias si&nificant ne&ative correlation Iith ;D"c and
inverselH proportional Iith )*'$ ;b<1c and &lHcemia 'n male patients$ ;D"c Ias
correlated inverselH proportional Iith )*' in >1D* and in >2D* patients ;D"c also
correlated Iith ;b<19
C$)c!("i$)": 'n neIlH dia&nosed >2D* patients$ risD factors for cardiovascular diseases
such as dHslipidemia Iith hHpercholesterolemia j=8 hHpertri&lHceridemia Iere more
freLuentlH present than in >1D* patients (p4####1) because >2D* patients are older
2.
Iith more co morbidities (obesitH$ hHpertension$ heart attacD$ cardiovascular diseases$
insulin resistance)
COMPLICATIILE CRONICE ALE DZ TIP H SI 5 NOU DESCOPERIT U
COHORTA 5PPO
Daniela Licaroiu, 2lena +n,urasu, Lu"inita Dospinoiu, Corina Nedelcu,
C. Ionescu5)Cr,o(iste
INDNB !N.Paulescu&, Bucuresti
Sc$1 : De obicei la descoperire diabetul este asimptomatic$ dar c3teodata pot fi prezente
complicaii micro i macrovasculare Scopul acestui studiu a fost s: evalueze prevalena
complicaiilor cronice la pacienii cu DZ nou descoperit %n 2##6$ %nre&istrai %n
'(D()* +( ,aulescu-
Mateia!e 2i #et$%e: 'n studiu au fost %nrolai 26/6 de pacieni nou dia&nosticai cu DZ
%n perioada ianuarie U decembrie 2##6! 15/. (0./1) b:rbai i 15./ (2#2 1) femei$ cu
v3rsta medie de 2B/2 ani (limite %ntre 0 i /6 ani)$ i un '*9 mediu de 2..Z&=m2
(limite %ntre 15 si 2B D&=m2) 9ele 2 loturi au fost studiate %n funcie de tipul DZ! 2#0
pacieni (651) cu DZ tip 1$ barbati 116 (2601) si /6 (02B1) femei i respectiv 22/5
pacieni (.261) cu DZ tip 2$ 1262 (0.21) barbati si 1511 (2#/1) femeiT
prezena=absena complicaiilor diabetului Datele folosite %n studiu provin din fiele
9<D ale pacienilor$ prelucrarea lor statistic: realiz3ndu8se cu aGutorul softului S,SS
12#$ semnificaia statistic: a diferenelor dintre cele dou: loturi realiz3ndu8se pe baza
testului 9hi8patrat pentru un pra& de semnificaie p c##2
Re'(!tate :
N6 T$ta!
1acie)7i
C$#1!ica7ii
#ic$va"c(!ae
C$#1!ica7ii #ac$va"c(!ae
Reti)$1atie Ne($1atie Atei$1atie IMA AVC
THDM 2#0 (6$51) 5 (#11) . (#21) 0 (#11) 1 (#11) 1 (#11)
T5DM 22/5 (.26) 2# (1/1) 156 (21) .2 (551) 25
(1/1)
.6
(501)
T$ta! 26/6 25 (1.1) 10B (221) .B (501) 20 ./
B#
(1##1) (1.1) (521)
*aGoritatea pacienilor 256# (/0$11)$ din care 1/6 (2$/1) cu DZ tip 1 i 21/5 (6/51)
cu DZ tip 2$ nu au prezentat complicaii$ acestea fiind evideniate numai la 016 pacieni
(12$.1)$ din care 16 pacieni (#$B1) cu DZ tip ' si 0## pacieni cu DZ tip 2 (12$51)
C$)c!('ii : ,acienii nou dia&nosticai 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! ;><$ dislipidemia$ hiperinsulinismul$ obezitatea 9el mai
frecvent complicaiile macrovasculare afecteaza un sin&ur teritoriu vascular$ acesta fiind
fie teritoriul cerebral$ fie cel periferic$ aceste teritorii fiind de apro7imativ 0 ori mai
frecvent afectate dec3t teritoriul coronarian "a pacienii cu complicaii microvasculare$
neuropatia este mai frecvent: dec3t retinopatia (p 4 ####1) 9omplicaiile cronice ale
diabetului nou descoperit sunt mai frecvente la DZ tip 2 fa: de DZ tip 1 datorita
perioadei mai mari de predia&nostic (p4 ##5/)
CHRONIC COMPLICATIONS AT NE+L, DIAGNOSED THDM AND
T5DMF COHORT 5PPO
Daniela Licaroiu, 2lena +n,urasu, Lu"inita Dospinoiu, Corina Nedelcu,
C. Ionescu5)Cr,o(iste
National Institute of Diabetes, Nutrition and etabolic Diseases !N.C. Paulescu&,
Bucharest, Ro"ania
Bac-.$()% a)% Ai#": Diabetes mellitus usuallH is asHmptomatic at dia&nosed$ but
sometimes micro8 and macrovascular complications mi&ht be present >he aim of this
studH Ias to evaluate the prevalence of chronic diabetes complications in neIlH
dia&nosed diabetic patients re&istered in the outpatient Department of 'nstitute (
,aulescu in 2##6
Mateia! a)% Met/$%": < cohort of 26/6 diabetic patients Ias analHzed betIeen
WanuarH U December$ 2##6 in )ucharest! 15/. (0./ 1) man$ 15./ (2#2 1) Ioman
avera&e a&e Ias 2B$ /2 HearsT )*' avera&e Ias 2.$ .Z&=m2 >he tIo &roups 2#0 (6$
51) >1D*$ 116 (2601) man and /6 (01B1) Ioman$ 22/5 (.261) >2D* 1262
(0.21) man and 1511 (2#/1) Ioman Iere studied dependin& on present=absent off
diabetic complications >he statistic pro&ram Ias S,SS 12#T Ie used 9hi8SLuare tests
Iith statistical si&nificant p c##2
B1
Re"(!t":
T$ta!
1atie)t
"
Mic$va"c(!a
c$#1!icati$)"
Mac$va"c(!a c$#1!icati$)"
Reti)$1at/
@
Ne($1at/
@
Atei$1at/@
Mi$ca%ica
! i)<acti$)
St$-e
THDM 2#0
(6$51)
5 (#11) . (#21) 0 (#11) 1 (#11) 1 (#11)
T5DM 22/5
(.26)
2# (1/1) 156 (21) .2 (551) 25 (1/1) .6 (501)
T$ta! 26/6
(1##1)
25 (1.1) 10B (221) .B (501) 20 (1.1) ./ (521)
*ost patients 256# (/01 1) had no complications! 1/6 (B61) >1D* and 21/5 (6/51)
>2D*$ onlH 016 patients (12. 1) had complications$ from Ihich 16 patients >1D* (#
B 1) and 0## patients >2D* (1251)
C$)c!("i$)": ObviouslH at dia&nosis >1D* patients and >2D* patients are mostlH free
of complications$ but if theH have it$ the most common ones are macrovascular
complications in >2D* patients due to the presence of additional vascular risD factors as!
hHpertension$ dHslipidemia$ hHperinsulinism$ obesitH *ost freLuent diabetic
macrovascular complications affects onlH one vascular territorH$ this is the cerebral
territorH or peripheral territories$ affected 0 times more freLuent than coronaries territorH
(p 4 ####1) >he loIer freLuencies of cardiac lesions are probablH due to different
dia&nosis criteria 'n patients Iith microvascular complications neuropathH is more
freLuent then retinopathH (p4 ####1) (eIlH dia&nosed chronic complications are hi&her
in >2D* than in >1D* patients (p 4 ##5/) due to a lon&er pre U dia&nosis period
PREVALENTA COMPLICATIILOR MICROVASCULARE LA PACIENTII CU
DZ TIP H SI TIP 5 CU SINDROM METABOLIC
Do(an D,
Institutul de Diabet, Nutritie si Boli etaboliceNProf. N.C. PaulescuOBucuresti,
Ro"ania
B2
I)t$%(cee : Sindromul metabolic reprezinta un important factor de risc pentru diabet
zaharat tip 2$ putine date e7ista insa$ despre importanta acestuia la pacientii cu diabet
zaharat tip 1
Obiective : Svaluarea prevalentei complicatiilor microvasculare la pacientii cu diabet
zaharat tip 1(DZ1) si tip 2(DZ2) cu sindrom metabolic(S*)
Mateia! "i #et$%a : <u fost inclusi in studiu 102. pacienti$ internati in perioada
#1#12##B851122##B la 'D()* +(,aulescu-$dintre care 26# cu DZ1 (15B barbati$
150 femei$ varsta medie 02$20C10$5B ani)$ iar 112. cu DZ2 (21/ barbati$ B01 femei$
varsta medie B#$16C1#$0/ ani) S* a fost prezent la 2# (1/$211) dintre pacientii cu DZ1$
respectiv .6# (/5$B.1) dintre cei cu DZ2$ restul pacientilor nu au intrunit criteriile de
dia&nostic S8au analizat urmatorii parametri prezenti in fisele de observatie ale
pacientilor ! varsta$ se7$ talie$ ;b<1c$ istoric de ;><$ colesterol total (9>)$ ;D"$ "D"$
tri&liceride (>?)$ raport >?=;D"$ complicatii microvasculare! neuropatie diabetica
(neuropatie diabetica senzitiva periferica$ neuropatie ve&etativa)$ retinopatie diabetica
(retinopatie diabetica proliferativa$ retinopatie diabetica neproliferativa) S* a fost
definit conform criteriilor 'DM "a pacientii cu DZ tip 1$ &licemia nu a constituit citeriu
de dia&nostic
Re'(!tate : ,acientii cu DZ1 si S*$ fata de cei cu DZ2 si S* au avut valori medii ale
varstei semnificativ mai mici (0.1BC1520vsB#22C1#55$ p_###1) si ale vechimii bolii
semnificativ mai mari (122/C.B5vs.5.C/21$ p_##1)$ relatii ce s8au mentinut si
atunci cand s8a efectuat diferentierea pe se7e De asemenea$ pacientii cu DZ1 si S* au
avut fata de cei cu DZ2 si S* un nivel semnificativ mai mare al ;b<1c (1#22C225
vs.21C20#$ p_##1)$ relatie ce s8a pastrat doar la barbati (1#62C26Bvs.#BC205$
p_##1) atunci cand s8au analizat diferentele barbati8femei <u e7istat diferente
semnificativ statistic in lotul cu DZ1 si S* fata de lotul cu DZ2 si S* in ceea ce priveste
prevalenta neuropatiei ve&etative (OR 526T .219'!15.86B6)$ retinopatiei diabetice (OR
25.T .219'!1528025) si retinopatiei diabetice neproliferative (OR 22BT.219'!1228
0#/)$ diferente ce s8au mentinut pentru retinopatia diabetica (OR 5#/T.219'!1068B0B)
si retinopatia diabetica neproliferativa (OR 261T.219'!12682/#) doar la femei atunci
cand s8a efectuat analiza pe se7e ,acientii cu DZ1 si S* au avut fata de cei fara S* o
prevalenta semnificativ mai mare a retinopatiei diabetice (OR 2#5T .21 9'! 1#.856/)$
fara diferente semnificative in ceea ce priveste neuropatia diabetica "a pacientii cu DZ2
si S* fata de cei fara S* nu au e7istat diferente semnificativ statistic in ceea ce priveste
complicatiile microvasculare'n urma analizei tertilelor de distributie ale ;b<1c si
raportului >?=;D" nu au e7istat diferente semnificativ statistic intre pacientii cu DZ tip
1 si tip 2 din tertila superioara de distributie comparativ cu cei din tertila inferioara'n
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 262T .21 9'! 1#68B.#)$ fara diferente la pacientii cu DZ2
C$)c!('ii: Sindromul metabolic reprezinta un factor de risc pentru afectarea
microvasculara la pacientii DZ tip1
B5
THE PREVALENCE OF MICROVASCULAR COMPLICATIONS IN T,PE I
AND T,PE II DIABETES PATIENTS +ITH METABOLIC S,NDROME
Do(an D., Popescu L.D., Ionescu I., Lichiardopol R.
Clinic of Diabetes, Nutrition and etabolic Diseases, ! N.C. Paulescu& Institute,
Bucharest, Ro"ania
I)t$%(cti$)! >he metabolic sHndrome is an important cardiovascular risD factor for tHpe
2 diabetes mellitus (D*2)$ there are thou&h feI data re&ardin& its importance in tHpe '
diabetes mellitus patients (D*1)
Ai#! >he evaluation of microvascular complications in D*1 and D*2 patients Iith
metabolic sHndrome (S*)
Met/$%"! 'n the studH there Iere included 102. patients$ Ihich Iere admitted in 2##B in
the diabetes department of the institute$ of Ihich 26# Iith D*1 (15B men$ 150 Iomen$
mean a&e 0220j105B Hears) and 112. Iith D*2 (21/ men$ B01 Iomen$ mean a&e
B#16j1#0/) S* Ias present in 2# (1/211) of the D*1 patients$ respectivelH .6#
(/5B.1) of the D*2 patients$ the rest of the patients not meetin& the dia&nostic criteria
>he folloIin& parameters in the patientsR file Iere analHzed! a&e$ se7$ Iaist
circumference$ hHpertension historH$ ;b<1c$ total cholesterol (9>)$ ;D" cholesterol
(;D")$ "D" cholesterol ("D")$ tri&lHcerides (>?)$ tri&lHceride=;D" cholesterol ratio$
presence of microvascular complications! diabetic neuropathH$ (peripheral diabetic
neuropathH$ autonomic neuropathH)$ diabetic retinopathH$ (proliferatin& diabetic
retinopathH$ non8proliferatin& diabetic neuropathH) S* Ias defined accordin& to the 'DM
criteria 'n D*1 patients$ &lucose blood level Ias not a dia&nostic criterion
Re"(!t"! ,atients Iith D*1 and S* had loIer mean a&e (0.1BC1520vsB#22C1#55$
p_###1) compare to patients Iith D*2 and S* (p_###1) and a si&nificantlH lon&er
disease duration (122/C.B5vs.5.C/21$ p_##1)$ relation that maintained in the se7
difference also <lso patients Iith D*1 and S* had a si&nificantlH hi&her level of
;b<1c (1#22C225 vs.21C20#$ p_##1)$ compared to the patients Iith D*2 and S* $
relationship that maintained onlH in men (1#62C26Bvs.#BC205$ p_##1) Ihen men8
Iomen differences Iere analHzed >here Iere statisticallH si&nificant differences
re&ardin& autonomic neuropathH (OR 526T .219'!15.86B6$ p_##1)$ diabetic
retinopathH (OR 25.T .219'!1528025$ p_##1) and non8proliferatin& diabetic
retinopathH (OR 22BT.219'!12280#/$ p_##1) betIeen the patients Iith D*1 and S*
compare Iith patients Iith D*2 and S*$ difference that maintained for diabetic
retinopathH (OR 5#/T.219'!1068B0B$ p_##1) and non8proliferatin& diabetic
retinopathH (OR 261T.219'!12682/#$ p_##1) onlH in Iomen Ihen se7 differences
Iere analHzed
B0
,atients Iith D*1 and S* had a si&nificantlH hi&her prevalence of diabetic retinopathH
(OR 2#5T .21 9'! 1#.856/) compared to the patients Iithout S*$ Iith no si&nificant
differences re&ardin& diabetic neuropathH 'n patients Iith D*2 and S* there Iere no
statisticallH si&nificant differences re&ardin& microvascular complications compared to
the patients Iith D*2 and Iithout S*
>here Iere not si&nificant differences in microvascular complication prevalence across
the tertiles of ;b<1c and >?=;D" distribution Khen analHzin& Iaist distribution
tertiles$ patients Iith D*1 in the superior tertile had a hi&her prevalence of diabetic
retinopathH (OR 262T .21 9'! 1#68B.#) compared to the patients in the loIer terile$
Iith no differences in patients Iith DZ2
C$)c!("i$)"! *etabolic sHndrome represents a risD factor for microvascular
complications in patients Iith DZ1
PREVALENA COMPLICATIILOR MACROVASCULARE LA PACIENTII CU
DIABET ZAHARAT TIP H CU VECHIME A BOLII DE PESTE 5M ANI
Diana Clenciu
9
, ihaela 4ladu
:
, %i,ina

$ar,a(u
9
, Nicoleta itroi
9
, 2(a )o"a
9
, aria
ota
:
9
%pitalul Clinic *udetean de +r,enta Craio(a 7 Clinica Diabet Nutritie Boli etabolice@
:
+/ Craio(a 7 Departa"entul de Diabet Nutritie Boli etabolice
Sc$1(! "t(%i(!(i: Svaluarea prevalentei complicatiilor macrovasculare la un lot de
pacienti cu diabet zaharat tip 1 cu vechime a bolii de peste 22 ani
Mateia! "i #et$%a: "otul studiat a cuprins 00 pacienti cu DZ tip 1 cu vechime a bolii de
peste 22 ani aflati in evidenta 9entrului 9linic de Diabet (utritie )oli *etabolice al
Spitalului 9linic Wudetean de Nr&enta 9raiova 9a 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$ femuraleT auscultatia vaselor de la baza &atului$ &licemie$ colesterol
total$ ;D"8colesterol$ "D"8colesterol$ tri&liceride$ electrocardio&rama$ e7amen
cardiolo&ic$ ecocardio&rafie si coronaro&rafie la indicatia medicului cardiolo&$ Sco
Doppler vascular periferic si vase baza &atului$ e7amen neurolo&ic$ 9> si R*( la
recomandarea medicului neurolo&
Re'(!tate: Din cei 00 pacieti$ 10 (51$/11) au fost de se7 feminin si 5# (B/$1.1) de se7
masculin 9u privire la varsta acestora$ 2 pacienti (0$201) se aflau in decada de varsta
5#80# ani$ 12 pacienti (26$261) in decada 0182# ani$ 12 pacienti (50$#.1) in decada 218
B# ani si 12 pacienti (50$#.1) peste B# ani Studiind parametrul complicatii
macrovasculare s8a remarcat o frecventa crescuta a arteriopatiei diabetice obliterante$ 2B
B2
pacienti (2.$#.1)$ dar si a cardiopatiei ischemice cronice 1B pacienti (5B$5B1) Nn
numar de 10 pacienti (51$/11) prezentau atat arteriopatie diabetica obliteranta cat si
cardiopatie ischemica cronica Din pacientii luati in studiu 0 pacienti (.$#.1) au
prezentat accident vascular cerebral pe parcursul evolutiei DZ Debutul arteriopatiei
diabetice a fost inre&istrat la 2 pacienti (6$B.1) la mai putin de 2 ani de evolutie ai DZ$ la
2 pacienti (6$B.1) intre 281# ani$ la 5 pacienti (11$251) intre 11812 ani$ la 0 pacienti
(12$5/1) intre 1B82# ani$ la 2 pacienti (1.$251) intre 21822 ani si la 1# pacienti (5/$0B1)
la mai mult de 22 ani de evolutie ai DZ Dislipidemia a fost evidentiata la 52 pacienti
(62$621) ;ipertensiunea arteriala s8a intalnit la 5B pacienti (/1$/11) Dintre pacientii
hipertensivi$ 2/ pacienti (66$661) prezentau ;>< si neuropatie$ 26 pacienti (621)
prezentau ;>< si retinopatie$ 16 pacienti (06$221) prezentau ;>< si arteriopatie$ 12
pacienti (01$B61) prezentau ;>< si nefropatie$ iar 15 pacienti (5B$111) prezentau atat
;>< cat si neuropatie$ retinopatie$ arteriopatie si nefropatie
C$)c!('ii: Se remarca o frecventa crescuta a complicatiilor macrovasculare dupa o
evolutie de peste 22 de ani ai DZ tip 1$ prevalenta complicatiilor creste paralel cu
vechimea diabetului zaharat <rteriopatia diabetica obliteranta a membrelor inferioare
este cea mai frecventa complicatie macrovasculara$ care poate sa apara precoce$ dar a
carei incidenta crescuta se inre&istreaza dupa 22 ani de evolutie ai DZ tip 1 9ardiopatia
ischemica cronica se identifica ca o complicatie macrovasculara frecventa comparativ cu
accidentul vascular cerebral care s8a intalnit in procent mai mic Dislipidemia si
hipertensiunea arteriala sunt intalnite frecvent la pacientul cu diabet cu o vechime de
peste 22 ani si se asociaza mai frecvent cu complicatiile diabetului
THE PREVALENCE OF MACROVASCULAR COMPLICATIONS IN T,PE H
DIABETES MELLITUS +ITH DURATION OF DIABETES MORE THAN 5M
,EARS
Diana Clenciu
9,
, %i,ina

$ar,a(u
9
, ihaela 4ladu
:
, Nicoleta itroi
9
, 2(a )o"a
9
, aria
ota
:
,
9
Clinic Count3 2"er,enc3 0ospital Craio(a, Diabetes Clinic@
:
+/ Craio(a
Bac-.$()%: >o analHze the freLuencH of macrovascular complications in patients Iith
duration of >1D* more than 22 Hears
Mateia! a)% #et/$%: Ke studied a &roup of 00 patients Iith duration of >1D* more
than 22 Hears$ hospitalized in the 9linic of Diabetes (utrition [ *etabolic Diseases
(9linic 9ountH Smer&encH ;ospital 9raiova) Ke analised historH of disease$ clinical and
paraclinical dates! the duration of diabetes mellitus$ personal historH$ blood pressure$
palpation of pulse at the level of dorsal arterH of foot$ posterior tibial arterH$ popliteal
arterH and femoral arterH$ the vessels auscultation from the base of the necD$ &lHcemia$
total cholesterol$ ;D"8cholesterol$ "D"8cholesterol$ tri&lHcerides$ S9?$ cardiolo&ic
BB
e7amination$ ecocardio&raphH and coronaro&raphH at the indication of the cardiolo&ist$
vascular Sco Doppler$ neurolo&ic e7amination$ 9> and (*R at the indication of the
neurolo&ist
Re"(!t" a)% %i"c(""i$)": Mrom the 00 patients included in the studH$ 10 patients
(51$/11) Iere female and 5# patients (B/$1.) male 9oncernin& the a&e of patients$ 2
patients (0$201) Iere betIeen 5#80# Hears$ 12 patients (26$261) Iere betIeen 0182#
Hears$ 12 (50$#.1) patients Iere betIeen 218B# Hears and 12 patients (50$#.1) over B#
Hears Re&ardin& macrovascular complications$ 2B patients (2.$#.1) presented peripheral
arterial disease and 1B patients (5B$5B1) presented ischemic heart disease Mrom the
patients included in the studH 0 patients (.$#.1) presented stroDe Diabetic arteriopathH
developed before 2 Hears of evolution in 2 patients (6$B.1)$ betIeen 281# Hears at 2
patients (6$B.1)$ betIeen 11812 Hears at 5 patients (11$251)$ betIeen 1B82# ani in 0
patients (12$5/1)$ betIeen 21822 Hears in 2 patients (1.$251) and 1# patients (5/$0B1)
presented the developement of diabetic arteriopathH after 22 Hears of evolution 52
patients (62$621) had dHslipidaemia and 5B patients (/1$/11) suffered of arterial
hHpertension
Mrom hHpertensive patients$ 2/ patients (66$661) presented after 22 Hears arterial
hHpertension and diabetic neuropathH$ 26 patients (621) arterial hHpertension and
diabetic retinopathH$ 16 patients arterial hHpertension and diabetic arteriopathH$ 12
patients arterial hHpertension and diabetic nefropathH and 15 patients (5B$111) presented
arterial hHpertension$ neuropathH$ retinopathH$ arteriopathH and nefropathH
C$)c!("i$)": >his studH shoIed that macrovascular complications appered Iith a bi&
freLuence after 22 Hears of evolution$ the complicationRs prevalence &roIs Iith the
oldness of diabetes mellitus ,eripheral arterial disease is the most freLuent
macrovascular complication Ihich can earlier appears$ but its hi&hest incidence is also
after 22 Hears of duration of diabetes 'schemic heart disease is more freLuent than stroDe$
Ihich Ias met in a smaller percenta&e <lso$ dHslipidaemia and arterial hHpertension are
freLuentlH met after 22 Hears of diabetes and theH are associated freLuentlH Iith diabetes
complications
EPIDIAB IN MUNICIPIUL CHISINAU: REZULTATELE PRIMELOR L LUNI6
2lena ornealo, Natalia Balta,, 6l,a Barano(, %il(ia Bodean, An,ela D"itrie(,
Dorina Cara"an, Chisinau.
Introducere0 Diabetul zaharat este unanim acceptat ca o problema medico8sociala de
e7trema actualitate$ prezentind o e7tindere epidemiolo&ica in intrea&a lume 'mpactul
ne&ativ al bolii este conditionat in mare parte de dezvoltarea complicatiilor &rave
B6
invalidizante$ precum si de cresterea maGora a riscului cardiovascular Datorita unei
perioade lun&i de hiper&licemie asimptomatica$ complicatiile cronice frecvent sunt
prezente deGa la momentul dia&nosticarii diabetului Din toate acestea reesa necesitatea
unei abordari specifice a persoanelor cu diabet zaharat nou depistat
6biecti(P <naliza epidemiolo&ica a cazurilor noi de diabet zaharat$ inre&istrate in
perioada ianuarie8septembrie 2##/ in municipiul 9hisinau$ determinarea prezentei
complicatiilor si a comorbiditatilor la momentul depistarii$ evaluarea optiunillor
terapeutice initiale si a calitatii in&riGirii persoanelor cu diabet zaharat nou depistat
aterial si "etode0 S8au luat in studiu 2#6 cazuri de diabet zaharat nou depistat in
perioada ianuarie8septembrie 2##/$ la care au fost analizate! aspectele epidemiolo&ice
le&ate de tipul de diabet$ se7$ varstaT datele antropometriceT screenin&8ul complicaiilor
croniceT asocierea cu alte entitati ale sindromului metabolic si bolii cardiovasculareT
structura terapeutica
Re?ultate0 "otul de studiu a cuprins 2#6 de persone$ dintre care 0/. au prezentat diabet
tip 2T repartitia pe se7e a fost aproape identica$ raportul barbati!femei constituind 1!1$#/
Aarsta medie la momentul dia&nosticarii a pacientilor cu tip1 de diabet U 2.$0# ani$ tip 2
U 2/$62 ani Doar 101 din persoane cu tip 2 de diabet sunt normoponderale$ 02$B1
prezinta suprapondere si 0#$21 obezitate B.$51 din persoane au talia peste /# cm la
femei sau peste .0 cm la b:rbati ,revalenta altor factori de risc cardio8vasculari este!
hipertensiunea arteriala U B5$/1$ dislipidemia U B2$61 Nn anumit numar de persoane au
fost dia&nosticate cu patolo&ia cardio8vasculara deGa la momentul depistarii diabetului!
2$251 au prezentat cardiopatie ischemica$ 1$.21 8 boala cerebrovasculara$ 5$221
8arteriopatie periferica$ 2$2/1 8 infarct miocardic Screenin&8ul si dia&nosticul
complicatiilor microvasculare specifice releva! 02$51 din persoanele nou depistate cu
diabet au fost scrinate pentru decelarea retinopatiei diabetice si la 2#$61 a fost
confirmata prezenta acestei complicatii la momentul dia&nosticului Screenin&8ul pentru
nefropatie diabetica s8a efectuat doar la 15$B 1 din pacienti$ .$21 din cei e7aminati
prezentind un &rad de nefropatie Screenin&8ul pentru polineuropatie diabetica si picior
diabetic s8a efectuat la 01$5B1 din nou depistati$ procentul celor dia&nosticati pozitiv
fiind de 20$01 9onsideram importanta analiza modului in care a fost depistata prezenta
diabetului! doar .$221 s8au adresat de sine statator cu careva acuze$ la maGoritatea U
26$061 8 hiper&licemia a fost descoperita in procesul e7aminarii cu ocazia altei patolo&ii
si inca 55$1#1 dintre persoane au fost dia&nosticate in mod activ
Structura terapeutica in diabet zaharat nou depistat a fost urmatoarea! 10$./1 numai
optimizarea stilului de viata$ B$211 sulfonilureice$ 2B$B61 8 bi&uanide$ 0$2B1 asociere
sulfonilureice cu metformin$ 1#$#.1 insulina$ 2$2/ 1 asociere insulina cu metformin$
0$//1 alte clase
Conclu?ii0 *a&nitudinea problemei diabetului zaharat este prezentata nu doar de
prevalenta si incidenta crescute a bolii per se$ ci si de asocierea sa cu obezitatea si factori
de risc cardio8vasculari$ in particular dislipidemie si hipertensiunea arteriala
<dresabilitatea foarte Goasa Gustifica aplicarea e7aminarilor active pentru depistarea
precoce a patolo&iei S7ista limite in e7aminarea persoanelor nou dia&nosticate$ in
depistarea complicatiilor$ conditionate in mare parte de deficiente or&anizatorice si de
B/
costuri Se impune necesitatea acuta elaborarii si implemintarii unor pro&rame nationale$
care vor contribui la ameliorarea calitatii in&riGirii persoanelor cu diabet zaharat
EPIDIAB IN CHISINAU: RESULTS FROM THE FIRST L MONTHS6
2lena ornealo, Natalia Balta,, 6l,a Barano(, %il(ia Bodean, An,ela D"itrie(,
Dorina Cara"an, Chisinau.
IntroductionP Diabetes mellitus is universallH accepted as a medical and social problem
of e7treme relevance$ presentin& epidemiolo&ical e7tension (spread) in the Ihole Iorld
>he ne&ative influence (impact) of the disease is caused in maGor portion bH the
development of severe complications and bH the &reat increase of the cardiovascular risD
as Iell )ecause of the lon& period of asHmptomatic hHper&lHcemia$ the chronic
complications are present freLuentlH Gust at the moment of dia&nosis 't folloIs that
persons Iith neI dia&nosed diabetes need a specific mana&ement
Ai": epidemiolo&ical analHsis of neIlH8dia&nosed cases of diabetes mellitus that have
been re&istered in 9hisinau in the period WanuarH8September 2##/$ determination of the
presence of complications and co morbidities at the time of dia&nosis$ evaluation of the
therapeutic options and the LualitH of care
aterial and "ethodP StudH involved 2#6 cases of neIlH8dia&nosed diabetes in period
WanuarH8September 2##/$ Ihich Iere analHzed in the folloIin&! epidemiolo&ical aspects
such as tHpe of diabetes$ se7$ a&eT anthropometric data$ screenin& for chronic
complications$ association Iith others features of metabolic sHndromeT therapeutic
structure
ResultsP from the 2#6 e7amined persons 0/. presented tHpe 2 diabetesT the distribution
on se7es Ias nearlH identical$ ratio men! Iomen bein& 1!1$#/ >he medium a&e at the
moment of diabetes identification Ias 2.$0# Hears for tHpe 1 and 2/$62 for tHpe 2 OnlH
101 of tHpe 2 neIlH8dia&nosed diabetes have normal Iei&ht$ 02$B1 overIei&ht and
0#$21 obesitH$ thou&h the share of abdominal obesitH constitute B.$51 >he prevalence
of other the cardiovascular risD factors is! hHpertension U B5$/1$ dHslipidemia U B2$61
< certain number patients have been dia&nosed Iith cardiovascular diseases alreadH at
the moment of diabetes identification! 2$251 presented ischemic cardiac disease$ 1$.21
cerebrovascular accident$ 5$221 peripheral vascular disease$ 2$2/1 mHocardial
infarction Screenin& and dia&nose of microvascular specific complications reveals!
02$51 of neIlH8dia&nosed persons Ias screened for diabetic retinopathH and in 2#$61
cases the presence of this Ias confirmedT screenin& for nephropathH Ias performed onlH
in 15$B1 of patients and .$21 from e7amined had some &rade of diabetic nephropathHT T
the screenin& for diabetic neuropathH and diabetic foot Ias done in 01$5B1$ the
percenta&e of positives bein& 20$01 >herapeutic structure of neIlH8dia&nosed cases of
diabetes Ias! lifestHle modification onlH in 10$5B1$ 2B$B61 8 metformin$ B$211 8
B.
sulphonnHlurea$ 0$2B1 8 sulphonnHlurea plus metformin$ 1#$#.1 8 insulin in
monotherapH$ 2$2/1 combination of insulin Iith metformin$ 0$//1 other therapies
ConclusionsP >he ma&nitude of diabetes mellitus problem is determined not onlH bH hi&h
incidence and prevalence of the disease per se$ but also bH the association Iith obesitH
and cardiovascular risD factors$ particularlH dHslipidemia and hHpertension "oI &rade of
addressabilitH Gustifies active e7aminations for earlH identification of patholo&H 9ertain
limits e7ist in neIlH8dia&nosed personsR e7amination$ in identification of complications$
caused for the most part bH or&anization deficient and costs 't is an acute necessitH in
elaboration and implementation of national pro&rams$ Ihich Iill ameliorate the LualitH
of diabetic patientsR care
FICATUL GRAS NONALCOOLIC U UN FACTOR DE RISC PENTRU BOALA
RENALA CRONICA LA PACIENTUL DIABETIC
/. Casoinic 9, Catalina Badau :, D. %a"peleanu 9, D. Constantinescu 9, Luchiana
Pruna A
9. +/ Clu1 Napoca. %pitalul +ni(ersitar C/R. Clinica edicala I4
:. Insitutul Ini"ii !Niculae %tancioiu&, Clu1 Napoca
A. %pitalul *udetean Baia are. Centrul deDiabet, Nutritie si Boli "etabolice
I)t$%(cee "i $biective
"a pacientii diabetici$ studii observationale au su&erat faptul ca prezenta ficatului
&ras nonalcoholic (M?(<)$ poate creste riscul de microalbuminurie si astfel de boala
cronica renala ()9R) Aeri&a pato&enetica intre aceste doua conditii poate fii
reprezentata de citoDinele proinflamatorii secretate de ficat Scopul studiului de fata
consta din evaluarea prezentei microalbuminuriei la pacientii diabetici cu M?(<
comparativ cu cei fara M?(< si corelarea acesteia cu marDeri ai inflamatiei U cum este
proteina 9reactiva cu sensibilitate inalta
Mateia! "i #et$%a
Studiul a fost desfasurat pe un &rup de 62 de pacienti diabetici cu M?(<
dia&nosticat ultrasono&rafic$ la care s8au e7clus consumul de alcool precum si alte cause
de boala cronica hepatica$ fumatul$ hipertensiunea arteriala si boala renala pree7istenta
?rupul de control a consistat din 6# de pacienti diabetici$ fara dovezi eco&rafice de
M?(<
"a toti pacientii s8au determinat parametrii antropometrici$ &licemia a Geun$
;b<1c$ colesterolul total$ "D" si ;D" colesterolul$ tri&liceridele$ transaminazele serice$
hs ,9R si microalbuminuria <naliza statistica a fost efectuata cu S,SS11# O valoare a
p_#$#2 a fost considerata semnificativ statistica
6#
Re'(!tate
*icroalbuminuria a fost a fost semnificativ mai frecventa la subiectii cu M?(<
decat la &rupul de control (12$61 vs 6$/1$ p_#$#2) *icroalbuminuria s8a corelat pozitiv
cu '*9$ ;b<1c$ tri&liceridele serice$ hs9R, si respectiv ne&ative cu nivele ;D" la
pacientii diabetici cu M?(<
C$)c!('ii
M?(< se coreleaza cu microalbuminuria8 marDer de boala cronica renala stadium
precoce la pacientii diabetici <ceasta pare a se datora unor nivele crescute de citoDine
proinflamatorii eliberate de ficat$ cum este hs9R, ,acientii diabetici cu M?(< au nivele
semnificativ mai crescute ale ;b<1c$ relevand un control slab pe termen lun& al
valorilor &licemice
NONALCOHOLIC FATT, LIVER DISEASE U A RIS3 FACTOR FOR
CHRONIC 3IDNE, DISEASE IN DIABETIC PATIENTS
/. Casoinic 9, Catalina Badau :, D. %a"peleanu 9, D. Constantinescu 9, Luchiana
Pruna A
9. +/ Clu1 Napoca. C/R +ni(ersit3 0ospital. I4th edical Clinic
:. 0eart Insitute !Niculae %tancioiu&, Clu1 Napoca
A. Count3 0ospital Baia are 7 Diabetes departa"ent
Bac-.$()%
'n diabetic patients observational studies have su&&ested that nonalcoholic fattH
liver disease8(<M"D maH increase the risD of microalbuminuria and thus that of chronic
DidneH disease (9ZD) >he patho&enetic linD betIeen these conditions could be
proinflammatorH cHtoDines secreted bH the liver >he aim of our studH Ias to assess the
presence of microalbuminuria in diabetic subGects Iith nonalcoholic fattH liver disease
((<M"D) compared Iith diabetic patients Iithout (<M"D and to correlate this Iith
inflammatorH marDers such as hi&h sensitive 98 reactive protein (hs9R,)
Mateia! a)% #et/$%"
>he studH Ias conducted on a &roup of 62 diabetic subGects Iith
ultrasono&raphical (<M"D$ in Ihich alcohol consumption and other causes of chronic
liver disease have been e7cluded >he e7clusion criteria also included smoDin&$ arterial
hHpertension$ DnoIn renal disease >he control &roup consisted of 6# diabetic patients$
matched for a&e and &ender$ Iithout ultrasono&raphical evidence of (<M"D
'n all subGects Ie measured hei&ht$ Iei&ht$ )*'$ fastin& &lucose$ ;b<1c$ total
cholesterol$ "D" and ;D" cholesterol$ tri&lHcerides$ serum transaminases$ hs98reactive
61
protein and microalbuminuria Statistical analHsis Ias performed usin& S,SS11# < p8
value_#$#2 Ias considered statisticallH si&nificant
Re"(!t"
*icroalbuminuria Ias si&nificantlH more freLuent in subGects Iith (<M"D than
in controls (12$61 vs 6$/1$ p_#$#2) *icroalbuminuria Ias positivelH correlated Iith
Iaist to hip ratio$ ;b<1c levels$ serum tri&lHcerides$ hs9R, levels and ne&ativelH
correlated Iith ;D" levels in subGects Iith (<M"D
C$)c!("i$)
(<M"D is correlated Iith microalbuminuria8 marDer of earlH sta&e 9ZD$ in
diabetic patients >his seems to be related to hi&her levels of proinflammatorH factors
released bH the liver$ such as hs9R, Diabetic patients Iith (<M"D had si&nificantlH
hi&her levels of ;b<1c$ Iitnessin& a poorer &lHcemic control
IMPORTANTA DIETOTERAPIEI LA PACIENTII OBEZI CU DIABET
ZAHARAT TIP II
$ Radulian,
9,:
, A.Dra,o"ir,
9,:
, Posea
:
+/ Carol Da(ila, Bucuresti
IDNB !N.Paulescu&, Bucuresti
I6 Sc$1: Dietoterapia si intensificarea efortului fizic sunt parte importanta in tratamentul
diabetului zaharat tip 2 <cest studiu a fost conceput pentru a evalua eficacitatea unei
diete hipo&lucidice (021)$ hipolipemiante (221) si hiperproteice (5#1) la pacientii obezi
cu diabet zaharat tip 2
II6 Mateia! "i #et$%e: Nn lot de B. de pacienti diabetici $ 55 barbati (06/1) si 5B
femei (2221)$ cu varsta medie de 215C /6$ in tratament cu antidiabetice orale$ cu
dislipidemie mi7ta si obezitate ('*9Y5# D&=m2) au fost inclusi intr8un pro&ram bazat pe
dieta hipo&lucidica (021)$ hipolipemianta (221) si hiperproteica (5#1) si e7ercitii fizice
(5 ore=saptamana) ;b <1c$ colesterolul total$ tri&liceridele$ ureea$ creatinina si &reutatea
fiecarui pacient au fost evaluate la inceput si la 5$ si respectiv B luni
III6Re'(!tate: ?reutatea medie la inceput a fost de /.$6 D& ( 622 U 1212 D& ) iar la o
luna$ 5 si respectiv B luni s8a constatat o scadere in &reutate de 55D&$ 62D&$ respectiv
.1D& ;b <1c medie a inre&istrat valori initiale de //1 ( BB1 81121 ) iar la evaluarile
urmatoare a fost de 6/1$ respectiv B.1 Aalorile colesterolului total au fost de 2B5 C
2#5 m&=dl iar la 5 si B luni au fost 20. C 212 m&=dl$ respectiv 20# C 222 m&=dl S8a
62
constatat o scadere a nivelului tri&liceridelor de 2B1 dupa B luni (ici un pacient nu a
fost inclus in studiu daca functia renala$ masurata prin uree si creatinina$ era afectata
9learence8ul la creatinina si microalbuminuria nu au fost modificate dupa B luni
IV6 C$)c!('ii: Dieta hipo&lucidica$ hipolipemianta si hiperproteica poate imbunatati
controlul metabolic la pacientii obezi cu diabet zaharat tip 2 Dieta hiperproteica poate
aGuta in pierderea &reutatii si in obtinerea unui control &licemic mai bun$ fara a avea
efecte adverse asupra functiei renale <cest tip de dieta poate fi o optiune de tratament la
anumiti pacienti obezi cu diabet zaharat tip 2
EFFICAC, OF DIET CHANGES IN OBESE PATIENTS +ITH T,PE 5
DIABETES
$abriela Radulian,
9,:
A. Dra,o"ir,
9,:
.Posea
:

9 +ni(ersit3 of edicine !C. Da(ila& Bucharest
: Institute of Diabetes, Nutrition Q etabolic Disease, Bucharest6

I6 Ob8ective: Diet and e7ercise are considered important treatment strate&ies of tHpe 2
diabetes >he obGective of this studH is to assess the efficacH of loI carbohHdrate (021)
and lipid (221 )$ hi&h protein ( 5#1 ) diet$ as an alternative dietarH treatment for obese
patients Iith tHpe 2 diabetes
II6 Met/$%": < total of B. obese patients Iith tHpe 2 diabetes $ 55 male ( 06$/1 ) and
5B female ( 22$21 )$ Iith a mean a&e of 21$5C /$6 Hears old$ receivin& oral
hHpo&licaemic a&ents$ Iho had hHpercholesterolemia ( total cholesterol Y 2## m&=dl)$
hHpertri&lHceridemia and obesitH ( )*' Y5# D&=m2)$ Iere allocated to a loI
carbohHdrate ( 021 ) and lipid ( 221 )$ hi&h protein ( 5#1 ) diet and each patient had 5
hour=IeeD re&ular phHsical activitH >heir ;b<1c$ cholesterol$ tri&lHcerides and Iei&ht
loss Iere monitored at the start of the studH and a&ain at 5 and B months
III6 Re"(!t": *ean Iei&ht at baseline Ias /.$6 D& ( 62$2 8 121$2 D& ) and Iei&ht loss
at 1$ 5 and B month respectivelH$ Iere 5$5 D&$ 6$2 D&$ .$1 D& *ean ;b<1c at baseline
Ias /$/1 ( B$B1 811$21 ) and mean results at 5 and B month Iere 6$/1 and B$.1 *ean
total cholesterol at baseline Ias 2B5 C 2#$5 m&=dl and at 5 and B month Ias 20. C 21$2
m&=dl$ respectivelH 20# C 22$2 m&=dl >ri&lHceridemia decreased Iith 2B1 after B
month Renal function as measured bH serum creatinine and urea Ias assessed at the start
of studH$ no patient Iith renal impairment Ias commenced on the diet NrinarH
microalbumin and creatinine clearence Iere not different after B month
65
IV6 C$)c!("i$)": < loI carbohHdrate and lipid$ hi&h protein diet maH help to improve
the metabolic control in tHpe 2 obese diabetic patients < hi&h protein diet can &enerate
Iei&ht loss$ a better &lHcaemic control$ Iithout adverse effects on the renal function
>his tHpe of diet have a place in mana&ement of obese 8 tHpe 2 diabetes in selected
patients
EPIDIAB 5PPR
Q LUNI: H IANUARIE>JP IUNIE 5PPR
%pitalul *udetean !%f.Ioan cel Nou& %ucea(a
%ecia Diabet5 Nutriie5Boli etabolice
R.Ca?iuc, C.La?r, 4.Rcaru, $.Creeanu
Obiectiv !
Svaluare incidenei diabetului zaharat nou dia&nosticat (%n cursul anului 2##/) la
9entrul <ntidiabetic Wudeean Suceava i analizarea prezenei complicaiilor la momentul
dia&nosticului
Mateia! 2i #et$%&:
S8au luat %n studiu un num:r de 10B/ cazuri noi cu diabet zaharat dintre care!
8/5 pacieni cu diabet zaharat insulinodependent
815/2 pacieni cu diabet zaharat tip ''$ la care au fost analizate datele
antropometrice(%n:lime$ &reutate$perimetrul taliei)$ clinice(tensiune arterial: sistolic: i
diastolic:$e7amenul piciorului diabetic i chestionar D(0)$ paraclinice(&licemie$profil
lipidic$e7amen de urin:$creatinin:) i e7amen oftalmolo&ic
Re'(!tate:
Distribuia pe se7e la pacienii cu diabet zaharat tip ' a fost de 011 femei i 2.1
b:rbai$%n timp ce la tipul ''$procentul de femei a fost de 211
B11 dintre pacienii cu diabet zaharat tip ' erau din mediul urban$ iar la tipul ''
procentul a fost de /01
,e &rupe de v3rst:$situaia a fost urm:toarea!
8la pacienii cu diabet zaharat tip '
60
8/$.1 au avut v3rsta sub 5# ani$ B01 %ntre 5#8B2 ani$261 peste B2 ani
8la pacienii cu diabet zaharat tip ''
8B01 au avut v3rsta intre 5#8B2 ani$ 5B1 peste B2 ani
Fn privina inde7ului masei corporale$datele au fost!
8Diabet zaharat tip '!
8061 dintre pacieni cu '*9 _ 22T
85#1 dintre pacieni cu '*9 42282.T
8251 dintre pacieni cu '*9 Y 5#
8Diabet zaharat tip ''!
81/1 dintre pacieni cu '*9 _ 22T
8261 dintre pacieni cu '*9 42282.T
8221 dintre pacieni cu '*9 Y 5#
"a m:surarea talie$ datele au fost! B01 dintre femeile cu diabet zaharat tip ' au avut
talia peste /#cm$ %n timp ce numai 221 dintre b:rbai au avut talia peste .0cmT la
pacienii cu diabet zaharat tip '' BB1 dintre femei au avut talie peste /#cm$ i respective
B#1 dintre b:rbai au m:surat %n talie peste .#cm
9omplicaiile la momentul dia&nosticului!
8 201 dintre pacieni au fost hipertensiviT
8 221 cu valori patolo&ice ale profilului lipidicT
8 #$/1 cu dia&nostic de retinopatieT
8 101 prezena neuropatiei diabeticeT
8 #$.1 prezena nefropatiei diabetice
Structura terapeutic: a fost!
8/5 pacienti %n tratament cu insulin:T
8211 dintre pacieni au primit numai recomandare de diet:T
8B21 tratament cu *etforminT
821 au primit recomandarea de asociere a dou: antidiabetice oraleT
812 1 pacieni in tratament cu sulfoniluree sau alte antidiabetice orale
C$)c!('ii:
(um:rul de pacieni cu diabet zaharat nou dia&nosticat este semnificativ mai mare
%n urma depist:rii active prin analizele recomandate de c:tre medicii de
62
familie$ridic3ndu8se %n aceste condiii problema volumului de munc: la nivelul Nnit:ii
Wudeene$ necesitatea educ:rii acestor pacieni$ precum i monitorizarea acestora
periodic( in3nd cont de faptul c: pacientul cu diabet zaharat tip '' %n tratament cu
<DO nu beneficiaz: de automonitorizare)
EPIDIAB 5PPR
Q MONTHS: ;ANUAR, H
ST
U ;UNE JP
TH
F 5PPR
R. Ca?iuc, C. La?ar, 4. Racaru, $. Creteanu
!%f. Ioan cel Nou& %ucea(a Count3 0ospital
Depart"ent of Diabetes 7 Nutrition 7 etabolic Diseases
Ob8ective!
>o assess the incidence of neIlH dia&nosed diabetes mellitus (durin& Hear 2##/)
at the Suceava 9ountH <nti8Diabetic 9entre and to analHze the presence of complications
at the moment of dia&nosis
Mateia! a)% Met/$%:
>here Iere studied 10B/ neI cases Iith diabetes mellitus amon& Ihich!
8 /5 patients Iith insulin8dependent diabetes mellitus
8 15/2 patients Iith tHpe 2 diabetes mellitus$ in Ihose case there Iere analHzed
the anthropometric data (hei&ht$ Iei&ht$ Iaist measurement)$ clinical data (sHstolic and
diastolic arterial blood pressure$ e7am of the diabetic le& and Luestionnaire D(0)$
paraclinical data (blood &lucose level$ lipid profile$ urine test$ creatinine) and
ophthalmolo&ic e7am
Re"(!t"!
>he distribution accordin& to se7es$ at the patients Iith tHpe 1 diabetes mellitus$
Ias 011 Iomen and 2.1 men$ Ihile at tHpe 2$ the percenta&e of Iomen Ias 211
B11 of the patients Iith tHpe 1 diabetes mellitus came from the urban
environment$ and at tHpe 2 the percenta&e Ias /01
<ccordin& to a&e &roups$ the situation Ias the folloIin&!
8 at the patients Iith tHpe 1 diabetes mellitus
8 /.1 Iere under 5# Hears old$ B01 betIeen 5#8B2 Hears old$ 261 over B2 Hears
old
8 at the patients Iith tHpe 2 diabetes mellitus
8 B01 Iere betIeen 5#8B2 Hears old$ 5B1 over B2 Hears old
Kith respect to the bodH Iei&ht inde7$ the data Iere!
8 >Hpe 1 diabetes mellitus!
8 061 of patients Iith bodH Iei&ht inde7 _ 22
8 5#1 of patients Iith bodH Iei&ht inde7 4 2282.
8 251 of patients Iith bodH Iei&ht inde7 Y 5#
8 >Hpe 2 diabetes mellitus!
8 1/1 of patients Iith bodH Iei&ht inde7 _22
6B
8 261 of patients Iith bodH Iei&ht inde7 4 2282.
8 221 of patients Iith bodH Iei&ht inde7 Y5#
'n the case of Iaist measurement$ the data Iere! B01 of Iomen Iith tHpe 1
diabetes mellitus had the Iaist over /# cm$ Ihile onlH 221 of the men had the Iaist over
.0 cmT at the patients Iith tHpe 2 diabetes mellitus$ BB1 of Iomen had the Iaist over /#
cm$ and B#1 of men measured in Iaist over .# cm
9omplications at the moment of dia&nosis!
8 201 of patients had hi&h blood pressureT
8 221 Iith patholo&ic values of the lipid profileT
8 #/1 Iith dia&nosis of retinopathHT
8 101 Iith presence of diabetic neuropathHT
8 #.1 Iith presence of diabetic nephropathH
>he therapeutic structure Ias!
8 /5 patients in treatment Iith insulinT
8 211 patients received onlH a diet recommendationT
8 B21 treatment Iith *etforminT
8 21 received the recommendation to associate tIo oral anti8diabetic dru&sT
8 121 patients in treatment Iith sulfonHlurea or other oral anti8diabetic dru&s
C$)c!("i$)"!
>he number of patients Iith neIlH dia&nosed diabetes mellitus is si&nificantlH
hi&her as a result of the active discoverH throu&h the tests recommended bH the familH
phHsicians$ in these conditions bein& raised the Luestion of the IorD amount at the level
of the 9ountH Nnit$ the necessitH to educate these patients$ as Iell as their periodical
surveillance (taDin& into account the fact that the patient Iith tHpe 2 diabetes mellitus in
treatment Iith oral anti8diabetic dru&s does not benefit from self8surveillance)

EVALUAREA RISCULUI DE DIABET NTR>UN GRUP POPULATIONAL DIN
ROMANIA
$abriela $hi"peteanu
'
, Andreea )ocan
'
, ihaela $ribo(schi
'
, Ra"ona %tefan
'
,
Andreea orosanu
'
, Dana Birsan
'
, .%. $hi"peteanu, $abriela Ro"an
'
'
Centrul Clinic de Diabet, Nutritie si Boli etabolice Clu15Napoca
I)t$%(cee: ,rezenta unor factori de risc precum hipertensiunea arteriala$ dis&licemia$
supraponderea=obezitatea asociate cu sedentarismul$ obiceiurile alimentare nesanatoase si
istoricul familial de diabet zaharat$ are valoare predictiva pentru aparitia pe termen lun& a
diabetului zaharat in populatia &enerala
Mateia! "i #et$%a: <u fost inclusi 5B/ subiecti neselectati$ f:r: diabet zaharat din B
orase mari din Romania ()rasov$ )uzau$ ,iatra (eamt$ <rad$ Sibiu$ >& *ures)
<cestora li s8a aplicat un chestionar pentru evaluarea riscului de a dezvolta diabet zaharat
in urmatorii 1# ani 9hestionarul a inclus date &enerale (varsta$ se7$ mediu) $ date
antropometrice (circumferinta abdominala$ &reutate$ inaltime$ '*9) precum si date
66
referitoare la nivelul de activitate fizica$ obiceiuri alimentare$ prezenta hipertensiunii
arteriale$ a dis&licemiei si a a&re&arii familiale a diabetului zaharat "a finalul testului s8a
calculat un scor de risc conform unui sistem de punctaG standardizat in cadrul studiului
M'(DR'SZ$ in functie de care participantii au fost incardati in mai multe cate&orii de risc
(scazut$ usor crescut$ moderat crescut$ crescut si foarte crescut)
Re'(!tate: Din cei 5B/ subiecti$ /#$21 au fost femei si 1.$/1b:rbati$ /2$. 1 au provenit
din mediul urban si 10$11 din mediul rural Din punct de vedere antropometric s8au
obtinut urmatoarele rezultate! 0#$21 au avut circumferinta abdominal: (9<)_/#cm la
femei si _.0cm la b:rbati$ 16$61 au avut 9< %ntre /#8//cm la femei si intre .#8.0 cm la
b:rbati si 02$1 1au avut 9<Y//cm la femei si Y1#2cm la barbati Din punctul de vedere
al indicelui de mas: corporal: ('*9)$ 06$/51 din subiecti au fost normoponderali$
50$211 au fost supraponderali si 16$BB1 au fost obezi$ pe se7e$ repartitia fiind in
procente relativ apropiate (normoponderali se7 M8 0/$21$ se7 *802$21T supraponderali8
se7 M852$//1 si se7 *801$11T obezi8se7 M81/$B01 si se7 *815$61) Dupa repartitia pe
cate&orii de scor$ s8au evidentiat urmatoarle rezultate! scor de risc _6 (risc sc:zut 1
subiect din 1## va dezvolta diabet in urmatorii 1# ani) 82#$201$ respectiv 1/B subiectiT
scor 6811(usor crescut$ 1din 22)! 26$61181#2 subiectiT scor 12810(moderat crescut$ 1 din
B)! 10$B61820 persoaneT scor 1282#(risc crescut$ 1 din 5)! B$221825persoaneT scor
Y2#(risc foarte crescut$ 1 din 2)! #$/1185 subiecti <pro7imativ 221 din subiecti au un
stil de viata nes:n:tos (sunt sedentari$ nu consum: zilnic fructe si le&ume proaspete) si au
hipertensiune arteriala si=sau urmeaza tratament medicamentos pentru aceasta
<pro7imativ 621 din participantii la studiu nu prezinta istoric familial de diabet zaharat$
un sfert av3nd rude cu diabet zaharat iar 121 au rude de &radul ' cu diabet <pro7imativ
121 din participanti prezint: valori ale &licemiei bazale peste 11#m&=dl "a studiu au
participat persoane din mai multe &rupe de varst:$ Gumatate fiind inclusi %n cate&oria de
varst: sub 02 de ani
Di"c(tii "i c$)c!('ii: Wumatate U 2#$201 din lotul studiat a prezentat un risc scazut de
aparitie a diabetului zaharat %n urm:torii 1# ani$ 05$21 au prezentat un risc intermediar$
in timp ce doar 6$#B1 au fost identificati la risc crescut de a prezenta diabet zaharat tip 2
%n urm:torii 1# ani "otul studiat a fost format preponderent din persoane tinere$ active$
sub 22 ani$ din care in medie Gumatate normoponderali si Gumatate supraponderali si obezi
cu predominanta net: a se7ului feminin
9hestionarul 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)$ fac3nd posibil: initierea precoce a OSA pentru a preveni=%nt3rzia aparitia bolii
Datele obtinute sunt asem:n:toare cu cele rezultate din analizele obli&atorii cerute de
*inisterului S:n:t:ii
6/
DIABETES RIS3 ASSESSMENT +ITHIN A ROMANIAN POPULATION
GROUP
$abriela $hi"peteanu
'
, Andreea )ocan
'
, ihaela $ribo(schi
'
, Ra"ona %tefan
'
,
Andreea orosanu
'
, Dana Birsan
'
, .%. $hi"peteanu, $abriela Ro"an
'
I)t$%(cti$): >he presence of risD factors such as hHpertension$ dis&lHcemia$
overIei&ht=obesitH$ associated Iith sedentarH lifestHle$ unhealthH dietarH habits and
familH historH of diabetes$ has predictive value for the lon& term development of diabetes
Iithin the &eneral population
Mateia! a)% #et/$%: 5B/ unselected subGects Iithout diabetes from si7 Romanian
cities ()rasov$ )uzau$ ,iatra (eamt$ <rad$ Sibiu$ >& *ures) Iere included <
Luestionnaire Ias applied to the studH &roup in order to evaluate the risD of develpin&
diabetes Iithin the ne7t ten Hears >he Luestionnaire included &eneral data( a&e$ se7$
environment)$ anthropometric data (Iaist cirumference$ Iei&ht$ hei&ht$ )*')$ as Iell as
data re&ardin& phHsical activitH$ dietarH habits$ the presence of arterial hHpertension$
dis&lHcemia and familH historH of diabetes <t the end of the test $ a risc score Ias
calculated$ accordin& to a standardized scorin& sHstem Iithin the M'(DR'SZ studH$
Ihich divided the patients into a feI risD cate&ories (loI$ sli&htlH elevated$ moderate$
hi&h$ verH hi&h)
Re"(!t": Mrom the 5B/ participants$ /#$21 Iere Iomen and 1.$/1 men$ environment!
/2$. 1 urban and 10$11 rural$ and from anthropometric point of vieI the folloIin&
aspects Iere noticed! 0#$21 had a Iaist circumference _ /#cm in Iomen and _.0cm in
men$ 16$61 had a Iaist circumference /#8//cm in Iomen and betIeen .#8.0 cm inmen
and 02$1 1 had a Iaist circumference Y//cm in Iomen and Y1#2cm in men <s
re&ardin& the )*'$ 06$/51 of subGects had a normal Iei&ht$ 50$211 Iere overIei&ht
and 16$BB1 Iere obese$ se7 repartition consistin& of verH close percents (normal Iei&ht
females8 0/$21$ males802$21T overIei&ht8 females 852$//1 and males *801$11T obese!
females81/$B01 and males *815$61) >he folloIin& risD cate&ories came out Ihen
calculatin& risD scores! _6 (loI risD8 1 subGect in 1## Iill develop diabetes durin& the
ne7t 1#Hears) 82#$20181/B subGectsT score 6811(sli&htlH elevated$ 1in 22)! 26$61181#2
subGectsiT score 12810(moderate$ 1 in B)! 10$B61820 personsT score 1282# (hi&h risD$ 1 in
5)! B$221825personsT score Y2# (verH hi&h risD$ 1 din 2)! #$/1185 subGects On avera&e$
221 have an unhealthH lifestHle ( sedentarH$ theH donRt eat fruits and ve&etables dailH)$
and theH suffer from hHpertension and=or theH are under medication for this condition
621 of the Luestioned donRt have a familH historH of diabetes$ 221 have relatives Iith
diabetes of Ihich$ 121 first de&ree relatives 121 of the studH &roup have a fastin&
&lHcemiaY11#m&=dl >he studH participants belon& to different a&e &roups$ half of them
bein& included in the _ 02Hears
Di"c(""i$) a)% c$)c!("i$)": ;alf82#$201fo the studH &roup had a loI risD of
developin& diabetes Iithin the ne7t 1# Hears$ 05$21 had a moderate risD$ Ihile onlH
6$#B1 Iere identified as bein& at hi&h risD >he studH &roup consisted mainlH of Houn&$
6.
active subGects$ beloI 22Hears of a&e$ from Ihich half havin& a normal Iei&ht and half
overIei&ht and obese$ Iith the clear predominance of females
>he Luestionnaire Ie applied could be used as an instrument of identifHin& people at
increased risD of developin& tHpe 2 diabetes (especiallH realtives of people Iith diabetes)$
havin& the opportunitH of an earlH initiation of lifestHle optimization$ in order to
prevent=delaH the onset of this disease
>he data Ie collected are much aliDe the ones published bH the *inisterH of ;ealth from
the compulsorH investi&ationsRpro&ramme
NUTRIIA PACIENILOR CU DIABET ZAHARAT
Conf. Dr. $abriela Ne,rianu, +/ >4ictor Babe& )i"ioara
Dr. Raluca e"u, %pitalul *udeean Drobeta )urnu %e(erin
I)t$%(cee
De8a lun&ul timpului$ recomand:rile alimentare pentru pacienii cu diabet zaharat (DZ) s8
au dovedit destul de restrictive %n privina hidrailor de carbon (;9) Re&imul alimentar
(dieta) %n DZ a trecut prin mai multe etape! restricia total: a re&imul bo&at %n lipide i
le&ume$ ]dieta convenional:-$ hipo&lucidic: Din 1./# s8a estimat c: raia &lucidic: %n
DZ poate fi de 228B#1 din necesarul caloric ((9)$ lipidele ma7im 5#1$ iar proteinele
ma7im 2#1 <D< subliniaz: rolul individualiz:rii re&imului alimentar prin aplicarea
terapiei medicale nutriionale (medical nutritional therapy1/23)
C$)7i)(t
*odificarea obiceiurilor alimentare Goac: un rol maGor %n tratamentul i mana&ementul
DZ Obiectivele *(> pentru pacienii cu DZ sunt! obinerea i meninerea &licemiei la
niveluri normale=apropiate de normal$ a profilului lipidic i lipoproteic ce asi&ur: un risc
cardiovascular redus$ a >< la niveluri normale=apropiate de normal$
prevenirea=%ncetinirea ratei de dezvoltare a complicaiilor cronice ale DZ$ asi&urarea
necesit:ilor nutriionale individuale Obiectivele *(> pentru tinerii cu DZ 1$ DZ 2$
&ravidele i femeile care al:pteaz:$ v3rstnicii cu DZ sunt asi&urarea necesit:ilor
nutriionale$ iar pentru cei tratai cu insulin: sau secreta&o&e$ asi&urarea autocontrolului
i tratamentul DZ %n bolile acute
Sste %ncuraGat consumul de ;9 din fructe$ cereale inte&rale$ le&ume$ le&uminoase i
produse lactate de&resate >rebuie limitat aportul de &r:simi saturate la sub 61 din (9$
cu evitarea consumului de &r:simi trans cu un aport de colesterol alimentar sub 2##m&=zi
i consumul a cel puin 2 porii de pete s:pt:m3nal Sunt dovezi insuficiente care s:
indice modificarea aportului proteic obinuit (1282#1 din (9) la diabeticii cu funcie
/#
renala normal: (umeroase studii au %ncercat s: stabileasc: proporia optim: a
macronutrienilor %n dieta diabeticilor 'ndividualizarea compoziiei %n macronutrieni se
va realiza %n funcie de statusul metabolic al pacientului <portul zilnic de alcool trebuie
limitat la o cantitate moderat: (u e7ist: dovezi clare ale beneficiului supliment:rii cu
vitamine i minerale la pacienii cu DZ care nu prezint: deficite
'nsulinoterapia trebuie inte&rat: %ntr8un plan individual de diet: i activitate fizic:
,acienii cu DZ tip 2 sunt %ncuraGai s: implementeze modificarea stilului de via: ,entru
femeile &ravide i cele care al:pteaz: cu DZ$ trebuie asi&urat aportul ener&etic adecvat
care s: asi&ure &reutatea corporal: corespunz:toare A3rstnicii 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 #$/81 &=D&c=zi la diabeticii care
prezint: stadii incipiente de boal: cronic: renal: i la #$/ &=D&c=zi la cei cu boal: cronic:
renal: ,entru diabeticii cu risc cardiovascular$ dietele bo&ate %n fructe$ le&ume$ cereale
inte&rale$ olea&inoase pot reduce riscul cardiovascular >ratamentul obinuit al
hipo&licemiei este reprezentat de in&estia a 1282# & de &lucoz:
<plicarea terapiei medicale nutriionale presupune parcur&erea a 0 etape! evaluarea
statusului iniial$ stabilirea obiectivelor$ intervenia nutriional:$ evaluarea periodic:
NUTRITION OF DIABETIC PATIENTS
Ass. Prof. Dr. $abriela Ne,risanu, +ni(ersit3 of edicine and Phar"ac3 !4ictor
Babes&, )i"isoara
Dr. Raluca e"u, Count3 0ospital, Drobeta )urnu %e(erin
I)t$%(cti$)
(utritional recommendations for diabetic patients Iere restrictive re&ardless
carbohHdrates for a lon& time >he diet has passed some periods! total restrictive in
carbohHdrates$ a diet rich in fat and le&umes$ +conventional diet- period Mrom 1./# Ias
accepted that carbohHdrate maH represent 228B#1 from caloric necessarH$ fat 5#1 or less
and protein 2#1 or less <D< pointed out the role of individualization of the diet and the
role of medical nutritional therapy1/23
C$)te)t
DietarH habits modification plaHs an important role in treatment and mana&ement of
diabetes mellitus?oals of *(> that applH to individuals Iith diabetes are! achieve and
maintain blood &lucose levels in the normal ran&e$ lipid and lipoprotein profile that
reduces the risD for vascular disease$ blood pressure levels in the normal ran&e$ to
prevent=sloI the rate of development of the chronic complications of diabetes ?oals of
*(> that applH to Houth Iith diabetes$ pre&nant and lactatin& Iomen$ and older adults
/1
Iith diabetes are! to meet the nutritional needs and for individuals treated Iith insulin or
insulin secreta&o&ues$ to provide self8mana&ement trainin& and diabetes treatment durin&
acute illness
'n diabetes mana&ement$ are recommended carbohHdrate from fruits$ ve&etables$ Ihole
&rains$ le&umes$ and loI8fat milD$ to limit saturated fat intaDe to #61 of total calories$ to
minimized intaDe of trans fat$ to limit dietarH cholesterol to #2## m&=daH Mor individuals
Iith diabetes and normal renal function$ there is insufficient evidence to su&&est that
usual protein intaDe (12U2#1 of ener&H) should be modified (umerous studies have
attempted to identifH the optimal mi7 of macronutrients for the diabetic diet >he best
mi7 of carbohHdrate$ protein$ and fat appears to varH dependin& on individual
circumstances 'ndividualization of the macronutrient composition Iill depend on the
metabolic status of the patient <lcohol dailH intaDe should be limited to moderate
amount >here is no clear evidence of benefit from vitamin or mineral supplementation in
people Iith diabetes Iho do not have underlHin& deficiencies
'nsulin therapH should be inte&rated into an individualRs dietarH and phHsical activitH
pattern 'ndividuals Iith tHpe 2 diabetes are encoura&ed to implement lifestHle
modifications Mor pre&nancH and lactation Iith diabetes adeLuate ener&H intaDe that
provides appropriate Iei&ht &ain is recommended Obese older adults Iith diabetes maH
benefit from modest ener&H restriction and an increase in phHsical activitH Reduction of
protein intaDe to #/U1# &=D& bodH It=daH in individuals Iith diabetes and the earlier
sta&es of chronic DidneH disease (9ZD) and to #/ &=D& bodH It=daH in the later sta&es of
9ZD maH improve measures of renal function and is recommended Mor patients Iith
diabetes at risD for 9AD$ diets hi&h in fruits$ ve&etables$ Ihole &rains$ and nuts maH
reduce the risD 'n&estion of 12U2# & &lucose is the preferred treatment for hHpo&lHcemia
Mor the implementation of *(> it is necessarH to run throu&h 0 steps! evaluation of
initial status$ establishment of the &oals$ nutritional intervention$ periodical evaluation
FACTORII DE RISC CARDIOVASCULAR :I STAREA POSTPRANDIAL9 N
DIABETUL ZAHARAT TIP 5
$abriela Ro"an
9,:
, Andreea oroanu
:
, Delia Ro"an
:
, ariana Coca
:
, N. 0#ncu
9,:
9
+ni(ersitatea &Iuliu 0aie,anu&@
:
Centrul Clinic de Diabet, Nutriie, Boli "etabolice,
Clu15Napoca
Bac-.$()%6 Mactorii de risc cardiovascular se asociaz: prin mecanisme etioptao&enice
interdependente %n cadrul sindromului metabolic i al diabetului zaharat tip 2 Statusul
postprandial este considerat un important factor de risc cardiometabolic$ prin
/2
hiper&licemie$ hiperlipidemie$ inflamaie$ adipoDine atero&ene Obiectiv6 Studiul de fa:
a avut ca obiectiv evaluarea implic:rii adiponectinei$ visfatinei i a marDerilor inflamatori
%n statusul postprandial %n dibetul zaharat tip 2 De"i.) 2i #et$%e6 Fn studiu au fost
incluse 0# persoane cu DZ tip 2 i obezitate i 2 persoane normoponderale f:r: diabet ca
i control ,robele biochimice au fost prelevate %n condiii bazale$ la 2 i 0 ore
postprandial! &licemia$ lipide$ adiponectin:$ visfatin:$ >(M8alpha$ interleuDin:8B$ hi&h
sensitive 98Reactive protein$ fibrino&en Re"(!tate6 n condiii bazale au fost evideniate
diferene semnificative %ntre lotul de personae cu diabet zaharat i lotul de control %n ce
privete visfatina (2B C 1/$5 vs 122 C 5 n&=mlT p 4 ##2) i hi&h sensitive 98Reactive
protein (06 C 56 vs #5/ C #52 m&="T p4###1) Fn statusul postprandial$ o cretere
semnificativ: a fost observat: %n cazul visfatinei (p4##5)$ interleuDinei8B (p4##12)
i hi&h sensitive 98Reactive protein (p4##16) Fn cadrul &rupului cu diabet zaharat$ la 2
ore postprandial s8a constatat o cretere semnificativ: a &licemiei i la 0 ore postprandial
a >(M8alpha i 98Reactive protein C$)c!('ii6 9reteri semnificative la persoanele cu
diabet zaharat tip 2 comparativ cu lotul de control au fost constatate %n cazul visfatinei i
hi&h sensitive 98Reactive protein <diponectina a fost sc:zut: la cei cu diabet zaharat$
f:r: diferen: semnificativ: cu lotul de control Fn &rupul cu diabet$ >(M8alpha$ 98
Reactive protein i &licemia au fost crescute postprandial$ ceea ce demonstreaz: c: %n
diabetul zaharat tip 2 acioneaz: multiplii factori de risc cardiovascular
3e@G$%": risc cardiometabolic$ adiponectin:$ visfatin:$ status postprandial
CARDIOVASCULAR RIS3 FACTORS AND POSTPRANDIAL STATUS IN
T,PE 5 DIABETES MELLITUS
$abriela Ro"an
9,:
, Andreea oroanu
:
, Delia Ro"an
:
, ariana Coca
:
, N. 0#ncu
9,:
9
&Iuliu 0atie,anu& +ni(ersit3 of edicine and Phar"ac3@
:
Clinical Center of
Diabetes, Nutrition, etabolic diseases, Clu15Napoca, Ro"ania
Bac-.$()%: >he cardiometabolic risD factors are clustered bH interdependent
ethiopatho&enetic mechanisms$ Iithin the metabolic sHndrome and tHpe 2 diabetes Due
to hHper&lHcemia and hHperlipidemia$ postprandial state is noI reco&nized an important
factor that increases the cardiovascular risD <lso other athero&enetic risD factors maH be
associated Iith postprandial state! inflammation$ adipoDHnes Ob8ective: >he aim of the
studH Ias to evaluate the involvement of adiponectin$ visfatin and inflammatorH marDers
in the postprandial state in people Iith tHpe 2 diabetes De"i.) a)% #et/$%! < number
of 0# persons Iith tHpe 2 diabetes and obesitH have been included Mive normoponderal
persons Iithout diabetes have provided the control )lood test have been performed
fastin& and at 2 and 0 hours postprandial! &lHcemia$ lipids$ adiponectin$ visfatin$
inflammatorH marDers (>(M8alpha$ interleuDin8B$ hi&h sensitive 98Reactive protein$
fibrino&en) Re"(!t": 'n basal conditions$ si&nificant differences have been found
betIeen the persons Iith obesitH and tHpe 2 diabetes and the control &roup in terms of
/5
visfatine (2B C 1/$5 vs 122 C 5 n&=mlT p 4 ##2) and hi&h sensitive 98Reactive protein
(06 C 56 vs #5/ C #52 m&="T p4###1) 'n postprandial state$ si&nificant increase of
visfatine (p4##5)$ interleuDin8B (p4##12) and hi&h sensitive 98Reactive protein
(p4##16) have been found in diabetes &roup compare to control Kithin diabetes
&roup$ a si&nificant 28hour postprandial &lHcemia and 08hour postprandial increase of
>(M8alpha and 98Reactive protein has been found C$)c!("i$)"6 < si&nificant
difference betIeen diabetes and control has been found in terms of visfatin and hi&h
sensitive 98Reactive protein that are increased in diabetes <diponectin Ias loIer in
diabetes &roup$ but not statisticallH si&nificant compare to control &roup 'n diabetes
&roup$ >(M8alpha$ 98Reactive protein and &lHcemia have been found to be increased in
the postprandial state$ Ihich demonstrates that in diabetes$ multiple factors act to
increase cardiovascular risD
3e@G$%": cardiometabolic risD$ adiponectin$ visfatin$ postprandial state
ROLUL LDL COLESTEROLULUI IN CADRUL SINDROMULUI METABOLIC
$eor,eta Inceu
9
, Nicolae 0ancu
9,:
9
Centrul Clinic de Diabet -aharat, Nutritie si Boli etabolice, Clu15Napoca
:
+ni(ersitatea de edicina si /ar"acie !Iuliu 0atie,anu&, Clu15Napoca
I)t$%(cee "i $biective
Diabetul zaharat este considerat echivalent de boala cardiovasculara$ astfel incat tintirea
a&resiva a tuturor factorilor ce alcatuiesc riscul cardiometabolic constituie un obiectiv
maGor in cadrul mana&ementului pacientilor cu diabet zaharat "D" colesterolul este un
important factor de risc cardiovascular$ dar implicatiile sale in cadrul sindromului
metabolic constituie inca o controversa "ucrarea de fata isi propune analiza unei posibile
corelatii intre sindromul metabolic si "D" colesterol la pacientii cu diabet zaharat tip 2
Mateia! "i #et$%a
<m efectuat un studiu retrospectiv la pacientii cu diabet zaharat tip 2 (DZ tip 2) internati
in 9entrul de Diabet 9luG in perioada ianuarie8martie 2##/ <m analizat date clinice si
demo&rafice$ prezenta sindromului metabolic (conform criteriilor 'DM 2##2)$ a bolii
cardiovasculare$ schemele de tratament folosite$ precum si corelatia dintre "D" colesterol
(luand ca si obiectiv tinta valoarea de 1##m&=dl) si diversi factori de risc cardiovascular
(in particular sindromul metabolic) Datele au fost prelucrate si analizate cu pro&ramul
S,SS 1#
Re'(!tate
/0
'ntre& lotul analizat a inclus 2## de pacienti cu DZ tip 2$ cu varsta medie de 2/C.$22 ani$
01$21 barbati$ cu o durata medie a diabetului de 1#$2C6$#5 (1851) ani Referitor la
tratament$ 1$11 erau sub monoterapie orala$ 11$21 cu terapie orala combinata$ 021 au
beneficiat de asocierea insulina8antihiper&licemiante orale$ 02$61 erau numai sub
insulinoterapie$ in timp ce 02$.1 din intre& lotul aveau metformin in schema terapeutica
Dintre pacienti$ //$/1 erau hipertensivi$ .2$B1 intruneau criteriile sindromului
metabolic$ 021 erau dia&nosticati cu boala cardiovasculara si 6.$51 aveau complicatii
microvasculare prezente Dintre pacientii cu sindrom metabolic 20$21 aveau "D"
colesterol @1## m&=dl si B2$B1 erau cu tri&liceride @12#m&=dl Dintre pacientii cu boala
cardiovasculara prezenta 0.$01 erau cu "D" colesterol @1##m&=dl si B2$/1 cu
tri&liceride @12#m&=dl <nalizand separat pacientii cu "D" cholesterol@1##m&=dl
(acestia reprezinta 2#$521 din intre& lotul ) am constatat ca /6$01 sunt hipertensivi$ 0#1
au fost dia&nosticati cu boala cardiovasculara si o maGoritate covarsitoare (.0$61)
intrunesc criteriile de dia&nostic ale sindromului metabolic
C$)c!('ii
Rezultatele acestei analize observationale ilustreaza inca o data rolul fundamental al "D"
colesterolului la pacientii cu sindrom metabolic si diabet zaharat Maptul ca peste .#1
dintre pacientii cu "D" cholesterol @1##m&=dl intruneau criteriile de dia&nostic ale
sindromului metabolic$ fac plauzibila ipoteza ca aceasta formatiune lipidica cu rol central
in atero&eneza ar putea deveni parte inte&ranta in cadru conceptului de sindrom
metabolic
LDL CHOLESTEROL AND ITS ROLE IN METABOLIC S,NDROME
$eor,eta Inceu
9
, Nicolae 0ancu
9,:
9
Clinical Center of Diabetes, Nutrition, etabolic diseases, Clu15Napoca, Ro"ania
:
!Iuliu 0atie,anu& +ni(ersit3 of edicine and Phar"ac3, Clu15Napoca
I)t$%(cti$) a)% $b8ective
Diabetes mellitus is considered cardiovascular disease eLuivalent$ so a&&ressive tar&etin&
of all cardiometabolic risD factors is a maGor obGective in the mana&ement of diabetic
patients "D" cholesterol is an important cardiovascular risD factor$ but its implications
in the metabolic sHndrome are still a controversH >his paper aims to analHze a possible
correlation betIeen metabolic sHndrome and "D" cholesterol in patients Iith tHpe 2
diabetes
Mateia! a)% #et/$%
Ke conducted a retrospective studH in patients Iith tHpe 2 diabetes admitted in 9luG
Diabetes 9enter durin& WanuarH to *arch 2##/ Ke analHzed demo&raphic and clinical
/2
data$ the presence of metabolic sHndrome (defined accordin& to the 'DM 2##2 criteria)$
cardiovascular disease$ treatment schemes used$ as Iell as the relationship betIeen "D"
cholesterol (taDin& as obGective tar&et value of 1##m&=dl) and various cardiovascular risD
factors (in particular metabolic sHndrome) >he data Iere processed and analHzed Iith
the S,SS 1#
Re"(!t"
>he entire batch analHzed included 2## patients Iith tHpe 2 diabetes$ Iith an avera&e a&e
of 2/ C .22 Hears$ 0121 men$ Iith an avera&e duration of diabetes 1#2 C 6#5 (1851)
Hears Re&ardin& the treatment$ 111 Iere under oral monotherapH$ 1121 received
combined oral therapH$ 021 benefited from the combination of oral therapH and insulin$
0261 Iere under insulin therapH$ Ihile 02.1 of all patients had metformin in their
treatment re&imen ///1 of the patients Iere hHpertensive$ .2B1 meet the metabolic
sHndrome criteria$ 021 Iere dia&nosed Iith cardiovascular disease and 6.51 had
microvascular complications <mon& patients Iith metabolic sHndrome 2021 had "D"
cholesterol @ 1## m& = dl and B2B1 had tri&lHcerides @ 12#m&=dl <mon& patients Iith
this cardiovascular disease 0.01 had "D" cholesterol @ 1##m&=dl and B2/1 had
tri&lHcerides @ 12#m&=dl Khen separatelH analHzed patients Iith "D" cholesterol @
1##m&=dl (this represents 2#521 of the entire lot) Ie found that /601 are hHpertensive$
0#1 Iere dia&nosed Iith the cardiovascular disease and an absolute maGoritH (.061)
meet metabolic sHndrome dia&nosis criteria
C$)c!("i$)"
Observed results of this paper illustrate once a&ain the fundamental role of "D"
cholesterol in patients Iith metabolic sHndrome and diabetes >he fact that over .#1 of
patients Iith "D" cholesterol @ 1##m&=dl meet the dia&nostic criteria for metabolic
sHndrome$ maDe plausible the assumption that this lipoprotein components Iith a central
role in athero&enesis could become an inte&ral part of the metabolic sHndrome concept
RAPORTARE DE CAZ:
HIPOGLICEMII REPETATE LA O PACIENT9 DIABETIC9 IN PROGRAM DE HIPOGLICEMII REPETATE LA O PACIENT9 DIABETIC9 IN PROGRAM DE
DPCA N TRATAMENT CU SOLUII DE ICODE0TRIN DPCA N TRATAMENT CU SOLUII DE ICODE0TRIN
$. Ioni $. Ioni
9 9
, D. Pencu , D. Pencu
: :
, A. Cir1an , A. Cir1an
: :
, C. Ionescu , C. Ionescu
: :
, . 4oiculescu , . 4oiculescu
: :
9 9
Institutul National de Diabet, Nutriie i Boli etabolice N. C. Paulescu , Bucuresti, Institutul National de Diabet, Nutriie i Boli etabolice N. C. Paulescu , Bucuresti,
Ro"ania Ro"ania
: :
Institutul Clinic /undeni C Institutul Clinic /undeni Cent entrul de edicin Intern5 rul de edicin Intern5 Buc Bucureti, ureti, Ro"ania Ro"ania
/B
Din ce %n ce mai muli pacienii cu 'R9 stadiul uremic sunt inclui %n pro&ramul
de dializ: peritoneal: continu: ambulatorie
Dintre acetia$ pacienii cu diabet zaharat sunt o cate&orie 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 'code7trin
(S7traneal)$ un polimer al &lucozei derivat din porumb care presupune o absorbie
sc:zut: a carbohidrailor$ permi3nd astfel un mai bun control al &licemiei i care poate
%mbun:t:i ultrafiltrarea i clearance8ul creatininei la pacienii cu ,S> ;i&h<vera&e sau
;i&h(transport peritoneal Fnalt sau Fnalt*ediu)
Dei 'code7trinul nu este metabolizat %n peritoneu$ poate fi absorbit prin sistemul
limfatic %n circulaia sistemic:$ unde este hidrolizat de c:tre amilaz: %n
oli&ozaharide(maltoz:$ maltotrioz:) *ulte &lucometre folosesc in benzile teste &lucoz8
dehidro&enaza cu coenzima piroloLuinolineLuinone$ pentru a cataliza conversia &lucozei
la acidul &luconic i a reduce acidul adenin dinucleotid nicotinamidic ((<D;)
9antitatea de (<D; m:surat: de &lucometru este direct proporional: cu concentraia
&lucozei din mostra de s3n&e ?lucoz8dehidro&enaza cu coenzima
piroloLuinolineLuinone (,QQ) poate reaciona cu radicalul liber al &lucozei localizat la
cap:tul moleculei de maltoz:$ produc3nd o cantitate adiional: de (<D;$ contribuind la
supraestimarea nivelului &licemiei (5)
Aom prezenta cazul unei paciente cu DZ tip ' i 'R9 std A %n pro&ram D,9<$ %n
tratament cu 'code7trin$ care a suferit repetate hipo&licemii datorit: m:sur:torilor
inadecvate a &licemiilor m:surate cu &lucometru pe baz: de &lucoz8dehidro&enaz:
,acienta$ %n v3rst: de 05 ani$ cunoscut: cu diabet zaharat tip 1 din 1..0 %n
tratament cu insulina aspart!1#N(ora/)81#N(ora10)81#N(ora2#) i
insulina &lar&ina! 1#N(ora22)$ nefropatie diabetic: din 2##B$ ;>< secundara reno8
parenchimatoas:$ dislipidemie mi7t:$ insuficien: renal: cronic: din 2##B %n pro&ram de
D,9< din #6#B2##6 se interneaz: pentru sindrom febril 5/85. k9 i su&hi de
apro7imativ 20ore$ stare confuzional:( iniial a&itaie psihomotorie$ ulterior refuz
alimentar i verbal de cca 0/ore) *enion:m c: la domiciliu pacienta a prezentat
numeroase episoade hipo&licemice (non8complian: la re&imul alimentar i tratament
antidiabetic$ non8complian: la indicaia de neutilizare pt determinarea &licemiei a
&lucometrelor8 test de &lucoz8dehidro&enaz:) i nu a mai urmat medicaia antidepresiv:
:n ultimele 2 luni (non8complian: la tratament)
Obiectiv! stare &eneral: mediocr:$ contient:$ febril: (5/k9)$ a&itaie psiho8
motorie$ dezorientat: temporo8spaial$ areactiv: la stimuli verbali$ reactiv: la stimuli
dureroiT redoare de ceaf:$ opistotonusT te&umente i mucoase palide$ uscateT fara edemeT
ap respirator U*A prezent bilateral$ fara raluriT ap cardiovascular U >< 25#=1## mm;& $
<A8.#= min$ ritm re&ulat$ fara sufluri supraad:u&ate$ artere periferice pulsatileT ap
di&estiv U abdomen suplu$ uor sensibil la palpare %n epi&astru$ mobil cu mic:rile
respiratorii$ ficat i splina %n limite normale$ tranzit intestinal normalT ap urinar U loGe
renale libere$ ?iordano (8) bilateral$ diureza42##ml$ NM41###ml=20ore$ efluent limpede
/6
,araclinic! sdr anemic(;b 1#68// &=dl$ ;t 55182611)$ sdr inflamator!
"eucocitoz:(12B##822B##=mmc)$ Mb&42B0m&=dl$ hipoalbuminemie$ hipoproteinemie$
coa&ulare$ (a$ Z %n limite normale$ hipocalcemie$ sdr de retenie azotat:! creatinina4B.8
B1m&=dl$ uree41B58215m&=dl$ oscilaii hipo8hiper&licemice cu valori %ntre 00822. m&=dl)
(determin:ri pe laborator)
9onsultul neurolo&ic a infirmat suspiciunea de meni&it:(,uncia lombar:8 "9R
limpede$ f:r: celule$ proteinorahie normala) sau de <A9 (9> cerebral f:r: acumul:ri
hemora&ice cu caracter recent intracerebrale) i a pus dia&nosticul de Sncefalopatie
metabolic: cu febra de ori&ine central: ,e parcursul intern:rii pacienta a prezentat crize
convulsive cu debut membre drepte i &eneralizare secundar:$ remise dup: administrare
de diazepam ivT s8a repetat puncia lombar:8 cu proteinorahie normal: 9onsultul
psihiatric a confirmat %ntreruperea tratmanetului antidepresiv i a pus dia&nosticul de
depresie reactiv: S8a efectuat R*( cerebral care a decelat leziuni demielinizante
supratentoriale bilaterale de mici dimensiuni$ minim proces inflamator mastoidian
bilateral i sfenoidal i moderat: atrofie cerebral:
Fn timpul intern:rii pacienta a primit tratament de echilibrare hidroelectrolitica i
acido8bazic:$ insulinoterapie$ hipotensoare$ anticonvulsivante i antidepresive cu evoluie
lent favorabil:$ cu remiterea convulsiilor i a sdr febril $ remiterea sindromului de a&itaie
psiho8motorie i creterea &radului de complian: la re&imul alimentar i medicamentos
%n condiiile controlului &licemic i normalizarea calcemiei
<m considerat simptomatolo&ia de la internare i din cursul spitaliz:rii secundar:
unor episoade repetate de hipo&licemie i a&rav:rii tulbur:rii depresive reactive prin non8
compliana la diet: i insulino8terapie$ prin utilizarea nepermis: a &lucometrelor pe baz:
de dehidro&enaz: %n conte7tul dializei peritoneale cu 'code7trin i prin non8compliana la
terapia antidepresiv:
S8au f:cut studii comparative %ntre diferite metode de m:surare a &licemiei pe
baz: de &lucometre8 prin &lucoz8dehidri&enaz:$ prin &lucoz8o7ireductaz:$ prin &lucoz8
o7idaz: comparativ cu valorile m:surate prin metoda de laborator din s3n&ele
venos(he7oDinaz:) la diabeticii aflai %n D,9< cu soluii cu 'code7trin >oate
&lucometrele supraestimeaz: valorile &licemiei$ cele mai mici diferene fa: de valorile
obinute prin laborator au fost %nre&istrate cu &lucometrele pe baz: de &lucoz8o7idaz:
'nclusiv firma producatoare de 'code7trin avertizeaz: asupra supraestim:rii valorilor
&licemiei determinate cu &lucometre pe baz: de ?D; ,QQ i &lucoz8o7idoreductaz: la
pacienii diabetici in pro&ram de D,9< cu soluii de 'code7trin(2) 9u toate acestea %nc:
se mai observ: cazuri de hipo&licemii din cauza folosirii acestor &lucometre
CASE REPORT:
REPEATED H,POGLICEMIC EPISODES IN A DIABETIC PATIENT +ITH
ESRD AND PERITONEAL D,ALISES +ITH ICODE0TRIN SOLUTION
//
$. Ioni $. Ioni
9 9
, D. Pencu , D. Pencu
: :
, A. Cir1an , A. Cir1an
: :
, C. Ionescu , C. Ionescu
: :
, . 4oiculescu , . 4oiculescu
: :
9 9
Institute of Diabetes, Nutrition and etabolic Diseases 8N. C. Paulescu8, Bucharest Institute of Diabetes, Nutrition and etabolic Diseases 8N. C. Paulescu8, Bucharest
Ro"ania Ro"ania
: :
/undeni /undeni Clinical Institute 5 Center of Internal edicine, Buc Clinical Institute 5 Center of Internal edicine, Bucharest, harest, Ro"ania Ro"ania
*ore and more patients sufferin& from SSRD are included in peritoneal dialHses
pro&rames Diabetic patients Iith SSRD and 99D, have to be carefullH monitorised
because of the interferences betIeen insulin treatment and dialHses solutions 'code7trin
(S7traneal) peritoneal dialHsis solution is a &lucose polimer derived from cornstarch Iich
has a loI carbohHdrates absobtion and is prefered in diabetic patients because of a better
&licemic control and because it can improve lon&8dIell ultrafiltration and clearance of
creatinine for patients Iith ;i&h8avera&e or ;i&h ,S>
>hese &lucose polHmers are absorbed via the peritoneal route and metabolised to
oli&osaccharides (mainlH maltose)$ Ihich interfere Iith &lucose *anH &lucometers are
usin& the &lucose dehHdro&enase$ an enzHme of the pHrroloLuinolineLuinone class$ for
catalHsin& the conversion of &lucose to &luconic acid and reducin& (icotinamide adenine
dinucleotide <cid ((<D;) >he LuantitH of (<D; is in direct proportion Iith the
&licemia >he &lucose dehHdro&enase reacts Iith the free reducin& &roup of the &lucose
molecule located at the end of each saccharide chain and this aditional LuantitH of (<D;
is leadin& to an overestimation of the &licemia
Ke Iill present the case of a patient Iith diabetes mellitus tHpe ' and SSRD in
dialHsis peritoneal pro&ram Iith 'code7trin$ that presented several hHpo&licemic
episodes because of the inadeLuacH measurements of &lHcemia usin& &lucose
dehHdro&enase pHrroloLuinolineLuinone &lucometers
>he patient$ a Ioman of a&e 05 Hears$ Iith diabetes mellitus tHpe ' from 1..0 in
treatment Iith aspart insulin! 1#N( at / am)8 1#N( at 10 am)8 1#N( at / pm) and
&lar&ina insulin! 1#N( at 1# pm)T diabetic nephropathH(2##B)T renal hHpertensionT
dHslipidemiaT SSRD in dialHsis peritoneal pro&ram from #6#B2##/ She presented for
fever (5/85. k9)$ hiccup (for the last 20 hours)$ confusional state (initiallH an7ietH$ then
she refused to speaD and to eat for the last 0/ hours) >he patient presented several
hHpo&licemic episodes (noncompliance at the diet and medical treatment$
noncompliance at the indication of not usin& &lucose8dehHdro&enase &lucometers) and
she has stopped the antidepressive medication for the last tIo months
,hHsical e7amination! fever(5/k9)$ an7ietH$ confusionT nonreactive to verbal
stimuli but reactive to painT nuchal ri&iditH to passive fle7ion$ opisthotonusT pale sDin and
mucous membranesT no edemaT pulmonar e7am U normalT cardiovascular e7am! ><8
25#=1##mm;&$ ;R8.#=minT mild epi&astric tenderness T no hepatosplenome&alHT
?iordano (8) bilateral$ diuresis 82##ml=daH$ ultrafiltrate 81###ml=daH$ clear peritoneal
effluent
/.
,araclinical! anemic sindrom (;b 1#68// &=dl$ ;t 55182611)$ inflamatorH
sindrom (K)9812B##822B##=mmc$ Mb&42B0m&=dl$ hHpoalbuminemia$ hHpoproteinemia$
hHpocalcemia$ coa&ulation$ (a$ Z U normal$ chronic renal disease(creatininemia4B.8
B1m&=dl$ )N(41B58215m&=dl$ hHpo8hHper&licemic values betIeen 00822. m&=dl
(eurolo&H specialist infirmed the suspicion of menin&itis(lombar puncture U
clear cephalorahidian liLuid$ normal proteinorahia) or of stroDe (cerebral tomo&raphH8 no
hemora&H ) and dia&nosed the patient Iith *etabolic SncephalophatH and fever of
central ori&inDurin& the hospitalisation she presented tIo partial seizures Iith
secondarH &eneralization remited after Diazepam iv < lombar puncture Ias repeated
and Ias normal
>he ,sHchiatrist confirmed that the patient stoped her antidepressive treatment
and dia&nosed the Reactive Depression >he cerebral R*' found small supratentorial
demHelinization lesions$ minimal inflamatorH process at the mastoid et sfenoid and
moderate cerebral atrophH
Durin& the hospitalization the patient received hHdratation and acid8alDali
eLuilibration treatament$ insulin$ antihHpertensives$ anticonvulsivants and antidepressives
Iith seizures$ fever and an7ietH remission$ Iith a better compliance to the diet and
medical treatment$ Iith a better &licemic control and normalization of the calcemia Ke c
Ke considered the simptomatolo&H as a conseLuence of the hHpo&licemic
episodes and of the a&ravation of the reactive depression due to noncompliance to the
diet and insulin treatment and utilisation of the &lucose dehHdro&enase &lucometers Ihile
peritoneal dHalises Iith 'code7trin solution and noncompliance to the antidepressive
therapH
>here are comparative studies betIeen different methods of &lHcemia
measurement at diabetics in peritoneal dHalise Iith 'code7trin usin& &lucose
dehHdro&enase$ &lucose dehHdro&enase nicotinamide adenine dinucleotide$ or &lucose
o7idase &lucometers and in venous blood usin& the laboratorH reference method
(he7oDinase) <ll &lucometers overestimate real blood &lucose concentrationT the
minimal errors Iere obtained usin& &lucose o7idase &lucometers Sven the producers of
'code7trin Iarn about overestimation of &licemic values usin& &lucose dehHdro&enase or
&lucose o7idoreductase &lucometers$ but there are still cases of severe hHpo&licemia
because of the use of this &lucometer
ASPECTE EPIDEMIOLOGICE IN DIABETUL ZAHARAT TIP 5 >
8 CAD = CENTRUL ANTIDIABETIC? SIBIUF HLOM U 5PPO
Dr. $hise $he.', Dr. %tru,ariu inola', Dr. ot Alina', Dr. Natea Car"en
Narcisa ', ''@
'%pitalul Clinic *ud. de +r,enta %ibiu 7 Clinica Diabet, Nutritie si Boli etabolice @
.#
'' /acultatea de edicina & 4ictor Papilian RR%ibiu, +LB%
I)t$%(cee "i $biective:
'ncidenta diabetului zaharat tip 2 este in crestere in intrea&a lume$ DZ fiind considerat ca
boala endemicaT 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
<utorii si8au propus analiza catorva aspecte epidemiolo&ice ale DZ tip 2 in teritoriul
arondat 9<D Sibiu cu intentia de a dsprinde particularitatile locale ale acestei probleme
pentru ca astfel sa poata &asi metodele necesare imbunatatirii calitatii in&riGirii
Mateia! "i #et$%a:
Studiul s8a realizat printr8o metoda retrospectiva$ datele fiind obtinute de la 9entrul
Wudetean de Statistica si 9entrul de diabet in perioada 1.62 U 2##6 'n studiul noastre am
urmarit!
1) ,revalenta si incidenta DZT
2) Rata complicatiilor in momentul dia&nosticT
5) Svolutia ratei mortalitatiiT
0) ,erioada de supravietuire si speranta de viata
Re'(!tate!
,revalenta DZ in teritoriul arondat orasului Sibiu a crescut de la 1266 ( 1$B1) U in 1.62$
la B$21 8 in 2##6T incidenta a crescut de la 66$2. l U 1.62 la 225$1Bl in 2##6 T rata
mortalitatii la persoanele diabetice s8a mentinut relativ stabil U 2$21 T repartitia pe se7e a
fost ! barbati ! 21$ B51$ femei U 0/$5B1 T in raport de tipul de DZ ! DZ tip ' U 2#$ 5/1$
tip '' U 6.$ B11 T durata medie a evolutiei aparente a DZ a fost de 1B$5 ani T ponderea cea
mai mare a deceselor a fost inre&istrata la cei cu o durata a diabetului cuprinsa intre B U
1# ani si fiind aproape dubla fata de cei cu evolutia DZ cuprinsa intre 182 ani si 11 812
ani T mortalitatea cea mai mare a fost inre&istrata la &rupele de varsta B#8 B. ani si 6# 86.
ani$ fiind de 2$2 ori mai mare fata de &rupa de varsta 2#82. ani 9auzele principale de
deces au fost ! boli cardiace8 B1$ 551$ <A9 U /$021$ tumori U 12$ 601$ boli ale ap
respirator U .$/1 altele U6$61
C$)c!('ii !
1) ,revalenta si incidenta DZ are aceeasi tendinta cu cea inre&istrata in intrea&a lume
si in Romania T
2) 'ncidenta mult crescuta din ultimii ani este data nu numai de evolutia naturala a
DZ $ cat si de depistarea activa T
5) 'ncidenta complicatiilor cronice in momentul dia&nostic este fals redusa din lipsa
investi&atiilor specifice T
0) (u dispunem de date referitoare la diabetul &etational T acest aspect va putea fi
corectat doar prin colaborare eficienta cu medicii de familie si medicii &inecolo&i
.1
T,PE 5 DIABETES MELLITUS U SOME EPIDEMIOLOG,CAL ASPECTS U
SIBIU COUNT,F HLOM U 5PPO
Dr. $hise $he.', Dr. %tru,ariu inola', Dr. ot Alina', Dr. Natea Car"en
Narcisa ', ''@
'%pitalul Clinic *ud. de +r,enta %ibiu 7 Clinica Diabet, Nutritie si Boli etabolice @
'' /acultatea de edicina & 4ictor Papilian RR%ibiu, +LB%
I)t$%(cti$) a)% ai#":
>he tHpe 2 diabetes incidence is increasin& throu&hout the Iorld$ it has bein&
considerated an endemic disease NnfortunatelH the cronic complications of diabetes have
devastatin& conseLuences on the life LualitH$ life e7pectancH and impose a &reat burden
to individuals and societH >he authors proposed to analHse some epidemiolo&ical aspects
of tHpe 2 diabetes in Sibiu District in order to DnoI the local particularities of this
problem and so to prove the specific measures to improve the LualitH of care
Mateia! a)% #et/$%:
>he studH Ias done bH a retrospective method$ the informations Iere collected from the
Statistic Departamental 9enter and Diabetes 9enter of Sibiu 9ountH in the period 1.62 U
2##6T in our studH Ie had a vieI! 1) the prevalence and incidence of diabetesT 2) the rate
of complications at the moment of dia&nosticsT 5) the evolution of the rate of mortalitHT
0) survive period and e7pectancH of life
Re"(!t"!
>he prevalence of D* in Sibiu 9ontH Ias increased from 1266 ( 1$B1) U 1.62 to B$21
8 2##6T the incidence Ias increased from 66$ 2.l 8 1.62 to 225l 82##6T the dHnamic of
mortalitH rate in diabetic population Ias in linear rate U about 2$21 of all casesT men
subGects 8 21$B51$ female subGects U 0/$5BT mortalitH and tHpe of diabetes! tHpe 18
2#$5/1$ tHpe 2 U 6.$B11T the overa&e of apparent evolution of diabetes Ias 1B$5 HearsT
the most freLuent rate of death Ias re&istred to those Iith len&th of D* betIeen B81#
Hears bein& almost double &iven those Iith D* evolution betIeen 182 Hears and 118 12
HearsT the hi&hrst rate of death Ias re&istrated at the &roup of a&e B#8 B. Hears and 6# 86.
Hears$ bein& 2$2 times hi&her than the &roup of a&e 2# U 2. HearsT the main causes of
death Iere heart diseases U B1$551$ stroDe U /$021$ tumors U 12$ 601$ respiratorH
diseases U .$/1$ others 6$6#1
C$)c!("i$)":
.2
1) >he prevalence and incidence of diabetes folloIed the Iorld and Romanian
tendencH T
2) >he hi&her increase in the last Hears Ias due not onlH bH the natural evolution of
diabetes as Iell an active manner of dia&nosisT
5) >he incidence of chronic complications at the moment of dia&nosis is false
decrease bH the lacD of investi&ationsT
0) Ke have no data about &estational diabetes this aspect Iill be effective and
efficient bH a stron& collaboration Iith ?, and &Hnaecolo&ists
MANIFESTARI AUTOIMUNE LA COPILUL
CU DIABET>CELIACHIA
$ina $02N$02A
%pitalului de Copii ,, %fanta aria& IA%I 7 Clinica a III5a

DEFINITIE
B$a!a ce!iaca (numita si celiachie$ intoleranta la &luten) este o boala di&estiva
cronica$ cauzata de in&estia la &luten$ ce implica absorbtia nutrientilor$ vitaminelor si
mineralelor de catre intestin
INTRODUCERE
<ceasta lucrare are ca scop scoaterea in evidenta a relatiei diabet U celiachie$
celiachia pare a fi frecventa la persoanele ce sufera de o boala autoimuna8diabet tip '
MATERIAL SI METODA
S8a luat in studiu un caz internat in clinica a ''' a Spitalului 9linic de
9opii $$Sfanta *aria- de la varsta de 5 ani
REZULTATE
S8a urmarit!
> dia&nosticul de baza pe baza e7amenelor clinice si de laboratorT
> stare clinica! evolutie$ complicatii$ tratament$ pro&nosticT
> complianta familiei in acceptarea di&nosticului si tratamentului
CONCLUZII
H6 Dificultatea dia&nosticarii sindromului celic la copilul cu diabet$
medicul trebuind sa elimine posibilitatea unei alte probleme di&estive
.5
mai frecvente (sindromul intestinului iritabil$ o intoleranta alimentara
sau o boala inflamatorie a intestinului)
56 (ecesitatea colaborarii pacient8mama8medic8asistenta
J <doptarea unei diete fara &luten
AUTOIMMUNE MANIFESTATIONS AT A DIABETIC CHILD U
CELIA3IE
$ina $02N$02A
%pitalului de Copii >%fanta aria& IA%I 7 Clinica a III a
De<i)iti$)
9eliac disease=illness ( also called celiac$ immobilitH to tolerate &luten) is a
chronic di&estive disease$ caused bH the intolerance of &luten$ Ihich prevents the
absorption of the nutrients$ the vitamins and the minerals bH the intestine
I)t$%(cti$)
>his paper IorD is meant to illustrate the relationship betIeen diabetsand celiac
9eliaDie appears more freLuentlH to the persons Iho suffer from an autoimmune disease8
diabetes tHpe '
Mateia! A)% Met/$%
't Ias studied the case of a child in the third class of St *arH 9linic ;ospital
since the a&e of three
Re"(!t"
ObGectives!
8 Dia&nosis based on clinical$ paraclinical and lab e7aminationsT
8 9linical state 9ourse of disease$ complications$ treatment$ pro&nosisT
8 >he familH capacitH of acceptin& the dia&nosis and treatments
C$)c!("i$)"
H6 DifficultH in dia&nosin& the celiac sHndrome at a diabetic child$ the doctor
havin& to eliminate the possibilitH of another freLuent di&estive illness ( the
irritable intestine sHndrome$ on alimental intolerance or an inflammatorH
disease of the intestine)
56 >he necessarH relationship betIeen patient8mother8doctor8nurse
.0
J6 9hoose a diet Iithout &luten
SUFERINA VASCULAR9 N STEATOZA HEPATIC9
DR. I.L. LA%C+,
Cabinet edicina /a"iliei JC/ F DR. LA%C+, -alu
SCOPUL STUDIULUI
Suferina vascular: %n steatoza hepatic: (S;) este comple7:! arterial:$
venoas:$ limfatic: i arteriocapilar:$ ca e7presie a tulbur:rilor metabolice comple7e cu
care se asociaz: S;
MATERIAL :I METOD9
<u fost studiai 1#0 bolnavi! B# femei (M) i 00 b:rbai ()) cu v3rste cuprinse
%ntre 5# i B# ani
Din 00 )! / erau cu diabet zaharat (DZ) tip 1$ 20 cu DZ tip 2 i 12 cu sc:derea
toleranei la &lucoz: (S>?)$ 2/ prezentau boal: varicoas: manifest: clinic i toi
prezentau retinopatie
Din B# M! 0 aveau DZ tip 1$ 2B cu DZ tip 2 i 5# cu sc:derea toleranei la
&lucoz: (S>?)$ 0/ prezentau boal: varicoas: manifest: clinic$ retinopatie dia&osticat:
oftalmoscopic la 0B
Studiul s8a bazat pe datele clinice$ eco&rafie abdominal:$ oftalmoscopie
Observaiile noastre ne8au permis urm:toarele concluzii!
1 Steatoza hepatic: (S;) este o tulburare metabolic: comple7: cu repercursiuni
asupra circulaiei arteriale$ venoase$ arterio8capilare i limfaticeT
2 S; se asociaz: frecvent cu tulbur:ri ale mecanismului &lucidic$ %ndeosebi$ DZ tip 2
i S>?T
5 S; reprezint: o cauz: frecvent: ce precipit: tulbur:rile de circulaie venoas: 8 boala
varicoas:T
0 %ntr8un procent important al cazurilor S; se asociaz: cu retinopatie i posibile
tulbur:ri ale circulaiei cerebrale observate clinicT
5. S; reprezint: un factor important ce precipit: apariia ascitei ce pledeaz: pentru
afectarea circulaiei limfatice
.2
VASCULAR INVOLVMENT IN LIVER STEATOSIS
DR. I.L. LA%C+,
/a"il3 Doctor Practice, -alu
?oal! >he vascular involvment in "iver Steatosis ("S) is verH comple7! arterial$
venous$ lHmphatic and arterio8capillarH$ due to the comple7 metabolic chan&es associated
Iith "S
>he studH Ias done on 1#0 patients$ B# females (M) and 00 males (*)$ Iith a&es
betIeen 5# and B# Hears old
Mrom 00 *! / had Diabetes *ellitus (D*) tHpe 1 and 22 had D* tHpe 2$ 12
presented Iith &lucose intolerance ('?>) and 2/ presents Iith varicose disease and all of
these patiens had retinopathH
Mrom B# M$ 0 presented Iith D* tHpe 1$ 2B presented D* tHpe 2$ 0/ presented
Iith varicose disease manifested and 5# '?>$ 0B Iith retinopathH sia&nosed bH
ophtalmoscope
>he studH Ias based on clinical data$ abdominal ultra8sound and ophtalmoscopic
e7amination of the retina
<fter e7aminations Ie draI the folloIin& conclusions!
1 "S is a comple7 metabolic chan&e Iith repercussion on the arterial$ venous$
arterio8capillarHand limphatic circulationT
2 "S is frecLuent associated Iith chan&es in &lucose U starch metabolism$ speciallH
in tHpe 2 D*T
5 "S represents a freLuent cause that precipitates venous circulatorH involvement U
varicose diseaseT
0 Si&nificant percenta&e of "S cases is associated Iith retinopathH and possible
cerebral circulation$ clinical observationT
2 "S represents an important cause that precipitates ascites$ meanin& the lHmphatic
circulation is impaired
E0ISTA IN PRACTICA FACTORI PREDICTIVI PENTRU DURATA DINTRE
DIAGNOSTICUL DIABETULUI ZAHARAT TIP 5 SI INITIEREA
INSULINOTERAPIEIY
Ilinca Lenta, Adrian Copcea, Dana %i"u, %il(ia %tefania Iancu
Centrul Clinic de Diabet, Nutritie si Boli etabolice Clu15Napoca
.B
INTRODUCERE: Diabetul zaharat tip 2$ caracterizat prin doua mecanisme
interdependente! deficitul insulinosecretor si insulinorezistenta$ are o evolutie pro&resiva$
potential influentata de factori precum &lucoto7icitatea$ lipoto7icitatea$ folosirea
anumitor clase de antidiabetice orale ,utini dintre parametrii folositi in practica clinica
au fost citati ca asociindu8se cu durata pana la esecul terapiei orale
OBIECTIVE: <m urmarit sa identificam$ dintre parametrii folositi curent in urmarirea
ambulatorie a pacientilor$ posibilii factori asociati cu durata dintre dia&nosticul diabetului
zaharat si initierea insulinoterapiei
MATERIAL SI METODE: S8au selectat .# de pacienti cu diabet zaharat tip 2
insulinotratat$ urmariti in ambulatorul 9entrului de Diabet 9luG 9riteriul de includere a
fost prezenta unei perioade de minim B luni de tratament non8insulinic$ criteriul de
e7cludere a fost initierea insulinei din alte motive decat esecul terapiei orale (e7
insuficienta hepatocelulara sau renala) Nn numar de 5# de parametri disponibili din
fisele de ambulator au fost documentati pentru fiecare caz in parte (parametri clinico8
biolo&ici$ antropometrici$ socio8demo&rafici$ durata tratamentului cu fiecare dintre
antidiabeticele orale folosite) S8a studiat le&atura dintre durata de la dia&nostic la
initierea insulinei si fiecare dintre acesti factori
REZULTATE: Durata medie de la dia&nosticul diabetului la initierea insulinei fDDg a
fost de /1 ani (min #. ma7 220) "otul a fost constituit din 51 barbati si 2. femei$
varsta medie la initierea insulinei a fost de 2.0 ani '*9 mediu in lot a fost de 5##
D&=m
2
$ &licemia medie la initiere! 22B m&=dl$ ;b<1c medie .51 (parametru disponibil la
221 dintre pacienti) DD s8a corelat pozitiv cu &reutatea la initierea insulinoterapiei$ nu
si la debutul diabetului (R4#2B respectiv #1B) < e7istat o asociere ne&ativa
nesemnificativa intre DD si &licemia la debut 'mpactul tratamentului cu metformin$
sulfoniluree si$ respectiv$ tiazolidindione asupra DD (R4#66$ R4#62$ R4 8#51) se
e7plica prin administrarea frecventa a acestora din urma ca ultima intensificare inaintea
insulinoterapiei (u s8au constatat corelatii semnificative intre DD si valoarea ma7ima
documentata pentru colesterol$ tri&liceride$ >< 'ntre persoanele care au refuzat insulina
la cel putin 5 vizite medicale (2551)$ a predominat se7ul feminin (/261) DD a fost
semnificativ mai mica la persoanele la care s8au efectuat cel putin 2 intensificari ale
tratamentului in primii 2 ani de la debut$ fata de cele la care tratamentul initial s8a
mentinut minim 2 ani (B5 vs 1B# ani$ p_##2) ,ersoanele cu studii superioare au avut o
initiere mai precoce a insulinei (DD medie 4 20 ani)
CONCLUZII: Durata dintre dia&nosticul diabetului tip 2 si initierea insulinei nu s8a
corelat semnificativ cu niciun parametru antropometric sau de laborator dintre cei
determinati de rutina Se7ul feminin si nivelul de educatie par a influenta acest interval$
probabil prin mecanisme psiholo&ice 'n studiul nostru$ numarul de intensificari ale
tratamentului in primii 2 ani de la dia&nostic a fost sin&urul factor predictiv pentru
intervalul de timp pana la insulinoterapie
.6
COULD +E FIND IN OUR CLINICAL PRACTICE PREDICTIVE FACTORS
FOR THE DURATION BET+EEN THE DIAGNOSIS OF T,PE 5 DIABETES
AND INSULIN INITIATIONY
Ilinca Lenta, Adrian Copcea, Dana %i"u, %il(ia %tefania Iancu
Centrul Clinic de Diabet, Nutritie si Boli etabolice Clu15Napoca
INTRODUCTION >Hpe 2 diabetes$ characterized bH tIo interdependent mechanisms!
m8cell dHsfunction and insulin resistance$ has a pro&ressive evolution$ potentiallH
influenced bH factors liDe &lucoto7icitH$ lipoto7icitH$ use of different antidiabetic dru&s
MeI of the parameters used currentlH in clinical practice Iere Luoted as related to the
duration betIeen dia&nosis of >2D* and insulin initiation
OB;ECTIVES Ke aimed to identifH$ amon& the parameters documented in an
outpatient settin&$ possible factors associated Iith the duration betIeen dia&nosis of
>2D* and insulin initiation
METHODS .# insulin treated tHpe 2 diabetic patients Iere randomlH selected from the
outpatient offices of our clinic$ usin& as an inclusion criterion the presence of at least B
months of non8insulinic therapH$ and as an e7clusion criterion the initiation of insulin for
other reasons than failure of oral therapH (ie renal or hepatic insufficiencH) < number of
5# different parameters available from the medical files Iere included in the analHsis for
each case (clinical$ biolo&ical$ anthropometrical$ socio8demo&raphical parameters$ as Iell
as duration of treatment Iith each antidiabetic dru&) Statistical evaluation of the
relations betIeen the time interval to insulin initiation and each of these parameters Ias
performed
RESULTS >he mean duration from the dia&nosis of >2D* and insulin initiation
fDDg Ias /1 Hears (min #.$ ma7 220) >he &roup consisted of 51 men and 2. Iomen$
havin& a mean a&e of 2.0 Hears at the time of insulin initiation >he mean )*' Ias 5##
D&=m
2
$ the mean fastin& blood &lucose (M)?) at insulin initiation Ias 22B m&=dl$ mean
;b<1c .51 (available in 221 of the patients) DD Ias positivelH correlated Iith the
Iei&ht at the time of insulin initiation$ but not at dia&nosis (R4#2B respectivelH R4#1B)
>here Ias a ne&ative$ non8si&nificant association betIeen DD and M)? at the time of
dia&nosis >he impact of metformin$ sulfonHlurea and$ respectivelH$ tiazolidindione use
on DD (R4#66$ R4#62$ R4 8#51) is Gustified bH the freLuent use of the latter as a last
intensification before insulin >here Iere no si&nificant correlations betIeen DD and the
hi&hest documented serum level of total cholesterol and tri&lHcerides$ neither Iith the
ma7imum blood pressure values <mon& the persons Iho refused at least at 5 visits the
initiation of insulin (2551)$ /261 Iere females DD Ias si&nificantlH loIer in persons
Iho had at least 2 treatment intensifications in the first 2 Hears$ compared to those in
./
Ihom the initial treatment Ias maintained (B5 vs 1B# Hears$ p_##2) >he patients Iith
the hi&hest education level had the earliest insulin initiation (mean DD420 Hears)
CONCLUSIONS >here Iere no si&nificant correlations betIeen the duration from
dia&nosis of tHpe 2 diabetes to insulin initiation and anH anthropometrical or laboratorH
parameters used in current practice >he education level and the female &ender seem to
influence this interval 'n our studH$ the number of treatment intensifications in the first 2
Hears folloIin& dia&nosis Ias the onlH predictive factor for the time interval to insulin
initiation
EPIDIAB 5PPR: ANALIZ9 PH6PH65PPR > JP6PL65PPR
D6 Ca#e) Ci2a)F D6 A%ia)a Ci<F D6 Mat$) Re-a U
A#b(!at$i(! %e Diabet T.6 M(e2
I)t$%(cee : ,ro&ramul S,'D'<) (Spidemia Diabetului) este un studiu prospectiv$
av3nd ca obiective obinerea de date epidemiolo&ice$ clinico8biolo&ice ale persoanelor cu
DZ nou depistat$ permi3nd analiza calit:ii %n&riGirii acestora
Sc$1(! !(c&ii : evaluarea rezultatelor pe primele . luni ale anului 2##/ i compararea
lor cu date din 2###82##6
Met$%& : rezultatele au fost obinute prelucr3nd datele demo&rafice$ antropometrice$ de
prevalen: a complicaiilor cronice i bolilor asociate precum i a tratamentului
persoanelor cu DZ nou depistat %n perioada ianuarie 8 septembrie 2##/
Re'(!tate ! Fn perioada studiat: au fost %nre&istrate 262/ persoane cu DZ nou depistat
Distribuia pe tipuri de DZ a fost urm:toarea ! 1$5/ 1 tip 1T ./$B2 1 tip 2 ,revalena
factorilor de risc cardiovasculari este! ;>< U B0$.6 1T obezitate 8 56$#2 1T suprapondere
802$#51T dislipidemii 8 B1$2# 1 (din totalul celor /.$5/ 1 screenai)T boal:
cardiovascular: ( la momentul depist:rii ) ! 22$15 1 Screenin&8ul i dia&nosticul
complicaiilor microvasculare specifice relev:! /B 1 din persoanele nou depistate cu DZ
au fost screenate pentru decelarea retinopatiei diabetice i 1#$12 1 au prezentat de la
dia&nostic aceast: complicaie Screenin& 8ul pentru nefropatie diabetic: s8a efectuat la
05$#5 1 din pacieni i 6$#5 1 au fost dia&nosticai ca av3nd aceast: complicaie
Screenin&8ul pentru polineuropatie diabetic: i picior diabetic s8a efectuat la 02$52 1 din
nou depistai$ fiind identificai 21$5B 1 cu acest dia&nostic Structura pe &rupe
terapeutice a fost urm:toarea ! diet: 8 12$./ 1 T sulfonilureice 81.$. 1 T metformin 8
52$/2 1 T sulfonilureic plus metformin 8 20$6B 1 T insulin: 8 2$./ 1T altele85$21 1
Di"c(7ii 2i c$)c!('ii ! incidena DZ se menine ridicat:$ remarc3ndu8se o important:
cretere fa: de anii anteriori ,revalena factorilor de risc cardiovascular i a
complicaiilor cronice cunoate o uoar: cretere fa: de anii anteriori$ verosimil datorit:
unui screenin& mai atent i mai frecvent aplicat indic3nd deci o calitate a actului medical
sporit:
..
EPIDIAB 5PPR: ANAL,SIS PH6PH65PPR > JP6PL65PPR
Dr. Car"en Crisan, Dr. Adriana Cif, Dr. arton Re<a
Diabete" A#b(!at$@ T.6 M(e"
INTRODUCTION ! S,'D'<) ,ro&ram is a prospective studH$ in order to provide
epidemiolo&ical$ clinical and biolo&ical data of persons Iith neIlH8dia&nosed diabetes
((DD)
METHOD! >he demo&raphic and anthropometric data$ the prevalence of chronic
complications and therapeutic structure of persons Iith (DD Ias analised in period
WanuarH8 September 2##/
AIM ! to evaluate the results on the first . months 8 2##/ and to compare Iith data from
2### 8 2##6 period
RESULTS ! 'n WanuarH 8 September 2##/$ 262/ persons Iith neIlH 8 dia&nosed diabetes
((DD) Iere re&istered$ 1$5/ 1 Iith tHpe 1T ./$B2 1 Iith tHpe 2 >he prevalence of
cardiovascular risD factors is! hHpertension 8 B0$.6 1$ obesitH 8 56$#2 1$ overIei&ht 8
02$#51$ dHslipidemia 8 B1$2# 1$ (screenin& Ias perform for /.$5/ 1 of patients)$
cardiovascular disease 8 22$15 1 at the moment of screenin& *icrovascular
complications screenin& and dia&nostic! for retinopathH Ias performed for /B 1 of
patients$ 1#$12 1 have some &rade of diabetic retinopathHT the screenin& for diabetic
nephropathH Ias performed in 05$#5 1 of patients$ 6$#5 1 bein& positiveT the screenin&
for diabetic neuropathH and diabetic foot Ias performed in 02$52 1$ the percenta&e of
positives bein& 21$5B1 >he therapeutic structure Ias! diet 8 12$./1$ sulphonHlurea U
1.$. 1$ bi&uanides U 52$/2 1T sulphonHlurea and bi&uanides U 20$6B 1T insulin 8 2$./
1 T another 5$2 1
CONCLUSION! >he incidence of diabetes mellitus increased in 2##/ comparative Iith
the previous Hears 9ardiovascular risD factors and chronic complications prevalence is
increasin& versus previous Hears
STUDIU PRELIMINAR ASUPRA MODIFICARILOR GLICEMICE
REZULTATE DIN PROGRAMUL NATIONAL DE EVALUARE A STARII DE
SANATATE
Ioana icle, onica ara?an, Ra"ona $iurescu, 2lena Pop, An,ela Du"itrescu,
Re"us Laslau, %i"ona Raicu, Car"en Patap
Clinica Pediatrie 9 )i"isoara
%pitalul Clinic de +r,enta pentru Copii&Louis )urcanu&
1##
Sc$1(! !(caii <utorii isi propun obiectivarea modificarilor &licemice depistate$ la
varsta copilariei$ prin pro&ramul national de evaluare a starii de sanatate a populatiei
Mateia!(! %e "t(%i( ?rupul de studiu este format din 26 copii cu varsta cuprinsa intre
281/ ani 9riteriul de selectie al copiilor indrumati in clinica ,ediatrie 1 >imisoara a fost
reprezentat de valoarea &licemiei bazale @ 1##m&1 obtinuta la doua determinari
succesiveMet$%a %e "t(%i( Datele ananmnestice cu privire la antecedentele heredo8
colaterale de diabet si boli metabolice au fost obtinute din foile de observatie S8a
calculat '*9 (Z&=mp) si s8a raportat cu nomo&ramele varstei )ilantul biolo&ic s8a
efectuat etapizat$ astfel! &licemia bazala$ profilul &licemic$ >>?O si ;b<1c$ apoi
insulinemia (nN=ml) ) si calculul indicelui de insulinorezistenta 8 ;O*< si la cazurile
selectionate 8 in functie de insulinemie 8 s8au determinat anticorpii anti U?<D
Re'(!tate Din cei 26 copii$ 2 (1/$21) au fost depistati cu diabet zaharat (DZ) Dintre
acestia 0=26 (10$/1) sunt dia&nosticati cu DZ tip 1 (la prima determinare a &licemiei) si
1=26 (5$61) a fost dia&nosticat cu DZtip 2 (dupa efectuarea profilului &licemic si a
>>?O) Restul de 22=26 (/1$0/1)) au avut urmatoarele modificari! .=26 (55551)
scaderea tolerantei la &lucoza (S?> 8&licemie la 2 h @10# m&1) si 15=26 (0/$101)
normo&licemie bazala si >>?O normal 'ndicele de insulinorezistenta ;O*< a fost
crescut la 2 copii care aveau concomitent obezitate si semne de insulinorezistenta
'nsulinemia bazala a fost scazuta la un copil cu Dztip 1 si crescuta la doi copii (dintre
care unul a fost dia&nosticat cu DZtip 2)9onduita terapeutica a fost diferentiata in
functie de dia&nosticul stabilit$ astfel! la cei 0 copii cu DZ tip 1 s8a initiat insulinoterapia
bazala la 5 copii si bazal8bolus terapie())>) la un copilTla copilul cu DZ tip 2 s8au
administrat antidiabetice orale (<DO) U metforminT . copii cu S>? au ramas in
e7pectativa terapeutica cu recomandari dietetice in S>?$ 15 copii urmand sa fie
reevaluati periodic 8 trimestrial sau la simptome minore C$)c!('ii Determinarea
&licemica 8 ca screenin& 8 in cadrul pro&ramului national de evaluare a starii de sanatate
ofera posibilitatea decelarii precoce a modificarilor &licemice$ a depistarii populatiei
infantile cu hiper&licemie bazala si dia&nosticul precoce al DZ Simptomatolo&ia clasica
de debut a DZ poate fi uneori nesesizata de familie si astfel$ orice &licemie peste limitele
normale necesita e7plorari suplimentare "a copil$ o &licemie sin&ulara peste limita
normala nu inseamna intotdeauna DZ intrucat$ chiar actul medical de prelevare a san&elui
este un stress$ dar nu trebuie ne&liGata ci$ reconsiderata si repetata
A PRELIMINAR, STUD, ON THE GL,CEMIC ALTERATIONS DETECTED
B, THE NATIONAL HEALTH SCREENING PROGRAM
AuthorsP Ioana icle, onica ara?an, Ra"ona $iurescu, 2lena Pop, An,ela
Du"itrescu, Re"us Laslau, %i"ona Raicu, Car"en Patap
9 Pediatric Clinic, !Louis )urcanu& ChildrenRs 2"er,enc3 0ospital )i"isoara
P(1$"e! >he authors aim to emphasize the &lHcemic alterations detected in children
throu&h the national health screenin& pro&ram
1#1
Mateia!! >he studH comprised 26 patients$ a&ed betIeen 2 and 1/ Hears old >he
selection criterion for referrin& the patients to our clinic Ias the value of the basal
&lHcemia over 1##m&1 in tIo separate determinations
Met/$%"! >he anamnestic data about the presence of diabetes and other metabolic
diseases in the families of the patients Ias &athered from the observation charts Ke
calculated the )*' (D&=m2) and compared Iith reference charts for a&e >he biolo&ical
investi&ations Iere performed in the folloIin& order! basal &lHcemia$ &lHcemic profile$
O?>> and ;b<1$ insulinemia (ui=ml)$ the insulino8resistance inde7 ;O*< and$ in
selected cases$ dependin& on the insulinemia$ the anti8?<D antibodH levels Iere
determined
Re"(!t"! Mrom a total of 26 patients$ 2 (1/$21) Iere dia&nosed Iith diabetes$ 0=26
(10$/1) Iere dia&nosed Iith diabetes tHpe 1 (at the first determination of &lHcemia) and
1=16 (5$61) Ias dia&nosed Iith diabetes tHpe 2 (after performin& a &lHcemic profile and
O?>>) >he rest 22=26 (/1$0/1) Iere dia&nosed Iith the folloIin& alteration! .=26
(55551) decreased &lucose tolerance (D?> U &lHcemia at 2hY10#m&1) and 15=26
(0/$101)had normal basal &lHcemia an O?>> >he insulin resistance inde7 ;O*< Ias
elevated in 2 children Iho presented simultaneouslH obesitH and si&ns of insulin
resistance >he basal level of insulin Ias decreased in one patient Iith diabetes tHpe 1
and elevated in tIo patients (one of Ihich Ias dia&nosed Iith diabetes tHpe 2) >he
therapeutic approach differed dependin& on the dia&nosis! for the 0 patients dia&nosed
Iith tHpe 1 diabetes Ie initiated basal insulin therapH in 5 and basal bolus therapH ())>)
in 1 patient$ the patient dia&nosed Iith tHpe 2 diabetes Ias treated Iith an oral anti8
diabetic a&ent (metformin)$ . patients Iith decreased &lucose tolerance remain in
observation Iith special diet recommendations$ 15 patients Iith minor sHmptoms are
&oin& to be evaluated periodicallH
9onclusions! >he screenin& of the &lHcemic value in the national pro&ram for evaluation
of populational health offers the possibilitH of earlH detection of &lHcemic alterations$
earlH detection of the infantile population Iho presents basal hHper&lHcemia and arlH
dia&nosis of diabetes >he classic sHmptoms at the onset of diabetes can be$ sometimes$
i&nored bH the familH$ therefore anH &lHcemic value above norm needs further
e7ploration 'n children$ one sin&le value above normal does not alIaHs implH diabetes
because even the prelevation of a blood sample cand brin& a si&nificant amount of stress
in apatient )ut still$ a &lHcemic value above nomal must not be i&nored and needs a
second determination
STUDIU COMPARATIV DE ADMINISTRARE MATINALA SAU VESPERALA
A INSULINEI GLARGINE LA COPIL SI ADOLESCENT
Ioana icle, onica ara?an, Ra"ona $iurescu, 2lena Pop, 6ana Do"nitei,
Cristina Da"acus, ihaela -barcea, Daniela Chiru
1#2
Clinica Pediatrie 9 )i"isoara
%pitalul Clinic de +r,enta pentru Copii >Louis )urcanu&
Sc$1(! !(caii! "ucrarea %i propune prezentarea comparativ: a echilibrului &licemic
realizat prin administrare de ?lar&ine ("antus)
dimineata (ora 6) sau seara (ora 1.T 25)
Mateia! %e "t(%i(! <u fost introdui %n studiu 06 copii cu diabet zaharat tip 1 (DZ1)$
cu insulinoterapie bazal8bolus())>) $ cu v3rsta cuprins: %ntre 0 81/ ani care utilizeaza
?lar&ine Dintre acestia 01=06 (/6$21) isi inGecteaza &lar&ine seara si B=06 (12$/1)
dimineata 9riteriul de selecie pentru modificarea orei de inGectare a insulinei &lar&ine a
fost numarul de hipo&licemii nocturne si valoarea &licemiei bazale
Met$%a %e "t(%i(! S8au efectuat profile &licemice i media orar: a &licemiilor %n mod
comparativ %n terapia cu &lar&ine administrat dimineata si seara De asemenea$ s8au
evaluat numarul hipo&licemiilor diurne si nocturne$ echilibrul &licemic prin valoarea
;b<1c
Re'(!tate "i %i"c(tii! S8a optat pentru administarea &lar&inului dimineata la copiii mici si
prescolari aflati in perioada de remisiune labila si in perioada de stare$ deoarece numarul
hipo&licemiilor nocturne la acestia era mare de 0 8 2episoade=saptamana *edia
&licemiilor din cadrul profilului &licemic a fost comparativa in administrarea de
dimineata 152CB2m&1 si in administrarea de seara 15/C 22 m&1 9u toate acestea$
media &licemiilor bazale este comparativ sc:zut: la administrarea de &lar&ine dimineata
116 C51 m&1 fa: de 10B C B/ m&1 la administrare seara <ceasta se poate e7plica prin
faptul ca la pubertate$ secretia hormonului de crestere determina consecutiv cresterea
rezistentei la insulina (fenomenul daIn) *aGoritatea copiilor cu DZ 1 aflati la varsta
pubertara au analo& cu actiune prelun&ita in administrare vesperala sau inainte de culcare
C$)c!('ii! Decizia momentului zilei (ora) de administrare a insulinei &lar&ine depinde
de valoarea &licemiei bazale ?lar&ine 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 "a pubertate insulina &lar&ine se administreaza seara sau inainte
de culcare
A COMPARATIVE STUD, ON MORNING VERSUS EVENING
ADMINISTRATION OF GLARGINE INSULIN IN CHILDREN AND
TEENAGERS
AuthorsP Ioana icle, onica ara?an, Ra"ona $iurescu, 2lena Pop, 6ana
Do"nitei, Cristina Da"acus, ihaela -barcea, Daniela Chiru
1#5
Pediatric Clinic nr 9. Louis )urcanu e"er,enc3 chiledrenRs hospital, )i"isoara
P(1$"e! the studH aims to present a comparison betIeen the &lHcemic response and
balance accomplished bH treatment Iith ?lar&ine ("antus) administered in the mornin&
(#6 <*) versus evenin& (1.$ 25 ,*)
Mateia!! the studH comprised 06 children Iith diabetes mellitus tHpe 1$ treated Iith
insulin ())> therapH)$ a&ed betIeen 0 and 1/ Hears Iho use ?lar&ine Of the 06
patients$ 01 (/6$21) inGect &lar&ine in the evenin& and B (12$/1) in the mornin& >he
selection criteria for chan&in& the hour of the &lar&ine inGection Ias the number of
nocturnal hHpo&lHcemias and the value of the basal &lHcemia
Met/$%! Ie studied the &lHcemic profile for all the patients$ evaluated the hourlH avera&e
of the &lHcemic values for the &lar&ine administered in the mornin& and in the evenin&
Ke also evaluated the number of mornin& and evenin& hHpo&lHcemic values$ the
&lHcemic balance determined throu&h the value of the ;b<1
Re"(!t" a)% %i"c(""i$): Ie decided to administer &lar&ine in the mornin& for the
children under B Hears Iith temporarH remission and those Iith lon&standin& diabetes$
because the freLuencH of nocturnal hHpo&lHcemia Ias hi&her than 082 episodes a IeeD
>he avera&e of the &lHcemic values from the &lHcemic profile Ias relativelH similar for
the mornin& administration 152j=8B2m&1 and evenin& administration 15/j=822m&1
Still$ the avera&e of the basal &lHcemic values for the mornin& administration of &lar&ine
is comparativelH loI 1164=851m&1 compared to 10Bj=8B/m&1 for the evenin&
administration >his is e7plained bH the fact that at pubertH$ the &roIth hormone causes
an increased resistance to insulin (daIn fenomenon) *ost of the pubertal patients are
treated Iith late action insulin analo&ue in the evenin& or before sleep
C$)c!("i$)"! >he decision toIards mornin& or evenin& administration of &lar&ine is
influenced bH the values of the basal &lHcemia >he mornin& administration of &lar&ine is
the therapeutic option for Houn& children Iith diabetes tHpe 1 in temporarH remission or
Iith lon&standin& diabetes <t pubertH$ &lar&ine is best administered in the evenin& or
before sleep
HIPOGONADISMUL LA PACIENTII CU DIABET ZAHARAT
Iulia Calota, Crina /ilisan, Car"en Dob1anschi
%pitalul Clinic !N. alaEa& 5 Clinica Diabet, Nutritie, Boli etabolice 7 Bucuresti
Pe#i"e: ;ormonii steroidieni sunt cunoscuti a fi re&latori importanti ai metabolismului
&lucidic si lipidic (ivele scazute ale testosteronului (>) sau ale S;)? (se7 hormone
bindin& &lobuline) au fost raportate la barbatii cu diabet zaharat tip 2 ;ipoandro&enismul
1#0
ramane deseori nedia&nosticat si netratat deoarece simptomatolo&ia este nespecifica si
multifactoriala
Sc$1(! "t(%i(!(i: evidentierea corelatiilor intre deficienta hormonilor andro&eni si
diabetul zaharat la barbat
Mateia! "i #et$%a: 'n acest studiu s8au determinat concentratiile serice ale S;)? si ale
testosteronului liber la 12 barbatii cu diabet zaharat tip 1 ( media de varsta 5B$02j=8 12
ani) si 50 cu diabet zaharat tip 2 ( media de varsta 2B/j=81. ani) internati in Spitalul
9linic- ( *ala7a- >estosteronul liber s8a calculat in functie de testosteronul total$
S;)? si concentratia albuminei serice ,robele s8au recoltat a Geun$ intre orele #/## si
1### am <u fost luate in calcul durata de evolutie a diabetului$ prezenta sindromului
metabolic$ tratamentul specific pentru diabet S8a determinat prin bioimpedanta procentul
de tesut adipos din masa corporala S8au determinat marDerii de inflamatie (,roteina 9
reactiva si fibrino&enul)$ profilul lipidic$ hematocritul si hem&lobina &licata
Re'(!tate: Aaloarea medie a )*' a pacientilor cu diabet zaharat tip 1 si diabet zaharat
tip 2 a fost de 262Bj=8 15 $ respectiv 5/$B/j=8 250 D&=m2 9oncentratia medie a
testosteronului total la pacientii cu diabet zaharat tip 1 a fost de 2#B. j=8 125 respectiv
1520j=8 1.. nmol=l ( ,_#$##1) la cei cu diabet zaharat tip 2 9oncentratia medie a
testosteronului liber a fost de #26Bj=8 ##/ pentru pacientii cu diabet zaharat tip 1$
respectiv de #2B0j=8 ##B nmol=l la pacientii cu diabet zaharat tip 2 ;ipo&onadismul nu
s8a asociat cu diabetul zaharat tip 1 Aalorile scazute ale S;)? si testosteronului total s8
au asociat cu prezenta componentelor sindromului metabolic$ in timp ce valorea
testosteronului liber s8a corelat doar cu circumferinta abdominala (u s8au observat o
corelatie intre hipo&onadism si valoarea hemo&lobinei &licate sau durata diabetului
Aalorile scazute ale testosteronului sunt$ de asemenea$ corelate cu un procent crescut de
tesut adipos din masa corporala Aaloarea proteinei 98reactive a fost crescuta la pacientii
cu hipo&onadism si s8a observat o corelatie inversa intre aceasta si concentratia
testosteronului plasmatic 9orelatia inversa intre valoarea proteinei 98reactive si a
testosteronului liber la pacientii cu diabet zaharat tip 2 su&ereaza ca inflamatia poate avea
un rol important in pato&eneza hipo&onadismului
C$)c!('ii: Relatia intre diabet$ sindromul metabolic si deficienta hormonilor andro&eni
este comple7a ;ipo&onadismul 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 ,revalenta
hipo&onadismului biochimic este mai mare in cazul determinarii testosteronului liber
*edicii diabetolo&i trebuie sa8si indrepte mai mult atentia asupra acestei afectiuni pentru
a8si putea sfatui si indruma pacientii spre alte consulturi interdisciplinare
THE RELATIONSHIP BET+EEN MALE H,POGONADISM AND DIABETES
MELLITUS
1#2
Iulia Calota, Crina /ilisan, Car"en Dob1anschi
!N. alaEa& 0ospital, Diabetes Clinic 7 Bucharest
Bac-.$()%: Se7 steroid hormones are DnoIn to be important re&ulators of the lipid and
&lucose metabolism "oIer levels of testosterone (>) or se7 hormone8bindin& &lobulin
(S;)?) have been reported in men Iith tHpe 2 diabetes >he dia&nosis of male
hHpoandro&enism often &oes undia&nosed and untreated because the sHmptomatolo&H is
multifactorial and not specific
T/e ai# $< t/e "t(%@: is to describe relationship betIeen andro&en deficiencH and
diabetes in men
De"i.) a)% Met/$%": 'n this studH Ie assessed serum concentrations of S;)?$ total
and free testosterone in 12 tHpe 1 diabetic (mean a&e 5B02 j=8 12 Hears) and 50 tHpe 2
diabetic (mean a&e 2B/ j=8 1. Hears) subGects U hospitalized in +(*ala7a- ;ospital
9alculation of free testosterone has been made from total testosterone$ S;)? and
albumin concentration )lood samples have been taDen betIeen #/## and 1### h in the
fastin& state Diabetes treatment$ the presence of metabolic sHndrome and subcutaneous
fat mass measured bH bioimpedance Iere noticed ;b<1c values$ duration of diabetes$
hemathocrit$ lipid profile$ inflammatorH marDers (the level of 98reactive protein and
fibrino&en) Iere collected
Re"(!t": >he mean )*' of tHpe 1 and tHpe 2 diabetic patients Ias 262B j=8 15 and
5/B/ j=8 250 D&=m(2)$ respectivelH >he mean total testosterone concentration of tHpe 1
and tHpe 2 diabetic patients Ias 2#B. j=8 125 and 1520 j=8 1.. nmol=l$ respectivelH (,
_ ###1) >he mean free testosterone concentration of tHpe 1 and tHpe 2 diabetic patients
Ias #26B j=8 ##/ and #2B0 j=8 ##B nmol=l$ respectivelH (, _ ###1) ;Hpo&onadism is
not associated Iith tHpe 1 diabetes S;)? and total testosterone Iere associated Iith
components of metabolic sHndrome and free testosterone Ias associated onlH Iith Iaist
circumference and tri&lHcerides >he duration of diabetes or ;b<1c are not related to
hHpo&onadism "oI testosterone concentrations are also related to an increase in
adipositH 98reactive protein concentrations have been shoIn to be elevated in patients
Iith hHpo&onadism and are inverselH related to plasma testosterone concentrations >his
inverse relationship betIeen plasma free testosterone and 98 reactive protein
concentrations in patients Iith tHpe 2 diabetes su&&ests that inflammation maH plaH an
important role in the patho&enesis of hHpo&onadism
C$)c!("i$)": >he relationship betIeen diabetes$ the metabolic sHndrome and andro&en
deficiencH is comple7 *ale hHpo&onadism is a clinical condition that affects a
si&nificant number of men dia&nosed Iith tHpe 2 diabetes but not Iith tHpe 1 diabetes
>he prevalence of biochemical hHpo&onadism is &reater if Ie use free testosterone
Diabetolo&ists need to have a better understandin& of this disease state to provide advice
for their patients and to coordinate care Iith other clinicians
1#B
RELATIA DINTRE PROTEINELE ALIMENTARE SI GLICEMIA
POSTPRANDIALA LA UN GRUP DE COPII CU DZ TIP H DIN ORADEA
Larisa Du"bra(a, /loare 0usar, 2lena Dra"barean, Claudia Clado(an, Danuta
$rebenisan, Bea Nil,es?, Iolanda i<los
%pitalul Clinic unicipal 6radea
I)t$%(cee <minoacizii sunt utilizati atat la sinteza si de&radarea edificiului
macromolecular proteic din celule cat si la furnizarea de ener&ie$ in lipsa unor cantitati
suficiente de &lucide sau lipide ?luconeo&eneza si o parte a ceto&enezei presupun
conversia aminoacizilor in hidrocarbonate
Sc$1 "ucrarea isi propune investi&area &luconeo&enezei la copiii cu DZ tip 1
comparativ cu copiii fara diabet$ la meniuri cu continut e7clusiv proteic din surse diferite$
respectiv carne de pui si peste oceanic
Mateia! "i Met$%a Nn &rup de 12 copii$ . fete si B baieti$ de 10j=80 ani cu DZ
tip 1 echilibrat (;b<1c46j=8#5/) impreuna cu &rupul control relativ omo&en compus din
12 copii 6 fete si / baieti$ de 12j=82 ani fara diabet$ consuma in prima zi un pranz din
2## & piept de pui la &ratar$ iar a 28a zi un pranz din 2## & peste oceanic la &ratar Se
determina la toti copiii &licemia pre8 si postprandial la 1 si 2 ore$ in acelasi ambient si
conditii de repaus$ fara administrirea dozei de insulina la copiii cu diabet
Re'(!tate!e evi%e)tia'a! o curba &licemica concav crescatoare dupa masa cu pui
si o curba &licemica concav descrescatoare dupa cea cu peste$ la copiii cu DZ Dupa masa
cu pui$ scaderea &licemiei la o ora este nesemnficativa (pY#$#2)$ iar la 2 ore &licemia
crete semnificativ fa: de de cea %nre&istrat: preprandial sau la 1 or: (p_#$#2) Dup:
masa cu pete$ &licemia scade semnificativ (p_#$##1) la o or: postprandial$ iar la 2 ore
crete semnificativ (p_#$#2) fata de valoarea de la 1 ora 'ar la copiii fara diabet$ evoluia
&licemiei pe parcursul celor 2 evalu:ri a urmat o curb: concav cresc:toare dup: masa cu
pui i o linie discret ascendent: dupa masa cu pete Dup: masa cu pui$ la o or:
postprandial valoarea &licemiei scade nesemnificativ (pY#$#2)$ iar la 2 ore crete
semnificativ fa: de de cea %nre&istrat: preprandial sau la 1 or: (p_#$#0) Dup: masa cu
pete$ atat la o or: cat si la 2 ore &licemia crete nesemnificativ (pY#$#2)
C$)c!('ii! Nn meniu e7clusiv proteic determina cresterea &licemiei postprandiale
la 2 ore atat la pacientii cu DZ tip 1 cat si la non8diabetici$ demonstrand conversia
proteinelor in &lucide Scaderea &licemiei la 1 ora postprandial dupa ambele meniuri este
probabil datorata timpului necesar pentru &luconeo&eneza Scaderea semnificativa a
&licemiei la 1 ora dupa masa de peste se poate datora si proprietatilor protective ale
acizilor polinesaturati din pestele oceanic$ inclusiv in bolile autoimune 9resterea
&licemica semnificativa la 2 ore postprandial dupa masa de pui vs peste$ atat la copiii cu
cat si la cei fara DZ$ evidentiaza un indice &licemic mai inalt la pui decat la peste
9resterea usoara si liniara a &licemiei copiiilor fara diabet dupa masa de peste$ vs curba
1#6
concav crescatoare dupa masa de pui$ poate recomanda consumul de peste in profila7ia
afectiunilor metabolice
THE RELATIONSHIP BET+EEN FOOD PROTEIN AND POSTPRANDIAL
GL,CAEMIA IN A GROUP OF T,PE H DIABETES CHILDREN FROM
ORADEA
Larisa Du"bra(a, /loare 0usar, 2lena Dra"barean, Claudia Clado(an, Danuta
$rebenisan, Bea Nil,es?, Iolanda i<los
unicipal Clinic 0ospital 6radea
Bac-.$()% <mino acids are used both in sHnthesis and de&radation of
macromolecular protein buildin& from the cells and also for supplHin& ener&H in lacD of
carbohHdrates or fats ?luconeo&enesis and a part of Deto&enesis suppose the conversion
from amino acids in carbohHdrates
T/e Ai# is to investi&ate &luconeo&enesis in tHpe 1 diabetes children vs children
Iithout diabetes$ after theH ate an e7clusive different protein meal$ from chicDen
respectivelH ocean fish
Mateia! a)% Met/$%" 12 children ( . &irls and B boHs$ 10j=80 Hears Iith tHpe 1
diabetes (;b<1c46j=8#5/) to&ether Iith control &roup (12 children 6 &irls and / boHs$
from 12j=82 Hears Iithout diabetes$ ate in first daH 2## & of Ihite meat from &rilled
chicDen and in the second daH 2## & of &rilled ocean fish Ke measured &lHcaemia
before and 1 and 2 hour after meal$ in seam condition of ambient$ Iithout e7ercise and in
children Iith diabetes Iithout taDin& insulin
T/e e"(!t" shoI an increase concave &lHcemic curve after chicDen meal and
decrease concave &lHcaemic curve after fish one$ in children Iith diabetes <fter chiDen
meal &lHcemia decrease insi&nificant (pY#$#2) at 1 hour but increase si&nificant at 2 hour
vs both fastin& and 1 hour postprandial &lHcemia (p_#$#2) <fter fish meal$ &lHcemia
decrease si&nificant (p_#$##1) at 1 hour postprandial$ but increase si&nificant at 2 hour
(p_#$#2) vs 1 hour &lHcemia 'n children Iithout diabetes$ &lHcemia draI an increase
concave curve after chicDen meal and a sloIlH increase line after the fish meal <fter
chiDen meal &lHcemia decrease insi&nificant (pY#$#2) at 1 hour but increase si&nificant at
2 hour vs both fastin& and 1 hour postprandial &lHcemia (p_#$#0) <fter fish meal$
&lHcemia increase insi&nificant both at 1 and 2 hour postprandial (pY#$#2)
I) C$)c!("i$)! <n e7clusive protein meal leads to the increasin& of 2 hours
postprandial &lHcemia both in tHpe 1 diabetes and non8diabetes children$ provin&
conversion of proteins in carbohHdrates Si&nificant decreasin& of &lHcemia at 1 hour
1#/
after fish meal could be also determined bH protective properties of polHunsaturated
acids from ocean fish$ inclusivelH in autoimmune diseases Si&nificant increasin& of
&lHcemia at 2 hours postprandial after chicDen meal vs fish meal$ both in diabetes and
non8diabetes children$ proves a hi&her &lHcemic inde7 in chicDen vs fish SloIlH and
rulin& increasin& of &lHcemia in non8diabetes children after fish meal vs concave
increasin& curve after chicDen meal$ could recommended fish meals in prevention of
metabolic diseases
PREVALENTA COMPLICATIILOR MACROVASCULARE LA PACIENTII CU
DZ TIP H SI TIP 5 CU SINDROM METABOLIC
Popescu L.D., Ionescu I., Do(an D., Lichiardopol R.
I)t$%(cee : Sindromul metabolic reprezinta un important factor de risc pentru diabet
zaharat tip 2 si boala cardiovasculara$ putine date e7ista insa$ despre importanta acestuia
la pacientii cu diabet zaharat tip 1
Obiective : Svaluarea prevalentei complicatiilor macrovasculare la pacientii cu diabet
zaharat (DZ) tip 1 si tip 2 cu sindrom metabolic
Mateia! "i #et$%a : <u fost inclusi in studiu 102. pacienti$ internati in perioada
#1#12##B851122##B la 'D()* +(,aulescu-$ dintre care 26# cu DZ tip 1 (15B
barbati$ 150 femei$ varsta medie 02$20C10$5B ani)$ iar 112. cu DZ tip 2 (21/ barbati$ B01
femei$ varsta medie B#$16C1#$0/ ani) Sindromul metabolic a fost prezent la 2# (1/$211)
dintre pacientii cu DZ tip 1$ respectiv .6# (/5$B.1) dintre cei cu DZ tip 2$ restul
pacientilor nu au intrunit criteriile de dia&nostic S8au analizat urmatorii parametri
prezenti in fisele de observatie ale pacientilor ! varsta$ se7$ talie$ indice de masa
corporala ('*9)$ statusul de fumator$ istoric de boala hipertensiva (;><)$ hemo&lobina
&licata (;b<1c)$ colesterol total (9>)$ ;D"8colesterol (;D")$ "D"8colesterol ("D")$
tri&liceride (>?)$ raport >?=;D"$ prezenta complicatiilor macrovasculare ! boala
cardiaca ischemica ()9')$ infarct miocardic ('*)$ accident vascular cerebral (<A9)$
arteriopatie obliteranta membre inferioare (<O*') Sindromul metabolic (S*) a fost
definit conform criteriilor 'DM
Re'(!tate : ,acientii cu S* si DZ tip 1$ fata de cei cu S* si DZ tip 2 au avut o vechime
semnificativ mai mare a bolii (p_##1)$ relatie ce s8a mentinut si atunci cand s8a efectuat
diferentierea pe se7e De asemenea$ pacientii cu S* si DZ tip1 au avut fata de cei cu DZ
tip 2 si S* un nivel semnificativ mai mare al ;b<1c (p_##1)$ 9> (p_##2)$ "D"
(p_##2) si >? (p_##2) Difrente semnificative au fost si in ceea ce priveste fumatul
(p_##1) si ;>< (p_##2)$ la cei cu DZ tip 2 si S*$ fata de cei cu DZ tip 1 si S*
)arbatii cu S* si DZ tip 1 au avut fata de cei DZ tip 2 un nivel semnificativ mai mare al
1#.
;b<1c (p_##1)$ 9> (p_##2)$ >? (p_###1) si al raportului >?=;D" (p_##1) Memeile
cu S* si DZ tip 1 fata de cele cu DZ tip 2 au avut un nivel seric al "D" semnificativ mai
mare (p_##2) si un nivel semnificativ mai mic al ;D" (p_##2)$ fara diferente
semnificative statistic in ceea ce priveste ;b<1c$ 9>$ >? (u au e7istat diferente
semnificative statistic intre cele doua &rupuri analizate in ceea ce priveste prezenta
compicatiilor macrovasculare ()9'$ '*$ <A9$ <O*')$ relatie ce s8a pastrat si atunci
cand s8au analizat diferentele barbati$ femei ,acientii cu DZ tip 1 si S* au avut fata de
cei fara S* o prevalenta semnificativ mai mare a )9' (OR 5#.T .21 9'! 15#8650) si
;>< (OR 221T .21 9'! 26181###) ,acientii cu DZ tip 2 au avut$ de asemenea$ o
prevalenta semnificativ mai mare in ceea ce priveste )9' (OR 160T .21 9'! 12B8201)$
respectiv ;>< (OR 225T .21 9'! 5./86B.)(u au fost diferente semnificative statistic
intre &rupurile analizate in ceea ce priveste prevalenta '*$ <A9$ <O*'
'n urma analizei tertilelor de distributie ale taliei$ pacientii cu DZ tip 1 din tertila
superioara de distributie au avut o prevalenta mai mare a )9' (OR #1#T .21 9'! ##08
#26) si ;>< (OR #12T .21 9'! ##08#50)$ iar cei cu DZ tip 2 o prevalenta mai mare a
;>< (OR #52T .21 9'! #228#0.)
C$)c!('ii : Sindromul metabolic reprezinta un factor de risc pentru afectarea
cardiovasculara atat la pacientii cu DZ tip 1$ cat si la pacientii cu DZ tip 2
THE PREVALENCE OF MACROVASCULAR COMPLICATIONS IN T,PE I
AND T,PE II DIABETES PATIENTS +ITH METABOLIC S,NDROME
Popescu L.D., Ionescu I., Do(an D., Lichiardopol R.
Clinic of Diabetes, Nutrition and etabolic Diseases, ! N.C. Paulescu& Institute,
Bucharest, Ro"ania
I)t$%(cti$)! >he metabolic sHndrome &roups numerous cardiovascular risD factors and
freLuentlH associates tHpe '' diabetes mellitus (D*2) >here are thou&h feI data
re&ardin& its importance and freLuencH in tHpe ' diabetes mellitus patients (D*1)
Ai#! 9omparative evaluation of prevalence of macrovascular complications in D*1 and
D*2 patients Iith metabolic sHndrome (S*)
Met/$%"! 'n the studH there Iere included 102. patients$ Ihich Iere admitted in 2##B in
the diabetes department of the institute$ of Ihich 26# Iith D*1 (15B men$ 150 Iomen$
mean a&e 0220j105B Hears) and 112. Iith D*2 (21/ men$ B01 Iomen$ mean a&e
B#16j1#0/) S* Ias present in 2# (1/211) of the D*1 patients$ respectivelH .6#
(/5B.1) of the D*2 patients$ the rest of the patients not meetin& the dia&nostic criteria
11#
>he folloIin& parameters in the patientsR file Iere analHzed! a&e$ se7$ Iaist
circumference$ hHpertension historH$ ;b<1c$ total cholesterol (9>)$ ;D" cholesterol$
"D" cholesterol$ tri&lHcerides (>?)$ tri&lHceride=;D" cholesterol ratio$ coronarH heart
disease (9;D)$ mHocardial infarction (*')$ stroDe$ peripheral arteriopathH disease
(,<D) S* Ias defined accordin& to the 'DM criteria$ Iith the specification that in D*1
patients$ &lucose blood level Ias not considered as dia&nostic criterion
Re"(!t"! ,atients Iith D*1 and S* had loIer mean a&e (0.1BC1520vsB#22C1#55$
p_###1) compare to patients Iith D*2 and S* (p_###1) and a si&nificantlH lon&er
disease duration (122/C.B5vs.5.C/21$ p_##1)$ relation that maintained in the se7
difference also >he first &roup$ compared to the second &roup$ had si&nificantlH hi&her
;b<1c (1#22C225vs.21C20#$ p_##1)$ 9> (2252BBC125vs2#B05C22#2$ p_##2)$
"D" cholesterol (1001#C0261vs12B.6C05#B$ p_##2) and >? (2.002C5116. vs
1..22pC16#62$ p_##2) levels >here Iere si&nificant differences in hHpertension
historH (;><$ OR 2#.T.21 9'!11285/1) in patients Iith D*2 and S* compared to
patients Iith D*1 and S* >here Iere no si&nificant differences betIeen the tIo
&roups re&ardin& 9;D$ stroDe$ ,<D 'n e7chan&e patients Iith D*1 and values of Iaist
circumference in the superior distribution tertile compared to the values in the loIer
distribution tertile$ had a si&nificantlH hi&her prevalence of 9;D (OR 1#1/T.21 9'!
56B8262B) )oth D*1 and D*2$ in the superior distribution tertile of Iaist
circumference compared Iith those in the loIer distribution tertile had a hi&her
prevalence of ;>< (OR /05T.21 9'! 2.282055$ OR 2/.T .21 9'! 2#B80#0) <fter
analHzin& >?=;D" distribution tertiles$ patients Iith D*1 in the superior tertile
compared Iith the patients in the loIer tertile had a hi&her prevalence of 9;D (OR 25BT
.21 9'! 1#2820B)$ hHpertension historH (OR 22BT .21 9'! 1#68066) and the patients
Iith D*2 had a hi&her prevalence of 9;D (OR 1BBT .21 9'! 1228226)$ ,<D (OR
1B2T .21 9'! 1#2822.)$ *' (OR 505T .21 9'! 12B8622) and hHpertension (OR 250T
.21 9'! 1B28551) ,atients Iith S* (D*1 or D*2) compared Iith patients Iithout
S* had a si&nificantlH hi&her prevalence of 9;D (OR 5#.T .21 9'! 15#8650)$ (OR
160T .21 9'! 12B8201) >here Iere no statisticallH si&nificant differences betIeen the
analHzed &roups re&ardin& the prevalence of stroDe and ,<D
C$)c!("i$)"! *etabolic sHndrome represents a risD factor for cardiovascular disease and
is associated Iith a hi&her prevalence of macrovascular complications both in tHpe ' and
tHpe '' diabetes mellitus patients
DIABETUL ZAHARAT SI SARCINA
Asistent educator. aca(ei Lidia
Asistent educator. Cont Loredana
2uro"edica 0ospital Baia are
111
INTRODUCERE:
?ravidele cu diabet zaharat tip 1 sau tip 2 sunt supuse unor riscuri e7treme de
ridicate in ceea ce priveste sanatatea lor si a copiilor ( risc de fat macrosom $ malformatii
intrauterine ale fatului $ posibilitate de polihidroamnios $ hipo7ia fatului la nastere
$intreruperea de sarcina)
SCOPUL LUCRARII:
<m vrut sa determinam in ce masura educatia pacientelor cu diabet zaharat pe
parcursul sarcinii aGuta la evitarea cresterii e7cesive in &reutate a &ravidei $ a
dezechilibrului &licemic si a altor complicatii care pot aparea pe parcursul sarcinii
MATERIAL SI METODE :
'n colaborare cu 9abinetul de Obstetrica ?inecolo&ie din cadrul clinicii am
selectionat un &rup de 1B paciente cu diabet zaharat (2 cu tip1 si 11 cu tip 2 ) in perioada
#1#12##B U #1#.2##/ <m facut ancheta nutritionala $ chestionar alimentar cu privire
la tipul alimentatiei (din punct de vedere calitativ si cantitativ )$ continutul in
macronutrienti si micronutrienti$ aGustarea dozelor de insulina $ determinarea
hipo&licemiilor $ monitorizarea &reutatii
REZULTATE :
<m constatat ca B paciente proveneau din mediul rural si 1# din mediul urban cu
varste cuprinse intre 2# respectiv 5B ani Dintre acestea B#1 la prima sarcina $ 5#1 la a8
2a sarcina si 1#1 la a85a sarcina
<m observat ! la pacientele din mediul rural U B61 consuma e7cesiv slanina $ untura
si mamali&a evitand fructele
8 6#1 au luat foarte mult in &reutate
(apro7B#D&)
8 621 prezinta dezechilibru
&licemic
la pacientele din mediul urban U /# 1 au un re&im alimentar mai
echilibrat cu 2 U 5 mese =zi
8 B21 prezinta o &reutate adecvata
perioadei de &estatie
8 /01 au un profil &licemic mai bun
112
CONCLUZIE:
<m constatat lipsa de informare si dezinteres al pacientelor din mediul rural cu privire
la educatia specifica diabetului zaharat in perioada sarcini
DIABETS MELLITUS AND PREGNANC,
Asistent 2ducatorP aca(ei Lidia
Asistent 2ducatorP Cont Loredana
2uro"edica 0ospital Baia are
INTRODUCTION:
,re&nant Iomen Iith tHpe 1 diabet mellitus and tHpe 2 are subGect to e7tremelH hi&h
risDs in tems of their health an children (risD of macrosomia $ intrauterine malformations
of the fetus $ possiblH polihidroamnios $ fetal hHpo7ia at birth $ the interruption of
pre&nancH)
AIMS:
' Ianted to determine to Ihat e7tent education for patients Iith diabetes durin&
pre&nancH help prevent e7cessive Iei&ht increase of pre&nant Iomen $ the imbalance in
blood &loucose and other complications that can occur durin& pre&nancH
MATERIALS AND METHODS:
'n collaboration Iith the 9abinet of Obstetric ?Hnecolo&H in our clinic Ie selected 1B
pacients Iith diabetes (2 Iith tHpe 1 and 11 Iith tHpe 2)$ betIeen #1#12##B U
#1#.2##/ ' did nutritional surveH $Luestionnaires food on the tHpe of food (in
Lualitative and Luantitative) $ cotent macronutrienti and micronutrients $ adGustment of
insulin $ the hHpo $ monitorin& Iei&ht
RESULTS :
' found that B pacients Iere from rural and 1# urban $ a&ed betIeen 2# an 5B Hears of
these B#1 8 1 of pre&nancH $ 5#1 in the 28d pre&nan& and 1#1 in the 58rd tasD
' obsverved U in pacients from rural area U B61 consume e7cessive slanina $ lar& and
polenta avoidin& fruits
8 6#1 theH tooD so mucht Iei&ht
(apro7B#D&)
8 621 the imbalance in blood &lucose
115
8 in pacients from urban area U /#1 balance diet Iith 2 85 meals=daH
8 B21 presents a Iei&ht appropriate period of
&estation
8 /01 a better &lHcemic profile
CONCLUSION: ' found the lacD of information and carelessness on the port of
patients from rural area on education specifH diabetes durin& pre&nancH
INTENSIFICAREA INSULINOTERAPIEI CU HUMALOG MI0 MP
LA PACIENII CU DIABET ZAHARAT TIP 5
AutoriP Dr. Li(ia Du"a
9
@ Dr. Anca Colda
:
@ Dr. Cristina Ni
9
.
9
Centrul edical de Diabet Clu1@
:
Institutul Naional de Diabet, Nutriie i Boli
etabolice Prof. N. Paulescu
Pe#i'e: Diabetul zaharat de tip 2 (DZ tip 2) reprezint: o problem: de s:n:tate public:
din ce %n ce mai important: datorit: asocierii unei morbidit:i i mortalit:i crescute Din
acest motiv$ &hidurile internaionale de bun: practic: medical: recomand: obinerea unor
valori int: sc:zute pentru parametrii echilibrului metabolic la pacienii cu DZ tip 2 Fn
ciuda multiplelor opiuni terapeutice disponibile$ un procent redus de pacieni se %nscriu
%n limitele recomandate de &hidurile internaionale
Obiectiv: Fn vederea obinerii unui control metabolic mai bun se poate opta pentru
intensificarea insulinoterapiei cu ;umalo& *i7 2# %n 5 prize$ ca soluie alternativ: %n
condiiile %n care terapia cu 2 prize de insulin: premi7at: nu mai poate asi&ura eficiena
scontat:
Mateia! 2i #et$%&: Se prezint: cazurile a trei pacieni cu DZ de tip 2 din dou: centre
universitare au primit tratament intensificat cu ;umalo& *i7 2# %n 5 prize %n condiiile
unui control metabolic insuficient S8au %nre&istrat parametrii clinici i biolo&ici %nainte i
dup: intensificarea insulinoterapiei cu ;umalo& *i7 2# <cetia au fost! &reutatea
corporal: (Z&)$ circumferina abdominal: (cm)$ valorile &licemice determinate prin
monitorizare continu: a &licemiei (9?*S) i profile &licemice cu 6 puncte$ ;b<1c i
profil lipidic complet
Re'(!tate: ;b<1c a sc:zut de la o valoare medie de .#51 la 6251 dup: 5 luni de la
intensificarea insulinoterapiei cu ;umalo& *i7 2# Aalorile &licemice %nre&istrate prin
9?*S au demonstrat sc:derea &licemiei a Geun c3t i a &licemiei postprandiale Fn ceea
ce privete &reutatea corporal: s8a %nre&istrat o reducere cu 12 Z& la unul dintre pacieni
110
C$)c!('ii: ;umalo& *i7 2# %n 5 prize prandiale reprezint: o soluie de atin&ere a
obiectivelor &licemice la pacienii cu DZ tip 2 necontrolai %n re&im cu 2 prize de insulin:
premi7at: <ceasta nou: abordare terapeutic: determin: creterea calit:ii vieii i a
complianei pacienilor la tratament printr8un re&im relativ comod i si&ur
INTENSIVE INSULIN TREATMENT +ITH HUMALOG MI0 MP TID
IN T,PE 5 DIABETES PATIENTS
AuthorsP Li(ia Du"a
9
@ Anca Colda
:
@ Cristina Ni
9
9
Clu1 Diabetes edical Center, Clu15Napoca@
:
National Institute of Diabetes, Nutrition
and etabolic Disease Prof. N. Paulescu, Bucharest
Bac-.$()%: >Hpe 2 diabetes (>2D*) is a &roIin& public health problem due to
increased mortalitH and mobiditH >herefore international &uidelines recommend loIer
tar&ets for metabolic control Despite manH therapeutic options a small percenta&e of
patients meet the recommended &oals
Ob8ective: ;umalo& *i7 2# >'D is a solution for intensive insulin treatment in order to
achieve better &lHcemic control Ihen premi7ed insulins tIice dailH no lon&er provide
adeLuate control
Met/$%: Ke report three cases of >2D* patients Iith poor metabolic control in tIo
academic centers Iho Iere treated Iith ;umalo& *i7 2# >'D 9linical and biolo&ical
measurements Iere performed before and after insulin therapH intensification Iith
;umalo& *i7 2# )odH Iei&ht (Z&) and Iaist circumference (cm) Iere measured
9ontinous blood &lucose monitorin& (9?*S)$ 6 points &lHcemic profiles$ lipid profiles
Iere performed
Re"(!t": *ean ;b<1c value decreased from .#51 la 6251 Iithin 5 months of
;umalo& *i7 2# >'D treatment 9?*S shoIed improved &lHcemic control Iith both
decreased fastin& and postprandial blood &lucose < decrease in bodH Iei&ht of 12 Z&
Ias reported for one patient
C$)c!("i$)": ;umalo& *i7 2# >'D provides improved &lHcemic control for >2D*
patients treated Iith tIo inGections of premi7ed insulin dailH >his neI therapeutic
approach increases LualitH of life and compliance Iith treatment in a safe and convenient
IaH
112
IMPORTANTA COMUNICARII IN INGRI;IREA COPILULUI DIABETIC
As."ed. Lu"inita +rsache, licentiata in Co"unicare %ociala si Relatii Publice
%pitalul de Copii 8%f aria& Iasi, Clinica III
Sanatatea este bunul suprem al omului$ care nu are pret$ iar viata este valoarea cea
mai mare a lumii materiale
'n&riGire medicala fara constiinta nu se poate si uneori nu e deaGuns doar buna
intentie si multa munca *ai 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
'n 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 &reu de inteles uneori $ de acceptat $ iar mai apoi de
cooperat8 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
<ceasta comunicare specifica este utilizata de personalul spitalului ca modalitate de
lucru
'n&riGirea copilului cu diabet pune probleme deosebite personalului nostru Sste
important ca familia copilului diabetic sa fie capabila sa faca fata schimbarilor intervenite
odata cu aparitia bolii 9opiii de varsta scolara pana la adolescenta accepta mai usor
informatiile le&ate de boala si tratament
,roblemele copilului cu diabet sunt si de natura emotionala $ de adaptare $
deoarece situatia lor este neobisnuita8 tuturor copiilor le este teama de spital $ de inGectii
$iar ei incep sa intelea&a ca viata lor se schimba iremediabil odata ce au fost confirmati cu
diabet (u mai sunt liberi ca inainte $ nu mai pot manca ce isi doresc si de obicei este
&reu de acceptat aceasta decizie ,ot simti frustrare $ pot deveni ostili si se pot razvrati!
+De ce eu\ De ce mi s8a intamplat mie\ + Din aceasta perspectiva trebuie vazuta
importanta comunicarii cu micii diabetici
Mamilia poate avea o atitudine asemanatoare in momentul confirmarii diabetului
pentru ca starea de boala este o situatie pentru care nimeni nu este pre&atit De aceea
prima reactie este de ne&are $ a doua de culpabilitate si in cele din urma $ de adaptare
Aor invata impreuna sa se impace si sa traiasca cu aceasta boala
Se stabileste astfel o perioada indelun&ata de colaborare cu copilul diabetic si cu
familia acestuia in care personalul spitalului sa confirme profesionalismul $
compasiunea $ speranta
11B
THE IMPORTANCE OF C OMUNICATION IN CARR,ING FOR DIABETIC
CHILD
Lu"inita +rsache5 licentiate in %ocial Co"unicatioon and Public Relation
;ealts represents the priceless supreme humansRassetand life is the bi&&est value in the material
Iord
>here is not medical care Iithout anH consciousness and sometimes Gust &ood intention and hard
IorD are not enou&h Ke need to do thin&s in such IaH so Ie could be fullH understood bH all
the people involved in this interdependent relationship! medical team $ ill child and this familH
'n our field anH verbal intervention! a Luestion $ a remarD $ an emphasis $ and after that anH
medical intervention have a purpose! Iell DnoIn bH those from medical sHstem but harder to be
understood or accepted and then to cope Iith bH those outside this sHstem >hatRs IhH itRs so
important for the medical staff to DnoI hoI to communicate in special situations $ to learn hoI
to listen and talD as &ood as possible <nd this needed in this profession more than others >his
specific communication is used bH the medical team as a IorDin& tool
9arrHin& for the diabetic child raises up special problems for our staff 't is important that the
familH of child Iith diabetes to be able to deal Iith the chan&es in their life brou&ht bH the
disease aoun& children cope better Iith the disease and treatment related information
>he diabetic childrenRs problems are of emotional or adaptation nature because theH find
themselves in an unusual situations <ll the Dids are afraid to &o the hospital $ all of them are
afraid of shots and then theH start to understand that once theH &ot this dia&nosis their life
chan&es for &ood >heH donRt feel free as before $ theH cantRt eat Ihat theH Iant and this
restriction is hard to accept >heH feel frustration and could &et hostile >heH asD!RKhH me\R $
+KhH this happened to me\- >he importance of communication Iith diabetic children has to be
seen from this perspective
>he familH can have the same attitudine Ihen theH have the confirmation of the dia&nosis
)ein& iil is usuallH a situation Hou are not readH for >heH Iill learn to&ether to deal and live
Iith this disease
< lon& period of collaboration Iith the sicD child and his familH is needed and the medical team
has to act professionallH and shoI compassion and hope
IMPACTUL BOLII CRONICE DE RINICHI ASUPRA PACIENTILOR CU
DIABET ZAHARAT: E0PERIENTA UNUI CENTRU DE DIABET DIN
ROMANIA
unteanu ., %chiller Ad., Ionutiu L., ihaescu A., 6lariu N., Cocos 6., )arta L.
116
+ni(ersitatea de edicina si /ar"acie )i"isoara, %pitalul *udetean )i"isoara,
Centrul de Diabet )i"isoara
,revalenta DZ in Romania este in Gur de B8/1 in populatia &eneralaT ea este in
crestere si$ potrivit unor date recente$ riscul relativ al acestor pacienti este de 12 (9ollins
<m W <dv Stud *ed 2##5$ 5 (59) S 1.081.6) DZ a fost considerat un factor de risc
pentru aparitia )9R din 2##2$ nu numai datorita nefropatiei diabetice$ ci si ;><$
nefritelor interstitiale$ leziunilor vasculare (cu prevalenta crescuta in DZ) 'n populatia cu
risc cardiovascular crescut$ prevalenta )9R a fost mai mare la pacientii diabetici$
comparativ cu cei fara DZ ( 5.201 vs 220#1)(>onelli et al W<S( 2##2$ 1B! 560/8
5620) Riscul relativ pentru )9R este 2$ insa atunci cand se asociaza DZ$ el creste la 20
<sadar$ )9R asociata DZ necesita o atentie speciala 'n centrul nostru$ prevalenta )9R
asociata DZ a fost foarte ridicata comparativ cu datele publicate ! 02/21$ iar in lucrarea
de fata ne8am propus sa analizam posibilele cauze ale acestui rezultat
<tat )9R cat si DZ$ sunt factori de risc pentru boala cardiovasculara ()9A) 'n
analizele combinate ale studiilor KOS9O,S$ 9<RS si "','D$ rata evenimentelor
cardiovasculare a fost semnificativ mai mare atat la pacientii cu DZ$ cat si la cei cu )9R
comparativ cu pacientii fara DZ si fara )9R8 2221 si 2121 vs 1B61 Rata
evenimentelor 9A a crescut la 5161 in cazul asocierii )9R si DZ 'n centrul nostru$
prevalenta )9A (boala coronariana8)9$ insuficienta cardiaca con&estiva 8'99 $ boala
vasculara priferica8)A, si boala vasculara cerebrala8)A9) a fost semnificativ mai
crescuta la pacientii cu )9R comparativ cu cei fara )9R ()980.B21 vs 26B/1
p_####2$ '99825121 vs 2.51 p_####2$ )A,821#/1 vs 1#651 p4####B si )A98
6101 vs 5B61 p4##5B)
Dislipidemia este un factor de risc cunoscut atat pentru )9A$ cat si pentru
pro&resia )9R ,e de alta parte$ aproape toti pacientii cu )9R dezvolta o forma intens
atero&ena de dislipidemie 'n centrul nostru$ dislipidemia a fost identificata la B/151
dintre pacientii cu DZ (hipercolesterolemie 1/651$ hipertri&liceridemie 1.2#1$
dislipidemie mi7ta 5#501) fara ca prevalenta sa difere semnificativ intre cele doua
&rupuri (cu )9R $ respectiv fara )9R) RM? a pacientilor cu DZ si )9R a corelat ne&ativ
cu valorile colesterolului total ,revalenta cea mai mare a )9R s8a observat la &rupul cu
dislipidemie mi7ta$ iar prevalenta )9A a fost ma7ima la &rupul cu hipercolesterolemie
<bordarea terapeutica este discutabila
"a urmaririle ulterioare$ prevalenta si severitatea )9R la pacienii cu DZ a crescut
Dupa 0 ani de urmarire$ prevalenta )9R in centrul nostru a crescut de la 02/21 la
20B#1$ la fel ca si severitatea )9R ,e perioada de urmarire$ mortalitatea de toate
cauzele a fost semnificativ mai crescuta la pacientii cu )9R (16/21) comparativ cu cei
fara )9R (0/51) *ortalitatea de toate cauzele s8a corelat pozitiv cu varsta$ ;b<1c$
colesterolul total si ne&ativ cu RM?
)9R asociata DZ necesita o atentie speciala dintr8o perspectiva multidisciplinara $
in scopul de a8i reduce severitatea si pro&nosticul infaust
11/
THE IMPACT OF CHRONIC 3IDNE, DISEASE ON DIABETES MELLITUS
PATIENTS
THE E0PERIENCE OF A SINGLE ROMANIAN DIABETES CENTRE
unteanu ., %chiller Ad., Ionutiu L., ihaescu A., 6lariu N. Cocos 6. )arta L.
+ni(ersit3 of edicine and Phar"ac3 )i"isoara, Count3 0ospital )i"isoara,
Diabetes Care Centre )i"isoara
>he prevalence of D* in Romania is about B8/1 of the &eneral population and
risin& and accordin& to recent data the relative risD of these patients is considered 12
(9ollins <m W <dv Stud *ed 2##5$ 5 (59) S 1.081.6) Since 2##2 D* is considered
risD factor for the development of chronic DidneH disease (9ZD) not onlH related to
diabetic nephropathH but to hHpertension$ interstitial nephritis$ vascular lesions (hi&hlH
prevalent in D*) also 'n the hi&h cardiovascular risD population the prevalence of 9ZD
Ias reported hi&her in D* patients as compared to no D* patients (5.201 vs 220#1)
(>onelli et al W<S( 2##2$ 1B! 560/85620) >he relative risD of 9ZD is 2 but associated to
D* is 20 So 9ZD associated to D* needs a special attention 'n our centre the
prevalence of 9ZD associated to D* Ias found to be verH hi&h 02/21 as compared to
published data and in our paper Ie discus the possible causes
)oth 9ZD and D* are risD factors for cardiovascular disease (9AD) >he 9A
event rate Ias found to be si&nificantlH hi&her in both D* and 9ZD as compared to no
D* no 9ZD in the combined analHsis of KOS9O,S$ 9<RS and "','D trials (2221
and 2121 vs 1B61) Khen associated (D* and 9ZD) the event rate vas even hi&her
5161 'n our centre the prevalence of 9AD (ie coronarH arterH disease U 9<D$
con&estive heart failure U 9;M$ peripheral vascular disease U ,AD and cerebral vascular
disease U9SAD) Ias found si&nificantlH hi&her in 9ZD patients as compared to no 9ZD
ones (9<D 8 0.B21 vs 26B/1 p_####2$ 9;M 8 25121 vs 2.51 p_####2$ ,AD 8
21#/1 vs 1#651 p4####B and of 9SAD 8 6101 vs 5B61 p4##5B)
DHslipidemia is DnoIn to be a risD factor for 9AD and it Ias found to be a risD
factor for the pro&ression of 9ZD On the other hand almost all 9ZD patients develop a
severelH athero&enic form of dHslipidemia 'n our centre dHslipidemia Ias identified in
B/151 of D* patients (1/651 hHpercholesterolemia$ 1.2# 1 hHpertri&lHceridemia
and 5#501 mi7ed dHslipidemia) but the prevalence did not si&nificantlH differ in the tIo
&roups (9ZD$ no 9ZD) >he ?MR of D* patients Iith 9ZD correlated ne&ativelH Iith
total cholesterolemia >he hi&hest prevalence of 9ZD Ias found in the mi7ed
dHslipidemia and of 9AD Ias in the hHpercholesterolemia &roup >he issue of therapH is
discussed
On folloI up$ the prevalence and severitH of 9ZD increases in D* patients 'n
a 0 Hears folloI up$ in our centre the prevalence of 9ZD si&nificantlH increased from
02/21 to 20B#1 and the same Ias true for severitH of 9ZD Durin& the folloI up
period the all cause mortalitH Ias si&nificantlH hi&her in 9ZD patients as compared to no
11.
9ZD ones (16/21 vs 0/51) <ll cause mortalitH Ias positivelH correlated Iith a&e$
;b<1c and cholesterol levels and ne&ativelH Iith e?MR
9ZD associated to D* needs special attention from a multidisciplinarH team in
order to improve severitH and poor pro&nosis
PARTICULARIT9I DE EVOLUIE A DIABETULUI ZAHARAT TIP H
ASOCIAT CU ALTE BOLI AUTOIMUNE > PREZENTARE DE CAZ >
AutoriP dlina Punescu
9
, Aura Re,hin
9,:
, Alice Albu
9
, Daniela 4oicu
A
, )udor
Arbna
9,:
,%i"ona /ica
9,:
9
%pitalul +ni(ersitar de +r,en 2lias Bucureti,
:
+/ Carol Da(ila Bucureti,
A
Institutul Naional de 0e"atolo,ie )ransfu?ional >Prof Dr C.). Nicolau& Bucureti
I)t$%(cee:
9onte7tul autoimun de apariie a diabetului zaharat de tip 1 determin: asocierea acestuia
cu alte boli autoimune! anemie pernicioas:$ boal: celiac:$ tiroidit: autoimun:$ alopecie$
insuficien: &onadal:$ vitili&o$ boal: <ddison i altele ,acienii sunt %n maGoritate femei
si cea mai frecvent: asociere este cu tiroidita ;ashimoto 'n peste Gum:tate din cazuri$
diabetul zaharat de tip 1 precede boala autoimun: cu c3iva ani
Sc$1(!:
"ucrarea %i propune prezentarea unui caz de diabet de tip 1 care$ %n evoluie$ asociaz:
mai multe afeciuni autoimune

Mateia! 2i #et$%&:
,acienta 'S %n v3rst: de B/ de ani$ a fost dia&nosticat: iniial cu diabet zaharat tip 1 i
tiroidit: ;ashimoto cu hipotiroidie iar dup: 5 ani asociaz: anemie )iermer Dia&nosticul
a fost stabilit pe baza e7amenului clinic$ a analizelor de laborator (&licemie$
hemo&lobin: &licozilat:$ anticorpi antitiropero7idaz: <>,O$ >S;$ hemo&ram:$ frotiu de
s3n&e periferic$ anticorpi anticelul: parietal: &astric:) i investi&aii! eco&rafie tiroidian:$
endoscopie di&estiv: superioar: Nlterior$ pacienta prezint: anticorpi antinucleari i
transaminaze dublu fa: de normal %n absena maDerilor virali hepatici$ stabilindu8se
dia&nosticul de hepatit: autoimun:
Re'(!tate:
Sub tratament cu insulin:$ hormoni tiroidieni i vitamin: )12$ evoluia pacientei a fost
favorabil: cu ameliorarea manifest:rilor clinice i %mbun:t:irea parametrilor paraclinici
S8a constatat c: la fiecare asociere de boal: autoimun: controlul metabolic (e7primat prin
hemo&lobina &licozilat:) s8a deteriorat$ necesarul de insulin: a crescut$ schema de
12#
insulin: a trebuit intensificat: ,rin tratarea bolii autoimune asociate s8a reuit
ameliorarea controlului &licemic
C$)c!('ii:
Din cauza frecventei asocieri a diabetului de tip 1 cu alte afeciuni autoimune trebuie
avut: %n vedere investi&area acestor pacieni (mai ales c3nd debutul bolii este la v3rsta
adult:) pentru depistarea precoce a posibilelor boli autoimune >ratarea acestora permite
obinerea unui control metabolic mai bun i prevenirea apariiei complicaiilor pe termen
lun&
CHARACTERISTIC FEATURES OF EVOLUTION OF T,PE H DIABETES
ASSOCIATED +ITH SEVERAL AUTOIMMUNE DISEASES
> ca"e 1e"e)tati$) >
I)t$%(cti$):
>Hpe 1 diabetes mellitus is an autoi""une disease and it is freLuentlH associated Iith
other autoimmune diseases! pernicious anemia$ celiac disease$ autoimmune thHroiditis$
alopecia$ &onadal failure$ vitili&o$ <ddison disease ,atients are mainlH Iomen and the
most freLuent association is ;ashimotoJs disease 'n over 2#1 of cases$ tHpe 1 diabetes
mellitus precedes autoimmune disease Iith several Hears
Ai#: to present the evolution of tHpe 1 diabetes in a patient Iho developed several
autoimmune diseases
Met/$%":
,atient 'S$ a&ed B/$ Ias initiallH dia&nosed Iith tHpe 1 diabetes mellitus and
;ashimotoJs thHroiditis and 5 Hears later$ she associated )iermerJs anemia >he dia&nosis
Ias based on the clinical e7amination$ laboratorH tests (&lHcemia$ &lHcosHlated
hemo&lobin$ thHroid pero7idase antibodH 8 >,O<b$ >S;$ hemo&ram$ peripheral smear$
anti8&astric parietal cell antibodies) and investi&ations such as! thHroid ultrasound$ upper
&astrointestinal endoscopH Murther$ the presence of antinuclear antibodies and raised
transaminases$ in the absence of hepatic viral marDers$ confirmed the dia&nosis of
autoimmune hepatitis
Re"(!t":
>he patient received insulin$ thHroid hormones and cHanocobalamin treatment$ and the
sHmptomatolo&H and paraclinic tests Iere si&nificantlH i"pro(ed Sach time a neI
autoimmune disease Ias dia&nosed$ a deterioration of "etabolic control Ias noticed
(hi&h &lHcosHlated hemo&lobin)$ and the patient needed to increase the dailH dose of
insulin >he i"pro(e"ent of ,l3ce"ic control Ias possible Iith adeSuate treatment of
the associated autoimmune diseases
121
C$)c!("i$)":
Due to the freLuent association of tHpe 1 diabetes mellitus Iith other autoimmune
diseases$ functional screenin& for autoimmune diseases in these patients must be done$
especiallH in those Iith tHpe 1 diabetes onset at advanced a&e >he treatment of
associated diseases alloIs a better metabolic control and prevention of lon&8term
complications
EVALUAREA DIABETULUI ZAHARAT NOU DESCOPERIT N
;UDEUL GALAI N PERIOADA IANUARIE U IUNIE 5PPR
a,dalena oroanu
9
, arta A,anencei
:
9
%pitalul *udeean de +r,en $alai,
:
%pitalul unicipal )ecuci
I)t$%(cee6 Diabetul zaharat (DZ) prin frecvena i caracterul evolutiv de lun&:
durat: constituie o problem: maGor: i o preocupare continu: pentru depistarea bolii$
pentru evaluarea clinico biolo&ic: i prevenirea complicaiilor cronice micro i
macroan&iopatice
Sc$16 <naliza cazurilor noi de diabet %n perioada #1#12##/ U 5##B2##/ conform
protocolului studiului S,'D'<)$ pentru a evalua!
8 incidena bolii
8 frecvena complicaiilor cronice la dia&nosticarea bolii
8 comorbidit:i prezente
8 structura terapeutic:
Mateia! 2i #et$%&6
un total de 1./6 subieci au fost dia&nosticai cu diabet zaharat in perioada #1
ianuarie8 5# iunie 2##/
s8au analizat!
- aspectele epidemiolo&ice le&ate de tipul de diabet$ se7$ v3rst:T
- screenin&8ul complicaiilor croniceT
- asocierea cu alte entit:i ale sindromului metabolic i bolii cardiovasculareT
- structura terapeutic:
122
Re'(!tate6
DZ U diabet zaharat$ 1 8 procent din totalul persoanelor cu diabet zaharat nou depistate$
* U masculin$ M U feminin$
N(#& t$ta!
)$( %e1i"ta7i
DZ ti1 5 =ADOF i)"(!i)& 2i ADOF i)"(!i)&F %iet&?
N(#&
t$ta! ti1 5
SeZ
ADO I)"(!i)a S I)"(!i)a [ADO Diet& M F
Ga!a7i 12B0 122# 6B6 6/5 //. 26 210
Tec(ci 025 025 2#5 22# 261 12 12.
T$ta! 1./6 1.65 .6# 1##5 11B# B. B05
DZ U diabet zaharat$ <DO U antidiabetice orale$ * U masculin$ M U feminin$
HTA =X? BCV =X?
DLP
E<ect(at N6 =X? P$'itiv N6 =X?
Ga!a7i 15/5 (/.$21) 12/ (/$2B1) 1122 (62$01) /5. (20$11)
3ecuci
1/0 (05$01) 112 (26$11) 511 (651) 1/B (05$.1)
TOTAL 12B6 (6/$/1) 205 (12$21) 1055 (62$11) 1#22 (21$21)
N(#& t$ta! )$(
%e1i"ta7i
DZ ti1 H
N(#&
t$ta! ti1
H
X
SeZ
* F
"alai
Tec(ci
)6)AL
12B0
025
1./6
10
#
10
#$.
#
#$6
1#
#
1#
0
#
0
125
;>< U hipertensiune arterial:$ )9A U boal: cardiovascular:$ D", U dislipidemie$ (r U
num:r$ 1 8 procent
(r U num:r$ 1 8 procent
Sducaie U 1./6 cazuri (1##1)T automonitorizare 8 26B diabetici (15$051)
C$)c!('ii6
1 Fn primele B luni ale anului 2##/ s8au %nre&istrat 1./6 cazuri noi de diabet$ cu /22
cazuri mai mult fa: de anul precedent
2 "a dia&nosticare se constat: complicaii cronice %n procente relativ crescute precum i
asocierea frecvent: a hipertensiunii arteriale$ bolii cardiovasculare i dislipidemiei
5 Screenin&8ul complicaiilor cronice i al comorbidit:ilor necesit: a fi mai activ
pentru depistarea mai precoce a acestora %n scopul %mbun:t:irii mana&ementului
clinic i reducerii riscului cardiovascular
4. 'niierea terapiei cu metformin la debutul DZ tip 2 %n 2##/ s8a realizat %ntr8un procent
apreciabil mai mare dec3t %n anul precedent
2 S7tinderea epidemiolo&ic: a diabetului zaharat impune elaborarea unor pro&rame mai
active de depistare la &rupele cu risc crescut$ folosirea celor mai adecvate metode de
educaie i popularizarea aspectelor le&ate de complicaii i comorbidit:i
Reti)$1atie Ne<$1atie Ne($1atie
E<ect(at N6
=X?
P$'itiv N6
=X?
E<ect(at N6
=X?
P$'itiv N6
=X?
E<ect(at N6
=X?
P$'itiv N6
=X?
Ga!a7i 110 (6$521) 1/ (1$1B1) .26
(2.$/1)
20 (1$221) 6#2 (00$/1) 1#0 (B$B1)
Tec(ci 2/
(15$61)
2 (#$061) 16B (011) 5 (1$6B1) 1./ (0B$/1) /0 (1.$/1)
T$ta! 162
(/$B1)
2# (1#1) 11#5(22$2
1)
26 (1$51) .##
(02$21)
1//(.$0
1)
120
THE ANAL,SIS OF NE+L, DIAGNOSED DIABETES MELLITUS IN GALATI
COUNT, BET+EEN ;ANUAR,>;UNE 5PPR
a,dalena oroanu
9
, arta A,anencei
:
9
2"er,enc3 Clinical Count3 0ospital $alai,
:
Cit3 0ospital )ecuci
Bac-.$()%6 Diabetes mellitus (D*) represents a pro&ressive lon&8term disease
Iith a hi&h prevalence in &eneral population Dia&nosin& diabetes constitutes a maGor
problem and causes continuous concern for appropriate clinical and biolo&ical evaluation
and the prevention of diabetes microvascular and macrovascular chronic complications
Ai#"6 >he analHsis of neIlH dia&nosed cases of diabetes betIeen WanuarH $1
st
U
Wune$ 5#
th
2##/ accordin& to S,'D'<) StudH protocol$ in order to evaluate!
- the incidence of the disease
- the freLuencH of chronic complications at disease at onset
- concomitant comorbidities
- therapeutic re&imens
Mateia! a)% #et/$%6
< total of 1./6 subGects Iere neIlH dia&nosed Iith diabetes betIeen
WanuarH $1
st
U Wune$ 5#
th
2##/
Ke analHzed!
- epidemiolo&ical aspects re&ardin& diabetes tHpe$ a&e$ se7
- the screenin& of chronic complications
- the association Iith other disorders included in metabolic sHndrome
- therapeutic structure
Re"(!t"6
122
(o U number$ 1 8 percent from total number of neIlH dia&nosed persons$ * U masculin$
M 8 feminin
T$ta! )$6
)eG!@
%ia.)$"e%
T@1e 5 %iabete" =OADF i)"(!i) a)% OADF i)"(!i)F %iet?
T$ta! )$6
t@1e 5
SeZ
OAD I)"(!i) S I)"(!i) [OAD Diet M F
Ga!a7i 12B0 122# 6B6 6/5 //. 26 210
Tec(ci 025 025 2#5 22# 261 12 12.
T$ta! 1./6 1.65 .6# 1##5 11B# B. B05
(o U number$ O<D U oral antidiabetic dru&s$ * U masculin$ M 8 feminin
HT =X? CVD =X?
DLP
Scee)e% N$6 =X? P$'itive N$6 =X?
Ga!a7i 15/5 (/.$21) 12/ (/$2B1) 1122 (62$01) /5. (20$11)
3ecuci
1/0 (05$01) 112 (26$11) 511 (651) 1/B (05$.1)
TOTAL 12B6 (6/$/1) 205 (12$21) 1055 (62$11) 1#22 (21$21)
T$ta! )$6 )eG!@
%ia.)$"e%
T@1e H %iabete"
T$ta! )$6
t@1e H
X
SeZ
* F
"alai
Tec(ci
)6)AL
12B0
025
1./6
10
#
10
#$.
#
#$6
1#
#
1#
0
#
0
12B
;> U ;Hpertension$ 9AD U cardiovascular disease$ D", U dHslipidemia$ no U number$ 1
8 percent
(o U number$ 1 8 percent
Sducation U performed in 1./6 cases (1##1)T self8monitorin& U performed bH 26B
persons Iith diabetes (15$051)
C$)c!("i$)"6
1 'n first B months of 2##/ Ie recorded 1./6 cases of neIlH dia&nosed diabetes$
Iith /22 cases e7ceedin& last Hear report for the same period
2 Ke found relativelH hi&h percenta&es of chronic complications$ as Iell as
freLuent association of hHpertension$ cardiovascular disease and dHslipidemia at
dia&nose
5 Ke need a more active screenin& of chronic complications and comorbidities for
an earlH dia&nose$ to improve clinical mana&ement and reduce cardiovascular
risD
0 >he initiation of metformin therapH (percent of total cases) in neIlH dia&nosed
tHpe 2 diabetes patients in 2##/ Ias appreciablH hi&her than in the previous Hear
Reti)$1at/@ Ne1/$1at/@ Ne($1at/@
Scee)e% N$6
=X?
P$'itive N$6
=X?
Scee)e% N$6
=X?
P$'itive N$6
=X?
Scee)e% N$6
=X?
P$'itive N$6
=X?
Ga!a7i 110 (6$521) 1/ (1$1B1) .26
(2.$/1)
20 (1$221) 6#2 (00$/1) 1#0 (B$B1)
Tec(ci 2/
(15$61)
2 (#$061) 16B (011) 5 (1$6B1) 1./ (0B$/1) /0 (1.$/1)
T$ta! 162
(/$B1)
2# (1#1) 11#5(22$2
1)
26 (1$51) .##
(02$21)
1//(.$0
1)
126
2 >he epidemiolo&ic e7tent of diabetes impose elaboration of more active screenin&
pro&rams in hi&h risD population &roups$ use of most adeLuate educational
methods and lar&elH discuss and disseminate the aspects re&ardin& complications
and comorbidities
ACTIVITATEA FIZIC9 N RELAIE CU FACTORI INDIVIDUALIF E0TERNI
:I CU STATUSUL PONDERAL
N POPULAIA GENERAL9 A ;UDEULUI GALAI
a,dalena oroanu
9
, Andreea oroanu
:
, 6cta(ian AleEe
A
9
%pitalul Clinic de +r,en $alai,
:
Centrul Clinic de Diabet, Nutriie i Boli
etabolice Clu15Napoca,
A
/acultatea de =inetoterapie, +ni(ersitatea !Dunrea de
*os&$alai
I)t$%(cee Stilul de via: sedentar are o influen: important: %n creterea
ponderal: Obezitatea i supraponderea sunt favorizate de reducerea activit:ii fizice$ care
a devenit o caracteristic: a stilului de via: %n societatea actual: ,romovarea i stimularea
activit:ii fizice au beneficii importante %n reducerea ponderal:$ %n prevenia creterii
ponderale$ %n reducerea riscului cardiovascular (prin reducerea insulinorezistenei) i %n
terapia obezit:ii i a supraponderii
Obiective6 Svaluarea activit:ii fizice %n funcie de factori individuali$ e7terni
(se7$ v3rst:$ domiciliu$ anotimp) i a relaiei acesteia cu starea ponderal: %n populaia
Gudeului ?alai
Mateia! 2i #et$%\6 "otul de studiu de 511 persoane a fost selecionat pe baza
reprezentativit:ii &enerale pentru populaia adult: a Gudeului ?alai %n funcie de &rupe
de v3rst:$ se7 i domiciliu (urban$ rural) <ctivitatea fizic: a fost cuantificat: ca frecven:
(@5 ori=s:pt:m3n:) i ca durat: (@ 5# minute) (r:spuns cotat cu ]da- i ]nu-) conform
fiei de screenin& a obezit:ii a <sociaiei Rom3ne pentru Studiul Obezit:ii (<RSO)
Datele antropometrice s8au obinut prin m:surarea &reut:ii$ %n:limii$ circumferinei
abdominale (9<) i calculul indicelui de mas: corporal: ('*9) 9ate&oriile st:rii
ponderale %n funcie de '*9 au fost ]subpondere-$ ]normopondere-$ ]suprapondere-$
]obezitate-$ adaptate dupa clasificarea O*S 9ate&oriile de risc ale obezit:ii abdominale
au fost ! ]risc sc:zut- (9< _ /# cm la femei$ _ .0 cm la b:rbai)$ ]risc mediu- (9< /#8//
cm la femei$ .081#2 cm la b:rbai) i ]risc crescut- (9< Y // cm la femei$ Y 1#2 cm la
b:rbai) 9ate&oriile de risc mediu i crescut indic: obezitatea abdominal: (visceral:)
,relucrarea statistic: a datelor s8au realizat %n pro&ramul S,SS 15# (ivelul semnificaiei
statistice a fost realizat pentru p_##2
12/
Re'(!tate6 A)a!i'a activit&7ii <i'ice ]) .(1(! "t(%iat a ar:tat c: 2.$1B1 din
persoane efectueaz: activitate fizic: mai mult de 5 ori pe s:pt:m3n: i mai mult de 5#
minute )arbaii fac activitate fizic: %n procent mai mare (B1/21) dec3t femeile (2/#1)
(pY##2) Fn &eneral$ ambele se7e %n ambele medii efectueaz: activitate fizic: %n proporie
mai mare de 2#1 S8a remarcat o pondere mai mare a efectuarii activit:ii fizice la
b:rbai %n mediul urban (B2B61) fa: de mediul rural (22/11)$ %n timp ce la femei
activitatea fizic: este efectuat: comparabil %n mediul urban (2//61) i rural (2B2/1)
(uor mai crescut: %n mediul urban) S8a constatat o prevalena a efectu:rii activit:ii
fizice mai mare la &rupele de v3rst: 2#82. ani (66101)$ 2#82. ani (B65.1) i B#8B2 ani
(26/.1) fa: de &rupele de v3rst: 5#85. ani (22#21)$ 0#80. ani (216/1) i peste B2
ani (00B/1)$ precum i %n timpul verii (B6501) fa: de perioada de iarn: (21/21)
<ceste diferene au fost semnificative statistic (p_##2) Re!a7ia activitate <i'ic& U "tae
1$)%ea!&6 ,ersoanele care fac activitate fizic: au '*9 semnificativ mai mic (22/2 C
20/ D&=m
2
) fa: de cele care nu fac activitate fizic: (2/0# C B1. D&=m
2
) ,ersoanele care
fac activitate fizic: sunt normoponderale$ subponderale i supraponderale %ntr8un procent
semnificativ mai mare dec3t cele care nu fac activitate fizic: (acestea sunt %ntr8un procent
mai mare incluse %n cate&oria de obezitate) (p_##2) ,ersoanele care fac activitate fizic:
au 9< semnificativ mai mic: (/../ C 120. cm) fa: de cele care nu fac activitate fizic:
(.00/ C 1616 cm) i sunt$ %ntr8un procent mai mare$ incluse %n cate&oriile de risc sc:zut
i mediu (p_##2)
C$)c!('ii6 <ctivitatea fizic: este efectuat: %n procent mai crescut de c:tre b:rbai$
%n special %n mediul urban$ la tineri (2#82. ani) i %ntre 2#8B2 ani i mai mult %n timpul
verii ,ersoanele care fac activitate fizic: sunt frecvent normo8 i supraponderale i
asociaz: 9< cu risc sc:zut i mediu$ %n timp ce persoanele sedentare sunt asociate mai
frecvent cu obezitatea i cu obezitatea abdominal: cu risc crescut 'dentificarea i
evaluarea factorilor care influeneaz: activitatea fizic: constituie parte inte&rant: din
pro&ramele de mana&ement i prevenie a obezit:ii
PH,SICAL ACTIVIT, IN RELATION +ITH INDIVIDUAL AND E0TERNAL
FACTORS AND +ITH PONDERAL STATUS IN GENERAL POPULATION OF
GALATI COUNT,
a,dalena oroanu
9
, Andreea oroanu
:
, 6cta(ian AleEe
A
9
2"er,enc3 Clinical Count3 0ospital $alai,
:
Clinical Center of Diabetes, Nutrition
and etabolic Diseases Clu15Napoca,
A
=inetotherap3 /acult3, !Dunrea de *os&
+ni(ersit3 $alai
Bac-.$()% SedentarH lifestHle is an important factor in Iei&ht &ain >he
decrease of phHsical activitH Ihich became a lifestHle feature in noIadaHs societH
12.
induces the appearance of obesitH and overIei&ht ,romotin& and stimulatin& the
increase of phHsical effort brin& important benefits in losin& Iei&ht$ in preventin& Iei&ht
&ain$ in reducin& cardiovascular risD (bH decreasin& insulinresistance) and in obesitH and
overIei&ht mana&ement
Ai#"6 >he assessment of phHsical activitH in relation Iith individual and e7ternal
factors and Iith ponderal status in &eneral population of ?alati 9ountH
Met/$% a)% "t(%@ .$(16 StudH &roup included 511 persons selected based on
&eneral representativitH for a&e$ se7 and residence (urban$ rural) in adult population of
?alati 9ountH ,hHsical activitH Ias Luantified bH +Hes-=-no- ansIer re&ardin& carrHin&
out of e7actlH or more than 5# minutes of phHsical effort at least 5 times a IeeD
accordin& to ObesitH Screenin& Record form Romanian <ssociation for the StudH of
ObesitH Ke assessed anthropometric parameters! Iei&ht$ hei&ht$ Iaist circumference
(K9) and calculated bodH mass inde7 ()*') Ke adapted O*S criteria for LuantifHin&
ponderal cate&ories based on )*' values! +underIei&ht-$ +normalIei&ht-$ +overIei&ht-
and +obesitH- >he risD cate&ories of K9 Iere as folloIin&! +loI risD- ( K9 _ /# cm in
Iomen and _ .0 cm in men)$ +medium risD- (K9 betIeen /#8// cm in Iomen and
betIeen .081#2 cm in men) and +hi&h risD- (K9 Y // cm in Iomen and Y 1#2 cm in
men) *edium and hi&h risD cate&ories indicate abdominal (visceral) obesitH Statistical
analHsis Ias performed Iith S,SS 15# pro&ram Statistical si&nificance Ias reached for
p_##2
Re"(!t"6 T/e a)a!@"i" $< 1/@"ica! activit@ !eve! shoIed that 2.1B1 of the
subGects perform phHsical effort more than 5# minutes of phHsical effort at least 5 times a
IeeD *en carrH out phHsical activitH in a hi&her e7tent (B1/21) than Iomen (2/#1)
(pY##2) ?enerallH$ more than 2#1 of both men and Iomen performed phHsical activitH
Ke noticed a hi&her percent of affirmative ansIers in men from urban area (B2B61)
than from rural area (22/11)$ Ihile Iomen had comparable affirmative ansIers in
urban (2//61) and rural areas (2B2/1) (sli&htlH hi&her for urban residence) Ke
noticed a hi&her prevalence of phHsical activitH for a&e betIeen 2#82. Hears (66101)$
2#82. Hears (B65.1) and B#8B2 Hears (26/.1) than for a&e betIeen 5#85. Hears
(22#21)$ 0#80. Hears (216/1) and over B2 Hears (00B/1) as Iell as durin& summer
time >hese differences Iere statisticallH si&nificant (p_##2) T/e e!ati$) betGee)
1/@"ica! activit@ a)% 1$)%ea! "tat("6 ,ersons Iho carrH out phHsical effort had
si&nificantlH loIer )*' (22/2 C 20/ D&=m
2
) than those Iho do not carrH out phHsical
effort (2/0# C B1. D&=m
2
) >he persons Iho perform phHsical activitH are normalIei&ht
and overIei&ht in a si&nificantlH hi&her e7tent$ Ihile persons Iho do not carrH out
phHsical effort as reLuired are more freLuentlH obese (p_##2) K9 is si&nificantlH loIer
(/../ C 120. cm) and is included more in loI and medium risD cate&ories in subGects
Iho perform phHsical activitH as needed than in those Iho do not (.00/ C 1616 cm)
Ihich are included more in hi&h risD cate&orH (p_##2)
C$)c!("i$)"6 *en perform more freLuent phHsical activitH$ especiallH in urban
area ,ersons Iith a&e betIeen 2#82. Hears and betIeen 2#8B2 Hears$ as Iell as durin&
summer time carrH out phHsical effort more freLuentlH <ctive persons are more often
normalIei&ht and overIei&ht and are included in loI and medium risD cate&ories of
K9$ Ihile sedentarH persons are more often obese and have hi&h risD of K9 values
15#
(abdominal obesitH) 'dentification and assessment of factors Ihich influence phHsical
activitH are important tools in the prevention and mana&ement of obesitH
DETERMINAREA COMPOZITIEI CORPULUI LA PACIENTI CU SINDROM
METABOLICF PRIN METODA BIOIMPEDANTEIF UTILIZAND APARATELE
IN BOD, J6PF OMRON BFMPPF
BC /resenius edical Care
AutoriP . IspasI, N. %tateI, C. %erafinceanuI G, C. ConstantinG H,D. ChetaI G
Afi liatia autorilor P 9F+/ !Carol Da(ila&
:FInstitutul de Diabet !Prof N. Paulescu&
AF%pitalul Clinic de +r,enta ilitar Central !Carol Da(ila&
I)t$%(cee6 Studiul compozitiei corporale prin bioimpedanta este o metoda frecvent
utilizata$ folosind aparate de productie diferita Rezultatele pot influenta decizia
terapeutica
Mateia!e "i #et$%e6 ,entru B/ de pacienti cu sindrom metabolic ('DM 2##2)$ selectati
dintre cei admisi in 'nstitutul +(,aulescu-$ (55b=52f)$ cu varsta medie de 22$16C1#$./
ani$ s8a e7aminat compozitia corporala cu aGutorul a trei aparate diferite ('n )odH 5#$
Omron )M 2##$ )9*8Mresenius *edical 9are) Dintre acestia$ 21 (22b=2.f) au fost
inclusi in studiu <u fost e7clusi pacienti care nu au urmat tot protocolul$ cu amputatii
sau cu dispozitive electronice implantate <u fost determinati parametri! &reutatea$ '*9$
volumele lichidiene intra8 si e7tracelular$ precum si masa$ respectiv procentul de tesut
adipos Datele obtinute au fost prelucrate statistic cu S,SS 15# folosind testul > student
modificat
Re'(!tate6 S8au luat drept referinta rezultatele obtinute de la aparatul 'n )odH 5#$ unde
media volumului total de lichid (A>") a fost de 02$12C/$5/l$ cu distributia 2/$21C2$22
(lichid intracelular U "'9) si 15$/.C2$./ (lichid e7tracelular U "S9) (rezultate diferite
pentru p_#$#2 fata de referinta) Rezultatele )9* Mresenius au fost! volumul total de
lichid de 56$06C66B l $ distribuit astfel! 2#$0C0$25 l ("'9)$ respectiv 16$0C5$2Bl ("S9)
'*9 (D&=mE) a fost diferit! 5#$01C0$22 ('n )odH) vs 5#$0/C0$22 (Omron) (pentru
p_#$#2) ?reutatea totala determinata! /0$2C10$20 D& ('n )odH) si /0$02C10$2B D&
(Omron) (p_#$#2) ,rocentul de tesut adipos a fost de 51$..C6$B61 ('n )odH) vs
52$10C1#$#51 (Omron) (p_#$#2)$ respectiv$ vs 5/$2.C/$#21 (Mresenius) (p_#$#2)$ cu o
valoare mai mare la se7ul feminin vs se7ul masculine ,entru se7ul feminin rezultatele
au fost 0#$/2C6$0/ (Omron) vs 52$51CB$0B1 ('n )odH) (p_#$#2) ,entru se7ul masculin
rezultatele au fost 26$2/C6$121 (Omron) vs 26$50CB$B. ('n )odH) (p_#$#2) Raportul
talie8sold! #$..C#$#B (masculin) vs #$./C#$#. (feminin)
151
<paratele 'n )odH si Omron au furnizat date diferite si despre metabolismul
bazal! 1022$.0C211$22$ respectiv 1B25$22C201$/2 Dcal=zi (p_#$#2)
C$)c!('ii6 93nt:rirea sub ap: i DSd< (dual8ener&H 78raH absorptiometrH) sunt e7emple
de metode validate tiinific si desi costisitoare i inaccesibile$ raman a fi +standardele de
aur- %n determinarea compoziiei corporaleT *aGoritatea diferentelor obtinute pe lotul
studiat sunt semnificative statistic$ su&erand ca metoda bioimpedantei utilizata de diversi
producatori necesita imbunatatirea tehnicii folosite
Di"c(tii6 Datele furnizate servesc pentru aprecierea compozitiei corporale a pacientilor cu
sindrom metabolic$ bioimpedanta fiind o metoda simpla$ neinvaziva si usor de folosit$ dar
ale&erea oricarui aparat dintre cele folosite$ va influenta conduita terapeutica in practica
Fi)a)7ae: Studiu realizat in cadrul proiectului ,(9D'2 221B0=2##/
DETERMINATION OF BOD, COMPOSITION IN PATIENTS +ITH
METABOLIC S,NDROMEF
B, BIO>IMPEDANCE METHODF
("i). I) B$%@J6PF O#$) BF MPPF BCM Fe"e)i(" Me%ica! Cae %evice"
AuthorsP . IspasI, N. %tateI, C. %erafinceanuI G, C. ConstantinG H, D. ChetaI G
AuthorsR affiliationP 9F !Carol Da(ila& +ni(ersit3 of edicine and Phar"ac3@
:F !N. Paulescu& National Institute of Diabetes@
AF !Carol Da(ila& Central ilitar3 2"er,enc3 Clinical 0ospital.
I)t$%(cti$)6 >he studH of bodH composition bH bio8impedance is a freLuentlH used
method$ usin& different devices >he results maH influence the therapeutic choice
Mateia!" a)% #et/$%"6 B/ patients (55m=52I) Iith metabolic sHndrome ('DM2##2)
Iere selected from patients admitted in the +( ,aulescu- 'nstitute >heir mean a&e Ias
of 2216C1#./Hears >heir bodH composition Ias e7amined$ usin& three different
devices! 'n )odH 5#$ Omron )M 2##$ )9*8Mresenius *edical 9are 21 patients (22m =
2.I) Iere included in the studH ,atients Iith amputation$ implanted electronic devices
or incomplete determinations Iere e7cluded Kei&ht$ )*'$ intra8 and e7tracellular liLuid
volumes$ fat tissue Iere also determined <ll data Iere statisticallH processed usin& >
Student test in S,SS 15#
152
Re"(!t"6 <s reference the results of 'n )odH 5# Iere used$ Ihere total bodH Iater
(>)K) Ias of 0212C/5/"$ distributed as folloIin&! 2/21C222" ')K (intracellular
bodH Iater) and 15/.C2./" S)K (e7tracellular bodH Iater) (results different for
p_##2 than reference) >he results of )9* Mresenius Iere! 5606C66B"$ distributed in
2#0C025" (')K) and 160C52B "(S)K) >he results for )*' (D&=mE) Iere different!
5#01C022('n )odH) and 5#0/C022(Omron) (p_##2) Determined Iei&ht Ias similar!
/02C1020 D&('n )odH) and /002C102B D&(Omron) (p_##2) >he percenta&e of fat
tissue Ias different 51..C6B61('n )odH) vs 5210C1##51(Omron) (p_##2)$
respectivelH 5/2.C/#21(Mresenius) (p_##2)$ Iith a hi&her value for Iomen than men!
5251CB0B1('n )odH)$ 0#/2C60/1(Omron) (p_##2) (Iomen) vs 2650CBB.1 ('n
)odH)$ 262/C6121 (Omron) (p4##20) (men)
Kere also recorded different information re&ardin& Restin& *etabolism Rate!
1022.0C21122 Dcal=daH ('n )odH) and 1B2522C201/2 Dcal=daH (Omron) (statisticallH
different for p_##2)
C$)c!("i$)"6 Nnder Iater Iei&htin& and DSd< (dual8ener&H878raH absorptiometrH)
remain the +&old standard- procedures for determinin& bodH composition$ but theH are
inaccessible and e7pensive >he maGoritH of obtained results are statisticallH different
Di"c(""i$)"6 >he obtained data are helpful in determinin& bodH composition in patients
Iith metabolic sHndrome$ as bio8impedance is a simple$ noninvasive$ easH to use method$
but choosin& anH of the devices above Iill influence the therapeutic behavior in clinical
practice
S(11$te% b@! ?rant ,(9D'2 221B0=2##/ from the Romanian Research *inistrH
STUDIU ASUPRA AUTOIMUNITATII ASOCIATE IN DIABETUL ZAHARAT
TIP H LA COPIL SI ADOLESCENT
ariana Andreica, Nicolae iu, %i"ona Cainap, Bo,dan Lucian, Lucia %la(escu,
Claudia Bolba, Rodica Cornean, )udor L. Pop
Clinica Pediatrie II, +/ 8Iuliu 0atie,anu8, Clu15Napoca
<socierile autoimune la pacientii cu DZ sunt bine cunoscute si pot apare fie
individual$ fie incadrate in sindroame <ceste asocieri implica &ene ale comple7ului
maGor de histocompatibilitate(*;9) de tipul ;"< DR si DQ 9ele mai frecvente asocieri
155
sunt reprezentate$ in ordinea incidentei$ de tiroidita autoimuna$ boala celiaca$ boala
<ddison si alte autoimunitai ca artrita cronica idiopatica sau vitili&o
S8au luat in studiu un numar de 0. de copii si adolescenti internati in 9linica
,ediatrie ''$ 9luG8 (apoca$ in perioada 2##282##6 S8a efectuat screenin& pentru tiroidita
autoimuna prin masurarea anticorpilor antitireopero7idaza(>,O)$ antitireo&lobulina(>?)$
a >S; si a f>0 Screenin&ul pentru boala celiaca s8a realizat prin masurarea anticorpilor
antiendomisium(<S*) si antitrans&lutaminaza tisulara(<>?t) Screenin&ul pentru boala
<ddison s8a efectuat prin masurarea cortizolemiei bazale si ulterior prin determinarea
anticorpilor antiadrenali De asemenea s8a realizat si screenin& pentru artrita cronica
idiopatica si alte cola&enoze prin detectarea factorului reumatoid$ a anticorpilor
antinucleari si a anticorpilor anti<D( ds 'n paralel s8a efectuat monitorizarea metabolica
a tuturor pacientilor
>iroidita autoimuna a fost descoperita la 5 pacienti(B$11) Din acestia $ un pacient
a prezentat forma hipertiroidiana(b )asedoI8?raves)$ unul a prezentat asociat boala
celiaca iar unul a prezentat sindrom poliendocrin autoimuin tip '' )oala celiaca a fost
prezenta la 0 pacienti(/$11) )oala <ddison a fost prezenta la 1 pacient(21) in conte7tul
sindromului poliendocrin autoimun tip '' Doi pacienti au prezentat artrita cronica
idiopatica(01) si 1 pacient a prezentat leziuni de vitili&o(21)
'n concluzie$ autoimunitatile asociate diabetului zaharat tip ' la copil si adolescent
impune efectuarea unor teste screenin& dupa protocoale bine standardizate$ atat pentru
ameliorarea controlului bolii cat si pentru prevenirea precocitatii complicatiilor micro si
macrovasculare ulterioare
STUD, OF ASSOCIATED AUTOIMMUNIT, AND T,PE H DIABETES
MELLITUS IN CHILDREN AND ADOLESCENTS
ariana Andreica, Nicolae iu, %i"ona Cainap, Bo,dan Lucian, Lucia %la(escu,
Claudia Bolba, Rodica Cornean, )udor L. Pop
:nd Pediatric Clinic, +ni(ersit3 of edicine and Phar"ac3 !Iuliu 0atie,anu&, Clu15
Napoca
<ssociated autoimmunitH and tHpe 1 diabetes mellitus(>1D*) is Iell DnoIn and
can e7ist individuallH or combined in sHndromes >his association implicates the
involvement of different &enes of the maGor histocompatibilitH comple7(*;9) such as
human leuDocHte anti&en(;"<) DR and DQ >he most common autoimmune
associations are represented bH autoimmune thHroid disease$ celiac disease$ <ddisonRs
disease and others such as chronic idiopathic arthritis or vitili&o
150
Ke have studied 0. children and adolescents admitted in >he 2
nd
,ediatric 9linic
in 9luG8(apoca betIeen 2##2 and 2##6 Ke have performed screenin& tests for
autoimmune thHroid disease bH measurin& thHroid pero7idase and thHro&lobulin
autoantibodies$ >S; and free >0 >he celiac disease screenin& has been made bH
antiendomHsial and trans8&lutaminase autoantibodies and <ddisonRs disease screenin&
has been made bH basal cortisol and antiadrenal antibodies Ke have also performed
screenin& for chronic idiopathic arthritis and other colla&en diseases bH determinin&
rheumatoid factor and antinuclear and anti D(< antibodies
<utoimmune thHroid disease Ias discovered in 5(B$11) patients of Ihich 1 had
hHperthHroid function()asedoI8?raves disease)$ one associated celiac disease and one
had autoimmune polHendocrine sHndrome tHpe '' 9eliac disease Ias revealed in 0
patients(/$11) <ddisonRs disease Ias revealed in one patient(21) and Ias associated in
the autoimmune polHendocrine sHndrome tHpe '' >Io patients(01) had had chronic
idiopathic arthritis and one of them had vitili&o lesions
<s a conclusion$ associated autoimmunitH and >1D* should emphasize the
important role of screenin& in this patients$ bH Iell standardized protocols$ in order to
ameliorate the natural historH of >1D* and to prevent the precocitH of developin& micro
and macro8 vascular complications of the disease
CORELAIA DINTRE CIRCUMFERINA ABDOMINAL9 =CA? :I RAPORTUL
TGSHDL^J CA MAR3ERI AI INSULINOREZISTENEI CU PERTURB9RILE
METABOLISMULUI GLUCIDIC
A(t$i: *ihaela " )%cu$ Simona ? ,opa$ R' Dinu$ 9amelia ,:nu$ *aria *oa
Spitalul 9linic Wudeean de Nr&en: 9raiova$ 9linica Diabet (utriie )oli *etabolice
Pe#i"e 2i "c$16 Scopul studiului a fost de a urm:ri corelaia e7istent: %ntre dou:
modalit:i de evaluare a insulinorezistenei! 1 circumferina abdominal: (9<)T 2 raportul
>?=;D" Y 5 i perturb:rile metabolismului &lucidic
Mateia! 2i #et$%&6 <m luat %n studiu 11. subieci internai %n 9linic: %n perioada iunie
2##/ 8septembrie 2##/$ cu suspiciune de diabet zaharat (DZ)$ cu v3rsta medie C dev st de
20$2# C 15$B/ ani (limite 2#8/# ani)$ dintre care B# b:rbai (2#$01) i 2. femei (0.$B1)
*enion:m c: au fost e7clui subiecii cu suspiciune de perturb:ri secundare ale
metabolismului &lucidic ,arametrii investi&ai au fost! v3rsta$ se7$ date antropometrice
(%n:lime$ &reutate$ inde7ul masei corporale 8 '*9$ 9<)$ test de toleran: oral: la &lucoz:
>>?O cu 62 & &lucoz: (&licemie a Geun$ &licemie la 1or:$ &licemie la 2 ore)$ tri&liceride
(>?)$ colesterol total$ ;D" colesterol
152
Re'(!tate 2i %i"c(7ii Din cei 11. subieci$ 12 (12$B#1) au prezentat toleran: normal: la
&lucoz: (>(?)$ restul 1#0 subieci (/6$0#1) prezent3nd modific:ri ale metabolismului
&lucidic$ astfel! 0B subieci (5/$B21) au fost dia&nosticai cu diabet zaharat (DZ)$ 20
( 2#$1B1) subieci cu alterarea &licemiei a Geun ('M?)$ 5 (2$221) subieci cu sc:derea
toleranei la &lucoz: ('?>)$ 25 (1.$521) subieci cu intoleran: combinata la &lucoz:
(9?'4 'M?j'?>) i / (B$621) subieci cu dis&licemie
Corelaia dintre circumferina abdominal *C#- 4i raportul 3"5HD67) ca markeri ai
insulinore8istenei si perturbrile metabolismului glucidic
Caactei"tica B&ba7i
(num:r B#)
Fe#ei
(num:r 2.)
CA =c#? TLI LI>HPH _HP5 TRP RP>RO _RR
(um:r (1) 1B
(2B$BB1)
11
(1/$551)
55 (221) B (1#$1B1) / (15$221) 02
(6B$261)
TGS
HD
L
^ J I =5MX? R
=O5FO5X?
55
=QQFQQX?
P =PX? 5 =5MX? HI
=JHFHHX?
>(? # (#1) 1 (12$21) 1 (0$201) # (#1) # (#1) 2
(10$2/1)
DZ 1 (221) 2 (221) 6
(51$/11)
# (#1) 1 (2#1) 2
( 52$611)
'M? 2 (2#1) 2 (221) 0
(1/$1/1)
# (#1) # (#1) 2
(10$2/1)
'?> # (#1) # (#1) 1 (0$201) # (#1) # (#1) # (#1)
9?' 1 (221) 2 (221) 6
(51$/11)
# (#1) # (#1) 0
(2/$261)
dis&licemi
e
# (#1) 1 (12$21) 2 (.$#.1) # (#1) 1 (2#1) 1 (6$101)
TGS
HD
L
T J H5 =OMX? J
=5OF5OX?
HH
=JJFJJX?
Q =HPPX? Q =OMX? JH
=QRFRRX?
>(? 2
(1B$BB1)
# (#1) 1 (.$#.1) 2 (/5$551) 1 (1B$BB1) 2 (B$021)
DZ 0
(55$551)
# (#1) 0
(5B$5B1)
# (#1) 1 (1B$BB1) 21
(B6$601)
'M? 0
(55$551)
2
(BB$BB1)
2
(1/$1/1)
1 (1B$BB1) 2 (55$551) 5 (.$B61)
15B
'?> # (#1) 1
(55$551)
# (#1) # (#1) 1 (1B$BB1) # (#1)
9?' 1 (/$551) # (#1) 5
(26$261)
# (#1) 1 (1B$BB1) 0 (12$.1)
dis&licemi
e
1 (/$551) # (#1) 1 (.$#.1) # (#1) # (#1) 1 (5$221)
Dintre b:rbaii cu 9< @ 1#2 cm$ BB$BB1 au prezentat raport >?=;D" Y 5$ spre deosebire de
femei$ la care nu am observat corelaie %ntre 9< i raportul >?=;D" Y 5 (51$111)
<t3t la b:rbai c3t i la femei$ am observat corelaie %ntre 9< @ 1#2 cm$ respectiv 9< @ // cm i
perturb:rile metabolismului &lucidic$ indiferent %ns: de valoarea raportului >?=;D"
C$)c!('ii6 ,rezena obezit:ii abdominale i implicit a perturb:rilor metabolismului lipidic$
impun investi&area metabolismului &lucidic prin efectuarea >>?O8ului$ %n vederea depist:rii
perturbarilor metabolismului &lucidic %n stadii precoce
THE CORRELATION BET+EEN +AIST CIRCUMFERENCE =+C? AND TGSHDL^J
RATIO AS INSULINRESISTANCE MAR3ERS +ITH THE DISTURBANCES OF
GL,CEMIC METABOLISM
A(t$": *ihaela " )icu$ Simona ? ,opa$ R' Dinu$ 9amelia ,anus$ *aria *ota
Department of Diabetes (utrition *etabolic Diseases$ 9linical 9ountH Smer&encH
;ospital 9raiova
Bac-.$()% a)% ai#6 >he obGective of this studH Ias the assessment of the correlation
betIeen Iaist circumference (K9) and >?=;D"Y5 ratio as insulinresistance marDers
Iith the disturbances of &lHcemic metabolism
Mateia! a)% #et/$%6 >he studH Ias performed 11. subGects Ihich Iere admitted in
Diabetes 9linical in Wune 2##/ 8 September 2##/ period$ in observation for Diabetes
*ellitus (D*)$ Iith an avera&e a&e C stdev of 20$2# C 15$B/ (limits 2#8/#) Hears$ from
Ihich B# men (2#$01) and 2. Iomen (0.$B1) Ke mentioned that Iere e7cluded the
subGects Iith suspicion on secundarH disturbances of &lHcemic metabolism >he
folloIin& parameters Iere analHzed! a&e$ &ender$ anthropometric parameters (hei&ht$
Iei&ht$ bodH mass inde78)*'$ K9)$ oral &lucose tolerance test (O?>>) usin& 62&
&lucose (fastin& &lHcemia$ &lHcemia at 1 hour$ &lHcemia at 2 hours)$ trH&licerides (>?)$
total cholesterol$ ;D" cholesterol
Re"(!t" a)% %i"c(""i$)"6 Mrom the 11. subGects studied$ 12 (12$B#1) subGects have a
normal &lucose tolerance ((?>)$ the rest of 1#0 (/6$0#1) subGects presented
156
disturbances of &lHcemic metabolism herebH! 0B subGects (5/$B21) Ias dia&nosed Iith
D*$ 20 subGects (2#$1B1) Iith impaired fastin& &lucose ('M?)$ 5 subGects (2$221) Iith
impaired &lucose tolerance ('?>)$ 25 subGects (1.$521) Iith combined &lucose
intolerance (9?'4'M?j'?>) and / subGects (B$621) Iith dHs&lHcemia
3he correlation bet9een 9aist circumference *:C- and 3"5HD67) ratio as
insulinresistance markers 9ith the disturbances of glycemic metabolism
C/aactei"tic" Me)
( B# subGects)
+$#e)
( 2. subGects)
+C =c#? TLI LI>HPH _HP5 TRP RP>RO _RR
(umber (1) 1B
(2B$BB1)
11
(1/$551)
55 (221) B (1#$1B1) / (15$221) 02
(6B$261)
TGS
HD
L
^ J I =5MX? R
=O5FO5X?
55
=QQFQQX?
P =PX? 5 =5MX? HI
=JHFHHX?
>(? # (#1) 1 (12$21) 1 (0$201) # (#1) # (#1) 2
(10$2/1)
DZ 1 (221) 2 (221) 6
(51$/11)
# (#1) 1 (2#1) 2
( 52$611)
'M? 2 (2#1) 2 (221) 0
(1/$1/1)
# (#1) # (#1) 2
(10$2/1)
'?> # (#1) # (#1) 1 (0$201) # (#1) # (#1) # (#1)
9?' 1 (221) 2 (221) 6
(51$/11)
# (#1) # (#1) 0
(2/$261)
dis&licemi
e
# (#1) 1 (12$21) 2 (.$#.1) # (#1) 1 (2#1) 1 (6$101)
TGS
HD
L
T J H5 =OMX? J
=5OF5OX?
HH
=JJFJJX?
Q =HPPX? Q =OMX? JH
=QRFRRX?
>(? 2
(1B$BB1)
# (#1) 1 (.$#.1) 2 (/5$551) 1 (1B$BB1) 2 (B$021)
DZ 0
(55$551)
# (#1) 0
(5B$5B1)
# (#1) 1 (1B$BB1) 21
(B6$601)
'M? 0
(55$551)
2
(BB$BB1)
2
(1/$1/1)
1 (1B$BB1) 2 (55$551) 5 (.$B61)
'?> # (#1) 1 # (#1) # (#1) 1 (1B$BB1) # (#1)
15/
(55$551)
9?' 1 (/$551) # (#1) 5
(26$261)
# (#1) 1 (1B$BB1) 0 (12$.1)
dHs&licem
ia
1 (/$551) # (#1) 1 (.$#.1) # (#1) # (#1) 1 (5$221)
Mrom the men Iith K9 @ 1#2 cm$ BB$BB1 shoIed >?=;D" Y 5 ratio$ comparative Iith the
Iomen$ on Ihich have not observed the correlation betIeen K9 and >?= ;D" Y 5 ratio
(51$111)
)oth Iomen and men Ie observed the correlation betIeen K9 @ 1#2 cm$ respectivelH K9 @
// cm Iith the disturbances of &lHcemic metabolism$ no matter the value on >?=;D" ratio
C$)c!("i$)"6 >he presence of abdominal obesitH and implicitlH of the disturbances of lipidic
metabolism$ maDes necessarH the investi&ation of the &lHcemic metabolism throu&h
effectuation of the O?>>$ Iith a vieI to earlH tracDin& of the disturbances of &lHcemic
metabolism6
COMPARAREA VARIABILIT9II GLICEMICE LA SUBIECI CU :I F9R9
MODIFIC9RI ALE METABOLISMULUI GLUCIDIC
AutoriP ihaela L. BCcu, %i"ona $. Popa, %i,ina R. $Cr,a(u, R.I. Dinu, aria oa
%pitalul Clinic *udeean de +r,en Craio(a, Clinica Diabet Nutriie Boli etabolice
Pe#i"e 2i "c$1: Aariabilitatea &licemic: la persoanele f:r: diabet zaharat este corelat:
cu r:spunsul metabolic postprandial Fn vederea cuantific:rii e7acte a variabilit:ii
&licemice se pot calcula indici specifici! *<?S (*ean <mplitude ?lHcemic
S7cursion4<mplitudinea *edie a S7cursiilor ?licemice)$ *ODD (*ean of DailH
Differences 4 *edia Diferenelor Zilnice)$ *'*S (*ean 'ndices of *eal S7cursions 4
'ndicele *ediu <l S7cursiilor ?licemice ,ostprandiale) *<?S evalueaz: e7cursiile
&licemice maGore din cursul unei zile$ e7cluz3nd e7cursiile &licemice minore *ODD
apreciaz: variaiile &licemice %n acelai moment din zile diferite$ la acelai subiect
*'*S evalueaz: e7cursiile &licemice corelate cu in&estia de alimente
Scopul studiului este de a compara! 1variabilitatea &licemic: la doi subieci cu diet: f:r:
restricie de hidrai de carbon (;9)$ unul cu toleran: normal: la &lucoz: ((?> normal
&lucose tolerance) i unul cu alterarea &licemiei a Geun ('M? impaired fastin& &lucose)T 2
variabilitatea &licemic: la subiectul cu 'M? 8 diet: f:r: restricie de ;9 versus diet: cu
restricie de ;9 (2##& ;9=zi)
15.
Mateia! 2i #et$%&: <m calculat cinci indici specifici de evaluare a variabilit:ii
&licemice (*?$ DS$ *<?S$ *ODD$ *'*S) la cei 2 subieci$ cu diet: f:r: restricie de
;9! unul cu (?> i unul cu 'M?$ de acelai se7$ comparabili ca v3rst:$ '*9$ condiii de
stressT de asemenea$ am calculat cei cinci indici la subiectul cu 'M?$ cu diet: cu 2## &
;9=zi "a cei doi subieci s8a montat 9?*S (continuous &lucose monitorin& sHstem 4
sistem de monitorizare continu: a &licemiei) pe o perioad: de 62 ore *enion:m c:
subiectul cu 'M? a avut montat 9?*S de 2 ori$ timp de 62 ore$ o dat: cu dieta f:r:
restricie de ;9$ i o dat: cu dieta cu 2## & ;9=zi Fn ziua a doua a mont:rii 9?*S8ului
am efectuat test de toleran: la &lucoz: pe cale oral: (>>?O) la cei doi subieci$ cu 62 &
&lucoz: pulvis
,entru calculul *?$ SD i *<?S au fost analizate %nre&istr:rile 9?*S obinute %n a
doua zi$ %n timp ce pentru calculul *ODD %nre&istr:rile din ziua a doua i a treia ,entru
calculul *'*S am evaluat e7cursiile &licemice postprandiale dup: masa cu 62& ;9$ c3t
i dup: >>?O (cu 62 & &lucoz:)
Svaluarea indicilor de variabilitate &licemic:! *<?S U media aritmetic: a e7cursiilor
&licemice ascendente maGore pe 20 ore *ODD U media diferenelor absolute %ntre
&licemii determinate %n acelai moment$ la un interval de 20 ore *'*S U s8a calculat %n
funcie de 5 elemente! o? (diferena dintre valoarea &licemic: ma7im: postprandial: i
valoarea preprandial: a &lucozei)T o> (timpul %n care se obine peaD8ul &licemic
postprandial)T 8 o? (diferena dintre &licemia la 1 or: dup: atin&erea peaD8ului &licemic
i valoarea &licemic: ma7im: postprandial:) *? (media &licemic:) i DS (deviaia
standard a &licemiilor)
Re'(!tate 2i %i"c(7ii:
Subiect *?C
DS
(m&=dl
)
*<?
S
(m&=dl
)
*OD
D
(m&=dl
)
*'*S (m&=dl) dup:
masa cu 62& ;9
*'*S (m&=dl) dup:
>>?O cu 62 & &lucoza
o?
(m&=dl
)
o>
min
o?
(m&=dl
)
o?
(m&=dl
)
o>
min
8 o?
(m&=dl
)
'M?8 dieta
fara restrictie
de ;9
1#6$25
C1.$B/
02$61 22$2/ 5. 0# 15 B1 2# B2
(?>8 dieta
fara restrictie
de ;9
1##$21
11$2
/
21 11$12 22 22 12 15 2# 15
'M?8 dieta cu
2##& ;9
.6C/ 25 16$#/ 2. 2# 2# 8 8 8
Subiectul cu 'M? prezint: e7cursii &licemice zilnice mai numeroase si mai ample
(*<?S crescut) i reproductibilitate de la o zi la alta a profilului &licemic mai redus:
10#
(*ODD crescut) comparativ cu subiectul cu (?> 9ompar3nd *'*S dup: >>?O (cu
62& &lucoz:) i dup: masa cu 62& ;9$ am observat valori mai mari ale celor 5 elemente
(o?$ o>$8 o?) dup: >>?O$ la subiectul cu 'M? "a subiectul cu 'M? s8au observat
valori semnificativ mai mici ale indicilor variabilit:ii &licemice pe perioada dietei cu
2##& ;9=zi$ fa: de perioada dietei f:r: restricie de ;9
C$)c!('ii: <naliza profilului e7cursiilor &licemice la persoanele cu i f:r: modific:ri ale
metabolismului &lucidic poate fi util: %n definirea valorilor dia&nostice i a celor int:
pentru diabet
THE COMPARISON OF GL,CEMIC INSTABILIT, IN SUB;ECTS +ITH AND
+ITHOUT DISTURBANCES OF GLUCOSE METABOLISM
AutorsP ihaela L. BCcu, %i"ona $. Popa, %i,ina R. $Cr,a(u, R.I. Dinu, aria oa
Depart"ent of Diabetes Nutrition etabolic Diseases, Clinical Count3 2"er,enc3
0ospital Craio(a
Bac-.$()% a)% ai#6 >he &lHcaemic variations observed in non diabetic subGects are
primarilH related to the postprandial metabolic responses 'n order to e7actlH LuantifH
&lHcemic variabilitH$ specific tools of calculation can be used! *<?S (*ean <mplitude
?lHcemic S7cursion)$ *ODD (*ean Of DailH Differences)$ *'*S (*ean 'ndices of
*eal) >he *<?S inde7 evaluate the intra8daH maGor &lHcemic e7cursions$ i&norin&
minor &lHcemic e7cursions *ODD inde7 appreciate the &lHcemic variation in the same
moment from different daH$ at the same patient *'*S evaluate the meal8related
&lHcemic e7cursions
>he obGective of this studH is to compare! 1 &lHcemic instabilitH at 2 subGects Iith diet
Iithout restriction of carbohHdrates (9;)$ one of them Iith normal &lucose tolerance
((?>) and the other Iith impaired fastin& &lucose ('M?)T 2 &lHcemic instabilitH in
subGect Iith 'M? U diet Iithout restriction of 9; versus diet Iith restriction of 9; (2##&
9;=daH)
Mateia! a)% #et/$%: >here Iere calculated five specific inde7 of &lHcemic instabilitH
(*)?$ SD$ *<?S$ *ODD$ *'*S) in tIo subGects$ Iith diet Iithout restriction of 9;!
one (?> subGect and one 'M? subGect$ both Iomen$ comparable to a&e$ )*' (bodH mass
inde7)$ stressT also$ Ie calculated five specific inde7 at subGect Iith 'M?$ Iith diet Iith
2##& 9; =daH >hese subGects Iere observed Iith continuous &lucose monitorin& sHstem
(9?*S) for 62 hours >o mention that subGect Iith 'M? Ias observed Iith 9?*S for
tIo times$ for 62 hours$ once Iith diet Iithout restriction of 9;$ and once diet Iith
restriction of 9; (2##& 9;=daH) 'n the second daH of 9?*S$ Ie perform oral &lucose
101
tolerance test (O?>>) usin& 62& &lucose at the tIo subGects *)?$ SD and *<?S Iere
calculated usin& 9?*S &lHcemic records from the second daH$ in time of *ODD Ias
measured usin& 9?*S &lHcemic records from the second and third daHs Mor the *'*S
measurement Ias evaluated postprandial &lHcemic e7cursion at meal Iith 62& 9;$ both
at O?>> ( 62& &lucose)
?lHcemic instabilitH inde7 calculation! *<?S U maGor ascendin& &lucose e7cursion
avera&e on 20 hours *ODD U mean of absolute difference betIeen &lHcemic values on
the same moment from different daHs *'*S U Ias calculated on the basis of three
elements! o? (difference betIeen ma7im postprandial &lHcemic value and preprandial
&lHcemic value)T o> (necessarH time for reach postprandial &lHcemic peaD)T 8 o?
(difference betIeen &lHcemic value at 1 hour after reach postprandial &lHcemic peaD and
ma7im postprandial &lHcemic) *ean level of blood &lucose (*)?) and blood &lucose
standard deviation (SD)
Re"(!t" a)% %i"c(""i$):
SubGect *)?C
SD
(m&=dl)
*<?S
(m&=dl)
*ODD
(m&=dl)
*'*S (m&=dl) at
meal Iith 62& 9;
*'*S (m&=dl) at O?>>
Iith 62 & &lucose
o?
(m&=dl)
o>
min
8 o?
(m&=dl)
o?
(m&=dl)
o>
min
8 o?
(m&=dl)
'M?8 diet
Iithout
restriction of
9;
1#6$25C
1.$B/
02$61 22$2/ 5. 0# 15 B1 2# B2
(?>8 diet
Iithout
restriction of
9;
1##$21
11$2/
21 11$12 22 22 12 15 2# 15
'M?8 diet
Iith 2##&
9;
.6C/ 25 16$#/ 2. 2# 2# 8 8 8
SubGect Iith 'M? presented numerous and more ample intra8daH &lucose e7cursions (hi&h
*<?S) and reduced daH8to8daH reproducibilitH of blood &lucose values (hi&h *ODD)$
comparative Iith subGect Iith (?> <t the subGect Iith 'M? Ie observed hi&er values
for the three elements (o?$ o>$8 o?) of *'*S at O?>> (62& &lucose)$ comparative
Iith meal Iith 62& 9;
>he subGect Iith 'M? Ias present values si&nificant loIer of the &lHcemic instabilitH
inde7 durin& diet Iith 2##& 9;=daH$ comparative Iith period of diet Iithout restriction
of 9;
102
C$)c!("i$)": >he profile of &lHcemic e7cursion in subGects Iith and Iithout
disturbances of &lucose metabolism maH have an important si&nificance in definin& the
dia&nostic cutoff8points and tar&ets for &lHcemic control on diabetes mellitus
RISCUL CARDIOVASCULAR LA PERSOANELE CU DIABET ZAHARAT TIP
5
ihaela $ribo(schiI, Anca /TrcaIGH, 2d,hiun Is"ailI, Nicolae 0#ncuIH
B
I Centrul edical !oilor&, Clu15Napoca@ G Clinica edicala I, Clu15Napoca@
H +ni(ersitatea de edicinT i /ar"acie !Iuliu 0atie,anu&, Clu15Napoca@
B
Centrul
Clinic de Diabet, Nutrite i Boli etabolice Clu15Napoca
Pe#i"e "i Obiective:Fn prezent$ ne confrunt:m cu o adev:rat: +epidemie- de diabet
zaharat (DZ)$ afeciune cu un puternic impact asupra morbidit:ii i mortalit:ii
cardiovasculare Diabetul zaharat asociaz: un comple7 de factori de risc cardiovascular$
fapt demonstrat de numeroase studii "ucrarea de fa: are ca i obiectiv cuantificarea
riscului cardiovascular la persoanele cu DZ tip 2$ precum i analiza diverilor factori de
risc
Mateia! "i Met$%e: S8au studiat un num:r de 12# pacieni cu diabet zaharat tip 2$ care
au fost investi&ai complet %n cadrul 9entrului *edical +*oilor- din 9luG (apoca S8au
colectat date referitoare la istoricul personal$ caracteristicile antropometrice (&reutate
corporal:$ %n:lime$ '*9$ circumferin: abdominal:)$ evaluarea compoziiei corporale
(esut adipos total$ esut adipos visceral$ mas: muscular: scheletic:) cu aGutorul
analizorului corporal 'n)odH 62#$ statusul biochimic (&licemie bazal:$ ;b<1c$ profil
lipidic)$ statusul &licemic (utiliz3nd monitorizarera &licemic: continu: pe o perioad: de
62 ore)$ e7amen cardiovascular complet (inclusiv determinarea &rosimii intim:8medie la
nivel carotidian bilateral) %n vederea evaluprii c3t mai complete a statusului metabolic i
a factorilor de risc cardiovascular (R9A) asociai R9A al fiec:rui pacient a fost calculat
pe baza pro&ramelor NZ,DS RisD Sn&ine$ ,RO9<* i Mramin&ham
Re'(!tate: ,ersoanele studiate au avut o durat: medie a DZ de 2$2B ani$ o v3rst: medie
de 21$/1 ani$ 0#$521 au fost femei S8a constatat c: masa muscular: este mai mare la
persoanele cu DZ av3nd nivele ale ;b<1ccB21 comparativ cu persoanele insuficient
controlate din punct de vedere &licemic (01$./C2$2D& vs 52$2C6$BD&$ p4#$##5)
9antitatea de esut adipos visceral a fost crecutp la persoanele studiate$ semnificativ mai
mare la cele av3nd un control &licemic nesatisfpcptor fa: de persoanele avand un DZ
bine echilibrat (;b<1ccB21) (1/6C2B$. vs 125$/C56$ p4##2/) ,e de alt: parte$ masa
totalp a esutului adipos a fost mai mare la persoanele bine controlate din punct de vedere
&licemic (05C2$2D& vs de 52$2C6$BD&)$ dar f:r: semnificaie statistic: (p4#$#2.) *asa
muscular: schelectic: a fost semnificativ mai mare %n r3ndul persoanelor cu ;b<cB21
(01$.C2$2D& vs 52$2C6$BD&$ p4 #$##5) (ivelul ;b<1c se coreleaz: cu R9A cuantificat
prin NZ,DS RisD Sn&ine (boalp coronarianp non8fatalp si fatalp! #$0 vs #$566$ p4####T
105
accident vascular cerebral non8fatal i fatal! #$1B. vs #$166$ p4#$#5) 'dentificarea
riscului cardiovascular de a dezvolta un eveniment coronarian %n urmptorii 1# ani$ prin
diferite pro&rame (NZ,DS RisD Sn&ine$ ,RO9<* i Mramin&ham) aratp e7istena unei
diferene %n sensul cp pro&ramul ,RO9<* este mai precis %n aprecierea R9A la
persoanele cu DZ dec3t aplicarea scorului Mramin&ham (p_##2) >oate cele trei
pro&rame de apreciere a R9A oferp date corelabile Statusul hiper&licemic
(&licemiiY1/#m&=dl) se coreleaz: cu RA9 evaluat prin pro&ramul ,RO9<* si NZ,DS
RisD Sn&ine <m constatat$ de asemenea$ efectul protectiv al activitpii fizice pentru
dezvoltarea unui <A9 fatal sau nonfatal (NZ,RS RisD Sn&ine) Fn mod surprinz:tor$
&rosimea intimp8medie (?'*) nu s8a corelat cu durata DZ i nici cu controlul &licemic$ %n
schimb s8au evideniat corelaii cu nivelul tri&liceridelor serice
C$)c!('ie Svaluare R9A prin cele 5 pro&rame ne8a permis o mai bun: cuantificare a
contribuiei fiecprui factor de risc prezent la persoana cu DZ tip 2 'nvesti&area statusului
&licemic prin aplicarea monitorizprii &licemice continue$ precum i determinarea
compoziiei corporale aduc date suplimentare deosebit de valoroase %n evaluarea R9A al
persoanei cu DZ cu at3t mai mult cu c3t sunt cuantificai parametrii +corectabili- printr8
un mana&ement terapeutic adecvat
100
CARDIOVASCULAR RIS3 IN PEOPLE +ITH T,PE 5 DIABETES MELLITUS



Bac-.$()% a)% $b8ective": (oIadaHs$ Ie are facin& a real +epidemH- of diabetes$ a 8
stron& impact upon cardiovascular morbiditH and mortalitH U disease Diabetes associates
a comple7 of cardiovascular risD factors$ shoIn bH numerous studies >he aim of this
studH Ias to determine the cardiovascular risD in people Iith tHpe 2 D* as Iell as the
analHsis the risD factors
Re"eac/ %e"i.) a)% #et/$%"! a number of 12# persons Iith tHpe 2 D* from
+*oilor- *edical 9enter Ias studied Mor these persons$ the historH and anthropometric
data as Iell as bodH composition (bodH fat mass$ visceral fat area$ sDeletal muscle mass)$
biochemical status (fastin& plasma blood &lucose$ &lHcated haemo&lobin$ lipids)$
&lHcemic status (bH continuous &lucose monitorin& sHstem)$ cardiovascular evaluation
(includin& carotid intima8media thicDness) Iere assessed 9ardiovascular risD (9AR) Ias
evaluated usin& NZ,DS RisD Sn&ine$ ,RO9<* and Mramin&ham risD score
Re"(!t": >he studH &roup had an avera&e diabetes duration of 22B HearsT a mean a&e of
21/1 Hears$ 0#$521 Iere Iomen 't has been observed that the sDeletal muscle mass is
increased in diabetic persons Iith ;b<1c cB21 compare Iith those less controlled
(01$./C2$2D& vs 52$2C6$BD&$ p4#$##5) <mount of visceral fat area Ias increased in
studH population$ si&nificantlH in persons Iith poor &lHcemic control versus optimal
&lHcemic control (;b<1ccB21) (1/6C2B$. vs 125$/C56$ p4##2/) One the other side$
bodH fat mass Ias increased in patients Iell controlled (05C2$2D& vs de 52$2C6$BD&)$ no
statistical poIer (p4#$#2.) SDeletal muscle mass Ias statisticallH lar&er in patients Iith
;b<1ccB21 (01$.C2$2D& vs 52$2C6$BD&$ p4 #$##5) >he levels of ;b<1c is correlated
Iith 9AR Luantified Iith NZ,DS RisD Sn&ine (non8fatal and fatal coronarH heart
disease #$0 respectivelH #$566$ p4####T non8fatal and fatal stroDe! #$1B. respectivelH
#$166$ p4#$#5) 'dentifHin& the cardiovascular risD of developin& a coronarH heart disease
in the ne7t 1# Hears$ bH different pro&rammes (NZ,DS RisD Sn&ine$ ,RO9<* and
Mramin&ham)$ shoIs the e7istence of a difference meanin& the ,RO9<* pro&ramme is
more accurate in assesin& 9AR in people Iith D* than applHin& the Mramin&ham score
(p_##2) <ll these pro&rammes assessin& 9AR offer correlable data >he period of
hHper&lHcemia (blood su&ar levelsY1/#m&=dl) is correlated to 9AR evaluated bH
,RO9<* pro&ramme and the NZ,DS RisD Sn&ine Ke also considered the protective
effect of phHsical activitH for developin& a non8fatal or fatal stroDe (NZ,DS RisD
Sn&ine) Surprisin&lH$ the carotid intima8media thicDness did not correlate itself neither
to the duration of D*$ or the &lHcemic control$ otherIise there Iere emphasised
correlations to the tri&lHcerides levels
C$)c!("i$): >he 9AR evaluation throu&h the three pro&rammes alloIed a better
Luantification of the contribution of each risD factor present at the patients Iith tHpe 2
D* >he investi&ation of the &lHcemic status bH applHin& the continuous &lucose
monitorin& sHstem (9?*S)$ also determin& the bodH composition brin& e7tremelH
valuable additional data in assessin& R9A of a person Iith D*$ ever more these LuantifH
+correctable- parameters bH an adeLuate therapeutical mana&ement
102

NEFROPATIA DIABETICA
anolache ihaela 7Clinica III Pediatrie Iasi
I)t$%(cee
Diabetul zaharat este afectiunea endocrina si metabolica cea mai frecventa in copilarie$
caracterizata printr8o crestere permanenta a &licemiei$ insotita sau nu de semne clinice$
fiind cauzata de alterarea secretiei de insulina sau perturbarii actiunii sale <ceasta
afecteaza ambele se7e$ apro7imativ in e&ala masura$ cu o usoara predominanta a se7ului
masculin
(efropatia diabetica este o complicatie a diabetului care este determinata de concentratii
mari de &lucoza in san&e ;iper&licemia tulbura functionarea unitatii de filtrare a
rinichiului (nefronul) 'n timp$ aceasta poate duce la insuficienta renala
,revenirea sau incetinirea leziunii renale este cel mai important pas in mana&ementul
bolii care se efectueaza dializa renala sau albuminurie)$ la care se adau&a$ in timp$
edeme$ hipertensiune arteriala etc
Obiective
Scopul lucrarii este de a investi&a frecventa afectarii renale la copiii diabetici si
consecintelem acestei complicatii
Mateia! "i #et$%a
Studiul a fost efectuat in perioada 1 #2 2##/81 #. 2##/$in clinica a '''a pediatrie$pe un
lot de 2# de bolnavi cu diabet
Re'(!tate
9a umare a investi&atiilor efectuate s8a constatat ce un numar mare de bolnavii
cronici de diabet prezinta afectare renala
Din acesta cauza mana&ementul corect al diabetului si a nefropatiei diabetice este
foarte importantNn mana&ement defectuos putind duce pana la insuficienta renala
C$)c!('ii
<fectarea renala$ prin nefropatie diabetica (complicatie tardiva a diabetului zaharat)$
determina pro&nosticul vital al copilului$motiv pentru care trebuie monitorizarea corecta
si frecventa a copiilor cu diabet este o prioritate maGora
10B
NEPHRITIC DIABETES
I)t$%(cti$)
Diabetes is the endocrine and metabolic disease most freLuent in childhood$
Ihich is characterized bH a permanent &roIth of &lucose that can be accompanied or not
bH clinical si&ns$ and Ihich is caused bH the alteration of the insulin secretion or bH the
perturbation of its action >his disease affects both se7es eLuallH$ bein& Gust a bit
predominant at the male se7
(ephritic diabetes is a complication of diabetes that is determined bH hi&h
dosa&es of &lucose in blood ;Hper&lHcemia disturbs the function of the filterin& unit in
the DidneH 'n time$ this maH cause DidneH failure
>he prevention or the sloIin& of DidneH failure is the most important step in
mana&in& the disease$ Ihich is obtained bH dialHsis
Ob8ective"
>he purpose of this paper is to investi&ate the freLuencH of renal affection at the
diabetic children and the conseLuences of this complication
Mateia! A)% Met$%e"
>he studH Ias conducted on 2# children Iith diabetes admitted in the 9linic '''
,ediatrics$ in the period of time 1#22##/ U 1#.2##/
Re"(!t"
<s a folloI8up of the investi&ations$ a lar&e number of children sufferin& of
diabetes also present DidneH related affections
>his is IhH the correct mana&e of diabetes and nephritic diabetes is verH
important 'f the treatment is not correct$ then the DidneH failure maH appear
C$)c!("i$)
ZidneH related affections$ especiallH nephritic diabetes$ determine the vital
pro&nosis of the child$ reason for Ihich the correct and constant monitorin& of the
diabetic child is the maGor prioritH
106
VARIATIA NECESARULUI INSULINIC LA PACIENTII CU DIABET
ZAHARAT TIP H CU VECHIME A BOLII DE PESTE 5M ANI
*ihaela Aladu
2
$ Si&ina

?ar&avu
1
$ Diana 9lenciu
1
$ (icoleta *itroi
1
$ Daniela )raicu
1
$
*aria *ota
2
1
Spitalul 9linic Wudetean de Nr&enta 9raiova U 9linica de Diabet (utritie )oli *etaboliceT
2
N*M 9raiova 8 Departamentul de Diabet (utritie )oli *etabolice
SCOPUL STUDIULUI: <nalizarea variatiei necesarului insulinic la un lot de pacienti
cu diabet zaharat tip 1 cu vechimea diabetului de peste 22 ani
MATERIAL SI METODA: "otul studiat a cuprins 00 pacienti cu DZ tip 1 cu
vechimea diabetului de peste 22 ani$ aflati in evidenta 9entrului 9linic de Diabet (utritie
)oli *etabolice al Spitalului 9linic Wudeean de Nr&enta 9raiova 'nformaiile
retroactive au provenit din fisele acestor pacienti S8au analizat urmatorii parametrii!
vechimea diabetului$ doza initiala de insulina$ la 12 ani de la debutul DZ si doza actuala
de insulina De asemenea$ am analizat tipul de tratament! conventional si intensiv (clasic
i modern)
REZULTATE: (ecesarul de insulina la pacientii luati in studiu a evoluat pe parcursul
timpului astfel!
INITIAL LA HM ANI ACTUAL
Sub 2# N' 2 (0$201) 1 (2$261) 1 (2$261)
2180# N' 21 (06$621) 1/ (0#$.#1) 2# (02$021)
018B# N' 2# (02$021) 16 (5/$B51) 12 (50$#.1)
,este B# N' 1 (2$261) / (1/$1/1) / (1/$1/1)
Me%ia ca!c(!ata a necesarului de insulina la momentul debutului a fost de 51$20 N'$ la
12 ani de evolutie a DZ 02$ /B N'$ iar la momentul actual s8a situat la o valoare de 5.$ 12
N'
Re.i#(! %e i)"(!i)$tea1ie a fost un alt parametru urmarit <stfel initial /B$5B1
pacienti se aflau sub tratament conventional (2 prize)$ 15$B51 intensiv clasic (5prize) "a
12 ani de la debut 2.$#.1 se aflau pe tratament conventional$ 0#$.11 pe tratament
intensiv clasic 'n ceea ce priveste momentul actual tratamentul conventional a fost
intalnit in procent de 26$261$ tratamentul intensiv clasic la 6#$001 pacienti$ iar tramentul
intensiv modern cu insulina (pompa de insulina) la un pacient (2$261)
<nalizand comparativ necesarul de insulina de la 12 ani de evolutie a DZ fata de cel de la
debut$ am inre&istrat urmatoarele date! la 2B$/11 dintre pacienti necesarul de insulina a
10/
crescut$ la 22$621 a scazut$ iar la 2#$021 s8a mentinut comparabil cu cel initial Referitor
la doza de insulina actuala comparativ cu doza la 12 ani de evolutie a DZ! la 02$021
dintre pacienti s8a evidentiat cresterea necesarului de insulina$ la 2#1 necesarul a scazut$
iar la 0$221 nu s8au inre&istrat modificari ale acestuia "a pacientii la care s8a inre&istrat
actual scaderea dozei de insulina nefropatia s8a intalnit in procent 2.$#.1 9oma
hipo&licemica s8a inre&istrat la 1/$1/1 din pacientii aflati actual pe tratament
conventional$ 2.$201 pe tratament intensificat (5 prize de insulin:=zi)$ 22$261 pe
tratament intensiv
C$)c!('ii: Se remarca o evolutie oscilanta a necesarului de insulina pe parcursul
evolutiei DZT dupa o vechime de 12 ani la maGoritatea pacientilor s8a inre&istrat cresterea
necesarului de insulina$ probabil datorit: epuiz:rii rezervei secretorii pancretice restanteT
dupa 22 ani de evolutie a diabetului s8a %nre&istrat o sc:dere a dozelor de insulin:$
probabil datorit: afect:rii renaleT la 2.1 dintre pacienii cu scaderea necesarului de
insulina s8a asociat nefropatia diabetic: 9omele hipo&licemice s8au inre&istrat mai
frecvent la pacientii cu tratament intensiv bazal8bolus >ratamentul conventional este
re&asit i actual intr8un procent relativ mare la pacientii luati in studiu$ din motive le&ate
de pacieni$ %n cea mai mare parte6
THE INSULIN NECESSAR, VARIATION IN PATIENTS +ITH DURATION OF
T,PE H DIABETES MELLITUS MORE THAN 5M ,EARS
*ihaela Aladu
2
$ Si&ina

?ar&avu
1
$ Diana 9lenciu
1$
$ (icoleta *itroi
1
$ Daniela )raicu$
*aria *ota
2
$
1
9linic 9ountH Smer&encH ;ospital 9raiova$ Diabetes 9linicT
2
N*M 9raiova
Bac-.$()%: >o analHze the insulin necessarH variation in patients Iith duration of
>1D* more than 22 Hears
Mateia! a)% #et/$%: Ke studied a &roup of 00 patients Iith duration of >1D* more
than 22 Hears$ hospitalized in the 9linic of Diabetes (utrition [ *etabolic Diseases
(9linic 9ountH Smer&encH ;ospital 9raiova) Ke used the informations arised from the
patients files and Ie analized the duration of diabetes mellitus$ the initial dose of insulin$
after 12 Hears of evolution and the actual dose <lso$ Ie studied the conventional and
intensiv (clasic and modern) tHpe of treatment
Re"(!t"! >he insulin necesarH developed durin& the evolution of diabetes mellitus in the
folloIin& IaH!
INITIAL AFTER HM ,EARS ACTUAL
Nnder 2# N' 2 (0$201) 1 (2$261) 1 (2$261)
2180# N' 21 (06$621) 1/ (0#$.#1) 2# (02$021)
10.
018B# N' 2# (02$021) 16 (5/$B51) 12 (50$#.1)
Over B# N' 1 (2$261) / (1/$1/1) / (1/$1/1)
9alculated mean of insulin necessarH in the be&inin& Ias 51$20 N'$ after 12 Hears became
02$/B N' and in the present is 5.$12 N' >he tHpe of insulin therapH Ias another
parameter Ihich Ie had in vieI >hus$ at the be&inin& /B$5B1 patients had a
conventional treatment (2 inGections=daH) and 15$B51 a clasic intensiv one (5
inGections=daH) <fter 12 Hears 2.$#.1 patients had a conventional treatment$ 0#$.11 a
clasical intensiv treatment a 'n the present the conventional treatment is used in 26$261
patients$ clasical intensiv treatment in 6#$001 patients and modern intensive treatment
(insulin pomp) is found onlH in one patient (2$261)
9omparativelH analizin& the insulin necessarH after 12 Hears of evolution Iith the
necessarH from the be&inin& Ie obtained the folloIin& dates! in 2B$/11 of patients the
insulin necessarH increased$ in 22$621 the necessarH decreased and in 2#$021 of cases
the necessarH Ias preserved Re&ardin& the actual insulin dose bH comparison Iith the
dose after 12 Hears of evolution in 02$021 of patients Ie had an increase of insulin
necessarH$ in 2#1 patients the necessarH decreased and in 0$221 patients didnRt chan&e
>he nefropathH Ias met in 2.$#.1 cases Iith insulin dose decreased ;ipo&licemic
coma Ias recorded in 1/$1/1 patients actuallH conventional treated (2 inGections=daH)$
2.$201 treated Iith 5 inGections=daH) and 22$261 actuallH on intensiv treatement (0
inGections=daH)
C$)c!("i$)": >his studH shoIed an oscilatorH development of insulin necessarH durin&
the evolution of >1D*T after 12 Hears most patients need much more insulin maHbe
because of e7haustin& pancreatic secretorH stora&e but after 22 Hears the necessarH
decreased maHbe throu&h the development of diabetic nefropathH 'n 2.1 patients Iith
the decrease of insulin necessarH diabetic nefropathH is associated ;ipo&licemic coma
Ias freLuentlH met in patients on intensiv treatment 9onventional treatment is actual
found in a considerable percenta&e manH times from reasons that re&ard the patients
12#
STUDIUL CORELATIILOR INTRE NIVELUL AMPUTATIEIF VARSTA SI
FACTORII DE RISC ASOCIATI LA PACIENTII CU AMPUTATII ALE
MEMBRELOR INFERIOARE
Nicoleta itroi
9
, aria ota
:
, %i,ina

$ar,a(u
9
, ihaela 4ladu
:
, Diana Clenciu
9
9
%pitalul Clinic *udetean de +r,enta Craio(a7Clinica Diabet Nutritie Boli etabolice@
:
+/ Craio(a5 Diabet Nutritie Boli etabolice
I)t$%(cee6 *ai mult de B#1 dintre amputatiile netraumatice ale membrelor inferioare
sunt cauzate de diabetul zaharat$ diabeticii prezentand un risc de 1# pana la de 0# de ori
mai mare pentru astfel de interventii chiru&icale "a fiecare 5# de secunde undeva in
lume se realizeaza o amputatie la nivelul membrelor inferioare cauzata de diabet

Sc$1(! "t(%i(!(i6 <u fost analizate amputatiile realizate intr8o clinica chirur&icala la pacientii
cu si fara DZ si au fost realizate corelatii intre anumiti parametrii urmarindu8se definirea
metodelor de prevenire si=sau reducere a numarului de amputatii
Mateia! "i #et$%a6 <u fost evaluati pacientii internatii intr8o clinica chirur&icala (Spitalul de
Nr&enta 9raiova) intr8o perioada de 2 ani care au suferit amputatii ale membrelor inferioare
Dintr8un total de 222 de pacienti$ 51 au avut mai multe amputatii si au fost analizati separat
<u fost urmariti mai multi parametrii$ realizandu8se apoi corelatii intre prezenta si vechimea
DZ$ nivelul amputatiei$ varsta$ ;><$ dislipidemie$ fumat$ prezenta altor amputatii in
antecedente
Re'(!tateF %i"c(tii6 61 de pacienti (56161) au avut DZ si 12# (B2/51) nu au avut DZ (u a
fost posibila evidentierea unei corelatii intre vechimea DZ si nivelul amputatiei$ deoarece nu a
putut fi stabilita cu e7actitate data debutului DZ$ ci numai momentul dia&nosticarii acestuia
Aarsta medie in momentul amputatiei a fost cu 05 ani mai mica la pacientii diabetici
comparativ cu cei fara DZ (2./5 respectiv B016 ani) 'n ceea ce priveste corelatia dintre
;><$ nivelul amputatiei si varsta la care s8a intervenit chirur&ical$ la pacientii cu DZ s8a
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 5. ani) (u au fost observate
corelatii intre prezenta ;>< si varsta la amputatie la pacientii fara DZ Referitor la prezenta
dislipidemiei$ nu au e7istat informatiile necesare pentru a putea fi analizata corelatia cu
ceilalti factori evaluatiAarsta la amputatie a fost mai mica la pacientii fumatori (cu si fara
DZ)$ indiferent de sediul amputatiei (cu 2/5 si respectiv 1/2 ani) Dintre pacientii cu DZ
care au fost amputati$ 221 au avut cel putin inca o alta amputatie in 2 ani$ comparativ cu
/B21 in cazul celor fara DZ
C$)c!('ii: numarul pacientilor cu DZ amputati reprezinta 0#1 din totalul de pacienti
amputati$ desi prevalenta DZ la populatia din DolG este _2 1T prezenta ;>< (ca factor de risc
cardiovascular) a influentat varsta la amputatie numai la pacientii cu DZ in studiul nostruT
fumatul a condus la scaderea varstei la amputatie atat la pacientii diabetici$ cat si la cei fara
DZT prezenta unei amputatii in antecedente a determinat cresterea riscului de noi amputatii$ in
special in DZT abordarea multidisciplinara a patolo&iei piciorului diabetic si interventia
concomitenta asupra factorilor de risc asociati au ca rezultat prevenirea=reducerea numarului
de amputatii
121
CORRELATIONS BET+EEN THE LEVEL OF THE AMPUTATIONF THE AGE
AND THE ASSOCIATED RIS3 FACTORS IN PATIENTS +ITH LO+ER
LIMBS AMPUTATIONS
Nicoleta itroi
9
, aria ota
:
, %i,ina

$ar,a(u
9
, ihaela 4ladu
:
, Diana Clenciu
9
9
Clinical Count3 2"er,enc3 0ospital Craio(a, Diabetes Clinic@
:
+/ Craio(a
Bac-.$()%6 *ore than B#1 of the non traumatic amputations of the loIer limbs are caused
bH diabetes$ the diabetic patients bein& up to 0# times more liDelH to suffer one of this sur&ical
intervention than people Iithout diabetes SverH 5# seconds a loIer limb is lost to diabetes
someIhere in the Iorld
T/e ai# $< t/e "t(%@6 Ke evaluated the amputations realized in a sur&ical clinic in patients
Iith and Iithout D* and Ie made correlations betIeen some parametersT the aim Ias to
define the procedure to prevent=decrease the number of the amputations
Met/$%$!$.@ a)% #ateia!"6 Ke evaluated the patients hospitalized in a sur&ical clinic
(Smer&encH ;ospital 9raiova) Iho suffered amputations of loIer limbs durin& a 2 Hears
period Mrom 222 patients$ 51 suffered several amputations and Iere studied separatelH *anH
parameters Iere analized$ and then Ie made correlations betIeen the presence and the oldness
of D*$ the level of the amputation$ the a&e$ ;),$ dHslipidaemia$ smoDe$ the presence of other
amputations
Re"(!t" a)% %i"c(""i$)"6 61 of the patients (56161) presented D* and 12# (B2/51) did not
't Ias not possible to hi&hli&ht anH correlation betIeen the a&e of D* and the level of
amputation as could not preciselH determines the e7act moment Ihen D* be&an$ but onlH the
moment of its dia&nosis6 >he avera&e a&e at amputation Ias Iith 05 Hears smaller in patients
Iith D* comparin& Iith those Iithout D* (2./5$ respective B016 Hears) Re&ardin& the
correlation betIeen ;),$ the level of the amputation and the a&e at amputation$ in diabetic
patients Ie noticed that the avera&e a&e at amputation Ias smaller in those Iith ;),
comparin& Iith patients Iith normal blood pressure (Iith 5. Hears) 'n patients Iithout D*
Ie didnRt observed correlations betIeen these parameters aet re&ardin& the presence of
dHslipidaemia$ there Ias no information that could help us identifH its relationship Iith the
additional factors analHzed >he avera&e a&e at amputation Ias smaller in smoDers (in both
patients Iith and Iithout D*) re&ardless of the level of the amputation (Iith 2/5 respective
1/2 Hears) <mon& the diabetic patients that suffered an amputation$ 221 of them had at least
another amputation in 2 Hears$ comparin& Iith /B21 of the patient Iithout D*
C$)c!("i$)"6 >he patients Iith D* represent 0#1 of the total that suffered an amputation$
even if the freLuencH of D* for the population of DolG district is loIer than 21T the presence
of ;), influenced the a&e at amputation onlH in diabetic patients in this studHT smoDin&
proved that diminishes the a&e at amputation in both patients Iith and Iithout D*T the
presence of another amputation Ias associated Iith a hi&h risD of a neI one$ especiallH in
patients Iith D*T the multilaterallH approach of the patholo&H of the diabetic foot and of the
associated risD factors Iill prevent=decrease the number of the amputations
122
INFECTIA CU HELICOBACTER P,LORI LA COPIII CU DIABET
Aioane Norina
Clinica a5III5a Pediatrie Iasi
Re'(#at
Diabetul zaharat are drept principala caracteristica incapacitatea or&anismului de a produce
si=sau utiliza hormonal pancreatic8insulina$ cu instalarea unei hiper&licemii cronice 'nfectiile
produc hiper&licemie la acesti pacienti 'nfectia cu ;elicobacter ,Hlori are un rol important in
manifestarile &astrointestinale la copiii diabetici si poate avea implicatii in controlul &licemic
Scopul lucrarii este de a investi&a frecventa infectiei cu ; ,Hlori la copiii cu diabet si
consecintele acestei infectii asupra controlului &licemic Studiul a fost efectuat in 9linica '''
,ediatrie $ in perioada 18#182##6 U 181#82##6 $ pe un lot de 0# de copii diabetici ce prezentau
simptome &astrointestinale 'nfectia cu ; ,Hlori a fost dia&nosticata la 2# de copii cu diabet
?rupa preponderant afectata a fost cea de 1#815 ani (12 cazuri) "eziunea histopatolo&ica cea
mai frecventa asociata cu infectia cu ; ,Hlori a fost &astrita nodulara antrala Sradicarea
infectiei a determinat o ameliorare a simptomatolo&iei &astrointestinale dar nu s8au constatat
diferente semnificative in ce priveste ;b<19 si dozele de insulina 'nfectia cu ; ,Hlori a fost
cea mai frecventa cauza la copii cu diabet $ eradicarea acestei infectii permitand o inbunatatire a
controlului &licemic
THE INFECTIONS +HITH H6P,LORI AT DIABETIC CHILDREN
Aioane Norina
Clinica III Pediatrie %/.ARIA IA%I
DiabetesRs main characteristic is the incapacitH of the or&anism to produce and =or use the
pancreatic hormone Uinsulin8Iith the installation of a chronic hHper&lHcemia <t this
tHpe of patients $ the infections produce hHper&lHcemia >he infection Iith ; ,Hlori has
an important role in the &astro8intestinal sHmptoms to the children Iho have diabetes and
maH have implications in the &lucose control
>he purpose of this paper is to investi&ate the freLuencH of the ;,Hlori infection at the
children Iith diabetes and the conseLuences of this infection in the &lucose control
>he studH Ias conducted on 0# children Iith diabetes Iith &astro8intestinal sHmptoms in
58rd ,ediatric 9linic in the period of time 18#182##6q181#82##6
>he ;,Hlori infection Ias found in 2# of the diabetics children *ost of the infection
cases Iere in the 1#815 a&e &roup(12 cases) >he histolo&ical lesion most freLuentlH
associated Iith ; ,Hlori infection Ias nodular antral &astritis
125
>he eradication of the infection determined an amelioration of the &astro8intestinal
sHmptomatolo&H but there Iere no maGor differences in re&ard to the ;b<19 and insulin
dosa&e
>he ;,Hlori infection Ias the most freLuent cause of &astritis amon& children Iith
diabetes$ the eradication of Ihich permitted an improved &lucose control
STATUSUL HIPOGONADIC LA PACIENII CU DIABET ZAHARAT
6li(ia $eor,escu
9
, %orina artin
9,:
, ihaela +rsache
9
, %i"ona /ica
9,:
9. %pitalul +ni(ersitar de +r,en 2lias 7 %ecia de 2ndocrinolo,ie, Diabet, Boli
de nutriie
:. +/. Carol Da(ila 7 Bucureti
Scopul studiului a fost evaluarea statusului hipo&onadic la pacienii de se7 masculin
cu diabet zaharat de tip 1 i 2$ precum i determinarea unor posibile asocieri cu
elemente definitorii ale echilibrului metabolic

*aterial i metod: ! ,entru B/ b:rbati cu diabet zaharat (12 cu diabet zaharat tip 1 i
2B cu diabet zaharat tip 2)$ cu v3rste cuprinse %ntre 1. i 6B ani a fost evaluat statusul
hipo&onadic prin %nre&istrarea simptomelor i semnelor clinice$ prin determinarea
seric: a testosteronului total$ S;)?$ D;S<8S$ cu calcularea ulterioar: a
testosteronului liber <u fost considerai hipo&onadici pacienii cu testosteron seric
total sub 5##n&=dl <u fost urm:rii de asemenea parametrii echilibrului metabolic!
;b<1c$ profil lipidic
Rezultate! 221 dintre pacienii evaluai au prezentat hipo&onadism (1B$B1 dintre cei
cu diabet zaharat tip1 i 25$21 dintre cei cu diabet zaharat tip 2) ,acienii diabetici
hipo&onadici $ comparativ cu restul pacienilor diabetici au prezentat %n medie o
valoare mai mare a circumferinei abdominale( p4 #$#2) i o valoare mai mic: a
;D"8colesterolului ( p4 #$#5) Sc:derea libidoului i a forei musculare s8a
corelat direct proporional cu valoarea sc:zut: a D;S<8S ( p4 #$##B ) i invers
proporional cu ;b<1c (p4 #$#2) Sc:derea frecvenei b:rbieritului i sc:derea
pilozit:ii corporale s8a corelat cu valoarea sc:zut: a testosteronului liber$
independent de v3rst: <lopecia s8a %nre&istrat mai frecvent la pacienii cu valori
sc:zute ale S;)? ( p 4#$#5)
9oncluzii! Statusul hipo&onadic s8a re&:sit mai frecvent %n r3ndul pacienilor cu
diabet zaharat tip 2$ fiind asociat cu unele componente ale sindromului metabolic
120
;ipo&onadismul simptomatic s8a corelat cu valoarea D;S<8S i ;b<1c$ iar semnele
clinice su&estive au fost asociate cu nivelul testosteronului liber i S;)?$
independent de v3rst:
THE H,POGONADIC STATUS IN DIABETES MELLITUS PATIENTS
6li(ia $eor,escu
9
, %orina artin
9,:
, ihaela +rsache
9
, %i"ona /ica
9,:
9. 2lias +ni(ersit3 2"er,enc3 0ospital5 Depart"ent of 2ndocrinolo,3, Diabetes and
etabolic Diseases
:. +/ Carol Da(ila 7 Bucharest
>he aim of this studH Ias to assess the hHpo&onadic status in male patients Iith tHpe 1
and tHpe 2 diabetes mellitus and to estimate the possible correlation Iith metabolic
balance
*aterial and methods! Mor B/ male patients! 12 >1D*= 2B >2D*$ a&ed betIeen 1.86B
Hears Ie evaluate the &onadic status based on both sHmptoms and biochemical measures
on total and free testosterone value$ S;)?$ D;S<8S >he patients Iith total testosterone
under 5## n&=dl Iere considered hHpo&onadic Ke also evaluate the metabolic balance
( ;b<1c$ lipid profile)
Results! ;Hpo&onadism Ias present in 221 of patients (1B$B1 in >1D* and 25$21 in
>2D*) >he hHpo&onadic diabetic patients had hi&her Iaist ( p4#$#2) and respectivelH
loIer ;D"8cholesterol (p4#$#5)$ compared Iith the other diabetic patients >he decrease
of libido and muscular force Ias positve corelated Iith loIer D;S<8S value and
ne&ative Iith ;b<1c (p4#$#2) >he decrease of shavin& freLuencH Ias positive corelated
Iith loIer free testosterone value$ not related Iith a&e <lopecia Ias more freLuentlH
observed in diabetic patients Iith loIer S;)? value (p4#$#5)
9onclusions! 'n our studH$ the hHpo&onadic status Ias most common defect in >2D*$ in
association Iith some components of metabolic sHndrome criteria >he hHpo&onadic
sHmptoms Ias corelated Iith D;S<8S and ;b<1c$ since clinical si&ns Iere associated
Iith free testosterone and S;)? value$ not related Iith a&e
122
PROTEINA C> REACTIV9 :I TULBUR9RILE METABOLICE LA
PACIENII OBEZI NOU DEPISTAI CU DIABET ZAHARAT
6li(ia $eor,escu
9
, La(inia ;oa(
:
, ihaela +rsache
9
, Aura Re,hin
9
9. %pitalul +ni(ersitar 2lias , %ecia de 2ndocrinolo,ie, Diabet i Boli de Nutriie 7
Bucureti
:. %pitalul Clinic %f. Constantin i 2lena 7 Bucureti
Obiectiv! Sste cunoscut faptul c: proteina 98reactiv: (,9R) poate prezice riscul de
apariie al diabetului zaharat %n r3ndul populaiei s:n:toase (e8am propus s: determin:m
posibilele corelaii %ntre ,9R i modific:rile metabolice %ntr8o populaie nou
dia&nosticat: cu diabet zaharat
*aterial i metod:! ,entru 0# de pacieni nou depistai cu diabet zaharat (22 obezi i 12
normoponderali)$cu v3rste cuprinse %ntre 5#86# ani (media 20$2 ani) am efectuat
m:sur:torile antropometrice$ am evaluat statusul metabolic (;b<1c$ profilul lipidic$
tensiunea arterial:) i inflamator (,9R) <naliza statistic: s8a efectuat cu aGutorul t8test$
consider3ndu8se semnificativ statistic: valoarea p4sub #$#2
Rezultate! <m &:sit o corelaie semnificativ statistic: %ntre valoarea ,9R i ;b<1c
numai pentru populaia obez: ( p4#$##/) Fn lotul studiat$ ,9R s8a asociat cu valoarea
crescut: a circumferinei abdominale (peste .0 cm) la pacienii de se7 masculin 2$#0
vs2$.0 m& l (p4#$#0) "a pacientele diabetice ,9R s8a corelat ne&ativ cu valoarea
sc:zut: a ;D"8colesterolului (sub 2#m&=dl) 5$22 vs 1$.B m&=l (u s8au observat corelaii
%ntre ,9R8 hipertensiune$ sau ,9R8hipertri&liceridemie ,revalena sindromului
metabolic %n lotul studiat a fost mai mare %n r3ndul pacienilor cu valori crescute ale ,9R
(Luartila superioar:) $ f:r: a fi %ns: semnificativ: statistic (p4#$12)
9oncluzii! ,9R poate fi considerat: un marDer al modific:rilor metabolice ap:rute %n
r3ndul pacienilor obezi cu diabet zaharat nou depistat$ dar nivelul s:u plasmatic se
coreleaz: diferit %n funcie de se7 cu componentele sindromului metabolic
12B
C> REACTIVE PROTEIN AND METABOLIC DISTURBANCES IN OBESE
NE+ DIAGNOSED T,PE 5 DIABETICS
6li(ia $eor,escu
9
,La(inia ;oa(
:
, ihaela +rsache
9
, Aura Re,hin
9

9. 2lias 2"er,enc3 +ni(ersitar3 0ospital 7 Depart"ent of 2ndocrinolo,3,
Diabetes and Nutrition 5 Bucharest
:. %f.Constantin si 2lena Clinical 0ospital 5 Bucharest
Bac-.$()% a)% ai#": 't is DnoIn that 98reactive protein (9R,) predicts future
risD for diabetes in healthH caucasian population Ke determined Ihich are the
corelations betIeen 9R, and metabolic disturbances in a neI onset tHpe 2
diabetes mellitus population
Mateia! a)% #et/$%": for 0# patients Iith neI onset tHpe 2 diabetes mellitus
(22 obese = 12 Iith normal Iei&ht)$ a&ed betIeen 5#86# Hears (mean 20$2 Hears)
Ie performed anthropometric measures and Ie evaluated metabolic ( ;b<1c$
lipid profile$ blood pressure) and inflammatorH status (9R, level)
Re"(!t": Ke found a statisticallH si&nificant corelation betIeen 9R,8level and
;b<1c onlH for obese population ( p 4 #$##/ ) 'n the Ihole studH &roup$ 9R,
level Ias associated Iith hi&her Iaist (over .0 cm) in male subGects (2$#0 vs
2$.0 m&=l$ p4#$#0) 'n female diabetics patients 9R, value Ias ne&ative corelated
Iith loIer ;D"8 cholesterol (under 2# m&=dl) 5$22 vs 1$.B m&=l Ke did not
found corelation betIeen 9R,8 hHpertension and also 9R,8 tri&lHceridemia >he
prevalence of metabolic sHndrome in our studH &roup increase in Ihose patients
Iith 9R, levels in a top Luartile but not statisticallH si&nificant ( p 4 #$12 )
C$)c!("i$)": 9R, could be considered a neI marDer of metabolic disturbances
in obese tHpe 2 diabetes mellitus population$ but his plasma level is different
corelated accordin& to se7 Iith components of metabolic sHndrome
EFECTELE SCADERII IN GREUTATE ASUPRA FICATULUI GRAS NON>
ALCOOLIC LA SUBIECTII CU SINDROM METABOLIC6
R. 4asilescu, %il(i Ifri"
%pital Clinic Colentina Bucuresti 7 %ectia Diabet, Nutritie, Boli etabolice
I)t$%(cee! )oala ficatului &ras non8alcoolic este una dintre cele mai frecvente cauze
de afectare hepatica$ care poate pro&resa de la steatoza simpla$ la steatohepatita$ ciroza
hepatica si hepatocarcinom 'n prezent boala ficatul &ras non8alcoolic este considerata
componenta hepatica a sindromului metabolic
126
Mateia! "i #et$%a! Studiul a inclus un numar de 2# subiecti de se7 masculin$ cu varsta
medie de 5/2 ani (limite 22 U 20 ani)$ cu sindrom metabolic (definit conform criteriilor
'DM)$ nediabetici$ cu o valoare medie a '*9 de 52#/ D&=m
2
(limite 51D&=m
2
U 0# D&=m
2
)$
la care s8a dia&nosticat ultrasono&rafic prezenta steatozei hepatice ,acientii au urmat o
dieta hipocalorica de 12## Dcal timp de 20 saptamani "a subiectii inclusi in studiu s8au
masurat &reutatea$ talia$ circumferinta abdominala si s8au dozat alanin8aminotrasferaza
(<"<>)$ aspartat8aminotrasferaza (<S<>)$ 8&lutamiltranspeptidaza (??>)$ "D"
colesterol$ ;D" colesterol$ tri&liceride$ &licemia a Geun ,entru analiza statistica a datelor
obtinute la 12 saptamani si 20 saptamani s8a folosit testul t8student
Re'(!tate:
I)itia! H5
"a1ta#a)i
5I
"a1ta#a)i
I)itia! v"6
H5
"a1ta#a)
i
I)itia! v"6
5I
"a1ta#a)i
$reutate 1#0C161 ..B6C1B0B .B/5C1B2B p4###5 ,4###1
IC J<,K":F 52#/C005 5505C022 5226C02. ,_###1 ,_###1
Corcu"ferint
a abdo"inala
Jc"F
11B22C1B2 112C1B#B 1#/2C1222 ,_###1 ,_###1
A%A) J)$6F B2C56#. 022C1B5 5B22C.20 ,4##2 ,4##2
ALA) J)$PF 12562C6##
/
B5C5022 5.62C162/ p4##5 p4##2
$$) .622CB.6B 622C0162 0622C2#6 p4##2 p4##5
LDL5
colesterol
10.2C205 15.C1// 12262C10/
B
p_###1 p_###1
0DL5
colesterol
512C521 5222C011 5062C0#5 (S (S
)ri,liceride 1.2C2.25 12122C1/#
/
15B62C1.B
2
p4##1 p4###2
$lice"ie .2C11B5 /B2C62. /02CB02 p4##0 p4###0
,rezenta ficatului &ras non8alcoolic se asocieaza cu valori crescute ale concentratiilor
plasmatice ale aminotransferazelor "a toti subiectii inclusi in studiu <"<> Y 127( si
raportul <"<>=<S<> Y 2 "a 5 luni s8au obtinut scaderea &reutatii cu 0B6 Z& (limite 28
B D&)$ scaderea <"<> cu B#62 N=l $ scaderea <S<> cu 222 N=l$ scaderea ??> cu 2062
N=l$ scaderea tri&liceridelor cu 0#62 m&=dl$ scaderea "D" colesterol cu 122 m&=dl$
scaderea &licemiei a Geun cu /2 m&=dl si cresterea ;D" colesterol cu #62 m&=dl "a B
luni s8au obtinut scaderea &reutatii cu 655 D& (limite 08. D&)$ scaderea concentratiei
plasmatice a <"<> cu /0 N=l$ scaderea <S<> cu 2/62 N=l$ scaderea ??> cu 2# N=l$
scaderea tri&liceridelor cu 2222 m&=dl$ scaderea "D"8colesterol cu 2562 m&=dl$
scaderea &licemiei a Geun cu 1#2 m&=dl si cresterea ;D"8colesterol cu 522 m&=dl
C$)c!('ii! Scaderea in &reutate este principala atitudine terapeutica la subiectii cu boala
ficatului &ras non8alcoolic Scaderea in &reutate la subiectii cu S* si boala ficatului &ras
12/
nonalcoolic se insoteste de scaderea importanta a concentratiei plasmatice a
transaminazelor De asemenea$ scaderea in &reutate se insoteste de imbunatatirea
semnificativa a profilului lipidic si a &licemiei a Geun
EFFECTS OF +EIGHT REDUCTION ON NON>ALCOHOLIC FATT, LIVER
DISEASE =NAFLD? IN PATIENTS +ITH METABOLIC S,NDROME
R. 4asilescu, %il(i Ifri"
Clinical 0ospital Colentina Bucharest 7 Departe"ent of Diabetes, Nutrition,
etabolic Diseases
I)t$%(cti$): (on8alcoholic fattH liver disease ((<M"D) is a maGor cause of liver
related morbiditH and mortalitH (<M"D maH pro&ress from simple stetosis to non8
alcoholic steatohepatitis ((<S;) and cirrohosis$ that maH be complicated bH
hapatocellular carcinoma 'n recent Hears (<M"D is considered as a hepatic
manifestation of metabolic sHndrome (*S)
Met/$%" a)% 1atie)t": Ke studied 2# subGects (males)$ mean a&e 5/2 Hears (ran&e 228
20 Hears) Iith *S ('DM criteria)$ non8diabetic$ mean )*' 52#/ D&=m
2
( ran&e 51D&=m
2
U
0# D&=m
2
)$ Iith hepatic steatosis (confirmed bH liver ultrasound) <ll patients have been
treated Iith a loI caloric diet (12## Dcal) for 20 IeeDs Kei&ht$ Iaist circumference$
<">$ <S>$ ??>$ tri&lHcerides$ "D" cholesterol$ ;D" cholesterol$ fastin& &lucose Iere
measured >8student test Ias used to compare variables variations betIeen baseline and
12 IeeDs and 20 IeeDs
Re"(!t":
KeeD # KeeD 12 KeeD 20 KeeD #
vs KeeD
12
KeeD #
vs KeeD
20
Kei&ht (Z&) 1#0C161 ..B6C1B0B .B/5C1B2B p4###5 ,4###1
)*' (D&=m2) 52#/C005 5505C022 5226C02. ,_###1 ,_###1
Kaist
circumference
11B22C1B2 112C1B#B 1#/2C1222 ,_###1 ,_###1
<S> (>?O) B2C56#. 022C1B5 5B22C.20 ,4##2 ,4##2
<"> (>?,) 12562C6##/ B5C5022 5.62C162/ p4##5 p4##2
??> .622CB.6B 622C0162 0622C2#6 p4##2 p4##5
"D"8
cholesterol
10.2C205 15.C1// 12262C10/B p_###1 p_###1
;D"8
cholesterol
512C521 5222C011 5062C0#5 (S (S
>ri&lHcerides 1.2C2.25 121C1/#/ 15B62C1.B2 p4##1 p4###2
12.
(m&=dl)
?lucose
(m&=dl)
.2C11B5 /B2C62. /02CB02 p4##0 p4###0
,atients Iith *S and (<M"D have hi&h serum transaminases <ll patients had
<">Y127( and <">=<S>Y2 *ean 12 IeeDs Iei&ht loss Ias 0B6 D& (ran&e 28B D&)$
<"> decreased Iith B#62 N=l$ <S> decreased Iith 222 N=l$ ??> decreased Iith 2062
N=l$ tri&lHcerides decreased Iith 0#62 m&=dl$ "D" cholesterol decreased Iith 122
m&=dl$ fastin& &lucose decreased Iith /2 m&=dl and ;D" cholesterol increased Iith #62
m&=dl *ean 20 IeeDs Iei&ht loss Ias 655 D& (ran&e 08. D&)$ <"> decreased Iith /0
N=l$ <S> decreased Iith 2/62 N=l$ ??> decreased Iith 2# N=l$ tri&lHcerides decreased
Iith 2222 m&=dl$ "D" cholesterol decreased Iith 2562 m&=dl$ fastin& &lucose decreased
Iith 1#2 m&=dl and ;D" cholesterol increased Iith 522 m&=dl
C$)c!("i$): Kei&ht loss is the main therapH in patients Iith (<M"D Reduction in bodH
Iei&ht in patients Iith *S and (<M"D is associated Iith a pronounced decrease in
serum transaminases 'n addition Iei&ht loss resulted in si&nificant improvements in the
lipoprotein profile and fastin& &lucose
PREVALENTA COMPLICATIILOR MICROVASCULARE LA PACIENTII CU
DIABET ZAHARAT TIP H CU VECHIME A BOLII DE PESTE 5M ANI
%i,ina

$ar,a(u
9
, ihaela 4ladu
:
, Diana Clenciu
9
, Nicoleta itroi
9
, Ca"elia Panus
9
,
aria ota
:
,
9
%pitalul Clinic *udetean de +r,enta Craio(a 7 Clinica Diabet Nutritie Boli etabolice@
:
+/ Craio(a 5 Departa"entul de Diabet Nutritie Boli etabolice
Sc$1(! "t(%i(!(i: Svaluarea prevalentei complicatiilor microvasculare la un lot de
pacienti cu diabet zaharat tip 1 cu vechime a bolii de peste 22 ani
Mateia! "i #et$%a! "otul studiat a cuprins 00 pacienti cu DZ tip 1 cu vechime a bolii de
peste 22 ani aflati in evidenta 9entrului 9linic de Diabet (utritie )oli *etabolice al
Spitalului 9linic Wudetean de Nr&enta 9raiova 9a metoda de lucru am utilizat
urmatoarele date anamnestice$ clinice si paraclinice! vechimea diabetului$ antecedentele
personale$ determinarea tensiunii arteriale$ &licemie$ uree$ creatinina$ colesterol total$
tri&liceride$ e7amen sumar urina$ microalbuminurie repetata de 5 ori la pacientii cu
uroculturi ne&ative$ e7amen oftalmolo&ic$ e7amen neurolo&ic
1B#
Re'(!tate! Din cei 00 pacienti$ 10 (51$/11) au fost de se7 feminin si 5# (B/$1.1) de se7
masculin 9u privire la varsta acestora$ 2 pacienti (0$201) se aflau in decada de varsta
5#80# ani$ 12 pacienti (26$261) in decada 0182# ani$ 12 pacienti (50$#.1) in decada 218
B# ani si 12 pacienti (50$#.1) peste B# ani Studiind parametrul complicatii
microvasculare s8a remarcat o frecventa crescuta a neuropatiei diabetice .2$021 si a
retinopatiei diabetice //$B51 (efropatie diabetica au prezentat 0#$.#1 din pacientii cu
vechime de peste 22 ani Dintre pacientii cu neuropatie diabetica$ /0$#.1 au avut
neuropatie periferica si 11$5B1 atat neuropatie periferica cat si ve&etativa Din cei cu
retinopatie diabetica 2#1 s8au aflat in stadiul neproliferativT 11$5B1 in stadiul
preproliferativ si 26$261 in stadiul proliferativ "a 51$#21 dintre acestia s8a intalnit
cecitatea ca si complicatie a retinopatiei diabetice (efropatia diabetica s8a intalnit in
55$551 in stadiul 5T B1$111 in stadiul 0 si 2$221 in stadiul 2 Dintre cei cu retinopatie
diabetica 05$2.1 prezentau si nefropatie Dislipidemia a fost evidentiata la 52 pacienti
(62$621) ;ipertensiunea arteriala s8a intalnit la 5B pacienti (/1$/11) Dintre pacientii
hipertensivi$ 2/ pacienti (66$661) prezentau ;>< si neuropatie$ 26 pacienti (621)
prezentau ;>< si retinopatie$ 16 pacienti (06$221) prezentau ;>< si arteriopatie$ 12
pacienti (01$B61) prezentau ;>< si nefropatie$ iar 15 pacienti (5B$111) prezentau atat
;>< cat si neuropatie$ retinopatie$ arteriopatie si nefropatie
*entionam ca nu s8a putut stabili o corelatie intre echilibrul &licemic si
complicatiile microvasculare datorita lipsei hemo&lobinei &licozilate din evidentele
pacientilor de8a lun&ul perioadei de evolutie a DZ
C$)c!('ii : Se remarca o frecventa alarmanta a complicatiilor microvasculare dupa o
vechime a DZ tip 1 de peste 22 ani (europatia diabetica este cea mai frecventa
complicatie intalnita$ dar si cea mai precoce Retinopatia diabetica este de asemenea o
complicatie frecventa$ dar este rara in primii ani de evolutie ?radul mic de corelatie al
retinopatiei diabetice cu nefropatia diabetica su&ereaza posibila participare a unor factori
individuali implicati in aparitia acestora$ cum ar fi factorii &enetici Dislipidemia si
hipertensiunea arteriala sunt frecvent intalnite la pacientii cu DZ de peste 22 ani <mbele
se7e sunt vulnerabile pentru complicatiilor microvasculare
THE PREVALENCE OF MICROVASCULAR COMPLICATIONS IN T,PE H
DIABETES MELLITUS +ITH DURATION OF DIABETES MORE THAN 5M
,EARS
%i,ina

$ar,a(u
9
, ihaela 4ladu
:
, Diana Clenciu
9,
, Nicoleta itroi
9
, Ca"elia Panus
9
,
aria ota
:
,
9
Clinical Count3 2"er,enc3 0ospital Craio(a, Diabetes Clinic@
:
+/ Craio(a
1B1
Bac-.$()%: >o analHze the freLuencH of microvascular complications in patients Iith
duration of >1D* more than 22 Hears
Mateia! a)% #et/$%: Ke studied a &roup of 00 patients Iith duration of >1D* more
than 22 Hears$ hospitalized in the 9linic of Diabetes (utrition [ *etabolic Diseases
(9linic 9ountH Smer&encH ;ospital 9raiova) Ke analized the folloIin& historH$ clinical
and paraclinical dates! the duration of diabetes mellitus$ personal historH$ blood pressure$
&lHcemia$ urea$ creatine$ total cholesterol$ ;D"8cholesterol$ "D"8cholesterol$
tri&lHcerides$ urinarH e7amination$ microalbuminuria (repeted for 5 times)$
ophtalmolo&ical e7amination$ neurolo&ical e7amination
Re"(!t" a)% %i"c(""i$)": Mrom the 00 patients included in the studH$ 10 patients
(51$/11) Iere female and 5# patients (B/$1.) Iere male 9oncernin& the a&e of patients$
2 patients (0$201) Iere betIeen 5#80# Hears$ 12 patients (26$261) Iere betIeen 0182#
Hears$ 12 (50$#.1) patients Iere betIeen 218B# Hears and 12 patients (50$#.1) over B#
Hears Re&ardin& microvascular complications$ .2$021 patients presented diabetic
neuropathH and //$B51 presented diabetic retinopathH Diabetic nefropathH presented
0#$.#1 of patients Iith duration of >1D* more than 22 Hears Mrom the patients Iith
diabetic neuropathH$ /0$#.1 had peripheral neuropathH and 11$5B1 both peripheral and
ve&etative neuropathH Mrom the patients Iith diabetic retinopathH$ nonproliferative DR
((,DR) Ias encountered in 2#1 of patients$ preproliferative DR in 11$5B1 Ihile
26$261 had proliferative DR (,DR) <s a complication of DR$ blindness Ias met in
51$#21 patients Re&ardin& diabetic nefropathH$ 55$551 of the cases presented 5rd sta&e$
B1$111 presented 0th sta&e and onlH one patient (2$221) presented 2th sta&e Mrom the
patients Iith retinopathH 05$2.1 presented nefropathH too 52 patients (62$621) had
dHslipidaemia and 5B patients (/1$/11) suffered of arterial hHpertension Mrom
hHpertensive patients$ 2/ patients (66$661) presented after 22 Hears arterial hHpertension
and diabetic neuropathH$ 26 patients (621) arterial hHpertension and diabetic retinopathH$
16 patients arterial hHpertension and diabetic arteriopathH$ 12 patients arterial
hHpertension and diabetic nefropathH and 15 patients (5B$111) presented arterial
hHpertension$ neuropathH$ retinopathH$ arteriopathH and nefropathH Ke can not
established a corelation betIeen &lHcemic control and microvascular complications
because the missin& of ;b<1c durin& the diabetes mellitus evolution
C$)c!("i$)": >his studH shoIed that microvascular complications appeared Iith an
alarmin& freLuencH after 22 Hears of evolution Diabetic neuropathH is the most freLuent
and precocious microvascular complication <lso DR is a freLuent complication too 'ts
smaller de&ree of corelation Iith diabetic nefropathH su&ests the possibilitH of
participation of others individuals factors$ liDe &enetic ones DHslipidemia and arterial
hHpertension Iere met after 22 Hears of tHpe 1 diabetes mellitus evolution$ even more
freLuentlH in patients Iith chronic complications )oth male and female are vulnerable
for microvascular complications
1B2
CERCET9RI PRIVIND OPTIMIZAREA CONSULTULUI DE DIABET N
AMBULATORIUL DE SPECIALITATE
%orin Ioacara, Clin )iu
Policlinica >ediRs& C#"pina, Ro"#nia
Sc$1 <naliza modului de desf:urare a consultului de diabet %n sistem ambulator i
optimizarea lui pentru a permite creterea calit:ii pentru acelai interval de timp folosit
Mateia! 2i #et$%& ,oliclinica ]*ediRs- a pus la dispoziie spaiul i dot:rile necesare
implement:rii unui pro&ram de mana&ement conceput i realizat local$ folosind
e7periena Spitalului ?eneral Salzbur&$ <ustria ,acientul se prezint: prin pro&ramare$
ateapt: %n medie 2#R$ intr: %n cabinetul asistentei$ unde se noteaz: DO<R %n calculator
datele demo&rafice$ antropometrice (inclusiv circumferina abdominal:)$ tensiune
arteriala$ fumat$ etc Nrmeaz: ultimile analize$ inclusiv cu data$ pentru &licemie$ ;b<1c$
colesterol total$ ;D"c$ tri&liceride$ uree$ creatinin: Nrmeaz: r:spunsul la %ntreb:ri intite
privind debutul diabetului$ &laucom$ cataracta$ furnic:turi picioare$ etc Sunt calculate
automat! v3rsta$ &reutatea ideal:$ '*9 actual$ '*9 ma7im %n cursul vieii$ "D"c$ rata
filtr:rii &lomerulare (formula *DRD) >impul mediu necesar! 0 minute ,acientul revine
%n sala de ateptare i intr: apoi %n cabinetul medicului$ care preia consultaia din punctul
l:sat de asistent: i introduce DO<R %n calculator prin clic %n c:sua potrivit: date le&ate
de complicaii oculare$ renale$ nervoase$ dislipidemie$ arteriopatie$ hipertensiune$
cardiopatie ischemic:$ infarct$ accident vascular cerebral$ insuficien: cardiac:$ fibrilaie
atrial: Se &enereaz: %n mod automat dia&nosticul complet (lun&)$ care poate fi modificat
(practic doar ad:u&:ri) i validat Nrmeaz: pa&ina 5 alocat: recomand:rilor$ unde se ale&
medicamentele din liste scurte$ %mp:rirea %ntr8o zi i perioada prescrierii Se &enereaz:
automat date de re&im alimentar (e7tins) Nrmeaz: momentul &ener:rii documentelor
medicale prin clic pe butonul corespunz:tor Reetele &ratuite sunt printate pe imprimante
matriciale (trei) 9alculatorul mai &enereaza automat bilet de consult$ identic cu biletul de
e7ternare (o pa&ina <0 plin:$ la font de 1#)$ ce cuprinde pe l3n&: dia&nostic absolut toate
informaiile e7istente %n calculator$ sub form: de fraze automate$ modificabile Similar$
sunt &enerate scrisoare medical:$ referat medical$ referat Gustificare medicamente$ etc$
care sunt printate laser >impul mediu necesar! 0 minute$ din care 281# secunde &enerarea
tuturor documentelor medicale Nn e7emplar din biletul de e7ternare este pus %n fia
pacientului pentru a consemna consultul 9alculatorul mai &enereaz: re&istrul de
consultaii i raportarea lunar: c:tre 9asa de S:n:tate
Re'(!tate n perioada 12=#5=2##/85#=#.=2##/ s8au efectuat 202# consultaii diabet
folosind mana&ementul descris anterior$ cu un timp mediu total (inclusiv asistentar) de
in&riGire medical: de / minute = pacient$ ceea ce corespunde la 12 pacieni = ora (0
minute=pacient 7 2 cabinete) ,acienii sunt studiai prospectiv sub diverse aspecte
(inclusiv mortalitate)$ cu &enerarea automat: a bazei de date
C$)c!('ii Molosind un mana&ement performant se poate e7ternaliza complet birocraia
prezent: i viitoare$ cu realizarea a /#8.# consultaii = B ore Dac: toate documentele
1B5
medicale sunt tampilate i semnate %n prealabil$ se elimin: total folosirea pi7ului i a
tampilei %n timpul consultaiei >impul c3ti&at poate fi transferat c:tre activit:i de
educaie$ cercetare$ etc Nn eventual Re&istru (ational de Diabet poate fi usor alimentat
cu informatii in acest fel
RESEARCH REGARDING THE OPTIMIZATION OF DIABETES
CONSULTATION IN OUTPATIENT CLINIC
%orin Ioacara, Calin )iu
>ediRs& 6utpatient Clinic, Ca"pina, Ro"ania
Ai# >o analHze the diabetes consultation and itRs optimization for increasin& the LualitH
Iithout anH e7pense of time
Mateia!" a)% #et/$%" ]*ediRs- Outpatient 9linic offered the space and materials
reLuired for implementation of a mana&ement plan desi&ned locallH$ usin& the e7perience
of Salzbur& ?eneral ;ospital$ <ustria >he patient comes onlH bH appointment$ he Iaits
around 2#R$ he enters the nurseRs cabinet$ Ihere data are recorded onlH in computer
re&ardin& demo&raphic$ anthropometrH (includin& Iaist circumference)$ blood pressure$
smoDin& >hen$ the neIest blood analHsis data are recorded$ includin& date$ for
&lHcaemia$ ;b<1c$ total and ;D" cholesterol$ tri&lHcerides$ urea and creatinine >hen$
the patient ansIers some Luestions re&ardin& diabetes onset$ &laucoma$ cataract
<utomated &enerated data include! a&e$ ideal Iei&ht$ present and ma7imum (durin& life)
)*'$ "D"c$ &lomerular filtration rate (*DRD formula) *ean time! 0 minutes >he
patient returns in the Iaitin& room and then he enters the doctorRs cabinet$ Iho continues
the consultation from the point left bH the nurse ;e records onlH in the computer data
re&ardin& ocular$ renal$ nervous complications$ dHslipidemia$ arteriopathH$ hHpertension$
ischemic heart disease$ mHocardial infarction$ stroDe$ heart insufficiencH$ atrial
fibrillation >he dia&nosis is &enerated automated$ modified (&eneralH bH completion) and
validated ,a&e three deals Iith recommendations$ Ihere medications are chosen from
small lists$ daHlH and the total period for prescription >he &eneral diet is computer
&enerated >hen$ the medical dischar&e documents are automaticallH &enerated Receipts
are printed on matricial printers (three) >he computer &enerates an dischar&e letter verH
similar Iith the one used in hospital (one <0 pa&e$ font! 1#)$ Ihich contains the
dia&nosis and all the information from computer$ but in lon& phrases$ Ihich are
modifiable 'n a similar manner are automaticallH &enerated other documents liDe letter
for the ?,$ medical note$ notes for prescription Gustification theH are laser printed >he
doctorRs mean time! 0 minutes$ from Ihich 281# seconds for documents &eneration One
dischar&e letter &oes to the patient medical file as a source document >he computer also
&enerates the consultations re&istrH and the monthlH report to the ;ealth 'nsurance
9ompanH
1B0
Re"(!t"6 Durin& 12=#5=2##/85#=#.=2##/ period$ there Iere 202# diabetes consultations$
all usin& the mana&ement plan described above$ Iith a mean time of medical care
(nursejdoctor) of / minutes = patient$ Ihich coresponds to 12 consultations = hour (0
minutes = patient 7 tIo cabinets) >he patients are prospectivelH studied from diffrent
aspects (includin& mortalitH)$ Iith the automaticallH &eneration of the database
C$)c!("i$)" 'f a top mana&ement plan is used$ it is possible to completelH e7ternalise
the present and future birocracH$ Iith the result of /#8.# consultations = B hours 'f all
medical documents are si&ned and stamped before$ there is no need for pen and stampin&
durin& the consultation >he &ained time can be transfered to activities for education$
research <nH future (ational Diabetes Re&istrH can be easilH fed Iith information
INDICII MOLECULARE SI GENETICE DE REVERSIBILIZARE A
DIABETULUI ZAHARAT TIP 5
%il(ia %tefania Iancu
Centrul Clinic de Diabet, Nutritie si Boli etabolice, Clu15Napoca
,rezentam 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 chirur&ical al obezitatii si care necesita a fi e7tinsa la alte sub&rupe de
pacienti cu diabet zaharat tip 2 <cest lucru este posibil prin cautarea si identificarea
&enelor de risc$ a cailor de semnalizare in care se implica produsii acestor &ene
<ceste abordari se focalizeaza pe! &ena >9M6l2$ cea mai frecvent asociata cu riscul de
diabet la multe populatii si implicarea in calea 9nt de semnalizare$ le&ata de
metabolismul lipidic si de homeostazia &lucozei si influenteaza numarul si functia
celulelor betaT calea ,,<R$ rezistenta la insulina si semnalizarea insulinica redusa la
nivel de receptor si postreceptor$ statusul inflamator
MOLECULAR AND GENETIC CLUES TO REVERSE T,PE 5 DIABETES
MELLITUS
%il(ia %tefania Iancu
Clinical Centre for Diabates Nutrition and etabolic Diseases, Clu15Napoca
1B2
Ke present an overvieI of the research directions aimin& at reversal of tHpe 2 diabetes
mellitus that Ias demonstrated and is reproducible in the sur&ical treatment of obesitH
>his fact should be e7tended to other sub&roups of tHpe 2 diabetes patients and this is
possible throu&h searchin& for the risD &enes$ the si&nallin& pathIaHs in Ihich their
action is involved
>hese approaches are focused on! >9M6l2 &ene$ the &ene most freLuentlH associated Iith
the risD for diabetes in manH populations and its implications in the Int si&nallin&
pathIaH that is connected Iith the lipid metabolism and &lucose homeostasis influences
beta cellsR number and fuctionT the ,,<R pathIaH$ insulin resistance and defects of
insulin si&nallin& reduced receptor and postreceptor activitH$ the inflammatorH status
NEUROPATIA VEGETATIVA CARDIACA ESTE SUBDIAGNOSTICATA IN
DIABETUL ZAHARAT DE TIP H
%il(ia % Iancu J9F, ariana Coca J9F, Ion Iancu J:F, Ioana %treulea J9F
9 Centrul Clinic de Diabet, Nutritie si Boli etabolice Clu15Napoca
: %ectia de neurolo,ie, Clinica edicala I4, Clu15Napoca
Sc$1 (europatia cardiaca ve&etativa se asociaza ((9A) cu risc cardiovascular crescut si
cu moarte subita la pacientii cu diabet$ din acest motiv am initiat studiul epidemiolo&ei
acestei afectiuni si asocierile ei cu alte complicatii cronice ale diabetului zaharat
Pacie)ti! <m inclus pacienti cu diabet zaharat tip 1$ 2# barbati$ 0/ femei$ cu varsta medie
52j / ani$ cu o durata a diabetului cuprinsa intre .$2825 ani$ fara insuficienta renala
Met$%e! ,entru dia&nosticul (9A am folosit rata variabilitatii frecventei cardiace in
cursul respiratiei profunde si ca raspuns la ortostatism$ Raspunsul presional la contractia
mainii si la ortostatism din bateria de teste SIin& <m dia&nosticat (9A daca doua din
testele mentionate anterior au fost pozitive <m realizat screenin&ul prezentei
complicatiilor cronice ale diabetului zaharat$ am evaluat >< de repaus$ '*9$ ;b<19$
profilul lipidic$ creatinina$ hemoleuco&rama$ sideremia$ SS? s8a realizat doar la 51 din
pacienti pana la data respectiva
Re'(!tate: <m aflat ca 2 din 22 (2#1) din barbatii cu durata diabetului (dd) intre 1#812
ani si 11 din 22 (001) din cei cu dd peste 12 ani au fost pozitivi pentru (9A$ in timp ce
la femei$ 0 din 20 (1B$B1) cu dd intre 1#812 ani si 1# din 20 (01$B1) cu ddY12 ani aveau
(9A <m &asit asocieri semnificative ale (9A cu hipo&licemiile severe=nerecunoscute
OR42$55$ cu prezenta retinopatiei$ OR4 1$/2$ cu tensiunea arteriala$ OR42$#1$ cu
neuropatia periferica simptomatica OR41$B2$ cu &astropareza sau diareea diabetica
OR40$#5 dar nu am decelat deocamdata nici o asociere cu aspectele SS? Doar 12$01
1BB
din pacienti au avut acuze de simptome su&estive pentru neuropatia autonoma la
prezentare
C$)c!('ie! <m &asit o prevalenta crescuta a (9A la persoanele cu diabet zaharat tip 1 cu
durata diabetului peste 1# ani$ prevalenta care creste cu varsta si cu durata bolii
Recomandam efectuarea screenin&8ului acestei complicatii la pacientii cu diabet zaharat
tip 1 mai ales cu peste peste 1# ani vechime a bolii
UNDERDIAGNOSED CARDIAC AUTONOMIC NEUROPATH, IN T,PE H
DIABETIC PATIENTS
%il(ia % Iancu J9F, ariana Coca J9F, I.. Iancu J:F, Ioana %treulea J9F
9 Clinical centre for diabetes, nutrition and "etabolic diseases Clu15Napoca
: Neurolo,3 Depart"ent, edical Clinic I4 Clu15Napoca
Ai#! 9ardiac autonomic neuropathH (9<() is associated Iith hi&hlH increased
cardiovascular risD and sudden death in diabetic patients Ke studied the epidemiolo&H of
the condition and its associations Iith other diabetic complications
Patie)t"! Ke included ./ tHpe 1 diabetes patients$ 2# males$ 0/ females$ a&ed 52j /
Hears$ Iith a diabetes duration betIeen .2825 Hears Iithout renal insufficiencH
Met/$%"! Mor the 9<( Ie assessed the heart rate (;R) variabilitH durin& deep breath$
;R response to standin&$ ), response to hand&rip and ), response to standin&$ from the
SIin& batterH of tests Ke dia&nosed 9<( if tIo of the tests previouslH mentioned Iere
ositive Ke screened the presence of chronic diabetes complications$ Ie evaluated
restin& ),$ )*'$ ;b<19$ lipid profile$ creatinine$ hemoleuco&ram$ iron$ SS? Ias
performed in onlH 51 of the patients to date
Re"(!t": Ke found that 2 of 22 (2#1) males Iith diabetes duration (dd) betIeen 1#812
Hears and 11 of 22 (001)Iith dd over 12 Hears Iere positive for 9<($ Ihereas in
females$ 0 out of 20 (1B$B1) Iith diabetes duration betIeen 1#812 Hears and 1# out of
20 (01$B1) Iith ddY12 Hears had 9<( Ke found si&nificant associations of 9<( Iith
unreco&nized U severe hHpo&lHcemias OR42$55$ Iith presence of retinopathH OR4 1$/2$
Iith blood pressure OR42$#1$ Iith sHmptomtic peripheral neuropathH OR41$B2$ Iith
diabetic &astropathH or diarrhea OR40$#5 but no association could be found Iith SS?
aspectsOnlH 12$01 of the patients complained of sHmptoms usuallH su&&estive of
autonomic neuropathH at presentation
C$)c!("i$)! Ke found a hi&h prevalence of 9<( in tHpe 1 diabetic patients$ increasin&
Iith a&e and disease duration$ and due to the hi&h 9A risD attributable to this condition
1B6
Ke stron&lH recommend the inclusion of the 9<( screenin& in the annual evaluation of
the tHpe 1 diabetes patients$ after 1# Hears of disease duration
ASPECTE ALE COMEI HIPOGLICEMICE
%tefanita P2)R2A, Andreea %2RBAN, 4i(iana 2LIAN, Prof .Dr C6N%).
I6N2%C+ )AR$64I%)2
Institutul de Diabet,Nutritie,Boli etabolice !N.Paulescu&Bucuresti
9oma hipo&licemica este manifestarea e7trema a hipo&licemiei$ insotita de pierderea
starii de constiinta$ cu incapacitatea pacientului de a actiona adecvat pentru a iesi din
hipo&licemie fara interventia altor persoane
SCOP STUDIULUI!urmarirea cazurilor de coma hipo&licemica internate la
'D()*-,<N"SS9N-in perioada martie 2##68februarie 2##/
MATERIAL SI METODA!au fost analizate 1#B pacienti$pe baza foii de observatie
completate in serviciul de terapie intensivaS8au urmarit parametrii fiziolo&ici la
internare$etiolo&ia episodului hipo&licemic si raspunsul la tratament
REZULTATE:in perioada martie 2##68februarie 2##/ au fost internati in sectia de
terapie intensiva a spitalului 'D()*-,<N"SS9N- 1#B cazuri$din care 2# barbati$si
2B femei cu varsta medie de B#$1 ani $cu o vechime medie a diabetului de 126. ani"a
internare$pacientii au avut o valoare &licemica medie de 52$/2 m&=dl$;ba1c medie de
/B1$un scor &las&oI mediu de .6/$><S medie 15/$12 mm;& $><D medie 65$0
mm;&$<A8.#$22 bpm$un procent de 2.$6/ 1din pacienti au prezentat hipertonie$25$02
1 semnul babinsDi si B2$.21 transpiratii9auza cea mai frecventa a comei
hipo&licemice a fost aportul alimentar inadecvat la BB$#51din pacienti12$#.1din cazuri
au survenit pe fondul 'R9$.051 pe fondul consumului e7cesiv de alcool$0611 in urma
efortului fizic intens$$5661 au survenit la persoane cu neoplazii< fost inre&istrat si un
caz de coma hipo&licemica pe fondul administrarii e7cesive de insulina in scop suicidal
la o tanara de 2/ ani*aGoritatea pacientilor erau pe terapie cu insulina umana B2$2B1$un
procent de 25$2/ 1 urmau tratament cu sulfoniluree si 10$121 urmau terapie cu analo&i
de insulinaRaspunsul la terapie a survenit in principal la 2 ore de la tratament $cu o
&licemie medie de 105 m&=dl$un sin&ur deces a fost semnalat la o persoana de 0/ ani$cu
neoplasm mamar operat $cu metastaze cerebrale si menin&eale
CONCLUZII:coma a survenit mai frecvent la persoane care urmau tratament cu
insulina umana$indeosebi pe schema cu 5 prize de insulina$iar aportul inadecvat de hidrati
a fost principala cauza declansatoare <cest fapt subliniaza importanta educatiei
1B/
terapeutice a pacientului atat in ceea ce priveste administrarea de insulina cat mai ales
importanta re&imului i&ieno8dietetic si aGustarea dozelor in functie de stilului de viata
CONSIDERATIONS ON H,POGL,CEMIC COMA
%tefanita P2)R2A, %2RBAN Andreea ,4i(iana 2LIAN, PR6/.C.I6N2%C+
)AR$64I%)2
Institute of diabetes, Nutrition and etabolic Diseases 8N. Paulescu8
;Hpo&lHcemic coma is the e7treme manifestation of hHpo&lHcemia$consecutive to
the loss of consciousness$Iith the incapacitH of the patient to act accordin&lH to &et off
the hHpo&licemic status$Iithout outside assistance
Ob8ective>the evaluation of the patients Iith hHpo&lHcemic coma Iho have been
hospitalized in the 'nstitute of Diabetes$(utrition and *etabolic Diseases ](,aulescu-$
)ucharest$ betIeen march 2##68 februarH 2##/
Re"eac/ %e"i.) a)% #et/$%"8 a &roup of 1#B patients Iith hHpo&lHcemic coma
has been analHsed usin& the medical records filled in the intensive care unit 't has been
recorded the phHsical e7amination$ vital si&ns$ the etiolo&H of the hHpo&licemic event
and the response at treatment
Re"(!t"! betIeen march 2##68 februarH 2##/ $ in the intensive care unit of the
'nstitute of Diabetes$(utrition and *etabolic Diseases $1#B patients have been
hospitalized $2# men and 2B Iomen $avera&e a&e of B#$1 Hears$ Iith an avera&e of
12$6. Hears of diabetes <t the hospitalisation moment$the patients had the folloIin&
avera&e parameters!&lHcemia of 52$/2 m&=dl $;b<1c of /$B 1$the ?las&oI coma scale
of .$6/$the sistolic blood pressure of 15/$12 and the diastolic blood pressure of 65$0$ the
heart rate of .2$22 beats per minute 2.$6/1 of
patients had hHpertonia$25$021 had a positive )abinsDi si&n and B2$.2 1 perspiration
>he most common cause for hHpo&lHcemic coma Ias the inadeLuate
nourishment$present at BB$#5 1 of patients12#. 1 of cases resulted from chronic renal
failure$.051 from the alcoholic abuse $0611 from increased phHsical activitH and 5$66
1 of patients had as concomitant illness cancer't has been recorded one case of
hHpo&lHcemic coma due to an insulin overdose administrated as a suicidal attempt bH a
2/ Hears old Ioman *ost of the patients Iere on human insulin
treatment( B2$2B1)$meanIhile 25$2/1 Iere treated Iith sulfonHlurea and 10$12 1 Iith
insulin analo&s>he patients recovered mainlH Iithin 2 hours after the be&inin& of the
treatment$ Iith an avera&e of &lHcemic level of 105 m&=dl$Iith one e7ception $ a 0/
Hears Ioman $Iith breast cancer and brain disemination $Iho died
1B.
C$)c!("i$)": the incidence of coma has been hi&her to the patients treated Iith
human insulin$ especiallH Iith 5 doses per daH$ and the inadeLuate nourishment has been
the primarH tri&&er >his underlines the importance of the patientRs trainin& re&ardin& not
onlH the administration of insulin but dietarH and insulinRs dosa&e as Iell$ accordin&lH to
oneRs lifestHle
DIABETUL ZAHARAT IN ;UDETUL SATU MARE PH PH 5PPR U PH PO 5PPR
PRELUCRAREA DATELOR CONFORM PROGRAMULUI EPIDIAB
REFERIRI LA DATELE EPIDIAB DE LA INITIERE PANA IN PREZENT
Dr %?ila,3i Iosif' , Dr B?duch arta' , Dr B?duch -solt Arpad'' , Dr Ciorba
Alina'''
' %pital *udetean de +r,enta %atu are
'' Centrul edical CARI)A% %atu are
''' Cabinet edical Indi(idual Dr %?ila,3i
RSZN*<>
Wudetul Satu *are face parte din acele Gudete care au fost inte&rate de la inceput in
pro&ramul S,'D'<) De la initierea pro&ramului si pana la #1 #6 2##/ numarul
diabeticilor in evidenta a crescut cu aproape 1# ### 9onform protocolului initial au fost
inre&istrati pacienti in functie de tipul diabetului$$ domiciliu$ se7$ varsta$'*9$
circumferinta abdominala$ comorbiditati si complicatii (;><$ dislipidemie$cardiopatia
ischemica$'*$<A9$arteriopatie diabetica$ retinopatie $ nefropatie diabetica$ neuropatie)
De asemenea a fost urmarita structura terapeutica (mod de viata$ tratament oral$
insulinoterapie de diverse tipuri$ terapie combinata)
'n anul 2##/ primul semestru au fost depistate 1562 cazuri noi din care 11 tip 1$ 1505
tip 2$ 1 diabet &estational$ 12 alte formeRepartitia in funtie de se7$ varsta$ domiciliu a
fost sensibil e&ala "a tipul 2 o prevalenta net superioara se re&aseste la supraponderali si
obezi "a tipul 2 peste 6#1 au ;><$ B.1 dislipidemie$ $ B11 afectare vasculara de
diverse tipuri$ 1.1 retinopatie$ 2$151 nefropatie clinic manifesta$ 6$221 neuropatie in
momentul depistarii
'n ceea ce priveste structura terapeutica predomina cu 50$6#1 cei cu tratament cu
re&imj metformin$55$021 deocamdata beneficiaza doar de re&im alimentar $ 12$.51 au
16#
tratament cu sulfonilureice /$#01 tratament oral combinat$ 0$11 insulinoterapie de
diverse tipuri
'n 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 Gustifica desfasurarea in continuare a
pro&ramului
DIABETES IN SATU>MARE COUNT, PH6PH65PPR U PH6PO65PPR
DATA ANAL,SIS ACCORDING TO EPIDIAB PROGRAM EPIDIAB DATA
FROM START TO PRESENT DA,S
Dr %?ila,3i Iosif@ Dr B?duch arta@ Dr B?duch -solt@ Dr Ciorba Alina
<)S>R<9>
Satu8*are 9ountH has been involved in >he S,'D'<) ,ro&ram from itsR be&innin&
>he number of the re&istered diabetic patients has been raised Iith 1#### since
S,'D'<) started until #1#62##/ <ccordin& to the initial protocol the patients have
been re&istered related to the diabetes tHpe$ residence$ se7$ a&e$ )*'$ Iaist
circumference$ co8morbidities and complications (arterial hHpertension$ dislipidemia$
coronarH arterial disease$ mHocardial infarction$ stroDe$ diabetes vascular disease$
retinopathH$ diabetes nephropathH$ and diabetes neuropathH)
'n the same time the therapeuticallH structure has been monitored(life stHle$ oral therapH$
different tHpes of insulinoteraphH and combination therapH)
'n the first semester of 2##/ there have been reported 1562 neI cases of diabetes from
Iitch 11cases of tHpe 1 diabetes$ 1505 tHpe 2 diabetes$ 1 &estational diabetes and 12
other tHpes >here Ias a Luite similar split based on se7$ a&e and residencH *ost of the
tHpe 2 diabetes patients are over8Iei&hted and obese <mon& the tHpe 2 diabetes patients
there are over 6#1 Iho suffered from arterial hHpertension$ B.1 Iith dislipidemia$ B11
Iith different Dind of vascular disease and 1.1 Iith retinopathH$ 2$151 Iith
nephropathH and 6$221 Iith neuropathH at the moment of re&istration
Re&ardin& the therapeutical structure there are 50$6#1 of the patients on metforminj
life stHle optimization measures$ 55$021 on diet $ 12$.51 on SN and /$#01 combinated
O<Ds and 0$11 on insulin
'n conclusion Ie could state the fact that there is a continuous and rapid increasin&
tendencH of the diabetes mellitus cases and also the fact that an active folloI8up of this
161
cases prevents or delaH complications$ all of this bein& a &ood ar&ument to continue the
pro&ram
CORELATII INTRE NIVELUL SERIC AL TNF>ALFA SI GROSIMEA INTIMA>
MEDIE LA PACIENTII CU DIABET ZAHARAT TIP 5 COMPLICAT CU
RETINOPATIE
AutoriP 4.Ne,reanI, ). AleEescuI, . Ada"I, %. )ar"ureI, N. LeachI, C. 4intelerG, D.
)odeaH, L. RoscaH,
95 Clinica edicala I4, +/ !Iuliu 0atie,anu&, %pitalul Clinic C/ Clu15Napoca
:5 Clinica Der"atolo,ie, %pitalul Clinic *udetean de +r,enta Clu15Napoca
A5 Clinica Pneu"ofti?iolo,ie, +/ !Iuliu 0atie,anu& Clu15Napoca
Obiectiv: Svaluarea relatiei intre indicele intima8medie(''*) si valoarea serica a alfa8
>(M la pcientii cu diabet zaharat tip 2 si retinopatie diabetica
Mateia! "i Met$%a! Studiul a inclus 0# de pacienti cu diabet zaharat tip 2 si retinopatie
diabetica internati in Spitalul 9linic 9M 9luG8(apoca in perioada 1122##685##52##/
Miecarui pacient i s8a intocmit o fisa ce cuprindea statusul metabolismului &lucidic$
lipidic si porteic$ precum si marDerii endoteliali inflamatori ( 9R,$ >(M8alfa) 'ndicele
intima8medie a fost evaluat ultrasono&rafic la nivelul arterei carotide comune$ bilateral$
inre&istrandu8se valoarea medie
Re'(!tate: . pacineti au avut niveluri crescute de >(M8alfa ( 22$21) $ iar indicele intima8
medie a fost semnificativ crescut la 22 de pacienti (221) S8a observat ca toti pacientii cu
niveluri crescute de alfa8>(M au avut un indice intima8medie crescut
C$)c!('ii: 'ndicele intima8medie masurat ultrasono&rafic reprezinta un semn precoce de
ateroscleroza 9resterea nivelurilor de >(M8alfa se coreleaza cu boala diabetica
macrovasculara Relatia intre semnele ultrasono&rafice de boala aterosclerotica subclinica
si nivelurile serice ale mediatorilor inflamatiei nu este pe deplin certa$ dar vom cauta noi
factori predictivi de dezvoltare a aterosclerozei la pacientii cu diabet zaharat
TNF>ALFA AND INTIMA>MEDIA THIC3NESS =IMT? IN PATIENTS +ITH
RETINOPATH,*S T,PE 5 DIABETES MELLITUS
Author Bloc< 4. Ne,rean
9
, ). AleEescu
9
, . Ada"
9
, %. )ar"ure
9
, N. LeachI, C.
4inteler
:
, D. )odea
A
, L. Rosca
A
@
162
9
edicala I4, Clinical 0ospital C/ clu15Napoca, Clu15napoca, Ro"ania,
:
Der"atolo,3, Clinical 0ospital of +r,enc3 Clu15Napoca, Clu15napoca, Ro"ania,
A
Pneu"olo,3, Clinical 0ospital of Pneu"olo,3 Clu15Napoca, Clu15napoca, Ro"ania.
Bac-.$()% a)% ai#"! Svaluation of the relationship betIeen '>* and >(M8alfa in
patients Iith diabetes mellitus tHpe 2 and diabetes retinopathH
Mateia!" a)% #et/$%"! >he studH included 0# patients Iith diabetes mellitus and
retinopathH from diabetes mellitus causes$ re&istered at NniversitarH ;ospital 9luG8
(apoca betIeen 1122##6 and 5##52##/ Sach patient had a record of research Ihere
included the status of &lucidic metabolism$ lipidic metabolism and proteic metabolism
and seric inflammatorH marDers ( 9R,$ >(M8alfa) '>* Ias evaluated usin& the
ultrasono&raphH of the common carotidal arterH$ on each side$ and the medium value Ias
recorded
Re"(!t"! . patients had increased level of >(M8alfa ( 22$21) and '>* Ias si&nificant
increased in 22 patients (221) 't Ias observed that all patients Iith hi&h levels of >(M8
alfa had si&nificant increased '>*
C$)c!("i$)! >he '>* measured bH ultrasono&raphH represents earlH si&n in the
development of atherosclerosis >he raisin& of >(M8alfa levels correlates Iith
macrovascular disease in patients Iith diabetes retinopathH >he relationship betIeen
ultrasono&raphic si&ns of sub8clinical atherosclerosis and the plasma levels of chemical
mediators of inflammation is not certain Het$ but Ie are looDin& for a neI prediction
factors of sub8clinical atherosclerosis in patients Iith diabetes mellitus and itRs sHstemic
complications
EVALUAREA MASEI DE ESUT ADIPOS DUP9 SUBSTITUIE
TESTOSTERONIC9 LA BARBAII CU SINDROM METABOLIC :I
DISFUNCIE ERECTIL9: E0PERIENA CLINIC9 A CENTRULUI CLINIC
DE DIABETF NUTRIIEF BOLI METABOLICEF CLU;>NAPOCA
4. C6CA, D
9
, $eor,iana NIC6L2%C+, D
:
, ariana C. C6CA, D, P0D
A
, Ildi<o
=IC%I5A)U+%, D
:
9
Cabinet Androlo,ie si edicina %eEualitii,
:
Cabinet 6be?itate i Dislipide"ii,
A
Departa"ent Laborator Clinic, Centrul de Diabet, Nutritie, Boli etabolica, Clu15
Napoca.
Obiective: <m urm:rit evoluia adipozit:ii &enerale$ a adipozit:ii intra8abdominale$ a
taliei i a raportului talie=old dup: tratament cu testosteron cu absorbie prelun&it: la
persoane cu sindrom metabolic (*etS) cu disfuncie erectil: (DS) i activitate &onadic:
diminuat:
165
Met$%a: "a un &rup de 1/ b:rbai cu *etS ('*9! 52B6C1#/ D&=m
2
T >4116C2#. cmT
&licemie411B6CB5 m&1T ?rup <) funcie &onadic: sc:zut: (testosteron total f>
t
g 4
./C5B nmol="$ testosteron liber ffree >g 4 #2.C##B2) i DS (C eGaculare precoce C
alterare de libidou) am evaluat distribuia adipozit:ii (impedan: f'n)odHgT A1)!
adipozitatea &eneral: (<?)! 0#6C011T adipozitatea visceral: (<,)! 1#/0C125 cm
2
T
talia (>)! 11.22C// cmT raport talie=old (>=S)! 11BC##B5 ,entru revi&orare se7ual:
am prescris testosteron inGectabil im cu absorbie prelun&it: ((S)'DO
e
1###$ 0 ml$ 22#
m&=ml) combinat cu ,DS2i <m evaluat participanii din punct de vedere se7ual ('ndice
'nternaional al Munciei Srectile! ''SM)$ andro&enic i prostatic (eco&rafie i ,S<)
%naintea fiec:rei inGect:ri (la 285 luni) i respectiv antropometric dup: 52 de s:pt:m3ni
(A2) plus profilul lipidic$ cel hematolo&ic i enzimele hepatice comparativ cu un lot de
2# de b:rbai (?rup )) cu *etS$ DS i activitate testosteronic: diminuat:$ tratai f:r:
testosteron$ doar cu ,DS2i

Re'(!tate: "a A2! <? 4 500C1#.1 (U6B1)$ ._##2 <, 4 11212C1#6 cm
2
(U1B0
cm
2
$ 10B1)$ ._##/ > 4 ..BCB#. cm (U. cm$ /551)$ ._##2 >=S 4 #./C##6. (U
##/)$ ._##1 9omparaia cu lotul de control (A2) a relevat urm:toarele semnificaii
statistice! <? (vs 0502C5#21)! . _ ##2 (4##2/)T <, (vs 15#1CBB cm
2
)! . _ ##B
(4##B6)T > (vs 12##2C2#1 cm)! . _ ##2 (4##2B)T >=S (vs 11C##5)! . ; #.
,arametrii lipidici$ hematolo&ici i enzimele hepatice nu au %re&istrat ascensiuni valorice
fa: de A1 >estosteronemia postterapeutic: nu a dep:it nivelul superior al normalului
(medie ?r <41/BBC5#. nmol=") i nu s8au %nre&istrat nici alter:ri ale ,S< (medie ?r
<4#1.BC##22 s&=")
C$)c!('ie: Substituia testosteronic: la b:rbaii obezi cu sindrom metabolic reduce masa
adipocitar: pe seama sc:derii semnificative a &r:simii abdominale i a taliei <cest
beneficiu$ al:turat profilului lipidic nealterat dup: testosteron$ su&ereaz: un potenial de
ameliorare a riscului cardiovascular
BOD, FAT MASS EVALUATION IN METABOLIC S,NDROME +ITH
ERECTILE D,SFUNCTION AFTER TESTOSTERONE SUBSTITUTION
THERAP,: CLINICAL E0PERIENCE OF THE CLINICAL CENTER OF
DIABETESF NUTRITION AND METABOLIC DISEASEF CLU;>NAPOCA6
4. C6CA, D
9
, $eor,iana NIC6L2%C+, D
:
, ariana C. C6CA, D, P0D
A
, Ildi<o
=IC%I5A)U+%, D
:
,
9
%eEual edicine and Androlo,3 6ffice,
:
6besit3 and Dislipide"ia 6ffice,
A
Laborator3
In(esti,ations Depart"ent, Diabetes Clinical Center, Count3 2"er,enc3 0ospital,
Clu15Napoca, Ro"ania
160
Ob8ective: >o assess total bodH fat mass$ abdominal fat$ Iaist and Iaist to hip ratio in
lon& actin& testosterone therapH in men havin& non8diabetic metabolic sHndrome (*etS)$
erectile dHsfunction (SD) and loI andro&enic activitH
Met/$%: < &roup of 1/ men Iith *etS ()*'! 52B6C1#/ D&=m
2
T K4116C2#. cm)$
loI=loI normal andro&enic activitH (testosterone f>g 4 ./C5B nmol=" and free > 4
#2.C##B2 nmol=") and SD (C premature eGaculation$ C loI libido) has been selected
(?roup <) )odH fat distribution (impedance method! 'n )odH) characteristics at A1
Iere! &eneral fat mass (?M)! 0#6C011T visceral adipose tissue (A<)! 1#/0C125 cm
2
T
Iaist (K)! 11.22C// cmT Iaist to hip ratio (K=;)! 11BC##B5 Mor se7ual
reestablishement lon& actin& testosterone ((ebido 1###
e
) associated to
phosphodiesteraze 2 inhibitors (,DS2i) Iere prescribed Se7ual ('nternational 'nde7 of
Srectile function! ''SM)$ serum testosterone and prostate (,S<$ ultrasound) evaluation
before everH testosterone inGection (285 month) Iere measured )odH fat parameters after
52 IeeDs inGected lon& actin& testosterone Iere also noted (A2) to&ether Iith lipid
profile$ hematolo&H and liver enzHmes Results Iere compared to those of a control
&roup Iith *etS$ SD and testosterone loI activitH$ treated onlH Iith ,DS2i (?r ))
Re"(!t": <t A2! ?M 4 500C1#.1 (U6B1)$ ._##2 A< 4 11212C1#6 cm
2
(U1B0 cm
2
$
10B1)$ ._##/ K 4 ..BCB#. cm (U. cm$ /551)$ ._##2 K=; 4 #./C##6. (U##/)$
._##1 9omparin& to the control &roup (also at A2) offered the folloIin& statistical
si&nificances! ?M (vs 0502C5#21)! . _ ##2 (4##2/)T A< (vs 15#1CBB cm
2
)! . _
##B (4##B6)T K (vs 12##2C2#1 cm)! . _ ##2 (4##2B)T K=; (vs 11C##5)! . ; #.
"ipid and hematolo&ical profile and liver enzHmes also at A2 did not enhanced from
normal patterns >estosterone serum levels remained in normal interval values after the
treatment (avera&e ?r <41/BBC5#. nmol=")T ,S< levels either (avera&e ?r
<4#1.BC##22 s&=")

C$)c!("i$)": >estosterone substitution therapH in metabolic sHndrome men havin& SD
decrease total bodH fat bH reducin& abdominal fat and Iaist >hese benefits and the
unaltered lipid profile su&&est a possible loIerin& in cardiovascular risD of lon& actin&
testosterone admission

EVALUAREA FUNCIEI SE0UALE DUP9 SUBSTITUIE TESTOSTERONIC9
LA PERSOANE CU SINDROM METABOLIC :I DISFUNCIE ERECTIL9:
E0PERIENA CLINIC9 A CENTRULUI CLINIC DE DIABETF NUTRIIEF
BOLI METABOLICEF CLU;>NAPOCA
4. C6CA, D
9
, D. P6RA4, D
:
, Ildi<o =IC%I5A)U+%, D
9
, $eor,iana
NIC6L2%C+, D
9
9
Centrul de Diabet, %pital *udeean de +r,en, Clu15Napoca.
162
:
%ecia +rolo,ic, %pital unicipal, Clu15Napoca.
Obiective: Svaluarea parametrilor de funcie se7ual: (funcie erectil:$ dorin: se7ual:$
satisfacie a penetr:rii$ satisfacie or&asmic: i satisfacie &eneral:) dup: substituie
testosteronic:$ %n sin8dromul metabolic (*etS) cu disfuncie erectil: (DS) i cu activitate
&onadic: diminuat:

Met$%a: "a 1/ b:rbai cu *etS ()*'! 52B6C1#/ D&=m
2
T K4116C2#. cmT ?rup <)$
testosteron seric sc:zut (testosteron total f>
t
g 4 ./C5B nmol="$ testosteron liber ffree >)
4 #2.C##B2) i DS (C eGaculare precoce C alterare de libidou) am asociat terapeutic
testosteron cu absorbie prelun&it: (testosterone undecanoat 22# m&=ml! (ebido 1###
e
) i
inhibitori de fosfodiesteraz: 2 (,DS2i! sildenafil 2# m&$ tadalafil 2# m&) 9omparaia s8a
facut cu un lot de control de 2# de b:rbai (?rup )) cu *etS i DS$ tratai doar cu ,DS2i$
f:r: testosteron Svaluarea se7ual: s8a f:cut prin calcularea scorului total al 'nde7ului
'nternaional de Muncie Srectil: (''SM) i al domeniilor acestuia! funcia erectil: (MS)! Q1
U 2$ 12T satisfacia penetr:rii (S,)! QB U /T satisfacia or&asmic: (SO)! Q. U 1#T dorina
se7ual: (DS)! Q11 U 12T satisfacia &eneral: (S?)! Q15 U 10 Svaluarile s8au facut la
%nrolare (A1) i dup: 52 de s:pt:m3ni de testosteron (5 inGecii imT A2)
Re'(!tate: Scorul <<E$% ?r <$ A1 vs A2! 01$/C62 vs B/0C2. (.4###1B)T la A2$ ?r
< vs ?r )! B/0C2. vs 265CBB (.4##56) Scor $E% ?r <$ A1 vs A2! 102C51 vs
2B2C22 (.4###5)T la A2$ ?r < vs ?r )! 2B2C22 vs 22BC20 (.4##2B) Scor S.%
?r <$ A1 vs A2! /6C#2 vs 10#C#/ (.4##60)T la A2$ ?r < vs ?r )! 10#C#/ vs
116C#0 (.4##21) Scor S=% ?r <$ A1 vs A2! /5C##/ vs/.C#6T la A2 ?r < vs ?r
)! /.C#6 vs /BC#1 (.4#$12) Scor DS% ?r <$ A1 vs A2! 25C#2 vs//C##0
(.4###12)T la A2 ?r < vs ?r )! //C##0 vs B#6C#2 (.4##62) Scor S"% ?r <$ A1
vs A2! 06C#5 vs/.C#1 (.4###/)T la A2 ?r < vs ?r )! /.C#1 vs B5C#2
(.4##B1) Discuii0 "u3nd %n considerare semnificaia statistic: de ._##2$ diferene
semnificative fa: de lotul martor au ap:rut la ameliorarea funciei erectile$ a dorinei
se7uale (libido) i a satisfaciei &enerale (u s8au putut face corelaii cu tipul de ,DS2i
asociat$ din cauza inconstantei utiliz:rii a aceleiai forme de ,DS2i pe durata studiului
C$)c!('ii: Substituia testosteronic: cu preparate cu absorbie prelun&it: amelioreaz:
calitatea vieii$ %mbun:t:ind funcia se7ual: la b:rbaii cu sindrom metabolic i disfuncie
erectil: i cresc3nd totodat: i eficiena ,DS2i la aceste persoane
SE0UAL FUNCTION ASSESSMENT AFTER TESTOSTERONE
SUBSTITUTION THERAP, IN MEN HAVING ERECTILE D,SFUNCTION
AND METABOLIC S,N>DROME: CLINICAL E0PERIENCE OF THE
16B
CLINICAL CENTER OF DIABETESF NUTRITION AND META>BOLIC
DISEASEF CLU;>NAPOCA
4. C6CA, D
9
, I. C6AN, D
:
, Ildi<o =IC%I5A)U+%, D
A
, $eor,iana
NIC6L2%C+, D
A
9
%eEual edicine5Androlo,3 6ffice, Diabetes Clinical Center, Count3 2"er,enc3
0ospital, Clu15Napoca, Ro"ania
:
%eEual edicine5Androlo,3 6ffice, +rolo,3 Depart"ent, unicipal 0ospital, Clu15
Napoca, Ro"ania
A
Diabetes Clinical Center, Count3 2"er,enc3 0ospital, Clu15Napoca, Ro"ania
Ob8ective: >o Iatch se7ual items (erectile function$ se7ual desire$ intercourse
satisfaction$ or&asmic satisfaction and overall satisfaction) after testosterone substitution
therapH in men Iith metabolic sHndrome havin& erectile dHsfunction Iith loI &onadic
activitH
Met/$%: < &roup of 1/ men Iith *etS ()*'! 52B6C1#/ D&=m
2
T K4116C2#. cm)$
loI=loI normal andro&enic activitH (testosterone f>g 4 ./C5B nmol=" and free > 4
#2.C##B2 nmol=") and SD (C premature eGaculation$ C loI libido) has been selected
(?roup <) >heH Iere treated Iith lon& actin& testosterone (testosterone undecanoat
1### m&) associated to phosphodiesteraze 2 inhibitors (,DS2i! sildenafil 2# m&$ tadalafil
2# m&) and compared to a 2# men control &roup ()) treated onlH Iith ,DS2i and (also
havin& *etS$ SD and testosterone loI activitH) Se7ual function has been evaluated bH
the 'nternational 'nde7 of Srectile DHsfunction (''SM) score and its domains! Srectile
Munction (SM)! Q1 8 2$ Q12T Se7ual Desire (SD)! QB U /T 'ntercourse Satisfaction ('S)!
Q. U 1#T Or&asmic Satisfaction (OS)! Q11 U 12T and Overall Satisfaction (OAS)! Q15 U
10
Re"(!t": <<E$ score% ?r <$ A1 vs A2! 01/C62 vs B/0C2. (.4###1B)T la A2$ ?r <
vs ?r )! B/0C2. vs 265CBB (.4##56) E$ score% ?r <$ A1 vs A2! 102C51 vs
2B2C22 (.4###5)T la A2$ ?r < vs ?r )! 2B2C22 vs 22BC20 (.4##2B) <S score%
?r <$ A1 vs A2! /6C#2 vs 10#C#/ (.4##60)T la A2$ ?r < vs ?r )! 10#C#/ vs
116C#0 (.4##21) =S score% ?r <$ A1 vs A2! /5C##/ vs/.C#6T la A2 ?r < vs
?r )! /.C#6 vs /BC#1 (.4#12) SD score% ?r <$ A1 vs A2! 25C#2 vs//C##0
(.4###12)T la A2 ?r < vs ?r )! //C##0 vs B#6C#2 (.4##62) =>S score% ?r <$
A1 vs A2! 06C#5 vs/.C#1 (.4###/)T la A2 ?r < vs ?r )! /.C#1 vs B5C#2
(.4##B1) 9onsiderin& as statistic si&nificance the ._##2$ a better improve8ment in
erectile function domain$ se7ual desire (libido component) and overall satisfaction$ for
the testosterone j ,DS2i treated &roup has been re&istered 't could not been done
correlations to each prescribed ,DS2i because the participants varied it durin& the studH
C$)c!("i$)": 'n men Iith erectile dHsfunction and metabolic sHndrome lon& actin&
testosterone therapH improves their se7ual function (erection and desire)$ also enhancin&
,DS2i pharmacolo&ical effect and basicallH improvin& their LualitH of life
166
HIPERGLICEMIA CRONICA USOARA IN TREI GENERATII: FORMA
MONOGENICA DE DIABET ZAHARAT > MOD, 5 =Y?
Dr. 4ictoria Cret JClinica Pediatrie I Clu1F
<pote8a0 Diabetul zaharat mono&enic$ rezultat al unor mutatii la nivelul unei sin&ure &ene$
se poate transmite autosomal dominant$ autosomal recesiv sau mutatia poate fi ]de novo-
"a copil$ aproape toate formele de diabet mono&enic sunt rezultatul mutatiilor la nivelul
&enelor care re&leaza functia celulelor beta8pancreatice$ mai frecvente fiind mutatiile
(peste 2##) &enei &lucoDinazei (?9Z) care determina *ODa 2$ maGoritatea fiind mutatii
inactivatoate in stare heterozi&ota$ responsabile de hiper&licemia cronica usoara$
nepro&resiva
,rezentam cazul unei paciente cu hiper&licemie cronica$ modificare biochimica prezenta
si la mama$ unchiul si bunicul matern$ la care suspectam o forma mono&enica$ autosomal
dominanta de diabet zaharat 8 *ODa 2
,acienta$ in varsta de 12 ani$ s8a prezentat pentru hiper&licemii usoare in ultimii ani$
&reutatea la nastere fiind normala Svaluarea clinica releva hipostatura$ '*9 normal$
dezvoltare neuropsihica si pubertara normala S7plorarile dia&nostice au aratat! &licemia
bazala! 1/2 m&=dlT >>?O! 512 m&=dl la 2 oreT ;b<1c 4 B$1.1T peptidul 9! 1$1B n&=ml
(A(! 1$1U0$0)T insulinemia bazala! 1#$# N=ml (A(! 2B$ dup: RanDe)T ;O*<8'R! 0$/B
(A( _ 0)T nu a prezentat cetonurieT evaluarea a7ei endocrine a cresterii a relevat valori
normale ale '?M1 si S>; stimulat *ama pacientei$ in varsta de 5. ani$ prezenta
hiper&licemie bazala$ >>?O! 2#2 m&=dl la 2 ore si ;b<1c! B$B01 Nnchiul matern$ in
varsta de 5# ani$ a fost recent dia&nosticat cu DZ tip 2$ ca si bunicul matern$ in varsta de
2. ani (ambii cu forme usoare de hiper&licemie! %ntre 15# U 12# m&=dl) 'n evolutie$
pacienta a prezentat valori ale &licemiei intre /# U 16# m&=dl$ controlate cu dieta
Dia&nosticul diferential a inclus diabetul zaharat tip 2 si alte forme mono&enice sau
specifice de diabet zaharat
Conclu8ii0 <m interpretat cazul ca o forma familiala de hiper&licemie cronica usoara 8 o
forma mono&enica de diabet zaharat cu transmitere autosomal dominanta si anume
*ODa 2T pentru confirmarea dia&nosticului se impune analiza moleculara cu precizarea
mutatiei la nivelul &enei &lucoDinazei 'mportanta cunoasterii mutatiei rezida din faptul
ca$ in familiile cu risc$ mutatiile in stare homozi&ota sau de heterozi&ot compus
determina deficitul total de ?9Z$ cu aparitia diabetului zaharat neonatal pernament iar
mutatiile activatoare heterozi&ote sunt asociate cu hiperinsulinismul con&enital
16/
MILD CHRONIC H,PERGLICEMIA IN THREE GENERATIONS:
MONOGENIC DIABETES MELLITUS > MOD, 5 =Y?
Dr. 4ictoria Cret J/irst Pediatric Clinic, Clu1F
*ono&enic diabetes mellitus$ as a result of one or more mutations in a sin&le &ene$ could
be transmited in an autosomal dominant = autosomal recesiv manner or the muation could
be ]de novo- 'n children$ almost all mono&enic diabetes mellitus cases result from
mutations in &enes Ihich re&ulate pancreatic beta8cells function$ the &lucoDinase &ene
mutations (over 2##)$ most of them bein& heterozi&ous and inactivatin& mutations$
clinicallH e7pressed as *ODa 2 8 mild chronic hHper&licemia
Ke present here a female patient Iith mild hHper&licemia$ biochemical marD present also
in her mother$ maternal &randfather and maternal uncle (dia&nosed as tHpe 2 diabetes
mellitus)$ familH Iho are under our susspicion to have mono&enic diabetes mellitus$
probablH *ODa 2
>he patient$ 12 Hears old &irl$ Iith normal birth Ihei&ht$ reco&nised mild hHper&licemia
Hears before but no records available 9linical evaluations shoIed! short stature$ normal
)*D$ normal pubertal and mental development "aboratorH tests revealed! fastin&
&lHcemia! 1/2 m&=dlT O?>>! 512 m&=dl at 2 hoursT ;b<1c! B$1.1T 9 peptide! 1$1B
n&=ml (normal value! 1$1U0$0)T fastin& insulinemia! 1#$# N=ml (normal value! 2B$ after
RanDe)T ;O*<8'R! 0$/B (normal value _ 0)T no DetonuriaT normal value for '?M1 and
stimulated ?; ;er mother$ 5. Hears old$ presents fastin& hHper&licemia (mild)$ O?>>!
2#2 m&=dl at 2 hours and ;b<1c! B$B01 *aternal uncle$ 5# Hears of a&e$ has been
recentlH dia&nosed Iith tHpe 2 diabetes mellitus$ as Iell as the maternal &randfather$ 2.
Hears of a&e (both Iith mild$ chronic hHper&licemia! betveen 15# U 12# m&=dl) Our
patient presented &lHcemia values arround /# U 16# m&=dl on diet onlH Ke discussed
differential dia&nosis Iith tHpe 2 diabetes mellitus and other mono&enic or specific forms
of diabetes mellitus
<n conclusion0 >his familH$ Iho shoI mild chronic hHper&licemia$ seems to have a
mono&enic form of diabetes mellitus$ an autosomal dominant one$ more probablH *ODa
2 *olecular analHsis sould be perform in order to identifH the ?9Z mutations >his is
important because$ in familH at risD$ a total deficiencH of ?9Z due to homo&enous or
compound heterozi&ous ?9Z mutations causes permanent neonatal diabetes mellitus and
the heterozi&ous activatin& mutations are associated Iith con&enital hHperinsulinemia o
infancH
16.
EVALUAREA PERFORMANEI DISPOZITIVELOR DE ADMINISTRARE A
INSULINEI UTILIZATE FRECVENT LA PACIENII CU DIABET ZAHARAT
TIP 5 N AMBULATOR
4iorel ;erban
9
, irela )ache
:
, $abriela )eodorescu
A
, 0el"ut Petto
B
, *ace< =il1an<si
B
9
%pitalul Clinic *udeean )i"ioara, Ro"#nia@
:
%pitalul Clinic N. alaEa Bucureti,
Ro"#nia@
A
2li Lill3 Ro"#nia %RL, Bucureti, Ro"#nia@
B
Centrul edical Re,ional
4iena, 2li Lill3 and Co"pan3, Austria
C$)teZt: Dispozitivele de administrare a insulinei (D<') au fost dezvoltate pentru a
reduce dificult:ile de ordin practic$ social i emoional asociate cu insulinoterapia *ici
diferene tehnice %ntre aceste dispozitive pot influena preferina pacienilor i pot afecta
acurateea doz:rii insulinei
Obiective: Svaluarea 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 D<' cele mai frecvent folosite (Optipen ,ro1$ Optiset$ (ovo,en 5$
(ovo"et i ;uma,en Sr&o)
Pacie)7i 2i #et$%e: Nn studiu prezent$ observaional$ multicentric$ deschis$ a fost
efectuat %n 02 de centre din Rom3nia %n anul 2##2$ pe parcursul a B luni <u fost %nrolai
B#. pacieni cu DZ tip 2 dintre care 50/ (261) pacieni care nu se aflau %n tratament
anterior cu insulin: U'nsulin (atve ,atients U'(, (2/1 femei$ v3rsta medie 2. ani$
durata medie a DZ 6$. ani) i 2B1 (051) pacieni care se aflau deGa %n tratament cu
insulin: U (on 'nsulin (atve ,atients 8 ('(, (B11 femei$ v3rsta medie B# ani$ durata
medie a DZ /$/ ani$ doza zilnic: medie de insulin: a fost 5/ N cu un interval de %ncredere
f9' 2B$ 0/g administrat: %n 2 inGecii pe zi) ,entru administrarea insulinei s8au folosit
serin&i$ Optipen ,ro1$ Optiset$ (ovo,en 5$ (ovo"et sau ;uma,en Sr&o care au putut fi
schimbate %ntre ele Statistica ilustreaz: valorile medii raportate fie cu intervalele de
%ncredere (9' .21)$ fie cu valori minime i ma7ime >estul ZrusDal Kallis a fost utilizat
pentru a calcula valorile p bilateral ale valorilor diferite dintre D<'
Re'(!tate: Scorul pentru dozarea corect: (SD9) a fost diferit %ntre D<' doar la %nceput
pentru pacienii '(, (p4##5) ,entru toate 'DS combinate s8a demonstrat o cretere %n
timp a doz:rilor corecte$ de la valoarea iniial: .51 (9' .10$ .00) la ..1 (9' ./2$
..2) dup: B luni ?lobal$ timpul necesar pentru instruirea pacienilor a sc:zut %n timp de
la /2 ore (9' 6.$ .1) la 1. ore (9' 1.$ 15)
SD9 a fost diferit %ntre D<' at3t iniial (p4##5) c3t i dup: cele B luni (p4###B) la
pacienii '((, ,entru toate 'DS combinate s8a demonstrate creterea %n timp a doz:rilor
corecte de la valoarea iniial: .21 ('9 .5#$ .B$1) la Y..1 ('9 ..0$ 1###) dup: B luni
>imp pentru reinstruire nu a fost disponibil la aceast: &rup:
C$)c!('ii: Fn pofida preciziei ridicate de dozare a insulinei$ %ndeplinit: de toate D<'
individual$ la %nceputul tratamentului se observ: diferene ale acurateei doz:rii la
pacienii '(, i '((, ,recizia doz:rii crete cu timpul$ diferenele dispar %n cursul
1/#
primelor B luni de utilizare a D<'$ iar la acei pacieni care dozeaz: &reit unit:ile de
insulin:$ valoarea erorii scade
C(vi)te c/eie: diabet zaharat tip 2$ dispozitive de administrare a insulinei$ pen pentru
insulin:$ studiu comparativ i observaional
Fi)a)7ae: <cest studiu ()2Z8A'8)##2) a fost finanat de Sli "illH and 9ompanH
C$)<!icte %e i)tee"e: ? >eodorescu$

; ,etto i W ZilGansDi sunt salariai ai Sli "illH
and 9ompanH
ASSESSMENT OF PERFORMANCE OF COMMONL, USED INSULIN
DELIVER, S,STEMS IN PATIENTS +ITH T,PE 5 DIABETES IN AN
OUTPATIENT SETTING
4iorel ;erban
9
on behalf of 2)C6N in(esti,ators, irela )ache
:
, $abriela
)eodorescu
A
, 0el"ut Petto
B
, *ace< =il1an<si
B

9
Count3 Clinical 2"er,enc3 0ospital )i"ioara, Ro"ania@
:
N. alaEa Clinical
0ospital Bucharest, Ro"ania@
A
2li Lill3 Ro"ania %RL, Bucharest, Ro"ania@
B
Area
edical Center 4ienna, 2li Lill3 and Co"pan3, Austria
Bac-.$()%: 'nsulin deliverH sHstems ('DS) are developed to reduce practical$ social
and emotional burden associated Iith insulin inGections Sli&ht technical differences
betIeen these devices maH be relevant for patientsR preference and affect accuracH of
insulin dosin&
Ob8ective": >o assess the number and size of dosin& mistaDes and the time ;ealth 9are
,rofessionals (;9,s) spent trainin& patients on commonlH used 'DS (Optipen ,ro1$
Optiset$ (ovo,en 5$ (ovo"et and ;uma,en Sr&o ) in a standard clinical settin& in
patients Iith tHpe 2 diabetes reLuirin& insulin therapH
Patie)t" a)% Met/$%": >his Ias a B8month observational$ multi8center$ open8label studH
conducted in 02 sites in Romania in 2##2 B#. patients Iith >Hpe 2 diabetes Iere
enrolled! 50/ (261) insulin natve patients ('(,sT 2/1 female$ mean a&e 2. Hears$ mean
diabetes duration 6. Hears) Iho started insulin therapH and 2B1 (051) non8insulin natve
patients (('(,sT B11 female$ mean a&e B# Hears$ mean diabetes duration // Hears$ mean
number of insulin inGection 8 2 per daHT dailH mean insulin dose 8 5/ f9' 2B$ 0/g N)
'nsulin Ias delivered bH sHrin&es$ Optipen ,ro1$ Optiset$ (ovo,en 5$ (ovo"et$ or
;uma,en Sr&o and there could be sIitch amon& these devices <s summarH statistics
mean values Iere reported either Iith parametric .21 confidence intervals or Iith
1/1
minimum and ma7imum values ZrusDal Kalis tests Iere used to calculate tIo8sided p8
values for differences betIeen insulin deliverH sHstems
Re"(!t" Mor '(, patients onlH at baseline the correct dosin& score (9DS) Ias different
betIeen 'DS (p4##5) <ll 'DS combined shoIed an increased correct dosin& over time
from .51 (9' .10$ .00) at baseline to ..1 (9' ./2$ ..2) after B months Overall the
time to train patients decreased over B months from /2 (9' 6.$ .1) to 1. (9' 1.$ 15)
hours
Mor ('(,s$ at baseline and after B months 9DS Ias different betIeen 'DS (p4##5 and
p4###B$ respectivelH) <ll 'DS combined shoIed an increased correct dosin& over time
from .21 (9' .5#$ .B1) at baseline to Y..1 (9' ..0$ 1##) after B months >ime to re8
train Ias not available for this &roup
C$)c!("i$)": >hese results indicate that despite of hi&h dosin& precision achieved Iith
all the individual 'DS$ differences in dose accuracH are observed in the be&innin& of
treatment for insulin natve and insulin non8natve patients >he accuracH of insulin dosin&
increased Iithin B months of 'DS use and in those patients Iho dosed incorrectlH the
ran&e of the error became smaller
3e@G$%": tHpe 2 diabetes$ insulin deliverH sHstems$ insulin pen$ observational and
comparative studH
F()%i).: >his studH ()2Z8A'8)##2) Ias funded bH Sli "illH and 9ompanH
C$)<!ict" $< i)tee"t": ? >eodorescu$

; ,etto and W ZilGansDi are emploHees of Sli
"illH and 9ompanH
IGF S,STEMS AT DIAGNOSIS IN PUBERTAL ADOLESCENT +ITH T,PE I
DIABETES MELLITUS6
%i"ona I. Chisalita
9, :, B
, *. Lud(i,sson
? @
and 0 *. ArnS(ist
9, A, B
9
Institution of Clinical and 2Eperi"ental edicine, Depart"ent of Cell Biolo,3,
:
2"er,enc3 Clinic,
A
Di(ision of Internal edicine, Depart"ent of edicine and Care,
B
Diabetes Research Centre,
L
Di(ision of Paediatrics,
/acult3 of 0ealth %ciences, Lin<Vpin, +ni(ersit3, Lin<Vpin,, %.eden
1/2
Bac-.$()%6 >Hpe 1 diabetes in pubertal adolescent is associated Iith alterations in the
'?M8sHstem probablH due to both a deran&ed metabolism and insulinopenia in the portal
vein
Ai#6 >o studH in pubertal adolescents Iith pubertal onset of tHpe 1 diabetes mellitus hoI
levels of '?M8' and '?M),81 are affected bH the deterioratin& endo&enous insulin
secretion
Met/$%" >en &irls and ten boHs Iith tHpe ' diabetes$ a&e 152 C152 (mean CSS*) Hears
at dia&nosis tooD part in the studH )lood samples Iere draIn at dia&nosis$ and after 5$ .
1/ month$ and after 5 and 2 Hears from the debut ;b<1c$ total '?M8'$ '?M),81 and 98
peptide Iere measured
Re"(!t" <t dia&nosis the patients had hi&h ;b<1c$ loI '?M8' and measurable 98peptide
<fter start of insulin treatment &lHcaemic control and '?M8' improved but 98peptide
decreased and after 0 Hears almost all patients Iere 98peptide ne&ative 98peptide Ias
correlated to '?M8' and '?M),81 at the dia&nosis (p_##2) ;b<1c Ias correlated to
'?M8' after 5 months of insulin treatment Ihereas '?M),81 Ias not correlated to ;b<1c
C$)c!("i$)"6 'n neIlH dia&nosed adolescents Iith tHpe ' diabetes mellitus '?M8' levels
but not '?M),81 is related to &lHcaemic control Sndo&enous insulin secretion is also of
importance for '?M8' and '?M),81
1/5