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Rezumate Congres Diabet Sibiu 2008
Rezumate Congres Diabet Sibiu 2008
Obiectiv: Obiectivul acestui studiu a fost acela de a identifica relaia dintre Scorul
Reaven i caracteristicile clinice si metabolice ale pacienilor nou descoperii cu diabet
zaharat tip 1 (DZ tip 1) si diabet zaharat tip 2 (DZ tip 2).
Material si metod: Lotul studiat a inclus 200 pacieni cu DZ tip 1 si DZ tip 2, nou
descoperii, nregistrai n ultimele 2 luni la Institutul de Diabet, Nutriie si Boli
Metabolice N.Paulescu, Bucureti, dintre care 98 au fost barbai (49%) si 102 au fost
femei (51%). Pe lotul studiat, pacienii au fost grupai n funcie de tipul de diabet zaharat
(DZ) n 2 loturi : lotul 1 incluznd pacienii cu DZ tip 1 (n=13) i lotul 2 incluznd
pacienii cu DZ tip 2 (n=187). Pentru fiecare lot au fost colectate date clinice si
antropometrice (nalime, greutate, indexul masei corporale-IMC, circumferina
abdominal i valorile tensiunii arteriale sistolice i diastolice), dar i parametrii
metabolici (HbA1c i profilul lipidic), date privind statusul de fumtor/nefumtor i
antecedente heredocolaterale de DZ.Pentru interpretarea rezultatelor, am utilizat criteriile
ATP III pentru definirea parametrilor sindromului metabolic i Scorul Reaven (raportul
TG/HDLcol3) pentru estimarea insulinorezistenei.Analiza statistic a datelor s-a
efectuat utiliznd SPSS 15.0.
Rezultate: Prevalena obezitii abdominale a fost de 30.7% n cazul lotului de
pacieni cu DZ tip 1 i de 47.05% n cazul lotului de pacieni cu DZ tip 2. Valori crescute
ale tensiunii arteriale sistolice s-au constatat la 74.2% dintre subieci, 23.1% dintre
acetia aparinnd lotului 1 de pacieni cu DZ tip 1, iar 77.2% aparinnd lotului 2 de
pacieni cu DZ tip 2. Valoarea medie a HbA1c a fost de 10.62.84% la pacienii cu DZ
tip 1, respectiv 9.082.54% la pacienii cu DZ tip 2. Valoarea medie a Scorului Reaven a
fost de 2.591.35 la lotul de pacieni cu DZ tip 1 i respectiv 6.443.98 la lotul de
pacieni cu DZ tip 2. Valorile medii ale IMC au fost 23.76kg/m la pacienii cu DZ tip 1,
respectiv 30.16kg/m la pacienii cu DZ tip 2.La pacienii cu DZ tip 1 nou diagnosticat,
raportul TG/HDLcol s-a corelat direct i puternic cu circumferina taliei (rs=0.670,
p=0.012, CD=44.89), astfel c 44% dintre subieci au prezentat o corelaie pozitiv ntre
cei doi parametri.La pacienii cu DZ tip 2 nou diagnosticat, Scorul Reaven s-a corelat
pozitiv cu circumferina abdominal (rs=0.740, p=0.001, CD=54.76%), cu valorile
HbA1c (rs=0.552, p=0.006, CD=30.47%) i cu tensiunea arteriala (p=0.001). Nu am
constatat diferene statistic semnificative ntre pacienii din cele 2 loturi n ceea ce
privete stratificarea lor n funcie de sex, antecedente de DZ i statusul de fumtor.
Concluzii: In cazul DZ tip 1 nou diagnosticat, Scorul Reaven se asociaz cu
circumferina taliei pacienilor. n cazul DZ tip 2, Scorul Reaven se asociaz cu
circumferina taliei, cu majoritatea parametrilor sindromului metabolic i cu gradul de
control metabolic al DZ. Circumferina taliei, fiind un parametru uor de msurat, poate
fi uzitat ca punct de plecare n screeningul insulinorezistenei.
Background and Aims: The objective of this study was to identify the relationship
between the Reaven`s Score which is an indicator for insulin resistance and the clinical
and metabolic features of patients with type 1 diabetes mellitus (T1DM) and type 2
diabetes mellitus (T2DM) newly diagnosed.
Materials and Methods: The study group included two hundred patients newly
diagnosed T1DM and T2DM registrated at N. Paulescu Institute of Diabetes, Nutrition
and Metabolic Disease, Bucharest during the last two month, 98 men (49%) and 102
women (51%). Depending on the type of diabetes mellitus (DM), the subjects were
selected in two groups: group 1 included the patients with T1DM newly diagnosed
(n=13) and group 2 included the patients with T2DM newly diagnosed (n=187). In each
group, we assessed the clinical and a few anthropometric data (heigh, weight, body mass
index - BMI, waist circumference and sistolic and diastolic blood pressure) as well as
metabolic parameters (HbA1c and lipid profiles), history of DM data and smoking/no
smoking status data.The ATP III criteria for metabolic syndrome (MetS), Reaven`s Score
(TG/HDL chol) 3 for estimation of insulin resistance have been used to interpret the
results.Statistical analysis was carried out using SPSS 15.0.
Results: The prevalence of large waist was 30.77% for T1DM group and 47.05% for
T2DM group. High sistolic blood pressure was found in 74.2% of the subjects, in 23.1%
of the patients with T1DM and in 77.2% of the patients with T2DM. The mean HbA1c
level was 10.62.84% in T1DM patients group and 9.082.54% in T2DM patients group.
The mean values of Reaven`s Score was 2.591.35 in T1DM patients and 6.443.98 in
T2DM patients. The mean values of BMI was 23.76kg/m in newly diagnosis T1DM
patients and 30.16kg/m in newly diagnosis T2DM patients. In patients with newly
diagnosed T1DM there was proved the existence of a positive correlation between
Reaven`s Score and waist circumference (rs=0.670, p=0.012, CD=44.89): in 44% of the
patients with newly diagnosed T1DM has been shown a positive correlation between the
TG/HDL chol. ratio values and the waist circumference values. In patients with newly
diagnosed T2DM there was proved the existence of a positive correlation between
Reaven`s Score and waist circumference values (rs=0.740, p=0.001, CD=54.76%) as well
as between Reaven`s Score and HbA1c values (rs=0.552, p=0,006, CD=30.47%) and
2
between the Reaven`s Score and high blood pressure (p=0,001). We have not found
semnificative statistical differences between the patients of the two groups regarding the
sex stratification (p=0.832), history of DM (p=0.267) and smoking status (p=0.225).
Conclusions: The Reaven`s Score is related to waist circumference in newly
diagnosed T1DM patients. In T2DM, The Reaven`s Score is related to anthropometric
and most parameters of metabolic syndrome and with the degree of metabolic control.
Based on the frequency and easy-to-determine waist circumference, it could be use as
starting point to screen for insulin resistance.
Introduction: Obesity in children is a major condition of health as the carried out studies
have shown that 20 25% of people become overweight before they reach 20.
The purpose of this study was to present the epidemiological, clinical, anamnestic and
etiological aspects in the occurrence of overweight in children.
Material and method: The study was performed on 33 overweight or obese children and
teenagers in a pediatrics office of the Out-patient Clinic of Sf. Spiridon Hospital from
January to June 2008. In these patients, the general clinical exam and the anthropometric
measuring were completed by a minute anamnesis with respect to the heredo-collateral
history, the pathological and physiological personal history, the food survey and the
carried out physical activity.
Results: Of the 33 patients, 23 children and teenagers, i.e. 69,7% were diagnosed with
obesity (IMC over 95 percentile according to age and sex) and 10 cases of overweight
(IMC over 85 percentile). The division according to sex showed a predominance of the
female sex (19 girls, i.e. 57,6%) as opposed to the male sex (14 boys 42,4%). Their
environment was an urban one in 66,7% of the cases and a rural one in 33,3% of the
patients. The positive family history with one or both affected parents (obesity, type 2
diabetes mellitus) was discovered in 14 patients. The birth weight was over 4000 grams
in 3 patients and below 2700 grams in 3 cases. In all cases, the main cause of overweight
was an unbalanced hyper caloric diet based on excessive sweets, pastry and fats. Only 8
of the patients were practicing an extra sport and were participating at the physical
education hours at school. The other children were exempted from physical education
classes or they were present without taking any part in the activities. From the associated
diseases, we mention the following: type 2 diabetes mellitus in one case, hypertension in
2 patients, impaired glucose tolerance in 4 cases and dyslipidemia in 10 patients.
Conclusions
Children obesity is a public health matter both due to the increase of prevalence and the
long term effects on health. Obesity prevention is achieved by an adequate diet, physical
activity and change of the life style.
The diagnoses of overweight and obesity along with their risk factors are the most
prophylactic role of the family medicine.
INFLUENTA HIPERGLICEMIEI POSTPRANDIALE ASUPRA
INTERVALULUI QT LA PACIENTII CU DIABET ZAHARAT TIP 2
Adriana Rusu1, Cristina Ni1,2, Ramona tefan2, Adriana Filimon2, Ildiko Kicsi
Matyus2, Nicolae Hncu1,2
1
(14.9%) au prezentat prelungirea intervalului QTc > 440 ms. Pentru predicia prezenei
intervalului QTc prelungit, utiliznd ROC, s-a determinat c o valoare a glicemiei
postprandiale de 173.5 mg/dl poate detecta prezena intervalului QTc prelungit cu o
sensibilitate de 86% i o specificitate de 51%. Valoarea predictiv negativ (VPN) a fost
de 95%, iar valoarea predictiv pozitiv (VPP) de 24%.
Concluzii. Alungirea intervalului QTc este frecvent asociat cu hiperglicemia
postprandial i poate reprezenta un factor de risc adiional pentru evenimentele
cardiovasculare. Reducerea excursiilor glicemice postprandiale ar putea preveni
prelungirea intervalului QTc i ulterior apariia unor aritmii potenial fatale.
prolongation of QTc interval in the postprandial state compared with preprandial QTc
duration. From these patients, 7 (14.9%) had a QTc interval > 440 ms. A cut-off point of
173.5 mg/dl for postprandial glycemia detected the presence of prolonged QTc interval
with a sensitivity of 86% and a specificity of 51%. Negative predictive value (NPV) was
95%, and positive predictive value (PPV) was 24% when referring to the presence of
prolonged QTc interval.
Conclusions. Prolongation of QTc occurs frequently during postprandial state in type 2
diabetes. Postprandial hyperglycemia alters myocardial ventricular repolarization in
patients with type 2 diabetes and might be an additional risk factor for cardiovascular
events. Limiting meal related glucose excursions over 173.5 mg/dl could prevent QTc
prolongation and possible could prevent the occurrence of arrhythmias.
Amfiana Gherman, M.A., PhD candidate, 2 Univ. Prof. Daniel David, PhD
qualities at the same time. Therefore, we need such an instrument to guide the
interventions of the clinical psychologists to decrease the psychological insulin
resistance.
Starting from the cognitive theory of emotions, at the basis of the maladaptive emotional
and behavioral consequences (such as the refusal of the insulin treatment or the
dysfunctional emotions such as anxiety, depression, anger) there are evaluative cognitive
mechanisms, such as demandingness towards self, life and others, awfulinsing the
negative character of an event, low frustration tolerance and negative global evaluation.
OBJECTIVES: The development and the validation of a scale that measures the
maladaptive believes about insulin treatment.
METHOD: Participants 50 patients with type 2 diabetes from the Clinic of Diabetes,
Nutrition and Metabolic Diseases, Cluj-Napoca. Instruments The Insulin Beliefs Scale
(IBS), The Attitudes and Beliefs Scale II(ABS II DiGiuseppe, Leaf, Exner & Robin,
1988), Automatic Thoughts Questionnaire (ATQ Hollon & Kendal, 1980) and
Emotional Distress Profile (Opri i Macavei, 2005), SCID (Semistructured Clinical
Interview after DSM-IV) for investigating depressive or anxiety disorders. Procedure:
The scale was constructed with the agreement of the experts and of the patients (IBS),
and then all the other scales were applied in order to compute the psychometric
coefficients of the scale. Results: The data analysis showed that IBS has a good intern
consistency; the content validity was analyzed by a group of experts in the rationalemotional and cognitive behavioral theories of emotions. IBS was constructed so that its
content reflects the cognitive theories of emotion and its wording is similar to other tests
that already prove their utility. Its construct validity was measured by correlating the IBS
items with the items of other scales that already prove their validity (ABS II, ATQ and
EDP). The data show good construct validity. In what the convergent validity is
concerned, the maladaptive evaluative cognitions correlate with the negative
dysfunctional beliefs, and the adaptive ones with the negative and positive adaptive
emotions.
CONCLUSIONS: IBS has high fidelity and validity coefficients, being able to
discriminate between the persons that refuse and those who accept the treatment with
insulin. This scale is an evidence-based instrument in the evaluation of the cognitive
factors that influence the refusal or the acceptance of the insulin therapy.
Drd. Psih. Gherman Amfiana, 1 Psih. Andreia Mocan, 2 Prof. Univ. Dr. Daniel David
11
Pentru a oferi cele mai bune i cele mai eficiente tratamente pacienilor, ne bazm pe
principiul interveniilor validate tiinific (evidence-based). Astfel, pentru ca o
intervenie s fie validat tiinific, este nevoie ca att teoria care st n spatele ei s fie
validat, ct i procedura de intervenie n sine. De aceea, se propune un ghid de
intervenie pentru psihologii clinicieni, consilieri psihologici i psihoterapeuii care
lucreaz cu persoane cu diabet care s satisfac n primul rnd acest principiu, att ct
este posibil avnd n vedere cercetrile existente n literatura de specialitate. Ghidul va
urma elementele principale ale unei proceduri de intervenie: psihodiagnostic i evaluare
clinic, conceptualizare clinic, relaie terapeutic i tehnici de intervenie.
Psihodiagnostic i evaluare clinic: utilizarea interviului clinic semi-structurat dup
DSM-IV sau IDC-10, utilizarea de scale care s msoare mecanismele psihologice
etiopatogenetice generale i specifice i care au caliti psihometrice bune (evidencebased). Scopul evalurii este acela de a stabili un diagnostic nosologic, ali factori
psihologici care influeneaz condiia medical, precum i stabilirea unei liste de
probleme specifice pentru situaia de consiliere psihologic sau de psihoterapie specific.
Conceptualizarea clinic trebuie s rspund la urmtoarele ntrebri: (1) Ce probleme
de natur psihologic sunt (care influeneaz factorii medicali)?; (2) De ce au aprut
aceste probleme? i (3) Ce se poate face pentru a remedia aceste probleme?
Relaia terapeutic este unul din factorii foarte importani, care explic pn la 30% din
mecanismele schimbrii psihologice i presupune cteva caracteristici majore pe care
trebuie s le aib psihologul: empatie, congruen, acceptare necondiionat i colaborare.
Tehnicile de intervenie recomandate vor fi n funcie de categoriile de probleme
psihologice care se pot regsi la pacienii cu diabet sau obezitate. Acestea vor fi abordate
din perspectiva modelelor validate tiinific ABC cognitiv i comportamental; n acelai
timp, se vor avea n vedere aspectele pozitive i punctele forte ale pacienilor. De
asemenea, n ceea ce privete tulburrile psihologice cuprinse n manualele de diagnostic
(DSM-IV sau ICD), cum ar fi tulburrile depresive, de tip anxios, tulburrile de
comportament alimentar ghidul va oferi trimiterile necesare spre cele mai eficiente
(evidence-based) protocoale de intervenie existente.
Amfiana Gherman, M.A., PhD candidate, 1 Psih. Andreia Mocan 2 Univ. Prof. Daniel
David, PhD
1
12
In order to offer the best and the most efficient treatments, we are based on the principle
of evidence-based interventions. Therefore, in order to be scientifically based, a
psychological intervention needs to have its theory as well as the intervention protocol
tested. As a consequence, we propose an intervention guide for the clinical psychologists,
counselors and psychotherapists that work with diabetic and obese persons, that satisfies
this criterion, according to the literature. The guide will follow the principal elements of
an intervention procedure: the psycho-diagnosis and clinical evaluation, the clinical
conceptualization, the therapeutic relationship and the intervention techniques.
Psycho-diagnosis and clinical evaluation: the use of the SCID (Semistructured Clinical
Interview after DSM-IV) for investigating depressive, anxiety disorders, and others, the
use of scales that measure the general and specific ethio-pathogenetic mechanisms, scales
that have good psychometric qualities (are evidence-based). The goal of the evaluation is
to establish a nosologic diagnosis, the factors that influence the medical condition and a
list of specific problems.
The clinical conceptualization must answer to the following questions: (1) What are the
psychological problems that influence the medical factors? (2) Why did these problems
appear? (3) What can be done in order to solve these problems?
The therapeutic relationship is one of the most important factors that explain 30% of
the psychological mechanisms of change and that implies a few characteristics that the
psychologist must have: empathy, congruence, unconditional acceptance and
collaboration.
The intervention techniques will be recommended according to the specific
psychological problems of the diabetic or obese patients. These problems will be
approached with the cognitive and behavioral ABC models; at the same time, the positive
characteristics of the patients will be used and reinforced. Regarding the ICD-10
psychological disorders, such as the depressive or anxious disorders, the guide will make
the necessary references to the most efficicent (evidence-based) intervention protocols.
13
Results: From a total of 85 students who answered the questionnaire, 27(31.8%) were in
the 5th grade, 18(21.2%) in the 6th grade, 18(21.2%) in the 7th grade, and 22(25.8%) were
in the 8th grade. Among all these 39(45.9%) were girls, and 46(54.1%) were boys. 60.2%
from the questioned pupils never eat the croissant given to them through this
governmental program, and 63.8% dont drink the milk or the yoghurt. Despite these
results, more than a half of the students who were questioned (59.5%) were delighted by
the idea of receiving milk and croissants at school, and 3.6% from those who answered
were discontented with this practice. More than one third of the pupils (37%) expressed
their wish to get other products together with the milk and the croissant, or, to replace
these with something else. Among the suggestions we encountered fruit, Eugenia
biscuits, crackers, Coca-Cola, processed cheese, and, during the warm season, ice-cream.
Almost 85% of the children have a daily, or almost daily home-packed lunch with them,
and almost 88% receive money from their parents in order to buy anything they wish to
eat or drink.
Conclusions: In the countryside school where the questionnaire was applied, 62.2% of
the pupils never eat the croissant given to them through this governmental program, and
63.8% dont drink the milk. Despite this fact, the majority of children are still in favor of
receiving milk and croissants at school.
Aim: The aim of our study was to build a psychological and psychopatological profile of
hypertensive patients, a profile that can provide imperative data and information for an
eficient management of the disease and that is useful to the therapeutical approach.
Another aim of this study was to determine the contribution of each metabolic syndrome
component to psychological and psychopatological characteristics, particularly the
contribution of hypertension.
Method: 30 patients hospitalised in the Prof. Dr. N.C Paulescu Diabetes, Nutrition and
Metabolic Disease Institute were compared to 60 hypertensive patients and 40
normotensive patients. Demographic and clinical data, comorbidities and medical
treatment before hospitalisation had been obtained through case history, clinical exam
and medical investigations. So as to evaluate the psychological status we used Symptom
Checklist 90, Hamilton Depression Rating Scale, Global Asset Functioning Scale, Social
Functioning Scale.
Results: Of the sample, 26% had metabolic syndrome. Hypertensive patients with or
without metabolic syndrome had greater scores for the studied psychological factors, with
statistical significance ( p- value<0.05) for medium somatization, obssesive-compulsive
symptoms and low depression symptoms. Patients with metabolic syndrome had lower
social and global functionality. Of the individual components, hypertension was strongly
associated with psychological characteristics ( B-value = 0.87 - 3.17; p-value<0.05).
Hyperglycemia was associated with anxiety, somatization, sensitivity and depression.
16
HDL-Cholesterol levels were negatively associated with anxiety and depression(B=- 2.31
; B= - 2.52; p<0.05).
Conclusions: Patients diagnosed with metabolic syndrome often develop depression
symptomes and anxiety, but have no particularly psychopatological characteristics.
Hypertension is the main contributor to psychological characteristics.
Total
Q1
Q2
Q3
Q4
IMC (kg/m2)
30.16
(5.11)
28.48
(4.71)
30.23
(5.00)
30.62
(4.86)
31.30
(5.49)
Circumferin
abdominal
(cm)
102.43
(12.01)
97.43
(12.61)
101.54
(9.90)
103.74
(12.31)
107.01
(11.16)
Vrsta (ani)
62.16
(9.30)
61.91
(8.67)
62.55
(9.51)
61.21
(9.37)
62.97
(9.71)
TAS (mmHg)
137.21
130.90
138.44
141.56
138.01
17
(22.71)
(21.69)
(22.23)
(25.03)
(20.79)
9.86 (2.50)
10.42
(2.41)
9.82
(2.37)
9.97
(2.61)
9.22
(2.50)
Colesterol total
(mg/dl)
210.15
(55.14)
197.96
(46.03)
208.40
(48.67)
215.25
(64.80)
219.05
(57.77)
HDL colesterol
(mg/dl)
38.43
(9.16)
39.31
(9.51)
38.99
(9.48)
37.39
(8.95)
38.01
(8.74)
197.53
(168.44)
180.81
(139.82)
199.23
(203.47)
191.60
(109.98)
218.42
(201.86)
5.52 (1,93)
3.44
(0.56)
4.6
(0.27)
5.81
(0.42)
8.14
(1.49)
HbA1c (%)
Trigliceride
(mg/dl)
Acid uric
(mg/dl)
19
Characteristic
Total
Q1
Q2
Q3
Q4
BMI (kg/m2)
30.16
(5.11)
28.48
(4.71)
30.23
(5.00)
30.62
(4.86)
31.30
(5.49)
Waist
circumference
(cm)
102.43
(12.01)
97.43
(12.61)
101.54
(9.90)
103.74
(12.31)
107.01
(11.16)
Age (years)
62.16
(9.30)
61.91
(8.67)
62.55
(9.51)
61.21
(9.37)
62.97
(9.71)
SBP (mmHg)
137.21
(22.71)
130.90
(21.69)
138.44
(22.23)
141.56
(25.03)
138.01
(20.79)
9.86 (2.50)
10.42
(2.41)
9.82
(2.37)
9.97
(2.61)
9.22
(2.50)
Total cholesterol
(mg/dl)
210.15
(55.14)
197.96
(46.03)
208.40
(48.67)
215.25
(64.80)
219.05
(57.77)
HDL cholesterol
(mg/dl)
38.43
(9.16)
39.31
(9.51)
38.99
(9.48)
37.39
(8.95)
38.01
(8.74)
197.53
(168.44)
180.81
(139.82)
199.23
(203.47)
191.60
(109.98)
218.42
(201.86)
3.44
(0.56)
4.6
(0.27)
5.81
(0.42)
8.14
(1.49)
HbA1c (%)
Triglycerides
(mg/dl)
21
The aim of this study is to analyze the relationship between rational and irrational
beliefs about controlling the glycaemic values recommended by the physicians and
the their influence regarding depression and anxiety.
An 8-item scale was elaborated based on A. Elliss rational-emotional model.
From this 8 items, 4 of them refer to irrational beliefs (global evaluation, low
frustration tolerance, self downing and awfulising) and four of them refer to rational
beliefs. Depression was evaluated with The Beck Depression Inventory and for
anxiety was used the State and Trait Anxiety Inventory.
The subjects, 30 of them, were selected from outpatient department and inpatient
department of Diabetes, Nutrition and Metabolic Clinic. We used demographical and
personal data like the frequency of glycaemic recording, last glycemia and HbA1c,
type of treatment (insulin therapy or oral therapy).
The data analysis revealed a correlation between depression and irrational beliefs
and one between anxiety and irrational beliefs.
Key words: irrational beliefs, rational beliefs, depression, anxiety.
22
The aim of this intervention is to control the glaycaemic values through changing the
life style. The intervention is scheduled for 9 weekly sessions. Each session lasts
between 60 and 90 minutes except the first one, which lasts for two hours. At this
intervention there can participate diabetes patients with no regard of the treatment they
are following (insulin or oral therapy); in fact this intervention aims a change in the
patients life style.
The therapy is modular so, regarding the needs of the patient, we can skip a module.
Module I targets a healthier eating behavior, module II targets the increase of the
physical activity and module III referrs to smoking cessation. During the intervention
we encourage the patients to record their glycaemias and to increase the frequency of
this behavior. The patient learns to establish real and touchable objectives and to have
realistic expectations from the life style modifications. Beside behavioral strategies the
patient learns also cognitive techniques to overcome the possible mental obstacles
regarding the changes from his life.
In the end of the intervention we try to establish a long-term change in the life
style.
Key words: glaycaemia and food records, smoking cessation, increasing physical
activity.
23
< 70 mg/dl
>180 mg/dl
Total
%ASC
1.60 3.04
46.88 29.99
DZ tip 1
%ASC
DZ tip 2
%ASC
24
Total
MVG (mg/dl) 60.39 5.00 226.77 27.01 132.63 17.67 112.48 4.98
DZ tip 1
MVG (mg/dl) 58.85 4.59* 235.43 25.91* 132.12 15.26 111.90 4.22
DZ tip 2
MVG (mg/dl) 62.73 4.86* 219.09 26.07* 133.06 19.65 112.98 5.59
25
>180 mg/dl
70-180 mg/dl
90-130 mg/dl
(meanSD)
All
%AUC
1.60 3.04
46.88 29.99
T1D
%AUC
T2D
%AUC
All
MGV (mg/dl)
26
51.50 29.37
21.42 22.00
T1D
MGV (mg/dl)
T2D
MGV (mg/dl)
HbA1c was positively correlated with MAGE in the entire group and in T2D, but
not in T1D. HbA1c was positively correlated with total AUC, with % AUC > 180 mg/dl,
total MGV, MGV >180 mg/dl. HbA1c was inversely correlated with %AUC 70-180
mg/dl, %AUC 90-130 mg/dl in the entire group as well as in T1D and T2D subgroups.
(p<0.05)
MAGE was positively correlated with total AUC, with %AUC > 180 mg/dl, total
MGV, MGV >180 mg/dl and inversely correlated with %AUC 70-180 mg/dl and %AUC
90-130 mg/dl in the entire group and in T2D (p<0.05). MAGE was positively correlated
with %AUC > 180 mg/dl and MGV > 180 mg/dl in T1D. Sensor overall accuracy was
94.44% for all the study cases.
Discussions. A1c showed a poor glucose control in both T1D and T2D persons. MAGE
was higher than normal value (40 mg/dl), in the whole group and in T1D and T2D
subgroups. T1D subjects had significantly higher MAGE than those with T2D (p<0.001),
even if A1c did not differ between the two subgroups.
T1D persons had significantly higher exposure to hypoglycemia and
hyperglycemia than T2D subjects. MGV for hypoglycemia was significantly lower and
MGV for hyperglycemia was significantly higher in T1D persons compared with T2D
ones, this fact being explained by the higher glucose variability in T1D individuals.
Conversely, T2D subjects had significantly higher exposure to normoglycemia.
A1c was correlated with MAGE which showed a direct linear relation between
poor glucose control and glucose variability in T2D and per total. A1c and MAGE were
directly correlated with hyperglycemic exposure and amplitude (in the entire group and in
T1D and T2D subgroups) and inversely correlated with normoglycemic exposure and
amplitude in T1D subgroup (only for A1c) and in T2D and the whole group (for A1c and
MAGE). It wasnt evident any relation between A1c, MAGE and hypoglycemic exposure
and amplitude.
Conclusions. At a similar A1c level, T1D persons had a poorer glucose control
emphasizing the need for more intensive approach from both physician and patient sides.
CGM marked out significant differences in glucose status between T1D and T2D persons
allowing further identification of the specific therapeutic changes for optimizing glucose
control
Acknowledgements: Current Research was supported by a Romanian Grant for Young
Researchers: Grant CNCSIS Td 472/2006-2007.
27
28
is an active hormone on bone tissue and rises in obesity. The adipose tissue transform
androstendion in estrone through aromatization and this is the main source of estrogen at
the postmenopause women, rather than ovarian or adrenal secretion. The aromatization
activity from stromal adipous cells depends on age, being higher at the postmenopausal
women then premenopausal ones. Thus, the rise of estrogen production at
postmenopausal women is due to the increased number of adipous cells and
aromatization activity. There are studies that demonstrated that DHEA adrenal androgen
is converted to estrone in osteoblasts by P450 aromatase making possible the
conservation of bone mass at women in sixth and seventh decade.
At obese postmenopausal women the risk of fracture is lower due to decreased rate of
bone loss. The result is a lower rate of osteoporothyc fractures specially at the femoural
head.
ROLUL OSTEOPROTEGERINEI N REMODELAREA OSOAS
Dinc Mihaela Eugenia*, Andreescu Georgeta*, Petrisor C.A.**, Petrisor
Iuliana Eugenia***
*U.M.F. Craiova Disciplina Boli Nutritie si Metabolism
**U.M.F. Craiova Disciplina Medicin Intern
*** Medic rezident endocrinologie Spital Universitar de Urgent Craiova
Integritatea sistemului osos necesit numeroase mecanisme de reglare. Recent, sau evideniat date noi despre remodelarea osoas i cauzele care conduc la apariia celei
mai comune boli metabolice osoase, osteoporoza, a crei incidena este n cretere
marcat. Dezvoltarea osteoclastelor mature depind de interaciunea corespunzatoare cu
celulele liniei osteoblastice. Astfel, este necesar interaciunea RANKL (Receptor
Activator of Nuclear Factor Kappa B Ligand) secretat de osteoblaste cu RANK (Receptor
Activator of NFkB) de pe suprafaa precursorilor osteoclastici. Aceast interaciune poate
fi blocat de osteoprotegerina (OPG), o glicoprotein membr a superfamiliei TNF
receptor. OPG funcioneaz ca un receptor capcan pentru RANKL, competiionnd cu
RANK pentru legarea de RANKL i dovedindu-se astfel un inhibitor important al
maturrii i activrii osteoclastelor in vivo i in vitro Mai multe studii au dovedit c
nivelurile serice ale OPG cresc semnificativ cu vrsta att la brbai, ct i la femei, fiind
un mecanism protectiv al scheletului menit s compenseze creterea resorbiei osoase i a
pierderii de os. OPG poate preveni reducerea osoas, fiind o valoare potenial n
tratamentul osteoporozei.
29
Diabetul zaharat este o boal cronic metabolic, cauzat de deficiena absolut sau
relativ de insulin.
Cei mai muli cercettori au gsit urmtoarele variabile psihosociale ca fiind implicate n
apectele psihosomatice ale diabetului :1) depresia, anxietatea, frica de hipoglicemie 2)
deficitul cognitiv, 3) stresul, evenimente stresante de via, 4) mecanisme de coping, 5)
percepia personal asupra bolii, 6) trsturi de personalitate, 7) suport social, incluznd
familia, 8) calitatea relaiei medic-pacient, 9)variabile socio-demografice, venit, educaia,
dizabilitile date de diabet.
Lucrarea prezenta este un studiu de caz al unei adolescente in varsta de 18 ani, aflata in
ultimul an de liceu, afectata de examenul de bacalaureat care o asteapta si de iminenta
plecarii mamei in strainatate.
Stresul generat de aceste doua evenimente, coroborat cu despartirea de prietenul sau au
determinat aparitia unui tablou clinic caracterizat prin fatigabilitate, senzatia de lesin.
Examinarile paraclinice au depistat hiperglicemie si testul de toleranta la glucoza crescut.
Cazul a fost interpretat ca si Diabet zaharat tip 2 si s-a impus urmarea unei diete si
tratament medicamentos specific. Aflarea acestui diagnostic si consecintele sale au
determinat dezvoltarea la adolescenta a unui Sindrom posttraumatic de stres. A refuzat
medicatia, chiar si pe cea homeopata. A urmat inconstant sedinte de psihoterapie
30
31
Material i metod: am evaluat toi pacienii aduli cu diabet zaharat tip 1 aflai n
evidena centrului nostru pn la data de 01.01.2007. Din analiza fielor de monitorizare,
lund n considerare doar datele din ultimii doi ani, am selectat informaiile referitoare la
vrst, sex, vechimea bolii, eliminrile urinare de proteine i clearance-ul de creatinin,
care au fost nregistrate ntr-o baz de date Microsoft Office Excel i supuse ulterior
prelucrrii statistice folosind programele SPSS.
Rezultate i discuii: Din totalul de 1072 pacieni, dup excluderea celor cu vrsta sub
18 ani i a celor cu patologie terminal de organ (care ar fi putut falsifica analiza statistic
a datelor de laborator), am selectat un lot de 994 pacieni. Am constatat o preponderen a
sexului masculin (553 cazuri 55,6%) i o vrst medie de 43,5813,66 ani, cu variaii
ntre 18 i 84 de ani. Vechimea diabetului zaharat tip 1 a variat ntre 1 i 49 de ani, cu o
medie de 11,029,05 ani. 305 pacieni (30,7% din totalul cazurilor) aveau determinate
semicantitativ sau cantitativ eliminrile urinare de proteine n ultimii 2 ani; dintre acetia,
majoritatea erau normoalbuminurici (48,2%), 24,6% prezentau microalbuminurie i
27,2% macroalbuminurie. La 817 pacieni (82,2% din totalul cazurilor) au fost
disponibile datele necesare pentru calculul clearance-ului de creatinin (ClCr) conform
formulei Cockcroft-Gault; 39,8% dintre aceti pacieni prezentau afectare renal (ClCr <
90 ml/min): 29,99% ClCr = 60-90 ml/min, 7,22% ClCr = 30-60 ml/min, 0,86% ClCr =
15-30 ml/min, 1,71% ClCr < 15 ml/min. Valoarea clearance-ului de creatinin a fost
semnificativ statistic mai mic la pacienii cu macroalbuminurie comparativ cu cei cu
normoalbuminurie i cu microalbuminurie. S-a constatat o preponderen a sexului
masculin n grupul cu eliminri urinare crescute de proteine (65,1% brbai vs. 34,9%
femei cu macroalbuminurie), ns fr a atinge pragul semnificaiei statistice. Pacienii cu
o vechime mai mare a bolii prezentau mai frecvent eliminri urinare crescute de proteine
i valori sczute ale clearance-ului de creatinin, cu diferene semnificative statistic ntre
grupurile menionate.
Concluzii: Peste 50% din cazurile evaluate aveau eliminri urinare crescute de proteine
i aproximativ 40% dintre pacieni prezentau o rat sczut de filtrare glomerular
evideniat prin determinarea clearance-ului de creatinin. Valoarea clearance-ului de
creatinin a fost semnificativ statistic mai mic la pacienii cu macroalbuminurie
comparativ cu cei cu normoalbuminurie i cu microalbuminurie. n grupul cu eliminri
urinare crescute de proteine s-a constatat o prevalen crescut a sexului masculin.
Pacienii cu o vechime mai mare a bolii prezentau mai frecvent eliminri urinare crescute
de proteine i valori sczute ale clearance-ului de creatinin.
32
33
Background: Pacienii cu diabet zaharat tip 2 (DZ2) nou diagnosticat pot prezenta
concomintent i modificarea sensibilitii periferice, evaluarea acesteia fiind descris
discordant n literatur.
Obiectiv: Studiul i-a dorit evaluarea pragului sensibilitii periferice (la rece) a
pacienilor cu DZ tip 2 nou diagnosticat utiliznd sistemul CASE IV i corelarea cu
prezena simptomelor de neuropatie (scorul NSS).
Materiale i metode: Studiul transversal a fost realizat pe un lot selectat dintre pacienii
internai n cadrul Institutului N. Paulescu diagosticai cu diabet zaharat tip 2 nou
descoperit (DZ2) i au fost evaluai utiliznd testarea senzorial cantitativ (QTS) i
scorul simptomelor de neuropatie (NSS). Parametrii urmrii au fost: HbA1c, BMI,
pragul sensibilitii la rece (PSR), simptomele de neuropatie. Testarea senzorial
cantitativ s-a realizat folosind sistemul CASE IV (Computer-Assisted Sensory
Examination IV) la nivelul membrului superior drept (MS) i al membrului inferior drept
(MI), iar ncadrarea privind pragul sensibilitii s-a facut n trei categorii: hiperestezic
7,5 JND, limite normale - LN ntre 7,5 i 12,5 JND i hipoestezic 12,5 JND. Dup NSS
mprirea pacienilor s-a realizat astfel: 0 pentru absena simptomelor, 3-4 simptome
uoare, 5-6 simptome moderate, 7-9 simptome severe.
Rezultate i discuii: A fost realizat un lot de 37 de pacieni cu o vrst medie de 54
13,3 de ani. HbA1c a avut o valoare medie de 12,3% 2,4% la prima determinare. BMI a
avut o valoare medie la internare de 26,65,1kg/m2, 54,1% dintre pacieni fiind
supraponderali. La MS, PSR este alterat la 62,2% (23) din pacieni, 37,8% (14)
prezentnd alterare de tip hiperestezie. La MI, PSR este alterat la 64,9% (24) din pacieni,
37,8% (14) prezentnd alterare de tip hiperestezie. n ceea ce privete scorul NSS, 37,8%
(14) din pacieni nu aveau simptomatologie sugestiv de neuropatie, dar 71,4% (10)
dintre ei prezentau alterri ale PSR la nivelul MS, respectiv 92,8% (13) la nivelul MI.
62,2% (21) dintre pacieni aveau simptome de neuropatie uoare (16,2%, NSS = 4) sau
moderate (45,9%, NSS 5 sau 6), chiar dac PSR era n limite normale la MS la 47,6%
34
(10) dintre pacieni, respectiv la MI la 57,14 % (12) dintre pacieni. Nici unul dintre
pacienii luai n studiu nu a prezentat simptome severe de neuropatie (NSS = 7-9).
Concluzii: La pacienii cu DZ2 nou diagnosticat alterarea pragului sensibilitii la rece
este att de tip hipoestezic, ct i de tip hiperestezic, fr a fi prezent o simptomatologie
clinic n direct corelaie cu modificrile evideniate. Neuropatia diabetic poate evolua
subclinic, fiind necesar o metod obiectiv de evaluare a sensibitii periferice.
Finanare: Studiu realizat n cadrul proiectului CEEX 92/2006, PNCDI2 52164/2008.
35
26.65.1kg/m2, 56.1% of patients being overweight. In the SL, CDT is altered in 62.2%
(23) of patients, 37.8% (14) presenting alteration type hyperesthesia. In the IL, CDT is
altered in 64.9% (24) of patients, 37.8% (14) presenting alteration type hyperesthesia.
Regarding NSS, 37.8% (14) of patients had no symptoms of neuropathy, but 71.4% (10)
of these patients had alteration of the CDT at the SL, and 92.8% (13) at the IL. 62.2%
(21) of patients had symptoms of light peripheral neuropathy (16.2% NSS=4) or
moderate peripheral neuropathy (45.9% NSS 5 or 6), even if CDT was normal in the SL
in 47.6% (10) of this patients, respectively in the IL in 57.14 % (12) of patients.
Conclusions: In newly diagnosed type 2 diabetes mellitus patients abnormal CDT is both
hypoaesthesia and hyperesthesia, without a direct correlation between clinical symptoms
and the alteration of peripheral sensitivity. Neuropathy may have a subclinical evolution,
being necessary an objective method to evaluate the peripheral sensitivity.
Supported by: Grant CEEX 92/2006, PNCDI2 52164/2008 from the Romanian Research
Ministry.
Obiectiv
Obiectivul acestui studiu a fost s evalueze evoluia pragului sensibilitii
vibratorii la pacienii cu diabet zaharat tip 2 (DZ2) nou diagnosticat.
Material i metode
Sistemul computerizat de determinare a sensibiliti vibratorii (CASE IV System)
este un instrument de calitate pentru evaluarea componentei vibratorii a polineuropatiei
diabetice. Acesta este un studiu deschis, prospectiv, desfurat pe durata a 3 luni. Au fost
alctuite dou grupuri de 12 pacieni cu DZ2 nou diagnosticat urmrind un tratament
intensiv cu insulin i diet adecvat. Comorbiditile neurologice au fost exluse la
nceputul i pe durata studiului. Criteriile de includere si de excludere din studiu au fost
urmate cu strictee.
36
Rezultate
Caracteristicile la momentul includerii n studiu au fost: pentru grupul A vrsta
medie a fost de 45,343,5ani, greutatea medie 89,712,25kg, HbA1c 12,711,27%,
pentru grupul B vrsta este de 64,236,54ani (p<0,05), greutatea medie 85,89,23kg
(p>0,05) HbA1c 11,92,21% (p>0,05). Pe parcursul perioadei studiate s-au nregistrat:
HbA1c, evenimentele hipogicemice, greutatea i indicele de mas corporal. Sistemul
CASE IV a nregistrat valori ale pragului sensibilitii vibratorii la intrarea n studiu, la o
lun, dou i trei luni. La trei luni: pentru grupul A s-a nregistrat un plus n greutate de
4,181,21kg i o scdere a valorii HbA1c pn la 7,90,8%, pentru grupul B s-a
nregistrat un plus n greutate de 5,022,03 kg (A vs. B, p>0,05), o descretere a HbA1c
la 8.020.27% (A vs. B, p>0,05). Numrul evenimentelor hipoglicemice a fost similar
pentru cele dou loturi: 4,121,03 vs. 3,961,22/lun, p>0,05). Evoluia pragului
sensibilitii vibratorii este descris n Tabelul 1, cu valori diferite semnificativ statistic la
3 luni (p<0.05).
Concluzii
Acesta este unul dintre primele studii care demonstreaz o mbuntire a pragului
sensibilitii vibratorii la pacienii cu DZ2 nou diagnosticat dup tratament intensiv cu
insulin i intervenie susinut asupra stilului de viat. mbuntirea pragului
sensibilitii vibratorii a fost semnificativ mai bun pentru partipanii mai tineri. S-a
constatat prezena unui dezechilibru metabolic major (HbA1c>12%) nsoit fiind de
semne ale deficitului insulinic.
Timp/
Unit.
JND
Grup A
Grup B
Grup A
Grup B
(MS Vib T)
Signf*
Baseline 11,920,23
12,122,10
p<0,05 8,340,84
8,722,10
p<0,05
1 lun
9,344,23
10,102,57
p>0,05 7,283,19
7,482,57
p>0,05
2 luni
8,402,33
10,802,64
p<0,05 6,001,22
7,882,64
p<0,05
3 luni
8,102,26
10,262,52
p<0,05 6,371,51
8,122,12
p<0,05
37
Objective
The objective of this study was to evaluate the evolution of vibratory threshold in
newly diagnosed type 2 diabetes mellitus patients.
Material and methods
Computed vibratory detection threshold (CASE IV System) is a valuable
instrument to evaluate diabetic sensory polyneuropathy. This is a 3 months open
prospective study. We have two groups of 12 subjects each, with type 2 newly diagnosed
DM following intensive insulin treatment and adequate diet. Common neurological
disorders were excluded at start and during the study. Inclusion Criteria: Patients must
fulfill all of the following criteria to be eligible for this study: 1.Newly diagnosed Type 2
diabetes mellitus, 2.Able to follow the protocol and willing to participate in the study as
confirmed by signed consent to release information, 3.Currently treated with (EASD
protocols): Life style intervention, Insulin (with or without oral agents), Different drugs
for co-morbidities, 4. No anamnestic stories or clinical signs about nervous impairement.
Results
Baseline characteristics: The group A has the mean age 45.343.5years and the
other one 64.236.54years. Baseline characteristics (mean) BMI, weight, systolic blood
pressure-sBP, HbA1c were similar for two groups. Data for HbA1c, hypoglicemic events,
weight and BMI were recorded. Computed vibratory detection threshold was monitored
at the baseline and after 1, 2 and 3 months. For the Group A mean weight at baseline was
89.712.25kg and weight gain at 3 months was 4.181.21 kg. Mean HbA1c at baseline
was 12.711.27% and decreased to 7.90.8% at 3 months. For Group B mean weight at
baseline was 85.89.23kg and weight gain at 3 months was 5.022.03 kg (A vs. B,
38
p>0.05). Mean HbA1c at baseline was 11.92.21% and decreased to 8.020.27% (A vs.
B, p>0.05) at 3 months. The hypoglicemic events are similar in the 2 lots during the
treatment (4.121.03 vs. 3.961.22/months, p>0.05). At baseline the computed vibratory
threshold was 11.920.23JND Units for Group A and 2.122.10JND Units for Group B
(Foot Vibration Test) (p>0.05). After three monts the computed vibratory threshold was
8.102.26JND Units for Group A and 10.262.52JND Units for Group B(p<0.05).
Table 1.
Conclusions
This is one of the first studies were we can see an improvement of vibratory
threshold after an intensive insulin treatment and lifestyle modifications in newly
diagnosed type 2 DM patients. The improvement vibratory threshold is significantly
better at younger participants (p<0.05).High metabolic disturbances (HbA1c%>12) were
present at the beginning of the study with signs of insulin deficit. Low power level of
study only 24 participants had finished the program.
Time/
JND
Units
Group A
Group B
Group A
Group B
(Foot Vib T*) (Foot Vib T) Signf* (Hand Vib T*) (Hand Vib T) Signf*
Baseline 11.920.23
12.122.10
p<0.05 8.340.84
8.722.10
p<0.05
9.344.23
10.102.57
p>0.05 7.283.19
7.482.57
p>0.05
2
months 8.402.33
10.802.64
p<0.05 6.001.22
7.882.64
p<0.05
3
months 8.102.26
10.262.52
p<0.05 6.371.51
8.122.12
p<0.05
1
month
*Foot Vib T Foot Vibration Test, *Hand Vib T Hand Vibration Test,
*Signf - statistical significance using t Student test
39
Introducere: Diabetul Zaharat de tip 1 (DZ tip 1) este o boal cronic cu patogenie
autoimun, caracterizat prin distrugerea mediat de limfocite T a celulelor beta
pancreatice. Principalele gene diabetogene descrise pn n prezent sunt localizate la
nivelul regiunii HLA de clasa a II-a, fiind reprezentate n special de unele alele ale HLA
DQB1 i DRB1. Exist ns i date privind implicarea unor alele de clasa I, HLA-A i
HLA-B. Pentru a evalua efectul diabetogen al unor alele HLA-B pentru populaia din
Romnia (ar cu una din cele mai mici incidene ale DZ tip 1 din Europa), am realizat o
tipare HLA-B complet pe un numr de 423 familii cu DZ tip 1.
Scop: Evaluarea implicrii unor alele HLA-B n patogenia DZ tip 1 pentru populaia din
Romnia.
Materiale i Metode: Lotul studiat a cuprins 1515 subieci dintre care 439 pacieni DZ
tip 1 (208 brbai/231 femei) i 1076 rude de gradul 1 nediabetice. Tiparea a fost fcut
prin metoda PCR-SSOP. Datele au fost analizate prin Transmission Disequilibrium Test
(TDT) i AFBAC folosind programul Stata 8.1 (http://www.stata.com). Pentru a stabili
dac efectele alelelor HLA-B sunt independente, datele au fost analizate prin metoda
regresiei logistice condiionate, folosind genotipurile DQB1 i DRB1 ale subiecilor
inclui n studiu.
Rezultate: Am identificat o transmisie semnificativ crescut la diabetici a alelelor HLA
B8 (71.3% transmitere, pTDT = 6.5x10-7), B15 (69.2% transmitere, pTDT = 0.005), B41
(74.1% transmitere, pTDT = 0.0002), B50 (85.7% transmitere, pTDT = 0.00002) i Bw6
(65.7% transmitere, pTDT = 2.35x10-8). Am identificat de asemenea o transmitere
semnificativ sczut a alelei HLA B52 la diabetici (25.8% transmitere, pTDT = 0.007).
Transmisia acelorai alele la fraii neafectai ai probanzilor diabetici nu a fost diferit
semnificativ de 50%, procent ateptat prin ans. Rezultatele sunt susinute i de
frecvena mai mare a acelorai alele la diabetici comparativ culotul pseudocontrol (16.6%
vs. 7,2% pentru B8; 6% vs. 2.6% pentru B15; 6.7% vs. 1.9% pentru B41; 4.8% vs. 1.1%
pentru B50, 69.25% vs. 54.4% pentru Bw6 i 1.24% vs. 3% pentru B52). Analiza prin
conditional logistic regression a artat ns c asocierea alelelor HLA B cu DZ tip 1 nu
este independent de influena alelelor HLA DQ i DR (Prob > chi2 = 0.1023).
40
Discuii: Rezultatele noastre indic un posibil efect diabetogen al alelelor HLA B8, B15,
B41, B50 i Bw6 precum i un efect protector al alelei HLA B52. Totui aceste asocieri
par a nu fi independente, cel mai probabil fiind datorate unui fenomen de linkage
disequilibrium cu alelele demonstrat diabetogene/protectoare aparinnd locilor HLA de
clasa a IIa DQ i DR.
41
transmission of the same alleles to unaffected sibs was not significant different from
50%. The results were supported by the higher frequency of these alleles in cases in
comparison with pseudocontrols (16.6% vs. 7,2% for B8; 6% vs. 2.6% for B15; 6.7% vs.
1.9% for B41; 4.8% vs. 1.1% for B50, 69.25% vs. 54.4% for Bw6 and 1.24% vs. 3% for
B52). Conditional logistic regression analysis showed that these associations are not
independent of the effect of DQ and DR alleles neither for HLA B (Prob > chi2 = 0.0577)
nor for HLA Bw (Prob > chi2 = 0.1023) alleles.
Discussion: Our results indicate a possible diabetogenic effect for HLA B8, B15, B41,
B50 and Bw6 alleles and a protective effect for HLA B52 allele. However, the
conditional logistic regression analysis showed that these effects are not independent but
most likely due to the strong linkage disequilibrium with diabetogenic/protective class II
DQ and DR alleles.
1.Introducere
Diabetul zaharat insulino-dependent la copilul mic ridica greutati in redarea unui
diagnostic rapid si correct , deseori in prezenta simptomatologiei atipice varstei.
2.Obiective
-studiul particularitatilor clinico-evolutive ale DID la copilul mic
-posibilitatile terapeutice si aspecte particulare ale insulinoterapiei la copilul mic
3.Metode Si Materiale De Lucru
Studiul a fost efectuat in Clinica a-III-a Pediatrie , Spitalul clinic de urgenta de copii
Sf. Maria Iasi in perioada 1-01-2005 si 1-01-2008 pe 10 copii.
4.Concluzii
Diabetul zaharat la copii mici prezinta:
-instabilitate metabolica
42
1. Introduction:
The insulin dependent diabetes mellitus in the small child raises several issues
related to establishing an accurate and rapid diagnosis in the presence, often, of atypical
symptoms as well as high instability specific to age.
2. Objectives:
- metabolic instability
- obtaining of a metabolic control, difficult to achieve
- the family plays an important role in obtaining a glycemic control which allows for the
improvement of the metabolic equilibrium by preventing tardive complications.
43
44
45
Introducere:
Numrul persoanelor cu diabet a crescut alarmant n ntreaga lume,fr nici o
tendin de atenuare a ritmului de cretere. Diabetul zaharat tip 2 este considerat n
momentul de fa una dintre cele mai ingrijortoare, costisitoare i serioas problem de
sntate. Programul EPIDIAB are ca scop analiza epidemiologica si a calitatii ingrijirii
persoanelor cu diabet zaharat nou depistat.
Scopul lucrarii:
Este de a analiza aspectele referitoare la datele demografice,antropometrice,
prevalenta factorilor de risc cardiometabolici,prevalenta complicatiilor cronice , precum
si structura terapeutica a persoanelor cu diabet diagnosticate in perioada ianuarieseptembrie 2008 in judetul Cluj.
Metoda:
Au fost preluate datele din fisele de consultatie ale persoanelor diagnosticate si
luate in evidenta cu diabet zaharat in perioada ianuarie-septembrie 2007 la Centrul Clinic
de Diabet, Nutritie si Boli Metabolice Cluj Napoca, la care s-au adaugat datele
comunicate de celelalte cabinet de Diabet din judetul Cluj.
Rezultate:
In perioada 1 ianuarie-30 septembrie 2008, au fost inregistrat 3705 persoane cu
diabet zaharat nou depistat, dintre care diabet zaharat tip 2:99,1%, diabet zaharat tip 1:
0,5 %, diabet gestational: 0,16%, diabet secundar: 0,24%. Raportul barbati:femei a fost
de 1:1,01 ;76 % provin din mediul urban, majoritatea(64,75%) se situeaza in grupa de
varsta 41-65 de ani.
Din punct de vedere antropometric 10,82 % din persoanele nou diagnosticate sunt
normoponderale, 35,9% cu suprapondere si 53,28% cu obezitate; 93,87% din persoane
au talia peste 80 cm la femei sau peste 94 cm la barbati.
Prevalenta hipertensiunii arteriale a fost de 64,63%, a dislipidemiei de 57%, iar
21% din persoanele nou depistate cu diabet zaharat prezinta deja o complicatie
macrovasculara(cardiopatie ischemica 45,64%,angina pectorala 29,61 %, infarct
miocardic14,98 %, boala cerebrovasculara16,02 %, arteriopatie periferica 7,32%).
Structura terapeutica in diabetul zaharat nou depistat a fost urmatoarea: 24,09%
optimizarea stilului de viata, 44,74% metformin in monoterapie, 8,88% sulfonilureice,
46
Introduction:
The number of individuals with diabetes has increased alarmingly through-out the world
and the rate of increase shows no signs of slowing. Type 2 diabetes is currently one of the
most costly and worrying chronic diseases and represents a serious health care problem
worldwide. The objective of EPIDIAB Program is to provide epidemiological data as
well as the quality care of newly-diagnosed diabetes.
Aim:
To analyze the demographic, anthropometric data, the prevalence of cardiometabolic risk
factors and chronic complications and the therapeutic structure of persons with newlydiagnosed diabetes, between January-September 2008, in Cluj County.
Method:
We analyzed data from the medical records of persons with newly-diagnosed diabetes
between January-September 2008 and registered in the Diabetes Clinics from Cluj
County.
Results:
In January-September 2008, 3705 persons with newly-diagnosed diabetes were
registered,99,1 % with type 2, 0,5% type 1, 0,16% gestational diabetes and 0,24% with
other specific types of diabetes; the ratio men: women is 1:1,01 ; 76% of the persons
come from urban areas, the majority (64,75%) being in the 41-65 years group of age.
47
10,82 % of type 2 newly-diagnosed diabetes have normal weight, 35,9% overweight and
53,28%obesity;93,87 % have the abdominal circumference over 80 cm in women or over
94 cm in men. The prevalence of hypertension is 64,63%, of dyslipidemia 57%; 21 % of
newly-diagnosed diabetes has already a macrovascular complications at diagnosis
( ischemic heart disease 45,64%, angina 29,61 %, myocardial infarction14,98%,
cerebrovascular disease 16,02%, peripheral vascular disease7,32%).
The therapeutic structure for newly diagnosed diabetes is as follows:24,09% lifestyle
intervention only,44,74 % metformin, 8,88 % sulphonylurea, 11,33% metformin plus
sulphonylurea, 6,49% insulin, 3,75%insulin plus oral therapy and 0,72% other drugs.
Conclusion:
The incidence of diabetes mellitus in the county of Cluj registers a significant increasing
about 44,83% more than the same period in 2007 and 182,82% more than 2006.
Increased diagnostic activity by initiation of National Population Health Assessment
Program in 2007 might generate a significant increase in the incidence of diabetes in
2007 and 2008 as compared with 2006. When treatment is considered, there are
significant increased as compared with the previous years for metformin therapy.
48
Rezultate i discuii: Din totalul de 1072 pacieni, dup excluderea celor cu vrsta sub
18 ani i a celor cu patologie terminal de organ (care ar fi putut falsifica analiza statistic
a datelor antropometrice), am selectat un lot de 994 pacieni. S-a constatat o
preponderen a sexului masculin (553 cazuri 55,6%) i o vrst medie de 43,5813,66
ani, cu variaii ntre 18 i 84 de ani. Vechimea diabetului zaharat tip 1 a variat ntre 1 i
49 de ani, cu o medie de 11,029,05 ani. Indicele de mas corporal a variat ntre 14,88
kg/m2 i 46,22 kg/m2, cu o medie de 25,624,50 kg/m2; a existat o preponderen net a
pacienilor normoponderali (46,34%) i supraponderali (33,95%). Utiliznd valorile
circumferinei abdominale (CA) i ale indicelui abdomino-fesier (IAF), am constatat c
45,8% i respectiv 39,1% dintre pacieni depeau valorile normale, cu diferene statistic
semnificative ntre cele dou sexe n ambele cazuri (CA 57,8% dintre femei i 35%
dintre brbai; IAF 47,3% dintre femei i 31,8% dintre brbai). 46,4% dintre pacienii
evaluai n ultimii 2 ani au fost diagnosticai cu retinopatie diabetic (RD): 35% RD
neproliferativ form uoar/medie, 1,7% RD neproliferativ form sever/foarte
sever, 9,7% RD proliferativ. Din cei 305 pacieni la care fuseser recent evaluate
eliminrile urinare de proteine, 48,2% erau normoalbuminurici, 24,6% prezentau
microalbuminurie i 27,2% macroalbuminurie. La cei 860 pacieni la care fusese evaluat
neuropatia, 68,7% prezentau forma periferic i 13,15% forma vegetativ.
Macroangiopatia era prezent la un numr mai mic de cazuri (12,7% din cei 106 pacieni
evaluai prezentau boal coronarian, 2,82% din totalul pacienilor aveau sechele de
accident vascular cerebral, 5,3% din cei 851 pacieni evaluai prezentau AOMI).
Concluzii: Preponderena crescut a sexului masculin este o particularitate a pacienilor
cu diabet zaharat tip 1 din centrul nostru, tiut fiind c n rile cu o prevalen sczut a
bolii (printre care i Romnia) exist o tendin de predominan feminin. Aproximativ
40% dintre pacieni prezentau o dispoziie abdominal a esutului adipos, mai ales n
cazul sexului feminin (circa jumtate din cazuri). Peste 50% din cazurile evaluate aveau
eliminri urinare crescute de proteine i aproape jumtate aveau retinopatie diabetic.
Peste dou treimi din cazuri prezentau neuropatie periferic. Comparativ cu celelalte
complicaii, macroangiopatia era prezent ntr-un numr mai redus de cazuri.
49
50
Introducere i Obiective
Evidenele actuale sugereaza c toate aspectele metabolismului glucozei -hemoglobina
glicat (A1C), glicemia bazal(GB) i glicemia postprandial(GPP)- sunt parametrii
clinic relevani pentru a fi monitorizai. Glicemia postprandiala(GPP), n particular, pare
s fie corelat cu boala cardiovascular (BCV).
Obiectivul acestui studiu a fost determinarea factorilor asociai cu excursiile glicemice
postprandiale n cazul pacienilor cu diabet zaharat tip 2 (DZ2).
Material i metod
Au fost evaluai factorii asociai cu hiperglicemia postprandial (>140mg/dl la 2 ore dup
mas) corectai n funcie de sex i tratament, la 122 de pacieni care s-au prezentat la
controlul periodic, n Centrul de Diabet i Boli de Nutriie Cluj Napoca, Romnia. Aceti
pacieni au fost invitai s participe la un studiu epidemiologic privind evaluarea
impactului glicemiei postprandiale asupra riscului cardiovascular, la persoanele cu DZ.
S-a efectuat o evaluare medical complet a acestor pacieni, cu istoric personal i
examen obiectiv (greutate, nlime, circumferin abdominal i tensiune arterial). De
asemenea s-a determinat n condiii bazale nivelul glicemiei plasmatice, A1C, colesterol
total, HDL-colesterol i trigliceride. Fiecare pacient a efectuat un profil glicemic n 6
puncte (preprandial i la 2h postprandial) i a completat un chestionar alimentar.
Rezultate
Vrsta medie a pacienilor inclusi n studiu a fost de 58 ani (minim 28, maxim 77 ani),
ntre care 59.8% au fost de sex masculin. n medie, vechimea diabetului la pacienii
inclui n studiu a fost de 6 ani ( minim 0, maxim 37 ani). Prin analiza factorial s-au
determinat patru factori care explic 73% din variaia glicemiei postprandiale [ Factorul 1
cu ncrcare pozitiv pentru greutate, IMC, Factorul 2 cu ncrcare pozitiv pentru
colesterol total i LDL colesterol, Factorul 3 cu ncrcare pozitiv pentru vechimea
diabetului i vrst, Factorul 4 cu ncrcare pozitiv pentru trigliceride i HDLcolesterol]. Factorii determinai cu ajutorul analizei factoriale au fost inclui ca variabile
independente ntr-un model de regresie liniar, avnd glicemia postprandial ca variabil
dependent. Acest model a fost semnificativ asociat cu valoarea medie a glicemiei
postprandiale ( p=0.002). n cadrul acestei analize Factorul 2 nu a atins nivelul
semnificaiei statistice ( p=0.593) i a fost exclus din analiz. Al doilea model de regresie
care a inclus numai Factorii 1, 2, 4 a fost semnificativ statistic (p=0.001, F
change=6.123, semnificaia F change= 0.001). n urma ajustrii modelului de
51
Background and Aims: Growing evidence suggests that all aspects of glucose
metabolism - glycated hemoglobin (A1c), fasting plasma glucose (FPG) and postprandial
glycemia (PPG)- are clinically relevant parameters to be monitored. PPG, in particular,
appears to be related to the cardiovascular disease (CVD).
The objective of this study was to investigate the factors associated with postprandial
glucose excursions in patients with type 2 diabetes (T2DM).
Materials and Methods: We have evaluated the factors associated with postprandial
hyperglycemia (>140 mg/dl at 2 hours after the meal), corrected for sex and treatment in
122 consecutive patients with T2DM attending the outpatient clinic from Clinical Center
of Diabetes, Nutrition and Metabolic Diseases Cluj-Napoca, Romania. These patients
were included in a larger epidemiological study aiming to assess the impact of
postprandial hyperglycemia on cardiovascular risk in persons with type 2 diabetes. A
complete medical history, physical examination (weight, height, waist circumference, and
blood pressure) was performed. Blood samples were collected in the overnight fasting
state, and A1c, total cholesterol, HDL-cholesterol and triglycerides were assessed. A six
points blood glucose profile (before and 2 h after meals) measured by patients at home,
together with a meal questionnaire was performed for each patient. To determine
variables associated with higher postprandial glycemic levels, factor analysis followed by
linear regression model was performed.
Results: The study group had a median age of 58 years (min 29, max 77 years), 59.8%
were males. The median duration of diabetes was 6 years (min 0, max 37 years). By
factor analysis we have extracted 4 factors that explained 73% of the variance of
postprandial glycemia [Factor 1 with positive loadings of weight and body mass index,
Factor 2 with positive loadings of total cholesterol and LDL-cholesterol, Factor 3 with
52
positive loadings of diabetes duration and age, Factor 4 with positive loadings of
triglycerides and HDL-cholesterol]. In an unadjusted linear regression, model which
included the four factors identified was significantly associated with postprandial
glycemia (p=0.002).Within the model, Factor 2 displayed a p value of 0.593 and was
removed from the analysis. A second regression included Factor 1, 3 and 4, and the
model remained statistically significant (p=0.001, F change=6.123, significance of F
change= 0.001). After adjustment for the sex and treatment, only Factor 1 and Factor 4
remained significantly associated with postprandial glycemic values (p=0.025, and 0.004)
Conclusion The results of our study shows that weight, body mass index, triglyceride
level and HDL-cholesterol are independently associated with postprandial glucose
excursion.
Introducere:
Stetohepatitta non-alcoolica se asociaz frecvent cu sindromul metabolic, un grup de
tulburri metabolice - obezitate central, diabet zaharat tip 2, rezisten la insulin,
dislipidemie, hipertensiune arterial. Scopul studiului nostru a fost de a determina riscul
dezvoltarii NASH la pacientii diabetici si posibilele corelatii ale nivelului glicemiei cu
gradul fibrozei hepatice.
Material si metoda:
Au fost luai n studiu toi bolnavii deplasabili internai n clinicile medicale ale Spitalelor
Judeene din Braov, Oradea i Sibiu n perioada 15.10.2006 31.12.2006, care au fost
examinai ecografic. Cei fr ficat hiperecogen i fr citoliz hepatic au constituit lotul
martor (812 pacienti) iar lotul de studiu a fost format din toti pacientii (68) la care s-a pus
diagnosticul de steatohepatita non-alcoolica (NASH). Fibroza hepatica a fost evaluata
prin scorul Forns. Rezultatele au fost analizate statistic folosind testul Pearson, testul t
Student i riscul relativ (RR).
53
Rezultate:
Repartitia pe genuri a pacientilor cu NASH a fost de 41.17% femei fata de 58.83%
barbati. Varsta medie a lotului a fost de 54.47 12.84 ani. Glicemia medie a pacinetilor
cu NASH a fost de 132.85 mg/dl fata de 100.13 mg/dl la pacientii din lotul martor,
diferenta fiind inalt semnificativa statistica (p=0.00000008). Riscul relativ de a dezvolta
NASH la pacientii cu diabet zaharat a fost de 3.33. Indicele de corelatie Pearson intre
nivelul glicemiei si scorul Forns de fibroza hepatica a fost r = -0.005; deci nu s-au gasit
corelatii intre nivelul glicemiei si scorul fibrozei hepatice. De asemenea, nivelul glicemiei
nu s-a corelat cu gradul de citoliza (r = 0.007, pentru TGO, respectiv r = -0.0003 pentru
TGP).
Concluzii:Valorile glicemice sunt semnificativ mai mari la pacientii cu NASH decat la
cei din lotul martor. Pacientii cu diabet zaharat de tip 2 sunt de trei ori mai expusi riscului
de a dezolta steatohepatita non-alcoolica decat restul populatiei. Nu exista corelatii intre
nivelul mediu al glicemiei si nivelul citolizei hepatice sau gradul fibrozei.
Introduction:
Non-alcoholic steatohepatitis (NASH) is frequently associated with the metabolic
syndrome, a group of metabolic disorders like central obesity, diabetes mellitus type 2,
insuline resistance, dyslipidemy and arterial hypertension. Our aim was to determine the
risk of developing NASH at the diabetic patients and the possible correlations between
the level of glycemia and the degree of liver fibrosis.
Material and method:We took in consideration a group formed by the patients who
were hospitalize in the Medical Departments of the Clinical Hospitals from Brasov,
Oradea and Sibiu during 15.10.2006 31.12.2006, who were ultrasonografically
examined. The ones without hyperecougenous liver and without liver cytolysis formed
54
the controlled group (812 patients) and 68 patients to whom the NASH diagnosis was
established formed the studied group. The liver fibrosis was evaluated using the Forns
index of correlation.
Results:The gender repartition of the NASH patients was 41.17% women and 58,83%
men. The medium age of the lot was 54.47 12.84 years of age. The medium level of
glycemia at the NASH patients was 132.85 mg/dl comparing with 100.13 mg/dl at the
patients from the control group, the difference being very statistically significant
(p=0.00000008). The relative risk of developing NASH at the diabetic patients was 3.33.
The Pearson index of correlation between the glicemic level and the Forns index of liver
fibrosis was r =-0.005; so there were no correlations found between the glycemic level
and the liver fibrosis index. No correlations were found between the level of glycemia
and the level of transaminases (r =0.007 for TGO and r =-0.0003 for TGP).
Conclusions:The values of gycemia are significantly higher at the patients with NASH
comparing with the control group. The patients with diabetes mellitus are three times
more likely to develop NASH than the rest of the population. There are no correlations
between the medium level of glycemia and the degree of liver cytolysis of liver fibrosis.
55
56
DZ tip I
DZ tip II
30.30 (15.62
55.86)
P = 0.0001
223.54 (120
P = 0.0001
57
1332)
HbA1c (%)
9.28 (4 20.3)
P = 0.0001
220.76 (190
1936)
P = 0.0001
HDL-colesterol (mg/dl)
NS
222.68 (90
4611)
P = 0.0001
TG (mg/dl)
Prezena hipercolesterolemiei (colesterol total > 200 mg/dl) a fost la pacienii cu DZ tip 1
de 23.5% i la DZ tip 2 de 41,6 %. S-a gsit corelaie semnificativ statistic ntre
valoarea colesterolului, IMC (rs1 = 0.229, rs2 = 0.073) i glicemie (rs1=0.215,
rs2=0.100).
Hipertrigliceridemia ( TG>150 mg/dl ) a fost prezent la 23% din pacienii cu DZ tip 1 i
la 45.2% din pacienii cu DZ tip 2. La ambele loturi, valorile TG au fost corelate direct cu
valorile IMC (rs1=0.515, rs2=0.179) i ale glicemiei (rs1=0.242, rs2=0.174), doar la
pacienii cu DZ tip 2 acestea fiind corelate i cu valorile HbA1c (rs2 = 0.105).
Semnificativ statistic, s-a ntlnit corelaie negativ la HDLc, unde la femeile cu DZ tip 1
HDLc a fost corelat invers proporional cu valorile IMC (rs1=0.529) i HbA1c (rs1=0.414), iar la femeile cu DZ tip 2, HDLc a fost corelat invers proporional cu valorile
HbA1c (rs2=-0.121) i ale glicemiei (rs2=-0.115). La pacienii de sex masculin, HDLc a
fost corelat invers proporional cu valorile IMC, att la cei cu DZ tip 1 (rs1=-0.326), ct
i la cei cu DZ tip 2 (rs2=- 0.087) unde a fost corelat i cu valorile HbA1c (rs2=-0.160).
Concluzii: La pacienii nou diagnosticai cu DZ tip 2, factorii de risc pentru bolile
cardiovasculare ca: dislipidemia cu hipercolesterolemie i/sau hipertrigliceridemie, au
fost mai frecvent prezente dect la pacienii cu DZ tip1 (p=0.0001), deoarece pacientii cu
DZ tip 2 sunt mai in varsta si cu comorbiditati ( obezitate, HTA, IMA,, BCI,
insulinoresistenta) .
average age was 56, 82 years; BMI average was 29, 9Kg/m2. The two groups 204 (7,
3%) T1DM, 117(57.4%) men and 87 (41.6%) women and 2583 (92.7%) T2DM, 1272
(49.2%) men and 1311 (50.8%) women, average age 58.86 were studied depending on
T1DM and T2DM.The following parameters were recorded: age, sex, BMI, fasting blood
glucose, HbA1C, cholesterol, triglycerides, HDLc. The statistic program was SPSS 15.0;
we used 2, Mann-Whitney, Kruskal Wallis, Spearman coefficient, with statistical
significant p 0.05.
Results:
T2DM
T1DM
Parameters
P for difference
between T1 and
T2
Mean (min
max)
30.30 (15.62
55.86)
P = 0.0001
223.54 (120
1332)
P = 0.0001
HbA1c (%)
9.28 (4 20.3)
P = 0.0001
Cholesterol (mg/dl)
220.76 (190
1936)
P = 0.0001
NS
222.68 (90
4611)
P = 0.0001
BMI (kg/m2)
Fasting blood glucose
(mg/dl)
HDL-c (mg/dl)
Triglycerides
59
Scop : De obicei la descoperire diabetul este asimptomatic, dar cteodata pot fi prezente
complicaii micro i macrovasculare. Scopul acestui studiu a fost s evalueze prevalena
complicaiilor cronice la pacienii cu DZ nou descoperit n 2007, nregistrai n
INDNBM N. Paulescu.
Materiale i metode: In studiu au fost nrolai 2787 de pacieni nou diagnosticai cu DZ
n perioada ianuarie decembrie 2007: 1389 (49.8%) brbai i 1398 (50.2 %) femei, cu
vrsta medie de 56.82 ani (limite ntre 4 i 87 ani), i un IMC mediu de 29.9Kg/m2
(limite ntre 13 si 56 kg/m2). Cele 2 loturi au fost studiate n funcie de tipul DZ: 204
pacieni (7.3%) cu DZ tip 1, barbati 117 (57.4%) si 87 (42.6%) femei i respectiv 2583
pacieni (92.7%) cu DZ tip 2, 1272 (49.2%) barbati si 1311 (50.8%) femei;
prezena/absena complicaiilor diabetului. Datele folosite n studiu provin din fiele
CAD ale pacienilor, prelucrarea lor statistic realizndu-se cu ajutorul softului SPSS
15.0, semnificaia statistic a diferenelor dintre cele dou loturi realizndu-se pe baza
testului Chi-patrat pentru un prag de semnificaie p 0.05.
Rezultate :
Nr. Total
pacieni
Complicaii
microvasculare
Complicaii macrovasculare
IMA
AVC
T1DM
204 (7,3%)
3 (0.1%)
9 (0.2%)
4 (0.1%)
1 (0.1%)
1 (0.1%)
T2DM
2583 (92.7)
50 (1.8%)
137 (5%)
92 (3.3%)
53
(1.8%)
97
(3.4%)
Total
2787
53 (1.9%)
146 (5.2%)
96 (3.4%)
54
98
60
(100%)
(1.9%)
(3.5%)
Majoritatea pacienilor 2370 (84,1%), din care 187 (5,8%) cu DZ tip 1 i 2183 (78.3%)
cu DZ tip 2, nu au prezentat complicaii, acestea fiind evideniate numai la 417 pacieni
(15,9%), din care 17 pacieni (0,6%) cu DZ tip I si 400 pacieni cu DZ tip 2 (15,3%).
61
Results:
Total
patient
s
Microvascular
complications
Macrovascular complications
Retinopath
y
Neuropath
y
Arteriopathy
Miocardica
l infarction
Stroke
T1DM
204
(7,3%)
3 (0.1%)
9 (0.2%)
4 (0.1%)
1 (0.1%)
1 (0.1%)
T2DM
2583
(92.7)
50 (1.8%)
137 (5%)
92 (3.3%)
53 (1.8%)
97 (3.4%)
Total
2787
(100%)
53 (1.9%)
146 (5.2%)
96 (3.4%)
54 (1.9%)
98 (3.5%)
Most patients 2370 (84.1 %) had no complications: 187 (6.7%) T1DM and 2183 (78.3%)
T2DM, only 417 patients (15.9 %) had complications, from which 17 patients T1DM (0.
6 %) and 400 patients T2DM (15.3%).
Conclusions: Obviously at diagnosis T1DM patients and T2DM patients are mostly free
of complications, but if they have it, the most common ones are macrovascular
complications in T2DM patients due to the presence of additional vascular risk factors as:
hypertension, dyslipidemia, hyperinsulinism, obesity. Most frequent diabetic
macrovascular complications affects only one vascular territory, this is the cerebral
territory or peripheral territories, affected 4 times more frequent than coronaries territory
(p = 0.0001). The lower frequencies of cardiac lesions are probably due to different
diagnosis criteria. In patients with microvascular complications neuropathy is more
frequent then retinopathy (p= 0.0001). Newly diagnosed chronic complications are higher
in T2DM than in T1DM patients (p = 0.038) due to a longer pre diagnosis period.
62
63
Introduction: The metabolic syndrome is an important cardiovascular risk factor for type
2 diabetes mellitus (DM2), there are though few data regarding its importance in type I
diabetes mellitus patients (DM1).
Aim: The evaluation of microvascular complications in DM1 and DM2 patients with
metabolic syndrome (SM).
Methods: In the study there were included 1429 patients, which were admitted in 2006 in
the diabetes department of the institute., of which 270 with DM1 (136 men, 134 women,
mean age 42.54+14.36 years) and 1159 with DM2 (518 men, 641 women, mean age
60.17+10.48). SM was present in 50 (18.51%) of the DM1 patients, respectively 970
(83.69%) of the DM2 patients, the rest of the patients not meeting the diagnostic criteria.
The following parameters in the patients file were analyzed: age, sex, waist
circumference, hypertension history, HbA1c, total cholesterol (CT), HDL cholesterol
(HDL), LDL cholesterol (LDL), triglycerides (TG), triglyceride/HDL cholesterol ratio,
presence of microvascular complications: diabetic neuropathy, (peripheral diabetic
neuropathy, autonomic neuropathy), diabetic retinopathy, (proliferating diabetic
retinopathy, non-proliferating diabetic neuropathy). SM was defined according to the IDF
criteria. In DM1 patients, glucose blood level was not a diagnostic criterion.
Results: Patients with DM1 and SM had lower mean age (49.1613.24vs.60.2510.33,
p<0.001) compare to patients with DM2 and SM (p<0.001) and a significantly longer
disease duration (12.589.63vs.9.398.21, p<0.01), relation that maintained in the sex
difference also. Also patients with DM1 and SM had a significantly higher level of
HbA1c (10.522.23 vs.9.512.40, p<0.01), compared to the patients with DM2 and SM ,
relationship that maintained only in men (10.752.76vs.9.062.43, p<0.01) when menwomen differences were analyzed. There were statistically significant differences
regarding autonomic neuropathy (OR 3.27; 95%CI:1.39-7.67, p<0.01), diabetic
retinopathy (OR 2.39; 95%CI:1.35-4.23, p<0.01) and non-proliferating diabetic
retinopathy (OR 2.26;95%CI:1.25-4.08, p<0.01) between the patients with DM1 and SM
compare with patients with DM2 and SM, difference that maintained for diabetic
retinopathy (OR 3.08;95%CI:1.47-6.46, p<0.01) and non-proliferating diabetic
retinopathy (OR 2.71;95%CI:1.27-5.80, p<0.01) only in women when sex differences
were analyzed.
64
Patients with DM1 and SM had a significantly higher prevalence of diabetic retinopathy
(OR 2.03; 95% CI: 1.09-3.78) compared to the patients without SM, with no significant
differences regarding diabetic neuropathy. In patients with DM2 and SM there were no
statistically significant differences regarding microvascular complications compared to
the patients with DM2 and without SM.
There were not significant differences in microvascular complication prevalence across
the tertiles of HbA1c and TG/HDL distribution. When analyzing waist distribution
tertiles, patients with DM1 in the superior tertile had a higher prevalence of diabetic
retinopathy (OR 2.72; 95% CI: 1.07-6.90) compared to the patients in the lower terile,
with no differences in patients with DZ2.
Conclusions: Metabolic syndrome represents a risk factor for microvascular
complications in patients with DZ1.
Spitalul Clinic Judetean de Urgenta Craiova Clinica Diabet Nutritie Boli Metabolice;
67
Introducere si obiective
La pacientii diabetici, studii observationale au sugerat faptul ca prezenta ficatului
gras nonalcoholic (FGNA), poate creste riscul de microalbuminurie si astfel de boala
cronica renala (BCR). Veriga patogenetica intre aceste doua conditii poate fii
reprezentata de citokinele proinflamatorii secretate de ficat. Scopul studiului de fata
consta din evaluarea prezentei microalbuminuriei la pacientii diabetici cu FGNA
comparativ cu cei fara FGNA si corelarea acesteia cu markeri ai inflamatiei cum este
proteina Creactiva cu sensibilitate inalta.
Material si metoda
Studiul a fost desfasurat pe un grup de 75 de pacienti diabetici cu FGNA
diagnosticat ultrasonografic, la care s-au exclus consumul de alcool precum si alte cause
de boala cronica hepatica, fumatul, hipertensiunea arteriala si boala renala preexistenta.
Grupul de control a consistat din 70 de pacienti diabetici, fara dovezi ecografice de
FGNA..
La toti pacientii s-au determinat parametrii antropometrici, glicemia a jeun,
HbA1c, colesterolul total, LDL si HDL colesterolul, trigliceridele, transaminazele serice,
hs PCR si microalbuminuria. Analiza statistica a fost efectuata cu SPSS11.0. O valoare a
p<0,05 a fost considerata semnificativ statistica.
70
Rezultate
Microalbuminuria a fost a fost semnificativ mai frecventa la subiectii cu FGNA
decat la grupul de control (12,7% vs 7,8%, p<0,05). Microalbuminuria s-a corelat pozitiv
cu IMC, HbA1c, trigliceridele serice, hsCRP si respectiv negative cu nivele HDL la
pacientii diabetici cu FGNA.
Concluzii
FGNA se coreleaza cu microalbuminuria- marker de boala cronica renala stadium
precoce la pacientii diabetici. Aceasta pare a se datora unor nivele crescute de citokine
proinflamatorii eliberate de ficat, cum este hsCRP. Pacientii diabetici cu FGNA au nivele
semnificativ mai crescute ale HbA1c, relevand un control slab pe termen lung al
valorilor glicemice.
Background
In diabetic patients observational studies have suggested that nonalcoholic fatty
liver disease-NAFLD may increase the risk of microalbuminuria and thus that of chronic
kidney disease (CKD). The pathogenetic link between these conditions could be
proinflammatory cytokines secreted by the liver. The aim of our study was to assess the
presence of microalbuminuria in diabetic subjects with nonalcoholic fatty liver disease
(NAFLD) compared with diabetic patients without NAFLD and to correlate this with
inflammatory markers such as high sensitive C- reactive protein (hsCRP).
Material and methods
The study was conducted on a group of 75 diabetic subjects with
ultrasonographical NAFLD, in which alcohol consumption and other causes of chronic
liver disease have been excluded. The exclusion criteria also included smoking, arterial
hypertension, known renal disease. The control group consisted of 70 diabetic patients,
matched for age and gender, without ultrasonographical evidence of NAFLD.
In all subjects we measured height, weight, BMI, fasting glucose, HbA1c, total
cholesterol, LDL and HDL cholesterol, triglycerides, serum transaminases, hsC-reactive
71
protein and microalbuminuria. Statistical analysis was performed using SPSS11.0. A pvalue<0,05 was considered statistically significant.
Results
Microalbuminuria was significantly more frequent in subjects with NAFLD than
in controls (12,7% vs 7,8%, p<0,05). Microalbuminuria was positively correlated with
waist to hip ratio, HbA1c levels, serum triglycerides, hsCRP levels and negatively
correlated with HDL levels in subjects with NAFLD.
Conclusion
NAFLD is correlated with microalbuminuria- marker of early stage CKD, in
diabetic patients. This seems to be related to higher levels of proinflammatory factors
released by the liver, such as hsCRP. Diabetic patients with NAFLD had significantly
higher levels of HbA1c, witnessing a poorer glycemic control.
I. Objective: Diet and exercise are considered important treatment strategies of type 2
diabetes. The objective of this study is to assess the efficacy of low carbohydrate (45%)
and lipid (25% ), high protein ( 30% ) diet, as an alternative dietary treatment for obese
patients with type 2 diabetes.
II. Methods: A total of 69 obese patients with type 2 diabetes , 33 male ( 47,8% ) and
36 female ( 52,2% ), with a mean age of 51,3 8,7 years old, receiving oral
hypoglicaemic agents, who had hypercholesterolemia ( total cholesterol > 200 mg/dl),
hypertriglyceridemia and obesity ( BMI >30 kg/m2), were allocated to a low
carbohydrate ( 45% ) and lipid ( 25% ), high protein ( 30% ) diet and each patient had 3
hour/week regular physical activity. Their HbA1c, cholesterol, triglycerides and weight
loss were monitored at the start of the study and again at 3 and 6 months.
III. Results: Mean weight at baseline was 89,7 kg ( 72,5 - 121,5 kg ) and weight loss
at 1, 3 and 6 month respectively, were 3,3 kg, 7,5 kg, 9,1 kg. Mean HbA1c at baseline
was 8,8% ( 6,6% -11,2% ) and mean results at 3 and 6 month were 7,8% and 6,9%. Mean
total cholesterol at baseline was 263 20,3 mg/dl and at 3 and 6 month was 249 21,5
mg/dl, respectively 240 25,5 mg/dl . Triglyceridemia decreased with 26% after 6
month. Renal function as measured by serum creatinine and urea was assessed at the start
of study, no patient with renal impairment was commenced on the diet. Urinary
microalbumin and creatinine clearence were not different after 6 month.
73
IV. Conclusions: A low carbohydrate and lipid, high protein diet may help to improve
the metabolic control in type 2 obese diabetic patients. A high protein diet can generate
weight loss, a better glycaemic control, without adverse effects on the renal function.
This type of diet have a place in management of obese - type 2 diabetes in selected
patients.
EPIDIAB 2008
6 LUNI: 1 IANUARIE-30 IUNIE 2008
Spitalul Judetean Sf.Ioan cel Nou Suceava
Secia Diabet- Nutriie-Boli Metabolice
R.Caziuc, C.Lazr, V.Rcaru, G.Creeanu
Obiectiv:
Evaluare incidenei diabetului zaharat nou diagnosticat (n cursul anului 2008) la
Centrul Antidiabetic Judeean Suceava i analizarea prezenei complicaiilor la momentul
diagnosticului.
Material i metod:
S-au luat n studiu un numr de 1468 cazuri noi cu diabet zaharat dintre care:
-83 pacieni cu diabet zaharat insulinodependent.
-1385 pacieni cu diabet zaharat tip II, la care au fost analizate datele
antropometrice(nlime, greutate,perimetrul taliei), clinice(tensiune arterial sistolic i
diastolic,examenul piciorului diabetic i chestionar DN4), paraclinice(glicemie,profil
lipidic,examen de urin,creatinin) i examen oftalmologic.
Rezultate:
Distribuia pe sexe la pacienii cu diabet zaharat tip I a fost de 41% femei i 59%
brbai,n timp ce la tipul II,procentul de femei a fost de 51%.
61% dintre pacienii cu diabet zaharat tip I erau din mediul urban, iar la tipul II
procentul a fost de 84%.
Pe grupe de vrst,situaia a fost urmtoarea:
-la pacienii cu diabet zaharat tip I
74
-8,9% au avut vrsta sub 30 ani, 64% ntre 30-65 ani,27% peste 65 ani.
-la pacienii cu diabet zaharat tip II
-64% au avut vrsta intre 30-65 ani, 36% peste 65 ani.
n privina indexului masei corporale,datele au fost:
-Diabet zaharat tip I:
-47% dintre pacieni cu IMC < 25;
-30% dintre pacieni cu IMC =25-29;
-23% dintre pacieni cu IMC > 30.
-Diabet zaharat tip II:
-18% dintre pacieni cu IMC < 25;
-27% dintre pacieni cu IMC =25-29;
-55% dintre pacieni cu IMC > 30.
La msurarea talie, datele au fost: 64% dintre femeile cu diabet zaharat tip I au avut
talia peste 80cm, n timp ce numai 22% dintre brbai au avut talia peste 94cm; la
pacienii cu diabet zaharat tip II 66% dintre femei au avut talie peste 80cm, i respective
60% dintre brbai au msurat n talie peste 90cm.
Complicaiile la momentul diagnosticului:
-
Concluzii:
Numrul de pacieni cu diabet zaharat nou diagnosticat este semnificativ mai mare
n urma depistrii active prin analizele recomandate de ctre medicii de
75
EPIDIAB 2008
6 MONTHS: JANUARY 1ST JUNE 30TH, 2008
R. Caziuc, C. Lazar, V. Racaru, G. Creteanu
Sf. Ioan cel Nou Suceava County Hospital
Department of Diabetes Nutrition Metabolic Diseases
Objective:
To assess the incidence of newly diagnosed diabetes mellitus (during year 2008)
at the Suceava County Anti-Diabetic Centre and to analyze the presence of complications
at the moment of diagnosis.
Material and Method:
There were studied 1468 new cases with diabetes mellitus among which:
- 83 patients with insulin-dependent diabetes mellitus
- 1385 patients with type 2 diabetes mellitus, in whose case there were analyzed
the anthropometric data (height, weight, waist measurement), clinical data (systolic and
diastolic arterial blood pressure, exam of the diabetic leg and questionnaire DN4),
paraclinical data (blood glucose level, lipid profile, urine test, creatinine) and
ophthalmologic exam.
Results:
The distribution according to sexes, at the patients with type 1 diabetes mellitus,
was 41% women and 59% men, while at type 2, the percentage of women was 51%.
61% of the patients with type 1 diabetes mellitus came from the urban
environment, and at type 2 the percentage was 84%.
According to age groups, the situation was the following:
- at the patients with type 1 diabetes mellitus
- 8.9% were under 30 years old, 64% between 30-65 years old, 27% over 65 years
old
- at the patients with type 2 diabetes mellitus
- 64% were between 30-65 years old, 36% over 65 years old.
With respect to the body weight index, the data were:
- Type 1 diabetes mellitus:
- 47% of patients with body weight index < 25
- 30% of patients with body weight index = 25-29
- 23% of patients with body weight index > 30
- Type 2 diabetes mellitus:
- 18% of patients with body weight index <25
76
78
79
active subjects, below 55years of age, from which half having a normal weight and half
overweight and obese, with the clear predominance of females.
The questionnaire we applied could be used as an instrument of identifying people at
increased risk of developing type 2 diabetes (especially realtives of people with diabetes),
having the opportunity of an early initiation of lifestyle optimization, in order to
prevent/delay the onset of this disease.
The data we collected are much alike the ones published by the Ministery of Health from
the compulsory investigationsprogramme.
Introducere
De-a lungul timpului, recomandrile alimentare pentru pacienii cu diabet zaharat (DZ) sau dovedit destul de restrictive n privina hidrailor de carbon (HC). Regimul alimentar
(dieta) n DZ a trecut prin mai multe etape: restricia total a regimul bogat n lipide i
legume, dieta convenional, hipoglucidic. Din 1980 s-a estimat c raia glucidic n
DZ poate fi de 55-60% din necesarul caloric (NC), lipidele maxim 30%, iar proteinele
maxim 20%. ADA subliniaz rolul individualizrii regimului alimentar prin aplicarea
terapiei medicale nutriionale (medical nutritional therapy-MNT)
Coninut
Modificarea obiceiurilor alimentare joac un rol major n tratamentul i managementul
DZ. Obiectivele MNT pentru pacienii cu DZ sunt: obinerea i meninerea glicemiei la
niveluri normale/apropiate de normal, a profilului lipidic i lipoproteic ce asigur un risc
cardiovascular redus, a TA la niveluri normale/apropiate de normal,
prevenirea/ncetinirea ratei de dezvoltare a complicaiilor cronice ale DZ, asigurarea
necesitilor nutriionale individuale. Obiectivele MNT pentru tinerii cu DZ 1, DZ 2,
gravidele i femeile care alpteaz, vrstnicii cu DZ sunt asigurarea necesitilor
nutriionale, iar pentru cei tratai cu insulin sau secretagoge, asigurarea autocontrolului
i tratamentul DZ n bolile acute.
Este ncurajat consumul de HC din fructe, cereale integrale, legume, leguminoase i
produse lactate degresate. Trebuie limitat aportul de grsimi saturate la sub 7% din NC,
cu evitarea consumului de grsimi trans cu un aport de colesterol alimentar sub 200mg/zi
i consumul a cel puin 2 porii de pete sptmnal. Sunt dovezi insuficiente care s
indice modificarea aportului proteic obinuit (15-20% din NC) la diabeticii cu funcie
80
Introduction
Nutritional recommendations for diabetic patients were restrictive regardless
carbohydrates for a long time. The diet has passed some periods: total restrictive in
carbohydrates, a diet rich in fat and legumes, conventional diet period. From 1980 was
accepted that carbohydrate may represent 55-60% from caloric necessary, fat 30% or less
and protein 20% or less. ADA pointed out the role of individualization of the diet and the
role of medical nutritional therapy-MNT.
Content
Dietary habits modification plays an important role in treatment and management of
diabetes mellitus.Goals of MNT that apply to individuals with diabetes are: achieve and
maintain blood glucose levels in the normal range, lipid and lipoprotein profile that
reduces the risk for vascular disease, blood pressure levels in the normal range, to
prevent/slow the rate of development of the chronic complications of diabetes. Goals of
MNT that apply to youth with diabetes, pregnant and lactating women, and older adults
81
with diabetes are: to meet the nutritional needs and for individuals treated with insulin or
insulin secretagogues, to provide self-management training and diabetes treatment during
acute illness.
In diabetes management, are recommended carbohydrate from fruits, vegetables, whole
grains, legumes, and low-fat milk, to limit saturated fat intake to 0.7% of total calories, to
minimized intake of trans fat, to limit dietary cholesterol to 0.200 mg/day. For individuals
with diabetes and normal renal function, there is insufficient evidence to suggest that
usual protein intake (1520% of energy) should be modified. Numerous studies have
attempted to identify the optimal mix of macronutrients for the diabetic diet. The best
mix of carbohydrate, protein, and fat appears to vary depending on individual
circumstances. Individualization of the macronutrient composition will depend on the
metabolic status of the patient. Alcohol daily intake should be limited to moderate
amount. There is no clear evidence of benefit from vitamin or mineral supplementation in
people with diabetes who do not have underlying deficiencies.
Insulin therapy should be integrated into an individuals dietary and physical activity
pattern. Individuals with type 2 diabetes are encouraged to implement lifestyle
modifications. For pregnancy and lactation with diabetes adequate energy intake that
provides appropriate weight gain is recommended. Obese older adults with diabetes may
benefit from modest energy restriction and an increase in physical activity. Reduction of
protein intake to 0.81.0 g/kg body wt/day in individuals with diabetes and the earlier
stages of chronic kidney disease (CKD) and to 0.8 g/kg body wt/day in the later stages of
CKD may improve measures of renal function and is recommended. For patients with
diabetes at risk for CVD, diets high in fruits, vegetables, whole grains, and nuts may
reduce the risk. Ingestion of 1520 g glucose is the preferred treatment for hypoglycemia.
For the implementation of MNT it is necessary to run through 4 steps: evaluation of
initial status, establishment of the goals, nutritional intervention, periodical evaluation.
82
visfatine (26 18,3 vs. 12.5 3 ng/ml; p = 0.02) and high sensitive C-Reactive protein
(4.7 3.7 vs. 0.38 0.35 mg/L; p=0.001). In postprandial state, significant increase of
visfatine (p=0.03), interleukin-6 (p=0.012) and high sensitive C-Reactive protein
(p=0.017) have been found in diabetes group compare to control. Within diabetes
group, a significant 2-hour postprandial glycemia and 4-hour postprandial increase of
TNF-alpha and C-Reactive protein has been found. Conclusions. A significant
difference between diabetes and control has been found in terms of visfatin and high
sensitive C-Reactive protein that are increased in diabetes. Adiponectin was lower in
diabetes group, but not statistically significant compare to control group. In diabetes
group, TNF-alpha, C-Reactive protein and glycemia have been found to be increased in
the postprandial state, which demonstrates that in diabetes, multiple factors act to
increase cardiovascular risk.
Keywords: cardiometabolic risk, adiponectin, visfatin, postprandial state
Introducere si obiective
Diabetul zaharat este considerat echivalent de boala cardiovasculara, astfel incat tintirea
agresiva a tuturor factorilor ce alcatuiesc riscul cardiometabolic constituie un obiectiv
major in cadrul managementului pacientilor cu diabet zaharat. LDL colesterolul este un
important factor de risc cardiovascular, dar implicatiile sale in cadrul sindromului
metabolic constituie inca o controversa. Lucrarea de fata isi propune analiza unei posibile
corelatii intre sindromul metabolic si LDL colesterol la pacientii cu diabet zaharat tip 2.
Material si metoda
Am efectuat un studiu retrospectiv la pacientii cu diabet zaharat tip 2 (DZ tip 2) internati
in Centrul de Diabet Cluj in perioada ianuarie-martie 2008. Am analizat date clinice si
demografice, prezenta sindromului metabolic (conform criteriilor IDF 2005), a bolii
cardiovasculare, schemele de tratament folosite, precum si corelatia dintre LDL colesterol
(luand ca si obiectiv tinta valoarea de 100mg/dl) si diversi factori de risc cardiovascular
(in particular sindromul metabolic). Datele au fost prelucrate si analizate cu programul
SPSS 10.
Rezultate
84
Intreg lotul analizat a inclus 200 de pacienti cu DZ tip 2, cu varsta medie de 589,25 ani,
41,5% barbati, cu o durata medie a diabetului de 10,27,03 (1-31) ani. Referitor la
tratament, 1,1% erau sub monoterapie orala, 11,2% cu terapie orala combinata, 42% au
beneficiat de asocierea insulina-antihiperglicemiante orale, 45,7% erau numai sub
insulinoterapie, in timp ce 45,9% din intreg lotul aveau metformin in schema terapeutica.
Dintre pacienti, 88,8% erau hipertensivi, 92,6% intruneau criteriile sindromului
metabolic, 42% erau diagnosticati cu boala cardiovasculara si 79,3% aveau complicatii
microvasculare prezente. Dintre pacientii cu sindrom metabolic 54,5% aveau LDL
colesterol 100 mg/dl si 62,6% erau cu trigliceride 150mg/dl. Dintre pacientii cu boala
cardiovasculara prezenta 49,4% erau cu LDL colesterol 100mg/dl si 65,8% cu
trigliceride 150mg/dl. Analizand separat pacientii cu LDL cholesterol100mg/dl
(acestia reprezinta 50,35% din intreg lotul ) am constatat ca 87,4% sunt hipertensivi, 40%
au fost diagnosticati cu boala cardiovasculara si o majoritate covarsitoare (94,7%)
intrunesc criteriile de diagnostic ale sindromului metabolic.
Concluzii
Rezultatele acestei analize observationale ilustreaza inca o data rolul fundamental al LDL
colesterolului la pacientii cu sindrom metabolic si diabet zaharat. Faptul ca peste 90%
dintre pacientii cu LDL cholesterol 100mg/dl intruneau criteriile de diagnostic ale
sindromului metabolic, fac plauzibila ipoteza ca aceasta formatiune lipidica cu rol central
in aterogeneza ar putea deveni parte integranta in cadru conceptului de sindrom
metabolic.
data, the presence of metabolic syndrome (defined according to the IDF 2005 criteria),
cardiovascular disease, treatment schemes used, as well as the relationship between LDL
cholesterol (taking as objective target value of 100mg/dl) and various cardiovascular risk
factors (in particular metabolic syndrome). The data were processed and analyzed with
the SPSS 10.
Results
The entire batch analyzed included 200 patients with type 2 diabetes, with an average age
of 58 9.25 years, 41.5% men, with an average duration of diabetes 10.2 7.03 (1-31)
years. Regarding the treatment, 1.1% were under oral monotherapy, 11.2% received
combined oral therapy, 42% benefited from the combination of oral therapy and insulin,
45.7% were under insulin therapy, while 45.9% of all patients had metformin in their
treatment regimen. 88.8% of the patients were hypertensive, 92.6% meet the metabolic
syndrome criteria, 42% were diagnosed with cardiovascular disease and 79.3% had
microvascular complications. Among patients with metabolic syndrome 54.5% had LDL
cholesterol 100 mg / dl and 62.6% had triglycerides 150mg/dl. Among patients with
this cardiovascular disease 49.4% had LDL cholesterol 100mg/dl and 65.8% had
triglycerides 150mg/dl. When separately analyzed patients with LDL cholesterol
100mg/dl (this represents 50.35% of the entire lot) we found that 87.4% are hypertensive,
40% were diagnosed with the cardiovascular disease and an absolute majority (94.7%)
meet metabolic syndrome diagnosis criteria.
Conclusions
Observed results of this paper illustrate once again the fundamental role of LDL
cholesterol in patients with metabolic syndrome and diabetes. The fact that over 90% of
patients with LDL cholesterol 100mg/dl meet the diagnostic criteria for metabolic
syndrome, make plausible the assumption that this lipoprotein components with a central
role in atherogenesis could become an integral part of the metabolic syndrome concept.
RAPORTARE DE CAZ:
HIPOGLICEMII REPETATE LA O PACIENT DIABETIC IN PROGRAM DE
DPCA N TRATAMENT CU SOLUII DE ICODEXTRIN
G. Ioni1, D. Pencu2, A. Cirjan2, C. Ionescu2, M. Voiculescu2
1 Institutul National de Diabet, Nutriie i Boli Metabolice N. C. Paulescu , Bucuresti,
Romania
2Institutul Clinic Fundeni Cent
rul de Medicin Intern- Bucureti,
Centrul
Bucureti, Romania
86
Din ce n ce mai muli pacienii cu IRC stadiul uremic sunt inclui n programul
de dializ peritoneal continu ambulatorie.
Dintre acetia, pacienii cu diabet zaharat sunt o categorie aparte ce implic o
serie de probleme suplimentare n ceea ce privete interferena ntre tratamentul insulinic
i soluiile de dializ peritoneal. Se prefer folosirea soluiilor peritoneale de Icodextrin
(Extraneal), un polimer al glucozei derivat din porumb care presupune o absorbie
sczut a carbohidrailor, permind astfel un mai bun control al glicemiei i care poate
mbunti ultrafiltrarea i clearance-ul creatininei la pacienii cu PET HighAverage sau
High.(transport peritoneal nalt sau naltMediu).
Dei Icodextrinul nu este metabolizat n peritoneu, poate fi absorbit prin sistemul
limfatic n circulaia sistemic, unde este hidrolizat de ctre amilaz n
oligozaharide(maltoz, maltotrioz). Multe glucometre folosesc in benzile teste glucozdehidrogenaza cu coenzima piroloquinolinequinone, pentru a cataliza conversia glucozei
la acidul gluconic i a reduce acidul adenin dinucleotid nicotinamidic (NADH).
Cantitatea de NADH msurat de glucometru este direct proporional cu concentraia
glucozei
din
mostra
de
snge.
Glucoz-dehidrogenaza
cu
coenzima
piroloquinolinequinone (PQQ) poate reaciona cu radicalul liber al glucozei localizat la
captul moleculei de maltoz, producnd o cantitate adiional de NADH, contribuind la
supraestimarea nivelului glicemiei. (3).
Vom prezenta cazul unei paciente cu DZ tip I i IRC std V n program DPCA, n
tratament cu Icodextrin, care a suferit repetate hipoglicemii datorit msurtorilor
inadecvate a glicemiilor msurate cu glucometru pe baz de glucoz-dehidrogenaz.
Pacienta, n vrst de 43 ani, cunoscut cu diabet zaharat tip 1 din 1994 n
tratament
cu
insulina
aspart:10U(ora8)-10U(ora14)-10U(ora20)
i
insulina glargina: 10U(ora22), nefropatie diabetic din 2006, HTA secundara renoparenchimatoas, dislipidemie mixt, insuficien renal cronic din 2006 n program de
DPCA din 07.06.2007 se interneaz pentru sindrom febril 38-39 C i sughi de
aproximativ 24ore, stare confuzional( iniial agitaie psihomotorie, ulterior refuz
alimentar i verbal de cca 48ore). Menionm c la domiciliu pacienta a prezentat
numeroase episoade hipoglicemice (non-complian la regimul alimentar i tratament
antidiabetic, non-complian la indicaia de neutilizare pt determinarea glicemiei a
glucometrelor- test de glucoz-dehidrogenaz) i nu a mai urmat medicaia antidepresiv
n ultimele 2 luni (non-complian la tratament).
Obiectiv: stare general mediocr, contient, febril (38C), agitaie psihomotorie, dezorientat temporo-spaial, areactiv la stimuli verbali, reactiv la stimuli
dureroi; redoare de ceaf, opistotonus; tegumente i mucoase palide, uscate; fara edeme;
ap respirator MV prezent bilateral, fara raluri; ap cardiovascular TA 230/100 mmHg ,
AV-90/ min, ritm regulat, fara sufluri supraadugate, artere periferice pulsatile; ap
digestiv abdomen suplu, uor sensibil la palpare n epigastru, mobil cu micrile
respiratorii, ficat i splina n limite normale, tranzit intestinal normal; ap urinar loje
renale libere, Giordano (-) bilateral, diureza=500ml, UF=1000ml/24ore, efluent limpede.
87
CASE REPORT:
REPEATED HYPOGLICEMIC EPISODES IN A DIABETIC PATIENT WITH
ESRD AND PERITONEAL DYALISES WITH ICODEXTRIN SOLUTION
88
More and more patients suffering from ESRD are included in peritoneal dialyses
programes. Diabetic patients with ESRD and CCDP have to be carefully monitorised
because of the interferences between insulin treatment and dialyses solutions. Icodextrin
(Extraneal) peritoneal dialysis solution is a glucose polimer derived from cornstarch wich
has a low carbohydrates absobtion and is prefered in diabetic patients because of a better
glicemic control and because it can improve long-dwell ultrafiltration and clearance of
creatinine for patients with High-average or High PET.
These glucose polymers are absorbed via the peritoneal route and metabolised to
oligosaccharides (mainly maltose), which interfere with glucose. Many glucometers are
using the glucose dehydrogenase, an enzyme of the pyrroloquinolinequinone class, for
catalysing the conversion of glucose to gluconic acid and reducing Nicotinamide adenine
dinucleotide Acid (NADH). The quantity of NADH is in direct proportion with the
glicemia. The glucose dehydrogenase reacts with the free reducing group of the glucose
molecule located at the end of each saccharide chain and this aditional quantity of NADH
is leading to an overestimation of the glicemia.
We will present the case of a patient with diabetes mellitus type I and ESRD in
dialysis peritoneal program with Icodextrin, that presented several hypoglicemic
episodes because of the inadequacy measurements of glycemia using glucose
dehydrogenase pyrroloquinolinequinone glucometers.
The patient, a woman of age 43 years, with diabetes mellitus type I from 1994 in
treatment with aspart insulin: 10U( at 8 a.m.)- 10U( at 14 a.m.)- 10U( at 8 p.m.) and
glargina insulin: 10U( at 10 p.m.); diabetic nephropathy(2006); renal hypertension;
dyslipidemia; ESRD in dialysis peritoneal program from 07.06.2008. She presented for
fever (38-39 C), hiccup (for the last 24 hours), confusional state (initially anxiety, then
she refused to speak and to eat for the last 48 hours). The patient presented several
hypoglicemic episodes (noncompliance at the diet and
medical treatment,
noncompliance at the indication of not using glucose-dehydrogenase glucometers) and
she has stopped the antidepressive medication for the last two months.
Physical examination: fever(38C), anxiety, confusion; nonreactive to verbal
stimuli but reactive to pain; nuchal rigidity to passive flexion, opisthotonus; pale skin and
mucous membranes; no edema; pulmonar exam normal; cardiovascular exam: TA230/100mmHg, HR-90/min; mild epigastric tenderness ; no hepatosplenomegaly;
Giordano (-) bilateral, diuresis -500ml/day, ultrafiltrate -1000ml/day, clear peritoneal
effluent.
89
ASPECTE EPIDEMIOLOGICE IN DIABETUL ZAHARAT TIP 2 - CAD ( CENTRUL ANTIDIABETIC) SIBIU, 1975 2007
Dr. Ghise Ghe.*, Dr. Strugariu Minola*, Dr. Mot Alina*, Dr. Natea Carmen
Narcisa *, **;
*Spitalul Clinic Jud. de Urgenta Sibiu Clinica Diabet, Nutritie si Boli Metabolice ;
90
Introducere si obiective:
Incidenta diabetului zaharat tip 2 este in crestere in intreaga lume, DZ fiind considerat ca
boala endemica; din pacate, complicatiile cronice ale DZ au consecinte devastatoare
privind calitatea vietii, speranta de viata a pacientilor, presupunand mari costuri atat
pentru individ cat si pentru societate.
Autorii si-au propus analiza catorva aspecte epidemiologice ale DZ tip 2 in teritoriul
arondat CAD Sibiu cu intentia de a dsprinde particularitatile locale ale acestei probleme
pentru ca astfel sa poata gasi metodele necesare imbunatatirii calitatii ingrijirii.
Material si metoda:
Studiul s-a realizat printr-o metoda retrospectiva, datele fiind obtinute de la Centrul
Judetean de Statistica si Centrul de diabet in perioada 1975 2007. In studiul noastre am
urmarit:
1) Prevalenta si incidenta DZ;
2) Rata complicatiilor in momentul diagnostic;
3) Evolutia ratei mortalitatii;
4) Perioada de supravietuire si speranta de viata.
Rezultate:
Prevalenta DZ in teritoriul arondat orasului Sibiu a crescut de la 1577 ( 1,6%) in 1975,
la 6,2% - in 2007; incidenta a crescut de la 77,59 1975 la 253,16 in 2007 ; rata
mortalitatii la persoanele diabetice s-a mentinut relativ stabil 5,5% ; repartitia pe sexe a
fost : barbati : 51, 63%, femei 48,36% ; in raport de tipul de DZ : DZ tip I 20, 38%,
tip II 79, 61% ; durata medie a evolutiei aparente a DZ a fost de 16,3 ani ; ponderea cea
mai mare a deceselor a fost inregistrata la cei cu o durata a diabetului cuprinsa intre 6
10 ani si fiind aproape dubla fata de cei cu evolutia DZ cuprinsa intre 1-5 ani si 11 -15
ani ; mortalitatea cea mai mare a fost inregistrata la grupele de varsta 60- 69 ani si 70 -79
ani, fiind de 2,5 ori mai mare fata de grupa de varsta 50-59 ani. Cauzele principale de
deces au fost : boli cardiace- 61, 33%, AVC 8,42%, tumori 12, 74%, boli ale ap.
respirator 9,8%. altele 7,7%.
Concluzii :
*Spitalul Clinic Jud. de Urgenta Sibiu Clinica Diabet, Nutritie si Boli Metabolice ;
** Facultatea de Medicina Victor Papilian Sibiu, ULBS
92
1) The prevalence and incidence of diabetes followed the world and Romanian
tendency ;
2) The higher increase in the last years was due not only by the natural evolution of
diabetes as well an active manner of diagnosis;
3) The incidence of chronic complications at the moment of diagnosis is false
decrease by the lack of investigations;
4) We have no data about gestational diabetes this aspect will be effective and
efficient by a strong collaboration with GP and gynaecologists.
DEFINITIE
Boala celiaca (numita si celiachie, intoleranta la gluten) este o boala digestiva
cronica, cauzata de ingestia la gluten, ce implica absorbtia nutrientilor, vitaminelor si
mineralelor de catre intestin.
INTRODUCERE
Aceasta lucrare are ca scop scoaterea in evidenta a relatiei diabet celiachie,
celiachia pare a fi frecventa la persoanele ce sufera de o boala autoimuna-diabet tip I.
MATERIAL SI METODA
Copii
93
2.
3.
Definition
Celiac disease/illness ( also called celiac, immobility to tolerate gluten) is a
chronic digestive disease, caused by the intolerance of gluten, which prevents the
absorption of the nutrients, the vitamins and the minerals by the intestine.
Introduction
This paper work is meant to illustrate the relationship between diabetsand celiac.
Celiakie appears more frequently to the persons who suffer from an autoimmune diseasediabetes type I.
Material And Method
It was studied the case of a child in the third class of St. Mary Clinic Hospital
since the age of three.
Results
Objectives:
- Diagnosis based on clinical, paraclinical and lab examinations;
- Clinical state. Course of disease, complications, treatment, prognosis;
- The family capacity of accepting the diagnosis and treatments.
Conclusions
1. Difficulty in diagnosing the celiac syndrome at a diabetic child, the doctor
having to eliminate the possibility of another frequent digestive illness ( the
irritable intestine syndrome, on alimental intolerance or an inflammatory
disease of the intestine).
2. The necessary relationship between patient-mother-doctor-nurse.
94
SCOPUL STUDIULUI
Suferina vascular n steatoza hepatic (S.H.) este complex: arterial,
venoas, limfatic i arteriocapilar, ca expresie a tulburrilor metabolice complexe cu
care se asociaz S.H.
MATERIAL I METOD
Au fost studiai 104 bolnavi: 60 femei (F) i 44 brbai (B) cu vrste cuprinse
ntre 30 i 60 ani.
Din 44 B: 8 erau cu diabet zaharat (DZ) tip 1, 24 cu DZ tip 2 i 12 cu scderea
toleranei la glucoz (STG), 28 prezentau boal varicoas manifest clinic i toi
prezentau retinopatie.
Din 60 F: 4 aveau DZ tip 1, 26 cu DZ tip 2 i 30 cu scderea toleranei la
glucoz (STG), 48 prezentau boal varicoas manifest clinic, retinopatie diagosticat
oftalmoscopic la 46.
Studiul s-a bazat pe datele clinice, ecografie abdominal, oftalmoscopie.
Observaiile noastre ne-au permis urmtoarele concluzii:
1.
2.
3.
4.
5.
95
Goal: The vascular involvment in Liver Steatosis (LS) is very complex: arterial,
venous, lymphatic and arterio-capillary, due to the complex metabolic changes associated
with LS.
The study was done on 104 patients, 60 females (F) and 44 males (M), with ages
between 30 and 60 years old.
From 44 M: 8 had Diabetes Mellitus (DM) type 1 and 22 had DM type 2, 12
presented with glucose intolerance (IGT) and 28 presents with varicose disease and all of
these patiens had retinopathy.
From 60 F, 4 presented with DM type 1, 26 presented DM type 2, 48 presented
with varicose disease manifested and 30 IGT, 46 with retinopathy siagnosed by
ophtalmoscope.
The study was based on clinical data, abdominal ultra-sound and ophtalmoscopic
examination of the retina.
After examinations we draw the following conclusions:
1.
2.
3.
4.
5.
96
97
98
whom the initial treatment was maintained (6.3 vs 16.0 years, p<0.05). The patients with
the highest education level had the earliest insulin initiation (mean DD=5.4 years).
CONCLUSIONS
There were no significant correlations between the duration from
diagnosis of type 2 diabetes to insulin initiation and any anthropometrical or laboratory
parameters used in current practice. The education level and the female gender seem to
influence this interval. In our study, the number of treatment intensifications in the first 2
years following diagnosis was the only predictive factor for the time interval to insulin
initiation.
99
Material: The study comprised 27 patients, aged between 2 and 18 years old. The
selection criterion for referring the patients to our clinic was the value of the basal
glycemia over 100mg% in two separate determinations.
Methods: The anamnestic data about the presence of diabetes and other metabolic
diseases in the families of the patients was gathered from the observation charts. We
calculated the BMI (kg/m2) and compared with reference charts for age. The biological
investigations were performed in the following order: basal glycemia, glycemic profile,
OGTT and HbA1, insulinemia (ui/ml), the insulino-resistance index HOMA and, in
selected cases, depending on the insulinemia, the anti-GAD antibody levels were
determined.
Results: From a total of 27 patients, 5 (18,5%) were diagnosed with diabetes, 4/27
(14,8%) were diagnosed with diabetes type 1 (at the first determination of glycemia) and
1/17 (3,7%) was diagnosed with diabetes type 2 (after performing a glycemic profile and
OGTT). The rest 22/27 (81,48%) were diagnosed with the following alteration: 9/27
(33.33%) decreased glucose tolerance (DGT glycemia at 2h>140mg%) and 13/27
(48,14%)had normal basal glycemia an OGTT. The insulin resistance index HOMA was
elevated in 2 children who presented simultaneously obesity and signs of insulin
resistance. The basal level of insulin was decreased in one patient with diabetes type 1
and elevated in two patients (one of which was diagnosed with diabetes type 2). The
therapeutic approach differed depending on the diagnosis: for the 4 patients diagnosed
with type 1 diabetes we initiated basal insulin therapy in 3 and basal bolus therapy (BBT)
in 1 patient, the patient diagnosed with type 2 diabetes was treated with an oral antidiabetic agent (metformin), 9 patients with decreased glucose tolerance remain in
observation with special diet recommendations, 13 patients with minor symptoms are
going to be evaluated periodically.
Conclusions: The screening of the glycemic value in the national program for evaluation
of populational health offers the possibility of early detection of glycemic alterations,
early detection of the infantile population who presents basal hyperglycemia and arly
diagnosis of diabetes. The classic symptoms at the onset of diabetes can be, sometimes,
ignored by the family, therefore any glycemic value above norm needs further
exploration. In children, one single value above normal does not always imply diabetes
because even the prelevation of a blood sample cand bring a significant amount of stress
in apatient. But still, a glycemic value above nomal must not be ignored and needs a
second determination.
103
104
105
106
concav crescatoare dupa masa de pui, poate recomanda consumul de peste in profilaxia
afectiunilor metabolice.
109
Introduction: The metabolic syndrome groups numerous cardiovascular risk factors and
frequently associates type II diabetes mellitus (DM2). There are though few data
regarding its importance and frequency in type I diabetes mellitus patients (DM1).
Aim: Comparative evaluation of prevalence of macrovascular complications in DM1 and
DM2 patients with metabolic syndrome (SM).
Methods: In the study there were included 1429 patients, which were admitted in 2006 in
the diabetes department of the institute., of which 270 with DM1 (136 men, 134 women,
mean age 42.54+14.36 years) and 1159 with DM2 (518 men, 641 women, mean age
60.17+10.48). SM was present in 50 (18.51%) of the DM1 patients, respectively 970
(83.69%) of the DM2 patients, the rest of the patients not meeting the diagnostic criteria.
110
The following parameters in the patients file were analyzed: age, sex, waist
circumference, hypertension history, HbA1c, total cholesterol (CT), HDL cholesterol,
LDL cholesterol, triglycerides (TG), triglyceride/HDL cholesterol ratio, coronary heart
disease (CHD), myocardial infarction (MI), stroke, peripheral arteriopathy disease
(PAD). SM was defined according to the IDF criteria, with the specification that in DM1
patients, glucose blood level was not considered as diagnostic criterion.
Results: Patients with DM1 and SM had lower mean age (49.1613.24vs.60.2510.33,
p<0.001) compare to patients with DM2 and SM (p<0.001) and a significantly longer
disease duration (12.589.63vs.9.398.21, p<0.01), relation that maintained in the sex
difference also. The first group, compared to the second group, had significantly higher
HbA1c (10.522.23vs.9.512.40, p<0.01), CT (223.5661.53vs.206.4355.05, p<0.05),
LDL cholesterol (144.1045.71vs.126.9743.06, p<0.05) and TG (294.45311.79 vs.
199.25p170.72, p<0.05) levels. There were significant differences in hypertension
history (HTA, OR 2.09;95% CI:1.15-3.81) in patients with DM2 and SM compared to
patients with DM1 and SM. There were no significant differences between the two
groups regarding CHD, stroke, PAD. In exchange patients with DM1 and values of waist
circumference in the superior distribution tertile compared to the values in the lower
distribution tertile, had a significantly higher prevalence of CHD (OR 10.18;95% CI:
3.76-27.56). Both DM1 and DM2, in the superior distribution tertile of waist
circumference compared with those in the lower distribution tertile had a higher
prevalence of HTA (OR 8.43;95% CI: 2.92-24.33, OR 2.89; 95% CI: 2.06-4.04). After
analyzing TG/HDL distribution tertiles, patients with DM1 in the superior tertile
compared with the patients in the lower tertile had a higher prevalence of CHD (OR 2.36;
95% CI: 1.02-5.46), hypertension history (OR 2.26; 95% CI: 1.07-4.77) and the patients
with DM2 had a higher prevalence of CHD (OR 1.66; 95% CI: 1.22-2.27), PAD (OR
1.65; 95% CI: 1.05-2.59), MI (OR 3.43; 95% CI: 1.56-7.55) and hypertension (OR 2.34;
95% CI: 1.65-3.31). Patients with SM (DM1 or DM2) compared with patients without
SM had a significantly higher prevalence of CHD (OR 3.09; 95% CI: 1.30-7.34), (OR
1.74; 95% CI: 1.26-2.41). There were no statistically significant differences between the
analyzed groups regarding the prevalence of stroke and PAD.
Conclusions: Metabolic syndrome represents a risk factor for cardiovascular disease and
is associated with a higher prevalence of macrovascular complications both in type I and
type II diabetes mellitus patients.
111
INTRODUCERE:
Gravidele cu diabet zaharat tip 1 sau tip 2 sunt supuse unor riscuri extreme de
ridicate in ceea ce priveste sanatatea lor si a copiilor ( risc de fat macrosom , malformatii
intrauterine ale fatului , posibilitate de polihidroamnios , hipoxia fatului la nastere
,intreruperea de sarcina)
SCOPUL LUCRARII:
Am vrut sa determinam in ce masura educatia pacientelor cu diabet zaharat pe
parcursul sarcinii ajuta la evitarea cresterii excesive in greutate a gravidei , a
dezechilibrului glicemic si a altor complicatii care pot aparea pe parcursul sarcinii
MATERIAL SI METODE :
In colaborare cu Cabinetul de Obstetrica Ginecologie din cadrul clinicii am
selectionat un grup de 16 paciente cu diabet zaharat (5 cu tip1 si 11 cu tip 2 ) in perioada
01.01.2006 01.09.2008 . Am facut ancheta nutritionala , chestionar alimentar cu privire
la tipul alimentatiei (din punct de vedere calitativ si cantitativ ), continutul in
macronutrienti si micronutrienti, ajustarea dozelor de insulina , determinarea
hipoglicemiilor , monitorizarea greutatii .
REZULTATE :
Am constatat ca 6 paciente proveneau din mediul rural si 10 din mediul urban cu
varste cuprinse intre 20 respectiv 36 ani .Dintre acestea 60% la prima sarcina , 30% la a2a sarcina si 10% la a-3a sarcina.
Am observat : la pacientele din mediul rural 67% consuma excesiv slanina , untura
si mamaliga evitand fructele
- 70% au luat foarte mult in greutate
(aprox.60kg)
- 72% prezinta dezechilibru
glicemic
la pacientele din mediul urban 80 % au un regim alimentar mai
echilibrat cu 2 3 mese /zi
- 62% prezinta o greutate adecvata
perioadei de gestatie
- 84% au un profil glicemic mai bun
112
CONCLUZIE:
Am constatat lipsa de informare si dezinteres al pacientelor din mediul rural cu privire
la educatia specifica diabetului zaharat in perioada sarcini
INTRODUCTION:
Pregnant women with type 1 diabet mellitus and type 2 are subject to extremely high
risks in tems of their health an children (risk of macrosomia , intrauterine malformations
of the fetus , possibly polihidroamnios , fetal hypoxia at birth , the interruption of
pregnancy).
AIMS:
I wanted to determine to what extent education for patients with diabetes during
pregnancy help prevent excessive weight increase of pregnant women , the imbalance in
blood gloucose and other complications that can occur during pregnancy.
MATERIALS AND METHODS:
In collaboration with the Cabinet of Obstetric Gynecology in our clinic we selected 16
pacients with diabetes (5 with type 1 and 11 with type 2), between 01.01.2006
01.09.2008. I did nutritional survey ,questionnaires food on the type of food (in
qualitative and quantitative) , cotent macronutrienti and micronutrients , adjustment of
insulin , the hypo , monitoring weight.
RESULTS :
I found that 6 pacients were from rural and 10 urban , aged between 20 an 36 years of
these 60% - 1 of pregnancy , 30% in the 2-d pregnang and 10% in the 3-rd task.
I obsverved in pacients from rural area 67% consume excessive slanina , larg and
polenta avoiding fruits
-
113
114
115
116
117
118
CKD ones (17.85% vs. 4.83%). All cause mortality was positively correlated with age,
HbA1c and cholesterol levels and negatively with eGFR
CKD associated to DM needs special attention from a multidisciplinary team in
order to improve severity and poor prognosis.
120
insulin a trebuit intensificat. Prin tratarea bolii autoimune asociate s-a reuit
ameliorarea controlului glicemic.
Concluzii:
Din cauza frecventei asocieri a diabetului de tip 1 cu alte afeciuni autoimune trebuie
avut n vedere investigarea acestor pacieni (mai ales cnd debutul bolii este la vrsta
adult) pentru depistarea precoce a posibilelor boli autoimune. Tratarea acestora permite
obinerea unui control metabolic mai bun i prevenirea apariiei complicaiilor pe termen
lung.
121
Conclusions:
Due to the frequent association of type 1 diabetes mellitus with other autoimmune
diseases, functional screening for autoimmune diseases in these patients must be done,
especially in those with type 1 diabetes onset at advanced age. The treatment of
associated diseases allows a better metabolic control and prevention of long-term
complications.
122
Rezultate.
Numr total nou
depistai
Galai
Tecuci
TOTAL
DZ tip 1
Numr
total tip
1
1564
14
0,9
10
423
1987
14
0,7
10
Sex
M
DZ diabet zaharat, % - procent din totalul persoanelor cu diabet zaharat nou depistate,
M masculin, F feminin,
DZ tip 2 (ADO, insulin i ADO, insulin, diet)
Numr total
nou depistai
Sex
Numr
total tip 2
ADO
Diet
Galai
1564
1550
767
783
889
57
514
Tecuci
423
423
203
220
271
12
129
Total
1987
1973
970
1003
1160
69
643
DLP
Galai
Tecuci
TOTAL
HTA (%)
BCV (%)
1383 (89,2%)
128 (8,26%)
1122 (72,4%)
839 (54,1%)
311 (73%)
186 (43,9%)
184 (43,4%)
1567 (78,8%)
115 (27,1%)
243 (12,2%)
123
1433 (72,1%)
1025 (51,5%)
114 (7,35%)
18 (1,16%)
Tecuci
58
(13,7%)
2 (0,47%)
Total
172
(8,6%)
20 (1.0%)
927
(59,8%)
176 (41%)
1103(55,5
%)
24 (1,55%)
702 (44,8%)
104 (6,6%)
3 (1,76%)
198 (46,8%)
84 (19,8%)
27 (1,3%)
900
(45,2%)
%)
188(9,4
numr, % - procent
Nr. numr, % - procent
Educaie 1987 cazuri (100%); automonitorizare - 276 diabetici (13,43%).
Concluzii.
1. n primele 6 luni ale anului 2008 s-au nregistrat 1987 cazuri noi de diabet, cu 852
cazuri mai mult fa de anul precedent.
2. La diagnosticare se constat complicaii cronice n procente relativ crescute precum i
asocierea frecvent a hipertensiunii arteriale, bolii cardiovasculare i dislipidemiei.
3. Screening-ul complicaiilor cronice i al comorbiditilor necesit a fi mai activ
pentru depistarea mai precoce a acestora n scopul mbuntirii managementului
clinic i reducerii riscului cardiovascular.
4. Iniierea terapiei cu metformin la debutul DZ tip 2 n 2008 s-a realizat ntr-un procent
apreciabil mai mare dect n anul precedent.
5. Extinderea epidemiologic a diabetului zaharat impune elaborarea unor programe mai
active de depistare la grupele cu risc crescut, folosirea celor mai adecvate metode de
educaie i popularizarea aspectelor legate de complicaii i comorbiditi.
124
We analyzed:
- epidemiological aspects regarding diabetes type, age, sex
- the screening of chronic complications
- the association with other disorders included in metabolic syndrome
- therapeutic structure
st
Results.
125
Galai
Tecuci
TOTAL
Type 1 diabetes
Total no.
type 1
%
Sex
M
1564
14
0,9
10
423
1987
14
0,7
10
No. number, % - percent from total number of newly diagnosed persons, M masculin,
F - feminin
Total no.
newly
diagnosed
OAD
Diet
Galai
1564
1550
767
783
889
57
514
Tecuci
423
423
203
220
271
12
129
Total
1987
1973
970
1003
1160
69
643
DLP
Galai
Tecuci
TOTAL
HT (%)
CVD (%)
1383 (89,2%)
128 (8,26%)
1122 (72,4%)
839 (54,1%)
311 (73%)
186 (43,9%)
184 (43,4%)
1567 (78,8%)
115 (27,1%)
243 (12,2%)
126
1433 (72,1%)
1025 (51,5%)
114 (7,35%)
18 (1,16%)
Tecuci
58
(13,7%)
2 (0,47%)
Total
172
(8,6%)
20 (1.0%)
927
(59,8%)
176 (41%)
1103(55,5
%)
24 (1,55%)
702 (44,8%)
104 (6,6%)
3 (1,76%)
198 (46,8%)
84 (19,8%)
27 (1,3%)
900
(45,2%)
188(9,4
%)
- percent
No. number, % - percent
Conclusions.
127
128
induces the appearance of obesity and overweight. Promoting and stimulating the
increase of physical effort bring important benefits in losing weight, in preventing weight
gain, in reducing cardiovascular risk (by decreasing insulinresistance) and in obesity and
overweight management.
Aims. The assessment of physical activity in relation with individual and external
factors and with ponderal status in general population of Galati County.
Method and study group. Study group included 311 persons selected based on
general representativity for age, sex and residence (urban, rural) in adult population of
Galati County. Physical activity was quantified by yes/no answer regarding carrying
out of exactly or more than 30 minutes of physical effort at least 3 times a week
according to Obesity Screening Record form Romanian Association for the Study of
Obesity. We assessed anthropometric parameters: weight, height, waist circumference
(WC) and calculated body mass index (BMI). We adapted OMS criteria for quantifying
ponderal categories based on BMI values: underweight, normalweight, overweight
and obesity. The risk categories of WC were as following: low risk ( WC < 80 cm in
women and < 94 cm in men), medium risk (WC between 80-88 cm in women and
between 94-102 cm in men) and high risk (WC > 88 cm in women and > 102 cm in
men). Medium and high risk categories indicate abdominal (visceral) obesity. Statistical
analysis was performed with SPSS 13.0 program. Statistical significance was reached for
p<0.05.
Results. The analysis of physical activity level showed that 59.16% of the
subjects perform physical effort more than 30 minutes of physical effort at least 3 times a
week. Men carry out physical activity in a higher extent (61.82%) than women (58.0%)
(p>0.05). Generally, more than 50% of both men and women performed physical activity.
We noticed a higher percent of affirmative answers in men from urban area (65.67%)
than from rural area (55.81%), while women had comparable affirmative answers in
urban (58.87%) and rural areas (56.58%) (slightly higher for urban residence). We
noticed a higher prevalence of physical activity for age between 20-29 years (77.14%),
50-59 years (67.39%) and 60-65 years (57.89%) than for age between 30-39 years
(52.05%), 40-49 years (51.78%) and over 65 years (44.68%) as well as during summer
time. These differences were statistically significant (p<0.05). The relation between
physical activity and ponderal status. Persons who carry out physical effort had
significantly lower BMI (25.82 5.48 kg/m2) than those who do not carry out physical
effort (28.40 6.19 kg/m2). The persons who perform physical activity are normalweight
and overweight in a significantly higher extent, while persons who do not carry out
physical effort as required are more frequently obese (p<0.05). WC is significantly lower
(89.98 15.49 cm) and is included more in low and medium risk categories in subjects
who perform physical activity as needed than in those who do not (94.48 17.17 cm)
which are included more in high risk category (p<0.05).
Conclusions. Men perform more frequent physical activity, especially in urban
area. Persons with age between 20-29 years and between 50-65 years, as well as during
summer time carry out physical effort more frequently. Active persons are more often
normalweight and overweight and are included in low and medium risk categories of
WC, while sedentary persons are more often obese and have high risk of WC values
130
132
Results. As reference the results of In Body 3.0 were used, where total body water
(TBW) was of 42.128.38L, distributed as following: 28.215.52L IBW (intracellular
body water) and 13.892.98L EBW (extracellular body water) (results different for
p<0.05 than reference). The results of BCM Fresenius were: 37.477.76L, distributed in
20.44.23L (IBW) and 17.43.26 L(EBW). The results for BMI (kg/m) were different:
30.414.55(In Body) and 30.484.55(Omron) (p<0.05). Determined weight was similar:
84.214.54 kg(In Body) and 84.4214.56 kg(Omron) (p<0.05). The percentage of fat
tissue was different 31.997.67%(In Body) vs. 35.1410.03%(Omron) (p<0.05),
respectively 38.298.05%(Fresenius) (p<0.05), with a higher value for women than men:
35.316.46%(In Body), 40.827.48%(Omron) (p<0.05) (women) vs. 27.346.69% (In
Body), 27.287.12% (Omron) (p=0.054) (men).
Were also recorded different information regarding Resting Metabolism Rate:
1452.94211.25 kcal/day (In Body) and 1653.52241.82 kcal/day (Omron) (statistically
different for p<0.05).
Conclusions. Under water weighting and DEXA (dual-energy-x-ray absorptiometry)
remain the gold standard procedures for determining body composition, but they are
inaccessible and expensive. The majority of obtained results are statistically different.
Discussions. The obtained data are helpful in determining body composition in patients
with metabolic syndrome, as bio-impedance is a simple, noninvasive, easy to use method,
but choosing any of the devices above will influence the therapeutic behavior in clinical
practice.
Supported by: Grant PNCDI2 52164/2008 from the Romanian Research Ministry.
Mariana Andreica, Nicolae Miu, Simona Cainap, Bogdan Lucian, Lucia Slavescu,
Claudia Bolba, Rodica Cornean, Tudor L. Pop
Clinica Pediatrie II, UMF "Iuliu Hatieganu", Cluj-Napoca
133
Mariana Andreica, Nicolae Miu, Simona Cainap, Bogdan Lucian, Lucia Slavescu,
Claudia Bolba, Rodica Cornean, Tudor L. Pop
2nd Pediatric Clinic, University of Medicine and Pharmacy Iuliu Hatieganu, ClujNapoca
Associated autoimmunity and type 1 diabetes mellitus(T1DM) is well known and
can exist individually or combined in syndromes. This association implicates the
involvement of different genes of the major histocompatibility complex(MHC) such as
human leukocyte antigen(HLA) DR and DQ. The most common autoimmune
associations are represented by autoimmune thyroid disease, celiac disease, Addisons
disease and others such as chronic idiopathic arthritis or vitiligo.
134
We have studied 49 children and adolescents admitted in The 2nd Pediatric Clinic
in Cluj-Napoca between 2005 and 2007. We have performed screening tests for
autoimmune thyroid disease by measuring thyroid peroxidase and thyroglobulin
autoantibodies, TSH and free T4. The celiac disease screening has been made by
antiendomysial and trans-glutaminase autoantibodies and Addisons disease screening
has been made by basal cortisol and antiadrenal antibodies. We have also performed
screening for chronic idiopathic arthritis and other collagen diseases by determining
rheumatoid factor and antinuclear and anti DNA antibodies.
Autoimmune thyroid disease was discovered in 3(6,1%) patients of which 1 had
hyperthyroid function(Basedow-Graves disease), one associated celiac disease and one
had autoimmune polyendocrine syndrome type II. Celiac disease was revealed in 4
patients(8,1%). Addisons disease was revealed in one patient(2%) and was associated in
the autoimmune polyendocrine syndrome type II. Two patients(4%) had had chronic
idiopathic arthritis and one of them had vitiligo lesions.
As a conclusion, associated autoimmunity and T1DM should emphasize the
important role of screening in this patients, by well standardized protocols, in order to
ameliorate the natural history of T1DM and to prevent the precocity of developing micro
and macro- vascular complications of the disease.
135
Rezultate i discuii. Din cei 119 subieci, 15 (12,60%) au prezentat toleran normal la
glucoz (TNG), restul 104 subieci (87,40%) prezentnd modificri ale metabolismului
glucidic, astfel: 46 subieci (38,65%) au fost diagnosticai cu diabet zaharat (DZ), 24
( 20,16%) subieci cu alterarea glicemiei a jeun (IFG), 3 (2,52%) subieci cu scderea
toleranei la glucoz (IGT), 23 (19,32%) subieci cu intoleran combinata la glucoz
(CGI= IFG+IGT) i 8 (6,72%) subieci cu disglicemie.
Corelaia dintre circumferina abdominal (CA) i raportul TG/HDL>3 ca markeri ai
insulinorezistenei si perturbrile metabolismului glucidic
Caracteristica
Brbai
Femei
(numr 60)
(numr 59)
CA (cm)
<94
94-101
102
<80
80-87
88
Numr (%)
16
(26,66%)
11
(18,33%)
33 (55%)
6 (10,16%)
8 (13,55%)
45
(76,27%)
TG/
>3
4 (25%)
22
(66,66%)
0 (0%)
2 (25%)
HD
L
8
(72,72%)
14
(31,11%)
TNG
0 (0%)
1 (12,5%)
1 (4,54%)
0 (0%)
0 (0%)
2
(14,28%)
DZ
1 (25%)
2 (25%)
7
(31,81%)
0 (0%)
1 (50%)
5
( 35,71%)
IFG
2 (50%)
2 (25%)
4
(18,18%)
0 (0%)
0 (0%)
2
(14,28%)
IGT
0 (0%)
0 (0%)
1 (4,54%)
0 (0%)
0 (0%)
0 (0%)
CGI
1 (25%)
2 (25%)
7
(31,81%)
0 (0%)
0 (0%)
4
(28,57%)
disglicemi
e
0 (0%)
1 (12,5%)
2 (9,09%)
0 (0%)
1 (50%)
1 (7,14%)
TG/
<3
12 (75%)
11
(33,33%)
6 (100%)
6 (75%)
HD
L
3
(27,27%)
31
(68,88%)
TNG
2
(16,66%)
0 (0%)
1 (9,09%)
5 (83,33%)
1 (16,66%)
2 (6,45%)
DZ
4
(33,33%)
0 (0%)
4
(36,36%)
0 (0%)
1 (16,66%)
21
(67,74%)
IFG
4
(33,33%)
2
(66,66%)
2
(18,18%)
1 (16,66%)
2 (33,33%)
3 (9,67%)
136
IGT
0 (0%)
1
(33,33%)
0 (0%)
0 (0%)
1 (16,66%)
0 (0%)
CGI
1 (8,33%)
0 (0%)
3
(27,27%)
0 (0%)
1 (16,66%)
4 (12,9%)
disglicemi
e
1 (8,33%)
0 (0%)
1 (9,09%)
0 (0%)
0 (0%)
1 (3,22%)
Dintre brbaii cu CA 102 cm, 66,66% au prezentat raport TG/HDL > 3, spre deosebire de
femei, la care nu am observat corelaie ntre CA i raportul TG/HDL > 3 (31,11%).
Att la brbai ct i la femei, am observat corelaie ntre CA 102 cm, respectiv CA 88 cm i
perturbrile metabolismului glucidic, indiferent ns de valoarea raportului TG/HDL.
Concluzii. Prezena obezitii abdominale i implicit a perturbrilor metabolismului lipidic,
impun investigarea metabolismului glucidic prin efectuarea TTGO-ului, n vederea depistrii
perturbarilor metabolismului glucidic n stadii precoce.
137
Men
Women
( 60 subjects)
( 59 subjects)
WC (cm)
<94
94-101
102
<80
80-87
88
Number (%)
16
(26,66%)
11
(18,33%)
33 (55%)
6 (10,16%)
8 (13,55%)
45
(76,27%)
TG/
>3
4 (25%)
22
(66,66%)
0 (0%)
2 (25%)
HD
L
8
(72,72%)
14
(31,11%)
TNG
0 (0%)
1 (12,5%)
1 (4,54%)
0 (0%)
0 (0%)
2
(14,28%)
DZ
1 (25%)
2 (25%)
7
(31,81%)
0 (0%)
1 (50%)
5
( 35,71%)
IFG
2 (50%)
2 (25%)
4
(18,18%)
0 (0%)
0 (0%)
2
(14,28%)
IGT
0 (0%)
0 (0%)
1 (4,54%)
0 (0%)
0 (0%)
0 (0%)
CGI
1 (25%)
2 (25%)
7
(31,81%)
0 (0%)
0 (0%)
4
(28,57%)
disglicemi
e
0 (0%)
1 (12,5%)
2 (9,09%)
0 (0%)
1 (50%)
1 (7,14%)
TG/
<3
12 (75%)
11
(33,33%)
6 (100%)
6 (75%)
HD
L
3
(27,27%)
31
(68,88%)
TNG
2
(16,66%)
0 (0%)
1 (9,09%)
5 (83,33%)
1 (16,66%)
2 (6,45%)
DZ
4
(33,33%)
0 (0%)
4
(36,36%)
0 (0%)
1 (16,66%)
21
(67,74%)
IFG
4
(33,33%)
2
(66,66%)
2
(18,18%)
1 (16,66%)
2 (33,33%)
3 (9,67%)
IGT
0 (0%)
0 (0%)
0 (0%)
1 (16,66%)
0 (0%)
138
(33,33%)
CGI
1 (8,33%)
0 (0%)
3
(27,27%)
0 (0%)
1 (16,66%)
4 (12,9%)
dysglicem
ia
1 (8,33%)
0 (0%)
1 (9,09%)
0 (0%)
0 (0%)
1 (3,22%)
From the men with WC 102 cm, 66,66% showed TG/HDL > 3 ratio, comparative with the
women, on which have not observed the correlation between WC and TG/ HDL > 3 ratio
(31,11%).
Both women and men we observed the correlation between WC 102 cm, respectively WC
88 cm with the disturbances of glycemic metabolism, no matter the value on TG/HDL ratio.
Conclusions. The presence of abdominal obesity and implicitly of the disturbances of lipidic
metabolism, makes necessary the investigation of the glycemic metabolism
through
effectuation of the OGTT, with a view to early tracking of the disturbances of glycemic
metabolism.
139
MG
DS
MAG
E
MOD
D
(mg/dl
)
(mg/dl
)
(mg/dl
)
G
(mg/dl
)
T
min
G
(mg/dl
)
G
(mg/dl
)
T
min
- G
(mg/dl
)
22,58
39
40
13
61
50
62
NGTdieta 100,21
fara restrictie 11,5
de HC
8
21
11,15
22
25
12
13
20
13
23
17,08
29
50
20
Subiectul cu IFG prezint excursii glicemice zilnice mai numeroase si mai ample
(MAGE crescut) i reproductibilitate de la o zi la alta a profilului glicemic mai redus
140
(MODD crescut) comparativ cu subiectul cu NGT. Comparnd MIME dup TTGO (cu
75g glucoz) i dup masa cu 75g HC, am observat valori mai mari ale celor 3 elemente
(G, T,- G) dup TTGO, la subiectul cu IFG. La subiectul cu IFG s-au observat
valori semnificativ mai mici ale indicilor variabilitii glicemice pe perioada dietei cu
200g HC/zi, fa de perioada dietei fr restricie de HC.
Concluzii: Analiza profilului excursiilor glicemice la persoanele cu i fr modificri ale
metabolismului glucidic poate fi util n definirea valorilor diagnostice i a celor int
pentru diabet.
Background and aim. The glycaemic variations observed in non diabetic subjects are
primarily related to the postprandial metabolic responses. In order to exactly quantify
glycemic variability, specific tools of calculation can be used: MAGE (Mean Amplitude
Glycemic Excursion), MODD (Mean Of Daily Differences), MIME (Mean Indices of
Meal). The MAGE index evaluate the intra-day major glycemic excursions, ignoring
minor glycemic excursions. MODD index appreciate the glycemic variation in the same
moment from different day, at the same patient. MIME evaluate the meal-related
glycemic excursions.
The objective of this study is to compare: 1. glycemic instability at 2 subjects with diet
without restriction of carbohydrates (CH), one of them with normal glucose tolerance
(NGT) and the other with impaired fasting glucose (IFG); 2. glycemic instability in
subject with IFG diet without restriction of CH versus diet with restriction of CH (200g
CH/day).
Material and method: There were calculated five specific index of glycemic instability
(MBG, SD, MAGE, MODD, MIME) in two subjects, with diet without restriction of CH:
one NGT subject and one IFG subject, both women, comparable to age, BMI (body mass
index), stress; also, we calculated five specific index at subject with IFG, with diet with
200g CH /day. These subjects were observed with continuous glucose monitoring system
(CGMS) for 72 hours. To mention that subject with IFG was observed with CGMS for
two times, for 72 hours, once with diet without restriction of CH, and once diet with
restriction of CH (200g CH/day). In the second day of CGMS, we perform oral glucose
141
tolerance test (OGTT) using 75g glucose at the two subjects. MBG, SD and MAGE were
calculated using CGMS glycemic records from the second day, in time of MODD was
measured using CGMS glycemic records from the second and third days. For the MIME
measurement was evaluated postprandial glycemic excursion at meal with 75g CH, both
at OGTT ( 75g glucose).
Glycemic instability index calculation: MAGE major ascending glucose excursion
average on 24 hours. MODD mean of absolute difference between glycemic values on
the same moment from different days. MIME was calculated on the basis of three
elements: G (difference between maxim postprandial glycemic value and preprandial
glycemic value); T (necessary time for reach postprandial glycemic peak); - G
(difference between glycemic value at 1 hour after reach postprandial glycemic peak and
maxim postprandial glycemic). Mean level of blood glucose (MBG) and blood glucose
standard deviation (SD).
Results and discussion:
Subject
MBG
MAGE
MODD
MIME (mg/dl) at
SD
(mg/dl)
(mg/dl)
(mg/dl)
G
(mg/dl)
T
min
G G
(mg/dl)
(mg/dl)
T
min
- G
(mg/dl)
IFGdiet 107,53
without
19,68
restriction of
CH
42,71
22,58
39
40
13
61
50
62
21
11,15
22
25
12
13
20
13
IFGwith
CH
23
17,08
29
50
20
diet 978
200g
Subject with IFG presented numerous and more ample intra-day glucose excursions (high
MAGE) and reduced day-to-day reproducibility of blood glucose values (high MODD),
comparative with subject with NGT. At the subject with IFG we observed higer values
for the three elements (G, T,- G) of MIME at OGTT (75g glucose), comparative
with meal with 75g CH.
The subject with IFG was present values significant lower of the glycemic instability
index during diet with 200g CH/day, comparative with period of diet without restriction
of CH.
142
Centrul
144
CARDIOVASCU
Background and
strong impact upo
a complex of car
study was to dete
145
NEFROPATIA DIABETICA
Manolache Mihaela Clinica III Pediatrie Iasi
Introducere
Diabetul zaharat este afectiunea endocrina si metabolica cea mai frecventa in copilarie,
caracterizata printr-o crestere permanenta a glicemiei, insotita sau nu de semne clinice,
fiind cauzata de alterarea secretiei de insulina sau perturbarii actiunii sale. Aceasta
afecteaza ambele sexe, aproximativ in egala masura, cu o usoara predominanta a sexului
masculin.
Nefropatia diabetica este o complicatie a diabetului care este determinata de concentratii
mari de glucoza in sange. Hiperglicemia tulbura functionarea unitatii de filtrare a
rinichiului (nefronul). In timp, aceasta poate duce la insuficienta renala.
Prevenirea sau incetinirea leziunii renale este cel mai important pas in managementul
bolii. care se efectueaza dializa renala. sau albuminurie), la care se adauga, in timp,
edeme, hipertensiune arteriala etc.
Obiective
Scopul lucrarii este de a investiga frecventa afectarii renale la copiii diabetici si
consecintelem acestei complicatii
Material si metoda
Studiul a fost efectuat in perioada 1 02 2008-1 09 2008,in clinica a IIIa pediatrie,pe un
lot de 20 de bolnavi cu diabet
Rezultate
Ca umare a investigatiilor efectuate s-a constatat ce un numar mare de bolnavii
cronici de diabet prezinta afectare renala.
Din acesta cauza managementul corect al diabetului si a nefropatiei diabetice este
foarte important.Un management defectuos putind duce pana la insuficienta renala.
Concluzii
Afectarea renala, prin nefropatie diabetica (complicatie tardiva a diabetului zaharat),
determina prognosticul vital al copilului,motiv pentru care trebuie monitorizarea corecta
si frecventa a copiilor cu diabet este o prioritate majora.
146
NEPHRITIC DIABETES
Introduction
Diabetes is the endocrine and metabolic disease most frequent in childhood,
which is characterized by a permanent growth of glucose that can be accompanied or not
by clinical signs, and which is caused by the alteration of the insulin secretion or by the
perturbation of its action. This disease affects both sexes equally, being just a bit
predominant at the male sex.
Nephritic diabetes is a complication of diabetes that is determined by high
dosages of glucose in blood. Hyperglycemia disturbs the function of the filtering unit in
the kidney. In time, this may cause kidney failure.
The prevention or the slowing of kidney failure is the most important step in
managing the disease, which is obtained by dialysis.
Objectives
The purpose of this paper is to investigate the frequency of renal affection at the
diabetic children and the consequences of this complication.
Material And Metodes
The study was conducted on 20 children with diabetes admitted in the Clinic III
Pediatrics, in the period of time 1.02.2008 1.09.2008.
Results
As a follow-up of the investigations, a large number of children suffering of
diabetes also present kidney related affections.
This is why the correct manage of diabetes and nephritic diabetes is very
important. If the treatment is not correct, then the kidney failure may appear.
Conclusion
Kidney related affections, especially nephritic diabetes, determine the vital
prognosis of the child, reason for which the correct and constant monitoring of the
diabetic child is the major priority.
147
Spitalul Clinic Judetean de Urgenta Craiova Clinica de Diabet Nutritie Boli Metabolice;
INITIAL
Sub 20 UI
21-40 UI
41-60 UI
Peste 60 UI
LA 15 ANI
(4,54%)
ACTUAL
(2,27%)
(2,27%)
21 (47,72%)
18 (40,90%)
20
(45,45%)
20 (45,45%)
17 (38,63%)
15
(34,09%)
(18,18%)
(2,27%)
(18,18%)
crescut, la 22,72% a scazut, iar la 20,45% s-a mentinut comparabil cu cel initial. Referitor
la doza de insulina actuala comparativ cu doza la 15 ani de evolutie a DZ: la 45,45%
dintre pacienti s-a evidentiat cresterea necesarului de insulina, la 50% necesarul a scazut,
iar la 4,55% nu s-au inregistrat modificari ale acestuia. La pacientii la care s-a inregistrat
actual scaderea dozei de insulina nefropatia s-a intalnit in procent 59,09%. Coma
hipoglicemica s-a inregistrat la 18,18% din pacientii aflati actual pe tratament
conventional, 29,54% pe tratament intensificat (3 prize de insulin/zi), 52,27% pe
tratament intensiv.
Concluzii: Se remarca o evolutie oscilanta a necesarului de insulina pe parcursul
evolutiei DZ; dupa o vechime de 15 ani la majoritatea pacientilor s-a inregistrat cresterea
necesarului de insulina, probabil datorit epuizrii rezervei secretorii pancretice restante;
dupa 25 ani de evolutie a diabetului s-a nregistrat o scdere a dozelor de insulin,
probabil datorit afectrii renale; la 59% dintre pacienii cu scaderea necesarului de
insulina s-a asociat nefropatia diabetic. Comele hipoglicemice s-au inregistrat mai
frecvent la pacientii cu tratament intensiv bazal-bolus. Tratamentul conventional este
regasit i actual intr-un procent relativ mare la pacientii luati in studiu, din motive legate
de pacieni, n cea mai mare parte.
INITIAL
Under 20 UI
21-40 UI
AFTER 15 YEARS
(4,54%)
21 (47,72%)
149
ACTUAL
(2,27%)
(2,27%)
18 (40,90%)
20
(45,45%)
41-60 UI
Over 60 UI
20 (45,45%)
17 (38,63%)
15
(34,09%)
(18,18%)
(2,27%)
(18,18%)
Calculated mean of insulin necessary in the begining was 31,54 UI, after 15 years became
45,86 UI and in the present is 39,15 UI. The type of insulin therapy was another
parameter which we had in view. Thus, at the begining 86,36% patients had a
conventional treatment (2 injections/day) and 13,63% a clasic intensiv one (3
injections/day). After 15 years 59,09% patients had a conventional treatment, 40,91% a
clasical intensiv treatment a. In the present the conventional treatment is used in 27,27%
patients, clasical intensiv treatment in 70,44% patients and modern intensive treatment
(insulin pomp) is found only in one patient (2,27%).
Comparatively analizing the insulin necessary after 15 years of evolution with the
necessary from the begining we obtained the following dates: in 56,81% of patients the
insulin necessary increased, in 22,72% the necessary decreased and in 20,45% of cases
the necessary was preserved. Regarding the actual insulin dose by comparison with the
dose after 15 years of evolution in 45,45% of patients we had an increase of insulin
necessary, in 50% patients the necessary decreased and in 4,55% patients didnt change.
The nefropathy was met in 59,09% cases with insulin dose decreased. Hipoglicemic
coma was recorded in 18,18% patients actually conventional treated (2 injections/day),
29,54% treated with 3 injections/day) and 52,27% actually on intensiv treatement (4
injections/day).
Conclusions: This study showed an oscilatory development of insulin necessary during
the evolution of T1DM; after 15 years most patients need much more insulin maybe
because of exhausting pancreatic secretory storage but after 25 years the necessary
decreased maybe through the development of diabetic nefropathy. In 59% patients with
the decrease of insulin necessary diabetic nefropathy is associated. Hipoglicemic coma
was frequently met in patients on intensiv treatment. Conventional treatment is actual
found in a considerable percentage many times from reasons that regard the patients.
150
151
Background. More than 60% of the non traumatic amputations of the lower limbs are caused
by diabetes, the diabetic patients being up to 40 times more likely to suffer one of this surgical
intervention than people without diabetes. Every 30 seconds a lower limb is lost to diabetes
somewhere in the world.
The aim of the study. We evaluated the amputations realized in a surgical clinic in patients
with and without DM and we made correlations between some parameters; the aim was to
define the procedure to prevent/decrease the number of the amputations.
Methodology and materials. We evaluated the patients hospitalized in a surgical clinic
(Emergency Hospital Craiova) who suffered amputations of lower limbs during a 5 years
period. From 222 patients, 31 suffered several amputations and were studied separately. Many
parameters were analized, and then we made correlations between the presence and the oldness
of DM, the level of the amputation, the age, HBP, dyslipidaemia, smoke, the presence of other
amputations.
Results and discussions. 71 of the patients (37.17%) presented DM and 120 (62.83%) did not.
It was not possible to highlight any correlation between the age of DM and the level of
amputation as could not precisely determines the exact moment when DM began, but only the
moment of its diagnosis. The average age at amputation was with 4.3 years smaller in patients
with DM comparing with those without DM (59.83, respective 64.17 years). Regarding the
correlation between HBP, the level of the amputation and the age at amputation, in diabetic
patients we noticed that the average age at amputation was smaller in those with HBP
comparing with patients with normal blood pressure (with 3.9 years). In patients without DM
we didnt observed correlations between these parameters. Yet regarding the presence of
dyslipidaemia, there was no information that could help us identify its relationship with the
additional factors analyzed. The average age at amputation was smaller in smokers (in both
patients with and without DM) regardless of the level of the amputation (with 5.83 respective
18.5 years). Among the diabetic patients that suffered an amputation, 25% of them had at least
another amputation in 5 years, comparing with 8.65% of the patient without DM.
Conclusions. The patients with DM represent 40% of the total that suffered an amputation,
even if the frequency of DM for the population of Dolj district is lower than 5%; the presence
of HBP influenced the age at amputation only in diabetic patients in this study; smoking
proved that diminishes the age at amputation in both patients with and without DM; the
presence of another amputation was associated with a high risk of a new one, especially in
patients with DM; the multilaterally approach of the pathology of the diabetic foot and of the
associated risk factors will prevent/decrease the number of the amputations.
152
153
Material i metod : Pentru 68 brbati cu diabet zaharat (12 cu diabet zaharat tip 1 i
56 cu diabet zaharat tip 2), cu vrste cuprinse ntre 19 i 76 ani a fost evaluat statusul
hipogonadic prin nregistrarea simptomelor i semnelor clinice, prin determinarea
seric a testosteronului total, SHBG, DHEA-S, cu calcularea ulterioar a
testosteronului liber. Au fost considerai hipogonadici pacienii cu testosteron seric
total sub 300ng/dl. Au fost urmrii de asemenea parametrii echilibrului metabolic:
HbA1c, profil lipidic .
Rezultate: 22% dintre pacienii evaluai au prezentat hipogonadism (16,6% dintre cei
cu diabet zaharat tip1 i 23,2% dintre cei cu diabet zaharat tip 2). Pacienii diabetici
hipogonadici , comparativ cu restul pacienilor diabetici au prezentat n medie o
valoare mai mare a circumferinei abdominale( p= 0,05) i o valoare mai mic a
HDL-colesterolului
( p= 0,03) .Scderea libidoului i a forei musculare s-a
corelat direct proporional cu valoarea sczut a DHEA-S ( p= 0,006 ) i invers
proporional cu HbA1c (p= 0,05) .Scderea frecvenei brbieritului i scderea
pilozitii corporale s-a corelat cu valoarea sczut a testosteronului liber,
independent de vrst. Alopecia s-a nregistrat mai frecvent la pacienii cu valori
sczute ale SHBG ( p =0,03) .
Concluzii: Statusul hipogonadic s-a regsit mai frecvent n rndul pacienilor cu
diabet zaharat tip 2, fiind asociat cu unele componente ale sindromului metabolic.
154
Material and methods: For 68 male patients: 12 T1DM/ 56 T2DM, aged between 19-76
years we evaluate the gonadic status based on both symptoms and biochemical measures
on total and free testosterone value, SHBG, DHEA-S. The patients with total testosterone
under 300 ng/dl were considered hypogonadic. We also evaluate the metabolic balance
( HbA1c, lipid profile).
Results: Hypogonadism was present in 22% of patients (16,6% in T1DM and 23,2% in
T2DM). The hypogonadic diabetic patients had higher waist ( p=0,05) and respectively
lower HDL-cholesterol (p=0,03), compared with the other diabetic patients. The decrease
of libido and muscular force was positve corelated with lower DHEA-S value and
negative with HbA1c (p=0,05). The decrease of shaving frequency was positive corelated
with lower free testosterone value, not related with age. Alopecia was more frequently
observed in diabetic patients with lower SHBG value (p=0,03).
Conclusions: In our study, the hypogonadic status was most common defect in T2DM, in
association with some components of metabolic syndrome criteria. The hypogonadic
symptoms was corelated with DHEA-S and HbA1c, since clinical signs were associated
with free testosterone and SHBG value, not related with age.
155
Obiectiv: Este cunoscut faptul c proteina C-reactiv (PCR) poate prezice riscul de
apariie al diabetului zaharat n rndul populaiei sntoase. Ne-am propus s determinm
posibilele corelaii ntre PCR i modificrile metabolice ntr-o populaie nou
diagnosticat cu diabet zaharat.
Material i metod: Pentru 40 de pacieni nou depistai cu diabet zaharat (25 obezi i 15
normoponderali),cu vrste cuprinse ntre 30-70 ani (media 54,2 ani) am efectuat
msurtorile antropometrice, am evaluat statusul metabolic (HbA1c, profilul lipidic,
tensiunea arterial) i inflamator (PCR) . Analiza statistic s-a efectuat cu ajutorul t-test,
considerndu-se semnificativ statistic valoarea p=sub 0,05.
156
EFECTELE SCADERII IN GREUTATE ASUPRA FICATULUI GRAS NONALCOOLIC LA SUBIECTII CU SINDROM METABOLIC.
R. Vasilescu, Silvi Ifrim
Spital Clinic Colentina Bucuresti Sectia Diabet, Nutritie, Boli Metabolice
Introducere: Boala ficatului gras non-alcoolic este una dintre cele mai frecvente cauze
de afectare hepatica, care poate progresa de la steatoza simpla, la steatohepatita, ciroza
hepatica si hepatocarcinom. In prezent boala ficatul gras non-alcoolic este considerata
componenta hepatica a sindromului metabolic.
157
Greutate
IMC (kg/m2)
Corcumferint
a abdominala
(cm)
ASAT (TGO)
ALAT (TGP)
GGT
LDLcolesterol
HDLcolesterol
Trigliceride
Glicemie
Initial
12
saptamani
24
saptamani
10417.1
35.084.43
116.2516.5
99.6716.46
33.434.52
11216.06
96.8316.56
32.274.59
108.515.55
6537.09
123.7570.0
8
97.2569.76
149.524.3
42.516.3
6334.22
36.259.54
39.7517.58
P=0.02
p=0.03
P=0.02
p=0.02
72.541.75
13918.8
p=0.05
p<0.001
p=0.03
p<0.001
31.53.51
32.254.11
47.2520.7
125.7514.8
6
34.754.03
NS
NS
19229.23
151.2518.0
8
86.57.59
136.7519.6
2
84.56.45
p=0.01
p=0.005
p=0.04
p=0.004
9511.63
158
Weight (Kg)
BMI (kg/m2)
Waist
circumference
AST (TGO)
ALT (TGP)
GGT
LDLcholesterol
HDLcholesterol
Triglycerides
Week 0
Week 12
Week 24
10417.1
35.084.43
116.2516.5
99.6716.46
33.434.52
11216.06
96.8316.56
32.274.59
108.515.55
Week 0 Week 0
vs. Week vs. Week
12
24
p=0.003 P=0.001
P<0.001 P<0.001
P<0.001 P<0.001
6537.09
123.7570.08
97.2569.76
149.524.3
42.516.3
6334.22
72.541.75
13918.8
36.259.54
39.7517.58
47.2520.7
125.7514.86
P=0.02
p=0.03
p=0.05
p<0.001
P=0.02
p=0.02
p=0.03
p<0.001
31.53.51
32.254.11
34.754.03
NS
NS
19229.23
15118.08
136.7519.62
p=0.01
p=0.005
159
(mg/dl)
Glucose
(mg/dl)
9511.63
86.57.59
84.56.45
p=0.04
p=0.004
Patients with MS and NAFLD have high serum transaminases. All patients had
ALT>1.5xN and ALT/AST>2. Mean 12 weeks weight loss was 4.67 kg (range 2-6 kg),
ALT decreased with 60.75 U/l, AST decreased with 22.5 U/l, GGT decreased with 24.75
U/l, triglycerides decreased with 40.75 mg/dl, LDL cholesterol decreased with 15.5
mg/dl, fasting glucose decreased with 8.5 mg/dl and HDL cholesterol increased with 0.75
mg/dl. Mean 24 weeks weight loss was 7.33 kg (range 4-9 kg), ALT decreased with 84
U/l, AST decreased with 28.75 U/l, GGT decreased with 50 U/l, triglycerides decreased
with 55.25 mg/dl, LDL cholesterol decreased with 23.75 mg/dl, fasting glucose decreased
with 10.5 mg/dl and HDL cholesterol increased with 3.25 mg/dl.
Conclusion: Weight loss is the main therapy in patients with NAFLD. Reduction in body
weight in patients with MS and NAFLD is associated with a pronounced decrease in
serum transaminases. In addition weight loss resulted in significant improvements in the
lipoprotein profile and fasting glucose.
Sigina Gargavu1, Mihaela Vladu2, Diana Clenciu1, Nicoleta Mitroi1, Camelia Panus1,
Maria Mota2,
1
Spitalul Clinic Judetean de Urgenta Craiova Clinica Diabet Nutritie Boli Metabolice;
160
Rezultate: Din cei 44 pacienti, 14 (31,81%) au fost de sex feminin si 30 (68,19%) de sex
masculin. Cu privire la varsta acestora, 2 pacienti (4,54%) se aflau in decada de varsta
30-40 ani, 12 pacienti (27,27%) in decada 41-50 ani, 15 pacienti (34,09%) in decada 5160 ani si 15 pacienti (34,09%) peste 60 ani. Studiind parametrul complicatii
microvasculare s-a remarcat o frecventa crescuta a neuropatiei diabetice 95,45% si a
retinopatiei diabetice 88,63%. Nefropatie diabetica au prezentat 40,90% din pacientii cu
vechime de peste 25 ani. Dintre pacientii cu neuropatie diabetica, 84,09% au avut
neuropatie periferica si 11,36% atat neuropatie periferica cat si vegetativa. Din cei cu
retinopatie diabetica 50% s-au aflat in stadiul neproliferativ; 11,36% in stadiul
preproliferativ si 27,27% in stadiul proliferativ. La 31,05% dintre acestia s-a intalnit
cecitatea ca si complicatie a retinopatiei diabetice. Nefropatia diabetica s-a intalnit in
33,33% in stadiul 3; 61,11% in stadiul 4 si 5,55% in stadiul 5. Dintre cei cu retinopatie
diabetica 43,59% prezentau si nefropatie. Dislipidemia a fost evidentiata la 32 pacienti
(72,72%). Hipertensiunea arteriala s-a intalnit la 36 pacienti (81,81%). Dintre pacientii
hipertensivi, 28 pacienti (77,77%) prezentau HTA si neuropatie, 27 pacienti (75%)
prezentau HTA si retinopatie, 17 pacienti (47,22%) prezentau HTA si arteriopatie, 15
pacienti (41,67%) prezentau HTA si nefropatie, iar 13 pacienti (36,11%) prezentau atat
HTA cat si neuropatie, retinopatie, arteriopatie si nefropatie.
Mentionam ca nu s-a putut stabili o corelatie intre echilibrul glicemic si
complicatiile microvasculare datorita lipsei hemoglobinei glicozilate din evidentele
pacientilor de-a lungul perioadei de evolutie a DZ.
Concluzii : Se remarca o frecventa alarmanta a complicatiilor microvasculare dupa o
vechime a DZ tip 1 de peste 25 ani. Neuropatia diabetica este cea mai frecventa
complicatie intalnita, dar si cea mai precoce. Retinopatia diabetica este de asemenea o
complicatie frecventa, dar este rara in primii ani de evolutie. Gradul mic de corelatie al
retinopatiei diabetice cu nefropatia diabetica sugereaza posibila participare a unor factori
individuali implicati in aparitia acestora, cum ar fi factorii genetici. Dislipidemia si
hipertensiunea arteriala sunt frecvent intalnite la pacientii cu DZ de peste 25 ani. Ambele
sexe sunt vulnerabile pentru complicatiilor microvasculare.
Sigina Gargavu1, Mihaela Vladu2, Diana Clenciu1,, Nicoleta Mitroi1, Camelia Panus1,
Maria Mota2 ,
1
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162
163
Aim. To analyze the diabetes consultation and its optimization for increasing the quality
without any expense of time.
Materials and methods. Medis Outpatient Clinic offered the space and materials
required for implementation of a management plan designed locally, using the experience
of Salzburg General Hospital, Austria. The patient comes only by appointment, he waits
around 20, he enters the nurses cabinet, where data are recorded only in computer
regarding demographic, anthropometry (including waist circumference), blood pressure,
smoking ... Then, the newest blood analysis data are recorded, including date, for
glycaemia, HbA1c, total and HDL cholesterol, triglycerides, urea and creatinine. Then,
the patient answers some questions regarding diabetes onset, glaucoma, cataract...
Automated generated data include: age, ideal weight, present and maximum (during life)
BMI, LDLc, glomerular filtration rate (MDRD formula). Mean time: 4 minutes. The
patient returns in the waiting room and then he enters the doctors cabinet, who continues
the consultation from the point left by the nurse. He records only in the computer data
regarding ocular, renal, nervous complications, dyslipidemia, arteriopathy, hypertension,
ischemic heart disease, myocardial infarction, stroke, heart insufficiency, atrial
fibrillation. The diagnosis is generated automated, modified (generaly by completion) and
validated. Page three deals with recommendations, where medications are chosen from
small lists, dayly and the total period for prescription. The general diet is computer
generated. Then, the medical discharge documents are automatically generated. Receipts
are printed on matricial printers (three). The computer generates an discharge letter very
similar with the one used in hospital (one A4 page, font: 10), which contains the
diagnosis and all the information from computer, but in long phrases, which are
modifiable. In a similar manner are automatically generated other documents like letter
for the GP, medical note, notes for prescription justification ... they are laser printed. The
doctors mean time: 4 minutes, from which 5-10 seconds for documents generation. One
discharge letter goes to the patient medical file as a source document. The computer also
generates the consultations registry and the monthly report to the Health Insurance
Company.
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165
166
167
We strongly recommend the inclusion of the CAN screening in the annual evaluation of
the type 1 diabetes patients, after 10 years of disease duration...
168
terapeutice a pacientului atat in ceea ce priveste administrarea de insulina cat mai ales
importanta regimului igieno-dietetic si ajustarea dozelor in functie de stilului de viata
169
Conclusions: the incidence of coma has been higher to the patients treated with
human insulin, especially with 3 doses per day, and the inadequate nourishment has been
the primary trigger. This underlines the importance of the patients training regarding not
only the administration of insulin but dietary and insulins dosage as well, accordingly to
ones lifestyle.
REZUMAT
Judetul Satu Mare face parte din acele judete care au fost integrate de la inceput in
programul EPIDIAB. De la initierea programului si pana la 01 07 2008 numarul
diabeticilor in evidenta a crescut cu aproape 10 000. Conform protocolului initial au fost
inregistrati pacienti in functie de tipul diabetului,, domiciliu, sex, varsta,IMC,
circumferinta abdominala, comorbiditati si complicatii (HTA, dislipidemie,cardiopatia
ischemica,IM,AVC,arteriopatie diabetica, retinopatie , nefropatie diabetica, neuropatie).
De asemenea a fost urmarita structura terapeutica (mod de viata, tratament oral,
insulinoterapie de diverse tipuri, terapie combinata).
In anul 2008 primul semestru au fost depistate 1372 cazuri noi din care 11 tip 1, 1343
tip 2, 1 diabet gestational, 15 alte forme.Repartitia in funtie de sex, varsta, domiciliu a
fost sensibil egala. La tipul 2 o prevalenta net superioara se regaseste la supraponderali si
obezi. La tipul 2 peste 70% au HTA, 69% dislipidemie, , 61% afectare vasculara de
diverse tipuri, 19% retinopatie, 2,13% nefropatie clinic manifesta, 7,22% neuropatie in
momentul depistarii.
In ceea ce priveste structura terapeutica predomina cu 34,70% cei cu tratament cu
regim+ metformin,33,45% deocamdata beneficiaza doar de regim alimentar , 15,93% au
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ABSTRACT
Satu-Mare County has been involved in The EPIDIAB Program from its beginning.
The number of the registered diabetic patients has been raised with 10.000 since
EPIDIAB started until 01.07.2008. According to the initial protocol the patients have
been registered related to the diabetes type, residence, sex, age, BMI, waist
circumference, co-morbidities and complications (arterial hypertension, dislipidemia,
coronary arterial disease, myocardial infarction, stroke, diabetes vascular disease,
retinopathy, diabetes nephropathy, and diabetes neuropathy).
In the same time the therapeutically structure has been monitored(life style, oral therapy,
different types of insulinoteraphy and combination therapy).
In the first semester of 2008 there have been reported 1372 new cases of diabetes from
witch 11cases of type 1 diabetes, 1343 type 2 diabetes, 1 gestational diabetes and 15
other types. There was a quite similar split based on sex, age and residency. Most of the
type 2 diabetes patients are over-weighted and obese. Among the type 2 diabetes patients
there are over 70% who suffered from arterial hypertension, 69% with dislipidemia, 61%
with different kind of vascular disease and 19% with retinopathy, 2,13% with
nephropathy and 7,22% with neuropathy at the moment of registration.
Regarding the therapeutical structure there are 34,70% of the patients on metformin+
life style optimization measures, 33,45% on diet , 15,93% on SU and 8,04% combinated
OADs and 4,1% on insulin.
In conclusion we could state the fact that there is a continuous and rapid increasing
tendency of the diabetes mellitus cases and also the fact that an active follow-up of this
171
cases prevents or delay complications, all of this being a good argument to continue the
program.
CORELATII INTRE NIVELUL SERIC AL TNF-ALFA SI GROSIMEA INTIMAMEDIE LA PACIENTII CU DIABET ZAHARAT TIP 2 COMPLICAT CU
RETINOPATIE
Autori: V.Negrean, T. Alexescu, M. Adam, S. Tarmure, N. Leach, C. Vinteler, D.
Todea, L. Rosca,
1- Clinica Medicala IV, UMF Iuliu Hatieganu, Spitalul Clinic CF Cluj-Napoca
2- Clinica Dermatologie, Spitalul Clinic Judetean de Urgenta Cluj-Napoca
3- Clinica Pneumoftiziologie, UMF Iuliu Hatieganu Cluj-Napoca
Obiectiv: Evaluarea relatiei intre indicele intima-medie(IIM) si valoarea serica a alfaTNF la pcientii cu diabet zaharat tip 2 si retinopatie diabetica.
Material si Metoda: Studiul a inclus 40 de pacienti cu diabet zaharat tip 2 si retinopatie
diabetica internati in Spitalul Clinic CF Cluj-Napoca in perioada 1.12.2007-30.03.2008.
Fiecarui pacient i s-a intocmit o fisa ce cuprindea statusul metabolismului glucidic,
lipidic si porteic, precum si markerii endoteliali inflamatori ( CRP, TNF-alfa). Indicele
intima-medie a fost evaluat ultrasonografic la nivelul arterei carotide comune, bilateral,
inregistrandu-se valoarea medie.
Rezultate: 9 pacineti au avut niveluri crescute de TNF-alfa ( 22,5%) , iar indicele intimamedie a fost semnificativ crescut la 22 de pacienti (55%). S-a observat ca toti pacientii cu
niveluri crescute de alfa-TNF au avut un indice intima-medie crescut.
Concluzii: Indicele intima-medie masurat ultrasonografic reprezinta un semn precoce de
ateroscleroza. Cresterea nivelurilor de TNF-alfa se coreleaza cu boala diabetica
macrovasculara. Relatia intre semnele ultrasonografice de boala aterosclerotica subclinica
si nivelurile serice ale mediatorilor inflamatiei nu este pe deplin certa, dar vom cauta noi
factori predictivi de dezvoltare a aterosclerozei la pacientii cu diabet zaharat.
172
Background and aims: Evaluation of the relationship between ITM and TNF-alfa in
patients with diabetes mellitus type 2 and diabetes retinopathy.
Materials and methods: The study included 40 patients with diabetes mellitus and
retinopathy from diabetes mellitus causes, registered at Universitary Hospital ClujNapoca between 1.12.2007 and 30.03.2008. Each patient had a record of research where
included the status of glucidic metabolism, lipidic metabolism and proteic metabolism
and seric inflammatory markers ( CRP, TNF-alfa). ITM was evaluated using the
ultrasonography of the common carotidal artery, on each side, and the medium value was
recorded.
Results: 9 patients had increased level of TNF-alfa ( 22,5%) and ITM was significant
increased in 22 patients (55%). It was observed that all patients with high levels of TNFalfa had significant increased ITM.
Conclusion: The ITM measured by ultrasonography represents early sign in the
development of atherosclerosis. The raising of TNF-alfa levels correlates with
macrovascular disease in patients with diabetes retinopathy. The relationship between
ultrasonographic signs of sub-clinical atherosclerosis and the plasma levels of chemical
mediators of inflammation is not certain yet, but we are looking for a new prediction
factors of sub-clinical atherosclerosis in patients with diabetes mellitus and its systemic
complications.
173
Sexual Medicine and Andrology Office, 2Obesity and Dislipidemia Office, 3Laboratory
Investigations Department, Diabetes Clinical Center, County Emergency Hospital,
Cluj-Napoca, Romania
174
Objective: To assess total body fat mass, abdominal fat, waist and waist to hip ratio in
long acting testosterone therapy in men having non-diabetic metabolic syndrome (MetS),
erectile dysfunction (ED) and low androgenic activity.
Method: A group of 18 men with MetS (BMI: 32.671.08 kg/m2; W=1175.09 cm),
low/low normal androgenic activity (testosterone [T] = 9.83.6 nmol/L and free T =
0.290.062 nmol/L) and ED ( premature ejaculation, low libido) has been selected
(Group A). Body fat distribution (impedance method: In Body) characteristics at V1
were: general fat mass (GF): 40.74.1%; visceral adipose tissue (VA): 108.412.3 cm2;
waist (W): 119.528.8 cm; waist to hip ratio (W/H): 1.160.063. For sexual
reestablishement long acting testosterone (Nebido 1000) associated to
phosphodiesteraze 5 inhibitors (PDE5i) were prescribed. Sexual (International Index of
Erectile function: IIEF), serum testosterone and prostate (PSA, ultrasound) evaluation
before every testosterone injection (2-3 month) were measured. Body fat parameters after
32 weeks injected long acting testosterone were also noted (V2) together with lipid
profile, hematology and liver enzymes. Results were compared to those of a control
group with MetS, ED and testosterone low activity, treated only with PDE5i (Gr. B).
Results: At V2: GF = 34.41.09% (7.6%), P<0.05. VA = 112.1510.7 cm2 (16.4 cm2,
14.6%), P<0.08. W = 99.66.09 cm (9 cm, 8.33%), P<0.05. W/H = 0.980.079 (0.08),
P<0.01. Comparing to the control group (also at V2) offered the following statistical
significances: GF (vs. 43.453.02%): P < 0.05 (=0.058); VA (vs. 130.16.6 cm2): P <
0.06 (=0.067); W (vs. 120.025.01 cm): P < 0.05 (=0.056); W/H (vs. 1.10.03): P < 0.9.
Lipid and hematological profile and liver enzymes also at V2 did not enhanced from
normal patterns. Testosterone serum levels remained in normal interval values after the
treatment (average Gr. A=18.663.09 nmol/L); PSA levels either (average Gr.
A=0.1960.022 g/L).
175
Metoda: La 18 brbai cu MetS (BMI: 32.671.08 kg/m2; W=1175.09 cm; Grup A),
testosteron seric sczut (testosteron total [Tt] = 9.83.6 nmol/L, testosteron liber [free T)
= 0.290.062) i DE ( ejaculare precoce alterare de libidou) am asociat terapeutic
testosteron cu absorbie prelungit (testosterone undecanoat 250 mg/ml: Nebido 1000) i
inhibitori de fosfodiesteraz 5 (PDE5i: sildenafil 50 mg, tadalafil 20 mg). Comparaia s-a
facut cu un lot de control de 20 de brbai (Grup B) cu MetS i DE, tratai doar cu PDE5i,
fr testosteron. Evaluarea sexual s-a fcut prin calcularea scorului total al Indexului
Internaional de Funcie Erectil (IIEF) i al domeniilor acestuia: funcia erectil (FE): Q1
5, 15; satisfacia penetrrii (SP): Q6 8; satisfacia orgasmic (SO): Q9 10; dorina
sexual (DS): Q11 12; satisfacia general (SG): Q13 14. Evaluarile s-au facut la
nrolare (V1) i dup 32 de sptmni de testosteron (3 injecii i.m.; V2).
Rezultate: Scorul IIEF. Gr. A, V1 vs. V2: 41,87.2 vs. 68.45.9 (P=0.0016); la V2, Gr.
A vs. Gr. B: 68.45.9 vs. 57.36.6 (P=0.037). Scor FE. Gr. A, V1 vs. V2: 14.23.1 vs.
26.52.2 (P=0.003); la V2, Gr. A vs. Gr. B: 26.52.2 vs. 22.62.4 (P=0.056). Scor SP.
Gr. A, V1 vs. V2: 8.70.2 vs. 14.00.8 (P=0.074); la V2, Gr. A vs. Gr. B: 14.00.8 vs.
11.70.4 (P=0.021). Scor SO. Gr. A, V1 vs. V2: 8.30.08 vs.8.90.7; la V2 Gr. A vs. Gr.
B: 8.90.7 vs. 8.60.1 (P=0,15). Scor DS. Gr. A, V1 vs. V2: 5.30.5 vs.8.80.04
(P=0.0012); la V2 Gr. A vs. Gr. B: 8.80.04 vs. 6.070.2 (P=0.072). Scor SG. Gr. A, V1
vs. V2: 4.70.3 vs.8.90.1 (P=0.008); la V2 Gr. A vs. Gr. B: 8.90.1 vs. 6.30.5
(P=0.061). Discuii: Lund n considerare semnificaia statistic de P<0.05, diferene
semnificative fa de lotul martor au aprut la ameliorarea funciei erectile, a dorinei
sexuale (libido) i a satisfaciei generale. Nu s-au putut face corelaii cu tipul de PDE5i
asociat, din cauza inconstantei utilizrii a aceleiai forme de PDE5i pe durata studiului.
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178
179
primelor 6 luni de utilizare a DAI, iar la acei pacieni care dozeaz greit unitile de
insulin, valoarea erorii scade.
Cuvinte cheie: diabet zaharat tip 2, dispozitive de administrare a insulinei, pen pentru
insulin, studiu comparativ i observaional.
Finanare: Acest studiu (B5K-VI-B005) a fost finanat de Eli Lilly and Company.
Conflicte de interese: G. Teodorescu, H. Petto i J. Kiljanski sunt salariai ai Eli Lilly
and Company.
Background: Insulin delivery systems (IDS) are developed to reduce practical, social
and emotional burden associated with insulin injections. Slight technical differences
between these devices may be relevant for patients preference and affect accuracy of
insulin dosing.
Objectives: To assess the number and size of dosing mistakes and the time Health Care
Professionals (HCPs) spent training patients on commonly used IDS (Optipen Pro1,
Optiset, NovoPen 3, NovoLet and HumaPen Ergo ) in a standard clinical setting in
patients with type 2 diabetes requiring insulin therapy.
Patients and Methods: This was a 6-month observational, multi-center, open-label study
conducted in 42 sites in Romania in 2005. 609 patients with Type 2 diabetes were
enrolled: 348 (57%) insulin nave patients (INPs; 58% female, mean age 59 years, mean
diabetes duration 7.9 years) who started insulin therapy and 261 (43%) non-insulin nave
patients (NINPs; 61% female, mean age 60 years, mean diabetes duration 8.8 years, mean
number of insulin injection - 2 per day; daily mean insulin dose - 38 [CI 26, 48] U).
Insulin was delivered by syringes, Optipen Pro1, Optiset, NovoPen 3, NovoLet, or
HumaPen Ergo and there could be switch among these devices. As summary statistics
mean values were reported either with parametric 95% confidence intervals or with
181
minimum and maximum values. Kruskal Walis tests were used to calculate two-sided pvalues for differences between insulin delivery systems.
Results For INP patients only at baseline the correct dosing score (CDS) was different
between IDS (p=0.03). All IDS combined showed an increased correct dosing over time
from 93% (CI 91.4, 94.4) at baseline to 99% (CI 98.5, 99.5) after 6 months. Overall the
time to train patients decreased over 6 months from 8.5 (CI 7.9, 9.1) to 1.9 (CI 1.9, 1.3)
hours.
For NINPs, at baseline and after 6 months CDS was different between IDS (p=0.03 and
p=0.006, respectively). All IDS combined showed an increased correct dosing over time
from 95% (CI 93.0, 96.1) at baseline to >99% (CI 99.4, 100) after 6 months. Time to retrain was not available for this group.
Conclusions: These results indicate that despite of high dosing precision achieved with
all the individual IDS, differences in dose accuracy are observed in the beginning of
treatment for insulin nave and insulin non-nave patients. The accuracy of insulin dosing
increased within 6 months of IDS use and in those patients who dosed incorrectly the
range of the error became smaller.
Keywords: type 2 diabetes, insulin delivery systems, insulin pen, observational and
comparative study
Funding: This study (B5K-VI-B005) was funded by Eli Lilly and Company.
Conflicts of interests: G. Teodorescu, H. Petto and J. Kiljanski are employees of Eli
Lilly and Company.
Emergency Clinic,
Division of Paediatrics,
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