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Acta Diabetologica Romana 2016 PDF
Acta Diabetologica Romana 2016 PDF
ROMÂNĂ
Volum de rezumate
Abstract Book
Preşedinte/President:
Vicepreşedinţi/Vice Presidents:
Membri/Members:
Preşedinte/President:
Secretar/Secretary:
Membri/Members:
Revieweri/Reviewers
Cuvântul Preşedintelui……………………………………………………………………………….……………………. 18
DIABETIC NEPHROPATHY: HAS THE TIME FOR ROUTINE KIDNEY BIOPSY ARRIVED?........................... 35
Page
Gener Ismail
RW 12. ALIMENTAȚIA RESTRICTIVĂ VERSUS ALIMENTAȚIA CU (MAI) PUȚINE CALORII…….……… 36
RESTRAINED EATING VS CALORIE RESTRICTION…………………………………………………….……….. 37
Mariana Graur
RW 13. WHAT IS DRIVING THE DIABETES EPIDEMIC? EVIDENCE FROM THE DIABETES IMPACT
STUDY, DENMARK……………………………………………………………………………………………….……... 38
Anders Green, Camilla Sortsø, Peter Bjødstrup Jensen, Martha Emneus
52
Mihai Bogdan Mircea, Botnariu Eosefina, Popescu Maria, Onofriescu Alina, Lăcătușu Cristina Mihaela
Page
RW 26. VARIABILITATEA GLICEMICĂ: ÎNTRE MECANISME ȘI CONSECINȚE………………………………..…. 53
GLYCEMIC VARIABILITY: FROM MECHANISMS TO OUTCOMES……………………………………………….… 53
Mihai Bogdan Mircea, Lăcătușu Cristina Mihaela
Polovina Snezana
RW 40. HEART FAILURE CONSIDERATIONS OF ANTIHYPERGLYCEMIC MEDICATIONS FOR TYPE 2
DIABETES………………………………………………………………………………………………………………………… 72
Eberhard Standl
Bala Cornelia
OP 7. CORELAṬII ALE INSULINOREZISTENṬEI CU CELELALTE COMPLICAṬII CRONICE ALE DIABETULUI
ZAHARAT TIP 1, ÎN FUNCṬIE DE PREZENṬA BOLII RENALE DIABETICE……………………….. 90
CORRELATIONS BETWEEN INSULIN RESISTANCE AND THE OTHER CHRONIC COMPLICATIONS OF TYPE
1 DIABETES MELLITUS, DEPENDING ON THE PRESENCE OF DIABETIC KIDNEY DISEASE……………………. 91
Bîcu Mihaela Larisa, Bîcu Daniel, Vladu Mihaela Ionela, Clenciu Diana, Sandu Magdalena, Moța Maria
OP 8. ONE YEAR FOLLOW-UP FOR OXIDATIVE STRESS STATUS, ADIPOKINES AND INFLAMMATORY
MARKERS IN OBESE TYPE 2 DIABETIC PATIENTS……………………………………………………………..……….. 92
Carniciu Simona, Lixandru Daniela, Petcu Laura, Picu Ariana, Roșca Adelina, Băcanu Elena, Mihai Andrada, Ionescu-Tîrgoviște
Constantin, Guja Cristian
OP 14. A NEW INSULIN UNIT CALCULATOR FOR THE MANAGEMENT OF TYPE 1 DIABETES
PATIENTS……………………………………………………………………………………………………………………..…. 102
Maurizi Anna Rita, Naciu Anda, Del Toro Rossella, Lauria Pantano Angelo, Fioriti Elvira, Manfrini Silvia, Pozzilli Paolo
PS 5. DEPRESSION AND COGNITIVE IMPAIRMENT IN TYPE 2 DIABETES: CORELLATION WITH SLEEP AND
BIOLOGICAL MARKERS…………………………………………………………………………………………………..…... 124
Cernea Simona, Șular Floredana-Laura, Huțanu Adina
PS 11. DIABET ZAHARAT TIP 1, TIROIDITA HASHIMOTO, ANEMIE BIERMER SI POSIBILA BOALA CELIACA
IN CAZUL UNEI TINERE FEMEI CU SINDROM POLIGLANDULAR AUTOIMUN TIP III…..………………………... 133
TYPE 1 DIABETES MELLITUS, HASHIMOTO THYROIDITIS, PERNICIOUS ANEMIA AND POSSIBLE CELIAC
DISEASE IN A YOUNG FEMALE WITH POLYGLANDULAR AUTOIMMUNE SYNDROME TYPE
III………………………………………………………………………………………………………………………..……….... 134
Cosma Daniel Tudor, Porojan Mihai, Grad Simona, Bala Cornelia
11
PS 12. SUPRADOZAJ INTENTIONAL CU INSULINA SI DIAZEPAM IN CAZUL UNEI FEMEI DIABETICE CU 135
TULBURARE DEPRESIVA MAJORA………………………………………………………………………………………....
Page
INTENTIONAL INSULIN AND DIAZEPAM OVERDOSE IN A DIABETIC FEMALE WITH SEVERE
DEPRESSION…………………………………………………………………………………………………………………...… 136
Cosma Daniel Tudor, Silaghi Cristina Alina, Silaghi Horațiu, Vereșiu Andrei
PS 13. SINDROM POLIGLANDULAR AUTOIMUN TIP IV CU BOALA CELIACA, DIABET ZAHARAT TIP 1 SI
ARTRITA REUMATOIDA JUVENILA – O ASOCIERE RARA……………………………………………………………... 137
A CASE OF POLYGLANDULAR AUTOIMMUNE SYNDROME TYPE IV WITH CELIAC DISEASE, TYPE 1
DIABETES MELLITUS AND JUVENILE RHEUMATOID ARTHRITIS – A RARE COMBINATION………………..… 138
Cosma Daniel Tudor, Silaghi Cristina Alina, Silaghi Horațiu, Vereșiu Ioan Andrei
PS 14. GENETIC SCORE FOR OBESITY AND WEIGHT CHANGES IN TYPE 2 DIABETES PATIENTS IN THE
FIRST YEAR AFTER THE START OF INSULIN THERAPY……………………………………………………………….. 139
Craciun Anca-Elena, Bala Cornelia, Roman Gabriela, Craciun Cristian, Ciobanu Dana, Hancu Nicolae
Gheorghiță Andra Gabriela, Rusu Emilia, Drăguț Ramona, Onilă Oana Daniela, Grosu Irina, Radulian Gabriela
Page
PS 23. PROBLEME DE IGIENĂ DENTARĂ LA PACIENŢII CU DIABET ZAHARAT TIP 1………………..…….. 154
ORAL HEALTH PROBLEMS IN PATIENTS WITH TYPE 1 DIABETES…………………………………………….. 155
Gheorghiță Andra Gabriela, Rusu Emilia, Ghițulescu Cristina, Enache Georgiana, Drăguț Ramona, Nan Raluca, Stoicescu
Florentina, Rusu Florin, Radulian Gabriela
PS 38. QUALITY OF LIFE IN DIFFERENT STAGES OF CHRONIC KIDNEY DISEASE IN PATIENTS WITH
DIABETTES MELITUS............................................................................................................ ............................................ 178
Pantea-Stoian Anca, Georgiana Ditu, Cristian Serafinceanu, Viviana Elian
PS 45. PREVALENȚA STEATOZEI HEPATICE LA PACIENȚII CU DIABET ZAHARAT TIP 2…………………. 188
THE PREVALENCE OF HEPATIC STEATOSIS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS………… 189
Alina Gabriela Prefac, Ana Maria Busneag, Ramona Maria Drăguț, Cristina Stoian, Florentina Stoicescu, Emilia Rusu, Gabriela
Radulian
PS 48. CARACTERISTICI ALE BOLII ARTERIALE PERIFERICE LA PACIENTUL CU DIABET ZAHARAT TIP
II…………………………………………………………………………………………………………………………...
Page
192
CHARACTERISTICS OF THE PERIPHERAL ARTERIAL DISEASE IN PATIENTS WITH TYPE 2
DIABETES………………………………………………………………………………………………………………….…. 193
Radu Florentina, Petrache Daniela, Bușneag Ana Maria, Cusi Daniela, Mureșan Alexandra, Grosu Irina, Rusu Emilia, Radulian
Gabriela
PS 55. THE CORRELATION OF LEFT VENTRICULAR HYPERTROPHY WITH SERUM CALCIUM LEVELS IN
OBESE PATIENTS…………………………………………………………………………………………………….…. 204
Sava Elisabeta, Iulia Soare, Sîrbu Anca, Martin Sorina, Fica Simona
PS 57. CHOICE OF THE ADD-ON THERAPY TO METFORMIN IN TYPE 2 DIABETES PATIENTS IN CLINICAL
PRACTICE. INITIAL RESULTS FROM A NON-INTERVENTIONAL MULTICENTRE STUDY IN ROMANIA
(REALITY)……………………….………………………………………………..…………………………….. 206
Serafinceanu Cristian, Timar Romulus, Catrinoiu Doina, Adrian Zaharia
TRANSVERSAL…………………………………………………………………………………………………………….… 208
Page
ASSOCIATIONS BETWEEN DIABETIC NEUROPATHY AND DEPRESSION: FINDINGS FROM A CROSS-
SECTIONAL STUDY………………………………………………………………………………………………………… 209
Lazăr Sandra, Timar Romulus, Mailat Diana, Levai Codrina, Timar Bogdan
210
PS 60. ANEMIA, DIABETUL SI BOALA RENALĂ CRONICĂ…………………………………………………………. 211
ANEMIA, DIABETES MELLITUS AND CHRONIC KIDNEY DISEASE………………………………………………
Ungureanu Carmen, Rusu Emilia, Bejinariu Cătălina, Petre Diana, Mureșan Alexandra, Stegaru Daniela, Soldea Lidia, Andoni
Adela, Ciobanu Delia, Dobre Alin, Chirilă Vlad, Radulian Gabriela
DOAR PUBLICARE
PUBLICATION ONLY
PO 1. HIPOGLICEMIA SEVERĂ, CAUZA DE INTERNARE A PACIENȚILOR CU DIABET ZAHARAT TIP 2…. 221
SEVERE HYPOGLYCEMIA, CASE OF HOSPITALIZATION IN PATIENTS WITH TYPE 2 DIABETES…….….... 222
Braha Adina, Diaconu Laura, Timar Romulus
PO 5. DIABET ZAHARAT TIP 1 SAU DIABET NEONATAL – CARE ESTE CEA MAI BUNĂ OPȚIUNE DE
TRATAMENT?………………………………………………………………………………………………………………….
16
228
TYPE 1 DIABETES MELLITUS OR NEONATAL DIABETES – WHICH IS THE BEST TREATMENT
OPTION?…………………………………………………………………………………………………………………………
Page
229
Herescu Irina Elena, Mintici Luana, Ioacara Sorin, Fica Simona
PO 6. TRATAMENTUL CU POMPĂ DE INSULINĂ – O SOLUŢIE PENTRU PACIENŢII CU DIABET ZAHARAT 230
TIP 1 ŞI SINDROM DE NERECUNOAŞTERE A HIPOGLICEMIILOR……………………………………………….…
INSULIN PUMP TREATMENT – AN ALTERNATIVE FOR TYPE 1 DIABETES MELLITUS PACIENTS WITH 231
HYPOGLICEMIC UNAWARENESS………………………………………………………………………………………….
Mintici Luana, Herescu Irina, Ionescu Olteea, Ioacara Sorin, Fica Simona
PO 10. ASOCIEREA DINTRE ACIDUL URIC ȘI OBEZITATEA LA PACIENȚII CU DIABET ZAHARAT TIP
2…………………………………………………………………………………………………………………….……………… 234
THE CORRELATION BETWEEN SERUM URIC ACID AND OBESITY IN PATIENTS WITH TYPE 2 DIABETES
MELLITUS……………………………………………………………………………………………………….…………….... 234
Zaharia Adelina, Liță Genoveva Andreea, Pavel Anca Ioana, Zaharia Mihaela Iulia, Stoicescu Florentina, Gheorghiță Andra
Gabriela, Rusu Emilia, Radulian Gabriela
Am prilejul ca în deschiderea volumului de rezumate al celui de al 42-lea Congres al Societății Române de Diabet
Nutriție și Boli Metabolice să transmit în numele și cu asentimentul Comitetului Director câteva dintre realizările pe
care societatea noastră le-a avut în ultimul an precum și unele gânduri pentru viitorul acesteia.
Este clar pentru noi toți că trăim o perioadă de schimbări majore, generate de necesitatea convergenței societății
noastre cu lumea contemporană. O parte dintre aceste schimbări sunt exterioare, constatăm modificări legislative
decisive, observăm mutații sociale și culturale profunde care ne influențează opțiunile personale și profesionale. Dar
aceste schimbări ale lumii noastre vor trebui să fie însoțite de mutații interioare, de mentalitate și de abordare, care să
se finalizeze prin acțiuni concrete.
Pornind de la aceste premise obiective am conceput mai multe linii și proiecte strategice pe care le voi prezenta pe
scurt membrilor SRDNBM în cadrul Adunării Generale.
Prima urgență este adaptarea Statutului SRDNBM la noile cerințe legislative din România și din Europa și am
conceput o propunere în acest scop, care să fie discutată și aprobată de membrii SRDNBM.
A doua direcție strategică este creșterea nivelului științific, profesional, dar și a gradului de implicare în activitățile
SRDNBM al membrilor noștri. În acest sens am completat baza de date cu medicii specialiști și primari din
specialitatea noastră din întreaga țară, pe care îi invit să devină membri titulari ai SRDNBM și să-și facă auzite
glasurile în acest cadru. Am făcut demersuri insistente către autorități pentru modificarea curiculei rezidenților și
alinierea acesteia la cea europeană, ceea ce va duce la creșterea calității profeisonale a specialiștilor noștri. Urmează
ca în lunile următoare să propunem și modificarea curiculei studenților, cu introducerea nutriției clinice în cadrul
studiului medicinei interne.
Activitatea științifică girată de SRDNBM a avut un curs ascendent în ultimii ani, lucru pentru care adresăm
mulțumirile noastre conducerilor anterioare ale Societății; este stringent necesar ca această tendință să fie continuată
și în viitor. În această direcție, a fost aprobată de către Adunerea Generală în 2015 continuarea drumului deschis prin
Studiul PREDATORR de cunoaștere a realităților diabetului zaharat în România, prin organizarea și sponsorizarea de
către Societate a unui studiu multicentric prospectiv observațional, studiul MENTOR. Dacă vom reuși să finalizăm
acest efort deosebit, vom avea argumente importante de a ne susține obiectivele în viitor.
De asemenea, SRDNBM a încheiat contracte de parteneriat științific și de colaborare cu alte societăți profesionale
medicale din România (cardiologie, endocrinologie, nefrologie) și cu Universități medicale (din București și
Timișoara), parteneriate care vor fi concretizate prin proiecte comune de cercetare și participarea reciprocă la sesiuni
științifice. Aceste demersuri sunt în concepția noastră dedicate în special tinerilor cercetători și specialiști, pe care
vrem să îi încurajăm prin toate mijloacele să devină factorul dinamizator al activităților științifice ale SRDNBM,
inclusiv al Congreselor anuale ale acesteia.
Aveți în fața dumneavoastră, în acest volum de rezumate o parte din roadele activității de cercetare a membrilor
SRDNBM. În opinia noastră suntem deja pe o cale bună din acest punct de vedere, cale pe care trebuie să continuăm
să mergem crescând în același timp efortul și exigența.
Vă invit să ne întâlnim cu bucurie și cu sufletele deschise ca în fiecare an, de această dată la Brașov, pentru a ne
revedea și a ne simți din nou bine împreună.
Cu prietenie,
18
On behalf of, and with the consent of the Board of Directors, I have the opportunity to communicate during this
opening of the volume of abstracts of the 42nd Congress of the Romanian Society of Diabetes Nutrition and Metabolic
Diseases a few of the achievements that our society has had in the last year as well as some thoughts for its future.
It is obvious to us all that we live in a time of major changes generated by our society’s need to converge with the
contemporary world. Some of these changes are external, decisive legislative changes, profound social and cultural
mutations that influence our personal and professional options. But these changes in our world will be accompanied
by interior evolutions of mentality and approach, finalized in concrete activities.
Building on these premises we have designed several objectives and strategic projects which I will be briefly
presenting to RSDNMD members of the General Assembly.
The first urgency is to adapt the Statute of RSDNMD to the new legislative requirements of Romania and Europe, and
I have created a proposal to this end, to be discussed and approved by RSDNMD members.
A second strategic directions is to raise the scientific and professional performance levels, as well as the degree of
involvement in RSDNMD activities of our members. Thus, we completed the database with medical practitioners of
our specialization from all over the country, whom I invite to become full RSDNMD members and make their voices
and ideas heard in this framework. We have persistently urged the authorities to modify the resident’s curriculum and
aligning it to the European one, which will lead to an increase of professional quality of our specialists. During the
upcoming months we will propose the modification of the student’s curriculum with the introduction of clinical
nutrition in the study of internal medicine.
The scientific research endorsed by RSDNMD has had an upward trend in recent years, for which we thank the
previous management of the society; it is absolutely necessary that this trend will be continued in the future. In this
respect, in 2015 the General Assembly has approved the path opened by the PREDATORR Study of acknowledging
the realities of diabetes in Romania by organizing and sponsoring a multicenter prospective observational study, the
MENTOR Study. If we manage to complete this particular effort, we will have strong arguments towards supporting
our goals in the future.
RSDNMD has also signed agreements on scientific partnership and collaboration with other professional medical
societies from Romania (cardiology, endocrinology, nephrology) and medical universities (from Bucharest and
Timisoara), partnerships which will be consolidated through joint research projects and reciprocal participation at
scientific sessions. We believe these actions are dedicated to young researchers and specialists, which we want to
encourage by all means to become the driving force of the scientific activities of RSDNMD, including its annual
Congresses.
In this volume of abstract, you have in front of you a part of the results of the research that RSDNMD members
concluded. In our opinion we are already on a good path from this point of view, path that we need to keep following
while increasing our efforts and exigency.
I invite you to meet with joy and open hearts, like every year, but this time in Brasov, to revisit us again and to feel
good together.
With kindness,
Cornelia Bala
Universitatea de Medicină şi Farmacie Iuliu Haţieganu Cluj-Napoca, România
Disciplina de Diabet, Nutriţie, Boli metabolice
Cornelia Bala
Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
Department of Diabet, Nutrition and Metabolic diseases
Beyond basic and clinical research, the evaluation of beta cell function is of clear interrest in few
clinical circumstances including differentiating between type 1 and type 2 diabetes, as well as
choice of antihyperglycemic treatments.
The main methods are measurements of insulinemia and C-peptide in fasting and stimulated state
and/or use of indices derived from Homeostasis model assessment (HOMA).
C-peptide is co-secretedwith insulin in echimolecular amounts, has a longer half-time than insulin
and can be more accuretely measured as its measurement is not influenced by exogeneous insulin
treatment. On the other hand, its longer half-time limits its value in stimulated conditions.
C-peptide can be stimulated with glucagon (1 mg IV, with measurement of C-peptide at 6 minutes),
during mixed-meal test (at 90 or 120 minutes), or less frequently with arginine or tolbutamide.
More recent data suggest that non-fasting, random measuremets of C-peptide at glucose levels of
more than 8 mmol/l (144 mg/dl) are superior to fasting or stimulated values in correctly classifing
type 1 and type 2 diabetes. Another parameter is the post-meal home meal urine C-
peptide:creatinine ratio. Absolute insulin deficiency/absolute insulin requirement is suggested at
<0,08 nmol/l, <0,2 nmol/l and <0,2 nmol/mmol for fasting C-peptide, stimulated C-peptide and
urine C-peptide:creatinine ratio, respectively. Likely Type 1 diabetes/inability to achieve
glycaemic control with non-insulin therapies are suggested at <0,25 nmol/l, <0.6 nmol/l şi <0,2
nmol/mmol.
Homeostasis model assessment (HOMA), originally developed in 1985, is a mathematical model
based on the fact that the steady-state basal plasma glucose and insulin concentrations are
determined by their interaction in a feedback loop. Two indices can be derived from this model:
HOMA-IR (insulin resistance), and HOMA-B (beta cell function). A step forward was the
development of HOMA2, which took account of variations in hepatic and peripheral glucose
resistance, increases in the insulin secretion curve for plasma glucose concentrations above 10
mmol/L (180 mg/dL) and the contribution of circulating proinsulin. If for the same subject insulin
and C-peptide values are available, C-peptide should be used for HOMA-B, and insulin for
HOMA-IR. In subjects with insulin-treated diabetes, the use of insulin-based HOMA-IR is not
validated. When HOMA-B is used in insulin-treated diabetes, values of C-peptide are to be used,
but validity is lacking for this situation as well. The use of HOMA-B in patients treated with
secretagogues, it should be taken into account that this is an index reflecting beta cell activity and
not beta-cell functional integrity.
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RW2. MODERN VIEWS ON BASAL INSULIN IN DIABETES MELLITUS
Geremia B. Bolli
University of Perugia, Italy
Type 2 diabetes is a progressive disease, i.e. the ability of pancreas to secrete insulin, decreases
over time both in terms of timely response as well as in quantity. The delayed and insufficient
insulin response to prevailing hyperglycemia is the main reason of deterioration of blood glucose
over the years, and related initiation and progression of micro- and macro-vascular complications.
Insulin resistance contributes to hyperglycemia by making the need for insulin secretion even
greater, but by itself is neither a necessary or a sufficient condition to result in diabetes mellitus.
Thus, deficiency of insulin secretion remains the pivotal factor of hyperglycemia waiting for
treatment.
Like in other endocrine diseases, deficiency of the native hormone calls for physiological
replacement. In Type 2 diabetes mellitus, substitution of insulin initiates with basal insulin which
regulates plasma glucose concentration in the fasting and interprandial state.
The modern approach to optimal treatment of Type 2 diabetes is to initiate basal insulin as soon as
A1C increases >7.0% despite use of oral agents (metformin +/- DPP-IV inhibitors) or injectable
GLP-1 RAs. Sulphonylureas should not be used, TZD are not recommended and SGLT2 inhibitors
have not a clear indication and position in the treatment of Type 2 diabetes.
Basal insulin should be initiated with 10 U or 0.2 U/kg and titrated every 4-6 days to reach the
target of fasting near-normoglycemia in 1 or 2 months. When titration is successfully done, nearly
50% of patients reach A1C <7.0%. Basal insulin can be given in combination with metformin,
DPP-4 inhibitors, GLP-1 RAs, prandial insulin.
NPH should not be used as basal insulin (neither pre-mixes based on NPH) because of the peak
activity resulting in risk for hypoglycaemia and variability of absorption. Glargine is the optimal
candidate as basal insulin every 24 h any time of day, every day at the same time. Detemir is a
better NPH with lower peak and lower risk for hypoglycaemia, but duration of action is shorter
than NPH and requires nearly always 2 daily dosing. Tresiba is a long-acting flat insulin once/day
with dosing flexibility. Glargine U300 is also flexible and has duration of action longer than
glargine U100 in addition to being flatter. More experience is needed to compare glargine U300
vs tresiba.
An experienced diabetologist can use every basal insulin as long he/she uses it according to the
characteristics of “that” basal insulin. In absolute there no one superior basal insulin vs the others,
there are only differences between the different basal insulins on the market which need to be
known and managed. At the end, the most important aspect is to titrate basal insulin to the target
of fasting plasma glucose. If basal insulin is not titrated, there is no improvement in plasam glucose
and A1C, and insulin treatment may be not efficacious to prevent complications.
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RW3. THE EPIDEMIC OF TYPE 2 DIABETES: A GLOBAL PROBLEM FOR THE
21ST CENTURY
For the first time in the history of mankind, non-communicable diseases have become the leading
cause of global mortality and morbidity. Amongst these, we are facing a worldwide epidemic of
type 2 diabetes. There are likely more than 450 million people worldwide with diabetes, with the
largest proportion being found in Asia and the Middle East. However, it is not only type 2 diabetes
but recent reports have suggested increases in type 1 diabetes in Finland and the United States.
Across the world, diabetes accounts for 8-15% of national healthcare budgets and it is the late
complications particularly those affecting the lower limb and the kidney, that drive costs. There
is overwhelming evidence for the impact of preventative measures in those with “pre-diabetes” or
IGT. Both the Diabetes Prevention Programme from the United States and the Diabetes
Prevention Study from Finland have shown that diet and lifestyle changes in this phase can lead
to a 58% reduction in the incidence of type 2 diabetes. Moreover, these 2 studies and studies from
China report a “legacy effect” and that is that lifestyle adjustment for a few years has a long-lasting
effect in protection from development of type 2 diabetes. For the management of type 2 diabetes,
a patient-centred approach is advocated as proposed by the revised EASD/ADA guidelines
published in 2015. Whereas strict control of diabetes in young people with type 2 diabetes with
few complications is indicated, one must remember the risks of hypoglycaemia in the elderly
population, especially those with co-morbidities, in whom a less aggressive approach is indicated.
The first line agent after diet and lifestyle adjustment for the management of type 2 diabetes
remains metformin. Second line drugs include the DPP4 inhibitors, GLP-1 analogues, SGLT-2
inhibitors, pioglitazone and the sulphonylureas. It must be remembered that the natural history of
type 2 diabetes is one of progressive loss of beta-cell function and most patients in the long-term
may well require insulin therapy. Finally, the outcome trials, especially that from the EMPA-REG
Cardiovascular Outcome Trial, suggest potential cardio protection from some of the agents
particularly SGLT-2 inhibitors.
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RW4. DIABETIC FOOT DISEASE: AN OVERVIEW
Foot disease remains a major cause of morbidity and mortality in the diabetic population today.
In the last 10 years there has been an increase in the amount of evidence-based data to support
various therapies used for diabetic foot problems. First, in terms of prevention, the team approach,
that is identifying patients at risk of foot problems providing them with education, regular podiatry
and good footwear has been shown to be helpful in several large studies. However, the impact of
education alone still remains unproven. In Western countries, neuropathic foot ulcers are not now
the most common cause of foot lesions: it is neuro-ischaemic disease that prevails. However,
prevention is most likely to be successful in the neuropathic foot and most healthcare systems
advocate an annual review for all those patients with diabetes to identify those at risk of foot
problems.
For the patient with a simple neuropathic foot ulcer, there is good evidence to support the use of
offloading using total contact casts or removable cast Walkers. For the non-adherent patient,
removable cast Walkers can be rendered irremovable and this improves the efficacy of the
treatment. There has recently been much debate about the use of hyperbaric oxygen in the
management of diabetic foot lesions. A trial from Sweden a few years ago suggested that this
therapy may benefit those patients with distal arterial disease that is non-reconstructable, and
chronic infected neuro-ischaemic or ischaemic foot lesions. However, 2 more recent randomised
controlled trials have not supported this and there is no evidence at present to support the use of
hyperbaric oxygen in both diabetic foot lesions. In contrast, there is evidence to support the use of
negative pressure wound therapy (NPWT) for those complex foot wounds (frequently after local
surgery) that don’t respond to standard of care. NPWT is particularly helpful in post-operative
local surgical wounds in the diabetic foot.
Lastly, although antibiotics are widely used, there is no strong evidence base to support the use of
any one particular antibiotic. The Infectious Disease of North America Associations 2012
Guidelines are on the management of diabetic foot infections remains a most useful source of
reference for the management of infected foot ulceration. Similarly, there is no evidence to support
the use of any particular dressing and there appears to be little benefit from more expensive
dressings over the more traditional ones.
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RW5. DIABETUL SI SINDROMUL CORONARIAN ACUT
Doina Catrinoiu
Exista o creștere globală a prevalenței diabetului de tip 2, dar si a altor tulburari in metabolismul
glucozei, cel mai frecvent alterarea toleranței la glucoză (IGT). Acestea reprezintă factori majori
de risc pentru ateroscleroza, inclusiv pentru sindromul coronarian acut (SCA), determinate de
boala arterială coronariană (CAD). Diabetul de tip 2 si alterarea tolerantei la glucoza apare doua
treimi din pacientii cu SCA, fara ca acesti pacienti sa fi fost diagnosticati anterior cu DZ. Urmarirea
pe termen lung a acestor pacienți a demonstrat că afectiunea metabolica influenteaza in sens
negativ prognosticul cardiovascular.
Există mai mulți factori care determina vulnerabilitatea cardiovasculara la pacienții cu DZ
tip 2 și IGT.
Printre acestea cele mai importante par a fi disfuncția endoteliala, modificarea functiei plachetare,
scăderea capacității fibrinolitice, cresterea produsilor de glicozilare avansata (AGE), dislipidemia,
hipertensiunea arterială și sensibilitatea redusa la insulină. Glicemia bazala este un factor de risc
cunoscut pentru BCV, dar asocierea glucozei cu CHD este mai putin importanta decât alți factori
de risc, cum ar fi colesterolul total, non-HDL colesterol, tensiunea arteriala, în special cea
sistolica.
Durata de evolutie a diabetului, este de asemenea un factor determinant important pentru
dezvoltarea BCV. Insuficienta cardiaca sau accidentul vascular cerebral apar mai frecvent în
rândul persoanelor cu evolutie indelungata a diabetului, fata de cei nou diagnosticati.
Impactul IGT asupra SCA și a morbidității cardiovasculare este încă incomplet cunoscut.
Diagnosticul precoce al diabetului este de asemenea important pentru evolutia afectiunii
cardiologice si de asemenea poate influența alegerea tehnicii de revascularizare.
In general, avand in vedere afectarea multivasculara interventia recomandata este by-passul, iar
cei care primesc stenturi necesita folosirea celor biologic active cu cresterea semnificativa a
supravietuirii si scaderea aparitiei unui nou infarct.
Alegerea terapiei antiagregante si hipotensoare este esentiala pentru evolutia pe termen
lung, de prima intentie fiind inhibitori ai ECA sau vasodilatatoare beta-blocante.
Relația dintre hipoglicemie și sindromul coronarian acut reprezinta in continuare motiv de
dezbatere privind implicarea hipoglicemiei in aparitia evenimentelor acute vasculare si chiar a
mortii subite.
Hipoglicemia crește intervalul QTc, creste producția de markeri proinflamatorii, determina
activarea trombocitelor, și a markerilor de stres oxidativ, scade functia endoteliala si de asemenea
scade fluxului sanguin miocardic. Toate că aceste modificări pot crește riscul de BCV si de moarte
subita, dar este greu de demonstrat ca hipoglicemia este o cauza directa a acestor modificari.
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DIABETES AND ACUTE CORONARY SYNDROME
Doina Catrinoiu
There is a global increase in the prevalence of type 2 diabetes, and other disorders in glucose
metabolism, most commonly altered glucose tolerance (IGT). These are major risk factors for
atherosclerosis, including acute coronary syndrome (ACS) caused by coronary artery disease
(CAD). Type 2 diabetes and impaired glucose tolerance occurs two thirds of patients with ACS
without these patients have been previously diagnosed with diabetes. Long term follow up of these
patients demonstrated that metabolic disease negatively affects cardiovascular outcomes.
There are several factors that cause cardiovascular vulnerability in patients with type 2
diabetes and IGT.
These seem to be the most important endothelial dysfunction, modification platelet function,
decreased fibrinolytic capacity, increasing product advanced glycation (AGE), dyslipidemia,
hypertension and reduced sensitivity to insulin. Basal blood glucose is a known risk factor for
CVD, but the association with CHD glucose is less important than other risk factors such as total
cholesterol, non-HDL cholesterol, blood pressure, especially the systolic.
The duration of evolution of diabetes, is also an important determinant factor for developing CVD.
Heart failure and stroke, occur most frequently among people with long evolution of diabetes,
compared to those newly diagnosed.
IGT impact on SCA and cardiovascular morbidity is still incomplete. Early diagnosis of diabetes
is also important for the evolution of cardiac disease and can also influence the choice of
revascularization technique.
In general, given the damage multivessel recommended by-pass surgery and those receiving stents,
require the use of biologically active with the significant increase survival and decrease the
appearance of a new heart atack.
Choice of antihypertensive therapy and antiplatelet agents is essential for long-term evolution, first
intention is vasodilators ACE inhibitors or beta-blockers.
The relationship between hypoglycemia and acute coronary syndrome is still cause for debate on
involvement in causing hypoglycaemia acute vascular events and even sudden death.
Hypoglycemia increase QTc interval increases production of proinflammatory markers, cause
platelet activation, and markers of oxidative stress, endothelial function and also decreases
myocardial blood flow decreases. While these changes may increase the risk of CVD and sudden
death, but it is hard to prove that hypoglycemia is a direct cause of these changes.
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RW6. CARDIOVASCULAR OUTCOME TRIALS: THE POSSIBLE MECHANISMS
BEHIND THE RESULTS
Clinical trials of glucose-lowering strategies in patients with type 2 diabetes mellitus (T2DM) have
shown a favorable effect of intensive glycemic control on microvascular complications but failed
to show a clear benefit on cardiovascular events. In 2008, the US Food and Drug Administration
(FDA) and European Medicines Agency (EMA) have required stringent criteria to approve new
glucose-lowering drugs, demanding proof of cardiovascular safety. As a result of these regulatory
requirements, a number of cardiovascular outcome trials in T2DM have been conducted examining
the cardiovascular safety of novel glucose-lowering drugs. Dipeptidyl peptidase 4 (DPP4)
inhibitors, analogs of glucagon-like peptide 1 (GLP-1), and inhibitors of the renal sodium-glucose
linked transporter-2 (SGLT2) are new classes of glucose-lowering drugs for subjects with T2DM.
The results of the cardiovascular outcome trials comparing the DPP4 inhibitors saxagliptin,
alogliptin, and sitagliptin or the GLP-1 analog lixisenatide to placebo have demonstrated that these
drugs are safe. The results of a cardiovascular outcome trial comparing the SGLT2 inhibitor
empagliflozin to placebo have been published. Notably, empagliflozin treatment has been
associated with a significant reduction in the primary composite cardiovascular outcome.
Moreover, a recent Press release announced that in the LEADER Trial, liraglutide seems to be able
to reduce all kind of cardiovascular events.
Although the question regarding the positive effect of glycemic control on cardiovascular risk is
still unanswered, current evidence suggests that new hypoglycemic agents which also impact on
both classical and non classical cardiovascular risk factors can have a significant role.
Several disorders of nutrition and metabolism are accompanying type 2 diabetes mellitus.
The carbohydrate disturbances include impaired glucose tolerance (IGT) and type 2
diabetes mellitus, but not only. The estrogen deficiency could represent an essential step in the
process of diabetogenesis. Other significant factors for the risk of type 2 diabetes are: ageing,
obesity (with increasing incidence after menopause), lowering of physical activity, smoking,
drinking, some drugs a.s.o. Additionally, modified metabolism of D3 vitamin and calcium
deficiency (specific to menopause) are inducing a high risk for both types of diabetes.
Unfortunately, there are in the scientific literature a number of controversies regarding the
relation menopause – diabetes. For instance, an important American study (Diabetes Prevention
Program) pointed out that natural menopause didn’t associate with an increased risk of diabetes
and didn’t influence the answer to the preventive strategy. On the other hand, a large European
trial (EPIC- InterAct Study), carried on eight countries, concluded that early menopause has
produced a higher risk for type 2 diabetes mellitus.
Reffering to the control of diabetes in the menopause period, many studies emphasize on
diet and improving lifestyle, with a major role of physical activity. It is interesting that metformin
use in postmenopausal women with diabetes was associated with lower incidence of invasive
breast cancer.
Hormone replacement therapy, proposed for the correction of menopause, seems not to be
adequate for the women with type 2 diabetes mellitus.
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RW8. BENEFITS FROM INSULIN PUMP IN PEOPLE WITH TYPE 2 DIABETES
Rudolf Chlup1,2
1
Dept. of Physiology and Dept. of Medicine, Palacký University Olomouc;
2
Dept. of Diabetes Moravský Beroun, Institute Paseka, Czech Republic.
Since 1978, Continuous Subcutaneous Insulin Infusion (CSII) became a sophisticated method of
insulin substitution/supplementation in persons with diabetes (PWD). To date, in the Czech
Republic (population of 10 milions inhabitants with 800 000 PWD), there are about 5000 PWD
on insulin pump. The international multicenter study Opt2mise (2010-2014) demonstrated that
CSII in PWD2 lead to significant reduction of HbA1c concentrations.
Aim of the present study was to explore global metabolic changes resulting from 6- and 12-month
CSII therapy in PWD2.
Methods: This prospective single-center trial recruited insulin-resistant CSII-naive PWD2,
uncontrolled, using insulin analogues-based Multiple Daily Injections (MDI) therapy + metformin.
Insulin dosing was optimized over an 8-week run-in period. A total of 23 subjects (16 men) with
persistent HbA1c ≥8% were randomly assigned to the CSII arm or to the MDI continuation arm.
After 6 months, the MDI arm (except one drop out) crossed over to CSII therapy as well. Mean
frequency of selfmonitoring on personal glucometer varied over the whole study in both arms
between 3.4 to 5.4 measurments/d.
Results: At 6 months, subjects assigned to the CSII arm achieved a significant mean HbA1c
reduction while reducing their total daily insulin dose (TDD) by 33% of baseline and also
achieving body mass reduction of 0.98% of baseline. Subjects on MDI demonstrated a non-
significant HbA1c reduction with TDD reduction of 5% from baseline and body mass reduction
of 0.99% of baseline. At 12 months, data from both arms of 22 patients, 11 continuing on CSII for
12 months, and 11 following overcross from MDI to CSII for 6 months, demonstrated mean 1.3%
HbA1c reduction from baseline (9.5%) with 54.6% values achieving HbA1c<8%. Mean TDD
reduction from baseline (95.7 ±22.75 U/d) was 19.5 U/d, No significant change vs. baseline was
noted in body mass, blood pressure, HDL, LDL and TAG. No ketoacidosis or severe hypoglycemia
occurred in either group.
Conclusion: In insulin resistant PWD2, CSII significatively and safely improved glucose control
with less insulin use and with no sustainable reduction of body mass, blood pressure and lipid
profile.
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RW9. PARTICULARITĂȚI ALE STATUSULUI NUTRIȚIONAL LA PACIENȚII CU
DIABET ZAHARAT ȘI BOALĂ CRONICĂ DE RINICHI AVANSATĂ
Malnutriția protein-calorică este frecvent întâlnită în rândul pacienților cu boală renală avansată.
Este demonstrată asocierea cu inflamația cronică și cu o creștere a riscului cardiovascular și
reprezintă un factor de prognostic negativ pentru supraviețuirea pacienților dializați. De aceea
evaluarea statusului nutrițional la acești pacienți trebuie efectuată regulat, prin metode multiple și,
dacă este evidențiată prezența malnutriției, trebuie intervenit prompt prin identificarea posibilelor
cauze și tratament adecvat.
Din punct de vedere nutrițional la pacientul cu boală cronică renală și diabet zaharat riscul de
malnutriție protein-calorică este exponențial crescut deoarece ambele patologii pot asocia sindrom
de wasting (PEW).
Sindromul de wasting este caracterizat prin pierderea depozitelor de proteine somatice, scăderea
nivelului de proteine viscerale și de energie. Cauzele PEW includ anorexia, aportul alimentar
redus, boli concomitente în special atunci când asociate cu procesele inflamatorii, dizabilitate
fizică sau mentală, îndepărtarea nutrienților prin procedura de dializă, acidoza metabolică,
scăderea condiției fizice, stresul oxidativ și carbonilic. Pacienții cu diabet zaharat sunt, de
asemenea, la un risc mai mare pentru PEW cauzat comorbiditățile diabetului. Aceste tulburări
includ boala vasculară ischemică, hipertensiunea, disfuncțiile gastrointestinale și neuropatia
autonomă. Tulburările metabolice, cum ar fi deficitul de insulina sau rezistenta la insulina si
nivelurile ridicate de hormoni de contrareglare, pot contribui de asemenea la PEW.
Starea de nutriție poate fi evaluată prin mai multe metode pornind de la măsurarea greutății, IMC,
circumferinței brațului, pliului tricipital și, pentru determinări mai precise prin forța de strângere
a pumnului, bioimpedanță, DXA, RMN.
Într-un studiu efectuat în București pe 137 pacienți hemodializați, evaluarea inițială a arătat o
prevalență semnificativ statistic mai mare (p <0,001) a PEW, la pacienții diabetici hemodializați
comparativ cu grupul de control, același model fiind observat în evoluție și la 12 și 24 luni. PEW
este mai frecventă la pacienții diabetici, care asociază și o creștere a masei de țesut adipos. Markerii
de PEW s-au corelat cu mortalitatea în ambele grupuri.
Evaluarea nutrițională este absolut necesară atât la începutul cât și în timpul urmăririi acestor
pacienți pentru o mai bună individualizare a tratamentului și implicit rezultate mai bune pe termen
lung.
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NUTRITIONAL STATUS SPECIFICITIES IN PATIENTS WITH DIABETES
MELLITUS AND ADVANCED CHRONIC KIDNEY DISEASE
Nutritional status can be assessed by several methods starting with weight, BMI, mid-arm
circumference, tricipital skinfold and, for more precise determinations hand-grip strength,
bioimpedance, DXA, MRI.
Nutritional assessment is absolutely necessary both at the beginning and during follow-up for an
appropriate individualized therapy and better long term outcomes.
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RW10. CHIRURGIA BARIATRICĂ- O OPȚIUNE SIGURĂ PENTRU OBEZITATE?
Potrivit datelor WHO, obezitatea la nivel mondial s-a dublat din 1980 până în prezent,
înregistrandu-se o creștere alarmantă atât a supraponderalității cât și a obezității la adulți și copii.
Obezitatea are un impact negativ asupra factorilor economici, sociali și, cel mai important, asupra
stării de sănătate, crescând riscul de boli cardiovasculare, diabet zaharat tip 2 și cancer. În Europa,
supraponderalitatea și obezitatea sunt responsabile de 80% din cazurile de diabet zaharat tip 2, de
35% din cazurile de boală cardiacă ischemică și 55% din hiperetensiunea arterială. Schimbarea
stilului de viată prin dietă, exerciții fizice și medicație s-a dovedid a fi folositoare, dar, din
nefericire, scăderea ponderală este moderată și temporară. De la sfarsitul secolului 20, chirurgia
bariatrică vine în ajutorul controlului comorbidităților obezității, motiv pentru care i s-a însușit și
titlul de chirurgie metabolică. Acest tip de intervenție a dus la ameliorarea sau chiar remisia
diabetului zaharat de tip 2, a hipertensiunii arteriale și a bolii cardiovasculare. Frecvent, scaderea
ponderală duce la diminuarea terapiei medicamentoase pentru comorbiditățile obezității.
Cand se apeleaza la chirurgia bariatrica este important să ne gândim atât la beneficii și riscuri, cât
si la atitudinea pacientului fata de aceasta optiune. Astfel, el trebuie să fie motivat și să înțeleagă
schimbările stilului de viată si faptul ca acestea vor fi permanente.
Există date referitoare la riscurile și complicațiile chirurgiei bariatrice precum litiaza biliară,
deficitul de micro si macronutrienți, osteoporoza și diverse patologii de natură psihiatrică. Unele
studii ne arată o scădere a densității minerale osoase, dar nu avem suficiente date care sa ne indice
riscul de fractură pe termen lung.
Pentru a avea rezultate favorabile, chirurgia bariatrică necesită evaluări psihologice și psihiatrice
preoperatorii pentru fiecare pacient. Acest lucru este necesar deoarece depresia și anxietatea pot
genera și pot fi generate de obezitate. Date din literatura de specialitate relatează o îmbunătățire a
componentei psihologice postoperatorii, dar acest lucru nu este valabil în toate cazurile. Unii dintre
pacienți continuă lupta cu scăderea în greutate, menținerea acesteia și tendința către reîngrășare.
Aceste rezultate confirmă importanța efectuării unor studii cu evaluare pe termen lung a depresiei
prin scale specifice.
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IS BARIATRIC SURGERY A SAFE OPTION FOR OBESITY?
According to WHO, there has been an alarming increase in rates of obesity and overweight in both
adults and children. Worldwide, obesity has more than doubled since 1980. Obesity has a great
number of negative consequences regarding the economic, social and, most important, health
factors such as a greater risk of cardiovascular diseases, diabetes and certain cancers. In Europe,
overweight and obesity are responsible for about 80% of cases of type 2 diabetes, 35% of ischemic
heart disease and 55% of hypertensive disease among adults. Lifestyle intervention programs with
diets, exercise programs and pharmacotherapy are used but, unfortunately, clinically significant
weight loss is very modest and transient. From the end of the 20th century, bariatric surgery has
emerged as a powerful tool in controlling obesity-related comorbidities, which has evolved rapidly
into the so-called metabolic surgery. Bariatric surgery has been shown to help improve or resolve
many obesity-related conditions, such as type 2 diabetes, high blood pressure, heart disease, and
more. Frequently, individuals who improve their weight find themselves taking less and less
medications to treat their obesity-related conditions.
When choosing bariatric surgery It is important to consider both benefits/ risks and the
understanding of the life-long commitment this type of option requires. Therefore, patients must
have serious motivation and a clear comprehension of the extensive dietary, exercise and medical
guidelines that must be followed for the rest of their lives after having weight loss surgery.
There is data regarding risks and complications of bariatric surgery, such as gallstones, nutritional
deficiencies, osteoporosis and psychiatric problems. There were some studies that showed a
significant change of the bone mineral density, yet not enough to prove that there is a related long
term risk of bone fractures.
In order to have a successful outcome bariatric surgery requires both preoperative psychological
and psychiatric evaluations of each patient. This is needed because symptoms of depression and
anxiety can trigger or be triggered by obesity. A review of the literature identified a trend
suggesting improvements in psychological health after bariatric surgery. However, not all patients
report psychological benefits after surgery. Some patients continue to struggle with weight loss,
maintenance and regain. These results emphasize the importance of long follow-up in future
studies, as well as the evaluation of different measures of depression.
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RW11. BOALA RENALĂ DIABETICĂ: ESTE MOMENTUL UTILIZĂRII DE RUTINĂ
A BIOPSIEI RENALE?
Gener Ismail
Clinica de Nefrologie, Institutul Clinic Fundeni, Bucuresti, Romania
Nefropatia diabetica este o cauza majora de Boala Cronica de Rinichi, iar incidenta diabetului
zaharat creste rapid in intreaga lume. Markerii serici si urinari utilizati actual in diagnosticul si
monitorizarea nefropatiei diabetice au numeroase limitari. In practica clinica actuala, primul semn
de nefropatie diabetica este considerat a fi aparitia microalbuminuriei, test care are cateva limitari,
cum ar fi sensibilitatea redusa si variabilitatea ridicata. Un diagnostic precis a leziunilor specifice
nefropatiei diabetice nu poate fi facut decat prin examenul histopatologic al tesutului renal. Acum
in practica curenta, biopsia renala este indicata in cazul pacientilor cu diabet zaharat doar in
conditiile existentei unei suspiciuni clinice a unei alte nefropatii, decat cea diabetica. Date
publicate sugereaza ca doar o treime din pacientii cu diabet zaharat biopsiati renal au nefropatie
diabetica, o treime au nefropatie diabetica asociata cu alte nefropatii, in timp ce o treime au alte
nefropatii. Diagnosticul precoce al unei nefropatii non-diabetice este vital in managementul
acestor pacienti, mai ales in cazul glomerulopatiilor primitive, glomerulopatiilor secundare unor
boli sistemice sau nefropatiilor interstitiale. In ciuda progreselor inregistrate in ultimii ani in
cunoasterea patogeniei bolii prognosticul pacientilor cu nefropatie diabetica ramane rezervat. De
aceea sunt necesare noi strategii terapeutice care sa fie confirmate de studii clinice puternice; una
din strategii ar putea fi instituirea tratamentului in fazele initiale ale bolii cand leziunile renale sunt
incipiente si au cota mare de reversibilitate. Utilizarea biopsiei renale in diagnosticul precoce si
monitorizarea raspunsului la terapie in cadrul trialurilor clinice ar putea contribui la identificarea
unor noi medicamente eficiente in tratamentul nefropatiei diabetice.
Gener Ismail
Nephrology Department, Fundeni Clinical Institute, Bucharest, Romania
Diabetic nephropathy is a major cause of ESRD, and the incidence of diabetes mellitus is rising
rapidly. Urinary and serum markers presently accepted in diagnosing and monitoring diabetic
nephropathy have many drawbacks. In the current clinical practice, microalbuminuria which is
considered to be the first sign of diabetic nephropathy, has also some limitations such as low
sensitivity and high variability. An accurate estimate of damage in diabetic nephropathy can only
be achieved by the histological analysis of tissue samples. At the present time, renal biopsy is
indicated on patients with diabetes under the suspicion of the presence of nephropathies other than
diabetic nephropathy. Available data suggest that approximately one third of patients with diabetes
36
that are biopsied show diabetic nephropathy, another third diabetic nephropathy with a
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Persoanele cu probleme de greutate obțin prea multă satisfacție din alimente sau insuficientă
Page
satisfacție. Cercetatorii privind functionarea creierului au venit cu două posibile explicații, opuse,
de ce oamenii manâncă în exces.
Hyper-răspuns: alimentele declanșează o plăcere mult mai mare la mâncatul în exces (mâncatul în
exces acționează ca un drog)
Hypo-răspuns: produsele alimentare declansează o plăcere mult mai mică, mâncatul în exces fiind
pentru a atinge nivelul de plăcere.
Teoria recompensei alimentare afirmă că recompensa (motivaÅ£ia) este valoarea hedonică
(plăcerea, palatabilitatea) dată de aportul alimentar și care influențează cantitatea de alimente și
grasimea corporală prin reglarea ponderostatului.
There is a continuum of eating behavior from normal eating to recognized psychiatric disorders
(binge eating disorder - BED and bulimia nervosa - BN). To ensure that our bodies receive the
necessary amount of nutrients of the best quality, we are encouraged to adopt normal eating habits
and most of us eventually manage to control and regulate our food intake in order to meet not only
our bodies’ energy demands, but also to fulfill our hedonic desires or urges with deep social and
symbolic implications. Nevertheless, there are still many people who either embrace over-
regulatory habits, resulting in underweight and malnutrition or fail in self-regulating their eating
behavior, leading to overweight and obesity. The eating disorders of both underweight and
overweight individuals often have somatic and psychic implications that require medical attention
and nutritional supervision.
Restrained eating involves the act of abstaining from consuming or avoiding certain food
categories, as well as eating in specific patterns that eliminate social flexibility. In other words,
restrained eating does not address the point of caloric control. This type of eating rarely leads to
long-term sustainable weight loss success; it is often associated with disinhibition, obsessive-
compulsive disorders and weight cyclying (yo-yo). In accordance with the Restraint Theory, the
preload eventually leads to loosening one’s restraints and to overeating because the overall dietary
program is based on strict caloric intake (counter effect).
Calorie restriction is a dietary intervention resulting in a caloric deficit; in other words, people eat
less than they burn and their bodies are forced to tap into their adipose tissue. In calorie restricted
diets, people are allowed to eat anything they want, provided their calorie limits are not exceeded.
Such dieters generally stay in a good mood because they can enjoy food diversity. Cognitive
factors, anticipation and taste are known to influence food intake, which generally triggers a
rewarding feeling-good experience. Associating food pleasure with the release of dopamine, many
scholars have interpreted the occurrence of high levels of dopamine in terms of elevated levels of
experienced food pleasure. Nevertheless, other studies have argued that the intensity of people’s
feelings of reward and happiness highly depend upon the number of specialized dopamine
38
receptors. Thus, the existence of fewer D2 receptors means less reward, even if the overall level
Page
of dopamine is high. The level or degree of food satisfaction among those who strive to control
their weight is dependent upon the number of these receptors.
Researchers investigating brain functioning and overeating have come up with two opposite
potential explanations on why people eat too much:
Hyper-response. It is believed that food triggers a much bigger pleasure response in overeaters
than that in normal eaters. Overeating functions like a drug.
Hypo-response. It is believed that food triggers a much smaller pleasure response in overeaters
than that in normal eaters. Thus, overeaters eat more to compensate for their lack of food reward
response.
The food reward theory states that the reward (motivation) and the hedonic (pleasure, palatability)
value of food influence food intake and body fat setpoint.
Globally, the prevalence of diabetes is rapidly increasing which has given rise to the notion of ‘the
diabetes epidemic’. The Danish Diabetes Impact Study builds on The Danish National Diabetes
Register covering all persons with diabetes in Denmark alive as of January 1st 1997 and included
hereafter. Using linked data from all relevant national health registers we have characterized the
epidemiology of diabetes in Denmark from the end of 1999 through 2011.
We have used ‘stock and flow’ models for the period 2000 through 2011 to describe scenarios of
the prevalence of diabetes under assumptions concerning the trends in (1) general population
demography; (2) incidence rate of diabetes; (3) rates of developing long-term complications, and
(4) mortality rate in the diabetes population. All analyses have been stratified for sex and age.
During year 2000 18,376 new cases of diabetes were registered in Denmark, contrasting 8,314
deaths in the diabetes population. During year 2011 31,821 new cases were registered in contrast
to 11,901 deaths.
During the 12-years period from end of 1999 to end of 2011 the prevalence increased from 132,624
to 300,769 (127%). According to the scenarios, explanatory fractions of this increase during the
period were: general population demography: +4.7%, incidence rate: +28.7%, complication rates:
+4.1% and mortality rates: +12.6%. The remaining 49.9% of the increase cannot be explained by
these conventional drivers but is attributable to the effect of the huge and increasing imbalance
39
between much higher number of new cases as compared to the number of deaths. These
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mechanisms will be further discussed and used for establishing scenarios for the future prevalence
of diabetes.
Our analysis shows that demographical changes in the background population contribute only little
to the increasing prevalence and that the major part of the prevalence increase is explained by the
huge and imbalance between annual new cases as contrasted with deaths.
The results of such analyses are specific for disease, populations and time periods covered.
However, the principles may be applied to other diseases, populations and periods, provided that
baseline epidemiological parameters are available empirically or by reasonable assumptions.
Cristian Guja
National Institute of Diabetes, Nutrition and metabolic Diseases “Prof. NC Paulescu”, Bucharest,
Romania
Glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1 RAs) are members of the modern
family of incretin based anti-diabetes drugs. Following binding on GLP-1 receptors, they stimulate
insulin secretion from the pancreatic beta cells, they inhibit glucagon secretion from the pancreatic
alpha cells (both in a glucose dependent manner). In the same time, they decrease appetite and
consequently food intake with weight benefits and delay gastric emptying, with improvement of
postprandial blood glucose values.
According to their action profile, GLP-1 RAs can have a short or long action. Short action
compounds include exenatide BID (Byetta®, Astra Zeneca) and lixisenatide (Lyxumia®, Sanofi).
Long acting compounds include liraglutide (Victoza®, Novo Nordisk) with daily administration
and the once weekly formulations exenatide QW (Bydureon®, Astra Zeneca), albiglutide
(Tanzeum®, Glaxo Smeetkline) and dulaglutide (Trulicity®, Eli Lilly). Biochemically, GLP-1 RAs
can be divided in exendin-4 derivates and human GLP-1R analogs. Exendin-4 is a 39 amino-acid
polypeptide extracted from the saliva of the Gila monster lizard. It shares 53% homology with
human GLP-1 but conserves full binding to the human GLP-1 Receptor. Exendin-4 derivates
include exenatide and lixisenatide. Human GLP-1 Receptor analogs include liraglutide
(substitution of lysine with arginine in position 34 and binding of a C16 fatty acid at lysine from
position 26), albiglutide (dimer of a 30 amino-acid peptide bound to human albumin) and
dulaglutide (two GLP-1 chains bound to a immunoglobulin fragment).
Short acting GLP-1 RAs have a strong effect of gastric emptying prolongation and
consequently seem to be more suitable for the treatment of patients with marked postprandial
hyperglycemia. They have more pronounced gastro-intestinal side effects, including nausea and
vomiting. Generally HbA1c decrease is lower in comparison with that obtained with the long
action GLP-1 RAs. The last have an attenuated effect on gastric emptying (due to a tachyphylaxis
effect) and consequently have less GI side effects and are better for patients with predominantly
40
fasting hyperglycemia.
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The efficacy of GLP-1 RAs is robust, with HbA1c decreases generally higher than 1%, up
to 2%. They can be recommended already from the second step of therapy in patients which do
not reach targets with metformin monotherapy or from the second step, in patients with failure of
combination therapy. They can also be combined with basal insulin, this association being
advocated both by the ADA/EASD 2015 algorithm and AACE 2016 guideline before adding
prandial insulin to basal insulin treatment.
Beyond blood glucose control, GLP-1RAs are associated with weight loss (generally in the
magnitude of 2-4 kg) and have a low risk of hypoglycemia (though significant in the case of
association with either insulin or suplphonylureas). Lixisenatide was shown to be neutral on CV
risk in the recently published ELIXA study while liraglutide seemed to decrease CV risk in patients
from the LEADER study, to be presented during the New Orleans, ADA 2016 annual meeting.
CV safety studies with exenatide QW (EXSCEL), albiglutide (HARMONY) and dulaglutide
(REWIND).
Obesity is one of the most common chronic diseases in human populations across the
globe, the current epidemic affecting over 500 million adults. Similar to other common human
complex diseases obesity pathogenesis involves both genetic and environmental factors. The last
include hypercaloric diet, sedentarism, stress and other conditions such as urbanization and
westernized lifestyle. Considerable evidence from epidemiologic twin, adoption and family
studies indicated that body weight and body fat disposition have a heritability of up to 70%,
highlighting the importance of heredity/genetics.
The discovery of single gene variants associated with rare causes of extreme obesity in
children highlighted the pivotal role of hormonal and neural hypothalamic networks regulating
body weight. The majority of these genes were discovered following studies in animal models
(mice) and subsequently confirmed in humans. Among these are the genes for leptin (Lep), leptin
receptor (Lepr), proopiomelanocortin (POMC), melanocortin 4 receptor (MC4R) and prohormone
convertase 1 (PCSK1). Some other gene variants were discovered analyzing the equally rare cases
with complex syndromes associating obesity. Again most genes identified are related to central
nervous system appetite centers. In contrast with the severe obesity cases induced by homozygous
mutations in these genes, carriers of heterozygous mutations exhibit less severe obesity.
In contrast with monogenic forms of obesity, in the common form of polygenic obesity the
genetic risk is influenced by the combined effect of variation at numerous loci. Thus, the recent
genome-wide association studies for obesity related traits such as body mass index or waist
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circumference identified more than 120 gene variants/loci, the vast majority with a modest effect
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(their combined effect explains only a small part of BMI heritability). Many of these were shown
to be highly expressed in the brain, particularly in the hypothalamus, highlighting again their
importance in regulating food intake and, subsequently, adiposity. The fat mass and obesity
associated gene (FTO) on chromosome 16 was the first gene convincingly proven to be associated
with common human obesity.
The fact that gene variants identified so far has such a poor predictive value for obesity,
especially when compared with risk calculators based on clinical factors, is known as missing
heritability and has several potential explanations. Epigenetic factors (such as DNA methylation
and histone modification) presumably play an important role in the pathogenesis of human obesity.
They might mediate the effects of the environment on the risk of obesity. Further research is
needed to clarify the role of genetic variation and epigenetic mechanisms in the development of
human obesity.
Aterogeneza, ateroscleroza și aterotromboza sunt stadii evolutive ale unui proces ce culminează
cu un eveniment coronarian acut. Prevalența și viteza de progresie a acestor procese sunt
influențate de diverși factori, cum ar fi genul, vârsta, stilul de viață sau afecțiunile asociate.
Diabetul zaharat este un cunoscut factor major de risc cardiovascular, care influențează nefast
aceste procese, datorită hiperglicemiei, inflamației, disfuncției microvasculare și creșterii stresului
oxidativ. Sunt descrise procesele moleculare prin care diabetul promovează inițierea leziunii
aterosclerotice, progresia plăcii de aterom și inhibă regresia leziunii. Între diabet și aterogeneză
există o puternică asociere, ateroscleroză în diabet având o evoluție strâns legată de inflamație și
tulburările metabolice asociate, iar afectarea proceselor de coagulare și tromboză favorizează
apariția aterotrombozei la această categorie de pacienți.
oxidative stress. There are described the molecular processes through which diabetes promotes
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atherosclerotic lesion initiation, progression of plaque and inhibits lesion regression. There is a
strong association between atherogenesis and diabetes, with atherosclerosis development in
diabetes closely linked to inflammation and associated metabolic disturbances and the presence of
impaired clotting and thrombosis processes favors the appearance of atherothrombosis in patients
with diabetes.
Nicolae Hâncu
În 10 noiembrie 2014 s-a întrunit la Paris (Franța) un consorțiu de experți europeni în domeniul
lipidologiei clinice și a bolii cardiovasculare pentru a discuta problema dislipidemiei aterogene
(DA) și abordarea în practică a riscului cardiovascular pe care aceasta îl reprezintă. Au fost
publicate în Atherosclerosis Supplements până în prezent 2 articole referitoare la propunerile
acestui consorțiu, unul în toamna anului 2015, intitulat ”A review of the evidence on reducing
macrovascular risk in patients with atherogenic dyslipidaemia: a report from an expert consensus
meeting on the role of fenofibrate–statin combination therapy” și cel de al doilea intitulat ”Current
practice in identifying and treating cardiovascular risk, with a focus on residual risk associated
with atherogenic dyslipidaemia” a fost publicat în aprilie 2016. În acest ultim articol a fost
propusă o definiție simplă și practică a dislipidemiei aterogene: trigliceride crescute (≥150 mg/dl)
și HDL-colesterol mic (sub 40mg/dl la bărbați și sub 50 mg/dl la femei) la pacienți tratați cu statine,
aflați la risc cardiovascular crescut. Managementul clinic cuprinde optimizarea stilului de viață,
statinoterapia pentru aducerea LDL-colesterol în ținte (se poate asocia și ezetimibul), iar
tratamentul DA reziduale se va completa cu fenofibrat, pentru a obține corectarea întregului tablou
lipidic. Se discută de asemnea diverse scenarii unde se propune utilizare fenofibratului: la pacienți
cu trigliceride foarte crescute sau la cei cu intoleranță la statine sau la cei tratați cu statine, dar cu
DA și risc cardiovascular crescut.
Nicolae Hâncu
A meeting of European experts in lipids and cardiovascular disease was convened in Paris (France)
on 10th of November 2014 to discuss the current understanding of atherogenic dyslipidaemia (AD)
and its associated cardiovascul risk. Two articles are published by now in Atherosclerosis
Supplements regarding the proposals of this consortium, first in autumn of 2015 entitled ”A review
of the evidence on reducing macrovascular risk in patients with atherogenic dyslipidaemia: a
report from an expert consensus meeting on the role of fenofibrate–statin combination therapy”
and the second entitled ”Current practice in identifying and treating cardiovascular risk, with a
43
focus on residual risk associated with atherogenic dyslipidaemia”was published in April 2016. In
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the latter article it was proposed a simple and practical definition of AD: high triglycerides (≥150
mg/dl) and low HDL cholesterol (less than 40 mg/dl in men and less than 50 mg/dl in women) in
statin-treated patients at high cardiovascular risk. Clinical management of AD includes lifestyle
optimization, LDL cholesterol lowering therapy with statins (ezetimibe can be added) and residual
AD can be treated with the addition of fenofibrate, since it can improve the complete lipoprotein
profile. Various scenarios regarding clinical situations where the use of fenofibrate might be
beneficial are discussed: patients with very high triglycerides or patients with intolerance to statins
or patients treated with statins, but with AD and increased cardiovascular risk.
Constantin Ionescu-Tîrgovişte
Institutul Naţional de Diabet, Nutriţie şi Boli Metabolice “Prof. NC Paulescu”, Bucureşti,
România
În ultimele 2 decenii, mai multe centre de diabet au inclus pentru urmărire prospectivă
copii sau fraţi ai pacienţilor cu DZ tip 1. Scopul a fost identificarea apariţiei primilor anticorpi anti
beta celulari (prima seroconversie), apoi aparişia celui de-al doilea, al treila tip ş)seroconversie
multiplă) şi aşa mai departe. În majoritatea acestor studii au fost prelevate probe de sânge încă de
la naştere (din cordonul ombilical) şi apoi anual timp de 15, 20 sau uneori chiar 30 de ani. În urma
rezultatelor acestor studii, riscul de a dezvolta diabet zaharat clinic manifest a fost estimat pe baza
vârstei la momentul primei seroconversii, pe baza numărului de autoanticorpi şi a titrului acestora,
uneori combinat cu determinarea prezenţei unor variante genice de predispoziţie/protecţie pentru
DZ tip 1. În unele cazuri predicţia apariţiei bolii a fost reuşită în procente de peste 95%, chiar şi
până la 99%. Cu toate aceste progrese, un diagnostic „oficial” de DZ tip 1 nu poate fi pus în absenţa
debutului clinic, cu hiperglicemie documentată biochimic (decompensare completă a
metabolismului glucidic). La acest moment însă este deja prea târziu pentru orice încercare de a
mai preveni diabetul sau chiar pentru a preveni distrugerea în continaure a puţinelor celule beta
pancreatice încă viabile. De aceea, de-a lungul anilor am propus în mod repetat ca definiţia
diabetului zaharat să fie făcută nu doar pe baza apariţiei epifenomenului „hiperglicemie” ci pe baza
fenomenului în sine, şi anume scăderea masei/funcţiei beta celulare.
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IDENTIFICATION OF THE EARLY STAGES OF TYPE 1 DIABETES, BEFORE FIRST
ANTI BETA CELL ANTIBODY SEROCONVERSION
Constantin Ionescu-Tîrgovişte
National Institute of Diabetes, Nutrition and Metabolic Diseases “Prof. NC Paulescu”, Bucharest,
Romania
More than 40 years have passed since the launch of the immune-genetic theory of type 1
diabetes (T1D). However, all the attempts carried out in the last 4 decades to prevent or stop the
autoimmune destruction of β-cells using immune suppression or immune modulator methods, have
failed. The main reason is that all prevention studies included patients selected soon after the
clinical onset of diabetes and, sometimes, even 2 or 5 years later. It is known today that when the
blood glucose starts to rise, more than 80-90% of the β-cell mass is already irreversibly lost.
In the last 2 decades, in several centers of diabetes, a large number of offspring or siblings
of patients with T1D have been enrolled in a prospective follow-up for the identification of the
first anti-beta cell antibodies appearance (first seroconversion), then of the second or third antibody
(multiple seroconversion) and, finally, of the clinical onset of diabetes. In the majority of these
studies blood samples have been obtained from the umbilical cord at birth and then, yearly, up to
15, 20 or, in a few studies, even more than 30 years. From these studies the risk of developing
clinical diabetes has been calculated according with the age of the first seroconversion, the number
and titer of antibodies and, in some cases, the presence of gene variants associated with
predisposition or protection for T1D. In some cases, the risk for developing diabetes was higher
than 95%, up to 99%. Despite all these progresses, the “official” diagnosis of type 1 diabetes could
not be accepted unless clinical onset (full blood glucose decompensation) took place. In this stage,
this is already too late for any attempt to prevent diabetes or even to prevent further destruction of
the small number of β-cells that still remain alive. That is why, along the years we proposed to use
for the definition of diabetes not the epiphenomenon (hyperglycemia), but the phenomenon itself,
which is the decrease of the β-cell mass/function.
György Jermendy, MD
Bajcsy-Zsilinszky Hospital, Budapest, Hungary
Self-monitoring of blood glucose (SMBG) should be considered in all patients with either type 1
or type 2 diabetes in order to detect or, more importantly, to avoid hypoglycemia. In addition,
SMBG is the only way to find out the blood glucose level at a certain point in time. It is the most
practical method of measuring post-meal glycemia. It support decision making with regards to
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changes to meals, activity and medication. When SMBG is taken over 2-3 days it can reveal
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Diabetic retinopathy, is the most common and specific microvascular complication of diabetes,
and remains among the leading causes of preventable blindness in the working age population. All
people with diabetes are at risk for DR, the numbers of people with diabetic retinopathy and vision
threatening disease are increasing, as the number of people with diabetes increases.
Several risk factors, modifiable or non-modifiable, have been identified for the development and
progression of diabetic retinopathy.
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For the last nearly 3 decades, managing the metabolic deregulation, has been the most effective
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way, to delay, or slow down the progression of diabetic retinopathy and other microvascular
complications. It has been clearly shown that, any reduction in HbA1c is likely to reduce the risk
of complications, with the lowest risk being in those with HbA1c values in the normal range. But
intensive blood glucose control as reflected by the HbA1c did not show this effect in a considerable
number of patients.
Another issue related to blood glucose control has arisen in the last decade. That is, whether the
shortterm and longterm glucose fluctuations has more deleterious effect on diabetes complications
than chronic stable hyperglycemia .
The evidence base shows that acute fluctuations in glycemia can produce enhanced alterations in
homeostasis such as those of endothelial dysfunction and increased inflammation, compared to
chronic stable hyperglycemia,.
But available clinical data remain elusive to answer the question, and further research in this field
can undoubtedly offer new insights.
At this moment, diabetic retinopathy remains one of the most complex, heterogenous,
multifactorial disorders.
Autonomic and sensory neuropathy are progressive complications of diabetes. Cardiac autonomic
neuropathy (CAN) is the most relevant manifestation and carries a fivefold risk of mortality in
patients with diabetes. The high mortality rate may be related to silent myocardial infarction,
cardiac arrhythmias, cardiovascular and cardiorespiratory instability and to other causes not
explained yet. Silent myocardial infarction should always be suspected in diabetic patients
suffering from acute cardiac failure/pulmonary oedema, collapse, vomiting or unexplained
hyperglycaemia, especially cetoacidosis of unknown origin.
Higher heart rate is associated with poor prognosis. Moreover, tachycardia is considered as an
independent risk factor for the development of atrial fibrillation as well. If hyperthyreodism,
anaemia and infection can be excluded in a diabetic patient with tachycardia, it is most likely due
to CAN. There is a close relationship between severity of CAN and prolongation of the corrected
QT-interval. Lengthening of the QT-interval leads to ventricular premature beats, ventricular
tachycardia, ventricular fibrillation and thus quite often to the sudden death of the diabetic patient.
The predominant feature of CAN is parasympathetic autonomic neuropathy. It is associated with
relative sympathetic overactivity and this way leads to the development of hypertension. It should
be noted that hypertension is often associated with orthostatic hypertension, while the symptoms
of orthostatic hypertension are often misinterpreted as hypoglycaemia.
The connection between autonomic neuropathy and hypoglycaemia is quite comprehensive and
includes hypoglycaemia unawareness, impaired counterregulation to hypoglycaemia, impairment
of autonomic function due to hypoglycaemia and a higher prevalence of severe hypoglycaemia
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Șef Lucr. Lăcătușu Cristina Gabriela1, Șef Lucr. Botnariu Gina Eosefina1, Șef Lucr. Popescu
Raluca Maria1, Asist. Univ. Popa Alina Delia1, Conf. Univ. Mihai Bogdan Mircea1
1
Universitatea de Medicină și Farmacie “Grigore T. Popa” Iași
Lect. Lăcătușu Cristina Gabriela1, Lect. Botnariu Gina Eosefina1, Lect. Popescu Raluca
Maria1, Assoc. Lect. Popa Alina Delia1, Assoc. Prof. Mihai Bogdan Mircea1
1
University of Medicine and Pharmacie “Grigore T. Popa” Iași
Radu Lichiardopol
UMF “Carol Davila”București
Ateroscleroza este o boalǎ sistemicǎ. Afectarea unui pat vascular (coronarian, cerebral , arterial
periferic) sugereazǎ cǎ este posibil sǎ fie afectate și alte teritorii vasculare. Boala polivascularǎ,
definitǎ ca aterotrombozǎ clinic manifestǎ ȋn douǎ sau mai multe paturi vasculare, conferǎ un risc
ȋnalt pentru evenimente cardiovasculare, fapt cunoscut mai ales ȋn urma studiilor de registru. Intre
acestea, REACH (Reduction of Atherothrombosis for Continued Health) a ȋnrolat o cohortǎ
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multinaționalǎ de pacienți din care 45227 (cu aterotrombozǎ simptomaticǎ sau cu factori majori
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Radu Lichiardopol
“Carol Davila”University of Medicine, Bucharest, Romania
Among the patients with a history of ischemic events, those with an ischemic event in the year
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before enrollment had a greater risk compared to those in whom ischemic event occurred more
than a year before enrollment in the Registry. The rate of cardiovascular events during follow-up,
increased lineary with the number of symptomatic disease locations: from 5.3% in patients with
risk factors only, to 12.6% in patients with one location, to 21.1% in patients with two locations,
to 26.3% in patients with location in three vascular beds. The prevalence of polyvascular
atherothrombosis changed with the location of symptomatic vascular beds: 25% in CAD (coronary
artery disease)patients, 40% in CVD (cerebrovascular disease) patients, and 61% in PAD
(peripheral arterial disease) patients. Recently, at ADA 75th Scientific Sessions (june2015), the
results of an ad-hoc analysis of data from SAVOR-TIMI 53 cohort over a 2-year follow-up were
presented. In this cohort, the incidence of adverse cardiovascular events increased lineary as a
function of the number of symptomatic vascular beds. Depending on the location of the vascular
bed involved (in those with only one bed involved), the patients with PAD had, as compared to
CAD and CVD had the greatest cardiovascular mortality. These data, in line with those of the
REACH Registry, are useful for cardiovascular risk stratification and to demarcate subgroups of
patients at extreme high risk for intensive secondary prevention.
Dragan D. Micic
School of Medicine, University of Belgrade
Department of Medical sciences, Serbian Academy of Sciences and Arts, Belgrade, Serbia
The risk of diabetes increases with the increasing BMI in men and women. A weight gain of 10
kilograms is associated with a two- to threefold increase in the risk of diabetes. The marked
increase in obesity is an important contributor to the increase in prevalence of Type 2 diabetes all
over the world. Obesity is characterized by an accumulation of fat tissue and by huge production
of adipocyte secretory products – adipokines which may have a negative impact on insulin
sensitivity at the peripheral levels, leading at the end to a state of insulin resistance. Increased
tissue fat content is associated with elevation of free faty acids, altered fat topography and
adiposopathy. Pathological adipose tissue dysfunction is composed of a several pathophysiological
mechanisms : impaired adipogenesis during positive caloric balance; dysfunctional fat storage;
impaired nutrient metabolism; abnormal adipocyte factor function; proinflammatory response and
dysfunctional „cross-talk“. Obesity is characterized by the existence of large, insulin resistant
adipocytes in which catecholamine mediated lipolysis is enhanced leading to excesissive flow of
free faty acids into circulation. When puffering capacity of eutopic fat tissue is compromised starts
production of ectopic fat tissues in human body ( epicardium, muscles, omentum, liver). Most type
2 diabetics posses too much fat; have an abnormal distribution of fat with excessive fat deposition
in muscle, liver and visceral adipocytes; they have large, insulin resistant fat cells whose capacity
to store triglycerides is compomised. In obesity , adipose tissue become a source of inflammation
that drives disease development in distant organs. Recent development in this field indicate a
LTB4 ( a chemokine from adypocites ) to cause macrophage-mediated inflammation leading to a
direct induction of insulin resistance in obesity. It was proposed that inhibition of LTB4 action
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Conf. Mihai Bogdan Mircea1,2, Şef Lucr. Botnariu Eosefina1,2, Şef Lucr. Popescu Maria1,2,
Asist. Univ. Onofriescu Alina1,2, Şef Lucr. Lăcătușu Cristina Mihaela1,2
1
Grigore T. Popa” Universitatea de Medicină şi Farmacie – Iași, Romania
2
Centrul Clinic de Diabet, Nutriţie şi Boli Metabolice – Iaşi, Romania
Assoc. Prof. Mihai Bogdan Mircea1,2, Lect. Botnariu Eosefina1,2, Lect. Popescu Maria1,2,
Assist. Prof Onofriescu Alina1,2, Lect. Lăcătușu Cristina Mihaela1,2
1
Grigore T. Popa” University of Medicine and Pharmacy – Iași, Romania
2
Clinical Centre of Diabetes, Nutrition and Metabolic Diseases – Iaşi, Romania
Premises and Objectives: Modern medical world is witnessing nowadays rapidly escalating rates
of the general prevalence of diabetes mellitus and its chronic complications. Prevention of the
latter is needed in order to keep a good quality and a quasi-normal duration of life in diabetic
patients. Aside macrovascular disease, having a multifactorial determinism and therefore implying
a complex range of preventive measures, prophylaxis of microvascular complications should also
represent a fundamental objective for clinicians in this area.
Content and Method: We conducted a review analysing publications about prevention of chronic
microvascular complications of diabetes, using adequate keywords to search in PubMed database
for publications between January 2000 and March 2016.
Results and Discussions: Most original papers and reviews focusing on prevention of diabetic
nephropathy are related to the concept of renin-angiotensin-aldosterone system blockade, with
multiple major clinical trials referring to the benefits of either angiotensin converting enzyme
inhibitors or angiotensin II-receptors blockers therapies on renoprotection. Efficacy of general
measures, such as tight glucose control, treatment of hypertension and dyslipidemia, is also a
matter of general agreement. As for diabetic retinopathy, besides similar general principles of
glycemic, blood pressure and lipid control, recent years have brought new evidence sustaining the
efficacy of anti-vascular endothelial growth factors (VEGF) therapies in the prevention of the
retinal microvascular complication. The concept of ‟metabolic memory”, involving a reduced risk
for developing extensive complications later in life when tight glycemic control is instituted in the
first years after diagnosis, is also largely mentioned in recent literature. The key perspective in the
prevention of both diabetic retinopathy and nephropathy is the ‟multifactorial approach”, aiming
to an optimal control of all the aforementioned risk factors.
Conclusions and Findings: As the burden of diabetes mellitus and its chronic complications is
continuously increasing, effective strategies to prevent subsequent health deterioration are
imperative. Research progresses in the last decades allow today a better preventive approach of
microvascular disease in diabetes mellitus, but supplemental results must stem from current efforts
to identify unconventional risk factors, yet unknown, and also optimal therapies addressing them.
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RW26. VARIABILITATEA GLICEMICĂ: ÎNTRE MECANISME ȘI CONSECINȚE
Premises and Objectives: As technical investigating procedures extended in the last years,
researchers have concentrated more and more on glycemic variability, a supplementary parameter
defining glycemic control in diabetic patients, as well as fluctuations in normoglycemic
individuals. Increased glycemic variability appears to be associated to complex pathophysiologic
54
repercussions and to induce major clinical consequences. Therefore, these considerations motivate
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Radu Mihalca, MD
Sanamed Hospital, Bucuresti, Romania
Prevalenta obezității a crescut mult începând cu anii ’60 in Europa de Vest si in Statele Unite ale
Americii iar recent aceeași tendința a fost observata in tari cu creștere economica rapida precum
China si India. Cercetările efectuate in ultimii ani au demonstrat ca barbatii cu obezitate sau diabet
zaharat tip-2 au frecvent valori subnormale ale testosteronului total si liber, asociate cu valori
inadecvat de mici ale LH. Nivelul scăzut al androgenilor nu este corelat cu durata obezității
respectiv cu durata diabetului sau cu valoarea hemoglobinei glicozilate ci a fost corelat mai
frecvent cu parametri precum Indicele de Masa Corporala (IMC), circumferința taliei sau gradul
de steatoza hepatica. Mecanismele aflate la baza acestui fenomen sunt complexe si constau, printre
altele, in reducerea activității axului hipotalamus-hipofiza=gonada, in creșterea nivelului
estrogenilor si in scăderea valorilor sex-hormone binding globulin (SHBG). Un nivel scăzut de
testosteron a fost asociat in populația generala cu o creștere a riscului cardio-vascular, dar datele
la barbatii obezi sau diabetici sunt inca insuficiente. Studii despre efectul tratamentului substitutiv
cu testosteron la nivelul controlului glicemic sau al factorilor de risc cardio-vasculari precum
colesterolul total sau proteina c-reactiva sunt de asemenea prea puține si fara rezultate certe.
Indiferent de metoda terapeutica folosita, scăderea in greutate tinde sa aducă cu sine o creștere a
nivelului androgenic, fapt care ar putea aduce o contribuție importanta la reducerea riscului
cardiovascular la barbatii cu disfuncții metabolice precum obezitatea si diabetul zaharat tip-2.
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METABOLIC DISORDERS AND MALE HYPOGONADISM, CAUSE OR
CONSEQUENCE ?
Radu Mihalca, MD
Sanamed Hospital, Bucharest, Romania
The prevalence of obesity has increased very much starting from the 60ties in Western Europe and
the in United States and now this phenomenon has been also observed in fast growing countries
like China and India. The research performed lately has clearly established that men with obesity
or type-2 diabetes have often subnormal total and free testosterone concentrations in association
with inappropriately low LH concentrations. The lower androgen levels are not related to the
duration of obesity, diabetes or to glycosylated hemoglobin values, but are correlated often with
parameters like BMI, waist circumference and even hemoglobin level. The underlying
mechanisms beyond this phenomenon are complex, consisting in reduced hypothalamic and
pituitary function, increased estrogen production and reduced circulating sex-hormone binding
globulin (SHBG) levels. Low levels of total testosterone have been linked to an increase in
cardiovascular risk in the general population, but data reported in diabetic or obese male population
are scanty. The effect of testosterone replacement therapy on glycemic control and cardiovascular
risk factors such as total cholesterol and C-reactive protein are also inconsistent. Independently of
the method used, weight reduction seems to trigger an improvement in androgen levels, which
might further reduce the cardiovascular risk of male patients with metabolic disorders like obesity
and diabetes.
Premise şi Obiective: Greutatea corporală normala reprezintă un echilibru între aportul energetic
și cheltuiala energetică si este menținută prin alimentație sănătoasă și activitate fizică. Obezitate
este generată de supraalimentație, comportamentul alimentar anormal sau/și sedentarism, fiind o
cauză majoră de apariție a diabetului zaharat. Durata timpului de ședere se corelează semnificativ
cu riscul pentru diabet zaharat, boală cardiovasculară, mortalitate cardiovasculară.
Exercițiul fizic de rezistență modulează lipidele circulante și musculare, crește sensibilitatea la
insulină și scade riscul de apariție a diabetului zaharat. Exercițiul fizic previne disfuncția
endotelială, mecanism patogenic important in prediabet si diabet si imbunătățește statusul glicemic
postprandial, toleranța la glucoză, profilul lipidic, tensiunea arterială.
Barierele în optimizarea stilului de viață sunt: vârsta, sexul, etnia, starea de boală.
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Cel puțin 30 minute de mers alert neîntrerupt zilnic sau activitate fizică moderată (înot, ciclism,
dans) sunt recomandate pentru întreținerea stării de sănătatate metabolică. Mersul alert zilnic 30
minute reduce riscul de diabet cu 35-40%.
Material şi Metodă: Grupul de studiu (311 persoane) a fost selecţionat din populaţia generală
adultă a judeţului Galaţi, iar reprezentativitatea eşantionului a fost calculată pentru populaţia adultă
în funcţie de sex, vârstă şi mediu (urban, rural). Date demografice: sex, vârstă, domiciliu, stare
civilă, studii, venit, anotimp (vara, iarna). Date antropometrice: greutate, înălţime, IMC,
circumferinţa abdominală. Criteriul pentru activitate fizică: exercițiu fizic (mers pe jos, bicicletă,
jogging, sport) ≥ 30 minute de ≥3 ori/săptămână. Răspunsul a fost cotat cu «da» sau «nu».
Rezultate şi Discuţii. Din studiul activităţii fizice rezultă că 59,16% dintre persoane efectuează
activitate fizică conform criteriului, iar 40,84% din persoanele adulte nu au activitate fizică, dintre
acestea procentul cel mai mare fiind al femeilor din mediul urban. Factorii demografici care
influenţează semnificativ activitatea fizică sunt vârsta şi anotimpul. Analiza relaţiei IMC –
activitate fizică, arată corelaţii semnificative cu IMC şi cu categoriile IMC, în sensul că proporţia
persoanelor cu activitate fizică scade odată cu creşterea în greutate. Studiul obezităţii abdominale
în relaţie cu activitatea fizică demonstrează corelaţii semnificative atât cu circumferinţa
abdominală, cât şi cu clasele de risc, în sensul creşterii CA şi a categoriei de risc odată cu scăderea
activităţii fizice.
Concluzii: Conștientizarea efectelor benefice ale exercițiului fizic asupra sănătății este esențială
în managementul obezității și prevenirea diabetului zaharat. Sunt necesare strategii practice care
să fie ușor de inclus în viața de fiecare zi a individului sau în colectivitate. Aceste aspecte sunt
importante în societatea modernă și sugerează că simpla limitare a timpului de ședere poate avea
un potențial în preventia diabetului.
Background and Objectives: Normal weight is a balance between energy intake and energy
expenditure and is maintained through healthy eating and physical activity. Obesity is caused by
overeating, abnormal eating behavior and / or physical inactivity, being a major cause of
developing diabetes. The duration of sitting is significantly correlated with the risk for diabetes,
cardiovascular disease and cardiovascular mortality.
Resistance exercise modulates circulating and muscle lipids, increases insulin sensitivity and
lowers the risk of diabetes. Exercise prevents endothelial dysfunction, an important pathogenic
mechanism in prediabetes and diabetes and improves postprandial glycemic status, glucose
tolerance, lipid profile, blood pressure.
Barriers to lifestyle improvement are: age, gender, ethnicity, illness.
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At least 30 minutes of brisk walking continuously daily or moderate physical activity (swimming,
cycling, dancing) are recommended for maintenance of metabolic health status. Brisk walking for
30 minutes daily reduces the risk of diabetes by 35-40%.
Material and Methods: Study Group (311 persons) was selected from the general adult
population of Galati county and representativeness of the sample was calculated for the adult
population by sex, age and environment (urban, rural). Demographic data: gender, age, residence,
marital status, education, income, season (summer, winter). Anthropometric data: weight, height,
BMI, waist circumference. Criteria for physical activity: exercise (walking, cycling, jogging,
sports) ≥ 30 minutes for ≥ 3 times / week. The answer was rated with "yes" or "no".
Results and Discussion. The study of physical activity showed that 59.16% of people perform
physical activity according to the criteria and 40.84% of adults do not perform physical exercise,
with the highest percentage of women in urban areas. Demographic factors that significantly
influence physical activity are age and season. Analysis of relationship between BMI - physical
activity showed significant correlations with BMI and BMI categories, meaning that the proportion
of persons with physical activity decreased with increasing weight. Study of abdominal obesity in
relation to physical activity showed significant correlations with both waist circumference and risk
classes; the higher was the risk category, the lower was physical activity.
Conclusions: Awareness of the beneficial effects of exercise on health is essential in the
management of obesity and diabetes prevention. Practical strategies are needed that are easy to
include in everyday life of the individual or the community. These issues are important in modern
society and suggests that simply limiting the sedentary time may have potential in diabetes
prevention.
Termenul „microalbuminurie” (MA) a apărut în 1964 când Profesorul Harrz Keen l-a folosit
pentru prima dată pentru a sublinia o cantitate mică de albumină în urina pacienţilor cu diabet
zaharat tip 1. Următoarea menţiune a MA în literatură a fost după 5 ani când Keen şi colab au
examinat MA în contextul testului de toleranţă la glucoză orală. La sfârşitul anilor ’70, când
Mogensen şi Vittinghus şi Viberti şi colab au evaluat efectele tratamentului cu insulină asupra MA
indusă de exerciţiul fizic şi au examinat excreţia de albumină în contextul controlului glicemic
(George L. Bakris, Mark Molitch, Diabetes Care. 2014;37(3):867-875). MA reprezintă un
important factor de risc renal dar şi un factor de risc cardiovascular la pacienţii cu diabet
(Mogensen 1984). Proteinuria este un marker important al mortalităţii cardiovasculare în
populaţia generală (studiul Framingham-1984). Terminologia MA s-a modificat în ultima vreme.
Grupul KDIGO a sugerat ca termenul „MA” să fie înlocuit de termenul „albuminurie înaltă”. MA
se foloseşte pentru a indica o excreţie urinară de albumină de 30-300mg/zi după estimarea după
raportul albumină urinară/ creatinină urinară (RACU) în urina emisă spontan dimineaţa (Sacks
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DB, Arnold M, Bakris GL, et al. 2011). Studiile iniţiale la pacienţii cu diabet au susţinut ideea că
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o dată cu creşterea nivelurilor MA, creşte şi riscul de progresie a BCR şi riscul CV. Mai mult,
dovezi ale studiilor epidemiologice la pacienţii cu diabet au indicat că mărimea excreţiei urinare
de albumină ar trebui privită ca un continuum al riscului CV (Jager A et al. 1998). Studiul
DCCT/EDIC a cuantificat:
- Incidenţa şi factorii de risc pentru apariţia iniţială a MA
- Progresia sa la macroalbuminurie (albumină urinară>300mg/g creatinină)
- Progresia pe termen lung a BCR după apariţia MA.
Datele din studiul UKPDS au demonstrat că un control glicemic mai bun încetineşte apariţia MA:
- 33% reducere a riscului relativ de apariţia a MA la 12 ani
- O reducere semnificativă a propoprţiei de pacienţi care îşi dublează nivelul creatininei
plasmatice (Bilous R. 2008).
Această creştere a albuminuriei poate apărea în prezenţa sau absenţa terapiei de reducere a
factorilor de risc cunoscuţi pentru progresia BCR (presiune arterială, glicemie). Predictorii
progresiei spre BCR stadiul 5, cu excepţia istoricului familial şi controlul deficitar al glicemiei şi
presiunii arteriale pentru o perioadă lungă de timp, nu sunt bine definiţi. Deşi există unii markeri
genetici, precum CUBN şi APOL1, utilizarea lor în practica curentă nu este bine documentată. Un
istoric familial pozitiv pentru BCR reprezintă un puternic predictor al riscului pentru apariţia şi
progresia BCR la pacienţii cu MA. Astfel, toţi pacienţii trebuiesc întrebaţi despre istoricul familial
de BCR sau necesitatea dializei. Greutatea mică la naştere reprezintă un alt factor de risc pentru
progresia BCR, în special in diabet deşi acest lucru nu este confirmat (Wheeler DC, Becker GJ.
2013). MA ar trebui privit ca un marker al riscului asociat cu o creştere a riscului CV şi de boală
renală. Prezenţa sa solitară nu indică instalarea bolii renale, în special dacă eRFG este peste
60ml/min/1,73m2. Creşteri ale MA, când presiunea arterială şi alţi factori de risc CV sunt
controlaţi, se pare, dar nu este dovedit, că pot să indice o progresie lentă spre BCR în timp.
The term "microalbuminuria" (MA) originated in 1964 when Professor Harry Keen first used it to
signify a small amount of albumin in the urine of patients with type 1 diabetes.
The next mention of MA in the literature was 5 years later when Keen et al. examined MA in the
context of oral glucose tolerance testing. In the late 1970s when Mogensen and Vittinghus and
Viberti et al. assessed the effects of insulin treatment on exercise-induced MA and examined
albumin excretion in the context of glycemic control (George L. Bakris, Mark Molitch, Diabetes
Care. 2014;37(3):867-875). Microalbuminuria is important renal risk factor but also a
cardiovascular risk factor in patients with diabetes (Mogensen 1984). Proteinuria is important
marker of cardiovascular mortality in the general population (Framingham study-1984). The
terminology of MA has changed recently. The KDIGO group suggested that the term "MA" be
replaced by the term "high albuminuria“. MA still refers to urinary albumin excretion of 30 to
<300 mg/day as estimated from the urinary albumin-to-urinary creatinine ratio (UACR) in a spot
morning urine specimen (Sacks DB, Arnold M, Bakris GL, et al. 2011). Early studies in patients
with diabetes supported the concept that as MA increases to higher levels, the risk of CKD
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progression and CV risk also increases. Moreover, evidence from epidemiological studies in
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patients with diabetes suggested that the magnitude of urine albumin excretion should be viewed
as a continuum of CV risk (Jager A et al. 1998). The DCCT/EDIC study quantified:
- the incidence of and risk factors for the initial development of MA,
- its progression to macroalbuminuria (urine albumin >300 mg/g creatinine),
- long-term CKD progression after the development of MA (de Boer IH, Rue TC, Cleary PA,
et al. 2011). Data from the UK Prospective Diabetes Study (UKPDS) demonstrated that better
glycemic control retards the development of MA:
- 33% reduction in relative risk of MA development at 12 years
- a significant reduction in the proportion of patients doubling their plasma creatinine levels
(Bilous R. 2008). This increase in albuminuria may occur in the presence or absence of therapy to
reduce established risk factors for CKD progression (i.e., blood pressure, glucose). Predictors of
progression to ESRD, apart from family history, and many years of poor glycemic and blood
pressure control are still not well defined.
Although there are some genetic markers, such as CUBN and APOL1, their use in practice is not
well established. A family history of CKD is a powerful predictor of risk for CKD development
and progression in patients with MA. Therefore, all patients should be asked about family history
of CKD or members requiring dialysis.
Low birth weight is another risk predictor of CKD progression, especially in diabetes, although
this is not proven (Wheeler DC, Becker GJ. 2013).
MA should be viewed as a risk marker associated with an increase in CV risk and for kidney
disease. Its presence alone does not indicate established kidney disease, especially if the eGFR is
well above 60 mL/min/1.73 m2. Increases in MA, with blood pressure and other CV risk factors
controlled, are likely but not proven to portend a poor prognosis for CKD progression over time.
DZ ; prevalența a fost mai mare la bărbați: 9,7% decât la femei: 7,6%. Prevalența / incidența
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diabetului în Italia: din 2000 până la 2007 a existat o creștere de 40% in prevalenta brută a
diabetului zaharat in regiunea Lombardia, de la 3,0% în 2000 la 4,2% în 2007.
Prevalenta diabetului zaharat in Scotia: prevalenta DZ (5.2 în 2003 vs. 9,4% în 2008);
diagnostic: folosind atât informații auto-raportate cât și măsurarea HbA1c. Prevalența DZ
diagnosticat si nediagnosticat in Franta: the French Nutrition and Health Survey 2006/2007; s-
a estimat prevalenta DZ nediagnosticat la populația în vârstă de 18-74 ani; prevalența DZ
diagnosticat a fost estimată folosind istoria de DZ-auto-raportată și prevalența DZ nediagnosticat
a fost estimată utilizând glicemia a jeun ≥7.0 mmol/l sau HbA1c ≥ 6.5%; prevalenta DZ
diagnosticat: 4,6%; prevalenta DZ nediagnosticat: 1% (95% CI 0.6-1.7). Prevalența DZ si alterării
reglării glucozei in Spania: the Di@bet.es Study:: prevalenta globala a DZ: 13,8% (95% IC 12,8,
14,7%), ajustat pentru varsta si sex, dintre care aproximativ jumatate au diabet zaharat necunoscut:
6,0% (95% CI 5,4, 6,7%); prevalența alterării toleranței la glucoză a jeun, ajustată în funcție de
vârstă și sex a fost de 3,4% (95% CI 2,9, 4,0%), a alterării toleranței la glucoză a fost de 9,2%,
IGT (95% CI 8,2, 10,2%) și a combinatiei lor a fost de 2,2% (95% CI 1,7, 2,7%). Prevalența de
DZ tip 2 în Elveția: prevalența DZ tip 2 este de 6,3%, mai mare la bărbați (9,1%) decât la femei
(3,8%, P <0,001) și a crescut odată cu vârsta (vârsta de 35-75 ani); DZ tip 2 a fost definit ca
glicemie plasmatică a jeun ≥7 mmol/l sau tratament al diabetului zaharat. România pe scurt -
studiul PREDATOR 2013: vârsta și prevalența DZ, ajustate în funcție de sex a diabetului zaharat
la populația adultă (20-79 ani) -11,6%. Studiul international Diabetes Management Practice
Study (IDMPS) (Europa de Est, Asia, America Latină, Africa): 22% din pacienții cu DZ tip 1
și 36% din pacienții cu DZ tip 2 nu au avut masuratori de HbA1c; 20-30% dintre pacienți au fost
la tinta HbA1c; numai 7,5% din tipul 1 și 3,6% dintre pacienții cu DZ de tip 2 au atins 3 obiective
de tratament (TA <130/80 mmHg, LDL-C <100 mg / dl si HbA1c <7%). Controlul glicemic în
DZ tip 2 - PANORAMA Study (Belgia, Franța, Germania, Grecia, Italia, Olanda, Spania, Turcia
și Marea Britanie): doar 7,5% dintre pacienți au îndeplinit toate cele trei obiective (HbA1c <7%,
BP < 130/80 mmHg și LDL-c <100 mg / dl). Concluzii: există diferențe reale în ceea ce privește
prevalența și incidența DM între diferite regiuni geografice, datorită: diferitelor metode de
diagnostic, diferitelor populatii de studiu.
population-based studies and one nationwide study were analysed - within the Diabetes
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Collaborative Research of Epidemiologic Studies (DIAB-CORE) to provide, for the first time,
population-based information on regional variation of known Type 2 DM prevalence in Germany.
For the nationwide study, a prevalence of 8.2% (7.3–9.2%) was estimated; prevalence was higher
in men: 9.7% than in women: 7.6%. Prevalence /incidence of diabetes in Italy: from 2000 to
2007 there was a 40% increase in the crude prevalence of diabetes in the Lombardy region, from
3.0% in 2000 to 4.2% in 2007. Diabetes prevalence in Scotland: prevalence of diabetes (5.2 in
2003 vs. 9.4% in 2008); diagnosis: using both self-reported information and measurement of
HbA1c. Prevalence of diagnosed and undiagnosed DM in France: the French Nutrition and
Health Survey 2006/2007; in 18- 74 year-old individuals; the prevalence of diagnosed DM was
estimated using self-reported DM history and the prevalence of undiagnosed DM was estimated
using fasting plasma glucose ≥7.0 mmol/l or HbA1c ≥ 6.5%; the prevalence of diagnosed DM:
4.6%; the prevalence of undiagnosed DM: 1% (95% CI 0.6–1.7). Prevalence of DM and
impaired glucose regulation in Spain: the Di@bet.es Study: the overall prevalence of DM:
13.8% (95% CI 12.8, 14.7%), adjusted for age and sex, of which about half have unknown
diabetes: 6.0% (95% CI 5.4, 6.7%); the age- and sex-adjusted prevalence of IFG was 3.4% (95%
CI 2.9, 4.0%), of IGT was 9.2% (95% CI 8.2, 10.2%) and of combined IFG–IGT was 2.2% (95%
CI 1.7, 2.7%). The prevalence of Type 2 DM in Switzerland: the prevalence of Type 2 DM is
6.3%, higher in men (9.1%) than in women (3.8%, P < 0.001) and increased with age (35-75 years
old); type 2 DM was defined as fasting plasma glucose ≥7mmol⁄l and ⁄or diabetes treatment.
Romania at a glance - PREDATORR 2013: age and sex-adjusted prevalence of diabetes in adult
population (20-79 years)-11,6%. The International Diabetes Management Practice Study
(IDMPS) (Eastern Europe, Asia, Latin America, Africa): 22% of type 1 and 36% of type 2 diabetic
patients never had HbA1c measurements; 20-30% of patients were at HbA1c goal; only 7.5% of
type 1 and 3.6% of type 2 diabetic patients attained 3 treatment goals (BP<130/80 mmHg, LDL-
C<100 mg/dL and HbA1c<7%). Glycaemic control in type 2 DM - PANORAMA Study
(Belgium, France, Germany, Greece, Italy, The Netherlands, Spain, Turkey and the UK): only
7.5% of the patients met all three targets, achieving HbA1c<7%, BP <130/80 mmHg and LDL-c
< 100 mg/dL. Conclusions: there are real differences regarding the prevalence and incidence of
DM between different geographical regions, due to: different methods of diagnosis, different study
population.
Diana Păun1, Alexandra Mirică, Rodica Petriş, Ioana Neamţu, Ruxandra Dănciulescu1
1
UMF Carol Davila
Institutul Național de Endocrinologie C.I.Parhon
Glanda suprarenala este compusa din două țesuturi embriologic diferite, corticala și medulara. Ea
produce hormoni care ajuta la reglarea metabolismului glucidic (glucocorticoizi,
mineralocorticoizi, catecolamine, androgeni suprarenali). Tulburările adrenale pot provoca hiper
sau hipofuncție ducând la modificări ale metabolismului glucidic.
Sindromul Cushing este definit in general ca un exces de hormoni glucocorticoizi. El poate fi
cauzat de producția endogenă de cortizol de catre adrenala sau prin administrarea de
glucocorticoizi exogeni. Atât glucocorticoizii exogeni cat și cei endogeni pot provoca diabet
zaharat și toleranța alterata la glucoză. Fiziologic, glucocorticoizii inhibă absorbția glucozei în
țesuturile periferice, ceea ce duce la hiperglicemie și hiperinsulinemie. Ei contribuie la dezvoltarea
intoleranței la glucoză și aparitia diabetului zaharat manifest prin creșterea gluconeogenezei
hepatice, inducerea rezistenței periferice la insulină la nivelul post-receptorilor și prin suprimarea
directă a secretiei de insulină, ca urmare a combinării efectelor lor asupra țesutului hepatic,
muscular, pancreas și adipos.
Pe de altă parte, feocromocitoamele sunt caracterizate printr-un exces de catecolamine, ceea ce
duce la hiperglicemie și diabet din cauza inhibarii directe a eliberării insulinei, mediată de
receptorii adrenergici tip alfa 2.
Mai mult decât atât, pacienții cu hiperaldosteronism primar pot avea modificari ale secretiei de
64
Diana Păun1, Alexandra Mirică, Rodica Petriş, Ioana Neamţu, Ruxandra Dănciulescu1
1
Carol Davila University of Medicine and Pharmacy
C.I.Parhon Institute of Endocrinology
The adrenal gland is composed of two different embryologically tissues, the cortex and medulla.
It produces hormones that helps regulate glucidic metabolism (glucocorticoids,
mineralocorticoids, catecholamines, adrenal androgens). Adrenal disorders may cause hyper or
hypofunction resulting in glucidic metabolism alterations.
Cushing’s syndrome is generally defined as a glucocorticoid hormones excess. It can be caused by
endogenous production of cortisol from the adrenal gland or by administration of exogenous
glucocorticoids. Both exogenous and endogenous glucocorticoids can cause diabetes and impaired
glucose tolerance. Physiologically glucocorticoids inhibit glucose uptake in peripheral tissues,
leading to hyperglycemia and hyperinsulinemia. They contribute to the development of impaired
glucose tolerance and overt diabetes mellitus by increasing hepatic gluconeogenesis, inducing
peripheral insulin resistance at the post-receptor level and by direct suppression of insulin release,
consequent to the combination of their effects on the liver, muscle, pancreas and adipose tissue.
On the other hand, pheochromocytomas are characterized by a catecholamine excess, leading to
hyperglycemia and diabetes due to a direct inhibition of insulin release, mediated by type 2 alpha
adrenergic receptors.
Moreover, patients with primary hyperaldosteronism can have altered insulin secretion and
reduction in insulin sensitivity by inhibiting insulin release through the effect of hypokalemia on
the pancreatic beta-cells.
The alterations in glucidic metabolism induced by all of these adrenal disorders mentioned above
can disappear after the primary cause has been solved.
The relationship between adrenal androgens and glucose metabolism modifications needs further
investigations, because the regulatory role of insulin on adrenal androgen metabolism remains
65
still unknown. In several animal studies, adrenal androgens demonstrated a conclusive role against
Page
obesity and diabetes, but further studies are required to elucidate their effects on human glucidic
metabolism.
Furthermore, adrenal insufficiency or hypofunction can be fatal if it goes untreated. The clinical
features depend on the extent of loss of adrenal function with the most common symptoms of
hypoglicemia, hyponatremia and hypotension.
In conclusion, understanding the incidence and interplay of glucidic disorders in patients with
adrenal pathology would provide future insights into the proper and current approach/management
of these disorders.
Corina Pop
Internal Medicine and Gastroenterology Department Carol Davila University of Medicine and
Pharmacy, Universitary Emergency Hospital Bucharest
Non-alcoholic fatty liver disease (NAFLD) indicate a spectrum of disease, ranging from hepatic
steatosis to necrosis and inflammation - NASH (non-alcoholic steatohepatitis). NASH often
advances to fibrosis, which can progress to cirrhosis.
NAFLD might affect up to one-third of the adult population chiefly individuals with multiple
metabolic risk factors including visceral obesity and diabetes.
NAFLD is a part of a multiorgan disorder and should be regarded as hepatic component of the
metabolic syndrome.
The relationship between type 2 diabetes mellitus and the liver is complex. 30-75% of patients
with NASH suffer from impaired glucose tolerance (prediabetes) or even diabetes.
Patients with NASH and diabetes are at increased risk for the development of cirrhosis.
Key pathogenic factor resulting in NAFLD is represented by insulin resistance. The transition from
steatosis to steatohepatitis is characterised by increased oxidative stress and by the expression of
proinflammatory cytokines.
The diagnosis of NAFLD is supported by detection of steatosis or/and necroinflammation and
appropriate exclusion of other liver diseases.
The liver biopsy remains the gold standard for the diagnosis of NASH. However, liver biopsy has
several drawbacks compare to the noninvasive markers that could accurately predict the stage of
liver disease, developed in the last two decades.
Despite researcher’s intense effort regarding therapeutic approach, there is still no approved drug
for the treatmenr of non-alcoholic steatohepatitis. We are looking for an ideal drug for NASH that
should reduce liver injury, and the occurance of liver fibrosis and should also corect insulin
resistance.
Diet, lifestyle changes and physical activity represent important therapeutic indications for
NAFLD’s patients.
Drugs commonly prescribed in patients with diabetes may affect liver histology by interfering with
insulin sensitivity and lipid profile.
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Continuous research should aim at identifying new targets for therapy and combine those that
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Studii recente sugerează că diabetul zaharat tip 2 implică mecanisme fiziopatologice heterogene
cu afectarea celulelor β, ficatului, mușchiului scheletic, adipocitelor, celulelor α, intestinului,
rinichiului și creierului.
Obiective: expunerea principalelor evenimente fiziologice, biochimice și moleculare implicate în
menținerea homeostaziei glucozei; înţeleagerea mecanismelor etiopatogenice ale hiperglicemiei –
“octetul nefast”; identificarea provocărilor actuale pentru obținerea și menținerea controlului
glicemic.
Procesele care contribuie la patogeneza și progresia diabetului zaharat tip 2 sunt reprezentate de:
Disfuncţia β-celulară şi alterarea secundară a insulinosecreţiei
Pacienţii cu diabet zaharat tip 2 prezintă defecte ale insulinosecreţiei caracterizate prin atenuarea
până la dispariţia primei faze a insulinosecreţiei cuplată cu prelungirea celei de a doua faze
insulinosecretorii. Principalele cauze ale disfuncţiei β-celulare în diabetul zaharat tip 2 sunt
îmbătrânirea, gene specifice, insulinorezistenţa, lipotoxicitatea, glucotoxicitatea, depozitele
pancreatice de amiloid, scăderea efectului incretinic.
Creşterea producţiei hepatice de glucoză şi scăderea utilizării periferice a glucozei
Pacienţii cu diabet zaharat tip 2 prezintă rezistenţă hepatică crescută la acţiunea insulinei şi declin
progresiv al utilizării periferice a glucozei.
Creşterea lipolizei
Creşterea producţiei de acizi graşi liberi de către adipocite în condiţiile insulinorezistenţei pot duce
la disfuncţie β-celulară şi de asemenea la insulinorezistenţă hepatică şi musculară.
Scăderea efectului incretinic
La subiecţii cu diabet zaharat tip 2 consecinţele scăderii efectului incretinic sunt reprezentate de
reducerea insulinosecreţiei, creşterea secreţiei de glucagon, creşterea producţiei hepatice de
glucoză, creşterea apetitului cu creştere ponderală.
Creşterea secreţiei de glucagon
Indivizii cu diabet zaharat tip 2 prezintă creşterea ariei celulelor α şi de asemenea a concentraţiei
plasmatice bazale de glucagon, ducând la creşterea ratei bazale a producţiei hepatice de glucoză.
Creşterea reabsorbţiei glucozei
Diabetul zaharat tip 2 este asociat cu creşterea expresiei şi activităţii cotransportorului 2 sodiu-
glucoză renal, ceea ce determină creşterea reabsorbţiei glucozei la nivelul tubului contort proximal.
Disfunţia neurotransmiţătorilor
Disfuncţia neurotransmiţătorilor hipotalamici poate contribui la dezvoltarea insulinorezistenţei,
alterarea homeostaziei glucozei şi/sau creştere ponderală.
Cunoaşterea fiziopatogeniei diabetului zaharat tip 2 are importante implicaţii terapeutice. Astfel,
terapia eficientă în diabetul zaharat tip 2 trebuie să se bazeze pe cunoaşterea modificărilor
patogenice şi necesită combinaţia de clase terapeutice multiple pentru a corecta defectele multiple
fiziopatogenice.
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THE OMINOUS OCTET OF HYPERGLYCEMIA
Current evidence suggests that type 2 diabetes is a heterogeneous disorder involving multiple
pathophysiologic defects in the β-cells, liver, muscle, adipocytes, α-cells, gut, kidney and brain.
Objectives: exposing of the main physiological, biochemical and molecular events involved in
glucose homeostasis; understanding the ethiopatogenic mechanisms of hyperglycemia - "the
ominous octet "; identifying current challenges to achieve and maintain glycemic control.
The processes that contribute to type 2 diabetes pathogenesis and progression are represented by
eight etiologic mechanisms:
β-cell dysfunction and secondary impaired insulin secretion
Patients with type 2 diabetes show defects in insulin secretion characterized by the attenuated to
nonexistent first-phase insulin response, coupled with a prolonged second-phase response. The
main potential causes of β-Cell failure in type 2 diabetes are aging, specific genes, insulin
resistance, lipotoxicity, glucotoxicity, pancreatic amyloid deposits, decreases in the incretin effect.
Increased hepatic glucose production and decreased glucose uptake
Patients with type 2 diabetes experience marked hepatic resistance to insulin action and a
progressive decline in glucose uptake.
Increased lipolysis
Increased free fatty acids production from fat cells resistant to insulin can lead to β-cell dysfunction
and also to insulin resistance in liver and skeletal muscle.
Decreased incretin effect
In type 2 diabetic individuals the consequences of decreased incretin effect are represented by the
reduced insulin secretion, increased glucagon secretion, increased hepatic glucose production,
increased appetite with weight gain.
Increased glucagon secretion
In type 2 diabetic individuals the pancreatic α-cell islet area and also the basal plasma glucagon
concentration are elevated leading to the increased basal rate of hepatic glucose production.
Increased glucose reabsorption
Type 2 diabetes is associated with increases in renal sodium-glucose cotransporters 2 expression
and activity which leads to increased reabsorption of glucose in the proximal tubule.
Neurotransmitter dysfunction
Hypothalamic neurotransmitter dysfunction may contribute to the development of insulin
resistance, impaired glucose homeostasis, and/or weight gain.
The potential mechanisms determining β-cell failure in type 2 diabetes (T2D) include
glucotoxicity, inflammation and failure in β-cell regeneration. Glucose stimulation exerts
beneficial effects on the β-cell phenotype between 2 and 10 mM, however over physiological
glucose concentrations (between 10 and 30 mM) are deleterious for β-cell function and survival.
Glucotoxicity plays an important role in the alteration of the functional β-cell mass in T2D, and it
contributes to the progressive worsening of glucose intolerance in these patients. On the other hand
adipose tissue dysfunction in obesity drives β-cell inflammation and T2D via several molecular
and cellular mechanisms linking inflammation to insulin resistance and β-cell dysfunction. The
overarching goal for improved therapy in T2D is to restore β-cell function preventing β-cell failure
and enhancing β-cell replacement. This could be achieved either by cell-replacement therapy or
by triggering intrinsic regenerative mechanisms of the pancreas. Therefore glucotoxicity,
lipotoxicity and possible β-cell regeneration should be targeted to prevent β-cell failure in T2D.
Continuous Subcutaneous Insulin Therapy (CSII) and other technologies can be helpful in
preventing β-cell failure in T2D. Recent studies showed that early intensive insulin therapy at T2D
diagnosis using CSII preserves β-cell function and significantly improves glycemic control
compared to multiple daily insulin injections (MDI). Moreover CSII is consistently superior to
MDI in patients with the highest baseline HbA1c.
The OPT2MISE study demonstrated that CSII provides a significant advantage in glycemic control
over MDI with a safe and consistent effect in long-term treatment, providing the durability of CSII
impact on glucose control during a 1 year period of treatment. The use of CSII especially in the
initial stages of T2D or in special populations may have an impact not only on metabolic control
but also on the disease process.
Diabetes technology is therefore an example of personalized therapy for T2D.
At least one quarter of patients with type 2 diabetes (T2D) who receive insulin injections show
very poor glycemic control (HbA1c ≥9%;75 mmol/mol). One of the possible barriers to achieving
glycemic control with multiple daily insulin therapy (MDI) is severe insulin resistance resulting
in high daily insulin dose requirement. Early intensive insulin therapy with continuous
subcutaneous insulin infusion (CSII) in T2D at onset induces protracted glycaemic remission and
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preserves β-cell function. CSII therapy may be considered as an effective method to achieve good
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glycaemic control, with a lower total daily insulin dose due to an increased basal insulin dose and
reduced bolus dose. CSII not only improves glycemic control in patients with type 2 diabetes, but
also has the additional benefit of inducing reduction of plasma ox-LDL, an important player in the
atherosclerotic process. This benefit is associated with a reduction in glucose excursion rather than
insulin dose or HbA1c.
The level of satisfaction and quality of life in T2D patients is influenced by problems such as
interference with daily activities, pain caused by injections and embarrassment. The use of
technology improves adherence to treatment. Several studies reported that diabetes satisfaction
scores improve over time with CSII. To improve adherence to CSII therapy, it is recommended
the use of a behavioral contract that provides specific metabolic goals to patients including
increased frequency of self glucose monitoring, a commitment on the part of the patient to go to
the diabetes centre for follow-up visits, frequency of pre-established visits and each patient’s
agreement to fulfill a detailed list of responsibilities.
Modern diabetes technology, such as CSII and continuous glucose monitoring, are now an
established and evidence-based part of diabetes care. Without a structured approach the new
technologies are often started and maintained improperly with poor cost-effective results. To
prevent this, the improvement not only of the advanced technologies but mostly of the healthcare
professional team who use them is crucial.
Obiectivul acestui studiu a fost evaluarea relației hepatită cronică cu virus C (HVC) și riscul
cardiovascular la pacienții cu sindrom metabolic (SM).
Material și metodă: Acest studiul este transversal, observațional, s-a desfășurat în Institutul
National de Diabet, Nutriţie şi Boli Metabolice "N.C. Paulescu" și a inclus un număr de 171 de
pacienţi. S-au urmărit indicii antropometrici (greutate, înălțime, circumferinţa taliei, IMC-ul),
parametrii biochimici (glicemia à jeun, hemoglobina glicozilată, profil lipidic, profil hepatic și
hemoleucograma). Riscul cardiovascular s-a calculat pentru fiecare pacient folosind scorul
UKPDS. Rezistenţa la insulină a fost determinată utilizând HOMA-IR. SM a fost definit conform
criteriilor IDF modificat.
Rezultate: SM a fost prezent la 58,4% (n=94) pacienți. Vârsta medie a fost de 50,5 ± 9,1 ani,
durata medie a diabetului zaharat a fost de 7,7±4,6 ani. Folosind scorul UKPDS, 27,3% (n=44) și
16,8% (n=27) dintre pacienți au prezentat risc cardiovascular moderat respectiv crescut.
Concentrațiile medii ale citokinelor proinflamatorii (TNF-α=13,58 pg/ml, IL-6=14,26 pg/ml,
leptină=16,38 ng/ml și rezistina=19,86 ng/ml) au fost mai mari la pacienții care au avut un scor
UKPDS mai mare de 30 (p <0,001). La pacienții cu SM, au existat corelații semnificative statistic
între UKPDS-CHD și HOMA-IR (r=0,44, p=0,001), IMC (r=0,39, p=0,001), TNF-α (r=0,39,
p=0,001 ), IL-6 (r=0,35, p=0,001), HbA1c (r=0,41, p=0,001), trigliceride serice (r=0,43, p=0,001),
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Asociarea intre diabetul zaharat tip 2 (DZ 2) si obezitate (OB) este foarte frecventa avand la baza
mecanisme fiziopatologice comune. Termenul „diabezitate” este utilizat pentru a caracteriza ata
epidemia comuna de OB si DZ 2, cat si asocierile fiziopatologice ale acestor doua boli cronice si
a multiplelor complicatii si comorbiditati. Pentru a reduce impactul negativ al diabezitatii se
impune dezvoltarea si derularea unui program strcuturat de interventie adresat preventiei,
screeningului si managementului clinic. Mari studii clinice arata ca la populatia cu OB si risc
crescut de DZ 2, interventii pe termen lung si intensive asupra stilului de viata pot reduce
semnificativ greutatea si concomitent prevalenta DZ 2. Alte dovezi se refera la interventii
farmacologice (metformin, orlistat), care combinate cu optimizarea stilului de viata au fost
eficiente in reducerea ponderala si a prevalentei DZ 2. In populatia cu OB, screeningul este esential
pentru depistarea precoce a DZ 2, crescand astfel posibilitatea unei interventii clinice optime.
Odata diagnosticat DZ 2, interventia terapeutica trebuie sa aiba ca obiective atat controlul glicemic
cat si cel ponderal. Datele din literatura demonstreaza ca interventiile adresate reducerii aportului
caloric, inversarii balantei energetice si scaderii ponderale, au efecte benefice metabolice si
cardiovasculare. Cu cat reducerea ponderala este mai mare, cu atat sunt mai mari sansele de remisie
ale DZ 2, mai ales daca aceasta interventie este efectuata precoce. Astfel ca optimizarea intensiva
a stilului de viata, prin diete hipocalorice si activitate fizica sustinta trebuie sa reprezinte baza
tratamentului. Conform ghidurilor, chirurgia bariatrica / metabolica este o optiune de considerat
in prezenta diabezitatii, la valori ale IMC peste 35 kg/m2. Pentru controlul multifactorial este
nevoie de un tratament farmacologic individualizat. Obiectivele terapeutice trebuie sa vizeze
concomitent controlul glicemic si ponderal. Alaturi de optimizarea stilului de viata, medicatia
antihiperglicemianta trebuie selectata prioritar dintre clasele de medicamente care reduc HbA1c si
greutatea: metformin, agonisti de receptori GLP-1 sau analogi de GLP-1, inhibitori de SGLT2 si
inhibitori de DPP-4. Cand insulinoterapia este necesara, se recomanda analogii de insulina bazala
in combinatie cu medicatia mai sus amintita. Medicatia adresata specific controlului ponderal se
va lua in considerare daca este disponibila.
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DIABESITY – PRACTICAL APPROACH
The association between Type 2 Diabetes (T2DM) and obesity (OB) is very frequent, with
common pathologic mechanisms linking the two conditions. Therefore “diabesity” is the term used
to characterize both the rising epidemic of OB and T2DM and the pathophysiologic association of
these two metabolic diseases and their multiple comorbidities and complications. In order to
reduce the burden of diabesity, a structured intervention program should be developed and applied
in terms of prevention, screening and clinical management. Great body of evidence shows that in
people with obesity and high risk for T2DM, long-term intensive lifestyle interventions can
significantly reduce the body weight and the prevalence of diabetes. Pharmacologic intervention
(metformin, orlistat) combined with lifestyle changes can also reduce both body weight and the
prevalence of T2DM. Screening among people with overweight and obesity is essential for early
diagnoses of T2DM, increasing thus the possibility of a more successful clinical management.
Once T2DM is already present, the therapeutic intervention should aim both weight and glycemic
control. Scientific literature proves that interventions aimed to reduce caloric intake, to revers
energy balance and thus to reduce body weight have beneficial metabolic and cardiovascular
effects. The greater weight loss is associated with the higher possibility of T2DM remission,
mainly if the intervention is applied early in the evolution of diabetes. Therefore, intensive lifestyle
optimization through hypocaloric diets and sustained physical exercise should be the cornerstone
of the treatment. Bariatric/metabolic surgery is a viable option in the presence of diabesity, at a
BMI above 35 kg/m2, according to the guidelines. Individualized pharmacologic treatment is
required to control all the cardiovascular risk factors. Therapeutic targets should be the control of
both glycemia and body weight. Together with lifestyle optimization, the antidiabetic medication
should be priority selected from the classes that reduces HbA1c and body weight: metformin,
GLP-1receptor agonists and GLP-1 analogues, SGLT2 inhibitors and DPP-4 inhibitors. When
insulin is required, the basal insulin analogues combined with the above medication is
recommended. Specific medication addressed to weight loss, if available, could be considered.
Polovina Snezana
Research Associate, MD, PhD on School of Medicine, University of Belgrade, Serbia
Clinic for Endocrinology, Diabetes and Diseases of Metabolism
Clinical Center of Serbia, Belgrade, Serbia
Bariatric or metabolic surgery is one of the most powerful therapeutic approach in severe
obesity treatment with long-term effect. The aims of bariatric surgery are from weight reduction
to improvement of metabolic abnormalities.
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Even it is well known that there is a high rate of diabetes remission after some bariatric
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procedures, we are still not sure what is realy underlying mechanism for this phenomenon. Some
data are on the side on resolving GLP-1 secretion and impact of other incretines, the other data
prefering the theory based on anti-incretines. Some authors argue that possible explanation of
metabolic changes, including diabetes remission lies on the changes of gut microbiota. Particularly
interesting are the changes in hormones with influence on glucose and lipide metabolism after
RYGB like insulin, amylin and leptin which levels becomes lower, although antiinflammatory
citokine, adiponectine becomes higher. Most powerful in diabetes remission is BPD/DS procedure
with remission rate of 95%, less efficient is RYGB (about 75-80%), VSG (about 70% ) and least
afficient is AGB with approximately 60% potential to achieve remission. Remission is not life-
long in all patients. Data confirm that the quality of sexual life in males improved after bariatric
surgery because of significantly higher levels of free testosterone. Potential side effect of
malabsorptive procedures is male infertility. A lot of women with PCOS and infertility normalised
the menstrual cycle and become pregnant in period of 3 years after surgery. Studies showed
changes in cortisol, TSH and GH levels after bariatric procedures. The bone metabolism is also
affected with bariatric surgery. Markers of bone turnover are more increased after gastric bypass
compared to gastric banding due to calcium and vitamin D malabsorption, preoperative low levels
of vitamin D and inadequately supplementation after surgery.
Prevalent and incident heart failure (HF) is increased in people with type 2 diabetes (T2DM), and
in dependence upon the degree of hyperglycemia. Furthermore, mortality is markedly increased
by about 10times in patients with T2DM and HF compared to T2DM patients without HF.
Reducing HF by improved glycemic control, however, has not been successful until recently. In
fact, HF as an important outcome in patients with T2DM appears to be heterogeneously modulated
by antihyperglycaemic medications, as derived from cardiovascular outcome trials (CVOTs) and
large observational cohort studies. Appropriately powered and executed CVOTs are necessary to
truly evaluate CV safety and efficacy of new medications, as also required by the guidance of the
Food and Drug Administration and other agencies since 2008. In light of the best available
evidence at present, especially metformin and the SGLT2-inhibitor empagliflozin seem to be
advantageous in HF patients, as their use appears to be associated with reduced HF events and
improved mortality. Acarbose, the DPP4-inhibitor sitagliptin, the GLP1-RA lixisenatide comprise
reasonable additional options, as significant harm in terms of HF has been excluded for those
drugs. Additions to this list are anticipated pending results of ongoing CVOTs including detailed
HF results from LEADER, a trial evaluating the GLP1-RA liraglutide. Although no HF harm was
seen in CVOTs for insulin or sulfonylureas, they should be used only with caution in HF patients,
given their established high risk for hypoglycemia and some uncertainties regarding their safety
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Diabetul zaharat (DZ) poate fi considerat o adevărată epidemie la nivel mondial - unul din 11
adulţi suferă de această afecţiune şi se estimează că acest raport va ajunge la 1 din 10 până în 2040.
Mai mult, la fiecare 6 secunde un pacient decedează datorită DZ şi a complicaţiilor acestuia. Bolile
cardiovasculare sunt principala cauză de mortalitate la aceşti pacienţi, urmate de afecţiunile
oncologice şi de diabetul per se. Totodată, bolile cerebrovasculare se situează pe locul patru, iar
boala arterială periferică pe locul şapte.
Deoarece terapia cu statine este eficientă doar într-un anumit procent din cazuri, chiar dacă
este administrată doza maximă (40 mg de rosuvastatină, respectiv 80 mg atorvastatină), în schema
terapeutică poate fi asociat şi ezetimib. Cu toate acestea, tratamentele actuale sunt insuficiente
pentru un număr semnificativ de pacienţi. O altă opţiune terapeutică superioară, alături de LDL
afereză, sunt inhibitorii de PCSK9. Aceştia sunt recomandaţi la pacienţii cu hipercolesterolemie
primară sau cu dislipidemie mixtă în combinaţie cu statine (sau alte hipolipemiante la pacienţii
care nu ating ţintele terapeutice sau la care statina este contraindicată) şi în cazul dislipidemiei
aterogene în combinaţie cu statină şi/sau fibrat atunci când celelalte terapii hipolipemiante nu sunt
suficiente.
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PRESENT AND FUTURE PERSPECTIVES REGARDING THE TREATMENT OF
DYSLIPIDEMIAIN PATIENTS WITH DIABETES
Diabetes mellitus (DM) has become a world epidemic, since one in eleven adults are already
diagnosed with diabetes and by 2040 it is estimated that the number will rise to one in ten people.
Moreover, every six seconds a person dies due to complications caused by DM. Cardiovascular
diseases are by far the highest cause of mortality in patients with DM, followed by malignancies
and diabetes itself on the third place. In addition, cerebrovascular diseases come on a fourth place
and peripheral artery disease on the seventh place.
Cardiometabolic risk factors include abnormal lipid metabolism (high LDLc, apoB and
triglycerides serum levels and low HDLc serum levels), an inflammatory status and
hypercoagulation, hypertension, physical inactivity, smoking, overweight or obesity and last but
not least age, race, gender and family history. However, one the most important risk factor when
discussing DM is dyslipidemia. This condition includes elevated tryglicerides (>150 mg/dl), low
HDLc (<40 mg/dl in males and <50 mg/dl in females) and an increase in small, dense LDL
particles, apoB and lipoprotein “a”.
The current recommendations regarding the treatment of dyslipidemia in patients with type
1 DM associated with renal disease and microalbuminuria propose a decrease (with statins) of
minimum 30-50% of the LDL cholesterol levels, irrespective of the basal concentration, while for
patients with type 2 DM and cardiovascular disease or chronic kidney disease the targets are <70
mg/dl for LDLc, 100 mg/dl for non-HDL cholesterol and <80 mg/dl for apoB.
Statin therapy is efficient in the highest recommended dose (40 mg for rosuvastatin and 80
mg for atorvastatin), however not for all patients, which is why in some cases ezetimibe is also
associated. Current available treatments prove inefficient in quite a number of cases, reason for
which LDL-apheresis has been proposed. A better initiative has been developing the PCSK9
inhibitors. They are recommended in primary hypercholesterolemia or mixed dyslipidemia, in
combination with a statin or with other lipid-lowering therapies in patients unable to reach LDLc
goals or for whom a statin is contraindicated, or for atherogenic dyslipidemia in combination with
a statin and/or fibrate - when lowering therapies are unable to reach lipidic goals.
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RW42. TULBURĂRI METABOLICE ASOCIATE HIPOTIROIDIEI
Vudu Lorina
Universitatea de Stat de Medicină și Farmacie "Nicolae Testemițanu"
Hipotiroidia primară se asociază cu dereglări ale diferitor tipuri de metabolism (lipidic, proteic,
glucidic, energetic etc.), fie prin efectul direct sau indirect al hormonilor tiroidieni. T3 și T4
reglează genele implicate în procesele de lipogeneză și lipoliză, având efecte genomice și
nongenomice. Deficitul de hormoni tiroidieni duce la dereglări ale metabolismului proteic
(încetinirea de sinteză și de degradare), acumularea în țesuturi a glicoproteinei mucina, a
condroitinsulfaților și a acidului hialuronic, care au capacitatea de a reține apa și cauzează edemul
mucinos al țesuturilor și organelor, contribuie la apariția hidropericardului și hidrotoraxului.
Dereglările metabolice care au loc în cazul scăderii funcției glandei tiroide, predispun către
dezvoltarea aterosclerozei. În hipotiroidie are loc scăderea metabolismului, scăderea lipolizei,
creșterea nivelului de colesterol total, LDL-colesterol, IDL-colesterol. Scade cantitatea și
activitatea LDL-receptorilor în ficat, în rezultat scade excreția hepatică a colesterolului și crește
concentrația LDL-colesterolului și VLDL-colesterolului, bogate în apolipoproteine B. Pacienții cu
hipotiroidie de obicei prezintă valori ascendente de HDL-colesterol, datorate creșterii concentrației
particulelor HDL-2. Scăderea activității CETP (cholesteril ester transfer protein) duce la scăderea
transformării esterilor de colesteril din HDL în LDL, scade transportul invers al colesterolului,
proces antiaterogen important în organismul uman. Scăderea activității lipazei hepatice provoacă
scăderea catabolismului HDL-2 particulelor. Are loc creștera valorilor lipoproteinei A. In
insuficiența tiroidiană nivelul trigliceridelor poate fi moderat crescut și este determinat de scăderea
activității lipoprotein lipazei în țesutul adipos și scăderea clearance-ului trigliceridelor de către
țesutul adipos. Unii autori consideră că hipertrigliceridemia este determinată de creșterea sintezei
de trigliceride.
Scopul lucrării a fost de a stabili la pacienţii cu hipotiroidie specificul modificării indicilor
metabolismului lipidic și al aminoacizilor, repartizați pe grupe funcţionale - mediatori, glicogeni
şi cetogeni, imunoactivi.
Materiale și metode. În studiu au fost incluși 100 pacienţi сu hipotiroidie primară pe fond
de tiroidită autoimună și 30 persoane sănătoase. Vârsta bolnavilor a constituit de la 23 pînă la 66
ani. A fost determinat profilul lipidic: colesterol total, LDL-C, HDL-C, trigliceride și conținutul
aminoacizilor în plasma sanguină la persoane sănătoase și cu hipotiroidie primară. Nivelul TSH la
pacienții investigați a constituit 63,18±9,39 µUI/ml, iar T4 liber - 7,33±1,20 pmol/L.
Rezultate și discuții. Analiza indicilor metabolismului lipidic la pacienții cu hipotiroidie
primară a arătat că nivelul colesterolului total a constituit 6,50±0,60 mmol/L, LDL-C - 4,28±0,44
mmol/L, HDL-C - 1,75±0,13 mmol/L, al trigliceridelor - 1,99±0,39 mmol/L. La pacienții studiați
erau prezenți cel puțin 2 factori de risc ai maladiilor cardiovasculare (stres cronic, hipertensiune,
fumat, masa corporală, etc.), ceea ce clasifică acești pacienți în grupa cu risc major conform
indicilor lipidici, recomandați de Asociația Europeană de Ateroscleroză.
Analiza aminoacizilor mediatori la pacienții cu hipotiroidie a arătat creșterea aminoacizilor
inhibitori (taurina, glicina şi γ-aminobutiric), pe cînd suma generală a aminoacizilor excitanți
(asparagina, glutamina) nu a suferit modificări statistic concludente. Analiza conţinutului fiecărui
aminoacid inhibitor şi excitant a arătat sporirea conţinutului de glicină la persoanele investigate.
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prin creșterea nivelului colesterolului total, LDL-C, trigliceridelor, ceea ce corespunde unui risc
cardiovascular major. La pacienţii cu hipotiroidie se estimează atât dereglări ale profilului, cît şi
ale valorilor numerice ale aminoacizilor mediatori sanguini, cu predominarea sumei aminoacizilor
inhibitori și creșterea statistic veridică a valorilor glicinei.
Vudu Lorina
State University of Medicine and Pharmacy "Nicolae Testemitanu"
disease (chronic stress, hypertension, smoking, body weight, etc.) were present in the studied
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patients, which classifies these patients into high risk group according to lipid indices
recommended by the European Association of Atherosclerosis.
Mediator amino acids analysis in patients with hypothyroidism showed an increase in
inhibitory amino acids (taurine, glycine and γ-aminobutyric acid), while the overall amount of
excitatory amino acids (asparagine, glutamine) did not show statistically conclusive changes.
Analysis of the content of each excitatory and inhibitory amino acids revealed an increased content
of glycine in the investigated individuals.
Conclusions. Changes in lipid metabolism in patients with hypothyroidism is characterized
by increased total cholesterol, LDL-C, triglycerides, which corresponds to a major cardiovascular
risk. In hypothyroid patients, both profile, as well as numerical values disturbances of mediator
amino acids are observed, with predominance of inhibitory amino acids amount and a statistically
reliable increase in glycine values.
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Page 79
PREZENTĂRI ORALE LUCRĂRI ORIGINALE /ORAL
PRESENTATIONS ORIGINAL PAPERS
Dr. Popa Adina1, Șef Lucr. Dr. Popa Simona Georgiana1, Dr. Soare Andreea1, Prof. Univ.
Dr. Moța Maria1, Prof. Univ. Dr. Pozzilli Paolo
1
Spitalul Clinic Judeţean de Urgenţă Craiova
Premise și Obiective: Studii effectuate în ultimii ani au arătat că progranulin (PGRN), proteină
recent inclusă în grupul adipocitokinelor, poate juca un rol atât în etiopatogenia diabetului zaharat
tip 2 (DZ), cât și a bolii Alzheimer (AD). Propunem un studiu pilot în vederea evaluării rolului
jucat de PGRN în asocierea DZ cu AD.
Material și Metodă: Studiul a inclus 40 subiecți, împărțiți în 4 grupuri: 10 subiecți cu asocierea
AD și DZ (Grup 1); 10 subiecți doar cu AD (Grup 2); 10 subiecți doar cu DZ (Grup 3); 10 subiecți
fără AD și DZ (Grup 4). PGRN a fost dozată prin metoda ELISA iar raportul PGRN/kg s-a
calculate la toți subiecții. De asemenea, la toți subiecții s-a evaluat genotipul apolipoproteinei E
(Apo E) și statusul mental prin testul mini mental (MMSE). Datele înregistrate au fost analizate
statistic cu software-ul SPSS 17.00.
Rezultate și Discuții: PGRN serică a diferit semnificativ statistic între cele 4 grupuri (p=0,01),
cea mai mare valoare înregistrându-se la subiecții din Grupul 3 (132,9±36,7), iar cea mai mică
valoare la cei din Grupul 1 (87,2±19,1). Raportul PGRN/kg a fost semnificativ statistic mai mare
la subiecții din Grupul 2 (p=0,023) și Grupul 3 (p=0,049) comparativ cu Grupul 1. La toți subiecții
cu AD (n=20), s-a analizat relația dintre nivelul PGRN, raportul PGRN/kg, genotipul Apo E, scorul
MMSE și durata bolii. Singura corelație semnificativă statistic s-a observant între scorul MMSE
și durata bolii (p=0,008).
Concluzii: Rezultatele noastre arată că PGRN poate juca un rol în asocierea dintre DZ și AD, dar
studii viitoare pe loturi mai mari de subiecți sunt necesare pentru a elucida contribuția
adipocitokinelor la asocierea celor două afecțiuni.
Popa Adina1, Lect. Dr. Popa Simona Georgiana1, Soare Andreea1, Prof. Moța Maria1, Prof.
Pozzilli Paolo
1
Emergency Clinical Hospital Craiova
Premises and Objectives: Studies performed in the last years showed that progranulin (PGRN),
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diagnosticați cu adenocarcinom colorectal primar; vârsta> 18 ani, femei și bărbați; fără istoric
familial de cancer colorectal; fără tratament oncologic anterior; cu diabet zaharat de tip 2
diagnosticat anterior cancerului colorectal-pentru grupul de diabetici. Etapa de microscopie optică
a reprezentat momentul central al evaluării histopatologice a secțiunilor de țesut, și a fost realizată
în mod independent de către doi medici anatomopatologi, în conformitate cu standardele
profesionale actuale. Toate datele au fost extrase din biletele de externare și din rapoartele
histologice.
După obținerea acordului comisiei de etică locale, cazurile au fost selectate din baza de date a
Departamentului de Anatomopatologie a Spitalului Clinic de Urgență București. Expresiile p53 si
Bcl2 au fost investigate prin metoda imunohistochimică automatizată utilizând platform
BenchMark XT Ventana, folosind protocolul dual Bcl2-p53 în cadrul Departamentului de
Histopatologie al Laboratorului Central de referință Synevo. Clonele folosite au fost soluții pentru
diagnostic in vitro: pentru proteina antiapoptotică Bcl2 clona a fost Ventana CONFIRM 124 anti-
Bcl2 Mouse Monoclonal Primary Antibody iar pentru proteina p53 supresoare tumorală clona a
fost Ventana Anti-p53 Primary Antibody Bp53-11.
Rezultate şi discuţii: Grupul de studiu a inclus 4 probe de mucoasă colonică non-lezională și 95
de probe cu ţesut tumoral de tip adenocarcinom colorectal, din care 43 de cazuri ce nu au asociat
T2D si 52 de cazuri cu T2D. Comparativ cu non-T2D, pacienții cu T2D au prezentat: o expresie
imunohistochimică crescută anormală a p53 (expresie pozitivă în> 70% din celulele tumorale, de
intensitate moderată sau ridicată) în 46,2% vs 34,9%, p = 0,306; coexpresie crescută Bcl2 / p53
(11,5% vs de 7%, p = 0,099), o frecvență mai mare a imunofenotipului Bcl2-/p53+ (42,3% vs
32,6%, p = 0,447) și o expresie Bcl2 mai scăzută (9,6%vs 16,3%, p =0,367). Analiza a evidenţiat
o creștere semnificativă a expresiei p53 la subgrupul de pacienti diabetici obezi, comparativ cu
diabeticii non-obezi (80%vs 40,5%) sau non-diabetici (80% vs 37%, p = 0,024), cu semnificație
statistică.
Concluzii: Rezultatul acestui studiu sugerează că pacienţii cu adenocarcinom colorectal ce
asociază T2D şi obezitate, prezintă mai frecvent expresia anormală a proteinei supresoare p53,
comparativ cu pacienţii diabetici non-obezi sau non-diabetici. Această expresie aberantă a p53
asociată cu T2D şi obezitatea în adenocarcinoamele colorectale oferă acestui grup de pacienţi un
prognostic mai rezervat, atât în ceea ce privește evoluția, progresia, recurenţa cât şi a raspunsului
la tratament.
6.
National Institute of Diabetes, Nutrition and Metabolic Diseases"Prof. N. C. Paulescu"
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Premises and objectives: Epidemiological studies have shown an increased risk of colorectal
cancer in type 2 diabetes (T2D) patients. Given the complexity of pathophysiological mechanisms
existing in T2D, we proposed a new potential inductive process for carcinogenicity in T2D patients
by investigating concomitant immunohistochemical expression in diabetic and non-diabetic
colorectal adenocarcinoma of two molecules involved in the pathogenesis of both cancer and
diabetes: tumour suppressor p53 protein and antiapoptotic Bcl2 protein.
Matherial and methods: This was a retrospective study analyzing all hospitalized patients with
colorectal cancer from 01.01.2011-15.06.2015 in Bucharest Emergency Hospital, using medical
informatic program Hippocrates according to International Statistical Classification of Diseases
classification and Related Health Problems 10th Revision -ICD10: colon cancer C18,
rectosigmoidian cancer C19 and rectal cancer C20. From a total of 1307 cases we identified, we
randomly selected in order of appearance only the cases with appropriate inclusion criteria:
patients diagnosed with primary colorectal adenocarcinoma, age > 18 years , women and men with
a family without familiy history of colorectal cancer , without previous oncologic treatment, type
2 diabetic patients earlier cancer diagnosed) ( for diabetic group).Optical microscopy stage was
the central moment of the histopathological evaluation of tissue sections , and was conducted
independently by two pathologists doctors in accordance with current professional standards.All
data were extracted from hospital discharge summaries and histological reports.After obtaining
the ethics committee agreement the cases were then selected from the Pathology Database of the
Bucharest Emergency Hospital. The p53 and Bcl2 expressions were investigated by automated
immunohistochemistry BenchMark XT Ventana platform using dual Bcl2-p53 protocol in the
Histopathology Department of the Central Reference Laboratory Synevo. The clone used were in
vitro diagnostic solutions: for antiapoptotic Bcl2 protein the clone was Ventana CONFIRM 124
anti-Bcl2 Mouse Monoclonal Primary Antibody and for p53 tumour suppressor protein was
Ventana Anti-p53 Primary Antibody Bp53-11 clone.
Results and discussions: The study group consisted of 4 samples of colonic non–lesional mucosa
and 95 patients with new primary colorectal adenocarcinoma, 43 non T2D and 52 with T2D.
Compared with non-T2D, patients with T2D had increased immunohistochemical abnormal p53
expression (positive expression in > 70 % of tumor cells of moderate or high intensity) in 46.2%
vs 34.9%, p= 0.306; increased Bcl2/p53 coexpression (11.5% vs 7%, p=0.099) and a higher
frequency of Bcl2-/p53+ immunophenotype (42.3% vs 32.6%, p=0.447), and a lower Bcl2
expression (9.6% vs 16.3%, p=0.367). Subgroup analysis showed a significant increase in p53
expression in obese T2D patients compared to non-obese diabetics (80% vs 40.5%) or non-
diabetics (80% vs 37 %, p = 0.024) with statistical significance.
Conclusion: The result of this study suggest that colorectal adenocarcinoma in T2D obese
subgroup patients, had a more frequent abnormal p53 expression compared to non-obese T2D and
non-T2D. Aberrant p53 expression associated with T2D and obesity in colorectal
adenocarcinomas, gives this group a more reserved prognosis both in terms of evolution,
progression , recurrence and treatment response.
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OP3. UTILIZAREA SISTEMULUI DE MONITORIZARE CONTINUĂ A GLICEMIEI
CA METODĂ DE INVESTIGARE A HIPOGLICEMIEI REACTIVE
Dr. Stoica Roxana Adriana1, Dr. Soare Andreea1, Dr. Del Toro Rossella1, Dr. Guja Cristian1,
Dr. Pozzilli Paolo
1.
Institutul Naţional de Diabet, Nutriţie şi Boli Metabolice"Prof. N. C. Paulescu"
În acest studiu pilot, SMCG a detectat cazuri adiționale de hipoglicemie reactivă comparativ
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TMM. Prin urmare, SMCG poate avea un rol în diagnosticul și evaluarea intervențiilor terapeutice
la pacienții afectați de această patologie. Studii suplimentare care să includă un număr mai mare
de pacienți sunt necesare pentru a confirma acest lucru. (Acest proiect a fost susținut de Societatea
Română de Diabet, Nutriție și Boli Metabolice.)
Dr. Stoica Roxana Adriana1, Dr. Soare Andreea1, Dr. Del Toro Rossella1, Dr. Guja Cristian1,
Dr. Pozzilli Paolo
1
National Institute of Diabetes, Nutrition and Metabolic Diseases"Prof. N. C. Paulescu"
difference in the percentage distribution between those that were disease positive and negative
according to CGMS as seen in Figure 1.
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Patients in the reactive hypoglycaemia group had higher percentages of glucose values between
41-50 mg/dl, 51-60 mg/dl, 61-70 mg/dl, 71-80 mg/dl and 81-90 mg/dl as compared with the normal
group (0.8%, 0.82%, 2.08%,10.2%, 30.26% and, respectively, 0%, 0.33%, 0.98%,
4.11%,17.47%). For each 10 mg/dl interval between 91 and 180 mg/dl, patients in the reactive
hypoglycaemia group had smaller percentages than the normal group. All comparisons between
the two groups were non-significant at an α level of 0.05.
In our pilot study CGMS detected additional cases of reactive hypoglycaemia compared to MMT.
Thus, it may have a role in diagnosing and evaluating therapeutic interventions in patients affected
by this condition. Further studies involving larger sample sizes are required. (This research project
was sustained by The Romanian Society of Diabetes, Nutrition and Metabolic Diseases.)
Dr. Sturza Adrian1, Dr, Duicu Oana1, Dr. Văduva Adrian1, Dr. Dănilă Maria1, Dr.
Privistirescu Andreea1, Dr. Munteanu Mircea1, Prof. Dr. Timar Romulus1, Prof. Dr.
Muntean Danina1
1.
Disciplina de Fiziopatologie, Centrul de Cercetare Translationala si Medicina Sistemelor,
Universitatea de Medicina si Farmacie ”Victor Babes” Timisoara
experimental.
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THE POSITIVE FEEDBACK LOOP BETWEEN HYDROGEN PEROXIDE AND
MONOAMINE OXIDASES – A NEW MECHANISM OF VASCULAR OXIDATIVE
STRESS IN DIABETES MELLITUS
Sturza Adrian1, Duicu Oana1, Văduva Adrian1, Dănilă Maria1, Privistirescu Andreea1,
Munteanu Mircea1, Prof. Timar Romulus1, Prof. Muntean Danina1
1.
Department of Pathophysiology, Center for Translational Research and Systems Medicine,
University of Medicine and Pharmacy "Victor Babes" Timisoara
Oxidative stress plays a central role in the pathogenetic sequence underlying endothelial
dysfunction in diabetes mellitus (DM). We have previously demonstrated that monoamine
oxidases (MAOs) with 2 isoforms (A and B) are mitochondrial sources of reactive oxygen species
(ROS) production in vascular walls in DM. By catalyzing catecholamine degradation, MAOs
constantly generate hydrogen peroxide (H2O2) as byproduct.
The present study performed in rat aortas was purported to evaluate the effects of: i) increased
concentration of H2O2 on endothelial dependent relaxation and MAO expression and ii) in vitro
stimulation with exogenous MAO on H2O2 production, respectively. To this aim measurements
of H2O2 production using FOX assay, vascular reactivity assessment in organ bath and MAO
expression by immunohistochemistry have been performed in isolated aortas.
Our data showed an impairment of endothelial-dependent relaxation together with an upregulation
of both MAO isoforms in vascular segments stimulated with H2O2. The amount of H2O2 was
significantly increased and the relaxation response was attenuated in diabetic vessels vs control;
incubation with catalase (H2O2 scavenger) significantly reversed this effect. Stimulation with
exogenous MAO lead to a overproduction of H2O2 in a dose-dependent manner in rat aortic
segments.
In conclusion, excessive production of ROS in diabetes contributes to the continuos activation of
MAO with subsequent H2O2 generation, thus triggering a positive feedback loop that contributes
to the perpetuation of endothelial dysfunction in experimental diabetes.
Dr. Bacanu Elena Violeta1, Rezident Parocescu Daniel1, Şef Lucr. Dr. Virgolici Bogdana1
1.
Institutul Naţional de Diabet, Nutriţie şi Boli Metabolice"Prof. N. C. Paulescu"
Introducere: Boala arterială periferica (BAP) a membrelor inferioare este echivalentă cu boala
coronariană ischemică la pacienții cu DZ, iar consecințele acesteia sunt de obicei amputațiile
membrelor inferioare. În acest studiu ne-am propus evaluarea BAP la pacienții cu DZ folosind
ecografia vasculară şi prin aceasta de a stabili atât localizarea cât şi severitatea leziunilor.
Material şi metode. În perioada martie 2015-martie 2016 am efectuat acest studiu observațional la
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un lot de 245 de pacienți diabetici (tip 1 si tip 2) cu vârstele cuprinse ȋntre 40 şi 82 ani. S-au luat
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ȋn considerare valori ale glicemiei bazale, HbA1c, nivelul colesterolului total şi HDL colesterolul,
prezența HTA şi statusul de fumător/nefumător. Tuturor pacienților li s-a efectuat indicele gleznă-
braț (IGB) şi ecografia vasculara (2D, color şi Doppler spectral) la nivelul arterelor membrelor
inferioare. BAP a fost definită printr-o valoare a IGB ≤ 0,9 sau prin prezența
simptomatologiei/semnelor sugestive ȋn contextul unui puls periferic slab. Ecografia vasculară
oferă atât detalii anatomice cât şi informațiile funcționale (gradiente de velocitate) la nivelul
leziunilor. Ecografia Doppler color permite atât localizarea anatomică cât şi cuantificarea
severității leziunilor (stenoză/ocluzie). Pacienții au fost ȋmpărțiți ȋn două loturi după tipul DZ: lotul
pacienților cu DZ tip 1 cu vârsta medie 52,5 ± 8,2 ani şi lotul pacienților cu DZ tip 2 cu vârsta
medie de 65,4 ± 9,0 ani.
Rezultate: Pacienții de sex masculin au fost majoritari ȋn ambele loturi 77,5% şi respectiv 75,2%
ȋn lotul 2. Statusul de fumător la intreg lotul de pacienți diabetici a fost ȋntâlnit ȋn proporție de
44%, cu proporție mai mare ȋn lotul celor cu DZ tip 1 (57%). Majoritatea pacienților diabetici cu
DZ tip 2 au HTA (90,01%) şi dislipidemie(82,5%). La aproximativ 30% din pacienții cu IGB<0,9
s-au găsit leziuni severe ecografic (stenoze strânse/ocluzii). La 99,5% din pacienții cu IGB ≤ 0,3
s-au găsit leziuni ecografice severe, iar aproximativ 26% pacienții simptomatici cu rezultate fals
negative ale IGB au avut leziuni moderate. La un procent de aproximativ 30% (ȋn special lotul cu
DZ tip 1) cu o vechime a diabetului de cel puțin 10 ani s-au decelat calcificări arteriale importante
bilaterale. Leziunile arteriale severe (stenoza strânsă sau ocluzie) au fost ȋn special unilaterale ȋn
proporție de 77,3% şi doar ȋn proporție de 12,5% au fost bilaterale. Leziunile periferice cele mai
frecvente au fost la nivelul AFS (59,42%) ȋn special la nivelul canalului Hunter, ATA (60,86%) şi
ATP ( 46,6%). Leziunile distale bilaterale pe ATA şi ATP au fost prezente ȋn aproximativ 38% cu
o vechime a bolii de cel puțin 10 ani.
Concluzii: Diabetul zaharat reprezintă unul dintre cei mai importanți factori de risc ai BAP.
Ecografia vasculară este o metodă neinvazivă, uşor de acceptat de către pacienți şi de o mare
importanță ȋn evaluarea BAP, ȋn scopul aplicării precoce a tratametului specific (inclusiv cel de
revascularizare).
Bacanu Elena Violeta, PhD1, Parocescu Daniel1, Lect. Virgolici Bogdana, PhD1
1.
National Institute of Diabetes, Nutrition and Metabolic Disease “Prof. N. Paulescu”
Introduction: Peripheral artery disease (PAD) of the inferior limbs is equivalent with the ischemic
coronary artery disease in diabetic patients and usually requires amputation. The aim of this study
is to evaluate PAD in diabetic patients by vascular ultrasonography in order to establish both the
location and the severity of the injuries.
Materials and methods: From March 2015 since March 2016 we did an observational study on
245 diabetic patients (type 1 and type2), 40 to 82 years old.
The levels for HbA1c, total cholesterol, HDL cholesterol, for blood pressure and the smoking/
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nonsmoking status were considered. All patients did ankel-brahial index (ABI) and
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ultrasonography (2D, color and spectral doppler) for the inferior limbs. PAD was defined for a
value ABI ≤ 0.9 or when suggestive symptoms/signs were present with a weak peripheric puls.
Vascular ultrasonography gave both anatomical and functional information (velocity gradient) at
the site of injuries. Color doppler ultrasonography gave information about anatomical location and
quatified the severity of injury (stenosis or oclusion). Diabetic patiets were divided into two groups
according to the type of diabetes: type 1, 52.5 ± 8.2 average age and type 2 diabetic patients, 65.4
± 9.0 average age.
Results: Male gender had high incidence in both groups, 77.5% and 75.2%, respectively. Smoking
status was present in 44% in all diabetic patients, with higher values (57%) in type 1 diabetes
mellitus group. Most of the type 2 diabetic patients had high blood pressure (90.01%) and
dyslipidemia (82.5%). In 30% of patients with ABI<0.9 severe injuries were observed by
ultrasonography (tight stenosis/oclusions). In 99.5% of patients with ABG ≤ 0.3 severe injuries
documented by ultrasonography were found, but about 20% of symptomatic patients with ABI
false negative had moderate stenosis. Almost in 30% patients (especially in type 1), with diabetes
mellitus for more than 10 years, arterial bilateral calcification were shown. Severe arterial injuries
(tight stenosis or oclusion) were unilateral in 77.3% and bilateral in 12.5% cases. Peripheral
injuries were at the AFS level (59,42%) especially at the Hunter channel, ATA (60,86%) si ATP
( 46,6%). Bilateral distal injuries ATA si ATP were present in about 38% of cases with diabetes
mellitus for more than 10 years.
Conclusion: Diabetes mellitus is one of the most important risk factors for PAD.
Vascular ultrasounds represents a noninvasive method for which the patients are compliant.
Vascular ultrasounds are of high value to analyse the PAD and help the physician to do a better
specific management, in time, including revascularisation treatment.
Obiectivele primare au fost diferenţele în valoarea HbA1c la finalul studiului vs. iniţial şi între
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months, and initiated at investigator decision on basal insulin analogues. Patients were randomized
1:1 to two groups- enhanced educational group (a predefined, standardized educational program
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with 2 sessions) and a control group (trained according to daily practice routine) and were followed
for 6 months. The primary endpoints were difference of HbA1c levels between the two groups at
baseline and at the end of observational period and the proportion of patients with adequate
individualized HbA1c at the end of the 6 months period. Secondary endpoints included EuroQol
five dimensions questionnaire (EQ5D) and Diabetes Empowerment Scale(DES) scores change,
incidence of all symptomatic and serious hypoglycemic events, changes in fasting plasma glucose
(FPG), total daily insulin dose, weight and waist circumference, and changes in eating habits and
physical activity.
Results and Discussions: The study group consisted of 746 T2DM patients (367 in the enhanced
educational and 379 in the control group), with a mean age of 60 years, 49% were males, mean
HbA1c at baseline 9.5% and diabetes duration 7.6 years, with no differences between groups. A
significant decrease of HbA1c was obtained at the end of study period in both groups (-2.06 and -
2.04%) but with only -0.08% in favor of enhanced education (p=NS). The proportion of patients
who reached HbA1c targets was significantly higher in patients with enhanced education (55.2 vs
42.2% [p<0.001]). FPG decreased with -95.55 mg/dl in study group and -95.94 mg/dl in control
group (p=NS between groups). EQ-5D and DES scores had a slightly tendency of improvement in
patients with enhanced education. Eleven severe hypoglycemic events (0 nocturnal) – 4 in
enhanced educational group and 7 in control group and 204 symptomatic hypoglycemic (18
nocturnal)- 82 (7 nocturnal) in enhanced education group and 122 (11 nocturnal) in standard
education group (p=0.003) were reported. No significant differences were seen for weight, waist
circumference and insulin dose at the study end between groups. Eating habits were improved in
89.6% people with enhanced education vs. 64.3% in standard education group (p<0.0001) and
physical activity increased in 54.2% people in study group vs. 27.2% in control group (p<0.0001).
Conclusions and Findings: An enhanced diabetes education improved achievement of
individualized HbA1c targets, with less severe and symptomatic hypoglycemic events in patients
with T2DM started on a basal insulin analogue regimen. Additional benefits were seen on eating
habits and physical activity level, as well as a slightly tendency of improvement in EQ-5D and
DES scores. (Funded by Sanofi; Registry number: DIREGL07301)
Dr. Bîcu Mihaela Larisa1, Dr. Bîcu Daniel1, Dr. Vladu Mihaela Ionela1, Dr. Clenciu Diana1,
Dr. Sandu Magdalena1, Prof. Dr. Moța Maria1
1.
Spitalul Clinic Municipal Filantropia, Craiova
Premise şi Obiective: Scopul studiului a fost identificarea unor corelaţii între estimated glucose
disposal rate (eGDR) - ca marker al insulinorezistenţei (IR) şi celelalte complicaţii cronice ale
diabetului zaharat (DZ) tip 1, atât micro- (retinopatie diabetică - RD, neuropatie diabetică
periferică senzitivo-motorie - NDPSM), cât şi macrovasculare (cardiopatie ischemică cronică -
CIC, infarct miocardic - IM, arteriopatie obliterantă a membrelor inferioare - AOMI), la pacienţi
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cu DZ tip 1 cu durata DZ >10 ani, în funcţie de prezenţa bolii renale diabetice (BRD).
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Material şi Metodă: Am inclus în studiu 140 de pacienţi neselectionaţi, cu DZ tip 1 cu durata DZ
>10 ani, 41.43% femei şi 58.57% bărbaţi, la care am analizat date anamnestice, antropometrice şi
paraclinice. eGDR (mg x kg-¹ x min-¹) a fost calculat după următoarea formulă: 24.31 - (12.22 x
WHR) - (3.29 x HTA) - (0.57 x HbA1c), unde WHR - waist to hip ratio, HTA - prezenţa
hipertensiunii arteriale (1=da; 0=nu). BRD a fost definitǎ ca rata filtrării glomerulare estimată -
RFGe (CKD-EPI) <60 ml/min/1.73m2 şi/sau raportul albumină/creatinină (RAC) urinarǎ ≥ 30
mg/g. Analiza statistică a datelor s-a realizat folosind programul SPSS, software 22.
Rezultate şi Discuţii: Analizând corelaţiile eGDR cu celelalte complicaţii cronice ale DZ tip 1, la
pacienţi cu durata DZ >10 ani, în funcţie de prezenţa BRD, se observă că prezintă semnificaţie
statistică: la pacienţii fără BRD - corelaţiile eGDR cu RD (p=0.019) şi cu CIC (p=0.003), iar la
pacienţii cu BRD - corelaţiile eGDR cu NDPSM (p=0.014) şi cu AOMI (p=0.004). Pacienţii ce
asociază BRD şi una dintre celelalte complicaţii cronice ale DZ tip 1 (RD, NDPSM, CIC, AOMI)
prezintă media eGDR mai mică (deci IR mai mare) decât pacienţii ce prezintă doar o complicaţie
cronică (fie doar BRD, fie doar una dintre celelalte complicaţii cronice); de menţionat că în rândul
pacienţilor fără BRD nu a existat niciun caz cu IM. Analizând corelaţiile quartilelor eGDR (Q1:
1.54-4.48; Q2: 4.48-6.105; Q3: 6.105-8.33; Q4: 8.33-10.92) cu celelalte complicaţii cronice ale
DZ tip 1, la pacienţi cu durata DZ >10 ani, în funcţie de prezenţa BRD, se observă că sunt
semnificative statistic: la pacienţii fără BRD - corelaţiile quartilelor eGDR cu RD (p=0.041) şi cu
CIC (p=0.003), iar la pacienţii cu BRD - corelaţiile quartilelor eGDR cu NDPSM (p=0.003) şi cu
AOMI (p=0.046). Atât la pacienţii cu BRD, cât şi fără BRD, procentul celor ce prezintă RD,
NDPSM, CIC, IM sau AOMI este mai mare corespunzător Q1 a eGDR (deci la IR mai mare),
scăzând către Q4 a eGDR.
Concluzii: IR este mai mare la pacienţii ce asociază BRD şi una dintre celelalte complicaţii cronice
ale DZ tip 1 decât la pacienţii fără BRD, ce prezintă doar una dintre celelalte complicaţii cronice.
Atât în cazul pacienţilor cu BRD, cât şi al celor fără BRD, se observă că procentul celor ce prezintă
RD, NDPSM, CIC, IM sau AOMI este mai mare corespunzător unei IR mai mari.
Dr. Bîcu Mihaela Larisa1, Dr. Bîcu Daniel1, Dr. Vladu Mihaela Ionela1, Dr. Clenciu Diana1,
Dr. Sandu Magdalena1, Prof. Dr. Moța Maria1
1.
Department of Diabetes, „Filantropia” Municipal Clinical Hospital, Craiova
Background and Aims: The aim of our study was to identify the correlations between estimated
glucose disposal rate (eGDR) - as insulin resistance (IR) marker and the other chronic
complications of type 1 diabetes mellitus (T1DM), both micro- (diabetic retinopathy - DR, diabetic
peripheral neuropathy - DPN) and macrovascular (chronic ischaemic heart disease - CIHD,
myocardial infarction - MI, peripheral arterial disease - PAD), in patients with T1DM with DM
duration > 10 years, depending on the presence of diabetic kidney disease (DKD).
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Material and Methods: We included in the study 140 unselected patients with T1DM with DM
duration > 10 years, 41.43% women and 58.57% men, to whom we analyzed anamnestic,
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anthropometric and laboratory data. eGDR (mg x kg-¹ x min-¹) was calculated by following
formula: 24.31 - (12.22 x WHR) - (3.29 x HT) - (0.57 x HbA1c), where HT - hypertension status
(1=with HT, 0=without HT). DKD was defined as estimated glomerular filtration rate - eGFR
(CKD-EPI) <60 ml/min/1.73m2 and/or urinary albumin to creatinine ratio (ACR) ≥ 30 mg/g. The
collected data were analyzed using the Statistic Package for Social Sciences (SPSS), the 22
software.
Results and Discussions: Analyzing correlations between eGDR and the other chronic
complications of T1DM, in patients with DM duration > 10 years, depending on the presence of
DKD, we observed that shows statistically significant: in patients without DKD - the correlations
between eGDR with DR (p=0.019) and between eGDR with CIHD (p=0.003), and in patients with
DKD - the correlations between eGDR with DPN (p=0.014) and between eGDR with PAD
(p=0.004). Patients associating DKD and one of the other chronic complications of T1DM (DR,
DPN, CIHD, PAD) have lower average of eGDR (so higher IR) than patients who showing only a
chronic complication (only DKD or only one of the other chronic complications); to mention that
among patients without DKD, there was no case with MI. Analyzing correlations between eGDR
quartiles (Q1: 1.54-4.48; Q2: 4.48-6.105; Q3: 6.105-8.33; Q4: 8.33-10.92) and the other chronic
complications of T1DM, in patients with DM duration > 10 years, depending on the presence of
DKD, shows statistical significance: in patients without DKD - the correlations between eGDR
with DR (p=0.041) and with CIHD (p=0.003), and in patients with DKD - the correlations between
eGDR with DPN (p=0.003) and with PAD (p=0.046). Both in patients with DKD and without
DKD, percentage of those who presented DR, DPN, CIHD, MI or PAD is increased corresponding
Q1 of eGDR (so at higher IR), decreasing by Q4 of eGDR.
Conclusions: IR is higher in patients associating DKD and one of the other chronic complications
of T1DM than in patients without DKD, showing only one of the other chronic complications.
Both in patients with DKD and without DKD, is seen as percentage of those who presented DR,
DPN, CIHD, MI or PAD is increased corresponding to a higher IR. Concluzii: IR este mai mare
la pacienţii ce asociază BRD şi una dintre celelalte complicaţii cronice ale DZ tip 1 decât la
pacienţii fără BRD, ce prezintă doar una dintre celelalte complicaţii cronice. Atât în cazul
pacienţilor cu BRD, cât şi al celor fără BRD, se observă că procentul celor ce prezintă RD,
NDPSM, CIC, IM sau AOMI este mai mare corespunzător unei IR mai mari.
Dr. Carniciu Simona1, Dr. Lixandru Daniela1, Petcu Laura1, Picu Ariana1, Dr. Roșca
Adelina1, Dr. Băcanu Elena1, Dr. Mihai Andrada1, Prof. Dr. Ionescu-Tîrgoviște Constantin1,
Dr. Guja Cristian1
1.
National Institute of Diabetes, Nutrition and Metabolic Diseases"Prof. N. C. Paulescu"
The aim of this study was to investigate the oxidative stress status, adipokines and inflamation
markers in obese type 2 diabetic patients (T2D) after one year lifestyle changes.
132 patients with newly diagnosed T2D were compared regarding clinical, biochemical, oxidative
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stress and inflammatory markers before and after one year lifesyle changes. The capacity of the
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peripheral blood mononuclear cells (PBMNC) to release pro-oxidants and to neutralize them was
determined by measuring the respiratory burst (RB) and the intracellular antioxidant enzyme
paraoxonase2 (PON2). Fructosamine, antioxidant enzymes superoxidedismutase (SOD) and
gluthathionperoxidase (GPx) were done by photometric method while for serum levels of leptin,
adiponectin, insulin, proinsulin, IL-6 and TNF-α ELISA method was used.
After one year reevaluation, GPx, adiponectin and PON2 activity were significantly lower in obese
T2D patients while SOD, IL-6, TNF-α and RB do not differ. They had also increased insulin,
proinsulin and fructosamine levels. PON2 levels were found to be inversely correlated to measures
of adiposity (BMI and WC), of glucose control (blood glucose, serum fructosamine and HbA1c)
and insulin resistance (HOMA-IR).
Up-regulation of monocyte PON2 activity may provide a compensatory protective mechanism
against oxidative stress damage in early (prehyperglycaemic) phase of type 2 diabetes.
Acknowledgement. This work was supported by a grant of the Romanian National Authority for
Scientific Research, CNCS-UEFISCDI, project number PN-II-ID-PCE-2011-3-0429.
În ultimii ani s-a conturat tot mai mult ideea unui exces de risc cardio- metabolic în cazul
pacienţilor consideraţi actual normoglicemici dar care prezintă o valoare crescută a glicemiei la 1
ora în cadrul TTGO.
Subiecţii cu toleranţă normală la glucoză şi glicemie la 1 oră în cadrul TTGO crescută reprezintă
o categorie intermediară de pacienţi care prezintă o alterare a metabolismului tradusă prin
insulinorezistenţă şi printr-o sensibilitate redusă la glucoză a celulelor β.
Acest studiu îşi propune să evalueze gradul de insulinorezistenţă şi insulinosecreţie la un lot de
subiecţi cu glicemie crescută la o oră, comparativ cu subiecţi cu normotoleranţă la glucoză şi cu
subiecţi cu alterarea toleranţei la glucoză.
Studiul s-a desfasurat în perioada ianuarie- august 2015 pe un lot de 75 de subiecţi selectaţi dintre
pacienţii care s-au prezentat la consultaţie în cadrul ambulatoriului Diab Clinique Craiova.
Populaţia ţintă a fost reprezentată de subiecţi nediagnosticaţi anterior cu diabet zaharat cărora li s-
a efectuat TTGO în vederea evaluării statusului metabolic. Conform datelor din literatură, valoarea
de cut-off a glicemiei la o oră a fost stabilită la 155mg/dl. În urma efectuării TTGO, subiecţii au
fost împarţiţi în 3 loturi: subiecţi cu toleranţă normală la glucoză şi glicemie la o oră < 155mg/dl;
subiecţi cu toleranţă normală la glucoză şi glicemie la o oră ≥ 155mg/dl; subiecţi cu alterarea
toleranţei la glucoză.
Au fost evaluaţi markerii clinici de insulinorezistenţă: IMC, CA, CA/CŞ, CA/H; markerii biologici
de insulinorezistenţă: trigliceridele plasmatice (TG), HDL- col, TG/HDL, insulinemia a jeun,
glicemie /insulinemie a jeun, HOMA-IR, indicele QUICKI, adiponectina iar funcţia β- celulară a
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Recently, the idea of an excess of metabolic and cardiovascular risk in patients currently
considered to have normal glucose tolerance but showing an elevated 1 hour blood glucose during
OGTT was emphasized.
Subjects with normal glucose tolerance and high 1 hour blood glucose during OGTT represent an
intermediate category of patients presenting an altered metabolism translated by insulin resistance
and reduced sensitivity of the β cells to glucose.
This study aims to evaluate the degree of insulin resistance and insulin secretion in a group of
subjects with high 1 hour blood glucose during OGTT, compared to subjects with normal glucose
tolerance and subjects with impaired glucose tolerance.
The study was conducted between January and August 2015 on a sample of 75 subjects selected
from patients who were admitted to the outpatient consultations at Diab Clinique Craiova.
The target population was represented by subjects that were not previously diagnosed with
diabetes, to whom the OGTT was performed to assess their metabolic status. According to the
literature, an1 hour blood glucose during OGTT cut- off was set at 155 mg / dl. After the OGTT
was performed, the subjects were divided into 3 groups: subjects with normal glucose tolerance
and 1 hour blood glucose < 155 mg / dl; subjects with normal glucose tolerance and 1 hour blood
glucose ≥ 155mg /dl; subjects with impaired glucose tolerance.
We evaluated clinical markers of insulin resistance : BMI , waist circumference , waist to hip ratio
95
, waist to height ratio and biological markers of insulin resistance: serum triglycerides (TG ) ,
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HDL- col , TG to HDL ratio , fasting insulin , fasting glucose to insulin ratio, HOMA -IR index,
QUICKI index and adiponectin. The β-cell function was assessed by HOMA % B.
The results we obtained in this study were consistent with data reported in the literature, high 1
hour blood glucose being significantly associated with insulin resistance consecrated parameters :
fasting insulin ( p = 0.0068 ), the glucose / insulin ratio <4.5 ( p = 0.04) , HOMA- IR≥ 2,5 ( p =
0.00007 ) , the QUICKI index ( p = 0.014 ) and with the HbA1c value ( p = 7,26X10-8 ). It was of
borderline significance correlated with increased plasma triglycerides value and TG / HDL ratio.
It was not correlated with clinical markers of insulin resistance: BMI, waist circumference, waist
to hip ratio, waist to height ratio or with low adiponectin as a biomarker.
Regarding insulin secretion, assessed by HOMA % B, although apparently there were high
numerical differences between the three averages, there was not a statistically significant
difference.
Given the undeniable value of these indicators in evaluating insulin resistance we have arguments
to support the idea of classifying subjects with high 1 hour glucose during OGTT in a special
category of patients with a particular metabolic profile. 1 hour glucose during OGTT becomes at
least as important as 2 hours glucose, identifying a group of patients who could benefit from early
prevention programs.
(57.66%), 30 de pacienţi au fost pierduţi din studiu, 24 au decedat (17.51%) şi 4 pacienţi au primit
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Premises and objectives: Protein energy wasting is common in patients with chronic kidney
disease and is associated with adverse clinical outcomes, especially in individuals receiving
maintenance dialysis therapy. A multitude of factors can affect the nutritional and metabolic status
of chronic kidney disease patients requiring a combination of therapeutic maneuvers to prevent or
reverse protein and energy depletion. The study aimed to monitor nutritional status development
in diabetic vs nondiabetic patients undergoing hemodialysis.
Materials and Methods: A number of 137 patients (42% female, 56.5% with DM, mean age
56±13 yrs) on chronic hemodialysis from two dialysis centers in Bucharest have been enrolled in
a descriptive longitudinal study, divided in 2 groups: one study group (77 patients with CKD-HD
and diabetes) and one control group (60 patients with CKD-HD without diabetes). Anthropometric
parameters, biological markers and handgrip strength (performed using a hydraulic hand
dynamometer) were measured. Follow up was performed at 12 and 24 months apart, using the
same parameters. At the 24 months follow-up were reevaluated 79 patients (57.66%), 30 patients
were lost at follow-up, 24 were dead (17.51%) and 4 patients had kidney transplant (2.91%).
Results and discussions: The initial evaluation showed a statistically significant (p<0.001) higher
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undergoing HD, HGS was lower; there was an inverse relationship between HGS and DM duration
and a direct relationship between HGS and inflammatory biomarkers. In patients without DM,
HGS correlates positively with CB and PCT, correlation that was not observed in DM group. The
assessments performed at 12 and 24 months showed similar evolution in both groups, with a
statistical significant decrease in muscular mass in diabetic patients. In the Kaplan–Meier survival
analysis, mortality rate was 60% in patients with decreased HGS versus 12% in patients with
normal HGS (p=0.028).
Conclusions: In patients undergoing hemodialysis, HGS is a reliable measurement of PEW and it
can be used on a large scale to evaluate nutritional status.
In our study mortality was higher in DM patients undergoing hemodialysis. PEW (represented by
decreased HGS) positively correlated with mortality.
Periodical nutritional assessment is necessary because of its permanent variations, mainly in
patients with DM, for an appropriate individualized therapy and better dialysis outcomes.
Dr. Ioacara Sorin1,2, Dr. DeVries J. Hans1,2, Dr. Kropff Jort1,2, Dr. Choudhary Pratik1,2, Dr.
Hovorka Roman1,2, Dr. Evans Mark1,2, Dr. Neupane Sankalpa1,2, Dr. Bain Steve C.1,2, Dr.
Kapitza Cristoph1,2, Dr. Forst Thomas1,2, Dr. Link Manuela1,2, Dr. Chen Oliver1,2,Dr.
DeHennis Andrew1,2, Dr. Fica Simona1,2
1.
Universitatea de medicină și farmacie “Carol Davila”
2.
Spitalul universitar de urgentă “Elias”
Dr. Ioacara Sorin1,2, Dr. DeVries J. Hans1,2, Dr. Kropff Jort1,2, Dr. Choudhary Pratik1,2, Dr.
Hovorka Roman1,2, Dr. Evans Mark1,2, Dr. Neupane Sankalpa1,2, Dr. Bain Steve C.1,2, Dr.
Kapitza Cristoph1,2, Dr. Forst Thomas1,2, Dr. Link Manuela1,2, Dr. Chen Oliver1,2,Dr.
DeHennis Andrew1,2, Dr. Fica Simona1,2
1.
“Carol Davila” University of Medicine and Pharmacy
2.
“Elias” University Emergency Hospital
Premises and Objectives: The implantable Eversense® Continuous Glucose Monitoring System
(Senseonics) consists of a fluorescence-based glucose sensor and a body-worn smart transmitter,
which communicates with a smartphone using a Bluetooth LE connection. Baseline performance
of this system in a 71 subject pivotal clinical trial analysed through 90 days of continuous showed
a 11.5% mean absolute relative difference (MARD) over 40-400mg/dL glucose range. The aim of
this study was to obtain a better glucose estimation algorithm to improve MARD results.
Content and Method: The raw data acquired during the PRECISE pivotal in addition to pilot
study sensors, 120 sensors in total, was used as the basis for developing improvements to the
glucose calculation algorithm used in the Eversense® system. The raw measurements included at
home and in clinic (five times, against venous blood) data for 90 days of continuous use.
Results and Discussions: When applying the updated glucose calculation algorithm to the
PRECISE dataset, the full range MARD through 90 days was reduced to 10.5% over 40-400mg/dL
glucose range. This improvement also reduced the lag of the system from 11.6 min to 10.5 min for
the full data set.
Conclusions and Findings: The implantable Eversense® CGM system has a similar accuracy and
precision with currently available “classic” CGM systems, while ensuring high compliance levels
due to its very long life expectancy. The newly design algorithm is now used in the PRECISE 2
pivotal study (USA).
Student Ioniță Roxana Monica1, Ing. Milian Theodor1, Dr. Ioacara Sorin1, Dr. Purcaru
Mircea1, Dr. Herescu Irina1, Prof. Fica Simona1
1.
Universitatea de medicină și farmacie “Carol Davila”
Premise şi Obiective: Noile tehnologii impun costuri ridicate, tocmai aceste costuri limitând
folosirea lor pe scară largă. Scopul studiului nostru a fost să obţinem o dovadă a conceptului că o
pompă de insulina cu acurateţe si precizie ridicată,dar şi costuri scăzute( sub 300€) poate fi creată.
Material şi Metodă: O pompă de insulina de mici dimensiuni, compactă a fost creată folosind
metode electronice inovative şi printare 3D. Toate comunicaţiile se fac prin intermediul unei
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Student Ioniță Roxana Monica1, Ing. Milian Theodor1, Dr. Ioacara Sorin1, Dr. Purcaru
Mircea1, Dr. Herescu Irina1, Prof. Fica Simona1
1.
UMF “Carol Davila”
Aim: Technology comes with a price, and is this precise cost that limits its widespread use. The
aim of our study was to obtain a proof of concept that an accurate, precise and cheap (under 300€)
insulin pump can be created.
Methods: A small and compact insulin pump was created using innovative electronics and 3D
printing technology. All communications are made through a Bluetooth LE connection with a
mobile device running a dedicated App. Cybersecurity measures ensures safety against common
threats. Accuracy and precision was tested against a 0.5U step insulin pen by air delivering of 15U
of regular insulin for 15 times with both devices and counting the number of insulin drops obtained
(see figure 1). The experiment was then repeated with new cartridges, finally obtaining 30
measurements for each device. Pump bolus programing was available in 0.15U incremental steps.
The experiment was video recorded.
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Results: There was no significant difference in number of insulin drops obtained for 15U insulin
delivery with both the pen (44.8±1.3 drops) and the pump (45.5±1.7 drops, p=0.075). Similar
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results were obtained comparing mean number of drops obtained with first cartridge (45.3±1.1
drops pen vs. 46.1±1.5 drops pump, p=0.129) or the second one (44.3±1.4 drops pen vs. 45±1.7
drops pump, p=0.249). Within cartridge variation for 15U pump insulin delivery was not
significant: 46.1±1.5 drops for first 7 commands (14 tests for 2 cartridges), and 45±1.6 drops for
next 8 commands (16 tests for 2 cartridges, p=0.058). Similar results were obtained for pen
delivery.
Conclusions: Investigational pump delivered similar number of insulin drops for a standard bolus
(15U) as compared with a standard pen (precision). Similar amount of insulin was delivered at the
beginning of the insulin cartridge compared with middle to advanced position of pump piston
(accuracy). Precision and accuracy were stable when testing was repeated with new insulin
cartridges. Building a precise, accurate and cheap insulin pump is possible, and might have
remarkable consequences on those in need.
Dr. Timar Bogdan1, Dr. Lazar Sandra1, Dr. Mailat Diana1, Prof. Dr. Timar Romulus1
"Victor Babes" University of Medicine and Pharmacy
Neuropatia diabetică (ND) este o complicație precoce și prevalentă a Diabetului Zaharat (DZ)
având un impact major asupra stării de sănătate și a calității vieții pacienților vizați. Premisa
noastră de studiu a fost că, prin intermediul disfuncționalităților asociate cu trei componente ale
ND (senzitivă - lipsa percepțiilor senzoriale din timpul mișcării; motorie - deficiențe ale
coordonării mișcărilor autonomă - prezența hipotensiunii posturale), prezența ND ar putea duce la
afectarea echilibrului.
Obiectivul principal al studiului nostru este de a evalua posibila asociere dintre prezența și
severitatea neuropatiei diabetice și afectarea probelor de echilibru respectiv a riscului de căderi în
rândul pacienților cu DZ tip 2.
În acest studiu transversal au fost înrolați 198 de pacienți diagnosticați DZ tip 2, aflați în evidența
Centrului Clinic Județean de Diabet zaharat, Nutriție și Boli Metabolice Timișoara. Datele clinice,
paraclinice și analizele de laborator folosite au fost obținute în timpul unei singure vizite. Prezența
și severitatea neuropatiei a fost evaluată cu ajutorul scorului MNSI, care permite atât
diagnosticarea cât și stabilirea severității neuropatiei. Afectarea echilibrului și estimarea riscului
de căderi au fost evaluate cu ajutorul a 4 instrumente validate și standardizate: Berg Balance Scale
(BBS), Timed-up and Go test (TUG), Single Leg Stand test (SLS) and Fall Efficacy Scale (FES-
I). Un scor ridicat al BBS și SLS, respectiv un scor scăzut al TUG și FES-I se asociază cu unui
păstrarea unui echilibru mai bun.
Prezența ND s-a asociat semnificativ cu scăderea scorului BBS (40,5 vs 43,7 puncte; p < 0,001 )
și a timpului SLS (9,3 vs 10,3 secunde; p = 0,003 ), respectiv cu creșterea TUG (8,9 vs. 7,6
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secunde; p = 0,002 ) și a scorului FES-I (38 vs. 33 de puncte; p = 0,034 ). Scorul MNSI a fost
corelat invers și semnificativ atât cu scorul BBS (r = -0.479; p < 0,001 ) cât și cu timpul SLS (r =
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Dr. Timar Bogdan1, Dr. Lazar Sandra1, Dr. Mailat Diana1, Prof. Dr. Timar Romulus1
"Victor Babes" University of Medicine and Pharmacy
Diabetic neuropathy (DN) is a prevalent complication of Diabetes Mellitus (DM) with a major
impact on the affected patient’s health. We hypothesized that mediated by the dysfunctionalities
associated with DN’s three major components: sensitive (lack of motion associated sensory),
motor (impairments in movement coordination) and autonomic (the presence of postural
hypotension), the presence of DN may impair the balance in the affected patients.
Our study main aim is to evaluate the possible association between the presence and severity of
DN and balance impairment and the risk of falls in patients with T2DM.
The presence of DN was associated with significant decreases in the BBS score (40.5 vs. 43.7
points; p<0.001) and SLS time (9.3 vs. 10.3 seconds; p=0.003) respectively increases in TUG time
(8.9 vs. 7.6 seconds; p=0.002) and FES-I score (38 vs. 33 points; p=0.034). The MNSI score was
reverse and significantly correlated with both BBS score (Spearman’s r = -0.479; p<0.001) and
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SLS time (Spearman’s r=-0.169; p=0.017) demonstrating that not only the presence of DN but also
its severity has a negative impact on balance parameters and thus, indirectly on the risk of falls. In
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the multivariate regression model, we observed that patient’s age, DN severity and depression’s
symptoms acted as independent, significant predictors for the risk of falls in patients with T2DM.
The presence of DN in patients with DM is associated with impaired balance and with a
consecutively increase in the risk of falls. Patients with DM and DN should have their balance
parameters evaluated and if impairments are to be found, in order to decrease the risk of falls, these
patients should be included in a rehabilitation program, consisting in kinesis and physical therapy,
aiming to improve their balance and walking stability.
Dr. Maurizi Anna Rita1, Dr. Naciu Anda1, Dr. Del Toro Rossella1, Dr. Lauria Pantano
Angelo1, Dr. Fioriti Elvira1, Dr. Manfrini Silvia1, Prof. Pozzilli Paolo1
1
University Campus Bio-Medico Rome
Diet, physical activity and proper dosage of insulin play a key role in the management of insulin
therapy in Type 1 Diabetes (T1D) patients on multiple daily injections (MDI). Thus, to obtain
optimal glycaemic control, adjustments of insulin dose at meal times must be made by taking into
account several parameters as blood glucose levels, the insulin/carbohydrate ratio, the
carbohydrate intake at each meal. A bolus advisor system (Accu-Chek - Aviva Connect) developed
for the establishment of the insulin dose to be administer, takes into account all above parameters.
Aim of this randomised trial was to evaluate the efficacy of a bolus advisor system on glycaemic
control as assessed by HbA1c and patients compliance to Self-Monitoring of Blood Glucose
(SMBG), through the use of a telemedicine system. 25 adults T1D patients were enrolled in the
study. HbA1c and patients compliance, assessed as average number of daily measurements and as
total measurements, were evaluated at entry into the trial and at 3 and 6 months follow-up. As
secondary end-points the number of hypoglycaemic events and the total results above target range
were evaluated. Paired test (two tailed) and analysis of variance were used to evaluate differences
in HbA1c at different time points. HbA1c at entry was 7.36% ±0.93 (SD) in patients using this
bolus advisor system with bolus calculator and data transmission by App on a Smartphone
activated and 7.6% ± 0.62 (SD) in the control group with bolus advisor turned off and on standard
education for insulin management (p:NS). After the follow-up there was a tendency for an
improvement in HbA1c levels in the bolus advisor system treated group vs. control group (7.27%
±0.76 % ± vs. 7.86% ± 1.5%, respectively, p:NS). Accordingly, a major compliance to SMBG in
bolus advisor system treated group compared to control subject it was found.
In conclusion, this bolus advisor system is a friendly wirelessly meter that helps to improve
glycaemic control, with the achievement of glycemic targets and the improvement of patients
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compliance to SMBG.
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OP15. CORELAŢII ÎNTRE ADIPONECTINĂ, LEPTINĂ ŞI CTRP 3 ŞI
COMPONENTELE SINDROMULUI METABOLIC
Asist. Univ. Mihai Doina Andrada1,2, Petcu Laura1,2, Manuela Mitu1,2, Picu Ariana1,2, Sef
Lucr. Lixandru Daniela1,2, Prof. Dr. Ionescu Tirgoviste Constantin1,2, Conf. Dr. Guja
Cristian1,2
1.
U.M.F. "C. Davila" Bucuresti
2.
INDNBM "N. Paulescu" Bucuresti
Assoc Lect. Mihai Doina Andrada1,2, Petcu Laura1,2, Manuela Mitu1,2, Picu Ariana1,2, Lect.
Lixandru Daniela1,2, Prof. Ionescu Tirgoviste Constantin1,2, Assoc. Prof. Guja Cristian1,2
1.
U.M.F. "C. Davila" Bucuresti
2.
INDNBM "N. Paulescu" Bucuresti
Background and aims: Abnormal secretion of adipokines causes a biochemical and metabolic
imbalance resulting in multiple pathological processes. The aim of the study is to evaluate the
associations between adipocyte function (levels of adiponectin, leptin and CTRP 3) and
components of the metabolic syndrome (MS).
Material and method: the present study included 219 subjects (53.9% men, 46.1% women, p
NS). 166 (94 men and 72 women, p NS) were newly diagnosed with type 2 diabetes mellitus
(T2DM) and 53 (24 men and 29 women, p NS) were with impaired fastig glucose or impaired
glucose tolerance. Clinical and anthropometrical parameters were measured for all patients, as well
as fasting plasma glucose, HbA1c, total-cholesterol, HDLc, triglycerides, aminotransferases (by
standard techniques) and also serum insulin, proinsulin, leptin, adiponectin and CTRP 3 levels
levels (by ELISA method).
Results and discussions: MS was diagnosed in 82.5% of T2DM patients and in 60.4% of those
with prediabetes (p<0.05). T2DM subjects presented higer values for: TG (153.38 (107.87-219.50)
mg/dL vs. 113.04 (88.79-141.89) mg/dL; p<0.001), insulinemia (11.57 (8.31-17.74) µIU/mL vs.
19.38 (7.34-14.61) µIU/mL; p<0.05), HOMA IR (5.21 (3.27-7.99) vs. 2.47 (2.01-4.19); p<0.001),
TG/HDL-c ratio 3.65 (2.42-5.61) vs. 2.29 (1.68-2.60); p<0.05), CTRP3 (162.98 (114.21-231.70)
ng/mL vs. 135.78 (99.97-183.48) ng/mL; p<0.05) an lower for: HDL-c (43.73 ± 10.82 mg/dL vs.
349.58 ± 14.85 mg/dL; p<0.001) and adiponectin (4.93 (2.72-10.34) µg/mL vs. 8.72 (4.73-14.79)
µg/mL; p<0,05). Subjects with prediabetes and presented significanly higher values for leptin
(16.71 (7.68-28.46) ng/mL vs. 6.53 (3.26-21.85) ng/mL; p<0.05) and CTRP3 (152.61 (122.54-
188.82) ng/mL vs. 98.00 (60.10-136.66) ng/mL; p<0.05) and lower for adiponectin (6.45 (3.51-
13.45) µg/mL vs. 12.52 (5.98-21.26) µg/mL; p<0.05). Those with T2DM presented significant
differences for leptin (hygher values in MS subjects – 14.06 (6.01-25.87 ng/mL vs. 4.08 (1.82-
6.77) ng/mL; p<0.001) and adiponectin (lower values in MS subjects – 4.31 (2.62-10.27) µg/mL
vs. 7.41 (4.56-11.55) µg/mL; p<0.05). Leptin levels raised with the number of MS fullfiled criteria
in both studied groups (p<0.05), while CTRP3 plasmatic levels raised with the number of MS
fullfiled criteria olny in prediabetic subjects (p<0.05). Leptin positively correlated with
insulinemia (p<0.01), HOMAB (p<0.01) and HOMA IR (p<0.05). Adiponectin negatively
correlated wiht visceral adipose tissure (p<0.01), TG/HDL-c ratio (p<0.01) and positively with
HDL-c (p<0.01). CTRP3 was associated with overweight p<0.001).
Conclusions: Adipokines concentration varied with the presence of DM and SM. Patients newly
discovered with T2DM had higher levels of CTRP3 and lower levels of adiponectin compared to
those with prediabetes. Subjects with MS had higher levels of leptin, CTRP3 (only those with
prediabetes)and lower of adiponectin.
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OP16. PREVALENȚA INFECȚIEI CU HELICOBACTER PYLORI LA PACIENȚII
BARIATRICI: CONCORDANȚA A DOUĂ METODE DE DIAGNOSTIC
Șef Lucr. Dr. Mihalache Laura1, Conf. Univ. Dr. Danciu Mihai1, Asist. Univ. Dr.
Constantinescu Daniela1, Asist. Univ. Dr. Gherasim Andreea1, Asist. Univ. Dr. Niță Otilia1,
Conf. Univ. Dr. Pădureanu Sergiu Serghei1, Șef Lucr. Dr. Arhire Lidia Iuliana1
1.
Departamentul Medicale, Universitatea de Medicină și Farmacie ”Grigore T. Popa” Iași
Helicobacter pylori (Hp) este o bacterie spiralată incriminată în apariția leziunilor inflamatorii
gastrice la peste jumătate din populația globului. Infecția cu Hp crește riscul de apariție a
afecțiunilor gastrice, unele cu risc vital, dar poate avea și consecințe cardiometabolice și asupra
statusului ponderal. Obezitatea cunoaște la rândul ei evoluție epidemică, singura metodă eficientă
în scăderea ponderală și menținerea noii greutăți pe termen lung fiind chirurgia bariatrică. Nu
există la ora actuală un consens cu privire la algoritmul de evaluare pre-chirurgie bariatrică.
Scopul studiului a fost de a evalua prevalența infecției cu Hp la pacienți propuși pentru chirurgie
bariatrică și concordanța între două metode de diagnostic a infecției.
Este un studiu prospectiv, ce a inclus 70 de pacienți asimptomatici evaluați preoperator serologic
(Ac IgG antiHp) și histologic (EDS cu biopsie de mucoasă gastrică) la care s-a practicat
gastrectomie longitudinală laparoscopică iar piesa de rezecție gastrică a fost examinată histologic.
Rezultatele au arătat că 58.6% dintre pacienți erau Hp pozitivi la serologie și 51.4% erau Hp
pozitivi la histologie. Dintre cei cu Hp pozitivi la serologie, 82.4% erau pozitivi și la examenul
histologic, în timp ce între cei cu Hp negativi la serologie, 12.5% erau Hp pozitivi la histologie.
Factorul de concordanță k între cele două metode de diagnostic a fost de 0.686 (p<0.001),
diagnosticul serologic al infecției cu Hp având o sensibilitate de 90.3% și o specificitate de 77.8%.
Prevalența infecției cu Hp în piesa de rezecție gastrică a fost de 11.4% iar prezența Hp s-a asociat
cu grade de severitate mai mari ale gastritei. Prezența infecției cu Hp nu s-a asociat cu complicații
precoce postoperatorii.
In concluzie, în rândul obezilor propuși pentru chirurgie bariatrică în centrul nostru prevalența
infecției cu Hp este mare, necesitând deci evaluare completă preoperatorie.
Lect. Dr. Mihalache Laura1, Assoc. Prof. Dr. Danciu Mihai1, Assist. Dr. Constantinescu
Daniela1, Assist. Dr. Gherasim Andreea1, Assist. Niță Otilia1, Assoc. Prof. Dr. Pădureanu
Sergiu Serghei1, Lect. Dr. Arhire Lidia Iuliana1
1.
Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy,
Iassy, Romania
Helicobacter pylori (H. pylori) is a spiralled bacterium and is the etiological factor for gastritis in
106
more than half of the worldwide population. H. pylori infection increases the risk for gastric
pathology, but could also have consequences on cardio-metabolic status. Obesity has as epidemic
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growth, and the only efficient long-term treatment for morbidly obese patients is currently surgery.
Although of vital importance, the preoperative assessment is not standardized, including the
aspects related to H. pylori infection.
The aim of this prospective study was to evaluate the prevalence of H. pylori infection in a group
of patients referred to bariatric surgery and the agreement of two commonly used methods for its
diagnosis.
We included 70 asymptomatic obese patients consecutively for 14 months, who were evaluated
by serology (anti-Hp IgG antibodies) and by histology (gastroscopy with gastric mucosa biopsy).
If diagnosed, H. pylori infection was standard treated and afterwards, all patients underwent
laparoscopic sleeve gastrectomy; the resected stomach was evaluated by histology.
A 58.6 percent of patients were H. pylori positive by serology and 51.4% were H. pylori positive
by histology, agreement coefficient factor kappa between the two methods being 0.686, p<0.001.
The serological diagnosis had a sensibility of 90.3% and a specificity of 77.8%. The prevalence of
H.pylori infection in the resected stomach was 11.4%, and was associated with more severe
degrees of chronic gastritis. The presence of Hp infection was not associated with early
postoperative complications.
In conclusion, among obese proposed for bariatric surgery in our center Hp infection prevalence
is high, thus requiring complete preoperative evaluation.
Premise si obiective: Sistemul medical reprezintă structura fizică și logistică prin care medicul și
echipa medicală își îndeplinesc funcția (tratează bolile), iar medicul este persoana specializată
pentru diagnosticarea și tratarea bolilor umane. Pentru ca relația între medic și sistemul medical sa
fie constructivă, trebuie identificați, analizați și optimizați factorii care influențează colaborarea.
Material și metodă: Prezentarea analizează empiric, din punctul de vedere al medicului
practician, sistemul medical, resursele disponibile, adresabilitatea persoanelor cu diabet la
serviciile medicale, precum si calitatea acestor servicii, pentru a evalua eficiența medicală.
Rezultate și discuții: Cu cât aplicăm mai corect, echilibrat, integrat factorii implicați în
desfășurarea serviciilor medicale: numărul de pacienți, resursele disponibile, calitatea serviciilor
medicale, cu atât eficiența acestor servicii este mai crescută (eficiența medicală).
Concluzii: Dacă identificăm corect variabilele care operează în relația medic-sistem medical,
putem crește eficiența actului medical, cu creșterea beneficiilor pentru medic, sistem medical și,
nu în ultimul rând, pentru persoanele cu diabet, care sunt, de fapt motivul și obiectivul
operațiunilor medicale.
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PHYSICIAN – HEALTCARE SYSTEM RELATIONSHIP: QUALITY VS. QUANTITY
Premises and objectives: The medical system is the physical and logistical structure through
which the medical doctors perform their functions (trearing diseases). The medical doctor is a
person specialized in diagnosing and treating human diseases. In order to make this relationship
constructive, we must identify, analyze and optimize the factors that affect this collaboration.
Material and method: The presentation is an empiric examination of the medical practitioner, the
medical system, available resources, diabetes patients’ access to medical services as well as the
quality of those services, in order to evaluate the medical efficiency.
Results and discussions: The correct, balanced and integrated implementation of the factors
involved in the development of health services, the number of patients, available resources and
quality of the services will lead to an increase in the effectiveness of the medical services.
Conclusions: If we manage to correctly identify the variables that affect the medical practitioner
and medical system relationship, we can increase the efficiency of the medical services while
having more benefits for the doctors, the medical system and last but not least, the patients
diagnosed with diabetes.
Şef Lucr. Mircea Munteanu1, Şef Lucr. Bogdan Timar1, Prof. Romulus Timar1, Lavinia
Munteanu1, Adrian Enache1, Şef Lucr. Adrian Sturza1, Prof. Adalbert Schiller1
1
Departamentul de Diabet şi Boli Metabolice – Universitatea de Medicină şi Farmacie, Timişoara,
Spitalul Judeţean de Urgenţă, Timisoara
In studiu au fost inclusi 594 de pacienți cu BCR, internați în clinica de Nefrologie (351 femei, 243
barbați, varstă medie 62.2 ani). DZ (tip 1 și 2) a fost prezent la 56.7% din cazuri iar HTA la 86.8%
din cazuri. În timpul spitalizarii, TA a fost măsuratâ de 2 ori pe zi, dimineața și seara, înainte de
administrarea medicației antihipertensive. Pe parcursul spitalizării (aprox. 8 zile) s-au efectuat
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Prevalența HTA este foarte mare la pacienții cu BCR predializați (mai mult de 80%) și în lotul
nostru fiind mai mare la pacienții fără DZ. Prin intervenție activă, sub supraveghere medicală, ținta
terapeutică a TA poate fi atinsă la mai mult de 74% dintre pacienți. Cu toate acestea, la pacienții
cu DZ și BCR asociat este mult mai dificil de atins ținta terapeutică; acest obiectiv poate fi atins,
dar folosind mai mult de 3 agenți hipotensori.
Lect. Mircea Munteanu1, Lect. Bogdan Timar1, Prof. Romulus Timar1, Dr. Lavinia
Munteanu1, Dr. Adrian Enache1, Lect. Adrian Sturza1, Prof. Adalbert Schiller1
1
Department of Diabetes and Metabolic Diseases, ”Victor Babeș” University of Medicine and
Pharmacy, County Emergency Hospital, Timisoara
The aim of the present study was to evaluate the therapeutical management of hypertension in
diabetes mellitus (DM) patients with chronic kidney disease (CKD), given the fact that DM and
CKD are powerful causes for cardiovascular diseases, especially in association with major
cardiovascular risk factors, such as hypertension. More, the coexistence of CKD and DM are
factors that increase the difficulty in blood pressure control.
594 predialysis CKD patients, admitted in a Nephrology Clinic have been randomly enrolled in
this study (351 female and 243 male patients, mean age 62,2 years). Patients presented DM (type
1 and 2) in 56.7% of the cases and HT in 86.8% of the cases. During hospitalization, BP was
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monitored twice a day, in the morning and in the evening, before antihypertensive drugs
administration. The average length of hospitalization in the clinic was 8 days, period in which BP
was monitored and were made several medication adjustments.
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There were no significant differences in mean age and sex distribution in the two groups. There
were also no differences between the groups (with and without DM) considering CKD severity.
The prevalence of BMI > 25 was also similar (80,1% vs 81,1%). The prevalence of HT was
significantly higher in the no DM patients (93.7% vs 80,9%, p<0.0001). After the 8 days of active
intervention BP was controlled (in target, <140/90mm Hg) in a significantly higher proportion in
non DM patients as compared with DM (86.3% vs. 74.3% p=0.0008). The average number of
hypotensive drugs including diuretics vas similar in both groups (2.47 vs 2.45). ACEI or ARB
were the most frequently used hypotensive drugs in both in both groups without difference
between DM and no DM patients
(82.3% vs 77,9%), but the use of ARBs was significantly higher in the DM group (18,3% vs 9,9%
p=0.009). The use of beta-blockers and diuretics was similar in both groups (around 66% and 57%
respectively) but the use of calcium channel blockers was significantly higher in the no DM group
(29% vs 5,1% p<0.0005). The prevalence of resistant HT as defined by the guidelines was
significantly higher in the CKD DM group (13,9% vs 7,8% p=0.031). In up to 37% of resistant
hypertension patients, BP control can be obtained with more than 3 hypotensive agents.
The prevalence of HT is very high in predialysis CKD patients (more than 80%) and in our cohort
being higher in no DM patients. By active intervention, under medical surveillance, target BP can
be obtained in more than 74% of the patients. However, in DM associated CKD is more difficult
to control BP in target values. In predialysis CKD patients with DM, BP control can be achieved,
but with more than 3 hypotensive agents.
Steriade Oana², Serafinceanu Cristian¹, Savu Octavian¹, Mihut Stela³, Elian Viviana¹
1
Institutul Naţional de Diabet, Nutriţie şi Boli Metabolice «N. Paulescu »
2
Cabinetul Medical Persepolis
3
Centrul de Hemodializă Diaverum
Variabilitatea glicemică la pacienții cu boală renală avansată are un impact major asupra calitații
vieții acestei categorii, precum și în privința outcome-ului cardiovascular. Mentinerea controlului
glicemic optim la indivizii aflati in programele de hemodializa cronica este o provocare.
Obiectiv: Analiza coeficientului de variabilitate(CV) al HbA1c la pacientii diabetici intrați în
program de substituție renala cronica pe secția de hemodializă a INDNBM “N. Paulescu” în
intervalul 2013-2015 prin raportare la perioada predialitică din intervalul 2010-2015
Material si metoda: Am realizat un studiu observațional, retrospectiv. Datele au fost obținute din
baza de date a INDNBM „N Paulescu”, secția Hemodializă. Pentru fiecare pacient s-au colectat:
valorile HbA1c disponibile din ultimii 5 ani, sexul, vârsta, tipul diabetului zaharat, data intrării în
dializa. Au fost luați în considerare doar pacienții care aveau cel puțin două determinări ale HbA1c
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în anii anteriori dializei precum și după inițierea substituției renale. S-a calculat coeficientul de
variabilitate al HbA1c (exprimat prin raportul dintre deviația standard și media aritmetică) pentru
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fiecare pacient, pentru intervalul de timp anterior inițierii dializei precum și pentru perioada
ulterioară. I-am exclus pe cei intrați în programul de substituție renala cronică în anul 2016 datorită
imposibilității calcului CV al HbA1c.
Rezultate și discuții Am adunat date despre 51 de pacienți intrați in programul de hemodializa
cronica la INDNBM N Paulescu in intervalul 2013-2015. 68% erau barbați. Lotul a fost compus
din 27% pacienți cu diabet zaharat tip 1 și 63% pacienți cu diabet zaharat tip 2. Vârsta medie a
celor cu DT1 a fost 44,64 ± 8,6 ani, iar a celor cu DT2 a fost 66,02 ± 5,98 ani. Majoritatea
subiecților au intrat în dializă în anul 2015.
CV al HbA1c a fost mai mare în perioada anterioară inițierii hemodializei, dar fără o semnificație
statistică ( 0,12 vs 0,07, p=0,89). Împărțind lotul în funcție de tipul de diabet, CV al HbA1c in cele
2 intervale de timp considerate a fost identic la pacienții cu DT1 (0,106 vs 0,105, p=0,55). In
schimb la cei cu DT2 CV al HbA1c a fost mai mic după inițierea dializei decât înaintea, fără ca
rezultatul să fie semnificativ statistic (0,13 vs 0,065, p=0,77).
Concluzii: Deși variabilitatea glicemica este mai importanta la pacienții aflați în program de
substituție renala decât la cei cu un alt nivel de boala cronica de rinichi, se pare ca nu este reflectata
și într-o variabilitate mai importantă a HbA1c. Totuși trebuie ținut cont de faptul ca, în studiul
nostru, perioada considerată fără substituție renala s-a întins pe ultimii 4 ani anteriori inițierii
hemodializei, interval în care subiecții aveau deja o boală renală avansată.
CV al HbA1c la pacienții cu diabet tip 1 a fost identic atât înainte cat și după inițierea hemodializei.
Steriade Oana², Serafinceanu Cristian¹, Savu Octavian¹, Mihut Stela³, Elian Viviana¹
1
National Institute of Diabetes Nutrition and Metabolic Disease «N. Paulescu »
2
“Persepolis” Medical Practice
3
“Diaverum” Haemodialysis Center
Glycaemic variability in advanced chronic kidney disease patients has a major impact on life
quality and influences the cardiovascular outcome. Maintaining a good glycaemic control in these
subjects is a challenge.
Objective: To analyse the variability coefficient (VC) of HbA1c in diabetic patients who started
hemodialysis in NIDNMD “N. Paulescu” between 2013-2015 by comparing it with the one
calculated in the last five years before dialysis.
Material and Methods: We did an observational, retrospective study. The data was obtained from
the NIDNMD “N. Paulescu”. For each patient we collected HbA1c levels for the last 5 years,
gender, age, the type of diabetes mellitus, the dialysis starting date. We considered only the patients
with at least two HbA1c values before and after the beginning of dialysis. We calculated the VC
of HbA1c for each patient before and after the initiation of hemodialysis. Those who entered the
dialysis program in 2016 were excluded due to the impossibility of calculating VC of Hba1c.
Results and discussions: We collected complete data for 51 patients who started hemodialysis in
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NIDNMD “N. Paulescu” between 2013-2015. 68% were men. 27% had type 1 diabetes mellitus
(DM), with a mean age of 44,64 ± 8,6 years and 63% type 2 diabetes mellitus, with a mean age of
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microalbuminuria increases with HbA1c ((r=0,257, p=0,031) and is lineary corelated. Persistent
increase in glycated haemoglobin and microalbuminuria may be considered as risk markers in
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cardiovascular and chronic kidney disease. Therefore, regular screening for microalbuminuria and
HbA1c estimation can help in clinical management to prevent complications.
Conclusion: Screening for microalbuminuria and HbA1c should be done both in newly and already
diagnosed type 1 and 2 diabetic patients albuminuria being an useful early biomarker of renal
dysfunction and glycemic control.
The subcutis dystrophy is a well-known consequence of insulin injections. What seems to be less
known about such a local insulin dystrophic reaction, is the engagement of cutis itself. The aim of
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this present study is to emphasize the role of high frequency ultrasound (20 MHz-Dermascan)
(HFU) interrogation of cutis layer, in addition to the conventional ultrasound (CU) as
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mentinut aproximativ aceeasi valoare, iar 7% au prezentat o crestere a HbA1c. HbA1c < 7% a fost
prezenta la 21% dintre pacienti, valori de 7-8% la 33% din pacienti, 44% din pacienti au avut
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valori HbA1c > 8%. Rata bazala a reprezentat 45% din totalul de insulina / 24 ore, 59% din pacienti
uitilizeaza doar bolusul standard, 39% nu utilizeaza rata bazala temporara.
Concluzii: Pentru ca tratamentul cu pompa de insulina sa-si dovedeasca eficienta pe termen
indelungat, evaluarea periodica a acestora de catre o echipa medicala antrenata este absolut
necesara.
Background and aims: Insulin pump therapy represents a real technologic progress in the
treatment of Type 1 Diabetes. The continuous subcutaneous insulin infusion, multiple options for
different basal rate patterns, types of boluses and temporary basal rate, can improve the metabolic
control and increase the quality of life. A qualified medical team and a motivated and well trained
patient are required for a successful treatment. As a regional coordinator for the insulin pump
national program, we aimed to evaluate the insulin pump treatment in terms of glycemic control,
insulin requirements, patient satisfaction, glucose self-monitoring and use of the technological
advantages provided by the pump.
Materials and methods: From 2002 to 2015, 99 patients with Type 1 diabetes have been switched
to insulin pump therapy, 87 patients have been included in the present analysis. Clinical and
biochemical assessment has been performed and both insulin pumps and glucometers have been
analyzed using ACCU-CHEK Smart Pix software. ICH-GCP rules have been applied. All the
patients gave their consent.
Results: The demographic characteristics of the patients are: 64% female gender, 64% age > 18
years, 75% living in urban areas. The initial HbA1c mean value was 9.2% (±1.4) and the last
HbA1c mean value was 8.2% (±1.4). Most of the patients (78%) have decreased their HbA1c
value, 15% maintained their initial value and 7% had an increased value. HbA1c < 7% was present
in 21% of the patients, between 7-8% in 33% of the patients, and 44% of the patients had the
HbA1c > 8%. Basal rate represents 45% from the total daily insulin, 59% of the patients use only
standard bolus, 39% of the patients do not use temporary basal rate.
Conclusions: For a successful and long-term glycemic control, periodic evaluation of the patients
using insulin pumps is required.
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OP23. IMPACTUL INSULINOTERAPIEI CU ANALOGI BAZALI ASUPRA
VARIABILITĂȚII GLICEMICE LA SUBIECȚI CU DIABET ZAHARAT TIP 2 ȘI
BOALĂ RENALĂ TERMINALĂ
MD PhD Octavian Savu1, MD PhD Viviana Elian1, MD Oana Steriade1, MD PhD Ileana
Teodoru1, MD Stela Mihuț, MD Cătălin Tacu, MD PhD Adrian Covic, MD PhD Cristian
Serafinceanu1
1
Institutul Naţional de Diabet, Nutriţie şi Boli Metabolice «N. Paulescu »
MD PhD Octavian Savu1, MD PhD Viviana Elian1, MD Oana Steriade1, MD PhD Ileana
Teodoru1, MD Stela Mihuț, MD Cătălin Tacu, MD PhD Adrian Covic, MD PhD Cristian
Serafinceanu1
1
“N.C. Paulescu” Institute of Diabetes, Nutrition and Metabolic Diseases
Very few data are available about the potential impact of insulin regimen on glucose variability
(GV) in patients with type 2 diabetes (DM) on hemodialysis (HD) for end stage renal disease
(ESRD). We aimed to analyze the impact of basal insulin analogues on GV in patients with type
2 DM ongoing substitution therapy for ESRD.
Subjects with type 2 DM under maintainance HD and various insulin regimens for at least 6
117
months (detemir, n=7; glargine, n=7) were prospectively analyzed. Continuous glucose monitoring
system (CGMS Gold, Dex Com 7+) was applied for 5 days, over 3 consecutive sessions of HD.
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Various glycemic profiles (CV) were compared between the day on (HD-on) and the day off (HD-
off) dialysis. The CV of HbA1c (HPLC) was used to assay the long term GV. Insulin resistance
was assessed by HOMA-IR using fasting glucose and C-peptide levels. Lipid profile (fasting HDL
cholesterol), cantitative C-reactive protein (cCRP) and ferritin (adjusted for Hb values) was
measured in serum at inclusion.
Insulin detemir reduced glucose variability (CV CGMS and CV of HbA1c), and cCRP and ferritin
values in insulin resistant subjects with type 2 DM on HD. All participants included were insulin
resistant (HOMA-IR >3).
Insulin detemir reduces glucose variability and attenuates pro-inflammatory profile in insulin
resistant patients with type 2 diabetes on hemodialysis for end stage renal disease.
Dr. Sturza Adrian1, Dr, Duicu Oana1, Dr. Văduva Adrian1, Dr. Munteanu Mircea1,Prof. Dr.
Timar Romulus1, Prof. Dr. Muntean Danina1
1
Disciplina de Fiziopatologie, Centrul de Cercetare Translationala si Medicina Sistemelor,
Universitatea de Medicina si Farmacie ”Victor Babes” Timisoara
Vitamina D este recunoscută la ora actuală ca fiind un agent protector la nivel cardiovascular, fără
ca mecanismele de acțiune să fie pe deplin elucidate.
Scopul prezentului studiu a constat în evaluarea efectelor 1,25-dihidroxicolecalciferolului (DHC)
asupra reactivității vasculare și respectiv, a expresiei monoaminoxidazei (MAO) și a receptorului
pentru produșii de glicare avansată (RAGE), la nivelul segmentelor vasculare izolate de la șobolani
cu diabet zaharat indus experimental.
The present study assessed the effects of 1,25-dihydroxi-cholecalciferol (DHC), the major
metabolite of vitamin D, on vascular reactivity and expression of MAO and RAGE (Receptors-
for-Advanced-Glycation-Endproducts) in vascular segments harvested from diabetic rats.
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PREZENTĂRI POSTER /POSTER PRESENTATIONS
Rezident Andoni Adela1, Rezident Prefac Alina1, Rezident Parocescu Daniel1, Dr. Stegaru
Daniela1, Rezident Velican Oana1, Dr. Rusu Emilia1, Dr. Radulian Gabriela1
1
Institutul Național de Diabet, Nutriție și Boli Metabolice “Nicolae Paulescu”, București
Prevalența diabetului zaharat în anul 2013 este de 382 de milioane de cazuri, dintre care 85 - 95%
sunt reprezentate de diabetul tip 2 (DZ2) și se estimează că până în anul 2035 aproximativ 592
milioane de oameni vor suferi de această maladie. Boala cardiovasculară se întâlnește cu o
frecvență de 2-4 ori mai mare. Studiul prezent îsi propune evaluarea legăturii dintre controlul
metabolic si prezența afectării macrovasculare.
Studiu observațional, retrospectiv, ce a cuprins un număr de 229 pacienti cu diabet zaharat tip 2
(62% bărbați, 38% femei) cu vârsta medie de 61.52 ± 10.5 ani și durata medie a diabetului zaharat
11.6 (10.56 - 12.6) ani, internați în I.N.D.N.B.M. “N.Paulescu”, București. La aceștia s-au
determinat parametri clinici și de laborator și au fost notate bolile asociate de care suferă.
Din cei 229 de pacienți, 77.3% au avut hipertensiune arterială (HTA) 76.8% din bărbați si 78.2%
din femei, aproximativ jumatate 48.5% au avut boală cardiacă ischemică (BCI) reprezentând 47.9
% din bărbați si 49.4 % din femei, 6.1% au avut insuficiență cardiacă (IC) clasele I-II NYHA,
2.2% au avut insuficiență cardiacă (IC) clasele III-IV NYHA. Boala arterială periferică (BAP) s-a
întâlnit la 23.1% pacienți iar accidentul vascular cerebral (AVC) la 7.4% pacienți. HbA1c peste
7% a fost întâlnită la 82.5% din pacienți (n=189). Media HbA1c a fost semnificativ mai mare
(p=0,021) la pacienții cu BCI (9.32 +- 2.26%) versus cei fără BCI (8.66 +- 1.99%). Nu s-au
înregistrat diferențe semnificative statistic pentru cei cu HTA, IC, BAP sau AVC.
Prevalența bolilor cardiovasculare a fost crescută în lotul studiat. HbA1C a fost mai mare la
pacienții cu BCI. Dezechilibrul metabolic exprimat prin HbA1C a fost prezent într-o proportie
foarte mare la acești pacienți. Pe de altă parte, subiecții cu numeroase comorbidități ating HbA1c
țintă într-o proporție mai mică.
Andoni Adela1,Prefac Alina1, Parocescu Daniel1, Stegaru Daniela1, Velican Oana1, Dr.
Rusu Emilia1, Dr. Radulian Gabriela1
1
National Institute of Diabetes Nutrition and Metabolic Disease «N. Paulescu »
The prevalence of diabetes in the year 2013 is 382 million cases, of which 85 - 95% are represented
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by diabetes type 2 (T2DM), and it is estimated that by the year 2035 approximately 592 million
people will suffer from this disease. Cardiovascular disease is 2 to 4 times more frequent among
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them. The present study evaluates the correlations between metabolic control and the presence of
macrovascular disease.
Material and method: it is a retrospective observational study which included a number of 229
patients with T2DM (62 % men, 38 % female), with mean age of 61.52 ± 10.5 years and average
duration of diabetes of 11.6 (10.56 - 12.6) years, hospitalized in NIDMD"N. Paulescu", Bucharest.
For them, clinical and laboratory parameters were noted and their associated conditions.
Of the 229 patients, 77.3% had hypertension (HBP) 76.8% men and 78.2% female, approximately
half of them 48.5% had coronary heart disease (CHD) 47.9 % men and 49.4 % female, 6.1% I-II
NYHA heart failure (HF), 2.2% III-IV NYHA heart failure (HF). Peripheral artery disease (PAD)
was encountered in 23.1% patients and stroke in 7.4% patients. Higher HbA1c than 7% was
encountered in 82,5% patients (n=189). Average HBA1c was significantly higher (p= 0.021) in
patients with CHD (9.32 +- 2.26%) versus those without CHD (8.66 +- 1.99%). There has been
no statistically significant difference for those with HBP, HF, PAD or Stroke.
The prevalence of CVD was increased in the studied plot. HbA1c was higher in the patients with
CHD. The poor metabolic control was expressed in HbA1c was positive in big proportion in this
patients. On the other hand, fewer subjects with numerous comorbities attain the HbA1c target.
Rezident Bejinariu Cătălina1, Dr. Rusu Emilia1, Rezident Ungureau Carmen1, Dr. Mureșan
Alexandra1, Dr. Stegaru Daniela1, Rezident Andoni Adela1, Rezident Petre Diana1, Rezident
Ciobanu Delia1, Rezident Prefac Alina1, Rezident Sordea Lidia1, Rezident Dobre Alin1,
Rezident Chirilă Vlad1, Prof. Dr. Radulian Gabriela1
1
Institutul Național de Diabet, Nutriție și Boli Metabolice “Nicolae Paulescu”, București
Sindromul Metabolic (SM) și boala renală cronică (BRC) au incidență crescută și duc la
morbiditate și mortalitate cardio-vasculară crescută. Relația dintre ele este complexă, dar
mecanismul acestei asocieri nu a fost încă elucidat. Componentele individuale ale SM sunt
cunoscute drept factori de risc pentru boala renală dar nu este clar cum înmănuncherea acestor
componente duce la dezvoltarea și progresia bolii renale.
Scopul studiului a fost determinarea frecvenței sindromului metabolic (SM) la pacienții cu boală
renală cronică (BRC) și diabet zaharat tip 2, stabilind cât de frecvent se întâlnește fiecare
componentă a SM la acești pacienti.
A fost realizat un studiu cross- sectional ce a inclus 229 de pacienți (87 femei și 142 bărbați) cu
diabet zaharat și BRC, desfășurat în perioada septembrie 2015- februarie 2016. Toți pacienții au
fost examinați clinic și au fost măsurate tensiunea arterială (TA), greutatea (G), înălțimea (H) și
circumferința abdominală (CA). Au fost efectuate, de asemenea, următoarele analize: glicemie,
trigliceride (TG), lipoproteine cu densitate moleculara mare (HDL-C), uree, creatinină, raport
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albumină/creatinină (RAC).
Din totalul de 229 de pacienți cu boală renală cronică 80.7% (n=) au prezentat sindrom metabolic
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(p=). Pacienții cu SM și BCR au prezentat vârstei mai avansată, vechimea diabetului mai mare,
valori tensionale mai ridicate, valorile crescute ale creatininei, ureei, acidului uric, RAC ( toate
p<0,05). Analiza componentelor sindromului metabolic în corelație cu boala renală cronică a
evidențiat că 47.6% (n=) dintre pacienții cu BRC au asociat obezitate, 82.6% (n=) aveau HTA,
47.7% (n=) au avut HDL-C scăzut și 45% (n=) valori crescute ale TG.
Sindromul metabolic este comun printre pacienții cu BRC și diabet zaharat tip 2. Frecvența BRC
a crescut proporțional cu numărul componentelor SM.
Bejinariu Cătălina1, Dr. Rusu Emilia1, Ungureau Carmen1, Dr. Mureșan Alexandra1, Dr.
Stegaru Daniela1, Andoni Adela1, Petre Diana1, Ciobanu Delia1, Prefac Alina1, Rezident
Sordea Lidia1, Dobre Alin1, Chirilă Vlad1, Prof. Radulian Gabriela1
1
National Institute of Diabetes Nutrition and Metabolic Disease «N. Paulescu »
Metabolic syndrome (MS) and chronic kidney disease (CKD) have increased incidence and lead
to cardiovascular morbidity and mortality. Their relationship is complex, but the mechanism of
this association has not yet been fully elucidated. The individual components of MS are known as
risk factors for kidney disease but it is not clear how bundling these components leads to the
development and progression of kidney disease.
The aim of the study was to determine the frequency of metabolic syndrome (MS) in patients with
chronic kidney disease (CKD) secondary to diabetes by observing how frequently each component
of MS meets in patients with CKD.
A cross-sectional study was conducted including 229 patients (87 women and 142 men) with
diabetes and CKD, held during September 2015- February 2016. All patients were assessed
clinically and were measured blood pressure (BP), the weight (G), the height (H) and waist
circumference (CA). Following analyzes was analyzed: glucose, TG, HDL, urea, creatinine, RAC.
Of the 229 patients with chronic kidney disease, 80.7% had metabolic syndrome but there was no
statistical correlation value between them (p> 0.005). Age, length of diabetes, urea and uric acid
values were positively correlated with chronic renal disease and metabolic syndrome (p <0.005).
Analysis of metabolic syndrome components correlated with chronic kidney disease showed that
47.6% of CKD patients were obese, 82.6% had hypertension, 47.7% had low HDL and 45%
elevated Tg.
Metabolic syndrome is common among patients with CKD secondary to diabetes. MS is associated
with CKD but the mechanism of this association has not been determined. It has also been observed
that the risk for CKD increased in proportion to the number of components and MS: compared
with those without MS participants two components had an increased risk, while those with three
components, have greater risk. Therefore, MS is an independent risk factor for CKD, therefore, a
program for early detection of patients with MS is important.
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PS3. FUMATUL ACCENTUEAZĂ GRADUL INSULINOREZISTENṬEI LA PACIENṬII
CU DIABET ZAHARAT TIP 1 CU BOALĂ RENALĂ DIABETICĂ
Scopul studiului a fost analiza corelaţiilor între estimated glucose disposal rate (eGDR) ca marker
al insulinorezistenţei (IR) şi prezenţa bolii renale diabetice (BRD), în funcţie de statusul de
fumător, la pacienţi cu diabet zaharat tip 1 (DZ 1) cu durata DZ >10 ani.
Am inclus în studiu 140 de pacienţi neselectionaţi cu DZ tip 1 cu durata DZ>10 ani, 41.43% femei
şi 58.57% barbati, la care am analizat date anamnestice, antropometrice şi paraclinice. Ca marker
al IR am utilizat estimated glucose disposal rate (eGDR), calculat după formula următoare: eGDR
(mg x kg‾¹ x min‾¹) = 24.31 - (12.22 x CA/CŞ) - (3.29 x HTA) - (0.57 x HbA1c), unde CA/CŞ
reprezintă raportul circumferinţa abdominală/circumferinţa şold, HTA - statusul hipertensiv (1=cu
HTA, 0=fără HTA). BRD a fost definitǎ ca rata filtrarii glomerulare estimată - RFGe (CKD-EPI)
<60 ml/min/1.73m2 şi/sau raportul albumină/creatinină (RAC) urinarǎ ≥ 30 mg/g.
Au fost consideraţi fumători pacienţii ce au fumat minim 5 ţigarete pe zi, minim 12 luni. Analiza
statistică a datelor s-a realizat folosind programul SPSS, software-ul 22.
Pacienţii cu BRD fumători au prezentat eGDR mai mic (deci IR mai mare) decât pacienţii fără
BRD fumători: 5.27±1.99 vs. 7.30±1.83, diferenţă semnificativă statistic (p=0.002). Pacienţii cu
BRD fumători au prezentat eGDR mai mic decât pacienţii cu BRD nefumători (5.27±1.99 vs.
6.72±2.34), diferenţă semnificativă statistic (p=0.004), deci putem spune că la pacienţii cu BRD
fumatul accentuează gradul IR; ca şi argument suplimentar, analizând corelaţia eGDR cu fumatul
la tot lotul de pacienţi cu DZ tip 1, s-a observat că pacienţii fumători au eGDR mai mic decât
pacienţii nefumători (5.69±2.12 vs. 7.06±2.44), p=0.001. În schimb, la pacienţii fără BRD se pare
că fumatul nu accentuează gradul de IR: pacienţii fără BRD fumători au eGDR mai mare decât
pacienţii fără BRD nefumători (7.30±1.83 vs. 7.12±2.36), însă diferenţa este nesemnificativă
statistic în acest caz (p=0.930).
Fumatul accentuează gradul IR (estimata cu ajutorul eGDR) la pacienţii cu DZ tip 1 cu durata
DZ>10 ani ce prezintă BRD.
Rezident Burde Roxana1, Rezident Groza Mădălina1, Conf. Dr. Roman Gabriela1
1
Centrul de Diabet, Nutritie si Boli Metabolice
Introducere: Tulburările de alimentație devin din ce în ce mai frecvent întâlnite în rândul femeilor
cu diabet zaharat tip 1. Astfel, ia naștere o noțiune nouă, dar încă nerecunoscută în teminologia
123
glicemic.
Se prezintă în cazul de față modalitatea de evaluare, diagnostic și tratament al unei paciente care
și-a modificat insulinioterapia în vederea obținerii scăderii ponderale.
Prezentarea cazului : Descriem cazul unei femei în vârstă de 28 de ani cunoscuta cu un istoric
de subpondere de aproximativ 10 ani, din momentul diagnosticării diabetului zaharat. Pacienta s-
a internat în Centrul de Diabet zaharat, Nutriție și Boli Metabolice din Cluj-Napoca. Anamneza a
relevat un IMC în medie de 15 kg/m2. La examinare se constată tegumente palide, deshidratate.
Tensiunea arterială avea valori de 90 60mmHg cu o frecvență cardiacă de 55 bpm. A prezentat
deasemenea o amenoree secundară, fără un regim de substituție hormonală constant.
Osteodensitometria DXA a relevat prezența osteoporozei.
Evaluările de laborator la internare au pus în evidență valori glicemice crescute , care se corecteaza
foarte rapid pe parcursul internării, cu doze reduse de insulină. Ph-ul arterial relevă acidoză
metabolică in prezența unui dezechilibru electrolitic semnificativ, cu hipercloremie și
hipernatremie. Evaluarea hormonala indică un hipogonadism hipogonadotrop, precum și un
hipotiroidism central, ambele de natura funcțională.
La examenul de urină se constată prezența infecției urinare.
Discursul pacientei s-a dovedit a fi unul rațional, fără tulburări de percepție.
Răspunsurile ei au fost clare, negând prezența tulburărilor legate de comportamentul alimentar.
Consultul psihiatric a relevat cu toate acestea prezența criteriilor pentru anorexia nervoasa conform
DSM-IV.
Abordarea terapeutica a fost una multidisciplinară incluzând un regim alimentar, insulinoterapie,
tratament antidepresiv, urmat de psihoterapie pentru reechilibrare ponderală, dar și hormonală,
avand in vedere etiologia functională/hipotalamică a acesteia.
Particularitatea cazului: Considerând diablumia o noțiune nouă, abordarea medicală și
terapeutică rămân neclare. Consecințele acestei afecțiuni pot să fie copleșitoare, dar speranța
rămâne în cercetări viitoare îndreptate în direcția unor terapii țintite și eficiente.
Introduction: Eating disorders are growing more and more frequent in girls and women with type
1 diabetes. Thus, a new, yet unrecognized medical term emerges- “diabulimia”.
This condition is characterized by weight and body image concerns that lead to the
mismanagement of diabetes. It represents some of the most complex patient problems—both
medically and psychologically.
The present case reports the assessment, diagnosis, and treatment of a young woman who
inappropriately manipulated her insulin to lose weight.
Case presentation: We describe a 28 years old female with a 10-year history of underweight
dating from her type 1 Diabetes diagnosis. She was admitted to the Clinical Center of Diabetes,
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Nutrition and Metabolic diseases in Cluj Napoca. Her case history revealed an average BMI of 15
kg/m2. On examination she was pale, emaciated and dehydrated. Her blood pressure was 90/60
Page
mmHg and heart rate of 55 bpm. In addition she was amenorrheic, with a discontinuous hormonal
replacement therapy. Osteodensitometry indicated the presence of osteoporosis.
Laboratory assessment showed hyperglycemia, metabolic acidosis with severe electrolytic
imbalance. Hormonal evaluation revealed a functional hypogonadotropic hypogonadism with
central hypothyroidism. General urine examination and culture were indicating an acute bacterial
infection.
Her speech was rational and did not reveal delusions or hallucinations. Her answers were
straightforward and insisted she desired a normal body shape. Her mood was depressed, yet she
fulfilled the diagnostic criteria for anorexia nervosa, according to DSM IV psychiatric evaluation,
though denying self-induced vomiting or purging.
Regarding the treatment, a multidisciplinary approach was established, including diet, insulin
therapy, antidepressants followed by psychotherapy not only to correct weight but moreover the
hormonal imbalance, as hormonal replacement therapy is futile since the disturbance is functional/
hypothalamic.
Case particularity: Considering diabulimia as a relative new notion, the medical approach and
treatment remains unclear. The consequences of these diseases can be overwhelming, but there is
hope with further research aimed at targeted and effective therapies.
The main objective of this cross-sectional study was to identify clinical and biological parameters
that correlate with depression and cognitive impairment in patients with type 2 diabetes (T2D).
The mental health comorbidities and sleep quality were evaluated by validated questionnaires and
several relevant biological parameters were measured in serum.
Cognitive impairment significantly correlated with age, education level, sleep quality, depression
and magnesium concentrations. Depression correlated with female gender, sleep quality and
duration, and leptin levels (p<0.05 for all). Mean leptin concentrations progressively increased in
healthy controls, patients with T2D without depression, with mild depression and with severe
depression (p:0.03). Patients with T2D had poor sleep quality, although sleep duration was not
significantly different compared with healthy controls. Mean serum leptin levels increased with
poorer sleep quality (p:0.009). These results are relevant both for clinical practice and future
research projects aimed at elucidating the mechanisms behind depression in T2D.
125
We demonstrated that in patients with T2D, poor sleep quality and depression are associated with
hyperleptinemia. These might constitute mechanisms that explain the complex relationship
Page
between the two conditions, possibly through increased adiposity. We also showed that low
magnesemia may play an important role in cognitive impairment in T2D patients.
This work was supported by an Internal Research Grant of the University of Medicine and
Pharmacy of Târgu Mureș number 1/23.12.2014).
Dr. Chioveanu Marinela1, Dr. Petre Diana Gabriela1, Dr. Sebestyen Ana-Maria Sabina1, Dr.
Ilinca Alexandra1, Dr. Mihai Andrada1, Prof. Dr. Radulian Gabriela1
1
Institutul Naţional de Diabet, Nutriţie şi Boli Metabolice «N. Paulescu »
Hipoglicemia reprezintă o problemă importantă a pacienților cu diabet zaharat tip 1 (DZ tip 1) și
a celor cu diabet zaharat tip 2 (DZ tip 2), ce primesc tratament intensiv. Hipoglicemiile severe ce
necesită spitalizare au fost asociate cu un risc crescut de apariție a demenței. În lucrarea de față ne
propunem identificarea pacienților cu risc crescut de hipoglicemii, cât și a modului în care aceștia
percep, recunosc și tratează hipoglicemiile.
Studiu observațional, cross-sectional, pe 130 pacienți cu DZ tip 1 (30,8%) și tip 2 (69,2%), cu
vârsta medie de 56,19 ± 14,67 ani, dintre care bărbați 54,6% și femei 45,4% și cu durata medie de
evoluție a bolii de 14,52 ± 9,38 ani, insulinotratați în proporție de 83,84% , cărora li s-a aplicat un
chestionar ce conține întrebări despre recunoașterea, tratamentul și prevenția hipoglicemiilor.
Dintre pacienții chestionați, 95,4% dețin un glucometru și 93,1% își automonitorizează glicemia.
Toți pacienții cu DZ tip 1 și 82,2% din pacienții cu DZ tip 2 au declarat cel puțin un episod de
hipoglicemie. Dintre pacienții cu DZ tip 1, 42,5% și-au pierdut conștiența iar 45% au fost nevoiți
să se interneze. Dintre pacienții cu DZ tip 2 care au prezentat hipoglicemie, 20% și-au pierdut
conștiența, iar 23,3% dintre ei s-au internat. Cauzele pentru hipoglicemii recunoscute de către
pacienți au fost: lipsa aportului de hidrați de carbon (HC) (51,53%), efortul fizic mare (42,30%),
întârzierea mesei (34,61%), supradozarea medicației (21,53%) și repetarea administrării
medicației (0,76%). Simptomele sugestive pentru hipoglicemie au fost următoarele: transpirații
(80%), foame (42,3%), confuzie (36,2%), palpitații (33,1%) și cefalee (25,4,%). În vederea evitării
hipoglicemiilor, 33,1% preferă glicemii mai mari, 20% scad efortul fizic, 60% cresc aportul de
HC, 3,1% scad doza de biguanid, 2,3% scad doza de sulfonilureic și 46,2% vor scădea doza de
insulină. 90% dintre pacienții cu DZ tip 1 și 40% din cei cu DZ tip 2 ajustează medicația.
Tratamentul de elecție a fost administrarea de HC (92,3%). Cei mai mulți pacienți cu DZ tip 1 își
determină HbA1c la 3 luni (32,5%), în timp ce majoritatea pacienților cu DZ tip 2 își măsoară
HbA1c la 1 an (36,7%). Prezența hipoglicemiilor s-a corelat pozitiv cu vechimea diabetului
(p=0,005), cu prezența tratamentului cu insulină (p=0,001), cu prezența retinopatiei diabetice (p=
0,019) și cu automonitorizarea (p= 0,047) și negativ cu tratamentul cu metformin (p=0,0001).
Pacienții cu DZ tip 2 ce au prezentat hipoglicemii au o durată mai lungă de evoluție a bolii
(p=0,012) și un indice de masă corporală mai mic (p=0,006) față cei cei care nu au experimentat
126
hipoglicemii.
Page
Pacienții cu DZ tip 1 au prezentat hipoglicemii mai des comparativ cu cei cu DZ tip 2. Aceștia
ajustează într-o proporție mai mare dozele de insulină și își monitorizează mai des glicemia și
HbA1c, ceea ce ar impune un program mai extins de educație adresat pacienților cu DZ tip 2.
Hypoglycemia is an important issue for patients with type 1 and type 2 diabetes mellitus receiving
intensive treatment. Severe hypoglycemia requiring hospitalization have been associated with an
increased risk of developing dementia. The study searches to identify patients at increased risk of
hypoglycemia, and to describe how they perceive, recognize and treat hypoglycemia.
It is an observational, cross-sectional study, on 130 patients with diabetes mellitus (DM) type 1
(30.8%) and type 2 (69.2%), with a mean age of 56.19 ± 14.674 yrs, 54.6% male and 45.4% female,
with a mean duration of disease 14.52 ± 9.38 yrs, 83.84 % insulin-treated, to whom we applied a
questionnaire regarding the recognition, treatment and prevention of hypoglycemia.
Among the studied subjects, 95.4% own a glucometer and 93.1% self-monitor their glycemic
levels. All patients suffering from T1DM and 82.2% of those with T2DM have had at least one
hypoglycemic episode during their lifetime. 42.5% of T1DM patient have lost consciousness at
least once and 45% had to be hospitalized because of hypoglicemias. 20% of T2DM patients have
lost consciousness and 23.3% had to be hospitalized because of hypoglicemias. The causes of
hypoglicemia were: low carbohydrate intake (51.53%), increased physical activity (42.30%),
delayed mealtime (34.61%), anti-diabetic medication overdose (21.53%) and accidentally taking
the same dose twice (0.76%). Symptoms that suggest hypoglycemia were recognized to be, in the
order of importance: sweating (80%), hunger (42.3%), confusion (36.2%), palpitations (33.1%)
and headache (25.4%). In order to avoid hypoglycemia 33.1% prefer to have higher blood suger
levels, 20% decrease their level of physical activity, 60% eat more carbohydrates (HC), 3.1%
decrease their biguanid dosage, 2.3% decrease their secretagogue dosage and 46.2% decrease the
number of insulin units. 90% of T1DM patients and 40% of T2DM patients adjust their medication.
The most frequent hypoglicemia treatment is carbohydrate ingestion (92.3% of the subjects). Most
patients with T1DM check their HbA1c every 3 months (32.5%), while most patients with T2DM
check their HbA1c once a year (36.7%). The presence of hypoglycemia was positively correlated
with the duration of the disease (p=0.005), with insulin treatment (p=0.001), with the presence of
diabetic retinopathy (p= 0.019) and with blood glucose self-monitoring (p= 0.047) and negatively
correlated with biguanid treatment (p=0.0001). Patients with T2DM and hypoglicemic episodes
have a longer disease duration (p=0.012) and a lower body mass index (p=0.006).
Patients with T1DM experimented hypoglycemia more often than those with T2DM. They adjust
more frequent insulin doses and check more often their glycemia and HbA1c, which requires
127
Rezident Chirila Vlad Horia1, Dr. Rusu Emilia1, Rezident Ungureanu Carmen1, Rezident
Bejinariu Catalina1, Dr. Muresan Alexandra1, Rezident Dobre Alin1, Dr. Stegaru Daniela1,
Prof. Dr. Radulian Gabriela1
1
Institutul Naţional de Diabet, Nutriţie şi Boli Metabolice «N. Paulescu »
Relația între eliminarea urinară de albumină și retinopatia diabetică este bine cunoscută și există
numeroase studii pe această temă la pacienții cu diabet zaharat tip 1; totuși pentru pacienții cu
diabet zaharat tip 2 există puține date.
Obiectivul acestui studiu a fost de a estima prevalența eliminării urinare crescute de
albumină(EAUC) la pacienții cu diabet zaharat tip 2 și de a determina relația acesteia cu retinopatia
diabetică.
Rezultate: În lotul studiat, prevalența EUA cu valori între 30-300 mg/L a fost de 37%, pacienții
care reprezintă grupul A2, iar prevalența EUA > 300 mg/L a fost de 15%, reprezentând grupul A3.
Pacienții cu eliminare crescută de albumină comparativ cu cei care au prezentat eliminare normală
de albumină au prezentat o prevalența mai mare a retinopatiei diabetice; 50% (n=15) din pacienții
grupului A3 au prezentat retinopatie diabetică, comparativ cu cei din grupul A2, în procent de
35,1% (n=26), respectiv cei din grupul A1, cu un procent de 21,9% (n=21) (p=0,09). Curba ROC
a arătat ca excreția urinară de albumină (AuROC=0,613, CI=95%, 0,53-0,69) poate fi un predictor
pentru retinopatia diabetică (p=0,011). Valoarea cut-off pentru EUA a fost de 24,18 mg/L. La
această valoare cut-off sensibilitatea a fost 74,2%, iar specificitatea a fost 46,4%.
Concluzii: Retinopatia diabetică a fost mai frecventă la pacienții cu diabet zaharat tip 2 și
eliminare crescută de albumină. Totuși un procent important de pacienți cu eliminare normală de
albumină (21,9 %) au asociat retinopatie diabetică.
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URINARY ALBUMIN EXCRETION AND DIABETIC RETINOPATHY IN PACIENTS
WITH TYPE 2 DIABETES MELLITUS
Resident Chirila Vlad Horia1,MD Rusu Emilia1, Resident Ungureanu Carmen1, Resident
Bejinariu Catalina1, MD Muresan Alexandra1, Resident Dobre Alin1, MD Stegaru Daniela1,
Prof. MD. Radulian Gabriela1
1
National Institute of Diabetes Nutrition and Metabolic Disease «N. Paulescu »
The relationship between urinary albumin excretion and diabetic retinopathy is well reported and
there are many studies in this area in pacients with type 1 diabetes mellitus; however for type 2
diabetes there is a paucity of data.
The objective of this study was to estimate the prevalence of elevated urinary albumin excretion
in pacients with type 2 diabetes and to determine its relationship with diabetic retinopathy.
Materials and metods: This was a transversal observational study, that included a number of 200
pacients of the INDNBM Paulescu, with type 2 diabetes. The study evaluated the anthropometric
indices (weight, height, BMI (body mass index)). The biochemical indices evaluated in the study
were the fasting blood glucose, the glycosylated hemoglobin, the lipid profile (cholesterol,
triglycerides, HDL-cholesterol, LDL-cholesterol), the renal function tests (blood urea nitrogen,
serum creatinine level), the albumin/creatinine ratio and the urinary albumin excretion (UAE). The
glomerular filtration rate was calculated using the CKD-EPI method. The pacients were divided
into 3 groups according to the UAE rate: A1 < 30 mg/L (n=96), A2 between 30 – 300 mg/L (n=74)
and A3 > 300 mg/L (n=30). The diabetic retinopathy was evaluated through a comprehensive eye
examination by an ophtalmologist at INDNBM Paulescu.
Results: In the study group, the prevalence of UAE with values between 30-300 mg/L was 37%,
representing the pacients in the A2 group, while the prevalence of UAE > 300mg/L was 15% ,
representing the A3 group. Pacients with elevated urinary albumin excretion in comparison with
those with normal urinary albumin excretion presented a higher prevalence of diabetic retinopathy;
50% (n=15) of the pacients in A3 group had diabetic retinopathy, in comparison with those in A2
group, representing 35,1% (n=26), and in A1 group respectively, representing 21,9% (n=21)
(p=0,09). ROC analysis showed that UAE (AuROC=0,613, CI=95%, 0,53-0,69) can be a predictor
for diabetic retinopathy (p=0,011). The cut-off value for UAE was 24,18 mg/L. At this cut-off
value, the sensitivity was 74,2%, while the specificity was 46,4%.
Conclusions: Diabetic retinopathy was more frequent in pacients with type 2 diabetes and elevated
urinary albumin excretion. However an important percentage of pacients with normal urinary
albumin excretion (21,9%) also asociated diabetic retinopathy.
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PS8. INFECȚIILE URINARE LA PACIENȚII CU DIABET ZAHARAT: CE
ANTIBIOTIC ALEGEM?
MD PhD Chita Teodora1, MD PhD Timar Bogdan1, MD PhD Sima Alexandra1, MD PhD
Muntean Delia1, MD PhD Licker Monica1, MD PhD Timar Romulus1
1
Universitatea de Medicina si Farmacie "Victor Babes" Timisoara, Spitalul Clinic Judeţean de
Urgenţă Timişoara
Pacienții cu diabet zaharat (DZ) sunt mai susceptibili de a dezvolta infecții comparativ cu populația
generală, infecțiile de tract urinar (ITU) fiind printre cele mai frecvent întâlnite. Prescrierea masivă
de agenți antimicrobieni pentru tratamentul ITU la acești pacienți, inclusiv a celor cu spectru larg,
poate duce la dezvoltarea unor uropatogeni rezistenți la antibiotice. Diagnosticul precoce și
intervenția promptă sunt recomandate pentru a limita morbiditatea infecțiilor simptomatice.
Scopul studiului nostru a fost de a determina sensibilitatea la antibiotice a germenilor cel mai
frecvent implicați în ITU, la un grup de pacienți din Timișoara, România.
Lotul de studiu a cuprins 2465 de pacienți cu DZ, internați în Clinica de Diabet, între 2011 și 2013.
La aceşti pacienţi s-au cules date anamnestice şi s-a efectuat urocultura. Identificarea germenilor
s-a realizat pe baza caracterelor morfologice, culturale si biochimice ale acestora. Identificarea
finală și testele de sensibilitate au fost realizate cu ajutorul analizorului Vitek 2 (Bio Merieux
France). Pentru analiza statistică s-a folosit programul SPSS v.17 (SPSS Inc. Chicago, IL).
Dintre cele 2465 probe de urină, 297 (12%) au fost pozitive. Bacteriile cel mai frecvent izolate din
urină au fost cele Gram-negative, dintre acestea Escherichia coli fiind cea mai bine reprezentată
(70% din totalul germenilor izolați). În ceea ce privește sensibilitatea la antibiotice a tulpinilor de
E. coli, acestea au fost foarte sensibile la cefalosporinele de generația a 2-a și a 3-a (96%),
carbapenemi (100%), aminoglicozide (96-99%), nitrofurantoin (99%), mai puțin sensibile la
fluoroquinolone (76%) și cotrimoxazol (62%) și rezistente la peniciline (50-70%). Următorul
germene ca frecvență a implicării în ITU a fost Klebsiella pneumoniae (12% dintre cazuri), la care
am constatat un profil de sensibilitate antimicrobiană asemănător cu al E. coli. Dintre germenii
Gram-pozitivi, cel mai frecvent izolat a fost Enterococcus faecalis (5% dintre cazuri), care a fost
sensibil la majoritatea antibioticelor testate.
ITU sunt frecvente la pacienții cu DZ. E. coli a fost cel mai frecvent izolat uropatogen. Studiul
nostru definește sensibilitatea antimicrobiană a microorganismelor implicate în ITU la pacienții
diabetici, oferind medicilor practicieni un ghid pentru începerea tratamentului antibiotic empiric
cu unul dintre antibioticele la care bacteriile implicate s-au dovedit a fi sensibile.
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URINARY TRACT INFECTIONS IN DIABETIC PATIENTS: WHAT
ANTIMICROBIAL AGENT DO WE CHOOSE?
MD PhD Chita Teodora1, MD PhD Timar Bogdan1, MD PhD Sima Alexandra1, MD PhD
Muntean Delia1, MD PhD Licker Monica1, MD PhD Timar Romulus1
1
University of Medicine and Pharmacy "Victor Babes" Timisoara,
Patients with diabetes mellitus (DM) are more prone to develop infections compared to the general
population, urinary tract infections (UTIs) being among the most commonly encountered. The
high rates of antibiotic prescription, including broad-spectrum antibiotics, for UTIs in these
patients may further induce the development of antibiotic-resistant urinary pathogens. Early
diagnosis and prompt intervention are recommended to limit morbidity of symptomatic infection.
The aim of this study was to determine the sensitivity to antibiotics of the most frequent
microorganisms involved in UTIs, in a group of patients from Timișoara, Romania.
The study group included 2,465 patients with DM, hospitalized in the Diabetes Clinic, between
2011 and 2013. We collected patients’ personal history data and performed urine culture. Germs’
identification relied on morphological, cultural and biochemical characteristics. Final
identification and antimicrobial testing were performed using the Vitek 2 (Bio Merieux France)
automatic analyzer. Data were collected and analyzed using SPSS v.17 (SPSS Inc. Chicago, IL)
statistical software suite.
From all the 2,465 urine samples, 297 (12%) were positive. The Gram-negative bacteria were the
most frequently isolated microorganisms in the urine, Escherichia coli being the best represented
among them (70% of the total number of isolated germs). E. coli was very sensitive to 2nd and 3rd
generation cephalosporins (96%), carbapenems (100%), aminoglycosides (96-99%),
nitrofurantoin (99%), less sensitive to fluroquinolones (76%) and cotrimoxazole (62%) and
resistant to penicillins (50-70%). Klebsiella pneumoniae, the second most frequently isolated germ
in UTIs (12% of the cases), showed a similar susceptibility pattern. Among the Gram-positive
bacteria, Enterococcus faecalis was isolated in 5% of the total cases, the majority of these strains
being sensitive to the tested antibiotics.
UTIs are frequent in diabetic patients. E. coli was the most frequently isolated uropathogen. Our
study clearly defines the antimicrobial sensitivity of microorganisms involved in UTIs in diabetic
patients, providing practioners a guideline for starting empiric therapy with one of the antibiotics
the involved bacteria proved to be sensitive to.
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PS9. SERUM MARKERS OF INFLAMMATION AND AMBULATORY HEART RATE
VARIABILITY IN TYPE 2 DIABETES
Assist.Prof. MD Ciobanu Dana M.1, Lecturer MD Craciun Anca E.1, Lecturer MD Bala
Cornelia G.1, Assoc.Prof. MD Veresiu Ioan A.1, Assoc.Prof., MD Roman Gabriela1
1
“Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca, Romania
The authors aimed to determine the relation between serum markers of inflammation, high-
sensitivity C-reactive protein, intercellular adhesion molecule-1 (ICAM-1) and vascular adhesion
molecule-1 (VCAM-1), and ambulatory heart rate variability assessed during 24-hours ambulatory
blood pressure monitoring in type 2 diabetes and control subjects.
Type 2 diabetes subjects had higher high-sensitivity C-reactive protein and cellular adhesion
molecules levels compared to controls. Serum inflammation markers significantly and positively
correlated with daytime, night-time and 24-hour heart rate variability.
2012-2013, folosind datele de la 2 studii efectuate pe pacienți cu diabet zaharat tip 2, după cel
puțin 3 luni de tratament cu metfomin, conform recomandarilor ADA2012.
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Au fost inclusi 40 pacienți cu DZ tip 2 tratați cu MET, cel puțin 1500 mg/zi (20 femei și 20 bărbați).
După evaluarea inițială au fos realizate 2 loturi: lotul A a primit MET si Dapa și lotul B a primit
MET si Saxa. Tratamentul a fost oprit dupa primele 3 luni ca urmare a atingerii tintei HbA1c,
conform protocolului studiului.
Rezultate şi Discuţii: Toate rezultatele au fost exprimate ca medie±deviația standard și
semnificația statistică a fost evaluată cu ajutorul testului T Student. Varsta, durata diabetului
greutatea, HbA1c au fost similare la începutul studiului pentru ambele grupuri. Toți pacienții au
primit suport adecvat constand in educație nutrițională. Ambele loturi au fost identice în repartiția
dupa criteriile urmatoare: sex, vârstă, durata de diabet, IMC, HbA1c la începutul studiului (p
<0,05).
Au fost monitorizati urmatorii parametri HbA1c, greutate la momentul inițial și după 3, respectiv
9 luni. Rezultatele sunt prezentate în tabelul următor.
Lot (20 Initial 3months 9monhs Initial 3months 9months
patiens/lot) HbA1c HbA1 HbA1c weight weight weight
A (Dapa plus 7.62±0.31 6.27±0.55 7,74±0,56 84,56±5.24 80.31±6.15 81.54±3.21
MET)
B (Saxa plus 7.59±0.23 6.31±0.49 7,82±0,38 83.47±3.58 82.97±4.12 83.15±5.74
MET)
Concluzii: În studiul nostru exista o diferența clinic semnificativa luând în considerare evoluția
greutatii intre inceputul studiului si finalul acestuia (p <0,05). Acest lucru pare a fi cunoscut, dar
date interesante sunt observate comparând lotul A vs. lotul B la 6 luni, după ce tratamentul a fost
oprit și același program de dieta a fost respectat: grupul tratat initial cu Dapa menține o scădere
semnificativă a greutății, comparativ cu grupul tratat cu Saxa (p <0,05).
Background and Aim: The weight control is a real challenge in treatment of type 2 diabetes
mellitus (T2DM) patients.
The aim of this retrospective study was to evaluate the influence of 2 new classes of medication
chosen as a step 2 therapy for T2DM patients treated with metfominum (MET): SGLT2 inhibitor
(Dapagliflozinum-DAPA) and DPP4 inhibitor (Saxagliptinum-SAXA).
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This was retrospective study during 2012-2013 years, using data from 2 studies performed on
T2DM patients uncontrolled with MET, after at least 3 month of treatment, according ADA2012
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guidelines.
Material and Method: We included 40 patients with T2DM treated with MET, at least
1500mg/day (20 women and 20 men). After initial evaluation we consider 2 lots: lot A received
DAPA plus MET, and lot B received SAXA plus MET. DAPA and SAXA therapy was stopped
after first 3 months. Target was established considering ADA2012 recommendations.
Results: All results were expressed as mean± standard deviation, and statistic significance was
evaluated using T student test. Age, duration of diabetes, weight, HbA1c were similar at the
beginning of study for both group. All patients receive adequate nutritional education therapy and
reach the target of HbA1c below 7%. All groups are identical in repartition of sex, age, duration
of diabetes, BMI, HbA1c at the beginning of study (p<0.05).
Observational parameters (HbA1c, weight) at baseline and after 3 and 9 months were included.
The results are shown in the next table.
Conclusion: In our study it seems to be a significant clinical differences considering the evolution
of weight after a short treatment period in the next step of T2DM uncontrolled with MET (p<0,05).
This could be a real known result, but a new interesting data is observed comparing lot A vs. lot
B at 6 months after the treatment was stopped and the same diet program was respected: the group
treated with DAPA maintains a significant decrease of weight (p<0.05).
Rezident Cosma Daniel Tudor1, Șef Lucr. Dr. Porojan Mihai1, Asist. Univ. Dr. Grad
Simona1, Șef Lucr. Dr. Bala Cornelia1
1
Centrul Clinic de Diabet, Nutritie si Boli metabolice Cluj
internarii in serviciul nostru (pe baza unei A1c=8,3%), se prezinta pentru: ameteli, xerostomie si
hiperglicemii la automonitorizare. Pacienta a fost diagnosticata in urma cu 2 luni anterior internarii
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cu tiroidita Hashimoto (pe baza aspectului ecografic si a titrului ridicat de anticorpi anti-TPO) si
anemie hipocroma, microcitara pentru care a urmat tratament cu fier pe cale intravenoasa.
Deasemenea, datorita nivelului scazut de vitamina B12, aceasta a urmat tratament cu B12. La
prezentare: tahicardie, tegumente uscate si cicatrice post-apendicectomie.
Rezultate si discutii: Examinarile de laborator releva: Gl=155mg/dl, glicozurie, cetonurie,
proteinurie, anemie hipocroma, microcitara forma usoara, feritina si sideremie scazuta, transferina
usor crescuta, usoara trombocitoza, iar A1c=8,5% denota dezechilibrul glicemic moderat din
ultimele 3 luni. Diagnosticul de DZ tip 1 a fost confirmat de titrul crescut de anticorpi anti-GAD65
si de pozitivarea anticorpilor anti-IA2. Screening-ul altor afectiuni autoimune a pus in evidenta
prezenta anticorpilor anti celula parietala gastrica, confirmand diagnosticul de anemie Biermer.
Endoscopia digestiva superioara nu a evidentiat modificari macroscopice de boala celiaca sau
gastrita cronica. Pentru optimizarea controlului glicemic, s-a initiat insulinoterapia in regim bazal
cu insulina glargin, cu ajustarea dozelor in functie de profilele glicemice. Datorita anemiei
feriprive persistente, s-a reluat tratamentul cu fier pe cale intravenoasa. Datorita suspiciunii
persistente de boala celiaca (chiar in absenta anticorpilor IgA si IgG anti-transglutaminaza si anti-
endomissium), s-a recomandat tipizarea HLA pentru boala celiaca. Instituirea unei diete fara
gluten a fost amanata pana la rezultatul tipizarii HLA.
Concluzii: Asocierea confirmata a 3 afectiuni autoimune a dus la stabilirea diagnosticului de PGA
tip III. Putine cazuri de boala celiaca fara prezenta anticorpilor specifici au fost raportate pana in
prezent. Din cunostiintele noastre, asocierea de tiroidita Hashimoto, DZ tip 1, anemie Biermer si
boala celiaca nu a mai fost raportata in literatura de specialitate pana in prezent.
Rezident Cosma Daniel Tudor1, Lect. Dr. Porojan Mihai1, Assist. Prof. Dr. Grad Simona1,
Lect. Dr. Bala Cornelia1
1
Diabetes, Nutrition and Metabolic diseases Clinical Center Cluj
Premises and Objectives: Polyglandular autoimmune syndromes (PAS) are rarely diagnosed
conditions characterized by the combination of two or more autoimmune endocrinopathies and
nonendocrine autoimmunopathies. Based on their clinical manifestation, PAS are divided into four
different type. In PAS III, autoimmune thyroiditis occurs with another organ-specific autoimmune
disease, but the syndrome cannot be classified as PAS I or II.
Content and Method: A 21-years old female, diagnosed with diabetes one week before
hospitalization in our service (based on an A1c=8.3%), was admitted for: dizziness, xerostomia
and high glycemic values on self monitoring. The patient was also diagnosed 2 months prior to
admission in our service with Hashimoto thyroiditis (based on ultrasound and high TPO
antibodies) and hypochromic and microcytic anemia for which she received iron intravenously.
Also, due to low vitamin B12 level she received treatment with vitamin B12. At admission:
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mild hypochromic and microcytic anemia, low ferritin, low serum iron, slightly elevated
transferring, mild thrombocytosis and A1c=8.5% suggests the moderate glycemic disequilibrium
in the last three months. Type 1 diabetes was confirmed by high titer of GAD65 and positive IA2
antibodies. The screening for other autoimmune disorders revealed positive antiparietal cell
antibodies, thus confirming pernicious anemia. No macroscopic findings of celiac disease or
atrophic gastritis were seen on upper gastrointestinal endoscopy, but microscopic views of the
duodenal and antral biopsies were consistent with celiac disease and respectively chronic gastritis.
In order to improve the glycemic control, treatment with glargine insulin was initiated and the
doses were adjusted according to the glycemic profiles. Due to the persistent iron deficiency
anemia, the treatment with iron intravenously was resumed. Given the persistent suspicion of
celiac disease (even with negative IgA and IgG anti-transglutaminase and anti-endomysium
antibodies), HLA typing for celiac disease was recommended. Following a gluten-free diet was
postponed until the HLA typing results.
Conclusions and Findings: The association of 3 confirmed autoimmune disorders led to the
diagnosis of PAS type III. Few cases of celiac disease cases with negative antibodies were reported
until present. To our knowledge, the association of type 1 diabetes, Hashimoto thyroiditis,
pernicious anemia and celiac disease was never reported in the medical literature.
Rezident Cosma Daniel Tudor1, Dr. Silaghi Cristina Alina1, Șef Lucr. Dr. Silaghi Horațiu1,
Conf. Univ. Dr. Vereșiu Andrei1
Centrul Clinic de Diabet, Nutritie si Boli metabolice Cluj
prin administrarea i.v. de clorura de potasiu. Pentru a limita absorbtia Diazepam-ului, s-a
administrat carbune activ. Evaluarea psihiatrica a relevat un episod depresiv sever si a recomandat
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Rezident Cosma Daniel Tudor1, Dr. Silaghi Cristina Alina1, Șef Lucr. Dr. Silaghi Horațiu1,
Conf. Univ. Dr. Vereșiu Andrei1
Centrul Clinic de Diabet, Nutritie si Boli metabolice Cluj
Premises and Objectives: Intentional insulin overdose in diabetic patients is a rare critical
situation. The severity is due to numerous neurological complications, electrolyte disturbances,
liver and lung damage or death. The mortality rate may increase considerably with the concomitant
intake of other substances (antidepressants, alcohol, oral antidiabetic drugs acetaminophen, β-
blockers).
Content and Method: A 52 – year old women, diagnosed with type 1 diabetes mellitus (DM)
since June 2015 and treated with glargine (52U/day) and aspart (20U/day) insulin was admitted to
the emergency room (ER) after administration of 300U aspart insulin, 52U glargine insulin, 80mg
of Diazepam and 500mg of Acetaminophen in the context of depression, without previous
psychiatric therapy. She arrived in the ER 45 minutes after overdose with a glycemic value of
77mg/dl. At admission: altered general status, BP=158/86mmHg, Glasgow Coma Scale=13 points
and 2 injection sites across her abdomen. Labs exams revealed: moderate leukocytosis,
hypokalemia, increased lactate and a positive toxicological screen for benzodiazepines and
acetaminophen.
Results and Discussions: After 20ml of 33% glucose, an infusion of 10% glucose was begun at
312ml/h. The glucose infusion rhythm and concentration was adjusted according to the glycemic
profile with a total duration of infusion of 9 hours. Hypokalemia was corrected by intravenous
(i.v.) administration of potassium chloride. In order to limit the Diazepam absorption, activated
charcoal was given. Psychiatric evaluation revealed a severe depressive episode and recommended
glycemic stabilization and hospitalization in the Psychiatric Department.
Conclusions and Findings: Insulin overdose requires intensive and prolonged glycemic
monitoring to prevent recurrent hypoglycemia due to an early cessation of i.v. therapy. The dose
is not correlated with the severity of hypoglycemia but with a prolonged hypoglycemic risk higher
than that deduced from the pharmacokinetics of insulin analogue administered. The concomitant
ingestion of substances with predominantly sedative effects (especially antidepressants) may mask
clinical symptoms and requires specific treatment.
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PS13. SINDROM POLIGLANDULAR AUTOIMUN TIP IV CU BOALA CELIACA,
DIABET ZAHARAT TIP 1 SI ARTRITA REUMATOIDA JUVENILA – O ASOCIERE
RARA
Rezident Cosma Daniel Tudor1, Dr. Silaghi Cristina Alina1, Șef Lucr. Dr. Silaghi Horațiu1,
Conf. Univ. Dr. Vereșiu Ioan Andrei1
Centrul Clinic de Diabet, Nutritie si Boli metabolice Cluj
Rezident Cosma Daniel Tudor1, Dr. Silaghi Cristina Alina1, Lect. Dr. Silaghi Horațiu1,
Assoc. Prof. Dr. Vereșiu Ioan Andrei1
Diabetes, Nutrition and Metabolic diseases Clinical Center Cluj
Content and Method: A 23-year old female, diagnosed with type 1 diabetes mellitus (DM) at the
age of 5 and treated with glargine (15U/day) and aspart (45U/day) insulin was admitted to our
center for: morning hyperglycemia, polyuria, polydipsia, nocturnal enuresis and xerostomia. The
patient was also diagnosed at the age of 12 with juvenile rheumatoid arthritis (based on clinical
findings, X-rays, inflammatory markers and positive rheumatoid factor) and celiac disease 3 years
later (with high titer of Ig A anti-transglutaminase and anti-endomysium antibodies and typical
microscopic view of the duodenal biopsy). At admission: BP=120/80mmHg, Pulse=82b/min, dry
skin and mucous membrane and a round shape tumor at the left edge of the C-section.
Results and Discussions: Labs exams revealed: moderate mixed dyslipidemia, hypocalcaemia,
mild hypochromic and microcytic anemia, low ferritin, low serum iron, glycosuria and A1c=11.9%
suggests the severe glycemic disequilibrium in the last three months. TSH, FT4 and and thyroid
antibodies (TPO, TG) were within the normal range. For the mixed dyslipidemia, we resumed the
treatment with rosuvastatin 10mg/day. Taking into account the previously diagnosis of celiac
disease, the anemia and in order to evaluate the adherence to the gluten-free diet, the Ig A and Ig
G anti-transglutaminase and anti-endomysium antibodies were repeated exhibiting high titers. The
psychological evaluation revealed a major depressive episode and recommended a psychiatric
consult. In order to improve the glycemic control, the insulin doses were adjusted according to the
glycemic values, carbs ingestion and respecting the correction factor of 1:30 and the sensibility
factor of 1:10. Oral treatment with iron and calcium was added at discharge. Therapeutic and
nutritional education was resumed emphasizing the importance of gluten-free diet and correct
estimation of the carbs intake.
Conclusions and Findings: This constellation of one endocrine disorder and 2 non-endocrine
abnormalities led to the diagnosis of PAS type IV. The evolution in these cases may be
unpredictable and requires the concomitant treatment of all the conditions involved in order to
achieve the therapeutic success.
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PS14. GENETIC SCORE FOR OBESITY AND WEIGHT CHANGES IN TYPE 2
DIABETES PATIENTS IN THE FIRST YEAR AFTER THE START OF INSULIN
THERAPY
Lect. Craciun Anca-Elena1, Lect. Bala Cornelia1, Assoc.Prof. Roman Gabriela1, Teaching
Assist. Craciun Cristian1, Teaching Assist. Ciobanu Dana1, Prof. Hancu Nicolae1
''Iuliu Hatieganu" Univeristy of Medicine and Pharmacy
Starting insulin therapy in patients with type 2 diabetes is often associated with weight gain. Our
primary objective was to evaluate the role of genetic score for general obesity, abdominal obesity,
unfavorable appetite regulation and reduced caloric expenditure in the evolution of T2DM
patients` weight in the first year of insulin therapy.
The weight gain after the start of insulin therapy is very heterogeneous. The new genome-wide
association study have discovered genes that are involved in the development of common diseases,
as obesity. The genetic score is calculated according to single nucleotide polymorphisms of
different genes previously identified and the result has three category: unfavorable predisposition,
normal predisposition (as general population) or protective genetic variant. There are available
genetic scores for general obesity, abdominal obesity, unfavorable appetite regulation and reduced
caloric expenditure and this might be a method to identify patients at high risk for weight gain
after insulin therapy is started.
Genetic score used for general population for obesity, abdominal obesity, unfavorable appetite
regulation and reduced caloric expenditure is not associated with weight changes after initiation
of insulin therapy in our study, although there are some SNPs significantly influencing weight and
deposition of fat in the first year of insulin therapy.
Asist. Univ. Dr. Dinu Robert1, Dr. Tudor Mirela1, Prof. Dr. Moța Eugen1
Universitatea de Medicina si Farmacie din Craiova
Diabetul zaharat (DZ) reprezintă o problemă majoră de sănătate publică atât în România cât şi în
lume, fiind principala cauză a bolii cronice de rinichi (BCR) şi având o prevalenţă de 11,6% în
ţara noastră. Pe de altă parte, BCR afectează peste 1.300.000 de români cu vârsta între 20-79 ani.
Afectarea vasculară cvasiprezentă la pacienţii cu DZ implică riscuri şi costuri semnificative în
asigurarea abordului vascular necesar hemodializei (HD). Comorbidităţile asociate BCR la
subiecţii cu DZ cresc semnificativ numărul, durata spitalizărilor şi costurile asociate tratamentului
acestora. Lucrarea actuală îşi propune analiza ratei spitalizarii şi a cost-eficienţei la un grup de
subiecţi internaţi cu DZ şi BCR stadiul 5 tratată prin HD.
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Studiul a cuprins 178 subiecţi cu BCR stadiul 5 trataţi prin hemodializa internaţi în Clinica
Nefrologie a Spitalului Clinic Judeţean de Urgenţă Craiova în perioada 1 ianuarie 2014 – 31
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decembrie 2014. Au fost înregistrate date privind vârsta, sexul, tipul abordului vascular, prezenţa
DZ, numărul zilelor de spitalizare, costurile legate de spitalizare.
Cei 178 pacienţi au realizat 316 internări în perioada menţionată, numărul de internări/pacient
variind de la 1 la 10. Comparând pacienţii cu DZ şi cei fără DZ se constată că primul grup a avut
o medie a vârstei uşor mai mare 63,26±8,05 vs 61,95±14,40 dar nesemnificativă statistic
(p=0,334). Efectuarea hemodializei utilizand cateterul venos central ca tip de abord vascular s-a
inregistrat la 55,22% vs. 56,80% (n.s.). Diferenţe semnificative statistic s-au înregistrat în ceea ce
priveşte costul pentru materialele sanitare utilizate (292,79 lei vs 201,07 lei, p=0,042) şi cel al
invetigaţilor, mai redus la cei cu DZ (70,13±18,74 lei) comparativ cu cei fără DZ (94,25±18,41),
p=0,034. În grupul pacienţilor cu DZ se observă diferenţe semnificative statistic la cei la care s-a
iniţiat HD, în ceea ce priveşte numărul zilelor de spitalizare (15,58±4,01 vs 6,39±6,14, p<0,001)
şi cheltuielile pentru materialele sanitare (547,66±292,78 vs 243,81±175,81, p=0,013). Nu s-au
înregistrat diferenţe semnificative analizând în funcţie de tipul abordului vascular.
DZ şi BCR diabetică generează multiple comorbidităţi şi costuri legate de spitalizare
proporţionale. Aplicarea măsurilor de prevenţie primară sau secundară ar limita costurile şi ar
creşte semnificativ durata şi calitatea vieţii la subiecţii aflaţi la risc.
Asist. Univ. Dr. Dinu Robert1, Dr. Tudor Mirela1, Prof. Dr. Moța Eugen1
Universitatea de Medicina si Farmacie din Craiova
Diabetes mellitus (DM) represents a severe public health problem and it is the main cause of
chronic kidney disease (CKD) and its prevalence in Romania is 11.6%. On the other hand, CKD
is diagnosed in 1,300.000 Romanians aged 20-79 years. The vascular disease present in almost all
subjects with DM implies significant risks and costs in providing the vascular access required for
hemodialysis (HD). CKD associated comorbidities in subjects with DM increase significantly the
number, the duration of hospitalization and treatment associated costs. This paper aims to assess
the cost and cost-effectiveness in a group of patients with DM and stage 5 CKD on HD.
The study included 178 subjects with stage 5 CKD on HD admitted in the Clinic of Nephrology
of the Emergency Clinical County Hospital Craiova during January 1st, 2014 and December 31st,
2014. Data regarding age, gender, type of vascular access, the presence of DM, duration of
hospitalization, hospitalization-related costs were recorded.
The 178 patients accomplished 316 hospitalizations in the given time, the number of
hospitalizations/patient varying from 1 to 10. Comparing subjects with DM and those without DM,
the first group had the average age slightly higher 63.26±8.05 vs 61.95±14.40 but statistically
insignificant (p=0.334). The use of a central venous catheter for vascular access in hameodialysis
was 55,22% vs. 56,80% (p=n.s.). Statistically significant differences were recorded only in costs
of sanitary materials (292,79 lei vs 201,07 lei, p=0,042) and those of investigations, lower in
141
patients with DM (70.13±18.74 lei) than in those without DM (94.25±18.41), p=0.034. In subjects
with DM there are statistically significant differences in those that began HD, regarding the
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duration of hospitalization (15.58±4.01 vs 6.39±6.14, p<0.001) and the costs for medical supplies
(547.66±292.78 vs 243.81±175.81, p=0.013). There were no significant differences regarding the
type of vascular access.
DM and diabetic CKD generate multiple comorbidities and costs related to hospitalization.
Applying primary and secondary prevention measures would limit the costs and would increase
significantly the duration and the quality of life in subjects at risk.
Conclusions: To our best knowledge, in medical literature, so far has been described only one
other case of type 2 DM associated with Sheehan Syndrome (2,3). It is not known whether there
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is a causality relation between Diabetes Mellitus and Sheehan syndrome or it's just appearing
associated. If a causality relation will be proven by further research then maybe Sheehan syndrome
can be considered as a risk factor for upcoming diabetes in women diagnosed with Sheehan
syndrome. We hope that our case will help further understanding of this association.
Dr. Drăguț Ramona Maria1, Dr. Rusu Emilia1, Dr. Nan Raluca1, Dr. Rusu Florin1, Dr.
Popescu Horațiu1, Dr. Grosu Larisa1, Dr. Grosu Irina1, Dr. Stoicescu Florina1, Dr. Rădulian
Gabriela1
1
Universitatea de Medicină şi Farmacie Carol Davila Bucureşti, România
Obiectivul acestui studiu a fost evaluarea relației dintre steatoza hepatică, insulinorezistență și
riscul cardiovascular la pacienții cu hepatită cronică cu virus C (HVC) și sindrom metabolic (SM).
Acest studiul transversal, observațional, s-a desfășurat în Institutul National de Diabet, Nutriţie şi
Boli Metabolice "N. Paulescu", a inclus un numar de 171 de pacienţi cu HVC și SM. Am urmărit
indici antropometrici (greutate, înălțime, circumferinţa taliei, IMC-ul). Parametrii biochimici
urmăriţi au fost glicemia à jeun, hemoglobina glicozilată, profil lipidic, profil hepatic și
hemoleucograma. Pentru fiecare pacient a fost calculat riscul cardiovascular folosind scorul
Framingham. Rezistenţa la insulina a fost determinată prin utilizarea HOMA-IR. SM a fost definit
conform criteriilor IDF 2005.
Din numarul total de pacienți 62% (n=106) au prezentat HCV, iar 38% (n=65) au prezentat diabet
zaharat tip 2 (DZT2) și HVC. Vârsta medie a pacienților cu DZT2 nu a fost semnificativ mai mare
decât a celor fără DZT2 (53,35±7,9 ani versus 53,01±8,5 ani). Prevalența SM la pacienții cu HVC
a fost de 50% (n=53), 37 dintre aceștia au prezentat steatoză hepatică și SM . În studiul de față
prevalența steatozei hepatice a fost de 60,8% în întreg lotul, cu o frecvență mai mare în rândul
pacienților cu DZT2+HVC (76,9%) comparativ cu pacienții cu HVC, fără DZT2, care au
înregistrat o prevalență de 50,9% (p˂0,001). Evaluând prevalența steatozei hepatice în funcție de
riscul cardiovascular, s-a observat că subiecții cu risc cardiovascular moderat și ridicat, conform
scorului Framingham, prezintă în număr mai mare steatoză hepatică (p˂0,001). În studiul de față
prevalența insulinorezistenței la pacienții cu HVC a fost ridicată, 83% (n=88) din pacienții cu HVC
fără DZT2 au prezentat HOMA-IR peste 2, iar 18,9% (n=20) au prezentat HOMA-IR peste 4. În
cazul pacienților cu DZT2+HVC prevalența insulinorezistenței a fost mai înaltă, 97,6% (n=40)
dintre aceștia au prezentat HOMA-IR peste 2, iar 68,3% (n=28) au prezentat HOMA-IR peste 4.
Factorul de risc predominant pentru apariția steatozei pare a fi insulinorezistența în asociere cu
sindromul metabolic. Rezultatele acestui studiu confirmă ipoteza că la pacienții cu HVC
insulinorezistența și steatoza hepatică reprezintă predictori independenți pentru boala
cardiovasculară și moarte de cauză cardiovasculară.
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RELATIONSHIP BETWEEN STEATOSIS AND INSULIN RESISTANCE IN PATIENTS
WITH CHRONIC HEPATITIS C AND METABOLIC SYNDROME
Dr. Drăguț Ramona Maria1, Dr. Rusu Emilia1, Dr. Nan Raluca1, Dr. Rusu Florin1, Dr.
Popescu Horațiu1, Dr. Grosu Larisa1, Dr. Grosu Irina1, Dr. Stoicescu Florina1, Dr. Rădulian
Gabriela1
University of Medicine and Farmacy “Carol Davila”
The objective of this study was to evaluate the relationship between steatosis, insulin resistance
and cardiovbnascular risk in patients with Chronic hepatitis C (HCV) and metabolic syndrome
(MetS).
This cross-sectional and observational study, held in the National Institute of Diabetes, Nutrition
and Metabolic Diseases "N. Paulescu ", included a total of 171 patients with HCV. We followed
anthropometric indices (weight, height, waist circumference, BMI). The biochemical parameters
followed were fasting plasma glucose, glycosylated hemoglobin, lipid profile, liver profile and
blood counts. For each patient the cardiovascular risk was calculated using the UKPDS software
(The United Kingdom Prospective Diabetes Study). Insulin resistance was determined by using
HOMA-IR. MetS was defined according to the IDF criteria 2005.
From the total number of patients, 62% (n=106) had HCV and 38% (n=65) had type 2 diabetes
(T2DM) and HCV. Average age of patients with diabetes was not significantly higher than those
without diabetes (53.35±7.9 years versus53.01± 8.5 years). The prevalence of MetS in patients
with HCV was 50% (n=53), 37 from this hand hepatic steatosis. In this study the prevalence of
hepatic steatosis was 60.8% in the entire group, with a higher frequency among patients with
HCV+T2DM (76.9%) compared to HCV patients without T2DM, which prevalence was 50.9%
(p˂0,001). Assessing the prevalence of hepatic steatosis in the class of cardiovascular risk was
observed that subjects with moderate and high cardiovascular risk according to the Framingham
score, present in greater numbers steatosis (p˂0,001). In this study the prevalence of insulin
resistance in patients with HCV was very high, 83% (n=88) of patients with HCV without T2DM
showed HOMA-IR than 2, and 18.9% (n=20) presented HOMA-IR than 4. In patients with
T2DM+HCV prevalence of insulin resistance was highest, 97.6% (n=40) of these patients
presented HOMA-IR than 2, and 68.3% (n=28) showed HOMA-IR more than 4.
Predominant risk factor for the development of steatosis appears to be insulin resistance associated
with the metabolic syndrome. The results of this study confirm the hypothesis that HCV patients
with insulin resistance and hepatic steatosis are independent predictors for cardiovascular disease
and cardiovascular death.
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PS18. EVALUAREA RELAȚIEI DINTRE HEPATITA CRONICĂ CU VIRUS C,
INSULINOREZISTENȚĂ ȘI RISCUL CARDIOVASCULAR
Obiectivul principal al acestui studiu a fost de a evalua relația dintre hepatita cronică cu virus C
(HVC), insulinorezistență și riscul cardiovascular la pacienții cu HVC.
Material si metodă: Acest studiul transversal, observațional, s-a desfășurat în Institutul National
de Diabet, Nutriţie şi Boli Metabolice "N. Paulescu", a inclus un numar de 171 de pacienţi cu
HVC. Am urmărit indici antropometrici (greutate, înălțime, circumferinţa taliei, IMC-ul).
Parametrii biochimici urmăriţi au fost glicemia à jeun, hemoglobina glicozilată, profil lipidic,
profil hepatic și hemoleucograma. Pentru fiecare pacient a fost calculat riscul cardiovascular
folosind scorul UKPDS. Rezistenţa la insulina a fost determinată prin utilizarea HOMA-IR,
raportul leptina/adiponectină și raportul TG/HDL-c.
Rezultate: Acest studiu a cuprins un număr de 171 pacienți ce au fost împărțiți în două grupuri:
grup A (pacienților cu hepatită cronică cu virus C) 62% (n=106) și grupul B (pacienți cu diabet
zaharat tip 2 și hepatită cronică cu virus C) 38% (n=65). Utilizând scorul UKPDS, din numărul
total de pacienți, 55.6% (n=95), 24% (n=41) și 20,5% (n=35) au prezentat risc cardiovascular
scăzut, moderat și respectiv crescut. HOMA-IR s-a corelat pozitiv cu valorile insulinemiei
(r=0,974, p˂0,001), ale circumferinței abdominale (r=0,381, p˂0,001), IMC (r=0,291, p=0,002),
trigliceride (r=0,393, p˂0,001), AST (r=0,447, p˂0,001), ALT (r=0,367, p˂0,001), GGT (r=0,286,
p=0,003). În cazul pacienților cu HVC 39,8% au prezentat valori ale raportului TG/HDL-c peste
3, iar dintre pacienții cu DZT2+HVC, doar 29,8% au prezentat valori ale raportului TG/HDL-c
peste 3 (p˂0,05). Analiza diferențiată în funcție de sex a demonstrat valori mai mari ale raportului
leptină/adiponectină pentru sexul feminin comparativ cu sexul masculin, (6,17 (4,77-7,56) vs.
(5,31 (4,37-6,26); p˂0,05).
Concluzii: Pacienții cu risc cardiovascular moderat și înalt au prezentat un grad mai crescut al
insulinorezistenței (valori mai mari pentru HOMA-IR, p˂0,001 și raportul TG/HDL-c, p˂0,001),
deasemenea s-au observat și valori mai mari ale insulinemiei și ale peptidului C, al această
categorie de pacienți.
Acest studiu a fost sprijinit de Autoritatea Națională pentru Cercetare Științifică Românească ca
parte a programului PNCDI 2 DIADIPOHEP 41-008 / 2007. PNCL2-3343 / 41
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ASSESSMENT OF RELATIONSHIP BETWEEN CHRONIC HEPATITIS C VIRUS,
INSULIN RESISTANCE AND CARDIOVASCULAR RISK
The primary objective of this study was to evaluate the relationship between chronic hepatitis C
(HCV), insulin resistance and cardiovascular risk in patients with HCV.
Material and methods: This cross-sectional and observational study, held in the National Institute
of Diabetes, Nutrition and Metabolic Diseases "N. Paulescu ", included a total of 171 patients with
HCV. We followed anthropometric indices (weight, height, waist circumference, BMI). The
biochemical parameters followed were fasting plasma glucose, glycosylated hemoglobin, lipid
profile, liver profile and blood counts. For each patient the cardiovascular risk was calculated using
the UKPDS software (The United Kingdom Prospective Diabetes Study). Insulin resistance was
determined by using HOMA-IR, leptin/adiponectin ratio and TG/HDL-c ratio.
Results: This study included a total of 171 patients who were divided into two groups: group A
(patients with HCV) 62% (n=106) and group B (patients with type 2 diabetes and HVC), 38%
(n=65). Using UKPDS score, the total number of patients, 55.6% (n=95), 24% (n=41) and 20.5%
(n=35) had low cardiovascular risk, moderate and increased respectively. HOMA-IR positively
correlated with insulinemie (r=0.974, p˂0,001), waist circumference (r = 0.381, p˂0,001), BMI
(r=0.291, p=0.002), triglycerides (r=0.393, p ˂0,001), AST (r=0.447, p˂0,001), ALT (r=0.367,
p˂0,001), GGT (r=0.286, p=0.003). In patients with HCV 39.8% had the TG/HDL-c ratio values
than 3 and between patients with HCV+T2DM, only 29.8% had values of the TG/HDL-c than 3
(p˂ 0.05). Differentiated analysis by gender showed higher values of the ratio leptin/adiponectin
for female versus male (6.17 (4.77 to 7.56) vs (5.31 (4.37 to 6, 26) p˂0,05).
Conclusions: Patients with moderate or high cardiovascular risk had a greater increased insulin
resistance (HOMA-higher values for IR, p˂0,001 and TG / HDL-c, p˂0,001) were also observed
values insulinemie high of C-peptide, of this population.
This study was supported by the Romanian National Authority for Scientific Research as a part of
the PNCDI 2 program DIADIPOHEP 41-008/2007. PNCI2-3343/41008/2007
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PS19. STUDIUL PREZENȚEI OBEZITĂŢII LA UN LOT DE PACIENȚI CU DIABET
INTERNAȚI
MD Firanescu Adela Gabriela1, Student Soare Mariana1, Student Simion Floriana Maria1,
Student Tuiu Daniela1, MD Mitrea Adina1, MD Popa Simona1, Prof. Univ. Dr. Moța Maria1
Spitalul Clinic Județean de Urgență Craiova
Material și metodă. A fost studiat un lot de 236 de pacienți din care 50% femei și 50% bărbați,
cu DZ, internați în Clinica de Diabet a Spitalului Clinic Județean de Urgență Craiova. Dintre
aceştia, 30 pacienţi (12,71%) au DZ tip 1 şi 206 pacienți (87,29%) au DZ tip 2. Vârsta medie a
pacienților cu DZ tip 1 este 39,76 ± 13,71 ani, iar a pacienţilor cu DZ tip 2 este 61,06 ± 10,58 ani.
Dintre pacienții cu DZ tip 1, 14 (46,67%) prezintă o vechime a DZ ≤ 10 ani, 9 pacienți (30%)
prezintă o vechime cuprinsă între 10 și 20 de ani, iar 7 (23,33%) au o durată de evoluție a DZ ≥ 20
ani. În ceea ce priveşte pacienții cu DZ tip 2, 121 (58,74%) au o vechime a DZ ≤ 10 ani, 68
(33,01%) au o vechime cuprinsă între 10 și 20 de ani, iar 17 (8,25%) au o durată a DZ ≥ 20 ani.
Referitor la tratamentul DZ tip 2, 2 pacienţi (0,97%) sunt echilibraţi glicemic prin dietă, 44 pacienţi
(21,36%) au tratament cu ADO, 32 pacienţi (15,53%) sunt trataţi cu insulină, 116 pacienţi
(56,31%) sunt trataţi cu ADO şi insulină şi în cazul a 7 pacienţi (3,40%) se administrează tratament
injectabil non-insulinic asociat ADO +/- insulină. Pentru studiul prezenţei obezităţii generale s-a
utilizat IMC≥30 kg/m2, iar pentru studiul prezenţei obezităţii abdominale s-au utilizat CA>80 cm
la femei şi >94 cm la bărbaţi, CA/CS>0,85 la femei şi >0,94 la bărbaţi. Datele au fost introduse în
programul Microsoft Excel și supuse analizei statistice utilizând programul SPSS.
Rezultate și discuții. Analizând obezitatea generală, 105 pacienţi (50,97%) cu DZ tip 2 prezintă
IMC≥30 kg/m2 şi 2 pacienţi cu DZ tip 1 (6,67%) prezintă IMC≥30 kg/m2 (p<0,0001);
suprapondere (IMC 25-29 kg/m2) au prezentat 59 pacienți cu DZ tip 2 (28,64%), comparativ cu
un numar de 11 pacienți cu DZ tip 1 (36,67%). În DZ tip 2 IMC mediu a fost 30,21 kg/m2, cu o
deviaţie standard de 5,99 (p<0,0001). În cazul DZ tip 1 IMC mediu a fost 24,28 kg/m2, cu o
deviaţie standard de 3,64 (p<0,0001). CA crescută este prezentă la 171 pacienţi (83,01%) cu DZ
tip 2 şi la 12 pacienţi (40%) cu DZ tip 1 (p<0,0001). Raportul CA/Î crescut este prezent la 185
pacienţi (89,81%) cu tip 2 şi la 15 pacienţi (50%) cu DZ tip 1 (p<0,0001).
MD Firanescu Adela Gabriela1, Student Soare Mariana1, Student Simion Floriana Maria1,
Student Tuiu Daniela1, MD Mitrea Adina1, MD Popa Simona1, Prof. Univ. Dr. Moța Maria1
Spitalul Clinic Județean de Urgență Craiova
Premises and objectives. Obesity, a growing disease, has important consequences for health,
resulting in increased LDL cholesterol, triglycerides and decreased HDL cholesterol. Also,
contributes to the major causes of death such as heart attack, stroke, hypertension, cancer, diabetes,
liver steatosis. The objective is to study the presence of obesity in a group of unselected
hospitalized patients with diabetes.
Content and Method. A group of 236 patients was studied, of which 50% women and 50% men,
with diabetes, hospitalized in the Department of Diabetes of Emergency County Hospital Craiova.
Among these, 30 patients (12.71%) have type 1 diabetes and 206 patients (87.29%) have type 2
diabetes. The average age of patients with type 1 diabetes is 39.76 ± 13.71, while those with type
2 diabetes is 61.06 ± 10.58. Among patients with type 1 diabetes, 14 (46.67%) have a duration of
diabetes ≤ 10 years, 9 patients (30%) have a duration between 10 and 20 years, and 7 (23.33%)
have a duration of diabetes ≥ 20 years. Regarding patients with type 2 diabetes, 121 (58.74%) have
a duration of diabetes ≤ 10 years, 68 (33.01%) have a duration between 10 and 20 years, and 17
(8.25 %) have a duration of diabetes ≥ 20 years. Regarding the treatment of type 2 diabetes, 2
patients (0.97%) are glycemic balanced through diet, 44 patients (21.36%) are treated with oral
antidiabetic medication, 32 patients (15.53%) are treated with insulin, 116 patients ( 56.31%) are
treated with oral antidiabetic medication and insulin and in the case of 7 patients (3.40%) non-
insulin injectable treatment associated antidiabetic medication +/- insulin is administered. To study
the presence of general obesity BMI≥30 kg/m2 was used, and to study the presence of abdominal
obesity AC>80 cm in women and >94 cm in men, WHR>0.85 in women and >0.94 in men were
used. Data was entered into Microsoft Excel and analyzed using SPSS statistics software.
Results and Discussions. Analyzing general obesity, 105 patients (50.97%) with type 2 diabetes
present BMI≥30 kg/m2 and 2 patients with type 1 diabetes (6.67%) present BMI≥30 kg/m2
(p<0.0001); overweight (BMI 25-29 kg/m2) had 59 patients with type 2 diabetes (28.64%),
compared with 11 patients with type 1 diabetes (36.67%). In type 2 diabetes the average BMI was
30.21 kg/m2, with a standard deviation of 5.99 (p<0.0001). In type 1 diabetes the average BMI
was 24.28 kg/m2, with a standard deviation of 3.64 (p<0.0001). Increased AC is present in 171
patients (83.01%) with type 2 diabetes and 12 patients (40%) with type 1 diabetes (p<0.0001).
Increased WHtR is present in 185 patients (89.81%) with type 2 diabetes and 15 patients (50%)
with type 1 diabetes (p<0.0001).
Conclusions. A rate of over 79% of patients with type 2 diabetes presented obesity and
overweight. There is a highly statistically significant difference (p<0.0001) regarding general and
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Dr. Gălățan Simona1, Dr. Dumitrașcu Ana-Cristina1, Conf. Dr. Roman Gabriela1
UMF “Iuliu Hatieganu” Cluj-Napoca
Premise si obiective: Stabilirea diagnosticului de diabet zaharat este relativ ușor și se face pe baza
unor criterii bine stabilite de Asociația Americana de Diabet în ce privește valoarea glicemiei în
anumite condiții de recoltare sau a valori HbA1c, uneori chiar și în absența simptomatologiei
specifice. Stabilirea tipului de diabet însă se face ținând cont de unele caracteristici clinice prezente
încă de la debut și permit orientarea diagnosticului și a recomandărilor terapeutice, însă nu de
puține ori tabloul clinic este polimorf și nu urmează considerentele tradiționale odată stabilite ca
și definitorii pentru un anume tip de diabet, precum statusul ponderal al pacientului, vârsta la debut
sau prezența cetoacidozei diabetice, motiv pentru care se recurge la determinarea prezenței
sindromului autoimun prin dozare de anticorpi și eventual a peptidului C pentru elucidarea
diagnosticului. În ce masură aceste determinari ne confirma sau nu diagnosticul etiologic în
concordanță cu tabloul clinic prezent la fiecare caz a fost subiectul lucrării de față.
Material si metoda: Am realizat un studiu analitic-observațional, retrospectiv ce a cuprins un lot
de 23 de pacienți internați în Centrul de Diabet și Boli Metabolice Cluj-Napoca în perioada
septembrie 2015-februarie 2016 și la care s-au recoltat probe biologice pentru determinarea
prezenței anticorpilor antiGAD65 si valoarea peptidului C. Pacienți întruneau caracteristici clinice
mixte ce făceau dificilă încadrarea lor într-un anume tip de diabet și la care aceste determinări au
fost solicitate în sprijinul elucidarii diagnosticului etiologic, mai exact confirmarea sau infirmarea
diagnosticului de diabet zaharat tip 1. Sau urmarit în același timp și concordanța caracteristicilor
clinice -vârsta ,IMC-ul pacienților, prezența complicațiilor acute la debut(cetoacidoza diabetica)
sau simptomatologia prezentă la debut, precum și valoarea peptidului C cu tipul de diabet stabilit.
Rezultate: Din lotul de pacienți studiați 13(56,5%) dintre ei erau cunoscuți cu diagnosticul de
DZ2 si 10(43.4%) cu DZ1, dintre care un pacient fusese diagnosticat cu forma latentă de DZ1-
LADA, iar rezultatele determinării titrului de anticorpi anti GAD a adus 11(47.8%) rezultate
pozitive care au confirmat 8(80%) din cele 10 cazuri de DZ1 diagnosticate astfel pe baza criteriilor
clinice anterior dozări de anticorpi, infirmând un caz diagnosticat ca și DZ1 și pe cel diagnosticat
ca si LADA, schimbând diagnosticul în cazul a 2 pacienți cunoscuți până atunci cu DZ2. Valoarea
peptidului C a fost sub limitele admise ca normale (<1,1ng/mL ) la 10(43.4%) din pacienți dintre
care 9(90%)) sunt pacienți cu DZ1. Vârsta la debutul diabetului a fost mai mică de 40 ani în
12(52.17%)din cazuri din care doar 4(36.36%) au fost confirmate ca și DZ1 prin prezența
anticorpilor antiGAD, restul de 7(63.63%) pacienti cu DZ1 au avut debutul bolii după vârsta de
40 ani. Statusul ponderal a fost de normopondere la 16(69.5%) pacienți dintre care 9(81.8%) fiind
din cei diagnosticați cu DZ1, obezitatea fiind prezentă la 2(18.18%) cazuri confirmate de DZ1. În
ce privește simptomatologia prezentă la debut cu caracter acut și cu sindrom poliuro-polidipsic
prezent și scădere marcată în greutate în decursul a mai puțin de 3 săptămâni, aceasta a fost
semnalată la 5(21.7%) din pacienți din care 5(100%) din ei au fost confirmați ca și DZ1. Prezența
cetoacidozei diabetice nu a fost înregistrată decât la 2(8.69%) din cazurile studiate dintre care doar
1(9%) din cei diagnosticați cu DZ1.
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particulare întâlnite la fiecare din aceste cazuri în ce privește vârsta la debutul bolii, statusul
ponderal al pacienților sau debutul acut cu simptomatologie clară poliuro-polidipsică și cu scădere
ponderală marcată ce se regăsesc în procente variabile între 36.36% si 100% nu fac decât să susțină
importanța corelării elementelor tabloului clinic cu dozările de laborator în vederea stabilirii
diagnosticului etiologic de diabet zaharat.
Dr. Gălățan Simona1, Dr. Dumitrașcu Ana-Cristina1, Conf. Dr. Roman Gabriela1
UMF “Iuliu Hatieganu” Cluj-Napoca
Premises and Objectives The diagnosis of diabetes is relatively easy and is based on well-
established criteria of the American Diabetes Association for the plasma glucose, harvest under
certain conditions or the HbA1c criteria, sometimes even without the presence of specific
symptoms. Determining the type of diabetes is considering some clinical features present even
since the onset and allows us to orient diagnostic and therapeutic recomandation but not
infrequently the clinical picture is polymorphic and are not following the traditional consideration
once established as defining a particular type of diabetes as the nutritional status of the patient, age
at onset or the presence of diabetic ketoacidosis at the debut, reson for resorting to determine the
presence of antibodies metered autoimmune syndrome and possibly C peptide to elucidate the
diagnosis. To what extent these determinations confirms the etiological diagnosis consistent with
the clinical picture present in each case was the subject of this paper.
Materials and method: : We conducted an analytical study , observational , retrospective that
included a group of 23 patients admitted in the Center for Diabetes and Metabolic Diseases Cluj-
Napoca between September 2015 and February 2016 to whom were collected biological samples
for the presence of GAD65 antibodies and the levels of serum peptide C.
Patients met the clinical characteristics mixed and made them difficult to framing them in a type
of diabetes reson for these determinations were requested in support to elucidate the etiologic
diagnosis , ie diagnosis confirmation or infirmation of type 1 diabetes. We also monitor the
consistency of clinical characteristics like age, patients BMI, presence of acute onset complications
(diabetic ketoacidosis) and the presence of symptoms at onset and the serum C-peptide value with
the established type of diabetes.
Results: From the group of 23 patients studied 13(56.5%) of them were known with diagnosis of
T2DM and 10 (43.4%)pacients with T1DM, of whom one patient was diagnosed with LADA , and
the results that determine the titer of GAD65 antibodies brought 11 (47.8%) positive results which
confirmed 8 (80%) of the 10 cases of T1DM diagnosed as on the clinical criteria, before the
dosages of antibodies, reversing one case diagnosed as T1DM and the suspicion of LADA,
changing diagnosis for 2 patients known as T2DM. Serum C-peptide value was below the limits
of the normal range (<1.1ng/mL) in 10 (43.4%) cases of whom 9 (90%)pacients diagnosed with
T1DM. Age at onset of diabetes was less than 40 years in 12 (52.17%) cases of which only 4
151
(36.36%) were confirmed asT1 DM by the presence of GAD65 antibodies, the remaining 7
(63.63%) patients with DM1 had disease onset after the age of 40 years.
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Weight status was normal weight in 16 (69.5%) patients of which 9 (81.8%) are those diagnosed
with T1DM, obesity is present in 2 (18.18%) confirmed cases of T1DM. Regarding symptoms
present at the onset of acute character like clear symptoms of poliuro-polydipsia syndrome and
marked decrease weight lose within less than three weeks, it was reported in 5 (21.7%) of patients
in whom 5 (100% ) of them were confirmed as T1DM. Diabetic ketoacidosis presence was
recorded only at 2 (8.69%) of the cases studied of which only one (9%) of those diagnosed with
DM1.
Conclusions: The results obtained from dosing the GAD65 antibody titer and value of serum C-
peptide confirmed 80% of the cases diagnosis of T1DM based on clinical picture but particular
situations encountered in each case like the age of disease onset, weight status of patients or acute
onset of symptoms such as clear poliuro-polydipsia syndrome and marked weight loss that are
found in varying percentages between 36.36% and 100% do nothing else then to support the
importance of correlating elements of clinical picture with the laboratory dosing to determine the
etiologic diagnosis of the type of diabetes.
Premise şi Obiective: În literatura de specialitate au fost descrise 14 mecanisme diferite prin care
este afectată homeostazia glucozei, printre care: rezistența la insulină, incapacitatea celulelor beta-
pancreatice de a produce insulină, transportul deficitar al insulinei, insuficiența funcțională a
canalelor ionice, probleme în funcționarea receptorului adrenergic, sensibilitate alterată la glucoză.
În acest moment, pentru diabetul zaharat de tip 2 sunt disponibile 14 clase terapeutice, iar
selectarea tratamentului se face mai mult sau mai puțin pe principiul “încercare-eroare”. În 43%
din cazuri, tratamentul pentru tipul 2 de diabet zaharat, administrat conform ghidurilor, nu
funcționează, la un pacient nou diagnosticat.
Material şi Metodă: Studiul Pioneer 100, inițiat în anul 2014, finanțat de statul Luxemburg și
desfășurat de Institute of Systemic Biology din SUA, a inclus 107 voluntari sănătoși, și și-a propus
colectarea datelor medicale ale acestora: analize de laborator, date provenind din secvențierea
genomului, a microbiomului, monitorizarea semnelor vitale, evaluarea statusului psihologic etc.
Un accent special s-a pus pe datele medicale ce pot fi colectate de voluntari înșiși, prin diverse
dispozitive hi-tech: telefoane mobile, brățări, ceasuri inteligente, ochelari pentru realitatea
augmentată. Toate aceste informații au fost integrate într-o bază de date (Big Data), au fost
analizate, cu scopul de a se descoperi noi corelații patogenice, noi căi de explorat pentru o
înțelegere mai bună a relației dintre starea de sănătate și boală. Analiza s-a făcut prin tehnici de
congnitive computing. O pondere importantă a studului se referă la analizarea în detaliu a
statusului cardio-metabolic, respectiv a riscului de dezvoltare a bolilor cardiovasculare și a
diabetului zaharat.
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Rezultate şi Discuţii: Analiza la 1 an a datelor de la cei 107 voluntari sănătoși au indicat existența
unui risc de a dezvolta diabetul zaharat la 59% din cazuri, în timp ce riscul cardio-vascular a fost
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definit în 58% din situații. De asemenea, markeri ai inflamației au fost identificați în 68% din
cazuri.
Concluzie: Personalizarea terapiei în diabetul zaharat de tip 2 poate fi posibilă, pe termen scurt,
prin analiza aprofundată a tuturor datelor medicale ale pacientului, prin implementarea unor
mijloace digitale care să-l ajute pe pacient să-și monitorizeze diverși parametri ai stării de sănătate
în intervalul dintre două vizite la medic. Pe termen mediu și lung, prin înțelegerea avansată a
componentelor omice implicate în patogeneza diabetului, putem spera la o personalizare a terapiei
bazată nu doar pe medicina digitală, ci și pe medicina genomică.
Background and objectives: In the literature were described 14 different mechanisms by which
glucose homeostasis is affected, including: insulin resistance, pancreatic beta-cell failure to
produce insulin, insulin deficient transport, insufficient functional ion channels, adrenergic
receptor problems, impaired glucose sensitivity. At this point, type 2 diabetes are available 14
therapeutic classes. The choice of treatment is more or less on a "trial and error" base. In 43 % of
cases, the treatment of type 2 diabetes mellitus, administered in accordance with the guidelines,
do not function in a newly diagnosed diabetes patient.
Material and method: Pioneer 100 Study, initiated in 2014, financed by the Luxembourg State
and conducted by Institute of Systemic Biology in the US, included 107 healthy volunteers, and
aims to collect medical data thereof: laboratory analysis, data from genome sequencing, the micro-
biome, monitoring vital signs, assessing psychological status etc. Special emphasis was placed on
medical data that can be collected by volunteers themselves through various hi-tech devices:
smartphones, bracelets, smart-watches and augmented reality glasses. All this information has
been integrated into a database (Big Data) and analysed in order to discover new pathogenic
correlations, explore new avenues for better understanding of the relationship between health and
disease. The analysis was done through cognitive computing techniques. An important part of the
study covers detailed analysis of the cardio-metabolic status, namely the risk of developing
cardiovascular disease and diabetes.
Results and discussions: Ad-interim analysis of data from 107 healthy volunteers have indicated
a risk of developing diabetes in 59 % of cases, while cardiovascular risk was defined in 58% of
cases. Also, inflammatory markers have been identified in 68% of cases.
Conclusion: On the short term, personalising therapy in type 2 diabetes may be possible by
promoting an in-depth analysis of all medical records of the patient, through the implementation
of digital tools that has the potential to help the patient to monitor several parameters of health
between two visits to the doctor. On a medium and long term, personalising therapy in type 2
diabetes may be possible by an advanced understanding of the omics involved in the pathogenesis
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of diabetes. Personalised therapy will based not only on digital medicine, but also on genomic
medicine.
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PS22. EVALUAREA RELAȚIEI DINTRE SINDROMUL METABOLIC ȘI
HIPERURICEMIE LA PACIENȚII CU DIABET ZAHARAT TIP 2
Obiectivul acestui studiu a fost investigarea relației dintre sindromul metabolic și hiperuricemie la
pacienții cu diabet zaharat tip 2.
Material și metodă: Acest studiu epidemiologic transversal, observaţional ce a inclus nu număr
de 300 pacienţi aflati in evidenta INDNBM „Paulescu”, cu diabet zaharat tip 2. S-au urmărit indicii
antropometrici (greutate, înălţime, circumferinţa taliei, IMC (indicele de masă corporală).
Parametrii biochimici urmăriți au fost de glicemia à jeun, hemoglobina glicozilată, profil lipidic
(colesterol, trigliceride, HDL-colesterol hemoleucograma, parametrii funcției renale (uree,
creatinina serica, raport albumina/creatinina) și acidul uric. Hiperuricemia a fost definită astfel: ≥7
mg/dl (la bărbați) sau ≥6 mg/dl (la femei). Sindromul metabolic a fost definit utilizând definiția
IDF modificat.
Rezultate: Vârsta medie a pacienților incluși în studiu a fost de 60,70±9,79 ani. Durata medie a
diabetului a fost de 11,55±8,58 ani. Prevalența hiperuricemie a fost de 46% (n=138), dintre aceștia
16,7% (n=50) au fost bărbați și 29,4% (n=88) au fost femei. Prevalența sindromului metabolic a
fost de 79% (n=237). Nivelul acidului uric la pacienții cu sindom metabolic a fost 7,02±2,04mg/dl
versus 6,32±1,96 mg/dl la pacienții cu diabet zaharat tip 2 fără sindrom metabolic (p˂0,05).
Hiperuricemia s-a corelat pozitiv cu circumferința abdominală (r=0,15, p=0,023), cu nivelul LDL-
colesterolului (r=0,16, p=0,009) și negativ cu nivelul HDL-colesterolului (r=-0,17,
p=0,002).persoanele cu hiperuricemie a u prezentatvalori semnificativ mai mari ale TAs și
circumferinței abdominale comparativ cu cei fără hiperuricemie (TAs 141,1±22,47 mmHg versus
136,6±20,8 mmHg; CA 107,7±17,96 cm versus 102,5±14,9 cm) (p˂0,05).
Concluzii: Acest studiu arată că nivelul acidului uric seric este semnificativ asociat cu prezența
sindromului metabolic dar și cu componentele sale, în special circumferința abdominală. Avand
in vedere incidența crescută a obezității și a sindromului metabolic la pacienții cu diabet zaharat
tip 2 și legătura potențială dintre ceste afcțiuni și hiperuricemie, accentul ar trebui pus pe
determinarea hiperuricemiei la această categorie de pacienți.
Objective : The objective of this study is to investigate the relationship between metabolic
syndrome and high levels of uric acid in plasma at patients with diabetes type 2
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Method and material: This observational transverse epidemiological study included a number of
300 patients with diabetes type 2 that are under observation of doctors working at National Institute
of diabetes, nutrition and metabolic disease “N. C. Paulescu” . We used anthropometric
measurements ( weight, height, waist circumference, index body mass ). Biochemical parameters
followed are : hemoglobin A1c, fasting glucose, lipid profile ( total cholesterol, triglycerides ,
HDL-cholesterol), hemoleucogram, renal function parameters (urea, serum creatinine, protein to
creatinine ratio) and uric acid. High levels of uric acid were defined as : ≥7 mg/dl (male patients)
and ≥6 mg/dl (women patients). Metabolic syndrome was defined usind the definition of modified
IDF.
Results: The average age of the patients included in our study was 60,70±9,79 years. The average
dration of diabetes was 11,55±8,58 years. The prevalence hyperuricemia was 6% (n=138), 16,7%
(n=50) male patients and 29,4% (n=88) female patients. The prevalence of metabolic syndrome
was 79% (n=237). The level of uric acid at patients with metabolic syndrome was 7,02±2,04mg/dl
versus 6,32±1,96 mg/dl at patients with diabetes type 2 without metabolic syndrome (p˂0,05).
High level of serum uric acid was positive correlated with abdominal waist (r=0,15, p=0,023), with
LDL-cholesterol level (r=0,16, p=0,009) and negative with levels of HDL-cholesterol (r=-0,17,
p=0,002). Patients with high level of uric acid had significantly higher values of systolic blood
pressure and abdominal waist compared with patients without hyperuricemia (TAs 141,1±22,47
mmHg versus 136,6±20,8 mmHg; CA 107,7±17,96 cm versus 102,5±14,9 cm) (p˂0,05).
Conclusions: This study revealed that the serum level of uric acid is related with the presence of
metabolic syndrome, even with his components, especially with abdominal waist. From this point
of view high prevalence of obesity and metabolic syndrome are present at pacients with type 2
diabetes, the potential link between this conditions and high levels of uric acid, the accent must be
placed on the hyperuricemia determination at this category of patients.
Obiective: Menținerea unei igiene dentare corecte pentru sănătatea dentară este o parte acceptată
dintre recomandările normale pentru un stil de viața sănătos. Scopurile acestui studiu au fost
reprezentate de evaluarea problemelor de sănătate orală la pacienții cu diabet zaharat tip 1 și relația
dintre controlul metabolic și sănătatea dentară.
Material si metodǎ: Statusul periodontal a fost examinat la 41 de pacienți cu diabet zaharat tip 1
(T1DM) și au fost folosite 41 de consultații utilizând inflamația gingivală (index gingival),
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prezența cariilor dentare și xerostomia, deasemenea pentru toți pacienții a fost utilizat un
chestionar semi-structurat care a inclus intrebari despre obicieiuri de igienă, patternuri nutriționale,
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frecvența consumului de alcool și fumat, vizite la dentist, consumul de pastă dentară, sângerări
gingivale, sângerări gingivale la ața dentară, sângerări gingivale pe durata perierii, sângerări
gingivale spontane. Au fost analizate probe sanguine pentru glicemia a jeun, HbA1c, profl lipidic,
creatinina. Un bun control metabolic a fost considerat la valori ale HbA1c <7%, iar un prost control
metabolic a fost considerat la valori HbA1c >7%. Prezența complicațiilor diabetului cum ar fi
retinopatia, neuropatia , prezența bolii renale cronice și a complicațiilor cardiovasculare au fost
deasemenea evaluate.
Rezultate: Durata medie a Diabetului zaharat tip 1 a fost 18.61 [14.94-22.28] ani. În ambele
grupuri doar un procent mic de oameni au periat dintii zilnic. Igiena saracă dentară afost observată
in ambele grupuri. Indexul gingival a fost mai mare la pacienții cu diabet zaharat (p=0.001). Trei
zeci și trei din 41 pacienți diabetici au avut gingivită; 40 (97.6%) au avut carii dentare iar 18
(43.9%) au avut candidoză orală. Gingivita, cariile dentare și candidoza orală au fost significant
mai des întalnite la pacienții diabetici decat la pacienții non-diabetici (p<0.05). La grupul
pacienților cu diabet zaharat tip 1 pierderea dinților a fost mai des întalnită. Pacienții cu diabetul
prost controlat au prezentat mai des gingivită si candidoză orală decât pacienții cu diabet slab
controlat iar relația aceasta a avut semnificație statistică.
Concluzie: Prevalența bolii orale a fost semnificativ mai mare la pacienții cu diabet decât la
pacienții nediabetici. Igiena orală neadecvată a fost observată la majoritatea populației evaluate.
Programe naționale ar trebui conduse public, campanii pentru sănătatea dentară, nutriție și sănătate
per total.
Aim: Maintenance of proper oral hygiene for good oral health is an accepted part of the normal
recommendations for a healthy lifestyle. The aims of this study was to evaluate the oral health
problems in type 1 diabetes patients and relationship between metabolic control and oral health
status.
Material and methods: Periodontal status was examined in 41 patients with type 1 diabetes
(T1DM) and 41 controls using inflammation of gums (gingival index), presence of dental caries,
and the xerostomia; also in all patients we used a semi-structured questionnaire which include
questions about hygiene habits, eating patterns, frequency and consumption of alcohol and
tobacco, visits to the dentist, tooth brushing frequency, use of toothpaste, gingival bleeding,
gingival bleeding with dental floss, gingival bleeding during toothbrushing, spontaneous gingival
bleeding. Blood samples were analyzed for fasting plasma glucose, HbA1c, lipid profile,
creatinine. Good metabolic control was assumed to be represented by HbA1c <7%, while poor
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control was defined as HbA1c >7%. The presence of diabetic complications such as retinopathy,
neuropathy, chronic kidney diaseases, and cardiovascular complication were also evaluated.
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Results: The mean duration of the T1DM was of 18.61 [14.94-22.28] years. In both groups only
a small percentage of people brushed their teeth daily. Poor oral hygiene was observed in in both
groups. Gingival index was greater in diabetic patients (p=0.001). Thirty-three out of 41 (80.5%)
diabetic patients had gingivitis; 40 (97.6%) had dental caries and 18 (43.9%) had oral candidosis.
Gingivitis, dental caries and oral candidosis was significantly higher in diabetics than non-
diabetics (p<0.05). Though there was a greater loss of teeth in the group with type 1 diabetes
mellitus. Poorly controlled diabetics presented more with gingivitis and candidiasis than well-
controlled diabetics and this relationship was statistically significant.
Conclusion: The prevalence of oral disease was significantly higher in diabetics than in non-
diabetic controls. Inadequate oral hygiene was observed in the majority of people evaluated.
Nationwide programs should be conducted public awareness campaigns on dental health, nutrition
and overall health.
Premise și Obiective: Complicaţiile diabetului zaharat (DZ) sunt legate de obicei de vechimea
DZ şi gradul dezechilibrului glicemic. De asemenea, în cazul DZ tip 2 predomină complicaţiile de
tip macroangiopatic, reprezentate de hipertensiunea arterială (HTA), cardiopatia ischemică
cronică(CIC), arteriopatia membrelor inferioare. Obiectiv: studiul prevalenţei complicaţiilor DZ
şi a tipului acestora la pacienţi cu DZ tip 2 şi tiroidită cronică autoimună (TCA).
Material şi Metodă: din 77 (69 F și 8 B) pacienţi cu DZ tip 2 şi TCA, 47 (42 F și 5 B) ( p=0,92,
X2=0,008) au prezentat complicaţii ale DZ.
În toate cazurile s-au evaluat:
- profilul lipidic: colesterol total (CT), trigliceride (TG), HDL-colesterol (HDL-C), LDL-
colesterol (LDL-C);
- echilibrul glicemic: glicemie a jeun, hemoglobina glicozilată;
- investigarea glandei tiroide: TSH, FT4, FT3, anticorpi antiperoxidază tiroidiană, ecografie
tiroidiană
- fundul de ochi pentru diagnosticul retinopatiei diabetice
- proteinurie/albuminurie pentru diagnosticul nefropatiei diabetice
- tensiunea arterială sistolică şi diastolică
- EKG pentru cardiopatia ischemică
- oscilometrie pentru arteriopatia diabetică
Toţi subiecţii investigaţi au prezentat DZ tip 2.
Rezultate și Discuții: Principalele complicaţii întâlnite la pacienţii cu DZ tip 2 şi TCA au fost:
HTA în 82,97% cazuri (80,95% F vs. 100% M, p=0,28, X2 =1,14), CIC în 40,42% cazuri
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(38,09% F vs. 60% M, p=0,34, X2=0,89), retinopatia diabetică în 17,02% cazuri (16,66% F vs.
20% M,p=0,85, X2=0,035), polineuropatia diabetică în 7,14% cazuri (4,76% F vs. 20% M,
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Premises and Objectives: Diabetes mellitus (DM) complications are usually related to the age
of diabetes and glycemic imbalance degree. Also, in diabetes mellitus type 2 are predominant
macroangiopathic complications, represented by hypertension, coronary heart disease, and
diabetic arteriopathy. Objective: to study the prevalence of diabetes complications and their type
in patients with type 2 diabetes and autoimmune chronic thyroiditis (ACT).
Research design and Methods: in 77 (69 F and 8 M) patients with type 2 diabetes and ACT, 47
(42 F and 5 men) (p =0.92, X2 = 0.008) had complications of diabetes.
In all cases were evaluated:
- Lipid profile: total cholesterol (TC), triglycerides (TG), HDL-cholesterol (HDL-C), LDL-
cholesterol (LDL-C);
- Glycemic balance: fasting blood glucose, glycosylated hemoglobin;
- Investigation of the thyroid gland: TSH, FT4, FT3, thyroid antibodies, thyroid ultrasound
- Bottom of the eye for diagnosis of diabetic retinopathy
- Proteinuria/albuminuria for the diagnosis of diabetic nephropathy
- Systolic and diastolic blood pressure
- EKG for coronary heart disease
- Oscillometric for diabetic arteriopathy
All investigated subjects had type 1 diabetes.
Results and Discussion: The main complications encountered in patients with type 2 diabetes
and thyroid disease were hypertension in 82.97% cases (80.95% F vs. 100% M, p=0.28, X2
=1.14), coronary heart disease in 40.42% cases (38.09% F vs. 60% M, p=0.34, X2 = 0.89),
diabetic retinopathy in 17.02% cases (16.66 % F vs. 20% M, p = 0.85, X2 = 0.035), diabetic
polyneuropathy in 7.14 % cases (4.76% F vs. 20% M, p = 0.18, X2 = 1.73). The presence of
complications was associated with age and diabetes glycemic imbalance degree.
Conclusions: There was an increased prevalence of hypertension and coronary heart disease due
to type 2 diabetes association of thyroid disease. Because both diseases present high risk for
atherosclerotic cardiovascular disease, it is necessary early detection and their correct treatment
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Material şi Metodă: dintr-un lot de 52 pacienţi cu STG şi tiroidită cronică autoimună (51 femei
şi 1 bărbat), 39 (75%) (38 femei şi 1 bărbat) au prezentat sindrom metabolic.
Criteriile folosite pentru identificarea sidromului metabolic au fost:
- circumferinţa abdominală (peste 80 cm la femei şi peste 94 cm la bărbaţi)
- valoarea glicemiei a jeun peste 100 mg%
- valoarea HDLc sub 40 mg% la bărbaţi şi sub 50 mg% la femei
- valoarea TA peste 130/85 mmHg
- valoarea Tg peste 150 mg%
S-au evaluat:
- profilul lipidic (colesterol total, trigliceride, HDL colesterol, LDL colesterol),
- tensiunea arterială sistolică şi diastolică,
- glicemia a jeun
- circumferinţa abdominală şi indicele masei corporale (IMC)
- investigarea gladei tiroide: determinarea TSH, FT4, FT3, anticorpi antitiroidieni, ecografie
tiroidiană
Premises and Objectives: Metabolic syndrome contains a group of disorders which determinate
a higher incidence of cardiovascular diseases. Objectives: study of metabolic syndrome
prevalence at patients with impaired glucose tolerance (IGT) and autoimmune chronic thyroiditis
(ACT).
Research design and Methods: from 52 patients with IGT and ACT (51 female and 1 male), 39
(75%) (38 female and 1 male) had metabolic syndrome.
The criteria used for identification of metabolic syndrome were:
- abdominal circumference (above 80 cm at girls and above 94 cm at boys)
- glucose concentration above 100 mg%
- HDLc concentration under 40 mg% at boys and under 50 mg% at girls
- blood pressure above 130/85 mmHg
- triglyceride concentration above 150 mg%
We evaluated:
• Lipid profile (total cholesterol, triglyceride, HDL cholesterol, LDL cholesterol);
• Systolic and diastolic blood pressure
• Fasting glycaemia
• Abdominal circumference and body mass index (BMI)
• Investigation of thyroid gland: determination of TSH, FT4, FT3, antithyroid antibodies, thyroid
echography
Dr. Liță Genoveva Andreea1, Dr. Zaharia Adelina1, Dr. Pavel Anca Ioana1, Student Zaharia
Mihaela Iulia1, Dr. Stoicescu Florentina1, Dr. Gheorghiță Andra Gabriela1, Dr. Rusu
Emilia1, Prof. Dr. Radulian Gabriela1
National Institute of Diabetes Mellitus, Nutrition and Metabolic Diseases ”Prof.N.C. Paulescu”,
Bucharest
Premise și Obiective: Este cunoscut faptul că nivelul crescut al acidului uric reprezintă un marker
predictiv pentru dezvoltarea Diabetului zaharat. Studii recente au evidențiat că, la pacienții
diabetici, hiperuricemia prezintă un rol important în dezvoltarea complicațiilor cronice micro- și
macrovasculare, prin favorizarea insulinorezistenței. Astfel, acest studiu a urmărit evaluarea
relației dintre acidul uric seric și Diabetul zaharat, respectiv complicațiile acestuia.
Rezultate şi Discuţii: Din numărul total de pacienți incluși în studiu 9% (n=13) au avut Diabet
zaharat de tip 1, 35,9% (n=52) au avut Diabet zaharat tip 2 în tratament antidiabetic oral și 55,2%
(n=80) au avut Diabet zaharat tip 2 insulinotratat. Nivelul mediu al acidului uric a fost 4,30 ± 1,81
mg/dl la pacienții cu Diabet zaharat tip 1, 5,99 ± 2,17 mg/dl la pacienții cu Diabet zaharat tip 2 în
tratament cu antidiabetice orale și 5,74 ± 1,73 mg/dl la pacienții cu Diabet zaharat tip 2
insulinotratat (p=0,019). Dintre pacienții cu Diabet zaharat tip 2 și hiperuricemie, care au fost în
număr de 132, 51,9% au prezentat Boală renală diabetică în diverse stadii. La pacienţii cu
hiperuricemie valoarea medie a ratei de filtrare glomerulară a fost 67,37 ± 26,86 ml/min/1,73 m2,
iar la cei fără hiperuricemie 93,57 ± 25,51 ml/min/1,73 m2 (p=0,001). În ceea ce priveşte celelalte
complicaţii ale Diabetului zaharat 35,9% dintre pacienţi au prezentat Retinopatie diabetică în
diferite grade, 30,5% Polineuropatie diabetică senzitivă distală, 45,5% Neuropatie diabetică
vegetativă, iar 41,7% au înregistrat complicaţii macrovasculare (Boală cardiacă ischemică).
Concluzii: S-a observat că pacienții cu Diabet zaharat tip 2 prezintă valori mai crescute ale
acidului uric comparativ cu pacienții cu Diabet zaharat tip 1. În ceea ce privește complicațiile
Diabetului zaharat, s-a înregistrat o prezenţă semnificativă a Bolii renale diabetice la pacienţii care
asociază Diabet zaharat tip 2 şi hiperuricemie.
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THE SERUM URIC ACID AND THE COMPLICATIONS OF DIABETES MELLITUS
Dr. Liță Genoveva Andreea1, Dr. Zaharia Adelina1, Dr. Pavel Anca Ioana1, Student Zaharia
Mihaela Iulia1, Dr. Stoicescu Florentina1, Dr. Gheorghiță Andra Gabriela1, Dr. Rusu
Emilia1, Prof. Dr. Radulian Gabriela1
National Institute of Diabetes Mellitus, Nutrition and Metabolic Diseases ”Prof.N.C. Paulescu”,
Bucharest
Premises and Objectives: It is known that the high level of serum uric acid is a predictive marker
in the development of Diabetes mellitus. Recent studies demonstrated that, in diabetic patients,
hyperuricemia has an important role in the development of chronic micro- and macrovascular
complications. Consequently, the aim of this study was to evaluate the relation between serum uric
acid and Diabetes mellitus, respectively its complications.
Content and Method: We realised a retrospective study on a group of 145 patients with Diabetes
mellitus, who were under the observation of N.I.D.N.M.D.”Prof.N.C.Paulescu” from Bucharest,
by using clinical and laboratory methods to evaluate the parameters included in the study. We used
the laboratory values of serum uric acid to evaluate the hyperuricemia; the complications of
Diabetes Mellitus were evaluated clinically and by laboratory methods, by using dilated-pupil
fundus examination, neurological and cardiological examination, determination of serum
creatinine, estimated glomerular filtration rate and urinary albumine/creatinine ratio.
Results and Discussions: From the total number of patients included in the study, 9% (n=13) had
Type 1 Diabetes mellitus, 35,9 % (n=52) had Type 2 Diabetes mellitus treated with oral
antidiabetic drugs and 55,2 % (n=80) were with Type 2 Diabetes mellitus treated with insulin. The
medium level of serum uric acid was 4,30 ± 1,81 mg/dl in patients with Type 1 Diabetes mellitus,
5,99 ± 2,17 mg/dl in patients with Type 2 Diabetes mellitus treated with oral antidiabetic drugs
and 5,74 ± 1,73 mg/dl in those with Type 2 Diabetes mellitus treated with insulin (p=0,019).
Among the patients with Type 2 Diabetes mellitus and hyperuricemia, which were 132, 51,9% had
Diabetic Kidney Disease in different stages. In patients with hyperuricemia, the medium value of
the estimated glomerular filtration rate was 67,37 ± 26,86 ml/min/1,73 m2 and in those without
hyperuricemia was 93,57 ± 25,51 ml/min/1,73 m2 (p=0,001). Regarding the other complications
of Diabetes mellitus, we found that 35,9% of the patients had Diabetic retinopathy in different
grades, 30,5% had Diabetic distal polyneuropathy, 45,5% had Diabetic vegetative neuropathy and
41,7% had macrovascular complications ( Ischemic heart disease).
Conclusions and Findings: We observed that the patients with Type 2 Diabetes mellitus had
higher values of serum uric acid comparing to patients with Type 1 Diabetes mellitus. Regarding
the complications of Diabetes mellitus, we found a significant presence of Diabetic kidney disease
in patients with Type 2 Diabetes mellitus and hyperuricemia.
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PS27. ABCESE MULTIPLE LA DISTANȚĂ COMPLICÂND O INFECȚIE
LOCALIZATĂ A PICIORULUI DIABETIC – PREZENTARE DE CAZ
Dr. Magopet Eliza1, Lect. Botnariu Eosefina1, Assist. Prof. Popa Delia1, Lect. Popescu
Maria1, Lect. Lăcătușu Cristina Mihaela1, Assoc. Prof. Mihai Bogdan Mircea1
Clinical Centre of Diabetes, Nutrition and Metabolic Diseases – Iaşi, Romania
Premise şi Obiective: Infecția localizată a piciorului poate determina sepsis generalizat în anumite
condiții. Scopul acestei prezentări de caz este de a avertiza asupra unei complicații severe a
leziunilor piciorului diabetic.
Material şi Metodă: Prezentăm cazul unui pacient în vârstă de 50 de ani, cu diabet zaharat tip 2,
neuropatie diabetică și factori de risc cardiovascular (hipertensiune arterială și obezitate), care a
dezvoltat sepsis și multiple abcese cu localizare la distanță față de leziunea inițială de la nivelul
piciorului. Cu excepția ulcerației neuropate, pacientul a prezentat durere importantă la nivelul feței
posterioare, edem și poziție antalgică a coapsei stângi, retinopatie diabetică și neuropatie periferică
senzitivo-motorie. Pe durata spitalizării pacientul a fost afebril. Pentru stabilirea diagnosticului au
fost necesare multiple investigații de laborator și imagistice.
Concluzii: Acest caz reprezintă o situație rară în care ulcerația piciorului diabetic poate evolua
spre o infecție generalizată, cu multiple abcese profunde ale coapsei și sepsis sever, punând în
pericol viața pacientului. Este importantă cunoașterea potențialului pe care îl au ulcerațiile
piciorului diabetic de a genera complicații infecțioase extensive, cu atât mai mult cu cât
simptomele asociate pot fi adesea înșelătoare și prin urmare alegerea terapiei optime poate fi
dificilă.
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MULTI-SITE ABSCESSES COMPLICATING A DIABETIC FOOT INFECTION –
CASE REPORT
Dr. Magopet Eliza1, Lect. Botnariu Eosefina1, Assist. Prof. Popa Delia1, Lect. Popescu
Maria1, Lect. Lăcătușu Cristina Mihaela1, Assoc. Prof. Mihai Bogdan Mircea1
Clinical Centre of Diabetes, Nutrition and Metabolic Diseases – Iaşi, Romania
Premises and Objectives: Localized foot infection can lead to dissemination and even generalized
sepsis under certain conditions. The purpose of the present report is to increase awareness of a
severe evolutive complication of diabetic foot ulcerations.
Content and Method: We present the case of a 50 year-old male, with long-standing type 2
diabetes mellitus, neuropathy and cardiovascular risk factors (hypertension and obesity), which
developed sepsis and distant site abscesses from a chronic foot infection. Apart of a neuropathic
foot wound, the patient presented severe pain, oedema and antalgic posture of the left thigh, retinal
microangiopathy and peripheral neuropathy. Fever was absent during hospitalization. Multiple
laboratory and imagistic exams were needed to establish the diagnosis.
Results and Discussions: As clinical signs of sepsis were evident, prolonged broad-spectrum
antibiotherapy was initiated even from the moment of admission. Laboratory exams showed
leucocytosis (36,180/mm3) with neutrophilia (92.3%), thrombocytosis (511,000/mm3),
inflammation (fibrinogen 912 mg/dl, CRP 28.53 mg/dl), low serum bicarbonate (20.1 mmol/l) and
hyperglycemia (386 mg/dl). Magnetic resonance imaging revealed multiple abscesses in
ischiopubian, ischiorectal and left femoral spaces, left femoral metaphyseal-diaphyseal internal
surface, left sciatic fossa and left pelvic obturator space, secondary to potential hematogenous
seeding from the plantar infection. The differential diagnosis was difficult, seeing that the patient
presented many non-specific symptoms. Percutaneous drainage of the abscesses was needed, using
large incisions and pus evacuation in the superior internal region of the thigh. Bacteriological exam
from intra-abscesses pus showed Klebsiella pneumoniae. Postoperative recovery was marked by
partial regaining of motor functions in the left inferior limb.
Conclusions and Findings: The aforementioned case represents a rare situation of a localized
foot suppuration evolving towards a generalized, life-threatening infectious condition, with
multiple profound abscesses of the thigh and severe sepsis. It is important to recognize the potential
for extensive infectious complications held by diabetic foot ulcerations, to be aware that
identifying symptoms may sometimes be delusive and choice of the optimal therapy for this
condition may be difficult, in order to prevent significant morbidity and mortality.
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PS28. PREZENȚA NEUROPATIEI DETERIOREAZĂ CALITATEA ACTIVITĂȚILOR
DE AUTO-MANAGEMENT AL DIABETULUI
Dr. Mailat Diana1, Dr. Timar Romulus1, Dr. Tîrziu Maria1, Dr. Lazăr Sandra1, Dr. Timar
Bogdan1
"Victor Babes" University of Medicine and Pharmacy
Material și Metodă: În acest studiu transversal am înrolat 198 pacienți cu DZ tip 2 (mediana
vârstei 61 ani; mediana duratei DZ 7 ani) conform unui principiu consecutiv-populațional, aflați
în evidența Centrului Clinic Județean de Diabet, Nutriție și Boli Metabolice din Timișoara. Tuturor
pacienților le-au fost colectate date antropometrice clinice și de laborator la vizita de screening.
Prezența și severitatea ND a fost evaluată cu ajutorul instrumentului de screening Michigan
(MNSI) respectiv calitatea activităților de auto-îngrijire a diabetului cu ajutorul chestionarului
Summary of Diabetes Self-Care Activities (SDSCA).
Rezultate și Discuții: Prezența ND s-a asociat cu o scădere semnificativă a scorului SDSCA (27
vs. 37 puncte; p<0.001), scădere ce s-a dovedit a fi semnificativă pentru toți sub-itemii scorului:
complianța la dietă (12 vs. 17 puncte; p<0.001), exercițiu fizic (5 vs. 6 puncte; p<0.001),
monitorizare glicemică (4 vs. 8 puncte; p<0.001) respectiv îngrijirea piciorului (3 vs. 6 puncte;
p=0.003). Scorul SDSCA s-a corelat negativ și semnificativ statistic cu severitatea ND măsurată
prin intermediul scorului MNSI (r=-0.527; p<0.001), această corelație fiind validă inclusiv pentru
toate sub-componentele scorului. Rezultatele indică o scădere a calității măsurilor de auto-îngrijire
a diabetului la pacienții cu simptomatologie avansată a ND.
Dr. Mailat Diana1, Dr. Timar Romulus1, Dr. Tîrziu Maria1, Dr. Lazăr Sandra1, Dr. Timar
Bogdan1
"Victor Babes" University of Medicine and Pharmacy
Background and aims: In the management of diabetes, the diabetes-related self-care activities
are of a paramount importance. It is demonstrated that a good glycemic control cannot be obtained
without an adequate diet, physical exercise and blood glucose self-monitoring with consecutive
treatment adjustments. Diabetic neuropathy (DN) is a prevalent complication of Diabetes Mellitus
(DM) with multiple consequences on the patient’s health which may also partially impair, directly
or mediated through other components, the quality of the diabetes-related self-care activities.
Our study aims to evaluate the impact of the presence and severity of neuropathy on the quality of
diabetes-related self-care activities.
Content and method: In this cross-sectional study, we enrolled 198 patients with Type 2 DM
(median age 61 years; median diabetes duration 7 years) attending scheduled visits at the
Outpatient of Emergency Hospital Timisoara, according to a consecutive-case, population-based
principle. In all patients, we collected anthropometric, clinical and laboratory data at the screening
visit. The presence and severity of DN was evaluated using the Michigan Neuropathy Screening
Instrument (MNSI), a higher score being associated with more severe DN. The quality of diabetes-
related self-care activities was evaluated using the Summary of Diabetes Self-Care Activities
questionnaire (SDSCA), a higher score being associated with a more appropriate diabetes self-
care.
Results and discussion: The presence of DN was associated with a significantly decreased
SDSCA score (27 vs. 37 points; p<0.001), the decreases being significant for all studied sub-items:
diet-related self-management (12 vs. 17; p<0.001), physical exercise (5 vs. 6; p=0.002), glycemic
values monitoring (4 vs. 8; p=0.010) respectively foot care (3 vs. 6; p=0.003). The SDSCA score
was reversely and significantly correlated with the severity of DN assessed using MNSI score
(Spearman’s r=-0.527; p<0.001), this correlation being valid for all the self-care sub-components.
The results are pointing to impaired diabetes-related self-care activities in patients with more
severe neuropathic symptoms.
Conclusion: The relationship between the severity of DN and the quality of DM self-management
points to a possible loop-type relationship between these two components, being possible a
reciprocal augmentation with negative consequences on the global management of DM. In order
to avoid a decrease in the quality of disease self-management, special self-management related
education should be provided in patients with DM which developed DN.
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PS29. CAZ SPECIAL DE DIABET ZAHARAT TIP MODY
Rezident Matei Laura Roxana1, Rezident Aricescu Alexandru1, Dr. Zetu Cornelia1
INDBM Prof. Dr. I. Paulescu
Premise și obiective: Diabetul Zaharat (DZ) tip MODY reprezintă un tip subdiagnosticat de
diabet, diagnosticul de certitudine putând fi pus doar după efectuarea testelor genetice. Scopul
acestui abstract este de a prezenta un caz clinic special de DZ tip MODY.
Material și metodă: Pacientă de sex feminin, în varstă de 18 ani, cu ereditate diabetică încarcată
- rude de gradul I, dg. la vârste tinere (fiica, mama, bunica), depistată in context asimptomatic la
11 ani cu DZ, cu recomandarea insulinoterapiei și administrarea inconstantă a acesteia, având în
total ~ 3 luni de tratament insulinic în 7 ani de diabet, cu dezechilibru glicemic reflectat de glicemii
random 250-300 mg/dl, dar fără episoade de decompensări metabolice acute. Din istoricul
pacientei menționăm valori ale Hb1Ac=7,6 %- 11%. La momentul actual, pacienta se prezintă
pentru valori glicemice crescute, insoțite de sindrom poliuro-polidipsic de 3 luni, în context de
dezechilibru glicemic major (HbA1c=12,1%).
Concluzii: Prevalența MODY în Europa este considerată aproximativ 1-2% din cazurile de DZ
neinsulinodependent. Având în vedere faptul că prezentarea clinică la debut orientează frecvent
clinicianul către diagnosticul de DZ tip 1 la pacientul tânăr cu hiperglicemie fără stigmate de
insulinorezistență, există tipuri particulare de diabet MODY uneori subdiagnosticate. Pentru aceste
cazuri, independența de tratamentul insulinic cel puțin 5 ani după diagnostic ajută diagnosticul
diferențial. Deși testele genetice nu au putut fi efectuate în acest caz, contextul clinico-biologic ne
orientează să suspicionăm subtipul MODY 2.
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PS30. ACANTHOSIS NIGRICANS- CUTANEOUS MANIFESTATION OF
ENDOCRINE ABNORMALITIES-CASE REPORT
Resident Mihai Gabriela1, Resident Captiu Florentina Iuliana1, Resident Micheu Adelina1,
Resident Gâmbuțean Ana Maria1, MD. PhD, Assist. Prof. Pop Radu Corina Cristina1, MD.
PhD Prof. Pașcanu Ionela Maria1
1
Mures County Clinical Hospital
Content and method: We report a clinical case of a 17 years old, RB, who presented to the
Endocrinology Department for evaluation of excessive facial hair, irregular menses since
menarche with a history of a secondary amenorrhea for 6 months in the last two years. A complete
physical examination revealed third-degree android obesity (BMI: 41 kg/m2) with a waist-hip
ratio: 1.03, facial acne, hirsutism with a Ferriman Gallwey score of 15. AN was found to be present
on the neck and under the breasts. Assessment of hormonal imbalance revealed hyperandrogenism
with elevated Total testosterone 143.23 ng/dl (10.83-56.94). Free testosterone : 3.41 ng/dl (0.3-
1.08) and Bioavailable Testosterone 82.4 ng/dl (0.8-10) were also markedly elevated. To evaluate
Adrenal androgen secretion, DHEA-S: 548.3 ug/dl (61.2-493.6) was determined and showed
overproduction. The homeostatic model assessment was used to quantify insulin resistance.
HOMA-IR revealed severe insulin resistance with a score of 6.45 (normal range <3).Cushing
syndrome and late-onset congenital adrenal hyperplasia were excluded.Abdominal
Ultrasonography described multiple small follicles (< 0.5 mm) in both ovaries.
Results and discussions: Management plan of hyperandrogenism and insulin resistance in obese
patients include lifestyle modification and insulin-sensitizing agents. Treatment with Metformin
in low doses (500 mg/daily) was initiated along with Dydrogesterone to improve menstrual cycles.
Patient follow-up is necessary for Metformin dosage adjustment, to combine therapy with
antiandrogens and to prevent further complications as well as possible treatment side effects.
Șef Lucr. Dr. Mihalache Laura1, Șef Lucr. Dr. Arhire Lidia Iuliana1
1
Universitatea de Medicină și Farmacie ”Grigore T. Popa” Iași
Ghrelina este un hormon neuroendocrin secretat la nivelul stomacului, descoperit în 1999 de către
Kojima și colab. în contextul cercetărilor efectuate în vederea optimizării tratamentului
persoanelor cu deficit de hormon de creștere (GH), unul dintre aspecte fiind identificarea liganzilor
endogeni ai receptorilor secretagogi de hormon de creștere. La acel moment, două aspecte au fost
considerate importante, și anume recunoașterea stomacului ca un organ secretor implicat în
reglarea GH prin intermediul ghrelinei, dar și necesitatea activării acesteia pentru a-și exercita
acțiunile endocrine.
Deși era considerat un aspect dificil al fiziologiei umane (receptori specifici situați la nivel cerebral
iar ligandul endogen este secretat de stomac), cercetările ulterioare au demonstrat faptul că
ghrelina nu este doar un peptid care stimulează secreția de GH, ci un important reprezentant al
unei noi familii de peptide gastrointestinale implicate în reglarea și modularea axei intestin-creier,
oferind noi perspective în cercetarea metabolică și neuroendocrină, cu potențe terapeutice
deosebite.
Ghrelina, ligandul endogen al receptorului secretagog de GH, este singurul hormon periferic cu
acțiune orexigenă, ce activează receptori exprimați mai ales la nivelul centrului apetitul
(hipotalmus și hipofiză). La nivel plasmatic, se regăsesc două forme ale ghrelinei: forma inactivă,
ghrelina neacilată, și forma activă, ghrelina acilată sintetizată sub acțiunea enzimei ghrelin O-
acyltransferaza (GOAT). În literatură este menționată chiar existența unui sistem
ghrelină/GOAT/GHSR extrem de complex, implicat în reglarea metabolismului energetic uman și
adaptarea homeostaziei energetice la modificările de mediu. La subiecți umani, nivelul ghrelinei
crește imediat preprandial și scade în perioada postprandială, fiind implicată în inițierea mesei dar
și în determinismul cantității și calității alimentelor ingerate. Suplimentar stimulării aportului
alimentar, ghrelina determină scăderea consumului energetic și promovează depozitarea acizilor
grași în adipocite.
Astfel, la nivelul organismului uman ghrelina duce la o balanță energetică pozitivă, cu creșterea
adipozității, deci cu creșterea depozitelor calorice, văzut ca un mecanism adaptativ pentru a putea
fi utilizate în condiții de restricție calorică. În contextul actual mondial, în care asistăm la creșterea
disponibilității alimentare și reducerea la minimum a consumului energetic, aceste mecanisme
devin patogene, ipoteza implicării ghrelinei în epidemia actuală a excesului ponderal devenind din
ce în ce mai atractivă.
colab. These authors were conducting a research aimed at improving the treatment of growth
hormone (GH) deficiency by identifying the endogenous ligand for GH secretagogue receptor
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(GHS-R). At that time, two aspects were considered important, namely recognition of the stomach
as a secreting organ involved in GH regulation through ghrelin and that in order to exert its
endocrine actions ghrelin has to be activated.
Although considered a difficult aspect of human physiology (the specific receptors situated in the
brain and the endogenous ligand secreted by the stomach), further research showed that ghrelin is
not only a peptide that stimulates GH secretion, but a leading representative of a new family of
gastrointestinal peptides involved in the regulation and modulation of gut-brain axis, thus
providing new insights into the metabolic and neuroendocrine research, with special therapeutic
potential.
Ghrelin, the endogenous ligand for the GH secretagogue receptor, is the only peripheral orexigenic
hormone that activates the receptors to be found especially in the appetite center (hypothalamus
and pituitary gland). Ghrelin is present in human plasma in two forms: an inactive form known as
deacylated ghrelin, and an active form called acylated ghrelin synthesized under the action of
ghrelin O-acyltransferase enzyme (GOAT). The literature even mentions an extremely complex
ghrelin/ GOAT / GHSR system involved in the regulation of human energy, metabolism and
adaptation of energy homeostasis to environmental changes. In humans, there is a preprandial rise
and a postprandial fall in plasma ghrelin levels, which strongly suggest that the peptide plays a
physiological role in meal initiation and may be employed in determining the amount and quality
of ingested food. Besides the stimulation of food intake, ghrelin determines a decrease in energy
expenditure and promotes the storage of fatty acids in adipocytes.
Thus, in the human body ghrelin induces a positive energy balance, an increased adiposity gain,
as well as an increase in caloric storage, seen as an adaptive mechanism to caloric restriction
conditions. In the current world context, when we are witnessing an increasing availability of food
and a reduction of energy expenditure to a minimum level, these mechanisms have become
pathogenic. As a consequence, the hypothesis that ghrelin is involved in the current obesity
epidemic has been embraced by many scholars and researchers.
de insulină Accu- Check Spirit Combo. Vârsta pacienților a fost între 7-63 ani, durata diabetului
zaharat tip 1 a fost intre 2-43 de ani. Perioada spitalizãrii a fost in medie 5 zile. Conform
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protocolului, rata bazală reprezintă inițial 80% din doza de insulină bazală, fiind verificată prin
proba postului pe diverse perioade a 3 zile diferite. Parametrii care au fost analizați sunt: HbA1c,
motivele tratamentului prin pompa de insulină, glicemia bazală la internare și cea la externare, rata
bazală totalã/24h la internare și cea de la externare (cu pompa), media glicemiilor/24h de la
internare și cea de la externare, doza totală de insulină (DTI/kgc) înaintea internării şi cea de la
externare cu pompa. Datele obţinute au fost centralizate și prelucrate statistic cu ajutorul
programului Microsoft Excel si SPSS.
Rezultate: Principalele motive pentru trecerea la tratamentul cu pompa de insulinã au fost in 11%
din cazuri hipoglicemiile frecvente iar în 89% a fost variabilitatea glicemică mare (43-400mg/dl).
Dezechilibrul glicemic a fost evaluat la internare în funcţie de valoarea HbA1c care a înregistrat
valori de 8-9% în majoritatea cazurilor 67%. Din totalul cazurilor studiate predomină sexul
feminin 70%. S-au obţinut diferenţe semnificative cu o medie de 0.19u.i./24h între doza totalã de
insulinã (DTI)/24h la internare și DTI/24h la externare (pompa) la 77,7% dintre pacienţi. S-a
înregistrat o medie a glicemiilor/24h la internare 168.4mg/dl (106-242mg/dl) şi media
glicemiilor/24h la externare 164.02mg/dl (111-214mg/dl). S-a observat o diferenţa între rata
bazalã la internare 17,44ui și cea de la externare 13.64ui, cu o scãdere a necesarului bazal de 3,8
u.i.
Concluzii: Rezultatele obţinute susțin protocolul aplicat în Centrul nostru pentru instalarea
pompei de insulină. Pe termen scurt, infuzia continuã subcutanată de insulină se asociazã cu o
reducere a necesarului de insulinã pe 24h, cu un numãr mai redus de evenimente hipoglicemice şi
de variabilitate a glicemiilor. Urmărirea periodică a pacienților este necesară pentru controlul pe
termen lung.
Backgrounds: The alternative basal-bolus therapy in patients with type I diabetes with frequent
hypoglycemia or asymptomatic high glycemic variability and low basal insulin needed it is
continuous subcutaneous insulin infusion (CSII) therapy. The advantages of this treatment
references to the possibility of obtaining and maintaining an optimal glycemic control, blood sugar
close to normal glycemic, variations minimal and low frequency of hypoglycemia.
Aims.
The objective of this study was to evaluate short-term protocol insulin pump installation.
Materials and methods: Between jan-march 2016, to 9 pacients with type 1 diabetes mellitus was
installed insulin pump Accu- Check Spirit Combo. The pacients age was between 7-63 years. Type
1 diabetes mellitus (DM) duration was between 2-43 years. Hospitalizations period it was in
average 5 days. According to protocol total basal rate represents initial 80% from the basal insulin
dosage, being checked by “fasting test” in tree different moments and tree different days.
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Parameters that were analyzed: HbA1c, treatment reasons by insulin pump, basal blood glucose at
admission and discharge of the patients, total basal rate / 24h at admission and the one at the
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discharge (with the pump), the average glycemia / 24h at admission and discharge of the patients,
the total daily dose (TDD) of insulin before the hospitalization and at the discharge of the patients,
with the pump. Centralized data obtained were processed statistically in Microsoft Excel and
SPSS.
Results: The main reasons for switching to CSII therapy insulin pump therapy were in 11% of
cases frequent hypoglycemia and in 89% it was higher glycemic variability (43-400 mg / dl). The
glycemic imbalance it was evaluated at admission of the patients regarding the value of HbA1c
which was recorded 8-9% in most cases. Of all cases studied predominates the female 70%. It was
obtained significant differences with an average of 0.19 ui / 24h between TDD / 24h at admission
and TDD/ 24h discharge (pump) 77.7% of patients. There has been an average glycemic / 24h on
admission 168.4 mg / dl (106-225mg/dl) and the mean glycemic / 24h discharge 164.02mg / dl
(111-214mh/dl). It was noticed a difference between basal rate at admission 17.44u.i. and at the
discharge 13.64u.i., with a decrease of 3.8 u.i. basal needs.
Conclusions: The results support the protocol used in our Centre following CSII therapy. reduces
total daily basal of insulin. Short-term CSII is associated with the decreases number of
hypoglycemic events and also the variability of blood glucose levels in most of the cases. Periodic
follow-up of patients is needed for long-term control.
Dr. Mureșan Alexandra1, Dr. Cavalioti-Enache Theodora-Elena1, Dr. Dobre Gabriel Alin1,
Dr. Ungureanu Carmen1, Dr. Ciobanu Delia1, Dr. Soldea Lidia1, Dr. Bejinariu Cătălina1, Dr.
Ilinca Alexandra1, Dr. Stegaru Daniela1, Dr. Radu Florentina1, Dr. Rusu Emilia1, Prof. Dr.
Radulian Gabriela1
Lotus Medica
Premise și Obiective: Retinopatia diabetică este una din cele mai redutabile si invalidante
complicații microvasculare care pot apărea in evoluția pacientului cu diabet zaharat.Totuși trebuie
să recunoaștem că pot exista diferențe în ceea ce privește apariția retinopatiei diabetice în special
datorită obezitații (deci a prezenței insulinorezistenței). End point-ul primar a urmărit riscul
apariției retinopatiei diabetice la pacienții obezi cu diabet zaharat tratați cu antidiabetice orale
versus pacienții obezi cu diabet zaharat insulinotratați. End point-ul secundar a urmărit apariția
retinopatiei diabetice la pacienții obezi cu diabet zaharat echilibrat versus pacienții obezi cu diabet
zaharat dezechilibrat.
Materiale si Metode: S-a realizat un studiu observațional, retrospectiv care a inclus un numar de
200 pacienți cu diabet zaharat internați la INDNBM Prof. Dr. N.C. Paulescu in perioada ianuarie
2015- ianuarie 2016. Din analiza foilor de observație clinică am reținut și analizat următoarele
date: sexul pacienților, IMC-ul (kg\m2), durata de evoluție a diabetului zaharat, valoarea HbA1c,
tratamentul antidiabetic (ADO sau insulinoterapie), complicații cronice ale diabetului zaharat
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Dr. Mureșan Alexandra1, Dr. Cavalioti-Enache Theodora-Elena1, Dr. Dobre Gabriel Alin1,
Dr. Ungureanu Carmen1, Dr. Ciobanu Delia1, Dr. Soldea Lidia1, Dr. Bejinariu Cătălina1, Dr.
Ilinca Alexandra1, Dr. Stegaru Daniela1, Dr. Radu Florentina1, Dr. Rusu Emilia1, Prof. Dr.
Radulian Gabriela1
Lotus Medica
Background and objectives: Diabetic retinopathy is one of the most difficult and invalidating
microvascular complication that may appear in the evolution of patients with diabetes. Still, one
has to acknowledge that there may be differences concerning the incidence of diabetic retinopathy
especially due to obesity (and thus due to resistance to treatment with insulin). The primary end-
point monitored the risk of occurrence of diabetic retinopathy at obese patients having oral
treatment compared to those treated with insulin. The secondary end-point monitored the incidence
of diabetic retinopathy at obese patients with balanced diabetes compared to those with unbalanced
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diabetes.
Materials and methods: A retrospective study was conducted on 200 diabetes patients treated at
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INDNBM Prof. Dr. N.C. Paulescu in the period January 2015 – January 2016. The following data
was monitored: sex, IMC (kg/m2), duration since diagnosis, HbA1c value, treatment (ADO or
insulin), chronic complications (diabetic retinopathy). For the diabetic retinopathy diagnostic was
used the eye exam, according to the severity scale from Early Tratment for Diabetic Retinopathy
Study.
Results and Discussions: Out of the total number of patients included in the study, 148 (74%)
were under insulin treatment and 52 (26%) under ADO treatment. As regards weight, 118 (59%)
presented various degrees of obesity and 82 patients were normal or slightly overweight. Out of
the obese patients, 88 (59.46%) are treated with insulin and 30 (57.69%) are treated with ADO; 51
(66.1%) do not have diabetic retinopathy, and the rest of 37 (42.04%) suffered from this condition.
However, only one of the obese patients (16.7%) treated with ADO presented diabetic retinopathy.
As regards (HbA1c), 97 obese patients presented values exceeding 7%, out of which 63 (64.94%)
did not present diabetic retinopathy and 34 (35.05%) had this condition. Out of the patients with
HbA1c below 7%, 18 patients (90%) did not present diabetic retinopathy and only 2 (10%) had
this condition.
Conclusions: Patients treated with insulin have relatively the same risk of occurrence of diabetic
retinopathy regardless of their weight, unlike those under ADO treatment, where the risk of
occurrence of diabetic retinopathy is higher for the normal or slightly overweight patients
compared to the obese patients. As regards the risk of occurrence of diabetic retinopathy in patients
with balanced diabetes, it may be noted that an optimum control of diabetes decreases the chances
of occurrence of diabetic retinopathy by approximately 25%.
Femeile cu diabet zaharat tip 2 au un turnover osos mai scăzut decât femeile non-diabetice, iar
DMO pare să subestimeze diagnosticul de osteoporoză în grupul pacienților diabetici. Astfel
markerii turnover-ului osos ar putea fi potențiali candidați pentru evaluarea osteoporozei la
pacienții cu diabet zaharat.
Datele curente plasează osteoporoza alături de celelalte complicații cronice ale diabetului zaharat.
Mecanismele prin care diabetul zaharat tip 2 afectează metabolismul osos sunt încă studiate.
Scopul acestui studiu a fost de a evalua metabolismul osos utilizând markerii biochimici ai
turnover-ului osos și densitatea minerală osoasă (DMO) la pacienții cu diabet zaharat tip 2 și
osteoporoză tip I nou diagnosticată.
Studiu retrospectiv care a inclus un număr de 120 de femei cu osteoporoză postmenopauză: 60 de
femei cu diabet zaharat tip 2 și 60 de femei fără diabet (grupul non-diabetic). În grupul non-diabetic
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a fost urmărită vârsta. Variabilele analizate au fost vârsta, indicele de masă corporală (IMC),
magneziu, calciu, fosfataza alcalină (FA), glicemia a jeun, nivelele serice de osteocalcină și
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crosslaps, 25-hidroxi vitamina D (25(OH)D) și DMO utilizând absorbțiometria duală cu raze X
(DXA).
Vârsta medie a femeilor studiate a fost de 64.21±8.01 ani. În grupul diabetic valoarea osteocalcinei
a fost de 22.26±14.49 ng/ml, iar valoarea crosslaps-ului de 0.34±0.19 ng/ml. Între acești
parametrii, în grupurile studiate, a fost o diferență statistic semnificativă (p<0.05). Deși DMO la
nivel lombar și la nivelul șoldului pare să fie mai mare în grupul diabetic, nu a existat o diferență
statistic semnificativă între grupurile studiate. Femeile diabetice au prezentat valori plasmatice ale
25(OH)D mai mici decât femeile non-diabetice (18.65 vs 20.17 ng/ml), însă fără semnificație
statistică. Valorile magneziului au fost semnificativ mai mici în grupul diabetic comparativ cu
grupul non-diabetic. IMC a fost semnificativ mai mare la femeile cu diabet zaharat tip 2 (p<0.001).
În analiza bivariată, DMO s-a corelat pozitiv cu IMC doar în grupul femeilor diabetice.
Current data available places the osteoporosis near the other chronic complications of diabetes.
The mechanims by which type 2 diabetes affects bone metabolism are still debated. This study
was designed to evaluate the bone metabolism by using biochemical markers of bone turnover and
bone mineral density (BMD) in patients with type 2 diabetes and recently diagnosed type I
osteoporosis.
A retrospective study which included 120 women with postmenopausal osteoporosis: 60 women
with type 2 diabetes and 60 women without diabetes (non-diabetic group). Non-diabetic group was
matched for age. The analyzed variables were age, body mass index (BMI), magnesium, calcium,
alkaline phosphatase (ALP), fasting plasma glucose (FPG), serum levels of osteocalcin and
crosslaps, 25-hydroxy vitamin D (25(OH)D) and BMD using Dual-energy X-ray absorptiometry
(DXA).
The mean age of women was 64.21±8.01 years. In diabetic group the levels of osteocalcin were
22.26±14.49 ng/ml and crosslaps 0.34±0.19 ng/ml. Among these parameters it was a statistically
significant difference (p<0.05) in the studied groups. Although BMD at the lumbar spine and hip
seems to be higher in diabetic women, there was not statistically significant difference among the
studied groups. Diabetic women had a lower plasma 25(OH)D than nondiabetic women (18.65 vs
20.17 ng/ml) but not significant. Magnesium levels were significantly lower in diabetic group than
non-diabetic group. BMI was significantly higher in women with type 2 diabetes (p<0.001). In
bivariate analysis BMD correlates positively with BMI in the diabetic women.
Women with type 2 diabetes have a lower bone turnover than non-diabetic women and BMD
seems to underestimate the diagnosis of osteoporosis in diabetic group. Thereby markers of bone
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turnover could be potentially better candidates for the evaluation of osteoporosis in the diabetic
patients
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PS35. CONEXIUNEA PUNCTELOR CHEIE ÎN DIABETUL ZAHARAT SECUNDAR
Dr. Alexandra Nila1, Dr. Cristina Șerbănescu1, Dr. Sorina Martin1, Dr. Sorin Ioacara1, Prof.
Univ. Dr. Simona Fica1, Dr. Sergiu Bârsan1, Conf. Univ. Dr. Adrian Miron1
Spitalul Universitar de Urgenta Elias, Sectia Endocrinologie si Diabet, Bucuresti
Afecțiunile glandelor endocrine pot duce la toleranță alterată la glucoză sau diabet zaharat. Excesul
de hormon de creștere, de glucocorticoizi sau de catecolamine, hiperaldosteronismul primar,
hipertiroidismul, tumorile intestinale sau ale pancreasului endocrin pot reprezenta cauza toleranței
alterate la glucoză sau diabetului secundar.
Prezentăm cazul unui pacient de sex masculin în vârstă de 29 ani, diagnosticat la vârsta de 27 ani
cu diabet zaharat tip 2 în cursul unei evaluări de rutină. La diagnostic, pacientul avea un IMC
normal, istoric negativ personal sau familial de toleranță alterată la glucoză sau diabet zaharat.
Pacientul asocia hipertensiune arterială și migrene ocazionale însoțite de diaforeză. A primit
recomandări de dietă, tratament antidiabetic cu Metformin 1000 mg, tratament antihipertensiv cu
Nebivolol, Amlodipina și Candesartan. În ianuarie 2016, pacientul s-a prezentat la spital pentru
cefalee severă și criza hipertensivă (TA 260/ 160 mmHg). Examenul clinic a relevat IMC normal
(23.29 kg/m2), tahicardie (AV 120 bpm), hipertensiune arterială (210/ 170 mmHg). Paraclinic:
glicemie la prezentare 173 mg/dl, HbA1c 7.3% (56.3 mmol/mol), fără alte modificari ale analizelor
uzuale. Ecocardiografic, pacientul a fost diagnosticat cu hipertrofie ventriculară stângă
concentrică. În acest context s-a ridicat suspiciunea unei cauze endocrine de hipertensiune arterială
secundară și după o evaluare completă biologică și imagistică, pacientul a fost diagnosticat cu
feocromocitom (metanefrine plasmatice 56.8 pg/ml, normetanefrine plasmatice 2239.3 pg/ml, CT
abdominal: formatiune tumorală suprarenaliană dreaptă de 42/ 42/ 40 mm). S-a inițiat tratament
cu inhibitor alfa adrenergic central și blocant de canal de calciu și s-a intervenit chirurgical
(suprarenalectomie dreaptă laparoscopică). Postoperator, presiunea arterială și glicemia s-au
normalizat fără tratament. La externare, pacientul a fost instruit să-și automonitorizeze glicemia și
tensiunea arterială și să se prezinte pentru reevaluare peste 2 luni.
Patologiile endocrine pot reprezenta cauza unui diabet zaharat secundar și chiar și patologiile rare,
precum feocromocitomul, trebuie luate în considerare.
Premise și obiective: Principala formă de manifestare a afectării sistemului nervos periferic atât
în DZ de tip 1, cât și în DZ de tip 2 este reprezentată de polineuropatia diabetică senzitivo-motorie.
Obiectivul îl reprezintă studiul prezenței neuropatiei diabetice periferice senzitivo-motorii la un
lot de pacienți internați.
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Material și metodă: Au fost studiați un număr de 236 de pacienți din care 50% femei și 50%
bărbați, cu diabet zaharat, internați în Clinica de Diabet a Spitalului Clinic Județean de Urgență
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Craiova. Numărul de pacienți cu DZ tip 1 a fost de 30 (12,71%), iar cu DZ tip 2 au fost înregistrați
206 pacienți (87,29%). Vârsta medie la pacienții cu DZ tip 1 a fost de 39,76 ± 13,71 ani, iar la cei
cu DZ tip 2 a fost de 61,06 ± 10,58 ani. În ceea ce privește durata DZ, reținem: dintre pacienții cu
DZ tip 1, un număr de 14 (46,67%) au o durată a bolii ≤ 10 ani, 9 pacienți (30%) au o durată de
evoluție cuprinsă între 10 și 20 de ani, iar 7 (23,33%) au o durată de evoluție ≥ 20 ani; dintre
pacienții cu DZ tip 2, 121 (58,74%) au o durată de evoluție ≤ 10 ani, 68 (33,01%) au o durată de
evoluție cuprinsă între 10 și 20 de ani, respectiv 17 (8,25%) sunt cu o durată a DZ ≥ 20 ani. Pentru
studiul prezenței neuropatiei diabetice am utilizat scorul Toronto – neuropatie ușoară scor
Toronto=8-9, moderată=9-11, respectiv severă=12-19. Analiza statistica a fost realizata cu
programele Microsoft Excel si IBM SPSS Statistics 20.0, pentru procesarea datelor.
Rezultate și discuții: Neuropatia diabetică forma severă este prezentă la 66,67% dintre subiecții
cu vechimea DZ peste 20 de ani (p=0,022). Neuropatie diabetică forma ușoară este prezentă în
grupa de vârstă 50-59 ani la 56,25% dintre subiecți, neuropatia diabetică forma moderată la
43,55% în aceeași categorie de vârstă, respectiv 33,87% dintre subiecți la grupa de vârstă 60-69
ani. Neuropatia diabetică forma severă este prezentă la 30,68% dintre subiecți cu vârsta cuprinsă
între 60-69 ani, respectiv 27,27% dintre subiecții cu vârsta peste 70 de ani. La 57,95% dintre
subiecții cu neuropatie diabetică severă este prezentă hiperkeratoza. 7,95% dintre subiecții cu
neuropatie diabetică severă au suferit amputații.
Concluzii: Severitatea neuropatiei diabetice este direct proporțională cu vechimea DZ (p=0,022).
Există o diferență semnificativă statistic în ceea ce privește severitatea neuropatiei în funcție de
vârsta pacienților (p=0,012). De asemenea, s-a înregistrat o diferență semnificativ statistic în ceea
ce privește asocierea hiperkeratozei cu severitatea neuropatiei (p=0,047). În ceea ce privește
asocierea neuropatiei diabetice severe cu amputațiile, există o diferență semnificativă din punct de
vedere statistic (p=0,033).
Background and objectives: The main manifestation of peripheral nervous system damage in
both type 1 diabetes and type 2 diabetes is represented by diabetic sensory-motor polyneuropathy.
The objective is to study the presence of diabetic sensory-motor peripheral neuropathy in a group
of hospitalized patients.
Material and method: A total of 236 patients were studied, of which 50% women and 50% men,
with diabetes, hospitalized in the Diabetes Department of the Emergency County Hospital Craiova.
The number of patients with type 1 diabetes was 30 (12.71%) and with type 2 diabetes there were
registered 206 patients (87.29%). The average age in patients with type 1 diabetes was 39.76 ±
13.71 years, while those with type 2 diabetes was 61.06 ± 10.58 years. Regarding the duration of
diabetes, we remember: among the patients with type 1 diabetes, 14 (46.67%) have a duration of
the disease ≤ 10 years, 9 patients (30%) have a duration of evolution between 10 and 20 years, and
7 (23.33%) have a duration of ≥ 20 years; among the patients with type 2 diabetes, 121 (58.74%)
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of diabetic neuropathy we used the Toronto score – mild neuropathy Toronto score=8-9, moderate
neuropathy=9-11, respectively severe neuropathy=12-19. Statistical analysis was performed using
Microsoft Excel and IBM SPSS Statistics 20.0 for processing the data.
Results and discussions: The severe form of diabetic neuropathy is present in 66.67% of subjects
with the duration of diabetes over 20 years (p=0.022). The mild form of diabetic neuropathy is
present in the 50-59 age group, at 56.25% of the subjects, moderate form of diabetic neuropathy
at 43.55% in the same age category, respectively at 33.87% of the subjects in the 60-69 age group.
The severe form of diabetic neuropathy is present in 30.68% of the subjects aged between 60-69,
respectively 27.27% of the subjects aged over 70. At 57.95% of the subjects with severe diabetic
neuropathy is present hyperkeratosis. 7.95% of the subjects with severe diabetic neuropathy
suffered amputations.
Conclusions: The severity of diabetic neuropathy is directly proportional with the duration of
diabetes (p=0.022). There is a statistically significant difference regarding the severity of
neuropathy according to the age of patients (p=0.012). Also, a statistically significant difference
has been recorded regarding the association of hyperkeratosis with the severity of the neuropathy
(p=0.047). Regarding the association of severe diabetic neuropathy with amputations, there is a
statistically significant difference (p=0.033).
other causes of proteinuria were excluded.The statistical software SPSS 20.0 was used for data
analysis .
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Results: Out of 71 cases 32(45,1%) were male and 39(54,9%) were female. Average age of
patients was 54,8 years and maximum duration of diabetes was 6 months.Prevalence of
microalbuminuria was 25 out of 71 patients.The present study identifies that the risk of
microalbuminuria increases with HbA1c ((r=0,257, p=0,031) and is lineary corelated. Persistent
increase in glycated haemoglobin and microalbuminuria may be considered as risk markers in
cardiovascular and chronic kidney disease. Therefore, regular screening for microalbuminuria and
HbA1c estimation can help in clinical management to prevent complications.
Conclusion: Screening for microalbuminuria and HbA1c should be done both in newly and
already diagnosed type 1 and 2 diabetic patients albuminuria being an useful early biomarker of
renal dysfunction and glycemic control.
effects.
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PS39. SONOGRAPHIC PANCREAS CHANGES IN PATIENTS WITH PANCREATIC
SECONDARY DIABETES.
Material and Methods: We included 59 patients diagnosed with chronic pancreatitis and
secondary diabetes mellitus, admitted in Gastrology II Department of Fundeni Clinical Institute,
and “N.C. Paulescu’’ Diabetes Institut, Bucharest. The study was retrospective. In each patient,
demographic parameters, family and personal history were recorded. All patients were initially
evaluated by transabdominal ultrasound. In selected cases other imagistic methods were used:
computer tomography, endoscopic ultrasound (EUS) and endoscopic retrograde
cholangiopancreatography (EUS-FNA).
Results: Patients age in the studied group ranged between 18 and 81 years with a mean age of
54.14 years (SD=11.75) The most frequent presenting symptom was abdominal pain (85,2%),
followed by denutrition (25.5%), steatorrhea (14.8%), weight loss (4,4%) , and flatulence. The
most frequent etiologic factor of chronic pancreatitis in the studied group was alcohol abuse
(87,8%) and smoking (85.1%). Using ultra sounds imaging methods the following complications
of chronic pancreatitis were diagnosed in the studied group: pancreatic calcifications (59,7%),
Wirsung dilations (49,3%), and Wirsung gallstones (15,3%), complicated or uncomplicated
pseudocysts (38.%), pancreatic cancer (10.2%).
Resident Andrada-Larisa Pasc1, Resident Adelina Micheu1, Dr. Mariana Roman1, Prof. Dr.
Ionela Maria Pașcanu1
Emergency Clinical County Hospital of Tirgu Mures
Pacienții cu boala Cushing prezintă un risc crescut de a dezvolta tulburări ale metabolismului
glucidic secundar secreției crescute de cortizol. Pasireotid este un analog de somatostatină utilizat
pentru tratarea bolii Cushing când tratamentul chirurgical este contraindicat sau când sunt prezente
recidive. Principalul efect advers al terapiei este hiperglicemia și dezvoltarea diabetului zaharat
secundar.
Pacientă în vârstă de 49 ani, internată în Compartimentul de Endocrinologie al Spitalului Clinic
Județean Mures, diagnosticată cu boala Cushing pentru care se intervine chirurgical-
adenomectomie transsfenoidală. Postoperator se evidențiază paraclinic persistența
hipercorticismului și se începe tratamentul cu Pasireotid. La o lună de la inițierea terapiei, pacienta
prezintă valori crescute ale glicemiei fiind îndrumată către specialistul diabetolog.
Pe baza datelor prezentate anterior pacienta începe tratamentul antidiabetic cu Metformin, cu
creșterea progresivă a dozei. Datorită controlului glicemic nesatisfăcător, se asociază Saxagliptina.
După 3 luni de dublă terapie, HbA1C este în afara obiectivelor și se optează pentru înlocuirea
Saxagliptinei cu Exenatidă. Cazul prezentat e în concordanță cu studiile publicate în reviste de
specialitate în ceea ce privește eficiența tratamentului cu Pasireotid în boala Cushing și apariția
hiperglicemiei la acești pacienți.
Toți pacienții cu boală Cushing pot dezvolta tulburări ale metabolismului glucidic, iar în cazul
celor tratați cu Pasireotid riscul este amplificat, hiperglicemia observându-se la aproximativ 43%
din pacienți. Ținând cont de mecanismele fiziopatologice care determină apariția hiperglicemiei
în cazul acestor pacienți, în tratamentul diabetului zaharat se optează inițial pentru Metformin,
apoi inhibitori de DPP4, analogi de GLP-1 și în final insulină. Acest lucru atrage atenția asupra
monitorizării acestor pacienți prin efectuarea de controale regulate și tratament corespunzător.
Dr. Popa Adina1, Dr. Firănescu Adela1, Dr. Voicu Andreea1, Soare Mariana1, Simion
Floriana Maria1, Țuiu Daniela1, Șef Lucr. Popa Simona Georgiana1, Prof. Univ. Dr. Moța
Maria1
Spitalul Clinic Judetean de Urgente Craiova
Premise și Obiective: Impactul diabetului zaharat (DZ) asupra celor mai multe organe a fost
studiat intens de-a lungul anilor, dar pielea, cel mai mare organ al corpului, nu a fost subiectul a
multe studii. Astfel, am propus un studiu care să analizeze leziunile cutanate la subiecții cu DZ.
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Clinic Județean de Urgență Craiova, România. Datele clinice și toate datele de laborator au fost
înregistrate la toți subiecții. Analiza statistica a fost realizata cu programele Microsoft Excel
(Microsoft Corp., Redmond, WA, USA) impreuna cu extensia XLSTAT pentru MS Excel
(Addinsoft SARL, Paris, France) si IBM SPSS Statistics 20.0 (IBM Corporation, Armonk, NY,
USA).
Rezultate și Discuții: Din totalul pacientilor luati in studiu, 118 au fost femei (50%) și 118 au fost
bărbați (50%), 30 (12,71%) dintre aceștia cu DZ tip 1, iar 206 (87,29%) subiecți cu DZ tip 2. Un
număr de 208 subiecți (88,14%) au prezentat leziuni cutanate. 18 subiecți (66,67%) cu DZ tip 1
au prezentat leziuni cutanate, în timp ce acestea au fost prezente la 188 subiecți (91,26%) cu DZ
tip 2, procent semnificativ statistic mai mare (p<0.001). Cele mai frecvente leziuni în rândul
populației studiate au fost: hipercheratoza plantara (49,15%), onicodistrofia (44,49%),
lipodistrofia (13,98%), carotenodermia (11,02%), intertrigo (6,36%). Ulcerul neuropat a fost
prezent la 2,12% dintre subiecți. Alte leziuni întâlnite la subiecții sutidiați au fost faciesul eritrozic,
fisuri, vitiligo, pitiriaziz, dermopatie diabetica, dermita seboreica, dermita de staza, xantelasme,
neurofibromatoza, ihtioza, granulom inelar, vergeturi. Deși literatura de specialitate descrie
asocierea dintre DZ și acanthosis nigricans ca fiind frecventa, niciunul dintre subiecții incluși în
studiu nu au prezentat acest tip de leziune. Cei mai mulți pacienți (62,7%) au prezentat asocierea
a cel puțin 2 tipuri de leziuni. Am observat o corelație semnificativă statistic între prezența
leziunilor și durata DZ tip 2 (p<0,05).
Concluzii: Pielea este de multe ori sediul unor leziuni la subiecții cu DZ. Studiul nostru confirmă
procentul înalt al leziunilor cutanate în DZ, precum și prevalența mai mare a acestora în rândul
subiecților cu DZ tip 2.
Dr. Popa Adina1, Dr. Firănescu Adela1, Dr. Voicu Andreea1, Soare Mariana1, Simion
Floriana Maria1, Țuiu Daniela1, Dr. Popa Simona Georgiana1, Prof. Dr. Moța Maria1
Emergency Clinical Hospital Craiova
Premises and Objectives: The impact of diabetes mellitus (DM) on most of the organs was largely
discussed over the years, but skin, which is the largest organ, was not the object of many studies.
Therefore, we designed a study to analyze the cutaneous manifestations in patients with diabetes.
Content and Method: We conducted an observational study of cutaneous manifestation in 236
subjects with DM consecutively hospitalized in the Clinic of Diabetes Nutrition and Metabolic
Diseases of the Emergency County Hospital of Craiova, Romania in 2016. Clinical findings
together with all the laboratory investigations were recorded for each case. Data were analyzed
using Microsoft Excel and SPSS software. Statistical analysis was performed using Microsoft
Excel (Microsoft Corp., Redmond, WA, USA), together with the XLSTAT add-on for MS Excel
(Addinsoft SARL, Paris, France) and IBM SPSS Statistics 20.0 (IBM Corporation, Armonk, NY,
USA) for processing the data.
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Results and Discussions: We examined 236 subjects, 118 females (50%) and 118 males (50%),
of them 30 (12.71%) having type 1 DM and 206 (87.29%) having type 2 DM. A number of 208
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subjects (88.14%) presented skin lesions. 18 subjects (66.67%) with type 1 DM presented
cutaneous manifestations, while in type 2 DM these lesions were present in 188 subjects (91.26%),
a number statistically significant higher (p<0.001). The most common skin lesions in our study
population were: hyperkeratosis (49.15%), onycodystrophy (44.49%), lipodystrophy (13.98%),
carotenaemia (11.02%), intertrigo (6.36%). Neuropathic ulcers were present in 2.12% of the
subjects. Other lesions observed in the studied patients included: facial erythrosis, skin fissures,
vitiligo, pityriasis, diabetic dermopathy, seborrheic dermatitis, stasis dermatitis, xanthelasma,
neurofibromatosis, ichthyosis, granuloma annulare, striae distensae. Although in the literature DM
is frequently associated with acanthosis nigricans, none of the evaluated subjects presented this
type o lesion. Most of the patients (62.7%) presented a combination of at least two types of lesions.
We found a statistically significant correlation between skin lesions presence and Dm duration
(p<0.05).
Conclusions and Findings: In DM, skin is affected in high percentage. In our study, as described
in the literature, higher prevalence of cutaneous manifestations was met in type 2 DM.
Dr. Popa Alexandru Sebastian1, Dr. Culman Mirela1, Dr. Steriade Oana1, Dr. Matei Monica1
INDNBM "Nicolae Paulescu", Bucuresti
Premise: Pe lângă rolul în îmbunătățirea profilului glicemic, în anumite cazuri, Exenatida reduce
răspunsul inflamator și stresul oxidativ prin suprimarea căii MAPK-protein kinazei mitogen
activate, prin scăderea nivelului citokinelor inflamatorii (TNF-alfa, IL-1B și IL-6), precum și prin
creșterea rolului antiinflamator al adiponectinei. Aceste efecte sunt non-dependente de controlul
glicemic sau de greutatea corporală.
Obiective: Argumente clinice în favoarea efectului antiinflamator al Exenatidei și punct de plecare
pentru studiul altor indicații ale acestei clase terapeutice.
Cazul 1
Pacientă în vârstă de 50 de ani, cu diabet zaharat tip 2 în evoluție de aproximativ 5 ani,cu obezitate
gr I, HTA și hernie de disc operată, în tratament de 4 ani cu Exenatidă 10 μg în 2 prize pe zi și 24
u insulin Glargin seara, se internează în Secția de Diabet pentru acutizare de boală renală prin
infecție urinară cu E. Coli. Pacienta a fost diagnosticată cu spondilită ankilozantă la vârsta de 19
ani, pentru care a primit corticoterapie timp de 8 ani, și pe tot parcursul acestui tratament, AINS
în doze mari, infiltrații cu dexametazonă, fizio și kinetoterapie. Asocierea dintre spondilita
ankilozantă, obezitate, diabet zaharat tip 2 insulinonecesitant, hernie de disc operată și HTA a
impus un management terapeutic care să asigure concomitent scăderea sigură în greutate pentru
descărcarea coloanei și aparatului osteo-articular afectat de spondilită, ameliorarea controlului
metabolic pe toate liniile și un control mai bun al tensiunii arteriale.
Rezultate și discuții: La internarea actuală, HbA1c: 7.2 %. De la inițierea tratamentului cu
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Exenatidă și insulină bazală, a scăzut în greutate 19 kg. Declară că de la bun început și nu după ce
a scăzut în greutate, a constatat ameliorarea semnificativă a simptomatologiei specifice spondilitei
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Cazul 2.
Pacientă în vârstă de 61 de ani cu diabet zaharat tip 2 în evoluție de 16 ani, poliartrită reumatoidă
de 11 ani, HTA, obezitate gr. 2, BCI cu BRS, polineuropatie diabetică senzitivă distală, sub
tratament cu Metformin 850 mg 2cp/zi se prezintă în ambulatoriul de specialitate pentru valori
glicemice postprandiale crescute, astenie fizică, dureri poliarticulare invalidante, pentru calmarea
cărora folosește zilnic AINS. Pentru poliartrita reumatoidă se află în tratament cu Plaquenil. Acuză
gonalgii bilaterale (8/10), durere la nivelul articulațiilor metacarpofalangiene și interfalangiene și
dureri la mobilizarea articulației umărului bilateral. Echilibrul glicemic este satisfăcător cu HbA1c
de 7,2%. Asocierea dintre poliartrita reumatoidă cu dureri invalidante și limitarea mișcărilor, cu
diabet și obezitate determină risc de injurie renală prin dozele mari de AINS utilizate și necesită o
abordare care să permită pe cât posibil ameliorarea simptomatologiei dureroase fără a se recurge
la AINS, concomitent cu scăderea în greutate și îmbunătățirea controlului metabolic. Se inițiază
tratamentului cu analog de GLP-1 cu durată lungă de acțiune (Exenatidă LAR 2 mg o
injecție/săptămână ), cu menținerea dozei de Metformin.
Rezultate și discuții: Revenită pentru evaluare la 9 luni de la inițierea Exenatidei LAR pacienta
declară o netă ameliorare a simptomatologiei, cu scădere ponderală de 7 kg, cu dispariția durerilor
din articulațiile mici și umărului, ameliorarea gonalgiilor (5/10), cu recăpătarea autonomiei de
mișcare. Echilibrul glicemic este optim cu HbA1c de 6,5%, fără hipoglicemii.
Efectul așteptat a însemnat o scădere în greutate de 7 kg în 9 luni.
Efectul neașteptat - amelioarea poliartralgiilor, inclusiv la nivelul articulațiilor care nu sunt
solicitate de greutatea corporală, nemaifiind necesară administrarea de AINS.
Este dispariția durerilor din articulațiile mici un efect independent de scăderea în greutate?
Concluzii: Ambele paciente declară că au constatat o ameliorare netă a poliartralgiilor de la
instituirea tratamentului cu Exenatidă. De la anumite categorii de pacienți, se acumulează din ce
în ce mai multe date concordante cu privire la beneficiile nonglicemice ale tratamentului cu
agoniști ai receptorilor de GLP-1 asociați sau nu cu insulină bazală. Pe lângă rolul în îmbunătățirea
profilului glicemic, în anumite cazuri, aceștia se pare că au un important efect antiinflamator.
Astfel, ne putem aștepta ca, pe viitor, să asistăm la apariția de noi indicații pentru această clasă de
medicamente.
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CASE STUDY: THE ANTI-INFLAMMATORY EFFECT OF EXENATIDE
Dr. Popa Alexandru Sebastian1, Dr. Culman Mirela1, Dr. Steriade Oana1, Dr. Matei Monica1
INDNBM "Nicolae Paulescu", Bucuresti
Background: In addition to its role in improving glycemic profile, in some cases, Exenatide seem
to have an anti-inflammatory effect. This is supported by several studies which demonstrate that
the Exenatide reduces the inflammatory response and oxidative stress by suppressing the MAPK
pathway (mitogen activated protein kinase) by reducing the level of inflammatory cytokines (TNF-
alpha, IL-1 and IL-6), and by increasing anti-inflammatory role of adiponectine. These effects are
non-dependent on glycemic control and body weight.
Objectives: Clinical arguments in favor of anti-inflammatory effect of Exenatide and starting
point for studying other indications of this therapeutic class.
Material and Methods: two presentations of clinical cases
Case 1
A 50 years old woman with type 2 diabetes evolving for about 5 years, with gr I obesity, AHT
with surgery for herniated disc in treatment for 4 years with Exenatide 10 mg in 2 doses per day
and 24 U of insulin Glargine evening, is hospitalized in Diabetes Department for acute kidney
injury by E. coli urinary infection. She was diagnosed with ankylosing spondylitis at the age of
19, he received corticosteroids for 8 years, and high doses of NSAIDs, Dexamethasone
infiltrations, physio and physical therapy. The association between ankylosing spondylitis,
obesity, type 2 diabetes, herniated disc surgery and AHT imposed special therapeutic management
to ensure simultaneous decrease of weight in order to download column and osteoarticular system,
to improve all lines of metabolic and hypertension control.
Results and discussions: The initiation of treatment with Exenatide and basal insulin produced a
weight loss of 19 kg. The current HbA1c is 7.2%. From the beginning and not after weight loss,
she found significant improvement of specific spondylitis symptoms and no longer requires the
use of NSAIDs, infiltration or kinesiology.
The expected effect was the progressive decrease in weight. The unexpected effect was the
disappearance of spondylitis specific pain.
Given the comorbidities association with stage 2 chronic kidney disease, which impose the
avoidance of NSAIDs, we decided to keep the treatment (Exenatide and Glargine) as the patient
feels better.
Is it the disappearance of pain an independent effect of weight loss?
Is the combination of insulin and Exenatide more effective in relieving inflammation and oxidative
stress than each of them independently?
Case 2
A 61 years old woman with type 2 diabetes evolving for about 16 years, with rheumatoid arthritis,
hypertension, gr 2 obesity, CID with LBB, diabetic polyneuropathy, treated with metformin 850
mg 2cp/day came in our ambulatory center for increased postprandial glycemia, asthenia,
debilitating joint pain, with daily NSAIDs use to relieve. Rheumatoid arthritis was treated with
Plaquenil. She complains of pain, of the metacarpophalangeal, interphalangeal and knee joints
(8/10) and bilateral pain to shoulder mobilization. The glycemic control was satisfactory - HbA1c
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7.2%. The association between rheumatoid arthritis with debilitating pain and limitation of
movements, diabetes and obesity compose a risk of kidney injury by using high doses of NSAIDs
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and requires a terapeutical approach to ensure simultaneously weight loss, improved metabolic
control and if it is possible, relieve of pain. The treatment was initiated with GLP-1 analog with
long duration of action (Exenatide LAR, 2 mg injection / week), while maintaining the dose of
Metformin.
Results and discussion In the evaluation of 9 months from the initiation of Exenatide LAR our
patient noted a net improvement of symptoms with 7 kg weight loss, the disappearance of small
joints and shoulder pain, improving of knee pain (5/10) with regaining movement independence.
The glycemic control was optimal - HbA1c 6.5% without hypoglycemia.
The expected effect was a 7 kg weight loss in 9 months, with optimal metabolic control.
The unexpected effect was relief of polyarthralgias, including the body weight loaded joints.
Is the disappearance of pain in small joints an independent effect of weight loss?
Conclusions: Both patients have noted a net improvement in pain after the initiation of Exenatide.
From certain patient, the medical practice accumulates increasingly more consistent data on the
nonglycemic benefits of treatment with GLP-1 receptor agonists associated or not with basal
insulin. Besides the role in improving glycemic profile, in some cases, GLP-1 receptor agonists
seem to have an anti-inflammatory effect. Thus, we can expect in the future to witness the
emergence of new indications for this class of drugs.
Dr. Popa Alexandru Sebastian1, Dr. Culman Mirela Ioana1, Dr. Sirotencu Edith1
INDNBM "Nicolae Paulescu’’, Bucureşti
Premise şi obiective. Prezentarea de caz are ca scop evidenţierea unei posibile legături între
diabetogeneză şi ciroza hepatică decompensată. În cazul de faţă, înlocuirea, prin transplant, a
ficatului cirotic cu unul sănătos, a determinat ameliorarea profilului glicemic si scăderea
importantă a necesarului de insulină.
Material şi metodă. Pacient în vârstă de 55 de ani, cu diabet zaharat în evoluţie de aproximativ 3
ani, insulinotratat de la debut, se internează pentru multiple hipoglicemii nocturne apărute în
ambulator. Nu are antecedente heredocolaterale de diabet. În urmă cu un an, pacientul a beneficiat
de un transplant hepatic pentru ciroză hepatică de etiologie mixtă - virală (VHB + D) şi toxic-
nutriţională (consum de etanol şi expunere la mercur), decompensată vascular şi parenchimatos,
clasa Child C. Înainte de transplant, pentru echilibrarea diabetului au fost necesare 73 U insulină/zi,
(0.86 U/kg corp/zi), iar la o lună după transplant necesarul a scăzut la 32 U insulină/zi (0.42 U/kg
corp/zi). La internarea actuală, pacientul se prezintă cu frecvente hipoglicemii la domiciliu, pe o
schemă bazal-bolus cu analogi de insulină totalizând 29 U insulină/zi, (0.3 U/kg corp/zi).
Biochimic: HbA1c = 6.7%, Bilirubina directă = 0.41 mg/dL, Bilirubina totală = 1.09 mg/dL, fără
alte elemente patologice. Frecvenţa hipoglicemiilor constatate pe parcursul internării a impus
renunţarea la doza de seară de analog rapid de insulină, iar echilibrarea metabolică s-a realizat în
regim Bazal + +, doar cu 10 U insulină/zi (0.1 U/kg corp/zi).
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Dr. Popa Alexandru Sebastian1, Dr. Culman Mirela Ioana1, Dr. Sirotencu Edith1
INDNBM "Nicolae Paulescu’’, Bucureşti
Background and objectives. This case report has the purpose of highlighting a possible
connection between diabetogenesis and decompensated liver cirrhosis. The replacement, by
transplantation, of the cirrhothic liver with a healthy one, determined an improvement of the
glycemic profile and an important decrease of insulin requirment.
Material and method. A pacient, at the age of 55, with diabetes mellitus evolving for about 3
years, insulin-treated from the beginning, is hospitalized for multiple nocturnal hypoglicemia. He
doesn’t have family history of diabetes mellitus. A year ago, the patient had a liver transplant for
cirrhosis of mixed ethyology – viral (VHB + D) and toxic-nutritional (alcohol comsumption and
exposure to mercury). The liver disease was decompensated vascular and parenchymal, class Child
C. Before the liver transplant, for balanced glycemic values, the patient needed 73 Units of insulin
(0.86 U/kg body), but after the transplantation, he only required 32 Units of insulin (0.42 U/kg
body/day). At the current hospitalization, the patient complains about frequent hypoglicemia at
home, using a basal-bolus scheme with insulin analogues totalizing 29 Units (0.3 U/kg body/day).
Biochemical values: HbA1c = 6.7%, Direct bilirubin = 0.41 mg/dL, Total bilirubin = 1.09 mg/dL,
without other pathological values. The frequency of hypoglicemia during hospitalization imposed
quitting the evening dose of rapid acting insulin analogue, the metabolic balanced being realised
with a Basal + + insulin regimen totalizing 10 Units of insulin / day (0.1 U/kg body/day).
Results and discussions. This case shows the physiopathologycal connection between
diabetogenesis and decompensated liver cirrhosis. Once the cirrhotic liver is replaced, we observe
a dramatic improvement of the metabolic balance. In this case, after an year from the liver
transplantation, the insulin requirment decreased 8 times. This is even more relevant if we consider
that the immunosuppressive treatment used after the transplantation (tacrolimus, cyclosporine and
corticosteroids) is known for beign diabetogenic. It would be very interesting to find out if the
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hyperglicemia after the replacement of the liver is caused by the immunosuppressive treatment. If
this hypothesis would be true, we would be facing a case of hepatogenic diabetes, in which the
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central role of the disease is the liver, not the pancreas, but which is not yet accepted as a distinct
clinical entity. Unfortunately, to make this distinction, we would have to stop the
immunosuppressive treatment, this being impossible, because it would raise the risk of transplant
rejection very much.
Conclusions. The dramatic improvement of the glycemic values, and the important decrease of
insulin requirment after the liver transplant, support the hypothesis that, in cirrhosis, the center of
insulin resistance is the liver.
Dr. Popescu Simona1, Dr. Timar Bogdan1, Dr. Diaconu Laura1, Dr. Timar Romulus1
1
Universitatea de Medicină și Farmacie ˶Victor Babeș̋ Timișoara
Premise și obiective: La ora actuală asistăm la o adevărată epidemie a bolilor metabolice, fapt
reflectat de creșterea alarmantă a incidenței diabetului zaharat (DZ) tip 2. Una dintre cele mai
frecvente complicații cronice ale DZ e reprezentată de polineuropatia senzitivă simetrică distală
(PSSD). Aceasta reprezintă o cauză majoră de morbiditate și mortalitate în rândul paciențiilor cu
DZ.
Scopul studiului nostru este să evaluam impactul PSSD asupra psihiculi pacientului cu DZ tip 2.
Material și metodă: lotul nostru de studiu a cuprins un număr de 198 de pacienți, diagnosticați
anterior cu DZ tip 2. PSSD a fost diagnosticată pe baza criteriilor instrumentului de scor Michigan.
Am considerat diagnosticul de PSSD, dacă a fost prezent oricare criteriu din următoarele: scor
total ≥ 9,5 sau scor la evaluarea subiectivă ≥ 7 sau scor la examenul obiectiv ≥ 2,5. Cu cât valoarea
acestui scor a fost mai mare, cu atât PSSD a fost considerată mai severă. Depresia am evaluat-o
cu ajutorul chestionarului PHQ 9. Am considerat că un scor < 14 corespunde absenței depresiei,
un scor între 15- 19 reprezintă depresie moderată, iar un scor ≥ 20, depresie severă.
Rezultate și discuții: în grupul nostru de studiu depresia, evaluată cu ajutorul chestionarului PHQ
9 a avut următoarea distribuție: depresie absentă 29,8% (59 pacienți), depresie moderată 52,5%
(104 pacienți) iar depresia severă a fost întâlnită la 17,7% (35 pacienți). Prevalența PSSD, în lotul
nostru de studiu a fost de 28,8%.
Prevalența depresiei a fost semnificativ mai crescută în rîndul paciențiilor cu PSSD, comparativ
cu grupul fără PSSD (77,2% vs 67,4%, p<0,001). Iar în ceea ce privește severitatea depresiei:
prevalența depresiei severe a fost mai mare în rândul pacienților cu PSSD 36,8%, comparativ cu
pacienții făra PSSD, 9,9%.
Concluzii: am observat o corelație moderată, directă și semnificativă statistic, între severitatea
PSSD și severitatea depresiei. Între cele două exista un coeficient de corelație Sperman de 0,495,
căruia îi corespunde o valoare p<0,001. Această corelație directă sugerează că pacienții cu PSSD
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mai severă, de regulă vor avea simptomatologie mai pregnantă în legătură cu depresia.
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IMPACT OF DISTAL SYMMETRIC POLYNEUROPATHY ON THE PSYCHIC OF
TYPE 2 DIABETES PATIENTS
Dr. Popescu Simona1, Dr. Timar Bogdan1, Dr. Diaconu Laura1, Dr. Timar Romulus1
1
Universitatea de Medicină și Farmacie ˶Victor Babeș̋ Timișoara
Alina Gabriela Prefac1, Ana Maria Busneag1, Ramona Maria Drăguț2, Cristina Stoian1,
Florentina Stoicescu1, Emilia Rusu2, Gabriela Radulian1,2
1.
Institutul Național de Diabet Nutriție și Boli Metabolice "N Paulescu"
2.
Universitatea de Medicină si Farmacie “Carol Davila”
Premize și Obiectie: Steatoza hepatică (SH) are o prevență crescută la pacienții cu diabet zaharat
tip 2, însă consecințele sale metabolice nu sunt pe deplin cunoscute. Acest studiu are ca obiectiv
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Alina Gabriela Prefac1, Ana Maria Busneag1, Ramona Maria Drăguț2, Cristina Stoian1,
Florentina Stoicescu1, Emilia Rusu2, Gabriela Radulian1,2
1.
Institutul Național de Diabet Nutriție și Boli Metabolice "N Paulescu"
2.
Universitatea de Medicină si Farmacie “Carol Davila”
Premises and objectives: Hepatic steatosis has a high prevalence in patients with type 2 diabetes
mellitus, however its metabolic consequences are not fully known. This study aims to evaluate the
prevalence of hepatic steatosis in patients with type 2 diabetes mellitus and the relationship with
the metabolic syndrome components.
Material and method: This cross-sectional, observational study was held in the National Institute
of Diabetes, Nutrition and Metabolic Diseases "Prof. N. Paulescu" and included 200 patients with
type 2 diabetes mellitus (67.5% men) with average age = 61.38 ± 10.51 years. We followed
anthropometric indices (weight, height, waist circumference, (Body Mass Index) BMI).
Biochemical parameters were: fasting blood glucose, glycosylated hemoglobin, lipid profile, liver
profile and complete blood count. Hepatic steatosis was diagnosed using ultrasonography.
Metabolic syndrome (MS) was defined according to the 2005 IDF criteria.
Results and discussions: Of the 200 patients, 32.5% had hepatic steatosis, and of these, 67.7%
were male. Of the 65 patients with hepatic steatosis, 44 patients were treated with insulin. 86.2%
of the patients with hepatic steatosishad hypertension, 76.9% were obese (BMI> 30 kg / m2),
53.8% of patients with hepatic steatosis had low values of HDL cholesterol and 60% of them had
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high values of triglycerides. 96.9% of the patients with metabolic syndrome associated with
hepatic steatosis, had the abdominal circumferences much higher than those without hepatic
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steatosis (p = 0.002). Ischemic heart disease was present in a proportion of 38.5%. No differences
were found in terms of metabolic control (HbA1c had a mean valueof 8.92 ± 1.86% in patients
with hepatic steatosis towards8.84 ± 2.06% in those without hepatic steatosis).
Conclusions: Metabolic syndrome was frequently associated with hepatic steatosis. Hepatic
steatosis could be considered as a component of the metabolic syndrome in diabetic patients.
Assoc. Prof. Puiu Ileana1, Prof. Niculescu Carmen1, Assist. Marinau Laura1, Assist. Dop
Dalia1, Senior Lect. Singer Cristina1, Rezident Puiu Alexandra Oltea1
Univesrsity of Medicine and Pharmacy Craiova
Cataract is a very rare disease during childhood, with a prevalence of under 1% in children with
diabetes, although it is common in adults with diabetes. The risk factors of cataract in children
with diabetes are: adolescence, history of long lasting hyperglycemia, diabetic ketoacidosis at
onset, high level of HbA1c at onset and, possibly, genetic factors.
Authors present the case of a 14-year-old boy admitted in Pediatric Clinic from Craiova in January
2016. The boy had a weight of 44 kg, height of 168 cm, BMI 15, previously healthy, with history
of type 2 diabetes in the family. Immediately after being diagnosed with type 1 diabetes, he was
also diagnosed with acquired bilateral cataract. Four weeks before admission, the adolescent
presented classical symptoms of diabetes: polyuria, polydipsia, severe weight loss. At admission,
the adolescent showed signs of severe diabetic ketoacidosis. Biological tests revealed the
following values: glycemia 900mg%, HbA1c 16,4%, C Peptide 0.223 ng/ml. The patient presented
blurred vision immediately after admission and posterior bilateral subcapsular cataracts was
diagnosed by ophthalmological examination; fundus examination revealed no abnormalities. The
patient currently has good glycemic control and is monitored by the pediatric and ophthalmologic
departments.
In patients newly diagnosed with type 1 diabetes, acute bilateral cataract can appear at onset of
diabetes or in a few weeks or months after being diagnosed. Visual symptoms are caused by the
hyperosmotic effect in the lens, due to long-term hyperglycemia. Catarct severity can vary from
mild forms to total loss of vision in a few days.
The presence of blurred vision at the child with type 1 diabetes in the first weeks or months after
diabetes onset should warn us of possible cataract and the need for a complete ophthalmological
examination. Although it is a rare diagnosis, early discovery and surgical treatment are essential
in order to prevent vision loss. However, scientific research mentions that when cataract appears
at diabetes onset, in some patients regression can be achieved after insulin treatment and if good
glycemic control is maintained.
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PS47. TRECEREA CU SUCCES PE SUFLONILUREICE LA O PACIENTĂ ÎN VARSTA
DE 9 ANI CU RETARD DE DEZVOLTARE NEUROPSIHICĂ, EPILEPSIE ȘI DIABET
ZAHARAT NEONATAL - SINDROM DEND
Dr. Purcaru Mircea1, Dr. Mintici Luana1, Dr. Herescu Irina1, Dr. Ioacara Sorin1, Prof. Dr.
Fica Simona1
1
Spitalul Universitar de Urgenta Elias
Sindromul DEND este o patologie foarte rară (<1/1.000.000), și reprezintă cea mai severă formă
de diabet zaharat neonatal permanent. Patologia este caracterizată prin retard de dezvoltare
neuropsihica, epilepsie de obicei rezistentă la tratamentul antiepileptic și diabet zaharat neonatal.
Acesta este cauzat cel mai adesea de o mutație aparută la nivelul genelor KCNJ11 / ABCC8 care
codează subunitatea Kir 6.2 și respectiv SUR1, de la nivelul canalului de K ATP-dependent.
Prezentarea cazului: Pacientă în vârstă de 9 ani și 11 luni, diagnosticată cu diabet zaharat
neonatal la varsta de 3 luni se prezintă pentru crize repetate de absenteism neînsoțite de
hipoglicemie, care în ultimile 2 luni au interferat semnificativ cu buna desfășurare a activităților
cotidiene, interpretate ca epilepsie minora, cu solicitarea sprijinului în vederea inițierii
tratamentului specific neurologic. Din anamneza reținem că după diagnosticarea diabetului a fost
tratată inițial cu insulinoterapie timp de 6 luni, urmat de tratament cu antidiabetice orale
(glibenclamid), timp de 8 ani, și de un an are insulinoterapie bazal bolus, inițiat în ianuarie 2015
pentru hiperglicemie persistentă cu HbA1c=10,6% (fără glibenclamid). De asemenea, prezintă și
retard de dezvoltare neuropsihică moderat. Clinic nu se decelează modificari patologice.
Paraclinic, analizele de laborator sunt modificate astfel: HbA1C = 10,3% (89 mmol/mol), glicemii
a jeun 200-300 mg/dl, glucozurie importantă. Testele genetice arată o mutație heterozigotă a genei
KCNJ11, responsabilă de declanșarea diabetului neonatal.
Se inițiază tratament cu glibenclamid 3,5 mg, crescut treptat până la 8tb/zi, cu răspuns foarte bun
la tratament. În vederea ameliorării retardului de dezvoltare psihomotoriei pacientei i se
recomandă stimularea funcțiilor cognitive prin diverse exerciții, minim 4-5 ore/zi. Reevaluarea
clinico-biologica la 3 luni arată dispariția completă a episoadelor de epilepsie minoră (cu
absenteism), glicemii în țintele terapeutice și HbA1C = 7,3% ( 56 mmol/mol)
Concluzii: În cazul pacienților identificați cu diabet zaharat neonatal trebuie realizate teste gentice,
întrucat mutația genei KCNJ11 / ABCC8 poate fi asociată cu posibilitatea înlocuirii
insulinoterapiei cu tratamentul oral cu sulfonilureice. De asemenea, tratamentul cu sulfonilureice
reușește să trateze și crizele de epilepsie și să înbunătățească, cel putin partial, atât dezvoltarea
motorie cât și cea neuropsihică.
Dr. Purcaru Mircea1, Dr. Mintici Luana1, Dr. Herescu Irina1, Dr. Ioacara Sorin1, Prof. Dr.
Fica Simona1
1
Spitalul Universitar de Urgenta Elias
192
DEND syndrome is a very rare disorder (<1 / 1,000,000), and is the most severe form of permanent
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Dr. Radu Florentina1, Dr. Petrache Daniela1, Dr. Bușneag Ana Maria1, Dr. Cusi Daniela1,
Dr. Mureșan Alexandra1, Dr. Grosu Irina1, Șl. Dr. Rusu Emilia1, Prof. Dr. Radulian
Gabriela1
1
UMF „Carol Davila” Bucuresti
Premise şi Obiective: Boala arterială periferică (BAP) reprezintă una din complicaţiile Diabetului
Zaharat tip II (DZ II) care augmentează riscul cardiovascular(RCV) al acestei populaţii; RCV de
obicei crescut în condiţiile în care fenotipul individului cu DZ II însumează elementele
sindromului metabolic(SM). Acest studiu are ca scop evidenţierea prevalenţei BAP şi factori
asociaţi acesteia într-un lot de pacienţi cu DZ II.
Material şi Metodă: Studiu retrospectiv, observaţional, care a cuprins 229 pacienţi cu DZ II, ce
au fost împărţiţi în 2 loturi: control 176 de pacienţi fără BAP şi cel de studiu 53 de pacienţi cu
BAP. Pentru ambele loturi au fost notate date clinice, antropometrice, prezenţa hipertensiunii
arteriale(HTA), a bolii cardiace ischemice(BCI), a retinopatiei diabetice(RD), a neuropatiei
193
diabetice(ND) şi a bolii renale cronice(BRC). BAP a fost definită printr-o valoare a indicelui
gleznă-braţ ≤0,9 sau prin prezenţa simptomatologiei/semnelor sugestive în contextul unui puls
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periferic slab.
Rezultate şi Discuţii: 142 de pacienţi(62%) au fost de sex masculin, vârsta medie a fost de
61,52±10,52 ani iar vechimea medie a DZ II a fost de 11,6±8,03 ani. BAP a fost prezentă la 53
pacienţi, iar 28,3% din aceştia aveau stadiul IV BAP. 56,6% din pacienţii cu BAP erau obezi,
75,5% erau hipertensivi,81% au fost încadraţi cu SM, 47,2% aveau BCI , 94,3% prezentau ND iar
60,4% îndeplineau criteriile de BRC. Comparativ cu lotul control, cei cu BAP au necesitat într-un
procent mai crescut insulinoterapie pentru controlul glicemic, au avut valori mai mare ale TA şi
au prezentat într-un procent mai mare ND şi RD. Nu au fost înregistrate diferenţe semnificative
statistic în ceea ce priveşte prezenţa BCI şi a BRC. Cei cu std IV BAP au asociat valori glicemice
crescute şi valori patologice ale profilului lipidic(p≤0,05) comparativ cu lotul martor.
Concluzii: Tabloul clinic şi paraclinic al acestui lot de studiu evidenţiază importanţa
diagnosticului şi managementului terapeutic precoce al BAP pentru a putea scădea RCV al acestor
pacienţi în contextul în care severitatea acestei patologii creşte cu vârsta, vechimea DZ II, prezenţa
ND şi a RD.
Dr. Radu Florentina1, Dr. Petrache Daniela1, Dr. Bușneag Ana Maria1, Dr. Cusi Daniela1,
Dr. Mureșan Alexandra1, Dr. Grosu Irina1, Șl. Dr. Rusu Emilia1, Prof. Dr. Radulian
Gabriela1
1
UMF „Carol Davila” Bucuresti
Peripheral arterial disease(PAD) is one of the type 2 diabetes mellitus(DM2) complications that
increases the cardiovascular risk(CVR); this CVR is ussualy high taking into acount the DM2
phenotype adds up the characteristics of the metabolic syndrome(MS).
Retrospective, observational study which included 229 patients with type 2 diabetes; they were
divided into 2 groups: the control- 176 patients without PAD and the study group 53 patients with
PAD. For both groups were noted clinical data, anthropometric data, presence of hypertension
(HTA), ischemic heart disease (IHD), diabetic retinopathy (DR), diabetic neuropathy (DN) and
chronic kidney disease (CKD). PAD was defined by an ankle-brachial index value ≤0,9 or by the
presence of symptoms / signs suggestive in the context of a weak peripheral pulse.
142 (62%) patients were males, the mean age of the group was 61,52±10,52 years and the average
age of the diabetes was 11,6±8,03 years. PAD was present in 53 patients, 28.3 % of those with
stage IV PAD. 56.6% of patients with PAD were obese, 75.5% were hypertensive, 81% were
classified with MS, 47.2% had IHD, 94.3% showed ND and 60.4% qualify for CKD. Compared
with the control group, those with PAD have required in a higher percentage insulin for glycemic
control, had higher blood presure values and showed a higher percentagein DN and in DR. There
were no statistically significant differences regarding the presence of IHD and CKD. Those who
experienced BAP std IV associated pathological values for glucose and lipid profile (p<0.05)
compared with controls.
The clinical and laboratory study of this group highlights the importance of early diagnosis and
therapeutic management of PAD, in order to decline the CVR of these patients ,given that the
severity of this condition increases with age, seniority of DM and with the presence of DN and
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DR.
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PS49. CORRELATIONS BETWEEN GLYCOSYLATED HEMOGLOBIN AND THE
NUTRITIONAL THERAPY IN PATIENTS WITH TYPE TWO DIABETES TREATED
WITH INSULIN
Rezident Radu Raluca1, Dr. Cristofor Cornelia1, Rezident Ilinca Alexandra1, Dr. Rusu
Emilia1, Rezident Pruteanu Diana1, Prof. Dr. Radulian Gabriela1
INDNBM N. Paulescu
Material and method: We evaluated a group of 101 patients with type 2 diabetes treated with
insulin and hospitalized in INDBM Prof. Dr. N. Paulescu , during 10.08.2015-10. 02.2016 . The
patients had to answer a questionnaire made of 10 questions in order to verify their knowledge on
nutrition and so on self-monitoring. The questionnaire has been applied before and after nutritional
education program. Program topics included knowledge of calculating carbohydrate meals, self-
glycemic automonitorization, physical activity, insulin therapy, hypoglycaemia- and
hyperglycaemia and complications of diabetes . Education sessions were held in groups.
Results and discussions: The study included 101 patients known with type 2 diabetes and treated
with insulin. The average age of 54.17 ± 15,06 years ,with a mean of age of diabetes 7,94 [6,37-
9,51] years. HbA1c < 7% was observed in 4%(n=4), HbA1c<7,5 in 9,9%(n=10) and HbA1c>9%
was observed in 66,3%(n=67). Patients with HbA1c levels between 7,5%-8% were well informed
on diet and the management of hyper and hypoglycaemia(p<0.005). In patients with different
levels of HbA1c ( variations between <7% and >9%) the management and knowledge of
hypoglycaemia are still insufficiently known( p<0,021)
Conclusions: Due to the results we obtained in this study, we noticed that the management of
hyper and hypoglycaemia is still insufficiently applied and understood by our patiens despite to
our enormous efforts in explaining continuously about it during the educational programs. In this
case, we strongly stand for continuing our programs of education especially for patients with type
2 diabetes treated with insulin.
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PS50. EXPERIENȚE DIN SCREENINGUL NEUROPATIEI ÎN POPULAȚIA
DIABETICĂ: REZULTATELE UNUI STUDIU TRANSVERSAL
Dr. Roman Deiana1, Prof. Dr. Timar Romulus1, Dr. Tîrziu Maria1, Dr. Lazăr Sandra1, Dr.
Timar Bogdan1
1
"Victor Babes" University of Medicine and Pharmacy
Concluzii: ND este o complicație frecventă a DZ. Prevalența ND este mai crescută la pacienții
vârstnici, la pacienții cu control glicemic deficitar și la pacientii cu IMC mai mare. Pacienții cu
ND au o probabilitate semnificativ crescută de a prezenta și alte complicații ale DZ.
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SCREENING FOR NEUROPATHY IN GENERAL DIABETIC POPULATION:
FINDINGS OF A CROSS-SECTIONAL STUDY
Dr. Roman Deiana1, Prof. Dr. Timar Romulus1, Dr. Tîrziu Maria1, Dr. Lazăr Sandra1, Dr.
Timar Bogdan1
1
"Victor Babes" University of Medicine and Pharmacy
Background and aims: Diabetic neuropathy (DN) is a prevalent and early complication of
Diabetes Mellitus (DM) having a major impact on the patient’s health and quality of life. DN is
cited to be present in up to ½ of the patients with DM, being associated with a longer DM duration
and poor glycemic control. Along with other DM complications, it is caused by a long-time
metabolic imbalance, associated with higher glycemic values.
Our study aims were to evaluate the prevalence of DN in general diabetic population and to assess
its association with other DM complications: retinopathy and chronic kidney disease (CKD).
Material and method: We screened for DN, retinopathy and CKD 198 patients with type 2 DM,
in a consecutive-case populational based cross-sectional study. The enrolled patients had a median
age of 61 years and a median DM duration of 7 years. The presence of DN was evaluated using
the Michigan Neuropathy Screening Instrument (MNSI), the positive diagnosis criteria being one
of the following: a global score higher than 10 points or a questionnaire score higher than 7.5
points respectively a score higher than 2.5 points at the clinical examination. The diagnosis of
CKD was established according KDIGO 2012 guideline criteria and the diagnosis of retinopathy
based on the fundoscopy examination.
Results: The prevalence of DN in our study cohort, according to the diagnosis criteria presented
before was 28.8% (57 cases), having a 95% populational confidence interval rate of 21.8% to
37.3%. The presence of DN was associated with a higher age (64.4 vs. 59.5 years; p=0.002),
HbA1c (8.6 % vs. 8.0%; p=0.027) and BMI (31.9 vs. 29.9 kg/m2; p=0.003). Also, patients with
DN had a higher incidence of CKD (56.1% vs. 14.2%; p<0.001) and retinopathy (54.4% vs. 22.0%;
p<0.001).
Conclusions: DN is a frequent complication of DM. The prevalence of DN is increasing in older
patients, patients with poor glycemic control and patients with higher BMI. Patients with DN have
a significantly higher prevalence of other DM complications.
Dr. Rusu Emilia1, Dr. Enache Georgiana1, Dr. Rusu Florin1, Dr. Drăguț Ramona Maria1,
Dr. Cursaru Raluca1, Dr. Stoicescu Florentina1, Conf. Dr. Jinga Mariana1, Prof. Univ.
Radulian Gabriela1
UMF „Carol Davila” Bucuresti
197
Premise și obiective: Obiectivul acestui studiu a fost acela de a evalua relația dintre produsul
trigliceride și glucoză (indicele TyG) și raportul lipidelor (colesterol total [CT]/ lipoproteine cu
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Dr. Rusu Emilia1, Dr. Enache Georgiana1, Dr. Rusu Florin1, Dr. Drăguț Ramona Maria1,
Dr. Cursaru Raluca1, Dr. Stoicescu Florentina1, Conf. Dr. Jinga Mariana1, Prof. Univ.
Radulian Gabriela1
UMF „Carol Davila” Bucuresti
Background and Aim: The objective of this study was to assessed the relationship between the
product of triglycerides and glucose (TyG index) and lipid ratio (total cholesterol [TC]/high
density lipoprotein cholesterol [HDL-C], triglycerides [TG]/HDL-C), and insulin resistance in
adults.
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Materials and Methods: The data analyzed in this study (n=208) belongs to patients included in
the project Adipocytokines, link between virus C hepatitis and type 2 diabetes mellitus
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(DIADIPOHEP); this study was approved by the Romanian National Authority for Scientific
Research. In these patients we analyzed anthropometric parameters (height, weight, body mass
index, waist circumference, hip circumference, ratio waist hip), biochemical parameters (fasting
plasma glucose (FPG), fasting plasma insulin (FPI), alanine aminotransferase, aspartate
aminotransferase, gamma glutamyl transpeptidase). Homeostasis model assessment of insulin
resistance (HOMA-IR) and HOMA-B were also calculated. The 75 percentile of the HOMA-IR
scores among nondiabetic adults was 2.77, that was used as the cut-off value to define insulin
resistance (IR) for this study. TyG index was calculated using a previously published formula
ln[(fasting triglycerides)(mg/dl) x fasting glucose (mg/dl)/2]. The TC/HDL-C and TG/HDL-C
ratio was also calculated.
Results: The study group included 56.7% women (n=118), with mean age 48.18±8.37 years.
39.4% (n=82) had obesity (BMI> 30 kg/m2), 33.7% (n=70) presented overweight (BMI=25-29.9
kg/m2), 26.9% (n=26) had normal weight.
Patients with IR had significantly higher values for TyG index and TG/HDL-C (all p <0.05).
When ROC curve analysis was used to see the suitability of this parameters to identify IR, area
under curve (AUC) was greater than 0.75; for TyG index AUC=0.844 (95%CI=0.785-0.904,
p<0.001), for TG/HDL-C ratio AUC=0.828 (95%CI=0.780-0.907, p<0.001), and for CT/HDL-C
AUC= 0.768 (95%CI=0.704-0.832, p <0.001). AUC remained greater than 0.75 for all parameters
after stratification by sex. The cut-off points were 5.22 for TyG index, 3.17 for TG/HDL-C ratio,
and 4.37 for CT/HDL-C.
Conclusion: TyG index, CT/HDL-C and TG/HDL-C increased in patients with IR compared to
healthy subjects. Subsequently, we also found that TyG index, TG/HDL-C ratio, and CT/HDL-C
above the cut-off point may help the clinician to predict IR.
Dr. Rusu Emilia1, Dr. Rusu Florin1, Dr. Enache Georgiana1, Conf. Dr. Jinga Mariana1, Dr.
Drăguț Ramona Maria1, Dr. Cursaru Raluca1, Dr. Stoian Marilena1, Conf. Dr. Costache
Adrian1, Prof. Univ. Radulian Gabriela1
UMF „Carol Davila” Bucuresti
Premise și obiective: Scopul acestui studiu a fost de a evalua fibroza hepatică la pacienții cu diabet
zaharat tip 2 (DZ).
Material și Metode: Am efectuat un studiu multicentric, transversal, care a inclus 144 pacienți cu
diabet zaharat de tip 2, 74 de femei (51,4%). Au fost urmăriți indicatorii antropometrici (greutate,
înălțime, circumferința taliei, indicele de masă corporală (IMC)). Parametrii biochimici evaluați
au fost: glicemia à jeun (FPG), insulinemia à jeun (FPI), profilului lipidic, teste funcționale
hepatice, hemoleucograma. Concentrațiile serice ale adiponectinei, leptinei, rezistinei, insulinei,
TNF-alfa, IL-6 au fost măsurate prin metoda ELISA. Rezistenta la insulina (IR) a fost estimată
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prin metoda HOMA. Fibroza hepatică a fost evaluată neinvaziv cu ajutorul următorilor parametri:
raportul aspartat aminotransferaza/alanin aminotransferaza (AST/ALT), raportul AST/Trombocite
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(APRI), scorul de fibroza-4 (FIB4) și indexul Forns. A fost folosită analiza multivariată pentru a
evalua relația dintre fibroza hepatică și factorii metabolici.
Rezultate si Discutii: Vârsta populației incluse a fost de 53,2 ani. Prevalența fibrozei hepatice a
variat între 13,2% (n=19) utilizand FIB4 și 31,9% (n=46) utilizând APRI. Concentrațiile serice
mediane ale TNF-alfa, IL-6, rezistinei la pacienții cu fibroză hepatică au fost semnificativ mai
mari (toate p <0,05). Toți indicii de fibroză au avut valori mai mari la pacienții cu obezitate (toate
p<0.05)). În analiză univariată următorii parametri s-au corelat cu fibroza: vârsta, IMC,
trigliceride, alaninaminotransferaza, gama-glutamiltranspeptidaza, FPI, HOMA-IR, leptina,
rezistina, IL-6, TNF-alfa. În analiză multivariată predictori independenți pentru fibroza hepatică
utilizând FI au fost de vârsta (OR: 1,13, 95%IC: 1,02-1,34), IMC (OR: 2,11, 95%IC: 1,01-3,46),
rezistența la insulină (OR: 2,32, 95%IC: 1,48-3,66) și TNF-alfa (OR: 1,2, 95%IC: 1,1-1,74).
Concluzii: Acest studiu a arătat o prevalență ridicată a fibrozei hepatice la pacientii cu diabet
zaharat, în special la cei cu vârsta de peste 54 de ani cu obezitate și IR, independent de vechimea
diabetului. În studiul de față, factorii predictivi pentru fibroza hepatică la pacienții diabetici au
fost: vârsta, indicele de masă corporală, HOMA-IR peste 4 și nivelul TNF alfa.
Dr. Rusu Emilia1, Dr. Rusu Florin1, Dr. Enache Georgiana1, Conf. Dr. Jinga Mariana1, Dr.
Drăguț Ramona Maria1, Dr. Cursaru Raluca1, Dr. Stoian Marilena1, Conf. Dr. Costache
Adrian1, Prof. Univ. Radulian Gabriela1
UMF „Carol Davila” Bucuresti
Background and Aim: The aim of this study was to investigate the presence of hepatic fibrosis
(HF) in diabetic patients.
Materials and Methods: We conducted a cross-sectional multicenter study which included a total
of 144 patients with type 2 diabetes, 74 women (51.4%). There were followed the anthropometric
indicators (weight, height, waist circumference, body mass index (BMI)). The biochemical
parameters followed were fasting plasma glucose (FPG), lipid profile, liver function tests, blood
count. Serum concentrations of adiponectin, leptin, resistin, insulin, TNF-alpha, IL-6 were
measured with ELISA method. Insulin resistance (IR) was estimated by the homeostasis model
assessment (HOMA). Liver fibrosis was non-invasively assessed using folowing parameters:
aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT); Aspartate to platelet
ratio index (APRI), Fibrosis-4 Score (FIB4) and the Forns index (FI). Multivariate analysis based
on backward logistic regression was used to evaluate the association between hepatic fibrosis and
metabolic factors.
Results: Median age was 53.2 years. The prevalence of fibrosis varied between 13.2% (n=19)
using FIB4 and 31.9% (n=46) using APRI. Median serum levels of TNF-alpha, IL-6, resistin in
patients with HF were significantly higher than in controls (all p<0.05). All fibrosis index used
was higher in patients with obesity (all p<0.05). In univariate analysis the following parameters
were significantly related to fibrosis: age, BMI, triglycerides, ALT, GGT, FPI, HOMA-IR, leptin,
resistin, IL-6, TNF-alpha levels. In multivariate analysis, independent predictors of fibrosis (using
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FI) were age (OR: 1.13, 95% CI: 1.02–1.34), BMI (OR: 2.11, 95% CI: 1.01–3.46), insulin
resistance (OR: 2.32, 95% CI: 1.48–3.66), and TNF-alpha (OR: 1.2, 95% CI: 1.1–1.74).
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Conclusion: This study showed an elevated prevalence of hepatic fibrosis in diabetic patients,
especially in patients aged over 54 years with obesity and IR. In the present study, the predictive
factors for hepatic fibrosis in diabetic patients were: age, body mass index, HOMA-IR over 4, and
TNF- alpha.
Rezident Rusu Elena Mihaela1, Rezident Lucan Daniela1, Dr. Zetu Cornelia1
Institutul National de Diabet, Nutritie si Boli Metabolice "Prof. N. Paulescu" Bucuresti
Introducere: Sindromul Sjogren este o boală sistemică autoimună relativ rară (prevalenţa 0,5-0,7
%) ce afectează glandele exocrine, în mod particular lacrimale şi salivare, şi într-o proporţie mai
mică pancreasul exocrin. În acest context diabetul zaharat (DZ) este o complicaţie rară a
sindromului Sjogren, un procent mic de cazuri fiind raportate (4,1%). În plus, studiile au arătat în
sindromul Sjogren o frecvenţă crescută a sindromului metabolic.
Obiective: Stabilirea etiopatogeniei DZ, nou diagnosticat la o pacientă cu poliautoimunitate certă:
tiroidită autoimună, sindrom Sjogren, sindrom Sicca, poliartrită reumatoidă, alopecie areata,
vitiligo.
Material şi metode: Pacientă de 57 de ani, nou diagnosticată cu DZ, hipertensivă, dislipidemică,
cu obezitate grad 1 (BMI=30,53kg/m2), cu ereditate diabetică (1 frate cu DZ tip 2 diagnosticat la
≈ 40 de ani, în tratament cu ADO ce asociază sindrom metabolic), care a prezentat valori glicemice
random crescute în ultimele 6 luni (în medie 150-160 mg/dl), asimptomatice specific, fără atitudine
terapeutică.
Rezultate şi discuţii: Biologic patologic: dislipidemie mixtă şi dezechilibru glicemic reflectat
printr-o HbA1c=6,7 % şi ca determinari speciale menţionăm: Peptid C: 4,34 ng/ml la o glicemie
= 95,57 mg/dl; Anticorpi anti-glutamat decarboxilaza (Ac anti GAD): 355 IE/ml; ATPO: 52,79
UI/ml; Ac antitireoglobulină: 23,24 UI/ml; ANA. Nu s-au putut realiza determinări autoimune
specifice pancreatice suplimentare. Ecuaţia HOMA utilizată pentru estimarea funcţiei beta celulare
a relevat : funcţie celulară ß 191,1% ; sensibilitate 30,9% şi IR (insulinorezistență) 3,24%.
Concluzii: Sindromul poliglandular autoimun (PAS) este un grup de boli autoimune ale glandelor
endocrine care se clasifică în 3 categorii, subcategoria III C cuprinzând tiroidită autoimună, vitiligo
și alopecie, la care se pot asocia și alte boli autoimune nespecifice de organ (exemplu: sindromul
Sjogren și poliartrită reumatoidă) fapt ce corespunde statusului clinico-biologic al pacientei.
Implicarea multigenică în dezvoltarea diferitelor componente PAS III a fost demonstrată în apariția
DZ și este legată de cațiva loci ai regiunilor genomice non-HLA. Este cunoscut faptul că în DZ
autoimun există o susceptibilitate genetică determinată de prezenţa unor alele specifice (care
codifică anumite antigene HLA): DQ2/DQ8, astfel există un risc deosebit de mare la cei care
prezintă haplotipul DR3/DR4 – DQ2/DQB de a dezvolta boala. O meta-analiză a studiilor
experimentale în sindromul Sjogren a evidenţiat că prezenţa DR3-DQA1/DQB1 s-a asociat cu risc
crescut de a dezvolta și DZ, în timp ce fenotipul DR1/DR7 este protectiv.
Ac anti GAD sunt un important marker de autoimunitate, responsabil de distrucţia celulelor beta
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pot necesita tratament cu insulină la puţin timp de la debut (de exemplu DZ tip LADA). De
menționat că valoarea predictivă a autoanticorpilor creşte cu titrul şi cu prezenţa simultană a altor
autoanticorpi.
Tinând seama că studiile familiale și populaționale cu privire la PAS III C au evidențiat un puternic
background genetic, este important de evaluat și autoimunitatea rudelor de gradul I ale pacientei
aflate în discuție.
Rezident Rusu Elena Mihaela1, Rezident Lucan Daniela1, Dr. Zetu Cornelia1
National Institute of Diabetes, Nutrition and Metabolic Diseases "Prof. N. Paulescu" Bucharest
GAD-Ab are an important marker of autoimmunity, responsible for pancreatic beta cells
destruction. Those are also encountered in high titers in patients who did not develop diabetes or
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other than autoimmune disorders. We can mention that some patients initially diagnosed with type
II diabetes may require insulin therapy shortly after onset (eg diabetes type LADA).It can be
mentioned that the predictive value of antibodies increases with the titer and the simultaneous
presence of other autoantibodies.
Taking into account the family and population studies on PAS III C showed a strong genetic
background, it is important to evaluate and autoimmunity degree relatives of the patient in
question.
In this context it is difficult to determine exactly etiopatogenit, of diabetes in this patient,
considering that there are arguments for both diabetes associated with Sjogren's syndrome (in the
absence of more specific determinations necessary) and type 2 diabetes in the family heredity and
the presence of metabolic syndrome.
Dr. Sandu Maria-Magdalena1, Dr. Firanescu Adela1, Dr. Voicu Andreea1, Dr. Soare
Mariana1, Dr. Simion Floriana Maria1, Dr. Tuiu Daniela1, Dr. Oprea Diana1, Dr. Popa
Adina1, Dr. Popa Simona1, Prof. Univ. Dr. Moța Maria1
Clinica de Diabet – Spitalul Clinic Județean de Urgență Craiova, Romania
Hiperuricemia nu s-a corelat cu vârsta, indicele de masă corporală (IMC), raportul circumferința
abdominală/înălțime (CA/Î), consumul de alcool, așa cum este frecvent descris în literatura de
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specialitate.
Concluzii: Prevalența crescută a hiperuricemiei, la pacienții cu DZ impune screening-ul acesteia
la pacienții cu DZ, pentru intervenție terapeutică în timp util, pentru a înlătura un factor de risc
suplimentar în instalarea bolii cronice de rinichi.
Dr. Sandu Maria-Magdalena1, Dr. Firanescu Adela1, Dr. Voicu Andreea1, Dr. Soare
Mariana1, Dr. Simion Floriana Maria1, Dr. Tuiu Daniela1, Dr. Oprea Diana1, Dr. Popa
Adina1, Dr. Popa Simona1, Prof. Univ. Dr. Moța Maria1
Emergency Clinical County Hospital of Craiova, Romania
Premises and Objectives: The aim of the study was to evaluate hyperuricemia in a group of
patients with diabetes mellitus (DM). Prevalence of (asymptomatic) hyperuricemia has a
significant increase in the last decades. As a reason of this we mention: lifestyle changes, the
dramatic increase in the prevalence of obesity, metabolic syndrome and diabetes, and also aging.
Material and Method: We included in our study 236 unselected patients with diabetes,
hospitalized in Diabetes Clinic of the Emergency County Hospital from Craiova at the beginning
of year 2016. Gender distribution was equal. 12.71% of the patients included in the study had type
1 diabetes (T1DM) and the rest of 87.29% - type 2 diabetes (T2DM). The average age of patients
with T1DM was 39.77 ± 12.71 years and for those with T2DM was 61, 06 ± 10.59 years,
significantly high statistical difference (p <0.0001). Most of the patients (57.20%) had DM for less
than 10 years, a significantly higher statistical difference (p = 0.037) than the rest of the patients
who had a evolution of diabetes between 10 to 20 years and more than 20 years. Hyperuricemia
was defined as serum uric acid level over 6 mg / dL in women and more than 7 mg/dL in men.
Statistical analysis was performed using Microsoft Excel and SPSS 20.0.
Results and Discussions: The general prevalence of hyperuricemia was 14.8%, as following:
6.66% in patients with T1DM and 16.01% in those with T2DM. Women had a significantly higher
statistical prevalence (p = 0.017) of hyperuricemia (20.3%), unlike men, where the prevalence was
9.32%. Also, hyperuricemia was correlated with the estimated glomerular filtration rate (eGFR),
so that in the case of patients with hyperuricemia, average eGFR was 68.13 ml/min/1.73mp
compared to the patients with levels of serum uric acid between physiological limits where the
average eGFR was 85,43ml/min/1.73mp, significantly high statistical difference (p <0.0001).
Hyperuricemia was not correlated with age, body mass index (BMI), waist circumference/height
ratio (WC/H), alcohol consumption, as commonly described in literature.
Conclusions: The increased prevalence of hyperuricemia in patients with DM requires screening
in patients with DM, for early therapeutic intervention to prevent an additional risk factor for
chronic kidney disease onset.
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PS55. THE CORRELATION OF LEFT VENTRICULAR HYPERTROPHY WITH
SERUM CALCIUM LEVELS IN OBESE PATIENTS
Dr. Sava Elisabeta1,2, Dr. Iulia Soare1,2, Dr. Sîrbu Anca1,2, Dr. Martin Sorina1,2, Prof. Dr.
Fica Simona1,2
1 Elias University Hospital, Endocrinology and Diabetes Department, Bucharest, Romania
2
UMF Carol Davila, Bucharest, Romania
Premises and Objectives: Left ventricular hypertrophy (LVH) is a common condition among
patients with obesity and hypertension. Recent studies revealed an association between protein-
adjusted calcium level and LVH. The aim of the study was to evaluate the relationship between
serum calcium level and LVH.
Patients and methods: We assessed 200 obese patients (49 men and 151 women), mean age
41.65±11.98 years, mean BMI 45.92±9.07kg/m2. Clinical (BMI, age, gender, blood pressure),
biological (fasting plasma glucose, HOMA, cholesterol, triglycerides, uric acid) and
echocardiographic parameters (LVM, LVMI, IVS and RV) were measured.
Results and Discussions: 46% were diagnosed with hypertension and 25% were diabetics. The
mean serum calcium level was higher in men (9.73±0.4 mg/dl) than in women (9.50±0.38 mg/dl)
and we found a significant positive correlation between protein-adjusted calcium levels and age
(p=0.003, r=0.225). Serum calcium was positively associated with fasting plasma glucose
(p=0.006, r=0.196), total cholesterol (p=0.03, r=0.153) and with triglycerides (p=0.018, r=0.170).
We demonstrate that echocardiographic parameters correlate positively with serum adjusted-
calcium level (IVS (p=0.003, r=0.227), LVMI (p=0.029, r=0.185), LVM (p=0.006, r=0.232), right
ventricle (RV) (p=0.001, r=0.281)). Linear regression showed that serum protein-adjusted calcium
was independently associated with LVMI (p=0.009, r=0.338). Metabolic syndrome parameters
were associated with LVH.
Conclusions: Our study showed that serum protein-adjusted calcium is independently associated
with LVH in patients with severe obesity.
Complicațiile cronice apar mai frecvent în condiții de dezechilibru metabolic, dar depind și de o
serie de alți factori de risc.
consemnat următorii parametri: vârstă, sex, durată de evoluție a diabetului, calitate de fumător,
IMC, antecedentele heredocolaterale de DZ, BCV și obezitate, HbA1c, RFG, profilul lipidic
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Chronic complications occur more frequently in metabolic imbalance conditions, but also depend
on a number of other risk factors.
We evaluated a group of patients with over 25 years of DM evolution, for which we recorded the
following parameters: age; sex; duration of diabetes evolution; smoker status; BMI; family history
of diabetes, CVD and obesity; HbA1c; GFR; lipid profile (total cholesterol, triglycerides),
206
conducting therapeutical education classes at disease onset and during the disease evolution;
insulin dose titration at every administration and CH calculation at each meal. GFR was calculated
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using the MDRD formula. We calculated the prevalence of chronic micro and macrovascular
complications and there was chased association of various risc factors in patients with and without
macrovascular damage.
Diabetic retinopathy and neuropathy were present in all patients with over 25 years of diabetes
evolution, and chronic kidney disease with GFR ˂ 60ml / min / 1.73m2 was revealed in 60%. We
analyzed risk factors that may be associated with GFR decrease in this category of patients and we
found correlations, presented in the following Table:
PS57. Choice of the add-on therapy to metformin in type 2 diabetes patients in clinical
practice. Initial results from a non-interventional multicentre study in Romania
(REALITY)
Prof. Dr. Serafinceanu Cristian1, Prof. Dr. Timar Romulus1, Prof. Dr. Catrinoiu Doina1,
Adrian Zaharia2
1
Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy
“Carol Davila” Bucharest
2
Astra Zeneca Company
Background and objectives: While metformin is generally recommended as the first-line agent
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in type 2 diabetes mellitus (T2DM), most patients will need eventually more than one
antihyperglycemic agent to achieve target blood glucose levels.
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The primary objective of this Study is to describe and compare the main criteria used by physicians
(regular outpatient setting) in selecting the add-on therapy (non-insulin) in patients with
inadequately metformin-controlled type 2 diabetes in 2 time points at 1 year distance.
Main secondary objectives are:
To describe the usage of add-on therapies in type 2 diabetes and changes observed within
one year;
To evaluate the prevalence of comorbidities and diabetes complications in study groups;
To evaluate the percentage of patients with target HbA1c level < 7% at the 2 time-points;
To describe the characteristics of the disease at the time of the initiating the add-on therapy
in Romanian patients with type 2 diabetes
Material and methods: This non-interventional study was conducted in Romania. The
investigators are diabetologists from hospital and ambulatory settings. The primary objective was
to describe the main criteria used by physicians during their normal clinical practice in selecting
the first non-insulin add-on therapy in patients with inadequately metformin-controlled T2DM.
Two study enrolment moments were planned at approximately at one-year distance. Three main
categories of reasons were considered: patient-related, agent-related, and physician decision. For
each of these categories, a list of possible secondary reasons was provided. Physicians had the
option to select multiple answers, specifying in the same time the most relevant category in
choosing a specific add-on class of non-insulinic antidiabetes medication for each patient. The
statistical analysis was descriptive.
Results: We report here the results after the first study enrolment moment (July-September 2014).
The total number of patients included in the analysis was 1143. Mean age of study subjects was
60.9 yr +/- 9.1. The great majority (94%) of patients were overweight and obese, with a mean BMI
at the time of enrolment [SD] of 32.1 kg/m2 [5.3]. The mean duration of diabetes [SD] was 6.8
years [4.3]. In average, the first oral agent was added to metformin after 3.2 years. Sulphonylureas
were the most prescribed first add-on treatment (63%), followed by DPP4-inhibitors (18%) and
GLP-1 receptor agonists (7%). Blood glucose lowering efficacy and durability (82.4% of answers
related to agent characteristics and 73.9% of patient-related characteristics) were the principal
reasons considered when selecting the first add-on treatment to metformin, followed by effect on
weight (30.1% and 29.7%, respectively) and access to treatment (21.1% and 28.6%, respectively).
Physician decision was selected as principal reason in 12% of the patients.
Conclusions: This is the first study in type 2 diabetes patients in Romania that aims to characterize
the complexity of factors influencing the add-on treatment decision. The need to add a new agent
to metformin was recorded after 3.2 years of monotherapy with metformin. Although a number of
oral and injectable medications are available, sulphonylureas remain the most prescribed
combination treatment to metformin. Newer classes of non-insulin medication are also present,
but their more intensive use is still limited by the difficult access to these treatments. The rationale
for selecting the first add-on therapy to metformin was based mainly on a patient’s characteristics
(glycemic control need, comorbidities, BMI) and therapeutic agent characteristics (efficacy in
lowering blood glucose levels, effect on weight, and access to treatment).
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PS58. PREVALENCE AND PREDICTORS OF NON-ALCOHOLIC FATTY LIVER
DISEASE
ASSESSED USING FATTY LIVER INDEX IN A TYPE 2 DIABETES POPULATION
Dr. Cristina Alina Silaghi1,2, Dr. Horațiu Silaghi1,2, Dr. Horațiu Alexandru Coloși1,2, Dr.
Anca Elena Crăciun1,2, Dr. Daniel Tudor Cosma1,2, Prof. Nicolae Hâncu1,2, Prof Carmen
Emanuela Georgescu1,2
1
Endocrinology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-
Napoca, Romania
2
County Clinic Emergency Hospital, Cluj-Napoca, Romania
We aimed to study prevalence and predictors factors of non-alcoholic fatty liver disease (NAFLD)
defined by fatty liver index (FLI) in type 2 diabetic patients (T2DM).
Three hundred and eighty-one T2DM outpatients who regularly attended Regina Maria Clinic in
Cluj were retrospectivelly included. FLI, a surrogate steatosis biomarker based on body mass index
(BMI), waist circumference (WC), triglycerides (TGL) and gammaglutamyl-transferase (GGT)
was used to assess NAFLD in all patients. Anthropometric and biochemical parameters were
measured. Hepatic steatosis (HS) was evaluated by ultrasonography.
NAFLD-FLI (defined as FLI - 60) was correlated with HS evaluated by ultrasounds (r = 0.28; p <
0.001). NAFLD-FLI was detected in 79% of T2DM. The prevalence of obesity in NAFLD-FLI
patients was 80 %. In normal alanine aminotransferase (ALAT) patients, 73.8 % had NAFLD. At
univariable analysis, NAFLD-FLI was correlated with age (r = -0.14; p = 0.007), sex (r = 0.20; p
< 0.001), LDLcholesterol (r = 0.12; p = 0.032), HDLcholesterol (r = - 0.13; p = 0.015), ALAT (r
= 0.20; p < 0.001) and ASAT (r = 0.19; p < 0.001). At multiple regression analysis, sex, ALAT
and LDL-cholesterol were independent predictors of NAFLD-FLI. After logistic regression model,
ALAT, LDL-cholesterol, HOMA-IR were good independent predictors of NAFLD-FLI.
NAFLD-FLI could be useful to identify NAFLD in T2DM patients. Subjects with T2DM had a
high prevalence of NADLD-FLI even ALAT levels are normal. Our findings showed that sex,
ALAT, LDL-cholesterol and IR were significant and independent factors associated with the
presence of NAFLD in T2DM subjects.
Dr. Lazăr Sandra1, Prof.Dr. Timar Romulus1, Dr. Mailat Diana1, Dr. Levai Codrina1, Dr.
Timar Bogdan1
1
Universitatea de Medicina si Farmacie "Victor Babes" Timisoara
Neuropatia diabetică (ND) este o complicație precoce și prevalentă a diabetului zaharat (DZ),
având un impact major asupra stării de sănătate și a calității vieții pacienților afectați. Alături de
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ND, depresia este frecvent asociată bolilor cronice, incluzând aici DZ. Este un fapt cunoscut că
depresia are un impact negativ asupra activităților de auto-management a DZ, putând așadar duce,
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indirect, la deteriorarea controlului glicemic și astfel la un prognostic mai puțin optimist la acești
pacienți. Obiectivele studiului nostru au fost de
a evalua impactul prezenței și severității ND asupra apariției și severității depresiei la pacienții cu
DZ tip 2.
În vederea realizării dezideratelor acestui studiu am înrolat 198 pacienți cu DZ tip 2 conform unui
principiu consecutiv populațional, ce se află în evidența Centrului de Diabet Timișoara. Tuturor
pacienților li s-au colectat datele clinice, paraclinice și antropometrice la începutul vizitei. Prezența
și severitatea neuropatiei diabetice a fost evaluată cu ajutorul scorului MNSI (The Michigan
Neuropathy Screening Instrument). Depresia a fost evaluată folosind chestionarul PHQ-9
(Patient’s Health Questionnaire - 9).
În lotul nostru de studiu prevalența ND a fost de 28% (57 de cazuri). Prezența depresiei a fost
asociată cu o creștere a scorului PHQ-9 (12 vs. 7 puncte; p<0.001) sugerând astfel că pacienții cu
ND tind să aibă o simptomatologie mai severă a depresiei. În același timp, prezența ND s-a asociat
cu o prevalența semnificativ crescută a depresiei severe (24.6% vs. 4.3%; p<0.001) și moderate
(22.8% vs. 12.8%; p<0.001), compensând cu o prevalență mai scăzută a depresiei ușoare sau
absente. Am observat o corelație pozitivă, moderată și semnificativă statistic (coeficient de
corelație Spearman r=0.55; p<0.001) între severitatea ND, evaluată cu ajutorul scorului MNSI, și
severitatea depresiei.
Dr. Lazăr Sandra1, Prof.Dr. Timar Romulus1, Dr. Mailat Diana1, Dr. Levai Codrina1, Dr.
Timar Bogdan1
1
"Victor Babes" University of Medicine and Pharmacy, Timisoara
Diabetic neuropathy (DN) is a prevalent complication of Diabetes Mellitus (DM), having a major
impact on the patient’s quality of life. Along DN, depression is a frequent condition associated
with chronic diseases, including here DM. Depression is cited to have a major negative impact on
the self-management of diabetes, decreasing so the overall quality of metabolic control, leading
thus to a worsened prognosis of DM. Our study main aim was to evaluate the impact of the
presence and severity of DN on the prevalence and severity of depression in patients with Type 2
DM.
In this cross-sectional study, 198 patients with T2DM were enrolled according to a consecutive-
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case population-based principle, from the Diabetes Outpatient of the Emergency Hospital
Timisoara. In all patients anthropometric, clinical and laboratory data were collected. The presence
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and severity of DN was assessed using The Michigan Neuropathy Screening Instrument while
depression was evaluated using the Patient’s Health Questionnaire.
In our study cohort, the prevalence of overt DN was 28.8% (57 cases). The presence of DN was
associated with and increased PHQ-9 score (12 vs. 7 points; p<0.001) which means that patients
with DN tend to have more severe depression symptoms. In the same time the presence of DN was
associated with a significantly increased prevalence of severe (24.6% vs. 4.3%; p<0.001) and
moderate (22.8% vs. 12.8%; p<0.001) depression. Between the severity of DN, evaluated using
the MNSI score, and the severity of depression we found a positive, moderate and significant
correlation (Spearman’s r = 0.55; p<0.001).
Rezident Ungureanu Carmen1, Dr. Rusu Emilia1, Rezident Bejinariu Cătălina1, Rezident
Petre Diana1, Dr. Mureșan Alexandra1, Dr. Stegaru Daniela1, Rezident Soldea Lidia1,
Rezident Andoni Adela1, Rezident Ciobanu Delia1, Rezident Dobre Alin1, Rezident Chirilă
Vlad1, Prof. Dr. Radulian Gabriela1
INDBM N. C. Paulescu
Premise si obiective: Anemia este comuna printre pacientii cu diabet zaharat (DZ) si boala cronica
de rinichi (BRC). Studii observationale indica faptul ca hemoglobina (Hb) scazuta la acesti
pacienti, poate creste riscul progresiei bolii renale si morbiditatea si mortalitatea cardio-vasculara.
Anemia este o complicatie a BRC si poate contribui la rezultate clinice nefavorabile. Identificarea
timpurie si tratamentul anemiei pot imbunatati morbiditatea si mortalitatea cardio-vasculara.
Obiectivul acestui studiu a fost să evalueze relația dintre prezenta anemiei și rata de filtrare
estimată (eRFG) prin formula CKD-EPI la pacientii cu DZ tip 2.
Material si metoda: Studiu observational, desfasurat la INDBM “NC Paulescu” din Bucuresti, in
perioada sept 2015- febr 2016. Au fost inclusi in studiu 229 pacienti cu DZ 2, din care 109 pacienti
cu BRC. Toți pacienții au fost examinați clinic și au fost măsurate tensiunea arterială (TA),
greutatea (G), înălțimea și circumferința abdominală (CA). Au fost efectuate, de asemenea,
următoarele analize: glicemie, trigliceride (TG), lipoproteine cu densitate moleculara mare (HDL-
C), uree, creatinină, hemograa, raport albumină/creatinină (RAC). S-a determinat prevalenta si
severitatea anemiei (anemie usoara daca Hb a fost sub 12,5 g/dl si moderată daca Hb a fost sub 10
g/dl).
Rezultate: Din cei 229 pacienti inclusi in studiu 61.51% au fost barbati, cu varsta medie de
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61,52±10,52 ani. Dintre acestia 25.3% (n=58) au prezentat eRFG< 60 ml/min/1,73m2. Hb < 12,5
g/dl au prezentat 49 pacienti ( 21.4%) si mai mica de 10 g/dl, 10 pacienti (4,4%). Pacientii cu
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anemie au avut varsta mai mare, greutate mai mica, IMC mai redus, CA mai mica, colesterol, LDL
scazute, RAC crescut, acid uric crescut. În analiza univariata nivelul Hb s-a corelat pozitiv cu
eRFG (r=0,385, p=0.01) și negativ cu vârsta (r=-0,338, p=0,001) și nivelul creatininei serice (r=-
0,395, p=0,01).
Concluzie: Anemia a fost prezenta la 25.8% din pacientii cu BRC. Prevalenta anemiei creste pe
masura ce rata de filtrare glomerulara scade.
Rezident Ungureanu Carmen1, Dr. Rusu Emilia1, Rezident Bejinariu Cătălina1, Rezident
Petre Diana1, Dr. Mureșan Alexandra1, Dr. Stegaru Daniela1, Rezident Soldea Lidia1,
Rezident Andoni Adela1, Rezident Ciobanu Delia1, Rezident Dobre Alin1, Rezident Chirilă
Vlad1, Prof. Dr. Radulian Gabriela1
INDBM N. C. Paulescu
Objectives: Anemia is frequent among patients with diabetes and chronic kidney disease.
Observational studies indicate that low Hb levels in such patients may increase risk for progression
of kidney disease and excessive cardiovascular morbidity and mortality. Anemia is a complication
of chronic kidney disease and may lead to unfavorable clinical results.
Early diagnosis and treatment may improve cardiovascular morbidity and mortality.
Our aim was to observe the relationship between anemia and RFG (using CKD – EPI formula) in
patient with type 2 diabetes.
Material and method: A retrospective, observational study was carried out in the National
Institute of Diabetes and Metabolic Disease “NC Paulescu”, of Bucharest between September
2015- February 2016. 229 pacients with type 2 diabetes were included in this study and 109 of this
had chronic kidney disease. There were 67 men and 42 women. All patients were assessed
clinically and were measured blood pressure (BP), the weight (G), the height (H) and waist
circumference (CA). Following analyzes was analyzed: glucose, TG, HDL, urea, creatinine, RAC.
We investigate the prevalence and severity of mild anemia (Hb < 12,5g/dl) and moderate anemia
(Hb<10 g/dl).
We used Pearson and Spearman algorithm of univariate correlation. We consider a p value of less
than 0.05 to be statistically significant.
Results: Of 229 patients included in the study 61.51% were men and 38,5% were women, with a
mean age of 61,52+/-10,52 years. A number of 58 patients (25,3%) had e RFG <
60ml/min/1,73m2.
In 21.4% patients ( 49 ) Hb was <12,5 g/dl and in 4,4% ( 10 patients) Hb was < 10 g/dl. Patients
with anemia had older age, lower weight, lower BMI, smaller waist circumference, low cholesterol
and LDL, increased RAC and uric acid. In univariate logistic analysis the level of Hb showed
significant statistical correlation with E RFG ( r= 0,385, p= 0.01) and negative correlation with
age ( r = -0,338, p = 0,001) and seric creatinine level ( r = -0.395, p= 0,01).
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Conclusions and discussions: We had 25.8% patient with anemia and chronic kidney disease.
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Material și metodă: Am analizat un lot de 150 de pacienți cu diabet zaharat internați în Spitalul
Clinic Th. Burghele în perioada ianuarie 2013-iulie 2014 pentru efectuarea unor intervenții
chirurgicale în sfera urologică. În lot au fost 82.6% (n=124) bărbați, cu o vârstă medie de 65.39+/-
9.95 ani, majoritatea cu diabet zaharat de tip 2 (96.67%). Durata medie a spitalizării a fost de
8.64+/-4.3 zile. 34.66% dintre pacienți (n=52) aveau diabet zaharat complicat. Pe parcursul
internării s-au determinat 4 glicemii a jeun din sângele venos: glicemia la internare (g1), în ziua
intervenției chirurgicale (glicemia preoperatorie) (g2), în prima zi postoperator (g3) și în cea de-a
doua zi postoperator (g4). Complicații postoperatorii au fost considerate orice devieri, biologice
sau clinice, de la evoluția postoperatorie normală. Pentru a clasifica corect și reproductibil
complicațiile postoperatorii, am folosit scala Clavien modificată. Am calculat un indice de
variabilitate glicemică, definit ca deviația standard față de media celor patru glicemii a jeun ale
unui pacient.
Background and objectives: Recently studies have shown that glycemic variability is associated
with mortality in surgical intensive care units and in patients in critical condition. The objective of
this study is to determine whether fasting glucose variability in the perioperative period correlates
with the occurrence of postoperative complications.
Material and method: We analyzed 150 patients with diabetes admitted to Clinical Hospital Th.
Burghele from January 2013 until July 2014 to perform an urologic surgery. In the group there
were 82.6% (n = 124) men, with an average age of 65.39 +/- 9.95 years, most of them with type 2
diabetes (96.67%). The mean duration of hospitalization was 4.3 +/- 8.64 days. 34.66% of patients
(n = 52) had complicated diabetes. During hospitalization we determined four fasting glucose from
venous blood: in the day of admission (g1), in the day of surgery (preoperative glucose)(g2), in
the first postoperative day (g3) and in the second day after surgery (g4). Postoperative
complications were considered any deviations from biological or clinical normal postoperative
course. To classify accurately and reproducibly postoperative complications, we used the modified
Clavien scale. We calculated an index of glycemic variability, defined as the standard deviation
from the average of the four fasting glucoses of a patient.
Conclusion: In this study, fasting glucose variability during hospitalization was correlated with
the presence of post-operative complications, the degree of post-operative complications, but did
not correlate with the duration of hospitalization. Patients who had complicated diabetes, had a
higher glycemic variability index. Further studies are needed on larger groups of patients to
investigate these findings.
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PS62. PREZENȚA BOLII CRONICE DE RINICHI ÎN RAPORT CU VÂRSTA ȘI
DURATA DIABETULUI ZAHARAT
Premise și obiective: Studiul de faţă îşi propune evaluarea prezenței bolii cronice renale în raport
cu vârsta și durata diabetului zaharat tip 1 și tip 2.
Vârsta la diagnosticarea DZ a pacienților cu BCR a fost semnificativ statistic (p<0,001) mai mică
la pacienții cu DZ tip 1 decât la cei cu DZ tip 2. Aplicând testele statistice Mann-Whitney U și
Wilcoxon W se constată diferențe semnificative între vârsta la diagnosticarea diabetului zaharat la
pacienții cu DZ tip 1 cu BCR comparativ cu vârsta pacienților cu DZ tip 2 cu BCR (p<0,001).
Durata medie de evoluție a DZ tip 1 asociat cu BCR s-a situat în jurul valorii de 19,69 ani, valoare
semnificativă statistic (p<0,001) mai mare comparativ cu durata de 8,23 ani de evoluție la pacienții
cu DZ tip 2 asociat cu BCR. Testul statistic Kruskal Wallis aplicat arată diferențe semnificativ
statistice între tipul 1 și tipul 2 de diabet zaharat (p< 0,001).
Concluzii: Prevalența BCR diabetică crește cu vârsta și durata de evoluție a DZ. Vârsta de apariție
a BCR este mai mică la pacienții cu DZ tip 1 comparativ cu cei cu tipul 2 și populația generală.
Incidența și prevalența BCR crește o dată cu înaintarea în vârstă. Vârsta înaintată pare a fi un
predictor negativ pentru apariția stadiului terminal al BCR.
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THE PRESENCE OF CHRONIC KIDNEY DISEASE IN RELATION TO AGE AND
DURATION OF DIABETES MELLITUS
Background and objectives: This study aims to assess the presence of chronic kidney disease in
relation to age and duration of type 1 and type 2 diabetes mellitus.
Material and method: The study type is epidemiological, transversal, noninterventional, with
unselected patients. It was performed by analyzing 600 subjects divided into three groups, as
follows: Lot 1 includes 200 patients with type 1 diabetes, Lot 2 includes 200 patients with type 2
diabetes and lot 3 (control) consisting of randomly recruited 200 individuals without diabetes.
Results and discussions: The age of patients with type 1 diabetes who have chronic kidney disease
(CKD) is lower versus the age of patients with type 2 diabetes and CKD, but comparable between
patients with type 2 diabetes and those without diabetes (control). This is proven by statistical tests
Mann-Whitney U and Wilcoxon W showing significant differences between age of patients with
type 2 diabetes with CKD and the age of patients with T1DM with CKD (p <0.001) between
patients with diabetes type 1 with CKD those without diabetes (control) with CKD (p <0.001), but
not significant between type 2 diabetes and CKD control group (p = 0.910).
The average age of developing CKD in type 1 diabetes lies around 43.55 years, in T2DM average
age is 64.93 years and 63.94 years in the control group. Kruskal Wallis statistical test applied show
statistically significant differences between type 1 and type 2 diabetes and between T1DM and the
control group (p <0.001), but not significant between T2DM and control group.
The age of patients at diagnosis of diabetes with CKD was statistically significant (p <0.001) lower
in patients with type 1 diabetes than in those with type 2 diabetes Applying statistical Mann-
Whitney U test and Wilcoxon W are significant differences between age diagnosing diabetes in
patients with type 1 diabetes compared with CKD aged patients with type 2 diabetes with CKD (p
<0.001).
The average duration of development of type 1 diabetes associated with CKD stood around 19.69
years, worth statistically significant (p <0.001) higher compared to the duration of 8.23 years of
development in patients with type 2 diabetes associated with CKD. Kruskal Wallis statistical test
applied show statistically significant differences between type 1 and type 2 diabetes mellitus (p
<0.001).
Conclusion: Diabetic CKD prevalence increases with age and duration of diabetes. Age of
occurrence of CKD is lower in patients with type 1 diabetes compared to those with type 2 and the
general population. CKD incidence and prevalence increases with age. Old age seems to be a
negative predictor for the occurrence of end stage of CKD.
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PS63. ASOCIEREA MICROALBUMINURIEI CU HIPERTENSIUNEA ARTERIALĂ
LA PACIENȚII CU DZ TIP 1 ȘI VECHIME DE CEL PUȚIN 10 ANI
Background and objectives: Micro and macroalbuminuria are important predictors for increased
mortality from any cause in DM. This study aims to assess the association of microalbuminuria
with artheryal hypertension in patients with type 1 diabetes diagnosed at least 10 years ago because
217
Dr. Vonica Camelia Larisa1, Dr. Muresan Andrada Alina1, Dr. Craciun Anca Elena1, Dr.
Farcas Anca1, Prof. Hancu Nicolae1, Assoc. Prof. Roman Gabriela1
Centrul de Diabet Cluj-Napoca
Măsurarea grosimii intimă –medie (GIM) permite detectarea leziunilor aterosclerotice ale pereților
arteriali la pacienții cu diabet zaharat (DZ), implicată în complicaţiile macrovasculare diabetice.
Totodată, grăsimea viscerală este puternic asociată cu rezistenţa la insulină, hipertensiunea
arterială, dislipidemia şi inflamaţia sistemică cronică, toate joacă un rol esențial în patogeneza
aterosclerozei. Scopul acestui studiu a fost de a investiga relația dintre GIM carotidiană şi rata de
filtrare glomerulară estimată (eGFR), dar şi alte date clinice precum aria grăsimii viscerale (VFA),
procentul de masă grăsă (PBF) la pacienții cu DZ tip 2.
Am efectuat un studiu retrospectiv pe o populație de 155 de pacienți din reţeaua privată de sănătate
„Regina Maria”, având ca şi criterii de includere: diagnostic de DZ 2, vârsta peste 18 ani, iar cele
de excludere: DZ 1, sarcina şi dispozitive medicale mecanice. Am evaluat eGRF , GIM, alături de
VFA , PBF. Am determinat VFA si PBF cu ajutorul analizatorului corporal InBody 720 prin
bioimpedanţă electrică.
Din totalul de pacienţi selectaţi, 54 au fost femei (34%) şi 104 bărbaţi (66%), vârsta medie
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56,3±9,45 ani, vechimea DZ2 6,17±5.79. GIM a fost 1.03±0,31 cm, iar eGFR 91,54±24.52
ml/min/1,73m². Parametrii privind masa grasă au fost VFA 169.45±45.45 cm2, PBF 35.5±9.05%.
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La cei 155 de pacienţi VFA a fost repartizată astfel: 6 (4%) sub valoare de 100 cm², iar 152 (96%)
peste 100 cm². Totodată, s-au observat corelații direct proporționale între GIM și: vârsta (p<0,01),
VFA (p<0,01) şi eGFR (p<0,05).
În lotul studiat s-a observat o prevalenţă crescută în rândul pacienţilor cu VFA peste 100 cm².
Totodată, corelaţia pozitivă dintre eGFR şi GIM, alături de cea dintre VFA şi GIM, confirmă
importanţa examinărilor intensive pentru detectarea precoce a aterosclerozei şi tratarea tuturor
factorilor de risc asociaţi acesteia la pacienţii cu DZ.
Dr. Vonica Camelia Larisa1, Dr. Muresan Andrada Alina1, Dr. Craciun Anca Elena1, Dr.
Farcas Anca1, Prof. Hancu Nicolae1, Assoc. Prof. Roman Gabriela1
Centrul de Diabet Cluj-Napoca
The measurement of the intima-media thickness (IMT) enables the detection of atherosclerotic
lesions of the arterial walls in diabetic patients involved in macrovascular diabetic complications.
In addition, visceral fat is strongly associated with insulin resistance, hypertension, dyslipidemia
and systemic chronic low-grade inflammation, all of which play a pivotal role in the pathogenesis
of atherosclerosis. The aim of this study was to investigate the relationship of the carotid IMT with
estimated glomerular filtration rate (eGFR) and the clinical backgrounds, including visceral fat
area (VFA) and percentage of fat mass (PBF) in patients with type 2 diabetes mellitus (DM2).
We performed a retrospective study on a population of 155 patients from a the private health center
‘Regina Maria’ with the following inclusion criteria: DM2, age over 18 years, and the exclusion
criteria: DM type 1 , pregnancy and medical mechanical device. We evaluated eGFR, IMT, along
with VFA, PBF. VFA, PBF were completed with electrical bioimpedance using InBody 720.
In the selected group, 54 were women (34%) and 104 men (66 %), mean age was 56.3 ± 9.45
years, years of diabetes were 6.17 ± 5.79. IMT was 1.03 ± 0.31cm and eGFR 91.54 ± 24.52
ml/min/1,73m². Parameters regarding fat mass were: VFA 169.45 ± 45.45 cm2, PBF 9.05 ± 35.5%.
Regarding VFA, the 155 patients were distributed as follows: 6 (4%) below 100 cm² and 152 (96
%) more than 100 cm². In addition, positive correlations were observed between IMT and: age (p
< 0.01), VFA (p < 0.01) and eGFR (p < 0.05).
In the studied group we observed an increased prevalence among patients with VFA >100 cm².
Also, the positive correlation between VFA and GIM, and also eGFR and GIM, confirms the
importance of intensive examinations for early detection of atherosclerosis and treating all its
associated risk factors in patients with diabetes.
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PS65. TREATMENT WITH CONTINUOUS SUBCUTANEOUS INSULIN INFUSION TO
A PATIENT WITH DIABETES MELLITUS TYPE 1
Physician Alexandra Ilinca1, Physician Carmen Novac1, Physician Emilia Rusu1, Physician
nutrition educator Cornelia Cristofor1, Physician Raluca Radu1, Professor Doctor Gabriela
Radulian1
1
INDBM N Paulescu
The insulin pump is an alternative treatment of any kind of diabetes mellitus with insulin therapy
in multiple daily doses.
Patient at age of 14 presents in the INDBM N Paulescu for many hypoglycemia episodes,
frequently in the morning, in order to start procedures for obtaining insulin pump, for continuous
subcutaneous insulin infusion, and with HbA1c = 6.3%. The patient was diagnosed about three
months earlier, at the Marie Curie Hospital with type 1 diabetes mellitus where the insulin therapy
basal bolus with aspart and glargine insulin was started. In January 2015 we mount the insulin
pump, with aspart insulin, with a TDD of 26U, of which 80% were used for insulin pump TDD,
distributed in 50% (10.4 U) for basal rates which was subsequently adjusted with fasting samples,
completed after 3 days. Boluses were calculated using insulin sensitivity factor (SF) and the Report
of Z (RZ) in relation to the quantity of ingested carbohydrates at every meal. The FS was 86 mg/dL,
and RZ = 24 g; The recommended amount of carbohydrate was 230g (60g-110g-60g) and total
insulin boluses summed 9.5 U (2,5-4,5-2,5). The patient was instructed to monitor his capillary
blood glucose 7 times/day, using the meter-remote, before and after 2 h of every meal, and insulin
adjustment with the correction formula (CF) = (target blood glucose - current blood glucose) / FC;
Fasting blood glucose target was set between 90-130 mg/dL and between 90-150 at bedtime and
during the night.
After two weeks of insulin pump therapy, the patient shows in the clinic for evaluation by using
the synchronizer of insulin pump with remote-glucose meter; in these two weeks, the patient had
2 glycemic targets set out, both in premeditated situations, when the patient knew how to restore
his blood glucose in targets by using the advanced menu in the insulin pump; also, very important,
it showed no glucose below target, and the average blood glucose between 110-120 mg/dL.
Treatment with insulin pump led to the disappearance of hypoglycemia and significantly increased
the quality of life of this patient. Adherence extremely good showed us that with a good nutritional
education and knowledge to use the pump and adjust insulin doses
properly, evolution of insulin treated diabetes mellitus is much better in reducing the frequency of
hypoglycemia.
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DOAR PUBLICARE/PUBLICATION ONLY
Dr. Braha Adina1, Dr. Diaconu Laura1, Prof. Dr. Timar Romulus1
1
Spitalul Clinic Judetean de Urgenta Timisoara
Controlul glicemic optim reduce riscul aparitiei complicatiilor cronice degenerative la pacientii cu
diabet zaharat tip 2. Principala limitare a tratamentului antidiabetic in scopul atingerii tintei
terapeutice pentru HbA1c este aparitia episoadelor de hipoglicemie. Consecințele posibile ale
hipoglicemiilor includ morbiditate fizică și psihologică și, în cazuri severe, deces. Obiectivele
studiului au fost evaluarea frecventei internarilor pentru hipoglicemie severa la pacientii cu diabet
zaharat tip 2 si identificarea factorilor determinanti si favorizanti ai acestora.
Lotul de studiu a inclus cei 304 pacienti cu diabet zaharat tip 2 care au fost internati prin serviciul
de urgenta, in Clinica de Diabet zaharat, nutritie si boli metabolice a Spitalului Clinic Judetean de
Urgenta “Pius Binzeu” Timisoara, in cursul anului 2015. Am efectuat un studiu retrospectiv, datele
fiind obtinute din foile de observatie clinica generala ale pacientilor.
Ponderea internarilor pentru hipoglicemie severa din totalul internarilor de urgenta ale pacientilor
cu diabet zaharat tip 2, in anul 2015, a fost de 13,81%. Caracteristicile principale ale celor 42 de
pacienti internati pentru hipoglicemie severa sunt: varsta medie = 72,09 ±9,43 ani, repartitia pe
sexe: 12 barbati si 30 femei, durata medie de evolutie a diabetului zaharat =12,52 ± 7,84 ani. Din
totalul episoadelor de hipoglicemie severa internate de urgenta, 50% au survenit la pacienti cu
insulinoterapie intensiva, 40,47% au fost induse de sulfonilureice si 9,52%, de asocierea de
insulina bazala cu medicatie antidiabetica non-insulinica. Factorii favorizanti ai hipoglicemiilor
severe identificati la pacientii inclusi in studiu au fost: varsta inaintata, scaderea ratei de filtrare
glomerulare, durata indelungata de evolutie a diabetului zaharat, factori comportamentali
(omiterea meselor, orar neregulat al meselor, administrarea gresita a medicatiei antidiabetice),
prezenta altor comorbiditati (dementa, tulburare depresiva, ciroza hepatica), suport social redus.
Dr. Braha Adina1, Dr. Diaconu Laura1, Prof. Dr. Timar Romulus1
1
Spitalul Clinic Judetean de Urgenta Timisoara
Optimal glycemic control reduces the risk of chronic degenerative complications in patients with
type 2 diabetes. Main limitation of antihyperglycemic treatment to achieve HbA1c target is the
occurrence of hypoglycemia. Possible consequences of hypoglycemia include physical and
psychological morbidity and, in severe cases, death. The study aims were to evaluate the frequency
of admissions for severe hypoglycemia in patients with type 2 diabetes and to identify contributing
and determinant factors.
The study group included 304 patients with type 2 diabetes who were hospitalized through the
emergency department in Diabetes, Nutrition and Metabolic Diseases Clinic of Emergency
Hospital "Pius Brinzeu" Timisoara, during year 2015. We conducted a retrospective study, data
were obtained from patients clinical observation sheets.
The share of total admissions for severe hypoglycemia emergency admissions of patients with type
2 diabetes in 2015 was 13.81 %. The main characteristics of the 42 patients hospitalized for severe
hypoglycemia are: mean age = 72.09 ± 9.43 years, sex distribution: 12 men and 30 women, mean
duration of diabetes 12.52 ± 7.84 years. Of all severe hypoglycemic episodes which required
emergency admission, 50% occurred in patients with intensive insulin therapy, 40.47% were
caused by sulfonylureas and 9.52% by basal insulin in combination with non-insulin antidiabetic
agents. The main causes of severe hypoglycemia that were identified among patients included in
the study were old age, decreased glomerular filtration rate, long duration of diabetes evolution,
behavioral factors (skipped meals, timing, irregular meals, wrong intake of antidiabetic
medication), other comorbidities (dementia, depressive disorder, cirrhosis), low social support.
To prevent episodes of severe hypoglycemia, their adverse consequences and the increased costs
of hospitalization, it is recommended to avoid sulfonylureas and intensive insulin therapy in type
2 diabetes patients with decreased renal function, aged over 65, in those with multiple
comorbidities, with cognitive decline, with liver dysfunction, with low life expectancy and in those
with low social support. Antidiabetic regimens must be patient-centered, individualized according
to HbA1c, resorting when appropriate to the use of new antidiabetic drugs with low risk of
hypoglycaemia (DPP4 inhibitors, GLP-1 receptor agonists, SGLT2 inhibitors).
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PO2. FUMATUL FACTOR DE RISC CARDIOVASCULAR
Studiul de faţă îşi propune evaluarea fumatului ca factor de risc de boală cardiovasculară la pacienţi
cu DZ tip 1 diagnosticat cu cel puţin 10 ani în urmă.
Lotul studiat a cuprins 106 pacienţi cu DZ tip 1 cu vechime de peste 10 ani aflaţi în evidenţa
Centrului Clinic de Diabet Nutriţie Boli Metabolice Craiova. La aceşti pacienţi am analizat
următoarele date demografice și anamnestice: vârstă, sex, vechimea DZ, stilul de viată
(fumător/nefumător), clinice (tensiunea arterială), date paraclinice (creatinina, colesterolul total şi
fracţiunile sale-HDL și LDL, trigliceridele, albuminuria). Riscul cardiovascular a fost evaluat
utilizând algoritmul Framingham.
Lotul studiat a fost alcătuit din 106 pacienţi dintre care 39,62% (42) pacienţi au fost de sex feminin
şi 60,37% (64) pacienţi de sex masculin. 32,07% (34) pacienţi s-au aflat în stadiul
normoalbuminuric, 14,15% (15) pacienţi în stadiul microalbuminuric, 49,05 (52) pacienţi în
stadiul macroalbuminuric, iar 4,71% (5) pacienţi în stadiul final al bolii renale diabetice. În
sublotul pacienților normoalbuminurici 67,65% (23) pacienţi erau nefumători, 20,59% (7) pacienţi
erau foşti fumători, iar 11,76% (4) pacienţi erau fumători la momentul actual. În sublotul
pacienţilor microalbuminurici (nefropatie diabetică stadiul 3), 60% (9) pacienţi erau nefumători,
6,67%) (1) pacient era fost fumător, 33,33% (5) pacienţi erau fumători. În sublotul pacienţilor
macroalbuminurici (nefropatie diabetică stadiul 4), 34,62% (18) pacienţi erau nefumători, 40,38%
(21) pacienţi erau foşti fumători, iar 25% (13) pacienţi erau fumători la momentul actual. În
sublotul pacienţilor aflaţi în stadiul terminal al bolii cronice de rinichi (ESRD) 40% (2) pacienţi
erau nefumători, 40% (2) dintre pacienţi erau foşti fumători, iar 20% (1) pacient era fumător la
momentul actual.
Se remarcă influenţa fumatului în apariția albuminuriei, fapt evidenţiat de valoarea lui p=0,033 (p
< 0.05), ce arată că pacienții cu nivele diferite de albuminurie sunt în procente diferite fumători
sau nefumători, diferență care este semnificativă din punct de vedere statistic. Valoarea calculată
prin testul Cramer de verificare a puterii asocierii dintre albuminurie și starea de fumător este
0.254, ceea ce indică o asociere, dar nu foarte puternică, între un anumit grad al proteinuriei și un
anumit status al fumatului (cei cu normoalbuminurie/microalbuminurie e mai probabil să fie
nefumători, iar cei cu macroalbuminurie să fie fumători sau foști fumători).
Fumatul a fost identificat în mai multe studii ca un factor de risc independent pentru diferite grade
ale BCR, inclusiv pentru apariția proteinuriei, creșterea creatininei serice, scăderea RFG estimate
și dezvoltarea ESRD sau ratei de deces asociate cu BCR. Fumatul a fost demonstrat, de asemenea,
ca factor de progresie a BCR diabetică. În studiul nostru nu s-a înregistrat o corelație puternică
între statusul de fumător și prezența albuminuriei, ridicând suspiciunea întreruperii de necesitate a
fumatului în momentul apariției complicațiilor majore.
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SMOKING – CARDIOVASCULAR RISK FACTOR IN PATIENTS WITH T1DM
DIAGNOSED AT LEAST 10 YEARS AGO
This study aims to assess smoking as a risk factor for cardiovascular disease in patients with type
1 diabetes diagnosed at least 10 years ago.
The study group included 106 unselected patients with type 1 diabetes older than 10 years,
hospitalized in the Clinic of Diabetes Nutrition and Metabolic Disease Craiova. In these patients
we analyzed the following demographic and anamnestic data: age, gender, diabetes duration,
lifestyle (smoking/non-smoking), clinical date (blood pressure), paraclinical data (creatinine, total
cholesterol and its fractions, HDL and LDL, triglycerides, albuminuria). Cardiovascular risk was
assessed using the Framingham algorithm.
The study group consisted of 106 unselected patients of which 39.62% (42) patients were female
and 60.37% (64) male patients. 32.07% (34) patients were in normoalbuminuria stage, 14.15%
(15) patients in microalbuminuric stage, 49.05 (52) of the patients in macroalbuminuria stage and
4.71% (5) patients in the end stage of diabetic kidney disease. In the subgroup of
normoalbuminuria patients 67.65% (23) patients were nonsmokers, 20.59% (7) patients were
former smokers and 11.76% (4) patients were curent smokers. In the subgroup of
microalbuminuria patients (diabetic nephropathy stage 3) 60% (9) patients were nonsmokers,
6.67%) (1) patient was a former smoker, 33.33% (5) patients were smokers. In the subgroup of
macroalbuminuria patients (diabetic nephropathy stage 4), 34.62% (18) patients were nonsmokers,
40.38% (21) patients were former smokers and 25% (13) patients were curent smokers. In the
subgroup of patients in end-stage chronic kidney disease (ESRD) 40% (2) patients were
nonsmokers, 40% (2) of the patients were former smokers and 20% (1) patient was curent smoker.
It notes the influence of smoking in the development of albuminuria, as evidenced by the value of
p = 0.033 (p <0.05), indicating that patients with different levels of albuminuria in different
percentages are smokers or never smokers, a difference that is statistically significant. The
calculated value of the Cramer test checking the power of the association between albuminuria
and smoking status is 0.254, which indicates an association, but not very strong, between a degree
of proteinuria and particular status of smoking (those with normoalbuminuria / microalbuminuria
is more likely to be smoking and those with macroalbuminuria be smokers or ex-smokers).
Smoking has been identified in several studies as an independent risk factor for various degrees of
CKD, including the appearance of proteinuria, serum creatinine, decline of eGFR and development
of ESRD or death rate associated with CKD. Smoking was also demonstrated as a factor for
progression of diabetic CKD. In our study has not been a strong correlation between smoking
status and the presence of albuminuria, raising the suspicion of necessary interruption of smoking
when major complications appered.
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PO3. PREZENȚA SINDROMULUI METABOLIC LA PACIENŢII CU DZ TIP 2
RECENT DIAGNOSTICAȚI
Din pacienții ce au alcătuit lotul de studiu, 63% s-au prezentat cu un IMC actual > 30kg\m2,
procent destul de mic datorită faptului că mare parte dintre pacienții studiați, fiind cazuri noi s-au
prezentat la medic după o scădere ponderală de 5-10kg. Din această cauză am analizat și IMC-ul
maxim în funcție de care 84% dintre pacienți au prezentat IMC > 30kg\m2, încadrându-se în unul
din gradele de obezitate. Hipertensiunea arterială a fost întâlnită la 65% din pacienți, predominant
de sex feminin.
S-a constatat incidenta mai mare a sindromului metabolic la pacientii de sex feminin.
Hipertensiunea arterială este frecvent întâlnită la debutul diabetului zaharat și poate fi luată în
considerare ca şi componentă a SM, dar în acelaşi timp trebuie să ţinem cont de o eventuală cauză
secundară a HTA. Totuşi procentul SM ar rămâne nemodificat deoarece pacienţii care aveau HTA
prezentau alte 3 elemente ale acestuia.
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METABOLIC SYNDROME IN PATIENTS WITH TYPE 2 DIABETES MELITUS
RECENTLY DIAGNOSED
The evaluation of the metabolic syndrome (MS) in patients with T2DM recently diagnosed.
We studied a group of 123 patients with T2DM presented in the Public Hospital of Craiova. We
analyzed the following clinical and paraclinical data: abdominal circumference (AC), blood
pressure, triglycerides, total cholesterol and its fractions (HDL, LDL), urea, creatinine,
microalbuminuria. For the diagnostic of MS we used the statement of IDF, NHLBI, AHA, World
Heart Federation; International Atherosclerosis Society and International Association for the
Study of Obesity editorialized in 2009: abdominal circumference (AC), triglycerides ≥ 150mg/dl,
HDL-cholesterol < 40 mg/dl (men), < 50 mg/dl (women), blood presure ≥ 130/85 mmHg or
treatment for artherial hypertension, fasting glycaemia ≥ 100mg% or antidiabetic treatment for
hiperglycaemia.
From the patients included in the study, 68 patients (55,28%) were women and 55 (44,71%) were
men. Metabolic syndrome was relieved in 69 patients (56,09%) of our studied group where from
29 (42,02%) were men and 40 (57,97%) women. The patients with T2DM presented 3 or more
elements of metabolic syndrome as tabel below suggest.
Of patients who had composed the study group, 63% were presented with a current BMI > 30
kg/m2, quite low because most of the studied patients, being new cases of diabetes, were presented
to the doctor after 5-10kg weight loss. Therefore we analyzed the maximum BMI according to
which 84% of patients had BMI > 30kg/m2, fits in one of the degrees of obesity. Artherial
hypertension was seen in 65% of patients, predominantly female.
We noted a higher incidence of metabolic syndrome in female patients. Artherial hypertension is
common in the onset of DM and can be considered as part of MS, but at the same time we must
take into account a possible secondary cause of hypertension. In spite, MS percent would remain
unchanged because the patients with artherial hypertension had other 3 elements of MS.
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PO4. REZISTENȚA LA INSULINĂ ÎN BOLILE ISCHEMICE CEREBROVASCULARE
LA PACIENTUL CU DIABET ZAHARAT TIP 2
Dr. Dondoi Carmen1, Dr. Cucuringu Mihaela Virginia1, Dr. Chelan Claudia1, Dr. Mogos
Tiberius Viorel1
1
INDNBM "Prof. Dr. N.C. Paulescu"
Premise şi obiective: Scopul studiului a fost să observe influenţa rezistenţei la insulină la pacientul
cu diabet zaharat tip 2 in ceea ce priveşte bolile ischemice cerebrovasculare. Această idee a pornit
de la creşterea prevalenţei accidentului vascular cerebral ischemic la pacienţii cu diabet zaharat tip
2 şi obezitate.
Material şi metode: Au fost incluşi 34 de pacienţi cu diabet zaharat tip 2 (16 femei şi 18 bărbaţii;
vârsta medie de 61 ± 3,2 ani; durata diabetului zaharat de 7,2 ± 4,6 ani; IMC = 34,2 ± 3,7 kg/m²).
Menţionăm că iniţial a fost ales un număr de 142 de pacienţi din care au fost selectaţi doar cei cu
echilibru metabolic bun (HbA1c < 7% pe o perioadă de 3 ani) şi fără modificări semnificative ale
indicelui de masă corporală în acest interval. Pentru calcularea rezistenţei la insulină s-a folosit
indicele HOMA2 obţinându-se diferite scoruri ale HOMA-IR. Au fost apoi selectaţi, în mod
aleatoriu, acei pacienţi cu scorul HOMA-IR de 3 (12 pacienţi) şi respectiv 3,4 (13 pacienţi).
Rezultate şi discuţii: În primul grup s-a observat apariţia atacului ischemic tranzitoriu la 2 pacienţi
(16,6%), a accidentului vascular cerebral (AVC) cu deficit motor reversibil la 1 pacient (8,3%) şi
a accidentului vascular cerebral cu deficit motor permanent la 4 pacienţi (33,3%). În grupul cu
HOMA-IR de 3,4, s-a observat 3 pacienţi (23%) cu atac ischemic tranzitoriu, 2 pacienţi (15,4%)
cu AVC cu deficit motor reversibil, 2 pacienţi (15,4%) cu AVC cu deficit motor permanent şi 1
pacient (7,7%) cu AVC cu comă.
Concluzii: Studiul de faţă arată cum creşterea scorului HOMA-IR reprezintă un factor de risc
important pentru bolile cerebrovasculare la pacientul cu diabet zaharat tip 2 chiar şi în condiţiile
unui echilibru metabolic bun.
Dr. Dondoi Carmen1, Dr. Cucuringu Mihaela Virginia1, Dr. Chelan Claudia1, Dr. Mogos
Tiberius Viorel1
1
INDNBM "Prof. Dr. N.C. Paulescu"
Objectives: The aim of this study was to evaluate the influence of insulin resistance to the diabetic
patients concerning the ischemic cerebrovascular diseases. This idea rise from the increased
prevalence within last 10 years of the stroke in obese diabetic patients.
Methods: We included 34 patients with type 2 diabetes (16 men and 18 women; age mean ± SD:
61 ± 3.2 years; duration of diabetes 7.2 ± 4.6 years; BMI = 34.2 ± 3.7 kg/m²). At the beginning,
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we screened 142 patients from which we choose only the patients having good metabolic control
(HbA1c < 7% for 3 years) and no significant change of BMI. We find using HOMA2 calculation
Page
different values of HOMA- IR score. We arbitrary selected those patients with HOMA- IR score
about 3 (12 patients) and 3.4 (13 patients).
Results: In the first group, we observed the appearance at 2 patients (16.6%) of transition ischemic
stroke, a transition hemiparesis at 1 patient (8.3%) and a definitive hemiparesis at 4 patients
(33.3%). In the group HOMAIR – score ≈ 3.4, we observed 3 patients (23%) with transition
ischemic strokes, 2 patients (15.4%) with transition hemiparesis, 2 patients (15,4%) with
permanent hemiparesis and 1 patient (7,7%) with neurological coma.
Conclusions: The study demonstrated that increase HOMA score represents an important factor
of risk for the cerebrovascular diseases even to the well balance diabetic patients.
PO5. DIABET ZAHARAT TIP 1 SAU DIABET NEONATAL – CARE ESTE CEA MAI
BUNĂ OPȚIUNE DE TRATAMENT?
Rezident Herescu Irina Elena1, Rezident Mintici Luana1, Rezident Ioacara Sorin1, Prof. Dr.
Fica Simona1
1
Elias Emergency Hospital, Endocrinology and Diabetes Department
Diabetul neonatal este o formă rară de diabet zaharat ce apare în urma unei mutaţii monogenice,
cel mai frecvent la nivelul genei KCNJ11 sau INS. Pe lângă hiperglicemia cronică, diabetul
neonatal poate fi însoţit de epilepsie şi întârziere în dezvoltarea psihomotorie. Această formă de
diabet zaharat apare în primele luni de viaţă şi poate fi confundată cu diabetul zaharat tip 1. Spre
deosebire de diabetul zaharat de tip 1 , în care singura variantă de tratament este reprezentată de
administrarea de insulină exogenă, în cazul diabetului neonatal pacienţii răspund frecvent la
terapia cu glibenclamid.
Prezentăm cazul unui baieţel în vârstă de 3 ani şi 6 luni, fără antecedente personale patologice sau
heredocolaterale semnificative, diagnosticat cu diabet zaharat tip 1 la vârsta de 10 luni, în contextul
unei cetoacidoze inaugurale. La debut, valoarea glicemiei a fost de 588 mg/dl, apoi s-a iniţiat
tratamentul cu insulină administrată în 3 prize zilnice, cu ameliorarea poliuriei şi polidipsiei.
Pacientul s-a prezentat pentru prima dată în clinica noastră în iulie 2014, prezentând oscilaţii
glicemice cu hipoglicemii frecvente, iar valoarea hemoglobinei glicate era 9,3%. Având în vedere
vârsta la care a debutat boala, s-au recoltat probe pentru testarea genetică pentru diabet neonatal,
însă nu s-au identificat mutaţii la nivelul genelor KCNJ11 sau INS. O lună mai târziu, când
pacientul revine la control, se decide iniţierea terapiei administrată prin intermediul pompei de
insulină. Astfel, se montează pompa de insulină, se stabilesc ratele bazale pe intervale orare şi se
ajusteaza bolusurile de insulină. S-a obţinut o evoluţie favorabilă a profilului glicemic pe perioada
internării. Pacientul revine periodic pentru evaluare clinico-biologica, pentru aprecierea calităţii
controlului glicemic şi a eficienţei terapiei administrate prin pompă de insulină. La cea mai recentă
prezentare (ianuare 2016), clinic, pacientul avea o înălţime şi greutate corespunzatoare vârstei, cu
semne vitale în limite normale. Paraclinic, analizele de laborator s-au situat în limite normale, cu
excepţia hemoglobinei glicate de 7,7%. Cu toate acestea, se constată o îmbunătăţire semnificativă
a controlului glicemic în urma montării pompei de insulină, cu scăderea hemoglobinei glicate de
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la 9,3% la 7,7%. Se recomandă măsurarea glicemiei de cel puţin 4 ori pe zi, cu adaptarea dozelor
de insulină şi dozarea hemoglobinei glicate peste 3 luni.
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În concluzie, în cazul pacienţilor diagnosticaţi cu diabet zaharat înainte de vârsta de 12 luni trebuie
avuta în vedere şi forma mai rară a bolii, cea de diabet neonatal. În ceea ce priveşte pacientul
prezentat mai sus, această formă de diabet nu s-a confirmat, iar cea mai bună metodă de tratament
a fost considerată insulina administrată prin pompă.
Rezident Herescu Irina Elena1, Rezident Mintici Luana1, Rezident Ioacara Sorin1, Prof. Dr.
Fica Simona1
1
Elias Emergency Hospital, Endocrinology and Diabetes Department
Neonatal diabetes is a rare form of diabetes mellitus that results from mutations in a single gene,
most frequently in KCNJ11 or INS gene. Besides the chronic hyperglycemia, the neonatal diabetes
may be associated with epilepsy and retarded psychomotor development. This form of diabetes
occurs in the first months of life and may be misdiagnosed as type 1 diabetes mellitus. Unlike the
type 1 diabetes mellitus, in which the only treatment option is the administration of exogenous
insulin, patients with neonatal diabetes respond frequently to glibenclamide treatment.
We present the case of a 3 years and 6 months little boy , without significant personal or family
medical history, diagnosed with type 1 diabetes mellitus at the age of 1 year and 10 months, in the
context of inaugural ketoacidosis. At the disease onset, the glucose level was 588 mg/dl. Then,
after the initiation of insulin therapy in three shots per day, the symptoms of polyuria and
polydipsia were attenuated.
The first admission of the patient in our clinic was in July 2014, when he presented glycemic
oscillations and frequent episodes of hypoglycemia and the glycated hemoglobin level was 9,3 %.
Considering the patient’s age at the disease onset, blood samples were collected for genetic testing
for the neonatal diabetes, but no mutation was identified in the KCNJ11 or INS genes. One month
later, when the patient returns for reevaluation, it was decided to initiate the insulin pump therapy.
So, the basal rates and the bolus doses of insulin were determined and adjusted. An improvement
in the glycemic control was achieved during hospitalization. The patient returns regularly for
follow-up visits, for clinical and biological evaluation, to assess the glycemic control and the
efficiency of the insulin pump therapy. At the most recent admission, his physical examination
revealed height and weight according to age, with stable vital signs. The laboratory findings were
all unremarkable, except for glycated hemoglobin level of 7.7%. Nevertheless, we can notice a
major improvement in the glycemic control after initiating the insulin pump therapy, with a drop
in the glycated hemoglobin level from 9.3% to 7.7%. The recommendations for the patient were
to check his blood sugar level at least 4 times/day, to adjust the insulin doses and to check the level
of glycated hemoglobin after 3 months.
In conclusion, for patients diagnosed with diabetes mellitus before 12 months of age we have to
take into consideration the less frequent type of the disease, the neonatal diabetes. Concerning the
patient presented above, this type of diabetes was not confirmed, and so the best treatment option
230
Rezident Mintici Luana1, Rezident Herescu Irina1, Rezident Ionescu Olteea1, Dr. Ioacara
Sorin1, Prof. Dr Fica Simona1
1
SUU Elias, Bucuresti
Rezident Mintici Luana1, Rezident Herescu Irina1, Rezident Ionescu Olteea1, Dr. Ioacara
Sorin1, Prof. Dr Fica Simona1
1
SUU Elias, Bucuresti
Case presentation: Female pacient, age 40, diagnosed at age 4 with type I diabetes mellitus
(polyuria, polydipsia, polyfagia, fasting plasma glucose > 300mg/dl when diagnosed), father also
diagnosed with DM, arrives in February for clinical and biological evaluation and initiation of
insulin pump therapy. Up to February 2016 she had been on a basal-bolus insulin treatment
(Humalog 6U-4U-5U; Lantus 12U administered in the morning) however she had important blood
glucose variations (36-400mg/dl) and two severe hipoglycemia episodes per month. The patient
has endocrynological medical history (thyroidectomy due to nodular goiter, presently under
hormonal substitution therapy), frequent lower urinary infections, hepatic hemangioma
(hyperechoic, homogenous, well defined nodule measuring 10/9 mm, localized in segment VI,
diagnosed in 2014 through echography) and carpal tunnel syndrome (2010).
At the clinical exam, except for paresthesia in all limbs no other irregularities are present.
Laboratory examination results are normal except for glycated hemoglobin – 7.5% (slightly higher
than the <7% target) and fasting plasma glucose of 53mg/dl when admitted (other fasting plasma
glucose values during hospitalization: 45, 36, 97 mg/dl). In april 2015 glycated hemoglobin value
was 7.8. Laboratory examination also shows euthyroidian post-thyroidectomy hipothyroidism
under hormonal substitution therapy with Levothyroxine (Euthyrox) 100μg/day. Fundus
examination shows minimal nonproliferative diabetic rethinopathy and stage II angiosclerosis. The
blood sugar charts show a significant reduction of the risk of hypoglycemia, especially at night.
Recommendations on release: blood glucose measurement at least 4 times/day and adjustment of
insulin intake via insulin pump, continuation of the hormonal substitution therapy and imagistical
evaluation with i.v. contrast for the hepatic nodule.
Conclusions: The use of the insulin pump at pacients with type I diabetes mellitus allowed a better
control over blood glucose levels through glycemia automonitorization, with significant benefits
to the quality of life and the risc of hypoglycemia in hypoglycemia unawareness syndrome.
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PO7. PATTERNS REGARDING VITAMIN AND MINERAL’S INTAKE IN
NORMALWEIGHT AND OBESE PATIENTS
To evaluate the vitamin and mineral’s intake in overweight and obese patients and to personalize
diet plan for reaching a healthy weight and to correct the deficiencies found. Knowing the factors
and the hypercaloric diet that lead to obesity we can achieve a healthy lifestyle program to be
maintained in the long term
The food log analysis showed that all the patients had food deficiencies of vitamin D, E, calcium
and magnesium even if they were eating a hypercaloric or a normocaloric diet. If the weight
management involve a calorie restriction, we need to be careful with these micronutrients and to
prevent the plasma deficiencies. Personalizing the diet and indicate the foods that are rich in
different nutrients, we can reach the recommended daily intake for vitamins and minerals.
The originality of our study is that we evaluated the vitamin and mineral’s intake both to
normalweight and obese patients and we demonstrated that neither the normal weight nor the obese
patient had adequate micronutrient intake. We developed a software that analyzed the diet from
the point of view of macro and micronutrient.
In our country, the latest study on obesity prevalence showed, in 2014, that 21.3% of Romanians
are obese and the trend is growing. In 2025, World Obesity Federation estimates that will be 177
million of obese people that will need treatment. Hypocaloric diet and regular exercise are the first
step to lose weight. These patients have an inadequate food intake, with an imbalance regarding
kilocalories, vitamins and minerals that could have consequences on health.
Student Souabni Seif Eddine1, Student Soury Arselen1, Student Houidi Ahmed1, Student
Selmi Monaam1
1
UMF Iasi
Diabetes mellitus and arterial hypertension are growing to be a major public health issue. Both
entities often coexist and their co-existence can significantly increase the risk of developing a
nephropathy. The chronicity of both conditions can significantly affect the management and the
life quality of the patient. Therefore we are aiming with this study to assess the role of these two
co-morbidities in the development of a nephropathy in order to provide a better care and to avoid
the progression to end stage renal disease (ESRD).
Our retrospective study was conducted in the diabetology, nutrition and metabolic diseases
department in Sfantul Spiridon Hospital IASI, we enrolled 606 patient, among them 304 male and
302 female and we used the same identical data sheet to collect the other morbidities and associated
233
and 467 (77%) had type 2 diabetes mellitus and 402 (66.3 %) had high blood pressure. 55 (13.92%)
of our diabetic patient have grade 1 high blood pressure (HBP), 104 (26.32 %) have grade 2 HBP
and 236 (59.76 % ) have grade 3 HBP. We noticed that 130 (32.9%) of the patients having diabetes
mellitus associated with arterial hypertension have a nephropathy of whom 109 (83.8 %) patient
had a preexisting grade 3 HBP. We should note that our patients did have associated risk factors
other then diabetes mellitus and arterial hypertension such as obesity (44 %) and smoking
(26.32%).
The existence of hypertension among diabetic patients can significantly increase the occurrence
of nephropathy, therefore early detection of diabetes mellitus, arterial Hypertension, a better care
and management of both entities may delay the progression of kidney disease in Diabetes mellitus.
Hereby studying the prevalence of nephropathy among patient with these two co-morbidities may
lead to a better understanding of the causing mechanism and prevent its complications.
Dr. Șerbănescu Cristina1, Dr. Nilă Alexandra1, Dr. Sava Elisabeta1, Dr. Sârbu Anca1, Dr.
Ioacără Sorin1, Prof. Univ. Dr. Fica Simona1
1
Spitalul Universitar de Urgenţă Elias
îmbunătățiri rapide în controlul glicemic, chiar în decurs de câteva zile, înainte de înregistrarea
unei scăderi ponderale semnificative.
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PO10. ASOCIEREA DINTRE ACIDUL URIC ȘI OBEZITATEA LA PACIENȚII CU
DIABET ZAHARAT TIP 2
Dr. Zaharia Adelina1, Dr. Liță Genoveva Andreea1, Dr. Pavel Anca Ioana1, Student Zaharia
Mihaela Iulia1, Dr. Stoicescu Florentina1, Dr. Gheorghiță Andra Gabriela1, Dr. Rusu
Emilia1, Prof. Dr. Radulian Gabriela1
1
National Institute of Diabetes Mellitus, Nutrition and Metabolic Diseases ”Prof.Dr. N.C.
Paulescu”, Bucharest
Dr. Zaharia Adelina1, Dr. Liță Genoveva Andreea1, Dr. Pavel Anca Ioana1, Student Zaharia
Mihaela Iulia1, Dr. Stoicescu Florentina1, Dr. Gheorghiță Andra Gabriela1, Dr. Rusu
Emilia1, Prof. Dr. Radulian Gabriela1
1
National Institute of Diabetes Mellitus, Nutrition and Metabolic Diseases ”Prof.Dr. N.C.
Paulescu”, Bucharest
235
Premises and Objectives: Hyperuricemia is a metabolic disease often seen in patients with Type
2 Diabetes Mellitus. However, the relation between the level of serum uric acid and Diabetes
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Mellitus which associates obesity is still in research. The aim of this study was to evaluate the
relation between serum uric acid and ponderal status, by comparing the level of serum uric acid in
patients with obesity and those without obesity.
Content and Method: We realised a retrospective study on a group of 218 patients with Diabetes
Mellitus, who were under the observation of N.I.D.N.M.D.”Prof. Dr.N.C.Paulescu” from
Bucharest, by using clinical and laboratory methods to evaluate the parameters included in the
study. We used the laboratory values of serum uric acid to evaluate the hyperuricemia; the ponderal
status was evaluated by calculating the body mass index, using anthropometric indices (weight
and height).
Results and Discussions: From the total number of patients included in the study, 62 (28,4%)
were women and 156 (71,6 %) were men. The average age of the patients was 58,71 ± 7,86 years;
the average duration of diabetes mellitus was 11,79 ± 7,12 years. Regarding the ponderal status of
the patients, 8,7 % (n=19) had normal weight, 25,7% (n=56) were overweight and 65,6 % (n=143)
had obesity in different grades. The medium level of the serum uric acid was 5,42 ± 1,86 mg/dl in
patients with normal body weight, 5,38 ± 1,69 mg/dl in overweight persons and 6,12 ± 1,88 mg/dl
in subjects with obesity (p=0,021). In patients with hyperuricemia, 75% had obesity in different
stages, as it follows: 32,5% grade 1 obesity, 37,5% grade 2 obesity and 5% grade 3 obesity
(p=0,05). Also, in 82,5% from patients with hyperuricemia we found the presence of metabolic
syndrome.
Conclusions and Findings: We observed that there are significant differences regarding the level
of serum uric acid in patients with Type 2 Diabetes Mellitus and obesity, comparing to patients
with normal body weight or overweight.
Dr. Stegaru Daniela1, Dr. Delcea Alina1, Conf. Dr. Guja Cristian1
1
UMF "Carol Davila"
Premise şi obiective: Sindromul Mauriac este una dintre complicaţiile foarte rare, dar grave ale
diabetului zaharat tip 1. În tabloul clinic al sindromului Mauriac regăsim retardul de creştere, faţa
în formă de “lună plină”, abdomenul mult mărit de volum şi atrofii muscular importante. Este
asociat cu dezechilibrul metabolic cronic important, în care alternează perioade lungi de
subinsulinizare cu perioade de suprainsulinizare. În prezent este o complicţie foarte rară, cel puţin
în statele dezvoltate. Prezentăm în cele ce urmează un astfel de caz.
Material şi metodă: A fost evaluat un pacient de sex masculin în vârstă de 10ani şi o lună,
cunoscut cu DZ tip 1 în evoluţie de la varsta de 10 luni, adus la spital de mamă pentru valori
glicemice crescute (350-450mg/dl) alternativ cu hipoglicemii severe (40-50mg/dl). Au fost
evaluaţi parametrii clinici (date antropometrice, examen clinic complet) şi paraclinici (probe de
laborator si date imagistice - radiografie pulmonară, ecografie abdominală). In cursul internarii a
fost reevaluata schema de insulinoterapie, cu ajustarea dozelor în funcţie de glicemii şi de aportul
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de carbohidraţi.
Rezultate: Copilul prezintă dezechilibru metabolic cronic (HbA1c – 10.4%), deficit de creştere
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staturo-ponderală (înalţime – 1.18 m, greutate – 21 kg, sub percentila 5 pentru vârstă, IMC – 15.1
kg/mp), hepatomegalie masivă (19cm) însoţită de hepatocitoliză şi dislipidemie severă (GGT –
1008 UI/l, TGO – 118 UI/l, TGP – 118 UI/l, colesterol total – 589 mg/dl, HDL – 16.6 mg/dl, TG
– 840 mg/dl). Examinarea ecografică indică prezenţa hepatomegaliei (diametrul hepatic prerenal
de 190mm), cu ecostructura relativ omogenă dar intens hiperecogenă, cu mici calcificări la nivel
pancreatic. După 4 zile de ameliorare metabolica (valori glicemice 120-250mg/dl), se poate
constata o uşoară îmbunătăţire a profilului lipidic cu scaderea CT la 467mg/dl şi a TG la 629mg/dl.
De adaugat ca am testat anticorpii anti celula beta pancreatica care au fost pozitivi anti GAD,
sustinand diagnosticul de DZ autoimun.
Discuţii: Este posibilă prezenţa sindromului Mauriac indus de controlul metabolic deficitar şi de
durată. Datorită vârstei la debutul diabetului (10 luni) putea fi luată în discuţie prezenţa unui diabet
neonatal sau a unui alt sindrom genetic complex care asocieaza diabet zaharat, însă prezenţa
anticorpilor anti GAD infirmă această teorie. Prezenţa hepatomegaliei importante asociată cu
hepatocitoliză şi dislipidemie severă apărute la vârsta de 6 ani, după un dezechilibru metabolic nu
foarte important în intervalul 10 luni – 6 ani (HbA1c aprox. 9%), ridică suspiciunea prezenţei unei
glicogenoze asociate DZ tip 1 sau a unui sindrom Fanconi-Bickel. Totusi, ameliorarea
semnificativă a profilului lipidic în numai 4 zile de internare (in paralele cu ameliorarea controlului
glicemic) înclină balanţa spre prezenţa unei glicogenoze secundare dezechilibrului metabolic
cronic, în cadrul unui tablou clinic de Sindrom Mauriac. Datorită prezenţei microcalcificărilor la
nivel pancreatic, ridicand suspiciunea unei eventual fibroze chistice, a fost efectuată şi radiografia
pulmonară care nu a indicat modificari sugestive pentru aceasta afectiune.
Dr. Stegaru Daniela1, Dr. Delcea Alina1, Conf. Dr. Guja Cristian1
1
UMF "Carol Davila"
Premises and objectives: Mauriac syndrome is a very rare and severe complication of type 1
diabetes (T1D). It is characterized by growth retardation and delayed pubertal maturation, short
stature, “moon-shaped” face, abdominal obesity and important muscle atrophy. It is associated
with poor management of T1D, with long periods of sub-insulinization alternating with periods of
overinsulinization. Today it is very rare complication of T1D, at least in developed countries. We
present below such a case.
Methods: We evaluated a boy aged 10 years and 1 month, diagnosed with T1D at the age of 10
months. He was admitted in hospital (brought by his mother) for elevated blood glucose (350-450
mg/dl) alternating with severe hypoglycemic episodes (40-50mg/dl). He was fully evaluated,
including clinical parameters (anthropometric data, complete clinical examination) and laboratory
data (lab tests and imaging data - chest X-ray, abdominal ultrasound). During hospitalization,
insulin regimen was reconsidered, with dose adjustments based on blood glucose levels and
carbohydrate intake.
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Results: The child presents a poor metabolic control (HbA1c - 10.4 % ), growth failure (height -
1.18 m, weight - 21 kg, below the 5th percentile for age, BMI – 15.1 kg/m2), massive
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hepatomegaly (19cm), with hepatocytolisis and severe dyslipidemia (GGT - 1008 IU/l, TGO - 118
IU/l, TGP - 118 IU/l, total cholesterol - 589 mg/dL, HDL - 16.6mg/dl, TG - 840 mg/dL).
Ultrasound examination indicated the presence of hepatomegaly (prerenal liver diameter of 190
mm) with relatively homogeneous echostructure but intensely hyperechoic, with small
calcifications in the pancreas. After 4 days of improvement of the blood glucose profile (glycemia
ranging between 120-250 mg/dL), there was a slight improvement in the lipid profile, with a
decrease of TC to 467 mg/dl and TG to 629 mg/dl. Also we tested pancreatic beta cell antibodies
that were positive for GAD autoantibodies, supporting a diagnosis of autoimmune diabetes.
Discussion: A diagnosis of Mauriac syndrome is possible, induced by the long period of poor
management of diabetes mellitus. We could also consider the presence of neonatal diabetes based
on the age at onset of diabetes (10 months), or other complex genetic syndrome that associated
diabetes. However,, the presence of anti GAD antibodies cripple this theory. The presence of
important hepatomegaly associated with hepatocytolisis and severe dyslipidaemia first evidenced
at the age of 6 years, after a period of moderately controlled diabetes between 10 months and 6
years (HbA1c approx. 9%) made us suspect the presence of an associated glycogenosis or Fanconi-
Bickel syndrome. However, the improvement of the lipid profile in only 4 days of hospitalization
(in parallel with the improvement of glycemic control) tilts the balance towards the presence of a
secondary glycogenosis explained by the chronic metabolic imbalance - a clinical manifestation
of Mauriac syndrome. Due to the presence of microcalcifications in the pancreas, possibly raising
the suspicion of cystic fibrosis, a chest radiography was performed which indicated no changes
suggestive for this condition.
proprietățile fizice și clinice ale medicamentului produs. Medicamentele biologice sunt molecule
mai mari și mai complexe. Spre deosebire de medicamentele clasice, care constau în molecule
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mici, produse prin sinteză chimică, medicamentele biologice au, de multe ori, structură proteică,
complexă, fiind formate din lanțuri de aminoacizi așezate într-o structură tridimensională
complexă, ce nu pot fi asamblate decât de către organismele vii. Deoarece medicamentele
biologice sunt produse de sisteme vii, pot prezenta o variabilitate mai mare în structura și
caracteristicile lor comparativ cu produsele farmaceutice tradiționale. Proprietățile
medicamentului biologic pot fi influențate atât de linia de celule utilizate pentru producție, cât și
condițiile de fabricație, deosebiri aparent minore ale mediului putând determina modificări
importante de eficiență și tolerabilitate.
Concluzie: În contextul dezvoltării medicamentelor biosimilare în domeniul diabetologiei, este
necesară o înțelegere aprofundată a procesului de dezvoltare a medicamentelor biologice, pentru
a face, ca medic diabetolog, alegerea potrivită a tratamentului și pentru a evita apariția efectelor
adverse ale medicației din cauza utilizării neconforme cu proprietățile biologice.
Background and Objectives: Biotechnology underpins the manufacture of hundreds of drugs that
benefit worldwide, over 350 million patients. They are used to treat or prevent a number of serious
diseases, including cancer, myocardial infarction, stroke, multiple sclerosis, diabetes, rheumatoid
arthritis and autoimmune diseases.
Material and method: Biological drugs are composed of substances which are often naturally
occurring in the human body, such as growth hormone, insulin, erythropoietin, enzymes,
antibodies , etc. They can not be produced by chemical synthesis, such as conventional drugs, but
are produced by living systems (plant or animal cells, bacteria, viruses and yeasts). For this reason,
the production of biological drugs is much more complex than the production of chemical
pharmaceutical products. Each biotechnology company has its own bank of cells with unique cell
lines that are used for the manufacture of drugs.
Results and discussions: Very small variations of the manufacturing process, for example in
temperature, can cause significant changes in physical and clinical properties of the drug.
Biological drugs are larger and more complex molecules. The classical medicines consisting of
small molecules produced by chemical synthesis. Biological medicines are often, protein structure,
complex, being made up of chains of amino acids arranged in a three-dimensional structure
complex, which can be assembled only by living organisms. Because biological drugs are
produced by living systems, may experience greater variability in their structure and characteristics
compared to traditional pharmaceuticals. Biological properties of the drug can be influenced by
the cell line used for production and manufacturing conditions, minor environmental differences
may cause significant changes of efficacy and tolerability.
Conclusion: In the context of developing biosimilar medicines in the field of diabetology, it
requires a deep understanding of the development process for biological medicines, in order to
make the appropriate choice of therapy and avoid the side effects of medication due to non-
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Casoinic Florin, Sampelean Dorel, Buzoianu Anca D., Hâncu Nicolae, Baston Dorina
Premise şi Obiective: Steatohepatita non-alcoolică (SHNA) – forma severă a ficatului gras non-
alcoolic (FGNA) – diagnosticată prin puncție biopsie hepatică, a fost asociată cu un risc crescut
de boală cardiovasculară aterosclerotică. Deși patogeneza SHNA rămane incă insuficient ințeleasă,
citokinele proinflamatorii prezintă un rol important atat in progresia și dezvoltarea SHNA precum
şi in procesul aterogen al afectării cardiovasculare. Obiectivul acestui studiu a fost acela de a
evalua profilul inflamator sistemic cronic (i.e., citokinele proinflamatorii (IL-6, IL-1β, TNF-α) și
nivelul hs-CRP) şi adiponectina serică la pacienți cu diabet zaharat de tip 2 (DZT2) și SHNA,
precum și corelațiile acestora cu caracteristici clinicobiochimice ale pacienților.
Material şi Metodă: Un număr total de 117 participanți (32 pacienți cu DZT2 si SHNA
diagnosticați histologic; 45 pacienți cu DZT2 fara afectare hepatică; 40 de subiecți sănătoşi clinic)
au fost incluși in studiu şi evaluaţi sub aspect clinico-biologic. Nivelurile serice ale unui panel de
markeri ai inflamației cronice sistemice (factorul de necroză tumorală-α (TNF-α), interleukina-6
(IL-6), interleukina-1β (IL-1), hs-PCR) și adiponectina au fost măsurate in serul pacienților incluși
in studiu, iar rezultatele obţinute au fost prelucrate statistic prin efectuarea analizelor de corelaţie.
Rezultate şi Discuţii: Pacienții cu SHNA și DZT2, in comparație cu pacienții cu DZT2 fără
afectare hepatică , au prezentat niveluri serice semnificativ mai mari de IL-6 (134.83 ± 57,18 pg/ml
vs. 55,68 ± 18,29 pg/ml; p = 0,001), IL- 1β (73,45 ± 15,11 pg/ml vs. 22,07 ± 9,17 pg/ml; p = 0,001)
și TNF-α (60,88 ± 12,31 pg/ml vs. 18,81 ± 7,25 pg/ml; p = 0,021). Spre deosebire de creșterea
concentrațiilor de citokine proinflamatorii, nivelul seric al adiponectinei la pacienții cu SHNA și
DZT2 a fost găsit mai scăzut decat la pacienții doar cu DZT2 (3950,5 ± 954 ng/ml vs. 6745 ± 1122
ng/ml; p = 0,002) și lotul martor. In ceea ce privește hs-CRP, acest parametru al inflamației cronice
sistemice a fost găsit semnificativ crescut la pacienții cu SHNA și DZT2 (8,4 ± 5,9 mg/l),
comparativ cu pacienții doar cu DZT2 (4,72 ± 3,6 mg/l) și lotul martor (2,11 ± 1 mg/ l) (p = 0,001).
Profilul clinic al pacienților cu DZT2 și SHNA indică: prevalență crescută a obezității morbide la
acest lot vs. pacienții cu DZT2 și ficat normal și vs. lotul martor; control slab al diabetului zaharat;
creștere a transaminazelor serice şi a gama GT, rezistență crescută la insulină, precum și un risc
cardiovascular calculat (scor UKPDS pe 10 ani) mult crescut sub aspectul morbidității și
mortalității de cauză coronariană și cerebrovasculară. Rezultatele analizelor de corelație au
evidențiat la pacienții cu DZT2 șiSHNA asocieri semnificative intre creşterea citokinelor
proinflamatorii şi hs-PCR, scăderea adipocitokinei antiaterogene, și diferiţi parametri clinici și
biochimici de risc cardiovascular.
Concluzii: Rezultatele acestui studiu arată că nivelurile serice ale IL-6, IL-1β, TNF-α și hs-PCR
sunt semnificativ crescute la pacienții cu DZT2 și SHNA, iar nivelul adiponectinei serice este
scăzut. Caracteristicile clinico-biochimice și profilul inflamator sistemic al pacienţilor cu DZT2 şi
SHNA se asociază cu un risc cardiovascular foarte inalt.
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CLINICAL AND BIOLOGICAL CORRELATIONS OF CARDIOVASCULAR RISK
AND THE LEVEL OF CHRONIC SYSTEMIC INFLAMMATION IN PATIENTS WITH
TYPE 2 DIABETES MELLITUS AND NON-ALCOHOLIC STEATOHEPATITIS
Casoinic Florin, Sampelean Dorel, Buzoianu Anca D., Hâncu Nicolae, Baston Dorina
cardiovascular risk.
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PO14 HIPERTRIGLICERIDEMIA, FACTOR DE RISC PENTRU PANCREATITA
ACUTĂ LA PACIENTUL CU DIABET ZAHARAT
Oana Albai1,2, Raluca Borza3, Ionela Tudora3, Alexandra Sima1,3, Adrian Vlad1,3, Romulus
Timar1,2, 3, Bogdan Timar1,2
1.Universitatea de Medicină și Farmacie "Victor Babeș" Timisoara, Romania
2. Centrul de Diabet, Nutriție și Boli Metabiolice Timişoara, Romania
3. Departamentul de Diabet, Nutriție și Boli Metabolice a Spitalului Județean de Urgență
Timisoara, Romania
Oana Albai1,2, Raluca Borza3, Ionela Tudora3, Alexandra Sima1,3, Adrian Vlad1,3, Romulus
Timar1,2, 3, Bogdan Timar1,2
1. University of Medicine and Pharmacy "Victor Babes" Timisoara, Romania
2. Center of Diabetes, Nutrition and Metabolic Diseases Timişoara, Romania
3. Department of Diabetes, Nutrition and Metabolic Diseases, County Hospital Timisoara,
Romania
Backgrouund and aims: Insulin resistance (IR) and/or insulin deficiency, characteristic of
patients with diabetes mellitus (DM) , contribute to the quantitative and qualitative changes of all
classes of lipoproteins (LP), special triglycerides (TG). Hypertriglyceridemia (HTG) is the third
leading cause of acute pancreatitis (AP) after alcohol consumption and gallstone.
The aim of the present study was to determine the prevalence of AP in patients with diabetes and
its correlation with TG values .
Material and methods: Were investigated 2355 patients with DM, hospitalized in Diabetes,
Nutrition and Metabolic Diseases Clinic of County Hospital Timisoara from October 2014 to
december 2015. The following parameters were investigated: age, sex, type of DZ , data about
alcohol consumption, smoking, presence of gallstones, body mass index (BMI), waist (abdominal
circumference), glycemic control (fasting, glycemia, postprandial glycemia, HbA1c), lipid profile
(TC , TG, HDLc, LDLc, non - HDLc), DZ conplications, serum lipase and amylase, blood pressure
, data of abdominal ultrasound and computed tomography .
Results and discussions: The study group included 1160 men (49.3%) and 1195 women
(50.7%) with mean age 60.7 ± 13.6 years. Refering to types of DM, 310 patients (13.2%) had DM
type 1 and and 2045 patients (86.8%) DM type 2. Mean of the HbA1c at patients included in our
study was 9.1 ± 2.2%.
The prevalence of HTG in the study group was 38%, 894 patients had values of TG ≥150 mg/dl.
The average value of TG was 183.7 ± 202.8 mg/dl.
The diagnosis of AP was established on 28 patients (1.2%), the prevalence is higher in males
compared to females: 1.6% versus 0.8%.
Analyzing the values of TG in patients with AP, we found that 21 patients (75%) had TG ≥200
mg/dL: 6 patients (21%) had TG> 2000 mg/dL, 5 patients (17%) have TG between 500 and 2000
mg/dl, and 11 patients (39%) had TG between 200 and 500 mg/dl.
By comparing the main parameters in patients with and those without AP, we noticed that the
average values of BMI, HbA1c, TC, TG were significantly higher in those with AP (p <0.0001).
Conclusion: The values of TG are strongly correlated with the degree of glycemic control,
quantify by values of HbA1c. HTG is a risk factor for AP, independent of cardiovascular risk.
Regular monitoring of lipid metabolism and carbohydrate metabolism is required, imposing an
early and effective treatment.
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