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Influence of Bromocriptine Plus Metformin Treatment on Glycaemia and Blood Pressure in Patients with Type 2 Diabetes Mellitus


Background and aims: Bromocriptine is a dopaminergic (D2) agonist that has shown hypoglycemic and normotensive activity in preclinical and clinical studies. The main objective of this study was to investigate the effect of bromocriptine plus metformin on glycaemia and blood pressure in patients with type 2 diabetes mellitus (T2DM).

Material and methods: An open-label randomised controlled trial was conducted for three months. It involved two groups (n=10), each containing 2 women and 8 men with an average age of 50 years. One group was given monotherapy (MT) with metformin (850 mg every 12 h) and the other combined therapy (CT) with the same dose of metformin plus an increasing dose of bromocriptine (from 1.25 mg per day to 2.5 mg per day). The parameters monitored were glycaemia, glycated hemoglobin (HbA1c), serum creatinine, blood pressure, and the body mass index.

Results: CT was able to significantly decrease the level of glycaemia, HbA1c and diastolic blood pressure, whereas MT had no effect on any of the measured variables.

Conclusions: The ability of CT with bromocriptine and metformin to control glycaemia and produce a normotensive effect reaffirms its advantages for controlling T2DM. Further research is needed to improve this therapeutic strategy.

Open access
The Influence of Glycemic Control on Heart Rate Variability and Blood Pressure in Adult Patients with the Type 1 Diabetes


Background and aims: to identify heart rate variability (HRV) and blood pressure (BP) in patients with type 1 diabetes depending on the duration of disease and glycemic control.

Materials and methods: 43 patients were examined. All patients were divided into 2 groups according to the level of НвА1с: group 1 (n=21) with НвА1с ≤ 7.5% and group 2 (n=22) with НвА1с > of 7.5%. All patients underwent daily monitoring of electrocardiogram Holter and ambulatory BP monitoring within 24 hours in parallel with long term monitoring of blood glucose.

Results: Hyppoglycemia is characterized by significant decrease root mean square difference between adjacent RR intervals (RMSSD) (r = −0.531; p = 0.003) and number of consecutive RR intervals, the difference between them is more than 50 ms expressed as a percentage of total number of RR-intervals (pNN50%) (r = the −0.503; p = 0.005) and increase of Low Frequency/High Frequency Ratio (LF/HF) (r = 0552; p = 0.002). Patients with hypoglycemia had significantly higher daily diastolic pressure area index (DPAI24) (p = 0.016), and daily diastolic pressure time index DPTI24 (p = 0.025).

Conclusion: our findings demonstrate the need to reduce the frequency of hypoglycemia episodes in patients with T1DM.

Open access
Nocturnal Hypoglycemia in Type 2 Diabetes


Background and aims: It is known that the majority of critical unacknowledged hypoglycemia has an increased incidence in patients with type 1 diabetes (T1DM) with a long evolution. The aim of this research is to evaluate the variability of glucose level and hypoglycemic events in patients with type 2 diabetes (T2DM) having pharmacological interventions with hypoglycemic risk. These events are sometimes asymptomatic also in T2DM: frequently in elderly, patients with autonomic neuropathy, or having a long evolution of disease.

Material and method: This analysis includes 72 patients with T2DM, with a relative good metabolic control, and possible glucose fluctuations. Glucose variability was appreciated using continuous glucose monitoring systems (CGMS) used for more than 72 hours in hospital or ambulatory setting.

Results: The incidence, duration and severity of hypoglycemia are not correlated with HbA1c value, age, disease duration or treatment. Approximately a quarter of patients had nocturnal hypoglycemia and in 37,5% of events hypoglycemia was prolonged, more 45 minutes. Clinical manifestations in diurnal hypoglycemia were presents in only 40% of the recorded events.

Conclusions: The study suggested that CGMS is beneficial for patients with type 2 diabetes, with hypoglycemic risk and complications, to adjusted medication, education and prevention the cardiovascular events.

Open access
Optimization of Efficacy of Core Strengthening Exercise Protocols on Patients Suffering from Diabetes Mellitus


Background and Aims: Lack of physical activity, obesity, eating habits contributes to an increase in metabolic disorders. Patients with diabetes have balance, gait, and proprioceptive impairments which hinder the activity of daily living. Therefore, the main objective of present research was to optimize and to find efficacy of the exercise protocols on gait, balance, proprioception and glycated haemoglobin (HbA1c) levels in patients suffering from Type 2 Diabetes mellitus (T2DM).

Material and Methods: Forty individuals with T2DM age between 35 to 60 were recruited and randomly allocated to four groups with 10 subjects per group. Core strengthening exercises were given with duration of twenty or thirty minutes per session and frequency of twice or thrice weekly for six weeks.

Results: Design Expert Software version 10.0.6 was used to analyse data Design Expert software. Further duration and frequency of exercises were compares using ful factorial design. Paired sample t test was used at significance level p<0.05 to find efficacy of core strengthening exercises. The results showed the roe of duration and frequency along with significant effect of exercises on balance, gait, proprioception and HbA1c.

Conclusion: Pilates based core strengthening exercises (PBCS) significantly improved all the parameter selected if exercise protocol was given for 30 minutes and thrice weekly for six weeks. Study has also shown impact of duration and frequency of exercises separately on these parameters.

Open access
The Relation Between Metabolic Syndrome and Testosterone Level


Metabolic syndrome is a group of conditions that increases the risk of developing diabetes and cardiovascular diseases. The most important pathogenic factors for metabolic syndrome are insulin resistance and obesity. The clinical presentation of this syndrome results from its influence on glucose and fat metabolism. Testosterone deficiency has a prevalence of up to 50% in men with metabolic syndrome and type 2 diabetes mellitus. A low level of testosterone is a factor for cardiovascular diseases and predictor of metabolic syndrome and, on the other hand, the components of metabolic syndrome can lead to low testosterone. This article reveals the bidirectional link between low testosterone level or hypogonadism and metabolic syndrome.

Open access
Secondary Diabetes Mellitus in Patients with Endogenous Cushing’s Syndrome - Clinical Characteristics at Diagnosis


Background and aims. Endogenous Cushing’s syndrome is a rare disease associated with severe morbidity and increased mortality if untreated. Diabetes mellitus is a frequent initial complaint of these patients. Our aim was to investigate the clinical characteristics at the time of diagnosis in a cohort of patients with endogenous Cushing’s syndrome (CS).

Material and methods. A retrospective analysis of the presentation of 68 cases diagnosed with endogenous Cushing’s syndrome followed-up in our institution was performed.

Results: There were 57 women and 11 men, aged 18-74 years (mean 45.57±14.2). 38 had Cushing’s disease (CD) while 30 had adrenal CS. The most frequent signs/symptoms leading to the initial consultation and diagnostic suspicion were central obesity (55 cases, 80.88%), purple striae (28 cases, 41.1%), secondary arterial hypertension (27 cases, 39.7%), secondary diabetes mellitus (24 cases, 35.29%), hirsutism in 23/55 women (41.81%), hypogonadism in 23 cases (33.82%), proximal myopathy in 17 cases (25%), edema (10 cases, 14.7%). 13 cases (19.11%) also had secondary osteoporosis (diagnosed by dual energy x-ray absorptiometry - DXA osteodensitometry). Among the two diagnostic groups there were several differences. Proximal myopathy, secondary hypertension and diabetes mellitus were all more frequent in cases with adrenal Cushing compared to those with CD. (p= 0.011, 0.006 and 0.024, respectively). This did not reflect more severe hypercortisolism in adrenal CS, as the hormonal values were similar in the two groups.

Conclusion: If associated with certain clinical signs, some nonspecific (central obesity, edema, arterial hypertension), other more suggestive of CS (purple striae, proximal myopathy) diabetes mellitus could be the initial sign of this severe condition.

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Assessment of Cardiac Autonomic Function by Post Exercise Heart Rate Recovery in Diabetics


Background and Aims: Autonomic dysfunction in type 2 diabetes mellitus (DM) patients may translate into an increased cardiovascular morbidity and mortality. Autonomic system regulates ‘heart rate recovery’ (HRR), an important predictor of cardiovascular mortality, which can be assessed using the exercise electrocardiogram (ECG). Hence, utilizing HRR, this study assessed the autonomic function of the cardiovascular system after one minute of exercise stress test in both, patients with and without type 2 DM.

Materials and Methods: A prospective case control study involving 50 patients with type 2 DM and 50 without type 2 DM, matched for age and sex, was carried out. Each subject underwent an exercise stress test by treadmill using the Bruce protocol. Cardiovascular parameters like heart rate was recorded using a 12 lead ECG along with blood pressure.

Results: Patients with T2DM had lesser HRR after exercise (p < 0.001). Exercise capacity was significantly reduced among patients with T2DM when compared to controls (p = 0.01). A multiple linear regression analysis (R2=0.26) revealed that duration of diabetes (β=−0.02, p=0.048) and resting systolic blood pressure (SBP) (β=−010, p=0.048) are independent predictors of HRR.

Conclusion: The study revealed HRR to be significantly reduced among patients with type 2 DM. HRR may hint at the presence of cardiac autonomic dysfunction and predict the cardiovascular mortality.

Open access
Effect of Pre-Ramadan Education on Dietary Intake and Anthropometry-Comparison Between Two Groups of Diabetic Patients


Background and aims: Fasting of Ramadan leads to changes in dietary habits, physical activity, sleep and time of drug intake for diabetics. The objective of this study was to evaluate the effect of pre-Ramadan education on dietary intake and anthropometry of two groups of patients.

Material and methods: The entire cohort was divided in a group (G1; n=86) which attended nutritional education sessions and group that did not attend these sessions (G2; n=72). The protocol included three visits before, during and after the month of Ramadan.

Results. Total energy intake of the G1 did not differ significantly between visits, unlike the G2. Patients in the G1 reduced their carbohydrate intake during Ramadan with 32.5g, compared to the G2 which decreased their consumption with17.2g. The intake of saturated fatty acids was significantly higher in the G2 (p=0.001) after Ramadan. The number of obese class 2 of the G1 decreased after Ramadan, however for the G2, the number increased. The waist-to-hip ratio and the body fat (%) were unchanged between the three periods.

Conclusion. The management of diabetes should be multidisciplinary to ensure better continuity of care. Specialized and individual educational actions must be concrete in diabetics wishing to fast.

Open access