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Open access

Raluca Dina, Iulia Vladu, Ciprian Dina and Adina Mitrea

Advanced Glycation End Products Measured by Age Reader in a Group of Patients with Obesity

Background and Aim: Skin autofluorescence (AF) is a method used to detect the accumulation of Advanced Glycation End Products (AGEs) in skin collagen using AGE Reader. AGEs accumulation is favorised by chronic hyperglycemia and oxidative stress and these products may contribute to the pathogenesis of cardiovascular disease. Materials and Methods. The inclusion criteria for the study were: patients with Body Mass Index (BMI) ≥30kg/m2. We excluded from the study patients of black color, because of the principle of fluorescence of AGE Reader, and also patients with diabetes. Patients underwent Oral Glucose Tolerance Test (OGTT) with 75g of glucose: fasting plasma glucose (FPG), two hours post glucose load, and HbA1c blood samples were analysed. Finnish diabetes risk score for predicting the incidence of diabetes (FINDRISK score) was calculated. Results. BMI had a negative correlation with AF (p<0.005), but Abdominal Circumference (AC) was not correlated with AF (p=0.065). No correlations were found between BMI and FPG, or blood sugar level two hour post glucose load. Glucose level at two hours post glucose load did not correlate with the AF. Conclusion. Our results do not confirm the theoretical assumption according to which AC and BMI, as markers of insulin resistance and metabolic disorders, are associated with the increase in AGEs, or the assumption that postprandial blood glucose levels would have a more important role in the development of chronic complications that AGEs could be pathogenic link. AF is not influenced by short-term variations in blood glucose such as blood sugar level at two hours post glucose load, but it is influenced by FPG and prolonged term variation in blood glucose as HbA1c.

Open access

Cristina Muntean, Adina Mitrea, Maria Mota and Valerica Tudorica

Type 2 Diabetes and its Implications in Cerebrovascular Disease

Type 2 diabetes represents an independent risk factor for vascular cerebral pathology, with a 2-3 times greater probability of stroke. The number of diabetic patients with stroke increased substantially from 6.2% to 11.3% during 1996-2006. Ischemic stroke, small or large vessels occlusion, is the main subtype of cerebrovascular disease, while a smaller percentage is attributed to cerebral hemorrhage. Hyperglycemia and hyperinsulinemia, excess free fatty acids, prothrombotic state cause endothelial dysfunction with blood flow disturbance and major cerebral vessels injury. Elevated blood sugar levels are also associated with a poor prognosis during post-stroke phase. From the total number of deaths caused by acute cerebrovascular events, 16% for men and 33% for women are due to diabetes.

Open access

Adina Mitrea, Andreea Soare, Simona Georgiana Popa, Mirela Nicoleta Tudor, Maria Mota and Paolo Pozzilli

Abstract

Background and aim: It was recently reported that wrist circumference is associated with insulin resistance (IR) both in children and adults. We aimed to evaluate whether wrist circumference is a useful anthropometrical parameter for the evaluation of IR in an elderly population. Material and method: We performed a study on 40 subjects, 20 with type 2 diabetes (T2D) and 20 control subjects. IR was evaluated using the homeostasis model assessment of insulin resistance (HOMA-IR). We measured the following anthropometrical parameters: weight, height, waist circumference (WC), hip circumference, wrist circumference, waist to hip ratio (WHR), waist to height ratio (WHtR), body mass index (BMI) and body adiposity index (BAI). Results: We found statistically significant differences between the subjects with T2D and the control group for all the analyzed parameters. Statistically significant correlations between all the anthropometrical parameters and HOMA-IR were observed. However, only WC was an independent predictor of IR. Wrist circumference was the only parameter negatively correlated with the estimated glomerular filtration rate (eGFR). Furthermore, this measurement was an independent predictor of chronic kidney disease (CKD) in the studied subjects. Conclusion: Wrist circumference can be used in the general practice as a surrogate marker of IR in the elderly, being both easily determined and a cost-free method

Open access

Adina Mitrea, Simona Georgiana Popa, Cristina Muntean, Andreea Soare, Laura Trotta, Antonio Callea and Maria Moţa

Abstract

Recent studies strongly suggest a significant association between diabetes mellitus and Alzheimer Disease (AD) justifying the term “type 3 diabetes”. Studies show that impairment of glucose metabolism occurs very early in the course of AD, leading to a broad range of consequences, among which the accumulation of amyloid beta (Aβ), which per se induces insulin resistance. Furthermore, adipocytokines, recognised markers of insulin resistance, seem to play a role in the development of AD. As for insulin resistance, when AD is considered, the most studied ones are leptin and adiponectin, but also a recently described adipokine - progranulin. It is our belief that both prospective and transversal studies on subjects with both AD and type 2 diabetes (T2D) may prove the role of adipokines not only in AD, but also in this most somber association.

Open access

Mirela – Nicoleta Tudor, Maria Francisca Navajas Martinez, Adina Mitrea and Eugen Moţa

Abstract

Background and aims. Hypertension and dyslipidemia (DLP) increase the risk of cardiovascular diseases (CVD), especially in patients with chronic kidney disease (CKD). A non dipping pattern is very common in CKD. The aim of the study was to determine whether there is a difference between dipping/non dipping hypertension in subjects with CKD and DLP with or without lipid-lowering therapy (LLT). Material and methods. We performed a retrospective study that included 129 subjects from the Nephrology- Hypertension Out-patient Department of the University Campus Bio-Medico, Rome from January 2011 to April 2013. Results. From a total of 129 CKD subjects, 73 (56.59%) subjects had a non dipping pattern and 56 (43.41%) had a dipper pattern. We found statistically significant differences between the dipping and non-dipping pattern in subjects with CKD stages 1-2 versus stages 3-4 (p=0.018). When we analyzed the association between non-dipping status with DLP and type 2 diabetes (T2D), we did not find a statistically significant result. Conclusions. Only CKD significantly influenced the dipping/non dipping pattern in the study group

Open access

Cristina Muntean, Maria Mota, Simona Popa and Adina Mitrea

Abstract

Central nervous system, mainly the hypothalamus and the brainstem are important keys in glucose homeostasis. Not only do they use glucose as primary fuel for their functioning but they are part of intricate neuronal circuits involved in glucose uptake and production as was first shown by Claude Bernard. Moreover electrophysiological analysis of hypothalamus revealed the existence of glucosensing neurons whose firing rates are controlled by glucose extracellular level. Further information was obtained regarding the importance of leptin, insulin and free fatty acids as afferent signals received by these neural structures. As for the main efferent pathways, autonomic system is the one connecting CNS with the effector organs (the liver, the pancreas and the adrenal glands).

Open access

Adina Mitrea, Maria Mota, Daniela Patru, Amorin Remus Popa, Diana Protasiewicz, Robert Dinu, Cristina Muntean, Raluca Dina, Magda Sandu, Flavia Dinu and Betty Bornagel

Abstract

As the latest data from the International Diabetes Federation (IDF) have shown, diabetes mellitus (DM) prevalence and incidence are continually increasing. Our purposes were to identify the socio-demographical characteristics of the subjects diagnosed with DM prior to this study, to establish the percent they represent of the studied group, to evaluate the metabolic control of the subjects enrolled in the study, as well as to ascertain whether the blood glucose level or the glycated haemoglobin (HbA1c) measurement leads to the detection of a higher percentage of DM newly diagnosed cases. The study conducted in 3 Romanian cities enrolled 4133 subjects (1340 from Craiova, 1224 from Oradea and 1569 from Sibiu). 1413 subjects (34%) reported having been diagnosed with DM prior to our study. Most of the subjects previously diagnosed with DM, 65%, take oral antidiabetic agents (OAA), 13% take insulin and 4% take both OAA and insulin. 20% of the subjects who did not report DM had a blood glucose level ≥126mg/dL and 17% of them had an HbA1c ≥6.5%, leading to a high number of newly diagnosed DM cases, therefore emphasising the importance of the simultaneous determination of these two parameters. The results of this study confirm the increasing prevalence of DM and the necessity of future studies in order to asses DM accurate prevalence in Romania.

Open access

Mirela - Nicoleta Tudor, Adina Mitrea, Simona Georgiana Popa, Sorin Zaharie, Maria Moţa and Eugen Mola

Abstract

Background and aims. Dyslipidemia (DLP) is a common complication of chronic kidney disease (CKD) and may accelerate its progression. Circulating lipoproteins and their constituent proteins, apolipoproteins, are risk factors for CKD and cardiovascular diseases (CVD). The aim of the study was to determine whether there is a correlation between apolipoproteins and estimated glomerular filtration rate (eGFR) or between apolipoproteins and anthropometrical and laboratory parameters or between evaluated cardiovascular risk (CV) and dyslipidemia/CKD. Material and methods. We performed a study on 51 subjects from the Nephrology Department of Emergency Clinical County Hospital of Craiova, from November 2011 to July 2013. Results. We found statistically significant correlations between eGFR and Apo A1. Also we found a linear correlation between C-reactive protein (CRP) and Apo B. When we evaluated the CV risk using CRP, we found statistically significant differences between the groups (CKD and DLP, only CKD, only DLP and control group), patients with CKD and DLP showing the highest levels of CRP. Conclusions. Elevated levels of Apo A1 are associated with a low rate of CKD. DLP and chronic inflammation play an important role in the progression of CKD. Patients with CKD and DLP had a high cardiovascular risk.