Type 2 diabetes is a progressive disease and, despite recent progress in the treatment of diabetes, the glycemic control usually deteriorates gradually and insulin therapy is needed. When insulin therapy should be started and which are the appropriate insulin therapy strategies, still represent subjects of debates. Insulin represents a therapeutic option in type 2 diabetes due to the existence of early β-cell dysfunction and significant reduction of β-cell mass in natural history of type 2 diabetes. The current guidelines recommend insulin in double therapy in association with metformin or in combination with metformin and other noninsulin agent. Initiation of insulin therapy is recommended in patients with newly diagnosed type 2 diabetes and symptomatic and/or presenting important hyperglycemia or elevated HbA1c. Initiation of insulin therapy in type 2 diabetes should take into consideration the pathophysiology of type 2 diabetes, the effects and the potential risks of insulin therapy, the guidelines recommendations and the barriers to insulin use. Literatures of only English language were analyzed from NCBI database. Guidelines were accessed electronically from organisations, i.e. American Diabetes Associations, American Association of Clinical Endocrinologists and American College of Endocrinology, European Association for the Study of Diabetes, International Diabetes Federation.
Diabetes Mellitus (DM) and Tuberculosis (TB) are two chronic diseases which have a major impact on the population health in developing countries. DM is a chronic, noncommunicable disease, characterized by hyperglycemia, caused by insulin-resistance, inadequate insulin secretion or both. TB is a disease caused by Mycobacterium tuberculosis, an airborne bacteria. DM implies a three times greater risk of developing TB and their association can be considered one of the most important challenges regarding TB control. TB can cause a temporary impaired glucose tolerance, which is a risk factor for DM development. The possibility of relapse or death of a patient with TB is significantly higher when the patient also has DM. The DM-TB association represents an important threat to the population health and requires the implementation of adequate programs in order to reduce the prevalence and incidence of the two diseases.
Humans spend almost one third of their life sleeping, thus sleep deprivation or poor sleep quality will have consequences upon the quality of life. Obstructive sleep apnea (OSA) is the most common sleep disorder that represents a respiratory cessation for at least ten seconds, which appears repeatable during sleep and it is accompanied by decreased oxygen saturation. The diagnosis of OSA is possible by filling in the STOP, STOP BANG, BERLIN questionnaires and performing the polysomnography, an accessible and more accurate method but yet very expensive. The prevalence of OSA is continuously increasing, but because of the nonspecific symptoms, the percentage of un-diagnosed cases is further increased. Data from 11 epidemiological studies published between 1993 and 2014 indicated an OSA prevalence of 22% in men and 17% in women. It has been suggested that there is a bidirectional causal relationship between OSA and obesity, and numerous studies have shown association of OSA with insulin resistance, diabetes mellitus, diabetic micro- and macrovascular complications and atrial fibrillation.
Central nervous system, mainly the hypothalamus and the brainstem are importantkeys in glucose homeostasis. Not only do they use glucose as primary fuel for theirfunctioning but they are part of intricate neuronal circuits involved in glucose uptakeand production as was first shown by Claude Bernard. Moreoverelectrophysiological analysis of hypothalamus revealed the existence of glucosensingneurons whose firing rates are controlled by glucose extracellular level. Furtherinformation was obtained regarding the importance of leptin, insulin and free fattyacids as afferent signals received by these neural structures. As for the main efferentpathways, autonomic system is the one connecting CNS with the effector organs (theliver, the pancreas and the adrenal glands).
Glucose enters the endothelium via a non-insulin sensitive GLUT-1 facilitated transporter that transports glucose continuously. Extracellular hyperglycemia is positively correlated with intracellular glucose. As the glucose levels increase, several changes in the glycolytic pathway, tricarboxilic acid cycle and the pentose phosphate pathway occur, all of them leading to an increase of oxygen reactive species (ROS). ROS are capable not only of directly impairing endothelial cells, but also indirectly by activating poly(ADPribose) polymerase, which inhibits glyceraldehyde 3-phosphate dehydrogenase. Further increase in glycloytic intermediates is followed by activation or overexpression of the main pathological pathways of hyperglycemia induced vascular damage: upregulation of glycation end-products, activation of protein kinase C, increased hexosamine pathway, and increased flux through polyol pathway, finally leading to the progressive narrowing and occlusion of the vessels.
Worldwide, tuberculosis (TB) is a major cause of morbi-mortality, about 30% of the population having a Mycobacterium tuberculosis infection. Patients with diabetes mellitus (DM) have a threefold increased risk of developing the disease. The prevalence of DM is rapidly increasing, especially in countries with low and middle income, where TB incidence is also increased, thus baffling the efforts for TB control. The DM-TB co-epidemic is more frequent in married, older men, with reduced level of education, low income, without a steady job, with lifestyle habits such as alcohol consumption, smoking, sedentarism, living in an urban environment, in crowded areas, in insanitary conditions. These patients have a higher body mass index (BMI) compared with those without DM and frequently present family history of TB, family history of DM, longer duration of DM and reduced glycemic control. TB associated with DM is usually asymptomatic, more contagious, multidrug resistant and is significantly associated with an increased risk of therapy failure, relapse and even death. Thus, the DM-TB comorbidity represents a threat to public health and requires the implementation of urgent measures in order to both prevent and manage the two diseases.
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.
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
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.
This study was conducted over a period of three month in the Cristian farm, Sibiu. For the physical, chemical and microbiological analyzes were taken a number of 15 samples per month. From physico-chemical point of view the content evolution of fat, not fat solid substance, density, protein, freezing point, temperature, lactose, conductivity, pH, water addition was followed. Samples were analyzed using the milk analyzer Ekomilk Total of the Research Centre in Biotechnology and Microbiology of the "Lucian Blaga" University. The microbiological contamination of milk was done by determining the total number of bacteria and coliform bacteria. From microbiological point of view it was observed that these conditions are largely met, but a more rigorous control on the cleanliness of utensils and of the staff is required.