Pathogenesis of Type 1 Diabetes Mellitus: A Brief Overview
Before the discovery of insulin, type 1 diabetes mellitus (DM) was a disease with acute evolution, leading to death shortly after diagnosis. During the first years of insulin therapy, the medical world was optimistic, even enthusiastic, considering that the therapeutic solution for the malady was found. Unfortunately this was only an illusion, because the patients started to develop chronic complications that shortened their lifespan and impaired their quality of life. In other words, insulin therapy transformed type 1 DM into a chronic disease. The prevention or the delay of the onset of hyperglycemia emerged as a new solution for the patients and, consequently, the understanding of the pathogenesis of the disease (a prerequisite for developing efficient preventive methods) became a priority for all the diabetologists involved in research. Almost 40 years have passed since the autoimmune theory regarding the pathogenesis of type 1 DM was imagined but, despite the tremendous research performed in this field since then, the prevention could not be obtained. The aim of this paper is to present the most important theoretic notions regarding the mechanisms that underlie the development of type 1 DM, in the way they are understood today.
Diana Bănică, Ramona Frăţilă, Alexandra Sima, Adrian Vlad and Romulus Timar
Autoimmune polyglandular syndromes are characterized by the association of two or more autoimmune diseases. They are classified into two major subtypes, each having its own characteristics. The autoimmune polyglandular syndrome type 2 is defined by the presence of at least two of the following diseases: Addison’s disease, type 1 diabetes mellitus and thyroid autoimmune disease. Other autoimmune diseases belonging to the autoimmune polyglandular syndrome type 2 are: primary hypogonadism, myasthenia gravis, celiac disease, pernicious anemia, alopecia, vitiligo. We are going to present the case of a patient, aged 40, with diabetes mellitus (probably latent autoimmune diabetes of the adult), chronic autoimmune thyroiditis and celiac disease.
Mihaela Vlad, Bogdan Timar, Adrian Vlad and Romulus Timar
Background and aims. Thyroid disorders are more frequently met in patients with diabetes mellitus than in general population. Thyroid hormones increase glycemia by several mechanisms, but the effect of antithyroid treatment on glucose control in type 1 diabetes mellitus (T1DM) cases is not well studied. The aim of our work was to analyze the evolution of glycemic control of T1DM patients submitted to specific therapy when hyperthyroidism was diagnosed. Material and method. The study group comprised by 37 patients, 35 women (94.6%) and 2 men (5.4%), known as having T1DM and diagnosed with hyperthyroidism during a 10-years interval. They were treated with antithyroid medication and reassessed after 6 months regarding thyroid function and glycemic control. Results. In the whole group, there was a significant decrease in mean HbA1c level (with 0.41%) and a significant increase in the percentage of patients being in the glycemic target (from 10.8% to 35.1%). The better glycemic control was obtained with a lower mean insulin dose. Patients who became euthyroid had a better evolution regarding glucose control in comparison to those who remained hyperthyroid. Changes in other cardiovascular risk factors were noted: systolic blood pressure decreased; diastolic blood pressure, HDL cholesterol, LDL cholesterol, non-HDL cholesterol, triglycerides and body weight increased. TSH and HbA1c values were inversely correlated. Conclusions. The therapeutic control of excessive thyroid function significantly contributes to the improvement of glycemic control in patients with T1DM and induces changes in the cardiovascular risk factors profile.
Mihaela Vlad, Daniela Amzar, Diana Bănică, Ioana Golu, Melania Balaș, Adrian Vlad, Romulus Timar and Ioana Zosin
Background and Aims. Acromegaly is frequently associated with abnormalities of glucose and lipid metabolism. The aim of our study was to analyze the prevalence of glucose and lipid metabolism abnormalities in newly diagnosed acromegaly patients. Material and Methods. This retrospective study included 14 patients (F/M=10/4), mean age 49.5 ± 10.6 years, registered with acromegaly between January and December 2013. In all the cases the values of blood glucose (fasting and during the oral glucose tolerance test), total cholesterol and triglycerides were analyzed. The glucose disorders were classified according to the current criteria of the American Diabetes Association. Regarding the lipid metabolism, the cases were classified as having normal cholesterol, normal triglycerides, high cholesterol and high triglycerides. Results. A number of 7 patients (50%) presented abnormalities of glucose metabolism. The prevalence of diabetes mellitus (14.3%) was lower compared to that reported by other studies (15.5%- 56%). Abnormalities of lipid metabolism were present in 8 patients (57.2%): high cholesterol was detected in 2 cases and 6 cases presented increased values for both cholesterol and triglycerides. Only 4/14 cases (28.6%) presented normal values for all glucose and lipid metabolisms parameters. Conclusions. Abnormalities of glucose and lipid metabolisms are very common in acromegalic patients.
Bogdan Timar, Cristian Serafinceanu, Adrian Vlad and Romulus Timar
Type 2 diabetes is a progressive metabolic disorder, accounting for more than 90% of all cases of diabetes. Treatment strategies target blood glucose reduction and non-glycemic effects that can reduce long-term complications, such as cardiovascular disease. Although metformin is often initially effective as monotherapy, the progressive nature of diabetes frequently requires additional therapies. Sodium-glucose transporter 2 (SGLT2) became a very attractive therapeutic target in diabetes management. The mechanism of action of SGLT2 inhibitors is not dependent on insulin, thus making them attractive options anytime over the course of the disease. Dapagliflozin is a stable and highly selective inhibitor of SGLT2. The reductions in fasting plasma glucose concentration and bodyweight recorded during the first week of treatment in the dapagliflozin groups continued over weeks and years of treatment. Early weight loss with dapagliflozin might be partly due to a mild osmotic diuresis, while the gradual progressive reduction in bodyweight is consistent with a reduction of fat mass. Although dapagliflozin is well tolerated, signs and symptoms suggestive for urinary and/or genital infections were reported during clinical trials in more patients assigned to the drug than in placebo groups.
Bogdan Timar, Viorel Șerban, Alina Lăcătușu, Laura Barna, Florentina Fiera and Adrian Vlad
Objectives: Optimal glycemic control is mandatory in diabetic children andadolescents for the prevention of diabetes complications, but it is difficult to beobtained due to a series of factors, including the limited availability of blood glucoseself-monitoring tests. The aim of our study was to investigate the relationshipbetween the number of daily self-monitoring tests and quality of glycemic control.Material and method: We enrolled 783 individuals previously diagnosed with Type 1Diabetes Mellitus and investigated the significance of differences in HbA1c valuesbetween groups with distinct number of blood glucose measurements at home foreach age group. Results: We found significant improvements of glycemic controlwith the increase in the number of daily tests, with some particularities among thegroups. Conclusions: Among other intrinsic and external factors, blood glucose selfmonitoringhas an important role in obtaining a good glycemic control.
Catalin Bailescu, Vlad Iordache, Florin Iordache and Adrian Marin
The acoustic comfort of a building or house is typically given little or no attention during project planning and design. This study is aimed at quantifying noise pollution from a building technical room. To attain the research specified result, simultaneous measurements were recorded for the gas flow and noise level in the boiler room. The noise levels were recorded for different operation statuses of the boilers (different thermal loads). It was observed that noise level depends on the thermal load: the increase of thermal load is directly proportional to the noise level inside the plant room). Further, the measured values of the noise level were compared with literature predicted values and the maximum limit values from the Romanian norm. These research findings are useful for mechanical design engineers and architects in order to assure the noise protection and fulfill the residents’ expectations.
Alin Albai, Romulus Timar, Bogdan Timar, Corina Hogea, Adrian Vlad, Oana Sdic, Ilie Cristina and Oana Albai
Background and aims: Pregnancy in women with type 1 diabetes mellitus (T1DM) is associated with increased risk of maternal and fetal complications. The aim of this study was to examine and to compare pregnancy outcomes between women with T1DM and a control group of non diabetic women. Material and method: The present study included all pregnancies in T1DM women followed at Diabetes Clinic, Emergency County Clinical Hospital, Timişoara, from 1990 to 2010. Results: We found a relative risk of spontaneous abortions of 1.85 (95%CI 1.01-3.39; p=0.05) and a relative risk of major congenital malformations of 4.32 (95%CI 1.55-12; p=0.005) in T1DM pregnancies compared to the control group. We also observed that the rate of stillbirth was more frequent in type 1 diabetic pregnancies (p=0.02). The offspring of T1DM women were more likely to be delivered preterm (32%) compared with the control group (9.5%). The relative risk of preterm delivery was 3.38 higher (95%CI 2.93-5.6; p<0.0001) in T1DM pregnancies compared with non diabetic mothers. There was a statistically significant difference in the proportion of macrosomic offspring between T1DM (17.3%) and non diabetic mothers (6.5%) Conclusions: The present study demonstrated that pregnancy outcome and perinatal complications are still high in T1DM pregnancies.
Alin Albai, Viorel Șerban, Romulus Timar, Adrian Vlad, Bogdan Timar, Cristina Ilie and Oana Sdic
Background and aims: A precarious glycemic control in the first 10 weeks ofpregnancy, the period defining organogenesis, increases the risk of pregnancy loss.The aim of this study was to estimate the relationship between pregnancy loss andHbA1c values in early pregnancy in type 1 diabetic women.Material and method: The present study included all pregnancies in type 1 diabetic women followed atDiabetes Clinic, Emergency County Clinical Hospital, Timişoara, from 1990-2011.Results: The risk of pregnancy loss was significantly increased compared with thebackground control group. In our study the relative risk of pregancy loss increasedwhen HbA1c exceeded 6.5%. We found a consistent increasing risk with stepwiseincreasing levels of HbA1c. Conclusions: A better glycemic control in this periodand throughout the pregnancy could reduce the risk of severe adverse outcomes intype 1 diabetic pregnancies.
Teodora Chiţă, Monica Licker, Alexandra Sima, Adrian Vlad, Bogdan Timar, Patricia Sabo and Romulus Timar
Background and aims: There is evidence that patients with diabetes have an increased risk of asymptomatic bacteriuria and urinary tract infections (UTIs). UTI is the most common bacterial infection in diabetic patients. The aim of this study was to assess the prevalence of UTIs among hospitalized diabetic patients and to identify the most frequent bacteria responsible for UTI. Material and methods: The study population included 1470 diabetic patients (847 women and 623 men), admitted to the Diabetes Clinic of the Emergency Clinical County Hospital Timişoara, between January and December 2012. We collected patients’ personal history data and performed urine cultures. For statistical analysis we used Graph Pad Prism 5; the significance of the difference between the percentage values was assessed using Fisher’s exact test. Results: From the total number of patients, 158 had positive urine cultures, meaning 10.7%. Out of the total number of 158 UTIs, 124 (78.4%) were asymptomatic bacteriuria. The most frequent bacteria involved in UTI was Escherichia coli (68.9%). Conclusion: UTIs are frequent in diabetic patients. Because of the great proportion of asymptomatic forms among diabetic patients, the urine culture should be performed in all hospitalized patients with diabetes.