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  • Author: Anca-Elena Crăciun x
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Cristian-Ioan Crăciun, Anca-Elena Crăciun, Adriana Rusu, Corina Ioana Bocşan, Nicolae Hâncu and Anca Dana Buzoianu

Abstract

Chronic hyperglycemia is an important cause for the development of chronic complications of diabetes, but glycemic variability has emerged in recent years as an independent contributor to diabetes-related complications. Our objective was to evaluate glycemic variability in patients with T2DM treated with insulin compared with other antidiabetic drugs. In this retrospective study, we collected 24-hour continuous glucose monitoring (CGM) recording data from 95 patients with T2DM, of which 27 treated with insulin and 68 with non-insulin treatment. We calculated and compared 16 glucose variability parameters in the insulin-treated and non-insulin treated groups. Insulin treated patients had significantly higher values of parameters describing the amplitude of glucose value fluctuations (standard deviation of glucose values, percentage coefficient of variation [%CV], and mean amplitude of glycemic excursion [MAGE], p <0.05) and time-dependent glucose variability (percentage of time with glycemic values below 70 mg/dl and continuous overall net glycemic action [CONGA] at 2, 4 and 6 hours, p <0.05). In conclusion, insulin therapy in T2DM is correlated with significantly higher glycemic variability.

Open access

Anca-Elena Crăciun, Cornelia Bala, Cristian Crăciun, Gabriela Roman, Carmen Georgescu and Nicolae Hâncu

Abstract

Background and aims. The aim of our research was to evaluate the impact of short-time continuous glucose monitoring (CGM) on glycemic control evaluated by HbA1c and within-day glucose variability. We also assessed if the initiation of insulin therapy in conjunction with lifestyle recommendations may prevent the weight gain. Materials and

method. We included 28 patients with type 2 diabetes with 2 consecutive CGMS recordings available (baseline and follow-up) and for which were collected data on weight, body mass index (BMI), percentage (%) of body fat, visceral fat area, HbA1c and glycemic variability. Results. The HbA1c decreased significantly from 8.8% at baseline to 7.3% at follow-up (p <0.0001) in the whole group, and from 10.5% to 7.5% in the subgroup for which the insulin therapy was initiated at baseline (p=0.011). The BMI, % body fat and visceral fat area decreased significantly from 29.2 kg/m2 to 28.4 kg/m2; from 32.3% to 30.4%; and from 141.6 to 129.3 (cm2), respectively. No increase of these parameters was observed in the subgroup for which the insulin therapy was initiated at baseline. Conclusion. The use of CGMS in combination with individualized lifestyle and therapeutic recommendations may have a beneficial effect on glycemic control and may prevent the weight gain associated with insulin initiation.

Open access

Anca-Elena Crăciun, Mirela Moldovan, Adriana Rusu, Cristina Niţă, C. Crăciun and A. Tătaru

Predictors of Changes in Physical Properties of Skin in Patients with Diabetes Mellitus

Introduction: The skin, the largest human organ, is often affected by diabetes mellitus (DM). We know that DM affects the hydration of stratum corneum (SC), the sebum content of the skin and to some extent, the barrier function of the epidermis and elasticity, but we do not know the factors leading to these changes. Objectives: The objectives of this study were to determine the factors associated with changes in physical properties of the skin (skin hydration degree, sebumetry, transepidermal water loss and skin elasticity) in patients with diabetes. Materials and methods: The physical properties of the skin were assessed using the Multi Probe Adapter Systems MPA ® (Courage-Khazaka, Germany) in 57 patients with diabetes and 46 non-diabetic. Results: Statistical analysis of the entire group of 103 subjects showed a significant association between female gender and decreased SC hydration (p<0.05 in all cases), decreased values of transepidermal water loss (TEWL) (β=-0.282, p=0.006) and decreased elasticity of the skin in forearm (β=-0.216, p=0.043). Also, the presence of DM was negatively associated with levels of SC hydration measured on the forearm (β=-0.281, p=0.005). Furthermore, in patients with diabetes, the presence of diabetic neuropathy (DNP) was negatively associated with the hydration of SC measured at all levels (forearm: β=-0.465, p<0.001; leg: β=-0.590, p<0.001; tight: β=-0.198, p<0.001). The observed relationship was independent of age and sex of the participants (p<0.05 after adjustment for age and sex). Regarding skin elasticity, increasing age was associated with lower levels of skin elasticity both in entire group and in patients with DM, at all sites of measurements (p<0.05 in all cases). Additionally, in patients with diabetes, elasticity of the skin measured at forearm and tight was negativelly associated with type of DM (forearm: β=-0.335, p=0.023; tight: β=-0.522, p<0.001). In our study, nor diabetes neither DNP were not associated with TEWL values. Conclusions: The presence of DNP seems to be the main predictor of decreased SC hydration in all measuring points and skin elasticity is significantly associated with age. There are some gender-related modification in physical properties of the skin. Surprisingly, type 2 DM was associated with reduced elasticity in the thigh, and this association was independent of age and sex.

Open access

Gabriela Roman, Cornelia Bala, Cristian Ioan Craciun, Adriana Rusu and Anca Elena Craciun

Abstract

Introduction. Dawn phenomenon could have deleterious effect on overall glycemic control. Glycemic variability may be an independent risk factor for the development of diabetes chronic complications. The study aimed to evaluate any correlations between the dawn phenomenon and parameters of glycemic variability in a cohort of type 2 diabetes patients (T2DM). Material and methods. This retrospective observational study included 131 T2DM patients. Continuous glucose monitoring (CGM) has been performed. Data from the first 24h of full recording were used for analysis of glycemic variability indices: mean level of 24h interstitial glucose value and standard deviation; % coefficient of variation; J index; mean amplitude of glycemic excursion - MAGE; continuous overall net glycemic action (CONGA) at 1, 2, 4 and 6 hours; mean of daily differences (MODD) index. Results. Mean age was 56.04 ± 9.91 years, 35.9% women, 17.6% on diet, 53.4% on oral therapy and 29% on insulin. Dawn phenomenon was more frequent in patients below 60 years (70%) and in oral therapy group (72.85%). Significant correlations between the dawn phenomenon and j-index, MAGE, CONGA-4 and CONGA-6 have been found in T2DM patients on diet therapy alone. The amplitude of dawn phenomenon was 46.10 ± 24.40 mg/dl and significantly correlated (p<0.05) after adjustment for age, gender and treatment with % CV, MAGE, CONGA-1, CONGA-2, CONGA-4, CONGA-6 and MODD. Conclusions. The dawn phenomenon significantly increases the glycemic variability parameters in drug-naive T2DM patients, with no impact in T2DM on oral or insulin therapy.