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Open access

Johann Trutz, Aurel Babeş and Katalin Babeş

Abstract

Background and Aims. The identification of type 2 diabetes mellitus (T2DM) patients with high cardio-vascular risk became more crucial, especially in patients with known coronary artery disease (CAD). Our study is focusing on T2DM patients who suffered recently an acute coronary syndrome (ACS), and evaluates the importance of albuminuria and NT-proBNP level as risk factors for short-term recurrence.

Material and methods. 221 T2DM patients with recent ACS were evaluated 1 month after discharge, assessing NT-proBNP and albuminuria level and followed for 12 months for major adverse cardiac events (MACE).

Results. Patients who reached the endpoint (33%) presented significantly higher levels of NT-proBNP (458.5 vs. 207.4 pg/ml, p<0.0001) and urinary albumin/creatinine ratio (80 vs. 27 mg/g, p<0.0001) than those who did not present a MACE in the follow-up period. Comparison of the MACE-free survival curves revealed that NT-proBNP has a better power than albuminuria in the prediction of the short-term outcome: hazard ratio (HR)=1.6176 (95%CI: 1.0047-2.6044), p=0.0433 vs. HR=1.4813 (95%CI: 0.8497-2.5824), p=0.1921. Only the NT-proBNP level entered the multivariable regression model besides age and represents an independent risk factor (HR=1.0025, 95%CI: 1.0014-1.0035, p=0.0036).

Conclusion. NT-proBNP provides excellent prognostic information in patients with diabetes mellitus who recently suffered an ACS. Albuminuria wasn’t an independent risk factor in this cohort.

Open access

Johann Trutz, Aurel Babeș and Katalin Babeș

Abstract

Background and Aims. Several factors are associated with a heightened risk of subsequent events, morbidity and mortality in patients with type 2 diabetes mellitus (T2DM) after an acute coronary syndrome (ACS). Improving the management of these patients is a challenge that requires urgent attention. We aimed to study the long-term effect of the change in treatment strategy depending on the HbA1c level detected during the hospitalization for ACS. Material and methods. The primary endpoints of this study were the major adverse cardiac events (MACE) at 12 months. From the originally included 221 patients 15 were lost (no response to follow-up phone calls). The suboptimal glycaemic control group (HbA1c>7.0%, n=84) was divided in two subgroups: patients who completed a diabetological consult with further treatment changes (intervention group) and patients without this referral (control group). Results. No significant differences in baseline characteristics were found between the 2 subgroups. The second subgroup had a triple risk for a MACE in 1 year (HR=2.8704, 95% CI: 1.109-7.423, p=0.0296) compared to the intervention group. No significant differences were found in secondary endpoints. Conclusion. This study suggests that, after hospitalization for an ACS, diabetologist referral and treatment strategy changes are recommended for all T2DM patients whose HbA1c level is over 7% before discharge.

Open access

Denisa Kovacs, Luiza Demian and Aurel Babeş

Abstract

Objectives: The aim of the study was to calculate the prevalence rates and risk of appearance of cutaneous lesions in diabetic patients with both type-1 and type-2 diabetes. Material and Method: 384 patients were analysed, of which 47 had type-1 diabetes (T1DM), 140 had type-2 diabetes (T2DM) and 197 were non-diabetic controls. Results: The prevalence of the skin lesions considered markers of diabetes was 57.75% in diabetics, in comparison to 8.12% in non-diabetics (p<0.01). The risk of skin lesion appearance is over 7 times higher in diabetic patients than in nondiabetics. In type-1 diabetes the prevalence of skin lesions was significantly higher than in type-2 diabetes, and the risk of skin lesion appearance is almost 1.5 times higher in type-1 diabetes than type-2 diabetes compared to non-diabetic controls. Conclusions: The diabetic patients are more susceptible than non-diabetics to develop specific skin diseases. Patients with type-1 diabetes are more affected.

Open access

Ioan Lucian Borza and Aurel Babes

Abstract

Background and Aims: We evaluated fecal calprotectin values in patients with colorectal neoplasms undergoing surgery, comparatively in patients with and without diabetes mellitus. Material and Methods: We studied 40 patients operated for colorectal neoplasm, divided into two groups: one group of 20 patients with insulin-treated type 2 diabetes and another group of 20 patients without diabetes. Results: Patients had a high percentage of preoperative calprotectin test positivity (90%, 36 patients). A total of 19 patients in group 1 and 17 patients in group 2 had a positive calprotectin test. Postoperatively at 3 months, fecal calprotectin values remained elevated in 7 patients from group 1 and 4 patients from group 2. At 6 months postoperatively, fecal calprotectin values remained elevated in 2 patients from group 1 and 1 patient from group 2. Conclusions: Calprotectin values in faeces from patients with colorectal cancer were significantly increased, with a trend towards post-operatory normalization, slower in patients with diabetes. Fecal calprotectin value as a screening marker was almost equal compared to the hemoccult test, and better compared to that of the carcinoembryonic antigen.

Open access

Denisa Kovacs, Luiza Demian and Aurel Babeş

Abstract

Objectives: The aim of the study was to calculate the prevalence rates and risk of appearance of Dupuytrèn disease in diabetic patients with both type-1 (T1DM) and type-2 diabetes (T2DM). Material and Method: 384 patients were analysed, of which 47 had T1DM, 140 had T2DM and 197 were non-diabetic controls. Diabetic patients were followed at the Clinical Center for Diabetes, Nutrition and Metabolic Disease of the Emergency Clinical County Hospital and Department of Dermatology in Oradea, all of them having a diabetes duration of at least 5 years. Results and Conclusions: The risk of Dupuytrèn’s disease is over 4.5 times greater in patients with type-2 diabetes. The risk of Dupuytrèn’s disease is 3-6 times greater in patients with micro-vascular complications.

Open access

Dănuț Dejeu, Viorel Dejeu and Aurel Babeș

Abstract

Background and Aims. We aimed to analyze the complications and mortality of acute abdomen cases in diabetic patients compared to non-diabetic patients. Materials and Method. This observational, retrospective, cohort study was conducted between 2008 - 2011, on a total of 4021 cases with acute abdomen admitted to the Surgical Ward I of the Clinical County Emergency Hospital Oradea. Of these, 488 were diabetic patients and 3533 non-diabetics. Results. Women represented the majority in both groups (62.24% respectively 58.40%). Entero-mesenteric infarction and acute pancreatitis were more common in diabetic patients compared to non-diabetics. Peritonitis was more frequent in non-diabetics, with statistically significant difference (p = 0.0003). In diabetic patients the postoperative morbidity was 36.27%, significantly higher than in non-diabetic patients (14.43%). The mortality was significantly higher in diabetic patients than in nondiabetics (9.84% vs. 5.38%). Average length of stay in Surgical Ward I is 3.8 days. For non-diabetic patients, mean hospitalization for acute abdomen was 5.1 days, and for diabetics 7.8 days. Conclusions. This study showed important differences between diabetics and non-diabetic patients in the clinical evolution, complications, mortality and length of hospitalization.

Open access

Viorel Dejeu, Dănuţ-Aurel Dejeu, Paula Dejeu and Aurel Babeş

Abstract

Background and aims: Bariatric surgery has been shown to be superior to nonsurgical approaches in terms of weight loss and remission of type 2 diabetes (T2DM) and metabolic syndrome. This prospective, single-center, follow-up study assessed percentage of excessive weight loss (%EWL), glycosylated hemoglobin (HbA1c) levels, prescribed antidiabetes drugs and diabetes remission rates in obese T2DM patients who underwent laparoscopic sleeve gastrectomy.

Materials and methods: 81 patients were selected and data recorded preoperatively, 3, 6 and 12 months postoperatively.

Results: We recorded - 69.3% EWL at 12 months (p<0.0001 compared to baseline) and a fall of HbA1c from 8.1±2.6% to 6.7±2.8% at 12 months postoperatively (p<0.0001). The percentage of patients with HbA1c<6.5% showed an increase to 40.7% (p=0.0004) and the one year T2DM remission rate was 20.9% (p=0.0012).

Conclusions: Laparoscopic sleeve gastrectomy can significantly reduce the BMI, with near 70% EWL and near 21% T2DM remission rate in 1 year.

Open access

Monica Vereş, Szidonia Lacziko and Aurel Babeş

Abstract

Background and Aims: Maternal hyperglycemia during the first trimester of pregnancy is frequently associated with the appearance of maternal and fetal complications. The aim of our study was to analyze the influence of the first trimester blood glucose on the glycemic values from the second and third trimester and on fetal birth weight. Material and method: We performed an observational study on a group of 46 pregnant women who finally delivered on due date. We determined glycemia values in the first and third trimester of pregnancy while an Oral Glucose Tolerance Test (OGTT) was performed during the second trimester (24 - 28 weeks of pregnancy). We divided the pregnancies in two groups: with normal glucose or hyperglycemia during the first trimester. Finally we analyzed the influence of first trimester hyperglycemia on different maternal characteristics and on fetal birth weight. Results: Third trimester glycemia was significantly increased in women with first trimester hyperglycemia in comparison with the control group (p= 0.04) but no effect of the last on OGTT values was recorded. The ROC curve for the influence of first trimester glycemia on fetal macrosomia had an Area Under the Curve (AUC) of 0.551. Conclusions: Firsttrimester glycemia has a low diagnostic accuracy in the appreciation of fetal macrosomia risk.

Open access

Monica Vereş, Aurel Babeş and Szidonia Lacziko

Abstract

Background and aims: Gestational diabetes represents a form of diabetes diagnosed during pregnancy that is not clearly overt diabetes. In the last trimester of gestation the growth of fetoplacental unit takes place, thus maternal hyperglycemia will determine an increased transplacental passage, hyperinsulinemia and fetal macrosomia. The aim of our study was that o analyzing the effect of maternal glycemia from the last trimester of pregnancy over fetal weight. Material and method: We run an observational study on a group of 46 pregnant women taken into evidence from the first trimester of pregnancy, separated in two groups according to blood glucose determined in the third trimester (before birth): group I normoglycemic and group II with hyperglycemia (>92mg/dl). Results: The mean value of third trimester glycemia for the entire group was of 87.13±22.03. The mean value of the glycemia determined in the third trimester of pregnancy was higher in the second group (109.17 mg/dl) in comparison to the first group (74.,21 mg/dl). The ROC curve for third trimester glycemia as fetal macrosomia appreciation test has an AUC of 0.517. Conclusions: Glycemia determined in the last trimester of pregnancy cannot be used alone as the predictive factor for fetal macrosomia.

Open access

Gabriela Oprea-Călin, Petru Aurel Babeș, Dan Valentin Andronescu and Crăița-Isabela Andronescu

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the commonest liver condition in the world, accounting for 20-30% of the adult population, and encompasses a spectrum of liver disorders characterized by fat accumulation within the liver, associated or not with varying degrees of hepatic inflammation and liver fibrosis through to cirrhosis. The prevalence of NAFLD increases significantly in the presence of obesity (60-80%) and type 2 diabetes (60%). NAFLD is associated with metabolic disorders (type 2 diabetes, obesity and hyperlipidemia) grouped together as the metabolic syndrome (MetS). It is now regarded as the hepatic manifestation of this syndrome and is closely linked to insulin resistance (IR).The presence of NAFLD predicts the development of type 2 diabetes independent of established risk factors. NAFLD patients should therefore be screened for diabetes, including by the Oral Glucose Tolerance Test (OGTT) if there any abnormalities of fasting blood glucose (FBG) and given appropriate lifestyle advice. Early diagnosis with the institution of lifestyle measures could help prevent or retard the onset of these metabolic disorders. Type 2 diabetes causes more severe non-alcoholic steatohepatitis (NASH), and patients with diabetes have an increased risk for cirrhosis and the development of hepatocellular carcinoma (HCC)