Tomina Popescu and Maria Mota
Aim: Type 2 diabetes mellitus (T2DM) is associated with a higher cardiovascular risk and also generates multiple microvascular complications. Diabetic retinal changes, diabetic maculopathy and proliferative retinopathy are major causes of loss of vision worldwide in people of working age. We evaluated diabetic retinopathy in a group of subjects with T2DM without known cardiovascular diseases. Material and methods: We examined 100 patients with T2DM, without clinical evidence of coronary, cerebrovascular or peripheral artery disease; 48 (48%) were women (mean age at examination 61.23±8.49) and 52 (52%) were men (mean age 60.75±8.43). Diabetic retinopathy (DR) was graded from retinal photograph according to Early Treatment for Diabetic Retinopathy Study severity scale. In each patient we measured abdominal circumference, Body Mass Index (BMI), total cholesterol, HDL - cholesterol, LDL - cholesterol, triglycerides, HbA1c, intima media thickness (IMT) and questioned about smoking habit. Statistically analysis was performed using features available in the SPSS 17.0 statistical package. Results: DR was found in 59.5% men and 40.5% women. Diabetes duration was significantly longer in patients with DR than in those without this complication (p=0.020). DR was associated significantly with a higher value of HbA1c (p=0.000), smoker status (p=0.003), hypertension (p=0.000), especially with diastolic value (p=0.003) and lipids value (p=0.001 for HDL-C and p=0.000 for LDL-C). IMT correlates highly significant with the presence of retinopathy (mean value 0,83mm in those without retinopathy vs. 0,90mm in those with nonproliferative retinopathy, vs. 0,93mm in those with proliferative retinopathy, with a p=0,000). In multiple regression analysis, diabetic retinopathy was the most significant predictor of increased IMT, with a p=0.000, along with smoking (p=0.031). Conclusions: We found a statistically significant association between retinopathy and dyslipidemia, hypertension and smoking habit, and also between DR and metabolic control, as we expected. . DR was also associated with an increased IMT in T2DM. We did not find differences regarding gender, BMI or abdominal circumference in patients with retinopathy comparing with those without this complication.
Flavia Diugan and Maria Mota
Background and aims: Recently, large scale studies emphasized the idea of an excess of metabolic and cardiovascular risk in patients currently considered to have normal glucose tolerance but showing an elevated 1 hour glucose (≥155mg/dl) during oral glucose tolerance test (OGTT).
Material and Methods: 75 subjects with normal glucose tolerance or impaired glucose tolerance were completely investigated. We evaluated the clinical and biological markers associated to insulin resistance and we calculated the cardiovascular risk of the subjects using the SCORE charts.
Results and Discussions: Our data found statistically significant correlations between subjects with normal glucose tolerance and elevated 1 hour glucose and the following markers of insulin resistance: triglycerides to HDL-cholesterol ratio (TG/HDL-chol), Homeostatic Model Assessment (HOMA-IR), The Quantitative Insulin Sensitivity Check Index (QUICKI), fasting insulin, fasting glucose to fasting insulin ratio. Also, the subjects with elevated 1 hour glucose had a greater cardiovascular risk compared to subjects with 1 hour glucose <155 mg/dl.
Conclusions: This study identifies a category of subjects currently considered as normal glucose-tolerant individuals but with a special metabolic profile, an increased cardiovascular risk and an increased risk of developing diabetes.
Sorin Ioan Zaharie, Teodora Daniela Maria, Mirela Zaharie, Maria Moţa and Eugen Moţa
Accurate measurement of blood pressure (BP) and evaluation of global cardiovascular risk is crucial for diagnosis and treatment of hypertensive patients. When hypertension and diabetes mellitus are associated, the risk for cardiovascular events is bigger than the sum of the components. Beyond systolic and diastolic BP values as targets for antihypertensive treatment, recent guidelines recognize BP variability as an independent predictor for future cardiovascular events. 24 hours ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM) are two methods used in patient day to day life conditions for BP measurements. Increased variability of systolic and/or diastolic BP within one day (“short-term BP variability”) and also over longer periods (“long-term BP variability”) showed by ABPM and/or HBPM is associated with target-organ damage and cardiovascular events. This review is focused on the prognostic importance of BP variability in hypertensive patients with diabetes mellitus.
Maria-Magdalena Roșu and Maria Moța
Background and aims: PREDATORR is a national study designed to estimate the prevalence of diabetes mellitus, prediabetes, overweight, obesity, dyslipidemia, hyperuricemia and chronic kidney disease in Romanian adult population. The aim of present study was to estimate the prevalence, incidence, treatment and control in subjects from PREDATORR study.
Material and methods: This study included 2727 adults aged 20 – 79 years. Subjects were examined, and three measurements were performed at a time of at least one minute and the mean of blood pressure readings was recorded. Hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and/or antihypertensive drug therapy.
Results: The prevalence of hypertension in Romanian adult population aged 20 – 79 years was 47.38% and was higher in men: 48.62% than women: 46.23%. The incidence of hypertension was: 10.7% in 20 – 39 years age group, 43.1% in 40 – 59 years age group and 75.1% in subjects aged ≥ 60 years. Among subjects with hypertension, 18.7% did not receive antihypertensive drug therapy, 27.7% received antihypertensive treatment in monotherapy, 34.7% were under double antihypertensive drugs and most of them (37.6%) received three or more antihypertensive drugs.
Conclusions: The prevalence of hypertension in Romania is high, possible explanations of this might be the unhealthy lifestyle and diet.
Simona Popa, Cristina Văduva, Maria Moţa and Eugen Moţa
Background and Aims. Peritoneal dialysis (PD) is accompanied by a multitude of factors that influence glycemic variability, and HbA1c does not detect dynamic glucose changes. In this study we wanted to assess glycemic variability, using a 72-hour continuous glucose monitoring system (CGMS), in 31 patients stratified according to the presence of type 2 diabetes and PD. Materials and Methods. The study included 31 patients (11 type 2 diabetic PD patients, 9 non diabetic PD patients and 11 type 2 diabetic patients without PD). Glycemic variability was assessed on CGM readings by: Mean Amplitude of Glycemic Excursion (MAGE), Mean of Daily Differences (MODD), Fractal Dimensions (FD), Mean Interstitial Glucose (MIG), Area Under glycemia Curve (AUC), M100, % time with glucose >180/<70 mg/dl. Results. The PD diabetic patients presented AUC, MIG and inter-day glycemic variability (MODD) significantly higher than diabetic patients without PD. In PD patients, the type of dialysis fluid in the nocturnal exchange and peritoneal membrane status did not significantly influence glycemic variability. Conclusions. CGMS is more useful than HbA1c in quantifying the metabolic imbalance of PD patients. PD induces inter-day glycemic variability and poor glycemic control, thus being a potential risk factor for chronic complications progression in diabetic patients.
Cristina Văduva, Simona Popa, Maria Moţa and Eugen Moţa
Background and Aims. In diabetic patients, chronic kidney disease (CKD) requires special attention due to the multitude of factors that determine glycemic variability. We aimed to assess glycemic variability in patients with CKD and type 2 diabetes mellitus (T2DM) using a continuous glucose monitoring system (CGMS) and identify the predictive value of inter-day and intra-day glycemic variability indices for metabolic imbalance. Material and method. We included 20 diabetic patients (10 CKD patients/10 patients without CKD) and 10 healthy volunteers. Anthropometric parameters, glycated hemoglobin (HbA1c), and glycemic variability indices on CGMS readings were registered. Results. CKD diabetic patients presented significantly higher inter-day and intra-day glycemic variability compared to the diabetic patients without CKD. HbA1c was not significantly different between diabetic subjects with/without CKD. ROC curves indicated that just some CGMS parameters had higher predictive value for metabolic imbalance (HbA1c≥6.5%) but only the percentage of time with glucose values>180 mg/dl (p=0.024) was an independent predictor for HbA1c≥6.5%. Conclusions. Subjects with CKD and T2DM had poor glycemic control and significantly higher glycemic variability comparative to those without CKD, and especially to healthy volunteers. Assessment of glycemic variability indices is more accurate than HbA1c for the quantification of glycemic control in CKD diabetic patients
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.
Adela-Gabriela Firănescu and Maria Moța
Tuberculosis (TB) and diabetes mellitus (DM) are two chronic diseases with major impact on worldwide morbidity and mortality. DM significantly increases the risk of death, therapeutic failure and relapse of TB, requiring a much more careful monitoring of these patients. In this article we present the case of a patient with type 2 DM in the stage of major chronic complications, with numerous risk factors for TB and atypical symptomatology, pulmonary X-ray showing active TB lesions. The patient did not follow the diabetologist's recommendations, discontinuing the antidiabetic treatment on his own initiative. The glycemic imbalance and chronic alcoholism caused the failure of the anti TB therapy.