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Adriana Rusu, Cristina Nita and Nicolae Hancu

Sleep Apnea and Type 2 Diabetes: A Short Review of the Literature

The prevalence of diabetes and obesity has reached epidemic proportions. Even if today it is an accepted fact that diet and reduced physical activity are causes of obesity epidemic, sleep disturbances are seen as risk factors for obesity, insulin resistance, type 2 diabetes and metabolic syndrome. Regardless of the nature of the relation between sleep apnea and diabetes, the observed association have important clinical, epidemiological and public health implications. Clinical studies have shown that the cardiovascular morbidity and mortality is high, both in diabetes and sleep apnea, overcoming the prevalence observed in general population. Thus, understanding the implications of sleep apnea in alteration of glucose metabolism and cardiovascular risk could contribute to the prevention of both micro- and macrovascular complications.

Open access

Mirela Florea and Nicolae Hâncu

Abstract

Objectives. The aim of this study was to compare the cardio-metabolic profile between younger (< 45 years) and older (≥ 45 years) people with newly diagnosed type 2 diabetes (T2DM). Material and Methods. A cross-sectional study including 910 persons with newly diagnosed T2DM and registered at the Clinical Center of Diabetes Cluj-Napoca was carried out between 2006 - 2008. Results: The mean age was 40.21±3.60 yrs. in the younger group and 60.08±8.22 yrs. in the older group. Both groups of patients were obese, but the younger-onset group was significantly more obese as measured by body mass index (BMI), than the older group (BMI 32.45 vs. 30.61 kg/m2, p=0.001). The absolute coronary heart disease (CHD) risk level was significantly higher in older than younger individuals (p<0.001). Conclusions: Despite being two decades younger, it is remarkable that many young people with newly diagnosed T2DM have a clustering of cardiovascular risk factors.

Open access

Cornelia Bala, Cristina Niţă and Nicolae Hâncu

Open access

Ramona Maria Ştefan, Cristina Niţă, Anca Crăciun, Adriana Rusu and Nicolae Hâncu

Abstract

Background and Aims: We assessed the effect of intensive therapy on modifiable cardiovascular (CV) risk factors and CV risk as compared to conventional therapy in patients with newly diagnosed type 2 diabetes mellitus (T2DM).

Material and Methods: This was an observational, prospective study, conducted in Romania. During 1-year follow-up period the enrolled participants received either multi-factorial pharmacotherapy associated with intensive therapeutic education (Intensive group), or conventional therapy (Control group). Current analysis included data (anthropometric measurements, blood pressure and biochemical parameters) recorded at months (M) 0, 6 and 12. CV risk was calculated at M1 and M12 using the UK Prospective Diabetes Study Risk Engine.

Results: 138 patients aged 57.02±10.05 years were included in this analysis (69 in each group). At M6 and M12 a significant improvement of the majority of the modifiable risk factors in the Intensive group compared to the Control group was observed. At M12, coronary heart disease (CHD)/fatal-CHD risks were significantly lower in the Intensive (7.5%/3.1%) than in the Control (17.95%/10.3%) group (p<0.05). A similar trend was observed for the stroke/fatal-stroke risks.

Conclusions: CHD/fatal-CHD and stroke/fatal-stroke risk burden decreased in newly diagnosed diabetic patients following multi-factorial pharmacotherapy association with intensive lifestyle changes during 1-year follow-up.

Open access

Mirela Florea, Cristina Niţă, Răzvan Florea and Nicolae Hâncu

Abstract

Background and Aims. The aim of this study was to assess the control of the cardiometabolic risk factors in subjects with newly diagnosed type 2 diabetes (T2DM) one year after initiating the clinical management. Material and Methods. We conducted a prospective observational study including 673 persons with newly diagnosed T2DM, registered at the Clinical Center of Diabetes Cluj-Napoca, between 2006-2008. Results: Of the total T2DM subjects who were followed-up until the end of the first year after diagnosis, the proportion of those reaching the optimal goals for major risk factors was 72.1% for HbA1c, 58.6% for blood pressure (BP) and 40.3% for LDL cholesterol. All three goals were met by only 6.9%. Achieving glycemic targets is associated with a lower HbA1c value at diagnosis (OR:0.66, 95%IC: 0.54-0.81). The parameters which were initially identified as associated with achieving the objectives of the clinical management were represented by age, male gender, clinical parameters (HbA1c, body mass index, BP), hypertension, pharmacotherapy. Conclusions: Implementing clinical management in newly diagnosed T2DM subjects resulted in improved glycemic control and cardiovascular risk factors one year after diagnosis. The management of newly diagnosed people with T2DM focused specifically on achieving the glycemic target

Open access

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

László Barkai, Nicolae Hâncu, György Jermendy, Maya Konstantinova, Radu Lichiardopol, Maria Moţa, Cvetalina Tankova, Natalia Temelkova and Gábor Winkler

Abstract

Both the prevalence and incidence of type 2 diabetes are increasing worldwide and over 60% of people with T2DM develop cardiovascular disease. There are many data supporting the view that glycaemic control plays a role in reducing cardiovascular complications. The relationship between hyperglycaemia and cardiovascular disease is complex with evidence suggesting that an acute increase of glycaemia, particularly after a meal, may have a direct detrimental effect on cardiovascular disease. Although control of fasting hyperglycaemia is necessary, it is usually insufficient to obtain optimal glycaemic control. A growing body of evidence suggests that reducing post meal plasma glucose excursions is as important, or perhaps more important for achieving HbA1c goals. New classes of therapies for managing post meal plasma glucose in people with diabetes (glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors) have shown significant benefits in reducing post meal plasma glucose excursions andlowering HbA1c. The individual properties of the various GLP‑1 receptor agonists might enable incretin-based treatment of type 2 diabetes mellitus to be tailored to the needs of each patient.

Open access

László Barkai, Nicolae Hâncu, György Jermendy, Maya Konstantinova, Radu Lichiardopol, Maria Moţa, Cvetalina Tankova, Natalia Temelkova and Gábor Winkler

Abstract

The objective of this position paper is to review the current medical evidence and guidelines regarding the treatment of type 2 diabetes (T2DM) and to issue medical recommendations strengthening the timely use of insulin in patients with T2DM uncontrolled on noninsulin therapy. When noninsulin therapy fails to achieve or to maintain HbA1c targets, insulin therapy is required. Timely insulin therapy could provide proper metabolic control that might prevent complications, lead to improvement of life expectancy and quality of life.