Oana Albai and Romulus Timar
The Relationship Between 1 Hour Glycemia, During Oral Glucose Tolerance Test and Cardiometabolic Risk
Background Diabetes mellitus is a very common disease, worldwide there are currently over 366 million diabetics. It seems that people with normal glucose tolerance and blood glucose at 1 hour during OGTT ≥200mg% represent an intermediate phenotype of abnormal glucose metabolism, another disturbance of carbohydrate metabolism that is associated with increased cardiometabolic risk. Objectives Starting from these premises, we decided to analyze the subjects with glucose at 1 hour during OGTT ≥200mg%, but with normal values for fasting glucose and 2 hours glucose. In this subgroup of subjects some parameters of CMR were analyzed. We also performed a comparison of this subgroup of subjects with both normal glucose tolerance and 1-hour glucose <200mg%, and with those with abnormal glucose tolerance. Results According to currently used recommendations to diagnose diabetes mellitus, from the 778 people included in this study, 167 (21.5%) had disturbances of carbohydrate metabolism, being classified as patoglycemic and 611 persons (78.5%) had normal values of fasting glucose and 2 hours glucose during OGTT, being considered normoglycemic. From the 611 people who were classified as normal glucose tolerance, based on the currently used criteria for diagnosis of diabetes mellitus, a total of 44 persons (7.2%) had, however, the value of 1-hour glucose during OGTT ≥200mg%, which represents 5.6% of the entire group studied. Conclusions Patients with normal glucose tolerance and glucose ≥200mg% at 1 hour during OGTT represent a new subgroup of impaired glucose tolerance, which requires strict lifestyle advice and possibly pharmacological measures to prevent or delay progression to abnormal glucose tolerance.
Adrian Vlad and Romulus Timar
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.
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.
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.
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.
Corina Marcela Hogea, Bogdan Timar, Alin Albai, Romulus Timar and Viorel Şerban
Background and Aims: Cardiovascular disease represents the principal cause of death in type 2 diabetes (T2DM) patients. The aim of our study was to evaluate the all cause mortality and the main causes of death in T2DM patients and their trend of evolution between 1970 and 1999. Material and methods: 3719 T2DM patients newly diagnosed between 1970-1979 in the Timisoara Diabetes, Nutrition and Metabolic Diseases Centre were followed until 1999. The study group included 2084 women (56.0%) and 1635 men (44%), with a mean age at diagnosis of 58.2±11.5 years. Results: Throughout the analyzed period we noticed a tendency of decrease for all cause mortality, the main causes of death being cardiovascular diseases. Conclusions: The results of the study confirm the tendency of reduced mortality in T2DM patients and maintenance of cardiovascular diseases as the main cause of death in T2DM patients.
Oana Albai, Bogdan Timar, Deiana Roman and Romulus Timar
Background and aims Diabetes mellitus (DM) is one of the leading causes of end-stage chronic kidney disease (CKD). Patients with DM and CKD have a 10 or even 20 times higher cardiovascular risk (CVR) than the general population. Lipid metabolism disorders are more frequent in these patients, dyslipidemia being aggravated by the presence of hyperglycemia and insulin resistance. The main purpose of our study was to identify possible correlations between lipid profile parameters and altered renal function in patients with DM. We have also analyzed the correlations between lipid parameters, CKD, quality of glycemic control and CVR.
Material and method: The study was performed on 2732 patients with DM which received medical treatment and care at the Center for Diabetes Timisoara, for a 6-month period from March to October 2016, 1508 women (55.2%) and 1224 men (44.8%), mean age 63.7 ± 9.1 (33-78) years and mean diabetes duration 12.4 ± 6.8 (6-33) years. The study group included 312 patients (11.4%) with T1DM and 2420 patients (88.6%) with T2DM.
Results: The prevalence of CKD (GFR< 60 ml/min) was 12.5%. The levels of total cholesterol (TC), triglycerides (TG) and LDLc were significantly higher in the case of patients with DM and CKD (p<0.0001). Patients with CKD had twice the prevalence of ischemic heart disease and cerebrovascular disease when compared to patients without CKD. Peripheral artery disease was present in 16.9% of those with CKD and in 11% of those without CKD. Hypertension (HTN) was present in 91.8% of patients with CKD and in 67.1% of patients without CKD (GFR > 60 ml/min).
Conclusion: Analyzed data showed a strong correlation between CKD, dyslipidemia and CVR in patients with DM. Impaired renal function was strongly correlated with age, duration of DM and weight status of these patients.
Simona Popescu, Laura Diaconu, Bogdan Timar and Romulus Timar
Parenteral nutrition (PN) represents an alternative or additional approach when other nutrition routes are not succeeding or when using other routes is not possible or would be unsafe. The main goal of PN is to deliver a nutrient mixture closely related to requirements in a safe manner and without complications. The concentration of parenteral solutions (PS) determines their osmolarity, according to which, the solutions will be infused by peripheral or central venous access. The solutions used in central PN contain more glucose, which, together with amino acids and electrolytes, determines a hyperosmolar solution, which has to be administered in a large caliber vein. Central venous access may be maintained over long periods of time. In peripheral PN there are used solutions with a lower concentration of dextrose in order to obtain (solutions with the) an osmolarity lower than 900 mOsm/L, which can be administered in a peripheral vein. Peripheral PN is used over short periods of time because of the limited tolerance for a long term of peripheral veins. PN is an efficient method to ensure the nutritional support which can be associated with numerous complications, some of them severe, with lethal potential. Patients with PN need a daily physical examination and laboratory tests.
Oana Albai, Bogdan Timar, Laura Diaconu and Romulus Timar
Objective: Despite the diversity of antidiabetic medication currently available, less than half of the patients with type 2 diabetes meet the therapeutic targets recommended by the guidelines: HbA1c <7%, or even <6.5%. This study aimed to investigate the efficacy and safety of sitagliptin in patients with type 2 diabetes mellitus, with inadequate glycemic control, as well as the effects on cardiovascular risk factors. Material and method: The study included 348 patients, 161 men (46.3%) and 187 women (53.7%), with mean age of 56.1 ± 6.2 years, who started treatment with sitagliptin, combined with either metformin, sulphonylurea or both. Results and discussions: Sitagliptin improved glycemic control reducing average HbA1c with 1.1%; the average weight decreased with 1.7 kg after 24 weeks of treatment, and the lipid profile improved significantly. Conclusions: Sitagliptin offers a new therapeutic option in patients with type 2 diabetes mellitus, with the advantage of a single dose oral administration.