Simona Georgiana Popa
Simona Clus, Gabriela Creteanu and Amorin Popa
Introduction. Iatrogenic hypoglycemia increases cardiovascular morbidity sometimes even with fatalities, and also increases cognitive disorders in most people with type 1 diabetes (T1D) and type 2 diabetes (T2D). Hypoglycemia is characterized by unawareness if the sympathoadrenal response is attenuated during the night, in autonomic neuropathy or in elderly patients. Therefore, hypoglycemia is a limiting factor in the glycemic management of diabetes.
Methods. We aimed to analyze the hypoglycemic events and the time spent with low glucose level (glucose <3.9 mmol/l) in patients with diabetes (T1D, T2D) with insulin therapy (basal or basal-bolus), in ambulatory or hospital setting. The glucose variability was assessed via the interstitial glucose concentration, measured with a Continuous Glucose Monitoring (CGM) system over 72 hours.
Results. The incidence, severity and duration of hypoglycemia are not correlated with HbA1c, disease’s duration and patient’s age. In patients with T1D, severe hypoglycemia is more frequent in patients with a long duration of diabetes. In this analysis, the type of basal analog insulin did not influence the presence of hypoglycemia (p=0.7), but the duration of nocturnal hypoglycemia was longer with insulin glargine U100 than with insulin detemir. The basal regimen is more protective for hypoglycemia than basal-bolus insulin.
Conclusions. The study suggested that hypoglycemic events are common, silent and prolonged in 1/3 of patients with T1D and T2D. The CGM system is beneficial for all patients with T1D and for patients with T2D with hypoglycemic risk and complications, to adjust medication in order to prevent cardiovascular events.
Simona Clus, Gabriela Crețeanu and Amorin Popa
Background and aims: It is known that the majority of critical unacknowledged hypoglycemia has an increased incidence in patients with type 1 diabetes (T1DM) with a long evolution. The aim of this research is to evaluate the variability of glucose level and hypoglycemic events in patients with type 2 diabetes (T2DM) having pharmacological interventions with hypoglycemic risk. These events are sometimes asymptomatic also in T2DM: frequently in elderly, patients with autonomic neuropathy, or having a long evolution of disease.
Material and method: This analysis includes 72 patients with T2DM, with a relative good metabolic control, and possible glucose fluctuations. Glucose variability was appreciated using continuous glucose monitoring systems (CGMS) used for more than 72 hours in hospital or ambulatory setting.
Results: The incidence, duration and severity of hypoglycemia are not correlated with HbA1c value, age, disease duration or treatment. Approximately a quarter of patients had nocturnal hypoglycemia and in 37,5% of events hypoglycemia was prolonged, more 45 minutes. Clinical manifestations in diurnal hypoglycemia were presents in only 40% of the recorded events.
Conclusions: The study suggested that CGMS is beneficial for patients with type 2 diabetes, with hypoglycemic risk and complications, to adjusted medication, education and prevention the cardiovascular events.
M. F. Popa, Lavinia-Simona Candea and I. Parlica
The purpose of this paper is to present a case of prosthetic mitral valve thrombosis in a young patient with a history of acute articular rheumatism with bivalvular damage which required prosthetic mitral twin disc and tricuspid annuloplasty that, despite effective anticoagulation treatment, shows a high degree of mitral valve obstruction with severe hemodynamic disturbances that ultimately led to death.
The particularity of the case lies in the development of thrombosis in twin disc prosthesis type, complication that, in the literature, is cited as being more rarely met than the cases of single-disc prosthesis.
Isabela Popa, Diana Protasiewicz, Cristina Muntean, Simona Georgiana Popa and Maria Mota
Phisical activity, regularly performed, give us a lot of health benefit, especially in preventing cardiovascular disease, diabetes mellitus (DM) and obesity. Physical exercise, defined as a controlled, progressive, supervised, requires muscular activity, involving energy consumption through metabolic and thermoregulatory processes. It can be classified as aerobic and anaerobic, according to the metabolic processes that take place. The metabolic equivalent (MET) represents the body’s energy consumption during rest and it is used for quantifying fhisical activity (for example, a MET value of 3 would require 3 times the energy that is consumed at rest). Muscle contraction has two different phases: the isometric one (usually during the first part of the contraction) and the isotonic one. This article presents the interrelation of phisical activity with with the complexity of metabolic patwais, bringing the arguments for the necessity of performing regular and controlled phisical activity.
Simona Georgiana Popa, Adina Popa and Maria Moţa
Type 2 diabetes is a progressive disease and, despite recent progress in the treatment of diabetes, the glycemic control usually deteriorates gradually and insulin therapy is needed. When insulin therapy should be started and which are the appropriate insulin therapy strategies, still represent subjects of debates. Insulin represents a therapeutic option in type 2 diabetes due to the existence of early β-cell dysfunction and significant reduction of β-cell mass in natural history of type 2 diabetes. The current guidelines recommend insulin in double therapy in association with metformin or in combination with metformin and other noninsulin agent. Initiation of insulin therapy is recommended in patients with newly diagnosed type 2 diabetes and symptomatic and/or presenting important hyperglycemia or elevated HbA1c. Initiation of insulin therapy in type 2 diabetes should take into consideration the pathophysiology of type 2 diabetes, the effects and the potential risks of insulin therapy, the guidelines recommendations and the barriers to insulin use. Literatures of only English language were analyzed from NCBI database. Guidelines were accessed electronically from organisations, i.e. American Diabetes Associations, American Association of Clinical Endocrinologists and American College of Endocrinology, European Association for the Study of Diabetes, International Diabetes Federation.
Adela-Gabriela Firănescu, Adina Popa, Maria-Magdalena Sandu, Diana Cristina Protasiewicz, Simona Georgiana Popa and Maria Moţa
Diabetes Mellitus (DM) and Tuberculosis (TB) are two chronic diseases which have a major impact on the population health in developing countries. DM is a chronic, noncommunicable disease, characterized by hyperglycemia, caused by insulin-resistance, inadequate insulin secretion or both. TB is a disease caused by Mycobacterium tuberculosis, an airborne bacteria. DM implies a three times greater risk of developing TB and their association can be considered one of the most important challenges regarding TB control. TB can cause a temporary impaired glucose tolerance, which is a risk factor for DM development. The possibility of relapse or death of a patient with TB is significantly higher when the patient also has DM. The DM-TB association represents an important threat to the population health and requires the implementation of adequate programs in order to reduce the prevalence and incidence of the two diseases.
Diana Cristina Protasiewicz, Adina Popa, Maria-Magdalena Roşu, Adela-Gabriela Firănescu, Simona Georgiana Popa and Maria Moța
Humans spend almost one third of their life sleeping, thus sleep deprivation or poor sleep quality will have consequences upon the quality of life. Obstructive sleep apnea (OSA) is the most common sleep disorder that represents a respiratory cessation for at least ten seconds, which appears repeatable during sleep and it is accompanied by decreased oxygen saturation. The diagnosis of OSA is possible by filling in the STOP, STOP BANG, BERLIN questionnaires and performing the polysomnography, an accessible and more accurate method but yet very expensive. The prevalence of OSA is continuously increasing, but because of the nonspecific symptoms, the percentage of un-diagnosed cases is further increased. Data from 11 epidemiological studies published between 1993 and 2014 indicated an OSA prevalence of 22% in men and 17% in women. It has been suggested that there is a bidirectional causal relationship between OSA and obesity, and numerous studies have shown association of OSA with insulin resistance, diabetes mellitus, diabetic micro- and macrovascular complications and atrial fibrillation.
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 Muntean, Maria Mota, Simona Popa and Adina Mitrea
Central nervous system, mainly the hypothalamus and the brainstem are important keys in glucose homeostasis. Not only do they use glucose as primary fuel for their functioning but they are part of intricate neuronal circuits involved in glucose uptake and production as was first shown by Claude Bernard. Moreover electrophysiological analysis of hypothalamus revealed the existence of glucosensing neurons whose firing rates are controlled by glucose extracellular level. Further information was obtained regarding the importance of leptin, insulin and free fatty acids as afferent signals received by these neural structures. As for the main efferent pathways, autonomic system is the one connecting CNS with the effector organs (the liver, the pancreas and the adrenal glands).