SEMNIFICAŢIA SCORULUI REAVEN ÎN CAZUL PACIENŢILOR CU DIABET ZAHARAT NOU DIAGNOSTICAT

A. Nicoară, C. Pencea, D. Licăroiu, R. Nafornita, R. Lichiardopol

Institutul de Diabet, Nutriţie şi Boli Metabolice “N. Paulescu“, Bucureşti, România

Obiectiv: Obiectivul acestui studiu a fost acela de a identifica relaţia dintre Scorul Reaven şi caracteristicile clinice si metabolice ale pacienţilor nou descoperiţi cu diabet zaharat tip 1 (DZ tip 1) si diabet zaharat tip 2 (DZ tip 2).

Material si metodă: Lotul studiat a inclus 200 pacienţi cu DZ tip 1 si DZ tip 2, nou descoperiţi, înregistraţi în ultimele 2 luni la Institutul de Diabet, Nutriţie si Boli Metabolice “N.Paulescu”, Bucureşti, dintre care 98 au fost barbaţi (49%) si 102 au fost femei (51%). Pe lotul studiat, pacienţii au fost grupaţi în funcţie de tipul de diabet zaharat (DZ) în 2 loturi : lotul 1 incluzând pacienţii cu DZ tip 1 (n=13) şi lotul 2 incluzând pacienţii cu DZ tip 2 (n=187). Pentru fiecare lot au fost colectate date clinice si antropometrice (înalţime, greutate, indexul masei corporale-IMC, circumferinţa abdominală şi valorile tensiunii arteriale sistolice şi diastolice), dar şi parametrii metabolici (HbA1c şi profilul lipidic), date privind statusul de fumător/nefumător şi antecedente heredocolaterale de DZ.Pentru interpretarea rezultatelor, am utilizat criteriile ATP III pentru definirea parametrilor sindromului metabolic şi Scorul Reaven (raportul TG/HDLcol≥3) pentru estimarea insulinorezistenţei.Analiza statistică a datelor s-a efectuat utilizând SPSS 15.0.

Rezultate: Prevalenţa obezităţii abdominale a fost de 30.7% în cazul lotului de pacienţi cu DZ tip 1 şi de 47.05% în cazul lotului de pacienţi cu DZ tip 2. Valori crescute ale tensiunii arteriale sistolice s-au constatat la 74.2% dintre subiecţi, 23.1% dintre aceştia aparţinând lotului 1 de pacienţi cu DZ tip 1, iar 77.2% aparţinând lotului 2 de pacienţi cu DZ tip 2. Valoarea medie a HbA1c a fost de 10.6±2.84% la pacienţii cu DZ tip 1, respectiv 9.08±2.54% la pacienţii cu DZ tip 2. Valoarea medie a Scorului Reaven a fost de 2.59±1.35 la lotul de pacienţi cu DZ tip 1 şi respectiv 6.44±3.98 la lotul de pacienţi cu DZ tip 2. Valorile medii ale IMC au fost 23.76kg/m² la pacienţii cu DZ tip 1, respectiv 30.16kg/m² la pacienţii cu DZ tip 2.La pacienţii cu DZ tip 1 nou diagnosticat, raportul TG/HDLcol s-a corelat direct şi puternic cu circumferinţa taliei (rs=0.670, p=0.012, CD=44.89), astfel că 44% dintre subiecţi au prezentat o corelaţie pozitivă între cei doi parametri.La pacienţii cu DZ tip 2 nou diagnosticat, Scorul Reaven s-a corelat pozitiv cu circumferinţa abdominală (rs=0.740, p=0.001, CD=54.76%), cu valorile HbA1c (rs=0.552, p=0.006, CD=30.47%) şi cu tensiunea arteriala (p=0.001). Nu am constatat diferenţe statistic semnificative între pacienţii din cele 2 loturi în ceea ce priveşte stratificarea lor în funcţie de sex, antecedente de DZ şi statusul de fumător.

Concluzii: In cazul DZ tip 1 nou diagnosticat, Scorul Reaven se asociază cu circumferinţa taliei pacienţilor. În cazul DZ tip 2, Scorul Reaven se asociază cu circumferinţa taliei, cu majoritatea parametrilor sindromului metabolic şi cu gradul de

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control metabolic al DZ. Circumferinţa taliei, fiind un parametru uşor de măsurat, poate fi uzitat ca punct de plecare în screeningul insulinorezistenţei.

THE SIGNIFICANCE OF REAVEN’S SCORE IN PATIENTS WITH DIABETES MELLITUS NEWLY DIAGNOSED

A.Nicoara, C.Pencea, D. Licaroiu, G. Stan, R. Lichiardopol

“N.Paulescu” Institute of Diabetes, Nutrition and Metabolic Disease, Bucharest, Roumania

Background and Aims: The objective of this study was to identify the relationship between the Reaven`s Score which is an indicator for insulin resistance and the clinical and metabolic features of patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) newly diagnosed.

Materials and Methods: The study group included two hundred patients newly diagnosed T1DM and T2DM registrated at “N. Paulescu” Institute of Diabetes, Nutrition and Metabolic Disease, Bucharest during the last two month, 98 men (49%) and 102 women (51%). Depending on the type of diabetes mellitus (DM), the subjects were selected in two groups: group 1 included the patients with T1DM newly diagnosed (n=13) and group 2 included the patients with T2DM newly diagnosed (n=187). In each group, we assessed the clinical and a few anthropometric data (heigh, weight, body mass index - BMI, waist circumference and sistolic and diastolic blood pressure) as well as metabolic parameters (HbA1c and lipid profiles), history of DM data and smoking/no smoking status data.The ATP III criteria for metabolic syndrome (MetS), Reaven`s Score (TG/HDL chol) ≥ 3 for estimation of insulin resistance have been used to interpret the results.Statistical analysis was carried out using SPSS 15.0.

Results: The prevalence of large waist was 30.77% for T1DM group and 47.05% for T2DM group. High sistolic blood pressure was found in 74.2% of the subjects, in 23.1% of the patients with T1DM and in 77.2% of the patients with T2DM. The mean HbA1c level was 10.6±2.84% in T1DM patients group and 9.08±2.54% in T2DM patients group. The mean values of Reaven`s Score was 2.59±1.35 in T1DM patients and 6.44±3.98 in T2DM patients. The mean values of BMI was 23.76kg/m² in newly diagnosis T1DM patients and 30.16kg/m² in newly diagnosis T2DM patients. In patients with newly diagnosed T1DM there was proved the existence of a positive correlation between Reaven`s Score and waist circumference (rs=0.670, p=0.012, CD=44.89): in 44% of the patients with newly diagnosed T1DM has been shown a positive correlation between the TG/HDL chol. ratio values and the waist circumference values. In patients with newly diagnosed T2DM there was proved the existence of a positive correlation between Reaven`s Score and waist circumference values (rs=0.740, p=0.001, CD=54.76%) as well as between Reaven`s Score and HbA1c values (rs=0.552, p=0,006, CD=30.47%) and

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between the Reaven`s Score and high blood pressure (p=0,001). We have not found semnificative statistical differences between the patients of the two groups regarding the sex stratification (p=0.832), history of DM (p=0.267) and smoking status (p=0.225).

Conclusions: The Reaven`s Score is related to waist circumference in newly diagnosed T1DM patients. In T2DM, The Reaven`s Score is related to anthropometric and most parameters of metabolic syndrome and with the degree of metabolic control. Based on the frequency and easy-to-determine waist circumference, it could be use as starting point to screen for insulin resistance.

INSTRUMENT INFORMATIC APLICAT IN EDUCATIA PENTRU O ALIMENTATIE SANATOASA

Calinici M.A.*, Pavel N.**, Pavel C.**, Calinici T.***

*Spitalul Judetean de Urgenta Zalau

**SC. Alfasoftware. SA Zalau

*** Universitatea de Medicina si Farmacie Iuliu Hatieganu, Cluj Napoca

In conditiile in care excesul ponderal ameninta sa dobandeasca proportii epidemice, am considerat util sa testam eficienta utilizarii instrumentelor informatice in educatia pentru o alimentatie sanatoasa. Obiectivul aplicatiei este sensibilizarea persoanelor sanatoase cu privire la importanta unei ratii calorice rezonabile si a unei structuri armonioase in principii nutritive. Grupul tinta e definit ca alcatuit din navigatori pe internet, grup caracterizat printr-un anume segment de varsta, coeficient intelectual si preocupari specifice. Site-ul www.anchetainfarfurie.ro are incorporata o aplicatie de tip Flash, ce permite alcatuirea unui jurnal alimentar prin intermediul unui site web (internet). Colectand date de la utilizator, aplicatia calculeaza I.M.C. si ratia calorica ideala si cea realizata. In serverul aplicatiei este inregistrata o baza de date cuprinzand peste 7500 de alimente, cu parametrii acestora. Aceste alimente se pot include in jurnalul fiecarui untilizator printr-o interfata simpla si prietenoasa. Serverul ce ruleaza aplicatia este in incinta Societatii Romane de Informatica Medicala Aplicata (SRIMA), baza de date cuprinzand alimentele provine de la The Nutricut Data Laboratory si este recomandata de catre Center for Food Safety and Applied Nutrition, din cadrul U.S. Food and Drink Administration. Programul « Ancheta in farfurie » este agreat de Societatea de Nutritie din Romania.

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INFORMATICAL INSTRUMENT APPLIED IN THE EDUCATION FOR A HEALTHY NUTRITION

Calinici M.A.*, Pavel N.**, Pavel C.**, Calinici T.***

*The Emergency County Hospital Zalau

**SC Alfasoftware SA, Zalau

***The “Iuliu Hatieganu” University of Medicine and Pharmacy, , Cluj Napoca

In the circumstances in which excessive ponderosity threatens to gain epidemical proportions, we considered it usefull to test the eficiency of some informatical instruments in the education for a healthy nutrition. The aim of the application is to make healthy people more sensitive to the importance of a reasonable caloric intake and of a structure that is harmonious in what concerns the nutritive principles. The target group is defined as being made of internet navigators. The group is characterized by a certain age segment, IQ or specific concerns. The site www. Anchetainfarfurie.ro has incorporated a FLASH application that allows the creation of an alimentary diary through a web (internet) site. Gathering data from the user, the application calculates the B.M.I. and the ideal and the achieved caloric intake. A database is registered inside the application server, containig over 7500 aliments and their parameters. These aliments can be included in each and every user’s diary, through a simple and friendly interface. The server that supports the application is inside The Romanian Society for Applied Medical Informatics (RSAMI), the database containing the aliments coming from The Nutricut Data Laboratory and is recommended by The Center for Food Safety and Applied Nutrition in the U.S. Food and Drink Administration. The program “Ancheta in farfurie” (investigation in your plate) is supported by The Romanian Society For Nutrition.

EDUCATIA TERAPEUTICA IN ROMANIA

Adina Sânpetreanu, Gina Vrânceanu

Centrul Clinic de DNBM Cluj-Napoca,

Centrul Clinic de DNBM Iaşi

Lucrarea de fata isi propune sa prezinte structura organizatorica a centrelor de diabet din tara in ceea ce priveste numarul existent de educatori specializati in diabet , dieteticieni , precum si organizarea programului educational .Metodele de abordare a educatiei pacientilor cu diabet zaharat sunt de asemenea parte importanta a acestei lucrari.

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TERAPEUTIC EDUCATION IN ROMANIA

Adina Sânpetreanu, Gina Vrânceanu

Diabetes demographic and epidemic data. Diabetes care network in Romania.

Therapeutic Education in Romania; network, methods , achievements , barriers.

FACTORI DE RISC AI EXCESULUI PONDERAL LA COPIL SI ADOLESCENT

Adriana Cosmescu, Doina Felea, Liliana Barbacariu, Antoneta Petroaie, Ana-Maria Slănină, Otilia Novac, Mihaela Manole

Disciplina Medicină de Familie – U.M.F. "Gr. T. Popa" Iaşi

Introducere: Obezitatea la copil reprezintă o problemă de sănătate majoră deoarece studiile efectuate au arătat ca 20 – 25% din populaţie devine supraponderală înainte de vârsta de 20 de ani.

Scopul acestui studiu a fost prezentarea aspectelor epidemiologice, clinico-anamnestice şi etiologice în apariţia excesului ponderal la copil.

Material şi metodă: Studiul a fost efectuat pe un lot de 33 de copii şi adolescenţi dignosticaţi cu suprapondere sau obezitate într-un cabinet de pediatrie din cadrul Ambulatoriului de Specialitate al Spitalului "Sf. Spiridon" din Iaşi, în perioada ianuarie-iunie 2008. La aceşti pacienţi, examenul clinic general şi măsurătorile antropometrice au fost completate cu o anamneză amanunţită privind antecedentele heredo-colaterale, antecedentele personale fiziologice şi patologice, ancheta alimentară, activitatea fizică efectuată, afecţiunile asociate.

Rezultate: Din cei 33 de pacienţi, 23 de copii şi adolescenţi, reprezentând 69,7%, au fost diagnosticaţi cu obezitate ( IMC peste percentila 95 după vârsta şi sex) şi 10 cazuri cu supraponderalitate ( IMC peste percentila 85 ). Repartiţia după sex a arătat o predominenţă a sexului feminin (19 fete, respectiv 57,6%), faţă de sexul masculin ( 14 baieti – 42,4% ). Mediul de provenienţă a fost urban în 66,7% din cazuri şi rural la 33,3% dintre pacienţi. Istoric familial pozitiv la unul sau ambii părinţi ( obezitate, diabet zaharat de tip 2 ) s-a întâlnit la 14 pacienţi. În ce priveşte greutatea la naştere, la 3 pacienţi a fost peste 4000 de grame şi în 3 cazuri sub 2700 de grame ( subponderalitate ). În toate cazurile, principala cauza a excesului ponderal a fost dieta dezechilibrată,

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hipercalorică, pe baza surplusului de dulciuri, fainoase şi grăsimi. Doar 8 dintre pacienţi practicau o activitate fizică corespunzătoare, respectiv orele de educaţie fizică dar şi un sport în afara şcolii. În celelalte cazuri, copiii fie erau scutiţi de sport, fie se prezentau la orele de educaţie fizică dar fără a participa efectiv. Dintre afecţiunile asociate menţionam: diabetul de tip 2 într-un caz, HTA la 2 pacienţi, scăderea toleranţei la glucoză în 4 cazuri şi dislipidemie la 10 pacienţi.

Concluzii

Obezitatea copilului este o problemă de sănătate publică atât prin creşterea prevalenţei cât şi prin efectele pe termen lung asupra sănătăţii. Prevenirea obezităţii se realizează prin dietă adecvată, activitate fizică şi modificarea stilului de viaţă. Depistarea supraponderii şi obezităţii precum şi factorii de risc ai acestora reprezintă cel mai important rol profilactic al medicului de familie.

RISK FACTORS OF OVERWEIGHT IN CHILDREN AND TEENAGERS

Adriana Cosmescu, Doina Felea, Liliana Barbacariu, Antoneta Petroaie, Ana-Maria Slanina, Otilia Novac, Mihaela Manole

Discipline Family Medicine – U.M.F. “Gr. T. Popa” Iasi

Introduction: Obesity in children is a major condition of health as the carried out studies have shown that 20 – 25% of people become overweight before they reach 20.

The purpose of this study was to present the epidemiological, clinical, anamnestic and etiological aspects in the occurrence of overweight in children.

Material and method: The study was performed on 33 overweight or obese children and teenagers in a pediatrics office of the Out-patient Clinic of “Sf. Spiridon” Hospital from January to June 2008. In these patients, the general clinical exam and the anthropometric measuring were completed by a minute anamnesis with respect to the heredo-collateral history, the pathological and physiological personal history, the food survey and the carried out physical activity.

Results: Of the 33 patients, 23 children and teenagers, i.e. 69,7% were diagnosed with obesity (IMC over 95 percentile according to age and sex) and 10 cases of overweight (IMC over 85 percentile). The division according to sex showed a predominance of the female sex (19 girls, i.e. 57,6%) as opposed to the male sex (14 boys – 42,4%). Their environment was an urban one in 66,7% of the cases and a rural one in 33,3% of the patients. The positive family history with one or both affected parents (obesity, type 2 diabetes mellitus) was discovered in 14 patients. The birth weight was over 4000 grams in 3 patients and below 2700 grams in 3 cases. In all cases, the main cause of overweight was an unbalanced hyper caloric diet based on excessive sweets, pastry and fats. Only 8

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of the patients were practicing an extra sport and were participating at the physical education hours at school. The other children were exempted from physical education classes or they were present without taking any part in the activities. From the associated diseases, we mention the following: type 2 diabetes mellitus in one case, hypertension in 2 patients, impaired glucose tolerance in 4 cases and dyslipidemia in 10 patients.

Conclusions

Children obesity is a public health matter both due to the increase of prevalence and the long term effects on health. Obesity prevention is achieved by an adequate diet, physical activity and change of the life style. The diagnoses of overweight and obesity along with their risk factors are the most prophylactic role of the family medicine.

INFLUENTA HIPERGLICEMIEI POSTPRANDIALE ASUPRA INTERVALULUI QT LA PACIENTII CU DIABET ZAHARAT TIP 2

Adriana Rusu1, Cristina Niţă1,2, Ramona Ştefan2, Adriana Filimon2, Ildiko Kicsi Matyus2, Nicolae Hâncu1,2

1 Universitatea de Medicină şi Farmacie„Iuliu Haţieganu”, Cluj Napoca

2 Centrul de Diabet , Nutriţie şi Boli Metabolice, Cluj-Napoca

Introducere şi obiective. Intervalul QT prelungit reflectă alungirea repolarizării şi∕sau creşterea heterogenităţii repolarizării miocardice, situaţii asociate cu un risc crescut de aritmii şi moarte subită. Studii recente au confirmat valoarea intervalului QT ca predictor al mortalităţii atât în cazul pacienţilor cu diabet zaharat, cât şi în cazul persoanelor fără diabet.

Obiectivul acestei cercetări a fost investigarea relaţiei între glicemia postprandială şi durata intervalului QT, precum şi identificarea valorii glicemiei postprandiale de la care creşte riscul de apariţie a intervalului QT prelungit.

Subiecţi şi Metodă. Au fost analizate date provenite de la 47 de pacienţi cu diabet zaharat tip 2 (66% femei), cu vârste cuprinse între 30 şi 79 ani. S-au înregistrat istoricul personal, caracteristicile clinice şi antropometrice, precum şi rezultatele determinărilor de laborator: A1c, profil lipidic. De asemeanea, a fost înregistrată electrocardiograma (ECG) în repaus, atât preprandial cât şi la 2h postprandial, fără controlul frecvenţei şi profunzimii respiraţiei. Intervalul QT a fost măsurat în derivaţiile II, V2, V5, iar valoarea medie a fost corectată pentru frecvenţa cardiacă utilizând formula lui Hodges. Prelungirea intervalului QTc > 440 ms a fost considerată patologică.

Rezultate. Postprandial, durata intervalului QTc a fost semnificativ mai mare decât în condiţii preprandiale (410.7±27.1ms vs. 403.3±23.03ms, p=0.03). În 59.6% din cazuri s-a constatat creşterea postprandială a duratei intervalului QTc, iar dintre aceşti pacienţi

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(14.9%) au prezentat prelungirea intervalului QTc > 440 ms. Pentru predicţia prezenţei intervalului QTc prelungit, utilizând ROC, s-a determinat că o valoare a glicemiei postprandiale de 173.5 mg/dl poate detecta prezenţa intervalului QTc prelungit cu o sensibilitate de 86% şi o specificitate de 51%. Valoarea predictivă negativă (VPN) a fost de 95%, iar valoarea predictivă pozitivă (VPP) de 24%.

Concluzii. Alungirea intervalului QTc este frecvent asociată cu hiperglicemia postprandială şi poate reprezenta un factor de risc adiţional pentru evenimentele cardiovasculare. Reducerea excursiilor glicemice postprandiale ar putea preveni prelungirea intervalului QTc şi ulterior apariţia unor aritmii potenţial fatale.

THE INFLUENCE OF POSTPRANDIAL HYPERGLYCEMIA ON QT INTERVAL IN PATIENTS WITH TYPE 2 DIABETES

Adriana Rusu1, Cristina Niţă1,2, Ramona Ştefan2, Adriana Filimon, Ildiko Kicsi Matyus2, Nicolae Hâncu1,2

1 „Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj Napoca

2 Clinical Center of Diabetes, Nutrition, Metabolic Diseases, Cluj-Napoca

Background and Aims. Ventricular myocardial depolarization and repolarization are reflected in QT interval. Prolonged QTc reflects cardiac repolarization prolongation and/or increased repolarization inhomogenity known to be associated with increased risk of arrhythmias and sudden death. In recent years, studies have confirmed the value of QT interval as a predictor of total mortality in both diabetic and non-diabetic subjects.

The objective of this study was to investigate the relationship between postprandial glycemia and the duration of QT interval and to identify cutoff values of postprandial glycemia from which QT interval is prolonged.

Subjects and Methods. A number of 47 persons (66% women) with type 2 diabetes, aged between 30-79 years were included in the study. A complete medical history and physical examination was performed. Blood samples were collected in the overnight fasting state, and A1c, total cholesterol, HDL-cholesterol, triglycerides were assessed. Pre- and 2 h-postprandial 12-lead resting ECG were recorded without controlling for depth and rate of respiration. QT interval was measured in II, V2, V5, and the mean value was corrected for heart rate using the Hodges` formula. QTc >440 ms was considered as abnormally prolonged.

Results. In postprandial state QTc duration was significantly longer than preprandial (410.7±27.1 ms vs. 403.3±23.03 ms, p=0.03). 28 patients (59.6%) presented a

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prolongation of QTc interval in the postprandial state compared with preprandial QTc duration. From these patients, 7 (14.9%) had a QTc interval > 440 ms. A cut-off point of 173.5 mg/dl for postprandial glycemia detected the presence of prolonged QTc interval with a sensitivity of 86% and a specificity of 51%. Negative predictive value (NPV) was 95%, and positive predictive value (PPV) was 24% when referring to the presence of prolonged QTc interval.

Conclusions. Prolongation of QTc occurs frequently during postprandial state in type 2 diabetes. Postprandial hyperglycemia alters myocardial ventricular repolarization in patients with type 2 diabetes and might be an additional risk factor for cardiovascular events. Limiting meal related glucose excursions over 173.5 mg/dl could prevent QTc prolongation and possible could prevent the occurrence of arrhythmias.

COGNIŢII DEZADAPTATIVE DESPRE TRATAMENTUL CU INSULINĂ. CONSTRUCŢIA ŞI VALIDAREA UNEI SCALE CARE SĂ ORIENTEZE

INTERVENŢIILE CARE VIZEAZĂ SCĂDEREA REZISTENŢEI PSIHOLOGICE LA INSULINĂ.

1, 2 Drd. Psih. Amfiana Gherman, 2Prof. Univ. Dr. Daniel David

1 Centrul Clinic de Diabet, Nutriţie şi Boli Metabolice

2 Catedra de Psihologie Clinică şi Psihoterapie, Universitatea Babeş-Bolyai

ASPECTE TEORETICE. Rezistenţa psihologică la insulină se referă la refuzul din partea pacientului sau a medicului de a iniţia insulino-terapia atunci când ar fi necesară în controlul diabetului de tip 2. În literatura de specialitate nu sunt disponibile instrumente validate ştiinţific care să măsoare acest concept din punct de vedere psihologic. Cu alte cuvinte, nu există instrumente care să aibă în spate o teorie validată ştiinţific pentru factorii psihologici implicaţi în refuzul tratamentului cu insulină şi care să aibă în acelaşi timp calităţi psihometrice bune. Astfel, este nevoie de un asemenea instrument care să ghideze intervenţiile psihologilor clinicieni pentru scăderea rezistenţei psihologice la insulină. Pornind de la teoria cognitivă a emoţiilor, la baza consecinţelor emoţionale şi comportamentale dezadaptative (cum ar fi refuzul tratamentului cu insulină sau emoţiile disfuncţionale de tip anxietate, deprimare, frustrare, furie) stau procese cognitive de tip evaluativ, cum ar fi cerinţele absolutiste faţă de sine, lume şi viaţă, catastrofarea unui eveniment, toleranţa scăzută la frustrare, evaluarea globală negativă a propriei persoane sau a altora.

OBIECTIVE: Construirea şi validarea unei scale care să măsoare cogniţiile dezadaptative specifice în rezistenţa psihologică la insulină.

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METODOLOGIE: Participanţi – 50 de pacienţi cu diabet zaharat de tip 2 din evidenţa Centrului de Diabet, Nutriţie şi Boli Metabolice, Cluj-Napoca. Instrumente: Scala de cogniţii despre insulină (SCI), Scala de atitudini şi convingeri II (ABS II – DiGiuseppe, Leaf, Exner şi Robin, 1988), Chestionarul gândurilor automate (ATQ – Hollon şi Kendal, 1980) şi Profilul distresului afectiv (Opriş şi Macavei, 2005), Interviu clinic pentru investigarea tulburărilor de tip depresiv sau anxios. Procedură: S-a construit (prin consultul experţilor şi al pacienţilor) scala care măsoară cogniţiile dezadaptative despre tratamentul cu insulină (SCI), iar apoi scalele de mai sus s-au aplicat participanţilor la studiu pentru a aduna date legate de fidelitatea şi validitatea acestei scale. Rezultate: Analiza datelor a evidenţiat faptul că SCI are o consistenţă internă ridicată; validitatea de conţinut a fost analizată de un grup de experţi în teoriile cognitiv-comportamentale ale emoţiilor. SCI a fost astfel construită încât conţinutul său să reflecte principiile teoriei raţional-emotive şi cognitiv-comportamentale, iar forma sa să fie asemănătoare altor teste similare deja existente şi care şi-au dovedit utilitatea. Validitatea de construct se referă la măsura în care scala reflectă constructul pe care îl măsoară; astfel, s-au corelat itemii acestui nou instrument cu itemii altor scale existente care şi-au dovedit deja validitatea şi fidelitatea (ABS II, ATQ şi PDA). Datele arată o bună validitate de construct a acestei scale. În ceea ce priveşte validitatea convergentă, cogniţiile evaluative dezadaptative corelează cu emoţiile negative disfuncţionale, iar cele adaptative cu emoţiile negative funcţionale şi cu cele pozitive.

CONCLUZII: SCI are coeficienţi de fidelitate şi validitate ridicaţi, putând discrimina cu succes între persoanele care refuză şi cele care acceptă tratamentul cu insulină. Această scală este un instrument de tip evidence-based în evaluarea factorilor cognitivi care influenţează refuzul/acceptarea insulino-terapiei.

MALADAPTIVE BELIEFS ABOUT INSULIN THERAPY. THE CONSTRUCTION AND VALIDATION OF A SCALE USEFUL FOR THE INTERVENTIONS THAT AIM TO DECREASE THE PSYCHOLOGICAL

INSULIN RESISTANCE.

1,2 Amfiana Gherman, M.A., PhD candidate, 2 Univ. Prof. Daniel David, PhD

1 Clinic of Diabetes, Nutrition and Metabolic Diseases

2 Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University

THEORETICAL ASPECTS. The psychological insulin resistance refers to the reluctance of both patients and medical staff to initiate insulin therapy when it would be beneficial for the control of the type 2 diabetes. In the literature there aren’t available evidence-based instruments to measure this concept from a psychological point of view. Therefore, there are no instruments based on an empirical theory for the psychological factors involved in the refusal of the insulin treatment and that has good psychometric

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qualities at the same time. Therefore, we need such an instrument to guide the interventions of the clinical psychologists to decrease the psychological insulin resistance.

Starting from the cognitive theory of emotions, at the basis of the maladaptive emotional and behavioral consequences (such as the refusal of the insulin treatment or the dysfunctional emotions such as anxiety, depression, anger) there are evaluative cognitive mechanisms, such as demandingness towards self, life and others, awfulinsing the negative character of an event, low frustration tolerance and negative global evaluation.

OBJECTIVES: The development and the validation of a scale that measures the maladaptive believes about insulin treatment.

METHOD: Participants – 50 patients with type 2 diabetes from the Clinic of Diabetes, Nutrition and Metabolic Diseases, Cluj-Napoca. Instruments – The Insulin Beliefs Scale (IBS), The Attitudes and Beliefs Scale II(ABS II – DiGiuseppe, Leaf, Exner & Robin, 1988), Automatic Thoughts Questionnaire (ATQ – Hollon & Kendal, 1980) and Emotional Distress Profile (Opriş şi Macavei, 2005), SCID (Semistructured Clinical Interview after DSM-IV) for investigating depressive or anxiety disorders. Procedure: The scale was constructed with the agreement of the experts and of the patients (IBS), and then all the other scales were applied in order to compute the psychometric coefficients of the scale. Results: The data analysis showed that IBS has a good intern consistency; the content validity was analyzed by a group of experts in the rational-emotional and cognitive behavioral theories of emotions. IBS was constructed so that its content reflects the cognitive theories of emotion and its wording is similar to other tests that already prove their utility. Its construct validity was measured by correlating the IBS items with the items of other scales that already prove their validity (ABS II, ATQ and EDP). The data show good construct validity. In what the convergent validity is concerned, the maladaptive evaluative cognitions correlate with the negative dysfunctional beliefs, and the adaptive ones with the negative and positive adaptive emotions.

CONCLUSIONS: IBS has high fidelity and validity coefficients, being able to discriminate between the persons that refuse and those who accept the treatment with insulin. This scale is an evidence-based instrument in the evaluation of the cognitive factors that influence the refusal or the acceptance of the insulin therapy.

PROPUNEREA UNUI GHID CLINIC PENTRU PSIHOLOGII CLINICIENI CARE LUCREAZĂ CU PACIENŢI CU DIABET SAU OBEZITATE

1,2 Drd. Psih. Gherman Amfiana, 1 Psih. Andreia Mocan, 2 Prof. Univ. Dr. Daniel David

1 Centrul Clinic de Diabet, Nutriţie şi Boli Metabolice

2 Catedra de Psihologie Clinică şi Psihoterapie, Universitatea Babeş-Bolyai

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Pentru a oferi cele mai bune şi cele mai eficiente tratamente pacienţilor, ne bazăm pe principiul intervenţiilor validate ştiinţific (evidence-based). Astfel, pentru ca o intervenţie să fie validată ştiinţific, este nevoie ca atât teoria care stă în spatele ei să fie validată, cât şi procedura de intervenţie în sine. De aceea, se propune un ghid de intervenţie pentru psihologii clinicieni, consilieri psihologici şi psihoterapeuţii care lucrează cu persoane cu diabet care să satisfacă în primul rând acest principiu, atât cât este posibil având în vedere cercetările existente în literatura de specialitate. Ghidul va urma elementele principale ale unei proceduri de intervenţie: psihodiagnostic şi evaluare clinică, conceptualizare clinică, relaţie terapeutică şi tehnici de intervenţie.

Psihodiagnostic şi evaluare clinică: utilizarea interviului clinic semi-structurat după DSM-IV sau IDC-10, utilizarea de scale care să măsoare mecanismele psihologice etiopatogenetice generale şi specifice şi care au calităţi psihometrice bune (evidence-based). Scopul evaluării este acela de a stabili un diagnostic nosologic, alţi factori psihologici care influenţează condiţia medicală, precum şi stabilirea unei liste de probleme specifice pentru situaţia de consiliere psihologică sau de psihoterapie specifică.

Conceptualizarea clinică trebuie să răspundă la următoarele întrebări: (1) Ce probleme de natură psihologică sunt (care influenţează factorii medicali)?; (2) De ce au apărut aceste probleme? şi (3) Ce se poate face pentru a remedia aceste probleme?

Relaţia terapeutică este unul din factorii foarte importanţi, care explică până la 30% din mecanismele schimbării psihologice şi presupune câteva caracteristici majore pe care trebuie să le aibă psihologul: empatie, congruenţă, acceptare necondiţionată şi colaborare.

Tehnicile de intervenţie recomandate vor fi în funcţie de categoriile de probleme psihologice care se pot regăsi la pacienţii cu diabet sau obezitate. Acestea vor fi abordate din perspectiva modelelor validate ştiinţific ABC cognitiv şi comportamental; în acelaşi timp, se vor avea în vedere aspectele pozitive şi punctele forte ale pacienţilor. De asemenea, în ceea ce priveşte tulburările psihologice cuprinse în manualele de diagnostic (DSM-IV sau ICD), cum ar fi tulburările depresive, de tip anxios, tulburările de comportament alimentar ghidul va oferi trimiterile necesare spre cele mai eficiente (evidence-based) protocoale de intervenţie existente.

THE PROPOSAL OF A CLINICAL GUIDE FOR THE CLINICAL PSYCHOLOGISTS THAT WORK WITH DIABETIC OR OBESE PATIENTS

1,2Amfiana Gherman, M.A., PhD candidate, 1 Psih. Andreia Mocan 2 Univ. Prof. Daniel David, PhD

1 Clinic of Diabetes, Nutrition and Metabolic Diseases

2 Chair of Clinical Psychology and Psychotherapy, Babeş-Bolyai University

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In order to offer the best and the most efficient treatments, we are based on the principle of evidence-based interventions. Therefore, in order to be scientifically based, a psychological intervention needs to have its theory as well as the intervention protocol tested. As a consequence, we propose an intervention guide for the clinical psychologists, counselors and psychotherapists that work with diabetic and obese persons, that satisfies this criterion, according to the literature. The guide will follow the principal elements of an intervention procedure: the psycho-diagnosis and clinical evaluation, the clinical conceptualization, the therapeutic relationship and the intervention techniques.

Psycho-diagnosis and clinical evaluation : the use of the SCID (Semistructured Clinical Interview after DSM-IV) for investigating depressive, anxiety disorders, and others, the use of scales that measure the general and specific ethio-pathogenetic mechanisms, scales that have good psychometric qualities (are evidence-based). The goal of the evaluation is to establish a nosologic diagnosis, the factors that influence the medical condition and a list of specific problems.

The clinical conceptualization must answer to the following questions: (1) What are the psychological problems that influence the medical factors? (2) Why did these problems appear? (3) What can be done in order to solve these problems?

The therapeutic relationship is one of the most important factors that explain 30% of the psychological mechanisms of change and that implies a few characteristics that the psychologist must have: empathy, congruence, unconditional acceptance and collaboration.

The intervention techniques will be recommended according to the specific psychological problems of the diabetic or obese patients. These problems will be approached with the cognitive and behavioral ABC models; at the same time, the positive characteristics of the patients will be used and reinforced. Regarding the ICD-10 psychological disorders, such as the depressive or anxious disorders, the guide will make the necessary references to the most efficicent (evidence-based) intervention protocols.

CUM ESTE APRECIAT PROGRAMUL GUVERNAMENTAL„CORNUL ŞI LAPTELE" DE CĂTRE ELEVII DE GIMNAZIU DINTR-O ŞCOALĂ DIN

MEDIUL RURAL

Crăciun Anca-Elena*, Streulea Ioana*, Crăciun Cristian-Ioan**, Costiuc Cristina Valentina***, Anca Todoran

*- medic rezident an III diabet zaharat, nutriţie, boli metabolice, Centrul Clinic de Diabet şi Nutriţie Cluj-Napoca; **- medic rezident an IV farmacologie clinică, Cluj-Napoca; ***- medic rezident an III sănătate publică şi management, Cluj-Napoca

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Introducere: Programul guvernamental „ Cornul şi laptele” a fost lansat în 16 septembrie 2002. Iniţial au beneficit de el doar elevii claselor primare. De curând de acest program beneficiază şi elevii de gimnaziu. Material şi metodă: Pentru a afla cât de apreciat este programul guvernamental „Cornul şi laptele” în rândul elevilor de gimnaziu, am aplicat un chestionar elevilor claselor V-VIII ai Şcolii Generale nr.1 din comuna Crişcior, judeţul Hunedoara. Chestionarul a fost aplicat în ultima oră de „Educaţie pentru sănătate” din anul şcolar 2007-2008. Rezultate: Au răspuns la chestionar 85 de elevi, dintre care 27 (31,8%) au fost în clasa a Va, 18 (21,2%) în clasa a VIa, 18 (21,2%) în clasa a VIIa şi 22 (25,8%) în clasa a VIIIa. Dintre aceştia, 39 (45,9%) au fost fete şi 46 (54,1%) au fost băieţi. 60,2% dintre elevii chestionaţi nu manâncă deloc cornul primit prin programul guvernamental, iar 63,8% nu beau laptele sau iaurtul. În ciuda acestor rezultate, mai bine de jumătate dintre elevii chestionaţi (59,5%) sunt încântaţi de ideea de a primi corn şi lapte la şcoală, iar la 3,6% dintre respondenţi le displace această măsură. Mai bine de o treime (37%) ar dori să primească şi altceva pe lângă corn şi lapte sau acestea să fie înlocuite. Dintre propuneri fac parte fructele, eugeniile, biscuiţii, coca-cola, brânza topită, iar în lunile de vară, îngheţata. Aproape 85% dintre copii au zilnic, sau aproape zilnic, pachet la şcoală, iar aproape 88% dintre ei primesc bani să-şi cumpere ce doresc de mâncat sau de băut. Concluzii: În şcoala din mediul rural unde am aplicat chestionarul, 60,2% dintre elevi nu mănâncă deloc cornul primit prin programul guvernamental, iar 63,8% nu beau laptele sau iaurtul. Cu toate acestea, majoritatea copiilor doresc în continuare să primească corn şi lapte la şcoală.

THE EXTENT TO WHICH COUNTRYSIDE SECONDARY SCHOOL CHILDREN APPRECIATE THE GOVERNMENTAL PROGRAM “CROISSANT

AND MILK”

Craciun Anca-Elena*, Streulea Ioana*, Craciun Cristian-Ioan**, Costiuc Cristina Valentina***, Anca Todoran

*resident doctor in Sugar Diabetes, Nutrition and Metabolic Diseases, 3rd year, at the Clinical Centre of Diabetes and Nutrition, Cluj-Napoca;**resident doctor in Clinical Pharmacology, 4th year, Cluj-Napoca; ***resident doctor in Public Health and Management, 3rd year , Cluj-Napoca

Introduction: The governmental program “Croissant and Milk” was launched on September 16, 2002. Initially, only the primary school children benefited from it, but recently, it was introduced to secondary school pupils as well.

Materials and methods: In order to determine the extent to which the governmental program “Croissant and Milk” is appreciated among the secondary school children, we have applied a questionnaire to pupils of 5th-8th grade from the No.1 Secondary School, in Criscior, the district of Hunedoara. The questionnaire was applied during the last “Education for Health” class, at the end of the school year 2007-2008.

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Results: From a total of 85 students who answered the questionnaire, 27(31.8%) were in the 5th grade, 18(21.2%) in the 6th grade, 18(21.2%) in the 7th grade, and 22(25.8%) were in the 8th grade. Among all these 39(45.9%) were girls, and 46(54.1%) were boys. 60.2% from the questioned pupils never eat the croissant given to them through this governmental program, and 63.8% don’t drink the milk or the yoghurt. Despite these results, more than a half of the students who were questioned (59.5%) were delighted by the idea of receiving milk and croissants at school, and 3.6% from those who answered were discontented with this practice. More than one third of the pupils (37%) expressed their wish to get other products together with the milk and the croissant, or, to replace these with something else. Among the suggestions we encountered fruit, Eugenia biscuits, crackers, Coca-Cola, processed cheese, and, during the warm season, ice-cream. Almost 85% of the children have a daily, or almost daily home-packed lunch with them, and almost 88% receive money from their parents in order to buy anything they wish to eat or drink.

Conclusions: In the countryside school where the questionnaire was applied, 62.2% of the pupils never eat the croissant given to them through this governmental program, and 63.8% don’t drink the milk. Despite this fact, the majority of children are still in favor of receiving milk and croissants at school.

DIMENSIUNEA PSIHOLOGICĂ ŞI PSIHOPATOLOGICĂ A SINDROMULUI METABOLIC ŞI A DIVERSELOR SALE COMPONENTE

Anca Frunză*, Radu L. Dumitru**, Prof.Dr. C-tin Ionescu-Tîrgovişte*

*Institutul de Diabet, Nutriţie şi Boli Metabolice „Prof. Dr. N.C. Paulescu”

**Institutul Clinic Fundeni

Scop: Studiul de faţă îşi propune construirea unui profil al pacientului cu sindrom metabolic care să conţină caracteristicile de ordin psihologic şi psihopatologic ale acestuia, profil care să furnizeze datele necesare unui management eficient al bolii şi care să vină în sprijinul abordării terapeutice de către medicii practicieni. De asemenea, studiul işi doreşte stabilirea gradului în care fiecare componentă a sindromului metabolic contribuie la caracteristicile de ordin psihologic şi psihopatologic ale bolnavilor cu sindrom metabolic, în special gradul în care hipertensiunea arterială este implicată în existenţa acestor caracteristici.

Material şi metodă: 30 de pacienţi diagnosticaţi cu sindrom metabolic, internaţi în Institutul de Diabet, Nutriţie şi Boli Metabolice „Prof. Dr. N.C. Paulescu” au fost comparaţi cu 60 de pacienţi hipertensivi şi cu 40 de pacienţi normotensivi. Datele demografice şi clinice, comorbidităţile la momentul internării şi tratamentul urmat au fost obţinute prin anamneză, examen clinic şi investigaţii paraclinice. Pentru evaluarea statusului psihologic am utilizat Symptom Checklist 90, Scala de Evaluare a Depresiei Hamilton, Scala funcţionalităţii globale şi Scala funcţionalităţii sociale.

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Rezultate:26% dintre subiecţii incluşi în studiu au fost diagnosticaţi cu sindrom metabolic. Pacienţii hipertensivi cu sau fără sindrom metabolic au înregistrat scoruri crescute la parametrii psihologici studiaţi, cu rezultate statistic semnificative( p-value<0.05) pentru somatizarea medie, manifestările obsesiv-compulsive şi depresia uşoară. Pacienţii cu sindrom metabolic au demonstrat o funcţionalitate socială şi globală redusă. Dintre diversele componente, hipertensiunea arterială a fost cel mai puternic asociată cu caracteristicile psihologice studiate( B-value între 0.87 şi 3.17; p-value<0.05).Hiperglicemia a fost semnificativ statistic asociată cu anxietatea, somatizarea, depresia şi senzitivitatea. Nivelul HDL-Colesterolului a fost asociat invers proporţional cu anxietatea şi depresia (B= - 2.31 ;şi, respectiv B= - 2.52; p<0.05).

Concluzii: Sindromul metabolic reprezintă o patologie ale cărei implicaţii de ordin psihologic sunt importante şi demne de luat în considerare. Hipertensiunea arterială este principalul determinant al caracteristicilor de ordin psihologic.

PSYCHOLOGICAL AND PSYCHOPATOLOGICAL DIMENSION OF METABOLIC SYNDROME AND ITS COMPONENTS

Anca Frunză*, Radu L. Dumitru**, Prof. Dr. C-tin Ionescu-Tîrgovişte*

*Diabetes, Nutrition and Metabolic Disease „Prof. Dr. N.C.Paulescu” Institute

**Fundeni Clinical Institute

Aim: The aim of our study was to build a psychological and psychopatological profile of hypertensive patients, a profile that can provide imperative data and information for an eficient management of the disease and that is useful to the therapeutical approach.

Another aim of this study was to determine the contribution of each metabolic syndrome component to psychological and psychopatological characteristics, particularly the contribution of hypertension.

Method: 30 patients hospitalised in the „Prof. Dr. N.C Paulescu” Diabetes, Nutrition and Metabolic Disease Institute were compared to 60 hypertensive patients and 40 normotensive patients. Demographic and clinical data, comorbidities and medical treatment before hospitalisation had been obtained through case history, clinical exam and medical investigations. So as to evaluate the psychological status we used Symptom Checklist 90, Hamilton Depression Rating Scale, Global Asset Functioning Scale, Social Functioning Scale.

Results: Of the sample, 26% had metabolic syndrome. Hypertensive patients with or without metabolic syndrome had greater scores for the studied psychological factors, with statistical significance ( p- value<0.05) for medium somatization, obssesive-compulsive symptoms and low depression symptoms. Patients with metabolic syndrome had lower social and global functionality. Of the individual components, hypertension was strongly associated with psychological characteristics ( B-value = 0.87 - 3.17; p-value<0.05). Hyperglycemia was associated with anxiety, somatization, sensitivity and depression.

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HDL-Cholesterol levels were negatively associated with anxiety and depression(B=- 2.31 ; B= - 2.52; p<0.05).

Conclusions: Patients diagnosed with metabolic syndrome often develop depression symptomes and anxiety, but have no particularly psychopatological characteristics. Hypertension is the main contributor to psychological characteristics.

ASOCIEREA DINTRE NIVELUL ACIDULUI URIC ŞI COMPONENTELE SINDROMUL METABOLIC LA PACIENŢII CU DIABET ZAHARAT DE TIP 2

Andrada Mihai1, Iuliana Filip2, Daniela Drăgoescu3, Maria Vlădică1, Constantin Ionescu-Tîrgovişte1

1Institutul de Diabet, Nutriţie şi Boli Metabolice „N. Paulescu”, Bucureşti; 2Secţia Diabet zaharat, Nutriţie şi Boli Metabolice, Spitalul Judeţean Ploieşti, PH; 3Spitalul Clinic CF Witing, Bucureşti

Introducere: Sindromul metabolic (Metsd) reprezintă o agregare de tulburări metabolice interrelaţionate care apar mai frecvent la persoanele insulinorezistente sau hiperinsulinemice şi semnifică risc crescut pentru bolile cardiovasculare. Hiperuricemia este consecinţa unor tulburări metabolice şi se asociază cu hipertensiune arterială, insulinorezistenţă, obezitate şi dislipidemie, însă despre asocierea cu sindromul metabolic există încă multe dezbateri.

Obiective: am examinat asocierea acidului uric seric cu componentele Metsd şi particularităţile acestor asocieri în funcţie de sex la pacienţi cu diabet zaharat de tip 2 (DZ2) şi Metsd (definiţia Adult Treatment Panel III).

Material şi metodă: am analizat, după împărţirea în quartile pentru acidul uric, 310 pacienţi cu DZ2 şi Metsd (194 f/116 b), internaţi în IDNBM „N. Paulescu” cu următoarele caracteristici – medie (±deviaţie standard):

Caracteristica Total Q1 Q2 Q3 Q4

IMC (kg/m2)30.16

(±5.11)28.48

(±4.71)30.23

(±5.00)30.62

(±4.86)31.30

(±5.49)

Circumferinţă abdominală (cm)

102.43 (±12.01)

97.43 (±12.61)

101.54 (±9.90)

103.74 (±12.31)

107.01 (±11.16)

Vârsta (ani)62.16

(±9.30)61.91

(±8.67)62.55

(±9.51)61.21

(±9.37)62.97

(±9.71)

TAS (mmHg) 137.21 130.90 138.44 141.56 138.01

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(±22.71) (±21.69) (±22.23) (±25.03) (±20.79)

HbA1c (%) 9.86 (±2.50)10.42

(±2.41)9.82 (±2.37) 9.97 (±2.61) 9.22 (±2.50)

Colesterol total (mg/dl)

210.15 (±55.14)

197.96 (±46.03)

208.40 (±48.67)

215.25 (±64.80)

219.05 (±57.77)

HDL colesterol (mg/dl)

38.43 (±9.16)

39.31 (±9.51)

38.99 (±9.48)

37.39 (±8.95)

38.01 (±8.74)

Trigliceride (mg/dl)

197.53 (±168.44)

180.81 (±139.82)

199.23 (±203.47)

191.60 (±109.98)

218.42 (±201.86)

Acid uric (mg/dl)

5.52 (±1,93) 3.44 (±0.56) 4.6 (±0.27) 5.81 (±0.42) 8.14 (±1.49)

De asemenea, am împărţit pacienţii în trei grupe în funcţie de numărul de componente ale Metsd îndeplinite şi am comparat nivelul mediu al acidului uric între aceste grupe. Am utilizat Student’s t-test şi Pearson correlation. Nivele ale acidului uric peste 7 mg/dl la bărbaţi si, respectiv, peste 6 mg/dl au fost considerate hiperuricemie.

Rezultate: 26,77% (24,74% f; 30,17% b) din pacienţi au prezentat hiperuricemie. În funcţie de numărul de componente ale Metsd îndeplinite, la cei cu 5 criterii, hiperuricemia a fost mai frecventă (37,23% vs 20,59% la cei cu 3 criterii), dar valoarea medie a acidului uric a fost semnificativ mai mare doar în cazul femeilor (5,74 vs 4,23; p<0,0001). Nivelul acidului uric s-a corelat cel mai bine cu circumferinţa abdomninală şi cu greutatea corporală (r=0.3). Analizând datele pe quartile, diferenţe semnificative statistic s-au înregistrat între prima şi ultima quartilă pentru: circumferinţa abdominală şi greutate (p<0,0001), IMC (p=0,0003), HbA1c (p=0,0014), colesterol total (p=0,006), numărul de criterii ATP III îndeplinite (p=0,03), LDL colesterol (p=0,02), TAS (p=0,01) şi vechimea diabetului (p=0,018).

Concluzii: hiperuricemia este frecventă la pacienţii cu DZ2 şi Metsd. Cel mai adesea se întâlneşte la femeile care întrunesc toate criteriile de definire a sindromului metabolic. Hiperuricemia se corelează puternic cu tulburările metabolice şi hemodinamice prezente la pacienţii cu DZ2 şi Metsd şi poate fi considerată un alt component al Metsd ce necesită mai multă atenţie în viitor.

ASSOCIATION BETWEEN SERUM URIC ACID LEVELS AND THE METABOLIC SYNDROME COMPONENTS IN TYPE 2 DIABETIC PATIENTS

Andrada Mihai1, Iuliana Filip2, Daniela Drăgoescu3, Maria Vlădică1, Constantin Ionescu-Tîrgovişte1

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1Institute of Diabetes, Nutrition and Metabolic Disease “N. Paulescu” Bucharest; 2Dept. of Diabetes, County Hospital Ploieşti; 3Clinical Hospital CF Witing, Bucharest

Background: Metabolic syndrome (MetS) is defined as a cluster of interrelated metabolic disorders more frequently found in persons with insulin resistence or hyperinsulinemia and represents an increased risk for cardiovascular disease. Hyperuricemia is associated with hypertension, insulin resistance, obesity and hyperlipidemia, but the association with the syndrome is still under debate.

Aims: We examined the associations of serum uric acid (UA) with MetS components and the sex-differences of these associations in type 2 diabetic patients with metabolic syndrome (Adult Treatment Panel III criteria).

Material and methods: the study is cross-sectional comprising 310 in-patients with T2DM and MetS (194 w/116 m), with the characteristics - mean (± standard deviation) presented in table.

Characteristic Total Q1 Q2 Q3 Q4

BMI (kg/m2)30.16

(±5.11)28.48

(±4.71)30.23

(±5.00)30.62

(±4.86)31.30

(±5.49)

Waist circumference (cm)

102.43 (±12.01)

97.43 (±12.61)

101.54 (±9.90)

103.74 (±12.31)

107.01 (±11.16)

Age (years)62.16

(±9.30)61.91

(±8.67)62.55

(±9.51)61.21

(±9.37)62.97

(±9.71)

SBP (mmHg)137.21

(±22.71)130.90

(±21.69)138.44

(±22.23)141.56

(±25.03)138.01

(±20.79)

HbA1c (%) 9.86 (±2.50)10.42

(±2.41)9.82 (±2.37) 9.97 (±2.61) 9.22 (±2.50)

Total cholesterol (mg/dl)

210.15 (±55.14)

197.96 (±46.03)

208.40 (±48.67)

215.25 (±64.80)

219.05 (±57.77)

HDL cholesterol (mg/dl)

38.43 (±9.16)

39.31 (±9.51)

38.99 (±9.48)

37.39 (±8.95)

38.01 (±8.74)

Triglycerides (mg/dl)

197.53 (±168.44)

180.81 (±139.82)

199.23 (±203.47)

191.60 (±109.98)

218.42 (±201.86)

Uric acid (mg/dl) 5.52 (±1,93) 3.44 (±0.56) 4.6 (±0.27) 5.81 (±0.42) 8.14 (±1.49)

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Different components of MetS were compared by quartiles of UA. We also compared mean UA levels among 3 groups defined on number of MetS components. Student’s t-test, Pearson correlation were used. Hyperuricemia was defined as >7 mg/dl in men and >6 mg/dl in women.

Results: 26.77% (24.74% w; 30.17% m) of patients presented hyperuricemia. Analyzing data for the number of MetS components fulfilled, in those with 5 criteria hyperuricemia was more frequent (37.23% vs. 20.59% in those with 3 criteria), but the mean UA value was significantly higher only in women (5.74 vs. 4.23; p<0.0001). UA levels correlated best with waist circumference and body weight (r=0.3). When analyzing data for UA quartiles, significant statistical differences were recorded between the first and the last quartile for: waist circumference and body weight (p<0.0001), BMI (p=0.0003), HbA1c (p=0.0014), total cholesterol (p=0.006), the number of ATP III criteria that were fulfilled (p=0.03), LDL cholesterol (p=0.02), SBP (p=0.01) and diabetes duration (p=0.018).

Conclusions: hyperuricemia is frequent in patients with type 2 diabetes and MetS. Women fulfilling all MetS criteria were most likely to have hyperuricemia. Hyperuricemia is strongly correlated with metabolic and hemodynamic disorders found in T2DM and MetS and might be a considered another component of MetS that needs more attention in the future.

RELAŢIA DINTRE DEPRESIE, ANXIETATE ŞI CREDINŢELE RAŢIONALE ŞI IRAŢIONALE PRIVIND MENŢINEREA CONTROLULUI ASUPRA VALORII

GLICEMICE

A.S. Mocan

Centrul de Diabet, Nutriţie şi Boli Metabolice Cluj-Napoca

Obiectivul acestui studiu este analiza relaţiei existente între credinţele raţionale şi iraţionale privind menţinerea glicemiei între valorile normale recomandate de medici şi apariţia depresiei şi a anxietăţii.

Astfel a fost elaborata o scală de 8 itemi conform modelului teoriei raţional-emotive al lui Albert Ellis. Din totalul de 8 itemi ai scalei, 4 itemi vizează credinţele iraţionale ce privesc evaluarea globala a propriei persoane sau a altora, catastofarea situaţiei, toleranta scăzută la frustrare şi trebuie cu necesitate, iar 4 itemi oferă varianta raţională a acestor gânduri. In ceea ce priveşte depresia s-a utilizat Chestionarul Depresiei (BDI) elaborat de A.T.Beck, iar pentru anxietate s-a folosit chestionarul STAI cu cele două forme ale sale, de evaluare a anxietăţii persoanei în momentul completării şi de evaluarea a anxietăţii generalizate.

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Subiecţii, in număr de 30, au fost selectaţi pe baza de voluntariat din cadrul ambulatorului şi a secţiei cu persoane internate a Centrului de Diabet si Boli de Nutriţie Cluj. Pe lângă datele demografice am fost interesaţi şi dacă persoana se automonitorizează, frecvenţa acestui comportament, care a fost valoarea ultimei glicemii şi a ultimei glicemii glicozicate, precum şi de tipul tratamentului pe care persoana îl urmează (terapie orala sau terapie cu insulină).

Din analiza datelor reiese existenţa unei corelaţii între depresie şi gândurile iraţionale pe de-o parte şi între gândurile iraţionale şi anxietate pe de altă parte.

Cuvinte cheie: credinţe iraţionale, credinţe raţionale, depresie, anxietate

RELATIONSHIP BETWEEN DEPRESSION, ANXIETY AND RATIONAL, IRRATIONAL BELIEFS ABOUT CONTROLLING THE GLYCAEMIC VALUES

A.S. MocanDiabetes, Nutrition and Metabolic Clinic-Napoca

The aim of this study is to analyze the relationship between rational and irrational beliefs about controlling the glycaemic values recommended by the physicians and the their influence regarding depression and anxiety.

An 8-item scale was elaborated based on A. Ellis’s rational-emotional model. From this 8 items, 4 of them refer to irrational beliefs (global evaluation, low frustration tolerance, self downing and awfulising) and four of them refer to rational beliefs. Depression was evaluated with The Beck Depression Inventory and for anxiety was used the State and Trait Anxiety Inventory.

The subjects, 30 of them, were selected from outpatient department and inpatient department of Diabetes, Nutrition and Metabolic Clinic. We used demographical and personal data like the frequency of glycaemic recording, last glycemia and HbA1c, type of treatment (insulin therapy or oral therapy).

The data analysis revealed a correlation between depression and irrational beliefs and one between anxiety and irrational beliefs.

Key words: irrational beliefs, rational beliefs, depression, anxiety.

INTERVENŢIE PRIVIND MENŢINEREA CONTROLULUI VALORII GLICEMICE

A.S.Mocan, A.Gherman

Centrul de Diabet, Nutriţie şi Boli Metabolice Cluj-Napoca

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Scopul acestei intervenţii este controlul valorilor glicemice prin modificarea stilului de viaţă. Astfel intervenţia durează o perioadă de o lună şi jumătate, cu 9 întâlniri, cu caracter săptămânal. Fiecare şedinţă de terapie durează între 60 - 90 de minute, mai puţin prima şedinţă, care este de cunoaştere a pacientului şi care durează două ore. La această intervenţie pot participa persoanele cu diabet, indiferent de tratamentul pe care-l urmează, intervenţia fiind de fapt o optimizare a stilului de viaţă.

Intervenţia se desfăşoară pe module. Astfel în funcţie de nevoile pacientului se poate renunţa la unul din module. Modulul I se referă la regularizarea meselor şi la un regim alimentar sănătos. Modulul II este adresat creşterii exerciţiului fizic. Modulul III este adresat persoanelor care doresc să reducă numărul ţigărilor sau să renunţe definitiv la fumat. Pe tot parcursul intervenţiei se automonitorizează glicemia dorindu-se creşterea numărului de măsurători a acesteia. De asemenea, pacientul este învăţat să-şi stabilească scopuri reale şi posibile, să aibă aşteptări realiste de la modificările pe care le doreşte. Pe lângă strategiile comportamentale sunt folosite şi tehnici de restructurare cognitivă care să ajute pacientul în depăşirea barierelor mentale pe care le are referitoare la modificările ce urmează a fi făcute.

La finalul intervenţiei se urmăreşte introducerea unei modificări pe termen lung a stilului de viaţă mai degrabă decât o modificare de moment.

Cuvinte cheie: monitorizare glicemică, alimentară, reducerea fumatului, intensificarea activităţii fizice.

INTERVENTION REGARDING THE CONTROL OF THE GLYCAEMIC VALUES

A.S.Mocan, A.Gherman

Diabetes, Nutrition and Metabolic Clinic Cluj-Napoca

The aim of this intervention is to control the glaycaemic values through changing the life style. The intervention is scheduled for 9 weekly sessions. Each session lasts between 60 and 90 minutes except the first one, which lasts for two hours. At this intervention there can participate diabetes patients with no regard of the treatment they are following (insulin or oral therapy); in fact this intervention aims a change in the patient’s life style.

The therapy is modular so, regarding the needs of the patient, we can skip a module. Module I targets a healthier eating behavior, module II targets the increase of the physical activity and module III referrs to smoking cessation. During the intervention we encourage the patients to record their glycaemias and to increase the frequency of this behavior. The patient learns to establish real and touchable objectives and to have realistic expectations from the life style modifications. Beside behavioral strategies the

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patient learns also cognitive techniques to overcome the possible mental obstacles regarding the changes from his life.

In the end of the intervention we try to establish a long-term change in the life style.

Key words: glaycaemia and food records, smoking cessation, increasing physical activity.

STATUSUL ACTUAL AL GLUCOZEI LA PERSOANELE CU DIABET ZAHARAT TIP 1 ŞI TIP 2

Andreea Moroşanu1, Gabriela Roman1,2, Mihaela Gribovschi1,3, Cristina Niţă1,2, Nicolae Hâncu1,2,3

1Centrul Clinic de Diabet, Nutriţie şi Boli metabolice Cluj-Napoca, 2Universitatea de Medicină şi Farmacie “Iuliu Haţieganu” Cluj-Napoca, 3 Centrul Medical Moţilor Cluj-Napoca

Introducere. Monitorizarea continuă a glucozei (MCG) este o metodă recentă care furnizază date extensive privind statusul actual al glucozei la persoanele investigate, prin determinarea procentului ariei de sub curbă (%ASC) – care defineşte expunerea glicemică - şi a mediei valorilor glucozei (MVG) atât pentru valorile încadrate în limitele stabilite, cât şi pentru cele situate în afara obiectivelor. De asemenea, MCG permite cuantificarea variabilităţii glucozei exprimată prin amplitudinea medie a excursiilor glucozei (MAGE), parametru care influenţează stresul oxidativ şi riscul de complicaţii cronice ale diabetului.

Obiectiv. Scopul acestui studiu a fost evaluarea comparativă prin MCG a statusului glucozei la persoanele cu diabet zaharat (DZ) tip 1, comparativ cu persoanele cu DZ tip 2.

Material şi metodă. Studiul a cuprins 55 de persoane: 24 cu DZ tip 1, 31 cu DZ tip 2, cu vârsta medie 43.69 ani (11-88), cu durata medie a diabetului de 9.86 ani (0-31), 29 femei şi 26 bărbaţi; 16 persoane au urmat tratament cu antidiabetice orale, iar 39 persoane au fost tratate cu insulină. Distribuţia valorilor glucozei fost evaluată prin determinarea %ASC şi a MVG pe domenii glicemice (< 70 mg/dl, > 180 mg/dl, 70-180 mg/dl şi 90-130 mg/dl). De asemenea, am evaluat variabilitatea glucozei prin intermediul MAGE, calculat pe baza datelor MCG şi am dozat hemoglobina glicată A1c (A1c), în vederea comparaţiei cu datele MCG. MCG a fost efectuată prin intermediul Continuous Glucose

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Monitoring System (CGMS, Minimed Medtronic) Analiza statistică a fost efectuată cu programul SPSS 13.0.Semnificaţia statistică a fost atinsă pentru p<0.05.

Rezultate. A1c a fost 8.33 ± 1.75% (medie ± deviaţie standard,DS) - întregul grup studiat, 8.69 ± 1.84% - DZ tip 1 şi 8.05 ± 1.65% - DZ tip 2 (p>0.05 DZ tip 1 vs. DZ tip 2). MAGE a fost 122.55 ± 47.22 mg/dl – întregul grup, 156.38 ± 34.00 mg/dl - DZ tip 1 şi 96.38 ± 38.79 mg/dl - DZ tip 2, diferenţă care a fost semnificativă statistic (p<0.001, DZ tip 1 vs DZ tip 2). Distribuţia valorilor glucozei a fost următoarea (*p<0.05, DZ tip 1 vs.DZ tip 2):

Distribuţia valorilor glucozei (medie±DS)

< 70 mg/dl >180 mg/dl 70-180 mg/dl 90-130 mg/dl

Total %ASC 1.60 ± 3.04 46.88 ± 29.99 51.50 ± 29.37 21.42 ± 22.00

DZ tip 1 %ASC 2.43 ± 3.95* 57.42 ± 20.16* 40.15 ± 18.59* 13.24 ± 8.98

DZ tip 2 %ASC 0.97 ± 1.96* 38.74 ± 33.91* 60.29 ± 33.25* 27.77 ± 26.72

Total MVG (mg/dl) 60.39 ± 5.00 226.77 ± 27.01 132.63 ± 17.67 112.48 ± 4.98

DZ tip 1 MVG (mg/dl) 58.85 ± 4.59* 235.43 ± 25.91*

132.12 ± 15.26 111.90 ± 4.22

DZ tip 2 MVG (mg/dl) 62.73 ± 4.86* 219.09 ± 26.07*

133.06 ± 19.65 112.98 ± 5.59

A1c a fost corelată direct cu MAGE per total şi în DZ tip 2, însă nu şi în DZ tip 1. A1c a fost direct corelată cu ASC total, %ASC > 180 mg/dl, MVG totală, MVG > 180 mg/dl. A1c a fost invers corelată cu %ASC între 70-180 mg/dl, % ASC între 90-130 mg/dl atât pentru întregul grup, cât şi pe subgrupurile cu DZ tip 1 şi tip 2 (p<0.05).

MAGE a fost corelată direct cu ASC total, %ASC > 180 mg/dl, MVG totală, MVG > 180 mg/dl şi a fost invers corelată cu % ASC 70-180 mg/dl şi % AUC 90-130 mg/dl per total şi în DZ tip 2 (p<0.05). În DZ tip 1, MAGE a fost corelată direct cu %ASC > 180 mg/dl şi MVG > 180 mg/dl (p<0.05). Acurateţea senzorului de glicemie a fost 94,44% pentru toate cazurile studiate.

Discuţii. MAGE a fost mai mare decât valoarea normală de 40 mg/dl pentru tot grupul studiat, dar şi pe subgrupuri. Subiecţii cu DZ tip 1 au avut MAGE semnificativ mai mare decât cei cu DZ tip 2 (p<0.001), chiar dacă grupurile nu au fost diferite din punctul de vedere al A1c.

Persoanele cu DZ tip 1 au avut expunerea glicemică la hipoglicemie şi hiperglicemie semnificativ mai mari decât persoanele cu DZ tip 2. Media valorilor hipoglicemice a fost semnificativ mai mică, în timp ce media valorilor hiperglicemice a fost semnificativ mai mare în DZ tip 1 comparativ cu DZ tip 2, fapt explicat şi de variabilitatea glicemică mai mare în DZ tip 1. Subiecţii cu DZ tip 2 au avut o expunere semnificativ mai mare la normoglicemie faţă de cei cu DZ tip 1.

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A1c a fost corelată cu MAGE, indicând o relaţie directă liniară între dezechilibrul glicemic şi variabilitatea valorilor glucozei, per total şi în DZ tip 2. A1c şi MAGE au fost corelate direct cu expunerea şi amplitudinea hiperglicemiei (per total şi separat pentru DZ tip 1 şi tip 2) şi invers cu expunerea şi amplitudinea normoglicemiei în DZ tip 1 (numai pentru A1c), în DZ tip 2 şi per total (A1c şi MAGE). Nu s-a observat o relaţie semnificativă între A1c, MAGE şi expunerea şi amplitudinea hipoglicemiei.

Concluzii. La acelaşi nivel al A1c, echilibrul glicemic al persoanelor cu DZ tip 1 este mai precar, necesitând o intervenţie intensiva atât din partea medicului cat si a persoanei cu diabet. MCG a facilitat evidenţierea unor diferenţe semnificative ale statusului glicemic la persoanele cu DZ tip 1 şi tip 2 oferind oportunitatea identificării măsurilor terapeutice adecvate în vederea optimizării controlului glicemic.

Studiul actual a fost finanţat prin Grantul CNCSIS Td 472/2006-2007.

CURRENT GLUCOSE STATUS IN PERSONS WITH TYPE 1 AND TYPE 2 DIABETES

Andreea Moroşanu1, Gabriela Roman1,2, Mihaela Gribovschi1,3, Cristina Niţă1,2, Nicolae Hâncu1,2,3

1Clinical Center of Diabetes, Nutrition and Metabolic Diseases Cluj-Napoca, 2“Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca, 3 Moţilor Medical Center Cluj-Napoca

Background. Continuous glucose monitoring is a recent evaluation method of glucose excursions that provides comprehensive data about current glucose status, measuring parameters like percent of area under the curve (%AUC) – defining glucose exposure - and mean glucose values (MGV) below, above and between target limits. It also allows the quantification of glucose variability expressed by mean amplitude of glucose excursions (MAGE) known to directly influence oxidative stress and further diabetes chronic complications.

Aims. We aimed to investigate the differences in current glucose status between type 1 diabetes (T1D) and type 2 diabetes (T2D) persons evaluated by continuous monitoring of interstitial glucose values (CGM).

Material and Methods: We assessed 55 persons: 24 with type 1 diabetes (T1D), 31 with type 2 diabetes (T2D), with mean age of 43.69 years (11-88), with mean diabetes duration of 9.86 years (0-31); 29 women, 26 men; 16 orally treated; 39 insulin treated. Glucose distribution was assessed by %AUC and MGV on glucose domains (< 70 mg/dl, > 180 mg/dl, 70-180 mg/dl and 90-130 mg/dl); glucose variability was assessed by MAGE. We evaluated glycated haemoglobin A1c (A1c) for all study subjects, for comparison with CGM data. CGM was performed by Continuous Glucose Monitoring

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System (CGMS, Minimed Medtronic). Statistical analysis was effectuated with SPSS 13.0 program. Statistical significance was reached for p<0.05.

Results: HbA1c was 8.33 ± 1.75% (mean ± SD) - the entire group, 8.69 ± 1.84% -T1D and 8.05 ± 1.65% -T2D (p>0.05, T1D vs. T2D). MAGE was 122.55 ± 47.22 mg/dl (mean ± SD) - the entire group, 156.38 ± 34.00 mg/dl -T1D and 96.38 ± 38.79 mg/dl - T2D (p<0.001 T1D vs. T2D). Glucose values distribution was:

Glucose values distribuiton

(mean±SD)

< 70 mg/dl >180 mg/dl 70-180 mg/dl 90-130 mg/dl

All %AUC 1.60 ± 3.04 46.88 ± 29.99 51.50 ± 29.37 21.42 ± 22.00

T1D %AUC 2.43 ± 3.95* 57.42 ± 20.16* 40.15 ± 18.59* 13.24 ± 8.98

T2D %AUC 0.97 ± 1.96* 38.74 ± 33.91* 60.29 ± 33.25* 27.77 ± 26.72

All MGV (mg/dl) 60.39 ± 5.00 226.77 ± 27.01 132.63 ± 17.67 112.48 ± 4.98

T1D MGV (mg/dl) 58.85 ± 4.59* 235.43 ± 25.91*

132.12 ± 15.26 111.90 ± 4.22

T2D MGV (mg/dl) 62.73 ± 4.86* 219.09 ± 26.07*

133.06 ± 19.65 112.98 ± 5.59

*P<0.05 (T1D vs.T2D)

HbA1c was positively correlated with MAGE in the entire group and in T2D, but not in T1D. HbA1c was positively correlated with total AUC, with % AUC > 180 mg/dl, total MGV, MGV >180 mg/dl. HbA1c was inversely correlated with %AUC 70-180 mg/dl, %AUC 90-130 mg/dl in the entire group as well as in T1D and T2D subgroups. (p<0.05)

MAGE was positively correlated with total AUC, with %AUC > 180 mg/dl, total MGV, MGV >180 mg/dl and inversely correlated with %AUC 70-180 mg/dl and %AUC 90-130 mg/dl in the entire group and in T2D (p<0.05). MAGE was positively correlated with %AUC > 180 mg/dl and MGV > 180 mg/dl in T1D. Sensor overall accuracy was 94.44% for all the study cases.

Discussions. A1c showed a poor glucose control in both T1D and T2D persons. MAGE was higher than normal value (40 mg/dl), in the whole group and in T1D and T2D subgroups. T1D subjects had significantly higher MAGE than those with T2D (p<0.001), even if A1c did not differ between the two subgroups.

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T1D persons had significantly higher exposure to hypoglycemia and hyperglycemia than T2D subjects. MGV for hypoglycemia was significantly lower and MGV for hyperglycemia was significantly higher in T1D persons compared with T2D ones, this fact being explained by the higher glucose variability in T1D individuals. Conversely, T2D subjects had significantly higher exposure to normoglycemia.

A1c was correlated with MAGE which showed a direct linear relation between poor glucose control and glucose variability in T2D and per total. A1c and MAGE were directly correlated with hyperglycemic exposure and amplitude (in the entire group and in T1D and T2D subgroups) and inversely correlated with normoglycemic exposure and amplitude in T1D subgroup (only for A1c) and in T2D and the whole group (for A1c and MAGE). It wasn’t evident any relation between A1c, MAGE and hypoglycemic exposure and amplitude.

Conclusions. At a similar A1c level, T1D persons had a poorer glucose control emphasizing the need for more intensive approach from both physician and patient sides. CGM marked out significant differences in glucose status between T1D and T2D persons allowing further identification of the specific therapeutic changes for optimizing glucose control

Acknowledgements: Current Research was supported by a Romanian Grant for Young Researchers: Grant CNCSIS Td 472/2006-2007.

OBEZITATEA – FACTOR DE PROTECŢIE ÎN OSTEOPOROZĂ

Andreescu Georgeta*, Dincă Mihaela Eugenia*, Petrisor C.A.**, Petrisor Iuliana Eugenia***

*U.M.F. Craiova – Disciplina Boli Nutritie si Metabolism

**U.M.F. Craiova – Disciplina Medicină Internă

*** Medic rezident endocrinologie – Spital Universitar de Urgentă Craiova

Obezitatea şi osteoporoza sunt două boli frecvente şi complexe. Amândouă au etiologie multifactorială, incluzând factori genetici şi de mediu cu potenţial de interacţiune. Existenţa unei relaţii între obezitate şi densitatea masei osoase a fost studiată în numeroase studii epidemiologice, cu rezultate pro şi contra asupra obezităţii ca factor de protecţie faţă de osteoporoză. Câteva mecanisme par a fi implicate , cum ar fi: efectul mecanic al greutăţii suportate de musculatură, creşterea transformării androgenilor în estrogeni la nivelul ţesutului adipos, scăderea legării hormonilor sexuali de globulină cu o rată mai mare a formelor libere a hormonilor sexuali, creşterea nivelului de leptină serică, scăderea sintezei de IGF la nivelul ficatului şi scheletului, hiperinsulinemia şi insulinorezistenţa. Estrogenul este un hormon activ pe sistemul osos care creşte în obezitate. Ţesutul adipos transformă androstendionul în estronă prin aromatizare şi acesta reprezintă principala sursă a estrogenului la femeia aflată în postmenopauză, mai degrabă decât secreţia ovariană sau adrenală. Activitatea de aromatizare de la nivelul celulelor

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stromale adipoase este crescută în funcţie de vârstă, fiind mai mare la femeia aflată în postmenopauză faţă de premenopauză. Astfel, creşterea producţiei de estrogen al femeilor aflate în postmenopauză este datorată numărului mare de celule adipose şi activităţii crescute de aromatizare. Există studii care au demonstrat că androgenul adrenal DHEA este convertit la estronă la nivelul osteoblaştilor de către aromataza P450, iar acest fapt contribuie la menţinerea masei osoase în decada a şasea şi a şaptea de viaţă.

La femeia obeză aflată în postmenopauză scade riscul de fractură datorită ritmului mai scăzut de pierdere osoasă. Consecinţa acestui fapt este o rată mai mică a fracturilor osteoporotice, în special la nivelul capului femural.

OBESITY –PROTECTION FACTOR IN OSTEOPOROSIS

Obesity and osteoporosis are two frecvent and complex diseases. Both have a multifactorial etiology, including genetic and environmental factor with interaction potential. An existing relationship between obesity and bone mass density was studied in several epidemiological studies, with different results regarding obesity as a protection factor for osteoporosis. Several mechanisms seems to be responsible: the mechanic effect of weight supported by muscles, the rise of transformation from androgen to estrogen hormones in adipous tissue, the decline of binding of sexual hormones to globuline, with a higher rate of free sexual hormones development, the rise of seric leptin levels, decline of IGF synthesis in liver and bones, hyperinsulinemia and insulin resistance. The estrogen is an active hormone on bone tissue and rises in obesity. The adipose tissue transform androstendion in estrone through aromatization and this is the main source of estrogen at the postmenopause women, rather than ovarian or adrenal secretion. The aromatization activity from stromal adipous cells depends on age, being higher at the postmenopausal women then premenopausal ones. Thus, the rise of estrogen production at postmenopausal women is due to the increased number of adipous cells and aromatization activity. There are studies that demonstrated that DHEA adrenal androgen is converted to estrone in osteoblasts by P450 aromatase making possible the conservation of bone mass at women in sixth and seventh decade.

At obese postmenopausal women the risk of fracture is lower due to decreased rate of bone loss. The result is a lower rate of osteoporothyc fractures specially at the femoural head.

ROLUL OSTEOPROTEGERINEI ÎN REMODELAREA OSOASĂ

Dincă Mihaela Eugenia*, Andreescu Georgeta*, Petrisor C.A.**, Petrisor Iuliana Eugenia***

*U.M.F. Craiova – Disciplina Boli Nutritie si Metabolism

**U.M.F. Craiova – Disciplina Medicină Internă

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*** Medic rezident endocrinologie – Spital Universitar de Urgentă Craiova

Integritatea sistemului osos necesită numeroase mecanisme de reglare. Recent, s-au evidenţiat date noi despre remodelarea osoasă şi cauzele care conduc la apariţia celei mai comune boli metabolice osoase, osteoporoza, a cărei incidenţa este în creştere marcată. Dezvoltarea osteoclastelor mature depind de interacţiunea corespunzatoare cu celulele liniei osteoblastice. Astfel, este necesară interacţiunea RANKL (Receptor Activator of Nuclear Factor Kappa B Ligand) secretat de osteoblaste cu RANK (Receptor Activator of NFkB) de pe suprafaţa precursorilor osteoclastici. Această interacţiune poate fi blocată de osteoprotegerina (OPG), o glicoproteină membră a superfamiliei TNF receptor. OPG funcţionează ca un receptor capcană pentru RANKL, competiţionând cu RANK pentru legarea de RANKL şi dovedindu-se astfel un inhibitor important al maturării şi activării osteoclastelor in vivo şi in vitro Mai multe studii au dovedit că nivelurile serice ale OPG cresc semnificativ cu vârsta atât la bărbaţi, cât şi la femei, fiind un mecanism protectiv al scheletului menit să compenseze creşterea resorbţiei osoase şi a pierderii de os. OPG poate preveni reducerea osoasă, fiind o valoare potenţială în tratamentul osteoporozei.

THE ROLE OF OSTEOPROTEGERIN IN BONE REMODELATION

The integrity of the bone tissue depends on numerous regulation mechanisms. Recently, new data about the bone remodelling and also new causes of the most common bone metabolic disease are available. The development of mature osteoclasts depend on the right interaction with the osteoblastic cell line. Thus, the interaction of RANKL (Receptor Activator of Nuclear Factor Kappa B Ligand)secreted by RANK osteoblasts (Receptor Activator of NFkB)is necessary. This interaction can be blocked by osteoprotegerin (OPG), a glycoprotein from the TNF receptor family. OPG works like a „trap” receptor for RANKL, competing with RANK for the binding with RANKL and proving to be an important inhibitor of osteoclasts maturation and activation in visvo and in vitro. Many studies showed that seric levels of OPG rise significantly with age at men and woman, this being a protective mechanism of the skeleton, meant to compensate the growth of bone resorbtion and bone loss. OPG can prevent bone loss, with potential value in osteoporosis treatment.

DIABETUL ZAHARAT, MODEL DE BOALA PSIHOSOMATICABianca Andreica1, Mariana Andreica2

1- Clinica Psihiatrie Pediatrica2- Clinica Pediatrie IICluj-Napoca

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Diabetul zaharat este o boală cronică metabolică, cauzată de deficienţa absolută sau relativă de insulină.

Cei mai mulţi cercetători au găsit următoarele variabile psihosociale ca fiind implicate în apectele psihosomatice ale diabetului :1) depresia, anxietatea, frica de hipoglicemie 2) deficitul cognitiv, 3) stresul, evenimente stresante de viaţă, 4) mecanisme de coping, 5) percepţia personală asupra bolii, 6) trăsături de personalitate, 7) suport social, incluzând familia, 8) calitatea relaţiei medic-pacient, 9)variabile socio-demografice, venit, educaţia, dizabilităţile date de diabet.

Lucrarea prezenta este un studiu de caz al unei adolescente in varsta de 18 ani, aflata in ultimul an de liceu, afectata de examenul de bacalaureat care o asteapta si de iminenta plecarii mamei in strainatate.

Stresul generat de aceste doua evenimente, coroborat cu despartirea de prietenul sau au determinat aparitia unui tablou clinic caracterizat prin fatigabilitate, senzatia de lesin.

Examinarile paraclinice au depistat hiperglicemie si testul de toleranta la glucoza crescut.

Cazul a fost interpretat ca si Diabet zaharat tip 2 si s-a impus urmarea unei diete si tratament medicamentos specific. Aflarea acestui diagnostic si consecintele sale au determinat dezvoltarea la adolescenta a unui Sindrom posttraumatic de stres. A refuzat medicatia, chiar si pe cea homeopata. A urmat inconstant sedinte de psihoterapie cognitive comportamentala si a inceput sa participe mai des la slujbe religioase. Dupa o luna, la control s-a depistat normalizarea parametrilor biochimici.

Cuvinte cheie: diabet zaharat, factori psihosociali, PTSD

DIABETTES MELLITUS – MODEL FOR PSYCHOSOMATIC DISEASE

Diabetes mellitus is a chronic metabolic disorder caused by an absolute or relative deficiency of insulin.The most frequent psychosocial variables found in diabetes are: 1) depression, anxiety, 2) cognitive deficits, 3) stress, 4) coping mechanisms, 5) temperament and character, 6) family and friends’ support, 7) socio-demographic variables.

The present paper is a case study of a 18 years old girl, in the last high-school year, affected by the forthcoming graduation exam and by the imminence of her mother’s departure abroad. The stress generated by these two events, corroborated with the separation from her boyfriend determined the apparition of a simptomatology, caracterised by fatigability, and the sensation of faint. The paraclinical examinations discovered hyperglycemia and the glucose tolerance test increased. The case was interpreted as diabetes mellitus type 2, and a diet and specific drug cure was imposed. This diagnosis and its consequences determined the onset of a posttraumatic stress syndrome. The patient refused medication, even if it was homeopathic. She followed

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inconstant behavioral cognitive psychotherapy sessions and began to attend more often religious masses. Two months after the examination, the normalization of biochemical parameters was discovered.

Key words: diabetes, psychosocial factors, PTSD

EVALUAREA AFECTĂRII RENALE LA PACIENŢII CU DIABET ZAHARAT TIP 1 DIN CENTRUL CLINIC DE DIABET, NUTRIŢIE, BOLI METABOLICE

IAŞI

Bogdan Mihai1,2, Cristina Lăcătuşu1,2, Roxana Ştefan2, Laura Mihalache1,2, Delia Vîtcă2, Mariana Graur1,2

1Universitatea de Medicină şi Farmacie „Gr. T. Popa” Iaşi

2Centrul Clinic de Diabet, Nutriţie, Boli Metabolice Iaşi

Scopul lucrării: am efectuat un studiu retrospectiv, observaţional, transversal, pentru a aprecia prevalenţa şi severitatea afectării renale la pacienţii cu diabet zaharat tip 1 aflaţi în evidenţa Centrului Clinic de Diabet, Nutriţie, Boli Metabolice Iaşi.

Material şi metodă: am evaluat toţi pacienţii adulţi cu diabet zaharat tip 1 aflaţi în evidenţa centrului nostru până la data de 01.01.2007. Din analiza fişelor de monitorizare, luând în considerare doar datele din ultimii doi ani, am selectat informaţiile referitoare la vârstă, sex, vechimea bolii, eliminările urinare de proteine şi clearance-ul de creatinină, care au fost înregistrate într-o bază de date Microsoft Office Excel şi supuse ulterior prelucrării statistice folosind programele SPSS.

Rezultate şi discuţii: Din totalul de 1072 pacienţi, după excluderea celor cu vârsta sub 18 ani şi a celor cu patologie terminală de organ (care ar fi putut falsifica analiza statistică a datelor de laborator), am selectat un lot de 994 pacienţi. Am constatat o preponderenţă a sexului masculin (553 cazuri – 55,6%) şi o vârstă medie de 43,58±13,66 ani, cu variaţii între 18 şi 84 de ani. Vechimea diabetului zaharat tip 1 a variat între 1 şi 49 de ani, cu o medie de 11,02±9,05 ani. 305 pacienţi (30,7% din totalul cazurilor) aveau determinate semicantitativ sau cantitativ eliminările urinare de proteine în ultimii 2 ani; dintre aceştia, majoritatea erau normoalbuminurici (48,2%), 24,6% prezentau microalbuminurie şi 27,2% macroalbuminurie. La 817 pacienţi (82,2% din totalul cazurilor) au fost disponibile datele necesare pentru calculul clearance-ului de creatinină (ClCr) conform formulei Cockcroft-Gault; 39,8% dintre aceşti pacienţi prezentau afectare renală (ClCr < 90 ml/min): 29,99% – ClCr = 60-90 ml/min, 7,22% – ClCr = 30-60 ml/min, 0,86% – ClCr = 15-30 ml/min, 1,71% – ClCr < 15 ml/min. Valoarea clearance-ului de creatinină a fost semnificativ statistic mai mică la pacienţii cu macroalbuminurie comparativ cu cei cu normoalbuminurie şi cu microalbuminurie. S-a constatat o preponderenţă a sexului masculin în grupul cu eliminări urinare crescute de proteine (65,1% bărbaţi vs. 34,9% femei cu macroalbuminurie), însă fără a atinge pragul semnificaţiei statistice. Pacienţii cu

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o vechime mai mare a bolii prezentau mai frecvent eliminări urinare crescute de proteine şi valori scăzute ale clearance-ului de creatinină, cu diferenţe semnificative statistic între grupurile menţionate.

Concluzii: Peste 50% din cazurile evaluate aveau eliminări urinare crescute de proteine şi aproximativ 40% dintre pacienţi prezentau o rată scăzută de filtrare glomerulară evidenţiată prin determinarea clearance-ului de creatinină. Valoarea clearance-ului de creatinină a fost semnificativ statistic mai mică la pacienţii cu macroalbuminurie comparativ cu cei cu normoalbuminurie şi cu microalbuminurie. În grupul cu eliminări urinare crescute de proteine s-a constatat o prevalenţă crescută a sexului masculin. Pacienţii cu o vechime mai mare a bolii prezentau mai frecvent eliminări urinare crescute de proteine şi valori scăzute ale clearance-ului de creatinină.

RENAL FUNCTION IN TYPE 1 DIABETIC PATIENTS IN CLINICAL CENTRE OF DIABETES, NUTRITION, METABOLIC DISEASES IAŞI

Bogdan Mihai1,2, Cristina Lăcătuşu1,2, Roxana Ştefan2, Laura Mihalache1,2, Delia Vîtcă2, Mariana Graur1,2

1The University of Medicine and Pharmacy „Gr. T. Popa” Iaşi

2The Clinical Centre of Diabetes, Nutrition, Metabolic Diseases Iaşi

Aim of study: we performed a retrospective, observational, transversal study in order to appreciate the prevalence and severity of renal disease in type 1 diabetic patients in Clinical Centre of Diabetes, Nutrition, Metabolic Diseases Iaşi.

Material and method: we evaluated all adult patients diagnosed with type 1 diabetes mellitus in our centre before January 1st 2007. We analyzed the record files, by considering only data available in the last two years. We searched information about age, sex, duration of disease, urinary albumin excretion rate and creatinine clearance, which were registered in a Microsoft Office Excel data base and afterwards undergone statistic analysis by using SPSS programs.

Results and discussions: Out of all 1072 patients, after excluding those under 18 years old and those with terminal organ pathology (that might have falsified the statistical analysis of laboratory data), we selected a group of 994 patients. We observed a predominance of male patients (553 cases – 55.6%) and a mean age of 43.58±13.66 years, with extremes of 18 and 84 years. The duration of type 1 diabetes mellitus varied between 1 and 49 years, with a mean value of 11.02±9.05 years. 305 patients (30.7% of all cases) had semiquantitative or quantitative urinary albumin excretion rate evaluation in the last 2 years; most of them had normal albuminuria values (48.2%), 24.6% had microalbuminuria and 27.2% had macroalbuminuria. 817 patients (82.2% of all cases)

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had available data as to calculate the creatinine clearance (ClCr) by Cockcroft-Gault equation; 39.8% of these patients had chronic kidney disease (ClCr < 90 ml/min): 29.99% – ClCr = 60-90 ml/min, 7.22% – ClCr = 30-60 ml/min, 0.86% – ClCr = 15-30 ml/min, 1.71% – ClCr < 15 ml/min. The creatinine clearance value was lower (with statistical significance) in patients with macroalbuminuria compared to those with normoalbuminuria and microalbuminuria. We noticed a predominance of male patients in the group with high urinary albumin excretion rate (65.1% males vs. 34.9% females with macroalbuminuria), but without reaching the level of statistical significance. Patients with a longer duration of diabetes had more often high urinary albumin excretion rates and low values of creatinine clearance, with statistically significant differences between the already mentioned groups.

Conclusions: More than 50% of the evaluated cases had high urinary albumin excretion rates and approximately 40% of the patients had low glomerular filtration rate as shown by the creatinine clearance value. The creatinine clearance value was statistically significant lower in patients with macroalbuminuria compared to those with normoalbuminuria and microalbuminuria. In the group with high urinary albumin excretion rates we noticed a higher prevalence of males. Patients with a longer duration of the disease had more often high urinary albumin excretion rates and low values of creatinine clearance.

SENSIBILITATEA PERIFERICĂ LA PACIENŢI CU DIABET ZAHARAT TIP 2 NOU DIAGNOSTICAT UTILIZÂND TESTAREA SENZORIALĂ

CANTITATIVĂ COMPUTERIZATĂ – CORELAŢIE CU SCORUL CLINIC NSS

C.Constantin2,3, C.Ioniţă 1, I.N.Gal 1, G.Stan 2,4, D.Cheţa1,2

1) Universitatea de Medicină şi Farmacie “Carol Davila” Bucureşti

2) Institutul Naţional de Diabet şi Boli de Nutriţie “ Prof. N Paulescu”

Bucureşti

3) Spitalul Clinic de Urgenţă Militar Central ”Carol Davila” Bucureşti

4) Fundaţia Pentru Alimentaţie Sănătoasă, Bucureşti

Background: Pacienţii cu diabet zaharat tip 2 (DZ2) nou diagnosticat pot prezenta concomintent şi modificarea sensibilităţii periferice, evaluarea acesteia fiind descrisă discordant în literatură.

Obiectiv: Studiul şi-a dorit evaluarea pragului sensibilităţii periferice (la rece) a pacienţilor cu DZ tip 2 nou diagnosticat utilizând sistemul CASE IV şi corelarea cu prezenţa simptomelor de neuropatie (scorul NSS).

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Materiale şi metode: Studiul transversal a fost realizat pe un lot selectat dintre pacienţii internaţi în cadrul Institutului „N. Paulescu” diagosticaţi cu diabet zaharat tip 2 nou descoperit (DZ2) şi au fost evaluaţi utilizând testarea senzorială cantitativă (QTS) şi scorul simptomelor de neuropatie (NSS). Parametrii urmăriţi au fost: HbA1c, BMI, pragul sensibilităţii la rece (PSR), simptomele de neuropatie. Testarea senzorială cantitativă s-a realizat folosind sistemul CASE IV (Computer-Assisted Sensory Examination IV) la nivelul membrului superior drept (MS) şi al membrului inferior drept (MI), iar încadrarea privind pragul sensibilităţii s-a facut în trei categorii: hiperestezic ≤ 7,5 JND, limite normale - LN între 7,5 şi 12,5 JND şi hipoestezic≥ 12,5 JND. După NSS împărţirea pacienţilor s-a realizat astfel: 0 pentru absenţa simptomelor, 3-4 simptome uşoare, 5-6 simptome moderate, 7-9 simptome severe.

Rezultate şi discuţii: A fost realizat un lot de 37 de pacienţi cu o vârstă medie de 54 ± 13,3 de ani. HbA1c a avut o valoare medie de 12,3% ± 2,4% la prima determinare. BMI a avut o valoare medie la internare de 26,6±5,1kg/m2, 54,1% dintre pacienţi fiind supraponderali. La MS, PSR este alterat la 62,2% (23) din pacienţi, 37,8% (14) prezentând alterare de tip hiperestezie. La MI, PSR este alterat la 64,9% (24) din pacienţi, 37,8% (14) prezentând alterare de tip hiperestezie. În ceea ce priveşte scorul NSS, 37,8% (14) din pacienţi nu aveau simptomatologie sugestivă de neuropatie, dar 71,4% (10) dintre ei prezentau alterări ale PSR la nivelul MS, respectiv 92,8% (13) la nivelul MI. 62,2% (21) dintre pacienţi aveau simptome de neuropatie uşoare (16,2%, NSS = 4) sau moderate (45,9%, NSS 5 sau 6), chiar dacă PSR era în limite normale la MS la 47,6% (10) dintre pacienţi, respectiv la MI la 57,14 % (12) dintre pacienţi. Nici unul dintre pacienţii luaţi în studiu nu a prezentat simptome severe de neuropatie (NSS = 7-9).

Concluzii: La pacienţii cu DZ2 nou diagnosticat alterarea pragului sensibilităţii la rece este atât de tip hipoestezic, cât şi de tip hiperestezic, fără a fi prezentă o simptomatologie clinică în directă corelaţie cu modificările evidenţiate. Neuropatia diabetică poate evolua subclinic, fiind necesară o metodă obiectivă de evaluare a sensibităţii periferice.

Finanţare: Studiu realizat în cadrul proiectului CEEX 92/2006, PNCDI2 52164/2008.

PERIPHERAL SENSITIVITY IN NEWLY DIAGNOSED TYPE 2 DIABETES MELLITUS PATIENTS USING COMPUTERIZED QUANTITATIVE SENSORY

TESTING - CORRELATION WITH CLINICAL SCORE NSS

C.Constantin²,³; C. Ioniţă ¹; I.N.Gal ¹; G.Stan²,4; D.Cheţa¹,².

1) “Carol Davila” University of Medicine and Pharmacy, Bucharest;

2) National Institute of Diabetes, Nutrition and Metabolic Diseases

“N.Paulescu”, Bucharest;

3) „Carol Davila” Central Military Emergency Hospital, Bucharest

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4). Healthy Nutrition Foundation, Bucharest

Background: Abnormal peripheral sensitivity could be identified at newly diagnosed type 2 diabetes mellitus patients (T2DM), but evaluation of diabetic neuropathy at T2DM having a controversial literature.  Objective: Evaluation of cold threshold sensitivity of newly diagnosed type 2 diabetes mellitus patients using the CASE IV System and correlation with the symptoms of neuropathy (NSS score). Materials and methods: This cross-sectional study was conducted on a lot of patients selected within the Institute "N. Paulescu " with newly diagnosed type 2 diabetes mellitus (T2DM) and were assessed using quantitative sensory testing (QTS) and neuropathy symptoms score (NSS). We recorded the next parameters: HbA1c, BMI, cooling detection threshold (CDT), symptoms of neuropathy (NSS). Quantitative sensory testing was performed using the CASE IV System (Computer-Assisted Sensory Examination IV) in the superior limb (SL) and inferior limb (IL) of each patient, and they were characterized in three categories: hyperesthesic ≤ 7.5 JND, normal - between 7.5 and 12.5 JND, hypoaesthetic ≥ 12.5 JND. After NSS the patients were divided as follows: 0 for no symptoms, 3-4 light symptoms, 5-6 moderate symptoms, 7-9 severe symptoms.Results and discussion: The lot of 37 patients with an average age of 54.00±13.3- years was studied. HbA1c had an average value of 12.3% ± 2.4%. BMI had an average value of 26.6±5.1kg/m2, 56.1% of patients being overweight. In the SL, CDT is altered in 62.2% (23) of patients, 37.8% (14) presenting alteration type hyperesthesia. In the IL, CDT is altered in 64.9% (24) of patients, 37.8% (14) presenting alteration type hyperesthesia. Regarding NSS, 37.8% (14) of patients had no symptoms of neuropathy, but 71.4% (10) of these patients had alteration of the CDT at the SL, and 92.8% (13) at the IL. 62.2% (21) of patients had symptoms of light peripheral neuropathy (16.2% NSS=4) or moderate peripheral neuropathy (45.9% NSS 5 or 6), even if CDT was normal in the SL in 47.6% (10) of this patients, respectively in the IL in 57.14 % (12) of patients.Conclusions: In newly diagnosed type 2 diabetes mellitus patients abnormal CDT is both hypoaesthesia and hyperesthesia, without a direct correlation between clinical symptoms and the alteration of peripheral sensitivity. Neuropathy may have a subclinical evolution, being necessary an objective method to evaluate the peripheral sensitivity.

Supported by: Grant CEEX 92/2006, PNCDI2 52164/2008 from the Romanian Research Ministry.

EVALUAREA PRAGULUI SENSIBILITĂŢII VIBRATORII LA PACIENŢII CU DIABET ZAHARAT TIP 2 NOU DIAGNOSTICAT

C. Constantin 1, 2, I. Gal3, C. Ionita3, G. Stan1,4, D. Cheta1,3

1. Institutul Naţional de Diabet, Nutriţie şi Boli Metabolice “Prof. NC Paulescu”

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2. Spitalul Clinic de Urgenţă Militar Central “Carol Davila”

3. Universitatea de Medicină şi Farmacie “Carol Davila”

4. Fundaţia Pentru Alimentaţie Sănătoasă Bucureşti

Obiectiv

Obiectivul acestui studiu a fost să evalueze evoluţia pragului sensibilităţii vibratorii la pacienţii cu diabet zaharat tip 2 (DZ2) nou diagnosticat.

Material şi metode

Sistemul computerizat de determinare a sensibilităţi vibratorii (CASE IV System) este un instrument de calitate pentru evaluarea componentei vibratorii a polineuropatiei diabetice. Acesta este un studiu deschis, prospectiv, desfăşurat pe durata a 3 luni. Au fost alcătuite două grupuri de 12 pacienţi cu DZ2 nou diagnosticat urmărind un tratament intensiv cu insulină şi dietă adecvată. Comorbidităţile neurologice au fost exluse la începutul şi pe durata studiului. Criteriile de includere si de excludere din studiu au fost urmate cu stricteţe.

Rezultate

Caracteristicile la momentul includerii în studiu au fost: pentru grupul A vârsta medie a fost de 45,34±3,5ani, greutatea medie 89,7±12,25kg, HbA1c 12,71±1,27%, pentru grupul B vârsta este de 64,23±6,54ani (p<0,05), greutatea medie 85,8±9,23kg (p>0,05) HbA1c 11,9±2,21% (p>0,05). Pe parcursul perioadei studiate s-au înregistrat: HbA1c, evenimentele hipogicemice, greutatea şi indicele de masă corporală. Sistemul CASE IV a înregistrat valori ale pragului sensibilităţii vibratorii la intrarea în studiu, la o lună, două şi trei luni. La trei luni: pentru grupul A s-a înregistrat un plus în greutate de 4,18±1,21kg şi o scădere a valorii HbA1c până la 7,9±0,8%, pentru grupul B s-a înregistrat un plus în greutate de 5,02±2,03 kg (A vs. B, p>0,05), o descreştere a HbA1c la 8.02±0.27% (A vs. B, p>0,05). Numărul evenimentelor hipoglicemice a fost similar pentru cele două loturi: 4,12±1,03 vs. 3,96±1,22/lună, p>0,05). Evoluţia pragului sensibilităţii vibratorii este descrisă în Tabelul 1, cu valori diferite semnificativ statistic la 3 luni (p<0.05).

Concluzii

Acesta este unul dintre primele studii care demonstrează o îmbunătăţire a pragului sensibilităţii vibratorii la pacienţii cu DZ2 nou diagnosticat după tratament intensiv cu insulină şi intervenţie susţinută asupra stilului de viată. Îmbunătăţirea pragului sensibilităţii vibratorii a fost semnificativ mai bună pentru partipanţii mai tineri. S-a constatat prezenţa unui dezechilibru metabolic major (HbA1c>12%) însoţit fiind de semne ale deficitului insulinic.

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Timp/ Unit. JND

Grup A

(MI Vib T*)

Grup B

(MI Vib T) Signf*

Grup A

(MS Vib T*)

Grup B

(MS Vib T) Signf*

Baseline 11,92±0,23 12,12±2,10 p<0,05 8,34±0,84 8,72±2,10 p<0,05

1 lună 9,34±4,23 10,10±2,57 p>0,05 7,28±3,19 7,48±2,57 p>0,05

2 luni 8,40±2,33 10,80±2,64 p<0,05 6,00±1,22 7,88±2,64 p<0,05

3 luni 8,10±2,26 10,26±2,52 p<0,05 6,37±1,51 8,12±2,12 p<0,05

*MI Vib T – Determinarea sensibilităţii vibratorii la nivelul membrului inferior, *MS Vib T – Determinarea sensibilităţii vibratorii la nivelul membrului superior,

*Signf - Semnificaţia statistică folosid testul T Student

Tabelul 1. Evoluţia pragului sensibilităţii vibratorii

Finanţare: Studiu realizat în cadrul proiectului CEEX 92/2006.

EVALUATION OF VIBRATORY DETECTION THRESHOLD IN NEWLY DIAGNOSED TYPE 2 DIABETES MELLITUS PATIENTS

C. Constantin 1,2, I. Gal3, C. Ionita3, G. Stan1,4, D. Cheta1,3

1. “Prof. NC Paulescu” Diabetes Institute Bucharest

2. “Carol Davila” Emergency Military Hospital Bucharest

3. “Carol Davila” University of Medicine and Pharmacy Bucharest

4. Healthy Nutrition Foundation Bucharest

Objective

The objective of this study was to evaluate the evolution of vibratory threshold in newly diagnosed type 2 diabetes mellitus patients.

Material and methods

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Computed vibratory detection threshold (CASE IV System) is a valuable instrument to evaluate diabetic sensory polyneuropathy. This is a 3 months open prospective study. We have two groups of 12 subjects each, with type 2 newly diagnosed DM following intensive insulin treatment and adequate diet. Common neurological disorders were excluded at start and during the study. Inclusion Criteria: Patients must fulfill all of the following criteria to be eligible for this study: 1.Newly diagnosed Type 2 diabetes mellitus, 2.Able to follow the protocol and willing to participate in the study as confirmed by signed consent to release information, 3.Currently treated with (EASD protocols): Life style intervention, Insulin (with or without oral agents), Different drugs for co-morbidities, 4. No anamnestic stories or clinical signs about nervous impairement.

Results

Baseline characteristics: The group A has the mean age 45.34±3.5years and the other one 64.23±6.54years. Baseline characteristics (mean) BMI, weight, systolic blood pressure-sBP, HbA1c were similar for two groups. Data for HbA1c, hypoglicemic events, weight and BMI were recorded. Computed vibratory detection threshold was monitored at the baseline and after 1, 2 and 3 months. For the Group A mean weight at baseline was 89.7±12.25kg and weight gain at 3 months was 4.18±1.21 kg. Mean HbA1c at baseline was 12.71±1.27% and decreased to 7.9±0.8% at 3 months. For Group B mean weight at baseline was 85.8±9.23kg and weight gain at 3 months was 5.02±2.03 kg (A vs. B, p>0.05). Mean HbA1c at baseline was 11.9±2.21% and decreased to 8.02±0.27% (A vs. B, p>0.05) at 3 months. The hypoglicemic events are similar in the 2 lots during the treatment (4.12±1.03 vs. 3.96±1.22/months, p>0.05). At baseline the computed vibratory threshold was 11.92±0.23JND Units for Group A and 2.12±2.10JND Units for Group B (Foot Vibration Test) (p>0.05). After three monts the computed vibratory threshold was 8.10±2.26JND Units for Group A and 10.26±2.52JND Units for Group B(p<0.05).

Table 1.

Conclusions

This is one of the first studies were we can see an improvement of vibratory threshold after an intensive insulin treatment and lifestyle modifications in newly diagnosed type 2 DM patients. The improvement vibratory threshold is significantly better at younger participants (p<0.05).High metabolic disturbances (HbA1c%>12) were present at the beginning of the study with signs of insulin deficit. Low power level of study – only 24 participants had finished the program.

Time/ JND Units

Group A

(Foot Vib T*)

Group B

(Foot Vib T) Signf*

Group A

(Hand Vib T*)

Group B

(Hand Vib T) Signf*

Baseline 11.92±0.23 12.12±2.10 p<0.05 8.34±0.84 8.72±2.10 p<0.05

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1

month 9.34±4.23 10.10±2.57 p>0.05 7.28±3.19 7.48±2.57 p>0.05

2 months 8.40±2.33 10.80±2.64 p<0.05 6.00±1.22 7.88±2.64 p<0.05

3 months 8.10±2.26 10.26±2.52 p<0.05 6.37±1.51 8.12±2.12 p<0.05

*Foot Vib T – Foot Vibration Test, *Hand Vib T – Hand Vibration Test,

*Signf - statistical significance using t Student test

Table 1. The evolution of vibratory threshold

Supported by: Grant CEEX 92/2006 from the Romanian Research Ministry.

ROLUL ALELELOR HLA-B ÎN SUSCEPTIBILITATEA GENETICĂ PENTRU DZ TIP 1 PENTRU POPULAŢIA DIN ROMÂNIA

C. Guja1, L Guja1, A. Călin1, S. Nutland2, J. Howson2, H. Rance2 şi J.A. Todd2 şi C. Ionescu-Tîrgovişte1

1 Clinica 1 de Diabet, Institutul “N. Paulescu”, Bucureşti, România

2 JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Cambridge Institute for Medical Research, Cambridge, UK

Introducere: Diabetul Zaharat de tip 1 (DZ tip 1) este o boală cronică cu patogenie autoimună, caracterizată prin distrugerea mediată de limfocite T a celulelor beta pancreatice. Principalele gene diabetogene descrise până în prezent sunt localizate la nivelul regiunii HLA de clasa a II-a, fiind reprezentate în special de unele alele ale HLA DQB1 şi DRB1. Există însă şi date privind implicarea unor alele de clasa I, HLA-A şi HLA-B. Pentru a evalua efectul diabetogen al unor alele HLA-B pentru populaţia din România (ţară cu una din cele mai mici incidenţe ale DZ tip 1 din Europa), am realizat o tipare HLA-B completă pe un număr de 423 familii cu DZ tip 1.

Scop: Evaluarea implicării unor alele HLA-B în patogenia DZ tip 1 pentru populaţia din România.

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Materiale şi Metode: Lotul studiat a cuprins 1515 subiecţi dintre care 439 pacienţi DZ tip 1 (208 bărbaţi/231 femei) şi 1076 rude de gradul 1 nediabetice. Tiparea a fost făcută prin metoda PCR-SSOP. Datele au fost analizate prin Transmission Disequilibrium Test (TDT) şi AFBAC folosind programul Stata® 8.1 (http://www.stata.com). Pentru a stabili dacă efectele alelelor HLA-B sunt independente, datele au fost analizate prin metoda regresiei logistice condiţionate, folosind genotipurile DQB1 şi DRB1 ale subiecţilor incluşi în studiu.

Rezultate: Am identificat o transmisie semnificativ crescută la diabetici a alelelor HLA B8 (71.3% transmitere, pTDT = 6.5x10-7), B15 (69.2% transmitere, pTDT = 0.005), B41 (74.1% transmitere, pTDT = 0.0002), B50 (85.7% transmitere, pTDT = 0.00002) şi Bw6 (65.7% transmitere, pTDT = 2.35x10-8). Am identificat de asemenea o transmitere semnificativ scăzută a alelei HLA B52 la diabetici (25.8% transmitere, pTDT = 0.007). Transmisia aceloraşi alele la fraţii neafectaţi ai probanzilor diabetici nu a fost diferită semnificativ de 50%, procent aşteptat prin şansă. Rezultatele sunt susţinute şi de frecvenţa mai mare a aceloraşi alele la diabetici comparativ culotul pseudocontrol (16.6% vs. 7,2% pentru B8; 6% vs. 2.6% pentru B15; 6.7% vs. 1.9% pentru B41; 4.8% vs. 1.1% pentru B50, 69.25% vs. 54.4% pentru Bw6 şi 1.24% vs. 3% pentru B52). Analiza prin conditional logistic regression a arătat însă că asocierea alelelor HLA B cu DZ tip 1 nu este independentă de influenţa alelelor HLA DQ şi DR (Prob > chi2 = 0.1023).

Discuţii: Rezultatele noastre indică un posibil efect diabetogen al alelelor HLA B8, B15, B41, B50 şi Bw6 precum şi un efect protector al alelei HLA B52. Totuşi aceste asocieri par a nu fi independente, cel mai probabil fiind datorate unui fenomen de linkage disequilibrium cu alelele demonstrat diabetogene/protectoare aparţinând locilor HLA de clasa a IIa DQ şi DR.

THE ROLE OF HLA B ALLELES ON TYPE 1 DIABETES GENETIC SUSCEPTIBILITY IN THE ROMANIAN POPULATION.

C. Guja1, L Guja1, A. Călin1, S. Nutland2, J. Howson2, H. Rance2 şi J.A. Todd2 şi C. Ionescu-Tîrgovişte1

1 Institute of Diabetes, Nutrition and Metabolic Diseases “N. Paulescu”, Bucharest, Romania;

2 Juvenile Diabetes Research Foundation/Wellcome Trust Diabetes and Inflammation Laboratory, Cambridge Institute for Medical Research, Cambridge, UK;

Introduction: Type 1 diabetes (T1DM) is a chronic autoimmune disease conditioned by multiple genetic and environmental factors. The main diabetes genes reported so far

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belong to the HLA class II region, DQB1 and DRB1 loci. However, multiple reports exists regarding the independent effect of some class I HLA A and B alleles. In order to assess the diabetogenic role of HLA B alleles for the Romanian population (with one of the lowest reported incidence of T1D in Europe), we performed a full HLA B typing in 423 nuclear families.

Aim: Our aim was to assess the potential involvement of HLA-B alleles in the pathogenesis of T1DM in Romanian families.

Materials and Methods: The study group comprised 1,515 individuals with 439 T1D patients (206 male/224 female) and 1,076 unaffected first degree relatives. Genotyping was done by PCR-SSOP. Data were analysed using the Transmission Disequilibrium Test (TDT) and AFBAC using Stata® 8.1 (http://www.stata.com). To establish if the effects of B alleles are independent, data were analysed by conditional logistic regression using the complete DQB1 and DRB1 genotypes for the entire study group.

Results: We found a significant increased transmission to diabetics of HLA B8 (71.3% transmission, pTDT = 6.5x10-7), B15 (69.2% transmission, pTDT = 0.005), B41 (74.1% transmission, pTDT = 0.0002), B50 (85.7% transmission, pTDT = 0.00002) and Bw6 alleles (65.7% transmission, pTDT = 2.35x10-8). We also found a significant decreased transmission of HLA B52 allele to diabetics (25.8% transmission, pTDT = 0.007). The transmission of the same alleles to unaffected sibs was not significant different from 50%. The results were supported by the higher frequency of these alleles in cases in comparison with pseudocontrols (16.6% vs. 7,2% for B8; 6% vs. 2.6% for B15; 6.7% vs. 1.9% for B41; 4.8% vs. 1.1% for B50, 69.25% vs. 54.4% for Bw6 and 1.24% vs. 3% for B52). Conditional logistic regression analysis showed that these associations are not independent of the effect of DQ and DR alleles neither for HLA B (Prob > chi2 = 0.0577) nor for HLA Bw (Prob > chi2 = 0.1023) alleles.

Discussion: Our results indicate a possible diabetogenic effect for HLA B8, B15, B41, B50 and Bw6 alleles and a protective effect for HLA B52 allele. However, the conditional logistic regression analysis showed that these effects are not independent but most likely due to the strong linkage disequilibrium with diabetogenic/protective class II DQ and DR alleles.

PARTICULARITATI ALE DIABETULUI ZAHARAT LA

COPILUL MIC

Banarescu Carmen

Spitalul de Copii Sfanta Maria Iasi

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1.Introducere

Diabetul zaharat insulino-dependent la copilul mic ridica greutati in redarea unui diagnostic rapid si correct , deseori in prezenta simptomatologiei atipice varstei.

2.Obiective

-studiul particularitatilor clinico-evolutive ale DID la copilul mic

-posibilitatile terapeutice si aspecte particulare ale insulinoterapiei la copilul mic

3.Metode Si Materiale De Lucru

Studiul a fost efectuat in Clinica a-III-a Pediatrie , Spitalul clinic de urgenta de copii Sf. Maria Iasi in perioada 1-01-2005 si 1-01-2008 pe 10 copii.

4.Concluzii

Diabetul zaharat la copii mici prezinta:

-instabilitate metabolica

-obtinerea controlului glicemic este greu de mentinut

-familia joaca un rol important in imbunatatirea echilibrului metabolic cu prevenirea complicatiilor tardive.

PARTICULARITIES OF THE DIABETES MELLITUS IN THE SMALL CHILD

Banarescu Carmen

Spitalul de Copii Sfanta Maria Iasi

1. Introduction:The insulin – dependent diabetes mellitus in the small child raises several issues

related to establishing an accurate and rapid diagnosis in the presence, often, of atypical symptoms as well as high instability specific to age.

2. Objectives:- study of the chemical-evolutive particularities of the insulin-dependent diabetes in

the infant and in the small child- therapeutic possibilities and particular issues of the insulinotherapy in the infant

and in the small child3. Method And Working Material:

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The study was conducted in Clinics 3 of Pediatrics January 1st 2005 through January 1st 2008 on 10 children

4. Conclusions:The diabetes mellitus in the small child shows:

- metabolic instability

- obtaining of a metabolic control, difficult to achieve

- the family plays an important role in obtaining a glycemic control which allows for the improvement of the metabolic equilibrium by preventing tardive complications.

PERTURBARILE METABOLISMULUI GLUCIDIC IN MUCOVISCIDOZA – CONSIDERATII PE MARGINEA UNUI CAZ

Carmen Oltean, Laura Bozomitu, Dana Anton, D. Moraru

Clinica a III-a Pediatrie, U.M.F. “Gr.T.Popa” Iasi

Mucoviscidoza reprezinta cea mai frecventa boala AR intalnita la populatia caucaziana, caracterizata prin afectare pluriorganica si cu consecinte severe asupra celor trei tipuri de metabolism. Afectarea metabolismului glucidic apare, in general, dupa o evolutie de mai lunga durata a bolii, avand grade diferite de severitate, de la hiperglicemii izolate, scaderea tolerantei la glucoza pana la diabet zaharat.

Obiectiv: prezentarea cazului unui copil cu mucoviscidoza - forma completa la care scaderea tolerantei la glucoza a aparut precoce, la varsta de 11 ani.

Material si metoda: autorii descriu cazul unui baiat diagnosticat tardiv, la varsta de 10 ani, cu fibroza chistica forma completa, la care scaderea tolerantei la glucoza s-a instalat precoce, in absenta unei simptomatologii de hiperglicemie.

Rezultate si discutii: pacientul S.V., 12 ani, cu repetate infectii respiratorii cu evolutie trenanta in antecedente, s-a internat pentru prima data in Clinica a III-a Pediatrie la varsta de 10 ani. La internare prezenta deficit staturo-ponderal sever (- 3,4 DS pentru T si – 3DS pentru G), cu semne patente de insuficienta respiratorie cronica, scaune nedigerate cu steatoree, anemie feripriva, hipoproteinemie cu hiposerinemie, hipolipemie, aspect de fibroza pulmonara si hepatica, testul sudorii pozitiv. S-a stabilit diagnosticul de mucoviscidoza forma completa fiind instituit tratamentul dietetic si medicamentos specific bolii. Urmarirea bolnavului a evidentiat ameliorarea deficitului nutritional si a insuficientei respiratorii dar evolutia a fost grevata de suprainfectii bacteriene pulmonare si perturbarea metabolismului lipidic (hipolipemie, hipocolesterolemie). La aproximativ

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un an de la diagnostic s-au decelat initial hiperglicemii postprandiale izolate (180-220 mg%) in absenta unei simptomatologii caracteristice. Efectuarea TTGO a stabilit diagnosticul de toleranta scazuta la glucoza.

Avand in vedere afectiunea de baza, pacientului i s-a recomandat o restrictie relativa la glucide cu absorbtie rapida (consumarea lor impreuna cu alte alimente pentru scaderea vitezei de absorbtie), dieta hipercalorica,hiperlipidica, hiperproteica si monitorizare bisaptamanala a glicemiei.

Concluzie: aparitia precoce a perturbarilor metabolismului glucidic in mucoviscidoza este consecinta evolutiei “naturale” a bolii (in absenta unei terapii specifice), cu extinderea rapida a leziunilor de fibroza, la care se adauga infectiile respiratorii repetate. Dieta glucidica este partial restrictiva, respectand necesitatile hipercalorice specifice bolii.

CARBOHYDRATE METABOLISM PERTURBATIONS IN CYSTIC FIBROSIS-CASE CONSIDERATIONS

Carmen Oltean, Laura Bozomitu, Dana Anton, D. Moraru

Clinica a III-a Pediatrie, U.M.F. “Gr.T.Popa” Iasi

Cystic fibrosis is the most frequent AR disease in caucasians, characterized by multiorganic involvement and with severe consequences on the three types of metabolism. The carbohydrate metabolism is generally impaired after a long-term evolution of the disease, with different stages of severity, from isolated hyperglycemia episodes, glucose intolerance, to diabetes mellitus.

Aim: to present the case of a 10 years old child with cystic fibrosis-complete form in whom the glucose intolerance has occurred early, at the age of 11.

Material and method: authors describe the case of a boy who was lately diagnosed with cystic fibrosis-complete form- at the age of 10, in whom the glucose intolerance has early occurred, without any symptoms due to hyperglycemia.

Results,discussions: the patient SV, aged 12, with recurrent, persistent respiratory infections in the history, was first admitted in the 3rd Pediatric Cclinic at the age of 10. At admittance he had severe growth retardation (-3,4 SD for H and -3 SD for W), with patent signs of chronic respiratory failure, steatorrhea, iron deficiency anemia, hypoproteinemia with hyposerinemia, hypolipemia, liver and lung fibrosis, positive sweat test. The diagnosis of cystic fibrosis-complete form was made and the diet and medical treatment specific to disease was begun. The follow up remarked the improvement of the

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nutritional impairment and of the respiratory failure but the outcome was subsequently poor, by pulmonary bacterial infections and lipidic metabolism perturbations (hypolipemia, hypocholesterolemia). After approximately one year after diagnosis there were initially detected only isolated postprandial hyperglycemias (180-220 mg%), without any characteristic symptom. After the oral glucose tolerance test was made (OGTT) the diagnosis was glucose intolerance. Considering the main diagnosis (CF), it was recommended for the patient a relative restriction of rapidly absorbed carbohydrates (their intake together with other food in order to decrease the absorption time), a hypercaloric, hyperlipidic, hyperproteic diet and twice a week glycemic monitoring.

Conclusion: the early occurrence of the carbohydrate metabolism troubles in cystic fibrosis is due to “natural” evolution of the disease (without any specific therapy), with rapid extension of fibrotic lesions, and also with further occurrence of recurrent respiratory infections. The carbohydrate intake is partially restricted, with respect to hypercaloric requirements specific for this disease.

EPIDIAB 2008 IN JUDEŢUL CLUJ

Mirela Florea, Cristina Nita, Adriana Rusu, Nicolae Hancu

Centrul Clinic de Diabet, Nutriţie şi Boli Metabolice Cluj Napoca

Introducere:

Numărul persoanelor cu diabet a crescut alarmant în întreaga lume,fără nici o tendinţă de atenuare a ritmului de creştere. Diabetul zaharat tip 2 este considerat în momentul de faţă una dintre cele mai ingrijorătoare, costisitoare şi serioasă problemă de sănătate. Programul EPIDIAB are ca scop analiza epidemiologica si a calitatii ingrijirii persoanelor cu diabet zaharat nou depistat.

Scopul lucrarii:

Este de a analiza aspectele referitoare la datele demografice,antropometrice, prevalenta factorilor de risc cardiometabolici,prevalenta complicatiilor cronice , precum si structura terapeutica a persoanelor cu diabet diagnosticate in perioada ianuarie-septembrie 2008 in judetul Cluj.

Metoda:

Au fost preluate datele din fisele de consultatie ale persoanelor diagnosticate si luate in evidenta cu diabet zaharat in perioada ianuarie-septembrie 2007 la Centrul Clinic de Diabet, Nutritie si Boli Metabolice Cluj Napoca, la care s-au adaugat datele comunicate de celelalte cabinet de Diabet din judetul Cluj.

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Rezultate:

In perioada 1 ianuarie-30 septembrie 2008, au fost inregistrat 3705 persoane cu diabet zaharat nou depistat, dintre care diabet zaharat tip 2:99,1%, diabet zaharat tip 1: 0,5 %, diabet gestational: 0,16%, diabet secundar: 0,24%. Raportul barbati:femei a fost de 1:1,01 ;76 % provin din mediul urban, majoritatea(64,75%) se situeaza in grupa de varsta 41-65 de ani.

Din punct de vedere antropometric 10,82 % din persoanele nou diagnosticate sunt normoponderale, 35,9% cu suprapondere si 53,28% cu obezitate; 93,87% din persoane au talia peste 80 cm la femei sau peste 94 cm la barbati.

Prevalenta hipertensiunii arteriale a fost de 64,63%, a dislipidemiei de 57%, iar 21% din persoanele nou depistate cu diabet zaharat prezinta deja o complicatie macrovasculara(cardiopatie ischemica 45,64%,angina pectorala 29,61 %, infarct miocardic14,98 %, boala cerebrovasculara16,02 %, arteriopatie periferica 7,32%).

Structura terapeutica in diabetul zaharat nou depistat a fost urmatoarea: 24,09% optimizarea stilului de viata, 44,74% metformin in monoterapie, 8,88% sulfonilureice, 11,33% metformin – sulfonilureice, 6,49% insulina, 3,75% insulina-terapie orala, 0,72% alte clase.

Concluzii:

Incidenta diabetului zaharat inregistreaza in judetul Cluj o crestere semnificativa, fiind de aproximativ 44,83% mai mare comparativ cu aceeasi perioada a anului 2007 si de aproximativ 182,82% comparativ cu anul 2006. Diferentele semnificative comparativ cu anul 2006 sunt in parte explicate prin derularea Programului National de Evaluare a Starii de Sanatate a Populatiei din iulie 2007.Din punct de vedere terapeutic se remarca o crestere a numarului de pacienti aflati pe modulul de terapie metformin in comparatie cu anii precedenti.

EPIDIAB 2008 IN CLUJ COUNTY

Mirela Florea, Cristina Nita, Adriana Rusu, Nicolae Hancu

Clinical Center of Diabetes, Nutrition, Metabolic Diseases Cluj Napoca

Introduction:

The number of individuals with diabetes has increased alarmingly through-out the world and the rate of increase shows no signs of slowing. Type 2 diabetes is currently one of the most costly and worrying chronic diseases and represents a serious health care problem

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worldwide. The objective of EPIDIAB Program is to provide epidemiological data as well as the quality care of newly-diagnosed diabetes.

Aim:

To analyze the demographic, anthropometric data, the prevalence of cardiometabolic risk factors and chronic complications and the therapeutic structure of persons with newly-diagnosed diabetes, between January-September 2008, in Cluj County.

Method:

We analyzed data from the medical records of persons with newly-diagnosed diabetes between January-September 2008 and registered in the Diabetes Clinics from Cluj County.

Results:

In January-September 2008, 3705 persons with newly-diagnosed diabetes were registered,99,1 % with type 2, 0,5% type 1, 0,16% gestational diabetes and 0,24% with other specific types of diabetes; the ratio men: women is 1:1,01 ; 76% of the persons come from urban areas, the majority (64,75%) being in the 41-65 years group of age. 10,82 % of type 2 newly-diagnosed diabetes have normal weight, 35,9% overweight and 53,28%obesity;93,87 % have the abdominal circumference over 80 cm in women or over 94 cm in men. The prevalence of hypertension is 64,63%, of dyslipidemia 57%; 21 % of newly-diagnosed diabetes has already a macrovascular complications at diagnosis ( ischemic heart disease 45,64%, angina 29,61 %, myocardial infarction14,98%, cerebrovascular disease 16,02%, peripheral vascular disease7,32%).

The therapeutic structure for newly diagnosed diabetes is as follows:24,09% lifestyle intervention only,44,74 % metformin, 8,88 % sulphonylurea, 11,33% metformin plus sulphonylurea, 6,49% insulin, 3,75%insulin plus oral therapy and 0,72% other drugs.

Conclusion:

The incidence of diabetes mellitus in the county of Cluj registers a significant increasing about 44,83% more than the same period in 2007 and 182,82% more than 2006. Increased diagnostic activity by initiation of National Population Health Assessment Program in 2007 might generate a significant increase in the incidence of diabetes in 2007 and 2008 as compared with 2006. When treatment is considered, there are significant increased as compared with the previous years for metformin therapy.

CARACTERISTICI GENERALE ALE PACIENŢILOR CU DIABET ZAHARAT TIP 1 DIN CENTRUL CLINIC DE DIABET, NUTRIŢIE, BOLI METABOLICE

IAŞI

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Cristina Lăcătuşu1,2, Bogdan Mihai1,2, Roxana Ştefan2, Laura Mihalache1,2, Delia Vîtcă2, Mariana Graur1,2

1Universitatea de Medicină şi Farmacie „Gr. T. Popa” Iaşi

2Centrul Clinic de Diabet, Nutriţie, Boli Metabolice Iaşi

Scopul lucrării: am efectuat un studiu retrospectiv, observaţional, transversal, pentru a aprecia caracteristicile generale ale pacienţilor cu diabet zaharat tip 1 aflaţi în evidenţa Centrului Clinic de Diabet, Nutriţie, Boli Metabolice Iaşi.

Material şi metodă: am evaluat toţi pacienţii adulţi cu diabet zaharat tip 1 aflaţi în evidenţa centrului nostru până la data de 01.01.2007. Din analiza fişelor de monitorizare, luând în considerare doar datele din ultimii doi ani, am selectat informaţiile referitoare la vârstă, sex, vechimea bolii, greutate, înălţime, circumferinţa abdominală, circumferinţa fesieră şi prezenţa complicaţiilor cronice ale diabetului, care au fost înregistrate într-o bază de date Microsoft Office Excel şi supuse ulterior prelucrării statistice folosind programele SPSS.

Rezultate şi discuţii: Din totalul de 1072 pacienţi, după excluderea celor cu vârsta sub 18 ani şi a celor cu patologie terminală de organ (care ar fi putut falsifica analiza statistică a datelor antropometrice), am selectat un lot de 994 pacienţi. S-a constatat o preponderenţă a sexului masculin (553 cazuri – 55,6%) şi o vârstă medie de 43,58±13,66 ani, cu variaţii între 18 şi 84 de ani. Vechimea diabetului zaharat tip 1 a variat între 1 şi 49 de ani, cu o medie de 11,02±9,05 ani. Indicele de masă corporală a variat între 14,88 kg/m2 şi 46,22 kg/m2, cu o medie de 25,62±4,50 kg/m2; a existat o preponderenţă netă a pacienţilor normoponderali (46,34%) şi supraponderali (33,95%). Utilizând valorile circumferinţei abdominale (CA) şi ale indicelui abdomino-fesier (IAF), am constatat că 45,8% şi respectiv 39,1% dintre pacienţi depăşeau valorile normale, cu diferenţe statistic semnificative între cele două sexe în ambele cazuri (CA – 57,8% dintre femei şi 35% dintre bărbaţi; IAF – 47,3% dintre femei şi 31,8% dintre bărbaţi). 46,4% dintre pacienţii evaluaţi în ultimii 2 ani au fost diagnosticaţi cu retinopatie diabetică (RD): 35% – RD neproliferativă formă uşoară/medie, 1,7% – RD neproliferativă formă severă/foarte severă, 9,7% – RD proliferativă. Din cei 305 pacienţi la care fuseseră recent evaluate eliminările urinare de proteine, 48,2% erau normoalbuminurici, 24,6% prezentau microalbuminurie şi 27,2% macroalbuminurie. La cei 860 pacienţi la care fusese evaluată neuropatia, 68,7% prezentau forma periferică şi 13,15% forma vegetativă. Macroangiopatia era prezentă la un număr mai mic de cazuri (12,7% din cei 106 pacienţi evaluaţi prezentau boală coronariană, 2,82% din totalul pacienţilor aveau sechele de accident vascular cerebral, 5,3% din cei 851 pacienţi evaluaţi prezentau AOMI).

Concluzii: Preponderenţa crescută a sexului masculin este o particularitate a pacienţilor cu diabet zaharat tip 1 din centrul nostru, ştiut fiind că în ţările cu o prevalenţă scăzută a bolii (printre care şi România) există o tendinţă de predominanţă feminină. Aproximativ 40% dintre pacienţi prezentau o dispoziţie abdominală a ţesutului adipos, mai ales în cazul sexului feminin (circa jumătate din cazuri). Peste 50% din cazurile evaluate aveau

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eliminări urinare crescute de proteine şi aproape jumătate aveau retinopatie diabetică. Peste două treimi din cazuri prezentau neuropatie periferică. Comparativ cu celelalte complicaţii, macroangiopatia era prezentă într-un număr mai redus de cazuri.

GENERAL FEATURES OF TYPE 1 DIABETIC PATIENTS IN CLINICAL CENTRE OF DIABETES, NUTRITION, METABOLIC DISEASES IAŞI

Cristina Lăcătuşu1,2, Bogdan Mihai1,2, Roxana Ştefan2, Laura Mihalache1,2, Delia Vîtcă2, Mariana Graur1,2

1The University of Medicine and Pharmacy „Gr. T. Popa” Iaşi

2The Clinical Centre of Diabetes, Nutrition, Metabolic Diseases Iaşi

Aim of study: we performed a retrospective, observational, transversal study in order to appreciate the general features of type 1 diabetic patients in Clinical Centre of Diabetes, Nutrition, Metabolic Diseases Iaşi.

Material and method: we evaluated all adult patients diagnosed with type 1 diabetes mellitus in our centre before January 1st 2007. We analyzed the record files, by considering only data available in the last two years. We searched information about age, sex, duration of disease, weight, height, waist circumference, hip circumference and the chronic complications of diabetes, which were registered in a Microsoft Office Excel data base and afterwards undergone statistic analysis by using SPSS programs.

Results and discussions: Out of all 1072 patients, after excluding those under 18 years old and those with terminal organ pathology (that might have falsified the statistical analysis of anthropometric data), we selected a group of 994 patients. We observed a predominance of male patients (553 cases – 55.6%) and a mean age of 43.58±13.66 years, with extremes of 18 and 84 years. The duration of type 1 diabetes mellitus varied between 1 and 49 years, with a mean value of 11.02±9.05 years. The body mass index varied between 14.88 kg/m2 and 46.22 kg/m2, with a mean value of 25.62±4.50 kg/m2; most patients were of normal weight (46.34%) or overweight (33.95%). By referring to waist circumference and waist-hip ratio, we noticed that 45.8% and respectively 39.1% of patients had abnormal values, with statistically significant differences between genders in both cases (waist circumference – 57.8% of women and 35% of men; waist-hip ratio – 47.3% of women and 31.8% of men). 46.4% of the patients evaluated in the last 2 years were diagnosed with diabetic retinopathy (DR): 35% – nonproliferative incipient/moderate DR, 1.7% – nonproliferative severe/very severe DR, 9.7% – proliferative RD. In the 305 patients who had recent evaluation of urinary albumin excretion rate, 48.2% had normoalbuminuria, 24.6% had microalbuminuria şi 27.2%

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macroalbuminuria. In the 860 patients who had been evaluated for neuropathy, 68.7% had the peripheral form and 13.15% had the autonomic form. Macrovascular disease was present in a smaller amount of cases (12.7% of the 106 patients that were evaluated had coronary disease, 2.82% of all patients had a stroke history, 5.3% of the 851 patients who were evaluated had peripheral arterial disease).

Conclusions: High prevalence of male gender is an uncommon feature of type 1 diabetic patients in our centre, as we know that in countries with low prevalence of the disease (which include Romania) there is a tendency towards female predominance. Approximately 40% of patients had abdominal deposition of the fat mass, found especially in females (about half of cases). More than 50% of the evaluated cases had high urinary albumin excretion rates and almost half of patients had diabetic retinopathy. More than two thirds of cases had peripheral neuropathy. By comparison to other complications, macrovascular disease was present in a more reduced number of cases.

PREDICTORII HIPERGLICEMIEI POSTPRANDIALE LA PACIENŢII CU DIABET ZAHARAT TIP 2

Cristina Niţă1,2, Adriana Rusu1, Cornelia Bala1,2, N. Hâncu1,2

1 Universitatea de Medicină şi Farmacie„Iuliu Haţieganu”, Cluj Napoca

2 Centrul de Diabet , Nutriţie şi Boli Metabolice, Cluj-Napoca

Introducere şi Obiective

Evidenţele actuale sugereaza că toate aspectele metabolismului glucozei -hemoglobina glicată (A1C), glicemia bazală(GB) şi glicemia postprandială(GPP)- sunt parametrii clinic relevanţi pentru a fi monitorizaţi. Glicemia postprandiala(GPP), în particular, pare să fie corelată cu boala cardiovasculară (BCV).

Obiectivul acestui studiu a fost determinarea factorilor asociaţi cu excursiile glicemice postprandiale în cazul pacienţilor cu diabet zaharat tip 2 (DZ2).

Material şi metodă

Au fost evaluaţi factorii asociaţi cu hiperglicemia postprandială (>140mg/dl la 2 ore după masă) corectaţi în funcţie de sex şi tratament, la 122 de pacienţi care s-au prezentat la controlul periodic, în Centrul de Diabet şi Boli de Nutriţie Cluj Napoca, România. Aceşti pacienţi au fost invitaţi să participe la un studiu epidemiologic privind evaluarea impactului glicemiei postprandiale asupra riscului cardiovascular, la persoanele cu DZ.

S-a efectuat o evaluare medicală completă a acestor pacienţi, cu istoric personal şi examen obiectiv (greutate, înălţime, circumferinţă abdominală şi tensiune arterială). De

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asemenea s-a determinat în condiţii bazale nivelul glicemiei plasmatice, A1C, colesterol total, HDL-colesterol şi trigliceride. Fiecare pacient a efectuat un profil glicemic în 6 puncte (preprandial şi la 2h postprandial) şi a completat un chestionar alimentar.

Rezultate

Vârsta medie a pacienţilor inclusi în studiu a fost de 58 ani (minim 28, maxim 77 ani), între care 59.8% au fost de sex masculin. În medie, vechimea diabetului la pacienţii incluşi în studiu a fost de 6 ani ( minim 0, maxim 37 ani). Prin analiza factorială s-au determinat patru factori care explică 73% din variaţia glicemiei postprandiale [ Factorul 1 cu încărcare pozitivă pentru greutate, IMC, Factorul 2 cu încărcare pozitivă pentru colesterol total şi LDL colesterol, Factorul 3 cu încărcare pozitivă pentru vechimea diabetului şi vârstă, Factorul 4 cu încărcare pozitivă pentru trigliceride şi HDL-colesterol]. Factorii determinaţi cu ajutorul analizei factoriale au fost incluşi ca variabile independente într-un model de regresie liniară, având glicemia postprandială ca variabilă dependentă. Acest model a fost semnificativ asociat cu valoarea medie a glicemiei postprandiale ( p=0.002). În cadrul acestei analize Factorul 2 nu a atins nivelul semnificaţiei statistice ( p=0.593) şi a fost exclus din analiză. Al doilea model de regresie care a inclus numai Factorii 1, 2, 4 a fost semnificativ statistic (p=0.001, F „change”=6.123, semnificaţia F „change”= 0.001). În urma ajustării modelului de regresie pentru sexul pacienţilor şi tratamentul hipoglicemiant urmat, numai Factorul 1 şi Factorul 4 au rămas semnificativ asociaţi cu glicemia postprandială (p=0.025 şi 0.004).

Concluzii

Rezultatele studiului arată că greutatea, indicele de masă corporală, nivelul trigliceridelor şi al HDL-colesterolului sunt asociate independent cu variaţiile glicemice postprandiale.

PREDICTORS OF POSTPRANDIAL HYPERGLYCEMIA IN PATIENTS WITH TYPE 2 DIABETES

Cristina Nita1,2, Adriana Rusu1, Cornelia Bala1,2, N. Hancu1,2

1 „Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj Napoca

2 Clinical Center of Diabetes, Nutrition, Metabolic Diseases, Cluj-Napoca

Background and Aims: Growing evidence suggests that all aspects of glucose metabolism - glycated hemoglobin (A1c), fasting plasma glucose (FPG) and postprandial glycemia (PPG)- are clinically relevant parameters to be monitored. PPG, in particular, appears to be related to the cardiovascular disease (CVD).

The objective of this study was to investigate the factors associated with postprandial glucose excursions in patients with type 2 diabetes (T2DM).

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Materials and Methods: We have evaluated the factors associated with postprandial hyperglycemia (>140 mg/dl at 2 hours after the meal), corrected for sex and treatment in 122 consecutive patients with T2DM attending the outpatient clinic from Clinical Center of Diabetes, Nutrition and Metabolic Diseases Cluj-Napoca, Romania. These patients were included in a larger epidemiological study aiming to assess the impact of postprandial hyperglycemia on cardiovascular risk in persons with type 2 diabetes. A complete medical history, physical examination (weight, height, waist circumference, and blood pressure) was performed. Blood samples were collected in the overnight fasting state, and A1c, total cholesterol, HDL-cholesterol and triglycerides were assessed. A six points blood glucose profile (before and 2 h after meals) measured by patients at home, together with a meal questionnaire was performed for each patient. To determine variables associated with higher postprandial glycemic levels, factor analysis followed by linear regression model was performed.

Results: The study group had a median age of 58 years (min 29, max 77 years), 59.8% were males. The median duration of diabetes was 6 years (min 0, max 37 years). By factor analysis we have extracted 4 factors that explained 73% of the variance of postprandial glycemia [Factor 1 with positive loadings of weight and body mass index, Factor 2 with positive loadings of total cholesterol and LDL-cholesterol, Factor 3 with positive loadings of diabetes duration and age, Factor 4 with positive loadings of triglycerides and HDL-cholesterol]. In an unadjusted linear regression, model which included the four factors identified was significantly associated with postprandial glycemia (p=0.002).Within the model, Factor 2 displayed a p value of 0.593 and was removed from the analysis. A second regression included Factor 1, 3 and 4, and the model remained statistically significant (p=0.001, F change=6.123, significance of F change= 0.001). After adjustment for the sex and treatment, only Factor 1 and Factor 4 remained significantly associated with postprandial glycemic values (p=0.025, and 0.004)

Conclusion The results of our study shows that weight, body mass index, triglyceride level and HDL-cholesterol are independently associated with postprandial glucose excursion.

RISCUL DEZVOLTARII NASH LA PACIENTII DIABETICI

E.C. Rezi1, R. Mihăilă2, L. Nedelcu3, O. Frăţilă4, C. Domnariu5, M. Deac2

1 Spitalul Clinic Judetean de Urgenta, Sibiu

2Facultatea de Medicina, Universitatea Lucian Blaga Sibiu

3Facultatea de Medicina, Universitatea Transilvania, Brasov

4Facultatea de Medicina, Universitatea Oradea

5Centru de Sanatate publica, Sibiu

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Introducere:

Stetohepatitta non-alcoolica se asociază frecvent cu sindromul metabolic, un grup de tulburări metabolice - obezitate centrală, diabet zaharat tip 2, rezistenţă la insulină, dislipidemie, hipertensiune arterială. Scopul studiului nostru a fost de a determina riscul dezvoltarii NASH la pacientii diabetici si posibilele corelatii ale nivelului glicemiei cu gradul fibrozei hepatice.

Material si metoda:

Au fost luaţi în studiu toţi bolnavii deplasabili internaţi în clinicile medicale ale Spitalelor Judeţene din Braşov, Oradea şi Sibiu în perioada 15.10.2006 – 31.12.2006, care au fost examinaţi ecografic. Cei fără ficat hiperecogen şi fără citoliză hepatică au constituit lotul martor (812 pacienti) iar lotul de studiu a fost format din toti pacientii (68) la care s-a pus diagnosticul de steatohepatita non-alcoolica (NASH). Fibroza hepatica a fost evaluata prin scorul Forns. Rezultatele au fost analizate statistic folosind testul Pearson, testul „t” Student şi riscul relativ (RR).

Rezultate:

Repartitia pe genuri a pacientilor cu NASH a fost de 41.17% femei fata de 58.83% barbati. Varsta medie a lotului a fost de 54.47 ± 12.84 ani. Glicemia medie a pacinetilor cu NASH a fost de 132.85 mg/dl fata de 100.13 mg/dl la pacientii din lotul martor, diferenta fiind inalt semnificativa statistica (p=0.00000008). Riscul relativ de a dezvolta NASH la pacientii cu diabet zaharat a fost de 3.33. Indicele de corelatie Pearson intre nivelul glicemiei si scorul Forns de fibroza hepatica a fost r = -0.005; deci nu s-au gasit corelatii intre nivelul glicemiei si scorul fibrozei hepatice. De asemenea, nivelul glicemiei nu s-a corelat cu gradul de citoliza (r = 0.007, pentru TGO, respectiv r = -0.0003 pentru TGP).

Concluzii:Valorile glicemice sunt semnificativ mai mari la pacientii cu NASH decat la cei din lotul martor. Pacientii cu diabet zaharat de tip 2 sunt de trei ori mai expusi riscului de a dezolta steatohepatita non-alcoolica decat restul populatiei. Nu exista corelatii intre nivelul mediu al glicemiei si nivelul citolizei hepatice sau gradul fibrozei.

THE RISK OF DEVELOPING NASH AT THE DIABETIC PATIENTS

E.C. Rezi1, R. Mihăilă2, L. Nedelcu3, O. Frăţilă4, C. Domnariu5, M. Deac2

1 Spitalul Clinic Judetean de Urgenta, Sibiu

2Facultatea de Medicina, Universitatea Lucian Blaga Sibiu

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3Facultatea de Medicina, Universitatea Transilvania, Brasov

4Facultatea de Medicina, Universitatea Oradea

5Centru de Sanatate publica, Sibiu

Introduction:

Non-alcoholic steatohepatitis (NASH) is frequently associated with the metabolic syndrome, a group of metabolic disorders like central obesity, diabetes mellitus type 2, insuline resistance, dyslipidemy and arterial hypertension. Our aim was to determine the risk of developing NASH at the diabetic patients and the possible correlations between the level of glycemia and the degree of liver fibrosis.

Material and method:We took in consideration a group formed by the patients who were hospitalize in the Medical Departments of the Clinical Hospitals from Brasov, Oradea and Sibiu during 15.10.2006 – 31.12.2006, who were ultrasonografically examined. The ones without hyperecougenous liver and without liver cytolysis formed the controlled group (812 patients) and 68 patients to whom the NASH diagnosis was established formed the studied group. The liver fibrosis was evaluated using the Forns index of correlation.

Results:The gender repartition of the NASH patients was 41.17% women and 58,83% men. The medium age of the lot was 54.47 ± 12.84 years of age. The medium level of glycemia at the NASH patients was 132.85 mg/dl comparing with 100.13 mg/dl at the patients from the control group, the difference being very statistically significant (p=0.00000008). The relative risk of developing NASH at the diabetic patients was 3.33. The Pearson index of correlation between the glicemic level and the Forns index of liver fibrosis was r =-0.005; so there were no correlations found between the glycemic level and the liver fibrosis index. No correlations were found between the level of glycemia and the level of transaminases (r =0.007 for TGO and r =-0.0003 for TGP).

Conclusions:The values of gycemia are significantly higher at the patients with NASH comparing with the control group. The patients with diabetes mellitus are three times more likely to develop NASH than the rest of the population. There are no correlations between the medium level of glycemia and the degree of liver cytolysis of liver fibrosis.

CORELAŢII CLINICO-BIOLOGICE ÎN HEPATOPATIA ADIPOASĂ NON-ALCOOLICĂ :DIABETUL ZAHARAT TIP 2 SI INSULINOREZISTENŢA –

COMORBIDITAŢI OMIPREZENTE ALE ACESTEI PATOLOGII

DASCĂLU DACIANA NICOLETA - medic specialist medicina interna

Spital Gen. CF Sibiu

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Ficatul gras non-alcoolic (FGNA) sau hepatopatia adipoasa non-alcoolica se încadreaza intr-un spectru de boli hepatice caracterizate in principal prin degenerescenta grasoasa macroveziculara ce apare in lipsa consumului semnificativ de alcool , respectiv sub 20-30 g alcool pur/zi sau sub 200g alcool pur/saptamana. Cu toate dificultatile in interpretarea rezultatelor studiilor privind prevalenta FGNA, aceasta pare a fi cea mai frecventa afectare hepatica in populatia generala, estimarile cele mai recente si elaborate apreciind o prevalenta hepatopatiei adipoase de 20% si a steatohepatitei non-alcoolice de 2-3%.

In contextul importantei majore ca problema de sanatate publica mai ales prin prisma comorbiditatilor si complicatiilor pe care le implica hepatopatia adipoasa non-alcoolica , scopul lucrarii este acela de a evidentia corelatiile clinico-biologice dar mai ales particularitatile afectiunii in randul pacientilor din aria noastra geografica .

Am realizat un studiu-ancheta prospectiv pe pacienti care prezinta aspect ecografic de steatoza hepatica , fara consum semnificativ de alcool si neinfectati cu virus hepatitic B sau C. Am urmarit gradul steatozei hepatice , afectiunile asociate, prezenta afectiunilor considerate clasic ca fiind premegatoare sau concomitente cu aparitia ficatului gras non-alcoolic (insulinorezistenta , diabetul zaharat de tip 2 , sindromul metabolic , obezitatea abdominala, etc.) incercand evidentierea unor posibile corelatii intre aspectele clinice si examinarile paraclinice . Datele obtinute au fost analizate comparativ cu un lot martor de pacienti . Am realizat calcule de semnificatii statistice si indice de corelatie intre valorile obtinute la cele doua loturi si am constatat existenta de corelatii pozitive intre valorile IL6 si taliei , PCR –talie, TNF-IMC , IL6-TNF , IL6 -PCR si PCR-TNF la pacientii cu FGNA.

Din analiza rezultatelor partiale prezentate mai sus se desprind cateva concluzii referitoare la pacientii studiati cum ar fi procentul important dintre subiecti care prezinta patologie cardiovasculara ( HTA , CIC ) fiind astfel clasificabili ca pacienti cu mare risc cardio-vascular , valorile medii ale IMC , indice talie/sold si circum-ferinta taliei care sunt mult crescute fata de limitele maxim admise , valorile medii calculate ale TNFα , PCR , IL6 si IL8 fiind si ele mai mari decat limitele maxim normale (semnificand implicarea acestor citokine in procesul inflamator care produce si insoteste boala). Calculul FLI (Fibrosis Liver Index) confirma aplicabilitatea acestui test bazat pe valorile trigliceridelor , IMC , GGT si circumf. taliei in predictia steatozei hepatice .Calculul non-invaziv gradului de fibroza hepatica utilizand formule brevetate pentru alte patologii hepatice cronice a avut rezultate usor diferite functie de formula utilizata: APRI , FIB-4 scor Forns , raport ASAT/ALAT , ASPRI.

Aceste concluzii confirma datele din literatura de specialitate conform carora ficatul gras non-alcoolic este o boala mult mai frecvent intalnita in populatia adulta decat se credea initial , fiind insotita de multiple comorbiditati, sindromul metabolic fiind cea mai importanta constelatie de patologie intalnita la acesti pacienti, iar hepatopatia adipoasa – componenta hepatica a acestui sindrom.

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CLINICAL CORRELATIONS CONCERNING NON-ALCOHOLIC FATTY LIVER DISEASE- DIABETES MELLITUS AND INSULINRESISTANCE AS

OMNIPRESENT CO-MORBIDITIES

Non-alcoholic fatty liver disease (NAFLD) is a broad spectrum liver disease produced in the absence of alcohol ingestion and described as a macrovesicular fatty degenerescence of the hepatocites , with a prevalence of 20% in the general population.

We present a prospective study on pts. with NAFLD comparing them with a set of healthy people concerning the weight , body mass index (BMI) , waist circumference, waist to hip ratio , IL6 , TNF α , PCR , and searching for co-morbidities like DM , insulinresistance , metabolic syndrome , ischemic heart disease , high blood pressure or obesity.

We also calculated the grade of liver fibrosis using non-invasives formulas like Forns score , APRI , ASPRI , FIB-4 , FLI (Fibrosis Liver Index) , ASAT/ALAT.

The conclusions are not optimistic since we proved a high correlation of NAFLD with cardio-vascular diseases , DM and Metabolic syndrome , a moderate degree of liver fibrosis in pts. with normal transaminases and positive correlations between IL6 -waist , PCR – waist, TNF-BMI , IL6-TNF , IL6 -PCR si PCR-TNF in patients with non-alcoholic fatty liver disease.

Metabolic syndrome is a broad constellation of pathologies with a high prevalence in the general population, NAFLD being just the hepatic branch of this dangerous syndrome.

PROFILUL LIPIDIC LA DZ TIP 1 ŞI 2 NOU DESCOPERIT – COHORTA 2007

Daniela Licăroiu,Elena Unguraşu, Alexandra Secrieru, C. Ionescu –Tîrgovişte

INDNBM “N.C. Paulescu” Bucureşti

Scop: Analiza elementelor profilului lipidic la pacienţii nou diagnosticaţi cu diabet şi relaţia acestora cu parametrii controlului glicemic (glicemie a jeun şi HbA1c) şi IMC.

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Material si metoda: În studiu au fost înrolaţi 2787 pacienţi nou diagnosticaţi cu DZ în perioada ianuarie – decembrie 2007, grupaţi în două loturi în funcţie de tipul DZ: a) 204 pacienţi cu DZ tip I - 117 bărbaţi (57.4%) şi 87 femei (42.6%), cu vârsta medie 31.09 ani (limite 4-76 ani) şi b) 2583 pacienţi cu DZ tip II, din care 1272 bărbaţi (49.2%) şi 1311 femei (50.8%), cu vârsta medie de 58.86 ani (limite 14–87 ani). Datele studiului (vârstă, sex, IMC, glicemie a jeun, HbA1c, colesterol total, HDL-colesterol şi TG) provin din fişele CAD ale pacienţilor, prelucrarea statistică realizându-se cu S.P.S.S 15.0, folosind testele: χ2, Mann-Whitney, Kruskal–Wallis şi coeficientul de corelaţie Sperman, cu un prag de semnificaţie statistică p ≤ 0.05.

Rezultate:

media (min – max) DZ tip I DZ tip II p

IMC (kg/m2) 22.32 (13.5 – 39.45)30.30 (15.62 –

55.86)P = 0.0001

Glicemie a jeun (mg/dl) 275.11 (43 – 990)223.54 (120 –

1332)P = 0.0001

HbA1c (%) 11.93 (5.10 – 18.20) 9.28 (4 – 20.3) P = 0.0001

Colesterol total (mg/dl) 197.06 (100 – 604)220.76 (190 –

1936)P = 0.0001

HDL-colesterol (mg/dl) 39.13 (20 – 98) 41.42 (30 – 216) NS

TG (mg/dl) 209.63 (39 – 3380)222.68 (90 –

4611)P = 0.0001

Prezenţa hipercolesterolemiei (colesterol total > 200 mg/dl) a fost la pacienţii cu DZ tip 1 de 23.5% şi la DZ tip 2 de 41,6 %. S-a găsit corelaţie semnificativ statistică între valoarea colesterolului, IMC (rs1 = 0.229, rs2 = 0.073) şi glicemie (rs1=0.215, rs2=0.100).

Hipertrigliceridemia ( TG>150 mg/dl ) a fost prezentă la 23% din pacienţii cu DZ tip 1 şi la 45.2% din pacienţii cu DZ tip 2. La ambele loturi, valorile TG au fost corelate direct cu valorile IMC (rs1=0.515, rs2=0.179) şi ale glicemiei (rs1=0.242, rs2=0.174), doar la pacienţii cu DZ tip 2 acestea fiind corelate şi cu valorile HbA1c (rs2 = 0.105).

Semnificativ statistic, s-a întâlnit corelaţie negativă la HDLc, unde la femeile cu DZ tip 1 HDLc a fost corelat invers proporţional cu valorile IMC (rs1=0.529) şi HbA1c (rs1=-0.414), iar la femeile cu DZ tip 2, HDLc a fost corelat invers proporţional cu valorile HbA1c (rs2=-0.121) şi ale glicemiei (rs2=-0.115). La pacienţii de sex masculin, HDLc a fost corelat invers proporţional cu valorile IMC, atât la cei cu DZ tip 1 (rs1=-0.326), cât şi la cei cu DZ tip 2 (rs2=- 0.087) unde a fost corelat şi cu valorile HbA1c (rs2=-0.160).

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Concluzii: La pacienţii nou diagnosticaţi cu DZ tip 2, factorii de risc pentru bolile cardiovasculare ca: dislipidemia cu hipercolesterolemie şi/sau hipertrigliceridemie, au fost mai frecvent prezente decât la pacienţii cu DZ tip1 (p=0.0001), deoarece pacientii cu DZ tip 2 sunt mai in varsta si cu comorbiditati ( obezitate, HTA, IMA,, BCI, insulinoresistenta) .

LIPID PROFILE AT NEWLY DIAGNOSED T1DM AND T2DM, COHORT(2007)

Daniela Licăroiu, Elena Unguraşu, Alexandra Secrieru, C. Ionescu – Tîrgovişte (National Institute of Diabetes, Nutrition and Metabolic Diseases “N.C. Paulescu”, Bucharest, Romania

Background and Aims: To analyze lipid profile at newly diagnosed T1DM and T2DM and the correlation of the lipid profile with fasting blood glucose, HbA1C and BMI.

Material and Methods: A cohort of 2787 diabetic patients was analyzed between January – December, 2007 in Bucharest: 1389 (49.8 %) man, 1398 (50.2 %) woman average age was 56, 82 years; BMI average was 29, 9Kg/m2. The two groups 204 (7, 3%) T1DM, 117(57.4%) men and 87 (41.6%) women and 2583 (92.7%) T2DM, 1272 (49.2%) men and 1311 (50.8%) women, average age 58.86 were studied depending on T1DM and T2DM.The following parameters were recorded: age, sex, BMI, fasting blood glucose, HbA1C, cholesterol, triglycerides, HDLc. The statistic program was SPSS 15.0; we used χ2, Mann-Whitney, Kruskal – Wallis, Spearman coefficient, with statistical significant p ≤0.05.

Results:

Parameters

T1DM

Mean (min – max)

T2DM

Mean (min – max)

P for difference between T1 and

T2

BMI (kg/m2) 22.32 (13.5 – 39.45)30.30 (15.62 –

55.86)P = 0.0001

Fasting blood glucose (mg/dl)

275.11 (43 – 990)223.54 (120 –

1332)P = 0.0001

HbA1c (%) 11.93 (5.10 – 18.20) 9.28 (4 – 20.3) P = 0.0001

Cholesterol (mg/dl) 197.06 (100 – 604)220.76 (190 –

1936)P = 0.0001

HDL-c (mg/dl) 39.13 (20 – 98) 41.42 (30 – 216) NS

Triglycerides 209.63 (39 – 3380)222.68 (90 –

4611)P = 0.0001

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Hypercholesterolemia (cholesterol>200mg/dl) was presented in 23.5% patients with T1DM and 41.6% patients with T2DM. We found a positive correlation between the following parameters: total cholesterol and BMI and fasting blood glucose with total cholesterol.Hypertriglyceridemia (triglyceride>150mg/dl) was present in 23% patients with T1DM and 45.2% patients with T2DM. In both groups was positive correlation between TG level, BMI and glycemia, at T2DM was correlated also with HbA1C.

In T1DM female patients, there was significant negative correlation with HDLc and inversely proportional with BMI, HbA1c and glycemia. In male patients, HDLc was correlated inversely proportional with BMI in T1DM and in T2DM patients. HDLc also correlated with HbA1C.

Conclusions: In newly diagnosed T2DM patients, risk factors for cardiovascular diseases such as dyslipidemia with hypercholesterolemia +/- hypertriglyceridemia were more frequently present than in T1DM patients (p=0.0001) because T2DM patients are older with more co morbidities (obesity, hypertension, heart attack, cardiovascular diseases, insulin resistance).

COMPLICATIILE CRONICE ALE DZ TIP 1 SI 2 NOU DESCOPERIT –COHORTA 2007

Daniela Licaroiu, Elena Ungurasu, Luminita Dospinoiu, Corina Nedelcu,

C. Ionescu-Tîrgoviste

INDNBM “N.Paulescu”, Bucuresti

Scop : De obicei la descoperire diabetul este asimptomatic, dar câteodata pot fi prezente complicaţii micro şi macrovasculare. Scopul acestui studiu a fost să evalueze prevalenţa complicaţiilor cronice la pacienţii cu DZ nou descoperit în 2007, înregistraţi în INDNBM “N. Paulescu”.

Materiale şi metode: In studiu au fost înrolaţi 2787 de pacienţi nou diagnosticaţi cu DZ în perioada ianuarie – decembrie 2007: 1389 (49.8%) bărbaţi şi 1398 (50.2 %) femei, cu vârsta medie de 56.82 ani (limite între 4 şi 87 ani), şi un IMC mediu de 29.9Kg/m2 (limite între 13 si 56 kg/m2). Cele 2 loturi au fost studiate în funcţie de tipul DZ: 204 pacienţi (7.3%) cu DZ tip 1, barbati 117 (57.4%) si 87 (42.6%) femei şi respectiv 2583 pacienţi (92.7%) cu DZ tip 2, 1272 (49.2%) barbati si 1311 (50.8%) femei; prezenţa/absenţa complicaţiilor diabetului. Datele folosite în studiu provin din fişele CAD ale pacienţilor, prelucrarea lor statistică realizându-se cu ajutorul softului SPSS

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15.0, semnificaţia statistică a diferenţelor dintre cele două loturi realizându-se pe baza testului Chi-patrat pentru un prag de semnificaţie p ≤0.05.

Rezultate :

Nr. Total pacienţi

Complicaţii microvasculare

Complicaţii macrovasculare

Retinopatie

Neuropatie

Arteriopatie

IMA AVC

T1DM

204 (7,3%) 3 (0.1%) 9 (0.2%) 4 (0.1%) 1 (0.1%) 1 (0.1%)

T2DM

2583 (92.7) 50 (1.8%) 137 (5%) 92 (3.3%) 53 (1.8%)

97 (3.4%)

Total 2787 (100%)

53 (1.9%) 146 (5.2%) 96 (3.4%) 54 (1.9%)

98 (3.5%)

Majoritatea pacienţilor 2370 (84,1%), din care 187 (5,8%) cu DZ tip 1 şi 2183 (78.3%) cu DZ tip 2, nu au prezentat complicaţii, acestea fiind evidenţiate numai la 417 pacienţi (15,9%), din care 17 pacienţi (0,6%) cu DZ tip I si 400 pacienţi cu DZ tip 2 (15,3%).

Concluzii : Pacienţii nou diagnosticaţi cu DZ tip 1 şi DZ tip 2 cel mai frecvent nu au complicaţii, dar sunt mai frecvente la pacientii cu DZ tip 2, datorita factorilor de risc vasculari prezenti, cum ar fi: HTA, dislipidemia, hiperinsulinismul, obezitatea. Cel mai frecvent complicaţiile macrovasculare afecteaza un singur teritoriu vascular, acesta fiind fie teritoriul cerebral, fie cel periferic, aceste teritorii fiind de aproximativ 4 ori mai frecvent afectate decât teritoriul coronarian. La pacienţii cu complicaţii microvasculare, neuropatia este mai frecventă decât retinopatia (p = 0.0001). Complicaţiile cronice ale diabetului nou descoperit sunt mai frecvente la DZ tip 2 faţă de DZ tip 1 datorita perioadei mai mari de prediagnostic (p= 0.038).

CHRONIC COMPLICATIONS AT NEWLY DIAGNOSED T1DM AND T2DM, COHORT 2007

Daniela Licaroiu, Elena Ungurasu, Luminita Dospinoiu, Corina Nedelcu,

C. Ionescu-Tîrgoviste

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National Institute of Diabetes, Nutrition and Metabolic Diseases “N.C. Paulescu”, Bucharest, Romania

Background and Aims: Diabetes mellitus usually is asymptomatic at diagnosed, but sometimes micro- and macrovascular complications might be present. The aim of this study was to evaluate the prevalence of chronic diabetes complications in newly diagnosed diabetic patients registered in the outpatient Department of Institute N. Paulescu in 2007.

Material and Methods: A cohort of 2787 diabetic patients was analyzed between January – December, 2007 in Bucharest: 1389 (49.8 %) man, 1398 (50.2 %) woman average age was 56, 82 years; BMI average was 29, 9Kg/m2. The two groups 204 (7, 3%) T1DM, 117 (57.4%) man and 87 (41.6%) woman, 2583 (92.7%) T2DM 1272 (49.2%) man and 1311 (50.8%) woman were studied depending on present/absent off diabetic complications. The statistic program was SPSS 15.0; we used Chi-Square tests with statistical significant p ≤0.05.

Results:

Total patients

Microvascular complications

Macrovascular complications

Retinopathy

Neuropathy

ArteriopathyMiocardic

al infarction

Stroke

T1DM 204 (7,3%)

3 (0.1%) 9 (0.2%) 4 (0.1%) 1 (0.1%) 1 (0.1%)

T2DM 2583 (92.7)

50 (1.8%) 137 (5%) 92 (3.3%) 53 (1.8%) 97 (3.4%)

Total 2787 (100%)

53 (1.9%) 146 (5.2%) 96 (3.4%) 54 (1.9%) 98 (3.5%)

Most patients 2370 (84.1 %) had no complications: 187 (6.7%) T1DM and 2183 (78.3%) T2DM, only 417 patients (15.9 %) had complications, from which 17 patients T1DM (0. 6 %) and 400 patients T2DM (15.3%).

Conclusions: Obviously at diagnosis T1DM patients and T2DM patients are mostly free of complications, but if they have it, the most common ones are macrovascular complications in T2DM patients due to the presence of additional vascular risk factors as: hypertension, dyslipidemia, hyperinsulinism, obesity. Most frequent diabetic macrovascular complications affects only one vascular territory, this is the cerebral territory or peripheral territories, affected 4 times more frequent than coronaries territory (p = 0.0001). The lower frequencies of cardiac lesions are probably due to different

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diagnosis criteria. In patients with microvascular complications neuropathy is more frequent then retinopathy (p= 0.0001). Newly diagnosed chronic complications are higher in T2DM than in T1DM patients (p = 0.038) due to a longer pre – diagnosis period.

PREVALENTA COMPLICATIILOR MICROVASCULARE LA PACIENTII CU DZ TIP 1 SI TIP 2 CU SINDROM METABOLIC

Dovan D,

Institutul de Diabet, Nutritie si Boli Metabolice«Prof. N.C. Paulescu»Bucuresti, Romania

Introducere : Sindromul metabolic reprezinta un important factor de risc pentru diabet zaharat tip 2, putine date exista insa, despre importanta acestuia la pacientii cu diabet zaharat tip 1.

Obiective : Evaluarea prevalentei complicatiilor microvasculare la pacientii cu diabet zaharat tip 1(DZ1) si tip 2(DZ2) cu sindrom metabolic(SM).

Material si metoda : Au fost inclusi in studiu 1429 pacienti, internati in perioada 01.01.2006-31.12.2006 la IDNBM “N.Paulescu”,dintre care 270 cu DZ1 (136 barbati, 134 femei, varsta medie 42,54±14,36 ani), iar 1159 cu DZ2 (518 barbati, 641 femei, varsta medie 60,17±10,48 ani). SM a fost prezent la 50 (18,51%) dintre pacientii cu DZ1, respectiv 970 (83,69%) dintre cei cu DZ2, restul pacientilor nu au intrunit criteriile de diagnostic . S-au analizat urmatorii parametri prezenti in fisele de observatie ale pacientilor : varsta, sex, talie, HbA1c, istoric de HTA, colesterol total (CT), HDL, LDL, trigliceride (TG), raport TG/HDL, complicatii microvasculare: neuropatie diabetica (neuropatie diabetica senzitiva periferica, neuropatie vegetativa), retinopatie diabetica (retinopatie diabetica proliferativa, retinopatie diabetica neproliferativa). SM a fost definit conform criteriilor IDF. La pacientii cu DZ tip 1, glicemia nu a constituit citeriu de diagnostic.

Rezultate : Pacientii cu DZ1 si SM, fata de cei cu DZ2 si SM au avut valori medii ale varstei semnificativ mai mici (49.16±13.24vs.60.25±10.33, p<0.001) si ale vechimii bolii semnificativ mai mari (12.58±9.63vs.9.39±8.21, p<0.01), relatii ce s-au mentinut si atunci cand s-a efectuat diferentierea pe sexe . De asemenea, pacientii cu DZ1 si SM au avut fata de cei cu DZ2 si SM un nivel semnificativ mai mare al HbA1c (10.52±2.23 vs.9.51±2.40, p<0.01), relatie ce s-a pastrat doar la barbati (10.75±2.76vs.9.06±2.43, p<0.01) atunci cand s-au analizat diferentele barbati-femei. Au existat diferente semnificativ statistic in lotul cu DZ1 si SM fata de lotul cu DZ2 si SM in ceea ce priveste prevalenta neuropatiei vegetative (OR 3.27; 95%CI:1.39-7.67), retinopatiei diabetice (OR

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2.39; 95%CI:1.35-4.23) si retinopatiei diabetice neproliferative (OR 2.26;95%CI:1.25-4.08), diferente ce s-au mentinut pentru retinopatia diabetica (OR 3.08;95%CI:1.47-6.46) si retinopatia diabetica neproliferativa (OR 2.71;95%CI:1.27-5.80) doar la femei atunci cand s-a efectuat analiza pe sexe. Pacientii cu DZ1 si SM au avut fata de cei fara SM o prevalenta semnificativ mai mare a retinopatiei diabetice (OR 2.03; 95% CI: 1.09-3.78), fara diferente semnificative in ceea ce priveste neuropatia diabetica. La pacientii cu DZ2 si SM fata de cei fara SM nu au existat diferente semnificativ statistic in ceea ce priveste complicatiile microvasculare.In urma analizei tertilelor de distributie ale HbA1c si raportului TG/HDL nu au existat diferente semnificativ statistic intre pacientii cu DZ tip 1 si tip 2 din tertila superioara de distributie comparativ cu cei din tertila inferioara.In urma analizei tertilelor de distributie ale taliei, pacientii cu DZ1 din tertila superioara comparativ cu cei din tertila inferioara au avut o prevalenta mai mare a retinopatiei diabetice (OR 2.72; 95% CI: 1.07-6.90), fara diferente la pacientii cu DZ2.

Concluzii: Sindromul metabolic reprezinta un factor de risc pentru afectarea microvasculara la pacientii DZ tip1.

THE PREVALENCE OF MICROVASCULAR COMPLICATIONS IN TYPE I AND TYPE II DIABETES PATIENTS WITH METABOLIC SYNDROME

Dovan D., Popescu L.D., Ionescu I., Lichiardopol R.

Clinic of Diabetes, Nutrition and Metabolic Diseases, “ N.C. Paulescu” Institute, Bucharest, Romania

Introduction: The metabolic syndrome is an important cardiovascular risk factor for type 2 diabetes mellitus (DM2), there are though few data regarding its importance in type I diabetes mellitus patients (DM1).

Aim: The evaluation of microvascular complications in DM1 and DM2 patients with metabolic syndrome (SM).

Methods: In the study there were included 1429 patients, which were admitted in 2006 in the diabetes department of the institute., of which 270 with DM1 (136 men, 134 women, mean age 42.54+14.36 years) and 1159 with DM2 (518 men, 641 women, mean age 60.17+10.48). SM was present in 50 (18.51%) of the DM1 patients, respectively 970 (83.69%) of the DM2 patients, the rest of the patients not meeting the diagnostic criteria.

The following parameters in the patients’ file were analyzed: age, sex, waist circumference, hypertension history, HbA1c, total cholesterol (CT), HDL cholesterol (HDL), LDL cholesterol (LDL), triglycerides (TG), triglyceride/HDL cholesterol ratio, presence of microvascular complications: diabetic neuropathy, (peripheral diabetic

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neuropathy, autonomic neuropathy), diabetic retinopathy, (proliferating diabetic retinopathy, non-proliferating diabetic neuropathy). SM was defined according to the IDF criteria. In DM1 patients, glucose blood level was not a diagnostic criterion.

Results: Patients with DM1 and SM had lower mean age (49.16±13.24vs.60.25±10.33, p<0.001) compare to patients with DM2 and SM (p<0.001) and a significantly longer disease duration (12.58±9.63vs.9.39±8.21, p<0.01), relation that maintained in the sex difference also. Also patients with DM1 and SM had a significantly higher level of HbA1c (10.52±2.23 vs.9.51±2.40, p<0.01), compared to the patients with DM2 and SM , relationship that maintained only in men (10.75±2.76vs.9.06±2.43, p<0.01) when men-women differences were analyzed. There were statistically significant differences regarding autonomic neuropathy (OR 3.27; 95%CI:1.39-7.67, p<0.01), diabetic retinopathy (OR 2.39; 95%CI:1.35-4.23, p<0.01) and non-proliferating diabetic retinopathy (OR 2.26;95%CI:1.25-4.08, p<0.01) between the patients with DM1 and SM compare with patients with DM2 and SM, difference that maintained for diabetic retinopathy (OR 3.08;95%CI:1.47-6.46, p<0.01) and non-proliferating diabetic retinopathy (OR 2.71;95%CI:1.27-5.80, p<0.01) only in women when sex differences were analyzed.

Patients with DM1 and SM had a significantly higher prevalence of diabetic retinopathy (OR 2.03; 95% CI: 1.09-3.78) compared to the patients without SM, with no significant differences regarding diabetic neuropathy. In patients with DM2 and SM there were no statistically significant differences regarding microvascular complications compared to the patients with DM2 and without SM.

There were not significant differences in microvascular complication prevalence across the tertiles of HbA1c and TG/HDL distribution. When analyzing waist distribution tertiles, patients with DM1 in the superior tertile had a higher prevalence of diabetic retinopathy (OR 2.72; 95% CI: 1.07-6.90) compared to the patients in the lower terile, with no differences in patients with DZ2.

Conclusions: Metabolic syndrome represents a risk factor for microvascular complications in patients with DZ1.

PREVALENŢA COMPLICATIILOR MACROVASCULARE LA PACIENTII CU DIABET ZAHARAT TIP 1 CU VECHIME A BOLII DE PESTE 25 ANI

Diana Clenciu1, Mihaela Vladu2, Sigina Gargavu1, Nicoleta Mitroi1, Eva Toma1, Maria Mota2

1 Spitalul Clinic Judetean de Urgenta Craiova – Clinica Diabet Nutritie Boli Metabolice;

2 UMF Craiova – Departamentul de Diabet Nutritie Boli Metabolice

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Scopul studiului: Evaluarea prevalentei complicatiilor macrovasculare la un lot de pacienti cu diabet zaharat tip 1 cu vechime a bolii de peste 25 ani

Material si metoda: Lotul studiat a cuprins 44 pacienti cu DZ tip 1 cu vechime a bolii de peste 25 ani aflati in evidenta Centrului Clinic de Diabet Nutritie Boli Metabolice al Spitalului Clinic Judetean de Urgenta Craiova. Ca metoda de lucru am utilizat urmatoarele date anamnestice, clinice si paraclinice: vechimea diabetului, antecedente personale, tensiunea arteriala, palparea pulsului la nivelul arterelor pedioase, tibiale posterioare, poplitee, femurale; auscultatia vaselor de la baza gatului, glicemie, colesterol total, HDL-colesterol, LDL-colesterol, trigliceride, electrocardiograma, examen cardiologic, ecocardiografie si coronarografie la indicatia medicului cardiolog, Eco Doppler vascular periferic si vase baza gatului, examen neurologic, CT si RMN la recomandarea medicului neurolog.

Rezultate: Din cei 44 pacieti, 14 (31,81%) au fost de sex feminin si 30 (68,19%) de sex masculin. Cu privire la varsta acestora, 2 pacienti (4,54%) se aflau in decada de varsta 30-40 ani, 12 pacienti (27,27%) in decada 41-50 ani, 15 pacienti (34,09%) in decada 51-60 ani si 15 pacienti (34,09%) peste 60 ani. Studiind parametrul complicatii macrovasculare s-a remarcat o frecventa crescuta a arteriopatiei diabetice obliterante, 26 pacienti (59,09%), dar si a cardiopatiei ischemice cronice 16 pacienti (36,36%). Un numar de 14 pacienti (31,81%) prezentau atat arteriopatie diabetica obliteranta cat si cardiopatie ischemica cronica. Din pacientii luati in studiu 4 pacienti (9,09%) au prezentat accident vascular cerebral pe parcursul evolutiei DZ. Debutul arteriopatiei diabetice a fost inregistrat la 2 pacienti (7,69%) la mai putin de 5 ani de evolutie ai DZ, la 2 pacienti (7,69%) intre 5-10 ani, la 3 pacienti (11,53%) intre 11-15 ani, la 4 pacienti (15,38%) intre 16-20 ani, la 5 pacienti (19,23%) intre 21-25 ani si la 10 pacienti (38,46%) la mai mult de 25 ani de evolutie ai DZ. Dislipidemia a fost evidentiata la 32 pacienti (72,72%). Hipertensiunea arteriala s-a intalnit la 36 pacienti (81,81%). Dintre pacientii hipertensivi, 28 pacienti (77,77%) prezentau HTA si neuropatie, 27 pacienti (75%) prezentau HTA si retinopatie, 17 pacienti (47,22%) prezentau HTA si arteriopatie, 15 pacienti (41,67%) prezentau HTA si nefropatie, iar 13 pacienti (36,11%) prezentau atat HTA cat si neuropatie, retinopatie, arteriopatie si nefropatie.

Concluzii: Se remarca o frecventa crescuta a complicatiilor macrovasculare dupa o evolutie de peste 25 de ani ai DZ tip 1, prevalenta complicatiilor creste paralel cu vechimea diabetului zaharat. Arteriopatia diabetica obliteranta a membrelor inferioare este cea mai frecventa complicatie macrovasculara, care poate sa apara precoce, dar a carei incidenta crescuta se inregistreaza dupa 25 ani de evolutie ai DZ tip 1. Cardiopatia ischemica cronica se identifica ca o complicatie macrovasculara frecventa comparativ cu accidentul vascular cerebral care s-a intalnit in procent mai mic. Dislipidemia si hipertensiunea arteriala sunt intalnite frecvent la pacientul cu diabet cu o vechime de peste 25 ani si se asociaza mai frecvent cu complicatiile diabetului .

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THE PREVALENCE OF MACROVASCULAR COMPLICATIONS IN TYPE 1 DIABETES MELLITUS WITH DURATION OF DIABETES MORE THAN 25

YEARS

Diana Clenciu1,, Sigina Gargavu1, Mihaela Vladu2, Nicoleta Mitroi1, Eva Toma1, Maria Mota2 ,

1 Clinic County Emergency Hospital Craiova, Diabetes Clinic; 2 UMF Craiova

Background: To analyze the frequency of macrovascular complications in patients with duration of T1DM more than 25 years.

Material and method: We studied a group of 44 patients with duration of T1DM more than 25 years, hospitalized in the Clinic of Diabetes Nutrition & Metabolic Diseases (Clinic County Emergency Hospital Craiova). We analised history of disease, clinical and paraclinical dates: the duration of diabetes mellitus, personal history, blood pressure, palpation of pulse at the level of dorsal artery of foot, posterior tibial artery, popliteal artery and femoral artery, the vessels auscultation from the base of the neck, glycemia, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, ECG, cardiologic examination, ecocardiography and coronarography at the indication of the cardiologist, vascular Eco Doppler, neurologic examination, CT and NMR at the indication of the neurologist.

Results and discussions: From the 44 patients included in the study, 14 patients (31,81%) were female and 30 patients (68,19) male. Concerning the age of patients, 2 patients (4,54%) were between 30-40 years, 12 patients (27,27%) were between 41-50 years, 15 (34,09%) patients were between 51-60 years and 15 patients (34,09%) over 60 years. Regarding macrovascular complications, 26 patients (59,09%) presented peripheral arterial disease and 16 patients (36,36%) presented ischemic heart disease. From the patients included in the study 4 patients (9,09%) presented stroke. Diabetic arteriopathy developed before 5 years of evolution in 2 patients (7,69%), between 5-10 years at 2 patients (7,69%), between 11-15 years at 3 patients (11,53%), between 16-20 ani in 4 patients (15,38%), between 21-25 years in 5 patients (19,23%) and 10 patients (38,46%) presented the developement of diabetic arteriopathy after 25 years of evolution. 32 patients (72,72%) had dyslipidaemia and 36 patients (81,81%) suffered of arterial hypertension.

From hypertensive patients, 28 patients (77,77%) presented after 25 years arterial hypertension and diabetic neuropathy, 27 patients (75%) arterial hypertension and diabetic retinopathy, 17 patients arterial hypertension and diabetic arteriopathy, 15 patients arterial hypertension and diabetic nefropathy and 13 patients (36,11%) presented arterial hypertension, neuropathy, retinopathy, arteriopathy and nefropathy.

Conclusions: This study showed that macrovascular complications appered with a big frequence after 25 years of evolution, the complication’s prevalence grows with the oldness of diabetes mellitus. Peripheral arterial disease is the most frequent macrovascular complication which can earlier appears, but its highest incidence is also

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after 25 years of duration of diabetes. Ischemic heart disease is more frequent than stroke, which was met in a smaller percentage. Also, dyslipidaemia and arterial hypertension are frequently met after 25 years of diabetes and they are associated frequently with diabetes complications.

EPIDIAB IN MUNICIPIUL CHISINAU: REZULTATELE PRIMELOR 9 LUNI.

Elena Mornealo, Natalia Baltag, Olga Baranov, Silvia Bodean, Angela Dmitriev, Dorina Caraman, Chisinau.

Introducere: Diabetul zaharat este unanim acceptat ca o problema medico-sociala de extrema actualitate, prezentind o extindere epidemiologica in intreaga lume. Impactul negativ al bolii este conditionat in mare parte de dezvoltarea complicatiilor grave invalidizante, precum si de cresterea majora a riscului cardiovascular. Datorita unei perioade lungi de hiperglicemie asimptomatica, complicatiile cronice frecvent sunt prezente deja la momentul diagnosticarii diabetului. Din toate acestea reesa necesitatea unei abordari specifice a persoanelor cu diabet zaharat nou depistat.

Obiectiv: Analiza epidemiologica a cazurilor noi de diabet zaharat, inregistrate in perioada ianuarie-septembrie 2008 in municipiul Chisinau, determinarea prezentei complicatiilor si a comorbiditatilor la momentul depistarii, evaluarea optiunillor terapeutice initiale si a calitatii ingrijirii persoanelor cu diabet zaharat nou depistat.

Material si metode: S-au luat in studiu 507 cazuri de diabet zaharat nou depistat in perioada ianuarie-septembrie 2008, la care au fost analizate: aspectele epidemiologice legate de tipul de diabet, sex, varsta; datele antropometrice; screening-ul complicaţiilor cronice; asocierea cu alte entitati ale sindromului metabolic si bolii cardiovasculare; structura terapeutica.

Rezultate: Lotul de studiu a cuprins 507 de persone, dintre care 489 au prezentat diabet tip 2; repartitia pe sexe a fost aproape identica, raportul barbati:femei constituind 1:1,08. Varsta medie la momentul diagnosticarii a pacientilor cu tip1 de diabet – 29,40 ani, tip 2 – 58,72 ani. Doar 14% din persoane cu tip 2 de diabet sunt normoponderale, 45,6% prezinta suprapondere si 40,2% obezitate. 69,3% din persoane au talia peste 80 cm la femei sau peste 94 cm la bărbati. Prevalenta altor factori de risc cardio-vasculari este: hipertensiunea arteriala – 63,8%, dislipidemia – 62,7%. Un anumit numar de persoane au fost diagnosticate cu patologia cardio-vasculara deja la momentul depistarii diabetului: 5,53% au prezentat cardiopatie ischemica, 1,95% - boala cerebrovasculara, 3,25% -arteriopatie periferica, 2,28% - infarct miocardic. Screening-ul si diagnosticul complicatiilor microvasculare specifice releva: 42,3% din persoanele nou depistate cu diabet au fost scrinate pentru decelarea retinopatiei diabetice si la 20,7% a fost

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confirmata prezenta acestei complicatii la momentul diagnosticului.. Screening-ul pentru nefropatie diabetica s-a efectuat doar la 13,6 % din pacienti, 9,5% din cei examinati prezentind un grad de nefropatie. Screening-ul pentru polineuropatie diabetica si picior diabetic s-a efectuat la 41,36% din nou depistati, procentul celor diagnosticati pozitiv fiind de 24,4%. Consideram importanta analiza modului in care a fost depistata prezenta diabetului: doar 9,52% s-au adresat de sine statator cu careva acuze, la majoritatea – 57,47% - hiperglicemia a fost descoperita in procesul examinarii cu ocazia altei patologii si inca 33,10% dintre persoane au fost diagnosticate in mod activ.

Structura terapeutica in diabet zaharat nou depistat a fost urmatoarea: 14,98% numai optimizarea stilului de viata, 6,51% sulfonilureice, 56,67% - biguanide, 4,56% asociere sulfonilureice cu metformin, 10,09% insulina, 2,28 % asociere insulina cu metformin, 4,88% alte clase.

Concluzii: Magnitudinea problemei diabetului zaharat este prezentata nu doar de prevalenta si incidenta crescute a bolii per se, ci si de asocierea sa cu obezitatea si factori de risc cardio-vasculari, in particular dislipidemie si hipertensiunea arteriala. Adresabilitatea foarte joasa justifica aplicarea examinarilor active pentru depistarea precoce a patologiei. Exista limite in examinarea persoanelor nou diagnosticate, in depistarea complicatiilor, conditionate in mare parte de deficiente organizatorice si de costuri. Se impune necesitatea acuta elaborarii si implemintarii unor programe nationale, care vor contribui la ameliorarea calitatii ingrijirii persoanelor cu diabet zaharat.

EPIDIAB IN CHISINAU: RESULTS FROM THE FIRST 9 MONTHS.

Elena Mornealo, Natalia Baltag, Olga Baranov, Silvia Bodean, Angela Dmitriev, Dorina Caraman, Chisinau.

Introduction: Diabetes mellitus is universally accepted as a medical and social problem of extreme relevance, presenting epidemiological extension (spread) in the whole world. The negative influence (impact) of the disease is caused in major portion by the development of severe complications and by the great increase of the cardiovascular risk as well. Because of the long period of asymptomatic hyperglycemia, the chronic complications are present frequently just at the moment of diagnosis. It follows that persons with new diagnosed diabetes need a specific management.

Aim: epidemiological analysis of newly-diagnosed cases of diabetes mellitus that have been registered in Chisinau in the period January-September 2008, determination of the presence of complications and co morbidities at the time of diagnosis, evaluation of the therapeutic options and the quality of care.

Material and method: Study involved 507 cases of newly-diagnosed diabetes in period January-September 2008, which were analyzed in the following: epidemiological aspects

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such as type of diabetes, sex, age; anthropometric data, screening for chronic complications, association with others features of metabolic syndrome; therapeutic structure.

Results: from the 507 examined persons 489 presented type 2 diabetes; the distribution on sexes was nearly identical, ratio men: women being 1:1,08. The medium age at the moment of diabetes identification was 29,40 years for type 1 and 58,72 for type 2. Only 14% of type 2 newly-diagnosed diabetes have normal weight, 45,6% overweight and 40,2% obesity, though the share of abdominal obesity constitute 69,3%. The prevalence of other the cardiovascular risk factors is: hypertension – 63,8%, dyslipidemia – 62,7%. A certain number patients have been diagnosed with cardiovascular diseases already at the moment of diabetes identification: 5,53% presented ischemic cardiac disease, 1,95% cerebrovascular accident, 3,25% peripheral vascular disease, 2,28% myocardial infarction. Screening and diagnose of microvascular specific complications reveals: 42,3% of newly-diagnosed persons was screened for diabetic retinopathy and in 20,7% cases the presence of this was confirmed; screening for nephropathy was performed only in 13,6% of patients and 9,5% from examined had some grade of diabetic nephropathy; ; the screening for diabetic neuropathy and diabetic foot was done in 41,36%, the percentage of positives being 24,4%. Therapeutic structure of newly-diagnosed cases of diabetes was: lifestyle modification only in 14,36%, 56,67% - metformin, 6,51% - sulphonnylurea, 4,56% - sulphonnylurea plus metformin, 10,09% - insulin in monotherapy, 2,28% combination of insulin with metformin, 4,88% other therapies.

Conclusions: The magnitude of diabetes mellitus problem is determined not only by high incidence and prevalence of the disease per se, but also by the association with obesity and cardiovascular risk factors, particularly dyslipidemia and hypertension. Low grade of addressability justifies active examinations for early identification of pathology. Certain limits exist in newly-diagnosed persons’ examination, in identification of complications, caused for the most part by organization deficient and costs. It is an acute necessity in elaboration and implementation of national programs, which will ameliorate the quality of diabetic patients’ care.

FICATUL GRAS NONALCOOLIC – UN FACTOR DE RISC PENTRU BOALA RENALA CRONICA LA PACIENTUL DIABETIC

F. Casoinic 1, Catalina Badau 2, D. Sampeleanu 1, D. Constantinescu 1, Luchiana Pruna 3

1. UMF Cluj Napoca. Spitalul Universitar CFR. Clinica Medicala IV

2. Insitutul Inimii “Niculae Stancioiu”, Cluj Napoca

3. Spitalul Judetean Baia Mare. Centrul deDiabet, Nutritie si Boli metabolice

Introducere si obiective

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La pacientii diabetici, studii observationale au sugerat faptul ca prezenta ficatului gras nonalcoholic (FGNA), poate creste riscul de microalbuminurie si astfel de boala cronica renala (BCR). Veriga patogenetica intre aceste doua conditii poate fii reprezentata de citokinele proinflamatorii secretate de ficat. Scopul studiului de fata consta din evaluarea prezentei microalbuminuriei la pacientii diabetici cu FGNA comparativ cu cei fara FGNA si corelarea acesteia cu markeri ai inflamatiei – cum este proteina Creactiva cu sensibilitate inalta.

Material si metoda

Studiul a fost desfasurat pe un grup de 75 de pacienti diabetici cu FGNA diagnosticat ultrasonografic, la care s-au exclus consumul de alcool precum si alte cause de boala cronica hepatica, fumatul, hipertensiunea arteriala si boala renala preexistenta. Grupul de control a consistat din 70 de pacienti diabetici, fara dovezi ecografice de FGNA..

La toti pacientii s-au determinat parametrii antropometrici, glicemia a jeun, HbA1c, colesterolul total, LDL si HDL colesterolul, trigliceridele, transaminazele serice, hs PCR si microalbuminuria. Analiza statistica a fost efectuata cu SPSS11.0. O valoare a p<0,05 a fost considerata semnificativ statistica.

Rezultate

Microalbuminuria a fost a fost semnificativ mai frecventa la subiectii cu FGNA decat la grupul de control (12,7% vs 7,8%, p<0,05). Microalbuminuria s-a corelat pozitiv cu IMC, HbA1c, trigliceridele serice, hsCRP si respectiv negative cu nivele HDL la pacientii diabetici cu FGNA.

Concluzii

FGNA se coreleaza cu microalbuminuria- marker de boala cronica renala stadium precoce la pacientii diabetici. Aceasta pare a se datora unor nivele crescute de citokine proinflamatorii eliberate de ficat, cum este hsCRP. Pacientii diabetici cu FGNA au nivele semnificativ mai crescute ale HbA1c, relevand un control slab pe termen lung al valorilor glicemice.

NONALCOHOLIC FATTY LIVER DISEASE – A RISK FACTOR FOR CHRONIC KIDNEY DISEASE IN DIABETIC PATIENTS

F. Casoinic 1, Catalina Badau 2, D. Sampeleanu 1, D. Constantinescu 1, Luchiana Pruna 3

1. UMF Cluj Napoca. CFR University Hospital. IVth Medical Clinic

2. Heart Insitute “Niculae Stancioiu”, Cluj Napoca

3. County Hospital Baia Mare – Diabetes departament

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Background

In diabetic patients observational studies have suggested that nonalcoholic fatty liver disease-NAFLD may increase the risk of microalbuminuria and thus that of chronic kidney disease (CKD). The pathogenetic link between these conditions could be proinflammatory cytokines secreted by the liver. The aim of our study was to assess the presence of microalbuminuria in diabetic subjects with nonalcoholic fatty liver disease (NAFLD) compared with diabetic patients without NAFLD and to correlate this with inflammatory markers such as high sensitive C- reactive protein (hsCRP).

Material and methods

The study was conducted on a group of 75 diabetic subjects with ultrasonographical NAFLD, in which alcohol consumption and other causes of chronic liver disease have been excluded. The exclusion criteria also included smoking, arterial hypertension, known renal disease. The control group consisted of 70 diabetic patients, matched for age and gender, without ultrasonographical evidence of NAFLD.

In all subjects we measured height, weight, BMI, fasting glucose, HbA1c, total cholesterol, LDL and HDL cholesterol, triglycerides, serum transaminases, hsC-reactive protein and microalbuminuria. Statistical analysis was performed using SPSS11.0. A p-value<0,05 was considered statistically significant.

Results

Microalbuminuria was significantly more frequent in subjects with NAFLD than in controls (12,7% vs 7,8%, p<0,05). Microalbuminuria was positively correlated with waist to hip ratio, HbA1c levels, serum triglycerides, hsCRP levels and negatively correlated with HDL levels in subjects with NAFLD.

Conclusion

NAFLD is correlated with microalbuminuria- marker of early stage CKD, in diabetic patients. This seems to be related to higher levels of proinflammatory factors released by the liver, such as hsCRP. Diabetic patients with NAFLD had significantly higher levels of HbA1c, witnessing a poorer glycemic control.

IMPORTANTA DIETOTERAPIEI LA PACIENTII OBEZI CU DIABET ZAHARAT TIP II

G Radulian,1,2, A.Dragomir,1,2, M Posea2

UMF Carol Davila, Bucuresti

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IDNBM “N.Paulescu”, Bucuresti

I. Scop: Dietoterapia si intensificarea efortului fizic sunt parte importanta in tratamentul diabetului zaharat tip 2. Acest studiu a fost conceput pentru a evalua eficacitatea unei diete hipoglucidice (45%), hipolipemiante (25%) si hiperproteice (30%) la pacientii obezi cu diabet zaharat tip 2.

II. Material si metode: Un lot de 69 de pacienti diabetici , 33 barbati (47.8%) si 36 femei (52.2%), cu varsta medie de 51.3± 8.7, in tratament cu antidiabetice orale, cu dislipidemie mixta si obezitate (IMC>30 kg/m2) au fost inclusi intr-un program bazat pe dieta hipoglucidica (45%), hipolipemianta (25%) si hiperproteica (30%) si exercitii fizice (3 ore/saptamana). Hb A1c, colesterolul total, trigliceridele, ureea, creatinina si greutatea fiecarui pacient au fost evaluate la inceput si la 3, si respectiv 6 luni.

III.Rezultate: Greutatea medie la inceput a fost de 89,7 kg ( 72.5 – 121.5 kg ) iar la o luna, 3 si respectiv 6 luni s-a constatat o scadere in greutate de 3.3kg, 7.5kg, respectiv 9.1kg. Hb A1c medie a inregistrat valori initiale de 8.8% ( 6.6% -11.2% ) iar la evaluarile urmatoare a fost de 7.8%, respectiv 6.9%. Valorile colesterolului total au fost de 263 ± 20.3 mg/dl iar la 3 si 6 luni au fost 249 ± 21.5 mg/dl, respectiv 240 ± 25.5 mg/dl. S-a constatat o scadere a nivelului trigliceridelor de 26% dupa 6 luni. Nici un pacient nu a fost inclus in studiu daca functia renala, masurata prin uree si creatinina, era afectata. Clearence-ul la creatinina si microalbuminuria nu au fost modificate dupa 6 luni.

IV. Concluzii: Dieta hipoglucidica, hipolipemianta si hiperproteica poate imbunatati controlul metabolic la pacientii obezi cu diabet zaharat tip 2. Dieta hiperproteica poate ajuta in pierderea greutatii si in obtinerea unui control glicemic mai bun, fara a avea efecte adverse asupra functiei renale. Acest tip de dieta poate fi o optiune de tratament la anumiti pacienti obezi cu diabet zaharat tip 2.

EFFICACY OF DIET CHANGES IN OBESE PATIENTS WITH TYPE 2 DIABETES

  Gabriela Radulian,1,2 A. Dragomir,1,2 M.Posea2

1 University of Medicine “C. Davila” Bucharest

2 Institute of Diabetes, Nutrition & Metabolic Disease, Bucharest. 

 

     I. Objective: Diet and exercise are considered important treatment strategies of type 2 diabetes. The objective of this study is to assess the efficacy of low carbohydrate (45%)  

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and lipid (25% ), high protein ( 30% ) diet, as an alternative dietary treatment for obese patients with type 2 diabetes.

     II. Methods: A total of  69 obese patients with type 2 diabetes , 33 male ( 47,8% ) and 36 female ( 52,2% ), with a mean age  of 51,3± 8,7 years old, receiving oral hypoglicaemic agents, who had hypercholesterolemia ( total cholesterol > 200 mg/dl), hypertriglyceridemia and obesity ( BMI >30 kg/m2), were allocated to a low  carbohydrate ( 45% ) and lipid ( 25% ), high protein ( 30% ) diet and each patient had 3 hour/week regular physical activity. Their HbA1c, cholesterol, triglycerides and weight loss were monitored at the start of the study and again at 3 and 6 months.

     III. Results: Mean weight at baseline was 89,7 kg ( 72,5 - 121,5 kg ) and weight loss at 1, 3 and 6 month respectively, were 3,3 kg,  7,5 kg,  9,1 kg. Mean HbA1c at baseline was 8,8% ( 6,6% -11,2% ) and mean results at 3 and 6 month were 7,8% and 6,9%. Mean total cholesterol at baseline was 263 ± 20,3 mg/dl and at 3 and 6 month was 249 ± 21,5 mg/dl, respectively 240 ± 25,5 mg/dl . Triglyceridemia decreased with 26% after 6 month. Renal function as measured by serum creatinine and urea was assessed at the start of study, no patient with renal impairment was commenced on the diet. Urinary microalbumin and creatinine clearence were not different after 6 month.

     IV. Conclusions: A low carbohydrate and lipid, high protein diet may help to improve the metabolic control in type 2 obese diabetic patients. A high protein diet can generate weight loss, a better glycaemic control, without adverse effects on the renal function. This type of diet have a place in management of obese - type 2 diabetes in selected patients.

EPIDIAB 2008

6 LUNI: 1 IANUARIE-30 IUNIE 2008

Spitalul Judetean “Sf.Ioan cel Nou” Suceava

Secţia Diabet- Nutriţie-Boli Metabolice

R.Caziuc, C.Lazăr, V.Răcaru, G.Creţeanu

Obiectiv :

Evaluare incidenţei diabetului zaharat nou diagnosticat (în cursul anului 2008) la Centrul Antidiabetic Judeţean Suceava şi analizarea prezenţei complicaţiilor la momentul diagnosticului.

Material şi metodă:

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S-au luat în studiu un număr de 1468 cazuri noi cu diabet zaharat dintre care:

-83 pacienţi cu diabet zaharat insulinodependent.

-1385 pacienţi cu diabet zaharat tip II, la care au fost analizate datele antropometrice(înălţime, greutate,perimetrul taliei), clinice(tensiune arterială sistolică şi diastolică,examenul piciorului diabetic şi chestionar DN4), paraclinice(glicemie,profil lipidic,examen de urină,creatinină) şi examen oftalmologic.

Rezultate:

Distribuţia pe sexe la pacienţii cu diabet zaharat tip I a fost de 41% femei şi 59% bărbaţi,în timp ce la tipul II,procentul de femei a fost de 51%.

61% dintre pacienţii cu diabet zaharat tip I erau din mediul urban, iar la tipul II procentul a fost de 84%.

Pe grupe de vârstă,situaţia a fost următoarea:

-la pacienţii cu diabet zaharat tip I

-8,9% au avut vârsta sub 30 ani, 64% între 30-65 ani,27% peste 65 ani.

-la pacienţii cu diabet zaharat tip II

-64% au avut vârsta intre 30-65 ani, 36% peste 65 ani.

În privinţa indexului masei corporale,datele au fost:

-Diabet zaharat tip I:

-47% dintre pacienţi cu IMC < 25;

-30% dintre pacienţi cu IMC =25-29;

-23% dintre pacienţi cu IMC > 30.

-Diabet zaharat tip II:

-18% dintre pacienţi cu IMC < 25;

-27% dintre pacienţi cu IMC =25-29;

-55% dintre pacienţi cu IMC > 30.

La măsurarea talie, datele au fost: 64% dintre femeile cu diabet zaharat tip I au avut talia peste 80cm, în timp ce numai 22% dintre bărbaţi au avut talia peste 94cm; la pacienţii cu diabet zaharat tip II 66% dintre femei au avut talie peste 80cm, şi respective 60% dintre bărbaţi au măsurat în talie peste 90cm.

Complicaţiile la momentul diagnosticului:

- 24% dintre pacienţi au fost hipertensivi;

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- 22% cu valori patologice ale profilului lipidic;- 0,8% cu diagnostic de retinopatie;- 14% prezenţa neuropatiei diabetice;- 0,9% prezenţa nefropatiei diabetice.

Structura terapeutică a fost:

-83 pacienti în tratament cu insulină;

-21% dintre pacienţi au primit numai recomandare de dietă;

-62% tratament cu Metformin;

-2% au primit recomandarea de asociere a două antidiabetice orale;

-15 % pacienţi in tratament cu sulfoniluree sau alte antidiabetice orale.

Concluzii:

Numărul de pacienţi cu diabet zaharat nou diagnosticat este semnificativ mai mare în urma depistării active prin analizele recomandate de către medicii de familie,ridicându-se în aceste condiţii problema volumului de muncă la nivelul Unităţii Judeţene, necesitatea educării acestor pacienţi, precum şi monitorizarea acestora periodic.( ţinând cont de faptul că pacientul cu diabet zaharat tip II în tratament cu ADO nu beneficiază de automonitorizare).

EPIDIAB 20086 MONTHS: JANUARY 1ST – JUNE 30TH, 2008

R. Caziuc, C. Lazar, V. Racaru, G. Creteanu “Sf. Ioan cel Nou” Suceava County HospitalDepartment of Diabetes – Nutrition – Metabolic Diseases

Objective:To assess the incidence of newly diagnosed diabetes mellitus (during year 2008)

at the Suceava County Anti-Diabetic Centre and to analyze the presence of complications at the moment of diagnosis.Material and Method:

There were studied 1468 new cases with diabetes mellitus among which:- 83 patients with insulin-dependent diabetes mellitus - 1385 patients with type 2 diabetes mellitus, in whose case there were analyzed

the anthropometric data (height, weight, waist measurement), clinical data (systolic and diastolic arterial blood pressure, exam of the diabetic leg and questionnaire DN4), paraclinical data (blood glucose level, lipid profile, urine test, creatinine) and ophthalmologic exam.

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Results:The distribution according to sexes, at the patients with type 1 diabetes mellitus,

was 41% women and 59% men, while at type 2, the percentage of women was 51%. 61% of the patients with type 1 diabetes mellitus came from the urban

environment, and at type 2 the percentage was 84%. According to age groups, the situation was the following: - at the patients with type 1 diabetes mellitus - 8.9% were under 30 years old, 64% between 30-65 years old, 27% over 65 years

old- at the patients with type 2 diabetes mellitus

- 64% were between 30-65 years old, 36% over 65 years old. With respect to the body weight index, the data were:- Type 1 diabetes mellitus:

- 47% of patients with body weight index < 25- 30% of patients with body weight index = 25-29

- 23% of patients with body weight index > 30- Type 2 diabetes mellitus:

- 18% of patients with body weight index <25- 27% of patients with body weight index = 25-29

- 55% of patients with body weight index >30. In the case of waist measurement, the data were: 64% of women with type 1

diabetes mellitus had the waist over 80 cm, while only 22% of the men had the waist over 94 cm; at the patients with type 2 diabetes mellitus, 66% of women had the waist over 80 cm, and 60% of men measured in waist over 90 cm.

Complications at the moment of diagnosis:- 24% of patients had high blood pressure;

- 22% with pathologic values of the lipid profile;- 0.8% with diagnosis of retinopathy;

- 14% with presence of diabetic neuropathy;- 0.9% with presence of diabetic nephropathy.

The therapeutic structure was:- 83 patients in treatment with insulin;

- 21% patients received only a diet recommendation; - 62% treatment with Metformin;

- 2% received the recommendation to associate two oral anti-diabetic drugs;- 15% patients in treatment with sulfonylurea or other oral anti-diabetic drugs.

Conclusions:The number of patients with newly diagnosed diabetes mellitus is significantly

higher as a result of the active discovery through the tests recommended by the family physicians, in these conditions being raised the question of the work amount at the level of the County Unit, the necessity to educate these patients, as well as their periodical surveillance (taking into account the fact that the patient with type 2 diabetes mellitus in treatment with oral anti-diabetic drugs does not benefit from self-surveillance).

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EVALUAREA RISCULUI DE DIABET ÎNTR-UN GRUP POPULATIONAL DIN ROMANIA

Gabriela Ghimpeteanu*, Andreea Tocan*, Mihaela Gribovschi*, Ramona Stefan*, Andreea Morosanu*, Dana Birsan*, M.S. Ghimpeteanu, Gabriela Roman*

*Centrul Clinic de Diabet, Nutritie si Boli Metabolice Cluj-Napoca

Introducere: Prezenta unor factori de risc precum hipertensiunea arteriala, disglicemia, supraponderea/obezitatea asociate cu sedentarismul, obiceiurile alimentare nesanatoase si istoricul familial de diabet zaharat, are valoare predictiva pentru aparitia pe termen lung a diabetului zaharat in populatia generala.

Material si metoda: Au fost inclusi 368 subiecti neselectati, fără diabet zaharat din 6 orase mari din Romania (Brasov, Buzau, Piatra Neamt, Arad, Sibiu, Tg. Mures) . Acestora li s-a aplicat un chestionar pentru evaluarea riscului de a dezvolta diabet zaharat in urmatorii 10 ani. Chestionarul a inclus date generale (varsta, sex, mediu) , date antropometrice (circumferinta abdominala, greutate, inaltime, IMC) precum si date referitoare la nivelul de activitate fizica, obiceiuri alimentare, prezenta hipertensiunii arteriale, a disglicemiei si a agregarii familiale a diabetului zaharat. La finalul testului s-a calculat un scor de risc conform unui sistem de punctaj standardizat in cadrul studiului FINDRISK, in functie de care participantii au fost incardati in mai multe categorii de risc (scazut, usor crescut, moderat crescut, crescut si foarte crescut).

Rezultate: Din cei 368 subiecti, 80,2% au fost femei si 19,8%bărbati, 85,9 % au provenit din mediul urban si 14,1% din mediul rural. Din punct de vedere antropometric s-au obtinut urmatoarele rezultate: 40,2% au avut circumferinta abdominală (CA)<80cm la femei si <94cm la bărbati, 17,7% au avut CA între 80-88cm la femei si intre 90-94 cm la bărbati si 42,1 %au avut CA>88cm la femei si >102cm la barbati. Din punctul de vedere al indicelui de masă corporală (IMC), 47,83% din subiecti au fost normoponderali, 34,51% au fost supraponderali si 17,66% au fost obezi, pe sexe, repartitia fiind in procente relativ apropiate (normoponderali sex F- 48,5%, sex M-45,2%; supraponderali- sex F-32,88% si sex M-41,1%; obezi-sex F-18,64% si sex M-13,7%). Dupa repartitia pe categorii de scor, s-au evidentiat urmatoarle rezultate: scor de risc <7 (risc scăzut 1 subiect din 100 va dezvolta diabet in urmatorii 10 ani) -50,54%, respectiv 186 subiecti; scor 7-11(usor crescut, 1din 25): 27,71%-102 subiecti; scor 12-14(moderat crescut, 1 din 6): 14,67%-54 persoane; scor 15-20(risc crescut, 1 din 3): 6,25%-23persoane; scor >20(risc foarte crescut, 1 din 2): 0,81%-3 subiecti. Aproximativ 25% din subiecti au un stil de viata nesănătos (sunt sedentari, nu consumă zilnic fructe si legume proaspete) si au hipertensiune arteriala si/sau urmeaza tratament medicamentos pentru aceasta. Aproximativ 75% din participantii la studiu nu prezinta istoric familial de diabet zaharat, un sfert având rude cu diabet zaharat iar 15% au rude de gradul I cu diabet. Aproximativ 15% din participanti prezintă valori ale glicemiei bazale peste 110mg/dl. La studiu au participat persoane din mai multe grupe de varstă, jumatate fiind inclusi în categoria de varstă sub 45 de ani.

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Discutii si concluzii: Jumatate – 50,54% din lotul studiat a prezentat un risc scazut de aparitie a diabetului zaharat în următorii 10 ani, 43,2% au prezentat un risc intermediar, in timp ce doar 7,06% au fost identificati la risc crescut de a prezenta diabet zaharat tip 2 în următorii 10 ani. Lotul studiat a fost format preponderent din persoane tinere, active, sub 55 ani, din care in medie jumatate normoponderali si jumatate supraponderali si obezi cu predominanta netă a sexului feminin.

Chestionarul aplicat poate fi utilizat ca instrument de identificare a persoanelor cu risc crescut de a dezvolta diabet zaharat tip 2( mai ales pentru rudele pacientilor cu diabet zaharat), facând posibilă initierea precoce a OSV pentru a preveni/întârzia aparitia bolii.

Datele obtinute sunt asemănătoare cu cele rezultate din analizele obligatorii cerute de Ministerului Sănătăţii.

DIABETES RISK ASSESSMENT WITHIN A ROMANIAN POPULATION GROUP

Gabriela Ghimpeteanu*, Andreea Tocan*, Mihaela Gribovschi*, Ramona Stefan*, Andreea Morosanu*, Dana Birsan*, M.S. Ghimpeteanu, Gabriela Roman*

Introduction: The presence of risk factors such as hypertension, disglycemia, overweight/obesity, associated with sedentary lifestyle, unhealthy dietary habits and family history of diabetes, has predictive value for the long term development of diabetes within the general population.

Material and method: 368 unselected subjects without diabetes from six Romanian cities (Brasov, Buzau, Piatra Neamt, Arad, Sibiu, Tg. Mures) were included. A questionnaire was applied to the study group in order to evaluate the risk of develping diabetes within the next ten years. The questionnaire included general data( age, sex, environment), anthropometric data (waist cirumference, weight, height, BMI), as well as data regarding physical activity, dietary habits, the presence of arterial hypertension, disglycemia and family history of diabetes. At the end of the test , a risc score was calculated, according to a standardized scoring system within the FINDRISK study, which divided the patients into a few risk categories (low, slightly elevated, moderate, high, very high).

Results: From the 368 participants, 80,2% were women and 19,8% men, environment: 85,9 % urban and 14,1% rural, and from anthropometric point of view the following aspects were noticed: 40,2% had a waist circumference < 80cm in women and <94cm in men, 17,7% had a waist circumference 80-88cm in women and between 90-94 cm inmen and 42,1 % had a waist circumference >88cm in women and >102cm in men. As

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regarding the BMI, 47,83% of subjects had a normal weight, 34,51% were overweight and 17,66% were obese, sex repartition consisting of very close percents (normal weight females- 48,5%, males-45,2%; overweight- females -32,88% and males M-41,1%; obese: females-18,64% and males M-13,7%). The following risk categories came out when calculating risk scores: <7 (low risk- 1 subject in 100 will develop diabetes during the next 10years) -50,54%-186 subjects; score 7-11(slightly elevated, 1in 25): 27,71%-102 subjectsi; score 12-14(moderate, 1 in 6): 14,67%-54 persons; score 15-20 (high risk, 1 in 3): 6,25%-23persons; score >20 (very high risk, 1 din 2): 0,81%-3 subjects. On average, 25% have an unhealthy lifestyle ( sedentary, they don’t eat fruits and vegetables daily), and they suffer from hypertension and/or they are under medication for this condition. 75% of the questioned don’t have a family history of diabetes, 25% have relatives with diabetes of which, 15% first degree relatives. 15% of the study group have a fasting glycemia>110mg/dl. The study participants belong to different age groups, half of them being included in the < 45years.

Discussion and conclusions: Half-50,54%fo the study group had a low risk of developing diabetes within the next 10 years, 43,2% had a moderate risk, while only 7,06% were identified as being at high risk. The study group consisted mainly of young, active subjects, below 55years of age, from which half having a normal weight and half overweight and obese, with the clear predominance of females.

The questionnaire we applied could be used as an instrument of identifying people at increased risk of developing type 2 diabetes (especially realtives of people with diabetes), having the opportunity of an early initiation of lifestyle optimization, in order to prevent/delay the onset of this disease.

The data we collected are much alike the ones published by the Ministery of Health from the compulsory investigations’programme.

NUTRIŢIA PACIENŢILOR CU DIABET ZAHARAT

Conf. Dr. Gabriela Negrişanu, UMF „Victor Babeş” Timişoara

Dr. Raluca Memu, Spitalul Judeţean Drobeta Turnu Severin

Introducere

De-a lungul timpului, recomandările alimentare pentru pacienţii cu diabet zaharat (DZ) s-au dovedit destul de restrictive în privinţa hidraţilor de carbon (HC). Regimul alimentar (dieta) în DZ a trecut prin mai multe etape: restricţia totală a regimul bogat în lipide şi legume, „dieta convenţională”, hipoglucidică. Din 1980 s-a estimat că raţia glucidică în DZ poate fi de 55-60% din necesarul caloric (NC), lipidele maxim 30%, iar proteinele

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maxim 20%. ADA subliniază rolul individualizării regimului alimentar prin aplicarea terapiei medicale nutriţionale (medical nutritional therapy-MNT)

Conţinut

Modificarea obiceiurilor alimentare joacă un rol major în tratamentul şi managementul DZ. Obiectivele MNT pentru pacienţii cu DZ sunt: obţinerea şi menţinerea glicemiei la niveluri normale/apropiate de normal, a profilului lipidic şi lipoproteic ce asigură un risc cardiovascular redus, a TA la niveluri normale/apropiate de normal, prevenirea/încetinirea ratei de dezvoltare a complicaţiilor cronice ale DZ, asigurarea necesităţilor nutriţionale individuale. Obiectivele MNT pentru tinerii cu DZ 1, DZ 2, gravidele şi femeile care alăptează, vârstnicii cu DZ sunt asigurarea necesităţilor nutriţionale, iar pentru cei trataţi cu insulină sau secretagoge, asigurarea autocontrolului şi tratamentul DZ în bolile acute.

Este încurajat consumul de HC din fructe, cereale integrale, legume, leguminoase şi produse lactate degresate. Trebuie limitat aportul de grăsimi saturate la sub 7% din NC, cu evitarea consumului de grăsimi trans cu un aport de colesterol alimentar sub 200mg/zi şi consumul a cel puţin 2 porţii de peşte săptămânal. Sunt dovezi insuficiente care să indice modificarea aportului proteic obişnuit (15-20% din NC) la diabeticii cu funcţie renala normală. Numeroase studii au încercat să stabilească proporţia optimă a macronutrienţilor în dieta diabeticilor. Individualizarea compoziţiei în macronutrienţi se va realiza în funcţie de statusul metabolic al pacientului. Aportul zilnic de alcool trebuie limitat la o cantitate moderată. Nu există dovezi clare ale beneficiului suplimentării cu vitamine şi minerale la pacienţii cu DZ care nu prezintă deficite.

Insulinoterapia trebuie integrată într-un plan individual de dietă şi activitate fizică. Pacienţii cu DZ tip 2 sunt încurajaţi să implementeze modificarea stilului de viaţă. Pentru femeile gravide şi cele care alăptează cu DZ, trebuie asigurat aportul energetic adecvat care să asigure greutatea corporală corespunzătoare. Vârstnicii obezi cu DZ pot avea unele beneficii în urma unei restricţii calorice modeste şi a creşterii nivelului de activitate fizică. Se recomandă reducerea aportului proteic la 0,8-1 g/kgc/zi la diabeticii care prezintă stadii incipiente de boală cronică renală şi la 0,8 g/kgc/zi la cei cu boală cronică renală. Pentru diabeticii cu risc cardiovascular, dietele bogate în fructe, legume, cereale integrale, oleaginoase pot reduce riscul cardiovascular. Tratamentul obişnuit al hipoglicemiei este reprezentat de ingestia a 15-20 g de glucoză.

Aplicarea terapiei medicale nutriţionale presupune parcurgerea a 4 etape: evaluarea statusului iniţial, stabilirea obiectivelor, intervenţia nutriţională, evaluarea periodică.

NUTRITION OF DIABETIC PATIENTS

Ass. Prof. Dr. Gabriela Negrisanu, University of Medicine and Pharmacy “Victor Babes”, Timisoara

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Dr. Raluca Memu, County Hospital, Drobeta Turnu Severin

Introduction

Nutritional recommendations for diabetic patients were restrictive regardless carbohydrates for a long time. The diet has passed some periods: total restrictive in carbohydrates, a diet rich in fat and legumes, “conventional diet” period. From 1980 was accepted that carbohydrate may represent 55-60% from caloric necessary, fat 30% or less and protein 20% or less. ADA pointed out the role of individualization of the diet and the role of medical nutritional therapy-MNT.

Content

Dietary habits modification plays an important role in treatment and management of diabetes mellitus.Goals of MNT that apply to individuals with diabetes are: achieve and maintain blood glucose levels in the normal range, lipid and lipoprotein profile that reduces the risk for vascular disease, blood pressure levels in the normal range, to prevent/slow the rate of development of the chronic complications of diabetes. Goals of MNT that apply to youth with diabetes, pregnant and lactating women, and older adults with diabetes are: to meet the nutritional needs and for individuals treated with insulin or insulin secretagogues, to provide self-management training and diabetes treatment during acute illness.

In diabetes management, are recommended carbohydrate from fruits, vegetables, whole grains, legumes, and low-fat milk, to limit saturated fat intake to 0.7% of total calories, to minimized intake of trans fat, to limit dietary cholesterol to 0.200 mg/day. For individuals with diabetes and normal renal function, there is insufficient evidence to suggest that usual protein intake (15–20% of energy) should be modified. Numerous studies have attempted to identify the optimal mix of macronutrients for the diabetic diet. The best mix of carbohydrate, protein, and fat appears to vary depending on individual circumstances. Individualization of the macronutrient composition will depend on the metabolic status of the patient. Alcohol daily intake should be limited to moderate amount. There is no clear evidence of benefit from vitamin or mineral supplementation in people with diabetes who do not have underlying deficiencies.

Insulin therapy should be integrated into an individual’s dietary and physical activity pattern. Individuals with type 2 diabetes are encouraged to implement lifestyle modifications. For pregnancy and lactation with diabetes adequate energy intake that provides appropriate weight gain is recommended. Obese older adults with diabetes may benefit from modest energy restriction and an increase in physical activity. Reduction of protein intake to 0.8–1.0 g/kg body wt/day in individuals with diabetes and the earlier stages of chronic kidney disease (CKD) and to 0.8 g/kg body wt/day in the later stages of CKD may improve measures of renal function and is recommended. For patients with diabetes at risk for CVD, diets high in fruits, vegetables, whole grains, and nuts may reduce the risk. Ingestion of 15–20 g glucose is the preferred treatment for hypoglycemia.

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For the implementation of MNT it is necessary to run through 4 steps: evaluation of initial status, establishment of the goals, nutritional intervention, periodical evaluation.

FACTORII DE RISC CARDIOVASCULAR ŞI STAREA POSTPRANDIALĂ ÎN DIABETUL ZAHARAT TIP 2

Gabriela Roman1,2, Andreea Moroşanu2, Delia Roman2, Mariana Coca2, N. Hâncu1,2

1Universitatea ”Iuliu Haţieganu”; 2Centrul Clinic de Diabet, Nutriţie, Boli metabolice, Cluj-Napoca

Background. Factorii de risc cardiovascular se asociază prin mecanisme etioptaogenice interdependente în cadrul sindromului metabolic şi al diabetului zaharat tip 2. Statusul postprandial este considerat un important factor de risc cardiometabolic, prin hiperglicemie, hiperlipidemie, inflamaţie, adipokine aterogene. Obiectiv. Studiul de faţă a avut ca obiectiv evaluarea implicării adiponectinei, visfatinei şi a markerilor inflamatori în statusul postprandial în dibetul zaharat tip 2. Design şi metode. În studiu au fost incluse 40 persoane cu DZ tip 2 şi obezitate şi 5 persoane normoponderale fără diabet ca şi control. Probele biochimice au fost prelevate în condiţii bazale, la 2 şi 4 ore postprandial: glicemia, lipide, adiponectină, visfatină, TNF-alpha, interleukină-6, high sensitive C-Reactive protein, fibrinogen. Resultate. În condiţii bazale au fost evidenţiate diferenţe semnificative între lotul de personae cu diabet zaharat şi lotul de control în ce priveşte visfatina (26 ± 18,3 vs. 12.5 ± 3 ng/ml; p = 0.02) şi high sensitive C-Reactive protein (4.7 ± 3.7 vs. 0.38 ± 0.35 mg/L; p=0.001). În statusul postprandial, o creştere semnificativă a fost observată în cazul visfatinei (p=0.03), interleukinei-6 (p=0.012) şi high sensitive C-Reactive protein (p=0.017). În cadrul grupului cu diabet zaharat, la 2 ore postprandial s-a constatat o creştere semnificativă a glicemiei şi la 4 ore postprandial a TNF-alpha şi C-Reactive protein. Concluzii. Creşteri semnificative la persoanele cu diabet zaharat tip 2 comparativ cu lotul de control au fost constatate în cazul visfatinei şi high sensitive C-Reactive protein. Adiponectina a fost scăzută la cei cu diabet zaharat, fără diferenţă semnificativă cu lotul de control. În grupul cu diabet, TNF-alpha, C-Reactive protein şi glicemia au fost crescute postprandial, ceea ce demonstrează că în diabetul zaharat tip 2 acţionează multiplii factori de risc cardiovascular.

Keywords: risc cardiometabolic, adiponectină, visfatină, status postprandial

CARDIOVASCULAR RISK FACTORS AND POSTPRANDIAL STATUS IN TYPE 2 DIABETES MELLITUS

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Gabriela Roman1,2, Andreea Moroşanu2, Delia Roman2, Mariana Coca2, N. Hâncu1,2

1”Iuliu Hatieganu” University of Medicine and Pharmacy; 2Clinical Center of Diabetes, Nutrition, Metabolic diseases, Cluj-Napoca, Romania

Background: The cardiometabolic risk factors are clustered by interdependent ethiopathogenetic mechanisms, within the metabolic syndrome and type 2 diabetes. Due to hyperglycemia and hyperlipidemia, postprandial state is now recognized an important factor that increases the cardiovascular risk. Also other atherogenetic risk factors may be associated with postprandial state: inflammation, adipokynes. Objective: The aim of the study was to evaluate the involvement of adiponectin, visfatin and inflammatory markers in the postprandial state in people with type 2 diabetes. Design and method: A number of 40 persons with type 2 diabetes and obesity have been included. Five normoponderal persons without diabetes have provided the control. Blood test have been performed fasting and at 2 and 4 hours postprandial: glycemia, lipids, adiponectin, visfatin, inflammatory markers (TNF-alpha, interleukin-6, high sensitive C-Reactive protein, fibrinogen). Results: In basal conditions, significant differences have been found between the persons with obesity and type 2 diabetes and the control group in terms of visfatine (26 ± 18,3 vs. 12.5 ± 3 ng/ml; p = 0.02) and high sensitive C-Reactive protein (4.7 ± 3.7 vs. 0.38 ± 0.35 mg/L; p=0.001). In postprandial state, significant increase of visfatine (p=0.03), interleukin-6 (p=0.012) and high sensitive C-Reactive protein (p=0.017) have been found in diabetes group compare to control. Within diabetes group, a significant 2-hour postprandial glycemia and 4-hour postprandial increase of TNF-alpha and C-Reactive protein has been found. Conclusions. A significant difference between diabetes and control has been found in terms of visfatin and high sensitive C-Reactive protein that are increased in diabetes. Adiponectin was lower in diabetes group, but not statistically significant compare to control group. In diabetes group, TNF-alpha, C-Reactive protein and glycemia have been found to be increased in the postprandial state, which demonstrates that in diabetes, multiple factors act to increase cardiovascular risk.

Keywords: cardiometabolic risk, adiponectin, visfatin, postprandial state

ROLUL LDL COLESTEROLULUI IN CADRUL SINDROMULUI METABOLIC

Georgeta Inceu1, Nicolae Hancu1,2

1Centrul Clinic de Diabet Zaharat, Nutritie si Boli Metabolice, Cluj-Napoca

2Universitatea de Medicina si Farmacie “Iuliu Hatieganu”, Cluj-Napoca

Introducere si obiective

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Diabetul zaharat este considerat echivalent de boala cardiovasculara, astfel incat tintirea agresiva a tuturor factorilor ce alcatuiesc riscul cardiometabolic constituie un obiectiv major in cadrul managementului pacientilor cu diabet zaharat. LDL colesterolul este un important factor de risc cardiovascular, dar implicatiile sale in cadrul sindromului metabolic constituie inca o controversa. Lucrarea de fata isi propune analiza unei posibile corelatii intre sindromul metabolic si LDL colesterol la pacientii cu diabet zaharat tip 2.

Material si metoda

Am efectuat un studiu retrospectiv la pacientii cu diabet zaharat tip 2 (DZ tip 2) internati in Centrul de Diabet Cluj in perioada ianuarie-martie 2008. Am analizat date clinice si demografice, prezenta sindromului metabolic (conform criteriilor IDF 2005), a bolii cardiovasculare, schemele de tratament folosite, precum si corelatia dintre LDL colesterol (luand ca si obiectiv tinta valoarea de 100mg/dl) si diversi factori de risc cardiovascular (in particular sindromul metabolic). Datele au fost prelucrate si analizate cu programul SPSS 10.

Rezultate

Intreg lotul analizat a inclus 200 de pacienti cu DZ tip 2, cu varsta medie de 58±9,25 ani, 41,5% barbati, cu o durata medie a diabetului de 10,2±7,03 (1-31) ani. Referitor la tratament, 1,1% erau sub monoterapie orala, 11,2% cu terapie orala combinata, 42% au beneficiat de asocierea insulina-antihiperglicemiante orale, 45,7% erau numai sub insulinoterapie, in timp ce 45,9% din intreg lotul aveau metformin in schema terapeutica. Dintre pacienti, 88,8% erau hipertensivi, 92,6% intruneau criteriile sindromului metabolic, 42% erau diagnosticati cu boala cardiovasculara si 79,3% aveau complicatii microvasculare prezente. Dintre pacientii cu sindrom metabolic 54,5% aveau LDL colesterol ≥100 mg/dl si 62,6% erau cu trigliceride ≥150mg/dl. Dintre pacientii cu boala cardiovasculara prezenta 49,4% erau cu LDL colesterol ≥100mg/dl si 65,8% cu trigliceride ≥150mg/dl. Analizand separat pacientii cu LDL cholesterol≥100mg/dl (acestia reprezinta 50,35% din intreg lotul ) am constatat ca 87,4% sunt hipertensivi, 40% au fost diagnosticati cu boala cardiovasculara si o majoritate covarsitoare (94,7%) intrunesc criteriile de diagnostic ale sindromului metabolic.

Concluzii

Rezultatele acestei analize observationale ilustreaza inca o data rolul fundamental al LDL colesterolului la pacientii cu sindrom metabolic si diabet zaharat. Faptul ca peste 90% dintre pacientii cu LDL cholesterol ≥100mg/dl intruneau criteriile de diagnostic ale sindromului metabolic, fac plauzibila ipoteza ca aceasta formatiune lipidica cu rol central in aterogeneza ar putea deveni parte integranta in cadru conceptului de sindrom metabolic.

LDL CHOLESTEROL AND ITS ROLE IN METABOLIC SYNDROME

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Georgeta Inceu1, Nicolae Hancu1,2

1Clinical Center of Diabetes, Nutrition, Metabolic diseases, Cluj-Napoca, Romania

2“Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca

Introduction and objective

Diabetes mellitus is considered cardiovascular disease equivalent, so aggressive targeting of all cardiometabolic risk factors is a major objective in the management of diabetic patients. LDL cholesterol is an important cardiovascular risk factor, but its implications in the metabolic syndrome are still a controversy. This paper aims to analyze a possible correlation between metabolic syndrome and LDL cholesterol in patients with type 2 diabetes.

Material and method We conducted a retrospective study in patients with type 2 diabetes admitted in Cluj Diabetes Center during January to March 2008. We analyzed demographic and clinical data, the presence of metabolic syndrome (defined according to the IDF 2005 criteria), cardiovascular disease, treatment schemes used, as well as the relationship between LDL cholesterol (taking as objective target value of 100mg/dl) and various cardiovascular risk factors (in particular metabolic syndrome). The data were processed and analyzed with the SPSS 10. Results The entire batch analyzed included 200 patients with type 2 diabetes, with an average age of 58 ± 9.25 years, 41.5% men, with an average duration of diabetes 10.2 ± 7.03 (1-31) years. Regarding the treatment, 1.1% were under oral monotherapy, 11.2% received combined oral therapy, 42% benefited from the combination of oral therapy and insulin, 45.7% were under insulin therapy, while 45.9% of all patients had metformin in their treatment regimen. 88.8% of the patients were hypertensive, 92.6% meet the metabolic syndrome criteria, 42% were diagnosed with cardiovascular disease and 79.3% had microvascular complications. Among patients with metabolic syndrome 54.5% had LDL cholesterol ≥ 100 mg / dl and 62.6% had triglycerides ≥ 150mg/dl. Among patients with this cardiovascular disease 49.4% had LDL cholesterol ≥ 100mg/dl and 65.8% had triglycerides ≥ 150mg/dl. When separately analyzed patients with LDL cholesterol ≥ 100mg/dl (this represents 50.35% of the entire lot) we found that 87.4% are hypertensive, 40% were diagnosed with the cardiovascular disease and an absolute majority (94.7%) meet metabolic syndrome diagnosis criteria. Conclusions Observed results of this paper illustrate once again the fundamental role of LDL cholesterol in patients with metabolic syndrome and diabetes. The fact that over 90% of patients with LDL cholesterol ≥ 100mg/dl meet the diagnostic criteria for metabolic syndrome, make plausible the assumption that this lipoprotein components with a central role in atherogenesis could become an integral part of the metabolic syndrome concept.

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RAPORTARE DE CAZ:

HIPOGLICEMII REPETATE LA O PACIENTĂ DIABETICĂ IN PROGRAM DEHIPOGLICEMII REPETATE LA O PACIENTĂ DIABETICĂ IN PROGRAM DE DPCA ÎN TRATAMENT CU SOLUŢII DE ICODEXTRINDPCA ÎN TRATAMENT CU SOLUŢII DE ICODEXTRIN

G. IoniţăG. Ioniţă11, D. Pencu, D. Pencu22, A. Cirjan, A. Cirjan22, C. Ionescu, C. Ionescu22, M. Voiculescu, M. Voiculescu22

1 1 Institutul National de Diabet, Nutriţie şi Boli Metabolice N. C. Paulescu , Bucuresti, Institutul National de Diabet, Nutriţie şi Boli Metabolice N. C. Paulescu , Bucuresti, RomaniaRomania

22Institutul Clinic Fundeni CInstitutul Clinic Fundeni Cententrul de Medicină Internă-rul de Medicină Internă- Buc Bucureşti,ureşti, Romania Romania

Din ce în ce mai mulţi pacienţii cu IRC stadiul uremic sunt incluşi în programul de dializă peritoneală continuă ambulatorie.

Dintre aceştia, pacienţii cu diabet zaharat sunt o categorie aparte ce implică o serie de probleme suplimentare în ceea ce priveşte interferenţa între tratamentul insulinic şi soluţiile de dializă peritoneală. Se preferă folosirea soluţiilor peritoneale de Icodextrin (Extraneal), un polimer al glucozei derivat din porumb care presupune o absorbţie scăzută a carbohidraţilor, permiţând astfel un mai bun control al glicemiei şi care poate îmbunătăţi ultrafiltrarea şi clearance-ul creatininei la pacienţii cu PET HighAverage sau High.(transport peritoneal Înalt sau ÎnaltMediu).

Deşi Icodextrinul nu este metabolizat în peritoneu, poate fi absorbit prin sistemul limfatic în circulaţia sistemică, unde este hidrolizat de către amilază în oligozaharide(maltoză, maltotrioză). Multe glucometre folosesc in benzile teste glucoz-dehidrogenaza cu coenzima piroloquinolinequinone, pentru a cataliza conversia glucozei la acidul gluconic şi a reduce acidul adenin dinucleotid nicotinamidic (NADH). Cantitatea de NADH măsurată de glucometru este direct proporţională cu concentraţia glucozei din mostra de sânge. Glucoz-dehidrogenaza cu coenzima piroloquinolinequinone (PQQ) poate reacţiona cu radicalul liber al glucozei localizat la capătul moleculei de maltoză, producând o cantitate adiţională de NADH, contribuind la supraestimarea nivelului glicemiei. (3).

Vom prezenta cazul unei paciente cu DZ tip I şi IRC std V în program DPCA, în tratament cu Icodextrin, care a suferit repetate hipoglicemii datorită măsurătorilor inadecvate a glicemiilor măsurate cu glucometru pe bază de glucoz-dehidrogenază.

Pacienta, în vârstă de 43 ani, cunoscută cu diabet zaharat tip 1 din 1994 în tratament cu insulina aspart:10U(ora8)-10U(ora14)-10U(ora20) şi insulina glargina: 10U(ora22), nefropatie diabetică din 2006, HTA secundara reno-parenchimatoasă, dislipidemie mixtă, insuficienţă renală cronică din 2006 în program de

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DPCA din 07.06.2007 se internează pentru sindrom febril 38-39 °C şi sughiţ de aproximativ 24ore, stare confuzională( iniţial agitaţie psihomotorie, ulterior refuz alimentar şi verbal de cca 48ore). Menţionăm că la domiciliu pacienta a prezentat numeroase episoade hipoglicemice (non-complianţă la regimul alimentar şi tratament antidiabetic, non-complianţă la indicaţia de neutilizare pt determinarea glicemiei a glucometrelor- test de glucoz-dehidrogenază) şi nu a mai urmat medicaţia antidepresivă ăn ultimele 2 luni (non-complianţă la tratament).

Obiectiv: stare generală mediocră, conştientă, febrilă (38°C), agitaţie psiho-motorie, dezorientată temporo-spaţial, areactivă la stimuli verbali, reactivă la stimuli dureroşi; redoare de ceafă, opistotonus; tegumente şi mucoase palide, uscate; fara edeme; ap respirator –MV prezent bilateral, fara raluri; ap cardiovascular – TA 230/100 mmHg , AV-90/ min, ritm regulat, fara sufluri supraadăugate, artere periferice pulsatile; ap digestiv – abdomen suplu, uşor sensibil la palpare în epigastru, mobil cu mişcările respiratorii, ficat şi splina în limite normale, tranzit intestinal normal; ap urinar – loje renale libere, Giordano (-) bilateral, diureza=500ml, UF=1000ml/24ore, efluent limpede.

Paraclinic: sdr anemic(Hb 10.7-8.8 g/dl, Ht 33.1-27.1%), sdr inflamator: Leucocitoză(15600-22600/mmc), Fbg=564mg/dl, hipoalbuminemie, hipoproteinemie, coagulare, Na, K în limite normale, hipocalcemie, sdr de retenţie azotată: creatinina=6.9-6.1mg/dl, uree=163-213mg/dl, oscilaţii hipo-hiperglicemice cu valori între 44-559 mg/dl) (determinări pe laborator).

Consultul neurologic a infirmat suspiciunea de menigită(Puncţia lombară- LCR limpede, fără celule, proteinorahie normala) sau de AVC (CT cerebral fără acumulări hemoragice cu caracter recent intracerebrale) şi a pus diagnosticul de Encefalopatie metabolică cu febra de origine centrală. Pe parcursul internării pacienta a prezentat crize convulsive cu debut membre drepte şi generalizare secundară, remise după administrare de diazepam iv; s-a repetat puncţia lombară- cu proteinorahie normală. Consultul psihiatric a confirmat întreruperea tratmanetului antidepresiv şi a pus diagnosticul de depresie reactivă. S-a efectuat RMN cerebral care a decelat leziuni demielinizante supratentoriale bilaterale de mici dimensiuni, minim proces inflamator mastoidian bilateral şi sfenoidal şi moderată atrofie cerebrală.

În timpul internării pacienta a primit tratament de echilibrare hidroelectrolitica şi acido-bazică, insulinoterapie, hipotensoare, anticonvulsivante şi antidepresive cu evoluţie lent favorabilă, cu remiterea convulsiilor şi a sdr febril , remiterea sindromului de agitaţie psiho-motorie şi creşterea gradului de complianţă la regimul alimentar şi medicamentos în condiţiile controlului glicemic şi normalizarea calcemiei.

Am considerat simptomatologia de la internare şi din cursul spitalizării secundară unor episoade repetate de hipoglicemie şi agravării tulburării depresive reactive prin non-complianţa la dietă şi insulino-terapie, prin utilizarea nepermisă a glucometrelor pe bază de dehidrogenază în contextul dializei peritoneale cu Icodextrin şi prin non-complianţa la terapia antidepresivă.

S-au făcut studii comparative între diferite metode de măsurare a glicemiei pe bază de glucometre- prin glucoz-dehidrigenază, prin glucoz-oxireductază, prin glucoz-

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oxidază comparativ cu valorile măsurate prin metoda de laborator din sângele venos(hexokinază) la diabeticii aflaţi în DPCA cu soluţii cu Icodextrin. Toate glucometrele supraestimează valorile glicemiei, cele mai mici diferenţe faţă de valorile obţinute prin laborator au fost înregistrate cu glucometrele pe bază de glucoz-oxidază. Inclusiv firma producatoare de Icodextrin avertizează asupra supraestimării valorilor glicemiei determinate cu glucometre pe bază de GDH PQQ şi glucoz-oxidoreductază la pacienţii diabetici in program de DPCA cu soluţii de Icodextrin.(2). Cu toate acestea încă se mai observă cazuri de hipoglicemii din cauza folosirii acestor glucometre.

CASE REPORT:

REPEATED HYPOGLICEMIC EPISODES IN A DIABETIC PATIENT WITH ESRD AND PERITONEAL DYALISES WITH ICODEXTRIN SOLUTION

G. IoniţăG. Ioniţă11, D. Pencu, D. Pencu22, A. Cirjan, A. Cirjan22, C. Ionescu, C. Ionescu22, M. Voiculescu, M. Voiculescu22

11 Institute of Diabetes, Nutrition and Metabolic Diseases "N. C. Paulescu", Bucharest Institute of Diabetes, Nutrition and Metabolic Diseases "N. C. Paulescu", Bucharest RomaniaRomania

22 Fundeni Fundeni Clinical Institute - Center of Internal Medicine, BucClinical Institute - Center of Internal Medicine, Bucharest,harest, Romania Romania

More and more patients suffering from ESRD are included in peritoneal dialyses programes. Diabetic patients with ESRD and CCDP have to be carefully monitorised because of the interferences between insulin treatment and dialyses solutions. Icodextrin (Extraneal) peritoneal dialysis solution is a glucose polimer derived from cornstarch wich has a low carbohydrates absobtion and is prefered in diabetic patients because of a better glicemic control and because it can improve long-dwell ultrafiltration and clearance of creatinine for patients with High-average or High PET.

These glucose polymers are absorbed via the peritoneal route and metabolised to oligosaccharides (mainly maltose), which interfere with glucose. Many glucometers are using the glucose dehydrogenase, an enzyme of the pyrroloquinolinequinone class, for catalysing the conversion of glucose to gluconic acid and reducing Nicotinamide adenine dinucleotide Acid (NADH). The quantity of NADH is in direct proportion with the glicemia. The glucose dehydrogenase reacts with the free reducing group of the glucose molecule located at the end of each saccharide chain and this aditional quantity of NADH is leading to an overestimation of the glicemia.

We will present the case of a patient with diabetes mellitus type I and ESRD in dialysis peritoneal program with Icodextrin, that presented several hypoglicemic episodes because of the inadequacy measurements of glycemia using glucose dehydrogenase pyrroloquinolinequinone glucometers.

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The patient, a woman of age 43 years, with diabetes mellitus type I from 1994 in treatment with aspart insulin: 10U( at 8 a.m.)- 10U( at 14 a.m.)- 10U( at 8 p.m.) and glargina insulin: 10U( at 10 p.m.); diabetic nephropathy(2006); renal hypertension; dyslipidemia; ESRD in dialysis peritoneal program from 07.06.2008. She presented for fever (38-39 °C), hiccup (for the last 24 hours), confusional state (initially anxiety, then she refused to speak and to eat for the last 48 hours). The patient presented several hypoglicemic episodes (noncompliance at the diet and medical treatment, noncompliance at the indication of not using glucose-dehydrogenase glucometers) and she has stopped the antidepressive medication for the last two months.

Physical examination: fever(38°C), anxiety, confusion; nonreactive to verbal stimuli but reactive to pain; nuchal rigidity to passive flexion, opisthotonus; pale skin and mucous membranes; no edema; pulmonar exam – normal; cardiovascular exam: TA-230/100mmHg, HR-90/min; mild epigastric tenderness ; no hepatosplenomegaly; Giordano (-) bilateral, diuresis -500ml/day, ultrafiltrate -1000ml/day, clear peritoneal effluent.

Paraclinical: anemic sindrom (Hb 10.7-8.8 g/dl, Ht 33.1-27.1%), inflamatory sindrom (WBC-15600-22600/mmc, Fbg=564mg/dl, hypoalbuminemia, hypoproteinemia, hypocalcemia, coagulation, Na, K – normal, chronic renal disease(creatininemia=6.9-6.1mg/dl, BUN=163-213mg/dl, hypo-hyperglicemic values between 44-559 mg/dl.

Neurology specialist infirmed the suspicion of meningitis(lombar puncture – clear cephalorahidian liquid, normal proteinorahia) or of stroke (cerebral tomography- no hemoragy ) and diagnosed the patient with Metabolic Encephalophaty and fever of central origin.During the hospitalisation she presented two partial seizures with secondary generalization remited after Diazepam i.v. A lombar puncture was repeated and was normal.

The Psychiatrist confirmed that the patient stoped her antidepressive treatment and diagnosed the Reactive Depression. The cerebral RMI found small supratentorial demyelinization lesions, minimal inflamatory process at the mastoid et sfenoid and moderate cerebral atrophy.

During the hospitalization the patient received hydratation and acid-alkali equilibration treatament, insulin, antihypertensives, anticonvulsivants and antidepressives with seizures, fever and anxiety remission, with a better compliance to the diet and medical treatment, with a better glicemic control and normalization of the calcemia. We c

We considered the simptomatology as a consequence of the hypoglicemic episodes and of the agravation of the reactive depression due to noncompliance to the diet and insulin treatment and utilisation of the glucose dehydrogenase glucometers while peritoneal dyalises with Icodextrin solution and noncompliance to the antidepressive therapy.

There are comparative studies between different methods of glycemia measurement at diabetics in peritoneal dyalise with Icodextrin using glucose dehydrogenase, glucose dehydrogenase nicotinamide adenine dinucleotide, or glucose

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oxidase glucometers and in venous blood using the laboratory reference method (hexokinase). All glucometers overestimate real blood glucose concentration; the minimal errors were obtained using glucose oxidase glucometers. Even the producers of Icodextrin warn about overestimation of glicemic values using glucose dehydrogenase or glucose oxidoreductase glucometers, but there are still cases of severe hypoglicemia because of the use of this glucometer.

ASPECTE EPIDEMIOLOGICE IN DIABETUL ZAHARAT TIP 2 -

- CAD ( CENTRUL ANTIDIABETIC) SIBIU, 1975 – 2007Dr. Ghise Ghe.*, Dr. Strugariu Minola*, Dr. Mot Alina*, Dr. Natea Carmen Narcisa *, **;

*Spitalul Clinic Jud. de Urgenta Sibiu – Clinica Diabet, Nutritie si Boli Metabolice ;

** Facultatea de Medicina ” Victor Papilian ’’Sibiu, ULBS

Introducere si obiective:

Incidenta diabetului zaharat tip 2 este in crestere in intreaga lume, DZ fiind considerat ca boala endemica; din pacate, complicatiile cronice ale DZ au consecinte devastatoare privind calitatea vietii, speranta de viata a pacientilor, presupunand mari costuri atat pentru individ cat si pentru societate.

Autorii si-au propus analiza catorva aspecte epidemiologice ale DZ tip 2 in teritoriul arondat CAD Sibiu cu intentia de a dsprinde particularitatile locale ale acestei probleme pentru ca astfel sa poata gasi metodele necesare imbunatatirii calitatii ingrijirii.

Material si metoda:

Studiul s-a realizat printr-o metoda retrospectiva, datele fiind obtinute de la Centrul Judetean de Statistica si Centrul de diabet in perioada 1975 – 2007. In studiul noastre am urmarit:

1) Prevalenta si incidenta DZ;2) Rata complicatiilor in momentul diagnostic;3) Evolutia ratei mortalitatii;4) Perioada de supravietuire si speranta de viata.

Rezultate:

Prevalenta DZ in teritoriul arondat orasului Sibiu a crescut de la 1577 ( 1,6%) – in 1975, la 6,2% - in 2007; incidenta a crescut de la 77,59 ‰ – 1975 la 253,16‰ in 2007 ; rata mortalitatii la persoanele diabetice s-a mentinut relativ stabil – 5,5% ; repartitia pe sexe a fost : barbati : 51, 63%, femei – 48,36% ; in raport de tipul de DZ : DZ tip I – 20, 38%,

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tip II – 79, 61% ; durata medie a evolutiei aparente a DZ a fost de 16,3 ani ; ponderea cea mai mare a deceselor a fost inregistrata la cei cu o durata a diabetului cuprinsa intre 6 – 10 ani si fiind aproape dubla fata de cei cu evolutia DZ cuprinsa intre 1-5 ani si 11 -15 ani ; mortalitatea cea mai mare a fost inregistrata la grupele de varsta 60- 69 ani si 70 -79 ani, fiind de 2,5 ori mai mare fata de grupa de varsta 50-59 ani. Cauzele principale de deces au fost : boli cardiace- 61, 33%, AVC – 8,42%, tumori – 12, 74%, boli ale ap. respirator – 9,8%. altele –7,7%.

Concluzii :

1) Prevalenta si incidenta DZ are aceeasi tendinta cu cea inregistrata in intreaga lume si in Romania ;

2) Incidenta mult crescuta din ultimii ani este data nu numai de evolutia naturala a DZ , cat si de depistarea activa ;

3) Incidenta complicatiilor cronice in momentul diagnostic este fals redusa din lipsa investigatiilor specifice ;

4) Nu dispunem de date referitoare la diabetul getational ; acest aspect va putea fi corectat doar prin colaborare eficienta cu medicii de familie si medicii ginecologi.

TYPE 2 DIABETES MELLITUS – SOME EPIDEMIOLOGYCAL ASPECTS – SIBIU COUNTY, 1975 – 2007

Dr. Ghise Ghe.*, Dr. Strugariu Minola*, Dr. Mot Alina*, Dr. Natea Carmen Narcisa *, **;

*Spitalul Clinic Jud. de Urgenta Sibiu – Clinica Diabet, Nutritie si Boli Metabolice ;

** Facultatea de Medicina ” Victor Papilian ’’Sibiu, ULBS

Introduction and aims:

The type 2 diabetes incidence is increasing throughout the world, it has being considerated an endemic disease. Unfortunately the cronic complications of diabetes have devastating consequences on the life quality, life expectancy and impose a great burden to individuals and society. The authors proposed to analyse some epidemiological aspects of type 2 diabetes in Sibiu District in order to know the local particularities of this problem and so to prove the specific measures to improve the quality of care.

Material and method:

The study was done by a retrospective method, the informations were collected from the Statistic Departamental Center and Diabetes Center of Sibiu County in the period 1975 –

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2007; in our study we had a view: 1) the prevalence and incidence of diabetes; 2) the rate of complications at the moment of diagnostics; 3) the evolution of the rate of mortality; 4) survive period and expectancy of life.

Results:

The prevalence of DM in Sibiu Conty was increased from 1577 ( 1,6%) – 1975 to 6,2% - 2007; the incidence was increased from 77, 59‰ - 1975 to 253‰ -2007; the dynamic of mortality rate in diabetic population was in linear rate – about 5,5% of all cases; men subjects - 51,63%, female subjects – 48,36; mortality and type of diabetes: type 1- 20,38%, type 2 – 79,61%; the overage of apparent evolution of diabetes was 16,3 years; the most frequent rate of death was registred to those with length of DM between 6-10 years being almost double given those with DM evolution between 1-5 years and 11- 15 years; the highrst rate of death was registrated at the group of age 60- 69 years and 70 -79 years, being 2,5 times higher than the group of age 50 – 59 years; the main causes of death were heart diseases – 61,33%, stroke – 8,42%, tumors – 12, 74%, respiratory diseases – 9,8%, others 7,70%.

Conclusions:

1) The prevalence and incidence of diabetes followed the world and Romanian tendency ;

2) The higher increase in the last years was due not only by the natural evolution of diabetes as well an active manner of diagnosis;

3) The incidence of chronic complications at the moment of diagnosis is false decrease by the lack of investigations;

4) We have no data about gestational diabetes this aspect will be effective and efficient by a strong collaboration with GP and gynaecologists.

MANIFESTARI AUTOIMUNE LA COPILUL

CU DIABET-CELIACHIA

Gina GHENGHEA

Spitalului de Copii ,, Sfanta Maria” IASI – Clinica a III-a

DEFINITIE

Boala celiaca (numita si celiachie, intoleranta la gluten) este o boala digestiva cronica, cauzata de ingestia la gluten, ce implica absorbtia nutrientilor, vitaminelor si mineralelor de catre intestin.

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INTRODUCERE

Aceasta lucrare are ca scop scoaterea in evidenta a relatiei diabet – celiachie, celiachia pare a fi frecventa la persoanele ce sufera de o boala autoimuna-diabet tip I.

MATERIAL SI METODA

S-a luat in studiu un caz internat in clinica a III a Spitalului Clinic de Copii ,,Sfanta Maria” de la varsta de 3 ani.

REZULTATE

S-a urmarit:

- diagnosticul de baza pe baza examenelor clinice si de laborator;- stare clinica: evolutie, complicatii, tratament, prognostic;- complianta familiei in acceptarea dignosticului si tratamentului.CONCLUZII

1. Dificultatea diagnosticarii sindromului celic la copilul cu diabet, medicul trebuind sa elimine posibilitatea unei alte probleme digestive mai frecvente (sindromul intestinului iritabil, o intoleranta alimentara sau o boala inflamatorie a intestinului).

2. Necesitatea colaborarii pacient-mama-medic-asistenta.3. Adoptarea unei diete fara gluten.

AUTOIMMUNE MANIFESTATIONS AT A DIABETIC CHILD – CELIAKIE

Gina GHENGHEA

Spitalului de Copii „Sfanta Maria” IASI – Clinica a III a

Definition

Celiac disease/illness ( also called celiac, immobility to tolerate gluten) is a chronic digestive disease, caused by the intolerance of gluten, which prevents the absorption of the nutrients, the vitamins and the minerals by the intestine.

Introduction

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This paper work is meant to illustrate the relationship between diabetsand celiac. Celiakie appears more frequently to the persons who suffer from an autoimmune disease-diabetes type I.

Material And Method

It was studied the case of a child in the third class of St. Mary Clinic Hospital since the age of three.

Results

Objectives:

- Diagnosis based on clinical, paraclinical and lab examinations;- Clinical state. Course of disease, complications, treatment, prognosis;- The family capacity of accepting the diagnosis and treatments.Conclusions

1. Difficulty in diagnosing the celiac syndrome at a diabetic child, the doctor having to eliminate the possibility of another frequent digestive illness ( the irritable intestine syndrome, on alimental intolerance or an inflammatory disease of the intestine).

2. The necessary relationship between patient-mother-doctor-nurse.3. Choose a diet without gluten.

SUFERINŢA VASCULARĂ ÎN STEATOZA HEPATICĂDR. I.L. LASCU,

Cabinet Medicina Familiei (CMF ) DR. LASCU, Zalău

SCOPUL STUDIULUI

Suferinţa vasculară în steatoza hepatică (S.H.) este complexă: arterială, venoasă, limfatică şi arteriocapilară, ca expresie a tulburărilor metabolice complexe cu care se asociază S.H.

MATERIAL ŞI METODĂ

Au fost studiaţi 104 bolnavi: 60 femei (F) şi 44 bărbaţi (B) cu vârste cuprinse între 30 şi 60 ani.

Din 44 B: 8 erau cu diabet zaharat (DZ) tip 1, 24 cu DZ tip 2 şi 12 cu scăderea toleranţei la glucoză (STG), 28 prezentau boală varicoasă manifestă clinic şi toţi prezentau retinopatie.

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Din 60 F: 4 aveau DZ tip 1, 26 cu DZ tip 2 şi 30 cu scăderea toleranţei la glucoză (STG), 48 prezentau boală varicoasă manifestă clinic, retinopatie diagosticată oftalmoscopic la 46.

Studiul s-a bazat pe datele clinice, ecografie abdominală, oftalmoscopie.

Observaţiile noastre ne-au permis următoarele concluzii:

1. Steatoza hepatică (SH) este o tulburare metabolică complexă cu repercursiuni asupra circulaţiei arteriale, venoase, arterio-capilare şi limfatice;

2. SH se asociază frecvent cu tulburări ale mecanismului glucidic, îndeosebi, DZ tip 2 şi STG;

3. SH reprezintă o cauză frecventă ce precipită tulburările de circulaţie venoasă - boala varicoasă;

4. într-un procent important al cazurilor SH se asociază cu retinopatie şi posibile tulburări ale circulaţiei cerebrale observate clinic;

5. SH reprezintă un factor important ce precipită apariţia ascitei ce pledează pentru afectarea circulaţiei limfatice.

VASCULAR INVOLVMENT IN LIVER STEATOSISDR. I.L. LASCU,

Family Doctor Practice, Zalău

Goal: The vascular involvment in Liver Steatosis (LS) is very complex: arterial, venous, lymphatic and arterio-capillary, due to the complex metabolic changes associated with LS.

The study was done on 104 patients, 60 females (F) and 44 males (M), with ages between 30 and 60 years old.

From 44 M: 8 had Diabetes Mellitus (DM) type 1 and 22 had DM type 2, 12 presented with glucose intolerance (IGT) and 28 presents with varicose disease and all of these patiens had retinopathy.

From 60 F, 4 presented with DM type 1, 26 presented DM type 2, 48 presented with varicose disease manifested and 30 IGT, 46 with retinopathy siagnosed by ophtalmoscope.

The study was based on clinical data, abdominal ultra-sound and ophtalmoscopic examination of the retina.

After examinations we draw the following conclusions:

1. LS is a complex metabolic change with repercussion on the arterial, venous, arterio-capillaryand limphatic circulation;

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2. LS is frecquent associated with changes in glucose – starch metabolism, specially in type 2 DM;

3. LS represents a frequent cause that precipitates venous circulatory involvement – varicose disease;

4. Significant percentage of LS cases is associated with retinopathy and possible cerebral circulation, clinical observation;

5. LS represents an important cause that precipitates ascites, meaning the lymphatic circulation is impaired.

EXISTA IN PRACTICA FACTORI PREDICTIVI PENTRU DURATA DINTRE DIAGNOSTICUL DIABETULUI ZAHARAT TIP 2 SI INITIEREA

INSULINOTERAPIEI?

Ilinca Lenta, Adrian Copcea, Dana Simu, Silvia Stefania Iancu

Centrul Clinic de Diabet, Nutritie si Boli Metabolice Cluj-Napoca

INTRODUCERE: Diabetul zaharat tip 2, caracterizat prin doua mecanisme interdependente: deficitul insulinosecretor si insulinorezistenta, are o evolutie progresiva, potential influentata de factori precum glucotoxicitatea, lipotoxicitatea, folosirea anumitor clase de antidiabetice orale. Putini dintre parametrii folositi in practica clinica au fost citati ca asociindu-se cu durata pana la esecul terapiei orale.

OBIECTIVE: Am urmarit sa identificam, dintre parametrii folositi curent in urmarirea ambulatorie a pacientilor, posibilii factori asociati cu durata dintre diagnosticul diabetului zaharat si initierea insulinoterapiei.

MATERIAL SI METODE: S-au selectat 90 de pacienti cu diabet zaharat tip 2 insulinotratat, urmariti in ambulatorul Centrului de Diabet Cluj. Criteriul de includere a fost prezenta unei perioade de minim 6 luni de tratament non-insulinic, criteriul de excludere a fost initierea insulinei din alte motive decat esecul terapiei orale (ex. insuficienta hepatocelulara sau renala). Un numar de 30 de parametri disponibili din fisele de ambulator au fost documentati pentru fiecare caz in parte (parametri clinico-biologici, antropometrici, socio-demografici, durata tratamentului cu fiecare dintre antidiabeticele orale folosite). S-a studiat legatura dintre durata de la diagnostic la initierea insulinei si fiecare dintre acesti factori.

REZULTATE: Durata medie de la diagnosticul diabetului la initierea insulinei [DD] a fost de 8.1 ani (min 0.9 max 22.4). Lotul a fost constituit din 31 barbati si 59 femei, varsta medie la initierea insulinei a fost de 59.4 ani. IMC mediu in lot a fost de 30.0 kg/m2, glicemia medie la initiere: 256 mg/dl, HbA1c medie 9.3% (parametru disponibil la 25% dintre pacienti). DD s-a corelat pozitiv cu greutatea la initierea insulinoterapiei, nu

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si la debutul diabetului (R=0.26 respectiv 0.16). A existat o asociere negativa nesemnificativa intre DD si glicemia la debut. Impactul tratamentului cu metformin, sulfoniluree si, respectiv, tiazolidindione asupra DD (R=0.77, R=0.75, R= -0.31) se explica prin administrarea frecventa a acestora din urma ca ultima intensificare inaintea insulinoterapiei. Nu s-au constatat corelatii semnificative intre DD si valoarea maxima documentata pentru colesterol, trigliceride, TA. Intre persoanele care au refuzat insulina la cel putin 3 vizite medicale (23.3%), a predominat sexul feminin (85.7%). DD a fost semnificativ mai mica la persoanele la care s-au efectuat cel putin 2 intensificari ale tratamentului in primii 2 ani de la debut, fata de cele la care tratamentul initial s-a mentinut minim 2 ani (6.3 vs 16.0 ani, p<0.05). Persoanele cu studii superioare au avut o initiere mai precoce a insulinei (DD medie = 5.4 ani).

CONCLUZII: Durata dintre diagnosticul diabetului tip 2 si initierea insulinei nu s-a corelat semnificativ cu niciun parametru antropometric sau de laborator dintre cei determinati de rutina. Sexul feminin si nivelul de educatie par a influenta acest interval, probabil prin mecanisme psihologice. In studiul nostru, numarul de intensificari ale tratamentului in primii 2 ani de la diagnostic a fost singurul factor predictiv pentru intervalul de timp pana la insulinoterapie.

COULD WE FIND IN OUR CLINICAL PRACTICE PREDICTIVE FACTORS FOR THE DURATION BETWEEN THE DIAGNOSIS OF TYPE 2 DIABETES

AND INSULIN INITIATION?

Ilinca Lenta, Adrian Copcea, Dana Simu, Silvia Stefania Iancu

Centrul Clinic de Diabet, Nutritie si Boli Metabolice Cluj-Napoca

INTRODUCTION Type 2 diabetes, characterized by two interdependent mechanisms: β-cell dysfunction and insulin resistance, has a progressive evolution, potentially influenced by factors like glucotoxicity, lipotoxicity, use of different antidiabetic drugs. Few of the parameters used currently in clinical practice were quoted as related to the duration between diagnosis of T2DM and insulin initiation.

OBJECTIVES We aimed to identify, among the parameters documented in an outpatient setting, possible factors associated with the duration between diagnosis of T2DM and insulin initiation.

METHODS 90 insulin treated type 2 diabetic patients were randomly selected from the outpatient offices of our clinic, using as an inclusion criterion the presence of at least 6 months of non-insulinic therapy, and as an exclusion criterion the initiation of insulin for other reasons than failure of oral therapy (i.e. renal or hepatic insufficiency). A number of

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30 different parameters available from the medical files were included in the analysis for each case (clinical, biological, anthropometrical, socio-demographical parameters, as well as duration of treatment with each antidiabetic drug). Statistical evaluation of the relations between the time interval to insulin initiation and each of these parameters was performed.

RESULTS The mean duration from the diagnosis of T2DM and insulin initiation [DD] was 8.1 years (min 0.9, max 22.4). The group consisted of 31 men and 59 women, having a mean age of 59.4 years at the time of insulin initiation. The mean BMI was 30.0 kg/m2, the mean fasting blood glucose (FBG) at insulin initiation was 256 mg/dl, mean HbA1c 9.3% (available in 25% of the patients). DD was positively correlated with the weight at the time of insulin initiation, but not at diagnosis (R=0.26 respectively R=0.16). There was a negative, non-significant association between DD and FBG at the time of diagnosis. The impact of metformin, sulfonylurea and, respectively, tiazolidindione use on DD (R=0.77, R=0.75, R= -0.31) is justified by the frequent use of the latter as a last intensification before insulin. There were no significant correlations between DD and the highest documented serum level of total cholesterol and triglycerides, neither with the maximum blood pressure values. Among the persons who refused at least at 3 visits the initiation of insulin (23.3%), 85.7% were females. DD was significantly lower in persons who had at least 2 treatment intensifications in the first 2 years, compared to those in whom the initial treatment was maintained (6.3 vs 16.0 years, p<0.05). The patients with the highest education level had the earliest insulin initiation (mean DD=5.4 years).

CONCLUSIONS There were no significant correlations between the duration from diagnosis of type 2 diabetes to insulin initiation and any anthropometrical or laboratory parameters used in current practice. The education level and the female gender seem to influence this interval. In our study, the number of treatment intensifications in the first 2 years following diagnosis was the only predictive factor for the time interval to insulin initiation.

EPIDIAB 2008: ANALIZĂ 01.01.2008 - 30.09.2008Dr. Carmen Crişan, Dr. Adriana Cif, Dr. Marton Reka –

Ambulatoriul de Diabet Tg. MureşIntroducere   : Programul EPIDIAB (Epidemia Diabetului) este un studiu prospectiv, având ca obiective obţinerea de date epidemiologice, clinico-biologice ale persoanelor cu DZ nou depistat, permiţând analiza calităţii îngrijirii acestora.

Scopul lucrării : evaluarea rezultatelor pe primele 9 luni ale anului 2008 şi compararea lor cu date din 2000-2007.

Metodă : rezultatele au fost obţinute prelucrând datele demografice, antropometrice, de prevalenţă a complicaţiilor cronice şi bolilor asociate precum şi a tratamentului persoanelor cu DZ nou depistat în perioada ianuarie - septembrie 2008.

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Rezultate : În perioada studiată au fost înregistrate 2758 persoane cu DZ nou depistat. Distribuţia pe tipuri de DZ a fost următoarea : 1,38 % tip 1; 98,62 % tip 2. Prevalenţa factorilor de risc cardiovasculari este: HTA – 64,97 %; obezitate - 37,02 %; suprapondere -45,03%; dislipidemii - 61,20 % (din totalul celor 89,38 % screenaţi); boală cardiovasculară ( la momentul depistării ) : 25,13 %. Screening-ul şi diagnosticul complicaţiilor microvasculare specifice relevă: 86 % din persoanele nou depistate cu DZ au fost screenate pentru decelarea retinopatiei diabetice şi 10,15 % au prezentat de la diagnostic această complicaţie. Screening -ul pentru nefropatie diabetică s-a efectuat la 43,03 % din pacienţi şi 7,03 % au fost diagnosticaţi ca având această complicaţie. Screening-ul pentru polineuropatie diabetică şi picior diabetic s-a efectuat la 42,35 % din nou depistaţi, fiind identificaţi 21,36 % cu acest diagnostic. Structura pe grupe terapeutice a fost următoarea : dietă - 12,98 % ; sulfonilureice -19,9 % ; metformin - 32,85 % ; sulfonilureic plus metformin - 24,76 % ; insulină - 5,98 %; altele-3,51 %.

Discuţii şi concluzii : incidenţa DZ se menţine ridicată, remarcându-se o importantă creştere faţă de anii anteriori. Prevalenţa factorilor de risc cardiovascular şi a complicaţiilor cronice cunoaşte o uşoară creştere faţă de anii anteriori, verosimil datorită unui screening mai atent şi mai frecvent aplicat indicând deci o calitate a actului medical sporită.

EPIDIAB 2008: ANALYSIS 01.01.2008 - 30.09.2008

Dr. Carmen Crisan, Dr. Adriana Cif, Dr. Marton Reka

Diabetes Ambulatory Tg. Mures

INTRODUCTION : EPIDIAB Program is a prospective study, in order to provide epidemiological, clinical and biological data of persons with newly-diagnosed diabetes (NDD).METHOD: The demographic and anthropometric data, the prevalence of chronic complications and therapeutic structure of persons with NDD was analised in period January- September 2008.AIM : to evaluate the results on the first 9 months - 2008 and to compare with data from 2000 - 2007 period.

RESULTS : In January - September 2008, 2758 persons with newly - diagnosed diabetes (NDD) were registered, 1,38 % with type 1; 98,62 % with type 2. The prevalence of cardiovascular risk factors is: hypertension - 64,97 %, obesity - 37,02 %, overweight - 45,03%, dyslipidemia - 61,20 %, (screening was perform for 89,38 % of patients), cardiovascular disease - 25,13 % at the moment of screening. Microvascular complications screening and diagnostic: for retinopathy was performed for 86 % of patients, 10,15 % have some grade of diabetic retinopathy; the screening for diabetic nephropathy was performed in 43,03 % of patients, 7,03 % being positive; the screening

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for diabetic neuropathy and diabetic foot was performed in 42,35 %, the percentage of positives being 21,36%. The therapeutic structure was: diet - 12,98%, sulphonylurea – 19,9 %, biguanides – 32,85 %; sulphonylurea and biguanides – 24,76 %; insulin - 5,98 % ; another 3,5 %CONCLUSION: The incidence of diabetes mellitus increased in 2008 comparative with the previous years. Cardiovascular risk factors and chronic complications prevalence is increasing versus previous years.

STUDIU PRELIMINAR ASUPRA MODIFICARILOR GLICEMICE REZULTATE DIN PROGRAMUL NATIONAL DE EVALUARE A STARII DE

SANATATE

Ioana Micle, Monica Marazan, Ramona Giurescu, Elena Pop, Angela Dumitrescu, Remus Laslau, Simona Raicu, Carmen Patap

Clinica Pediatrie 1 Timisoara

Spitalul Clinic de Urgenta pentru Copii”Louis Turcanu”

Scopul lucrarii. Autorii isi propun obiectivarea modificarilor glicemice depistate, la varsta copilariei, prin programul national de evaluare a starii de sanatate a populatiei.

Materialul de studiu. Grupul de studiu este format din 27 copii cu varsta cuprinsa intre 2-18 ani . Criteriul de selectie al copiilor indrumati in clinica Pediatrie 1 Timisoara a fost reprezentat de valoarea glicemiei bazale ≥ 100mg% obtinuta la doua determinari succesive.Metoda de studiu. Datele ananmnestice cu privire la antecedentele heredo-colaterale de diabet si boli metabolice au fost obtinute din foile de observatie. S-a calculat IMC (Kg/mp) si s-a raportat cu nomogramele varstei. Bilantul biologic s-a efectuat etapizat, astfel: glicemia bazala, profilul glicemic, TTGO si HbA1c, apoi insulinemia (µU/ml) ) si calculul indicelui de insulinorezistenta - HOMA si la cazurile selectionate - in functie de insulinemie - s-au determinat anticorpii anti –GAD. Rezultate Din cei 27 copii, 5 (18,5%) au fost depistati cu diabet zaharat (DZ). Dintre acestia 4/27 (14,8%) sunt diagnosticati cu DZ tip 1 (la prima determinare a glicemiei) si 1/27 (3,7%) a fost diagnosticat cu DZtip 2 (dupa efectuarea profilului glicemic si a TTGO). Restul de 22/27 (81,48%)) au avut urmatoarele modificari: 9/27 (33.33%) scaderea tolerantei la glucoza (SGT -glicemie la 2 h ≥140 mg%) si 13/27 (48,14%) normoglicemie bazala si TTGO normal. Indicele de insulinorezistenta HOMA a fost crescut la 2 copii care aveau concomitent obezitate si semne de insulinorezistenta.

Insulinemia bazala a fost scazuta la un copil cu Dztip 1 si crescuta la doi copii (dintre care unul a fost diagnosticat cu DZtip 2).Conduita terapeutica a fost diferentiata in functie de diagnosticul stabilit, astfel: la cei 4 copii cu DZ tip 1 s-a initiat insulinoterapia bazala la 3 copii si bazal-bolus terapie(BBT) la un copil;la copilul cu DZ tip 2 s-au administrat antidiabetice orale (ADO) – metformin; 9 copii cu STG au ramas in expectativa terapeutica cu recomandari dietetice in STG, 13 copii urmand sa fie

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reevaluati periodic - trimestrial sau la simptome minore. Concluzii. Determinarea glicemica - ca screening - in cadrul programului national de evaluare a starii de sanatate ofera posibilitatea decelarii precoce a modificarilor glicemice, a depistarii populatiei infantile cu hiperglicemie bazala si diagnosticul precoce al DZ. Simptomatologia clasica de debut a DZ poate fi uneori nesesizata de familie si astfel, orice glicemie peste limitele normale necesita explorari suplimentare. La copil, o glicemie singulara peste limita normala nu inseamna intotdeauna DZ intrucat, chiar actul medical de prelevare a sangelui este un stress, dar nu trebuie neglijata ci, reconsiderata si repetata.

A PRELIMINARY STUDY ON THE GLYCEMIC ALTERATIONS DETECTED BY THE NATIONAL HEALTH SCREENING PROGRAM

Authors: Ioana Micle, Monica Marazan, Ramona Giurescu, Elena Pop, Angela Dumitrescu, Remus Laslau, Simona Raicu, Carmen Patap

1 Pediatric Clinic, “Louis Turcanu” Children’s Emergency Hospital Timisoara

Purpose: The authors aim to emphasize the glycemic alterations detected in children through the national health screening program.

Material: The study comprised 27 patients, aged between 2 and 18 years old. The selection criterion for referring the patients to our clinic was the value of the basal glycemia over 100mg% in two separate determinations.

Methods: The anamnestic data about the presence of diabetes and other metabolic diseases in the families of the patients was gathered from the observation charts. We calculated the BMI (kg/m2) and compared with reference charts for age. The biological investigations were performed in the following order: basal glycemia, glycemic profile, OGTT and HbA1, insulinemia (ui/ml), the insulino-resistance index HOMA and, in selected cases, depending on the insulinemia, the anti-GAD antibody levels were determined.

Results: From a total of 27 patients, 5 (18,5%) were diagnosed with diabetes, 4/27 (14,8%) were diagnosed with diabetes type 1 (at the first determination of glycemia) and 1/17 (3,7%) was diagnosed with diabetes type 2 (after performing a glycemic profile and OGTT). The rest 22/27 (81,48%) were diagnosed with the following alteration: 9/27 (33.33%) decreased glucose tolerance (DGT – glycemia at 2h>140mg%) and 13/27 (48,14%)had normal basal glycemia an OGTT. The insulin resistance index HOMA was elevated in 2 children who presented simultaneously obesity and signs of insulin resistance. The basal level of insulin was decreased in one patient with diabetes type 1 and elevated in two patients (one of which was diagnosed with diabetes type 2). The therapeutic approach differed depending on the diagnosis: for the 4 patients diagnosed with type 1 diabetes we initiated basal insulin therapy in 3 and basal bolus therapy (BBT) in 1 patient, the patient diagnosed with type 2 diabetes was treated with an oral anti-diabetic agent (metformin), 9 patients with decreased glucose tolerance remain in

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observation with special diet recommendations, 13 patients with minor symptoms are going to be evaluated periodically.

Conclusions: The screening of the glycemic value in the national program for evaluation of populational health offers the possibility of early detection of glycemic alterations, early detection of the infantile population who presents basal hyperglycemia and arly diagnosis of diabetes. The classic symptoms at the onset of diabetes can be, sometimes, ignored by the family, therefore any glycemic value above norm needs further exploration. In children, one single value above normal does not always imply diabetes because even the prelevation of a blood sample cand bring a significant amount of stress in apatient. But still, a glycemic value above nomal must not be ignored and needs a second determination.

STUDIU COMPARATIV DE ADMINISTRARE MATINALA SAU VESPERALA A INSULINEI GLARGINE LA COPIL SI ADOLESCENT

Ioana Micle, Monica Marazan, Ramona Giurescu, Elena Pop, Oana Domnitei, Cristina Damacus, Mihaela Zbarcea, Daniela Chiru

Clinica Pediatrie 1 Timisoara

Spitalul Clinic de Urgenta pentru Copii „Louis Turcanu”

Scopul lucrarii: Lucrarea îşi propune prezentarea comparativă a echilibrului glicemic realizat prin administrare de Glargine (Lantus)

dimineata (ora 7) sau seara (ora 19; 23).

Material de studiu: Au fost introduşi în studiu 47 copii cu diabet zaharat tip 1 (DZ1), cu insulinoterapie bazal-bolus(BBT) , cu vârsta cuprinsă între 4 -18 ani care utilizeaza Glargine. Dintre acestia 41/47 (87,2%) isi injecteaza glargine seara si 6/47 (12,8%) dimineata. Criteriul de selecţie pentru modificarea orei de injectare a insulinei glargine a fost numarul de hipoglicemii nocturne si valoarea glicemiei bazale.

Metoda de studiu: S-au efectuat profile glicemice şi media orară a glicemiilor în mod comparativ în terapia cu glargine administrat dimineata si seara. De asemenea, s-au evaluat numarul hipoglicemiilor diurne si nocturne, echilibrul glicemic prin valoarea HbA1c.

Rezultate si discutii: S-a optat pentru administarea glarginului dimineata la copiii mici si prescolari aflati in perioada de remisiune labila si in perioada de stare, deoarece numarul hipoglicemiilor nocturne la acestia era mare de 4 - 5episoade/saptamana. Media glicemiilor din cadrul profilului glicemic a fost comparativa in administrarea de dimineata 135±65mg% si in administrarea de seara 138± 25 mg%. Cu toate acestea,

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media glicemiilor bazale este comparativ scăzută la administrarea de glargine dimineata 117 ±31 mg% faţă de 146 ± 68 mg% la administrare seara. Aceasta se poate explica prin faptul ca la pubertate, secretia hormonului de crestere determina consecutiv cresterea rezistentei la insulina (fenomenul dawn). Majoritatea copiilor cu DZ 1 aflati la varsta pubertara au analog cu actiune prelungita in administrare vesperala sau inainte de culcare.

Concluzii: Decizia momentului zilei (ora) de administrare a insulinei glargine depinde de valoarea glicemiei bazale. Glargine in administrare matinala este o opţiune terapeutică pentru copiii mici si prescolari cu DZ aflati in perioada de remisiune parţială sau in perioada de stare. La pubertate insulina glargine se administreaza seara sau inainte de culcare.

A COMPARATIVE STUDY ON MORNING VERSUS EVENING ADMINISTRATION OF GLARGINE INSULIN IN CHILDREN AND

TEENAGERS

Authors: Ioana Micle, Monica Marazan, Ramona Giurescu, Elena Pop, Oana Domnitei, Cristina Damacus, Mihaela Zbarcea, Daniela Chiru

Pediatric Clinic nr 1. Louis Turcanu emergency chiledren’s hospital, Timisoara

Purpose: the study aims to present a comparison between the glycemic response and balance accomplished by treatment with Glargine (Lantus) administered in the morning (07 A.M.) versus evening (19, 23 P.M.)

Material: the study comprised 47 children with diabetes mellitus type 1, treated with insulin (BBT therapy), aged between 4 and 18 years who use Glargine. Of the 47 patients, 41 (87,2%) inject glargine in the evening and 6 (12,8%) in the morning. The selection criteria for changing the hour of the glargine injection was the number of nocturnal hypoglycemias and the value of the basal glycemia.

Method: we studied the glycemic profile for all the patients, evaluated the hourly average of the glycemic values for the glargine administered in the morning and in the evening. We also evaluated the number of morning and evening hypoglycemic values, the glycemic balance determined through the value of the HbA1.

Results and discussion: we decided to administer glargine in the morning for the children under 6 years with temporary remission and those with longstanding diabetes, because the frequency of nocturnal hypoglycemia was higher than 4-5 episodes a week. The average of the glycemic values from the glycemic profile was relatively similar for the morning administration 135+/-65mg% and evening administration 138+/-25mg%. Still, the average of the basal glycemic values for the morning administration of glargine is comparatively low 117=/-31mg% compared to 146+/-68mg% for the evening administration. This is explained by the fact that at puberty, the growth hormone causes

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an increased resistance to insulin (dawn fenomenon). Most of the pubertal patients are treated with late action insulin analogue in the evening or before sleep.

Conclusions: The decision towards morning or evening administration of glargine is influenced by the values of the basal glycemia. The morning administration of glargine is the therapeutic option for young children with diabetes type 1 in temporary remission or with longstanding diabetes. At puberty, glargine is best administered in the evening or before sleep.

HIPOGONADISMUL LA PACIENTII CU DIABET ZAHARAT

Iulia Calota, Crina Filisan, Carmen DobjanschiSpitalul Clinic “N. Malaxa” - Clinica Diabet, Nutritie, Boli Metabolice – Bucuresti

Premise: Hormonii steroidieni sunt cunoscuti a fi reglatori importanti ai metabolismului glucidic si lipidic. Nivele scazute ale testosteronului (T) sau ale SHBG (sex hormone binding globuline) au fost raportate la barbatii cu diabet zaharat tip 2. Hipoandrogenismul ramane deseori nediagnosticat si netratat deoarece simptomatologia este nespecifica si multifactoriala.

Scopul studiului: evidentierea corelatiilor intre deficienta hormonilor androgeni si diabetul zaharat la barbat.

Material si metoda: In acest studiu s-au determinat concentratiile serice ale SHBG si ale testosteronului liber la 12 barbatii cu diabet zaharat tip 1 ( media de varsta 36,45+/- 1.2 ani) si 34 cu diabet zaharat tip 2 ( media de varsta 56.8+/-1.9 ani) internati in Spitalul Clinic” N. Malaxa”. Testosteronul liber s-a calculat in functie de testosteronul total, SHBG si concentratia albuminei serice. Probele s-au recoltat a jeun, intre orele 08.00 si 10.00 am. Au fost luate in calcul durata de evolutie a diabetului, prezenta sindromului metabolic, tratamentul specific pentru diabet. S-a determinat prin bioimpedanta procentul de tesut adipos din masa corporala. S-au determinat markerii de inflamatie (Proteina C reactiva si fibrinogenul), profilul lipidic, hematocritul si hemglobina glicata.

Rezultate: Valoarea medie a BMI a pacientilor cu diabet zaharat tip 1 si diabet zaharat tip 2 a fost de 27.56+/- 1.3 , respectiv 38,68+/- 2.34 kg/m2. Concentratia medie a testosteronului total la pacientii cu diabet zaharat tip 1 a fost de 20.69 +/- 1.23 respectiv 13.54+/- 1.99 nmol/l ( P<0,001) la cei cu diabet zaharat tip 2. Concentratia medie a testosteronului liber a fost de 0.576+/- 0.08 pentru pacientii cu diabet zaharat tip 1, respectiv de 0.264+/- 0.06 nmol/l la pacientii cu diabet zaharat tip 2. Hipogonadismul nu s-a asociat cu diabetul zaharat tip 1. Valorile scazute ale SHBG si testosteronului total s-au asociat cu prezenta componentelor sindromului metabolic, in timp ce valorea testosteronului liber s-a corelat doar cu circumferinta abdominala. Nu s-au observat o

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corelatie intre hipogonadism si valoarea hemoglobinei glicate sau durata diabetului. Valorile scazute ale testosteronului sunt, de asemenea, corelate cu un procent crescut de tesut adipos din masa corporala. Valoarea proteinei C-reactive a fost crescuta la pacientii cu hipogonadism si s-a observat o corelatie inversa intre aceasta si concentratia testosteronului plasmatic. Corelatia inversa intre valoarea proteinei C-reactive si a testosteronului liber la pacientii cu diabet zaharat tip 2 sugereaza ca inflamatia poate avea un rol important in patogeneza hipogonadismului.

Concluzii: Relatia intre diabet, sindromul metabolic si deficienta hormonilor androgeni este complexa. Hipogonadismul poate fi prezent in cazul unui numar semnificativ de pacienti cu diabet zaharat tip 2, dar nu si la cei cu diabet zaharat tip 1. Prevalenta hipogonadismului biochimic este mai mare in cazul determinarii testosteronului liber. Medicii diabetologi trebuie sa-si indrepte mai mult atentia asupra acestei afectiuni pentru a-si putea sfatui si indruma pacientii spre alte consulturi interdisciplinare.

THE RELATIONSHIP BETWEEN MALE HYPOGONADISM AND DIABETES MELLITUS

Iulia Calota, Crina Filisan, Carmen Dobjanschi“N. Malaxa” Hospital, Diabetes Clinic – Bucharest

Background: Sex steroid hormones are known to be important regulators of the lipid and glucose metabolism. Lower levels of testosterone (T) or sex hormone-binding globulin (SHBG) have been reported in men with type 2 diabetes. The diagnosis of male hypoandrogenism often goes undiagnosed and untreated because the symptomatology is multifactorial and not specific.

The aim of the study: is to describe relationship between androgen deficiency and diabetes in men.

Design and Methods: In this study we assessed serum concentrations of SHBG, total and free testosterone in 12 type 1 diabetic (mean age 36.45 +/- 1.2 years) and 34 type 2 diabetic (mean age 56.8 +/- 1.9 years) subjects – hospitalized in “N.Malaxa” Hospital. Calculation of free testosterone has been made from total testosterone, SHBG and albumin concentration. Blood samples have been taken between 08.00 and 10.00 h in the fasting state. Diabetes treatment, the presence of metabolic syndrome and subcutaneous fat mass measured by bioimpedance were noticed. HbA1c values, duration of diabetes, hemathocrit, lipid profile, inflammatory markers (the level of C-reactive protein and fibrinogen) were collected.

Results: The mean BMI of type 1 and type 2 diabetic patients was 27.56 +/- 1.3 and 38.68 +/- 2.34 kg/m(2), respectively. The mean total testosterone concentration of type 1

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and type 2 diabetic patients was 20.69 +/- 1.23 and 13.54 +/- 1.99 nmol/l, respectively (P < 0.001). The mean free testosterone concentration of type 1 and type 2 diabetic patients was 0.576 +/- 0.08 and 0.264 +/- 0.06 nmol/l, respectively (P < 0.001). Hypogonadism is not associated with type 1 diabetes. SHBG and total testosterone were associated with components of metabolic syndrome and free testosterone was associated only with waist circumference and triglycerides. The duration of diabetes or HbA1c are not related to hypogonadism. Low testosterone concentrations are also related to an increase in adiposity. C-reactive protein concentrations have been shown to be elevated in patients with hypogonadism and are inversely related to plasma testosterone concentrations. This inverse relationship between plasma free testosterone and C- reactive protein concentrations in patients with type 2 diabetes suggests that inflammation may play an important role in the pathogenesis of hypogonadism.

Conclusions: The relationship between diabetes, the metabolic syndrome and androgen deficiency is complex. Male hypogonadism is a clinical condition that affects a significant number of men diagnosed with type 2 diabetes but not with type 1 diabetes. The prevalence of biochemical hypogonadism is greater if we use free testosterone. Diabetologists need to have a better understanding of this disease state to provide advice for their patients and to coordinate care with other clinicians.

RELATIA DINTRE PROTEINELE ALIMENTARE SI GLICEMIA POSTPRANDIALA LA UN GRUP DE COPII CU DZ TIP 1 DIN ORADEA

Larisa Dumbrava, Floare Husar, Elena Drambarean, Claudia Cladovan, Danuta Grebenisan, Bea Nilgesz, Iolanda Miklos

Spitalul Clinic Municipal Oradea

Introducere. Aminoacizii sunt utilizati atat la sinteza si degradarea edificiului macromolecular proteic din celule cat si la furnizarea de energie, in lipsa unor cantitati suficiente de glucide sau lipide. Gluconeogeneza si o parte a cetogenezei presupun conversia aminoacizilor in hidrocarbonate.

Scop. Lucrarea isi propune investigarea gluconeogenezei la copiii cu DZ tip 1 comparativ cu copiii fara diabet, la meniuri cu continut exclusiv proteic din surse diferite, respectiv carne de pui si peste oceanic.

Material si Metoda. Un grup de 15 copii, 9 fete si 6 baieti, de 14+/-4 ani cu DZ tip 1 echilibrat (HbA1c=7+/-0.38) impreuna cu grupul control relativ omogen compus din 15 copii 7 fete si 8 baieti, de 15+/-2 ani fara diabet, consuma in prima zi un pranz din 200 g piept de pui la gratar, iar a 2-a zi un pranz din 200 g peste oceanic la gratar. Se

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determina la toti copiii glicemia pre- si postprandial la 1 si 2 ore, in acelasi ambient si conditii de repaus, fara administrirea dozei de insulina la copiii cu diabet.

Rezultatele evidentiaza: o curba glicemica concav crescatoare dupa masa cu pui si o curba glicemica concav descrescatoare dupa cea cu peste, la copiii cu DZ. Dupa masa cu pui, scaderea glicemiei la o ora este nesemnficativa (p>0,05), iar la 2 ore glicemia creşte semnificativ faţă de de cea înregistrată preprandial sau la 1 oră (p<0,05). După masa cu peşte, glicemia scade semnificativ (p<0,001) la o oră postprandial, iar la 2 ore creşte semnificativ (p<0,05) fata de valoarea de la 1 ora. Iar la copiii fara diabet, evoluţia glicemiei pe parcursul celor 2 evaluări a urmat o curbă concav crescătoare după masa cu pui şi o linie discret ascendentă dupa masa cu peşte. După masa cu pui, la o oră postprandial valoarea glicemiei scade nesemnificativ (p>0,05), iar la 2 ore creşte semnificativ faţă de de cea înregistrată preprandial sau la 1 oră (p<0,04). După masa cu peşte, atat la o oră cat si la 2 ore glicemia creşte nesemnificativ (p>0,05).

Concluzii: Un meniu exclusiv proteic determina cresterea glicemiei postprandiale la 2 ore atat la pacientii cu DZ tip 1 cat si la non-diabetici, demonstrand conversia proteinelor in glucide. Scaderea glicemiei la 1 ora postprandial dupa ambele meniuri este probabil datorata timpului necesar pentru gluconeogeneza. Scaderea semnificativa a glicemiei la 1 ora dupa masa de peste se poate datora si proprietatilor protective ale acizilor polinesaturati din pestele oceanic, inclusiv in bolile autoimune. Cresterea glicemica semnificativa la 2 ore postprandial dupa masa de pui vs peste, atat la copiii cu cat si la cei fara DZ, evidentiaza un indice glicemic mai inalt la pui decat la peste. Cresterea usoara si liniara a glicemiei copiiilor fara diabet dupa masa de peste, vs curba concav crescatoare dupa masa de pui, poate recomanda consumul de peste in profilaxia afectiunilor metabolice.

THE RELATIONSHIP BETWEEN FOOD PROTEIN AND POSTPRANDIAL GLYCAEMIA IN A GROUP OF TYPE 1 DIABETES CHILDREN FROM

ORADEA

Larisa Dumbrava, Floare Husar, Elena Drambarean, Claudia Cladovan, Danuta Grebenisan, Bea Nilgesz, Iolanda Miklos

Municipal Clinic Hospital Oradea

Background. Amino acids are used both in synthesis and degradation of macromolecular protein building from the cells and also for supplying energy in lack of carbohydrates or fats. Gluconeogenesis and a part of ketogenesis suppose the conversion from amino acids in carbohydrates.

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The Aim is to investigate gluconeogenesis in type 1 diabetes children vs children without diabetes, after they ate an exclusive different protein meal, from chicken respectively ocean fish.

Material and Methods. 15 children ( 9 girls and 6 boys, 14+/-4 years with type 1 diabetes (HbA1c=7+/-0.38) together with control group (15 children 7 girls and 8 boys, from 15+/-2 years without diabetes, ate in first day 200 g of white meat from grilled chicken and in the second day 200 g of grilled ocean fish. We measured glycaemia before and 1 and 2 hour after meal, in seam condition of ambient, without exercise and in children with diabetes without taking insulin.

The results show an increase concave glycemic curve after chicken meal and decrease concave glycaemic curve after fish one, in children with diabetes. After chiken meal glycemia decrease insignificant (p>0,05) at 1 hour but increase significant at 2 hour vs both fasting and 1 hour postprandial glycemia (p<0,05). After fish meal, glycemia decrease significant (p<0,001) at 1 hour postprandial, but increase significant at 2 hour (p<0,05) vs 1 hour glycemia. In children without diabetes, glycemia draw an increase concave curve after chicken meal and a slowly increase line after the fish meal. After chiken meal glycemia decrease insignificant (p>0,05) at 1 hour but increase significant at 2 hour vs both fasting and 1 hour postprandial glycemia (p<0,04). After fish meal, glycemia increase insignificant both at 1 and 2 hour postprandial (p>0,05).

In Conclusion: An exclusive protein meal leads to the increasing of 2 hours postprandial glycemia both in type 1 diabetes and non-diabetes children, proving conversion of proteins in carbohydrates. Significant decreasing of glycemia at 1 hour after fish meal could be also determined by protective properties of polyunsaturated acids from ocean fish, inclusively in autoimmune diseases. Significant increasing of glycemia at 2 hours postprandial after chicken meal vs fish meal, both in diabetes and non-diabetes children, proves a higher glycemic index in chicken vs fish. Slowly and ruling increasing of glycemia in non-diabetes children after fish meal vs concave increasing curve after chicken meal, could recommended fish meals in prevention of metabolic diseases.

PREVALENTA COMPLICATIILOR MACROVASCULARE LA PACIENTII CU DZ TIP 1 SI TIP 2 CU SINDROM METABOLIC

Popescu L.D., Ionescu I., Dovan D., Lichiardopol R.

Introducere : Sindromul metabolic reprezinta un important factor de risc pentru diabet zaharat tip 2 si boala cardiovasculara, putine date exista insa, despre importanta acestuia la pacientii cu diabet zaharat tip 1.

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Obiective : Evaluarea prevalentei complicatiilor macrovasculare la pacientii cu diabet zaharat (DZ) tip 1 si tip 2 cu sindrom metabolic.

Material si metoda : Au fost inclusi in studiu 1429 pacienti, internati in perioada 01.01.2006-31.12.2006 la IDNBM “N.Paulescu”, dintre care 270 cu DZ tip 1 (136 barbati, 134 femei, varsta medie 42,54±14,36 ani), iar 1159 cu DZ tip 2 (518 barbati, 641 femei, varsta medie 60,17±10,48 ani). Sindromul metabolic a fost prezent la 50 (18,51%) dintre pacientii cu DZ tip 1, respectiv 970 (83,69%) dintre cei cu DZ tip 2, restul pacientilor nu au intrunit criteriile de diagnostic . S-au analizat urmatorii parametri prezenti in fisele de observatie ale pacientilor : varsta, sex, talie, indice de masa corporala (IMC), statusul de fumator, istoric de boala hipertensiva (HTA), hemoglobina glicata (HbA1c), colesterol total (CT), HDL-colesterol (HDL), LDL-colesterol (LDL), trigliceride (TG), raport TG/HDL, prezenta complicatiilor macrovasculare : boala cardiaca ischemica (BCI), infarct miocardic (IM), accident vascular cerebral (AVC), arteriopatie obliteranta membre inferioare (AOMI). Sindromul metabolic (SM) a fost definit conform criteriilor IDF.

Rezultate : Pacientii cu SM si DZ tip 1, fata de cei cu SM si DZ tip 2 au avut o vechime semnificativ mai mare a bolii (p<0.01), relatie ce s-a mentinut si atunci cand s-a efectuat diferentierea pe sexe . De asemenea, pacientii cu SM si DZ tip1 au avut fata de cei cu DZ tip 2 si SM un nivel semnificativ mai mare al HbA1c (p<0.01), CT (p<0.05), LDL (p<0.05) si TG (p<0.05). Difrente semnificative au fost si in ceea ce priveste fumatul (p<0.01) si HTA (p<0.05), la cei cu DZ tip 2 si SM, fata de cei cu DZ tip 1 si SM. Barbatii cu SM si DZ tip 1 au avut fata de cei DZ tip 2 un nivel semnificativ mai mare al HbA1c (p<0.01), CT (p<0.05), TG (p<0.001) si al raportului TG/HDL (p<0.01). Femeile cu SM si DZ tip 1 fata de cele cu DZ tip 2 au avut un nivel seric al LDL semnificativ mai mare (p<0.05) si un nivel semnificativ mai mic al HDL (p<0.05), fara diferente semnificative statistic in ceea ce priveste HbA1c, CT, TG. Nu au existat diferente semnificative statistic intre cele doua grupuri analizate in ceea ce priveste prezenta compicatiilor macrovasculare (BCI, IM, AVC, AOMI), relatie ce s-a pastrat si atunci cand s-au analizat diferentele barbati, femei. Pacientii cu DZ tip 1 si SM au avut fata de cei fara SM o prevalenta semnificativ mai mare a BCI (OR 3.09; 95% CI: 1.30-7.34) si HTA (OR 5.21; 95% CI: 2.71-10.00). Pacientii cu DZ tip 2 au avut, de asemenea, o prevalenta semnificativ mai mare in ceea ce priveste BCI (OR 1.74; 95% CI: 1.26-2.41), respectiv HTA (OR 5.53; 95% CI: 3.98-7.69).Nu au fost diferente semnificative statistic intre grupurile analizate in ceea ce priveste prevalenta IM, AVC, AOMI.

In urma analizei tertilelor de distributie ale taliei, pacientii cu DZ tip 1 din tertila superioara de distributie au avut o prevalenta mai mare a BCI (OR 0.10; 95% CI: 0.04-0.27) si HTA (OR 0.12; 95% CI: 0.04-0.34), iar cei cu DZ tip 2 o prevalenta mai mare a HTA (OR 0.35; 95% CI: 0.25-0.49).

Concluzii : Sindromul metabolic reprezinta un factor de risc pentru afectarea cardiovasculara atat la pacientii cu DZ tip 1, cat si la pacientii cu DZ tip 2.

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THE PREVALENCE OF MACROVASCULAR COMPLICATIONS IN TYPE I AND TYPE II DIABETES PATIENTS WITH METABOLIC SYNDROME

Popescu L.D., Ionescu I., Dovan D., Lichiardopol R.

Clinic of Diabetes, Nutrition and Metabolic Diseases, “ N.C. Paulescu” Institute, Bucharest, Romania

Introduction: The metabolic syndrome groups numerous cardiovascular risk factors and frequently associates type II diabetes mellitus (DM2). There are though few data regarding its importance and frequency in type I diabetes mellitus patients (DM1).

Aim: Comparative evaluation of prevalence of macrovascular complications in DM1 and DM2 patients with metabolic syndrome (SM).

Methods: In the study there were included 1429 patients, which were admitted in 2006 in the diabetes department of the institute., of which 270 with DM1 (136 men, 134 women, mean age 42.54+14.36 years) and 1159 with DM2 (518 men, 641 women, mean age 60.17+10.48). SM was present in 50 (18.51%) of the DM1 patients, respectively 970 (83.69%) of the DM2 patients, the rest of the patients not meeting the diagnostic criteria.

The following parameters in the patients’ file were analyzed: age, sex, waist circumference, hypertension history, HbA1c, total cholesterol (CT), HDL cholesterol, LDL cholesterol, triglycerides (TG), triglyceride/HDL cholesterol ratio, coronary heart disease (CHD), myocardial infarction (MI), stroke, peripheral arteriopathy disease (PAD). SM was defined according to the IDF criteria, with the specification that in DM1 patients, glucose blood level was not considered as diagnostic criterion.

Results: Patients with DM1 and SM had lower mean age (49.16±13.24vs.60.25±10.33, p<0.001) compare to patients with DM2 and SM (p<0.001) and a significantly longer disease duration (12.58±9.63vs.9.39±8.21, p<0.01), relation that maintained in the sex difference also. The first group, compared to the second group, had significantly higher HbA1c (10.52±2.23vs.9.51±2.40, p<0.01), CT (223.566±1.53vs.206.43±55.05, p<0.05), LDL cholesterol (144.10±45.71vs.126.97±43.06, p<0.05) and TG (294.45±311.79 vs. 199.25p±170.72, p<0.05) levels. There were significant differences in hypertension history (HTA, OR 2.09;95% CI:1.15-3.81) in patients with DM2 and SM compared to patients with DM1 and SM. There were no significant differences between the two groups regarding CHD, stroke, PAD. In exchange patients with DM1 and values of waist circumference in the superior distribution tertile compared to the values in the lower distribution tertile, had a significantly higher prevalence of CHD (OR 10.18;95% CI: 3.76-27.56). Both DM1 and DM2, in the superior distribution tertile of waist circumference compared with those in the lower distribution tertile had a higher prevalence of HTA (OR 8.43;95% CI: 2.92-24.33, OR 2.89; 95% CI: 2.06-4.04). After analyzing TG/HDL distribution tertiles, patients with DM1 in the superior tertile compared with the patients in the lower tertile had a higher prevalence of CHD (OR 2.36;

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95% CI: 1.02-5.46), hypertension history (OR 2.26; 95% CI: 1.07-4.77) and the patients with DM2 had a higher prevalence of CHD (OR 1.66; 95% CI: 1.22-2.27), PAD (OR 1.65; 95% CI: 1.05-2.59), MI (OR 3.43; 95% CI: 1.56-7.55) and hypertension (OR 2.34; 95% CI: 1.65-3.31). Patients with SM (DM1 or DM2) compared with patients without SM had a significantly higher prevalence of CHD (OR 3.09; 95% CI: 1.30-7.34), (OR 1.74; 95% CI: 1.26-2.41). There were no statistically significant differences between the analyzed groups regarding the prevalence of stroke and PAD.

Conclusions: Metabolic syndrome represents a risk factor for cardiovascular disease and is associated with a higher prevalence of macrovascular complications both in type I and type II diabetes mellitus patients.

DIABETUL ZAHARAT SI SARCINA

Asistent educator. Macavei Lidia

Asistent educator. Cont Loredana

Euromedica Hospital Baia Mare

INTRODUCERE:

Gravidele cu diabet zaharat tip 1 sau tip 2 sunt supuse unor riscuri extreme de ridicate in ceea ce priveste sanatatea lor si a copiilor ( risc de fat macrosom , malformatii intrauterine ale fatului , posibilitate de polihidroamnios , hipoxia fatului la nastere ,intreruperea de sarcina)

SCOPUL LUCRARII:

Am vrut sa determinam in ce masura educatia pacientelor cu diabet zaharat pe parcursul sarcinii ajuta la evitarea cresterii excesive in greutate a gravidei , a dezechilibrului glicemic si a altor complicatii care pot aparea pe parcursul sarcinii

MATERIAL SI METODE :

In colaborare cu Cabinetul de Obstetrica Ginecologie din cadrul clinicii am selectionat un grup de 16 paciente cu diabet zaharat (5 cu tip1 si 11 cu tip 2 ) in perioada 01.01.2006 – 01.09.2008 . Am facut ancheta nutritionala , chestionar alimentar cu privire la tipul alimentatiei (din punct de vedere calitativ si cantitativ ), continutul in macronutrienti si micronutrienti, ajustarea dozelor de insulina , determinarea hipoglicemiilor , monitorizarea greutatii .

REZULTATE :

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Am constatat ca 6 paciente proveneau din mediul rural si 10 din mediul urban cu varste cuprinse intre 20 respectiv 36 ani .Dintre acestea 60% la prima sarcina , 30% la a-2a sarcina si 10% la a-3a sarcina.

Am observat : la pacientele din mediul rural – 67% consuma excesiv slanina , untura

si mamaliga evitand fructele

- 70% au luat foarte mult in greutate

(aprox.60kg)

- 72% prezinta dezechilibru

glicemic

la pacientele din mediul urban – 80 % au un regim alimentar mai

echilibrat cu 2 – 3 mese /zi

- 62% prezinta o greutate adecvata

perioadei de gestatie

- 84% au un profil glicemic mai bun

CONCLUZIE:

Am constatat lipsa de informare si dezinteres al pacientelor din mediul rural cu privire la educatia specifica diabetului zaharat in perioada sarcini

DIABETS MELLITUS AND PREGNANCY

Asistent Educator: Macavei Lidia

Asistent Educator: Cont Loredana

Euromedica Hospital Baia Mare

INTRODUCTION:

Pregnant women with type 1 diabet mellitus and type 2 are subject to extremely high risks in tems of their health an children (risk of macrosomia , intrauterine malformations of the fetus , possibly polihidroamnios , fetal hypoxia at birth , the interruption of pregnancy).

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AIMS:

I wanted to determine to what extent education for patients with diabetes during pregnancy help prevent excessive weight increase of pregnant women , the imbalance in blood gloucose and other complications that can occur during pregnancy.

MATERIALS AND METHODS:

In collaboration with the Cabinet of Obstetric Gynecology in our clinic we selected 16 pacients with diabetes (5 with type 1 and 11 with type 2), between 01.01.2006 – 01.09.2008. I did nutritional survey ,questionnaires food on the type of food (in qualitative and quantitative) , cotent macronutrienti and micronutrients , adjustment of insulin , the hypo , monitoring weight.

RESULTS :

I found that 6 pacients were from rural and 10 urban , aged between 20 an 36 years of these 60% - 1 of pregnancy , 30% in the 2-d pregnang and 10% in the 3-rd task.

I obsverved – in pacients from rural area – 67% consume excessive slanina , larg and

polenta avoiding fruits

- 70% they took so mucht weight (aprox60kg)

- 72% the imbalance in blood glucose - in pacients from urban area – 80% balance diet with 2 -3 meals/day

- 62% presents a weight appropriate period of

gestation

- 84% a better glycemic profile

CONCLUSION: I found the lack of information and carelessness on the port of patients from rural area on education specify diabetes during pregnancy

INTENSIFICAREA INSULINOTERAPIEI CU HUMALOG MIX 50

LA PACIENŢII CU DIABET ZAHARAT TIP 2

Autori: Dr. Livia Duma1; Dr. Anca Colda2; Dr. Cristina Niţă1.

1Centrul Medical de Diabet Cluj; 2Institutul Naţional de Diabet, Nutriţie şi Boli Metabolice Prof. N. Paulescu

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Premize: Diabetul zaharat de tip 2 (DZ tip 2) reprezintă o problemă de sănătate publică din ce în ce mai importantă datorită asocierii unei morbidităţi şi mortalităţi crescute. Din acest motiv, ghidurile internaţionale de bună practică medicală recomandă obţinerea unor valori ţintă scăzute pentru parametrii echilibrului metabolic la pacienţii cu DZ tip 2. În ciuda multiplelor opţiuni terapeutice disponibile, un procent redus de pacienţi se înscriu în limitele recomandate de ghidurile internaţionale.

Obiectiv: În vederea obţinerii unui control metabolic mai bun se poate opta pentru intensificarea insulinoterapiei cu Humalog Mix 50 în 3 prize, ca soluţie alternativă în condiţiile în care terapia cu 2 prize de insulină premixată nu mai poate asigura eficienţa scontată.

Material şi metodă: Se prezintă cazurile a trei pacienţi cu DZ de tip 2 din două centre universitare au primit tratament intensificat cu Humalog Mix 50 în 3 prize în condiţiile unui control metabolic insuficient. S-au înregistrat parametrii clinici şi biologici înainte şi după intensificarea insulinoterapiei cu Humalog Mix 50. Aceştia au fost: greutatea corporală (Kg), circumferinţa abdominală (cm), valorile glicemice determinate prin monitorizare continuă a glicemiei (CGMS) şi profile glicemice cu 7 puncte, HbA1c şi profil lipidic complet.

Rezultate: HbA1c a scăzut de la o valoare medie de 9.03% la 7.23% după 3 luni de la intensificarea insulinoterapiei cu Humalog Mix 50. Valorile glicemice înregistrate prin CGMS au demonstrat scăderea glicemiei a jeun cât şi a glicemiei postprandiale. În ceea ce priveşte greutatea corporală s-a înregistrat o reducere cu 1.5 Kg la unul dintre pacienţi.

Concluzii: Humalog Mix 50 în 3 prize prandiale reprezintă o soluţie de atingere a obiectivelor glicemice la pacienţii cu DZ tip 2 necontrolaţi în regim cu 2 prize de insulină premixată. Aceasta nouă abordare terapeutică determină creşterea calităţii vieţii şi a complianţei pacienţilor la tratament printr-un regim relativ comod şi sigur.

INTENSIVE INSULIN TREATMENT WITH HUMALOG MIX 50 TID

IN TYPE 2 DIABETES PATIENTS

Authors: Livia Duma1; Anca Colda2; Cristina Niţă1

1Cluj Diabetes Medical Center, Cluj-Napoca; 2National Institute of Diabetes, Nutrition and Metabolic Disease Prof. N. Paulescu, Bucharest

Background: Type 2 diabetes (T2DM) is a growing public health problem due to increased mortality and mobidity. Therefore international guidelines recommend lower targets for metabolic control. Despite many therapeutic options a small percentage of patients meet the recommended goals.

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Objective: Humalog Mix 50 TID is a solution for intensive insulin treatment in order to achieve better glycemic control when premixed insulins twice daily no longer provide adequate control.

Method: We report three cases of T2DM patients with poor metabolic control in two academic centers who were treated with Humalog Mix 50 TID. Clinical and biological measurements were performed before and after insulin therapy intensification with Humalog Mix 50. Body weight (Kg) and waist circumference (cm) were measured. Continous blood glucose monitoring (CGMS), 7 points glycemic profiles, lipid profiles were performed.

Results: Mean HbA1c value decreased from 9.03% la 7.23% within 3 months of Humalog Mix 50 TID treatment. CGMS showed improved glycemic control with both decreased fasting and postprandial blood glucose. A decrease in body weight of 1.5 Kg was reported for one patient.

Conclusions: Humalog Mix 50 TID provides improved glycemic control for T2DM patients treated with two injections of premixed insulin daily. This new therapeutic approach increases quality of life and compliance with treatment in a safe and convenient way.

IMPORTANTA COMUNICARII IN INGRIJIREA COPILULUI DIABETIC

As.med. Luminita Ursache, licentiata in Comunicare Sociala si Relatii Publice Spitalul de Copii "Sf Maria” Iasi, Clinica III

Sanatatea este bunul suprem al omului, care nu are pret, iar viata este valoarea cea mai mare a lumii materiale.

Ingrijire medicala fara constiinta nu se poate si uneori nu e deajuns doar buna intentie si multa munca . Mai este nevoie ca ceea ce facem sa fie realizat in asa fel incat sa fim pe deplin intelesi de toti cei implicati in aceasta relatie de interdependenta: echipa medicala , copilul bolnav, familia acestuia.

In domeniul nostru de activitate orice interventie verbala: intrebare , remarca , subliniere, mai apoi manevra medicala are un scop bine stabilit , bine cunoscut de cei din interiorul sistemului sanitar , insa greu de inteles uneori , de acceptat , iar mai apoi de cooperat- de catre cei din afara. De aceea este atat de important ca personalul din sistemul sanitar sa stie sa comunice in situatiile speciale in care isi desfasoara activitatea , sa invete sa asculte si sa vorbeasca cat mai bine , mai mult decat in orice alta profesie . Aceasta comunicare specifica este utilizata de personalul spitalului ca modalitate de lucru.

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Ingrijirea copilului cu diabet pune probleme deosebite personalului nostru . Este important ca familia copilului diabetic sa fie capabila sa faca fata schimbarilor intervenite odata cu aparitia bolii . Copiii de varsta scolara pana la adolescenta accepta mai usor informatiile legate de boala si tratament .

Problemele copilului cu diabet sunt si de natura emotionala , de adaptare , deoarece situatia lor este neobisnuita- tuturor copiilor le este teama de spital , de injectii ,iar ei incep sa inteleaga ca viata lor se schimba iremediabil odata ce au fost confirmati cu diabet . Nu mai sunt liberi ca inainte , nu mai pot manca ce isi doresc si de obicei este greu de acceptat aceasta decizie. Pot simti frustrare , pot deveni ostili si se pot razvrati: “De ce eu? De ce mi s-a intamplat mie? “ Din aceasta perspectiva trebuie vazuta importanta comunicarii cu micii diabetici .

Familia poate avea o atitudine asemanatoare in momentul confirmarii diabetului pentru ca starea de boala este o situatie pentru care nimeni nu este pregatit. De aceea prima reactie este de negare , a doua de culpabilitate si in cele din urma , de adaptare . Vor invata impreuna sa se impace si sa traiasca cu aceasta boala.

Se stabileste astfel o perioada indelungata de colaborare cu copilul diabetic si cu familia acestuia in care personalul spitalului sa confirme profesionalismul , compasiunea , speranta .

THE IMPORTANCE OF C OMUNICATION IN CARRYING FOR DIABETIC CHILD

Luminita Ursache- licentiate in Social Comunicatioon and Public Relation

Healts represents the priceless supreme humans’assetand life is the biggest value in the material word.There is not medical care without any consciousness and sometimes just good intention and hard work are not enough . We need to do things in such way so we could be fully understood by all the people involved in this interdependent relationship: medical team , ill child and this family .

In our field any verbal intervention: a question , a remark , an emphasis , and after that any medical intervention have a purpose: well known by those from medical system but harder to be understood or accepted and then to cope with by those outside this system . That’s why it’s so important for the medical staff to know how to communicate in special situations , to learn how to listen and talk as good as possible . And this needed in this profession more than others . This specific communication is used by the medical team as a working tool.

Carrying for the diabetic child raises up special problems for our staff. It is important that the family of child with diabetes to be able to deal with the changes in their life brought by the disease. Young children cope better with the disease and treatment related information .

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The diabetic children’s problems are of emotional or adaptation nature because they find themselves in an unusual situations. All the kids are afraid to go the hospital , all of them are afraid of shots and then they start to understand that once they got this diagnosis their life changes for good . They don’t feel free as before , they cant’t eat what they want and this restriction is hard to accept. They feel frustration and could get hostile . They ask:’Why me?’ , “Why this happened to me?”. The importance of communication with diabetic children has to be seen from this perspective.

The family can have the same attitudine when they have the confirmation of the diagnosis . Being iil is usually a situation you are not ready for . They will learn together to deal and live with this disease.

A long period of collaboration with the sick child and his family is needed and the medical team has to act professionally and show compassion and hope.

IMPACTUL BOLII CRONICE DE RINICHI ASUPRA PACIENTILOR CU DIABET ZAHARAT: EXPERIENTA UNUI CENTRU DE DIABET DIN

ROMANIA

Munteanu M., Schiller Ad., Ionutiu L., Mihaescu A., Olariu N., Cocos O., Tarta L.

Universitatea de Medicina si Farmacie Timisoara, Spitalul Judetean Timisoara, Centrul de Diabet Timisoara

Prevalenta DZ in Romania este in jur de 6-8% in populatia generala; ea este in crestere si, potrivit unor date recente, riscul relativ al acestor pacienti este de 1.5 (Collins Am. J Adv. Stud. Med. 2003, 3 (3C) S 194-197). DZ a fost considerat un factor de risc pentru aparitia BCR din 2002, nu numai datorita nefropatiei diabetice, ci si HTA, nefritelor interstitiale, leziunilor vasculare (cu prevalenta crescuta in DZ). In populatia cu risc cardiovascular crescut, prevalenta BCR a fost mai mare la pacientii diabetici, comparativ cu cei fara DZ ( 39.54% vs 22.40%)(Tonelli et al JASN 2005, 16: 3748-3754). Riscul relativ pentru BCR este 2, insa atunci cand se asociaza DZ, el creste la 2.4. Asadar, BCR asociata DZ necesita o atentie speciala. In centrul nostru, prevalenta BCR asociata DZ a fost foarte ridicata comparativ cu datele publicate : 45.82%, iar in lucrarea de fata ne-am propus sa analizam posibilele cauze ale acestui rezultat.

Atat BCR cat si DZ, sunt factori de risc pentru boala cardiovasculara (BCV). In analizele combinate ale studiilor WOSCOPS, CARE si LIPID, rata evenimentelor cardiovasculare a fost semnificativ mai mare atat la pacientii cu DZ, cat si la cei cu BCR comparativ cu pacientii fara DZ si fara BCR- 25.2% si 21.2% vs. 16.7%. Rata evenimentelor CV a crescut la 31.7% in cazul asocierii BCR si DZ. In centrul nostru, prevalenta BCV (boala coronariana-BC, insuficienta cardiaca congestiva -ICC , boala vasculara priferica-BVP si boala vasculara cerebrala-BVC) a fost semnificativ mai

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crescuta la pacientii cu BCR comparativ cu cei fara BCR (BC-49.65% vs. 27.68% p<0.0005, ICC-23.12% vs. 5.93% p<0.0005, BVP-21.08% vs. 10.73% p=0.0006 si BVC-7.14% vs. 3.67% p=0.036).

Dislipidemia este un factor de risc cunoscut atat pentru BCV, cat si pentru progresia BCR. Pe de alta parte, aproape toti pacientii cu BCR dezvolta o forma intens aterogena de dislipidemie. In centrul nostru, dislipidemia a fost identificata la 68.13% dintre pacientii cu DZ (hipercolesterolemie 18.73%, hipertrigliceridemie 19.50%, dislipidemie mixta 30.34%) fara ca prevalenta sa difere semnificativ intre cele doua grupuri (cu BCR , respectiv fara BCR). RFG a pacientilor cu DZ si BCR a corelat negativ cu valorile colesterolului total. Prevalenta cea mai mare a BCR s-a observat la grupul cu dislipidemie mixta, iar prevalenta BCV a fost maxima la grupul cu hipercolesterolemie. Abordarea terapeutica este discutabila.

La urmaririle ulterioare, prevalenta si severitatea BCR la pacienii cu DZ a crescut. Dupa 4 ani de urmarire, prevalenta BCR in centrul nostru a crescut de la 45.82% la 54.60%, la fel ca si severitatea BCR. Pe perioada de urmarire, mortalitatea de toate cauzele a fost semnificativ mai crescuta la pacientii cu BCR (17.85%) comparativ cu cei fara BCR (4.83%). Mortalitatea de toate cauzele s-a corelat pozitiv cu varsta, HbA1c, colesterolul total si negativ cu RFG.

BCR asociata DZ necesita o atentie speciala dintr-o perspectiva multidisciplinara , in scopul de a-i reduce severitatea si prognosticul infaust.

THE IMPACT OF CHRONIC KIDNEY DISEASE ON DIABETES MELLITUS PATIENTS

THE EXPERIENCE OF A SINGLE ROMANIAN DIABETES CENTRE

Munteanu M., Schiller Ad., Ionutiu L., Mihaescu A., Olariu N. Cocos O. Tarta L.

University of Medicine and Pharmacy Timisoara, County Hospital Timisoara, Diabetes Care Centre Timisoara

The prevalence of DM in Romania is about 6-8% of the general population and rising and according to recent data the relative risk of these patients is considered 1.5 (Collins Am. J Adv. Stud. Med. 2003, 3 (3C) S 194-197). Since 2002 DM is considered risk factor for the development of chronic kidney disease (CKD) not only related to diabetic nephropathy but to hypertension, interstitial nephritis, vascular lesions (highly prevalent in DM) also. In the high cardiovascular risk population the prevalence of CKD was reported higher in DM patients as compared to no DM patients (39.54% vs. 22.40%) (Tonelli et al JASN 2005, 16: 3748-3754). The relative risk of CKD is 2 but associated to DM is 2.4. So CKD associated to DM needs a special attention. In our centre the

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prevalence of CKD associated to DM was found to be very high 45.82% as compared to published data and in our paper we discus the possible causes.

Both CKD and DM are risk factors for cardiovascular disease (CVD). The CV event rate was found to be significantly higher in both DM and CKD as compared to no DM no CKD in the combined analysis of WOSCOPS, CARE and LIPID trials (25.2% and 21.2% vs. 16.7%). When associated (DM and CKD) the event rate vas even higher 31.7%. In our centre the prevalence of CVD (i.e. coronary artery disease – CAD, congestive heart failure – CHF, peripheral vascular disease – PVD and cerebral vascular disease –CEVD) was found significantly higher in CKD patients as compared to no CKD ones (CAD - 49.65% vs. 27.68% p<0.0005, CHF - 23.12% vs. 5.93% p<0.0005, PVD - 21.08% vs. 10.73% p=0.0006 and of CEVD - 7.14% vs. 3.67% p=0.036).

Dyslipidemia is known to be a risk factor for CVD and it was found to be a risk factor for the progression of CKD. On the other hand almost all CKD patients develop a severely atherogenic form of dyslipidemia. In our centre dyslipidemia was identified in 68.13% of DM patients (18.73% hypercholesterolemia, 19.50 % hypertriglyceridemia and 30.34% mixed dyslipidemia) but the prevalence did not significantly differ in the two groups (CKD, no CKD). The GFR of DM patients with CKD correlated negatively with total cholesterolemia. The highest prevalence of CKD was found in the mixed dyslipidemia and of CVD was in the hypercholesterolemia group. The issue of therapy is discussed.

On follow up, the prevalence and severity of CKD increases in DM patients. In a 4 years follow up, in our centre the prevalence of CKD significantly increased from 45.82% to 54.60% and the same was true for severity of CKD. During the follow up period the all cause mortality was significantly higher in CKD patients as compared to no CKD ones (17.85% vs. 4.83%). All cause mortality was positively correlated with age, HbA1c and cholesterol levels and negatively with eGFR

CKD associated to DM needs special attention from a multidisciplinary team in order to improve severity and poor prognosis.

PARTICULARITĂŢI DE EVOLUŢIE A DIABETULUI ZAHARAT TIP 1 ASOCIAT CU ALTE BOLI AUTOIMUNE - PREZENTARE DE CAZ -

Autori: Mădălina Păunescu1, Aura Reghină1,2, Alice Albu1, Daniela Voicu3, Tudor Arbănaş1,2 ,Simona Fica1,2

1 Spitalul Universitar de Urgenţă Elias Bucureşti, 2 UMF Carol Davila Bucureşti, 3

Institutul Naţional de Hematologie Transfuzională „Prof Dr C.T. Nicolau” Bucureşti

Introducere: Contextul autoimun de apariţie a diabetului zaharat de tip 1 determină asocierea acestuia cu alte boli autoimune: anemie pernicioasă, boală celiacă, tiroidită autoimună, alopecie,

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insuficienţă gonadală, vitiligo, boală Addison şi altele. Pacienţii sunt în majoritate femei si cea mai frecventă asociere este cu tiroidita Hashimoto. In peste jumătate din cazuri, diabetul zaharat de tip 1 precede boala autoimună cu câţiva ani.

Scopul:Lucrarea îşi propune prezentarea unui caz de diabet de tip 1 care, în evoluţie, asociază mai multe afecţiuni autoimune. .

Material şi metodă: Pacienta I.E în vârstă de 68 de ani, a fost diagnosticată iniţial cu diabet zaharat tip 1 şi tiroidită Hashimoto cu hipotiroidie iar după 3 ani asociază anemie Biermer. Diagnosticul a fost stabilit pe baza examenului clinic, a analizelor de laborator (glicemie, hemoglobină glicozilată, anticorpi antitiroperoxidază ATPO, TSH, hemogramă, frotiu de sânge periferic, anticorpi anticelulă parietală gastrică) şi investigaţii: ecografie tiroidiană, endoscopie digestivă superioară. Ulterior, pacienta prezintă anticorpi antinucleari şi transaminaze dublu faţă de normal în absenţa makerilor virali hepatici, stabilindu-se diagnosticul de hepatită autoimună.

Rezultate: Sub tratament cu insulină, hormoni tiroidieni şi vitamină B12, evoluţia pacientei a fost favorabilă cu ameliorarea manifestărilor clinice şi îmbunătăţirea parametrilor paraclinici. S-a constatat că la fiecare asociere de boală autoimună controlul metabolic (exprimat prin hemoglobina glicozilată) s-a deteriorat, necesarul de insulină a crescut, schema de insulină a trebuit intensificată. Prin tratarea bolii autoimune asociate s-a reuşit ameliorarea controlului glicemic.

Concluzii:Din cauza frecventei asocieri a diabetului de tip 1 cu alte afecţiuni autoimune trebuie avută în vedere investigarea acestor pacienţi (mai ales când debutul bolii este la vârsta adultă) pentru depistarea precoce a posibilelor boli autoimune. Tratarea acestora permite obţinerea unui control metabolic mai bun şi prevenirea apariţiei complicaţiilor pe termen lung.

CHARACTERISTIC FEATURES OF EVOLUTION OF TYPE 1 DIABETES ASSOCIATED WITH SEVERAL AUTOIMMUNE DISEASES

- case presentation -

Introduction:Type 1 diabetes mellitus is an autoimmune disease and it is frequently associated with other autoimmune diseases: pernicious anemia, celiac disease, autoimmune thyroiditis, alopecia, gonadal failure, vitiligo, Addison disease. Patients are mainly women and the

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most frequent association is Hashimoto`s disease. In over 50% of cases, type 1 diabetes mellitus precedes autoimmune disease with several years.

Aim: to present the evolution of type 1 diabetes in a patient who developed several autoimmune diseases.

Methods:Patient I.E, aged 68, was initially diagnosed with type 1 diabetes mellitus and Hashimoto`s thyroiditis and 3 years later, she associated Biermer`s anemia. The diagnosis was based on the clinical examination, laboratory tests (glycemia, glycosylated hemoglobin, thyroid peroxidase antibody - TPOAb, TSH, hemogram, peripheral smear, anti-gastric parietal cell antibodies) and investigations such as: thyroid ultrasound, upper gastrointestinal endoscopy. Further, the presence of antinuclear antibodies and raised transaminases, in the absence of hepatic viral markers, confirmed the diagnosis of autoimmune hepatitis.

Results:The patient received insulin, thyroid hormones and cyanocobalamin treatment, and the symptomatology and paraclinic tests were significantly improved. Each time a new autoimmune disease was diagnosed, a deterioration of metabolic control was noticed (high glycosylated hemoglobin), and the patient needed to increase the daily dose of insulin. The improvement of glycemic control was possible with adequate treatment of the associated autoimmune diseases.

Conclusions:Due to the frequent association of type 1 diabetes mellitus with other autoimmune diseases, functional screening for autoimmune diseases in these patients must be done, especially in those with type 1 diabetes onset at advanced age. The treatment of associated diseases allows a better metabolic control and prevention of long-term complications.

EVALUAREA DIABETULUI ZAHARAT NOU DESCOPERIT ÎN

JUDEŢUL GALAŢI ÎN PERIOADA IANUARIE – IUNIE 2008

Magdalena Moroşanu1, Marta Aganencei2

1Spitalul Judeţean de Urgenţă Galaţi, 2Spitalul Municipal Tecuci

Introducere. Diabetul zaharat (DZ) prin frecvenţa şi caracterul evolutiv de lungă durată constituie o problemă majoră şi o preocupare continuă pentru depistarea bolii, pentru evaluarea clinico biologică şi prevenirea complicaţiilor cronice micro şi macroangiopatice.

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Scop. Analiza cazurilor noi de diabet în perioada 01.01.2008 – 30.06.2008 conform protocolului studiului EPIDIAB, pentru a evalua:

- incidenţa bolii

- frecvenţa complicaţiilor cronice la diagnosticarea bolii

- comorbidităţi prezente

- structura terapeutică

Material şi metodă.

un total de 1987 subiecţi au fost diagnosticaţi cu diabet zaharat in perioada 01 ianuarie- 30 iunie 2008

s-au analizat:- aspectele epidemiologice legate de tipul de diabet, sex, vârstă;- screening-ul complicaţiilor cronice;- asocierea cu alte entităţi ale sindromului metabolic şi bolii cardiovasculare;- structura terapeutică.

Rezultate.

DZ – diabet zaharat, % - procent din totalul persoanelor cu diabet zaharat nou depistate, M – masculin, F – feminin,

Număr total nou depistaţi

DZ tip 2 (ADO, insulină şi ADO, insulină, dietă)

Număr total tip 2

Sex

ADO Insulina / Insulina +ADO DietăM F

Număr total nou depistaţi DZ tip 1

Număr total tip

1 %

Sex

M F

Galaţi

Tecuci

TOTAL

1564

423

1987

14

0

14

0,9

0

0,7

10

0

10

4

0

4

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Galaţi 1564 1550 767 783 889 57 514

Tecuci 423 423 203 220 271 12 129

Total 1987 1973 970 1003 1160 69 643

DZ – diabet zaharat, ADO – antidiabetice orale, M – masculin, F – feminin,

HTA (%) BCV (%)

DLP

Efectuat Nr. (%) Pozitiv Nr. (%)

Galaţi 1383 (89,2%) 128 (8,26%) 1122 (72,4%) 839 (54,1%)

Tecuci184 (43,4%) 115 (27,1%) 311 (73%) 186 (43,9%)

TOTAL 1567 (78,8%) 243 (12,2%) 1433 (72,1%) 1025 (51,5%)

Retinopatie Nefropatie Neuropatie

Efectuat Nr. (%)

Pozitiv Nr. (%)

Efectuat Nr. (%)

Pozitiv Nr. (%)

Efectuat Nr. (%)

Pozitiv Nr. (%)

Galaţi 114 (7,35%) 18 (1,16%) 927 (59,8%)

24 (1,55%) 702 (44,8%) 104 (6,6%)

Tecuci 58 (13,7%)

2 (0,47%) 176 (41%) 3 (1,76%) 198 (46,8%) 84 (19,8%)

Total 172 (8,6%)

20 (1.0%) 1103(55,5%)

27 (1,3%) 900 (45,2%)

188(9,4%)

HTA – hipertensiune arterială, BCV – boală cardiovasculară, DLP – dislipidemie, Nr. – număr, % - procent

Nr. – număr, % - procent

Educaţie – 1987 cazuri (100%); automonitorizare - 276 diabetici (13,43%).

Concluzii.

1. În primele 6 luni ale anului 2008 s-au înregistrat 1987 cazuri noi de diabet, cu 852 cazuri mai mult faţă de anul precedent.

2. La diagnosticare se constată complicaţii cronice în procente relativ crescute precum şi asocierea frecventă a hipertensiunii arteriale, bolii cardiovasculare şi dislipidemiei.

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3. Screening-ul complicaţiilor cronice şi al comorbidităţilor necesită a fi mai activ pentru depistarea mai precoce a acestora în scopul îmbunătăţirii managementului clinic şi reducerii riscului cardiovascular.

4. Iniţierea terapiei cu metformin la debutul DZ tip 2 în 2008 s-a realizat într-un procent apreciabil mai mare decât în anul precedent.

5. Extinderea epidemiologică a diabetului zaharat impune elaborarea unor programe mai active de depistare la grupele cu risc crescut, folosirea celor mai adecvate metode de educaţie şi popularizarea aspectelor legate de complicaţii şi comorbidităţi.

THE ANALYSIS OF NEWLY DIAGNOSED DIABETES MELLITUS IN GALATI COUNTY BETWEEN JANUARY-JUNE 2008

Magdalena Moroşanu1, Marta Aganencei2

1Emergency Clinical County Hospital Galaţi, 2City Hospital Tecuci

Background. Diabetes mellitus (DM) represents a progressive long-term disease with a high prevalence in general population. Diagnosing diabetes constitutes a major problem and causes continuous concern for appropriate clinical and biological evaluation and the prevention of diabetes microvascular and macrovascular chronic complications.

Aims. The analysis of newly diagnosed cases of diabetes between January ,1 st – June, 30th 2008 according to EPIDIAB Study protocol, in order to evaluate:

- the incidence of the disease- the frequency of chronic complications at disease at onset- concomitant comorbidities- therapeutic regimens

Material and method.

A total of 1987 subjects were newly diagnosed with diabetes between January ,1 st – June, 30th 2008

We analyzed:- epidemiological aspects regarding diabetes type, age, sex- the screening of chronic complications- the association with other disorders included in metabolic syndrome- therapeutic structure

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Results.

No. – number, % - percent from total number of newly diagnosed persons, M – masculin, F - feminin

Total no. newly diagnosed

Type 2 diabetes (OAD, insulin and OAD, insulin, diet)

Total no. type 2

Sex

OAD Insulin / Insulin +OAD DietM F

Galaţi 1564 1550 767 783 889 57 514

Tecuci 423 423 203 220 271 12 129

Total 1987 1973 970 1003 1160 69 643

No. – number, OAD – oral antidiabetic drugs, M – masculin, F - feminin

HT (%) CVD (%)

DLP

Screened No. (%) Pozitive No. (%)

Galaţi 1383 (89,2%) 128 (8,26%) 1122 (72,4%) 839 (54,1%)

Tecuci184 (43,4%) 115 (27,1%) 311 (73%) 186 (43,9%)

Total no. newly diagnosed Type 1 diabetes

Total no. type 1

%

Sex

M F

Galaţi

Tecuci

TOTAL

1564

423

1987

14

0

14

0,9

0

0,7

10

0

10

4

0

4

125

TOTAL 1567 (78,8%) 243 (12,2%) 1433 (72,1%) 1025 (51,5%)

Retinopathy Nephropathy Neuropathy

Screened No. (%)

Pozitive No. (%)

Screened No. (%)

Pozitive No. (%)

Screened No. (%)

Pozitive No. (%)

Galaţi 114 (7,35%) 18 (1,16%) 927 (59,8%)

24 (1,55%) 702 (44,8%) 104 (6,6%)

Tecuci 58 (13,7%)

2 (0,47%) 176 (41%) 3 (1,76%) 198 (46,8%) 84 (19,8%)

Total 172 (8,6%)

20 (1.0%) 1103(55,5%)

27 (1,3%) 900 (45,2%)

188(9,4%)

HT – Hypertension, CVD – cardiovascular disease, DLP – dyslipidemia, no. – number, % - percent

No. – number, % - percent

Education – performed in 1987 cases (100%); self-monitoring – performed by 276 persons with diabetes (13,43%).

Conclusions.

1. In first 6 months of 2008 we recorded 1987 cases of newly diagnosed diabetes, with 852 cases exceeding last year report for the same period.

2. We found relatively high percentages of chronic complications, as well as frequent association of hypertension, cardiovascular disease and dyslipidemia at diagnose.

3. We need a more active screening of chronic complications and comorbidities for an early diagnose, to improve clinical management and reduce cardiovascular risk.

4. The initiation of metformin therapy (percent of total cases) in newly diagnosed type 2 diabetes patients in 2008 was appreciably higher than in the previous year.

5. The epidemiologic extent of diabetes impose elaboration of more active screening programs in high risk population groups, use of most adequate educational methods and largely discuss and disseminate the aspects regarding complications and comorbidities.

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ACTIVITATEA FIZICĂ ÎN RELAŢIE CU FACTORI INDIVIDUALI, EXTERNI

ŞI CU STATUSUL PONDERAL

ÎN POPULAŢIA GENERALĂ A JUDEŢULUI GALAŢI

Magdalena Moroşanu1, Andreea Moroşanu2, Octavian Alexe3

1Spitalul Clinic de Urgenţă Galaţi, 2Centrul Clinic de Diabet, Nutriţie şi Boli Metabolice Cluj-Napoca, 3Facultatea de Kinetoterapie, Universitatea “Dunărea de Jos”Galaţi

Introducere. Stilul de viaţă sedentar are o influenţă importantă în creşterea ponderală. Obezitatea şi supraponderea sunt favorizate de reducerea activităţii fizice, care a devenit o caracteristică a stilului de viaţă în societatea actuală. Promovarea şi stimularea activităţii fizice au beneficii importante în reducerea ponderală, în prevenţia creşterii ponderale, în reducerea riscului cardiovascular (prin reducerea insulinorezistenţei) şi în terapia obezităţii şi a supraponderii.

Obiective. Evaluarea activităţii fizice în funcţie de factori individuali, externi (sex, vârstă, domiciliu, anotimp) şi a relaţiei acesteia cu starea ponderală în populaţia judeţului Galaţi.

Material şi metodǎ. Lotul de studiu de 311 persoane a fost selecţionat pe baza reprezentativităţii generale pentru populaţia adultă a judeţului Galaţi în funcţie de grupe de vârstă, sex şi domiciliu (urban, rural). Activitatea fizică a fost cuantificată ca frecvenţă (≥3 ori/săptămână) şi ca durată (≥ 30 minute) (răspuns cotat cu „da” şi „nu”) conform fişei de screening a obezităţii a Asociaţiei Române pentru Studiul Obezităţii (ARSO). Datele antropometrice s-au obţinut prin măsurarea greutăţii, înălţimii, circumferinţei abdominale (CA) şi calculul indicelui de masă corporală (IMC). Categoriile stării ponderale în funcţie de IMC au fost „subpondere”, „normopondere”, „suprapondere”, „obezitate”, adaptate dupa clasificarea OMS. Categoriile de risc ale obezităţii abdominale au fost : „risc scăzut” (CA < 80 cm la femei, < 94 cm la bărbaţi), „risc mediu” (CA 80-88 cm la femei, 94-102 cm la bărbaţi) şi „risc crescut” (CA > 88 cm la femei, > 102 cm la bărbaţi). Categoriile de risc mediu şi crescut indică obezitatea abdominală (viscerală). Prelucrarea statistică a datelor s-au realizat în programul SPSS 13.0. Nivelul semnificaţiei statistice a fost realizat pentru p<0.05.

Rezultate. Analiza activităţii fizice în grupul studiat a arătat că 59,16% din persoane efectuează activitate fizică mai mult de 3 ori pe săptămână şi mai mult de 30 minute. Barbaţii fac activitate fizică în procent mai mare (61.82%) decât femeile (58.0%) (p>0.05). În general, ambele sexe în ambele medii efectuează activitate fizică în proporţie mai mare de 50%. S-a remarcat o pondere mai mare a efectuarii activităţii fizice la bărbaţi în mediul urban (65.67%) faţă de mediul rural (55.81%), în timp ce la femei

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activitatea fizică este efectuată comparabil în mediul urban (58.87%) şi rural (56.58%) (uşor mai crescută în mediul urban). S-a constatat o prevalenţa a efectuării activităţii fizice mai mare la grupele de vârstă 20-29 ani (77.14%), 50-59 ani (67.39%) şi 60-65 ani (57.89%) faţă de grupele de vârstă 30-39 ani (52.05%), 40-49 ani (51.78%) şi peste 65 ani (44.68%), precum şi în timpul verii (67.34%) faţă de perioada de iarnă (51.82%). Aceste diferenţe au fost semnificative statistic (p<0.05). Relaţia activitate fizică – stare ponderală. Persoanele care fac activitate fizică au IMC semnificativ mai mic (25.82 ± 5.48 kg/m2) faţă de cele care nu fac activitate fizică (28.40 ± 6.19 kg/m2). Persoanele care fac activitate fizică sunt normoponderale, subponderale şi supraponderale într-un procent semnificativ mai mare decât cele care nu fac activitate fizică (acestea sunt într-un procent mai mare incluse în categoria de obezitate) (p<0.05). Persoanele care fac activitate fizică au CA semnificativ mai mică (89.98 ± 15.49 cm) faţă de cele care nu fac activitate fizică (94.48 ± 17.17 cm) şi sunt, într-un procent mai mare, incluse în categoriile de risc scăzut şi mediu (p<0.05).

Concluzii. Activitatea fizică este efectuată în procent mai crescut de către bărbaţi, în special în mediul urban, la tineri (20-29 ani) şi între 50-65 ani şi mai mult în timpul verii. Persoanele care fac activitate fizică sunt frecvent normo- şi supraponderale şi asociază CA cu risc scăzut şi mediu, în timp ce persoanele sedentare sunt asociate mai frecvent cu obezitatea şi cu obezitatea abdominală cu risc crescut. Identificarea şi evaluarea factorilor care influenţează activitatea fizică constituie parte integrantă din programele de management şi prevenţie a obezităţii.

PHYSICAL ACTIVITY IN RELATION WITH INDIVIDUAL AND EXTERNAL FACTORS AND WITH PONDERAL STATUS IN GENERAL POPULATION OF

GALATI COUNTY

Magdalena Moroşanu1, Andreea Moroşanu2, Octavian Alexe3

1Emergency Clinical County Hospital Galaţi, 2Clinical Center of Diabetes, Nutrition and Metabolic Diseases Cluj-Napoca, 3Kinetotherapy Faculty, “Dunărea de Jos” University Galaţi

Background. Sedentary lifestyle is an important factor in weight gain. The decrease of physical activity which became a lifestyle feature in nowadays society induces the appearance of obesity and overweight. Promoting and stimulating the increase of physical effort bring important benefits in losing weight, in preventing weight gain, in reducing cardiovascular risk (by decreasing insulinresistance) and in obesity and overweight management.

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Aims. The assessment of physical activity in relation with individual and external factors and with ponderal status in general population of Galati County.

Method and study group. Study group included 311 persons selected based on general representativity for age, sex and residence (urban, rural) in adult population of Galati County. Physical activity was quantified by “yes”/”no” answer regarding carrying out of exactly or more than 30 minutes of physical effort at least 3 times a week according to Obesity Screening Record form Romanian Association for the Study of Obesity. We assessed anthropometric parameters: weight, height, waist circumference (WC) and calculated body mass index (BMI). We adapted OMS criteria for quantifying ponderal categories based on BMI values: “underweight”, “normalweight”, “overweight” and “obesity”. The risk categories of WC were as following: “low risk” ( WC < 80 cm in women and < 94 cm in men), “medium risk” (WC between 80-88 cm in women and between 94-102 cm in men) and “high risk” (WC > 88 cm in women and > 102 cm in men). Medium and high risk categories indicate abdominal (visceral) obesity. Statistical analysis was performed with SPSS 13.0 program. Statistical significance was reached for p<0.05.

Results. The analysis of physical activity level showed that 59.16% of the subjects perform physical effort more than 30 minutes of physical effort at least 3 times a week. Men carry out physical activity in a higher extent (61.82%) than women (58.0%) (p>0.05). Generally, more than 50% of both men and women performed physical activity. We noticed a higher percent of affirmative answers in men from urban area (65.67%) than from rural area (55.81%), while women had comparable affirmative answers in urban (58.87%) and rural areas (56.58%) (slightly higher for urban residence). We noticed a higher prevalence of physical activity for age between 20-29 years (77.14%), 50-59 years (67.39%) and 60-65 years (57.89%) than for age between 30-39 years (52.05%), 40-49 years (51.78%) and over 65 years (44.68%) as well as during summer time. These differences were statistically significant (p<0.05). The relation between physical activity and ponderal status. Persons who carry out physical effort had significantly lower BMI (25.82 ± 5.48 kg/m2) than those who do not carry out physical effort (28.40 ± 6.19 kg/m2). The persons who perform physical activity are normalweight and overweight in a significantly higher extent, while persons who do not carry out physical effort as required are more frequently obese (p<0.05). WC is significantly lower (89.98 ± 15.49 cm) and is included more in low and medium risk categories in subjects who perform physical activity as needed than in those who do not (94.48 ± 17.17 cm) which are included more in high risk category (p<0.05).

Conclusions. Men perform more frequent physical activity, especially in urban area. Persons with age between 20-29 years and between 50-65 years, as well as during summer time carry out physical effort more frequently. Active persons are more often normalweight and overweight and are included in low and medium risk categories of WC, while sedentary persons are more often obese and have high risk of WC values (abdominal obesity). Identification and assessment of factors which influence physical activity are important tools in the prevention and management of obesity.

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DETERMINAREA COMPOZITIEI CORPULUI LA PACIENTI CU SINDROM METABOLIC, PRIN METODA BIOIMPEDANTEI, UTILIZAND APARATELE

IN BODY 3.0, OMRON BF500,

BCM Fresenius Medical Care

Autori: M. Ispas¹, N. State¹, C. Serafinceanu¹ ², C. Constantin² ³,D. Cheta¹ ²

Afiliatia autorilor: 1)UMF “Carol Davila”

2)Institutul de Diabet “Prof N. Paulescu”

3)Spitalul Clinic de Urgenta Militar Central “Carol Davila”

Introducere. Studiul compozitiei corporale prin bioimpedanta este o metoda frecvent utilizata, folosind aparate de productie diferita. Rezultatele pot influenta decizia terapeutica.

Materiale si metode. Pentru 68 de pacienti cu sindrom metabolic (IDF 2005), selectati dintre cei admisi in Institutul “N.Paulescu”, (33b/35f), cu varsta medie de 55,17±10,98 ani, s-a examinat compozitia corporala cu ajutorul a trei aparate diferite (In Body 3.0, Omron BF 500, BCM-Fresenius Medical Care). Dintre acestia, 51 (22b/29f) au fost inclusi in studiu. Au fost exclusi pacienti care nu au urmat tot protocolul, cu amputatii sau cu dispozitive electronice implantate. Au fost determinati parametri: greutatea, IMC, volumele lichidiene intra- si extracelular, precum si masa, respectiv procentul de tesut adipos. Datele obtinute au fost prelucrate statistic cu SPSS 13.0 folosind testul T student modificat.

Rezultate. S-au luat drept referinta rezultatele obtinute de la aparatul In Body 3.0, unde media volumului total de lichid (VTL) a fost de 42,12±8,38l, cu distributia 28,21±5,52 (lichid intracelular – LIC) si 13,89±2,98 (lichid extracelular – LEC) (rezultate diferite pentru p<0,05 fata de referinta). Rezultatele BCM Fresenius au fost: volumul total de lichid de 37,47±7.76 l , distribuit astfel: 20,4±4,23 l (LIC), respectiv 17,4±3,26l (LEC). IMC (kg/m²) a fost diferit: 30,41±4,55 (In Body) vs. 30,48±4,55 (Omron) (pentru p<0,05). Greutatea totala determinata: 84,2±14,54 kg (In Body) si 84,42±14,56 kg (Omron) (p<0,05). Procentul de tesut adipos a fost de 31,99±7,67% (In Body) vs. 35,14±10,03% (Omron) (p<0,05), respectiv, vs. 38,29±8,05% (Fresenius) (p<0,05), cu o valoare mai mare la sexul feminin vs. sexul masculine. Pentru sexul feminin rezultatele au fost 40,82±7,48 (Omron) vs. 35,31±6,46% (In Body) (p<0,05). Pentru sexul masculin rezultatele au fost 27,28±7,12% (Omron) vs. 27,34±6,69 (In Body) (p<0,05). Raportul talie-sold: 0,99±0,06 (masculin) vs. 0,98±0,09 (feminin).

Aparatele In Body si Omron au furnizat date diferite si despre metabolismul bazal: 1452,94±211,25, respectiv 1653,52±241,82 kcal/zi (p<0,05).

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Concluzii. Cântărirea sub apă şi DEXA (dual-energy x-ray absorptiometry) sunt exemple de metode validate ştiinţific si desi costisitoare şi inaccesibile, raman a fi “standardele de aur” în determinarea compoziţiei corporale;. Majoritatea diferentelor obtinute pe lotul studiat sunt semnificative statistic, sugerand ca metoda bioimpedantei utilizata de diversi producatori necesita imbunatatirea tehnicii folosite.

Discutii. Datele furnizate servesc pentru aprecierea compozitiei corporale a pacientilor cu sindrom metabolic, bioimpedanta fiind o metoda simpla, neinvaziva si usor de folosit, dar alegerea oricarui aparat dintre cele folosite, va influenta conduita terapeutica in practica.

Finanţare: Studiu realizat in cadrul proiectului PNCDI2 52164/2008

DETERMINATION OF BODY COMPOSITION IN PATIENTS WITH METABOLIC SYNDROME,

BY BIO-IMPEDANCE METHOD,

using In Body3.0, Omron BF 500, BCM Fresenius Medical Care devices

Authors: M. Ispas¹, N. State¹, C. Serafinceanu¹ ², C. Constantin² ³, D. Cheta¹ ²

Authors’ affiliation: 1) “Carol Davila” University of Medicine and Pharmacy;

2) “N. Paulescu” National Institute of Diabetes;

3) “Carol Davila” Central Military Emergency Clinical Hospital.

Introduction. The study of body composition by bio-impedance is a frequently used method, using different devices. The results may influence the therapeutic choice.

Materials and methods. 68 patients (33m/35w) with metabolic syndrome (IDF2005) were selected from patients admitted in the “N. Paulescu” Institute. Their mean age was of 55.17±10.98years. Their body composition was examined, using three different devices: In Body 3.0, Omron BF 500, BCM-Fresenius Medical Care. 51 patients (22m /29w) were included in the study. Patients with amputation, implanted electronic devices or incomplete determinations were excluded. Weight, BMI, intra- and extracellular liquid volumes, fat tissue were also determined. All data were statistically processed using T Student test in SPSS 13.0.

Results. As reference the results of In Body 3.0 were used, where total body water (TBW) was of 42.12±8.38L, distributed as following: 28.21±5.52L IBW (intracellular body water) and 13.89±2.98L EBW (extracellular body water) (results different for p<0.05 than reference). The results of BCM Fresenius were: 37.47±7.76L, distributed in 20.4±4.23L (IBW) and 17.4±3.26 L(EBW). The results for BMI (kg/m²) were different: 30.41±4.55(In Body) and 30.48±4.55(Omron) (p<0.05). Determined weight was similar:

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84.2±14.54 kg(In Body) and 84.42±14.56 kg(Omron) (p<0.05). The percentage of fat tissue was different 31.99±7.67%(In Body) vs. 35.14±10.03%(Omron) (p<0.05), respectively 38.29±8.05%(Fresenius) (p<0.05), with a higher value for women than men: 35.31±6.46%(In Body), 40.82±7.48%(Omron) (p<0.05) (women) vs. 27.34±6.69% (In Body), 27.28±7.12% (Omron) (p=0.054) (men).

Were also recorded different information regarding Resting Metabolism Rate: 1452.94±211.25 kcal/day (In Body) and 1653.52±241.82 kcal/day (Omron) (statistically different for p<0.05).

Conclusions. Under water weighting and DEXA (dual-energy-x-ray absorptiometry) remain the “gold standard” procedures for determining body composition, but they are inaccessible and expensive. The majority of obtained results are statistically different.

Discussions. The obtained data are helpful in determining body composition in patients with metabolic syndrome, as bio-impedance is a simple, noninvasive, easy to use method, but choosing any of the devices above will influence the therapeutic behavior in clinical practice.

Supported by: Grant PNCDI2 52164/2008 from the Romanian Research Ministry.

STUDIU ASUPRA AUTOIMUNITATII ASOCIATE IN DIABETUL ZAHARAT TIP 1 LA COPIL SI ADOLESCENT

Mariana Andreica, Nicolae Miu, Simona Cainap, Bogdan Lucian, Lucia Slavescu, Claudia Bolba, Rodica Cornean, Tudor L. Pop

Clinica Pediatrie II, UMF "Iuliu Hatieganu", Cluj-Napoca

Asocierile autoimune la pacientii cu DZ sunt bine cunoscute si pot apare fie individual, fie incadrate in sindroame. Aceste asocieri implica gene ale complexului major de histocompatibilitate(MHC) de tipul HLA DR si DQ. Cele mai frecvente asocieri sunt reprezentate, in ordinea incidentei, de tiroidita autoimuna, boala celiaca, boala Addison si alte autoimunitai ca artrita cronica idiopatica sau vitiligo.

S-au luat in studiu un numar de 49 de copii si adolescenti internati in Clinica Pediatrie II, Cluj- Napoca, in perioada 2005-2007. S-a efectuat screening pentru tiroidita autoimuna prin masurarea anticorpilor antitireoperoxidaza(TPO), antitireoglobulina(TG), a TSH si a fT4. Screeningul pentru boala celiaca s-a realizat prin masurarea anticorpilor

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antiendomisium(AEM) si antitransglutaminaza tisulara(ATGt). Screeningul pentru boala Addison s-a efectuat prin masurarea cortizolemiei bazale si ulterior prin determinarea anticorpilor antiadrenali. De asemenea s-a realizat si screening pentru artrita cronica idiopatica si alte colagenoze prin detectarea factorului reumatoid, a anticorpilor antinucleari si a anticorpilor antiADN ds. In paralel s-a efectuat monitorizarea metabolica a tuturor pacientilor.

Tiroidita autoimuna a fost descoperita la 3 pacienti(6,1%). Din acestia , un pacient a prezentat forma hipertiroidiana(b. Basedow-Graves), unul a prezentat asociat boala celiaca iar unul a prezentat sindrom poliendocrin autoimuin tip II. Boala celiaca a fost prezenta la 4 pacienti(8,1%). Boala Addison a fost prezenta la 1 pacient(2%) in contextul sindromului poliendocrin autoimun tip II. Doi pacienti au prezentat artrita cronica idiopatica(4%) si 1 pacient a prezentat leziuni de vitiligo(2%).

In concluzie, autoimunitatile asociate diabetului zaharat tip I la copil si adolescent impune efectuarea unor teste screening dupa protocoale bine standardizate, atat pentru ameliorarea controlului bolii cat si pentru prevenirea precocitatii complicatiilor micro si macrovasculare ulterioare.

STUDY OF ASSOCIATED AUTOIMMUNITY AND TYPE 1 DIABETES MELLITUS IN CHILDREN AND ADOLESCENTS

Mariana Andreica, Nicolae Miu, Simona Cainap, Bogdan Lucian, Lucia Slavescu, Claudia Bolba, Rodica Cornean, Tudor L. Pop

2nd Pediatric Clinic, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca

Associated autoimmunity and type 1 diabetes mellitus(T1DM) is well known and can exist individually or combined in syndromes. This association implicates the involvement of different genes of the major histocompatibility complex(MHC) such as human leukocyte antigen(HLA) DR and DQ. The most common autoimmune associations are represented by autoimmune thyroid disease, celiac disease, Addison’s disease and others such as chronic idiopathic arthritis or vitiligo.

We have studied 49 children and adolescents admitted in The 2nd Pediatric Clinic in Cluj-Napoca between 2005 and 2007. We have performed screening tests for autoimmune thyroid disease by measuring thyroid peroxidase and thyroglobulin autoantibodies, TSH and free T4. The celiac disease screening has been made by antiendomysial and trans-glutaminase autoantibodies and Addison’s disease screening has been made by basal cortisol and antiadrenal antibodies. We have also performed

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screening for chronic idiopathic arthritis and other collagen diseases by determining rheumatoid factor and antinuclear and anti DNA antibodies.

Autoimmune thyroid disease was discovered in 3(6,1%) patients of which 1 had hyperthyroid function(Basedow-Graves disease), one associated celiac disease and one had autoimmune polyendocrine syndrome type II. Celiac disease was revealed in 4 patients(8,1%). Addison’s disease was revealed in one patient(2%) and was associated in the autoimmune polyendocrine syndrome type II. Two patients(4%) had had chronic idiopathic arthritis and one of them had vitiligo lesions.

As a conclusion, associated autoimmunity and T1DM should emphasize the important role of screening in this patients, by well standardized protocols, in order to ameliorate the natural history of T1DM and to prevent the precocity of developing micro and macro- vascular complications of the disease.

CORELAŢIA DINTRE CIRCUMFERINŢA ABDOMINALĂ (CA) ŞI RAPORTUL TG/HDL>3 CA MARKERI AI INSULINOREZISTENŢEI CU PERTURBĂRILE

METABOLISMULUI GLUCIDIC

Autori: Mihaela L. Bîcu, Simona G. Popa, R.I. Dinu, Camelia Pănuş, Maria Moţa

Spitalul Clinic Judeţean de Urgenţă Craiova, Clinica Diabet Nutriţie Boli Metabolice

Premise şi scop. Scopul studiului a fost de a urmări corelaţia existentă între două modalităţi de evaluare a insulinorezistenţei: 1. circumferinţa abdominală (CA); 2. raportul TG/HDL > 3 şi perturbările metabolismului glucidic.

Material şi metodă. Am luat în studiu 119 subiecţi internaţi în Clinică în perioada iunie 2008 -septembrie 2008, cu suspiciune de diabet zaharat (DZ), cu vârsta medie ± dev st de 54,50 ± 13,68 ani (limite 20-80 ani), dintre care 60 bărbaţi (50,4%) şi 59 femei (49,6%).

Menţionăm că au fost excluşi subiecţii cu suspiciune de perturbări secundare ale metabolismului glucidic. Parametrii investigaţi au fost: vârsta, sex, date antropometrice (înălţime, greutate, indexul masei corporale - IMC, CA), test de toleranţă orală la glucoză TTGO cu 75 g glucoză (glicemie a jeun, glicemie la 1oră, glicemie la 2 ore), trigliceride (TG), colesterol total, HDL colesterol.

Rezultate şi discuţii. Din cei 119 subiecţi, 15 (12,60%) au prezentat toleranţă normală la glucoză (TNG), restul 104 subiecţi (87,40%) prezentând modificări ale metabolismului glucidic, astfel: 46 subiecţi (38,65%) au fost diagnosticaţi cu diabet zaharat (DZ), 24 ( 20,16%) subiecţi cu alterarea glicemiei a jeun (IFG), 3 (2,52%) subiecţi cu scăderea toleranţei la glucoză (IGT), 23 (19,32%) subiecţi cu intoleranţă combinata la glucoză (CGI= IFG+IGT) şi 8 (6,72%) subiecţi cu disglicemie.

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Corelaţia dintre circumferinţa abdominală (CA) şi raportul TG/HDL>3 ca markeri ai insulinorezistenţei si perturbările metabolismului glucidic

Caracteristica Bărbaţi

(număr 60)

Femei

(număr 59)

CA (cm) <94 94-101 ≥102 <80 80-87 ≥88

Număr (%) 16 (26,66%)

11 (18,33%)

33 (55%) 6 (10,16%) 8 (13,55%) 45 (76,27%)

TG/

HDL

> 3 4 (25%) 8 (72,72%)

22 (66,66%)

0 (0%) 2 (25%) 14 (31,11%)

TNG 0 (0%) 1 (12,5%) 1 (4,54%) 0 (0%) 0 (0%) 2 (14,28%)

DZ 1 (25%) 2 (25%) 7 (31,81%)

0 (0%) 1 (50%) 5 ( 35,71%)

IFG 2 (50%) 2 (25%) 4 (18,18%)

0 (0%) 0 (0%) 2 (14,28%)

IGT 0 (0%) 0 (0%) 1 (4,54%) 0 (0%) 0 (0%) 0 (0%)

CGI 1 (25%) 2 (25%) 7 (31,81%)

0 (0%) 0 (0%) 4 (28,57%)

disglicemie

0 (0%) 1 (12,5%) 2 (9,09%) 0 (0%) 1 (50%) 1 (7,14%)

TG/

HDL

< 3 12 (75%) 3 (27,27%)

11 (33,33%)

6 (100%) 6 (75%) 31 (68,88%)

TNG 2 (16,66%)

0 (0%) 1 (9,09%) 5 (83,33%) 1 (16,66%) 2 (6,45%)

DZ 4 (33,33%)

0 (0%) 4 (36,36%)

0 (0%) 1 (16,66%) 21 (67,74%)

IFG 4 (33,33%)

2 (66,66%)

2 (18,18%)

1 (16,66%) 2 (33,33%) 3 (9,67%)

IGT 0 (0%) 1 (33,33%)

0 (0%) 0 (0%) 1 (16,66%) 0 (0%)

CGI 1 (8,33%) 0 (0%) 3 (27,27%)

0 (0%) 1 (16,66%) 4 (12,9%)

disglicemi 1 (8,33%) 0 (0%) 1 (9,09%) 0 (0%) 0 (0%) 1 (3,22%)

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e

Dintre bărbaţii cu CA ≥ 102 cm, 66,66% au prezentat raport TG/HDL > 3, spre deosebire de femei, la care nu am observat corelaţie între CA şi raportul TG/HDL > 3 (31,11%).

Atât la bărbaţi cât şi la femei, am observat corelaţie între CA ≥ 102 cm, respectiv CA ≥ 88 cm şi perturbările metabolismului glucidic, indiferent însă de valoarea raportului TG/HDL.

Concluzii. Prezenţa obezităţii abdominale şi implicit a perturbărilor metabolismului lipidic, impun investigarea metabolismului glucidic prin efectuarea TTGO-ului, în vederea depistării perturbarilor metabolismului glucidic în stadii precoce.

THE CORRELATION BETWEEN WAIST CIRCUMFERENCE (WC) AND TG/HDL>3 RATIO AS INSULINRESISTANCE MARKERS WITH THE DISTURBANCES OF

GLYCEMIC METABOLISM

Autors: Mihaela L. Bicu, Simona G. Popa, R.I. Dinu, Camelia Panus, Maria Mota

Department of Diabetes Nutrition Metabolic Diseases, Clinical County Emergency Hospital Craiova

Background and aim. The objective of this study was the assessment of the correlation between waist circumference (WC) and TG/HDL>3 ratio as insulinresistance markers with the disturbances of glycemic metabolism.

Material and method. The study was performed 119 subjects which were admitted in Diabetes Clinical in June 2008 - September 2008 period, in observation for Diabetes Mellitus (DM), with an average age ± stdev of 54,50 ± 13,68 (limits 20-80) years, from which 60 men (50,4%) and 59 women (49,6%). We mentioned that were excluded the subjects with suspicion on secundary disturbances of glycemic metabolism. The following parameters were analyzed: age, gender, anthropometric parameters (height, weight, body mass index-BMI, WC), oral glucose tolerance test (OGTT) using 75g glucose (fasting glycemia, glycemia at 1 hour, glycemia at 2 hours), tryglicerides (TG), total cholesterol, HDL cholesterol.

Results and discussions. From the 119 subjects studied, 15 (12,60%) subjects have a normal glucose tolerance (NGT), the rest of 104 (87,40%) subjects presented disturbances of glycemic metabolism hereby: 46 subjects (38,65%) was diagnosed with DM, 24 subjects (20,16%) with impaired fasting glucose (IFG), 3 subjects (2,52%) with impaired glucose tolerance (IGT), 23 subjects (19,32%) with combined glucose intolerance (CGI=IFG+IGT) and 8 subjects (6,72%) with dysglycemia.

The correlation between waist circumference (WC) and TG/HDL>3 ratio as insulinresistance markers with the disturbances of glycemic metabolism

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Characteristics Men

( 60 subjects)

Women

( 59 subjects)

WC (cm) <94 94-101 ≥102 <80 80-87 ≥88

Number (%) 16 (26,66%)

11 (18,33%)

33 (55%) 6 (10,16%) 8 (13,55%) 45 (76,27%)

TG/

HDL

> 3 4 (25%) 8 (72,72%)

22 (66,66%)

0 (0%) 2 (25%) 14 (31,11%)

TNG 0 (0%) 1 (12,5%) 1 (4,54%) 0 (0%) 0 (0%) 2 (14,28%)

DZ 1 (25%) 2 (25%) 7 (31,81%)

0 (0%) 1 (50%) 5 ( 35,71%)

IFG 2 (50%) 2 (25%) 4 (18,18%)

0 (0%) 0 (0%) 2 (14,28%)

IGT 0 (0%) 0 (0%) 1 (4,54%) 0 (0%) 0 (0%) 0 (0%)

CGI 1 (25%) 2 (25%) 7 (31,81%)

0 (0%) 0 (0%) 4 (28,57%)

disglicemie

0 (0%) 1 (12,5%) 2 (9,09%) 0 (0%) 1 (50%) 1 (7,14%)

TG/

HDL

< 3 12 (75%) 3 (27,27%)

11 (33,33%)

6 (100%) 6 (75%) 31 (68,88%)

TNG 2 (16,66%)

0 (0%) 1 (9,09%) 5 (83,33%) 1 (16,66%) 2 (6,45%)

DZ 4 (33,33%)

0 (0%) 4 (36,36%)

0 (0%) 1 (16,66%) 21 (67,74%)

IFG 4 (33,33%)

2 (66,66%)

2 (18,18%)

1 (16,66%) 2 (33,33%) 3 (9,67%)

IGT 0 (0%) 1 (33,33%)

0 (0%) 0 (0%) 1 (16,66%) 0 (0%)

CGI 1 (8,33%) 0 (0%) 3 (27,27%)

0 (0%) 1 (16,66%) 4 (12,9%)

dysglicemia

1 (8,33%) 0 (0%) 1 (9,09%) 0 (0%) 0 (0%) 1 (3,22%)

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From the men with WC ≥ 102 cm, 66,66% showed TG/HDL > 3 ratio, comparative with the women, on which have not observed the correlation between WC and TG/ HDL > 3 ratio (31,11%).

Both women and men we observed the correlation between WC ≥ 102 cm, respectively WC ≥ 88 cm with the disturbances of glycemic metabolism, no matter the value on TG/HDL ratio.

Conclusions. The presence of abdominal obesity and implicitly of the disturbances of lipidic metabolism, makes necessary the investigation of the glycemic metabolism through effectuation of the OGTT, with a view to early tracking of the disturbances of glycemic metabolism.

COMPARAREA VARIABILITĂŢII GLICEMICE LA SUBIECŢI CU ŞI FĂRĂ MODIFICĂRI ALE METABOLISMULUI GLUCIDIC

Autori: Mihaela L. Bîcu, Simona G. Popa, Sigina R. Gîrgavu, R.I. Dinu, Maria Moţa

Spitalul Clinic Judeţean de Urgenţă Craiova, Clinica Diabet Nutriţie Boli Metabolice

Premise şi scop: Variabilitatea glicemică la persoanele fără diabet zaharat este corelată cu răspunsul metabolic postprandial. În vederea cuantificării exacte a variabilităţii glicemice se pot calcula indici specifici: MAGE (Mean Amplitude Glycemic Excursion=Amplitudinea Medie a Excursiilor Glicemice), MODD (Mean of Daily Differences = Media Diferenţelor Zilnice), MIME (Mean Indices of Meal Excursions = Indicele Mediu Al Excursiilor Glicemice Postprandiale). MAGE evaluează excursiile glicemice majore din cursul unei zile, excluzând excursiile glicemice minore. MODD apreciază variaţiile glicemice în acelaşi moment din zile diferite, la acelaşi subiect. MIME evaluează excursiile glicemice corelate cu ingestia de alimente.

Scopul studiului este de a compara: 1.variabilitatea glicemică la doi subiecţi cu dietă fără restricţie de hidraţi de carbon (HC), unul cu toleranţă normală la glucoză (NGT normal glucose tolerance) şi unul cu alterarea glicemiei a jeun (IFG impaired fasting glucose); 2. variabilitatea glicemică la subiectul cu IFG - dietă fără restricţie de HC versus dietă cu restricţie de HC (200g HC/zi).

Material şi metodă: Am calculat cinci indici specifici de evaluare a variabilităţii glicemice (MG, DS, MAGE, MODD, MIME) la cei 2 subiecţi, cu dietă fără restricţie de HC: unul cu NGT şi unul cu IFG, de acelaşi sex, comparabili ca vârstă, IMC, condiţii de stress; de asemenea, am calculat cei cinci indici la subiectul cu IFG, cu dietă cu 200 g HC/zi. La cei doi subiecţi s-a montat CGMS (continuous glucose monitoring system = sistem de monitorizare continuă a glicemiei) pe o perioadă de 72 ore. Menţionăm că subiectul cu IFG a avut montat CGMS de 2 ori, timp de 72 ore, o dată cu dieta fără

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restricţie de HC, şi o dată cu dieta cu 200 g HC/zi. În ziua a doua a montării CGMS-ului am efectuat test de toleranţă la glucoză pe cale orală (TTGO) la cei doi subiecţi, cu 75 g glucoză pulvis.

Pentru calculul MG, SD şi MAGE au fost analizate înregistrările CGMS obţinute în a doua zi, în timp ce pentru calculul MODD înregistrările din ziua a doua şi a treia. Pentru calculul MIME am evaluat excursiile glicemice postprandiale după masa cu 75g HC, cât şi după TTGO (cu 75 g glucoză).

Evaluarea indicilor de variabilitate glicemică: MAGE – media aritmetică a excursiilor glicemice ascendente majore pe 24 ore. MODD – media diferenţelor absolute între glicemii determinate în acelaşi moment, la un interval de 24 ore. MIME – s-a calculat în funcţie de 3 elemente: ΔG (diferenţa dintre valoarea glicemică maximă postprandială şi valoarea preprandială a glucozei); ΔT (timpul în care se obţine peak-ul glicemic postprandial); - ΔG (diferenţa dintre glicemia la 1 oră după atingerea peak-ului glicemic şi valoarea glicemică maximă postprandială). MG (media glicemică) şi DS (deviaţia standard a glicemiilor).

Rezultate şi discuţii:

Subiect MG±DS

(mg/dl)

MAGE

(mg/dl)

MODD

(mg/dl)

MIME (mg/dl) după

masa cu 75g HC

MIME (mg/dl) după TTGO cu 75 g glucoza

ΔG (mg/dl)

ΔT min

ΔG (mg/dl)

ΔG (mg/dl)

ΔT min

- ΔG

(mg/dl)

IFG- dieta fara restrictie de HC

107,53±19,68

42,71 22,58 39 40 13 61 50 62

NGT- dieta fara restrictie de HC

100,2111,58

21 11,15 22 25 12 13 20 13

IFG- dieta cu 200g HC

97±8 23 17,08 29 50 20 - - -

Subiectul cu IFG prezintă excursii glicemice zilnice mai numeroase si mai ample (MAGE crescut) şi reproductibilitate de la o zi la alta a profilului glicemic mai redusă (MODD crescut) comparativ cu subiectul cu NGT. Comparând MIME după TTGO (cu 75g glucoză) şi după masa cu 75g HC, am observat valori mai mari ale celor 3 elemente (ΔG, ΔT,- ΔG) după TTGO, la subiectul cu IFG. La subiectul cu IFG s-au observat valori semnificativ mai mici ale indicilor variabilităţii glicemice pe perioada dietei cu 200g HC/zi, faţă de perioada dietei fără restricţie de HC.

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Concluzii: Analiza profilului excursiilor glicemice la persoanele cu şi fără modificări ale metabolismului glucidic poate fi utilă în definirea valorilor diagnostice şi a celor ţintă pentru diabet.

THE COMPARISON OF GLYCEMIC INSTABILITY IN SUBJECTS WITH AND WITHOUT DISTURBANCES OF GLUCOSE METABOLISM

Autors: Mihaela L. Bîcu, Simona G. Popa, Sigina R. Gîrgavu, R.I. Dinu, Maria Moţa

Department of Diabetes Nutrition Metabolic Diseases, Clinical County Emergency Hospital Craiova

Background and aim. The glycaemic variations observed in non diabetic subjects are primarily related to the postprandial metabolic responses. In order to exactly quantify glycemic variability, specific tools of calculation can be used: MAGE (Mean Amplitude Glycemic Excursion), MODD (Mean Of Daily Differences), MIME (Mean Indices of Meal). The MAGE index evaluate the intra-day major glycemic excursions, ignoring minor glycemic excursions. MODD index appreciate the glycemic variation in the same moment from different day, at the same patient. MIME evaluate the meal-related glycemic excursions.

The objective of this study is to compare: 1. glycemic instability at 2 subjects with diet without restriction of carbohydrates (CH), one of them with normal glucose tolerance (NGT) and the other with impaired fasting glucose (IFG); 2. glycemic instability in subject with IFG – diet without restriction of CH versus diet with restriction of CH (200g CH/day).

Material and method: There were calculated five specific index of glycemic instability (MBG, SD, MAGE, MODD, MIME) in two subjects, with diet without restriction of CH: one NGT subject and one IFG subject, both women, comparable to age, BMI (body mass index), stress; also, we calculated five specific index at subject with IFG, with diet with 200g CH /day. These subjects were observed with continuous glucose monitoring system (CGMS) for 72 hours. To mention that subject with IFG was observed with CGMS for two times, for 72 hours, once with diet without restriction of CH, and once diet with restriction of CH (200g CH/day). In the second day of CGMS, we perform oral glucose tolerance test (OGTT) using 75g glucose at the two subjects. MBG, SD and MAGE were calculated using CGMS glycemic records from the second day, in time of MODD was measured using CGMS glycemic records from the second and third days. For the MIME measurement was evaluated postprandial glycemic excursion at meal with 75g CH, both at OGTT ( 75g glucose).

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Glycemic instability index calculation: MAGE – major ascending glucose excursion average on 24 hours. MODD – mean of absolute difference between glycemic values on the same moment from different days. MIME – was calculated on the basis of three elements: ΔG (difference between maxim postprandial glycemic value and preprandial glycemic value); ΔT (necessary time for reach postprandial glycemic peak); - ΔG (difference between glycemic value at 1 hour after reach postprandial glycemic peak and maxim postprandial glycemic). Mean level of blood glucose (MBG) and blood glucose standard deviation (SD).

Results and discussion:

Subject MBG±

SD (mg/dl)

MAGE

(mg/dl)

MODD

(mg/dl)

MIME (mg/dl) at

meal with 75g CH

MIME (mg/dl) at OGTT with 75 g glucose

ΔG (mg/dl)

ΔT min

- ΔG (mg/dl)

ΔG (mg/dl)

ΔT min

- ΔG

(mg/dl)

IFG- diet without restriction of CH

107,53±19,68

42,71 22,58 39 40 13 61 50 62

NGT- diet without restriction of CH

100,2111,58

21 11,15 22 25 12 13 20 13

IFG- diet with 200g CH

97±8 23 17,08 29 50 20 - - -

Subject with IFG presented numerous and more ample intra-day glucose excursions (high MAGE) and reduced day-to-day reproducibility of blood glucose values (high MODD), comparative with subject with NGT. At the subject with IFG we observed higer values for the three elements (ΔG, ΔT,- ΔG) of MIME at OGTT (75g glucose), comparative with meal with 75g CH.

The subject with IFG was present values significant lower of the glycemic instability index during diet with 200g CH/day, comparative with period of diet without restriction of CH.

Conclusions: The profile of glycemic excursion in subjects with and without disturbances of glucose metabolism may have an important significance in defining the diagnostic cutoff-points and targets for glycemic control on diabetes mellitus.

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RISCUL CARDIOVASCULAR LA PERSOANELE CU DIABET ZAHARAT TIP 2

Mihaela Gribovschi¹, Anca Fǎrcaş¹²³, Edghiun Ismail¹, Nicolae Hâncu¹³4

¹ Centrul Medical “Moţilor”, Cluj-Napoca; ² Clinica Medicala I, Cluj-Napoca;

³ Universitatea de Medicinǎ şi Farmacie “Iuliu Hatieganu”, Cluj-Napoca; 4 Centrul Clinic de Diabet, Nutritţe şi Boli Metabolice Cluj-Napoca

Premise si Obiective:În prezent, ne confruntăm cu o adevărată “epidemie” de diabet zaharat (DZ), afecţiune cu un puternic impact asupra morbidităţii şi mortalităţii cardiovasculare. Diabetul zaharat asociază un complex de factori de risc cardiovascular, fapt demonstrat de numeroase studii. Lucrarea de faţă are ca şi obiectiv cuantificarea riscului cardiovascular la persoanele cu DZ tip 2, precum şi analiza diverşilor factori de risc.

Material si Metode: S-au studiat un număr de 120 pacienţi cu diabet zaharat tip 2, care au fost investigaţi complet în cadrul Centrului Medical “Moţilor” din Cluj Napoca. S-au colectat date referitoare la istoricul personal, caracteristicile antropometrice (greutate corporală, înălţime, IMC, circumferinţă abdominală), evaluarea compoziţiei corporale (ţesut adipos total, ţesut adipos visceral, masă musculară scheletică) cu ajutorul analizorului corporal InBody 720, statusul biochimic (glicemie bazală, HbA1c, profil lipidic), statusul glicemic (utilizând monitorizarera glicemică continuă pe o perioadă de 72 ore), examen cardiovascular complet (inclusiv determinarea grosimii intimă-medie la nivel carotidian bilateral) în vederea evaluǎrii cât mai complete a statusului metabolic şi a factorilor de risc cardiovascular (RCV) asociaţi. RCV al fiecărui pacient a fost calculat pe baza programelor UKPDS Risk Engine, PROCAM şi Framingham.

Rezultate: Persoanele studiate au avut o durată medie a DZ de 5,56 ani, o vârstă medie de 51,81 ani, 40,35% au fost femei. S-a constatat că masa musculară este mai mare la persoanele cu DZ având nivele ale HbA1c≤6.5% comparativ cu persoanele insuficient controlate din punct de vedere glicemic (41,98±5,5kg vs 32,5±7,6kg, p=0,003). Cantitatea de ţesut adipos visceral a fost crecutǎ la persoanele studiate, semnificativ mai mare la cele având un control glicemic nesatisfǎcǎtor faţă de persoanele avand un DZ bine echilibrat (HbA1c≤6.5%) (187±26,9 vs 153,8±37, p=0.028). Pe de altă parte, masa totalǎ a ţesutului adipos a fost mai mare la persoanele bine controlate din punct de vedere glicemic (43±5,5kg vs de 32,5±7,6kg), dar fără semnificaţie statistică (p=0,059). Masa musculară schelectică a fost semnificativ mai mare în rândul persoanelor cu HbA≤6.5% (41,9±5,5kg vs. 32,5±7,6kg, p= 0,003). Nivelul HbA1c se corelează cu RCV cuantificat prin UKPDS Risk Engine (boalǎ coronarianǎ non-fatalǎ si fatalǎ: 0,4 vs 0,377, p=0.000; accident vascular cerebral non-fatal şi fatal: 0,169 vs 0,177, p=0,03). Identificarea riscului cardiovascular de a dezvolta un eveniment coronarian în urmǎtorii 10 ani, prin diferite programe (UKPDS Risk Engine, PROCAM şi Framingham) aratǎ existenţa unei diferenţe în sensul cǎ programul PROCAM este mai precis în aprecierea RCV la persoanele cu DZ decât aplicarea scorului Framingham (p<0.05). Toate cele trei

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programe de apreciere a RCV oferǎ date corelabile. Statusul hiperglicemic (glicemii>180mg/dl) se corelează cu RVC evaluat prin programul PROCAM si UKPDS Risk Engine. Am constatat, de asemenea, efectul protectiv al activitǎţii fizice pentru dezvoltarea unui AVC fatal sau nonfatal (UKPRS Risk Engine). În mod surprinzător, grosimea intimǎ-medie (GIM) nu s-a corelat cu durata DZ şi nici cu controlul glicemic, în schimb s-au evidenţiat corelaţii cu nivelul trigliceridelor serice.

Concluzie Evaluare RCV prin cele 3 programe ne-a permis o mai bună cuantificare a contribuţiei fiecǎrui factor de risc prezent la persoana cu DZ tip 2. Investigarea statusului glicemic prin aplicarea monitorizǎrii glicemice continue, precum şi determinarea compoziţiei corporale aduc date suplimentare deosebit de valoroase în evaluarea RCV al persoanei cu DZ cu atât mai mult cu cât sunt cuantificaţi parametrii “corectabili” printr-un management terapeutic adecvat.

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CARDIOVASCULAR RISK IN PEOPLE WITH TYPE 2 DIABETES MELLITUS Background and objectives: Nowadays, we are facing a real “epidemy” of diabetes, a - strong impact upon cardiovascular morbidity and mortality – disease. Diabetes associates a complex of cardiovascular risk factors, shown by numerous studies. The aim of this study was to determine the cardiovascular risk in people with type 2 DM as well as the analysis the risk factors. Research design and methods: a number of 120 persons with type 2 DM from “Moţilor” Medical Center was studied. For these persons, the history and anthropometric data as well as body composition (body fat mass, visceral fat area, skeletal muscle mass), biochemical status (fasting plasma blood glucose, glycated haemoglobin, lipids), glycemic status (by continuous glucose monitoring system), cardiovascular evaluation (including carotid intima-media thickness) were assessed. Cardiovascular risk (CVR) was evaluated using UKPDS Risk Engine, PROCAM and Framingham risk score. Results: The study group had an average diabetes duration of 5.56 years; a mean age of 51.81 years, 40,35% were women. It has been observed that the skeletal muscle mass is increased in diabetic persons with HbA1c ≤6.5% compare with those less controlled (41,98±5,5kg vs 32,5±7,6kg, p=0,003). Amount of visceral fat area was increased in study population, significantly in persons with poor glycemic control versus optimal glycemic control (HbA1c≤6.5%) (187±26,9 vs 153, 8±37, p=0.028). One the other side, body fat mass was increased in patients well controlled (43±5,5kg vs de 32,5±7,6kg), no statistical power (p=0,059). Skeletal muscle mass was statistically larger in patients with HbA1c≤6.5% (41,9±5,5kg vs. 32,5±7,6kg, p = 0,003). The levels of HbA1c is correlated with CVR quantified with UKPDS Risk Engine (non-fatal and fatal coronary heart disease 0,4 respectively 0,377, p=0.000; non-fatal and fatal stroke: 0,169 respectively 0,177, p=0,03). Identifying the cardiovascular risk of developing a coronary heart disease in the next 10 years, by different programmes (UKPDS Risk Engine, PROCAM and Framingham), shows the existence of a difference meaning the PROCAM programme is more accurate in assesing CVR in people with DM than applying the Framingham score (p<0.05). All these programmes assessing CVR offer correlable data. The period of hyperglycemia (blood sugar levels>180mg/dl) is correlated to CVR evaluated by PROCAM programme and the UKPDS Risk Engine. We also considered the protective effect of physical activity for developing a non-fatal or fatal stroke (UKPDS Risk Engine). Surprisingly, the carotid intima-media thickness did not correlate itself neither to the duration of DM, or the glycemic control, otherwise there were emphasised correlations to the triglycerides levels. Conclusion: The CVR evaluation through the three programmes allowed a better quantification of the contribution of each risk factor present at the patients with type 2 DM. The investigation of the glycemic status by applying the continuous glucose monitoring system (CGMS), also determing the body composition bring extremely valuable additional data in assessing RCV of a person with DM, ever more these quantify “correctable” parameters by an adequate therapeutical management.

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NEFROPATIA DIABETICA

Manolache Mihaela –Clinica III Pediatrie Iasi

Introducere

Diabetul zaharat este afectiunea endocrina si metabolica cea mai frecventa in copilarie, caracterizata printr-o crestere permanenta a glicemiei, insotita sau nu de semne clinice, fiind cauzata de alterarea secretiei de insulina sau perturbarii actiunii sale. Aceasta afecteaza ambele sexe, aproximativ in egala masura, cu o usoara predominanta a sexului masculin.

Nefropatia diabetica este o complicatie a diabetului care este determinata de concentratii mari de glucoza in sange. Hiperglicemia tulbura functionarea unitatii de filtrare a rinichiului (nefronul). In timp, aceasta poate duce la insuficienta renala.

Prevenirea sau incetinirea leziunii renale este cel mai important pas in managementul bolii. care se efectueaza dializa renala. sau albuminurie), la care se adauga, in timp, edeme, hipertensiune arteriala etc.

Obiective

Scopul lucrarii este de a investiga frecventa afectarii renale la copiii diabetici si consecintelem acestei complicatii

Material si metoda

Studiul a fost efectuat in perioada 1 02 2008-1 09 2008,in clinica a IIIa pediatrie,pe un lot de 20 de bolnavi cu diabet

Rezultate

Ca umare a investigatiilor efectuate s-a constatat ce un numar mare de bolnavii cronici de diabet prezinta afectare renala.

Din acesta cauza managementul corect al diabetului si a nefropatiei diabetice este foarte important.Un management defectuos putind duce pana la insuficienta renala.

Concluzii

Afectarea renala, prin nefropatie diabetica (complicatie tardiva a diabetului zaharat), determina prognosticul vital al copilului,motiv pentru care trebuie monitorizarea corecta si frecventa a copiilor cu diabet este o prioritate majora.

145

NEPHRITIC DIABETES

Introduction

Diabetes is the endocrine and metabolic disease most frequent in childhood, which is characterized by a permanent growth of glucose that can be accompanied or not by clinical signs, and which is caused by the alteration of the insulin secretion or by the perturbation of its action. This disease affects both sexes equally, being just a bit predominant at the male sex.

Nephritic diabetes is a complication of diabetes that is determined by high dosages of glucose in blood. Hyperglycemia disturbs the function of the filtering unit in the kidney. In time, this may cause kidney failure.

The prevention or the slowing of kidney failure is the most important step in managing the disease, which is obtained by dialysis.

Objectives

The purpose of this paper is to investigate the frequency of renal affection at the diabetic children and the consequences of this complication.

Material And Metodes

The study was conducted on 20 children with diabetes admitted in the Clinic III Pediatrics, in the period of time 1.02.2008 – 1.09.2008.

Results

As a follow-up of the investigations, a large number of children suffering of diabetes also present kidney related affections.

This is why the correct manage of diabetes and nephritic diabetes is very important. If the treatment is not correct, then the kidney failure may appear.

Conclusion

Kidney related affections, especially nephritic diabetes, determine the vital prognosis of the child, reason for which the correct and constant monitoring of the diabetic child is the major priority.

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VARIATIA NECESARULUI INSULINIC LA PACIENTII CU DIABET ZAHARAT TIP 1 CU VECHIME A BOLII DE PESTE 25 ANI

Mihaela Vladu2, Sigina Gargavu1, Diana Clenciu1, Nicoleta Mitroi1, Daniela Braicu1, Maria Mota2

1 Spitalul Clinic Judetean de Urgenta Craiova – Clinica de Diabet Nutritie Boli Metabolice;

2 UMF Craiova - Departamentul de Diabet Nutritie Boli Metabolice

SCOPUL STUDIULUI: Analizarea variatiei necesarului insulinic la un lot de pacienti cu diabet zaharat tip 1 cu vechimea diabetului de peste 25 ani.

MATERIAL SI METODA: Lotul studiat a cuprins 44 pacienti cu DZ tip 1 cu vechimea diabetului de peste 25 ani, aflati in evidenta Centrului Clinic de Diabet Nutritie Boli Metabolice al Spitalului Clinic Judeţean de Urgenta Craiova. Informaţiile retroactive au provenit din fisele acestor pacienti. S-au analizat urmatorii parametrii: vechimea diabetului, doza initiala de insulina, la 15 ani de la debutul DZ si doza actuala de insulina. De asemenea, am analizat tipul de tratament: conventional si intensiv (clasic şi modern).

REZULTATE: Necesarul de insulina la pacientii luati in studiu a evoluat pe parcursul timpului astfel:

INITIAL LA 15 ANI ACTUAL

Sub 20 UI 2 (4,54%) 1 (2,27%) 1 (2,27%)

21-40 UI 21 (47,72%) 18 (40,90%) 20 (45,45%)

41-60 UI 20 (45,45%) 17 (38,63%) 15 (34,09%)

Peste 60 UI 1 (2,27%) 8 (18,18%) 8 (18,18%)

Media calculata a necesarului de insulina la momentul debutului a fost de 31,54 UI, la 15 ani de evolutie a DZ 45, 86 UI, iar la momentul actual s-a situat la o valoare de 39, 15 UI.

Regimul de insulinoterapie a fost un alt parametru urmarit. Astfel initial 86,36% pacienti se aflau sub tratament conventional (2 prize), 13,63% intensiv clasic (3prize). La 15 ani de la debut 59,09% se aflau pe tratament conventional, 40,91% pe tratament intensiv clasic. In ceea ce priveste momentul actual tratamentul conventional a fost intalnit in procent de 27,27%, tratamentul intensiv clasic la 70,44% pacienti, iar tramentul intensiv modern cu insulina (pompa de insulina) la un pacient (2,27%).

Analizand comparativ necesarul de insulina de la 15 ani de evolutie a DZ fata de cel de la debut, am inregistrat urmatoarele date: la 56,81% dintre pacienti necesarul de insulina a

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crescut, la 22,72% a scazut, iar la 20,45% s-a mentinut comparabil cu cel initial. Referitor la doza de insulina actuala comparativ cu doza la 15 ani de evolutie a DZ: la 45,45% dintre pacienti s-a evidentiat cresterea necesarului de insulina, la 50% necesarul a scazut, iar la 4,55% nu s-au inregistrat modificari ale acestuia. La pacientii la care s-a inregistrat actual scaderea dozei de insulina nefropatia s-a intalnit in procent 59,09%. Coma hipoglicemica s-a inregistrat la 18,18% din pacientii aflati actual pe tratament conventional, 29,54% pe tratament intensificat (3 prize de insulină/zi), 52,27% pe tratament intensiv.

Concluzii: Se remarca o evolutie oscilanta a necesarului de insulina pe parcursul evolutiei DZ; dupa o vechime de 15 ani la majoritatea pacientilor s-a inregistrat cresterea necesarului de insulina, probabil datorită epuizării rezervei secretorii pancretice restante; dupa 25 ani de evolutie a diabetului s-a înregistrat o scădere a dozelor de insulină, probabil datorită afectării renale; la 59% dintre pacienţii cu scaderea necesarului de insulina s-a asociat nefropatia diabetică. Comele hipoglicemice s-au inregistrat mai frecvent la pacientii cu tratament intensiv bazal-bolus. Tratamentul conventional este regasit şi actual intr-un procent relativ mare la pacientii luati in studiu, din motive legate de pacienţi, în cea mai mare parte.

THE INSULIN NECESSARY VARIATION IN PATIENTS WITH DURATION OF TYPE 1 DIABETES MELLITUS MORE THAN 25 YEARS

Mihaela Vladu2, Sigina Gargavu1, Diana Clenciu1,, Nicoleta Mitroi1, Daniela Braicu, Maria Mota2 ,

1 Clinic County Emergency Hospital Craiova, Diabetes Clinic; 2 UMF Craiova

Background: To analyze the insulin necessary variation in patients with duration of T1DM more than 25 years.

Material and method: We studied a group of 44 patients with duration of T1DM more than 25 years, hospitalized in the Clinic of Diabetes Nutrition & Metabolic Diseases (Clinic County Emergency Hospital Craiova). We used the informations arised from the patients files and we analized the duration of diabetes mellitus, the initial dose of insulin, after 15 years of evolution and the actual dose. Also, we studied the conventional and intensiv (clasic and modern) type of treatment.

Results: The insulin necesary developed during the evolution of diabetes mellitus in the following way:

INITIAL AFTER 15 YEARS ACTUAL

Under 20 UI 2 (4,54%) 1 (2,27%) 1 (2,27%)

21-40 UI 21 (47,72%) 18 (40,90%) 20 (45,45%)

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41-60 UI 20 (45,45%) 17 (38,63%) 15 (34,09%)

Over 60 UI 1 (2,27%) 8 (18,18%) 8 (18,18%)

Calculated mean of insulin necessary in the begining was 31,54 UI, after 15 years became 45,86 UI and in the present is 39,15 UI. The type of insulin therapy was another parameter which we had in view. Thus, at the begining 86,36% patients had a conventional treatment (2 injections/day) and 13,63% a clasic intensiv one (3 injections/day). After 15 years 59,09% patients had a conventional treatment, 40,91% a clasical intensiv treatment a. In the present the conventional treatment is used in 27,27% patients, clasical intensiv treatment in 70,44% patients and modern intensive treatment (insulin pomp) is found only in one patient (2,27%).

Comparatively analizing the insulin necessary after 15 years of evolution with the necessary from the begining we obtained the following dates: in 56,81% of patients the insulin necessary increased, in 22,72% the necessary decreased and in 20,45% of cases the necessary was preserved. Regarding the actual insulin dose by comparison with the dose after 15 years of evolution in 45,45% of patients we had an increase of insulin necessary, in 50% patients the necessary decreased and in 4,55% patients didn’t change. The nefropathy was met in 59,09% cases with insulin dose decreased. Hipoglicemic coma was recorded in 18,18% patients actually conventional treated (2 injections/day), 29,54% treated with 3 injections/day) and 52,27% actually on intensiv treatement (4 injections/day).

Conclusions: This study showed an oscilatory development of insulin necessary during the evolution of T1DM; after 15 years most patients need much more insulin maybe because of exhausting pancreatic secretory storage but after 25 years the necessary decreased maybe through the development of diabetic nefropathy. In 59% patients with the decrease of insulin necessary diabetic nefropathy is associated. Hipoglicemic coma was frequently met in patients on intensiv treatment. Conventional treatment is actual found in a considerable percentage many times from reasons that regard the patients.

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STUDIUL CORELATIILOR INTRE NIVELUL AMPUTATIEI, VARSTA SI FACTORII DE RISC ASOCIATI LA PACIENTII CU AMPUTATII ALE

MEMBRELOR INFERIOARE

Nicoleta Mitroi1, Maria Mota2, Sigina Gargavu1, Mihaela Vladu2, Diana Clenciu1

1 Spitalul Clinic Judetean de Urgenta Craiova–Clinica Diabet Nutritie Boli Metabolice; 2 UMF Craiova- Diabet Nutritie Boli Metabolice

Introducere. Mai mult de 60% dintre amputatiile netraumatice ale membrelor inferioare sunt cauzate de diabetul zaharat, diabeticii prezentand un risc de 10 pana la de 40 de ori mai mare pentru astfel de interventii chirugicale. La fiecare 30 de secunde undeva in lume se realizeaza o amputatie la nivelul membrelor inferioare cauzata de diabet.

Scopul studiului. Au fost analizate amputatiile realizate intr-o clinica chirurgicala la pacientii cu si fara DZ si au fost realizate corelatii intre anumiti parametrii urmarindu-se definirea metodelor de prevenire si/sau reducere a numarului de amputatii.

Material si metoda. Au fost evaluati pacientii internatii intr-o clinica chirurgicala (Spitalul de Urgenta Craiova) intr-o perioada de 5 ani care au suferit amputatii ale membrelor inferioare. Dintr-un total de 222 de pacienti, 31 au avut mai multe amputatii si au fost analizati separat. Au fost urmariti mai multi parametrii, realizandu-se apoi corelatii intre prezenta si vechimea DZ, nivelul amputatiei, varsta, HTA, dislipidemie, fumat, prezenta altor amputatii in antecedente.

Rezultate, discutii. 71 de pacienti (37.17%) au avut DZ si 120 (62.83%) nu au avut DZ. Nu a fost posibila evidentierea unei corelatii intre vechimea DZ si nivelul amputatiei, deoarece nu a putut fi stabilita cu exactitate data debutului DZ, ci numai momentul diagnosticarii acestuia. Varsta medie in momentul amputatiei a fost cu 4.3 ani mai mica la pacientii diabetici comparativ cu cei fara DZ (59.83 respectiv 64.17 ani). In ceea ce priveste corelatia dintre HTA, nivelul amputatiei si varsta la care s-a intervenit chirurgical, la pacientii cu DZ s-a constatat ca amputatia are loc la o varsta mai mica in cazul bolnavilor hipertensivi comparativ cu cei cu valori normale ale tensiunii arteriale (in medie cu 3.9 ani). Nu au fost observate corelatii intre prezenta HTA si varsta la amputatie la pacientii fara DZ. Referitor la prezenta dislipidemiei, nu au existat informatiile necesare pentru a putea fi analizata corelatia cu ceilalti factori evaluati.Varsta la amputatie a fost mai mica la pacientii fumatori (cu si fara DZ), indiferent de sediul amputatiei (cu 5.83 si respectiv 18.5 ani). Dintre pacientii cu DZ care au fost amputati, 25% au avut cel putin inca o alta amputatie in 5 ani, comparativ cu 8.65% in cazul celor fara DZ.

Concluzii: numarul pacientilor cu DZ amputati reprezinta 40% din totalul de pacienti amputati, desi prevalenta DZ la populatia din Dolj este <5 %; prezenta HTA (ca factor de risc cardiovascular) a influentat varsta la amputatie numai la pacientii cu DZ in studiul nostru; fumatul a condus la scaderea varstei la amputatie atat la pacientii diabetici, cat si la cei fara DZ; prezenta unei amputatii in antecedente a determinat cresterea riscului de noi amputatii, in special in DZ; abordarea multidisciplinara a patologiei piciorului diabetic si interventia concomitenta asupra factorilor de risc asociati au ca rezultat prevenirea/reducerea numarului de amputatii.

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CORRELATIONS BETWEEN THE LEVEL OF THE AMPUTATION, THE AGE AND THE ASSOCIATED RISK FACTORS IN PATIENTS WITH LOWER

LIMBS AMPUTATIONS

Nicoleta Mitroi1, Maria Mota2 , Sigina Gargavu1, Mihaela Vladu2, Diana Clenciu1

1 Clinical County Emergency Hospital Craiova, Diabetes Clinic; 2 UMF Craiova

Background. More than 60% of the non traumatic amputations of the lower limbs are caused by diabetes, the diabetic patients being up to 40 times more likely to suffer one of this surgical intervention than people without diabetes. Every 30 seconds a lower limb is lost to diabetes somewhere in the world.

The aim of the study. We evaluated the amputations realized in a surgical clinic in patients with and without DM and we made correlations between some parameters; the aim was to define the procedure to prevent/decrease the number of the amputations.

Methodology and materials. We evaluated the patients hospitalized in a surgical clinic (Emergency Hospital Craiova) who suffered amputations of lower limbs during a 5 years period. From 222 patients, 31 suffered several amputations and were studied separately. Many parameters were analized, and then we made correlations between the presence and the oldness of DM, the level of the amputation, the age, HBP, dyslipidaemia, smoke, the presence of other amputations.

Results and discussions. 71 of the patients (37.17%) presented DM and 120 (62.83%) did not. It was not possible to highlight any correlation between the age of DM and the level of amputation as could not precisely determines the exact moment when DM began, but only the moment of its diagnosis. The average age at amputation was with 4.3 years smaller in patients with DM comparing with those without DM (59.83, respective 64.17 years). Regarding the correlation between HBP, the level of the amputation and the age at amputation, in diabetic patients we noticed that the average age at amputation was smaller in those with HBP comparing with patients with normal blood pressure (with 3.9 years). In patients without DM we didn’t observed correlations between these parameters. Yet regarding the presence of dyslipidaemia, there was no information that could help us identify its relationship with the additional factors analyzed. The average age at amputation was smaller in smokers (in both patients with and without DM) regardless of the level of the amputation (with 5.83 respective 18.5 years). Among the diabetic patients that suffered an amputation, 25% of them had at least another amputation in 5 years, comparing with 8.65% of the patient without DM.

Conclusions. The patients with DM represent 40% of the total that suffered an amputation, even if the frequency of DM for the population of Dolj district is lower than 5%; the presence of HBP influenced the age at amputation only in diabetic patients in this study; smoking proved that diminishes the age at amputation in both patients with and without DM; the presence of another amputation was associated with a high risk of a new one, especially in patients with DM; the multilaterally approach of the pathology of the diabetic foot and of the associated risk factors will prevent/decrease the number of the amputations.

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INFECTIA CU HELICOBACTER PYLORI LA COPIII CU DIABET

Aioane Norina

Clinica a-III-a Pediatrie Iasi

Rezumat

Diabetul zaharat are drept principala caracteristica incapacitatea organismului de a produce si/sau utiliza hormonal pancreatic-insulina, cu instalarea unei hiperglicemii cronice. Infectiile produc hiperglicemie la acesti pacienti . Infectia cu Helicobacter Pylori are un rol important in manifestarile gastrointestinale la copiii diabetici si poate avea implicatii in controlul glicemic. Scopul lucrarii este de a investiga frecventa infectiei cu H. Pylori la copiii cu diabet si consecintele acestei infectii asupra controlului glicemic. Studiul a fost efectuat in Clinica III Pediatrie , in perioada 1-01-2007 – 1-10-2007 , pe un lot de 40 de copii diabetici ce prezentau simptome gastrointestinale. Infectia cu H. Pylori a fost diagnosticata la 20 de copii cu diabet. Grupa preponderant afectata a fost cea de 10-13 ani (12 cazuri). Leziunea histopatologica cea mai frecventa asociata cu infectia cu H. Pylori a fost gastrita nodulara antrala . Eradicarea infectiei a determinat o ameliorare a simptomatologiei gastrointestinale dar nu s-au constatat diferente semnificative in ce priveste HbA1C si dozele de insulina. Infectia cu H. Pylori a fost cea mai frecventa cauza la copii cu diabet , eradicarea acestei infectii permitand o inbunatatire a controlului glicemic.

THE INFECTIONS WHITH H.PYLORI AT DIABETIC CHILDREN

Aioane NorinaClinica III Pediatrie SF.MARIA IASI

Diabetes’s main characteristic is the incapacity of the organism to produce and /or use the pancreatic hormone –insulin-with the installation of a chronic hyperglycemia. At this type of patients , the infections produce hyperglycemia. The infection with H. Pylori has an important role in the gastro-intestinal symptoms to the children who have diabetes and may have implications in the glucose control. The purpose of this paper is to investigate the frequency of the H.Pylori infection at the children with diabetes and the consequences of this infection in the glucose control.

The study was conducted on 40 children with diabetes with gastro-intestinal symptoms in 3-rd Pediatric Clinic in the period of time 1-01-2007—1-10-2007.

The H.Pylori infection was found in 20 of the diabetics children. Most of the infection cases were in the 10-13 age group(12 cases) . The histological lesion most frequently associated with H. Pylori infection was nodular antral gastritis.

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The eradication of the infection determined an amelioration of the gastro-intestinal symptomatology but there were no major differences in regard to the HbA1C and insulin dosage.

The H.Pylori infection was the most frequent cause of gastritis among children with diabetes, the eradication of which permitted an improved glucose control.

STATUSUL HIPOGONADIC LA PACIENŢII CU DIABET ZAHARAT

Olivia Georgescu 1 , Sorina Martin 1,2, Mihaela Ursache 1, Simona Fica 1,2

1. Spitalul Universitar de Urgenţă Elias – Secţia de Endocrinologie, Diabet, Boli de nutriţie

2. UMF. Carol Davila – Bucureşti

Scopul studiului a fost evaluarea statusului hipogonadic la pacienţii de sex masculin cu diabet zaharat de tip 1 şi 2, precum şi determinarea unor posibile asocieri cu elemente definitorii ale echilibrului metabolic.

Material şi metodă : Pentru 68 bărbati cu diabet zaharat (12 cu diabet zaharat tip 1 şi 56 cu diabet zaharat tip 2), cu vârste cuprinse între 19 şi 76 ani a fost evaluat statusul hipogonadic prin înregistrarea simptomelor şi semnelor clinice, prin determinarea serică a testosteronului total, SHBG, DHEA-S, cu calcularea ulterioară a testosteronului liber. Au fost consideraţi hipogonadici pacienţii cu testosteron seric total sub 300ng/dl. Au fost urmăriţi de asemenea parametrii echilibrului metabolic: HbA1c, profil lipidic .

Rezultate: 22% dintre pacienţii evaluaţi au prezentat hipogonadism (16,6% dintre cei cu diabet zaharat tip1 şi 23,2% dintre cei cu diabet zaharat tip 2). Pacienţii diabetici hipogonadici , comparativ cu restul pacienţilor diabetici au prezentat în medie o valoare mai mare a circumferinţei abdominale( p= 0,05) şi o valoare mai mică a HDL-colesterolului ( p= 0,03) .Scăderea libidoului şi a forţei musculare s-a corelat direct proporţional cu valoarea scăzută a DHEA-S ( p= 0,006 ) şi invers proporţional cu HbA1c (p= 0,05) .Scăderea frecvenţei bărbieritului şi scăderea pilozităţii corporale s-a corelat cu valoarea scăzută a testosteronului liber, independent de vârstă. Alopecia s-a înregistrat mai frecvent la pacienţii cu valori scăzute ale SHBG ( p =0,03) .

Concluzii: Statusul hipogonadic s-a regăsit mai frecvent în rândul pacienţilor cu diabet zaharat tip 2, fiind asociat cu unele componente ale sindromului metabolic.

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Hipogonadismul simptomatic s-a corelat cu valoarea DHEA-S şi HbA1c, iar semnele clinice sugestive au fost asociate cu nivelul testosteronului liber şi SHBG, independent de vârstă.

THE HYPOGONADIC STATUS IN DIABETES MELLITUS PATIENTSOlivia Georgescu 1, Sorina Martin 1,2, Mihaela Ursache 1, Simona Fica 1,2

1. Elias University Emergency Hospital- Department of Endocrinology, Diabetes and Metabolic Diseases2. UMF Carol Davila – Bucharest

The aim of this study was to assess the hypogonadic status in male patients with type 1 and type 2 diabetes mellitus and to estimate the possible correlation with metabolic balance.

Material and methods: For 68 male patients: 12 T1DM/ 56 T2DM, aged between 19-76 years we evaluate the gonadic status based on both symptoms and biochemical measures on total and free testosterone value, SHBG, DHEA-S. The patients with total testosterone under 300 ng/dl were considered hypogonadic. We also evaluate the metabolic balance ( HbA1c, lipid profile).

Results: Hypogonadism was present in 22% of patients (16,6% in T1DM and 23,2% in T2DM). The hypogonadic diabetic patients had higher waist ( p=0,05) and respectively lower HDL-cholesterol (p=0,03), compared with the other diabetic patients. The decrease of libido and muscular force was positve corelated with lower DHEA-S value and negative with HbA1c (p=0,05). The decrease of shaving frequency was positive corelated with lower free testosterone value, not related with age. Alopecia was more frequently observed in diabetic patients with lower SHBG value (p=0,03).

Conclusions: In our study, the hypogonadic status was most common defect in T2DM, in association with some components of metabolic syndrome criteria. The hypogonadic symptoms was corelated with DHEA-S and HbA1c, since clinical signs were associated with free testosterone and SHBG value, not related with age.

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PROTEINA C- REACTIVĂ ŞI TULBURĂRILE METABOLICE LA PACIENŢII OBEZI NOU DEPISTAŢI CU DIABET ZAHARAT

Olivia Georgescu 1, Lavinia Şoavă 2, Mihaela Ursache 1, Aura Reghină 1

1. Spitalul Universitar Elias , Secţia de Endocrinologie, Diabet şi Boli de Nutriţie –Bucureşti

2. Spitalul Clinic Sf. Constantin şi Elena – Bucureşti

Obiectiv: Este cunoscut faptul că proteina C-reactivă (PCR) poate prezice riscul de apariţie al diabetului zaharat în rândul populaţiei sănătoase. Ne-am propus să determinăm posibilele corelaţii între PCR şi modificările metabolice într-o populaţie nou diagnosticată cu diabet zaharat.

Material şi metodă: Pentru 40 de pacienţi nou depistaţi cu diabet zaharat (25 obezi şi 15 normoponderali),cu vârste cuprinse între 30-70 ani (media 54,2 ani) am efectuat măsurătorile antropometrice, am evaluat statusul metabolic (HbA1c, profilul lipidic, tensiunea arterială) şi inflamator (PCR) . Analiza statistică s-a efectuat cu ajutorul t-test, considerându-se semnificativ statistică valoarea p=sub 0,05.

Rezultate: Am găsit o corelaţie semnificativ statistică între valoarea PCR şi HbA1c numai pentru populaţia obeză ( p=0,008) .În lotul studiat, PCR s-a asociat cu valoarea crescută a circumferinţei abdominale (peste 94 cm) la pacienţii de sex masculin 2,04 vs.2,94 mg l (p=0,04). La pacientele diabetice PCR s-a corelat negativ cu valoarea scăzută a HDL-colesterolului (sub 50mg/dl) 3,25 vs. 1,96 mg/l. Nu s-au observat corelaţii între PCR- hipertensiune, sau PCR-hipertrigliceridemie. Prevalenţa sindromului metabolic în lotul studiat a fost mai mare în rândul pacienţilor cu valori crescute ale PCR (quartila superioară) , fără a fi însă semnificativă statistic (p=0,15) .

Concluzii: PCR poate fi considerată un marker al modificărilor metabolice apărute în rândul pacienţilor obezi cu diabet zaharat nou depistat, dar nivelul său plasmatic se corelează diferit în funcţie de sex cu componentele sindromului metabolic.

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C- REACTIVE PROTEIN AND METABOLIC DISTURBANCES IN OBESE NEW DIAGNOSED TYPE 2 DIABETICS

Olivia Georgescu 1 ,Lavinia Şoavă 2, Mihaela Ursache 1, Aura Reghină 1

1. Elias Emergency Universitary Hospital – Department of Endocrinology, Diabetes and Nutrition - Bucharest

2. Sf.Constantin si Elena Clinical Hospital - Bucharest

Background and aims: It is known that C-reactive protein (CRP) predicts future risk for diabetes in healthy caucasian population. We determined which are the corelations between CRP and metabolic disturbances in a new onset type 2 diabetes mellitus population.

Material and methods: for 40 patients with new onset type 2 diabetes mellitus (25 obese / 15 with normal weight), aged between 30-70 years (mean 54,2 years) we performed anthropometric measures and we evaluated metabolic ( HbA1c, lipid profile, blood pressure) and inflammatory status (CRP level).

Results: We found a statistically significant corelation between CRP-level and HbA1c only for obese population ( p = 0,008 ). In the whole study group, CRP level was associated with higher waist (over 94 cm) in male subjects (2,04 vs. 2,94 mg/l, p=0,04). In female diabetics patients CRP value was negative corelated with lower HDL- cholesterol (under 50 mg/dl) 3,25 vs. 1,96 mg/l. We did not found corelation between CRP- hypertension and also CRP- triglyceridemia. The prevalence of metabolic syndrome in our study group increase in whose patients with CRP levels in a top quartile but not statistically significant ( p = 0,15 ).

Conclusions: CRP could be considered a new marker of metabolic disturbances in obese type 2 diabetes mellitus population, but his plasma level is different corelated according to sex with components of metabolic syndrome.

EFECTELE SCADERII IN GREUTATE ASUPRA FICATULUI GRAS NON-ALCOOLIC LA SUBIECTII CU SINDROM METABOLIC.

R. Vasilescu, Silvi IfrimSpital Clinic Colentina Bucuresti – Sectia Diabet, Nutritie, Boli Metabolice

Introducere: Boala ficatului gras non-alcoolic este una dintre cele mai frecvente cauze de afectare hepatica, care poate progresa de la steatoza simpla, la steatohepatita, ciroza hepatica si hepatocarcinom. In prezent boala ficatul gras non-alcoolic este considerata componenta hepatica a sindromului metabolic.

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Material si metoda: Studiul a inclus un numar de 20 subiecti de sex masculin, cu varsta medie de 38.5 ani (limite 25 – 54 ani), cu sindrom metabolic (definit conform criteriilor IDF), nediabetici, cu o valoare medie a IMC de 35.08 kg/m2 (limite 31kg/m2 – 40 kg/m2), la care s-a diagnosticat ultrasonografic prezenta steatozei hepatice. Pacientii au urmat o dieta hipocalorica de 1200 kcal timp de 24 saptamani. La subiectii inclusi in studiu s-au masurat greutatea, talia, circumferinta abdominala si s-au dozat alanin-aminotrasferaza (ALAT), aspartat-aminotrasferaza (ASAT), -glutamiltranspeptidaza (GGT), LDL colesterol, HDL colesterol, trigliceride, glicemia a jeun. Pentru analiza statistica a datelor obtinute la 12 saptamani si 24 saptamani s-a folosit testul t-student.

Rezultate:

Initial 12 saptamani

24 saptamani

Initial vs. 12 saptamani

Initial vs. 24 saptamani

Greutate 104±17.1 99.67±16.46 96.83±16.56 p=0.003 P=0.001IMC (kg/m2) 35.08±4.43 33.43±4.52 32.27±4.59 P<0.001 P<0.001Corcumferinta abdominala (cm)

116.25±16.5 112±16.06 108.5±15.55 P<0.001 P<0.001

ASAT (TGO) 65±37.09 42.5±16.3 36.25±9.54 P=0.02 P=0.02ALAT (TGP) 123.75±70.0

863±34.22 39.75±17.58 p=0.03 p=0.02

GGT 97.25±69.76 72.5±41.75 47.25±20.7 p=0.05 p=0.03LDL-colesterol

149.5±24.3 139±18.8 125.75±14.86

p<0.001 p<0.001

HDL-colesterol

31.5±3.51 32.25±4.11 34.75±4.03 NS NS

Trigliceride 192±29.23 151.25±18.08

136.75±19.62

p=0.01 p=0.005

Glicemie 95±11.63 86.5±7.59 84.5±6.45 p=0.04 p=0.004

Prezenta ficatului gras non-alcoolic se asocieaza cu valori crescute ale concentratiilor plasmatice ale aminotransferazelor. La toti subiectii inclusi in studiu ALAT > 1.5xN si raportul ALAT/ASAT > 2. La 3 luni s-au obtinut scaderea greutatii cu 4.67 Kg (limite 2-6 kg), scaderea ALAT cu 60.75 U/l , scaderea ASAT cu 22.5 U/l, scaderea GGT cu 24.75 U/l, scaderea trigliceridelor cu 40.75 mg/dl, scaderea LDL colesterol cu 15.5 mg/dl, scaderea glicemiei a jeun cu 8.5 mg/dl si cresterea HDL colesterol cu 0.75 mg/dl. La 6 luni s-au obtinut scaderea greutatii cu 7.33 kg (limite 4-9 kg), scaderea concentratiei plasmatice a ALAT cu 84 U/l, scaderea ASAT cu 28.75 U/l, scaderea GGT cu 50 U/l, scaderea trigliceridelor cu 55.25 mg/dl, scaderea LDL-colesterol cu 23.75 mg/dl, scaderea glicemiei a jeun cu 10.5 mg/dl si cresterea HDL-colesterol cu 3.25 mg/dl.

Concluzii: Scaderea in greutate este principala atitudine terapeutica la subiectii cu boala ficatului gras non-alcoolic. Scaderea in greutate la subiectii cu SM si boala ficatului gras

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nonalcoolic se insoteste de scaderea importanta a concentratiei plasmatice a transaminazelor. De asemenea, scaderea in greutate se insoteste de imbunatatirea semnificativa a profilului lipidic si a glicemiei a jeun.

EFFECTS OF WEIGHT REDUCTION ON NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) IN PATIENTS WITH METABOLIC SYNDROME

R. Vasilescu, Silvi IfrimClinical Hospital Colentina Bucharest – Departement of Diabetes, Nutrition, Metabolic Diseases

Introduction: Non-alcoholic fatty liver disease (NAFLD) is a major cause of liver related morbidity and mortality. NAFLD may progress from simple stetosis to non-alcoholic steatohepatitis (NASH) and cirrohosis, that may be complicated by hapatocellular carcinoma. In recent years NAFLD is considered as a hepatic manifestation of metabolic syndrome (MS).

Methods and patients: We studied 20 subjects (males), mean age 38.5 years (range 25-54 years) with MS (IDF criteria), non-diabetic, mean BMI 35.08 kg/m2 ( range 31kg/m2 – 40 kg/m2), with hepatic steatosis (confirmed by liver ultrasound). All patients have been treated with a low caloric diet (1200 kcal) for 24 weeks. Weight, waist circumference, ALT, AST, GGT, triglycerides, LDL cholesterol, HDL cholesterol, fasting glucose were measured. T-student test was used to compare variables variations between baseline and 12 weeks and 24 weeks.

Results:

Week 0 Week 12 Week 24 Week 0 vs. Week 12

Week 0 vs. Week 24

Weight (Kg) 104±17.1 99.67±16.46 96.83±16.56 p=0.003 P=0.001BMI (kg/m2) 35.08±4.43 33.43±4.52 32.27±4.59 P<0.001 P<0.001Waist circumference

116.25±16.5 112±16.06 108.5±15.55 P<0.001 P<0.001

AST (TGO) 65±37.09 42.5±16.3 36.25±9.54 P=0.02 P=0.02ALT (TGP) 123.75±70.08 63±34.22 39.75±17.58 p=0.03 p=0.02GGT 97.25±69.76 72.5±41.75 47.25±20.7 p=0.05 p=0.03LDL-cholesterol

149.5±24.3 139±18.8 125.75±14.86 p<0.001 p<0.001

HDL-cholesterol

31.5±3.51 32.25±4.11 34.75±4.03 NS NS

Triglycerides 192±29.23 151±18.08 136.75±19.62 p=0.01 p=0.005

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(mg/dl)Glucose (mg/dl)

95±11.63 86.5±7.59 84.5±6.45 p=0.04 p=0.004

Patients with MS and NAFLD have high serum transaminases. All patients had ALT>1.5xN and ALT/AST>2. Mean 12 weeks weight loss was 4.67 kg (range 2-6 kg), ALT decreased with 60.75 U/l, AST decreased with 22.5 U/l, GGT decreased with 24.75 U/l, triglycerides decreased with 40.75 mg/dl, LDL cholesterol decreased with 15.5 mg/dl, fasting glucose decreased with 8.5 mg/dl and HDL cholesterol increased with 0.75 mg/dl. Mean 24 weeks weight loss was 7.33 kg (range 4-9 kg), ALT decreased with 84 U/l, AST decreased with 28.75 U/l, GGT decreased with 50 U/l, triglycerides decreased with 55.25 mg/dl, LDL cholesterol decreased with 23.75 mg/dl, fasting glucose decreased with 10.5 mg/dl and HDL cholesterol increased with 3.25 mg/dl.

Conclusion: Weight loss is the main therapy in patients with NAFLD. Reduction in body weight in patients with MS and NAFLD is associated with a pronounced decrease in serum transaminases. In addition weight loss resulted in significant improvements in the lipoprotein profile and fasting glucose.

PREVALENTA COMPLICATIILOR MICROVASCULARE LA PACIENTII CU DIABET ZAHARAT TIP 1 CU VECHIME A BOLII DE PESTE 25 ANI

Sigina Gargavu1, Mihaela Vladu2, Diana Clenciu1, Nicoleta Mitroi1, Camelia Panus1, Maria Mota2,

1 Spitalul Clinic Judetean de Urgenta Craiova – Clinica Diabet Nutritie Boli Metabolice;

2 UMF Craiova - Departamentul de Diabet Nutritie Boli Metabolice

Scopul studiului: Evaluarea prevalentei complicatiilor microvasculare la un lot de pacienti cu diabet zaharat tip 1 cu vechime a bolii de peste 25 ani.

Material si metoda: Lotul studiat a cuprins 44 pacienti cu DZ tip 1 cu vechime a bolii de peste 25 ani aflati in evidenta Centrului Clinic de Diabet Nutritie Boli Metabolice al Spitalului Clinic Judetean de Urgenta Craiova. Ca metoda de lucru am utilizat urmatoarele date anamnestice, clinice si paraclinice: vechimea diabetului, antecedentele personale, determinarea tensiunii arteriale, glicemie, uree, creatinina, colesterol total, trigliceride, examen sumar urina, microalbuminurie repetata de 3 ori la pacientii cu uroculturi negative, examen oftalmologic, examen neurologic.

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Rezultate: Din cei 44 pacienti, 14 (31,81%) au fost de sex feminin si 30 (68,19%) de sex masculin. Cu privire la varsta acestora, 2 pacienti (4,54%) se aflau in decada de varsta 30-40 ani, 12 pacienti (27,27%) in decada 41-50 ani, 15 pacienti (34,09%) in decada 51-60 ani si 15 pacienti (34,09%) peste 60 ani. Studiind parametrul complicatii microvasculare s-a remarcat o frecventa crescuta a neuropatiei diabetice 95,45% si a retinopatiei diabetice 88,63%. Nefropatie diabetica au prezentat 40,90% din pacientii cu vechime de peste 25 ani. Dintre pacientii cu neuropatie diabetica, 84,09% au avut neuropatie periferica si 11,36% atat neuropatie periferica cat si vegetativa. Din cei cu retinopatie diabetica 50% s-au aflat in stadiul neproliferativ; 11,36% in stadiul preproliferativ si 27,27% in stadiul proliferativ. La 31,05% dintre acestia s-a intalnit cecitatea ca si complicatie a retinopatiei diabetice. Nefropatia diabetica s-a intalnit in 33,33% in stadiul 3; 61,11% in stadiul 4 si 5,55% in stadiul 5. Dintre cei cu retinopatie diabetica 43,59% prezentau si nefropatie. Dislipidemia a fost evidentiata la 32 pacienti (72,72%). Hipertensiunea arteriala s-a intalnit la 36 pacienti (81,81%). Dintre pacientii hipertensivi, 28 pacienti (77,77%) prezentau HTA si neuropatie, 27 pacienti (75%) prezentau HTA si retinopatie, 17 pacienti (47,22%) prezentau HTA si arteriopatie, 15 pacienti (41,67%) prezentau HTA si nefropatie, iar 13 pacienti (36,11%) prezentau atat HTA cat si neuropatie, retinopatie, arteriopatie si nefropatie.

Mentionam ca nu s-a putut stabili o corelatie intre echilibrul glicemic si complicatiile microvasculare datorita lipsei hemoglobinei glicozilate din evidentele pacientilor de-a lungul perioadei de evolutie a DZ.

Concluzii : Se remarca o frecventa alarmanta a complicatiilor microvasculare dupa o vechime a DZ tip 1 de peste 25 ani. Neuropatia diabetica este cea mai frecventa complicatie intalnita, dar si cea mai precoce. Retinopatia diabetica este de asemenea o complicatie frecventa, dar este rara in primii ani de evolutie. Gradul mic de corelatie al retinopatiei diabetice cu nefropatia diabetica sugereaza posibila participare a unor factori individuali implicati in aparitia acestora, cum ar fi factorii genetici. Dislipidemia si hipertensiunea arteriala sunt frecvent intalnite la pacientii cu DZ de peste 25 ani. Ambele sexe sunt vulnerabile pentru complicatiilor microvasculare.

THE PREVALENCE OF MICROVASCULAR COMPLICATIONS IN TYPE 1 DIABETES MELLITUS WITH DURATION OF DIABETES MORE THAN 25

YEARS

Sigina Gargavu1, Mihaela Vladu2, Diana Clenciu1,, Nicoleta Mitroi1, Camelia Panus1, Maria Mota2 ,

1 Clinical County Emergency Hospital Craiova, Diabetes Clinic; 2 UMF Craiova

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Background: To analyze the frequency of microvascular complications in patients with duration of T1DM more than 25 years.

Material and method: We studied a group of 44 patients with duration of T1DM more than 25 years, hospitalized in the Clinic of Diabetes Nutrition & Metabolic Diseases (Clinic County Emergency Hospital Craiova). We analized the following history, clinical and paraclinical dates: the duration of diabetes mellitus, personal history, blood pressure, glycemia, urea, creatine, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, urinary examination, microalbuminuria (repeted for 3 times), ophtalmological examination, neurological examination.

Results and discussions: From the 44 patients included in the study, 14 patients (31,81%) were female and 30 patients (68,19) were male. Concerning the age of patients, 2 patients (4,54%) were between 30-40 years, 12 patients (27,27%) were between 41-50 years, 15 (34,09%) patients were between 51-60 years and 15 patients (34,09%) over 60 years. Regarding microvascular complications, 95,45% patients presented diabetic neuropathy and 88,63% presented diabetic retinopathy. Diabetic nefropathy presented 40,90% of patients with duration of T1DM more than 25 years. From the patients with diabetic neuropathy, 84,09% had peripheral neuropathy and 11,36% both peripheral and vegetative neuropathy. From the patients with diabetic retinopathy, nonproliferative DR (NPDR) was encountered in 50% of patients, preproliferative DR in 11,36% while 27,27% had proliferative DR (PDR). As a complication of DR, blindness was met in 31,05% patients. Regarding diabetic nefropathy, 33,33% of the cases presented 3rd stage, 61,11% presented 4th stage and only one patient (5,55%) presented 5th stage. From the patients with retinopathy 43,59% presented nefropathy too. 32 patients (72,72%) had dyslipidaemia and 36 patients (81,81%) suffered of arterial hypertension. From hypertensive patients, 28 patients (77,77%) presented after 25 years arterial hypertension and diabetic neuropathy, 27 patients (75%) arterial hypertension and diabetic retinopathy, 17 patients arterial hypertension and diabetic arteriopathy, 15 patients arterial hypertension and diabetic nefropathy and 13 patients (36,11%) presented arterial hypertension, neuropathy, retinopathy, arteriopathy and nefropathy. We can not established a corelation between glycemic control and microvascular complications because the missing of HbA1c during the diabetes mellitus evolution.

Conclusions: This study showed that microvascular complications appeared with an alarming frequency after 25 years of evolution. Diabetic neuropathy is the most frequent and precocious microvascular complication. Also DR is a frequent complication too. Its smaller degree of corelation with diabetic nefropathy sugests the possibility of participation of others individuals factors, like genetic ones. Dyslipidemia and arterial hypertension were met after 25 years of type 1 diabetes mellitus evolution, even more frequently in patients with chronic complications. Both male and female are vulnerable for microvascular complications.

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CERCETĂRI PRIVIND OPTIMIZAREA CONSULTULUI DE DIABET ÎN AMBULATORIUL DE SPECIALITATE

Sorin Ioacara, Călin Tiu

Policlinica „Medi’s” Câmpina, România

Scop. Analiza modului de desfăşurare a consultului de diabet în sistem ambulator şi optimizarea lui pentru a permite creşterea calităţii pentru acelaşi interval de timp folosit.

Material şi metodă. Policlinica „Medi’s” a pus la dispoziţie spaţiul şi dotările necesare implementării unui program de management conceput şi realizat local, folosind experienţa Spitalului General Salzburg, Austria. Pacientul se prezintă prin programare, aşteaptă în medie 20’, intră în cabinetul asistentei, unde se notează DOAR în calculator datele demografice, antropometrice (inclusiv circumferinţa abdominală), tensiune arteriala, fumat, etc. Urmează ultimile analize, inclusiv cu data, pentru glicemie, HbA1c, colesterol total, HDLc, trigliceride, uree, creatinină. Urmează răspunsul la întrebări ţintite privind debutul diabetului, glaucom, cataracta, furnicături picioare, etc. Sunt calculate automat: vârsta, greutatea ideală, IMC actual, IMC maxim în cursul vieţii, LDLc, rata filtrării glomerulare (formula MDRD). Timpul mediu necesar: 4 minute. Pacientul revine în sala de aşteptare şi intră apoi în cabinetul medicului, care preia consultaţia din punctul lăsat de asistentă şi introduce DOAR în calculator prin clic în căsuţa potrivită date legate de complicaţii oculare, renale, nervoase, dislipidemie, arteriopatie, hipertensiune, cardiopatie ischemică, infarct, accident vascular cerebral, insuficienţă cardiacă, fibrilaţie atrială. Se generează în mod automat diagnosticul complet (lung), care poate fi modificat (practic doar adăugări) şi validat. Urmează pagina 3 alocată recomandărilor, unde se aleg medicamentele din liste scurte, împărţirea într-o zi şi perioada prescrierii. Se generează automat date de regim alimentar (extins). Urmează momentul generării documentelor medicale prin clic pe butonul corespunzător. Reţetele gratuite sunt printate pe imprimante matriciale (trei). Calculatorul mai genereaza automat bilet de consult, identic cu biletul de externare (o pagina A4 plină, la font de 10), ce cuprinde pe lângă diagnostic absolut toate informaţiile existente în calculator, sub formă de fraze automate, modificabile. Similar, sunt generate scrisoare medicală, referat medical, referat justificare medicamente, etc., care sunt printate laser. Timpul mediu necesar: 4 minute, din care 5-10 secunde generarea tuturor documentelor medicale. Un exemplar din biletul de externare este pus în fişa pacientului pentru a consemna consultul. Calculatorul mai generează registrul de consultaţii şi raportarea lunară către Casa de Sănătate.

Rezultate. Ȋn perioada 15/03/2008-30/09/2008 s-au efectuat 2450 consultaţii diabet folosind managementul descris anterior, cu un timp mediu total (inclusiv asistenta!) de ingrijire medicală de 8 minute / pacient, ceea ce corespunde la 15 pacienţi / ora (4 minute/pacient x 2 cabinete). Pacienţii sunt studiaţi prospectiv sub diverse aspecte (inclusiv mortalitate), cu generarea automată a bazei de date.

Concluzii. Folosind un management performant se poate externaliza complet birocraţia prezentă şi viitoare, cu realizarea a 80-90 consultaţii / 6 ore. Dacă toate documentele

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medicale sunt ştampilate şi semnate în prealabil, se elimină total folosirea pixului şi a ştampilei în timpul consultaţiei. Timpul câştigat poate fi transferat către activităţi de educaţie, cercetare, etc. Un eventual Registru National de Diabet poate fi usor alimentat cu informatii in acest fel.

RESEARCH REGARDING THE OPTIMIZATION OF DIABETES CONSULTATION IN OUTPATIENT CLINIC

Sorin Ioacara, Calin Tiu

„Medi’s” Outpatient Clinic, Campina, Romania

Aim. To analyze the diabetes consultation and it’s optimization for increasing the quality without any expense of time.

Materials and methods. „Medi’s” Outpatient Clinic offered the space and materials required for implementation of a management plan designed locally, using the experience of Salzburg General Hospital, Austria. The patient comes only by appointment, he waits around 20’, he enters the nurse’s cabinet, where data are recorded only in computer regarding demographic, anthropometry (including waist circumference), blood pressure, smoking ... Then, the newest blood analysis data are recorded, including date, for glycaemia, HbA1c, total and HDL cholesterol, triglycerides, urea and creatinine. Then, the patient answers some questions regarding diabetes onset, glaucoma, cataract... Automated generated data include: age, ideal weight, present and maximum (during life) BMI, LDLc, glomerular filtration rate (MDRD formula). Mean time: 4 minutes. The patient returns in the waiting room and then he enters the doctor’s cabinet, who continues the consultation from the point left by the nurse. He records only in the computer data regarding ocular, renal, nervous complications, dyslipidemia, arteriopathy, hypertension, ischemic heart disease, myocardial infarction, stroke, heart insufficiency, atrial fibrillation. The diagnosis is generated automated, modified (generaly by completion) and validated. Page three deals with recommendations, where medications are chosen from small lists, dayly and the total period for prescription. The general diet is computer generated. Then, the medical discharge documents are automatically generated. Receipts are printed on matricial printers (three). The computer generates an discharge letter very similar with the one used in hospital (one A4 page, font: 10), which contains the diagnosis and all the information from computer, but in long phrases, which are modifiable. In a similar manner are automatically generated other documents like letter for the GP, medical note, notes for prescription justification ... they are laser printed. The doctor’s mean time: 4 minutes, from which 5-10 seconds for documents generation. One discharge letter goes to the patient medical file as a source document. The computer also generates the consultations registry and the monthly report to the Health Insurance Company.

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Results. During 15/03/2008-30/09/2008 period, there were 2450 diabetes consultations, all using the management plan described above, with a mean time of medical care (nurse+doctor) of 8 minutes / patient, which coresponds to 15 consultations / hour (4 minutes / patient x two cabinets). The patients are prospectively studied from diffrent aspects (including mortality), with the automatically generation of the database.

Conclusions. If a top management plan is used, it is possible to completely externalise the present and future birocracy, with the result of 80-90 consultations / 6 hours. If all medical documents are signed and stamped before, there is no need for pen and stamping during the consultation. The gained time can be transfered to activities for education, research. Any future National Diabetes Registry can be easily fed with information.

INDICII MOLECULARE SI GENETICE DE REVERSIBILIZARE A DIABETULUI ZAHARAT TIP 2

Silvia Stefania Iancu

Centrul Clinic de Diabet, Nutritie si Boli Metabolice, Cluj-Napoca

Prezentam o trecere in revista a directiilor de cercetare actuale care au ca scop reversibilizarea diabetului zaharat de tip 2, reversibilitate demonstrata si reproductibila prin tratamentul chirurgical al obezitatii si care necesita a fi extinsa la alte subgrupe de pacienti cu diabet zaharat tip 2. Acest lucru este posibil prin cautarea si identificarea genelor de risc, a cailor de semnalizare in care se implica produsii acestor gene.

Aceste abordari se focalizeaza pe: gena TCF7l2, cea mai frecvent asociata cu riscul de diabet la multe populatii si implicarea in calea wnt de semnalizare, legata de metabolismul lipidic si de homeostazia glucozei si influenteaza numarul si functia celulelor beta; calea PPAR, rezistenta la insulina si semnalizarea insulinica redusa la nivel de receptor si postreceptor, statusul inflamator.

MOLECULAR AND GENETIC CLUES TO REVERSE TYPE 2 DIABETES MELLITUS

Silvia Stefania Iancu

Clinical Centre for Diabates Nutrition and Metabolic Diseases, Cluj-Napoca

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We present an overview of the research directions aiming at reversal of type 2 diabetes mellitus that was demonstrated and is reproducible in the surgical treatment of obesity. This fact should be extended to other subgroups of type 2 diabetes patients and this is possible through searching for the risk genes, the signalling pathways in which their action is involved.

These approaches are focused on: TCF7l2 gene, the gene most frequently associated with the risk for diabetes in many populations and its implications in the wnt signalling pathway that is connected with the lipid metabolism and glucose homeostasis influences beta cells’ number and fuction; the PPAR pathway, insulin resistance and defects of insulin signalling reduced receptor and postreceptor activity, the inflammatory status.

NEUROPATIA VEGETATIVA CARDIACA ESTE SUBDIAGNOSTICATA IN DIABETUL ZAHARAT DE TIP 1

Silvia S Iancu (1), Mariana Coca (1), Ion Iancu (2), Ioana Streulea (1)

1 Centrul Clinic de Diabet, Nutritie si Boli Metabolice Cluj-Napoca2 Sectia de neurologie, Clinica Medicala IV, Cluj-Napoca

Scop Neuropatia cardiaca vegetativa se asociaza (NCV) cu risc cardiovascular crescut si cu moarte subita la pacientii cu diabet, din acest motiv am initiat studiul epidemiologei acestei afectiuni si asocierile ei cu alte complicatii cronice ale diabetului zaharat.

Pacienti: Am inclus pacienti cu diabet zaharat tip 1, 50 barbati, 48 femei, cu varsta medie 35+ 8 ani, cu o durata a diabetului cuprinsa intre 9,5-23 ani, fara insuficienta renala.

Metode: Pentru diagnosticul NCV am folosit rata variabilitatii frecventei cardiace in cursul respiratiei profunde si ca raspuns la ortostatism, Raspunsul presional la contractia mainii si la ortostatism din bateria de teste Ewing. Am diagnosticat NCV daca doua din testele mentionate anterior au fost pozitive. Am realizat screeningul prezentei complicatiilor cronice ale diabetului zaharat, am evaluat TA de repaus, IMC, HbA1C, profilul lipidic, creatinina, hemoleucograma, sideremia, EEG s-a realizat doar la 31 din pacienti pana la data respectiva

Rezultate: Am aflat ca 5 din 25 (20%) din barbatii cu durata diabetului (dd) intre 10-15 ani si 11 din 25 (44%) din cei cu dd peste 15 ani au fost pozitivi pentru NCV, in timp ce la femei, 4 din 24 (16,6%) cu dd intre 10-15 ani si 10 din 24 (41,6%) cu dd>15 ani aveau NCV. Am gasit asocieri semnificative ale NCV cu hipoglicemiile severe/nerecunoscute OR=2,33, cu prezenta retinopatiei, OR= 1,82, cu tensiunea arteriala, OR=2,01, cu neuropatia periferica simptomatica OR=1,65, cu gastropareza sau diareea diabetica OR=4,03 dar nu am decelat deocamdata nici o asociere cu aspectele EEG. Doar 12,4%

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din pacienti au avut acuze de simptome sugestive pentru neuropatia autonoma la prezentare..

Concluzie: Am gasit o prevalenta crescuta a NCV la persoanele cu diabet zaharat tip 1 cu durata diabetului peste 10 ani, prevalenta care creste cu varsta si cu durata bolii. Recomandam efectuarea screening-ului acestei complicatii la pacientii cu diabet zaharat tip 1 mai ales cu peste peste 10 ani vechime a bolii

UNDERDIAGNOSED CARDIAC AUTONOMIC NEUROPATHY IN TYPE 1 DIABETIC PATIENTS

Silvia S Iancu (1), Mariana Coca (1), I.. Iancu (2), Ioana Streulea (1)

1 Clinical centre for diabetes, nutrition and metabolic diseases Cluj-Napoca2 Neurology Department, Medical Clinic IV Cluj-Napoca

Aim: Cardiac autonomic neuropathy (CAN) is associated with highly increased cardiovascular risk and sudden death in diabetic patients. We studied the epidemiology of the condition and its associations with other diabetic complications.

Patients: We included 98 type 1 diabetes patients, 50 males, 48 females, aged 35+ 8 years, with a diabetes duration between 9.5-23 years without renal insufficiency.

Methods: For the CAN we assessed the heart rate (HR) variability during deep breath, HR response to standing, BP response to handgrip and BP response to standing, from the Ewing battery of tests. We diagnosed CAN if two of the tests previously mentioned were ositive. We screened the presence of chronic diabetes complications, we evaluated resting BP, BMI, HbA1C, lipid profile, creatinine, hemoleucogram, iron, EEG was performed in only 31 of the patients to date.

Results: We found that 5 of 25 (20%) males with diabetes duration (dd) between 10-15 years and 11 of 25 (44%)with dd over 15 years were positive for CAN, whereas in females, 4 out of 24 (16,6%) with diabetes duration between 10-15 years and 10 out of 24 (41,6%) with dd>15 years had CAN. We found significant associations of CAN with unrecognized – severe hypoglycemias OR=2,33, with presence of retinopathy OR= 1,82, with blood pressure OR=2,01, with symptomtic peripheral neuropathy OR=1,65, with diabetic gastropathy or diarrhea OR=4,03 but no association could be found with EEG aspects..Only 12,4% of the patients complained of symptoms usually suggestive of autonomic neuropathy at presentation.

Conclusion: We found a high prevalence of CAN in type 1 diabetic patients, increasing with age and disease duration, and due to the high CV risk attributable to this condition

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We strongly recommend the inclusion of the CAN screening in the annual evaluation of the type 1 diabetes patients, after 10 years of disease duration...

ASPECTE ALE COMEI HIPOGLICEMICE

Stefanita PETREA, Andreea SERBAN, Viviana ELIAN, Prof .Dr CONST. IONESCU TARGOVISTE

Institutul de Diabet,Nutritie,Boli Metabolice “N.Paulescu”Bucuresti

Coma hipoglicemica este manifestarea extrema a hipoglicemiei, insotita de pierderea starii de constiinta, cu incapacitatea pacientului de a actiona adecvat pentru a iesi din hipoglicemie fara interventia altor persoane.

SCOP STUDIULUI:urmarirea cazurilor de coma hipoglicemica internate la I.D.N.B.M.”PAULESCU”in perioada martie 2007-februarie 2008.

MATERIAL SI METODA:au fost analizate 106 pacienti,pe baza foii de observatie completate in serviciul de terapie intensiva.S-au urmarit parametrii fiziologici la internare,etiologia episodului hipoglicemic si raspunsul la tratament.

REZULTATE:in perioada martie 2007-februarie 2008 au fost internati in sectia de terapie intensiva a spitalului .I.D.N.B.M”PAULESCU” 106 cazuri,din care 50 barbati,si 56 femei cu varsta medie de 60,1 ani ,cu o vechime medie a diabetului de 12.79 ani.La internare,pacientii au avut o valoare glicemica medie de 32,85 mg/dl,Hba1c medie de 8.6%,un scor glasgow mediu de 9.78,TAS medie 138,15 mmHg ,TAD medie 73,4 mmHg,AV-90,52 bpm,un procent de 29,78 %din pacienti au prezentat hipertonie,23,45 % semnul babinski si 65,95% transpiratii.Cauza cea mai frecventa a comei hipoglicemice a fost aportul alimentar inadecvat la 66,03%din pacienti.15,09%din cazuri au survenit pe fondul IRC,9.43% pe fondul consumului excesiv de alcool,4.71% in urma efortului fizic intens,,3.77% au survenit la persoane cu neoplazii.A fost inregistrat si un caz de coma hipoglicemica pe fondul administrarii excesive de insulina in scop suicidal la o tanara de 28 ani.Majoritatea pacientilor erau pe terapie cu insulina umana 62,26%,un procent de 23,58 % urmau tratament cu sulfoniluree si 14,15% urmau terapie cu analogi de insulina.Raspunsul la terapie a survenit in principal la 2 ore de la tratament ,cu o glicemie medie de 143 mg/dl,un singur deces a fost semnalat la o persoana de 48 ani,cu neoplasm mamar operat ,cu metastaze cerebrale si meningeale.

CONCLUZII:coma a survenit mai frecvent la persoane care urmau tratament cu insulina umana,indeosebi pe schema cu 3 prize de insulina,iar aportul inadecvat de hidrati a fost principala cauza declansatoare .Acest fapt subliniaza importanta educatiei

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terapeutice a pacientului atat in ceea ce priveste administrarea de insulina cat mai ales importanta regimului igieno-dietetic si ajustarea dozelor in functie de stilului de viata

CONSIDERATIONS ON HYPOGLYCEMIC COMA

Stefanita PETREA, SERBAN Andreea ,Viviana ELIAN, PROF.C.IONESCU TARGOVISTE

Institute of diabetes, Nutrition and Metabolic Diseases "N. Paulescu"

Hypoglycemic coma is the extreme manifestation of hypoglycemia,consecutive to the loss of consciousness,with the incapacity of the patient to act accordingly to get off the hypoglicemic status,without outside assistance.

Objective-the evaluation of the patients with hypoglycemic coma who have been hospitalized in the Institute of Diabetes,Nutrition and Metabolic Diseases „N.Paulescu”, Bucharest, between march 2007- february 2008.

Research design and methods- a group of 106 patients with hypoglycemic coma has been analysed using the medical records filled in the intensive care unit. It has been recorded the physical examination, vital signs, the etiology of the hypoglicemic event and the response at treatment.

Results: between march 2007- february 2008 , in the intensive care unit of the Institute of Diabetes,Nutrition and Metabolic Diseases ,106 patients have been hospitalized ,50 men and 56 women ,average age of 60,1 years, with an average of 12,79 years of diabetes. At the hospitalisation moment,the patients had the following average parameters:glycemia of 32,85 mg/dl ,HbA1c of 8,6 %,the Glasgow coma scale of 9,78,the sistolic blood pressure of 138,15 and the diastolic blood pressure of 73,4, the heart rate of 92,52 beats per minute .29,78% of

patients had hypertonia,23,45% had a positive Babinski sign and 65,95 % perspiration.

The most common cause for hypoglycemic coma was the inadequate nourishment,present at 66,03 % of patients.15.09 % of cases resulted from chronic renal failure,9.43% from the alcoholic abuse ,4.71% from increased physical activity and 3,77 % of patients had as concomitant illness cancer.It has been recorded one case of hypoglycemic coma due to an insulin overdose administrated as a suicidal attempt by a 28 years old woman .Most of the patients were on human insulin treatment( 62,26%),meanwhile 23,58% were treated with sulfonylurea and 14,15 % with insulin analogs.The patients recovered mainly within 2 hours after the begining of the treatment, with an average of glycemic level of 143 mg/dl,with one exception , a 48 years woman ,with breast cancer and brain disemination ,who died .

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Conclusions: the incidence of coma has been higher to the patients treated with human insulin, especially with 3 doses per day, and the inadequate nourishment has been the primary trigger. This underlines the importance of the patient’s training regarding not only the administration of insulin but dietary and insulin’s dosage as well, accordingly to one’s lifestyle.

DIABETUL ZAHARAT IN JUDETUL SATU MARE 01 01 2008 – 01 07 2008

PRELUCRAREA DATELOR CONFORM PROGRAMULUI EPIDIAB

REFERIRI LA DATELE EPIDIAB DE LA INITIERE PANA IN PREZENT

Dr Szilagyi Iosif* , Dr Bzduch Marta* , Dr Bzduch Zsolt Arpad** , Dr Ciorba Alina***

* Spital Judetean de Urgenta Satu Mare

** Centrul Medical CARITAS Satu Mare

*** Cabinet Medical Individual Dr Szilagyi

REZUMAT

Judetul Satu Mare face parte din acele judete care au fost integrate de la inceput in programul EPIDIAB. De la initierea programului si pana la 01 07 2008 numarul diabeticilor in evidenta a crescut cu aproape 10 000. Conform protocolului initial au fost inregistrati pacienti in functie de tipul diabetului,, domiciliu, sex, varsta,IMC, circumferinta abdominala, comorbiditati si complicatii (HTA, dislipidemie,cardiopatia ischemica,IM,AVC,arteriopatie diabetica, retinopatie , nefropatie diabetica, neuropatie).

De asemenea a fost urmarita structura terapeutica (mod de viata, tratament oral, insulinoterapie de diverse tipuri, terapie combinata).

In anul 2008 primul semestru au fost depistate 1372 cazuri noi din care 11 tip 1, 1343 tip 2, 1 diabet gestational, 15 alte forme.Repartitia in funtie de sex, varsta, domiciliu a fost sensibil egala. La tipul 2 o prevalenta net superioara se regaseste la supraponderali si obezi. La tipul 2 peste 70% au HTA, 69% dislipidemie, , 61% afectare vasculara de diverse tipuri, 19% retinopatie, 2,13% nefropatie clinic manifesta, 7,22% neuropatie in momentul depistarii.

In ceea ce priveste structura terapeutica predomina cu 34,70% cei cu tratament cu regim+ metformin,33,45% deocamdata beneficiaza doar de regim alimentar , 15,93% au

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tratament cu sulfonilureice 8,04% tratament oral combinat, 4,1% insulinoterapie de diverse tipuri.

In concluzie putem afirma faptul ca in continuare se mentine tendinta de crestere rapida a cazurilor de diabet zaharat , dar si faptul ca urmarirea active a acestora poate duce la prevenirea sau intarzierea complicatiilor , ceea ce justifica desfasurarea in continuare a programului.

DIABETES IN SATU-MARE COUNTY 01.01.2008 – 01.07.2008

DATA ANALYSIS ACCORDING TO EPIDIAB PROGRAM EPIDIAB DATA FROM START TO PRESENT DAYS

Dr Szilagyi Iosif; Dr Bzduch Marta; Dr Bzduch Zsolt; Dr Ciorba Alina

ABSTRACT

Satu-Mare County has been involved in The EPIDIAB Program from its’ beginning. The number of the registered diabetic patients has been raised with 10.000 since EPIDIAB started until 01.07.2008. According to the initial protocol the patients have been registered related to the diabetes type, residence, sex, age, BMI, waist circumference, co-morbidities and complications (arterial hypertension, dislipidemia, coronary arterial disease, myocardial infarction, stroke, diabetes vascular disease, retinopathy, diabetes nephropathy, and diabetes neuropathy).

In the same time the therapeutically structure has been monitored(life style, oral therapy, different types of insulinoteraphy and combination therapy).

In the first semester of 2008 there have been reported 1372 new cases of diabetes from witch 11cases of type 1 diabetes, 1343 type 2 diabetes, 1 gestational diabetes and 15 other types. There was a quite similar split based on sex, age and residency. Most of the type 2 diabetes patients are over-weighted and obese. Among the type 2 diabetes patients there are over 70% who suffered from arterial hypertension, 69% with dislipidemia, 61% with different kind of vascular disease and 19% with retinopathy, 2,13% with nephropathy and 7,22% with neuropathy at the moment of registration.

Regarding the therapeutical structure there are 34,70% of the patients on metformin+ life style optimization measures, 33,45% on diet , 15,93% on SU and 8,04% combinated OADs and 4,1% on insulin.

In conclusion we could state the fact that there is a continuous and rapid increasing tendency of the diabetes mellitus cases and also the fact that an active follow-up of this

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cases prevents or delay complications, all of this being a good argument to continue the program.

CORELATII INTRE NIVELUL SERIC AL TNF-ALFA SI GROSIMEA INTIMA-MEDIE LA PACIENTII CU DIABET ZAHARAT TIP 2 COMPLICAT CU

RETINOPATIE

Autori: V.Negrean¹, T. Alexescu¹, M. Adam¹, S. Tarmure¹, N. Leach¹, C. Vinteler², D. Todea³, L. Rosca³,

1- Clinica Medicala IV, UMF “Iuliu Hatieganu”, Spitalul Clinic CF Cluj-Napoca2- Clinica Dermatologie, Spitalul Clinic Judetean de Urgenta Cluj-Napoca3- Clinica Pneumoftiziologie, UMF “Iuliu Hatieganu” Cluj-Napoca

Obiectiv: Evaluarea relatiei intre indicele intima-medie(IIM) si valoarea serica a alfa-TNF la pcientii cu diabet zaharat tip 2 si retinopatie diabetica.

Material si Metoda: Studiul a inclus 40 de pacienti cu diabet zaharat tip 2 si retinopatie diabetica internati in Spitalul Clinic CF Cluj-Napoca in perioada 1.12.2007-30.03.2008. Fiecarui pacient i s-a intocmit o fisa ce cuprindea statusul metabolismului glucidic, lipidic si porteic, precum si markerii endoteliali inflamatori ( CRP, TNF-alfa). Indicele intima-medie a fost evaluat ultrasonografic la nivelul arterei carotide comune, bilateral, inregistrandu-se valoarea medie.

Rezultate: 9 pacineti au avut niveluri crescute de TNF-alfa ( 22,5%) , iar indicele intima-medie a fost semnificativ crescut la 22 de pacienti (55%). S-a observat ca toti pacientii cu niveluri crescute de alfa-TNF au avut un indice intima-medie crescut.

Concluzii: Indicele intima-medie masurat ultrasonografic reprezinta un semn precoce de ateroscleroza. Cresterea nivelurilor de TNF-alfa se coreleaza cu boala diabetica macrovasculara. Relatia intre semnele ultrasonografice de boala aterosclerotica subclinica si nivelurile serice ale mediatorilor inflamatiei nu este pe deplin certa, dar vom cauta noi factori predictivi de dezvoltare a aterosclerozei la pacientii cu diabet zaharat.

TNF-ALFA AND INTIMA-MEDIA THICKNESS (IMT) IN PATIENTS WITH RETINOPATHY’S TYPE 2 DIABETES MELLITUS

Author Block V. Negrean1, T. Alexescu1, M. Adam1, S. Tarmure1, N. Leach¹, C. Vinteler2, D. Todea3, L. Rosca3;

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1Medicala IV, Clinical Hospital CF cluj-Napoca, Cluj-napoca, Romania, 2Dermatology, Clinical Hospital of Urgency Cluj-Napoca, Cluj-napoca, Romania, 3Pneumology, Clinical Hospital of Pneumology Cluj-Napoca, Cluj-napoca, Romania.

Background and aims: Evaluation of the relationship between ITM and TNF-alfa in patients with diabetes mellitus type 2 and diabetes retinopathy.Materials and methods: The study included 40 patients with diabetes mellitus and retinopathy from diabetes mellitus causes, registered at Universitary Hospital Cluj-Napoca between 1.12.2007 and 30.03.2008. Each patient had a record of research where included the status of glucidic metabolism, lipidic metabolism and proteic metabolism and seric inflammatory markers ( CRP, TNF-alfa). ITM was evaluated using the ultrasonography of the common carotidal artery, on each side, and the medium value was recorded.Results: 9 patients had increased level of TNF-alfa ( 22,5%) and ITM was significant increased in 22 patients (55%). It was observed that all patients with high levels of TNF-alfa had significant increased ITM.Conclusion: The ITM measured by ultrasonography represents early sign in the development of atherosclerosis. The raising of TNF-alfa levels correlates with macrovascular disease in patients with diabetes retinopathy. The relationship between ultrasonographic signs of sub-clinical atherosclerosis and the plasma levels of chemical mediators of inflammation is not certain yet, but we are looking for a new prediction factors of sub-clinical atherosclerosis in patients with diabetes mellitus and it’s systemic complications.

EVALUAREA MASEI DE ŢESUT ADIPOS DUPĂ SUBSTITUŢIE TESTOSTERONICĂ LA BARBAŢII CU SINDROM METABOLIC ŞI

DISFUNCŢIE ERECTILĂ: EXPERIENŢA CLINICĂ A CENTRULUI CLINIC DE DIABET, NUTRIŢIE, BOLI METABOLICE, CLUJ-NAPOCA

V. COCA, MD1, Georgiana NICOLESCU, MD2, Mariana C. COCA, MD, PHD3, Ildiko KICSI-MATYUS, MD2

1Cabinet Andrologie si Medicina Sexualităţii, 2Cabinet Obezitate şi Dislipidemii, 3Departament Laborator Clinic, Centrul de Diabet, Nutritie, Boli Metabolica, Cluj-Napoca.

Obiective: Am urmărit evoluţia adipozităţii generale, a adipozităţii intra-abdominale, a taliei şi a raportului talie/şold după tratament cu testosteron cu absorbţie prelungită la persoane cu sindrom metabolic (MetS) cu disfuncţie erectilă (DE) şi activitate gonadică diminuată.

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Metoda: La un grup de 18 bărbaţi cu MetS (IMC: 32.67±1.08 kg/m2; T=117±5.09 cm; glicemie=116.7±6.3 mg%; Grup A) funcţie gonadică scăzută (testosteron total [T t] = 9.8±3.6 nmol/L, testosteron liber [free T] = 0.29±0.062) şi DE (± ejaculare precoce ± alterare de libidou) am evaluat distribuţia adipozităţii (impedanţă [InBody]; V1): adipozitatea generală (AG): 40.7±4.1%; adipozitatea viscerală (AP): 108.4±12.3 cm2; talia (T): 119.52±8.8 cm; raport talie/şold (T/S): 1.16±0.063. Pentru revigorare sexuală am prescris testosteron injectabil i.m. cu absorbţie prelungită (NEBIDO® 1000, 4 ml, 250 mg/ml) combinat cu PDE5i. Am evaluat participanţii din punct de vedere sexual (Indice Internaţional al Funcţiei Erectile: IIEF), androgenic şi prostatic (ecografie şi PSA) înaintea fiecărei injectări (la 2-3 luni) şi respectiv antropometric după 32 de săptămâni (V2) plus profilul lipidic, cel hematologic şi enzimele hepatice comparativ cu un lot de 20 de bărbaţi (Grup B) cu MetS, DE şi activitate testosteronică diminuată, trataţi fără testosteron, doar cu PDE5i.

Rezultate: La V2: AG = 34.4±1.09% (–7.6%), P<0.05. AP = 112.15±10.7 cm2 (–16.4 cm2, 14.6%), P<0.08. T = 99.6±6.09 cm (–9 cm, 8.33%), P<0.05. T/S = 0.98±0.079 (–0.08), P<0.01. Comparaţia cu lotul de control (V2) a relevat următoarele semnificaţii statistice: AG (vs. 43.45±3.02%): P < 0.05 (=0.058); AP (vs. 130.1±6.6 cm2): P < 0.06 (=0.067); T (vs. 120.02±5.01 cm): P < 0.05 (=0.056); T/S (vs. 1.1±0.03): P < 0.9. Parametrii lipidici, hematologici şi enzimele hepatice nu au îregistrat ascensiuni valorice faţă de V1. Testosteronemia postterapeutică nu a depăşit nivelul superior al normalului (medie Gr. A=18.66±3.09 nmol/L) şi nu s-au înregistrat nici alterări ale PSA (medie Gr. A=0.196±0.022 μg/L).

Concluzie: Substituţia testosteronică la bărbaţii obezi cu sindrom metabolic reduce masa adipocitară pe seama scăderii semnificative a grăsimii abdominale şi a taliei. Acest beneficiu, alăturat profilului lipidic nealterat după testosteron, sugerează un potenţial de ameliorare a riscului cardiovascular.

BODY FAT MASS EVALUATION IN METABOLIC SYNDROME WITH ERECTILE DYSFUNCTION AFTER TESTOSTERONE SUBSTITUTION THERAPY: CLINICAL EXPERIENCE OF THE CLINICAL CENTER OF DIABETES, NUTRITION AND METABOLIC DISEASE, CLUJ-NAPOCA.

V. COCA, MD1, Georgiana NICOLESCU, MD2, Mariana C. COCA, MD, PHD3, Ildiko KICSI-MATYUS, MD2,

1Sexual Medicine and Andrology Office, 2Obesity and Dislipidemia Office, 3Laboratory Investigations Department, Diabetes Clinical Center, County Emergency Hospital, Cluj-Napoca, Romania

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Objective: To assess total body fat mass, abdominal fat, waist and waist to hip ratio in long acting testosterone therapy in men having non-diabetic metabolic syndrome (MetS), erectile dysfunction (ED) and low androgenic activity.

Method: A group of 18 men with MetS (BMI: 32.67±1.08 kg/m2; W=117±5.09 cm), low/low normal androgenic activity (testosterone [T] = 9.8±3.6 nmol/L and free T = 0.29±0.062 nmol/L) and ED (± premature ejaculation, ± low libido) has been selected (Group A). Body fat distribution (impedance method: In Body) characteristics at V1 were: general fat mass (GF): 40.7±4.1%; visceral adipose tissue (VA): 108.4±12.3 cm2; waist (W): 119.52±8.8 cm; waist to hip ratio (W/H): 1.16±0.063. For sexual reestablishement long acting testosterone (Nebido 1000®) associated to phosphodiesteraze 5 inhibitors (PDE5i) were prescribed. Sexual (International Index of Erectile function: IIEF), serum testosterone and prostate (PSA, ultrasound) evaluation before every testosterone injection (2-3 month) were measured. Body fat parameters after 32 weeks injected long acting testosterone were also noted (V2) together with lipid profile, hematology and liver enzymes. Results were compared to those of a control group with MetS, ED and testosterone low activity, treated only with PDE5i (Gr. B).

Results: At V2: GF = 34.4±1.09% (–7.6%), P<0.05. VA = 112.15±10.7 cm2 (–16.4 cm2, 14.6%), P<0.08. W = 99.6±6.09 cm (–9 cm, 8.33%), P<0.05. W/H = 0.98±0.079 (–0.08), P<0.01. Comparing to the control group (also at V2) offered the following statistical significances: GF (vs. 43.45±3.02%): P < 0.05 (=0.058); VA (vs. 130.1±6.6 cm2): P < 0.06 (=0.067); W (vs. 120.02±5.01 cm): P < 0.05 (=0.056); W/H (vs. 1.1±0.03): P < 0.9. Lipid and hematological profile and liver enzymes also at V2 did not enhanced from normal patterns. Testosterone serum levels remained in normal interval values after the treatment (average Gr. A=18.66±3.09 nmol/L); PSA levels either (average Gr. A=0.196±0.022 μg/L).

Conclusions: Testosterone substitution therapy in metabolic syndrome men having ED decrease total body fat by reducing abdominal fat and waist. These benefits and the unaltered lipid profile suggest a possible lowering in cardiovascular risk of long acting testosterone admission.

EVALUAREA FUNCŢIEI SEXUALE DUPĂ SUBSTITUŢIE TESTOSTERONICĂ LA PERSOANE CU SINDROM METABOLIC ŞI DISFUNCŢIE ERECTILĂ: EXPERIENŢA CLINICĂ A CENTRULUI CLINIC DE DIABET, NUTRIŢIE,

BOLI METABOLICE, CLUJ-NAPOCA

V. COCA, MD1, D. PORAV, MD2, Ildiko KICSI-MATYUS, MD1, Georgiana NICOLESCU, MD1

1Centrul de Diabet, Spital Judeţean de Urgenţă, Cluj-Napoca.

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2Secţia Urologică, Spital Municipal, Cluj-Napoca.

Obiective: Evaluarea parametrilor de funcţie sexuală (funcţie erectilă, dorinţă sexuală, satisfacţie a penetrării, satisfacţie orgasmică şi satisfacţie generală) după substituţie testosteronică, în sin-dromul metabolic (MetS) cu disfuncţie erectilă (DE) şi cu activitate gonadică diminuată.

Metoda: La 18 bărbaţi cu MetS (BMI: 32.67±1.08 kg/m2; W=117±5.09 cm; Grup A), testosteron seric scăzut (testosteron total [Tt] = 9.8±3.6 nmol/L, testosteron liber [free T) = 0.29±0.062) şi DE (± ejaculare precoce ± alterare de libidou) am asociat terapeutic testosteron cu absorbţie prelungită (testosterone undecanoat 250 mg/ml: Nebido 1000®) şi inhibitori de fosfodiesterază 5 (PDE5i: sildenafil 50 mg, tadalafil 20 mg). Comparaţia s-a facut cu un lot de control de 20 de bărbaţi (Grup B) cu MetS şi DE, trataţi doar cu PDE5i, fără testosteron. Evaluarea sexuală s-a făcut prin calcularea scorului total al Indexului Internaţional de Funcţie Erectilă (IIEF) şi al domeniilor acestuia: funcţia erectilă (FE): Q1 – 5, 15; satisfacţia penetrării (SP): Q6 – 8; satisfacţia orgasmică (SO): Q9 – 10; dorinţa sexuală (DS): Q11 – 12; satisfacţia generală (SG): Q13 – 14. Evaluarile s-au facut la înrolare (V1) şi după 32 de săptămâni de testosteron (3 injecţii i.m.; V2).

Rezultate: Scorul IIEF. Gr. A, V1 vs. V2: 41,8±7.2 vs. 68.4±5.9 (P=0.0016); la V2, Gr. A vs. Gr. B: 68.4±5.9 vs. 57.3±6.6 (P=0.037). Scor FE. Gr. A, V1 vs. V2: 14.2±3.1 vs. 26.5±2.2 (P=0.003); la V2, Gr. A vs. Gr. B: 26.5±2.2 vs. 22.6±2.4 (P=0.056). Scor SP. Gr. A, V1 vs. V2: 8.7±0.2 vs. 14.0±0.8 (P=0.074); la V2, Gr. A vs. Gr. B: 14.0±0.8 vs. 11.7±0.4 (P=0.021). Scor SO. Gr. A, V1 vs. V2: 8.3±0.08 vs.8.9±0.7; la V2 Gr. A vs. Gr. B: 8.9±0.7 vs. 8.6±0.1 (P=0,15). Scor DS. Gr. A, V1 vs. V2: 5.3±0.5 vs.8.8±0.04 (P=0.0012); la V2 Gr. A vs. Gr. B: 8.8±0.04 vs. 6.07±0.2 (P=0.072). Scor SG. Gr. A, V1 vs. V2: 4.7±0.3 vs.8.9±0.1 (P=0.008); la V2 Gr. A vs. Gr. B: 8.9±0.1 vs. 6.3±0.5 (P=0.061). Discuţii: Luând în considerare semnificaţia statistică de P<0.05, diferenţe semnificative faţă de lotul martor au apărut la ameliorarea funcţiei erectile, a dorinţei sexuale (libido) şi a satisfacţiei generale. Nu s-au putut face corelaţii cu tipul de PDE5i asociat, din cauza inconstantei utilizării a aceleiaşi forme de PDE5i pe durata studiului.

Concluzii: Substituţia testosteronică cu preparate cu absorbţie prelungită ameliorează calitatea vieţii, îmbunătăţind funcţia sexuală la bărbaţii cu sindrom metabolic şi disfuncţie erectilă şi crescând totodată şi eficienţa PDE5i la aceste persoane.

SEXUAL FUNCTION ASSESSMENT AFTER TESTOSTERONE SUBSTITUTION THERAPY IN MEN HAVING ERECTILE DYSFUNCTION

AND METABOLIC SYN-DROME: CLINICAL EXPERIENCE OF THE

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CLINICAL CENTER OF DIABETES, NUTRITION AND META-BOLIC DISEASE, CLUJ-NAPOCA

V. COCA, MD1, I. COMAN, MD2, Ildiko KICSI-MATYUS, MD3, Georgiana NICOLESCU, MD3

1Sexual Medicine-Andrology Office, Diabetes Clinical Center, County Emergency Hospital, Cluj-Napoca, Romania

2Sexual Medicine-Andrology Office, Urology Department, Municipal Hospital, Cluj-Napoca, Romania

3Diabetes Clinical Center, County Emergency Hospital, Cluj-Napoca, Romania

Objective: To watch sexual items (erectile function, sexual desire, intercourse satisfaction, orgasmic satisfaction and overall satisfaction) after testosterone substitution therapy in men with metabolic syndrome having erectile dysfunction with low gonadic activity.

Method: A group of 18 men with MetS (BMI: 32.67±1.08 kg/m2; W=117±5.09 cm), low/low normal androgenic activity (testosterone [T] = 9.8±3.6 nmol/L and free T = 0.29±0.062 nmol/L) and ED (± premature ejaculation, ± low libido) has been selected (Group A). They were treated with long acting testosterone (testosterone undecanoat 1000 mg) associated to phosphodiesteraze 5 inhibitors (PDE5i: sildenafil 50 mg, tadalafil 20 mg) and compared to a 20 men control group (B) treated only with PDE5i and (also having MetS, ED and testosterone low activity). Sexual function has been evaluated by the International Index of Erectile Dysfunction (IIEF) score and its domains: Erectile Function (EF): Q1 - 5, Q15; Sexual Desire (SD): Q6 – 8; Intercourse Satisfaction (IS): Q9 – 10; Orgasmic Satisfaction (OS): Q11 – 12; and Overall Satisfaction (OVS): Q13 – 14.

Results: IIEF score. Gr. A, V1 vs. V2: 41.8±7.2 vs. 68.4±5.9 (P=0.0016); la V2, Gr. A vs. Gr. B: 68.4±5.9 vs. 57.3±6.6 (P=0.037). EF score. Gr. A, V1 vs. V2: 14.2±3.1 vs. 26.5±2.2 (P=0.003); la V2, Gr. A vs. Gr. B: 26.5±2.2 vs. 22.6±2.4 (P=0.056). IS score. Gr. A, V1 vs. V2: 8.7±0.2 vs. 14.0±0.8 (P=0.074); la V2, Gr. A vs. Gr. B: 14.0±0.8 vs. 11.7±0.4 (P=0.021). OS score. Gr. A, V1 vs. V2: 8.3±0.08 vs.8.9±0.7; la V2 Gr. A vs. Gr. B: 8.9±0.7 vs. 8.6±0.1 (P=0.15). SD score. Gr. A, V1 vs. V2: 5.3±0.5 vs.8.8±0.04 (P=0.0012); la V2 Gr. A vs. Gr. B: 8.8±0.04 vs. 6.07±0.2 (P=0.072). OVS score. Gr. A, V1 vs. V2: 4.7±0.3 vs.8.9±0.1 (P=0.008); la V2 Gr. A vs. Gr. B: 8.9±0.1 vs. 6.3±0.5 (P=0.061). Considering as statistic significance the P<0.05, a better improve-ment in erectile function domain, sexual desire (libido component) and overall satisfaction, for the testosterone + PDE5i treated group has been registered. It could not been done correlations to each prescribed PDE5i because the participants varied it during the study.

Conclusions: In men with erectile dysfunction and metabolic syndrome long acting testosterone therapy improves their sexual function (erection and desire), also enhancing PDE5i pharmacological effect and basically improving their quality of life.

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HIPERGLICEMIA CRONICA USOARA IN TREI GENERATII: FORMA MONOGENICA DE DIABET ZAHARAT - MODY 2 (?)

Dr. Victoria Cret (Clinica Pediatrie I Cluj)

Ipoteza: Diabetul zaharat monogenic, rezultat al unor mutatii la nivelul unei singure gene, se poate transmite autosomal dominant, autosomal recesiv sau mutatia poate fi „de novo”. La copil, aproape toate formele de diabet monogenic sunt rezultatul mutatiilor la nivelul genelor care regleaza functia celulelor beta-pancreatice, mai frecvente fiind mutatiile (peste 200) genei glucokinazei (GCK) care determina MODY 2, majoritatea fiind mutatii inactivatoate in stare heterozigota, responsabile de hiperglicemia cronica usoara, neprogresiva.

Prezentam cazul unei paciente cu hiperglicemie cronica, modificare biochimica prezenta si la mama, unchiul si bunicul matern, la care suspectam o forma monogenica, autosomal dominanta de diabet zaharat - MODY 2.

Pacienta, in varsta de 12 ani, s-a prezentat pentru hiperglicemii usoare in ultimii ani, greutatea la nastere fiind normala. Evaluarea clinica releva hipostatura, IMC normal, dezvoltare neuropsihica si pubertara normala. Explorarile diagnostice au aratat: glicemia bazala: 182 mg/dl; TTGO: 312 mg/dl la 2 ore; HbA1c = 6,19%; peptidul C: 1,16 ng/ml (VN: 1,1–4,4); insulinemia bazala: 10,0 U/ml (VN: 26, după Ranke); HOMA-IR: 4,86 (VN < 4); nu a prezentat cetonurie; evaluarea axei endocrine a cresterii a relevat valori normale ale IGF1 si STH stimulat. Mama pacientei, in varsta de 39 ani, prezenta hiperglicemie bazala, TTGO: 202 mg/dl la 2 ore si HbA1c: 6,64%. Unchiul matern, in varsta de 30 ani, a fost recent diagnosticat cu DZ tip 2, ca si bunicul matern, in varsta de 59 ani (ambii cu forme usoare de hiperglicemie: între 130 – 150 mg/dl). In evolutie, pacienta a prezentat valori ale glicemiei intre 80 – 170 mg/dl, controlate cu dieta. Diagnosticul diferential a inclus diabetul zaharat tip 2 si alte forme monogenice sau specifice de diabet zaharat

Concluzii: Am interpretat cazul ca o forma familiala de hiperglicemie cronica usoara - o forma monogenica de diabet zaharat cu transmitere autosomal dominanta si anume MODY 2; pentru confirmarea diagnosticului se impune analiza moleculara cu precizarea mutatiei la nivelul genei glucokinazei. Importanta cunoasterii mutatiei rezida din faptul ca, in familiile cu risc, mutatiile in stare homozigota sau de heterozigot compus determina deficitul total de GCK, cu aparitia diabetului zaharat neonatal pernament iar mutatiile activatoare heterozigote sunt asociate cu hiperinsulinismul congenital.

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MILD CHRONIC HYPERGLICEMIA IN THREE GENERATIONS: MONOGENIC DIABETES MELLITUS - MODY 2 (?)

Dr. Victoria Cret (First Pediatric Clinic, Cluj)

Monogenic diabetes mellitus, as a result of one or more mutations in a single gene, could be transmited in an autosomal dominant / autosomal recesiv manner or the muation could be „de novo”. In children, almost all monogenic diabetes mellitus cases result from mutations in genes which regulate pancreatic beta-cells function, the glucokinase gene mutations (over 200), most of them being heterozigous and inactivating mutations, clinically expressed as MODY 2 - mild chronic hyperglicemia.

We present here a female patient with mild hyperglicemia, biochemical mark present also in her mother, maternal grandfather and maternal uncle (diagnosed as type 2 diabetes mellitus), family who are under our susspicion to have monogenic diabetes mellitus, probably MODY 2.

The patient, 12 years old girl, with normal birth wheight, recognised mild hyperglicemia years before but no records available. Clinical evaluations showed: short stature, normal BMD, normal pubertal and mental development. Laboratory tests revealed: fasting glycemia: 182 mg/dl; OGTT: 312 mg/dl at 2 hours; HbA1c: 6,19%; C peptide: 1,16 ng/ml (normal value: 1,1–4,4); fasting insulinemia: 10,0 U/ml (normal value: 26, after Ranke); HOMA-IR: 4,86 (normal value < 4); no ketonuria; normal value for IGF1 and stimulated GH. Her mother, 39 years old, presents fasting hyperglicemia (mild), OGTT: 202 mg/dl at 2 hours and HbA1c: 6,64%. Maternal uncle, 30 years of age, has been recently diagnosed with type 2 diabetes mellitus, as well as the maternal grandfather, 59 years of age (both with mild, chronic hyperglicemia: betveen 130 – 150 mg/dl). Our patient presented glycemia values arround 80 – 170 mg/dl on diet only. We discussed differential diagnosis with type 2 diabetes mellitus and other monogenic or specific forms of diabetes mellitus.

In conclusion: This family, who show mild chronic hyperglicemia, seems to have a monogenic form of diabetes mellitus, an autosomal dominant one, more probably MODY 2. Molecular analysis sould be perform in order to identify the GCK mutations. This is important because, in family at risk, a total deficiency of GCK due to homogenous or compound heterozigous GCK mutations causes permanent neonatal diabetes mellitus and the heterozigous activating mutations are associated with congenital hyperinsulinemia o infancy.

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EVALUAREA PERFORMANŢEI DISPOZITIVELOR DE ADMINISTRARE A INSULINEI UTILIZATE FRECVENT LA PACIENŢII CU DIABET ZAHARAT

TIP 2 ÎN AMBULATOR

Viorel Şerban1 , Mirela Tache 2, Gabriela Teodorescu3, Helmut Petto4, Jacek Kiljanksi4

1Spitalul Clinic Judeţean Timişoara, România; 2Spitalul Clinic N. Malaxa Bucureşti, România; 3Eli Lilly România SRL, Bucureşti, România; 4Centrul Medical Regional Viena, Eli Lilly and Company, Austria

Context: Dispozitivele de administrare a insulinei (DAI) au fost dezvoltate pentru a reduce dificultăţile de ordin practic, social şi emoţional asociate cu insulinoterapia. Mici diferenţe tehnice între aceste dispozitive pot influenţa preferinţa pacienţilor şi pot afecta acurateţea dozării insulinei.

Obiective: Evaluarea erorilor de dozare a insulinei la pacienţii cu diabet zaharat tip 2 (DZ tip 2) insulinonecesitant, a timpului pe care personalul medical îl petrece instruind pacienţii să utilizeze DAI cele mai frecvent folosite (Optipen Pro1, Optiset, NovoPen 3, NovoLet şi HumaPen Ergo).

Pacienţi şi metode: Un studiu prezent, observaţional, multicentric, deschis, a fost efectuat în 42 de centre din România în anul 2005, pe parcursul a 6 luni. Au fost înrolaţi 609 pacienţi cu DZ tip 2 dintre care 348 (57%) pacienţi care nu se aflau în tratament anterior cu insulină –Insulin Naïve Patients –INP (58% femei, vârsta medie 59 ani, durata medie a DZ 7,9 ani) şi 261 (43%) pacienţi care se aflau deja în tratament cu insulină – Non Insulin Naïve Patients - NINP (61% femei, vârsta medie 60 ani, durata medie a DZ 8,8 ani, doza zilnică medie de insulină a fost 38 U cu un interval de încredere [CI 26, 48] administrată în 2 injecţii pe zi.). Pentru administrarea insulinei s-au folosit seringi, Optipen Pro1, Optiset, NovoPen 3, NovoLet sau HumaPen Ergo care au putut fi schimbate între ele. Statistica ilustrează valorile medii raportate fie cu intervalele de încredere (CI 95%), fie cu valori minime şi maxime. Testul Kruskal Wallis a fost utilizat pentru a calcula valorile p bilateral ale valorilor diferite dintre DAI.

Rezultate: Scorul pentru dozarea corectă (SDC) a fost diferit între DAI doar la început pentru pacienţii INP (p=0.03). Pentru toate IDS combinate s-a demonstrat o creştere în timp a dozărilor corecte, de la valoarea iniţială 93% (CI 91.4, 94.4) la 99% (CI 98.5, 99.5) după 6 luni. Global, timpul necesar pentru instruirea pacienţilor a scăzut în timp de la 8.5 ore (CI 7.9, 9.1) la 1.9 ore (CI 1.9, 1.3).

SDC a fost diferit între DAI atât iniţial (p=0.03) cât şi după cele 6 luni (p=0.006) la pacienţii INNP. Pentru toate IDS combinate s-a demonstrate creşterea în timp a dozărilor corecte de la valoarea iniţială 95% (IC 93.0, 96,1) la >99% (IC 99.4, 100.0) după 6 luni. Timp pentru reinstruire nu a fost disponibil la această grupă.

Concluzii: În pofida preciziei ridicate de dozare a insulinei, îndeplinită de toate DAI individual, la începutul tratamentului se observă diferenţe ale acurateţei dozării la pacienţii INP şi INNP. Precizia dozării creşte cu timpul, diferenţele dispar în cursul

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primelor 6 luni de utilizare a DAI, iar la acei pacienţi care dozează greşit unităţile de insulină, valoarea erorii scade.

Cuvinte cheie: diabet zaharat tip 2, dispozitive de administrare a insulinei, pen pentru insulină, studiu comparativ şi observaţional.

Finanţare: Acest studiu (B5K-VI-B005) a fost finanţat de Eli Lilly and Company.

Conflicte de interese: G. Teodorescu, H. Petto şi J. Kiljanski sunt salariaţi ai Eli Lilly and Company.

ASSESSMENT OF PERFORMANCE OF COMMONLY USED INSULIN DELIVERY SYSTEMS IN PATIENTS WITH TYPE 2 DIABETES IN AN

OUTPATIENT SETTING

Viorel Şerban1 on behalf of METCON investigators, Mirela Tache 2, Gabriela Teodorescu3, Helmut Petto4, Jacek Kiljanksi4

1County Clinical Emergency Hospital Timişoara, Romania; 2N. Malaxa Clinical Hospital Bucharest, Romania; 3Eli Lilly Romania SRL, Bucharest, Romania; 4Area Medical Center Vienna, Eli Lilly and Company, Austria

Background: Insulin delivery systems (IDS) are developed to reduce practical, social and emotional burden associated with insulin injections. Slight technical differences between these devices may be relevant for patients’ preference and affect accuracy of insulin dosing.

Objectives: To assess the number and size of dosing mistakes and the time Health Care Professionals (HCPs) spent training patients on commonly used IDS (Optipen Pro1, Optiset, NovoPen 3, NovoLet and HumaPen Ergo ) in a standard clinical setting in patients with type 2 diabetes requiring insulin therapy.

Patients and Methods: This was a 6-month observational, multi-center, open-label study conducted in 42 sites in Romania in 2005. 609 patients with Type 2 diabetes were enrolled: 348 (57%) insulin naïve patients (INPs; 58% female, mean age 59 years, mean diabetes duration 7.9 years) who started insulin therapy and 261 (43%) non-insulin naïve patients (NINPs; 61% female, mean age 60 years, mean diabetes duration 8.8 years, mean number of insulin injection - 2 per day; daily mean insulin dose - 38 [CI 26, 48] U). Insulin was delivered by syringes, Optipen Pro1, Optiset, NovoPen 3, NovoLet, or HumaPen Ergo and there could be switch among these devices. As summary statistics mean values were reported either with parametric 95% confidence intervals or with

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minimum and maximum values. Kruskal Walis tests were used to calculate two-sided p-values for differences between insulin delivery systems.

Results For INP patients only at baseline the correct dosing score (CDS) was different between IDS (p=0.03). All IDS combined showed an increased correct dosing over time from 93% (CI 91.4, 94.4) at baseline to 99% (CI 98.5, 99.5) after 6 months. Overall the time to train patients decreased over 6 months from 8.5 (CI 7.9, 9.1) to 1.9 (CI 1.9, 1.3) hours.

For NINPs, at baseline and after 6 months CDS was different between IDS (p=0.03 and p=0.006, respectively). All IDS combined showed an increased correct dosing over time from 95% (CI 93.0, 96.1) at baseline to >99% (CI 99.4, 100) after 6 months. Time to re-train was not available for this group.

Conclusions: These results indicate that despite of high dosing precision achieved with all the individual IDS, differences in dose accuracy are observed in the beginning of treatment for insulin naïve and insulin non-naïve patients. The accuracy of insulin dosing increased within 6 months of IDS use and in those patients who dosed incorrectly the range of the error became smaller.

Keywords: type 2 diabetes, insulin delivery systems, insulin pen, observational and comparative study

Funding: This study (B5K-VI-B005) was funded by Eli Lilly and Company.

Conflicts of interests: G. Teodorescu, H. Petto and J. Kiljanski are employees of Eli Lilly and Company.

IGF SYSTEMS AT DIAGNOSIS IN PUBERTAL ADOLESCENT WITH TYPE I DIABETES MELLITUS.

Simona I. Chisalita 1, 2, 4, J. Ludvigsson 4, 5 and H J. Arnqvist 1, 3, 4

1 Institution of Clinical and Experimental Medicine, Department of Cell Biology,

2 Emergency Clinic,

3 Division of Internal Medicine, Department of Medicine and Care,

4 Diabetes Research Centre,

5 Division of Paediatrics,

Faculty of Health Sciences, Linköping University, Linköping, Sweden.

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Background. Type 1 diabetes in pubertal adolescent is associated with alterations in the IGF-system probably due to both a deranged metabolism and insulinopenia in the portal vein.

Aim. To study in pubertal adolescents with pubertal onset of type 1 diabetes mellitus how levels of IGF-I and IGFBP-1 are affected by the deteriorating endogenous insulin secretion.

Methods. Ten girls and ten boys with type I diabetes, age 13.5 ±1.35 (mean ±SEM) years at diagnosis took part in the study. Blood samples were drawn at diagnosis, and after 3, 9 18 month, and after 3 and 5 years from the debut. HbA1c, total IGF-I, IGFBP-1 and C-peptide were measured.

Results. At diagnosis the patients had high HbA1c, low IGF-I and measurable C-peptide. After start of insulin treatment glycaemic control and IGF-I improved but C-peptide decreased and after 4 years almost all patients were C-peptide negative. C-peptide was correlated to IGF-I and IGFBP-1 at the diagnosis (p<0.05). HbA1c was correlated to IGF-I after 3 months of insulin treatment whereas IGFBP-1 was not correlated to HbA1c. Conclusions. In newly diagnosed adolescents with type I diabetes mellitus IGF-I levels but not IGFBP-1 is related to glycaemic control. Endogenous insulin secretion is also of importance for IGF-I and IGFBP-1.

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