HIGH PREVALENCE OF CHRONIC COMPLICATIONS AMONG TYPE 2 DIABETIC OUTPATIENTS IN URBAN CHINA
B. Xu
School of Public Health, Fudan University

Objective: To determine prevalences of chronic complications among urban Chinese T2DM outpatients; and to examine the distribution of chronic complications among different demographics strata, and to describe the relationship between complications and age, as well diabetic duration.  Methods: This cross-sectional hospital-based study was carried out in 4 major Chinese cities -Shanghai, Chengdu, Beijing and Guangzhou. The survey was conducted from March to July in 2007 among T2DM outpatients. The subjects were interviewed face-to-face by trained interviewers using a questionnaire to capture information on demographics, disease presentations and complications. Results: Of the 1,524 study participants, 637 (41.8%) were male, and the mean age was 63.3±10.2 years. At least one chronic complication was diagnosed in 792 individuals (52.0%) of the study participants; 509 (33.4%) presented with macrovascular complications and 528 (34.7%) with microvascular complications. The prevalence of cardiovascular and cerebrovascular conditions, neuropathy, ocular lesions, nephropathy and foot disease were 30.1%, 14.8%, 17.8%, 10.7%, 10.7% and 0.8%, respectively. The prevalence of chronic complications varied over cities, and significantly increased with age and duration of diagnosed diabetes. Conclusions: Chronic complications are highly prevalent among T2DM outpatients, and future efforts should be directed at strengthening early diagnosis and improving case management to prevent and delay the occurrence of complications. Keywords: Type 2 diabetes mellitus; Chronic complications; Prevalence; China

CAROTID ARTERY DISTENSIBILITY IS REDUCED BUT CAROTID  ARTERY IMT IS COMPARABLE  IN  TYPE 2 DIABETIC PATIENTS WITH WELL CONTROLLED HYPERTENSION IN COMPARISON WITH CONTROL SUBJECTS
J. Charvat, J. Chlumskyý
Medical department, 2nd Faculty of Medicine, V Uvalu 84, Prague 5, Czech republic

Objectives: The aim of the study was to evaluate carotid artery parameters  - intimomedial thickness of carotid artery (IMT), the size of carotid atheroma and carotid artery distensibility in  type 2 diabetic patients with well controlled hypertension and no history of cardiovascular disease  in comparison with non diabetic subjects. Methods: Using a high-resolution B-mode ultrasound scanner carotid IMT was assessed as well as the presence and size of atheroma plaques. Distensibility of carotid artery was calculated according to Reneman equation. Results: The age of 82 type 2 diabetic patients was 61,1±6,3 comparing to 61,2±4,7 years  of 41 control subjects (NS). IMT in type 2 diabetics was 0,71±0,09 mm and 0,69±0,09 mm in controls (NS), the greatest atheroma  in type 2 diabetics was 1,66±0,54 mm comparing to 1,42±0,50 mm (p=0,014), distensibility was 0,27±0,11 mm Hg-1 comparing to 0,37±0,16 mm Hg-1 (p=0,001). Stepwise linear regression analysis revealed the association of carotid artery disensibility with postischemic dilatation of the brachial artery, BMI, and diabetes duration in diabetic patients. Conclusion: Carotid IMT in type 2 diabetic patients with well controlled hypertension is comparable with nondiabetic subjects while the size of carotid atheroma and  carotid distensibility abnormality are more pronounced in type 2 diabetic patients.

THE ASSESSMENT OF PHYSICIANS´ NEEDS: CONTROVERSY OF AN UNDER-ESTIMATED AREA IN THE CURRENT CPD-PROGRAMMES IN DIABETES?
P. Posel1, V. Finstrle2, S. Svacina3
1CEO QUAIME AG Switzerland 2CEO Pears Health Cyber, Czech Republic 33rd Department of Medicine, 1st Medical Faculty Charles University Prague Czech republic

The needs assessment (NA) is an absolutely critical activity for the development of quality-driven CPD-programmes. Based on NA in two European countries (the Czech Republic and Germany) on the topic of diabetes and comorbidities, we show obstacles, challenges and highlights in the assessment.  46 diabetes specialists in the Czech Republic (response rate was > 90 % during a symposium) and 1.200 physicians in Bavaria (response rate was > 10%). With the aim of improving quality of care for the diabetes comorbidities in four fields: skin diseases, age related problems, depression and cardiovascular diseases, we developed a multinational needs assessment (using multiple choise test – more then one right answer) together with physician associations, allowing a pan-european perspective. Via tailored and customized channels we get a high awareness. The results of the needs assessment show a clearly remarkable picture for detailed programmes issues. The results show controversial differences: the knowledge regarding pharmacology and cardiovascular diseases was very solid, but detailed knowledge gain and interdisciplinary knowledge exchange has to be improved. This refers to knowledge regarding elderly, skin, and depression and show the need for specially tailored initiatives. They permit the design of tailored online CME/CPD-programmes, supposed to encourage the physicians to effectively take care of the patients and to successfully implement optimized therapeutic plans in close cooperation with their patients and other specialists. NA is the basis for aligning CME with Performance Improvement. More studies on the design, roll-out and evaluation of the NA and the coverage of other topics, e.g. obesity and diabetes, are required. 

COMPARISON OF FOOT DEFORMITIES AND DISEASES OF DIABETICS IN BULGARIA, CHINA AND THE CZECH REPUBLIC
B.S. Sibova, P.H. Hlavacek, J.P. Pavlackova, R.K. Kocourek
Tomas Bata University in Zlin, Engineering and Hygiene of footwear, Zlín, Czech Republic

Introduction: The disease of diabetes also manifests itself in changes in the health and functionality of the foot. Aim: The main goal of this study was to determine the most common foot defects in the population afflicted by diabetes in selected countries:  Bulgaria, China and the Czech Republic. Methods: Measured in the Czech Republic were 100 men and 100 women; in Bulgaria 46 men and 60 women; in China 50 men and 50 women, all suffering from type-2 diabetes mellitus. Measurement was conducted using the same methodology. Result: In the set of Czech diabetics, the most frequently occurring defects were bunions 64%, dry and cracked skin 45%; for Czech women the most frequent defects included bunions 75%, dry and cracked skin 38%. In the group of Bulgarian diabetics, the most frequent defects that appeared were toe nail deformity 24%; dry and cracked skin 22%. For female Bulgarian diabetics, the most frequent defects included dry and cracked skin 25%; toe nail deformities 22% and enlarged big toe 15%. The most numerous defects among Chinese diabetics included toe nail deformities 24%, dry and cracked skin 13%. For female Chinese diabetics, the most frequent defects that appeared were hallux valgus 17%, and a combination of calluses and dry and cracked skin 17%. Conclusion: The results show that the frequency of individual foot defects for diabetics in individual countries are altogether significantly different despite the fact that the same evaluation methodology was used. This fact may be explained by different cultural influences and customs.

PDU measurements are well established method of assessing the peripheral vascular disease (PVD) in diabetes. We examined a group of 104 patients with DM2. 64 of them had normal PDU and the following characteristics: age 57.62 ± 8.77, duration of diabetes 8.72 ±3.97 years, M/F=34:32, BMI 28.23 ± 3.90, mean levels of HbA1c 8.08 ± 1.08, hypertension was found in 41 patients (64.06%), triglycerides 2.56 ± 1.21, LDL cholesterol 3.29 ± 0.79, HDL cholesterol 1.00±0.11, documented retinopathy 31 (48.43%), proteinuria 9 patients (14.06%), coronary vascular disease 13 patients (20.31%). The second group consisted of 40 patients with PDU consistent with peripheral vascular insufficiency and/or claudication. They had the following characteristics: age 51.45 ± 22.77, duration of diabetes 26.95 ± 12.31 years, M/F=22:18, BMI 26.58 ± 4.63, mean levels of HbA1c 8.89 ± 1.30, hypertension was found in 22 patients (57.56%), triglycerides 3.08 ± 1.39, LDL cholesterol 3.67 ± 1.03, HDL cholesterol 0.92 ± 0.13, documented retinopathy 23 (57.56%), proteinuria in 10 patients (25%), coronary vascular disease in 20 patients (50%).Conclusion: Descriptive statistics as well as Student’s T test and analyses of variance were performed. Pathological PDU was associated with significantly greater frequency of both diabetic microangiopathy (retinopathia and proteinuria) as well as the coronary vascular disease.

GLOBULAR ADIPONECTIN INCREASES VCAM-1 EXPRESSION VIA P38MAPK/NF-KB/CYCLOOXYGENASE-2 IN ENDOTHELIUM
F. Addabbo, M. Tarquinio, C. Nacci, L. De Benedictis1, S. Gagliardi1, M.A. Potenza1, J. Quon2, M. Montagnani1
Department of Pharmacology and Human Physiology, Bari, Italy 2NCCAM, NIH, Bethesda, USA

The globular fragment of adiponectin (gAd) resulting from enzymatic cleavage of full-length Ad (fAd) is particularly abundant on atherosclerotic lesions. While beneficial anti-inflammatory properties of fAd are well known, vascular effects of gAd are still uncertain. Activation of signaling pathways related to production of endothelial mediators by gAd and fAd were investigated in Human Aortic Endothelial Cells (HAEC) in primary culture. Both fAd and gAd (10 microg/ml, 10 min) stimulated NO production (by DAF2-DA). Unlike fAd, gAd slightly increased ROS levels (by DHE) overtime. gAd –but not fAd- acutely increased p38MAPK phosphorylation, degradation of IkB-alpha and nuclear translocation of p65 protein (by WB and IF analysis). Prolonged stimulation (1-8 h) with gAd, but not with fAd, also increased mRNA (by RT-PCR) and protein levels of cyclo-oxygenase-2 (COX-2) (by WB). Pre-treatment of HAEC with p38MAPK inhibitor SB203580 (10 microM, 1 h), and with NF-kB inhibitor BAY 11-7082 (20 microM, 1h) reduced COX-2 overexpression in response to gAd. In HAEC lacking AdipoR1 (by siRNA) COX-2 overexpression by gAd was abrogated. In control HAEC, gAd increased expression of VCAM-1 and PAI-1 (by RT-PCR, ELISA and WB) and subsequently enhanced adhesion of activated monocytes (by IF). These gAd-mediated effects were reduced by pre-treatment of HAEC with BAY 11-7082 or COX-2 inhibitor NS-398 (10 microM, 1 h).  Thus, gAd and fAd possess divergent biological properties and gAd has the distinct ability to activate pro-inflammatory signaling pathways in endothelium. Our results may have important implications for

GLYCEMIC CONTROL DURING POST-PTCA PERIOD PREDICTS THE PROGRESSION OF CAOD IN PATIENTS WITH DIABETES
W.H. Shim, E.H. Lee, S.H. Beom, S.A. Kim, E.S. Kim,  J.S. Yoo, J.S. Nam, M.H. Cho, J.S. Park, C.W. Ahn,  K.R. Kim   
Internal Medicine, Yonsei University College of Medicine, Seol, 1350720, Korea

Background: Several studies reported that HbA1c level is not a predictor of major adverse cardiovascular events (MACE). However, these studies assessed the initial HbA1c level, and not the trend of glycemic control during the follow up period. We investigated the effect of different degrees of glycemic control on a need for an additional percutaneous transluminal coronary angioplasty (PTCA) in the follow-up angiography. Methods: From 887 diabetes patients who received a successful balloon angioplasty or drug-eluting stent implantation, 232 patients who underwent a 9-month angiographic follow-up were enrolled in the study. BMI, blood pressure, ejection fraction, HbA1c, lipid profile, cystatinC level, medication list, and angiographic findings were reviewed serially from the initial intervention to the follow-up angiography. Results : Sixty-four patients received additional PTCA for a newly developed coronary lesion or restenosis of the previous intervention site while there was no need for an intervention in 168 patients. There were no differences in anthropometric and biochemical parameters between the two groups except for baseline HbA1c(7.36%vs7.76%, p=0.041), follow-up HbA1c(7.14% vs 7.53%, p=0.02) and mean HbA1c(7.25%vs7.64%, p=0.012). Both group showed an improved HbA1c level through the follow-up period, but the prognosis was dependent on the overall degree of glycemic control. Multiple logistic regression identified a poor glycemic control, representing higher level of mean HbA1c, to be an independent risk factor for predicting a need to redo PTCA(OR 1.59, 95%CI 1.06-2.36, p=0.024). Conclusion: Glycemic control at baseline as well as during post-PTCA period is an independent predictor of the need for additional PTCA.

PREVALENCE OF HYPERHOMOCYSTEINAEMIA IN A PORTUGUESE TYPE 2 DIABETIC POPULATION: RELATIONSHIP WITH BODY FAT COMPOSITION
A.S. Valente1, R. Duarte2, R. Carvalho2, J.F. Raposo2, H.S. Costa1
1Departamento de Alimentação e Nutrição (DAN), Instituto Nacional de Saúde Doutor Ricardo Jorge, I.P. (INSA) 2Associação Protectora dos Diabéticos de Portugal (APDP)

Diabetes mellitus is a major public health threat in the World. In Portugal, there are around 1 million of type 2 diabetic patients. This chronic disease, hyperhomocysteinaemia and obesity are known as risk factors of cardiovascular disease. Some epidemiological studies have reported that body fat composition (BF) is positively associated with homocysteine (Hcy) plasma levels. The aim of this study was to measure the Hcy levels in Portuguese diabetic patients with and without angiopathy and to investigate a possible relationship between the prevalence of hyperhomocysteinaemia and high BF. Plasma Hcy concentration was measured in 150 Portuguese type 2 diabetic patients. The population under study was divided in two groups: group I - 75 diabetics with angiopathy; group II - 75 diabetics without angiopathy. Hyperhomocysteinaemia was defined for Hcy levels ≥15 µM. Bioelectrical Impedance Analysis was applied to all diabetic subjects in order to estimate BF.  The prevalence of hyperhomocysteinaemia was 20% for group I and 8% for group II. The mean Hcy plasma levels in group I (10.6 ± 4.8 µM) was higher than in group II (9.4 ± 4.7 µM). The mean values for BF were similar in group I (37.6 ± 9.2 %) and in group II (37.4 ± 7.5 %), but in the diabetic subjects with hyperhomocysteinaemia, the mean value for BF was (42.4 ± 8.3 %). The prevalence of hyperhomocysteinaemia is associated with high BF and with the presence of angiopathic complications in type 2 diabetes.

BENEFICIAL DEXA-RELATED EFFECTS OF NATURAL PROANTHOCYANIDINS ON EXPERIMENTALLY-INDUCED DIABETES MELLITUS COMPLICATIONS
L.V. Badescu1, M.V. Badescu1, I. Tutunaru2, I. Ciocoiu1
1University of Medicine and Pharmacy "G. T. Popa" of Iasi, Romania 2University "Dunarea de Jos", Galati, Romania

Introduction: The benefits of the proanthocyanidins extracted from black grape skin and seeds, have been shown by using as experimental model, namely streptozotocin-induced diabetes mellitus on female Wistar rats. Materials and method: Streptozotocin was administered in a single intraperitoneal dose of 60 mg/Kg body mass. Vegetal proanthocyanidins were administered as water solution, in a dose of 0.028 mg/Kg body mass, p.o., every two days, for a period of 12 weeks. We performed DEXA bone mineral density tests, in order to determine BDM (bone mineral density), BMC (body mass index) and fat (%Fat) in control and diabetic animals, before and after proanthocyanidins delivery. Results: The evolution of bone mineral density depending on the area, in diabetic females, measured from the beginning to the end of the experiment, has shown a significant decrease, especially in the femur area. In diabetic females that received treatment, these differences are statistically minimum. In diabetic females that received proanthocyanidins treatment, we noticed a 4-7% decrease of their body fat as compared to the beginning of the experiment, for all the analyzed samples. As for the spine, the highest BMC difference depending on the area was found in diabetic females with polyphenol intake, and the overall highest difference was noticed in diabetic males. The body fat index was the lowest in the diabetic females. Conclusions: Osteoporosis regression due to polyphenols proves the benefits of proanthoyianidins used treating the chronic complications of diabetes mellitus. Keywords: diabetes mellitus, grape skin and seeds, proanthocyianidins.

TYPE 2 DIABETES PATIENTS TREATED ONLY WITH BIGUANIDES ARE HIGH RISK INDIVIDUALS
S. Ioacara1, C. Tiu2
1"Medi's" Outpatient Clinic, Campina, Romania 2"Universitary" Hospital, Bucharest, Romania

Aims: Many physicians tend to consider diabetes treated with biguanides monotherapy as being mild or benign. We investigated the prevalence of major micro and macro-vascular complications and how this special category of patients performs with respect to current treatment goals. Methods. We performed a cross-sectional study in type 2 diabetes subjects treated with biguanides in monotherapy, attending a standard diabetes outpatient clinic during 2008-2009. We used the latest available visit at the Clinic for data regarding demographics, anthropometrics, biochemistry, micro and macrovascular complications of diabetes. Results. We investigated 814 subjects, 463(56.9%) females, aged 22-88 years (mean age 62.6±10.5years), with a mean age at diabetes onset 60±10.4years, and a disease duration at study inclusion 2.6±3.9years. There were 44.8% of subjects with >20% increase in body weight; 5.2% of females and 17.7% (p<0.01) of males had a waist circumference <80/<94 cm. Only 40.4% of cases had a fasting plasma glucose<7.21mmol/l. The therapeutic target for blood pressure was achieved in only 14.7% cases for SBP (<130mmHg) and 29.6% for DBP (<80mmHg). The prevalence of microvascular complications was: 7.8% retinopathy, 8.1% chronic renal failure and 57.5% polyneuropathy; and macrovascular complications: 61.5% ischaemic heart disease, 13.3% lower limb arteriopathy, 9.2% heart failure, 7.3% stroke, 3.9% myocardial infarction and 2.9% atrial fibrillation. Conclusions: Individuals with type 2 diabetes treated with biguanides monotherapy are poorly controlled, have a high prevalence of metabolic syndrome components as well as micro and macrovascular complications and should by no means be considered as mild or benign diabetes patients.

RENAL INTERSTITIAL FIBROSIS IN TYPE 2 DIABETES PATIENTS: ASSOCIATING WITH RENAL ARTERY STENOSIS
O. Kurumova, M. Shestakova, M. Shamkhalova, I. Sitkin, A. Ilin, M. Arbuzova, N. Goncharov, G. Katsaya, S. Saveleva
Endocrinology Center, Dmitrya Ulyanova 11, Moscow, Russia

Aims: to estimate renal interstitial fibrosis factors in  type 2 diabetics with renal artery stenosis and without renal artery stenosis. Methods: We studied 30 diabetic type 2 patients with RAS and 22 diabetic type 2 patients without RAS. All patients were invited to undergo multispiral computer tomography or selective angiography of renal arteries to define the presence of renal artery stenosis (renal artery stenosis more than 60%). Transforming growth factor (TGF - β1), vascular endothelial growth factor (VEGF), markers of endothelial dysfunctions (sICAM, VCAM), nonspecific atherosclerotic markers (C-reactive protein, homocystein), matrix metalloproteinase 9 (ММР 9), interleukin 6, angiotensin II were measured. The control group included normotensive persons of more than 45 years without diabetes (n=20). Glomerular filtration rate (GFR) was calculated by the MDRD equation.  Results: It was found that GFR was significantly lower in diabetics with RAS than without RAS [73,1 (63,3; 96,0) vs.92,5 (78,5; 114,0) ml/mines/1,73m2, р <0,05]. TGF - β1 level was significantly higher in the group with renal artery stenosis than the one in the group without renal artery stenosis [90,9 (52,2; 119,4) vs. 51,6 (25,2; 78,5) ng/ml, р <0,02]. TGF - β1 positively correlated with ММР 9 (r=0,23; p<0,04) and VEGF (r=0,26; p <0,01). ММР 9 in a cohort of patients without RAS appeared to be paradoxically higher in comparison with persons with RAS [138,0 (109,0; 173,0) vs. 96,5 (68,0; 131,0) ng/ml, р <0,01]. Other indicators didn’t differ significantly between the researched groups. CONCLUSIONS: We found that in diabetic type 2 patients with renal artery stenosis was significant increase of TGF – β1, which is known to have a predictive role in the development of the tubulointerstitial expansion. 

SUBTYPES OF ISCHEMIC STROKE: THE ANALYSIS OF CHANGES IN INSULIN SENSITIVITY AND INFLAMMATORY MARKERS IN PATIENTS WITH TYPE 2 DIABETES AND NONDIABETICS
Z. Jotic1, M. Lalic1, S. Kostic2, N. Covickovic Sternic2,  K. Lalic1, T. Milicic1, L. Lukic1, M. Mijailovic2, N. Rajkovic1, M. Zamaklar1
1Institute for Endocrinology, Diabetes and Metabolic Diseases 2Institute for Neurology, Clinical Center of Serbia

Aim: Decreased insulin sensitivity and inflammation play important role in development and progression of atherosclerosis. The study was aimed to analyze the level of: [a] insulin sensitivity [IS] and [b] inflamatory markers in patients with Type 2 diabetes [T2D] with atherotrombotic ischemic [ATI] and lacunar infarction [LI] [group A1 N=16; A2 N=10], T2D without stroke [group B, N=15], nondiabetics with ATI or LI [group C1 N=18; C2 N=9] and nondiabetics without stroke [group D, N=16]. Methods: ATI, LI were confirmed on cranial computerized scan or magnetic resonance imaging. IS levels were determined by the minimal model analysis [Si index]. Fibrinogen level was detected using F gen-IL ACL- 7000 and hs-C reactive protein (CRP) by Olympus Analyzer. Results: The Si levels were significantly lower in A1 and A2 vs B [1.00±0.32, 1.97vs 1.3±0.97min-1/mU/lx104;p<0.05] and in C1 and C2 vs D [3.51±0.81, 3.78±0.80 vs 6.76±0.70min-1/mU/lx104 p<0.001]. Fibrinogen and hs CRP levels were significantly higher in A1 and A2 vs B [4.48±0.30, 4.23±0.86 vs 3.48 ±0.86 g/l; 16.58±2.40, 14.83±1.86 vs 10.48 ±0.1.91 g/l;p<0.05] and C1 and C2 vs D [4.02±0.25, 3.92±0.56 vs 3.25 ±0.75 g/l; 7.36±0.86, 6.62±0.72 vs 2.55±0.35 g/l;p<0.05]. The changes in Si significantly correlated with fibrinogen and hs-CRP levels both in T2D (r=0.429; r=0.359 p<0.05) and nondiabetics (r=0.412; r=0.378, p<0.05). Conclusions: Decreased IS was associated with higher fibrinogen and hs-CRP levels both in T2D and nondiabetics with ATI and LI, which implies that decreased IS might exert an important part of its atherogenic influence though activation of the low-grade inflammation.

IS DIABETIC CARDIOMYOPATHY THE EARLIEST STAGE OF CARDIOMETABOLIC CONTINUUM?
P. Seferovic Mitrovic1, M. Lalic1, M. Seferovic2,  B. Vujisic Tesic2, A. Jotic1, D. Ristic2,  T. Milicic1, L. Lukic1,  M. Macesic1, S. Aleksic1
1Institute of Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Belgrade, Serbia 2Institute of Cardiovascular Diseases, Clinical Centre of Serbia, Belgrade, Serbia

Background: Diabetic cardiomiopathy (DC) is an early complication of diabetes, defined as left ventricular diastolic dysfunction in the absence of hypertension, coronary artery disease or any other cardiovascular disease.  Objectives: To assess the prevalence and predictors of DC, as well as the correlations of the echocardiographic features with laboratory, metabolic and therapeutic parameters.  Design and methods: We investigated 78 type 2 diabetic patients, without hypertension and coronary artery disease. They underwent high-resolution transthoracic echocardiography including tissue Doppler and exercise stress-echocardiography. Laboratory assessment included metabolic parameters and specific biomarkers. Statistical analysis included descriptive and analytic methods, as well as uni- and multiple linear regression analysis.  Results: DC was diagnosed in 8 (10.3%) patients. Patients with DC were significantly older, had a higher body surface area and used metformin less frequently. HDL cholesterol and apolipoprotein A1 were significantly elevated in patients with DC. Univariant analysis identified older age, metformin therapy, apolipoprotein A1 and urea as statistically significant predictors of DC. Multiple linear regression analysis demonstrated apolipoprotein A1 and metformin therapy were independent predictors of DC. There was statistically significant correlations among E/E' ratio and age, HDL cholesterol, apolipoprotein A1 and metformin therapy. Conclusion: The prevalence of DC was 10.3% in patients with diabetes. Patients with DC were significantly older, had a higher body surface area and used metformin less frequently, while HDL cholesterol and apolipoprotein A1 were significantly elevated. Furthermore, higher apolipoprotein A1 and less frequent use of metformin therapy were recognized as independent predictors of DC.

ISCHEMIC STROKE IS ASSOCIATED WITH IMPAIRED INSULIN SENSITIVITY AND INCREASED LDL-C LEVELS BOTH IN DIABETICS AND NONDIABETICS
J. Milicic1, M. Lalic1, A. Jotic1, S. Kostic2,  N. Covickovic Sternic2, K. Lalic1, L. Lukic1, M. Mijailovic2,  N. Rajkovic1, M. Zamaklar1, M. Macesic1,  P. Seferovic Mitrovic1
1Institute for Endocrinology,Diabetes and Metabolic Diseases 2Institute for Neurology,Clinical Center of Serbia

Aim: Decreased insulin sensitivity (IS) facilitates vascular atherogenesis, but its role in ischemic stroke has not been clarified. This study was aimed to analyze IS, plasma insulin (PI) and lipoprotein levels, in 34 patients with Type 2 diabetes (T2D) and ischemic stroke (group A), 33 patients with T2D without ischemic stroke (group B), 30 nondiabetics with ischemic stroke (group C) and 30 healthy controls (group D). Methods: An ischemic stroke was defined as atherothrombotic infarction confirmed on cranial computerized scan or magnetic resonance imaging. IS levels were detected by minimal model analysis (Si index), PI levels by RIA. Total cholesterol, HDL-cholesterol, and tryglicerides were determined by chromatography, LDL-cholesterol (LDL-c) concentrations were calculated by Friedewald formula. Results: We found that Si levels were significantly lower in group A vs B (1.15+/-0.25 vs 2.37+/-0.91 min-1/mU/lx104; p<0.05) and in C vs D (3.731+/-0.60 vs 6.79+/-0.81 min-1/mU/lx104; p<0.001). Simultaneously, we found that PI and LDL-c were higher in group A vs B (PI:24.1+/-2.9 vs 16.3+/-1.7 mU/l; LDL-c: 5.08±0.41vs 4.21±0.59 mmol/l; p<0.001) and in C vs D (PI:15.7+/-2.4 vs 9.3+/-1.2 mU/l; LDL-c:4.30±0.55vs3.51±0.12mmol/l;p<0.05).The HDL-h and triglycerides levels didn’t differ among groups. Also, Si levels correlated with PI and LDL-c (r=0.427, p<0.05, r= -0.489, p<0.0001) in T2D and nondiabetics (r=0.522, p<0.05, r= -0.296 p<0.01). Conclusions: Our results signify that appearance of ischemic stroke was strongly associated with decreased insulin sensitivity, i.e. insulin resistance, both in T2D and in nondiabetics. Our results imply that insulin resistance exerts its atherogenic influence through increases in PI and LDL-c levels.

THE ASSOCIATION BETWEEN TYPE 2 DIABETES MELLITUS AND COLORECTAL CANCER
Y. Park1, D. Yi1, H. Kim1, H. Kim2, K. Choi2, W.  Lee Lee1
1Busan St. Mary’s medical center, Busan, South Korea 2Pusan National University school of Medicine

Background: There is a close connection between type 2 diabetes mellitus and the risk of cancers and related mortality. The aim of the present study is to explore the association between type 2 diabetes and colorectal cancer. Methods: We retrospectively compared 1111 subjects (age > 30 years) who were performed colonoscopy at between June 2006 and June 2009.  We evaluated the anthropometric data, presenting symptom and sign, history of diabetes, laboratory data, colonoscopy finding and biopsy results. We analyzed correlation between colorectal cancer and influencing factors and compared mean incidence of colorectal cancer between type 2 diabetes and control group. Results: 407 of the subjects had diabetes mellitus. The incidence of colorectal cancer was significantly increased in type 2 diabetes than control group (7% vs. 3%, P < 0.05). Colorectal cancer revealed significant correlations with age (r = 0.181, P < 0.05), type 2 diabetes (r = 0.089, P < 0.05), symptom (r = 0.066, P < 0.05), constipation (r = 0.105, P < 0.05), anemia (r = 0.089, P < 0.05). After linear regression analysis, age is significantly associated with colorectal cancer (b = 0.181, P < 0.01). In subgroup age below 65 years, the incidence of colorectal cancer was significantly increased in type 2 diabetes than control group (5.0% vs. 1.6%, P < 0.05) after adjust with age. Conclusion: Type 2 diabetes was associated with increased risk for colorectal cancer. This association was more definite in younger than 65 years.

PREVALENCE OF CARDIOVASCULAR DISEASE AND RISK FACTOR IN KOREAN TYPE 2 DIABETIC PATIENTS
M.K. Park1, S.R. Lee1, H.J. Lee2, D.K. Kim1
1Division of Endocrinology and Metabolism, Department of Internal Medicine,Dong-A University College of Medicine 2Department of Pharmacology, Dong-A University College of Medicine

Aim:To evaluate the prevalence of cardiovascular disease (CVD), cardiovascular risk factors and to compare metabolic syndrome (MS) with Framingham risk score (FRS) as predictors of cardiovascular events in Korean type 2 diabetic patients (T2DM). Method: This was a retrospective study of 200 patients registered in our diabetic clinic. We evaluated the prevalence of CVD, MS and CHD risk at 10years. MS was established according to modified Adult Treatment Panel III (ATP III) criteria, but we applied body mass index instead of waist circumference for obesity component. CHD risk at 10 years (FRS) was estimated according to the ATP III criteria. Results: The prevalence of CVD was 15% (15.1% in male, 14.9% in female). The prevalence of cardiovascular risk factors was: hypertension 45%; dyslipidemia 48%; smoking 29.8% and obesity (BMI ¡Ý 25 Kg/m2) 43%. MS prevalence was 56%. Mean FRS was 7.3%. The prevalence of CVD was related to age only, but not to FRS, MS and other parameters in this group. There was a trend of association between the number of component of MS and the prevalence of CVD, but not significantly (P =0.07). There was no significant correlation with FRS according to presence of MS. There was significantly correlation FRS with the number of component of MS (P=0.01) Conclusions: We suggested the component of MS and its number is more meaningful than FRS and MS itself for predicting of CVD in T2DM patients. But the prospective study needs to be further evaluated.

TESTOSTERONE LEVELS IN MALES WITH TYPE 2 DIABETES AND THEIR RELATIONSHIP WITH CARDIOVASCULAR RISK FACTORS AND CARDIOVASCULAR DISEASE
M Victor1,4, K. Garcia1,4, M. Rocha1,4, E. Sola1,2, C. Bañuls1,3, V. Bellod1,4, J. Gomez-Martinez5, R. Marmol5,  A. Hernandez-Mijares1,2,3
1Endocrinology Department, Dr. Peset University Hospital. Valencia. Spain 2Medical Department. University of Valencia. Valencia, Spain 3Research group CIBER CB/06/02/0045  Valencia, Spain 4Hospital Universitary Doctor Peset Foundation, Valencia, Spain. 5Cardiology Department, Dr. Peset University Hospital. Valencia. Spain

Introduction. One of the factors involved in type 2 diabetes in males is a reduction in levels of testosterone, which has been shown to predict resistance to insulin and the development of cardiovascular diseases.  Aim. To assess the levels of testosterone in patients with type 2 diabetes and to evaluate their relationship with cardiovascular risk factors, peripheral arterial disease (PAD) and silent myocardial ischemia (SMI).  Methods. Total testosterone and SHBG were measured and free and bioavailable testosterones were calculated using Vermeulen’s formula.  Levels of total testosterone > 12 nmol/l or free testosterone > 225 pmol/l were considered normal. PAD was evaluated using the ankle- brachial index. SMI was assessed by doppler echocardiogram, 24 hour ECG- Holter, exercise stress testing (EST), nuclear stress and coronary angiography.  Results. The study population was (192 diabetic males, 56.1 ± 7.8 years) without vascular disease. 23% presented total testosterone below normal and 21.8% presented low testosterone. BMI, waist circumference, neuropathy, triglycerides, CRP, glucose, insulin and HOMA-IR were found to be significantly incremented with respect to subjects with normal testosterone. There was a negative correlation of HOMA-IR with total testosterone. PAD was detected in 12% and SMI in 10.9% of subjects, and differences were not related to testosterone levels.  Conclusion. We have verified the prevalence of low testosterone levels in male patients with type 2 diabetes and have related them to variations in BMI, waist circumference, neuropathy, triglycerides, CRP, glucose, insulin and HOMA-IR, but not with an increase of SMI or PAD.

EFFECTS OF SOME PHENOLIC COMPOUNDS ON EXPERIMENTAL DIABETES AND RESPONSE OF VAS DEFERENS OF DIABETIC RATS
N. Bektas, Y. Ozturk
Anadolu University, Faculty of Pharmacy, Department of Pharmacology, Tepebasi, 276470 Eskiehir Turkey

In this study, diabetic complications developed in isolated aorta, Vas deferens from rats with streptozotocin (STZ)-induced diabetes for 6 weeks and effects of 3 weeks treatment with 10 mg/kg p-OH benzoic acid, protocatechic acid and gallic acid, which have antioxidant activities with increasing potency order related to their hydroxyl number, were investigated on the development of these complications by using isolated organ experiments. In STZ-diabetic rats for 6 weeks, hyperglycemia was developed, water and food consumptions along with urine and feces outputs were increased and body weights decreased. Protocatechic acid prevented significant increases in food consumption and feces output due to diabetes. In diabetic animals, responses of isolated organs, Vas deferens to phenylephrine and acetylcholine were found to be increased. It was found that the in vivo administration of p-OH benzoic acid, protocatechic acid and gallic acid inhibited or unchanged the changes occurred in smooth muscles, and sometimes, they caused alterations in unchanged smooth muscle activity due to diabetes relative to control animals. On the basis of these findings, it was concluded that by p-OH benzoic acid, protocatechic acid and gallic acid exhibit the improving or impairing effects in a manner independent of their antioxidant power and from diabetic complications and they may exhibit prooxidant activities in the experimental conditions applied.

STREPTOZOTOCIN(STZ)-INDUCED DIABETES CAUSES BRADYKININ B1 RECEPTOR UP-REGULATION IN RAT DUODENUM
Y. Ozturk
Anadolu University Faculty of Pharmacy Department of Pharmacology, Tepebasi 26470 Eskisehir Turkey

Bradykinin B1 receptors causes contractions which are increased by their up-regulation. Certain experimental manipulations and pathophysiological conditions have been shown to induce this up-regulation process in various tissues. Previous studies have demonstrated that experimental diabetes causes an up-regulation of B1 receptors in various tissues. In the present study, effect of STZ-diabetes for 8 weeks on B1 receptor mediated contractions of the isolated rat duodenum was investigated.  After 8 weeks of STZ diabetes, the contractile effects of bradykinin and des-Arg9-bradykinin were found to be increased. These findings, it was concluded that STZ diabetes causes an up-regulation of B1 receptors in rat duodenum

EFFECT OF DAILY INSULIN TREATMENT ON DEPRESSION PARAMETERS OF SIX WEEKS STZ-DIABETIC RATS
O.D. Can, Y. Ozturk, D. Ozkay
Anadolu University Faculty of Pharmacy Department of Pharmacology, Eskisehir, Turkey

Introduction: The aim of the present study was examining the effect of daily insulin treatment on depression parameters of 6 weeks STZ-diabetic rats.  Method; Diabetes was induced by a single intravenous injection of STZ (60 mg/kg). 72 hours after the STZ injection, glucose was determined in blood samples obtained by pricking the tail, using Glukotrend®. Animals, blood glucose levels higher than 300 mg/dl, were accepted as diabetic.  Insulin treatment was initiated 72 hours after the STZ-injection, when occurrence of diabetes was observed, and continued for 6 weeks. Insulin was administered (i.p) at a dose of 2 IU/kg per day. The same day of every week, control, non-treated diabetic and insulin treated diabetic animals were forced to swim and climbing, swimming and immobility times were recorded. Results: Immobility times of diabetic animals increased until third week and than decreased. Conversely, climbing times decreased until third week and than increased. Decreasing in swimming times in first two week was followed by the increase at fifth and sixth weeks. Insulin treatment partially restored the alterations in depression parameters.  Conclusion: Results of the present study indicated the augmentation of depression levels in diabetic rats. Based on the partial recovery in the depression parameters of diabetic rats after insulin treatment, it can be conclude that, insulin deficiency is an important factor for the depression level as well as some other mechanisms, which are needed to clarify.

USING A THEORETICAL MODEL FOR DEVELOPING A FOOT CARE GUIDELINE FOR DIABETIC PATIENTS
T. Namwong1, S. Parboteeah2, L. Rafter3
1PhD Candidate, De Montfort University, UK 2Principal Lecturer, De Montfort University, UK 3Nurse Specialist Tissue Viability, Burton Hospital NHS Trust, UK

Preventing complications of diabetes is a key factor to reduce the cost of care, the rate of amputation, and to improve the quality of life for patients with diabetes. Aim: This paper describes how an evidence based practice framework was used to develop the foot care guideline for diabetic patients in Thailand. Method: The author chose an evidence-base practice model as a conceptual framework to develop foot care guideline. This was based on the work of Soukup (2000) which included the following four phases: evidence-trigger phase, evidence–supported phase, evidence-observed phase and evidence –based phase. The Evidence – trigger phase refers to knowledge trigger of foot care management and focuses on foot care problem in Thailand. Five educators, five nurses and nineteen patients were interviewed to evaluate the current issues in foot care provision for diabetic patients and patients’ knowledge of foot care. Phase of evidence support involved developing ten practical recommendations for foot care extracted from clinical statement from a total of 871 literatures by PubMed, Medline search (approximately 1965-2008). In the Evidence – support phase, 20 experts critically reviewed the foot care guidelines and made relevant comments. The findings from these four phases were used to develop the nursing practice recommendation for foot care for diabetic patients in Thailand. Conclusion: The poster will further explore the implication of using this model for developing the foot care guidelines. It will discuss the practical issues of using this framework and the implementation of the foot care guideline in Prapkkloa Hospital.

PREVALENCE AND INCIDENCE OF DIABETIC FOOT ULCERS IN A DISTRICT HOSPITAL IN THAILAND (PROVINCE OF CHANTABURI)
T. Namwong1, S. Parboteeah2, L. Rafter3
1PhD Candidate, De Montfort University, UK 2Principal Lecturer,De Montfort University, UK 3Nurse Specialist Tissue Viability, Burton Hospital NHS Trust, UK

A diabetic foot ulcer is one of the most important complications of long term diabetes. Diabetic foot ulcers can severely affects the quality of life, increase the morbidity and mortality and the cost of health care services. Aim: This study aims to explore the incidence and prevalence of diabetic foot ulcers among diabetic patients in a District Hospital in the province of Chantaburi: Thailand. Method: A cross sectional study in the diabetic foot clinic in Prapokklao Hospital, Chantaburi Province, Thailand was carried out from 2006 to 2008. Patients in Out Patient Department were screened by nurses. Sample size 3437 diabetic patients were analyzed. A diabetic foot ulcer was diagnosed if ulceration involved full-thickness penetration of the dermis of the foot in a person with diabetes. Ulcer severity was classified using the Wagner system.: All patients attending the OPD had their feet examined and foot care advice given by the nurses. Result: The findings indicate that the prevalence of diabetic foot ulcer in Prapokkloa Hospital in 2006 – 2008 was 4.16%, 5.34 % and 3.91% respectively. Incidence of diabetic foot ulcers in diabetes patients in 2006 -2008 is 8.34%, 11.04% and 10.10% respectively. This incidence and prevalence are implicated for practice. Conclusion: 15 percent of diabetic patients will develop to Diabetic foot ulcer which WHO predicted the number of diabetic people rise to 300 million in 2025. Trend of diacritic foot ulcer is increasing. While the low trend of the diabetes foot ulcer in Thailand, patients’ education in foot care diary and foot examination should be continued to reduce amputation and diabetic foot ulcer rate. This poster will present the implications of these findings.

NEGATIVELY CHARGED LDL SUBFRACTION CONTRIBUTES TO BOTH ATHEROSCLEROSIS AND HYPERTENSION IN TYPE 2 DIABETES
R.A.F. Dixon1, J. Lu1, C.H. Chen1
Texas Heart Institute, Houston, TX, USA

Aim: To evaluate the interrelationships between indexes of insulin resistance, lipid profile, C reactive protein (CRP) and homocysteine in patients with autoimmune thyroiditis (AIT) and subclinical hypothyroidism (elevated TSH, normal free T3 [FT3] and free T4 [FT4]). Patients and Methods: We analyzed lipid profile, CRP, anti-thyroid antibodies, homocysteine, folic acid, vitamin B12 levels, and insulin resistance indexes, such as HOMA-IR (Homeostasis Model Assessment), QUICKI (Quantitative Insulin Sensitivity Check Index), HISI (Hepatic Insulin Sensitivity Index), WBISI (Whole-Body ISI) and IGI (Insulinogenic Index) in 171 patients with AIT and TSH <2.5µUI/ml (TSH=0.82±0.66µUI/ml) and in 71 patients with AIT and TSH>2.5µUI/ml (TSH=9.66±19.60µUI/ml). An OGTT was performed with measurements of glucose and insulin at 0, 30, 60, 90 and 120 minutes after ingestion of 75g glucose. Statistical analysis was performed using t-Student and Pearson correlation tests. The results are expressed as means±SD. We considered significant a bilateral value of p<0.05. Results: In patients with TSH>2.5 µUI/ml we found significantly lower IGI indexes (0.036±0.378 vs 0.252±0.310, p=0.02), significantly higher levels of homocysteine (10.8±12.6 vs 8.3±3.3mmol/L, p=0.04), insulin at 120min in OGTT (65.9±57.8 vs 84.1± 65.4µUI/ml, p=0.02), and WBISI results (6.323±7.335 vs. 6.112±4.019, p=0.003). We also found positive correlations between FT4 levels and BMI (r=0.413, p<0.001), FT4 and Lp(a) (r=0.259, p=0.04), TSH and LDL levels (r=0.245, p=0.04), and negative correlations between FT3 and LDL levels (r=0.259, p=0.04) in patients with TSH>2.5µUI/ml. Conclusion: The increased cardiovascular risk in patients with subclinical hypothyroidism and AIT may be related to the inter-relationships between lipid profile, homocysteine and insulin resistance.

EFFECTS OF SMBG IN PATIENT WITH TYPE 2 DIABETES MELLITUS: A RANDOMIZED CONTROLLED TRIAL
K. Petkova1, S. Ganeva2
1Silvia Ganeva, Clinic of Endocrinology and Metabolic Diseases, University Hospital, Pleven, Bulgaria

Background: The first step recommendations for patients with Type 2 Diabetes Mellitus (T2DM) are lifestyle changes, aiming to improve metabolic control of the diseases. Self-measurement of blood glucose (SMBG) is an easy tool for evaluation the effect of lifestyle modification on blood glucose levels.  Aim of the study was to examine the effect of SMBG and lifestyle intervention in patients with T2DM.  Methods: a randomized controlled trial was conducted and 111 SMBG-naive T2DM ambulatory patients were randomly assigned to a SMBG (n=55) and a control group (n=56). Both groups were given a manual with basic information about healthy lifestyle. At baseline and after 12 weeks glucometabolic parameters were assessed in both groups. The manual for the SMBG group includes information about SMBG in addition and they generated 7-point blood glucose diurnal profiles every four weeks. Results: Mean age of the patients from SMBG group was 58.73± 8.16 and 60.52±7.27 years; (p>0.01) for the control group; duration of T2DM was 5.58±4.56 and 6.15±4.42 years; (p>0.01) respectively. Both groups managed to improve their glucometabolic control, reduction of HbA1c (-0.9% vs. -0.4%; p<0.01) and weight loss (-2.9 kg vs. + 0.1kg; p<0.01) was significantly higher in the SMBG group than in the control group. Cardiovascular risk factors such as BMI, waist circumference, blood pressure, triglycerides and cholesterol levels improved significantly also. Conclusions: Adding SMBG to lifestyle modification is an appropriate method for patient`s motivation to achieve and maintain better glycemic control, and reduce cardiovascular risk factors.

COST IMPACT OF SELF-MEASUREMENT OF BLOOD GLUCOSE (SMBG) ON COMPLICATIONS OF TYPE 2 DIABETES: THE SWEDISH PERSPECTIVE
K. Neeser, C. Weber
Institute for Medical Informatics and Biostatistics; Department of Health Economics; Basel, Switzerland

Background:  Despite the increasing prevalence of type 2 diabetes, its financial burden on the Swedish healthcare system remains unclear. This study was conducted to determine the cost share of self-measurement of blood glucose (SMBG) by comparing the direct costs of reduced diabetic complications in SMBG users versus nonusers in the Swedish statutory health insurance system. Methods:  Matched-pair analysis was done of the average annual total direct cost of diabetes monitoring, treatment-related services, complications, and follow-up in the RetrOlective Study Self-Monitoring of Blood Glucose and Outcome in Patients with Type 2 Diabetes (ROSSO) study cohort, updated to 2009 from the year of occurrence or diagnosis of diabetes.  Results:  In patients treated with oral antidiabetic drugs only, total annual costs were €3,493 in SMBG users and €3,531 in nonusers. In those treated with oral antidiabetic drugs plus insulin, total annual costs were €5,801 and €7,085, respectively. By increasing the number of patients using SMBG, the Swedish statutory health insurance system might save several million Euros annually. Conclusions:  The analysis showed that the promotion of self-measurement of blood glucose in patients with type 2 diabetes is associated with considerable cost savings for the Swedish healthcare system.

THE IMPACT OF POSTPRANDIAL BLOOD GLUCOSE IN MODELING APPROACHES FOR COST-EFFECTIVENESS ANALYSES IN DIABETES MELLITUS
C. Weber, F. Heister, S. Kocher, K. Neeser
Institute for Medical Informatics and Biostatistics; Department of Health Economics; Basel, Switzerland

Background and aim:  An increasing number of studies is demonstrating that postprandial blood glucose values (PPG), which are not necessarily reflected by higher HbA1c values, constitute a strong risk factor for the development of cardiovascular complications. Aim of this study was to assess the potential economic effects of an inclusion of PPG in diabetes models. Methods: Under the assumptions that (1) high PPG values represent a strong risk factor for the development of cardiovascular complications, and (2) high PPG values are not necessarily reflected by a higher HbA1c level, we applied an additional risk factor to the outcomes of the UKPDS risk engine. This adapted risk calculator was employed in a Markov model, comparing two type 2 diabetic cohorts. In scenario 1, we assumed a HbA1c improvement of 0.6% in the treatment group compared to the control group. In scenario 2, an additional reduction of PPG was assumed in the treatment group. Results:  In scenario 1, the mean life expectancy was 8.06 years (treatment) vs. 8.01 years (control), total cost was €14,016 (treatment) and €10,749 (control). In scenario 2, the mean life expectancy was 8.20 years (treatment) and 8.01 years (control) and total costs €13,552 and €10,749, respectively. The incremental cost effectiveness ratio (ICER) when applying treatment was €58,580 per life year gained (LYG) in scenario 1, and €14,971 per LYG in scenario 2.  Conclusions:  The potential benefits of antidiabetic therapies might be underestimated by using only HbA1c as a risk factor for coronary heart disease (CHD), compared to using HbA1c and PPG. This fact may lead to a restricted use or even to the refusal of valuable health care technologies.

SIMILAR PULSE PRESSURE AND “SBP x HR” DOUBLE PRODUCT IN MIDDLE-AGE PATIENTS WITH TYPE 1 DIABETES AND TYPE 2 DIABETES
A.J. Scheen, J.C. Philips, M. Marchand
University of Liège, Division of Diabetes, Nutrition & Metabolic Disorders, CHU Sart Tilman, B-4000 Liège, Belgium

Background: Arterial pulse pressure (PP) is considered as an independent cardiovascular risk factor in both patients with type 1 (T1DM) and type 2 (T2DM) diabetes mellitus. We compared systolic blood pressure (SBP), PP and SBP x heart rate (HR) double product during an active orthostatic test in patients with T1DM and patients with T2DM matched for age (40-60 years) and sex ratio (1/1). Methods : 40 patients with T1DM (mean age 50 years, diabetes duration 23 years, BMI 23.0 kg/m²) were compared to 40 patients with T2DM (respectively, 50 years, 8 years, 29.7 kg/m²). Patients taking antihypertensive agents or with renal insufficiency were excluded. All patients were evaluated with a continuous noninvasive arterial blood pressure monitoring (Finapres®) in standing (1min), squatting (1min) and again standing position again (1min).  Results: There were no significant differences between T1DM and T2DM patients regarding SBP (126 vs 128 mmHg), PP (59 vs 58 mm Hg) and SBPxHR (11220 vs 11772 mmHg/min).  PP increase (+10 vs +8 mmHg) and HR reduction (-6 vs -6 beats/min) during squatting were also similar in both groups. Conclusion: Patients with T1DM have comparable PP, an indirect marker of arterial stiffness, and SBPxHR double product, an index of cardiac workload, as patients with T2DM at similar mean age of 50 years. The negative influence of much longer diabetes duration might be compensated for by the positive influence of lower BMI and less insulin resistance in T1DM patients, leading finally to comparable cardiovascular risk markers as in T2DM. 

HYPERTENSION ENHANCES THE RISK OF DYSLIPIDEMIA IN TYPE 2 DIABETICS. THE CHILEAN DIABETES STUDY
A. Sanchez1, J. Salas1, L. Lera1, T. Valenzuela2,   G. Cavada3, G. Aguirre4, C. Albala1
1Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile 2Dpto. Public Health, Universidad of Los Andes, Santiago, Chile 3Dpto. Biostatistics,  Public Health School, University of Chile. 4Diabetics Association of Chile

Objective. To study the risk of Dyslipidemia in subjects with Diabetes plus hypertension, compared with Diabetics (DM) and hypertensive. Methods.  The Chilean diabetes study is a population based cross-sectional study done in 2006 in a national representative sample of 1463 people (mean age 40,6y range:13-78y). After informed consent all the participants underwent home interviews including socioeconomic characteristics, history of chronic diseases and blood pressure, weight, height and waist circumference measurements. Plasma glucose, insulin and lipid profile was performed in a venous fasting blood sample.  Hypertension was defined as having systolic blood pressure &#8805;140 mmHg or diastolic blood pressure &#8805;90 mmHg.  NCEP-ATPIII criteria were used for serum lipids and waist circumference categories. ADA 2003 criteria were used for the diagnosis of diabetes. WHO BMI categories were used for nutritional status. Logistic regression models were used to adjust the results by age, sex and BMI.  Results: The prevalence of Diabetes was 7,8%(CI95%:6,3-9,3); Hypertension: 22,6%(CI95%:20,3-24,9); Diabetes plus Hypertension: 3,9%(CI95%:2,8-5,0);; Dyslipidemia: 21,3%(CI95%:19,1-23,6); Obesity in men 17,4%(CI95%:13.9-20.9) and 29.7% (CI95%:26.5-32.8) in women; Abdominal obesity was 19.9%(CI95%:16.2-23.6) in men and 48.6%(CI95%:45.2-52.0) in women.  When compared with normal group, the OR for elevated triglycerides was 1.5(CI95%:1.1-2.0) for hypertension alone, OR 1.6(CI95%:1.0-2.4) for diabetics and 3.0(CI95%:1.6-5.5) for people with diabetes plus hypertension. The OR for low HDL, were 1.21(CI95%: 0.9-1.6), 1.25(CI95%:0.8-1.9) and 3.78(CI95%:2.0-7.0) respectively.  No differences for cholesterol were observed between the groups. Conclusion. Considering the high risk of dyslipidemia that hypertension imposes over diabetes, its tight control at primary care in diabetics is compulsory.

CONTROVERSIES IN SEX RELATED DIABETES AND HYPERTENSION RISK FACTORS
S. Svacina1, M. Matoulek1, J. Lajka2, P. Horak3
13rd Department of Internal Medicine, Charles University-1st Medical Faculty, Prague, Czech republic 2STEM/MARK Agency, Prague Czech repuiblic 3State General health insurance office Prague

An epidemiological research of obesity and comorbidities  was realised in Czech Republic. Sex difference in type 2 diabetes and hypertension risk factors was analysed. Representative sample of 2058 adult persons was investigated using weight, waist, height  and personal interview. x2 test was used to analyse diference in data categories of BMI, waist and  height. Mean BMI of men was 26.9, mean BMI of women 26.1 kg/m2. Diabetes prevalence was 7% in both sexes. There is a higher relation of diabetes to obesity in women 25%  with diabetes and only 15%  with diabetes in obese men. There is no difference in the obesity dependent hypertension prevalence in both sexes. Both diabetes and hypertension are waist dependent and there is no difference between sexes. In both sexes there is a negative relation of hypertension and diabetes prevalence to height. Hypertension prevalence 32% in men below 172 cm and  11% above 186 cm height. Hypertension prevalence 33% in women below 161 cm and 12% above 172 cm height. Diabetes 13% in men below 172 cm and  3% above 186 cm. Diabetes prevalence  11% in women below 161 cm and 3% above 172 cm.   We conclude: In both sexes was shown that low body height is a risk factor for diabetes and hypertension. Waist is a very good universal measure of hypertension and diabetes risk in both sexes.k. In controversy BMI is therefore not a universal diabetes risk marker for men and women and for high and low body height. This indicates that theweight -height relation is perhaps influenced by social factors and that small people are at high risk of diabetes and hypertension today. Supported by preventive program of  General Health Insurance Office and Grant NP II - Healthy food. 

FACTOR ANALYSIS OF POSSIBLE RISKS FOR HYPERTENSION IN PATIENTS WITH TYPE 2 DIABETES
T.M. Milenkovic1, V.P. Percan2, G.P. Petrovski3
1Medical Faculty, Clinic of endocrinology, diabetes and metabolic disorders, Skopje, Macedonia

Background and aims: The most important risk factors may predict the transition from borderline to established hypertension and primary prevention has to focus on identifying individuals who are at highest risk to develop hypertension. The aim of this study was to investigate the association between blood pressure and factors known to contribute to hypertension. Materials and methods: The study sample consist a total of 120 patients with type 2 diabetes divided in two groups according to their blood pressure. First group - 73 were patients with blood pressure exceeding 140/90 mmHg (39 female, 34 male, age 63,0±8,8 years) and second group - 47 normotensive (25 female, 22 male, age 56,0±8,4 years). Results: In first group 51 patients are with hyperinsulinemia (versus 12 in second group), 37 with recognized cardiovascular disease (versus 2), 18 with microalbuminuria (versus 2), 42 were smokers (versus 13). In the first group the patients are older, with longer diabetes duration, and similar BMI. Hypertensive patients have significantly higher HbA1c 8,7±1,2% versus normotensive patients HbA1c 7,64±0,8%, as well as triglycerides (2,9±1,2mmol/l versus 2,3±1,1mmol/l), total cholesterol (6,6±1,0mmol/l versus 6,1±0,7mmol/l) and LDL cholesterol (3,6±0,9mmol/l versus 3,0±0,6mmol/l). HDL was significantly lower in group with hypertension (0,9±0,1mmol/l versus 1,0±0,1mmol/l). Conclusions: In our study major factors associated with hypertension were hyperinsulinemia, bad metabolic control, dyslipidemia, and smoking. For successful prevention of hypertension should be corrected a whole risk pattern, rather than an individual risk.

PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY AND STENTING IN TRANSPLANT RENAL ARTERY STENOSIS
P. Pappas, E. Barberi, P. Sourla, V. Oikonomopoulou, G. Gkeneralis, V. Zioga
Laiko General Hospital, Athens, Greece

Objective: To evaluate the efficacy of percutaneous angioplasty and stenting in cases of artery stenosis of the transplanted kidney or proximal iliac artery stenosis causing transplant dysfunction and/or increase of the arterial blood pressure. Method: Between 2000 and 2009, we evaluated 27 patients who had undergone renal transplantation and subsequently were diagnosed with refractory hypertension and transplant dysfunction for signs of possible renal transplant artery stenosis. Color Doppler ultrasonography and magnetic resonance angiography preceded the intrarterial angiographic investigation, with false-negative results in 18.2% and 13.6% of patients, respectively. In 2 of the 27 patients, arterial angiography did not reveal arterial stenosis affecting the transplanted kidney. 3 patients had severe ipsilateral iliac artery stenosis and the remaining 22 had transplant artery stenosis. Successful angioplasty and stenting were performed in these 25 patients. Results: The method was technically feasible in 100%. The procedure-related morbidity was 0%. During the follow-up period (range: 3 to 118 months, mean 71 months), 3 patients died with acceptable transplant function, 3 suffered transplant failure, and the remaining 19 still have normal transplant function and easily controlled hypertension. Conclusion: Percutaneous angioplasty and stenting in cases of arterial stenosis affecting the renal transplant function are safe and effective procedures. Even more, the strong clinical suspicion must lead to angiographic investigation regardless of the results of other imaging approaches.

RENAL ARTERIES ANGIOPLASTY IN RESISTANT HYPERTENSION AND/OR RENAL MALFUNCTION
P. Pappas, E. Barberi, P. Sourla, V. Oikonomopoulou,  E. Felesaki, D. Tzortzis
Laiko General Hospital, Athens, Greece

Purpose: To evaluate the efficacy of percutaneous transluminal renal arteries angioplasty and stent placement, in patients with resistant renal hypertension or diminished renal function due to renal artery stenosis. Material and method:  78 patients with renal artery stenosis were managed with percutaneous transluminal angioplasty. 5 patients had only one kidney, 4 had fibromuscular dysplasia, 20 had a transplanted kidney, 40 patients had unilateral and 9 bilateral renal artery stenosis.  Way of access for the renal vessels was femoral or brachial artery and through a sheath a selective catheterization of the renal artery was performed. Then a guide wire was inserted through the vessel stenosis. Afterwards a balloon catheter was inserted at the stenotic area and a dilatation was performed according to the diameter of the adjacent healthy lumen. In 18 of 87 kidneys only angioplasty was performed and in 69 a metallic stent was placed, in 51 of them directly, without prior dilatation (primary stenting). The balloons were of 12-20mm length and of 4-6mm diameter and stents had same lengths and widths.Results: Intraluminal stent placement and balloon dilatation of the arterial stenotic areas were successful in all the patients (technical success 100%).  We noticed a following decrease of systolic and diastolic blood pressure in 87% of patients with resistant hypertension and also a decrease of creatinine levels in 73% of patients with diminished renal function. Conclusion:  The percutaneous transluminal renal arteries angioplasty is an efficient and safe method for the management of renal hypertension due to renal artery stenosis.

PREVALENCE OF HYPERTENSION; ITS CORRELATES WITH ADDING SALT, BMI AND DIABETE IN AHWAZ PRIMARY SCHOOLS TEACHERS
S. Ashrafizadeh
Department of Social Medicine, Ahwaz Jundishapure University of Medical Sciences

Background: Hypertension is one of the main risk factors of many diseases .Despite improvements in detection, there has not been any decline in the prevalence of hypertension.  Objective: To study the prevalence, correlates of hypertension and BMI, adding salt in Ahwaz primary schools teachers. Design: This study was descriptive in design. Subjects were 293 primary schools teachers. Data collection was carried out using standard questionnaire performed by previous studies and statistical analyses were employed using SPSS for windows.  Results: The overall prevalence of hypertension was found to be 11%.6% of respondents were diabetic (type 2) Significant risk of hypertension with using fisher test was found with increase in adding salt and increase in BMI (p<0/001). Also there was meaning relation between physical activity and BMI<25(p<0/009). Conclusion: This study has recommended an appropriate intervention program shall be launched considering the modifiable risk factors in the area are BMI, adding salt and physical activity.

CLINICAL EFFECTS OF VARIOUS ANGIOTENSIN II RECEPTOR BLOCKERS IN JAPANESE SUBJECTS WITH TYPE 2 DIABETES
Y. Wada1, Y. Hamamoto1, S. Honjo1, H. Ikeda1,2,  Y. Kawasaki1, K. Nomura1,3, Y. Iwasaki1, H. Koshiyama1
1Center for Diabetes and Endocrinology, The Tazuke Kofukai Medical Institute Kitano Hospital 2Ikeda Hospital 3Division of Diabetes, Metabolism and Endocrinology, Kobe Graduate School of Medicine

To clarify the difference of beneficial effects of angiotensin II type 1 receptor blockers (ARBs) in type 2 diabetes, we investigated the effects of various ARBs in subjects with type 2 diabetes and hypertension. First, we investigated the effect of telmisartan on glycemic control. Telmisartan (20-40mg/day) was administered in 20 subjects, and in a control group (n=18), candesartan (8mg/day) was administered. Those who received 40mg telmisartan (n=11) showed a significant decrease in HbA1c after 3 months (8.12 to 7.46%, p<0.05). Second, we investigated the effect of olmesartan in subjects with diabetic nephropathy (n=43) by switching other ARBs to olmesartan (20mg/day). In the subjects with microalbuminuria (n=24), urinary albumin/creatinine ratio (ACR) was significantly decreased between before and 3 months after the switching to olmesartan (120.1 to 86.0mg/g-creatinine, p<0.05). Systolic blood pressure was significantly decreased in the microalbuminuria group (149.4 to 140.7mmHg, p<0.05), although diastolic pressure was not changed. Third, we examined the effect of fixed-dose combination, Los/HCTZ (losartan 50mg and hydrochlorothiazide 12.5mg/day) in a total of 32 Japanese subjects with type 2 diabetes and hypertension with albuminuria by switching from other ARBs to Los/HCTZ. Both systolic and diastolic blood pressure was significantly decreased after 3 months. Urinary ACR was significantly decreased (96.8 to 51.2mg/g-creatinine, p<0.01). However, HbA1c showed an increase after Los/HCTZ. In conclusion, telmisartan, olmesartan and Los/HCTZ have different beneficial effects on Japanese subjects with type 2 diabetes: telmisartan on glycemic control, olmesartan and Los/HCTZ on early nephropathy, but the latter with deteriorating effect on glycemic control.

COMPARISON OF CARDIAC STRUCTURE AND FUNCTION IN DIABETES MELLITUS  WITH AND WITHOUT SYSTEMIC HYPERTENSION
K.I. Cho, H.G. Lee, S.M. Kim, T.I. Kim
Division of Cardiology, Maryknoll Medical Center

Background and Objectives: As hypertension and left ventricular hypertrophy (LVH) frequently coexist with diabetes, we sought in this study to compare myocardial functional and structural changes in diabetic patients with or without hypertension with those in nondiabetic subjects with hypertension (essential hypertension), in order to identify the role of diabetes alone in relation to myocardial dysfunction. Subjects and Methods: We studied 50 patients with essential hypertension (HTN, 20 men, 30 women, aged 59 „b12 years), 54 diabetes mellitus patients without hypertension (DM-HTN, 24 men, 30 women, aged 60„b9 years), 53 diabetes mellitus patients with hypertension (DM+HTN, 23 men, 30 women, aged 61„b7 years), 49 normal subjects (22 men, 27 women, aged 56 „b 13 years). We used echocardiography comprising standard 2-dimensional and conventional Doppler imaging for the estimation of left ventricular mass index (LVMI), relative wall thickness (RWT) and Doppler-derives myocardial performance index (MPI). Subjects were considered to have: normal geometry (NG) if both LVMI and RWT were normal (LVMI„T104g/m2 in female, LVMI„T116g/m2 in male, RWT„T0.43); concentric hypertrophy (CH) if both were elevated; eccentric hypertrophy (EH) if LVMI was elevated and RWT was normal; and concentric remodeling (CR) if LVMI was normal and RWT was elevated. Results: The MPI was significantly higher in patients with essential hypertension and diabetes, especially DM+HTN (HTN=0.48„b0.13; DM-HTN=0.41„b0.09; DM+HTN=0.53 „b0.11) compared to controls (0.31„b0.11, p<0.05). LVMI and RWT were significantly higher in patients with essential hypertension and diabetes, especially DM+HTN (HTN=132.2„b44.4 g/m2 and 0.45„b0.11; DM-HTN=125.9„b34.4 g/m2 and 0.44„b0.07; DM+HTN=153.9„b42.9 g/m2 and 0.48 „b0.07) compared to controls (108.9„b22.2 g/m2 and 0.39„b0.05, p<0.05). Conclusion: Our study demonstrated the early appearance of adverse myocardial functional and geometric changes in diabetic patients and the contributory effects of diabetes to myocardial impairment and LV hypertrophy produced by hypertension.

OUTCOME PREDICTORS IN HYPERTENSIVE HYPERTROPHIC CARDIOMYOPATHY HHCM
N. Elkilany
Cardiology Consultant, Tanta University, ARE, Specialist at CDH, Kuwait

Purpose: To identify HHCM patients at risk of Sudden Cardiac Death. Patients & Methods: Using echocardiography, we identified 12 hypertensive patients with a syndrome that included severe cardiac hypertrophy, a small left ventricular cavity, and supernormal indexes of systolic function.   The patients mean age 65.3 years, predominantly female (8 patients). Their cardiac function was hyperdynamic (ejection fraction on two-dimensional echocardiography [patients vs. controls], 75 +/- 4 vs. 58 +/- 5 per cent, P<0.001) and abnormal diastolic function as manifested by a prolonged early diastolic filling period (279 +/- 25 vs. 160 +/- 45 msec, P < 0.001) in 8 patients , Psuedo normal pattern of standard mitral flow in 2 and reduced deceleration time (restrictive filling pattern) in 2 patients. Tissue Doppler imaging has been used to identify abnormal diastolic function in individuals with HHCM. Results: The transmitral pulse wave Doppler deceleration time (Ed)has been shown to be a powerful predictor of functional capacity and outcomes in patients with HHCM ;In  HHCM patients a deceleration time  <140 ms, has been shown to be the single best predictor of cardiac death in such patients population. In addition, a combination of restrictive physiology pattern and reduced mitral annular diastolic velocity (Ea) < 8cm/second has been shown to be a stronger predictor of cardiac death. The presence of a resting LVOT gradient of > 50 mm Hg, a septal thickness > 18 mm and presence of NYHA functional class III or IV symptoms are predictive of an increased incidence for re hospitalization (p< 0.005 for all).
Conclusion: Echocardiography can be utilised to identify high risk patients and to tailor treatment for individuals with HHCM.

Objective: To examine associations between antrhopometric measures (body mass index [BMI], waist circumference [WC] and waist-to-height ratio [WHtR] and blood pressure among school-aged children.  Design: 1239 children aged 9.4 years (range; 7.6 to 13.5) were assessed in 10 public schools of low socioeconomic status in Mexico City. Blood pressure (BP) was assesed according to the American Pediatric Academy. Anthropometrics (including weight, height, waist circumference [WC] and body composition with bioelectric impedance) were taken in all children. BMI was calculated as kg/m2 and categorized in agreement with the International Obesity Task Force cut points. WHtR was calculated by dividing the WC  by the height.  Results: 49.5% of the sample were boys, mean systolic and diastolic BP were 107.7 and 75.0 mmHg, respectively. We observed that WC showed the highest correlations with systolic BP (r=0.588, p<0.001) and diastolic BP (r=0.509, p<0.001), while BMI showed the highest correlations with total FM (r=0.956, p<0.001). Linear regression was also performed to calculate the variation of BP explained by different anthropometric indices (R2), the results confirmed our findings in the partial correlations analyses. Further analyses in boys and girls separately showed that BMI explained the greater variation of diastolic BP (R2=29.6%) in boys and systolic BP (R2=35.8%) in girls, than WC and WtHR, meanwhile WC explained in a higher proportion SBP in boys (R2=37.3%) and DBP in girls (R2=23.2%).  Conclusions: Among Mexican urban school children, BMI and WtHR do not differ in their associations with BP. However WC was a better indicator of blood pressure, and may be preferred because of its simplicity, additional data are neededto examine its relation to another cardiovascular risk factors

AT1-RECEPTOR BLOCKADE AND INSULIN SENSITIVITY IN HYPERTENSIVE SUBJECTS: THE ROLE OF CAPILLARY RECRUITMENT
A.M. Jonk1, J.H.M. Houben1, N.C. Schaper1, P.W. de Leeuw1, E.H. Serné2, Y.M. Smulders2,
C.D.A. Stehouwer1
1Maastricht University Medical Centre, Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands 2VU Medical Center, Amsterdam, The Netherlands

Background: Catecholamine-secreting tumours are rare neoplasms, probably ocurring in less than 0,2% of patients with hypertension. Sustained or paroxysmal hypertension is the most common sign of pheochromocytoma, but approximately 5 to 15 percent of patients present with normal blood pressure. Patients and methods: We collected data from all patients submitted to 24-hour urinary fractioned metanephrines and catecholamines in 2008, including requester consultation and motivation, age, gender, personal and family history, imaging diagnosis (CT/MR), MIBG results, needing for surgery and histopathological results. Results: We selected 354 laboratory data (306 patients) of 189 female and 117 male. Urinary cathecolamines, metanephrines, vanilmandelic acid and dopamine were normal in 223 patients (73%) and only 47% were hypertensive patients. Twelve percent of the 223 patients were submitted to MIBG scintigraphy, which revealed different degrees of hyperfixation in 65%. Thirty five percent of patients submitted to MIBG scintigraphy had normal MR and/or CT, 67% of whom had positive MIBG scintigraphy. Only 2 patients went to surgery and none had the diagnosis of pheochromocytoma. Urinary normetanephrines were high in 83 patients (27%) and 81% of them were hypertensive patients. Urinary metanephrines were above normal range (also with high normethanephrines) in 7 patients (2%). All of them needed surgery and we diagnosed 3 pheochromocytomas, a paraganglioma relapse, an oncocytoma, and an adrenal incidentaloma. Conclusion: There is a high rate of urinary normethanephrine false-positive testing. Metanephrines measurement revealed higher diagnostic accuracy. Careful should be taken when interpreting isolated elevated normethanephrines in this population to avoid excessive healthcare expenditures.
 

PREVALENCE OF HYPERTENSION AT THE PATIENTS WITH NONALCOHOLIC FATTY LIVER DISEASE AND THE RELATION WITH GLYCEMIC DISORDERS
E. Caceaune1, D. Licaroiu1, L. Micu2, N. Caceaune2, C. Ionescu-Tîrgovişte
1NIDNMD "N.C. Paulescu", Bucharest, Romania 2CI "Fundeni"

Aim.The treatment with different antihypertensive drugs exerts different influences on insulin sensitivity and intracellular glucose metabolism in type 2 diabetes (T2D) patients. This study was aimed to evaluate the effects of the short-term treatment of 30 days with an ACE inhibitor, cilazapril, in 28 T2D patients matched for age, body mass index and duration of diabetes, showing moderate hypertension (diastolic arterial blood pressure (ABP) 90 - 100 mmHg). Methods. The ABP was measured by sphygmomanometer, and the dose of cilazapril was adjusted at 3 day intervals during the first 15 days to obtain the diastolic ABP < 90 mmHg. Before the beginning and on the last day of the treatment we analyzed total, oxidative and nonoxidative glucose disposal by using a euglycemic hyperinsulinemic clamp combined with indirect calorimetry. Results. We found that ABP decreased to normal range in T2D patients at the end of the treatment (systolic: 133.2+/-12.3 vs 162.6+/-14.5, p<0.05; diastolic: 81.4+/-3.2 vs 104.6+/-5.3mmHg; p<0.05). Moreover, we detected a significant increase in total (3.2+/-0.3 vs 2.3+/-0.2 mg/kg/min; p<0.05) and oxidative glucose disposal (1.8+/-0.2 vs 1.1+/-0.3 mg/kg/min; p<0.05), while we did not detect the increase in nonoxidative glucose disposal (1.5+/-0.2 vs 1.2+/-0.2 mg/kg/min; 0.05<p<0.1). Conclusions. Our results have demonstrated that the short-term cilazapril treatment was able to induce an important improvement in total and oxidative while it was unable to improve nonoxidative glucose disposal in the hypertensive T2D patients. The results imply that the beneficial effect of the short-term treatment was restricted to the improvement in glucose oxidation.

DIABETES MELLITUS, CARDIOVASCULAR DISEASES, RENAL INSUFFICIENCY AND VITAMIN D
V. Mojto1, Z. Rausova2, J. Chrenova2, V. Bada1, L. Dedik2
1IIIrd Internal Clinic , Derer's Hospital, Faculty of Medicine, Comenius University Bratislava, Slovakia 2Institute of Automation, Measurement and Applied Informatics,  Faculty of Mechanical Engineering, Slovak University of Technology, Bratislava, Slovakia

Objective: Vitamin D deficiency and insufficiency is common and primarily caused by reduced sun exposure, and the consequent limiting of vitamin D production in the skin. Observational data support the concept, that vitamin D is involved in the pathogenesis of cardiovascular diseases, diabetes, renal insufficiency and arterial hypertension. To evaluate this association, we analysed data of patients after adjustment for age and sex.   Methods: Analyses were performed from April 2009 to October 2009.  A sample of 92 adults (25 – 95 years old) was admitted to III. Internal clinic or examined in outpatient department of Derer´s hospital in Bratislava. Vitamin D levels were determined using electrochemiluminescence immunoassay. Serum 25-hydroxycalciferol vitamin D levels was characterized as ≤ 29 ng/ml vitamin D insufficiency.  Results: Overall, 75% of adults had hypertension, 71% had ischaemic heart disease, 43% had renal insufficiency, 33% had diabetes mellitus and 95% had vitamin D insufficiency. There was a higher occurrence of diseases in adults whose vitamin D levels are <16 ng/ml and both sexes were equally affected. According to our finding, this may be the threshold limit value for the risk of hypertension, ischaemic heart disease, renal insufficiency and diabetes mellitus. Conclusions: There is an association between vitamin D insufficiency and the presence of hypertension, ischaemic heart disease, renal insufficiency and diabetes mellitus, even after adjustment for age, sex and other variables. Further studies of this relationship may lead to new interventions that decrease prevalence of the observed diseases.

ISCHEMIA-MODIFIED ALBUMIN CAN BE A MARKER FOR DIABETES MELLITUS BUT NOT FOR IMPAIRED GLUCOSE TOLERANCE
M.D. Tapan, A. Sonmez, T. Dogru, H. Genc, U. Safer, A. Taslýpýnar, I. Tasci, M. Kutlu, M. Erbil, I. Kurt
Gulhane Medical School, Ankara, Turkey

Objectives: IMA is regarded as a biomarker of oxidative stress related to ischemia-reperfusion in different clinical conditions associated with oxidative stress, such as chronic kidney disease, hypercholesterolemia, in type 2 diabetes . The aim of this study was the evaluation of ischemia-modified albumin (IMA) in patients with type 2 diabetes mellitus and impaired glucose tolerance (IGT).  Material methods: Fasting glucose, total cholesterol, HDL cholesterol, LDLcholesterol, triglycerides, HOMA-IR and IMA were measured in 40 patients with type 2 diabetes, 41 patients with impaired glucose tolerance (IGT) and 43 controls. Results: Fasting glucose, HOMA-IR and IMA were significantly higher in patients with type 2 diabetes compared with IGT patients and control (p<0,001 for glucose and HOMA-IR, p=0.001 for IMA). Fasting glucose, HOMA-IR were significantly higher with IGT patients compared with control (p<0,001). IMA was not significant in IGT patients compared with control. Conclusions: We have shown higher levels of IMA in type 2 diabetes but not in IGT patients. We can suggest that hyperglycemia especially in diabetic patients frequently associated with chronic hypoxia conditions provoked mainly by oxidative stress but not early stages of disease presented in impaired glucose tolerance, reduce the capacity of albumin to bind cobalt, resulting in higher IMA levels.

THE CLINICAL PROFILE OF HYPOGLYCEMIA IN EMERGENCY ROOM IN A COMMUNITY HOSPITAL
V. Varadarajan1.2, M. Mahalingam1
1Sundaram Medical Foundation,Chennai,India 2brakes India Occupational Health Centre,Chennai,India

This study involves the profile of 67 patients admitted with hypoglycemia in Emergency Room of a Community Hospital.The various clinical aspects regarding symptoms,signs and recovery were analysed Most of our patients were Type 2 diabetics,Our analysis revealed unawareness of hypoglycemia might be the most possible cause of hypoglycemia as indicated by 01. absence of autonomic symptoms 02. no overdosage of medicines  and 03. no change in dietary pattern. According to literature this phenomenon of unawareness of hypoglycemia was more common in Insulin dependant (Type 1) diabetics The exact mechanisms leading to unawareness of hypoglycemia in Type 2 diabetics  especially in elderly age  group needs further studies so that prevention of hypoglycemic episodes is possible.

FACTORS ASSOCIATED WITH HYPOGLICEMIA IN PATIENTS WITH DIABETES: A RETROSPECTIVE STUDY ON 196 PATIENTS IN AN ADVANCED EMERGENCY DEPARTMENT
C. Berra1, V. Torri2, M.G. Radaelli3, M. Monteforte2, Y. Goldstein1, G. Noè4, P. Arosio5, A. Voza5, M. Mirani1, M. Podda6, S. Badalamenti5
1IRCCS Istituto Clinico Humanitas Metabolic Unit Rozzano Milano 2Istituto di Ricerche Farmacologiche "Mario Negri" 3IRCCS S. Raffaele Hospital Segrate Milano 4IRCCS Istituto Clinico Humanitas Rozzano Milano 5IRCCS Istituto Clinico Humanitas EAS Rozzano Milano 6University of Milan Milano