DEMOGRAPHIC AND METABOLIC PROFILE MAY INFLUENCE SPECIFICITY OF HBA1C IN DIAGNOSING DIABETES MELLITUS
J.P. Foo, R. Chen, L.W. Cho, V. Au, E. Tan, T.L. Tay, J. Khoo, S.B. Soh
Changi General Hospital, Singapore
Background: Glycated Hemoglobin (HbA1c) ≥6.5% is recommended as diagnostic criteria for Type 2 Diabetes (T2DM) by the American Diabetes Association (ADA). We aim to evaluate the optimum HbA1c cut-off and prevalence of false positive/negative using HbA1c as diagnostic criteria in our population. Methods: Observational study involving 90 Asians with Oral Glucose Tolerance Test (OGTT) and HbA1c done for diabetes screening. Demographic and metabolic parameters were ascertained. T2DM was diagnosed if 2-hour post-load glucose ≥11.1mM. Receiver operating characteristics (ROC) analysis was performed to assess best predictive cut-off HbA1c for diagnosing T2DM. Chi-square test was used to evaluate prevalence of false positive/negative HbA1c. Results: 44.4% of the subjects were diagnosed T2DM using OGTT criteria. Area under ROC curve (AUROC) was 0.672 (95% CI 0.558-0.787, p=0005, sensitivity 48.8%, specificity 85.7%) using ADA-recommended HbA1c cut-off ≥ 6.5% for T2DM diagnosis. Best predictive HbA1c in this cohort was 6.2% (AUROC 0.705, sensitivity 75.6%, specificity 65.3%). Using cut-off of 6.2%, prevalence of false positive and false negative HbA1c were 20% and 11.1% respectively. Only 68.9% were correctly diagnosed using optimum HbA1c criteria of 6.2%. Subjects with false positive HbA1c were predominantly females with trend towards higher BMI (28.9±9.3 vs 25.5±7.3, p=0.15). False negatives were predominantly males and older (70.3±15.6 vs 60.2±16.7, P=0.072). Conclusions: Population-specific cut-off has to be determined before HbA1c can be utilized to diagnose T2DM. Despite so, significant false positive and negative exist if HbA1c is interpreted alone. HbA1c to diagnose T2DM has to be interpreted with patient's demographic and metabolic profile in entirety
LEFT VENTRICLE DIASTOLIC DYSFUNCTION IN PATIENTS WITH DIABETES MELLITUS TYPE 2: THE FUNCTIONAL AND BIOCHEMICAL MARKERSS. Kukharenko, A. Aleksandrov, N. Yadrikhinskya, A. Shatskaya, N. Drozdova, N.P. Goncharov, S. Kolesnikova, A. Moshina, M.V. Shestakova, I. Dedov
Endocrinology Research Center, Moscow, Russia
Background and Aim: Left ventricle (LV) diastolic dysfunction most often is diagnosed using several indices obtained by echocardiographic methods in clinical conditions. Finding the LV diastolic dysfunction (DD) echocardiographic single index or similar biochemical marker is of great practical importance. Materials and methods: There were examined 66 patients with chronic heart failure I-III NYHA (46 patients with diabetes mellitus type 2 and 20 nondiabetic pts). The functional and morphological indexes of the left ventricular chamber remodeling and systolic function were evaluated by echocardiographic techniques (two-dimensional echo, PW, CW, color and tissue Doppler) in pts. Left ventricular diastolic function paramaters were evaluated using tissue Doppler data on the background of the measuring of biochemical and electrophysiological markers of prognosis of chronic heart failure. Results: Pts with diabetes mellitus type 2 can be exactly and statistically significantly divided on the degree of the LV DD using the measuring of pulmonary capillary wedge pressure (PCWP), obtained with the use of tissue Doppler study (Rigid. type vs Psevdonorm. type of the DD: 9,8+2,3 vs 11,5+2,4, p=0.060; Psevdonorm. type vs Restr. Type of the DD: 11,5+2,4 vs 14,6+2,6, p=0.018). The level of PCWP was correlated strongly and statistically significantly with the concentrations of NT-pro BNP in the blood in pts with type 2 diabetes mellitus (r=0.519, p<0.000). Conclusion: Measuring of the blood concentration of NT-pro BNP allows highly significantly estimate of the degree of LV diastolic dysfunction in pts with diabetes mellitus type 2 without the use of echocardiographic methods.
HIGH PREVALENCE OF CHRONIC COMPLICATIONS AMONG TYPE 2 DIABETIC OUTPATIENTS IN URBAN CHINAB. 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.
PERIFERAL DOPLER ULTRASOUND (PDU) MEASUREMENTS IN DIABETES MELLITUS TYPE 2: RELATIONSHIP TO RISK FACTORS, OTHER MACROANGIOPATHIES AND MICROANGIOPATHY
V.P. Percan, T.M. Milenkovic, I.A. Ahmeti
Medical Faculty, Clinic of endocrinology, diabetes and metabolic disorders, Skopje, Macedonia
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 - β1), 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 - β1 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 - β1 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
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
Background and Objective: The etiology of coronary artery disease in type 2 diabetes (T2DM) involves LDL-associated vascular changes. However, diabetic dyslipidemia is characterized by high triglycerides and low HDL-C without LDL-C elevation. To identify the lipid species responsible for diabetic vasculopathy irrespective of plasma LDL-C concentrations, we chromatographically divided plasma LDL from T2DM patients into 5 subfractions, with L5 the most negatively charged. Major Findings: By suppressing FGF-2 autoregulation and Akt signaling, L5 induced endothelial cell (EC) apoptosis; by provoking EC release of adhesion molecules, it stimulated monocyte-EC adhesion. L5 disrupted the homeostasis between nitric oxide (NO) and endothelin-1 (ET-1) by reducing NO and increasing ET-1 production. The resultant functional disequilibrium may contribute to both endothelial dysfunction and abnormal vascular wall remodeling, as ET-1 is a potent smooth muscle cell (SMC) mitogen. This was evidenced by our finding that conditioned medium of L5-treated ECs promoted SMC proliferation, which was then attenuated by ET-1 receptor antagonists. By accelerating senescence, L5 inhibited endothelial progenitor cell (EPC) differentiation, thus restricting cellular capacities for reendothelialization and collateralization. Moreover, L5 activated MMP-2 and MMP-9 in mature EPCs through MAPK signaling. This may potentially accentuate neovascularization and plaque instability. Additionally, in a hamster model, diet-induced L5 accumulation was associated with atheroma formation and impairment of endothelium-dependent relaxation. Conclusions: Our results strongly suggest that L5 is capable of producing atherogenic and hypertensive changes in the arterial walls of patients with T2DM. Pilot trials are being conducted to confirm the clinical relevance of these findings.
INSULIN RESISTANCE, LIPID PROFILE, C-REACTIVE PROTEIN AND HOMOCYSTEINE IN PATIENTS WITH AUTOIMMUNE THYROIDITIS ASSOCIATED SUBCLINICAL HYPOTHYROIDISM
C. Neves1, R. Ramalho2, M. Alves1, M. Pereira1, E. Carvalho1, I. Pimentel1, C. Palmares2, C. Guimarães2, J.P. Ramos2, D. Carvalho1, L. Delgado2, J.L. Medina1
1Endocrinology Service 2Immunology Service
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 ≥140 mmHg or diastolic blood pressure ≥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
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
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.
REDUCTION OF ARTERIAL STIFFNESS AS ADDITIONAL BENEFIT ON RAMIPRIL THERAPY IN HIGH RISK T2 DIABETIC PATIENTS
O.K. Vikulova, I.R. Yarek-Martynova, M.V. Shestakova
Endocrinology Research Center, Dm. Ulyanova str, 11, Moscow, Russia
Increased arterial stiffness suspected as an important factor of increased cardiovascular risk in type 2 diabetes mellitus (T2DM). We evaluated the arterial stiffness on ramipril therapy in patients with T2DM, arterial hypertension (AH) and at least one additional cardiovascular risk factor. Patients with inadequately controlled blood pressure (BP) >130/80 mmHg on any antihypertensive treatment were included (N=30) . After 2-week wash-out period ramipril 5-10 mg per day was added. Ambulatory blood pressure monitoring (ABPM) and parameters of arterial stiffness using digital arterial tonometry and reactive hyperemia were assessed before and after 12-week treatment. Computerized pulse wave analysis was performed. Augmentation index (Aix) was estimated from the difference between the second (P2) and first (P1) systolic peaks and expressed in % of pulse pressure (PP) ([P2-P1]/PP)x100(%). The study was approved by local Ethical Committee. Results: median age 65.2±6.9yr, M/F 5/25, AH duration 10.1±6.9yr, mean BP 148/85 mmHg, mean HbA1c 8.1±1.8% (HbA1c >7%: 72%, 6.5-7%: 21%, <6.5%: 7% of patients). Increased arterial stiffness was found in 93% of patients. After treatment ABPM showed significant decrease of BP during active (147/78 vs 135/74, p<0.001) and passive period (135/74 vs.129/65 mmHg, p<0.05) . There were statistically reliable differences in parameters of arterial stiffness: Aix (39.9vs 35.3%, p<0.05) and time of ejection period (T [ED/mc]: 295.8 vs. 268.9, p<0.001). We conclude that reduction of arterial stiffness might be an additional benefit of antihypertensive treatment with ramipril in high risk T2DM patients.
ANTHROPOMETRIC ASSESSMENT AND BLOOD PRESSURE IN MEXICAN SCHOOL-AGED CHILDREN
A. Vergara-Castaneda1, L. Castillo-Martinez2, A. Orea-Tejeda2, E. Colín-Ramírez2
1Unam, D.F.,Mexico, Mexico 2incmnsz, D.F., Mexico, Mexico
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,
1Maastricht University Medical Centre, Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands 2VU Medical Center, Amsterdam, The Netherlands
Objective: Blocking the renin-angiotensin system improves insulin sensitivity in hypertensive subjects. The underlying mechanisms are undefined. An effect of insulin that is crucial for stimulating glucose uptake is it’s ability to recruitment skeletal muscle capillaries. This study was designed to investigate the effect of acute angiotensin II AT1 receptor blockade (ARB) on insulin-mediated microvascular function and insulin-mediated glucose uptake in hypertensive subjects. Methods: A randomised, double-blind placebo-controlled trial was performed in 15 untreated mildly hypertensive subjects (BMI 26.9±2 kg/m2, BP 150/92 mmHg), to examine the effects of acute ARB treatment (irbesartan, 600mg, oral single dose) or Ca2+-blockade (felodipine, 10mg idem) as a pressor control on insulin-induced microvascular function and on insulin-mediated whole body glucose uptake (WBGU, mg/kg/min) during a hyperinsulinaemic euglycaemic clamp (50mU/kg/h). Effects of irbesartan and felodipine were compared to placebo. Skin capillary density (n/mm2) and capillary recruitment (peak n/mm2 during post-occlusive reactive hyperaemia, PRH) were measured with capillaroscopy. Subjects were tested on a low sodium diet (100 mmol/day). Results: Compared to the basal state, hyperinsulinaemia increased baseline capillary density (P<0.02). Relative to placebo, irbesartan, but not felodipine, increased insulin-induced capillary density (P<0.02). Insulin-induced capillary recruitment was not altered by either treatment. Neither irbesartan nor felodipine enhanced WBGU. Conclusion: Our data demonstrate that acute AT1-blockade augments insulin-induced capillary density in mildly hypertensive subjects. Although glucose uptake did not increase significantly, the increased insulin-induced microvascular function found with ARB might point to improved insulin and glucose delivery as the underlying mechanism for the improved insulin sensitivity with longterm ARB treatment.
THE TRAP OF THE HIGH RATE OF FALSE-POSITIVE URINARY NORMETANEPHRINE
M. Alves1, M. Faria2, S. Martins2, C. Neves1, M.F. Almeida2, T. Guimarães2, J.L. Medina1
1Endocrinology Service 2Clinical Pathology Service
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: To evaluate the prevalence of hypertension at the patients with NAFLD depending of glycemic status. Material and Methods: 213 patients (161 with NAFLD), evaluated by: BMI, blood pressure(BP) mmHg, fasting plasma glucose (FPG) mg/dl, total cholesterol (TC) mg/dl, LDL–c mg/dl, triglycerides (TG) mg/dl, HbA1c(%), fasting insulinaemia (FI) and HOMA–IR index. The patients with NAFLD vs without NAFLD with normal FPG – group 1 had significantly higher values for: BMI (30,3 vs 28,4), FI (14,5 vs 6,2) and HOMA–IR (3,22 vs 1,43), patients with IFG/IGT – group 2 had: BMI (29,7 vs 27,4), BP (143 vs 132; 78 vs 70), TC (222 vs 203), LDL-c (150 vs 134), FI (14,06 vs 6,65) and HOMA–IR (3,81 vs 1,78) and patients with DM – group 3 had: BMI (33,2 vs 25,5), BP (140,6 vs 132,5; 82 vs 77), FPG (152,5 vs 106,2), HbA1c (7,1 vs 5,9), FI (15,5 vs 7,2), HOMA–IR (6,3 vs 1,86), TG (203 vs 124) and LDL–c(140 vs 102). Conclusions: We found high prevalence of BP (33,3 % vs 25 %) at patients with NAFLD from group 1 with obesity. When NAFLD was associated with glycemic disorders, the prevalence of BP was significantly higher (46,1% vs 34,2%), independent of age, sex, BMI. BP was correlated with FI and HOMA–IR after adjusting for age, sex, BMI, HbA1c at the patients with NAFLD.
SHORT-TERM EFFECT OF THE CILAZAPRIL ON TOTAL, OXIDATIVE AND NONOXIDATIVE GLUCOSE DISPOSAL IN HYPERTENSIVE TYPE 2 DIABETICS
Z. Lukic, M. Lalic, A. Jotic, K. Lalic, T. Milicic, N. Rajkovic, M. Zamaklar, J.P. Seferovic, M. Mitrovic, M. Macesic, M. Aleksic
Institute for Endocrinology, Diabetes and Metabolic Diseases
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
The incidence and prevalence rates of diabetes, particularly type 2, are rapidly increasing worldwide. Hypoglycemia represents a major adverse event complicating the treatement of diabetes. Severe hypoglycemia is associated with significant morbidity, including permanent neurological and occasionally life-threatening outcomes. We performed a retrospective analysis of data from patients with diabetes hospitalized in the Emergency Department of our Institute with a diagnosis of hypoglicemia between 2003 and 2008. We analized the frequency of admissions according to year, age, sex, type of diabetes, comorbidites (acute and chronic), ongoing diabetes treatments, possible causes, code attributed at triage, utilized treatments in the emergency room, and hospitalization rates. Among the 196 enrolled patients we found a higher frequency of type 1 versus type 2 diabetes. The frequency of associated acute diseases was significantly higher for cardiovascular, neurological, and infectious diseases. No significant association was observed between hypoglicemia and the type or schedule of ongoing treatments at the time of admission. The degree of urgency code attributed in the triage process was significantly associated with the hospitalisation rate. Among all the treatments the therapy with boluses of insulin without basal was associated with a significantly lower frequency of hospitalisation. Conversely, no associations were found between hypoglycemia and the other included variables.
NORDIC WALKING DECREASED CIRCULATING CHEMERIN AND LEPTIN CONCENTRATIONS IN PREDIABETIC MIDDLE-AGED MEN
M.E Venojärvi1, M. Manderoos2, N. Wasenius2, M. Hernelahti3, J. Surakka4, H. Lindholm5, O.J Heinonen3, J. Lindström6, S. Aunola7, M. Atalay8, J.G. Eriksson2
1Turku University of Applied Sciences, Turku, Finland, 2University of Helsinki, Helsinki, Finland, 3University of Turku, Turku, Finland, 4Arcada, University of Applied Sciences, Helsinki, Finland
5Finnish Institute of Occupational Health, Helsinki, Finland, 6National Institute for Health and Welfare, Helsinki, Finland, 7National Institute for Health and Welfare, Turku, Finland, 8University of Kuopio, Kuopio, Finland
Introduction: An elevated secretion of various adipokines, including chemerin, IL-6, leptin, RBP-4 and TNF-alpha and decreased secretion of adiponectin are considered to play an important role in the development of diseases like the metabolic syndrome and type 2 diabetes. In the present study, the effects of a 12 weeks exercise intervention on serum levels of adipokines in obese prediabetic men were investigated. Methods: Prediabetic obese men aged 40–65 years were studied at baseline and at 12 weeks in a randomized controlled multi-centre intervention study. Their BMI varied from 25.1 to 34.9. The subjects were randomised to one of three groups: (1) a control group (C, n = 47) that had no supervised exercise during the intervention period, (2) a Nordic walking group (NW, n = 48) that trained aerobically 60 minutes with Nordic walking exercises three times per week, or (3) a resistance training group (RT, n = 49) that trained 60 minutes with strength and power type exercises three times per week. Participants were advised not to change their habitual diet during the intervention. Results: Both types of exercise decreased significantly serum chemerin concentrations compared to control group. In addition, leptin concentration decreased in the NW group. Nordic walking also decreased body fat percentage and improved aerobic performance capacity compared to the RT and C groups. Conclusions: Nordic walking decreased circulating leptin concentrations after 12 weeks of intervention in prediabetic obese middle-aged men and both types of exercise had regulatory effects on circulating chemerin without significant weight loss.
PREDICTIVE FACTORS OF MYOCARDIAL INFARCTION IN TEHRAN CITY: A POPULATION BASE STUDY
K. Sayehmiri1, F. Azizi2
1Ilam university of Medical Sciences,Iran 2Research Institute for Endocrine Sciences,Iran
Introduction: Chronic heart diseases are in chief of cause of death in Iran. Prediction of myocardial infarction in healthy people is very important because it helps them to control some risk factors. Methods: A total 5183 man and woman more than 3o years old in east of Tehran, follow from 1998 till 2008 . The mean of follow up time was 6.5 years. Data analyzed using Cox proportional hazard regression. Results: Multivariate proportional Cox regression models show that diabetes(RR=4.81; 95% CI, 2.9-7.95; P=<.000), SBP(RR=1.8;95% CI,1.05-3.09; P<.001), LDL(RR=1.76; 95% CI,1.01-3.1; P<.045 ), TG(RR=1.84; 95% CI,1.13-3; P<.013), smoking(RR=2.22; 95% CI,1.17-4.2), sex(RR=2.27; 95% CI, 1.33-3.86; P<.003) and age(RR=1.05; 95% CI, 1.02-1.07; P<.001) are independed risk factors for myocardial infarction. The number of MI risk factors classify to three groups (<5,5-6,>6 ) is the best variable to access the hazard of MI. Conclusion: The hazard of MI is predictable using Diabets, SBP, LDL, TG, smoking, sex and age . Key words: myocardial infarction; prediction; Cox proportional hazard regression models.
INSULIN RESISTANCE, LIPID PROFILE, C-REACTIVE PROTEIN AND HOMOCYSTEINE IN PATIENTS WITH AUTOIMMUNE THYROIDITIS AND SUBCLINICAL HYPOTHYROIDISM
C. Neves1, M. Alves1, E. Carvalho1, I. Pimentel1, M. Pereira1, R. Ramalho2, C. Palmares2, C. Guimarães2, J.P. Ramoas2, D. Carvalho1, L. Delgado2, J.L. Medina1
1Endocrinology Service, São João Hospital, Faculty of Medicine, University of Porto, Portugal. 2 Immunology Service, São João Hospital, Faculty of Medicine, University of Porto, Portugal
Background: Thyroid function, insulin resistance, serum lipid, C-reactive protein (CRP) and homocysteine are associated with an increased cardiovascular risk in patients with autoimmune thyroiditis (AIT).Objective: To evaluate the interrelations between hyroid function, insulin resistance, serum lipid concentrations, CRP and homocysteine in patients with AIT and subclinical hypothyroidism. Subjects and Methods: We recorded thyroid function tests, BMI and the levels of total cholesterol (TC), HDL, LDL-cholesterol, triglycerides (TG), apolipoprotein B (ApoB), ApoA1, lipoprotein (a) (Lp[a]), homocysteine, CRP, folic acid, vitamin B12, and insulin resistance markers comprising the HOMA-IR, HISI (Hepatic Insulin Sensitivity Index), WBISI (Whole-Body Insulin Sensitivity Index), IGI (Insulinogenic Index) in 500 patients with AIT, with a mean age of 47.2±14.8 years. A 75-g OGTT was performed in the morning, and blood samples were obtained every 30min for 120min for measurements of plasma glucose, insulin, and C-peptide. Statistical analysis was performed with ANOVA and Pearson’s Correlations test. A two-tailed p value < 0.05 was considered significant. Results: TSH levels were 3.680±11.877 UI/mL and BMI was 27.5±5.6 kg/m2. There were significant positive correlations between TSH and serum TC (r=0.167; P<0.001), LDL (r=0.131; p= 0.004), TG (r=0.168; P<0.001), and ApoB (0.141; P=0.008). We found significant positive correlations between IGI and anti-TPO (r=0.179;P=0.005), CRP (r=0.162;P=0.02), and TSH(r=0.126;P=0.048). We also found significant positive correlations between HISI and TSH (r=0.173;P=0.006), and significant negative correlations between WBISI and CRP (r=-0.181;P=0.008). Conclusions: In patients with AIT, there are positive associations between the levels of TSH, the lipid profile, and insulin resistance markers, such as IGI, and HISI.
CONTROVERSIES IN SOLUBLE RECEPTOR FOR ADVANCED GLYCATION ENDPRODUCTS AND EN-RAGE IN T1 AND T2 DIABETES MELLITUS
J. J. Skrha jr.1,2, A. Germannova2, J. Svarcova2, M. Kalousova2, T. Zima2, J. Skrha1
13rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague 2Institute of Clinical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University, Prague
The aim of the study was to compare concentration of soluble receptor for advanced glycation endproducts (sRAGE) and natural pro-inflammatory ligand EN-RAGE (extracellular RAGE-binding protein) with glycated hemoglobin (HbA1c), diabetes duration and albuminuria in Type 1 (T1DM) and Type 2 (T2DM) diabetes mellitus. Total number of 45 T1DM (age 47±13 yrs, diabetes duration 21±12 yrs) and 68 T2DM (age 64±10 yrs, diabetes duration 12±9 yrs) were examined. Control group consisted of 44 healthy persons. Serum sRAGE and EN-RAGE concentrations have been determined by ELISA kits. HbA1c was estimated by HPLC and albuminuria by immunonephelometry. Serum sRAGE concentration was significantly higher in both T1DM (1137±78 ng/ml, p<0,001) and T2DM (995±63 ng/ml, p<0,001) compared to healthy persons (821±46 ng/ml). Similarly, EN-RAGE was significantly higher in T1DM (253±29 ng/ml, p<0,001) and T2DM (292±25 ng/ml, p<0,001) than in the controls (128±17 ng/ml). Significant positive relationship was found between sRAGE and HbA1c (r=0.36, p<0.05), diabetes duration (r=0.58, p<0.01) and albuminuria (r=0.39, p<0.05) in T2DM, but not in T1DM. Serum EN-RAGE did not correlate with these parameters in neither T1DM nor T2DM. Serum sRAGE is an important biomarker in many pathological states. Its association with HbA1c, diabetes duration and albuminuria in T2DM but not T1DM needs further investigation.
HAEMOGLOBINA1C DERIVED AVERAGE BLOOD GLUCOSE ARE MISLEADING
G.M. Jørgensen, B. Borggaard
University of Copenhagen
A Haemoglobin A1c (HbA1c) derived plasma glucose (PG) concentration has recently been proposed to alleviate confusion by the presence of two HbA1c standardizations. The present study was initiated to investigate the stochastic dependency of PG on HbA1c, evaluate the prerequisites for its calculation, and describe the scatter of glucose around HbA1c. In a large county population under glycaemic control a number of 858 individual pairs of randomly selected HbA1c and PG concentrations were investigated. The samples were standardized analysed at the department of clinical chemistry. As criteria for category selection was used a comparison of the empirical vs. the fitted probit plot in classes that fulfilled the criteria. The significance was tested by the slope deviation from 1 and R2 from zero. The scatter of PG was illustrated in a prediction plot with the 95% prediction interval as indicator of the individual variability. Mean and median age of all cases were 62 years ( 25% vs. 75% centiles: 53 vs. 73 years). Fifty three % were males. Females were on average 3 years older than men. The mean HbA1c NGSP was 6.6 % (median 5.9%, 25% vs. 75% centiles: 5.4% vs. 6.8%). Mean PG was 6.9 mmol/l (median 5.8 mmol/l, 25% vs. 75% centiles:5.2 vs. 7.3 mmol/l). No serious gender differences were present. The distribution of markers was not Gaussian. Transformation into International Federation Clinical Chemistry (IFCC) units or ln transformation did not improve this. Two resultant HbA1c classes (< vs.³ 6.8 NGSP units) were considered. The stochastic dependency in categories was 0.163 vs. 0.638 (p< 0.001) with unexplained variation of 83% vs. 36 (p< 0.05). The empirical glucose concentrations varied highly around HbA1c and the derived glucose (maximal deviation: -6.68 to +10.84 mmol/l glucose). The measurement of glucose may will give more optimised reliability on clinical situation than the estimated average glucose
CLINICAL AND LABORATORY CHARACTERISTICS OF PATIENTS WITH DIABETES MELLITUS TYPE 2 AND EVALUATION OF COAGULATION PARAMETERS AND METABOLIC COMPENSATION INDICES
I.F. Fotopoulou1, E.P. Kariori2, S.I. Paratiras1, E. Jelastopulu2, A.A. Nikolopoulou1
1Laboratory of Haematology, Saint Andrews General Hospital, Patras, Greece 2Department of Public Health, School of Medicine, University of Patras, Greece
Introduction: Type 2 diabetes mellitus (T2DM) is a leading cause of vascular morbidity and mortality, since it constitutes a risk factor for cardiovascular and cerebrovascular diseases. The aim of this study was to describe the main clinical and laboratory characteristics of patients with T2DM and to evaluate coagulation parameters and other biochemical, haemostatic and clinical parameters in comparison to non-diabetic controls. Methods: A case control study was conducted during the year 2008 including patients with T2DM and non-diabetic controls. Biochemical, hemostatic and metabolic compensation parameters were recorded. Statistical analysis was made using SPSS v.17.0. Results: The study included 52 type 2 diabetes mellitus patients and 32 controls. Among the diabetic patients, 81% were not appropriate treated, 27.6% suffered from undertreated hypertension, 12.1% from hypercholesterolemia and 17.2% from hypertriglyceridemia. Increased fibrinogen levels were observed in 17.2%, low ATIII, PC and PS in 3.4%, 1.7% and 12.1% respectively. Diabetes-related diseases were observed in 8.6% of the patients. We observed significantly higher mean levels in diabetic patients than controls for fasting plasma glucose (162.50 vs 97.9mg/dl, p<0.001), HbA1c (6.83% vs 4.66%, p=0.003), albumin (37.43 vs 6.97mg/l, p=0.003), fibrinogen (328.2 vs 298.7mg/dl, p=0.041), ATIII (100.6% vs 88.9%, p=0.038), PC (109.5% vs 96.5%, p=0.009), and PS (90.4%, 67.5%, p<0.001). Significantly higher mean ratio A/C was calculated in diabetic patients (32.26 vs 5.94, p<0.001). Conclusions: The study demonstrates substantial deficits in control and therapy of diabetic patients and underlines the need for improvement in diabetes management, especially in the face of increased risk of vascular diseases.
GLUCOSE 6 PHOSPHATE DEHYDROGENASE (G6PD) DEFICIENCY AS A RISK FACTOR FOR DEVELOPING INSULIN DEFICIENT DIABETES
J. Cohen, B. Shainberg
Maccabi Health Services, Diabetes Clinic. Israel
Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common human enzyme defect, being present in more than 400 million people worldwide. G6PD deficiency is an X-linked, hereditary genetic defect due to mutations in the G6PD gene, which cause functional variants with many biochemical and clinical phenotypes. The intracellular enzyme glucose-6-phosphate dehydrogenase (G6PD) catalyzes the first step of the pentose phosphate pathway, producing reduced nicotinamide adenine dinucleotide (NADPH), the principal cellular reductant in all cell types. Although there are other metabolic pathways that produce NADPH, G6PD is the predominant source for cellular defense against oxidative stress. Observational data: in our clinic 30 diabetes patients were diagnosed as G6PD deficient, G6PD activity was measured because of a false low level of HbA1c, which did not correspond to their blood glucose monitoring, laboratory glucose tests, and fructosamine. In these individuals G6PD enzyme activity was nearly absent. Diabetes characteristics: 24 men and 6 women, mean age at diagnosis 37±9.2 years, average body mass index [BMI] 25±3.1 kg², low levels of C-Peptide. Conclusion: in our study group G6PD deficient diabetes patients are predominant males, diagnosis mean age and BMI lower than frequent type 2 diabetes patients in Israel, most of them are insulin dependent at the beginning of the disease. Deficiency of G6PD activity of a Mediterranean type or a variant mutation, seems to predispose insulin deficient diabetes due to oxidative stress. To determine the extent of this phenomenon and the risk to develop the disease, epidemiological and genetic studies are required.
THE QUALITY OF DIABETES CONTROL IN DIFFERENT THERAPEUTIC REGIMENTS
P. Polovina1, T. Nemet2, D. Micic1
1Snezana Polovina, General Hospital Subotica, Serbia 2Klara Tucic Nemet, General Hospital Subotica, Serbia 3Jelena D. Micic, Clinic of gynecology and obstetrition, Clinical Center Serbia
Aim: to investigate which therapeutic approach in T2DM has the best diabetes regulation according average values of HbA1c. Material and methods: we have analyzed the values of HbA1c of 99 patients from diabetic ambulance. They were divided in three groups: group I (n=33) on oral anti diabetic agents, group II (n=33), on conventional insulin therapy and group III (n=33) on intensive insulin therapy. We have calculated the average values of HbA1c on the beginning and six months after change of therapeutic approach Results: the average value of HbA1c on the beginning, in group I was 8.92% (±3.2), in group II 6.88% (±2.3), in group III 9.7% (±2.8). After six months HbA1c in group I was 6.8% (±2.3), in group II 9.7% (±2.8), and in group III 7.5% (±2.6). The difference in HbA1c value on the start and after six months was in group I 2.1%, in group II 2.03%, in group III 1.97%. In group on oral anti diabetic drugs there was good diabetes control (HbA1c<7.0%) in 10%, on conventional therapy 57% and on intensive therapy 33%. Conclusion: our results suggest that the best glycemic control have the patients with T2DM on conventional insulin therapy, and the worst on oral agents. Unsatisfactory decrease of average HbA1c in group on intensive insulin therapy might be regarding late intensification insulin therapy in patients with secondary failure of conventional therapy and high starting values of HbA1c.
RELATIONSHIP BETWEEN NUTRITIONAL STATUS OF VITAMIN D AND ANTHROPOMETRIC AND BIOCHEMICAL PARAMETERS DESCRIBED IN METABOLIC SYNDROME (METSYN)
N.J. Schuch, V.C. Garcia, M.O. Cicca, A.C. Siqueira, R.M. Fisberg, S.R.G. Vivolo, L.A. Martini
University of Sao Paulo. Sao Paulo. Brazil
Metabolic syndrome (MetSyn) has been associated with vitamin D status. The objective was to evaluate the relationship between nutritional status of vitamin D (Grant & Holick, 2005) and parameters described by MetSyn (NCEP-ATP III) in 409 adults in Sao Paulo, Brazil. After an overnight fasting, a single blood sample was collected and anthropometric measurements were undertaken. The dietary intakes of participants were evaluated by a 24h dietary record. For nutrient analysis the Nutrition Data System software was used. Serum levels of 25(OH)D3 was measured by HPLC while iPTH and serum calcium by standard methods. Statistical analyses (Student T and Chi-Square tests, p<0.05) had been made in the SPSS (v 17.0 for Windows). 47% of the participants presented MetSyn. Comparing individuals without and with MetSyn, the means(sd) of age 46(15) vs 56(12)years, BMI 27(5) vs 31(6)kg/m2, waist circumference 92(13) vs 104(13)cm, fasting glucose 89(10) vs 99(12)mg/dl, iPTH 41.9(17.6) vs 49.0(22.9)pg/ml and serum calcium 9.3(0.6) vs 9.4(0.5)mg/dl were significant higher in individuals with MetSyn. The mean calcium dietary(601mg) and vitamin D(2.9µg) intakes was low in all participants. Vitamin D insufficiency was present in 85% of individuals. The serum levels 25(OH)D3 was 56.6(17.7). In women with MetSyn, the concentrations of 25(OH)D3 was significantly higher when compared to without MetSyn, 62.7(18.4) vs 52.0(15.2)nmol/L, respectively. The study showed high prevalence of vitamin D insufficiency. A positive association between MetSyn only in women indicates that other factors such as hormonal and body composition should be investigated.
WEIGHT LOSS REDUCES URINARY ALBUMIN EXCRETION IN PATIENTS WITH METABOLIC SYNDROME
B. de Paula, G.A. Ezequiel, C. Machado, B. Costa
Federal University of Juiz de Fora
The relationship between metabolic syndrome (MS) and renal damage in non-diabetic obese patients is not well understood. The aim of this study was to investigate the impact of weight loss in urinary albumin excretion (UAE) and renal functional reserve (RFR) in non-diabetic patients with MS. Outpatients with MS were recruited at the Nephrology Unit of Federal University of Juiz de Fora. Thirty-five patients were evaluated before (phase 1) and after 3 months on a calorie-restricted diet (phase 2). Metabolic profile included fasting plasma glucose and 2h-post glucose overload, lipids and uric acid while renal evaluation was made by determining UAE and creatinine clearance. To estimate RFR, patients were submitted to creatinine clearance calculation before and after an acute protein overload. Two groups were constituted: patients who succeeded in losing weight (R- responders, N= 14) and patients who did not achieve the target weight reduction, (NR- non-responders, N= 21). Patients in R group showed a better lipid profile, UAE reduction (median = 162.5mg/24h, at phase 1 vs 10.4 mg/24h, at phase 2) as well as a significant reduction of the creatinine clearance (121.4.3 ± 66.5 mL/min to 92.9 ± 35.6 mL/min (p=0.001) while in NR group, there were no statistically significant differences in UAE and creatinine clearance after phase 2. In conclusion, weight reduction has a positive impact on glomerular hyperfiltration, characterized by reduction of UAE and creatinine clearance.
ANTHROPOMETRIC MEASUREMENTS FOR PREDICTION OF THE METABOLIC SYNDROME IN CHINESE ADULTS
W.H. Xu1, J. Gu2, Y. Wu3, G. Zhao1, H. Zhang3, Q. Jiang1, Y. Bai2, Q. Zhu1, X. Fu2, Y. Zhou3, H. Qiu3, X. Ruan2
1Department of Epidemiology, school of Public Health, Fudan University 2Health Bureau of Shanghai Pudong New Area 3Pudong New Area Centers for Disease Control and Prevention
ABSTRACT: We evaluated and compared the predictive value of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) for metabolic abnormalities and the metabolic syndrome (MS) in Chinese adults. A cross-sectional study was conducted in 5584 adults at age 20-79 randomly selected from Pudong New Area of Shanghai, China, through a three-stage sampling. Anthropometric variables and blood pressure were measured according to a standard protocol and a fasting blood sample was collected for biochemical analysis. The metabolic abnormalities and the MS were defined by the modified criteria of National Cholesterol Education Program Adult Treatment Panel III report (ATP III). After adjusting for age, a significant linear correlation was observed for measured BMI, WC, WHR and WHtR with individual metabolic variables. Prevalence of the MS was also observed to increase with increasing BMI, WC, WHR or WHtR in both sexes. Participants with the MS or any non-adipose metabolic abnormalities had a higher BMI, WC, WHR or WHtR than those without, and a significant association was observed between these measures and the metabolic disorders. Areas under the receiver operating characteristic curves (AUC) for the anthropometric parameters indicated that WHtR had higher predictive ability for the MS and individual metabolic abnormalities in both men and women and provided a satisfactory balance between sensitivity and specificity. In conclusion, WHtR may be a better predictor for the MS and metabolic components in Chinese adults.
SOLUBLE E-SELECTIN AND 24H URINE ALBUMIN, ENDOTHELIAL CELLS DYSFUNCTION BIOMARKERS, MAY DISCRIMINATE AGAINST DIFFERENT LEVELS OF CARDIOAVASCULAR RISK IN PERSONS WITH THE METABOLIC SYNDROME
T. Majnariæ1, B. Vitale2
1Faculty Of Medicine Osijek , Osijek, Croatia 2institute Rudjer Boškoviæ Zagreb, Zagreb, Croatia
Hypertension has been suggested to have a higher propensity for developing cardiovascular diseases than other features of the metabolic syndrome. Endothelial cells dysfunction is thought to have a central role in hypertension-induced of the both, end-organ disease and atherosclerosis. We proposed that markers of endothelial cells dysfunction, soluble E-selectin and 24h urine albumin, can be used to discriminate against different levels of cardiovascular risk in persons with the metabolic syndrome. We measured soluble E-selectin concentrations in the blood and 24h urine albumin in a group of 116 volunteers, 50-65 years old (median 57). Patients were divided into six groups, depending on whether they have hypertension and elevated triglycerides. Groups were assigned as follows: 1)non-hypertension, non-hypertriglyceridemiae, 2) non-hypertension, hypertriglyceridemiae, 3) mild-moderate hypertension, non-hypertriglyceridemiae, 4) mild-moderate hypertension, hypertriglyceridemiae, 5) severe hypertension, non-hypertriglyceridemiae and 6) severe hypertension, hypertriglyceridemiae. We found significantly increased soluble E-selectin blood concentrations in a patient group with mild-moderate hypertension and hypertriglyceridemiae and 24h urine albumin in a patient group with severe hypertension and hypertriglyceridemiae, compared to the lower ranked patient groups (Kruskal-Wallis ANOVA test, p<0,05). Marker of inflammation, total leukocyte count, significantly raised at the stage 2 (non-hypertension, hypertriglyceridemiae) (K-W ANOVA, p<0,05), and C-reactive protein significantly raised at the stage 4 (mild-moderate hypertension, hypertriglyceridemiae) (K-W ANOVA, p<0,05). Results showed that hypertension, especially when combined with elevated triglycerides, is associated with endothelial cells dysfunction. We suggest a cumulative scoring system and measuring markers of endothelial cells dysfunction when assessing cardiovascular risk in patients with the metabolic syndrome.
DIETARY-INDUCED WEIGHT LOSS DECREASES MACROPHAGE CONTENT IN ABDOMINAL BUT NOT IN GLUTEAL ADIPOSE TISSUE OF OBESE WOMEN
M.T. Kovacikova1, C. Sengenes2, Z. Kovacov1, M.S. Vitkova1, E. Klimcakova1, J. Polak1, L. Rossmeislova1, Z. Wedellova1, K. Koppo1, A. Bouloumie2, D. Langin2,
1Department of Sports Medicine and Franco-Czech Laboratory for Clinical Research on Obesity, Third Faculty of Medicine, Prague, Czech Republic 2Inserm, U858, Obesity Research Laboratory, Rangueil Institute of Molecular Medicine, Toulouse, F-31432 France
Introduction: Obesity is associated with increased accumulation of macrophages in adipose tissue (ATM) and may be possible cause of insulin resistance and other metabolic complications. The aim of this study was to investigate the effect of long-term dietary intervention (DI) on content of macrophages in subcutaneous adipose tissue (SAT) of obese patients and to compare two depots of SAT: abdominal (AB) and gluteal (G) in this term. Design and methods: 16 obese pre-menopausal women (age 39 ± 2 years, BMI 33.3 ± 0.5 kg/m2) underwent 6 month DI consisting of 4 weeks very low calorie diet, subsequent 2 moths´ low calorie diet and 3 months´ weight maintenance diet. At baseline and at the end of intervention paired samples of AB and G SAT were obtained by needle biopsy and blood samples were drawn. ATM content was analyzed by flow cytometry using CD45, CD14, CD206 markers and gene expression of macrophage specific markers was determined by real-time PCR in both SAT depots. Results: 6 month DI induced a decrease of body weight (p<0.001), plasma C- reactive protein (p<0.05) and HOMA-IR (p<0.001). ATM content defined by CD45+/14+/206+ decreased only in AB (p<0.01), but not in G SAT (ns). These results were also reached for mRNA levels of macrophage markers (CD14, CD163, CD68, LYVE-1). Conclusion: 6 months´ weight-reducing DI promotes a decrease of content of macrophages only in AB SAT. G SAT stayed in this term metabolically silent and did not contribute to changes during diet. The study was supported by a grant from The Ministry of Health of the Czech Republic (IGA NS 10519-3-2009), research projects of MSMT of Czech Republic MSM 0021620814 and by projects HEPADIP (www.hepadip.org) and ADAPT (www.adapt-eu.net) supported by the Commision of European Communities.
CHARACTERISTICS OF METABOLIC SYNDROME IN ESTONIAN ADULT POPULATION
T. Eglit, M. Lember, T. Rajasalu
Department of Internal Medicine, University of Tartu, Tartu, Estonia
Objective: The aim of the study was to estimate the prevalence of metabolic syndrome (MS) in Estonian adult population and to evaluate associations between insulin resistance and the components of MS. Research design and methods: We studied a cross-sectional, population-based sample (n = 502), aged 20-75 years, corresponding to the age and gender structure of the general population in Estonia. The MS was diagnosed by the Adult Treatment Panel (ATP III) criteria. Insulin resistance (IR) was estimated by homeostasis model assessment (HOMA-IR) and defined as the gender specific upper quartile of HOMA-IR in individuals without known diabetes. Results: The prevalence of MS was found to be 28% (30% and 26% for men and women, respectively). 59% of the men and 66% of the women with MS were insulin resistant according to the HOMA-IR. Estimation of the associations between IR and the characteristics of MS revealed the highest correlation for waist circumference and fasting glucose for both sexes (r values 0.55 and 0.49 for waist circumference and 0.52 and 0.57 for fasting glucose for men and women, respectively). The weakest associations were found between IR and diastolic blood pressure for men (r = 0.23) and between IR and HDL-cholesterol for women (r = - 0.25). Conclusions: The prevalence of MS among Estonian adults is similar to the prevalence reported from other Western countries. IR is not a unifying trait of MS. The associations between IR and the individual components of MS vary significantly.
METABOLIC SYNDROME IN REPRODUCTIVE CLINIC
T. Gegechkori, G. Gulbani, A. Sabakhtarashvili
Zhordania Institute of Human Reproduction, Tbilisi, Georgia
Nowadays metabolic syndrome (MS) is quite popular. The MS is the combination of pathogeneticaly related symptoms such as insulin-resistance (IR) / hyperinsulinemia (HI), obesity (O), arterial hypertension (AH), dyslipidemia, diabetes mellitus type II or disorders in tolerance toward carbohydrate, atherosclerosis. IR/HI is the is basis of the MS. At the same time it is the factor of disordered reproductive functions in women and independent factor for polycystic ovary in particular. Investigations of many authors dedicated to the problem – how to detect which factor is the prime among them IR or HI, the common opinion about the problem is absent. The aim of our investigations was to detect the role of IR and interrelated HI during reproductive pathologies – the Diencephalyc syndrome accompanied with metabolic derangements and Insulin-resistant metabolic syndrome with secondary polycystic ovary. Investigations were carried out in the Zhordania Institute of HR. A total of 521 patients with age 16 to 40 and 47 healthy women (control) were under observation. Anamnesis and state menstrual and reproductive functions were studied. The objective status-BMI (kg/m2), lumbar/femoral ratio(I L/F), hirsute index and other dermatopathies; Instrumental investigations of pelvic; Hormonal testing – FSH, LH, PRL, IRI, fr,TST, DEA-S. It is supposed that in the pathogenesis of reproductive diseases accompanied by insulinresistant metabolic derangemrnts the leading role play hyperandrogenia, IR and related visceral obesity. The difference is that, initiating factor in case of IR-MS with OPS is IR/HI, and case of neuroendocrine type of diencepalyc syndrome – excess body mass determined by hypothalamic dismodulation.
PATIENTS’ AND PHYSICIANS’ ATTITUDE AND EXPECTATIONS FOR TREATMENT OF METABOLIC SYNDROME - A EUROPEAN STUDY
B. Schau1, M. Bielfeldt2, C. Schröck3
1Omron Healthcare Europe, Mannheim Germany 2Perleberg Pharma Partner Health Research GmbH, Barcelona, Spain 3Perleberg Pharma Partner Health Research GmbH, Hamburg, Germany
Metabolic syndrome, a cluster of cardiovascular disease risk factors, is a growing health epidemic in developed as well as in developing countries. Therefore the right strategy in the treatment of metabolic syndrome becomes increasingly important. So far tremendous efforts have been made in its treatment including medical therapy as well as lifestyle changes and diet with relatively little success. The question is whether we can identify a missing link for the development of a holistic concept in the treatment of metabolic syndrome. Methods: We undertook a qualitative research in Germany, UK, France, Italy and Spain to get insight into attitude and expectations of patients with metabolic syndrome (n=74) and the involved physicians (n=40). Results: Our study revealed that the different official definitions of metabolic syndrome are perceived as too restrictive. Many more factors including psychological aspects need to be considered and the latter may even be the key drivers for successful interventions. During our study, all stakeholders stressed the importance of overcoming the motivational barriers in the treatment of metabolic syndrome. Furthermore our results emphasized the tremendous importance of an individualized treatment approach that would enhance the general acceptance by patients and their doctors, thus increase the success rate of the therapy. Conclusions: To successfully address the global challenge of metabolic syndrome, we need a holistic concept addressing not only physical but also psychological dimensions in metabolic syndrome. Such new concepts require an individualized treatment strategy as well as the close cooperation of different medical specialities.
BENEFICIAL EFFECTS OF 2 YEARS TESTOSTERONE ON THE METABOLIC SYNDROME AND NAFLD AND CRP
A. Saad1,2, A. Haider3, S. Padungtod4, J.G. Gooren5
1Scientific Affairs Men's Healthcare, Bayer Schering Pharma, Berlin, Germany2Gulf Medical University School of Medicine, Ajman, UAE 3Private Urology Practice, Bremerhaven, Germany 4Faculty of Veterinary Medicine, Chiangmai University, Chiangmai, Thailand 5Dpt of Endocrinology, VU Medical Center, Amsterdam, The Netherlands
Background: Elderly men often show a concurrence of a decline of testosterone with features of the metabolic syndrome. This study tested the effects of normalization of testosterone. Subjects and methods: 122 hypogonadal men (18 – 83 years, mean 59.6 ± 8.0 years), with testosterone levels between 0.14 –4.51 ng/mL (N>4.90 ng/ml) were treated with parenteral testosterone undecanoate for 2 year as the sole intervention. Results: Plasma testosterone rose from 3.3 ± 1.9 ng/mL to 4.1 ± 1.5 ng/mL ( P< 0.01) at 3 months, then stabilized at 6.8 ± 1.3 ng/mL after the first 6 months. There was a remarkable progressive linear decline of body weight, BMI and waist circumference over the full study period. Plasma cholesterol decreased significantly over the first 12 months, then stabilized. Plasma glucose, triglyceride, LDL-cholesterol and C-reactive protein decreased significantly and HDL-cholesterol increased significantly over the 24 month study period in a non-linear fashion. There was a significant decrease of levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) over the first 12 and 9 months, then values leveled off. Changes in variables were largely correlated with changes in testosterone levels. At baseline 47/122 met the criteria of the metabolic syndrome as defined by the National Cholesterol Education Program (2001); after two years of testosterone treatment this number had declined to 11/122. Conclusion: With testosterone treatment over two years, the most significant improvement of the metabolic syndrome was noted over the first 12 months but over the following 12 months further improvement was observed.
INFLAMMATORY INDICES AND INSULIN RESISTANCE IN PATIENTS WITH METABOLIC SYNDROME WITH AND WITHOUT ISCHEMIC HEART DISEASE
M. Solati1, M. Nikparvar2, M. Khademi1, M.D. Zahedani3
1Department of Internal Medicine and Endocrinology, Hormozgan University of Medical Sciences, Iran 2Department of Cardiology, Hormozgan University of Medical Sciences, Iran 3Department of Pathology, Hormozgan University of Medical Sciences, Iran
BACKGRUND: Prospective studies have demonstrated that markers of inflammation such as hsCRP, fibrinogen and insulin level Predict future cardiovascular disease risk. The aim of this study was to assess the association of insulin resistance and inflammatory markers with the occurrence and extent of CAD in the patients with metabolic syndrome. METHODS: Plasma level of FBS, oral glucose tolerance test (OGTT),insulin, fibrinogen, TG, LDL-C, HDL-C, ESR, C-reactive protein (CRP), magnesium(Mg) and calcium (Ca) were measured in 24 patients who had metabolic syndrome with coronary arteries diseases (cases),and 25 patients who had metabolic syndrome without CAD (controls). CAD was documented by coronary angiography. RESULTS: There was a significant increased level of hsCRP and fibrinogen in IHD patients (p value<0.001). Although the insulin level, ESR and smoking were higher in cases but differences were not significant. CONCLUSION: Elevated levels of inflammatory markers, particularly hsCRP and fibrinogen level indicate an increased risk of coronary heart disease.
THE ASSOCIATION OF METABOLIC SYNDROME AND FOOD PATTERN IN NON-MENOPAUSE WOMEN
M. Hajifaraji1, S. Haddad Tabrizi Sara2, F. Hussein Panah F3, A. Houshiar Rad4, A.R. Abadi5
1NNFTRI- Shahid Beheshti University of Medical Sciences 2Shahid Beheshti University of Medical Sciences 3Research Institute of Endocrine Sciences of Iran –SBMU 4NNFTRI- Shahid Beheshti University of Medical Sciences 5Shahid Beheshti University of Medical Sciences
Objective: The relationship of food patterns with metabolic syndrome (MetS) among Tehrani non-menopausal women was studied. Methods: Study was conducted as Nested case-control. MetS was defined based on IDF guideline. 920 non-menopause women 18-50 yr old were selected. Dietary intakes were assessed via 168 item semi-quantitative FFQ. Factor analysis-PCA, was used to derive the dominant food patterns among, those without having any specific diet. In the second stage, 135 cases of MetS were matched to 135 controls for age, and dietary pattern score was calculated for subjects in both food patterns of matched groups. Results: Mean age of subjects was 31± 9 yr and their BMI was 25.7 ± 5.2 Kg/m2. 14.7% of non- menopausal women had undistinguished metabolic syndrome. Two dietary patterns were identified explaining 23% of the dietary variation in the study. Matching for age, the difference between two groups was non-significant. Adjusting for energy intakes, energy expenditure, education level, job, family history of diabetes or stroke, smoking and BMI, the desirable food pattern was inversely associated with MetS (odds ratio: 0.87, P-value < .001), and hyperglycemia (odds ratio: 0.34, P-value < .05). Among components of metabolic syndrome (WC, TG, FBS, HDL-C, BP), only triglyceride was associated with this food pattern (odds ratio: 2.17, P-value < .001). Conclusion: Desirable food pattern including vegetables, fruits, low fat dairy, legumes, nuts, egg, oil and whole grains is significantly associated with reduced MetS, whereas undesirable food pattern has no association. Key Words: metabolic syndrome, food pattern, non-menopause women, factor analysis.
COMPARISON OF DIAGNOSTIC PROPOSALS FOR METABOLIC SYNDROME IN A MEXICAN ADOLESCENT POPULATION, BASELINE EVALUATION OF RIESGO COHORT (REGISTRY OF MEDICAL STUDENTS FOR EMERGENT OBESITY AND CARDIOVASCULAR RISK FACTORS)
C. Rodríguez-Leal1, L.G. Mancillas-Adame2, F.J. Lavalle-González2, J.Z. Villarreal-Pérez2,
J.G. González-Gónzalez2, J. Montes-Villarreal2, P.A.García-Hernández2, Z.M. Hernández-Lorenzo2
1Internal Medicine Department, University Hospital "Dr. José Eleuterio González", Monterrey, México 2Endocrinology Service, University Hospital "Dr. José Eleuterio González", Monterrey, México
Abstract: The prevalence of Metabolic Syndrome (SdM) has been confirmed in different ethnic groups including Latin-American population. There are not previous studies on prevalence of SdM in adolescent population using different criteria. Subjects and Methods: 148 subjects, age 16 to 24, 45.2% women, all Hispanic. The prevalence of SdM was compared previous blood sampling for TG, HDL and glucose levels, anthropometric and blood pressure measuring, using DeFerranti, IDF, Cook, Weiss and Ford criteria. Results: The mean values for glucose were 84.89 mg/dL, CC 78.6 cm, TG 47.01 mg/dL, HDL 68.87 mg/dL, systolic/diastolic 115/73 mmHg. The prevalence of SdM using De Ferranti criteria is 7.4% , 6.8% with IDF, 4.1% with Ford, 6.1% with Cruz, 2.7% with Weiss and only 1.3 subjects with SdM were reported using Cook criteria. Being more prevalent in the males, except when using Weiss criteria. Conclusion: No variation was found in the incidence of SdM when compared with previous studies.
NUTRITIONAL HABITS AND CARDIOVASCULAR DISEASE
S. Capitão, H. Sampaio, V. Ferro Lebres
Polytechnic Institute of Braganca, Bragança, Portugal
An elevated predominance of the risk factors associated to the illnesses of the circulatory system, particurily hypercholesterolemia and arterial hypertension aim for a special attention to its prevention. This way, the composition of the digested food daily can influence the sprouting of Cardiovascular Disease (CVD), which has shown association between the risk factors and the things we consume. The present study had an objective to identify the influential factors of social economics and education in the nutritional state and in the sprouting of CVD. There were 234 individuals studied over the age of 18, belonging to a population of the northeast of Portugal. Experienced and trained professionals collected anthropometry facts and carried out an interview where personal information, from personal and social level and relative facts to the normal and daily ingesta habits. The total individuals inquired 63% are of the female sex and 37% of the male sex, 37% demonstrate excess weight and 23% Obesity. The married couples, 22% demonstrate risk factors of CVD, 25% that live with family, 5% that live alone, 23% of the individuals with a low education level and 41% of the individuals that are found inactive, present risk factors of CVD. This work reflects the lifestyles and the nutritional habits of the population in study. In conclusion we found that the social economical and educational lifestyles are associated to the presence or absence of risk factors of a cardiovascular disease, influencing the ingesta and the BMI of the individuals.
THE IMPACT OF EXERCISE ON VISCERAL OBESITY AND ENDOTHELIAL DYSFUNCTION AT YOUNG SUBJECTS WITH METABOLIC SYNDROME
R. Vasilescu1, L. Rusu1, M. Oravitan2, B. Maria3, T.A. Balseanu3, C.M. Nan1, G. Cosma1
1University of Craiova, Craiova, Romania 2West University, Timisoara, Romania 3University of Medicine, Craiova, Romania
Introduction. Metabolic Syndrome (MS), a complex disorder including several factors (abdominal obesity, hypertension, insulin resistance and dyslipidemia), is associated with an increased risk of the subsequent development of cardiovascular events by causing vascular dysfunction. The aim of this study was to examine the impact of two training programs, continuous aerobic exercise (CAE) versus intermittent aerobic exercise (IAE) on body composition, abdominal adiposity and endothelial dysfunction at young subjects with metabolic syndrome. Material and method. The study included 40 male patients with MS, with ages between 18-24years, which have been separated into two groups: group A(n=20), who has undertaken 40 minutes of continuous aerobic exercise, 5days/week, at submaximal intensity (70-75%VO2max), and group B(n=20) who has undertaken same type of exercise but daily session was divided in two events of 20 minutes at minimum 2hours interval. The training program, that consisted in stationary cycling, has been monitored by a heart rate monitor (PolarRS800). General indications regarding the diet were set for each patient. Results. After 18 weeks of physical exercises we noticed a significant evolution of investigated parameters at group B comparative with group A. Weight (kg): 9.8±12.2/83.5±11 versus 89.8±12.2/83.5±11; waist circumference (cm): 103±7.8/98.86±7.7 versus 110±15.4/100.9±13.9; BMI: 33.3±3/30.85±3.0 versus 33.3±6.8/30±5.4; %BodyFat: 28.83±4.59/24.77±4.21 versus 37.6±6.7/32.7±5.7, brachial artery flow mediated dilatation (%FMD): 5.9 ± 1.9/ 6.9 ± 2.4 versus 5.8 ± 2.1/6.1±2.2. Conclusions. The present study establishes the positive effect of intermittent aerobic exercise in treatment of metabolic syndrome at young subjects with MS by the effect on visceral obesity and endothelial dysfunction.
THE RISK FOR TYPE 2 DIABETES MELLITUS IN OVERWEIGHT AND OBESE PATIENTS WITH METABOLIC SYNDROME
D.A. Mihai1, M.I. Filip2, I.D. Dragoescu3, A.M.C. Oprea1, C. Ionescu-Tirgoviste1
1Diabetes, Nutrition And Metabolic Disease Institute "N. Paulescu", Bucharest, Romania 2Department Of Diabetes, County Hospital Ploiesti, Ploiesti, Romania 3clinical Hospital Cf Witing, Bucharest, Romania
Background and aims: Metabolic syndrome (MS) is a constellation of risk factors for cardiovascular disease and type 2 diabetes (T2DM). Our study analyses the prevalence and particularities of MS (the new, 2009 definition) in overweight and obese subjects, and their 10 years risk of acquiring T2DM, using a diabetes risk algorithm (the QDScore). Material and methods: the study is cross-sectional, comprising 100 overweight (31) and obese (69) out-patients - (59 women/41 men), aged between 25 and 79 years old, without T2DM. Results and discussions: 47% of the patients were diagnosed with MS, having significantly higher values for age, waist (p<0.05), triglycerides, fasting glycemia (p<0.001) and lower for HDLcholesterol (p 0.001). The risk score for T2DM was significantly higher in patients with MS (p 0.003), especially in the ones presenting 4 or 5 components comparing to those with only 3 components (p 0.01). Patients with high blood pressure, fasting glycemia ≥100 mg/dl and waist ≥88 cm (women) or ≥102 cm (men) presented statistically significant greater values of the risk score that the ones with normal blood pressure (p<0.001), with fasting glycemia <100 mg/dl (p 0.003) and, respectively, a waist <88 cm (women) or <102 cm (men) (p<0.001). Conclusions: in overweight and obese patients MS occurs with a high incidence. The new risk algorithm for T2DM is well correlated with the MS, number of the components, waist and glycemia values and it proves to be useful for setting out the risk level in overweight and obese people.
PARTICULARITIES OF METABOLIC SYNDROME IN OVERWEIGHT AND OBESE PATIENTS
D.A. Mihai1, M.I. Filip2, I.D. Dragoescu3, A.M.C. Oprea1, C. Ionescu-Tirgoviste1
1Diabetes, Nutrition And Metabolic Disease Institute "N. Paulescu", Bucharest, Romania 2department Of Diabetes, County Hospital Ploiesti, Ploiesti, Romania 3clinical Hospital Cf Witing, Bucharest, Romania
Background and aims: excessive weight, particularly central adiposity, increase the risk for type 2 diabetes mellitus (T2DM) and cardiovascular disease and it is a central trait of the metabolic syndrome (MS). Our aim is to reveal the MS (the new, 2009 definition) particularities in overweight and obese patients with or without T2DM. Material and methods: the study is cross-sectional, comprising 100 overweight (31) and obese (69) out-patients - (59 w/41 m) without T2DM and another 100 patients matched for BMI and sex, with T2DM. Results and discussions: 92% of diabetic patients and 47% of nondiabetic patients had MS. Diabetics were older, had more MS components and statistically significant lower values for HDL cholesterol, LDL cholesterol and total cholesterol (p<0.001). After the waist, the decreasing frequency of MS components was: low HDL cholesterol, elevated triglycerides and glycemia over 100 mg/dl in nondiabetic patients; and low HDL cholesterol, high blood pressure and elevated triglycerides in diabetics patients. Conclusions: the study shows that MS is prevalent in overweight and obese subjects and that the association of T2DM with overweight and obesity increases even more the MS prevalence. In overweight and obese patients, the presence of MS is associated with more profound lipid disorders and if T2DM is present too, HDL cholesterol levels are particularly lower even while lower LDL and total cholesterol.
ACHIEVING LOW-DENSITY LIPOPROTEIN CHOLESTEROL GOALS IN DIABETIC PATIENTS IN REAL WORLD CLINICAL PRACTICE SETTING
J.H. Ko, T.K. Kim, H.J. Jun, M.J. Kwon, J.H. Park, S.H. Lee
Department of Internal Medicine, College of Medicine, Inje University, Pusan, South Korea
Background: Numerous large clinical trials have shown that reducing low-density lipoprotein cholesterol (LDL-C) levels lower cardiovascular mortality and morbidity. As a consequence, national practice guidelines have based treatment goals primarily around lowering LDL-C. The National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III recommended an LDL-C goal of less than 100 mg/dL for diabetic patients. Aim: To evaluate attainment of the NCEP-ATP III LDL-C goal of less than 100 mg/dL with statin treatments in diabetic patients in real clinical practice setting. Design and Methods: A retrospective study was performed by reviewing charts of patients at Pusan Paik Hospital, Pusan, South Korea from January 2008 to November 2009. Of the 2729 new users of statin therpy, 17% started on simvastatin, 23% started on rosuvastatin, 49% on atorvastatin, 11% on fluvastatin-XL. The primary outcome measure was the proportion of patients who achieved the LDL-C goal of less than 100 mg/dL. Results Patients using each statin were similar in age, sex. But baseline LDL-C was significantly lower in simvastatin group [122±37 mg/dL, P<0.05 vs atorvastatin (142± 34 mg/dL), fluvastatin-XL (143±39 mg/dL) , and rosuvastatin (147±55 mg/dL)]. The average dosage of drugs was as follows: atorvastatin (22.7±13.7 mg), fluvastatin-XL (80.0±0.0 mg), rosuvastain (10.4±1.9 mg) and simvastatin (22.1±6.2 mg). LDL-cholesterol goal attainment was highest in atorvastatin group (86%) and lowest in fluvastatin-XL group (61%). But other groups had similar attainment rates (simvastatin 77%, rosuvastatin 77%). Conclusions: We found that overall 75% of patients using statins reached target LDL-C goals, which are slightly higher rates than published in the several clinical trials. We guess that this higher achieving rate of LDL-C goals results from lower baseline LDL-C in our study. This may indicate that baseline LDL-C level in Korean diabetic patients is lower than Caucasian. We also verified that randomized controlled trial results were also valid for real world clinical practice setting.
PREDICTIVE POWER OF CARDIO-VASCULAR RISK FACTORS IN HIGH DENSITY LIPOPROTEIN CHOLESTEROL (HDL-C) LEVELS IN LLEIDA (SPAIN)
M. Pena, M. Caldero, V. Sanchez, A. Quesada, M. Villanueva, J. Real, M.A. Mollo, M. Falguera, R. Llovet, M.B. Vilanova, M. Plana, J.P. Fabregat
ABS Pla Urgell, Mollerussa, Spain
Objectives: estimate the predictive power of different cardio-vascular risk factors in High Density Lipoprotein Cholesterol (HDL-c) levels in Lleida (Spain). Design and methods: cross-sectional study. A total of 230 people were recruited (mean [SD] age, 53±17.38 years) from Primary Care patients, 141 women (61.3%) and 89 men (38.7%), including urban and rural areas. The sample was selected by consecutive random process. Results: Using a multiple linear regression model, we obtained a coefficient of determination R2=0.34, that included significative coefficients for: triglicerides, with a negative coefficient of -0,1 [IC95% -0.13 to -0.07], p<0.001, smoking, coefficient of -3.96 [IC 95% -7.42 to -0.5], p< 0.005, and body mass index (BMI), with a coefficient of -0.66 [IC 95% -1.07 to -0.25], p<0.005. Gender (women) showed a coefficient of 6.39 [IC 95% 2.83 to 9.95], p<0.001. Other factors studied, like alcohol consumption or working activity did not show statistically significant coefficients. Conclusions: This study highlights the influence of some cardio-vascular risk factors in HDL-c levels. Triglicerides, BMI, smoking, age and gender predicted 34% of the variability of HDL-cholesterol levels. The three first factors showed negative coefficient values, so, we can conclude that the higher levels of TG, BMI and the fact of being smoker, the lower HDL-c levels. The strong coefficient obtained with the women group confirms the influence of gender in HDL-cholesterol levels, as other studies have already stablished before.
ASSOCIATION OF LEISURE-TIME PHYSICAL ACTIVITY WITH METABOLIC SYNDROME IN SPANISH ADULTS
M. Pena, A. Quesada, M. Caldero, V. Sanchez, R. Llovet, M.A. Mollo, M. Falguera, A. Rodriguez, J. Sangra, I. Perello, M.B. Vilanova, J. Montserrat
ABS Pla Urgell, Mollerussa, Spain
Objective: The purpose of this study was to examine the relationship between the metabolic syndrome (MS) and physical activity (PA) in a representative sample of Spanish adults. Research Design and Methods: Cross-sectional study. We analyzed data from participants aged 18 or older in Lleida. The sample was recruited from the general population census by consecutive random process. The metabolic syndrome was defined according to the Adult Treatment Panel III (ATPIII) criteria. Participants self-reported PA activity time for the previous week. Results: A total of 293 participants were included in the study, 122 men (41.6%, 95% CI 47.5-54.7%) and 171 women (58.6%, 95% CI 47.1-54.1%). The mean of age were 50,8 years (SD 19.3). The prevalence of MS was 22.5% (95% CI 17.7-27.4). Compared with those who were less active (<2.5 h per week), the MS was present in 53.3% (95% CI 35.5–71.2%) men and in 52.94% (95% CI 36.2–69.7%) of the women group. In the active PA group (≥2.5 h per week), the MS prevalence was 46.7% (95% CI 28.8–64.5%) in men and 47.1% (95% CI 30.3–63.8%) in women. The differences in MS prevalence, according to PA and gender, resulted no significative (T student test, p>0.05). Conclusions: Our study suggests that physical activity may play a positive effect in metabolic syndrome, by decreasing its prevalence. Further studies are needed to elucidate the influence of physical activity in metabolic syndrome. The prevalence of metabolic syndrome could improve if general population increased physical activity.
COMPARISON OF HDL-CHOLESTEROL DISTRIBUTION IN GENERAL POPULATION WITH PRIMARY CARE POPULATION IN LLEIDA (SPAIN)
V. Sanchez, M. Caldero, R. Llovet, M.A. Mollo, J.R. Marsal, M. Pena, A. Quesada, M.Falguera, M.B. Vilanova, J. Montserrat, I. Perello, J. Sangra
ABS Pla Urgell, Mollerussa, Spain
Objectives: compare the distribution of HDL-c levels between general population and primary care population. Design and methods: cross-sectional study. Population 1: The sample was selected by simple alleatory sampling. A total of 284 people were analized (mean [SD] age, 50±8.24 years) from general population census. 165 women (58.09%) and 119 men (41.9%). Diabetic people were excluded. Population 2: The sample was selected by consecutive random process. 230 people were included (mean [SD] age, 53±17.38 years) from primary care patients, 141 women (61.3%) and 89 men (38.7%), including urban and rural areas. Diabetic people were included. Results: The overall mean value of HDL-c in general population was 59.4 mg/dl [CI 95% 57.6 – 61.2]. The mean value in primary care population was 62.43mg/dl, [CI 95% 60.47-64.39]. The differences in both groups were not statistically significative (T Student test, p>0.005). Conclusions: In our study, the distribution levels of HDL-c is far from risk levels (<50mg/dl in women and <40mg/dl in men) in general population, as well as in primary care population. The main controversial point is the fact that diabetic people were included in the primary care sample and not included in the general population sample. Previous studies stablished that diabetes influences in lipidic profile. It is interesting to highlight that we didn´t obtain significative differences in both goups, in contrast to our previous expectations. So we can conclude that other cardio-vascular risk factors as well as life style factors must be taken into account when we are evaluating HDL-c levels.
EFFECTS OF PLIN GENE VARIATION ON ENERGY METABOLISM AND BODY COMPOSITION CHANGES AFTER DIETARY ENERGY RESTRICTION IN SPANISH OBESE WOMEN
I. labayen1, E. Larrarte2, J. Margareto2, R. Ares3, M. Agueda1
1Department of Nutrition and Food Science, University of the Basque Country 2Unit of Genomics and Molecular Biology, Dep. of Clinical Nutrition Research 3Department of New Products Food, Food Area, LEIA Foundation, 01510
Background: Genetic polymorphisms at the Perilipin (PLIN) locus have been associated with the metabolic syndrome. Objective: To test the association of two polymorphisms of PLIN gene (PLIN 11482G>A and PLIN 13041A>G) with body composition, energy and substrate metabolism, and metabolic changes in response to a 12weeks energy-restricted diet intervention in a group of obese women. Design: A total of 78 obese (BMI 34.0±2.8kg/m2) women aged 36.7±7y volunteered to participate in the study. We measured by DXA body fat mass (FM) and lean mass (LM). Resting metabolic rate and fasting glucose and lipid oxidation rates were measured by indirect calorimetry. Fasting plasma glucose, cholesterol, insulin and leptin were analyzed before and after the intervention. Results: There were significant gene-diet interaction effects between the PLIN 11482G>A polymorphism and energy-restricted diet in waist circumference (P=0.064), and lipid oxidation rate (P=0.004) changes. Energy restriction resulted in lower decreases of waist circumference percentage in carriers of the A allele at the PLIN 11482G>A (P<0.05), regardless of changes on FM. Energy restricted diet resulted in higher decrease on lipid oxidation in A allele carriers of the PLIN 11482G>A (P<0.02) independently of body weight changes. There were no significant gene-diet interaction effects between PLIN5 13041A>G polymorphism and energy-restricted diet induced changes. Conclusions: These findings suggest that PLIN 11482G>A polymorphism could be a modulator of the metabolic response to an energy-restricted diet intervention. Likewise, the presence of the minor A allele may result in a poorer response to diet therapies aimed to reduce body weight and decrease metabolic syndrome risk in obese women.