CODHy Prague Abstracts 2 - The 3rd World Congress on Controversies to Consensus in Diabetes, Obesity and Hypertension (CODHy)

The 3rd World Congress on
Controversies to Consensus in Diabetes, Obesity and Hypertension (CODHy)
Hilton Hotel, Prague, Czech Republic, May 13-16, 2010

CODHy Prague Abstracts 2

THE ROLE OF MEAN PLATELET VOLUME IN CARDIOVASCULAR RISK ASSOCIATED WITH NON-ALCOHOLIC FATTY LIVER DISEASE
S. Tapan, F. Ors, T. Dogru, N. Ercin, M. Kara, C. Haymana, G. Kilciler, Y. Karslioglu, C. Acýkel, M. Kantarcioglu, S. Bagci, I. Kurt
Gulhane Medical School, Ankara, Turkey

Introduction: Non-alcoholic fatty liver disease (NAFLD) is linked to an increased risk of cardiovascular disease. Mean platelet volume (MPV), a determinant of platelet activation, is a newly emerging risk factor for atherothrombosis. We aimed to search whether the levels of MPV are altered in subjects with NAFLD having no confounding factors for atherosclerosis such as obesity, diabetes mellitus and hypertension. In addition, the possible association of MPV with carotid artery intima media thickness (cIMT), a well known marker of subclinical atherosclerosis was also searched. Methods: MPV and cIMT levels were measured in 60 biopsy proven NAFLD subjects and 54 healthy controls. The measurement of cIMT was performed by using a high resolution ultrasonography. The degree of insulin resistance was determined by the homeostatic model assessment of insulin resistance (HOMA-IR). Results: Age was similar between the two groups. Body mass index and waist circumference levels were higher in NAFLD group when compared to controls. MPV and cIMT levels were not significantly different between two groups (p= 0.77 and p=0.23, respectively). In multivariate analyses, cIMT levels were positively correlated to age in patients with NAFLD (r=0.37, p=0.03). However, no significant correlation was found between MPV and CIMT levels. Conclusion: This preliminary report does not show any difference in MPV levels between male subjects with NAFLD and healthy controls. These finding suggests that in the absence of other metabolic risk factors, MPV perse might not be involved in the mechanism(s) of increased cardiovascular risk in NAFLD.

ENVIRONMENTAL AND POPULATION RISK FACTORS PREDICTING HYPERTENSION, AND DIABETES IN WORKING POPULATIONS
M. Colombi
Adjunct Associate Professor -Graduate School of Public Health- University of Pittsburgh, USA

Purpose: to study community, and worksite factors predicting the occurrence of Hypertension, Obesity and Diabetes in working populations. Methods: Health Risk Appraisal aggregate information of 29 worksites of one employer where linked by postal code with publicly available social determinants of health describing the surrounding communities. Multi-factorial models of Population risk and social determinants of health were tested to predict the variance in the worksite occurrence of Obesity, Hypertension and Diabetes episodes of care . Results: 81% of the variance in Hypertension episodes of care/1000 active members in 29 worksites was predicted by worksite percent Aged50+, Percent at Low Risk, Nutrition Supportive Environment Score , and by community median property value . 63% of the variance in Diabetes -Episodes of Care /1000 active and retired members was predicted by worksite percent Aged50+, Percent in pre-diabetes risk pool , and by community median property value . 51% of the variance in Diabetes -Episodes of Care /1000 Active Members, was predicted by worksite Nutrition Supportive Environment Score, percent of those exercising, and of those severely obese (BMI 35+) 74 % of Obesity prevalence was predicted by the community increase in food stamps utilization (2009-2007), by minorities food stamps use , and by women’s health preventive services utilization . Conclusions: Worksite Health promotion programs regarding Hypertension , Obesity and Diabetes, should consider the interaction of population health risk , worksite environment support and the influence of corresponding community socio-economic factors.

RISKS OF HYPERTENSION AND HYPERCHOLESTEROLEMIA TREATMENT DURING PREGNANCY
E. Manakova, L. Hubickova
3rd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic

Many women get pregnant in their 35 years or later that increases risk of diabetes type II or metabolic syndrome with hypertension and hyperlipidemia. Drugs of choice are metformin, ramipril, fenofibrate, or simvastatin. ACE inhibitors are contraindicated during pregnancy. Studies assessing their teratogenicity are controversial, however due to their proved fetotoxicity should be replaced immediately, if woman elicits pregnancy. Lipid reducers are supposed teratogenic and should be discontinued as soon as possible, too. Recommended treatment is only plasmaferresis. If risk is too high, statins are suggested during second and third trimester in some countries. Acute myocardial infarction, the most severe complication, is rare in women of reproductive age; however pregnancy increases the risk three- to four-fold. Although spontaneous coronary dissection is the most common cause during pregnancy, coronary atherosclerosis is evident in 43% subject. We present two pregnant patients that contacted Czech teratology information service for counseling with very high hyperlipidemia and poor familial history. Risk results from disease as well as from treatment with drugs contraindicated during pregnancy. If potential complication as myocardial infarction threatens, we suppose, that dropping out the lipid reducers for all pregnancy may be too risky. Therefore consensus, how to treat complicated cases, is needed. Work was supported by Grant of Ministry of Education of Czech Republic INGO LA 08034 and VZ MSM 0021620814

LINAGLIPTIN HAS NO PHARMACOKINETIC INTERACTION WITH COMMONLY PRESCRIBED ORAL ANTIDIABETIC DRUGS
U. Graefe-Mody, A. Ring, M. von Eynatten, H.J. Woerle
Boehringer Ingelheim, Biberach, Germany

BACKGROUND: For the treatment of type 2 diabetes mellitus, linagliptin is a novel, once-daily, oral, potent and selective dipeptidyl peptidase-4 (DPP-4) inhibitor. Potential pharmacokinetic (PK) interaction was assessed between linagliptin and representatives of the three most frequently prescribed antihyperglycaemic drug classes: (1) the biguanide, metformin; (2) the thiazolidinedione, pioglitazone and (3) the sulfonylurea derivative, glyburide. METHODS: We conducted three open-label, randomized, crossover studies in healthy subjects, comparing the PK of: metformin (850 mg/day x 3 days) with and without linagliptin (10 mg/day x 6 days); pioglitazone (45 mg/day x 14 days) with and without linagliptin (10 mg/day x 12 days); and glyburide (1.75 mg single dose) with and without linagliptin (5 mg q.d. x 6 days). Linagliptin concentrations were also measured in all studies. RESULTS: Co-administration of linagliptin 10 mg with metformin and pioglitazone had no effect on the total exposure of these drugs. Maximum concentrations were slightly reduced, which was considered to be of no clinical relevance in chronic treatment. Linagliptin co-administered with glyburide reduced glyburide exposure by approximately 14%. However, this was not seen as clinically relevant because of the absence of a reliable dose-response relationship and the known large pharmacokinetic interindividual variability of glyburide. Linagliptin exposure was not significantly altered by co-administration of these drugs. CONCLUSION: No dose adjustment is required, based on pharmacokinetic considerations, should linagliptin be combined with the commonly prescribed antihyperglycaemic agents metformin, pioglitazone and glyburide in patients with type 2 diabetes.

LINAGLIPTIN HAS NO PHARMACOKINETIC INTERACTION WITH DRUGS COMMONLY USED IN PATIENTS WITH CARDIAC DISORDERS
U. Graefe-Mody, C. Friedrich, T. Brand, A. Ring, M. von Eynatten, H.J. Woerle
Boehringer Ingelheim, Biberach, Germany

BACKGROUND: Linagliptin is a novel, once-daily, oral, potent and selective dipeptidyl peptidase-4 (DPP-4) inhibitor for the treatment of type 2 diabetes mellitus. Linagliptin is likely to be co-administered in the clinical setting with drugs such as digoxin and warfarin, which are commonly prescribed in patients with cardiovascular comorbidities. The aim of these studies was to assess the potential effect of linagliptin on digoxin and warfarin pharmacokinetics (PK). METHODS: The digoxin study was a single-centre, open-label, randomized, two-period cross-over study in healthy male and female subjects (n=20, aged 18–55 years). The steady states PK of digoxin 0.25 mg q.d. with and without co-administration of linagliptin 5 mg q.d. were compared. The warfarin study was an open-label, two-period, fixed sequence study in 18 healthy male volunteers (mean age 35.3+/-8.6 years). The PK of R- and S-warfarin from a single 10 mg warfarin dose with and without co-administration of multiple linagliptin 5 mg doses were compared. RESULTS: Co-administration of linagliptin 5 mg with digoxin 0.25 mg or warfarin 10 mg had no clinically significant effect on the pharmacokinetics of these drugs. The 90% confidence intervals of the geometric mean ratios for area under the plasma concentration-time curve (AUC) and maximum plasma concentration (Cmax) for digoxin, R- and S-warfarin were contained within the acceptance range for bioequivalence (80–125%). CONCLUSION: No dose adjustment is required, based on pharmacokinetic considerations, should linagliptin be co-administered with digoxin or warfarin in patients with type 2 diabetes and cardiovascular comorbidities.

NATURAL PRODUCTS COULD BE A POSSIBLE ALTERNATIVE THERAPY OF FUTURE FOR PREVENTION OF DIABETES
M. Ali, M. Thomson, K. Al-Qattan, M. Al-Houli, D. Jay Shree, S. Al-Sawan, J. Al-Hassan
Dept. of Biological Sciences, Faculty of Science, Kuwait University

Diabetes Mellitus (DM) is one of the primary threats to human health due to its increasing prevalence, chronic course and disabling complications. Control of postprandial hyperglycemia and inhibition of oxidative stress are suggested to be important in the treatment of diabetes. In the present study the effect of chronic administration of aqueous extracts of garlic and ginger compared to aspirin was evaluated on lipid peroxidation and antioxidant properties in streptozotocin (STZ) induced diabetic rats. Diabetic rats (sugar >300 mg dl ) were divided into four groups: control , garlic treated, ginger treated and aspirin treated. Garlic, ginger and aspirin were administered daily for 8 weeks. Malondialdehyde (MDA) concentration in liver and kidney homogenates of diabetic control rats were significantly increased compared to non-diabetic rats. Ginger and garlic treated rats showed significant reduction in MDA concentration compared to diabetic control rats. Aspirin treatment only caused significant reduction of kidney MDA. Total antioxidants levels were significantly reduced in diabetic control rats compared to saline-treated normal rats in serum and tissue homogenates. Significant increases were observed in the ginger and garlic treated rats. Aspirin treatment had no effect on the levels of total antioxidants in the serum and tissue homogenates. Similar results were observed with activity of the antioxidant enzyme, catalase. Aspirin treatment did not demonstrate any significant increase in the catalase activity. These results strongly suggests the generation of free radicals in diabetes could be prevented by regular intake of garlic and ginger in moderate amounts. This study was supported by KFAS grant # 2007-1302-04.

CARDIOMETABOLIC RISK FACTORS IN TYPE 2 DIABETIC PATIENTS IN BULGARIA
P. Kamenova
University Specialized Hospital for Active Treatment in Endocrinology "Acad. Iv. Penchev", Department of Diabetology, Sofia, Bulgaria

The aim of the study was to characterize cardiometabolic risk factors (CMRF) in type 2 diabetic patients (T2D pts) according to the International Diabetes Federation (IDF) definition of metabolic syndrome (MS) and to investigate if IDF definition of MS could identify T2D pts with insulin resistance (IR). Methods: A cross sectional study was performed in 383 pts of mean age 62.2±10.4 yrs, mean BMI 30.8±4.8 kg/m2. Fifty normal glucose tolerant subjects of mean age 60.7±11.2 yrs, mean BMI 30.6±4.9 kg/m2 served as controls in terms of insulin sensitivity (IS). It was measured with manual hyperinsulinaemic euglycaemic clamp technique, expressed as a glucose disposal rate (M) and homeostasis model assessment of insulin resistance (HOMA). Results: MS was diagnosed in 76.5% and central obesity in 76.8 % of T2D pts. All MS components had 37.5% of the pts. The most common CMRF was raised blood pressure (75.1%). IS of the MS pts M 3.238±1.673 was significantly lower than IS of non MS pts M 6.893±3.846 and controls M 6.296±3.176 (mg/kg/min), both p <0.01. HOMA of the MS pts 6.02±1.69 was significantly higher than HOMA of non MS pts 3.07±1.27 and controls 3.54±1.92, both p<0.001. Conclusions: Multiple CMRF treatment in T2D pts is required for reduction of global cardiometabolic risk. IDF definition of MS could identify T2D pts with IR.

TELMISARTAN PREVENTS WEIGHT GAIN AND OBESITY THROUGH ACTIVATION OF PPAR-δ DEPENDENT PATHWAYS
Z. Zhu1, H. He1, D. Yang1, D. Liu1
1Department of Hypertension and Endocrinology, Daping Hospital, Center for Hypertension and Metabolic Diseases, Third Military Medical University, Chongqing Institute of Hypertension

Objectives Telmisartan shows antihypertensive and several pleiotropic effects that interact with metabolic pathways. In the present study we tested the hypothesis that telmisartan prevents adipogenesis in vitro and weight gain in vivo through activation of peroxisome proliferator-activated receptor-δ (PPAR -δ)-dependent pathways in several tissues. Methods and Results In vitro, telmisartan significantly upregulated PPAR-δ expression in 3T3-L1-preadipocytes in time and dose dependent manner. Besides enhancing PPAR -δ expression by 68.2 ±17.3% and PPAR-δ activity by 102.0 ± 9.0%, telmisartan also upregulated PPAR γ expression, whereas neither candesartan nor losartan affected PPAR-δ expression. In vivo, long-term administration of telmisartan significantly reduced visceral fat from 3.0 ± 0.4 g to 1.2 ± 0.2 g (P<0.01) and prevented high fat diet induced obesity in wild type mice and hypertensive rats, but not in PPAR-δ knockout mice. Administration of telmisartan did not influence food intake in mice. Telmisartan influenced several lipolytic and energy uncoupling related proteins (UCPs), enhanced phosphorylated protein kinase A (p-PKA) and hormone sensitive lipase (HSL), but reduced perilipin expression and finally inhibited adipogenesis in 3T3-L1-preadipocytes. Telmisartan associated reduction of adipogenesis in preadipocytes was significantly blocked after PPAR-δ gene knockout. Chronic telmisartan treatment upregulated the expressions of PKA, HSL and UCP1, but reduced perilipin expression in adipose tissue and increased UCP 2 and 3 expression in skeletal muscle in wild type mice but not in PPAR-δ knockout mice. Conclusions These findings suggest that telmisartan prevents adipogenesis and weight gain through activation of PPAR-δ dependent lipolytic pathways and energy uncoupling in several tissues.

FABPS, PAI-I AND OTHER BIOMARKERS IN SERUM IN INDIVIDUALS WITH DIABETIC TYPE 2 AND NONDIABETIC
M.P. Buzga1, R.B. Yahia2, R.L. Lichnovska3, V.K. Krcova4, V.Z. Zavadilova5
1University of Ostrava, Ostrava, Czech Republik 2University of Ostrava, Ostrava, Czech Republik 3Palacky University, Olomouc, Czech Republik 4Palacky University, Olomouc, Czech Republik 5University of Ostrava, Ostrava, Czech Republik

Aims: The aims of this pilot study were (i) determine the concentration of A-FABP, leptin, adiponectin, PAI-I and other markers of metabolic syndrome in the serum of individuals with type 2 type diabets mellitus and in normal individuals and (ii) to assess the possible correlation between these parameters. Material and Methods: The experimental group consisted of 15 people with diabetes type 2 in age 45 to 80 years with diabetes duration of 1 to 28 years who were treated with insulin respectively, antihypertensive and diuretics. In the control group was selected 10 non-diabetics aged 22 to 26 years. Concentrations observed markers were determined in serum using sandwich ELISA sets (Bio Vendor). Results: The obtained values are shown in Table No1 Table1: Results of the determination of BMI, A-FABP, E-FABP, leptin, adiponectin, t-PA and PAI-I. Conclusion: In the serum of people with Dibetes type 2 compared with those in the control group were found significantly (p <0.05) increased concentrations of leptin, PAI-I, E-FABP and A-FABP. The concentration of adiponectin and t-PA were considerably increased only in the diabetic group. For both groups, adiponectin correlated negatively with BMI and A-FABP and PAI-I positively with BMI and diabetes have leptin correlated positively with A-FABP.

NO CONTROVERSIES TOWN-VILLAGE DIFFERENCE OF CHILD AND PARENTS OBESITY TODAY
M. Boledovicova1, L. Saradyova1, S. Svacina2
1Constantine the Philosopher University, Faculty of Social Sciences and Health Care 23rd Department of Medicine, 1st Medical Faculty Charles University Prague Czech republic

There was a typical diffence in town and village obesity prevalence in the history of obesity. We have evaluated local influences on obesity in town and rural families today. in the former Czechoslovakia ( in Prague - a big city - and a small Slovak village Horná Streda). 47 children from Prague and 43 children from Horná Streda were examined. The age group 6 to 10 years of age (1st to 4th school year). The age, height and weight of the children was monitored and their Body Mass Index (BMI) was calculated. Results: No significant difference in height, age, weight and BMI was found between fathers, mothers and children in both groups. Significant negative correlation between weight and height was found in both groups of mothers. As expected, the age of the town parents was slightly higher. The BMI of fathers and mothers correlates with the BMI of the children. The height of the parents correlates with the height of the children, but the shorter parents have more obese children. Conclusions: There were no considerable differences in height, weight or BMI of the parents in both groups. We conclude that the lifestyle of today’s population in both small and big places leads to the same prevalence of obesity in village and town. With the global changes in eating habits and physical activities, the children of obese parents and of short parents are in more danger of becoming obese, because of their energetic balance being probably less adequate. Also mothers with lower height have typically heigher weight in both types of population. Globalisation trends are the same in small village and big town.

LIVER FA METABOLISM BY PET: VALIDATION IN PIGS AND EVIDENCE OF INCREASED OXIDATION IN OBESE HUMANS
M. Bucci1,2, A. Roivainen1, K. Någren1, M.J. Järvisalo1,
J. Kiss1,3, L. Guiducci2, B. Fielding4, R. Borra1, K. Virtanen1, J. Knuuti1, P. Nuutila1, P. Iozzo1,2
1Turku PET Centre, and Dept. of Medicine, University of Turku, Turku, Finland, 2Institute of Clinical Physiology, PET Lab, National Research Council (CNR), Pisa, Italy, 3Dept. of Surgery, University of Turku, Turku, Finland, 4Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Churchill Hospital, Oxford, United Kingdom

Hepatic lipotoxicity plays a central role as both a target and a cause in obesity-related disorders. The metabolism of fatty acids (FA) in the liver is not accessible in humans. We combined 11C-palmitate imaging by Positron Emission Tomography (PET) with compartmental modelling to describe rates of hepatic FA uptake, oxidation, storage and release in triglycerides. Validation measurements were conducted in six pigs, in which PET estimated substrate rates were compared to the organ balance of FAs and their products, as determined through arterial, portal and hepatic vein sampling. The PET methodology was then applied to fifteen human subjects, subdivided in a obese and control subjects (BMI 30 kg•m-2 cut-off). Plasma 11C-palmitate kinetics was used to quantify systemic lipolysis. In animals, comparisons of PET-derived and corresponding measured FA fluxes (FA uptake, esterification and TGFA release) showed no significant differences and were correlated. In nine humans, indirect calorimetry and ß-hydroxybutyrate levels were correlated with the model predicted hepatic oxidative metabolism. Obese subjects were characterized by a pronounced elevation in hepatic FA oxidation as compared with controls (0.16±0.01 vs 0.08±0.01, p=0.0007), while FA uptake and esterification rates where unaffected. Liver FA oxidation was correlated with plasma insulin levels (r=0.61, p=0.016), adipose tissue and systemic insulin resistance (r=0.57, p=0.028 and r=0.53, p=0.041). Hepatic FA esterification correlated with systemic FA lipolysis (r=0.71, p=0.003). We show that the fate of FA in the liver can be resolved by the proposed approach, and that higher FA oxidation is the earlier metabolic deviation in obesity.

PREVALENCE OF OBESITY AND IT,S CORRELATES WITH HIRSUTISM AMONG FEMALE STUDENTS IN AHWAZ GONDISHAPURE MEDICAL SCHOOL
S. Vaziri Esfarjani, S. Ashrafizadeh
Department of Social Medicine, Ahwaz Jundishapure University of Medical Sciences

Background: Hirsutism has defined as excessive male – pattern hair growth, affects approximately 5-10% of women. The aim of this study is to determine the prevalence of obesity and its relationship with some factors such as hirsutism and age of menarche. Methods: It is cross-sectional study, is based on the examination of 310 students(20-30 years old).A questionnaire was filled out for each person on the basis of the ferryman-gallway scoring system. Statistical analyses were using SPSS program and Chi-square test. Results: of 310 students,46(14.8%)had hirsutism (126%mild and2.2%moderate).From the total hirsute students,18(39%) have bmi>25 . There was a strong positive correlation between hirsutism and BMI>25(p=0/000). There was not relationship between obesity and age of menarche in medical school students (p=0/277). Conclusion: The result of this study does not show any differences with other studies. As the obesity may be one of the etiological factors in the development of hirsutism, the effectiveness of weight reduction has been well documented in female hirsute

SERUM LEVEL OF TRIGLYCERIDES AND WAIST CIRCUMFERENCE AS THE MARKERS OF CARDIOVASCULAR RISK FACTORS IN FEMALES (TEHRAN LIPID AND GLUCOSE STUDY)
M. Solati1, M.J. Ghabbili2, M. Majid2, P. Mirmiran2, F. Azizi2
1Department of Internal Medicine and Endocrinology, Hormozgan University of Medical Sciences, Iran 2Endocrine Research Center, Shaheed Beheshti University of Medical Sciences, Iran

Background: Risk factors of cardiovascular diseases have been investigated by different studies. To determine a simple screening procedure which can predict non-traditional risk factors, recent studies have proposed simultaneous high waist circumference and high serum triglycerides as an index to predict metabolic disorders resulting in coronary artery disease. The aim of the study was to investigate the risk factors of cardiovascular disorders in subjects with this phenotype. Methods: 5630 non-diabetic, 18-65 years old, females recruited in Tehran Lipid and Glucose Study (TLGS) were enrolled. Based on fasting serum triglycerides (Tg) and waist circumference (WC), subjects fell into four groups: TgHWH (Tg>150 mg/dl, WC>80 cm), TgHWL (Tg>150 mg/dl, WC<80 cm), TgLWH (Tg<150 mg/dl, WC>80 cm) and TgLWL (Tg<150 mg/dl, WC<80 cm). Cardiovascular risk factors including lipid profiles and anthropometric variables were compared between the groups. The prevalence of hypertension, LDL-C>130 mg/dl, total cholesterol>220 mg/dl and HDL- C<45 mg/dl were determined. Results: TgLWL and TgHWH consisted of 27.5 and 31.9 percent of subjects, respectively. Systolic and diastolic blood pressures, body mass index and waist circumference were significantly higher in TgHWH rather than others. Serum total cholesterol, triglycerides and LDL-C were significantly higher in TgHWH compared to others whereas HDL-C was significantly lower in this group. The prevalence of subjects who had at least four risk factors was 61.4% and 1% in TgHWH and TgLWL, respectively. Conclusion: Simultaneous high waist circumference and high serum triglycerides (TgHWH) can be used as a simple screening procedure to predict risk factors of cardiovascular diseases in females.

OBESITY AND GESTATIONAL DIABETES
A. Aghamohammady
Islamic Azad University, Sari Branch - Sari - Islamic Republic of Iran

Introduction:Obesity is a modern day epidemic. The incidence appears to be rapidly increasing in both developed and developing countries and has become much more obvious in the last decade. the aim of this article was To study the effects of obesity defined as a first trimester maternal body mass index >30 on the pregnancy outcome. Methods: This study was a descriptive comparative study two hundred fifty singleton pregnancies of women with first trimester BMI >30 who delivered at Emam Hospital, Sari Iran during 2008–2009 were studied. A control group with two hundred fifty nine women of normal body mass index matched for age and parity were selected and the pregnancy outcomes were compared between groups. the consequences of the pregnancy outcome in each group were examined and studied. ÷2 and Odds-ratio were used to analyze the data. Results: There was a significant relation between obesity and adverse pregnancy outcomes including gestational diabetes (23.8 vs. 2.7%, P<0.0001), preeclampsia (20.8 vs. 5.8%, P<0.0001), cesarian section (64.4 vs. 47.5%, P<0.0001), low apgare score (12.5 vs. 1.6, P<0.0001) and macrosomia (3.9 vs. 0.0%, P<0.002) compared to non-obese women. Conclusion: obesity appears to be an independent risk factor for gestational diabetes and pregnancy induced hypertension and other adverse pregnancy outcomes.

ELEVATED FETUIN-A CONCENTRATIONS IN MORBID OBESITY DECREASE AFTER DRAMATIC WEIGHT LOSS
J.M. Brix 1 H. Stingl 1 F. Höllerl1, G.H. Schernthaner 2 H.P. Kopp 1 G. Schernthaner1
1Department of Internal Medicine I, Rudolfstiftung Hospital Vienna, Vienna, Austria, 2Department of Internal Medicine II, Div. Angiology, Medical University of Vienna, Vienna, Austria

Introduction: Morbid obesity (MO) is a risk factor for cardiovascular morbidity, mortality and diabetes, which can be effectively reduced by bariatric surgery. The liver-secreted protein Fetuin-A is elevated in insulin resistance (IR), is an independent predictor of type 2 diabetes and is associated with atherosclerosis. We studied Fetuin-A concentrations in patients with MO before and after weight loss induced by gastric bypass. Methods: We included 47 MO patients (40 women, BMI 46.1±5.8kg/m²) and 38 healthy controls (CO; 21 women, BMI 26.0±5.5kg/m²) in a cross sectional study. Additionally, 28 of the MO patients were investigated before and 16 months after gastric bypass surgery in a longitudinal study. Apart from measurements of blood pressure and routine laboratory parameters, a 75g-OGTT was performed. IR was calculated by using HOMA. Fetuin-A levels were determined by a commercial ELISA. Results: Fetuin-A levels were significantly higher in MO (795±192µg/ml) than in CO (295±61µg/ml; p<0.001) and were associated with HOMA-IR (r= –0.464; p= 0.034). After surgery-induced weight loss (BMI: 46.6±7.3 vs 31.6±6.8kg/m²; p < 0.001), HOMA (6.6±6.3 vs. 2.0±1.2; p<0.001) and Fetuin-A decreased (745±187 vs 698±213µg/ml; p= 0.034). Delta (Ä)Fetuin-A concentrations correlated with Äfasting insulin (r= 0.687; p= 0.001), Ä2-hours insulin (r=0.661; p= 0.005) and HOMA-IR (r= 0.624; p= 0.003). Conclusions: Fetuin-A is markedly increased in MO patients. The reduction of Fetuin-A after weight loss could play an important role in the beneficial effects of gastric bypass surgery.

OBESITY INTERVENTION PROGRAM UTILIZING GENETIC POLYMORPHISM ANALYSIS
H. Imai1, H. Nakao2, H. Sata3
1National Institute of Public Health 2National Institute of Public Health 3National Institute of Public Health

Objective: To evaluate the effects of the single-nucleotide polymorphism (SNP)-based intervention program including dietary therapy and physical activity in obese local residents with abnormal glucose or lipid metabolism. Method: A total of 115 adults with obesity were included in this study who met the following selection criteria: (i) waist circumference cutoff value of 85 cm for males and 90 cm for females; (ii) fasting blood glucose level greater than 110 mg/dL or HbA1c above 5.2%. These conditions were identified by community-based annual health check-up surveillance system performed for early detection and prevention of life-style-related diseases. At enrollment the subjects were genotyped for the SNPs of the beta3-adrenergic receptor Trp64Arg, beta2-adrenergic receptor Arg16Gly, and UCP1 A-3826G. The intervention program was tailored for each subject based on the results of the SNP analysis. Subjects found positive for any of these SNPs were given specific dietary advise to reduce daily alimentary energy intake by 100 to 200 kcal. Results: At the end of the one-year program, the mean values of the following parameters demonstrated a significant decrease: body weight by 4.15 kg (P < 0.001); waist circumference by 6.23 cm (P < 0.001); HbA1c by 0.10% (P < 0.01). Conclusion: With the recent technological innovation, rapid methods for SNP analysis are becoming widely available at a low cost. Identification of obesity-related SNPs along with regular health check-ups will be effective for designing specific life-style-related disorder prevention programs.

N-TERMINAL PRO–B-TYPE NATRIURETIC PEPTIDE IN OVERWEIGHT AND OBESE PATIENTS WITH AND WITHOUT DIABETES: AN ANALYSIS BASED ON THE BODY MASS INDEX AND LV GEOMETRY
K.I. Cho, H.G. Lee, S.M. Kim, T.I. Kim
Division of Cardiology, Maryknoll Medical Center

Background and Objectives: Several recent studies have shown that there is an inverse relationship between plasma B-type natriuretic peptide (BNP) and body mass index (BMI) in subject with and without heart failure. Obesity frequently coexists with diabetes, so it is important to consider the relationship between diabetes and natriuretic peptide levels. We evaluated the influence of diabetes on the correlation of BNP and BMI. Subjects and Methods: We examined 933 patients with chest pain and/or dyspnea undergoing cardiac catheterization from Feb. 2006 to Nov. 2007 in Maryknoll cardiac center who had creatinine of < 2.0 mg/dl, normal systolic heart function. BMI was checked and transthoracic echocardiography was performed, and aminoterminal pro-brain natriuretic peptide (NT-proBNP) was sampled at the start of each case. Results: In non-diabetic 733 patients, mean plasma NT-proBNP levels of non obese (BMI < 23kg/m2), overweight (23≤ BMI < 25kg/m2), obese (BMI ≥25kg/m2) group showed significant 159.6 pg/ml, 289.62237.3 pg/ml, 601.69negative correlation with BMI (856.39 164.9 pg/ml, respectively, p<0.0001). However, in diabetic 200 patients, there was no significant correlation between BMI and NT-proBNP (r=-0.21, p=0.19), and NT-proBNP did not correlate with mitral E/Ea in obese diabetic patients (r= 0.14, p= 0.56). Whereas NT-proBNP significantly correlated with mitral E/Ea in the non obese (r=0.24, p=0.008) and non diabetic (r=0.32, p=0.003) groups. LV mass index was significantly correlated with NT-proBNP in all BMI groups (r=0.61, p<0.001), and patients with concentric hypertrophy showed the highest NT-proBNP levels. Conclusion: The present study demonstrates that obese patients have reduced concentrations of NT-proBNP compared to non obese patients despite having higher LV filling pressure. However, NT-proBNP is not suppressed in obese patients with diabetes. This suggests that factors other than cardiac status impact on NT-proBNP concentrations.

INSULIN RESISTANCE AS A RISK FACTOR FOR GALLBLADDER STONE DISEASE
B.H. Kim, M.R. Kim, J.Y. Mok, Y.K. Jeon, S.S. Kim, I.J. Kim
Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea

Background: The aim of this study was to determine whether insulin resistance is associated with gallbladder stone in non-diabetic Korean women according to menopausal state. Methods: The Study included subjects were 7,734 consecutive Korean subjects (30-79 years of age; 3,609 males and 4,125 females). Subjects who had medical history of diabetes, hypertension, dyslipidemia, other cardiovascular disorders, and hormone replacement therapy were excluded from this analysis. Gallbladder status was assessed by abdominal ultrasonography after overnight fasting. Results: The subjects with gallbladder stone were significantly older and evidenced higher measurements for BMI, waist circumference, insulin, HOMA-IR than were observed in the subjects without gallbladder stone. In analysis with men and premenopausal women, there were no significant differences in HOMA-IR between two groups according to gallstone disease, respectively. An increased risk of gallbladder stone was observed for increasing ages in mainly men. The association between gallstone disease and age, obesity, abdominal obesity, hyperinsulinemia and high HOMA-IR index were statistically significant in analysis with postmenopausal women. In additional analysis stratified by obesity, insulin resistance was a significant risk factor for gallbladder stone in only central obesity premenopausal group. In multiple logistic regression, age and HOMA-IR were associated significantly with gallbladder stone in postmenopausal women. Conclusion: Gallbladder stones appear to be a marker for insulin resistance in postmenopausal women with abdominal obesity.

CALCIUM INTAKE AND CARDIOVASCULAR RISK FACTORS IN MEXICAN SCHOOL-AGED CHILDREN
A. Vergara-Castañeda1, L. Castillo-Martinez2, A. Orea-Tejeda2, E. Colín-Ramírez2
1Universidad Nacional Autonoma De Mexico, D.F., Mexico, Mexico 2incmnsz, D.F., Mexico, Mexico

Objective: To determine if calcium intake is associated with cardiovascular risk factors(body mass index [BMI], waist circumference [WC] and blood pressure [BP]) in school children. Design: 477 children (225 boys and 252 girls) were assessed in public schools in Méco City. Anthropometrics (including WC and fat mass [FM]) were taken. BMI was categorized considering the International Obesity Task Force cut points. BP was assesed and classified as systolic or diastolic hypertension (HTA) according to the American Heart Association. A 24-hour intake recall was obtained. High calcium group (HCG) had a calcium intake greater than the recommended daily allowance ( children until 8 years >800 mg/d; children aged 9 to 13 years >13000 mg/d) and the low calcium group (LCG) had a calcium intake less than the recommended daily allowance.Results: Mean age was 9.4 years, 60,2% belong to the LCG. BMI was significantly higher in the LCG vs the HCG (18.9 vs 18.3kg/m2, p<0.05), as well as WC (67.7 vs 65.5cm, p<0.05), and FM (11.8 vs 10.7kg, p<0.01). There were no stastistical differences between groups for systolic BP(108.7 vs 106.4, p=0.170) or diastolic BP(77.01 vs 75.4, p=0.269). Also the prevalences of HTA apperead to be higher in the LCG vs HCG (systolic HTA 60.2 vs 39.8%, p=437; diastolic HTA 61.4 vs 38.6%, p=0.234) Conclusions: Among school children, cardiovascular risk factors as BMI, WC and FM were lower in the HCG. Also the results of this investigation showed a trend where low calsium intake s associated to higher systolic and diastolic BP, as well as the presence of HTA.

PERCENTILE DISTRIBUTION OF HOMA-IR IN HEALTHY SUBJECTS WITH NORMAL BODY MASS INDEX
J.L. Muñoz-de Hoyos1, L.G. Mancillas-Adame2, F.J. Lavalle-González2, J.Z. Villarreal-Pérez2, J.G. González-Gónzalez2, J. Montes-Villarreal2, P.A. García-Hernández2, C.A. Garza-García2
1Internal Medicine Department, University Hospital "Dr. José Eleuterio González", Monterrey, México 2Endocrinology Service, University Hospital "Dr. José Eleuterio González", Monterrey, México

Objective: To obtain a homeostasis model for insulin resistance (HOMA-IR) and describe its percentile distribution in a healthy Mexican adolescent group with normal weight. Subjects and methods: We used a representative sample of 115 subjects, 55 females and 60 males (age 17±1.4 years, BMI 23.9±5kg/m2) out of the RIESGOS cohort (RegIstry of mEdical Students for emergent Obesity and metabolic Syndrome), integrated by 750 freshmen in the Faculty of Medicine, Universidad Autónoma de Nuevo León (UANL). Measurement of height and weight was performed in a BAME® scale and stadiometer, then, BMI was calculated. The plasmatic glucose determination was performed with glucose oxidase (LX-20, Falcon) in µU/ml, and the basal insulin levels were obtained via ELISA luminometry (Lincoplex 200, Lincoresearch) in mmol/L. The HOMA-IR calculation was performed using the following formula: (insulin x glucose)/22.5. For statistical analysis it was used percentile distribution, Kolmogorov-Smirnov test, skewness and kurtosis coefficients. Results: For the group we obtained a skewness coefficient= 5.3078 (p=< 0.0001), kurtosis coefficient= 36.1899 (p=< 0.0001), and a Kolmogorov-Smirnov= Not normal (< 0.001). For subjects within the 25 percentile the HOMA-IR was equal to 0.733 with a confidence interval of 0.506-0.918. And for subjects within the 75 percentile, the HOMA-IR was 1.669-2.352. Conclusions. The HOMA-IR does not show a normal distribution in our study population. We propose as a cut point in this population figures above the percentile 75.

CONCORDANCE OF BODY MASS INDEX BASED ON SELF REPORT AND MEASUREMENTS IN A YOUNG MEXICAN POPULATION
M.P. Pequeño-Luévano1, 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

Objective: To assess in a representative sample of young population the concordance of Body Mass Index (BMI) based on self-reported weight and height. Methods: We included subjects of the RIESGOS cohort consistent of 715 first year students (mean age= 17.5 years) from the Faculty of Medicine, Universidad Autónoma de Nuevo León, 199 of them agreed to participate in this study. Self-reported weight and height were recorded through a survey and then measured with a BAME® scale and a stadiometer. Results. We obtained a weight correlation coefficient of 0.3853 with a significance level p<0.0001 and a 95% confidence interval for r= 0.2601 to 0.4977. Conclusions: There’s a good and significant concordance between self weight report and measured weight in our population, therefore, the self report can be used as a follow up.

LOW- DOSE COSYNTROPIN STIMULATION. IS IT THE APPROPRIATE DOSE FOR THE OBESE?
L.G. Mancillas-Adame1, G. Morales-González1, G.L. Espinosa-Rodríguez2, Z.M. Hernández-Lorenzo1, J.T. Palacios-Zertuche2, C.A. Vélez-Viveros2, C.A. Villafuerte-Alonso2
1Endocrinology Service, University Hospital "Dr. José Eleuterio González", Monterrey, México 2Medicine School, Universidad Autónoma de Nuevo León

The assessment of the adrenal gland functional reserve with the short cosyntropin test is the most reliable diagnostic screening procedure in high risk populations. The plasma cortisol response to 1 µg is equivalent to that obtained with 250 µg. Corticotroph sensitivity to the negative feedback action of glucocorticoids is often impaired in obese population. Subjects and Methods: 11 obese subjects (median BMI= 21.73, p25= 31.08, p=75 33.48) and 8 non obese (median BMI= 31.59, p25=19.73, p75= 23.78) with an age range of 19.7 – 51.9 years, volunteered to participate in this double-blinded study. All subjects underwent in random order to four ACTH testing doses, placebo, 0.2 µg/kg, 10 µg and 1 µg. Results: In the control group the baseline mean cortisol results for 0.2 µg/kg, 10 µg, 1 µg and placebo were: 131.43 (SD=42.279), 145.4 (SD=45.43), 137.44 (SD=44.564), 147.48 (SD=61.269); in the cases group were 151.06 (SD=42.682), 156 (SD=52.94), 151.37 (SD=54.512), 153.77 (SD=50.558). At 30 minutes for the control group the results were 229.58 (SD=45.517), 239.6 (SD=37.566), 217.4 (SD=26.43) and 103.18 (SD=63.82); for cases, in the same order 271.74 (SD=35.193), 268.42 (SD=49.642), 214.5 (SD=34.89) and 105.18 (SD=27.975). At 60 minutes the mean results for controls were 257.06 (SD=70.245), 257.26 (SD=56.602), 153.38 (SD=66.025) and 96.69 (SD=58.23); for the case group 255.26 (SD=76.29), 285.73 (SD=51.233), 166.57 (SD=30.004) and 91.44 (SD=30.226). Conclusion: the obese patients have a minor adrenal response at 1 µg ACTH dosing.

INCREASE IN SERUM MAGNESIUM FOLLOWING WEIGHT LOSS IN MORBIDLY OBESE PATIENTS WITH TYPE 2 DIABETES
J.M. Brix1, H.P. Kopp1, C. Schnack1, S. Kriwanek2, G.H. Schernthaner3, G. Schernthaner
1Department of Internal Medicine I, Rudolfstiftung Hospital Vienna, Vienna, Austria, 2Department of Surgery, Rudolfstiftung Hospital Vienna, Vienna, Austria
3Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria

Background: Low magnesium has been associated with Insulin resistance and Type 2 diabetes (T2D). In this study we investigated the magnesium status in patients with morbid obesity (MO) in relation to their metabolic state. Methods: 745 MO patients (77.8% women, mean age 39.5±12.0years) were included in a cross-sectional study and compared to 91 healthy controls (63.8% women, mean age 45.4 ± 14.0years, mean BMI 25.6±4.4 kg/m²). 130 patients with MO (mean BMI 44.9±5.9kg/m²) were included in a longitudinal study and were analysed before and two years after bariatric surgery. Apart from serum magnesium levels, weight, a glucose tolerance test and standard laboratory parameters were assessed. Results: Patients with MO had significantly lower magnesium levels compared with healthy controls (0.84 ± 0.09 mmol/l vs 0.92 ± 0.06mmol/l;p<0.001) Magnesium levels were significantly lower in patients with T2D compared to patients with Normal Glucose Tolerance (NGT) before surgery (0.77±0.08 vs 0.85±0.07 mg/dl; p<0.001). Additionally we found a significant difference in the change of magnesium between both groups after surgery (T2D vs NGT -0.09±0.09 mmol/l vs -0.007± 0.07 mmol/l; p<0.001). After bariatric surgery we found a significant increase in magnesium levels (0.84±0.07 mmol/l vs 0.86±0.06 mmol/l; p=0.002). In a correlation analysis the ÄMagnesium correlated significantly with Äfasting glucose (r=-0.355;p<0.001), Ä1h glucose (r=-0.201;p=0.044), Ä2h glucose (r=-0.311;p=0.002), ÄHbA1c (r=-0.292;p=0.001) and Äbilirubin (r=0.197p=0.039). Conclusion: We found significant lower magnesium levels in patients with MO compared with healthy controls. In addition we could demonstrate an increase in magnesium levels, especially in patients suffering from diabetes after bariatric surgery.

WEIGHT CONTROL BEHAVIORS AMONG OVERWEIGHT, NORMAL WEIGHT AND UNDERWEIGHT ADOLESCENTS IN PALESTINE: FINDINGS FROM THE NATIONAL STUDY OF PALESTINIAN SCHOOLCHILDREN (HBSC-WBG2004)
H. Al Sabbah1,2, C. Vereecken1, Z. Abdeen2, C. Kelly3, K. Ojala4, A. Németh5, N. Ahluwalia6, L. Maes1
1Department of Public Health, Faculty of Medicine, Gent University, Belgium 2Nutrition and Health Research Institute, Al Quds University, Palestine 3Department of Health Promotion, National University of Ireland, Galway, Ireland 4Department of Health Sciences, University of Jyväskylä, Finland 5National Institute of Child Health, Hungary 6INSERM U558, Faculty of Medicine, Toulouse, France

Objective: To examine the relationship between weight control behaviors and self-reported socio-demographic characteristics, weight status and perception of body weight. Method: The Palestinian Health Behavior in School-aged Children (HBSC) study is a cross-sectional survey of adolescents in a representative sample of grades 6, 8, 10 and 12 (12-18 years). In total, 8885 questionnaires were considered in the analysis for this paper.Results: Among underweight boys, 37.3% engaged in disordered eating behaviors to control their weight. Older adolescents in grade 12 (18 years) were less likely than younger adolescents in grade 6 (12 years) to exercise, diet, and engage in disordered eating (p<0.01). Perception of body weight as too fat was the key determinant in following an unhealthy diet to lose weight (p<0.001). Conclusion: Disordered eating and unhealthy dieting practices are common among adolescents. These findings suggest the need to develop appropriate education programs for adolescents to adopt improve eating and dieting behaviors

FATNESS, LEANESS AND FAT DISTRIBUTION AMOUNG YOUNG VOLLEYBALL PLAYERS
A. Demuth, M. Krzykala, U. Czerniak
University School of Physical Education, Poznañ, Poland

Background. There is much concern about the fitness or leaness of children also in those, who are engaged in some sport activity. Fatness has a negative influence upon fitness especially in sports requaring jumps, rapid movement and lifting. The aim of present study was to describe fitness, leaness and region of fat distribution in young volleyball players. Material and methods. For this purpose in 2009 y, 49 polish girls (age 10 years) specialized in volleyball, were assessed. Several anthropometric measures were done: body height, body weight and some circumferences. Anthropometric indexes were used to evaluate body fat distribution. General level of body fat was done by bioelectric impedance method (BIA). All girls were devided into three groups according to fat level (fitness, normal, leaness). Fat distribution were assessed among those girls. Results. Marked differences in fat level were observed among girls. A big part of them were overweight and leaness. It sugest necessity of control young athletes in early stage of training to prevent obesity and many sport disappointments in the future.

LIFE QUALITY SENSING AND CHOSEN FAT MEASUREMENTS AMONG WOMEN AT THE AGE OF 40-60 (GRANT NR N40402932/0534)
A. Demuth, U. Czerniak, M. Krzykala
University School of Physical Education, Poznañ, Poland

Aim of this work is describing the dependence between life quality sense and biologic condition of adults. Material consists of research results conducted among 225 women – physical education university graduates and people from Greatpoland social elites. Among the elites were people on strategic government positions. All researched women had higher education and were at the age of 40-60. Variable differing both research groups was profession. For the analyze were used waist circumference, BMI index, Waist-to-height ratio (WHtR) and life quality estimation. Most of researched women positively estimates their personal life, is satisfied with their marriage, friends, spending their leisure time and education. Those women are also characterized with better body fat parameters. The lack of satisfaction from different spheres of life more often concerns physical education university graduates and is combined with their professional life. Those women significantly more often negatively estimate their work, life in Poland, earnings and are much more often characterized with overweight and obesity. Conclusions: 1. Calendar age and education are stronger determinates of life quality than profession among researched women. There are no significant differences in perceiving life satisfaction between analyzed groups. 2. A relation between life quality and biological condition among researched women was presented, which is described by higher satisfaction among people, among whom more often appear pro-health fat parameters.

MOBILE ACTIVITY CONDITIONED THE STATE OF OBESITY AMONG PEOPLE TREATED DUE TO BREAST CANCER
A. Demuth, U. Czerniak, M. Krzykala, M. Drozdowski
University School of Physical Education, Poznao, Poland

The aim of this work is the estimation of obesity state of women after mastectomy caused by malignant breast tumor who have undertaken physical activity or did not. The material of this work are the results of anthropometric measurements and body composition using bioelectric impedance method as well as questionnaire research conducted among 69 women after mastectomy from Poland. The age of examined women ranged from 38 to 68 years, however over 50% of the subjects were aged between 50 and 65 years. Women, who were from 1 to 5 years after the operation were a significant percentage of the research group( 46%). It is worth mentioning that the longest period from operation was 15 years. Research concerning this work was done using the Physical Activity International Questionnaire, what resulted in emerging two groups of women: physically active and inactive ones. The content of fat tissue by BIA among physically active women was lower comparing them to those inactive. Most of general obesity and fat tissue distribution indexes were different between those two groups at statistic significance level. Also a large percentage of obese women was observed in both analyzed groups. Preliminary data analyze does not allow to present detailed conclusions though it allows to state that majority of women after mastectomy who undertake physical activity after finalizing treatment is characterized with lower levels of fat tissue comparing to women who do not undertake such activity, with the value of this body component is over the population norm.

BODY MASS, BEHAVIOURS AND SOCIAL/HEALTH SITUATION IN DIABETES PATIENTS AT THE LEVEL OF BASIC MEDICAL HEALTHCARE - A POLISH NATIONAL STUDY
A.A. Abramczyk
Faculty of Health Sciences Medical Academy, 51-618 Wroclaw, ul. Bartla 5, Poland

Body mass, behaviours and social/health situation in diabetes patients at the level of basic medical healthcare - a Polish national study. Background. Multiple health and economic consequences related with obesity cause it to be regarded as a problem of a social significance and body mass control became a crucial element in the process of diabetes treatment. Objective. This paper presents factors differentiating body mass values among diabetes patients and defines the need for professional help depending on the BMI values. Methods. For the purpose of this work, research was carried out on 1,986 patients with diabetes from 61 randomly chosen national primary health service units, within the scope of NCSR grant no 6P05D02320, managed by the Author of this work. For the purpose of this work, the research was carried out on the basis of: guided nurse interview, relative assessment of fitness and independence of the patients, analysis of the medical documentation. Results. Normal body mass was found only in 12.8% of patients. Overweight were 36.5 % of the patients and 48.5% of patients were obese. Body mass assessment was not done for 42 patients (2%), due to the lack of measurements. Conclusions. The obtained results showed that the body mass values defined with BMI depend on the level of health consciousness, healthy behaviours, family and socio-living situation in diabetic patients. Obese persons have a higher risk of complications as well as high and very high requirement for professional care. No conflict of interest.

THE PREVALENCE OF METABOLIC SYNDROME AT NEWLY DIAGNOSED PATIENTS WITH T2DM – COHORT 2009
D. Licaroiu, E. Caceaune, O. Bradescu, N. Caceaune, C. Ionescu-Tîrgovişte
IDNBM N.C.Paulescu Str . Ion Movila 5-7, Bucuresti Romania

Background: Metabolic syndrome criteria include 5 factors that are associated with high cardiovascular risks. We investigated the prevalence of metabolic syndrome at newly diagnosed patients. Materials and Methods: We studied 1799 patients with newly diagnosed T2DM between Januarys - December 2009, 939 (52.19%) men and 860 (47.80%) women (mean age 57.36 years, mean BMI 31.2 Kg/m2). Waist circumferences (WC), BMI, fasting blood glucose, cholesterol, triglycerides, LDLc, HDLc, blood pressure were measured. The statistic program was SPSS 16.0; we used Spearman’s rho, and Pearson correlation tests with statistical significant p ≤0.05. Results: We found an inversely proportional correlation between HbA1C – BMI (p<0.01), HbA1C - HDLc (Pearson coefficient - 0.218) and FBG - HDLc (Pearson coefficient - 0.130), HDLc -TG (Pearson coefficient - 0.199), Cholesterol-TG (p< 0.01). Conclusions: The high numbers of patients that we’ve studied justify us to conclude that newly diagnosed patients with TD2M will be certainty candidate for MS. We have to investigate the presence of MS features at newly T2DM patients and the correlation with risk of coronary heart diseases.

THE PRESENCE OF METABOLIC DISORDERS AT T1DM AND T2DM AT NEWLY DIAGNOSED PATIENTS
D. Licaroiu1, E. Caceaune2, L. Dospinoiu3, C. Ionescu-Tîrgovişte4
1IDNBM N.C.Paulescu Str . Ion Movila 5-7 , Bucuresti Romania 2"I.L. Caragiale", Str. I. L. Caragiale nr. 12, Bucuresti, Romania 3CMI Motru, str. Carol Davila 1, Romania 4"I.L. Caragiale", Str. I. L.Caragiale nr. 12, Bucuresti, Romania

Aim: To analyze the presence of metabolic disorders at the newly diagnosed patients with type 1 diabetes (T1DM) and type 2 diabetes (T2DM),the correlation of HbA1C with the lipid profile, body mass index , fasting plasma glucose and triglycerides. Material and Methods: A cohort of 1804 diabetic patients was analyzed between January – November, 2009: 941 (52, 16%) male and 863 (47, 83%) female. We studied two groups 60 (3, 32%) T1DM: 34 (56, 66%) male, 26 (43, 34%) female and 1744 (96, 68%) T2DM: male 907 (52, 01%), female 837 (47, 99%), depending on HbA1C, fasting plasma glucose, body mass index (BMI), triglycerides. Results: We found the following mean values (male vs. female) for T1DM: BMI 29, 2 vs. 20 (kg/m2), Fasting plasma glucose - 225 vs. 343 mg/dl, HbA1C - 12, 93% vs. 12, 46%, triglycerides - 297, 14 mg/dl vs. 176 mg/dl. At T2DM the mean values of BMI were: 30 (kg/m2) vs. 31, 2 (kg/m2), fasting plasma glucose - 216 mg/dl vs. 210, 3 mg/dl, HbA1C - 9% vs. 8, 6%, triglycerides 279 vs. 193 mg/dl. The mean age at T1DM was 35, 29 years and at T2DM 58 years. Conclusions: In newly diagnosed T1DM patients, the metabolic disorders were more frequently presented than in T2DM patients. Triglycerides were higher at male patients with T1DM vs. T2DM and at female patients with T2DM vs. T1DM.

POLYMORPHISM OF THE RENIN-ANGIOTENSIN-ALDOSTERON SYSTEM GENES AND METABOLIC SYNDROME IN YOUNG WORKING POPULATION OF BANK EMPLOYERS
O.P. Rotar, V.V. Ivanenko, I.V. Fursova, L.S. Korostovtseva, A.A. Kostareva, V.N. Solntsev, A.O. Konradi
Almazov Federal Center of Heart, Blood and Endocrinology, Saint-Petersburg, Russia

Objective: The assess the association of the renin-angiotensin-aldosteron system (RAAS) polymorphism with metabolic disorders in the patients with mental stress. Patients and methods: 1600 bank office workers were screened at their working places in Saint-Petersburg. Fasting levels of lipids and glucose were determined on Hitachi-902 with Roche reagents (Switzerland). Anthropometry and blood pressure (BP) measurement were performed. Amplification by PCR method was used for identification of the I/D polymorphism of ACE gene, G/A polymorphism of angiotensinogen gene, A1166C polymorphism of gene of the ATII receptor. Informed consent was obtained from all subjects. Results. The prevalence of different genotypes in patient with and without metabolic syndrome was insignificantly different. Patients with MS have prevalence of ACE gene: II 25,9%, ID 49,3%, DD 24,8%, G/A polymorphism in promoter part of angiotensinogen: AA 23,1%, AG 50,8%, GG 26,1% and A1166C polymorphism of gene of AT II receptors type 1 was: AA 65,2%, AC 30,2%, CC 4,6%. The patients with different genotypes had no difference in anthropometrics, blood pressure and metabolic indicators. Gender differences were not detected too. Conclusions. Analysis of the prevalence of polymorphic markers of the metabolism gene-regulators didn't reveal any significant relation between RAAS polymorphism and components of metabolic syndrome.

C-REACTIVE PROTEIN LEVELS IN SEVERE OBESE WOMEN WITH NORMAL AND IMPAIRED GLUCOSE TOLERANCE
M.S. Sumarac-Dumanovic, D.D. Micic, D.H. Stamenkovic-Pejkovic, D.D. Jeremic, G.P. Cvijovic, S.A. Zoric
Institute of endocrinology, diabetes and diseases of metabolism

The aim of the study was to investigate possible association between C-reactive protein (hs-CRP) and adiposity measures as well as insulin sensitivity in 30 severe obese women (BMI >30kg/m2) with normal fasting glucose. In all women oral glucose tolerance test (OGTT) and euglycemic hyperinsulinemic clamp (120 min)) were performed. According OGTT impaired glucose tolerance were found in 10 of 30 women with normal fasting glucose. There was no correlation between CRP and BMI, waist circumference, fasting glucose, fasting insulin, M (insulin sensitivity from clamp study), AUCOGTT for insulin, AUCOGTT for glucose. When comparison in subgroup of women (with NGT-normal and IGT-impaired glucose tolerance) was done following results were obtained. There was no significant difference in CRP (NGT vs. IGT: 4.34±0.99 vs. 6.12±1.15mg/L, p>0.05) as well as in BMI, waist, age, HOMA index, total cholesterol, HDL-C, LDL-C, fasting insulin, but there was significant difference in following parameters: M index (NGT vs. IGT: 5.39 ± 0.48 vs. 2.88 ± 0.47mg/kg/min, P<0.05; index Total-cholesterol/HDL-C (NGT vs. IGT: 3.99 ± 0.21 vs. 5.45 ± 0.46; triglyceride (NGT vs. IGT: 1.48 ± 0.19 vs. 3.22 ± 0.65 mmol/L, P <0.05; and between insulin response at 120 min of OGTT (NGT vs. IGT: 46.16 ± 7.09 vs. 85.88 ± 16.77 mU/L, P <0.05). Our data could not confirm correlation between glucose tolerance and insulin senssitivity with CRP in obesity. Also these data suggest that impairment in insulin sensitivity and lipids profile changes precede change in inflammatory markers (CRP) during development of type 2 diabetes in obesity.

POSSIBILITIES OF SCREENING FOR SUBCLINICAL CUSHING’S SYNDROME IN PATIENTS WITH METABOLIC SYNDROME?
D. Jelic1,2
1University Clinic for Internal Medicine, "Dr Dragisa Misovic-Dedinje" Clinical-Hospital Center, Belgrade, Serbia 2Faculty of Medicine, University of Belgrade, Serbia

Endogenous Cushing’s syndrome is rather unusual in general population. However, in obese patients, especially with poorly controlled type 2 diabetes and hypertension, the reported prevalence of Cushing’s syndrome is not negligible (2-5%). So, the aim of this study was to investigate cortisol dynamics in 20 obese patients (13 females, 7 males, age 49.25+15.52 years; BMI: 33.13+3.96 kg/m2) and 20 type 2 diabetic patients (10 females, 10 males, age 56.05+10.16 years; BMI: 27.86+2.29 kg/m2) compared with 20 healthy volunteers (13 females, 7 males, age 42.1+12.39 years; BMI: 23.00+2.14 kg/m2) and 18 patients with proven Cushing’s syndrome (12 females, 6 males, age 47.94+14.82 years; BMI: 30.91+4.82 kg/m2). Screening tests included: 1) basal morning (08:00h) and late-night (23:00h) salivary cortisol, and 2) salivary cortisol response to overnight 1 mg dexamethasone suppression (post-DXM). Calculation of morning to late-night (AM:PM) and basal morning to post-suppression (08:00h/post-DMX) salivary cortisol ratio was also performed for every subject. AM:PM salivary cortisol ratios in obese patients (3.76+1.31) as well as in type 2 diabetic patients (2.49+0.59) were significantly higher, compared with the values calculated in patients with proven Cushing’s syndrome (1.17+0.39, p<0.000001), but also significantly lower than those in healthy controls (5.23+2.46, p<0.05). Basal morning to post-DXM salivary cortisol ratios indicated altered suppressibility in obese (4.28+3.06) and type 2 diabetic patients (3.58+0.93), in comparisson with healthy controls (8.45+3.57, p<0.001). These subtle abnormalities of cortisol dynamics as well as the existence of reliable tests make the screening for subclinical Cushing’s syndrome in patients with metabolic syndrome practically defensible.

VISFATIN RESPONSE DURING OGTT IN OBESE HEALTHY WOMEN
D. Micic, K. Sumarac-Dumanovic, Z. Cvijovic Stamenkovic-Pejkovic Jeremic
Institute of Endokrinology, Diabetes and Diseases of Metabolism, Belgrade, Serbia

Visfatin is an insulin-mimetic adipokine secreted predominantly from visceral fat. It was shown that diabetics have increased visfatin levels. However, conflicting results were reported considering glucose-visfatin interplay during OGTT in nondiabetic patients. The aim of our study was to evaluate visfatin response during OGTT (75 grams of glucose) in obese healthy women. Material and methods: In 8 obese healthy women (age: 43.50+/-10.69 years, BMI: 37.52+/-6.88 kg/m2, FAT%: 45.02+/-4.63%) OGTT was performed and glucose, insulin and visfatin levels were measured at 0, 30, 60, 90 and 120 minutes. Glucose (Glucoso-oxydase, Randox), insulin (RIA, INEP) and visfatin (ELISA, Phoenix) response was evaluated as a peak and area under the curve (AUC). RESULTS: There was significant increase in visfatin levels after glucose load (0 vs peak) (4.00+/-2.82 vs. 10.45+/-2.90, p<0.05). There was negative correlation between visfatin response and glucose levels during OGTT (peak visfatin and AUC glucose: r= -0.80, p<0.05; AUC visfatin and AUC glucose: r= -0.71, p<0.05). There was positive correlation between FAT% and insulin response during OGTT (peak insulin: r= 0.78, p<0.05, AUC insulin: r= 0.74, p<0.05). There was no correlation between FAT% and basal visfatin (r= 0.21, p>0.05) or visfatin response during OGTT (peak: r=-0.07, p>0.05; AUC: r=-0.04, p>0.05). There were no correlations of visfatin and BMI, basal and stimulated insulin levels. In conclusion, the observed rise in visfatin levels during OGTT in our group of obese healthy women was influenced by glucose levels during the test.

INFLUENCE OF OBESITY ON POSTPRANDIAL LIPEMIA IN TYPE 2 DIABETIC PATIENTS
N.V. Rajkovic1, M. Zamaklar1, K. Lalic1, N. Majkic-Singh2, N.M. Lalic1, S. Singh1, L. Stosic1, A. Jotic1, L. Lukic1, T. Milicic1, D. Tesic2
1Clinical Center of Serbia,Institute for Endocrinology 2Clinical Center of Serbia, Institute for Biochemistry

Aim: The study was aimed to analyze influence of obesity on postprandial lipemia in obese type 2 diabetics (T2D) patients (group A, n=35), nonobese T2D (group B, n= 28) and healthy subjects (group C, n=30). Methods: Postprandial lipids [total cholesterol (TCh), HDL-Ch, LDL-Ch and triglyceride (TG) determined by enzymatic methods] and insulin levels (RIA method) response were measured after mixed meal (51g fat) at 2-h intervals during 8 hrs. Insulin resistance (IR) was evaluated by HOMA method. Results: Postprandial TG increase (AUC) were significantly higher in group A vs B (1896.4±133 vs 1545.6±100.4 mmol/l/min; p<0.01), and in group B vs C (1133±100.2 mmol/l/min; p<0.01). Postprandial TCh response (AUC) were significantly higher in both groups A and B compare to group C (A: 2988.9±213, B: 2879±150, C: 2482±145mmol/l/min; A,B vs C p<0.01; A vs B: NS), while we could not find significant differences in postprandial response of HDL and LDL-Ch between the groups. Also, insulin response and HOMA-IR were significantly increased in group A vs B, and in group B vs C (insulin AUC: A:32400±254; B:22900±129; C:19800±117mI/ml/h; A vs B p<0.01, B vs C p<0.05), (HOMA-IR: A: 11.9±2.3, B: 7.65±1.8, C: 4.5±1.2; A vs B and B vs C p<0.01). Simultaneously, postprandial TG response correlated with HOMA-IR and insulin response (r=0.44, p<0.05; r=0.42 p<0,05) only in group A. Conclusion: Our results signify that in T2D obesity additionally amplify postprandial lipid response, especially of TGs. This enhancement could be influenced by higher postprandial insulin response and IR found in obese T2D.

RELATIONSHIP BETWEEN OBESITY INDICES AND CARDIOVASCULAR RISK FACTORS IN KOREAN TYPE 2 DIABETES PATIENTS
H.J. Chin1, D.M. Lim2, K.Y. Park2, G. Koh3
1Hankook General Hospital, Jeju, Republic of Korea 2Konyang University Hospital, Daejeon, Republic of Korea 3Jeju National University Hospital, Jeju, Republic of Korea

There were few studies which evaluate the relationship between obesity index and cardiovascular disease in type 2 diabetes mellitus (T2DM) patients. We aimed to determine which index of obesity is the best discriminator of cardiovascular (CV) risk in Korean T2DM patients. This is a cross-sectional study involving 658 T2DM patients from 2 university hospitals. We measured body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) in all subjects. Systolic (SBP) & diastolic (DBP) blood pressures, hsCRP, homocysteine, fibrinogen, uric acid, total cholesterol (TC), triglyceride (TG), HDL & LDL cholesterols, ApoB, ApoAI and microalbuminuria were regarded as CV risk factors. In addition, the 10-year coronary heart diseases risk (10-YR CHD) was calculated with the Framingham risk algorithm proposed by Wilson et al. because it include diabetes patients. BMI was positively correlated to SBP, TG, LDL and Apo B. WC was significantly correlated to hsCRP, homocysteine, TG, HDL, LDL and Apo B. WHR was positively correlated to hsCRP, homocysteine, TG and HDL. WHtR was significantly correlated to SBP, TG, HDL, LDL and Apo B. WC (Panova=0.045, Ptrend=0.004) and WHtR (Panova =0.011, Ptrend =0.001), but not BMI (Panova =0.763, Ptrend =0.051) and WHR (Panova =0.598, Ptrend =0.065), showed significant differences according to increasing quintiles of 10-YR CHD. In conclusion, WC and WHtR are more related to CV risk factors than BMI or WHR. It support the superiority of measuring of WC and WHtR, over BMI and WHR, for assessing CV risk in Korean T2DM patients.

ADIPONECTIN AND BREAST CANCER: META-ANALYSIS
Y.I. Kim, N.J. Sung, S.W. Oh
Center for Obesity, Nutrition, and Metabolism, Department of Family Medicine, Dongguk University Ilsan Hospital, Dongguk Univ-Seoul, Graduate School of Medicine, 410-773, Goyang, Korea

Background. : Recent studies investigated the association between adiponectin and breast cancer occurrence. But the study results were inconsistent. To provide quantitative evidence for relation, we applied meta-analysis techniques to combine and summarize the results of existing relevant studies. Methods: We searched data bases and reviewed citations in relevant articles to identify studies that met inclusion criteria. Nine case–control studies were included in our meta-analyses. We conducted meta-analyses of the results of these studies with adjustment for confounding factors. Random effect model were applied to estimate combined effect values. STATA Version 10 computer program was used to calculate effect size with 95% confidence interval (CI). Results. : In the meta-analysis including nine studies the OR (Odds Ratio) of the highest adiponectin subgroup was 0.81 (95% CI, 0.69-0.95) which means that subjects with the highest adiponectin level subgroup had lower occurrence of breast cancer than the lowest adiponectin subgroup. Conclusion: Our meta-analysis provides the strong evidence that adiponectin has the protective effect against breast cancer occurrence.

DIFFERENCES IN PREVALENCE OF LOW HDL-C LEVELS BETWEEN GENERAL POPULATION AND PRIMARY CARE POPULATION IN LLEIDA (SPAIN)
V. Sanchez, M. Caldero, A. Quesada, R. Llovet, M.A. Mollo, M. Falguera, A. Rodriguez, J. Montserrat, M.B. Vilanova, M. Pena, M. Alvarez, J.P. Fabregat
ABS PLa Urgell, Mollerussa, Spain

Objectives: compare the prevalence of low HDL-c levels in general population with 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%). Population 2: The sample was selected by consecutive random process. 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. Low levels of HDL-c were defined according to ATP-III criteria (<50mg/dl in women and <40mg/dl in men). Results: The prevalence of low HDL-c was 26.1% [CI 95% 21.0 – 31.2] in general population, and 10.6% [CI 95% 6.8 – 14.3] in primary care population. The differences in both groups were statistically significative (T Student test, p<0.05). Conclusions: It is well-known that low HDL-c is an independent risk factor for coronary heart disease. Before the end of this study we expected to obtain higher prevalence of low HDL-c in primary care population. Surprisingly, we obtained a higher prevalence in general population than in primary care. The main controversial point in our study is the fact that people under dyslipemia treatment were included in the general population sample, in contrast to the primary care population sample, where they were excluded. Further reflections are needed to elucidate better the influence of both, environmental and genetic determinants, in HDL-c levels in Spanish population.

THE ORPHAN NUCLEAR RECEPTORS ROR- AND PPAR- GAMMA: TRANSCRIPTIONAL LINKS IN DIABESITY
I. Moreno-Santos1, F.J. Tinahones2, M. Macias-Gonzalez1
1Laboratorio Investigacion, Hospital Virgen De La Victoria 2servicio De Endocrinologia, Hospital Virgen De La Victoria

The orphan nuclear receptor, retinoic acid receptor-related orphan receptors gamma (RORg) and peroxisome proliferator-activated receptor gamma (PPARg), are central mediators controlling adipocyte differentiation. The aim of the study was to evaluate whether RORg and PPARg expression in human adipose tissues should be associated with insulin resistance (IR) in morbid obesity (MO) versus non obese patients. Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) biopsies were obtained from 23 morbidly obese (MO) patients undergoing bariatric surgery procedures and lean patients during surgical repair of hiatus hernias. RORg and PPARg mRNA and protein expression levels were measured in the tissues obtained by quantitative RT-PCR and western blotting respectively. The DNA binding activities of these ONRs were observed by electrophoretic mobility shift assays (EMSAs) in VAT. The MO patients were divided into two groups: those with a low homeostasis model assessment of insulin resistance (HOMA-IR<5) (MO no-IR) and those with a high HOMA-IR (HOMA-IR < 8) (MO-IR). RORg mRNA and protein expression levels were higher in VAT in the MO IR than in the MO non-IR group. In contrast, PPARg mRNA and protein expression levels were lower in VAT in the MO no-IR in comparison with MO-IR. Finally, we demonstrated by EMSAs that the activation of these ONRs on DNA is modulated by insulin resistance in VAT, but not in SAT. In conclusion, the expression of RORg and PPARg are regulated in morbid obesity and showed to be related with the insulin resistance in VAT, but not in SAT.

ADIPONECTIN PROTECTS AGAINST DIABETES IN ADULT MEN
S. Sans1, P. Padró2, B. Badimón2
1Institute of Health Studies 2Cardiovascular Sciences Institute 3Cardiovascular Sciences Institute

Purpose: Adiponectin, an adipose tissue hormone, has metabolic properties over many organs. The purpose of this study was to investigate its relationship with diabetes incidence in a white Mediterranean men cohort. Material and methods: A general population random sample cardiovascular survey conducted during 1986-88 in men aged 35 to 69 years (n=1011, response rate 73%) and re-interviewed in 1996-97 (n=904). Methods followed the WHO-MONICA protocol, plus the diabetes questionnaire of the Hispanic NHANES. Height and weight measured with a roman balance. BMI calculated by Quetelet index. Blood pressure with random zero mercury sphygmomanometers. 12-hour fasting venous blood sample analyzed for lipids and glucose with conventional enzymatic methods. HDL-cholesterol by manual precipitation. Adiponectin and insulin were measured in serum, kept frozen at -80oC by X-Map luminex technology. Type-2 diabetes defined as 12-hour fasting glucose >=7.0 mmol/l or self-report of diabetes diagnosed or treated by a doctor. Incident diabetes defined as absence of these criteria at baseline but presence at re-examination. Prevalent diabetes excluded from the analysis. X2 test, ANOVA and Cox regression were calculated with SPPS-13©. Results: Incidence of diabetes 10.3 per º/º º/year (n=89). Median adiponectin 19 ugr/ml. Incidence of diabetes decreased by quartiles of adiponectin (X2=21.34, df3, p<0.0001, IRR Q4-Q1= 0.15). In Cox regression, log-adiponectin remained a significant protector of diabetes (HR=0.24, 95%CI 0.08-0.72), after adjusting for age, BMI, years of school, diastolic blood pressure, HDL-cholesterol, triglycerides, leptin and insulin. Conclusion: Incidence of diabetes is high and serum adiponectin is a significant protector for diabetes independently of other factors.

CHANGES IN TOTAL, OXIDATIVE AND NONOXIDATIVE GLUCOSE DISPOSAL AFTER WEIGHT REDUCTION IN OBESE TYPE 2 DIABETICS

V. Macesic, M. Lalic, A. Jotic, K. Lalic, T. Milicic, L. Lukic, N. Rajkovic, M. Zamaklar, J.P. Seferovic Mitrovic

Institute for Endocrinology,Diabetes and Metabolic Diseases

Aim. The study was aimed to evaluate the changes in total, oxidative and nonoxidative insulin-stimulated intracellular glucose disposal after a moderate weight reduction diet (1000 kcal/day; 28 days) in obese type 2 diabetic (T2D) patients (BMI>30 kg/m2): 18 high-responders (ÄBMI >2 kg/m2, group A) and 22 low-responders to the diet (ÄBMI < 2 kg/m2, group B) compared to 15 healthy nonobese controls (BMI<25 kg/m2,group C). Methods. We conducted euglycemic hyperinsulinemic clamp combined with continuous indirect calorimetry. Results. We found significantly lower values in fasting blood glucose (FBG) in groups A and B (FBG: A: 6.7+/-0.7 vs 8.8+/-1.5, p<0.01; B: 7.4+/-0.6 vs 8.8+/-0.6 mmol/l, p<0.05, A vs B, p<0.05) after the diet. In group A, we found increases in total, oxidative and nonoxidative glucose disposal (6.7+/-0.6 vs 4.8+/-0.5; 3.3+/-0.4 vs 2.2+/-0.2; 3.8+/-0.3 vs 2.7+/-0.2 mg/kgbw/min, respectively; p<0.05). In group B, total and oxidative glucose disposal increased in contrast to nonoxidative disposal which did not change significantly (6.0+/-0.4 vs 4.9+/-0.5, p<0.05; 3.3+/-0.3 vs 2.1+/-0.1,p<0.05; 2.9+/-0.4 vs 2.8+/-0.3 mg/kgbw/min, p=NS; respectively). Moreover, the improved glucose disposal levels after the diet in groups A and B were still significantly lower than in group C (8.7+/-0.5, 3.8+/-0.3 and 3.7+/-0.2 mg/kgbw/min, respectively, p<0.05). Conclusions. Our results signify that the weight reduction diet was efficient in improving nonoxidative insulin-stimulated glucose disposal only in the high-responder obese T2D. The results imply that a significant amount of the weight loss is required for obtaining an improvement in nonoxidative glucose disposal in the obese T2D.

ASSOCIATION BETWEEN NUTRITIONAL STATUS AND LIFE STYLE PRACTICES OF PRIMARY SCHOOL CHILDREN IN COLOMBO DISTRICT
L.R. Thilakarathne1, N.G. Wijesinghe2
1Nutrition Coordination Division, Colombo, Sri Lanka 2University of Peradeniya, Peradeniya, Sri Lanka

This study aims to determine the association between nutritional status and life style practices among primary School Children in Colombo. This cross-sectional study comprised 1347 school children in grade 4 and 5 deploying random cluster sampling method from eight randomly allocated National schools in Colombo. Life style practices were assessed using a questionnaire. Height, weight and waist circumference (WC) were measured. The prevalence of stunting and underweight was 3.8% and 16.6% respectively. The prevalence of undernutrition was significantly high in girls (P<0.05). According to the age and sex specific BMI charts 5.1% were obese, 8.9% were overweight, and 30.9% were thin. Over weight and obesity were significantly high in boys (P<0.05) Daily intake of breakfast was only 67.1%. Daily intake of fruits, vegetables and green leaves were 52.1%, 71.8% & 52.9% respectively. Children who consumed breakfast daily shows high intake of daily vegetables and of daily green leaves (P<0.05). The frequency of consuming milk and fast foods were high in boys (P<0.05). According to the leisure time activities, 73.3% were physically inactive. Proportion of children who spend their leisure time in front of TV / computer was high in boys (P <0.05). Children who is watching TV while eating foods reported poor diet includes less daily intake of vegetables (P<0.05) and green leaves (P>0.05), and high habitual intake of soft drinks (P<0.05), and fast foods (P<0.05). Therefore study concludes that the nutrition challenge among primary school children in Colombo is shifting from undernutrition to overnutrition, with boys particularly at risk.

PLASMA APELIN CONCENTRATIONS IN WOMEN WITH POLYCYSTIC OVARY SYNDROME
F. Chan
Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

OBJECTIVE: To test whether there was a difference in plasma apelin concentrations between subjects with polycystic ovary syndrome (PCOS) and those with a healthy regular menstrual cycle, and to investigate the association of apelin with a variety of parameters including body mass indexes (BMI), insulin sensitivity. and lipid profile. METHODS: Forty seven patients with PCOS and 55 healthy controls were enrolled. Apelin concentrations were measured along with BMI, lipids, glucose, insulin and various hormone levels, and HOMA indexes. RESULTS: Plasma apelin concentrations were not significantly different in the PCOS group compared to controls (557.0±204.8, 534.4±181.7 pg/ml; p=0.557). Insulin levels and HOMA indexes were significantly higher in patients with PCOS (p=0.016 and p=0.022, respectively). Apelin levels were not correlated with age, BMI, fasting blood glucose and insulin, and HOMA indexes. Apolipoprotein A (Apo A) concentrations were significantly correlated to Apelin concentrations by multiple linear regression analysis (r=0.396, r2=0.157, p=0.044). CONCLUSIONS: Plasma apelin concentrations in PCOS and control women are not different. Apelin levels might not be influenced by PCOS itself. Apelin concentrations might not be a useful marker of insulin resistance in PCOS subjects. The circulating apelin concentrations were positive correlated to Apo A concentrations. Dysregulation of apelin and Apo A might be involved in the mechanism of establishment of associated atherosclerotic complications.

EVALUATION OF THE EFFECTS OF WEIGHT LOSS ON RESTING ENERGY EXPENDITURE, BODY COMPOSITION AND SOME BIOCHEMICAL PARAMETERS IN ADULT OBESE WOMEN
C. Akbulut1, N. Rakicioglu2
1Gazi University, The Department of Nutrition and Dietetics, Ankara, Turkey 2Hacettepe University, The Department of Nutrition and Dietetics, Ankara, Turkey

The aim of this study was to determine the effects of weight loss on energy expenditure, body composition and some biochemical parameters in adult obese women. This is a prospective cohort study, conducted on adult women aged 20-45 years, living in Ankara, between the years of 2005-2007. The participants were divided into two groups according to their body mass index (BMI) >27 kg/m2. While the first group has performed diet therapy alone, the second group has performed both diet therapy and physical activity. The energy expenditure of the subjects were monitored by means of indirect calorimetry (ergospirometry), body composition was measured using by dual energy X-ray absorptiometry (DXA) and other anthropometric measurements, and also some biochemical parameters has evaluated. At the end of the study, it has found statistically significant reductions on serum total cholesterol (TC) (p=0.000), low-density lipoprotein cholesterol (LDL-C) (p=0.001), very low-density lipoprotein cholesterol (VLDL-C) (p=0.040), triglycerides (TG) (p=0.036), systolic blood pressure (SBP) (p=0.040), diastolic blood pressure (DBP) (p=0.043) of the diet+physical activity group, and there was a significant reduction on the TC (p=0.033) of the diet alone group. The bio-electrical impedance analysis (BIA) was closely correlated to DXA on the determination of body weight (r=0.99, p<0.001). We have found statistically significant reductions on the basal metabolic rate (BMR) and resting metabolic rate (RMR) of the diet alone group during the study period (p<0.001). According to the food consumption variables of the groups, it has been determined a significant reduction on dietary energy intake, total fat, saturated fatty acids and animal protein (p<0.05). As a result of this study, the diet and physical activity together have positive affects on weight loss, biochemical parameters and energy expenditure.

ABDOMINAL OBESITY IN SUB-SAHARAN AFRICAN MEN: WAIST AND CARDIOVASCULAR RISK PROFILE IN MEN WITH TYPE 2 DIABETES
J. Kalk
Musgrove Park Hospital, Taunton, UK

Background: The waist circumference (W-C) which defines central obesity in sub-Saharan African men is unknown; the IDF suggests ?94cm in defining the Metabolic Syndrome, as for white populations, but African men (with/without diabetes) are leaner than white men in Southern Africa. Aim: Evaluation of the effects of W-C on cardiovascular risk factors in 203 C-peptide positive African men with type 2 diabetes (mean age 50.0±8.2yrs; 45.8% insulin treated) divided into waist quartiles (Q1 to Q4). Results: Age, duration of diabetes, glycaemic control and renal function were similar in each quartile. Between Q1 (W-C ?87cm) and Q2+Q3 (W-C 88-103cm, all variables comparable) there was a step down in the prevalence of smoking (42 vs 21%, p=0.018), and a step up in frequencies of hypertriglyceridaemia (>2.0mmol/l) (17.3 vs 34.7%, p=0.040), low HDLC (<1.0mmo/l) (22.0 vs 54.3%, p=0.0096) and higher LDLC (?3.0mol/l) (22.0 vs 45.0%, p=0.010). W-C correlated significantly with HDLC (negative, r=0.304), LDLC (r=0.300), C-peptide (r=0.381) and modified HOMA-IR (r=0.400) (p<0.0001 for all). Subjects in Q4 (W-C >103cm) had a further significant increase of high LDLC prevalence, but not of high triglyceride nor low HDLC prevalence. Hypertension was weakly associated with W-C (p=0.041). The 10yr Framingham risk score was low (median 7.0, range 4-16); it correlated significantly with W-C (p<0.0001).
Conclusions: A waist circumference of ?88cm may be appropriate to define abdominal obesity in African men; in these diabetic subjects W-C influenced LDLC throughout its range. Population-based studies are required to confirm/refute these findings in sub-Saharan African populations.

A MICRODIALYSIS STUDY OF INFLAMMATION AND OBESITY: CHANGES IN CYTOKINES WITH WEIGHT LOSS
L. Simchowitz1, J.D. Linderman1, N.G. Sebring2, S. M. Smith1, A. B. Courville2, F. S. Celi1
1National Institute of Diabetes and Digestive and Kidney Diseases/NIH 2Clinical Center/NIH

In order to assess serial changes in cytokines and adipokines during weight loss, 50 Overweight Subjects (BMI 28-45) were enrolled in a calorie-restricted diet protocol. The Overweight Group was studied at 3 months intervals over the course of one year, analyzing serum and fluid samples obtained by subcutaneous abdominal fat microdialysis. Results were compared with a group of 15 Normal-Weight individuals (BMI 19-24.9). As expected, serum leptin correlated strongly with BMI as did microdialysate leptin levels. Both declined as patients lost weight. At baseline, there was a direct, positive correlation with BMI for serum TNF-á, IL-6, IL-2, and IL-8, but not for IL-10 or Interferon-ã. Microdialysate IL-10 and Interferon-ã levels did, however, correlate with BMI. Cytokines were readily detected in microdialysate fluid --- levels of IL-6 and IL-8 were 50-fold higher than in serum, consistent with local in situ production. Patients who lost >10 kg (from BMI ~38 to ~31) showed slow, progressive declines in serum levels of TNF-á, IL-6, IL-2, and IL-8. In contrast, the time course of microdialysis data was more complex, demonstrating a bi- or triphasic response: a rise during the initial period of rapid weight loss followed by a gradual fall and then a second rise. Overweight Subjects who failed to lose weight (<2 kg) did not exhibit these effects. These studies indicate that the microdialysis technique is a simple, convenient, and efficacious method for assessing the intercellular milieu in subcutaneous adipose tissue.

BENEFITS OF INITIAL COMBINATION THERAPY WITH SAXAGLIPTIN + METFORMIN: THE LATIN AMERICAN EXPERIENCE IN TREATMENT-NAÏVE TYPE 2 DIABETES PATIENTS WITH INADEQUATE GLYCAEMIC CONTROL
M. Jadzinsky1, G. Fuente1, G. Dieuzeide2, H. Fideleff3, S. Hermida4, M. Vico5, L. Jotimliansky6, M. Waschbusch6, C. Dantuono7, F. Esquivel7
1Hospital Durand, Buenos Aires, Argentina 2CAIDEM, Chacabuco, Argentina 3Hospital Alvarez, Buenos Aires, Argentina 4CIAD, Morón, Argentina 5Instituto de Investigaciones, Zarate, Argentina 6Bristol-Myers Squibb, Buenos Aires, Argentina 7AstraZeneca, Haedo, Argentina

Introduction: We present the Latin American (LA) population subanalysis of study CV039 performed to evaluate the efficacy of initial SM combination therapy: [saxagliptin (a potent, selective dipeptidyl peptidase-4 (DPP-4) inhibitor + metformin) vs saxagliptin or metformin monotherapy in treatment-naïve patients with T2D and inadequate glycaemic control. Methods: Multicentre, randomized, double-blind, active-controlled phase III trial comparing saxagliptin 5 mg + metformin 500 mg (S5M), saxagliptin 10 mg + metformin 500 mg (S10M), saxagliptin 10 mg + placebo (SP) or metformin 500 mg + placebo (MP) for 24 weeks. The primary efficacy endpoint was the change in glycated hemoglobin A1C (HbA1c) from baseline to week 24. Secondary outcomes were change in fasting plasma glucose (FPG), proportion of patients achieving HbA1c <7% and postprandial glucose area under the curve (PPG-AUC). Statistical analysis was performed using the LOCF method with ANCOVA model. Results: The overall study population consisted of 1,306 pts, 370 (28.3%) of whom were from LA (Argentina, Brazil, Mexico). Población global del estudio: 1306 pacientes; 370 de los cuales (28,3%) eran de LA (Argentina, Brasil y México). Compared to the overall population, the LA cohort showed similar demographic and clinical baseline characteristics. % of subjects with HbA1c <7% in S5M group was 30.9% greater than SP (p<0.0001) and 19.5% greater than MP (p=0.0073). In S10M group, % of subjects with HbA1c<7% was 21.2% greater thant SP (p=0.0047) and 9.9% greater than MP (NS). FPG and PPG-AUC reduction were also statistically greater in groups SM. Conclusions: Saxagliptin + metformin as initial combination therapy led to statistically significant and clinically meaningful benefits in LA diabetic patients.

DIABETIC NOMOGRAM: A NEW APPROACH FOR PREDICTING DIABETES RISK

E. Wanothayaroj, C. Pongchaiyakul, P. Kotruchin

Division of Endocrinology & Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

Objective: To develop a prognostic model based on demographic and clinical risk factors and develop nomogram for predicting diabetes risk in Thai population. Research Design and Methods: The study was designed as a cross-sectional investigation with 4,314 participants of Thai background, aged between 15 and 85 years (mean age: 48). Fasting plasma glucose was measured and repeated if the first measurement was more than 126 mg/dl. Diabetes was diagnosed using World Health Organization’s criteria. Demographic data and clinical risk factors were obtained from all participants. Logistic regression model was used to develop the prognostic model. The prognostic performance of the model was assessed by the area under the receiver operating characteristic curve (AUC) and a nomogram was constructed separated by gender. Results: In the whole sample, the prevalence of diabetes was 7.4% (n = 125/1693) and 3.4% (n = 98/2621) in men and women, respectively. The prevalence increased with age and body mass index (BMI). Age, BMI and systolic blood pressure (SBP) were each significantly associated with diabetes risk. Based on the estimated parameters of model, a nomogram was constructed for predicting diabetes separated by gender. The AUC of the model was 0.77 for men and 0.70 for women. Conclusions: These data suggest that the combination of age, BMI and systolic blood pressure could significantly improve the prognosis of diabetes in Thai population, and that the nomogram can assist primary care physicians and also health care providers in the identification of high-risk individuals.

THE RELATIONSHIP BETWEEN BIRTH WEIGHT AND INSULIN RESISTANCE IN CHILDHOOD
H.C. Rondo1, O. Lemos1, A. Pereira1, G. Oliveira1, S. Freire2, B. Sonsin1
1Department of Nutrition, School of Public Health, University of São Paulo, Sao Paulo, Brazil 2Jundiaí Medical School, Jundiaí, SP, Brazil

Chronic diseases that are typical of adulthood may originate in intrauterine life, through inadequate foetal development. This epidemiological cohort study of 506 healthy children aged five to eight years evaluated the relationship between birth weight and insulin resistance in an age group that has been assessed in few similar studies. Insulin concentration was determined by chemiluminescence, and insulin resistance by the homeostasis model assessment (HOMA). Blood glucose, total cholesterol and fractions (LDL-c and HDL-c) and triglyceride concentrations were determined by automated enzymatic methods. Linear regression analysis investigated the relationship between birth weight and the HOMA index, using backward stepwise selection, and biological models to explain the causal pathway of the relationship. There were a negative association between birth weight (p<0.001) and the HOMA index, and a positive association between waist circumference (p<0.001) and the HOMA index. In summary, the results of this study showed increased insulin resistance in apparently healthy, young children, who had lower weight at birth. There is a need to develop public health policies that adopt preventive measures to promote adequate maternal-foetal and child development and enable early diagnosis of metabolic abnormalities.

THE DIFFERENCES OF THE ANTHROPOMETRIC PARAMETERS OF THE STUDENTS OF THE SOUTH BOHEMIA UNIVERSITY AND OF THE CHARLES UNIVERSITY OF PRAGUE
A. Adamkova1, M. Vrablik2, J.A. Hubacek1, V. Lanska1
1Institute for Clinical and Experimental Medicine , Prague,Czech Republic 21 Medical Faculty, Charles University, Prague, Czech Republic

Aim: To ascertain by one day dietary recall the nutrition of the students of two different regions., their basic anthropometric parameters, blood pressure and the level of fast glucose and total cholesterol. Method and group: We examinated 1486 probands, 753 males, 727 females, average age in the both groups 22,3 ± 3,21years, n.s. Height, weight, circumference of waist were measured, body mass index ( BMI, kg/m²) was calculated, blood pressure by standard conditions was measured ( 3 measurements ), nobody of the probands have had antihypertensive drug therapy. The one day dietary recall was analysed – total energy intake, consumption of fats, saccharides, proteins, vitamine C. For statistic analyses ANOVA was used. Results: The circumference of waist was smaller and BMI lower only in the females from South Bohemia (p< 0,05) than from Prague ( 88,6 ± 11,34 x 89,9 ± 8,56 cm) Males were higher from Prague (p< 0,05) 182,36 ± 12,654 x 180,9 ± 10,32 cm than from South Bohemia, 68% of the probands from South Bohemia have exercised 3x weekly ( both gender), but only 59% males nad 56% females from Prague (p< 0,05). No differences of the nutrition and of the lab tests ( fast glucose, total cholesterol) was ascertained between these groups. Conclusion: The students from the South Bohemia have ecercised more than students from Prague, BMI and circumference of waist were lower only in females from South Bohemia . This project was supported by IGA of Ministery of Health, Czech Republic No 10579-3

IS IT POSSIBLE TO IMPROVE THE CARDIOVASCULAR RISK PROFILE IN PATIENTS WITH CARDIOVASCULAR DISEASES AND TYPE 2 DIABETES BY A COMPLEX INTERVENTION?
H. Rosolova
Nussbaumerova Sipova Sifalda Simon Sefrna 2nd DPT of Medicine, University Hospital in Pilsen, Charles University in Prague

Patients with type 2 diabetes (DM2) and concomitant cardiovascular disease (CVD) are considered to have the highest risk for new atherothrombotic CV events among the whole population. Aim of the study was to assess the efficacy of Complex Intervention Programme (CIP) and an addition of fenofibrate to the already constituted drug treatment in DM2 with CVD. Personal history, anthropometric and laboratory parameters and current medication were extracted from patients‘ medical reports. The CIP consists of educational interview of lifestyle (diet recommendation, smoking intervention and regular weekly physical exercise offer) and start hypolipidemic therapy by micronised fenofibrate 267 mg daily added to the current therapy. We recruited 420 DM2; 227 (54 %) had evidence of concomitant CVD (105 males, aged 70 ± 8 y., and 122 females, 71±9 y.). After 6 months of CIP the risk profile and risk factors control of DM2 with CVD improved. Recommended fasting plasma lipid levels, i.e. total cholesterol < 4.5 mmol/L, LDL-chol < 2.5 mmol/L, triglycerides < 1.7 mmol/L and HDL-chol> 1.0 in males and 1.3 mmol/L in females, were achieved before CIP only in 14% males and 17% females, after CIP in 60% of the both sexes. Blood pressure control below 130/80 mmHg also improved from 6% to 18% in males and from 9% to 20% in females, although any change of antihypertensive therapy was realized. The results provide the evidence that a special care in high risk patients is fruitful; improvement in treatment compliance is also suggested.

BENEFICIAL EFFECTS OF TESTOSTERONE ON GLUCOSE HOMEOSTASIS AND METABOLIC SYNDROME PERSIST AFTER ITS DISCONTINUATION
A. Saad1,4, E. Heufelder2, C. Bunck3, L.J. Gooren3
1Scientific Affairs Men's Healthcare, Bayer Schering Pharma, Berlin, Germany 2Private Practice for Internal Medicine and Diabetology 3Dpr of Endocrinology, VU Medical Center, Amsterdam, The Netherlands 4Gulf Medical University School of Medicine, Ajman, UAE

Objectives: In an earlier study of 32 men with the metabolic syndrome (MetS) and newly diagnosed type 2 diabetes (T2D) with hypogonadal serum testosterone (T) (<12.0 nmol/L), all received supervised diet + exercise (D&E) but 16 also testosterone (T) gel 50 mg once daily). Serum T, HbA1c, fasting plasma glucose, HDL-cholesterol, and triglyceride concentrations, and the waist circumference improved in both treatment groups after 52-weeks of treatment. But addition of T significantly further improved these measures compared to D&E alone. All D&E+T patients reached the HbA1c goal of <7.0%, 87.5% reached an HbA1c <6.5%. Based on ATPIII, 81.3% of the patients randomized to D&E+T no longer matched the criteria of the MetS, 31.3% of the D&E alone patients did. (Heufelder et al, J Androl 2009; 30: 726-33). Research question: do these effects persist after discontinuation of T treatment? Design: After 12-18 months administration of T, T was discontinued and for the next 6 months the above variables were followed up. Results: In the group earlier treated with T for 12-18 months, there were no significant changes in waist circumference, body weight, HbA1c, fasting glucose, serum insulin, LDL- and HDL-cholesterol, and triglycerides over the 6 months after discontinuation of T while maintaining D&E. After 24 months all variables studied were significantly more favorable in the group which had received T compared to the placebo group. Conclusions: Beneficial effects of T treatment of men with diabetes and metabolic syndrome continued for at least 6 months after discontinuation of T.

TREATMENT WITH DIET AND EXERCISE PLUS TESTOSTERONE IMPROVES GLYCAEMIC CONTROL
A. Saad1,2, E. Heufelder3, C. Bunck4, J.G. Gooren4
1Scientific Affairs Men's Healthcare, Bayer Schering Pharma, Berlin, Germany 2Gulf Medical University School of Medicine, Ajman, UAE 3Private Practice for Internal Medicine and Diabetology, Munich, Germany 4Dpt of Endocrinology, VU Medical Center, Amsterdam, The Netherlands

Objectives: Men with the metabolic syndrome (MetS) and type 2 diabetes (T2D) often have low testosterone levels. Elevating low testosterone levels may improve features of the MetS and glycemic control. In a single blind, 52-week randomized clinical trial, the effects of supervised diet and exercise (D&E) with or without transdermal testosterone administration on components of the MetS in hypogonadal men with the MetS and newly diagnosed T2D were assessed. 32 hypogonadal men (total testosterone <12.0 nmol/L) with the MetS as defined by the Adult Treatment Panel-III and the International Diabetes Federation, and newly diagnosed T2D received supervised D&E but 16 in combination with testosterone gel 50 mg once daily (n=16). No glucose lowering agents were administered. Outcome measures were components of the MetS as defined by the ATPIII and IDF. Results: Serum testosterone, HbA1c, fasting plasma glucose, HDL-cholesterol, and triglyceride concentrations, and the waist circumference improved in both treatment groups after 52-weeks of treatment. Addition of testosterone significantly further improved these measures compared to D&E alone. All D&E+T patients reached the HbA1c goal of <7.0%, 87.5% reached an HbA1c <6.5%. Based on ATPIII, 81.3% of the patients randomized to D&E+T no longer matched the criteria of the MetS, whereas 31.3% of the D&E alone patients did. Additionally, testosterone treatment improved insulin sensitivity, adiponectin and high-sensitivity C-reactive protein. Conclusions: Addition of testosterone to supervised D&E results in greater therapeutic improvements of glycaemic control and reverses the MetS in hypogonadal patients with the MetS and newly diagnosed T2D.

MICROALBUMINURIA AS INDEX OF NEPHROPATHY IN PATIENTS WITH TYPE II DIABETES MELLITUS
I.F. Fotopoulou1, S.I. Paratiras1, O.S. Drakoulogkona2, E.Y. Patrinis1, S.O. Anastasiadou1, D.K. Kastamoniti2, K.O. Paraskevopoulou1, K.C. Goula2, P.A. Masoura1, K.L. Kastamonitis2, A.R. Nikolopoulou1
1Laboratory of Haematology, General Hospital “Saint Andrews” 2Department of Nephrology, General Hospital “Saint Andrews”

Introduction: The type II diabetes is responsible for the appearance of vascular diseases (microangiopathy, macroangiopathy) and mortality. The study tested our patients in the Haematology laboratory of General Hospital of Patras ' Saint Andrews '. Purpose: Evaluation of microalbuminuria in patients with type II diabetes for assessment of diabetic nephropathy. Population study: We study 341 patients for 4 years (2005-2008). 141 were men (41%) and 200 women (49%), with average age of 62 years. Method: The mean duration of disease was 7,5 years and the BMI of patients was 27-35. A) Based on the kind of their medication, were divided into 4 categories: Treatment with tablets, insulin, insulin combined treatment tablets and without treatment. B) Based on glycosilated haemoglobin 1c (HbA1c), patients were divided into those who had excellent, good and lack setting. C) Based on the microalbuminuria, these patients were divided into 4 categories. Patients with ratio A / C in urine < 30, between 30-300 and >300. Results: In 185 patients with poor regulation of HbA1c the 76 (41%) were men and 109 (59%) were women: 39 (21%) had no controlled HbA 1 c and microalbuminuria [men 15 (20%) and women 24 (22%)] while 9 (5%) had non controlled HbA 1 c and protein in the urine [men 7 (9%) and women 2 (2%)]. Conclusion: The study showed that a percentage of 21% with inadequate setting of type II diabetes mellitus presents subclinic nephropathy and needs further regulation. Therefore the ratio A/C in urine is an early index of incoming diabetic nephropathy.

EFFICACY AND SAFETY OF USING INTRAVENOUS INSULIN INFUSION IN TREATMENT OF DIABETIC KETO ACIDOSIS PATIENT BY MICRO DRIP METHOD COMPARED WITH INFUSION PUMP
M. Arsana1, M. Fajari2
1Endocrinologist - Division of Endocrinology and Metabolic Disease, Department of Internal Medicine Brawijaya University, Saiful Anwar, General Hospital, Malang, East-Java, Indonesia 2Internist- Department of Internal Medicine Brawijaya University, Malang, East-Java, Indonesia

Introduction: Management of DKA consisted of rehidration, administering of low dose intravenous insulin, and elimination of precipitating factor. This research analyzed efficacy of using intravenous insulin infusion by micro drip method compared by infusion pump method to reach resolution of DKA and analyzed the safety of both methods by assessing hypoglycemia event during therapy. Method: A randomized-single blind clinical trial was held in ICU ward of Internal Medicine Department of Saiful Anwar General Hospital Malang upon thirty two DKA patients. Sixteen patients were treated by micro drip method and sixteen patients were treated by infusion pump method. Characteristic patients was showed by mean and standard deviation. Unpaired independent t test was used to analyze differentiation between variables, ANOVA test was performed to analyze between variables. All statistics used alpha=0.05, considered significant if p<0.05. Result: Ability of insulin infusion by micro drip method to reach resolution of DKA was not significantly different compared with infusion pump method in the average of declining plasma keton, changing of pH and bicarbonate level (p >0,05). The delta of declining blood glucose level hourly was not significantly different also between both methods p>0,05. During this research, there was no hypoglycemia event of both methods. Conclusion: The efficacy and safety of using intravenous insulin infusion by micro drip method were similar to infusion pump method as control to reach resolution of DKA Keyword: Diabetic Keto Acidosis (DKA), intravenous insulin infusion, micro drip, infusion pump.

PROTECTIVE EFFECT OF Á-LIPOIC ACID AGAINST DIABETES-INDUCED APOPTOSIS AND OXIDATIVE STRESS IN THE HEART OF RAT
A. Shirpoor
Dep of Physiology, Faculty of Medicine, Jaddeh nazloo, Urmia, IRAN

Oxidative stress is produced under diabetic condition and possibly causes various forms of tissue damage in patients with diabetes.The present study was designed to evaluate the protective effect of á-lipoic acid on cardiomyocyte apoptosis, and the status of oxidative stress in the heart under diabetic condition in vivo. Twenty-four wistar rats were divided into three groups (n=8), namely control, non-treated diabetic and lipoic acid-treated diabetic groups. The lipoic acid-treated diabetic group received 30 mg/kg of lipoic acid dissolved in 0.1mM NAOH intraperitonealy once a day. Cardiac complications such as autonomic neuropathy as prolonged QT interval along with significant increases in level of 8- isoprostane, protein carbonyl content, and SOD activity were observed after 6 weeks in diabetic group. Structural abnormality was also observed as severe induction of apoptosis in cardiomyocytes. Significant amelioration of cardiomyoctes apoptosis, prolonged QT interval, lipid per oxidation, and protein oxidation were found in lipoic acid-treated group, which strongly implies that this radical scavenger may promote a convalescing effect on diabetic cardiomyopathy through the attenuation of oxidative stress and abrogation of apoptotic signals, which was verified by restoring normal QT interval.

THE EFFECT OF VITAMIN E ON OXIDATIVE STRESS STATUS IN THE SMALL INTESTINE OF DIABETIC RATS
A. Shirpoor1, M.H. Khadem Ansari2, S. Salami3
1Dep of Physiology, Faculty of Medicine, Jaddeh nazloo, Urmia, Iran 2Dep of Biochemistry, Faculty of Medicine, Jaddeh nazloo, Urmia, IRAN 3Dep of Biochemistry, Faculty of Medicine, Jaddeh nazloo, Urmia, IRAN

The oxidative stress, defined as an imbalance between oxidants and antioxidants, is considered a hallmark of the pathophysiology of diabetes mellitus.The aim of this study was to investigate the effect of vitamin E on the occurrence of oxidative stress in the small intestine of diabetic rats. Twenty-four male Wistar rats were divided into three groups: control group, nontreated diabetic group, and diabetic group treated with vitamin E (300mg daily). After 6 weeks, lipid peroxidation, protein oxidation, superoxide dismutase (SOD), and catalase levels of the small intestine were measured. Diabetes caused significant increase of small intestine lipid peroxidation, protein oxidation, and SOD levels and decrease of catalase activity. Lipid peroxidation and protein oxidation were attenuated after consumption of vitamin E in the diabetic rats, and increased catalase activity. The results revealed the occurrence of oxidative stress in the small intestine of diabetic rats. Vitamin E, as an antioxidant, attenuates lipid peroxidation and protein oxidation, and increases antioxidant defense mechanism. Keywords: Diabetes; Vitamin E; Oxidative stress; Small Intestine

THE EFFECT OF LITERACY LEVEL ON CARDIOVASCULAR RISK FACTORS IN DIABETIC PATIENTS
A.S. Jahanlou1, A. Sobhani2, N. Alishan3
1Assistant Professor, Department of Social Medicine, Hormozgan University of Medical Sciences 2Assistant Professor, Department of Pathology, Hormozgan University of Medical Sciences 3Expert in charge, Med. Info Dept., Hormozgan University of Medical Sciences

Background: In studies on diabetes and cardiac risk factors, literacy level, especially illiteracy, is ignored. Coronary heart disease (CHD) is a major complication of diabetes and the leading cause of premature death. The incidence of cardiovascular disease can be reduced by control of blood pressure (BP), lipid modification and by tight glycemic control (5). To identify the effect of literacy level on coronary risk factors in diabetes type 2, we measured HbA1c, lipid profile serum, BMI and BP. Methods: A cross-sectional study was carried out in an urban federally-funded diabetics’ clinic in Bandarabbas, Iran. 256 diabetic patients were chosen during July, June and August 2007. Patients were classified into three groups: Illiterates, Low-literates and literates. Cardiovascular risk factors including HbA1c, LDL-cholesterol, Triglyceride (TG), Total Cholesterol (TC) and HDL-Cholesterol were measured by appropriate methods. In addition we measured Blood pressure and BMI by standard method. Data analysis based on literacy level was carried out with one way ANOVA Post Hoc (Test-Tukey), and bivariate analysis method. Results: 67.5% of patients were female. 42.1% were illiterates and 70% of them had overweight. The averages of TC and BMI in females were more than males (P<0.004). The level of LDL, TC, HDL and TG among the literacy groups were significant (p< 0.012). There was no significant difference in the level of HbA1C among three groups. Conclusion: Literacy level does not have any role in glycemic control. We found a positive relationship between literacy level with LDL, HDL, TC and TG level.

THE EFFECT OF LITERACY LEVEL ON HEALTH RELATED-QUALITY OF LIFE, SELF-EFFICACY AND SELF-MANAGEMENT BEHAVIORS IN DIABETIC PATIENTS
A.S. Jahanlou1, F. Ghofranipour2, A. Sobhani3, N. Alishan4
1Assistant professor Department of Social Medicine, Hormozgan University of Medical Sciences 2Assistant professor, Department of Health Education- Tarbiat Modares University 3Assistant Professor, Department of Pathology, Hormozgan University of Medical Sciences 4Expert in charge, Med. Info Dept., Hormozgan University of Medical Sciences

Background-Illiteracy in studies on quality of life (QOL) and self-efficacy (SE) of diabetic patients has been ignored. Illiteracy and diabetes have high rates in developing countries. Objective-The aim of this study was to identify the effect of literacy level on health outcomes. To achieve this, we studied health outcomes such as SE, self-management behaviors and Health-Related Quality of Life (HRQOL) in diabetic patients. Methods-A cross-sectional study was carried out in an Iranian urban federally-funded diabetics’ clinic (with 1400 diabetes patients) in Bandar Abbas, a city located in south of Iran. 256 Non Insulin Dependent Diabetic Mellitus patients were chosen during June, July and August 2007. Patients were grouped as illiterates, low-literates and literates. SE and QOL were measured by standard questionnaires (World Health Organization Quality of Life –BREF26; self-efficacy questionnaire). HbA1C was measured by calorimetric method. Data was collected with interview. Data analysis was carried out with one way ANOVA Post Hoc, and bivariate analysis method. Results- Literacy level among the three groups from the view points of age, physical domain, psychological domain, environmental domain and SE were significant. There was no significant difference for the level of HbA1C among three groups. Conclusion- Literacy level does not have any effects on glycemic control. We found a strong relationship between SE and HRQOL. We remind that SE is an important area for diabetes interventions but targeting only SE is unlikely to reduce literacy-related disparities. Therefore, SE may be a relevant determinant of self-management behaviors among populations with limited health literacy

INDIVIDUALIZED PHYSICAL TRAINING PROGRAMME BENEFIT ON BODY COMPOSITION OF YOUNG OBESE
M. Oravitan1, C. Avram1, A. Armeanca1, A. Vlad2, M. Barzu1, M. Vasilescu3, E. Bota1, S. Iurciuc2
1West University of Timisoara 2"Victor Babes" Medicine and Pharmacy University of Timisoara 3University of Craiova

Abstract: An important role in obesity treatment have the lifestyle changes including an individualized physical training programme. Our purpose in this study was to assess the benefit on body composition of such a programme combined with nutrition counselling. Material and methods: We conduct a randomized prospective study of 6 months on 43 voluntary obese students. The subjects benefit from an intensive supervised exercise training programme; the standard assessment protocol include cardiopulmonary exercise testing, somatometric examination, body composition analysis (with In Body 720 body compostion analyzer) at inclusion and after 6 months. Due to ergospirometric analysis, the physical effort was done mostly in the corresponding area for maximum consumption of lipids. Results: After 9 moths, we obtained the decrease of fat mass from 40.95±5.67% to 34.36±7.15%(p<0.01), of visceral fat area from 118.36±21.32 cm2 to 100.17±19.46 cm2(p<0.001), of the obesity degree from 146.25±25.41% to 132.34±27.27%(p<0.01), of the extracellular fat/total fat from 0.331±0.02 to 0.330±0.03(p>0.05), of the fat mass from 39.9±13.2% to 30.4±11.8%(p<0.05), of the upper limbs muscular mass from 2.68±0.6kg to 2.60±0.7kg(p>0.05) and the increase of active mass from 46.95±12.2% to 47.14±11.4%(p>0.05) and of the lower limb muscular mass from 7.78±1.5kg to 7.98±1.7kg(p<0.05); we have found a strong correlation between decrease of fat tissue and increase of the fitness score (r=-0.8) and between weight control and fat mass control (r=0.92). Conclusions: A supervised and individualized training programme and nutrition counselling induce after 6 months signifficant changes of body composition regarding fat proportion and distribution with the maintenance of subjects´ active mass. Acknowledgements: The project was supported by a Research CNCSIS Project Ideas, code 2330/2008

GLUCOSE CONTROL IN INTENSIVE CARE UNIT IN PATIENTS WITH DIABETES MELLITUS WHO HAD UNDERGONE SURGICAL THERAPY
G. Beliaeva, S. Yashina, G. Grigoryn, G. Strongin
State Medical Academy Nizhny Novgorod Russia

Background: The aim of the study was to compare blood glucose control by insulin infusion algorithm with routine glucose management protocols in intensive care unit of patients with diabetes after the operations. Materials and methods: Among the patients who were admitted to the intensive care unit after surgery (enterectomy, appendectomy, partial pancreatic resection, amputation of the limbs), 12 were assigned to receive intensive treatment, 11 - conventional therapy. In the intensive-treatment group, a continuous infusion of insulin (50 IU of Actrapid HM in 50 ml of 0.9 % sodium chloride), was administered with the use of a pump (Perfusor-FM, B. Braun). The infusion was adjusted to maintain the level of glucose at a value between 5 and 7 mmol/L. Risk scoring was performed using Acute Physiology and Chronic Health Evaluation (APACHE) score. Results: The mean blood glucose level on admission was 12,0 mmol/L in the infusion group and 11,8 mmol/L in the control group. The median APACHE score was the same in the two treatment group (median score 24.5). In the intensive care group target glucose level was reached at a median time of 11 hours in 83 % patients. In the control group 56 % achieved the glucose targets in 15 hours ( p=0.04). Hypoglycemic incident occured during the first day after the operation in the insulin infusion group. Conclusion: Intravenous insulin infusion shown to be effective and safe after the operation among diabetic patients in the surgical intensive care unit.

MULTIFACTORIAL ALGORITHMICAL APPROACH IN TYPE 2 DIABETES MANAGEMENT
E.V. Ivanova, N.A. Chernikova, A.S. Ametov
Department of Endocrinology, Russian Medical Academy of Postgraduate Education, Moscow, Russia

Aims: to determine whether a 6 months intensive multifactorial therapy (MT) using clinical algorithm with tight glucose regulation and the use of renin-angiotensin blockers, aspirin, and lipid-lowering agents, resulted in greater goal attainment than standard treatment (ST), focusing predominantly on glycemic control. Material and methods: A total of 200 patients were assigned to receive MT according algorithm developed by the team from International Diabetes Center, Minneapolis, USA or ST. Patients were enrolled from the outpatient setting from 6 regions (Rostov, Krasnodar, Stavropol, Perm, Sochi, Moscow). Among total amount 60 patients with similar baseline data were chosen (30 patients received MT, 30 patients- ST). The intervention period lasted 6 months. Results: At 6 months, no one patient had achieved goals for HbA1c, but there were decreasing of HbA1c in both groups, (–1.0 ± 0.1%, P < 0.001) and (–1.6 ± 0.1%, P < 0.001); however, statistical non-inferiority of MT to ST was not established. MT group presented a higher % of change for diastolic BP, but there was no significant difference between groups in change of systolic BP. In MT group 6 patients (20%) achieved normal lipid profile at 6 months, in MT group mean values of total cholesterol, LDL-C and HDL-C were at target, presenting significantly greater improvement in mean values of total cholesterol, LDL-C and HDL-C (12,6% v 2,7%; 30,1%, P < 0.001 v 7,2%; 22,8% v 8,5%, P < 0.001) in ST group consequently. Conclusion: This study demonstrates advantages of MT presenting that algorithm play a certain role in clinical effectiveness of some aspects of this approach.

THE ROLE OF DPP-IV INHIBITORS IN THE GLYCEMIC CONTROL IMPROVEMENT IN TYPE 2 DIABETES PATIENTS
E.V. Karpova, A.S. Ametov
Endocrinology and diabetology department of Russian Academy for Advanced Medical Studies (RAAMS), Moscow, Russia

Objectives: Estimate effectiveness of combined therapy with Vildagliptin and metformin on glycemic control and glucose variability in Type 2 Diabetes patients. Materials and methods. 20 patients (5 males/15 females) with type 2 Diabetes took part in this open-label observational 12-week study, mean age 50,3±3,56 y.o., BMI-34,00±6,80 êg/ì2, mean waist circumference (WC) 98,26±6,96 sm. Baseline therapy in all patients was 1500-3000 mg of metformin. Vildagliptin 50-100 mg/day was added to metformin, combined with diet and physical activity. Primary outcome parameters were the following: fasting plasma glucose (FPG), postprandial glycemia (PPG), HbA1c, fasting insulin, C-peptide, 72-h Continuous Glucose Monitoring. Results. It was shown significant improvement of all parameters on Vildagliptin + metformin therapy: FPG decreased from 10,8±0,26 to 6,2±0,64 mM/l (p<0,001), PPG from 14,6±0,75 to 8,5±0,58 mM/l (p<0,001), HbA1c from 9,7±0,83 to 6,8±0,37% (p<0,001), MADE (mean amplitude of daily excursions) from 8,4±0,36 to 5,9±0,18 mM/l. Weight lose versus baseline >5% was registered in 80% of the patients and more than 10% in 20% of patients. Safety profile and tolerability were within target range. All patients reported on improvement of their quality of life. Conclusion. Vildagliptin combined with metformin proved its high efficacy and safety, particularly in improvement of daily glycemic control and glucose variability.

INSULIN INFUSION IN PATIENTS WITH ACUTE ISCHEMIC STROKE AND TYPE 2 DIABETES MELLITUS IN INTENSIVE CARE UNIT
G. Beliaeva, G. Grigoryan, S. Yashina, G. Strongin
State Medical Academy Nizhny Novgorod Russia

Background and Aims: Trial to evaluate an effect of insulin infusion in intensive care unit in patients with ischemic stroke and diabetes. Materials and methods: a comparison of an intravenous insulin infusion for 24 hours (n=10), with conventional glucose lowering therapy (n = 10) in patients with ischaemic stroke and hyperglycaemia >13 mmol/l at admission has been carried out in patients suffered from type 2 diabetes mellitus. A continuous infusion of short-acting insulin in 50 ml 0.9% sodium chloride was initiated using a pump. The infusion was continued for at least 24 hours. The target range of glucose control for both groups was 7.8–10 mmol/l. National Institutes of Health Stroke Scale score (NIHSS ) was used to identify the severity of stroke. Results: In the insulin infusion group target glucose level was reached at a median time of 2,8 hours, in the control group in 5 hours. The amount of insulin to achieve the target level was 7 units, in the control group - 11,6 units. Median NIHSS score decreased from 14,8 to 2 in the infusion group and from 16,2 to 6,4 in the control group. There was only one symptomatic patient with hypoglycemia in the control group and zero in the infusion group. The length of stay in a hospital in the basic group was 19 day, in control group - 24 days. Conclusion: insulin infusion in intensive care unit for patients with acute ischemic stroke is feasible and decreases length of stay in hospital.

LIRAGLUTIDE, A ONCE-DAILY HUMAN GLP-1 ANALOG, PROVIDES BETTER GLYCEMIC CONTROL WITH REDUCED BODY WEIGHT COMPARED WITH GLIMEPIRIDE, AS ADD-ON TO METFORMIN IN SOUTH KOREAN SUBJECTS WITH TYPE 2 DIABETES
H.C. Jang1, J.T. Woo2, S.H. Baik3, I.B. Park4, Y.M. Cho5, K.H. Song6, K.W. Lee7, Y.D. Song8, S. Lee9, K.H. Yoon10, K.W. Kim10, K.H. Yoon10
1Seoul National University Bundang Hospital, Gyeongi-do, South Korea 2Kyunghee University Medical Center, Seoul, South Korea 3Korea University Guro Hospital, Seoul, South Korea 4Gachon University Gil Medical Center, Incheon, South Korea 5Seoul National University Hospital, Seoul, South Korea 6St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea 7Ajou University Hospital, Gyeongi-do, South Korea 8National Health Insurance Corporation Ilsan Hospital, Gyeongi-do, South Korea 9Novo Nordisk Pharma Korea, ltd, Seoul, South Korea 10Kangnam St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea

The efficacy of adding liraglutide (0.6, 1.2 or 1.8mg once daily) to metformin was compared with adding glimepiride (4mg once daily) to metformin in 928 subjects with type 2 diabetes from China, India and South Korea. Results from the South Korea cohort are presented. In this 16-week, randomised, double-blind, active control trial, 170 South Korean subjects with mean age of 54.3±10.3 y, mean body weight of 68.7±11.3 kg and mean HbA1c of 8.5±0.8% were randomised and 169 were exposed. Adding liraglutide 1.2mg or 1.8mg to metformin reduced HbA1c by 1.73% and 2.04% resp and adding glimepiride to metformin reduced HbA1c by 1.38% (NS vs liraglutide 1.2mg; p<0.05 vs liraglutide 1.8mg). Higher percentages of subjects achieved HbA1c <7.0% on liraglutide 1.2 and 1.8mg, compared to glimepiride. No difference was found in fasting plasma glucose (FPG) between the liraglutide groups and the glimepiride group. Body weight decreased in the liraglutide groups (2.20–2.86 kg) compared to an increase in the glimepiride group (+0.22 kg). No major hypoglycemic events were reported in any groups. One minor hypoglycemic event was reported in the liraglutide 0.6 mg group, 1 in the liraglutide 1.8 mg group and 2 in the glimepiride group. Gastrointestinal disorders (mainly nausea and diarrhoea) were the most common adverse events in the liraglutide groups, but these decreased gradually over time. In South Korean subjects with type 2 diabetes, once-daily liraglutide added to metformin was well-tolerated and led to significantly better overall glycemic control with a reduction in body weight compared to glimepiride.

IMPACT OF LACTATION ON GLYCEMIC CONTROL IN DIABETIC MOTHERS

M. Sattari, M. Lo, I. Doycheva, A. Kazory

Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; University of Florida College of Medicine, Gainesville, Florida, USA

Background: Breastfeeding portends several beneficial effects and is currently recognized as the recommended modality of feeding infants. Protective effect against future development of diabetes mellitus (DM) in mothers is among the proven benefits of breastfeeding. It has been suggested that lactation can also improve glycemic control in mothers with pre-existing DM, regardless of type. Methods: A literature search was conducted, using keywords “diabetes mellitus”, “lactation” and “breastfeeding,” in PubMed database. Searches were limited to English language publications. Relevant articles from 1976 to 2009 were selected. Bibliographies of these publications were reviewed for identification of additional important articles. Both animal and human studies were included. Results: A total of 38 relevant articles were identified on maternal DM and lactation (breastfeeding). Two of these were animal studies that demonstrated improved insulin sensitivity and glucose tolerance in rats during lactation. All human studies were prospective and demonstrated improved glucose metabolism in lactating mothers with type I DM and gestational DM, compared to non-lactating women. One study also found improved HDL levels in lactating mothers. Conclusions: Currently available data suggest that lactation is associated with improved glucose metabolism in mothers with type I and gestational DM. While it is conceivable that lactation can improve glucose metabolism in type 2 DM by the same mechanisms, existing evidence does not convincingly support this hypothesis. Given the prevalence of type 2 DM in women of childbearing age, the impact of breastfeeding on glucose metabolism in type 2 diabetics should be explored further.

EARLY EXERCISE PERSISTED ATTENUATION OF OBESITY, HYPERTRIGLYCEMIA, AND HEPATIC STEATOSIS IN OBESE DIABETIC OLETF RAT
M. Nam, S.H. Kim, S.J. Piao
Dept of Internal Medicine, School of Medicine Inha University

Aerobic exercise is a key component for the prevention and clinical management of type 2 diabetes mellitus and fatty liver. Although short-term exercise training improved insulin signaling in skeletal muscle in young men, these changes did not occur in middle-aged men. The differential effects of aerobic exercise done at different aging points on metabolic parameters, inflammatory cytokine level and fatty change in liver were investigated in obese diabetic animal model. We evaluated the early (from 12 weeks old to 26 weeks old), late (from 26 weeks old to 40 weeks old) and continuous (from 12 weeks old to 40 weeks old) effects of aerobic exercise on body weight and composition, lipid profiles and morphological change of liver in OLETF rats. Decreased total body mass, increased lean body mass, and decreased fat mass were observed in all exercise groups. More significant improvement of oral glucose tolerance was observed in the continuous exercise group compared with early and late exercise (each group, n=10). Early exercise showed delayed beneficial effects on body weight and glucose tolerance which persisted throughout even without exercise at later stages. The decreased changes of lipid profiles in triglyceride and free fatty acid were observed in early and late exercise groups and more significant decrease in triglyceride was observed in the continuous exercise group. The plasma levels of cytokine IL-10 showed more significant increase in continuous exercise groups compared with early exercise. Furthermore, both early and late exercise exhibited significantly reduced large lipid vacuole filling in the cytoplasm and reduced lipid droplet size compared with OLETF control group. Although not delivered continuously, both early and late exercise showed improved glucose tolerance. Furthermore, both early and continuous exercise can maintain the beneficial effects for the management and prevention of type 2 diabetes mellitus and hepatic steatosis.

HEALTH ECONOMIC ANALYSIS OF “ROSSO-IN-PRAXI”: A 12-WEEK MOTIVATION AND EDUCATION PROGRAM FOR PATIENTS WITH TYPE 2 DIABETES
R. Neeser1, K. Kempf2, C. Weber1, S. Kocher1, C. Weiss1, S. Martin2
1Institute for Medical Informatics and Biostatistics, Basel, Switzerland 2West-German Centre of Diabetes and Health, Sana Hospital Gerresheim, Sana Clinics Düsseldorf GmbH, Düsseldorf, Germany

Introduction Lifestyle changes like appropriate diet and physical activity can improve blood glucose (BG) control in patients with type 2 diabetes. An efficient tool to visualize the immediate effects of lifestyle changes on BG levels is self-monitoring of blood glucose (SMBG). “ROSSO-in-praxi” is a 12-week motivation and education program for patients with type 2 diabetes not treated with insulin. The program includes a dedicated manual, a pedometer, a BG meter with 100 BG test strips, and feedback by a call center. We performed a health economic analysis based on the metabolic improvements of “ROSSO-in-praxi”. Methods We estimated total cost with and without the “ROSSO-in-praxi” intervention using a Markov based diabetes model. The following parameters were the basis for our calculations: (1) the differences of HbA1c (–0.3%), systolic BP (–3 mmHg), total cholesterol (–2.2 mg/dL) and triglycerides (–7.1 mg/dL) at weeks 0 and 12, (2) annual program costs of €100 per patient. We assumed that the diabetes patients will maintain the lifestyle changes made during “ROSSO-in-praxi”. Results Over 10 years, total costs decreased by €298 and life expectancy increased by 0.026 years with the “ROSSO-in-praxi” intervention. In economic terms the intervention is dominant, i.e. decreasing cost and increasing life expectancy. Up to annual cost of €141 per patient the intervention remains dominant. Conclusion The lifestyle changes induced by “ROSSO-in-praxi” lead to improvements of several clinical parameters. We showed that the 12-week “ROSSO-in-praxi” motivation and education program is saving costs and leads to an increase in life expectancy.

NOVEL RP-HPLC METHOD FOR THERAPEUTIC DRUG MONITORING OF SITAGLIPTIN USING MONOLITHIC SILICA COLUMN
N.O. Can1, G. Arli1, M.A. Isikdag2
1Department of Analytical Chemistry, Faculty of Pharmacy, Anadolu University, Yunusemre Campus, Eskisehir 26470, Turkey 2Department of Chemical and Process Engineering, Faculty of Engineering, Bilecik University, Bilecik 11210, Turkey

Sitagliptin phosphate is a novel anti-diabetic compound that is used in the treatment of type 2 diabetes mellitus. It is the first member of a new class of drugs that inhibit the proteolytic activity of dipeptidyl peptidase-4, potentiating the action of endogenous glucoregulatory peptides incretins. A reversed phase liquid chromatographic method for therapeutic drug monitoring of sitagliptin phosphate has been developed and validated, in this study. Sitagliptin phosphate and prazosin HCl (internal standard) were separated in a monolithic silica column (Merck Chromolith Performance RP 18E, 5 µm 100x4.6 mm ID) using a mobile phase consisting of phosphate buffer (pH=2, 0.025 M): acetonitrile: water (50: 17: 33, v/v). 5 µL aliquots of samples were injected onto the column at ambient temperature and they were eluted at the rate of 1.0 mL.min-1. Sitagliptin phosphate and IS were detected using a diode array detector at 200 nm wavelength within an average analysis time of 8 minutes. The method was applied to real samples to test its applicability. Validation studies were performed according to recommendations of International Conference on Harmonisation Q2(R1) and United States Pharmacopeia, which included tests for accuracy, precision, range, limits, robustness and system suitability parameters. The proposed method was found to be suitable for therapeutic drug monitoring of sitagliptin phosphate in routine assays.

PREDICTING IMPENDING HYPERGLYCAEMIA IN NORMOGLYCAEMIC RENAL TRANSPLANT RECIPIENTS
A. Sharif1, V.K. Ravindran2, G. Dunseath3, S.D. Luzio3, D.R. Owens3, K. Baboolal2
1Queen Elizabeth Hospital, Birmingham, United Kingdom 2University Hospital of Wales, Cardiff, United Kingdom 3Diabetes Research Institute, Penarth, United Kingdom

Aims. Transplant-associated hyperglycaemia is a significant complication of solid-organ transplantation. Declining disposition index anticipates impending hyperglycaemia and would be valuable to detect simply and non-invasively with fasting blood sampling. We investigated surrogate disposition indexes by three methods: physiological correlation, demonstration of a mathematical hyperbola and robustness across a heterogeneous group of patients. Methods. First-phase insulin secretion and sensitivity was determined by mathematical minimal model analysis of 58 frequently sampled, intravenous glucose tolerance tests in 58 non-diabetic renal transplant recipients and correlated against surrogate indexes based on fasting blood samples. Products of insulin secretion/resistance indexes were correlated against calculated disposition index, properly weighted regression analysis performed to ensure hyperbolic compatibility, auto-correlation studies conducted and surrogates tested in various sub-groups of renal transplant recipients to ensure robustness in a heterogeneous group. Results. From all evaluated surrogates, the best correlation was achieved with ‘HOMAsec (first-phase insulin secretion) x McAuley’s index (insulin resistance)’ (r = 0.594, p < 0.001). Regression analysis was consistent with a mathematical hyperbola (ln HOMAsec vs. ln McAuley’s index, r = –0.639 [95% CI -1.772 to –0.950]), statistical auto-correlation was excluded (in a subset of 20 patients with repeat metabolic investigations) and the surrogate remained valid in different subgroups of transplant recipients. Conclusions. Our experimental surrogate ‘HOMAsec x McAuley’s index’, which requires only fasting glucose, insulin and triglyceride measurements, is a simple and non-invasive surrogate for the disposition index. Its potential predictive utility for identifying impending hyperglycaemia post-transplantation, and potentially in the general population, requires further investigation.

POST PRANDIAL HYPER TRIGLYCERIDEMIA IN SMOKER AND NONSMOKER SUBJECTS
H. Rashidi1, M. Salesi2, F. Fatahi3
1Diabetes research center jundishapur university of medical sciences ahwaz Iran 2University of medical sciences isfahan Iran 3Endocrine clinic milad hospital tehran Iran

Objectives: Smokers have recently been shown to be insulin resistant and to exhibit several characteristics of the insulin resistance syndrome. In this study, we assessed fasting and postprandial triglyceride levels in healthy,normolipidaemic, chronic smokers and a matched group of nonsmoking individuals. Methods and materials: We evaluated 78 subjects with simple sampling. 39 were smoker and 39 nonsmokers. All of them had normal lipid and glycemic profile and had BMI between 18.5 and 29.9. Then we give them 60 gm butter (which was composed of 716 Kcal/100gm energy and 81.06% fats) and triglyceride level was checked one and six hours postprandial. Between these times the subjects should not eat anything except water and smokers were allowed to smoke. If the subjects had CAD or previously elevated fasting TG>150mg/dl, FBS>100mg/dl, age>60 or <30, did not tolerate butter, BMI>29.9 or<18.5, or were alcoholic were excluded from our study. All data analyzed with T test and for repeated data ANOVA. Analysis performs with spss software. Results: In our study was shown that TG levels among women and men had no significant difference (P=0.403). there was a significant difference among fasting TG, one hour postprandial and six hours postprandial in both groups(P<0.001). Also the changing rate of lipid from fasting state to one and six hours postprandial, among smokers and nonsmokers was significantly different (P<0.001).Conclusion: We concluded that smoking can change lipid profile in normolipemic subjects; and smokers with normal fasting triglyceride have more elevated levels of postprandial triglyceride in compared to nonsmokers.Postprandial hypertriglyceridemia has been an important factor for cardiovascular disease,then smoking can increase cardiovascular disease risk in this way.

EFFECT OF DAILY INSULIN TREATMENT ON NOCICEPTIVE PERCEPTION OF 5 WEEKS STZ-DIABETIC MICE
U. Demir, O.D. Can
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 nociceptive perception of STZ-diabetic mice. Method; Diabetes was induced by a single intravenous injection of STZ (200 mg.kg-1 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 400 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 5 weeks. Insulin was administered (i.p) at a dose of 10 IU/kg per day. The same day of every week, tail-clip and tail-flick tests were performed and nociception times were recorded. Results: Reaction times of diabetic animals to noxious stimulus were observed to decrease in tail clip tests during 5 weeks. In tail flick tests, reaction times of diabetic animals were decreased for two weeks following the induction of diabetes in contrast to prolongation at fifth week. Insulin treatment totally restored the alterations in nociception parameters in both tests. Conclusion: Results of the present study indicated the mechanical hyperalgesia, beginning at the first week, in STZ-diabetic mice. In the manner of thermal nociception, hyperalgesia was observed for first two week in spite of hypoalgesia in the last week. Hypoalgesia is thought to be related with the progressive damage of the neurons carrying thermal stimulus, by time. Restoration of these alterations with insulin treatment exhibited the importance of insulin deficiency in the nociception perception of diabetic animals.

AMAZONIAN FISH AND THE GENETIC EFFECTS OF LEPTIN ON LIPIDIC METABOLISM
R.P.C. Carvalho1, D.M.C. Coelho1, E.M.C. Correa1, J.B.M. Monteiro1, N.P.G. Garcia1, F.S. Souza2, S.A.F. Astolfi-Filho3, R.S. Sales4, C.S.I. Inacio4
1Departamento De Fisiologia (Dcf), Instituto De Ciencias Biologicas (Icb), Universidade Federal Do Amazonas (Ufam), Manaus, Am, Brasil 2Programa De Pos-Graduacao Em Biotecnologia, Centro De Apoio Multidisciplinar (Cam), Ufam, Manaus, Am, Brasil 3Laboratorio De Tecnologia De Dna, Cam, Ufam, Manaus, Am, Brasil 4Laboratorio De Fisiologia, Dcf, Icb, Ufam, Manaus, Am, Brasil

The fish is the most promising resource to increase the production of animal protein in the Amazonian Basin, with the minimum of environmental degradation. Rich polyunsaturated fatty acid diets from amazonic fish promote lipidic metabolism alterations. Leptin, product of obese gene (ob), regulates energy balance. Leptin and hiperlipidic diets have an important roll in the lipidic metabolism and favoring the obesity and hypertension. Forty males one-month old Wistar rats Rattus norvegicus were divided in four groups (n=10) and fed “ad libitum” for thirty days with: mapara “Hypophthalmus edentatus” (Gmap), matrinxa “Brycon amazonicus” (Gmat) and tambaqui “Colossoma macropomum” (Gtam) and regular ration (GC). It was proceed genomic analysis. The cloning and sequencing was not observed any alterations in gDNA-Lep among the groups, proving it physiologic functionality. Then, the inclusion of amazonic fishes in diet would be of promising importance to improve lipidic metabolism.

KNOWLEDGE, ATTITUDE AND BEHAVIOUR TOWARD OWN DISEASE AMONG PATIENTS WITH TYPE 2 DIABETES IN SERBIA
D. Nikolic1, D. Miloradovic2, N. Dimic1
1Faculty of medicine 2Health care centar Merosina

Diabetes mellitus, as chronic dissease, with its wide presence in general population, complex and financially demanding therapy, solicit a necessity of constant, and coordinated cooperation, beetwen medical professionals and the patients, on the topics considering prevention and reduction of consequences of the dissease. Aim. Creating quantitative insight in knowledge about own dissease at diabetes mellitus (type 2) patients, as well as their behaviour toward own disease during the therapy. Patients and methods: The research included 45 diabetes mellitus patients, observated ambulatory in Health Centre – Merosina, with average age of 64.68±10.69 years. Quantitative scorring of patient`s knowledge about own dissease and behaviour, as well as socio-epidemiological anamnesis were performed by use of standardized questionary, their body weight and height were measured, body mass index was calculated, and all quantified variables were statistically analyzed. Results: Average score of patient`s knowledge about diabetes was 15±5.02, which is considered insufficient, nevertheless that more of half examinees was satisfying familliar with symptoms, complications and prevention of diabetes. Minimal score of knowledge was 7, and maximal 24. Male patients showed slightly better knowledge scores (17.8±4.64) about own dissease, than female, however without statistically significant difference. Average score of attitude was 3.96±1.48 points, and could be considered as satisfactory. The necessity for precise determination of medical education effects in specific populations, i.e. population of diabetes mellitus patients, where personal participation has major influence on efficacy of therapy.

SYSTOLIC HYPERTENSION, ANEMIA AND AGE ARE INDEPENDENT FACTORS OF LEFT VENTRICULAR HYPERTROPHY DEVELOPMENT IN PATIENTS WITH DIABETES MELLITUS AND CHRONIC KIDNEY DISEASE

A. Martynov, V. Shestakova, A. Alexandrov, I. Dedov

Endocrinology Scientific Center

Introduction: Left ventricular hypertrophy (LVH) is associated with a lower cardiac functional status. The aim of study to define a factors influencing on development of LVH in patients with DM and chronic kidney disease (CKD). Methods: 86 patients with DM were studied (30 - type 1 and 56 - type 2), mean age was 52.3±16.9. 38 patients had chronic renal failure (CRF). The prevalence of hypertension was 97.6%, anemia was 44.2%. LVH was defined by left ventricular mass index (LVMI) > 134 g/m2 for men and > 110 g/m2 for women). Results: LVH was found in 69.8% patients and highly prevalent in patients with hypertension - 71.4% and anemia - 81.6%. The prevalence of LVH in patients with macroalbuminuria was 64%, in CRF was 82%. Concentric hypertrophy of left ventricular was found in 52.3%, eccentric LVH - in 17.4%, 19.8% patients had concentric remodeling of left ventricular, only 10.5% - were with normal geometry of left ventricular. The LVMI is significantly associated with older age (R=0.32, p<0.01), systolic BP (R=0.29, p<0.01), Hb (R= - 0.23, p<0.05), proteinuria (R=0.38, p<0.05) and GFR (R= - 0.25, p<0.05). Independent factor affecting on development of LVH by multiple logistic regression analysis were age, value of systolic BP and Hb level (p<0.001). Conclusions: The most frequent type of geometry of LVH in patients with DM and CKD – diabetic nephropathy is concentric. The age, systolic hypertension and anemia are significant and independent risk factor for development of LVH in DM and CKD.

IMPAIRED ERYTHROPOIETIN RESPONSE TO ANEMIA IN DIABETIC NEPHROPATHY

A. Martynov 1 V. Shestakova 1 V. Ilyin 1 I. Dedov 1

1Endocrinology Scientific Center, Moscow, Russian Federation

Background: Diabetic nephropathy (DN) is associated with early development of anemia compared to chronic kidney disease (CKD) of other etiology. The purpose of the study is to determine of serum EPO level and its response to anemia in DN patients. Materials and methods: 131 DN patients were studied (47 pts with diabetes mellitus (DM) type 1 and 84 with DM type 2). Anemia was defined as hemoglobin < 13.5 g/dl in men and < 12.0 g/dl in women by the definition of anemia for CKD. Results: Mean EPO level was similar in patients with anemia (7.6¡À4.4 mIU/ml) and without anemia (8.4¡À5.5 mIU/ml). We did not find significant differences of EPO concentration in anemic and non-anemic patients with microalbuminuria (n=59) (9.0¡À4.2 mIU/ml and 8.5¡À5.8 mIU/ml) and macroalbuminuria (n=72) (7.3¡À4.2 mIU/ml and 8.2¡À5.8 mIU/ml). The significant physiological inverse correlation of EPO and Hb was found for patients without anemia (72 pts) (R=-0.26; p<0.05), and for patients with glomerular filtration rate (GFR) lead off from ¡Ý60 ml/min (R=-0.29; p<0.01). The intensity of physiological correlation between EPO and Hb increased when GFR level enhanced: GFR¡Ý70 ml/min (R=-0.40; p<0.001), GFR¡Ý80 ml/min (R=-0.41; p<0.001) and at GFR¡Ý90 ml/min (R=-0.49; p<0.01). No correlation of EPO and Hb was observed in patients with GFR<60 ml/min. Conclusion: The renal EPO production in DN pts with anemia is not elevated and remains inappropriately at the same level as in pts without anemia. Low response of EPO expression to anemia is observed when moderate decrease of GFR develops (GFR <60 ml/min).

GLYCAEMIC CONTROL OF PATIENT WITH TYPE 1 DIABETES MELLITUS IN THE RUSSIA

L. Bolotskaya, O.V. Maslova, Y.I. Suntsov
The Endocrynology Research center

Background and Aims: to assess extent of adequate glycaemic control observed in people of various ages diseased with type 1 diabetes mellitus (DM) and residing in different Federal districts (FD). Materials and Methods: 6402 randomly selected patients with DM were examined using register database. Number of patients of age groups 0-14 was 1537, 15-17 ¡V 1100 and older than 18 years - 3765. The HbA1c level was determined at (%). Assessment of disease compensation was performed in accordance with IDF criteria (HbA1c<7%). Data are presented as Me„bSD.
Results: Regardless of a region of residence, HbA1c level was certainly above (p<0.002) in adolescent group (15-17), and its median comprised 10.02„b2.4. Number of patients with HbA1c<7% in this age cohort proved to be the lowest, 9.8% of the total sample; the best indices are observed in Ural and in Siberian (12.3 and 11.7%, respectively). The median HbA1c was 9.2„b2.44 in the group older than 18 years. The greatest number of patients with HbA1c<7% in this group was registered in Siberian (20.9%), the minimum number was registered in Central (10.3%). In the group (0-14) median HbA1c was 9.5„b2.3%. Number of children with HbA1c<7% was 11.6% and reached the highest level (13.6%) in Central and the lowest level (8.8%) in Ural. Conclusion: Number of patients with HbA1c<7% comprised 13.2%. The best degree of adequate glycaemic control was observed in South.

LIPID PROFILE IN RELATION TO ANTHROPOMETRIC MEASUREMENTS AMONG COLLEGE MALES STUDENTS IN RIYADH, SAUDI ARABIA: A CROSS-SECTIONAL STUDY
A.S. Al-Ajlan
KIng Saud University, Riyadh, Saudi Arabia

Background: Anthropometric measurements can easily reflect any changes in the lipid concentration in the human body. Objectives: The present work aimed at studying lipid profile and its relation to anthropometric measurements in college males from Riyadh, Saudi Arabia. Subjects and methods: This study was conducted during the period from September 2006 to December 2008. 333 students aged 18-35 years of Riyadh College of Health Science –male section- participated in the present study. Anthropometric measurements including weight, height, waist circumference and hip circumference were measured. BMI was calculated. Fasting blood sugar and lipid profile including total cholesterol (TC), Low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL) and triglycerides (TG) were estimated. Socio-demographic data was collected through a questionnaire sheet. Results: The mean TC level was 4.227±0.869 mmol/l, while it was 2.57±0.724, 1.360±0.545 and 1.385±0.731 mmol/l for LDL, HDL and TG respectively. The mean TC level did not differ significantly between different weight groups except among obese patients. The mean HDL, LDL and TG did not differ significantly among different groups at 5% level of significance. There was positive statistically insignificant correlation between age and BMI. The correlation between age and all lipid parameters were statistically insignificant. There was positive correlation between BMI and TC and LDL, while there was a negative correlation between BMI and HDL. There was no correlation between BMI and triglyceride.
Conclusion: BMI, waist circumference and hip circumference increases with age. TC, LDL, and TG increased with age and with increased BMI. HDL decreased with increasing BMI. Key words: Obesity, WC, Hip Circumference, underweight, BMI, TC, HDL, LDL, TG, Dyslipidemia.

ASSOCIATION BETWEEN VISCERAL FAT MASS AND PARAMETERS OF THE METABOLIC SYNDROME IN A QUOTA SAMPLE OF CZECH ADOLESCENTS
H. Zamrazilova, P. Hlavaty, L. Dusatkova, B. Sedlackova, M. Kunesova, V. Hainer
Obesity Management Center, Institute of Endocrinology, Prague, Czech Republic

Aim: Central obesity plays a critical role in chronic disease and in development of cardiometabolic health risks. The aim of the study was to investigate an association between visceral fat mass determined by bioimpedance (BIA; Tanita Viscan) and selected markers of the metabolic syndrome. Methods: Investigated group: a quota sample of 490 Czech adolescents aged 15.0-17.9; median (Upper Control Limit, Lower Control Limit); girls: n = 246; BMI: 21.1 (20.7, 21.6) kg/m2; trunk fat mass: 28.6 (26.9, 29.9) %, visceral fat level: 4.0 (4.0, 4.5); boys: n = 244; BMI: 21.6 (21.1, 22.0) kg/m2; trunk fat mass: 14.6 (13.7, 15.4) %; visceral fat level: 4.5 (4.0, 5.0). The following parameters were evaluated separately in girls and boys: biochemical (insulin, blood glucose, C-peptide, lipid profile), anthropometric (BMI, circumferences, skinfolds), data on body composition (BIA) and blood pressure. Results: Visceral fat determined by BIA correlated significantly (p<0.001) with triglycerides, HDL cholesterol, LDL cholesterol, C-peptide, insulin, HOMA index and diastolic blood pressure in both gender. Significant differences (p<0.05) in all followed parameters were found between upper and lower quartile of visceral fat level. Similar associations between waist circumference and cardiometabolic health risks were observed.
Conclusion: The visceral fat mass is a strong predictor of the selected markers of the metabolic syndrome. Our results suggest that accumulation of visceral fat measured by BIA is significantly associated with cardiometabolic health risks in Czech adolescents. Supported by a grant No. CZ 0123 from Norway through the Norwegian Financial Mechanisms.

LEPTIN DYSREGULATION IN METABOLIC SYNDROME AFTER HEMATOPOIETIC STEM CELL TRANSPLANTATION
L. Airaghi1, P. Usardi2, S. Forti3, A. Orsatti4, M. Baldini1, C. Annaloro2, G. Lambertenghi2

1First Internal Medicine, Fondazione IRCCS Cא Granda Ospedale Maggiore Policlinico, Milan, Italy
2First Hematological Unit and Bone Marrow Transplantation Unit, Fondazione IRCCS Cא Granda Ospedale Maggiore Policlinico, Milan, Italy, 3Audiology Unit, Fondazione IRCCS Cא Granda Ospedale Maggiore Policlinico, Milan, Italy, 4Department of Internal Medicine, University of Milan, Milan, Italy

Introduction In recent years there has been an intense focus on leptin as it relates to the cardiovascular system. In fact, plasma leptin concentration is markedly elevated in obesity and the metabolic syndrome (MS), both of which are associated with increased incidence of cardiovascular pathologies. In a previous research we found that MS is a common late effect after both autologous and allogeneic hematopoietic stem cell transplantation (HSCT). Post-HSCT MS differs from spontaneously occurring MS on clinical and laboratory grounds. Since a key role for leptin resistance has been suggested, we have compared common metabolic parameters and leptin concentrations in post-transplant and “spontaneously occurring” MS patients. Patients and Methods Post-transplant MS patients were compared to “spontaneously occurring” MS patients. For each subject a record of conventional clinical parameters was made; moreover, serum leptin and insulin concentrations were measured. Results The patients with post-HSCT MS had significantly higher levels of leptin than the patients with “spontaneously occurring” MS. A generalized linear model comprising serum insulin, BMI, gender, and group (i.e. post-HSCT or spontaneously occurring MS) explained serum leptin variability. Serum leptin concentrations and BMI were related in the patients with “spontaneously occurring” MS but not in those with post-HSCT MS. Conclusions It’s well known that leptin expression and action are altered in metabolic disorders associated with insulin resistance, such MS. Furthermore, leptin plays a role in the immune response. Our data might suggest a different pathogenetic role of leptin in post-HSCT MS, probably through complex interactions between leptin and immune function.

ACUTE CORONARY SYNDROME IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AT THE INTERNAL DISEASES EMERGENCY ROOM
V.H. Hoxha1, E.P. Petrela2, E.Z. Zaimi1
1Internal Diseases Emergency Room – UHC “Mother Teresa”, Tirane, 2Statistics Division, Department of Public Health, Faculty of Medicine

Diabetes mellitus (DM) presents a major public health challenge, as its prevalence continues to increase. Type 2 DM, irrespective of other health risk factors, increases the risk of cardio-vascular morbidity and mortality rates. The aim of the study was to assess the ”alarm symptoms” of acute coronary syndrome (ACS) in patients with type 2 DM and the role of other cardiovascular risk factors in patients with ACS. Materials and methods. The study included 272 patients with DM and ACS, of which 82 were female and 190 were male. The patients involved were at mean age 43-86 years old, and had been hospitalized at the ER for a period of 8 months. The data were analyzed by using the SPSS 15.0 packet. Results. Our study revealed a predominant number of males aged 40-70. Also, 38% of the patients were smokers. APP and IAM p a vale Q are the most prevalent forms of ACS (36.7% ;38.0%). Dyspnea is the most predominant clinical symptom (75.5%). The study also demonstrated an important causal relationship between the ACS diagnosis and microalbuminuria (p=0.001), as well as another correlation between micoralbuminuria and hypertension (r=.31,p=0.005). Additionally, there is a significant connection between microalbuminuria and the age of diabetes ( r=0.699,p=0.001). The study also revealed a causal relationship between the ACS diagnosis and the cholesterol level (p=0.013), triglyceride level (p=0.007), obesity (p=0.006) and hypertension (p=0.009) Conclusion. Diabetes patients show atypical forms of the clinical representation of ACS. Dyspnea is the most predominant symptom. Microalbuminuria is also an important companion of ACS. It is also related to the age of diabetes and hypertension. Obesity, dyslipidemia and hypertension are other important companions of ACS. Keywords: type 2 diabetes mellitus, acute coronary syndrome, microalbuminuria.