It has been questioned whether aiming at near-normoglycaemia by intensified insulin treatment regimens is feasible and safe for the majority of patients with insulin-dependent diabetes. In this study, intensified insulin injection therapy (including blood glucose self-monitoring and multiple insulin injections) based upon a 5-day inpatient group teaching programme was evaluated in Type 1 (insulin-dependent) diabetes mellitus in the centralised health care system of Bucharest. One hundred patients (group A, initial HbA1 12.5%) were followed for 1 year on their standard therapy (individual teaching, no metabolic self-monitoring), and thereafter for 1 year on intensified therapy. Another 100 patients (group B, HbA1 12.3%) were followed for 2 years on intensified therapy. A third 100 patients (group C, HbA1 11.7%) were assigned to a basic 4-day inpatient group teaching programme with conventional insulin therapy (including self-monitoring of glucosuria and acetonuria) and followed for 1 year. Mean HbA1 remained unchanged after standard treatment (group A: 12.8% at 12 months), but decreased during intensified therapy (group A: 10.1% at 24 months; group B: 9.3% at 12 months, 9.5% at 24 months; p less than 0.0001). In group C, no change was found compared to standard treatment (i.e. group A at 12 months). Incidence rates of ketoacidosis were 0.16 episodes per patient per year during standard treatment, 0.01 during intensified treatment (p less than 0.01) and 0.04 in group C (p less than 0.025). Hospitalisation rates were reduced by 60% during intensified therapy and by 40% in group C. Frequency of severe hypoglycaemia was not significantly different between the three treatment regimens. Thus, under the condition that insulin treatment is based upon a structured and comprehensive training of the patient, intensified insulin injection therapy performed as routine treatment of Type 1 diabetes significantly lowers HbA1 levels without increasing the risk of severe hypoglycaemia.

The PREDATORR study shows a high prevalence of impaired glucose regulation in the adult Romanian population, providing data on the prevalence of DM and prediabetes and their association with several risk factors.

Much of our present knowledge concerning the etiopathogenesis, treatment and prevention of human diabetes would never have been acquired without the study of animal models of diabetes. The main models of IDDM may be divided into two groups: induced (through pancreatectomy, chemicals such as alloxan and streptozotocin, viruses and others) and spontaneous (mainly using BB rats and NOD mice). The latter, at different ages, develop a diabetic syndrome, with clinical characteristics, genetics and immunology that are very similar to the human disease. Among the more significant differences are lymphopenia (in BB rats) and the predominance of diabetes in females (in NOD mice). Studies aimed at preventing IDDM have advanced by leaps and bounds by using the two spontaneous models. These include various methods such as genomic modification, an influence over some environmental agents, immunosuppression, immunotherapy, immunomodulation and tolerance induction as well as protection of the beta-cell from autoimmune attack. The conclusions drawn from animal experiments have allowed some human trials to be carried out with encouraging results.

The blood glucose and plasma insulin responses to some simple carbohydrates (glucose, fructose, lactose) and some complex ones (apples, potatoes, bread, rice, carrots and honey) were studied in 32 Type 2 (non-insulin-dependent) diabetic patients. Blood glucose and plasma insulin were measured at zero time and then at 15, 30, 60, 90 and 120 min after ingestion of 25 g glucose, fructose or lactose, or 30 g honey, 50 g white bread, 125 g white rice or potatoes, 150 g apples or 260 g carrots. Maximum blood glucose and plasma insulin responses were recorded 60 min after ingestion of each test meal. At this time the increases in blood glucose and in plasma insulin were significantly higher after the more refined carbohydrates (glucose, fructose and lactose) than after the more complex ones (apples, potatoes, rice, carrots and honey, -p less than 0.01). Counting the blood glucose increase after glucose as 100%, the corresponding increases in glycaemia for other carbohydrates were: fructose, 81.3%; lactose, 68.6%; apples, 46.9%; potatoes, 41.4%; bread, 36.3%; rice, 33.8%; honey, 32.4% and carrots, 16.1%.

BackgroundIn patients with chronic hepatitis C (CHC), obesity is involved in the pathogenesis of insulin resistance, fatty liver disease and progression of fibrosis. The objective of this study was to compare a normoglucidic low-calorie diet (NGLCD) with a low-fat diet (LFD) among participants with CHC. Aimed to measure the impact of dietary changes in reduction of insulin resistance, obesity but also in steatosis and fibrosis.MethodsRandomized, controlled trial in three medical centers with assessments at baseline, 6 months and 12 months. Participants were patients over 35 years with chronic hepatitis C (n = 120) with BMI over 25 kg/m2. We evaluated the effects of NGLCD vs. LFD in weight management and metabolic improvement. The primary endpoint was to measure the impact of dietary changes through nutritional intervention in reversibility of insulin resistance, obesity, steatosis, and fibrosis. We performed anthropometric measurements, fasting glucose profile, serum lipids, liver profile, blood count at baseline, 6 and 12 months. Steatosis was evaluated using ultrasonographic criteria. Liver fibrosis was non-invasively assessed.ResultsAfter 6 and 12 months of intervention, both groups had a significant decrease in caloric consumption. At 6 months, weight loss was greater in the NGLCD group (−5.02 ± 3.43 kg vs. −4.1 ± 2.6 kg; p = 0.002) compared to the LFD group. At 1-year, however, weight loss was similar in both groups (−3.9 ± 3.3 kg vs. −3.1 ± 2.6 kg; p = 0.139). At 12 months, fasting plasma glucose, fasting plasma insulin, and HOMA-IR had significant improvements in both groups. With both diets aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT) decreased with significant differences; also there were significant improvements in AST/ALT ratio, Forns fibrosis index. The two diets were associated with reduction of both the prevalence and the severity of steatosis (all p < 0.001). At 12 months, total cholesterol, HDL-cholesterol, triglycerides improved in both groups (all p < 0.05).ConclusionsThe present study establishes the benefits of low-calorie diet and low-fat diet in management of patients with hepatitis C regarding improvement of insulin resistance, steatosis and also fibrosis.Overweight or obese patients with CHC undergoing a lifestyle intervention (specific dietary intervention and physical activity) for 1-year had significant improvements in body weight, lipid and hepatic profile.Trial registrationPNCI2-3343/41008/2007