Insulin-resistant patients with type 2 diabetes undergoing hemodialysis for end-stage renal disease on insulin detemir exhibit lower glycemic variability and pro-inflammatory profile than with insulin glargine.
Background and aims: PREDATORR Study estimated diabetes mellitus (DM) prevalence in Romania at 11.7%. MENTOR is the first national major study trying to determine the quality of the metabolic control in patients with type 2 diabetes (T2DM), the therapeutic options used, and the microvascular and macrovascular complications prevalence in order to achieve a better management for Romanian patients with T2DM. Material and methods: The study was designed as an observational analytical, multicenter, prospective study. Study population was selected from T2DM patients stratified by: age, diabetes duration and gender. Data was collected in an eCRF: demographics, physical examination, cardiovascular evaluation, blood tests, known pathology, treatment. Results: There were 54.80% women, mean age was 60.53±7.39 years. The average BMI is over 30 kg/m2 with a decreasing trend over the age. 60% had their HbA1c over the threshold of 7%. Average blood pressure was less than 140/80 mmHg. 76,66% of T2DM subjects have at least one chronic complication. On oral therapy we have 55.44% of patients, on insulin only therapy 12.99% and on a combination of oral and insulin therapy 22.51%. Conclusions: This study showed a high prevalence of diabetes complications and metabolic alterations (obesity, hypertension, dyslipidemia, etc.). Age, male gender and diabetes duration were associated with a higher risk for poor metabolic control and complications. Further data will be collected over a 3 years period to obtain a better image over T2DM evolution in Romanian population.
Background. The cardiovascular risk in obese patients is very high and is the main cause of mortality and morbidity. While many studies have focused on obese patients who already developed cardiovascular pathologies few tried to address the prevention of atherosclerosis in healthy young adults.Objectives. In the present study we assessed the effect of weight loss on atherosclerosis risk factors and on vascular stiffness. While no important clinical events were expected our goal was to show that weight loss in obese patients will lower the vascular risk.Subjects and methods. 159 obese patients with no cardiovascular pathology were assigned, for 6 months, to either weight loss program or a weight maintenance recommendation. The intensive care group subjects participated to weekly visits consisting of counseling on hypocaloric diets and physical exercise programs.We have measured BMI, lipid profile, adipokines levels, glycemia as well as markers of arterial stiffness (CAVI, BP, ABI).Results. At the study endpoint, we found a clinically and statistically significant (p<0.001) difference between the lipid and the adipokines profiles, and, in univariate analysis, this difference correlates with weight loss: for total cholesterolemia r= 0.63, LDL r= 0.65, HDL r= -0.48, adiponectin r= -0.59, leptin r=0.6 and also with abdominal circumference decrease. We also found a correlation between vascular stiffness parameters (CAVI, diastolic blood pressure) and the adipose tissue loss (r = 0.71; p < 0.001 for CAVI and r = 0.4; p = 0.001 for DBP).Conclusions. We found that using a moderate hypocaloric diet and encouraging physical exercise, even after a short period of time, subjects can lose weight, mainly by losing fat mass. The weight loss improved the lipid and adipokines levels and had reduced vascular stiffness.
The treatment and interdisciplinary management of patients with chronic kidney disease (CKD) continue to improve long-term outcomes. The medical nutrition intervention’s role is to establish a healthy diet plan for kidney protection, reach blood pressure and blood glucose goals, and prevent or delay health problems caused by kidney disease. Our study aims to report the effects of medical nutrition therapy—substituting foods rich in phosphorus-containing additives with ones low in phosphates content on phosphatemia and phosphate binders drug prescription in stage 5 CKD patients with hemodialysis. Thus, 18 adults with high phosphatemia levels (over 5.5 mg/dL) were monitored at a single center. Everyone received standard personalized diets to replace processed foods with phosphorus additives according to their comorbidities and treatment with prosphate binder drugs. Clinical laboratory data, including dialysis protocol, calcemia, and phosphatemia, were evaluated at the beginning of the study, after 30 and 60 days. A food survey was assessed at baseline and after 60 days. The results did not show significant differences between serum phosphate levels between the first and second measurements; thus, the phosphate binders’ initial doses did not change. After 2 months, phosphate levels decreased considerably (from 7.322 mg/dL to 5.368 mg/dL); therefore, phosphate binder doses were diminished. In conclusion, medical nutrition intervention in patients with hemodialysis significantly reduced serum phosphate concentrations after 60 days. Restricting the intake of processed foods containing phosphorus additives—in particularized diets adapted to each patient’s comorbidities—and receiving phosphate binders represented substantial steps to decrease phosphatemia levels. The best results were significantly associated with life expectancy; at the same time, they showed a negative correlation with the dialysis period and participants’ age.
Endogenous Cushing's syndrome is rare, with an incidence of 0.7-2.4 per a million people a year. Clinical presentation of Cushing syndrome can be pleomorphic, and establishing diagnosis can be difficult. Early recognition and rapid control of hypercortisolaemia are necessary to decrease morbidity and mortality in these patients.We report a series of 6 endogenous Cushing's syndromes of different etiologies (4 Cushing's disease and 2 adrenal Cushing's syndrome) assessed in our endocrine department over a decade (2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019). In order to highlight the diversity of clinical forms, diagnostic tools and specific management of this condition we labelled each case suggestively: the typical Cushing's disease, the Pseudo Cushing's, the elusive Cushing's disease, the mild autonomous cortisol hypersecretion, Cushing's syndrome in pregnancy and Cushing's disease with thromboembolism. We discussed their particularities which were revelatory for the diagnosis, such as dermatologic, cardiovascular, musculoskeletal, neuropsychiatric, or reproductive signs, reviewing literature for each manifestation. We also discuss the commonalities and differences in laboratory and imagistic findings. Therapeutic approach can also differ with respect to the particular condition of each patient and the multiple choices of therapy will be reviewed.
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