Adriana Rusu

HbA1c levels are associated with severity of hypoxemia and not with apnea hypopnea index in patients with type 2 diabetes: Results from a cross-sectional study.

The aim of the present study was to evaluate the effect of untreated sleep apnea syndrome (SAS) on glycemic control, evaluated by HbA1c, in patients with type 2 diabetes (T2D).

Hypertensive Waist: First Step of the Screening for Metabolic Syndrome

BACKGROUND In previous studies, we have suggested that hypertensive waist is a frequent combination in persons with metabolic syndrome. The objective of the current study was to analyze the ability of hypertensive waist to predict the presence of the metabolic syndrome. METHODS A total of 1294 women and men, randomly selected from general population, aged > or =18 years were included in this study. For these persons, the clinical and anthropometric data as well as fasting plasma blood glucose, triglycerides, total cholesterol, and high-density lipoprotein cholesterol were assessed. Hypertensive waist was defined as the presence of the systolic blood pressure > or =130 mmHg or a diastolic blood pressure > or =85 mmHg or history of treated hypertension plus a waist circumference > or =80 cm for women and > or =94 for men. International Diabetes Federation criteria were used for the diagnosis of the metabolic syndrome. RESULTS The prevalence of hypertensive waist was 43.3% and the prevalence of the metabolic syndrome was 45.7%. Persons with hypertensive waist were 6.7 times more likely to have metabolic syndrome (95% confidence interval, 5.5-8.2) when compared with people without hypertensive waist. The high values of specificity (84%) and sensitivity (80.4%) showed that hypertensive waist is a very good predictor of the metabolic syndrome. CONCLUSIONS On the basis of the easy-to-determine clinical parameters and on high predictive value, the clinical couple of hypertensive waist could be used as a starting point to screen for metabolic syndrome in Romanian population.

Clinical nutrition education in medical schools – Comment on the ESPEN survey

We read with great interest the recently published editorial “Clinical nutrition education in medical schools: Results of an ESPEN survey” [1], as well as commentaries linked to this editorial [2,3]. No data on the status of nutrition education is provided for Romania, as no Romanian medical school was included in this survey or in any previous survey [4]. To gather such data, we examined curricula available on the websites of all medical universities and faculties in Romania. The statusofnutritioneducation training forundergraduatemedical students in Romania is similar to the one reported in the ESPEN survey, with compulsory and elective trainings. Nutrition topics are usually part of instructions in different disciplines, starting from pre-clinical ones (medical biochemistry, hygiene) and further topics covered in various clinical disciplines (diabetes/diabetes and nutrition in universities where this discipline exists as standalone, paediatrics, gastroenterology, internal medicine, cardiology, nephrology). Inmostuniversities, the theoretical contentonprevention, diagnosis, and management of nutritional and metabolic changes is covered during 2e4 lecture hours and practical trainings in theDiabetes/Diabetes and Nutrition discipline, while training on nutritional recommendations in various pathologies are mainly covered in the clinical disciplines as mentioned above. Recently, elective lectures with longer duration (14 h) and a broader content, covering healthy lifestyle and healthy nutrition, eating behavior, preventive and therapeuticnutritionhavebeen introduced in twomedical schools.However, in some cases a limited number of students are accepted for enrollment to these elective lectures. As opposed to trainings for medical students, training on nutrition is better developed for nursing students. The topics of prevention, diagnosis, and management of nutritional and metabolic changes and dietetic recommendations in various disease states are covered in 28 h of theoretical training and 28 h of practical, problem-based training in Nutrition and Dietetics discipline. Nutrition training (14 h of theoretical and 14 h of practical training) has also been recently introduced in the curriculum of physiokinesiotherapy/medical rehabilitation undergraduate programs.

The association study of high-sensitivity C-reactive protein, pentraxin 3, nitrotyrosine, and insulin dose in patients with insulin-treated type 2 diabetes mellitus

Purpose The objective of this study was to examine the association between insulin dose and high-sensitivity C-reactive protein (hsCRP), nitrotyrosine, and pentraxin 3 in patients with insulin-treated type 2 diabetes. Patients and methods Eighty patients with type 2 diabetes treated with insulin for >6 months and with stable insulin doses (±10%) within 3 months before inclusion were enrolled in this study. Medical history, including use of insulin and insulin doses, concomitant diseases and medication, and anthropometric and routine biochemical parameters were collected for each patient. hsCRP, nitrotyrosine, and pentraxin 3 were measured in fasting conditions. Comparison analysis was performed according to the distribution in tertiles of insulin dose/kg of body weight, and linear regression adjusted for confounding factors was used to examine the associations between markers of inflammation, oxidative stress, and insulin dose. Results In the comparison analysis, no statistically significant difference was found between hsCRP, nitrotyrosine, and pentraxin 3 levels across tertiles of insulin dose expressed as IU/kg of body weight (p for trend >0.05 for all comparisons) except a significantly higher hsCRP level in tertile 3 compared to tertile 1 (3.9±3.6 vs 6.1±3.8 mg/dL, p=0.035). In regression analysis, after adjustment for age, gender, smoking, body mass index, glycated hemoglobin, C-peptide, metformin, antiplatelet, and statin use, only hsCRP levels were statistically significant associated with insulin dose/kg of body weight (β=0.237, p=0.043). Conclusion In this sample of patients with type 2 diabetes treated with insulin for >6 months, hsCRP was positively associated with insulin doses. No such association was found for pentraxin 3, a more specific marker of vascular inflammation, and for nitrotyrosine as a marker of oxidative stress.

Increased glycemic variability in type 2 diabetes patients treated with insulin - a real-life clinical practice, continuous glucose monitoring (CGM) study

Abstract Chronic hyperglycemia is an important cause for the development of chronic complications of diabetes, but glycemic variability has emerged in recent years as an independent contributor to diabetes-related complications. Our objective was to evaluate glycemic variability in patients with T2DM treated with insulin compared with other antidiabetic drugs. In this retrospective study, we collected 24-hour continuous glucose monitoring (CGM) recording data from 95 patients with T2DM, of which 27 treated with insulin and 68 with non-insulin treatment. We calculated and compared 16 glucose variability parameters in the insulin-treated and non-insulin treated groups. Insulin treated patients had significantly higher values of parameters describing the amplitude of glucose value fluctuations (standard deviation of glucose values, percentage coefficient of variation [%CV], and mean amplitude of glycemic excursion [MAGE], p <0.05) and time-dependent glucose variability (percentage of time with glycemic values below 70 mg/dl and continuous overall net glycemic action [CONGA] at 2, 4 and 6 hours, p <0.05). In conclusion, insulin therapy in T2DM is correlated with significantly higher glycemic variability.

Social jetlag, sleep-related parameters, and glycemic control in adults with type 1 diabetes: results of a cross-sectional study

Social jetlag (SJL) is a small recurrent circadian rhythm disruption and the most frequent form of circadian rhythm misalignment. The main aim of this study was to investigate the effect of SJL on glycemic control, as assessed by HbA1c, in real‐life settings.

Investigation of biomarker variations post-return of spontaneous circulation following an out-of-hospital cardiac arrest

Abstract Objective: The objective of this research was to describe evolution of several biomarkers post-return of spontaneous circulation (ROSC) following an out-of-hospital cardiac arrest (OHCA). Methods: Thirteen adult patients were divided in 2 groups according to their survival status at 30 days, survivors (alive at 30 days or discharged alive) and non-survivors (not alive at 30 days). Glycemia, lactate, C-reactive protein (CRP), neurofilament heavy chain (NfH) and presepsin were assessed at pre-set time-points, during OHCA and the first 72 hours post-ROSC. Results: In survivors, lactate levels decreased steadily throughout the 72 hours from a maximum observed during OHCA; in non-survivors, it increased during ROSC, then decreased abruptly at 2 hours post-ROSC and remained lower than in survivors for up to 24 hours. Glycemia at all-time points within the first 24 hours and CRP levels at 2 hours post-ROSC were higher in non-survivors, but this observed difference was not statistically significant. The variation of NfH was bi-modal, with peaks at 12 and 48 hours. The interpretation of NfH was limited by the large number of samples outside the limit of detection. Conclusion: Glycemia, lactate and CRP showed different patterns of evolution in survivors and non-survivors and should be further investigated as potential predictors of survival after ROSC

Response to: Untreated sleep apnea syndrome and glycemic control in patients with type 2 diabetes

We appreciate Dr Kawada’s thoughtful commentary on our recent paper. In our study enrolling 100 consecutive patients with type 2 diabetes (T2D), 64 had sleep apnea syndrome (SAS; SAS prevalence 64%), as assessed by a portable sleep diagnostic device (ApneaLink; ResMed, Poway, CA, USA), and we showed that patients with SAS had poorer diabetes control than those without SAS (HbA1c 8.4% vs 7.6%, respectively P = 0.04). After adjustment for age, gender, diabetes duration, diabetes treatment, and body mass index, HbA1c was associated with mean and lowest O2 saturation during sleep (β = −0.23 [P = 0.03] and β = −0.24 [P = 0.007], respectively). Further adjustment for waist circumference showed that HbA1c was independently associated only with the lowest O2 saturation during sleep (β = −0.21; P = 0.05). We did not observe any association between the apnea–hypopnea index and HbA1c. Dr Kawada noted that in previous studies enrolling people without diabetes an association was observed between the severity of SAS and HbA1c, as well as between nocturnal hypoxemia and the risk of poor glycemic control. Studies in patients with T2D had mixed results, with studies showing no relationship between SAS and glycemic control, an association between SAS severity as assessed by the apnea–hypopnea index and glycemic control, or an association between mean and minimum O2 saturation and glycemic control. 5 It has been hypothesized that these results may be explained by the duration of sleep recording. Therefore, we cannot conclude that the relationship between sleep recording parameters varies across the spectrum of glucose metabolism disturbances. We agree with Dr Kawada’s comments on the sample size and its effect on the regression analysis, as well as with his observation on psychological factors that may have affected glycemic control. To add to this, sleep duration and sleep quality may also have affected the glycemic control of the patients enrolled in our study. We acknowledged these and other limitations in our paper. A larger number of patients and collection of data on other potentially cofounding variables would have increased the generalizability of our analysis. Investigations into the interaction between sleep and glycemic metabolism are still in their infancy and there are more questions than available answers in this area. We believe that our research adds to the available information in this area and further large-scale clinical studies performed in real-world settings are required to delineate the mechanisms by which sleep disorders affect glucose metabolism in patients with and without diabetes.

The correlation of dawn phenomenon with glycemic variability parameters in type 2 diabetes mellitus

Abstract Introduction. Dawn phenomenon could have deleterious effect on overall glycemic control. Glycemic variability may be an independent risk factor for the development of diabetes chronic complications. The study aimed to evaluate any correlations between the dawn phenomenon and parameters of glycemic variability in a cohort of type 2 diabetes patients (T2DM). Material and methods. This retrospective observational study included 131 T2DM patients. Continuous glucose monitoring (CGM) has been performed. Data from the first 24h of full recording were used for analysis of glycemic variability indices: mean level of 24h interstitial glucose value and standard deviation; % coefficient of variation; J index; mean amplitude of glycemic excursion - MAGE; continuous overall net glycemic action (CONGA) at 1, 2, 4 and 6 hours; mean of daily differences (MODD) index. Results. Mean age was 56.04 ± 9.91 years, 35.9% women, 17.6% on diet, 53.4% on oral therapy and 29% on insulin. Dawn phenomenon was more frequent in patients below 60 years (70%) and in oral therapy group (72.85%). Significant correlations between the dawn phenomenon and j-index, MAGE, CONGA-4 and CONGA-6 have been found in T2DM patients on diet therapy alone. The amplitude of dawn phenomenon was 46.10 ± 24.40 mg/dl and significantly correlated (p<0.05) after adjustment for age, gender and treatment with % CV, MAGE, CONGA-1, CONGA-2, CONGA-4, CONGA-6 and MODD. Conclusions. The dawn phenomenon significantly increases the glycemic variability parameters in drug-naive T2DM patients, with no impact in T2DM on oral or insulin therapy.

Prevention Of Coronary Heart Disease And Stroke Complications In Type 2 Diabetes Mellitus: An Observational, Prospective Study

Abstract Background and Aims: We assessed the effect of intensive therapy on modifiable cardiovascular (CV) risk factors and CV risk as compared to conventional therapy in patients with newly diagnosed type 2 diabetes mellitus (T2DM). Material and Methods: This was an observational, prospective study, conducted in Romania. During 1-year follow-up period the enrolled participants received either multi-factorial pharmacotherapy associated with intensive therapeutic education (Intensive group), or conventional therapy (Control group). Current analysis included data (anthropometric measurements, blood pressure and biochemical parameters) recorded at months (M) 0, 6 and 12. CV risk was calculated at M1 and M12 using the UK Prospective Diabetes Study Risk Engine. Results: 138 patients aged 57.02±10.05 years were included in this analysis (69 in each group). At M6 and M12 a significant improvement of the majority of the modifiable risk factors in the Intensive group compared to the Control group was observed. At M12, coronary heart disease (CHD)/fatal-CHD risks were significantly lower in the Intensive (7.5%/3.1%) than in the Control (17.95%/10.3%) group (p<0.05). A similar trend was observed for the stroke/fatal-stroke risks. Conclusions: CHD/fatal-CHD and stroke/fatal-stroke risk burden decreased in newly diagnosed diabetic patients following multi-factorial pharmacotherapy association with intensive lifestyle changes during 1-year follow-up.