Konstantinos Makrilakis

Validation of the Finnish diabetes risk score (FINDRISC) questionnaire for screening for undiagnosed type 2 diabetes, dysglycaemia and the metabolic syndrome in Greece

AIMnThe present study aimed to validate the Finnish Type 2 Diabetes Risk Score (FINDRISC) questionnaire for its ability to predict the presence of any glucose homoeostasis abnormalities and the metabolic syndrome (MetS) in the Greek population.nnnMETHODSnValidation was performed on a sample of individuals who had agreed to participate in a screening program for type 2 diabetes (T2D) prevention (the Greek part of the DE-PLAN study), using both FINDRISC and oral glucose tolerance tests (OGTT). Impaired fasting glucose (IFG) was defined as a fasting plasma glucose level of 6.1-6.9 mmol/L, and impaired glucose tolerance (IGT) as a 2-h plasma glucose of 7.8-11.0 mmol/L. The predictive value of the FINDRISC was cross-sectionally evaluated using the area under the receiver operating characteristic (AUROC) curve method.nnnRESULTSnA total of 869 individuals (379 men, aged 56.2 ± 10.8 years) were screened from the general population living in the city and suburbs of Athens. OGTT revealed the presence of unknown diabetes in 94 cases (10.8%), IFG in 85 (9.8%) and IGT in 109 (12.6%). The sensitivity of a FINDRISC score greater or equal to 15 (45% of the population) to predict unknown diabetes was 81.9% and its specificity was 59.7%. The AUROC curve for detecting unknown diabetes was 0.724 (95% CI: 0.677-0.770). For any dysglycaemia, the AUROC curve was 0.716 (0.680-0.752) while, for detection of the MetS, it was 0.733 (0.699-0.767).nnnCONCLUSIONnThe FINDRISC questionnaire performed well as a screening tool for the cross-sectional detection of unknown diabetes, IFG, IGT and the MetS in the Greek population.

Implementation and effectiveness of the first community lifestyle intervention programme to prevent Type 2 diabetes in Greece. The DE-PLAN study

Diabet. Med. 27, 459–465 (2010)

The Performance of Serum Inflammatory Markers for the Diagnosis and Follow-up of Patients With Osteomyelitis:

Serum inflammatory markers, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cells (WBC), and procalcitonin (PCT), have been used for the diagnosis of foot infections in patients with diabetes. However, little is known about their changes during treatment of patients with foot infections. The aim of this prospective study was to examine the performance of serum inflammatory markers for the diagnosis and follow-up of patients with osteomyelitis. A total of 61 patients (age 63.1 ± 7.0 years, 45 men and 16 women, 7 with type 1 and 54 with type 2 diabetes) with untreated foot infection (34 with soft-tissue infection and 27 with osteomyelitis) were recruited. Diagnosis of osteomyelitis was based on clinical examination and was confirmed by imaging studies (X-ray, scintigraphy, magnetic resonance imaging). Determination of the inflammatory markers was performed at baseline, after 1 week, after 3 weeks, and after 3 months of treatment. At baseline, the values of CRP, ESR, WBC, and PCT were significantly higher in patients with osteomyelitis than in those with soft-tissue infections. The sensitivity and specificity for the diagnosis of osteomyelitis of CRP (cutoff value >14 mg/L) were 0.85 and 0.83, of ESR (cutoff value >67 mm/h) 0.84 and 0.75, of WBC (cutoff value >14 × 109/L) 0.75 and 0.79, and of PCT (cutoff value >0.30 ng/mL) 0.81 and 0.71, respectively. All values declined after initiation of treatment with antibiotics; the WBC, CRP, and PCT values returned to near-normal levels at day 7, whereas the values of ESR remained high until month 3 only in patients with bone infection. From the inflammatory markers, ESR is recommended to be used for the follow-up of patients with osteomyelitis.

Moisture Status of the Skin of the Feet Assessed by the Visual Test Neuropad Correlates With Foot Ulceration in Diabetes

OBJECTIVE To examine the association between the moisture status of the skin of the feet with foot ulceration in subjects with diabetes. RESEARCH DESIGN AND METHODS A total of 379 subjects with diabetes were examined. Assessment of peripheral neuropathy was based on neuropathy symptom score, neuropathy disability score, vibration perception threshold, and the 10-g monofilament perception. The moisture status of the skin of the feet was assessed using the visual test Neuropad. RESULTS Patients with foot ulceration had more severe peripheral neuropathy and more often an abnormal Neuropad response. Multivariate logistic regression analysis demonstrated that the odds of foot ulceration increased with measures of neuropathy but increased also with an abnormal Neuropad response. CONCLUSIONS An abnormal Neuropad response correlates with foot ulceration in subjects with diabetes. This finding, if confirmed prospectively, suggests that the Neuropad test may be included in the screening tests for the prediction of foot ulceration.

Vinegar reduces postprandial hyperglycaemia in patients with type II diabetes when added to a high, but not to a low, glycaemic index meal.

Background/Objectives:Earlier studies have shown that the addition of vinegar in a carbohydrate-rich meal lowers glucose and insulin response in healthy individuals. The mechanism of how this is accomplished, however, remains unclear. The aim of this study is to examine the effect of vinegar on glucose and insulin response in patients with type II diabetes (T2D) in relation to the type of carbohydrates consumed in a meal.Subjects/Methods:Sixteen patients with T2D were divided into two groups, matched for age, gender and HbA1c. Patients in the first group (group A) were given a high-glycaemic index (GI) meal (mashed potatoes and low-fat milk) on two different days, with and without the addition of vinegar, respectively. In the second group (group B), patients were given an isocaloric meal with the same nutrient composition, but low GI (whole grain bread, lettuce and low-fat cheese). Postprandial plasma glucose and insulin values were measured every 30u2009min for 2u2009h.Results:In group A, the incremental area under the curve of glucose (GiAUC120) was lower after the addition of vinegar (181±78u2009mmol·min/l vs 311±124u2009mmol·min/l, P=0.04). The iAUC of insulin (IiAUC120) was also reduced, but the difference was of marginal statistical significance (2368±1061u2009μU·min/ml vs 3545±2586u2009μU·min/ml, P=0.056). In group B, the addition of vinegar did not affect either the GiAUC120 (229±38u2009mmol·min/l vs 238±25u2009mmol·min/l, P=0.56) or the IiAUC120 (2996±1302u2009μU·min/ml vs 3007±1255u2009μU·min/ml, P=0.98).Conclusions:We conclude that the addition of vinegar reduces postprandial glycaemia in patients with T2D only when it is added to a high-GI meal.

Cardiac Autonomic Function Correlates with Arterial Stiffness in the Early Stage of Type 1 Diabetes

Arterial stiffness is increased in type 1 diabetes (T1D), before any clinical complications of the disease are evident. The aim of the present paper was to investigate the association between cardiac autonomic function and arterial stiffness in a cohort of young T1D patients, without history of hypertension and any evidence of macrovascular and/or renal disease. Large artery stiffness was assessed by measurement of carotid-femoral pulse wave velocity (PWV). Cardiac autonomic function was assessed by the cardiovascular tests proposed by Ewing and Clarke. Patients with a high cardiac autonomic neuropathy score (≥4) had significantly higher PWV than those with a low score (0-1). A negative, heart rate-independent, correlation between PWV and heart rate variation during respiration was observed (r = −0.533,u2009u2009P < 0.001). In multivariable analysis, E/I index was the strongest correlate of PWV (β-coefficient = −0.326, P = 0.002). Cardiac parasympathetic function is a strong predictor of large arterial stiffness, in young T1D patients free of macrovascular and renal complications.

Changes in dietary habits and their association with metabolic markers after a non-intensive, community-based lifestyle intervention to prevent type 2 diabetes, in Greece. The DEPLAN study

AIMSnThe aim of the present study was to evaluate the impact on dietary and activity habits of a non-intensive, community based lifestyle intervention for type 2 diabetes prevention, in high-risk Greek individuals.nnnMETHODSnA total of 191 high-risk persons were invited to participate in a one-year lifestyle intervention program, consisting of six bi-monthly sessions with a dietician. The dietary aims of the intervention were: reduction of saturated fat, sugars and refined cereals intake and at least five servings of fruits and vegetables, daily. Demographic, dietary, anthropometric, medical and biochemical indices were recorded at baseline and at the end of the intervention.nnnRESULTSnThe intervention was completed by 126 participants. At study end, participants reported decreased whole fat dairies and processed meats consumption (p=0.018 and 0.016, respectively), sugars (p=0.006) and refined cereals (p=0.045). Participants who improved their diet, decreased body weight (p=0.040), plasma triglycerides (p=0.020) and 2-h post-load plasma glucose (p=0.05) compared to those who had worsened their dietary habits. Total time spent daily on physical activity, remained unchanged throughout the intervention.nnnCONCLUSIONSnThe implementation of a group-based, non-intensive dietary counseling proved to be practical and feasible in real-world community settings and was accompanied by favorable dietary changes and health benefits.

Metabolic syndrome and Mediterranean dietary pattern in a sample of young, male, Greek navy recruits

Figure 1 Distribution of the Mediterranean diet score among the participants. The Mediterranean Diet (MD) is very beneficial, because of cardiovascular and other effects. The dietary habits of the population nowadays, however, have considerably changed. As there are only few data about the frequency of the metabolic syndrome (MS) in young Greeks, and their adherence to the MD, we studied the prevalence of the MS in a representative sample of young Navy recruits, while investigating adherence to the MD. We studied demographic, lifestyle, dietary and clinical information in 832 male navy recruits (M SD, 22.5 2.8 years-old [range 17e39, full data available for 714]). The MS was defined according to the IDF and NCEP criteria. Dietary habits were recorded through a validated, quantitative food-frequency questionnaire that assessed the consumption of various foods over the previous year, including individual portion sizes. A special diet score (range 0e55) was developed that assessed adherence to the MD (Table 1). The subjects ‘‘closer’’ to it were identified with the median value of the monthly average of foods consumed [1]. All gave their informed consents and the study was approved by the participating institution’s ethics committee. The MS was present in 11.1% and 5.0% (IDF and NCEP criteria, respectively). Around 32% were overweight (BMI: 25e30 kg/m) and 8% obese (BMI 30 kg/m). Smoking was very prevalent (50.4%). Adherence to the MD was quite poor: out of a maximum possible score of 55, the majority (w99%) had a score <31 (M SD, 24.5 3.68, median 25.0) (Fig. 1). In a multivariate logistic regression model, with the MS as dependent variable and the MD score as an independent one, and after adjustment for age, smoking habits, exercise activity, marital status, coffee consumption, family history of diabetes and CHD and several biochemical measurements, MD did not predict the presence of the MS, with either criteria used. It seems that adherence to the MD depends on age, possibly because in younger people the traditional MD style is decreasing. This is probably due to the globalization of food practices and habits among the young, with the advent and prevalence of westernised, fast-food diets in these age

Baseline osteocalcin levels and incident diabetes in a 3-year prospective study of high-risk individuals

AIMnExperimental evidence suggests that osteocalcin is a key messenger that affects both adipocytes and insulin-producing β cells. Epidemiological cross-sectional studies have shown a negative association between plasma levels of osteocalcin and glucose. For this reason, the hypothesis that lower baseline osteocalcin plasma levels are associated with diabetes was prospectively tested.nnnMETHODSnThe study population consisted of individuals at high risk for type 2 diabetes who were screened for participation in the Greek arm of a European type 2 diabetes prevention study (the DE-PLAN study). All participants were free of diabetes at baseline and underwent a second evaluation 3 years later. Diabetes status was defined according to an oral glucose tolerance test.nnnRESULTSnA total of 307 subjects were included in the present analysis. The population, including 154 men (50.3%), was middle-aged (54.4 ± 10.2 years) and overweight (BMI: 29.5 ± 4.9 kg/m(2)). At baseline, mean total plasma osteocalcin was lower in those with impaired fasting glucose and/or impaired glucose tolerance compared with those with normal glucose tolerance (6.0 ± 3.1 ng/mL vs. 7.3 ± 4.0 ng/mL, respectively; P = 0.01). After 3 years, 36 subjects had developed diabetes. In the prospective evaluation, there was no association between baseline osteocalcin levels and diabetes (OR: 1.04 per 1 ng/mL, 95% CI: 0.93-1.15; P = 0.49) on multivariable logistic regression analysis, nor was there any correlation with changes in plasma glucose after 3 years (r = 0.09, P = 0.38).nnnCONCLUSIONnOur prospective results show that lower levels of circulating osteocalcin do not predict future diabetes development and, in contrast to most cross-sectional published data so far, suggest that this molecule may not be playing a major role in glucose homoeostasis in humans.

The effect of a non-intensive community-based lifestyle intervention on the prevalence of Metabolic Syndrome. The DEPLAN study in Greece

OBJECTIVEThe aim of the present study was to evaluate the effectiveness of a non-intensive, community-based, lifestyle intervention program on the prevalence of metabolic syndrome (MS), in individuals at high risk for development of type 2 diabetes (T2D).DESIGNIn accordance with the FINDRISC score, 191 high-risk persons for T2D, 56.3±10.8 years old, participated in a one-year lifestyle intervention program consisting of six bi-monthly sessions with a dietician. MS prevalence was assessed at baseline and one year later.RESULTSThe intervention was completed by 125 participants. They lost on average 1.0±4.8 kg (p=0.025) (mean±SD) and registered favourable dietary changes. The baseline prevalence of MS was similar among age groups and genders and decreased after one year (from 63.4±48.4% to 54.8±50.0%, p<0.001). In a multiple logistic regression model, younger age (p=0.009), male gender (p=0.004), improvement of the dietary score after one year (p=0.022), a lower FINDRISC score (p=0.033), a lower triglyceride level (p=0.010) and a higher baseline HDL-C level (p=0.003) were significantly and independently associated with improvement in MS status.CONCLUSIONSA non-intensive lifestyle intervention program to prevent T2D is effective in decreasing the prevalence of MS in individuals at high risk for T2D development, possibly conferring multiple cardiovascular health benefits.