Maria Moţa

Effects of Sleeve Gastrectomy Versus Gastric Bypass on Type 2 Diabetes Mellitus Remission in Obese Patients

Abstract Objectives: To determine and compare the efficacy of two weight-reducing surgical interventions, gastric bypass (GBP) and sleeve gastrectomy (SG), in inducing remission/improvement of type 2 diabetes mellitus (T2DM). Materials and Methods: Data were collected from 162 obese T2DM subjects who underwent SG (96) or GBP (66) between 2009 and 2011. The following parameters were recorded: body mass index, waist-hip-ratio, blood pressure, fasting plasma glucose, HbA1c, lipid profile, hypoglycemic drugs used. Results: Remission of T2DM was achieved in 83% of patients who underwent SG and in 81% of patients who underwent GBP. For both procedures, T2DM remission rate was higher for patients with a shorter duration of T2DM, with better preoperative glycemic control and for those not requiring pharmacological agents before surgery. Conclusions: SG and GBP are effective in inducing T2DM remission in obese patients. The clinical features of T2DM are important predictors for the remission of the disease after bariatric surgery.

Data Regarding the Prevalence and Incidence of Diabetes Mellitus and Prediabetes

Abstract Diabetes Mellitus (DM) represents one of the highest challenges in our century, due to the fact that in the last 20 years the number of patients with DM has doubled, at present affecting hundreds of millions of people worldwide, both in developed countries and in developing ones, as well. One of the most serious consequences of this increase is the onset of type 2 DM in children, adolescents and young people, the main causes being an unhealthy lifestyle: unhealthy food, lack of physical exercise, which, most of the times, lead to obesity. Also, DM is often associated to micro and macrovascular complications, thus determining disabilities and high costs in the healthcare systems, respectively. DM is one of the main causes of death all over the world, a reason for which there are required prevention programs worldwide.

Peritoneal dialysis – risk factor for glycemic variability assessed by continuous glucose monitoring system

Abstract Background and Aims. Peritoneal dialysis (PD) is accompanied by a multitude of factors that influence glycemic variability, and HbA1c does not detect dynamic glucose changes. In this study we wanted to assess glycemic variability, using a 72-hour continuous glucose monitoring system (CGMS), in 31 patients stratified according to the presence of type 2 diabetes and PD. Materials and Methods. The study included 31 patients (11 type 2 diabetic PD patients, 9 non diabetic PD patients and 11 type 2 diabetic patients without PD). Glycemic variability was assessed on CGM readings by: Mean Amplitude of Glycemic Excursion (MAGE), Mean of Daily Differences (MODD), Fractal Dimensions (FD), Mean Interstitial Glucose (MIG), Area Under glycemia Curve (AUC), M100, % time with glucose >180/<70 mg/dl. Results. The PD diabetic patients presented AUC, MIG and inter-day glycemic variability (MODD) significantly higher than diabetic patients without PD. In PD patients, the type of dialysis fluid in the nocturnal exchange and peritoneal membrane status did not significantly influence glycemic variability. Conclusions. CGMS is more useful than HbA1c in quantifying the metabolic imbalance of PD patients. PD induces inter-day glycemic variability and poor glycemic control, thus being a potential risk factor for chronic complications progression in diabetic patients.

The relationship between periodontal disease and diabetes mellitus

Abstract Periodontitis is a common complication in patients with diabetes. Their classification is complex and it is based on the clinical presentation, rate of disease progression, age at diagnosis and local and systemic factors that may multiply the risk. The two major stages of periodontal diseases are gingivitis and periodontitis. The relationship between these two diseases appears bidirectional insofar that the existence of one disease tends to promote the other and that the meticulous management of either may help the treatment of the other. Treatment of periodontitis using a association of mechanical therapy, scaling and root planning, plus systemic tetracycline antibiotics has been demonstrated to have important reductions in HbA1c values. Therefore, for a better control of diabetes we suggest that periodontal patients with diabetes should be consulted and treated by a periodontist.

Insulin Resistance and Chronic Kidney Disease in Patients with Type 1 Diabetes Mellitus

Background and Aims. Diabetes mellitus (DM) is a chronic disease which can evolve towards devastating micro- and macrovascular complications. DM is the most frequent cause of chronic kidney disease (CKD). Insulin resistance plays an important role in the natural history of type 1 diabetes. The purpose of the study was to determine the prevalence of CKD in T1DM and the correlation with insulin resistance (IR) in patients with CKD. Materials and Methods. The study was conducted over a period of three years (2010–2013) and included patients with DM registered in the Clinical Centre of Diabetes, Nutrition and Metabolic Diseases of Dolj county. The study design was an epidemiological, transversal, noninterventional type. Finally, the study group included 200 subjects with type 1 DM. Insulin resistance (IR) was estimated by eGDR. The subjects with eGDR ≤ 7.5 mg/kg/min were considered with insulin resistance. Results. CKD was found in 44% of the patients. Analyzing statistically the presence of CKD, we found highly significant differences between patients with CKD and those without CKD regarding age and sex of the patients, the duration of diabetes, glycosylated hemoglobin (HbA1c), the estimated glucose disposal rate (eGDR), and the presence of hypertension, dyslipidemia, and hyperuricaemia. In patients with CKD, age and diabetes duration are significantly higher than in those who do not have this complication. CKD is more frequent in males than in females (50.9% men versus 34.5% women, p = 0.022). From the elements of metabolic syndrome, high blood pressure, hyperuricemia, and dyslipidemia are significantly increased in diabetic patients with CKD. eGDR value (expressed as mg·kg−1·min−1) is lower in patients with CKD than in those without CKD (15.92 versus 6.42, p < 0.001) indicating the fact that patients with CKD show higher insulin resistance than those without CKD. Conclusions. This study has shown that insulin resistance is associated with an increased risk of CKD, but, due to the cross-sectional design, the causal relationship cannot be assessed. However, the existence of this causality and the treatment benefit of insulin resistance in type 1 diabetes are issues for further discussion.

Insulin Resistance Markers in Type 1 Diabetes Mellitus

Abstract Insulin resistance (IR) is a fundamental disorder of type 2 Diabetes Mellitus (DM), but it is also involved in the etiopathogenesis of type 1 DM, with important implications in the onset and progression of micro- and macrovascular complications in type 1 DM. Overweight plays the main role in the increased incidence of both types of DM, exacerbating IR. The epidemic increase of overweight and obesity makes it difficult to diagnose the exact phenotype of DM, as IR and autoimmunity often coexist. Many studies showed an increase in incidence of micro- and macrovascular complications in patients with type 1 DM with IR, compared to patients with type 1 DM without IR. The gold standard of IR evaluation is represented by the method of euglycemic-hyperinsulinemic clamp, applied on a reduced scale in research. Thus, it is necessary to identify early IR markers (clinical or biological markers), less laboured ones, that could be used on a large scale in current medical practice, for the IR determination in type 1 DM. Clinicians and health experts should prevent/ reduce the epidemic of overweight and obesity in young people, thus decreasing IR, and implicitly the chronic complications of DM.

Biochemistry of hyperglycemia induced vascular dysfunction

Abstract Glucose enters the endothelium via a non-insulin sensitive GLUT-1 facilitated transporter that transports glucose continuously. Extracellular hyperglycemia is positively correlated with intracellular glucose. As the glucose levels increase, several changes in the glycolytic pathway, tricarboxilic acid cycle and the pentose phosphate pathway occur, all of them leading to an increase of oxygen reactive species (ROS). ROS are capable not only of directly impairing endothelial cells, but also indirectly by activating poly(ADPribose) polymerase, which inhibits glyceraldehyde 3-phosphate dehydrogenase. Further increase in glycloytic intermediates is followed by activation or overexpression of the main pathological pathways of hyperglycemia induced vascular damage: upregulation of glycation end-products, activation of protein kinase C, increased hexosamine pathway, and increased flux through polyol pathway, finally leading to the progressive narrowing and occlusion of the vessels.

Hepatic fibrosis, measured by fibroscan in a group of patients with obesity

Abstract Introduction.Hepatic steatosis is a reversible condition caused by accumulation of triglycerides in liver cells. Non-alcoholic fatty liver disease (NAFLD) can progress to advanced liver disease: fibrosis, cirrhosis, liver failure, cancer, and finally can lead to death; therefore NAFLD contributes significantly to morbidity and mortality of hepatic cause. Materials and methods: The study was conducted on a group of 88 patients with Body Mass Index (BMI) ≥ 30kg/m², they were excluded patients with known diabetes. Results, Discussion: The statistical analysis showed that in more than half of subjects elastometry values were higher than those considered normal, obesity is a risk factor for NAFLD that progresses in hepatic fibrosis. Conclusions: Liver fibrosis is present in high percentage in patients with obesity (52% of subjects) and it was positively correlated with age, arterial stiffness and fasting glucose.

Associations of smoking with cardiometabolic profile and renal function in a Romanian population-based sample from the PREDATORR cross-sectional study

Abstract Background: The impact of smoking on morbidity is well known, but in Romania, limited data are available regarding the smoking prevalence and relationship with cardiometabolic profile and kidney function. Objectives: To assess the association of smoking with cardiometabolic traits and kidney function, in a Romanian population-based sample from the PREDATORR study. Methods: PREDATORR was an epidemiological cross-sectional study. Between 2012 and 2014, participants were randomly selected from the lists of general practitioners and enrolled if they were aged 20 to 79 years, born and living in the past 10 years in Romania. Sociodemographic and lifestyle characteristics were collected through interviewer-administered questionnaires. Results: Overall, 2704 participants were included in the analysis, 18% of them being current smokers and 30.8% former smokers. Current smokers compared to non-smokers had higher total cholesterol (220.6 ± 50.4 versus 213.9 ± 86.8 mg/dl, P = 0.017), LDL-cholesterol (137.8 ± 45.2 versus 130.7 ± 83.7 mg/dl, P = 0.004) and glomerular filtration rate (96.9 ± 16.8 versus 90.7 ± 19.1 ml/min/1.73 m2, P <0.001) in women and higher triglycerides (170.7 ± 129.8 versus 144.3 ± 94.2 mg/dl, P = 0.007), glomerular filtration rate (97.6 ± 17 versus 90.3 ± 18 ml/min/1.73 m2, P < 0.001) and lower HDL-cholesterol (48 ± 15.5 versus 50.4 ± 14.1 mg/dl, P = 0.002) in men. Active smoking was associated with hypercholesterolaemia [OR: 1.40 (95% CI: 1.01–1.96), P = 0.04] and low HDL-cholesterolaemia [OR: 1.39 (95% CI: 1.01–1.91), P = 0.04] and negatively associated with overweight/obesity [OR: 0.67 (95% CI: 0.48–0.94), P = 0.02]. Male former smokers had higher prevalence of abdominal obesity (82.4% versus 76.4%, P = 0.02), hypertriglyceridaemia (43.6% versus 35.6%, P = 0.01), hypertension (64% versus 56.4%, P = 0.01) and ischaemic vascular disease (40.5% versus 30.9%, P = 0.003) than male non-smokers. Conclusion: The PREDATORR study showed a high prevalence of smoking in the adult Romanian population providing data on the association of smoking with cardiometabolic traits.

Insulin Initiation in Type 2 Diabetes – Why, When and How?

Abstract Type 2 diabetes is a progressive disease and, despite recent progress in the treatment of diabetes, the glycemic control usually deteriorates gradually and insulin therapy is needed. When insulin therapy should be started and which are the appropriate insulin therapy strategies, still represent subjects of debates. Insulin represents a therapeutic option in type 2 diabetes due to the existence of early β-cell dysfunction and significant reduction of β-cell mass in natural history of type 2 diabetes. The current guidelines recommend insulin in double therapy in association with metformin or in combination with metformin and other noninsulin agent. Initiation of insulin therapy is recommended in patients with newly diagnosed type 2 diabetes and symptomatic and/or presenting important hyperglycemia or elevated HbA1c. Initiation of insulin therapy in type 2 diabetes should take into consideration the pathophysiology of type 2 diabetes, the effects and the potential risks of insulin therapy, the guidelines recommendations and the barriers to insulin use. Literatures of only English language were analyzed from NCBI database. Guidelines were accessed electronically from organisations, i.e. American Diabetes Associations, American Association of Clinical Endocrinologists and American College of Endocrinology, European Association for the Study of Diabetes, International Diabetes Federation.