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Perciun R.,N C Paulescu National Institute Of Diabetes
Romanian Journal of Diabetes, Nutrition and Metabolic Diseases | Year: 2011

Non-invasive ultrasound investigations are frequently used as a screening maneuver for peripheral vascular disease. The ankle to brachial pressure index (ABPI) it is a noninvasive hand-held Doppler test that is able to perform a peripheral vascular interrogation. It is thaught to be reasonable accurate for the diagnosis of hemodynamical significant arterial disease, meaning that the advanced wall injuries are already set. When performing the ABPI investigation the lack of methodological standardization is challanging even in the nondiabetic population. In this review we highlight the ankle to brachial pressure index (ABPI) effectiveness and limitations comparing non-diabetic versus diabetic patients with peripheral arterial disease, trying a (re)consideration of its diagnostic accuracy. Almost 60% of peripheral arterial diseased patients are free of symptoms, probably because of collaterals network. The vascular disease is particularly high among diabetic individuals and suggests that multiple arterial beds are simultaneously affected. As we know, there is a general consensus about regular vascular assessment in diabetic population. The ABPI as a screening tool for lower limb arterial disease is less sensitive in diabetic individuals, mainly when neuropathy and vascular calcification exist. ABPI interrogation should therefore always be cautiously considered. Hand held Doppler assessment and ABPI results should be integrated in the clinical context of the patients. Either clinically symptomatic or silent (because of collaterals efficiency and neuropathy), lower limb arterial disease needs to be further and detailed interrogated. Color duplex investigation (CDI) seems to be a highly sensitive and accurate method ofassessing arterial vasculopathy mainly in diabetics. Source

Florentiu A.,N C Paulescu National Institute Of Diabetes | Dima I.,Buftea Obstetrics and Gynecology Hospital
Romanian Journal of Diabetes, Nutrition and Metabolic Diseases | Year: 2014

Background and aims: The epidemic of diabetes mellitus has made the effective treatment of hyperglycemia a top priority. Maintaining near-normal glycemic levels has been demonstrated to have a beneficial effect on diabetes-specific complications. Insulin can decrease any level of elevated glycated hemoglobin. Insulin glargine (Lantus®) is a long-acting insulin analog with a favorable 24-h time-action profile, once daily administration and low risk of hypoglycemia used in type 1 and 2 diabetes. In Romania, real-life data about glycaemic control is lacking. Material and methods: We present results from a retrospective, open-label, non-randomised, registry trial in 2946 Romanian diabetes patients. The objective of the study was to assess the proportion of patients with appropriate glycaemic control after 3 to 6 months of glargine treatment. Results and conclusions: A little over one third of the patients had reached target glycated hemoglobin after 3-6 months of glargine treatment in both types of diabetes. In type 2 diabetes patients the glargine dose used was not high (0.33 UI/kg). Inadequate insulin titration is a possible cause for not reaching glycemic target. © 2014 ILEX PUBLISHING HOUSE, Bucharest, Roumania. Source

Pop A.,Professor Dr C C Iliescu Institute Of Cardiovascular Diseases | Clenciu D.,Filantropia City Hospital | Anghel M.,N C Paulescu National Institute Of Diabetes | Radu S.,N C Paulescu National Institute Of Diabetes | And 4 more authors.
Journal of Diabetes | Year: 2016

Background: Insulin resistance (IR) is present in type 1 diabetes mellitus (T1DM) and is suggested to be related to chronic diabetic complications. The primary aim of our study was to assess IR in T1DM patients with and without chronic complications. A secondary aim was to evaluate the possible association between IR and chronic diabetic complications. Methods: This cross-sectional study enrolled 272 patients with T1DM. Insulin resistance was quantified using the estimated glucose disposal rate (eGDR). Associations between eGDR and each diabetes complication were first evaluated using binary logistic regression, then multiparametric logistic regression with stepwise selection of covariates. The discriminative value of eGDR was assessed by receiver operating characteristic (ROC) curve analysis. Results: Estimated GDR was lower in patients with chronic diabetic complications (6.1 vs 6.9mg/kg per min [P = 0.02] for retinopathy; 6.3 vs 7.3mg/kg per min [P < 0.01] for nephropathy; 6.5 vs 7.6mg/kg per min [P < 0.01] for neuropathy; and 5.2 vs 7.5mg/kg per min [P < 0.01] for cardiovascular complications). In univariate analysis eGDR was associated all diabetic complications. These associations remained significant after adjustment for different variables in the final regression models. In addition, eGDR was a good discriminator for each diabetic complication, with an area under the curve between 0.609 and 0.759. Conclusions: Patients with chronic diabetic complications are more insulin resistant than those without complications. Moreover, IR was independently associated with the presence of each chronic diabetic complication, and seems to be a good discriminator for them all. © 2016 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd. Source

Culman M.,N C Paulescu National Institute Of Diabetes | Guja C.,N C Paulescu National Institute Of Diabetes | Mihai A.,N C Paulescu National Institute Of Diabetes | Serafinceanu C.,N C Paulescu National Institute Of Diabetes
Romanian Journal of Legal Medicine | Year: 2013

Depression is more common and severe in people with diabetes, decreasing the glycemic control and quality of life and increasing the risk for long-term complications. In the same time, it can lead to acute life threatening medical crises, including suicidal risk. The aim of our study was estimate the prevalence of depression and asses its severity on a group of diabetic patients. In addition we aimed to identify clinical factors associated with the risk for depression. The study group included 198 diabetic patients. Depression screening was performed with the 21-item Beck Depression Inventory (BDI). The mean BDI score was 11.4, indicating mild depression. 58% of patients had significantly elevated levels of depressive symptomatology. Severe depression score was found in 25% of recently diagnosed (< 1 year) patients and 28% of patients with short duration diabetes (1-4 years). Patients not performing self-monitoring of blood glucose (SMBG), those with 2 or 3 chronic complications and those who were overweight showed the highest prevalence of depression. Instead of labeling the patient as "non-compliant", the diabetologists might develop the ability to easily and accurately diagnose depression. © 2013 Romanian Society of Legal Medicine. Source

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