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Ioacara S.,University of Bucharest | Ioacara S.,Carol Davila University of Medicine and Pharmacy | Guja C.,Carol Davila University of Medicine and Pharmacy | Guja C.,Prof Nc Paulescu National Institute Of Diabetes | And 9 more authors.
Journal of Diabetes Research

The study investigated the impact of insulin glargine exposure on cardiovascular mortality in type 2 diabetes patients with incident insulin initiation. All consecutive diabetes patients aged >40 years were screened at their first diabetes outpatient visit between 01/01/2001 and 12/31/2008 (n = 79869). Exclusion criteria restricted the cohort to 4990 incident insulin users, aged 40-79 years, who were followed up for death until 12/31/2011. Baseline was defined 6 months after insulin initiation. Adjusted time-dependent competing risk regression analysis was performed. Mean baseline age was 62 ± 9 years, with mean follow-up of 4.7 ± 1.9 years. During 23179 person-years of exposure time, there were 887 deaths (521 cardiovascular). Glargine cumulative time exposure significantly lowered overall cardiovascular, subhazard ratio (SHR) 0.963 (CI 95% 0.944-0.981, p < 0.001), and myocardial infarction mortality, SHR 0.945 (CI 95% 0.899-0.994, p = 0.028), but not stroke mortality. Glargine cumulative dose exposure (10,000 IU increments) significantly lowered cardiovascular mortality, SHR 0.977 (CI 95% 0.960-0.993, p = 0.006), but not for myocardial infarction and stroke. Both cumulative dose and time exposure to insulin glargine were associated with lower cardiovascular mortality. The effect was mostly driven by myocardial infarction end point, supporting the concept of macrovascular benefit for basal analogue insulin use in type 2 diabetes. © 2015 Sorin Ioacara et al. Source

Toma N.,Prof Nc Paulescu National Institute Of Diabetes | Stancu M.M.,Prof Nc Paulescu National Institute Of Diabetes | Savu O.,Prof Nc Paulescu National Institute Of Diabetes
Romanian Journal of Diabetes, Nutrition and Metabolic Diseases

Background. Acute intermittent porphyria (AIP) is a hereditary metabolic aberration resulting from a partial defect in the activity of the enzyme porphobilinogen deaminase (PBDG) during the course of haeme synthesis. Diabetic metabolism may attenuate the episodes of porphyria related symptoms. Case report. Our subject (male; age 75) was hospitalized one week after onset of diffuse abdominal pain and constipation and overt type 2 diabetes mellitus (DM). The patient's long history of alcohol intake with acute alcohol consumption 12 days before admission, in the presence of abdominal pain with spectacular remission after oral administration of 5% glucose solution, accompanied by a 2.5 fold increase of urinary porphobilinogen with normal values for porphyrins and urinary lead, and normal full blood count establishes the diagnosis of AIP. Conclusion We describe a case of AIP probably triggered by acute alcohol consumption, with neurovisceral dominant clinical picture mimicking an acute abdomen. Late disease occurrence as first acute episode at older age accompanied by overt type 2 DM, suggests a latent type of AIP in our patient. The appropriate recognition of latent AIP cases in proband's offspring prevents unnecessary blind surgery when repeated episodes of unexplained abdominal pain occur. Source

Elian V.I.,Carol Davila University of Medicine and Pharmacy | Cucu I.,Prof Nc Paulescu National Institute Of Diabetes | Cheta D.,Carol Davila University of Medicine and Pharmacy | Cheta D.,Prof Nc Paulescu National Institute Of Diabetes | And 2 more authors.
Acta Endocrinologica

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. Source

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