Acta Diabetologica Romana 2016

ACTA DIABETOLOGICA
ROMN
Volum de rezumate
Abstract Book
Al 42-lea Congres Naional al Societii

Romne de Diabet, Nutriie
i Boli Metabolice
The42nd National Congres of the

Romanian Society of Diabetes, Nutrition
And Metabolic Diseases
Comitetul Director al SRDNBM
Steering Committee of RSDNMD
Preedinte/President:
Prof. Dr. Cristian SERAFINCEANU
Vicepreedini/Vice Presidents:
Conf. Dr. Cristian GUJA

Conf. Dr. Bogdan Mircea MIHAI
Membri/Members:
Prof. Dr. Romulus TIMAR

Prof. Dr. Doina CATRINOIU
Conf. Dr. Gabriela ROMAN
ef lucrri Dr. Cornelia BALA
ef lucrri Dr. Simona Georgiana POPA
Secretar/Secretary: Asist. Univ. Dr. Viviana ELIAN
Secretariat tehnic/Technical Secretary: Mariana ROCSIN
Comitetul tiinific al congresului:

Congress Scientific Committee:
Prof. Dr. Doina CATRINOIU Prof. Dr. Cristian SERAFINCEANU

Prof. Dr. Dan Mircea CHEA Prof. Dr. Viorel ERBAN
Prof. Dr. Mihaela DINC Prof. Dr. Romulus TIMAR
Prof. Dr. Mariana GRAUR Conf. Dr. Cristian GUJA
Prof. Dr. Nicolae HNCU Conf. Dr. Bogdan MAIHAI
Prof. Dr. C-tin IONESCU TRGOVITE Conf. Dr. Magdalena MOROANU
Prof. Dr. Radu LICHIARDOPOL Conf. Dr. Gabriela ROMAN
Prof. Dr. Maria MOA Conf. Dr. Adrian VLAD
Prof. Dr. Amorin Remus POPA Conf. Dr. Ioan Andrei VEREIU
Prof. Dr. Gabriela RADULIAN ef Lucr. Dr. Cornelia BALA
ef Lucr. Dr. Ruxandra DNCIULESCU
ef Lucr. Dr. Simona POPA
Asist. Univ. Dr. Viviana ELIAN
Comitetul de organizare al congresului/Organizing Committee of the Congress:
Preedinte/President:
Prof. Dr. Cristian SERAFINCEANU
Secretar/Secretary:
Membri/Members:

Conf. Dr. Bogdan MIHAI
Asist. Univ. dr. Anca STOIAN PANTEA
Dr. Oana STERIADE
Mariana ROCSIN
Dr. Simona STEFAN
Revieweri/Reviewers

Conf. Dr. Bogdan Mircea MIHAI
Prof. Dr. Romulus TIMAR
Prof. Dr. Doina CATRINOIU
Conf. Dr. Gabriela ROMAN
ef lucrri Dr. Cornelia BALA
ef lucrri Dr. Simona Georgiana POPA
CUPRINS/CONTENTS
Cuvntul Preedintelui.. 18
Word of the president.... 19
PREZENTRI ORALE REVIEWS
ORAL PRESENTATIONS REVIEWS
RW 1. METODE DE EVALUARE A FUNCIEI BETACELULARE N PRACTICA

CLINIC 21
EVALUATION OF BETA CELL FUNCTION IN CLINICAL PRACTICE..... 22
Cornelia Bala
RW 2. MODERN VIEWS ON BASAL INSULIN IN DIABETES MELLITUS.. 23

Geremia B. Bolli
RW 3. THE EPIDEMIC OF TYPE 2 DIABETES: A GLOBAL PROBLEM FOR THE 21ST

CENTURY. 24
Andrew JM Boulton
RW 4. DIABETIC FOOT DISEASE: AN OVERVIEW... 25

Andrew JM Boulton
RW 5. DIABETUL SI SINDROMUL CORONARIAN ACUT. 26

DIABETES AND ACUTE CORONARY SYNDROME.... 27
Doina Catrinoiu
RW 6. CARDIOVASCULAR OUTCOME TRIALS: THE POSSIBLE MECHANISMS BEHIND THE

RESULTS.... 28
Antonio Ceriello
RW 7. DIABETUL ZAHARAT TIP 2 I MENOPAUZA.................................................................................................. 28

TYPE 2 DIABETES AND MENOPAUSE........................... 29
Dan Chea, Vlad Chiril
RW 8. BENEFITS FROM INSULIN PUMP IN PEOPLE WITH TYPE 2 DIABETES 30

Rudolf Chlup
RW 9. PARTICULARITI ALE STATUSULUI NUTRIIONAL LA PACIENII CU DIABET ZAHARAT I

BOAL CRONIC DE RINICHI AVANSAT.... 31
NUTRITIONAL STATUS SPECIFICITIES IN PATIENTS WITH DIABETES MELLITUS AND ADVANCED
CHRONIC KIDNEY DISEASE... 32
Viviana Elian, Georgiana Ditu, Anca Pantea-Stoian, Oana Steriade, Cristian Serafinceanu
RW 10. CHIRURGIA BARIATRIC - O OPIUNE SIGUR PENTRU OBEZITATE?............................................ 33

IS BARIATRIC SURGERY A SAFE OPTION FOR OBESITY?.................................................................................... 34
Simona Fica , Anca Sirbu
RW 11. BOALA RENAL DIABETIC: ESTE MOMENTUL UTILIZRII DE RUTIN A BIOPSIEI

RENALE?...................................................................................................................... ......................................................... 35
5
DIABETIC NEPHROPATHY: HAS THE TIME FOR ROUTINE KIDNEY BIOPSY ARRIVED?........................... 35
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Gener Ismail
RW 12. ALIMENTAIA RESTRICTIV VERSUS ALIMENTAIA CU (MAI) PUINE CALORII. 36
RESTRAINED EATING VS CALORIE RESTRICTION... 37
Mariana Graur
RW 13. WHAT IS DRIVING THE DIABETES EPIDEMIC? EVIDENCE FROM THE DIABETES IMPACT
STUDY, DENMARK.... 38
Anders Green, Camilla Sorts, Peter Bjdstrup Jensen, Martha Emneus
RW 14. TREATMENT WITH GLUCAGON LIKE PEPTIDE RECEPTOR AGONISTS 10 YEARS

AFTER.... 39
Cristian Guja
RW 15. THE GENETIC BACKGROUND OF HUMAN OBESITY... 40

Cristian Guja, Constantin Ionescu-Trgovite
RW 16. ATEROGENEZA, ATEROSCLEROZA, ATEROTROMBOZA: DE CE PREZINT DIFERENE N

DIABETUL ZAHARAT?................................................................................................ ...................................................... 41
ATHEROGENESIS, ATHEROSCLEROSIS, ATHEROTHROMBOSIS: WHY ARE THEY DIFFERENT IN
DIABETES?.................................................................................................................... ....................................................... 41
Nicolae Hncu, Anca-Elena Crciun
RW 17. CONSENS ASUPRA DISLIPIDEMIEI ATEROGENE........................... 42

CONSENSUS ON ATHEROGENIC DYSLPIDAEMIA........................... 42
Nicolae Hncu
RW 18. IDENTIFICAREA STADIILOR PRECOCE ALE DIABETULUI ZAHARAT DE TIP 1, NAINTEA

APARIIEI PRIMILOR ANTICORPI ANTI BETA CELULARI................................................................................... 43
IDENTIFICATION OF THE EARLY STAGES OF TYPE 1 DIABETES, BEFORE FIRST ANTI BETA CELL
ANTIBODY SEROCONVERSION..... 44
Constantin Ionescu-Trgovite
RW 19. SELF-MONITORING OF BLOOD GLUCOSE IN TYPE 2 DIABETES WHY, WHEN, HOW

OFTEN?....................................................................................................................... ........................................................... 44
Gyrgy Jermendy
RW 20. THE GLUCOSE VARIABILITY AND DIABETIC RETINOPATHY.............................................................. 45

Sehnaz Karadeniz
RW 21. CLINICAL ASPECTS OF AUTONOMIC NERVE DYSFUNCTION IN DIABETES.... 46

Peter Kempler
RW 22. GOLIREA GASTRIC I RISCUL CARDIOVASCULAR N DIABETUL ZAHARAT... 47

GASTRIC EMPTYING IN DIABETES AND RELATED CARDIOVASCULAR RISK.. 48
Lctuu Cristina Gabriela, Botnariu Gina Eosefina, Popescu Raluca Maria, Popa Alina Delia, Mihai Bogdan Mircea
RW 23. RISCUL CARDIOVASCULAR AL AFECTARII POLIVASCULARE LA PACIENII CU DIABET

ZAHARAT TIP 2........................................... 48
CARDIOVASCULAR RISK IN TYPE 2 DIABETES MELLITUS PATIENTS WITH ATHEROTHROMBOSIS
IN MULTIPLE VASCULAR BEDS........................................................................ 49
Radu Lichiardopol
RW 24. DIABETES AND OBESITY.... 50

Dragan D. Micic
RW 25. STRATEGII PREVENTIVE N COMPLICAIILE MICROVASCULARE ALE DIABETULUI

ZAHARAT.. 51
PREVENTIVE STRATEGIES IN DIABETES-RELATED MICROVASCULAR COMPLICATIONS.
6
52
Mihai Bogdan Mircea, Botnariu Eosefina, Popescu Maria, Onofriescu Alina, Lctuu Cristina Mihaela
Page
RW 26. VARIABILITATEA GLICEMIC: NTRE MECANISME I CONSECINE... 53
GLYCEMIC VARIABILITY: FROM MECHANISMS TO OUTCOMES. 53
Mihai Bogdan Mircea, Lctuu Cristina Mihaela
RW27. DISFUNCIILE METABOLICE I HIPOGONADISMUL MASCULIN, CAUZ SAU CONSECIN ?......... 54

METABOLIC DISORDERS AND MALE HYPOGONADISM, CAUSE OR CONSEQUENCE ?...................................... 55
Radu Mihalca
RW 28. ROLUL ACTIVITII FIZICE N PREVENIA I TRATAMENTUL DIABETULUI ZAHARAT... 55

THE ROLE OF PHYSICAL ACTIVITY IN PREVENTION AND TREATMENT OF DIABETES MELLITUS.. 56
Andreea Moroanu, Magdalena Moroanu
RW 29. MICROALBUMINURIA - PREDICTOR AL RISCULUI IN DIABET I BOALA CRONIC DE

RINICHI......................................................................................................................................................................................... 57
MICROALBUMINURIA AS A RISK PREDICTOR IN DIABETES AND CKD RISK.... 58
Eugen Moa
RW 30. PROVOCRILE LEGATE DE DIABET DIN REGIUNEA NOASTR.... 59

THE CHALLENGE OF DIABETES IN THE LOCAL REGION.... 60
Maria Moa, Simona Popa
RW 31. MEDICAMENTE ANTIDIABETICE NOI I VIITOARE.. 61

NEW AND EMERGING ANTIDIABETIC DRUGS.. 62
Maria Moa, Simona Popa
RW 32. PATOLOGIA ADRENAL I TULBURRILE METABOLISMULUI GLUCIDIC.. 63

ADRENAL PATHOLOGY AND GLUCIDIC METABOLISM DISORDERS... 64
Diana Pun, Alexandra Miric, Rodica Petri, Ioana Neamu, Ruxandra Dnciulescu
RW 33. NON-ALCOHOLIC FATTY LIVER DISEASE AND DIABETES MELLITUS . 65

Corina Pop
RW 34. OCTETUL NEFAST AL HIPERGLICEMIEI.. 66

THE OMINOUS OCTET OF HYPERGLYCEMIA... 67
Popa Simona Georgiana, Popa Adina, Moa Maria
RW 35. RESETTING THE BETA CELL IN TYPE 2 DIABETES.... 68

Paolo Pozzilli
RW 36. THE IMPACT OF NEW TECHNOLOGIES IN THE MANAGEMENT OF DIABETES... 68

Paolo Pozzilli
RW 37. RELAIA DINTRE SINDROMUL METABOLIC I HEPATITA CRONIC CU VIRUS C... 69

Gabriela Radulian, Rusu Emilia, Dragut Ramona
RW 38. DIABEZITATEA ABORDARE PRACTICA............................................................................................................. 70

DIABESITY PRACTICAL APPROACH................................................................................................................................. 71
Gabriela Roman
7
RW 39. ENDOCRINE OUTCOMES AFTER BARIATRIC SURGERY................................................................................. 71

Page
Polovina Snezana
RW 40. HEART FAILURE CONSIDERATIONS OF ANTIHYPERGLYCEMIC MEDICATIONS FOR TYPE 2
DIABETES 72
Eberhard Standl
RW 41. PREZENT I VIITOR N TRATAMENTUL DISLIPIDEMIILOR LA PACIENTUL CU DIABET

ZAHARAT 73
PRESENT AND FUTURE PERSPECTIVES REGARDING THE TREATMENT OF DYSLIPIDEMIAIN PATIENTS
WITH DIABETES... 74
Romulus Timar, Laura Gai, Bogdan Timar
RW 42. TULBURRI METABOLICE ASOCIATE HIPOTIROIDIEI. 75

METABOLIC DISORDERS LINKED TO HYPOTHYROIDISM. 76
Vudu Lorina
PREZENTRI ORALE LUCRRI ORIGINALE

ORAL PRESENTATIONS ORIGINAL PAPERS
OP 1. PROGRANULINA ROLUL JUCAT N ASOCIEREA BOLII ALZHEIMER CU DIABETUL ZAHARAT TIP

2.. 79
PROGRANULIN DOES IT PLAY A ROLE IN THE ASSOCIATION BETWEEN ALZHEIMER DISEASE AND
TYPE 2 DIABETES?............................................................................................................................. .......................................... 79
Popa Adina, Popa Simona Georgiana, Soare Andreea, Moa Maria, Pozzilli Paolo
OP 2. ANALIZA IMUNOHISTOCHIMIC A PROTEINELOR P53, BCL2, P53/BCL2 LA PACIENII CU

ADENOCARCINOM COLORECTAL I DIABET ZAHARAT TIP 2. 80
IMMUNOHISTOCHEMICAL ANALYSIS OF P53, BCL2, P53/BCL2 PROTEINS IN PATIENTS WITH
COLORECTAL ADENOCARCINOMA AND TYPE 2 DIABETES.. 81
Horaiu-Cristian Popescu-Vlceanu, Mihai Stoicea, Coralia Bleotu, Valentin Enache, Veronica Ilie, Raluca Nan, Ramona Maria
Drgu, Emilia Rusu, Constantin Ionescu-Trgovite, Gabriela Radulian
OP 3. UTILIZAREA SISTEMULUI DE MONITORIZARE CONTINU A GLICEMIEI CA METOD DE

INVESTIGARE A HIPOGLICEMIEI REACTIVE 83
THE USE OF THE CONTINUOUS GLUCOSE MONITORING SYSTEM AS A NEW TOOL TO INVESTIGATE
REACTIVE HYPOGLYCAEMIA. 84
Stoica Roxana Adriana, Soare Andreea, Del Toro Rossella, Guja Cristian, Pozzilli Paolo
OP 4. BUCLA DE FEED-BACK POZITIV DINTRE PEROXIDUL DE HIDROGEN I MONOAMINOXIDAZE UN

NOU MECANISM DE STRESS OXIDATIV VASCULAR N DIABETUL ZAHARAT.... 85
THE POSITIVE FEEDBACK LOOP BETWEEN HYDROGEN PEROXIDE AND MONOAMINE OXIDASES A
NEW MECHANISM OF VASCULAR OXIDATIVE STRESS IN DIABETES MELLITUS.. 86
Sturza Adrian, Duicu Oana, Vduva Adrian, Dnil Maria, Privistirescu Andreea, Munteanu Mircea, Timar Romulus, Muntean
Danina
OP 5. ROLUL ECOGRAFIEI VASCULARE N EVALUAREA BOLII ARTERIALE PERIFERICE LA PACIENII

CU DIBET ZAHARAT.... 86
THE ROLE OF VASCULAR ULTRASONOGRAPHY FOR PERIPHERAL ARTERY DISEASE EVALUATION IN
DIABETIC PATIENTS................... 87
Bacanu Elena Violeta, Parocescu Daniel,, Virgolici Bogdana
OP 6. STUDIU PROSPECTIV DE EVALUARE A IMPACTULUI EDUCAIEI TERAPEUTICE ASUPRA

CONTROLULUI GLICEMIC LA PACIENI CU DIABET ZAHARAT TIP 2 LA CARE SE INIIAZ UN ANALOG
DE INSULIN BAZAL.... 88
PROSPECTIVE STUDY TO ASSESS THE IMPACT OF EDUCATION IN T2DM PATIENTS AT INITIATION OF A
8
BASAL INSULIN ANALOGUE ON GLYCAEMIC CONTROL... 89

Page
Bala Cornelia
OP 7. CORELAII ALE INSULINOREZISTENEI CU CELELALTE COMPLICAII CRONICE ALE DIABETULUI
ZAHARAT TIP 1, N FUNCIE DE PREZENA BOLII RENALE DIABETICE.. 90
CORRELATIONS BETWEEN INSULIN RESISTANCE AND THE OTHER CHRONIC COMPLICATIONS OF TYPE
1 DIABETES MELLITUS, DEPENDING ON THE PRESENCE OF DIABETIC KIDNEY DISEASE. 91
Bcu Mihaela Larisa, Bcu Daniel, Vladu Mihaela Ionela, Clenciu Diana, Sandu Magdalena, Moa Maria
OP 8. ONE YEAR FOLLOW-UP FOR OXIDATIVE STRESS STATUS, ADIPOKINES AND INFLAMMATORY
MARKERS IN OBESE TYPE 2 DIABETIC PATIENTS.... 92
Carniciu Simona, Lixandru Daniela, Petcu Laura, Picu Ariana, Roca Adelina, Bcanu Elena, Mihai Andrada, Ionescu-Trgovite
Constantin, Guja Cristian
OP 9. GLICEMIA LA O OR N CADRUL TESTULUI DE TOLERAN ORAL LA GLUCOZ: UN PARAMETRU

NEGLIJAT?
- CORELAII ALE GLICEMIEI LA O OR N CADRUL T.T.G.O. CU INSULINOREZISTENA I
INSULINOSECREIA.... 93
ONE HOUR GLUCOSE DURING ORAL GLUCOSE TOLERANCE TEST: A NEGLECTED PARAMETER?
- CORRELATIONS BETWEEN ONE HOUR GLUCOSE DURING OGTT AND INSULIN RESISTANCE AND
INSULIN SECRETION 94
Diugan Flavia Cristina, Moa Maria
OP 10. DENUTRIIA ROTEIN-CALORIC EVALUAT CU AJUTORUL FOREI DE STRGERE A PUMNULUI

UN FACTOR DE PROGNOSTIC NEGATIV LA PACIENII CU DIABET ZAHARAT
HEMODIALIZAI.......................................................................................................................................................................... 95
PROTEIN-ENERGY WASTING EVALUATED BY HANDGRIP STRENGHT PREDICTS POOR OUTCOME IN
DIABETES MELLITUS HEMODIALYZED PATIENTS.......................................................................................................... 96
Georgiana Diu, Anca Pantea Stoian, Mihaela Bodnarescu, Viviana Elian
OP 11. MONITORIZAREA GLICEMIC CONTINU CU SENZORI IMPLANTABILI PE TERMEN LUNG

NOUTI DIN STUDIUL PRECISE.... 97
LONG TERM FULLY IMPLANTABLE CGM UPDATES FROM PRECISE STUDY 98
Ioacara Sorin, DeVries J. Hans, Kropff Jort, Choudhary Pratik, Hovorka Roman, Evans Mark, Neupane Sankalpa, Bain Steve C.,
Kapitza Cristoph, Forst Thomas, Link Manuela, Chen Oliver,DeHennis Andrew, Fica Simona
OP 12. CREAREA UNOR POMPE DE INSULIN ACCESIBILE CA PRE FOLOSIND ELECTRONIC

INOVATIV I PRINTARE 3D.... 98
CREATING CHEAP AFFORDABLE INSULIN PUMPS WITH INNOVATE ELECTRONICS AND 3D
PRINTING.... 99
Ioni Roxana Monica, Milian Theodor, Ioacara Sorin, Purcaru Mircea, Herescu Irina, Fica Simona
OP 13. IMPACTUL NEUROPATIEI ASUPRA ECHILIBRULUI I RISCULUI DE CDERI LA PACIENII CU

DIABET ZAHARAT TIP 2 .... 100
THE IMPACT OF NEUROPATHY ON BALANCE AND THE RISK OF FALLS IN PATIENTS WITH TYPE 2
DIABETES MELLITUS..... 101
Timar Bogdan, Lazar Sandra, Mailat Diana, Timar Romulus
OP 14. A NEW INSULIN UNIT CALCULATOR FOR THE MANAGEMENT OF TYPE 1 DIABETES
PATIENTS... 102
Maurizi Anna Rita, Naciu Anda, Del Toro Rossella, Lauria Pantano Angelo, Fioriti Elvira, Manfrini Silvia, Pozzilli Paolo
OP 15. CORELAII NTRE ADIPONECTIN, LEPTIN I CTRP 3 I COMPONENTELE SINDROMULUI

METABOLIC 103
RELATIONSHIP OF ADIPONECTIN, LEPTIN AND CTRP 3 TO COMPONENTS OF METABOLIC
SYNDROME..... 104
Mihai Doina Andrada, Petcu Laura, Manuela Mitu, Picu Ariana, Lixandru Daniela, Ionescu Tirgoviste Constantin, Guja Cristian
9
OP 16. PREVALENA INFECIEI CU HELICOBACTER PYLORI LA PACIENII BARIATRICI: CONCORDANA

Page
A DOU METODE DE DIAGNOSTIC. 105

PREVALENCE OF HELICOBACTER PYLORI INFECTION IN BARIATRIC PATIENTS: THE AGREEMENT OF
TWO METHODS OF DIAGNOSIS............................... 105
Mihalache Laura, Danciu Mihai, Constantinescu Daniela, Gherasim Andreea, Ni Otilia, Pdureanu Sergiu Serghei, Arhire Lidia
Iuliana
OP 17. RELAIA MEDIC - SISTEM DE SNTATE: CANTITATE VERSUS CALITATE....... 106

PHYSICIAN HEALTCARE SYSTEM RELATIONSHIP: QUALITY VS. QUANTITY..................... 107
Moroanu Andreea, Moroanu Magdalena
OP 18. CONTROLUL TENSIUNII ARTERIALE N BOALA CRONIC DE RINICHI ASOCIAT DIABETULUI

ZAHARAT.... 107
BLOOD PRESSURE CONTROL IN CHRONIC KIDNEY DISEASE ASSOCIATED TO DIABETES MELLITUS 108
Mircea Munteanu, Bogdan Timar, Romulus Timar, Lavinia Munteanu, Adrian Enache, Adrian Sturza, Adalbert Schiller
OP 19. STUDIUL VARIABILITATII GLICEMICE LA PACIENII CU DIABET ZAHARAT AFLAI IN PROGRAM

DE HEMODIALIZA CRONICA.... 109
A STUDY OF GLYCEMIC VARIABILITY IN HEMODIALYZED DIABETIC PATIENTS.... 110
Steriade Oana, Serafinceanu Cristian, Savu Octavian, Mihut Stela, Elian Viviana
OP 20. CORRELATION BETWEEN MICROALBUMINURIC STAGE AND HBA1C IN RELATION WITH

CHRONIC KIDNEY DISEASE AT NEWLY DIAGNOSED DIABETES. 111
Anca Pantea-Stoian, Georgiana Ditu, Florentina Gherghiceanu, Viviana Elian
OP 21. UTILIZAREA ULTRASONOGRAFIEI DE NALT FRECVEN N STUDIUL DISTROFIEI CUTANATE

N CONTEXTUL CO-AFECTRII SUBCUTANATE INDUSE DE ADMINISTRAREA INSULINEI - SERIE DE
CAZURI........................................ 113
DYSTROPHIC THICKENED CUTIS AS PART OF THE COMPLEX CUTIS-SUBCUTIS LOCAL INSULIN
DYSTROPHY, HIGH FREQUENCY ULTRASOUND ASSESSED - CASE SERIES. 113
Perciun Rodica, Telcian Ancua
OP 22. INSULINOTERAPIA CU POMPA DE INSULIN N PRACTICA ZILNIC. 114

INSULIN PUMP THERAPY IN DAILY PRACTICE... 115
Roman Gabriela
OP 23. IMPACTUL INSULINOTERAPIEI CU ANALOGI BAZALI ASUPRA VARIABILITII GLICEMICE LA

SUBIECI CU DIABET ZAHARAT TIP 2 I BOAL RENAL TERMINAL 116
THE IMPACT OF BASAL INSULIN ANALOGUES ON GLUCOSE VARIABILITY IN SUBJECTS WITH TYPE 2
DIABETES ON HEMODIALYSIS. 116
Octavian Savu, Viviana Elian, Oana Steriade, Ileana Teodoru, Stela Mihu, Ctlin Tacu, Adrian Covic, Cristian Serafinceanu
OP 24. VITAMINA D3 AMELIOREAZ DISFUNCIA ENDOTELIAL LA OBOLANI DIABETICI PRIN

SCDEREA EXPRESIEI MONOAMINOXIDAZEI I A RAGE / ... 117
VITAMIN D3 ALLEVIATES ENDOTHELIAL DYSFUNCTION IN DIABETIC RATS BY DECREASING
MONOAMINE OXIDASE AND RAGE EXPRESSION...... 117
Sturza Adrian, Duicu Oana, Vduva Adrian, Munteanu Mircea, Timar Romulus, Muntean Danina
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PREZENTRI POSTER
POSTER PRESENTATIONS
PS 1. PREVALENA BOLII CARDIOVASCULARE LA PACIENII CU DIABET ZAHARAT TIP 2......... 119

CARDIOVASCULAR DISEASE PREVALENCE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS... 119
Andoni Adela, Prefac Alina, Parocescu Daniel, Stegaru Daniela, Velican Oana, Rusu Emilia, Radulian Gabriela
PS 2. SINDROMUL METABOLIC I BOALA RENALA CRONICA LA PACIENII DIABETICI... 120

METABOLIC SYNDROME AND CHRONIC KIDNEY DISEASE AMONG DIABETIC PATIENTS.... 121
Bejinariu Ctlina, Rusu Emilia, Ungureau Carmen, Murean Alexandra, Stegaru Daniela, Andoni Adela, Petre Diana, Ciobanu
Delia, Prefac Alina, Sordea Lidia, Dobre Alin, Chiril Vlad, Radulian Gabriela
PS 3. FUMATUL ACCENTUEAZ GRADUL INSULINOREZISTENEI LA PACIENII CU DIABET ZAHARAT

TIP 1 CU BOAL RENAL DIABETIC... 122
Bcu Mihaela Larisa, Moa Maria
PS 4. DIABETUL ZAHARAT TIP 1 I ANOREXIA NERVOAS: CE ESTE DIABULIMIA?....................................... 122

TYPE 1 DIABETES AND ANOREXIA NERVOSA: WHAT IS DIABULIMIA?............................................................... 123
Burde Roxana, Groza Mdlina, Roman Gabriela
PS 5. DEPRESSION AND COGNITIVE IMPAIRMENT IN TYPE 2 DIABETES: CORELLATION WITH SLEEP AND
BIOLOGICAL MARKERS..... 124
Cernea Simona, ular Floredana-Laura, Huanu Adina
PS 6. HIPOGLICEMIILE I UNELE CARACTERISTICI CLINICE ALE DIABETULUI ZAHARAT. 125

HYPOGLYCEMIAS AND SOME CLINICAL FEATURES OF DIABETES MELLITUS.. 126
Chioveanu Marinela, Petre Diana Gabriela, Sebestyen Ana-Maria Sabina, Ilinca Alexandra, Mihai Andrada, Radulian Gabriela
PS 7. ELIMINAREA URINAR DE ALBUMIN I RETINOPATIA DIABETIC LA PACIENII CU DIABET

ZAHARAT TIP 2...... 127
URINARY ALBUMIN EXCRETION AND DIABETIC RETINOPATHY IN PACIENTS WITH TYPE 2 DIABETES
MELLITUS.. 128
Chirila Vlad Horia, Rusu Emilia, Ungureanu Carmen, Bejinariu Catalina, Muresan Alexandra, Dobre Alin, Stegaru Daniela,
Radulian Gabriela
PS 8. INFECIILE URINARE LA PACIENII CU DIABET ZAHARAT: CE ANTIBIOTIC ALEGEM?......................... 129

URINARY TRACT INFECTIONS IN DIABETIC PATIENTS: WHAT ANTIMICROBIAL AGENT DO WE
CHOOSE?...................................................................................................................... ................................................................... 130
Chita Teodora, Timar Bogdan, Sima Alexandra, Muntean Delia, Licker Monica,Timar Romulus
PS 9. SERUM MARKERS OF INFLAMMATION AND AMBULATORY HEART RATE VARIABILITY IN TYPE 2

DIABETES..... 131
Ciobanu Dana M., Craciun Anca E., Bala Cornelia G., Veresiu Ioan A., Roman Gabriela
PS 10. COULD BE ANY IMPACT OF MEDICATION CONSIDERING WEIGHT EVOLUTION? A RETROSPECTIVE

EVALUATION OF TWO GROUPS RECEIVING DAPAGLIFLOZINUM OR SAXAGLIPTINUM AS A SECOND 131
STEP AFTER FAILURE OF METFORMINUM THERAPY.......... 132
Ciprian Constantin, Aurelian Ranetti, Georgiana Constantin, Dan Cheta
PS 11. DIABET ZAHARAT TIP 1, TIROIDITA HASHIMOTO, ANEMIE BIERMER SI POSIBILA BOALA CELIACA
IN CAZUL UNEI TINERE FEMEI CU SINDROM POLIGLANDULAR AUTOIMUN TIP III..... 133
TYPE 1 DIABETES MELLITUS, HASHIMOTO THYROIDITIS, PERNICIOUS ANEMIA AND POSSIBLE CELIAC
DISEASE IN A YOUNG FEMALE WITH POLYGLANDULAR AUTOIMMUNE SYNDROME TYPE
III...... 134
Cosma Daniel Tudor, Porojan Mihai, Grad Simona, Bala Cornelia
11
PS 12. SUPRADOZAJ INTENTIONAL CU INSULINA SI DIAZEPAM IN CAZUL UNEI FEMEI DIABETICE CU 135
TULBURARE DEPRESIVA MAJORA....
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INTENTIONAL INSULIN AND DIAZEPAM OVERDOSE IN A DIABETIC FEMALE WITH SEVERE
DEPRESSION... 136
Cosma Daniel Tudor, Silaghi Cristina Alina, Silaghi Horaiu, Vereiu Andrei
PS 13. SINDROM POLIGLANDULAR AUTOIMUN TIP IV CU BOALA CELIACA, DIABET ZAHARAT TIP 1 SI
ARTRITA REUMATOIDA JUVENILA O ASOCIERE RARA... 137
A CASE OF POLYGLANDULAR AUTOIMMUNE SYNDROME TYPE IV WITH CELIAC DISEASE, TYPE 1
DIABETES MELLITUS AND JUVENILE RHEUMATOID ARTHRITIS A RARE COMBINATION.. 138
Cosma Daniel Tudor, Silaghi Cristina Alina, Silaghi Horaiu, Vereiu Ioan Andrei
PS 14. GENETIC SCORE FOR OBESITY AND WEIGHT CHANGES IN TYPE 2 DIABETES PATIENTS IN THE
FIRST YEAR AFTER THE START OF INSULIN THERAPY.. 139
Craciun Anca-Elena, Bala Cornelia, Roman Gabriela, Craciun Cristian, Ciobanu Dana, Hancu Nicolae
PS 15. STUDIUL RATEI SPITALIZRII I A COST-EFICIENEI LA SUBIECII CU BOAL CRONIC DE

RINICHI DIABETIC.... 139
THE STUDY OF THE HOSPITALIZATION RATE AND COST-EFFECTIVENESS IN PATIENTS WITH DIABETIC
CHRONIC KIDNEY DISEASE....... 140
Dinu Robert, Tudor Mirela, Moa Eugen
PS 16. ASOCIERE NTRE DIABETUL ZAHARAT TIP 2 I SINDROMUL SHEEHAN. 141

AN ASSOCIATION BETWEEN TYPE 2 DIABETES AND SHEEHAN SYNDROME.. 142
Georgiana Diu, Mihaela Bodnrescu, Anca Pantea Stoian, Viviana Elian
PS 17. RELAIA DINTRE STEATOZ HEPATIC I INSULINOREZISTEN LA PACIENII CU HEPATITA

CRONICA CU VIRUS C SI SINDROM METABOLIC.. 143
RELATIONSHIP BETWEEN STEATOSIS AND INSULIN RESISTANCE IN PATIENTS WITH CHRONIC
HEPATITIS C AND METABOLIC SYNDROME.. 144
Drgu Ramona Maria, Rusu Emilia, Nan Raluca, Rusu Florin, Popescu Horaiu, Grosu Larisa, Grosu Irina, Stoicescu Florina,
Rdulian Gabriela
PS 18. EVALUAREA RELAIEI DINTRE HEPATITA CRONIC CU VIRUS C, INSULINOREZISTEN I

RISCUL CARDIOVASCULAR.. 145
ASSESSMENT OF RELATIONSHIP BETWEEN CHRONIC HEPATITIS C VIRUS, INSULIN RESISTANCE AND
CARDIOVASCULAR RISK....... 146
Drgu Ramona, Rusu Emilia, Nan Raluca, Rusu Florin, Popescu Horaiu, Stoicescu Florentina, Radulian Gabriela
PS 19. STUDIUL PREZENEI OBEZITII LA UN LOT DE PACIENI CU DIABET INTERNAI.. 147

STUDY OF THE PRESENCE OF OBESITY IN A GROUP OF HOSPITALIZED DIABETIC PATIENTS... 148
Firanescu Adela Gabriela, Soare Mariana, Simion Floriana Maria, Tuiu Daniela, Mitrea Adina, Popa Simona, Moa Maria
PS 20. ANTICORPI ANTIGAD65, PEPTIDUL C I TABLOUL CLINIC N STABILIREA DIAGNOSTICULUI DE

DIABET ZAHARAT..... 149
GAD65 AUTOANTIBODIES, C PEPTIDE AND CLINICAL PICTURE IN DIAGNOSIS OF DIABETES.. 150
Glan Simona, Dumitracu Ana-Cristina, Roman Gabriela
PS 21. MEDICINA PERSONALIZAT N DIABETOLOGIE: MEDICIN DIGITAL I MEDICIN

GENOMIC...... 151
PERSONALIZED MEDICINE IN DIABETES: DIGITAL MEDICINE AND GENOMIC MEDICINE... 152
Marius Geant
PS 22. EVALUAREA RELAIEI DINTRE SINDROMUL METABOLIC I HIPERURICEMIE LA PACIENII CU

DIABET ZAHARAT TIP 2...... 153
THE EVALUATION OF THE RELATIONSHIP BETWEEN HIGH LEVEL OF URIC ACID AND METABOLIC
SYNDROME AT PATIENTS WITH DIABETES TYPE 2... 153
12
Gheorghi Andra Gabriela, Rusu Emilia, Drgu Ramona, Onil Oana Daniela, Grosu Irina, Radulian Gabriela
Page
PS 23. PROBLEME DE IGIEN DENTAR LA PACIENII CU DIABET ZAHARAT TIP 1.... 154
ORAL HEALTH PROBLEMS IN PATIENTS WITH TYPE 1 DIABETES.. 155
Gheorghi Andra Gabriela, Rusu Emilia, Ghiulescu Cristina, Enache Georgiana, Drgu Ramona, Nan Raluca, Stoicescu
Florentina, Rusu Florin, Radulian Gabriela
PS 24. PREVALENA COMPLICAIILOR DIABETULUI ZAHARAT I A TIPULUI ACESTORA LA PACIENII

CU DIABET ZAHARAT TIP 2 I TIROIDIT CRONIC AUTOIMUN 156
DIABETES MELLITUS AND THEIR TYPE COMPLICATIONS PREVALENCE AT PATIENTS WITH TYPE 2
DIABETES AND CHRONIC AUTOIMMUNE THYROIDITIS.. 157
Gherbon Adriana
PS 25. PREVALENA SINDROMULUI METABOLIC I A CRITERIILOR DE IDENTIFICARE A ACESTUIA PE

SEXE LA PACIENI CU SCDEREA TOLERANEI LA GLUCOZ I TIROIDIT CRONIC
AUTOIMUN 158
PREVALENCE OF METABOLIC SYNDROME AND ITS IDENTIFICATION CRITERIA BY SEX AT PATIENTS
WITH IMPAIRED GLUCOSE TOLERANCE AND AUTOIMMUNE CHRONIC THYROIDITIS 159
Gherbon Adriana
PS 26. ACIDUL URIC I COMPLICAIILE DIABETULUI ZAHARAT 160

THE SERUM URIC ACID AND THE COMPLICATIONS OF DIABETES MELLITUS.. 161
Li Genoveva Andreea, Zaharia Adelina, Pavel Anca Ioana, Zaharia Mihaela Iulia, Stoicescu Florentina, Gheorghi Andra
Gabriela, Rusu Emilia, Radulian Gabriela
PS 27. ABCESE MULTIPLE LA DISTAN COMPLICND O INFECIE LOCALIZAT A PICIORULUI

DIABETIC PREZENTARE DE CAZ.. 162
MULTI-SITE ABSCESSES COMPLICATING A DIABETIC FOOT INFECTION CASE REPORT 163
Magopet Eliza, Botnariu Eosefina, Popa Delia, Popescu Maria, Lctuu Cristina Mihaela, Mihai Bogdan Mircea
PS 28. PREZENA NEUROPATIEI DETERIOREAZ CALITATEA ACTIVITILOR DE AUTO-MANAGEMENT

AL DIABETULUI.. 164
THE PRESENCE OF NEUROPATHY DECREASES THE QUALITY OF DIABETES-RELATED SELF-CARE
ACTIVITIES IN PATIENTS WITH TYPE 2 DIABETES 165
Mailat Diana, Timar Romulus, Trziu Maria, Lazr Sandra, Timar Bogdan
PS 29. CAZ SPECIAL DE DIABET ZAHARAT TIP MODY.. 166

Matei Laura Roxana, Aricescu Alexandru, Zetu Cornelia
PS 30. ACANTHOSIS NIGRICANS- CUTANEOUS MANIFESTATION OF ENDOCRINE ABNORMALITIES-CASE

REPORT... 167
Mihai Gabriela, Captiu Florentina Iulian, Micheu Adelina, Gmbuean Ana Maria, Pop Radu Corina Cristina, Pacanu Ionela
Maria
PS 31. GHRELINA, METABOLISMUL ENERGETIC I APETITUL... 168

GHRELIN, ENERGY METABOLISM AND APPETITE.. 168
Mihalache Laura, Arhire Lidia Iuliana
PS 32. EVALUAREA PE TERMEN SCURT A PROTOCOLULUI DE INSTALARE A POMPEI DE INSULIN 169

SHORT-TERM ASSESSMENT OF THE PROTOCOL INSULIN PUMP INSTALLATION.. 170
Morariu Diana, Dumitracu Ana-Cristina, Ladariu Otilia, Galaan Simona, Roman Gabriela
PS 33. PREVALENA RETINOPATIEI DIABETICE LA PACIENII OBEZI CU DIABET ZAHARAT O ANALIZ

RETROSPECTIV N CADRUL UNEI POPULAII DE PACIENI CU DIABET ZAHARAT.. 171
PREVALENCE OF DIABET RETINOPATHY AT OBESE PATIENTS- A RETROSPECTIVE ANALISYS IN A
POPULATION OF PACIENTS WITH DIABETES MELLITUS.. 172
Murean Alexandra, Cavalioti-Enache Theodora-Elena, Dobre Gabriel Alin, Ungureanu Carmen, Ciobanu Delia, Soldea Lidia,
Bejinariu Ctlina, Ilinca Alexandra, Stegaru Daniela, Radu Florentina, Rusu Emilia, Radulian Gabriela
PS 34. DIABETUL DE TIP 2 I OSTEOPOROZA. 173

DIABETES AND OSTEOPOROSIS 174
Nan Raluca, Cursaru Adrian, Drgu Maria Ramona, Rusu Emilia, Stoicescu Florentina, Popescu Horaiu, Grigorie Daniel, Muat
13
Mdlina, Radulian Gabriela

Page
PS 35. CONEXIUNEA PUNCTELOR CHEIE N DIABETUL ZAHARAT SECUNDAR.. 175
Alexandra Nila, Cristina erbnescu, Sorina Martin, Sorin Ioacara, Simona Fica, Sergiu Brsan, Adrian Miron
PS 36. STUDIUL PREZENEI NEUROPATIEI DIABETICE PERIFERICE SENZITIVO-MOTORII LA UN LOT DE

PACIENI INTERNAI.. 175
STUDY OF THE PRESENCE OF SENSOMOTORY DIABETIC PERIPHERAL NEUROPATHY IN A GROUP OF
HOSPITALIZED PATIENTS 176
Oprea Diana, Firanescu Adela, Rezident Voicu Andreea
PS 37. CORRELATION BETWEEN MICROALBUMINURIC STAGE AND HBA1C IN RELATION WITH

CHRONIC KIDNEY DISEASE AT NEWLY DIAGNOSED DIABETES.. 177
Anca PANTEA-STOIAN, Georgiana DITU, Florentina Gherghiceanu, Viviana ELIAN
PS 38. QUALITY OF LIFE IN DIFFERENT STAGES OF CHRONIC KIDNEY DISEASE IN PATIENTS WITH
DIABETTES MELITUS............................................................................................................ ............................................ 178
Pantea-Stoian Anca, Georgiana Ditu, Cristian Serafinceanu, Viviana Elian
PS 39. SONOGRAPHIC PANCREAS CHANGES IN PATIENTS WITH PANCREATIC SECONDARY

DIABETES. 179
Anca Pantea-Stoian, Georgiana Ditu, Florentina Gherghiceanu,Viviana Elian
PS 40. CONTROLUL GLICEMIC AL PACIENILOR CU BOAL CUSHING TRATAI CU PASIREOTID -

PREZENTARE DE CAZ. 180
Andrada-Larisa Pasc, Adelina Micheu, Mariana Roman, Ionela Maria Pacanu
PS 41. STUDIUL OBSERVAIONAL AL LEZIUNILOR CUTANATE LA SUBIECII CU DIABET ZAHARAT 180

AN OBSERVATIONAL STUDY OF CUTANEOUS MANIFESTATIONS IN DIABETES MELLITUS.. 181
Popa Adina, Firnescu Adela, Voicu Andreea, Soare Mariana, Simion Floriana Maria, uiu Daniela, Popa Simona Georgiana,
Moa Maria
PS 42. STUDIU DE CAZ: EFECTUL ANTIINFLAMATOR AL EXENATIDEI.. 182

CASE STUDY: THE ANTI-INFLAMMATORY EFFECT OF EXENATIDE... 184
Popa Alexandru Sebastian, Culman Mirela, Steriade Oana, Matei Monica
PS 43. STUDIU DE CAZ: ROLUL FICATULUI N DIABETOGENEZ..... 185

CASE REPORT: THE ROLE OF THE LIVER IN DIABETOGENESIS... 186
Popa Alexandru Sebastian, Culman Mirela Ioana, Sirotencu Edith
PS 44. IMPACTUL POLINEUROPATIEI DIABETICE PREDOMINANT SENZITIVE SIMETRICE DISTALE

ASUPRA PSIHICULUI PACIENTULUI CU DIABET ZAHARAT 187
IMPACT OF DISTAL SYMMETRIC POLYNEUROPATHY ON THE PSYCHIC OF TYPE 2 DIABETES
PATIENTS.. 188
Popescu Simona, Timar Bogdan, Diaconu Laura, Timar Romulus
PS 45. PREVALENA STEATOZEI HEPATICE LA PACIENII CU DIABET ZAHARAT TIP 2. 188

THE PREVALENCE OF HEPATIC STEATOSIS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS 189
Alina Gabriela Prefac, Ana Maria Busneag, Ramona Maria Drgu, Cristina Stoian, Florentina Stoicescu, Emilia Rusu, Gabriela
Radulian
PS 46. BILATERAL CATARACT IN A 14-YEAR-OLD WITH TYPE 1 DIABETES.. 190

Puiu Ileana, Niculescu Carmen, Marinau Laura, Dop Dalia, Singer Cristina, Puiu Alexandra Oltea
PS 47. TRECEREA CU SUCCES PE SUFLONILUREICE LA O PACIENT N VARSTA DE 9 ANI CU RETARD DE

DEZVOLTARE NEUROPSIHIC, EPILEPSIE I DIABET ZAHARAT NEONATAL - SINDROM
DEND... 191
SUCCESSFUL TREATMENT WITH SULFONYLUREAS AT A 9 YEAR OLD PATIENT WITH NEUROPSYHICAL
DEVELOPMENT DELAY, EPILEPSY AND NEONATAL DIABETES DEND
SYNDROME... 191
Purcaru Mircea, Mintici Luana, Herescu Irina, Ioacara Sorin, Fica Simona
14
PS 48. CARACTERISTICI ALE BOLII ARTERIALE PERIFERICE LA PACIENTUL CU DIABET ZAHARAT TIP
II...
Page
192
CHARACTERISTICS OF THE PERIPHERAL ARTERIAL DISEASE IN PATIENTS WITH TYPE 2
DIABETES.. 193
Radu Florentina, Petrache Daniela, Buneag Ana Maria, Cusi Daniela, Murean Alexandra, Grosu Irina, Rusu Emilia, Radulian
Gabriela
PS 49. CORRELATIONS BETWEEN GLYCOSYLATED HEMOGLOBIN AND THE NUTRITIONAL THERAPY IN

PATIENTS WITH TYPE TWO DIABETES TREATED WITH INSULIN 194
Radu Raluca, Cristofor Cornelia, Ilinca Alexandra, Rusu Emilia, Pruteanu Diana, Radulian Gabriela
PS 50. EXPERIENE DIN SCREENINGUL NEUROPATIEI N POPULAIA DIABETIC: REZULTATELE UNUI

STUDIU TRANSVERSAL. 195
SCREENING FOR NEUROPATHY IN GENERAL DIABETIC POPULATION: FINDINGS OF A CROSS-
SECTIONAL STUDY 196
Roman Deiana, Timar Romulus, Trziu Maria, Lazr Sandra, Timar Bogdan
PS 51. INDEXUL TRIGLICERIDE GLUCOZ I RAPORTUL LIPIDELOR CA MARKERI AI RISCULUI DE

196
INSULINOREZISTEN N PRACTICA CLINIC...
TRIGLYCERIDES AND GLUCOSE INDEX AND LIPID RATIOS AS RISK MARKERS OF INSULIN RESISTANCE
197
IN CLINICAL PRACTICE.
Rusu Emilia, Enache Georgiana, Rusu Florin, Drgu Ramona Maria, Cursaru Raluca, Stoicescu Florentina, Jinga Mariana,
Radulian Gabriela
PS 52. FIBROZA HEPATIC LA PACIENII CU DIABET ZAHARAT. 198

HEPATIC FIBROSIS IN DIABETIC PATIENTS.. 199
Rusu Emilia, Rusu Florin, Enache Georgiana, Jinga Mariana, Drgu Ramona Maria, Cursaru Raluca, Stoian Marilena, Costache
Adrian, Radulian Gabriela
PS 53. DIABETUL ZAHARAT I SINDROMUL SJOGREN (CAZ CLINIC) 200

DIABETES MELLITUS AND SJOGREN'S SYNDROME (CASE REPORT) .. 201
Rusu Elena Mihaela, Lucan Daniela, Zetu Cornelia
PS 54. STUDIUL HIPERURICEMIEI LA UN LOT DE PACIENI CU DIABET ZAHARAT... 202

THE STUDY OF HYPERURICEMIA IN A GROUP OF PATIENTS WITH TYPE 2 DIABETES. 203
Sandu Maria-Magdalena, Firanescu Adela, Voicu Andreea, Soare Mariana, Simion Floriana Maria, Tuiu Daniela, Oprea Diana,
Popa Adina, Popa Simona, Moa Maria
PS 55. THE CORRELATION OF LEFT VENTRICULAR HYPERTROPHY WITH SERUM CALCIUM LEVELS IN
OBESE PATIENTS.. 204
Sava Elisabeta, Iulia Soare, Srbu Anca, Martin Sorina, Fica Simona
PS 56. PARTICULARITI FENOTIPICE LA PACIENII CU DURAT LUNG DE EVOLUIE A DIABETULUI

ZAHARAT. 204
PHENOTYPIC PARTICULARITIES IN PATIENTS WITH LONG-TERM EVOLUTION DIABETES
MELLITUS.. 205
Sava Isabella, Meroiu Andreea, Dobjanschi Carmen
PS 57. CHOICE OF THE ADD-ON THERAPY TO METFORMIN IN TYPE 2 DIABETES PATIENTS IN CLINICAL
PRACTICE. INITIAL RESULTS FROM A NON-INTERVENTIONAL MULTICENTRE STUDY IN ROMANIA
(REALITY)..... 206
Serafinceanu Cristian, Timar Romulus, Catrinoiu Doina, Adrian Zaharia
PS 58. PREVALENCE AND PREDICTORS OF NON-ALCOHOLIC FATTY LIVER DISEASE.. 208

ASSESSED USING FATTY LIVER INDEX IN A TYPE 2 DIABETES POPULATION 208
Cristina Alina Silaghi, Horaiu Silaghi, Horaiu Alexandru Coloi, Anca Elena Crciun, Daniel Tudor Cosma, Nicolae Hncu,
Carmen Emanuela Georgescu
PS 59.INTERRELAIA DINTRE NEUROPATIA DIABETIC I DEPRESIE: REZULTATELE UNUI STUDIU

15
TRANSVERSAL. 208
Page
ASSOCIATIONS BETWEEN DIABETIC NEUROPATHY AND DEPRESSION: FINDINGS FROM A CROSS-
SECTIONAL STUDY 209
Lazr Sandra, Timar Romulus, Mailat Diana, Levai Codrina, Timar Bogdan
210
PS 60. ANEMIA, DIABETUL SI BOALA RENAL CRONIC. 211
ANEMIA, DIABETES MELLITUS AND CHRONIC KIDNEY DISEASE
Ungureanu Carmen, Rusu Emilia, Bejinariu Ctlina, Petre Diana, Murean Alexandra, Stegaru Daniela, Soldea Lidia, Andoni
Adela, Ciobanu Delia, Dobre Alin, Chiril Vlad, Radulian Gabriela
PS 61. VARIABILITATEA GLICEMIC DIN PERIOADA PERIOPERATORIE I RISCUL APARIIEI 212

COMPLICAIILOR POSTOPERATORII.
VARIABILITATEA GLICEMIC DIN PERIOADA PERIOPERATORIE I RISCUL APARIIEI 213
COMPLICAIILOR POSTOPERATORII.
Verde Ioana, Rusu Emilia, Armean Petru
PS 62. PREZENA BOLII CRONICE DE RINICHI N RAPORT CU VRSTA I DURATA DIABETULUI

ZAHARAT... 214
THE PRESENCE OF CHRONIC KIDNEY DISEASE IN RELATION TO AGE AND DURATION OF DIABETES
MELLITUS... 215
Vladu Mihaela, Clenciu Diana, Bcu Mihaela
PS 63. ASOCIEREA MICROALBUMINURIEI CU HIPERTENSIUNEA ARTERIAL LA PACIENII CU DZ TIP 1

I VECHIME DE CEL PUIN 10 ANI... 216
ASSOCIATION OF MICROALBUMINURIA WITH ARTHERYAL HYPERTENSION IN PATIENTS WITH TYPE 1
DM WITH A DURATION OF 10 YEARS OLD 216
Vladu Mihaela, Clenciu Diana, Bcu Mihaela
PS 64. RELAIA DINTRE RATA DE FILTRARE GLOMERULAR ESTIMAT, GROSIMEA INTIM-MEDIE I

GRSIMEA VISCERAL NTR-O POPULAIE DE PACIENI CU DZ2 217
THE RELATIONSHIP BETWEEN ESTIMATED GLOMERULAR FILTRATION RATE, INTIMA -MEDIA
THICKNESS AND VISCERAL FAT IN A POPULATION OF PATIENTS WITH DM2 . 218
Vonica Camelia Larisa, Muresan Andrada Alina, Craciun Anca Elena, Farcas Anca, Hancu Nicolae, Roman Gabriela
PS 65. TREATMENT WITH CONTINUOUS SUBCUTANEOUS INSULIN INFUSION TO A PATIENT WITH

DIABETES MELLITUS TYPE 1... 219
Alexandra Ilinca, Carmen Novac, Emilia Rusu, Cornelia Cristofor, Raluca Radu, Gabriela Radulian
DOAR PUBLICARE
PUBLICATION ONLY
PO 1. HIPOGLICEMIA SEVER, CAUZA DE INTERNARE A PACIENILOR CU DIABET ZAHARAT TIP 2. 221

SEVERE HYPOGLYCEMIA, CASE OF HOSPITALIZATION IN PATIENTS WITH TYPE 2 DIABETES..... 222
Braha Adina, Diaconu Laura, Timar Romulus
PO 2. FUMATUL FACTOR DE RISC CARDIOVASCULAR.. 223

SMOKING CARDIOVASCULAR RISK FACTOR IN PATIENTS WITH T1DM DIAGNOSED AT LEAST 10 YEARS
AGO.... 224
Clenciu Diana, Vladu Mihaela, Bcu Mihaela
PO 3. PREZENA SINDROMULUI METABOLIC LA PACIENII CU DZ TIP 2 RECENT DIAGNOSTICAI 210

METABOLIC SYNDROME IN PATIENTS WITH TYPE 2 DIABETES MELITUS RECENTLY DIAGNOSED. 211
Clenciu Diana, Vladu Mihaela, Bcu Mihaela
PO 4. REZISTENA LA INSULIN N BOLILE ISCHEMICE CEREBROVASCULARE LA PACIENTUL CU

DIABET ZAHARAT TIP 2INSULIN RESISTANCE IN ISCHEMIC CEREBROVASCULAR DISEASES AT
PATIENTS WITH TYPE 2 DIABETES MELLITUS 227
Dondoi Carmen, Cucuringu Mihaela Virginia, Chelan Claudia, Mogos Tiberius Viorel
PO 5. DIABET ZAHARAT TIP 1 SAU DIABET NEONATAL CARE ESTE CEA MAI BUN OPIUNE DE
TRATAMENT?.
16
228
TYPE 1 DIABETES MELLITUS OR NEONATAL DIABETES WHICH IS THE BEST TREATMENT
OPTION?
Page
229
Herescu Irina Elena, Mintici Luana, Ioacara Sorin, Fica Simona
PO 6. TRATAMENTUL CU POMP DE INSULIN O SOLUIE PENTRU PACIENII CU DIABET ZAHARAT 230
TIP 1 I SINDROM DE NERECUNOATERE A HIPOGLICEMIILOR.
INSULIN PUMP TREATMENT AN ALTERNATIVE FOR TYPE 1 DIABETES MELLITUS PACIENTS WITH 231
HYPOGLICEMIC UNAWARENESS.
Mintici Luana, Herescu Irina, Ionescu Olteea, Ioacara Sorin, Fica Simona
PO 7. PATTERNS REGARDING VITAMIN AND MINERALS INTAKE IN NORMALWEIGHT AND OBESE

PATIENTS. 232
Mihaela Posea, Andreea Dragomir, Gabriela Radulian
PO 8. PREVALENCE OF NEPHROPATHY AMONG PATIENT WITH DIABETES MELLITUS ASSOCIATED WITH

ARTERIAL HYPERTENSION... 232
Souabni Seif Eddine, Soury Arselen, Houidi Ahmed, Selmi Monaam
PO 9. ROLUL CHIRURGIEI BARIATRICE IN TRATAMENTUL DIABETULUI ZAHARAT TIP 2..... 233

erbnescu Cristina, Nil Alexandra, Sava Elisabeta, Srbu Anca, Ioacr Sorin, Fica Simona
PO 10. ASOCIEREA DINTRE ACIDUL URIC I OBEZITATEA LA PACIENII CU DIABET ZAHARAT TIP
2. 234
THE CORRELATION BETWEEN SERUM URIC ACID AND OBESITY IN PATIENTS WITH TYPE 2 DIABETES
MELLITUS..... 234
Zaharia Adelina, Li Genoveva Andreea, Pavel Anca Ioana, Zaharia Mihaela Iulia, Stoicescu Florentina, Gheorghi Andra
Gabriela, Rusu Emilia, Radulian Gabriela
PO 11. SINDROMUL MAURIAC - O COMPLICAIE RAR A DIABETULUI ZAHARAT. 235

MAURIAC SYNDROME - A RARE COMPLICATION OF DIABETES MELLITUS. 236
Stegaru Daniela, Delcea Alina, Guja Cristian
PO 12. TERAPIILE BIOLOGICE N DIABETOLOGIE: OPORTUNITATE I PROVOCRI. 237

TERAPIILE BIOLOGICE N DIABETOLOGIE: OPORTUNITATE I PROVOCRI.. 238
Geanta Marius
PO 13. CORELAII CLINICO-BIOLOGICE DE RISC CARDIOVASCULAR I NIVELUL INFLAMAIEI CRONICE

SISTEMICE LA PACIENII CU DIABET ZAHARAT DE TIP 2 I STEATOHEPATIT
NONALCOOLIC. 239
CLINICAL AND BIOLOGICAL CORRELATIONS OF CARDIOVASCULAR RISK AND THE LEVEL OF CHRONIC
SYSTEMIC INFLAMMATION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND NON-ALCOHOLIC
STEATOHEPATITIS.. 240
Casoinic Florin, Sampelean Dorel, Buzoianu Anca D., Hncu Nicolae, Baston Dorina
PO 14 HIPERTRIGLICERIDEMIA, FACTOR DE RISC PENTRU PANCREATITA ACUT LA PACIENTUL CU

DIABET ZAHARAT.. 241
HYPERTRIGLYCERIDEMIA, A RISK FACTOR FOR ACUTE PANCREATITIS IN PATIENTS WITH DIABETES
MELLITUS.. 242
Oana Albai, Raluca Borza, Ionela Tudora, Alexandra Sima, Adrian Vlad, Romulus Timar, Bogdan Timar
17
Page
Dragi colegi,
Am prilejul ca n deschiderea volumului de rezumate al celui de al 42-lea Congres al Societii Romne de Diabet
Nutriie i Boli Metabolice s transmit n numele i cu asentimentul Comitetului Director cteva dintre realizrile pe
care societatea noastr le-a avut n ultimul an precum i unele gnduri pentru viitorul acesteia.
Este clar pentru noi toi c trim o perioad de schimbri majore, generate de necesitatea convergenei societii
noastre cu lumea contemporan. O parte dintre aceste schimbri sunt exterioare, constatm modificri legislative
decisive, observm mutaii sociale i culturale profunde care ne influeneaz opiunile personale i profesionale. Dar
aceste schimbri ale lumii noastre vor trebui s fie nsoite de mutaii interioare, de mentalitate i de abordare, care s
se finalizeze prin aciuni concrete.
Pornind de la aceste premise obiective am conceput mai multe linii i proiecte strategice pe care le voi prezenta pe
scurt membrilor SRDNBM n cadrul Adunrii Generale.
Prima urgen este adaptarea Statutului SRDNBM la noile cerine legislative din Romnia i din Europa i am
conceput o propunere n acest scop, care s fie discutat i aprobat de membrii SRDNBM.
A doua direcie strategic este creterea nivelului tiinific, profesional, dar i a gradului de implicare n activitile
SRDNBM al membrilor notri. n acest sens am completat baza de date cu medicii specialiti i primari din
specialitatea noastr din ntreaga ar, pe care i invit s devin membri titulari ai SRDNBM i s-i fac auzite
glasurile n acest cadru. Am fcut demersuri insistente ctre autoriti pentru modificarea curiculei rezidenilor i
alinierea acesteia la cea european, ceea ce va duce la creterea calitii profeisonale a specialitilor notri. Urmeaz
ca n lunile urmtoare s propunem i modificarea curiculei studenilor, cu introducerea nutriiei clinice n cadrul
studiului medicinei interne.
Activitatea tiinific girat de SRDNBM a avut un curs ascendent n ultimii ani, lucru pentru care adresm
mulumirile noastre conducerilor anterioare ale Societii; este stringent necesar ca aceast tendin s fie continuat
i n viitor. n aceast direcie, a fost aprobat de ctre Adunerea General n 2015 continuarea drumului deschis prin
Studiul PREDATORR de cunoatere a realitilor diabetului zaharat n Romnia, prin organizarea i sponsorizarea de
ctre Societate a unui studiu multicentric prospectiv observaional, studiul MENTOR. Dac vom reui s finalizm
acest efort deosebit, vom avea argumente importante de a ne susine obiectivele n viitor.
De asemenea, SRDNBM a ncheiat contracte de parteneriat tiinific i de colaborare cu alte societi profesionale
medicale din Romnia (cardiologie, endocrinologie, nefrologie) i cu Universiti medicale (din Bucureti i
Timioara), parteneriate care vor fi concretizate prin proiecte comune de cercetare i participarea reciproc la sesiuni
tiinifice. Aceste demersuri sunt n concepia noastr dedicate n special tinerilor cercettori i specialiti, pe care
vrem s i ncurajm prin toate mijloacele s devin factorul dinamizator al activitilor tiinifice ale SRDNBM,
inclusiv al Congreselor anuale ale acesteia.
Avei n faa dumneavoastr, n acest volum de rezumate o parte din roadele activitii de cercetare a membrilor
SRDNBM. n opinia noastr suntem deja pe o cale bun din acest punct de vedere, cale pe care trebuie s continum
s mergem crescnd n acelai timp efortul i exigena.
V invit s ne ntlnim cu bucurie i cu sufletele deschise ca n fiecare an, de aceast dat la Braov, pentru a ne
revedea i a ne simi din nou bine mpreun.
Cu prietenie,
18
Prof. Cristian Serafinceanu

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Presedinte Societatea Romana de Diabet, Nutritie si Boli Metabolice

Page 19
Dear colleagues,
On behalf of, and with the consent of the Board of Directors, I have the opportunity to communicate during this
opening of the volume of abstracts of the 42nd Congress of the Romanian Society of Diabetes Nutrition and Metabolic
Diseases a few of the achievements that our society has had in the last year as well as some thoughts for its future.
It is obvious to us all that we live in a time of major changes generated by our societys need to converge with the
contemporary world. Some of these changes are external, decisive legislative changes, profound social and cultural
mutations that influence our personal and professional options. But these changes in our world will be accompanied
by interior evolutions of mentality and approach, finalized in concrete activities.
Building on these premises we have designed several objectives and strategic projects which I will be briefly
presenting to RSDNMD members of the General Assembly.
The first urgency is to adapt the Statute of RSDNMD to the new legislative requirements of Romania and Europe, and
I have created a proposal to this end, to be discussed and approved by RSDNMD members.
A second strategic directions is to raise the scientific and professional performance levels, as well as the degree of
involvement in RSDNMD activities of our members. Thus, we completed the database with medical practitioners of
our specialization from all over the country, whom I invite to become full RSDNMD members and make their voices
and ideas heard in this framework. We have persistently urged the authorities to modify the residents curriculum and
aligning it to the European one, which will lead to an increase of professional quality of our specialists. During the
upcoming months we will propose the modification of the students curriculum with the introduction of clinical
nutrition in the study of internal medicine.
The scientific research endorsed by RSDNMD has had an upward trend in recent years, for which we thank the
previous management of the society; it is absolutely necessary that this trend will be continued in the future. In this
respect, in 2015 the General Assembly has approved the path opened by the PREDATORR Study of acknowledging
the realities of diabetes in Romania by organizing and sponsoring a multicenter prospective observational study, the
MENTOR Study. If we manage to complete this particular effort, we will have strong arguments towards supporting
our goals in the future.
RSDNMD has also signed agreements on scientific partnership and collaboration with other professional medical
societies from Romania (cardiology, endocrinology, nephrology) and medical universities (from Bucharest and
Timisoara), partnerships which will be consolidated through joint research projects and reciprocal participation at
scientific sessions. We believe these actions are dedicated to young researchers and specialists, which we want to
encourage by all means to become the driving force of the scientific activities of RSDNMD, including its annual
Congresses.
In this volume of abstract, you have in front of you a part of the results of the research that RSDNMD members
concluded. In our opinion we are already on a good path from this point of view, path that we need to keep following
while increasing our efforts and exigency.
I invite you to meet with joy and open hearts, like every year, but this time in Brasov, to revisit us again and to feel
good together.
With kindness,
Professor Cristian Serafinceanu

President of the Romanian Society of Diabetes, Nutrition and Metabolic Diseases
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Page 21
PREZENTRI ORALE REVIEWS/ORAL PRESENTATIONS REVIEWS
RW1. METODE DE EVALUARE A FUNCIEI BETACELULARE N PRACTICA

CLINIC
Cornelia Bala
Universitatea de Medicin i Farmacie Iuliu Haieganu Cluj-Napoca, Romnia
Disciplina de Diabet, Nutriie, Boli metabolice
Evaluarea funciei betacelulare, dincolo de interesul n cercetare, poate fi relevant i n cteva

circumstane clinice ntlnite relativ frecvent n practic, printre care diagnosticul diferenial ntre
diabetul zaharat tip 1 i 2 sau alegerea terapiei n anumite faze de evoluie ale diabetului tip 2.
Principalele metode de evaluare sunt determinarea insulinemiei i peptidului C n condiii bazele
sau stimulate i/sau utilizarea indicilor derivai din Homeostasis model assessment (HOMA).
Peptidul C, cosecretat cu insulina n concentraii echimolare, are un timp de njumtire mai mare
dect insulina i poate fi msurat cu mai mult acuratee, nefiind influenat de tratamentul cu
insulin exogen. Pe de alt parte, timpul de njumtire crescut al peptidului C face ca evaluarea
modificrilor insulinosecreiei n condiii de stimulare s fie mai dificil.
Testele de stimulare a peptidului C se pot face cu glucagon (1 mg IV, cu msurarea peptidului C
la 6 min dup administrarea de glucagon), mas-test standard (cantitate n funcie de greutate), cu
determinarea peptidului C la 90 sau 120 min- cele mai frecvent aplicate sau cu arginin sau
tolbutamid (mai rar utilizate). Date mai recente sugereaz c msurarea peptidului C n condiii
random, non-fasting, la nivele ale glicemiei peste 8 mmol/l (144 mg/dl) sunt superioare att valorii
n condiii bazale, ct i valorilor stimulate cu glucagon n diagnosticul diferenial ntre diabetul
tip 1 i tip 2. Un alt indice recomandat este raportul ntre peptidul C urinar dup o mas
nestandardizat i creatinina urinar. Valorile sugestive pentru un deficit absolut de insulin
specific diabetului tip 1 sunt <0,08 nmol/l, <0,2 nmol/l i <0,2 nmol/mmol pentru peptid C bazal,
stimulat i respectiv raport peptid C urinar:creatinin urinar. Valorile care sugereaz un diabet tip
1 posibil sau inabilitatea potenial de a obine controlul glicemic fr tratament cu insulin sunt
<0,25 nmol/l, <0.6 nmol/l i <0,2 nmol/mmol.
Homeostasis model assessment (HOMA), dezvoltat n anul 1985, este un model de interaciune
ntre dinamica glucozei i a insulinei, utilizat pentru predicia concentraiilor de glucoz i insulin
n stare bazal. Indicii rezultai din acest model sunt HOMA-IR (index de insulinorezisten),
respectiv HOMA-B (index al funciei betacelulare). O variant actualizat este HOMA2, un model
computerizat care ia n considerare att variaiile n condiii de hiperglicemie ale produciei
hepatice de glucoz i secreiei de insulin, ct i eliminarea urinar a glucozei. Dac la acelai
subiect sunt disponibile att insulinemia ct i peptidul C, se recomand utilizarea peptidului C
pentru calcularea HOMA-B, respectiv a insulinemiei pentru calcularea HOMA-IR. La subiecii cu
diabet zaharat insulinotratat nu exist date care s valideze utilizarea HOMA-IR. Atunci cnd se
dorete calcularea HOMA-B, se va utiliza valoarea peptidului C, dar nici aceast situaie nu este
validat prin studii publicate pn la aceast dat. HOMA-B la subiecii aflai sub tratament cu
secretagoge trebuie s in cont de faptul c acest index descrie activitatea celulei beta, nu
integritatea sa funcional.
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EVALUATION OF BETA CELL FUNCTION IN CLINICAL PRACTICE
Cornelia Bala
Iuliu Haieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
Department of Diabet, Nutrition and Metabolic diseases
Beyond basic and clinical research, the evaluation of beta cell function is of clear interrest in few
clinical circumstances including differentiating between type 1 and type 2 diabetes, as well as
choice of antihyperglycemic treatments.
The main methods are measurements of insulinemia and C-peptide in fasting and stimulated state
and/or use of indices derived from Homeostasis model assessment (HOMA).
C-peptide is co-secretedwith insulin in echimolecular amounts, has a longer half-time than insulin
and can be more accuretely measured as its measurement is not influenced by exogeneous insulin
treatment. On the other hand, its longer half-time limits its value in stimulated conditions.
C-peptide can be stimulated with glucagon (1 mg IV, with measurement of C-peptide at 6 minutes),
during mixed-meal test (at 90 or 120 minutes), or less frequently with arginine or tolbutamide.
More recent data suggest that non-fasting, random measuremets of C-peptide at glucose levels of
more than 8 mmol/l (144 mg/dl) are superior to fasting or stimulated values in correctly classifing
type 1 and type 2 diabetes. Another parameter is the post-meal home meal urine C-
peptide:creatinine ratio. Absolute insulin deficiency/absolute insulin requirement is suggested at
<0,08 nmol/l, <0,2 nmol/l and <0,2 nmol/mmol for fasting C-peptide, stimulated C-peptide and
urine C-peptide:creatinine ratio, respectively. Likely Type 1 diabetes/inability to achieve
glycaemic control with non-insulin therapies are suggested at <0,25 nmol/l, <0.6 nmol/l i <0,2
nmol/mmol.
Homeostasis model assessment (HOMA), originally developed in 1985, is a mathematical model
based on the fact that the steady-state basal plasma glucose and insulin concentrations are
determined by their interaction in a feedback loop. Two indices can be derived from this model:
HOMA-IR (insulin resistance), and HOMA-B (beta cell function). A step forward was the
development of HOMA2, which took account of variations in hepatic and peripheral glucose
resistance, increases in the insulin secretion curve for plasma glucose concentrations above 10
mmol/L (180 mg/dL) and the contribution of circulating proinsulin. If for the same subject insulin
and C-peptide values are available, C-peptide should be used for HOMA-B, and insulin for
HOMA-IR. In subjects with insulin-treated diabetes, the use of insulin-based HOMA-IR is not
validated. When HOMA-B is used in insulin-treated diabetes, values of C-peptide are to be used,
but validity is lacking for this situation as well. The use of HOMA-B in patients treated with
secretagogues, it should be taken into account that this is an index reflecting beta cell activity and
not beta-cell functional integrity.
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RW2. MODERN VIEWS ON BASAL INSULIN IN DIABETES MELLITUS
Geremia B. Bolli
University of Perugia, Italy
Type 2 diabetes is a progressive disease, i.e. the ability of pancreas to secrete insulin, decreases
over time both in terms of timely response as well as in quantity. The delayed and insufficient
insulin response to prevailing hyperglycemia is the main reason of deterioration of blood glucose
over the years, and related initiation and progression of micro- and macro-vascular complications.
Insulin resistance contributes to hyperglycemia by making the need for insulin secretion even
greater, but by itself is neither a necessary or a sufficient condition to result in diabetes mellitus.
Thus, deficiency of insulin secretion remains the pivotal factor of hyperglycemia waiting for
treatment.
Like in other endocrine diseases, deficiency of the native hormone calls for physiological
replacement. In Type 2 diabetes mellitus, substitution of insulin initiates with basal insulin which
regulates plasma glucose concentration in the fasting and interprandial state.
The modern approach to optimal treatment of Type 2 diabetes is to initiate basal insulin as soon as
A1C increases >7.0% despite use of oral agents (metformin +/- DPP-IV inhibitors) or injectable
GLP-1 RAs. Sulphonylureas should not be used, TZD are not recommended and SGLT2 inhibitors
have not a clear indication and position in the treatment of Type 2 diabetes.
Basal insulin should be initiated with 10 U or 0.2 U/kg and titrated every 4-6 days to reach the
target of fasting near-normoglycemia in 1 or 2 months. When titration is successfully done, nearly
50% of patients reach A1C <7.0%. Basal insulin can be given in combination with metformin,
DPP-4 inhibitors, GLP-1 RAs, prandial insulin.
NPH should not be used as basal insulin (neither pre-mixes based on NPH) because of the peak
activity resulting in risk for hypoglycaemia and variability of absorption. Glargine is the optimal
candidate as basal insulin every 24 h any time of day, every day at the same time. Detemir is a
better NPH with lower peak and lower risk for hypoglycaemia, but duration of action is shorter
than NPH and requires nearly always 2 daily dosing. Tresiba is a long-acting flat insulin once/day
with dosing flexibility. Glargine U300 is also flexible and has duration of action longer than
glargine U100 in addition to being flatter. More experience is needed to compare glargine U300
vs tresiba.
An experienced diabetologist can use every basal insulin as long he/she uses it according to the
characteristics of that basal insulin. In absolute there no one superior basal insulin vs the others,
there are only differences between the different basal insulins on the market which need to be
known and managed. At the end, the most important aspect is to titrate basal insulin to the target
of fasting plasma glucose. If basal insulin is not titrated, there is no improvement in plasam glucose
and A1C, and insulin treatment may be not efficacious to prevent complications.
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RW3. THE EPIDEMIC OF TYPE 2 DIABETES: A GLOBAL PROBLEM FOR THE
21ST CENTURY
Andrew JM Boulton, MD, DSc, FICP, FACP, FRCP

Professor of Medicine, University of Manchester.
Consultant Physician, Manchester Royal Infirmary.
Visiting Professor, University of Miami.
President, Worldwide Initiative for Diabetes Education.
For the first time in the history of mankind, non-communicable diseases have become the leading
cause of global mortality and morbidity. Amongst these, we are facing a worldwide epidemic of
type 2 diabetes. There are likely more than 450 million people worldwide with diabetes, with the
largest proportion being found in Asia and the Middle East. However, it is not only type 2 diabetes
but recent reports have suggested increases in type 1 diabetes in Finland and the United States.
Across the world, diabetes accounts for 8-15% of national healthcare budgets and it is the late
complications particularly those affecting the lower limb and the kidney, that drive costs. There
is overwhelming evidence for the impact of preventative measures in those with pre-diabetes or
IGT. Both the Diabetes Prevention Programme from the United States and the Diabetes
Prevention Study from Finland have shown that diet and lifestyle changes in this phase can lead
to a 58% reduction in the incidence of type 2 diabetes. Moreover, these 2 studies and studies from
China report a legacy effect and that is that lifestyle adjustment for a few years has a long-lasting
effect in protection from development of type 2 diabetes. For the management of type 2 diabetes,
a patient-centred approach is advocated as proposed by the revised EASD/ADA guidelines
published in 2015. Whereas strict control of diabetes in young people with type 2 diabetes with
few complications is indicated, one must remember the risks of hypoglycaemia in the elderly
population, especially those with co-morbidities, in whom a less aggressive approach is indicated.
The first line agent after diet and lifestyle adjustment for the management of type 2 diabetes
remains metformin. Second line drugs include the DPP4 inhibitors, GLP-1 analogues, SGLT-2
inhibitors, pioglitazone and the sulphonylureas. It must be remembered that the natural history of
type 2 diabetes is one of progressive loss of beta-cell function and most patients in the long-term
may well require insulin therapy. Finally, the outcome trials, especially that from the EMPA-REG
Cardiovascular Outcome Trial, suggest potential cardio protection from some of the agents
particularly SGLT-2 inhibitors.
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RW4. DIABETIC FOOT DISEASE: AN OVERVIEW
Andrew JM Boulton, MD, DSc, FICP, FACP, FRCP

Professor of Medicine, University of Manchester.
Consultant Physician, Manchester Royal Infirmary.
Visiting Professor, University of Miami.
President, Worldwide Initiative for Diabetes Education.
Foot disease remains a major cause of morbidity and mortality in the diabetic population today.
In the last 10 years there has been an increase in the amount of evidence-based data to support
various therapies used for diabetic foot problems. First, in terms of prevention, the team approach,
that is identifying patients at risk of foot problems providing them with education, regular podiatry
and good footwear has been shown to be helpful in several large studies. However, the impact of
education alone still remains unproven. In Western countries, neuropathic foot ulcers are not now
the most common cause of foot lesions: it is neuro-ischaemic disease that prevails. However,
prevention is most likely to be successful in the neuropathic foot and most healthcare systems
advocate an annual review for all those patients with diabetes to identify those at risk of foot
problems.
For the patient with a simple neuropathic foot ulcer, there is good evidence to support the use of
offloading using total contact casts or removable cast Walkers. For the non-adherent patient,
removable cast Walkers can be rendered irremovable and this improves the efficacy of the
treatment. There has recently been much debate about the use of hyperbaric oxygen in the
management of diabetic foot lesions. A trial from Sweden a few years ago suggested that this
therapy may benefit those patients with distal arterial disease that is non-reconstructable, and
chronic infected neuro-ischaemic or ischaemic foot lesions. However, 2 more recent randomised
controlled trials have not supported this and there is no evidence at present to support the use of
hyperbaric oxygen in both diabetic foot lesions. In contrast, there is evidence to support the use of
negative pressure wound therapy (NPWT) for those complex foot wounds (frequently after local
surgery) that dont respond to standard of care. NPWT is particularly helpful in post-operative
local surgical wounds in the diabetic foot.
Lastly, although antibiotics are widely used, there is no strong evidence base to support the use of
any one particular antibiotic. The Infectious Disease of North America Associations 2012
Guidelines are on the management of diabetic foot infections remains a most useful source of
reference for the management of infected foot ulceration. Similarly, there is no evidence to support
the use of any particular dressing and there appears to be little benefit from more expensive
dressings over the more traditional ones.
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RW5. DIABETUL SI SINDROMUL CORONARIAN ACUT
Doina Catrinoiu
Exista o cretere global a prevalenei diabetului de tip 2, dar si a altor tulburari in metabolismul
glucozei, cel mai frecvent alterarea toleranei la glucoz (IGT). Acestea reprezint factori majori
de risc pentru ateroscleroza, inclusiv pentru sindromul coronarian acut (SCA), determinate de
boala arterial coronarian (CAD). Diabetul de tip 2 si alterarea tolerantei la glucoza apare doua
treimi din pacientii cu SCA, fara ca acesti pacienti sa fi fost diagnosticati anterior cu DZ. Urmarirea
pe termen lung a acestor pacieni a demonstrat c afectiunea metabolica influenteaza in sens
negativ prognosticul cardiovascular.
Exist mai muli factori care determina vulnerabilitatea cardiovasculara la pacienii cu DZ
tip 2 i IGT.
Printre acestea cele mai importante par a fi disfuncia endoteliala, modificarea functiei plachetare,
scderea capacitii fibrinolitice, cresterea produsilor de glicozilare avansata (AGE), dislipidemia,
hipertensiunea arterial i sensibilitatea redusa la insulin. Glicemia bazala este un factor de risc
cunoscut pentru BCV, dar asocierea glucozei cu CHD este mai putin importanta dect ali factori
de risc, cum ar fi colesterolul total, non-HDL colesterol, tensiunea arteriala, n special cea
sistolica.
Durata de evolutie a diabetului, este de asemenea un factor determinant important pentru
dezvoltarea BCV. Insuficienta cardiaca sau accidentul vascular cerebral apar mai frecvent n
rndul persoanelor cu evolutie indelungata a diabetului, fata de cei nou diagnosticati.
Impactul IGT asupra SCA i a morbiditii cardiovasculare este nc incomplet cunoscut.
Diagnosticul precoce al diabetului este de asemenea important pentru evolutia afectiunii
cardiologice si de asemenea poate influena alegerea tehnicii de revascularizare.
In general, avand in vedere afectarea multivasculara interventia recomandata este by-passul, iar
cei care primesc stenturi necesita folosirea celor biologic active cu cresterea semnificativa a
supravietuirii si scaderea aparitiei unui nou infarct.
Alegerea terapiei antiagregante si hipotensoare este esentiala pentru evolutia pe termen
lung, de prima intentie fiind inhibitori ai ECA sau vasodilatatoare beta-blocante.
Relaia dintre hipoglicemie i sindromul coronarian acut reprezinta in continuare motiv de
dezbatere privind implicarea hipoglicemiei in aparitia evenimentelor acute vasculare si chiar a
mortii subite.
Hipoglicemia crete intervalul QTc, creste producia de markeri proinflamatorii, determina
activarea trombocitelor, i a markerilor de stres oxidativ, scade functia endoteliala si de asemenea
scade fluxului sanguin miocardic. Toate c aceste modificri pot crete riscul de BCV si de moarte
subita, dar este greu de demonstrat ca hipoglicemia este o cauza directa a acestor modificari.
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DIABETES AND ACUTE CORONARY SYNDROME
Doina Catrinoiu
There is a global increase in the prevalence of type 2 diabetes, and other disorders in glucose
metabolism, most commonly altered glucose tolerance (IGT). These are major risk factors for
atherosclerosis, including acute coronary syndrome (ACS) caused by coronary artery disease
(CAD). Type 2 diabetes and impaired glucose tolerance occurs two thirds of patients with ACS
without these patients have been previously diagnosed with diabetes. Long term follow up of these
patients demonstrated that metabolic disease negatively affects cardiovascular outcomes.
There are several factors that cause cardiovascular vulnerability in patients with type 2
diabetes and IGT.
These seem to be the most important endothelial dysfunction, modification platelet function,
decreased fibrinolytic capacity, increasing product advanced glycation (AGE), dyslipidemia,
hypertension and reduced sensitivity to insulin. Basal blood glucose is a known risk factor for
CVD, but the association with CHD glucose is less important than other risk factors such as total
cholesterol, non-HDL cholesterol, blood pressure, especially the systolic.
The duration of evolution of diabetes, is also an important determinant factor for developing CVD.
Heart failure and stroke, occur most frequently among people with long evolution of diabetes,
compared to those newly diagnosed.
IGT impact on SCA and cardiovascular morbidity is still incomplete. Early diagnosis of diabetes
is also important for the evolution of cardiac disease and can also influence the choice of
revascularization technique.
In general, given the damage multivessel recommended by-pass surgery and those receiving stents,
require the use of biologically active with the significant increase survival and decrease the
appearance of a new heart atack.
Choice of antihypertensive therapy and antiplatelet agents is essential for long-term evolution, first
intention is vasodilators ACE inhibitors or beta-blockers.
The relationship between hypoglycemia and acute coronary syndrome is still cause for debate on
involvement in causing hypoglycaemia acute vascular events and even sudden death.
Hypoglycemia increase QTc interval increases production of proinflammatory markers, cause
platelet activation, and markers of oxidative stress, endothelial function and also decreases
myocardial blood flow decreases. While these changes may increase the risk of CVD and sudden
death, but it is hard to prove that hypoglycemia is a direct cause of these changes.
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RW6. CARDIOVASCULAR OUTCOME TRIALS: THE POSSIBLE MECHANISMS
BEHIND THE RESULTS
Antonio Ceriello 1,2

1
Insititut d'Investigacions Biomdiques August Pi i Sunyer (IDIBAPS) and Centro de
Investigacin Biomdica en Red de Diabetes y Enfermedades Metablicas Asociadas
(CIBERDEM), Barcelona, Spain
2
IRCCS MultiMedica Sesto San Giovanni (MI), Italy
Clinical trials of glucose-lowering strategies in patients with type 2 diabetes mellitus (T2DM) have
shown a favorable effect of intensive glycemic control on microvascular complications but failed
to show a clear benefit on cardiovascular events. In 2008, the US Food and Drug Administration
(FDA) and European Medicines Agency (EMA) have required stringent criteria to approve new
glucose-lowering drugs, demanding proof of cardiovascular safety. As a result of these regulatory
requirements, a number of cardiovascular outcome trials in T2DM have been conducted examining
the cardiovascular safety of novel glucose-lowering drugs. Dipeptidyl peptidase 4 (DPP4)
inhibitors, analogs of glucagon-like peptide 1 (GLP-1), and inhibitors of the renal sodium-glucose
linked transporter-2 (SGLT2) are new classes of glucose-lowering drugs for subjects with T2DM.
The results of the cardiovascular outcome trials comparing the DPP4 inhibitors saxagliptin,
alogliptin, and sitagliptin or the GLP-1 analog lixisenatide to placebo have demonstrated that these
drugs are safe. The results of a cardiovascular outcome trial comparing the SGLT2 inhibitor
empagliflozin to placebo have been published. Notably, empagliflozin treatment has been
associated with a significant reduction in the primary composite cardiovascular outcome.
Moreover, a recent Press release announced that in the LEADER Trial, liraglutide seems to be able
to reduce all kind of cardiovascular events.
Although the question regarding the positive effect of glycemic control on cardiovascular risk is
still unanswered, current evidence suggests that new hypoglycemic agents which also impact on
both classical and non classical cardiovascular risk factors can have a significant role.
RW7. DIABETUL ZAHARAT TIP 2 I MENOPAUZA

Institutul Naional de Diabet, Nutriie i Boli Metabolice N. C. Paulescu din Bucureti
Menopauza evolueaz nsoit de o gam larg de tulburri nutriionale i metabolice.

Perturbrile metabolismului glucidic includ tolerana alterat la glucoz i diabetul zaharat
tip 2, dar nu numai. Deficiena estrogenic poate reprezenta o etap fundamental n procesul de
diabetogenez. Ali factori asociai riscului pentru diabetul de tip 2 sunt: naintarea n vrst,
obezitatea (cu inciden crescut la menopauz), sedentarismul, fumatul, alcoolul, unele
medicamente etc. n plus, metabolismul alterat al vitaminei D3 i deficiena de calciu (aspecte
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caracteristice menopauzei) conduc la un risc crescut pentru ambele tipuri de diabet.

Page
Dar exist n literatura de specialitate i o serie de controverse n ceea ce privete relaia
menopauz diabet zaharat. Aa, de pild, un important studiu american (Diabetes Prevention
Program) a relevat c menopauza natural nu s-a nsoit de un risc mai crescut de diabet i nici nu
a afectat rspunsul la intervenia preventiv. Pe de alt parte, un amplu studiu european (EPIC-
InterAct Study), efectuat n opt ri, a constatat c menopauza precoce s-a asociat cu un risc mai
mare pentru diabetul zaharat de tip 2.
Din punct de vedere al combaterii diabetului n condiiile menopauzei, multe studii pun
accentul pe alimentaia dietetic i mbuntirea stilului de via, cu un rol major al exerciiului
fizic. Este interesant c utilizarea metforminului pe cale oral la femei diabetice n menopauz a
fost acompaniat de o inciden mai redus a cancerului de sn invaziv.
Se consider c terapia de substituie hormonal, propus pentru influenarea menopauzei,
nu este recomandabil femeilor cu diabet zaharat de tip 2.
TYPE 2 DIABETES AND MENOPAUSE

N. C. Paulescu National Institute of Diabetes, Nutrition and Metabolic Diseases, Bucharest
Several disorders of nutrition and metabolism are accompanying type 2 diabetes mellitus.
The carbohydrate disturbances include impaired glucose tolerance (IGT) and type 2
diabetes mellitus, but not only. The estrogen deficiency could represent an essential step in the
process of diabetogenesis. Other significant factors for the risk of type 2 diabetes are: ageing,
obesity (with increasing incidence after menopause), lowering of physical activity, smoking,
drinking, some drugs a.s.o. Additionally, modified metabolism of D3 vitamin and calcium
deficiency (specific to menopause) are inducing a high risk for both types of diabetes.
Unfortunately, there are in the scientific literature a number of controversies regarding the
relation menopause diabetes. For instance, an important American study (Diabetes Prevention
Program) pointed out that natural menopause didnt associate with an increased risk of diabetes
and didnt influence the answer to the preventive strategy. On the other hand, a large European
trial (EPIC- InterAct Study), carried on eight countries, concluded that early menopause has
produced a higher risk for type 2 diabetes mellitus.
Reffering to the control of diabetes in the menopause period, many studies emphasize on
diet and improving lifestyle, with a major role of physical activity. It is interesting that metformin
use in postmenopausal women with diabetes was associated with lower incidence of invasive
breast cancer.
Hormone replacement therapy, proposed for the correction of menopause, seems not to be
adequate for the women with type 2 diabetes mellitus.
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RW8. BENEFITS FROM INSULIN PUMP IN PEOPLE WITH TYPE 2 DIABETES
Rudolf Chlup1,2
1
Dept. of Physiology and Dept. of Medicine, Palack University Olomouc;
2
Dept. of Diabetes Moravsk Beroun, Institute Paseka, Czech Republic.
Since 1978, Continuous Subcutaneous Insulin Infusion (CSII) became a sophisticated method of
insulin substitution/supplementation in persons with diabetes (PWD). To date, in the Czech
Republic (population of 10 milions inhabitants with 800 000 PWD), there are about 5000 PWD
on insulin pump. The international multicenter study Opt2mise (2010-2014) demonstrated that
CSII in PWD2 lead to significant reduction of HbA1c concentrations.
Aim of the present study was to explore global metabolic changes resulting from 6- and 12-month
CSII therapy in PWD2.
Methods: This prospective single-center trial recruited insulin-resistant CSII-naive PWD2,
uncontrolled, using insulin analogues-based Multiple Daily Injections (MDI) therapy + metformin.
Insulin dosing was optimized over an 8-week run-in period. A total of 23 subjects (16 men) with
persistent HbA1c 8% were randomly assigned to the CSII arm or to the MDI continuation arm.
After 6 months, the MDI arm (except one drop out) crossed over to CSII therapy as well. Mean
frequency of selfmonitoring on personal glucometer varied over the whole study in both arms
between 3.4 to 5.4 measurments/d.
Results: At 6 months, subjects assigned to the CSII arm achieved a significant mean HbA1c
reduction while reducing their total daily insulin dose (TDD) by 33% of baseline and also
achieving body mass reduction of 0.98% of baseline. Subjects on MDI demonstrated a non-
significant HbA1c reduction with TDD reduction of 5% from baseline and body mass reduction
of 0.99% of baseline. At 12 months, data from both arms of 22 patients, 11 continuing on CSII for
12 months, and 11 following overcross from MDI to CSII for 6 months, demonstrated mean 1.3%
HbA1c reduction from baseline (9.5%) with 54.6% values achieving HbA1c<8%. Mean TDD
reduction from baseline (95.7 22.75 U/d) was 19.5 U/d, No significant change vs. baseline was
noted in body mass, blood pressure, HDL, LDL and TAG. No ketoacidosis or severe hypoglycemia
occurred in either group.
Conclusion: In insulin resistant PWD2, CSII significatively and safely improved glucose control
with less insulin use and with no sustainable reduction of body mass, blood pressure and lipid
profile.
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RW9. PARTICULARITI ALE STATUSULUI NUTRIIONAL LA PACIENII CU
DIABET ZAHARAT I BOAL CRONIC DE RINICHI AVANSAT
Viviana Elian1,2, Georgiana Ditu2, Anca Pantea-Stoian1, Oana Steriade, Cristian

Serafinceanu1,2
1
Universitatea de Medicin i Farmacie Carol Davila, Bucureti
2
Institutul Naional de Diabet, Nutriie i Boli Metabolice N.C.Paulescu, Bucureti
Malnutriia protein-caloric este frecvent ntlnit n rndul pacienilor cu boal renal avansat.
Este demonstrat asocierea cu inflamaia cronic i cu o cretere a riscului cardiovascular i
reprezint un factor de prognostic negativ pentru supravieuirea pacienilor dializai. De aceea
evaluarea statusului nutriional la aceti pacieni trebuie efectuat regulat, prin metode multiple i,
dac este evideniat prezena malnutriiei, trebuie intervenit prompt prin identificarea posibilelor
cauze i tratament adecvat.
Din punct de vedere nutriional la pacientul cu boal cronic renal i diabet zaharat riscul de
malnutriie protein-caloric este exponenial crescut deoarece ambele patologii pot asocia sindrom
de wasting (PEW).
Sindromul de wasting este caracterizat prin pierderea depozitelor de proteine somatice, scderea
nivelului de proteine viscerale i de energie. Cauzele PEW includ anorexia, aportul alimentar
redus, boli concomitente n special atunci cnd asociate cu procesele inflamatorii, dizabilitate
fizic sau mental, ndeprtarea nutrienilor prin procedura de dializ, acidoza metabolic,
scderea condiiei fizice, stresul oxidativ i carbonilic. Pacienii cu diabet zaharat sunt, de
asemenea, la un risc mai mare pentru PEW cauzat comorbiditile diabetului. Aceste tulburri
includ boala vascular ischemic, hipertensiunea, disfunciile gastrointestinale i neuropatia
autonom. Tulburrile metabolice, cum ar fi deficitul de insulina sau rezistenta la insulina si
nivelurile ridicate de hormoni de contrareglare, pot contribui de asemenea la PEW.
Starea de nutriie poate fi evaluat prin mai multe metode pornind de la msurarea greutii, IMC,
circumferinei braului, pliului tricipital i, pentru determinri mai precise prin fora de strngere
a pumnului, bioimpedan, DXA, RMN.
ntr-un studiu efectuat n Bucureti pe 137 pacieni hemodializai, evaluarea iniial a artat o
prevalen semnificativ statistic mai mare (p <0,001) a PEW, la pacienii diabetici hemodializai
comparativ cu grupul de control, acelai model fiind observat n evoluie i la 12 i 24 luni. PEW
este mai frecvent la pacienii diabetici, care asociaz i o cretere a masei de esut adipos. Markerii
de PEW s-au corelat cu mortalitatea n ambele grupuri.
Evaluarea nutriional este absolut necesar att la nceputul ct i n timpul urmririi acestor
pacieni pentru o mai bun individualizare a tratamentului i implicit rezultate mai bune pe termen
lung.
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NUTRITIONAL STATUS SPECIFICITIES IN PATIENTS WITH DIABETES
MELLITUS AND ADVANCED CHRONIC KIDNEY DISEASE
Viviana Elian1,2, Georgiana Ditu2, Anca Pantea-Stoian1, Oana Steriade, Cristian

Serafinceanu1,2
1
Carol Davila University of Medicine and Pharmacy, Bucharest
2
National Institute of Diabetes, Nutrition and Metabolic Diseases N.C.Paulescu, Bucharest
Protein-energy malnutrition is a frequent complication in patients with advanced renal disease. It

is well known to be associated with inflammation and increased cardiovascular risk and it is a
predictive factor of poor survival in dialysis patients. Therefore, nutritional status needs to be
regularly assessed in these patients, by using several methods, and, if malnutrition is present, the
possible causes should be thoroughly searched for and properly treated.
From nutritional perspective, a patient with chronic kidney disease (CKD) and diabetes mellitus
(DM) has an exponentially increased risk of protein malnutrition as both illnesses are associated
with protein-energy wasting (PEW).
ProteinEnergy Wasting Syndrome is characterized by the loss of somatic protein deposits,

decreased visceral protein levels and decreased energy. The causes of PEW include anorexia,
reduced food intake, concurrent illnesses particularly when associated with inflammatory
processes, physical or mental disability, removal of nutrients by dialysis procedure, acidemia,
possibly physical deconditioning, oxidant and carbonyl stress. However, diabetic patients are also
at greater risk for PEW from comorbidities related to diabetes per se. These disorders include
ischemic vascular disease, hypertension, gastrointestinal dysfunction and autonomic neuropathy.
Metabolic disorders such as insulin deficiency or insulin resistance, and elevated levels of counter
regulatory hormones, may also contribute to PEW.
Nutritional status can be assessed by several methods starting with weight, BMI, mid-arm
circumference, tricipital skinfold and, for more precise determinations hand-grip strength,
bioimpedance, DXA, MRI.
In a study performed in Bucharest on 137hemodialysed patients, the initial evaluation showed a

statistically significant higher prevalence (p<0.001) of PEW (protein energy wasting) in
hemodialysis diabetic patients compared to the control group, the same pattern being seen at 12
and 24 months reassessments. PEW is more frequent in diabetic patients, which also associate an
increase in body fat. Markers of PEW correlated with mortality in both groups.
Nutritional assessment is absolutely necessary both at the beginning and during follow-up for an
appropriate individualized therapy and better long term outcomes.
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RW10. CHIRURGIA BARIATRIC- O OPIUNE SIGUR PENTRU OBEZITATE?
Simona Fica1,2 , Anca Sirbu1,2

1
Universitatea de Medicin i Farmacie Carol Davila, Bucureti, Disciplina de Endocrinologie
i Diabet
2
Spitalul Universitar de Urgen Elias, Clinica de Endocrinologie i Diabet, Bucureti, Romnia
Potrivit datelor WHO, obezitatea la nivel mondial s-a dublat din 1980 pn n prezent,
nregistrandu-se o cretere alarmant att a supraponderalitii ct i a obezitii la aduli i copii.
Obezitatea are un impact negativ asupra factorilor economici, sociali i, cel mai important, asupra
strii de sntate, crescnd riscul de boli cardiovasculare, diabet zaharat tip 2 i cancer. n Europa,
supraponderalitatea i obezitatea sunt responsabile de 80% din cazurile de diabet zaharat tip 2, de
35% din cazurile de boal cardiac ischemic i 55% din hiperetensiunea arterial. Schimbarea
stilului de viat prin diet, exerciii fizice i medicaie s-a dovedid a fi folositoare, dar, din
nefericire, scderea ponderal este moderat i temporar. De la sfarsitul secolului 20, chirurgia
bariatric vine n ajutorul controlului comorbiditilor obezitii, motiv pentru care i s-a nsuit i
titlul de chirurgie metabolic. Acest tip de intervenie a dus la ameliorarea sau chiar remisia
diabetului zaharat de tip 2, a hipertensiunii arteriale i a bolii cardiovasculare. Frecvent, scaderea
ponderal duce la diminuarea terapiei medicamentoase pentru comorbiditile obezitii.
Cand se apeleaza la chirurgia bariatrica este important s ne gndim att la beneficii i riscuri, ct
si la atitudinea pacientului fata de aceasta optiune. Astfel, el trebuie s fie motivat i s neleag
schimbrile stilului de viat si faptul ca acestea vor fi permanente.
Exist date referitoare la riscurile i complicaiile chirurgiei bariatrice precum litiaza biliar,
deficitul de micro si macronutrieni, osteoporoza i diverse patologii de natur psihiatric. Unele
studii ne arat o scdere a densitii minerale osoase, dar nu avem suficiente date care sa ne indice
riscul de fractur pe termen lung.
Pentru a avea rezultate favorabile, chirurgia bariatric necesit evaluri psihologice i psihiatrice
preoperatorii pentru fiecare pacient. Acest lucru este necesar deoarece depresia i anxietatea pot
genera i pot fi generate de obezitate. Date din literatura de specialitate relateaz o mbuntire a
componentei psihologice postoperatorii, dar acest lucru nu este valabil n toate cazurile. Unii dintre
pacieni continu lupta cu scderea n greutate, meninerea acesteia i tendina ctre rengrare.
Aceste rezultate confirm importana efecturii unor studii cu evaluare pe termen lung a depresiei
prin scale specifice.
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IS BARIATRIC SURGERY A SAFE OPTION FOR OBESITY?
Simona Fica1,2 , Anca Sirbu1,2

1 UMF Carol Davila, Endocrinology and Diabetes Department, Bucharest, Romania
2
Elias University Hospital, Endocrinology and Diabetes Department, Bucharest, Romania
According to WHO, there has been an alarming increase in rates of obesity and overweight in both
adults and children. Worldwide, obesity has more than doubled since 1980. Obesity has a great
number of negative consequences regarding the economic, social and, most important, health
factors such as a greater risk of cardiovascular diseases, diabetes and certain cancers. In Europe,
overweight and obesity are responsible for about 80% of cases of type 2 diabetes, 35% of ischemic
heart disease and 55% of hypertensive disease among adults. Lifestyle intervention programs with
diets, exercise programs and pharmacotherapy are used but, unfortunately, clinically significant
weight loss is very modest and transient. From the end of the 20th century, bariatric surgery has
emerged as a powerful tool in controlling obesity-related comorbidities, which has evolved rapidly
into the so-called metabolic surgery. Bariatric surgery has been shown to help improve or resolve
many obesity-related conditions, such as type 2 diabetes, high blood pressure, heart disease, and
more. Frequently, individuals who improve their weight find themselves taking less and less
medications to treat their obesity-related conditions.
When choosing bariatric surgery It is important to consider both benefits/ risks and the
understanding of the life-long commitment this type of option requires. Therefore, patients must
have serious motivation and a clear comprehension of the extensive dietary, exercise and medical
guidelines that must be followed for the rest of their lives after having weight loss surgery.
There is data regarding risks and complications of bariatric surgery, such as gallstones, nutritional
deficiencies, osteoporosis and psychiatric problems. There were some studies that showed a
significant change of the bone mineral density, yet not enough to prove that there is a related long
term risk of bone fractures.
In order to have a successful outcome bariatric surgery requires both preoperative psychological
and psychiatric evaluations of each patient. This is needed because symptoms of depression and
anxiety can trigger or be triggered by obesity. A review of the literature identified a trend
suggesting improvements in psychological health after bariatric surgery. However, not all patients
report psychological benefits after surgery. Some patients continue to struggle with weight loss,
maintenance and regain. These results emphasize the importance of long follow-up in future
studies, as well as the evaluation of different measures of depression.
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RW11. BOALA RENAL DIABETIC: ESTE MOMENTUL UTILIZRII DE RUTIN
A BIOPSIEI RENALE?
Gener Ismail
Clinica de Nefrologie, Institutul Clinic Fundeni, Bucuresti, Romania
Nefropatia diabetica este o cauza majora de Boala Cronica de Rinichi, iar incidenta diabetului
zaharat creste rapid in intreaga lume. Markerii serici si urinari utilizati actual in diagnosticul si
monitorizarea nefropatiei diabetice au numeroase limitari. In practica clinica actuala, primul semn
de nefropatie diabetica este considerat a fi aparitia microalbuminuriei, test care are cateva limitari,
cum ar fi sensibilitatea redusa si variabilitatea ridicata. Un diagnostic precis a leziunilor specifice
nefropatiei diabetice nu poate fi facut decat prin examenul histopatologic al tesutului renal. Acum
in practica curenta, biopsia renala este indicata in cazul pacientilor cu diabet zaharat doar in
conditiile existentei unei suspiciuni clinice a unei alte nefropatii, decat cea diabetica. Date
publicate sugereaza ca doar o treime din pacientii cu diabet zaharat biopsiati renal au nefropatie
diabetica, o treime au nefropatie diabetica asociata cu alte nefropatii, in timp ce o treime au alte
nefropatii. Diagnosticul precoce al unei nefropatii non-diabetice este vital in managementul
acestor pacienti, mai ales in cazul glomerulopatiilor primitive, glomerulopatiilor secundare unor
boli sistemice sau nefropatiilor interstitiale. In ciuda progreselor inregistrate in ultimii ani in
cunoasterea patogeniei bolii prognosticul pacientilor cu nefropatie diabetica ramane rezervat. De
aceea sunt necesare noi strategii terapeutice care sa fie confirmate de studii clinice puternice; una
din strategii ar putea fi instituirea tratamentului in fazele initiale ale bolii cand leziunile renale sunt
incipiente si au cota mare de reversibilitate. Utilizarea biopsiei renale in diagnosticul precoce si
monitorizarea raspunsului la terapie in cadrul trialurilor clinice ar putea contribui la identificarea
unor noi medicamente eficiente in tratamentul nefropatiei diabetice.
DIABETIC NEPHROPATHY: HAS THE TIME FOR ROUTINE KIDNEY BIOPSY

ARRIVED?
Gener Ismail
Nephrology Department, Fundeni Clinical Institute, Bucharest, Romania
Diabetic nephropathy is a major cause of ESRD, and the incidence of diabetes mellitus is rising
rapidly. Urinary and serum markers presently accepted in diagnosing and monitoring diabetic
nephropathy have many drawbacks. In the current clinical practice, microalbuminuria which is
considered to be the first sign of diabetic nephropathy, has also some limitations such as low
sensitivity and high variability. An accurate estimate of damage in diabetic nephropathy can only
be achieved by the histological analysis of tissue samples. At the present time, renal biopsy is
indicated on patients with diabetes under the suspicion of the presence of nephropathies other than
diabetic nephropathy. Available data suggest that approximately one third of patients with diabetes
36
that are biopsied show diabetic nephropathy, another third diabetic nephropathy with a
Page
superimposed non-diabetic disease and the other third a non-diabetic condition.

Early diagnosis of diseases different from diabetic nephropathy in diabetic patients is fundamental
to preserve renal function in patients with renal diseases for which the natural history can be
modified by treatment, especially in primary glomerulonephritis, systemic diseases with renal
involvement or interstitial nephritis.
For that reason, we need new therapeutic strategies confirmed by powerful clinical studies; one
approach should be starting the treatment in the early phases of the disease when renal injury is
incipient and with a high potential of reversibility. Using renal biopsy for timely diagnosis and
monitoring of response to therapy in clinical trials could have an impact on identification of new
and more efficient drugs in the treatment of diabetic nephropathy.
RW12. ALIMENTAIA RESTRICTIV VERSUS ALIMENTAIA CU (MAI) PUINE

CALORII
Prof. Univ. Dr. Mariana Graur1,2

1
UMF "Grigore T.Popa"
2
Spitalul "Sf Spiriodon" Iasi, Romania
Exist un continuum al comportamentului alimentar de la alimentaia normal la tulburrile

recunoscute psihiatric (binge eating disorder (BED) sau bulimia nervoasa (BN)).
Mncatul sntos (normal) ofer organismului necesarul cantitativ si calitativ de nutrieni dar i
plcere. Majoritatea populaiei reuete s-i auto-regleze comportamentul alimentar spre
satisfacerea necesitilor energetice dar i hedonice i simbolice. Unele persoane prezint
suprareglri ale comportamentului alimentar care duc la subponderalitate si malnutriie, alii
nregistreaz eecuri n auto-reglare care duc la suprapondere si obezitate. Dereglrile, fie n plus
fie n minus, atrag complicaii somatice i psihice, care necesit control medical i sfat nutriional
tiintific adecvat. Pentru prevenia/ combaterea obezitii se remarc dou abordri distincte:
mncatul restrictiv vs restricia de calorii.
Mncatul restrictiv/reinut nseamn evitarea anumitor alimente sau modele autoimpuse de diete
considerate sntoase, care elimin flexibilitatea social, fr referire la controlul caloric.
Mncatul restrictiv duce rareori la succes pe termen lung privind pierderea n greutate, genereaz
dezinhibare, tulburri de tip obsesiv-compulsiv i greutate ciclic, de tip yo-yo. Teoria restrictiv
susine c pre-sarcina duce la slbirea restriciilor i la cont reglare (supraalimentare) pentru c
dieta a avut un efect de contor.
Restricia de calorii creaz un deficit caloric, adic se mannc mai puin dect se consum (arde),
deficitul fiind acoperit de grsime corporal. A mnca orice, n limita caloriilor permise, pstreaz
o stare de spirit bun, asigurnd libertatea de a mnca variat i divers.
Alimentele aduc un sentiment de satisfacie (recompens) care poate apare la anticiparea
consumrii produselor sau la degustarea i ingerarea lor. Studiile au demonstrat c un nivel ridicat
de dopamin este egal cu un nivel ridicat de plcere la hran, dar sunt necesari i un numr adecvat
de receptori pentru dopamin pentru a obine acel sentiment de recompens i de fericire. Mai
putini receptori D2 nseamn recompens redus, chiar dac nivelul dopaminei este ridicat.
37
Persoanele cu probleme de greutate obin prea mult satisfacie din alimente sau insuficient
Page
satisfacie. Cercetatorii privind functionarea creierului au venit cu dou posibile explicaii, opuse,
de ce oamenii mannc n exces.
Hyper-rspuns: alimentele declaneaz o plcere mult mai mare la mncatul n exces (mncatul n
exces acioneaz ca un drog)
Hypo-rspuns: produsele alimentare declanseaz o plcere mult mai mic, mncatul n exces fiind
pentru a atinge nivelul de plcere.
Teoria recompensei alimentare afirm c recompensa (motivaia) este valoarea hedonic
(plcerea, palatabilitatea) dat de aportul alimentar i care influeneaz cantitatea de alimente i
grasimea corporal prin reglarea ponderostatului.
RESTRAINED EATING VS CALORIE RESTRICTION
Prof. Mariana Graur, PhD1,2

1
UMF "Grigore T.Popa"
2
Hospital "Sf Spiriodon" Iasi, Romania
There is a continuum of eating behavior from normal eating to recognized psychiatric disorders
(binge eating disorder - BED and bulimia nervosa - BN). To ensure that our bodies receive the
necessary amount of nutrients of the best quality, we are encouraged to adopt normal eating habits
and most of us eventually manage to control and regulate our food intake in order to meet not only
our bodies energy demands, but also to fulfill our hedonic desires or urges with deep social and
symbolic implications. Nevertheless, there are still many people who either embrace over-
regulatory habits, resulting in underweight and malnutrition or fail in self-regulating their eating
behavior, leading to overweight and obesity. The eating disorders of both underweight and
overweight individuals often have somatic and psychic implications that require medical attention
and nutritional supervision.
Restrained eating involves the act of abstaining from consuming or avoiding certain food
categories, as well as eating in specific patterns that eliminate social flexibility. In other words,
restrained eating does not address the point of caloric control. This type of eating rarely leads to
long-term sustainable weight loss success; it is often associated with disinhibition, obsessive-
compulsive disorders and weight cyclying (yo-yo). In accordance with the Restraint Theory, the
preload eventually leads to loosening ones restraints and to overeating because the overall dietary
program is based on strict caloric intake (counter effect).
Calorie restriction is a dietary intervention resulting in a caloric deficit; in other words, people eat
less than they burn and their bodies are forced to tap into their adipose tissue. In calorie restricted
diets, people are allowed to eat anything they want, provided their calorie limits are not exceeded.
Such dieters generally stay in a good mood because they can enjoy food diversity. Cognitive
factors, anticipation and taste are known to influence food intake, which generally triggers a
rewarding feeling-good experience. Associating food pleasure with the release of dopamine, many
scholars have interpreted the occurrence of high levels of dopamine in terms of elevated levels of
experienced food pleasure. Nevertheless, other studies have argued that the intensity of peoples
feelings of reward and happiness highly depend upon the number of specialized dopamine
38
receptors. Thus, the existence of fewer D2 receptors means less reward, even if the overall level
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of dopamine is high. The level or degree of food satisfaction among those who strive to control
their weight is dependent upon the number of these receptors.
Researchers investigating brain functioning and overeating have come up with two opposite
potential explanations on why people eat too much:
Hyper-response. It is believed that food triggers a much bigger pleasure response in overeaters
than that in normal eaters. Overeating functions like a drug.
Hypo-response. It is believed that food triggers a much smaller pleasure response in overeaters
than that in normal eaters. Thus, overeaters eat more to compensate for their lack of food reward
response.
The food reward theory states that the reward (motivation) and the hedonic (pleasure, palatability)
value of food influence food intake and body fat setpoint.
RW13. WHAT IS DRIVING THE DIABETES EPIDEMIC? EVIDENCE FROM THE

DIABETES IMPACT STUDY, DENMARK
Anders Green1,2, Camilla Sorts1,3, Peter Bjdstrup Jensen2, Martha Emneus1

1
Institute of Applied Economics and Health Research (ApEHR), Copenhagen, Denmark;
2
Odense Patient data Explorative Network (OPEN), Odense University Hospital and University
of Southern Denmark, Denmark;
3
Centre of Health Economics Research (COHERE), Department of Business and Economics,
University of Southern Denmark, Denmark
Globally, the prevalence of diabetes is rapidly increasing which has given rise to the notion of the
diabetes epidemic. The Danish Diabetes Impact Study builds on The Danish National Diabetes
Register covering all persons with diabetes in Denmark alive as of January 1st 1997 and included
hereafter. Using linked data from all relevant national health registers we have characterized the
epidemiology of diabetes in Denmark from the end of 1999 through 2011.
We have used stock and flow models for the period 2000 through 2011 to describe scenarios of
the prevalence of diabetes under assumptions concerning the trends in (1) general population
demography; (2) incidence rate of diabetes; (3) rates of developing long-term complications, and
(4) mortality rate in the diabetes population. All analyses have been stratified for sex and age.
During year 2000 18,376 new cases of diabetes were registered in Denmark, contrasting 8,314
deaths in the diabetes population. During year 2011 31,821 new cases were registered in contrast
to 11,901 deaths.
During the 12-years period from end of 1999 to end of 2011 the prevalence increased from 132,624
to 300,769 (127%). According to the scenarios, explanatory fractions of this increase during the
period were: general population demography: +4.7%, incidence rate: +28.7%, complication rates:
+4.1% and mortality rates: +12.6%. The remaining 49.9% of the increase cannot be explained by
these conventional drivers but is attributable to the effect of the huge and increasing imbalance
39
between much higher number of new cases as compared to the number of deaths. These
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mechanisms will be further discussed and used for establishing scenarios for the future prevalence
of diabetes.
Our analysis shows that demographical changes in the background population contribute only little
to the increasing prevalence and that the major part of the prevalence increase is explained by the
huge and imbalance between annual new cases as contrasted with deaths.
The results of such analyses are specific for disease, populations and time periods covered.
However, the principles may be applied to other diseases, populations and periods, provided that
baseline epidemiological parameters are available empirically or by reasonable assumptions.
RW14. TREATMENT WITH GLUCAGON LIKE PEPTIDE RECEPTOR AGONISTS

10 YEARS AFTER
Cristian Guja
National Institute of Diabetes, Nutrition and metabolic Diseases Prof. NC Paulescu, Bucharest,
Romania
Glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1 RAs) are members of the modern
family of incretin based anti-diabetes drugs. Following binding on GLP-1 receptors, they stimulate
insulin secretion from the pancreatic beta cells, they inhibit glucagon secretion from the pancreatic
alpha cells (both in a glucose dependent manner). In the same time, they decrease appetite and
consequently food intake with weight benefits and delay gastric emptying, with improvement of
postprandial blood glucose values.
According to their action profile, GLP-1 RAs can have a short or long action. Short action
compounds include exenatide BID (Byetta, Astra Zeneca) and lixisenatide (Lyxumia, Sanofi).
Long acting compounds include liraglutide (Victoza, Novo Nordisk) with daily administration
and the once weekly formulations exenatide QW (Bydureon, Astra Zeneca), albiglutide
(Tanzeum, Glaxo Smeetkline) and dulaglutide (Trulicity, Eli Lilly). Biochemically, GLP-1 RAs
can be divided in exendin-4 derivates and human GLP-1R analogs. Exendin-4 is a 39 amino-acid
polypeptide extracted from the saliva of the Gila monster lizard. It shares 53% homology with
human GLP-1 but conserves full binding to the human GLP-1 Receptor. Exendin-4 derivates
include exenatide and lixisenatide. Human GLP-1 Receptor analogs include liraglutide
(substitution of lysine with arginine in position 34 and binding of a C16 fatty acid at lysine from
position 26), albiglutide (dimer of a 30 amino-acid peptide bound to human albumin) and
dulaglutide (two GLP-1 chains bound to a immunoglobulin fragment).
Short acting GLP-1 RAs have a strong effect of gastric emptying prolongation and
consequently seem to be more suitable for the treatment of patients with marked postprandial
hyperglycemia. They have more pronounced gastro-intestinal side effects, including nausea and
vomiting. Generally HbA1c decrease is lower in comparison with that obtained with the long
action GLP-1 RAs. The last have an attenuated effect on gastric emptying (due to a tachyphylaxis
effect) and consequently have less GI side effects and are better for patients with predominantly
40
fasting hyperglycemia.
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The efficacy of GLP-1 RAs is robust, with HbA1c decreases generally higher than 1%, up
to 2%. They can be recommended already from the second step of therapy in patients which do
not reach targets with metformin monotherapy or from the second step, in patients with failure of
combination therapy. They can also be combined with basal insulin, this association being
advocated both by the ADA/EASD 2015 algorithm and AACE 2016 guideline before adding
prandial insulin to basal insulin treatment.
Beyond blood glucose control, GLP-1RAs are associated with weight loss (generally in the
magnitude of 2-4 kg) and have a low risk of hypoglycemia (though significant in the case of
association with either insulin or suplphonylureas). Lixisenatide was shown to be neutral on CV
risk in the recently published ELIXA study while liraglutide seemed to decrease CV risk in patients
from the LEADER study, to be presented during the New Orleans, ADA 2016 annual meeting.
CV safety studies with exenatide QW (EXSCEL), albiglutide (HARMONY) and dulaglutide
(REWIND).
RW15. THE GENETIC BACKGROUND OF HUMAN OBESITY
Cristian Guja, Constantin Ionescu-Trgovite

National Institute of Diabetes, Nutrition and metabolic Diseases Prof. NC Paulescu, Bucharest,
Romania
Obesity is one of the most common chronic diseases in human populations across the
globe, the current epidemic affecting over 500 million adults. Similar to other common human
complex diseases obesity pathogenesis involves both genetic and environmental factors. The last
include hypercaloric diet, sedentarism, stress and other conditions such as urbanization and
westernized lifestyle. Considerable evidence from epidemiologic twin, adoption and family
studies indicated that body weight and body fat disposition have a heritability of up to 70%,
highlighting the importance of heredity/genetics.
The discovery of single gene variants associated with rare causes of extreme obesity in
children highlighted the pivotal role of hormonal and neural hypothalamic networks regulating
body weight. The majority of these genes were discovered following studies in animal models
(mice) and subsequently confirmed in humans. Among these are the genes for leptin (Lep), leptin
receptor (Lepr), proopiomelanocortin (POMC), melanocortin 4 receptor (MC4R) and prohormone
convertase 1 (PCSK1). Some other gene variants were discovered analyzing the equally rare cases
with complex syndromes associating obesity. Again most genes identified are related to central
nervous system appetite centers. In contrast with the severe obesity cases induced by homozygous
mutations in these genes, carriers of heterozygous mutations exhibit less severe obesity.
In contrast with monogenic forms of obesity, in the common form of polygenic obesity the
genetic risk is influenced by the combined effect of variation at numerous loci. Thus, the recent
genome-wide association studies for obesity related traits such as body mass index or waist
41
circumference identified more than 120 gene variants/loci, the vast majority with a modest effect
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(their combined effect explains only a small part of BMI heritability). Many of these were shown
to be highly expressed in the brain, particularly in the hypothalamus, highlighting again their
importance in regulating food intake and, subsequently, adiposity. The fat mass and obesity
associated gene (FTO) on chromosome 16 was the first gene convincingly proven to be associated
with common human obesity.
The fact that gene variants identified so far has such a poor predictive value for obesity,
especially when compared with risk calculators based on clinical factors, is known as missing
heritability and has several potential explanations. Epigenetic factors (such as DNA methylation
and histone modification) presumably play an important role in the pathogenesis of human obesity.
They might mediate the effects of the environment on the risk of obesity. Further research is
needed to clarify the role of genetic variation and epigenetic mechanisms in the development of
human obesity.
RW16. ATEROGENEZA, ATEROSCLEROZA, ATEROTROMBOZA: DE CE

PREZINT DIFERENE N DIABETUL ZAHARAT?
Aterogeneza, ateroscleroza i aterotromboza sunt stadii evolutive ale unui proces ce culmineaz
cu un eveniment coronarian acut. Prevalena i viteza de progresie a acestor procese sunt
influenate de diveri factori, cum ar fi genul, vrsta, stilul de via sau afeciunile asociate.
Diabetul zaharat este un cunoscut factor major de risc cardiovascular, care influeneaz nefast
aceste procese, datorit hiperglicemiei, inflamaiei, disfunciei microvasculare i creterii stresului
oxidativ. Sunt descrise procesele moleculare prin care diabetul promoveaz iniierea leziunii
aterosclerotice, progresia plcii de aterom i inhib regresia leziunii. ntre diabet i aterogenez
exist o puternic asociere, ateroscleroz n diabet avnd o evoluie strns legat de inflamaie i
tulburrile metabolice asociate, iar afectarea proceselor de coagulare i tromboz favorizeaz
apariia aterotrombozei la aceast categorie de pacieni.
ATHEROGENESIS, ATHEROSCLEROSIS, ATHEROTHROMBOSIS: WHY ARE

THEY DIFFERENT IN DIABETES?
Atherogenesis, atherosclerosis and atherothrombosis are evolutionary stages of a process that

culminates with an acute coronary event . The prevalence and the rate of progression of these
processes are impacted by various factors such as gender, age, lifestyle or related diseases.
Diabetes mellitus is a known major cardiovascular risk factor that negatively influences these
processes, due to hyperglycemia, inflammation, microvascular dysfunction and increased
42
oxidative stress. There are described the molecular processes through which diabetes promotes
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atherosclerotic lesion initiation, progression of plaque and inhibits lesion regression. There is a
strong association between atherogenesis and diabetes, with atherosclerosis development in
diabetes closely linked to inflammation and associated metabolic disturbances and the presence of
impaired clotting and thrombosis processes favors the appearance of atherothrombosis in patients
with diabetes.
RW17. CONSENS ASUPRA DISLIPIDEMIEI ATEROGENE
Nicolae Hncu
n 10 noiembrie 2014 s-a ntrunit la Paris (Frana) un consoriu de experi europeni n domeniul
lipidologiei clinice i a bolii cardiovasculare pentru a discuta problema dislipidemiei aterogene
(DA) i abordarea n practic a riscului cardiovascular pe care aceasta l reprezint. Au fost
publicate n Atherosclerosis Supplements pn n prezent 2 articole referitoare la propunerile
acestui consoriu, unul n toamna anului 2015, intitulat A review of the evidence on reducing
macrovascular risk in patients with atherogenic dyslipidaemia: a report from an expert consensus
meeting on the role of fenofibratestatin combination therapy i cel de al doilea intitulat Current
practice in identifying and treating cardiovascular risk, with a focus on residual risk associated
with atherogenic dyslipidaemia a fost publicat n aprilie 2016. n acest ultim articol a fost
propus o definiie simpl i practic a dislipidemiei aterogene: trigliceride crescute (150 mg/dl)
i HDL-colesterol mic (sub 40mg/dl la brbai i sub 50 mg/dl la femei) la pacieni tratai cu statine,
aflai la risc cardiovascular crescut. Managementul clinic cuprinde optimizarea stilului de via,
statinoterapia pentru aducerea LDL-colesterol n inte (se poate asocia i ezetimibul), iar
tratamentul DA reziduale se va completa cu fenofibrat, pentru a obine corectarea ntregului tablou
lipidic. Se discut de asemnea diverse scenarii unde se propune utilizare fenofibratului: la pacieni
cu trigliceride foarte crescute sau la cei cu intoleran la statine sau la cei tratai cu statine, dar cu
DA i risc cardiovascular crescut.
CONSENSUS ON ATHEROGENIC DYSLPIDAEMIA
Nicolae Hncu
A meeting of European experts in lipids and cardiovascular disease was convened in Paris (France)
on 10th of November 2014 to discuss the current understanding of atherogenic dyslipidaemia (AD)
and its associated cardiovascul risk. Two articles are published by now in Atherosclerosis
Supplements regarding the proposals of this consortium, first in autumn of 2015 entitled A review
of the evidence on reducing macrovascular risk in patients with atherogenic dyslipidaemia: a
report from an expert consensus meeting on the role of fenofibratestatin combination therapy
and the second entitled Current practice in identifying and treating cardiovascular risk, with a
43
focus on residual risk associated with atherogenic dyslipidaemiawas published in April 2016. In
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the latter article it was proposed a simple and practical definition of AD: high triglycerides (150
mg/dl) and low HDL cholesterol (less than 40 mg/dl in men and less than 50 mg/dl in women) in
statin-treated patients at high cardiovascular risk. Clinical management of AD includes lifestyle
optimization, LDL cholesterol lowering therapy with statins (ezetimibe can be added) and residual
AD can be treated with the addition of fenofibrate, since it can improve the complete lipoprotein
profile. Various scenarios regarding clinical situations where the use of fenofibrate might be
beneficial are discussed: patients with very high triglycerides or patients with intolerance to statins
or patients treated with statins, but with AD and increased cardiovascular risk.
RW18. IDENTIFICAREA STADIILOR PRECOCE ALE DIABETULUI ZAHARAT DE

TIP 1, NAINTEA APARIIEI PRIMILOR ANTICORPI ANTI BETA CELULARI
Institutul Naional de Diabet, Nutriie i Boli Metabolice Prof. NC Paulescu, Bucureti,
Romnia
Au trecut mai mult de 40 de ani de la apariia teoriei imunogenetice privind patogenia

diabetului zaharat de tip 1 (DZ tip 1). Cu toate acestea, toate ncercrile din ultimele 4 decade
pentru prevenirea sau mcar oprirea distrugerii autoimune a celulelor beta pancreatice folosind
diferite metode de imunosupresie sau imunomodulare au euat. Principala explicaie este
reprezentat de faptul c toate aceste studii au inclus pacieni selectai la scurt timp de la debutul
clinic al bolii, uneori chiar i la 2 sau 5 ani de la acesta. Se tie ns n prezent c la momentul
diagnosticului clinic al diabetului, mai mult de 80-90% din masa beta celular este deja ireversibil
pierdut.
n ultimele 2 decenii, mai multe centre de diabet au inclus pentru urmrire prospectiv
copii sau frai ai pacienilor cu DZ tip 1. Scopul a fost identificarea apariiei primilor anticorpi anti
beta celulari (prima seroconversie), apoi apariia celui de-al doilea, al treila tip )seroconversie
multipl) i aa mai departe. n majoritatea acestor studii au fost prelevate probe de snge nc de
la natere (din cordonul ombilical) i apoi anual timp de 15, 20 sau uneori chiar 30 de ani. n urma
rezultatelor acestor studii, riscul de a dezvolta diabet zaharat clinic manifest a fost estimat pe baza
vrstei la momentul primei seroconversii, pe baza numrului de autoanticorpi i a titrului acestora,
uneori combinat cu determinarea prezenei unor variante genice de predispoziie/protecie pentru
DZ tip 1. n unele cazuri predicia apariiei bolii a fost reuit n procente de peste 95%, chiar i
pn la 99%. Cu toate aceste progrese, un diagnostic oficial de DZ tip 1 nu poate fi pus n absena
debutului clinic, cu hiperglicemie documentat biochimic (decompensare complet a
metabolismului glucidic). La acest moment ns este deja prea trziu pentru orice ncercare de a
mai preveni diabetul sau chiar pentru a preveni distrugerea n continaure a puinelor celule beta
pancreatice nc viabile. De aceea, de-a lungul anilor am propus n mod repetat ca definiia
diabetului zaharat s fie fcut nu doar pe baza apariiei epifenomenului hiperglicemie ci pe baza
fenomenului n sine, i anume scderea masei/funciei beta celulare.
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IDENTIFICATION OF THE EARLY STAGES OF TYPE 1 DIABETES, BEFORE FIRST
ANTI BETA CELL ANTIBODY SEROCONVERSION
National Institute of Diabetes, Nutrition and Metabolic Diseases Prof. NC Paulescu, Bucharest,
Romania
More than 40 years have passed since the launch of the immune-genetic theory of type 1
diabetes (T1D). However, all the attempts carried out in the last 4 decades to prevent or stop the
autoimmune destruction of -cells using immune suppression or immune modulator methods, have
failed. The main reason is that all prevention studies included patients selected soon after the
clinical onset of diabetes and, sometimes, even 2 or 5 years later. It is known today that when the
blood glucose starts to rise, more than 80-90% of the -cell mass is already irreversibly lost.
In the last 2 decades, in several centers of diabetes, a large number of offspring or siblings
of patients with T1D have been enrolled in a prospective follow-up for the identification of the
first anti-beta cell antibodies appearance (first seroconversion), then of the second or third antibody
(multiple seroconversion) and, finally, of the clinical onset of diabetes. In the majority of these
studies blood samples have been obtained from the umbilical cord at birth and then, yearly, up to
15, 20 or, in a few studies, even more than 30 years. From these studies the risk of developing
clinical diabetes has been calculated according with the age of the first seroconversion, the number
and titer of antibodies and, in some cases, the presence of gene variants associated with
predisposition or protection for T1D. In some cases, the risk for developing diabetes was higher
than 95%, up to 99%. Despite all these progresses, the official diagnosis of type 1 diabetes could
not be accepted unless clinical onset (full blood glucose decompensation) took place. In this stage,
this is already too late for any attempt to prevent diabetes or even to prevent further destruction of
the small number of -cells that still remain alive. That is why, along the years we proposed to use
for the definition of diabetes not the epiphenomenon (hyperglycemia), but the phenomenon itself,
which is the decrease of the -cell mass/function.
RW19. SELF-MONITORING OF BLOOD GLUCOSE IN TYPE 2 DIABETES WHY,

WHEN, HOW OFTEN?
Gyrgy Jermendy, MD
Bajcsy-Zsilinszky Hospital, Budapest, Hungary
Self-monitoring of blood glucose (SMBG) should be considered in all patients with either type 1
or type 2 diabetes in order to detect or, more importantly, to avoid hypoglycemia. In addition,
SMBG is the only way to find out the blood glucose level at a certain point in time. It is the most
practical method of measuring post-meal glycemia. It support decision making with regards to
45
changes to meals, activity and medication. When SMBG is taken over 2-3 days it can reveal
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patterns in blood glucose levels.

As for the association between SMBG and glycemic control (HbA1c values), insulin-treated and
non-insulin-treated diabetic patients should be assessed separately. There is no doubt that SMBG
is a useful method for achieving and maintaining proper glycemic control in insulin-treated
diabetic patients. On the other hand, the relationship of SMBG to glycemic control in non-insulin-
treated type 2 diabetic patients is debated in the literature. However, there are strong providing
data for using regular SMBG in these patients as well. For example, The German multicentre
Retrolective Study 'Self-monitoring of Blood Glucose and Outcome in Patients with Type 2
Diabetes' (ROSSO) followed 3,268 patients from diagnosis of type 2 diabetes between 1995 and
1999 until the end of 2003. In this study SMBG was associated with decreased diabetes-related
morbidity and all-cause mortality and this association remained in a subgroup of patients who were
not receiving insulin therapy. Recently, the randomized, prospective STeP study demonstrated that
the structured SMBG in poorly controlled, insulin-nave type 2 diabetic patients proved to be
efficacious and clinically meaningful. In the St. Carlos randomized, prospective study SMBG was
used as an educational tool supporting lifestyle changes and for the management of
pharmacological treatment while treatment of controls were based on HbA1c values among newly
diagnosed type 2 diabetic patients. After 1 year, the SMBG group showed significant reductions
in median HbA1c values as compared with no change in the control group. The Cochrane review
Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using
insulin published in 2012 reported an overall effect of SMBG on glycemic control up to 6
months after initiation, which was considered to subside after 12 months. Nevertheless, this review
was criticized later. A European Perspective and Expert Recommendation (Addressing Schemes
of SMBG in type 2 diabetes) was published in 2011 and Recommendations from the International
Central-Eastern European Expert Group became also available in 2014.
The frequency of SMBG should be less or more intensive depending the antidiabetic treatment of
patients with type 2 diabetes. Undoubtedly, SMBG should be performed in a structured setting. In
addition, personalized approaches of SMBG are a prerequisite for its success in type 2 diabetic
patients. SMBG is not a measure for collecting blood glucose values, rather it is a method for
achieving better glycemic control by using it in a structured and personalized approach.
RW20. THE GLUCOSE VARIABILITY AND DIABETIC RETINOPATHY
Prof. Dr. Sehnaz Karadeniz 1,2

1
Istanbul Florence Nightingale Hospital, Ophthalmology Dept. and
2
Istanbul Science University, Ophthalmology Dept.
Diabetic retinopathy, is the most common and specific microvascular complication of diabetes,
and remains among the leading causes of preventable blindness in the working age population. All
people with diabetes are at risk for DR, the numbers of people with diabetic retinopathy and vision
threatening disease are increasing, as the number of people with diabetes increases.
Several risk factors, modifiable or non-modifiable, have been identified for the development and
progression of diabetic retinopathy.
46
For the last nearly 3 decades, managing the metabolic deregulation, has been the most effective
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way, to delay, or slow down the progression of diabetic retinopathy and other microvascular
complications. It has been clearly shown that, any reduction in HbA1c is likely to reduce the risk
of complications, with the lowest risk being in those with HbA1c values in the normal range. But
intensive blood glucose control as reflected by the HbA1c did not show this effect in a considerable
number of patients.
Another issue related to blood glucose control has arisen in the last decade. That is, whether the
shortterm and longterm glucose fluctuations has more deleterious effect on diabetes complications
than chronic stable hyperglycemia .
The evidence base shows that acute fluctuations in glycemia can produce enhanced alterations in
homeostasis such as those of endothelial dysfunction and increased inflammation, compared to
chronic stable hyperglycemia,.
But available clinical data remain elusive to answer the question, and further research in this field
can undoubtedly offer new insights.
At this moment, diabetic retinopathy remains one of the most complex, heterogenous,
multifactorial disorders.
RW21. CLINICAL ASPECTS OF AUTONOMIC NERVE DYSFUNCTION IN

DIABETES
Prof. Peter Kempler

1st Dept. of Medicine, Semmelweis University, Budapest, Hungary
Autonomic and sensory neuropathy are progressive complications of diabetes. Cardiac autonomic
neuropathy (CAN) is the most relevant manifestation and carries a fivefold risk of mortality in
patients with diabetes. The high mortality rate may be related to silent myocardial infarction,
cardiac arrhythmias, cardiovascular and cardiorespiratory instability and to other causes not
explained yet. Silent myocardial infarction should always be suspected in diabetic patients
suffering from acute cardiac failure/pulmonary oedema, collapse, vomiting or unexplained
hyperglycaemia, especially cetoacidosis of unknown origin.
Higher heart rate is associated with poor prognosis. Moreover, tachycardia is considered as an
independent risk factor for the development of atrial fibrillation as well. If hyperthyreodism,
anaemia and infection can be excluded in a diabetic patient with tachycardia, it is most likely due
to CAN. There is a close relationship between severity of CAN and prolongation of the corrected
QT-interval. Lengthening of the QT-interval leads to ventricular premature beats, ventricular
tachycardia, ventricular fibrillation and thus quite often to the sudden death of the diabetic patient.
The predominant feature of CAN is parasympathetic autonomic neuropathy. It is associated with
relative sympathetic overactivity and this way leads to the development of hypertension. It should
be noted that hypertension is often associated with orthostatic hypertension, while the symptoms
of orthostatic hypertension are often misinterpreted as hypoglycaemia.
The connection between autonomic neuropathy and hypoglycaemia is quite comprehensive and
includes hypoglycaemia unawareness, impaired counterregulation to hypoglycaemia, impairment
of autonomic function due to hypoglycaemia and a higher prevalence of severe hypoglycaemia
47
among patients with CAN.

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Gastrointestinal autonomic neuropathy represents the unattended borderline between diabetology
and gastroenterology. The most characteristic symptoms of diabetic gastroparesis are postprandial
fullness, early satiety, nausea and vomiting, bloating and abdominal pain. Postprandial
hypoglycaemia called also gastric hypoglycaemia may occur as a consequence of delayed food
absorption among insulin treated patients, usually with long standing diabetes. Other
manifestations of autonomic neuropathy will be mentioned very briefly.
RW22. GOLIREA GASTRIC I RISCUL CARDIOVASCULAR N DIABETUL

ZAHARAT
ef Lucr. Lctuu Cristina Gabriela1, ef Lucr. Botnariu Gina Eosefina1, ef Lucr. Popescu
Raluca Maria1, Asist. Univ. Popa Alina Delia1, Conf. Univ. Mihai Bogdan Mircea1
1
Universitatea de Medicin i Farmacie Grigore T. Popa Iai
Premise i Obiective: Golirea gastric pare a fi legat de riscul cardiovascular la persoanele cu

diabet zaharat, avnd n vedere c cea dinti exercit efecte asupra hiperglicemiei postprandiale i
este implicat n rspunsul protector mpotriva hipoglicemiei, iar ambele fenomene menionate
implic posibile consecine asupra aparatului cardiovascular. Prin urmare, aceast lucrare i
propune s abordeze principalele asocieri care exist ntre motilitatea gastric i riscul
cardiovascular la pacienii diabetici.
Material i Metod: Am trecut n revist publicaiile referitoare la motilitatea gastric i riscul
cardiovascular n diabet, utiliznd cuvinte cheie adecvate pentru a cuta n baza de date PubMed
articolele care analizeaz aceast tem ntre ianuarie 2000 i martie 2016.
Rezultate i Discuii: Analiza corelaiilor directe i indirecte care exist ntre golirea gastric i
riscul cardiovascular este efectuat ntr-un numr tot mai mare de publicaii din ultimii ani. Cele
mai vizibile subiecte abordate de literatura medical se refer la relaiile dintre fluctuaiile
glicemice i boala cardiovascular, dar i la efectele cardiovasculare exercitate de terapiile
incretinice. n timp ce hiperglicemia postprandial pare a fi direct corelat cu riscul cardiovascular,
unele episoade hipoglicemice ar putea precipita un accident macrovascular acut; din aceast
perspectiv, optimizarea evacurii gastrice pare a fi o msur benefic la toi pacienii diabetici.
Mai mult, terapiile incretinice i alte medicaii care au efect asupra evacurii gastrice sunt n ziua
de azi subiectul unor cercetri extinse, care au furnizat variate rezultate referitoare la beneficiile
cardiovasculare clinic semnificative; mecanismele care se presupune c stau la baza acestor
asocieri sunt de asemenea discutate n lucrarea de fa.
Concluzii: Perspectivele actuale referitoare la relaia dintre golirea gastric n diabet i riscul
cardiovascular necesit probabil restructurri, n sensul evidenierii consecinelor negative induse
de motilitatea gastric anormal, dar i a posibilelor efecte benefice pe care terapiile adresate
acesteia le-ar putea aduce n viitor pacienilor diabetici.
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GASTRIC EMPTYING IN DIABETES AND RELATED CARDIOVASCULAR RISK
Lect. Lctuu Cristina Gabriela1, Lect. Botnariu Gina Eosefina1, Lect. Popescu Raluca
Maria1, Assoc. Lect. Popa Alina Delia1, Assoc. Prof. Mihai Bogdan Mircea1
1
University of Medicine and Pharmacie Grigore T. Popa Iai
Premises and Objectives: Gastric emptying appears to be related to cardiovascular risk in

diabetes, as the former exerts effects on postprandial hyperglycemia and is involved in the
protective response against hypoglycemia, and both of these phenomena imply possible
consequences on cardiovascular system. Therefore, this paper aims to review the main associations
existing between gastric motility and cardiovascular risk in diabetic patients. Content and method:
We conducted a review analysing publications about gastric emptying and cardiovascular risk in
diabetes, using adequate keywords to search in PubMed database for publications between January
2000 and March 2016.
Results and Discussions: Review of direct and indirect correlations between gastric emptying and
cardiovascular risk involve an increasing number of publications in the last years. The most
outward subjects approached in medical literature are the relationships between glycemic
fluctuations and cardiovascular disease, but also the topic of cardiovascular effects exerted by
incretin-based therapies. As postprandial hyperglycemia seems directly related to cardiovascular
risk, while some hypoglycemic episodes might precipitate an acute macrovascular accident,
optimizing the stomach evacuation would seem an appropriate measure to take in all diabetic
patients. Moreover, incretin-based therapies and other drugs known to influence gastric motility
are nowadays subject to research with various results on outcomes of clinically significant
cardiovascular benefits; presumed mechanisms are also discussed in this paper.
Conclusions: Knowledge upon gastric emptying in diabetes from the perspective of its
relationship with cardiovascular risk should be restructured, as to emphasize both the negative
consequences of abnormal gastric motility and the possible benefits targeted therapies might bring
in the future to diabetic patients.
RW23. RISCUL CARDIOVASCULAR AL AFECTARII POLIVASCULARE LA

PACIENII CU DIABET ZAHARAT TIP 2
Radu Lichiardopol
UMF Carol DavilaBucureti
Ateroscleroza este o boal sistemic. Afectarea unui pat vascular (coronarian, cerebral , arterial
periferic) sugereaz c este posibil s fie afectate i alte teritorii vasculare. Boala polivascular,
definit ca aterotromboz clinic manifest n dou sau mai multe paturi vasculare, confer un risc
nalt pentru evenimente cardiovasculare, fapt cunoscut mai ales n urma studiilor de registru. Intre
acestea, REACH (Reduction of Atherothrombosis for Continued Health) a nrolat o cohort
49
multinaional de pacieni din care 45227 (cu aterotromboz simptomatic sau cu factori majori
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de risc cardiovascular) urmrii prospectiv 4 ani cu obiectiv principal rata evenimentelor

cardiovasculare. Intre acetia, 44% (19699) cu diabet zaharat tip 2. Au fost identificate subgrupe
de pacieni cu riscuri diferite: de la 7% la pacienii nediabetici avnd doar factori de risc CV, la
25% la pacienii cu boal polivascular i istoric de evenimente ischemice. Cel mai puternic
predictor pentru evenimente ischemice pe durata urmririi prospective a fost prezena unui
eveniment ischemic anterior nscrierii n registru. Intre pacienii cu istoric de evenimente
ischemice, cei cu un eveniment ischemic n anul anterior nrolrii n registru au avut un risc mai
mare dect cei la care evenimentul ischemic a survenit la mai mult de un an nainte de nrolarea n
registru. Frecvena evenimentelor cardiovasculare a crescut linear cu numrul de paturi vasculare
afectate: de la 5,3% la pacienii cu factori de risc dar fr aterotromboza , la 12,6% la cei cu un
singur pat vascular afectat la 21,1% la cei cu dou paturi,i la 26,3% la cei cu 3 paturi vasculare
afectate. Prevalena bolii polivasculare a variat n funcie de teritoriul vascular afectat:25% la
pacienii cu boal coronariana, 40% la cei cu boal cerebrovascular i 61% la cei cu boal arterial
periferic. Recent, la Congresul Anual al Asociaiei Americane de Diabet (iunie 2015), au fost
prezentate rezultatele unei analize ad-hoc pe datele cohortei din studiul SAVOR-TIMI 53 care a
fost urmrit prospective cca 2 ani. Au fost analizate: incidena evenimentelor cardiovasculare
adverse n funcie de numrul paturilor vasculare afectate, pe de o parte, i de locaia patului
vascular afectat (la cei cu un singur pat afectat), pe de alt parte. Datele au confirmat rezultatele
REACH privind creterea frecvenei evenimentelor cardiovasculare cu numrul de paturi
vasculare afectate. Analiza a mai artat c pacienii cu boal arterial periferic au avut
,comparativ cu celelalte localizri (coronariana, cerebrovasculara) cea mai mare inciden a
mortalitii de cauz cardiovasculara Aceste date sunt utile pentru stratificarea riscului CV i
evidenierea unor subgrupe de pacieni la risc nalt care necesit o prevenie secundar intensive
CARDIOVASCULAR RISK IN TYPE 2 DIABETES MELLITUS PATIENTS WITH

ATHEROTHROMBOSIS IN MULTIPLE VASCULAR BEDS
Radu Lichiardopol
Carol DavilaUniversity of Medicine, Bucharest, Romania
Atheroslerosis is a systemic disease. The presence of symptomatic atherothrombosis in one

vascular bed (coronary, cerebrovascular or peripheral arterial) is frequently associated with
simultaneous presence of atherosclerotic lesions in other vascular beds. Polyvascular disease,
defined as symptomatic atherothrombosis in at least two major vascular arterial beds, is carrying
a high risk for future cardiovascular events, demonstrated by registry studies such as REACH
Registry (Reduction of Atherothrombosis for Continued Health). A cohort of 45227 patients (with
symptomatic atherothrombosis or risk factors only) were followed-up over the course of 4 years
for cumulative risk for cardiovascular death, myocardial infarction or stroke. In this cohort, 44%
(19,699) were type 2 diabetes patients. Subgroups of patients with varying risks were demarcated:
from 7% in non-diabetic patients with cardiovascular risk factors only, to 25% in patients with
polyvascular disease and history of ischemic events. The strongest predictor for ischemic events
over the prospective follow-up was a history of ischemic event before enrollment in the Registry.
50
Among the patients with a history of ischemic events, those with an ischemic event in the year
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before enrollment had a greater risk compared to those in whom ischemic event occurred more
than a year before enrollment in the Registry. The rate of cardiovascular events during follow-up,
increased lineary with the number of symptomatic disease locations: from 5.3% in patients with
risk factors only, to 12.6% in patients with one location, to 21.1% in patients with two locations,
to 26.3% in patients with location in three vascular beds. The prevalence of polyvascular
atherothrombosis changed with the location of symptomatic vascular beds: 25% in CAD (coronary
artery disease)patients, 40% in CVD (cerebrovascular disease) patients, and 61% in PAD
(peripheral arterial disease) patients. Recently, at ADA 75th Scientific Sessions (june2015), the
results of an ad-hoc analysis of data from SAVOR-TIMI 53 cohort over a 2-year follow-up were
presented. In this cohort, the incidence of adverse cardiovascular events increased lineary as a
function of the number of symptomatic vascular beds. Depending on the location of the vascular
bed involved (in those with only one bed involved), the patients with PAD had, as compared to
CAD and CVD had the greatest cardiovascular mortality. These data, in line with those of the
REACH Registry, are useful for cardiovascular risk stratification and to demarcate subgroups of
patients at extreme high risk for intensive secondary prevention.
RW24. DIABETES AND OBESITY
Dragan D. Micic
School of Medicine, University of Belgrade
Department of Medical sciences, Serbian Academy of Sciences and Arts, Belgrade, Serbia
The risk of diabetes increases with the increasing BMI in men and women. A weight gain of 10
kilograms is associated with a two- to threefold increase in the risk of diabetes. The marked
increase in obesity is an important contributor to the increase in prevalence of Type 2 diabetes all
over the world. Obesity is characterized by an accumulation of fat tissue and by huge production
of adipocyte secretory products adipokines which may have a negative impact on insulin
sensitivity at the peripheral levels, leading at the end to a state of insulin resistance. Increased
tissue fat content is associated with elevation of free faty acids, altered fat topography and
adiposopathy. Pathological adipose tissue dysfunction is composed of a several pathophysiological
mechanisms : impaired adipogenesis during positive caloric balance; dysfunctional fat storage;
impaired nutrient metabolism; abnormal adipocyte factor function; proinflammatory response and
dysfunctional cross-talk. Obesity is characterized by the existence of large, insulin resistant
adipocytes in which catecholamine mediated lipolysis is enhanced leading to excesissive flow of
free faty acids into circulation. When puffering capacity of eutopic fat tissue is compromised starts
production of ectopic fat tissues in human body ( epicardium, muscles, omentum, liver). Most type
2 diabetics posses too much fat; have an abnormal distribution of fat with excessive fat deposition
in muscle, liver and visceral adipocytes; they have large, insulin resistant fat cells whose capacity
to store triglycerides is compomised. In obesity , adipose tissue become a source of inflammation
that drives disease development in distant organs. Recent development in this field indicate a
LTB4 ( a chemokine from adypocites ) to cause macrophage-mediated inflammation leading to a
direct induction of insulin resistance in obesity. It was proposed that inhibition of LTB4 action
51
could be a possible therapeutic goal in the treatment of insulin resistance diseases.

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RW25. STRATEGII PREVENTIVE N COMPLICAIILE MICROVASCULARE ALE
DIABETULUI ZAHARAT
Conf. Mihai Bogdan Mircea1,2, ef Lucr. Botnariu Eosefina1,2, ef Lucr. Popescu Maria1,2,
Asist. Univ. Onofriescu Alina1,2, ef Lucr. Lctuu Cristina Mihaela1,2
1
Grigore T. Popa Universitatea de Medicin i Farmacie Iai, Romania
2
Centrul Clinic de Diabet, Nutriie i Boli Metabolice Iai, Romania
Premise i Obiective: Lumea medical se confrunt n prezent cu creteri ngrijortoare ale

prevalenelor diabetului zaharat, precum i a complicaiilor cronice ale acestuia. Prevenia acestor
complicaii cronice este necesar pentru a asigura pacienilor diabetici o bun calitate a vieii i o
durat relativ normal a acesteia. Pe lng profilaxia bolii macrovasculare, al crei determinism
multifactorial implic o gam complex de msuri preventive, prevenirea complicaiilor
microvasculare trebuie de asemenea s reprezinte un obiectiv fundamental pentru medicii din
aceast specialitate.
Material i Metod: Am trecut n revist publicaiile referitoare la complicaiile cronice
microvasculare ale diabetului zaharat, utiliznd cuvinte cheie adecvate pentru a cuta n baza de
date PubMed articolele care analizeaz aceast tem ntre ianuarie 2000 i martie 2016.
Rezultate i Discuii: Cele mai multe dintre articolele originale i tip review referitoare la
prevenia nefropatiei diabetice sunt legate de conceptul blocadei sistemului renin-angiotensin-
aldosteron, incluznd multiple studii clinice de mari dimensiuni referitoare la beneficiile
renoprotective aduse de tratamentele cu inhibitori de enzim de conversie sau cu blocante de
receptor de angiotensin II. Eficiena msurilor generale, precum controlul glicemic riguros,
tratamentul hipertensiunii arteriale i al dislipidemiei, este de asemenea unanim acceptat. n ceea
ce privete retinopatia diabetic, pe lng principii generale similare referitoare la controlul
glicemic, tensional i dislipidemic, cercetrile din ultimii ani au furnizat dovezi care susin
eficiena tratamentului anti-VEGF (vascular endothelial growth factors) n prevenia
complicaiilor vasculare retiniene. Conceptul memoriei metabolice, presupunnd un risc redus
pentru dezvoltarea mai trziu n cursul vieii a unor complicaii cronice extensive atunci cnd
controlul glicemic riguros este instituit nc din primii ani dup momentul diagnosticului, este de
asemenea menionat frecvent n literatura de dat recent. Perspectiva central din care sunt
abordate prevenia nefropatiei si a retinopatiei este cea de abordare multifactorial, care vizeaz
un control optim al tuturor factorilor de risc menionai anterior.
Concluzii: Pe fondul agravrii progresive a problematicii induse de diabetul zaharat i de
complicaiile sale cronice, se impun strategii eficiente care s mpiedice degradarea strii de
sntate consecutiv acestora. Progresele nregistrate de cercetrile din ultimele decenii permit
astzi o abordare profilactic de mai bun calitate a bolii microvasculare secundar diabetului
zaharat, dar sunt nc necesare date suplimentare, provenind din eforturile desfurate la ora
actual, care s identifice unii factori neconvenionali de risc, nc neprecizai, precum i terapiile
optime care s se adreseze acestora.
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PREVENTIVE STRATEGIES IN DIABETES-RELATED MICROVASCULAR
COMPLICATIONS
Assoc. Prof. Mihai Bogdan Mircea1,2, Lect. Botnariu Eosefina1,2, Lect. Popescu Maria1,2,
Assist. Prof Onofriescu Alina1,2, Lect. Lctuu Cristina Mihaela1,2
1
Grigore T. Popa University of Medicine and Pharmacy Iai, Romania
2
Clinical Centre of Diabetes, Nutrition and Metabolic Diseases Iai, Romania
Premises and Objectives: Modern medical world is witnessing nowadays rapidly escalating rates
of the general prevalence of diabetes mellitus and its chronic complications. Prevention of the
latter is needed in order to keep a good quality and a quasi-normal duration of life in diabetic
patients. Aside macrovascular disease, having a multifactorial determinism and therefore implying
a complex range of preventive measures, prophylaxis of microvascular complications should also
represent a fundamental objective for clinicians in this area.
Content and Method: We conducted a review analysing publications about prevention of chronic
microvascular complications of diabetes, using adequate keywords to search in PubMed database
for publications between January 2000 and March 2016.
Results and Discussions: Most original papers and reviews focusing on prevention of diabetic
nephropathy are related to the concept of renin-angiotensin-aldosterone system blockade, with
multiple major clinical trials referring to the benefits of either angiotensin converting enzyme
inhibitors or angiotensin II-receptors blockers therapies on renoprotection. Efficacy of general
measures, such as tight glucose control, treatment of hypertension and dyslipidemia, is also a
matter of general agreement. As for diabetic retinopathy, besides similar general principles of
glycemic, blood pressure and lipid control, recent years have brought new evidence sustaining the
efficacy of anti-vascular endothelial growth factors (VEGF) therapies in the prevention of the
retinal microvascular complication. The concept of metabolic memory, involving a reduced risk
for developing extensive complications later in life when tight glycemic control is instituted in the
first years after diagnosis, is also largely mentioned in recent literature. The key perspective in the
prevention of both diabetic retinopathy and nephropathy is the multifactorial approach, aiming
to an optimal control of all the aforementioned risk factors.
Conclusions and Findings: As the burden of diabetes mellitus and its chronic complications is
continuously increasing, effective strategies to prevent subsequent health deterioration are
imperative. Research progresses in the last decades allow today a better preventive approach of
microvascular disease in diabetes mellitus, but supplemental results must stem from current efforts
to identify unconventional risk factors, yet unknown, and also optimal therapies addressing them.
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RW26. VARIABILITATEA GLICEMIC: NTRE MECANISME I CONSECINE
Conf. Mihai Bogdan Mircea1,2, ef Lucr. Lctuu Cristina Mihaela1,2

1
Grigore T. Popa Universitatea de Medicin i Farmacie Iai, Romania
2
Centrul Clinic de Diabet, Nutriie i Boli Metabolice Iai, Romania
Premise i Obiective: Odat cu extinderea posibilitilor tehnice de investigare, atenia

cercettorilor s-a concentrat tot mai mult n ultimii ani asupra variabilitii glicemice, ca un
parametru suplimentar care caracterizeaz controlul glicemic la pacienii diabetici, dar i
fluctuaiile existente la persoanele normoglicemice. Se pare c accentuarea variabilitii glicemice
se asociaz cu repercusiuni fiziopatologice complexe i are consecine clinice majore.
Considerentele menionate motiveaz alegerea acestui subiect n lucrarea de fa.
Material i Metod: Am trecut n revist publicaiile referitoare la variabilitatea glicemic,
implicaiile sale fiziopatologice i clinice, utiliznd cuvinte cheie adecvate pentru a cuta n baza
de date PubMed articolele care analizeaz aceast tem ntre ianuarie 2000 i aprilie 2016.
Rezultate i Discuii: Fluctuaii ample ale valorilor glicemice se asociaz cu accentuarea stresului
oxidativ, status inflamator cronic, creterea ratei apoptozei celulelor endoteliale i, n final, cu
disfuncie endotelial. Pe acest fond, persoanele diabetice caracterizate printr-o variabilitate
glicemic mare sunt expuse pe termen lung unui risc crescut pentru complicaii micro- i
macrovasculare i unei rate mai ridicate de mortalitate. Pe termen scurt, creterea variabilitii
glicemice este de asemenea un factor de prognostic precar, asociindu-se cu creterea riscului de
hipoglicemie. n plus, n ultimii ani s-au publicat date care sugereaz c o variabilitate glicemic
ridicat conduce la creterea riscului neoplazic i de deteriorare cognitiv. La rndul su,
variabilitatea glicemic este determinat la persoanele diabetice de un numr mare de factori, care
trebuie identificai i abordai adecvat pentru a le reduce consecinele negative.
Concluzii: Pe fondul asocierii cu un risc crescut pentru hipoglicemie, complicaii cronice, boli
asociate i mortalitate, conceptul variabilitii glicemice intr tot mai mult n ultimii ani n atenia
clinicienilor. Cunoaterea factorilor favorizani pentru aceast situaie i a mecanismelor
fiziopatologice declanate de variabilitatea glicemic se impune ca o condiie sine qua non pentru
identificarea unor soluii terapeutice adecvate i eficiente.
GLYCEMIC VARIABILITY: FROM MECHANISMS TO OUTCOMES
Assoc. Prof. Mihai Bogdan Mircea1,2, Lect. Lctuu Cristina Mihaela1,2

1
Grigore T. Popa University of Medicine and Pharmacy Iai, Romania
2
Premises and Objectives: As technical investigating procedures extended in the last years,
researchers have concentrated more and more on glycemic variability, a supplementary parameter
defining glycemic control in diabetic patients, as well as fluctuations in normoglycemic
individuals. Increased glycemic variability appears to be associated to complex pathophysiologic
54
repercussions and to induce major clinical consequences. Therefore, these considerations motivate
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the choice for this subject in the present paper.

Content and Method: We conducted a review analysing publications about glycemic variability,
its pathophysiologic and clinical consequences, by using adequate keywords to search in PubMed
database for publications between January 2000 and April 2016.
Results and Discussions: High fluctuations in glycemic values are associated to a pronounced
oxidative stress, chronic inflammatory status, a greater rate for endothelial cells apoptosis and
eventually to endothelial dysfunction. On this ground, diabetic persons with increased glycemic
variability are exposed on long term to a higher risk for micro- and macrovascular complications
and to a greater mortality rate. On short term, increased glycemic variability also leads to a worse
prognosis, as it is associated to a higher risk for hypoglycaemia. Moreover, recent data suggest
greater glycemic variability determines an increased risk for neoplastic disease and cognitive
impairment. At its turn, glycemic variability has a large number of causative conditions in diabetic
patients, needing identification and adequate approach to reduce their negative consequences.
Conclusions and Findings: As associated to an increased risk for hypoglycemia, chronic
complications, co-morbid conditions and mortality, clinicians' attention turns more and more
towards the concept of glycemic variability. Knowledge of favouring factors for this situation and
of pathophysiologic mechanisms it switches off is mandatory for identifying adequate and efficient
therapeutic solutions.
RW27. DISFUNCIILE METABOLICE I HIPOGONADISMUL MASCULIN, CAUZ

SAU CONSECIN ?
Radu Mihalca, MD
Sanamed Hospital, Bucuresti, Romania
Prevalenta obezitii a crescut mult ncepnd cu anii 60 in Europa de Vest si in Statele Unite ale
Americii iar recent aceeai tendina a fost observata in tari cu cretere economica rapida precum
China si India. Cercetrile efectuate in ultimii ani au demonstrat ca barbatii cu obezitate sau diabet
zaharat tip-2 au frecvent valori subnormale ale testosteronului total si liber, asociate cu valori
inadecvat de mici ale LH. Nivelul sczut al androgenilor nu este corelat cu durata obezitii
respectiv cu durata diabetului sau cu valoarea hemoglobinei glicozilate ci a fost corelat mai
frecvent cu parametri precum Indicele de Masa Corporala (IMC), circumferina taliei sau gradul
de steatoza hepatica. Mecanismele aflate la baza acestui fenomen sunt complexe si constau, printre
altele, in reducerea activitii axului hipotalamus-hipofiza=gonada, in creterea nivelului
estrogenilor si in scderea valorilor sex-hormone binding globulin (SHBG). Un nivel sczut de
testosteron a fost asociat in populaia generala cu o cretere a riscului cardio-vascular, dar datele
la barbatii obezi sau diabetici sunt inca insuficiente. Studii despre efectul tratamentului substitutiv
cu testosteron la nivelul controlului glicemic sau al factorilor de risc cardio-vasculari precum
colesterolul total sau proteina c-reactiva sunt de asemenea prea puine si fara rezultate certe.
Indiferent de metoda terapeutica folosita, scderea in greutate tinde sa aduc cu sine o cretere a
nivelului androgenic, fapt care ar putea aduce o contribuie importanta la reducerea riscului
cardiovascular la barbatii cu disfuncii metabolice precum obezitatea si diabetul zaharat tip-2.
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METABOLIC DISORDERS AND MALE HYPOGONADISM, CAUSE OR
CONSEQUENCE ?
Radu Mihalca, MD
Sanamed Hospital, Bucharest, Romania
The prevalence of obesity has increased very much starting from the 60ties in Western Europe and
the in United States and now this phenomenon has been also observed in fast growing countries
like China and India. The research performed lately has clearly established that men with obesity
or type-2 diabetes have often subnormal total and free testosterone concentrations in association
with inappropriately low LH concentrations. The lower androgen levels are not related to the
duration of obesity, diabetes or to glycosylated hemoglobin values, but are correlated often with
parameters like BMI, waist circumference and even hemoglobin level. The underlying
mechanisms beyond this phenomenon are complex, consisting in reduced hypothalamic and
pituitary function, increased estrogen production and reduced circulating sex-hormone binding
globulin (SHBG) levels. Low levels of total testosterone have been linked to an increase in
cardiovascular risk in the general population, but data reported in diabetic or obese male population
are scanty. The effect of testosterone replacement therapy on glycemic control and cardiovascular
risk factors such as total cholesterol and C-reactive protein are also inconsistent. Independently of
the method used, weight reduction seems to trigger an improvement in androgen levels, which
might further reduce the cardiovascular risk of male patients with metabolic disorders like obesity
and diabetes.
RW28. ROLUL ACTIVITII FIZICE N PREVENIA I TRATAMENTUL

DIABETULUI ZAHARAT
Andreea Moroanu 1,2, Magdalena Moroanu 1,2

1
Universitatea Dunrea de Jos Galai
2
Diamed Obesity SRL, Galai
Premise i Obiective: Greutatea corporal normala reprezint un echilibru ntre aportul energetic
i cheltuiala energetic si este meninut prin alimentaie sntoas i activitate fizic. Obezitate
este generat de supraalimentaie, comportamentul alimentar anormal sau/i sedentarism, fiind o
cauz major de apariie a diabetului zaharat. Durata timpului de edere se coreleaz semnificativ
cu riscul pentru diabet zaharat, boal cardiovascular, mortalitate cardiovascular.
Exerciiul fizic de rezisten moduleaz lipidele circulante i musculare, crete sensibilitatea la
insulin i scade riscul de apariie a diabetului zaharat. Exerciiul fizic previne disfuncia
endotelial, mecanism patogenic important in prediabet si diabet si imbuntete statusul glicemic
postprandial, tolerana la glucoz, profilul lipidic, tensiunea arterial.
Barierele n optimizarea stilului de via sunt: vrsta, sexul, etnia, starea de boal.
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Cel puin 30 minute de mers alert nentrerupt zilnic sau activitate fizic moderat (not, ciclism,
dans) sunt recomandate pentru ntreinerea strii de sntatate metabolic. Mersul alert zilnic 30
minute reduce riscul de diabet cu 35-40%.
Material i Metod: Grupul de studiu (311 persoane) a fost selecionat din populaia general
adult a judeului Galai, iar reprezentativitatea eantionului a fost calculat pentru populaia adult
n funcie de sex, vrst i mediu (urban, rural). Date demografice: sex, vrst, domiciliu, stare
civil, studii, venit, anotimp (vara, iarna). Date antropometrice: greutate, nlime, IMC,
circumferina abdominal. Criteriul pentru activitate fizic: exerciiu fizic (mers pe jos, biciclet,
jogging, sport) 30 minute de 3 ori/sptmn. Rspunsul a fost cotat cu da sau nu.
Rezultate i Discuii. Din studiul activitii fizice rezult c 59,16% dintre persoane efectueaz
activitate fizic conform criteriului, iar 40,84% din persoanele adulte nu au activitate fizic, dintre
acestea procentul cel mai mare fiind al femeilor din mediul urban. Factorii demografici care
influeneaz semnificativ activitatea fizic sunt vrsta i anotimpul. Analiza relaiei IMC
activitate fizic, arat corelaii semnificative cu IMC i cu categoriile IMC, n sensul c proporia
persoanelor cu activitate fizic scade odat cu creterea n greutate. Studiul obezitii abdominale
n relaie cu activitatea fizic demonstreaz corelaii semnificative att cu circumferina
abdominal, ct i cu clasele de risc, n sensul creterii CA i a categoriei de risc odat cu scderea
activitii fizice.
Concluzii: Contientizarea efectelor benefice ale exerciiului fizic asupra sntii este esenial
n managementul obezitii i prevenirea diabetului zaharat. Sunt necesare strategii practice care
s fie uor de inclus n viaa de fiecare zi a individului sau n colectivitate. Aceste aspecte sunt
importante n societatea modern i sugereaz c simpla limitare a timpului de edere poate avea
un potenial n preventia diabetului.
THE ROLE OF PHYSICAL ACTIVITY IN PREVENTION AND TREATMENT OF

DIABETES MELLITUS
Andreea Moroanu 1,2, Magdalena Moroanu 1,2

1
Lower Danube University Galai
2
Background and Objectives: Normal weight is a balance between energy intake and energy
expenditure and is maintained through healthy eating and physical activity. Obesity is caused by
overeating, abnormal eating behavior and / or physical inactivity, being a major cause of
developing diabetes. The duration of sitting is significantly correlated with the risk for diabetes,
cardiovascular disease and cardiovascular mortality.
Resistance exercise modulates circulating and muscle lipids, increases insulin sensitivity and
lowers the risk of diabetes. Exercise prevents endothelial dysfunction, an important pathogenic
mechanism in prediabetes and diabetes and improves postprandial glycemic status, glucose
tolerance, lipid profile, blood pressure.
Barriers to lifestyle improvement are: age, gender, ethnicity, illness.
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At least 30 minutes of brisk walking continuously daily or moderate physical activity (swimming,
cycling, dancing) are recommended for maintenance of metabolic health status. Brisk walking for
30 minutes daily reduces the risk of diabetes by 35-40%.
Material and Methods: Study Group (311 persons) was selected from the general adult
population of Galati county and representativeness of the sample was calculated for the adult
population by sex, age and environment (urban, rural). Demographic data: gender, age, residence,
marital status, education, income, season (summer, winter). Anthropometric data: weight, height,
BMI, waist circumference. Criteria for physical activity: exercise (walking, cycling, jogging,
sports) 30 minutes for 3 times / week. The answer was rated with "yes" or "no".
Results and Discussion. The study of physical activity showed that 59.16% of people perform
physical activity according to the criteria and 40.84% of adults do not perform physical exercise,
with the highest percentage of women in urban areas. Demographic factors that significantly
influence physical activity are age and season. Analysis of relationship between BMI - physical
activity showed significant correlations with BMI and BMI categories, meaning that the proportion
of persons with physical activity decreased with increasing weight. Study of abdominal obesity in
relation to physical activity showed significant correlations with both waist circumference and risk
classes; the higher was the risk category, the lower was physical activity.
Conclusions: Awareness of the beneficial effects of exercise on health is essential in the
management of obesity and diabetes prevention. Practical strategies are needed that are easy to
include in everyday life of the individual or the community. These issues are important in modern
society and suggests that simply limiting the sedentary time may have potential in diabetes
prevention.
RW29 MICROALBUMINURIA - PREDICTOR AL RISCULUI IN DIABET I BOALA

CRONIC DE RINICHI
Prof. dr. Eugen Moa
Termenul microalbuminurie (MA) a aprut n 1964 cnd Profesorul Harrz Keen l-a folosit
pentru prima dat pentru a sublinia o cantitate mic de albumin n urina pacienilor cu diabet
zaharat tip 1. Urmtoarea meniune a MA n literatur a fost dup 5 ani cnd Keen i colab au
examinat MA n contextul testului de toleran la glucoz oral. La sfritul anilor 70, cnd
Mogensen i Vittinghus i Viberti i colab au evaluat efectele tratamentului cu insulin asupra MA
indus de exerciiul fizic i au examinat excreia de albumin n contextul controlului glicemic
(George L. Bakris, Mark Molitch, Diabetes Care. 2014;37(3):867-875). MA reprezint un
important factor de risc renal dar i un factor de risc cardiovascular la pacienii cu diabet
(Mogensen 1984). Proteinuria este un marker important al mortalitii cardiovasculare n
populaia general (studiul Framingham-1984). Terminologia MA s-a modificat n ultima vreme.
Grupul KDIGO a sugerat ca termenul MA s fie nlocuit de termenul albuminurie nalt. MA
se folosete pentru a indica o excreie urinar de albumin de 30-300mg/zi dup estimarea dup
raportul albumin urinar/ creatinin urinar (RACU) n urina emis spontan dimineaa (Sacks
58
DB, Arnold M, Bakris GL, et al. 2011). Studiile iniiale la pacienii cu diabet au susinut ideea c
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o dat cu creterea nivelurilor MA, crete i riscul de progresie a BCR i riscul CV. Mai mult,
dovezi ale studiilor epidemiologice la pacienii cu diabet au indicat c mrimea excreiei urinare
de albumin ar trebui privit ca un continuum al riscului CV (Jager A et al. 1998). Studiul
DCCT/EDIC a cuantificat:
- Incidena i factorii de risc pentru apariia iniial a MA
- Progresia sa la macroalbuminurie (albumin urinar>300mg/g creatinin)
- Progresia pe termen lung a BCR dup apariia MA.
Datele din studiul UKPDS au demonstrat c un control glicemic mai bun ncetinete apariia MA:
- 33% reducere a riscului relativ de apariia a MA la 12 ani
- O reducere semnificativ a propopriei de pacieni care i dubleaz nivelul creatininei
plasmatice (Bilous R. 2008).
Aceast cretere a albuminuriei poate aprea n prezena sau absena terapiei de reducere a
factorilor de risc cunoscui pentru progresia BCR (presiune arterial, glicemie). Predictorii
progresiei spre BCR stadiul 5, cu excepia istoricului familial i controlul deficitar al glicemiei i
presiunii arteriale pentru o perioad lung de timp, nu sunt bine definii. Dei exist unii markeri
genetici, precum CUBN i APOL1, utilizarea lor n practica curent nu este bine documentat. Un
istoric familial pozitiv pentru BCR reprezint un puternic predictor al riscului pentru apariia i
progresia BCR la pacienii cu MA. Astfel, toi pacienii trebuiesc ntrebai despre istoricul familial
de BCR sau necesitatea dializei. Greutatea mic la natere reprezint un alt factor de risc pentru
progresia BCR, n special in diabet dei acest lucru nu este confirmat (Wheeler DC, Becker GJ.
2013). MA ar trebui privit ca un marker al riscului asociat cu o cretere a riscului CV i de boal
renal. Prezena sa solitar nu indic instalarea bolii renale, n special dac eRFG este peste
60ml/min/1,73m2. Creteri ale MA, cnd presiunea arterial i ali factori de risc CV sunt
controlai, se pare, dar nu este dovedit, c pot s indice o progresie lent spre BCR n timp.
MICROALBUMINURIA AS A RISK PREDICTOR IN DIABETES AND CKD RISK
Prof. dr. Eugen Moa
The term "microalbuminuria" (MA) originated in 1964 when Professor Harry Keen first used it to
signify a small amount of albumin in the urine of patients with type 1 diabetes.
The next mention of MA in the literature was 5 years later when Keen et al. examined MA in the
context of oral glucose tolerance testing. In the late 1970s when Mogensen and Vittinghus and
Viberti et al. assessed the effects of insulin treatment on exercise-induced MA and examined
albumin excretion in the context of glycemic control (George L. Bakris, Mark Molitch, Diabetes
Care. 2014;37(3):867-875). Microalbuminuria is important renal risk factor but also a
cardiovascular risk factor in patients with diabetes (Mogensen 1984). Proteinuria is important
marker of cardiovascular mortality in the general population (Framingham study-1984). The
terminology of MA has changed recently. The KDIGO group suggested that the term "MA" be
replaced by the term "high albuminuria. MA still refers to urinary albumin excretion of 30 to
<300 mg/day as estimated from the urinary albumin-to-urinary creatinine ratio (UACR) in a spot
morning urine specimen (Sacks DB, Arnold M, Bakris GL, et al. 2011). Early studies in patients
with diabetes supported the concept that as MA increases to higher levels, the risk of CKD
59
progression and CV risk also increases. Moreover, evidence from epidemiological studies in
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patients with diabetes suggested that the magnitude of urine albumin excretion should be viewed
as a continuum of CV risk (Jager A et al. 1998). The DCCT/EDIC study quantified:
- the incidence of and risk factors for the initial development of MA,
- its progression to macroalbuminuria (urine albumin >300 mg/g creatinine),
- long-term CKD progression after the development of MA (de Boer IH, Rue TC, Cleary PA,
et al. 2011). Data from the UK Prospective Diabetes Study (UKPDS) demonstrated that better
glycemic control retards the development of MA:
- 33% reduction in relative risk of MA development at 12 years
- a significant reduction in the proportion of patients doubling their plasma creatinine levels
(Bilous R. 2008). This increase in albuminuria may occur in the presence or absence of therapy to
reduce established risk factors for CKD progression (i.e., blood pressure, glucose). Predictors of
progression to ESRD, apart from family history, and many years of poor glycemic and blood
pressure control are still not well defined.
Although there are some genetic markers, such as CUBN and APOL1, their use in practice is not
well established. A family history of CKD is a powerful predictor of risk for CKD development
and progression in patients with MA. Therefore, all patients should be asked about family history
of CKD or members requiring dialysis.
Low birth weight is another risk predictor of CKD progression, especially in diabetes, although
this is not proven (Wheeler DC, Becker GJ. 2013).
MA should be viewed as a risk marker associated with an increase in CV risk and for kidney
disease. Its presence alone does not indicate established kidney disease, especially if the eGFR is
well above 60 mL/min/1.73 m2. Increases in MA, with blood pressure and other CV risk factors
controlled, are likely but not proven to portend a poor prognosis for CKD progression over time.
RW30. PROVOCRILE LEGATE DE DIABET DIN REGIUNEA NOASTR
Maria Moa1, Simona Popa1

Universitatea de Medicin i Farmacia Craiova, Romnia
Cauzele ce au crescut prevalena / incidena diabetului zaharat: mbtrnirea progresiv a

populaiei, supraponderea i obezitatea, alimentaia nesntoas, lipsa activitatii fizice, cresterea
supravieirii pacientilor cu diabet zaharat, creterea activitii de screening, criteriile pentru
diagnosticarea diabetului zaharat. Exist aproximativ 60 de milioane de persoane cu diabet zaharat
in regiunea europeana, sau aproximativ 10,3% dintre brbai i 9,6% dintre femeile cu varsta de
25 de ani i peste. Prevalenta diabetului este in crestere la toate vrstele n regiunea european.
Rezultatele de la sase studii bazate pe populaia din Germania (DIAB-CORE Consortium):
realizat ntre 1997 i 2006; au fost analizate datele de la subieci cu vrsta cuprins ntre 45-74 ani
din cinci studii regionale populationale i dintr-un studiu la nivel national n the Diabetes
Collaborative Research of Epidemiologic Studies (DIAB-CORE) pentru a asigura, pentru prima
dat, informaii populaionale regionale legate de variabilitatea regional a prevalenei DZ tip 2 n
Germania. Pentru acest studiu la nivel national a fost estimat o prevalenta de 8,2% (7.3-9.2%) a
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DZ ; prevalena a fost mai mare la brbai: 9,7% dect la femei: 7,6%. Prevalena / incidena
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diabetului n Italia: din 2000 pn la 2007 a existat o cretere de 40% in prevalenta brut a
diabetului zaharat in regiunea Lombardia, de la 3,0% n 2000 la 4,2% n 2007.
Prevalenta diabetului zaharat in Scotia: prevalenta DZ (5.2 n 2003 vs. 9,4% n 2008);
diagnostic: folosind att informaii auto-raportate ct i msurarea HbA1c. Prevalena DZ
diagnosticat si nediagnosticat in Franta: the French Nutrition and Health Survey 2006/2007; s-
a estimat prevalenta DZ nediagnosticat la populaia n vrst de 18-74 ani; prevalena DZ
diagnosticat a fost estimat folosind istoria de DZ-auto-raportat i prevalena DZ nediagnosticat
a fost estimat utiliznd glicemia a jeun 7.0 mmol/l sau HbA1c 6.5%; prevalenta DZ
diagnosticat: 4,6%; prevalenta DZ nediagnosticat: 1% (95% CI 0.6-1.7). Prevalena DZ si alterrii
reglrii glucozei in Spania: the Di@bet.es Study:: prevalenta globala a DZ: 13,8% (95% IC 12,8,
14,7%), ajustat pentru varsta si sex, dintre care aproximativ jumatate au diabet zaharat necunoscut:
6,0% (95% CI 5,4, 6,7%); prevalena alterrii toleranei la glucoz a jeun, ajustat n funcie de
vrst i sex a fost de 3,4% (95% CI 2,9, 4,0%), a alterrii toleranei la glucoz a fost de 9,2%,
IGT (95% CI 8,2, 10,2%) i a combinatiei lor a fost de 2,2% (95% CI 1,7, 2,7%). Prevalena de
DZ tip 2 n Elveia: prevalena DZ tip 2 este de 6,3%, mai mare la brbai (9,1%) dect la femei
(3,8%, P <0,001) i a crescut odat cu vrsta (vrsta de 35-75 ani); DZ tip 2 a fost definit ca
glicemie plasmatic a jeun 7 mmol/l sau tratament al diabetului zaharat. Romnia pe scurt -
studiul PREDATOR 2013: vrsta i prevalena DZ, ajustate n funcie de sex a diabetului zaharat
la populaia adult (20-79 ani) -11,6%. Studiul international Diabetes Management Practice
Study (IDMPS) (Europa de Est, Asia, America Latin, Africa): 22% din pacienii cu DZ tip 1
i 36% din pacienii cu DZ tip 2 nu au avut masuratori de HbA1c; 20-30% dintre pacieni au fost
la tinta HbA1c; numai 7,5% din tipul 1 i 3,6% dintre pacienii cu DZ de tip 2 au atins 3 obiective
de tratament (TA <130/80 mmHg, LDL-C <100 mg / dl si HbA1c <7%). Controlul glicemic n
DZ tip 2 - PANORAMA Study (Belgia, Frana, Germania, Grecia, Italia, Olanda, Spania, Turcia
i Marea Britanie): doar 7,5% dintre pacieni au ndeplinit toate cele trei obiective (HbA1c <7%,
BP < 130/80 mmHg i LDL-c <100 mg / dl). Concluzii: exist diferene reale n ceea ce privete
prevalena i incidena DM ntre diferite regiuni geografice, datorit: diferitelor metode de
diagnostic, diferitelor populatii de studiu.
THE CHALLENGE OF DIABETES IN THE LOCAL REGION

University of Medicine and Pharmacy Craiova, Romania
Causes of increased diabetes prevalence / incidence: progressive ageing of the population,

overweight and obesity, unhealthy diet, physical inactivity, increasing the survival of patients with
diabetes, the increase in screening activity, criteria for diagnosing diabetes. There are about 60
million people with diabetes in the European Region, or about 10.3% of men and 9.6% of women
aged 25 years and over. Prevalence of diabetes is increasing among all ages in the European
Region. Results from six population-based studies in Germany (DIAB-CORE Consortium):
conducted between 1997 and 2006; data of subjects aged 4574 years from five regional
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population-based studies and one nationwide study were analysed - within the Diabetes
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Collaborative Research of Epidemiologic Studies (DIAB-CORE) to provide, for the first time,
population-based information on regional variation of known Type 2 DM prevalence in Germany.
For the nationwide study, a prevalence of 8.2% (7.39.2%) was estimated; prevalence was higher
in men: 9.7% than in women: 7.6%. Prevalence /incidence of diabetes in Italy: from 2000 to
2007 there was a 40% increase in the crude prevalence of diabetes in the Lombardy region, from
3.0% in 2000 to 4.2% in 2007. Diabetes prevalence in Scotland: prevalence of diabetes (5.2 in
2003 vs. 9.4% in 2008); diagnosis: using both self-reported information and measurement of
HbA1c. Prevalence of diagnosed and undiagnosed DM in France: the French Nutrition and
Health Survey 2006/2007; in 18- 74 year-old individuals; the prevalence of diagnosed DM was
estimated using self-reported DM history and the prevalence of undiagnosed DM was estimated
using fasting plasma glucose 7.0 mmol/l or HbA1c 6.5%; the prevalence of diagnosed DM:
4.6%; the prevalence of undiagnosed DM: 1% (95% CI 0.61.7). Prevalence of DM and
impaired glucose regulation in Spain: the Di@bet.es Study: the overall prevalence of DM:
13.8% (95% CI 12.8, 14.7%), adjusted for age and sex, of which about half have unknown
diabetes: 6.0% (95% CI 5.4, 6.7%); the age- and sex-adjusted prevalence of IFG was 3.4% (95%
CI 2.9, 4.0%), of IGT was 9.2% (95% CI 8.2, 10.2%) and of combined IFGIGT was 2.2% (95%
CI 1.7, 2.7%). The prevalence of Type 2 DM in Switzerland: the prevalence of Type 2 DM is
6.3%, higher in men (9.1%) than in women (3.8%, P < 0.001) and increased with age (35-75 years
old); type 2 DM was defined as fasting plasma glucose 7mmoll and or diabetes treatment.
Romania at a glance - PREDATORR 2013: age and sex-adjusted prevalence of diabetes in adult
population (20-79 years)-11,6%. The International Diabetes Management Practice Study
(IDMPS) (Eastern Europe, Asia, Latin America, Africa): 22% of type 1 and 36% of type 2 diabetic
patients never had HbA1c measurements; 20-30% of patients were at HbA1c goal; only 7.5% of
type 1 and 3.6% of type 2 diabetic patients attained 3 treatment goals (BP<130/80 mmHg, LDL-
C<100 mg/dL and HbA1c<7%). Glycaemic control in type 2 DM - PANORAMA Study
(Belgium, France, Germany, Greece, Italy, The Netherlands, Spain, Turkey and the UK): only
7.5% of the patients met all three targets, achieving HbA1c<7%, BP <130/80 mmHg and LDL-c
< 100 mg/dL. Conclusions: there are real differences regarding the prevalence and incidence of
DM between different geographical regions, due to: different methods of diagnosis, different study
population.
RW31. MEDICAMENTE ANTIDIABETICE NOI I VIITOARE

Universitatea de Medicin i Farmacia Craiova, Romnia
Inhibitorii cotransportorilor 2 de sodiu-glucoz (SGLT2): SGLT2 joaca un rol important in

reabsorbia glucozei renale n tubul contort proximal; reabsorbtia glucozei renale este crescut n
DZ tip 2; Inhibitorii SGLT2 - ce s ateptam: Inhibarea SGLT2 induce att glicozurie cat i
natriureza, ceea ce duce la reducerea hiperglicemiei, greutii corporale, a tensiunii arteriale i a
proteinuriei. Publicat recent, studiul EMPA-REG OUTCOME a demonstrat beneficii
cardiovasculare si de mortalitate semnificative, ale inhibitorilor de de SGLT2 (empagliflozin) la
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pacienii cu diabet zaharat de tip 2, cu prezenta de boli cardiovasculare.

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Noi terapii pe baz de incretine: factori intestinali care favorizeaz secreia de insulin ca
rspuns la nutrieni; efectul incretinic indica amplificarea secreiei de insulin ca urmare a
incarcarii cu glucoza pe cale oral; incretinele majore: Glucagon like peptide-1 (GLP-1), Glucose-
dependent insulinotropic peptide (GIP); GLP-1/ GIP sunt rapid degradate de enzima DPP-4.
Secretia de GLP-1 este redusa in DZ tip 2. Analogii/ Agonistii GLP-1: Exenatide BID, QW;
Liraglutide; Lixisenatide; Albiglutide; Dulaglutide. Inhibitorii de DPP-4: Sitagliptin, Saxagliptin,
Vildagliptin, Linagliptin, Anagliptin, Teneligliptin, Alogliptin, Trelagliptin, Omarigliptin. Efortul
de a restaura metabolismul normal in diabet numai cu tratament insulinic a fost suboptim,
hipoglicemia fiind problema majora.
Transplantul de pancreas este restrictionat de disponibilitatea pancreasului uman si riscului
medicatiei imunosupresive.
Implantarea de insule normale se face, cu succes limitat. Abordarea alternativ, crearea unui
pancreas artificial, este acum un domeniu major de investigare activ.
Pompe de insulina automata closed-loop: in intregime automatizata, bihormonala (insulin si
glucagon) a fost de asemeni evaluata in ambulatoriu, pentru o perioda de timp. Desi raman
provocari semnificative, cu ameliorari in terapia prin pompa si tehnologia senzorilor, progrese
semnificative s-au facut in ultimele 5 decade. Modele matematice sofisticate si algoritmuri
complexe, sisteme de comunicare si factori de securitate se dezvolta pentru a se efectua close the
loop intre senzor si dispozitivul de infuzie a insulinei. Pentru a ajuta majoritatea persoanelor cu
diabet zaharat, eforturile s-au concentrat pe dezvoltarea de sisteme mai mici, ieftine, fiabile, uor
de folosit, discrete, uor de purtat, minim invazive (non invazive), cu CGM care comunic cu
precizie i fr fir cu pompele de insulina.
NEW AND EMERGING ANTIDIABETIC DRUGS

1
Sodium-glucose cotransporter 2 (SGLT2) inhibitors: SGLT2 plays a role in renal glucose

reabsorption in proximal tubule; renal glucose reabsorption is increased in T2DM; SGLT2
Inhibitors - what to expect: Inhibition of sodiumglucose cotransporter 2 causes both glycosuria
and natriuresis, leading to reductions in hyperglycemia, body weight, blood pressure, and
proteinuria. The recently published EMPA-REG OUTCOME study demonstrated significant
cardiovascular and mortality benefits of sodiumglucose cotransporter 2 inhibition with
empagliflozin in patients with type 2 diabetes and established cardiovascular disease, and may
suggest a broader role for sodiumglucose cotransporter 2 inhibition in patients with heart failure.
New incretin based therapies: INCRETINS: gut factors that promote insulin secretion in
response to nutrients; incretin effect designates amplification of insulin secretion following oral
glucose load; major incretins: Glucagon like peptide-1 (GLP-1), Glucose-dependent insulinotropic
peptide (GIP); GLP-1/ GIP are rapidly degraded by enzyme DPP-4. GLP-1 secretion is reduced
in type 2 diabetes. GLP-1 Analogues/Receptor agonists: Exenatide BID, QW; Liraglutide;
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Lixisenatide; Albiglutide; Dulaglutide. DPP-4 Inhibitors: Sitagliptin, Saxagliptin, Vildagliptin,

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Linagliptin, Anagliptin, Teneligliptin, Alogliptin, Trelagliptin, Omarigliptin.

Efforts to restore normal metabolism in diabetes with insulin therapy alone have been suboptimal,
with hypoglycemia being a major problem.
Pancreatic transplantation is restricted by the availability of the human pancreas and the risks
of immunosuppressive therapy. The implantation of normal islets has met with limited success.
The alternative approach, the creation of an artificial pancreas, is now a major area of active
investigation.
Automated closed-loop insulin pump: fully automated bihormonal (insulin and glucagon)
closed-loop system has also been evaluated in the outpatient setting over a period of time.
Although significant challenges remain, with improvements in pump therapy and sensor
technologies, considerable progress has been made over the past 5 decades. Sophisticated
mathematical models and associated complex control algorithms, communication systems, and
safety features are being developed to close the loop between the sensor and insulin infusion
device. To help most individuals with diabetes, efforts have concentrated on the development of
smaller, inexpensive, reliable, easy to use, comfortable, discreet, wearable systems that use
minimally invasive (or ideally noninvasive) CGM that communicate accurately and wirelessly to
subcutaneous insulin infusion systems.
RW32. PATOLOGIA ADRENAL I TULBURRILE METABOLISMULUI

GLUCIDIC
Diana Pun1, Alexandra Miric, Rodica Petri, Ioana Neamu, Ruxandra Dnciulescu1
1
UMF Carol Davila
Institutul Naional de Endocrinologie C.I.Parhon
Glanda suprarenala este compusa din dou esuturi embriologic diferite, corticala i medulara. Ea
produce hormoni care ajuta la reglarea metabolismului glucidic (glucocorticoizi,
mineralocorticoizi, catecolamine, androgeni suprarenali). Tulburrile adrenale pot provoca hiper
sau hipofuncie ducnd la modificri ale metabolismului glucidic.
Sindromul Cushing este definit in general ca un exces de hormoni glucocorticoizi. El poate fi
cauzat de producia endogen de cortizol de catre adrenala sau prin administrarea de
glucocorticoizi exogeni. Att glucocorticoizii exogeni cat i cei endogeni pot provoca diabet
zaharat i tolerana alterata la glucoz. Fiziologic, glucocorticoizii inhib absorbia glucozei n
esuturile periferice, ceea ce duce la hiperglicemie i hiperinsulinemie. Ei contribuie la dezvoltarea
intoleranei la glucoz i aparitia diabetului zaharat manifest prin creterea gluconeogenezei
hepatice, inducerea rezistenei periferice la insulin la nivelul post-receptorilor i prin suprimarea
direct a secretiei de insulin, ca urmare a combinrii efectelor lor asupra esutului hepatic,
muscular, pancreas i adipos.
Pe de alt parte, feocromocitoamele sunt caracterizate printr-un exces de catecolamine, ceea ce
duce la hiperglicemie i diabet din cauza inhibarii directe a eliberrii insulinei, mediat de
receptorii adrenergici tip alfa 2.
Mai mult dect att, pacienii cu hiperaldosteronism primar pot avea modificari ale secretiei de
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insulin i de reducere a sensibilitii la insulin prin inhibarea eliberrii de insulin de efectul

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hipokaliemiei asupra celulelor beta pancreatice.

Alterarile metabolismului glucidic induse de toate aceste tulburri suprarenale menionate mai sus
pot disprea dup rezolvarea cauzei principale.
Relaia dintre androgenii suprarenali i modificrile metabolismului glucidic necesit investigaii
suplimentare, deoarece rolul de reglare al insulinei asupra metabolismului androgenilor rmne
nc necunoscut. In mai multe studii pe animale, androgenii suprarenali au demonstrat un rol
hotrtor mpotriva obezitii i a diabetului zaharat, dar sunt necesare studii suplimentare pentru
a elucida efectele lor asupra metabolismului glucidic la oameni.
Mai mult dect att, insuficiena suprarenal sau hipofuncia poate fi fatala daca este netratata.
Manifestarile clinice depind de gradul de pierdere al funciei adrenalei avand printre cele mai
frecvente simptome: hipoglicemia, hiponatremia i hipotensiunea.
In concluzie, nelegerea incidenei i interaciunilor tulburrilor glucidice la pacienii cu patologie
adrenal ar putea oferi perspective viitoare n abordarea corect i actual a acestor boli.
ADRENAL PATHOLOGY AND GLUCIDIC METABOLISM DISORDERS
Diana Pun1, Alexandra Miric, Rodica Petri, Ioana Neamu, Ruxandra Dnciulescu1
1
Carol Davila University of Medicine and Pharmacy
C.I.Parhon Institute of Endocrinology
The adrenal gland is composed of two different embryologically tissues, the cortex and medulla.
It produces hormones that helps regulate glucidic metabolism (glucocorticoids,
mineralocorticoids, catecholamines, adrenal androgens). Adrenal disorders may cause hyper or
hypofunction resulting in glucidic metabolism alterations.
Cushings syndrome is generally defined as a glucocorticoid hormones excess. It can be caused by
endogenous production of cortisol from the adrenal gland or by administration of exogenous
glucocorticoids. Both exogenous and endogenous glucocorticoids can cause diabetes and impaired
glucose tolerance. Physiologically glucocorticoids inhibit glucose uptake in peripheral tissues,
leading to hyperglycemia and hyperinsulinemia. They contribute to the development of impaired
glucose tolerance and overt diabetes mellitus by increasing hepatic gluconeogenesis, inducing
peripheral insulin resistance at the post-receptor level and by direct suppression of insulin release,
consequent to the combination of their effects on the liver, muscle, pancreas and adipose tissue.
On the other hand, pheochromocytomas are characterized by a catecholamine excess, leading to
hyperglycemia and diabetes due to a direct inhibition of insulin release, mediated by type 2 alpha
adrenergic receptors.
Moreover, patients with primary hyperaldosteronism can have altered insulin secretion and
reduction in insulin sensitivity by inhibiting insulin release through the effect of hypokalemia on
the pancreatic beta-cells.
The alterations in glucidic metabolism induced by all of these adrenal disorders mentioned above
can disappear after the primary cause has been solved.
The relationship between adrenal androgens and glucose metabolism modifications needs further
investigations, because the regulatory role of insulin on adrenal androgen metabolism remains
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still unknown. In several animal studies, adrenal androgens demonstrated a conclusive role against
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obesity and diabetes, but further studies are required to elucidate their effects on human glucidic
metabolism.
Furthermore, adrenal insufficiency or hypofunction can be fatal if it goes untreated. The clinical
features depend on the extent of loss of adrenal function with the most common symptoms of
hypoglicemia, hyponatremia and hypotension.
In conclusion, understanding the incidence and interplay of glucidic disorders in patients with
adrenal pathology would provide future insights into the proper and current approach/management
of these disorders.
RW33. NON-ALCOHOLIC FATTY LIVER DISEASE AND DIABETES MELLITUS
Corina Pop
Internal Medicine and Gastroenterology Department Carol Davila University of Medicine and
Pharmacy, Universitary Emergency Hospital Bucharest
Non-alcoholic fatty liver disease (NAFLD) indicate a spectrum of disease, ranging from hepatic
steatosis to necrosis and inflammation - NASH (non-alcoholic steatohepatitis). NASH often
advances to fibrosis, which can progress to cirrhosis.
NAFLD might affect up to one-third of the adult population chiefly individuals with multiple
metabolic risk factors including visceral obesity and diabetes.
NAFLD is a part of a multiorgan disorder and should be regarded as hepatic component of the
metabolic syndrome.
The relationship between type 2 diabetes mellitus and the liver is complex. 30-75% of patients
with NASH suffer from impaired glucose tolerance (prediabetes) or even diabetes.
Patients with NASH and diabetes are at increased risk for the development of cirrhosis.
Key pathogenic factor resulting in NAFLD is represented by insulin resistance. The transition from
steatosis to steatohepatitis is characterised by increased oxidative stress and by the expression of
proinflammatory cytokines.
The diagnosis of NAFLD is supported by detection of steatosis or/and necroinflammation and
appropriate exclusion of other liver diseases.
The liver biopsy remains the gold standard for the diagnosis of NASH. However, liver biopsy has
several drawbacks compare to the noninvasive markers that could accurately predict the stage of
liver disease, developed in the last two decades.
Despite researchers intense effort regarding therapeutic approach, there is still no approved drug
for the treatmenr of non-alcoholic steatohepatitis. We are looking for an ideal drug for NASH that
should reduce liver injury, and the occurance of liver fibrosis and should also corect insulin
resistance.
Diet, lifestyle changes and physical activity represent important therapeutic indications for
NAFLDs patients.
Drugs commonly prescribed in patients with diabetes may affect liver histology by interfering with
insulin sensitivity and lipid profile.
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Continuous research should aim at identifying new targets for therapy and combine those that
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target common pathways.

RW34. OCTETUL NEFAST AL HIPERGLICEMIEI
Popa Simona Georgiana1, Popa Adina2, Mota Maria1

1
Universitatea de Medicin i Farmacie Craiova, Romnia
2
Spitalul Clinic Judeean de Urgen Craiova, Romnia
Studii recente sugereaz c diabetul zaharat tip 2 implic mecanisme fiziopatologice heterogene
cu afectarea celulelor , ficatului, muchiului scheletic, adipocitelor, celulelor , intestinului,
rinichiului i creierului.
Obiective: expunerea principalelor evenimente fiziologice, biochimice i moleculare implicate n
meninerea homeostaziei glucozei; neleagerea mecanismelor etiopatogenice ale hiperglicemiei
octetul nefast; identificarea provocrilor actuale pentru obinerea i meninerea controlului
glicemic.
Procesele care contribuie la patogeneza i progresia diabetului zaharat tip 2 sunt reprezentate de:
Disfuncia -celular i alterarea secundar a insulinosecreiei
Pacienii cu diabet zaharat tip 2 prezint defecte ale insulinosecreiei caracterizate prin atenuarea
pn la dispariia primei faze a insulinosecreiei cuplat cu prelungirea celei de a doua faze
insulinosecretorii. Principalele cauze ale disfunciei -celulare n diabetul zaharat tip 2 sunt
mbtrnirea, gene specifice, insulinorezistena, lipotoxicitatea, glucotoxicitatea, depozitele
pancreatice de amiloid, scderea efectului incretinic.
Creterea produciei hepatice de glucoz i scderea utilizrii periferice a glucozei
Pacienii cu diabet zaharat tip 2 prezint rezisten hepatic crescut la aciunea insulinei i declin
progresiv al utilizrii periferice a glucozei.
Creterea lipolizei
Creterea produciei de acizi grai liberi de ctre adipocite n condiiile insulinorezistenei pot duce
la disfuncie -celular i de asemenea la insulinorezisten hepatic i muscular.
Scderea efectului incretinic
La subiecii cu diabet zaharat tip 2 consecinele scderii efectului incretinic sunt reprezentate de
reducerea insulinosecreiei, creterea secreiei de glucagon, creterea produciei hepatice de
glucoz, creterea apetitului cu cretere ponderal.
Creterea secreiei de glucagon
Indivizii cu diabet zaharat tip 2 prezint creterea ariei celulelor i de asemenea a concentraiei
plasmatice bazale de glucagon, ducnd la creterea ratei bazale a produciei hepatice de glucoz.
Creterea reabsorbiei glucozei
Diabetul zaharat tip 2 este asociat cu creterea expresiei i activitii cotransportorului 2 sodiu-
glucoz renal, ceea ce determin creterea reabsorbiei glucozei la nivelul tubului contort proximal.
Disfunia neurotransmitorilor
Disfuncia neurotransmitorilor hipotalamici poate contribui la dezvoltarea insulinorezistenei,
alterarea homeostaziei glucozei i/sau cretere ponderal.
Cunoaterea fiziopatogeniei diabetului zaharat tip 2 are importante implicaii terapeutice. Astfel,
terapia eficient n diabetul zaharat tip 2 trebuie s se bazeze pe cunoaterea modificrilor
patogenice i necesit combinaia de clase terapeutice multiple pentru a corecta defectele multiple
fiziopatogenice.
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THE OMINOUS OCTET OF HYPERGLYCEMIA
Popa Simona Georgiana1, Popa Adina2, Mota Maria1

1
2
Emergency Clinical Hospital Craiova, Romania
Current evidence suggests that type 2 diabetes is a heterogeneous disorder involving multiple
pathophysiologic defects in the -cells, liver, muscle, adipocytes, -cells, gut, kidney and brain.
Objectives: exposing of the main physiological, biochemical and molecular events involved in
glucose homeostasis; understanding the ethiopatogenic mechanisms of hyperglycemia - "the
ominous octet "; identifying current challenges to achieve and maintain glycemic control.
The processes that contribute to type 2 diabetes pathogenesis and progression are represented by
eight etiologic mechanisms:
-cell dysfunction and secondary impaired insulin secretion
Patients with type 2 diabetes show defects in insulin secretion characterized by the attenuated to
nonexistent first-phase insulin response, coupled with a prolonged second-phase response. The
main potential causes of -Cell failure in type 2 diabetes are aging, specific genes, insulin
resistance, lipotoxicity, glucotoxicity, pancreatic amyloid deposits, decreases in the incretin effect.
Increased hepatic glucose production and decreased glucose uptake
Patients with type 2 diabetes experience marked hepatic resistance to insulin action and a
progressive decline in glucose uptake.
Increased lipolysis
Increased free fatty acids production from fat cells resistant to insulin can lead to -cell dysfunction
and also to insulin resistance in liver and skeletal muscle.
Decreased incretin effect
In type 2 diabetic individuals the consequences of decreased incretin effect are represented by the
reduced insulin secretion, increased glucagon secretion, increased hepatic glucose production,
increased appetite with weight gain.
Increased glucagon secretion
In type 2 diabetic individuals the pancreatic -cell islet area and also the basal plasma glucagon
concentration are elevated leading to the increased basal rate of hepatic glucose production.
Increased glucose reabsorption
Type 2 diabetes is associated with increases in renal sodium-glucose cotransporters 2 expression
and activity which leads to increased reabsorption of glucose in the proximal tubule.
Neurotransmitter dysfunction
Hypothalamic neurotransmitter dysfunction may contribute to the development of insulin
resistance, impaired glucose homeostasis, and/or weight gain.
Knowledge of the pathophysiology of type 2 diabetes has important therapeutic implications.

Therefore the effective treatment of type 2 diabetes should be based upon known pathogenic
abnormalities and require multiple drugs in combination to correct multiple pathophysiologic
defects.
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RW35. RESETTING THE BETA CELL IN TYPE 2 DIABETES
Professor Paolo Pozzilli1

1
University Campus Bio-Medico, Rome, Italy and Queen Mary College, London UK
The potential mechanisms determining -cell failure in type 2 diabetes (T2D) include
glucotoxicity, inflammation and failure in -cell regeneration. Glucose stimulation exerts
beneficial effects on the -cell phenotype between 2 and 10 mM, however over physiological
glucose concentrations (between 10 and 30 mM) are deleterious for -cell function and survival.
Glucotoxicity plays an important role in the alteration of the functional -cell mass in T2D, and it
contributes to the progressive worsening of glucose intolerance in these patients. On the other hand
adipose tissue dysfunction in obesity drives -cell inflammation and T2D via several molecular
and cellular mechanisms linking inflammation to insulin resistance and -cell dysfunction. The
overarching goal for improved therapy in T2D is to restore -cell function preventing -cell failure
and enhancing -cell replacement. This could be achieved either by cell-replacement therapy or
by triggering intrinsic regenerative mechanisms of the pancreas. Therefore glucotoxicity,
lipotoxicity and possible -cell regeneration should be targeted to prevent -cell failure in T2D.
Continuous Subcutaneous Insulin Therapy (CSII) and other technologies can be helpful in
preventing -cell failure in T2D. Recent studies showed that early intensive insulin therapy at T2D
diagnosis using CSII preserves -cell function and significantly improves glycemic control
compared to multiple daily insulin injections (MDI). Moreover CSII is consistently superior to
MDI in patients with the highest baseline HbA1c.
The OPT2MISE study demonstrated that CSII provides a significant advantage in glycemic control
over MDI with a safe and consistent effect in long-term treatment, providing the durability of CSII
impact on glucose control during a 1 year period of treatment. The use of CSII especially in the
initial stages of T2D or in special populations may have an impact not only on metabolic control
but also on the disease process.
Diabetes technology is therefore an example of personalized therapy for T2D.
RW36. THE IMPACT OF NEW TECHNOLOGIES IN THE MANAGEMENT OF

DIABETES
Professor Paolo Pozzilli1

1
University Campus Bio-Medico, Rome, Italy and Queen Mary College, London UK
At least one quarter of patients with type 2 diabetes (T2D) who receive insulin injections show
very poor glycemic control (HbA1c 9%;75 mmol/mol). One of the possible barriers to achieving
glycemic control with multiple daily insulin therapy (MDI) is severe insulin resistance resulting
in high daily insulin dose requirement. Early intensive insulin therapy with continuous
subcutaneous insulin infusion (CSII) in T2D at onset induces protracted glycaemic remission and
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preserves -cell function. CSII therapy may be considered as an effective method to achieve good
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glycaemic control, with a lower total daily insulin dose due to an increased basal insulin dose and
reduced bolus dose. CSII not only improves glycemic control in patients with type 2 diabetes, but
also has the additional benefit of inducing reduction of plasma ox-LDL, an important player in the
atherosclerotic process. This benefit is associated with a reduction in glucose excursion rather than
insulin dose or HbA1c.
The level of satisfaction and quality of life in T2D patients is influenced by problems such as
interference with daily activities, pain caused by injections and embarrassment. The use of
technology improves adherence to treatment. Several studies reported that diabetes satisfaction
scores improve over time with CSII. To improve adherence to CSII therapy, it is recommended
the use of a behavioral contract that provides specific metabolic goals to patients including
increased frequency of self glucose monitoring, a commitment on the part of the patient to go to
the diabetes centre for follow-up visits, frequency of pre-established visits and each patients
agreement to fulfill a detailed list of responsibilities.
Modern diabetes technology, such as CSII and continuous glucose monitoring, are now an
established and evidence-based part of diabetes care. Without a structured approach the new
technologies are often started and maintained improperly with poor cost-effective results. To
prevent this, the improvement not only of the advanced technologies but mostly of the healthcare
professional team who use them is crucial.
RW37. RELAIA DINTRE SINDROMUL METABOLIC I HEPATITA CRONIC CU

VIRUS C
Prof. Dr. Gabriela Radulian1, Rusu Emilia1, Dragut Ramona 1

1 Institutul Naional de Diabet Nutriie i Boli Metabolice "N Paulescu"
Obiectivul acestui studiu a fost evaluarea relaiei hepatit cronic cu virus C (HVC) i riscul
cardiovascular la pacienii cu sindrom metabolic (SM).
Material i metod: Acest studiul este transversal, observaional, s-a desfurat n Institutul
National de Diabet, Nutriie i Boli Metabolice "N.C. Paulescu" i a inclus un numr de 171 de
pacieni. S-au urmrit indicii antropometrici (greutate, nlime, circumferina taliei, IMC-ul),
parametrii biochimici (glicemia jeun, hemoglobina glicozilat, profil lipidic, profil hepatic i
hemoleucograma). Riscul cardiovascular s-a calculat pentru fiecare pacient folosind scorul
UKPDS. Rezistena la insulin a fost determinat utiliznd HOMA-IR. SM a fost definit conform
criteriilor IDF modificat.
Rezultate: SM a fost prezent la 58,4% (n=94) pacieni. Vrsta medie a fost de 50,5 9,1 ani,
durata medie a diabetului zaharat a fost de 7,74,6 ani. Folosind scorul UKPDS, 27,3% (n=44) i
16,8% (n=27) dintre pacieni au prezentat risc cardiovascular moderat respectiv crescut.
Concentraiile medii ale citokinelor proinflamatorii (TNF-=13,58 pg/ml, IL-6=14,26 pg/ml,
leptin=16,38 ng/ml i rezistina=19,86 ng/ml) au fost mai mari la pacienii care au avut un scor
UKPDS mai mare de 30 (p <0,001). La pacienii cu SM, au existat corelaii semnificative statistic
ntre UKPDS-CHD i HOMA-IR (r=0,44, p=0,001), IMC (r=0,39, p=0,001), TNF- (r=0,39,
p=0,001 ), IL-6 (r=0,35, p=0,001), HbA1c (r=0,41, p=0,001), trigliceride serice (r=0,43, p=0,001),
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LDL-C (r=0,29, p=0,001) i negativ cu HDL-C (r -0,44, p=0,001), adiponectina (r=-0,38,

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p=0,001). La acest pacieni a fost un nivel mai ridicat al TNF-, care se coreleaz cu gradul
inflamaiei, dar, de asemenea, cu rezistenta la insulina.
Concluzii: Sindromul metabolic a avut o prevalen ridicat la pacienii cu hepatit cronica cu
virus C, crescnd astfel riscul cardiovascular. Strategiile suplimentare trebuie implementate pentru
a identifica i a trata pacienii cu sindrom metabolic, pentru prevenia precoce a bolii
cardiovasculare.
RW38. DIABEZITATEA ABORDARE PRACTICA
Gabriela Roman 1,2

1
Universitatea de Medicina si Farmacie Iuliu Hatieganu
2
Centrul Clinic de Diabet, Nutritie, Boli Metabolice, Cluj-Napoca
Asociarea intre diabetul zaharat tip 2 (DZ 2) si obezitate (OB) este foarte frecventa avand la baza
mecanisme fiziopatologice comune. Termenul diabezitate este utilizat pentru a caracteriza ata
epidemia comuna de OB si DZ 2, cat si asocierile fiziopatologice ale acestor doua boli cronice si
a multiplelor complicatii si comorbiditati. Pentru a reduce impactul negativ al diabezitatii se
impune dezvoltarea si derularea unui program strcuturat de interventie adresat preventiei,
screeningului si managementului clinic. Mari studii clinice arata ca la populatia cu OB si risc
crescut de DZ 2, interventii pe termen lung si intensive asupra stilului de viata pot reduce
semnificativ greutatea si concomitent prevalenta DZ 2. Alte dovezi se refera la interventii
farmacologice (metformin, orlistat), care combinate cu optimizarea stilului de viata au fost
eficiente in reducerea ponderala si a prevalentei DZ 2. In populatia cu OB, screeningul este esential
pentru depistarea precoce a DZ 2, crescand astfel posibilitatea unei interventii clinice optime.
Odata diagnosticat DZ 2, interventia terapeutica trebuie sa aiba ca obiective atat controlul glicemic
cat si cel ponderal. Datele din literatura demonstreaza ca interventiile adresate reducerii aportului
caloric, inversarii balantei energetice si scaderii ponderale, au efecte benefice metabolice si
cardiovasculare. Cu cat reducerea ponderala este mai mare, cu atat sunt mai mari sansele de remisie
ale DZ 2, mai ales daca aceasta interventie este efectuata precoce. Astfel ca optimizarea intensiva
a stilului de viata, prin diete hipocalorice si activitate fizica sustinta trebuie sa reprezinte baza
tratamentului. Conform ghidurilor, chirurgia bariatrica / metabolica este o optiune de considerat
in prezenta diabezitatii, la valori ale IMC peste 35 kg/m2. Pentru controlul multifactorial este
nevoie de un tratament farmacologic individualizat. Obiectivele terapeutice trebuie sa vizeze
concomitent controlul glicemic si ponderal. Alaturi de optimizarea stilului de viata, medicatia
antihiperglicemianta trebuie selectata prioritar dintre clasele de medicamente care reduc HbA1c si
greutatea: metformin, agonisti de receptori GLP-1 sau analogi de GLP-1, inhibitori de SGLT2 si
inhibitori de DPP-4. Cand insulinoterapia este necesara, se recomanda analogii de insulina bazala
in combinatie cu medicatia mai sus amintita. Medicatia adresata specific controlului ponderal se
va lua in considerare daca este disponibila.
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DIABESITY PRACTICAL APPROACH
Gabriela Roman 1,2

1
Iuliu Hatieganu University of Medicine & Pharmacy
2
Clinical Center of Diabetes, Nutrition, Metabolic diseases, Cluj-Napoca
The association between Type 2 Diabetes (T2DM) and obesity (OB) is very frequent, with
common pathologic mechanisms linking the two conditions. Therefore diabesity is the term used
to characterize both the rising epidemic of OB and T2DM and the pathophysiologic association of
these two metabolic diseases and their multiple comorbidities and complications. In order to
reduce the burden of diabesity, a structured intervention program should be developed and applied
in terms of prevention, screening and clinical management. Great body of evidence shows that in
people with obesity and high risk for T2DM, long-term intensive lifestyle interventions can
significantly reduce the body weight and the prevalence of diabetes. Pharmacologic intervention
(metformin, orlistat) combined with lifestyle changes can also reduce both body weight and the
prevalence of T2DM. Screening among people with overweight and obesity is essential for early
diagnoses of T2DM, increasing thus the possibility of a more successful clinical management.
Once T2DM is already present, the therapeutic intervention should aim both weight and glycemic
control. Scientific literature proves that interventions aimed to reduce caloric intake, to revers
energy balance and thus to reduce body weight have beneficial metabolic and cardiovascular
effects. The greater weight loss is associated with the higher possibility of T2DM remission,
mainly if the intervention is applied early in the evolution of diabetes. Therefore, intensive lifestyle
optimization through hypocaloric diets and sustained physical exercise should be the cornerstone
of the treatment. Bariatric/metabolic surgery is a viable option in the presence of diabesity, at a
BMI above 35 kg/m2, according to the guidelines. Individualized pharmacologic treatment is
required to control all the cardiovascular risk factors. Therapeutic targets should be the control of
both glycemia and body weight. Together with lifestyle optimization, the antidiabetic medication
should be priority selected from the classes that reduces HbA1c and body weight: metformin,
GLP-1receptor agonists and GLP-1 analogues, SGLT2 inhibitors and DPP-4 inhibitors. When
insulin is required, the basal insulin analogues combined with the above medication is
recommended. Specific medication addressed to weight loss, if available, could be considered.
RW39. ENDOCRINE OUTCOMES AFTER BARIATRIC SURGERY
Polovina Snezana
Research Associate, MD, PhD on School of Medicine, University of Belgrade, Serbia
Clinic for Endocrinology, Diabetes and Diseases of Metabolism
Clinical Center of Serbia, Belgrade, Serbia
Bariatric or metabolic surgery is one of the most powerful therapeutic approach in severe
obesity treatment with long-term effect. The aims of bariatric surgery are from weight reduction
to improvement of metabolic abnormalities.
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Even it is well known that there is a high rate of diabetes remission after some bariatric
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procedures, we are still not sure what is realy underlying mechanism for this phenomenon. Some
data are on the side on resolving GLP-1 secretion and impact of other incretines, the other data
prefering the theory based on anti-incretines. Some authors argue that possible explanation of
metabolic changes, including diabetes remission lies on the changes of gut microbiota. Particularly
interesting are the changes in hormones with influence on glucose and lipide metabolism after
RYGB like insulin, amylin and leptin which levels becomes lower, although antiinflammatory
citokine, adiponectine becomes higher. Most powerful in diabetes remission is BPD/DS procedure
with remission rate of 95%, less efficient is RYGB (about 75-80%), VSG (about 70% ) and least
afficient is AGB with approximately 60% potential to achieve remission. Remission is not life-
long in all patients. Data confirm that the quality of sexual life in males improved after bariatric
surgery because of significantly higher levels of free testosterone. Potential side effect of
malabsorptive procedures is male infertility. A lot of women with PCOS and infertility normalised
the menstrual cycle and become pregnant in period of 3 years after surgery. Studies showed
changes in cortisol, TSH and GH levels after bariatric procedures. The bone metabolism is also
affected with bariatric surgery. Markers of bone turnover are more increased after gastric bypass
compared to gastric banding due to calcium and vitamin D malabsorption, preoperative low levels
of vitamin D and inadequately supplementation after surgery.
RW40. HEART FAILURE CONSIDERATIONS OF ANTIHYPERGLYCEMIC

MEDICATIONS FOR TYPE 2 DIABETES
Eberhard Standl MD, PhD, FESC

Munich Diabetes Research Group e.V. at Helmholtz Centre, Germany
Prevalent and incident heart failure (HF) is increased in people with type 2 diabetes (T2DM), and
in dependence upon the degree of hyperglycemia. Furthermore, mortality is markedly increased
by about 10times in patients with T2DM and HF compared to T2DM patients without HF.
Reducing HF by improved glycemic control, however, has not been successful until recently. In
fact, HF as an important outcome in patients with T2DM appears to be heterogeneously modulated
by antihyperglycaemic medications, as derived from cardiovascular outcome trials (CVOTs) and
large observational cohort studies. Appropriately powered and executed CVOTs are necessary to
truly evaluate CV safety and efficacy of new medications, as also required by the guidance of the
Food and Drug Administration and other agencies since 2008. In light of the best available
evidence at present, especially metformin and the SGLT2-inhibitor empagliflozin seem to be
advantageous in HF patients, as their use appears to be associated with reduced HF events and
improved mortality. Acarbose, the DPP4-inhibitor sitagliptin, the GLP1-RA lixisenatide comprise
reasonable additional options, as significant harm in terms of HF has been excluded for those
drugs. Additions to this list are anticipated pending results of ongoing CVOTs including detailed
HF results from LEADER, a trial evaluating the GLP1-RA liraglutide. Although no HF harm was
seen in CVOTs for insulin or sulfonylureas, they should be used only with caution in HF patients,
given their established high risk for hypoglycemia and some uncertainties regarding their safety
73
in HF patients derived from epidemiologic observations. Pioglitazone is contraindicated in HF

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patients >NYHA I, despite some benefits suggested by CVOT sub-analyses and a recent CVOT
in non-diabetic patients.
RW41. PREZENT I VIITOR N TRATAMENTUL DISLIPIDEMIILOR LA

PACIENTUL CU DIABET ZAHARAT
RomulusTimar, Laura Gai, BogdanTimar

Universitatea de Medicin i Farmacie, Timioara, Romnia
Diabetul zaharat (DZ) poate fi considerat o adevrat epidemie la nivel mondial - unul din 11
aduli sufer de aceast afeciune i se estimeaz c acest raport va ajunge la 1 din 10 pn n 2040.
Mai mult, la fiecare 6 secunde un pacient decedeaz datorit DZ i a complicaiilor acestuia. Bolile
cardiovasculare sunt principala cauz de mortalitate la aceti pacieni, urmate de afeciunile
oncologice i de diabetul per se. Totodat, bolile cerebrovasculare se situeaz pe locul patru, iar
boala arterial periferic pe locul apte.
Factorii de risc cardiometabolic includ dislipidemia (LDLc, apoB i trigliceridele crescute,

HDLc sczut), statusul inflamator i hipercoagulabilitatea, hipertensiunea arterial, sedentarismul,
fumatul, obezitatea/supraponderea i, nu n ultimul rnd, vrsta, rasa, sexul i istoricul familial.
Dintre acetia, dislipidemia se evideniaz ca unul din cei mai importani factori de risc
cardiovascular atunci cnd vorbim despre DZ. Un profil lipidic frecvent ntlnit la pacienii cu DZ
poate fi caracterizat prin trigliceride >150 mg/dl, HDLc <40 mg/dl la brbai i <50 mg/dl la femei,
i creterea numrului de particule mici i dense de LDLc, precum i apoB i lipoproteina a cu
valori crescute.
Recomandrile actuale privind tratamentul dislipidemiilor la pacienii cu DZ tip 1 asociat

cu boal renal i microalbuminurie propun scderea LDL colesterolului cu cel putin 30-50% cu
statine, indiferent de valoarea sa de baz, iar la pacienii cu DZ tip 2 i boal cardiovascular sau
boal cronic de rinichi intele sunt <70 mg/dl pentru LDLc, <100 mg/dl pentru colesterolul non-
HDL i <80 mg/dl pentru apoB.
Deoarece terapia cu statine este eficient doar ntr-un anumit procent din cazuri, chiar dac
este administrat doza maxim (40 mg de rosuvastatin, respectiv 80 mg atorvastatin), n schema
terapeutic poate fi asociat i ezetimib. Cu toate acestea, tratamentele actuale sunt insuficiente
pentru un numr semnificativ de pacieni. O alt opiune terapeutic superioar, alturi de LDL
aferez, sunt inhibitorii de PCSK9. Acetia sunt recomandai la pacienii cu hipercolesterolemie
primar sau cu dislipidemie mixt n combinaie cu statine (sau alte hipolipemiante la pacienii
care nu ating intele terapeutice sau la care statina este contraindicat) i n cazul dislipidemiei
aterogene n combinaie cu statin i/sau fibrat atunci cnd celelalte terapii hipolipemiante nu sunt
suficiente.
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PRESENT AND FUTURE PERSPECTIVES REGARDING THE TREATMENT OF
DYSLIPIDEMIAIN PATIENTS WITH DIABETES
RomulusTimar, Laura Gai, BogdanTimar

University of Medicine and Pharmacy, Timioara, Romania
Diabetes mellitus (DM) has become a world epidemic, since one in eleven adults are already
diagnosed with diabetes and by 2040 it is estimated that the number will rise to one in ten people.
Moreover, every six seconds a person dies due to complications caused by DM. Cardiovascular
diseases are by far the highest cause of mortality in patients with DM, followed by malignancies
and diabetes itself on the third place. In addition, cerebrovascular diseases come on a fourth place
and peripheral artery disease on the seventh place.
Cardiometabolic risk factors include abnormal lipid metabolism (high LDLc, apoB and
triglycerides serum levels and low HDLc serum levels), an inflammatory status and
hypercoagulation, hypertension, physical inactivity, smoking, overweight or obesity and last but
not least age, race, gender and family history. However, one the most important risk factor when
discussing DM is dyslipidemia. This condition includes elevated tryglicerides (>150 mg/dl), low
HDLc (<40 mg/dl in males and <50 mg/dl in females) and an increase in small, dense LDL
particles, apoB and lipoprotein a.
The current recommendations regarding the treatment of dyslipidemia in patients with type
1 DM associated with renal disease and microalbuminuria propose a decrease (with statins) of
minimum 30-50% of the LDL cholesterol levels, irrespective of the basal concentration, while for
patients with type 2 DM and cardiovascular disease or chronic kidney disease the targets are <70
mg/dl for LDLc, 100 mg/dl for non-HDL cholesterol and <80 mg/dl for apoB.
Statin therapy is efficient in the highest recommended dose (40 mg for rosuvastatin and 80
mg for atorvastatin), however not for all patients, which is why in some cases ezetimibe is also
associated. Current available treatments prove inefficient in quite a number of cases, reason for
which LDL-apheresis has been proposed. A better initiative has been developing the PCSK9
inhibitors. They are recommended in primary hypercholesterolemia or mixed dyslipidemia, in
combination with a statin or with other lipid-lowering therapies in patients unable to reach LDLc
goals or for whom a statin is contraindicated, or for atherogenic dyslipidemia in combination with
a statin and/or fibrate - when lowering therapies are unable to reach lipidic goals.
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RW42. TULBURRI METABOLICE ASOCIATE HIPOTIROIDIEI
Vudu Lorina
Universitatea de Stat de Medicin i Farmacie "Nicolae Testemianu"
Hipotiroidia primar se asociaz cu dereglri ale diferitor tipuri de metabolism (lipidic, proteic,
glucidic, energetic etc.), fie prin efectul direct sau indirect al hormonilor tiroidieni. T3 i T4
regleaz genele implicate n procesele de lipogenez i lipoliz, avnd efecte genomice i
nongenomice. Deficitul de hormoni tiroidieni duce la dereglri ale metabolismului proteic
(ncetinirea de sintez i de degradare), acumularea n esuturi a glicoproteinei mucina, a
condroitinsulfailor i a acidului hialuronic, care au capacitatea de a reine apa i cauzeaz edemul
mucinos al esuturilor i organelor, contribuie la apariia hidropericardului i hidrotoraxului.
Dereglrile metabolice care au loc n cazul scderii funciei glandei tiroide, predispun ctre
dezvoltarea aterosclerozei. n hipotiroidie are loc scderea metabolismului, scderea lipolizei,
creterea nivelului de colesterol total, LDL-colesterol, IDL-colesterol. Scade cantitatea i
activitatea LDL-receptorilor n ficat, n rezultat scade excreia hepatic a colesterolului i crete
concentraia LDL-colesterolului i VLDL-colesterolului, bogate n apolipoproteine B. Pacienii cu
hipotiroidie de obicei prezint valori ascendente de HDL-colesterol, datorate creterii concentraiei
particulelor HDL-2. Scderea activitii CETP (cholesteril ester transfer protein) duce la scderea
transformrii esterilor de colesteril din HDL n LDL, scade transportul invers al colesterolului,
proces antiaterogen important n organismul uman. Scderea activitii lipazei hepatice provoac
scderea catabolismului HDL-2 particulelor. Are loc cretera valorilor lipoproteinei A. In
insuficiena tiroidian nivelul trigliceridelor poate fi moderat crescut i este determinat de scderea
activitii lipoprotein lipazei n esutul adipos i scderea clearance-ului trigliceridelor de ctre
esutul adipos. Unii autori consider c hipertrigliceridemia este determinat de creterea sintezei
de trigliceride.
Scopul lucrrii a fost de a stabili la pacienii cu hipotiroidie specificul modificrii indicilor
metabolismului lipidic i al aminoacizilor, repartizai pe grupe funcionale - mediatori, glicogeni
i cetogeni, imunoactivi.
Materiale i metode. n studiu au fost inclui 100 pacieni u hipotiroidie primar pe fond
de tiroidit autoimun i 30 persoane sntoase. Vrsta bolnavilor a constituit de la 23 pn la 66
ani. A fost determinat profilul lipidic: colesterol total, LDL-C, HDL-C, trigliceride i coninutul
aminoacizilor n plasma sanguin la persoane sntoase i cu hipotiroidie primar. Nivelul TSH la
pacienii investigai a constituit 63,189,39 UI/ml, iar T4 liber - 7,331,20 pmol/L.
Rezultate i discuii. Analiza indicilor metabolismului lipidic la pacienii cu hipotiroidie
primar a artat c nivelul colesterolului total a constituit 6,500,60 mmol/L, LDL-C - 4,280,44
mmol/L, HDL-C - 1,750,13 mmol/L, al trigliceridelor - 1,990,39 mmol/L. La pacienii studiai
erau prezeni cel puin 2 factori de risc ai maladiilor cardiovasculare (stres cronic, hipertensiune,
fumat, masa corporal, etc.), ceea ce clasific aceti pacieni n grupa cu risc major conform
indicilor lipidici, recomandai de Asociaia European de Ateroscleroz.
Analiza aminoacizilor mediatori la pacienii cu hipotiroidie a artat creterea aminoacizilor
inhibitori (taurina, glicina i -aminobutiric), pe cnd suma general a aminoacizilor excitani
(asparagina, glutamina) nu a suferit modificri statistic concludente. Analiza coninutului fiecrui
aminoacid inhibitor i excitant a artat sporirea coninutului de glicin la persoanele investigate.
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Concluzii. Modificrile metabolismului lipidic la pacienii cu hipotiroidie se caracterizeaz

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prin creterea nivelului colesterolului total, LDL-C, trigliceridelor, ceea ce corespunde unui risc
cardiovascular major. La pacienii cu hipotiroidie se estimeaz att dereglri ale profilului, ct i
ale valorilor numerice ale aminoacizilor mediatori sanguini, cu predominarea sumei aminoacizilor
inhibitori i creterea statistic veridic a valorilor glicinei.
METABOLIC DISORDERS LINKED TO HYPOTHYROIDISM
Vudu Lorina
State University of Medicine and Pharmacy "Nicolae Testemitanu"
Primary hypothyroidism (H) is associated with disorders of different types of metabolism

(lipid, protein, carbohydrate, energy, etc.), either by direct or indirect effect of thyroid hormones.
T3 and T4 regulate genes involved in lipogenesis and lipolysis processes, with non-genomic and
genomic effects. Deficiency of thyroid hormones leads to protein metabolism disorders (slowing
synthesis and breakdown), accumulation in the tissues of the glycoprotein mucin, chondroitin
sulfates and hyaluronic acid who have the ability to retain water and cause mucinous edema of the
tissues and organs, and promote the development of hydrothorax and hydropericardium. Metabolic
disorders that occur when thyroid function declines, predispose to the development of
atherosclerosis. Decreased metabolism, decreased lipolysis, increased total cholesterol, LDL-
cholesterol, IDL-cholesterol occur in H. The amount and activity of LDL- receptors in the liver is
reduced, resulting in decreased hepatic excretion of cholesterol and increased concentration of
LDL-cholesterol and VLDL-cholesterol, rich in apolipoprotein B. Patients with H usually show
rising values of HDL-cholesterol, due to the increasing concentrations of HDL-2 particles.
Decreased activity of CETP leads to decreased transformation of cholesteryl esters from HDL to
LDL, decreased reverse cholesterol transport an important antiatherogenic process in the human
body. The decreased hepatic lipase activity causes a decreased catabolism of HDL-2 particles.
Elevated lipoprotein A level occurs. Triglyceride level may be moderately increased in thyroid
insufficiency and is caused by decreased activity of lipoprotein lipase in adipose tissue and
decreased triglyceride clearance by adipose tissue. Some authors consider that
hypertriglyceridemia is due to increased synthesis of triglycerides.
The purpose of the study was to determine the specific of changes in lipid and amino acid
metabolism indices, divided by functional groups - mediator, glycogen and ketogenic,
immunoactive in hypothyroid patients.
Materials and methods. The study included 100 patients with primary H, on the background
of autoimmune thyroiditis and 30 healthy subjects. The age of patients was from 23 to 66 years.
The lipid profile was determined: total cholesterol, LDL-C, HDL-C, triglycerides, and the content
of amino acids in the blood plasma of healthy persons and those with primary H. TSH level in the
investigated patients was 63.18 9.39 UI/ml and free T4 - 7.33 1.20 pmol/L.
Results and discussion. Analysis of lipid metabolism indices in patients with primary H
showed that total cholesterol was 6.50 0.60 mmol/L, LDL-C - 4.28 0.44 mmol/L, HDL-C -
1.75 0.13 mmol/L, triglycerides - 1.99 0.39 mmol/L. At least two risk factors for cardiovascular
77
disease (chronic stress, hypertension, smoking, body weight, etc.) were present in the studied
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patients, which classifies these patients into high risk group according to lipid indices
recommended by the European Association of Atherosclerosis.
Mediator amino acids analysis in patients with hypothyroidism showed an increase in
inhibitory amino acids (taurine, glycine and -aminobutyric acid), while the overall amount of
excitatory amino acids (asparagine, glutamine) did not show statistically conclusive changes.
Analysis of the content of each excitatory and inhibitory amino acids revealed an increased content
of glycine in the investigated individuals.
Conclusions. Changes in lipid metabolism in patients with hypothyroidism is characterized
by increased total cholesterol, LDL-C, triglycerides, which corresponds to a major cardiovascular
risk. In hypothyroid patients, both profile, as well as numerical values disturbances of mediator
amino acids are observed, with predominance of inhibitory amino acids amount and a statistically
reliable increase in glycine values.
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PREZENTRI ORALE LUCRRI ORIGINALE /ORAL
PRESENTATIONS ORIGINAL PAPERS
OP1. PROGRANULINA ROLUL JUCAT N ASOCIEREA BOLII ALZHEIMER CU

DIABETUL ZAHARAT TIP 2
Dr. Popa Adina1, ef Lucr. Dr. Popa Simona Georgiana1, Dr. Soare Andreea1, Prof. Univ.
Dr. Moa Maria1, Prof. Univ. Dr. Pozzilli Paolo
1
Spitalul Clinic Judeean de Urgen Craiova
Premise i Obiective: Studii effectuate n ultimii ani au artat c progranulin (PGRN), protein
recent inclus n grupul adipocitokinelor, poate juca un rol att n etiopatogenia diabetului zaharat
tip 2 (DZ), ct i a bolii Alzheimer (AD). Propunem un studiu pilot n vederea evalurii rolului
jucat de PGRN n asocierea DZ cu AD.
Material i Metod: Studiul a inclus 40 subieci, mprii n 4 grupuri: 10 subieci cu asocierea
AD i DZ (Grup 1); 10 subieci doar cu AD (Grup 2); 10 subieci doar cu DZ (Grup 3); 10 subieci
fr AD i DZ (Grup 4). PGRN a fost dozat prin metoda ELISA iar raportul PGRN/kg s-a
calculate la toi subiecii. De asemenea, la toi subiecii s-a evaluat genotipul apolipoproteinei E
(Apo E) i statusul mental prin testul mini mental (MMSE). Datele nregistrate au fost analizate
statistic cu software-ul SPSS 17.00.
Rezultate i Discuii: PGRN seric a diferit semnificativ statistic ntre cele 4 grupuri (p=0,01),
cea mai mare valoare nregistrndu-se la subiecii din Grupul 3 (132,936,7), iar cea mai mic
valoare la cei din Grupul 1 (87,219,1). Raportul PGRN/kg a fost semnificativ statistic mai mare
la subiecii din Grupul 2 (p=0,023) i Grupul 3 (p=0,049) comparativ cu Grupul 1. La toi subiecii
cu AD (n=20), s-a analizat relaia dintre nivelul PGRN, raportul PGRN/kg, genotipul Apo E, scorul
MMSE i durata bolii. Singura corelaie semnificativ statistic s-a observant ntre scorul MMSE
i durata bolii (p=0,008).
Concluzii: Rezultatele noastre arat c PGRN poate juca un rol n asocierea dintre DZ i AD, dar
studii viitoare pe loturi mai mari de subieci sunt necesare pentru a elucida contribuia
adipocitokinelor la asocierea celor dou afeciuni.
PROGRANULIN DOES IT PLAY A ROLE IN THE ASSOCIATION BETWEEN

ALZHEIMER DISEASE AND TYPE 2 DIABETES?
Popa Adina1, Lect. Dr. Popa Simona Georgiana1, Soare Andreea1, Prof. Moa Maria1, Prof.
Pozzilli Paolo
1
Emergency Clinical Hospital Craiova
Premises and Objectives: Studies performed in the last years showed that progranulin (PGRN),
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recently described as an adipocytokine, may be involved in the etiopathogenesis of both Alzheimer

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disease (AD) and type 2 diabetes (T2D). We propose a pilot study evaluating the contribution of
PGRN to the association between AD and T2D.
Content and Method: The study included 40 subjects divided into 4 groups: 10 subjects with
both AD and T2D (Group 1); 10 subjects with AD only (Group 2); 10 subjects with T2D only
(Group 3); 10 age and sex matched healthy controls (Group 4). PGRN was evaluated by ELISA
assay and PGRN/kg ratio was calculated in all the subjects. Apolipoprotein E (Apo E) genetic
analysis as well as mini-mental state examination (MMSE) were assessed in all the participants.
Recorded data were analyzed using SPSS 17.00 software
Results and Discussions: PGRN levels were statistically significant different between the 4
studied groups (p=0.01), with the highest value in Group 3 (132.936.7) lowest mean value in
Group 1 (87.219.1). Regarding PGRN/kg ratio, we found statistically significant higher values
in Group 2 (p=0.023) and Group 3 (p=0.049) compared to Group 1. In all the subjects with AD
(n=20), we analyzed the relationships between PGRN levels, PGRN/kg ratio, Apo E genotype,
MMSE score and the duration of the disease. The only statistically significant correlation was
found between MMSE and the duration of the disease (p=0.008).
Conclusions and Findings: Our findings suggest that PGRN may play a role in the association
between T2D and AD, but further studies, on a larger number of subjects are needed in order to
elucidate the contribution of adipokines to the association of these two conditions.
OP2. ANALIZA IMUNOHISTOCHIMIC A PROTEINELOR P53, BCL2, P53/BCL2 LA

PACIENII CU ADENOCARCINOM COLORECTAL I DIABET ZAHARAT TIP 2
Horaiu-Cristian Popescu-Vlceanu1, Mihai Stoicea2, Coralia Bleotu3, Valentin Enache4,

Veronica Ilie5, Raluca Nan1, Ramona Maria Drgu1, Emilia Rusu1, Constantin Ionescu-
Trgovite1,6, Gabriela Radulian1,6
1.
Carol Davila Universitatea de Medicin i Farmacie, Buucreti;
2.
Laboratorul Central Synevo, Bucureti;
3.
Institutul de of Virusologie Stefan S. Nicolau;
4.
Spitalul Clinic de Urgen Departamentul de Patologie, Bucureti
5.
Spitalul Fundeni;
6.
Institutul Naional de Diabet, Nutriie i Boli Metabolice"Prof. N. C. Paulescu"
Premise i obiective: Studiile epidemiologice au evideniat un risc crescut de cancer colorectal la

pacienii cu diabet zaharat de tip 2 (T2D). Avnd n vedere complexitatea mecanismelor
fiziopatologice existente n DZ tip 2, ne-am propus un nou proces potenial carcinogen la pacienii
cu T2D, prin investigarea expresiei imunohistochimice concomitente n adenocarcinomul
colorectal la diabetici i non-diabetici, a dou molecule implicate n patogeneza cancerului i
diabetului zaharat: proteina supresoare tumoral p53 i proteina anti-apoptotic Bcl2.
Material i metod: Studiul a fost unul retrospectiv i a analizat toi pacienii spitalizai cu cancer
colorectal de la 01.01.2011-15.06.2015 n Spitalul Clinic de Urgen Bucureti, folosind
programul informatic medical Hipocrate n conformitate cu Clasificarea Internaional Statistic a
Clasificrii Bolilor ediia a 10 -ICD10, astfel: cancerul de colon C18, C19 cancerul
rectosigmoidian i C20 cancerul rectal. Dintr-un total de 1307 de cazuri identificate, am selectat
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aleatoriu n ordinea apariiei doar cazurile ce au prezentat criteriile de includere: pacienii

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diagnosticai cu adenocarcinom colorectal primar; vrsta> 18 ani, femei i brbai; fr istoric

familial de cancer colorectal; fr tratament oncologic anterior; cu diabet zaharat de tip 2
diagnosticat anterior cancerului colorectal-pentru grupul de diabetici. Etapa de microscopie optic
a reprezentat momentul central al evalurii histopatologice a seciunilor de esut, i a fost realizat
n mod independent de ctre doi medici anatomopatologi, n conformitate cu standardele
profesionale actuale. Toate datele au fost extrase din biletele de externare i din rapoartele
histologice.
Dup obinerea acordului comisiei de etic locale, cazurile au fost selectate din baza de date a
Departamentului de Anatomopatologie a Spitalului Clinic de Urgen Bucureti. Expresiile p53 si
Bcl2 au fost investigate prin metoda imunohistochimic automatizat utiliznd platform
BenchMark XT Ventana, folosind protocolul dual Bcl2-p53 n cadrul Departamentului de
Histopatologie al Laboratorului Central de referin Synevo. Clonele folosite au fost soluii pentru
diagnostic in vitro: pentru proteina antiapoptotic Bcl2 clona a fost Ventana CONFIRM 124 anti-
Bcl2 Mouse Monoclonal Primary Antibody iar pentru proteina p53 supresoare tumoral clona a
fost Ventana Anti-p53 Primary Antibody Bp53-11.
Rezultate i discuii: Grupul de studiu a inclus 4 probe de mucoas colonic non-lezional i 95
de probe cu esut tumoral de tip adenocarcinom colorectal, din care 43 de cazuri ce nu au asociat
T2D si 52 de cazuri cu T2D. Comparativ cu non-T2D, pacienii cu T2D au prezentat: o expresie
imunohistochimic crescut anormal a p53 (expresie pozitiv n> 70% din celulele tumorale, de
intensitate moderat sau ridicat) n 46,2% vs 34,9%, p = 0,306; coexpresie crescut Bcl2 / p53
(11,5% vs de 7%, p = 0,099), o frecven mai mare a imunofenotipului Bcl2-/p53+ (42,3% vs
32,6%, p = 0,447) i o expresie Bcl2 mai sczut (9,6%vs 16,3%, p =0,367). Analiza a evideniat
o cretere semnificativ a expresiei p53 la subgrupul de pacienti diabetici obezi, comparativ cu
diabeticii non-obezi (80%vs 40,5%) sau non-diabetici (80% vs 37%, p = 0,024), cu semnificaie
statistic.
Concluzii: Rezultatul acestui studiu sugereaz c pacienii cu adenocarcinom colorectal ce
asociaz T2D i obezitate, prezint mai frecvent expresia anormal a proteinei supresoare p53,
comparativ cu pacienii diabetici non-obezi sau non-diabetici. Aceast expresie aberant a p53
asociat cu T2D i obezitatea n adenocarcinoamele colorectale ofer acestui grup de pacieni un
prognostic mai rezervat, att n ceea ce privete evoluia, progresia, recurena ct i a raspunsului
la tratament.
IMMUNOHISTOCHEMICAL ANALYSIS OF P53, BCL2, P53/BCL2 PROTEINS IN

PATIENTS WITH COLORECTAL ADENOCARCINOMA AND TYPE 2 DIABETES
Horaiu-Cristian Popescu-Vlceanu1, Mihai Stoicea2, Coralia Bleotu3, Valentin Enache4,

Veronica Ilie5, Raluca Nan1, Ramona Maria Drgu1, Emilia Rusu1, Constantin Ionescu-
Trgovite1,6, Gabriela Radulian1,6
1.
Carol Davila University of Medicine and Pharmacy;
2.
Bucharest Central Lab Synevo;
3.
Institute of Virology Stefan S. Nicolau;
4.
Bucharest Emergency Clinical Hospital- Pathology Departament;
5.
Fundeni Hospital;
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6.
National Institute of Diabetes, Nutrition and Metabolic Diseases"Prof. N. C. Paulescu"
Page
Premises and objectives: Epidemiological studies have shown an increased risk of colorectal
cancer in type 2 diabetes (T2D) patients. Given the complexity of pathophysiological mechanisms
existing in T2D, we proposed a new potential inductive process for carcinogenicity in T2D patients
by investigating concomitant immunohistochemical expression in diabetic and non-diabetic
colorectal adenocarcinoma of two molecules involved in the pathogenesis of both cancer and
diabetes: tumour suppressor p53 protein and antiapoptotic Bcl2 protein.
Matherial and methods: This was a retrospective study analyzing all hospitalized patients with
colorectal cancer from 01.01.2011-15.06.2015 in Bucharest Emergency Hospital, using medical
informatic program Hippocrates according to International Statistical Classification of Diseases
classification and Related Health Problems 10th Revision -ICD10: colon cancer C18,
rectosigmoidian cancer C19 and rectal cancer C20. From a total of 1307 cases we identified, we
randomly selected in order of appearance only the cases with appropriate inclusion criteria:
patients diagnosed with primary colorectal adenocarcinoma, age > 18 years , women and men with
a family without familiy history of colorectal cancer , without previous oncologic treatment, type
2 diabetic patients earlier cancer diagnosed) ( for diabetic group).Optical microscopy stage was
the central moment of the histopathological evaluation of tissue sections , and was conducted
independently by two pathologists doctors in accordance with current professional standards.All
data were extracted from hospital discharge summaries and histological reports.After obtaining
the ethics committee agreement the cases were then selected from the Pathology Database of the
Bucharest Emergency Hospital. The p53 and Bcl2 expressions were investigated by automated
immunohistochemistry BenchMark XT Ventana platform using dual Bcl2-p53 protocol in the
Histopathology Department of the Central Reference Laboratory Synevo. The clone used were in
vitro diagnostic solutions: for antiapoptotic Bcl2 protein the clone was Ventana CONFIRM 124
anti-Bcl2 Mouse Monoclonal Primary Antibody and for p53 tumour suppressor protein was
Ventana Anti-p53 Primary Antibody Bp53-11 clone.
Results and discussions: The study group consisted of 4 samples of colonic nonlesional mucosa
and 95 patients with new primary colorectal adenocarcinoma, 43 non T2D and 52 with T2D.
Compared with non-T2D, patients with T2D had increased immunohistochemical abnormal p53
expression (positive expression in > 70 % of tumor cells of moderate or high intensity) in 46.2%
vs 34.9%, p= 0.306; increased Bcl2/p53 coexpression (11.5% vs 7%, p=0.099) and a higher
frequency of Bcl2-/p53+ immunophenotype (42.3% vs 32.6%, p=0.447), and a lower Bcl2
expression (9.6% vs 16.3%, p=0.367). Subgroup analysis showed a significant increase in p53
expression in obese T2D patients compared to non-obese diabetics (80% vs 40.5%) or non-
diabetics (80% vs 37 %, p = 0.024) with statistical significance.
Conclusion: The result of this study suggest that colorectal adenocarcinoma in T2D obese
subgroup patients, had a more frequent abnormal p53 expression compared to non-obese T2D and
non-T2D. Aberrant p53 expression associated with T2D and obesity in colorectal
adenocarcinomas, gives this group a more reserved prognosis both in terms of evolution,
progression , recurrence and treatment response.
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OP3. UTILIZAREA SISTEMULUI DE MONITORIZARE CONTINU A GLICEMIEI
CA METOD DE INVESTIGARE A HIPOGLICEMIEI REACTIVE
Dr. Stoica Roxana Adriana1, Dr. Soare Andreea1, Dr. Del Toro Rossella1, Dr. Guja Cristian1,
Dr. Pozzilli Paolo
1.
Hipoglicemia este frecvent ntlnit n practica medical ca reacie advers a tratamentului

antidiabetic. Episoadele ce nu sunt legate de diabetul zaharat sunt rare i pot reprezenta o problem
de diagnostic pentru clinicieni. Hipoglicemia reactiv este un diagnostic controversat, fiind
definit ca o scdere a glicemiei sangvine indus de mas. Recomandrile pentru evaluarea i
managementul acesteia sunt bazate n principal pe experiena clinic. Actual, testul de toleran la
o mas mixt (TMM) este principala metod de diagnostic. Tehnologii noi precum sistemul de
monitorizare continu a glicemiei (SMCG) pot fi folosite pentru evaluarea hipoglicemiei reactive,
att n spital, ct i la domiciliul pacientului. Obiectivul acestui studiu este investigarea SMCG ca
metod de evaluare i diagnostic a hipoglicemiei reactive.
Am realizat un studiu pilot observaional ce s-a desfurat pe o perioad de un an la Universitatea
Campus Bio-Medico din Roma i Institutul Naional de Diabet, Nutriie i Boli Metabolice
Bucureti, ce a nrolat aptesprezece pacieni ce s-au prezentat consecutiv n ambulatorul celor
dou clinici acuznd simptome de hipoglicemie reactiv. Majoritatea pacienilor a fost
reprezentat de femei (14/17 pacieni) cu o vrst medie de 44 (25) ani i un indice de mas
corporal mediu de 27.5 ( 4.4) kg/m2. Toi pacienii au fost testai folosind TMM cu durat de 5
ore, urmat de montarea SMCG pentru o perioad de 3 zile (Medtronic Enlite). Am analizat datele
folosind softul SPSS (IBM Statistics versiunea 20) utliznd coeficientul Pearson, Mann-Whitney
U i testul t Student, cu un nivel de semnificaie de 0.05. Rezultatele sunt exprimate ca medie (
DS) sau median (IQR).
SMCG a detectat episoade de hipoglicemie postprandial definite ca valori glicemice mai mici de
70 mg/dl timp de cel puin 10 minute, la 8 din 17 pacieni (47.05%), comparativ cu TMM care a
diagnosticat numai 5 din 17 pacieni (29.41%). Adiional, SMCG a detectat episoade de
hipoglicemie nocturn (2/17 pacieni) sau atipice - nelegate de mas sau de activitatea fizic (6/17
pacieni) ce nu au fost considerate diagnostice. Pacienii au avut n medie 2 ( 1) episoade de
hipoglicemie postprandial cu o durat medie de 25 (10) minute.
Media glicemiilor ntre 2 i 5 ore postprandial dup TMM a fost corelat cu media glicemiilor
postprandiale detectate de SMCG, rezultatul fiind la limita semnificaiei statistice (coeficientul
Pearson= 0.457; p=0.065). Analiznd procentul de valori glicemice pentru fiecare interval de 10
mg/dl cuprinse ntre 41 mg/dl i 180 mg/dl pe cele 3 zile monitorizare glicemic, am observat o
diferen ntre grupul de pacieni diagnosticai cu hipoglicemie reactiv i cei normali conform
SMCG, aa cum reiese din Figura 1.
Figura 1. Pacienii din grupul cu hipoglicemie reactiv au avut un procent mai mare de
hipoglicemii ntre 41-50 mg/dl, 51-60 mg/dl, 61-70 mg/dl, 71-80 mg/dl i 81-90 mg/dl comparativ
cu cei normali (0.8%, 0.82%, 2.08%,10.2%, 30.26% i,respectiv, 0%, 0.33%, 0.98%,
4.11%,17.47%). Pentru fiecare interval de 10 mg/dl ntre 91 i 180 mg/dl, pacienii cu
hipoglicemie reactiv au avut un procent de valori glicemice mai mic fa de cei normali.
Comparaiile dintre grupuri nu au fost semnificative statistic.
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n acest studiu pilot, SMCG a detectat cazuri adiionale de hipoglicemie reactiv comparativ
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TMM. Prin urmare, SMCG poate avea un rol n diagnosticul i evaluarea interveniilor terapeutice
la pacienii afectai de aceast patologie. Studii suplimentare care s includ un numr mai mare
de pacieni sunt necesare pentru a confirma acest lucru. (Acest proiect a fost susinut de Societatea
Romn de Diabet, Nutriie i Boli Metabolice.)
THE USE OF THE CONTINUOUS GLUCOSE MONITORING SYSTEM AS A NEW

TOOL TO INVESTIGATE REACTIVE HYPOGLYCAEMIA
Dr. Stoica Roxana Adriana1, Dr. Soare Andreea1, Dr. Del Toro Rossella1, Dr. Guja Cristian1,
Dr. Pozzilli Paolo
1
Hypoglycaemia is frequently encountered in daily practice as an adverse effect of antidiabetic

treatment. Episodes that are non-related to diabetes mellitus are rare and confront the clinician
with diagnostic difficulties. Reactive hypoglycaemia is a controversial medical diagnosis defined
as a meal-induced lowering of blood glucose. The recommendations for its evaluation and
management rely largely on clinical experience. Currently, the mixed meal tolerance test (MMT)
is the main diagnostic tool. New technologies like continuous glucose monitoring systems
(CGMS) can be used to comprehensively assess reactive hypoglycaemia in hospital care and also,
under real life conditions.
The aim of the study is to investigate whether CGMS can be used as a diagnostic method for
reactive hypoglycaemia.
We designed an observational pilot study developed at University Campus Bio-Medico in Rome
and National Institute of Diabetes, Nutrition and Metabolic Diseases in Bucharest for a 1 year
period, that enrolled seventeen patients presenting consecutively in the outpatient clinic with
symptoms of reactive hypoglycaemia. The majority of patients was represented by women (14/17
patients); median age of the population was 44 (25) years and mean body mass index 27.5 ( 4.4)
kg/m2. In all of them, we have performed a standard MMT for 5 hours that was followed by a 3
day monitoring with a CGMS (Medtronic Enlite). The data were analysed using SPSS software
(IBM Statistics version 20) using Pearson coefficient, Mann Whitney U and t-test, with a
significance alpha level of 0.05. Results are expressed as mean ( SD) or median (IQR).
CGMS detected postprandial hypoglycaemic episodes (defined as glucose values less than
70mg/dl for at least 10 minutes) in 8/17 patients (47.05%), as compared with MMT that diagnosed
only 5/17 patients (29.41%). Additionally, CGMS detected nocturnal (2/17 patients) or other
atypical episodes - defined as non-related to a meal or physical activity (6/17 patients), that were
not considered as diagnostic. Patients had 2 ( 1) postprandial hypoglycaemic episodes with a
median duration of 25 (10) minutes.
Mean postprandial glycaemic values between 2 and 5 hours in MMT correlated with the mean
postprandial glycaemic values detected by CGMS, almost reaching statistical significance
(Pearson coefficient= 0.457; p=0.065). Analysing the percentage of glucose values at each 10
mg/dl interval (ranging from 41 mg/dl to 180 mg/dl) during 72 hours monitoring, we observed a
85
difference in the percentage distribution between those that were disease positive and negative
according to CGMS as seen in Figure 1.
Page
Patients in the reactive hypoglycaemia group had higher percentages of glucose values between
41-50 mg/dl, 51-60 mg/dl, 61-70 mg/dl, 71-80 mg/dl and 81-90 mg/dl as compared with the normal
group (0.8%, 0.82%, 2.08%,10.2%, 30.26% and, respectively, 0%, 0.33%, 0.98%,
4.11%,17.47%). For each 10 mg/dl interval between 91 and 180 mg/dl, patients in the reactive
hypoglycaemia group had smaller percentages than the normal group. All comparisons between
the two groups were non-significant at an level of 0.05.
In our pilot study CGMS detected additional cases of reactive hypoglycaemia compared to MMT.
Thus, it may have a role in diagnosing and evaluating therapeutic interventions in patients affected
by this condition. Further studies involving larger sample sizes are required. (This research project
was sustained by The Romanian Society of Diabetes, Nutrition and Metabolic Diseases.)
OP4. BUCLA DE FEED-BACK POZITIV DINTRE PEROXIDUL DE HIDROGEN I

MONOAMINOXIDAZE UN NOU MECANISM DE STRESS OXIDATIV VASCULAR
N DIABETUL ZAHARAT
Dr. Sturza Adrian1, Dr, Duicu Oana1, Dr. Vduva Adrian1, Dr. Dnil Maria1, Dr.
Privistirescu Andreea1, Dr. Munteanu Mircea1, Prof. Dr. Timar Romulus1, Prof. Dr.
Muntean Danina1
1.
Disciplina de Fiziopatologie, Centrul de Cercetare Translationala si Medicina Sistemelor,
Universitatea de Medicina si Farmacie Victor Babes Timisoara
Stress-ul oxidativ deine un rol central n secvena patogenic responsabil de disfuncia

endotelial n diabetul zaharat (DZ). Am demonstrat anterior c monoaminoxidazele (MAO) cu 2
izoforme, A i B, reprezint surse mitocondriale de de specii reactive de oxigen (SRO) n DZ.
Avnd rol n degradarea catecolaminelor, MAO cu genereaz constant peroxid de hidrogen
(H2O2) ca i compus de reacie.
Studiul prezent, efectuat pe fragmente vasculare izolate de la obolani cu i far DZ, a urmrit
evaluarea efectelor: i) concentraiilor crescute de H2O2 asupra relaxrii vasculare i respectiv,
expresiei MAO la nivelul peretelui aortic i ii) stimulrii cu MAO exogen a produciei de H2O2
la acest nivel. Diabetul zaharat experimental a fost indus cu streptozotocin i au fost determinate
dup cum urmeaz: producia de H2O2 cu ajutorul tehnicii FOX, reactivitatea vascular n baie de
organ i expresia MAO prin studii de imunohistochimie.
Datele noastre au aratat o atenuare semnificativa a relaxrii dependente de endoteliu asociat cu
creterea expresiei ambelor izoforme ale MAO la nivelul segmentelor vasculare stimulate cu
H2O2. Cantitatea de H2O2 a fost semnificativ crescut i rspunsul vasodilatator a fost
semnificativ atenuat n vasele izolate de la obolani diabetici comparativ cu lotul martor; incubarea
cu catalaz (scavenger de H2O2) a mbuntit rspunsul vascular. Stimularea cu MAO a indus o
cretere dependent de doz a produciei de H2O2 la nivelul segmentelor de aort de obolan.
n concluzie, producia excesiv de radicali liberi contribuie la activarea continu a MAO cu
generare secundar de peroxid de hidrogen cu instalarea unei bucle de feedback pozitiv care
implic H2O2 i MAO i care contribuie la perpetuarea disfunciei endoteliale n diabetul zaharat
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experimental.
Page
THE POSITIVE FEEDBACK LOOP BETWEEN HYDROGEN PEROXIDE AND
MONOAMINE OXIDASES A NEW MECHANISM OF VASCULAR OXIDATIVE
STRESS IN DIABETES MELLITUS
Sturza Adrian1, Duicu Oana1, Vduva Adrian1, Dnil Maria1, Privistirescu Andreea1,
Munteanu Mircea1, Prof. Timar Romulus1, Prof. Muntean Danina1
1.
Department of Pathophysiology, Center for Translational Research and Systems Medicine,
University of Medicine and Pharmacy "Victor Babes" Timisoara
Oxidative stress plays a central role in the pathogenetic sequence underlying endothelial
dysfunction in diabetes mellitus (DM). We have previously demonstrated that monoamine
oxidases (MAOs) with 2 isoforms (A and B) are mitochondrial sources of reactive oxygen species
(ROS) production in vascular walls in DM. By catalyzing catecholamine degradation, MAOs
constantly generate hydrogen peroxide (H2O2) as byproduct.
The present study performed in rat aortas was purported to evaluate the effects of: i) increased
concentration of H2O2 on endothelial dependent relaxation and MAO expression and ii) in vitro
stimulation with exogenous MAO on H2O2 production, respectively. To this aim measurements
of H2O2 production using FOX assay, vascular reactivity assessment in organ bath and MAO
expression by immunohistochemistry have been performed in isolated aortas.
Our data showed an impairment of endothelial-dependent relaxation together with an upregulation
of both MAO isoforms in vascular segments stimulated with H2O2. The amount of H2O2 was
significantly increased and the relaxation response was attenuated in diabetic vessels vs control;
incubation with catalase (H2O2 scavenger) significantly reversed this effect. Stimulation with
exogenous MAO lead to a overproduction of H2O2 in a dose-dependent manner in rat aortic
segments.
In conclusion, excessive production of ROS in diabetes contributes to the continuos activation of
MAO with subsequent H2O2 generation, thus triggering a positive feedback loop that contributes
to the perpetuation of endothelial dysfunction in experimental diabetes.
OP5. ROLUL ECOGRAFIEI VASCULARE N EVALUAREA BOLII ARTERIALE

PERIFERICE LA PACIENII CU DIBET ZAHARAT
Dr. Bacanu Elena Violeta1, Rezident Parocescu Daniel1, ef Lucr. Dr. Virgolici Bogdana1
1.
Introducere: Boala arterial periferica (BAP) a membrelor inferioare este echivalent cu boala
coronarian ischemic la pacienii cu DZ, iar consecinele acesteia sunt de obicei amputaiile
membrelor inferioare. n acest studiu ne-am propus evaluarea BAP la pacienii cu DZ folosind
ecografia vascular i prin aceasta de a stabili att localizarea ct i severitatea leziunilor.
Material i metode. n perioada martie 2015-martie 2016 am efectuat acest studiu observaional la
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un lot de 245 de pacieni diabetici (tip 1 si tip 2) cu vrstele cuprinse ntre 40 i 82 ani. S-au luat
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n considerare valori ale glicemiei bazale, HbA1c, nivelul colesterolului total i HDL colesterolul,
prezena HTA i statusul de fumtor/nefumtor. Tuturor pacienilor li s-a efectuat indicele glezn-
bra (IGB) i ecografia vasculara (2D, color i Doppler spectral) la nivelul arterelor membrelor
inferioare. BAP a fost definit printr-o valoare a IGB 0,9 sau prin prezena
simptomatologiei/semnelor sugestive n contextul unui puls periferic slab. Ecografia vascular
ofer att detalii anatomice ct i informaiile funcionale (gradiente de velocitate) la nivelul
leziunilor. Ecografia Doppler color permite att localizarea anatomic ct i cuantificarea
severitii leziunilor (stenoz/ocluzie). Pacienii au fost mprii n dou loturi dup tipul DZ: lotul
pacienilor cu DZ tip 1 cu vrsta medie 52,5 8,2 ani i lotul pacienilor cu DZ tip 2 cu vrsta
medie de 65,4 9,0 ani.
Rezultate: Pacienii de sex masculin au fost majoritari n ambele loturi 77,5% i respectiv 75,2%
n lotul 2. Statusul de fumtor la intreg lotul de pacieni diabetici a fost ntlnit n proporie de
44%, cu proporie mai mare n lotul celor cu DZ tip 1 (57%). Majoritatea pacienilor diabetici cu
DZ tip 2 au HTA (90,01%) i dislipidemie(82,5%). La aproximativ 30% din pacienii cu IGB<0,9
s-au gsit leziuni severe ecografic (stenoze strnse/ocluzii). La 99,5% din pacienii cu IGB 0,3
s-au gsit leziuni ecografice severe, iar aproximativ 26% pacienii simptomatici cu rezultate fals
negative ale IGB au avut leziuni moderate. La un procent de aproximativ 30% (n special lotul cu
DZ tip 1) cu o vechime a diabetului de cel puin 10 ani s-au decelat calcificri arteriale importante
bilaterale. Leziunile arteriale severe (stenoza strns sau ocluzie) au fost n special unilaterale n
proporie de 77,3% i doar n proporie de 12,5% au fost bilaterale. Leziunile periferice cele mai
frecvente au fost la nivelul AFS (59,42%) n special la nivelul canalului Hunter, ATA (60,86%) i
ATP ( 46,6%). Leziunile distale bilaterale pe ATA i ATP au fost prezente n aproximativ 38% cu
o vechime a bolii de cel puin 10 ani.
Concluzii: Diabetul zaharat reprezint unul dintre cei mai importani factori de risc ai BAP.
Ecografia vascular este o metod neinvaziv, uor de acceptat de ctre pacieni i de o mare
importan n evaluarea BAP, n scopul aplicrii precoce a tratametului specific (inclusiv cel de
revascularizare).
THE ROLE OF VASCULAR ULTRASONOGRAPHY FOR PERIPHERAL ARTERY

DISEASE EVALUATION IN DIABETIC PATIENTS
Bacanu Elena Violeta, PhD1, Parocescu Daniel1, Lect. Virgolici Bogdana, PhD1
1.
National Institute of Diabetes, Nutrition and Metabolic Disease Prof. N. Paulescu
Introduction: Peripheral artery disease (PAD) of the inferior limbs is equivalent with the ischemic
coronary artery disease in diabetic patients and usually requires amputation. The aim of this study
is to evaluate PAD in diabetic patients by vascular ultrasonography in order to establish both the
location and the severity of the injuries.
Materials and methods: From March 2015 since March 2016 we did an observational study on
245 diabetic patients (type 1 and type2), 40 to 82 years old.
The levels for HbA1c, total cholesterol, HDL cholesterol, for blood pressure and the smoking/
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nonsmoking status were considered. All patients did ankel-brahial index (ABI) and
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ultrasonography (2D, color and spectral doppler) for the inferior limbs. PAD was defined for a
value ABI 0.9 or when suggestive symptoms/signs were present with a weak peripheric puls.
Vascular ultrasonography gave both anatomical and functional information (velocity gradient) at
the site of injuries. Color doppler ultrasonography gave information about anatomical location and
quatified the severity of injury (stenosis or oclusion). Diabetic patiets were divided into two groups
according to the type of diabetes: type 1, 52.5 8.2 average age and type 2 diabetic patients, 65.4
9.0 average age.
Results: Male gender had high incidence in both groups, 77.5% and 75.2%, respectively. Smoking
status was present in 44% in all diabetic patients, with higher values (57%) in type 1 diabetes
mellitus group. Most of the type 2 diabetic patients had high blood pressure (90.01%) and
dyslipidemia (82.5%). In 30% of patients with ABI<0.9 severe injuries were observed by
ultrasonography (tight stenosis/oclusions). In 99.5% of patients with ABG 0.3 severe injuries
documented by ultrasonography were found, but about 20% of symptomatic patients with ABI
false negative had moderate stenosis. Almost in 30% patients (especially in type 1), with diabetes
mellitus for more than 10 years, arterial bilateral calcification were shown. Severe arterial injuries
(tight stenosis or oclusion) were unilateral in 77.3% and bilateral in 12.5% cases. Peripheral
injuries were at the AFS level (59,42%) especially at the Hunter channel, ATA (60,86%) si ATP
( 46,6%). Bilateral distal injuries ATA si ATP were present in about 38% of cases with diabetes
mellitus for more than 10 years.
Conclusion: Diabetes mellitus is one of the most important risk factors for PAD.
Vascular ultrasounds represents a noninvasive method for which the patients are compliant.
Vascular ultrasounds are of high value to analyse the PAD and help the physician to do a better
specific management, in time, including revascularisation treatment.
OP6. STUDIU PROSPECTIV DE EVALUARE A IMPACTULUI EDUCAIEI

TERAPEUTICE ASUPRA CONTROLULUI GLICEMIC LA PACIENI CU DIABET
ZAHARAT TIP 2 LA CARE SE INIIAZ UN ANALOG DE INSULIN BAZAL
ef Lucr. Dr. Bala Cornelia1

1.
Universitatea de Medicin i Farmacie Iuliu Haieganu Cluj-Napoca, Disciplina de Diabet,
Nutriie, Boli Metabolice
Premise i Obiective: Educaia terapeutic este o component integrat n managementul

diabetului, cu potenial de a ameliora controlul glicemic i calitatea vieii. n acest studiu ne-am
propus s examinm dac o educaie intensiv este asociat cu beneficii asupra controlului
glicemic la pacienii cu diabet zaharat (DZ tip 2) la care se iniiaz un analog de insulin bazal.
Material i Metod: Studiul a fost unul epidemiologic, longitudinal-prospectiv, multicentric,
randomizat, cu dou brae paralele, desfurat n 65 de centre din Romnia i a inclus aduli <75
ani, cu DZ tip 2, necontrolai cu doze stabile de ADO n ultimele 3 luni i la care s-a iniiat
insulinoterapie bazal conform deciziei investigatorului. Pacienii au fost randomizai 1:1 n 2
grupuri- educaie intensiv (program predefinit, standardizat, cu 2 sesiuni individuale) i grup de
control cu educaie standard (educaie conform practicii locale), cu o durat de urmrire de 6 luni.
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Obiectivele primare au fost diferenele n valoarea HbA1c la finalul studiului vs. iniial i ntre
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grupuri i proporia de pacieni care au atins intele individualizate de HbA1c. Obiectivele

secundare au inclus modificrile scorurilor EuroQol five dimensions questionnaire (EQ5D) i
Diabetes Empowerment Scale(DES), incidena hipoglicemiilor simptomatice i severe,
modificrile glicemiei bazale, dozei de insulin, greutii, circumferinei abdominale i
modificrile obiceiurilor alimentare i a activitii fizice.
Rezultate i Discuii: Studiul a inclus 746 pacieni cu DZ tip 2 (367 n grupul de educaie intensiv
i 379 n grupul de control), cu vrsta medie de 60 ani, 49% brbai, HbA1c medie de 9,5% i o
durat a diabetului de 7,6 ani, fr diferene ntre grupuri la includerea n studiu. Ambele grupuri
au obinut o reducere semnificativ a HbA1c vs. nivelul iniial (-2,06 i -2,04%), cu o diferen de
-0,08% n favoarea grupului intensiv (p=NS). Proporia de pacieni care au atins inta de HbA1c a
fost semnificativ mai mare n grupul intensiv (55,2 vs 42,2% [p<0.001]). Glicemia bazal a sczut
cu -95,55 mg/dl n grupul intensiv i cu -95,94 mg/dl n grupul control (p=NS ntre grupuri).
Scorurile EQ5D i DES au avut o uoar tendin de mbuntire la grupul cu educaie intensiv.
Au fost nregistrate 11 hipoglicemii severe (0 nocturne) 4 n grupul intensiv i 7 n grupul control
i 204 hipoglicemii simptomatice (18 nocturne)- 82 (7 nocturne) n grupul intensiv i 122 (11
nocturne) n grupul cu educaie standard (p=0.003). Nu s-au nregistrat diferene semnificative ale
greutii, circumferinei abdominale i dozei de insulin la finalul studiului ntre cele 2 grupuri.
Obiceiurile alimentare s-au mbuntit la 89,6% din pacienii din grupul intensiv fa de 64,3% n
grupul control (p<0.0001) iar nivelul de activitate fizic a crescut la 54,2% din subiecii cu educaie
intensiv vs. 27,2% n grupul control (p<0.0001).
Concluzii: Educaia terapeutic intensiv aplicat pacienilor cu DZ tip 2 la care s-a iniiat
insulinoterapie cu un analog bazal a condus la o cretere a gradului de atingere a intelor
individualizate de HbA1c, cu mai puine hipoglicemii severe i simptomatice. Beneficii
suplimentare au fost observate n obiceiurile alimentare i gradul de activitate fizic, precum i o
tendin de ameliorare a EQ5D i DES. (Studiu finanat de Sanofi; Numr de registru:
DIREGL07301).
PROSPECTIVE STUDY TO ASSESS THE IMPACT OF EDUCATION IN T2DM

PATIENTS AT INITIATION OF A BASAL INSULIN ANALOGUE ON GLYCAEMIC
CONTROL
Lect. MD PhD Bala Cornelia1

1.
Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Department of Diabetes,
Nutrition and Metabolic Diseases
Premises and Objectives: Therapeutic education is an integrated component of diabetes

management and has the potential to improve glycaemic control and quality of life in patients with
diabetes. In this study, we sought to examine if enhanced diabetes education was associated with
benefits on glycaemic control in patients with type 2 diabetes mellitus (T2DM) initiated on a basal
insulin analogue.
Content and Method: This was an epidemiological, longitudinal - prospective, multi-center,
randomized, parallel groups disease registry in 65 sites from Romania which included adult
patients <75 year old, with T2DM inadequately controlled on stable doses of OADs during last 3
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months, and initiated at investigator decision on basal insulin analogues. Patients were randomized
1:1 to two groups- enhanced educational group (a predefined, standardized educational program
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with 2 sessions) and a control group (trained according to daily practice routine) and were followed
for 6 months. The primary endpoints were difference of HbA1c levels between the two groups at
baseline and at the end of observational period and the proportion of patients with adequate
individualized HbA1c at the end of the 6 months period. Secondary endpoints included EuroQol
five dimensions questionnaire (EQ5D) and Diabetes Empowerment Scale(DES) scores change,
incidence of all symptomatic and serious hypoglycemic events, changes in fasting plasma glucose
(FPG), total daily insulin dose, weight and waist circumference, and changes in eating habits and
physical activity.
Results and Discussions: The study group consisted of 746 T2DM patients (367 in the enhanced
educational and 379 in the control group), with a mean age of 60 years, 49% were males, mean
HbA1c at baseline 9.5% and diabetes duration 7.6 years, with no differences between groups. A
significant decrease of HbA1c was obtained at the end of study period in both groups (-2.06 and -
2.04%) but with only -0.08% in favor of enhanced education (p=NS). The proportion of patients
who reached HbA1c targets was significantly higher in patients with enhanced education (55.2 vs
42.2% [p<0.001]). FPG decreased with -95.55 mg/dl in study group and -95.94 mg/dl in control
group (p=NS between groups). EQ-5D and DES scores had a slightly tendency of improvement in
patients with enhanced education. Eleven severe hypoglycemic events (0 nocturnal) 4 in
enhanced educational group and 7 in control group and 204 symptomatic hypoglycemic (18
nocturnal)- 82 (7 nocturnal) in enhanced education group and 122 (11 nocturnal) in standard
education group (p=0.003) were reported. No significant differences were seen for weight, waist
circumference and insulin dose at the study end between groups. Eating habits were improved in
89.6% people with enhanced education vs. 64.3% in standard education group (p<0.0001) and
physical activity increased in 54.2% people in study group vs. 27.2% in control group (p<0.0001).
Conclusions and Findings: An enhanced diabetes education improved achievement of
individualized HbA1c targets, with less severe and symptomatic hypoglycemic events in patients
with T2DM started on a basal insulin analogue regimen. Additional benefits were seen on eating
habits and physical activity level, as well as a slightly tendency of improvement in EQ-5D and
DES scores. (Funded by Sanofi; Registry number: DIREGL07301)
OP7. CORELAII ALE INSULINOREZISTENEI CU CELELALTE COMPLICAII

CRONICE ALE DIABETULUI ZAHARAT TIP 1, N FUNCIE DE PREZENA BOLII
RENALE DIABETICE
Dr. Bcu Mihaela Larisa1, Dr. Bcu Daniel1, Dr. Vladu Mihaela Ionela1, Dr. Clenciu Diana1,
Dr. Sandu Magdalena1, Prof. Dr. Moa Maria1
1.
Spitalul Clinic Municipal Filantropia, Craiova
Premise i Obiective: Scopul studiului a fost identificarea unor corelaii ntre estimated glucose
disposal rate (eGDR) - ca marker al insulinorezistenei (IR) i celelalte complicaii cronice ale
diabetului zaharat (DZ) tip 1, att micro- (retinopatie diabetic - RD, neuropatie diabetic
periferic senzitivo-motorie - NDPSM), ct i macrovasculare (cardiopatie ischemic cronic -
CIC, infarct miocardic - IM, arteriopatie obliterant a membrelor inferioare - AOMI), la pacieni
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cu DZ tip 1 cu durata DZ >10 ani, n funcie de prezena bolii renale diabetice (BRD).
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Material i Metod: Am inclus n studiu 140 de pacieni neselectionai, cu DZ tip 1 cu durata DZ
>10 ani, 41.43% femei i 58.57% brbai, la care am analizat date anamnestice, antropometrice i
paraclinice. eGDR (mg x kg- x min-) a fost calculat dup urmtoarea formul: 24.31 - (12.22 x
WHR) - (3.29 x HTA) - (0.57 x HbA1c), unde WHR - waist to hip ratio, HTA - prezena
hipertensiunii arteriale (1=da; 0=nu). BRD a fost definit ca rata filtrrii glomerulare estimat -
RFGe (CKD-EPI) <60 ml/min/1.73m2 i/sau raportul albumin/creatinin (RAC) urinar 30
mg/g. Analiza statistic a datelor s-a realizat folosind programul SPSS, software 22.
Rezultate i Discuii: Analiznd corelaiile eGDR cu celelalte complicaii cronice ale DZ tip 1, la
pacieni cu durata DZ >10 ani, n funcie de prezena BRD, se observ c prezint semnificaie
statistic: la pacienii fr BRD - corelaiile eGDR cu RD (p=0.019) i cu CIC (p=0.003), iar la
pacienii cu BRD - corelaiile eGDR cu NDPSM (p=0.014) i cu AOMI (p=0.004). Pacienii ce
asociaz BRD i una dintre celelalte complicaii cronice ale DZ tip 1 (RD, NDPSM, CIC, AOMI)
prezint media eGDR mai mic (deci IR mai mare) dect pacienii ce prezint doar o complicaie
cronic (fie doar BRD, fie doar una dintre celelalte complicaii cronice); de menionat c n rndul
pacienilor fr BRD nu a existat niciun caz cu IM. Analiznd corelaiile quartilelor eGDR (Q1:
1.54-4.48; Q2: 4.48-6.105; Q3: 6.105-8.33; Q4: 8.33-10.92) cu celelalte complicaii cronice ale
DZ tip 1, la pacieni cu durata DZ >10 ani, n funcie de prezena BRD, se observ c sunt
semnificative statistic: la pacienii fr BRD - corelaiile quartilelor eGDR cu RD (p=0.041) i cu
CIC (p=0.003), iar la pacienii cu BRD - corelaiile quartilelor eGDR cu NDPSM (p=0.003) i cu
AOMI (p=0.046). Att la pacienii cu BRD, ct i fr BRD, procentul celor ce prezint RD,
NDPSM, CIC, IM sau AOMI este mai mare corespunztor Q1 a eGDR (deci la IR mai mare),
scznd ctre Q4 a eGDR.
Concluzii: IR este mai mare la pacienii ce asociaz BRD i una dintre celelalte complicaii cronice
ale DZ tip 1 dect la pacienii fr BRD, ce prezint doar una dintre celelalte complicaii cronice.
Att n cazul pacienilor cu BRD, ct i al celor fr BRD, se observ c procentul celor ce prezint
RD, NDPSM, CIC, IM sau AOMI este mai mare corespunztor unei IR mai mari.
CORRELATIONS BETWEEN INSULIN RESISTANCE AND THE OTHER CHRONIC

COMPLICATIONS OF TYPE 1 DIABETES MELLITUS, DEPENDING ON THE
PRESENCE OF DIABETIC KIDNEY DISEASE
Dr. Bcu Mihaela Larisa1, Dr. Bcu Daniel1, Dr. Vladu Mihaela Ionela1, Dr. Clenciu Diana1,
Dr. Sandu Magdalena1, Prof. Dr. Moa Maria1
1.
Department of Diabetes, Filantropia Municipal Clinical Hospital, Craiova
Background and Aims: The aim of our study was to identify the correlations between estimated
glucose disposal rate (eGDR) - as insulin resistance (IR) marker and the other chronic
complications of type 1 diabetes mellitus (T1DM), both micro- (diabetic retinopathy - DR, diabetic
peripheral neuropathy - DPN) and macrovascular (chronic ischaemic heart disease - CIHD,
myocardial infarction - MI, peripheral arterial disease - PAD), in patients with T1DM with DM
duration > 10 years, depending on the presence of diabetic kidney disease (DKD).
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Material and Methods: We included in the study 140 unselected patients with T1DM with DM
duration > 10 years, 41.43% women and 58.57% men, to whom we analyzed anamnestic,
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anthropometric and laboratory data. eGDR (mg x kg- x min-) was calculated by following
formula: 24.31 - (12.22 x WHR) - (3.29 x HT) - (0.57 x HbA1c), where HT - hypertension status
(1=with HT, 0=without HT). DKD was defined as estimated glomerular filtration rate - eGFR
(CKD-EPI) <60 ml/min/1.73m2 and/or urinary albumin to creatinine ratio (ACR) 30 mg/g. The
collected data were analyzed using the Statistic Package for Social Sciences (SPSS), the 22
software.
Results and Discussions: Analyzing correlations between eGDR and the other chronic
complications of T1DM, in patients with DM duration > 10 years, depending on the presence of
DKD, we observed that shows statistically significant: in patients without DKD - the correlations
between eGDR with DR (p=0.019) and between eGDR with CIHD (p=0.003), and in patients with
DKD - the correlations between eGDR with DPN (p=0.014) and between eGDR with PAD
(p=0.004). Patients associating DKD and one of the other chronic complications of T1DM (DR,
DPN, CIHD, PAD) have lower average of eGDR (so higher IR) than patients who showing only a
chronic complication (only DKD or only one of the other chronic complications); to mention that
among patients without DKD, there was no case with MI. Analyzing correlations between eGDR
quartiles (Q1: 1.54-4.48; Q2: 4.48-6.105; Q3: 6.105-8.33; Q4: 8.33-10.92) and the other chronic
complications of T1DM, in patients with DM duration > 10 years, depending on the presence of
DKD, shows statistical significance: in patients without DKD - the correlations between eGDR
with DR (p=0.041) and with CIHD (p=0.003), and in patients with DKD - the correlations between
eGDR with DPN (p=0.003) and with PAD (p=0.046). Both in patients with DKD and without
DKD, percentage of those who presented DR, DPN, CIHD, MI or PAD is increased corresponding
Q1 of eGDR (so at higher IR), decreasing by Q4 of eGDR.
Conclusions: IR is higher in patients associating DKD and one of the other chronic complications
of T1DM than in patients without DKD, showing only one of the other chronic complications.
Both in patients with DKD and without DKD, is seen as percentage of those who presented DR,
DPN, CIHD, MI or PAD is increased corresponding to a higher IR. Concluzii: IR este mai mare
la pacienii ce asociaz BRD i una dintre celelalte complicaii cronice ale DZ tip 1 dect la
pacienii fr BRD, ce prezint doar una dintre celelalte complicaii cronice. Att n cazul
pacienilor cu BRD, ct i al celor fr BRD, se observ c procentul celor ce prezint RD,
NDPSM, CIC, IM sau AOMI este mai mare corespunztor unei IR mai mari.
OP8. ONE YEAR FOLLOW-UP FOR OXIDATIVE STRESS STATUS, ADIPOKINES

AND INFLAMMATORY MARKERS IN OBESE TYPE 2 DIABETIC PATIENTS
Dr. Carniciu Simona1, Dr. Lixandru Daniela1, Petcu Laura1, Picu Ariana1, Dr. Roca
Adelina1, Dr. Bcanu Elena1, Dr. Mihai Andrada1, Prof. Dr. Ionescu-Trgovite Constantin1,
Dr. Guja Cristian1
1.
The aim of this study was to investigate the oxidative stress status, adipokines and inflamation
markers in obese type 2 diabetic patients (T2D) after one year lifestyle changes.
132 patients with newly diagnosed T2D were compared regarding clinical, biochemical, oxidative
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stress and inflammatory markers before and after one year lifesyle changes. The capacity of the
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peripheral blood mononuclear cells (PBMNC) to release pro-oxidants and to neutralize them was
determined by measuring the respiratory burst (RB) and the intracellular antioxidant enzyme
paraoxonase2 (PON2). Fructosamine, antioxidant enzymes superoxidedismutase (SOD) and
gluthathionperoxidase (GPx) were done by photometric method while for serum levels of leptin,
adiponectin, insulin, proinsulin, IL-6 and TNF- ELISA method was used.
After one year reevaluation, GPx, adiponectin and PON2 activity were significantly lower in obese
T2D patients while SOD, IL-6, TNF- and RB do not differ. They had also increased insulin,
proinsulin and fructosamine levels. PON2 levels were found to be inversely correlated to measures
of adiposity (BMI and WC), of glucose control (blood glucose, serum fructosamine and HbA1c)
and insulin resistance (HOMA-IR).
Up-regulation of monocyte PON2 activity may provide a compensatory protective mechanism
against oxidative stress damage in early (prehyperglycaemic) phase of type 2 diabetes.
Acknowledgement. This work was supported by a grant of the Romanian National Authority for
Scientific Research, CNCS-UEFISCDI, project number PN-II-ID-PCE-2011-3-0429.
OP9. GLICEMIA LA O OR N CADRUL TESTULUI DE TOLERAN ORAL LA

GLUCOZ: UN PARAMETRU NEGLIJAT?
- CORELAII ALE GLICEMIEI LA O OR N CADRUL T.T.G.O. CU
INSULINOREZISTENA I INSULINOSECREIA
Dr. Diugan Flavia Cristina1, Prof. Univ. Dr. Moa Maria1

1.
Universitatea de Farmacie i Medicin Craiova
n ultimii ani s-a conturat tot mai mult ideea unui exces de risc cardio- metabolic n cazul
pacienilor considerai actual normoglicemici dar care prezint o valoare crescut a glicemiei la 1
ora n cadrul TTGO.
Subiecii cu toleran normal la glucoz i glicemie la 1 or n cadrul TTGO crescut reprezint
o categorie intermediar de pacieni care prezint o alterare a metabolismului tradus prin
insulinorezisten i printr-o sensibilitate redus la glucoz a celulelor .
Acest studiu i propune s evalueze gradul de insulinorezisten i insulinosecreie la un lot de
subieci cu glicemie crescut la o or, comparativ cu subieci cu normotoleran la glucoz i cu
subieci cu alterarea toleranei la glucoz.
Studiul s-a desfasurat n perioada ianuarie- august 2015 pe un lot de 75 de subieci selectai dintre
pacienii care s-au prezentat la consultaie n cadrul ambulatoriului Diab Clinique Craiova.
Populaia int a fost reprezentat de subieci nediagnosticai anterior cu diabet zaharat crora li s-
a efectuat TTGO n vederea evalurii statusului metabolic. Conform datelor din literatur, valoarea
de cut-off a glicemiei la o or a fost stabilit la 155mg/dl. n urma efecturii TTGO, subiecii au
fost mparii n 3 loturi: subieci cu toleran normal la glucoz i glicemie la o or < 155mg/dl;
subieci cu toleran normal la glucoz i glicemie la o or 155mg/dl; subieci cu alterarea
toleranei la glucoz.
Au fost evaluai markerii clinici de insulinorezisten: IMC, CA, CA/C, CA/H; markerii biologici
de insulinorezisten: trigliceridele plasmatice (TG), HDL- col, TG/HDL, insulinemia a jeun,
glicemie /insulinemie a jeun, HOMA-IR, indicele QUICKI, adiponectina iar funcia - celular a
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fost evaluat prin HOMA%B.

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Rezultatele obinute n acest studiu au fost n concordan cu datele prezentate n literatur,
glicemia crescut la o or fiind semnificativ statistic asociat cu parametrii consacrai ai
insulinorezistenei: hiperinsulinemia a jeun(p=0,0068), raportul glicemie /insulinemie< 4,5
(p=0,04), HOMA-IR2,5 (p=0,00007), indicele QUICKI (p=0,014), precum i cu valoarea HbA1c
(p=7,26X10-8). S-a corelat la limita semnificaiei statistice cu valoarea crescut a trigliceridelor
plasmatice i cu raportul TG/ HDL. Nu s-a corelat cu indicatorii clinici de insulinorezistena: IMC,
CA, CA/C, CA/H i nici cu adiponectina sczut ca i indicator biologic.
n ceea ce privete insulinosecreia, evaluat prin HOMA%B dei, aparent, diferenele numerice
ntre cele trei medii obtinute au fost mari, nu s-a evideniat o diferen semnificativ statistic.
Avnd n vedere valoarea incontestabil a acestor indicatori n evaluarea insulinorezistenei avem
argumente pentru a susine ideea ncadrrii pacienilor cu glicemie crescut la o or n cadrul
TTOG ntr- o categorie aparte de pacieni, cu un profil metabolic particular. Valoarea glicemiei la
o or n cadrul TTGO devine astfel cel puin la fel de important ca cea a glicemiei la 2 ore,
identificnd o categorie de pacieni care ar putea beneficia de programe de prevenie precoce.
ONE HOUR GLUCOSE DURING ORAL GLUCOSE TOLERANCE TEST: A

NEGLECTED PARAMETER?
- CORRELATIONS BETWEEN ONE HOUR GLUCOSE DURING OGTT AND
INSULIN RESISTANCE AND INSULIN SECRETION
Dr. Diugan Flavia Cristina1, Prof. Moa Maria1

1.
University of Medicine and Pharmacy Craiova
Recently, the idea of an excess of metabolic and cardiovascular risk in patients currently
considered to have normal glucose tolerance but showing an elevated 1 hour blood glucose during
OGTT was emphasized.
Subjects with normal glucose tolerance and high 1 hour blood glucose during OGTT represent an
intermediate category of patients presenting an altered metabolism translated by insulin resistance
and reduced sensitivity of the cells to glucose.
This study aims to evaluate the degree of insulin resistance and insulin secretion in a group of
subjects with high 1 hour blood glucose during OGTT, compared to subjects with normal glucose
tolerance and subjects with impaired glucose tolerance.
The study was conducted between January and August 2015 on a sample of 75 subjects selected
from patients who were admitted to the outpatient consultations at Diab Clinique Craiova.
The target population was represented by subjects that were not previously diagnosed with
diabetes, to whom the OGTT was performed to assess their metabolic status. According to the
literature, an1 hour blood glucose during OGTT cut- off was set at 155 mg / dl. After the OGTT
was performed, the subjects were divided into 3 groups: subjects with normal glucose tolerance
and 1 hour blood glucose < 155 mg / dl; subjects with normal glucose tolerance and 1 hour blood
glucose 155mg /dl; subjects with impaired glucose tolerance.
We evaluated clinical markers of insulin resistance : BMI , waist circumference , waist to hip ratio
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, waist to height ratio and biological markers of insulin resistance: serum triglycerides (TG ) ,
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HDL- col , TG to HDL ratio , fasting insulin , fasting glucose to insulin ratio, HOMA -IR index,
QUICKI index and adiponectin. The -cell function was assessed by HOMA % B.
The results we obtained in this study were consistent with data reported in the literature, high 1
hour blood glucose being significantly associated with insulin resistance consecrated parameters :
fasting insulin ( p = 0.0068 ), the glucose / insulin ratio <4.5 ( p = 0.04) , HOMA- IR 2,5 ( p =
0.00007 ) , the QUICKI index ( p = 0.014 ) and with the HbA1c value ( p = 7,26X10-8 ). It was of
borderline significance correlated with increased plasma triglycerides value and TG / HDL ratio.
It was not correlated with clinical markers of insulin resistance: BMI, waist circumference, waist
to hip ratio, waist to height ratio or with low adiponectin as a biomarker.
Regarding insulin secretion, assessed by HOMA % B, although apparently there were high
numerical differences between the three averages, there was not a statistically significant
difference.
Given the undeniable value of these indicators in evaluating insulin resistance we have arguments
to support the idea of classifying subjects with high 1 hour glucose during OGTT in a special
category of patients with a particular metabolic profile. 1 hour glucose during OGTT becomes at
least as important as 2 hours glucose, identifying a group of patients who could benefit from early
prevention programs.
OP10. DENUTRIIA ROTEIN-CALORIC EVALUAT CU AJUTORUL FOREI DE

STRGERE A PUMNULUI UN FACTOR DE PROGNOSTIC NEGATIV LA
PACIENII CU DIABET ZAHARAT HEMODIALIZAI
Georgiana Diu, Anca Pantea Stoian Mihaela Bodnarescu, Viviana Elian

Institutul National de Diabet, Nutritie si Boli Metabolice N.C.Paulescu, Bucuresti, Romania
Institutul National de Igiena si Sanatate Publica Bucuresti, Romania
Universitatea de Medicina si Farmacie Carol Davila Bucuresti, Romania
Premise i obiective: Denutriia protein-energetic (PEW) este o complicaie frecvent la

pacienii cu diabet zaharat i boal cronic renal i se asociaz cu o evolutie nefavorabil, n
special la pacienii dializai.
O multitudine de factori pot afecta statusul metabolic i nutritional la aceti pacieni fiind necesar
un plan therapeutic avizat pentru a preveni denutriia proteic i pierderea de energie. Studiul a
avut drept scop monitorizarea evoluiei strii de nutriie la pacienii diabetici vs pacienii
nediabetici n program de hemodializ.
Materiale i Metode: Au fost inclui ntr-un studiu descriptiv, longitudinal 137 de pacieni (42%
femei, 56.5% cu diabet zaharat, vrsta medie de 5613 ani) n program de hemodializ, din 2
centre de dializ din Bucureti. Pacienii au fost mprii n dou loturi: un lot de studiu (77 de
pacieni cu diabet zaharat i boal cronic renal hemodializai) i un lot control (60 pacieni cu
boal cronic de rinichi hemodializai). Au fost determinai parametrii antropometrici, cei
biologici i fora de strangere a pumnului (folosind un dinamometru hidraulic). Au fost reevaluai
la 12 i la 24 de luni folosind aceiai parametrii. La 24 de luni au fost reevaluai 79 de pacieni
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(57.66%), 30 de pacieni au fost pierdui din studiu, 24 au decedat (17.51%) i 4 pacieni au primit
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transplant renal (2.91%).

Rezultate i discuii: Evaluarea iniial a artat o prevalen semnificativ statististic (p<0.001)
mai crescut a denutriiei protein-calorice la pacienii HD cu DZ comparativ cu cei HD fr DZ.
La pacienii cu diabet zaharat n program de hemodializ HGS a fost mai sczut i s-a corelat
negativ cu durata DZ i pozitiv cu markeri inflamatori. La pacienii fr DZ HD HGS s-a corelat
pozitiv cu circumferina braului i cu pliul cutanat tricipital, corelaie care nu a fost observat i
la cei cu DZ. Reevaluarile de la 12 i 24 de luni au artat o evoluie similar n cele 2 loturi, cu o
scdere semnificativ a masei musculare la pacienii cu diabet zaharat. n urma analizei
supravieuirii Kaplan-Meier rata de mortalitate a fost de 60% la pacienii cu o valoare sczut a
HGS comparativ cu 12 % la cei cu o valoare normal a HGS (p=0.028).
Concluzii: La pacienii hemodializai HGS este un marker de ncredere pentru determinarea
denutriiei protein-calorice i poate fi utilizat pe o scar larg pentru evaluarea statusului ntriional.
n studiul nostru mortalitatea a fost mai crescut la pacienii cu diabet zaharat hemodializai. PEW
(determinat printr-un HGS sczut) corelnduse pozitiv cu mortalitatea la aceti pacieni.
Evaluarea periodic a statusului nutriional este necesar datorit variaiilor sale permanente , n
special la pacienii cu diabet zaharat hemodializai, pentru o individualizare a terapiei i un
prognostic mai bun.
PROTEIN-ENERGY WASTING EVALUATED BY HANDGRIP STRENGHT

PREDICTS POOR OUTCOME IN DIABETES MELLITUS HEMODIALYZED
PATIENTS
Georgiana Diu, Anca Pantea Stoian Mihaela Bodnarescu, Viviana Elian

National Institute of Hygiene and Environmental Health, Bucharest
Premises and objectives: Protein energy wasting is common in patients with chronic kidney
disease and is associated with adverse clinical outcomes, especially in individuals receiving
maintenance dialysis therapy. A multitude of factors can affect the nutritional and metabolic status
of chronic kidney disease patients requiring a combination of therapeutic maneuvers to prevent or
reverse protein and energy depletion. The study aimed to monitor nutritional status development
in diabetic vs nondiabetic patients undergoing hemodialysis.
Materials and Methods: A number of 137 patients (42% female, 56.5% with DM, mean age
5613 yrs) on chronic hemodialysis from two dialysis centers in Bucharest have been enrolled in
a descriptive longitudinal study, divided in 2 groups: one study group (77 patients with CKD-HD
and diabetes) and one control group (60 patients with CKD-HD without diabetes). Anthropometric
parameters, biological markers and handgrip strength (performed using a hydraulic hand
dynamometer) were measured. Follow up was performed at 12 and 24 months apart, using the
same parameters. At the 24 months follow-up were reevaluated 79 patients (57.66%), 30 patients
were lost at follow-up, 24 were dead (17.51%) and 4 patients had kidney transplant (2.91%).
Results and discussions: The initial evaluation showed a statistically significant (p<0.001) higher
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prevalence of PEW syndrome in diabetic vs. non-diabetic HD patients. In patients with DM

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undergoing HD, HGS was lower; there was an inverse relationship between HGS and DM duration
and a direct relationship between HGS and inflammatory biomarkers. In patients without DM,
HGS correlates positively with CB and PCT, correlation that was not observed in DM group. The
assessments performed at 12 and 24 months showed similar evolution in both groups, with a
statistical significant decrease in muscular mass in diabetic patients. In the KaplanMeier survival
analysis, mortality rate was 60% in patients with decreased HGS versus 12% in patients with
normal HGS (p=0.028).
Conclusions: In patients undergoing hemodialysis, HGS is a reliable measurement of PEW and it
can be used on a large scale to evaluate nutritional status.
In our study mortality was higher in DM patients undergoing hemodialysis. PEW (represented by
decreased HGS) positively correlated with mortality.
Periodical nutritional assessment is necessary because of its permanent variations, mainly in
patients with DM, for an appropriate individualized therapy and better dialysis outcomes.
OP11. MONITORIZAREA GLICEMIC CONTINU CU SENZORI IMPLANTABILI

PE TERMEN LUNG NOUTI DIN STUDIUL PRECISE
Dr. Ioacara Sorin1,2, Dr. DeVries J. Hans1,2, Dr. Kropff Jort1,2, Dr. Choudhary Pratik1,2, Dr.
Hovorka Roman1,2, Dr. Evans Mark1,2, Dr. Neupane Sankalpa1,2, Dr. Bain Steve C.1,2, Dr.
Kapitza Cristoph1,2, Dr. Forst Thomas1,2, Dr. Link Manuela1,2, Dr. Chen Oliver1,2,Dr.
DeHennis Andrew1,2, Dr. Fica Simona1,2
1.
Universitatea de medicin i farmacie Carol Davila
2.
Spitalul universitar de urgent Elias
Premise i Obiective: Sistemul implantabil de monitorizare continu a glicemiei Eversense

(Senseonics) const ntr-un sensor glicemic bazat pe fluorescent i un cititor extern, care
comunic printr-o legatur Bluetooth LE cu un smartphone. Analiza initial a performanelor
acestui sistem pentru 90 de zile ntr-un studiu pivotal, ce a inclus 71 de pacieni a aratat o valoare
medie a diferenei relative fa de etalon (mean absolute relative difference - MARD) de 11,5% n
domeniul glicemic 40-400 mg/dL. Scopul prezentului studiu a fost de a obine un algoritm mai
bun de estimare a glicemiilor afiate de senzor, pentru a mbuntii valorile MARD.
Material i Metod: Datele primare din studiul pivotal PRECISE combinate cu cele din studiul
pilot, 120 de senzori n total, au fost folosite ca baz pentru mbuntirea algoritmului de calcul a
glicemiei din sistemul Eversense. Au fost disponibile glicemii msurate cu glucometrul acas i
recoltri venoase n clinic (de cinci ori, snge venos), timp de 90 de zile de folosire continu.
Rezultate i Discuii: Cnd noul algoritm obinut a fost aplicat la setul de date din studiul
PRECISE, valoarea MARD pentru 90 de zile n domeniul glicemic 40-400 mg/dL s-a redus la
10,5%. Aceast mbuntire a redus i gradul de ntrziere a masurtorilor glicemice fa de
sangele venos de la 11,6 min la 10,5 min.
Concluzii: Sistemul implantabil Eversense CGM are o acuratee i precizie similar cu sistemele
clasice CGM disponibile actual, asigurnd o complian nalt prin durata lung de viat a
senzorului. Algoritmul nou obinut este folosit n prezent n studiul pivotal PRECISE 2 (USA).
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LONG TERM FULLY IMPLANTABLE CGM UPDATES FROM PRECISE STUDY
Dr. Ioacara Sorin1,2, Dr. DeVries J. Hans1,2, Dr. Kropff Jort1,2, Dr. Choudhary Pratik1,2, Dr.
Hovorka Roman1,2, Dr. Evans Mark1,2, Dr. Neupane Sankalpa1,2, Dr. Bain Steve C.1,2, Dr.
Kapitza Cristoph1,2, Dr. Forst Thomas1,2, Dr. Link Manuela1,2, Dr. Chen Oliver1,2,Dr.
DeHennis Andrew1,2, Dr. Fica Simona1,2
1.
2.
Elias University Emergency Hospital
Premises and Objectives: The implantable Eversense Continuous Glucose Monitoring System
(Senseonics) consists of a fluorescence-based glucose sensor and a body-worn smart transmitter,
which communicates with a smartphone using a Bluetooth LE connection. Baseline performance
of this system in a 71 subject pivotal clinical trial analysed through 90 days of continuous showed
a 11.5% mean absolute relative difference (MARD) over 40-400mg/dL glucose range. The aim of
this study was to obtain a better glucose estimation algorithm to improve MARD results.
Content and Method: The raw data acquired during the PRECISE pivotal in addition to pilot
study sensors, 120 sensors in total, was used as the basis for developing improvements to the
glucose calculation algorithm used in the Eversense system. The raw measurements included at
home and in clinic (five times, against venous blood) data for 90 days of continuous use.
Results and Discussions: When applying the updated glucose calculation algorithm to the
PRECISE dataset, the full range MARD through 90 days was reduced to 10.5% over 40-400mg/dL
glucose range. This improvement also reduced the lag of the system from 11.6 min to 10.5 min for
the full data set.
Conclusions and Findings: The implantable Eversense CGM system has a similar accuracy and
precision with currently available classic CGM systems, while ensuring high compliance levels
due to its very long life expectancy. The newly design algorithm is now used in the PRECISE 2
pivotal study (USA).
OP12. CREAREA UNOR POMPE DE INSULIN ACCESIBILE CA PRE FOLOSIND

ELECTRONIC INOVATIV I PRINTARE 3D
Student Ioni Roxana Monica1, Ing. Milian Theodor1, Dr. Ioacara Sorin1, Dr. Purcaru
Mircea1, Dr. Herescu Irina1, Prof. Fica Simona1
1.
Universitatea de medicin i farmacie Carol Davila
Premise i Obiective: Noile tehnologii impun costuri ridicate, tocmai aceste costuri limitnd
folosirea lor pe scar larg. Scopul studiului nostru a fost s obinem o dovad a conceptului c o
pomp de insulina cu acuratee si precizie ridicat,dar i costuri sczute( sub 300) poate fi creat.
Material i Metod: O pomp de insulina de mici dimensiuni, compact a fost creat folosind
metode electronice inovative i printare 3D. Toate comunicaiile se fac prin intermediul unei
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conexiuni Bluetooth LE cu un dispozitiv mobil, pe care ruleaz o aplicaie dedicat. Msurile de

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securitate cibernetic asigur sigurana mpotriva ameninrilor obisnuite din acest

domeniu.Acurateea i precizia au fost testate comparativ cu un pen de insulin cu un pas de 0,5U
prin eliberarea n aer a 15U de insulin obinuit de 15 ori pentru ambele dispozitive, cuantificand
numrul de picturi obinute (veziFigura 1). Experimentul a fost apoi repetat folosind un alt
rezervor de insulin, n final obinnd30 de msurtori pentru fiecare dispozitiv. Programarea
bolusului s-a putut face n trepte de 0.15 U. Experimentul a fost nregistrat video.
Rezultate i Discuii: Numrul de picturi obinute prin administrarea a 15U insulin nu a fost
semnificativ diferit pentru pen (44.81.3 picturi)fa de pomp(45.51.7 picturi, p=0.075).
Rezultate similare au fost obinute comparnd numrul mediu de picturi eliberate din primul
cartus de insulina (45.31.1 picturi pentru pen vs. 46.11.5 picturi pentru pomp, p=0.129) i
cel de-al doilea (44.31.4 picturi pen vs. 451.7 picturi pompa, p=0.249). ntre cele doua cartue
de insulin, variaia pentru eliberarea a 15U de insulin nu a fost semnificativ: 46.11.5 picturi
pentru primele 7 comenzi (14 teste pentru 2 cartuse), i 451.6 picturi pentru urmtoarele 8
comenzi (16 teste pentru 2 cartuse, p=0.058): Rezultate similare au fost obinute i la testarea
folosind penul.
Concluzii: Pompa supus experimentului a eliberat un numr similar de picturi de insulin pentru
un bolus standard (15U) comparativ cu un pen de insulin (precizie). Cantiti similare de insulin
au fost eliberate din prima parte a rezervorului comparativ cu poziia medie pn la avansat a
pistonului pompei (acuratee). Precizia i acurateea s-au meninut la testari repetate cu alt cartus
de insulin. Constuirea unei pompe de insulin cu precizie, acuratee i costuri sczute este posibil
i ar putea avea consecine remarcabile asupra celor care au nevoie de astfel de dispozitive.
CREATING CHEAP AFFORDABLE INSULIN PUMPS WITH INNOVATE

ELECTRONICS AND 3D PRINTING
Student Ioni Roxana Monica1, Ing. Milian Theodor1, Dr. Ioacara Sorin1, Dr. Purcaru
Mircea1, Dr. Herescu Irina1, Prof. Fica Simona1
1.
UMF Carol Davila
Aim: Technology comes with a price, and is this precise cost that limits its widespread use. The
aim of our study was to obtain a proof of concept that an accurate, precise and cheap (under 300)
insulin pump can be created.
Methods: A small and compact insulin pump was created using innovative electronics and 3D
printing technology. All communications are made through a Bluetooth LE connection with a
mobile device running a dedicated App. Cybersecurity measures ensures safety against common
threats. Accuracy and precision was tested against a 0.5U step insulin pen by air delivering of 15U
of regular insulin for 15 times with both devices and counting the number of insulin drops obtained
(see figure 1). The experiment was then repeated with new cartridges, finally obtaining 30
measurements for each device. Pump bolus programing was available in 0.15U incremental steps.
The experiment was video recorded.
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Results: There was no significant difference in number of insulin drops obtained for 15U insulin
delivery with both the pen (44.81.3 drops) and the pump (45.51.7 drops, p=0.075). Similar
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results were obtained comparing mean number of drops obtained with first cartridge (45.31.1
drops pen vs. 46.11.5 drops pump, p=0.129) or the second one (44.31.4 drops pen vs. 451.7
drops pump, p=0.249). Within cartridge variation for 15U pump insulin delivery was not
significant: 46.11.5 drops for first 7 commands (14 tests for 2 cartridges), and 451.6 drops for
next 8 commands (16 tests for 2 cartridges, p=0.058). Similar results were obtained for pen
delivery.
Conclusions: Investigational pump delivered similar number of insulin drops for a standard bolus
(15U) as compared with a standard pen (precision). Similar amount of insulin was delivered at the
beginning of the insulin cartridge compared with middle to advanced position of pump piston
(accuracy). Precision and accuracy were stable when testing was repeated with new insulin
cartridges. Building a precise, accurate and cheap insulin pump is possible, and might have
remarkable consequences on those in need.
OP13. IMPACTUL NEUROPATIEI ASUPRA ECHILIBRULUI I RISCULUI DE

CDERI LA PACIENII CU DIABET ZAHARAT TIP 2
Dr. Timar Bogdan1, Dr. Lazar Sandra1, Dr. Mailat Diana1, Prof. Dr. Timar Romulus1
"Victor Babes" University of Medicine and Pharmacy
Neuropatia diabetic (ND) este o complicaie precoce i prevalent a Diabetului Zaharat (DZ)
avnd un impact major asupra strii de sntate i a calitii vieii pacienilor vizai. Premisa
noastr de studiu a fost c, prin intermediul disfuncionalitilor asociate cu trei componente ale
ND (senzitiv - lipsa percepiilor senzoriale din timpul micrii; motorie - deficiene ale
coordonrii micrilor autonom - prezena hipotensiunii posturale), prezena ND ar putea duce la
afectarea echilibrului.
Obiectivul principal al studiului nostru este de a evalua posibila asociere dintre prezena i
severitatea neuropatiei diabetice i afectarea probelor de echilibru respectiv a riscului de cderi n
rndul pacienilor cu DZ tip 2.
n acest studiu transversal au fost nrolai 198 de pacieni diagnosticai DZ tip 2, aflai n evidena
Centrului Clinic Judeean de Diabet zaharat, Nutriie i Boli Metabolice Timioara. Datele clinice,
paraclinice i analizele de laborator folosite au fost obinute n timpul unei singure vizite. Prezena
i severitatea neuropatiei a fost evaluat cu ajutorul scorului MNSI, care permite att
diagnosticarea ct i stabilirea severitii neuropatiei. Afectarea echilibrului i estimarea riscului
de cderi au fost evaluate cu ajutorul a 4 instrumente validate i standardizate: Berg Balance Scale
(BBS), Timed-up and Go test (TUG), Single Leg Stand test (SLS) and Fall Efficacy Scale (FES-
I). Un scor ridicat al BBS i SLS, respectiv un scor sczut al TUG i FES-I se asociaz cu unui
pstrarea unui echilibru mai bun.
Prezena ND s-a asociat semnificativ cu scderea scorului BBS (40,5 vs 43,7 puncte; p < 0,001 )
i a timpului SLS (9,3 vs 10,3 secunde; p = 0,003 ), respectiv cu creterea TUG (8,9 vs. 7,6
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secunde; p = 0,002 ) i a scorului FES-I (38 vs. 33 de puncte; p = 0,034 ). Scorul MNSI a fost
corelat invers i semnificativ att cu scorul BBS (r = -0.479; p < 0,001 ) ct i cu timpul SLS (r =
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- 0.169; p = 0,017), demonstrnd c nu numai prezena neuropatiei diabetice ci i severitatea sa

are un impact negativ asupra parametrilor de echilibru i, astfel asupra riscului de cderi. Modelul
de regresie multivariat construit a demonstrat c vrsta pacientului, severitatea neuropatiei
diabetice i simptomele depresiei acioneaz att independent ct i drept co-factori n prezicerea
riscului de cderi la pacienii cu DZ tip 2.
Prezena neuropatiei diabetice la pacienii cu DZ tip 2 duce la apariia de tulburri de echilibru i

la creterea riscului de cderi. Pacienilor cu DZ i ND ar trebui s le fie evaluai parametrii
echilibrului, iar n cazul n care sunt descoperite deficiene ale acestuia, s fie inclui ntr-un
program de reabilitare, constnd n kineto- i fizioterapie, cu scopul mbuntirii echilibrului i a
stabilitii n timpul mersului.
THE IMPACT OF NEUROPATHY ON BALANCE AND THE RISK OF FALLS IN

PATIENTS WITH TYPE 2 DIABETES MELLITUS
Dr. Timar Bogdan1, Dr. Lazar Sandra1, Dr. Mailat Diana1, Prof. Dr. Timar Romulus1
Diabetic neuropathy (DN) is a prevalent complication of Diabetes Mellitus (DM) with a major
impact on the affected patients health. We hypothesized that mediated by the dysfunctionalities
associated with DNs three major components: sensitive (lack of motion associated sensory),
motor (impairments in movement coordination) and autonomic (the presence of postural
hypotension), the presence of DN may impair the balance in the affected patients.
Our study main aim is to evaluate the possible association between the presence and severity of
DN and balance impairment and the risk of falls in patients with T2DM.
In this cross-sectional study we enrolled, according to a consecutive-case population-based setting

198 patients previously diagnosed with T2DM which attended scheduled visits at the Diabetes
Outpatient of the Emergency Hospital Timisoara. In all patients anthropometrical, clinical and
laboratory assessment was performed at the time of the screening. The presence and severity of
DN was evaluated using the Michigan Neuropathy Screening Instrument, a tool which allows both
diagnosing and severity staging of DN. The balance impairment and the risk of falls were evaluated
using four validated and standardized tools: Berg Balance Scale (BBS), Timed-up and Go test
(TUG), Single Leg Stand test (SLS) and Fall Efficacy Scale (FES-I). A higher score in BBS and
SLS respectively a lower TUG and FES-I scores are associated with improved balance.
The presence of DN was associated with significant decreases in the BBS score (40.5 vs. 43.7
points; p<0.001) and SLS time (9.3 vs. 10.3 seconds; p=0.003) respectively increases in TUG time
(8.9 vs. 7.6 seconds; p=0.002) and FES-I score (38 vs. 33 points; p=0.034). The MNSI score was
reverse and significantly correlated with both BBS score (Spearmans r = -0.479; p<0.001) and
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SLS time (Spearmans r=-0.169; p=0.017) demonstrating that not only the presence of DN but also
its severity has a negative impact on balance parameters and thus, indirectly on the risk of falls. In
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the multivariate regression model, we observed that patients age, DN severity and depressions
symptoms acted as independent, significant predictors for the risk of falls in patients with T2DM.
The presence of DN in patients with DM is associated with impaired balance and with a
consecutively increase in the risk of falls. Patients with DM and DN should have their balance
parameters evaluated and if impairments are to be found, in order to decrease the risk of falls, these
patients should be included in a rehabilitation program, consisting in kinesis and physical therapy,
aiming to improve their balance and walking stability.
OP14. A NEW INSULIN UNIT CALCULATOR FOR THE MANAGEMENT OF TYPE 1

DIABETES PATIENTS
Dr. Maurizi Anna Rita1, Dr. Naciu Anda1, Dr. Del Toro Rossella1, Dr. Lauria Pantano
Angelo1, Dr. Fioriti Elvira1, Dr. Manfrini Silvia1, Prof. Pozzilli Paolo1
1
University Campus Bio-Medico Rome
Diet, physical activity and proper dosage of insulin play a key role in the management of insulin
therapy in Type 1 Diabetes (T1D) patients on multiple daily injections (MDI). Thus, to obtain
optimal glycaemic control, adjustments of insulin dose at meal times must be made by taking into
account several parameters as blood glucose levels, the insulin/carbohydrate ratio, the
carbohydrate intake at each meal. A bolus advisor system (Accu-Chek - Aviva Connect) developed
for the establishment of the insulin dose to be administer, takes into account all above parameters.
Aim of this randomised trial was to evaluate the efficacy of a bolus advisor system on glycaemic
control as assessed by HbA1c and patients compliance to Self-Monitoring of Blood Glucose
(SMBG), through the use of a telemedicine system. 25 adults T1D patients were enrolled in the
study. HbA1c and patients compliance, assessed as average number of daily measurements and as
total measurements, were evaluated at entry into the trial and at 3 and 6 months follow-up. As
secondary end-points the number of hypoglycaemic events and the total results above target range
were evaluated. Paired test (two tailed) and analysis of variance were used to evaluate differences
in HbA1c at different time points. HbA1c at entry was 7.36% 0.93 (SD) in patients using this
bolus advisor system with bolus calculator and data transmission by App on a Smartphone
activated and 7.6% 0.62 (SD) in the control group with bolus advisor turned off and on standard
education for insulin management (p:NS). After the follow-up there was a tendency for an
improvement in HbA1c levels in the bolus advisor system treated group vs. control group (7.27%
0.76 % vs. 7.86% 1.5%, respectively, p:NS). Accordingly, a major compliance to SMBG in
bolus advisor system treated group compared to control subject it was found.
In conclusion, this bolus advisor system is a friendly wirelessly meter that helps to improve
glycaemic control, with the achievement of glycemic targets and the improvement of patients
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compliance to SMBG.
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OP15. CORELAII NTRE ADIPONECTIN, LEPTIN I CTRP 3 I
COMPONENTELE SINDROMULUI METABOLIC
Asist. Univ. Mihai Doina Andrada1,2, Petcu Laura1,2, Manuela Mitu1,2, Picu Ariana1,2, Sef
Lucr. Lixandru Daniela1,2, Prof. Dr. Ionescu Tirgoviste Constantin1,2, Conf. Dr. Guja
Cristian1,2
1.
U.M.F. "C. Davila" Bucuresti
2.
INDNBM "N. Paulescu" Bucuresti
Premise i obiective: Secreia anormal de adipokine determin apartiia unui dezechilibru

biochimic i metabolic ce conduce la apariia mai multor procese patologice. Scopul studiului este
de a evalua asocierile dintre funcia adipocitar (nivelurile de adiponectin, leptin i CTRP3) i
componentele sindromului metabolic (SM).
Material i metod: am inclus n studiu 219 subieci (53,9% brbai, 46,1% femei, p NS), dintre
care 166 (94 brbai i 72 femei, p NS) pacieni cu diabet zaharat de tip 2 (DZ tip 2) nou depistat
i 53 (24 brbai i 29 femei, p NS) persoane fr diabet dar cu hiperglicemie jeun sau toleran
alterat la glucoz. La acetia s-au nregistrat datele antropometrice i clinice i s-au determinat,
n condiii jeun glicemie, HbA1c, colesterol total, HDL colesterol, trigliceride, transaminaze
(folosind metodele standard) precum i insulina, proinsulina, leptina, adiponectina i CTRP 3
(folosind metoda ELISA).
Rezultate i discuii: 82,5% din subiecii cu DZ tip 2 i 60,4% din cei cu prediabet au prezentat
SM (p<0,05). Persoanele DZ tip 2 au prezentat valori semnificativ mai mari pentru: TG (153,38
(107,87-219,50) mg/dl vs. 113,04 (88,79-141,89) mg/dl; p<0,001), insulinemie (11,57 (8,31-
17,74) IU/ml vs. 19,38 (7,34-14,61) IU/ml; p<0,05), HOMA IR (5,21 (3,27-7,99) vs. 2,47 (2,01-
4,19); p<0,001), raport TG/HDL-c 3,65 (2,42-5,61) vs. 2,29 (1,68-2,60); p<0,05), CTRP3 (162,98
(114,21-231,70) ng/ml vs. 135,78 (99,97-183,48) ng/ml; p<0,05) i mai sczute pentru HDL-c
(43,73 10,82 mg/dl vs. 349,58 14,85 mg/dl; p<0,001) i adiponectin (4,93 (2,72-10,34) g/ml
vs. 8,72 (4,73-14,79) g/ml; p<0,05). n grupul cu prediabet, pacienii cu SM au prezentat valori
semnificativ mai mari pentru leptin (16,71 (7,68-28,46) ng/ml vs. 6,53 (3,26-21,85) ng/ml;
p<0,05) i CTRP3 (152,61 (122,54-188,82) ng/ml vs. 98,00 (60,10-136,66) ng/ml; p<0,05) i mai
mici pentru adiponectin (6,45 (3,51-13,45) g/ml vs. 12,52 (5,98-21,26) g/ml; p<0,05). Pentru
grupul cu DZ tip 2 diferenele au fost semnificative doar pentru leptin (valori mai mari la cei cu
SM, respectiv 14,06 (6,01-25,87 ng/ml vs. 4,08 (1,82-6,77) ng/ml; p<0,001) i adiponectin (valori
mai mici la cei cu SM, respectiv 4,31 (2,62-10,27) g/ml vs. 7,41 (4,56-11,55) g/ml; p<0,05).
Concentraia leptinei a crescut odat cu numrul de criterii ntrunite pentru SM n ambele grupuri
studiate (p<0,05), n timp ce pentru CTRP3 concentraia plasmatic a crescut cu numrul de criterii
ndeplinite numai pentru subiecii cu prediabet (p<0,05). Leptina s-a corelat pozitiv cu insulinemia
(p<0,01), HOMAB (p<0,01) i HOMA IR (p<0,05). Adiponectina s-a corelat negativ cu procentul
de esutul adipos visceral (p<0,01), cu raportul TG/HDL-c (p<0,01) i pozitiv cu HDL-c (p<0,01).
CTRP3 s-a asociat cu excesul ponderal (p<0,001).
Concluzii: Concentraiile adipokinelor studiate variaz n funcie de prezena sau abesena DZ i
SM. Pacienii cu DZ tip 2 nou descoperit au prezentat valori mai mari ale CTRP3 i mai mici ale
adiponectinei comparativ cu cei cu prediabet, iar subiecii cu SM au prezentat valori mai mari ale
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leptinei, CTRP3 (doar la cei cu prediabet) i mai mici ale adiponectinei

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RELATIONSHIP OF ADIPONECTIN, LEPTIN AND CTRP 3 TO COMPONENTS OF
METABOLIC SYNDROME
Assoc Lect. Mihai Doina Andrada1,2, Petcu Laura1,2, Manuela Mitu1,2, Picu Ariana1,2, Lect.
Lixandru Daniela1,2, Prof. Ionescu Tirgoviste Constantin1,2, Assoc. Prof. Guja Cristian1,2
1.
U.M.F. "C. Davila" Bucuresti
2.
INDNBM "N. Paulescu" Bucuresti
Background and aims: Abnormal secretion of adipokines causes a biochemical and metabolic
imbalance resulting in multiple pathological processes. The aim of the study is to evaluate the
associations between adipocyte function (levels of adiponectin, leptin and CTRP 3) and
components of the metabolic syndrome (MS).
Material and method: the present study included 219 subjects (53.9% men, 46.1% women, p
NS). 166 (94 men and 72 women, p NS) were newly diagnosed with type 2 diabetes mellitus
(T2DM) and 53 (24 men and 29 women, p NS) were with impaired fastig glucose or impaired
glucose tolerance. Clinical and anthropometrical parameters were measured for all patients, as well
as fasting plasma glucose, HbA1c, total-cholesterol, HDLc, triglycerides, aminotransferases (by
standard techniques) and also serum insulin, proinsulin, leptin, adiponectin and CTRP 3 levels
levels (by ELISA method).
Results and discussions: MS was diagnosed in 82.5% of T2DM patients and in 60.4% of those
with prediabetes (p<0.05). T2DM subjects presented higer values for: TG (153.38 (107.87-219.50)
mg/dL vs. 113.04 (88.79-141.89) mg/dL; p<0.001), insulinemia (11.57 (8.31-17.74) IU/mL vs.
19.38 (7.34-14.61) IU/mL; p<0.05), HOMA IR (5.21 (3.27-7.99) vs. 2.47 (2.01-4.19); p<0.001),
TG/HDL-c ratio 3.65 (2.42-5.61) vs. 2.29 (1.68-2.60); p<0.05), CTRP3 (162.98 (114.21-231.70)
ng/mL vs. 135.78 (99.97-183.48) ng/mL; p<0.05) an lower for: HDL-c (43.73 10.82 mg/dL vs.
349.58 14.85 mg/dL; p<0.001) and adiponectin (4.93 (2.72-10.34) g/mL vs. 8.72 (4.73-14.79)
g/mL; p<0,05). Subjects with prediabetes and presented significanly higher values for leptin
(16.71 (7.68-28.46) ng/mL vs. 6.53 (3.26-21.85) ng/mL; p<0.05) and CTRP3 (152.61 (122.54-
188.82) ng/mL vs. 98.00 (60.10-136.66) ng/mL; p<0.05) and lower for adiponectin (6.45 (3.51-
13.45) g/mL vs. 12.52 (5.98-21.26) g/mL; p<0.05). Those with T2DM presented significant
differences for leptin (hygher values in MS subjects 14.06 (6.01-25.87 ng/mL vs. 4.08 (1.82-
6.77) ng/mL; p<0.001) and adiponectin (lower values in MS subjects 4.31 (2.62-10.27) g/mL
vs. 7.41 (4.56-11.55) g/mL; p<0.05). Leptin levels raised with the number of MS fullfiled criteria
in both studied groups (p<0.05), while CTRP3 plasmatic levels raised with the number of MS
fullfiled criteria olny in prediabetic subjects (p<0.05). Leptin positively correlated with
insulinemia (p<0.01), HOMAB (p<0.01) and HOMA IR (p<0.05). Adiponectin negatively
correlated wiht visceral adipose tissure (p<0.01), TG/HDL-c ratio (p<0.01) and positively with
HDL-c (p<0.01). CTRP3 was associated with overweight p<0.001).
Conclusions: Adipokines concentration varied with the presence of DM and SM. Patients newly
discovered with T2DM had higher levels of CTRP3 and lower levels of adiponectin compared to
those with prediabetes. Subjects with MS had higher levels of leptin, CTRP3 (only those with
prediabetes)and lower of adiponectin.
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OP16. PREVALENA INFECIEI CU HELICOBACTER PYLORI LA PACIENII
BARIATRICI: CONCORDANA A DOU METODE DE DIAGNOSTIC
ef Lucr. Dr. Mihalache Laura1, Conf. Univ. Dr. Danciu Mihai1, Asist. Univ. Dr.
Constantinescu Daniela1, Asist. Univ. Dr. Gherasim Andreea1, Asist. Univ. Dr. Ni Otilia1,
Conf. Univ. Dr. Pdureanu Sergiu Serghei1, ef Lucr. Dr. Arhire Lidia Iuliana1
1.
Departamentul Medicale, Universitatea de Medicin i Farmacie Grigore T. Popa Iai
Helicobacter pylori (Hp) este o bacterie spiralat incriminat n apariia leziunilor inflamatorii
gastrice la peste jumtate din populaia globului. Infecia cu Hp crete riscul de apariie a
afeciunilor gastrice, unele cu risc vital, dar poate avea i consecine cardiometabolice i asupra
statusului ponderal. Obezitatea cunoate la rndul ei evoluie epidemic, singura metod eficient
n scderea ponderal i meninerea noii greuti pe termen lung fiind chirurgia bariatric. Nu
exist la ora actual un consens cu privire la algoritmul de evaluare pre-chirurgie bariatric.
Scopul studiului a fost de a evalua prevalena infeciei cu Hp la pacieni propui pentru chirurgie
bariatric i concordana ntre dou metode de diagnostic a infeciei.
Este un studiu prospectiv, ce a inclus 70 de pacieni asimptomatici evaluai preoperator serologic
(Ac IgG antiHp) i histologic (EDS cu biopsie de mucoas gastric) la care s-a practicat
gastrectomie longitudinal laparoscopic iar piesa de rezecie gastric a fost examinat histologic.
Rezultatele au artat c 58.6% dintre pacieni erau Hp pozitivi la serologie i 51.4% erau Hp
pozitivi la histologie. Dintre cei cu Hp pozitivi la serologie, 82.4% erau pozitivi i la examenul
histologic, n timp ce ntre cei cu Hp negativi la serologie, 12.5% erau Hp pozitivi la histologie.
Factorul de concordan k ntre cele dou metode de diagnostic a fost de 0.686 (p<0.001),
diagnosticul serologic al infeciei cu Hp avnd o sensibilitate de 90.3% i o specificitate de 77.8%.
Prevalena infeciei cu Hp n piesa de rezecie gastric a fost de 11.4% iar prezena Hp s-a asociat
cu grade de severitate mai mari ale gastritei. Prezena infeciei cu Hp nu s-a asociat cu complicaii
precoce postoperatorii.
In concluzie, n rndul obezilor propui pentru chirurgie bariatric n centrul nostru prevalena
infeciei cu Hp este mare, necesitnd deci evaluare complet preoperatorie.
PREVALENCE OF HELICOBACTER PYLORI INFECTION IN BARIATRIC

PATIENTS: THE AGREEMENT OF TWO METHODS OF DIAGNOSIS
Lect. Dr. Mihalache Laura1, Assoc. Prof. Dr. Danciu Mihai1, Assist. Dr. Constantinescu
Daniela1, Assist. Dr. Gherasim Andreea1, Assist. Ni Otilia1, Assoc. Prof. Dr. Pdureanu
Sergiu Serghei1, Lect. Dr. Arhire Lidia Iuliana1
1.
Department of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy,
Iassy, Romania
Helicobacter pylori (H. pylori) is a spiralled bacterium and is the etiological factor for gastritis in
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more than half of the worldwide population. H. pylori infection increases the risk for gastric
pathology, but could also have consequences on cardio-metabolic status. Obesity has as epidemic
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growth, and the only efficient long-term treatment for morbidly obese patients is currently surgery.
Although of vital importance, the preoperative assessment is not standardized, including the
aspects related to H. pylori infection.
The aim of this prospective study was to evaluate the prevalence of H. pylori infection in a group
of patients referred to bariatric surgery and the agreement of two commonly used methods for its
diagnosis.
We included 70 asymptomatic obese patients consecutively for 14 months, who were evaluated
by serology (anti-Hp IgG antibodies) and by histology (gastroscopy with gastric mucosa biopsy).
If diagnosed, H. pylori infection was standard treated and afterwards, all patients underwent
laparoscopic sleeve gastrectomy; the resected stomach was evaluated by histology.
A 58.6 percent of patients were H. pylori positive by serology and 51.4% were H. pylori positive
by histology, agreement coefficient factor kappa between the two methods being 0.686, p<0.001.
The serological diagnosis had a sensibility of 90.3% and a specificity of 77.8%. The prevalence of
H.pylori infection in the resected stomach was 11.4%, and was associated with more severe
degrees of chronic gastritis. The presence of Hp infection was not associated with early
postoperative complications.
In conclusion, among obese proposed for bariatric surgery in our center Hp infection prevalence
is high, thus requiring complete preoperative evaluation.
OP17. RELAIA MEDIC - SISTEM DE SNTATE: CANTITATE VERSUS

CALITATE
ef Lucr. Dr. Moroanu Andreea1,2, Conf. Dr. Moroanu Magdalena1,2

1
2
Universitatea Dunrea de Jos Galai
Premise si obiective: Sistemul medical reprezint structura fizic i logistic prin care medicul i
echipa medical i ndeplinesc funcia (trateaz bolile), iar medicul este persoana specializat
pentru diagnosticarea i tratarea bolilor umane. Pentru ca relaia ntre medic i sistemul medical sa
fie constructiv, trebuie identificai, analizai i optimizai factorii care influeneaz colaborarea.
Material i metod: Prezentarea analizeaz empiric, din punctul de vedere al medicului
practician, sistemul medical, resursele disponibile, adresabilitatea persoanelor cu diabet la
serviciile medicale, precum si calitatea acestor servicii, pentru a evalua eficiena medical.
Rezultate i discuii: Cu ct aplicm mai corect, echilibrat, integrat factorii implicai n
desfurarea serviciilor medicale: numrul de pacieni, resursele disponibile, calitatea serviciilor
medicale, cu att eficiena acestor servicii este mai crescut (eficiena medical).
Concluzii: Dac identificm corect variabilele care opereaz n relaia medic-sistem medical,
putem crete eficiena actului medical, cu creterea beneficiilor pentru medic, sistem medical i,
nu n ultimul rnd, pentru persoanele cu diabet, care sunt, de fapt motivul i obiectivul
operaiunilor medicale.
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PHYSICIAN HEALTCARE SYSTEM RELATIONSHIP: QUALITY VS. QUANTITY
Lect. Dr. Moroanu Andreea1,2, Assoc. Prof. Moroanu Magdalena1,2

1
2
Dunrea de Jos University Galai
Premises and objectives: The medical system is the physical and logistical structure through
which the medical doctors perform their functions (trearing diseases). The medical doctor is a
person specialized in diagnosing and treating human diseases. In order to make this relationship
constructive, we must identify, analyze and optimize the factors that affect this collaboration.
Material and method: The presentation is an empiric examination of the medical practitioner, the
medical system, available resources, diabetes patients access to medical services as well as the
quality of those services, in order to evaluate the medical efficiency.
Results and discussions: The correct, balanced and integrated implementation of the factors
involved in the development of health services, the number of patients, available resources and
quality of the services will lead to an increase in the effectiveness of the medical services.
Conclusions: If we manage to correctly identify the variables that affect the medical practitioner
and medical system relationship, we can increase the efficiency of the medical services while
having more benefits for the doctors, the medical system and last but not least, the patients
diagnosed with diabetes.
OP18. CONTROLUL TENSIUNII ARTERIALE N BOALA CRONIC DE RINICHI

ASOCIAT DIABETULUI ZAHARAT
ef Lucr. Mircea Munteanu1, ef Lucr. Bogdan Timar1, Prof. Romulus Timar1, Lavinia
Munteanu1, Adrian Enache1, ef Lucr. Adrian Sturza1, Prof. Adalbert Schiller1
1
Departamentul de Diabet i Boli Metabolice Universitatea de Medicin i Farmacie, Timioara,
Spitalul Judeean de Urgen, Timisoara
Studiul prezent a fost efectuat pentru evaluarea managementului terapeutic al hipertensiunii

arteriale (HTA) la pacieni cu diabet zaharat (DZ) i boal cronic de rinichi (BCR), innd cont
de faptul c DZ i BCR sunt factori cauzali extrem de importani pentru boala cardiovascular
(CV), mai ales n condiii de asociere cu factori de risc majori CV, cum este HTA. Mai mult,
asocierea BCR cu DZ implic un control dificil al valorilor tensiunii arteriale (TA).
In studiu au fost inclusi 594 de pacieni cu BCR, internai n clinica de Nefrologie (351 femei, 243
barbai, varst medie 62.2 ani). DZ (tip 1 i 2) a fost prezent la 56.7% din cazuri iar HTA la 86.8%
din cazuri. n timpul spitalizarii, TA a fost msurat de 2 ori pe zi, dimineaa i seara, nainte de
administrarea medicaiei antihipertensive. Pe parcursul spitalizrii (aprox. 8 zile) s-au efectuat
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ajustri ale medicaiei administrate.

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Nu au existat diferene semnificative n ceea ce privete vrsta medie i distribuia sexului n cele
dou grupuri (cu i fr DZ). De asemenea, nu au existat diferene ntre grupuri lund n
considerare gravitatea BCR. Prevalenta IMC>25 a fost similar (80,1% fa de 81,1%). Prevalena
HTA a fost semnificativ mai mare n cazul pacienilor fr DZ (93,7% vs 80,9%, p <0,0001). Dup
8 zile de intervenie activ TA a fost controlat (n int, <140 / 90mm Hg) ntr-o proporie
semnificativ mai mare la pacienii non-DZ comparativ cu DZ (86,3% vs. 74,3% p = 0.0008).
Numrul mediu de medicamente hipotensoare, inclusiv diuretice a fost similar n ambele grupuri
(2,47 vs 2,45). IECA sau BRA au fost cele mai frecvent utilizate medicamente hipotensoare n
ambele grupuri, fr diferene statistic seminificative ntre pacienii cu i fr DZ (82,3% vs
77,9%), dar utilizarea BRA a fost semnificativ mai mare n grupul DZ (18,3% vs. 9,9% p = 0,009).
Utilizarea beta-blocantelor i a diureticelor a fost similar n ambele grupuri (n jur de 66% i
respectiv, 57%), dar utilizarea de blocante ale canalelor de calciu a fost semnificativ mai mare la
cei fr DZ (29% vs. 5,1%, p <0,0005). Prevalena HTA rezistente a fost semnificativ mai mare
n grupul pacienior cu DZ i BCR (13,9% fa de 7,8%, p = 0,031). n pn la 37% dintre pacienii
cu HTA rezistent, controlul TA poate fi obinut cu mai mult de 3 ageni hipotensori.
Prevalena HTA este foarte mare la pacienii cu BCR predializai (mai mult de 80%) i n lotul
nostru fiind mai mare la pacienii fr DZ. Prin intervenie activ, sub supraveghere medical, inta
terapeutic a TA poate fi atins la mai mult de 74% dintre pacieni. Cu toate acestea, la pacienii
cu DZ i BCR asociat este mult mai dificil de atins inta terapeutic; acest obiectiv poate fi atins,
dar folosind mai mult de 3 ageni hipotensori.
BLOOD PRESSURE CONTROL IN CHRONIC KIDNEY DISEASE

ASSOCIATED TO DIABETES MELLITUS
Lect. Mircea Munteanu1, Lect. Bogdan Timar1, Prof. Romulus Timar1, Dr. Lavinia
Munteanu1, Dr. Adrian Enache1, Lect. Adrian Sturza1, Prof. Adalbert Schiller1
1
Department of Diabetes and Metabolic Diseases, Victor Babe University of Medicine and
Pharmacy, County Emergency Hospital, Timisoara
The aim of the present study was to evaluate the therapeutical management of hypertension in
diabetes mellitus (DM) patients with chronic kidney disease (CKD), given the fact that DM and
CKD are powerful causes for cardiovascular diseases, especially in association with major
cardiovascular risk factors, such as hypertension. More, the coexistence of CKD and DM are
factors that increase the difficulty in blood pressure control.
594 predialysis CKD patients, admitted in a Nephrology Clinic have been randomly enrolled in
this study (351 female and 243 male patients, mean age 62,2 years). Patients presented DM (type
1 and 2) in 56.7% of the cases and HT in 86.8% of the cases. During hospitalization, BP was
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monitored twice a day, in the morning and in the evening, before antihypertensive drugs
administration. The average length of hospitalization in the clinic was 8 days, period in which BP
was monitored and were made several medication adjustments.
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There were no significant differences in mean age and sex distribution in the two groups. There
were also no differences between the groups (with and without DM) considering CKD severity.
The prevalence of BMI > 25 was also similar (80,1% vs 81,1%). The prevalence of HT was
significantly higher in the no DM patients (93.7% vs 80,9%, p<0.0001). After the 8 days of active
intervention BP was controlled (in target, <140/90mm Hg) in a significantly higher proportion in
non DM patients as compared with DM (86.3% vs. 74.3% p=0.0008). The average number of
hypotensive drugs including diuretics vas similar in both groups (2.47 vs 2.45). ACEI or ARB
were the most frequently used hypotensive drugs in both in both groups without difference
between DM and no DM patients
(82.3% vs 77,9%), but the use of ARBs was significantly higher in the DM group (18,3% vs 9,9%
p=0.009). The use of beta-blockers and diuretics was similar in both groups (around 66% and 57%
respectively) but the use of calcium channel blockers was significantly higher in the no DM group
(29% vs 5,1% p<0.0005). The prevalence of resistant HT as defined by the guidelines was
significantly higher in the CKD DM group (13,9% vs 7,8% p=0.031). In up to 37% of resistant
hypertension patients, BP control can be obtained with more than 3 hypotensive agents.
The prevalence of HT is very high in predialysis CKD patients (more than 80%) and in our cohort
being higher in no DM patients. By active intervention, under medical surveillance, target BP can
be obtained in more than 74% of the patients. However, in DM associated CKD is more difficult
to control BP in target values. In predialysis CKD patients with DM, BP control can be achieved,
but with more than 3 hypotensive agents.
OP19. STUDIUL VARIABILITATII GLICEMICE LA PACIENII CU DIABET

ZAHARAT AFLAI IN PROGRAM DE HEMODIALIZA CRONICA
1
Institutul Naional de Diabet, Nutriie i Boli Metabolice N. Paulescu
2
Cabinetul Medical Persepolis
3
Centrul de Hemodializ Diaverum
Variabilitatea glicemic la pacienii cu boal renal avansat are un impact major asupra calitaii
vieii acestei categorii, precum i n privina outcome-ului cardiovascular. Mentinerea controlului
glicemic optim la indivizii aflati in programele de hemodializa cronica este o provocare.
Obiectiv: Analiza coeficientului de variabilitate(CV) al HbA1c la pacientii diabetici intrai n
program de substituie renala cronica pe secia de hemodializ a INDNBM N. Paulescu n
intervalul 2013-2015 prin raportare la perioada predialitic din intervalul 2010-2015
Material si metoda: Am realizat un studiu observaional, retrospectiv. Datele au fost obinute din
baza de date a INDNBM N Paulescu, secia Hemodializ. Pentru fiecare pacient s-au colectat:
valorile HbA1c disponibile din ultimii 5 ani, sexul, vrsta, tipul diabetului zaharat, data intrrii n
dializa. Au fost luai n considerare doar pacienii care aveau cel puin dou determinri ale HbA1c
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n anii anteriori dializei precum i dup iniierea substituiei renale. S-a calculat coeficientul de
variabilitate al HbA1c (exprimat prin raportul dintre deviaia standard i media aritmetic) pentru
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fiecare pacient, pentru intervalul de timp anterior iniierii dializei precum i pentru perioada
ulterioar. I-am exclus pe cei intrai n programul de substituie renala cronic n anul 2016 datorit
imposibilitii calcului CV al HbA1c.
Rezultate i discuii Am adunat date despre 51 de pacieni intrai in programul de hemodializa
cronica la INDNBM N Paulescu in intervalul 2013-2015. 68% erau barbai. Lotul a fost compus
din 27% pacieni cu diabet zaharat tip 1 i 63% pacieni cu diabet zaharat tip 2. Vrsta medie a
celor cu DT1 a fost 44,64 8,6 ani, iar a celor cu DT2 a fost 66,02 5,98 ani. Majoritatea
subiecilor au intrat n dializ n anul 2015.
CV al HbA1c a fost mai mare n perioada anterioar iniierii hemodializei, dar fr o semnificaie
statistic ( 0,12 vs 0,07, p=0,89). mprind lotul n funcie de tipul de diabet, CV al HbA1c in cele
2 intervale de timp considerate a fost identic la pacienii cu DT1 (0,106 vs 0,105, p=0,55). In
schimb la cei cu DT2 CV al HbA1c a fost mai mic dup iniierea dializei dect naintea, fr ca
rezultatul s fie semnificativ statistic (0,13 vs 0,065, p=0,77).
Concluzii: Dei variabilitatea glicemica este mai importanta la pacienii aflai n program de
substituie renala dect la cei cu un alt nivel de boala cronica de rinichi, se pare ca nu este reflectata
i ntr-o variabilitate mai important a HbA1c. Totui trebuie inut cont de faptul ca, n studiul
nostru, perioada considerat fr substituie renala s-a ntins pe ultimii 4 ani anteriori iniierii
hemodializei, interval n care subiecii aveau deja o boal renal avansat.
CV al HbA1c la pacienii cu diabet tip 1 a fost identic att nainte cat i dup iniierea hemodializei.
A STUDY OF GLYCEMIC VARIABILITY IN HEMODIALYZED DIABETIC

PATIENTS
1
National Institute of Diabetes Nutrition and Metabolic Disease N. Paulescu
2
Persepolis Medical Practice
3
Diaverum Haemodialysis Center
Glycaemic variability in advanced chronic kidney disease patients has a major impact on life
quality and influences the cardiovascular outcome. Maintaining a good glycaemic control in these
subjects is a challenge.
Objective: To analyse the variability coefficient (VC) of HbA1c in diabetic patients who started
hemodialysis in NIDNMD N. Paulescu between 2013-2015 by comparing it with the one
calculated in the last five years before dialysis.
Material and Methods: We did an observational, retrospective study. The data was obtained from
the NIDNMD N. Paulescu. For each patient we collected HbA1c levels for the last 5 years,
gender, age, the type of diabetes mellitus, the dialysis starting date. We considered only the patients
with at least two HbA1c values before and after the beginning of dialysis. We calculated the VC
of HbA1c for each patient before and after the initiation of hemodialysis. Those who entered the
dialysis program in 2016 were excluded due to the impossibility of calculating VC of Hba1c.
Results and discussions: We collected complete data for 51 patients who started hemodialysis in
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NIDNMD N. Paulescu between 2013-2015. 68% were men. 27% had type 1 diabetes mellitus
(DM), with a mean age of 44,64 8,6 years and 63% type 2 diabetes mellitus, with a mean age of
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66,02 5,98 years. The majority of patients started hemodialysis in 2015.

The variability coefficient of HbA1c calculated for the years before the beginning of hemodialysis
was higher than in dialyzed period without reaching significance level ( 0,12 vs 0,07, p=0,89).
The VC of HbA1c was identic for the 2 considered periods in type 1 DM (0,106 vs 0,105, p=0,55),
and slightly lower in type 2 DM after the initiation of dialysis (0,13 vs 0,065, p=0,77).
Discussions: Even if the glycemic variability is more important in diabetic patients with end stage
renal disease than in those with a less important chronic kidney disease, this is not reflected by a
variability of HbA1c. However, we have to consider the fact that, during the analyzed period of
five years before the beginning of the dialysis, all patients already had an advanced chronic kidney
disease and this could explain the lack of significant differences.
The variability coefficient of HbA1c was identical in type 1 diabetes mellitus before and after the
beginning of renal replacement therapy.
OP20. CORRELATION BETWEEN MICROALBUMINURIC STAGE AND HBA1C IN

RELATION WITH CHRONIC KIDNEY DISEASE AT NEWLY DIAGNOSED
DIABETES
Anca PANTEA-STOIAN 1,3, Georgiana DITU, Florentina Gherghiceanu1, Viviana

ELIAN1,2
"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
National Institute of Diabetes ,Nutrition and Metabolic Disease "N.C.Paulescu", Bucharest,
Romania
Hygiene and Environmental Health, University of Medicine and Pharmacy" Carol Davila"
Bucharest, Romania
Background: Microalbuminuria is a renal marker of generalized vascular endothelial damage and

early atherosclerosis. Patients with microalbuminuria are at increased risk of microvascular and
macrovascular complications of diabetes mellitus like myocardial infarction, stroke and
nephropathy. Poor glycemic control increases the risk of microalbuminuria. This study was
conducted to determine the frequency of microalbuminuria levels and correlate them with
glycosylated hemoglobin (HbA1c) in newly diagnosed patients and to evaluate the prevalence of
microalbuminuria at diabetes mellitus diagnosis.
Material & Methods: Seventy one type 1 and type 2 diabetic patients were included in the study.
Fasting blood samples were used to analyze glycemia and HbA1c levels for the estimation of
metabolic control and subsequently random urine specimens to investigate microalbumin levels.
Complete clinical details, general physical and systemic examinations were made. Patients with
other causes of proteinuria were excluded.The statistical software SPSS 20.0 was used for data
analysis .
Results: Out of 71 cases 32(45,1%) were male and 39(54,9%) were female. Average age of
patients was 54,8 years and maximum duration of diabetes was 6 months.Prevalence of
microalbuminuria was 25 out of 71 patients.The present study identifies that the risk of
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microalbuminuria increases with HbA1c ((r=0,257, p=0,031) and is lineary corelated. Persistent
increase in glycated haemoglobin and microalbuminuria may be considered as risk markers in
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cardiovascular and chronic kidney disease. Therefore, regular screening for microalbuminuria and
HbA1c estimation can help in clinical management to prevent complications.
Conclusion: Screening for microalbuminuria and HbA1c should be done both in newly and already
diagnosed type 1 and 2 diabetic patients albuminuria being an useful early biomarker of renal
dysfunction and glycemic control.
CORRELATION BETWEEN MICROALBUMINURIC STAGE AND HBA1C IN

DIABETES

ELIAN1,2
Romania
Bucharest, Romania

Material & Methods: Seventy one type 1 and type 2 diabetic patients were included in the study.
analysis .
Conclusion: Screening for microalbuminuria and HbA1c should be done both in newly and already
diagnosed type 1 and 2 diabetic patients albuminuria being an useful early biomarker of renal
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dysfunction and glycemic control.

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OP21. UTILIZAREA ULTRASONOGRAFIEI DE NALT FRECVEN N STUDIUL
DISTROFIEI CUTANATE N CONTEXTUL CO-AFECTRII SUBCUTANATE
INDUSE DE ADMINISTRAREA INSULINEI - SERIE DE CAZURI
MD PhD Perciun Rodica1, Biologist Telcian Ancua1

1
Distrofia subcutanat este o bine-cunoscut consecin a tratamentului insulinic. Mai puin

cunoscut este ns, afectarea pturii cutanate. Scopul lucrrii este de a evidenia rolul
ultrasonografiei de nalt frecven (20 MHz-Dermascan) (HFU) n studierea cutanat,
complementar investigaiei subcutanate efectuate prin ultrasonografie convenional (CU).
Studiul a inclus 8 pacieni insulino-tratai (6 adolesceni i 2 aduli) care au fost clinic diagnosticai
cu distrofii subcutanate (4 injectnd bolusuri i 4 fiind utilizatori de pomp).
Implicarea cutanat a fost demonstrat utiliznd HFU n timp ce afectarea subcutanat a fost
identificat prin CU. Ariile anatomice neinjectate contralaterale au fost considerate martori.
Toate cazurile au prezentat lipodistrofii subcutanate ca o consecin a administrrilo de insulin.
n acord cu abilitile tehnice, HFU a demonstrat modificri semnificative statistic ale grosimii
cutanate comparnd structurile afectate cu martorii, independent de sistemul de administrare
insulinic. n acest fel au fost identificate 2 cazuri cu distrofie hipertrofic extrem cutanat (6mm
i respectiv 6,8mm), alturi de alte 2 cazuri care prezentau extrem de reduse grosimi ale unitii
esut cutanat-subcutanat (6mm i respectiv 2,94mm). US convenional a fost utilizat la
caracterizarea esutului subcutanat.
Cazurile prezentate au demonstrat asocierea constant a distrofiilor subcutanate cu cele ale pturii
cutanate supraiacente indiferent de sistemul de administrare a insulinei. Apreciem utilitatea
metodei HFU de investigare cutanat pentru precizarea caracterelor distrofice i dimensionale,
diagnosticndu-se astfel cazuri de un particular interes pentru practician. Identificarea corect a
grosimii cutanate i a unitii derm-esut subcutanat prin echipamente US adecvate minimizeaz
rata agresiunilor prin injectare repetitiv a esuturilor dermice i musculare.
DYSTROPHIC THICKENED CUTIS AS PART OF THE COMPLEX CUTIS-SUBCUTIS

LOCAL INSULIN DYSTROPHY, HIGH FREQUENCY ULTRASOUND ASSESSED -
CASE SERIES
MD PhD Perciun Rodica1, Biologist Telcian Ancua1

1
Romania
The subcutis dystrophy is a well-known consequence of insulin injections. What seems to be less
known about such a local insulin dystrophic reaction, is the engagement of cutis itself. The aim of
114
this present study is to emphasize the role of high frequency ultrasound (20 MHz-Dermascan)
(HFU) interrogation of cutis layer, in addition to the conventional ultrasound (CU) as
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complementary imaging tools for subcutis abnormalities.

This study included 8 insulin-treated patients (6 adolescents and 2 adults) who were clinically
diagnosed with subcutis dystrophy, 4 of them being injected by boluses and 4 by pump. The
involvement of integument (epidermis and dermis layers) has been proved and only detailed by
using the dedicated HFU equipment. The anatomo - pathological related data of subcutis dystrophy
was identified by CU technique while the contralateral areas served as normal controls.
All cases presented both subcutis and cutis dystrophic changes as a consequence of local insulin
delivery. According to their technical capabilities, HFU has been specifically relevant for cutis
assessment while CU system has been used for subcutis interrogation. We found a statistical
significant p-value between abnormal and unaffected integument counterparts dystrophic-
thickness, irrespective of insulin injecting system. We precisely located two cases with extreme
thickened cutis (6mm and 6.8mm respectively) and two cases with the thinnest cutis/subcutis unit
(6mm and 2.94mm respectively).
These cases showed that subcutis dystrophy has constantly an overlying cutis abnormalities
irrespective of injected/continuous infusion systems. Our original contribution assumed that HFU
interrogation is an efficient method for detecting both integument thickening and echostructure
abnormalities. The rate of prejudicial intradermal insulin delivery by using suitable needles and
injecting techniques could be significantly decreased. Equally important, the adequate
identification of cutis/subcutis layers could minimize intramuscular damage.
OP22. INSULINOTERAPIA CU POMPA DE INSULIN N PRACTICA ZILNIC
Conf.Dr. Roman Gabriela1

1
UMF "Iuliu Hatieganu", Centrul Clinic de Diabet, Nutritie, Boli metabolice
Introducere si obiectiv: Pompa de insulin reprezint un real progres tehnologic n tratamentul

diabetului zaharat tip 1. Opiunile pentru diverse profiluri de rat bazal, tipuri de bolus i rata
bazal temporar, pot determina o mbuntire a controlului glicemic i a calitii vieii. Pentru
eficienta maxima, tratamentul cu pompa de insulina trebuie sa fie coordonat de o echipa medicala
antrenata, iar persoana cu diabet sa fie motivata si sa aiba deprinderile necesare. Ca si centru de
coordonare regionala a programului national de pompe de insulina, ne-am propus o analiza a
tratamentului cu pompa de insulina din punct de vedere al controlului glicemic, a dozelor de
insulina, a auto-monitorizarii, a satisfactiei cu tratamentul si a modului in care optiunile tehnice
ale pompei sunt utilizate.
Materiale si metoda: Din 2002 si pina in 2015, 99 persoane cu DZ tip 1 au fost trecute pe pompa
de insulina in centrul nostru. Dintre acestia, 87 au fost inclusi in analiza prezenta: evaluare clinica
si biochimica, descarcare de pompa de insulina si glucometru utilizand softul ACCU-CHEK Smart
Pix. Toti pacientii si-au dat consimtamantul, analiza a respectat regulile ICH-GCP.
Rezultate: Caracteristicile grupului analizat sunt: 64% de gen feminin, 64% cu varsta > 18 ani,
75% din zona urbana. Valoarea initiala HbA1c a fost in medie de 9.2% (1.4) iar ultima valoare a
fost de 8.2% (1.4). Majoritatea pacientilor (78%) au prezentat o scadere a HbA1c, 15% au
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mentinut aproximativ aceeasi valoare, iar 7% au prezentat o crestere a HbA1c. HbA1c < 7% a fost
prezenta la 21% dintre pacienti, valori de 7-8% la 33% din pacienti, 44% din pacienti au avut
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valori HbA1c > 8%. Rata bazala a reprezentat 45% din totalul de insulina / 24 ore, 59% din pacienti
uitilizeaza doar bolusul standard, 39% nu utilizeaza rata bazala temporara.
Concluzii: Pentru ca tratamentul cu pompa de insulina sa-si dovedeasca eficienta pe termen
indelungat, evaluarea periodica a acestora de catre o echipa medicala antrenata este absolut
necesara.
INSULIN PUMP THERAPY IN DAILY PRACTICE
Assoc. Prof. Roman Gabriela1

1
UMF "Iuliu Hatieganu", Centrul Clinic de Diabet, Nutritie, Boli metabolice
Background and aims: Insulin pump therapy represents a real technologic progress in the
treatment of Type 1 Diabetes. The continuous subcutaneous insulin infusion, multiple options for
different basal rate patterns, types of boluses and temporary basal rate, can improve the metabolic
control and increase the quality of life. A qualified medical team and a motivated and well trained
patient are required for a successful treatment. As a regional coordinator for the insulin pump
national program, we aimed to evaluate the insulin pump treatment in terms of glycemic control,
insulin requirements, patient satisfaction, glucose self-monitoring and use of the technological
advantages provided by the pump.
Materials and methods: From 2002 to 2015, 99 patients with Type 1 diabetes have been switched
to insulin pump therapy, 87 patients have been included in the present analysis. Clinical and
biochemical assessment has been performed and both insulin pumps and glucometers have been
analyzed using ACCU-CHEK Smart Pix software. ICH-GCP rules have been applied. All the
patients gave their consent.
Results: The demographic characteristics of the patients are: 64% female gender, 64% age > 18
years, 75% living in urban areas. The initial HbA1c mean value was 9.2% (1.4) and the last
HbA1c mean value was 8.2% (1.4). Most of the patients (78%) have decreased their HbA1c
value, 15% maintained their initial value and 7% had an increased value. HbA1c < 7% was present
in 21% of the patients, between 7-8% in 33% of the patients, and 44% of the patients had the
HbA1c > 8%. Basal rate represents 45% from the total daily insulin, 59% of the patients use only
standard bolus, 39% of the patients do not use temporary basal rate.
Conclusions: For a successful and long-term glycemic control, periodic evaluation of the patients
using insulin pumps is required.
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OP23. IMPACTUL INSULINOTERAPIEI CU ANALOGI BAZALI ASUPRA
VARIABILITII GLICEMICE LA SUBIECI CU DIABET ZAHARAT TIP 2 I
BOAL RENAL TERMINAL
MD PhD Octavian Savu1, MD PhD Viviana Elian1, MD Oana Steriade1, MD PhD Ileana
Teodoru1, MD Stela Mihu, MD Ctlin Tacu, MD PhD Adrian Covic, MD PhD Cristian
Serafinceanu1
1
Impactul insulinoterapiei asupra variabilitii glicemice (VG) la pacieni diabetici (DZ)

insulinorezisteni cu boal renal terminal (ESRD) este puin studiat. Studiul prezentat a analizat
impactul insulinoterapiei cu analogi umani bazali asupra VG la pacieni cu DZ tip 2 n program de
hemodializ (HD).
Subiecii cu DZ tip 2 n program de hemodializ (HD) i diverse regimuri de insulinoterapie de
cel puin 6 luni (detemir, n=7; glargin, n=7) au fost analizai prospectiv. Monitorizarea glicemic
continu (CGMS Gold, Dex Com 7+) s-a realizat timp de 5 zile, pe durata a 3 edine consecutive
de HD. Profilele glicemice (CV) au fost comparate intra i inter dialitic. VG de lung durat a fost
evaluat prin CV pentru cel puin 3 valori ale HbA1c (HPLC) de la iniierea HD. Insulinorezistena
a fost estimat prin HOMA-IR (peptid C i glicemie a jeun). Profilul lipidic seric a jeun (HDL
colesterol), proteina C reactiv msurat cantitativ (cPCR) i feritina seric (ajustat pentru
valoarea Hb) la includere au fost analizate comparativ.
Variabilitatea glicemic (CV CGMS i CV HbA1c), cPCR i feritina au fost sczute la subiecii
tratai cu detemir. Toi subiecii au fost insulinorezisteni (HOMA-IR >3).
Insulina detemir reduce variabilitatea glicemic i profilul proinflamator la pacienii
insulinorezisteni cu diabet zaharat tip 2 i boal renal terminal.
THE IMPACT OF BASAL INSULIN ANALOGUES ON GLUCOSE VARIABILITY IN

SUBJECTS WITH TYPE 2 DIABETES ON HEMODIALYSIS
MD PhD Octavian Savu1, MD PhD Viviana Elian1, MD Oana Steriade1, MD PhD Ileana
Teodoru1, MD Stela Mihu, MD Ctlin Tacu, MD PhD Adrian Covic, MD PhD Cristian
Serafinceanu1
1
N.C. Paulescu Institute of Diabetes, Nutrition and Metabolic Diseases
Very few data are available about the potential impact of insulin regimen on glucose variability
(GV) in patients with type 2 diabetes (DM) on hemodialysis (HD) for end stage renal disease
(ESRD). We aimed to analyze the impact of basal insulin analogues on GV in patients with type
2 DM ongoing substitution therapy for ESRD.
Subjects with type 2 DM under maintainance HD and various insulin regimens for at least 6
117
months (detemir, n=7; glargine, n=7) were prospectively analyzed. Continuous glucose monitoring
system (CGMS Gold, Dex Com 7+) was applied for 5 days, over 3 consecutive sessions of HD.
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Various glycemic profiles (CV) were compared between the day on (HD-on) and the day off (HD-
off) dialysis. The CV of HbA1c (HPLC) was used to assay the long term GV. Insulin resistance
was assessed by HOMA-IR using fasting glucose and C-peptide levels. Lipid profile (fasting HDL
cholesterol), cantitative C-reactive protein (cCRP) and ferritin (adjusted for Hb values) was
measured in serum at inclusion.
Insulin detemir reduced glucose variability (CV CGMS and CV of HbA1c), and cCRP and ferritin
values in insulin resistant subjects with type 2 DM on HD. All participants included were insulin
resistant (HOMA-IR >3).
Insulin detemir reduces glucose variability and attenuates pro-inflammatory profile in insulin
resistant patients with type 2 diabetes on hemodialysis for end stage renal disease.
OP24. VITAMINA D3 AMELIOREAZ DISFUNCIA ENDOTELIAL LA OBOLANI

DIABETICI PRIN SCDEREA EXPRESIEI MONOAMINOXIDAZEI I A RAGE /
VITAMIN D3 ALLEVIATES ENDOTHELIAL DYSFUNCTION IN DIABETIC RATS
BY DECREASING MONOAMINE OXIDASE AND RAGE EXPRESSION
Dr. Sturza Adrian1, Dr, Duicu Oana1, Dr. Vduva Adrian1, Dr. Munteanu Mircea1,Prof. Dr.
Timar Romulus1, Prof. Dr. Muntean Danina1
1
Disciplina de Fiziopatologie, Centrul de Cercetare Translationala si Medicina Sistemelor,
Universitatea de Medicina si Farmacie Victor Babes Timisoara
Vitamina D este recunoscut la ora actual ca fiind un agent protector la nivel cardiovascular, fr
ca mecanismele de aciune s fie pe deplin elucidate.
Scopul prezentului studiu a constat n evaluarea efectelor 1,25-dihidroxicolecalciferolului (DHC)
asupra reactivitii vasculare i respectiv, a expresiei monoaminoxidazei (MAO) i a receptorului
pentru produii de glicare avansat (RAGE), la nivelul segmentelor vasculare izolate de la obolani
cu diabet zaharat indus experimental.
Vitamin D is widely reported as a cardiovascular protective agent. However, the precise

mechanism underlying the beneficial effect of vitamin D has not been fully elucidated.
We have previously demonstrated that monoamine oxidase (MAO), an enzyme located in the outer
mitochondrial membrane that constantly generates hydrogen peroxide as by-product, is a mediator
of endothelial dysfunction in diabetes.
The present study assessed the effects of 1,25-dihydroxi-cholecalciferol (DHC), the major
metabolite of vitamin D, on vascular reactivity and expression of MAO and RAGE (Receptors-
for-Advanced-Glycation-Endproducts) in vascular segments harvested from diabetic rats.
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PREZENTRI POSTER /POSTER PRESENTATIONS
PS1. PREVALENA BOLII CARDIOVASCULARE LA PACIENII CU DIABET

ZAHARAT TIP 2
Rezident Andoni Adela1, Rezident Prefac Alina1, Rezident Parocescu Daniel1, Dr. Stegaru
Daniela1, Rezident Velican Oana1, Dr. Rusu Emilia1, Dr. Radulian Gabriela1
1
Institutul Naional de Diabet, Nutriie i Boli Metabolice Nicolae Paulescu, Bucureti
Prevalena diabetului zaharat n anul 2013 este de 382 de milioane de cazuri, dintre care 85 - 95%
sunt reprezentate de diabetul tip 2 (DZ2) i se estimeaz c pn n anul 2035 aproximativ 592
milioane de oameni vor suferi de aceast maladie. Boala cardiovascular se ntlnete cu o
frecven de 2-4 ori mai mare. Studiul prezent si propune evaluarea legturii dintre controlul
metabolic si prezena afectrii macrovasculare.
Studiu observaional, retrospectiv, ce a cuprins un numr de 229 pacienti cu diabet zaharat tip 2
(62% brbai, 38% femei) cu vrsta medie de 61.52 10.5 ani i durata medie a diabetului zaharat
11.6 (10.56 - 12.6) ani, internai n I.N.D.N.B.M. N.Paulescu, Bucureti. La acetia s-au
determinat parametri clinici i de laborator i au fost notate bolile asociate de care sufer.
Din cei 229 de pacieni, 77.3% au avut hipertensiune arterial (HTA) 76.8% din brbai si 78.2%
din femei, aproximativ jumatate 48.5% au avut boal cardiac ischemic (BCI) reprezentnd 47.9
% din brbai si 49.4 % din femei, 6.1% au avut insuficien cardiac (IC) clasele I-II NYHA,
2.2% au avut insuficien cardiac (IC) clasele III-IV NYHA. Boala arterial periferic (BAP) s-a
ntlnit la 23.1% pacieni iar accidentul vascular cerebral (AVC) la 7.4% pacieni. HbA1c peste
7% a fost ntlnit la 82.5% din pacieni (n=189). Media HbA1c a fost semnificativ mai mare
(p=0,021) la pacienii cu BCI (9.32 +- 2.26%) versus cei fr BCI (8.66 +- 1.99%). Nu s-au
nregistrat diferene semnificative statistic pentru cei cu HTA, IC, BAP sau AVC.
Prevalena bolilor cardiovasculare a fost crescut n lotul studiat. HbA1C a fost mai mare la
pacienii cu BCI. Dezechilibrul metabolic exprimat prin HbA1C a fost prezent ntr-o proportie
foarte mare la aceti pacieni. Pe de alt parte, subiecii cu numeroase comorbiditi ating HbA1c
int ntr-o proporie mai mic.
CARDIOVASCULAR DISEASE PREVALENCE IN PATIENTS WITH TYPE 2

DIABETES MELLITUS
Andoni Adela1,Prefac Alina1, Parocescu Daniel1, Stegaru Daniela1, Velican Oana1, Dr.
Rusu Emilia1, Dr. Radulian Gabriela1
1
The prevalence of diabetes in the year 2013 is 382 million cases, of which 85 - 95% are represented
120
by diabetes type 2 (T2DM), and it is estimated that by the year 2035 approximately 592 million
people will suffer from this disease. Cardiovascular disease is 2 to 4 times more frequent among
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them. The present study evaluates the correlations between metabolic control and the presence of
macrovascular disease.
Material and method: it is a retrospective observational study which included a number of 229
patients with T2DM (62 % men, 38 % female), with mean age of 61.52 10.5 years and average
duration of diabetes of 11.6 (10.56 - 12.6) years, hospitalized in NIDMD"N. Paulescu", Bucharest.
For them, clinical and laboratory parameters were noted and their associated conditions.
Of the 229 patients, 77.3% had hypertension (HBP) 76.8% men and 78.2% female, approximately
half of them 48.5% had coronary heart disease (CHD) 47.9 % men and 49.4 % female, 6.1% I-II
NYHA heart failure (HF), 2.2% III-IV NYHA heart failure (HF). Peripheral artery disease (PAD)
was encountered in 23.1% patients and stroke in 7.4% patients. Higher HbA1c than 7% was
encountered in 82,5% patients (n=189). Average HBA1c was significantly higher (p= 0.021) in
patients with CHD (9.32 +- 2.26%) versus those without CHD (8.66 +- 1.99%). There has been
no statistically significant difference for those with HBP, HF, PAD or Stroke.
The prevalence of CVD was increased in the studied plot. HbA1c was higher in the patients with
CHD. The poor metabolic control was expressed in HbA1c was positive in big proportion in this
patients. On the other hand, fewer subjects with numerous comorbities attain the HbA1c target.
PS2. SINDROMUL METABOLIC I BOALA RENALA CRONICA LA PACIENII

DIABETICI
Rezident Bejinariu Ctlina1, Dr. Rusu Emilia1, Rezident Ungureau Carmen1, Dr. Murean
Alexandra1, Dr. Stegaru Daniela1, Rezident Andoni Adela1, Rezident Petre Diana1, Rezident
Ciobanu Delia1, Rezident Prefac Alina1, Rezident Sordea Lidia1, Rezident Dobre Alin1,
Rezident Chiril Vlad1, Prof. Dr. Radulian Gabriela1
1
Institutul Naional de Diabet, Nutriie i Boli Metabolice Nicolae Paulescu, Bucureti
Sindromul Metabolic (SM) i boala renal cronic (BRC) au inciden crescut i duc la
morbiditate i mortalitate cardio-vascular crescut. Relaia dintre ele este complex, dar
mecanismul acestei asocieri nu a fost nc elucidat. Componentele individuale ale SM sunt
cunoscute drept factori de risc pentru boala renal dar nu este clar cum nmnuncherea acestor
componente duce la dezvoltarea i progresia bolii renale.
Scopul studiului a fost determinarea frecvenei sindromului metabolic (SM) la pacienii cu boal
renal cronic (BRC) i diabet zaharat tip 2, stabilind ct de frecvent se ntlnete fiecare
component a SM la aceti pacienti.
A fost realizat un studiu cross- sectional ce a inclus 229 de pacieni (87 femei i 142 brbai) cu
diabet zaharat i BRC, desfurat n perioada septembrie 2015- februarie 2016. Toi pacienii au
fost examinai clinic i au fost msurate tensiunea arterial (TA), greutatea (G), nlimea (H) i
circumferina abdominal (CA). Au fost efectuate, de asemenea, urmtoarele analize: glicemie,
trigliceride (TG), lipoproteine cu densitate moleculara mare (HDL-C), uree, creatinin, raport
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albumin/creatinin (RAC).
Din totalul de 229 de pacieni cu boal renal cronic 80.7% (n=) au prezentat sindrom metabolic
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(p=). Pacienii cu SM i BCR au prezentat vrstei mai avansat, vechimea diabetului mai mare,
valori tensionale mai ridicate, valorile crescute ale creatininei, ureei, acidului uric, RAC ( toate
p<0,05). Analiza componentelor sindromului metabolic n corelaie cu boala renal cronic a
evideniat c 47.6% (n=) dintre pacienii cu BRC au asociat obezitate, 82.6% (n=) aveau HTA,
47.7% (n=) au avut HDL-C sczut i 45% (n=) valori crescute ale TG.
Sindromul metabolic este comun printre pacienii cu BRC i diabet zaharat tip 2. Frecvena BRC
a crescut proporional cu numrul componentelor SM.
METABOLIC SYNDROME AND CHRONIC KIDNEY DISEASE AMONG DIABETIC

PATIENTS
Bejinariu Ctlina1, Dr. Rusu Emilia1, Ungureau Carmen1, Dr. Murean Alexandra1, Dr.
Stegaru Daniela1, Andoni Adela1, Petre Diana1, Ciobanu Delia1, Prefac Alina1, Rezident
Sordea Lidia1, Dobre Alin1, Chiril Vlad1, Prof. Radulian Gabriela1
1
Metabolic syndrome (MS) and chronic kidney disease (CKD) have increased incidence and lead
to cardiovascular morbidity and mortality. Their relationship is complex, but the mechanism of
this association has not yet been fully elucidated. The individual components of MS are known as
risk factors for kidney disease but it is not clear how bundling these components leads to the
development and progression of kidney disease.
The aim of the study was to determine the frequency of metabolic syndrome (MS) in patients with
chronic kidney disease (CKD) secondary to diabetes by observing how frequently each component
of MS meets in patients with CKD.
A cross-sectional study was conducted including 229 patients (87 women and 142 men) with
diabetes and CKD, held during September 2015- February 2016. All patients were assessed
clinically and were measured blood pressure (BP), the weight (G), the height (H) and waist
circumference (CA). Following analyzes was analyzed: glucose, TG, HDL, urea, creatinine, RAC.
Of the 229 patients with chronic kidney disease, 80.7% had metabolic syndrome but there was no
statistical correlation value between them (p> 0.005). Age, length of diabetes, urea and uric acid
values were positively correlated with chronic renal disease and metabolic syndrome (p <0.005).
Analysis of metabolic syndrome components correlated with chronic kidney disease showed that
47.6% of CKD patients were obese, 82.6% had hypertension, 47.7% had low HDL and 45%
elevated Tg.
Metabolic syndrome is common among patients with CKD secondary to diabetes. MS is associated
with CKD but the mechanism of this association has not been determined. It has also been observed
that the risk for CKD increased in proportion to the number of components and MS: compared
with those without MS participants two components had an increased risk, while those with three
components, have greater risk. Therefore, MS is an independent risk factor for CKD, therefore, a
program for early detection of patients with MS is important.
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PS3. FUMATUL ACCENTUEAZ GRADUL INSULINOREZISTENEI LA PACIENII
CU DIABET ZAHARAT TIP 1 CU BOAL RENAL DIABETIC
Dr. Bcu Mihaela Larisa1, Prof. Univ. Dr. Moa Maria1

1
Departamentul de Diabet, Spitalul Clinic Municipal Filantropia Craiova
Scopul studiului a fost analiza corelaiilor ntre estimated glucose disposal rate (eGDR) ca marker
al insulinorezistenei (IR) i prezena bolii renale diabetice (BRD), n funcie de statusul de
fumtor, la pacieni cu diabet zaharat tip 1 (DZ 1) cu durata DZ >10 ani.
Am inclus n studiu 140 de pacieni neselectionai cu DZ tip 1 cu durata DZ>10 ani, 41.43% femei
i 58.57% barbati, la care am analizat date anamnestice, antropometrice i paraclinice. Ca marker
al IR am utilizat estimated glucose disposal rate (eGDR), calculat dup formula urmtoare: eGDR
(mg x kg x min) = 24.31 - (12.22 x CA/C) - (3.29 x HTA) - (0.57 x HbA1c), unde CA/C
reprezint raportul circumferina abdominal/circumferina old, HTA - statusul hipertensiv (1=cu
HTA, 0=fr HTA). BRD a fost definit ca rata filtrarii glomerulare estimat - RFGe (CKD-EPI)
<60 ml/min/1.73m2 i/sau raportul albumin/creatinin (RAC) urinar 30 mg/g.
Au fost considerai fumtori pacienii ce au fumat minim 5 igarete pe zi, minim 12 luni. Analiza
statistic a datelor s-a realizat folosind programul SPSS, software-ul 22.
Pacienii cu BRD fumtori au prezentat eGDR mai mic (deci IR mai mare) dect pacienii fr
BRD fumtori: 5.271.99 vs. 7.301.83, diferen semnificativ statistic (p=0.002). Pacienii cu
BRD fumtori au prezentat eGDR mai mic dect pacienii cu BRD nefumtori (5.271.99 vs.
6.722.34), diferen semnificativ statistic (p=0.004), deci putem spune c la pacienii cu BRD
fumatul accentueaz gradul IR; ca i argument suplimentar, analiznd corelaia eGDR cu fumatul
la tot lotul de pacieni cu DZ tip 1, s-a observat c pacienii fumtori au eGDR mai mic dect
pacienii nefumtori (5.692.12 vs. 7.062.44), p=0.001. n schimb, la pacienii fr BRD se pare
c fumatul nu accentueaz gradul de IR: pacienii fr BRD fumtori au eGDR mai mare dect
pacienii fr BRD nefumtori (7.301.83 vs. 7.122.36), ns diferena este nesemnificativ
statistic n acest caz (p=0.930).
Fumatul accentueaz gradul IR (estimata cu ajutorul eGDR) la pacienii cu DZ tip 1 cu durata
DZ>10 ani ce prezint BRD.
PS4. DIABETUL ZAHARAT TIP 1 I ANOREXIA NERVOAS: CE ESTE

DIABULIMIA?
Rezident Burde Roxana1, Rezident Groza Mdlina1, Conf. Dr. Roman Gabriela1
1
Centrul de Diabet, Nutritie si Boli Metabolice
Introducere: Tulburrile de alimentaie devin din ce n ce mai frecvent ntlnite n rndul femeilor
cu diabet zaharat tip 1. Astfel, ia natere o noiune nou, dar nc nerecunoscut n teminologia
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medical din Romnia-diabulimia. Afeciunea se caracterizeaz printr-un interes excesiv atribuit

greutaii si imaginii propriului corp, fapt ce va duce n final la un control slab al echilibrului
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glicemic.
Se prezint n cazul de fa modalitatea de evaluare, diagnostic i tratament al unei paciente care
i-a modificat insulinioterapia n vederea obinerii scderii ponderale.
Prezentarea cazului : Descriem cazul unei femei n vrst de 28 de ani cunoscuta cu un istoric
de subpondere de aproximativ 10 ani, din momentul diagnosticrii diabetului zaharat. Pacienta s-
a internat n Centrul de Diabet zaharat, Nutriie i Boli Metabolice din Cluj-Napoca. Anamneza a
relevat un IMC n medie de 15 kg/m2. La examinare se constat tegumente palide, deshidratate.
Tensiunea arterial avea valori de 90 60mmHg cu o frecven cardiac de 55 bpm. A prezentat
deasemenea o amenoree secundar, fr un regim de substituie hormonal constant.
Osteodensitometria DXA a relevat prezena osteoporozei.
Evalurile de laborator la internare au pus n eviden valori glicemice crescute , care se corecteaza
foarte rapid pe parcursul internrii, cu doze reduse de insulin. Ph-ul arterial relev acidoz
metabolic in prezena unui dezechilibru electrolitic semnificativ, cu hipercloremie i
hipernatremie. Evaluarea hormonala indic un hipogonadism hipogonadotrop, precum i un
hipotiroidism central, ambele de natura funcional.
La examenul de urin se constat prezena infeciei urinare.
Discursul pacientei s-a dovedit a fi unul raional, fr tulburri de percepie.
Rspunsurile ei au fost clare, negnd prezena tulburrilor legate de comportamentul alimentar.
Consultul psihiatric a relevat cu toate acestea prezena criteriilor pentru anorexia nervoasa conform
DSM-IV.
Abordarea terapeutica a fost una multidisciplinar incluznd un regim alimentar, insulinoterapie,
tratament antidepresiv, urmat de psihoterapie pentru reechilibrare ponderal, dar i hormonal,
avand in vedere etiologia functional/hipotalamic a acesteia.
Particularitatea cazului: Considernd diablumia o noiune nou, abordarea medical i
terapeutic rmn neclare. Consecinele acestei afeciuni pot s fie copleitoare, dar sperana
rmne n cercetri viitoare ndreptate n direcia unor terapii intite i eficiente.
TYPE 1 DIABETES AND ANOREXIA NERVOSA: WHAT IS DIABULIMIA?
Burde Roxana1, Groza Mdlina1, Assoc. Prof. Roman Gabriela1

1
Centrul de Diabet, Nutritie si Boli Metabolice
Introduction: Eating disorders are growing more and more frequent in girls and women with type
1 diabetes. Thus, a new, yet unrecognized medical term emerges- diabulimia.
This condition is characterized by weight and body image concerns that lead to the
mismanagement of diabetes. It represents some of the most complex patient problemsboth
medically and psychologically.
The present case reports the assessment, diagnosis, and treatment of a young woman who
inappropriately manipulated her insulin to lose weight.
Case presentation: We describe a 28 years old female with a 10-year history of underweight
dating from her type 1 Diabetes diagnosis. She was admitted to the Clinical Center of Diabetes,
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Nutrition and Metabolic diseases in Cluj Napoca. Her case history revealed an average BMI of 15
kg/m2. On examination she was pale, emaciated and dehydrated. Her blood pressure was 90/60
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mmHg and heart rate of 55 bpm. In addition she was amenorrheic, with a discontinuous hormonal
replacement therapy. Osteodensitometry indicated the presence of osteoporosis.
Laboratory assessment showed hyperglycemia, metabolic acidosis with severe electrolytic
imbalance. Hormonal evaluation revealed a functional hypogonadotropic hypogonadism with
central hypothyroidism. General urine examination and culture were indicating an acute bacterial
infection.
Her speech was rational and did not reveal delusions or hallucinations. Her answers were
straightforward and insisted she desired a normal body shape. Her mood was depressed, yet she
fulfilled the diagnostic criteria for anorexia nervosa, according to DSM IV psychiatric evaluation,
though denying self-induced vomiting or purging.
Regarding the treatment, a multidisciplinary approach was established, including diet, insulin
therapy, antidepressants followed by psychotherapy not only to correct weight but moreover the
hormonal imbalance, as hormonal replacement therapy is futile since the disturbance is functional/
hypothalamic.
Case particularity: Considering diabulimia as a relative new notion, the medical approach and
treatment remains unclear. The consequences of these diseases can be overwhelming, but there is
hope with further research aimed at targeted and effective therapies.
PS5. DEPRESSION AND COGNITIVE IMPAIRMENT IN TYPE 2 DIABETES:

CORELLATION WITH SLEEP AND BIOLOGICAL MARKERS
MD PhD Cernea Simona1,2, MD ular Floredana-Laura1,2, MD Huanu Adina1,2

1
Department M3/Internal Medicine IV, University of Medicine and Pharmacy, Trgu Mure;
2
Diabetes, Nutrition and Metabolic Diseases Outpatient Unit, Emergency County Clinical
Hospital, Trgu Mure
The main objective of this cross-sectional study was to identify clinical and biological parameters
that correlate with depression and cognitive impairment in patients with type 2 diabetes (T2D).
The mental health comorbidities and sleep quality were evaluated by validated questionnaires and
several relevant biological parameters were measured in serum.
Cognitive impairment significantly correlated with age, education level, sleep quality, depression
and magnesium concentrations. Depression correlated with female gender, sleep quality and
duration, and leptin levels (p<0.05 for all). Mean leptin concentrations progressively increased in
healthy controls, patients with T2D without depression, with mild depression and with severe
depression (p:0.03). Patients with T2D had poor sleep quality, although sleep duration was not
significantly different compared with healthy controls. Mean serum leptin levels increased with
poorer sleep quality (p:0.009). These results are relevant both for clinical practice and future
research projects aimed at elucidating the mechanisms behind depression in T2D.
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We demonstrated that in patients with T2D, poor sleep quality and depression are associated with
hyperleptinemia. These might constitute mechanisms that explain the complex relationship
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between the two conditions, possibly through increased adiposity. We also showed that low
magnesemia may play an important role in cognitive impairment in T2D patients.
This work was supported by an Internal Research Grant of the University of Medicine and
Pharmacy of Trgu Mure number 1/23.12.2014).
PS6. HIPOGLICEMIILE I UNELE CARACTERISTICI CLINICE ALE DIABETULUI

ZAHARAT
Dr. Chioveanu Marinela1, Dr. Petre Diana Gabriela1, Dr. Sebestyen Ana-Maria Sabina1, Dr.
Ilinca Alexandra1, Dr. Mihai Andrada1, Prof. Dr. Radulian Gabriela1
1
Hipoglicemia reprezint o problem important a pacienilor cu diabet zaharat tip 1 (DZ tip 1) i
a celor cu diabet zaharat tip 2 (DZ tip 2), ce primesc tratament intensiv. Hipoglicemiile severe ce
necesit spitalizare au fost asociate cu un risc crescut de apariie a demenei. n lucrarea de fa ne
propunem identificarea pacienilor cu risc crescut de hipoglicemii, ct i a modului n care acetia
percep, recunosc i trateaz hipoglicemiile.
Studiu observaional, cross-sectional, pe 130 pacieni cu DZ tip 1 (30,8%) i tip 2 (69,2%), cu
vrsta medie de 56,19 14,67 ani, dintre care brbai 54,6% i femei 45,4% i cu durata medie de
evoluie a bolii de 14,52 9,38 ani, insulinotratai n proporie de 83,84% , crora li s-a aplicat un
chestionar ce conine ntrebri despre recunoaterea, tratamentul i prevenia hipoglicemiilor.
Dintre pacienii chestionai, 95,4% dein un glucometru i 93,1% i automonitorizeaz glicemia.
Toi pacienii cu DZ tip 1 i 82,2% din pacienii cu DZ tip 2 au declarat cel puin un episod de
hipoglicemie. Dintre pacienii cu DZ tip 1, 42,5% i-au pierdut contiena iar 45% au fost nevoii
s se interneze. Dintre pacienii cu DZ tip 2 care au prezentat hipoglicemie, 20% i-au pierdut
contiena, iar 23,3% dintre ei s-au internat. Cauzele pentru hipoglicemii recunoscute de ctre
pacieni au fost: lipsa aportului de hidrai de carbon (HC) (51,53%), efortul fizic mare (42,30%),
ntrzierea mesei (34,61%), supradozarea medicaiei (21,53%) i repetarea administrrii
medicaiei (0,76%). Simptomele sugestive pentru hipoglicemie au fost urmtoarele: transpiraii
(80%), foame (42,3%), confuzie (36,2%), palpitaii (33,1%) i cefalee (25,4,%). n vederea evitrii
hipoglicemiilor, 33,1% prefer glicemii mai mari, 20% scad efortul fizic, 60% cresc aportul de
HC, 3,1% scad doza de biguanid, 2,3% scad doza de sulfonilureic i 46,2% vor scdea doza de
insulin. 90% dintre pacienii cu DZ tip 1 i 40% din cei cu DZ tip 2 ajusteaz medicaia.
Tratamentul de elecie a fost administrarea de HC (92,3%). Cei mai muli pacieni cu DZ tip 1 i
determin HbA1c la 3 luni (32,5%), n timp ce majoritatea pacienilor cu DZ tip 2 i msoar
HbA1c la 1 an (36,7%). Prezena hipoglicemiilor s-a corelat pozitiv cu vechimea diabetului
(p=0,005), cu prezena tratamentului cu insulin (p=0,001), cu prezena retinopatiei diabetice (p=
0,019) i cu automonitorizarea (p= 0,047) i negativ cu tratamentul cu metformin (p=0,0001).
Pacienii cu DZ tip 2 ce au prezentat hipoglicemii au o durat mai lung de evoluie a bolii
(p=0,012) i un indice de mas corporal mai mic (p=0,006) fa cei cei care nu au experimentat
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hipoglicemii.
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Pacienii cu DZ tip 1 au prezentat hipoglicemii mai des comparativ cu cei cu DZ tip 2. Acetia
ajusteaz ntr-o proporie mai mare dozele de insulin i i monitorizeaz mai des glicemia i
HbA1c, ceea ce ar impune un program mai extins de educaie adresat pacienilor cu DZ tip 2.
HYPOGLYCEMIAS AND SOME CLINICAL FEATURES OF DIABETES MELLITUS
Chioveanu Marinela1, Petre Diana Gabriela1, Sebestyen Ana-Maria Sabina1, Ilinca

Alexandra1, Mihai Andrada1, Prof. Radulian Gabriela1
1
Hypoglycemia is an important issue for patients with type 1 and type 2 diabetes mellitus receiving
intensive treatment. Severe hypoglycemia requiring hospitalization have been associated with an
increased risk of developing dementia. The study searches to identify patients at increased risk of
hypoglycemia, and to describe how they perceive, recognize and treat hypoglycemia.
It is an observational, cross-sectional study, on 130 patients with diabetes mellitus (DM) type 1
(30.8%) and type 2 (69.2%), with a mean age of 56.19 14.674 yrs, 54.6% male and 45.4% female,
with a mean duration of disease 14.52 9.38 yrs, 83.84 % insulin-treated, to whom we applied a
questionnaire regarding the recognition, treatment and prevention of hypoglycemia.
Among the studied subjects, 95.4% own a glucometer and 93.1% self-monitor their glycemic
levels. All patients suffering from T1DM and 82.2% of those with T2DM have had at least one
hypoglycemic episode during their lifetime. 42.5% of T1DM patient have lost consciousness at
least once and 45% had to be hospitalized because of hypoglicemias. 20% of T2DM patients have
lost consciousness and 23.3% had to be hospitalized because of hypoglicemias. The causes of
hypoglicemia were: low carbohydrate intake (51.53%), increased physical activity (42.30%),
delayed mealtime (34.61%), anti-diabetic medication overdose (21.53%) and accidentally taking
the same dose twice (0.76%). Symptoms that suggest hypoglycemia were recognized to be, in the
order of importance: sweating (80%), hunger (42.3%), confusion (36.2%), palpitations (33.1%)
and headache (25.4%). In order to avoid hypoglycemia 33.1% prefer to have higher blood suger
levels, 20% decrease their level of physical activity, 60% eat more carbohydrates (HC), 3.1%
decrease their biguanid dosage, 2.3% decrease their secretagogue dosage and 46.2% decrease the
number of insulin units. 90% of T1DM patients and 40% of T2DM patients adjust their medication.
The most frequent hypoglicemia treatment is carbohydrate ingestion (92.3% of the subjects). Most
patients with T1DM check their HbA1c every 3 months (32.5%), while most patients with T2DM
check their HbA1c once a year (36.7%). The presence of hypoglycemia was positively correlated
with the duration of the disease (p=0.005), with insulin treatment (p=0.001), with the presence of
diabetic retinopathy (p= 0.019) and with blood glucose self-monitoring (p= 0.047) and negatively
correlated with biguanid treatment (p=0.0001). Patients with T2DM and hypoglicemic episodes
have a longer disease duration (p=0.012) and a lower body mass index (p=0.006).
Patients with T1DM experimented hypoglycemia more often than those with T2DM. They adjust
more frequent insulin doses and check more often their glycemia and HbA1c, which requires
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intensives education programs adressing to patients with type 2 diabetes.

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PS7. ELIMINAREA URINAR DE ALBUMIN I RETINOPATIA DIABETIC LA
PACIENII CU DIABET ZAHARAT TIP 2
Rezident Chirila Vlad Horia1, Dr. Rusu Emilia1, Rezident Ungureanu Carmen1, Rezident
Bejinariu Catalina1, Dr. Muresan Alexandra1, Rezident Dobre Alin1, Dr. Stegaru Daniela1,
Prof. Dr. Radulian Gabriela1
1
Relaia ntre eliminarea urinar de albumin i retinopatia diabetic este bine cunoscut i exist
numeroase studii pe aceast tem la pacienii cu diabet zaharat tip 1; totui pentru pacienii cu
diabet zaharat tip 2 exist puine date.
Obiectivul acestui studiu a fost de a estima prevalena eliminrii urinare crescute de
albumin(EAUC) la pacienii cu diabet zaharat tip 2 i de a determina relaia acesteia cu retinopatia
diabetic.
Materiale i metode: A fost realizat un studiu transversal, observaional ce a inclus un numr de

200 pacieni aflai n evidena INDNBM Paulescu, cu diabet zaharat tip 2. S-au urmrit indicii
antropometrici (greutate, nlime, IMC). Parametrii biochimici urmrii au fost glicemia a jeun,
hemoglobina glicozilat, colesterolul total, HDL-colesterol, LDL-colesterol, trigliceride,
parametrii de retenie azotat (uree, creatinin), raportul albumin/creatinin i eliminarea urinar
de albumin (EUA). Rata de filtrare glomerular a fost calculat prin metoda CKD-EPI. Pacienii
au fost mprii n 3 grupuri n funcie de EUA: A1< 30 mg/L (n=96), A2 ntre 30-300 mg/L
(n=74) i A3 > 300 mg/L (n=30). Retinopatia diabetic a fost evaluat prin fundoscopie realizat
de un oftalmolog la INDNBM Paulescu.
Rezultate: n lotul studiat, prevalena EUA cu valori ntre 30-300 mg/L a fost de 37%, pacienii
care reprezint grupul A2, iar prevalena EUA > 300 mg/L a fost de 15%, reprezentnd grupul A3.
Pacienii cu eliminare crescut de albumin comparativ cu cei care au prezentat eliminare normal
de albumin au prezentat o prevalena mai mare a retinopatiei diabetice; 50% (n=15) din pacienii
grupului A3 au prezentat retinopatie diabetic, comparativ cu cei din grupul A2, n procent de
35,1% (n=26), respectiv cei din grupul A1, cu un procent de 21,9% (n=21) (p=0,09). Curba ROC
a artat ca excreia urinar de albumin (AuROC=0,613, CI=95%, 0,53-0,69) poate fi un predictor
pentru retinopatia diabetic (p=0,011). Valoarea cut-off pentru EUA a fost de 24,18 mg/L. La
aceast valoare cut-off sensibilitatea a fost 74,2%, iar specificitatea a fost 46,4%.
Concluzii: Retinopatia diabetic a fost mai frecvent la pacienii cu diabet zaharat tip 2 i
eliminare crescut de albumin. Totui un procent important de pacieni cu eliminare normal de
albumin (21,9 %) au asociat retinopatie diabetic.
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URINARY ALBUMIN EXCRETION AND DIABETIC RETINOPATHY IN PACIENTS
WITH TYPE 2 DIABETES MELLITUS
Resident Chirila Vlad Horia1,MD Rusu Emilia1, Resident Ungureanu Carmen1, Resident
Bejinariu Catalina1, MD Muresan Alexandra1, Resident Dobre Alin1, MD Stegaru Daniela1,
Prof. MD. Radulian Gabriela1
1
The relationship between urinary albumin excretion and diabetic retinopathy is well reported and
there are many studies in this area in pacients with type 1 diabetes mellitus; however for type 2
diabetes there is a paucity of data.
The objective of this study was to estimate the prevalence of elevated urinary albumin excretion
in pacients with type 2 diabetes and to determine its relationship with diabetic retinopathy.
Materials and metods: This was a transversal observational study, that included a number of 200
pacients of the INDNBM Paulescu, with type 2 diabetes. The study evaluated the anthropometric
indices (weight, height, BMI (body mass index)). The biochemical indices evaluated in the study
were the fasting blood glucose, the glycosylated hemoglobin, the lipid profile (cholesterol,
triglycerides, HDL-cholesterol, LDL-cholesterol), the renal function tests (blood urea nitrogen,
serum creatinine level), the albumin/creatinine ratio and the urinary albumin excretion (UAE). The
glomerular filtration rate was calculated using the CKD-EPI method. The pacients were divided
into 3 groups according to the UAE rate: A1 < 30 mg/L (n=96), A2 between 30 300 mg/L (n=74)
and A3 > 300 mg/L (n=30). The diabetic retinopathy was evaluated through a comprehensive eye
examination by an ophtalmologist at INDNBM Paulescu.
Results: In the study group, the prevalence of UAE with values between 30-300 mg/L was 37%,
representing the pacients in the A2 group, while the prevalence of UAE > 300mg/L was 15% ,
representing the A3 group. Pacients with elevated urinary albumin excretion in comparison with
those with normal urinary albumin excretion presented a higher prevalence of diabetic retinopathy;
50% (n=15) of the pacients in A3 group had diabetic retinopathy, in comparison with those in A2
group, representing 35,1% (n=26), and in A1 group respectively, representing 21,9% (n=21)
(p=0,09). ROC analysis showed that UAE (AuROC=0,613, CI=95%, 0,53-0,69) can be a predictor
for diabetic retinopathy (p=0,011). The cut-off value for UAE was 24,18 mg/L. At this cut-off
value, the sensitivity was 74,2%, while the specificity was 46,4%.
Conclusions: Diabetic retinopathy was more frequent in pacients with type 2 diabetes and elevated
urinary albumin excretion. However an important percentage of pacients with normal urinary
albumin excretion (21,9%) also asociated diabetic retinopathy.
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PS8. INFECIILE URINARE LA PACIENII CU DIABET ZAHARAT: CE
ANTIBIOTIC ALEGEM?
MD PhD Chita Teodora1, MD PhD Timar Bogdan1, MD PhD Sima Alexandra1, MD PhD
Muntean Delia1, MD PhD Licker Monica1, MD PhD Timar Romulus1
1
Universitatea de Medicina si Farmacie "Victor Babes" Timisoara, Spitalul Clinic Judeean de
Urgen Timioara
Pacienii cu diabet zaharat (DZ) sunt mai susceptibili de a dezvolta infecii comparativ cu populaia
general, infeciile de tract urinar (ITU) fiind printre cele mai frecvent ntlnite. Prescrierea masiv
de ageni antimicrobieni pentru tratamentul ITU la aceti pacieni, inclusiv a celor cu spectru larg,
poate duce la dezvoltarea unor uropatogeni rezisteni la antibiotice. Diagnosticul precoce i
intervenia prompt sunt recomandate pentru a limita morbiditatea infeciilor simptomatice.
Scopul studiului nostru a fost de a determina sensibilitatea la antibiotice a germenilor cel mai
frecvent implicai n ITU, la un grup de pacieni din Timioara, Romnia.
Lotul de studiu a cuprins 2465 de pacieni cu DZ, internai n Clinica de Diabet, ntre 2011 i 2013.
La aceti pacieni s-au cules date anamnestice i s-a efectuat urocultura. Identificarea germenilor
s-a realizat pe baza caracterelor morfologice, culturale si biochimice ale acestora. Identificarea
final i testele de sensibilitate au fost realizate cu ajutorul analizorului Vitek 2 (Bio Merieux
France). Pentru analiza statistic s-a folosit programul SPSS v.17 (SPSS Inc. Chicago, IL).
Dintre cele 2465 probe de urin, 297 (12%) au fost pozitive. Bacteriile cel mai frecvent izolate din
urin au fost cele Gram-negative, dintre acestea Escherichia coli fiind cea mai bine reprezentat
(70% din totalul germenilor izolai). n ceea ce privete sensibilitatea la antibiotice a tulpinilor de
E. coli, acestea au fost foarte sensibile la cefalosporinele de generaia a 2-a i a 3-a (96%),
carbapenemi (100%), aminoglicozide (96-99%), nitrofurantoin (99%), mai puin sensibile la
fluoroquinolone (76%) i cotrimoxazol (62%) i rezistente la peniciline (50-70%). Urmtorul
germene ca frecven a implicrii n ITU a fost Klebsiella pneumoniae (12% dintre cazuri), la care
am constatat un profil de sensibilitate antimicrobian asemntor cu al E. coli. Dintre germenii
Gram-pozitivi, cel mai frecvent izolat a fost Enterococcus faecalis (5% dintre cazuri), care a fost
sensibil la majoritatea antibioticelor testate.
ITU sunt frecvente la pacienii cu DZ. E. coli a fost cel mai frecvent izolat uropatogen. Studiul
nostru definete sensibilitatea antimicrobian a microorganismelor implicate n ITU la pacienii
diabetici, oferind medicilor practicieni un ghid pentru nceperea tratamentului antibiotic empiric
cu unul dintre antibioticele la care bacteriile implicate s-au dovedit a fi sensibile.
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URINARY TRACT INFECTIONS IN DIABETIC PATIENTS: WHAT
ANTIMICROBIAL AGENT DO WE CHOOSE?
MD PhD Chita Teodora1, MD PhD Timar Bogdan1, MD PhD Sima Alexandra1, MD PhD
Muntean Delia1, MD PhD Licker Monica1, MD PhD Timar Romulus1
1
University of Medicine and Pharmacy "Victor Babes" Timisoara,
Patients with diabetes mellitus (DM) are more prone to develop infections compared to the general
population, urinary tract infections (UTIs) being among the most commonly encountered. The
high rates of antibiotic prescription, including broad-spectrum antibiotics, for UTIs in these
patients may further induce the development of antibiotic-resistant urinary pathogens. Early
diagnosis and prompt intervention are recommended to limit morbidity of symptomatic infection.
The aim of this study was to determine the sensitivity to antibiotics of the most frequent
microorganisms involved in UTIs, in a group of patients from Timioara, Romania.
The study group included 2,465 patients with DM, hospitalized in the Diabetes Clinic, between
2011 and 2013. We collected patients personal history data and performed urine culture. Germs
identification relied on morphological, cultural and biochemical characteristics. Final
identification and antimicrobial testing were performed using the Vitek 2 (Bio Merieux France)
automatic analyzer. Data were collected and analyzed using SPSS v.17 (SPSS Inc. Chicago, IL)
statistical software suite.
From all the 2,465 urine samples, 297 (12%) were positive. The Gram-negative bacteria were the
most frequently isolated microorganisms in the urine, Escherichia coli being the best represented
among them (70% of the total number of isolated germs). E. coli was very sensitive to 2nd and 3rd
generation cephalosporins (96%), carbapenems (100%), aminoglycosides (96-99%),
nitrofurantoin (99%), less sensitive to fluroquinolones (76%) and cotrimoxazole (62%) and
resistant to penicillins (50-70%). Klebsiella pneumoniae, the second most frequently isolated germ
in UTIs (12% of the cases), showed a similar susceptibility pattern. Among the Gram-positive
bacteria, Enterococcus faecalis was isolated in 5% of the total cases, the majority of these strains
being sensitive to the tested antibiotics.
UTIs are frequent in diabetic patients. E. coli was the most frequently isolated uropathogen. Our
study clearly defines the antimicrobial sensitivity of microorganisms involved in UTIs in diabetic
patients, providing practioners a guideline for starting empiric therapy with one of the antibiotics
the involved bacteria proved to be sensitive to.
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PS9. SERUM MARKERS OF INFLAMMATION AND AMBULATORY HEART RATE
VARIABILITY IN TYPE 2 DIABETES
Assist.Prof. MD Ciobanu Dana M.1, Lecturer MD Craciun Anca E.1, Lecturer MD Bala
Cornelia G.1, Assoc.Prof. MD Veresiu Ioan A.1, Assoc.Prof., MD Roman Gabriela1
1
Iuliu Haieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
The authors aimed to determine the relation between serum markers of inflammation, high-
sensitivity C-reactive protein, intercellular adhesion molecule-1 (ICAM-1) and vascular adhesion
molecule-1 (VCAM-1), and ambulatory heart rate variability assessed during 24-hours ambulatory
blood pressure monitoring in type 2 diabetes and control subjects.
Elevated high-sensitivity C-reactive protein and increased expression of cellular adhesion

molecules were reported in type 2 diabetes subjects compared with their healthy peers. Heart rate
variability is indicator of autonomic nervous system function and cardiovascular risk. Sparse
medical evidence described the relation between serum inflammatory markers and heart rate
variability in type 2 diabetes.
Type 2 diabetes subjects had higher high-sensitivity C-reactive protein and cellular adhesion
molecules levels compared to controls. Serum inflammation markers significantly and positively
correlated with daytime, night-time and 24-hour heart rate variability.
PS10. COULD BE ANY IMPACT OF MEDICATION CONSIDERING WEIGHT

EVOLUTION?
A RETROSPECTIVE EVALUATION OF TWO GROUPS RECEIVING
DAPAGLIFLOZINUM OR SAXAGLIPTINUM AS A SECOND STEP AFTER FAILURE
OF METFORMINUM THERAPY
Ciprian Constantin1, Aurelian Ranetti1, Georgiana Constantin2, Dan Cheta3

1
Carol Davila Universitary Emergency Central Military Hospital, Bucharest
2
Prof Agrippa Ionescu Emergency Hospital, Bucharest
3
Prof N Paulescu National Institute of Diabetes, Bucharest
Premise i Obiective: Controlul greutii este o adevrat provocare n tratamentul pacienilor cu

diabet zaharat de tip 2.
Scopul acestui studiu a fost de a evalua influenta a 2 noi clase de medicamente alese ca terapie de
treapta a doua pentru pacienti cu diabet zaharat tip 2 tratati cu metfominum (MET): inhibitorii de
SGLT2 (Dapagliflozin-Dapa) i inhibitorii DPP4 (Saxagliptina-Saxa).
Material i Metod: Acest lucru a fost realizat ntr-un studiu retrospectiv pe parcursul anilor
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2012-2013, folosind datele de la 2 studii efectuate pe pacieni cu diabet zaharat tip 2, dup cel
puin 3 luni de tratament cu metfomin, conform recomandarilor ADA2012.
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Au fost inclusi 40 pacieni cu DZ tip 2 tratai cu MET, cel puin 1500 mg/zi (20 femei i 20 brbai).
Dup evaluarea iniial au fos realizate 2 loturi: lotul A a primit MET si Dapa i lotul B a primit
MET si Saxa. Tratamentul a fost oprit dupa primele 3 luni ca urmare a atingerii tintei HbA1c,
conform protocolului studiului.
Rezultate i Discuii: Toate rezultatele au fost exprimate ca mediedeviaia standard i
semnificaia statistic a fost evaluat cu ajutorul testului T Student. Varsta, durata diabetului
greutatea, HbA1c au fost similare la nceputul studiului pentru ambele grupuri. Toi pacienii au
primit suport adecvat constand in educaie nutriional. Ambele loturi au fost identice n repartiia
dupa criteriile urmatoare: sex, vrst, durata de diabet, IMC, HbA1c la nceputul studiului (p
<0,05).
Au fost monitorizati urmatorii parametri HbA1c, greutate la momentul iniial i dup 3, respectiv
9 luni. Rezultatele sunt prezentate n tabelul urmtor.
Lot (20 Initial 3months 9monhs Initial 3months 9months
patiens/lot) HbA1c HbA1 HbA1c weight weight weight
A (Dapa plus 7.620.31 6.270.55 7,740,56 84,565.24 80.316.15 81.543.21
MET)
B (Saxa plus 7.590.23 6.310.49 7,820,38 83.473.58 82.974.12 83.155.74
MET)
Concluzii: n studiul nostru exista o diferena clinic semnificativa lund n considerare evoluia
greutatii intre inceputul studiului si finalul acestuia (p <0,05). Acest lucru pare a fi cunoscut, dar
date interesante sunt observate comparnd lotul A vs. lotul B la 6 luni, dup ce tratamentul a fost
oprit i acelai program de dieta a fost respectat: grupul tratat initial cu Dapa menine o scdere
semnificativ a greutii, comparativ cu grupul tratat cu Saxa (p <0,05).
COULD BE ANY IMPACT OF MEDICATION CONSIDERING WEIGHT

EVOLUTION?
A RETROSPECTIVE EVALUATION OF TWO GROUPS RECEIVING
DAPAGLIFLOZINUM OR SAXAGLIPTINUM AS A SECOND STEP AFTER FAILURE
OF METFORMINUM THERAPY
Ciprian Constantin1, Aurelian Ranetti1, Georgiana Constantin2, Dan Cheta3

1
Carol Davila Universitary Emergency Central Military Hospital, Bucharest
2
Prof Agrippa Ionescu Emergency Hospital, Bucharest
3
Prof N Paulescu National Institute of Diabetes, Bucharest
Background and Aim: The weight control is a real challenge in treatment of type 2 diabetes
mellitus (T2DM) patients.
The aim of this retrospective study was to evaluate the influence of 2 new classes of medication
chosen as a step 2 therapy for T2DM patients treated with metfominum (MET): SGLT2 inhibitor
(Dapagliflozinum-DAPA) and DPP4 inhibitor (Saxagliptinum-SAXA).
133
This was retrospective study during 2012-2013 years, using data from 2 studies performed on
T2DM patients uncontrolled with MET, after at least 3 month of treatment, according ADA2012
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guidelines.
Material and Method: We included 40 patients with T2DM treated with MET, at least
1500mg/day (20 women and 20 men). After initial evaluation we consider 2 lots: lot A received
DAPA plus MET, and lot B received SAXA plus MET. DAPA and SAXA therapy was stopped
after first 3 months. Target was established considering ADA2012 recommendations.
Results: All results were expressed as mean standard deviation, and statistic significance was
evaluated using T student test. Age, duration of diabetes, weight, HbA1c were similar at the
beginning of study for both group. All patients receive adequate nutritional education therapy and
reach the target of HbA1c below 7%. All groups are identical in repartition of sex, age, duration
of diabetes, BMI, HbA1c at the beginning of study (p<0.05).
Observational parameters (HbA1c, weight) at baseline and after 3 and 9 months were included.
The results are shown in the next table.
Lot (20 Initial 3months 9monhs Initial 3months 9months

patiens/lot) HbA1c HbA1 HbA1c weight weight weight
A (DAPA 7.620.31 6.270.55 7,740,56 84,565.24 80.316.15 81.543.21
plus met)
B (SAXA 7.590.23 6.310.49 7,820,38 83.473.58 82.974.12 83.155.74
plus met)
Conclusion: In our study it seems to be a significant clinical differences considering the evolution
of weight after a short treatment period in the next step of T2DM uncontrolled with MET (p<0,05).
This could be a real known result, but a new interesting data is observed comparing lot A vs. lot
B at 6 months after the treatment was stopped and the same diet program was respected: the group
treated with DAPA maintains a significant decrease of weight (p<0.05).
PS11. DIABET ZAHARAT TIP 1, TIROIDITA HASHIMOTO, ANEMIE BIERMER SI

POSIBILA BOALA CELIACA IN CAZUL UNEI TINERE FEMEI CU SINDROM
POLIGLANDULAR AUTOIMUN TIP III
Rezident Cosma Daniel Tudor1, ef Lucr. Dr. Porojan Mihai1, Asist. Univ. Dr. Grad
Simona1, ef Lucr. Dr. Bala Cornelia1
1
Centrul Clinic de Diabet, Nutritie si Boli metabolice Cluj
Premise si obiective: Sindroamele poliglandulare autoimmune (PGA) sunt afectiuni rar

diagnosticate caracterizate de prezenta a 2 sau mai multe endocrinopatii autoimune sau
autoimunopatii non-endocriniene. In functie de tabloul clinic, PGA sunt separate in 4 tipuri. In
PGA tipul III, tiroidita autoimuna apare asociata cu alta autoimunitate specifica de organ, dar
sindromul nu poate fi clasificat ca tip 1 sau 2.
Material si metoda: Pacienta in varsta de 21 de ani, doagnosticata cu DZ cu o saptamana anterior
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internarii in serviciul nostru (pe baza unei A1c=8,3%), se prezinta pentru: ameteli, xerostomie si
hiperglicemii la automonitorizare. Pacienta a fost diagnosticata in urma cu 2 luni anterior internarii
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cu tiroidita Hashimoto (pe baza aspectului ecografic si a titrului ridicat de anticorpi anti-TPO) si
anemie hipocroma, microcitara pentru care a urmat tratament cu fier pe cale intravenoasa.
Deasemenea, datorita nivelului scazut de vitamina B12, aceasta a urmat tratament cu B12. La
prezentare: tahicardie, tegumente uscate si cicatrice post-apendicectomie.
Rezultate si discutii: Examinarile de laborator releva: Gl=155mg/dl, glicozurie, cetonurie,
proteinurie, anemie hipocroma, microcitara forma usoara, feritina si sideremie scazuta, transferina
usor crescuta, usoara trombocitoza, iar A1c=8,5% denota dezechilibrul glicemic moderat din
ultimele 3 luni. Diagnosticul de DZ tip 1 a fost confirmat de titrul crescut de anticorpi anti-GAD65
si de pozitivarea anticorpilor anti-IA2. Screening-ul altor afectiuni autoimune a pus in evidenta
prezenta anticorpilor anti celula parietala gastrica, confirmand diagnosticul de anemie Biermer.
Endoscopia digestiva superioara nu a evidentiat modificari macroscopice de boala celiaca sau
gastrita cronica. Pentru optimizarea controlului glicemic, s-a initiat insulinoterapia in regim bazal
cu insulina glargin, cu ajustarea dozelor in functie de profilele glicemice. Datorita anemiei
feriprive persistente, s-a reluat tratamentul cu fier pe cale intravenoasa. Datorita suspiciunii
persistente de boala celiaca (chiar in absenta anticorpilor IgA si IgG anti-transglutaminaza si anti-
endomissium), s-a recomandat tipizarea HLA pentru boala celiaca. Instituirea unei diete fara
gluten a fost amanata pana la rezultatul tipizarii HLA.
Concluzii: Asocierea confirmata a 3 afectiuni autoimune a dus la stabilirea diagnosticului de PGA
tip III. Putine cazuri de boala celiaca fara prezenta anticorpilor specifici au fost raportate pana in
prezent. Din cunostiintele noastre, asocierea de tiroidita Hashimoto, DZ tip 1, anemie Biermer si
boala celiaca nu a mai fost raportata in literatura de specialitate pana in prezent.
TYPE 1 DIABETES MELLITUS, HASHIMOTO THYROIDITIS, PERNICIOUS

ANEMIA AND POSSIBLE CELIAC DISEASE IN A YOUNG FEMALE WITH
POLYGLANDULAR AUTOIMMUNE SYNDROME TYPE III
Rezident Cosma Daniel Tudor1, Lect. Dr. Porojan Mihai1, Assist. Prof. Dr. Grad Simona1,
Lect. Dr. Bala Cornelia1
1
Diabetes, Nutrition and Metabolic diseases Clinical Center Cluj
Premises and Objectives: Polyglandular autoimmune syndromes (PAS) are rarely diagnosed
conditions characterized by the combination of two or more autoimmune endocrinopathies and
nonendocrine autoimmunopathies. Based on their clinical manifestation, PAS are divided into four
different type. In PAS III, autoimmune thyroiditis occurs with another organ-specific autoimmune
disease, but the syndrome cannot be classified as PAS I or II.
Content and Method: A 21-years old female, diagnosed with diabetes one week before
hospitalization in our service (based on an A1c=8.3%), was admitted for: dizziness, xerostomia
and high glycemic values on self monitoring. The patient was also diagnosed 2 months prior to
admission in our service with Hashimoto thyroiditis (based on ultrasound and high TPO
antibodies) and hypochromic and microcytic anemia for which she received iron intravenously.
Also, due to low vitamin B12 level she received treatment with vitamin B12. At admission:
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tachycardia, dry skin and post appendectomy scar.

Results and Discussions: Labs exams revealed: Gl=155mg/dl, glycosuria, ketonuria, proteinuria,
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mild hypochromic and microcytic anemia, low ferritin, low serum iron, slightly elevated
transferring, mild thrombocytosis and A1c=8.5% suggests the moderate glycemic disequilibrium
in the last three months. Type 1 diabetes was confirmed by high titer of GAD65 and positive IA2
antibodies. The screening for other autoimmune disorders revealed positive antiparietal cell
antibodies, thus confirming pernicious anemia. No macroscopic findings of celiac disease or
atrophic gastritis were seen on upper gastrointestinal endoscopy, but microscopic views of the
duodenal and antral biopsies were consistent with celiac disease and respectively chronic gastritis.
In order to improve the glycemic control, treatment with glargine insulin was initiated and the
doses were adjusted according to the glycemic profiles. Due to the persistent iron deficiency
anemia, the treatment with iron intravenously was resumed. Given the persistent suspicion of
celiac disease (even with negative IgA and IgG anti-transglutaminase and anti-endomysium
antibodies), HLA typing for celiac disease was recommended. Following a gluten-free diet was
postponed until the HLA typing results.
Conclusions and Findings: The association of 3 confirmed autoimmune disorders led to the
diagnosis of PAS type III. Few cases of celiac disease cases with negative antibodies were reported
until present. To our knowledge, the association of type 1 diabetes, Hashimoto thyroiditis,
pernicious anemia and celiac disease was never reported in the medical literature.
PS12. SUPRADOZAJ INTENTIONAL CU INSULINA SI DIAZEPAM IN CAZUL UNEI

FEMEI DIABETICE CU TULBURARE DEPRESIVA MAJORA
Rezident Cosma Daniel Tudor1, Dr. Silaghi Cristina Alina1, ef Lucr. Dr. Silaghi Horaiu1,
Conf. Univ. Dr. Vereiu Andrei1
Premise si obiective: Supradozajul intentional cu insulina in cazul pacientiilor cu diabet zaharat

(DZ) este rar intalnit. Severitatea este data de numeroasele complicatii neurologice, tulburari
electrolitice, afectare hepatica si pulmonara si deces. Rata mortalitatii creste considerabil prin
ingestia concomitenta a altor subtante (antidepresive, alcool, antidiabetice orale, paracetamol, -
blocante).
Material si metoda: Pacienta in varsta de 52 de ani, diagnosticata cu DZ tip 1 din Iunie 2015 in
prezent sub tratament cu insulina glargin (52UI/zi) si insulina aspart (20U/zi) este spitalizata in
servicul UPU dupa administrarea a 300UI insulina aspart, 52UI insulina glargin, 80mg de
Diazepam si 500mg de Paracetamol. Pacienta ajunge in serviciul UPU la 45 de minute de la
supradozaj cu o glicemie de 77mg/dl. La prezentare: stare generala alterata, TA=158/86mmHg,
Scala de Coma Glasgow=13 puncte si 2 locuri de injectare a insulinei la nivel abdominal.
Examinarile de laborator au relevat: leucocitoza moderata, hipopotasemie, lactat crescut si test
toxicologic pozitiv pentru benzodiazepine si paracetamol.
Rezultate si discutii: Dupa 20ml G 33%, se decide administrarea de G 10% in perfuzie continua,
in ritm de 312ml/h. Ajustarea concentratiei de glucoza si a ritmului de perfuzie s-a realizat in
functie de profilul glicemic, cu durata totala a infuziei de 9 ore. Hipopotasemie a fost corectata
136
prin administrarea i.v. de clorura de potasiu. Pentru a limita absorbtia Diazepam-ului, s-a
administrat carbune activ. Evaluarea psihiatrica a relevat un episod depresiv sever si a recomandat
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echilibrarea glicemica si internarea pacientei in cadrul Clinicii de Psihiatrie.

Concluzii: Supradozajul masiv cu insulina presupune monitorizare glicemica intensiva si de lunga
durata pentru prevenirea hipoglicemiilor recurente datorate intreruperii precoce a terapiei i.v. Doza
administrata nu se coreleaza cu severitatea hipoglicemiei, ci cu o perioada prelungita de risc
hipoglicemic superioara celei deduse pe baza farmacocineticii analogilor de insulina administrati.
Ingestia concomitenta de substante cu actiune predominat sedativa (in special antidepresive) poate
masca simptomatologia clinica si necesita terapie specifica.
INTENTIONAL INSULIN AND DIAZEPAM OVERDOSE IN A DIABETIC FEMALE

WITH SEVERE DEPRESSION
Conf. Univ. Dr. Vereiu Andrei1
Premises and Objectives: Intentional insulin overdose in diabetic patients is a rare critical
situation. The severity is due to numerous neurological complications, electrolyte disturbances,
liver and lung damage or death. The mortality rate may increase considerably with the concomitant
intake of other substances (antidepressants, alcohol, oral antidiabetic drugs acetaminophen, -
blockers).
Content and Method: A 52 year old women, diagnosed with type 1 diabetes mellitus (DM)
since June 2015 and treated with glargine (52U/day) and aspart (20U/day) insulin was admitted to
the emergency room (ER) after administration of 300U aspart insulin, 52U glargine insulin, 80mg
of Diazepam and 500mg of Acetaminophen in the context of depression, without previous
psychiatric therapy. She arrived in the ER 45 minutes after overdose with a glycemic value of
77mg/dl. At admission: altered general status, BP=158/86mmHg, Glasgow Coma Scale=13 points
and 2 injection sites across her abdomen. Labs exams revealed: moderate leukocytosis,
hypokalemia, increased lactate and a positive toxicological screen for benzodiazepines and
acetaminophen.
Results and Discussions: After 20ml of 33% glucose, an infusion of 10% glucose was begun at
312ml/h. The glucose infusion rhythm and concentration was adjusted according to the glycemic
profile with a total duration of infusion of 9 hours. Hypokalemia was corrected by intravenous
(i.v.) administration of potassium chloride. In order to limit the Diazepam absorption, activated
charcoal was given. Psychiatric evaluation revealed a severe depressive episode and recommended
glycemic stabilization and hospitalization in the Psychiatric Department.
Conclusions and Findings: Insulin overdose requires intensive and prolonged glycemic
monitoring to prevent recurrent hypoglycemia due to an early cessation of i.v. therapy. The dose
is not correlated with the severity of hypoglycemia but with a prolonged hypoglycemic risk higher
than that deduced from the pharmacokinetics of insulin analogue administered. The concomitant
ingestion of substances with predominantly sedative effects (especially antidepressants) may mask
clinical symptoms and requires specific treatment.
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PS13. SINDROM POLIGLANDULAR AUTOIMUN TIP IV CU BOALA CELIACA,
DIABET ZAHARAT TIP 1 SI ARTRITA REUMATOIDA JUVENILA O ASOCIERE
RARA
Conf. Univ. Dr. Vereiu Ioan Andrei1
Premise si obiective: Sindroamele poliglandulare autoimune (PGA) reprezinta un grup heterogen

de boli rare caracterizate de prezenta autoimunitatii indreptata catre mai multe organe endocrine,
dar si cu posibila afectare a altor organe autoimune. Sindromul PGA tip IV este o afectiune rara
caracterizata prin asocierea mai multor afectiuni autoimune glandulare, dar care nu indeplineste
criteriile de incadrare in PGA tip I-III.
Material si metoda: Pacienta in varsta de 23 de ani, diagnosticata cu DZ tip 1 la varsta de 5 ani

si sub tratament actual cu insulina glargin (15UI/zi) si insulina aspart (45u/zi), se prezinta in
serviciul nostru pentru: hiperglicemii matinale, poliurie, polidipsie, nicturie si xerostomie.
Deasemenea, pacienta a fost diagnosticata cu la varsta de 12 ani cu artrita reumatoida juvenila (pe
baza tabloului clinic, examinarilor radiologice, markerilor inflamatorii si factorului reumatoid
pozitiv) si cu boala celiaca 3 ani mai tarziu (cu titru crescut de anticorpi IgA anti-transglutaminaza
si anti-endomisium si aspectul microscopic tipic al biopsiei duodenale). La prezentare:
TA=120/80mmHg, FC=82b/min, tegumente uscate, mucoase deshidratate si o formatiune
tumorala rotunda la nivelul marginii stangi a cicatricei post-cezariana.
Rezultate si discutii: Examinarile de laborator au evidentiat: dislipidemie mixta forma moderata,

hipocalcemie, usoara anemie hipocroma, microcitara, feritina si sideremie scazuta, glicozurie, iar
A1c=11,9% sugereaza dezechilibrul glicemic sever din ultimele 3 luni. TSH, FT4 si anticorpii
antitiroidieni (anti-TPO si anti-TG) au fost in limite normale. Pentru dislipidemia mixta decelata
s-a decis reluarea tratamentului cu Rosuvastatina 10mg/zi. Avand in vedere diagnosticul anterior
de boala celiaca, prezenta anemiei si pentru a evalua aderenta la dieta fara gluten s-au repetat
anticorpii IgA si IgG anti-transglutaminaza si anti-endomisium care au prezentat titruri crescute.
Evaluarea psihologica a evidentiat un episod depresiv major si a recomandat efectuarea unui
consult psihiatric. Pentru optimizarea controlului glicemic, ajustarea insulinoterapiei s-a facut in
functie de valorile glicemice, aportul de glucide cu respectarea factorului de corectie (FC) de 1:30
si factorului de sensibilitate (FS) de 1:10. La externare, pacienta a primit recomandari de tratament
oral cu fier si calciu. Educatia terapeutica si nutritionala a fost reluata cu sublinierea importantei
dietei fara gluten si calcularii precise a glucidelor consumate.
Concluzii: Aceasta asociere (o disfunctie endocrina si doua afectiuni non-endocrine) a dus la

stabilirea diagnosticului de sindrom PGA tip 4. Evolutia in cadrul acestor cazuri este imprevizibila
si necesita tratamentul concomitent al tuturor conditiilor intricate pentru obtinerea succesului
terapeutic.
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A CASE OF POLYGLANDULAR AUTOIMMUNE SYNDROME TYPE IV WITH
CELIAC DISEASE, TYPE 1 DIABETES MELLITUS AND JUVENILE RHEUMATOID
ARTHRITIS A RARE COMBINATION
Rezident Cosma Daniel Tudor1, Dr. Silaghi Cristina Alina1, Lect. Dr. Silaghi Horaiu1,
Assoc. Prof. Dr. Vereiu Ioan Andrei1
Diabetes, Nutrition and Metabolic diseases Clinical Center Cluj
Premises and Objectives: Polyglandular autoimmune syndromes (PAS) are a heterogeneous

group of rare diseases characterized by autoimmune activity against more than one endocrine
organ, although non-endocrine organs can be affected. PAS type IV is a rare syndrome
characterized by the association of autoimmune endocrine gland disorder which doesnt fulfill the
criteria of PAS type I-III.
Content and Method: A 23-year old female, diagnosed with type 1 diabetes mellitus (DM) at the
age of 5 and treated with glargine (15U/day) and aspart (45U/day) insulin was admitted to our
center for: morning hyperglycemia, polyuria, polydipsia, nocturnal enuresis and xerostomia. The
patient was also diagnosed at the age of 12 with juvenile rheumatoid arthritis (based on clinical
findings, X-rays, inflammatory markers and positive rheumatoid factor) and celiac disease 3 years
later (with high titer of Ig A anti-transglutaminase and anti-endomysium antibodies and typical
microscopic view of the duodenal biopsy). At admission: BP=120/80mmHg, Pulse=82b/min, dry
skin and mucous membrane and a round shape tumor at the left edge of the C-section.
Results and Discussions: Labs exams revealed: moderate mixed dyslipidemia, hypocalcaemia,
mild hypochromic and microcytic anemia, low ferritin, low serum iron, glycosuria and A1c=11.9%
suggests the severe glycemic disequilibrium in the last three months. TSH, FT4 and and thyroid
antibodies (TPO, TG) were within the normal range. For the mixed dyslipidemia, we resumed the
treatment with rosuvastatin 10mg/day. Taking into account the previously diagnosis of celiac
disease, the anemia and in order to evaluate the adherence to the gluten-free diet, the Ig A and Ig
G anti-transglutaminase and anti-endomysium antibodies were repeated exhibiting high titers. The
psychological evaluation revealed a major depressive episode and recommended a psychiatric
consult. In order to improve the glycemic control, the insulin doses were adjusted according to the
glycemic values, carbs ingestion and respecting the correction factor of 1:30 and the sensibility
factor of 1:10. Oral treatment with iron and calcium was added at discharge. Therapeutic and
nutritional education was resumed emphasizing the importance of gluten-free diet and correct
estimation of the carbs intake.
Conclusions and Findings: This constellation of one endocrine disorder and 2 non-endocrine
abnormalities led to the diagnosis of PAS type IV. The evolution in these cases may be
unpredictable and requires the concomitant treatment of all the conditions involved in order to
achieve the therapeutic success.
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PS14. GENETIC SCORE FOR OBESITY AND WEIGHT CHANGES IN TYPE 2
DIABETES PATIENTS IN THE FIRST YEAR AFTER THE START OF INSULIN
THERAPY
Lect. Craciun Anca-Elena1, Lect. Bala Cornelia1, Assoc.Prof. Roman Gabriela1, Teaching
Assist. Craciun Cristian1, Teaching Assist. Ciobanu Dana1, Prof. Hancu Nicolae1
''Iuliu Hatieganu" Univeristy of Medicine and Pharmacy
Starting insulin therapy in patients with type 2 diabetes is often associated with weight gain. Our
primary objective was to evaluate the role of genetic score for general obesity, abdominal obesity,
unfavorable appetite regulation and reduced caloric expenditure in the evolution of T2DM
patients` weight in the first year of insulin therapy.
The weight gain after the start of insulin therapy is very heterogeneous. The new genome-wide
association study have discovered genes that are involved in the development of common diseases,
as obesity. The genetic score is calculated according to single nucleotide polymorphisms of
different genes previously identified and the result has three category: unfavorable predisposition,
normal predisposition (as general population) or protective genetic variant. There are available
genetic scores for general obesity, abdominal obesity, unfavorable appetite regulation and reduced
caloric expenditure and this might be a method to identify patients at high risk for weight gain
after insulin therapy is started.
Genetic score used for general population for obesity, abdominal obesity, unfavorable appetite
regulation and reduced caloric expenditure is not associated with weight changes after initiation
of insulin therapy in our study, although there are some SNPs significantly influencing weight and
deposition of fat in the first year of insulin therapy.
PS15. STUDIUL RATEI SPITALIZRII I A COST-EFICIENEI LA SUBIECII CU

BOAL CRONIC DE RINICHI DIABETIC
Asist. Univ. Dr. Dinu Robert1, Dr. Tudor Mirela1, Prof. Dr. Moa Eugen1
Universitatea de Medicina si Farmacie din Craiova
Diabetul zaharat (DZ) reprezint o problem major de sntate public att n Romnia ct i n
lume, fiind principala cauz a bolii cronice de rinichi (BCR) i avnd o prevalen de 11,6% n
ara noastr. Pe de alt parte, BCR afecteaz peste 1.300.000 de romni cu vrsta ntre 20-79 ani.
Afectarea vascular cvasiprezent la pacienii cu DZ implic riscuri i costuri semnificative n
asigurarea abordului vascular necesar hemodializei (HD). Comorbiditile asociate BCR la
subiecii cu DZ cresc semnificativ numrul, durata spitalizrilor i costurile asociate tratamentului
acestora. Lucrarea actual i propune analiza ratei spitalizarii i a cost-eficienei la un grup de
subieci internai cu DZ i BCR stadiul 5 tratat prin HD.
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Studiul a cuprins 178 subieci cu BCR stadiul 5 tratai prin hemodializa internai n Clinica
Nefrologie a Spitalului Clinic Judeean de Urgen Craiova n perioada 1 ianuarie 2014 31
Page
decembrie 2014. Au fost nregistrate date privind vrsta, sexul, tipul abordului vascular, prezena
DZ, numrul zilelor de spitalizare, costurile legate de spitalizare.
Cei 178 pacieni au realizat 316 internri n perioada menionat, numrul de internri/pacient
variind de la 1 la 10. Comparnd pacienii cu DZ i cei fr DZ se constat c primul grup a avut
o medie a vrstei uor mai mare 63,268,05 vs 61,9514,40 dar nesemnificativ statistic
(p=0,334). Efectuarea hemodializei utilizand cateterul venos central ca tip de abord vascular s-a
inregistrat la 55,22% vs. 56,80% (n.s.). Diferene semnificative statistic s-au nregistrat n ceea ce
privete costul pentru materialele sanitare utilizate (292,79 lei vs 201,07 lei, p=0,042) i cel al
invetigailor, mai redus la cei cu DZ (70,1318,74 lei) comparativ cu cei fr DZ (94,2518,41),
p=0,034. n grupul pacienilor cu DZ se observ diferene semnificative statistic la cei la care s-a
iniiat HD, n ceea ce privete numrul zilelor de spitalizare (15,584,01 vs 6,396,14, p<0,001)
i cheltuielile pentru materialele sanitare (547,66292,78 vs 243,81175,81, p=0,013). Nu s-au
nregistrat diferene semnificative analiznd n funcie de tipul abordului vascular.
DZ i BCR diabetic genereaz multiple comorbiditi i costuri legate de spitalizare
proporionale. Aplicarea msurilor de prevenie primar sau secundar ar limita costurile i ar
crete semnificativ durata i calitatea vieii la subiecii aflai la risc.
THE STUDY OF THE HOSPITALIZATION RATE AND COST-EFFECTIVENESS IN

PATIENTS WITH DIABETIC CHRONIC KIDNEY DISEASE
Asist. Univ. Dr. Dinu Robert1, Dr. Tudor Mirela1, Prof. Dr. Moa Eugen1
Universitatea de Medicina si Farmacie din Craiova
Diabetes mellitus (DM) represents a severe public health problem and it is the main cause of
chronic kidney disease (CKD) and its prevalence in Romania is 11.6%. On the other hand, CKD
is diagnosed in 1,300.000 Romanians aged 20-79 years. The vascular disease present in almost all
subjects with DM implies significant risks and costs in providing the vascular access required for
hemodialysis (HD). CKD associated comorbidities in subjects with DM increase significantly the
number, the duration of hospitalization and treatment associated costs. This paper aims to assess
the cost and cost-effectiveness in a group of patients with DM and stage 5 CKD on HD.
The study included 178 subjects with stage 5 CKD on HD admitted in the Clinic of Nephrology
of the Emergency Clinical County Hospital Craiova during January 1st, 2014 and December 31st,
2014. Data regarding age, gender, type of vascular access, the presence of DM, duration of
hospitalization, hospitalization-related costs were recorded.
The 178 patients accomplished 316 hospitalizations in the given time, the number of
hospitalizations/patient varying from 1 to 10. Comparing subjects with DM and those without DM,
the first group had the average age slightly higher 63.268.05 vs 61.9514.40 but statistically
insignificant (p=0.334). The use of a central venous catheter for vascular access in hameodialysis
was 55,22% vs. 56,80% (p=n.s.). Statistically significant differences were recorded only in costs
of sanitary materials (292,79 lei vs 201,07 lei, p=0,042) and those of investigations, lower in
141
patients with DM (70.1318.74 lei) than in those without DM (94.2518.41), p=0.034. In subjects
with DM there are statistically significant differences in those that began HD, regarding the
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duration of hospitalization (15.584.01 vs 6.396.14, p<0.001) and the costs for medical supplies
(547.66292.78 vs 243.81175.81, p=0.013). There were no significant differences regarding the
type of vascular access.
DM and diabetic CKD generate multiple comorbidities and costs related to hospitalization.
Applying primary and secondary prevention measures would limit the costs and would increase
significantly the duration and the quality of life in subjects at risk.
PS16. ASOCIERE NTRE DIABETUL ZAHARAT TIP 2 I SINDROMUL SHEEHAN
Georgiana Diu, Mihaela Bodnrescu, Anca Pantea Stoian , Viviana Elian

Institutul Naional de Diabet Zaharat, Nutriie i Boli Metabolice N.C.Pulescu, Bucureti,
Romnia
Institutul Naional de Igien i Sntate Public Bucureti, Romnia
Universitatea de Medicin i Farmacie Carol Davila Bucureti, Romnia
Introducere: Sindromul Seehan apare n urma infarctizrii glandei hipofize determinate de o

hemoragie sever declanat n timpul sau dup natere, descris pentru prima data de H. Sheehan
drept cauz comun de hipopituitarism aprut postpartum. Fluxul de snge care perfuzeaz glanda
hipofizar, gland deja mrit n timpul sarcinii este sever compromis n timpul depleiei volemice
acute generate de vasoconstricia circulatorie posthemoragic. Un risc crescut de apariie al acestei
complicaii l au gravidele care asociaz diabet zaharat tip 1, n special cele cu o boal vascular
preexistent (1). Una dintre cele mai comune forme de prezentare ale sindromului Sheehan este
involuia glandei mamare cu agalactoree determinate de deficitul de prolactin. Aceasta este
urmat de apariia amenoreei i absena pilozitii axilare i pubiene. Progresiv apar simptome
specifice hipopituitarismului i hipoadrenalismului. Poate asocia deficit cognitiv i uneori psihoz
(1).
Materiale i Metode: Prezentm cazul unei paciente D.M., n vrst de 62 ani, cu sindrom
Sheehan diagnosticat n urm cu 33 de ani, la 1 an dup ce-a de-a doua natere complicat cu
hemoragie sever, diagnosticat ca urmare a apariiei amenoreei i a agalactoreei. Pacient cu
panhipopituitarism n tratament substitutiv (levotiroxin 50ug/zi i prednison 5mg/zi), se prezint
pentru semne i simptome sugestive pentru diabet zaharat. Pacienta deceleaz la un control de
rutin o glicemie a jeun de 279 mg/dl asociind scdere n greutate (10 kg n 3 luni), xerostomie,
disurie, fr sindrom poliuro-polidipsic. Menionm ereditate diabetic (mtua patern DZ tip 2
n tratament ADO). HbA1c = 11,3 % i i se recomand insulinoterapia pe care pacienta o refuz
i se decide de comun acord instituirea unui tratament cu metformin 1,5g/zi i repaglinid 3mg/zi.
Dup 4 luni pacienta se prezint n cadrul clinicii noastre cu valori glicemice crescute att a jeun
ct i postprandial. Examenul fizic relev pacient anxioas, cu obezitate abdominal, IMC=24,6
kg/m2, pilozitate absent axilar i a membrelor inferioare, sistem muscular cu hipotrofie marcat
a musculaturii membrelor inferioare. Paraclinic constatm HbA1c=10 %, peptid C = 5,32 ng/ml,
profil lipidic n limite normale sub tratament cu statin, sumar de urin cu eritrocite i leucocite n
sediment i flor microbian prezent. Se decide asocierea la tratamentul cu antidiabetice orale
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insulinoterapie n regim bazal (Glargine 14 u) cu evoluie favorabil a valorilor glicemice. n

prezent cu evoluie bun a valorilor glicemice (HbA1c = 6.9%) sub tratament cu Metformin 2g/zi
i Glargine 12 U/zi cu o uoar cretere n greutate.
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Concluzii: n literatura de specialitate am mai ntlnit un singur caz de asociere a DZ tip 2 cu
Sindrom Sheehan (2,3). Pn la momentul actual nu se tie dac exist o legtur de cauzalitate
ntre diabetul zaharat de tip 2 i sindromul Sheehan sau dac apare ca i un eveniment izolat.
Ne dorim ca prezentarea acestui caz s ne ajute n studierea relaiei dintre cele 2 patologii.
AN ASSOCIATION BETWEEN TYPE 2 DIABETES AND SHEEHAN SYNDROME
Georgiana Diu, Mihaela Bodnarescu, Anca Pantea Stoian , Viviana Elian

National Institute of Hygiene and Environmental Health, Bucharest
Introduction: Sheehan syndrome is caused by hypophysis gland infarction due to a severe

hemorrhage during or post-partum, and has been described for the first time by H Sheehan in 1937
as a common cause of postpartum hypopituitarism. Blood flow to hypophysis gland (gland that
already increases it's volume during pregnancy requiring more blood perfusion) is severely
impaired during acute blood volume depletion resulting infarction. A higher risk for Sheehan
syndrome appears to be in pregnant women who present type 1 diabetes, especially with vascular
complications of diabetes. (1) One of the most common forms of presentation of Sheehan
syndrome is breast involution and agalactorrhea as a consequence of prolactin hormone deficit.
This is followed by amenorrhea and lack of hair growth in pubic and axillar areas. Progressively,
symptoms associated with hypopituitarism and hypoadrenalism will follow. A cognitive deficit or
psychosis can appear. (1)
Materials and methods: We present the case of D.M, a 62 y.o. patient with Sheehan syndrome
diagnosed 33 years ago, 1 year after her second pregnancy that has been complicated with severe
hemorrhage. The patient is under treatment for panhypopituitarism with Levothyroxine 50u/day
and prednisone 5 mg/day for 33 years and this year has been diagnosed with type 2 diabetes
mellitus. At a routine check-up she has been discovered with a blood sugar value of 279 mg/dl and
also from patient history she mentions that she lost 10 kg in the last 3 months.
The only diabetes heredity is on her father line (aunt with type 2 DM). At diagnosis she had a
HbA1c = 11.3%, beeing advised to start insulin therapy. Patient refused insulin at that point and
metformin was started at a dose of 1500 mg/day and repaglinide 3 mg/day. After 4 months of
treatment, the patient presented to our clinic with high blood sugar values. At physical exam patient
is anxious, BMI = 24.6 kg/m2, lack of hair in axillar, legs and pubic area hypotrophy of leg
muscles. Lab tests were as follow: HbA1c = 10%, peptide C= 5.32 ng/ml, blood fats in normal
range under statin treatment, urinalysis with small number of leukocytes and erythrocytes and
bacterial flora present. Once again insulin therapy was advised, this time the patient accepted, so
we started with Glargine 14 U associated to the previous oral antidiabetics, with a good evolution
of glycemic values. 3 yrs after insulin therapy was initiated patient had a HbA1c of 6.9% but she
complaint of taking a few extra kilos.
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Conclusions: To our best knowledge, in medical literature, so far has been described only one
other case of type 2 DM associated with Sheehan Syndrome (2,3). It is not known whether there
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is a causality relation between Diabetes Mellitus and Sheehan syndrome or it's just appearing
associated. If a causality relation will be proven by further research then maybe Sheehan syndrome
can be considered as a risk factor for upcoming diabetes in women diagnosed with Sheehan
syndrome. We hope that our case will help further understanding of this association.
PS17. RELAIA DINTRE STEATOZ HEPATIC I INSULINOREZISTEN LA

PACIENII CU HEPATITA CRONICA CU VIRUS C SI SINDROM METABOLIC
Dr. Drgu Ramona Maria1, Dr. Rusu Emilia1, Dr. Nan Raluca1, Dr. Rusu Florin1, Dr.
Popescu Horaiu1, Dr. Grosu Larisa1, Dr. Grosu Irina1, Dr. Stoicescu Florina1, Dr. Rdulian
Gabriela1
1
Obiectivul acestui studiu a fost evaluarea relaiei dintre steatoza hepatic, insulinorezisten i
riscul cardiovascular la pacienii cu hepatit cronic cu virus C (HVC) i sindrom metabolic (SM).
Acest studiul transversal, observaional, s-a desfurat n Institutul National de Diabet, Nutriie i
Boli Metabolice "N. Paulescu", a inclus un numar de 171 de pacieni cu HVC i SM. Am urmrit
indici antropometrici (greutate, nlime, circumferina taliei, IMC-ul). Parametrii biochimici
urmrii au fost glicemia jeun, hemoglobina glicozilat, profil lipidic, profil hepatic i
hemoleucograma. Pentru fiecare pacient a fost calculat riscul cardiovascular folosind scorul
Framingham. Rezistena la insulina a fost determinat prin utilizarea HOMA-IR. SM a fost definit
conform criteriilor IDF 2005.
Din numarul total de pacieni 62% (n=106) au prezentat HCV, iar 38% (n=65) au prezentat diabet
zaharat tip 2 (DZT2) i HVC. Vrsta medie a pacienilor cu DZT2 nu a fost semnificativ mai mare
dect a celor fr DZT2 (53,357,9 ani versus 53,018,5 ani). Prevalena SM la pacienii cu HVC
a fost de 50% (n=53), 37 dintre acetia au prezentat steatoz hepatic i SM . n studiul de fa
prevalena steatozei hepatice a fost de 60,8% n ntreg lotul, cu o frecven mai mare n rndul
pacienilor cu DZT2+HVC (76,9%) comparativ cu pacienii cu HVC, fr DZT2, care au
nregistrat o prevalen de 50,9% (p0,001). Evalund prevalena steatozei hepatice n funcie de
riscul cardiovascular, s-a observat c subiecii cu risc cardiovascular moderat i ridicat, conform
scorului Framingham, prezint n numr mai mare steatoz hepatic (p0,001). n studiul de fa
prevalena insulinorezistenei la pacienii cu HVC a fost ridicat, 83% (n=88) din pacienii cu HVC
fr DZT2 au prezentat HOMA-IR peste 2, iar 18,9% (n=20) au prezentat HOMA-IR peste 4. n
cazul pacienilor cu DZT2+HVC prevalena insulinorezistenei a fost mai nalt, 97,6% (n=40)
dintre acetia au prezentat HOMA-IR peste 2, iar 68,3% (n=28) au prezentat HOMA-IR peste 4.
Factorul de risc predominant pentru apariia steatozei pare a fi insulinorezistena n asociere cu
sindromul metabolic. Rezultatele acestui studiu confirm ipoteza c la pacienii cu HVC
insulinorezistena i steatoza hepatic reprezint predictori independeni pentru boala
cardiovascular i moarte de cauz cardiovascular.
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RELATIONSHIP BETWEEN STEATOSIS AND INSULIN RESISTANCE IN PATIENTS
WITH CHRONIC HEPATITIS C AND METABOLIC SYNDROME
Dr. Drgu Ramona Maria1, Dr. Rusu Emilia1, Dr. Nan Raluca1, Dr. Rusu Florin1, Dr.
Popescu Horaiu1, Dr. Grosu Larisa1, Dr. Grosu Irina1, Dr. Stoicescu Florina1, Dr. Rdulian
Gabriela1
University of Medicine and Farmacy Carol Davila
The objective of this study was to evaluate the relationship between steatosis, insulin resistance
and cardiovbnascular risk in patients with Chronic hepatitis C (HCV) and metabolic syndrome
(MetS).
This cross-sectional and observational study, held in the National Institute of Diabetes, Nutrition
and Metabolic Diseases "N. Paulescu ", included a total of 171 patients with HCV. We followed
anthropometric indices (weight, height, waist circumference, BMI). The biochemical parameters
followed were fasting plasma glucose, glycosylated hemoglobin, lipid profile, liver profile and
blood counts. For each patient the cardiovascular risk was calculated using the UKPDS software
(The United Kingdom Prospective Diabetes Study). Insulin resistance was determined by using
HOMA-IR. MetS was defined according to the IDF criteria 2005.
From the total number of patients, 62% (n=106) had HCV and 38% (n=65) had type 2 diabetes
(T2DM) and HCV. Average age of patients with diabetes was not significantly higher than those
without diabetes (53.357.9 years versus53.01 8.5 years). The prevalence of MetS in patients
with HCV was 50% (n=53), 37 from this hand hepatic steatosis. In this study the prevalence of
hepatic steatosis was 60.8% in the entire group, with a higher frequency among patients with
HCV+T2DM (76.9%) compared to HCV patients without T2DM, which prevalence was 50.9%
(p0,001). Assessing the prevalence of hepatic steatosis in the class of cardiovascular risk was
observed that subjects with moderate and high cardiovascular risk according to the Framingham
score, present in greater numbers steatosis (p0,001). In this study the prevalence of insulin
resistance in patients with HCV was very high, 83% (n=88) of patients with HCV without T2DM
showed HOMA-IR than 2, and 18.9% (n=20) presented HOMA-IR than 4. In patients with
T2DM+HCV prevalence of insulin resistance was highest, 97.6% (n=40) of these patients
presented HOMA-IR than 2, and 68.3% (n=28) showed HOMA-IR more than 4.
Predominant risk factor for the development of steatosis appears to be insulin resistance associated
with the metabolic syndrome. The results of this study confirm the hypothesis that HCV patients
with insulin resistance and hepatic steatosis are independent predictors for cardiovascular disease
and cardiovascular death.
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PS18. EVALUAREA RELAIEI DINTRE HEPATITA CRONIC CU VIRUS C,
INSULINOREZISTEN I RISCUL CARDIOVASCULAR
MD Drgu Ramona1, MD Rusu Emilia1, MD Nan Raluca1, MD Rusu Florin1, MD Popescu

Horaiu1, MD Stoicescu Florentina1, PhD Radulian Gabriela1
1
Obiectivul principal al acestui studiu a fost de a evalua relaia dintre hepatita cronic cu virus C
(HVC), insulinorezisten i riscul cardiovascular la pacienii cu HVC.
Material si metod: Acest studiul transversal, observaional, s-a desfurat n Institutul National
de Diabet, Nutriie i Boli Metabolice "N. Paulescu", a inclus un numar de 171 de pacieni cu
HVC. Am urmrit indici antropometrici (greutate, nlime, circumferina taliei, IMC-ul).
Parametrii biochimici urmrii au fost glicemia jeun, hemoglobina glicozilat, profil lipidic,
profil hepatic i hemoleucograma. Pentru fiecare pacient a fost calculat riscul cardiovascular
folosind scorul UKPDS. Rezistena la insulina a fost determinat prin utilizarea HOMA-IR,
raportul leptina/adiponectin i raportul TG/HDL-c.
Rezultate: Acest studiu a cuprins un numr de 171 pacieni ce au fost mprii n dou grupuri:
grup A (pacienilor cu hepatit cronic cu virus C) 62% (n=106) i grupul B (pacieni cu diabet
zaharat tip 2 i hepatit cronic cu virus C) 38% (n=65). Utiliznd scorul UKPDS, din numrul
total de pacieni, 55.6% (n=95), 24% (n=41) i 20,5% (n=35) au prezentat risc cardiovascular
sczut, moderat i respectiv crescut. HOMA-IR s-a corelat pozitiv cu valorile insulinemiei
(r=0,974, p0,001), ale circumferinei abdominale (r=0,381, p0,001), IMC (r=0,291, p=0,002),
trigliceride (r=0,393, p0,001), AST (r=0,447, p0,001), ALT (r=0,367, p0,001), GGT (r=0,286,
p=0,003). n cazul pacienilor cu HVC 39,8% au prezentat valori ale raportului TG/HDL-c peste
3, iar dintre pacienii cu DZT2+HVC, doar 29,8% au prezentat valori ale raportului TG/HDL-c
peste 3 (p0,05). Analiza difereniat n funcie de sex a demonstrat valori mai mari ale raportului
leptin/adiponectin pentru sexul feminin comparativ cu sexul masculin, (6,17 (4,77-7,56) vs.
(5,31 (4,37-6,26); p0,05).
Concluzii: Pacienii cu risc cardiovascular moderat i nalt au prezentat un grad mai crescut al
insulinorezistenei (valori mai mari pentru HOMA-IR, p0,001 i raportul TG/HDL-c, p0,001),
deasemenea s-au observat i valori mai mari ale insulinemiei i ale peptidului C, al aceast
categorie de pacieni.
Acest studiu a fost sprijinit de Autoritatea Naional pentru Cercetare tiinific Romneasc ca
parte a programului PNCDI 2 DIADIPOHEP 41-008 / 2007. PNCL2-3343 / 41
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ASSESSMENT OF RELATIONSHIP BETWEEN CHRONIC HEPATITIS C VIRUS,
INSULIN RESISTANCE AND CARDIOVASCULAR RISK
MD Drgu Ramona1, MD Rusu Emilia1, MD Nan Raluca1, MD Rusu Florin1, MD Popescu

Horaiu1, MD Stoicescu Florentina1, PhD Radulian Gabriela1
University of Medicine and Farmacy Carol Davila
The primary objective of this study was to evaluate the relationship between chronic hepatitis C
(HCV), insulin resistance and cardiovascular risk in patients with HCV.
Material and methods: This cross-sectional and observational study, held in the National Institute
of Diabetes, Nutrition and Metabolic Diseases "N. Paulescu ", included a total of 171 patients with
HCV. We followed anthropometric indices (weight, height, waist circumference, BMI). The
biochemical parameters followed were fasting plasma glucose, glycosylated hemoglobin, lipid
profile, liver profile and blood counts. For each patient the cardiovascular risk was calculated using
the UKPDS software (The United Kingdom Prospective Diabetes Study). Insulin resistance was
determined by using HOMA-IR, leptin/adiponectin ratio and TG/HDL-c ratio.
Results: This study included a total of 171 patients who were divided into two groups: group A
(patients with HCV) 62% (n=106) and group B (patients with type 2 diabetes and HVC), 38%
(n=65). Using UKPDS score, the total number of patients, 55.6% (n=95), 24% (n=41) and 20.5%
(n=35) had low cardiovascular risk, moderate and increased respectively. HOMA-IR positively
correlated with insulinemie (r=0.974, p0,001), waist circumference (r = 0.381, p0,001), BMI
(r=0.291, p=0.002), triglycerides (r=0.393, p 0,001), AST (r=0.447, p0,001), ALT (r=0.367,
p0,001), GGT (r=0.286, p=0.003). In patients with HCV 39.8% had the TG/HDL-c ratio values
than 3 and between patients with HCV+T2DM, only 29.8% had values of the TG/HDL-c than 3
(p 0.05). Differentiated analysis by gender showed higher values of the ratio leptin/adiponectin
for female versus male (6.17 (4.77 to 7.56) vs (5.31 (4.37 to 6, 26) p0,05).
Conclusions: Patients with moderate or high cardiovascular risk had a greater increased insulin
resistance (HOMA-higher values for IR, p0,001 and TG / HDL-c, p0,001) were also observed
values insulinemie high of C-peptide, of this population.
This study was supported by the Romanian National Authority for Scientific Research as a part of
the PNCDI 2 program DIADIPOHEP 41-008/2007. PNCI2-3343/41008/2007
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PS19. STUDIUL PREZENEI OBEZITII LA UN LOT DE PACIENI CU DIABET
INTERNAI
MD Firanescu Adela Gabriela1, Student Soare Mariana1, Student Simion Floriana Maria1,
Student Tuiu Daniela1, MD Mitrea Adina1, MD Popa Simona1, Prof. Univ. Dr. Moa Maria1
Premise i obiective. Obezitatea, o afeciune n continu cretere, are consecine importante

asupra strii de sntate, avnd ca efecte creterea LDL colesterol, a trigliceridelor i scderea
HDL colesterol. De asemenea, contribuie la cauze majore de deces, precum infarct miocardic,
accident vascular cerebral, HTA, cancer, DZ, hepatosteatoz. Obiectivul l reprezint studiul
prezenei obezitii la un lot de pacieni cu DZ neselecionai, internai.
Material i metod. A fost studiat un lot de 236 de pacieni din care 50% femei i 50% brbai,
cu DZ, internai n Clinica de Diabet a Spitalului Clinic Judeean de Urgen Craiova. Dintre
acetia, 30 pacieni (12,71%) au DZ tip 1 i 206 pacieni (87,29%) au DZ tip 2. Vrsta medie a
pacienilor cu DZ tip 1 este 39,76 13,71 ani, iar a pacienilor cu DZ tip 2 este 61,06 10,58 ani.
Dintre pacienii cu DZ tip 1, 14 (46,67%) prezint o vechime a DZ 10 ani, 9 pacieni (30%)
prezint o vechime cuprins ntre 10 i 20 de ani, iar 7 (23,33%) au o durat de evoluie a DZ 20
ani. n ceea ce privete pacienii cu DZ tip 2, 121 (58,74%) au o vechime a DZ 10 ani, 68
(33,01%) au o vechime cuprins ntre 10 i 20 de ani, iar 17 (8,25%) au o durat a DZ 20 ani.
Referitor la tratamentul DZ tip 2, 2 pacieni (0,97%) sunt echilibrai glicemic prin diet, 44 pacieni
(21,36%) au tratament cu ADO, 32 pacieni (15,53%) sunt tratai cu insulin, 116 pacieni
(56,31%) sunt tratai cu ADO i insulin i n cazul a 7 pacieni (3,40%) se administreaz tratament
injectabil non-insulinic asociat ADO +/- insulin. Pentru studiul prezenei obezitii generale s-a
utilizat IMC30 kg/m2, iar pentru studiul prezenei obezitii abdominale s-au utilizat CA>80 cm
la femei i >94 cm la brbai, CA/CS>0,85 la femei i >0,94 la brbai. Datele au fost introduse n
programul Microsoft Excel i supuse analizei statistice utiliznd programul SPSS.
Rezultate i discuii. Analiznd obezitatea general, 105 pacieni (50,97%) cu DZ tip 2 prezint
IMC30 kg/m2 i 2 pacieni cu DZ tip 1 (6,67%) prezint IMC30 kg/m2 (p<0,0001);
suprapondere (IMC 25-29 kg/m2) au prezentat 59 pacieni cu DZ tip 2 (28,64%), comparativ cu
un numar de 11 pacieni cu DZ tip 1 (36,67%). n DZ tip 2 IMC mediu a fost 30,21 kg/m2, cu o
deviaie standard de 5,99 (p<0,0001). n cazul DZ tip 1 IMC mediu a fost 24,28 kg/m2, cu o
deviaie standard de 3,64 (p<0,0001). CA crescut este prezent la 171 pacieni (83,01%) cu DZ
tip 2 i la 12 pacieni (40%) cu DZ tip 1 (p<0,0001). Raportul CA/ crescut este prezent la 185
pacieni (89,81%) cu tip 2 i la 15 pacieni (50%) cu DZ tip 1 (p<0,0001).
Concluzii. Un procent de peste 79% dintre pacienii cu DZ tip 2 au prezentat obezitate i

suprapondere. Exist o diferen nalt semnificativ statistic (p<0,0001) n ceea ce privete
asocierea obezitii generale i abdominale cu diabetul zaharat tip 2.
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STUDY OF THE PRESENCE OF OBESITY IN A GROUP OF HOSPITALIZED
DIABETIC PATIENTS
MD Firanescu Adela Gabriela1, Student Soare Mariana1, Student Simion Floriana Maria1,
Student Tuiu Daniela1, MD Mitrea Adina1, MD Popa Simona1, Prof. Univ. Dr. Moa Maria1
Premises and objectives. Obesity, a growing disease, has important consequences for health,
resulting in increased LDL cholesterol, triglycerides and decreased HDL cholesterol. Also,
contributes to the major causes of death such as heart attack, stroke, hypertension, cancer, diabetes,
liver steatosis. The objective is to study the presence of obesity in a group of unselected
hospitalized patients with diabetes.
Content and Method. A group of 236 patients was studied, of which 50% women and 50% men,
with diabetes, hospitalized in the Department of Diabetes of Emergency County Hospital Craiova.
Among these, 30 patients (12.71%) have type 1 diabetes and 206 patients (87.29%) have type 2
diabetes. The average age of patients with type 1 diabetes is 39.76 13.71, while those with type
2 diabetes is 61.06 10.58. Among patients with type 1 diabetes, 14 (46.67%) have a duration of
diabetes 10 years, 9 patients (30%) have a duration between 10 and 20 years, and 7 (23.33%)
have a duration of diabetes 20 years. Regarding patients with type 2 diabetes, 121 (58.74%) have
a duration of diabetes 10 years, 68 (33.01%) have a duration between 10 and 20 years, and 17
(8.25 %) have a duration of diabetes 20 years. Regarding the treatment of type 2 diabetes, 2
patients (0.97%) are glycemic balanced through diet, 44 patients (21.36%) are treated with oral
antidiabetic medication, 32 patients (15.53%) are treated with insulin, 116 patients ( 56.31%) are
treated with oral antidiabetic medication and insulin and in the case of 7 patients (3.40%) non-
insulin injectable treatment associated antidiabetic medication +/- insulin is administered. To study
the presence of general obesity BMI30 kg/m2 was used, and to study the presence of abdominal
obesity AC>80 cm in women and >94 cm in men, WHR>0.85 in women and >0.94 in men were
used. Data was entered into Microsoft Excel and analyzed using SPSS statistics software.
Results and Discussions. Analyzing general obesity, 105 patients (50.97%) with type 2 diabetes
present BMI30 kg/m2 and 2 patients with type 1 diabetes (6.67%) present BMI30 kg/m2
(p<0.0001); overweight (BMI 25-29 kg/m2) had 59 patients with type 2 diabetes (28.64%),
compared with 11 patients with type 1 diabetes (36.67%). In type 2 diabetes the average BMI was
30.21 kg/m2, with a standard deviation of 5.99 (p<0.0001). In type 1 diabetes the average BMI
was 24.28 kg/m2, with a standard deviation of 3.64 (p<0.0001). Increased AC is present in 171
patients (83.01%) with type 2 diabetes and 12 patients (40%) with type 1 diabetes (p<0.0001).
Increased WHtR is present in 185 patients (89.81%) with type 2 diabetes and 15 patients (50%)
with type 1 diabetes (p<0.0001).
Conclusions. A rate of over 79% of patients with type 2 diabetes presented obesity and
overweight. There is a highly statistically significant difference (p<0.0001) regarding general and
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abdominal obesity association with type 2 diabetes.

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PS20. ANTICORPI ANTIGAD65, PEPTIDUL C I TABLOUL CLINIC N STABILIREA
DIAGNOSTICULUI DE DIABET ZAHARAT
Dr. Glan Simona1, Dr. Dumitracu Ana-Cristina1, Conf. Dr. Roman Gabriela1
UMF Iuliu Hatieganu Cluj-Napoca
Premise si obiective: Stabilirea diagnosticului de diabet zaharat este relativ uor i se face pe baza
unor criterii bine stabilite de Asociaia Americana de Diabet n ce privete valoarea glicemiei n
anumite condiii de recoltare sau a valori HbA1c, uneori chiar i n absena simptomatologiei
specifice. Stabilirea tipului de diabet ns se face innd cont de unele caracteristici clinice prezente
nc de la debut i permit orientarea diagnosticului i a recomandrilor terapeutice, ns nu de
puine ori tabloul clinic este polimorf i nu urmeaz considerentele tradiionale odat stabilite ca
i definitorii pentru un anume tip de diabet, precum statusul ponderal al pacientului, vrsta la debut
sau prezena cetoacidozei diabetice, motiv pentru care se recurge la determinarea prezenei
sindromului autoimun prin dozare de anticorpi i eventual a peptidului C pentru elucidarea
diagnosticului. n ce masur aceste determinari ne confirma sau nu diagnosticul etiologic n
concordan cu tabloul clinic prezent la fiecare caz a fost subiectul lucrrii de fa.
Material si metoda: Am realizat un studiu analitic-observaional, retrospectiv ce a cuprins un lot
de 23 de pacieni internai n Centrul de Diabet i Boli Metabolice Cluj-Napoca n perioada
septembrie 2015-februarie 2016 i la care s-au recoltat probe biologice pentru determinarea
prezenei anticorpilor antiGAD65 si valoarea peptidului C. Pacieni ntruneau caracteristici clinice
mixte ce fceau dificil ncadrarea lor ntr-un anume tip de diabet i la care aceste determinri au
fost solicitate n sprijinul elucidarii diagnosticului etiologic, mai exact confirmarea sau infirmarea
diagnosticului de diabet zaharat tip 1. Sau urmarit n acelai timp i concordana caracteristicilor
clinice -vrsta ,IMC-ul pacienilor, prezena complicaiilor acute la debut(cetoacidoza diabetica)
sau simptomatologia prezent la debut, precum i valoarea peptidului C cu tipul de diabet stabilit.
Rezultate: Din lotul de pacieni studiai 13(56,5%) dintre ei erau cunoscui cu diagnosticul de
DZ2 si 10(43.4%) cu DZ1, dintre care un pacient fusese diagnosticat cu forma latent de DZ1-
LADA, iar rezultatele determinrii titrului de anticorpi anti GAD a adus 11(47.8%) rezultate
pozitive care au confirmat 8(80%) din cele 10 cazuri de DZ1 diagnosticate astfel pe baza criteriilor
clinice anterior dozri de anticorpi, infirmnd un caz diagnosticat ca i DZ1 i pe cel diagnosticat
ca si LADA, schimbnd diagnosticul n cazul a 2 pacieni cunoscui pn atunci cu DZ2. Valoarea
peptidului C a fost sub limitele admise ca normale (<1,1ng/mL ) la 10(43.4%) din pacieni dintre
care 9(90%)) sunt pacieni cu DZ1. Vrsta la debutul diabetului a fost mai mic de 40 ani n
12(52.17%)din cazuri din care doar 4(36.36%) au fost confirmate ca i DZ1 prin prezena
anticorpilor antiGAD, restul de 7(63.63%) pacienti cu DZ1 au avut debutul bolii dup vrsta de
40 ani. Statusul ponderal a fost de normopondere la 16(69.5%) pacieni dintre care 9(81.8%) fiind
din cei diagnosticai cu DZ1, obezitatea fiind prezent la 2(18.18%) cazuri confirmate de DZ1. n
ce privete simptomatologia prezent la debut cu caracter acut i cu sindrom poliuro-polidipsic
prezent i scdere marcat n greutate n decursul a mai puin de 3 sptmni, aceasta a fost
semnalat la 5(21.7%) din pacieni din care 5(100%) din ei au fost confirmai ca i DZ1. Prezena
cetoacidozei diabetice nu a fost nregistrat dect la 2(8.69%) din cazurile studiate dintre care doar
1(9%) din cei diagnosticai cu DZ1.
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Concluzii: Rezultatele obinute n urma dozriilor titrului de anticorpi antiGAD65 si valoarea

Peptidului C confirm n 80% din cazuri diagnosticul stabilit pe baza tabloului clinic ns situaiile
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particulare ntlnite la fiecare din aceste cazuri n ce privete vrsta la debutul bolii, statusul
ponderal al pacienilor sau debutul acut cu simptomatologie clar poliuro-polidipsic i cu scdere
ponderal marcat ce se regsesc n procente variabile ntre 36.36% si 100% nu fac dect s susin
importana corelrii elementelor tabloului clinic cu dozrile de laborator n vederea stabilirii
diagnosticului etiologic de diabet zaharat.
GAD65 AUTOANTIBODIES, C PEPTIDE AND CLINICAL PICTURE IN DIAGNOSIS

OF DIABETES
Dr. Glan Simona1, Dr. Dumitracu Ana-Cristina1, Conf. Dr. Roman Gabriela1
UMF Iuliu Hatieganu Cluj-Napoca
Premises and Objectives The diagnosis of diabetes is relatively easy and is based on well-
established criteria of the American Diabetes Association for the plasma glucose, harvest under
certain conditions or the HbA1c criteria, sometimes even without the presence of specific
symptoms. Determining the type of diabetes is considering some clinical features present even
since the onset and allows us to orient diagnostic and therapeutic recomandation but not
infrequently the clinical picture is polymorphic and are not following the traditional consideration
once established as defining a particular type of diabetes as the nutritional status of the patient, age
at onset or the presence of diabetic ketoacidosis at the debut, reson for resorting to determine the
presence of antibodies metered autoimmune syndrome and possibly C peptide to elucidate the
diagnosis. To what extent these determinations confirms the etiological diagnosis consistent with
the clinical picture present in each case was the subject of this paper.
Materials and method: : We conducted an analytical study , observational , retrospective that
included a group of 23 patients admitted in the Center for Diabetes and Metabolic Diseases Cluj-
Napoca between September 2015 and February 2016 to whom were collected biological samples
for the presence of GAD65 antibodies and the levels of serum peptide C.
Patients met the clinical characteristics mixed and made them difficult to framing them in a type
of diabetes reson for these determinations were requested in support to elucidate the etiologic
diagnosis , ie diagnosis confirmation or infirmation of type 1 diabetes. We also monitor the
consistency of clinical characteristics like age, patients BMI, presence of acute onset complications
(diabetic ketoacidosis) and the presence of symptoms at onset and the serum C-peptide value with
the established type of diabetes.
Results: From the group of 23 patients studied 13(56.5%) of them were known with diagnosis of
T2DM and 10 (43.4%)pacients with T1DM, of whom one patient was diagnosed with LADA , and
the results that determine the titer of GAD65 antibodies brought 11 (47.8%) positive results which
confirmed 8 (80%) of the 10 cases of T1DM diagnosed as on the clinical criteria, before the
dosages of antibodies, reversing one case diagnosed as T1DM and the suspicion of LADA,
changing diagnosis for 2 patients known as T2DM. Serum C-peptide value was below the limits
of the normal range (<1.1ng/mL) in 10 (43.4%) cases of whom 9 (90%)pacients diagnosed with
T1DM. Age at onset of diabetes was less than 40 years in 12 (52.17%) cases of which only 4
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(36.36%) were confirmed asT1 DM by the presence of GAD65 antibodies, the remaining 7
(63.63%) patients with DM1 had disease onset after the age of 40 years.
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Weight status was normal weight in 16 (69.5%) patients of which 9 (81.8%) are those diagnosed
with T1DM, obesity is present in 2 (18.18%) confirmed cases of T1DM. Regarding symptoms
present at the onset of acute character like clear symptoms of poliuro-polydipsia syndrome and
marked decrease weight lose within less than three weeks, it was reported in 5 (21.7%) of patients
in whom 5 (100% ) of them were confirmed as T1DM. Diabetic ketoacidosis presence was
recorded only at 2 (8.69%) of the cases studied of which only one (9%) of those diagnosed with
DM1.
Conclusions: The results obtained from dosing the GAD65 antibody titer and value of serum C-
peptide confirmed 80% of the cases diagnosis of T1DM based on clinical picture but particular
situations encountered in each case like the age of disease onset, weight status of patients or acute
onset of symptoms such as clear poliuro-polydipsia syndrome and marked weight loss that are
found in varying percentages between 36.36% and 100% do nothing else then to support the
importance of correlating elements of clinical picture with the laboratory dosing to determine the
etiologic diagnosis of the type of diabetes.
PS21. MEDICINA PERSONALIZAT N DIABETOLOGIE: MEDICIN DIGITAL I

MEDICIN GENOMIC
Dr. Marius Geant1

Center for Innovation in Medicine / Public Health Genomics Network Europe
Premise i Obiective: n literatura de specialitate au fost descrise 14 mecanisme diferite prin care
este afectat homeostazia glucozei, printre care: rezistena la insulin, incapacitatea celulelor beta-
pancreatice de a produce insulin, transportul deficitar al insulinei, insuficiena funcional a
canalelor ionice, probleme n funcionarea receptorului adrenergic, sensibilitate alterat la glucoz.
n acest moment, pentru diabetul zaharat de tip 2 sunt disponibile 14 clase terapeutice, iar
selectarea tratamentului se face mai mult sau mai puin pe principiul ncercare-eroare. n 43%
din cazuri, tratamentul pentru tipul 2 de diabet zaharat, administrat conform ghidurilor, nu
funcioneaz, la un pacient nou diagnosticat.
Material i Metod: Studiul Pioneer 100, iniiat n anul 2014, finanat de statul Luxemburg i
desfurat de Institute of Systemic Biology din SUA, a inclus 107 voluntari sntoi, i i-a propus
colectarea datelor medicale ale acestora: analize de laborator, date provenind din secvenierea
genomului, a microbiomului, monitorizarea semnelor vitale, evaluarea statusului psihologic etc.
Un accent special s-a pus pe datele medicale ce pot fi colectate de voluntari nii, prin diverse
dispozitive hi-tech: telefoane mobile, brri, ceasuri inteligente, ochelari pentru realitatea
augmentat. Toate aceste informaii au fost integrate ntr-o baz de date (Big Data), au fost
analizate, cu scopul de a se descoperi noi corelaii patogenice, noi ci de explorat pentru o
nelegere mai bun a relaiei dintre starea de sntate i boal. Analiza s-a fcut prin tehnici de
congnitive computing. O pondere important a studului se refer la analizarea n detaliu a
statusului cardio-metabolic, respectiv a riscului de dezvoltare a bolilor cardiovasculare i a
diabetului zaharat.
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Rezultate i Discuii: Analiza la 1 an a datelor de la cei 107 voluntari sntoi au indicat existena
unui risc de a dezvolta diabetul zaharat la 59% din cazuri, n timp ce riscul cardio-vascular a fost
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definit n 58% din situaii. De asemenea, markeri ai inflamaiei au fost identificai n 68% din
cazuri.
Concluzie: Personalizarea terapiei n diabetul zaharat de tip 2 poate fi posibil, pe termen scurt,
prin analiza aprofundat a tuturor datelor medicale ale pacientului, prin implementarea unor
mijloace digitale care s-l ajute pe pacient s-i monitorizeze diveri parametri ai strii de sntate
n intervalul dintre dou vizite la medic. Pe termen mediu i lung, prin nelegerea avansat a
componentelor omice implicate n patogeneza diabetului, putem spera la o personalizare a terapiei
bazat nu doar pe medicina digital, ci i pe medicina genomic.
PERSONALIZED MEDICINE IN DIABETES: DIGITAL MEDICINE AND GENOMIC

MEDICINE
Dr. Marius Geant1

Center for Innovation in Medicine / Public Health Genomics Network Europe
Background and objectives: In the literature were described 14 different mechanisms by which
glucose homeostasis is affected, including: insulin resistance, pancreatic beta-cell failure to
produce insulin, insulin deficient transport, insufficient functional ion channels, adrenergic
receptor problems, impaired glucose sensitivity. At this point, type 2 diabetes are available 14
therapeutic classes. The choice of treatment is more or less on a "trial and error" base. In 43 % of
cases, the treatment of type 2 diabetes mellitus, administered in accordance with the guidelines,
do not function in a newly diagnosed diabetes patient.
Material and method: Pioneer 100 Study, initiated in 2014, financed by the Luxembourg State
and conducted by Institute of Systemic Biology in the US, included 107 healthy volunteers, and
aims to collect medical data thereof: laboratory analysis, data from genome sequencing, the micro-
biome, monitoring vital signs, assessing psychological status etc. Special emphasis was placed on
medical data that can be collected by volunteers themselves through various hi-tech devices:
smartphones, bracelets, smart-watches and augmented reality glasses. All this information has
been integrated into a database (Big Data) and analysed in order to discover new pathogenic
correlations, explore new avenues for better understanding of the relationship between health and
disease. The analysis was done through cognitive computing techniques. An important part of the
study covers detailed analysis of the cardio-metabolic status, namely the risk of developing
cardiovascular disease and diabetes.
Results and discussions: Ad-interim analysis of data from 107 healthy volunteers have indicated
a risk of developing diabetes in 59 % of cases, while cardiovascular risk was defined in 58% of
cases. Also, inflammatory markers have been identified in 68% of cases.
Conclusion: On the short term, personalising therapy in type 2 diabetes may be possible by
promoting an in-depth analysis of all medical records of the patient, through the implementation
of digital tools that has the potential to help the patient to monitor several parameters of health
between two visits to the doctor. On a medium and long term, personalising therapy in type 2
diabetes may be possible by an advanced understanding of the omics involved in the pathogenesis
153
of diabetes. Personalised therapy will based not only on digital medicine, but also on genomic
medicine.
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PS22. EVALUAREA RELAIEI DINTRE SINDROMUL METABOLIC I
HIPERURICEMIE LA PACIENII CU DIABET ZAHARAT TIP 2
MD Gheorghi Andra Gabriela1, MD Rusu Emilia1, MD Drgu Ramona1, MD Onil Oana

Daniela1, MD Grosu Irina1, PhD Radulian Gabriela1
Institutul National Diabet, Nutritie si Boli Metabolice N Paulescu
Obiectivul acestui studiu a fost investigarea relaiei dintre sindromul metabolic i hiperuricemie la
pacienii cu diabet zaharat tip 2.
Material i metod: Acest studiu epidemiologic transversal, observaional ce a inclus nu numr
de 300 pacieni aflati in evidenta INDNBM Paulescu, cu diabet zaharat tip 2. S-au urmrit indicii
antropometrici (greutate, nlime, circumferina taliei, IMC (indicele de mas corporal).
Parametrii biochimici urmrii au fost de glicemia jeun, hemoglobina glicozilat, profil lipidic
(colesterol, trigliceride, HDL-colesterol hemoleucograma, parametrii funciei renale (uree,
creatinina serica, raport albumina/creatinina) i acidul uric. Hiperuricemia a fost definit astfel: 7
mg/dl (la brbai) sau 6 mg/dl (la femei). Sindromul metabolic a fost definit utiliznd definiia
IDF modificat.
Rezultate: Vrsta medie a pacienilor inclui n studiu a fost de 60,709,79 ani. Durata medie a
diabetului a fost de 11,558,58 ani. Prevalena hiperuricemie a fost de 46% (n=138), dintre acetia
16,7% (n=50) au fost brbai i 29,4% (n=88) au fost femei. Prevalena sindromului metabolic a
fost de 79% (n=237). Nivelul acidului uric la pacienii cu sindom metabolic a fost 7,022,04mg/dl
versus 6,321,96 mg/dl la pacienii cu diabet zaharat tip 2 fr sindrom metabolic (p0,05).
Hiperuricemia s-a corelat pozitiv cu circumferina abdominal (r=0,15, p=0,023), cu nivelul LDL-
colesterolului (r=0,16, p=0,009) i negativ cu nivelul HDL-colesterolului (r=-0,17,
p=0,002).persoanele cu hiperuricemie a u prezentatvalori semnificativ mai mari ale TAs i
circumferinei abdominale comparativ cu cei fr hiperuricemie (TAs 141,122,47 mmHg versus
136,620,8 mmHg; CA 107,717,96 cm versus 102,514,9 cm) (p0,05).
Concluzii: Acest studiu arat c nivelul acidului uric seric este semnificativ asociat cu prezena
sindromului metabolic dar i cu componentele sale, n special circumferina abdominal. Avand
in vedere incidena crescut a obezitii i a sindromului metabolic la pacienii cu diabet zaharat
tip 2 i legtura potenial dintre ceste afciuni i hiperuricemie, accentul ar trebui pus pe
determinarea hiperuricemiei la aceast categorie de pacieni.
THE EVALUATION OF THE RELATIONSHIP BETWEEN HIGH LEVEL OF URIC

ACID AND METABOLIC SYNDROME AT PATIENTS WITH DIABETES TYPE 2
MD Gheorghi Andra Gabriela1, MD Rusu Emilia1, MD Drgu Ramona1, MD Onil Oana

Daniela1, MD Grosu Irina1, PhD Radulian Gabriela1
Institutul National Diabet, Nutritie si Boli Metabolice N Paulescu
154
Objective : The objective of this study is to investigate the relationship between metabolic
syndrome and high levels of uric acid in plasma at patients with diabetes type 2
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Method and material: This observational transverse epidemiological study included a number of
300 patients with diabetes type 2 that are under observation of doctors working at National Institute
of diabetes, nutrition and metabolic disease N. C. Paulescu . We used anthropometric
measurements ( weight, height, waist circumference, index body mass ). Biochemical parameters
followed are : hemoglobin A1c, fasting glucose, lipid profile ( total cholesterol, triglycerides ,
HDL-cholesterol), hemoleucogram, renal function parameters (urea, serum creatinine, protein to
creatinine ratio) and uric acid. High levels of uric acid were defined as : 7 mg/dl (male patients)
and 6 mg/dl (women patients). Metabolic syndrome was defined usind the definition of modified
IDF.
Results: The average age of the patients included in our study was 60,709,79 years. The average
dration of diabetes was 11,558,58 years. The prevalence hyperuricemia was 6% (n=138), 16,7%
(n=50) male patients and 29,4% (n=88) female patients. The prevalence of metabolic syndrome
was 79% (n=237). The level of uric acid at patients with metabolic syndrome was 7,022,04mg/dl
versus 6,321,96 mg/dl at patients with diabetes type 2 without metabolic syndrome (p0,05).
High level of serum uric acid was positive correlated with abdominal waist (r=0,15, p=0,023), with
LDL-cholesterol level (r=0,16, p=0,009) and negative with levels of HDL-cholesterol (r=-0,17,
p=0,002). Patients with high level of uric acid had significantly higher values of systolic blood
pressure and abdominal waist compared with patients without hyperuricemia (TAs 141,122,47
mmHg versus 136,620,8 mmHg; CA 107,717,96 cm versus 102,514,9 cm) (p0,05).
Conclusions: This study revealed that the serum level of uric acid is related with the presence of
metabolic syndrome, even with his components, especially with abdominal waist. From this point
of view high prevalence of obesity and metabolic syndrome are present at pacients with type 2
diabetes, the potential link between this conditions and high levels of uric acid, the accent must be
placed on the hyperuricemia determination at this category of patients.
PS23. PROBLEME DE IGIEN DENTAR LA PACIENII CU DIABET ZAHARAT

TIP 1
MD Gheorghi Andra Gabriela1, MD Rusu Emilia1, MD Ghiulescu Cristina1, MD Enache

Georgiana1,2, MD Drgu Ramona1, MD Nan Raluca1, MD Stoicescu Florentina1, MD Rusu
Florin4, MD PhD Radulian Gabriela1,3
1.
Universitatea de Medicina i Farmacie Carol Davila
2.
Spitalul de Urgen Clrai
3.
Institutul National de Diabet, Nutritie si Boli Metabolice Prof. N. Paulescu
4.
Spitalul Clinic de Urgen
Obiective: Meninerea unei igiene dentare corecte pentru sntatea dentar este o parte acceptat
dintre recomandrile normale pentru un stil de viaa sntos. Scopurile acestui studiu au fost
reprezentate de evaluarea problemelor de sntate oral la pacienii cu diabet zaharat tip 1 i relaia
dintre controlul metabolic i sntatea dentar.
Material si metod: Statusul periodontal a fost examinat la 41 de pacieni cu diabet zaharat tip 1
(T1DM) i au fost folosite 41 de consultaii utiliznd inflamaia gingival (index gingival),
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prezena cariilor dentare i xerostomia, deasemenea pentru toi pacienii a fost utilizat un
chestionar semi-structurat care a inclus intrebari despre obicieiuri de igien, patternuri nutriionale,
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frecvena consumului de alcool i fumat, vizite la dentist, consumul de past dentar, sngerri
gingivale, sngerri gingivale la aa dentar, sngerri gingivale pe durata perierii, sngerri
gingivale spontane. Au fost analizate probe sanguine pentru glicemia a jeun, HbA1c, profl lipidic,
creatinina. Un bun control metabolic a fost considerat la valori ale HbA1c <7%, iar un prost control
metabolic a fost considerat la valori HbA1c >7%. Prezena complicaiilor diabetului cum ar fi
retinopatia, neuropatia , prezena bolii renale cronice i a complicaiilor cardiovasculare au fost
deasemenea evaluate.
Rezultate: Durata medie a Diabetului zaharat tip 1 a fost 18.61 [14.94-22.28] ani. n ambele
grupuri doar un procent mic de oameni au periat dintii zilnic. Igiena sarac dentar afost observat
in ambele grupuri. Indexul gingival a fost mai mare la pacienii cu diabet zaharat (p=0.001). Trei
zeci i trei din 41 pacieni diabetici au avut gingivit; 40 (97.6%) au avut carii dentare iar 18
(43.9%) au avut candidoz oral. Gingivita, cariile dentare i candidoza oral au fost significant
mai des ntalnite la pacienii diabetici decat la pacienii non-diabetici (p<0.05). La grupul
pacienilor cu diabet zaharat tip 1 pierderea dinilor a fost mai des ntalnit. Pacienii cu diabetul
prost controlat au prezentat mai des gingivit si candidoz oral dect pacienii cu diabet slab
controlat iar relaia aceasta a avut semnificaie statistic.
Concluzie: Prevalena bolii orale a fost semnificativ mai mare la pacienii cu diabet dect la
pacienii nediabetici. Igiena oral neadecvat a fost observat la majoritatea populaiei evaluate.
Programe naionale ar trebui conduse public, campanii pentru sntatea dentar, nutriie i sntate
per total.
ORAL HEALTH PROBLEMS IN PATIENTS WITH TYPE 1 DIABETES
MD Gheorghi Andra Gabriela1, MD Rusu Emilia1, MD Ghiulescu Cristina1, MD Enache

Georgiana1,2, MD Drgu Ramona1, MD Nan Raluca1, MD Stoicescu Florentina1, MD Rusu
Florin4, MD PhD Radulian Gabriela1,3
1.
Universitatea de Medicina i Farmacie Carol Davila
2.
Spitalul de Urgen Clrai
3.
Institutul National de Diabet, Nutritie si Boli Metabolice Prof. N. Paulescu
4.
Spitalul Clinic de Urgen
Aim: Maintenance of proper oral hygiene for good oral health is an accepted part of the normal
recommendations for a healthy lifestyle. The aims of this study was to evaluate the oral health
problems in type 1 diabetes patients and relationship between metabolic control and oral health
status.
Material and methods: Periodontal status was examined in 41 patients with type 1 diabetes
(T1DM) and 41 controls using inflammation of gums (gingival index), presence of dental caries,
and the xerostomia; also in all patients we used a semi-structured questionnaire which include
questions about hygiene habits, eating patterns, frequency and consumption of alcohol and
tobacco, visits to the dentist, tooth brushing frequency, use of toothpaste, gingival bleeding,
gingival bleeding with dental floss, gingival bleeding during toothbrushing, spontaneous gingival
bleeding. Blood samples were analyzed for fasting plasma glucose, HbA1c, lipid profile,
creatinine. Good metabolic control was assumed to be represented by HbA1c <7%, while poor
156
control was defined as HbA1c >7%. The presence of diabetic complications such as retinopathy,
neuropathy, chronic kidney diaseases, and cardiovascular complication were also evaluated.
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Results: The mean duration of the T1DM was of 18.61 [14.94-22.28] years. In both groups only
a small percentage of people brushed their teeth daily. Poor oral hygiene was observed in in both
groups. Gingival index was greater in diabetic patients (p=0.001). Thirty-three out of 41 (80.5%)
diabetic patients had gingivitis; 40 (97.6%) had dental caries and 18 (43.9%) had oral candidosis.
Gingivitis, dental caries and oral candidosis was significantly higher in diabetics than non-
diabetics (p<0.05). Though there was a greater loss of teeth in the group with type 1 diabetes
mellitus. Poorly controlled diabetics presented more with gingivitis and candidiasis than well-
controlled diabetics and this relationship was statistically significant.
Conclusion: The prevalence of oral disease was significantly higher in diabetics than in non-
diabetic controls. Inadequate oral hygiene was observed in the majority of people evaluated.
Nationwide programs should be conducted public awareness campaigns on dental health, nutrition
and overall health.
PS24. PREVALENA COMPLICAIILOR DIABETULUI ZAHARAT I A TIPULUI

ACESTORA LA PACIENII CU DIABET ZAHARAT TIP 2 I TIROIDIT CRONIC
AUTOIMUN
Asist. Univ. Gherbon Adriana1

Disciplina de Fiziologie, UMF "V. Babe" Timioara
Premise i Obiective: Complicaiile diabetului zaharat (DZ) sunt legate de obicei de vechimea
DZ i gradul dezechilibrului glicemic. De asemenea, n cazul DZ tip 2 predomin complicaiile de
tip macroangiopatic, reprezentate de hipertensiunea arterial (HTA), cardiopatia ischemic
cronic(CIC), arteriopatia membrelor inferioare. Obiectiv: studiul prevalenei complicaiilor DZ
i a tipului acestora la pacieni cu DZ tip 2 i tiroidit cronic autoimun (TCA).
Material i Metod: din 77 (69 F i 8 B) pacieni cu DZ tip 2 i TCA, 47 (42 F i 5 B) ( p=0,92,
X2=0,008) au prezentat complicaii ale DZ.
n toate cazurile s-au evaluat:
- profilul lipidic: colesterol total (CT), trigliceride (TG), HDL-colesterol (HDL-C), LDL-
colesterol (LDL-C);
- echilibrul glicemic: glicemie a jeun, hemoglobina glicozilat;
- investigarea glandei tiroide: TSH, FT4, FT3, anticorpi antiperoxidaz tiroidian, ecografie
tiroidian
- fundul de ochi pentru diagnosticul retinopatiei diabetice
- proteinurie/albuminurie pentru diagnosticul nefropatiei diabetice
- tensiunea arterial sistolic i diastolic
- EKG pentru cardiopatia ischemic
- oscilometrie pentru arteriopatia diabetic
Toi subiecii investigai au prezentat DZ tip 2.
Rezultate i Discuii: Principalele complicaii ntlnite la pacienii cu DZ tip 2 i TCA au fost:
HTA n 82,97% cazuri (80,95% F vs. 100% M, p=0,28, X2 =1,14), CIC n 40,42% cazuri
157
(38,09% F vs. 60% M, p=0,34, X2=0,89), retinopatia diabetic n 17,02% cazuri (16,66% F vs.
20% M,p=0,85, X2=0,035), polineuropatia diabetic n 7,14% cazuri (4,76% F vs. 20% M,
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p=0,18, X2=1,73). Prezena complicaiilor a fost asociat cu vechimea DZ i cu gradul

dezechilibrului glicemic.
Concluzii: S-a remarcat o prevalen crescut a HTA i cardiopatiei ischemice datorit asocierii
la DZ tip 2 i TCA. Deoarece ambele afeciuni prezint risc crescut pentru boala cardiovascular
aterosclerotic, este necesar depistarea precoce i tratamentul corect al acestora pentru
prevenirea i ntrzierea apariiei aterosclerozei.
DIABETES MELLITUS AND THEIR TYPE COMPLICATIONS PREVALENCE AT

PATIENTS WITH TYPE 2 DIABETES AND CHRONIC AUTOIMMUNE
THYROIDITIS

Premises and Objectives: Diabetes mellitus (DM) complications are usually related to the age
of diabetes and glycemic imbalance degree. Also, in diabetes mellitus type 2 are predominant
macroangiopathic complications, represented by hypertension, coronary heart disease, and
diabetic arteriopathy. Objective: to study the prevalence of diabetes complications and their type
in patients with type 2 diabetes and autoimmune chronic thyroiditis (ACT).
Research design and Methods: in 77 (69 F and 8 M) patients with type 2 diabetes and ACT, 47
(42 F and 5 men) (p =0.92, X2 = 0.008) had complications of diabetes.
In all cases were evaluated:
- Lipid profile: total cholesterol (TC), triglycerides (TG), HDL-cholesterol (HDL-C), LDL-
cholesterol (LDL-C);
- Glycemic balance: fasting blood glucose, glycosylated hemoglobin;
- Investigation of the thyroid gland: TSH, FT4, FT3, thyroid antibodies, thyroid ultrasound
- Bottom of the eye for diagnosis of diabetic retinopathy
- Proteinuria/albuminuria for the diagnosis of diabetic nephropathy
- Systolic and diastolic blood pressure
- EKG for coronary heart disease
- Oscillometric for diabetic arteriopathy
All investigated subjects had type 1 diabetes.
Results and Discussion: The main complications encountered in patients with type 2 diabetes
and thyroid disease were hypertension in 82.97% cases (80.95% F vs. 100% M, p=0.28, X2
=1.14), coronary heart disease in 40.42% cases (38.09% F vs. 60% M, p=0.34, X2 = 0.89),
diabetic retinopathy in 17.02% cases (16.66 % F vs. 20% M, p = 0.85, X2 = 0.035), diabetic
polyneuropathy in 7.14 % cases (4.76% F vs. 20% M, p = 0.18, X2 = 1.73). The presence of
complications was associated with age and diabetes glycemic imbalance degree.
Conclusions: There was an increased prevalence of hypertension and coronary heart disease due
to type 2 diabetes association of thyroid disease. Because both diseases present high risk for
atherosclerotic cardiovascular disease, it is necessary early detection and their correct treatment
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for the prevention and delaying atherosclerosis occurrence.

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PS25. PREVALENA SINDROMULUI METABOLIC I A CRITERIILOR DE
IDENTIFICARE A ACESTUIA PE SEXE LA PACIENI CU SCDEREA
TOLERANEI LA GLUCOZ I TIROIDIT CRONIC AUTOIMUN

Premise i Obiective: Sindromul metabolic cuprinde un grup de tulburri care au drept

consecin creterea incidenei bolilor cardiovasculare. Obiective: studiul prevalenei
sindromului metabolic la pacieni cu scderea toleranei la glucoz (STG) i tiroidit cronic
autoimun.
Material i Metod: dintr-un lot de 52 pacieni cu STG i tiroidit cronic autoimun (51 femei
i 1 brbat), 39 (75%) (38 femei i 1 brbat) au prezentat sindrom metabolic.
Criteriile folosite pentru identificarea sidromului metabolic au fost:
- circumferina abdominal (peste 80 cm la femei i peste 94 cm la brbai)
- valoarea glicemiei a jeun peste 100 mg%
- valoarea HDLc sub 40 mg% la brbai i sub 50 mg% la femei
- valoarea TA peste 130/85 mmHg
- valoarea Tg peste 150 mg%
S-au evaluat:
- profilul lipidic (colesterol total, trigliceride, HDL colesterol, LDL colesterol),
- tensiunea arterial sistolic i diastolic,
- glicemia a jeun
- circumferina abdominal i indicele masei corporale (IMC)
- investigarea gladei tiroide: determinarea TSH, FT4, FT3, anticorpi antitiroidieni, ecografie
tiroidian
Rezultate i Discuii: Nu s-a constatat o predominan a sindromului metabolic n funcie de sex

(74,5% vs. 100%, p=0,55, X2=0,33). Pe lng prezena STG, dintre criteriile utilizate pentru
definirea sindromului metabolic, mai frecvente au fost circumferina abdominal (100%)
(100%F vs. 100 %B), valoarea HDLc (84,61%) (84,21%F vs. 100%B, p=0.66, X2=0,18),
valoarea TA (46,15%) (44,73%F vs. 100%B, p=0,27, X2=1,19) i valoarea Tg (46,15%)
(44,73%F vs. 100%B, p=0,27, X2=1,19).
Concluzii: Prezena sindromului metabolic pledeaz pentru creterea riscului de morbiditate-

mortalitate cardiovascular, n special pentru boala cardiovascular aterosclerotic. La pacienii
cu STG i TCA, asocierea acesteia din urm, care n timp evolueaz cu hipotiroidie, reprezint
un factor de risc suplimentar pentru boala cardiovascular aterosclerotic, fiind necesar
depistarea precoce i tratamentul adecvat al acesteia, n vederea ntrzierii procesul de
ateroscleroz.
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PREVALENCE OF METABOLIC SYNDROME AND ITS IDENTIFICATION
CRITERIA BY SEX AT PATIENTS WITH IMPAIRED GLUCOSE TOLERANCE AND
AUTOIMMUNE CHRONIC THYROIDITIS

Premises and Objectives: Metabolic syndrome contains a group of disorders which determinate
a higher incidence of cardiovascular diseases. Objectives: study of metabolic syndrome
prevalence at patients with impaired glucose tolerance (IGT) and autoimmune chronic thyroiditis
(ACT).
Research design and Methods: from 52 patients with IGT and ACT (51 female and 1 male), 39
(75%) (38 female and 1 male) had metabolic syndrome.
The criteria used for identification of metabolic syndrome were:
- abdominal circumference (above 80 cm at girls and above 94 cm at boys)
- glucose concentration above 100 mg%
- HDLc concentration under 40 mg% at boys and under 50 mg% at girls
- blood pressure above 130/85 mmHg
- triglyceride concentration above 150 mg%
We evaluated:
Lipid profile (total cholesterol, triglyceride, HDL cholesterol, LDL cholesterol);
Systolic and diastolic blood pressure
Fasting glycaemia
Abdominal circumference and body mass index (BMI)
Investigation of thyroid gland: determination of TSH, FT4, FT3, antithyroid antibodies, thyroid
echography
Results and Discussion: We don't noticed a prevalence of metabolic syndrome in function of

gender (74.5% vs. 100%, p=0.55, X2=0.33). Besides the presence of IGT, the criteria used for
definition of metabolic syndrome, more frequent were abdominal circumference (100%) (100%F
vs. 100%M), HDLc concentration (84.61%) (84.21%F vs. 100%M, p=0.66, X2=0.18), blood
pressure levels (46.15%) (44.73%F vs. 100%M, p=0.27, X2=1.19), and triglyceride
concentration (46.15%) (44.73%F vs. 100%M, p=0.27, X2=1.19).
Conclusions: Presence of metabolic syndrome shows a higher risk of cardiovascular mortality-

morbidity, especially for cardiovascular arteriosclerosis disease
At patients with IGT and ACT, association of thyroid disease, which in time evolves with
hypothyroidism, represents a supplementary risk factor for cardiovascular arteriosclerosis
disease, being necessary early detection and adequate treatment of it, for slowing down
arteriosclerosis process.
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PS26. ACIDUL URIC I COMPLICAIILE DIABETULUI ZAHARAT
Dr. Li Genoveva Andreea1, Dr. Zaharia Adelina1, Dr. Pavel Anca Ioana1, Student Zaharia
Mihaela Iulia1, Dr. Stoicescu Florentina1, Dr. Gheorghi Andra Gabriela1, Dr. Rusu
Emilia1, Prof. Dr. Radulian Gabriela1
National Institute of Diabetes Mellitus, Nutrition and Metabolic Diseases Prof.N.C. Paulescu,
Bucharest
Premise i Obiective: Este cunoscut faptul c nivelul crescut al acidului uric reprezint un marker
predictiv pentru dezvoltarea Diabetului zaharat. Studii recente au evideniat c, la pacienii
diabetici, hiperuricemia prezint un rol important n dezvoltarea complicaiilor cronice micro- i
macrovasculare, prin favorizarea insulinorezistenei. Astfel, acest studiu a urmrit evaluarea
relaiei dintre acidul uric seric i Diabetul zaharat, respectiv complicaiile acestuia.
Material i Metod: Am realizat un studiu retrospectiv pe un numr de 145 pacieni cu Diabet

zaharat, aflai n evidena I.N.D.N.B.M.Prof.N.C.Paulescu, folosind metode clinice i de
laborator pentru evaluarea parametrilor inclui n studiu. Astfel, am utilizat determinarea acidului
uric seric pentru evaluarea hiperuricemiei, iar prezena complicaiilor Diabetului zaharat a fost
apreciat clinic i biologic, prin examen fund de ochi, consult neurologic si cardiologic,
determinarea creatininei serice, a ratei de filtrare glomerular i a raportului albumin/creatinin
urinar.
Rezultate i Discuii: Din numrul total de pacieni inclui n studiu 9% (n=13) au avut Diabet
zaharat de tip 1, 35,9% (n=52) au avut Diabet zaharat tip 2 n tratament antidiabetic oral i 55,2%
(n=80) au avut Diabet zaharat tip 2 insulinotratat. Nivelul mediu al acidului uric a fost 4,30 1,81
mg/dl la pacienii cu Diabet zaharat tip 1, 5,99 2,17 mg/dl la pacienii cu Diabet zaharat tip 2 n
tratament cu antidiabetice orale i 5,74 1,73 mg/dl la pacienii cu Diabet zaharat tip 2
insulinotratat (p=0,019). Dintre pacienii cu Diabet zaharat tip 2 i hiperuricemie, care au fost n
numr de 132, 51,9% au prezentat Boal renal diabetic n diverse stadii. La pacienii cu
hiperuricemie valoarea medie a ratei de filtrare glomerular a fost 67,37 26,86 ml/min/1,73 m2,
iar la cei fr hiperuricemie 93,57 25,51 ml/min/1,73 m2 (p=0,001). n ceea ce privete celelalte
complicaii ale Diabetului zaharat 35,9% dintre pacieni au prezentat Retinopatie diabetic n
diferite grade, 30,5% Polineuropatie diabetic senzitiv distal, 45,5% Neuropatie diabetic
vegetativ, iar 41,7% au nregistrat complicaii macrovasculare (Boal cardiac ischemic).
Concluzii: S-a observat c pacienii cu Diabet zaharat tip 2 prezint valori mai crescute ale
acidului uric comparativ cu pacienii cu Diabet zaharat tip 1. n ceea ce privete complicaiile
Diabetului zaharat, s-a nregistrat o prezen semnificativ a Bolii renale diabetice la pacienii care
asociaz Diabet zaharat tip 2 i hiperuricemie.
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THE SERUM URIC ACID AND THE COMPLICATIONS OF DIABETES MELLITUS
Dr. Li Genoveva Andreea1, Dr. Zaharia Adelina1, Dr. Pavel Anca Ioana1, Student Zaharia
National Institute of Diabetes Mellitus, Nutrition and Metabolic Diseases Prof.N.C. Paulescu,
Bucharest
Premises and Objectives: It is known that the high level of serum uric acid is a predictive marker
in the development of Diabetes mellitus. Recent studies demonstrated that, in diabetic patients,
hyperuricemia has an important role in the development of chronic micro- and macrovascular
complications. Consequently, the aim of this study was to evaluate the relation between serum uric
acid and Diabetes mellitus, respectively its complications.
Content and Method: We realised a retrospective study on a group of 145 patients with Diabetes
mellitus, who were under the observation of N.I.D.N.M.D.Prof.N.C.Paulescu from Bucharest,
by using clinical and laboratory methods to evaluate the parameters included in the study. We used
the laboratory values of serum uric acid to evaluate the hyperuricemia; the complications of
Diabetes Mellitus were evaluated clinically and by laboratory methods, by using dilated-pupil
fundus examination, neurological and cardiological examination, determination of serum
creatinine, estimated glomerular filtration rate and urinary albumine/creatinine ratio.
Results and Discussions: From the total number of patients included in the study, 9% (n=13) had
Type 1 Diabetes mellitus, 35,9 % (n=52) had Type 2 Diabetes mellitus treated with oral
antidiabetic drugs and 55,2 % (n=80) were with Type 2 Diabetes mellitus treated with insulin. The
medium level of serum uric acid was 4,30 1,81 mg/dl in patients with Type 1 Diabetes mellitus,
5,99 2,17 mg/dl in patients with Type 2 Diabetes mellitus treated with oral antidiabetic drugs
and 5,74 1,73 mg/dl in those with Type 2 Diabetes mellitus treated with insulin (p=0,019).
Among the patients with Type 2 Diabetes mellitus and hyperuricemia, which were 132, 51,9% had
Diabetic Kidney Disease in different stages. In patients with hyperuricemia, the medium value of
the estimated glomerular filtration rate was 67,37 26,86 ml/min/1,73 m2 and in those without
hyperuricemia was 93,57 25,51 ml/min/1,73 m2 (p=0,001). Regarding the other complications
of Diabetes mellitus, we found that 35,9% of the patients had Diabetic retinopathy in different
grades, 30,5% had Diabetic distal polyneuropathy, 45,5% had Diabetic vegetative neuropathy and
41,7% had macrovascular complications ( Ischemic heart disease).
Conclusions and Findings: We observed that the patients with Type 2 Diabetes mellitus had
higher values of serum uric acid comparing to patients with Type 1 Diabetes mellitus. Regarding
the complications of Diabetes mellitus, we found a significant presence of Diabetic kidney disease
in patients with Type 2 Diabetes mellitus and hyperuricemia.
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PS27. ABCESE MULTIPLE LA DISTAN COMPLICND O INFECIE
LOCALIZAT A PICIORULUI DIABETIC PREZENTARE DE CAZ
Dr. Magopet Eliza1, Lect. Botnariu Eosefina1, Assist. Prof. Popa Delia1, Lect. Popescu
Maria1, Lect. Lctuu Cristina Mihaela1, Assoc. Prof. Mihai Bogdan Mircea1
Premise i Obiective: Infecia localizat a piciorului poate determina sepsis generalizat n anumite
condiii. Scopul acestei prezentri de caz este de a avertiza asupra unei complicaii severe a
leziunilor piciorului diabetic.
Material i Metod: Prezentm cazul unui pacient n vrst de 50 de ani, cu diabet zaharat tip 2,
neuropatie diabetic i factori de risc cardiovascular (hipertensiune arterial i obezitate), care a
dezvoltat sepsis i multiple abcese cu localizare la distan fa de leziunea iniial de la nivelul
piciorului. Cu excepia ulceraiei neuropate, pacientul a prezentat durere important la nivelul feei
posterioare, edem i poziie antalgic a coapsei stngi, retinopatie diabetic i neuropatie periferic
senzitivo-motorie. Pe durata spitalizrii pacientul a fost afebril. Pentru stabilirea diagnosticului au
fost necesare multiple investigaii de laborator i imagistice.
Rezultate i Discuii: Prezena semnelor clinice evidente de sepsis a impus iniierea

antibioterapiei cu spectru larg, nc din momentul internrii. Examenele de laborator au relevat
leucocitoz (36 180/mm3) cu neutrofilie (92,3%), trombocitoz (511 000/mm3), sindrom
inflamator (fibrinogen 912 mg/dl, CRP 28,53 mg/dl), rezerva alcalin sczut (20,1 mmol/l) i
hiperglicemie (386 mg/dl). Examenul de rezonan magnetic nuclear a evideniat multiple
abcese n spaiile ischiopubiene, ischiorectale i femurale stngi, pe faa intern metafizo-diafizar
femural stng, n fosa sciatic i spaiul obturator stng, secundare posibilei diseminri
hematogene de la nivelul infeciei plantare. Diagnosticul diferenial a fost dificil din cauza faptului
c simptomele pacientului erau nespecifice. A fost necesar drenajul percutan al abceselor,
efectundu-se o incizie de mari dimensiuni i evacuarea puroiului la nivelul regiunii supero-interne
a coapsei stngi. Examenul bacteriologic al puroiului evacuat a evideniat prezena Klebsiella
pneumoniae. Postoperator, pacientul i-a recuperat parial funcia motorie a membrului inferior
stng.
Concluzii: Acest caz reprezint o situaie rar n care ulceraia piciorului diabetic poate evolua
spre o infecie generalizat, cu multiple abcese profunde ale coapsei i sepsis sever, punnd n
pericol viaa pacientului. Este important cunoaterea potenialului pe care l au ulceraiile
piciorului diabetic de a genera complicaii infecioase extensive, cu att mai mult cu ct
simptomele asociate pot fi adesea neltoare i prin urmare alegerea terapiei optime poate fi
dificil.
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MULTI-SITE ABSCESSES COMPLICATING A DIABETIC FOOT INFECTION
CASE REPORT
Dr. Magopet Eliza1, Lect. Botnariu Eosefina1, Assist. Prof. Popa Delia1, Lect. Popescu
Maria1, Lect. Lctuu Cristina Mihaela1, Assoc. Prof. Mihai Bogdan Mircea1
Premises and Objectives: Localized foot infection can lead to dissemination and even generalized
sepsis under certain conditions. The purpose of the present report is to increase awareness of a
severe evolutive complication of diabetic foot ulcerations.
Content and Method: We present the case of a 50 year-old male, with long-standing type 2
diabetes mellitus, neuropathy and cardiovascular risk factors (hypertension and obesity), which
developed sepsis and distant site abscesses from a chronic foot infection. Apart of a neuropathic
foot wound, the patient presented severe pain, oedema and antalgic posture of the left thigh, retinal
microangiopathy and peripheral neuropathy. Fever was absent during hospitalization. Multiple
laboratory and imagistic exams were needed to establish the diagnosis.
Results and Discussions: As clinical signs of sepsis were evident, prolonged broad-spectrum
antibiotherapy was initiated even from the moment of admission. Laboratory exams showed
leucocytosis (36,180/mm3) with neutrophilia (92.3%), thrombocytosis (511,000/mm3),
inflammation (fibrinogen 912 mg/dl, CRP 28.53 mg/dl), low serum bicarbonate (20.1 mmol/l) and
hyperglycemia (386 mg/dl). Magnetic resonance imaging revealed multiple abscesses in
ischiopubian, ischiorectal and left femoral spaces, left femoral metaphyseal-diaphyseal internal
surface, left sciatic fossa and left pelvic obturator space, secondary to potential hematogenous
seeding from the plantar infection. The differential diagnosis was difficult, seeing that the patient
presented many non-specific symptoms. Percutaneous drainage of the abscesses was needed, using
large incisions and pus evacuation in the superior internal region of the thigh. Bacteriological exam
from intra-abscesses pus showed Klebsiella pneumoniae. Postoperative recovery was marked by
partial regaining of motor functions in the left inferior limb.
Conclusions and Findings: The aforementioned case represents a rare situation of a localized
foot suppuration evolving towards a generalized, life-threatening infectious condition, with
multiple profound abscesses of the thigh and severe sepsis. It is important to recognize the potential
for extensive infectious complications held by diabetic foot ulcerations, to be aware that
identifying symptoms may sometimes be delusive and choice of the optimal therapy for this
condition may be difficult, in order to prevent significant morbidity and mortality.
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PS28. PREZENA NEUROPATIEI DETERIOREAZ CALITATEA ACTIVITILOR
DE AUTO-MANAGEMENT AL DIABETULUI
Dr. Mailat Diana1, Dr. Timar Romulus1, Dr. Trziu Maria1, Dr. Lazr Sandra1, Dr. Timar
Bogdan1
Premise i Obiective: n managementul diabetului, msurile de auto-ngrijire a bolii au un loc

deosebit de important. S-a demonstrat c un control glicemic de calitate nu poate fi obinut fr
aderena la msurile igieno-dietetice, exerciiu fizic i auto-monitorizare glicemic urmat de
ajustarea dozelor n consecin. Neuropatia diabetic (ND) este o complicaie prevalent i precoce
a diabetului zaharat (DZ) avnd consecine multiple asupra strii de sntate a pacientului i care
ar putea, fie direct, fie mediat prin alte componente, calitatea aderenei la msurile de auto-
management al DZ la pacienii afectai.
Scopul studiului nostru a fost acela de a evalua impactul prezenei i a severitii ND asupra
calitii activitilor de auto-ngrijire a DZ.
Material i Metod: n acest studiu transversal am nrolat 198 pacieni cu DZ tip 2 (mediana
vrstei 61 ani; mediana duratei DZ 7 ani) conform unui principiu consecutiv-populaional, aflai
n evidena Centrului Clinic Judeean de Diabet, Nutriie i Boli Metabolice din Timioara. Tuturor
pacienilor le-au fost colectate date antropometrice clinice i de laborator la vizita de screening.
Prezena i severitatea ND a fost evaluat cu ajutorul instrumentului de screening Michigan
(MNSI) respectiv calitatea activitilor de auto-ngrijire a diabetului cu ajutorul chestionarului
Summary of Diabetes Self-Care Activities (SDSCA).
Rezultate i Discuii: Prezena ND s-a asociat cu o scdere semnificativ a scorului SDSCA (27
vs. 37 puncte; p<0.001), scdere ce s-a dovedit a fi semnificativ pentru toi sub-itemii scorului:
compliana la diet (12 vs. 17 puncte; p<0.001), exerciiu fizic (5 vs. 6 puncte; p<0.001),
monitorizare glicemic (4 vs. 8 puncte; p<0.001) respectiv ngrijirea piciorului (3 vs. 6 puncte;
p=0.003). Scorul SDSCA s-a corelat negativ i semnificativ statistic cu severitatea ND msurat
prin intermediul scorului MNSI (r=-0.527; p<0.001), aceast corelaie fiind valid inclusiv pentru
toate sub-componentele scorului. Rezultatele indic o scdere a calitii msurilor de auto-ngrijire
a diabetului la pacienii cu simptomatologie avansat a ND.
Concluzii: Interrelaia dintre severitatea ND i calitatea auto-managementului DZ ne indic o

strns interdependen ntre aceste dou componente, fiind posibil o augmentare reciproc care
poate duce la consecine negative asupra managementului global al DZ. Pentru a evita o scdere
n calitatea auto-ngrijirii DZ, educaia terapeutic de auto-management al bolii ar trebui
intensificat n rndul pacienilor cu DZ care prezint i simptomatologie asociat ND.
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THE PRESENCE OF NEUROPATHY DECREASES THE QUALITY OF DIABETES-
RELATED SELF-CARE ACTIVITIES IN PATIENTS WITH TYPE 2 DIABETES
Dr. Mailat Diana1, Dr. Timar Romulus1, Dr. Trziu Maria1, Dr. Lazr Sandra1, Dr. Timar
Bogdan1
Background and aims: In the management of diabetes, the diabetes-related self-care activities
are of a paramount importance. It is demonstrated that a good glycemic control cannot be obtained
without an adequate diet, physical exercise and blood glucose self-monitoring with consecutive
treatment adjustments. Diabetic neuropathy (DN) is a prevalent complication of Diabetes Mellitus
(DM) with multiple consequences on the patients health which may also partially impair, directly
or mediated through other components, the quality of the diabetes-related self-care activities.
Our study aims to evaluate the impact of the presence and severity of neuropathy on the quality of
diabetes-related self-care activities.
Content and method: In this cross-sectional study, we enrolled 198 patients with Type 2 DM
(median age 61 years; median diabetes duration 7 years) attending scheduled visits at the
Outpatient of Emergency Hospital Timisoara, according to a consecutive-case, population-based
principle. In all patients, we collected anthropometric, clinical and laboratory data at the screening
visit. The presence and severity of DN was evaluated using the Michigan Neuropathy Screening
Instrument (MNSI), a higher score being associated with more severe DN. The quality of diabetes-
related self-care activities was evaluated using the Summary of Diabetes Self-Care Activities
questionnaire (SDSCA), a higher score being associated with a more appropriate diabetes self-
care.
Results and discussion: The presence of DN was associated with a significantly decreased
SDSCA score (27 vs. 37 points; p<0.001), the decreases being significant for all studied sub-items:
diet-related self-management (12 vs. 17; p<0.001), physical exercise (5 vs. 6; p=0.002), glycemic
values monitoring (4 vs. 8; p=0.010) respectively foot care (3 vs. 6; p=0.003). The SDSCA score
was reversely and significantly correlated with the severity of DN assessed using MNSI score
(Spearmans r=-0.527; p<0.001), this correlation being valid for all the self-care sub-components.
The results are pointing to impaired diabetes-related self-care activities in patients with more
severe neuropathic symptoms.
Conclusion: The relationship between the severity of DN and the quality of DM self-management
points to a possible loop-type relationship between these two components, being possible a
reciprocal augmentation with negative consequences on the global management of DM. In order
to avoid a decrease in the quality of disease self-management, special self-management related
education should be provided in patients with DM which developed DN.
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PS29. CAZ SPECIAL DE DIABET ZAHARAT TIP MODY
Rezident Matei Laura Roxana1, Rezident Aricescu Alexandru1, Dr. Zetu Cornelia1
INDBM Prof. Dr. I. Paulescu
Premise i obiective: Diabetul Zaharat (DZ) tip MODY reprezint un tip subdiagnosticat de
diabet, diagnosticul de certitudine putnd fi pus doar dup efectuarea testelor genetice. Scopul
acestui abstract este de a prezenta un caz clinic special de DZ tip MODY.
Material i metod: Pacient de sex feminin, n varst de 18 ani, cu ereditate diabetic ncarcat
- rude de gradul I, dg. la vrste tinere (fiica, mama, bunica), depistat in context asimptomatic la
11 ani cu DZ, cu recomandarea insulinoterapiei i administrarea inconstant a acesteia, avnd n
total ~ 3 luni de tratament insulinic n 7 ani de diabet, cu dezechilibru glicemic reflectat de glicemii
random 250-300 mg/dl, dar fr episoade de decompensri metabolice acute. Din istoricul
pacientei menionm valori ale Hb1Ac=7,6 %- 11%. La momentul actual, pacienta se prezint
pentru valori glicemice crescute, insoite de sindrom poliuro-polidipsic de 3 luni, n context de
dezechilibru glicemic major (HbA1c=12,1%).
Rezultate i discuii: Avnd n vedere insulinoterapia inconstant, absena decompensrilor acute

la o pacient tnr, subponderal (BMI=16,7 kg/m2), fr stigmatele clasice de insulinorezisten
(IR) (exces ponderal, sindrom de ovar polichistic, dislipidemie, etc), cu ereditate diabetic pe
vertical, se ridic problema etiopatogeniei diabetului zaharat. n acest context, s-a dozat peptidul
C a jeun cu o valoare de 1,42 ng/dl la o glicemie=247 mg/dl i insulinemie=4,32 uUI/ml, sugernd
o funcie secretorie B celular nc existent. S-au mai determinat Ac. antiGAD= 0.084 (N<1) i
ATPO= 14,59 UI/ml. Corobornd datele din istoricul pacientei (varst tanar la diagnostic,
prezena ereditii pe 3 generaii consecutive, lipsa decompensrilor acute in absena tratamentului
insulinic), cu cele clinice (fr stigmate de IR) i paraclinice (peptidul C normal la mai mult de 5
ani de la diagnostic, absena Ac. antiGAD, secreie de insulin prezent, autoimunitate tiroidiana
negativ) constatm argumente nalt sugestive pentru DZ tip MODY. Nu au putut fi efectuate teste
genetice specifice.
Concluzii: Prevalena MODY n Europa este considerat aproximativ 1-2% din cazurile de DZ
neinsulinodependent. Avnd n vedere faptul c prezentarea clinic la debut orienteaz frecvent
clinicianul ctre diagnosticul de DZ tip 1 la pacientul tnr cu hiperglicemie fr stigmate de
insulinorezisten, exist tipuri particulare de diabet MODY uneori subdiagnosticate. Pentru aceste
cazuri, independena de tratamentul insulinic cel puin 5 ani dup diagnostic ajut diagnosticul
diferenial. Dei testele genetice nu au putut fi efectuate n acest caz, contextul clinico-biologic ne
orienteaz s suspicionm subtipul MODY 2.
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PS30. ACANTHOSIS NIGRICANS- CUTANEOUS MANIFESTATION OF
ENDOCRINE ABNORMALITIES-CASE REPORT
Resident Mihai Gabriela1, Resident Captiu Florentina Iuliana1, Resident Micheu Adelina1,
Resident Gmbuean Ana Maria1, MD. PhD, Assist. Prof. Pop Radu Corina Cristina1, MD.
PhD Prof. Pacanu Ionela Maria1
1
Mures County Clinical Hospital
Premises and Objective: HAIR-AN syndrome is a subphenotype of polycystic ovary syndrome

(PCOS) and is characterized by hyperandrogenism, insulin resistance (IR) and Acanthosis
Nigricans (AN). Evaluating for insulin resistance becomes mandatory in patients with AN and
hormone imbalance. Treatment with insulin-sensitizing agents seem to show beneficial effects.
Content and method: We report a clinical case of a 17 years old, RB, who presented to the
Endocrinology Department for evaluation of excessive facial hair, irregular menses since
menarche with a history of a secondary amenorrhea for 6 months in the last two years. A complete
physical examination revealed third-degree android obesity (BMI: 41 kg/m2) with a waist-hip
ratio: 1.03, facial acne, hirsutism with a Ferriman Gallwey score of 15. AN was found to be present
on the neck and under the breasts. Assessment of hormonal imbalance revealed hyperandrogenism
with elevated Total testosterone 143.23 ng/dl (10.83-56.94). Free testosterone : 3.41 ng/dl (0.3-
1.08) and Bioavailable Testosterone 82.4 ng/dl (0.8-10) were also markedly elevated. To evaluate
Adrenal androgen secretion, DHEA-S: 548.3 ug/dl (61.2-493.6) was determined and showed
overproduction. The homeostatic model assessment was used to quantify insulin resistance.
HOMA-IR revealed severe insulin resistance with a score of 6.45 (normal range <3).Cushing
syndrome and late-onset congenital adrenal hyperplasia were excluded.Abdominal
Ultrasonography described multiple small follicles (< 0.5 mm) in both ovaries.
Results and discussions: Management plan of hyperandrogenism and insulin resistance in obese
patients include lifestyle modification and insulin-sensitizing agents. Treatment with Metformin
in low doses (500 mg/daily) was initiated along with Dydrogesterone to improve menstrual cycles.
Patient follow-up is necessary for Metformin dosage adjustment, to combine therapy with
antiandrogens and to prevent further complications as well as possible treatment side effects.
Conclusions and Findings:Conclusions: Clinical recognition of AN becomes an important matter

concerning several metabolic abnormalities often associated due to IR such as obesity, diabetes or
PCOS. Aside from symptoms relief, IR treatment prevents long-term cardiovascular
complications.
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PS31. GHRELINA, METABOLISMUL ENERGETIC I APETITUL
ef Lucr. Dr. Mihalache Laura1, ef Lucr. Dr. Arhire Lidia Iuliana1

1
Universitatea de Medicin i Farmacie Grigore T. Popa Iai
Ghrelina este un hormon neuroendocrin secretat la nivelul stomacului, descoperit n 1999 de ctre
Kojima i colab. n contextul cercetrilor efectuate n vederea optimizrii tratamentului
persoanelor cu deficit de hormon de cretere (GH), unul dintre aspecte fiind identificarea liganzilor
endogeni ai receptorilor secretagogi de hormon de cretere. La acel moment, dou aspecte au fost
considerate importante, i anume recunoaterea stomacului ca un organ secretor implicat n
reglarea GH prin intermediul ghrelinei, dar i necesitatea activrii acesteia pentru a-i exercita
aciunile endocrine.
Dei era considerat un aspect dificil al fiziologiei umane (receptori specifici situai la nivel cerebral
iar ligandul endogen este secretat de stomac), cercetrile ulterioare au demonstrat faptul c
ghrelina nu este doar un peptid care stimuleaz secreia de GH, ci un important reprezentant al
unei noi familii de peptide gastrointestinale implicate n reglarea i modularea axei intestin-creier,
oferind noi perspective n cercetarea metabolic i neuroendocrin, cu potene terapeutice
deosebite.
Ghrelina, ligandul endogen al receptorului secretagog de GH, este singurul hormon periferic cu
aciune orexigen, ce activeaz receptori exprimai mai ales la nivelul centrului apetitul
(hipotalmus i hipofiz). La nivel plasmatic, se regsesc dou forme ale ghrelinei: forma inactiv,
ghrelina neacilat, i forma activ, ghrelina acilat sintetizat sub aciunea enzimei ghrelin O-
acyltransferaza (GOAT). n literatur este menionat chiar existena unui sistem
ghrelin/GOAT/GHSR extrem de complex, implicat n reglarea metabolismului energetic uman i
adaptarea homeostaziei energetice la modificrile de mediu. La subieci umani, nivelul ghrelinei
crete imediat preprandial i scade n perioada postprandial, fiind implicat n iniierea mesei dar
i n determinismul cantitii i calitii alimentelor ingerate. Suplimentar stimulrii aportului
alimentar, ghrelina determin scderea consumului energetic i promoveaz depozitarea acizilor
grai n adipocite.
Astfel, la nivelul organismului uman ghrelina duce la o balan energetic pozitiv, cu creterea
adipozitii, deci cu creterea depozitelor calorice, vzut ca un mecanism adaptativ pentru a putea
fi utilizate n condiii de restricie caloric. n contextul actual mondial, n care asistm la creterea
disponibilitii alimentare i reducerea la minimum a consumului energetic, aceste mecanisme
devin patogene, ipoteza implicrii ghrelinei n epidemia actual a excesului ponderal devenind din
ce n ce mai atractiv.
GHRELIN, ENERGY METABOLISM AND APPETITE
Lect. Dr. Mihalache Laura1, Lect. Dr. Arhire Lidia Iuliana1

Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
Ghrelin is a neuroendocrine hormone secreted in the stomach, discovered in 1999 by Kojima M et

169
colab. These authors were conducting a research aimed at improving the treatment of growth
hormone (GH) deficiency by identifying the endogenous ligand for GH secretagogue receptor
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(GHS-R). At that time, two aspects were considered important, namely recognition of the stomach
as a secreting organ involved in GH regulation through ghrelin and that in order to exert its
endocrine actions ghrelin has to be activated.
Although considered a difficult aspect of human physiology (the specific receptors situated in the
brain and the endogenous ligand secreted by the stomach), further research showed that ghrelin is
not only a peptide that stimulates GH secretion, but a leading representative of a new family of
gastrointestinal peptides involved in the regulation and modulation of gut-brain axis, thus
providing new insights into the metabolic and neuroendocrine research, with special therapeutic
potential.
Ghrelin, the endogenous ligand for the GH secretagogue receptor, is the only peripheral orexigenic
hormone that activates the receptors to be found especially in the appetite center (hypothalamus
and pituitary gland). Ghrelin is present in human plasma in two forms: an inactive form known as
deacylated ghrelin, and an active form called acylated ghrelin synthesized under the action of
ghrelin O-acyltransferase enzyme (GOAT). The literature even mentions an extremely complex
ghrelin/ GOAT / GHSR system involved in the regulation of human energy, metabolism and
adaptation of energy homeostasis to environmental changes. In humans, there is a preprandial rise
and a postprandial fall in plasma ghrelin levels, which strongly suggest that the peptide plays a
physiological role in meal initiation and may be employed in determining the amount and quality
of ingested food. Besides the stimulation of food intake, ghrelin determines a decrease in energy
expenditure and promotes the storage of fatty acids in adipocytes.
Thus, in the human body ghrelin induces a positive energy balance, an increased adiposity gain,
as well as an increase in caloric storage, seen as an adaptive mechanism to caloric restriction
conditions. In the current world context, when we are witnessing an increasing availability of food
and a reduction of energy expenditure to a minimum level, these mechanisms have become
pathogenic. As a consequence, the hypothesis that ghrelin is involved in the current obesity
epidemic has been embraced by many scholars and researchers.
PS32. EVALUAREA PE TERMEN SCURT A PROTOCOLULUI DE INSTALARE A

POMPEI DE INSULIN
Rezident Morariu Diana1, Rezident Dumitracu Ana-Cristina1, Rezident Ladariu Otilia1,

Rezident Galaan Simona1, Conf. Dr. Roman Gabriela1
Centru Clinic de Diabet, Nutritie si Boli metabolice, Cluj-Napoca, Romania
Introducere: Alternativa tratamentului bazal-bolus la pacienii cu DZ tip1 cu hipoglicemii

frecvente sau asimptomatice, variabilitate glicemic mare i necesar scazut de insulin bazal este
pompa de infuzie continu subcutanat. Avantajele acestui tratament se refer la posibilitatea
obinerii si meninerii unui echilibru glicemic optim, cu glicemii apropiate de normal, variaii
glicemice minime si frecven redus a hipoglicemiilor.
Obiectivul acestui studiu a fost evaluarea pe termen scurt a protocolului de instalare a pompei de
insulin.
Materiale si metod: n perioada ianuarie-martie 2016, la 9 pacieni cu DZ tip1 s-a instalat pompa
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de insulin Accu- Check Spirit Combo. Vrsta pacienilor a fost ntre 7-63 ani, durata diabetului
zaharat tip 1 a fost intre 2-43 de ani. Perioada spitalizrii a fost in medie 5 zile. Conform
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protocolului, rata bazal reprezint iniial 80% din doza de insulin bazal, fiind verificat prin
proba postului pe diverse perioade a 3 zile diferite. Parametrii care au fost analizai sunt: HbA1c,
motivele tratamentului prin pompa de insulin, glicemia bazal la internare i cea la externare, rata
bazal total/24h la internare i cea de la externare (cu pompa), media glicemiilor/24h de la
internare i cea de la externare, doza total de insulin (DTI/kgc) naintea internrii i cea de la
externare cu pompa. Datele obinute au fost centralizate i prelucrate statistic cu ajutorul
programului Microsoft Excel si SPSS.
Rezultate: Principalele motive pentru trecerea la tratamentul cu pompa de insulin au fost in 11%
din cazuri hipoglicemiile frecvente iar n 89% a fost variabilitatea glicemic mare (43-400mg/dl).
Dezechilibrul glicemic a fost evaluat la internare n funcie de valoarea HbA1c care a nregistrat
valori de 8-9% n majoritatea cazurilor 67%. Din totalul cazurilor studiate predomin sexul
feminin 70%. S-au obinut diferene semnificative cu o medie de 0.19u.i./24h ntre doza total de
insulin (DTI)/24h la internare i DTI/24h la externare (pompa) la 77,7% dintre pacieni. S-a
nregistrat o medie a glicemiilor/24h la internare 168.4mg/dl (106-242mg/dl) i media
glicemiilor/24h la externare 164.02mg/dl (111-214mg/dl). S-a observat o diferena ntre rata
bazal la internare 17,44ui i cea de la externare 13.64ui, cu o scdere a necesarului bazal de 3,8
u.i.
Concluzii: Rezultatele obinute susin protocolul aplicat n Centrul nostru pentru instalarea
pompei de insulin. Pe termen scurt, infuzia continu subcutanat de insulin se asociaz cu o
reducere a necesarului de insulin pe 24h, cu un numr mai redus de evenimente hipoglicemice i
de variabilitate a glicemiilor. Urmrirea periodic a pacienilor este necesar pentru controlul pe
termen lung.
SHORT-TERM ASSESSMENT OF THE PROTOCOL INSULIN PUMP

INSTALLATION
Rezident Morariu Diana1, Rezident Dumitracu Ana-Cristina1, Rezident Ladariu Otilia1,

Rezident Galaan Simona1, Conf. Dr. Roman Gabriela1
Centru Clinic de Diabet, Nutritie si Boli metabolice, Cluj-Napoca, Romania
Backgrounds: The alternative basal-bolus therapy in patients with type I diabetes with frequent
hypoglycemia or asymptomatic high glycemic variability and low basal insulin needed it is
continuous subcutaneous insulin infusion (CSII) therapy. The advantages of this treatment
references to the possibility of obtaining and maintaining an optimal glycemic control, blood sugar
close to normal glycemic, variations minimal and low frequency of hypoglycemia.
Aims.
The objective of this study was to evaluate short-term protocol insulin pump installation.
Materials and methods: Between jan-march 2016, to 9 pacients with type 1 diabetes mellitus was
installed insulin pump Accu- Check Spirit Combo. The pacients age was between 7-63 years. Type
1 diabetes mellitus (DM) duration was between 2-43 years. Hospitalizations period it was in
average 5 days. According to protocol total basal rate represents initial 80% from the basal insulin
dosage, being checked by fasting test in tree different moments and tree different days.
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Parameters that were analyzed: HbA1c, treatment reasons by insulin pump, basal blood glucose at
admission and discharge of the patients, total basal rate / 24h at admission and the one at the
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discharge (with the pump), the average glycemia / 24h at admission and discharge of the patients,
the total daily dose (TDD) of insulin before the hospitalization and at the discharge of the patients,
with the pump. Centralized data obtained were processed statistically in Microsoft Excel and
SPSS.
Results: The main reasons for switching to CSII therapy insulin pump therapy were in 11% of
cases frequent hypoglycemia and in 89% it was higher glycemic variability (43-400 mg / dl). The
glycemic imbalance it was evaluated at admission of the patients regarding the value of HbA1c
which was recorded 8-9% in most cases. Of all cases studied predominates the female 70%. It was
obtained significant differences with an average of 0.19 ui / 24h between TDD / 24h at admission
and TDD/ 24h discharge (pump) 77.7% of patients. There has been an average glycemic / 24h on
admission 168.4 mg / dl (106-225mg/dl) and the mean glycemic / 24h discharge 164.02mg / dl
(111-214mh/dl). It was noticed a difference between basal rate at admission 17.44u.i. and at the
discharge 13.64u.i., with a decrease of 3.8 u.i. basal needs.
Conclusions: The results support the protocol used in our Centre following CSII therapy. reduces
total daily basal of insulin. Short-term CSII is associated with the decreases number of
hypoglycemic events and also the variability of blood glucose levels in most of the cases. Periodic
follow-up of patients is needed for long-term control.
PS33. PREVALENA RETINOPATIEI DIABETICE LA PACIENII OBEZI CU

DIABET ZAHARAT O ANALIZ RETROSPECTIV N CADRUL UNEI
POPULAII DE PACIENI CU DIABET ZAHARAT
Dr. Murean Alexandra1, Dr. Cavalioti-Enache Theodora-Elena1, Dr. Dobre Gabriel Alin1,
Dr. Ungureanu Carmen1, Dr. Ciobanu Delia1, Dr. Soldea Lidia1, Dr. Bejinariu Ctlina1, Dr.
Ilinca Alexandra1, Dr. Stegaru Daniela1, Dr. Radu Florentina1, Dr. Rusu Emilia1, Prof. Dr.
Radulian Gabriela1
Lotus Medica
Premise i Obiective: Retinopatia diabetic este una din cele mai redutabile si invalidante
complicaii microvasculare care pot aprea in evoluia pacientului cu diabet zaharat.Totui trebuie
s recunoatem c pot exista diferene n ceea ce privete apariia retinopatiei diabetice n special
datorit obezitaii (deci a prezenei insulinorezistenei). End point-ul primar a urmrit riscul
apariiei retinopatiei diabetice la pacienii obezi cu diabet zaharat tratai cu antidiabetice orale
versus pacienii obezi cu diabet zaharat insulinotratai. End point-ul secundar a urmrit apariia
retinopatiei diabetice la pacienii obezi cu diabet zaharat echilibrat versus pacienii obezi cu diabet
zaharat dezechilibrat.
Materiale si Metode: S-a realizat un studiu observaional, retrospectiv care a inclus un numar de
200 pacieni cu diabet zaharat internai la INDNBM Prof. Dr. N.C. Paulescu in perioada ianuarie
2015- ianuarie 2016. Din analiza foilor de observaie clinic am reinut i analizat urmtoarele
date: sexul pacienilor, IMC-ul (kg\m2), durata de evoluie a diabetului zaharat, valoarea HbA1c,
tratamentul antidiabetic (ADO sau insulinoterapie), complicaii cronice ale diabetului zaharat
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(retinopatia diabetic).Pentru diagnosticul de retinopatie diabetic s-a folosit examenul fundului

de ochi conform scalei de severitate din Early Tratment for Diabetic Retinopathy Study.
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Rezultate i Discuii: Din numarul total de pacieni inclusi in studiu 148 (74%) se aflau n
tratament cu insulin i 52 (26%) pacieni se aflau n tratament cu antidiabetice orale. n ceea ce
privete statusul ponderal 118 pacieni (59%) au fost obezi n diferite grade i 82 pacieni (41%)
au fost normo i supraponderali. Dintre pacienii obezi, 88 (59.46%) sunt insulinotratai i 30
pacieni (57.69%%) sunt tratai cu antidiabetice orale, iar din categoria normo si supraponderali
60 (40,54%) sunt n tratament cu insulin i 22(42,30%) de pacieni sunt n tratament cu ADO.
Dintre obezi 51 (66,1%) nu au prezentat retinopatie iar restul de 37(42,04%) de pacieni au
dezvoltat retinopatie diabetic. In schimb pacienii cu obezitate aflai n tratament cu antidiabetice
orale 30 pacieni- 57,69%, 29 (63%) dintre ei nu aveau retinopatie diabetic si un singur pacient
(16,7%) a prezentat retinopatie diabetic. n ceea ce privete hemoglobina glicat (HbA1c), la 97
pacieni din rndul celor obezi valoarea HbA1c a fost peste 7%, din care 63 (64,94%) erau fara
retinopatie diabetic si 34 (35,05%) au prezentat retinopatie diabetic, in schimb 20 pacieni au
avut HbA1c sub 7%, din care 18(90%) pacieni au fost fr retinopatie diabetic i doar 2 (10%)
pacieni au fost cu retinopatie diabetic.
Concluzii: Ceea ce trebuie s reinem este c pacienii insulinotratai au relativ acelai risc de
apariie a retinopatiei diabetice indiferent de statusul ponderal, spre deosebire de cei aflai n
tratament cu antidiabetice orale unde riscul de apariie a retinopatiei diabetice este mai mare pentru
cei normoponderali i supraponderali fa de pacienii cu obezitate. n ceea ce privete riscul
apariiei retinopatiei diabetice la pacienii obezi cu diabet zaharat echilibrat i pacienii cu diabet
zaharat dezechilibrat, se observ c un control optim al diabetului zaharat scad ansele de apariie
a retinopatiei diabetice cu aproximativ 25%.
PREVALENCE OF DIABET RETINOPATHY AT OBESE PATIENTS- A

RETROSPECTIVE ANALISYS IN A POPULATION OF PACIENTS WITH DIABETES
MELLITUS
Dr. Murean Alexandra1, Dr. Cavalioti-Enache Theodora-Elena1, Dr. Dobre Gabriel Alin1,
Dr. Ungureanu Carmen1, Dr. Ciobanu Delia1, Dr. Soldea Lidia1, Dr. Bejinariu Ctlina1, Dr.
Ilinca Alexandra1, Dr. Stegaru Daniela1, Dr. Radu Florentina1, Dr. Rusu Emilia1, Prof. Dr.
Radulian Gabriela1
Lotus Medica
Background and objectives: Diabetic retinopathy is one of the most difficult and invalidating
microvascular complication that may appear in the evolution of patients with diabetes. Still, one
has to acknowledge that there may be differences concerning the incidence of diabetic retinopathy
especially due to obesity (and thus due to resistance to treatment with insulin). The primary end-
point monitored the risk of occurrence of diabetic retinopathy at obese patients having oral
treatment compared to those treated with insulin. The secondary end-point monitored the incidence
of diabetic retinopathy at obese patients with balanced diabetes compared to those with unbalanced
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diabetes.
Materials and methods: A retrospective study was conducted on 200 diabetes patients treated at
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INDNBM Prof. Dr. N.C. Paulescu in the period January 2015 January 2016. The following data
was monitored: sex, IMC (kg/m2), duration since diagnosis, HbA1c value, treatment (ADO or
insulin), chronic complications (diabetic retinopathy). For the diabetic retinopathy diagnostic was
used the eye exam, according to the severity scale from Early Tratment for Diabetic Retinopathy
Study.
Results and Discussions: Out of the total number of patients included in the study, 148 (74%)
were under insulin treatment and 52 (26%) under ADO treatment. As regards weight, 118 (59%)
presented various degrees of obesity and 82 patients were normal or slightly overweight. Out of
the obese patients, 88 (59.46%) are treated with insulin and 30 (57.69%) are treated with ADO; 51
(66.1%) do not have diabetic retinopathy, and the rest of 37 (42.04%) suffered from this condition.
However, only one of the obese patients (16.7%) treated with ADO presented diabetic retinopathy.
As regards (HbA1c), 97 obese patients presented values exceeding 7%, out of which 63 (64.94%)
did not present diabetic retinopathy and 34 (35.05%) had this condition. Out of the patients with
HbA1c below 7%, 18 patients (90%) did not present diabetic retinopathy and only 2 (10%) had
this condition.
Conclusions: Patients treated with insulin have relatively the same risk of occurrence of diabetic
retinopathy regardless of their weight, unlike those under ADO treatment, where the risk of
occurrence of diabetic retinopathy is higher for the normal or slightly overweight patients
compared to the obese patients. As regards the risk of occurrence of diabetic retinopathy in patients
with balanced diabetes, it may be noted that an optimum control of diabetes decreases the chances
of occurrence of diabetic retinopathy by approximately 25%.
PS34. DIABETUL DE TIP 2 I OSTEOPOROZA
MD Nan Raluca1, MD Cursaru Adrian1, MD Drgu Maria Ramona1, MD PhD Rusu

Emilia1, MD Stoicescu Florentina1, MD Popescu Horaiu1, MD PhD Grigorie Daniel1, MD
PhD Muat Mdlina1, Prof. PhD Radulian Gabriela1
Carol Davila Universitatea Medicina si Farmacie Bucuresti
Femeile cu diabet zaharat tip 2 au un turnover osos mai sczut dect femeile non-diabetice, iar
DMO pare s subestimeze diagnosticul de osteoporoz n grupul pacienilor diabetici. Astfel
markerii turnover-ului osos ar putea fi poteniali candidai pentru evaluarea osteoporozei la
pacienii cu diabet zaharat.
Datele curente plaseaz osteoporoza alturi de celelalte complicaii cronice ale diabetului zaharat.
Mecanismele prin care diabetul zaharat tip 2 afecteaz metabolismul osos sunt nc studiate.
Scopul acestui studiu a fost de a evalua metabolismul osos utiliznd markerii biochimici ai
turnover-ului osos i densitatea mineral osoas (DMO) la pacienii cu diabet zaharat tip 2 i
osteoporoz tip I nou diagnosticat.
Studiu retrospectiv care a inclus un numr de 120 de femei cu osteoporoz postmenopauz: 60 de
femei cu diabet zaharat tip 2 i 60 de femei fr diabet (grupul non-diabetic). n grupul non-diabetic
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a fost urmrit vrsta. Variabilele analizate au fost vrsta, indicele de mas corporal (IMC),
magneziu, calciu, fosfataza alcalin (FA), glicemia a jeun, nivelele serice de osteocalcin i
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crosslaps, 25-hidroxi vitamina D (25(OH)D) i DMO utiliznd absorbiometria dual cu raze X
(DXA).
Vrsta medie a femeilor studiate a fost de 64.218.01 ani. n grupul diabetic valoarea osteocalcinei
a fost de 22.2614.49 ng/ml, iar valoarea crosslaps-ului de 0.340.19 ng/ml. ntre aceti
parametrii, n grupurile studiate, a fost o diferen statistic semnificativ (p<0.05). Dei DMO la
nivel lombar i la nivelul oldului pare s fie mai mare n grupul diabetic, nu a existat o diferen
statistic semnificativ ntre grupurile studiate. Femeile diabetice au prezentat valori plasmatice ale
25(OH)D mai mici dect femeile non-diabetice (18.65 vs 20.17 ng/ml), ns fr semnificaie
statistic. Valorile magneziului au fost semnificativ mai mici n grupul diabetic comparativ cu
grupul non-diabetic. IMC a fost semnificativ mai mare la femeile cu diabet zaharat tip 2 (p<0.001).
n analiza bivariat, DMO s-a corelat pozitiv cu IMC doar n grupul femeilor diabetice.
DIABETES AND OSTEOPOROSIS
MD Nan Raluca1, MD Cursaru Adrian1, MD Drgu Maria Ramona1, MD PhD Rusu

Emilia1, MD Stoicescu Florentina1, MD Popescu Horaiu1, MD PhD Grigorie Daniel1, MD
PhD Muat Mdlina1, Prof. PhD Radulian Gabriela1
Current data available places the osteoporosis near the other chronic complications of diabetes.
The mechanims by which type 2 diabetes affects bone metabolism are still debated. This study
was designed to evaluate the bone metabolism by using biochemical markers of bone turnover and
bone mineral density (BMD) in patients with type 2 diabetes and recently diagnosed type I
osteoporosis.
A retrospective study which included 120 women with postmenopausal osteoporosis: 60 women
with type 2 diabetes and 60 women without diabetes (non-diabetic group). Non-diabetic group was
matched for age. The analyzed variables were age, body mass index (BMI), magnesium, calcium,
alkaline phosphatase (ALP), fasting plasma glucose (FPG), serum levels of osteocalcin and
crosslaps, 25-hydroxy vitamin D (25(OH)D) and BMD using Dual-energy X-ray absorptiometry
(DXA).
The mean age of women was 64.218.01 years. In diabetic group the levels of osteocalcin were
22.2614.49 ng/ml and crosslaps 0.340.19 ng/ml. Among these parameters it was a statistically
significant difference (p<0.05) in the studied groups. Although BMD at the lumbar spine and hip
seems to be higher in diabetic women, there was not statistically significant difference among the
studied groups. Diabetic women had a lower plasma 25(OH)D than nondiabetic women (18.65 vs
20.17 ng/ml) but not significant. Magnesium levels were significantly lower in diabetic group than
non-diabetic group. BMI was significantly higher in women with type 2 diabetes (p<0.001). In
bivariate analysis BMD correlates positively with BMI in the diabetic women.
Women with type 2 diabetes have a lower bone turnover than non-diabetic women and BMD
seems to underestimate the diagnosis of osteoporosis in diabetic group. Thereby markers of bone
175
turnover could be potentially better candidates for the evaluation of osteoporosis in the diabetic
patients
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PS35. CONEXIUNEA PUNCTELOR CHEIE N DIABETUL ZAHARAT SECUNDAR
Dr. Alexandra Nila1, Dr. Cristina erbnescu1, Dr. Sorina Martin1, Dr. Sorin Ioacara1, Prof.
Univ. Dr. Simona Fica1, Dr. Sergiu Brsan1, Conf. Univ. Dr. Adrian Miron1
Spitalul Universitar de Urgenta Elias, Sectia Endocrinologie si Diabet, Bucuresti
Afeciunile glandelor endocrine pot duce la toleran alterat la glucoz sau diabet zaharat. Excesul
de hormon de cretere, de glucocorticoizi sau de catecolamine, hiperaldosteronismul primar,
hipertiroidismul, tumorile intestinale sau ale pancreasului endocrin pot reprezenta cauza toleranei
alterate la glucoz sau diabetului secundar.
Prezentm cazul unui pacient de sex masculin n vrst de 29 ani, diagnosticat la vrsta de 27 ani
cu diabet zaharat tip 2 n cursul unei evaluri de rutin. La diagnostic, pacientul avea un IMC
normal, istoric negativ personal sau familial de toleran alterat la glucoz sau diabet zaharat.
Pacientul asocia hipertensiune arterial i migrene ocazionale nsoite de diaforez. A primit
recomandri de diet, tratament antidiabetic cu Metformin 1000 mg, tratament antihipertensiv cu
Nebivolol, Amlodipina i Candesartan. n ianuarie 2016, pacientul s-a prezentat la spital pentru
cefalee sever i criza hipertensiv (TA 260/ 160 mmHg). Examenul clinic a relevat IMC normal
(23.29 kg/m2), tahicardie (AV 120 bpm), hipertensiune arterial (210/ 170 mmHg). Paraclinic:
glicemie la prezentare 173 mg/dl, HbA1c 7.3% (56.3 mmol/mol), fr alte modificari ale analizelor
uzuale. Ecocardiografic, pacientul a fost diagnosticat cu hipertrofie ventricular stng
concentric. n acest context s-a ridicat suspiciunea unei cauze endocrine de hipertensiune arterial
secundar i dup o evaluare complet biologic i imagistic, pacientul a fost diagnosticat cu
feocromocitom (metanefrine plasmatice 56.8 pg/ml, normetanefrine plasmatice 2239.3 pg/ml, CT
abdominal: formatiune tumoral suprarenalian dreapt de 42/ 42/ 40 mm). S-a iniiat tratament
cu inhibitor alfa adrenergic central i blocant de canal de calciu i s-a intervenit chirurgical
(suprarenalectomie dreapt laparoscopic). Postoperator, presiunea arterial i glicemia s-au
normalizat fr tratament. La externare, pacientul a fost instruit s-i automonitorizeze glicemia i
tensiunea arterial i s se prezinte pentru reevaluare peste 2 luni.
Patologiile endocrine pot reprezenta cauza unui diabet zaharat secundar i chiar i patologiile rare,
precum feocromocitomul, trebuie luate n considerare.
PS36. STUDIUL PREZENEI NEUROPATIEI DIABETICE PERIFERICE SENZITIVO-

MOTORII LA UN LOT DE PACIENI INTERNAI
Dr. Oprea Diana1, Rezident Firanescu Adela1, Rezident Voicu Andreea1
Premise i obiective: Principala form de manifestare a afectrii sistemului nervos periferic att
n DZ de tip 1, ct i n DZ de tip 2 este reprezentat de polineuropatia diabetic senzitivo-motorie.
Obiectivul l reprezint studiul prezenei neuropatiei diabetice periferice senzitivo-motorii la un
lot de pacieni internai.
176
Material i metod: Au fost studiai un numr de 236 de pacieni din care 50% femei i 50%
brbai, cu diabet zaharat, internai n Clinica de Diabet a Spitalului Clinic Judeean de Urgen
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Craiova. Numrul de pacieni cu DZ tip 1 a fost de 30 (12,71%), iar cu DZ tip 2 au fost nregistrai
206 pacieni (87,29%). Vrsta medie la pacienii cu DZ tip 1 a fost de 39,76 13,71 ani, iar la cei
cu DZ tip 2 a fost de 61,06 10,58 ani. n ceea ce privete durata DZ, reinem: dintre pacienii cu
DZ tip 1, un numr de 14 (46,67%) au o durat a bolii 10 ani, 9 pacieni (30%) au o durat de
evoluie cuprins ntre 10 i 20 de ani, iar 7 (23,33%) au o durat de evoluie 20 ani; dintre
pacienii cu DZ tip 2, 121 (58,74%) au o durat de evoluie 10 ani, 68 (33,01%) au o durat de
evoluie cuprins ntre 10 i 20 de ani, respectiv 17 (8,25%) sunt cu o durat a DZ 20 ani. Pentru
studiul prezenei neuropatiei diabetice am utilizat scorul Toronto neuropatie uoar scor
Toronto=8-9, moderat=9-11, respectiv sever=12-19. Analiza statistica a fost realizata cu
programele Microsoft Excel si IBM SPSS Statistics 20.0, pentru procesarea datelor.
Rezultate i discuii: Neuropatia diabetic forma sever este prezent la 66,67% dintre subiecii
cu vechimea DZ peste 20 de ani (p=0,022). Neuropatie diabetic forma uoar este prezent n
grupa de vrst 50-59 ani la 56,25% dintre subieci, neuropatia diabetic forma moderat la
43,55% n aceeai categorie de vrst, respectiv 33,87% dintre subieci la grupa de vrst 60-69
ani. Neuropatia diabetic forma sever este prezent la 30,68% dintre subieci cu vrsta cuprins
ntre 60-69 ani, respectiv 27,27% dintre subiecii cu vrsta peste 70 de ani. La 57,95% dintre
subiecii cu neuropatie diabetic sever este prezent hiperkeratoza. 7,95% dintre subiecii cu
neuropatie diabetic sever au suferit amputaii.
Concluzii: Severitatea neuropatiei diabetice este direct proporional cu vechimea DZ (p=0,022).
Exist o diferen semnificativ statistic n ceea ce privete severitatea neuropatiei n funcie de
vrsta pacienilor (p=0,012). De asemenea, s-a nregistrat o diferen semnificativ statistic n ceea
ce privete asocierea hiperkeratozei cu severitatea neuropatiei (p=0,047). n ceea ce privete
asocierea neuropatiei diabetice severe cu amputaiile, exist o diferen semnificativ din punct de
vedere statistic (p=0,033).
STUDY OF THE PRESENCE OF SENSOMOTORY DIABETIC PERIPHERAL

NEUROPATHY IN A GROUP OF HOSPITALIZED PATIENTS
Dr. Oprea Diana1, Rezident Firanescu Adela1, Rezident Voicu Andreea1
Background and objectives: The main manifestation of peripheral nervous system damage in
both type 1 diabetes and type 2 diabetes is represented by diabetic sensory-motor polyneuropathy.
The objective is to study the presence of diabetic sensory-motor peripheral neuropathy in a group
of hospitalized patients.
Material and method: A total of 236 patients were studied, of which 50% women and 50% men,
with diabetes, hospitalized in the Diabetes Department of the Emergency County Hospital Craiova.
The number of patients with type 1 diabetes was 30 (12.71%) and with type 2 diabetes there were
registered 206 patients (87.29%). The average age in patients with type 1 diabetes was 39.76
13.71 years, while those with type 2 diabetes was 61.06 10.58 years. Regarding the duration of
diabetes, we remember: among the patients with type 1 diabetes, 14 (46.67%) have a duration of
the disease 10 years, 9 patients (30%) have a duration of evolution between 10 and 20 years, and
7 (23.33%) have a duration of 20 years; among the patients with type 2 diabetes, 121 (58.74%)
177
have a duration of development 10 years, 68 (33.01%) have a duration of evolution between 10

and 20 years, and 17 (8.25%) have a duration of diabetes 20 years. For the study of the presence
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of diabetic neuropathy we used the Toronto score mild neuropathy Toronto score=8-9, moderate
neuropathy=9-11, respectively severe neuropathy=12-19. Statistical analysis was performed using
Microsoft Excel and IBM SPSS Statistics 20.0 for processing the data.
Results and discussions: The severe form of diabetic neuropathy is present in 66.67% of subjects
with the duration of diabetes over 20 years (p=0.022). The mild form of diabetic neuropathy is
present in the 50-59 age group, at 56.25% of the subjects, moderate form of diabetic neuropathy
at 43.55% in the same age category, respectively at 33.87% of the subjects in the 60-69 age group.
The severe form of diabetic neuropathy is present in 30.68% of the subjects aged between 60-69,
respectively 27.27% of the subjects aged over 70. At 57.95% of the subjects with severe diabetic
neuropathy is present hyperkeratosis. 7.95% of the subjects with severe diabetic neuropathy
suffered amputations.
Conclusions: The severity of diabetic neuropathy is directly proportional with the duration of
diabetes (p=0.022). There is a statistically significant difference regarding the severity of
neuropathy according to the age of patients (p=0.012). Also, a statistically significant difference
has been recorded regarding the association of hyperkeratosis with the severity of the neuropathy
(p=0.047). Regarding the association of severe diabetic neuropathy with amputations, there is a
statistically significant difference (p=0.033).
PS37. CORRELATION BETWEEN MICROALBUMINURIC STAGE AND HBA1C IN

DIABETES

ELIAN1,2
Romania
Bucharest, Romania

Material & Methods:Seventy one type 1 and type 2 diabetic patients were included in the study.
178
analysis .
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Conclusion: Screening for microalbuminuria and HbA1c should be done both in newly and
already diagnosed type 1 and 2 diabetic patients albuminuria being an useful early biomarker of
renal dysfunction and glycemic control.
PS38. QUALITY OF LIFE IN DIFFERENT STAGES OF CHRONIC KIDNEY DISEASE

IN PATIENTS WITH DIABETTES MELITUS.
Pantea-Stoian Anca ,Georgiana Ditu, Cristian Serafinceanu, Viviana Elian.

National Institute of Diabetes ,Nutrition and Metabolic Disease N.C.Paulescu
,Bucharest,Romania
Hygiene and Environmental Health,University of Medicine and Pharmacy" Carol Davila"
Bucharest, Romania
Introduction: The information available on the quality of life of patients on conservative

treatment and the relationship between the quality of life and glomerular filtration rate is limited.
Aim: To compare the dimensions of quality of life in the stages of diabetes chronic kidney disease
and the influence of sociodemographic, clinical and laboratory data.
Methods: 123 (70,7% male N=87 and 29,3% female N=36) patients in stages 1-5 of chronic
kidney disease and diabetes were included . The study was conducted in INDNBM Paulescu
Bucharest ,Nephrology Departament between 2013 and 2015. Quality of life was rated by the
Medical Outcomes Study Short Form 36-Item (SF-36) and functional status by the Karnofsky
Performance Scale. Clinical, laboratory and sociodemographic variables were investigated.
Results: Quality of life decreased in all stages of kidney disease. A reduction in physical
functioning, physical role functioning and in the physical component summary was observed
progressively in the different stages of kidney disease. Older patients performed worse on the
physical component summary and better on the mental component summary. Hemoglobin
HbA1c levels correlated with higher physical component summary values and the Karnofsky
scale.
Conclusion: Quality of life is decreased in renal patients even form the early stages of disease . It
was possible to establish sociodemographic, clinical and laboratory risk factors for a low quality
of life in this population. End-stage complications have the greatest perceived burden on quality
of life; however, comprehensive diabetes treatments also have significant negative quality-of-life
179
effects.
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PS39. SONOGRAPHIC PANCREAS CHANGES IN PATIENTS WITH PANCREATIC
SECONDARY DIABETES.
Anca Pantea-Stoian , Georgiana Ditu2 , Florentina Gherghiceanu4 ,Viviana Elian2,3

Hygiene and Environmental Health, University of Medicine and Pharmacy "Carol Davila"
Bucharest, Romania
2.
National Institute of Diabetes, Nutrition and Metabolic Diseases N.C.Paulescu, Bucharest,
Romania
3.
Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Carol
Davila", Bucharest, Romania
Background: Chronic pancreatitis is a chronic inflammatory disease of diverse etiologies, with

progressive evolution, characterized by reiterative episodes of inflammation and of necrosis and,
subsequently, by glandular tissue fibrosis leading progressively to exocrine and endocrine cells
destruction and finally to pancreatic failure.
Objectives: To determine the most suited test for chronic pancreatitis diagnosis and the
particularities of tissue alterations in patients that associate secondary diabetes mellitus.
Material and Methods: We included 59 patients diagnosed with chronic pancreatitis and
secondary diabetes mellitus, admitted in Gastrology II Department of Fundeni Clinical Institute,
and N.C. Paulescu Diabetes Institut, Bucharest. The study was retrospective. In each patient,
demographic parameters, family and personal history were recorded. All patients were initially
evaluated by transabdominal ultrasound. In selected cases other imagistic methods were used:
computer tomography, endoscopic ultrasound (EUS) and endoscopic retrograde
cholangiopancreatography (EUS-FNA).
Results: Patients age in the studied group ranged between 18 and 81 years with a mean age of
54.14 years (SD=11.75) The most frequent presenting symptom was abdominal pain (85,2%),
followed by denutrition (25.5%), steatorrhea (14.8%), weight loss (4,4%) , and flatulence. The
most frequent etiologic factor of chronic pancreatitis in the studied group was alcohol abuse
(87,8%) and smoking (85.1%). Using ultra sounds imaging methods the following complications
of chronic pancreatitis were diagnosed in the studied group: pancreatic calcifications (59,7%),
Wirsung dilations (49,3%), and Wirsung gallstones (15,3%), complicated or uncomplicated
pseudocysts (38.%), pancreatic cancer (10.2%).
Conclussions: Transabdominal ultrasound is quite accurate in diagnosing chronic pancreatitis and

its morbidities and its non-invasiveness makes it the method of choice in the initial assessment of
the disease. EUS has the advantage of visualizing not just the modifications of the pancreatic ducts,
but also the parenchyma. Moreover, it can be used as EUS-FNA in order to increase the sensitivity
of the differential diagnosis between pseudo-tumoral chronic pancreatitis and pancreatic cancer
but it is more invasive and expensive.
Key words: chronic pancreatitis, transabdominal ultrasounds, diabettes melittus , alchool intake,
smoking.
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PS40. CONTROLUL GLICEMIC AL PACIENILOR CU BOAL CUSHING TRATAI
CU PASIREOTID - PREZENTARE DE CAZ
Resident Andrada-Larisa Pasc1, Resident Adelina Micheu1, Dr. Mariana Roman1, Prof. Dr.
Ionela Maria Pacanu1
Emergency Clinical County Hospital of Tirgu Mures
Pacienii cu boala Cushing prezint un risc crescut de a dezvolta tulburri ale metabolismului
glucidic secundar secreiei crescute de cortizol. Pasireotid este un analog de somatostatin utilizat
pentru tratarea bolii Cushing cnd tratamentul chirurgical este contraindicat sau cnd sunt prezente
recidive. Principalul efect advers al terapiei este hiperglicemia i dezvoltarea diabetului zaharat
secundar.
Pacient n vrst de 49 ani, internat n Compartimentul de Endocrinologie al Spitalului Clinic
Judeean Mures, diagnosticat cu boala Cushing pentru care se intervine chirurgical-
adenomectomie transsfenoidal. Postoperator se evideniaz paraclinic persistena
hipercorticismului i se ncepe tratamentul cu Pasireotid. La o lun de la iniierea terapiei, pacienta
prezint valori crescute ale glicemiei fiind ndrumat ctre specialistul diabetolog.
Pe baza datelor prezentate anterior pacienta ncepe tratamentul antidiabetic cu Metformin, cu
creterea progresiv a dozei. Datorit controlului glicemic nesatisfctor, se asociaz Saxagliptina.
Dup 3 luni de dubl terapie, HbA1C este n afara obiectivelor i se opteaz pentru nlocuirea
Saxagliptinei cu Exenatid. Cazul prezentat e n concordan cu studiile publicate n reviste de
specialitate n ceea ce privete eficiena tratamentului cu Pasireotid n boala Cushing i apariia
hiperglicemiei la aceti pacieni.
Toi pacienii cu boal Cushing pot dezvolta tulburri ale metabolismului glucidic, iar n cazul
celor tratai cu Pasireotid riscul este amplificat, hiperglicemia observndu-se la aproximativ 43%
din pacieni. innd cont de mecanismele fiziopatologice care determin apariia hiperglicemiei
n cazul acestor pacieni, n tratamentul diabetului zaharat se opteaz iniial pentru Metformin,
apoi inhibitori de DPP4, analogi de GLP-1 i n final insulin. Acest lucru atrage atenia asupra
monitorizrii acestor pacieni prin efectuarea de controale regulate i tratament corespunztor.
PS41. STUDIUL OBSERVAIONAL AL LEZIUNILOR CUTANATE LA SUBIECII

CU DIABET ZAHARAT
Dr. Popa Adina1, Dr. Firnescu Adela1, Dr. Voicu Andreea1, Soare Mariana1, Simion
Floriana Maria1, uiu Daniela1, ef Lucr. Popa Simona Georgiana1, Prof. Univ. Dr. Moa
Maria1
Spitalul Clinic Judetean de Urgente Craiova
Premise i Obiective: Impactul diabetului zaharat (DZ) asupra celor mai multe organe a fost
studiat intens de-a lungul anilor, dar pielea, cel mai mare organ al corpului, nu a fost subiectul a
multe studii. Astfel, am propus un studiu care s analizeze leziunile cutanate la subiecii cu DZ.
181
Material i Metod: Am realizat un studiu observaional al leziunilor cutanate la 236 subiecii

neselectionati, internai in anul 2016 n Clinica Diabet Nutriie i Boli Metabolice a Spitalului
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Clinic Judeean de Urgen Craiova, Romnia. Datele clinice i toate datele de laborator au fost
nregistrate la toi subiecii. Analiza statistica a fost realizata cu programele Microsoft Excel
(Microsoft Corp., Redmond, WA, USA) impreuna cu extensia XLSTAT pentru MS Excel
(Addinsoft SARL, Paris, France) si IBM SPSS Statistics 20.0 (IBM Corporation, Armonk, NY,
USA).
Rezultate i Discuii: Din totalul pacientilor luati in studiu, 118 au fost femei (50%) i 118 au fost
brbai (50%), 30 (12,71%) dintre acetia cu DZ tip 1, iar 206 (87,29%) subieci cu DZ tip 2. Un
numr de 208 subieci (88,14%) au prezentat leziuni cutanate. 18 subieci (66,67%) cu DZ tip 1
au prezentat leziuni cutanate, n timp ce acestea au fost prezente la 188 subieci (91,26%) cu DZ
tip 2, procent semnificativ statistic mai mare (p<0.001). Cele mai frecvente leziuni n rndul
populaiei studiate au fost: hipercheratoza plantara (49,15%), onicodistrofia (44,49%),
lipodistrofia (13,98%), carotenodermia (11,02%), intertrigo (6,36%). Ulcerul neuropat a fost
prezent la 2,12% dintre subieci. Alte leziuni ntlnite la subiecii sutidiai au fost faciesul eritrozic,
fisuri, vitiligo, pitiriaziz, dermopatie diabetica, dermita seboreica, dermita de staza, xantelasme,
neurofibromatoza, ihtioza, granulom inelar, vergeturi. Dei literatura de specialitate descrie
asocierea dintre DZ i acanthosis nigricans ca fiind frecventa, niciunul dintre subiecii inclui n
studiu nu au prezentat acest tip de leziune. Cei mai muli pacieni (62,7%) au prezentat asocierea
a cel puin 2 tipuri de leziuni. Am observat o corelaie semnificativ statistic ntre prezena
leziunilor i durata DZ tip 2 (p<0,05).
Concluzii: Pielea este de multe ori sediul unor leziuni la subiecii cu DZ. Studiul nostru confirm
procentul nalt al leziunilor cutanate n DZ, precum i prevalena mai mare a acestora n rndul
subiecilor cu DZ tip 2.
AN OBSERVATIONAL STUDY OF CUTANEOUS MANIFESTATIONS IN DIABETES

MELLITUS
Dr. Popa Adina1, Dr. Firnescu Adela1, Dr. Voicu Andreea1, Soare Mariana1, Simion
Floriana Maria1, uiu Daniela1, Dr. Popa Simona Georgiana1, Prof. Dr. Moa Maria1
Emergency Clinical Hospital Craiova
Premises and Objectives: The impact of diabetes mellitus (DM) on most of the organs was largely
discussed over the years, but skin, which is the largest organ, was not the object of many studies.
Therefore, we designed a study to analyze the cutaneous manifestations in patients with diabetes.
Content and Method: We conducted an observational study of cutaneous manifestation in 236
subjects with DM consecutively hospitalized in the Clinic of Diabetes Nutrition and Metabolic
Diseases of the Emergency County Hospital of Craiova, Romania in 2016. Clinical findings
together with all the laboratory investigations were recorded for each case. Data were analyzed
using Microsoft Excel and SPSS software. Statistical analysis was performed using Microsoft
Excel (Microsoft Corp., Redmond, WA, USA), together with the XLSTAT add-on for MS Excel
(Addinsoft SARL, Paris, France) and IBM SPSS Statistics 20.0 (IBM Corporation, Armonk, NY,
USA) for processing the data.
182
Results and Discussions: We examined 236 subjects, 118 females (50%) and 118 males (50%),
of them 30 (12.71%) having type 1 DM and 206 (87.29%) having type 2 DM. A number of 208
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subjects (88.14%) presented skin lesions. 18 subjects (66.67%) with type 1 DM presented
cutaneous manifestations, while in type 2 DM these lesions were present in 188 subjects (91.26%),
a number statistically significant higher (p<0.001). The most common skin lesions in our study
population were: hyperkeratosis (49.15%), onycodystrophy (44.49%), lipodystrophy (13.98%),
carotenaemia (11.02%), intertrigo (6.36%). Neuropathic ulcers were present in 2.12% of the
subjects. Other lesions observed in the studied patients included: facial erythrosis, skin fissures,
vitiligo, pityriasis, diabetic dermopathy, seborrheic dermatitis, stasis dermatitis, xanthelasma,
neurofibromatosis, ichthyosis, granuloma annulare, striae distensae. Although in the literature DM
is frequently associated with acanthosis nigricans, none of the evaluated subjects presented this
type o lesion. Most of the patients (62.7%) presented a combination of at least two types of lesions.
We found a statistically significant correlation between skin lesions presence and Dm duration
(p<0.05).
Conclusions and Findings: In DM, skin is affected in high percentage. In our study, as described
in the literature, higher prevalence of cutaneous manifestations was met in type 2 DM.
PS42. STUDIU DE CAZ: EFECTUL ANTIINFLAMATOR AL EXENATIDEI
Dr. Popa Alexandru Sebastian1, Dr. Culman Mirela1, Dr. Steriade Oana1, Dr. Matei Monica1
INDNBM "Nicolae Paulescu", Bucuresti
Premise: Pe lng rolul n mbuntirea profilului glicemic, n anumite cazuri, Exenatida reduce
rspunsul inflamator i stresul oxidativ prin suprimarea cii MAPK-protein kinazei mitogen
activate, prin scderea nivelului citokinelor inflamatorii (TNF-alfa, IL-1B i IL-6), precum i prin
creterea rolului antiinflamator al adiponectinei. Aceste efecte sunt non-dependente de controlul
glicemic sau de greutatea corporal.
Obiective: Argumente clinice n favoarea efectului antiinflamator al Exenatidei i punct de plecare
pentru studiul altor indicaii ale acestei clase terapeutice.
Material si metod: 2 prezentri de cazuri clinice
Cazul 1
Pacient n vrst de 50 de ani, cu diabet zaharat tip 2 n evoluie de aproximativ 5 ani,cu obezitate
gr I, HTA i hernie de disc operat, n tratament de 4 ani cu Exenatid 10 g n 2 prize pe zi i 24
u insulin Glargin seara, se interneaz n Secia de Diabet pentru acutizare de boal renal prin
infecie urinar cu E. Coli. Pacienta a fost diagnosticat cu spondilit ankilozant la vrsta de 19
ani, pentru care a primit corticoterapie timp de 8 ani, i pe tot parcursul acestui tratament, AINS
n doze mari, infiltraii cu dexametazon, fizio i kinetoterapie. Asocierea dintre spondilita
ankilozant, obezitate, diabet zaharat tip 2 insulinonecesitant, hernie de disc operat i HTA a
impus un management terapeutic care s asigure concomitent scderea sigur n greutate pentru
descrcarea coloanei i aparatului osteo-articular afectat de spondilit, ameliorarea controlului
metabolic pe toate liniile i un control mai bun al tensiunii arteriale.
Rezultate i discuii: La internarea actual, HbA1c: 7.2 %. De la iniierea tratamentului cu
183
Exenatid i insulin bazal, a sczut n greutate 19 kg. Declar c de la bun nceput i nu dup ce
a sczut n greutate, a constatat ameliorarea semnificativ a simptomatologiei specifice spondilitei
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ankilozante, nemaifiind necesar administrarea de corticoterapie, AINS, infiltraii sau de

kinetoterapie.
Efectul ateptat a nsemnat scderea progresiv n greutate.Efectul neateptat - dispariia durerilor
specifice spondilitei ankilozante. innd cont de asocierea celorlalte comorbiditi precum i bolii
cornice renale st 2 care contraindic utilizarea AINS, am optat pentru continuarea tratamentului
cu Exenatid i insulin Glargin sub care pacienta, de 4 ani, devenise asimptomatic.
Este oare disparitia durerilor un efect independent de scderea n greutate?

Este oare combinatia dintre insulin i Exenatid mai eficient n ameliorarea inflamaiei i
stresului oxidativ dect fiecare dintre ele luate separat?
Cazul 2.
Pacient n vrst de 61 de ani cu diabet zaharat tip 2 n evoluie de 16 ani, poliartrit reumatoid
de 11 ani, HTA, obezitate gr. 2, BCI cu BRS, polineuropatie diabetic senzitiv distal, sub
tratament cu Metformin 850 mg 2cp/zi se prezint n ambulatoriul de specialitate pentru valori
glicemice postprandiale crescute, astenie fizic, dureri poliarticulare invalidante, pentru calmarea
crora folosete zilnic AINS. Pentru poliartrita reumatoid se afl n tratament cu Plaquenil. Acuz
gonalgii bilaterale (8/10), durere la nivelul articulaiilor metacarpofalangiene i interfalangiene i
dureri la mobilizarea articulaiei umrului bilateral. Echilibrul glicemic este satisfctor cu HbA1c
de 7,2%. Asocierea dintre poliartrita reumatoid cu dureri invalidante i limitarea micrilor, cu
diabet i obezitate determin risc de injurie renal prin dozele mari de AINS utilizate i necesit o
abordare care s permit pe ct posibil ameliorarea simptomatologiei dureroase fr a se recurge
la AINS, concomitent cu scderea n greutate i mbuntirea controlului metabolic. Se iniiaz
tratamentului cu analog de GLP-1 cu durat lung de aciune (Exenatid LAR 2 mg o
injecie/sptmn ), cu meninerea dozei de Metformin.
Rezultate i discuii: Revenit pentru evaluare la 9 luni de la iniierea Exenatidei LAR pacienta
declar o net ameliorare a simptomatologiei, cu scdere ponderal de 7 kg, cu dispariia durerilor
din articulaiile mici i umrului, ameliorarea gonalgiilor (5/10), cu recptarea autonomiei de
micare. Echilibrul glicemic este optim cu HbA1c de 6,5%, fr hipoglicemii.
Efectul ateptat a nsemnat o scdere n greutate de 7 kg n 9 luni.
Efectul neateptat - amelioarea poliartralgiilor, inclusiv la nivelul articulaiilor care nu sunt
solicitate de greutatea corporal, nemaifiind necesar administrarea de AINS.
Este dispariia durerilor din articulaiile mici un efect independent de scderea n greutate?
Concluzii: Ambele paciente declar c au constatat o ameliorare net a poliartralgiilor de la
instituirea tratamentului cu Exenatid. De la anumite categorii de pacieni, se acumuleaz din ce
n ce mai multe date concordante cu privire la beneficiile nonglicemice ale tratamentului cu
agoniti ai receptorilor de GLP-1 asociai sau nu cu insulin bazal. Pe lng rolul n mbuntirea
profilului glicemic, n anumite cazuri, acetia se pare c au un important efect antiinflamator.
Astfel, ne putem atepta ca, pe viitor, s asistm la apariia de noi indicaii pentru aceast clas de
medicamente.
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CASE STUDY: THE ANTI-INFLAMMATORY EFFECT OF EXENATIDE
Dr. Popa Alexandru Sebastian1, Dr. Culman Mirela1, Dr. Steriade Oana1, Dr. Matei Monica1
INDNBM "Nicolae Paulescu", Bucuresti
Background: In addition to its role in improving glycemic profile, in some cases, Exenatide seem
to have an anti-inflammatory effect. This is supported by several studies which demonstrate that
the Exenatide reduces the inflammatory response and oxidative stress by suppressing the MAPK
pathway (mitogen activated protein kinase) by reducing the level of inflammatory cytokines (TNF-
alpha, IL-1 and IL-6), and by increasing anti-inflammatory role of adiponectine. These effects are
non-dependent on glycemic control and body weight.
Objectives: Clinical arguments in favor of anti-inflammatory effect of Exenatide and starting
point for studying other indications of this therapeutic class.
Material and Methods: two presentations of clinical cases
Case 1
A 50 years old woman with type 2 diabetes evolving for about 5 years, with gr I obesity, AHT
with surgery for herniated disc in treatment for 4 years with Exenatide 10 mg in 2 doses per day
and 24 U of insulin Glargine evening, is hospitalized in Diabetes Department for acute kidney
injury by E. coli urinary infection. She was diagnosed with ankylosing spondylitis at the age of
19, he received corticosteroids for 8 years, and high doses of NSAIDs, Dexamethasone
infiltrations, physio and physical therapy. The association between ankylosing spondylitis,
obesity, type 2 diabetes, herniated disc surgery and AHT imposed special therapeutic management
to ensure simultaneous decrease of weight in order to download column and osteoarticular system,
to improve all lines of metabolic and hypertension control.
Results and discussions: The initiation of treatment with Exenatide and basal insulin produced a
weight loss of 19 kg. The current HbA1c is 7.2%. From the beginning and not after weight loss,
she found significant improvement of specific spondylitis symptoms and no longer requires the
use of NSAIDs, infiltration or kinesiology.
The expected effect was the progressive decrease in weight. The unexpected effect was the
disappearance of spondylitis specific pain.
Given the comorbidities association with stage 2 chronic kidney disease, which impose the
avoidance of NSAIDs, we decided to keep the treatment (Exenatide and Glargine) as the patient
feels better.
Is it the disappearance of pain an independent effect of weight loss?
Is the combination of insulin and Exenatide more effective in relieving inflammation and oxidative
stress than each of them independently?
Case 2
A 61 years old woman with type 2 diabetes evolving for about 16 years, with rheumatoid arthritis,
hypertension, gr 2 obesity, CID with LBB, diabetic polyneuropathy, treated with metformin 850
mg 2cp/day came in our ambulatory center for increased postprandial glycemia, asthenia,
debilitating joint pain, with daily NSAIDs use to relieve. Rheumatoid arthritis was treated with
Plaquenil. She complains of pain, of the metacarpophalangeal, interphalangeal and knee joints
(8/10) and bilateral pain to shoulder mobilization. The glycemic control was satisfactory - HbA1c
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7.2%. The association between rheumatoid arthritis with debilitating pain and limitation of
movements, diabetes and obesity compose a risk of kidney injury by using high doses of NSAIDs
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and requires a terapeutical approach to ensure simultaneously weight loss, improved metabolic
control and if it is possible, relieve of pain. The treatment was initiated with GLP-1 analog with
long duration of action (Exenatide LAR, 2 mg injection / week), while maintaining the dose of
Metformin.
Results and discussion In the evaluation of 9 months from the initiation of Exenatide LAR our
patient noted a net improvement of symptoms with 7 kg weight loss, the disappearance of small
joints and shoulder pain, improving of knee pain (5/10) with regaining movement independence.
The glycemic control was optimal - HbA1c 6.5% without hypoglycemia.
The expected effect was a 7 kg weight loss in 9 months, with optimal metabolic control.
The unexpected effect was relief of polyarthralgias, including the body weight loaded joints.
Is the disappearance of pain in small joints an independent effect of weight loss?
Conclusions: Both patients have noted a net improvement in pain after the initiation of Exenatide.
From certain patient, the medical practice accumulates increasingly more consistent data on the
nonglycemic benefits of treatment with GLP-1 receptor agonists associated or not with basal
insulin. Besides the role in improving glycemic profile, in some cases, GLP-1 receptor agonists
seem to have an anti-inflammatory effect. Thus, we can expect in the future to witness the
emergence of new indications for this class of drugs.
PS43. STUDIU DE CAZ: ROLUL FICATULUI N DIABETOGENEZ
Dr. Popa Alexandru Sebastian1, Dr. Culman Mirela Ioana1, Dr. Sirotencu Edith1
INDNBM "Nicolae Paulescu, Bucureti
Premise i obiective. Prezentarea de caz are ca scop evidenierea unei posibile legturi ntre
diabetogenez i ciroza hepatic decompensat. n cazul de fa, nlocuirea, prin transplant, a
ficatului cirotic cu unul sntos, a determinat ameliorarea profilului glicemic si scderea
important a necesarului de insulin.
Material i metod. Pacient n vrst de 55 de ani, cu diabet zaharat n evoluie de aproximativ 3
ani, insulinotratat de la debut, se interneaz pentru multiple hipoglicemii nocturne aprute n
ambulator. Nu are antecedente heredocolaterale de diabet. n urm cu un an, pacientul a beneficiat
de un transplant hepatic pentru ciroz hepatic de etiologie mixt - viral (VHB + D) i toxic-
nutriional (consum de etanol i expunere la mercur), decompensat vascular i parenchimatos,
clasa Child C. nainte de transplant, pentru echilibrarea diabetului au fost necesare 73 U insulin/zi,
(0.86 U/kg corp/zi), iar la o lun dup transplant necesarul a sczut la 32 U insulin/zi (0.42 U/kg
corp/zi). La internarea actual, pacientul se prezint cu frecvente hipoglicemii la domiciliu, pe o
schem bazal-bolus cu analogi de insulin totaliznd 29 U insulin/zi, (0.3 U/kg corp/zi).
Biochimic: HbA1c = 6.7%, Bilirubina direct = 0.41 mg/dL, Bilirubina total = 1.09 mg/dL, fr
alte elemente patologice. Frecvena hipoglicemiilor constatate pe parcursul internrii a impus
renunarea la doza de sear de analog rapid de insulin, iar echilibrarea metabolic s-a realizat n
regim Bazal + +, doar cu 10 U insulin/zi (0.1 U/kg corp/zi).
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Rezultate i discuii. Cazul de fa demonstreaz legtura fiziopatologic dintre diabetogenez i

ciroza hepatic. Odat nlocuit ficatul cirotic, prin transplant, se produce o ameliorare
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spectaculoas a echilibrului glicemic. Astfel, pe parcursul unui an de la transplantul hepatic,

necesarul de insulin sczut de 8 ori. Acest lucru este cu att mai relevant cu ct imunosupresoarele
utilizate posttransplant (tacrolimus, ciclosporinele i corticosteroizi) sunt recunoscute ca fiind
diabetogene. Prin urmare, ar fi de mare interes s aflam dac i n ce msur hiperglicemia
posttransplant s-ar datora imunosupresoarelor. Dac aceast ipotez se adeverete, ne-am afla n
faa unui caz de diabet hepatogen care nu este nc unanim acceptat ca entitate clinic distinct. n
acest situaie, rolul central n diabetogenez este ocupat de ficat, nu de pancreas. Din pcate,
pentru a face aceast distincie, ar fi necesar ntreruperea tratamentului imunosupresor, ceea ce
ar crete nepermis de mult riscul de rejet.
Concluzii: mbuntirea spectaculoas a valorilor glicemice i scderea important a necesarului
de insulin dup transplant hepatic, vin n sprijinul ipotezei c, n ciroza hepatic, sediul rezistenei
la insulin este la nivel hepatic i nu periferic.
CASE REPORT: THE ROLE OF THE LIVER IN DIABETOGENESIS
Dr. Popa Alexandru Sebastian1, Dr. Culman Mirela Ioana1, Dr. Sirotencu Edith1
INDNBM "Nicolae Paulescu, Bucureti
Background and objectives. This case report has the purpose of highlighting a possible
connection between diabetogenesis and decompensated liver cirrhosis. The replacement, by
transplantation, of the cirrhothic liver with a healthy one, determined an improvement of the
glycemic profile and an important decrease of insulin requirment.
Material and method. A pacient, at the age of 55, with diabetes mellitus evolving for about 3
years, insulin-treated from the beginning, is hospitalized for multiple nocturnal hypoglicemia. He
doesnt have family history of diabetes mellitus. A year ago, the patient had a liver transplant for
cirrhosis of mixed ethyology viral (VHB + D) and toxic-nutritional (alcohol comsumption and
exposure to mercury). The liver disease was decompensated vascular and parenchymal, class Child
C. Before the liver transplant, for balanced glycemic values, the patient needed 73 Units of insulin
(0.86 U/kg body), but after the transplantation, he only required 32 Units of insulin (0.42 U/kg
body/day). At the current hospitalization, the patient complains about frequent hypoglicemia at
home, using a basal-bolus scheme with insulin analogues totalizing 29 Units (0.3 U/kg body/day).
Biochemical values: HbA1c = 6.7%, Direct bilirubin = 0.41 mg/dL, Total bilirubin = 1.09 mg/dL,
without other pathological values. The frequency of hypoglicemia during hospitalization imposed
quitting the evening dose of rapid acting insulin analogue, the metabolic balanced being realised
with a Basal + + insulin regimen totalizing 10 Units of insulin / day (0.1 U/kg body/day).
Results and discussions. This case shows the physiopathologycal connection between
diabetogenesis and decompensated liver cirrhosis. Once the cirrhotic liver is replaced, we observe
a dramatic improvement of the metabolic balance. In this case, after an year from the liver
transplantation, the insulin requirment decreased 8 times. This is even more relevant if we consider
that the immunosuppressive treatment used after the transplantation (tacrolimus, cyclosporine and
corticosteroids) is known for beign diabetogenic. It would be very interesting to find out if the
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hyperglicemia after the replacement of the liver is caused by the immunosuppressive treatment. If
this hypothesis would be true, we would be facing a case of hepatogenic diabetes, in which the
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central role of the disease is the liver, not the pancreas, but which is not yet accepted as a distinct
clinical entity. Unfortunately, to make this distinction, we would have to stop the
immunosuppressive treatment, this being impossible, because it would raise the risk of transplant
rejection very much.
Conclusions. The dramatic improvement of the glycemic values, and the important decrease of
insulin requirment after the liver transplant, support the hypothesis that, in cirrhosis, the center of
insulin resistance is the liver.
PS44. IMPACTUL POLINEUROPATIEI DIABETICE PREDOMINANT SENZITIVE

SIMETRICE DISTALE ASUPRA PSIHICULUI PACIENTULUI CU DIABET
ZAHARAT
Dr. Popescu Simona1, Dr. Timar Bogdan1, Dr. Diaconu Laura1, Dr. Timar Romulus1
1
Universitatea de Medicin i Farmacie Victor Babe Timioara
Premise i obiective: La ora actual asistm la o adevrat epidemie a bolilor metabolice, fapt
reflectat de creterea alarmant a incidenei diabetului zaharat (DZ) tip 2. Una dintre cele mai
frecvente complicaii cronice ale DZ e reprezentat de polineuropatia senzitiv simetric distal
(PSSD). Aceasta reprezint o cauz major de morbiditate i mortalitate n rndul pacieniilor cu
DZ.
Scopul studiului nostru este s evaluam impactul PSSD asupra psihiculi pacientului cu DZ tip 2.
Material i metod: lotul nostru de studiu a cuprins un numr de 198 de pacieni, diagnosticai
anterior cu DZ tip 2. PSSD a fost diagnosticat pe baza criteriilor instrumentului de scor Michigan.
Am considerat diagnosticul de PSSD, dac a fost prezent oricare criteriu din urmtoarele: scor
total 9,5 sau scor la evaluarea subiectiv 7 sau scor la examenul obiectiv 2,5. Cu ct valoarea
acestui scor a fost mai mare, cu att PSSD a fost considerat mai sever. Depresia am evaluat-o
cu ajutorul chestionarului PHQ 9. Am considerat c un scor < 14 corespunde absenei depresiei,
un scor ntre 15- 19 reprezint depresie moderat, iar un scor 20, depresie sever.
Rezultate i discuii: n grupul nostru de studiu depresia, evaluat cu ajutorul chestionarului PHQ
9 a avut urmtoarea distribuie: depresie absent 29,8% (59 pacieni), depresie moderat 52,5%
(104 pacieni) iar depresia sever a fost ntlnit la 17,7% (35 pacieni). Prevalena PSSD, n lotul
nostru de studiu a fost de 28,8%.
Prevalena depresiei a fost semnificativ mai crescut n rndul pacieniilor cu PSSD, comparativ
cu grupul fr PSSD (77,2% vs 67,4%, p<0,001). Iar n ceea ce privete severitatea depresiei:
prevalena depresiei severe a fost mai mare n rndul pacienilor cu PSSD 36,8%, comparativ cu
pacienii fra PSSD, 9,9%.
Concluzii: am observat o corelaie moderat, direct i semnificativ statistic, ntre severitatea
PSSD i severitatea depresiei. ntre cele dou exista un coeficient de corelaie Sperman de 0,495,
cruia i corespunde o valoare p<0,001. Aceast corelaie direct sugereaz c pacienii cu PSSD
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mai sever, de regul vor avea simptomatologie mai pregnant n legtur cu depresia.
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IMPACT OF DISTAL SYMMETRIC POLYNEUROPATHY ON THE PSYCHIC OF
TYPE 2 DIABETES PATIENTS
Dr. Popescu Simona1, Dr. Timar Bogdan1, Dr. Diaconu Laura1, Dr. Timar Romulus1
1
Universitatea de Medicin i Farmacie Victor Babe Timioara
Premises and Objectives: currently we are witnessing at a veritable epidemic of metabolic

diseases, as reflected by the alarming increase of type 2 diabetes mellitus (T2DM). Distal
symmetric polyneuropathy (DSPN) is the most common neuropathic complication of diabetes.
DSPN is a major cause of morbidity and mortality.
The aim of our study is to assess the impact of DSPN on the patient's psychic.
Content and Method: for this study, we enrolled 198 patients, previously diagnosed with T2DM.
DSPN was assessed using the Michigan Neuropathy Screening Instrument (MNSI). We considered
positive for overt neuropathy the presence of one out of the following criteria: a global score 9.5
respectively questionnaire score 7 or clinical score 2.5. A higher score is associated with more
severe neuropathy. Depression was assessed by using the PHQ 9 questionnaire. We consider:
depression is absent at a score <14, moderate depression a score between 15- 19 and severe
depression 20.
Results and Discussions: In the study group, as interpreted PHQ-9 score instrument, depression
scores distribution was as follows: absent 29.8% (59 patients), moderate 52.5% (104 patients)
severe 17.7% (35 patients). The prevalence of DSPN has also been 28.8%.
The prevalence of depression of any severity was significantly increased in patients with DSPN
compared with the subgroup without DSPN (77.2% vs. 67.4%; p <0.001). Also, with regard to the
severity of depression: the prevalence of severe depression is higher among patients with DSPN,
36.8%, compared with patients without DSPN 9.9%.
Conclusions: We observed a moderate correlation, direct and statistically significant between the
severity of the DSPN, assessed using the MNSI score, and the depression severity as assessed by
PHQ-9 scores. Between these two, there is a correlation coefficient Sperman of 0,495 with a
corresponding p-value <0.001. This direct correlation suggests that patients with severe DSPN
usually will have more obvious symptoms related to depression.
PS45. PREVALENA STEATOZEI HEPATICE LA PACIENII CU DIABET

ZAHARAT TIP 2
Alina Gabriela Prefac1, Ana Maria Busneag1, Ramona Maria Drgu2, Cristina Stoian1,
Florentina Stoicescu1, Emilia Rusu2, Gabriela Radulian1,2
1.
Institutul Naional de Diabet Nutriie i Boli Metabolice "N Paulescu"
2.
Universitatea de Medicin si Farmacie Carol Davila
Premize i Obiectie: Steatoza hepatic (SH) are o preven crescut la pacienii cu diabet zaharat
tip 2, ns consecinele sale metabolice nu sunt pe deplin cunoscute. Acest studiu are ca obiectiv
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evaluarea prevalenei steatozei hepatice la pacienii cu diabet zaharat tip 2 i relaia cu

componentele sindromului metabolic.
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Material i metod: Acest studiul transversal, observaional, s-a desfurat n Institutul Naional
de Diabet, Nutriie i Boli Metabolice "Prof. N. Paulescu", a inclus un numar de 200 de pacieni
cu diabet zaharat tip 2 (67,5% brbai), cu vrsta medie=61,3810,51 ani. Am urmrit indici
antropometrici (greutate, nlime, circumferina taliei, (Indice de masa corporala) IMC-ul).
Parametrii biochimici urmrii au fost: glicemia jeun, hemoglobina glicozilat, profilul lipidic,
profilul hepatic i hemoleucograma. Steatoza hepatic a fost diagnosticat ultrasonografic.
Sindromul metabolic (SM) a fost definit conform criteriilor IDF 2005.
Rezultate i discuii: Din cei 200 de pacieni, 32,5% au avut steatoz hepatic, iar din acetia
67,7% au fost de sex masculin. Din cei 65 pacieni cu SH, 44 pacieni au fost insulinotratai. 86,2%
din pacienii cu SH au avut HTA, 76,9% cu obezitate (IMC>30 kg/m2), 53,8% din pacienii cu SH
au avut HDL-colesterol sczut, iar 60% au prezentat valori crescute ale trigliceridelor. 96,9% din
pacienii cu SH au asociat SM, asociind circumferinele abdominale mult mai mari fa de cei fr
SH (p=0,002). Boala cardiac ischemic a fost ntlnit la un procent de 38,5%. Nu s-au constatat
diferene n ceea ce privete echilibrul metabolic (HbA1c a avut o valoare medie de 8,921,86%
la cei cu SH fa de 8,842,06% la cei fr SH).
Concluzii: Sindromul metabolic a fost frecvent asociat cu steatoza hepatic. Steatoza hepatic
poate fi considerat component a sindromului metabolic la pacienii cu diabet zaharat.
THE PREVALENCE OF HEPATIC STEATOSIS IN PATIENTS WITH TYPE 2

DIABETES MELLITUS
Alina Gabriela Prefac1, Ana Maria Busneag1, Ramona Maria Drgu2, Cristina Stoian1,
Florentina Stoicescu1, Emilia Rusu2, Gabriela Radulian1,2
1.
Institutul Naional de Diabet Nutriie i Boli Metabolice "N Paulescu"
2.
Universitatea de Medicin si Farmacie Carol Davila
Premises and objectives: Hepatic steatosis has a high prevalence in patients with type 2 diabetes
mellitus, however its metabolic consequences are not fully known. This study aims to evaluate the
prevalence of hepatic steatosis in patients with type 2 diabetes mellitus and the relationship with
the metabolic syndrome components.
Material and method: This cross-sectional, observational study was held in the National Institute
of Diabetes, Nutrition and Metabolic Diseases "Prof. N. Paulescu" and included 200 patients with
type 2 diabetes mellitus (67.5% men) with average age = 61.38 10.51 years. We followed
anthropometric indices (weight, height, waist circumference, (Body Mass Index) BMI).
Biochemical parameters were: fasting blood glucose, glycosylated hemoglobin, lipid profile, liver
profile and complete blood count. Hepatic steatosis was diagnosed using ultrasonography.
Metabolic syndrome (MS) was defined according to the 2005 IDF criteria.
Results and discussions: Of the 200 patients, 32.5% had hepatic steatosis, and of these, 67.7%
were male. Of the 65 patients with hepatic steatosis, 44 patients were treated with insulin. 86.2%
of the patients with hepatic steatosishad hypertension, 76.9% were obese (BMI> 30 kg / m2),
53.8% of patients with hepatic steatosis had low values of HDL cholesterol and 60% of them had
190
high values of triglycerides. 96.9% of the patients with metabolic syndrome associated with
hepatic steatosis, had the abdominal circumferences much higher than those without hepatic
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steatosis (p = 0.002). Ischemic heart disease was present in a proportion of 38.5%. No differences
were found in terms of metabolic control (HbA1c had a mean valueof 8.92 1.86% in patients
with hepatic steatosis towards8.84 2.06% in those without hepatic steatosis).
Conclusions: Metabolic syndrome was frequently associated with hepatic steatosis. Hepatic
steatosis could be considered as a component of the metabolic syndrome in diabetic patients.
PS46. BILATERAL CATARACT IN A 14-YEAR-OLD WITH TYPE 1 DIABETES
Assoc. Prof. Puiu Ileana1, Prof. Niculescu Carmen1, Assist. Marinau Laura1, Assist. Dop
Dalia1, Senior Lect. Singer Cristina1, Rezident Puiu Alexandra Oltea1
Univesrsity of Medicine and Pharmacy Craiova
Cataract is a very rare disease during childhood, with a prevalence of under 1% in children with
diabetes, although it is common in adults with diabetes. The risk factors of cataract in children
with diabetes are: adolescence, history of long lasting hyperglycemia, diabetic ketoacidosis at
onset, high level of HbA1c at onset and, possibly, genetic factors.
Authors present the case of a 14-year-old boy admitted in Pediatric Clinic from Craiova in January
2016. The boy had a weight of 44 kg, height of 168 cm, BMI 15, previously healthy, with history
of type 2 diabetes in the family. Immediately after being diagnosed with type 1 diabetes, he was
also diagnosed with acquired bilateral cataract. Four weeks before admission, the adolescent
presented classical symptoms of diabetes: polyuria, polydipsia, severe weight loss. At admission,
the adolescent showed signs of severe diabetic ketoacidosis. Biological tests revealed the
following values: glycemia 900mg%, HbA1c 16,4%, C Peptide 0.223 ng/ml. The patient presented
blurred vision immediately after admission and posterior bilateral subcapsular cataracts was
diagnosed by ophthalmological examination; fundus examination revealed no abnormalities. The
patient currently has good glycemic control and is monitored by the pediatric and ophthalmologic
departments.
In patients newly diagnosed with type 1 diabetes, acute bilateral cataract can appear at onset of
diabetes or in a few weeks or months after being diagnosed. Visual symptoms are caused by the
hyperosmotic effect in the lens, due to long-term hyperglycemia. Catarct severity can vary from
mild forms to total loss of vision in a few days.
The presence of blurred vision at the child with type 1 diabetes in the first weeks or months after
diabetes onset should warn us of possible cataract and the need for a complete ophthalmological
examination. Although it is a rare diagnosis, early discovery and surgical treatment are essential
in order to prevent vision loss. However, scientific research mentions that when cataract appears
at diabetes onset, in some patients regression can be achieved after insulin treatment and if good
glycemic control is maintained.
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PS47. TRECEREA CU SUCCES PE SUFLONILUREICE LA O PACIENT N VARSTA
DE 9 ANI CU RETARD DE DEZVOLTARE NEUROPSIHIC, EPILEPSIE I DIABET
ZAHARAT NEONATAL - SINDROM DEND
Dr. Purcaru Mircea1, Dr. Mintici Luana1, Dr. Herescu Irina1, Dr. Ioacara Sorin1, Prof. Dr.
Fica Simona1
1
Spitalul Universitar de Urgenta Elias
Sindromul DEND este o patologie foarte rar (<1/1.000.000), i reprezint cea mai sever form
de diabet zaharat neonatal permanent. Patologia este caracterizat prin retard de dezvoltare
neuropsihica, epilepsie de obicei rezistent la tratamentul antiepileptic i diabet zaharat neonatal.
Acesta este cauzat cel mai adesea de o mutaie aparut la nivelul genelor KCNJ11 / ABCC8 care
codeaz subunitatea Kir 6.2 i respectiv SUR1, de la nivelul canalului de K ATP-dependent.
Prezentarea cazului: Pacient n vrst de 9 ani i 11 luni, diagnosticat cu diabet zaharat
neonatal la varsta de 3 luni se prezint pentru crize repetate de absenteism nensoite de
hipoglicemie, care n ultimile 2 luni au interferat semnificativ cu buna desfurare a activitilor
cotidiene, interpretate ca epilepsie minora, cu solicitarea sprijinului n vederea iniierii
tratamentului specific neurologic. Din anamneza reinem c dup diagnosticarea diabetului a fost
tratat iniial cu insulinoterapie timp de 6 luni, urmat de tratament cu antidiabetice orale
(glibenclamid), timp de 8 ani, i de un an are insulinoterapie bazal bolus, iniiat n ianuarie 2015
pentru hiperglicemie persistent cu HbA1c=10,6% (fr glibenclamid). De asemenea, prezint i
retard de dezvoltare neuropsihic moderat. Clinic nu se deceleaz modificari patologice.
Paraclinic, analizele de laborator sunt modificate astfel: HbA1C = 10,3% (89 mmol/mol), glicemii
a jeun 200-300 mg/dl, glucozurie important. Testele genetice arat o mutaie heterozigot a genei
KCNJ11, responsabil de declanarea diabetului neonatal.
Se iniiaz tratament cu glibenclamid 3,5 mg, crescut treptat pn la 8tb/zi, cu rspuns foarte bun
la tratament. n vederea ameliorrii retardului de dezvoltare psihomotoriei pacientei i se
recomand stimularea funciilor cognitive prin diverse exerciii, minim 4-5 ore/zi. Reevaluarea
clinico-biologica la 3 luni arat dispariia complet a episoadelor de epilepsie minor (cu
absenteism), glicemii n intele terapeutice i HbA1C = 7,3% ( 56 mmol/mol)
Concluzii: n cazul pacienilor identificai cu diabet zaharat neonatal trebuie realizate teste gentice,
ntrucat mutaia genei KCNJ11 / ABCC8 poate fi asociat cu posibilitatea nlocuirii
insulinoterapiei cu tratamentul oral cu sulfonilureice. De asemenea, tratamentul cu sulfonilureice
reuete s trateze i crizele de epilepsie i s nbunteasc, cel putin partial, att dezvoltarea
motorie ct i cea neuropsihic.
SUCCESSFUL TREATMENT WITH SULFONYLUREAS AT A 9 YEAR OLD PATIENT

WITH NEUROPSYHICAL DEVELOPMENT DELAY, EPILEPSY AND NEONATAL
DIABETES DEND SYNDROME
Dr. Purcaru Mircea1, Dr. Mintici Luana1, Dr. Herescu Irina1, Dr. Ioacara Sorin1, Prof. Dr.
Fica Simona1
1
Spitalul Universitar de Urgenta Elias
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DEND syndrome is a very rare disorder (<1 / 1,000,000), and is the most severe form of permanent
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neonatal diabetes. Pathology is characterized by neuropsychiatric development delay, epilepsy

usually resistant to antiepileptic treatment and neonatal diabetes. It is most often caused by a
mutation occurs in the gene KCNJ11 / ABCC8 encoding SUR1 subunit Kir 6.2, respectively, from
the K ATP channel -dependent.
Case presentation: Patient aged 9 years and 11 months, diagnosed with diabetes neonatal at 3
months, presented for repeated episodes of absenteeism accompanied by hypoglycemia, which in
the last two months have interfered significantly with daily activities interpreted as minor epilepsy,
with the request to initiate specific neurological treatment. Anamnesis showed that after the
diagnosis of diabetes, the patient was treated initially with insulin for 6 months, followed by
treatment with oral antidiabetics (glibenclamide) for 8 years and after that one year with insulin
basal bolus, initiated in January 2015 for persistent hyperglycemia with HbA1c = 10.6% (no
glibenclamide). It also presents moderately retarded neuropsychological development. Clinic
exam reveals no pathological changes. Some laboratory tests are modified: HbA1c = 10.3% (89
mmol / mol), fasting blood glucose 200-300 mg / dl, important glucosuria. Genetic tests show a
heterozygous mutation of the gene KCNJ11 responsible for neonatal onset of diabetes.
A treatment with glyburide 3.5 mg is initiated and is increased gradually up to 8TB / day, with
very good response to treatment. In order to improve psychomotor development delay, the patient
is encouraged to make various exercises to stimulate cognitive functions, minimum 4-5 hours /
day. Clinical and biological reassessment at 3 months shows complete disappearance of episodes
of minor epilepsy ( with absenteeism ) , blood glucose and HbA1C in therapeutic targets = 7.3 %
( 56 mmol / mol ).
Conclusions: In case of patients with neonatal diabetes mellitus, genetic tests should be done
because KCNJ11/ABCC8 gene mutation can be associated with replacement of intensive insulin
therapy with sulfonylureas. Also sulfonylureas treatment can cure epilepsy seizures and improves
psychomotor development.
PS48. CARACTERISTICI ALE BOLII ARTERIALE PERIFERICE LA PACIENTUL

CU DIABET ZAHARAT TIP II
Dr. Radu Florentina1, Dr. Petrache Daniela1, Dr. Buneag Ana Maria1, Dr. Cusi Daniela1,
Dr. Murean Alexandra1, Dr. Grosu Irina1, l. Dr. Rusu Emilia1, Prof. Dr. Radulian
Gabriela1
1
UMF Carol Davila Bucuresti
Premise i Obiective: Boala arterial periferic (BAP) reprezint una din complicaiile Diabetului
Zaharat tip II (DZ II) care augmenteaz riscul cardiovascular(RCV) al acestei populaii; RCV de
obicei crescut n condiiile n care fenotipul individului cu DZ II nsumeaz elementele
sindromului metabolic(SM). Acest studiu are ca scop evidenierea prevalenei BAP i factori
asociai acesteia ntr-un lot de pacieni cu DZ II.
Material i Metod: Studiu retrospectiv, observaional, care a cuprins 229 pacieni cu DZ II, ce
au fost mprii n 2 loturi: control 176 de pacieni fr BAP i cel de studiu 53 de pacieni cu
BAP. Pentru ambele loturi au fost notate date clinice, antropometrice, prezena hipertensiunii
arteriale(HTA), a bolii cardiace ischemice(BCI), a retinopatiei diabetice(RD), a neuropatiei
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diabetice(ND) i a bolii renale cronice(BRC). BAP a fost definit printr-o valoare a indicelui
glezn-bra 0,9 sau prin prezena simptomatologiei/semnelor sugestive n contextul unui puls
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periferic slab.
Rezultate i Discuii: 142 de pacieni(62%) au fost de sex masculin, vrsta medie a fost de
61,5210,52 ani iar vechimea medie a DZ II a fost de 11,68,03 ani. BAP a fost prezent la 53
pacieni, iar 28,3% din acetia aveau stadiul IV BAP. 56,6% din pacienii cu BAP erau obezi,
75,5% erau hipertensivi,81% au fost ncadrai cu SM, 47,2% aveau BCI , 94,3% prezentau ND iar
60,4% ndeplineau criteriile de BRC. Comparativ cu lotul control, cei cu BAP au necesitat ntr-un
procent mai crescut insulinoterapie pentru controlul glicemic, au avut valori mai mare ale TA i
au prezentat ntr-un procent mai mare ND i RD. Nu au fost nregistrate diferene semnificative
statistic n ceea ce privete prezena BCI i a BRC. Cei cu std IV BAP au asociat valori glicemice
crescute i valori patologice ale profilului lipidic(p0,05) comparativ cu lotul martor.
Concluzii: Tabloul clinic i paraclinic al acestui lot de studiu evideniaz importana
diagnosticului i managementului terapeutic precoce al BAP pentru a putea scdea RCV al acestor
pacieni n contextul n care severitatea acestei patologii crete cu vrsta, vechimea DZ II, prezena
ND i a RD.
CHARACTERISTICS OF THE PERIPHERAL ARTERIAL DISEASE IN PATIENTS

WITH TYPE 2 DIABETES
Dr. Radu Florentina1, Dr. Petrache Daniela1, Dr. Buneag Ana Maria1, Dr. Cusi Daniela1,
Dr. Murean Alexandra1, Dr. Grosu Irina1, l. Dr. Rusu Emilia1, Prof. Dr. Radulian
Gabriela1
1
Peripheral arterial disease(PAD) is one of the type 2 diabetes mellitus(DM2) complications that
increases the cardiovascular risk(CVR); this CVR is ussualy high taking into acount the DM2
phenotype adds up the characteristics of the metabolic syndrome(MS).
Retrospective, observational study which included 229 patients with type 2 diabetes; they were
divided into 2 groups: the control- 176 patients without PAD and the study group 53 patients with
PAD. For both groups were noted clinical data, anthropometric data, presence of hypertension
(HTA), ischemic heart disease (IHD), diabetic retinopathy (DR), diabetic neuropathy (DN) and
chronic kidney disease (CKD). PAD was defined by an ankle-brachial index value 0,9 or by the
presence of symptoms / signs suggestive in the context of a weak peripheral pulse.
142 (62%) patients were males, the mean age of the group was 61,5210,52 years and the average
age of the diabetes was 11,68,03 years. PAD was present in 53 patients, 28.3 % of those with
stage IV PAD. 56.6% of patients with PAD were obese, 75.5% were hypertensive, 81% were
classified with MS, 47.2% had IHD, 94.3% showed ND and 60.4% qualify for CKD. Compared
with the control group, those with PAD have required in a higher percentage insulin for glycemic
control, had higher blood presure values and showed a higher percentagein DN and in DR. There
were no statistically significant differences regarding the presence of IHD and CKD. Those who
experienced BAP std IV associated pathological values for glucose and lipid profile (p<0.05)
compared with controls.
The clinical and laboratory study of this group highlights the importance of early diagnosis and
therapeutic management of PAD, in order to decline the CVR of these patients ,given that the
severity of this condition increases with age, seniority of DM and with the presence of DN and
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DR.
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PS49. CORRELATIONS BETWEEN GLYCOSYLATED HEMOGLOBIN AND THE
NUTRITIONAL THERAPY IN PATIENTS WITH TYPE TWO DIABETES TREATED
WITH INSULIN
Rezident Radu Raluca1, Dr. Cristofor Cornelia1, Rezident Ilinca Alexandra1, Dr. Rusu
Emilia1, Rezident Pruteanu Diana1, Prof. Dr. Radulian Gabriela1
INDNBM N. Paulescu
Introduction: The nutritional therapy is known as an extremely important part of diabetes

management and evolution. The purpose of all these actions is to optimize metabolic control, to
prevent acute and chronic complications and the most important of them all: improving quality of
life.
Goal: To asses the relationship between HbA1c, knowledge about nutrition therapy and the
management of hypoglycaemia and hyperglycaemia in patients with type 2 diabetes treated with
insulin.
Material and method: We evaluated a group of 101 patients with type 2 diabetes treated with
insulin and hospitalized in INDBM Prof. Dr. N. Paulescu , during 10.08.2015-10. 02.2016 . The
patients had to answer a questionnaire made of 10 questions in order to verify their knowledge on
nutrition and so on self-monitoring. The questionnaire has been applied before and after nutritional
education program. Program topics included knowledge of calculating carbohydrate meals, self-
glycemic automonitorization, physical activity, insulin therapy, hypoglycaemia- and
hyperglycaemia and complications of diabetes . Education sessions were held in groups.
Results and discussions: The study included 101 patients known with type 2 diabetes and treated
with insulin. The average age of 54.17 15,06 years ,with a mean of age of diabetes 7,94 [6,37-
9,51] years. HbA1c < 7% was observed in 4%(n=4), HbA1c<7,5 in 9,9%(n=10) and HbA1c>9%
was observed in 66,3%(n=67). Patients with HbA1c levels between 7,5%-8% were well informed
on diet and the management of hyper and hypoglycaemia(p<0.005). In patients with different
levels of HbA1c ( variations between <7% and >9%) the management and knowledge of
hypoglycaemia are still insufficiently known( p<0,021)
Conclusions: Due to the results we obtained in this study, we noticed that the management of
hyper and hypoglycaemia is still insufficiently applied and understood by our patiens despite to
our enormous efforts in explaining continuously about it during the educational programs. In this
case, we strongly stand for continuing our programs of education especially for patients with type
2 diabetes treated with insulin.
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PS50. EXPERIENE DIN SCREENINGUL NEUROPATIEI N POPULAIA
DIABETIC: REZULTATELE UNUI STUDIU TRANSVERSAL
Dr. Roman Deiana1, Prof. Dr. Timar Romulus1, Dr. Trziu Maria1, Dr. Lazr Sandra1, Dr.
Timar Bogdan1
1
Premise i obiective: Neuropatia diabetic (ND) este o complicaie prevalent i precoce a

diabetului zaharat (DZ), avnd un impact major asupra sntii pacientului i asupra calitii vieii
acestuia. ND este citat a fi prezent n pn la din pacienii cu DZ, fiind asociat cu o durat mai
lung a bolii i un control glicemic necorespunztor. Alturi de alte complicaii ale DZ, aceasta
este cauzat de un dezechilibru metabolic de lung durat, asociat cu valori glicemice mai mari.
Obiectivele studiului nostru au fost de a evalua prevalena ND n populaia diabetic general i
de a investiga asocierea sa cu alte complicaii ale DZ: retinopatia i boala cronic de rinichi (BCR).
Material i Metod: Am efectuat screeningul complicaiilor ND la un lot de 198 de pacieni cu

DZ tip 2: ND, retinopatie i BRC, ntr-un scenariu de studiu cu design transversal, consecutiv
populaional. Pacienii nrolai au avut o median a vrstei de 61 de ani i o median a duratei DZ
de 7 ani. Prezena ND a fost evaluat cu ajutorul Instrumentului de Screening al Neuropatiei
Michigan (MNSI), criteriile de diagnostic pozitiv fiind oricare unul dintre urmtoarele: un scor
global mai mare de 10 puncte sau un chestionar cu un scor mai mare dect 7,5 puncte, respectiv,
un scor mai mare de 2,5 puncte la examen clinic. Diagnosticul de BCR a fost stabilit conform
criteriilor ghidului KDIGO 2012, iar diagnosticul de retinopatie pe baza examinrii fundului de
ochi.
Rezultate i Discuii: Prevalena ND n lotul nostru de studiu, n conformitate cu criteriile de

diagnostic prezentate mai sus a fost de 28,8% (57 cazuri), avnd un interval de ncredere pentru
estimarea populaional cuprins ntre 21,8% i 37,3%. Prezena ND s-a asociat cu o vrst mai
naintat (64.4 vs 59.5 ani; p = 0,002), o valoare crescut a HbA1c (8,6% fa de 8,0%, p = 0.027)
i un IMC mai crescut (31,9 vs 29,9 kg/m2; p = 0,003). Se observ o inciden semnificativ
crescut a celorlalte complicaii ale DZ investigate la pacienii cu ND comparativ cu cei fr ND:
BCR (56,1% vs. 14,2%; p <0,001) respectiv retinopatie (54,4% vs. 22,0%; p <0,001).
Concluzii: ND este o complicaie frecvent a DZ. Prevalena ND este mai crescut la pacienii
vrstnici, la pacienii cu control glicemic deficitar i la pacientii cu IMC mai mare. Pacienii cu
ND au o probabilitate semnificativ crescut de a prezenta i alte complicaii ale DZ.
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SCREENING FOR NEUROPATHY IN GENERAL DIABETIC POPULATION:
FINDINGS OF A CROSS-SECTIONAL STUDY
Dr. Roman Deiana1, Prof. Dr. Timar Romulus1, Dr. Trziu Maria1, Dr. Lazr Sandra1, Dr.
Timar Bogdan1
1
Background and aims: Diabetic neuropathy (DN) is a prevalent and early complication of
Diabetes Mellitus (DM) having a major impact on the patients health and quality of life. DN is
cited to be present in up to of the patients with DM, being associated with a longer DM duration
and poor glycemic control. Along with other DM complications, it is caused by a long-time
metabolic imbalance, associated with higher glycemic values.
Our study aims were to evaluate the prevalence of DN in general diabetic population and to assess
its association with other DM complications: retinopathy and chronic kidney disease (CKD).
Material and method: We screened for DN, retinopathy and CKD 198 patients with type 2 DM,
in a consecutive-case populational based cross-sectional study. The enrolled patients had a median
age of 61 years and a median DM duration of 7 years. The presence of DN was evaluated using
the Michigan Neuropathy Screening Instrument (MNSI), the positive diagnosis criteria being one
of the following: a global score higher than 10 points or a questionnaire score higher than 7.5
points respectively a score higher than 2.5 points at the clinical examination. The diagnosis of
CKD was established according KDIGO 2012 guideline criteria and the diagnosis of retinopathy
based on the fundoscopy examination.
Results: The prevalence of DN in our study cohort, according to the diagnosis criteria presented
before was 28.8% (57 cases), having a 95% populational confidence interval rate of 21.8% to
37.3%. The presence of DN was associated with a higher age (64.4 vs. 59.5 years; p=0.002),
HbA1c (8.6 % vs. 8.0%; p=0.027) and BMI (31.9 vs. 29.9 kg/m2; p=0.003). Also, patients with
DN had a higher incidence of CKD (56.1% vs. 14.2%; p<0.001) and retinopathy (54.4% vs. 22.0%;
p<0.001).
Conclusions: DN is a frequent complication of DM. The prevalence of DN is increasing in older
patients, patients with poor glycemic control and patients with higher BMI. Patients with DN have
a significantly higher prevalence of other DM complications.
PS51. INDEXUL TRIGLICERIDE GLUCOZ I RAPORTUL LIPIDELOR CA

MARKERI AI RISCULUI DE INSULINOREZISTEN N PRACTICA CLINIC
Dr. Rusu Emilia1, Dr. Enache Georgiana1, Dr. Rusu Florin1, Dr. Drgu Ramona Maria1,
Dr. Cursaru Raluca1, Dr. Stoicescu Florentina1, Conf. Dr. Jinga Mariana1, Prof. Univ.
Radulian Gabriela1
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Premise i obiective: Obiectivul acestui studiu a fost acela de a evalua relaia dintre produsul
trigliceride i glucoz (indicele TyG) i raportul lipidelor (colesterol total [CT]/ lipoproteine cu
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densitate moleculara mare [HDL-C], trigliceride [TG]/HDL-C) i rezistena la insulin la aduli.

Material i metode: Datele analizate n acest studiu (n=208), aparin pacienilor inclui n
proiectul Adipocitokinele, punte de legatur ntre diabetul zaharat tip 2 i hepatita cronic cu
virus C)(DIADIPOHEP); acest studiu a fost aprobat de ctre Autoritatea Naional pentru
Cercetare tiinific din Romnia. La aceti pacieni, am analizat parametrii antropometrici
(nlime, greutate, indicele de mas corporal (IMC), circumferina taliei, circumferina
oldurilor, raportul talie/old), parametrii biochimici (glicemia jeun (FPG), insulinemia jeun
(FPI), alanin aminotransferaza, aspartataminotransferaza, gamma-glutamiltranspeptidaza). Au
fost calculai i urmtorii parametri: HOMA-IR i HOMA-B. HOMA-IR peste percentila 75 n
rndul adulilor nediabetici a fost 2,77, iar aceast valoare a fost utilizat pentru a defini rezistena
la insulin (IR). Indicele TyG a fost calculat folosind formula publicat anterior n literatur
ln[(trigliceride jeun) (mg/dl) x glicemia jeun (mg/dl)/2]. Raporturile TC/ HDL-C i TG/HDL-
C au fost calculate.
Rezultate: Grupul de studiu a inclus 56,7% femei (n=118), cu vrsta medie 48,188,37 ani. 39,4%
(n=82) au avut obezitate (IMC> 30 kg/m2), 33,7% (n=70) au prezentat exces ponderal (IMC=25-
29,9 kg/m2), 26,9% (n=26) a avut o greutate normal.
Pacienii cu IR au avut valori semnificativ mai mari pentru indicele TyG, TG/HDL-C, CT/HDL-
C (toate p <0,05).
Atunci cnd s-a folosit analiza curbei ROC pentru a vedea dac aceti parametri sunt utili n
identificarea insulinorezistentei, aria de sub curba (AUC) fost mai mare de 0,75; pentru indicele
TyG AUC a fost de 0,844 (IC95%=0,785-0,904, p<0,001), pentru raportul TG/HDL-C a fost de
0,828 (IC95%=0,780-0,907, p <0,001); pentru CT/HDL-C AUC a fost de 0,768 (IC95%=0,704-
0,832, p <0,001) AUC a rmas mai mare de 0,75 pentru toi parametrii dup stratificare pe sexe.
Valoarea prag a fost de 5,22 pentru indicele de TyG, 3,17 pentru raportul TG/HDL-C i 4,37 pentru
CT/HDL-C.
Concluzii: Indexul TyG, CT/HDL-C i TG/HDL-C au avut valori crescute la pacienii cu IR,
comparativ cu subiecii sntoi. Indexul TyG, raportul TG/HDL-C i CT/HDL-C peste valoarea
prag poate ajuta clinicianul n evaluarea IR.
TRIGLYCERIDES AND GLUCOSE INDEX AND LIPID RATIOS AS RISK MARKERS

OF INSULIN RESISTANCE IN CLINICAL PRACTICE
Dr. Rusu Emilia1, Dr. Enache Georgiana1, Dr. Rusu Florin1, Dr. Drgu Ramona Maria1,
Dr. Cursaru Raluca1, Dr. Stoicescu Florentina1, Conf. Dr. Jinga Mariana1, Prof. Univ.
Radulian Gabriela1
Background and Aim: The objective of this study was to assessed the relationship between the
product of triglycerides and glucose (TyG index) and lipid ratio (total cholesterol [TC]/high
density lipoprotein cholesterol [HDL-C], triglycerides [TG]/HDL-C), and insulin resistance in
adults.
198
Materials and Methods: The data analyzed in this study (n=208) belongs to patients included in
the project Adipocytokines, link between virus C hepatitis and type 2 diabetes mellitus
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(DIADIPOHEP); this study was approved by the Romanian National Authority for Scientific
Research. In these patients we analyzed anthropometric parameters (height, weight, body mass
index, waist circumference, hip circumference, ratio waist hip), biochemical parameters (fasting
plasma glucose (FPG), fasting plasma insulin (FPI), alanine aminotransferase, aspartate
aminotransferase, gamma glutamyl transpeptidase). Homeostasis model assessment of insulin
resistance (HOMA-IR) and HOMA-B were also calculated. The 75 percentile of the HOMA-IR
scores among nondiabetic adults was 2.77, that was used as the cut-off value to define insulin
resistance (IR) for this study. TyG index was calculated using a previously published formula
ln[(fasting triglycerides)(mg/dl) x fasting glucose (mg/dl)/2]. The TC/HDL-C and TG/HDL-C
ratio was also calculated.
Results: The study group included 56.7% women (n=118), with mean age 48.188.37 years.
39.4% (n=82) had obesity (BMI> 30 kg/m2), 33.7% (n=70) presented overweight (BMI=25-29.9
kg/m2), 26.9% (n=26) had normal weight.
Patients with IR had significantly higher values for TyG index and TG/HDL-C (all p <0.05).
When ROC curve analysis was used to see the suitability of this parameters to identify IR, area
under curve (AUC) was greater than 0.75; for TyG index AUC=0.844 (95%CI=0.785-0.904,
p<0.001), for TG/HDL-C ratio AUC=0.828 (95%CI=0.780-0.907, p<0.001), and for CT/HDL-C
AUC= 0.768 (95%CI=0.704-0.832, p <0.001). AUC remained greater than 0.75 for all parameters
after stratification by sex. The cut-off points were 5.22 for TyG index, 3.17 for TG/HDL-C ratio,
and 4.37 for CT/HDL-C.
Conclusion: TyG index, CT/HDL-C and TG/HDL-C increased in patients with IR compared to
healthy subjects. Subsequently, we also found that TyG index, TG/HDL-C ratio, and CT/HDL-C
above the cut-off point may help the clinician to predict IR.
PS52. FIBROZA HEPATIC LA PACIENII CU DIABET ZAHARAT
Dr. Rusu Emilia1, Dr. Rusu Florin1, Dr. Enache Georgiana1, Conf. Dr. Jinga Mariana1, Dr.
Drgu Ramona Maria1, Dr. Cursaru Raluca1, Dr. Stoian Marilena1, Conf. Dr. Costache
Adrian1, Prof. Univ. Radulian Gabriela1
Premise i obiective: Scopul acestui studiu a fost de a evalua fibroza hepatic la pacienii cu diabet
zaharat tip 2 (DZ).
Material i Metode: Am efectuat un studiu multicentric, transversal, care a inclus 144 pacieni cu
diabet zaharat de tip 2, 74 de femei (51,4%). Au fost urmrii indicatorii antropometrici (greutate,
nlime, circumferina taliei, indicele de mas corporal (IMC)). Parametrii biochimici evaluai
au fost: glicemia jeun (FPG), insulinemia jeun (FPI), profilului lipidic, teste funcionale
hepatice, hemoleucograma. Concentraiile serice ale adiponectinei, leptinei, rezistinei, insulinei,
TNF-alfa, IL-6 au fost msurate prin metoda ELISA. Rezistenta la insulina (IR) a fost estimat
199
prin metoda HOMA. Fibroza hepatic a fost evaluat neinvaziv cu ajutorul urmtorilor parametri:
raportul aspartat aminotransferaza/alanin aminotransferaza (AST/ALT), raportul AST/Trombocite
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(APRI), scorul de fibroza-4 (FIB4) i indexul Forns. A fost folosit analiza multivariat pentru a
evalua relaia dintre fibroza hepatic i factorii metabolici.
Rezultate si Discutii: Vrsta populaiei incluse a fost de 53,2 ani. Prevalena fibrozei hepatice a
variat ntre 13,2% (n=19) utilizand FIB4 i 31,9% (n=46) utiliznd APRI. Concentraiile serice
mediane ale TNF-alfa, IL-6, rezistinei la pacienii cu fibroz hepatic au fost semnificativ mai
mari (toate p <0,05). Toi indicii de fibroz au avut valori mai mari la pacienii cu obezitate (toate
p<0.05)). n analiz univariat urmtorii parametri s-au corelat cu fibroza: vrsta, IMC,
trigliceride, alaninaminotransferaza, gama-glutamiltranspeptidaza, FPI, HOMA-IR, leptina,
rezistina, IL-6, TNF-alfa. n analiz multivariat predictori independeni pentru fibroza hepatic
utiliznd FI au fost de vrsta (OR: 1,13, 95%IC: 1,02-1,34), IMC (OR: 2,11, 95%IC: 1,01-3,46),
rezistena la insulin (OR: 2,32, 95%IC: 1,48-3,66) i TNF-alfa (OR: 1,2, 95%IC: 1,1-1,74).
Concluzii: Acest studiu a artat o prevalen ridicat a fibrozei hepatice la pacientii cu diabet
zaharat, n special la cei cu vrsta de peste 54 de ani cu obezitate i IR, independent de vechimea
diabetului. n studiul de fa, factorii predictivi pentru fibroza hepatic la pacienii diabetici au
fost: vrsta, indicele de mas corporal, HOMA-IR peste 4 i nivelul TNF alfa.
HEPATIC FIBROSIS IN DIABETIC PATIENTS
Dr. Rusu Emilia1, Dr. Rusu Florin1, Dr. Enache Georgiana1, Conf. Dr. Jinga Mariana1, Dr.
Drgu Ramona Maria1, Dr. Cursaru Raluca1, Dr. Stoian Marilena1, Conf. Dr. Costache
Adrian1, Prof. Univ. Radulian Gabriela1
Background and Aim: The aim of this study was to investigate the presence of hepatic fibrosis
(HF) in diabetic patients.
Materials and Methods: We conducted a cross-sectional multicenter study which included a total
of 144 patients with type 2 diabetes, 74 women (51.4%). There were followed the anthropometric
indicators (weight, height, waist circumference, body mass index (BMI)). The biochemical
parameters followed were fasting plasma glucose (FPG), lipid profile, liver function tests, blood
count. Serum concentrations of adiponectin, leptin, resistin, insulin, TNF-alpha, IL-6 were
measured with ELISA method. Insulin resistance (IR) was estimated by the homeostasis model
assessment (HOMA). Liver fibrosis was non-invasively assessed using folowing parameters:
aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT); Aspartate to platelet
ratio index (APRI), Fibrosis-4 Score (FIB4) and the Forns index (FI). Multivariate analysis based
on backward logistic regression was used to evaluate the association between hepatic fibrosis and
metabolic factors.
Results: Median age was 53.2 years. The prevalence of fibrosis varied between 13.2% (n=19)
using FIB4 and 31.9% (n=46) using APRI. Median serum levels of TNF-alpha, IL-6, resistin in
patients with HF were significantly higher than in controls (all p<0.05). All fibrosis index used
was higher in patients with obesity (all p<0.05). In univariate analysis the following parameters
were significantly related to fibrosis: age, BMI, triglycerides, ALT, GGT, FPI, HOMA-IR, leptin,
resistin, IL-6, TNF-alpha levels. In multivariate analysis, independent predictors of fibrosis (using
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FI) were age (OR: 1.13, 95% CI: 1.021.34), BMI (OR: 2.11, 95% CI: 1.013.46), insulin
resistance (OR: 2.32, 95% CI: 1.483.66), and TNF-alpha (OR: 1.2, 95% CI: 1.11.74).
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Conclusion: This study showed an elevated prevalence of hepatic fibrosis in diabetic patients,
especially in patients aged over 54 years with obesity and IR. In the present study, the predictive
factors for hepatic fibrosis in diabetic patients were: age, body mass index, HOMA-IR over 4, and
TNF- alpha.
PS53. DIABETUL ZAHARAT I SINDROMUL SJOGREN (CAZ CLINIC)
Rezident Rusu Elena Mihaela1, Rezident Lucan Daniela1, Dr. Zetu Cornelia1
Institutul National de Diabet, Nutritie si Boli Metabolice "Prof. N. Paulescu" Bucuresti
Introducere: Sindromul Sjogren este o boal sistemic autoimun relativ rar (prevalena 0,5-0,7
%) ce afecteaz glandele exocrine, n mod particular lacrimale i salivare, i ntr-o proporie mai
mic pancreasul exocrin. n acest context diabetul zaharat (DZ) este o complicaie rar a
sindromului Sjogren, un procent mic de cazuri fiind raportate (4,1%). n plus, studiile au artat n
sindromul Sjogren o frecven crescut a sindromului metabolic.
Obiective: Stabilirea etiopatogeniei DZ, nou diagnosticat la o pacient cu poliautoimunitate cert:
tiroidit autoimun, sindrom Sjogren, sindrom Sicca, poliartrit reumatoid, alopecie areata,
vitiligo.
Material i metode: Pacient de 57 de ani, nou diagnosticat cu DZ, hipertensiv, dislipidemic,
cu obezitate grad 1 (BMI=30,53kg/m2), cu ereditate diabetic (1 frate cu DZ tip 2 diagnosticat la
40 de ani, n tratament cu ADO ce asociaz sindrom metabolic), care a prezentat valori glicemice
random crescute n ultimele 6 luni (n medie 150-160 mg/dl), asimptomatice specific, fr atitudine
terapeutic.
Rezultate i discuii: Biologic patologic: dislipidemie mixt i dezechilibru glicemic reflectat
printr-o HbA1c=6,7 % i ca determinari speciale menionm: Peptid C: 4,34 ng/ml la o glicemie
= 95,57 mg/dl; Anticorpi anti-glutamat decarboxilaza (Ac anti GAD): 355 IE/ml; ATPO: 52,79
UI/ml; Ac antitireoglobulin: 23,24 UI/ml; ANA. Nu s-au putut realiza determinri autoimune
specifice pancreatice suplimentare. Ecuaia HOMA utilizat pentru estimarea funciei beta celulare
a relevat : funcie celular 191,1% ; sensibilitate 30,9% i IR (insulinorezisten) 3,24%.
Concluzii: Sindromul poliglandular autoimun (PAS) este un grup de boli autoimune ale glandelor
endocrine care se clasific n 3 categorii, subcategoria III C cuprinznd tiroidit autoimun, vitiligo
i alopecie, la care se pot asocia i alte boli autoimune nespecifice de organ (exemplu: sindromul
Sjogren i poliartrit reumatoid) fapt ce corespunde statusului clinico-biologic al pacientei.
Implicarea multigenic n dezvoltarea diferitelor componente PAS III a fost demonstrat n apariia
DZ i este legat de caiva loci ai regiunilor genomice non-HLA. Este cunoscut faptul c n DZ
autoimun exist o susceptibilitate genetic determinat de prezena unor alele specifice (care
codific anumite antigene HLA): DQ2/DQ8, astfel exist un risc deosebit de mare la cei care
prezint haplotipul DR3/DR4 DQ2/DQB de a dezvolta boala. O meta-analiz a studiilor
experimentale n sindromul Sjogren a evideniat c prezena DR3-DQA1/DQB1 s-a asociat cu risc
crescut de a dezvolta i DZ, n timp ce fenotipul DR1/DR7 este protectiv.
Ac anti GAD sunt un important marker de autoimunitate, responsabil de distrucia celulelor beta
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pancreatice. De asemenea sunt ntalnii n titruri mari i la pacieni care nu au dezvoltat DZ i au

alte afeciuni dect cele autoimune. Menionm c unii pacieni iniial diagnosticai ca DZ tip 2
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pot necesita tratament cu insulin la puin timp de la debut (de exemplu DZ tip LADA). De
menionat c valoarea predictiv a autoanticorpilor crete cu titrul i cu prezena simultan a altor
autoanticorpi.
Tinnd seama c studiile familiale i populaionale cu privire la PAS III C au evideniat un puternic
background genetic, este important de evaluat i autoimunitatea rudelor de gradul I ale pacientei
aflate n discuie.
DIABETES MELLITUS AND SJOGREN'S SYNDROME (CASE REPORT)
Rezident Rusu Elena Mihaela1, Rezident Lucan Daniela1, Dr. Zetu Cornelia1
National Institute of Diabetes, Nutrition and Metabolic Diseases "Prof. N. Paulescu" Bucharest
Introduction: Sjogren's syndrome is a relatively rare systemic autoimmune disease (prevalence

0,5-0,7 %), which affects exocrine glands, particularly the lacrimal and salivary ones, and on a
small scale, the exocrine pancreas. In this context, diabetes is a rare complication of Sjogren's
syndrome, a small percentage of cases being reported (4,1%). In addition, Sjogren's syndrome,
studies have shown an increased frequency of metabolic syndrome.
Objective: Setting the diabetes etiopatogenit, in a new diagnosed patient with definite poli
autoimmunity: autoimmune thyroiditis, sdr. Sjogren, sdr. Sicca, alopecia areata, vitiligo,
rheumatoid arthritis.
Material and methods: 57 years old female patient, new diagnosed with diabetes, hypertension,
dyslipidemia, obesity grd. 1 (BMI=30,53kg/m2), with diabetic heredity (one brother with type 2
diabetes diagnosed at 40 years, therapeutic attitude with ADO, and associated metabolic
syndrome), who has presented random blood glucose values increased in the last 6 months ( in
average 150-160 mg/dl), asymptomatic, without therapeutically attitude.
Results and discussions: Pathological resultes: mixed dyslipidemia and glycemic imbalance
reflected in a HbA1c=6,7 %, and as special determinations we mention: Peptide C: 4.34 ng / ml in
blood sugar = 95.57 mg / dl; Autoantibodies to glutamic acid decarboxylase ( GAD-Ab:) 355 IE /
ml; ATPO: 52.79 IU / ml; AC antithyroglobulin: 23.24 IU / ml; ANA pozitive. We could not have
specific autoimmune pancreatic further determinations. HOMA equation used to estimate beta cell
function revealed: cell function 191.1%; IR sensitivity 30.9% and 3.24%;
Conclusion: Polyglandular autoimmune syndrome (PAS) is a group of autoimmune diseases of
the endocrine glands which are classified in 3 categories, sub-category III C including autoimmune
thyroiditis, vitiligo and alopecia, which can be associated and other organ nonspecific autoimmune
diseases (eg Sjogren's syndrome and rheumatoid arthritis ) which corresponds to clinical and
biological status of the patient. Multigene involvement in developing various components PAS III
was demonstrated in development of diabetes and is linked to several loci non -HLA genomic
regions. It is known that in type 1 diabetes there is a genetic susceptibility caused by the presence
of allele-specific (encoding specific antigens HLA) DQ2 / DQ8, so there is a particularly high risk
to develop the disease for those who have the haplotype DR3 / DR4 - DQ2/DQB. A meta-analysis
of experimental studies showed that the presence of Sjogren's syndrome DR3-DQA1 / DQB1 was
associated with increased risk of developing diabetes, while phenotype DR1 / DR7 is protective.
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GAD-Ab are an important marker of autoimmunity, responsible for pancreatic beta cells
destruction. Those are also encountered in high titers in patients who did not develop diabetes or
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other than autoimmune disorders. We can mention that some patients initially diagnosed with type
II diabetes may require insulin therapy shortly after onset (eg diabetes type LADA).It can be
mentioned that the predictive value of antibodies increases with the titer and the simultaneous
presence of other autoantibodies.
Taking into account the family and population studies on PAS III C showed a strong genetic
background, it is important to evaluate and autoimmunity degree relatives of the patient in
question.
In this context it is difficult to determine exactly etiopatogenit, of diabetes in this patient,
considering that there are arguments for both diabetes associated with Sjogren's syndrome (in the
absence of more specific determinations necessary) and type 2 diabetes in the family heredity and
the presence of metabolic syndrome.
PS54. STUDIUL HIPERURICEMIEI LA UN LOT DE PACIENI CU DIABET

ZAHARAT
Dr. Sandu Maria-Magdalena1, Dr. Firanescu Adela1, Dr. Voicu Andreea1, Dr. Soare
Mariana1, Dr. Simion Floriana Maria1, Dr. Tuiu Daniela1, Dr. Oprea Diana1, Dr. Popa
Adina1, Dr. Popa Simona1, Prof. Univ. Dr. Moa Maria1
Clinica de Diabet Spitalul Clinic Judeean de Urgen Craiova, Romania
Premise i obiective: Evaluarea hiperuricemiei la un lot de pacieni cu diabet zaharat (DZ).

Prevalena hiperuricemiei (asimptomatice) a nregistrat o cretere important n ultimele decenii,
printre motivele incriminate putndu-se enumera: modificri ale stilului de via, creterea
dramatic a prevalenei obezitii, sindromului metabolic i DZ, precum i mbtrnirea populaiei.
Material i metod: n studiul nostru au fost inclui 236 de pacieni neselectionai, cu DZ,
internai n Clinica de Diabet a Spitalului Judeean de Urgen Craiova la nceputul anului 2016.
Repartiia pe sexe a fost egal. Dintre acetia, 12,71% au prezentat DZ tip 1, iar restul, 87,29% -
DZ tip 2. Media de vrst a fost de 39,77 12,71 ani n cazul pacienilor cu DZ tip 1 i de 61,06
10,59 ani n cazul celor cu DZ tip 2, diferen nalt semnificativ statistic (p<0,0001). Cei mai
muli dintre pacieni (57,20%) au avut o vechime a DZ sub 10 ani, diferen semnificativ statistic
(p=0,037) mai mare fa de restul pacienilor care au avut o durat a DZ ntre 10 i 20 ani sau peste
20 ani. Hiperuricemia a fost definit ca valoarea acidului uric seric peste 6 mg/dl la femei i peste
7 mg/dl la brbai. Analiza statistic a fost realizat cu ajutorul programelor Microsoft Excel i
SPSS 20.0.
Rezultate i discuii: Prevalena hiperuricemiei, la ntregul lot, a fost de 14,8%, dup cum
urmeaz: 6,66% la pacienii cu DZ tip 1 i de 16,01% la cei cu DZ tip 2. Femeile au avut o
prevalen semnificativ statistic mai mare (p=0,017) a hiperuricemiei (20,3%), spre deosebire de
brbai, unde prevalena a fost de 9,32%. De asemenea, hiperuricemia s-a corelat cu rata filtrrii
glomerulare estimat (RFGe), astfel c n cazul pacienilor cu hiperuricemie, media RFGe a fost
de 68,13 ml/min/1.73mp, n comparaie cu pacienii cu valori n limite fiziologice ale acidului uric,
unde media RFGe a fost de 85,43ml/min/1.73mp, diferen nalt semnificativ statistic (p< 0,0001).
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Hiperuricemia nu s-a corelat cu vrsta, indicele de mas corporal (IMC), raportul circumferina
abdominal/nlime (CA/), consumul de alcool, aa cum este frecvent descris n literatura de
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specialitate.
Concluzii: Prevalena crescut a hiperuricemiei, la pacienii cu DZ impune screening-ul acesteia
la pacienii cu DZ, pentru intervenie terapeutic n timp util, pentru a nltura un factor de risc
suplimentar n instalarea bolii cronice de rinichi.
THE STUDY OF HYPERURICEMIA IN A GROUP OF PATIENTS WITH TYPE 2

DIABETES
Dr. Sandu Maria-Magdalena1, Dr. Firanescu Adela1, Dr. Voicu Andreea1, Dr. Soare
Mariana1, Dr. Simion Floriana Maria1, Dr. Tuiu Daniela1, Dr. Oprea Diana1, Dr. Popa
Adina1, Dr. Popa Simona1, Prof. Univ. Dr. Moa Maria1
Emergency Clinical County Hospital of Craiova, Romania
Premises and Objectives: The aim of the study was to evaluate hyperuricemia in a group of
patients with diabetes mellitus (DM). Prevalence of (asymptomatic) hyperuricemia has a
significant increase in the last decades. As a reason of this we mention: lifestyle changes, the
dramatic increase in the prevalence of obesity, metabolic syndrome and diabetes, and also aging.
Material and Method: We included in our study 236 unselected patients with diabetes,
hospitalized in Diabetes Clinic of the Emergency County Hospital from Craiova at the beginning
of year 2016. Gender distribution was equal. 12.71% of the patients included in the study had type
1 diabetes (T1DM) and the rest of 87.29% - type 2 diabetes (T2DM). The average age of patients
with T1DM was 39.77 12.71 years and for those with T2DM was 61, 06 10.59 years,
significantly high statistical difference (p <0.0001). Most of the patients (57.20%) had DM for less
than 10 years, a significantly higher statistical difference (p = 0.037) than the rest of the patients
who had a evolution of diabetes between 10 to 20 years and more than 20 years. Hyperuricemia
was defined as serum uric acid level over 6 mg / dL in women and more than 7 mg/dL in men.
Statistical analysis was performed using Microsoft Excel and SPSS 20.0.
Results and Discussions: The general prevalence of hyperuricemia was 14.8%, as following:
6.66% in patients with T1DM and 16.01% in those with T2DM. Women had a significantly higher
statistical prevalence (p = 0.017) of hyperuricemia (20.3%), unlike men, where the prevalence was
9.32%. Also, hyperuricemia was correlated with the estimated glomerular filtration rate (eGFR),
so that in the case of patients with hyperuricemia, average eGFR was 68.13 ml/min/1.73mp
compared to the patients with levels of serum uric acid between physiological limits where the
average eGFR was 85,43ml/min/1.73mp, significantly high statistical difference (p <0.0001).
Hyperuricemia was not correlated with age, body mass index (BMI), waist circumference/height
ratio (WC/H), alcohol consumption, as commonly described in literature.
Conclusions: The increased prevalence of hyperuricemia in patients with DM requires screening
in patients with DM, for early therapeutic intervention to prevent an additional risk factor for
chronic kidney disease onset.
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PS55. THE CORRELATION OF LEFT VENTRICULAR HYPERTROPHY WITH
SERUM CALCIUM LEVELS IN OBESE PATIENTS
Dr. Sava Elisabeta1,2, Dr. Iulia Soare1,2, Dr. Srbu Anca1,2, Dr. Martin Sorina1,2, Prof. Dr.
Fica Simona1,2
1 Elias University Hospital, Endocrinology and Diabetes Department, Bucharest, Romania
2
UMF Carol Davila, Bucharest, Romania
Premises and Objectives: Left ventricular hypertrophy (LVH) is a common condition among
patients with obesity and hypertension. Recent studies revealed an association between protein-
adjusted calcium level and LVH. The aim of the study was to evaluate the relationship between
serum calcium level and LVH.
Patients and methods: We assessed 200 obese patients (49 men and 151 women), mean age
41.6511.98 years, mean BMI 45.929.07kg/m2. Clinical (BMI, age, gender, blood pressure),
biological (fasting plasma glucose, HOMA, cholesterol, triglycerides, uric acid) and
echocardiographic parameters (LVM, LVMI, IVS and RV) were measured.
Results and Discussions: 46% were diagnosed with hypertension and 25% were diabetics. The
mean serum calcium level was higher in men (9.730.4 mg/dl) than in women (9.500.38 mg/dl)
and we found a significant positive correlation between protein-adjusted calcium levels and age
(p=0.003, r=0.225). Serum calcium was positively associated with fasting plasma glucose
(p=0.006, r=0.196), total cholesterol (p=0.03, r=0.153) and with triglycerides (p=0.018, r=0.170).
We demonstrate that echocardiographic parameters correlate positively with serum adjusted-
calcium level (IVS (p=0.003, r=0.227), LVMI (p=0.029, r=0.185), LVM (p=0.006, r=0.232), right
ventricle (RV) (p=0.001, r=0.281)). Linear regression showed that serum protein-adjusted calcium
was independently associated with LVMI (p=0.009, r=0.338). Metabolic syndrome parameters
were associated with LVH.
Conclusions: Our study showed that serum protein-adjusted calcium is independently associated
with LVH in patients with severe obesity.
PS56. PARTICULARITI FENOTIPICE LA PACIENII CU DURAT LUNG DE

EVOLUIE A DIABETULUI ZAHARAT
Dr. Sava Isabella1, Dr. Meroiu Andreea1, Dr. Dobjanschi Carmen1

Spitalul Clinic Nicolae Malaxa Bucuresti
Complicaiile cronice apar mai frecvent n condiii de dezechilibru metabolic, dar depind i de o
serie de ali factori de risc.
Am evaluat un grup de pacieni cu DZ i durat de evoluie de peste 25 de ani, la care am

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consemnat urmtorii parametri: vrst, sex, durat de evoluie a diabetului, calitate de fumtor,
IMC, antecedentele heredocolaterale de DZ, BCV i obezitate, HbA1c, RFG, profilul lipidic
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(colesterol total, trigliceride), efectuarea cursurilor de educaie terapeutic la debutul i pe

parcursul bolii, titrarea dozelor de insulin la fiecare administrare i calculul HC la fiecare mas.
RFG a fost calculat dup formula MDRD. S-a calculat prevalena complicaiilor cronice micro i
macrovasculare i s-a urmrit asocierea diferiilor factori de risc la pacienii cu i fr afectare
macrovascular.
Retinopatia i neuropatia diabetic au fost prezente la toi pacienii cu o durata a DZ de peste 25
de ani, iar boala renal cronic cu RFG 60ml/min/1.73m2 a fost evideniat la 60%. Au fost
analizai factorii de risc ce se pot asocia cu scderea RFG la aceast categorie de pacieni i s-au
constatat urmtoarele corelaii prezentate n Tabel:
Grup A= 60ml/min/1.73m2 Grup B= 60ml/min/1.73m2 P value

Fumtor 2 7 0.07
AHC de DZ 5 4 0.44
AHC de BCV 7 6 0.36
AHC de obezitate 5 4 0.44
Durata DZ 43.6013.62 31.007.35 0.01
IMC 29.704.88 23.273.13 0.001
HbA1c(%) 9.441.56 8.691.34 0.23
Colesterol(mg/dl) 186.9046.16 187.6736.66 0.96
Trigliceride(mg/dl) 139.1039.05 106.0047.16 0.05
RFG(ml/min/1,73m2)43.179.67 91.8136.09 0.001
Educaie terapeutic iniial 5 7 0.72
Prevalena complicaiilor cronice macrovasculare: BCI=68.18%, IMA=9.09%, AVC=18.18%,
AOMI=40.9%. Pacienii cu afectare macrovascular au avut o RFG semnificativ statistic mai
sczut (53.4316.78) fa de cei fr afectare macrovascular (100.3346.81) (p=0,002).
Boala renal cronic diabetic s-a corelat semnificativ statistic cu AHC de BCV, IMC, durata de
evoluie a DZ i nivelul trigliceridelor serice. La pacienii cu o durat lung de evoluie a DZ,
afectarea macrovascular este asociat prioritar cu scderea RFG, probabil n legtur cu
disfuncia endotelial, independent de nivelul echilibrului metabolic.
PHENOTYPIC PARTICULARITIES IN PATIENTS WITH LONG-TERM EVOLUTION

DIABETES MELLITUS
Dr. Sava Isabella1, Dr. Meroiu Andreea1, Dr. Dobjanschi Carmen1

Spitalul Clinic Nicolae Malaxa Bucuresti
Chronic complications occur more frequently in metabolic imbalance conditions, but also depend
on a number of other risk factors.
We evaluated a group of patients with over 25 years of DM evolution, for which we recorded the
following parameters: age; sex; duration of diabetes evolution; smoker status; BMI; family history
of diabetes, CVD and obesity; HbA1c; GFR; lipid profile (total cholesterol, triglycerides),
206
conducting therapeutical education classes at disease onset and during the disease evolution;
insulin dose titration at every administration and CH calculation at each meal. GFR was calculated
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using the MDRD formula. We calculated the prevalence of chronic micro and macrovascular
complications and there was chased association of various risc factors in patients with and without
macrovascular damage.
Diabetic retinopathy and neuropathy were present in all patients with over 25 years of diabetes
evolution, and chronic kidney disease with GFR 60ml / min / 1.73m2 was revealed in 60%. We
analyzed risk factors that may be associated with GFR decrease in this category of patients and we
found correlations, presented in the following Table:
Group A= 60ml/min/1.73m2 Group B= 60ml/min/1.73 P value

Smoker status 2 7 0.07
Family history of DM 5 4 0.44
Family history of CVD 7 6 0.36
Family history of obesity 5 4 0.44
DM duration 43.6013.62 31.007.35 0.01
Myocardial infarction 29.704.88 23.273.13 0.001
HbA1c(%) 9.441.56 8.691.34 0.23
Cholesterol(mg/dl) 186.9046.16 187.6736.66 0.96
Triglyceride(mg/dl) 139.1039.05 106.0047.16 0.05
GFR(ml/min/1,73m2) 43.179.67 91.8136.09 0.001
Therapeutical education classes at disease onset 5 7 0.72
The prevalence of chronic macrovascular complications: ischemic heart disease = 68.18%,
myocardial infarction = 9.09%, stroke = 18.18%, peripheral artery disease = 40.9%. Patients with
macrovascular damage had a statistically significant lower GRF (53.43 16.78) than those without
macrovascular damage (100.33 46.81) (p = 0.002).
Diabetic chronic kidney disease was statistically significant correlated with family history of CVD,
BMI, duration of diabetes and triglyceride levels. In patients with a long-term evolution of diabetes
mellitus, macrovascular damage is primarily associated with decreased GFR, probably concerning
endothelial dysfunction, independent of the metabolic balance.
PS57. Choice of the add-on therapy to metformin in type 2 diabetes patients in clinical
practice. Initial results from a non-interventional multicentre study in Romania
(REALITY)
Prof. Dr. Serafinceanu Cristian1, Prof. Dr. Timar Romulus1, Prof. Dr. Catrinoiu Doina1,
Adrian Zaharia2
1
Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy
Carol Davila Bucharest
2
Astra Zeneca Company
Background and objectives: While metformin is generally recommended as the first-line agent
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in type 2 diabetes mellitus (T2DM), most patients will need eventually more than one
antihyperglycemic agent to achieve target blood glucose levels.
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The primary objective of this Study is to describe and compare the main criteria used by physicians
(regular outpatient setting) in selecting the add-on therapy (non-insulin) in patients with
inadequately metformin-controlled type 2 diabetes in 2 time points at 1 year distance.
Main secondary objectives are:
To describe the usage of add-on therapies in type 2 diabetes and changes observed within
one year;
To evaluate the prevalence of comorbidities and diabetes complications in study groups;
To evaluate the percentage of patients with target HbA1c level < 7% at the 2 time-points;
To describe the characteristics of the disease at the time of the initiating the add-on therapy
in Romanian patients with type 2 diabetes
Material and methods: This non-interventional study was conducted in Romania. The
investigators are diabetologists from hospital and ambulatory settings. The primary objective was
to describe the main criteria used by physicians during their normal clinical practice in selecting
the first non-insulin add-on therapy in patients with inadequately metformin-controlled T2DM.
Two study enrolment moments were planned at approximately at one-year distance. Three main
categories of reasons were considered: patient-related, agent-related, and physician decision. For
each of these categories, a list of possible secondary reasons was provided. Physicians had the
option to select multiple answers, specifying in the same time the most relevant category in
choosing a specific add-on class of non-insulinic antidiabetes medication for each patient. The
statistical analysis was descriptive.
Results: We report here the results after the first study enrolment moment (July-September 2014).
The total number of patients included in the analysis was 1143. Mean age of study subjects was
60.9 yr +/- 9.1. The great majority (94%) of patients were overweight and obese, with a mean BMI
at the time of enrolment [SD] of 32.1 kg/m2 [5.3]. The mean duration of diabetes [SD] was 6.8
years [4.3]. In average, the first oral agent was added to metformin after 3.2 years. Sulphonylureas
were the most prescribed first add-on treatment (63%), followed by DPP4-inhibitors (18%) and
GLP-1 receptor agonists (7%). Blood glucose lowering efficacy and durability (82.4% of answers
related to agent characteristics and 73.9% of patient-related characteristics) were the principal
reasons considered when selecting the first add-on treatment to metformin, followed by effect on
weight (30.1% and 29.7%, respectively) and access to treatment (21.1% and 28.6%, respectively).
Physician decision was selected as principal reason in 12% of the patients.
Conclusions: This is the first study in type 2 diabetes patients in Romania that aims to characterize
the complexity of factors influencing the add-on treatment decision. The need to add a new agent
to metformin was recorded after 3.2 years of monotherapy with metformin. Although a number of
oral and injectable medications are available, sulphonylureas remain the most prescribed
combination treatment to metformin. Newer classes of non-insulin medication are also present,
but their more intensive use is still limited by the difficult access to these treatments. The rationale
for selecting the first add-on therapy to metformin was based mainly on a patients characteristics
(glycemic control need, comorbidities, BMI) and therapeutic agent characteristics (efficacy in
lowering blood glucose levels, effect on weight, and access to treatment).
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PS58. PREVALENCE AND PREDICTORS OF NON-ALCOHOLIC FATTY LIVER
DISEASE
ASSESSED USING FATTY LIVER INDEX IN A TYPE 2 DIABETES POPULATION
Dr. Cristina Alina Silaghi1,2, Dr. Horaiu Silaghi1,2, Dr. Horaiu Alexandru Coloi1,2, Dr.
Anca Elena Crciun1,2, Dr. Daniel Tudor Cosma1,2, Prof. Nicolae Hncu1,2, Prof Carmen
Emanuela Georgescu1,2
1
Endocrinology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-
Napoca, Romania
2
County Clinic Emergency Hospital, Cluj-Napoca, Romania
We aimed to study prevalence and predictors factors of non-alcoholic fatty liver disease (NAFLD)
defined by fatty liver index (FLI) in type 2 diabetic patients (T2DM).
Three hundred and eighty-one T2DM outpatients who regularly attended Regina Maria Clinic in
Cluj were retrospectivelly included. FLI, a surrogate steatosis biomarker based on body mass index
(BMI), waist circumference (WC), triglycerides (TGL) and gammaglutamyl-transferase (GGT)
was used to assess NAFLD in all patients. Anthropometric and biochemical parameters were
measured. Hepatic steatosis (HS) was evaluated by ultrasonography.
NAFLD-FLI (defined as FLI - 60) was correlated with HS evaluated by ultrasounds (r = 0.28; p <
0.001). NAFLD-FLI was detected in 79% of T2DM. The prevalence of obesity in NAFLD-FLI
patients was 80 %. In normal alanine aminotransferase (ALAT) patients, 73.8 % had NAFLD. At
univariable analysis, NAFLD-FLI was correlated with age (r = -0.14; p = 0.007), sex (r = 0.20; p
< 0.001), LDLcholesterol (r = 0.12; p = 0.032), HDLcholesterol (r = - 0.13; p = 0.015), ALAT (r
= 0.20; p < 0.001) and ASAT (r = 0.19; p < 0.001). At multiple regression analysis, sex, ALAT
and LDL-cholesterol were independent predictors of NAFLD-FLI. After logistic regression model,
ALAT, LDL-cholesterol, HOMA-IR were good independent predictors of NAFLD-FLI.
NAFLD-FLI could be useful to identify NAFLD in T2DM patients. Subjects with T2DM had a
high prevalence of NADLD-FLI even ALAT levels are normal. Our findings showed that sex,
ALAT, LDL-cholesterol and IR were significant and independent factors associated with the
presence of NAFLD in T2DM subjects.
PS59.INTERRELAIA DINTRE NEUROPATIA DIABETIC I DEPRESIE:

REZULTATELE UNUI STUDIU TRANSVERSAL
Dr. Lazr Sandra1, Prof.Dr. Timar Romulus1, Dr. Mailat Diana1, Dr. Levai Codrina1, Dr.
Timar Bogdan1
1
Universitatea de Medicina si Farmacie "Victor Babes" Timisoara
Neuropatia diabetic (ND) este o complicaie precoce i prevalent a diabetului zaharat (DZ),
avnd un impact major asupra strii de sntate i a calitii vieii pacienilor afectai. Alturi de
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ND, depresia este frecvent asociat bolilor cronice, incluznd aici DZ. Este un fapt cunoscut c
depresia are un impact negativ asupra activitilor de auto-management a DZ, putnd aadar duce,
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indirect, la deteriorarea controlului glicemic i astfel la un prognostic mai puin optimist la aceti
pacieni. Obiectivele studiului nostru au fost de
a evalua impactul prezenei i severitii ND asupra apariiei i severitii depresiei la pacienii cu
DZ tip 2.
n vederea realizrii dezideratelor acestui studiu am nrolat 198 pacieni cu DZ tip 2 conform unui
principiu consecutiv populaional, ce se afl n evidena Centrului de Diabet Timioara. Tuturor
pacienilor li s-au colectat datele clinice, paraclinice i antropometrice la nceputul vizitei. Prezena
i severitatea neuropatiei diabetice a fost evaluat cu ajutorul scorului MNSI (The Michigan
Neuropathy Screening Instrument). Depresia a fost evaluat folosind chestionarul PHQ-9
(Patients Health Questionnaire - 9).
n lotul nostru de studiu prevalena ND a fost de 28% (57 de cazuri). Prezena depresiei a fost
asociat cu o cretere a scorului PHQ-9 (12 vs. 7 puncte; p<0.001) sugernd astfel c pacienii cu
ND tind s aib o simptomatologie mai sever a depresiei. n acelai timp, prezena ND s-a asociat
cu o prevalena semnificativ crescut a depresiei severe (24.6% vs. 4.3%; p<0.001) i moderate
(22.8% vs. 12.8%; p<0.001), compensnd cu o prevalen mai sczut a depresiei uoare sau
absente. Am observat o corelaie pozitiv, moderat i semnificativ statistic (coeficient de
corelaie Spearman r=0.55; p<0.001) ntre severitatea ND, evaluat cu ajutorul scorului MNSI, i
severitatea depresiei.
n rndul pacienilor cu DZ, prezena ND se asociaz cu o prevalen crescut a depresiei,

severitatea depresiei corelndu-se pozitiv cu severitatea ND. Avnd n vedere c depresia este o
afeciune tratabil, iar un rezultat pozitiv poate duce la ameliorarea prognosticului global n cazul
pacienilor vizai, devine evident, n special n rndul pacienilor cu DZ i ND, importana
screeningului urmat n vederea coreciei acesteia.
ASSOCIATIONS BETWEEN DIABETIC NEUROPATHY AND DEPRESSION:

FINDINGS FROM A CROSS-SECTIONAL STUDY
Dr. Lazr Sandra1, Prof.Dr. Timar Romulus1, Dr. Mailat Diana1, Dr. Levai Codrina1, Dr.
Timar Bogdan1
1
"Victor Babes" University of Medicine and Pharmacy, Timisoara
Diabetic neuropathy (DN) is a prevalent complication of Diabetes Mellitus (DM), having a major
impact on the patients quality of life. Along DN, depression is a frequent condition associated
with chronic diseases, including here DM. Depression is cited to have a major negative impact on
the self-management of diabetes, decreasing so the overall quality of metabolic control, leading
thus to a worsened prognosis of DM. Our study main aim was to evaluate the impact of the
presence and severity of DN on the prevalence and severity of depression in patients with Type 2
DM.
In this cross-sectional study, 198 patients with T2DM were enrolled according to a consecutive-
210
case population-based principle, from the Diabetes Outpatient of the Emergency Hospital
Timisoara. In all patients anthropometric, clinical and laboratory data were collected. The presence
Page
and severity of DN was assessed using The Michigan Neuropathy Screening Instrument while
depression was evaluated using the Patients Health Questionnaire.
In our study cohort, the prevalence of overt DN was 28.8% (57 cases). The presence of DN was
associated with and increased PHQ-9 score (12 vs. 7 points; p<0.001) which means that patients
with DN tend to have more severe depression symptoms. In the same time the presence of DN was
associated with a significantly increased prevalence of severe (24.6% vs. 4.3%; p<0.001) and
moderate (22.8% vs. 12.8%; p<0.001) depression. Between the severity of DN, evaluated using
the MNSI score, and the severity of depression we found a positive, moderate and significant
correlation (Spearmans r = 0.55; p<0.001).
The prevalence of depression is increased in patients with overt-neuropathy. The depressions

severity increases with the severity of DN. Since it is a treatable condition and its treatment may
lead to an overall improved prognosis, depressions screening is of a paramount importance in
patients with T2DM its role being emphasized in patients with associated DN.
PS60. ANEMIA, DIABETUL SI BOALA RENAL CRONIC
Rezident Ungureanu Carmen1, Dr. Rusu Emilia1, Rezident Bejinariu Ctlina1, Rezident
Petre Diana1, Dr. Murean Alexandra1, Dr. Stegaru Daniela1, Rezident Soldea Lidia1,
Rezident Andoni Adela1, Rezident Ciobanu Delia1, Rezident Dobre Alin1, Rezident Chiril
Vlad1, Prof. Dr. Radulian Gabriela1
INDBM N. C. Paulescu
Premise si obiective: Anemia este comuna printre pacientii cu diabet zaharat (DZ) si boala cronica
de rinichi (BRC). Studii observationale indica faptul ca hemoglobina (Hb) scazuta la acesti
pacienti, poate creste riscul progresiei bolii renale si morbiditatea si mortalitatea cardio-vasculara.
Anemia este o complicatie a BRC si poate contribui la rezultate clinice nefavorabile. Identificarea
timpurie si tratamentul anemiei pot imbunatati morbiditatea si mortalitatea cardio-vasculara.
Obiectivul acestui studiu a fost s evalueze relaia dintre prezenta anemiei i rata de filtrare
estimat (eRFG) prin formula CKD-EPI la pacientii cu DZ tip 2.
Material si metoda: Studiu observational, desfasurat la INDBM NC Paulescu din Bucuresti, in
perioada sept 2015- febr 2016. Au fost inclusi in studiu 229 pacienti cu DZ 2, din care 109 pacienti
cu BRC. Toi pacienii au fost examinai clinic i au fost msurate tensiunea arterial (TA),
greutatea (G), nlimea i circumferina abdominal (CA). Au fost efectuate, de asemenea,
urmtoarele analize: glicemie, trigliceride (TG), lipoproteine cu densitate moleculara mare (HDL-
C), uree, creatinin, hemograa, raport albumin/creatinin (RAC). S-a determinat prevalenta si
severitatea anemiei (anemie usoara daca Hb a fost sub 12,5 g/dl si moderat daca Hb a fost sub 10
g/dl).
Rezultate: Din cei 229 pacienti inclusi in studiu 61.51% au fost barbati, cu varsta medie de
211
61,5210,52 ani. Dintre acestia 25.3% (n=58) au prezentat eRFG< 60 ml/min/1,73m2. Hb < 12,5
g/dl au prezentat 49 pacienti ( 21.4%) si mai mica de 10 g/dl, 10 pacienti (4,4%). Pacientii cu
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anemie au avut varsta mai mare, greutate mai mica, IMC mai redus, CA mai mica, colesterol, LDL
scazute, RAC crescut, acid uric crescut. n analiza univariata nivelul Hb s-a corelat pozitiv cu
eRFG (r=0,385, p=0.01) i negativ cu vrsta (r=-0,338, p=0,001) i nivelul creatininei serice (r=-
0,395, p=0,01).
Concluzie: Anemia a fost prezenta la 25.8% din pacientii cu BRC. Prevalenta anemiei creste pe
masura ce rata de filtrare glomerulara scade.
ANEMIA, DIABETES MELLITUS AND CHRONIC KIDNEY DISEASE
Rezident Ungureanu Carmen1, Dr. Rusu Emilia1, Rezident Bejinariu Ctlina1, Rezident
Petre Diana1, Dr. Murean Alexandra1, Dr. Stegaru Daniela1, Rezident Soldea Lidia1,
Rezident Andoni Adela1, Rezident Ciobanu Delia1, Rezident Dobre Alin1, Rezident Chiril
Vlad1, Prof. Dr. Radulian Gabriela1
INDBM N. C. Paulescu
Objectives: Anemia is frequent among patients with diabetes and chronic kidney disease.
Observational studies indicate that low Hb levels in such patients may increase risk for progression
of kidney disease and excessive cardiovascular morbidity and mortality. Anemia is a complication
of chronic kidney disease and may lead to unfavorable clinical results.
Early diagnosis and treatment may improve cardiovascular morbidity and mortality.
Our aim was to observe the relationship between anemia and RFG (using CKD EPI formula) in
patient with type 2 diabetes.
Material and method: A retrospective, observational study was carried out in the National
Institute of Diabetes and Metabolic Disease NC Paulescu, of Bucharest between September
2015- February 2016. 229 pacients with type 2 diabetes were included in this study and 109 of this
had chronic kidney disease. There were 67 men and 42 women. All patients were assessed
clinically and were measured blood pressure (BP), the weight (G), the height (H) and waist
circumference (CA). Following analyzes was analyzed: glucose, TG, HDL, urea, creatinine, RAC.
We investigate the prevalence and severity of mild anemia (Hb < 12,5g/dl) and moderate anemia
(Hb<10 g/dl).
We used Pearson and Spearman algorithm of univariate correlation. We consider a p value of less
than 0.05 to be statistically significant.
Results: Of 229 patients included in the study 61.51% were men and 38,5% were women, with a
mean age of 61,52+/-10,52 years. A number of 58 patients (25,3%) had e RFG <
60ml/min/1,73m2.
In 21.4% patients ( 49 ) Hb was <12,5 g/dl and in 4,4% ( 10 patients) Hb was < 10 g/dl. Patients
with anemia had older age, lower weight, lower BMI, smaller waist circumference, low cholesterol
and LDL, increased RAC and uric acid. In univariate logistic analysis the level of Hb showed
significant statistical correlation with E RFG ( r= 0,385, p= 0.01) and negative correlation with
age ( r = -0,338, p = 0,001) and seric creatinine level ( r = -0.395, p= 0,01).
212
Conclusions and discussions: We had 25.8% patient with anemia and chronic kidney disease.
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The prevalency of anemia increase with reduction of kidney function.

PS61. VARIABILITATEA GLICEMIC DIN PERIOADA PERIOPERATORIE I
RISCUL APARIIEI COMPLICAIILOR POSTOPERATORII
MD Verde Ioana1, MD Rusu Emilia1, Prof. Armean Petru1

Spitalul Clinic Th. Burghele, Bucharest; UMF Carol Davila
Premise i obiective: Studii recente au artat c variabilitatea glicemic este asociat cu

mortalitatea n unitile de terapie intensiv chirurgicale i la pacienii aflai n stare critic.
Obiectivul acestui studiu este de a determina n ce msur variabilitatea glicemiei a jeun din
perioada perioperatorie se coreleaz cu apariia complicaiilor postoperatorii.
Material i metod: Am analizat un lot de 150 de pacieni cu diabet zaharat internai n Spitalul
Clinic Th. Burghele n perioada ianuarie 2013-iulie 2014 pentru efectuarea unor intervenii
chirurgicale n sfera urologic. n lot au fost 82.6% (n=124) brbai, cu o vrst medie de 65.39+/-
9.95 ani, majoritatea cu diabet zaharat de tip 2 (96.67%). Durata medie a spitalizrii a fost de
8.64+/-4.3 zile. 34.66% dintre pacieni (n=52) aveau diabet zaharat complicat. Pe parcursul
internrii s-au determinat 4 glicemii a jeun din sngele venos: glicemia la internare (g1), n ziua
interveniei chirurgicale (glicemia preoperatorie) (g2), n prima zi postoperator (g3) i n cea de-a
doua zi postoperator (g4). Complicaii postoperatorii au fost considerate orice devieri, biologice
sau clinice, de la evoluia postoperatorie normal. Pentru a clasifica corect i reproductibil
complicaiile postoperatorii, am folosit scala Clavien modificat. Am calculat un indice de
variabilitate glicemic, definit ca deviaia standard fa de media celor patru glicemii a jeun ale
unui pacient.
Rezultate i discuii: Complicaiile postoperatorii au aprut la un procent de 42% (n=63) dintre

pacieni. Majoritatea complicaiilor au avut un scor mic pe scala Clavien (69.84% dintre
complicaii au fost de gradul 1). Media celor 4 glicemii a fost 184.48 mg/dl (g1), 148.15 mg/dl
(g2), 150.98 mg/dl (g3), respectiv 146.04 mg/dl (g4). Indicele variabilitii glicemiei a jeun
calculat s-a corelat semnificativ statistic cu dezvoltarea complicaiilor postoperatorii (p<0.001).
Variabilitatea glicemic a fost cu att mai mare, cu ct gradul complicaiilor pe scala Clavien a
fost mai mare (p<0.001). Variabilitatea glicemic s-a mai corelat semnificativ statistic cu prezena
diabetului zaharat complicat (p=0.02). Aplicnd funcia de regresie liniar pentru stabilirea unei
relaii ntre indicele de variabilitate i valoarea medie a duratei de spitalizare, nu s-a obinut o
relaie liniar ntre aceste variabile (p=0.456).
Concluzii: n acest studiu variabilitatea glicemiei a jeun din perioada spitalizrii s-a corelat cu
prezena complicaiilor postoperatorii, cu gradul complicaiilor postoperatorii, dar nu s-a corelat
cu durata spitalizrii. Pacienii care au avut diabet zaharat complicat au avut o variabilitate
glicemic mai mare. Sunt necesare studii suplimentare, pe loturi mai mari de pacieni, pentru a
cerceta suplimentar aceste concluzii.
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VARIABILITATEA GLICEMIC DIN PERIOADA PERIOPERATORIE I RISCUL
APARIIEI COMPLICAIILOR POSTOPERATORII
MD Verde Ioana1, MD Rusu Emilia1, Prof. Armean Petru1

Spitalul Clinic Th. Burghele, Bucharest; UMF Carol Davila
Background and objectives: Recently studies have shown that glycemic variability is associated
with mortality in surgical intensive care units and in patients in critical condition. The objective of
this study is to determine whether fasting glucose variability in the perioperative period correlates
with the occurrence of postoperative complications.
Material and method: We analyzed 150 patients with diabetes admitted to Clinical Hospital Th.
Burghele from January 2013 until July 2014 to perform an urologic surgery. In the group there
were 82.6% (n = 124) men, with an average age of 65.39 +/- 9.95 years, most of them with type 2
diabetes (96.67%). The mean duration of hospitalization was 4.3 +/- 8.64 days. 34.66% of patients
(n = 52) had complicated diabetes. During hospitalization we determined four fasting glucose from
venous blood: in the day of admission (g1), in the day of surgery (preoperative glucose)(g2), in
the first postoperative day (g3) and in the second day after surgery (g4). Postoperative
complications were considered any deviations from biological or clinical normal postoperative
course. To classify accurately and reproducibly postoperative complications, we used the modified
Clavien scale. We calculated an index of glycemic variability, defined as the standard deviation
from the average of the four fasting glucoses of a patient.
Results and discussions: Postoperative complications occurred at a rate of 42% (n = 63) of

patients. Most complications had a low score on the Clavien scale (69.84% of complications were
grade 1). Average blood glucose was 184.48 mg / dl (g1), 148.15 mg/dl (g2), 150.98 mg/dl (g3)
and 146.04 mg/dl (g4). The calculated variability fasting glucose index correlated significantly
with the development of postoperative complications (p <0.001). As the degree on Clavien scale
complications was higher the glycemic variability was greater (p <0.001). Glycemic variability
was also significantly correlated with the presence of complicated diabetes (p = 0.02). Applying
linear regression function to establish a relationship between variability index and average of
length of stay, we didnt get a linear relationship between these variables (p =0.456).
Conclusion: In this study, fasting glucose variability during hospitalization was correlated with
the presence of post-operative complications, the degree of post-operative complications, but did
not correlate with the duration of hospitalization. Patients who had complicated diabetes, had a
higher glycemic variability index. Further studies are needed on larger groups of patients to
investigate these findings.
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PS62. PREZENA BOLII CRONICE DE RINICHI N RAPORT CU VRSTA I
DURATA DIABETULUI ZAHARAT
Dr. Vladu Mihaela1, Dr. Clenciu Diana1, Dr. Bcu Mihaela1

1
Spitalul Municipal Filantropia
Premise i obiective: Studiul de fa i propune evaluarea prezenei bolii cronice renale n raport
cu vrsta i durata diabetului zaharat tip 1 i tip 2.
Material i metod: Studiul este de tip epidemiologic, transversal, neintervenional, cu pacieni

neselecionai, s-a realizat analiznd 600 de subieci repartizai n trei loturi, astfel: lotul 1 ce
include 200 pacieni cu diabet zaharat tip 1, lotul 2 ce include 200 pacieni cu diabet zaharat tip 2
i lotul 3 (control) alctuit din 200 indivizi recrutai aleator, fr diabet zaharat.
Rezultate i discuii: Vrsta pacienilor cu DZ tip 1 care prezint boal cronic de rinichi (BCR)
este mai mic versus vrsta pacienilor cu DZ tip 2 i BCR, dar comparabil ntre pacienii cu DZ
tip 2 i cei fr DZ (control). Acest lucru este dovedit de testele statistice Mann-Whitney U i
Wilcoxon W care arat diferene semnificative ntre vrsta pacienilor cu DZ tip 2 cu BCR i vrsta
pacienilor cu DZ tip 1 cu BCR (p<0,001), ntre pacienii cu DZ tip1 cu BCR i cei fr DZ
(control) cu BCR (p<0,001), dar nesemnificative ntre DZ tip 2 cu BCR i lotul control cu BCR
(p=0,910).
Vrsta medie de apariie a bolii renale cronice n DZ tip 1 se situeaz n jurul valorii de 43,55 ani,
n DZ tip 2 vrsta medie este de 64,93 ani, iar la lotul control 63,94 ani. Testul statistic Kruskal
Wallis aplicat arat diferene semnificativ statistice ntre tipul 1 i tipul 2 de diabet zaharat,
respectiv ntre DZ tip 1 i lotul control (p< 0,001), dar nesemnificative ntre DZ tip 2 i lotul
control.
Vrsta la diagnosticarea DZ a pacienilor cu BCR a fost semnificativ statistic (p<0,001) mai mic
la pacienii cu DZ tip 1 dect la cei cu DZ tip 2. Aplicnd testele statistice Mann-Whitney U i
Wilcoxon W se constat diferene semnificative ntre vrsta la diagnosticarea diabetului zaharat la
pacienii cu DZ tip 1 cu BCR comparativ cu vrsta pacienilor cu DZ tip 2 cu BCR (p<0,001).
Durata medie de evoluie a DZ tip 1 asociat cu BCR s-a situat n jurul valorii de 19,69 ani, valoare
semnificativ statistic (p<0,001) mai mare comparativ cu durata de 8,23 ani de evoluie la pacienii
cu DZ tip 2 asociat cu BCR. Testul statistic Kruskal Wallis aplicat arat diferene semnificativ
statistice ntre tipul 1 i tipul 2 de diabet zaharat (p< 0,001).
Concluzii: Prevalena BCR diabetic crete cu vrsta i durata de evoluie a DZ. Vrsta de apariie
a BCR este mai mic la pacienii cu DZ tip 1 comparativ cu cei cu tipul 2 i populaia general.
Incidena i prevalena BCR crete o dat cu naintarea n vrst. Vrsta naintat pare a fi un
predictor negativ pentru apariia stadiului terminal al BCR.
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THE PRESENCE OF CHRONIC KIDNEY DISEASE IN RELATION TO AGE AND
DURATION OF DIABETES MELLITUS

1
Background and objectives: This study aims to assess the presence of chronic kidney disease in
relation to age and duration of type 1 and type 2 diabetes mellitus.
Material and method: The study type is epidemiological, transversal, noninterventional, with
unselected patients. It was performed by analyzing 600 subjects divided into three groups, as
follows: Lot 1 includes 200 patients with type 1 diabetes, Lot 2 includes 200 patients with type 2
diabetes and lot 3 (control) consisting of randomly recruited 200 individuals without diabetes.
Results and discussions: The age of patients with type 1 diabetes who have chronic kidney disease
(CKD) is lower versus the age of patients with type 2 diabetes and CKD, but comparable between
patients with type 2 diabetes and those without diabetes (control). This is proven by statistical tests
Mann-Whitney U and Wilcoxon W showing significant differences between age of patients with
type 2 diabetes with CKD and the age of patients with T1DM with CKD (p <0.001) between
patients with diabetes type 1 with CKD those without diabetes (control) with CKD (p <0.001), but
not significant between type 2 diabetes and CKD control group (p = 0.910).
The average age of developing CKD in type 1 diabetes lies around 43.55 years, in T2DM average
age is 64.93 years and 63.94 years in the control group. Kruskal Wallis statistical test applied show
statistically significant differences between type 1 and type 2 diabetes and between T1DM and the
control group (p <0.001), but not significant between T2DM and control group.
The age of patients at diagnosis of diabetes with CKD was statistically significant (p <0.001) lower
in patients with type 1 diabetes than in those with type 2 diabetes Applying statistical Mann-
Whitney U test and Wilcoxon W are significant differences between age diagnosing diabetes in
patients with type 1 diabetes compared with CKD aged patients with type 2 diabetes with CKD (p
<0.001).
The average duration of development of type 1 diabetes associated with CKD stood around 19.69
years, worth statistically significant (p <0.001) higher compared to the duration of 8.23 years of
development in patients with type 2 diabetes associated with CKD. Kruskal Wallis statistical test
applied show statistically significant differences between type 1 and type 2 diabetes mellitus (p
<0.001).
Conclusion: Diabetic CKD prevalence increases with age and duration of diabetes. Age of
occurrence of CKD is lower in patients with type 1 diabetes compared to those with type 2 and the
general population. CKD incidence and prevalence increases with age. Old age seems to be a
negative predictor for the occurrence of end stage of CKD.
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Page
PS63. ASOCIEREA MICROALBUMINURIEI CU HIPERTENSIUNEA ARTERIAL
LA PACIENII CU DZ TIP 1 I VECHIME DE CEL PUIN 10 ANI

1
Premise i obiective: Micro i macroalbuminuria sunt predictori importani pentru creterea

mortalitii de orice cauz n DZ. Studiul de fa i propune evaluarea asocierii microalbuminuriei
cu hipertensiunea arterial la pacienii cu DZ tip 1 diagnosticat cu cel puin 10 ani n urm deoarece
n DZ tip 1, HTA apare de obicei la pacieni cu microalbuminurie sau BCR manifest.
Microalbuminuria apare dup o evoluie de 6-15 ani a DZ tip 1.
Material i metod: Lotul studiat a cuprins 106 pacieni cu DZ tip 1 cu vechime de peste 10 ani
aflai n evidena Centrului Clinic de Diabet Nutriie Boli Metabolice Craiova. La aceti pacieni
am analizat date anamnestice (vrst, sex, vechimea DZ), date clinice (tensiunea arterial) i date
paraclinice (eliminarea urinar de albumin).
Rezultate i discuii: Lotul studiat a fost alctuit din 106 pacieni dintre care 39,62% (42) pacieni
au fost de sex feminin i 60,37% (64) pacieni de sex masculin. n ceea ce privete vechimea
diabetului zaharat, 51,88% (55) pacieni aveau o vechime a DZ cuprins ntre 10-20 ani, 37,73%
(40) pacieni ntre 21-30 ani, 7,54% (8) pacieni ntre 31-40 ani i 2,83% (3) pacieni peste 40 ani.
Cei 106 pacieni ce au alctuit lotul de studiu au fost mprii n 3 subloturi: normo, micro,
macroalbuminurici. Astfel, 32,07% (34) pacieni s-au aflat n stadiul normoalbuminuric, 14,15%
(15) pacieni n stadiul microalbuminuric, 53,76% (57) pacieni n stadiul macroalbuminuric.
Hipertensiunea arterial a fost gsit la 44,12% (15) dintre pacienii normoalbuminurici, la 46,67%
(7) pacieni microalbuminurici, 80,7% (46) pacieni macroalbuminurici.
Relaia dintre hipertensiunea arterial i eliminarea renal de albumin este semnificativ statistic
(p = 0,042).
Valoarea calculat prin testul Cramer de verificare a puterii asocierii dintre prezena albuminuriei
i a HTA este 0.277, ceea ce indic o asociere, dar nu foarte puternic, ntre un anumit grad al
proteinuriei i prezenta sau absena hipertensiunii arteriale.
Concluzii: n DZ tip 1, factorii de risc cardiovascular sunt interpretai de regul n funcie de
prezena sau absena albuminuriei. Hipertensiunea arterial reprezint un factor de risc pentru
prezena i progresia bolii cronice de rinichi.
ASSOCIATION OF MICROALBUMINURIA WITH ARTHERYAL HYPERTENSION

IN PATIENTS WITH TYPE 1 DM WITH A DURATION OF 10 YEARS OLD

1
Background and objectives: Micro and macroalbuminuria are important predictors for increased
mortality from any cause in DM. This study aims to assess the association of microalbuminuria
with artheryal hypertension in patients with type 1 diabetes diagnosed at least 10 years ago because
217
in T1DM, hypertension usually occurs in patients with microalbuminuria or manifest CKD.

Microalbuminuria occurs after a 6-15 year development of T1DM.
Page
Material and method: The study group included 106 patients with type 1 diabetes older than 10
years hospitalized in the Clinic of Diabetes Nutrition and Metabolic Diseases Craiova. In these
patients we analyzed historical data (age, gender, DM duration), clinical data (blood pressure) and
laboratory data (urinary excretion of albumin).
Results and discussions: The study group consisted of 106 patients of which 39.62% (42) patients
were female and 60.37% (64) male. Regarding diabetes age, 51.88% (55) patients ranged in age
from 10 to 20 years of DM, 37.73% (40) patients between 21-30 years, 7.54% (8) patients between
31-40 years and 2.83% (3) patients over 40 years.
The patients entered in the study were divided into 3 subgroups: normo, micro and
macroalbuminuria. Thus, 32.07% (34) patients were in normoalbuminuria stage, 14.15% (15)
patients in microalbuminuric stage, 53.76% (57) patients in macroalbuminuria stage. Hypertension
was found at 44.12% (15) of the normoalbuminuria patients, 46.67% (7) microalbuminuric
patients and in 80.7% (46) macroalbuminuria patients.
The relationship between hypertension and renal excretion of albumin is statistically significant (p
= 0.042). The value calculated by Cramer verification test of the power of association between the
presence of albuminuria and hypertension is 0.277, which indicates an association, but not very
strong between a certain degree of proteinuria and the presence or absence of hypertension.
Conclusion: In type 1 diabetes, cardiovascular risk factors are usually interpreted according to the
presence or absence of albuminuria. Hypertension is a risk factor for the occurrence and
progression of chronic kidney disease.
PS64. RELAIA DINTRE RATA DE FILTRARE GLOMERULAR ESTIMAT,

GROSIMEA INTIM-MEDIE I GRSIMEA VISCERAL NTR-O POPULAIE DE
PACIENI CU DZ2
Dr. Vonica Camelia Larisa1, Dr. Muresan Andrada Alina1, Dr. Craciun Anca Elena1, Dr.
Farcas Anca1, Prof. Hancu Nicolae1, Assoc. Prof. Roman Gabriela1
Centrul de Diabet Cluj-Napoca
Msurarea grosimii intim medie (GIM) permite detectarea leziunilor aterosclerotice ale pereilor
arteriali la pacienii cu diabet zaharat (DZ), implicat n complicaiile macrovasculare diabetice.
Totodat, grsimea visceral este puternic asociat cu rezistena la insulin, hipertensiunea
arterial, dislipidemia i inflamaia sistemic cronic, toate joac un rol esenial n patogeneza
aterosclerozei. Scopul acestui studiu a fost de a investiga relaia dintre GIM carotidian i rata de
filtrare glomerular estimat (eGFR), dar i alte date clinice precum aria grsimii viscerale (VFA),
procentul de mas grs (PBF) la pacienii cu DZ tip 2.
Am efectuat un studiu retrospectiv pe o populaie de 155 de pacieni din reeaua privat de sntate
Regina Maria, avnd ca i criterii de includere: diagnostic de DZ 2, vrsta peste 18 ani, iar cele
de excludere: DZ 1, sarcina i dispozitive medicale mecanice. Am evaluat eGRF , GIM, alturi de
VFA , PBF. Am determinat VFA si PBF cu ajutorul analizatorului corporal InBody 720 prin
bioimpedan electric.
Din totalul de pacieni selectai, 54 au fost femei (34%) i 104 brbai (66%), vrsta medie
218
56,39,45 ani, vechimea DZ2 6,175.79. GIM a fost 1.030,31 cm, iar eGFR 91,5424.52
ml/min/1,73m. Parametrii privind masa gras au fost VFA 169.4545.45 cm2, PBF 35.59.05%.
Page
La cei 155 de pacieni VFA a fost repartizat astfel: 6 (4%) sub valoare de 100 cm, iar 152 (96%)
peste 100 cm. Totodat, s-au observat corelaii direct proporionale ntre GIM i: vrsta (p<0,01),
VFA (p<0,01) i eGFR (p<0,05).
n lotul studiat s-a observat o prevalen crescut n rndul pacienilor cu VFA peste 100 cm.
Totodat, corelaia pozitiv dintre eGFR i GIM, alturi de cea dintre VFA i GIM, confirm
importana examinrilor intensive pentru detectarea precoce a aterosclerozei i tratarea tuturor
factorilor de risc asociai acesteia la pacienii cu DZ.
THE RELATIONSHIP BETWEEN ESTIMATED GLOMERULAR FILTRATION

RATE, INTIMA -MEDIA THICKNESS AND VISCERAL FAT IN A POPULATION OF
PATIENTS WITH DM2
Dr. Vonica Camelia Larisa1, Dr. Muresan Andrada Alina1, Dr. Craciun Anca Elena1, Dr.
Farcas Anca1, Prof. Hancu Nicolae1, Assoc. Prof. Roman Gabriela1
Centrul de Diabet Cluj-Napoca
The measurement of the intima-media thickness (IMT) enables the detection of atherosclerotic
lesions of the arterial walls in diabetic patients involved in macrovascular diabetic complications.
In addition, visceral fat is strongly associated with insulin resistance, hypertension, dyslipidemia
and systemic chronic low-grade inflammation, all of which play a pivotal role in the pathogenesis
of atherosclerosis. The aim of this study was to investigate the relationship of the carotid IMT with
estimated glomerular filtration rate (eGFR) and the clinical backgrounds, including visceral fat
area (VFA) and percentage of fat mass (PBF) in patients with type 2 diabetes mellitus (DM2).
We performed a retrospective study on a population of 155 patients from a the private health center
Regina Maria with the following inclusion criteria: DM2, age over 18 years, and the exclusion
criteria: DM type 1 , pregnancy and medical mechanical device. We evaluated eGFR, IMT, along
with VFA, PBF. VFA, PBF were completed with electrical bioimpedance using InBody 720.
In the selected group, 54 were women (34%) and 104 men (66 %), mean age was 56.3 9.45
years, years of diabetes were 6.17 5.79. IMT was 1.03 0.31cm and eGFR 91.54 24.52
ml/min/1,73m. Parameters regarding fat mass were: VFA 169.45 45.45 cm2, PBF 9.05 35.5%.
Regarding VFA, the 155 patients were distributed as follows: 6 (4%) below 100 cm and 152 (96
%) more than 100 cm. In addition, positive correlations were observed between IMT and: age (p
< 0.01), VFA (p < 0.01) and eGFR (p < 0.05).
In the studied group we observed an increased prevalence among patients with VFA >100 cm.
Also, the positive correlation between VFA and GIM, and also eGFR and GIM, confirms the
importance of intensive examinations for early detection of atherosclerosis and treating all its
associated risk factors in patients with diabetes.
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PS65. TREATMENT WITH CONTINUOUS SUBCUTANEOUS INSULIN INFUSION TO
A PATIENT WITH DIABETES MELLITUS TYPE 1
Physician Alexandra Ilinca1, Physician Carmen Novac1, Physician Emilia Rusu1, Physician
nutrition educator Cornelia Cristofor1, Physician Raluca Radu1, Professor Doctor Gabriela
Radulian1
1
INDBM N Paulescu
The insulin pump is an alternative treatment of any kind of diabetes mellitus with insulin therapy
in multiple daily doses.
Patient at age of 14 presents in the INDBM N Paulescu for many hypoglycemia episodes,
frequently in the morning, in order to start procedures for obtaining insulin pump, for continuous
subcutaneous insulin infusion, and with HbA1c = 6.3%. The patient was diagnosed about three
months earlier, at the Marie Curie Hospital with type 1 diabetes mellitus where the insulin therapy
basal bolus with aspart and glargine insulin was started. In January 2015 we mount the insulin
pump, with aspart insulin, with a TDD of 26U, of which 80% were used for insulin pump TDD,
distributed in 50% (10.4 U) for basal rates which was subsequently adjusted with fasting samples,
completed after 3 days. Boluses were calculated using insulin sensitivity factor (SF) and the Report
of Z (RZ) in relation to the quantity of ingested carbohydrates at every meal. The FS was 86 mg/dL,
and RZ = 24 g; The recommended amount of carbohydrate was 230g (60g-110g-60g) and total
insulin boluses summed 9.5 U (2,5-4,5-2,5). The patient was instructed to monitor his capillary
blood glucose 7 times/day, using the meter-remote, before and after 2 h of every meal, and insulin
adjustment with the correction formula (CF) = (target blood glucose - current blood glucose) / FC;
Fasting blood glucose target was set between 90-130 mg/dL and between 90-150 at bedtime and
during the night.
After two weeks of insulin pump therapy, the patient shows in the clinic for evaluation by using
the synchronizer of insulin pump with remote-glucose meter; in these two weeks, the patient had
2 glycemic targets set out, both in premeditated situations, when the patient knew how to restore
his blood glucose in targets by using the advanced menu in the insulin pump; also, very important,
it showed no glucose below target, and the average blood glucose between 110-120 mg/dL.
Treatment with insulin pump led to the disappearance of hypoglycemia and significantly increased
the quality of life of this patient. Adherence extremely good showed us that with a good nutritional
education and knowledge to use the pump and adjust insulin doses
properly, evolution of insulin treated diabetes mellitus is much better in reducing the frequency of
hypoglycemia.
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DOAR PUBLICARE/PUBLICATION ONLY
PO1. HIPOGLICEMIA SEVER, CAUZA DE INTERNARE A PACIENILOR CU

DIABET ZAHARAT TIP 2
Dr. Braha Adina1, Dr. Diaconu Laura1, Prof. Dr. Timar Romulus1
1
Spitalul Clinic Judetean de Urgenta Timisoara
Controlul glicemic optim reduce riscul aparitiei complicatiilor cronice degenerative la pacientii cu
diabet zaharat tip 2. Principala limitare a tratamentului antidiabetic in scopul atingerii tintei
terapeutice pentru HbA1c este aparitia episoadelor de hipoglicemie. Consecinele posibile ale
hipoglicemiilor includ morbiditate fizic i psihologic i, n cazuri severe, deces. Obiectivele
studiului au fost evaluarea frecventei internarilor pentru hipoglicemie severa la pacientii cu diabet
zaharat tip 2 si identificarea factorilor determinanti si favorizanti ai acestora.
Lotul de studiu a inclus cei 304 pacienti cu diabet zaharat tip 2 care au fost internati prin serviciul
de urgenta, in Clinica de Diabet zaharat, nutritie si boli metabolice a Spitalului Clinic Judetean de
Urgenta Pius Binzeu Timisoara, in cursul anului 2015. Am efectuat un studiu retrospectiv, datele
fiind obtinute din foile de observatie clinica generala ale pacientilor.
Ponderea internarilor pentru hipoglicemie severa din totalul internarilor de urgenta ale pacientilor
cu diabet zaharat tip 2, in anul 2015, a fost de 13,81%. Caracteristicile principale ale celor 42 de
pacienti internati pentru hipoglicemie severa sunt: varsta medie = 72,09 9,43 ani, repartitia pe
sexe: 12 barbati si 30 femei, durata medie de evolutie a diabetului zaharat =12,52 7,84 ani. Din
totalul episoadelor de hipoglicemie severa internate de urgenta, 50% au survenit la pacienti cu
insulinoterapie intensiva, 40,47% au fost induse de sulfonilureice si 9,52%, de asocierea de
insulina bazala cu medicatie antidiabetica non-insulinica. Factorii favorizanti ai hipoglicemiilor
severe identificati la pacientii inclusi in studiu au fost: varsta inaintata, scaderea ratei de filtrare
glomerulare, durata indelungata de evolutie a diabetului zaharat, factori comportamentali
(omiterea meselor, orar neregulat al meselor, administrarea gresita a medicatiei antidiabetice),
prezenta altor comorbiditati (dementa, tulburare depresiva, ciroza hepatica), suport social redus.
Pentru prevenirea episoadelor de hipoglicemie severa, a consecintelor nefavorabile ale acestora si

a costurilor legate de necesitatea spitalizarii, se recomanda evitarea tratamentului cu sulfonilureice
si a schemelor de insulinoterapie intensiva la pacientii cu functie renala scazuta, cu varsta peste 65
de ani, cu comorbiditati multiple asociate, cu declin cognitiv, cu deteriorarea functiei hepatice, cu
speranta de viata redusa si la cei cu suport social redus. Schemele terapeutice antidiabetice trebuie
sa fie centrate pe pacient, individualizate in functie de HbA1c, recurgand, atunci cand este cazul,
si la utilizarea antidiabeticelor noi cu risc scazut de hipoglicemie (inhibitori de DPP4, agonisti de
receptori pentru GLP1, inhibitori SGLT2).
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SEVERE HYPOGLYCEMIA, CASE OF HOSPITALIZATION IN PATIENTS WITH
TYPE 2 DIABETES
Dr. Braha Adina1, Dr. Diaconu Laura1, Prof. Dr. Timar Romulus1
1
Spitalul Clinic Judetean de Urgenta Timisoara
Optimal glycemic control reduces the risk of chronic degenerative complications in patients with
type 2 diabetes. Main limitation of antihyperglycemic treatment to achieve HbA1c target is the
occurrence of hypoglycemia. Possible consequences of hypoglycemia include physical and
psychological morbidity and, in severe cases, death. The study aims were to evaluate the frequency
of admissions for severe hypoglycemia in patients with type 2 diabetes and to identify contributing
and determinant factors.
The study group included 304 patients with type 2 diabetes who were hospitalized through the
emergency department in Diabetes, Nutrition and Metabolic Diseases Clinic of Emergency
Hospital "Pius Brinzeu" Timisoara, during year 2015. We conducted a retrospective study, data
were obtained from patients clinical observation sheets.
The share of total admissions for severe hypoglycemia emergency admissions of patients with type
2 diabetes in 2015 was 13.81 %. The main characteristics of the 42 patients hospitalized for severe
hypoglycemia are: mean age = 72.09 9.43 years, sex distribution: 12 men and 30 women, mean
duration of diabetes 12.52 7.84 years. Of all severe hypoglycemic episodes which required
emergency admission, 50% occurred in patients with intensive insulin therapy, 40.47% were
caused by sulfonylureas and 9.52% by basal insulin in combination with non-insulin antidiabetic
agents. The main causes of severe hypoglycemia that were identified among patients included in
the study were old age, decreased glomerular filtration rate, long duration of diabetes evolution,
behavioral factors (skipped meals, timing, irregular meals, wrong intake of antidiabetic
medication), other comorbidities (dementia, depressive disorder, cirrhosis), low social support.
To prevent episodes of severe hypoglycemia, their adverse consequences and the increased costs
of hospitalization, it is recommended to avoid sulfonylureas and intensive insulin therapy in type
2 diabetes patients with decreased renal function, aged over 65, in those with multiple
comorbidities, with cognitive decline, with liver dysfunction, with low life expectancy and in those
with low social support. Antidiabetic regimens must be patient-centered, individualized according
to HbA1c, resorting when appropriate to the use of new antidiabetic drugs with low risk of
hypoglycaemia (DPP4 inhibitors, GLP-1 receptor agonists, SGLT2 inhibitors).
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PO2. FUMATUL FACTOR DE RISC CARDIOVASCULAR
Dr. Clenciu Diana1, Dr. Vladu Mihaela1, Dr. Bcu Mihaela1

1
Spitalul Municipal Filantropia, Bucuresti
Studiul de fa i propune evaluarea fumatului ca factor de risc de boal cardiovascular la pacieni

cu DZ tip 1 diagnosticat cu cel puin 10 ani n urm.
Lotul studiat a cuprins 106 pacieni cu DZ tip 1 cu vechime de peste 10 ani aflai n evidena
Centrului Clinic de Diabet Nutriie Boli Metabolice Craiova. La aceti pacieni am analizat
urmtoarele date demografice i anamnestice: vrst, sex, vechimea DZ, stilul de viat
(fumtor/nefumtor), clinice (tensiunea arterial), date paraclinice (creatinina, colesterolul total i
fraciunile sale-HDL i LDL, trigliceridele, albuminuria). Riscul cardiovascular a fost evaluat
utiliznd algoritmul Framingham.
Lotul studiat a fost alctuit din 106 pacieni dintre care 39,62% (42) pacieni au fost de sex feminin
i 60,37% (64) pacieni de sex masculin. 32,07% (34) pacieni s-au aflat n stadiul
normoalbuminuric, 14,15% (15) pacieni n stadiul microalbuminuric, 49,05 (52) pacieni n
stadiul macroalbuminuric, iar 4,71% (5) pacieni n stadiul final al bolii renale diabetice. n
sublotul pacienilor normoalbuminurici 67,65% (23) pacieni erau nefumtori, 20,59% (7) pacieni
erau foti fumtori, iar 11,76% (4) pacieni erau fumtori la momentul actual. n sublotul
pacienilor microalbuminurici (nefropatie diabetic stadiul 3), 60% (9) pacieni erau nefumtori,
6,67%) (1) pacient era fost fumtor, 33,33% (5) pacieni erau fumtori. n sublotul pacienilor
macroalbuminurici (nefropatie diabetic stadiul 4), 34,62% (18) pacieni erau nefumtori, 40,38%
(21) pacieni erau foti fumtori, iar 25% (13) pacieni erau fumtori la momentul actual. n
sublotul pacienilor aflai n stadiul terminal al bolii cronice de rinichi (ESRD) 40% (2) pacieni
erau nefumtori, 40% (2) dintre pacieni erau foti fumtori, iar 20% (1) pacient era fumtor la
momentul actual.
Se remarc influena fumatului n apariia albuminuriei, fapt evideniat de valoarea lui p=0,033 (p
< 0.05), ce arat c pacienii cu nivele diferite de albuminurie sunt n procente diferite fumtori
sau nefumtori, diferen care este semnificativ din punct de vedere statistic. Valoarea calculat
prin testul Cramer de verificare a puterii asocierii dintre albuminurie i starea de fumtor este
0.254, ceea ce indic o asociere, dar nu foarte puternic, ntre un anumit grad al proteinuriei i un
anumit status al fumatului (cei cu normoalbuminurie/microalbuminurie e mai probabil s fie
nefumtori, iar cei cu macroalbuminurie s fie fumtori sau foti fumtori).
Fumatul a fost identificat n mai multe studii ca un factor de risc independent pentru diferite grade
ale BCR, inclusiv pentru apariia proteinuriei, creterea creatininei serice, scderea RFG estimate
i dezvoltarea ESRD sau ratei de deces asociate cu BCR. Fumatul a fost demonstrat, de asemenea,
ca factor de progresie a BCR diabetic. n studiul nostru nu s-a nregistrat o corelaie puternic
ntre statusul de fumtor i prezena albuminuriei, ridicnd suspiciunea ntreruperii de necesitate a
fumatului n momentul apariiei complicaiilor majore.
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SMOKING CARDIOVASCULAR RISK FACTOR IN PATIENTS WITH T1DM
DIAGNOSED AT LEAST 10 YEARS AGO

1
This study aims to assess smoking as a risk factor for cardiovascular disease in patients with type
1 diabetes diagnosed at least 10 years ago.
The study group included 106 unselected patients with type 1 diabetes older than 10 years,
hospitalized in the Clinic of Diabetes Nutrition and Metabolic Disease Craiova. In these patients
we analyzed the following demographic and anamnestic data: age, gender, diabetes duration,
lifestyle (smoking/non-smoking), clinical date (blood pressure), paraclinical data (creatinine, total
cholesterol and its fractions, HDL and LDL, triglycerides, albuminuria). Cardiovascular risk was
assessed using the Framingham algorithm.
The study group consisted of 106 unselected patients of which 39.62% (42) patients were female
and 60.37% (64) male patients. 32.07% (34) patients were in normoalbuminuria stage, 14.15%
(15) patients in microalbuminuric stage, 49.05 (52) of the patients in macroalbuminuria stage and
4.71% (5) patients in the end stage of diabetic kidney disease. In the subgroup of
normoalbuminuria patients 67.65% (23) patients were nonsmokers, 20.59% (7) patients were
former smokers and 11.76% (4) patients were curent smokers. In the subgroup of
microalbuminuria patients (diabetic nephropathy stage 3) 60% (9) patients were nonsmokers,
6.67%) (1) patient was a former smoker, 33.33% (5) patients were smokers. In the subgroup of
macroalbuminuria patients (diabetic nephropathy stage 4), 34.62% (18) patients were nonsmokers,
40.38% (21) patients were former smokers and 25% (13) patients were curent smokers. In the
subgroup of patients in end-stage chronic kidney disease (ESRD) 40% (2) patients were
nonsmokers, 40% (2) of the patients were former smokers and 20% (1) patient was curent smoker.
It notes the influence of smoking in the development of albuminuria, as evidenced by the value of
p = 0.033 (p <0.05), indicating that patients with different levels of albuminuria in different
percentages are smokers or never smokers, a difference that is statistically significant. The
calculated value of the Cramer test checking the power of the association between albuminuria
and smoking status is 0.254, which indicates an association, but not very strong, between a degree
of proteinuria and particular status of smoking (those with normoalbuminuria / microalbuminuria
is more likely to be smoking and those with macroalbuminuria be smokers or ex-smokers).
Smoking has been identified in several studies as an independent risk factor for various degrees of
CKD, including the appearance of proteinuria, serum creatinine, decline of eGFR and development
of ESRD or death rate associated with CKD. Smoking was also demonstrated as a factor for
progression of diabetic CKD. In our study has not been a strong correlation between smoking
status and the presence of albuminuria, raising the suspicion of necessary interruption of smoking
when major complications appered.
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PO3. PREZENA SINDROMULUI METABOLIC LA PACIENII CU DZ TIP 2
RECENT DIAGNOSTICAI

1
Evaluarea prezentei sindromului metabolic (SM) la un lot de pacieni cu DZ tip 2 recent

diagnosticat.
Lotul studiat a cuprins 123 pacieni cu DZ tip 2 recent diagnosticati n ambulatorul de Diabet
Nutriie, Boli Metabolice al Spitalului Municipal Craiova. La aceti pacieni am analizat
urmtoarele date clinice i paraclinice: circumferina abdominal, tensiunea arterial, glicemia a
jeun, colesterolul total i fraciunile sale (HDL, LDL), trigliceridele, ureea, creatinina. Pentru
diagnosticul SM am utilizat criteriile enunate n octombrie 2009 de IDF, NHLBI, AHA, World
Heart Federation; International Atherosclerosis Society and International Association for the
Study of Obesity: circumferina abdominal (CA), trigliceride serice 150mg/dl, HDL-colesterol
< 40 mg/dl (brbai), < 50 mg/dl (femei), tensiunea arterial 130/85 mmHg sau tratament
antihipertensiv, glicemie a jeun 100mg% sau tratament antidiabetic pentru hiperglicemie.
Din pacienii ce au alctuit lotul de studiu, 68 (55,28%) au fost de sex feminin i 55 (44,71%) de
sex masculin. Sindromul metabolic a fost evideniat la 69 (56,09%) dintre pacienii lotului studiat,
dintre care 29 (42,02%) brbai i 40 (57,97%) femei. Acetia au prezentat cel puin 3 elemente
ale SM dup cum este redat n tabelul de mai jos.
Componente SM Nr (100%) Femei Brbai

DZ+HTA + Hiper TG+CA 42 (34,14%) 25 (59,82%) 18 (40,47%)
DZ+HipoHDL + CA 40 (32,52%) 28 (70%) 12 (30%)
DZ+HTA + HipoHDL + CA 24 (19,51%) 20 (83,33%) 4 (16,66%)
DZ+HTA+HipoHDL+CA+HiperTG 17 (13,82%) 13 (76,47%) 4 (23,52%)
Din pacienii ce au alctuit lotul de studiu, 63% s-au prezentat cu un IMC actual > 30kg\m2,
procent destul de mic datorit faptului c mare parte dintre pacienii studiai, fiind cazuri noi s-au
prezentat la medic dup o scdere ponderal de 5-10kg. Din aceast cauz am analizat i IMC-ul
maxim n funcie de care 84% dintre pacieni au prezentat IMC > 30kg\m2, ncadrndu-se n unul
din gradele de obezitate. Hipertensiunea arterial a fost ntlnit la 65% din pacieni, predominant
de sex feminin.
S-a constatat incidenta mai mare a sindromului metabolic la pacientii de sex feminin.
Hipertensiunea arterial este frecvent ntlnit la debutul diabetului zaharat i poate fi luat n
considerare ca i component a SM, dar n acelai timp trebuie s inem cont de o eventual cauz
secundar a HTA. Totui procentul SM ar rmne nemodificat deoarece pacienii care aveau HTA
prezentau alte 3 elemente ale acestuia.
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METABOLIC SYNDROME IN PATIENTS WITH TYPE 2 DIABETES MELITUS
RECENTLY DIAGNOSED

1
The evaluation of the metabolic syndrome (MS) in patients with T2DM recently diagnosed.
We studied a group of 123 patients with T2DM presented in the Public Hospital of Craiova. We
analyzed the following clinical and paraclinical data: abdominal circumference (AC), blood
pressure, triglycerides, total cholesterol and its fractions (HDL, LDL), urea, creatinine,
microalbuminuria. For the diagnostic of MS we used the statement of IDF, NHLBI, AHA, World
Heart Federation; International Atherosclerosis Society and International Association for the
Study of Obesity editorialized in 2009: abdominal circumference (AC), triglycerides 150mg/dl,
HDL-cholesterol < 40 mg/dl (men), < 50 mg/dl (women), blood presure 130/85 mmHg or
treatment for artherial hypertension, fasting glycaemia 100mg% or antidiabetic treatment for
hiperglycaemia.
From the patients included in the study, 68 patients (55,28%) were women and 55 (44,71%) were
men. Metabolic syndrome was relieved in 69 patients (56,09%) of our studied group where from
29 (42,02%) were men and 40 (57,97%) women. The patients with T2DM presented 3 or more
elements of metabolic syndrome as tabel below suggest.
Metabolic syndrome elements Total Women Men

DM + HTN + Hiper TG + AC 42 (34,14%) 25 (59,82%) 18 (40,47%)
DM +HipoHDL + AC 40 (32,52%) 28 (70%) 12 (30%)
DM + HTN + HipoHDL + AC 24 (19,51%) 20 (83,33%) 4 (16,66%)
DM + HTN +HipoHDL+AC+HiperTG 17 (13,82%) 13 (76,47%) 4 (23,52%)
Of patients who had composed the study group, 63% were presented with a current BMI > 30
kg/m2, quite low because most of the studied patients, being new cases of diabetes, were presented
to the doctor after 5-10kg weight loss. Therefore we analyzed the maximum BMI according to
which 84% of patients had BMI > 30kg/m2, fits in one of the degrees of obesity. Artherial
hypertension was seen in 65% of patients, predominantly female.
We noted a higher incidence of metabolic syndrome in female patients. Artherial hypertension is
common in the onset of DM and can be considered as part of MS, but at the same time we must
take into account a possible secondary cause of hypertension. In spite, MS percent would remain
unchanged because the patients with artherial hypertension had other 3 elements of MS.
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PO4. REZISTENA LA INSULIN N BOLILE ISCHEMICE CEREBROVASCULARE
LA PACIENTUL CU DIABET ZAHARAT TIP 2
Dr. Dondoi Carmen1, Dr. Cucuringu Mihaela Virginia1, Dr. Chelan Claudia1, Dr. Mogos
Tiberius Viorel1
1
INDNBM "Prof. Dr. N.C. Paulescu"
Premise i obiective: Scopul studiului a fost s observe influena rezistenei la insulin la pacientul
cu diabet zaharat tip 2 in ceea ce privete bolile ischemice cerebrovasculare. Aceast idee a pornit
de la creterea prevalenei accidentului vascular cerebral ischemic la pacienii cu diabet zaharat tip
2 i obezitate.
Material i metode: Au fost inclui 34 de pacieni cu diabet zaharat tip 2 (16 femei i 18 brbaii;
vrsta medie de 61 3,2 ani; durata diabetului zaharat de 7,2 4,6 ani; IMC = 34,2 3,7 kg/m).
Menionm c iniial a fost ales un numr de 142 de pacieni din care au fost selectai doar cei cu
echilibru metabolic bun (HbA1c < 7% pe o perioad de 3 ani) i fr modificri semnificative ale
indicelui de mas corporal n acest interval. Pentru calcularea rezistenei la insulin s-a folosit
indicele HOMA2 obinndu-se diferite scoruri ale HOMA-IR. Au fost apoi selectai, n mod
aleatoriu, acei pacieni cu scorul HOMA-IR de 3 (12 pacieni) i respectiv 3,4 (13 pacieni).
Rezultate i discuii: n primul grup s-a observat apariia atacului ischemic tranzitoriu la 2 pacieni
(16,6%), a accidentului vascular cerebral (AVC) cu deficit motor reversibil la 1 pacient (8,3%) i
a accidentului vascular cerebral cu deficit motor permanent la 4 pacieni (33,3%). n grupul cu
HOMA-IR de 3,4, s-a observat 3 pacieni (23%) cu atac ischemic tranzitoriu, 2 pacieni (15,4%)
cu AVC cu deficit motor reversibil, 2 pacieni (15,4%) cu AVC cu deficit motor permanent i 1
pacient (7,7%) cu AVC cu com.
Concluzii: Studiul de fa arat cum creterea scorului HOMA-IR reprezint un factor de risc
important pentru bolile cerebrovasculare la pacientul cu diabet zaharat tip 2 chiar i n condiiile
unui echilibru metabolic bun.
INSULIN RESISTANCE IN ISCHEMIC CEREBROVASCULAR DISEASES AT

PATIENTS WITH TYPE 2 DIABETES MELLITUS
Dr. Dondoi Carmen1, Dr. Cucuringu Mihaela Virginia1, Dr. Chelan Claudia1, Dr. Mogos
Tiberius Viorel1
1
INDNBM "Prof. Dr. N.C. Paulescu"
Objectives: The aim of this study was to evaluate the influence of insulin resistance to the diabetic
patients concerning the ischemic cerebrovascular diseases. This idea rise from the increased
prevalence within last 10 years of the stroke in obese diabetic patients.
Methods: We included 34 patients with type 2 diabetes (16 men and 18 women; age mean SD:
61 3.2 years; duration of diabetes 7.2 4.6 years; BMI = 34.2 3.7 kg/m). At the beginning,
228
we screened 142 patients from which we choose only the patients having good metabolic control
(HbA1c < 7% for 3 years) and no significant change of BMI. We find using HOMA2 calculation
Page
different values of HOMA- IR score. We arbitrary selected those patients with HOMA- IR score
about 3 (12 patients) and 3.4 (13 patients).
Results: In the first group, we observed the appearance at 2 patients (16.6%) of transition ischemic
stroke, a transition hemiparesis at 1 patient (8.3%) and a definitive hemiparesis at 4 patients
(33.3%). In the group HOMAIR score 3.4, we observed 3 patients (23%) with transition
ischemic strokes, 2 patients (15.4%) with transition hemiparesis, 2 patients (15,4%) with
permanent hemiparesis and 1 patient (7,7%) with neurological coma.
Conclusions: The study demonstrated that increase HOMA score represents an important factor
of risk for the cerebrovascular diseases even to the well balance diabetic patients.
PO5. DIABET ZAHARAT TIP 1 SAU DIABET NEONATAL CARE ESTE CEA MAI
BUN OPIUNE DE TRATAMENT?
Rezident Herescu Irina Elena1, Rezident Mintici Luana1, Rezident Ioacara Sorin1, Prof. Dr.
Fica Simona1
1
Elias Emergency Hospital, Endocrinology and Diabetes Department
Diabetul neonatal este o form rar de diabet zaharat ce apare n urma unei mutaii monogenice,
cel mai frecvent la nivelul genei KCNJ11 sau INS. Pe lng hiperglicemia cronic, diabetul
neonatal poate fi nsoit de epilepsie i ntrziere n dezvoltarea psihomotorie. Aceast form de
diabet zaharat apare n primele luni de via i poate fi confundat cu diabetul zaharat tip 1. Spre
deosebire de diabetul zaharat de tip 1 , n care singura variant de tratament este reprezentat de
administrarea de insulin exogen, n cazul diabetului neonatal pacienii rspund frecvent la
terapia cu glibenclamid.
Prezentm cazul unui baieel n vrst de 3 ani i 6 luni, fr antecedente personale patologice sau
heredocolaterale semnificative, diagnosticat cu diabet zaharat tip 1 la vrsta de 10 luni, n contextul
unei cetoacidoze inaugurale. La debut, valoarea glicemiei a fost de 588 mg/dl, apoi s-a iniiat
tratamentul cu insulin administrat n 3 prize zilnice, cu ameliorarea poliuriei i polidipsiei.
Pacientul s-a prezentat pentru prima dat n clinica noastr n iulie 2014, prezentnd oscilaii
glicemice cu hipoglicemii frecvente, iar valoarea hemoglobinei glicate era 9,3%. Avnd n vedere
vrsta la care a debutat boala, s-au recoltat probe pentru testarea genetic pentru diabet neonatal,
ns nu s-au identificat mutaii la nivelul genelor KCNJ11 sau INS. O lun mai trziu, cnd
pacientul revine la control, se decide iniierea terapiei administrat prin intermediul pompei de
insulin. Astfel, se monteaz pompa de insulin, se stabilesc ratele bazale pe intervale orare i se
ajusteaza bolusurile de insulin. S-a obinut o evoluie favorabil a profilului glicemic pe perioada
internrii. Pacientul revine periodic pentru evaluare clinico-biologica, pentru aprecierea calitii
controlului glicemic i a eficienei terapiei administrate prin pomp de insulin. La cea mai recent
prezentare (ianuare 2016), clinic, pacientul avea o nlime i greutate corespunzatoare vrstei, cu
semne vitale n limite normale. Paraclinic, analizele de laborator s-au situat n limite normale, cu
excepia hemoglobinei glicate de 7,7%. Cu toate acestea, se constat o mbuntire semnificativ
a controlului glicemic n urma montrii pompei de insulin, cu scderea hemoglobinei glicate de
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la 9,3% la 7,7%. Se recomand msurarea glicemiei de cel puin 4 ori pe zi, cu adaptarea dozelor
de insulin i dozarea hemoglobinei glicate peste 3 luni.
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n concluzie, n cazul pacienilor diagnosticai cu diabet zaharat nainte de vrsta de 12 luni trebuie
avuta n vedere i forma mai rar a bolii, cea de diabet neonatal. n ceea ce privete pacientul
prezentat mai sus, aceast form de diabet nu s-a confirmat, iar cea mai bun metod de tratament
a fost considerat insulina administrat prin pomp.
TYPE 1 DIABETES MELLITUS OR NEONATAL DIABETES WHICH IS THE BEST

TREATMENT OPTION?
Rezident Herescu Irina Elena1, Rezident Mintici Luana1, Rezident Ioacara Sorin1, Prof. Dr.
Fica Simona1
1
Elias Emergency Hospital, Endocrinology and Diabetes Department
Neonatal diabetes is a rare form of diabetes mellitus that results from mutations in a single gene,
most frequently in KCNJ11 or INS gene. Besides the chronic hyperglycemia, the neonatal diabetes
may be associated with epilepsy and retarded psychomotor development. This form of diabetes
occurs in the first months of life and may be misdiagnosed as type 1 diabetes mellitus. Unlike the
type 1 diabetes mellitus, in which the only treatment option is the administration of exogenous
insulin, patients with neonatal diabetes respond frequently to glibenclamide treatment.
We present the case of a 3 years and 6 months little boy , without significant personal or family
medical history, diagnosed with type 1 diabetes mellitus at the age of 1 year and 10 months, in the
context of inaugural ketoacidosis. At the disease onset, the glucose level was 588 mg/dl. Then,
after the initiation of insulin therapy in three shots per day, the symptoms of polyuria and
polydipsia were attenuated.
The first admission of the patient in our clinic was in July 2014, when he presented glycemic
oscillations and frequent episodes of hypoglycemia and the glycated hemoglobin level was 9,3 %.
Considering the patients age at the disease onset, blood samples were collected for genetic testing
for the neonatal diabetes, but no mutation was identified in the KCNJ11 or INS genes. One month
later, when the patient returns for reevaluation, it was decided to initiate the insulin pump therapy.
So, the basal rates and the bolus doses of insulin were determined and adjusted. An improvement
in the glycemic control was achieved during hospitalization. The patient returns regularly for
follow-up visits, for clinical and biological evaluation, to assess the glycemic control and the
efficiency of the insulin pump therapy. At the most recent admission, his physical examination
revealed height and weight according to age, with stable vital signs. The laboratory findings were
all unremarkable, except for glycated hemoglobin level of 7.7%. Nevertheless, we can notice a
major improvement in the glycemic control after initiating the insulin pump therapy, with a drop
in the glycated hemoglobin level from 9.3% to 7.7%. The recommendations for the patient were
to check his blood sugar level at least 4 times/day, to adjust the insulin doses and to check the level
of glycated hemoglobin after 3 months.
In conclusion, for patients diagnosed with diabetes mellitus before 12 months of age we have to
take into consideration the less frequent type of the disease, the neonatal diabetes. Concerning the
patient presented above, this type of diabetes was not confirmed, and so the best treatment option
230
was considered to be the insulin pump therapy.

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PO6. TRATAMENTUL CU POMP DE INSULIN O SOLUIE PENTRU
PACIENII CU DIABET ZAHARAT TIP 1 I SINDROM DE NERECUNOATERE A
HIPOGLICEMIILOR
Rezident Mintici Luana1, Rezident Herescu Irina1, Rezident Ionescu Olteea1, Dr. Ioacara
Sorin1, Prof. Dr Fica Simona1
1
SUU Elias, Bucuresti
Introducere: Hipoglicemia sever i nerecunoaterea acesteia datorate cantitilor insuficiente de

hormoni de contrareglare i rspunsului autonom deficitar la pacienii cu diabet zaharat tip I pot
compromite controlul glicemic i reduce calitatea vieii.
Prezentarea cazului: Pacient n vrst de 40 de ani, diagnosticat cu diabet zaharat de tip 1 la
vrsta de 4 ani (poliurie, polidipsie, polifagie, glicemie >300mg/dl la debut), cu antecedente
heredo-colaterale de diabet (tatl) se prezint n luna februarie n clinica noastr pentru evaluare
clinico-biologic de specialitate i iniierea tratamentului prin pomp de insulin. Pacienta a urmat
tratament cu insulin n regim bazal-bolus pn n luna februarie 2016 (Humalog 6U-4U-5U,
Lantus12U dimineaa) ns a prezentat variaii glicemice importante (36-400 mg/dl) cu episoade
de hipoglicemie sever de 2 ori/lun. Pacienta este cunoscut cu antecedente personale patologice
endocrinologice (tiroidectomie pentru gu nodular, n prezent n tratament de substituie
hormonal), infecii urinare joase frecvente, hemangiom hepatic (nodul hiperecogen, omogen, bine
delimitat cu dimensiuni 10/9 mm n segmentul VI diagnosticat ecografic n 2014) i sindrom de
tunel carpian (2010).
Clinic, nu se deceleaz modificri patologice cu excepia paresteziilor la membrele inferioare i
superioare. Paraclinic, analizele de laborator s-au situat n limite normale, mai puin valoarea
hemoglobinei glicate de 7,5% (uor crescut comparativ cu inta terapeutic <7 %) i a glicemiei
a jeun de 53 mg/dl la internare (valori ale glicemiei a jeun pe durata internrii de 45, 36, 97mg/dl).
n luna aprilie 2015 valoarea hemoglobinei glicate a fost de 7,8. Biologic se deceleaz
hipotiroidism post-tiroidectomie eutiroidian sub tratament de substituie cu Levotiroxin
(Euthyrox) 100 g /zi. La examenul oftalmologic fund de ochi s-a decelat retinopatie diabetic
nonproliferativ, form minim i angioscleroz stadiul II. Evoluia glicemiilor arat o scdere
semnificativ a riscului de hipoglicemie, n special nocturn. La externare se recomand msurarea
glicemiei de cel puin 4 ori pe zi, cu adaptarea dozelor de insulin prin pompa de insulin,
continuarea tratamentului de substituie hormonal i evaluare printr-o metod imagistic cu
substan de contrast i.v. a nodului hepatic.
Concluzii: Utilizarea pompei de insulin la pacienii cu diabet zaharat tip 1 a permis ameliorarea
controlului glicemic evaluat prin automonitorizare glicemic, cu beneficii semnificative asupra
calitii vieii i a riscului de hipoglicemie n contextul sindromului de nerecunoatere a
hipoglicemiei.
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INSULIN PUMP TREATMENT AN ALTERNATIVE FOR TYPE 1 DIABETES
MELLITUS PACIENTS WITH HYPOGLICEMIC UNAWARENESS
Rezident Mintici Luana1, Rezident Herescu Irina1, Rezident Ionescu Olteea1, Dr. Ioacara
Sorin1, Prof. Dr Fica Simona1
1
SUU Elias, Bucuresti
Introduction: Severe hypoglycemia and hypoglycemia unawareness due to deficient

counterregulatory hormone release and diminished autonomic response in type I diabetes mellitus
patients can compromise glycemic control and reduce the quality of life.
Case presentation: Female pacient, age 40, diagnosed at age 4 with type I diabetes mellitus
(polyuria, polydipsia, polyfagia, fasting plasma glucose > 300mg/dl when diagnosed), father also
diagnosed with DM, arrives in February for clinical and biological evaluation and initiation of
insulin pump therapy. Up to February 2016 she had been on a basal-bolus insulin treatment
(Humalog 6U-4U-5U; Lantus 12U administered in the morning) however she had important blood
glucose variations (36-400mg/dl) and two severe hipoglycemia episodes per month. The patient
has endocrynological medical history (thyroidectomy due to nodular goiter, presently under
hormonal substitution therapy), frequent lower urinary infections, hepatic hemangioma
(hyperechoic, homogenous, well defined nodule measuring 10/9 mm, localized in segment VI,
diagnosed in 2014 through echography) and carpal tunnel syndrome (2010).
At the clinical exam, except for paresthesia in all limbs no other irregularities are present.
Laboratory examination results are normal except for glycated hemoglobin 7.5% (slightly higher
than the <7% target) and fasting plasma glucose of 53mg/dl when admitted (other fasting plasma
glucose values during hospitalization: 45, 36, 97 mg/dl). In april 2015 glycated hemoglobin value
was 7.8. Laboratory examination also shows euthyroidian post-thyroidectomy hipothyroidism
under hormonal substitution therapy with Levothyroxine (Euthyrox) 100g/day. Fundus
examination shows minimal nonproliferative diabetic rethinopathy and stage II angiosclerosis. The
blood sugar charts show a significant reduction of the risk of hypoglycemia, especially at night.
Recommendations on release: blood glucose measurement at least 4 times/day and adjustment of
insulin intake via insulin pump, continuation of the hormonal substitution therapy and imagistical
evaluation with i.v. contrast for the hepatic nodule.
Conclusions: The use of the insulin pump at pacients with type I diabetes mellitus allowed a better
control over blood glucose levels through glycemia automonitorization, with significant benefits
to the quality of life and the risc of hypoglycemia in hypoglycemia unawareness syndrome.
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PO7. PATTERNS REGARDING VITAMIN AND MINERALS INTAKE IN
NORMALWEIGHT AND OBESE PATIENTS
MD Mihaela Posea1, MD Andreea Dragomir1, Prof. Gabriela Radulian1

1
Clinic of Nutrition and Diabetes Diet4life
To evaluate the vitamin and minerals intake in overweight and obese patients and to personalize
diet plan for reaching a healthy weight and to correct the deficiencies found. Knowing the factors
and the hypercaloric diet that lead to obesity we can achieve a healthy lifestyle program to be
maintained in the long term
The food log analysis showed that all the patients had food deficiencies of vitamin D, E, calcium
and magnesium even if they were eating a hypercaloric or a normocaloric diet. If the weight
management involve a calorie restriction, we need to be careful with these micronutrients and to
prevent the plasma deficiencies. Personalizing the diet and indicate the foods that are rich in
different nutrients, we can reach the recommended daily intake for vitamins and minerals.
The originality of our study is that we evaluated the vitamin and minerals intake both to
normalweight and obese patients and we demonstrated that neither the normal weight nor the obese
patient had adequate micronutrient intake. We developed a software that analyzed the diet from
the point of view of macro and micronutrient.
In our country, the latest study on obesity prevalence showed, in 2014, that 21.3% of Romanians
are obese and the trend is growing. In 2025, World Obesity Federation estimates that will be 177
million of obese people that will need treatment. Hypocaloric diet and regular exercise are the first
step to lose weight. These patients have an inadequate food intake, with an imbalance regarding
kilocalories, vitamins and minerals that could have consequences on health.
PO8. PREVALENCE OF NEPHROPATHY AMONG PATIENT WITH DIABETES

MELLITUS
ASSOCIATED WITH ARTERIAL HYPERTENSION
Student Souabni Seif Eddine1, Student Soury Arselen1, Student Houidi Ahmed1, Student
Selmi Monaam1
1
UMF Iasi
Diabetes mellitus and arterial hypertension are growing to be a major public health issue. Both
entities often coexist and their co-existence can significantly increase the risk of developing a
nephropathy. The chronicity of both conditions can significantly affect the management and the
life quality of the patient. Therefore we are aiming with this study to assess the role of these two
co-morbidities in the development of a nephropathy in order to provide a better care and to avoid
the progression to end stage renal disease (ESRD).
Our retrospective study was conducted in the diabetology, nutrition and metabolic diseases
department in Sfantul Spiridon Hospital IASI, we enrolled 606 patient, among them 304 male and
302 female and we used the same identical data sheet to collect the other morbidities and associated
233
risk factors among all our patients.

During our study 606 patients were examined of whom 108 (17.8 %) had type 1 diabetes mellitus
Page
and 467 (77%) had type 2 diabetes mellitus and 402 (66.3 %) had high blood pressure. 55 (13.92%)
of our diabetic patient have grade 1 high blood pressure (HBP), 104 (26.32 %) have grade 2 HBP
and 236 (59.76 % ) have grade 3 HBP. We noticed that 130 (32.9%) of the patients having diabetes
mellitus associated with arterial hypertension have a nephropathy of whom 109 (83.8 %) patient
had a preexisting grade 3 HBP. We should note that our patients did have associated risk factors
other then diabetes mellitus and arterial hypertension such as obesity (44 %) and smoking
(26.32%).
The existence of hypertension among diabetic patients can significantly increase the occurrence
of nephropathy, therefore early detection of diabetes mellitus, arterial Hypertension, a better care
and management of both entities may delay the progression of kidney disease in Diabetes mellitus.
Hereby studying the prevalence of nephropathy among patient with these two co-morbidities may
lead to a better understanding of the causing mechanism and prevent its complications.
PO9. ROLUL CHIRURGIEI BARIATRICE IN TRATAMENTUL DIABETULUI

ZAHARAT TIP 2
Dr. erbnescu Cristina1, Dr. Nil Alexandra1, Dr. Sava Elisabeta1, Dr. Srbu Anca1, Dr.
Ioacr Sorin1, Prof. Univ. Dr. Fica Simona1
1
Spitalul Universitar de Urgen Elias
Introducere: Chirurgia bariatrica duce la scderea ponderal substanial i mbuntirea

controlului glicemic la pacienii cu obezitate i diabet zaharat tip 2, datorit restriciei calorice i a
modificrii secreiei peptidelor intestinale. n particular, intervenia tip gastric bypass duce la
creterea secreiei i a sensibilitii la insulin, reprezentnd un tratament adecvat pentru pacienii
ce nu pot atinge intele glicemice recomandate prin tratament medicamentos.
Prezentare caz: Pacienta n vrst de 61 ani, cu diabet zaharat tip 2 din 2000, obezitate pentru
care s-a intervenit prin chirurgie bariatric - bypass gastric n 2010, cu antecedente de
feocromocitom operat n 2000, cu polimialgie reumatic diagnosticat n 2013, se prezint n
clinica noastr n februarie 2016 pentru reevaluare clinico-metabolica la 6 ani dupa gastric bypass.
Pacienta este cunoscut clinicii din 2010, cnd s-a prezentat pentru evaluare preoperatorie, avnd
IMC = 48 kg/m2, diabet zaharat tip 2 dezechilibrat (HbA1c = 10,19 %), n tratament cu insulin
premixat 30/70, 58 UI/zi, i Metformin 3000 mg/zi. Postoperator evoluia profilului glicemic a
fost favorabil cu dispariia necesitii administrrii de insulin la o sptmn postoperator,
rmnnd n tratament cu 1500 mg Metformin/zi. La 6 luni postoperator HbA1c era 6.51 %, IMC
= 40 kg/m2, iar la 1 an HbA1c = 6.03 % i IMC = 37,9 kg/m2. n 2013 a debutat tratamentul cu
Prednison 5 mg/zi pentru polimialgie reumatic, fr modificarea tratamentului antidiabetic.
Actual, clinic prezint obezitate (IMC = 37.7 kg/m2), tegumente i mucoase palide, stare general
bun. Paraclinic prezint anemie feripriva uoar, deficit vitamina D, funcie tiroidan normal,
funcie hepatica i renal normale. HbA1c se menine n tina terapeutic, fiind 6,9 %.
Se decide meninerea tratamentului cu Metformin 1500 mg/zi, corectarea anemiei i a deficitului
de vitamina D, efectuarea osteodensitometriei n ambulator.
Concluzii: Chirurgia bariatric intete reducerea greutii i meninerea acestui progres. Pe lng
aceasta, exist beneficii metabolice independente, astfel, n urma acestei proceduri, apar
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mbuntiri rapide n controlul glicemic, chiar n decurs de cteva zile, nainte de nregistrarea
unei scderi ponderale semnificative.
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PO10. ASOCIEREA DINTRE ACIDUL URIC I OBEZITATEA LA PACIENII CU
DIABET ZAHARAT TIP 2
Dr. Zaharia Adelina1, Dr. Li Genoveva Andreea1, Dr. Pavel Anca Ioana1, Student Zaharia
1
National Institute of Diabetes Mellitus, Nutrition and Metabolic Diseases Prof.Dr. N.C.
Paulescu, Bucharest
Premise si obiective: Hiperuricemia reprezint o afeciune metabolic frecvent ntlnit la

pacienii cu Diabet zaharat tip 2. Cu toate acestea, relaia dintre nivelul acidului seric i Diabetul
zaharat care asociaz i obezitate se afl nc n cercetare. Astfel, scopul acestui studiu a fost s
evalueze relaia dintre acidul uric i statusul ponderal, comparnd nivelul acidului uric la pacienii
diabetici obezi fa de cei non-obezi.
Material i metod: Am realizat un studiu retrospectiv pe un numr de 218 pacieni cu Diabet
Zaharat tip 2, aflai n evidena I.N.D.N.B.M.Prof.Dr.N.C.Paulescu, Bucureti, folosind metode
clinice i de laborator pentru evaluarea parametrilor inclui n studiu. Astfel, am utilizat
determinarea acidului uric seric pentru evaluarea hiperuricemiei, iar statusul ponderal al
pacienilor a fost evaluat prin calcularea indicelui de masa corporal n funcie de indicii
antropometrici (greutate i nlime).
Rezultate i discuii: Din numrul total de pacieni inclui n studiu 62 (28,4%) au fost de sex
feminin i 156 (71,6 %) au fost de sex masculin. Vrsta medie a pacienilor a fost de 58,71 7,86
ani; durata medie a diabetului a fost de 11,79 7,12 ani. n ceea ce privete statusul ponderal al
pacienilor, 8,7 % (n=19) au fost normoponderali, 25,7% (n=56) au fost supraponderali, iar 65,6
% (n=143) au prezentat obezitate n diferite grade. Nivelul mediu al acidului uric a fost de 5,42
1,86 mg/dl la pacienii normoponderali, 5,38 1,69 mg/dl la persoanele supraponderale i 6,12
1,88 mg/dl la pacienii care au prezentat obezitate (p=0,021). Dintre pacienii care au prezentat
hiperuricemie, 75% au prezentat obezitate n diferite grade, astfel: 32,5% obezitate gradul 1, 37,5%
obezitate gradul 2 i 5% obezitate gradul 3 (p=0,05). De asemenea, la 82,5 % dintre pacienii cu
hiperuricemie s-a inregistrat i prezena sindromului metabolic.
Concluzii: S-a observat c exist diferene semnificative din punct de vedere statistic n ceea ce
privete nivelul acidului uric la pacienii cu Diabet Zaharat tip 2 i obezitate, comparativ cu
pacienii normoponderali sau supraponderali.
THE CORRELATION BETWEEN SERUM URIC ACID AND OBESITY IN PATIENTS

WITH TYPE 2 DIABETES MELLITUS
Dr. Zaharia Adelina1, Dr. Li Genoveva Andreea1, Dr. Pavel Anca Ioana1, Student Zaharia
1
National Institute of Diabetes Mellitus, Nutrition and Metabolic Diseases Prof.Dr. N.C.
Paulescu, Bucharest
235
Premises and Objectives: Hyperuricemia is a metabolic disease often seen in patients with Type
2 Diabetes Mellitus. However, the relation between the level of serum uric acid and Diabetes
Page
Mellitus which associates obesity is still in research. The aim of this study was to evaluate the
relation between serum uric acid and ponderal status, by comparing the level of serum uric acid in
patients with obesity and those without obesity.
Content and Method: We realised a retrospective study on a group of 218 patients with Diabetes
Mellitus, who were under the observation of N.I.D.N.M.D.Prof. Dr.N.C.Paulescu from
Bucharest, by using clinical and laboratory methods to evaluate the parameters included in the
study. We used the laboratory values of serum uric acid to evaluate the hyperuricemia; the ponderal
status was evaluated by calculating the body mass index, using anthropometric indices (weight
and height).
Results and Discussions: From the total number of patients included in the study, 62 (28,4%)
were women and 156 (71,6 %) were men. The average age of the patients was 58,71 7,86 years;
the average duration of diabetes mellitus was 11,79 7,12 years. Regarding the ponderal status of
the patients, 8,7 % (n=19) had normal weight, 25,7% (n=56) were overweight and 65,6 % (n=143)
had obesity in different grades. The medium level of the serum uric acid was 5,42 1,86 mg/dl in
patients with normal body weight, 5,38 1,69 mg/dl in overweight persons and 6,12 1,88 mg/dl
in subjects with obesity (p=0,021). In patients with hyperuricemia, 75% had obesity in different
stages, as it follows: 32,5% grade 1 obesity, 37,5% grade 2 obesity and 5% grade 3 obesity
(p=0,05). Also, in 82,5% from patients with hyperuricemia we found the presence of metabolic
syndrome.
Conclusions and Findings: We observed that there are significant differences regarding the level
of serum uric acid in patients with Type 2 Diabetes Mellitus and obesity, comparing to patients
with normal body weight or overweight.
PO11. SINDROMUL MAURIAC - O COMPLICAIE RAR A DIABETULUI

ZAHARAT
Dr. Stegaru Daniela1, Dr. Delcea Alina1, Conf. Dr. Guja Cristian1
1
UMF "Carol Davila"
Premise i obiective: Sindromul Mauriac este una dintre complicaiile foarte rare, dar grave ale
diabetului zaharat tip 1. n tabloul clinic al sindromului Mauriac regsim retardul de cretere, faa
n form de lun plin, abdomenul mult mrit de volum i atrofii muscular importante. Este
asociat cu dezechilibrul metabolic cronic important, n care alterneaz perioade lungi de
subinsulinizare cu perioade de suprainsulinizare. n prezent este o complicie foarte rar, cel puin
n statele dezvoltate. Prezentm n cele ce urmeaz un astfel de caz.
Material i metod: A fost evaluat un pacient de sex masculin n vrst de 10ani i o lun,
cunoscut cu DZ tip 1 n evoluie de la varsta de 10 luni, adus la spital de mam pentru valori
glicemice crescute (350-450mg/dl) alternativ cu hipoglicemii severe (40-50mg/dl). Au fost
evaluai parametrii clinici (date antropometrice, examen clinic complet) i paraclinici (probe de
laborator si date imagistice - radiografie pulmonar, ecografie abdominal). In cursul internarii a
fost reevaluata schema de insulinoterapie, cu ajustarea dozelor n funcie de glicemii i de aportul
236
de carbohidrai.
Rezultate: Copilul prezint dezechilibru metabolic cronic (HbA1c 10.4%), deficit de cretere
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staturo-ponderal (nalime 1.18 m, greutate 21 kg, sub percentila 5 pentru vrst, IMC 15.1
kg/mp), hepatomegalie masiv (19cm) nsoit de hepatocitoliz i dislipidemie sever (GGT
1008 UI/l, TGO 118 UI/l, TGP 118 UI/l, colesterol total 589 mg/dl, HDL 16.6 mg/dl, TG
840 mg/dl). Examinarea ecografic indic prezena hepatomegaliei (diametrul hepatic prerenal
de 190mm), cu ecostructura relativ omogen dar intens hiperecogen, cu mici calcificri la nivel
pancreatic. Dup 4 zile de ameliorare metabolica (valori glicemice 120-250mg/dl), se poate
constata o uoar mbuntire a profilului lipidic cu scaderea CT la 467mg/dl i a TG la 629mg/dl.
De adaugat ca am testat anticorpii anti celula beta pancreatica care au fost pozitivi anti GAD,
sustinand diagnosticul de DZ autoimun.
Discuii: Este posibil prezena sindromului Mauriac indus de controlul metabolic deficitar i de
durat. Datorit vrstei la debutul diabetului (10 luni) putea fi luat n discuie prezena unui diabet
neonatal sau a unui alt sindrom genetic complex care asocieaza diabet zaharat, ns prezena
anticorpilor anti GAD infirm aceast teorie. Prezena hepatomegaliei importante asociat cu
hepatocitoliz i dislipidemie sever aprute la vrsta de 6 ani, dup un dezechilibru metabolic nu
foarte important n intervalul 10 luni 6 ani (HbA1c aprox. 9%), ridic suspiciunea prezenei unei
glicogenoze asociate DZ tip 1 sau a unui sindrom Fanconi-Bickel. Totusi, ameliorarea
semnificativ a profilului lipidic n numai 4 zile de internare (in paralele cu ameliorarea controlului
glicemic) nclin balana spre prezena unei glicogenoze secundare dezechilibrului metabolic
cronic, n cadrul unui tablou clinic de Sindrom Mauriac. Datorit prezenei microcalcificrilor la
nivel pancreatic, ridicand suspiciunea unei eventual fibroze chistice, a fost efectuat i radiografia
pulmonar care nu a indicat modificari sugestive pentru aceasta afectiune.
MAURIAC SYNDROME - A RARE COMPLICATION OF DIABETES MELLITUS
Dr. Stegaru Daniela1, Dr. Delcea Alina1, Conf. Dr. Guja Cristian1
1
UMF "Carol Davila"
Premises and objectives: Mauriac syndrome is a very rare and severe complication of type 1
diabetes (T1D). It is characterized by growth retardation and delayed pubertal maturation, short
stature, moon-shaped face, abdominal obesity and important muscle atrophy. It is associated
with poor management of T1D, with long periods of sub-insulinization alternating with periods of
overinsulinization. Today it is very rare complication of T1D, at least in developed countries. We
present below such a case.
Methods: We evaluated a boy aged 10 years and 1 month, diagnosed with T1D at the age of 10
months. He was admitted in hospital (brought by his mother) for elevated blood glucose (350-450
mg/dl) alternating with severe hypoglycemic episodes (40-50mg/dl). He was fully evaluated,
including clinical parameters (anthropometric data, complete clinical examination) and laboratory
data (lab tests and imaging data - chest X-ray, abdominal ultrasound). During hospitalization,
insulin regimen was reconsidered, with dose adjustments based on blood glucose levels and
carbohydrate intake.
237
Results: The child presents a poor metabolic control (HbA1c - 10.4 % ), growth failure (height -
1.18 m, weight - 21 kg, below the 5th percentile for age, BMI 15.1 kg/m2), massive
Page
hepatomegaly (19cm), with hepatocytolisis and severe dyslipidemia (GGT - 1008 IU/l, TGO - 118
IU/l, TGP - 118 IU/l, total cholesterol - 589 mg/dL, HDL - 16.6mg/dl, TG - 840 mg/dL).
Ultrasound examination indicated the presence of hepatomegaly (prerenal liver diameter of 190
mm) with relatively homogeneous echostructure but intensely hyperechoic, with small
calcifications in the pancreas. After 4 days of improvement of the blood glucose profile (glycemia
ranging between 120-250 mg/dL), there was a slight improvement in the lipid profile, with a
decrease of TC to 467 mg/dl and TG to 629 mg/dl. Also we tested pancreatic beta cell antibodies
that were positive for GAD autoantibodies, supporting a diagnosis of autoimmune diabetes.
Discussion: A diagnosis of Mauriac syndrome is possible, induced by the long period of poor
management of diabetes mellitus. We could also consider the presence of neonatal diabetes based
on the age at onset of diabetes (10 months), or other complex genetic syndrome that associated
diabetes. However,, the presence of anti GAD antibodies cripple this theory. The presence of
important hepatomegaly associated with hepatocytolisis and severe dyslipidaemia first evidenced
at the age of 6 years, after a period of moderately controlled diabetes between 10 months and 6
years (HbA1c approx. 9%) made us suspect the presence of an associated glycogenosis or Fanconi-
Bickel syndrome. However, the improvement of the lipid profile in only 4 days of hospitalization
(in parallel with the improvement of glycemic control) tilts the balance towards the presence of a
secondary glycogenosis explained by the chronic metabolic imbalance - a clinical manifestation
of Mauriac syndrome. Due to the presence of microcalcifications in the pancreas, possibly raising
the suspicion of cystic fibrosis, a chest radiography was performed which indicated no changes
suggestive for this condition.
PO12. TERAPIILE BIOLOGICE N DIABETOLOGIE: OPORTUNITATE I

PROVOCRI
Dr. Geanta Marius1

1
Centrul pentru Inovatie in Medicina, Public Health Genomics Network Europe
Premise i Obiective: Biotehnologia st la baza fabricrii a sute de medicamente, de care

beneficiaz, la nivel mondial, peste 350 de milioane de pacieni. Acestea se folosesc n tratamentul
sau pentru prevenirea multor boli grave, inclusiv cancerul, infarctul miocardic, accidentul vascular
cerebral, scleroza multipl, diabetul, artrita reumatoid i bolile autoimune.
Material i Metod: Medicamentele biologice sunt alctuite din substane care, adesea, sunt
produse n mod natural n corpul uman, cum ar fi hormonul de cretere, insulina, eritropoietina,
enzimele, anticorpii etc. Acestea nu pot fi obinute prin sintez chimic, cum este cazul
medicamentelor clasice, ci sunt produse de ctre sisteme vii (celule vegetale sau animale, bacterii,
virusuri i drojdii). Din acest motiv, fabricarea de medicamente biologice este mult mai complex
dect producia de produse farmaceutice chimice. De cele mai multe ori, se folosete o linie
celular modificat genetic, astfel nct celulele s produc substana dorit. Fiecare companie de
biotehnologie are o banc proprie de celule, cu linii celulare unice, care sunt folosite pentru
fabricarea medicamentelor.
Rezultate i Discuii: Avnd n vedere c se folosesc structuri vii, variaii foarte mici ale
procesului de fabricaie, de exemplu, n temperatur, pot cauza schimbri semnificative n
238
proprietile fizice i clinice ale medicamentului produs. Medicamentele biologice sunt molecule
mai mari i mai complexe. Spre deosebire de medicamentele clasice, care constau n molecule
Page
mici, produse prin sintez chimic, medicamentele biologice au, de multe ori, structur proteic,
complex, fiind formate din lanuri de aminoacizi aezate ntr-o structur tridimensional
complex, ce nu pot fi asamblate dect de ctre organismele vii. Deoarece medicamentele
biologice sunt produse de sisteme vii, pot prezenta o variabilitate mai mare n structura i
caracteristicile lor comparativ cu produsele farmaceutice tradiionale. Proprietile
medicamentului biologic pot fi influenate att de linia de celule utilizate pentru producie, ct i
condiiile de fabricaie, deosebiri aparent minore ale mediului putnd determina modificri
importante de eficien i tolerabilitate.
Concluzie: n contextul dezvoltrii medicamentelor biosimilare n domeniul diabetologiei, este
necesar o nelegere aprofundat a procesului de dezvoltare a medicamentelor biologice, pentru
a face, ca medic diabetolog, alegerea potrivit a tratamentului i pentru a evita apariia efectelor
adverse ale medicaiei din cauza utilizrii neconforme cu proprietile biologice.
TERAPIILE BIOLOGICE N DIABETOLOGIE: OPORTUNITATE I PROVOCRI
Dr. Geanta Marius1

1
Centrul pentru Inovatie in Medicina, Public Health Genomics Network Europe
Background and Objectives: Biotechnology underpins the manufacture of hundreds of drugs that
benefit worldwide, over 350 million patients. They are used to treat or prevent a number of serious
diseases, including cancer, myocardial infarction, stroke, multiple sclerosis, diabetes, rheumatoid
arthritis and autoimmune diseases.
Material and method: Biological drugs are composed of substances which are often naturally
occurring in the human body, such as growth hormone, insulin, erythropoietin, enzymes,
antibodies , etc. They can not be produced by chemical synthesis, such as conventional drugs, but
are produced by living systems (plant or animal cells, bacteria, viruses and yeasts). For this reason,
the production of biological drugs is much more complex than the production of chemical
pharmaceutical products. Each biotechnology company has its own bank of cells with unique cell
lines that are used for the manufacture of drugs.
Results and discussions: Very small variations of the manufacturing process, for example in
temperature, can cause significant changes in physical and clinical properties of the drug.
Biological drugs are larger and more complex molecules. The classical medicines consisting of
small molecules produced by chemical synthesis. Biological medicines are often, protein structure,
complex, being made up of chains of amino acids arranged in a three-dimensional structure
complex, which can be assembled only by living organisms. Because biological drugs are
produced by living systems, may experience greater variability in their structure and characteristics
compared to traditional pharmaceuticals. Biological properties of the drug can be influenced by
the cell line used for production and manufacturing conditions, minor environmental differences
may cause significant changes of efficacy and tolerability.
Conclusion: In the context of developing biosimilar medicines in the field of diabetology, it
requires a deep understanding of the development process for biological medicines, in order to
make the appropriate choice of therapy and avoid the side effects of medication due to non-
239
compliant use of the biological drugs.

Page
PO13. CORELAII CLINICO-BIOLOGICE DE RISC CARDIOVASCULAR I
NIVELUL INFLAMAIEI CRONICE SISTEMICE LA PACIENII CU DIABET
ZAHARAT DE TIP 2 I STEATOHEPATIT NONALCOOLIC
Premise i Obiective: Steatohepatita non-alcoolic (SHNA) forma sever a ficatului gras non-
alcoolic (FGNA) diagnosticat prin puncie biopsie hepatic, a fost asociat cu un risc crescut
de boal cardiovascular aterosclerotic. Dei patogeneza SHNA rmane inc insuficient ineleas,
citokinele proinflamatorii prezint un rol important atat in progresia i dezvoltarea SHNA precum
i in procesul aterogen al afectrii cardiovasculare. Obiectivul acestui studiu a fost acela de a
evalua profilul inflamator sistemic cronic (i.e., citokinele proinflamatorii (IL-6, IL-1, TNF-) i
nivelul hs-CRP) i adiponectina seric la pacieni cu diabet zaharat de tip 2 (DZT2) i SHNA,
precum i corelaiile acestora cu caracteristici clinicobiochimice ale pacienilor.
Material i Metod: Un numr total de 117 participani (32 pacieni cu DZT2 si SHNA
diagnosticai histologic; 45 pacieni cu DZT2 fara afectare hepatic; 40 de subieci sntoi clinic)
au fost inclui in studiu i evaluai sub aspect clinico-biologic. Nivelurile serice ale unui panel de
markeri ai inflamaiei cronice sistemice (factorul de necroz tumoral- (TNF-), interleukina-6
(IL-6), interleukina-1 (IL-1), hs-PCR) i adiponectina au fost msurate in serul pacienilor inclui
in studiu, iar rezultatele obinute au fost prelucrate statistic prin efectuarea analizelor de corelaie.
Rezultate i Discuii: Pacienii cu SHNA i DZT2, in comparaie cu pacienii cu DZT2 fr
afectare hepatic , au prezentat niveluri serice semnificativ mai mari de IL-6 (134.83 57,18 pg/ml
vs. 55,68 18,29 pg/ml; p = 0,001), IL- 1 (73,45 15,11 pg/ml vs. 22,07 9,17 pg/ml; p = 0,001)
i TNF- (60,88 12,31 pg/ml vs. 18,81 7,25 pg/ml; p = 0,021). Spre deosebire de creterea
concentraiilor de citokine proinflamatorii, nivelul seric al adiponectinei la pacienii cu SHNA i
DZT2 a fost gsit mai sczut decat la pacienii doar cu DZT2 (3950,5 954 ng/ml vs. 6745 1122
ng/ml; p = 0,002) i lotul martor. In ceea ce privete hs-CRP, acest parametru al inflamaiei cronice
sistemice a fost gsit semnificativ crescut la pacienii cu SHNA i DZT2 (8,4 5,9 mg/l),
comparativ cu pacienii doar cu DZT2 (4,72 3,6 mg/l) i lotul martor (2,11 1 mg/ l) (p = 0,001).
Profilul clinic al pacienilor cu DZT2 i SHNA indic: prevalen crescut a obezitii morbide la
acest lot vs. pacienii cu DZT2 i ficat normal i vs. lotul martor; control slab al diabetului zaharat;
cretere a transaminazelor serice i a gama GT, rezisten crescut la insulin, precum i un risc
cardiovascular calculat (scor UKPDS pe 10 ani) mult crescut sub aspectul morbiditii i
mortalitii de cauz coronarian i cerebrovascular. Rezultatele analizelor de corelaie au
evideniat la pacienii cu DZT2 iSHNA asocieri semnificative intre creterea citokinelor
proinflamatorii i hs-PCR, scderea adipocitokinei antiaterogene, i diferii parametri clinici i
biochimici de risc cardiovascular.
Concluzii: Rezultatele acestui studiu arat c nivelurile serice ale IL-6, IL-1, TNF- i hs-PCR
sunt semnificativ crescute la pacienii cu DZT2 i SHNA, iar nivelul adiponectinei serice este
sczut. Caracteristicile clinico-biochimice i profilul inflamator sistemic al pacienilor cu DZT2 i
SHNA se asociaz cu un risc cardiovascular foarte inalt.
240
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CLINICAL AND BIOLOGICAL CORRELATIONS OF CARDIOVASCULAR RISK
AND THE LEVEL OF CHRONIC SYSTEMIC INFLAMMATION IN PATIENTS WITH
TYPE 2 DIABETES MELLITUS AND NON-ALCOHOLIC STEATOHEPATITIS
Background and Objectives: Non-alcoholic steatohepatitis (NASH) the severe form of

nonalcoholic fatty liver disease (NAFLD) diagnosed by liver biopsy, was associated with an
increased risk of atherosclerotic cardiovascular disease. Although the pathogenesis of NASH
remains poorly understood, proinflammatory cytokines play an important role in the progression
and development of NASH as well as in the process of atherogenic cardiovascular impairment.
The objective of this study was to assess the chronic systemic inflammatory profile (i.e.,
proinflammatory cytokines (IL-6, IL-1, TNF-) and the level of hs-CRP), and the serum
adiponectin in patients with type 2 diabetes mellitus (DMT2) and NASH, as well as their
correlations with clinical and biochemical patient characteristics.
Materials and methods: A total of 117 participants (32 patients with DMT2 and NASH
(diagnosed by liver biopsy); 45 patients with DMT2 only, and without liver impairment; and 40
controls) were included in the present study, being clinically and biologically assessed. The serum
levels of a panel of markers of chronic systemic inflammation (tumor necrosis factor- (TNF),
interleukin6 (IL6), interleukin-1 (IL-1), hs-CRP) and adiponectin were measured in the serum
of patients included in the study, and the results were statistically processed by means of
correlation analyses.
Results and discussion: Patients with NASH and DMT2, in comparison with patients with DMT2
only, exhibited significantly higher serum levels of IL-6 (134.83 57.18 pg/ml vs. 55.68 18.29
pg/ml, p = 0.001), IL-1 (73.45 15.11 pg/ml vs. 22.07 9.17 pg/ml, p = 0.001), and TNF-
(60.88 12.31 pg/ml vs. 18.81 7.25 pg/ml, p = 0.021). In contrast to the increase of
proinflammatory cytokine concentrations, the serum level of adiponectin in patients with NASH
and DMT2 was found lower than in patients with DMT2 only (3950.5 954 ng/ml vs. 6745
1122 ng/ml, p = 0.002), and controls. Moreover, regarding the hs-CRP, this parameter of chronic
systemic inflammation was found significantly elevated in patients with NASH and DMT2 (8.4
5.9 mg/l) compared to patients with DMT2 only (4.72 3.6 mg/l) and controls (2.11 1 mg/l) (p
= 0.001). The clinical profile of patients with NASH and DMT2 indicates an increased prevalence
of morbid obesity in this population, compared to patients with DMT2 only and normal liver, and
controls; poor control of diabetes; an increase in serum transaminases, gamma GT levels, and
insulin resistance; and a cardiovascular risk (UKPDS score estimated for a 10-year span) much
increased, both in terms of morbidity and mortality from coronary and cerebrovascular causes.
Correlation analysis results have revealed, in patients with DMT2 and NASH, significant
associations between the increase of proinflammatory cytokines and hs-CRP, the decrease of
antiatherogenic adipocytokine, and various clinical and biochemical parameters of cardiovascular
risk.
Conclusions: Overall, this studys evidence indicates that the serum levels of IL-6, IL-1, TNF-
, and hs-CRP are significantly increased in patients with NASH and DMT2, and the serum level
of adiponectin are decreased. The clinical and biochemical patient characteristics, and the systemic
inflammatory profile of patients with DMT2 and NASH, are associated with a very high
241
cardiovascular risk.
Page
PO14 HIPERTRIGLICERIDEMIA, FACTOR DE RISC PENTRU PANCREATITA
ACUT LA PACIENTUL CU DIABET ZAHARAT
Oana Albai1,2, Raluca Borza3, Ionela Tudora3, Alexandra Sima1,3, Adrian Vlad1,3, Romulus
Timar1,2, 3, Bogdan Timar1,2
1.Universitatea de Medicin i Farmacie "Victor Babe" Timisoara, Romania
2. Centrul de Diabet, Nutriie i Boli Metabiolice Timioara, Romania
3. Departamentul de Diabet, Nutriie i Boli Metabolice a Spitalului Judeean de Urgen
Timisoara, Romania
Premise i obiective: Insulinorezistena (IR) i/sau Insulinodeficiena, caracteristice pacienilor

cu diabet zaharat (DZ), contribuie la apariia modificrilor cantitative i calitative ale tuturor
claselor de lipoproteine (LP), n special ale trigliceridelor (TG). Hipertrigliceridemia (HTG)
reprezint a treia cauz de pancreatit acut (PA), dup consumul de alcool i litiaza biliar.
Scopul studiului de fa a fost de a determina prevalena PA la pacienii cu DZ, precum i corelaia
acesteia cu valorile TG.
Material i metod: Au fost investigai 2355 pacieni cu DZ, internai n Clinica Medical III-
Diabet, Nutriie i Boli Metabolice a Spitalului Clinic Judeean de Urgen din Timioara n
perioada octombrie 2014- decembrie 2015. S-au cercetat urmtorii parametrii clinici i paraclinici:
vrst, sex, tip DZ, date referitoare la consumul de alcool, fumat, prezena litiazei biliare, indice
de mas corporal (IMC), talia (circumferina abdominal), controlul glicemic (glicemie jeun,
glicemie postprandial, HbA1c), profilul lipidic (CT, TG, HDLc, LDLc, non-HDLc), prezena
conplicaiilor DZ, lipaza i amilaza seric, valorile tensionale, datele examenelor de
ultrasonografie abdomial i computer tomografie.
Rezultate i discuii: Lotul a cuprins 1160 brbai (49,3%) i 1195 femei (50,7%), cu vrsta medie
60,7 13,6 ani. Pe tipuri, 310 pacieni (13,2%) au prezentat DZ tip 1 i 2045 pacieni (86,8%) DZ
tip 2. Valoarea medie a HbA1c la pacienii inclui n studiu a fost de 9,1 2,2%.
Prevalena HTG la lotul studiat a fost 38%, 894 de pacieni prezentnd valori ale TG 150 mg/dl.
Valoarea medie a TG a fost de 183,7 202,8 mg/dl.
Diagnosticul de PA a fost stabilit la 28 pacieni (1,2%), prevalena fiind mai mare la sexul
masculin, fa de sexul feminin: 1,6%, versus 0,8%.
Analiznd valorile TG la pacienii cu PA, am constatat c 21 pacieni (75%) au avut valori ale
acestora 200 mg/dl: 6 pacieni (21%) au avut TG > 2000 mg/dl, 5 pacieni (17%) au avut valori
cuprinse ntre 500 i 2000 mg/dl, iar 11 pacieni (39%) au avut TG ntre 200 i 500 mg/dl.
Efectund o comparaie ntre principalii parametrii urmrii la pacienii cu PA i cei fr PA, am
costatat c valorile medii ale IMC, HbA1c, CT, TG serice au fost semnificativ statistic mai mari
la cei cu PA (p < 0,0001).
Concluzii: Valorile TG se coreleaz pozitiv cu controlul DZ, evaluat prin valorile HbA1c. HTG
reprezint un factor de risc pentru PA, independent de riscul cardiovascular. Monitorizarea
periodic a metabolismului lipidic, alturi de cel glucidic este imperios necesar, impunndu-se
un tratament precoce i eficient.
242
Page
HYPERTRIGLYCERIDEMIA, A RISK FACTOR FOR ACUTE PANCREATITIS IN
PATIENTS WITH DIABETES MELLITUS
Oana Albai1,2, Raluca Borza3, Ionela Tudora3, Alexandra Sima1,3, Adrian Vlad1,3, Romulus
Timar1,2, 3, Bogdan Timar1,2
1. University of Medicine and Pharmacy "Victor Babes" Timisoara, Romania
2. Center of Diabetes, Nutrition and Metabolic Diseases Timioara, Romania
3. Department of Diabetes, Nutrition and Metabolic Diseases, County Hospital Timisoara,
Romania
Backgrouund and aims: Insulin resistance (IR) and/or insulin deficiency, characteristic of
patients with diabetes mellitus (DM) , contribute to the quantitative and qualitative changes of all
classes of lipoproteins (LP), special triglycerides (TG). Hypertriglyceridemia (HTG) is the third
leading cause of acute pancreatitis (AP) after alcohol consumption and gallstone.
The aim of the present study was to determine the prevalence of AP in patients with diabetes and
its correlation with TG values .
Material and methods: Were investigated 2355 patients with DM, hospitalized in Diabetes,
Nutrition and Metabolic Diseases Clinic of County Hospital Timisoara from October 2014 to
december 2015. The following parameters were investigated: age, sex, type of DZ , data about
alcohol consumption, smoking, presence of gallstones, body mass index (BMI), waist (abdominal
circumference), glycemic control (fasting, glycemia, postprandial glycemia, HbA1c), lipid profile
(TC , TG, HDLc, LDLc, non - HDLc), DZ conplications, serum lipase and amylase, blood pressure
, data of abdominal ultrasound and computed tomography .
Results and discussions: The study group included 1160 men (49.3%) and 1195 women
(50.7%) with mean age 60.7 13.6 years. Refering to types of DM, 310 patients (13.2%) had DM
type 1 and and 2045 patients (86.8%) DM type 2. Mean of the HbA1c at patients included in our
study was 9.1 2.2%.
The prevalence of HTG in the study group was 38%, 894 patients had values of TG 150 mg/dl.
The average value of TG was 183.7 202.8 mg/dl.
The diagnosis of AP was established on 28 patients (1.2%), the prevalence is higher in males
compared to females: 1.6% versus 0.8%.
Analyzing the values of TG in patients with AP, we found that 21 patients (75%) had TG 200
mg/dL: 6 patients (21%) had TG> 2000 mg/dL, 5 patients (17%) have TG between 500 and 2000
mg/dl, and 11 patients (39%) had TG between 200 and 500 mg/dl.
By comparing the main parameters in patients with and those without AP, we noticed that the
average values of BMI, HbA1c, TC, TG were significantly higher in those with AP (p <0.0001).
Conclusion: The values of TG are strongly correlated with the degree of glycemic control,
quantify by values of HbA1c. HTG is a risk factor for AP, independent of cardiovascular risk.
Regular monitoring of lipid metabolism and carbohydrate metabolism is required, imposing an
early and effective treatment.
243
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ACTA DIABETOLOGICA

Al 42-lea Congres Naional al Societii

The42nd National Congres of the

Prof. Dr. Cristian SERAFINCEANU

Conf. Dr. Cristian GUJA

Prof. Dr. Romulus TIMAR

Secretar/Secretary: Asist. Univ. Dr. Viviana ELIAN

Secretariat tehnic/Technical Secretary: Mariana ROCSIN

Comitetul tiinific al congresului:

Prof. Dr. Doina CATRINOIU Prof. Dr. Cristian SERAFINCEANU

Prof. Dr. Cristian SERAFINCEANU

Asist. Univ. Dr. Viviana ELIAN

Conf. Dr. Cristian GUJA

Conf. Dr. Cristian GUJA

Word of the president.... 19

PREZENTRI ORALE REVIEWS

ORAL PRESENTATIONS REVIEWS

RW 1. METODE DE EVALUARE A FUNCIEI BETACELULARE N PRACTICA

RW 2. MODERN VIEWS ON BASAL INSULIN IN DIABETES MELLITUS.. 23

RW 3. THE EPIDEMIC OF TYPE 2 DIABETES: A GLOBAL PROBLEM FOR THE 21ST

RW 4. DIABETIC FOOT DISEASE: AN OVERVIEW... 25

RW 5. DIABETUL SI SINDROMUL CORONARIAN ACUT. 26

RW 6. CARDIOVASCULAR OUTCOME TRIALS: THE POSSIBLE MECHANISMS BEHIND THE

RW 7. DIABETUL ZAHARAT TIP 2 I MENOPAUZA.................................................................................................. 28

RW 8. BENEFITS FROM INSULIN PUMP IN PEOPLE WITH TYPE 2 DIABETES 30

RW 9. PARTICULARITI ALE STATUSULUI NUTRIIONAL LA PACIENII CU DIABET ZAHARAT I

RW 10. CHIRURGIA BARIATRIC - O OPIUNE SIGUR PENTRU OBEZITATE?............................................ 33

RW 11. BOALA RENAL DIABETIC: ESTE MOMENTUL UTILIZRII DE RUTIN A BIOPSIEI

RW 14. TREATMENT WITH GLUCAGON LIKE PEPTIDE RECEPTOR AGONISTS 10 YEARS

RW 15. THE GENETIC BACKGROUND OF HUMAN OBESITY... 40

RW 16. ATEROGENEZA, ATEROSCLEROZA, ATEROTROMBOZA: DE CE PREZINT DIFERENE N

RW 17. CONSENS ASUPRA DISLIPIDEMIEI ATEROGENE........................... 42

RW 18. IDENTIFICAREA STADIILOR PRECOCE ALE DIABETULUI ZAHARAT DE TIP 1, NAINTEA

RW 19. SELF-MONITORING OF BLOOD GLUCOSE IN TYPE 2 DIABETES WHY, WHEN, HOW

RW 20. THE GLUCOSE VARIABILITY AND DIABETIC RETINOPATHY.............................................................. 45

RW 21. CLINICAL ASPECTS OF AUTONOMIC NERVE DYSFUNCTION IN DIABETES.... 46

RW 22. GOLIREA GASTRIC I RISCUL CARDIOVASCULAR N DIABETUL ZAHARAT... 47

RW 23. RISCUL CARDIOVASCULAR AL AFECTARII POLIVASCULARE LA PACIENII CU DIABET

RW 24. DIABETES AND OBESITY.... 50

RW 25. STRATEGII PREVENTIVE N COMPLICAIILE MICROVASCULARE ALE DIABETULUI

RW27. DISFUNCIILE METABOLICE I HIPOGONADISMUL MASCULIN, CAUZ SAU CONSECIN ?......... 54

RW 28. ROLUL ACTIVITII FIZICE N PREVENIA I TRATAMENTUL DIABETULUI ZAHARAT... 55

RW 29. MICROALBUMINURIA - PREDICTOR AL RISCULUI IN DIABET I BOALA CRONIC DE

RW 30. PROVOCRILE LEGATE DE DIABET DIN REGIUNEA NOASTR.... 59

RW 31. MEDICAMENTE ANTIDIABETICE NOI I VIITOARE.. 61

RW 32. PATOLOGIA ADRENAL I TULBURRILE METABOLISMULUI GLUCIDIC.. 63

RW 33. NON-ALCOHOLIC FATTY LIVER DISEASE AND DIABETES MELLITUS . 65

RW 34. OCTETUL NEFAST AL HIPERGLICEMIEI.. 66

RW 35. RESETTING THE BETA CELL IN TYPE 2 DIABETES.... 68

RW 36. THE IMPACT OF NEW TECHNOLOGIES IN THE MANAGEMENT OF DIABETES... 68

RW 37. RELAIA DINTRE SINDROMUL METABOLIC I HEPATITA CRONIC CU VIRUS C... 69

RW 38. DIABEZITATEA ABORDARE PRACTICA............................................................................................................. 70

RW 39. ENDOCRINE OUTCOMES AFTER BARIATRIC SURGERY................................................................................. 71

RW 41. PREZENT I VIITOR N TRATAMENTUL DISLIPIDEMIILOR LA PACIENTUL CU DIABET

RW 42. TULBURRI METABOLICE ASOCIATE HIPOTIROIDIEI. 75

PREZENTRI ORALE LUCRRI ORIGINALE

OP 1. PROGRANULINA ROLUL JUCAT N ASOCIEREA BOLII ALZHEIMER CU DIABETUL ZAHARAT TIP

OP 2. ANALIZA IMUNOHISTOCHIMIC A PROTEINELOR P53, BCL2, P53/BCL2 LA PACIENII CU

OP 3. UTILIZAREA SISTEMULUI DE MONITORIZARE CONTINU A GLICEMIEI CA METOD DE

OP 4. BUCLA DE FEED-BACK POZITIV DINTRE PEROXIDUL DE HIDROGEN I MONOAMINOXIDAZE UN

OP 5. ROLUL ECOGRAFIEI VASCULARE N EVALUAREA BOLII ARTERIALE PERIFERICE LA PACIENII

OP 6. STUDIU PROSPECTIV DE EVALUARE A IMPACTULUI EDUCAIEI TERAPEUTICE ASUPRA

BASAL INSULIN ANALOGUE ON GLYCAEMIC CONTROL... 89