PSYCHO-SOCIAL AND CLINICAL VARIABLES ASSOCIATED WITH DEPRESSION IN PATIENTS WITH TYPE 2 DIABETES

Background: Type 2 diabetes (T2DM) doubles the odds of comorbid depression. Depression is a strong predictor of developing T2DM. The aim of the study was to compare depressed patients with T2DM to non-depressed ones with respect to demographic, psycho-social, clinical, anthropometric and metabolic characteristics; to examine the relationship between glycemic control and depression severity in depressed patients; to estimate the risk factors of depression. Subjects and Methods: A group of depressed diabetic patients comprising those with a Major depressive episode, first or repeated (ICD-10; 1992) and endocrinologist-diagnosed T2DM, duration ≥5 years on oral, insulin therapy or both (N=46) and nondepressed ones (N=44) (90 in total) of both genders (<65 years) were included in this cross-sectional study. Laboratory and nonlaboratory measures were performed.. The patient Health Questionnaire (PHQ-9) and a structured interview (MINI) were used to establish diagnosis, while the Beck Depression Inventory (BDI; cut off ≥16) was used to assess the severity ofdepression. Scaling of Life Events (SLE) for self-assessment of life events and Problem in Areas in Diabetes (PAID) for self-assessment of diabetes distress were also performed. Results: Statistically significant higher rates of psychiatric heredity, neuropathy, higher level of diabetes related distress and a greater number of life events in depressed patients compared to non-depressed ones were found. There was a statistically significant positive correlation between BDI somatic subscore and the HbA1c level (r=0.343; p=0.020). The level of diabetes related distress (OR=1.084; p=0.000), total number of life events (OR=4.528; p=0.001) and neuropathy (OR=8.699; p=0.039) were statistically significant predictors of depression using logistic regression. Conclusions: The results obtained showed that depression in diabetic patients was predicted by both psychological (diabetes related distress, life events) and disease-specific variables (neuropathy). The severity of self-reported somatic depressive symptoms significantly correlated with the HbA1c level in depressed diabetic patients

The prevalence of hypertension and microalbuminuria in diabetes mellitus type 1 and type 2

INTRODUCTION. The prevalence of hypertension is two times higher in diabetics than in non-diabetics. In type 1 diabetes mellitus (T1DM), the incidence of hypertension is similar to the incidence of nephropathy. In obese patients with type 2 DM (T2DM) there can be associated complications of hyperinsulinaemia, dyslipidaemia, and hypertension, which can lead to coronary artery disease and stroke. These associated complications are the result of a genetic defect that produces insulin resistance - Syndrome X. Increased microalbuminuria correlates with increased levels of blood pressure (BP) and increased LDL cholesterol, and this is why microalbuminuria is associated with an increase in cardiovascular deaths in diabetics, even in the absence of renal failure. AIM. The aim of this study was to research the influence of a patient's age, diabetes duration, and obesity on the frequency of hypertension and its association with microalbuminuria inT1DM and T2DM. METHOD. 168 hospitalized patients with DM (79T1DM, 89T2DM) were analyzed. The main outcome measures were: 24-hour urinary albumin excretion rate by radioimmunoassay (MA=30-30O mg/24h), arterial hypertension (systolic BP&gt;140 mm Hg and/or diastolic BP&gt;90 mm Hg), and body mass index (BMI). RESULTS. Microalbuminuria was detected in 42% of patients with T1DM and 47% of patients with T2DM. 34% of T1DM patients and 78% of T2DM patients were hypertensive. Patients were divided into four groups, according to the presence of hypertension and microalbuminuria; Group I - patients with hypertension and MA, Group II - patients with hypertension but without MA, Group III - patients without hypertension and MA, Group IV - patients without hypertension but with MA. 44% of T1DM patients were without hypertension and microalbuminuria, while the most frequent T2DM patients were those with hypertension (37% with and 41% without microalbuminuria). A significant correlation between BMI and diastolic BP in both types of DM (p&lt;0.01 for T1 DM, and p&lt;0.05 for T2DM) was discovered. T2DM hypertensive patients were obese and there was a significant correlation between a patient's systolic BP and his or her age (p&lt;0.05). CONCLUSION. These results suggest that hypertension can be prevented in patients with T2DM with weight reduction. There was a significant association between hypertension and microalbuminuria, especially in T1DM patients. Tight control of blood pressure is essential for the reduction of microalbuminuria as well as further micro- and macro-vascular diabetic complications

Relationship between low glomerular filtration rate, hypertension, and microalbuminuria in type 1 diabetes mellitus

Aim. To investigate the influence of low glomerular filtration rate, as well as of systolic and diastolic hypertension, on microalbuminuria in patients with type 1 diabetes mellitus. Methods. Twenty seven patients with type 1 diabetes mellitus (18 males, 9 females) were studied. All of the patients were below 50 years of age. In 93% of the cases, the duration of diabetes was less than 15 years. GFR was determined, after intravenous injection in the lying position, by using a 99m-Tc-DTPA, while microalbuminuria was calculated for the 24-hour urine using the nephelometric immunoassay (30−300 mg/24 h). The patients were divided into 3 groups according to the value of GFR. The values ranged from 90 to 125 ml/min/1.73 m2 were considered normal (in 63% of the patients in group 1), those above that range were considered as hyperfiltration (in 22.2% of the patients in group 2), while those below that range were considered as hypofiltration (in 13.8% of the patient in group 3). Results. Data analyzed with the one-way ANOVA, indicated a significant statistical difference between the 3 groups in the duration of diabetes (p &lt; 0.05), microalbuminuria (p &lt; 0.01), systolic BP (p &lt; 0.01), diastolic BP (p &lt; 0.05), fructosamine (p = 0.50), urea (p &lt; 0.05), creatinine (p = 0.05), and uric acid (p &lt; 0.05). Microalbuminuria correlated with the age of patients (p &lt;0.05) (Spearman's rho), diabetes mellitus duration (p &lt; 0.01), systolic BP (p &lt; 0.05), diastolic BP (p &lt; 0.05), LDL cholesterol (p &lt; 0.05). There was no statistically significant correlation between GFR and the other parameters. Hypertension, microalbuminuria, and the duration of diabetes correlated positively with the reduction of GFR, revealing the most frequent reduction of GFR in the patients with more than 15-year duration of diabetes. Conclusions. Hypertension and low GFR were associated with microalbuminuria in type 1 diabetes, while the duration of diabetes was shown to be the independent risk factor for the development of microalbuminuria

Relationship between Obesity, Adipocytokines and Inflammatory Markers in Type 2 Diabetes: Relevance for Cardiovascular Risk Prevention

This study aimed to analyse the impact of obesity in type 2 diabetes (T2D) on adipocytokines (adiponectin, leptin and resistin) and inflammatory markers (TNF-α, IL-6 and hsCRP) as cardiovascular risk factors. A cross-sectional study comparing the basal levels of adipocytokines and inflammatory markers was done in 18 obese (BMI ≥ 30 kg/m2) (group A), 21 overweight (25 kg/m2 ≤ BMI &lt; 30 kg/m2) (group B), 25 non-obese T2D patients (group C) and 15 non-obese controls (group D). The lowest levels of adiponectin and the highest levels of leptin, resistin, TNF-α, IL-6 and hsCRP were found in group A. Adiponectin levels were significantly lower, and resistin, TNF-α, and hsCRP levels were elevated in group C vs. D. However, leptin and IL-6 levels differed significantly between groups A and B, but not between groups C and D. Moreover, we found a significant negative correlation between adiponectin and TNF-α, but not with other markers, which was independent of the presence of obesity. In contrast, leptin and resistin correlated with the inflammatory markers, and this correlation was obesity-dependent. Our results suggest that obesity influences cardiovascular risk primarily through changes in leptin and resistin and less efficiently at the level of adiponectin

Original paper OXIDIZED LDL AND OTHER LIPIDS AS RISK FACTORS FOR CARDIOVASCULAR DISEASE IN THE PATIENTS WITH METABOLIC SYNDROM

Summary: We estimated relationship between lipids, LDL oxidation, antioxidant activity and CRP in diabetic patients with metabolic syndrom (MS), with and without coronary heart disease (CHD), in non diabetic patients with and without CHD and in obese patients, with and without diabetes. We didn’t find significant difference in lipids among diabetic MS patients. Patients from all subgroups have simillar level of oxLDL, but significant higher comparing with healthy control. MS diabetic patients have oxLDL in positive corelation with TC, LDL-C, non HDL-C and apo B 100, as vell as with molar ratio LDL-C/HDL-C and TG/HDL-C (p&lt;0.001). Among non diabetics, CHD patients had higher Lp(a), but oxLDL was simillar in both subgroups. In the nondiabetics we found correlation between oxLDL, TC, LDL-C and TG (p&lt;0.01) and apo B 100 (p&lt;0.001), but not with TG/HDL-C molar ratio. Obese patients from both groups had simillar lipids profile but, oxLDL was higher, not significant, in non diabetics. We didn’t find significant differences in antioxidative activity and CRP in both diabetics MS subgroups, and both obese subgroups. Nondiabetics with CHD have lower E-SOD and E-GPX activity and higher level of CRP than non CHD patients (p&lt;0.05). MS diabetics and non diabetics didn&apos;t have significant correlation between levels of oxLDL and CRP, but CHD patients (with or without diabetes) had (p&lt;0. 01). Key words: diabetes mellitus type 2, coronary heart disease, lipids, oxLDL, antioxidative statu

Oxidized LDL and lipids as risk factors for ischemic heart disease in type 2 diabetes

Background. Abnormal lipid profile is an important risk factor in the development of macrovascular atherosclerotic complications in patients with type 2 diabetes mellitus (T2D). Factors that contribute to endothelial cell dysfunction associated with the initiation of atherosclerosis include oxidative stress. The aim of this study was to investigate the relationship between lipid profile and oxidative stress in type 2 diabetics with and without ischemic heart disease (IHD). Methods. We studied 80 patients with T2D, 40 with IHD (group A1) and 40 without IHD (group A2). We also studied 51 non-diabetics, 31 with IHD (group B1), and 20 without IHD (group B2 - control group). Lipid profile was estimated by the total cholesterol, HDL cholesterol, LDL cholesterol, the level of triglyceride (Tg), lipoproteina a (Lp a), Apo A I, A II, B 100 and E. To evaluate the oxidative status we measured circulating oxidized LDL (ox LDL), erythrocyte antioxidative enzyme activity: superoxide dismutase (E-SOD), glutathione peroxidase (E-GPX), as well as the total antioxidative serum activity (TAS). Inflammatory reaction was estimated by C-reactive protein (CRP) and fibrinogen. Results. No significant difference was found in the lipid profile in groups A1, A2 and B1, but the group B2 had the lowest one. Lp a level was significantly higher in group B1 comparing to other groups (p &lt; 0.05). There was no significant difference in the level of ox LDL between the groups. In diabetics, ox LDL positively correlated with the total cholesterol, LDL cholesterol, non HDL cholesterol, Apo B 100 and the relations between LDL/HDL and Tg/HDL (p &lt; 0.001), as well as with Tg and fibrinogen (p &lt; 0.05). In group B1, ox LDL positively correlated with total cholesterol, Tg (p &lt; 0.01), LDL, and non HDL cholesterol (p &lt; 0.05) and significantly with Apo B 100 (p &lt; 0.001). There was no significant difference in the antioxidant enzyme activities between the groups of diabetics (A1 and A2), but fibrinogen was higher in the group with IHD (group A1, p &lt; 0.05). Group B1 had lower ESOD activity than the groups A1 and A2 (p &lt; 0.05), but CRP was higher (p &lt; 0.05). There were no significant correlations between oxLDL and CRP in groups A1 and A2, but it was statistically significant in the group B1 (p &lt; 0.05). Conclusion. In this study we demonstrated the increased oxidative stress in diabetics compared to non-diabetics regardless of the presence of IHD. Fibrinogen, but not CRP, was higher in diabetics with IHD, compared to diabetics without IHD. The increased oxidative stress, the reduced antioxidative activity E-SOD, and the higher level of CRP were found in non-diabetics with IHD compared to non-diabetics without IHD

Ischemic stroke in patients with type 2 diabetes: Relationship between decreased insulin sensitivity and fibrinolysis impairment

The role of insulin sensitivity (IS), as well as the association of IS with fibrinolysis impairment, in the occurrence of ischemic stroke, has not been clarified. The study was aimed to analyze IS, plasma insulin (PI) and plasminogen activator inhibitor (PAI)-1 levels in 34 type 2 diabetics (T2D) with ischemic stroke (group A), 30 T2D without ischemic stroke (group B), 33 nondiabetics with ischemic stroke (group C) and 33 healthy controls (group D). Ischemic stroke was confirmed by clinical and neuroimaging criteria. IS levels were determined by the minimal model analysis (Si index). Plasma insulin levels were measured by radioimmunoassay and PAI-1 activity was performed by the plasminogen chromogenic plasmin substrate assay. We found that Silevels were significantly lower in group A vs. B (1.17+/-0.66 vs. 2.79+/-0.62 min-1/mU/Lx104; p<0.001) and in C vs. D (3.25+/-0.84 vs. 6.03+/-1.69 min-1/mU/Lx104; p<0.001), while PI levels were higher in group A vs. B (19.46+/-4.11 vs. 14.79+/-1.75 mU/L; p<0.001) and in C vs. D (15.16+/-2.23 vs. 7.54+/-2.03 mU/L; p <0.001). Also, PAI-1 activity was significantly higher in group A vs. B (7.78+/-1.05 i 4.56+/-0.71 mU/L; p<0.001) and in C vs D (4.65+/-0.69 i 3.48+/-1.29 mU/L; p<0.001). Moreover, Silevels correlated with PAI-1, both in T2D and nondiabetics. Our results indicate that appearance of ischemic stroke was associated with decreased insulin sensitivity, together with compensatory hyperinsulinemia, both in T2D and nondiabetics. Our results imply that impaired insulin sensitivity exerts its atherogenic influence, at least in part, by decreased fibrinolysis