Insulin Therapy in Gestational Diabetes

The prevalence of gestational diabetes risen in several populations during the past 20 years, and increased direct and indirect healthcare costs, including those for insulin treatment. Establishing the optimal treatment and initiation momentum are critical to achieve glycemic control and minimize the impact on fetal development and perinatal complications. Insulin is the only therapy that does not cross the placenta, and some of its types were proved to be safe in pregnancy. Intrapartum management is based on intravenous insulin administration, and standard protocols should be implemented in every center. Postpartum management requires special attention, as insulin necessary has a fast decline exposing mothers to hypoglycemia

Prevalence of comorbidities and survival analysis of COVID-19 patients – an observational study from a tertiary healthcare center in North West Romania

Objectives. The experience accumulated in the last two years shows that the prevention of COVID-19 in people with comorbidities (protective measures, vaccination, etc.) still remains a public health priority. In this context, the aim of our study was to perform a retrospective, observational study in order to assess the time-to-death and risk factors of mortality among COVID-19 patients. Materials and Methods. The study was conducted on 177 patients admitted to Oradea Emergency County Hospital, Bihor, Romania, between October and December 2021. Inclusion criteria were patients over 18 years positive for COVID-19 in upper respiratory tract samples using real-time PCR test. Exclusion criteria were pregnant women, ageyears, and patients with incomplete records at admission. Results. The mortality rate was assessed in correlation with the most prevalent comorbidities such as diabetes, cardiovascular diseases, hypertension, chronic kidney disease, and chronic pulmonary diseases, either alone or associated. During hospitalization, an aggravated health condition was noticed for 71 patients (40.11%). Among them, 47 patients were transferred to the intensive care unit (66.20%) due to severe respiratory failure, aggravation of associated diabetes and/or other associated comorbidities. Ventilation support was necessary in 122 cases (68.63%). The average survival time was 8.66 days. In conclusion, we found that the most prevalent comorbidities were cardiovascular diseases, being the major risk factor for mortality or aggravation after hospitalization. Its association with diabetes caused a risk of death 2.1 times higher than in patients without comorbidities. Based on Kaplan–Meier survival analysis, we found that the in-hospital survival rate was significantly higher in females compared to males (50.52% vs 33.75%)

Metformin Modulates the Mechanisms of Ageing

Living in a time when population is continuously ageing, the challenge and demand for assessing the age-related pathways, potential diseases and longevity have become of major interest. The pharmaceutical industry possesses huge resources in this field, mainly due to the recent discoveries of novel mechanisms of action of old-established, classical drugs. Here we find metformin, a well-established antidiabetic medicine but with new potential benefits, as the most recent reports quote. We present the main pathways of the possible implications of metformin in the modulation of ageing processes, evolution and diseases, focussing on its ageing counteraction, based on the latest scientifically based biochemical reports

Follow-up care after metabolic surgery – a prospective study in the North-Eastern region of Romania

Background. Anti-obesity therapeutic strategies are continuously evolving. Bariatric procedures or metabolic surgery are among the most effective and long-lasting therapies for obesity and its complications. Our objective was to investigate the clinical and biological evolution after metabolic surgery in a group of patients from North-Eastern Romania and to evaluate a nutritional intervention plan for this population. Materials and Methods. Our clinic surveyed 50 patients who received nutritional counselling before and after bariatric surgery. The patient\u27s weight loss, metabolic markers, and lifestyle changes from January to December 2021 were recorded. SPSS Statistics v.18 was used for statistical analyses. Results and Discussions. Patients had a mean age of 37.70 ± 11.38 years, with an initial body mass index (BMI) of 42.98 ± 6.12 kg/m2. One month after surgery, longitudinal gastrectomy patients lost 12.6 kg (114.33 ± 19.26 vs 101.73±17.27 kg), and gastric bypass patients lost 10.86 kg (119.33 ± 20.83 vs 108.47±17.96 kg). Body composition improved in the first six months after the intervention due to adipose (mean value 37.83±6.42 from 46.38±6.63) and visceral (mean value 8.50 ± 4.42 from 13.72±5.67) tissues decrease. Muscle tissue increased from 35.54±12.63 to a mean value of 39.95±17.96. HbA1c values improved from 5.90±0.63% to 5.30±0.30% in the first month after the intervention. The nutritional intervention was safe without significant deficits after 1 and 6 months. Conclusions. Metabolic surgery is associated with a weight loss of 10.8 to 12.6 kg and improved body composition. Patients require follow-up and further dietary counseling to sustain long-term results

Metformin Indications, Dosage, Adverse Reactions, and Contraindications

Metformin or dimethyl biguanide is the oral antidiabetic drug with the most extensive experience of prescribing in the clinical practice of type 2 diabetes mellitus. In this chapter, we reviewed the indications, contraindications, and adverse drug reactions (ADR) of metformin. The most significant adverse drug reactions of metformin are lactic acidosis, allergies, hypoglycemia, vitamin B12 deficiency, altered taste, and gastrointestinal intolerance. Metformin is contraindicated in severe chronic diseases (hepatic, renal, and cardiac failure) or acute complications of diabetes (ketoacidosis and hyperosmolar state). Metformin is considered by all international guidelines the first-line treatment in type 2 diabetes mellitus (T2DM) together with medical, nutritional therapy. It is one of the most prescribed molecules worldwide. Furthermore, metformin can also be prescribed for other diseases like polycystic ovary syndrome or prediabetes (impaired glucose tolerance/fasting hyperglycemia). Recent studies have shown positive results concerning the use of metformin for cardiovascular or neuroprotective effects; also, several scientific papers are suggesting an antitumor or antiaging effect of metformin. Having such an excellent efficiency in practice, thus predicting its sustainability on the pharmaceutical market, research is directed toward characterizing metformin action on bacteria genera in the gut. Modifying the microbiota composition by pre- and probiotics could improve metformin action

The effects of SGLT2 inhibitors in patients with metabolic dysfunction-associated fatty liver disease; a narrative review

Worldwide, metabolic dysfunction-associated fatty liver disease (MAFLD) is a significant public health concern, especially since more than fifty percent of people with type 2 diabetes are affected by it. This pathological condition includes all states of fatty liver disease, from non-alcoholic fatty liver disease (NAFLD) to steatohepatitis (NASH). Prolonged evolutions can lead to cirrhosis and cancer, so treatment must be started early. Hepatic steatosis may be improved by sodium glucose co-transporter 2 inhibitors (SGLT2 inhibitors), which prevent glucose reabsorption in the proximal renal tubule and increase urinary excretion, thus lowering plasma glucose levels. Experimental studies in animal models have suggested that SGLT2 inhibitors may have beneficial modulatory effects on NAFLD and NASH, while numerous clinical trials have demonstrated their favorable effects on the liver enzymes, body mass index, blood lipids, blood glucose, and insulin resistance in NAFLD patients. This review highlights the state of knowledge regarding the epidemiology, diagnosis and pathogenetic pathways of MAFLD, focusing primarily on the effectiveness of SGLT2 inhibitors as a promising drug class in the treatment of NAFLD

Metformin and Its Benefits in Improving Gut Microbiota Disturbances in Diabetes Patients

The human gastrointestinal tract presents a vastly population of microorganisms, called the microbiota. The presence of these microorganisms offers many benefits to the host, through a range of physiological functions. However, there is a potential for these mechanisms to be disrupted condition, known as dysbiosis. Recent results are showing important associations between diabetes and the gut microbiota and how the intestinal flora can influence the prognosis of this illness. Microbial intestinal imbalance has been linked to alterations in insulin sensitivity and in glucose metabolism and may play an important role in the development of diabetes. Metformin is one of the most important and widely used first-line medications for the management of type 2 diabetes (T2D). It is a complex drug with multiple sites of action and multiple molecular mechanisms. In recent years, attention has been directed to other modes of action, other than the classic ones, with increasing evidence of a major key role of the intestine. By analysing the effects of metformin on the homeostasis of the microbiota of diabetes patients, our present topic becomes one of the major importance in understanding how metformin therapy can improve gut microbiota dysbiosis and thus provide a better outcome for this illness

Anxio-depressive disorders in a pandemic context: A comparative analysis: year 2019 versus 2020

The outbreak of SARS-CoV-2 pandemic has resulted in increased rates of anxiety and depression worldwide. Objective. To comparatively evaluate factors associated with the psychological impact of Coronavirus disease between 2019 and the pandemic year 2020. Materials and Methods. The study was performed on a group of 3224 patients, of which 197 were hospitalized, selected from Jan 1st 2019 until 30th Dec 2020 in a tertiary care center for psychiatric disorders. Data were collected from the observation charts. Results. The incidence of anxiety disorders is higher in the age range 40-70 years with an average value of 53 years old. In 2019, a third of patients (29,45%) had alcohol-related conditions and developed anxiety-depressive disorder. In 2020, the percentage was lower (9.38%), but also the number of admitted patients significantly decreased (p<0.0001). There were not found significant differences in age, gender or environment. Hypnotic disorders were more predominant in 2019 (54.6% vs 37.5%, p=0.01), whereas in 2020 anxiety and agitation increased significantly (34.4% vs 84.38%, p=0.0001). Relapses were similarly frequent in both years, in half of the cases. Conclusions. Coronavirus pandemic lead to a decrease in both presentations and admission to hospital. Although there were not found significant differences in age or gender, more patients from urban environment were admitted, which can have several explanations. Anxiety and agitation became the main reason for hospitalization in 2020

The efficacy and safety of dipeptidyl peptidase-4 inhibitors compared to other oral glucose-lowering medications in the treatment of type 2 diabetes

Introduction: The dipeptidyl peptidase-4 inhibitors (DPP-4is), which belong to the class of incretin-based-medications, are recommended as second or third-line therapies in guidelines for the management of type 2 diabetes mellitus. They have a favorable drug tolerability and safety profile compared to other glucose-lowering agents.Objective: This review discusses data concerning the use of DPP-4is and their cardiovascular profile, and gives an updated comparison with the other oral glucose-lowering medications with regards to safety and efficacy. Currently available original studies, abstracts, reviews articles, systematic reviews and meta-analyses were included in the review.Discussion: DPP4is are moderately efficient in decreasing the HbA1c by an average of 0.5% as monotherapy, and 1.0% in combination therapy with other drugs. They have a good tolerability and safety profile compared to other glucose-lowering drugs. However, there are possible risks pertaining to acute pancreatitis and pancreatic cancer.Conclusion: Cardiovascular outcome trials thus far have proven the cardiovascular safety for ischemic events in patients treated with sitagliptin, saxagliptin, alogliptin, linagliptin and vildagliptin. Data showing increased rate of hospitalisation in the case of saxagliptin did not seem to be a class effect. (C) 2020 Published by Elsevier Inc