Predicting cardiovascular risk in diabetic patients: arewe all on the same side?

Cardiovascular diseases are the main reason for morbidity and mortality in diabetic patients, and cardiovascular risk is increased at least twofold in men and at least fourfold in women with diabetes compared to non-diabetic populations. Predictive medicine is of the utmost importance in the clinical care of diabetic patients, since predicting cardiovascular risk is essential for modification of risk factors aimed at prevention or delay of future cardiovascular events. The prediction of cardiovascular risk is a valuable tool within the context of patient-centered care, as it includes active participation of diabetic patients in the decision-making process, resulting in higher compliance with the treatments agreed. However, there are differences among the current guidelines of various international authorities, such as the International Diabetes Federation (IDF), European Society of Cardiology (ESC) / European Association for Study of Diabetes (EASD), American College of Cardiology (ACC) / American Heart Association (AHA), American Diabetes Association (ADA), and National Institute for Health and Care Excellence (NICE), for the prediction of cardiovascular risk in diabetic patients. Furthermore, the clinical use of models with classic risk factors and novel biomarkers that would predict cardiovascular risk in diabetic patients from various populations with acceptable precision poses a challenge. Taking into consideration the global diabetes pandemic and its close association with cardiovascular diseases, there is an urgent need for streamlining of current guidelines on the prediction of cardiovascular risk and its use in clinical practice

National eHealth system – platform for preventive, predictive and personalized diabetes care

National eHealth System, covering all citizens and all healthcare levels in Republic of Macedonia, was introduced in July 2013, has been internationally recognized System for successful reduction of waiting times and instrumental in the management of national healthcare resources. For the first time, National Diabetes Committee, formed in February 2015 according to the Law on healthcare and being overall responsible for the diabetes care in the country, was able to derive exact figures on the national diabetes prevalence from the System, instead of extrapolations used before, serving as a basis for development of strategies for prediction and prevention of diabetic complications, as well as for personalized diabetes care. Number of diabetes cases identified through the National eHealth System in June 2015 was 84,568 (4.02 % of total population), 36,119 males (3.42 % of total male population) and 48,449 females (4.61% of total female population). Age stratified diabetes prevalence was as follows: less than 20 years – 549 cases (0.11 % of respective population), 20-39 years – 3,202 (0.49 %), 40-59 years – 26,561 (4.58 %), 60-79 years – 48,470 (14.57 %), 80 years or more – 5,786 (12.96 %). Addition of parameters for metabolic control and diabetic complications in the System is under way, further facilitating the modeling of diabetes treatment, metabolic control and the outcomes. Inclusion of pre-diabetes patients (IGT and IFG) is also planned, thus providing opportunity to also focus healthcare activities for prevention of progression into overt type 2 diabetes

Diabetes Care in Republic of Macedonia: Challenges and Opportunities

B A C K G R O U N D The Republic of Macedonia (RoM) has experienced a rapid rise in the prevalence of type 2 diabetes (T2D) over the past 2 decades, a period characterized by significant social, political, and economic change. RoM now has one of the highest rates of diabetes in Europe. O B J E C T I V E S To explore the modifiable conditions that may underlie and exacerbate the T2D epidemic; describe the state of diabetes care; and consider improved mechanisms for prevention and treatment, including research priorities, in RoM. M E T H O D S Methods included data mining from reliable sources and collaboration of authors to consider and describe applications of research from outside RoM and to identify evidence-based strategies to reduce the burden of T2D in RoM. F I N D I N G S In 2014, the national prevalence of diabetes was 11.44% of the population (20-79 years) of RoM. Per capita caloric intake has increased significantly over the past 2 decades, with the majority of these calories coming from sugar, pork, chicken, beef, and sunflower oil. Excess calories, in the form of nutrient-deficient foods, animal products, and added oils promote insulin resistance and T2D. Tobacco use and lack of physical activity also contribute to the diabetes epidemic. Insulin, especially insulin analogues, are widely available and used to manage diabetes, often over other interventions that are more appropriate for patients with T2D, and more frequently than in other more developed countries, resulting in higher and unsustainable related costs. C O N C L U S I O N S A new National eHealth System allows for better identification and monitoring of citizens with diabetes. However, the rapidly growing expense of insulin in the past has been unsustainable. The potential exists for a stronger role for lifestyle interventions in prevention and treatment of T2D. Significant changes in dietary patterns parallel the rise in diabetes prevalence and are likely a leading cause of diabetes and its complications. Research in RoM is needed to determine the impact and acceptability of dietary interventions for prevention and treatment of T2D, as a first step toward reduction of diabetes prevalence and its complications and controlling spiraling health care costs

Respiratory Complications from Acute Corrosive Poisonings in Adults

Introduction: Acute corrosive poisonings are caused by ingestion of corrosive chemicals which are most commonly used as household agents. Intoxications with these kind of agents produce numerous and severe post-corrosive complications of the upper gastrointestinal tract. On the other hand, our experience showed that corrosive agents may also cause injuries of the respiratory system, which makes the treatment very hard and additionally complicates the severe clinical condition of the patient. Objective: The aim of the study is to show the incidence of respiratory complications in acute corrosive poisonings, the need of various clinical investigations and also the treatment and final outcome of these kind of poisoning. Methods: We retrospectively analyzed clinical records of 415 patients hospitalized and treated at the University clinic for toxicology and urgent internal medicine, in Skopje, Republic of Macedonia, in the period between 2007 and 2011. The protocol consisted of methods for analyzing the systemic complications, with an accent on the post-corrosive respiratory complications. Results: From the total number of patients even 98 (23.61%) exhibited systemic complications, from which 51 (52.04%) are respiratory complications. The majority of patients are female (n=40, 78.43%) and the most common complication is pneumonia (n=47). The youngest patient in this study was 14 and the oldest was 87 years old. Conclusion: Besides the gastrointestinal complications in the acute corrosive poisonings respiratory complications are also very often. They complicate the clinical state of patient and very often lead to fatal endings

Diabetes Care in Republic of Macedonia: Challenges and Opportunities

Background: The Republic of Macedonia (RoM) has experienced a rapid rise in the prevalence of type 2 diabetes (T2D) over the past 2 decades, a period characterized by significant social, political, and economic change. RoM now has one of the highest rates of diabetes in Europe. Objectives: To explore the modifiable conditions that may underlie and exacerbate the T2D epidemic; describe the state of diabetes care; and consider improved mechanisms for prevention and treatment, including research priorities, in RoM. Methods: Methods included data mining from reliable sources and collaboration of authors to consider and describe applications of research from outside RoM and to identify evidence-based strategies to reduce the burden of T2D in RoM. Findings: In 2014, the national prevalence of diabetes was 11.44% of the population (20-79 years) of RoM. Per capita caloric intake has increased significantly over the past 2 decades, with the majority of these calories coming from sugar, pork, chicken, beef, and sunflower oil. Excess calories, in the form of nutrient-deficient foods, animal products, and added oils promote insulin resistance and T2D. Tobacco use and lack of physical activity also contribute to the diabetes epidemic. Insulin, especially insulin analogues, are widely available and used to manage diabetes, often over other interventions that are more appropriate for patients with T2D, and more frequently than in other more developed countries, resulting in higher and unsustainable related costs. Conclusions: A new National eHealth System allows for better identification and monitoring of citizens with diabetes. However, the rapidly growing expense of insulin in the past has been unsustainable. The potential exists for a stronger role for lifestyle interventions in prevention and treatment of T2D. Significant changes in dietary patterns parallel the rise in diabetes prevalence and are likely a leading cause of diabetes and its complications. Research in RoM is needed to determine the impact and acceptability of dietary interventions for prevention and treatment of T2D, as a first step toward reduction of diabetes prevalence and its complications and controlling spiraling health care costs

Nutritional therapy in the treatment of acute corrosive intoxication in adults

Introduction: Acute intoxications with corrosive substances can cause severe chemical injuries of the upper gastrointestinal tract, most often located in the mouth, pharynx, esophagus, stomach and duodenum. If a patient survives the acute phase of intoxication, regenerative response may result in esophageal and/or gastric stenosis, and increased risk of esophageal and gastric cancer. Such intoxication may be fatal due to perforation or tracheal necrosis. Enteral nutrition is a nutritional method when nutritional substances are administered through specially designed tubing placed through the nose or percutaneously, directly into the GIT. Aim: The aim of this study is to describe the methods of artificial nutrition in patients with acute corrosive intoxications and the importance of nutritional support in the treatment of these intoxications. Discussion: Nutrition in the treatment of acute corrosive intoxications is one of the most important therapeutic processes that largely contribute to faster recovery of the post-corrosive injuries of upper GIT, stabilization of biologic, immunologic and metabolic parameters, and reduction of length of stay in hospital Aim of the treatment of acute corrosive intoxications is to prevent perforation and progressive fibrosis, and esophageal and gastric stenosis. There are different and often conflicting positions, on the conservative treatment of acute corrosive intoxications in adults. Such treatment mainly consists of anti-secretory treatment, antibiotics and intensive hyper-alimentation, aiming to prevent late post-corrosive intoxications. Conclusion: It is considered that nutritional support plays a major role in maintenance of metabolic processes and prevention of severe metabolic complications that could additionally aggravate the condition and impair the treatment. Key words: corrosive poisonings, deglutition, deglutition disorders, nutritional therapy, enteral nutrition, parenteral nutritio

Multi–System Complications after Intravenous Cocaine Abuse

BACKGROUND: Use and abuse of cocaine are associated with numerous adverse effects, independent of the route of administration. More severe conditions of poisoning, however, are observed after cocaine intravenous administration.AIM: We present a case of severe poisoning after violent intravenous injection of cocaine, but with a good outcome.CASE PRESENTATION: Cocaine was intravenously (i.v.) administered in 16-years old female patient as a homicide attempt. Shortly after that, patient experienced series of generalised tonic-clonic seizures, was highly febrile (400C), somnolent, agitated, presenting with tachycardia, tachypnea and with increased blood pressure 150/90 mmHg. Neurologic status, lumbar puncture and computerised tomography (CT) of the brain were without remarks. Electroencephalogram (EEG) was characterised with signs of diffuse encephalopathy, and acid-base analyses resulted in metabolic acidosis. Urine screening revealed the presence of cocaine and benzodiazepines. The patient presented with signs of the hepatic lesion, acute renal insufficiency (ARI), and increased D-dimers resulting from activated fibrinolysis. The patient was discharged in stable general condition after being hospitalised for 23 days.CONCLUSION: Intravenous abuse of cocaine results in overdose and serous multi-system complications requiring multidisciplinary diagnostic and intensive therapeutic approach

EPMA-World Congress 2015: Bonn, Germany. 3-5 September 2015

Table of contents A1 Predictive and prognostic biomarker panel for targeted application of radioembolisation improving individual outcomes in hepatocellular carcinoma Jella-Andrea Abraham, Olga Golubnitschaja A2 Integrated market access approach amplifying value of “Rx-CDx” Ildar Akhmetov A3 Disaster response: an opportunity to improve global healthcare Russell J. Andrews, Leonidas Quintana A4 USA PPPM: proscriptive, profligate, profiteering medicine-good for 1 % wealthy, not for 99 % unhealthy Russell J. Andrews A5 The role of IDO in a murine model of gingivitis: predictive and therapeutic potentials Babak Baban, Jun Yao Liu, Xu Qin, Tailing Wang, Mahmood S. Mozaffari A6 Specific diets for personalised treatment of diabetes type 2 Viktoriia V. Bati, Tamara V. Meleshko, Olga B. Levchuk, Nadiya V. Boyko A7 Towards personalized physiotherapeutic approach Joanna Bauer, Ewa Boerner, Halina Podbielska A8 Cells, animal, SHIME and in silico models for detection and verification of specific biomarkers of non-communicable chronic diseases Alojz Bomba, Viktor O. Petrov, Volodymyr G. Drobnych, Rostyslav V. Bubnov, Oksana M. Bykova, Nadiya V. Boyko A9 INTERACT-chronic care model: Self-treatment by patients with decision support e-Health solution Hans-Peter Brunner-La Rocca, Lutz Fleischhacker, Olga Golubnitschaja, Frank Heemskerk, Thomas Helms, Tiny Jaarsma, Judita Kinkorova, Jan Ramaekers, Peter Ruff, Ivana Schnur, Emilio Vanoli, Jose Verdu A10 PPPM in cardiovascular medicine in 2015 Hans-Peter Brunner-La Rocca A11 Magnetic resonance imaging of nanoparticles in mice, potential for theranostic and contrast media development – pilot results Rostyslav V. Bubnov, Sergiy A. Grabovetskyi, Olena M. Mykhalchenko, Natalia O. Tymoshok, Oleksandr B. Shcherbakov, Igor P. Semeniv, Mykola Y. Spivak A12 Ultrasound diagnosis for diabetic neuropathy - comparative study Rostyslav V. Bubnov, Tetyana V. Ostapenko A13 Ultrasound for stratification patients with diabetic foot ulcers for prevention and personalized treatment - pilot results Rostyslav V. Bubnov, Nazarii M. Kobyliak, Nadiya M. Zholobak, Mykola Ya. Spivak A14 Project ImaGenX – designing and executing a questionnaire on environment and lifestyle risk of breast cancer John Paul Cauchi A15 Genomics – a new structural brand of predictive, preventive and personalized medicine or the new driver as well? Dmitrii Cherepakhin, Marina Bakay, Artem Borovikov, Sergey Suchkov A16 Survey of questionnaires for evaluation of the quality of life in various medical fields Barbara Cieślik, Agnieszka Migasiewicz, Maria-Luiza Podbielska, Markus Pelleter, Agnieszka Giemza, Halina Podbielska A17 Personalized molecular treatment for muscular dystrophies Sebahattin Cirak A18 Secondary mutations in circulating tumour DNA for acquired drug resistance in patients with advanced ALK + NSCLC Marzia Del Re, Paola Bordi, Valentina Citi, Marta Palombi, Carmine Pinto, Marcello Tiseo, Romano Danesi A19 Recombinant species-specific FcεRI alpha proteins for diagnosis of IgE-mediated allergies in dogs, cats and horses Lukas Einhorn, Judit Fazekas, Martina Muhr, Alexandra Schoos, Lucia Panakova, Ina Herrmann, Krisztina Manzano-Szalai, Kumiko Oida, Edda Fiebiger, Josef Singer, Erika Jensen-Jarolim A20 Global methodology for developmental neurotoxicity testing in humans and animals early and chronically exposed to chemical contaminants Arpiné A. Elnar, Nadia Ouamara, Nadiya Boyko, Xavier Coumoul, Jean-Philippe Antignac, Bruno Le Bizec, Gauthier Eppe, Jenny Renaut, Torsten Bonn, Cédric Guignard, Margherita Ferrante, Maria Liusa Chiusano, Salvatore Cuzzocrea, Gerard O'Keeffe, John Cryan, Michelle Bisson, Amina Barakat, Ihsane Hmamouchi, Nasser Zawia, Anumantha Kanthasamy, Glen E. Kisby, Rui Alves, Oscar Villacañas Pérez, Kim Burgard, Peter Spencer, Norbert Bomba, Martin Haranta, Nina Zaitseva, Irina May, Stéphanie Grojean, Mathilde Body-Malapel, Florencia Harari, Raul Harari, Kristina Yeghiazaryan, Olga Golubnitschaja, Vittorio Calabrese, Christophe Nemos, Rachid Soulimani A21 Mental indicators at young people with attributes hypertension and pre-hypertension Maria E. Evsevyeva, Elena A. Mishenko, Zurida V. Kumukova, Evgeniy V. Chudnovsky, Tatyana A. Smirnova A22 On the approaches to the early diagnosis of stress-induced hypertension in young employees of State law enforcement agencies Maria E. Evsevyeva, Ludmila V. Ivanova, Michail V. Eremin, Maria V. Rostovtseva A23 Сentral aortic pressure and indexes of augmentation in young persons in view of risk factors Maria E. Evsevyeva, Michail V. Eremin, Vladimir I. Koshel, Oksana V. Sergeeva, Nadesgda M. Konovalova A24 Breast cancer prediction and prevention: Are reliable biomarkers in horizon? Shantanu Girotra, Olga Golubnitschaja A25 Flammer Syndrome and potential formation of pre-metastatic niches: A multi-centred study on phenotyping, patient stratification, prediction and potential prevention of aggressive breast cancer and metastatic disease Olga Golubnitschaja, Manuel Debald, Walther Kuhn, Kristina Yeghiazaryan, Rostyslav V. Bubnov, Vadym M. Goncharenko, Ulyana Lushchyk, Godfrey Grech, Katarzyna Konieczka A26 Innovative tools for prenatal diagnostics and monitoring: improving individual pregnancy outcomes and health-economy in EU Olga Golubnitschaja, Jan Jaap Erwich, Vincenzo Costigliola, Kristina Yeghiazaryan, Ulrich Gembruch A27 Immunohistochemical assessment of APUD cells in endometriosis Vadym M. Goncharenko, Vasyl O. Beniuk, Olga V. Kalenska, Rostyslav V. Bubnov A28 Updating personalized management algorithm of endometrial hyperplasia in pre-menopause women Vadym M. Goncharenko, Vasyl O. Beniuk, Rostyslav V. Bubnov, Olga Melnychuk A29 The personified treatment approach of polimorbid patients with periodontal inflammatory diseases Irina A. Gorbacheva, Lyudmila Y. Orekhova, Vadim V. Tachalov A30 Ukrainian experience in hybrid war – the challenge to update algorithms for personalized care and early prevention of different military injuries Olena I. Grechanyk, Rizvan Ya. Abdullaiev, Rostyslav V. Bubnov A31 Tear fluid biomarkers: a comparison of tear fluid sampling and storage protocols Suzanne Hagan, Eilidh Martin, Ian Pearce, Katherine Oliver A32 The correlation of dietary habits with gingival problems during menstruation Cenk Haytac, Fariz Salimov, Servin Yoksul, Anatoly A. Kunin, Natalia S. Moiseeva A33 Genomic medicine in a contemporary Spanish population of prostate cancer: our experience Bernardo Herrera-Imbroda, Sergio del Río-González, Maria Fernanda Lara, Antonia Angulo, Francisco Javier Machuca Santa-Cruz A34 Challenges, opportunities and collaborations for personalized medicine applicability in uro-oncological disease Bernardo Herrera-Imbroda, Sergio del Río-González, Maria Fernanda Lara A35 Metabolic hallmarks of cancer as targets for a personalized therapy John Ionescu A36 Influence of genetic polymorphism as a predictor of the development of periodontal disease in patients with gastric ulcer and 12 duodenal ulcer Alfiya Z. Isamulaeva, Anatoly A. Kunin, Shamil Sh. Magomedov, Aida I. Isamulaeva A37 Challenges in diabetic macular edema Tatjana Josifova A38 Overview of the EPMA strategies in laboratory medicine relevant for PPPM Marko Kapalla, Juraj Kubáň, Olga Golubnitschaja, Vincenzo Costigliola A39 EPMA initiative for effective organization of medical travel: European concepts and criteria Vincenzo Costigliola, Marko Kapalla, Juraj Kubáň, Olga Golubnitschaja A40 Design and innovation in e-textiles: implications for PPPM Anthony Kent, Tom Fisher, Tilak Dias A41 Biobank in Pilsen as a member of national node BBMRI_CZ Judita Kinkorová, Ondřej Topolčan A42 Big data in personalized medicine: hype and hope Matthias Kohl A43 The 3P approach as the platform of the European Dentistry Department (DPPPD) Anatoly A. Kunin, Natalia S. Moiseeva A44 The endometrium cytokine patterns for predictive diagnosis of proliferation severity and cancer prevention Andrii I. Kurchenko, Vasyl A. Beniuk, Vadym M. Goncharenko, Rostyslav V. Bubnov, Nadiya V. Boyko, Andriy M. Strokan A45 A monocyte-based in-vitro system for testing individual responses to the implanted material: future for personalized implant construction Julia Kzhyshkowska, Alexandru Gudima, Ksenia S. Stankevich, Victor D. Filimonov4, Harald Klüter, Evgeniya M. Mamontova, Sergei I. Tverdokhlebov A46 Prediction and prevention of adverse health effects by meteorological factors: Biomarker patterns and creation of a device for self-monitoring and integrated care Ulyana B. Lushchyk, Viktor V. Novytskyy, Igor P. Babii, Nadiya G. Lushchyk, Lyudmyla S. Riabets, Ivanna I. Legka A47 Targeting "disease signatures" towards personalized healthcare Mira Marcus-Kalish, Alexis Mitelpunkt, Tal Galili, Neta Shachar, Yoav Benjamini A48 Influence of the skin imperfection on the personal quality of life and possible tools for objective diagnosis Agnieszka Migasiewicz, Markus Pelleter, Joanna Bauer, Ewelina Dereń, Halina Podbielska A49 The new direction in caries prevention based on the ultrastructure of dental hard tissues and filling materials Natalia S. Moiseeva, Anatoly A. Kunin, Dmitry A. Kunin A50 The use of LED radiation in prevention of dental diseases Natalia S. Moiseeva, Yury A. Ippolitov, Dmitry A. Kunin, Alexei N. Morozov, Natalia V. Chirkova, Nakhid T. Aliev A51 Status of endothelial progenitor cells in diabetic nephropathy: predictive and preventive potentials Mahmood S. Mozaffari, Jun Yao Liu, Babak Baban A52 The status of glucocorticoid-induced leucine zipper protein in salivary gland in Sjögren’s syndrome: predictive and personalized treatment potentials Mahmood S. Mozaffari, Jun Yao Liu, Rafik Abdelsayed, Xing-Ming Shi, Babak Baban A53 Maximal aerobic capacity - important quality marker of health Jaroslav Novák, Milan Štork, Václav Zeman A54 The EMPOWER project: laboratory medicine and Horizon 2020 Wytze P. Oosterhuis, Elvar Theodorsson A55 Personality profile manifestations in patient’s attitude to oral care and adherence to doctor’s prescriptions Lyudmila Y. Orekhova, Tatyana V. Kudryavtseva, Elena R. Isaeva, Vadim V. Tachalov, Ekaterina S. Loboda A56 Results of an European survey on personalized medicine addressed to directions of laboratory medicine Mario Pazzagli, Francesca Malentacchi, Irene Mancini, Ivan Brandslund, Pieter Vermeersch, Matthias Schwab, Janja Marc, Ron H.N. van Schaik, Gerard Siest, Elvar Theodorsson, Chiara Di Resta A57 MCI or early dementia predictive speech based diagnosis techniques Matus Pleva, Jozef Juhar A58 Personalized speech based mobile application for eHealth Matus Pleva, Jozef Juhar A59 Circulating tumor cell-free DNA as the biomarker in the management of cancer patients Jiří Polívka jr., Filip Janků, Martin Pešta, Jan Doležal, Milena Králíčková, Jiří Polívka A60 Complex stroke care – educational programme in Stroke Centre University Hospital Plzen Jiří Polívka, Alena Lukešová, Nina Müllerová, Petr Ševčík, Vladimír Rohan A61 Sleep apnea and sleep fragmentation contribute to brain aging Kneginja Richter, Lence Miloseva, Günter Niklewski A62 Personalised approach for sleep disturbances in shift workers Kneginja Richter, Jens Acker, Guenter Niklewski A63 Medical travel and innovative PPPM clusters: new concept of integration Olga Safonicheva, Vincenzo Costigliola A64 Medical travel and women health Olga Safonicheva A65 Continuity of generations in the training of specialists in the field of reconstructive microsurgery Maxim Sautin, Janna Sinelnikova, Sergey Suchkov A66 Telemonitoring of stroke patients – empirical evidence of individual risk management results from an observational study in Germany Songül Secer, Stephan von Bandemer A67 Women’s increasing breast cancer risk with n-6 fatty acid intake explained by estrogen-fatty acid interactive effect on DNA damage: implications for gender-specific nutrition within personalized medicine Niva Shapira A68 Cytobacterioscopy of the gingival crevicular fluid as a method for preventive diagnosis of periodontal diseases Aleksandr Shcherbakov, Anatoly A. Kunin, Natalia S. Moiseeva A69 Use of specially treated composites in dentistry to avoid violations of aesthetics Bogdan R. Shumilovich, Zhanna Lipkind, Yulia Vorobieva, Dmitry A. Kunin, Anastasiia V. Sudareva A70 National eHealth system – platform for preventive, predictive and personalized diabetes care Ivica Smokovski, Tatjana Milenkovic A72 The common energy levels of Prof. Szent-Györgyi, the intrinsic chemistry of melanin, and the muscle physiopathology. Implications in the context of Preventive, Predictive, and Personalized Medicine Arturo Solís-Herrera, María del Carmen Arias-Esparza, Sergey Suchkov A73 Plurality and individuality of hepatocellular carcinoma: PPPM perspectives Krishna Chander Sridhar, Olga Golubnitschaja A74 Strategic aspects of higher medical education reforms to secure newer educational platforms for getting biopharma professionals matures Maria Studneva, Sihong Song, James Creeden, Мark Мandrik, Sergey Suchkov A75 Overview of the strategies and activities of the European Federation of Clinical Chemistry and Laboratory Medicine, (EFLM) Elvar Theodorsson, EFLM A76 New spectroscopic techniques for point of care label free diagnostics Syed A. M. Tofail A77 Tumor markers for personalized medicine and oncology - the role of Laboratory Medicine Ondřej Topolčan, Judita Kinkorová, Ondřej Fiala, Marie Karlíková, Šárka Svobodová, Radek Kučera, Radka Fuchsová, Vladislav Třeška, Václav Šimánek, Ladislav Pecen, Jan Šoupal, Štěpán Svačina2 A78 Modern medical terminology (MMT) as a driver of the global educational reforms Evgeniya Tretyak, Maria Studneva, Sergey Suchkov A79 Juvenile hypertension; the relevance of novel predictive, preventive and personalized assessment of its determinants Francesca M. Trovato, G. Fabio Martines, Daniela Brischetto, Daniela Catalano, Giuseppe Musumeci, Guglielmo M. Trovato A80 Proteomarkers Biotech George Th. Tsangaris, Athanasios K. Anagnostopoulos A81 Proteomics and mass spectrometry based non-invasive prenatal testing of fetal health and pregnancy complications George Th. Tsangaris, Athanasios K. Anagnostopoulos A82 Integrated Ecosystem for an Integrated Care model for Heart Failure (HF) patients including related comorbidities (ZENITH) José Verdú, German Gutiérrez, Jordi Rovira, Marta Martinez, Lutz Fleischhacker, Donna Green, Arthur Garson, Elena Tamburini, Stefano Cuomo, Juan Martinez-Leon, Teresa Abrisqueta, Hans-Peter Brunner-La Rocca, Tiny Jaarsma, Teresa Arredondo, Cecilia Vera, Giuseppe Fico, Olga Golubnitschaja, Fernando Arribas, Martina Onderco, Isabel Vara, on behalf of ZENITH consortium A83 Predictive, preventive and personalized medicine in diabetes onset and complication (MOSAIC project) José Verdú, Francesco Sambo, Barbara Di Camillo, Claudio Cobelli, Andrea Facchinetti, Giuseppe Fico, Riccardo Bellazzi, Lucia Sacchi, Arianna Dagliati, Daniele Segnani, Valentina Tibollo, Manuel Ottaviano, Rafael Gabriel, Leif Groop, Jacqueline Postma, Antonio Martinez, Liisa Hakaste, Tiinamaija Tuomi, Konstantia Zarkogianni, on behalf of MOSAIC consortium A84 Possibilities for personalized therapy of diabetes using in vitro screening of insulin and oral hypoglycemic agents Igor Volchek, Nina Pototskaya, Andrey Petrov A85 The innovative technology for personalized therapy of human diseases based on in vitro drug screening Igor Volchek, Nadezhda Pototskaya, Andrey Petrov A86 Bone destruction and temporomandibular joint: predictive markers, pathogenetic aspects and quality of life Ülle Voog-Oras, Oksana Jagur, Edvitar Leibur, Priit Niibo, Triin Jagomägi, Minh Son Nguyen, Chris Pruunsild, Dagmar Piikov, Mare Saag A87 Sub-optimal health management – global vision for concepts in medical travel Wei Wang A88 Sub-optimal health management: synergic PPPM-TCAM approach Wei Wang A89 Innovative technologies for minimal invasive diagnostics Andreas Weinhäusel, Walter Pulverer, Matthias Wielscher, Manuela Hofner, Christa Noehammer, Regina Soldo, Peter Hettegger, Istvan Gyurjan, Ronald Kulovics, Silvia Schönthaler, Gabriel Beikircher, Albert Kriegner, Stephan Pabinger, Klemens Vierlinger A90 Rare disease diobanks for personalized medicine Ayşe Yüzbaşıoğlu, Meral Özgüç, Member of EuroBioBank - European Network of DNA, Cell and Tissue Banks for Rare Disease

Self-monitoring as an important tool in preventing diabetes complications - Evidence from the real world

Despite the increasing use of Continuous Glucose Monitoring (CGM), Self-Monitoring of Blood Glucose (SMBG), although in use for almost four decades, remains the cornerstone of home and hospital glucose monitoring for majority of diabetes patients worldwide. As demonstrated in large clinical trials that included SMBG as part of multifactorial intervention, glycemic control in diabetes remains essential to prevent microvascular complications and reduce long-term risk of macrovascular disease. For patients on insulin treatment, frequent SMBG is key for achieving recommended glycemic targets, and prevention of hypoglycemia and hyperglycemia. Increased daily frequency of SMBG in type 1 diabetes patients was significantly associated with lower HbA1c, and fewer acute complications Randomized controlled and observational trials in non-insulin treated type 2 diabetes patients about the use of SMBG for improvement of glycaemic control and/or reduction of hypoglycemic risk, provided mixed results. SMBG remains essential tool of proactive diabetes care approach in these patients, as it provides immediate feedback on glycaemic control, rather than waiting months for the next HbA1c. SMBG is necessary for education of non-insulin treated type 2 diabetes patients, and should be individualized in terms of frequency, timing and communication with healthcare providers, as part of structured diabetes management. Recent randomized controlled trial on the use of structured SMBG in non-insulin treated type 2 diabetes patients provided mean reduction in HbA1c of 0.9%. HbA1c is recognized as key surrogate marker for development of long-term diabetes complications; however, its numerous limitations (lack of information on acute complications of hypo- and hyperglycemia, and glucose variability; confounded by conditions such as anemia, hemoglobinopathies, iron deficiency, and pregnancy), resulted in a need for novel metrics of glucose control (glucometrics), such as Mean Glucose; Time in Range (TIR); Time Above Range (TAR); Time Below Range (TBR); Glucose Management Indicator (GMI); Glycemic Variability (GV); Ambulatory Glucose Profile (AGP). Although primarily developed for CGM, glucometrics could also be applied for use with SMBG (Mean and Median Glucose; Standard Deviation; % Coefficient of Variation; Interquartile Range, Minimum, Maximum; Glucose Profile by Time of Day and by Date; Percentage of Time in Range, Above Range, Below Range; integration with insulin dose, medication, meal, exercise). Analysis of 7-point SMBG data from the Diabetes Control and Complications Trial (DCCT) demonstrated correlations of TIR with diabetes complications. Accuracy is crucial for reliable use of SMBG in real world, and two most used standards for accuracy of blood glucose monitors are those of International Organization for Standardization (ISO 15197:2013) and FDA. Healthcare providers need to be familiar with measures of accuracy, such as, bias; precision; arithmetic and absolute deviation; Absolute Relative Difference (ARD) – Mean ARD (MARD) and Median ARD (MedARD); Rectangle Target Plot. Although healthcare providers and patients assume that regulatory approved blood glucose monitors are accurate, recent analysis found that only 6 of top 18 glucose meters met the accuracy standard. Some of factors known to affect SMBG accuracy include higher and lower oxygen tension conditions, temperature, interfering substances, manufacturing defects, test strip lot-to-lot variation, alternate site testing, skin contaminants. Considerable increase in the number of free test strips for type 1 and insulin-treated type 2 diabetes patients was identified as a single most important event resulting in 10% reduction in cases of diabetic ketoacidosis after 2 years. Recent real-world studies reported that SMBG is underutilized in patients with type 2 diabetes treated or not with insulin; that postprandial glycaemia is seldom investigated; and poor metabolic control with unsatisfactory rates of hyper- and hypoglycemia was observed. Unfortunately, there are still countries where SMBG is not available, or is available for minority of patients who mostly perform it once a month, or at no regular interval. In conclusion, SMBG is not a stand-alone activity; rather a part of a multi-component diabetes care program; and, despite emerging technologies, it is here to stay, as no diabetes management is possible without measurement of glycaemia

Comment on Publications from OpT2mise Study

It is well known that the type 2 diabetes ‘‘pandemic’’ is spreading relentlessly throughout the world, and the Republic of Macedonia is certainly not an exception: according to the latest International Diabetes Federation Atlas data from 2015, the country is occupying the unpopular third place in Europe in terms of diabetes comparative prevalence (10.3%), with the vast majority of cases (approximately 98%) diagnosed with type 2 diabetes. Many factors have contributed to such a high prevalence of type 2 diabetes in the country, including the considerable rise in caloric intake per capita with no concurrent physical activity, very high smoking prevalence, and the transition from a socialist to a market economy with jobs and income insecurity—leading to steep rise in unemployment and associated stress. Such an explosion of type 2 diabetes has been among the main reasons for categorization of the Republic of Macedonia as a very high-risk country in Europe in terms of cardiovascular mortality. Consequently, type 2 diabetes prevalence in the country and worldwide has been associated with alarming socioeconomic effects: approximately 40% of the country’s total budget for all reimbursed non-hospital medications was spent only on insulin, glucometers, test strips, glucagon, insulin needles, insulin pumps, and related supplies, provided free through a government program, not including oral antidiabetes drugs or other direct and indirect diabetes-related costs DIABETES TECHNOLOGY & THERAPEUTICSVolume 18, Number 7, 2016