449-P: Assessing Cardiovascular Risk in Prediabetes

Prediabetes carries a risk of diabetes and cardiovascular disease (CVD) . Assessment of CVD risk in prediabetes is not as routine, as is assessment of diabetes risk. However, it is not less important. This can be done through conventional SCORE charts and through coronary artery calcium (CAC) score. CAC is examined through multislice CT. Calcifications indicate late-stage subclinical coronary atherosclerosis. The AIM of our study was to assess traditional CVD risk through score charts and CAC in subjects with prediabetes (preDM) and to evaluate whether any correlation exists between the two. After diagnosing preDM with an oral glucose tolerance test and HbA1c, ECG, lipids, body mass index and blood pressure measurements were performed. Subjects were evaluated for CVD risk through Score charts. Thereafter, all subjects were appointed for multi-slice CT to obtain the CAC. A writen consent was obtained from all subjects. Results: 80 subjects with preDM were screened for CVD. CAC score of 0 was present in 35 subjects. Minimal calcifications with a CAC score of 1-AU were present in subjects with preDM. Moderate calcification of 11-100 AU were present in 18 subjects. 12 subjects had significant calcifications with 101-400 AU. Five subjects had a CAC score &amp;gt;400 AU. Evaluation of the Score charts reviled that Score risk below 2% was present in 20 subjects. Score risk of 3-4% was present in 10, 5-9% risk was present in 16 and a score risk of 10-14% was present in 8 subjects. Twenty six subjects with PreDM has a score risk of 15% and more. No significant correlation was found between Score charts and CAC. However, a trend of finding more calcifications in those with a 10% and above Score risk was noted. Conclusion: An approach to CVD risk assessment that combines the traditional Score charts with a more personalized atherosclerosis-imaging model may be appropriate for high risk subjects with pre diabetes. Disclosure T.Beljic zivkovic: None. </jats:sec

The effects of metformin plus sulfonylurea therapy on clinical features of the metabolic syndrome

Introduction. Insulin resistance is a well-known leading factor in the development of metabolic syndrome. The aim of this study was to evaluate metabolic effects of metformin added to sulfonylurea in unsuccessfully treated type 2 diabetic patients with metabolic syndrome. Material and methods. A group of thirty subjects, with type 2 diabetes, secondary sulfonylurea failure and metabolic syndrome were administered the combined therapy of sulfonylurea plus metformin for six months. Metformin 2000 mg/d was added to previously used sulfonylurea agent in maximum daily dose. Antihypertensive and hypolipemic therapy was not changed. The following parameters were assessed at the beginning and after six months of therapy: glycemic control, body mass index, waist circumference, blood pressure, triglycerides, total cholesterol and its fractions, homeostatic models for evaluation of insulin resistance and secretion (HOMA R, HOMA B) and C- peptide. Results. Glycemic control was significantly improved after six months of the combined therapy: (fasting 7.89 vs. 10.61 mmol/l. p&lt;0.01; postprandial 11.12 vs. 12.61 mmol/l. p&lt;0.01, p&lt;0.01; glycosylated hemoglobin 6.81 vs. 8.83%. p&lt;0.01). the body mass index and waist circumference were significantly lower (26.7 vs. 27.8 kg/m2, p&lt;0.01 and 99.7 vs. 101.4 cm for men, p&lt;0.01; 87.2 vs. 88.5 for women, p&lt;0.01). Fasting plasma triglycerides decreased from 3.37 to 2.45 mmol/l (p&lt;0.001) and HOMA R from 7.04 to 5.23 (p&lt;0.001). No treatment effects were observed on blood pressure, cholesterol, and residual insulin secretion. Conclusion. Administration of metformin in type 2 diabetes with metabolic syndrome decreased cardiovascular risk factors by reducing glycemia, triglycerides, BMI, central obesity and insulin resistance.</jats:p

Role of standard test meal in initiation of insulin therapy in type 2 diabetes

Introduction Secondary monotherapy failure in diabetes mellitus type 2 occurs early in the course of disease. Choosing the optimal combination therapy depends on the primary pathogenic mechanism. Evaluation of the residual beta cell function is of primary importance in deciding whether insulin should be included in the combination therapy. Objective To investigate the influence of standard meal test and homeostasis model assessment (HOMA-B) index, as markers of residual insulin secretion, on the efficacy of two different therapeutic strategies in secondary sulphonylurea (SU) failure. Methods In the group of thirty subjects with diabetes type 2, metabolic syndrome and secondary SU failure, metformin (MET) was added for the following six months. In the group of 30 subjects with diabetes type 2, secondary SU failure, with no metabolic syndrome, insulin (INS) was added for the same period. During the six-month follow-up period, fasting, postprandial, mean daily blood glucose and glycosylated haemoglobin (HbA1C) were evaluated. Fasting and meal stimulated C-peptide (CP) and insulin levels were measured at the beginning; absolute and relative increase of CP (delta CP, delta CP%), and HOMA-B were calculated. Correlation between CP secretion and HOMA-B at the beginning and glycaemic control after six months of therapy were evaluated by using Pearson correlation coefficient. Results Glycaemic control after six months was significantly improved in both therapeutic combinations (p&lt;0.01). However, target values were not met in either group. Stimulated CP levels correlated best with all the parameters of glycaemic control in the group SU+MET (r -0.479 to -0.791; p&lt;0.01), and in the group SU+INS (r 0.382 to 0.635; p&lt;0.01). HOMA-B correlated only with HbA1C in the SU+MET group (r=-0.382; p&lt;0.05). Conclusion Clinical diagnosis of metabolic syndrome and evaluation of residual insulin secretion are necessary in choosing the best combination therapy in secondary SU failure in subjects with type 2 diabetes. Stimulated standard meal CP level is a clinically useful marker of residual insulin secretion

Different insulin treatment regimens in patient with diabetes mellitus type 1: Effects on quality of life

Background/Aim. Despite of contemporary diabetes mellitus (DM) treatment, one half of patients do not achieve an optimal metabolic control. Considering great psychological burden of diabetic patients, the purpose of this study was to assess the effect of different insulin treatment regimens, glycemic control and the presence of vascular complications on self-reported well-being and quality of life (QoL) of subjects with type 1 DM. Methods. The patients with type 1 DM (n = 122) recruited from the outpatient Diabetes Endocrinology Clinic of Zvezdara University Medical Center were divided into 4 groups according to the specific treatment regimen: 26 were on continuous subcutaneous insulin infusion (CSII), 30 on conventional insulin therapy, 33 on multiple daily injections (MDI) with human insulins, and 33 on MDI with insulin analogues. QoL was assessed by self-reported well-being with the following questionnaires: WHO-5 item Well Being Index (WHO- 5), 36 item Short Form (SF-36) survey, and Insulin Treatment Appraisal Scale (ITAS). Objective metabolic control was assessed by glycosylated hemoglobin (HbA1c), lipid levels and the presence of vascular complications. Statistical analyses used in this crosssectional study included: descriptive statistics, Student?s t-test, Chisqare test, contingency tables, ANOVA and correlation methods. Results. The patients on CSII had significantly better metabolic control than all other treatment groups, especially when compared to the one on conventional therapy (CSII HbA1c 7.07 ? 1.48% vs conventional therapy, HbA1c 10.04 ? 1.44; p = 0.000). No significant difference in glycemic control was observed between patients on MDI with human insulins and insulin analogues. Good glycemic control significantly influenced the reported QoL. The patients with retinopathy and nephropathy reported significantly lower physical well-being, and the patients with polyneuropathy and cardiovascular complications reported also lower psychological well being. Conclusions. Insulin treatment regiment selection affects not only objective metabolic control, but also QoL.</jats:p