Romanian Journal of Diabetes Nutrition and Metabolic Diseases http://www.rjdnmd.org/index.php/RJDNMD <p>The <strong>Romanian Journal of Diabetes Nutrition and Metabolic Diseases</strong> is the journal of the <strong>Romanian Society of Diabetes Nutrition and Metabolic Diseases</strong>.</p> <p>It appeared for the first time in 1992, in Romanian language and beginning with 2006 it was published entirely in English. It is a peer reviewed journal, therefore the accepted articles were peer-reviewed by <strong>at least two scientific experts</strong> in the field.</p> <p>It contains <strong>original papers</strong>, including fundamental and clinical research, <strong>literature reviews</strong>, <strong>clinical reports</strong>, <strong>editorials</strong>, articles that contain the <strong>results of the most important clinical studies</strong>, reports from the important congresses and <strong>book reviews</strong>.&nbsp;</p> <p>In Romanian Journal of Diabetes Nutrition and Metabolic Diseases there may be published only papers exclusively sent to this journal, not published previously. The authors should include possible conflicts of interest and financing sources. The laws of copyright and international rules of scientific research are respected.</p> <p>The Romanian Journal of Diabetes Nutrition and Metabolic Diseases <strong>strictly requires</strong> for all the scientific work published <strong>to be 100% compliant</strong> with the&nbsp;<a title="ICMJE.ORG" href="http://www.icmje.org/icmje-recommendations.pdf" target="_blank" rel="noopener">Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals</a>&nbsp;and with the&nbsp;<a title="Best Practices" href="http://doaj.org/bestpractice" target="_blank" rel="noopener">Principles of Transparency and Best Practice in Scholarly Publishing</a> (joint statement by COPE, DOAJ, WAME, and OASPA).</p> <p>This journal appears trimestrially (four numbers/year). 650-800 copies are printed on each number.</p> <p>ILEX Printing House, Bucharest, has the exclusivity for the typesetting, printing and distribution of the Romanian Journal of Diabetes, Nutrition and Metabolic Diseases.</p> <p>Our journal is recognized by the Romanian National University Research Council (CNCSIS - 2009) to be part in the B+ category, Code 322.</p> <p>The Romanian Journal of Diabetes Nutrition and Metabolic Diseases is currently indexed in:</p> <p>- Index Copernicus<br>- Get Cited<br>- SCOPUS<br>- Scirus<br>- Celdes<br>- CNKI Scholar (China National Knowledge Infrastucture)<br>- CNPIEC<br>- EBSCO - TOC Premier<br>- EBSCO Discovery Service<br>- Google Scholar<br>- J-Gate<br>- Naviga (Softweco)<br>- Primo Central (ExLibris)<br>- SCImago (SJR)<br>- Summon (Serials Solutions/ProQuest)<br>- TDOne (TDNet)<br>- Ulrich's Periodicals Directory/ulrichsweb<br>- WorldCat (OCLC)</p> Romanian Society of Diabetes Nutrition and Metabolic Diseases en-US Romanian Journal of Diabetes Nutrition and Metabolic Diseases 2068-8245 SHIFTING THE PARADIGM IN TYPE 2 DIABETES TREATMENT. A PRAGMATIC APPROACH OF THE ADA/EASD 2018 CONSENSUS: THE DIABETES DECALOGUE http://www.rjdnmd.org/index.php/RJDNMD/article/view/556 <div class="page" title="Page 1"> <div class="layoutArea"> <div class="column"> <p><em>On 5th of October 2018, at the 54th Annual Meeting of the European Association for the Study of Diabetes the two major professional associations from the field of Diabetes: the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) presented a consensus position paper regarding the new paradigm of Type 2 Diabetes Mellitus (T2DM) treatment</em></p> </div> </div> </div> Dan Gaita Bogdan Timar ##submission.copyrightStatement## 2018-12-22 2018-12-22 25 4 353 356 EFFECT OF FIBER-RICH SNACKS ON C-REACTIVE PROTEIN AND ATHEROGENIC INDEX IN TYPE 2 DIABETES PATIENTS http://www.rjdnmd.org/index.php/RJDNMD/article/view/491 <p><em><strong>Background and aims:</strong> High levels of non-HDL and atherogenic cholesterol can induce inflammation, and as risk factor for cardiovascular diseases. This study was to evaluate the effects of fiber-rich snacks on non-HDL cholesterol, atherogenic index, and C-reactive protein (CRP) levels in type 2 diabetes patients (T2DM). <strong>Material and Methods: </strong>Twenty T2DM patients, were recruited from the Policlinic of Endocrine, Dr. Sardjito General Hospital, Yogyakarta, Indonesia. The subjects received daily 32g fiber-rich snacks made of Dioscorea esculenta, arrowroot, cassava and pumpkin for 4 weeks. Fasting non-HDL cholesterol, atherogenic index, CRP and HbA1c levels were measured before and after intervention. Paired t-test was used to evaluate the results. &nbsp;<strong>Results:</strong> The fiber-rich snack intervention in T2DM patients significantly reduced levels of non-HDL cholesetrol and CRP levels (p&lt;0.05), but the decreased the atherogenic index was not significant (p&gt;0.05). The intervention also significantly reduced the CRP levels (p&lt;0.05), but did not affect HbA1c levels. Body weight, body mass index (BMI), waist circumference decreased significantly after consuming the snacks (p&lt;0.05). <strong>Conclusions:</strong> This study showed fiber-rich snack has a positive effect in improving non-HDL cholesterol, atherogenic index and CRP levels but does not affect HbA1c levels in T2DM patients.</em></p> Sunarti . Sri Lestari Sulistyo Rini Hemi Sinorita Dini Ariani ##submission.copyrightStatement## 2018-12-22 2018-12-22 25 4 357 362 OMEGA-3 POLYUNSATURATED FATTY ACIDS IMPROVED ARTERIAL STIFFNESS PARAMETERS IN TYPE 2 DIABETIC PATIENTS WITH CARDIAC AUTONOMIC NEUROPATHY http://www.rjdnmd.org/index.php/RJDNMD/article/view/502 <p><strong><em>Background and Aims:</em></strong> <em>Cardi</em><em>ovascular</em><em> autonomic neuropathy</em><em> (CAN)</em><em> in type 2</em> <em>diabetes mellitus (</em><em>T2</em><em>DM)</em> <em>is one of the independent risk factor for cardiovascular mortality</em><em>. <strong>Material and Methods:</strong> 36 patients with T2</em><em>DM</em> <em>and confirmed CAN were involved. The study was carried out on two separate arms: traditional hypoglycemic therapy (n = 15, control) and </em><em>long-chain </em><em>w</em><em>-3 polyunsaturated fatty acids </em><em>(</em><em>w</em><em>-3 PUFAs, n = 21). The duration of the study was three month.</em> <strong><em>Results:</em></strong><em> In subjects with T2</em><em>DM</em><em> and </em><em>С</em><em>AN treatment with </em><em>w</em><em>-3 PUFAs resulted in a significant decrease of aorta augmentation index (AIxao), pulse wave velocity (PWV) during the active period of the day and decrease of AIxao, brachial augmentation index and PWV during the passive period of the day compared with the control group. Therefore, the administration of omega-3 PUFAs to patients with T2DM for three months promotes to improvement of arterial stiffness parameters. <strong>Conclusions:</strong> In patients with T2</em><em>DM</em><em> and </em><em>С</em><em>AN treatment with </em><em>w</em><em>-3 PUFAs improved arterial stiffness parameters. </em><em>T</em><em>he efficacy of </em><em>w</em><em>-3 PUFA</em><em>s</em><em> is not associated with improved </em><em>glycaemic control</em><em>, </em><em>but is rather the </em><em>result of a direct effect of </em><em>the </em><em>pharmacological agent on the investigated </em><em>indexes</em><em>.</em></p> Victoria Alexandrivna Serhiyenko Ludmila Mykhailivna Serhiyenko Alexandr Aleksijovych Serhiyenko ##submission.copyrightStatement## 2018-12-22 2018-12-22 25 4 363 368 IMPACT OF LOW CALORIC DIET AND EXERCISE ON ATHEROGENIC INDICES IN OBESE HYPERTENSIVE ADULTS http://www.rjdnmd.org/index.php/RJDNMD/article/view/520 <p><em><strong>Background and aims:</strong> The influence of a low caloric diet with exercise were studied on several biochemical parameters including the lipid profile and atherogenic indices in overweight subjects including obesity with hypertension. <strong>Material and method:</strong> The study focused on 327 patients (144 men and 183 women) aged 54-73 years selected randomly, We chose hypertensives who live in the city of Tiaret and are over 50 years old, because it is the age group most affected by hypertension in Algeria and even in the world. We invited the subjects of our study to follow a program involving a low caloric diet, which was characterized by the suppression of the consumption of sucrose and refined white flour and by the choice of low-fat products, especially dairy products. <strong>Results:</strong> We observed a decrease in the mean value of blood pressure with its two components, systolic and diastolic. Systolic blood pressure ranged from 13.06 ± 1.40 cmHg for the overall sample to 13.01 ± 1.12 cmHg after the six-month program. The same finding is made for diastolic pressure, which decreased by 1.58% for the study population. For biochemical parameters, we observe a decrease in the mean value of all parameters after participation in the low-calorie diet and physical activity program, with the exception of HDL-c, which experienced an increase of 6.25%. <strong>Conclusions:</strong> The hypocaloric diet with exercice that we proposed to a group of hypertensives showed its effectiveness. A healthy lifestyle including a healthy and balanced diet with physical activity therefore allow better management of the hypertensive subject and could actually prevent atherclerosis.</em></p> Mohamed Abdelhaq Abbes Karima Bereksi Reguig ##submission.copyrightStatement## 2018-12-22 2018-12-22 25 4 369 375 ASSOCIATION OF VITAMIN D STATUS WITH BODY MASS INDEX IN ADOLESCENTS IN UKRAINE http://www.rjdnmd.org/index.php/RJDNMD/article/view/530 <p><em><strong>Background and aims:</strong> Vitamin D status in many health maintenance have been researched extensively, but its dependence with obesity still remains controversial. This article is devoted to the investigation of vitamin D status of Ukrainian population and establishment the association between serum 25(OH)D level and body mass index (BMI). <strong>Material and method:</strong> For this observational study, data were collected during the summer 2017, over a period of one week from three township areas in Carpathian region, Ukraine from 304 adults aged 19–78 years. Measured variables contained 25(OH)D level, weight and weight applied to check BMI degree. The average level of vitamin D among adolescents presented 23.1 ± 8.2 ng/ml. Female gender was associated with lower vitamin D concentrations (22.9 ± 9.3 ng/ml vs. 26.2 ± 8.5 ng/ml for men). Among the participants, 74.4% had a BMNI of 25 kg/m<sup>2</sup> and over, and in 27.3% of them the number was 30 kg/m<sup>2</sup> and over. <strong>Results:</strong> Violation of vitamin D status was detected in 90.5% persons. 1.8% people had been identified to be severe vitamin D deficiency. Measurement of 25(OH)D demonstrated meaningful relationship between vitamin D level and BMI only among persons with overweight (BMI 25-29.9 kg/m<sup>2</sup>). The average vitamin D concentrations in persons with BMI over30 kg/m<sup>2</sup> did not vary to a significant range from data in persons with normal body weight. <strong>Conclusions: </strong>Vitamin D status among the adolescents in Ukraine is far from optimum. Our results confirm reliable relationship between vitamin D level and BMI among persons with overweight. Interchange between conservation of vitamin D and BMI needs additional surveys.</em></p> Volodymyr Pankiv Ivan Pankiv ##submission.copyrightStatement## 2018-12-22 2018-12-22 25 4 377 381 COMPARATIVE STUDY OF THE EFFECT OF VARIOUS FORMS OF QUERCETIN ON EXPERIMENTAL DIABETES http://www.rjdnmd.org/index.php/RJDNMD/article/view/538 <p><strong><em>Background and aims:</em></strong> <em>Diabetes mellitus (DM) is a multifactorial metabolic disorder characterized by hyperglycemia caused by insulin deficiency or insulin resistance. It is a global public health problem. This study aimed to </em><em>determine specific pharmacological effect of quercetin in water soluble and liposomal preparations in experimental diabetes mellitus.</em></p> <p><strong><em>Material and methods:</em></strong><em> We examined the effect of Corvitin and Lipoflavone (at the dose of 10 mg / kg body weight) in a comparative study in white rats with type 1 diabetes and type 2 diabetes coupled with obesity. To simulate the forms of diabetes mellitus most analogous to those in humans we used Streptozotocin at the doses of 30 mg / kg and 50 mg / kg. We tested the levels of glucose, glycosylated hemoglobin, C-reactive protein, and interleukins 6 and 4 in the blood.</em></p> <p><strong><em>Results</em></strong><strong><em>:</em></strong> <em>In animals with type 1 and type 2 diabetes Lipoflavone significantly reduces glucose and glycosylated hemoglobin levels compared to the rats treated with Corvitin. When administered to animals with diabetes, the effect of quercetin in liposomal form on the concentrations of IL-6, IL-4 and C-reactive protein is also larger compared to the water-soluble form. <strong>Conclusions</strong>: Water soluble quercetin preparation Corvitin and to a larger extent liposomal preparation of this flavonoid, Lipoflavone, show anti-inflammatory effect and restore key parameters of carbohydrate metabolism in experimental type 1 diabetes mellitus and type 2 diabetes coupled with obesity, reducing blood glucose and glycosylated hemoglobin levels.</em></p> Kateryna Posokhova Iryna Stechyshyn Inna Krynytska Mariya Marushchak Inna Birchenko Ivan Klishch ##submission.copyrightStatement## 2018-12-22 2018-12-22 25 4 383 388 PREDICTIVE VALUE OF BLOOD GLUCOSE RANGE FOR ONSET OF COMPLICATIONS IN PATIENTS WITH DIABETES MELLITUS TYPE 1 http://www.rjdnmd.org/index.php/RJDNMD/article/view/542 <p><strong><em>Background and aims:</em></strong><em> to develop a prognostic mathematical model for risk of microangiopathy in patients with diabetes mellitus type 1 (T1DM). <strong>Materials and methods:</strong> 62 T1DM patients were divided into 2 groups according to</em> <em>НвА1с level: group 1 (n=18) with НвА1с ≤ 7.0% and group 2 (n=44) with НвА1с &gt; of 7.0%. HbA1c, C-peptide, blood creatinine, estimated glomerular filtration rate (eGFR) CKD-EPI, first morning urinary albumin excretion (AU) were determined. Blood glucose levels were conducted by CGMS (Continuous Glucose Monitoring System). All patients were followed for 3 months. </em><em>Rank correlation method was used. <strong>Results</strong></em><strong><em>:</em></strong><em> We established the direct correlation between HbA1c the AU level ρ=0.29 (р&lt;0.016) at the beginning and ρ=0.4 (р=0.021) after 3 months. AU level has a direct correlation with blood glucose range, at the beginning ρ=0.51 (р&lt;0.001) and after 3 month ρ=0.48 (р=0.004) visits. We made the mathematical description of this dependence. Each additional unit of blood glucose range is accompanied by increasing an average level AU level by 0.4816 mg/l. <strong>Conclusion:</strong> our mathematical equation of dependence between AU level and blood glucose range gives the opportunities to predict diabetic kidney disease progression in T1DM patients.</em></p> Kateryna Moshenets ##submission.copyrightStatement## 2018-12-22 2018-12-22 25 4 389 397 MARKERS OF ENDOGENOUS INTOXICATION IN RATS WITH DIABETES MELLITUS COMBINED WITH CARRAGEENAN-INDUCED ENTEROCOLITIS http://www.rjdnmd.org/index.php/RJDNMD/article/view/543 <p><strong>Background and aims:</strong> Diabetes mellitus (DM) is a significant public health issue, being one of the major contributors to morbidity and mortality in the modern societies. Chronic hyperglycemia produces significant physiological, biochemical, and histological changes in the affected organisms. This study aims to evaluate the markers of endogenous intoxication in rats with diabetes mellitus combined with carrageenan-induced enterocolitis. <strong>Material</strong><strong>s</strong><strong> and methods:</strong> Diabetes mellitus was induced by a single intraperitoneal administration of streptozotocin (Sigma Aldrich, USA, at a dose of 60 mg/kg body weight). Carrageenan-induced enterocolitis was modeled by giving the animals free access to 1.0 % solution of carrageenan in drinking water for 1 month. The syndrome of endogenous intoxication was assessed by quantification of low and medium molecular weight substances in blood plasma, red blood cell suspension and urine using extraction-spectrophotometric method. <strong>Results:</strong> The increase in endogenous intoxication in streptozotocin-induced diabetes combined with chronic enterocolitis can mainly be attributed to the catabolic pool of blood plasma substances of low and medium molecular weight. The index of distribution of low- and medium-molecular-weight substances between blood plasma proteins and glycocalyx of erythrocytes in the experimental groups increased simultaneously with the quantities of investigated fractions in the erythrocyte suspension measured at the wavelengths of 242, 254 and 280 nm. <strong>Conclusions:</strong> We observed upsurge of endogenous intoxication markers in the rats with diabetes mellitus. Endotoxicosis became even more evident in the rats with diabetes mellitus combined with carrageenan-induced enterocolitis.</p> Inna Krynytska Mariya Marushchak Inna Birchenko Ivan Klishch ##submission.copyrightStatement## 2018-12-22 2018-12-22 25 4 399 407 CLINICAL AND THERAPEUTIC CHARACTERISTICS OF PATIENTS WITH TYPE 2 DIABETES MELLITUS IN ROMANIA – MENTOR STUDY http://www.rjdnmd.org/index.php/RJDNMD/article/view/537 <p><strong>Background and aims:</strong> PREDATORR Study estimated diabetes mellitus(DM) prevalence at 11,7%. MENTOR is the first national major study trying to determine metabolic control of patients with type 2 diabetes(T2DM), the therapeutic options used, and the microvascular and macrovascular complications prevalence in order to achieve a better management for Romanian patients with T2DM.</p> <p><strong>Material and methods:</strong> The study was designed as an observational analytical, multicenter, prospective study. Study population was selected from T2DM patients stratified by: age, diabetes duration and gender. Data was collected in an eCRF: demographics, physical examination, cardiovascular evaluation, blood tests, known pathology, treatment.</p> <p><strong>Results:</strong> There were 54.80% women, mean age was 60.53±7.39 years. The average BMI is over 30 kg/m2 with a decreasing trend over the age. 60% had their HbA1c over the threshold of 7%. Average blood pressure was less than 140/80 mmHg. 76,66% of T2DM subjects have at least one chronic complication. On oral therapy we have 55.44% of patients, on insulin only therapy 12.99% and on a combination of oral and insulin therapy 22.51%.</p> <p><strong>Conclusions: </strong>This study showed a high prevalence of diabetes complications and metabolic alterations (obesity, hypertension, dyslipidemia, etc.). Age, male gender and diabetes duration were associated with a higher risk for poor metabolic control and complications. Further data will be collected over a 3 years period to obtain a better image over T2DM evolution in Romanian population.</p> Cristian Serafinceanu Viviana Iulia Elian Doina Catrinoiu Cristian Guja Bogdan Mihai Maria Mota Gabriela Roman Romulus Timar ##submission.copyrightStatement## 2018-12-22 2018-12-22 25 4 409 418 INTERDISCIPLINARY APPROACH FOR ORAL REHABILITATION IN A YOUNG TYPE 1 DIABETES PATIENT http://www.rjdnmd.org/index.php/RJDNMD/article/view/527 <p><strong><em>Introduction</em></strong><em>. </em><em>In addition to other systemic complications, oral and dental complications are also experienced frequently in diabetic patients. Periodontal disease is one of the most frequent </em><em>oral complications of diabetes, which consists in progressive destruction of the supporting tissues of the teeth and the alveolar bone, which may eventuslly lead to tooth loss. </em><em>The level of periodontal destruction is affected directly or indirectly by glycaemic control and by the individual’s immune system capacity in diabetes</em><em>. </em><em>Tooth loss, especially in young people, is a debilitating state, that can lead to functional and psychological problems. </em></p> <p><strong><em>Case report</em></strong><em>. This case report presents a type 1 diabetes young female patient with periodontal disease, poor decay control and tooth loss, that create functional and esthetic issues. After consulting the diabetes specialist, </em><em>an interdisciplinary dental treatment plan which comprise surgical, periodontal, endodontic and prosthetic rehabilitation was initiated. &nbsp;</em><em>A minimally invasive prosthetic treatment with long-term interim CAD-CAM (computer aided design/computer aided manufacturing) fixed partial dentures was intended to stabilize the vertical dimension of occlusion (VDO) and to achieve in short term an adequate functional and esthetic rehabilitation.</em></p> <p><strong><em>Conclusion. </em></strong><em>This case reveals a consistent collaboration between the prosthodontist, periodontist and endodontist, with an effective monitoring from the diabetes specialist, that conduct to a successful oral rehabilitation for a young female patient with type I diabetes. </em></p> Anca Jivanescu Luciana Maria Goguta Armina Stemper Raul Rotar Luminita Maria Nica ##submission.copyrightStatement## 2018-12-22 2018-12-22 25 4 419 423 VERY SEVERE HYPERTRIGLYCERIDEMIA-CASE REPORT WITH GENERAL CONSIDERATIONS http://www.rjdnmd.org/index.php/RJDNMD/article/view/540 <p><em>Hypertriglyceridemia </em><em>is defined as a value of fasting serum triglyceride over 150 mg/dl</em><em>. </em><em>The classification of hypertriglyceridemia according to the Endocrinology Society include mild and moderate hypertriglyceridemia, severe hypertriglyceridemia and very severe hypertriglyceridemia. Mild and moderate hypertriglyceridemia</em><em> i</em><em>ncrease the risk for cardiovascular events w</em><em>hile severe and very severe hypertriglyceridemia </em><em>is a risk factor</em><em> for acute</em> <em>pancreatitis. </em><em>Conventional pharmacological therapy of hypertriglyceridemia includes: fibrates, niacin, statins, ezetimibe, omega-3-fatty acid. Other triglyceride-lowering therapies are represented by plasmapheresis and lipoprotein lipase gene therapy. The present work refers to a 59-year old man without history of family diabetes, dyslipidemia, premature coronary artery disease, diagnosed with T2DM in 2012, from 2014 on insulin treatment; he was hospitalized for endocrine evaluation. History: high blood pressure for approximately 25 years, chronic kidney disease, very severe hypertriglyceridemia, thyroid papillary carcinoma. The patient followed treatment with hypoglycemic, hypolipemic, low salt content diet, fibrates, statins, omega-3-fatty acid. Due to the fact that the patient did not respond to conventional therapy plasmapheresis was considered.</em></p> Rucsandra Elena Danciulescu Miulescu Anna Maria Tinu Denisa Margina Daniela Gradinaru Anca Ungurianu Loreta Guja ##submission.copyrightStatement## 2018-12-22 2018-12-22 25 4 425 430 WEB OF CAUSATION BETWEEN DIETARY PATTERNS AND CHILDHOOD OBESITY: APPLYING HILL'S CRITERIA http://www.rjdnmd.org/index.php/RJDNMD/article/view/535 <p><em>Since their publication in 1965, the Bradford Hill criteria for causality have been largely used as a framework for causal inference in epidemiology. We aim at employing this classical approach to shed new light onto the web of causation of childhood obesity. Although the fundamental cause of obesity is the long term imbalance of energy between needs and intake, this medical condition is multifactorial in origin, influenced by genetic, behavioural, socioeconomic, and environmental factors. This imbalance leads to accumulation of excessive fat tissue. Observational studies tend to mostly quantify any possible association between dietary factors and accumulation of fat tissue. On the other hand, multivariate analysis proved some of these associations to be spurious, therefore prospective trials are needed to demonstrate causality. Short term experimental studies have been conducted to identify unique dietary patterns change on specific outcomes, but long term, community based studies would offer more comprehensive answers on the dietary pattern effects.We discuss the applicability of Bradford Hill criteria by using examples of dietary patterns and accumulation of body fat in excess as exposure-response associations. We also put forward and analyse the evidence that prospective studies would bring, as foundation for future interventions.</em></p> Costela Lacrimioara Serban Denis Mihai Serban Stefania Ioana Butica Diana Lungeanu ##submission.copyrightStatement## 2018-12-22 2018-12-22 25 4 431 438