Romanian Journal of Diabetes Nutrition and Metabolic Diseases

Lancet Diabetes & Endocrinology Commission on diagnosis of clinical obesity- possible implications on clinical practice

2025-03-16T14:58:18+02:00

On the 14th of January 2025, the long-awaited and anticipated report of the Lancet Diabetes & Endocrinology Commission on clinical obesity was published. The report is constructed through a Delphi consensus process, and it is very complex, addressing numerous aspects regarding obesity- its causes, pathophysiology, phenotypes, relationship with other diseases, views and attitudes about obesity among patients, healthcare professionals, and policymakers. It should also be noted that the report was endorsed by 79 international, regional and national scientific societies, including the World Obesity Federation (WOF). The editorial discusses two important aspects with clear implications on clinical practice- definitions and criteria for the diagnosis of obesity and criteria for the diagnosis of clinical obesity. The proposals of the Commission on clinical obesity are challenging for the medical community, and we should wait until the future to validate all or a part of them in new guidelines for the evaluation and treatment of obesity.

Evaluation of menstrual cycle parameters under the influence of stress

2025-03-16T14:58:18+02:00

Menstrual cycle is highly sensitive to the influence of external and internal factors. Stress, associated with adverse consequences for the female organism, leads to dysfunction of the menstrual cycle and, consequently, reproductive health disorders. The investigation of the impact of chronic stress on the female reproductive sphere convincingly demonstrates the role of external triggering factors in the development and functioning of the menstrual cycle, which serves as a marker of reproductive health. Simultaneously, it opens up broad possibilities for detailing aspects of this pathological process, taking into account the stress factor. The question of the difficulty of identifying individuals experiencing the effects of chronic stress has always arisen, particularly during the COVID-19 pandemic. Therefore, previous studies have yielded conflicting results regarding the influence on the menstrual cycle under these conditions. In light of these findings, further in-depth research on this issue is crucial and promising.

The correlation of body mass index and skin hydration in diabetic patients

2025-03-16T14:58:18+02:00

Diabetes Mellitus (DM) affects approximately 9.8% of the global population, with type 2 DM as the most common case in the world. Excess body weight and obesity are significant risk factors for type 2 DM. Previous studies have reported that obese diabetic mice show a reduction of stratum corneum water content and lipid content in the skin. Our study aims to further evaluate the correlation between BMI and skin hydration in type 2 DM patients. This study was an observational study with a cross-sectional design. All study subjects underwent skin hydration measurement with CM 825 corneometer®, while the anthropometric measurement was done using Charder Medical Scale® (MS 4900). The correlation between BMI and skin hydration was analyzed using the Chi-Square test and was significant if the p-value <0.05. The majority of type 2 DM patients were female (61.9%), with BMI ≥25 kg/m2 (62.9%) and dry skin hydration (93.8%). The results of this study showed that there was no correlation between BMI and skin hydration in type 2 DM patients (p=0.236). There was no correlation between BMI and skin hydration in type 2 DM patients.

Survey of HOMA1-IR and HOMA2-IR indexes in first-diagnosed type 2 diabetes patients

2025-03-16T14:58:19+02:00

Insulin resistance is the primary pathogenesis leading to type 2 diabetes. The HOMA model is widely used to assess insulin resistance. This study aims to examine the HOMA1-IR and HOMA2-IR indices in patients with type 2 diabetes diagnosed for the first time. A comparative cross-sectional study including two groups: the patient group was patients with type 2 diabetes diagnosed for the first time (n=101), and the control group was healthy people (n=98). Statistical analysis was performed using SPSS 22.0 software. The study showed that patients with type 2 diabetes had an average value of HOMA1-IR of 3.79 and HOMA2-IR of 1.79, significantly higher than that of healthy people. With a cutoff value of 1.96, the sensitivity and specificity of HOMA1-IR to distinguish between disease and non-disease were 91.1% and 96.9%, respectively. For HOMA2-IR with a cutoff of 0.96, the sensitivity and specificity were 62.4% and 86.7%, respectively. Patients with type 2 diabetes diagnosed for the first time had higher HOMA1-IR and HOMA2-IR than healthy people; HOMA1-IR and HOMA2-IR were higher in type 2 diabetic patients with dyslipidemia than in type 2 diabetic patients without dyslipidemia. HOMA1-IR had higher sensitivity and specificity than HOMA2-IR in distinguishing type 2 diabetes from healthy people.

Evaluating nutrient profiles of packaged foods in Peru pre- and post-introduction of front-of-pack warning labels, 2018–2021

2025-03-16T14:58:19+02:00

This study assessed differences in the nutritional labeling content of processed foods based on Peruvian regulations before and during the two implementation stages of Law 30021. A cross-sectional analysis of 1137 food labels collected between 2018 and 2021 was conducted, comparing nutritional information across three periods: pre-implementation (2018), first stage (2019–2020), and second stage (2021). Nutrient content variations were analyzed using the Kruskal-Wallis test, while changes in front-of-package labeling were assessed with the McNemar test. Statistical analyses were performed using SPSS version 25, with significance set at p<0.05. The study found significant reductions in key nutrients over time, with total decreases of 3.4% in calories (p=0.001), 14% in sodium (p=0.001), 36.7% in sugar (p=0.001), and 9.2% in saturated fats (p=0.028). The introduction of front-of-package warning labels contributed to a 10–30% decline in high sodium, high sugar, and high saturated fat warnings in solid foods, except for trans-fat labeling, which remained unchanged (p=0.874). Among liquid ultra-processed foods, sugar content showed a notable 49% reduction during the initial implementation phase (p=0.01). These findings suggest that the implementation of Law 30021 in Peru has led to a decline in critical nutrient levels in processed foods, particularly in calories and saturated fats. Front-of-package warning labels play a role in improving nutritional profiles, potentially promoting healthier food choices. However, further research is necessary to assess long-term consumer behavior and health impacts.

The effect of quercetin on the development of oxidative stress and nitric oxide production in the blood of patients with Type 2 Diabetes Mellitus

2025-03-16T14:58:19+02:00

Diabetes mellitus is a non-communicable disease that is recognized as a global epidemic and is a leading cause of disability and mortality. An important area of research in diabetology is the creation and implementation of brand-new drugs that affect the key mechanisms of diabetes development and prevent the occurrence or progression of associated complications. The aim of the study is to evaluate the effect of quercetin on the activity of antioxidant enzymes, lipid peroxidation and nitric oxide synthesis in the blood of patients with type 2 diabetes mellitus. Methods and Material. During the study, 36 patients with an average age of 58.86±1.89 years have been examined. The subjects have been treated at the Municipal Institution “2nd City Clinical Hospital” in Poltava in 2023. All subjects were divided into two groups: the experimental group (n=21), which included patients with diagnosed type 2 diabetes mellitus and the control group (n=15), which included individuals without disorders in carbohydrate metabolism. Quercetin enhances antioxidant defense and effectively reduces excessive nitric oxide production, which is of great importance in treating type 2 diabetes mellitus.

A prospective study on the relationship between comorbidities and metformin-induced gastrointestinal symptoms in elderly patients with diabetes

2025-03-16T14:58:19+02:00

This study explores the impact of comorbidities on Metformin-induced gastrointestinal (GI) symptoms in elderly patients with Type 2 diabetes mellitus. Conducted over six months at a tertiary care hospital in Erode, India, the prospective study involved 200 patients aged 55 years and above. Participants were categorized into two groups—those with additional comorbidities [such as hypertension (HTN) and coronary artery disease (CAD)] and those without. Data collection utilized a structured 20-question questionnaire focusing on Metformin usage, GI symptoms, and comorbid conditions. The findings revealed that elderly patients with both Type 2 diabetes and HTN had a significantly higher incidence of GI symptoms (69.44%) compared to those with diabetes alone (54.16%) or HTN alone (56%). The highest prevalence of symptoms was observed in patients with diabetes, HTN, and CAD (70.83%). Abdominal pain emerged as the most common symptom, particularly among those concurrently taking Amlodipine, affecting 15 cases. Additionally, lifestyle factors like smoking and alcohol use further increased GI symptom prevalence, with smokers showing a rate of 91.6% and alcohol users 81.81%. These results underscore the exacerbating role of comorbid conditions like HTN and CAD on Metformin-induced GI symptoms in elderly patients, complicating diabetes management. The study highlights the need for careful assessment and tailored management strategies for this demographic to mitigate adverse effects and improve therapeutic outcomes.

Peculiarities of the immune status of patients with diabetic retinopathy in the framework of metabolic syndrome

2025-03-16T14:58:19+02:00

Diabetic retinopathy (DR) is the most significant and common cause of visual impairment in diabetes patients. The aim of the study was to enhance the understanding of the pathogenesis of DR associated with metabolic syndrome (MS) and elucidate the role of cellular and humoral immunity factors. The study included 130 patients. Group 1 comprised 70 patients diagnosed with DR and insulin-dependent type 2 diabetes against the background of MS. Group 2 included 60 patients diagnosed with DR and non-insulin-dependent type 2 diabetes associated with MS. The immunological analysis focused on evaluating subpopulations of blood lymphocytes using flow cytometry; systemic inflammation markers, such as CRP, specific IgA, IgM, and IgG, cytokines measured by ELISA. Significant changes in immune status were observed in patients with DR associated with MS, depending on diabetes compensation. In Group 1 patients with DR, more pronounced alterations in the T-cell immunity pathway were observed, including T-cell immunodeficiency accompanied by the activation of killer and B-cell immunity, compared to non-insulin-dependent patients. Both groups exhibited type IV hypersensitivity reactions. Elevated CRP level was detected only in insulin-dependent patients with DR. An analysis of the immune parameters indicated predominant activation of the specific humoral immunity pathway, suggesting chronicity of the condition. Non-insulin-dependent patients showed significant activation of mucosal humoral defenses and early humoral protective mechanisms. The data revealed more pronounced changes in specific humoral immunity markers, such as immunoglobulins, compared to systemic inflammation markers like CRP.

Correlation between cognitive disorders in rats with type 2 diabetes mellitus and biochemical markers of oxidative stress

2025-03-16T14:58:19+02:00

In recent decades, the prevalence of type 2 diabetes mellitus (T2D) has risen due to population aging. T2D is closely linked to nervous system pathology, with metabolic disorders affecting biochemical pathways crucial for neural function and cognitive processes. Scientific evidence indicates that patients with T2D exhibit increased brain GABA levels, correlating with cognitive impairment. This study aimed to examine the relationship between cognitive disorders, oxidative stress markers in the cerebral cortex and hippocampus, and the modulation of GABA receptors by carbacetam. Experiments were conducted on male albino rats, with T2D induced by streptozotocin (30 mg/kg) and a high-fat, high-fructose diet. Carbacetam (5 mg/kg) was administered for 14 days. Findings revealed significant correlations between cognitive dysfunction and oxidative stress, highlighting the need for novel neurodegenerative treatment strategies. These results provide an experimental basis for future clinical research on carbacetam as a potential therapeutic agent for T2D-related cognitive decline.

Exploring the factors affecting hypertension screening practices among elderly in rural setting

2025-03-16T14:58:19+02:00

Hypertension is a significant public health concern in India, with a particularly high burden in rural areas. Among the elderly population (aged 60 and above) in rural regions, the prevalence can reach up to 60–70%. This study aimed to explore the factors affecting hypertension screening practices in this population. A cross-sectional study was conducted in rural Erode, Tamil Nadu, India. A sample of 323 participants aged 60 years and above without hypertension screening in the past two years and no prior diagnosis were randomly selected. A developed and validated questionnaire was used to identify barriers to screening. Current blood pressure readings were recorded to determine the prevalence of newly diagnosed hypertension. Among the 323 participants, 77 (23.8%) were found to have hypertension. Significant associations were observed between hypertension prevalence and age (p=0.021), gender (p=0.034), smoking (p=0.013), and alcohol consumption (p=0.042). The most prominent barriers were a lack of knowledge about hypertension consequences (89.4%), absence of obvious symptoms (69%), and lack of reminders from healthcare providers or family members (67%). Other barriers included mistrust in healthcare (8%), previous normal readings (7.4%), work culture/time constraints (2.7%), and cost concerns (3%). Multifaceted barriers, often with gender disparities, affect hypertension screening practices among the elderly in rural India. Comprehensive, community-based education programs and targeted interventions addressing these barriers are crucial to improve screening rates and early detection of hypertension in this population.

Analysis of urinary ET-1 levels and kidney function in obese and non-obese young adults

2025-03-16T14:58:19+02:00

Obesity is characterized by abnormal fat accumulation. The onset and morbidity of obesity are common in adults, leading to various complications, including decreased renal function. Endothelin-1, a molecule that functions as a vasoconstrictor, significantly contributes to the pathophysiology of the renal and cardiovascular systems. This cross-sectional analytical study used purposive sampling, involving 30 obese and 26 non-obese young adult subjects. Urine samples were analyzed using the human Endothelin-1 kit with the ELISA method, while blood samples were analyzed for urea and creatinine levels using an enzymatic technique. The results of urinary Endothelin-1 concentrations between the obese group, which had a median of 92.27 ng/L, and the non-obese group, with a median of 74.41 ng/L. Kidney function test showed in the group for urea 16.50 mg/dL, creatinine 0.70 mg/dL, and GFR 128.35 ml/min/1.73 m2, while the non-obese group showed urea 22.00 mg/dL, creatinine 0.65 mg/dL, and GFR 148.97 ml/min/1.73 m2. The levels of Urinary Endothelin-1 were notably elevated in obese individuals compared to those who were not obese. However, kidney function, as measured by urea, creatinine, and GFR, was not consistently worse in the obese group.

Risk factors analysis of peripheral arterial disease in type 2 diabetes: a cross-sectional study

2025-03-16T14:58:19+02:00

Peripheral Arterial Disease (PAD) is characterized by the narrowing of the arteries in the upper and lower extremities due to the atherosclerotic process. The incidence and mortality rates of PAD are increasing, particularly among patients with Type 2 Diabetes (T2D). The impact of T2D on PAD is associated with several risk factors. This study aims to evaluate the relationship between risk factors and PAD in patients with T2D. A Cross-sectional analytic study with total sampling was conducted at Dr. Wahidin Sudirohusodo Hospital. The study samples were T2D patients who performed an Ankle Brachial Index (ABI) to determine PAD. Risk factors included age, gender, PAD, nutritional status, hypertension, dyslipidemia, smoking, duration of T2D and glycemic control. Data analysis was conducted using Chi-square and multiple logistic regression tests. This study involved 170 patients with T2D who fulfilled the study’s eligibility criteria. In this study, there was a significant association between T2D and PAD in males (p=0.029), age >60 years (p=<0.001), had hypertension (p=0.009), smoking (P=0.001), duration of T2D >10 years (p=<0.001). Multivariate analysis demonstrated that age >60 years (OR 3.3, 95%CI: 1.64–6.59, p=0.001), T2D duration >10 years (OR 3.3, 95%CI: 1.63–6.83. p=0.001) and smoking (OR 2.9, 95%CI: 1.41–6.09, p=0.004) were independently associated with the incidence of PAD. Risk factors associated with PAD in T2D are age, gender, hypertension, duration of T2D, and smoking. Age, duration of T2D and smoking significantly increased the incidence of PAD. The risk factors of dyslipidemia, BMI, and glycemic control have not been proven to play a role in the incidence of PAD in T2D.

Assessment of quality of life in women with combined gynecological pathology

2025-03-16T14:58:19+02:00

Despite the centuries-old history of studying various aspects of endometriosis, this disease remains a central medical and social problem. Endometriosis is a widespread pathology that affects 10 to 30% of reproductive-aged women, causing reproductive function failure, invalidism, and inferiority complex. The aim of this study is to determine the level of quality of life in women with combined gynecological pathology. The clinical part of the work was carried out at the Ternopil regional clinical perinatal center “Mother and Child”. The study included 102 patients with genital endometriosis, aged from 27 to 45 years. Adenomyosis and fibrocystic mastopathy diagnosis was based on complaints, medical history, objective data, gynecological examination, and instrumental examination. The research groups were formed taking into account the polymorphism of genes in the detoxification system. Group I included 75 individuals with GSTT1del and GSTM1del. Group II consisted of 27 individuals who did not have deletions in both phase II detoxification system genes. According to our observations, these diseases significantly determine the indicators of the quality of life of sick women, which requires new approaches to the treatment of such patients in order to reduce the reproductive potential of the nation.

Burnout syndrome comparative study in doctors, psychologists, and law enforcement officers during the full-scale invasion in Ukraine

2025-03-16T14:58:19+02:00

The article deals with theoretical and practical aspects of burnout syndrome manifestation peculiarities in doctors, psychologists, and law enforcement officers during the full-scale invasion of Ukraine and aims to provide its analysis and prevention. The empirical study, conducted in 2023–2024, involved 568 people, including 264 psychologists, 148 general practitioners-family physicians, and 156 law enforcement unit officers from the Odesa region. The study used the author’s questionnaire for the burnout syndrome characteristics, as well as standardized psychodiagnostic techniques. More than a third of the surveyed showed various signs of emotional, physical, and mental burnout. Decreased physical vitality was more typical for doctors, loss of meaning in life and professional activity, regular physical ailments, frequent illnesses, and chronic disease exacerbation were more common for law enforcement officers. A third of psychologists have a partial or complete loss of professional motivation, a decreased sense of competence and work value, dissatisfaction with themselves, and negative self-perception in the professional sphere. The obtained data were taken as a basis for the development of the training program to prevent and correct the burnout syndrome manifestations and develop and improve their stress resistance and tolerance skills, especially during today’s war conditions.

Euglycemic diabetic ketoacidosis induced by empagliflozin in the setting of helicobacter pylori and hypertriglyceridemia treatment

2025-03-16T14:58:20+02:00

Euglycemic diabetic ketoacidosis (EDKA) is a rare complication in diabetes, with clinical triad: 1) metabolic acidosis with an increased anion gap, 2) ketonemia or/and ketonuria, and 3) normal levels of glucose in the blood (<11 mmol/L). This condition is very challenging to diagnose as euglycemia can mask the underlying diabetic acute complication of ketoacidosis. Therefore, clinical suspicion is needed in all patients at possible risk for EDKA. Here, we present a patient with type 2 diabetes, obesity, and hypertriglyceridemia. Also, with a history of cardiovascular disease, He was diagnosed with EDKA on admission and treated recently with Empagliflozin in a setting of Helicobacter pylori Eradication Therapy and Bezafibrate for hypertriglyceridemia. During admission, the patient was treated with fluids intravenously and insulin according to glucose levels in the blood until the metabolic acidosis was reversed.

Androgen-secreting ovarian tumor complicated by secondary erythrocytosis in a postmenopausal women

2025-03-16T14:58:20+02:00

Androgen-secreting ovarian tumors are a rare pathology that occurs both in a woman’s reproductive period and in the postmenopausal period. We have described a rare clinical case of acute virilization growth in the postmenopausal woman. The diagnosis of the left ovary androgen-secreting tumor was made on the base of a significant increase in testosterone and 17-OH progesterone, suppression of gonadotropic hormones, and left ovary solid hypoechoic lesion obtained by ultrasound examination. The patient had concomitant pathologies: type 2 diabetes mellitus, arterial hypertension, and secondary erythrocytosis. After panhysterectomy with omentectomy, the patient experienced gradual regression of hirsutism and virilization. Laboratory examinations 6 months after the operation showed that testosterone and 17 OH progesterone levels were normalized, gonadotropin levels corresponded to the postmenopausal period and erythrocytosis was eliminated.

Intermittent fasting: a novel approach for managing type 2 diabetes: systematic review

2025-03-16T14:58:18+02:00

The prevalence of Type 2 Diabetes Mellitus (T2DM) has escalated, positioning it as the ninth-leading cause of mortality. Unhealthy lifestyles contribute to the development of cardiovascular disease, including T2DM. This study aims to analyze the effects of intermittent fasting concerning T2DM, synthesizing findings from literature published between 2019 and 2024. Literature was gathered from Scopus, PubMed, and ScienceDirect, focusing on recent studies. Criteria were set to select relevant articles, resulting in the inclusion of 5 studies. The outcomes were analyzed to ascertain the impact of intermittent fasting on various parameters related to T2DM. Intermittent fasting demonstrated a significant effect on several factors associated with T2DM, including HbA1c levels, glucose tolerance, insulin dosage, HOMA-IR (Homeostatic Model Assessment of Insulin Resistance), LDL-C (Low-Density Lipoprotein Cholesterol), MSS (Metabolic Syndrome Score), total leptin and cholesterol levels, HDL (High-Density Lipoprotein Cholesterol), βHB (beta-hydroxybutyrate), body weight, and other anthropometric measurements. The literature review suggests that intermittent fasting can effectively modulate multiple aspects of T2DM. It is proposed as a potential preventive measure for T2DM. However, it is advisable for individuals, especially those with diabetes, to seek medical consultation before adopting intermittent fasting as part of their lifestyle.

Gut microflora: the unheeded factor in type 2 diabetes mellitus: a review

2025-03-16T14:58:18+02:00

Type 2 Diabetes Mellitus is rising globally. The pathogenesis of Type 2 Diabetes Mellitus remains unclear. Recent research indicates that the composition of the intestinal microbiota is linked to obesity and type 2 diabetes. This article provides an overview of the involvement of intestinal microbiota in the etiology of type 2 diabetes. The intestinal microbiota affects body weight, bile acid metabolism, inflammation, insulin resistance, and gut hormones. Modifying the gut microbiota using probiotics and fecal microbiota transplantation may improve glucose metabolism and insulin resistance. Research to understand the intricate interactions between gut microflora and the pathogenesis of Type 2 Diabetes Mellitus will help develop newer, effective therapeutic modalities.