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Content available remote Primary prevention of nephropathy in obese type 2 diabetic patient
We report a case of a 36-year-old obese man who presented with newly onset diabetes mellitus type 2 and hypertension. The estimated value of glomerular filtration rate - 203.7 ml/min was associated with the patient being at high risk of developing progressive renal disease. In this case, in order to prevent nephropathy, the preferred therapy was a gradual bodyweight reduction. A low-calorie diet providing an 800 kcal/day deficit was recommended to the patient, as well as an increase in physical activity. After a total weight reduction of 50 kg (33% of initial bodyweight), the patient’s glomerular filtration, body mass index, and blood pressure normalized without any drug therapy. Glucose, blood pressure and lipid target levels can only be simultaneously achieved through body-weight reduction. In the presented case, we show the beneficial effects of bodyweight reduction, and dietary and physical activity changes on high glomerular filtration rate. Bodyweight reduction stops the cascade of events that are caused by glomerular hyperfiltration and the progression toward irreversible renal damage.
Genetic variations of the antioxidant enzymes may influence the susceptibility to oxidative stress and consequently the development and progression of diabetic complications. The aim of the current study was to test the association between the −262C/T polymorphism in the catalase gene promoter and carotid atherosclerosis in Slovenian patients with type 2 diabetes. Two-hundred and eighty six diabetics and 150 healthy controls were enrolled in the study. Carotid atherosclerosis was quantified ultrasonographiocally by carotid intima-media thickness (CITM), plaque score and plaque type. Genotypes were determined using the real-time PCR. Fibrinogen concentration showed a borderline statistically significant difference due to catalase genotypes (p=0,05). No difference in clinical characteristics, CIMT, plaque stability or plaque score was observed. Logistic regression model adjusted for age, gender, smoking, BMI, lipid parameters and duration of hypertension and diabetes showed significant association of T allele and lower risk for higher plaque score (OR=0,25; p=0,025). No association with CIMT>1mm and unstable plaques was observed. T allele of −262C/T is associated with lower risk for higher plaque score but it did not affect clinical parameters, CIMT and plaque stability. Whether this polymorphism can be used as a genetic marker for advanced carotid atherosclerosis in diabetic patients needs to be evaluated in the future.
The present study deals with the application of two major multivariate statistical approaches - Cluster Analysis (CA) and Principal Components Analysis (PCA) as an option for assessment of clinical data from diabetes mellitus type 2 patients. One hundred clinical cases of patients are considered as object of the statistical classification and modeling, each one of them characterized by 34 various clinical parameters. The goal of the study was to find patterns of similarity, both between the patients and the clinical tests. Each group of similarity is interpreted revealing at least five clusters of correlated parameters or five latent factors, which determine the data structure. Relevant explanation of the clustering is found based on the pattern of similarity like glucose level, anthropometric data, enzyme level, liver function, kidney function etc. It is assumed that this classification could be of help in optimizing the performance of clinical test for this type of patients and for designing a pattern for the role of the different groups of test in determining the metabolic syndrome of the patients.
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