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Type 2 diabetes mellitus (T2DM) is a common metabolic disorder with various medical and psychological adverse effects. Well-being in patients with T2DM is often compromised. The aim of the present study was to investigate clinicodemographic predictors of well-being in patients with T2DM with no known psychiatric history and explore the mediatory role of undiagnosed anxiety and depression. We recruited 175 outpatients with T2DM (54.3% males, aged 34-79 (mean 59.9) years) followed-up at the Diabetes Center of the General Hospital of Nikaia-Peiraeus in Athens. Patients included had no severe diabetes-related complications or known psychiatric history. Well-being was measured with the Mental Health Continuum Short-Form (MHC-SF), a novel 14-item tool measuring the emotional (EWB), social (SWB) and psychological (PWB) dimensions of well-being, as well as a total score of well-being (WBT). Hospital Anxiety and Depression Scale (HADS) was used for screening for undiagnosed anxiety (HADS-A) and depression (HADS-D). Patients' demographics, Body Mass Index (BMI), glycemic control (HbA1c), T2DM duration, comorbid hypertension or dyslipidemia and type of antidiabetic medication were investigated as predictors of well-being or its dimensions in stepwise linear regression models, also including or excluding HADS-A and HADS-D. Mediational effects of HADS-A and HADS-D were explored in structural equation models through path analyses. Results showed that 21.1% of participants had comorbid depression (HADS-D≥11) and 5.1% comorbid anxiety disorder (HADS-A≥11). In the models without HADS, higher WBT as well as EWB and PWB were significantly predicted by lower HbA1c (all p=0.001) and lower BMI (p=0.015, 0.019 and 0.030, respectively). After being included in the model, HADS-A and HADS-D significantly predicted WBT and every dimension of well-being, but the effects of HbA1c and BMI were no longer statistically significant. In path analyses, the indirect effects of HbA1c and BMI on well-being via HADS-D were statistically significant, while the direct and indirect effects via HADS-A were not. Therefore, the effects of HbA1c and BMI on EWB, PWB and WBT were completely mediated by HADS-D. Concludingly, this is the first study using MHC-SF to measure well-being in patients with T2DM. High levels of undiagnosed depression were recorded, in agreement with other studies. Depression was predicted by HbA1c and BMI and finally predicted well-being. Undiagnosed depression fully explained the effects of HbA1c and BMI on well-being. The interplay of glycemic control and positive mental health should be further investigated.

Background: Insulin glargine is a well known long-acting insulin analog in the contemporary treatment of type 2 diabetes mellitus (T2DM). A new long-acting, but more expensive insulin, degludec, shows greater duration compared to already existing long-acting insulins. Aim: The aim of the study is to examine the effect of insulin degludec on T2DM glycaemic control and patient quality of life in low-income patients compared with insulin glargine. Material and Methods: 116 T2DM patients were enrolled in the study. 41 were insulin naïve treated with degludec (Group A), 40 were insulin naïve treated with insulin glargine (Group B) and 36 patients who were on glargine without satisfactory glycemic control were treated with degludec instead of glargine (Group C). Three and six months later, their glycemic control, insulin units, quality of life (SF-36), as well as flexibility in insulin use were assessed. All patients answered the PHQ-9 questionnaire Results: The mean HbA1c for all patients was 8.42±1.23 (p=0.251). The reduction in HbA1c was similar between the three groups (p=0.182). Hypoglycemias became less frequent after the transition from insulin glargine to degludec (p=0.059). Patients in Group A showed less hypoglycemias in 3 months (p=0.036) and six months (p=0.033). Hypoglycemias were significantly reduced for Group B after the first 3 months (p=0.087). All three groups showed a significant improvement in quality of life but patients in Group A achieved the better score in physical (56.2±10.6 vs. 50.8±9.7 vs. 52.7±10.4, p=0.059) and mental (46.2±8.4 vs. 42.5±7.7 vs. 44.5±8.5, p=0.064) health summary compared to Group B and C respectively. Patients in Group A used fewer units compared to Group B and Group C (p=0.067)). Conclusion: The use of degludec is associated with a lower rate of hypoglycemias and a good quality of life while many patients availed themselves of the possibility of degludec insulin’s flexible use. Disclosure A. Koutsovasilis: None. A. Sotiropoulos: None. M. Pappa: None. S. Bousboulas: None. T. Peppas: None.

Background: Dulaglutide is a once-weekly glucagon-like peptide-1 receptor agonist GLP-1. Aim: The aim of the study was to investigate dulaglutide’s quantitative and qualitative long-term effects in type 2 diabetes patients with unsatisfactory glycemic control. Material and Methods: 310 patients under treatment with dulaglutide were included in the study. Parameters of glycemic control (HbA1c, Fasting Blood Glucose -FBG) and cardiovascular risk factors (weight, body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, LDL, HDL, and triglycerides) were recorded, while treatment satisfaction was evaluated with the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Follow up period was 52±2 weeks with assessment of study’s parameters at 12 ±2 weeks and 24±2 weeks. All the data were collected for 254 patients. Results: Patients’ age was 60.23±10.21 years. A reduction of HbA1c was during the follow-up period. HbA1c was reduced from the baseline at the 3, 6 and 12 month monitoring times (8.0±1.31 vs. 7.0.9±0.9 vs. 6.97±1.1, vs. 6.77±0.9) p Conclusion: The long-term use of dulaglutide leads to a significant reduction of HbA1c and to significant improvement of cardiovascular risk factors from the first three months of dulaglutide’s use. All these parameters are showing a steady improvement during the first twelve months of dulaglutide’s use in type 2 diabetes with an unsatisfactory glycemic control. Disclosure A. Koutsovasilis: None. A. Sotiropoulos: None. M. Pappa: None. T. Peppas: None.

Aims To estimate and compare the prescription costs for the management of patients with diabetes over a period of 20 years in Greece, based on real world data. Methods The records of outpatients with T2D, monitored at three diabetes centres, were examined in four cross-sections (1998, 2006, 2012, 2018). Prescribed medicines per patient, along with a set of clinical indicators were recorded. Annual costs of pharmaceutical treatment per patient were calculated by using each year’s nominal retail prices, as well as by adjusting for 2018 price levels, in order to account for price differences over time. Results 4066 patients were included in the analysis. Prescription patterns indicate a quick uptake of the new classes of glucose-lowering drugs and a reduction in the proportional use of sulfonylurea and glitazone. Adjusting for 2018 prices, the average total annual prescription cost per patient was 381.54 Euros (s.d. 297.44) in 1998 and 1147.21 Euros (s.d. 814.39) in 2018. Glucose-lowering drug costs per patient increase from 1998 onwards, whereas the costs of antihypertensive, antiplatelet and lipid-lowering treatment declined gradually, especially after 2006. Conclusions Per patient prescription costs for glucose-lowering drugs present a steep increase, in Greece over the last 20 years. Real-world evidence studies that compare this increase with the changes in patient outcomes are essential in order to examine whether a costs-vs-outcomes balance is optimal.

Background: The efficacy and safety of IDegLira and the benefits of its complementary mode of action have been examined in the large global DUAL clinical trial program. Aim: The aim of this study is to examine the effect of the IDegLira on the glycemic control and the cardiometabolic risk factors compared to the non-fixed adiministration of degludec and liraglutide. Material and Methods: 473 patients with type 2 diabetes mellitus (T2DM) were included in the study. 158 patients on oral antidiabetic drugs (OADs) switched to OADs and IDegLira (Group A), 163 under OADs and liraglutide treatment added degludec to their regimen (Group B) and in 152 patients using degludec and OADs, liraglutide was added (Group C). Follow-up period was 52 ±2 weeks and changes in HbA1c, cardiometabolic risk factors and treatment adherence (with the 8-item Morisky Medication Adherence Scale (MMAS-8)) were recorded. Results: There was no difference at baseline between the three groups as to age (61.88 ± 9.98 years, p =0.212), diabetes duration (12.08 ± 5.83, p = 0.332), HbA1c (mean HbA1c: 8.59± 1.13, p = 0.118) καιΒΜΙ (BMI 32.08 ± 3.22, p = 0.144). Mean HbA1c levels after the follow-up period was 6.79 ± 0.77, 7.14 ± 1.19, 7.18 ± 1.07 (p = 0.033) for Group A, B and C, respectively. Most of patients in Group A reached the treatment target for HbA1c (p = 0.041). Weight change was -3.2 ± 1.2 kg for Group A, -1.2 ± 1.1 kg for Group B and -4.3 ± 1.7 kg for Group C (p < 0.001). There was no difference in the hypoglycemic episodes between the groups (p = 0.251). The highest levels of adherence were noticed in Group A compared to Group B and C (7.58 ± 1.08, 6.38 ± 1.28 and 6.44 ± 1.16, p = 0.031, respectively) while total insulin dose was lower for Group A compared to the other groups (p=0.041). Conclusion: Uncontrolled patients on oral antidiabetic drugs when switched to an IDegLira regimen achieved a significant improvement in their glycemic control and a more significant adherence compared the non-fixed combination of degludec and liraglutide. Disclosure A. Koutsovasilis: None. A. Sotiropoulos: None. A. Antoniou: None. M. Pappa: None. S. Bousboulas: None. T. Peppas: None.

Background: Using a software, which creates a closed loop between the pump and the monitoring glucose sensor is considered to be a progress in controlling and using insulin pumps in type 1 diabetes patients (T1DM). OpenAPS is a system which completes and closes the pump-glucose sensor loop. Aim: The aim of this study is to examine the effect of an independent closed-loop insulin system using the OpenAPS system on the glycemic control of T1DM patients. Material and Methods: 24 T1DM patients with insulin pump were included in the study. 11 started using the OpenAPS closed-loop system and 13 continued using an insulin pump without OpenAPS. The effect on glycemic control (HbA1c, Fasting Blood Glucose (FBG), pre-meal, post-meal and before bedtime glucose) was recorded before the beginning of the study and on 12±1 and 24±1 weeks. Hypoglycemic episodes were also recorded. Results: Patients using OpenAPS noted a significant reduction of HbA1c on the 3 and 6-month follow-up (7.70±1.14 vs. 6.85±1.17 vs. 6.63±1.05, p Conclusions: Using a closed-loop in an insulin pump via OpenAPS system leads to a better glycemic control, less hypoglycemic episodes and lower daily blood glucose levels fluctuations compared to using an insulin pump with no closed-loop system. Disclosure A. Koutsovasilis: None. A. Sotiropoulos: None. A. Antoniou: None. V. Kordinas: None. D. Papadaki: None. T. Peppas: None.

Background: Liraglutide and dulaglutide are long-acting GLP-1 receptor agonists. Dulaglutide is used once a week, while liraglutide once a day. Aim: The aim of the study was to investigate dulaglutide’s quantitative and qualitative effect in patients, who used to take liraglutide independently of their glycemic control. Material and Methods: 124 patients in liraglutide treatment were included in the study and switched to dulaglutide. Patients were taking the same medication before study for at least 6 months. The switch to dulaglutide was made on patients with HbA1c < 7% (Group A) and on patients with HbA1c > 7% (Group B). Parameters of glycemic control (HbA1c, Fasting Blood Glucose -FBG) and cardiovascular risk factors were recorded, while treatment satisfaction was evaluated with the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Follow-up period was 24±2 weeks. Results: Patients’ age was 57.65±7.43 years. A reduction of HbA1c was noticed on both groups. Group B’s HbA1c was reduced on the 3 and 6 month monitoring compared to the baseline (7.78±0.93 vs. 7.26±1.09 vs. 7.05±0.93, p= 0.001) and so was Group A’s on the same monitoring times (6.52±0.82 vs. 6.33±0.96 vs. 6.05±0.77, p=0.014). Body weight was also reduced on Group B (112.26 ±18.15 vs. 109.76±22.67 vs. 106.86±19.78, p=0.048), while Group A did not show any statistically significant difference (98.39±18.15 vs. 95.54±21.18 vs. 94.76±20.66, p=0.155). No change on blood pressure was noticed on Group A (p= 0.435) and Group B (p= 0.631). Treatment satisfaction was improved as evaluated via DTSQ on both Group A (p = 0.038) and Group B (p= 0.022) with a greater improvement in Group B. Conclusions: Switching patients from liraglutide 1.2mg to dulaglutide 1.5mg leads to a significant reduction of HbA1c even in patients with HbA1c < 7% and to an improvement of the body weight in patients who have not achieved glycemic control. Patients under treatment with dulaglutide are more satisfied with their regimen. Disclosure A. Sotiropoulos: None. A. Koutsovasilis: None. A. Antoniou: None. S. Bousboulas: None. T. Peppas: None.

Background and Aims: Clinical audit is applied to optimize clinical practice and quality of healthcare services while controlling for money spent, critically in resource-deprived settings. This case study reports on the outcomes of a retrospective clinical audit on private hospitalizations, for which reimbursement had been pending by the Health Care Organization for Public Servants (OPAD) in Greece. This case study is the first effort by a social insurance organization in Greece to employ external clinical audit before settling contracted private healthcare charges. Methods: One thousand two hundred hospitalization records were reviewed retrospectively and a fully anonymized clinical audit summary report created for each one of them by a team of clinical audit experts, proposing evidence-based cuts in pending charges where medical services were deemed clinically unnecessary. These audit reports were then collated and analysed to test trends in overcharges among hospitalized insureds per reason for hospitalization. Results: The clinical audit report concluded that 17.4% of a total reimbursement claim of €12,387,702.18 should not be reimbursed, as it corresponded to unnecessary or not fully justifiable according to evidence-based, best practice, medical service provision. The majority of proposed cuts were related to charges for medical devices, which are borne directly by social insurance with no patient or private insurance co-payment. Conclusion: Clinical audit of hospital practice may be a key tool to optimize care provision, address supplier-induced demand and effectively manage costs for national health insurance, especially in circumstances of budgetary constraints, such as in austerity-stricken settings or developing national healthcare systems.

Aims To determine the prevalence of Associated Autoimmune Diseases (AADs) in Latent Autoimmune Diabetes of Adults (LADA) versus autoimmune Type 1 Diabetes (T1D) and the role of glutamic-acid decarboxylase antibodies (GADA) and other factors. Methods Adults with autoimmune diabetes mellitus (DM) were recruited from the Diabetes Center of Nikaia-Piraeus Hospital. Demographic and clinical parameters were recorded and anti-pancreatic and organ-specific antibodies were measured. Results Of 160 patients, 33.75% had one AAD and 24.37% had two or more. Patients with LADA had higher overall prevalence of AADs, mainly autoimmune thyroiditis and gastritis. Celiac disease was present only in T1D. GADA positive patients had higher prevalence of AADs and multiple autoimmunity, especially thyroiditis and gastritis. Patients with LADA had higher rates of positive GADA or islet-cell antibodies (ICA). After controlling for LADA, GADA remained a significant predictor of AADs. Female gender and chronological age were also significant predictors of AADs. Conclusions AADs were present in 58.13% of patients. Patients with LADA were more prone to a generalized autoimmune disorder than those with T1D. AADs development was significantly associated with female sex, older age and positive GADA, which proved an independent marker of associated autoimmunity.

Aims To examine the prevalence of diabetic chronic kidney disease (DCKD) and its risk factors in adult Greek subjects with type 2 diabetes mellitus (T2DM) in a population from hospital-based diabetes clinics. Methods This is a cross-sectional multicentre study based on data collected from Greek hospital-based diabetes clinics from June 2015 to March 2016. DCKD severity was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 guidelines. Multivariate analyses assessed the associations between DCKD and its potential risk factors. Results Among the entire population (n = 1759), the overall prevalence of DCKD was 45% including mild, moderate and severe CKD. Older age, male gender, body-mass index, lack of exercise and diabetes duration were significantly associated with DCKD. Conclusions In Greece, DCKD in T2DM is highly prevalent. It is significantly associated with demographic and lifestyle parameters, as well as T2DM complications, suggesting that further efforts to prevent DCKD should be addressed to subjects with specific characteristics.

Introduction: The efficacy and safety of IDegLira and the benefits of its complementary mode of action have been examined in the large global DUAL clinical trial program. Aim: The aim of this study is to examine the qualitative and quantitative effect of IDegLira compared to the non-fixed adiministration of degludec and liraglutide. Methods: Uncontrolled type 2 diabetes (T2D) patients (n=473) were included in the study. 158 patients on oral antidiabetic drugs (OADs) switched to OADs and IDegLira (Group A), 163 on OADs and liraglutide switched to degludec and the existing therapeutic regime (Group B) and 152 patients on degludec and OADs switched to liraglutide and the existing treatment (Group C). All patients also received metformin while none of them received sulfonylurea. Follow-up was 12 months and changes in HbA1c, cardiometabolic risk factors, and treatment adherence (with the 8-item Morisky Medication Adherence Scale) were recorded. Results: There was no difference at baseline between the three Groups as to age (p=0.224), diabetes duration (p=0.322), HbA1c (8.56±1.12, p=0.116) and BMI (32.14±3.56, p=0.142). The mean HbA1c after 12 months was 6.79±0.77, 7.14±1.19, 7.18±1.07 (p=0.033) for Groups A, B and C respectively. More patients achieved the therapeutic target for HbA1c in Group A (p=0.048). The weight change was -3.2±1.2 Kg for Group A, 1.2±1.1 Kg for Group B and -4.3±1.7 Kg for Group C (p Conclusions: Uncontrolled patients on oral antidiabetic drugs when switched to a therapeutic regimen with IDegLira achieved a significant improvement in their glycemic control with a significant adherence to their therapeutic regimen while the adherence in a non-fixed combination was not significant enough. Disclosure A. Koutsovasilis: None. A. Sotiropoulos: None. D. Papadaki: None. E. Bletsa: None. G. Kokotos: None. I. Kounelakis: None. S. Bousboulas: None. T. Peppas: None.

Introduction: Medications currently taken by patients with NAFLD target concomitant metabolic diseases such as hypertension, dyslipidemia and diabetes. Aim: The aim of the study was to examine the effectiveness of lixisenatide and dapagliflozin in NAFLD patients with type 2 diabetes mellitus (T2DM) compared with sitagliptin and pioglitazone. Methods: T2DM patients with NAFLD (n=306) were included in the study. Patients were divided in 4 groups according to their treatment with lixisenatide (n=62), dapagliflozin (n=85), pioglitazone (n=67) and sitagliptin (n=92). All patients also received metformin. Mean follow-up period was 76 weeks ± 2 weeks. The evaluation of liver fibrosis depended on calculation of aspartase aminotransferase (AST) to platelet counts ratio (APRI) index. All patients went through an ultrasonography before being included in the study and after the end of the study. Results: There were no differences between groups in patient age (p=0.256), duration of T2DM (p=0.283), Body Mass Index (BMI) (p=0.337) and HbA1c (p=0.156). There was a greater improvement of APRI index for the lixisenatide group (1.07 (0.46-1.23) vs. 0.74 (0.38-0.90) p Conclusions: Administration of lixisenatide and dapagliflozin led not only to good control of T2DM but also improvement of liver inflammation, alteration of liver fibrosis, and reduction of body weight, which are particularly important factors in patients with T2DM. Disclosure A. Koutsovasilis: None. A. Sotiropoulos: None. M. Pappa: None. D. Papadaki: None. V. Kordinas: None. C. Tamvakos: None. M. Bourikou: None. S. Bousboulas: None. T. Peppas: None.

BACKGROUND: Dessert compositions may conform to diabetic diet when it contains low sugar or artificial sweetener to replace sugar. However, it is still questionable whether glycemic control in type 2 diabetes patients is improved by the use of diet-conforming dessert compositions. OBJECTIVE: To compare, in type 2 diabetes patients, the glycemic, insulin, and C-peptide responses to seven modified dessert compositions for diabetics (D-dessert) with the response to seven similar desserts of non-modified composition, used as control desserts (C-dessert). METHODS: Seventy type 2 diabetes patients were allocated to seven groups of ten. On three occasions, each patient received either the meal which consisted of bread and cheese, or the meal and D-dessert, or the meal and the respective C-dessert. Differences in postprandial glucose, insulin, and C-peptide were evaluated using analysis of repeated measures at 0, 30, 60, 90, and 120 min after consumption. RESULTS: D-cake and D-pastry cream resulted in lower glucose levels (8.81 ± 0.32 mmol/l and 8.67 ± 0.36 mmol/l, respectively) and D-strawberry jelly in lower insulin levels (16.46 ± 2.66 μU/ml) than the respective C-desserts (9.99 ± 0.32 mmol/l for C-cake, 9.28 ± 0.36 mmol/l for C-pastry cream, and 27.42 ± 2.66 μU/ml for C-strawberry jelly) (p < 0.05). Compared with the meal, D-cake did not increase glucose or insulin levels (p < 0.05), while C-cake did (p < 0.05). D-pastry cream increased glucose to a lesser extent than C-pastry cream (p < 0.05). Similar effects were reported for D-milk dessert, D-millefeuille, and D-chocolate on glucose, insulin, and C-peptide at specific timepoints. D-creme caramel showed no effect. CONCLUSIONS: Some desserts formulated with sugar substitutes and soluble fiber may have a favorable effect on postprandial levels of glucose, insulin, and C-peptide in type 2 diabetic patients.

Background: Diabetes mellitus is a well-established risk factor for ischemic stroke and is associated with in- creased in-hospital mortality. The aim of the present study was to determine the potential predictors of in-hospital mortal- ity after an ischemic stroke in diabetic and nondiabetic subjects. Methods: 159 diabetic subjects (66 males / 93 females, mean age ± SD: 77.4 ± 6.4 years) and 159 non diabetic subjects (66 males / 93 females, mean age ± SD: 77.3 ± 5.2 years) hospitalized for ischemic stroke were studied. Demographic characteristics and laboratory tests on admission as well as outcome were recorded. Brain computed tomography scan was performed in all study subjects. Results: In-hospital death rates did not differ between the diabetic and the nondiabetic patients (36 (22.6%) vs. 27 (17.0%), respectively, P = 0.20). In the diabetic study group multivariate analysis, after controlling for CRP, total choles- terol, LDL-C, urea and creatinine levels, demonstrated that death was related with WBC count (OR: 1.002, 95% CI: 1.001-1.004, P = 0.005), glucose levels (OR: 1.007, 95% CI: 1.002-1.012, P = 0.008), and UA levels (OR: 1.51, 95% CI: 1.003-2.260, P = 0.05). In the nondiabetic study group, after controlling for WBC count, CRP, total cholesterol and LDL- C levels, death was related only with glucose levels (OR: 1.016, 95% CI: 1.001-1.031, P = 0.03). Conclusions: WBC count and UA levels on hospital admission are independent predictors for in-hospital mortality in dia- betic subjects with ischemic stroke. Plasma glucose levels are predictor for in-hospital mortality in both diabetic and nondiabetic subjects.

To examine trends in the prevalence of myocardial infarction (MI) and conventional risk factors in Greek adults between 2002 and 2006.Repeated cross-sectional study.Self-reported data from surveys given in Salamis during two election days in 2002 and 2006 were analysed. The same sampling method and procedures were used on both surveys. The study sample included 2805 and 3478 subjects (or =20 years) in 2002 and 2006, respectively, with similar age and sex distribution to the target population.The prevalence of MI increased from 4.1% (men, 6.3%; women, 1.9%) in 2002 to 4.8% (men, 7.3%; women, 2.2%) in 2006 (P = 0.18). At the same time, prevalence rates of major risk factors were as follows: diabetes increased from 8.7% to 10.3% (P = 0.037), hypertension from 20.1% to 25.7% (P0.001) and hypercholesterolemia (cholesterol240 mg/dl or the use of cholesterol-lowering medication) increased from 17.5% to 22.3% (P0.001). Prevalence of current smokers in 2002 (defined as persons who smokedor =5 cigarettes/day) was 37.0% and in 2006 (defined as those who smokedor =1 cigarettes/day) was 40.1%. Logistic regression analysis showed that the aforementioned risk factors were significantly associated with MI in both surveys; the factor that showed the greatest magnitude of association with MI was hypercholesterolemia, followed by diabetes, hypertension and smoking.These findings show that, in the Greek population, prevalence of MI continues to rise (at approximately 4% per year). This trend seems to be driven by a persistently high prevalence of smoking and the rapidly increasing burden of diabetes, hypertension and hypercholesterolemia.

To examine trends in the prevalence of self-reported diabetes between 2002 and 2006 among urban adults in Greece.Data were derived from two consecutive population-based surveys conducted in Salamis, during two election days (13 October 2002 and 15 October 2006). In both surveys was used the same selection procedure and data were collected using the same questionnaire, completed by almost the same team of interviewers. There were randomly selected 2805 adults (or =20 years) in 2002 and 3478 in 2006, with similar age and sex distribution to the target population.The overall crude prevalence of diabetes increased significantly, from 245 (8.7%) in 2002 to 358 (10.3%) in 2006 (P=0.037). The age-adjusted prevalence of diabetes among adults was 8.2% (men, 8.5%; women, 7.8%) in 2002 and 9.5% (men, 9.7%; women, 9.3%) in 2006. These changes correspond to a total increasing rate of 16% (4% per year). At the same time, the age-adjusted prevalence of obesity increased from 17.9 to 21.1%, giving an increase of 18% (P0.05); however, the prevalence of overweight did not increase (43.8-42.9%).Our findings show that the prevalence of diabetes is rising rapidly in the Greek population and appears to be increasing in parallel with prevalence of obesity.

The aim of this study was to evaluate the significance of alcohol intake in relation to blood pressure control in treated subjects and to determine if there is a causative link between alcohol and inadequate control of hypertension.Our study population comprised 637 elderly individuals who reside in Nemea and in four other villages located in Corinthia, Peloponnesus, of which 615 were included in the analysis. The average age was 73.5±6.15 years. A special epidemiological questionnaire was completed by each participant and the blood pressure (BP) was measured according to a predefined protocol. Odds ratios were calculated and adjusted for potential confounders.The overall prevalence of hypertension was 69.1%, 70.7% in men and 67.0% in women. In total, 11% of the hypertensives were not aware of having hypertension. Of those who were aware of having hypertension 91.0% were being treated. Among treated hypertensives 49.1% had systolic BP140 mmHg and diastolic BP90 mmHg. Only heavy drinking (300 g/week) was found to be related with hypertension control.Our study showed that the level of control among the elderly, in a Greek population, is positively associated with alcohol intake only for heavy drinking. The role of alcohol consumption in hypertension in the elderly needs further investigation.

Background Except for the established risk factors, presence of target organ damage has an important role in the treatment of hypertensive subjects. The aim of the present study was to estimate the prevalence of target organ damage in primary care subjects. Methods This multi-centre, cross-sectional survey of 115 primary care physicians recruited 1095 consecutive subjects with hypertension: 611 men (55.8%); and 484 women (44.2%). A detailed history for the presence of cardiovascular disease and a thorough clinical examination was performed to each subject. Results Of the total study population, 44.5% (n = 487) had target organ damage (33.0% had left ventricular hypertrophy, 21.8% increased carotid intima media thickness, 11.0% elevated plasma creatinine levels and 14.6% microalbuminuria). Target organ damage was more prevalent in males than in females (P = 0.05). In addition, males had more often increased carotid intima media thickness than females (P = 0.009). On the contrary, females had more often microalbuminuria (P = 0.06) than males. No differences were observed between the two genders regarding left ventricular hypertrophy (P = 0.35) and elevated plasma creatinine levels (P = 0.21). Logistic regression analysis showed associations between target organ damage and dyslipidemia (P < 0.001), presence of metabolic syndrome (P = 0.005), diabetes (P < 0.001) and coronary artery disease (P < 0.001). Conclusion A significant proportion of hypertensive subjects in primary care had documented associated target organ damage, with left ventricular hypertrophy being the most prevalent target organ damage.

Type 2 diabetes mellitus (T2DM) is a major risk factor for peripheral arterial disease (PAD). A simple, noninvasive method for the estimation of PAD is ankle brachial index (ABI). The aim of the present study was to determine whether there is an association between ABI and cardiovascular risk factors in T2DM subjects without apparent macrovascular disease.A total of 125 T2DM subjects (84 males, 41 females, mean age ± standard deviation 62.2 ± 9.1 years) who had no apparent macrovascular disease and who attended the Health Center of Erymantheia between January 2008 and June 2009 were recruited to the study.Of the study subjects 20% (n=25) had ABI0.90. Univariate linear regression analysis showed that ABI was significantly associated with history of hypertension (p=0.02), fasting serum glucose levels (p=0.02), serum urea levels (p=0.005), serum uric acid levels (p=0.007) and white blood cell (WBC) count (p=0.04). Multivariate linear regression analysis demonstrated significant independent associations between ABI and fasting serum glucose levels (p=0.03) as well as WBC count (p=0.03).Elevated plasma glucose and WBC count increase the risk of PAD in asymptomatic diabetics.

Background The aim of the present study was to determine the prevalence of thyroid dysfunction in patients with type 2 diabetes (T2D) attending an outpatient clinic. Methods We examined thyroid dysfunction in a total of 1,092 patients with T2D. Results Prevalence rate of thyroid dysfunction was 12.3%. In the group with thyroid dysfunction there was an excess of females in comparison with the group without thyroid dysfunction (P < 0.001). In addition, patients with thyroid dysfunction had higher values of body mass index (P = 0.03) and HDL-cholesterol levels (P = 0.01), and lower values of LDL-cholesterol levels (P = 0.001) in comparison with patients without thyroid dysfunction. Multivariate analysis demonstrated that presence of thyroid dysfunction was related with gender (OR: 0.220, 95% CI: 0.141 - 0.352) and LDL-cholesterol levels (OR: 0.990, 95% CI: 0.985 - 0.995). Conclusions The prevalence of thyroid dysfunction among Greek diabetic patients is 12.3%. Diabetic women were more frequently affected than men. Presence of thyroid dysfunction was associated with lower levels of LDL-cholesterol concentrations. Keywords Type 2 diabetes mellitus; Thyroid dysfunction; Hypothyroidism; Gender; LDL-cholesterol; Greece

Background A lot of studies have showed an excess maternal transmission of type 2 diabetes (T2D). The aim, therefore, of the present study was to estimate the prevalence of familial history of T2D in Greek patients, and to evaluate its potential effect on the patient's metabolic control and the presence of diabetic complications. Methods A total of 1,473 T2D patients were recruited. Those with diabetic mothers, diabetic fathers, diabetic relatives other than parents and no known diabetic relatives, were considered separately. Results The prevalence of diabetes in the mother, the father and relatives other than parents, was 27.7, 11.0 and 10.7%, respectively. Patients with paternal diabetes had a higher prevalence of hypertension (64.8 vs. 57.1%, P = 0.05) and lower LDL-cholesterol levels (115.12 ± 39.76 vs. 127.13 ± 46.53 mg/dl, P = 0.006) than patients with diabetes in the mother. Patients with familial diabetes were significantly younger (P < 0.001), with lower age at diabetes diagnosis (P < 0.001) than those without diabetic relatives. Patients with a diabetic parent had higher body mass index (BMI) (31.22 ± 5.87 vs. 30.67 ± 5.35 Kg/m2, P = 0.08), higher prevalence of dyslipidemia (49.8 vs. 44.6%, P = 0.06) and retinopathy (17.9 vs. 14.5%, P = 0.08) compared with patients with no diabetic relatives. No difference in the degree of metabolic control and the prevalence of chronic complications were observed. Conclusion The present study showed an excess maternal transmission of T2D in a sample of Greek diabetic patients. However, no different influence was found between maternal and paternal diabetes on the clinical characteristics of diabetic patients except for LDL-cholesterol levels and presence of hypertension. The presence of a family history of diabetes resulted to an early onset of the disease to the offspring.

Seasonal variations in fasting glucose and HbA1c levels in 638 diabetic patients (attending a primary care diabetic clinic during 2003-2007) were examined and found to be significantly higher in colder than in warmer months. Moreover, there were apparent peaks in fasting glucose levels after Christmas and Easter months. This study provides further evidence of monthly fluctuations in glycemic control, underscoring the need to consider seasonal/cultural effects when managing diabetic patients.

Background Depression is common among diabetic subjects. We conducted the present study to estimate the prevalence of depression in subjects with type 2 diabetes (T2D) in Greece. Methods The study sample consisted of 320 T2D subjects without overt macrovascular disease attending the diabetes outpatient clinic of our hospital, from June 2007 to December 2007. Depressive symptoms were measured using the 21-item Beck Depression Inventory, modified for use in diabetic subjects. Results Of the study subjects 107 (33.4%) reported elevated depressive symptoms. More women than men with diabetes reported symptoms of depression (48.4% vs. 12.7%, P < 0.001). In the female study group, depressive symptoms were correlated with HbA1c (P = 0.04), and duration of diabetes (P = 0.004). In the male study group, univariate linear regression analysis showed no significant relationships between depressive symptoms and the testing variables. Conclusion The prevalence of depression in Greek T2D subjects is high. Diabetic female subjects showed increased levels of depressive symptoms compared with male subjects. Independent risk factors of depressive symptoms in diabetic female subjects were diabetes duration and glycemic control.

Our aim was to investigate the relationship between the serologic status concerning Chlamydia pneumoniae and Helicobacter pylori with the presence of coronary artery disease (CAD), which remain a controversial issue in literature. We studied 208 patients with CAD and 94 controls with no evidence of obstructive CAD; all of them angiographically confirmed. The seropositivity to C. pneumoniae was 91% in patients with CAD vs 86% in controls (P>0.05). The H. pylori seroprevalence rates were 77% and 68%, respectively (P>0.05). The multivariate analysis, adjusting for age, sex, educational level, diabetes, hypertension, obesity, smoking, family history of CAD and lipids, confirmed the results of univariate analysis. Therefore, this study adds evidence against the association of seropositivity to C. pneumoniae and H. pylori with angiographically documented CAD.

Dear Editor, After perusing the report by Vardavas and Kafatos,1 on smoking policy and prevalence in Greece, we thought that would be of interest to demonstrate the findingsof our study concerning the urban-rural differences in smoking prevalence. The study was conducted during the recent election day (15 October 2006) in the municipality of Salamis and Nemea. The first represent an urban area and the second a rural one. Data were collected through face to face interviews (response rate: 88% and 83%, respectively) conducted by trained health professionals. A current smoker was considered a person …

Background The continuous monitoring and future prediction of the growing epidemic of diabetes mellitus worldwide presuppose consistent information about the extent of the problem. The aim of this study was to determine the prevalence of diagnosed diabetes and to identify associated risk factors in a sample of adult urban Greek population. Methods A cross-sectional population-based survey was conducted in municipality of Salamis, Greece, during an election day (2002). The study sample consisted of 2805 participants, aged 20–94 years. Data were collected using a standardized short questionnaire that was completed by a face-to-face interview. Multiple regression analyses were performed to evaluate the association of diabetes with potential risk factors. Results The overall prevalence of diagnosed diabetes was 8.7% (95% CI 7.7–9.8%). After age adjustment for the current adult population (2001 census) of Greece, the projection prevalence was calculated to 8.2%. Multivariate logistic regression analysis identified as independent risk factors: increasing age (odds ratio, OR = 1.07, 95% CI 1.06–1.08), male sex (OR = 1.43, 95% CI 1.04–1.95), overweight and obesity (OR = 1.97, 95% CI 1.29–3.01 and OR = 3.76, 95% CI 2.41–5.86, respectively), family history of diabetes (OR = 6.91, 95% CI 5.11–9.34), hypertension (OR = 2.19, 95% CI 1.60–2.99) and, among women, lower educational level (OR = 2.62, 95% CI 1.22–5.63). The prevalence of overweight and obesity, based on self-reported BMI, were 44.2% and 18.4%, respectively. Moreover, the odds for diabetes in obese subjects with family history were 25-fold higher than those with normal weight and without family history of diabetes, while the odds in overweight subjects with family history of diabetes were 15-fold higher. Conclusions Our findings indicated that the prevalence of diabetes is high in Greek population. It is suggested that the main modifiable contributing factor is obesity, whose effect is extremely increased upon positive heredity presence.

Background Out of 1705 patients hospitalised for various reasons in the 3rd Internal Medicine Department of the Regional General Hospital of Nikaea, in Piraeus, 146(8,5%) persons were admitted for drug intoxication between November 1999 and November 2000. Methods On average, these persons [male 50(34,2%) – female 96(65,8%)] were admitted to the hospital within 3.7 hours after taking the drug. Results The drugs that were more frequently taken, alone or in combination with other drugs, were sedatives (67.1%), aspirins and analgesics (mainly paracetamol) (43.5%). 38.3% of patients had a mental illness history, 31.5% were in need of psychiatric help and 45.2% had made a previous suicide attempt. No death occurred during the above period and the outcome of the patients' health was normal. After mental state examination, the mental illnesses diagnosed were depression (20.96%), psychosis (15.32%), dysthymic disorder (16,2%), anxiety disorder (22.58%) and personality disorder (8.87%). Conclusions Self-poisoning remains a crucial problem. The use of paracetamol and sedatives are particularly important in the population studied. Interpersonal psychiatric therapy may be a valuable treatment after people tried to poison themselves.

Background Self-medication is an important driver of antimicrobial overuse as well as a worldwide problem. The aim of the present study was to estimate the use of antibiotics, without medical prescription, in a sample of rural population presenting in primary care in southern Greece. Methods The study included data from 1,139 randomly selected adults (545 men/594 women, mean age ± SD: 56.2 ± 19.8 years), who visited the 6 rural Health Centres of southern Greece, between November 2009 and January 2010. The eligible participants were sought out on a one-to-one basis and asked to answer an anonymous questionnaire. Results Use of antibiotics within the past 12 months was reported by 888 participants (77.9%). 508 individuals (44.6%) reported that they had received antibiotics without medical prescription at least one time. The major source of self-medication was the pharmacy without prescription (76.2%). The antibiotics most frequently used for self-medication were amoxicillin (18.3%), amoxicillin/clavulanic acid (15.4%), cefaclor (9.7%), cefuroxim (7.9%), cefprozil (4.7%) and ciprofloxacin (2.3%). Fever (41.2%), common cold (32.0%) and sore throat (20.6%) were the most frequent indications for the use of self-medicated antibiotics. Conclusion In Greece, despite the open and rapid access to primary care services, it appears that a high proportion of rural adult population use antibiotics without medical prescription preferably for fever and common cold.

Background The aim of the present study was to investigate whether selenium levels differ between type 2 diabetic subjects with and without coronary artery disease (CAD). Methods A total of 200 subjects with type 2 diabetes (100 with CAD and 100 without CAD), consecutively selected from the diabetes outpatient clinic of our hospital were enrolled into the study. A detailed medical history and a physical examination were obtained by all the participants. Results Serum selenium levels did not differ between diabetic subjects with and without CAD (102.40 ± 31.10 vs. 108.86 ± 33.88 microg/L, p = 0.16). In diabetic subjects with CAD multivariate linear regression analysis demonstrated significant independent associations between selenium and sex (beta = 0.21, p = 0.03) and glucose levels (beta = 0.25, p = 0.008). In diabetic subjects without CAD multivariate linear regression analysis demonstrated significant independent associations between selenium and peripheral artery disease (beta = 0.16, p = 0.05) and glucose levels (beta = -0.09, p = 0.05). Conclusion Serum selenium levels did not differ between diabetic subjects with and without CAD. In diabetic subjects with CAD, the only determinants of serum selenium levels were sex and glucose levels. In diabetic subjects without CAD the only determinants of serum selenium levels were peripheral artery disease and glucose levels.