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Background: Glycated hemoglobin A1c (HbA1c) among diabetic hemodialysis patients continues to be the standard of care, although its limitations are well recognized. This study evaluated glycated albumin (GA) and glycated serum protein (GSP) as alternatives to HbA1c in detecting glycemic control among diabetic hemodialysis patients using continuous-glucose-monitoring (CGM)-derived glucose as reference standard.Methods: A CGM system (iPRO) was applied for 7 days in 37 diabetic hemodialysis patients to determine glycemic control. The accuracy of GA and GSP versus HbA1c in detecting a 7-day average glucose ≥184 mg/dL was evaluated via receiver-operating-characteristic (ROC) analysis.Results: CGM-derived glucose exhibited strong correlation (r = 0.970, p < 0.001) and acceptable agreement with corresponding capillary glucose measurements obtained by the patients themselves in 1,169 time-points over the 7-day-long CGM. The area under ROC curve (AUC) for GA, GSP, and HbA1c to detect poor glycemic control was 0.976 (0.862-1.000), 0.682 (0.502-0.862), and 0.776 (0.629-0.923) respectively. GA levels >20.3% had 90.9% sensitivity and 96.1% specificity in detecting a 7-day average glucose ≥184 mg/dL. The AUC for GA was significantly higher than the AUC for GSP (difference between areas: 0.294, p < 0.001) and the AUC for HbA1c (difference between areas: 0.199, p < 0.01).Conclusion: Among diabetic hemodialysis patients, GA is a stronger indicator of poor glycemic control assessed with 7-day-long CGM when compared to GSP and HbA1c. [ABSTRACT FROM AUTHOR]

Background Psychological disorders and quality of life in diabetic patients has received much attention in the literature [1-4]. The aim of our study was to evaluate the prevalence of depression, anxiety and various aspects of positive well-being in uncontrolled adults with Type 2 diabetes. Materials and methods 72 out-patients with type 2 diabetes, aged 32-83 years old, 38 men and 34 women, completed the Hospital Anxiety and Depression Scale and the Well-Being Questionnaire, whilst waiting for their first diabetes appointment. Demographic characteristics, details of diabetes status and HbA1c were recorded. None of these patients was under psychological treatment or had previously consulted a psychiatrist. Results 62,5% of the patients reported either anxiety or depressive symptoms and 31,9% reported both. 20,8% of the patients reported mild anxiety and 23,6% moderate to severe anxiety, while 27,8% reported mild depression and 22,2% moderate to severe depression. Women were more likely to report mild anxiety and moderate to severe depression, while mean WBQ positive well-being score was significantly higher in men (p=0,05). Duration of diabetes was positively correlated with WBQ depression score (r=0,306; p=0,009) and negatively correlated with WBQ energy (r= -0,241; p=0,041), WBQ positive well-being (r= -0,253; p=0,032) and WBQ total score (r= -0,250; p=0,034). HbA1c was positively correlated with HADS anxiety score (r=0,239; p=0,043). Conclusions Prevalence rates of psychological symptoms in this uncontrolled diabetic population were high. Diabetes' duration was significantly associated with levels of depression and various aspects of positive well-being, while glycaemic control was related to levels of anxiety. Women reported higher levels of psychological symptoms. A considerable proportion of diabetics require psychological support, which, if available, might help improve glycaemic control and overall well-being. [ABSTRACT FROM AUTHOR]

Aim: Obesity frequently co-exists with hypertension (HTN). Hypothalamus neuropeptides such as neuropeptide Y (NPY) and alpha-melanocyte stimulating hormone (a-MSH) interact with leptin, an anorexic peptide produced mainly by adipose tissue and are involved in the regulation of appetite, energy balance and sympathetic nervous system (SNS) activity, possibly contributing to blood pressure (BP) elevation. We compared plasma NPY and a-MSH levels between patients with or without hypertension and/or obesity and the differences in these neuropeptides between patients with or without pathological heart echo findings, aiming to investigate the possible role of these peptides in obesity induced HTN., Patients and Methods: 160 non-diabetic, treatment-naïve individuals were randomly recruited from our outpatient clinics. Study population was divided into 6 groups, according to body mass index-BMI (OB=obese, OW=overweight, NW=normal weight) and blood pressure. Waist circumference (WC) and heart rate (HR) were also recorded. A heart echo was performed and plasma NPY and a-MSH levels were measured for all participants., Results: Plasma NPY levels and HR were higher in OW and OB hypertensives compared with NW hypertensives. OW and OB hypertensives had also higher NPY concentrations compared with OW and OB normotensives, respectively. However, in NW patients, plasma NPY concentrations did not differ between hypertensives and normotensives. Patients with central obesity (COB) had also higher NPY levels compared with patients without COB, a difference also observed in hypertensives but not in normotensive patients. Furthermore, plasma NPY concentrations were significantly correlated with BMI, WC, HR, systolic and diastolic BP. Patients with left ventricle hypertrophy had higher plasma NPY levels compared with those with normal findings, but this was not seen in hypertensives. The majority of these differences were also observed in male and female patient populations. In contrast, plasma a-MSH levels were similar in all study groups., Conclusions: These results suggest that NPY may be involved in obesity-related HTN, possibly via increased SNS activity. Further investigation is needed to elucidate the role of both NPY and a-MSH in obesity-related HTN.

The aim of this study was to evaluate the comparative effects of rosiglitazone and metformin on metabolic parameters in recently diagnosed type 2 Greek diabetic patients. A total of 41 drug-naive individuals, with recently diagnosed type 2 diabetes, were randomized in 3 groups: DIET, diet alone; ROSI, diet plus rosiglitazone; and MET, diet plus metformin. Anthropometric indexes, blood pressure, hematological and biochemical parameters were estimated at baseline and after 18 weeks of treatment. We observed a significant decrease of fasting glucose (FBG) (p<0.001), glycated haemoglobin (HbA1c) (ROSI: p=0.001, MET: p<0.001), homeostasis model assessment for insulin resistance (HOMA-IR) (ROSI: p=0.006, MET: p =0.009) and glutamic pyruvic transaminase (SGPT) (ROSI: p=0.004, MET: p=0.003) in both ROSI and MET groups. Metformin significantly reduced fasting insulin (p=0.04), body weight (p=0.026), body mass index (BMI) (p=0.022), waist circumference (p=0.022) and gamma glutamyl transpeptidase (gamma-GT) (p=0.039), while rosiglitazone decreased blood pressure (systolic: p = 0.05, mean: p = 0.03) and alkaline phosphatase (ALP) (p =0.001) compared to baseline values. Combined intervention with rosiglitazone and diet led to a slight, not significant, weight loss. Rosiglitazone and metformin are equaly effective in controling diabetes, decreasing insulin resistance and improving liver function. However, considering the more favorable effects of metformin on body composition and its documented cost-effectiveness, it seems to be preferable in newly diagnosed Greek diabetic patients.