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ID: 346Results of combined therapy with exenatide, metformin andhypolipidemic drugs in patients with diabetes mellitus type 2S. Vorobiev, N. Kuzmenko, Z. Gusova, E. Petrovskaya,N. Nelassov, J. Kirtanasov

Endocrinology, Rostov State Medical University, Rostov-on-Don,Russian Federation

Aims: In this study we decided to analyze the efficacy of com-bined hypoglycemic therapy based on the intake of incretin mimeticexenatide in patients with diabetes mellitus type 2 complicated bydislipidemy and fatty hepatosis. Material and methods: 30 patients(mean age 60.9 ± 1.2 years) with diabetes mellitus type 2 (meanduration of disease 9.2 ± 1.2 years) were treated with metformin(1500 mg per day), exenatide (20 mg daily intramuscularly), feno-fibrate (tricor 145 mg per day) and statin (simvastatin 20 mg daily)for 3 months. Entry criteria were: the presence of dislipidemy andfatty hepatosis, and level of glycated hemoglobin between 6.5 and11%. Parameters of carbohydrate/lipid metabolism and sonographichepatic echodensitometry were analyzed before and after treatment.Results: After 3 months of treatment level of fasting plasma glucosedecreased significantly on 14.3% (6.3 ± 0.3 mmol/l, p b 0.05), post-prandial glucose — on 21.6% (p b 0.05), glycated hemoglobin — on15.1% (6.2 ± 0.2%, p b 0.05), total cholesterol — on 28.3% (p b 0.01),LDL-C — on 48,3% (p b 0.01), and triglycerides — on 45.7% (p b 0.01).Level of HDL-C increased on 26.8% (p b 0.05). Parameter of hepaticechodencity LA decreased on 44.9% (p b 0.05) and attenuation index—

on 17.7% (p b 0.05). Conclusion: 3 months combined therapy withincretin mimetic exenatide, metformin and hypolipidemic drugs inpatients with diabetes mellitus type 2 complicated by dyslipidemy andfatty hepatosis can improve parameters of carbohydrate and lipidmetabolism and diminish intensity of fatty hepatosis.

doi:10.1016/j.ejim.2013.08.236

ID: 367The burden of diabetes mellitus in an internal medicineinpatient departmentR. Louro, M. Duarte, N. Vieira, D. Faria, M.J. Grade, P. Magalhães,C. Santos, L. Arez

Internal Medicine Department, Centro Hospitalar do Barlavento Algarvio,Portimão, Portugal

Introduction: The total prevalence of Diabetes Mellitus type 2(DM 2) in Portugal is 12.7%, 5.5% of which are underdiagnosed. TheInternal Medicine Specialist has a crucial role when it comes toidentifying new cases in inpatients. The authors want to characterizethe population of diabetic patients in an Internal Medicine Serviceof a tertiary hospital that serves a population of about 166,000habitants. Material and methods: Retrospective, observational andtransversal study, which included all the patients in an InternalMedicine service between 1st January 2009 and 30th July 2012 withDM 2 as a first or already known diagnostic. Demographic andclinical data were analyzed. Results: The number of diabetic patientswas 1894, corresponding to 22.6% of the total of inpatients. The meanage was 74.6 years and 50.8% were male. The major comorbilitiesrecorded were: ischemic cardiopathy (14.3%), cerebrovascular disease(24.9%) and chronic renal disease (19.7%). Regarding other cardio-vascular risk factors 70% of our diabetic patients had hypertension,19.3% had a BMI N 30 mg/m2 and 28.6% had high levels of cholesterol.

Accordingwith the classification of diagnostics used in our hospital, themain admission pathologies were: pneumonia (10.2%), stroke (9.5%)and acute heart failure (7.1%). About 104 patients (5.5%) had theirdiabetes diagnosed for the first time. The mean length of the hospitalstay was 11.97 days, the mortality rate was 13.8%, the readmission30 days after discharge was 16% and the mortality rate 30 days afterdischarge was 2.7%. Conclusion: These results reflect our countryreality in which concerns the new cases that weren't diagnosed asoutpatients. This is very important because it allows a better epide-miologic vigilance and better control of other cardiovascular riskfactors. Diabetes has a negative impact on the hospital stay, because itincreases the mean duration and mortality. When the disease and thereferred comorbilities aren't controlled these patients have a worseprognosis compared to non-diabetic patients.

doi:10.1016/j.ejim.2013.08.237

ID: 370Glimepride effect compare to glibenclamide on metabolicparameters and insulin resistance in type 2 diabetes mellitusM. Emini Sadiku

Internal Diseases, University Clinical Center of Kosova, Pristina, Serbia

Aim: The aim of our study is to assess the improvement of insulinresistance and other metabolic parameters in type 2 diabetic patientstreated with glimepiride (GP) compared to glibenclamide (GB).Materials and methods: This single-blind, prospective study includ-ed 40 type 2 DM patients (age 55.43 ± 8.3 years, duration of diabetes3.7 ± 3.3 years) without cardiovascular disease, which were ran-domly assigned to keep the original GB (n = 20) therapy or switchto GP (n = 20). Except anthropometric parameters, the followinglaboratory parameters were evaluated after 24 weeks of treatment:fasting venous plasma glucose, lipid profile, HbA1C, insulin, adiponectinand hs-CRP. Results: After treatment, the GP group showed significantdifferences in anthropometric measurements, hip having decreasedfrom 108.5 ± 6.7 cm to 106.2 ± 6.5 cm (P b 0.01), HbA1C, whichdecreased from 8.9 ± 1.4% to 8.4% ± 1.2% (P b 0.0001), and HOMA-IR,which decreased from 3.0 ± 1.5 to 1.9 ± 1.4 (P = 0.02), whereasadiponectin increased but not significantly (P= 0.08), and lipid profiledid not changed significantly. In the GB group significant differenceswere observed in HbA1C, decreased from 8.8% ± 1.4% to 8.3% ±1.1%(P b 0.0002), whereas adiponectin decreased from 34.3 ± 22.6 to20.3 ± 11.3 ng/ml (P = 0.011). No changes for CRP were presentin both groups. Conclusions: The present study demonstrates thatglimepiride has a good effect on insulin resistance and anthropo-metric measurements compare to glibenclamidewhereas both drugshave same effect HbA1c in type 2 diabetic patients. The impact ofglibenclamide on adiponectine is worst compare to glimepiride.

Keywords: insulin resistance, adiponectin, glimepiride, glibenclamide

doi:10.1016/j.ejim.2013.08.238

ID: 380The prevalence of peripheral arterial disease and associated riskfactors in patients with diabetesI.I. Simaa, A.M.S. Sebestyena, F. Stoicescua, M. Jingab,c, I. Dutaa,b,A.E. Cosnitaa, G.A. Dinua, A.I. Pavela, E. Rusua,b, G. Raduliana,b

aIInd Diabetes, Nutrition and Metabolic Diseases Department, Prof. Dr.N.C. Paulescu National Institute of Diabetes, Nutrition and MetabolicDiseases, Bucharest, Romania

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bUniversity of Medicine and Pharmacy, “Carol Davila”, Bucharest,Bucharest, RomaniacInternal Medicine and Gastroenterology Clinic II, Central UniversitaryEmergencyMilitary Hospital “Carol Davila”, Bucharest, Bucharest, Romania

Objective: Peripheral arterial disease (PAD) is an important pre-dictor of cardiovascular disease with major medico-economic con-sequences. The objectives of this study were to assess the prevalenceof PAD in diabetic patients and to describe associated risk factors.Methods: We performed a retrospective, analytical observationalstudy, which included 200 patients diagnosed with diabetes mellitus(DM) admitted between January and March 2013, at the NationalInstitute of Diabetes, Nutrition and Metabolic Diseases “Prof. N.C.Paulescu”, Bucharest; patients were divided into 2 groups: a controlgroup of 108 patients (54%) without PAD, respectively a test group of92 patients (46%) with PAD. For this population were noted clinical,anthropometric data, presence of hypertension (HT), ischemic heartdisease (IHD), diabetic retinopathy (DR), diabetic neuropathy (DN)and chronic kidney disease (CKD). Peripheral arterial disease wasdefined by the presence of an ankle-brachial index ≤0.9 or thepresence of signs and symptoms suggestive in the presence of adiminished pedal pulse. Results: 92 patients (46%) presented withPAD: 18 patients with stage I (9%), 42 with stage II (21%), 3 withstage III (1.5%) and 29 (14.5%) with stage IV. In the test group meanage was higher (62.4 years vs. 56.07 years, p b 0.05) and meanduration of DM was longer (15.28 years vs. 11.1 years, p = 0.002).Dividing into sex groups showed a higher frequency of PAD in men(68.5%) but without significant statistical differences. In univariateanalysis, PAD correlated with age (r = 0.239, p = 0.002), type ofdiabetes (r = 0.516, p = 0.0001), HT (r = 0.185, p = 0.015), IHD(r = 0.466, p = 0.0001), CKD (r = 0.161, p = 0.036), abdominalobesity (r = 0.318, p = 0.0001). In these patients the prevalenceof hypertension and IHD was very high (81.5%, respectively 87%).Conclusions: PAD is a common complication in patientswith diabetesand especially in thosewith associated hypertension and IHD. Primaryprevention outpatient screening of a population with intermediateor high cardiovascular risk can identify numerous patients with PAD.The medical impact in terms of cardiovascular mortality and mor-bidity of such a screening needs to be assessed.

doi:10.1016/j.ejim.2013.08.239

ID: 382Factors associated with stage IV peripheral arterial disease inpatients with diabetesF. Stoicescua, A.M.S. Sebestyena, I.I. Simaa, M. Jingab,c, G.A. Dinua,A.I. Pavela, A.E. Cosnitaa, I. Dutaa,b, E. Rusua,b, G. Raduliana,b

aIInd Diabetes, Nutrition and Metabolic Diseases Department, Prof. Dr.N.C. Paulescu National Institute of Diabetes, Nutrition and MetabolicDiseases, Bucharest, RomaniabUniversity of Medicine and Pharmacy, “Carol Davila”, Bucharest,Bucharest, RomaniacInternal Medicine and Gastroenterology Clinic II, Central UniversitaryEmergency Military Hospital “Carol Davila”, Bucharest, Bucharest, Romania

Objective: The diabetic foot is an important and serious problem;in its development a multitude of factors contribute, and most ofthem are related to complications of diabetes mellitus (DM). Theobjectives of this study are to assess the prevalence of end stageperipheral arterial disease (PAD) in diabetic patients and to describeassociated factors. Methods: We performed a retrospective, analytical

observational study, which included 200 patients diagnosed withdiabetes mellitus, admitted between January and March 2013, at theNational Institute of Diabetes, Nutrition and Metabolic Diseases “Prof.N.C. Paulescu”, Bucharest; patientswere divided into 2 groups: a controlgroup of 171 patients (85.5%) without PAD or with PAD in early stages,and a test group of 29 patients (14.5%) with stage IV PAD. For thispopulation were noted clinical, anthropometric data, presence ofhypertension (HT), ischemic heart disease (IHD), diabetic retinopathy(DR), diabetic neuropathy (DN) and chronic kidney disease (CKD).Stage IV peripheral arterial disease was defined by the presence of painat rest accompanied by trophic disorders (ischemic ulcers, areas ofnecrosis, gangrene, amputation). Results: Stage IV peripheral arterialdisease was present in 14.5% of patients (n = 29), 82.8% (n = 24)were men (p = 0.026). 65.5% (n = 19) had insulin-treated type 2diabetes (p = 0.0001). These patients associated more frequentlyHT (p = 0.012), IHD (p = 0.0001), DR (p = 0.001), proliferative DR(p = 0.0636) and CKD (p = 0.007). Patients with stage IV peripheralarterial disease had a higher mean age (64.21 years vs. 58.1 years)and longer mean duration of diabetes (17.66 years vs. 12.24 years,p b 0.05) but we could not find significant statistical differences inHbA1c, cholesterol, triglycerides or HDL-cholesterol between groups.Conclusions: Prompt identification and management of patients withperipheral arterial disease can improve quality of life, save limbs andreduce cardiovascular events. Peripheral arterial disease's severityincreases with the association of other comorbidities, either macro-or microvascular (HT, IHD, CKD, DR), with age, duration of diabetes andis predominantly found in male patients with insulin-treated type 2diabetes.

doi:10.1016/j.ejim.2013.08.240

ID: 428Peripheral neuropathy in patients with diabetes and hepatitis CE. Rusua, M. Jingaa,b, C. Parpalac, R. Draguta, S. Ateiaa, G. Enachec,F. Rusub, G. Raduliana,c

aGeneral Medicine, University of Medicine and Farmacy Carol Davila,Bucharest, RomaniabInternal Medicine, Emergency Military Hospital Carol Davila,Bucharest, RomaniacDiabetes, National Institute of Diabetes Nutrition and Metabolic Diseases,Bucharest, Romania

Background and aim: Chronic infection with hepatitis C virus(HCV) is associated with a wide spectrum of extrahepatic manifesta-tions. Pathogenetic mechanisms responsible for nervous systemdysfunction aremainly related to the upregulation of the host immuneresponse with production of autoantibodies, immune complexes, andcryoglobulins. The aim of this study was to investigate the prevalenceof peripheral neuropathy (PN) in patients with diabetes and HCV.Material and methods: Medical record review of two hundred andeighty-five patients with diabetes seen in our clinic between January2011 and December 2011, divided into two groups: patients withdiabetes-diabetes group (DG, n = 106) and patients with diabetesand HCV (diabetes and hepatitis group (DHG, n = 179). Clinical neu-ropathy was diagnosed based on presence of symptoms and signsof peripheral sensory or motor involvement. We used the standardNeuropathy Symptom Score (NSS) and Neuropathy Disability Score(NDS) criteria for the diagnosis of diabetic neuropathy. We used thet-test for data analysis to compare quantitative variables, and quali-tative variables were compared with the chi-square or Fisher's exacttests. The characteristics of cases with PN and controls were com-pared in analysis and in multivariate logistic regression models with

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