How to prevent and manage Diabetic Kidney Disease in the Republic of Macedonia.

The Macedonian Society of Nephrology, Dialysis, Transplantation and Artificial Organs, the Macedonian Society of Nephrology and the Macedonian Society of Endocrinology and Metabolic Diseases and the general physicians held a one-day meeting on 11 March 2010 at the Macedonian Academy of Sciences and Arts devoted to the prevention and treatment of diabetic kidney disease. In the Republic of Macedonia there are about 100,000 patients with diabetes mellitus type 1 and 2; 85-95 % have diabetes mellitus type 2. On insulin therapy there are around 28,000-30,000 patients. In our papers: Chronic Kidney Disease: a Hidden Epidemic (2) and Public Health Aspects of Renal Disease in the Republic of Macedonia 1983-2007 (3) we have shown a continuous increase of end stage renal disease and renal replacement therapy (RRT) in the Republic of Macedonia. In 2002, we had 1,056 patients on RRT compared to 1,216 in 2005. In some dialysis centres 20% of the patients on haemodialysis are diabetics. Our message was that there is an urgent need for a screening programme for the detection of Chronic Kidney Disease (CKD) and we will suggest developing a strategy to check each patient in the Republic of Macedonia with diabetes mellitus, to detect early diabetic kidney disease by screening for albuminuria as well as for a reduced glomerular filtration rate. Health authorities, nephrologists and general physiccians should collaborate on the detection of CKD. In our country we should work harder on the prevention of diabetic kidney diseases, to stop or postpone the development of CKD and chronic renal failure with modern therapy and the need for RRT.

Prevalence of thyroid dysfunction and autoimmunity in pregnant women with gestational diabetes and diabetes type 1.

OBJECTIVE: The aim of the present study was to determine the prevalence of abnormal thyroid function and antithyroid antibodies during pregnancy in women with diabetes type 1 and gestational diabetes mellitus (GDM). METHODS: The study group included 83 pregnant women who attended the Outpatient Department of the Endocrinology, Diabetes and Metabolic Disorders Clinic in the period from 05.2009 to 11.2009. The one hundred-g. oral glucose tolerance test (OGTT) was conducted on the pregnant women except for women with diabetes type 1. Thyroid functions were evaluated in all the pregnant women. After routine screening for GDM, thirty of the pregnant women were healthy and GDM was diagnosed in forty of them. The rest, thirteen women, had diabetes type 1. RESULTS: The women who developed GDM showed a mean free thyroxin concentration (fT4) significantly lower than that observed in the healthy pregnant women and women with diabetes type 1. Among the pregnant women with GDM, 10 women or 25% had fT4 concentrations below the lower cut-off with normal thyroid-stimulating hormone concentrations (TSH). A statistically significant difference was found in the prevalence of antithyroid antibodies (anti-TPO) between the (30%) women with diabetes type 1 and (10%) healthy pregnant women (p<0.05). In the women positive for anti-TPO, TSH was significantly higher (p<0.05). CONCLUSION: The significantly higher prevalence of hypothyroxinemia in GDM pregnancies and anti-TPO titres in pregnancies with diabetes type 1, than in healthy pregnant women warrants routine screening for thyroid abnormalities in these groups of pregnant women.

Dyslipidaemia and hypertension in patients with subclinical hypothyroidism.

OBJECTIVE: The aim of this study was to assess whether subclinical hypothyroidism (SCH) is associated with dyslipidaemia and arterial hypertension. METHODS: At the Department of Endocrinology, Diabetes and Metabolic Disorders, Skopje, R. Macedonia, we examined 24 consecutive patients with SCH and 13 healthy controls in a period of 6 months. SCH was defined as an elevated thyrotropin (TSH) (> 4.2 mU/l) and normal free thyroxine (fT4) level (10.3-24.45 pmol/l). None of the patients had been previously treated with thyroxine. In all participants we determined blood pressure, body mass index (BMI), TSH, fT4, antibodies to thyroid peroxidise (TPOabs), total lipids (TL), total cholesterol (TH), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides. RESULTS: Mean diastolic blood pressure increased in SCH patients vis-a-vis controls (85 vs. 74 mmHg; p < 0.05). Mean values of TL, TH, HDL-C, LDL-C, triglycerides, TC/HDL-C, and LDL-C/HDL-C were no different in patients with SCH compared with controls. Individual analysis revealed that the percentages of patients with SCH having arterial hypertension (29%), hypertriglyceridaemia (34.78%), elevated LDL-C (41.66%), elevated TC/HDL-C (21.7%), and LDL-C/HDL-C (21.74%) ratios were higher than the percentages in controls. No significant correlation between TSH and biochemical parameters was detected. CONCLUSION: Our study revealed that SCH patients have a greater prevalence of dyslipidaemia and arterial hypertension, and, as well, a greater value of mean diastolic pressure vs. control patients.

Association between foetal growth and different maternal metabolic characteristics in women with gestational diabetes mellitus.

OBJECTIVE: The aim of the study was to investigate the association between foetal growth and different maternal metabolic characteristics in women with gestational diabetes mellitus (GDM). METHODS: The study group included 200 consecutive pregnant women who attended the Endocrinology, Diabetes and Metabolic Disorders Outpatient Department in the period from 02.2006 to 02.2009 with singleton pregnancy and GDM diagnosed following ADA criteria. The following parameters were studied: pre-pregnancy maternal body mass index (BMI), 3-hours 100g oral glucose tolerance test (OGTT) results, glycosylated haemoglobin (HbA1c), total lipids (TL), total cholesterol (TH), triglycerides (TG), HDL- and LDL-cholesterol levels at admission. Neonatal birth weight and the prevalence of being large for gestational age (LGA) was an end-point. RESULTS: We found a significant association between birth weight and pre-pregnancy BMI, HDL-C and birth weight of a large child born previously. Birth weight of a large child born previously was the strongest independent predictor for LGA. The prevalence of LGA (from 27% to 80%) was related to a number of altered maternal characteristics. CONCLUSION: Pre-pregnancy BMI, HDL-C and birth weight of a large child born previously are the independent predictors for LGA, but results of glucose levels during OGTT are not useful in the prediction of LGA in GDM pregnancies. Probably more factors and other maternal metabolic parameters than glucose levels during OGTT are responsible for the risk of LGA.

Metformin improves menstrual patterns, endocrine and metabolic profile in obese hyperinsulinemic women with a polycystic ovary syndrome.

OBJECTIVE: To evaluate the therapeutic effect of metformin on the clinical features, hormonal and metabolic profile in obese women with a hyperinsulinemic polycystic ovary syndrome (PCOS). MATERIAL AND METHODS: We analyzed 25 women with PCOS, mean age 27.28+/-7.85 years, BMI 34.42+/-6.61 kg/m2, FerrimanGallwey (F/G) score 17.43+/-5.45 and duration of menstrual cycle 79.2 +/- 54.5 days. Basal hormone measurements included: FSH, LH, total testosterone, DHEAS, 17 alpha OHP and E2. All patients underwent a 75 g oral glucose tolerance test (OGTT), during which fasting and stimulated levels of glucose and insulin were measured at 0', 60' and 120'. The lipid profile was also performed. Both basal and stimulated parameters were analyzed before and after treatment with metformin (500 mg orally, three times daily for 9 months). RESULTS: After metformin treatment the mean frequency of menses became significantly more regular (79.2+/-54.5 days vs. 31.61 +/-7.7 days, P<0.01) and mean testosterone level had significantly decreased (2.78+/-1.23 vs. 1.72+/-0.95 ng/ml, (P<0.01). We also observed a statistically significant decrease in the metabolic parameters, both basal insulinemia (22.18 +/- 5.76 vs. 17.19+/-6.67 microU/ml, P<0.01), stimulated insulinemia after 60' (179.18+/-88.96 vs. 136.38+/-75.43 microU/ml, P=0.04), stimulated insulinemia after 120' (163.23 +/-89.2 vs. 88.46 +/- 61.5 U/ml, P<0.01) and glucose response to OGTT on 120' (7.07 +/- 1.82 vs. 6.15 +/-1.52 mmol/L, P=0.04). The levels of HDL cholesterol had increased (0.94+/-0.16 vs. 1.13+/-0.19 mmol/L, P=0.04). No changes were noted on the hirsutism score and other steroid levels. CONCLUSION: In women with PCOS treatment with metformin is effective in the lowering of hyperinsulinemia and hyperandrogenemia. In most women metformin improves the menstrual pattern, but has no effect on hirsutism.