[Biological factors associated with depression in patients with type ΙΙ diabetes mellitus].

This study was undertaken in order to identify the prevalence and factors associated with depression in a group of patients with type II diabetes mellitus. 200 patients (127 women/73 men) with type II diabetes mellitus, from Diabetic Clinic of 1st Propedeutic Medical Department of Aristotle's University of Thessaloniki, AHEPA Hospital, were enrolled in our study. Patients, sex, age, duration of diabetes, antidiabetic treatment, diabetic complications, body mass index (BMI), waist circumference, blood pressure, smoking, physical exercise and alcohol intake were assessed. BDI-II(Beck Depression Inventory-II) scale was used to measure the presence of depression. Prevalence of depression was high in the total of our patients (31.5%) and also in men (26%) and women (34.6%) separately. Depression appeared not to be related to patients' age, duration of diabetes, smokingand physical exercise, in the total of them (p>0.05). Patients, who were prescribed insulin, seemed to be more often depressed compared to those undertaking oral antidiabetic medication. The presence of depression was statistically significant increased in patients with diabetic complicationsin the total (p=0.013) and in men (p=0.001), while it was almost significantly increased in patients with diabetic nephropathy (p=0.052) and stroke (p=0.097). Depression was statistically significant related to obese patients compared to normal weight patients, in the total (p=0.003), and in menseparately (p=0.013), and also statistically significant was the relationship of depression with central obesity in the total (p=0.011) and in men (p=0.014). Statistically important was the relationship of arterial hypertension with depression in diabetic men (p=0.030), while in the limits of statistical importance was the relationship between depression and modest to heavy alcohol consumption in women (p=0.063). In a clinical aspect, depression seems to influence the development of type II diabetes mellitus, as it is shown by the significant association of diabetic complications anddepressive symptoms. The development of depression has often been considered a secondary response to the onset of complications, but depression might also play a primary role in the development or exacerbation of diabetic complications. It would be reasonable to speculate that obesity and arterial hypertension are biological variables that may interact with depression to produce diabetic complications. Further studies are needed to identify the pathways that mediate this association. These observations demonstrate that depression has a significant role in the development of type II diabetes mellitus, implying the necessity of its diagnosis and treatment, for the most optimal confrontation of the diabetic patient.

Endothelial nitric oxide synthase (eNOS) is not upregulated in gastric mucosa of Helicobacter pylori (H. pylori)-positive patients with type 2 diabetes mellitus.

AIM: To evaluate the expression of eNOS and CD34 in gastric mucosa of Helicobacter pylori (H. pylori) positive diabetic patients, in correlation with glycaemic control and diabetic autonomic neuropathy (DAN). METHODS: We prospectively studied 49 diabetic type 2 patients (29 women, mean age 65.32+/-8.56 years) and 30 control subjects (15 women, mean age 58.47+/-12.40) that underwent endoscopy. Biopsies from the body and antrum were evaluated for H. pylori-gastritis, eNOS and angiogenic marker CD34 expression. Statistical analysis in correlation with mean glycosylated haemoglobin (HbA1c) of the last 3 years, and DAN was performed. RESULTS: The two groups were matched for age (p=0.144), sex (p=0.335), H. pylori-infection (p=0.617) and degree of gastritis (p=0.78). eNOS and CD34 attenuated expression correlated with diabetes mellitus (DM) in the corpus (p=0.009 and 0.02, respectively). eNOS and CD34 expression was upregulated in H. pylori-positive controls but not in H. pylori-positive diabetic patients (p=0.010 and 0.007 for the corpus and p=0.036 and 0.047 for the antrum, respectively). eNOS expression correlated with good glycaemic control (GGC) in the gastric corpus (p<0.001) and antrum (p=0.0037) and with absence of DAN (p=0.009 and 0.036, respectively for the corpus and antrum). CONCLUSION: Chronic glycaemic control affects eNOS expression and angiogenesis in the gastric mucosa of patients with type 2 DM. eNOS expression is not upregulated in H. pylori-positive diabetic patients.

Beneficial effects of rosiglitazone on novel cardiovascular risk factors in patients with Type 2 diabetes mellitus.

AIM: Impaired exercise capacity, adiponectin, MMPs and TIMPs have all been implicated in the development of cardiovascular disease. The aim of our study was to determine the effects of rosiglitazone on these factors in diabetic patients. METHODS: Seventy individuals with Type 2 diabetes were assigned randomly to either a rosiglitazone group (8 mg/day, RG) or a control group (CG) for 6 months. All participants took gliclazide 160 mg plus metformin 1700 mg in stable dose. None of the individuals had diabetic complications or had previously participated in an exercise programme. Anthropometric parameters, VO2 peak, oxygen pulse, glycaemic indices, lipid profile, adiponectin, insulin resistance, blood pressure and serum MMP-9, TIMP-1, TIMP-2 levels were assessed at baseline and at the end of the study. After Bonferroni adjustment, a P-value < 0.017 was assumed to be statistically significant. RESULTS: Rosiglitazone treatment significantly increased VO2 peak (P < 0.0001), the duration of the exercise test (P < 0.0001), oxygen pulse (P = 0.010) and TIMP-2 levels (P = 0.008) in comparison with CG. Insulin resistance, hyperglycaemia, diastolic blood pressure and MMP-9 levels were also reduced (P < 0.017). Fat mass, lipid profile, TIMP-1 levels and MMP9 : TIMP-1 ratio were unaltered after rosiglitazone treatment. There were no significant changes in these parameters in control subjects. In univariate analysis, the rosiglitazone-induced increment of VO2 peak was associated with alterations in plasma adiponectin (r = 0.691), HOMA-IR (r = -0.782) and HbA(1c) (r = -0.676) (P < 0.017). These relationships retained significance after multiple regression analysis (P = 0.005). CONCLUSIONS: Rosiglitazone treatment increases cardiorespiratory fitness and modulates favourably serum adiponectin, MMP-9 and TIMP-2 levels. Whether these effects produce cardiovascular benefits in the long term requires further investigation.