Screening for diabetes among Roma people living in Serbia.

AIM: To investigate the prevalence of diabetes in the Roma population in Serbia. METHODS: We screened 11 urban and 8 rural Roma communities from October 2006 to May 2008 for the presence of diabetes. Blood glucose values, name, age, sex, presence of diabetes, family history, and obesity were recorded. RESULTS: We analyzed the data from 1465 Roma people, 953 women and 512 men (785 in urban and 680 in rural communities), with mean age of 42.42-/+15.69 years. Abdominal obesity was present in 600 (41%) participants. Eighty seven participants (5.9%) already had diabetes and there were 76 (5.2%) newly discovered cases of diabetes type 2. Participants with diabetes were significantly older (F=28.33; P<0.01). Family history for diabetes was positive in a third of participants. The risk for diabetes was 3.48 times higher in participants with positive family history (odds ratio [OR], 3.47; 95% confidence interval [CI], 2.37-5.1; P<0.01). Abdominal obesity was less frequent in healthy participants than in participants with diabetes (Chi(2)=32.55; P<0.01). The risk of diabetes in participants with abdominal obesity was 2 times higher than in the non-obese (OR, 2.11; 95% CI, 1.24-3.55; P<0.01). Diabetes was significantly more present in urban communities (Chi(2)=25.20; P<0.01). The risk of developing diabetes was 3.65 times higher in participants from urban settlements (OR, 3.64; 95% CI, 1.99-6.66; P<0.01). CONCLUSION: Prevalence of diabetes in the Roma people living in Serbia may possibly be higher than in the general population of Serbia and needs further investigation.

HER-2/neu oncogene and estrogen receptor expression in non small cell lung cancer patients.

Non-small cell lung cancers are among the leading causes of cancer morbidity and mortality worldwide. The prognosis is usually based on traditional pathohistological parameters and clinical stage, but additional prognostic survival factors have also been sought. The aim of this retrospective study was to explore the membranous expression of HER-2/neu and estrogen receptors in nonsmall cell lung cancers and their relation to survival of patients with non-small cell lung cancers and to traditional prognostic factors. The sample consisted of 132 consecutive, surgically resected patient tissues of non-small cell lung cancers, and the following parameters were examined: HER-2/neu and estrogen receptor expression, as well as the related clinical and pathological features: tumor, nodes, and metastases stage, level of tumor necrosis, histological and nuclear grade, lymphocytic infiltrate, and number of mitoses. HER-2/neu was positive in 28.8% of tumor samples, and estrogen receptor expression was positive in 29.5% of tumors, but neither was significantly associated with the outcome of non-small cell lung cancers. There was a significant association between HER-2/neu and nuclear grade (P=0.01). In addition, the association between estrogen receptor expression and histological type of tumor (P=0.04) and mitotic rate (P=0.008) was found. Kaplan-Meier analysis showed a significant association of patients' overall survival with the tumor node metastasis stage (P<0.001) and the degree of tumor necrosis (P=0.02). Cox proportional hazard regression analysis showed that male gender (P=0.01), histological type (P=0.03), high degree of necrosis (P=0.006), and higher histological grade (P=0.037) were associated with the patients' survival. Our findings indicate that the expression of HER-2/neu and estrogen receptor is less reliable than traditional histological parameters in predicting the survival of patients with non-small cell lung cancers.

[The effects of metformin plus sulfonylurea therapy on clinical features of the metabolic syndrome].

INTRODUCTION: Insulin resistance is a well-known leading factor in the development of metabolic syndrome. The aim of this study was to evaluate metabolic effects of metformin added to sulfonylurea in unsuccessfully treated type 2 diabetic patients with metabolic syndrome. MATERIAL AND METHODS: A group of thirty subjects, with type 2 diabetes, secondary sulfonylurea failure and metabolic syndrome were administered the combined therapy of sulfonylurea plus metformin for six months. Metformin 2000 mg/d was added to previously used sulfonylurea agent in maximum daily dose. Antihypertensive and hypolipemic therapy was not changed. The following parameters were assessed at the beginning and after six months of therapy: glycemic control, body mass index, waist circumference, blood pressure, triglycerides, total cholesterol and its fractions, homeostatic models for evaluation of insulin resistance and secretion (HOMA R, HOMA B) and C- peptide. RESULTS: Glycemic control was significantly improved after six months of the combined therapy: (fasting 789 vs. 10.61 mmol/l. p < 0.01; postprandial 11.12 vs. 12.61 mmol/l. p < 0.01, p < 0.01; glycosylated hemoglobin 6.81 is. 8.83%. p < 0.01) the body mass index and waist circumference were significantly lower (26.7 vs. 27.8 kg/m2, p < 0.01 and 99.7 vs. 101.4 cm for men, p < 0.01, 87.2 vs. 88.5 for women, p < 0.01). Fasting plasma triglycerides decreased from 3.37 to 2.45 mmol/l (p < 0.01) and HOMA R from 7.04 to 5.23 (p < 0.001). No treatment effects were observed on blood pressure, cholesterol, and residual insulin secretion. CONCLUSION: Administration of metformin in type 2 diabetes with metabolic syndrome decreased cardiovascular risk factors by reducing glycemia, triglycerides, BMI, central obesity and insulin resistance.

[Role of standard test meal in initiation of insulin therapy in type 2 diabetes].

INTRODUCTION: Secondary monotherapy failure in diabetes mellitus type 2 occurs early in the course of disease. Choosing the optimal combination therapy depends on the primary pathogenic mechanism. Evaluation of the residual beta cell function is of primary importance in deciding whether insulin should be included in the combination therapy. OBJECTIVE: To investigate the influence of standard meal test and homeostasis model assessment (HOMA-B) index, as markers of residual insulin secretion, on the efficacy of two different therapeutic strategies in secondary sulphonylurea (SU) failure. METHODS: In the group of thirty subjects with diabetes type 2, metabolic syndrome and secondary SU failure, metformin (MET) was added for the following six months. In the group of 30 subjects with diabetes type 2, secondary SU failure, with no metabolic syndrome, insulin (INS) was added for the same period. During the six-month follow-up period, fasting, postprandial, mean daily blood glucose and glycosylated haemoglobin (HbA1C) were evaluated. Fasting and meal stimulated C-peptide (CP) and insulin levels were measured at the beginning; absolute and relative increase of CP (delta CP, delta CP%), and HOMA-B were calculated. Correlation between CP secretion and HOMA-B at the beginning and glycaemic control after six months of therapy were evaluated by using Pearson correlation coefficient. RESULTS: Glycaemic control after six months was significantly improved in both therapeutic combinations (p < 0.01). However, target values were not met in either group. Stimulated CP levels correlated best with all the parameters of glycaemic control in the group SU+MET (r -0.479 to -0.791; p < 0.01), and in the group SU+INS (r 0.382 to 0.635; p < 0.01). HOMA-B correlated only with HbA1C in the SU+MET group (r = -0.382; p < 0.05). CONCLUSION: Clinical diagnosis of metabolic syndrome and evaluation of residual insulin secretion are necessary in choosing the best combination therapy in secondary SU failure in subjects with type 2 diabetes. Stimulated standard meal CP level is a clinically useful marker of residual insulin secretion.