ACTA ENDOCRINOLOGICA (BUC)

Aims. To investigate the historical changes in survival with diabetes in patients treated with insulin from diagnosis.\r\nMethods. We analyzed 2811 deaths, 51.5% males, registered at ?I. Pavel? Bucharest Diabetes Centre, aged 40-64 years and deceased between 1943 and 2009. We split the analysis in three time periods according to year of death: 1943-1965,\r\n1966-1988 and 1989-2009.\r\nResults. The mean age at diabetes onset was 51.4?6.8 years, with mean disease duration at death of 17.7?11.6 years\r\nand mean age at death of 69.1?11.2 years. The mean survival after diabetes onset was 13.9?9.8 years in 1943-1965, and rose to 17.3?9.6 years (p<0.001) in 1989-2009. There was a significant increase for coronary heart diseases and cancer and a significant decrease for infections and endstage\r\nrenal disease as causes of death.\r\nConclusions. We found no significant changes in age at onset, which combined with an increase in survival with diabetes lead to a significant increase in age at death.\r\nMajor historical events have a strong impact over survival after the onset of diabetes.

Aims. Earlier studies suggested that patients with nonfunctioning pituitary adenoma (NFPA) experience premature mortality, mostly from vascular diseases. The present study aims to identify risk factors associated with mortality in patients with NFPA. Methods. All consecutive patients admitted to a tertiary neuroendocrinology center for pituitary adenoma during 2001-2010 were screened. Only those with a final diagnostic of NFPA were retained. All 196 NFPA subjects (57.7% males, mean age 52.7±0.9 years) were followed-up for allcause mortality until December 31, 2011 (1298 person-years of follow-up). PAMCOMP software was used to calculate standardized mortality ratio (SMR), using the corresponding general population as reference. Cox regression analysis evaluated the independent hazards for mortality. Results. There were 26 deaths among 196 patients as compared to 20 expected. Standard Mortality Ratio (SMR) was 1.2 (95% Confidence interval (CI) 0.83-1.86). Females had a doubled mortality ratio: SMR 2.03 (95%CI 1.01-3.64), but males had a mortality ratio similar with general population: SMR 0.87 (95%CI 0.48-1.44). More patients with hypopituitarism for at least one axis deceased (22/156, 14.10%), as compared with patients without pituitary failure (1/22 patient deceased –2.07%), p=0.03. Prednison replacement for corticotrophin insufficiency (HR 1.46 (95%CI 1.12-1.90)) was correlated to mortality in females, but not in males, and mortality rose progressively with prednison dose (log rank: p=0.01). In males, last known maximal pituitary tumour diameter (HR 1.04 (95%CI 1.001-1.08) and age at baseline (HR 1.1 (95%CI 1.05-1.1) were modestly related to mortality. Conclusions. Females with nonfunctioning pituitary adenomas and hypopituitarism had a reduced life expectancy as compared with general population, possibly related to glucocorticoid substitution or a more severe pituitary insufficiency.

Aims. We investigated the prevalence of micro and macro-vascular complications and how these patients perform with respect to current treatment goals. \r\nMethods. We performed a cross-sectional study in type 2 diabetes subjects treated with biguanides in monotherapy, attending a standard diabetes outpatient clinic during 2008-2009. We used the latest available visit at the Clinic for data regarding demographics, anthropometrics, biochemistry, micro and macrovascular complications of diabetes. \r\nResults. We investigated 814 subjects, 463 (56.9%) females, mean age 62.6?10.5 years, age at diabetes onset 60?10.4 years, and a disease duration at study inclusion 2.6?3.9 years. Only 5.2% of females and 17.7% (p<0.01) of males had a waist circumference <80/<94 cm and 40.4% of cases had a fasting plasma glucose <7.21 mmol/l. The therapeutic target for blood pressure was achieved in 14.7% of cases for systolic blood pressure (<130 mmHg) and 29.6% for diastolic blood pressure (<80 mmHg). \r\nConclusion. Individuals with type 2 diabetes treated with biguanides in monotherapy are poorly controlled, have a high prevalence of metabolic syndrome components as well as micro and macrovascular complications.

Aims. To investigate the effect of sulphonylurea (SU) treatment on all-cause and cardiovascular mortality as compared with metformin (MET), when used in combination with insulin (INS) in type 2 diabetes. Methods. All type 2 diabetes patients aged ≥40 years were included at their first prescription of INS+MET or INS+SU, during 2001-2008. They were considered at risk until death or December 31st, 2011. Mortality rates were calculated per 1000 person-years. Crude and adjusted rate ratios (RR) were calculated using time dependent analysis with INS+MET as reference. Results. There were 7122 patients (60.8% women) included in the analysis, with a mean age at baseline of 62.0±9.9 years. During the 11 years of study, patients on INS+MET contributed 13620 person-years and 330 deaths (mortality rate 24, CI95% 22-27), while those on INS+SU contributed 8720 person-years and 393 deaths (mortality rate 45, CI95% 41-50). Adjusted all-cause mortality RR were: SU 1.6 (CI95% 1.21-2.11, p<0.001), glimepiride 1.18 (CI95% 0.73-1.91, p=0.51), gliclazide 1.78 (CI95% 1.07-2.95, p=0.024), glibenclamide 1.66 (CI95% 0.71-3.88, p=0.23), glipizide 1.24 (CI95% 0.68-2.27, p=0.49), and gliquidonum 2.32 (CI95% 1.54-3.50, p=0.001). Conclusions. When combined with insulin as dual therapy, patients treated with SU were at increased mortality risk as compared with insulin + MET.