o:34241 Uticaj ranog uvođenja insulinske terapije na očuvanje beta-ćelijske funkcije kod pacijenata sa novootkrivenim dijabetes melitusom tip 2 doktorska disertacija The impact of early insulin treatment on beta cell function preservation in newly diagnosed type 2 diabetes mellitus : doctoral dissertation sr rojni su poremećaji krivi za nastanak dijabetes melitusa tip 2 (DM2), a najčešći suinsulinska rezistencija i beta ćelijska insuficijencija. Praktično, a pouzdano testiranje stepena βćelijske disfunkcije je još nedostižno. Identifikovanje reverzibilnih faktora koji doprinosedisfunkciji β ćelija moglo bi da usmeri nalaženju bolest modifikujućih terapijskih opcija u DM2.Cilj: Ispitivanje beta ćelijske funkcije standardizovanim test obrokom (STO) kod pacijenata sanovootkrivenim DM2 i poređenje efekata rane, kratkotrajne insulinske terapije sa efektima terapijeoralnim agensom glimepirid, dodate na metformin, na ćelijsku funkciju, glikemijsku kontrolu imetabolizam lipida.Pacijenti i metode: Analizirano je povećanje C-peptida (ΔCP), kao razlika u vrednostipostprandijalnog i C-peptida našte kod pacijenata sa novootkrivenim DM2 (N=80; 30-65 godina;47muškaraca) sa inicijalnim HbA1c≥9% i ITM 18,5-40kg/m2, koji su primali nasumično inicijalnujednomesečnu insulinsku terapiju uz metformin (grupa INS), ili oralne antijabetike - glimepirid imetformin (grupa OAD). Svi su retestirani STO nakon 3 i 12 meseci, uz praćenje C-peptida, ΔCP,Hba1c i lipida.Rezultati: Postoji povezanost prosečnog baznog C-peptida (2.29±0.14 ng/ml) sa prosečnim ITM(29.7±0.5 kg/m2) (p<0.01), kao i ΔCP u STO (1.40±0.20 ng/ml) sa ITM (29.7±0.5 kg/m2) (p <0.05). Bazni C-peptid se povećao za 63.6% ± 7.7%, uz značajno veće ΔCP u STO kod žena: 1.92± 0.33 ng/ml vs. 1.04 ± 0.14 ng/ml (p<0,05). Kratkotrajna insulinska terapija je dovela do boljeglikoregulacije u 3. mesecu: HbA1c 6.26 ± 0.18% vs 6.78 ± 0.10% (p<0.05). ΔCP korigovan zaITM u 3.mesecu je bio značajno veći u INS nego u OAD grupi (4.60 ± 0.59 vs 3.21 ± 0.34m2/kg;p<0.05), što se održavalo do 12. meseca (4.57 ± 0.56 vs 3.04 ± 0.34m2/kg; p<0.05). Porast ΔCPod 3. do 12.meseca u grupi INS je bio 100.8%, prema 51.3% u OAD grupi. Prevalenca pacijenatasa ΔCP≥2.4 ng/ml u STO se tokom 12 meseci i u grupi INS povećala 3,2 puta, a u OAD grupi 2.4puta (p<0.05)... Numerous disorders are responsible for the development of diabetes mellitus type2 (DM2), the most common being insulin resistance and beta cell insufficiency. Practical butreliable beta-cell function testing is still elusive. Identifying potentially reversible contributors tobeta-cell failure could hallmark possibilities for disease-modifying treatment in DM2.Aim: Assessment of beta-cell function by standardized test meal (STM) in newly diagnosed DM2patients and comparison of early short-term insulin treatment effects vs. oral-only antidiabeticagent glimepiride, both added to metformin, upon beta-cell function, glycemic control and lipidmetabolism.Patients and Methods: The increase in C-peptide (ΔCP) was analyzed, as the difference betweenpostprandial and fasting C-peptide values, in newly diagnosed DM2 patients (N=80; 30-65 yearsold; 47 males) with initial HbA1c ≥ 9% and BMI 18.5-40kg/m2, randomly assigned to one-monthinitial insulin treatment added to metformin (INS) or oral-only antidiabetics-glimepiride andmetformin (OAD). All were STM retested after 3 months and 12 months, with follow-up of Cpeptide,ΔCP, HbA1c and serum lipids.Results: BMI correlated significantly with baseline C-peptide (p<0.01) and C-peptide rise in STM-ΔCP (p<0.05). STM increased C-peptide by 63.6% ± 7.7%, significantly more in women vs. men:1.92 ± 0.33ng/ml vs. 1.04 ± 0.14ng/ml (p<0.05). Early short-term insulin treatment resulted insignificantly better glycemic control at 3-months: HbA1c 6.26 ± 0.18% vs 6.78 ± 0.10% (p<0.05).BMI-adjusted ΔCP at 3-months was significantly greater in INS compared to OAD group (4.60 ±0.59 vs 3.21 ± 0.34m2/kg; p<0.05), persisting by 12-months (4.57 ± 0.56 vs 3.04 ± 0.34m2/kg;p<0.05). Average ΔCP increase from baseline visit to 3-months was 100.8% in INS, vs 51.3% inOAD group. Prevalence of subjects reaching STM-ΔCP ≥ 2.4ng/ml increased over 12 monthsfollow-up 3.2-fold in INS, vs. 2.4-fold in OAD group (p<0.05)... Medicina - Interna medicina – Endokrinologija / Medicine - Internal medicine – Endocrinology Datum odbrane: 28.02.2024. standardizovani test obrok, beta ćelija, dijabetes melitus tip 2, insulinska terapija, aterogeni indeks plazme Standardized test meal, beta-cell, diabetes mellitus type 2, insulin treatment, atherogenic index of plasma 616.379-008.64-08(043.3) 91552100 148185353 91552101 9756 2024-07-09T13:01:12.053Z 45 no 46 Jelena, 1977- Stojanović 115664905 2023 63 mentor Teodora, 1959- Beljić Živković 14004583 2023 63 član komisije Milan, 1959- Petakov 12530791 2023 63 član komisije Aleksandar, 1967- Đukić 13561191 2023 63 član komisije Ljiljana, 1970- Lukić 81952009 2023 60 str. 3068340 http://phaidrabg.bg.ac.rs/o:34241 no yes 12 2024-07-09T13:01:12.320Z 70 11 1066950 1066999 standardizovani test obrok, beta ćelija, dijabetes melitus tip 2, insulinska terapija,aterogeni indeks plazme Standardized test meal, beta-cell, diabetes mellitus type 2, insulin treatment,atherogenic index of plasma 616.379-008.64-08(043.3) 1738 11A32 2023