Faculty of Medicine

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    Association Between Hormone Replacement Therapy and Glycemic Control in Postmenopausal Women with Type 2 Diabetes
    (Македонско лекарско друштво = Macedonian medical association, 2015-01)
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    Markovik-Temelkova, Snezhana
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    Jovanovska-Misevska, Sasa
    Introduction. In women with diabetes, the changes that accompany menopause may further diminish glycemic control. Little is known about how hormone replacement therapy (HRT) affects glucose metabolism in diabetes. The aim of this study was to examine whether HbA1C levels are influenced by current HRT among postmenopausal women with type 2 diabetes. Methods. A total of 40 postmenopausal women with type 2 diabetes were enrolled. All of them fulfilled the criteria of natural menopause, with intact uterus, low estrogen levels (E2) and high follicle-stimulating hormone (FSH) levels. Half of them (20 women) were assigned to take HRT (DM-HRT group). The other half (20 women) were assigned to the control group, those who did not take HRT (DM-non HRT group). HRT consisted of 17 β-estradiol (E2) 1 mg and drospirenone (DRSP) 2 mg. Fasting plasma glycemia, insulinemia and HbA1C were followed in both groups throughout 12 months. Results. The mean age was 49 years (SD±3,3) and 48,5 (SD±3.1), respectively. HRT was associated with statistically significant decrease in serum fasting glucose, HbA1C and insulinemia levels in the DM-HRT group. There was no significant reduction in glucose levels and HbA1C together with no significant increase in insulinemia levels in the DM non-HRT group throughout 12 months. Conclusion. HRT was associated with statistically significant decrease of plasma glucose levels and HbA1C level. Larger clinical trials are necessary to understand whether HRT may improve glycemic control in women with diabetes, especially when it is given shortly after entering menopause.
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    Oral Health Status in Diabetic and Non-Diabetic Patients on Maintenance Hemodialysis Treatment
    (Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs, 2022)
    Emilija Rambabova
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    Gjorgjievska, Gordana
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    Vasiliki Krecova
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    Introduction. Uremic toxins and inflammation influence the oral health in patients on maintenance hemodialysis treatment. The presence of diabetes additionally aggravates the oral status. The aim of the study was to compare the oral health status in diabetic and non-diabetic patients on chronic hemodialysis program. Methods. Observational, cross-section, monocentric study was conducted in 72 hemodialysis (HD) patients divided into two groups regarding the presence of Diabetes mellitus (DM). Demographic characteristics as patients age, dialysis vintage, laboratory inflammatory markers as C-reactive protein (CRP), albumin and Interleukin 6 (IL-6) were measured at the start of the study. Also, uremic small and middle molecules as blood urea nitrogen (BUN), creatinine, β2-microglobilin (β2M), myoglobin, albumin, free light chains kappa (FLC-k), and free light chains lambda (FLC-λ) were analyzed. Patients were examined by a dentist specialist scoring the oral hygiene index (OHI) by Greene Vermillion as good, fair and poor. Presence of hyperkeratosis, periodontal disease, erosions, ulceration, erythema, pigmentations, tongue coating and uremic fetor were notified. Gingival hyperplasia (GH) was scored (1-3) with 3 for the worst score. Data was presented as mean and standard deviation for continuous and percentages for nominal values. X squared Fisher exact and Mann Whitney test were used for statistical analysis. P<0.05 was considered as significant. Results. The patients from group 1-with DM (N=26) didn’t differ from the non-diabetic group (N=46) in respect of gender, age but had significantly shorter dialysis vintage (48.68±37.45 vs. 88.13±63.29, p=0.02, respectively). From the inflammatory markers only Il6 was significantly higher in DM patients (p=0.03). All the analyzed uremic toxins-small and middle molecules also didn’t differ between the two groups. Diabetic patients were at 3 fold risk for manifestation of fissure, 4 fold risk for pigmentations and 7 fold risk for erythema (OR 3.58; CI:1.017-12.380, p= 0.003; OR 4.12; CI:0.684-22.870; p=0.02, OR 4.84; CI:1.343-17.498, p=0.000), (OR 7.25; CI:1.123-46.880, p=0.000), respectively. GH was more likely to be present in diabetic patients (35%, 54%, 11% vs 83%, 15, 0%, p=0.000, respectively). The presence of hyperkeratosis, periodontal disease, erosions, didn’t differ between the groups. Patients with DM were found with higher percentage of bad oral hygiene index (38% vs 20%), but the overall comparison of OHI showed no significant difference. Conclusion. Oral health is significantly deteriorated in dialysis patients, especially in those with inflammation. Diabetic patients are at higher risk of developing changes in the oral health status.
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    Design of a Non-invasive ECG-based Glucose Measurement System
    (IEEE, 2020-09-28)
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    Gusheva, E
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    Diabetic patients have to pay for each glucose reading with a blood drop and a small fortune. In addition, routine finger pricking is troublesome for diabetic patients because it can lead to scarring. It is no surprise then that the idea that glucose measurement can be done cheaply and in a non-invasive way surpasses the wildest dreams of diabetic patients. The goal of this paper is to present the design of a new technology solution for non-invasive glucose measurement based on processing the electrocardiogram obtained via a light easy-to-wear ECG monitor. We present details on how to develop a service that tracks glucose levels based on real-time ECG monitoring, and using sophisticated machine learning and related technologies. Our initial analysis shows that no similar solution is present on the market today, although several research initiatives are ongoing.
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    Metabolic Syndrome and Myocardial Infarction in Women
    (Bentham Science Publishers, 2021-04-29)
    Djuro Macut
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    Sanja Ognjanovic
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    Milka Ašanin
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    Gordana Krljanac
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    Abstract: Metabolic syndrome (MetS) represents a cluster of metabolic disorders that arise from insulin resis-tance (IR) and adipose tissue dysfunction. As a consequence, there is an increased risk for type 2 diabetes melli-tus and atherosclerotic cardiovascular disease (CVD). MetS is associated with a 2-fold increase in cardiovascu-lar outcomes. Earlier population analyses showed a lower prevalence of MetS in women (23.9%) in comparisonto men (27.8%), while later analyses suggest significantly reduced difference due to an increase in the preva-lence in women aged between 20 and 39. However, the prevalence of MetS in specific populations of women,such as in women with polycystic ovary syndrome, ranges from 16% to almost 50% in some geographical re-gions. Abdominal fat accumulation and IR syndrome are recognized as the most important factors in the patho-genesis of MetS. After menopause, a decline in insulin sensitivity corresponds to an increase in fat mass, circu-lating fatty acids, low-density lipoproteins, and triglycerides. Prevalence of MetS in acute coronary syndrome(ACS) is significantly more present in women (55.9%-66.3%) than in men (40.2%-47.3%) in different cohorts.Younger women with ACS had a higher mortality rate than younger men. Acute myocardial infarction (AMI)remains a leading cause of death in aging women. Women with AMI had significantly higher rates of prior con-gestive heart failure, hypertension history, and diabetes. The role of androgens in CVD pathogenesis in womenhas not yet been clarified. The current review aims to provide an insight into the role of MetS components andinflammation for the development of atherosclerosis, CVD, and AMI in women.