To investigate the prevalence of diabetes in the Roma population in Serbia. 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. 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 (X2 = 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 (X2 = 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). 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.

Background/aim: Type 2 diabetes mellitus (T2D) is a complex metabolic impairment. Beta cell (BC) failure is the most challenging among its pathogenetic mechanisms. Recognizing reversible contributors to BC failure could guide individualized approach to early T2D treatment. The aim of this study was to compare early short-term insulin treatment vs. glimepiride, both added to metformin, on BC function, glycemic and lipid control, during 12-month follow-up. Patients and methods: Eighty newly diagnosed T2D patients, 30-65 years of age, presenting with HbA1c ≥ 9% were enrolled in the study. They were randomly assigned to single-month initial insulin therapy (INS) added to metformin, or to glimepiride and metformin (OAD) as only treatment. Subjects assigned to initial insulin intervention were thereafter switched to OAD. C-peptide (C-Pep) was analyzed at baseline and 2 hours after standardized test meal (STM). All subjects were STM-retested after 3 and 12 months. HbA1c, serum lipids, BMI, HOMA IR, and HOMA B were assessed over follow-up. Results: HbA1c was lower in INS vs OAD at 3-months: 6.26 ± 0.18% vs 6.78 ± 0.10% (p = 0.016), remaining so by 12 months (p = 0.056). BMI-adjusted ΔC-Pep was greater in INS vs. OAD at 3 months (4.60 ± 0.59 vs. 3.21 ± 0.34 m2/kg; p = 0.044), persisting by 12 months (4.57 ± 0.56 vs. 3.04 ± 0.34 m2/kg; p = 0.023). Average ΔC-Pep improvement from recruitment to 3 months was 100.8% in INS, vs. 51.3% in OAD. Prevalence of STM-ΔC-Pep response greater than 2.4 ng/mL had risen 3.2-fold by 12 months in the INS, vs. 2.4-fold only in the OAD group (p = 0.018). Conclusion: Early short-term insulin intervention in newly diagnosed T2D improves beta cell function more than glimepiride, both added to metformin, resulting in a superior and longer lasting glycemic and lipid control.

Although emerging evidence suggests that epigenetic mechanisms contribute to the pathogenesis and progression of type 2 diabetes mellitus (T2DM), data remain limited for patients with suboptimal metabolic control. The aim of this study was to assess global DNA methylation in patients with poorly controlled T2DM and to identify diabetes-related factors associated with DNA methylation levels. The study included 107 patients and 50 healthy controls. Global DNA methylation (5mC) was measured by UHPLC-DAD method. Pro-oxidant and antioxidant biomarkers, advanced glycation end-products, high-sensitivity C-reactive protein (hsCRP) and complete blood count were determined and leukocyte indices calculated. Patients had a significantly lower 5mC than controls (3.56 ± 0.31% vs. 4.00 ± 0.68%; p < 0.001), with further reductions observed in those with longer disease duration and diabetic foot ulcers. Oxidative stress and inflammatory biomarkers were higher in the patient group. DNA hypomethylation was associated with a higher monocyte-to-lymphocyte ratio and hsCRP, pro-oxidant–antioxidant balance, ischemia-modified albumin, and advanced oxidation protein products levels. Conversely, 5mC levels showed positive correlations with total antioxidant status and total sulfhydryl groups. Principal component analysis identified five key factors: proinflammatory, pro-oxidant, aging, hyperglycemic, and antioxidant. The pro-oxidant factor emerged as the sole independent predictor of global DNA hypomethylation in T2DM (OR = 2.294; p = 0.027). Our results indicate that global DNA hypomethylation could be a biomarker of T2DM progression, reflecting the complex interactions between oxidative stress, inflammation, and epigenetic modifications in T2DM.

Introduction Basal insulin analogues offer persons with type 2 diabetes mellitus (T2DM) adequate glycemic control combined with a favorable safety profile. BASAL-BALI—a prospective, noninterventional, multicenter disease registry—assessed the effectiveness and safety of basal insulin analogues in adult Serbians with T2DM previously inadequately controlled on other insulin types. Methods The primary objective was to assess the reduction in glycated hemoglobin (HbA_1c) from basal insulin analogue initiation to the end of a 6-month observation period. Data collection was performed at three study visits: baseline, 3 months, and 6 months. All treatments and procedures were performed at the physicians’ discretion. Results In total, 460 subjects were included. Mean diabetes duration was 11.6 ± 6.6 years. Late complications of diabetes were present in 67% of subjects and comorbidities in 85%. After 6 months, the mean reduction in HbA_1c was 1.8% (p < 0.01 vs. baseline); body weight (mean reduction of 0.9 kg, p < 0.01), waist circumference (1.5 cm, p < 0.01), and BMI (0.2 kg/m², p < 0.01) were also reduced. A total of 49.1% of subjects reached their individualized HbA_1c treatment target, and 42.0% met the composite HbA_1c and fasting plasma glucose (FPG) target. The incidence of symptomatic hypoglycemia was reduced from 96.3% in the 6 months prior to initiating basal insulin analogues to 15.4% over the 6-month treatment period. Conclusion Introducing basal insulin analogues in persons with T2DM previously inadequately controlled on other insulin types can significantly improve glycemic control and reduce the risk of hypoglycemia, without adversely affecting body weight. Funding Sanofi, Serbia.

Type 2 diabetes mellitus (T2DM) is a progressive disease with declining beta cell function, ultimately necessitating insulin therapy. Timely introduction of adequate insulin improves management of diabetes. The aim of this study was to evaluate the unmet needs in the management of T2DM patients recently initiated on insulin therapy in routine clinical practice in Serbia.

Background: It is difficult to predict the risk of developing atherosclerotic cardiovascular disease in subjects with prediabetes and obesity. The aim of this study was to assess risk factors for coronary artery calcifications (CACs) and the development of type 2 diabetes (T2D) and coronary vascular events (CVEs) after 7 years in 100 overweight or obese persons with prediabetes, according to the baseline coronary artery calcium score (CACS). Methods: Lipids, HbA1c, uric acid, and creatinine were assessed. Glucose, insulin, and c-peptide were determined during an oral glucose tolerance test. Multi-sliced computerized tomography with evaluation of CACS was performed. After 7 years, the subjects were assessed for T2D/CVE. Results: CACs were present in 59 subjects. No single biochemical marker could predict presence of a CAC. After 7 years, T2D developed in 55 subjects (61.8% initially had both IFG and IGT). A gain in weight was the only contributing factor for T2D. Nineteen subjects developed a CVE; increased initial clustering of HOMA-IR > 1.9, LDL > 2.6, and mmol/Land TGL > 1.7 mmol/L and higher CACS were present in that group. Conclusions: No risk factors for CACs could be identified. A gain in weight is associated with T2D development, as are higher CACS and clustering of high LDL+TGL+HOMA-IR with CVEs.