Diabetes Mellitus Compensation Research Articles

Аnalysis of clinical cases of diabetic retinopathy progression in pregnant women with type 1 diabetes

Аnalysis of clinical cases of diabetic retinopathy progression in pregnant women with type 1 diabetes

Modern methods for assessing compensation of diabetes mellitus. Effect of continuous glucose monitoring on glycemic control in patients with type 2 diabetes

Background. An integral part of diabetes mellitus (DM) management is its timely diagnosis. The reference method to study the quality of glycemic control is evaluating the level of glycated hemoglobin (HbA1c) as one of the most accessible and informative tools. However, the introduction of novel technologies, namely the use of continuous glucose monitoring (CGM), has given patients with DM, their relatives and healthcare professionals an access to new indicators of glycemic control such as time in range (TIR), time above range and time below range. These indicators are criteria for compensation of carbohydrate metabolism according to the 2023 American Diabetes Association guidelines. The purpose of the study was to compare the effectiveness of using glucometers and the FreeStyle Libre system for flash glucose monitoring in patients with DM. Materials and methods. An examination of 60 patients with type 2 DM who received insulin therapy was conducted. They were aged 45–65 years, with DM duration of 5 ± 2 years. All participants were divided into two equal groups of 30 people each. The first group consisted of patients with CGM devices, the second group used glucometers for daily glycemic control. Additional CGM parameters were used: glucose coefficient of variation, glucose management indicator, which shows the probable level of HbA1c. Results. When evaluating the data obtained from patients who used CGM, it is important to note their high adherence to the use of flash glucose monitoring. The use of CGM made it possible to achieve compensation of carbohydrate metabolism faster compared to patients who used glucometers to correct glycemia. Discontinuation of CGM resulted in poorer glycemic control. The obtained results prove that the compensation of patients depends primarily on their motivation, willingness to follow medical prescriptions, careful glycemic control, and compliance with medical recommendations. Conclusions. For better control of the DM course, patients should use CGM. In order to assess diabetes compensation, it is not enough to consider only TIR. Time below range indicating hypoglycemia, time above range indicating hyperglycemia, glucose management indicator should also be taken into account. Discontinuation of CGM resulted in a loss of approximately half of the initial TIR gain achieved while using CGM. CGM is more favored among patients than a 7-point self-monitoring of blood glucose.

Index-based assessment of type I diabetes mellitus compensation level influence on oral health condition in adolescents

Relevance. Type I diabetes mellitus is generally recognized as a socially significant disease which directly affects the nature and severity of clinical symptoms of comorbidities, including in the oral cavit y.Material and methods. The study, which was conducted in the Department of Pediatrics of the “V.A. Almazov National Medical Research Center” in St. Petersburg, included 54 patients with type I diabetes mellitus. The mean age of the study group was 15.4 ± 1.27 years. Diabetes duration was 71.2 ± 46 months. The average value of glycated hemoglobin is 8.64 ± 1.69. 11% of patients appeared to have uncontrolled hyperglycemia (HbA1c > 7%). The dental examination included a questionnaire, examination and index evaluation using the Green-Vermillion Hygiene Index (OHI), the PMA index modified by Parma, Russell’s periodontal index (PI) and the DMF index. Statistical data was processed using the JAMOVI 2.3.13 software.Results. The principal component analysis distributed the studied indices by three independent mathematical models-constructs. The binomial regression of the OHI and glycated hemoglobin showed a specificity of 0.903 and a sensitivity of 0.348. Regression analysis of the PI and Hb1Ac showed a specificity of 0.919 and a sensitivity of 0.294.Conclusion. The binomial regression model of dental indices with the glycated hemoglobin index values helped to formulate the Hb1Ac key-point values, which allows for suspecting a highly likely initial stage of gingivitis. Hb1Ac above 8.6 is this value.

Indicators of endothelial dysfunction and the rate of thrombotic complications in patients with type 2 diabetes mellitus at different periods after COVID-19

Introduction. Damage to the vascular endothelium and hypercoagulation are two of the main causes of post-­COVID-19 complications. The aim of our study was to evaluate endothelial dysfunction and thrombotic complications at different periods after COVID-19 in patients with type 2 diabetes mellitus. Patients and methods. We conducted a cross-­sectional study of 135 patients with type 2 diabetes mellitus who applied for inpatient treatment at the RSSPMCE clinic (Tashkent, Uzbekistan) in the period from 3 to 24 months after the acute period of COVID-19. The following laboratory parameters were assessed: fibrinogen, INR, APTT, D-dimer, von Willebrand factor, and cell adhesion molecules (VCAM-1, ICAM-1). Results. Despite normal or near-normal INR, APTT and fibrinogen levels, many patients had elevated levels of D-dimer (41.4 % of cases), von Willebrand factor (27.6 % of cases) and vascular cell molecules up to 24 months after infection. The concentrations of ICAM-1 and VCAM-1 did not have statistically significant correlations with the degree of compensation of diabetes mellitus (HbA1c level). At various times after COVID-19, cases of ischemic forms of diabetic foot syndrome and thrombosis affecting the cavernous sinus and upper extremities were recorded. Conclusion. Taking into account the results obtained, patients with type 2 diabetes mellitus after SARS-CoV-2 infection require careful monitoring, and, in addition to assessing standard coagulation parameters, determining the level of cell adhesion molecules may have diagnostic value.

Individual approach in treating patients with pulmonary and tracheobronchial tuberculosis, with a long history of tobacco smoking and decompensated diabetes mellitus

Introduction. At the end of 2020, the clinical cure rate in all registration groups of patients with pulmonary tuberculosis was 48.2 %. There is now ample evidence that additional risk factors influence the more severe course of pulmonary tuberculosis and reduce the effectiveness of standard anti-tuberculosis therapeutic programs. Diabetes mellitus and tobacco use are among the significant risk factors. Complementing standard TB therapeutic programs with nicotine addiction and diabetes mellitus treatment programs with the formation of an individual comprehensive patient treatment plan will increase the effectiveness of TB treatment. Thus, the goal of this work is to demonstrate the high effectiveness of an individualized approach to the treatment of a patient with pulmonary tuberculosis with a comorbid background.The aim of the work was to demonstrate the high effectiveness of an individualized approach to the treatment of a patient with pulmonary tuberculosis with a comorbid background.Materials and methods At the Central TB Research Institute the patient underwent a comprehensive examination, including mandatory, additional and facultative methods of investigation. Based on the findings, the patient underwent complex treatment: antituberculosis chemotherapy, correction of carbohydrate metabolism disorders using oral antidiabetic drugs, nicotine replacement therapy according to the selected scheme, taking into account the degree of nicotine addiction.Results and Discussion Against the background of complex treatment, by four months of therapy the following was achieved: knockdown of systemic inflammatory reactions, cessation of bacterial excretion, compensation of diabetes mellitus. X-ray examination revealed closure of a large decay cavity, resorption and consolidation of focal infiltrative changes. There was regression of infiltrative changes of trachea and bronchi. The patient completely stopped using tobacco due to nicotine replacement therapy.Conclusion This clinical example demonstrates the high effectiveness of an individualized approach to the treatment of tuberculosis, including the need for an individualized regimen of anti-tuberculosis therapy, adequate compensation for diabetes mellitus, and the implementation of relevant smoking cessation techniques among smokers with pulmonary tuberculosis.

Clinical features of joint damage in patients with diabetes mellitus

Background. The development of diabetes-associated osteoarthritis is a complex and multifactorial process that depends on the type and compensation of diabetes mellitus (DM). Currently, the data about the role of various risk factors in the development of joint damage among the patients with DM are extremely contradictory. The purpose of the research was to study the clinical characteristics and risk factors of diabetes-associated osteoarthritis in the patients with type 1 DM (T1DM) and type 2DM (T2DM). Materials and methods. 556subjects were examined, who were divided into groups according to the type of DM, the presence, and the degree of severity of diabetes-associated osteoarthritis. Results. In the group of the subjects with T1DM, diabetes-associated osteoarthritis was diagnosed in 185 (74.5%) patients, and in patients with T1DM, joint damage was diagnosed in 241 (78.2%) persons. It was established that in the vast majority of the patients, diabetes-associated osteoarthritis was localized in the joints of the upper limbs. Oligoarthritis was frequent of the patients with T1DM, while polyarthritis is more common in patients with T2DM. It has been established that the probability of diabetes-associated osteoarthritis developing in patients with T1DM probably increases after the age of 35, with a body mass index (BMI) of more than 25.0kg/m2, a level of glycated hemoglobin (HbA1c) of more than 8.0%, and duration of DM of more than 28 years, and in the patients with T1DM, it develops more often among the patients after the age of 61 years, with HbA1c higher than 8.2%, BMI 27.9 kg/m2 and higher, and duration of DM more than 14 years. Conclusions. Measures to prevent diabetes-associated osteoarthritis in patients with DM should be based on long-term compensation of the underlying disease and maintenance of the optimal body mass.

"Non-Enzymatic Glycation in the Assessment of Metabolic Compensation of Diabetes Mellitus in Children"

"Non-Enzymatic Glycation in the Assessment of Metabolic Compensation of Diabetes Mellitus in Children"

Surgical treatment of giant hiatal hernia in patient with type 2 diabetes mellitus. Clinical case

Introduction: Gastroesophageal reflux disease (GERD) is a common pathology today, especially in the population of patients with obesity and type 2 diabetes mellitus. Particular attention should be paid to the comorbid condition of patients, especially in the diagnosis of esophageal hernia, complicated by “short” esophagus, which can be reliably detected (intraoperatively) when it is impossible to surgically mobilize his/her abdomen, without tension, more than 2 — 3 cm in abdominal cavity, below the esophageal orifice of the diaphragm. “Short” esophagus occurs due to fibrosis, which progresses against the background of GERD and persistent chronic inflammation. Conservative long-term GERD treatment, especially against the background of decompensated diabetes, is ineffective and doesn’t provide satisfactory results and, and consequently leads to a complicated course of the disease. In the presence of a «short» esophagus against the background of hiatal, one of the effective surgical techniques is to perform gastroplasty according to Collis-Nissen, and compensation of type 2 diabetes in the prehospital stage is important for both favorable results and choice of adequate type of surgery (both antireflux and bariatric).
 Clinical case: A 63-year-old patient after type 2 diabetes mellitus compensation in outpatient settings, with hospitalized in the surgical department with complaint of chest pain and aching epigastric pain without irradiation that worsened after eating, belching air, periodic vomiting of food and shortness of breath. The anamnesis of the disease was followed for several decades of life. After correction of carbohydrate metabolism against the background of decompensated DM 2 and comprehensive follow-up, the patient was diagnosed with a giant hiatal hernia, complicated with a «short» esophagus. The patient underwent laparoscopic crurography and Nissen fundoplication supplemented by Collis gastroplasty in a Terry modification. The postoperative period was uncomplicated. The check-up after 1 month showed no complaints, no radiological signs of reflux (barium radioscopy in the Trendelenburg position), no data for recurrence of hiatal hernia (as per results of fibrogastroduodenoscopy and contrast-enhanced abdominal computed tomography).

BLOOD FLOW CONDITION IN LOWER EXTREMITY VESSELS AND ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS DEPENDING ON DISEASE DURATION

The purpose of the study. Study arterial blood flow and blebbing of the plasma membrane of lymphocytes in the neuroischemic form of diabetic foot syndrome (SDS) depending on the age of the disease.
 Material and methods. In a prospective study, 150 patients of type 2 DM were examined, of which 50 people with a neuroischemic form of SDS. Blood flow condition on vessels of lower extremities and plasma membrane of lymphocytes was examined. There were 30 women (60%), 20 men (40%). Vascular channel condition was evaluated by ultrasound dopplerography of lower extremity arteries, degree of diabetes mellitus compensation was determined by glycated hemoglobin level, lymphocyte membrane condition was evaluated by phase contrast microscope imaging results.
 Results of the study. 72% of patients had complete occlusion of the tibia-foot segment of the arteries of the lower extremity, 28% had stenosis. The glycated hemoglobin level averaged 10.3 [8.5; 14.3]%, i.e. all observed patients had insufficient compensation for carbohydrate metabolism disorders. The total and terminal lymphocyte blebbing was 30.1 [25.4; 33.2]% and 15.8 [11.8; 18.4]%, which was 3 and 5 times higher than the control group, respectively. A high positive correlation between the duration of DM disease and the total (rS=0,72; p = 0.001) and terminal (rS=0,78; p = 0.001) blebbing of lymphocyte membrane.
 Conclusion. The high correlation between the timing of DM disease and the blebbing of the lymphocyte plasma membrane allows these indicators to be used as markers of endothelial dysfunction in neuroischemic and ischemic forms of SDS. The level of summary and terminal blebbing can be considered as a prognostic marker of the development of macroangiopathy in patients with type 2 DM.

Особливості післяопераційного періоду у хворих на хронічний дакріоцистит та цукровий діабет 2-го типу після проведення ендоскопічної ендоназальної дакріоцисториностомії залежно від ступеня компенсації цукрового діабету

The aim. To identify the features of the postoperative period in patients with chronic dacryocystitis and type 2 diabetes mellitus (DM2) after endoscopic endonasal dacryocystorhinostomy (DCR), depending on the degree of compensation of DM. Materials and methods. The study involved 30 DM2 patients with chronic dacryocystitis who underwent endoscopic endonasal DCR according to standard methods. The patients were divided into groups according to the degree of compensation of DM2: 6 patients with compensated, 7 patients with subcompensated and 17 patients with decompensated DM2. The results of the operation were evaluated after 2 months, 6 months and 2 years. In addition to standard methods, ophthalmic examination included nasolacrimal duct probing, lacrimal duct lavage, and endoscopic examination of the nasal cavity. Results and discussion. The efficiency of endoscopic endonasal DCR in decompensated DM2 after 2 months (58.8 ± 11.9 % of patients) on average was 1.4 times, and after 6 months (52.9 ± 12.1 % of patients) and 2 years (41.2 ± 11,9 % of patients) – it was 1.5 times less than that in subcompensated and compensated DM2 (p < 0.05). In patients with decompensated DM2, tearing was observed in 41.2 ± 11.9 % of patients after 2 months, in 47.1 ± 12.1 % of patients after 6 months and in 58.8 ± 11.9 % of patients after 2 years post-op, which was, on average, 2.7 times, 2.1 times and 1.5 times more often than that in subcompensated and compensated DM2, respectively (p < 0.05); there were no significant differences between the values (p > 0.05). Conclusions. Features of the postoperative period in patients with chronic dacryocystitis after endoscopic endonasal DCR depend on the degree of compensation of DM2. The efficiency of endoscopic endonasal DCR in decompensated DM2 after 2 months is on average 1.4 times, and after 6 months and 2 years it is 1.5 times less than that in subcompensated and compensated DM2. Keywords: type 2 diabetes mellitus, degree of compensation of diabetes mellitus, chronic dacryocystitis, efficiency of endoscopic endonasal dacryocystorhinostomy, features of postoperative period.

Системний огляд ефективності місцевого лікування виразок за синдрому діабетичної стопи з позицій доказової медицини

В роботі зроблено огляд різних методів місцевого лікування синдрому діабетичної стопи. Проведено аналіз робіт, дизайн і методи яких відповідають критеріям доказової медицини. Відзначено, що більшість досліджень були низької методологічної якості. Існують проблеми з чіткою оцінкою через різний ступінь компенсації цукрового діабету, супутньої патології (тобто гетерогенності клінічного матеріалу), що пов’язане з повільною реакцією виразок на різні методи терапії, а також із визначенням кінцевих точок контролю та лікування.

Вплив вітаміну D на показники компенсації цукрового діабету 2-го типу

Актуальність. Цукровий діабет (ЦД) призводить до порушення всіх видів обміну речовин (насамперед вуглеводного), ураження судин, нервів, різних органів і тканин. Проте вплив ЦД на рівень вітамінів та мікроелементів залишається недостатньо висвітленим. Попри достатній арсенал лікарських середників, досягти компенсації ЦД вдається менше ніж у 30 % пацієнтів. Саме тому пошук нових шляхів покращення вуглеводного обміну залишається актуальним. Мета дослідження: виявлення дефіциту 25-гідроксивітаміну D та встановлення його кореляційного зв’язку з рівнем глікованого гемоглобіну (HbA1c) у хворих на ЦД 2-го типу. Матеріали та методи. Обстежено 35 хворих на ЦД 2-го типу віком 55–74 роки з тривалістю захворювання від двох до чотирьох років. Контрольну групу становили 35 практично здорових осіб такого ж віку. Показники 25-гідроксивітаміну D вимірювали за допомогою радіоімунологічного аналізу. Рівень HbA1c вимірювали за допомогою рідинної хроматографії. Результати. У 37,1 % хворих на ЦД 2-го типу виявлено недостатність вітаміну D. При цьому в 61,5 % з них компенсація ЦД була задовільною (рівень HbA1с становив 7,5–8,5 %), а в 38,5 % — незадовільною (рівень HbA1с > 8,5 %). Встановлено обернену кореляцію між підвищенням рівня HbA1с та зниженням вмісту 25(OH)D (r = –0,39, p < 0,05). Висновки. Встановлено вірогідне покращання стану компенсації цукрового діабету 2-го типу після медикаментозної корекції рівня вітаміну D.

Порівняльна характеристика впливу омега-3 поліненасичених жирних кислот, статинів та їх комбінування на показники ліпідного спектра крові, судинно-тромбоцитарного гомеостазу і варіативності ритму серця у хворих на цукровий діабет 2-го типу з кардіоваскуля

Актуальність. Особливу зацікавленість у лікуванні дисліпопротеїнемій (ДЛП) у хворих на цукровий діабет 2-го типу (ЦД-2) з кардіоваскулярною автономною нейропатією (КАН) викликає аналіз ефективності комбінування омега-3 поліненасичених жирних кислот (w-3 ПНЖК) і статинів, однак інформація про особливості їх використання неоднозначна, має фрагментарний характер, є предметом дискусії, а тому потребує подальшого уточнення. Мета. Проведення порівняльної характеристики впливу w-3 ПНЖК, статинів та їх комбінування на показники ліпідного спектра крові, судинно-тромбоцитарного гомеостазу і варіативності ритму серця (ВРС) у хворих на ЦД-2 з КАН. Матеріали та методи. Обстежено 75 хворих на ЦД-2 із функціональною стадією КАН. У крові визначали концентрацію глюкози, глікозильваного гемоглобіну, загального холестерину (ЗХС), тригліцеридів (ТГ), холестерину ліпопротеїнів високої (ХС ЛПВЩ) і низької щільності (ХС ЛПНЩ); вміст ендотеліну-1 (ЕТ-1), тромбоксану B2 (TXB2), 6-кетопростагландину F1a (6-ketoPGF1a), розраховували коефіцієнт атерогенності (КА), співвідношення TXB2/6-ketoPGF1a. З метою оцінки результатів короткотривалої ВРС використовували часові й спектральні параметри. Пацієнти з ЦД-2 та функціональною стадією КАН були стратифіковані на чотири групи і протягом трьох місяців, окрім цукрознижувальної терапії, отримували: 1-ша група (n = 21) — препарат w-3 ПНЖК 1 капс/добу; 2-га група (n = 22) — симвастатин 20 мг/добу; 3-тя група (n = 17) — препарат w-3-ПНЖК 1 г/добу і симвастатин 10 мг/добу; у контрольній (n = 15) — стандартну цукрознижувальну терапію протягом трьох місяців. Результати. Включення в лікувальні заходи препарату w-3 ПНЖК виявляло більш значуще порівняно з симвастатином зниження рівня ТГ, зменшення вмісту КА та збільшення концентрації ХС ЛПВЩ і не впливало на концентрацію ЗХС і ХС ЛПНЩ. Використання симвастатину супроводжувалось більш вірогідним зменшенням рівня ЗХС, ХС ЛПНЩ, КА, ТХВ2, TXB2/6-ketoPGF1a і зростанням вмісту ХС ЛПВЩ, ЕТ-1, 6-ketoPGF1a; часових і спектральних параметрів ВРС. Комбінація w-3 ПНЖК і симвастатину супроводжувалась найбільш вираженими, позитивними, вірогідними змінами ліпідного обміну, ендотеліальної функції, ТХВ2, TXB2/6-ketoPGF1a; часових і спектральних параметрів ВРС. Висновки. Отримані результати дозволяють вважати, що ефективність комбінованої терапії w-3 ПНЖК і симвастатином не пов’язана зі станом компенсації захворювання, а є результатом безпосереднього впливу цих фармакологічних агентів на досліджувані показники, що обґрунтовує доцільність її використання в лікуванні ДЛП у хворих на ЦД-2 і функціональну стадію КАН.

Особливості перебігу та частота клінічних проявів полігландулярного синдрому IIIА типу у хворих, які проживають у йододефіцитному Тернопільському регіоні

Актуальність. Актуальною на сьогодні залишається проблема ранньої діагностики поєднаних ендокринопатій, таких як цукровий діабет (ЦД) 1-го типу, автоімунне ураження щитоподібної залози, надниркових залоз на тлі інших автоімунних патологій. Одним із проявів такого поєднання нозологій є автоімунний полігландулярний синдром (АПС), що характеризується послідовним або одночасним дефіцитом функцій декількох ендокринних залоз і включає широкий спектр автоімунних порушень не тільки ендокринної системи. Ризик розвитку АПС у пацієнтів, які мешкають на йододефіцитних територіях, зростає у декілька разів, що потребує більш ретельного обстеження та уваги. Мета. Вивчення особливостей перебігу та частоти клінічних проявів АПС ІІІА типу у жителів йододефіцитного Тернопільського регіону. Матеріали та методи. Обстежені 184 жінки із АПС ІІІА типу, які проживають на йододефіцитних територіях Тернопільщини. Вік обстежених становив від 19 до 74 років. Результати. В обстежених у Тернопільській університетській лікарні 73,14 % пацієнтів маніфестація АПС ІІІА типу починалася із ЦД 1-го типу. Патологію щитоподібної залози було діагностовано через 5–8 років після виявлення ЦД. Функціональні розлади патології щитоподібної залози проявлялися гіпотиреозом у 31,77 %, еутиреозом — у 48,96 % та гіпертиреозом — у 19,27 %. Компенсація ЦД досягалася важче у хворих із патологією щитоподібної залози з її функціональною недостатністю. Середні титри антитіл до тиреоїдної пероксидази (ТПО) становили 382,46 МО/мл. Максимальний показник антитіл до ТПО дорівнював 873,12 МО/мл. Встановлено, що у хворих із вищим показником антитіл до ТПО складніше було досягнути компенсації ЦД. Висновки. Всіх пацієнтів із ЦД 1-го типу в йододефіцитному регіоні доцільно обстежувати на наявність ознак ураження щитоподібної залози і АПС ІІІА типу.

Капилляроскопия как скрининговое обследование сосудов при сахарном диабете. Обзор литературы

Nailfold capillaroscopy is currently one of the highly informative methods for assessing the state of microcirculation. The advantages are ease of implementation, non-invasiveness, accessibility of the research object, instant visualization of the microvasculature, painlessness. The object of the study is the nailfold capillaries of the fingers or toes, due to their horizontal position in relation to the surface of the body, which makes it possible to evaluate the capillary throughout. Many authors have shown pronounced microvascular anomalies in type 1 and type 2 diabetes mellitus: tortuosity and dilation of capillaries, a decrease in their density, microhemorrhages, avascular zones, ectasias and aneurysms, newly formed capillaries; a relationship with the duration and compensation of diabetes mellitus as well as the severity of diabetic retinopathy was revealed. Thus, nailfold capillaroscopy can be used as a method for diagnosing and predicting diabetic retinopathy in patients with diabetes mellitus with the aim of early detection of initial changes in the microvasculature and timely retinopathy treatment. Key words: capillaroscopy; nailfold; diabetes mellitus.

Insulin resistance and need for a lifestyle change to eliminate it.

The AIM of our work is to point out the relationship between insulin resistance and metabolic compensation of diabetes mellitus, as well as to explore the possibilities of improving these parameters by non-drug measures. The rising incidence of insulin resistance associated with many comorbidities, especially due to the increase in obesity and unhealthy lifestyles, is a serious medical problem today. It is therefore necessary to be able to recognize and evaluate the presence of insulin resistance, prevent its occurrence, and ensure its elimination in high-risk individuals. In our study, we evaluated 106 patients with diabetes mellitus based on glycated hemoglobin parameters, ratio of triacylglycerols to high-density lipoproteins, and body mass index before and after adjustment of dietary and regime measures. Statistical analysis of our data showed a positive correlation between the assessed parameters of insulin resistance and metabolic compensation of diabetes with a Pearson correlation coefficient of 0.3156, and a decrease in glycated hemoglobin and insulin resistance after adjustment of dietary and regimen measures in 73.58 % of patients. Based on the above results, it is shown that non-drug measures are able to significantly improve the parameters of metabolic compensation of diabetes mellitus as well as those of insulin resistance (Tab. 4, Fig. 1, Ref. 18) Keywords: insulin resistance, TAG/HDL ratio, diabetes mellitus.

Assessment of type i diabetes mellitus compensation degree in children and adolescents of Perm Krai

Aim. To assess the dependence of carbohydrate metabolism state in children and adolescents with type I diabetes mellitus (DM) in Perm Krai on patients age, disease duration, way of insulin administration (regimen of multiple insulin injections or insulin pump therapy), complications available.
 Materials and methods. The study enclosed 451 children and adolescents, living in Perm Krai, who were hospitalized for type 1 DM to Endocrine Unit of Regional Childrens Clinical Hospital during 2016-2017. Glycated hemoglobin level (HbA1c), daily insulin requirement, availability and character of complications were assessed in these patients.
 Conclusions. The state of decompensation more often is connected with the disease duration for more than 5 years and adolescent age. There was detected a feedback between the physical development level and the duration of disease and number of chronic complications. The period of development of type 1 DM chronic complications depends on patients age, sex and compensation of disease. The degree of compensation of the disease is higher when using insulin pump therapy or regimen of multiple injections of ultrashort analogs of insulin in combination with basal analogs.

Glycated proteins

Glycation is a biological reaction that occurs in all proteins. Thisreaction proceeds more slowly in healthy subjects and more rapidly in patients suffering from a hyperglycemia. Glycated proteins cannot fulfill their functions that could lead to metabolic disorders. The process of glycation leads to building of advanced glycation end-products (AGEs). Thestructureof AGEs has not been fully researched yet. Glycated proteins have diagnostic meaning in different health conditions and not only in patients with diabetes mellitus. Determination of glycated proteins level (hemoglobin and plasma proteins) in diagnostics of diabetes mellitus and the effectiveness of its treatment; measurements of glycated proteins could be used as a predictor of different illnesses and their complications. Glycated hemoglobin was researched in children with diabetes mellitus of different severity. It has been shown that the level of glycated proteins does not always correlate with blood sugar level. Results of glycated proteins measurements in patients with thyroid disorders shows that the glycation takes place not only in patients with diabetes mellitus, but also with other illnesses without hyperglycemia. Our research in patients with diabetes mellitus has shown that the measured level of glycated proteins and plasma proteins could be more significant in the course of disease than the level of blood sugar. Compensation of diabetes mellitus in children in regard of the blood sugar level does not always correlate with the level of glycated proteins. This assumption could lead to the conclusion that only the combination of measurements like blood sugar, glycated hemoglobin and glycated proteins could give a full picture of disease compensation.

Блеббинг плазматической мембраны лимфоцитов у пациентов с атеросклерозом магистральных артерий и ишемической формой синдрома диабетической стопы

Aim: to assess the blood flow state and the lymphocyte plasma membrane blebbing in atherosclerosis of the lower limb arteries and the ischemic diabetic foot (IDF).Patients and Methods: 75 patients (51 (68%) of them — women) underwent a prospective study with IDF and signs of chronic obliterating disease of lower limb arteries. In the majority of cases (92%), IDF occurred in the setting of type 2 diabetes mellitus. Blood circulation disorder corresponded to the stage II–III Fontaine–Pokrovsky classification, ulcerative defects — to the PEDIS grade 1–2 without signs of infection and with signs of local inflammation. The control group consisted of 25 healthy patients. Blood flow state (using Doppler ultrasound of the lower limb arteries) and diabetes mellitus compensation degree (by the level of glycated hemoglobin), as well as the lymphocyte membrane state were evaluated.Results: 72% of patients had a total occlusion of tibial and foot segments, 28% — stenosis. The level of glycated hemoglobin was 10.3 [8.5; 14.3]%, which indicated insufficient compensation of carbohydrate metabolism disorders. Total and terminal blebbing was 30.1 [25.4; 33.2]% and 15.8 [11.8; 18.4]%, which was 3 and 5 times higher than the control group, respectively. A high positive correlation was observed between the level of glycated hemoglobin and total (rS=0.72; p=0.001) and terminal (rS=0.78; p=0.001) lymphocyte membrane blebbing.Conclusion: given the presence of a high correlation between the indicator of glycated hemoglobin and lymphocyte plasma membrane blebbing, an increase in glycated hemoglobin can be used as a marker for the development of endothelial insufficiency in atherosclerosis of the lower limbs and IDF. At the same time, the level of total and terminal blebbing can be considered as a pathogenetic marker of macroangiopathy. KEYWORDS: diabetes mellitus, atherosclerosis, ischemia, hemodynamics, blebbing, glycated hemoglobin.FOR CITATION: Dunaevskaya S.S., Khachatryan A.T., Deulina V.V. Blebbing of plasma membrane of lymphocytes in patients with atherosclerosis of main arteries and ischemic form of diabetic foot syndrome. Russian Medical Inquiry. 2020;4(7):452–456. DOI: 10.32364/2587-6821-2020-4-7-452-456.

The Role of Insulin, IGF-1 and PRAS40 in the Processes of Oncogenesis in Women with Type 2 Diabetes Mellitus and Endometrial Cancer

The objective of the research was to investigate the content of insulin, insulin-like growth factor-1 and phosphorylated protein kinase proline-rich Akt substrate of 40kDa and to determine their role in the activation of oncogenesis processes in women with type 2 diabetes mellitus and endometrial cancer.
 Materials and methods. There were examined 46 women who were divided into 4 groups: Group I included healthy women; Group II comprised women with type 2 diabetes mellitus; Group III included women with endometrial cancer; Group IV comprised women with endometrial cancer and co-existent type 2 diabetes mellitus. The levels of insulin, insulin-like growth factor-1, phospho- proline-rich Akt substrate of 40kDa were determined by immune-enzyme analysis. The compensation of diabetes mellitus was evaluated by hemoglobin A1c level using method of ion-exchange chromatography. The results obtained were analyzed using statistical analysis.
 Results. Women of all study groups had increased levels of insulin and insulin-like growth factor-1 as compared to the control group (p<0.05). The level of phospho-proline-rich Akt substrate of 40kDa increased in the patients of Group II (p<0.05) and the patients of Group III (p<0.05) and decreased in the patients of Group IV (p<0.05). According to correlation analysis, phospho-proline-rich Akt substrate of 40kDa was found to correlate with body mass index, insulin and insulin-like growth factor-1 in Group II, body mass index and insulin-like growth factor-1 in Group III and body mass index in Group IV (p<0.05).
 Conclusions. There was found an association between type 2 diabetes mellitus and endometrial cancer through obesity, hyperinsulinemia and insulin-like growth factor-1. The increase in phospho- proline-rich Akt substrate of 40kDa level was a sign of activation of mTOR and oncogenesis processes in the patients with type 2 diabetes mellitus. The decrease in phospho-proline-rich Akt substrate of 40kDa in the patients with endometrial cancer and co-existent type 2 diabetes mellitus can be explained by the influence of other intracellular regulatory systems or the effects of antidiabetic drugs, that requires additional study.