Diabetes Mellitus Compensation Research Articles

HOMEOSTASIS OF SEX HORMONES IN WOMEN WITH DIABETES MELLITUS I

Objectives: to study the effect of the level of sex hormones on the compensation of diabetes mellitus I in women with regular or irregular menstrual cycle. Materials and Methods. 155 women with diabetes mellitus I were examined. The main group included 117 women with regular menstrual cycle (RMC) and 38 women with menstrual irregularities (IMC). The first group was divided into two subgroups depending on the phase of the menstrual cycle at the time of the study. The first subgroup was at the folliculin phase of RMC (n = 40), the second subgroup was at the lutein phase of RMC (n = 77). The comprehensive survey consisted of questionnaires, clinical anamnestic, functional diagnostic study and laboratory biochemical studies. The statistical analysis of the material was performed with the application of Statistica program 6.0 for Windows. Results. The women with IMC detected a lower body mass index and increased insulin requirements at the expense of short-acting insulin (p < 0,05). The level of HbA1C, the average level of glucose in the interstitial fluid and the maximum level of glucose in the interstitial fluid in IMC were reliably higher than those in RMC (P < 0,05). The estradiol, progesterone and FSH levels in the women with IMC were significantly lower (p < 0,05) than those in the women with RMC. Hyperglycemia in IMC causes a reduction of DHEA-S level. Conclusion. The low compensation level of diabetes mellitus I exerts a negative effect on the regularity of the menstrual cycle in women. The estradiol, progesterone and FSH levels in the women with IMC were significantly lower than in the women with RMC. Hyperglycemia in IMC causes a reduction of DHEA-S level.

Biliary pathology in patients with type 2 diabetes mellitus and methods for its correction with the use of health resort and spa factors

Diagnostics and treatment of hepatobiliary pathologies are known to be the indispensable prerequisites for the successful compensation of diabetes mellitus (DM). The present study revealed disturbances of bile-producing and bile-secreting functions of the liver in all the examined patients with DM. Moreover, the biochemical composition of bile and the ratio of its major components proved to be pathologically altered. The treatment program based at the Metallurg health resort including consumption of the local mineral water resulted in the significant improvement of the hepatic secretory function and normalization of motor-tonic activity of the bile-secreting system in patients presenting with type 2 diabetes mellitus at the stage of noncalculous cholecystitis.

How can we avoid the danger of hypoglycemia, one of the most serious complications of therapy of type 2 diabetes mellitus? The role of DPP-4 inhibitors

Optimal or near-optimal compensation of diabetes mellitus is almost inevitably fraught with the risk of hypoglycemia. In patients with type 2 diabetes (DM2), especially in those of old-age groups, the development of hypoglycemia increases the risk of CV death, cardiac rhythm disturbances, dementia, and depressive states. Whether absolutely all diabetic patients should be treated so as to ensure blood glucose levels close the physiological values thus far remains a matter of controversy. The results of large-scale clinical studies carried out in the recent years suggest the necessity to revise the existing algorithms for the treatment of patients with DM2. Highly efficacious agents for the purpose should be chosen with reference to both their glucose-normalizing activity and "the safety profile" (i.e. reduced risk of hypoglycemia). A panel of experts for the Russian Association of Endocrinologists (RAE) developed and published «Consensus Algorithm on the initiation and intensification of therapy of type 2 diabetes mellitus». Its main provisions emphasize the necessity of treating diabetics on an individual basis and establish target levels of glycemia for each patient. Special attention should be given to the patients belonging to high risk groups, i.e. those with manifest macrovascular pathology, unable to recognize hypoglycemia, and having serious concomitant diseases. The following first line preparations are recommended to enhance the safety of DM2 therapy: metformin, dipeptidyl peptidase-4 (DPP-4) inhibitors and agonists of glucagon-like peptide-1 (GLP-1) receptors. The results of both national and international clinical studies of vildaglyptin give reason to recommend this DPP-4 inhibitor for a wider application to the treatment of patients with type 2 diabetes mellitus.

The Contrast Sensitivity Test in Early Detection of Ocular Changes in the Relation to the Type I Diabetes Mellitus Compensation in Children,Teenagers, and Young Adults

An alteration of contrast sensitivity (CS) might be connected with structural and functional changes in foveolar and perifoveolar regions caused by different etiologies. We tested the hypothesis, that disturbances of CS can precede the typical changes in macular area in nonproliferative diabetic retinopathy (NPDR) in young patients with diabetes type 1 (T1DM). One hundred and twenty one (121) patients (63 girls and young women and 58 boys and young men) were included in the study; their age ranged 7 to 36 years, (median: 17.6 years). The T1DM duration was 6 to 21 years (median: 9.8 years), and it was diagnosed at the age from 2 to 30 years (median: 10.5 years). CS was examined in all patients repeatedly after one year (range, 11 - 15 months, median: 12.5 months) by means of CSV-1000 instrument in 3, 6, 12, and 18 cycles/degree (c/deg) respectively. In 42 patients older than 18 years of age, the simultaneous CS and fluorescein angiography (FA) were performed; in all of them, the T1DM duration was longer than 10 years. The compensation of the metabolic state was evaluated from average yearlong values of the glycolysated hemoglobin (Hb1Ac). The value of pathologically decreased CS in most of the cases was found in four spatial frequencies and the difference increased depending on the T1DM duration and was from 5 % to 8 % between 6 and 10 years of diabetes duration and from 17 % to 25 % after 15 years of diabetes duration. The total decrease of CS, especially in middle and higher frequencies (6, 12, and 18 c/deg), was determined by the increase of changes at the posterior pole. The early changes at the fundus related to the alteration of CS were of two types: (1) the dilatation of the capillaries with their possible obliteration and tortuosity (DCT) and (2) the changes of the macular structure (CMS) by means of the irregularity of the foveolar reflex and relative retinal thickening without significant macular edema and with increased pigmentation of this region. The combination of these two findings was considered as diabetic preretinopathy (DpR) with preserved visual acuity and decrease of CS in 65 % of cases. The authors also compared the decrease in every single space frequency marked on the CS curvature for NPDR and DpR (distinguished by means of FA). Comparing the NPDR with the norm, the authors found important and fundamental pathological defect of the CS (p = 0.0058). Comparing the DpR with the norm showed significant defect of the CS (p = 0.0197). Comparing NPDR and DpR, the difference was found in more noticeable pathological defect of the CS (p = 0.0228). The T1DM metabolic status during study (actual blood sugar and one year level of Hb1Ac) did not affected the CS positively nor negatively. The regressive study concerning the average Hb1Ac level (norm: 6.5 - 7.5 % by DCCT) during the 10 years' period found, that in NPDR patients the Hb1Ac level was pathologically increased during three quarters (7.5 years) of the follow up period and in DpR patients during one half of the same period (5 years). The CS test by means of the CSV - 1000 device can already detect the first retinal changes in patients with normal visual acuity and is positive in patients with still normal ophthalmologic macular finding.

New affine sorbent for determining glycosylated hemoglobin in early diagnostics of carbohydrate metabolism disturbances

Data on the synthesis and properties of a new affine sorbent created on the basis of a modified poly(acrylamide) gel with immobilized m-aminophenylboronic acid are presented. The new sorbent can be used for a multiple (no less then 7 cycles) quantitative determination of compounds containing cis-diol groups, in particular, glycosylated hemoglobin. The proposed affine sorbent offers a promising basis for the creation of diagnostic screening systems of carbohydrate metabolism disturbances and for monitoring diabetes mellitus compensation. In a series of tests for glycosylated hemoglobin determination with the new sorbent, the variation coefficient did not exceed 5%.

Psychopathologic peculiarities in compensated and noncompensated diabetes mellitus

Psychic disorders in patients with diabetes mellitus depending on the degree of its compensation are studied. The current methods of determining the level of glycemia and glucosuria and the classification of psychopathologic manifestations are used. The structure of the study performed is simple. The psychopatholoc manifestations are correlated with the diabetes mellitus compensation degree. The results of the study will make it possible to determine the diabetes mellitus compensation degree on the basis of the clinical picture and dynamics of psychopathologic symptoms.

Contribution of various sections of the hypothalamus to the pathogenesis of experimental diabetes mellitus in rats

The status of subnuclei of the paraventricular and ventromedial nuclei of the hypothalamus in the pathogenesis of experimental diabetes mellitus was studied in Wistar rats by morphohistochemical, radioimmunological, immunocytochemical, and electrophysiological methods. A close correlation was revealed between morphohistochemical and hormonal characteristics of the neuronal status of the studied hypothalamic subnuclei, on the one hand, and of their bioelectrical activity, on the other. The reactions of the subnuclei of paraventricular and ventromedial nuclei during development of diabetes were found to differ. The hypofunction of the ventrolateral subnucleus of the ventromedial nucleus was shown to be one of the mechanisms of compensation of diabetes mellitus, directed, together with other mechanisms, at stimulation of insulin biosynthesis. The results confirm the important role of the hypothalamic structures in the regulation of the endocrine function of the pancreas and in the pathogenesis of diabetes mellitus.

Hemodynamic parameters and exercise tolerance in insulin- dependent diabetes mellitus

The problem of development of diabetic myocardiodystrophy is analyzed. Thirty-seven patients with type 1 diabetes running a grave course with various disease duration were examined. The major parameters of intracardiac hemodynamics were examined by echolocation; exercise tolerance was studied by bicycle ergometry. The data indicate the development of diastolic rigidity, reduced volume of leftventricular myocardium, and decreased stroke and minute output at the early stages of the disease. Bicycle ergometry showed reduced exercise tolerance. These changes were in direct proportion to disease duration, presence of microangiopathy, and compensation status. These parameters may appreciably improve in recovery of the disturbed metabolic processes with restoration of the age-specific norm in patients with not long disease standing. Hence, echolocation of the heart and bicycle ergometry may be regarded among the criteria of diabetes mellitus compensation.