Concomitant Diabetes Mellitus Type Research Articles

#707 Effectiveness of a personalized approach to the treatment of patients with chronic coronary syndrome with type 2 diabetes and renal dysfunction

Abstract Background and Aims To evaluate the effectiveness of complex personalized treatment of patients with chronic coronary syndrome (CCS) with type 2 diabetes mellitus (T2DM). Method We observed patients with chronic stable angina pectoris III (FC) (Group I, 16) and CV IV FC (Group II, 18) with T2DM who underwent planned stenting of the coronary arteries (SCA). At baseline and after 3 and 6 months, we studied cholesterol, LDL cholesterol and HDL cholesterol, triglycerides (TG), ALT and AST, total bilirubin (TB), polymorphism of the CYP2C19 and 9p21 genes (rs 2383206 and rs 10757272), assessed myocardial viability (ECHOCG, MSCT), an ultrasound of the liver was performed. Against the background of basic therapy (antiplatelet agents, statins, beta blockers, ACE inhibitors), patients received a herbal hepatoprotector. Results Initial lipid parameters in patients with CCS and T2DM: cholesterol—6.9 mmol/l; LDL cholesterol –3.6; HDL cholesterol –1.1; TG –2.5 mmol/l. Parameters of global and regional systolic function were reduced. At the end of observation, lipid content: cholesterol—5.0; LDL cholesterol—2.3; HDL cholesterol –1.18; TG—1.61 mmol/l. Statins and antiplatelet agents were well tolerated, and there were no cases of withdrawal. Enzyme activity (ALT, AST), OB content were within normal values. The genetic studies carried out helped to select the most effective and safe doses of antiplatelet drugs and statins and significantly reduced the risk of complications and drug resistance. The hepatoprotector had a beneficial effect on the condition and function of the liver and improved the tolerability of medications. A personalized approach to the treatment of CCS was carried out taking into account the results of genetic testing with the selection of optimal doses of drugs. When the genotypes of CYP2C19*17 (rs 12248560) CC, ST and TT were distributed, the dose of antiplatelet agents was increased, and when the genotypes of the CYP2C19 gene (rs 4244285) GG, AG and AA were distributed, they were reduced. Assessment of myocardial viability, selection of doses of statins and antiplatelet agents according to individual characteristics, as well as a hepatoprotector increased the effectiveness and safety of treatment. SCA and basic treatment had an impact on the pathogenetic links of CCS, which is especially important in the treatment of patients with concomitant T2DM. Conclusion A personalized approach to the treatment of patients with CCS with T2DM who require SCA, taking into account the functional state and viability of the myocardium, the pharmacogenetic characteristics of the drugs, increases the effectiveness of revascularization, prevents the development of resistance, side effects and complications.

SGLT2i impact on HCC incidence in patients with fatty liver disease and diabetes: a nation-wide cohort study in South Korea.

This study evaluated the effect of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on cancer development, particularly in hepatocellular carcinoma (HCC), in individuals with concomitant fatty liver disease (FLD) and type 2 diabetes mellitus (T2DM). Using data from Korea's Health Insurance Review and Assessment Service, we performed Kaplan-Meier and Cox regression analyses in patients with non-alcoholic fatty liver disease (NAFLD) and T2DM (NAFLD-T2DM cohort) and those with chronic viral hepatitis (CVH) alongside FLD and T2DM (FLD-T2DM-CVH cohort). In the propensity score (PS) matched NAFLD-T2DM cohort (N = 107,972), SGLT2i use was not associated with the occurrence of overall cancer, including HCC. However, old age, male sex, liver cirrhosis, and hypothyroidism were identified as independent risk factors for HCC occurrence, whereas statin and fibrate usage were associated with reduced HCC risk in this cohort in multivariate Cox analysis. In the PS-matched FLD-T2DM-CVH cohort (N = 2798), a significant decrease in HCC occurrence was observed among SGLT2i users (P = 0.03). This finding remained consistent in the multivariate Cox regression analysis (Hazard ratio = 2.21, 95% confidence interval = 1.01-4.85, P = 0.048). In conclusion, SGLT2i may be a beneficial option for diabetes management in patients with concomitant T2DM, FLD, and CVH while affirming the overall safety of SGLT2i in other types of cancer.

Quality of Life of Patients with Hypertensive Disease and Type 2 Diabetes mellitus and Its Parameters Depending on Plasma Catestatin and Relaxin-2 Levels

The objective: to investigate the impact of hypertensive disease (HD) and concomitant type 2 diabetes mellitus (T2DM) on the quality of life (QOL) of patients using the SF-36 questionnaire and to evaluate the peculiarities of the QOL parameters depending on plasma relaxin-2 (RLN-2) and catestatin (CTS) levels. Materials and methods. The study was conducted in accordance with the principles of the Declaration of Helsinki. 136 patients took part in the study: 106 patients with HD and 30 healthy volunteers. The patients with HD were divided into two groups. The first group included 55 patients with HD and T2DM, the second group – 51 persons with HD without T2DM. Each study participant underwent a comprehensive clinical, laboratory and instrumental examinations. All participants filled out quality of life SF-36 questionnaire and the questionary of HD patient. Concentrations of CTS and RLN-2 in blood plasma were determined by enzyme immunoassay method (E4996Hu, BT Lab, Shanghai, China and E-EL-H1582, Elabscience, USA, respectively). All patients filled the home blood pressure monitoring diaries for 31 days. Statistical data analysis was performed using the SPSS 25.0 statistical program. Results. The patients with HD had lower parameters of physical and mental components of health compared to healthy volunteers (p<0.005). It was found that the presence of concomitant T2DM leads to even a greater decrease in quality of life indicators than in patients with HD without carbohydrate metabolism disorders (p<0.05). In patients with RLN-2 levels ≥4.69 pg/ml the lower parameters of the physical component of health (p<0.05) and social functioning (p=0.012) were determined. Lower CTS scores are associated with lower QOL scores (p≤0.005). Significant negative correlations were found between average SBP (aSBP) and indicators of physical and mental components of health (p<0.001), while mean DBP had correlations only with general health and total physical component of health (p<0.05). Conclusions. HD leads to a decreased QOL of patients, which is confirmed by lower scores of the SF-36 questionnaire and established negative correlations between aSBP and QOL parameters. The presence of concomitant T2DM is associated with even a greater decline in physical and mental health components.

The significance of chronic hyperglycemia for the reduced efficacy of eradication therapy in patients with type 2 diabetes mellitus and for Helicobacter pylori survival

Aim: This study aims to determine the significance of chronic hyperglycemia for the reduced efficacy of eradication therapy in patients with type 2 diabetes mellitus (T2DM) and Helicobacter pylori (H. pylori)-associated upper gastrointestinal tract pathology as well as for H. pylori survival. Methods: A prospective randomized study with the participation of 180 patients (87 men and 93 women) with H. pylori-associated upper gastrointestinal pathology was carried out. Ninety of these patients were with T2DM and 90 were without diabetes mellitus (DM). The patients were divided into 4 groups of 45 patients: the group 1 included non-diabetic patients treated with the classical triple eradication scheme; the group 2 included patients with T2DM treated with the classical triple eradication scheme; the group 3 included non-diabetic patients treated with bismuth quadro-therapy; the group 4 included patients with T2DM treated with bismuth quadro-therapy. The presence of H. pylori and evaluation of eradication efficacy was carried out using the Helix breath test. Results: The effectiveness of 1st line anti-Helicobacter therapy was higher (88.2%) in patients without diabetes in comparison with the group of patients with concomitant T2DM (74.7%). The efficacy of classical triple eradication therapy in patients with concomitant T2DM was 69.1%, and quadro-therapy was 80.5%. There was significantly lower effectiveness (P < 0.017) of eradication therapy in patients with T2DM and glycated hemoglobin (HbA1c) level ≥ 7.0% as compared with the group of patients in whom the target (≤ 6.5%) level of HbA1c was achieved. Conclusions: Chronic hyperglycemia has a favorable effect on the viability of H. pylori bacteria in patients with T2DM. A hypothesis explaining the reduced efficacy of eradication therapy in patients with hyperglycemia has been proposed.

The significance of catestatin and relaxin-2 in the diagnosis of myocardial remodeling in patients with essential hypertension and type 2 diabetes mellitus

Objective — to evaluate the peculiarities of electrocardiographic (ECG) and echocardiographic (EchoCG) parameters in patients with essential hypertension (EH) in combination with type 2 diabetes mellitus (T2DM) and their relationships with plasma catestatin (CTS) and relaxin­‑2 (RLN­­2) levels.
 Materials and methods. Examinations involved 106 patients with EH, from whom 55 subjects had concomitant T2DM, and 30 practically healthy volunteers. The mean age of the participants was (64.06±8.44) years, and women prevailed in the patients’ group (55.9%). All study participants underwent anthropometric data measurement, laboratory and instrumental investigations. The levels of biomarkers CTS and RLN­­2 were determined with the enzyme‑linked immunosorbent assay. Instrumental investigations included electrocardiography and transthoracic echocardiography.
 Results. CTS levels were reduced in patients with concentric (5.04±1.14 ng/mL) and eccentric left ventricular hypertrophy (LVH) (5.08±0.89 ng/mL) compared with the normal geometry (6.63±0.73 ng/mL, p <0.001). The significant correlation has been established between CTS levels and ECG parameters of LVH (Cornell voltage criterion (r=–0.222; p=0.009) and Sokolow‑Lyon index (r=–0.226; p=0.008)), and EchoCG parameters, including LV end‑diastolic dimension (EDD (r=–0.388; p <0.001), LV end‑systolic dimension (ESD (r=–0.453; p <0.001), LV end‑diastolic volume index (EDVi (r=–0.329; p <0.001), LV end‑systolic volume index ESVi (r=–0.415; p <0.001), LV ejection fraction (EF (r=0.469; p <0.001), septal sickness (SS) (r=–0.593; p <0.001), posterior wall thickness (PWS) (r=–0.647; p <0.001), relative wall thickness (RWS) (r=–0.568; p <0.001), and LV myocardial mass index (LVMi) (r=–0.576; p <0.001). Patients with RLN­­2 ≥ 4.69 pg/mL had higher EchoCG parameters, including LV EDD, LV ESD, LV EDVi, LV ESVi, SV, SS, PWS, RWS, LVMi (p <0.05). In addition, a significant positive relationship between CTS and RLN­­2 levels has been revealed (r=0.191; p=0.026), which was also confirmed in the subgroup of patients with RLN­­2 levels above 4.69 pg/mL (r=0.585; p <0.001).
 Conclusions. The decrease in CTS levels at LVH and established correlations with the ECG signs of LVH and EchoCG parameters allow us to consider CTS as a predictor of the development of LVH, especially in patients with EH combined with T2DM.

Non-alcoholic fatty liver disease and type 2 diabetes mellitus: diagnostic and therapeutic aspects. Review

The increase in the prevalence of non‑alcoholic fatty liver disease (NAFLD) occurs in parallel with the global epidemic of obesity and type 2 diabetes mellitus (T2DM) in the world. T2DM is an independent risk factor for the development of NAFLD. At the same time, researchers found that patients diagnosed with NAFLD have a two‑fold increased risk of developing T2DM. NAFLD is encompasses a spectrum of liver manifestations ranging from simple steatosis to nonalcoholic steatohepatitis (NASH), fibrosis and cirrhosis, which may ultimately progress to hepatocellular carcinoma. NASH is an aggressive form of NAFLD, associated with an increased risk of liver and non‑liver‑related mortality. Liver‑biopsy remains the gold standard for diagnosis, but the majority of patients liver damage can be diagnosed accurately by noninvasive methods.
 The presence of NAFLD in a patient with T2DM makes it difficult to achieve adequate glycemic control, deepens the manifestations of insulin resistance and atherogenic dyslipidemia, increases the risk of serious cardiovascular events and chronic kidney disease. Lifestyle modification and treatment of concomitant T2DM should be undertaken in all patients with NAFLD. To reduce the severity of liver steatosis, weight reduction by 3—5% is necessary, to reduce the inflammatory‑necrotic process, a more significant reduction may be required — up to 10% within 6—12 months. Physical activity increases the sensitivity of insulin receptors, and in combination with diet leads to a significantly significant improvement in biochemical and histological indicators in patients with NAFLD. Early identification and management of patients with intensive dietary and lifestyle modification are essential to prevent the development of advanced liver disease and its complications. Pharmacological therapy should be administered to patients with NASH purposed on the fibrosis inhibition, especially in case of the established predictors of high risk of disease progression (age >50 years, metabolic syndrome, T2DM, or increase in the activity of alanine aminotransferase), as well as to the patients with active NASH with high inflammatory activity.
 At the congress of the European Association for the Study of the Liver (EASL), which took place in Vienna on June 21—24, 2023, a new classification and nomenclature of NAFLD was adopted. It was proposed to replace the term «non‑alcoholic fatty liver disease» to the term «metabolic dysfunction‑associated steatotic liver disease» (MASLD). This diagnosis is established in patients with confirmed steatosis of the liver and one of five cardiometabolic risk factors: obesity, T2DM, insulin resistance, hyperlipidemia, atherosclerosis. The concept of «non‑alcoholic steatohepatitis» (NASH) has been changed to the concept of «metabolic dysfunction‑ associated steatohepatitis» (MASH). Coordination of the views of international and domestic experts in the field of studying this pathology will be important for clinical practice and scientific research.

Features of the course of COVID-19 in patients with type 2 diabetes mellitus

To identify the features of the course of COVID-19 in patients with type 2 diabetes mellitus (T2DM), depending on the intake of hypoglycemic therapy at the prehospital stage, in conjunction with the functional state of the kidneys. A retrospective analysis of 291 case histories of patients with COVID-19 and T2DM hospitalized in the infection department of Semashko Regional Clinical Hospital from January to December 2021, including the main clinical and laboratory parameters.Results. Among hospitalized patients with COVID-19, patients with T2DM had a higher mortality rate. An analysis of the case histories of deceased patients with COVID-19 and T2DM showed that at admission, body mass index (BMI), C-reactive protein, and creatinine were higher than those of survivors and amounted to BMI - 33 [30; 39] and 33 [28; 36] kg/m3; p=0.039, C-reactive protein - 77 [47.5; 106.0] and 57 [27.0; 89.0] mg/l; p=0.015, in terms of creatinine level - 89 [70.0; 144.0] and 82 [66.0; 101.0] µmol/l; p=0.039, respectively. It was found that in the second week of hospitalization in the group of deceased patients with COVID-19 and T2DM, the creatinine level was statistically significantly higher than in surviving patients and amounted to 94.5 [71.5; 141.0] and 72.5 [57.0; 88.0] µmol/L; p<0.001, respectively. The probability of death in hospitalized patients with type 2 COVID-19 and T2DM depended on BMI and creatinine levels at the second week of hospitalization. Patients with prehospital correction of hyperglycemia dipeptidyl peptidase-4 inhibitors (iDPP-4)/ glucagon-like peptide-1 receptor agonists (agGLP-1)/ sodium-glucose co-transporter 2 inhibitors (iSGLT-2) had significantly lower creatinine levels at week 2 of hospitalization. In patients with moderate to severe COVID-19 with concomitant T2DM, special attention should be paid to the combination of high BMI and creatinine in the second week of hospitalization, which is a prognostically unfavorable predictor of death in such patients.

FEATURES OF THE MORPHO-FUNCTIONAL MYOCARDIUM STATE AND RELATIONSHIP WITH GALECTIN-3 IN PATIENTS WITH CHRONIC HEART FAILURE OF ISCHEMIC ORIGIN ON THE BACKGROUND OF METABOLIC PATHOLOGY

The aim. To evaluate the presence and nature of changes in the morpho-functional state of the myocardium in patients with coronary heart disease (CHD) with concomitant type 2 diabetes mellitus (T2DM) and obesity, depending on the functional class (FC) of chronic heart failure (CHF) and the relationship with the concentration of galectin-3 in blood serum.&#x0D; Materials and methods. The study involved 75 patients with CHD with concomitant metabolic diseases such as T2DM and obesity, who were treated in the cardiology department of the State Clinical Hospital No. 27. Patients were divided into groups according to the FC of CHF. Group 1 included 30 patients with CHF FC II, group 2 – 24 patients with CHF FC III, group 3 – 21 patients with CHF FC IV.&#x0D; Results. In patients with СHD and metabolic disorders with CHF FC III, the levels of end-systolic dimension (ESD) and end-diastolic dimension (EDD) were higher by 16.3 % and 17.9 %, respectively, compared with FC II, end-systolic volume (ESV) and end-diastolic volume (EDV) also increased significantly in patients of this cohort with FC III compared with CHF FC II by 35.8 % and 16.5 %, respectively. Significantly increased ESV, EDV by 42.9 % and 37.8 %, respectively, as well as the size of the left atrium by 14.3 % in patients of the study group who had CHF FC IV compared with FC III. The ejection fraction (EF) index decreased in patients of this cohort with CHF FC IV by 14.4 % compared with FC III. The size of the right ventricle was larger by 10.8 % in CHF FC IV than in FC III in patients with CHD on the background of comorbid metabolic pathology. Indicators of the thickness of the LV posterior wall, LV relative wall thickness and intraventricular septum were lower in patients with FC IV compared with FC II, left ventricle mass (LVM) and left ventricle mass index (LVMI) increased by 32 % and 33 %, respectively. Сomparing the levels of Ea/Es in patients with CHF FC II and IV in СHD with concomitant T2DM and obesity, a significant increase in this indicator was found in FC IV (p&lt;0.05). The level of galectin-3 in patients with CHF FC III and IV of ischemic origin against the background of concomitant metabolic disorders was higher than in patients with FC II. Сomparing the concentration of galectin-3 in patients with CHF FC III and IV in patients with CHD with comorbid metabolic pathology, significantly higher levels were found in FC IV (p&lt;0.05). The study of the relationship between the fibrosis factor galectin-3 and cardiohemodynamic parameters revealed probable links, namely direct links between galectinemia and ESV (r=0.52; p&lt;0.05), EDV (r=0.58; p&lt;0.05), Еа/Es (r=0.51; p&lt;0.05).&#x0D; Conclusions. The growth of the functional class of chronic heart failure is accompanied by dilatation of the left cavities of the heart, a decrease in the inotropic function of the left ventricle, an increase in myocardial-arterial stiffness, and an increase in the levels of the galectin-3 fibrosis factor in the studied patients.

The assessment of the depressive states severity and their relationship with concomitant type 2 diabetes and obesity in patients with chronic heart failure of ischemic origin

The aim is to assess the prevalence and expressiveness of depressive disorders in patients with chronic heart failure (CHF) of the ischemic origin, depending on the presence of concomitant type 2 diabetes mellitus (T2DM), obesity and their combined course, as well as to assess the influence of existing metabolic disorders on the development of depression in individuals of this cohort. Materials and methods. The study included 154 patients with CHF of ischemic origin. Group 1 included patients with CHF with coronary heart disease (CHD), T2DM and obesity (n = 42). The second group consisted of patients with CHF on the background of CHD with concomitant T2DM (n = 46), and the third group – with concomitant obesity (n = 36). The comparison group was formed from patients who had signs of CHF of ischemic origin without metabolic disorders (n = 30). The Beck Depression Inventory (BDI) was used to assess the presence and nature of depressive disorders. Results. In patients with isolated CHF of ischemic origin, depression was found in 60 % of cases, according to BDI. In the second group depression was manifested in 80.6 % of cases, and in the third group – in 91.3 % of cases. 95.2 % of patients of the first group had depressive disorders. The average value of scores in patients of the first group significantly exceeded that of the patients of the fourth group by almost two times. Comparing the scores of patients of the second and third groups with the fourth group determined their increase by 57 % and 36 %, respectively. It was established that in patients with CHF of ischemic origin against the background of the combined course of T2DM, mild depression was found in 1/3 of patients, a quarter of patients had manifestations of moderate depression, 9.5 % of patients had severe depression and 4.8 % of people in this group had symptoms of mild depression. Conclusions. The presence of type 2 diabetes mellitus is associated with the development of depression in patients with chronic heart failure of ischemic origin. The combined course of type 2 diabetes mellitus and obesity is a risk factor for the development of depression and its progression to a marked/severe form.

Review of the Case Reports on Metformin, Sulfonylurea, and Thiazolidinedione Therapies in Type 2 Diabetes Mellitus Patients.

Type 2 diabetes mellitus (T2DM) is the world's most common metabolic disease. The development of T2DM is mainly caused by a combination of two factors: the failure of insulin secretion by the pancreatic β-cells and the inability of insulin-sensitive tissues to respond to insulin (insulin resistance); therefore, the disease is indicated by a chronic increase in blood glucose. T2DM patients can be treated with mono- or combined therapy using oral antidiabetic drugs and insulin-replaced agents; however, the medication often leads to various discomforts, such as abdominal pain, diarrhea or constipation, nausea and vomiting, and hypersensitivity reactions. A biguanide drug, metformin, has been used as a first-line drug to reduce blood sugar levels. Sulfonylureas work by blocking the ATP-sensitive potassium channel, directly inducing the release of insulin from pancreatic β-cells and thus decreasing blood glucose concentrations. However, the risk of the failure of sulfonylurea as a monotherapy agent is greater than that of metformin or rosiglitazone (a thiazolidinedione drug). Sulfonylureas are used as the first-line drug of choice for DM patients who cannot tolerate metformin therapy. Other antidiabetic drugs, thiazolidinediones, work by activating the peroxisome proliferator-activated receptor gamma (PPARγ), decreasing the IR level, and increasing the response of β-cells towards the glucose level. However, thiazolidines may increase the risk of cardiovascular disease, weight gain, water retention, and edema. This review article aims to discuss case reports on the use of metformin, sulfonylureas, and thiazolidinediones in DM patients. The literature search was conducted on the PubMed database using the keywords 'metformin OR sulfonylureas OR thiazolidinediones AND case reports', filtered to 'free full text', 'case reports', and '10 years publication date'. In some patients, metformin may affect sleep quality and, in rare cases, leads to the occurrence of lactate acidosis; thus, patients taking this drug should be monitored for their kidney status, plasma pH, and plasma metformin level. Sulfonylureas and TZDs may cause a higher risk of hypoglycemia and weight gain or edema due to fluid retention. TZDs may be associated with risks of cardiovascular events in patients with concomitant T2DM and chronic obstructive pulmonary disease. Therefore, patients taking these drugs should be closely monitored for adverse effects.

Insulin‐growth factor 1 (IGF‐1) in older adults with the concomitant presence of Alzheimer’s disease and type 2 diabetes mellitus

AbstractBackgroundAlzheimer’s disease (AD) may be related to changes in insulin pathways, suggesting that individuals with type 2 diabetes mellitus (T2DM) are more likely to develop AD compared to healthy individuals. Insulin plays an important role in the mechanisms related to brain activity, especially in the formation of memories. Given the similarity between insulin‐like growth factor (IGF‐1) and insulin itself, this molecule has the ability to bind to the insulin receptor, but with low affinity. In addition to the brain, IGF‐1 is present in several tissues, acting as a mediator of physiological responses related to neuronal protection against toxicity caused by glucose deprivation and oxidative stress, in addition to playing an important role in apoptosis, cell proliferation and differentiation. In vitro studies have demonstrated the potential that this protein has to decrease tau protein hyperphosphorylation, one of the pathological hallmarks of AD. Moreover, in response to neuronal damage, IGF‐1 promotes neurogenesis and synaptogenesis.MethodThis is a cross‐sectional study, based on the assumptions of quantitative research, approved by the Ethics Committee of Federal University of São Carlos, SP, Brazil (CAAE: 12968413.1.0000.5504). It has been developed with a sample of 36 participants aged over 60 years, users of health services in the municipality. Specific inclusion and exclusion criteria and the MMSE and CDR cognitive assessment instruments were applied to participants from all groups. Quantification of IGF‐1 plasma levels was performed using the ELISA technique (Enzyme‐Linked Immunosorbent Assay).ResultHigher plasma levels of IGF‐1 were found in older adults with AD and concomitant T2DM when compared with older adults with diabetes (T2DM) (p = 0.0167) and healthy participants (p = 0.0003).ConclusionThe increase in IGF‐1 levels in plasma of older adults with AD+T2DM and T2DM groups may indicate an initial compensatory response against neuronal damage in the elderly with both diseases or T2DM. The findings and conclusions of the present study are exploratory, and further studies with larger sample sizes are needed to draw a firm conclusion.

THE EFFICACY OF COMBITATION OF EMPAGLIFLOZIN AND METFORMIN IN PATIENTS WITH ARTERIAL HYPERTENSION AND TYPE 2 DIABETES MELLITUS

Objective: To determine the efficacy of combination of empagliflozin and metformin in patients with arterial hypertension (AH) and type 2 diabetes mellitus (T2DM). Design and method: A total of 52 patients with AH, stage II; obesity, stage I and concomitant T2DM were examined (28 women and 24 men, mean age 58.4 ± 2.9, fasting plasma glucose &lt; 9 mmol/L, glycosylated hemoglobin (HbA1c) - 7.54 ± 1.2%, mean blood pressure (BP) 167/104 ± 15.5/3.6 mm Hg, BMI 32.2 ± 2.1 kg/m2, disease duration 5.4 ± 1.6 years,). Two groups of patients were formed: the comparison group included 25 patients who received metformin 1000 mg 2/day, amlodipine 10 mg 1/day and lisinopril 10 mg 1/day. Patients of the main group (n = 27) received empagliflozin 10 mg in addition to standard therapy. The follow-up period lasted 6 months. Results: The following results were obtained by the end of the study period: HbA1C in the main group was 6.23±0.7%, while in the comparison group – 6.58±0.5% (p &lt; 0.05). 46.6% of patients in the main group had achieved the target HgA1c&lt;7.0% compared to 24.5% in the control group (p&lt;0.01). There was no significant increase in the frequency and severity of hypoglycemic episodes. The patients of the main group were characterized by greater weight loss (3.4±0.4 kg) than those of comparison group (0.9±0.3 kg), p&lt;0.01. The mean systolic BP in the main group was 133 ± 6.12 mm Hg., while in the comparison group - 147.2 ± 8.13 mm Hg., p &lt; 0.05. The diastolic blood pressure (DBP) was 84.6 ± 3.7 mm Hg and 89,8 ± 5.1 mm Hg, respectively. Conclusions: The obtained data suggest that inclusion of empagliflozin into a standard therapy of hypertension and type 2 diabetes provides multiple benefits, namely: improves glycemic control, ensures better regulation of blood pressure and promotes weight loss.

Obesity in HFpEF with and without diabetes - Risk factor or innocent bystander?

Heart failure with preserved ejection fraction (HFpEF) is a condition that commonly coexists with type 2 diabetes mellitus (T2DM) and obesity. Whether the obesity-related survival benefit generally observed in HFpEF extends to individuals with concomitant T2DM is unclear. This study sought to examine the prognostic role of overweight and obesity in a large cohort of HFpEF with and without T2DM. This large-scale cohort study included patients with HFpEF enrolled between 2010 and 2020. The relationship between body mass index (BMI), T2DM and survival was assessed. 6,744 individuals with HFpEF were included, of which 1,702 (25%) had T2DM. Patients with T2DM had higher BMI values (29.4kg/m2 vs. 27.1kg/m2, p<0.001), higher NT-proBNP values (864mg/dl vs. 724mg/dl, p<0.001) and a higher prevalence of numerous risk factors/comorbidities than those without T2DM. During a median follow-up time of 47 months (Q1-Q3: 20-80), 2014 (30%) patients died. Patients with T2DM had a higher incidence of fatal events compared to those without T2DM, with a mortality rate of 39.2% and 26.7% respectively (p<0.001). In the overall cohort, using the BMI category 22.5 to 24.9 kg/m2 as the reference group, the unadjusted hazard ratio (HR) for all-cause death was increased in patients with BMI <22.5kg/m2 (HR: 1.27 [CI 1.09-1.48], p=0.003) and decreased in BMI categories ≥25kg/m2. After multivariate adjustment, BMI remained significantly inversely associated with survival in non-T2DM, whereas survival was unaltered at a wide range of BMI in patients with T2DM. Among the various phenotypes of HFpEF, the T2DM phenotype is specifically associated with greater disease burden. Higher BMI is linked to improved survival in HFpEF overall, while this effect neutralises in patients with concomitant T2DM. Advising BMI-based weight targets and weight loss may be pursued with different intensity in the management of HFpEF, particularly in the presence of T2DM.

Abstract #1395812: Patterns and Influence of Cardio-Metabolic Insufficiency in Patients with Essential Hypertensive Disease and Concomitant Type 2 Diabetes Mellitus

Metabolic syndrome diseases, MSD (Hypertension, Adiposity, Diabetes mellitus and Dyslipidemia) are interrelated diseases with very high morbidity and mortality rates, thus requiring the search for new and effective treatment options [1]. The objective of the research was to study the patterns and influence of cardio-metabolic insufficiency in patients with essential hypertensive disease (EHD) and concomitant type 2 diabetes mellitus (T2DM). 105 patients (56 females and 49 males), aged 41-70 years were examined for 3 months. The average age was (60.5±2.5) years. Group I (GI) included 25 patients with treatment-compensated essential hypertensive disease, II stage, 1-2 degree; Group II (GII) - 25 patients with subcompensated type 2 diabetes mellitus (glycated hemoglobin (HbA1C) - from 7.0 to 11.0%); Group III (GIII) - 55 patients with treatment-compensated essential hypertensive disease, II stage, 1-2 degree and concomitant subcompensated type 2 diabetes mellitus (HbA1C - from 7.0 to 11.0%). The control group consisted of 15 practically healthy volunteers, 10 (66.7%) females and 5 (33.3%) males, aged (62.5±4.5) years. The groups were randomized according to age, sex, BMI, duration of EHD and T2DM. In addition to general clinical examination conducted including blood lipid levels – triglycerides (TG), LDL, HDL, total cholesterol (TC); glucose metabolism was assessed using HbA1C index. Statistical analyses of the results of the research were carried out using "Statistica 13.4 for Windows" and Student’s t-test series. Research was conducted with strict adherence to the Declaration of Helsinki (DoH) 2013 concerning human research. More severe dyslipidemia (and a higher risk of cardiovascular disease) was found in patients with type 2 diabetes mellitus and concomitant essential hypertension [2, 3]. Dyslipidemia was more pronounced in patients with EHD and concomitant T2DM. TG, LDL and TC levels were 20.14%, 28.72% and 24.21% higher compared with GI (p<0.05). HDL was 13.7% lower in GII compared with GI (p<0.05). HbA1C in GIII patients was (9.41±0.42) % and in GII patients was (7.21±0.45) % (p<0.05). Correlations between HbA1C with TG, LDL and TC levels were (r=+0.42; r=+0.60; r=+0.49 respectively, p<0.05). Correlations between SBP (systolic blood pressure) with TG, LDL and TC were (r=+0.41; r=+0.52; r=+0.45 respectively, p<0.05). Correlations between HbA1C and SBP was (r=+0.62; p˂0.05). In patients with essential hypertensive disease and concomitant type 2 diabetes mellitus, there is a remarkable tendency towards cardio-metabolic insufficiency as evidenced by increase in systolic blood pressure, hyperglycemia, and dyslipidemia.

Cardiotrophin-1 as a prognostic biomarker of hypertension and a key regulator of cardiac glucose metabolism

Background. Hypertension, type 2 diabetes mellitus (T2DM), and obesity are among the most common diseases in the world, and their growth rates are of a pandemic nature. Since cardiovascular diseases still occupy a leading place in the structure of mortality, the study of biomarkers continues that can be key in the diagnosis of early signs of cardiovascular pathology. Such promising molecule is cardiotrophin-1 (CTF-1). CTF-1 is a protein with a molecular weight of 21.5 kDa, which belongs to the interleukin-6 (IL-6) family. The purpose of this study is to evaluate the circulating level of CTF-1 in comorbid patients with hypertension, and to conduct a comparative analysis of its serum concentration in the presence of various comorbidities. Materials and methods. One hundred and eleven patients with hypertension (men/women— 50/61) aged (54.37±1.18) years and 20 persons of the control group were examined. In the process of examination, they were divided into 4 groups depending on the presence of comorbid pathology: hypertension— group 1 (n=22); hypertension combined with obesity— group 2 (n=30); hypertension and T2DM— group 3 (n=31); hypertension, T2DM and obesity— group 4 (n=28). In all patients, body weight and height were measured, body mass index (BMI) was calculated, glycated hemoglobin (HbA1c) levels, lipid metabolism indicators were determined, systolic and diastolic blood pressure levels were measured. CTF-1 content in blood serum was determined by enzyme-linked immunosorbent assay. Results. A direct correlation of CTF-1 level with weight, BMI, HbA1c level, systolic and diastolic blood pressure was found (p &lt; 0.001). The data obtained prove that CTF-1 can be a trigger for the occurrence of cardiovascular complications, since its level progressively increases with increasing severity of comorbid pathology, and its highest serum concentration is found in patients with hypertension, concomitant T2DM and obesity. The detected changes demonstrate the role of CTF-1, the adipose tissue hormone, in the development of comorbid pathology and make it possible to assert that CTF-1 is a potential biomarker of cardiovascular complications. Conclusions. The level of CTF-1 was significantly higher in patients with hypertension, T2DM, obesity compared to those with hypertension, hypertension and obesity, as well as compared to this indicator in the control group. The concentration of CTF-1 in blood serum positively correlates with the levels of systolic and diastolic blood pressure, body weight, BMI, total cholesterol and HbA1c level. The study of the relationship between the serum level of CTF-1 and metabolic and hormonal indicators in comorbid patients is a promising direction for further research.

EFFECT OF CARDIOPROTECTIVE THERAPY ON INFLAMMATION AND FIBROSIS FORMATION IN PATIENTS WITH MYOCARDIAL INFARCTION IN COMBINATION WITH TYPE 2 DIABETES MELLITUS

Myocardial infarction, especially ST-elevation myocardial infarction (STEMI), is the leading cause of death worldwide. Rapid detection and treatment of patients with STEMI is essential to minimize heart muscle damage and improve patient outcomes. Type 2 diabetes mellitus (T2DM) is a common metabolic disorder that is associated with various cardiovascular diseases, including STEMI. Patients with T2DM have a higher risk of developing STEMI, and this relationship is explained by factors such as insulin resistance, oxidative stress, and low-grade inflammation. Low-grade inflammation is now considered a characteristic feature of T2DM associated with the development of cardiovascular disease.&#x0D; Aim: to evaluate the effect of quercetin and adenosine-containing drug Advocard on inflammation and myocardial remodeling in patients with STEMI and concomitant T2DM.&#x0D; Materials and methods. This study involved 97 patients who were diagnosed with STEMI and T2DM who were inpatients at the Ivano-Frankivsk Regional Clinical Cardiology Center. The patients were divided into three separate groups. The first group included 34 patients who received only standard treatment as prescribed by current protocols for STEMI and T2D. The second group consisted of 29 patients who received the same basic therapy, but with the addition of quercetin (4.5 g intravenously for 5 days) to the treatment complex. The third group included 34 patients who received quercetin and Advocard (adenosine -29.25 mg in combination with molsidomine - 0.3 mg and folic acid - 0.45 mg in one half tablet) 2 tablets 3 times a day for 3 weeks against the background of similar basic therapy.&#x0D; Results. After analyzing the data of the three groups, it was found that the mean fibronectin level before treatment was 2.92±0.11 ng/ml in group 1, 2.67±0.39 ng/ml in group 2 and 2.68±0.38 ng/ml in group 3 (group 1 vs. group 2 p=0.892, group 1 vs. group 3 p=0.12). After treatment, the average fibronectin level decreased to 1.82±0.35 ng/ml in group 1, 1.11±0.26 ng/ml in group 2, and 0.82±0.28 ng/ml in group 3 (group 1 vs. group 2 p&lt;0.001, group 1 vs. group 3 p&lt;0.001). The difference between pre- and post-treatment levels (Δ fibronectin) was 0.86 ng/ml in group 1, 1.57 ng/ml in group 2, and 2.10 ng/ml in group 3. The mean level of sST2 before treatment was 23.08±1.39 ng/ml in the first group, 22.96±1.13 ng/ml in the second group and 23.11±1.05 ng/ml in the third group (group 1 vs. group 2, p=0.705, group 1 vs. group 3, p=0.916). After treatment, the mean level of sST2 decreased to 15.88±1.76 ng/mL in the first group, 10.06±1.77 ng/mL in the second group, and 7.11±1.65 ng/mL in the third group (group 1 vs. group 2 p&lt;0.001, group 1 vs. group 3 p&lt;0.001). The difference between the pre- and post-treatment levels, or Δ sST2, was 7.21 ng/mL in the first group, 12.90 ng/mL in the second group, and 16.00 ng/mL in the third group.&#x0D; Conclusions:&#x0D; The use of quercetin and advocard in the pharmacological management of patients with STEMI and T2DM reduces the intensity of inflammation and fibrosis, as evidenced by a decrease in the levels of fibronectin and sST2 in the blood.

Cardiopulmonary exercise testing for exercise prescription in cardiac rehabilitation

Aerobic endurance training is acore component of exercise training (ET) during cardiac rehabilitation (CR). Improvements of cardiopulmonary performance and symptom-free exercise capacity that can be achieved by ET during CR are essential for patient's prognosis and quality of life. Before initiating exercise training in CR, adetailed risk stratification including incremental exercise testing is required in order to ensure safe and effective exercise training conditions. Cardiopulmonary exercise testing (CPX) with measurement of respiratory gases is considered the gold standard of cardiopulmonary performance diagnostics. The oxygen uptake measured at the highest exercise intensity achieved (peakVO2) has strong prognostic implications in primary and secondary prevention of cardiovascular diseases, respectively. The use of CPX with measurement of peakVO2 and determination of ventilatory thresholds (VT) enables areliable determination of the individual cardiopulmonary performance (peakVO2) and also the aerobic exercise capacity. In addition, CPX is avaluable tool to detect increments in exercise capacity that were achieved by ET during CR. The measurement of peakVO2 and the determination of ventilatory thresholds are basic parameters for an individually tailored exercise prescription. In addition, the targeted control of aerobic endurance training on the basis of CPX parameters increases the effectiveness and safety of the exercise program during CR. In this article, recommendations for an individual exercise prescription, based on the results of CPX, are given for patients with coronary heart disease (CHD), heart failure, as well as for patients with CHD and concomitant type2 diabetes mellitus.

NESFATIN-1 ACTIVITY IN THE BLOOD SERUM IN PATIENTS WITH CHRONIC HEART FAILURE OF ISCHEMIC ORIGIN AGAINST THE BACKGROUND OF TYPE 2 DIABETES MELLITUS AND OBESITY.

The aim: To study the nesfatin-1 activity in the blood serum of patients with chronic heart failure (CHF) of ischemic origin against the background of such metabolic disorders as type 2 diabetes mellitus (T2DM) and obesity. Materials and methods: 154 patients with CHF were examined, and divided into 4 groups, according to the presence of metabolic disorders. Group 1 included patients with CHF on the background of coronary heart disease (CHD) and T2DM and obesity (n=42). The second group consisted of patients with heart failure on the background of CHD with concomitant T2DM (n=46), the third group - with concomitant obesity (n=36), the fourth group was formed from patients with signs of heart failure of ischemic origin without metabolic disorders (n=30). The control group (CG) included 30 practically healthy persons of comparable age. Results: The mean level of serum nesfatin-1 was 1.64±0.27 ng/mL in the СHF group, 0.342±0.19 ng/mL in the CHF + T2DM + obesity group, 1.06±0.36 ng/ mL in the obese + CHF group, 0.96±0.27 ng/mL in the CHF + T2DM group and 2.98±0.38 ng/mL in the CG. Significant correlation was found between the serum nesfatin-1 level and BMI (r=-0.34, p<0.05), HOMA (r=-0.54, p<0.05), insulin (r=-0.41, p<0.05). No significant correlation was found between the serum nesfatin-1 level and blood glucose level (r=0.13, p=0.65). Conclusions: Thus, nesfatin-1 may play a significant role in the pathogenesis of both weight-related abnormalities and type 2 diabetes mellitus in patients with chronic heart failure of ischemic origin.

Clinical and laboratory COVID-19 features in hospitalized patients with concomitant diabetes mellitus type 2: A retrospective study

&lt;b&gt;Objective:&lt;/b&gt;&amp;nbsp;To investigate the prevalence of diabetes mellitus in comorbidity structures and its effect on the clinical course in hospitalized COVID-19 patients in south region of Kazakhstan.&lt;br /&gt; &lt;b&gt;Material and methods:&lt;/b&gt; A retrospective analysis of data from 918 patients with COVID-19 treated at the City Clinical Infectious Diseases Hospital was carried out. Pearson's Chi-square test and Student's t-test were conducted.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; In Kazakhstan, diabetes mellitus occupies the second position in the structure of comorbidities in patients with COVID-19 with a share of 20%. Diabetes mellitus in patients most often occurs in combination with cardiovascular diseases and arterial hypertension (20.3% and 16.3%, respectively). Combination of diabetes mellitus, arterial hypertension and other diseases was detected in 72.4% of patients. Combination of diabetes mellitus, cardiovascular and other diseases was detected in 32.5%.&lt;br /&gt; In diabetes mellitus patients, COVID-19 was more severe, the hospital stay was longer, and patients over 60 years of age suffered. These patients had a combination of diabetes mellitus with arterial hypertension, obesity, and cardiovascular diseases. Hyperglycemia, elevated blood pressure, rapid breathing, and low saturation were more common for these patients.&lt;br /&gt; &lt;b&gt;Conclusion:&lt;/b&gt; Diabetes mellitus ranks second in the structure of comorbidities in COVID-19 in the south region of Kazakhstan and is characterized by a combination with cardiovascular diseases, arterial hypertension and obesity. In patients with diabetes, COVID-19 is more severe, which affects the length of stay in the hospital, the mortality rate and the need for transfer to the Intensive Care Unit.

Динаміка рівня ендотеліального моноцитактивуючого пептиду-ІІ у хворих на гострий інфаркт міокарда з супутнім цукровим діабетом 2 типу

The purpose of the study was to investigate the dynamics of endothelial monocyte activating polypeptide-ІІ in patients with acute myocardial infarction with concomitant diabetes mellitus type 2 six months after a coronary event. Materials and methods. 120 patients participated in the study: group 1 – patients with acute myocardial infarction with diabetes mellitus type 2 (n=70), group 2 – patients with acute myocardial infarction (n=50). The control group included 20 practically healthy people. All patients underwent laboratory and instrumental examination on the first day of acute myocardial infarction and 6 months after it. The level of endothelial monocyte activating polypeptide-ІІ was determined using the test system “Human Endothelial Monocyte Activating Polypeptide-ІІ ELISA KIT”. Results and discussion. The average level of endothelial monocyte activating polypeptide-ІІ on the first day of an acute myocardial infarction was: in patients who were part of the 1st group – 4.54 ± 0.331 ng/ml; 2nd – 2.74 ± 0.21 ng/ml; control group – 1.1 ± 0.037 ng/ml (р&lt;0.05). In patients of the 1st group, half a year after acute myocardial infarction, the average level of endothelial monocyte activating polypeptide-ІІ was equal to 3.6 ± 0.11 ng/ml; 2nd – 2.28 ± 0.05 ng/ml (р&lt;0.00001). Re-examination of patients, depending on treatment tactics, showed the following results: in patients with acute myocardial infarction with concomitant diabetes mellitus type 2 after cardiac ventriculography, the endothelial monocyte activating polypeptide-ІІ level was equal to 3.5 ± 0.04 ng/ml; in patients with acute myocardial infarction with concomitant diabetes mellitus type 2 after standard anticoagulant therapy it was 3.71 ± 0.03 ng/ml; in patients with isolated acute myocardial infarction after cardiac ventriculography – 2.24 ± 0.01 ng/ml; in patients with isolated acute myocardial infarction after standard anticoagulant therapy – 2.33 ± 0.04 (р&lt;0.01). Conclusion. Endothelial monocyte activating polypeptide-ІІ is a marker of endothelial dysfunction that has prognostic properties in relation to comorbid pathology in the form of acute myocardial infarction with. diabetes mellitus type 2. In patients with an acute myocardial infarction in the presence of diabetes mellitus type 2, a higher level of endothelial monocyte activating polypeptide-ІІ was noted on the 1st day of a coronary event and 6 months after it, compared to patients with an isolated acute myocardial infarction and individuals of the control group (p&lt;0.05). After cardiac ventriculography in patients, the level of endothelial monocyte activating polypeptide-ІІ was significantly lower compared to this indicator after standard anticoagulant therapy