Obesity is the basis of metabolic syndrome

Metabolic syndrome is a symptom complex that is based on visceral obesity and insulin resistance. Its prevalence is quite high, which is a big problem, since this condition increases the risk of developing cardiovascular diseases and mortality from them. Metabolic syndrome includes, in addition to abdominal obesity, arterial hypertension, disorders of carbohydrate, lipid and purine metabolism. Visceral adipose tissue plays a key role in the formation of insulin resistance and other components of the metabolic syndrome. This is due to the fact that abdominal fat, in contrast to subcutaneous fat, synthesizes pro-inflammatory cytokines, as well as adipokines — adipose tissue hormones that are involved in the formation of insulin resistance, affect carbohydrate and fat metabolism and the cardiovascular system. These include leptin, adiponectin, resistin, apelin and others. Some adipokines have an adverse effect on metabolism and increase cardiovascular risks, while others, on the contrary, have a positive effect. Taking into account their role in the development of the components of the metabolic syndrome, the possibilities of a therapeutic effect on the hormones of adipose tissue to improve metabolic processes and prevent complications associated with it are discussed

The specifics of cardiovascular disease and the role of self-monitoring in patients with type 2 diabetes

High risk of cardiovascular complications in patients with diabetes mellitus (DM) is a global health problem. Preventing the onset and progression of the pathology in diabetes should be primarily considered in terms of its maximum compensation, where the leading role belongs to patient education and adequate self-monitoring of blood glucose

Diabetic autonomic neuropathy is a barrier to achieving glycemic control

Diabetic autonomic neuropathy is the second most common form of damage to the nervous system in diabetes mellitus as a result of disorders of the central and/or peripheral parts of the autonomic nervous system. On average, its frequency of occurrence is about 40%, and 60% or more with an increase in the duration of diabetes over than 10 years. Diabetic autonomic neuropathy is characterized by polysyndromism of clinical manifestations. In this regard, a number of forms of diabetic autonomic neuropathy are distinguished both in the form of an isolated violation of the function of organs and systems, and with their combined defeat. In the pathogenesis of autonomic neuropathy, vascular and metabolic changes common to the development of diabetic polyneuropathy play an important role. The most significant risk factors for the development of diabetic autonomic neuropathy are the patient's age, duration of diabetes mellitus, and a higher average HbA1c. The development and progression of diabetic autonomic neuropathy depends on glycemic control, but its forms such as gastrointestinal and impaired recognition of hypoglycemia (asymptomatic hypoglycemia) can cause poor compensation for diabetes. This article discusses the various clinical manifestations of gastrointestinal autonomic neuropathy. Attention is drawn to the fact that the clinical picture is often nonspecific and asymptomatic, which complicates timely diagnosis. The gastrointestinal form of diabetic autonomic neuropathy leads to limited performance, social maladaptation of patients, dramatically reduces the quality of life of patients with diabetes mellitus. In clinical practice, the doctor must remember that it can significantly affect the achievement of glycemic control, as a result of a violation of the digestion and passage of food, as well as a violation of the pharmacokinetics of hypoglycemic drugs. Impaired recognition of hypoglycemia also makes it difficult to compensate well. These complications require a personalized approach to the patient from the doctor, and strict and frequent self-control of glycemia with the help of a modern glucometer from the patient to maintain optimal glycemic control and prevent possible hypoglycemic conditions

The content of adipokines in women with hypothyroidism and type 2 diabetes mellitus

Introduction. Type 2 diabetes mellitus (DM) and hypothyroidism are the most common endocrine pathologies. These diseases are associated with atherogenic dyslipidemia, insulin resistance, and overweight.Aim. Тo assess the relationship between adipokines and hormone-metabolic parameters in women with hypothyroidism, type 2 diabetes mellitus and their combination.Materials and methods. We examined 119 women aged 45 to 74 years: 42 women with primary hypothyroidism, 38 women with type 2 diabetes and 39 women with a combination of type 2 diabetes and hypothyroidism. All patients underwent an anthropometric examination, studied the indicators of lipid and carbohydrate metabolism, the content of adiponectin, leptin and resistin.Results. In women with type 2 diabetes and its combination with hypothyroidism, hyperglycemia, hyperinsulinemia, and insulin resistance were revealed. In all groups, an increase in total cholesterol, triglycerides, atherogenic coefficient was found. The examined women with a combination of hypothyroidism and type 2 diabetes mellitus had a decreased level of adiponectin and an increased level of leptin. In patients with hypothyroidism and patients with type 2 diabetes, a decrease in adiponectin levels and an increase in leptin and resistin were revealed.Discussion. The most pronounced hyperinsulinemia and insulin resistance were found in the group of patients with a combination of hypothyroidism and type 2 diabetes. At the same time, the combination of type 2 diabetes and hypothyroidism in the examined women, according to our data, did not aggravate lipid metabolism disorders. Against the background of visceral obesity in women with a combination of diseases, hypoadiponectinemia and hyperleptinemia were most pronounced. In this group, the level of resistin was positively correlated with the level of insulin and the index of insulin resistance.Conclusion. In women with hypothyroidism, type 2 diabetes and their combination, atherogenic dyslipidemia, hyperleptinemia, and hypoadiponectinemia were established. Hypoadiponectinemia and hyperleptinemia are involved in the development of atherogenic dyslipidemia in women with primary hypothyroidism

REZUL'TATY RENTGENOMORFOMETRII POZVONOChNIKA U bol'nykh sakharnym diabetom2 tipa

In this study we analyzed degree, character, spreading and location of vertebral deformation in lateral radiograph of the thoracic and lumbar spine (by method of Felsenberg).We analyzed radiographs 55 patients with diabetes mellitus (25 men and 30 women). Index Saville was also estimated. Deformation of anterior vertebral areas prevailed over deformations of vertebral bodies in this kind of patients. The conclusion is that diabetes mellitus doesn't go along with frequent development of vertebral osteoporosis

Adipokines and metabolic parameters in patients with type 2 diabetes mellitus in combination with gout

Aim. To study the impact of type 2 diabetes and its combination with gout on the level of adipokines, hormonal and metabolic parameters.Materials and methods. The study included 18 men with type 2 diabetes with a mean age 57,83 ± 1,67 years, and 21 subjects with a combination of type 2 diabetes and gout, whose average age was 57,57 ± 1,44 years. The controls were 40 healthy men: 20 subjects with an average age of 21,03 ± 0,15 years and 20 men with average age 51,31 ± 1,34 years. All patients had anthropometric measurements, evaluation of parameters of lipid and carbohydrate metabolism, uric acid, levels of adiponectin, leptin and resistin.Results. Patients of both groups had elevated concentrations of leptin, resistin and reduced level of adiponectin. Men with type 2 diabetes, and its combination with gout had increased levels of total cholesterol, triglycerides, glucose and insulin.Conclusion. In patients with type 2 diabetes, and its combination with gout are characterized by hyperleptinemia, hypererresistinemia, hypooadiponectinemia. Insulin resistance with compensatory hyperinsulinemia and atherogenic dyslipidemia was found in all patient groups

The role of sulfonylures in the treatment of type 2 diabetes

Type 2 diabetes mellitus (T2DM) is one of the most common diseases in the world accounting for about 85--90% of the total number of people with diabetes. More than 80% of these patients are overweight or obese, and lead sedentary lifestyles. If earlier T2DM was considered "a disease of the elderly", now half of patients suffering from the disease are people of working age. Reduced working ability as well as financial burden of prevention and treatment of late complications of DM are a significant problem for the healthcare system and society as a whole. At the same time, T2DM therapy involving effective medicines which are convenient and have minimum side effects could markedly reduce treatment costs

ADIPOKINES CONTENT AND ECHOCARDIOGRAPHY INDICATORS OF WOMEN WITH HYPOTHYROIDISM

Study objective: to study the adipokines content and echocardiography indicators of women with hypothyroidism.Materials and methods. 30 women with hypothyroidism were included into the study with the average age of 55.2 ± 2.2 years old and the duration of disease of 8.53 ± 0.84 years. Anthropometric parameters of all patients were measured. Levels of leptin, resistin, adiponectin were investigated with enzyme multiplied immunoassay. Morphometric parameters of the left ventricle (LV) were assessed with echocardiography.Results. The examined patients with hypothyroidism displayed increased concentration of leptin and resistin, as well as decreased concentration of adiponectin. Concentric and eccentric hypertrophy of the left ventricle is revealed in more than half of cases with patients with the hypofunction of the thyroid gland.Conclusion. Evident decreasing of the level of adiponektin and increasing of the level of leptin and resistin was revealed with examined patients on the background of the excessive body weight. Hypertrophy of the left ventricle and diastolic dysfunction of the myocard with its relatively preserved contractile ability was revealed with women that suffer from hypothyroidism. Age, excessive body weight, increasing of arterial blood pressure, and hypoadiponectinemia play a significant role in the left ventricle myocardial remodeling.</p

Symbiosis of cardiology and endocrinology

In medical practice, there are often patients who have several diseases at once, both pathogenetically related to each other and not related. The article discusses endocrine diseases in which there are manifestations from the cardiovascular system - disorders of carbohydrate metabolism, pathology of the thyroid gland, adrenal glands and acromegaly. These diseases reduce the quality of life of patients and increase the risks of cardiovascular complications. The article also discusses the features of cardiovascular manifestations in these diseases and indications for differential diagnosis. Type 2 diabetes mellitus significantly increases the cardiovascular risks, which leads to a more rapid progression of atherosclerosis. Moreover, vascular disorders are detected already at the stage of prediabetes. Therefore, it is necessary to identify disorders of carbohydrate metabolism as early as possible and initiate appropriate therapy. When prescribing antihyperglycemic therapy, preference should be given to drugs with a low risk of hypoglycemia (metformin, glucagon-like peptide-1 agonists, type 2 sodium glucose co-transporter inhibitors). Thyroid dysfunctions - thyrotoxicosis and hypothyroidism - also have an adverse effect on the cardiovascular system. Hypothyroidism often has a blurred clinical picture and manifestations from various organs, and therefore it is diagnosed late. Therefore, an active diagnosis of this condition should be carried out in persons with a combination of a wide variety of diseases, especially in old age. Adrenal pathology (pheochromocytoma, hyperaldosteronism and hypercorticism) is manifested by an increase in blood pressure. Differential diagnosis is worthwhile in case of severe arterial hypertension or resistance to antihypertensive therapy. In acromegaly, lesions of the cardiovascular system are quite common and are the main cause of death in these patients. Therefore, early detection of this pathology is especially important. Thus, such patients should be monitored jointly by a cardiologist and an endocrinologist, and timely diagnosis and treatment of endocrine pathology will help reduce their cardiovascular risks

Insulin resistance in therapeutic clinic

Today an obesity became the global epidemic striking both children, and adults and represents one of the most important problems of health care worldwide. Excess accumulation of fatty tissue is resulted by insulin resistance and a compensatory hyperinsulinaemia which are the main predictors of development of a diabetes mellitus type 2. Insulin resistance is also one of key links of a pathogenesis of such diseases as cardiovascular pathology, not-alcoholic fatty liver disease, a polycystic ovary syndrome, gestational diabetes and many others. Depression of sensitivity of tissues to insulin can be physiological reaction of an organism to stress factors and pathological process. The endogenic reasons also take part in development of insulin resistance besides factors of the external environment. The role of genetic predisposition, a subclinical inflammation of fatty tissue, thyroid hormones, adipokines and vitamin D in formation of this pathological process is studied. As insulin resistance takes part in a pathogenesis of various diseases, methods of its diagnostics and correction are of great importance in therapeutic practice. At purpose of treatment it is worth giving preference to the drugs which are positively influencing sensitivity of tissues to insulin