DIABETES MELLITUS IN PATIENTS FROM BURYAT POPULATION

The paper considers specific features of type 1 Diabetes Mellitus in patients from Buryat populations. Characteristics of the incidence and prevalence of type 1 Diabetes Mellitus in patients of Buryat nationality are presented. Clinicalfeatures of type 1 Diabetes Mellitus in patients-buryats are highlighted. The aim of this study was to determine the ethnic characteristics of Diabetes Mellitus in patientsfrom Buryat population. It was found that the incidence and prevalence of type 1 Diabetes Mellitus in the Buryat population was below the relevant indicators of Russia and constituted 0.73 and 24.18 per 100 thousand population. Late vascular complications of the disease (diabetic nephropathy, diabetic retinopathy) occur in patients with type 1 Diabetes Mellitus of Buryat nationality less frequently than in the general population of patients with type 1 Diabetes Mellitus. Found that diabetic polyneuropathy (DP) was diagnosed in 25.8 % of patients

METABOLISM

According to the World Health Organization experts, the prevalence of diabetes is ahead of the most pessimistic forecasts and has already acquired the character of non-infectious epidemic in the world. Furthermore, today there is a tendency not only to the increase in the incidence of type 2 diabetes, but to the prevalence of comorbid conditions, including osteoporosis and osteopenia. In turn, in recent decades, osteoporosis is one of the most widespread and socially significant diseases, in all countries without exception its frequency in recent decades has been steadily increasing particularly among postmenopausal women. At the same time, a special state of bone metabolism in patients with type 2 diabetes is marked. The paper presents the study results of the content of the markers of bone metabolism in postmenopausal women with type 2 diabetes. Twenty-eight women, 15 of them with type 2 diabetes and 13 - in the control group were examined. The levels of ionized calcium, 25-OH vitamin D, osteocalcin, N-terminal propeptide of type 1 procollagen C-terminal telopeptides of type I collagen were determined. We also estimated the average daily calcium intake in women with type 2 diabetes. A substantial reduction in markers of bone metabolism, reflecting fixation processes, due to lower markers characterizing osteoresorption in patients with type 2 diabetes relative to the control group was determined. The findings raise the question of further studies of the mechanisms of formation of bone metabolism disorders in conditions of hyperglycemia

TYPE 2 DIABETES MELLITUS AND CORONARY HEART DISEASE

In recent years, the growth in the number of diabetic patients has been registered in the most countries. In turn, the diseases of the cardiovascular system are still the leading cause of death in many countries. Against the background of rapid growth in the incidence of diabetes mellitus, the number of patients with combined pathology including coronary heart disease and type 2 diabetes mellitus increases. Oxidation of LDL with the subsequent generation of cytokines and other biologically active molecules is considered one of the major pathogenic mechanisms of atherosclerosis. Hyperglycemia contributes to the processes of lipid peroxidation with activation of atherogenesis with increased risk of vascular lesions. The modern views on commonality of the mechanisms of the development of diabetes and coronary heart disease are studied. Attention is paid to the generation of free radicals, which being highly reactive unstable chemical compounds damage the endothelium. However, activation of free radical processes in the conditions of hyperglycemia stimulate the increased synthesis of pro-inflammatory cytokines, including necrosisfactor-a tumor, interleukins, which are a reflection of local and systemic inflammation. This review presents detailed description of the main pro-inflammatory cytokines (interleukin-1ß, interleukin-6, interleukin-8, TNF-a) and C-reactive protein. The value of insulin resistance and hyperfibrinogenemia in diabetes mellitus combined with coronary heart disease and the factors, which increase the risk for adverse outcomes of coronary heart disease, is presented in the article

Ethnic characteristics of bone remodeling in female patients with type 2 diabetes mellitus

Background: Structural and metabolic disorders of bone tissue in women with T2DM have no clinical manifestations, but they are accompanied by the risk of fractures.Aim: To study the parameters of bone metabolism, BMD and microarchitectonics in female patients with T2DM in the Buryat population.Materials and methods: The observational single-center one-stage controlled study included 73 women with T2DM, which were divided into 2 groups depending on the functional state of the ovaries (reproductive and postmenopausal periods). In each group, subgroups of the Buryat and Russian populations were identified. The first group included 34 patients with T2DM of the reproductive period: 16 from the Buryat population and 18 from the Russian population. The second group consisted of 39 postmenopausal patients with T2DM: 17 from the Buryat population and 22 from the Russian population. The study of BMD in the lumbar spine (L1-L4), femoral neck (Neck), in the proximal femur (Total hip), trabecular bone score (TBS), serum osteocalcin (OC), N-terminal propeptide type 1 procollagen was carried out (P1NP), vitamin D 25 (OH), blood plasma type I collagen C-terminal telopeptide (β-Cross laps) and ionized calcium (iCa).Results: In female patients with T2DM of the reproductive age of the Buryat population, an increase in both markers of osteosynthesis P1NP (p=0.035), OC (p=0.047), and bone resorption β-Cross laps (p=0.040) was found relative to the similar group of the Russian population. In women with T2DM in the postmenopausal period of the Buryat population, there was also an increase in P1NP (p = 0.016), OC (p = 0.048), β-Cross laps (p = 0.020) compared with the group of postmenopausal women in the Russian population. Structural disorders, characterized by a decrease in TBS, were detected only in the postmenopausal period in female patients of the Buryat population compared to women in the Russian population (p = 0.029).Comparative analysis among women with T2DM of the Buryat population, depending on the functional state of the ovaries, showed that activation of bone remodeling with an increase in P1NP (p = 0.019), OC (p = 0.004) and β-Cross laps (p = 0.004) is characteristic of postmenopausal women accompanied by a decrease in BMD Neck (p = 0.006), BMD Total hip (p = 0.003), BMD L1-L4 (p = 0.049) and TBS (p = 0.020) relative to female patients with T2DM in the reproductive period.Conclusion: In women with T2DM in the Buryat population, both in the reproductive and postmenopausal periods, an increase in bone remodeling markers and BMD stability was found when compared with the corresponding groups of patients in the Russian population. The postmenopausal period was characterized by an additional decrease in TBS in patients with T2DM in the Buryat population relative to women in the Russian population

Bone remodeling in women with diabetes mellitus

Background. 1t is known that the type 2 diabetes mellitus (DM) and osteoporosis are more often diagnosed in senior women. The condition of a bone tissue is accompanied by the metabolic violations that are typical for DM. The recent researches established the multidirectional changes of bone remodeling markers in women with type 2 DM at different age periods. Aims: to study the condition of bone remodeling in women with type 2 DM at different age periods. Materials and methods. We examined 27 women with type 2 DM, among them 15 were in the post-menopausal period and 12 with preserved menstrual function. Levels of osteocalcin, N-terminal propeptide of type 1 collagen (P1NP), C-terminal telopeptide of type 1 collagen (β-Crosslaps), 25-OH vitamin D, the ionized calcium were researched. Results. The analysis showed that increase in β-Crosslaps levels, P1NP, levels of osteocaltcin were observed in women with type 2 DM in the post-menopausal period, compared to parameters of women with type 2 DM with preserved menstrual function. Inverse correlation relation of osteocaltcin and 25-OH vitamin D was revealed in women with type 2 DM. Conclusion. Significant increase in markers of osteosynthesis and osteoresorption in women with type 2 DM was shown in the post-menopausal period compared with indicators of women with type 2 DM with preserved menstrual function

LIPID PEROXIDATION SYSTEM IN TYPE 1 DIABETES: ETHNIC ASPECTS

Oxidative stress is an acknowledged pathogenic mechanism in Type 1 diabetes mellitus. Acute increases in plasma glucose concentration may increase free radical production by the following mechanisms: labile glycation; auto-oxidation of glucose, and intracellular activation of the polyol pathway; which produces an imbalance in the NADh/NAD+ ratio and favours the production of free radicals. Incidence, severity, and rate of complications of Type 1 diabetes mellitus are associated with many factors including geographic location and ethnicity. The main features of lipid peroxidation in 30 women with type 1 diabetes in Buryat and Russian ethnic groups were examined. The materials for biochemical studies were blood serum and red cells. The content of the substrates and products of lipid peroxidation (diene conjugates, ketodienes and coupled trienes, malondialdehyde), total antioxidant activity of serum and its components (superoxide dismutase, α-tocopherol, retinol, reduced and oxidized glutathione) were evaluated by a spectrofluorophotometer «SHIMADZU-1501» (Japan). Statistical analysis was performed by non-parametric tests. It is shown that the intensity of lipid peroxidation processes in patients Buryat ethnic group is reduced in comparison with Russian ethnic group, that confirmed by the values of the coefficient of oxidative stress. The study was supported by grants of the President of the Council of the Russian Federation (Scientific School 494.2012.7)

Canagliflozin: from glycemic control to improvement of cardiovascular and renal prognosis in patients with type 2 diabetes mellitus. Resolution of Advisory Board

Inhibitors of the sodium-glucose cotransporter type 2 (SGLT2i) are a modern class of antihyperglycemic drugs with an insulin-independent mechanism of action. Due to its ability to effectively lower blood glucose levels, improve a number of other cardiometabolic parameters (body weight, blood pressure, uric acid), as well as reduce cardiovascular and renal risks, SGLT2i have become drugs of choice for many of patients with type 2 diabetes mellitus (T2DM). Meanwhile, along with the generally recognized classes-effects of this group of drugs, there are intragroup features, including those associated with their different selectivity in sodium-glucose cotransporters of types 1 and 2 (SGLT1 and SGLT 2). For example, one of the most studied SGLT2i, canagliflozin, in addition to its inhibitory activity against SGLT2, can also moderately block SGLT1 in the intestine and kidneys that could give a maximum efficiency in the control glycemia and others cardiometabolic parameters. In addition, canagliflozin improves not only cardiovascular, but also renal prognosis in patients with T2DM, which is reflected in the corresponding indications in the summary of product characteristics of the drug. This document summarize the established and new data regarding the efficacy and safety of canagliflozin, as well as its place in the treatment of T2DM

Glycemia control and choice of antihyperglycemic therapy in patients with type 2 diabetes mellitus and COVID-19: a consensus decision of the board of experts of the Russian association of endocrinologists

A dangerous viral disease COVID-19, caused by a new RNA coronavirus SARS-COV-2, has been actively spreading in the world since December 2019. The main manifestations of this disease are bilateral pneumonia, often accompanied by the development of acute respiratory syndrome and respiratory failure. Patients with diabetes mellitus (DM) are at high risk of infection with the SARS-COV-2 virus, severe illness and death.Maintaining of target glycemic levels is the most important factor in a favorable outcome of COVID-19 in both type 1 and type 2 DM. The choice of antihyperglycemic therapy in a patient with DM in the acute period of COVID-19 depends on the initial therapy, the severity of hyperglycemia, the severity of the viral infection and the patient’s clinical condition.The article presents the recommendations of the board of experts of the Russian Association of Endocrinologists on glycemic control and the choice of antihyperglycemic therapy in patients with type 2 DM and COVID-19, and also on the use of glucocorticosteroids used in the treatment of COVID-19 in patients with type 2 DM

METABOLIC CHARACTERISTICS OF PATIENTS WITH OBESITY

Background: Obesity is considered to be the most wide-spared disease all over the world [1]. Having a hormonal activity, adipose tissue takes part in coordinating of metabolic processes. Taking into consideration the excess accumulation of the adipose tissue, the proceeding of metabolic process gets abidingly broken [2]. Aims: The aim of this thesis is to analyze a hormone metabolism of the hormones of adipose tissue among the patients who has obesity. Materials and methods: 30 patients with obesity without any accompanying disease were examined. This examination was done to determine the level of adipokines (leptin, adiponectin, visfatin), insulin with index calculus of insulin resistance, blood lipids. Results: The analysis showed the fact that patients with obesity have a higher level of insulin, leptin in comparison to the control group. However, the level of adiponectin among people from the control group increased the same level of patients with obesity. The essential differences in the level of visfatin has not been discovered. Hyperinsulinemia and Dyslipidemia (increased cholesterol low density lipoprotein (TC-LDL), triglycerides (TG), reduction of cholesterol of high density lipoproteins (HDL – C)) are observed alongside the increase of leptin level among the patients with obesity. Conclusion: Multidirectional changes of hormones of adipose tissue are established among the patients with obesity without somatic pathology in comparison with the ones without obesity and overweight. The determined dynamics of adipokines contributes changes of functioning of physiological systems of out organism and demands the research of more informative and essential methods of correction

THE INTERIM EXPERTS’ COUNCIL RESOLUTION ON THE EMPA-REG OUTCOME TRIAL ISSUES

The interdisciplinary interim experts’ council on March 3, 2016 in Moscow have considered the EMPA-REG OUTCOME trial results and suggested a number of propositions and recommendations on further empagliflozin’s cardiovascular effects investigation and its clinical application in patients with type 2 diabetes at high cardiovascular risk