Vol 23, No 4 (2021)



Dedov I.I., Mokrysheva N.G., Mel'nichenko G.A., Troshina E.A., Mazurina N.V., Ershova E.V., Komshilova K.A., Andreeva E.N., Antsiferov M.B., Biriukova E.V., Bordan N.S., Vagapova G.R., Volkova A.R., Volkova N.I., Volynkina A.P., Dzgoeva F.K., Kiseleva T.P., Neimark A.E., Romantsova T.I., Ruiatkina L.A., Suplotova L.A., Khalimov Y.S., Yashkov Y.I.
Consilium Medicum. 2021;23(4):311-325
pages 311-325 views

Eating disorders in patients with obesity and type 2 diabetes mellitus. Lecture for physicians

Zelenkova-Zakharchuk T.A.


Obesity and type 2 diabetes mellitus (DM 2) that result from eating disorders (ED) which lead to weight gain are endocrine diseases provoked (caused) by psychopathology, and are psychosomatic diseases. The clinical features of ED in obesity and diabetes mellitus 2 are that they rarely occur as independent psychopathological units and are mainly represented by syndromic classification in the structure of other mental disorders. Preference of the predominant type of overeating for certain types of ED onset was revealed. Thus, fetal onset is characterized by permanent overeating, pubertal one - by compulsive overeating, psychogenic one - evening overeating and menopausal/age-related hypoandrogenic one - by polysyndromic overeating. Psychopharmacotherapy and psychotherapy combination is used to treat ED in patients with DM 2 and obesity. For prevention of obesity, it is recommended to diagnose early signs of ED which lead to weight gain, and to initiate psychiatric and psychotherapeutic care as soon as possible if ED occurred. Recent 2021 clinical guidelines for the treatment of obesity were updated with recommendation that all obese patients after secondary causes for weight gain were excluded, should be consulted by a psychiatrist-psychotherapist specializing in the general somatic network.
Consilium Medicum. 2021;23(4):326-331
pages 326-331 views

Obesity and non-alcoholic fatty liver disease: cardiometabolic risks and their correction

Komshilova K.A., Mazurina N.V., Ershova E.V., Troshina E.A.


Non-alcoholic fatty liver disease (NAFLD) is the common chronic disease, associated with obesity, especially abdominal obesity, and a metabolic syndrome, that considerably raises cardiometabolic risk and is reflected in morbidity, prognosis of the disease and life expectancy of patients. NAFLD at the stage of steatosis does not increase the risk of mortality in the general population, however, the potentially dangerous stage, non-alcoholic steatohepatitis, in many cases remains unrecognized in a timely manner and, in the absence of adequate treatment, can progress and lead to the development of cirrhosis, liver failure, and hepatocellular carcinoma. The issues of NAFLD treatment are relevant due to the high prevalence of obesity, diabetes mellitus type 2, cardiovascular diseases and their complications. NAFLD therapy should be aimed primarily at the etiopathogenetic factors that contribute to its development and progression, as well as the correction of associated metabolic disorders. The growing prevalence of obesity, NAFLD and associated risk factors, diagnostic difficulties and the lack of an algorithm for managing such patients confirm the urgency of this problem. In this article describes the basic mechanisms of pathogenesis NAFLD, its role in obesity, prognosis of the disease, diagnostics and treatment.
Consilium Medicum. 2021;23(4):332-337
pages 332-337 views

Bariatricheskiy patsient: osnovnye aspekty podgotovki k khirurgicheskomu lecheniyu ozhireniya i vedeniya posle nego. Lektsiya dlya prakticheskikh vrachey

Ershova E.V., Komshilova K.A., Mazurina N.V., Troshina E.A.


Over the past years and decades, in the world in general and particularly in Russia, bariatric surgery is becoming more widespread for the treatment of severe forms of obesity. There is an increase in the number of operations performed along with the effectiveness and minimising risks of the operations held due to the improvement of surgical techniques. In this lecture, there are clearly stated indications and contraindications for the surgical treatment of obesity. Here are presented various types of bariatric surgeries and their pathophysiological mechanisms which affect on body weight, carbohydrate and lipid metabolism. There is also presented their effectiveness in comorbid obesity pathology, primarily among patients with type 2 diabetes. Here was held an analysis of possible negative effects after surgical treatment for obesity, including secondary hyperparathyroidism, post-bariatric hypoglycemia, etc., as well as predictors of postoperative prognosis in relation on metabolic control among patients with obesity and type 2 diabetes.
Consilium Medicum. 2021;23(4):339-346
pages 339-346 views

Klinicheskiy sluchay molodoy patsientki s ishemicheskim insul'tom i ozhireniem

Dzgoeva F.K., Ekusheva E.V., Rafikova D.S., Vardanian E.M.


Stroke in young adults is a serious medical and socio-economic problem. The relevance and complexity of the problem of ischemic stroke (IS) in young patients is due to insufficient knowledge of this issue, the complexity of medical and diagnostic aspects, as well as the difference in the causes of strokes from those in older age groups. Due to the variety of clinical manifestations, IS is of big interest for cardiologists, neurologists, obstetricians-gynecologists, hematologists, rheumatologists and is also relevant for endocrinologists and nutritionists. This article examines a clinical case of a patient with IS at a young age and a history of obesity and confirmed hemophilia.
Consilium Medicum. 2021;23(4):347-357
pages 347-357 views

The role of microRNA in the diagnosis of cardiovascular diseases in obese patients

Shvangiradze T.A., Bondarenko I.Z., Troshina E.A.


Obesity remains a global problem in modern society. It is commonly associated with an increased risk of cardiovascular diseases (CVD). The search for specific and sensitive biomarkers of CVD continues. Currently, a lot of studies focused on the potential role of microRNA (miRNA) in CVD development and progression. MiRNAs are involved in various pathological disorders associated with CVD. Endothelial dysfunction is considered as the initial step in the pathogenesis of many CVD, and atherosclerosis in particular. Altered expression of several miRNAs is associated with the development of endothelial dysfunction. Some miRNAs are considered as potential therapeutic targets. Further studies to evaluate the role of miRNAs in the pathogenesis of CVD are needed. It will improve the diagnosis and treatment of CVD in patients with obesity.
Consilium Medicum. 2021;23(4):358-362
pages 358-362 views

Pioglitazone is a forgotten hypoglycemic drug with proven cardioprotective and nephroprotective properties

Pesheva E.D., Fadeev V.V.


Considering that type 2 diabetes mellitus is a multicomponent disease and is associated with an extremely high risk of macrovascular complications (myocardial infarction, stroke and death from cardiovascular diseases), at present, much attention is paid to the choice of hypoglycemic drugs, given the individual characteristics of the patient. Preference is given to drugs of those classes that have a positive effect on cardiovascular outcomes. Along with relatively new molecules (inhibitors of the sodium-glucose cotransporter type 2 and agonists of glucagon-like peptide-1 receptors), the well-known drug pioglitazone, which belongs to the thiazolidinediones group, has not left the field of attention of researchers. Importantly, the cardioprotective effect of pioglitazone has been confirmed in several large randomized trials that showed a delay in atherosclerosis and a reduced risk of cardiovascular disease (PERISCOPE, CHICAGO, IRIS and PROactive). As an insulin sensitizer, pioglitazone reduces insulin resistance, has a protective effect on pancreatic 0-cells, and also has a beneficial effect on components of insulin resistance syndrome (lowers blood pressure, lipid spectrum parameters) and improves the course of non-alcoholic fatty liver disease. There is evidence of possible side effects (weight gain, fluid retention, fractures), but their severity decreases with decreasing dose of the drug.
Consilium Medicum. 2021;23(4):366-371
pages 366-371 views

Modern approaches and possibilities for assessing bone mineral density by quantitative computed tomography (literature review)

Melnikov A.A., Diachenko V.V., Shubin I.V., Nikitin A.E., Sozykin A.V., Averin E.E.


The review provides the literature data on the basal issues of bone remodeling and the applied use of medical imaging techniques for the prevention of clinically significant consequences of osteoporosis. The article discusses the role and prospects of using the method of quantitative computed tomography and its modifications for the diagnosis of osteoporosis and osteopenic syndrome. It considers the advantages of quantitative computed tomography over widely used medical techniques for assessing bone mineral density (mono- and dual-energy X-ray absorptiometry, mono- and dual-energy isotope absorptiometry).
Consilium Medicum. 2021;23(4):372-381
pages 372-381 views

Evaluation of calcium level in patients with diabetes mellitus according to the examination in the mobile medical center (Diamodule)

Zheleznyakova A.V., Volodicheva V.L., Vikulova O.K., Serkov A.A., Eremkina A.K., Shestakova M.V., Mokrysheva N.G.


Background. Diabetes mellitus (DM) is characterized by multiple risk factors for the combined development of disorders of phosphorus-calcium metabolism, due to more frequent overweight, decreased renal filtration function and vitamin D deficiency in this category of patients. Aim. To assess the level of calcium in blood serum and its correlations with parameters of carbohydrate metabolism, body mass index (BMI) and renal function in patients with type 1 and type 2 diabetes. Materials and methods. The object of the study: adult patients with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) >18 years old who underwent examination in Diamodule (n=294) in 2019 in the Voronezh region, who were additionally tested for serum calcium. The examination at the mobile medical center includes: assessment of anthropometric data (height, weight, BMI), biochemical data of blood lipids and creatinine levels with calculation of glomerular filtration rate (GFR-EPI), albuminuria and the albumin/creatinine in a single portion of urine, measurement of glycated hemoglobin (HbA1c), blood pressure, electrocardiogram, consultation with a cardiologist, ophthalmologist, specialist of the Diabetic Foot office, diabetologist. All biochemical parameters was carried out using commercial kits on a biochemical express analyzer Spotchem EZ ArkraySP-4430. Determination of HbA1c, albuminuria, albumin/creatinine was performed by immunochemical method on a DCA Vantage analyzer. Data analysis was carried out using the Statistica v.13.3 software package (TIBCO Software Inc., USA). The results are presented as medians and quartiles [25; 75], the level of reliability is taken as p<0.05. Results. Hypocalcemia (serum calcium level less 2.15 mmol/L) was detected in 88.3% of patients with T1DM and 73.6% of patients with T2DM. The level of serum calcium in T1DM was 1.96 [1.83; 2.07], in T2DM - 2.04 [1.97; 2.16] (p<0.001) with significant differences in GFR: in T1DM 69.6 [57.8; 82.5], with T2DM 50.5 [44.1; 59.9] (p<0.001). We observed correlation between GFR and calcium level r=-0.3 (p<0.05,). GFR<60 ml/min/1.73 m2 was observed in 30.5% of T1DM patients, in 75.0% of T2DM. The HbA1c in T1DM was 8.7% [7.7; 9.8], in T2DM - 8.3% [6.8; 9.4] (p=0.01). Obesity was revealed in T1DM in 12.3%, in T2DM in 71.4%; the median BMI in T1DM was 25.5 kg/m2 [21.9; 28.4], in T2DM - 33.2 kg/m2 [29.7; 37.9]. There was correlation between BMI and calcium level r=0.26 (p<0.05). Conclusion. The results of the study revealed a high prevalence of hypocalcemia among patients with diabetes, the most pronounced in type 1 diabetes. In the presence of a correlation between calcium and GFR, there was a high incidence of hypocalcemia in patients with T1DM, even in the absence of a significant decrease in GFR, which may indicate to additional risk factors. Since the assessment of the level of calcium is not included in the list of standard clinical examination, it is recommended to include this parameter and conduct regular screening in risk groups, which include patients with diabetes. More extensive research is needed to analyze the factors.
Consilium Medicum. 2021;23(4):382-388
pages 382-388 views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies