Vol 24, No 4 (2022)


A new round in the development of diabetology service

Consilium Medicum. 2022;24(4):221-223
pages 221-223 views

Chronic kidney disease risk calculator: new possibilities for predicting pathology in patients with diabetes mellitus

Vikulova O.K., Elfimova A.R., Zheleznyakova A.V., Isakov M.A., Shamkhalova M.S., Shestakova M.V., Mokrysheva N.G.


Background. Chronic kidney disease (CKD) is a socially significant pathology associated with an increased risk of mortality and progression to terminal stages, requiring expensive treatment with renal replacement therapy, which determines the priority of preventive strategies, especially in patients with diabetes mellitus (DM), who are at high risk of Kidney's injury.

Aim. To analyze the predictors of a decrease in glomerular filtration rate (GFR) less than 60 ml/min/1.73 m2 and develop an applied CKD prediction calculator in patients with type 1 and type 2 diabetes.

Materials and methods. The object of the study is a depersonalized database of the Federal Registry of DM, implemented under the auspices of the Endocrinology Research Centre. The study was based on a retrospective analysis of patients with type 1 and type 2 diabetes with different GFR dynamics over a 5-year period of 2014–2018. 68 911 patients were included (type 1 DM – 7919 and type 2 DM – 60 992). Stepwise logistic regression analysis was used to predict the risk of developing CKD.

Results. Sets of the most significant predictors of CKD development were established, which included 6 factors in type 1 DM: female sex, age, body mass index, the presence of myocardial infarction, diabetic coma and retinopathy, and 11 factors in type 2 DM: female sex, age, body mass index, glycated hemoglobin, baseline GFR and total cholesterol, presence of diabetic retinopathy, neuropathy, stroke, amputations and oncology in anamnesis.

Conclusion. An applied interactive CKD prognosis calculator has been developed that allows assessing the individual risk of developing pathology in patients with type 1 and type 2 diabetes based on the parameters available in routine clinical practice. The calculator has been introduced into the system of the Federal Registry of DM, which significantly expands the possibilities of diagnosing and monitoring CKD in DM.

Consilium Medicum. 2022;24(4):224-233
pages 224-233 views

From eating to obesity: issues of diagnosis and neuroendocrine regulation. A review

Maksim O.V., Salukhov V.V.


The problem of eating disorders, as well as the problem of obesity, is multidisciplinary and does not lose its relevance. The violation of the food pattern is caused by the influence of many factors, such as genetic, humoral, psychological, psychosocial, etc. The implementation of eating behavior is carried out through neurohumoral interaction at various levels of regulation, including the structures of the central, autonomic nervous system and the gastrointestinal tract, the functional characteristics of which are currently time continue to be actively studied. The functional characteristics of the intestinal microbiota play a significant role in the hedonistic and humoral regulation of eating behavior. Alimentary obesity is considered as a psychosomatic disease, which is formed as a result of eating disorders by the type of overeating.

Consilium Medicum. 2022;24(4):234-241
pages 234-241 views

Association of anthropometric parameters with the risk of developing type 2 diabetes in overweight or obese individuals: cohort prospective study

Valeeva F.V., Khasanova K.B., Yilmaz T.S., Mansurova R.G.


Background. Type 2 diabetes mellitus (T2DM) is a non-infectious pandemic of the 21st century. The severity and complexity of this disease is associated with the development and progression of chronic complications that begin at the stage of early carbohydrate and fat metabolism disorders.

Aim. To identify the leading anthropometric predictors of the development of type 2 diabetes in overweight or obese patients with early carbohydrate metabolism disorders.

Materials and methods. The cohort prospective study involved 112 overweight or obese adults (all citizens of Russia, Republic of Tatarstan) aged 22 to 79. The study was carried out from 2016 to 2018 in the City polyclinic №18. R 4.1.0 environment was used for statistical analysis. Univariable and multivariable logistic regression modeling were performed to evaluate association between outcomes and possible predictors, odds ratios with 95% confidence intervals were estimated. Area under the ROC-curve and Nagelkerke pseudo R-squared was used to compare prognostic performance of predictors.

Results. During 3 years of follow-up of 112 patients –– with early carbohydrate metabolism disorders (prediabetes; n=64), without prediabetes (n=48) – without medical intervention, new cases of type 2 diabetes in people with prediabetes and obesity amounted to 29% (n=18) compared with 6% (n=3) for patients with normal glucose levels. The ratio of waist circumference to height (WHtR) and the ratio of waist to hip circumference (WHR) had the greatest discriminative ability according to univariate and multifactorial analyses.

Discussion. Our study is consistent with previous work indicating a negative impact of visceral adipose tissue on the risk of developing T2DM. WHR and WHtR most accurately reveal the visceral type of obesity. WHR and WHtR are statistically significant parameters for assessing the risk of developing T2DM according to our study.

Conclusion. WHR and WHtR can be used as predictors of type 2 diabetes in overweight or obese individuals.

Consilium Medicum. 2022;24(4):242-246
pages 242-246 views

The role Time in range depending on the method of assessing glycemic control in diabetes: A review

Suplotova L.A., Sudnitsyna A.S., Dushina T.S.


Despite modern advances in diabetology, diabetes is a progressive non-communicable disease with the possible development of vascular complications, which is a global health problem. Therefore, maintaining optimal glycemic control is important for managing diabetes and preventing the development of acute and chronic complications of the disease. One of the parameters for assessing glycemic control is the indicator of time in the target range (Time in range – TIR), calculated on the basis of data from continuous glucose monitoring (CGM), which is quite simple and convenient to calculate and use, and also has a proven connection with the development of micro- and macrovascular complications of diabetes. However, the main obstacle to the widespread use of TIR is the limited use of CGM systems. Therefore, of particular interest is the study of the derived indicator of the time in range of glycemia (derived TIR – dTIR), obtained on the basis of self-monitoring of blood glucose. In this review, the issues of the relationship of TIR, dTIR with HbA1c levels, the development of micro- and macrovascular complications of diabetes type 1 and 2 are discussed, and the comparability of TIR and dTIR is analyzed.

Consilium Medicum. 2022;24(4):247-251
pages 247-251 views

The relevance of screening for cognitive and psychoemotional disorders in patients with metabolic syndrome and insulin resistance: A review

Shishkova V.N., Adasheva T.V.


Studying the issues of pathogenetic interaction in the development and progression of cognitive, psycho-emotional and vascular-metabolic disorders is the most relevant area of modern clinical research. Over the past decade, there has been a surge of interest in the scientific literature and a detailed discussion of current trends in the prevalence of diseases and conditions associated with insulin resistance and metabolic syndrome, with a particularly strong focus on the global problems of obesity and type 2 diabetes mellitus (DM). The models proposed by experts for the interaction of neurohumoral, metabolic, social and psychoemotional factors are important in understanding the processes leading to an increase in the prevalence of these conditions associated with insulin resistance throughout the world. The mechanisms of reciprocal development of such common psycho-emotional disorders as anxiety and depression in obese patients are evaluated from the standpoint of their socio-psychological relationship, as well as key triggers for the development of eating disorders. Thus, modern clinicians are gradually immersed in the need to understand the intricacies of the processes of formation of psycho-emotional disorders and master the optimal screening skills for their detection in patients with obesity and DM. The issues of studying the formation of neuronal damage in patients with insulin resistance and DM are also a priority for modern diabetologists. Possible options for the development of cerebrovascular complications, including cognitive impairment in patients with DM, described in the literature, require additional attention. A number of diagnostic tests for early detection of cognitive impairments include screening scales: MMSE (Mini-Mental State Examination), Montreal Cognitive Assessment Scale (MoCA) and Mini-Cog-test. Thus, cognitive and psychoemotional disorders, along with the developing vascular and metabolic complications of diabetes and obesity, are gradually becoming a new therapeutic target for improving the condition and prognosis of patients.

Consilium Medicum. 2022;24(4):252-255
pages 252-255 views

Retrospective analysis of patients with diabetes mellitus type 2 and acute myocardial infarction

Bardymova T.P., Tsyretorova S.S., Donirova O.S.


Background. Acute myocardial infarction (AMI) in patients with type 2 diabetes mellitus (T2DM) is characterized by a severe course and unfavorable clinical outcomes. Accumulating information, which characterize the features of the development of AMI depending on the degree of carbohydrate metabolism disorders (CMD).

Aim. To conduct a retrospective analysis of medical records with an assessment of the clinical profiles of the patients with T2DM and AMI.

Materials and methods. A retrospective analysis of medical records of patients in the acute period of myocardial infarction over a five-year period was carried out. The exclusion criteria were: unstable or stable angina pectoris. The average values and standard deviations (M±SD) were calculated. Comparison of quantitative variables between groups was carried out using the Student's t-test. Absolute (n) and relative (%) values were calculated to describe qualitative data. The value p<0.05 was used as the level of statistical significance.

Results. The total number of medical records is 7618, of them with AMI – 2337 cards, of which 1114 (48%) patients with T2DM, type 1 diabetes mellitus, impaired glucose tolerance/impaired fasting glycemia (IGT/IFG) and AMI, as well as 1223 (52%) patients with AMI without CMD. Among patients with AMI, patients with T2DM and AMI accounted for 23%. Gender differences with female dominance were registered in the group of T2DM and AMI (63%), men dominated among patients with AMI without CMD. In the groups of T2DM and AMI, IGT/IFG and AMI, AMI without CMD, women were older than men (p<0.05%). In patients with T2DM and AMI, compared with patients with AMI without CMD, repeated AMI and high mortality are more often registered. The presence of diabetes was associated with a higher incidence of concomitant diseases and the presence of severe complications of the disease.

Conclusion. Clinical features of AMI in patients with T2DM are represented by gender-age parameters, characteristics of concomitant pathology and the nature of complications of acute ischemia, the frequency of repeated AMI with an increased risk of adverse outcomes.

Consilium Medicum. 2022;24(4):256-260
pages 256-260 views

The problem of identification and correction of micro- and macronutrients deficiency after bariatric surgery: A review

Salukhov V.V., Kovalevskaya E.A., Sardinov R.T.


Surgical treatment of obesity is one of the most effective ways to reduce and maintain body weight for a long time. Depending on the type of operation, patients with different frequency develop malabsorption syndrome. As a result, in individuals who have received this type of medical care, at different times after bariatric surgery, micro and macronutrient deficiencies may be detected. Therefore, the long-term safety of this treatment method is associated with the correction of vitamin and trace element deficiencies both before and after bariatric intervention. This review highlights the most common deficiencies that are found in obese patients, as well as methods for their diagnosis and treatment.

Consilium Medicum. 2022;24(4):261-265
pages 261-265 views

The role of the rs1801282 PPARG polymorphic marker in the prediction and choice of carbohydrate metabolism disorders management: A review

Khasanova K.B., Medvedeva M.S., Valeeva E.V., Rodygina Z.A., Kiseleva T.A., Valeeva F.V.


The PPARG gene has the great value in predicting of carbohydrate metabolism disorders development and the patients’ response to different therapy options. The article presents the information about the association between the single nucleotide polymorphism rs1801282 PPARG and the risk of different carbohydrate metabolism disorders development based on a review of the domestic and foreign researches. Despite that literature data regarding the association of this polymorphism with the development of metabolic disorders differ, most researchers agree that the G-allele of rs1801282 PPARG has the protective effect in relation to the risk of carbohydrate metabolism disorders development. The particular emphasis is placed on the association of rs1801282 PPARG with the results of carbohydrate metabolism disorders management, taking into account the lifestyle changes as well as the intake of oral hypoglycemic drugs used in the treatment of prediabetes and type 2 diabetes. Thus, a number of studies have shown that the G-allele carriers of rs1801282 PPARG had a better response to pioglitazone treatment in the form of lowering of fasting glucose and A1C levels and lipid profile normalization. The association of the polymorphism with the results of therapy with metformin remains an open question that requires further study.

Consilium Medicum. 2022;24(4):266-270
pages 266-270 views

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