Vol 24, No 4 (2022)

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.

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.

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.

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.