[The clinical features of cystic fibrosis in adult patients with carbohydrate metabolic disturbances].

AIM: To investigate the clinical features of cystic fibrosis (CF) in adult patients with carbohydrate metabolic disturbances (CMD). MATERIAL AND METHODS: CF was diagnosed on the basis of its clinical picture and a positive sweat test, and/or genetic study. Clinical, anthropometric, functional, microbiological data were compared with the results of imaging diagnosis in CF patients with and without CMD. RESULTS: The data of 350 patients were retrospectively analyzed. An oral glucose tolerance test was randomly performed in 154 CF patients without CMD. There was normal carbohydrate metabolism in 92 (59.7%) patients with CF, impaired glucose tolerance (IGT) in 44 (28.6%), CF-dependent diabetes mellitus (CFDDM) in 18 (11.70%). The latter had been previously diagnosed in 37 (10.6%) other patients with CF. Three groups of patients were formed: 1) 92 patients without CMD; 2) 44 with IGT, and 3) 55 with CFDDM. The patients with CFDDM had lower stature, weight, and lung function, significantly more common bronchiectases, a lower Staphylococcus aureus colonization with a tendency toward a higher Burkholderia cepacia colonization than those without CMD. As compared with the patients without CMD, those with this disorder were found to have a high rate of severe mutations; mild mutations were absent in the patients with CFDDM. CONCLUSION: CMD in CF is characterized by its high rates and latent course. The patients with CMD have retarded physical development, more pronounced morphofunctional disorders in the bronchopulmonary system, lower lung functional parameters, and more aggressive sputum microbial composition.

[Association between chronic obstructive pulmonary diseases and diabetes mellitus, type I and II].

AIM: To study an association between multifactorial obstructive pulmonary disease (COPD) and asthma and types 1 and 2 diabetes (T1D and T2D). SUBJECTS AND METHODS: A multicenter study was conducted in two formed cohorts of patients with bronchopulmonary pathology (n = 616) and diabetes (n = 700). Random sampling, retrospective data collection, by applying a blind approach, as well as questioning and, if need be, diagnosis verification and an additional study were accomplished. Statistical methods were employed to make a cross assessment of the prevalence of the diseases in each cohort as compared to a control group in which population-based values were used. RESULTS: In the cohort of patients with bronchopulmonary pathology, the prevalence of T2D was considerable in patients with COPD, it was 9.49%, which was greater than the control values (3.0; p < 0.01), more than 25 times higher (p < 0.05) than that in asthmatic patients in whom the prevalence was 3.64% and it did not differ from the control group. In COPD concurrent with T2D, the prevalence of diabetes was as high as 16.15% (p < 0.001). At the same time, the prevalence of bronchopulmonary pathology in the T2D cohort being 2.3% for COPD and 1.0% for asthma was lower than the population-based value (p < 0.05), 2.6% and 6.1%, respectively. It was contrastingly found that T1D was absent in the asthmatic patients and the prevalence of asthma (0.33%) was low in patients with asthma (p < 0.05). In parallel, an association between COPD and T1D could not be traced, by taking into account an age difference and other specific features of a pathological process in these patient groups. CONCLUSION: Unlike asthma, COPD, in combination with asthma in particular, is an essential risk factor for T2D. Asthma and T1D mutually exclude each other.

[Associations of chronic obstructive pulmonary disease, bronchial asthma, and type 1 diabetes mellitus].

The aim of the study was to clarify the relationships between bronchial asthma (BA), chronic obstructive pulmonary disease (COPD), and type 1 diabetes mellitus. Reduced prevalence of concomitant BA and DM1 suggests inverse relation between the two conditions and their mutually exclusive nature. The problem needs further studies. Taking into account age-specific and other features of COPD and DM1 pathological processes elucidation of their interrelation appears impractical.

[Investigation into relationship between chronic obstructive pulmonary disease, bronchial asthma, and type 2 diabetes].

We studied the relationship between bronchopulmonary pathology (chronic pulmonary disease, CPD, and bronchial asthma, BA) and type 2 diabetes (DM2). The two conditions were shown to be underlain by inflammation of different character. In patients with CPD it leads to DM2. Concomitant CPD and BA significantly increase the risk of DM2 and require the development of measures for its diagnosis and prevention.

[A comparative study of leptin content in diabetics and obese subjects].

AIM: To compare leptin content in morphologically heterogenic group of patients with type 2 diabetes mellitus and obese patients without family history of diabetes. MATERIAL AND METHODS: Leptin concentration was estimated with enzyme immunoassay (Leptin kit Sandwish ELISA, DRG diagnostics GmdH) in 21 patients with type 2 diabetes mellitus (2DM) and 12 obese patients without family history of diabetes. Distribution of patients with a documented diagnosis type 2 diabetes mellitus was conducted with application of instruments for antropometric examination (G.P. Gneupel, Switzerland). Statistic processing was made with the program Statistica 6 using Student's t-criterion. RESULTS: Patients with diabetes mellitus and phenotypical marker of 2DM had the lowest level of leptin (mean leptin level 1.99 ng/ml in males, 11.01 ng/ml in females versus 2DM patients without the marker (mean leptin level 9.16 n/mg in males, 23.56 n/mg in females) and control group (13.86 ng/ ml in males, 22.55 ng/ml in females). CONCLUSION: There is a correlation between leptin concentration and anthropological features of the patients.

[Leptin levels in patients with bronchial asthma and diabetes mellitus]. / Soderzhanie leptina u bol'nykh bronkhial'noi astmoi i sakharnym diabetom.

AIM: To estimate leptin production in long-term steroid therapy, insulin resistance and obesity. MATERIAL AND METHODS: Leptin concentrations were measured with enzyme immunoassay in 101 patients with bronchial asthma and diabetes mellitus and 31 healthy controls with overweight. The mean age was 54.4 +/- 14.1 years in males and 56.8 +/- 12.1 years in females. The body mass index ranged from 18 to 47 kg/m2, while leptin varied from 0.1 to 105.8 ng/ml. RESULTS: Leptin was highest in patients with bronchial asthma and steroids-induced diabetes mellitus, lower in patients with diabetes mellitus type 2 and obese controls while it was lowest in patients with atopic bronchial asthma. CONCLUSION: Steroids and insulin resistance participate in the regulation of leptin production. Steroids induce hyperleptinemia in vivo more intensively than insulin.

[Diabetes mellitus incidence and its prevalence in Moscow]. / Zabolevaemost' sakharnym diabetom i ego rasprostranennost' v Moskve.

Epidemiologic survey of two diabetes mellitus types in Moscow has shown that the incidence of type I diabetes markedly increases from birth (0.012-0.013%) to the age of 10-14 (0.04-0.045%), after which somewhat reduces (0.02-0.03%) and thus persists up to 40. Type I diabetes prevalence increases from 0.002-0.004% at the age of 0 to 4 years to 0.14-0.092% by the age of 35-39 in men and women, respectively. Type II diabetes is diagnosed after the age of 20. At the age of 20 to 24 this diabetes incidence is lower than that of type I condition; at the age of 25-34 the incidence of both is approximately the same, and after 35 the incidence of type II is much higher than that of type I diabetes. Type II diabetes prevalence by the age of 40 is 0.074 and 0.122% in men and women, respectively. Prevalence of diabetes cases treated with diets and oral sugar-reducing drugs at the age 75 and older is 4.3% in men and 5.5% in women, of insulin-treated cases 1.2 and 0.5%, respectively. The true prevalence of type II diabetes is however higher and that of type I condition lower than the resultant values; this is explained by a frequent prescription of insulin to elderly patients with type II diabetes because of complications or concomitant diseases.

[Genetic analysis of the structure of predisposition to diabetes mellitus. IV. Population-genetics study of two types of diabetes mellitus with onset at age 20-40]. / Geneticheskii analiz struktury predraspolozheniia k sakharnomu diabetu. Soobshchenie IV. Populiatsionno-geneticheskoe issledovanie dvukh tipov sakharnogo diabeta, voznikshego vozraste ot 20 do 40 let.

It was found that age-specific morbidity risks of type I diabetes mellitus (DM I) increased from the age of 0-4 yrs (0.012-0.013%) to the age of 10-14 yrs (0.04-0.045%) and then slightly decreased to 0.02-0.03%, remaining at this level up to 40 yrs. The "cumulative" morbidity risk of DM I (population risk of development of DM I for each born individual, irrespective of family history) was found to be 0.2% for the age from 0-4 to 40 yrs. Assuming the age-specific morbidity risks of DM I after the age of 40 yrs to be the same as that at 40 yrs (0.02-0.03%), the "cumulative" morbidity risk for this type of DM from birth to 75 yrs old was estimated to be 0.36-0.44%. First incidences of DM II in the population were only observed in 20 yrs olds. The morbidity risk level for DM II at the age 20-24 yrs was found to be lower than that for DM I at this age. The risk was about the same level both for DM I and for DM II at the age 25-34 yrs, the morbidity risk levels for DM II after 35 yrs exceeding that for DM I. The "cumulative" risk of DM II by the age of 40 yrs was 0.1% for men and 0.15% for women. Analysis of familial data revealed statistically significant increase in recurrent morbidity risk in relatives only for the types of DM presented in probands.(ABSTRACT TRUNCATED AT 250 WORDS)

[An analysis of the interrelationship of the HLA genotype and carbohydrate metabolism in the families of probands with insulin-dependent diabetes mellitus]. / Analiz vzaimosviazi HLA-genotipa i sostoianiia uglevodnogo obmena v sem'iakh probandov s insulinzavisimym sakharnym diabetom.

A total of 15 families were investigated: probands with insulin-dependent diabetes mellitus and their relatives of the 1st degree of progeny (43 persons) in order to study the distribution of HLA antigens and their interrelationship with the gravity of a course of diabetes mellitus and the type of GTT. Antigens DR3 and/or DR4 were revealed in 93% of probands, especially in heterozygous patients (57.1%). A low level of C-peptide (0.21 +/- 0.03 ng/ml) was noted in most of the probands excluding 3 patients with nephropathy. Distinct relationship of antigens DR3 and DR4 with a clinical course of disease and its severity was undetectable. Antigens DR3 or/and DR4 were detected in 96% of the relatives with the prevalence of antigen DR4 (in 54.2%). During GTT normal tolerance was observed in 82.1% (23 persons), disorders were noted in 4, insulin-dependent diabetes mellitus--in one. Most of the relatives (82.6%) with normal glucose tolerance had antigens DR3 and/or DR4. Irrespective of the type of DR antigens the probands' relatives were characterized by moderate hyperinsulinism (by the results of IRI and C-peptide of blood serum).

[Epidemiologic study of types I and II diabetes mellitus in the inhabitants of Moscow]. / Epidemiologicheskoe issledovanie sakharnogo diabeta I i II tipov u zhitelei Moskvy.

An epidemiological survey of types I and II diabetes mellitus was conducted in the population of Moscow. Altogether 1256 diabetes mellitus patients aged 20 to 40 registered by the time of the survey in 70 outpatient clinics in 21 administrative areas of Moscow, were examined. The survey resulted in the assessment of prevalence and incidence of diabetes mellitus and the assessment of "accumulated" incidence used as population frequencies as compared to familial frequencies estimated by a similar principle.