ANALYSIS OF ANTIDIABETIC THERAPY FOR TYPE 2 DIABETES IN PRIMARY HEALTH CARE (WESTERN KAZAKHSTAN).

Diabetes Mellitus Type 2 (T2D) represents a significant global health challenge, with increasing prevalence and the need for effective management strategies. Despite the widespread nature of the disease, there is disagreement regarding the optimal glycemic targets for patients with Type 2 diabetes. The American Diabetes Association recommends aiming for an HbA1C level of less than 7% (53 mmol/mol). About 50% of diabetes patients do not meet their glycemic targets, leading to an increased risk of chronic complications associated with diabetes. Although lifestyle modifications are crucial for prevention and management, most T2D patients eventually need pharmacotherapy to maintain control over their blood glucose levels. In Western Kazakhstan, a study was conducted to evaluate the efficacy of antidiabetic therapy in primary healthcare settings. Aim - to assess the proportion of patients with uncontrolled glycemia among adult patients with T2D, and to analyze antidiabetic therapy in the primary health care (Western Kazakhstan). The cross-sectional study involved 96 participants, divided into two groups based on their HbA1c levels: 32 patients with an HbA1c <7%; 64 patients with an HbA1c >7%. In the study 58 patients (60,6%) were female and 38 patients (39,4%) were male. Data analysis was performed using IBM SPSS 26 and GraphPad, employing Kolmogorov-Smirnov and Shapiro-Wilk tests for distribution, medians and interquartile ranges for non-normal variables, Chi-squared and Fisher's Exact tests for nominal variables, and representation of nominal data in absolute and percentage values. The study found that 66.67±5.89% of participants had unsatisfactory glycemic control at enrollment, with only 33.33±8.33% achieving the desired HbA1c level of <7% (p<=0.005; t=3.26). Statistical analysis showed a significant association between higher glucose levels and the type of therapy, with insulin therapy more common in patients with glucose levels >7 (χ²=5.500, df = 1, p <0.05) and a similar correlation with SGLT-2 inhibitors (Fisher's Exact Test, p<0.01). Analysis of the data collected from urban polyclinics in Aktobe highlighted a troubling fact: two-thirds of the participants (66.67%) had unsatisfactory glycemic control. This is considerably lower than the 45% to 60% control rates reported internationally, indicating an area for significant improvement in the regional management of T2D. The study underscores the importance of a tailored therapeutic approach, balancing drug efficacy, patient response, and individual healthcare needs. Higher variability and blood sugar peaks were observed in patients with HbA1c levels above 7%. In the Western region of Kazakhstan, metformin was the most commonly prescribed antidiabetic drug, consistent with its first-line therapy status. Patients with HbA1c >7% were more likely to receive insulin therapy and SGLT-2 inhibitors, indicating their role in more intensive treatment strategies. Less use of incretins and sulfonylureas was noted among patients with HbA1c <7%, possibly due to their efficacy, safety profiles, or availability of newer alternatives. The findings call for enhanced strategies to improve diabetes management and increase the percentage of patients achieving their glycemic targets, aiming for a more personalized, patient-centered care model in Kazakhstan and potentially similar healthcare settings.

EPIDEMIOLOGY OF GENES ASSOCIATED WITH OBESITY IN ASIAN POPULATION. LITERATURE REVIEW.

Among the general population, there is a category of individuals with an innate predisposition to obesity. In recent decades, the increase in the prevalence of obesity and related diseases worldwide indicates the need to study the etiological factors associated with its development. At present, it is still unknown how many genes are involved in the pathophysiology of obesity, and many studies are underway to identify "candidate genes" in clinical medicine. The detection of obesity by molecular genetic diagnostics and the implementation of appropriate preventive measures can significantly reduce the incidence. Considering that the majority of people suffering from metabolic diseases are members of the working population, the prevention of these diseases and early diagnosis are of both clinical and social and economic importance. The aim of this study is to analysis of data on the most significant genetic markers in the development of obesity in the Asian population. An online search for literature on genetic markers associated with the development of obesity was conducted in the databases Elibrary, Google Scholar, PubMed, Web of Science databases was carried out. The study of genetic markers and their determination has great prospects for the successful verification of the main clinical and biological markers of obesity. This will allow assessing the risks of developing obesity and developing standards for corrective measures for individuals with a high genetic risk. Most of the GWAS studies have been conducted in the European population, the discovery of new genes in the Asian population has made a significant contribution to the identification of loci of predisposition to obesity. identification of polymorphic variants of candidate genes that are most significant in the development of this disease is an urgent task for both fundamental science and practical medicine.

[INFLUENCE OF METFORMIN ON THE DIAMETER AND NUMBER OF DNA BREAKS IN BLOOD LYMPHOCYTES IN OBESITY].

Aim - to assess the DNA damage of lymphocytes before and after the use of Metformin in obese individuals by two indicators: the diameter and the number of DNA breaks in blood lymphocytes. The sample included 27 obese patients aged 18-61 years. Among the participants, persons with chronic decompensated diseases, with bad habits (smokers, drug users, alcohol) were excluded. In order to study the dynamics of blood lymphocyte DNA breaks, patients were prescribed Metformin (Acino) at a daily dose of 850 mg/day for 3 months. DNA damage analysis was performed by assessing foci of phosphorylated histone protein HAX (γ-H2AX) on blood lymphocytes (AKLIDES, Nuk Human Lymphocyte Complete, Medipan, Blankenfelde-Mahlow, Germany). With the appointment of Metformin, the diameter of the ruptures changed and amounted to 0.45±0.23 before treatment, and 0.44±0.27 after treatment, but no statistically significant differences were found. When evaluating the dynamics, a significant decrease in the indicator was revealed, and it amounted to 2.60% (p<0.0001; z=9.97). Before treatment, the value of the indicator "Mean number of ruptures per 1 cell" was 0.57±1.32, after the appointment of Metformin it decreased to 0.27±0.56, but the differences are insignificant and after treatment, there is a decrease in the indicator by 52.18% (p<0.0001; z=9.97). The use of metformin 850 mg/day for 3 months in obesity leads to a decrease in the diameter of cell ruptures and the average number of γ-H2AX foci per cell of serum lymphocyte DNA, which may affect the reduction in the risk of oncopathology. Further research is needed to determine the protective mechanisms of Metformin against genomic instability, especially in relation to DNA damage reactions and epigenetic changes.

[MARKERS OF OBESITY IN CLINICAL RESEARCH AND PRACTICAL MEDICINE (REVIEW)].

The purpose of this article is to describe the state-of-the-art knowledge of risk factors and targetmarkers of obesity needed for personalization of disease prevention. The frequency of diagnosis of obesity depends to a large extent on how it is determined. In the clinical evaluation of a patient with obesity, it is necessary to assess the anthropometric, metabolic and functional status of organs and systems. This review discusses modern tactics for the diagnosis of obesity. Early diagnosis of the pathological conditions associated with obesity is necessary for their timely treatment and prevention of severe complications. Accurate diagnosis of visceral obesity is not an easy task, as most methods have both merits and limitations for their use.

[DNA DAMAGE AND THEIR CONNECTION WITH EXCESSIVE BODY MASS AND OBESITY (REVIEW)].

The aim of this article is to describe the current level of knowledge about the relationship between overweight and genomic instability. The relationship between overweight / obesity and cancer has been well studied in numerous studies. A feature of overweight and obesity is the formation of reactive oxygen species and cytokines, which lead to damage to the genetic material of the cell. The review article analyzes literary sources, which condemn the data on the methods used in research concerning the links between genomic instability and obesity. Analyzed studies on the stability of DNA in humans and animals with overweight and obesity.