Prevalence and risk factors of sleep breathing disorders in patients with acromegaly from Moscow region.

AIM: Assessment of prevalence and risk factors of sleep breathing disorders in patients with acromegaly from Moscow region. MATERIALS AND METHODS: Cardiorespiratory monitoring was executed to 55 patients with acromegaly (18 men and 37 women): 27 patients with de novo disease, 28 patients on treatment of acromegaly (including 18 patietns with uncontrolled and 10 - with controlled acromegaly). All subgroups did not differ on sex, BMI and age. Also 24-hour monitoring of arterial blood pressure was carried out in 39 patients (12 men and 27 women, 14 patients with de novo acromegaly, 15 and 10 patients with uncontrolled and controlled acromegaly, respectively). RESULTS: The high prevalence of sleep breathing disorders (SBD) was revealed in patients with acromegaly from Moscow Region. SBD was found in 92.6%, 83.5% and 70.0% patients with newly diagnosed, uncontrolled and controlled acromegaly, respectively. The majority of patients had severe/moderate SBD in all subgroups (78.8%, 72.2% and 60.0%, respectively). In patients with newly diagnosed and uncontrolled acromegaly index of apnea-hypopnea (31 and 38.5 respectively), number of apnoe episodes (76 and 72) and saturation level (93% and 93.5%) did not differ significantly while these parameters were better in patients with a controlled acromegaly (apnea-hypopnea index 20, apnea episodes 45.5 and saturation level 95%). The peak of desaturation was subphysiological in 91.7%, 86.7% and 77.8% of patients with newly diagnosed, uncontrolled and controlled acromegaly, respectively. Severity of SBD did not depend on GH and IGF-1 levels as well as acromegaly duration. Such all-population risk factors of SBD as BMI and age were valuable for patients with acromegaly, however gender did not matter. SBD were associated with lack of physiological decrease of systolic and diastolic night BP. CONCLUSION: Acromegaly per se is a strong risk factor of sleep breathing disorders. The high prevalence of sleep breathing disorders in patients with acromegaly even after achievement of control over a disease emphasized need of specialized treatment of these violations.

[Clinical and functional characteristics of giant pituitary adenomas in the population of patients in the Moscow region]. / Klinicheskie i funktsional'nye kharakteristiki gigantskikh adenom gipofiza v populiatsii patsientov Moskovskoi oblasti.

Benign pituitary tumors are the most common sellar neoplasms. Lesions larger than 39 mm in the maximum dimension are called giant. They are rare, and, therefore, there are few data on the clinical and morphological features of giant pituitary tumors with different hormonal activity. AIM: The aim of this study was to identify the clinical and functional features of giant pituitary tumors with different hormonal activity. MATERIAL AND METHODS: We analyzed data of clinical, laboratory, and instrumental examinations of 351 patients diagnosed with pituitary macroadenomas at the Moscow Regional Research Clinical Institute in the period between 2008 and 2017: there were 144 hormonally inactive pituitary adenomas and 207 hormonally active pituitary adenomas (65 prolactinomas and 142 somatotropinomas). RESULTS AND DISCUSSION: Among 351 patients with pituitary macroadenomas, there were 32 (9.1%) giant adenoma cases: 18 (12.5%) 144 patients with hormonally inactive pituitary adenomas and 14 (6.8%) 207 patients with hormonally active pituitary adenomas 6 (3.9%) 65 prolactinomas and 6 (2.9%) 142 somatotropinomas. The volume of giant adenomas was somewhat larger among somatotropinomas 48 926 [35 067; 97 650] mm3 and prolactinomas 36 872 [15 281; 75 102] mm3 compared to that of hormonally inactive pituitary adenomas 26 933 [21 910; 42 895] mm3. Tumors had predominant suprasellar and posterosellar growth (31 (97.8%) and 29 (90.6%) cases, respectively). The most common first patient complaints were visual impairments (59.4%) and headache and/or dizziness (43.8%). Correspondingly, due to these complaints, 16 (50%) patients first consulted an ophthalmologist. Hypopituitarism detected before any treatment was present in 16 (50%) patients. CONCLUSION: In most cases, visual impairments and headaches/dizziness were the first manifestations of giant pituitary adenomas; therefore, ophthalmologists and neurologists should always refer patients with these complaints to MRI. Patients with identified giant pituitary tumors should be referred to an endocrinologist for exclusion of hypopituitarism and, if necessary, timely prescription of hormonal therapy.

Effects of allogenic fetal pancreatic tissue transplantation on regeneration of islet cells in recipient rats with alloxan-induced diabetes mellitus.

The linear parameters and number of Langerhans islets were evaluated in rats with alloxaninduced diabetes mellitus after transplantation of fetal pancreatic tissue to the anterior chamber of the eye. The islets significantly increased in size by week 3 after surgery and a trend to an increase in their number was observed.

[Risk of type 2 diabetes mellitus and acute cardiovascular disorders in patients with early disturbances of carbohydrate metabolism].

The aim of this work was to estimate the relative risk (RR) of type 2 diabetes mellitus (DM2) and cardiovascular diseases, total and cardiovascular mortality in patients with disturbances of carbohydrate metabolism revealed in the prospective study carried out in 2009 that included patients found to have disturbances of carbohydrate metabolism in 2006. We analysed the 3-year risk of development of type 2 diabetes mellitus, total and cardiovascular mortality. RR of DM2 was significantly increased in association with practically all early disturbances of carbohydrate metabolism. The most unfavourable combination is fasting glycemia and impaired glucose tolerance. Within 3 years after its determination, 33.3% of the patients developed DM2 while RR of DM2 increased 11-fold. Newly diagnosed DM2 increased RR of total mortality by 2.3 times. Fasting glycemia during 3 years increased RR of cardiovascular mortality by 3.2 times. Results of the study suggest the necessity of not only timely diagnosis of fasting glycemia and impaired glucose tolerance but also further monitoring and correction of carbohydrate metabolism in patients with this pathology as well as of the elaboration and implementation of a comprehensive program for the screening of disturbed carbohydrate metabolism in high-risk groups.

[Major risk factors of glucose metabolism abnormalities].

Using the data of population base study of adult residents of 2 districts of Moscow Region (2638 persons), prevalence is studied and influence on occurrence of glucose metabolism abnormalities of major risk factors is estimated. Influence of risk factors was estimated with Cox regression analyses. High prevalence undiagnosed glucose metabolism abnormalities among persons (24,9%) is taped; it is established that relative risk of diabetes mellitus type 2 significantly raised at persons is more than 50 years of age independently of BMI, at the same time first-degree obesity increased relative risk of diabetes mellitus type 2 in 4,3 times and third-degree obesity--in 9,0 times independently of age.

[Correlation of HBA(1c) and postprandial glycemia during a standard breakfast test in patients with type 2 diabetes mellitus receiving glibenclamide].

AIM: To analyze the effect of glibenclamide on carbohydrate metabolic parameters, glucose values after standard breakfast in particular, in patients with type 2 diabetes (T2D). SUBJECTS AND METHODS: Thirty patients aged 57.6 +/- 9.4 years with a 4.4 +/- 4.0-year history of T2D received glibenclamide in a daily dose of 10.9 +/- 4.4 mg in combination with diet therapy for 3 months. Venous plasma glycemia was determined before and at the end of the fasting test, 60 and 120 minutes after a standard breakfast test. The area under the glycemic curve was calculated using the trapezoidal method during the standard breakfast test. Out of all possible formulas reflecting a blood glucose increase in relative values during the test, there were two most acceptable formulas that were chosen for further calculations: (1) the contribution of postprandial glycemia exceeding fasting glycemia to postprandial glycemia exceeding 6.1 mmol/l (OS(1/2)); (2) that of postprandial glycemia exceeding the glycemia of 6.1 mmol/l to postprandial glycemia in the standard breakfast test (OS2/S). RESULTS: Follow 3-month therapy, glycated hemoglobin (HBA1c) decreased from 8.7 +/- 1.8 to 7.0 +/- 1.0% (p < 0.0001), fasting plasma glucose reduced from 9.8 +/- 2.7 to 8.3 +/- 1.7 mmol/l (p < 0.01); it decreased from 14.8 +/- 3.9 to 13.2 +/- 3.3 mmol/l (p < 0.01) and from 13.3 +/- 3.6 to 11.1 +/- 3.0 mmol/l (p < 0.02) 1 and 2 hours after the load test, respectively. There was a significant reduction in the total area under the glycemic curve (S)--from 1583.5 +/- 405.8 to 1375.7 +/- 320.1 mmol/l x rmin. However, there were no significant changes. There was a significant increase in the relative value OS(1/2) from 51.7 +/- 17.7 to 62.8 +/- 20.0% and a significant reduction in OS2/S. Analysis of the area in relative values (OS(1/2) and OS2/S) obviates the ambiguousness of the results obtained when analyzing the area in absolute values. CONCLUSION: Glibenclamide treatment causes a statistically significant reduction in fasting and postprandial plasma glucose levels, glycated hemoglobin, and relative area values during the standard breakfast test.

[Influence of age and body weight on plasma glucose levels during an oral glucose tolerance test in subjects without carbohydrate metabolic disturbances].

AIM: To evaluate the influence of age and body mass index (BMI) on fasting and postprandial (2 hours after glucose load) plasma glucose (FPG and PPG) levels in males and females. SUBJECTS AND METHODS: A screening for carbohydrate metabolic disturbances (by using an oral glucose tolerance test) was made in the stratified adult sample from two municipal districts of the Moscow Region. The data were statistically processed by the computer program SPSS 11.0. RESULTS: The mean FPG level in normoglycemic subjects was 5.26 +/- 0.43 mmol/l. There was a significant (p < 0.001) positive correlation between age and FPG: r = 0.11 in men and r = 0.17 in women. The mean PPG was 6.15 +/- 1.35 mmol/l; in males it was significantly lower than that in females. There was a significant correlation between age and PPG: r = 0.30 in males and r = 0.13 in females. A weak, but statistically significant correlation was found between FPG and body mass index (BMI) in women: r = 0.02. There was no significant correlation between FPG and BMI in men. No significant correlation was found between PPG and BMI in both males and females. A lower PPG level was 2 times more frequently observed in men than that in women (37.70 and 17.57%, respectively). CONCLUSION: Fasting and postprandial (2 hours after glucose load) plasma glucose levels increase with age in subjects without carbohydrate metabolic disturbances. A predictable plasma glucose level increase depending on age is described by the cubic regression model equation.

[Primary hyperparathyroidism in Russia according to the registry].

BACKGROUND: There are no large-scale epidemiological studies on primary hyperparathyroidism (PHPT) in Russia. The high prevalence of the disease, the high risk of disability and death in this cohort of patients requires the study of the epidemiological and clinical structure of PHPT to determine the extent of medical care. AIM: Evaluate the frequency of PHPT detection and characterize its clinical forms in Russia using an online registry. METHODS: The object of the study is the database of the State Register of Patients with PHPT 1914 patients from 71 regions of the Russian Federation. New cases of the disease, as well as dynamic indicators are recorded when patients visit outpatient clinics or medical institutions. The analysis of data made at the end of December 2017 was carried out. The following parameters were evaluated: demographic and clinical indicators; indicators of phosphorus-calcium metabolism, the main forms of PHPT and its course, the primary characteristic of PHPT in hereditary syndromes and parathyroid carcinoma. Results are presented as mean and standard deviations, or medians and quartiles; descriptive statistics of qualitative attributes absolute and relative frequencies. RESULTS: the total number of patients with PHPT in the registry on 31 of December 2017 was 1914 cases (0.001% of the population of the Russian Federation). Identification of PHPT was 1.3 cases per 100 thousand of the population in Russia, 7.6 cases in Moscow, 6.1 cases per 100 thousand in the Moscow region. The average age of patients at the time of diagnosis was 55.6 10 years. The active phase of the disease was registered in 84.6% of patients (1620/1914), most of whom had a symptomatic PHPT 67.1% (1087/1620), and 32.9% a asymptomatic disease (533/1620). Symptomatic disease with visceral complications was detected in 15.8% cases (172/1087), with bone complications in 48.4% (526/1087). The mixed form of the disease was detected in 35.8% of patients with manifest form (389/1087). Normocalcemic variant PHPT (nPHPT) was registered in 14.5% cases (234/1620). Sporadic PHPT occurs in 83% of cases (1592/1914). 326 patients (17%) had a suspicion for hereditary form of the disease: average age was 31.2 12.3 years. A genetic analysis was conducted in 61 patients (3.2%): showed the mutation in the MEN1 gene in 2.9% of cases (55/1914) and the mutation in the CDC73 gene in 0.3% of cases (6/1914) (HPT-JT syndrome). Parathyroid carcinoma was confirmed in 1.8% of all patients (35/1914). Surgical treatment was performed in 64.5% of patients (1234/1914). Remission was achieved in 94% of cases (1160/1234), in 6% of cases relapse after surgical treatment or persistence of PHPT was recorded. CONCLUSION: detection of PHPT in the Russian Federation raised in comparison to 2016, which is associated with an active start of registration of patients in the regions. At this stage, it is necessary to modify the principles of registration and control, to make a platform for gathering information and calculating the necessary volumes of medical care for PHPT patients.

[Vascular topography of glycemia in diabetes mellitus type 1 and in norm (theoretical analysis)].

Glycemia level in peripheral circulation is the basic parameter of diabetes diagnosing as well as a criteria of treatment effectiveness. Also there are a lot of the experimental data concerns glucose metabolism in different parts of the circulation. This permits to calculate so called circulatory topography of glycemia--glucose level in different parts of the circulation. As a result of the calculation was shown that in DM1 glycemia level is elevated in insulin-independent tissues even when glycemia level is normal in clinically useful peripheral circulation. These results can explain the predisposal of DM1 patients to diabetic retinopathy and nephropathy because eyes and kidney are the insulin-independent tissues. The reason why changes circulatory topography of glycemia in DM1 is changes in prime insulin delivery in circulation: insulin medication input not in the portal vein of hepar as in normal state but in peripheral circulation. It was shown that stable glycemia level in DM1 could be reached only in case of hepatic insulin-resistance.

Insulin-like growth factors and binding proteins in patients with recent-onset type 1 (insulin-dependent) diabetes mellitus: influence of diabetes control and intraportal insulin infusion.

Type 1 diabetes mellitus is associated with decreased insulin-like growth factor-1 (IGF-1) levels, enhanced values of growth hormone (GH) and IGF-binding protein 1 (IGFBP-1). Since the liver is the major source of IGF and IGFBP production, we have therefore examined whether levels of IGFs (IGF-1 and IGF-11) and IGFBPs (IGFBP-1 and IGFBP-3) differ when insulin is infused into the portal or peripheral vascular system. IGF, IGFBP, and GH levels were determined within 1-3 weeks of diagnosis in 36 patients (ranging in age from 18 to 22 years) with Type 1 diabetes mellitus. IGF-1 levels were low before insulin therapy administration (0.49 +/- 0.05 vs. 1.11 +/- 0.04 U/ml in controls, P < 0.01). With insulin treatment, IGF-1 levels rose to the normal range and IGF-1 normalisation depended on diabetes control and the route of insulin infusion. Diabetic patients with conventional insulin therapy (CIT; n = 12) had low IGF-1 (0.57 +/- 0.07 U/ml) compared with patients with continuous subcutaneous insulin infusion (CSII; n = 12; 0.75 +/- 0.08 U/ml; P < 0.05) and intraportal insulin infusion (IPII; n = 12; 1.07 +/- 10.05 U/ml; P < 0.05). Significant correlations were found between IGF-1 and parameters of glycemic control: HbA1c (r = -0.64; P < 0.01) and glycemia (r = -0.56; P < 0.05). The pattern of changes in IGF-11 levels was not significantly different from that of controls and was not altered by insulin therapy (0.98 +/- 0.08 and 1.01 +/- 0.04 U/ml in controls). Measured fasting 08:00 h IGFBP-1 levels were elevated 3-fold and IGFGP-3 levels were 2-fold lower in diabetic patients than in controls. Elevated IGFBP-1 levels were significantly correlated with metabolic control (glycemia, r = 0.64, P < 0.01; HbA1c, r = 0.71, P < 0.01). The mean elevated GH level before insulin administration (13.4 +/- 0.9 mg/l) was decreased by intensified insulin therapy (CSII, 8.8 +/- 0.6, P < 0.05; IPII, 5.6 +/- 0.9 mg/l, P < 0.001). There was a negative correlation between GH and IGF-1 (r = -0.72, P < 0.01). These results show the role of glycemic control and the route of insulin administration in the normalisation of IGF-1, IGFBP-1 and GH up to non-diabetic controls in patients with recent-onset Type 1 diabetes mellitus.

[Checking of some hypotheses of the pathogenesis of diabetes mellitus by mathematical modeling]. / Proverka nekotorykh gipotez patogeneza sakharnogo diabeta putem matematicheskogo modelirovaniia.

A mathematical model of normal regulation of carbohydrate metabolism by the pancreas endocrine apparatus is presented. In a numerical experiment the model imitated changed levels of sucrose, insulin glucagon and gastrointestinal hormones in the blood in response to the ingested 50 g of glucose. The model of normal regulation was damaged in the way which theoretically should result in diabetes development. Then an estimation was made to what extent the disturbances of carbohydrate metabolism characteristic of diabetes were reproduced by the changed model. It has been shown that disturbances specific for diabetes appear when the sensitivity of beta-cells to glucose stimulus or hyperproduction of glucagon decreased. No changes in the behaviour of blood glucose typical of diabetes were obtained in the model when a decrease of the sensitivity of insulin receptors due to hyperinsulinemia in insulin-dependent tissues was imitated, as well as an increased activity of liver insulinase or hyposecretion of gastrointestinal hormones. These results point to the necessity of further development of these hypotheses.

[How physicians and patients look at the problem of obesity]. / Problema ozhireniia glazami vracha i glazami potentsial'nogo patsienta.

AIM: To elicit attitude of physicians and population to the problem of obesity; to assess awareness and diagnostic and therapeutic tool. MATERIAL AND METHODS: A questionnaire survey was performed among 384 endocrinologists and 54 other medical professional in 13 cities of Russia. 1405 randomly selected citizens of Moscow (males and females) aged 18-64 years were interviewed according to the standard questionnaire on the telephone. THE RESULTS: Opinion of the physicians. Endocrinologists think that the key factors of weight gain are the following: overeating (81%), hypodynamia (53%), heredity (36%), endocrine pathology (20%), diet rich in fat (18%). Body weight is assessed on the basis of BWI (80%), weight-height tables (38%), Brock's formula (25%), waist and hip circumferences (21%). Endocrinologists believe that obesity should be treated to improve wellbeing (75%), concomitant syndromes (53%), appearance (4%). 92% of endocrinologists recommend a low-calory diet, 82%--physical exercise, 15%--medication, 6%--food additives. Potential patients. 1/3 of city population have overweight. 1/4 of them want to lose weight. Women want to lose weight three times more frequently than men. The proportion of men and women wanting to lose weight is higher at the age group of 40-49 years. Obese subjects more frequently than subjects with normal weight want to lose weight without keeping diet (53 vs 39%) or extra physical activity (38% vs 27%). Women more frequently use methods of losing weight (both registered and unregistered). CONCLUSION: Physicians underestimate the role of obesity in genesis of concomitant diseases, the role of high-calory diets in development of obesity. Most of potential patients have an inadequate attitude to the necessity and feasibility of weight loss, are unrealistic as to methods of losing weight and effectiveness of such methods.

[Products with high glycemic indices as factors in the metabolic stress of patients with insulin-dependent diabetes mellitus]. / Produkty s vysokimi glikemicheskimi indeksami kak faktory metabolicheskogo stressa u bol'nykh insulinzavisimym sakharnym diabetom.

Fifty-five patients aged 15-35 years with insulin-dependent diabetes mellitus lasting 3.8 +/- 1.2 years underwent carbohydrate food loading. Within 2 hours after the meal, at 15-min intervals measurements were made of glycemia, C-peptide, insulin, glucagon, hydrocortisone, blood STH levels. Contrary to foodstuffs with low glycemia indices (GI), i.e. vermicelli, buckwheat, the intake of fast absorbed products with high GI (potatoes, hardtack, bread) stimulates glycemia and residual secretion of the islet cells. Enhanced entrance of gastrointestinal glucose into the systemic blood flow and growing insulinemia aroused glucagon secretion depression. The body responses to the above processes, assessed as metabolic stress, with increasing blood hydrocortisone and STH concentrations.

[Two-dimensional parameter of the kinetics of glucose (rho-criterion) in the assessment of the efficacy and prognosis of therapy of diabetes mellitus]. / Dvumernyi parametr kinetiki gliukozy (rho-kriterii) v otsenke éffektivnosti i prognoza lecheniia sakharnogo diabeta.

The authors describe the results of i. v. GTT in 10 patients with diabetes mellitus before and after a course of hyperbaric oxygenation, in 5 of them the test was repeated. The results of the test were processed with the help of a new type of model of glucose kinetics based on the production of glucose by the liver and its elimination in the test. A new quantitative criterion (the so-called rho-criterion) of a degree of carbohydrate metabolic derangement was introduced for diabetic patients. Its calculation before and after a course of HBO permitted reliable quantitative assessment of the efficacy of sugar lowering therapy in such patients. The new method permitted the assessment of the production of glucose by the liver and the rate of its elimination in i.v. GTT. The mechanism of HBO-action was unraveled (the suppression of glucose production by the liver). Examples of 2 patients with type II diabetes mellitus have demonstrated the efficacy of the rho-criterion in the prediction of a sugar lowering effect of antidiabetic tablets in serious clinical situations.

[The immune status in different clinical forms of insulin-dependent diabetes mellitus]. / Immunnyi status pri razlichnykh klinicheskikh formakh insulinzavisimogo sakharnogo diabeta.

Immune status with reference to the disease duration and genetic factors (HLA-typing) was studied in various clinical variants of insulin-dependent diabetes mellitus. The disease duration appeared the key factor in development of immune deficiency in insulin-dependent diabetes mellitus. Critical immunological values were established (CD5+ cells--1200 in 1 microliter, CD4+ cells--35%, expression of CD5 and antigens HLA class II--110 and 75%, respectively) for septic complications which are highly probable in lower indices. Females with diffuse thyroid enlargement, subclinical hypothyroidism, wide spectrum of antibodies to DNA, antigenic determinants of thyroid gland, hypophysis were found to be a group associated with HLA--DR3 carriage.

[Pharmacokinetics of insulin and glucose during insulin infusions to diabetes patients. I. Basal regimen]. / Farmakokinetika insulina i gliukozy pri infuzionnom vvedenii insulina bol'nym diabetom. I. Bazal'nyi rezhim.

The model of the vascular bed is presented. With this model, pharmacokinetics of insulin and glucose in diabetics is studied while insulin is infused through a dispenser. Calculations have shown the simulation of prostatic activity function by the insulin dispenser leads to hypoinsulinism in the hepatic vascular bed and to hyperinsulinism in the remaining vascular bed. Insulin supply through the dispenser to any part of the vascular bed, in order to provide normal insulin concentration, is followed by changing in insulin concentration in the another areas of the vascular bed as well as fluctuating of the blood sugar level. So far, to normalize the blood sugar level by means of the current therapeutic methods with the insulin infuser is impossible because the sites of its administration does not topographically fit to normal insulin delivery into the vascular bed.

[Dispersion injection needle for insulin administration]. / Dispersionnaia in"ektsionnaia igla dlia vvedeniia insulina.

A new dispersion syringe needle is proposed to administrate insulin to diabetics. It features side location of injection holes 4-8 of which are arranged along the needle body. The needle so designed provides greater absorption area, thus increasing absorption rate and reducing insulin decay in the subcutaneous layer. With the needle, more effective insulin action to compensate glucose content is achieved as compared to the conventional design.

[Clinical trial of a portable insulin dosage pump]. / Ispytanie nosimogo dozatora insulina v klinicheskikh usloviiakh.

The wearable drug pump HDL-2M has been clinically tested. It is of small dimensions, high reliability and easy-to-use. By means of the unit insulin was administered to patients suffering from insulin-dependent diabetes mellitus. With the HDL-2M, the therapy of the diabetes has been shown to be more effective than the traditional hypodermic injections because it allows a rapid glycemia normalization with less insulin dosage, as a rule, and a considerable decrease in glycemia lability. The numerous tests demonstrate that the HDL-2M can be extensively and successfully used for therapy of insulin-dependent diabetes mellitus in clinical practice.

[Effects of anti-atherosclerosis diet containing omega 3 fatty acids on the lipid spectrum of blood and cell membranes in patients with ischemic heart disease and essential hypertension]. / Vliianie protivoateroskleroticheskoi diety, soderzhashchei zhirnye kisloty semeistva omega 3, na lipidnyi spektr syvorotki krovi i kletochnykh membran u bol'nykh ishemicheskoi bolezn'iu serdtsa i gipertonicheskoi bolezn'iu.

A total of 27 patients received an anti-atherosclerotic diet containing fatty fish Greenland halibut, 100 g/day. Significant reduction of the total cholesterol level, cholesterol levels of very low and low density proteins, triglycerides, atherogenic index, elevation of blood fibrinolytic activity in the presence of lowered levels of arachidonic acid and an increased relative content of omega 3 polyunsaturated fatty acids (PUFA) were recorded in membranes of red blood cells and platelets. The results of the investigations conducted have shown that even rather low doses of omega 3 PUFA introduced in the presence of the hypolipidemic diet are conductive to the alimentary correction of the blood serum lipid spectrum of the fatty-acid content in cellular membrane structural lipids.

Prevalence of diabetes mellitus in patients with acromegaly.

Early carbohydrate metabolism disorders (ECMDs) and diabetes mellitus (DM) are frequently associated with acromegaly. We aimed to assess the prevalence of ECMDs in patients with acromegaly and to compare the results with those in adults without acromegaly using two population-based epidemiologic surveys. We evaluated 97 patients with acromegaly in several phases of their disease (mean age, 56 years and estimated duration of acromegaly, 12.5 years). An oral glucose tolerance test was done in those not yet diagnosed with DM to reveal asymptomatic DM or ECMDs (impaired glucose tolerance+impaired fasting glucose). Comparisons were made between patients with acromegaly and participants from the general adult population (n=435) and an adult population with multiple type 2 diabetes risk factors (n=314), matched for gender, age and BMI. DM was diagnosed in 51 patients with acromegaly (52.5%) and 14.3% of the general population (P<0.001). The prevalence of ECMDs was also higher in patients with acromegaly than in the general population and in the high-risk group; only 22% of patients with acromegaly were normoglycaemic. The prevalence of newly diagnosed ECMDs or DM was 1.3-1.5 times higher in patients with acromegaly compared with the high-risk group. Patients with acromegaly having ECMDs or DM were older, more obese and had longer disease duration and higher IGF1 levels (Z-score). Logistic regression showed that the severity of glucose derangement was predicted by age, BMI and IGF1 levels. In patients with acromegaly, the prevalence of DM and ECMDs considerably exceeds that of the general population and of a high-risk group, and development of DM depends on age, BMI and IGF1 levels.