[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.

[Main trends in the studies of diabetes mellitus epidemiology]. / Osnovnye napravleniia issledovanii épidemiologii sakharnogo diabeta.

At present there are three main research trends in the development of Russian epidemiology of diabetes mellitus: 1) study of the prevalence of diabetes mellitus and its factors that have an influence on its occurrence and development in various economic geographic areas of the country; 2) examination of the prognosis of its occurrence, and 3) exploration of the natural history and pathogenesis of diabetes mellitus under the natural living conditions of populations. The results of the epidemiological surveys which have been conducted since 1978 suggest that there are varying contrasting parameters in the spread of diabetes mellitus in different areas of the country, these are 0 to 4.1%. There is a relationship between diabetes mellitus and various factors, such as inheritance, obesity, dyslipoproteinemia, impaired carbohydrate and lipid metabolism, coronary heart disease, arterial hypertension, etc. There is a trend for diabetes mellitus to increase in the Russian Federation. Taking into account socioeconomic changes in our country, one cannot rule out the fact that the diabetes mellitus epidemiological situation and the pattern of its aggravation may change. So the studies in the third direction are acquiring its most importance.

[Various aspects of the relation between blood sugar levels and the prevalence of ischemic heart disease among 20 to 69-year-old men and women (a simultaneous epidemiologic study)]. / Nekotorye osobennosti vzaimosviazi urovnia glikemii s rasprostranennost'iu ishemicheskoi bolezni serdtsa u muzhchin i zhenshchin 20-69 let (odnomomentnoe épidemiologicheskoe issledovanie).

A random sample of 1,225 male and 1,243 female residents of a Moscow district, aged 20 to 69, has been studied. Their carbohydrate metabolism was assessed by means of an oral glucose tolerance test, and the diagnosis of coronary heart disease (CHD) was made on the basis of a WHO questionnaire and electrocardiography. The incidence of CHD was shown to be unassociated with the distribution of glycemia (both fasting and provoked by the glucose tolerance test) in males, while the association was significant in females. It is suggested that hyperglycemia is important as a coronary risk factor in women only.

[Prevalence of ischemic heart disease, arterial hypertension and dyslipoproteinemia in persons with disorders of glucose tolerance]. / Rasprostranennost ishemicheskoi bolezni serdtsa, arteria'lnoi gipertenzii, dislipoproteidemii u lits s narushennoi tolerant- nostiu k gliukoze.

Among 3490 males and females aged 20-69 years, oral glucose tolerance testing (GTT) revealed diabetes mellitus (DM) and abnormal glucose tolerance (AGT) in 94 and 401 persons, respectively. The prevalence of coronary heart disease (CHD), arterial hypertension (AH), and dyslipoproteinemias (DLP) was examined in groups of subjects that had normal GTT indices, patients with DM, and persons with AGT. In the latter, the prevalence of CHD was found to significantly higher than in those with normal GTT indices and be increased with severity of carbohydrate metabolic disturbances. The prevalence of AH did not drastically differ in persons with AGT and those with normal carbohydrate metabolism. The prevalence of DLP was significantly higher in subjects with AGT than in those with normal GTT values. It was also ascertained that DLP, as opposed to AH, was more meaningful as a risk factor for the development of CHD in persons with AGT and patients with DM.

[Role of blood insulin in the etiology of dyslipoproteinemias and ischemic heart disease in males aged 20-69 years]. / Znachenie urovnia insulinemii v rasprostranennosti dislipoproteidemii i ishemicheskoi bolezni serdtsa u muzhchin 20-69 let.

A random sample of males aged 20-69 years and living in one of the administrative districts of Moscow was studied. The total number of those enrolled was 1225, and they were studied for the incidence of dyslipoproteinemias and coronary heart disease (CHD) in relation to the level of glycemia, basal insulinemia, diabetes mellitus or impaired tolerance to glucose. It was shown that the effect of disorders of carbohydrate metabolism is largely determined by the level of insulinemia and is mediated through the development of dyslipoproteinemias. The prevalence of CHD without dyslipoproteinemias as well as in combination with arterial hypertension or an excessive body weight did not depend on the level of glycemia and baseline insulinemia or the presence of diabetes mellitus. Hyperinsulinemia was found to be associated with types of dyslipoproteinemias most unfavourable in terms of CHD development.

[HDL cholesterol lipoprotein levels and the atherogenicity coefficient in males with diabetes mellitus and ischemic heart disease]. / Uroven' kholesterina lipoproteidov vysokoi plotnosti i koéfficient aterogennosti u muzhchin s sakharnym diabetom i ishemicheskoi bolezn'iu serdtsa.

A hundred males aged 40-69 years receiving treatment at the Institute of Experimental Endocrinology and Hormone Chemistry for type I and II diabetes mellitus were examined. Thirty-eight patients had coronary heart disease (CHD). The diagnosis of CHD was based on the data of the WHO Cardiological Questionnaire and the presence of ECG changes corresponding to the categories of the Minnesota Code 1-1,2,7; 4-1,2 and 5-1,2 (without 3-1,3). The blood levels of total cholesterol (CS), triglycerides (TG), high density lipoprotein cholesterol (HDLC) and the atherogenicity coefficient (AC) were determined in all patients. The results of the study showed that males with diabetes mellitus irrespective of its type or the presence of CHD had significantly higher mean values of total CS, TG and AC than in control. The mean levels of HDLC in males with type I diabetes mellitus without CHD did not differ from those in normal subjects whereas the level of HDLC in patients with type II diabetes mellitus was lowered. The patients with CHD showed a significant decrease in HDLC in both type I and II diabetes. The highest mean values of TG, AC and the lowest levels of HDLC were characteristic of the males with type II diabetes mellitus and CHD.

[Blood glucose level and nutritional factors in the male population aged 20-59 years]. / Uroven' glikemii i faktory pitaniia v populiatsii muzhchin 20-59 let.

The levels of glycemia were studied on an empty stomach, 1 and 2 h after a glucose tolerance test (75 g of glucose) in an organized population of 799 men. The character of nutrition was studied by a questionnaire method regarding all food consumed during a previous day using models of previously weighed meals and food-stuffs as well as standard plates, spoons, glasses, etc. An analysis of the results obtained revealed the following peculiarities: in young patients (under 40) the level of glycemia was associated with excessive consumption of carbohydrates, especially starch; in the older age group (40-59) the level of glycemia showed positive correlation with the amount of consumed fats, protein, especially animal protein. The level of glycemia in persons with dyslipoproteinemia showed direct correlation with the amount of consumed saturated and monounsaturated fatty acids.

[Incidence of arterial hypertension in relation to the blood sugar level in men and women aged 20 to 69 (a 1-factor epidemiological study)]. / Rasprostranennost' arterial'noi gipertenzii v zavisimosti ot urovnia glikemii u muzhchin i zhenshchin v vozratse 20-69 (odnomomentnoe épidemiologicheskoe issledovanie).

Arterial blood pressure (BP) was measured in 1225 males and 1243 females aged 20 to 69 years, who were also screened for glycemia by means of the glucose tolerance test (GTT). According to WHO recommendations, arterial hypertension (AH) was defined as systolic BP elevated to or above 160 mm Hg or diastolic BP elevated to or above 95 mm Hg. The incidence of AH was shown to be significantly related to the degree of glycemia in both males and females, the relationship being much closer in the latter. The prevalence of systolic AH in the females showed highly significant correlation to glycemia at any point of the GTT, while that of diastolic AH was only correlated with basal and 1-hour glycemia. In the males, the prevalence of systolic AH was significantly related to basal and 1-hour glycemia, and that of diastolic AH was only related to the distribution of basal glycemia.

[Data from the diabetes mellitus registry]. / Nekotorye dannye registra sakharnogo diabeta.

Data on lethal cases of diabetes mellitus which occurred before January 1, 1992 were recorded. The total number of diabetics in Leninsky district of Moscow was 1729, 86 of them with insulin-dependent and 1643 with noninsulin-dependent disease. Diabetes prevalence in the district was 2.4%, that of insulin-dependent condition being 0.12% and of noninsulin-dependent one 2.3%. Various complications were detected in the majority of diabetics, microangiopathies (retinopathies, neuropathies) being the most incident in patients with insulin-dependent disease and macroangiopathies (coronary disease, arterial hypertension, myocardial infarction, brain stroke) predominating in patients with noninsulin-dependent disease. Cardiovascular diseases and involvement of the peripheral vessels were the most frequent causes of death of patients with both conditions.

[Dynamics of the prevalence of non-insulin-dependent diabetes mellitus (10-year prospective study)]. / Dinamika rasprostranennosti insulinnezavisimogo sakharnogo diabeta (10-letnee prospektivnoe issledovanie).

Carbohydrate metabolism was tested in 2468 subjects (male and female) aged 20 to 69 living in one of Moscow districts by means of standard oral glucose tolerance test. Primary screening was carried out in 1979, repeated in 1989. The results indicate an evident increase in the incidence of noninsulin-dependent diabetes mellitus both among men and women. The disease incidence in women was reliably higher than in age-matched men. Prevalence of the condition among women was characterized by a lower, in comparison with that among men, parameters of its time course.

[Predictors of non-insulin-dependent diabetes mellitus]. / Prediktory insulinnezavisimogo sakharnogo diabeta.

A random sampling of males and females aged 20 to 69 (1125 males and 1243 females), residing in Moscow, were investigated. The first screening was in 1979, the final one--in 10 years. The program of the first screening included anthropometry, evaluation of the CVS, carbohydrate and fat metabolism, studies on hereditary aggravation with regard to diabetes mellitus (DM); the program of final screening included the state of carbohydrate metabolism. Data processing was done using methods of multidimensional analysis. Independent signs to be used as predictors of noninsulin dependent diabetes mellitus were shown to be the age of 40 and older, a general GTT index of 16, and atherogenicity coefficient values of 3.5 and lower in men, and the presence of dyslipoproteinemia in women.

[Prevalence of diabetes mellitus and disordered glucose tolerance in persons of working age (a 1-step population study)]. / Rasprostranennost' sakharnogo diabeta i narushennoi tolerantnosti k gliukozu u lits trudosposobnogo vozrasta (odnomomentnoe populiatsionnoe issledovanie).

Representative, accidentally selected men and women, living in one of the Moscow regions, were examined, comprising in total 2468 persons: 1225 males and 1243 females. An analysis of the data obtained has shown that the real diabetes mellitus prevalence among persons of 20 to 69 years old is 1.64 to 4.01 times as high as that of registered patients, being 2.01 times as high in females and having several age-sex specific features.

[The interrelation of the glucose tolerance test indices with nutritional factors in persons with excess body weight]. / Vzaimosviaz' pokazatelei testa tolerantnosti k gliukoze s faktorami pitaniia u lits s izbytochnoi massoi tela.

An organized population of males aged 20 to 59 (799 persons) was investigated, of them 55 had excess body mass (EBM). Body mass was evaluated using Quetelet's rule, its values 30 and more being regarded as the presence of EBM in an examinee. Nutrition was investigated by a method of examination of food eaten up over a preceding day. Carbohydrate metabolism was investigated with GTT per os with the determination of glycemia on an empty stomach 1 and 2 h after glucose (75 g) intake. Analysis of the obtained results has shown that dietary habits of persons with EBM do not differ considerably from those of the population. However in persons with EBM the relationship of the glycemia level with the amount of consumed carbohydrates as well as with the amount of fats and proteins, especially proteins of animal origin, turned out to be specific. With some exceptions, these relationships in the population were undetectable.

[Primary prevention of diabetes mellitus by nutritional correction]. / Pervichnaia profilaktika sakharnogo diabeta putem korrektsii pitaniia.

Nutrition and the status of carbohydrate and lipid metabolism were investigated in an organized population of men aged 20 to 59. Nutritional correction was based on the results obtained. Repeated investigation of the same population in 3 years has shown that a decrease in the caloric content of the daily ration at the expense of fats and carbohydrates, especially starch and refined sugars, causes a decrease in the level of basal insulin, mean values of glycemia during a GTT, and atherogenic fractions of the lipid spectrum. Correlation between the level of glycemia and the ratio of polyunsaturated and saturated fatty acids was established. Nutritional correction as a prophylactic method was shown to be more effective in persons of younger age.

[Prevalence of dyslipoproteinemias among diabetes mellitus patients]. / Rasprostranennost' dislipoproteidemii sredi bol'nykh sakahrnym diabetom.

The blood levels of total cholesterol, triglycerides, HDL cholesterol were determined in 330 patients with Type I and II diabetes mellitus (DM) and in 400 persons with the normal glucose tolerance test (GTT). On a curve of the distribution of values of total cholesterol, triglycerides, HDL cholesterol the upper 10% values were regarded as hypercholesterinemia (HCS) and hypertriglyceridemia (HTG) and the lower 10% values as hypo-alpha-cholesterinemia (hypo-alpha-CS). The prevalence of dyslipoproteinemia was shown to be much higher in the DM patients than in the healthy persons resulting from a more frequent development of HCS, HTG and hypo-alpha-CS in the patients. Some peculiarities of the prevalence of dyslipoproteinemia with relation to a DM type were revealed. It was shown that in Type I DM the prevalence of HCS and HTG was much higher than that in the persons with the normal GTT whereas the frequency of hypo-alpha-CS in both groups was the same. In patients with Type II DM as compared to the control group not only HCS and HTG but also hypo-alpha-CS were much more frequent. Moreover, the prevalence of HTG and hypo-alpha-CS in Type II DM was much higher than in Type I DM. Since dyslipoproteinemias were a risk factor in the development of atherosclerosis and coronary heart disease, one might assume that their greater prevalence among DM patients would determine patients' greater predisposition to atherosclerosis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Indices of carbohydrate metabolism and levels of HDL2 and HDL3 cholesterol in the blood plasma of males]. / Pokazateli uglevodnogo obmena i soderzhanie kholesterina LPVP2 i LPVP3v plazme krovi u muzhchin.

A random sample of men (319) aged 20 to 59 was examined in one of the administrative districts in Moscow. A study was made of the blood plasma content of HDL2 and HDL3 cholesterol, triglycerides with relation to insulinemia and glycemia both on an empty stomach and during the GTT. An analysis of the data obtained led to a conclusion that the level of insulinemia was a factor influencing the level of HDL2 and HDL3. Derangements in the metabolism of the above lipoproteins were likely to be associated with a high risk of CHD development especially among patients with diabetes mellitus. Therapeutic measures aimed at insulin secretion reduction were recommended for the normalization of lipid metabolism including the content of HDL2 and HDL3.

[The questionnaire method in mass screening of the population for the presence of diabetes mellitus]. / Anketnyyi metod v massovykh obsledovaniiakh naseleniia na nalichie sakharnogo diabeta.

A questionnaire form for detection of diabetes mellitus among high risk persons has been prepared. The form includes only such questions and answers which provide information on the presence of absence of diabetes. Their qualitative characteristics are presented in the form of a scale of assessment, and the total assessment is expressed by integral characteristics of a degree of probability of the presence of diabetes mellitus. A study of the efficacy of this method permitted one to divide population into 3 categories: with a low, average and high probability of diabetes. Persons with a high probability of diabetes mellitus should be examined using a standard glucose tolerance test (GTT). As compared to a mass screening this method permits sparing about 70% of expenses and detecting 80-90% of diabetes mellitus patients who are not in the focus of physician's attention at the moment.

[Basal insulinemia, its relation to dyslipoproteinemias and arterial pressure]. / Bazal'naia insulinemiia, sviaz' ee s dislipoproteidemiiami i arterial'nym davleniem.

A representative random sampling of men aged 30-49 was examined. There was found a statistically significant correlation between basal insulinemia and blood serum levels of total cholesterole, high density lipoprotein cholesterole and triglycerides. No precise data were obtained on the correlation of the fasting basal insulin level in blood, and glycemia as well as insulinemia and glycemia during the glucose tolerance test with the blood pressure level.