[Features of type 2 diabetes mellitus and its pharmacotherapy in outpatients].

BACKGROUND: Type 2 diabetes mellitus (DM) remains the most common type of DM and is associat-ed with disabling complications, reduced quality of life and reduced life expectancy. Satisfactory control of carbohydrate metabolism remains the key way to manage them. AIM: To perform a retrospective analysis of carbohydrate metabolism (in terms of glycated hemoglobin - HbA1c), the prevalence of complications, and features of hypoglycemic and concomitant therapy in patients with type 2 DM. MATERIALS AND METHODS: The analysis of sex and age characteristics, achieved level of HbA1c, diabetes complications, sugar-reducing and concomitant therapy according to the data of outpatient records of the patients who are on dispensary registration with an endocrinologist in the Endocrinology Department of the Consultative and Diagnostic Polyclinic of the Tomsk Regional Clinical Hospital in Tomsk was carried out. RESULTS: 546 outpatient medical records of patients with type 2 DM were analysed, among which there were 39.6% men (n=216) with a history of type 2 DM 8.0 years [3.0; 13.0] , median age 64.0 years [54.5; 71.0] and 60.4% women (n=330), history of type 2 DM 10.0 years [5.0; 15.0], median age 70.0 years [63.0; 75.0]. The achieved HbA1c level in men was 7.6% [6.3; 9.0] and in women 7.4% [6.4; 9.1]. 19.4% of men and 13.6% of women had an aggravated history of type 2 DM. According to the history, 6.5% of men (n=14) and 3% of women (n=10) with type 2 DM had a history of stroke, and myocardial infarction 12% (n=26) and 1.5% (n=5), respectively. Among the analysed outpatient records of type 2 DM patients, 18.5% of men (n=40) and 12.4% of women (n=41) were found to have diabetic nephropathy. Diabetic retinopathy was reported in 9.3% (n=20) of men and 4.2% (n=14) of women. Diabetic macroangiopathies were detected in 29.6% (n=64) of males and 9.7% (n=32) of females. Among other chronic complications of DM, diabetic neuroosteoarthropathy was recorded in 1% (n=2) of males and 3% (n=10) of females, diabetic polyneuropathy in 25% (n=54) and 21.5% (n=71), respectively. Diabetic foot was diagnosed in 1.9% (n=4) of men and 1.8% (n=6) of women. Among comorbid pathology, obesity was diagnosed in 45.4% (n=88) of men and 69.1% (n=228) of women, dyslipidaemia in 10.2% (n=22) and 10.6% (n=35) respectively, hypertension in 39.8% (n=86) and 32.6% (n=108) of cases. The diagnosis of non-alcoholic fatty liver disease was verified in 3.7% of men (n=7) and 1.8% of women (n=6), chronic heart failure in 7.4% of men (n=16) and 2.4% of women (n=8) registered for type 2 DM. According to the analysed outpatient records, 4.1% (n=23) of patients received diet therapy, 48.3% (n=263) received monotherapy and 47.6% (n=260) received combination therapy for type 2 DM. Metformin was the most commonly used monotherapy for type 2 DM 36.1% (n=197), followed by insulin 6.9% (n=38), sulfonylurea derivatives - 2.7% (n=15). Combination of metformin and dipeptidyl peptidase-4 inhibitors (13.9%) was the most commonly used combination therapy. CONCLUSION: Analysis of the current situation in the diabetology service will help to identify weaknesses and strengths, which is necessary to optimise existing therapeutic approaches in accordance with current clinical recommendations.

[Biochemical markers of autism]. / Biokhimicheskie markery autizma.

Autism spectrum disorder (ASD) is becoming an increasingly common disorder of the development of the nervous system in the modern world. The diagnosis is made based on observation of the patient's behavior, which significantly complicates the diagnosis and treatment of the disorder. The subjectivity of behavioral diagnostics dictates the need for the study of biomarkers of ASD. Over the past two decades, researchers have focused on identifying specific biological abnormalities in ASD that will help in the diagnosis of the disease. This review discusses the state of research on various biomarkers currently being developed for ASD.

[Clinical effectiveness and pharmacokinetics of gliflozin from the point of view of individual genetic characteristics: A review].

A review of publications devoted to the analysis of genetic polymorphisms and features of the functioning of genes that affect the pharmacokinetics and pharmacodynamics of sodium-glucose cotransporter-2 inhibitors (SGLT2i) is presented. Objective of the study was to reveal information about genes whose polymorphism may affect the effectiveness of SGLT2i. The review was carried out in accordance with the PRISMA 2020 recommendations, the search for publications was carried out in the PubMed databases (including Medline), Web of Science, as well as Russian scientific electronic libraries eLIBRARY.RU from 1993 to 2022. Polymorphisms in the structure of several genes (SLC5A2, UGT1A9, ABCB1, PNPLA3) have been described that may affect the treatment of type 2 diabetes mellitus complicated by diseases such as chronic heart failure, chronic kidney disease, or non-alcoholic fatty liver disease. The information found on the genetic features of the development of the effects of SGLT2i is limited to a description of the differences in their pharmacokinetics. The relevance of currently available pharmacogenetic studies is largely constrained by small sample sizes.

[Structural and functional characteristics of the brain and their role in the development of eating behaviour in obesity: A review].

Obesity is a major public health problem that requires new approaches. Despite all interventions, the behavioural and therapeutic interventions developed have demonstrated limited effectiveness in curbing the obesity epidemic. Findings from imaging studies of the brain suggest the existence of neural vulnerabilities and structural changes that are associated with the development of obesity and eating disorders. This review highlights the clinical relevance of brain neuroimaging research in obese individuals to prevent risky behaviour, early diagnosis, and the development of new safer and more effective treatments.

[Patterns of eating habits and body composition in primary school children].

The study of the influence of nutrition and its associations with other parameters, which are closely related to the metabolic profile, in order to better understand the mechanisms of realization of the obesity phenotype in the child population is of particular interest. The aim of the study was to investigate the eating habits of elementary school children and their dependence on the parameters of physical development and body composition of the child population of Tomsk. Material and methods. 506 children aged 7 to 12 years were examined. The main group consisted of 216 children (53.1% boys, 46.9% girls) with overweight and obesity, the control group - 290 healthy children (49.0% boys, 51.0% girls). All children underwent measurement of anthropometric parameters with the calculation of SDS body mass index (WHO Anthro Plus), estimation of body composition by bioimpedancemetry. The actual nutrition of schoolchildren was assessed by the frequency method using a questionnaire. Results. Overweight and obese children had levels of body fat, percent body fat, visceral fat area and whole-body phase angle which were statistically significantly (p<0.001) higher in comparison with the control group. Regular meals were more typical for schoolchildren of the control group compared to the main group (p=0.002). A survey of parents showed that 55.0% of them don't have problems with the nutrition of their children, 32.0% do not have conditions for monitoring their nutrition, 37.5% of children consume high-calorie foods, 29.0% do not comply with the diet, 64.5% - eat while watching TV. Only 21.1% of children consume fresh vegetables daily, cereals - 21.8%, dairy products - 30.3%, milk - 56.5%, meat - 58.5%, cottage cheese - 10.3%. Fish is not consumed by 25.6% of children, consumed less than once a week - by 47.2%. Several times a week, sausages and sausages are consumed by 41.7% of schoolchildren, confectionery - by 32.5%, chocolate and sweets - by 51.5%. Conclusion. The food habits of primary school students in Tomsk are characterized by an insufficient amount of vegetables and fruits, dairy products, fish dishes, a high level of consumption of ultra-processed red meat and various confectionery products (sweets, chocolate, cakes). The absence of statistically significant differences in the results of the survey between the control group and the main group may be due to the multifactorial nature of obesity associated with a variety of behavioral, biological and social factors, the real contribution of which remains to be determined.

[Genetic aspects of type 1 glucagon peptide agonists clinical efficacy: A review].

A review of publications devoted to the analysis of genetic polymorphisms of the gene encoding the glucagon-like peptide type 1 receptor and some other genes directly and indirectly involved in the implementation of its physiological action is presented. The aim of the study: to search for information on genes polymorphism that can affect the effectiveness of glucagon-like peptide type 1 agonists. The review was carried out in accordance with the PRISMA 2020 recommendations, the search for publications was based on PubMed databases (including Medline), Web of Science, as well as Russian scientific electronic source eLIBRARY.RU from 1993 to 2022. The several genes polymorphisms (GLP1R, TCF7L2, CNR1, SORCS1, WFS1, PPARD, CTRB1/2) that may affect the course and therapy of type 2 diabetes mellitus, metabolic syndrome and obesity, was described. Single nucleotide substitutions in some regions of these genes can both decrease and increase the clinical efficacy of the treatment of diabetes mellitus and metabolic syndrome with the help of type 1 glucagon-like peptide agonists: exenatide, liraglutide. Data on the role of genetic variations in the structure of the products of these genes in the effectiveness of other type 1 glucacone-like peptide agonists have not been found.

[Body composition in sarcopenia in middle-aged individuals].

Sarcopenia is characterized by a progressive loss of muscle mass, strength, and function, leading to poor outcomes and reduced quality of life. In middle age, the decrease in muscle mass begins to be progressive. Bioimpedancemetry allows diagnosing this condition before the onset of clinical symptoms. THE PURPOSE OF THE STUDY: to evaluate the parameters of body composition in the early diagnosis of sarcopenia in middle-aged people. MATERIALS AND METHODS: The participants were divided into two groups - the main one with sarcopenia - 146 people and the control group - 75 people. The complex of examinations included: neuropsychological testing (Hospital Anxiety and Depression Scale (HADS), quality of life questionnaire for patients with sarcopenia (SarQoL), short health assessment form (SF-36)), 4-meter walking speed test, dynamometry and bioimpedancemetry. The results of neuropsychological examination did not differ in the main and control groups. Patients with sarcopenia showed a decrease in muscle strength according to dynamometry. The scores of the walking speed assessment test in the study group were significantly higher than in the control group. The main and control groups had excessive body weight. According to the results of bioimpedanceometry, the main group had increased fat mass, percentage of fat mass, visceral fat area, and fat mass index compared with the control group. Skeletal muscle mass was less in the main group, probable sarcopenia was confirmed by decreased appendicular mass, decreased protein and mineral content was also recorded. There was a more pronounced decrease in cell mass in the main group. In patients with sarcopenia the volume of intracellular and extracellular fluid was less than in the control group. Significant differences were considered at p<0.05. CONCLUSIONS: the introduction of bioimpedancemetry and dynamometry into early screening for muscle mass reduction will allow timely start of therapeutic and preventive measures even in middle age, which will lead to a decrease in the progression of sarcopenia in the elderly, as well as improve the quality of life.

[Evaluation of FreeStyle Libre in pediatric t1dm: improved glycemic control, reduction in diabetic ketoacidosis and severe hypoglycemia].

BACKGROUND: Self-monitoring of blood glucose (SMBG) with glucometers provides only a snapshot of the glycemic profile and is accompanied by significant psychological discomfort and pain, especially in children. Flash Glucose Monitoring System - FreeStyle Libre (FSL) overcomes many of the barriers associated with glucose measurement and improves metabolic control. AIM: To evaluate the efficacy of FSL in children with type 1 diabetes mellitus (T1DM) in terms of glycemic control, episodes of severe hypoglycemia (SH) and diabetic ketoacidosis (DKA). MATERIALS AND METHODS: A multicenter, prospective, observational study in real clinical practice was carried out. A total of 469 subjects (258 boys and 211 girls) aged 4-18 were included in the study. The median age was 11.3 (8.4-14.6) years, duration of T1DM - 4.2 (2.1-7.1) years. After FSL start, patient was followed up for 6 months. RESULTS: After 3 and 6 months of FSL use, HbA1c significantly decreased from 7.4% to 7.1% and 7.2%, respectively (p<0.001). The number of children with HbA1c ><7.5% increased from 51% to 60% and 58% at 3 and 6 months, respectively (p><0.001). The incidence of DKA and SH, as well as the proportion of patients experiencing at least one episode of DKA and SH, were significantly reduced after 6 months of FSL use compared with baseline (p><0.001). CONCLUSION: The Study demonstrated a significant improvement in metabolic control in children with T1DM 6 months after FSL start: decrease in HbA1c, accompanied by reduction in incidence of DKA and SH.

[Neural networks in the predictive diagnosis of cognitive impairment in type 1 and type 2 diabetes mellitus].

BACKGROUND: Cognitive dysfunction, including mild cognitive impairment and dementia, is increasingly recognized as a serious complication of diabetes mellitus (DM) that affects patient well-being and disease management. Magnetic resonance imaging (MRI)-studies have shown varying degrees of cortical atrophy, cerebral infarcts, and deep white matter lesions. To explain the relationship between DM and cognitive decline, several hypotheses have been proposed, based on the variability of glycemia leading to morphometric changes in the brain. The ability to predict cognitive decline even before its clinical development will allow the early prevention of this pathology, as well as to predict the course of the existing pathology and to adjust medication regimens. AIM: To create a computer neural network model for predicting the development of cognitive impairment in DM on the basis of brain neuroimaging techniques. MATERIALS AND METHODS: The study was performed in accordance with the standards of good clinical practice; the protocol was approved by the Ethics Committee. The study included 85 patients with type 1 diabetes and 95 patients with type 2 diabetes, who were divided into a group of patients with normal cognitive function and a group with cognitive impairment. The patient groups were comparable in age and duration of disease. Cognitive impairment was screened using the Montreal Cognitive Assessment Scale. Data for glycemic variability were obtained using continuous glucose monitoring (iPro2, Libre). A standard MRI scan of the brain was performed axially, sagittally, and coronally on a Signa Creator E, GE Healthcare, 1.5 Tesla, China. For MRI data processing we used Free Surfer program (USA) for analysis and visualization of structural and functional neuroimaging data from cross-sectional or longitudinal studies, and for segmentation we used Recon-all batch program directly. All statistical analyses and data processing were performed using Statistica Statsofi software (version 10) on Windows 7/XP Pro operating systems. The IBM WATSON cognitive system was used to build a neural network model. RESULTS: As a result of the study, cognitive impairment in DM type 1was predominantly of mild degree 36.9% (n=24) and moderate degree 30.76% (n=20), and in DM type 2 mild degree 37% (n=30), moderate degree 49.4% (n=40) and severe degree 13.6% (n=11). Cognitive functions in DM type 1 were impaired in memory and attention, whereas in DM type 2 they were also impaired in tasks of visual-constructive skills, fluency, and abstraction (p0.001). The analysis revealed differences in glycemic variability indices in patients with type 1 and type 2 DM and cognitive impairment. Standard MRI of the brain recorded the presence of white and gray matter changes (gliosis and leukoareosis). General and regional cerebral atrophy is characteristic of type 1 and type 2 DM, which is associated with dysglycemia. When building neural network models for type 1 diabetes, the parameters of decreased volumes of the brain regions determine the development of cognitive impairment by 93.5%, whereas additionally, the coefficients of glycemic variability by 98.5%. The same peculiarity was revealed in type 2 DM 95.3% and 97.9%, respectively. CONCLUSION: In DM type 1 and type 2 with cognitive impairment, elevated coefficients of glycemic variability are more frequently recorded. This publication describes laboratory and instrumental parameters as potential diagnostic options for effective management of DM and prevention of cognitive impairment. Neural network models using glycemic variability coefficients and MR morphometry allow for predictive diagnosis of cognitive disorders in both types of diabetes.

[A prognostic model of cognitive impairment in patients with type 1 diabetes mellitus]. / Prognosticheskaya model' razvitiya kognitivnykh narushenii u patsientov s sakharnym diabetom 1-go tipa.

OBJECTIVE: To develop a model for the prognosis of cognitive impairment in patients with type 1 diabetes mellitus based on data from proton magnetic resonance spectroscopy. MATERIALS AND METHODS: Patients with type 1 diabetes mellitus and individuals without diabetes were examined (control group). All participants were evaluated for carbohydrate metabolism, underwent neuropsychological testing (MoCa test), proton magnetic resonance spectroscopy of the brain. Statistical processing of the results was performed using the IBM SPSS Statistics 20.0 program. The predictive model is calculated using discriminant analysis. RESULTS: Based on the data of proton magnetic resonance spectroscopy, a predictive model for the development of cognitive impairment in patients with type 1 diabetes mellitus was obtained using discriminant analysis. CONCLUSIONS: The method for the early diagnosis of cognitive impairment allows predicting the development of cognitive dysfunction in patients with type 1 diabetes in the early stages and can be used in clinical practice to assess the effectiveness of preventive therapy for cognitive impairment.

[The role of the neurophysiological methods in the assessment of the effectiveness of the rehabilitation of sensorimotor disturbances associated with the lesions of the central nervous system at the spinal cord level].

AIM: The objective of the present study was the evaluation and comparison of the effectiveness of the differential approaches to the neurorehabilitation of the somatosensory disturbances in the patients presenting with the spinal cord lesions. MATERIALS AND METHODS: A total of 68 patients with spinal cord lesions were enrolled in the study, including 38 suffering from vascular myelopathy, 18 with the consequences of extramedullar meningioma surgery, 12 with the sequelae of acute transverse myelitis. The control groups was comprised of were 55 subjects. All the participants of the study underwent rehabilitation which included robotized mechanotherapy, stabilography, neuro-muscular stimulation, kinesiotherapy, physical therapy, ergotherapy, massage, etc. Transcranial magnetic stimulation (TMS) and evaluation of somatosensory evoked potentials (SSEP) were carried out before and after the therapy. RESULTS: In those patients who received personalized therapy, significant changes of TMS parameters (central motor conduction time at rest and in facilitation probe), but not SSEP ones were registered. Moreover, the patients who had undergone personalized therapy exhibited better clinical results than in the absence of such treatment. CONCLUSION: The results of the study gave evidence that neurorehabilitation had produced the more pronounced beneficial influence as regards the correction of motor disturbances even though the disturbances of the somatosensory functions proved to be more resistant to therapy. The data obtained suggest that taking into consideration the afferent deficit has to be mandatory for the purpose of planning the neurorehabilitative treatment of the patients suffering from sensorimotor disturbances associated with the lesions of the central nervous system at the spinal cord level. TMS and SSEP have to be utilized as the tools for the objective evaluation of the effectiveness of the neurorehabilitation process in such patients.

[Verification of risk factors and aspects of primary prevention depending on the age].

The article presents the results of population screening study in the Health Center. There is a high prevalence of cardiometabolic risk factors among the young and middle-aged population (56.66; 51.18 and 41.04%). Among elderly, there is high prevalence of chronic cardiometabolic diseases (80.65; 90.70%). Progressive deterioration of clinical and functional parameters comes with age, which leads towards the increased risk of heart and metabolic diseases. In particular, increase of blood pressure (p < 0.01), BMI (p < 0.01) and total cholesterol (p < 0.01) was seen. Early detection of risk factors and prevention of their realization have to be reached by more active work of health centers and higher level of their attendance by young and middle-aged persons.

[The use of computer electronystagmography in the assessment of optokinetic nystagmic reactions]. / Primenenie komp'iuternoi élektronistagmografii v otsenke optokineticheskikh nistagmennykh reaktsii.

A novel technique of computer-assisted electronystagmography (CENG) has been used in 90 patients with vertigo. Two variants of optokinetic nystagmus (cortical and subcortical) were analysed. Registration of optokinetic nystagmus (OKN) was carried out using original devices for CENG. Right- and left-directed nystagmic reactions and their quantitation were performed according to specially devised registering and analysing programs. In one-sided vestibular disorders cases of cross-over OKN asymmetry prevailed in affection of the cerebellopontine angle (neurinoma of the VIII nerve) compared to labyrinthine disturbances (one-sided Meniere's disease). In 90% of patients with vertebrobasillar deficiency OKN asymmetry was found even in a straight position of the head. OKN asymmetry was less pronounced or disappeared in the OKN test performed with the head turned right or left by 90 degrees.

[An exogenous psychotraumatizing factor as one of the causes for the development of neurotic reactions in subjects suffering from sensorineural hypoacusis]. / Ekzogennyi psikhotravmiruiushchii faktor kak odna iz prichin razvitiia nevroticheskikh reaktsii u lits, stradaiushchikh

We performed special psychological investigations in 120 patients with neurosensory hypoacusis (NSHA) and emotional somatovegetative disorders. These patients were found to have neurosis and neurosis-like conditions. To elucidate the involvement of the exogenic factor on the onset of neurotic reactions in NSHA, we performed a questionnaire survey reflecting the attitude of the family, coworkers, strangers to people with hearing problems. It was found that neuroses and neurosis-like conditions in NSHA patients are provoked not only by premorbid personality traits but also by exogenic psychotraumatic factors.

[The effect of Lasix on nystagmus in the caloric and optokinetic tests in Menière's disease]. / Vliianie laziksa na nistagm v kaloricheskom i optokineticheskom testakh pri bolezni Men'era.

The study was made of labyrinthine changes induced by lasix dehydration. Changes indicative of Meniere's disease were identified at comparison of the findings obtained by audiological lasix test, caloric optokinetic reactions. Four types of the nystagmic response in the bithermal lasix-test were determined. These reactions are helpful for more precise staging of the disease.

[The phenomenon of the fixation suppression of caloric nystagmus in the diagnosis of vestibular disorders]. / Fenomen fiksatsionnogo podavleniia kaloricheskogo nistagma v diagnostike vestibuliarnykh rasstroistv.

Fixation nystagmus suppression in caloric tests was used in examination of 56 patients suffering from chronic remittent labyrinthopathy, acute labyrinthopathy, vestibular neuronitis, otosclerosis, adhesive otitis media, vertebrobasilar insufficiency, motor disease, chronic remittent vestibulopathy and neurinoma of the VIII nerve. The bithermal test (BT) with electronystagmography was made to calculate the fixation suppression index (FSI). Complete suppression of the caloric nystagmus in at least one BT test appeared to be the most frequent variant of the response (24 cases). This was not dependent on the severity of the vestibular analyzer lesion. In 3 cases FSI of the caloric nystagmus was rather high (> 0.50). Introduction of the period of glance fixation in performance of all the 4 BT tests may serve an additional method in differential diagnosis of the vestibular disorders. The fixation test results should be compared to findings obtained in the other vestibulometric tests.