[Determination of fructosamine in the early diagnosis of disorders of carbohydrate metabolism]. / Opredelenie fruktozamina v rannei diagnostike narushenii uglevodnogo obmena.

Blood serum fructosamine level were measured on an empty stomach in 97 normal subjects and subjects with various disorders of carbohydrate metabolism (the so-called "pre-diabetes" and changed glucose tolerance) in order to elucidate the significance of this factor as a marker of such disorders. Fructosamine concentrations were for the first time measured in children whose parents suffered from insulin-dependent or noninsulin-dependent diabetes mellitus. The content of fructosamine on an empty stomach was found to depend on the degree of carbohydrate metabolism disorders, increasing with the progress of these disorders. The findings permit a conclusion on the possibility of using fructosamine as a marker for the diagnosis of "pre-diabetes" in subjects with its levels of 2.5 to 2.99 mmol/l and of disordered glucose tolerance in those with its levels over 3 mmol/l and glucose level on an empty stomach no more than 6 mmol/l.

[Minidiab test to assess the functional state of pancreatic beta-cells in the children of diabetics]. / Proba s minidiabom v otsenke funktsional'nogo sostoianiia beta-kletok podzheludochnoi zhelezy u potomkov bol'nykh sakharnym diabetom.

The levels of glucose, insulin, and C-peptide in the blood serum were measured in 38 subjects with normal and impaired glucose tolerance whose parents suffered from insulin-dependent and noninsulin-dependent diabetes mellitus (IDDM and NIDDM, respectively) and in 12 normal subjects without hereditary aggravation for diabetes mellitus in order to specify the peculiarities of development of diabetes mellitus of various types. Reliably increased levels of glucose, insulin, and C-peptide on an empty stomach and absence of adequate secretion of insulin and C-peptide in response to stimulation with 5 mg of minidiab, expressed by a later and less manifest release of insulin and C-peptide, were observed in the test group, in contrast to healthy controls. The detected changes augment with the progress of carbohydrate metabolism disorders, being more marked in the subjects whose parents suffered from IDDM. The findings permit a conclusion that function of the insular system is changed during early disorders of carbohydrate metabolism in subjects whose parents suffered from both forms of diabetes mellitus. Minidiab test is recommended to specify the function of the pancreatic insular system.

[Importance of a number of risk factors and their combination in detecting diabetes with the prednisolone and glucose test]. / Znachenie riada faktorov riska i ikh sochetaniia v vyiavlenii diabeticheskogo tipa prednizolon-gliukoznoi proby.

A total of 494 persons with normal and borderline types of glucose tolerance (GTT) with relation to diabetes mellitus were examined to analyse dependence of the frequency of the diabetic type of the prednisolone-glucose tolerance test (PGTT) on the presence and combination of the following risk factors: heredity aggravated by diabetes mellitus, excess body mass and the presence of disturbed glucose tolerance of the borderline type in the age aspect. A significant rise of the frequency of the diabetic type PGTT in the presence of the borderline type GTT or obesity and the absence of influence of heredity aggravated by diabetes mellitus was established in persons under and over 40 as compared to the control group. An increase in the number of risk factors (2-3) brought about significant rise of the frequency of the diabetic type PGTT in both age groups. A significant rise of the frequency of the diabetic type PGTT was noted in persons aged 40 and older as compared to the group aged under 40 with obesity combined with the borderline type GTT. For early detection of disturbed glucose tolerance the PGTT is recommended to persons with heredity aggravated by diabetes mellitus, obesity and the borderline type GTT and their combination, particularly in advanced age groups. Therapeutic measures are recommended to persons with the diabetic type PGTT.

[Diabetic type of the prednisolone-glucose test as the earliest latent stage of diabetes mellitus]. / Diabeticheskii tip prednizolon-gliukoznoi proby kak naibolee ranniaia skrytaia stadiia sakharnogo diabeta.

Prednisolone-glucose tests (PGT) were done in 349 healthy persons and immunoreactive insulin (IRI) secretion in the time course of the glucose tolerance test (GTT) was studied in 48 persons. PGT of diabetic type was established in 33.3% of the persons with normal body mass and in 55.1% with excess body mass and GTT of boundary type. PGT of diabetic type is characterized by insulin secretion of diabetic type in response to glucose intake: the absence of the first peak of a rise of the IRI level and the second higher peak of the IRI level with a prolonged maintenance of IRI values up to the end of the test. The results suggest that PGT of diabetic type is an earlier stage of diabetes mellitus as compared to GTT of diabetic type. Therefore PGT can be used for distinguishing GTT of boundary type as one of the manifestations of diabetes mellitus and as a risk factor. Therapeutic antidiabetic measures are recommended to persons with PGT of diabetic type and prophylactic measures to persons with PGT of normal type.

[Effect of various methods of treating patients with the diabetic type of glucose tolerance]. / Effekt razlichnykh metodov lecheniia bol'nykh s diabeticheskim tipom tolerantnosti k gliukoze.

A study of the frequency of "remissions" of disorders of the glucose tolerance test (GTT) of the diabetic type depending on therapy: diet and diet combined with sulfanilurea derivatives in 130 patients revealed the absence of significant dependence on the method of treatment of patients with a low level of glycemia following glucose load (below 11 and 8.25 mmol/l after 1 and 2 hours, respectively) and a significant rise of the frequency of the GTT return to normal (from 7% to 40%) with the use of sulfanilurea derivatives together with diabetic management from the moment of diagnosing the disease in patients with a higher level of glycemia in the process of the GTT (over 11 and 8.25 mmol/l 1 and 2 h, respectively after glucose load). On the other hand, in 38% of persons with the different GTT disturbances of the diabetic type receiving no therapy, with glycemia level after 1 hour up to 11 mmol/l and 8.25 mmol/l after 2 h, spontaneous GTT improvement can be observed in 3-6 years to come. To raise the frequency of remissions, the authors recommend differentiated treatment of patients with GTT of the diabetic type in the initial period of treatment depending on the glycemia level in the process of the GTT.

[Use of biguanide preparations in the treatment of diabetes mellitus]. / O primenenii preparatov biguanidov u bol'nykh sakharnym diabetom.

The blood content of lactic acid was measured in 186 patients with overt diabetes mellitus. The patients had normal or excess body weight and were placed on different treatment methods during decompensation, subcompensation and compensation stages. During diabetes mellitus compensation attained with different treatment methods as well as during treatment including biguanides in the presence of normoglycemia, the mean blood level of lactic acid did not differ significantly from its mean content in normal subjects. Patients with decompensated diabetes mellitus manifested a significant elevation of the mean blood content of lactic acid. There was a definite relationship between the glycemia and high lactic acid level in the blood. Based on an analysis of the reported data and own materials the conclusion is drawn that biguanides should not be used in the treatment of decompensated diabetes mellitus, since this may lead to an increase in blood lactic acid and to the growth of lactic acidosis risk. It is proposed that contraindications to the use of biguanides in diabetes mellitus patients should also include hyperglycemia. Indications to the use of biguanides in diabetes mellitus patients are provided as well as the table of diseases in which biguanides are contraindicated. A list of drugs incompatible with biguanides is also presented. It is recommended that biguanides should not be applied for over 4 to 6 months. It is also recommended that detection of blood lactic acid should be introduced into medical practice on a wider basis, since lactic acidosis cannot be diagnosed without using such a test.

[Disputable problems of the effect of sulfanilylurea derivatives in patients with diabetes mellitus and perspectives on their use]. / Spornye voprosy ob éffekte proizvodnykh sul'fanilmocheviny u bol'nykh sakharnym diabetom i perspektivy ikh primeneniia.

Critical analysis of studies, realized by the University Group on diabetes mellitus program (UGDP), involving 12 colleges of the USA, was performed. A higher death rate due to cardiovascular pathology was manifested by patients with diabetes mellitus given tolbutamide. A possible restriction and/or prohibition of drugs of this series was discussed. The literature data and the authors' findings are presented, disproving the results, obtained by this Group. A wide use of sulfanilurea derivatives is recommended in the treatment of early stages of the disease, provided a stable 24 hours' normoglycemia is attained in patients with evident diabetes. The results obtained and the literature data allow the conclusion, that sulfanilurea derivatives exert an antiatherogenic effect under conditions of diabetes mellitus compensation.