[Use of logical decision rules during screening in order to identify groups at risk for diabetes mellitus]. / Ispol'zovanie logicheskikh reshaiushikh pravil pri obsledovanii naseleniia dlia formirovaniia grupp riska nalichiia sakharnogo diabeta.

The paper describes two-staged examination of population to detect diabetes mellitus using computerized methods and modern methods based on control theory. The authors present the results of screening population in one of the Moscow districts using a standard GTT with a logic decision rule to identify groups at high risk of developing diabetes mellitus. The efficacy of the rule and its use under actual conditions of limited resources were considered.

[Pathogenesis of lower limb diabetic angiopathies in patients with non-insulin-dependent diabetes mellitus]. / K patogenezu diabeticheskikh angiopatii nizhnikh konechnostei u bol'nykh insulinnezavisimym sakharnym diabetom.

Some indices of the system of homeostasis, lipid metabolism, lipid peroxidation (LPO), the levels of IRI, C-peptide, glycosylated Hb and glycemia (on an empty stomach) were investigated in 131 patients with noninsulin dependent diabetes mellitus (the patients ranged in age from 40 to 60). Correlation analysis has shown that derangements in the system of homeostasis, lipid metabolism and LPO are correlated and interrelated, resulting in disorder of the arterial blood flow in the lower limbs and hence to the development and progression of diabetic angiopathies. The authors have proposed a scheme of LPO involvement in the development of lower limb diabetic angiopathies.

[Medico-genetic counselling of the relatives of patients with type I diabetes mellitus]. / Mediko-geneticheskoe konsul'tirovanie rodstvennikov bol'nykh sakharnym diabetom I tipa.

Population-genetic surveys show that for the relatives of patients with type I diabetes mellitus (the 1st degree of kinship) a risk of developing the same type of diabetes is 2-5%. Tables of repeated risk of developing diabetes mellitus (DM) of type I for persons with a different number of relatives affected by this type of DM were calculated on the basis of analysis of 2000 family histories of DM patients (a random sampling). A risk of developing this disease is in direct correlation with the number of sick and healthy relatives and their age. The presence of patients with type II DM in a family does not influence the risk of developing type I DM. Risk assessments are of prognostic rather than diagnostic value. The effectiveness of medico-genetic counselling can be increased with the help of various genetic markers, associated with type I DM. Risk assessment must lay the basis of a follow-up of persons with aggravated heredity by investigating immunological, hormonal and metabolic derangements in them.

[Genetic analysis of the structure of predisposition to diabetes mellitus. IV. Population-genetics study of two types of diabetes mellitus with onset at age 20-40]. / Geneticheskii analiz struktury predraspolozheniia k sakharnomu diabetu. Soobshchenie IV. Populiatsionno-geneticheskoe issledovanie dvukh tipov sakharnogo diabeta, voznikshego vozraste ot 20 do 40 let.

It was found that age-specific morbidity risks of type I diabetes mellitus (DM I) increased from the age of 0-4 yrs (0.012-0.013%) to the age of 10-14 yrs (0.04-0.045%) and then slightly decreased to 0.02-0.03%, remaining at this level up to 40 yrs. The "cumulative" morbidity risk of DM I (population risk of development of DM I for each born individual, irrespective of family history) was found to be 0.2% for the age from 0-4 to 40 yrs. Assuming the age-specific morbidity risks of DM I after the age of 40 yrs to be the same as that at 40 yrs (0.02-0.03%), the "cumulative" morbidity risk for this type of DM from birth to 75 yrs old was estimated to be 0.36-0.44%. First incidences of DM II in the population were only observed in 20 yrs olds. The morbidity risk level for DM II at the age 20-24 yrs was found to be lower than that for DM I at this age. The risk was about the same level both for DM I and for DM II at the age 25-34 yrs, the morbidity risk levels for DM II after 35 yrs exceeding that for DM I. The "cumulative" risk of DM II by the age of 40 yrs was 0.1% for men and 0.15% for women. Analysis of familial data revealed statistically significant increase in recurrent morbidity risk in relatives only for the types of DM presented in probands.(ABSTRACT TRUNCATED AT 250 WORDS)

[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.

[An analysis of the interrelationship of the HLA genotype and carbohydrate metabolism in the families of probands with insulin-dependent diabetes mellitus]. / Analiz vzaimosviazi HLA-genotipa i sostoianiia uglevodnogo obmena v sem'iakh probandov s insulinzavisimym sakharnym diabetom.

A total of 15 families were investigated: probands with insulin-dependent diabetes mellitus and their relatives of the 1st degree of progeny (43 persons) in order to study the distribution of HLA antigens and their interrelationship with the gravity of a course of diabetes mellitus and the type of GTT. Antigens DR3 and/or DR4 were revealed in 93% of probands, especially in heterozygous patients (57.1%). A low level of C-peptide (0.21 +/- 0.03 ng/ml) was noted in most of the probands excluding 3 patients with nephropathy. Distinct relationship of antigens DR3 and DR4 with a clinical course of disease and its severity was undetectable. Antigens DR3 or/and DR4 were detected in 96% of the relatives with the prevalence of antigen DR4 (in 54.2%). During GTT normal tolerance was observed in 82.1% (23 persons), disorders were noted in 4, insulin-dependent diabetes mellitus--in one. Most of the relatives (82.6%) with normal glucose tolerance had antigens DR3 and/or DR4. Irrespective of the type of DR antigens the probands' relatives were characterized by moderate hyperinsulinism (by the results of IRI and C-peptide of blood serum).

[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.

[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.

[Prevention of diabetes mellitus]. / Profilaktika sakharnogo diabeta.

Problems dealing with the current status of diabetes prevention are discussed. Data on the epidemiology and pathogenesis of the main types of diabetes is presented which is based on the original research and international experience in the primary and secondary prophylaxis of this disease. The necessity of an integrated approach to the prophylaxis of diabetes and other chronic non-infectious diseases is emphasized stemming from the concept of common risk factors. The efficacy of programmes on the diet correction in the primary prophylaxis, populational health study, use of automated systems for the determination of risk groups and primary prophylaxis in them, and the system of diabetics' self-control are analysed.

[Comparative clinico-immunologic and microcirculation studies in families of patients with type 1 diabetes mellitus and systemic lupus erythematosus]. / Sravitel'nye kliniko-immunologicheskie i mikrotsirkuliatornye issledovaniia v sem'iakh bol'nykh sakharnym diabetom 1 tipa i sistemnoi krasnoi volchankoi.

Presented are findings of comparative studies of the clinico-immunological parameters and the microcirculatory bed status in 17 DM I probands and 37 of their family members and in 17 SLE probands with 54 of their relatives. The DM I families were found to have DM and prediabetic cases, while among the SLE probands' families rheumatic and, less frequently, cardiovascular diseases prevailed. In the DM I probands' families, a significantly greater number of relatives were found to have rheumatoid factor, high IgG level, anti-DNA antibodies, and CIC (as compared to the SLE series). Both DM I and SLE groups demonstrated reduced efficacy of the cutaneous circulation as compared to norm; in the DM I relatives this disorder was more pronounced than in SLE relatives. The degree to which circulatory changes were pronounced was related to immunological disorders.

[Diagnostic significance of determining glycosylated hemoglobin in the detection of early forms of diabetes mellitus]. / Diagnosticheskoe znachenie opredeleniia glikozilirovannogo gemoglobina v vyiavlenii rannikh form sakharnogo diabeta.

In order to determine the diagnostic value of glycolytic hemoglobin (HbA1c) in early forms of diabetes mellitus its content was studied in 62 individuals with disturbed glucose tolerance, then used as a kind of screening for examination of 357 workers employees at a factory with a subsequent glucose tolerance test (GTT). The level of HbA1c was raised almost in all persons with disturbed carbohydrate metabolism. There was correlation between HbA1c and GTT results in the diagnosis of disturbed glucose tolerance. The highest was the correlation between the HbA1c and glycemia in 2 hours during a GTT (r = +0.91). A conclusion was made that the level of HbA1c can serve as a diagnostic criterion of early forms of diabetes mellitus; HbA1c determination taking into account its lesser dependence on the conditions of investigation as compared to GTT, can be used as a method for mass screening and prophylactic medical examination.

[Characteristics of disturbances in the hemostasis system in patients with insulin-dependent diabetes mellitus with angiopathies of the vessels of the lower extremities]. / Osobennosti narushenii v sisteme gemostaza u bol'nykh insulinnezavisimym tipom sakharnogo diabeta s angiopatiiami sosudov nizhnikh konechnostei.

Indices of the system of hemostasis, the levels of glycolysated hemoglobin were studied in 67 patients suffering from non-insulin-dependent diabetes mellitus with lower limb angiopathies (aged 40 to 60). Rheovasography of the lower limbs was performed. The patients were treated with antidiabetic drugs per os (with the exception of hydroxydione sodium succinate), platelet aggregation inhibitors (pentoxifylline, acetylsalicylic acid) and vasodilators (xanthinol nicotinate, solcoseryl and cinnarizine). The use of pentoxifylline after therapy increased the rate of platelet aggregation inhibition and decreased the prothrombin index, not influencing the other indices of the system of hemostasis. Pentoxifylline combined with acetylsalicylic acid at small doses normalized not only platelet indices but also the other indices of the system of hemostasis. Positive changes in the system of hemostasis were accompanied by a rise of the rheographic index in patients with vascular functional changes. In obliterating atherosclerosis the rheographic index was not on an increase indicating the necessity of corrective therapy of vascular lesions, first of all in the system of hemostasis, in the early period of diabetes mellitus.

[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)

[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.