AIM: The study was aimed at evaluation of hospital neuropsychological dynamics in ischemic heart disease patients with comorbid type 2 diabetes mellitus (T2DM) undergone on-pump coronary artery bypass grafting.
MATERIALS AND METHODS: 14 from a total of 37 examined patients had T2DM. Diabetic patients were found to have lower attention parameters prior to the intervention in comparison to non-diabetic controls. At days 7-10 after the surgery all patients demonstrated deterioration of cognitive functions.
RESULTS: We observed deeper deterioration in diabetic patients, regarding attention, memory, sensorimotor speed and quantity of erroneous test responses, as measured against individuals with normal glucose tolerance.
CONCLUSIONS: Diabetic patients undergone coronary artery bypass surgery show lower cognitive characteristics when compared to controls without T2DM, suggesting this cohort to be a high-risk group for further cognitive decline.
Our study was aimed to assess the influence of non-specific inflammation and endothelial dysfunction on developmentof cardiovascular events in patients with type 2 diabetes mellitus (T2DM) and progressive angina pectoris.
Materials and methods.
140 patients (63 of them were also diabetic) received follow-up for cardiovascular events during12 months after an episode of unstable angina pectoris. Upon hospitalization for acute coronary syndrome analyses wereperformed to assess the degree of systemic inflammation evaluating plasma concentration of pro- and anti-inflammatorymarkers (CRP, fibrinogen, IL-6, -8, -10, TNF-?), as well as blood glucose and glycated haemoglobin HbA1c.
Results.
TNF-? and IL-6 levels were significantly higher in patients with unfavorable prognosis (p<0.05). On the contrary,an anti-inflammatory IL-10 was found to be more active in patients with better cardiovascular prognosis (p<0.05). Diabeticindividuals were characterized with statistically significant elevation of CRP and fibrinogen, as compared to non-diabeticcontrols. We show a correlation of glycemic parameters, evaluated at 10th day of inpatient care, with IL-6 and CRP.We also established a strong correlation between markers of dyslipidemia and inflammation, evaluated at 10th day ofhospitalization for cardiovascular event in patients with unfavorable prognosis, which suggests common nature of differentmechanisms of atherosclerosis progression.
To summarize practical experience of insulin pump therapy (IPT) in child population of Krasnoyarsk and to assess its efficacy for treatment of type 1 diabetes mellitus (T1DM) in paediatrics.
Materials and Methods.
We performed a comparative analysis of clinical and laboratory data from 48 children with T1DM prior to and after 6-12 months of IPT.
Results.
IPT yielded fourfold decrease in complaints of hyperglycemia and labile glycemia without concurrent increase in reports of severe hypoglycemia. We observed a trend for lowering of mean HbA1c levels, where 65% of patients showed positive dynamics in comparison with the period of multiple daily injection regimen. Interestingly, after 6-12 months of IPT, insulin requirement dropped in most patients.
Conclusion.
Our data support clinical efficiency and safety of IPT, as well as superiority of this treatment over multiple daily injection regimen. We conclude that IPT is a treatment of choice for children with T1DM.
To compare disease attitudes in patients with type 1 and type 2 diabetes mellitus (T1DM and T2DM) and to evaluate relationship between attitudes and psychological welfare of these groups.
Materials and Methods.
We examined 140 patients with T1DM and 70 patients with T2DM on insulin therapy (mean age 22.6?3.2 and 60.1?7.8 years; male/female ratio 47/93 and 15/55; duration of diabetes 12.1?5.7 and 11.4?6.5 years, HbA1c 9.3?2.2 и 9.0?1.4%, respectively). Psychological parameters were assessed by following methods: Bekhterev Disease Attitude Typing (DAT), Colour Attitude Test (CAT), SF-36 (36-Item Short Form Health Survey), Spielberger Anxiety Inventory (SAI), CES-D Depression Scale, Dembo-Rubinstein (DR) technique for self-esteem assessment.
Results.
DAT showed increased sensitive attitude to their disease in patients with T1 and T2DM, being significantly higher in T2DM. According to CAT, T2DM patients perceive DM as a disease, associated with severe manifestations and complications, while T1DM patients tend to incorporate the notion of diabetes with lifestyle. Cluster analysis showed negative disease attitude to be associated independently of diabetes type with decrease in quality of life and emotional deterioration (higher anxiety and depression score, as measured by SF-36, SAI and CES-D).
Conclusion.
Disease attitude typing and correction is important in management of DM. Emotional acceptance allows improvement in quality of life and promotes psychological welfare. Also, despite the absence of direct relationship between HbA1c and disease attitudes (which, is plausibly non-linear), emotional acceptance may favour glycemic compensation due to increase in compliance.
Current study was aimed to identify symptoms and risk factors for depression and anxiety and to estimate quality of life (QoL) in patients with diabetes mellitus type 2 (T2DM) and cerebrovascular disease (CVD).
Materials and methods.
We examined 73 patients with T2DM. 1st group included 49 patients with T2DM and CVD, 2nd group - 24 patients with T2DM and no cardiovascular pathology. The groups were not significantly different in terms of age, BMI, level of HbAlc, fasting and postprandial glycemia. All patients received antihyperglycemic and antihypertensive therapy. Anxiety and depression were diagnosed with Beck Depression Inventory and Spielberger State and Trait Anxiety Scale (SSTAS). SF-36 questionnaire was used for estimation of QoL.
Results.
2nd group showed symptoms of anxiety and depressive disorders in 100% and 75% of cases, respectively. 1st group showed significantly more prominent anxiety and depression symptoms. Risk factors for anxiety and depressive disorders in patients with T2DM and CVD were found to be senior age, obesity and atherogenic dyslipidemia.
Conclusion.
Cardiovascular comorbidity in T2DM significantly decreases QoL, especially in aspects of physical functioning and vitality. Timely diagnostics of anxiety and depression in patients with T2DM and CVD requires development of screening and rehabilitation programs.
To determine sensitivity and specificity of glycated hemoglobin (HbA1c) test with direct immunoturbidimetry as a method to diagnose gestational diabetes (GD).
Materials and Methods.
74 pregnant females were recruited during initial screening. Glycemic disorders were diagnosed with two methods: oral glucose tolerance test with 75 g of glucose and glycated hemoglobin test.
Results.
HbA1c test with direct immunoturbidimetry is a highly sensitive method for diagnosis of glycemic disorders of pregnancy, provided that cut-off level is lowered to 5.5%.
Conclusion.
Mild anemia was not found to have a significant impact on diagnostic value of HbA1c test.
To evaluate of kidney cytomembranes stability during pregnancy and its outcomes in patients with diabetes mellitus type on type 1 with different stages of diabetic nephropathy (DN) according to the route of insulin administration.
Materials and Methods.
We study 100 pregnant women with type 1 diabetes with the introduction of insulin in the mode of multiple subcutaneous injections (MSII) and with portable dispenser with a continuous subcutaneous insulin infusion (CSII). DN stage determined by the level of albumin in the daily urine. Cytomembranes stability assessment conducted on daily excretion of ethanolamine and phospholipids with urine in each trimester. Pregnancy outcomes were analyzed in 52 patients with type 1 diabetes. In the group of pregnant women with delivery at term 38-40 weeks we also analyzed the status of newborns.
Results.
Indicators of cytomembranes stability of kidneys in pregnant women on CSII consistent with those in healthy pregnant women (p>0.05) the whole pregnancy, regardless of the level of daily urinary albumin excretion. There were no differences in cytomembrana stability of kidneys between the group of patients on MSII with normal albumin excretion (NAU) and the control group regardless to the gestational age (p>0.05). With the introduction of insulin in the mode of MSII on the stage of microalbuminuria (MAU) in the 3rd trimester we found the increase of ethanolamine excretion as compared to control groupy (U=8,00, p=0.012) and the group on CSII with a similar stage of nephropathy (U=2.00, p=0.033). In patients with proteinuria (PU) in the group on the MSII in the third trimester phospholipids excretion is increased with a daily urine (U=27,5, p=0.03 and U=22,00, p=0.07 for patients MSII and CSII, respectively). The use of an insulin pump allowed to prolong gestational period, even in severe proteinuric stage of nephropathy. Manifestations of diabetic fetopathy as macrosomia, hypoglycemia in the fetus at birth time mothers using CSII mode were less common than with MSII (p=0.01 and p=0.04, respectively). In the CSII group no resuscitation was needed, as opposed to 20% of children whose mothers used the MSII.
Conclusion.
The administration of insulin using portable dispenser the of mode CSII during pregnancy in patients with type 1 diabetes, even at the initial stage of the DN the cytomembranes stability is saved, pregnancy outcomes are improved.
Current review discusses novel data concerning prevalence of Cushing syndrome without characteristic clinical signs among patients with type 2 diabetes mellitus. We also provide detailed analysis of difficulties in diagnostics and management of this condition

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