Diabetes mellitus

BACKGROUND: Determine the effect of personal anxiety, sleep disorders on the 15-year risk of developing (RR) diabetes mellitus (DM) type 2 among men (M) 45-69 years in Russia / Siberia (Novosibirsk).

METHODS: In 2003–2005 As part of the IV screening of the international epidemiological study “HAPIEE”, a representative sample of m 45–69 years was examined (n=781 M, mean age-56.48±0.20 years, response – 61.00%). The level of personal anxiety (PA) was assessed using the Spielberger scale (HPA – high, MPA – medium, LPA – low). With the help of the scale “Knowledge and attitude to one’s health”, the level of sleep disorders (SD) was assessed. The period of observation of the cohort was 15 years. To check the statistical significance of the differences between the groups, the Pearson χ² test was used. For risk assessment, Cox-regression single-factor and multivariate regression proportional hazards model was used (Cox-­regression).

RESULTS: Among persons with the first occurrence of DM type 2, HPA at the screening was 59.50%, and 63.30% had SD. The combination of HPA and SD was significant among M with the first-onset diabetes mellitus. During the 15-year period, among M with HLA, the risk of developing type 2 diabetes was 1.60 times higher than without. Among people with SD, the risk of developing type 2 diabetes was 2.40 times higher than without. In Cox – the proportional multifactor model, each variable had its own independent influence. HPA increased the RR DM of the 2nd type by 1.90 times, and SD – by 2.80 times.

CONCLUSION: It was established that a high level of PA and SD are independent predictors of type 2 diabetes, moreover, with SD, the risk of developing type 2 diabetes is higher than with a high level of PA.

BACKGROUND: Diabetes Mellitus (DM) is a common metabolic disease worldwide. Electrolyte played significant roles in the normal functioning of the body, and deregulation is indicative of different types of disease and electrolyte disturbances are often reported in type 2 DM (T2DM).

AIM: The aim of the study was to estimate the levels of serum electrolytes in outpatients with T2DM and correlate serum electrolytes with random blood sugar (RBS).

MATERIALS AND METHODS: Patients with T2DM visiting the outpatient Departments of Medicine, between April 2016 and March 2017 were included. Of 148 diagnosed T2DM cases, 74 were had RBS level >300mg/dL (group-1) and 74 had RBS level ≤300mg/dL (group-2). Serum sodium (Na⁺), potassium (K⁺), chloride (Cl^-) levels were measured by using the Roche 9180 electrolyte analyzer.

RESULTS: In this study, there was a significant decrease in serum Na⁺ levels in group 1 (131.83±4.36 mmol/L) compared to group 2 (134.15±4.90 mmol/L).The serum levels of K⁺ was found to be increased in group 1 (4.51±0.61 mmol/L) in comparison with group 2 (4.26±0.52 mmol/L). In group-1, an inverse relationship was present between serum Na⁺ (r=-0.342) and Cl^- (r=-0.538) with RBS which was statistically significant. In group-2, a significant correlation was present between serum K⁺ and RBS (r=0.356, p<0.05).

CONCLUSIONS: The study showed lower levels of Na⁺ and higher K⁺ levels in group-1 compared to group-2 subjects. This study showed that the distribution of serum Na⁺ and K⁺ levels is dependent on plasma glucose levels in patients with DM and also suggests that monitoring the electrolyte levels in hyperglycemia is pertinent in the management of diabetes.

The increased incidence of diabetes mellitus type 2 (DM2T) all over the world and in Russia in particular, indicates a lack of effectiveness of antidiabetic therapy and suggests the existence of gaps in the understanding of the mechanisms of onset and clinical course of this disease as well as a concomitant lack of effectiveness of antidiabetic therapy. It is known that metabolic disorders that cause DM2T are caused by disturbances in mitochondrial activity resulting in increased cellular fatty acid inclusions and insulin resistance. The present review presents the current state of knowledge about new cellular structures, fat inclusions or, using a more conventional term, lipid droplets (LDs), as a pathological feature accompanying the occurrence of DM2T. The review describes the biochemical and functional characteristics of LDs and their possible role in the onset and development of diabetes. The interrelationship of LDs and mitochondria and the effect of LDs on the nervous system are considered. Particular attention is paid to highlighting the effect of the microbiota of the gastrointestinal tract on the dynamics of the emergence of LDs. The GIT microbiota plays an important role in the development and course of many human diseases associated with metabolic disorders. Further knowledge of the relationship between the gastrointestinal microbiota and the dynamics of LD emergence will uncover new aspects of the molecular mechanism of mitochondrial function, which gives the prospect of preventive approaches in the treatment of obesity, metabolic disorders and diabetes.

COVID-19 poses a real threat to patients with comorbid conditions such as diabetes mellitus (DM), hypertension, cardiovascular, renal or hepatic disorders. Kidney damage is very likely in people with diabetes who have undergone a new infection, and the risk of developing acute renal injury is associated with mortality. Potential mechanisms of kidney involvement in the clinical picture of the disease may include cytokine damage, cross-organ damage, and systemic effects that determine the treatment strategy. These mechanisms are closely interrelated and are important for individuals on extracorporeal therapy and kidney transplants. Autopsy data provide evidence of SARS-CoV-2 virus invasion into kidney tissue with damage to tubular epithelium cells and podocytes, and red blood cell aggregation in severely COVID-19 patients. By including individuals with chronic kidney disease in planned COVID-19 research protocols, an evidence base for effective and safe treatments can be generated.

1,5-anhydroglucitol (1,5-AG) is a short-term indicator of glycemic status, reflecting hyperglycemic glucose excursions over the prior 1–2 weeks. As glucose level remains in the normal range, plasma concentration of 1,5-AG is maintained stable due to the balance between intake with the food and renal excretion. Under hyperglycemic conditions, when the renal threshold for glucose is exceeded, concentration of 1,5-AG decreases due to competitive inhibition of 1,5-AG reabsorption by glucose. In clinical practice, plasma 1,5-AG is used for retrospective assessment of postprandial glucose fluctuations in diabetic subjects with mild or moderate elevation of HbA_1c. The marker is also applied in clinical trials of new agents affecting postprandial glycemia. The advantages of 1,5-AG as a marker of glycemic status are stability, independence on the physiological state when sampling, applicability for patients with abnormalities of hemoglobin and lifespan of erythrocytes. Meantime, the value of this marker is limited in subjects with renal tubular acidosis, 4-5 stages of chronic kidney disease, renal glucosuria, in those receiving acarbose and SGLT2 inhibitors. Application of 1,5-AG for the diagnosis and screening of type 2 diabetes, gestational diabetes and prediabetes has been tested. It was revealed that sensitivity of 1,5-AG as screening tool may be insufficient in individuals with mild hyperglycemia, especially if fasting hyperglycemia prevails. Therefore, it has been proposed to combine 1,5-AG with assessment of fasting glucose for the screening purposes. In type 2 diabetic subjects low plasma 1,5-AG is a predictor of renal failure, cardiovascular events, including ischemic heart disease, heart failure and stroke. Decreased 1,5-AG concentration in pregnant women is a risk factor for gestational diabetes and macrosomia. Chromatography and enzymatic methods are used to determine 1,5-AG in blood, urine and other biological fluids. Currently, the relatively high cost and lack of standardization restrain the use of 1,5-AG in clinical practice. Further studies are needed for estimation of 1,5-AG value as a marker of glycemic status in type 1 diabetes, in patients with different levels of HbA_1c and different magnitude of glucose variability, as well as in situations where the clinical value of HbA_1c is limited.

Simultaneous pancreas-kidney transplantation (SPKT) is the most promising treatment option for patients with type 1 diabetes mellitus (T1DM) and end-stage renal disease (ESRD) due to diabetic nephropathy (DN). Successful SPKT eliminates uremic intoxication and hyperglycemia – the leading trigger of vascular diabetic complications. Therefore, euglycemia is an important metabolic change in patients after surgery and remains only one of the factors for the saved renal allograft functioning. In the case of resuming renal replacement therapy by dialysis after SPKT, the management and monitoring of the pancreatic graft remains open. Special attention to the pancreatic graft’s function is due to both the potential risk of surgical complications, and some probability of T1DM relapse with the need to resume insulin therapy. In patients with saved function of both transplants, the assessment of the dynamics of diabetic complications in general becomes more important. The results of few studies in this regard remain contradictory. Thus, clinical options can be unpredictably diverse and require not only search for the root cause, but also optimization of rehabilitation tactics, even if the expected results are achieved.