Vol 9, No 9 (2023)

It is now well known that hypogonadism is detected in at least every third male patient with type 2 diabetes mellitus (T2 DM). According to recent data, the prevalence of hypogonadism in T2 DM may exceed 50%. At the same time, androgen deficiency is considered today as an independent risk factor for mortality. Therefore, studying the characteristics of the course of T2 DM in male patients with androgen deficiency is of particular interest.

The aim: to study the clinical and metabolic peculiarities of type 2 diabetes in male patients with testosterone deficiency. Target functions: to identify the prevalence of testosterone deficiency in different age groups in male patients with T2 DM; to estimate the incidence of hypogonadism, including also among men having diabetes mellitus for about ≤1 year; to compare anthropometric characteristics of male patients with T2 DM and hypogonadism and without it; to compare carbohydrate metabolism rates in both groups; to estimate cardiovascular risk (CVR) factors – the frequency of arterial hypertension (AH) and lipid profile indexes.

Material and methods. The first stage included laboratory diagnosis of hypogonadism in the general population of male patients with T2 DM (n=287). The second stage of the study included only patients with less than 1 year of diabetes mellitus 2, subject to compensation of carbohydrate metabolism – a totally 36 persons (19 with diagnosed hypogonadism and 17 without hypogonadism). Serum analysis for total testosterone was performed from 07.00 to 11.00 am. At all stages of the study, BMI, waist circumference (WC), hip circumference (HC), WC/HR were estimated, bioimpedance analysis of body composition and blood pressure measurements were also performed. Laboratory parameters included HbA1c, fasting plasma glucose, and lipid profile.

Results. The incidence of hypogonadism was 46,8% in the general sample of patients (42,8% among men <55 years old and 51,1% among men ≥55 years old) and 52,8% in the second stage of the study among men with ≤1 year of DM duration. Patients with hypogonadism had a higher % of fat mass and a tendency to higher Waist/Hips measurement index. AH in male patients with hypogonadism took place more common, and the lipid profile had more atherogenic characteristics.

Conclusion. Among male patients with T2 DM, even with compensation of carbohydrate metabolism, hypogonadism occurs in almost every second case, regardless of age. Male patients with T2 DM and androgen deficiency have potentially higher CVR due to severe atherogenic dyslipidemia and more often developing AH. Moreover, male patients with androgen deficiency and T2 DM lasting ≤1 year, even with carbohydrate metabolism compensation, also have a higher % of fat mass and CVR, which dictates the need for an independent assessment of testosterone levels in newly diagnosed T2 DM, especially in patients with visceral obesity.

Nowadays, innovative hypoglycemic metformin-combined therapy is recommended for a large number of patients with type 2 diabetes mellitus (T2 DM). Analysis of the ambulatory glycemic profile (AGP) and glycemic variability (GV) of patients can be informative when choosing the priority of prescribing dipeptidyl peptidase-4 (DPP-4) inhibitors or sodium-glucose cotransporter type 2 (SGLT-2) inhibitors.

The aim: to compare AGP and GA indexes in groups of patients with T2 DM receiving innovative glucose-lowering therapy combined with metformin.

Material and methods. The results of flash glucose monitoring (FMG) were assessed in 56 patients with type 2 diabetes mellitus aged from 45 to 60 years with an HbA1c level of ≤7,5% and disease duration of ≤5 years, receiving a combination of metformin and DPP-4 inhibitors or metformin and SGLT-2 inhibitors. For FMG, the FreeStyle Libre system (Abbott) was used.

Results. Mean sensor activity time was 86±9 (95%CI: 83–90) % and 85±9 (95%CI: 81–89) % in the groups of patients receiving metformin + DPP-4 inhibitors and metformin + SGLT-2 inhibitors, respectively. The time the glucose level was in the target range in the same groups was 91 [84–97] % versus 95 [87–97] %, the number and total duration of hypoglycemia episodes was 4 [1–16] times and 126 [45–186] minutes versus 3 [1–8] times and 90 [30–165] minutes, respectively. These differences were not statistically significant. When analyzing GV, statistically significant differences were observed only in relation to HBGI index: 1,12 [0,63–1,90] in the metformin + DPP-4 inhibitors group versus 2,17 [1,06–3,25] in the metformin + SGLT-2 inhibitors group (p=0,030). Differences in LI index (3,11 [1,76–3,85] vs. 4,45 [2,30–5,25]), J-index (15,23 [12,38–19,52] vs. 17,14 [13,99–23,43]) and ADDR (7,85 [3,22–13,00] index vs. 6,48 [4,30–14,61]) were not statistically significant (p >0,05).

Conclusion. In analyzed sample, among patients with type 2 diabetes mellitus receiving metformin + SGLT-2 inhibitors, the risk of hyperglycemia was significantly higher than in the group using metformin + DPP-4 inhibitors.

Identifying the nutritional peculiarities of pregnant females with various subtypes of gestational diabetes mellitus (GDM) may be important for timely verification of diagnosis and selection of therapy.

The aim: to evaluate the nutritional habits of female patients with different GDM subtypes.

Material and methods. The study included 130 pregnant females without a history of carbohydrate metabolism pathology. Research subjects were divided into three groups: group I – 45 pregnant females with GDM and β-cell dysfunction, group II – 43 pregnant females with GDM and insulin resistance (IR), group III – 42 pregnant females without GDM (control). All patients were questioned to assess the type of the actual diet. A complete clinical examination was carried out, carbohydrate metabolism was assessed according to fasting venous plasma glucose, and oral glucose tolerance test with 75 g of glucose. To assess IR and β-cell function, as well as to verify GDM subtypes, Matsuda index was calculated.

Results. Comparatively with healthy pregnant females, more pregnant females with GDM and IR consume >2 servings of fruits and berries daily (29 (67%) vs. 22 (52%) persons, p=0,03), >2 servings of vegetables (32 (74%) versus 21 (50%), p=0,02), as well as more meat, poultry and eggs (33 (77%) versus 26 (62%), p=0,007). Among pregnant females with GDM and β-cell dysfunction, comparatively with controls, more female patients consumed >2 servings of vegetables (27 (60%) vs. 21 (50%), p=0,02) and less of them consumed meat, poultry, and eggs (12 (27%) vs. 26 (62%), p=0,001). Patients with GDM and IR, comparatively with pregnant females with GDM and β-cell dysfunction, consume more meat, poultry and eggs daily (33 (77%) vs. 12 (27%), p=0,001), confectionery products (14 (33%) vs. 4 (9%), p=0,04) and less whole grains (6 (14%) vs. 12 (27%), p=0,04).

Conclusion. Obtained results indicate that the diets of pregnant female patients with different subtypes of GDM are largely similar, however, there are some differences in this regard, which may affect the development of these subtypes of GDM and require correction during the treatment of such type of patients.

Due to the increased frequency of cardiovascular risk factors among patients with hyperparathyroidism (PHPT), the study of the carbohydrate metabolism pathology in this cohort of patients will allow developing optimal approaches to their timely diagnosis and treatment.

Aim: to determine the frequency and describe the clinical features of carbohydrate metabolism disorders in patients with PHPT.

Material and methods. A single-center retrospective study was performed based on medical records of 367 patients with PHPT, assessing the main indicators of mineral and carbohydrate metabolism before surgical treatment of the disease. The frequency of various disorders of carbohydrate metabolism in PHPT, the comparative characteristics of mineral parameters in patients with and without them, as well as the severity of type 2 diabetes mellitus (T2 DM) in PHPT were determined. In addition, potential relationships between the parameters of various types of metabolism have been studied.

Results. The overall incidence of prediabetic disorders was 4,9% (95% CI: 3–8). T2 DM was previously diagnosed in 45 patients (12%; 95% CI: 9–16), there were no cases of first diagnosed DM. Individuals with impaired carbohydrate metabolism had a statistically significantly higher BMI and lower values of osteocalcin: 27,2 [24,2; 30,4] vs. 32,7 [28,1; 39,4] kg/m2 and 48,1 [34; 76,3] vs. 33,1 [20,8; 51,8] ng/ml, respectively (for all parameters p <0,001). Among patients with T2 DM, 36 people (80%) took hypoglycemic therapy, 14 of which received metformin monotherapy and 8 received two-component therapy, including metformin. 5 people were on insulin therapy. Diabetic nephropathy was diagnosed in 36,4% of patients, 15,4% had signs of diabetic retinopathy, symptoms of diabetic distal neuropathy were observed in 61,9% of patients with PHPT. Fasting glucose and HbA1c were negatively correlated with bone metabolism, and also expectedly depended on the glomerular filtration rate.

Conclusion. Among patients with PHPT, T2 DM is more common than in the general population. The likely reason of this may be insulin resistance, that can be caused by the effects of bone metabolites, primarily osteocalcin. In most cases, metformin makes it possible to achieve compensation for T2 DM in PHPT.

Implementation of measures to identify individuals with signs of frailty syndrome (FS) helps preserve cognitive functions and functional independence of patients.

The aim: to determine the role of obesity as a predictor of decreased physical and functional activity, as well as cognitive impairment in persons over 75 years old.

Material and methods. 40 patients (19 males and 21 females) aged 80,2±3,8 years were included in the study. They were divided into two groups: 17 (42,5%) persons with BMI <30 (25,8±2,1 kg/m²) and 23 (57,5%) with obesity (BMI 33,2±2,9 kg/m²).The probability of FS was assessed using the «Age is not a barrier» questionnaire, Morse scale, cognitive status was assessed according to MINI-COG, MMSE criteria. All patients underwent muscle strength assessment: dynamometry values <16 daN in females and <27 daN in males were taken as a symptom of probable sarcopenia.

Results. Risk of FS developing according to the «Age is not a barrier» questionnaire and the Morse scale was 40 and 71,2% higher among individuals with obesity. According to MINI-COG, 3 patients (17,6%) scored <3 points (one of the signs of dementia) in the group with BMI <30 kg/m², while in the obese group – 8 patients (34,8%). Among persons with BMI <30 kg/m², manifestations of mild dementia according to MMSE were observed in 4 (23,6%), moderate – in 5 (29,4%) cases; in obese patients they were more common – in 9 (39,2%) and 7 (30,5%) cases, respectively. Low indexes of dynamometry in the group with BMI <30 kg/m² were fixed in 8 persons (23,6±0,15 kg), in the obese group – in 19 persons(19,8±0,9 kg). Moreover, all patients with a high risk of falls according to the Morse scale (≥51 points) and dementia disorders according to the MMSE had a decrease in muscle strength. A positive correlation of BMI with Morse scale scores was revealed (r=0,49, p <0,05) both with inverse correlation between BMI and MMSE data (r=-0,56, p >0,05). There was an inverse correlation between dynamometry indexes and the age of patients (r=-0,53, p <0,05), as well as BMI (r=-0,42, p <0,05).

Conclusion. A significant decrease in the level of functional activity, muscle strength and cognitive status was found among elderly patients with obesity. This can be explained by the development of «sarcopenic obesity» in them, when excess body weight masks a lack of muscle mass, which is confirmed by dynamometry data.

Understanding factors influencing the clinical condition of patients after COVID-19, depending on the level of devotion to the principles of a healthy lifestyle (HLS), can make an additional contribution to improving approaches to the management of patients at the outpatient stage.

The aim: to evaluate healthy lifestyle devotion in patients after COVID-19.

Material and methods. 122 outpatients having had COVID-19 were included in the study. Devotion to a healthy lifestyle was assessed using the integral index of healthy lifestyle devotion (HLSI).

Results. 41,8% of patients aged 43 (28,5; 49,5) years had satisfactory HLSI, 58,2% of patients aged 47 (37; 53) years had unsatisfactory one. Comparatively with persons with unsatisfactory HLSI, satisfactory HLSI was more often recorded in females (p=0,043), younger age (p=0,017), with a lower body mass index (p <0,001), lower incidence of obesity (p <0,001), diabetes mellitus (p=0,04) and arterial hypertension (p=0,021). The probabiluty of a more severe course of the disease with an unsatisfactory HLSI was 2,93 (95% CI: 1,48–5,93), and the risk of hospitalization for COVID-19 was 4 times higher (95% CI: 2,16–7,7) regarding persons with satisfactory HLSI.

Conclusion. The importance of following the principles of a healthy lifestyle for COVID-19 has been confirmed. That can prevent or slow down the progression of the disease, development of complications and speed up the recovery process.

Prediabetes is an important problem of our time, as it is not only a metabolic condition associated with a high risk of type 2 diabetes mellitus developing, but also has a role of independent predictor of the development of cardiovascular diseases and other complications. Quite often diabetes it is proceeding asymptomatic, and therefore current review considers the risk factors associated with prediabetes, basing on which the primary care physician will be able to examine the relevant group of patients more specifically. Despite existing generally accepted criteria, diagnosing prediabetes remains to be a quite complicated task, since the world’s leading experts do not agree on the threshold values for this condition. Use of comprehensive screening and lower glycemic values may lead to earlier detection of prediabetes and slow its further progression.

Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease of metabolic origin in individuals without exogenous factors of toxic damage. It is associated not only with an unfavorable hepatic prognosis, but also with cardiovascular morbidity and mortality increase. There is existing a bidirectional relationship between NAFLD and type 2 diabetes mellitus; in addition, there is close comorbidity between NAFLD and a number of other pathologies. Currently, this hepatic disease is becoming the same non-infectious epidemic as cancer, obesity, diabetes mellitus, cardiovascular diseases, and a multidisciplinary approach to its treatment includes the improvement of not only «liver health» parameters, but also the health of the patient as a whole. Article discusses the key areas of examination and treatment of a patient with a presumed diagnosis of NAFLD.

Infectious endocarditis remains challenging to diagnose, especially for patients with no apparent clinical symptoms. The presented clinical case describes a rapid progression of sepsis and challenges in treating a patient with risk factors, including undergoing immunosuppressive therapy due to a transplanted kidney, renal failure and the need for conventional dialysis. The case report highlights the significance of frequent monitoring of patients with the described risk factors, and emphasises the critical role of adopting more aggressive treatment strategies during the initial phases of the disease.

Observations of three cases of one of complications of tumor processes – non-bacterial (non-infectious, aseptic) thrombotic endocarditis as paraneoplastic process in patients with adenocarcinoma and gastrointestinal stromal tumor – GIST of stomach wall are presented. Clinical manifestations of autoimmune and coagulopathic syndromes associated with tumors and endocarditis are discussed.

As an official diagnosis for autonomic disorders, ICD-10 uses code G90 – «disorders of the autonomic nervous system». According to a survey of 206 neurologists and therapists in Russia, 97% of respondents use the diagnosis «vegetative dysfunction syndrome» (VDS) in their practice. Among its symptoms are asthenia, functional dizziness, breathing disorders, paroxysmal conditions, etc. VDS always develops against the background of anxiety and/or depressive disorders, and therefore the entire range of psychotropic drugs is used in outpatient practice – antidepressants, tranquilizers, antipsychotics. However, the patients are not always ready to accept psychotropic therapy, so there is often a need to search for alternative treatment strategies for VDS, including the use of herbal drugs and nootropics. Complex therapy with Picamilon and Corvalol Phyto/Phytocomfort makes it possible to level out, and in some cases stabilize, the manifestations of autonomic dysfunction by its impact on the pathogenesis of VDS.