Pub Date : 2023-11-30DOI: 10.22141/2224-0721.19.7.2023.1330
K. Shyshkan-Shyshova, O. Zinych, N.M. Кushnareva, A.V. Кovalchuk, О.В. Prybyla
Background. The purpose was to investigate the effect of therapy with glucagon-like peptide-1 receptor agonists (GLP-1ra) on the serum concentration of trimethylamine-N-oxide (TMAO), an intestinal microbiome metabolite, in patients with type 2 diabetes mellitus (T2DM) in relation to clinical and laboratory indicators and parameters of body composition. Materials and methods. Thirty-three T2DM patients (17 women and 16 men) were examined aged 31 to 72 years who had unsatisfactory control of carbohydrate metabolism (HbA1c > 7.4 %) against the background of previous glucose-lowering therapy (metformin, sulfonylurea derivatives, insulin, gliflozin) and were administered GLP-1ra. Before the start of treatment and after 6 months of therapy, parameters of anthropometry, body composition were measured (using the bioelectrical impedance analysis with the Tanita analyzer); blood glucose and glycated hemoglobin, TMAO concentration, blood lipids were assessed. Results. Patients diagnosed with Т2DM had HbA1c > 7.4 %; 91 % had general obesity (body mass index 34.7 ± 6.6 kg/m2), 100 % had abdominal obesity (waist circumference 118.00 ± 11.24 cm, Med ± SD). In 72 % of cases, there was a history of cardiovascular complications (myocardial infarction, stroke, coronary and peripheral atherosclerosis, arterial stenosis). Under the influence of a 6-month administration of GLP1ra, there was a decrease in the degree of total and abdominal obesity, a significant drop in the percentage of fat and the level of visceral fat, which was accompanied by an increase in hydration, a reduction in triglyceridemia and the concentration of very-low-density lipoprotein cholesterol (VLDL-C). A significant decrease in the level of TMAO microbial metabolite in the blood serum was recorded, which may reflect the antiatherogenic effect of GLP1ra, associated with the control of cholesterol and bile acid metabolism, the stimulation of VLDL-C receptors, and the effect on the secretion of insulin, glucagon, ghrelin, leptin, incretins. Conclusions. A study on the clinical effects of the incretin mimetic (GLP-1ra) in patients with T2DM confirmed its positive impact on glucose metabolism and blood lipids. At the same time, during GLP-1ra therapy, an improvement of some compositional and lipid indicators (visceral fat, triglycerides, VLDL-C) was recorded with a simultaneous decrease in the concentration of TMAO toxic metabolite.
{"title":"The effects of incretin mimetics on the level of the microbial metabolite trimethylamine-N-oxide, a marker of cardiovascular risk in type 2 diabetic patients","authors":"K. Shyshkan-Shyshova, O. Zinych, N.M. Кushnareva, A.V. Кovalchuk, О.В. Prybyla","doi":"10.22141/2224-0721.19.7.2023.1330","DOIUrl":"https://doi.org/10.22141/2224-0721.19.7.2023.1330","url":null,"abstract":"Background. The purpose was to investigate the effect of therapy with glucagon-like peptide-1 receptor agonists (GLP-1ra) on the serum concentration of trimethylamine-N-oxide (TMAO), an intestinal microbiome metabolite, in patients with type 2 diabetes mellitus (T2DM) in relation to clinical and laboratory indicators and parameters of body composition. Materials and methods. Thirty-three T2DM patients (17 women and 16 men) were examined aged 31 to 72 years who had unsatisfactory control of carbohydrate metabolism (HbA1c > 7.4 %) against the background of previous glucose-lowering therapy (metformin, sulfonylurea derivatives, insulin, gliflozin) and were administered GLP-1ra. Before the start of treatment and after 6 months of therapy, parameters of anthropometry, body composition were measured (using the bioelectrical impedance analysis with the Tanita analyzer); blood glucose and glycated hemoglobin, TMAO concentration, blood lipids were assessed. Results. Patients diagnosed with Т2DM had HbA1c > 7.4 %; 91 % had general obesity (body mass index 34.7 ± 6.6 kg/m2), 100 % had abdominal obesity (waist circumference 118.00 ± 11.24 cm, Med ± SD). In 72 % of cases, there was a history of cardiovascular complications (myocardial infarction, stroke, coronary and peripheral atherosclerosis, arterial stenosis). Under the influence of a 6-month administration of GLP1ra, there was a decrease in the degree of total and abdominal obesity, a significant drop in the percentage of fat and the level of visceral fat, which was accompanied by an increase in hydration, a reduction in triglyceridemia and the concentration of very-low-density lipoprotein cholesterol (VLDL-C). A significant decrease in the level of TMAO microbial metabolite in the blood serum was recorded, which may reflect the antiatherogenic effect of GLP1ra, associated with the control of cholesterol and bile acid metabolism, the stimulation of VLDL-C receptors, and the effect on the secretion of insulin, glucagon, ghrelin, leptin, incretins. Conclusions. A study on the clinical effects of the incretin mimetic (GLP-1ra) in patients with T2DM confirmed its positive impact on glucose metabolism and blood lipids. At the same time, during GLP-1ra therapy, an improvement of some compositional and lipid indicators (visceral fat, triglycerides, VLDL-C) was recorded with a simultaneous decrease in the concentration of TMAO toxic metabolite.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":"126 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139207528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.22141/2224-0721.19.7.2023.1327
V.І. Kravchenko, K. Ivaskiva, I. Andrusyshyna, V.I. Pankiv, M.D. Khalangot, V. Orlenko, V.L. Vasiuk
Background. The research deals with the provision of calcium, magnesium and zinc in patients with type 2 diabetes mellitus (T2DM). The purpose was to investigate the serum content of calcium, magnesium and zinc in patients with type 2 DM. Materials and methods. The open-label controlled study included 27 patients with T2DM. The control group consisted of 12 people without endocrine and somatic diseases. 70 % of patients had newly diagnosed DM; in others, the disease duration was up to 5 years. Most of the examined were of mature age, on average 61.83 ± 5.52 years for patients and 55.25 ± 5.52 years for controls. In the group with T2DM, women accounted for 62.96 %, among controls — 63.64 %. Anthropometric measurements and glucose indicators were determined according to a standard procedure. Concentrations of calcium, magnesium, zinc in serum were evaluated by atomic optical emission spectrometry with inductively coupled plasma (PerkinElmer Optima 2100 DV ICP-OES, USA) according to the original procedure approved by the Kundiiev Institute of Occupational Health of the NAMS of Ukraine. Results. The level of fasting blood sugar ranged from 7.1 to 17.2 mmol/l and indicated the presence of T2DM, glycated hemoglobin was from 7.1 to 11.2 %. According to anthropometric data, the group of patients almost completely corresponded to the control group. Although a slight increase in body weight and waist circumference was registered already at the stage of initial diabetes, the level of triglycerides increased significantly, and the level of high-density lipoprotein decreased. A significant reduction in the levels of calcium and magnesium in the blood serum of patients with T2DM was found. The zinc content was at the level of the lower edge of the reference value in 44 % of patients, in the control group — only in 16.6 % of cases. There were no significant differences in this indicator in the observation groups. A high correlation was found between the studied parameters in the blood, as well as an inverse correlation between the fasting glucose level and the content of calcium and magnesium. Conclusions. A significant decrease in the level of calcium and magnesium in the blood of Ukrainian patients with type 2 diabetes mellitus was found. There is a high correlation between serum calcium, magnesium and zinc levels in patients with T2DM. Significant risks of diabetes were revealed when the serum concentration of calcium and magnesium decreased.
{"title":"Assessment of serum calcium, magnesium and zinc levels in patients with type 2 diabetes mellitus in the Ukrainian population","authors":"V.І. Kravchenko, K. Ivaskiva, I. Andrusyshyna, V.I. Pankiv, M.D. Khalangot, V. Orlenko, V.L. Vasiuk","doi":"10.22141/2224-0721.19.7.2023.1327","DOIUrl":"https://doi.org/10.22141/2224-0721.19.7.2023.1327","url":null,"abstract":"Background. The research deals with the provision of calcium, magnesium and zinc in patients with type 2 diabetes mellitus (T2DM). The purpose was to investigate the serum content of calcium, magnesium and zinc in patients with type 2 DM. Materials and methods. The open-label controlled study included 27 patients with T2DM. The control group consisted of 12 people without endocrine and somatic diseases. 70 % of patients had newly diagnosed DM; in others, the disease duration was up to 5 years. Most of the examined were of mature age, on average 61.83 ± 5.52 years for patients and 55.25 ± 5.52 years for controls. In the group with T2DM, women accounted for 62.96 %, among controls — 63.64 %. Anthropometric measurements and glucose indicators were determined according to a standard procedure. Concentrations of calcium, magnesium, zinc in serum were evaluated by atomic optical emission spectrometry with inductively coupled plasma (PerkinElmer Optima 2100 DV ICP-OES, USA) according to the original procedure approved by the Kundiiev Institute of Occupational Health of the NAMS of Ukraine. Results. The level of fasting blood sugar ranged from 7.1 to 17.2 mmol/l and indicated the presence of T2DM, glycated hemoglobin was from 7.1 to 11.2 %. According to anthropometric data, the group of patients almost completely corresponded to the control group. Although a slight increase in body weight and waist circumference was registered already at the stage of initial diabetes, the level of triglycerides increased significantly, and the level of high-density lipoprotein decreased. A significant reduction in the levels of calcium and magnesium in the blood serum of patients with T2DM was found. The zinc content was at the level of the lower edge of the reference value in 44 % of patients, in the control group — only in 16.6 % of cases. There were no significant differences in this indicator in the observation groups. A high correlation was found between the studied parameters in the blood, as well as an inverse correlation between the fasting glucose level and the content of calcium and magnesium. Conclusions. A significant decrease in the level of calcium and magnesium in the blood of Ukrainian patients with type 2 diabetes mellitus was found. There is a high correlation between serum calcium, magnesium and zinc levels in patients with T2DM. Significant risks of diabetes were revealed when the serum concentration of calcium and magnesium decreased.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":"413 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139204815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.22141/2224-0721.19.7.2023.1322
I. Kovalska, O. Dronov, T. Ivanets, L. Roshchyna
Background. Acute pancreatitis is an aseptic inflammation of the pancreas with diverse complications and further development of necrosis of the gland, parapancreatic tissue and possible addition of secondary infection. A significant number of biochemical markers that can be predictors of pancreatitis complications are still being researched. However, most of them are expensive and their indicators are increased only in the first 24–48 hours after the onset of the disease, so they are not used in daily clinical routine. The purpose of this study is to evaluate the factors that indicate an elevated risk of necrosis in acute severe pancreatitis. Materials and methods. A retrospective analysis of 80 patients with acute pancreatitis was performed via creation of a multivariate logistic regression model. Results. The dependence of the risk of pancreatic necrosis on the following factor signs was found: lipase at the onset of the disease (cut-off value = 599.6 U/l, area under the receiver operating characteristic curve (АUС) = 0.72 (95% confidence interval (СІ) 0.57–0.88)), severity of the disease, fibrinogen on day 3 of the disease (cut-off value = 9.7, АUС = 0.65 (95% СІ 0.48–0.81)), C-reactive protein (cut-off value = 175.7 mg/L, AUC = 0.70 (95% CI 0.54–0.86)), and intra-abdominal mean capillary perfusion pressure on the first day of the disease (cut-off value ≤ 63.3 mm Hg, АUС = 0.88 (95% СІ 0.77–0.99)). The autopsy results revealed the presence of necrosis and microthrombosis of the pancreas. Conclusions. Factors that may indicate an increased risk of pancreatic necrosis were high levels of lipase, fibrinogen on the third day of the disease, C-reactive protein, decreased intra-abdominal mean capillary perfusion pressure, severity of the disease, and the presence of portosplenomesentric thrombosis.
{"title":"Risk factors for pancreatic necrosis in acute pancreatitis in obese patients","authors":"I. Kovalska, O. Dronov, T. Ivanets, L. Roshchyna","doi":"10.22141/2224-0721.19.7.2023.1322","DOIUrl":"https://doi.org/10.22141/2224-0721.19.7.2023.1322","url":null,"abstract":"Background. Acute pancreatitis is an aseptic inflammation of the pancreas with diverse complications and further development of necrosis of the gland, parapancreatic tissue and possible addition of secondary infection. A significant number of biochemical markers that can be predictors of pancreatitis complications are still being researched. However, most of them are expensive and their indicators are increased only in the first 24–48 hours after the onset of the disease, so they are not used in daily clinical routine. The purpose of this study is to evaluate the factors that indicate an elevated risk of necrosis in acute severe pancreatitis. Materials and methods. A retrospective analysis of 80 patients with acute pancreatitis was performed via creation of a multivariate logistic regression model. Results. The dependence of the risk of pancreatic necrosis on the following factor signs was found: lipase at the onset of the disease (cut-off value = 599.6 U/l, area under the receiver operating characteristic curve (АUС) = 0.72 (95% confidence interval (СІ) 0.57–0.88)), severity of the disease, fibrinogen on day 3 of the disease (cut-off value = 9.7, АUС = 0.65 (95% СІ 0.48–0.81)), C-reactive protein (cut-off value = 175.7 mg/L, AUC = 0.70 (95% CI 0.54–0.86)), and intra-abdominal mean capillary perfusion pressure on the first day of the disease (cut-off value ≤ 63.3 mm Hg, АUС = 0.88 (95% СІ 0.77–0.99)). The autopsy results revealed the presence of necrosis and microthrombosis of the pancreas. Conclusions. Factors that may indicate an increased risk of pancreatic necrosis were high levels of lipase, fibrinogen on the third day of the disease, C-reactive protein, decreased intra-abdominal mean capillary perfusion pressure, severity of the disease, and the presence of portosplenomesentric thrombosis.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139208905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.22141/2224-0721.19.7.2023.1323
M. Derbak, O. V. Buchok, T. M. Ganych, O. A. Rishko, V. V. Timashev, Derbak Mariya
Background. Chronic hepatitis C (СHC) is often complicated by the presence of concomitant gastrointestinal diseases, one of which is chronic pancreatitis (CP). This has a negative impact on the clinical course of both diseases, contributes to nutrient deficiencies, in particular vitamin D, and worsens the quality of life of patients. The aim of the research was to study the features of the clinical course of CHC in comorbidity with CP and to evaluate the quality of life in patients with different levels of vitamin D in blood serum. Materials and methods. The study included 120 patients who were divided into 2 groups: group 1 — 72 patients with CHC and CP and group 2 — 48 patients with CHC. In turn, patients of group 1, depending on the enzymatic activity of the pancreas, were divided into group 1a (n = 52), which included patients with CHC and CP with exocrine insufficiency (EI), and group 1b (n = 20) — patients with CHC and CP with preserved exocrine function of the pancreas. In all patients, fecal coproscopy was performed, the level of fecal elastase (FE-1), vitamin D, viral load was determined, and the degree of fibrosis and necroinflammatory activity was evaluated using FibroTest and ActiTest. Situational anxiety was assessed according to the Spielberger-Hanin method, and quality of life using the SF-12 questionnaire. The analysis and processing of the results of the examination of patients was carried out using the computer program Jamovi 2.3.2.1, Microsoft Office Excel for Windows 2016 using the Kruskal-Wallis method, the Mann-Whitney-Wilcoxon criterion and the Pearson correlation coefficient. The difference was considered to be statistically significant at p < 0.05. Results. A significantly lower level of vitamin D was found in patients of group 1a than in patients of groups 1b and 2. Patients of group 1 with higher stages of fibrosis (F2–3 and F3–4), a higher degree of necroinflammatory activity in the liver (> A2) and a high viral load have lower levels of vitamin D than those with initial stages of fibrosis and less severe necroinflammatory process in the liver. Patients with CHC, CP and exocrine insufficiency complained of mood changes, increased anxiety, rapid fatigue, and muscle weakness significantly more often than those with preserved exocrine function and patients with CHC. The level of vitamin D in people with CHC, CP and exocrine insufficiency positively correlates with the level of FE-1. In all patients with CHC in comorbidity with CP, a negative effect of low levels of vitamin D on indicators of quality of life and anxiety was found. Conclusions. A reduced level of vitamin D in the blood of patients with CHC and CP worsens the course of the disease and is associated with a decrease in quality of life.
背景。慢性丙型肝炎（СHC）往往因同时患有胃肠道疾病而变得复杂，慢性胰腺炎（CP）就是其中之一。这对两种疾病的临床过程都会产生负面影响，导致营养缺乏，尤其是维生素 D 的缺乏，并降低患者的生活质量。本研究旨在研究合并 CP 的 CHC 临床病程特点，并评估血清中维生素 D 含量不同的患者的生活质量。材料和方法研究纳入了 120 名患者，将其分为两组：第 1 组--72 名 CHC 和 CP 患者，第 2 组--48 名 CHC 患者。而根据胰腺酶活性的不同，第1组患者又分为1a组（n = 52）和1b组（n = 20），前者包括胰腺外分泌功能不全（EI）的CHC和CP患者，后者包括胰腺外分泌功能保留的CHC和CP患者。对所有患者进行了粪便镜检查，确定了粪便弹性蛋白酶（FE-1）、维生素 D 和病毒载量的水平，并使用 FibroTest 和 ActiTest 评估了纤维化程度和坏死性炎症活动。根据斯皮尔伯格-哈宁法评估了情境焦虑，并使用 SF-12 问卷评估了生活质量。对患者检查结果的分析和处理采用计算机程序 Jamovi 2.3.2.1、Microsoft Office Excel for Windows 2016，使用 Kruskal-Wallis 方法、Mann-Whitney-Wilcoxon 标准和皮尔逊相关系数。与肝纤维化初期和肝脏坏死炎症过程不严重的患者相比，病毒载量高的患者维生素 D 水平较低。CHC、CP 和外分泌功能不全的患者诉说情绪变化、焦虑增加、快速疲劳和肌肉无力的频率明显高于外分泌功能保留者和 CHC 患者。CHC、CP 和外分泌功能不全患者的维生素 D 水平与 FE-1 水平呈正相关。在所有合并有 CP 的 CHC 患者中，发现低水平的维生素 D 对生活质量和焦虑指标有负面影响。结论是CHC合并CP患者血液中维生素D水平降低会加重病情，并与生活质量下降相关。
{"title":"Assessment of the influence of vitamin D level on the course of chronic hepatitis C in comorbidity with chronic pancreatitis","authors":"M. Derbak, O. V. Buchok, T. M. Ganych, O. A. Rishko, V. V. Timashev, Derbak Mariya","doi":"10.22141/2224-0721.19.7.2023.1323","DOIUrl":"https://doi.org/10.22141/2224-0721.19.7.2023.1323","url":null,"abstract":"Background. Chronic hepatitis C (СHC) is often complicated by the presence of concomitant gastrointestinal diseases, one of which is chronic pancreatitis (CP). This has a negative impact on the clinical course of both diseases, contributes to nutrient deficiencies, in particular vitamin D, and worsens the quality of life of patients. The aim of the research was to study the features of the clinical course of CHC in comorbidity with CP and to evaluate the quality of life in patients with different levels of vitamin D in blood serum. Materials and methods. The study included 120 patients who were divided into 2 groups: group 1 — 72 patients with CHC and CP and group 2 — 48 patients with CHC. In turn, patients of group 1, depending on the enzymatic activity of the pancreas, were divided into group 1a (n = 52), which included patients with CHC and CP with exocrine insufficiency (EI), and group 1b (n = 20) — patients with CHC and CP with preserved exocrine function of the pancreas. In all patients, fecal coproscopy was performed, the level of fecal elastase (FE-1), vitamin D, viral load was determined, and the degree of fibrosis and necroinflammatory activity was evaluated using FibroTest and ActiTest. Situational anxiety was assessed according to the Spielberger-Hanin method, and quality of life using the SF-12 questionnaire. The analysis and processing of the results of the examination of patients was carried out using the computer program Jamovi 2.3.2.1, Microsoft Office Excel for Windows 2016 using the Kruskal-Wallis method, the Mann-Whitney-Wilcoxon criterion and the Pearson correlation coefficient. The difference was considered to be statistically significant at p < 0.05. Results. A significantly lower level of vitamin D was found in patients of group 1a than in patients of groups 1b and 2. Patients of group 1 with higher stages of fibrosis (F2–3 and F3–4), a higher degree of necroinflammatory activity in the liver (> A2) and a high viral load have lower levels of vitamin D than those with initial stages of fibrosis and less severe necroinflammatory process in the liver. Patients with CHC, CP and exocrine insufficiency complained of mood changes, increased anxiety, rapid fatigue, and muscle weakness significantly more often than those with preserved exocrine function and patients with CHC. The level of vitamin D in people with CHC, CP and exocrine insufficiency positively correlates with the level of FE-1. In all patients with CHC in comorbidity with CP, a negative effect of low levels of vitamin D on indicators of quality of life and anxiety was found. Conclusions. A reduced level of vitamin D in the blood of patients with CHC and CP worsens the course of the disease and is associated with a decrease in quality of life.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139198249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. Arterial hypertension (AH) is the cause of 70–75 % of strokes. Atherosclerotic lesion of the carotid artery (CA) is a classic example of a vascular lesion in individuals with hypertension. The risk of stroke increases twice when hypertension and diabetes are combined. Carotid endarterectomy (CA), which has both a curative and preventive nature, is the main method of surgical treatment of CA stenoses. The purpose was to study the course of blood pressure in patients with type 2 diabetes and without it after CE. Materials and methods. 138 patients with arterial hypertension and CA stenosis were selected for the purpose of CE under local anesthesia. Patients were divided into two groups: 68 patients with type 2 diabetes (group I) and 70 patients without diabetes (group II). The median age of patients in group I was 64 [50–71] years, group II — 63.5 [47–68] years. Daily blood pressure monitoring (BPD) was performed 2 days before surgery (1 examination), 5–7 days after surgery (2 examinations) and 3–6 months after CE (3 examinations). The average indicators of systolic blood pressure (SBP) and diastolic blood pressure (DBP) per day, day, and night were evaluated; average pulse blood pressure (BP); variability of SBP and DBP per day, day, night. Results. Before the operation, group I, in contrast to group II, recorded significantly higher indicators: SATdb (p = 0.02), SATd (p = 0.03), SATn (p = 0.01), DBTn (p < 0, 05), PAT (p = 0.03), varDATdb (p = 0.03), varSATd (p = 0.03), varDATn (p = 0.04). During the second examination in group II, significantly more significant dynamics of DMAT indicators were noted: SATdb (p = 0.002), SATd (p = 0.02), DAPdb (p = 0.002), DAPd (p = 0.01), DAPn (p = 0.03), varSATn (p < 0.04), varDATn (p < 0.05), varSATdb (p = 0.0002), varDATdb (p = 0.0001). The dynamics of PAT and midnight SAT were insignificant. 3 months after KE, all mean values of SBP and DBP, as well as PAT, decreased significantly in patients of group II. The expressiveness of changes in SBP indicators during the day, day and night, as well as indicators of SBP variability in group II was more significant. During the third examination, the proportion of patients with a "dipper" circadian rhythm increased in the two groups (p < 0.05). In group II, the proportion of patients with an unfavorable type of daily profile "over-dipper" significantly decreased (p < 0.001), which did not occur in group I. Conclusions. Surgical treatment of carotid stenoses in patients with and without type 2 diabetes is associated with a decrease in blood pressure in the early postoperative period and is observed for several months after the operation.
{"title":"The course of arterial hypertension in patients with type 2 diabetes after surgical treatment of carotid artery stenotic lesions","authors":"Didenko O.Z., Kobza I.I., Dutka R.Ya., Dronyk I.S., Chmyr N.V.","doi":"10.22141/2224-0721.19.7.2023.1326","DOIUrl":"https://doi.org/10.22141/2224-0721.19.7.2023.1326","url":null,"abstract":"Background. Arterial hypertension (AH) is the cause of 70–75 % of strokes. Atherosclerotic lesion of the carotid artery (CA) is a classic example of a vascular lesion in individuals with hypertension. The risk of stroke increases twice when hypertension and diabetes are combined. Carotid endarterectomy (CA), which has both a curative and preventive nature, is the main method of surgical treatment of CA stenoses. The purpose was to study the course of blood pressure in patients with type 2 diabetes and without it after CE. Materials and methods. 138 patients with arterial hypertension and CA stenosis were selected for the purpose of CE under local anesthesia. Patients were divided into two groups: 68 patients with type 2 diabetes (group I) and 70 patients without diabetes (group II). The median age of patients in group I was 64 [50–71] years, group II — 63.5 [47–68] years. Daily blood pressure monitoring (BPD) was performed 2 days before surgery (1 examination), 5–7 days after surgery (2 examinations) and 3–6 months after CE (3 examinations). The average indicators of systolic blood pressure (SBP) and diastolic blood pressure (DBP) per day, day, and night were evaluated; average pulse blood pressure (BP); variability of SBP and DBP per day, day, night. Results. Before the operation, group I, in contrast to group II, recorded significantly higher indicators: SATdb (p = 0.02), SATd (p = 0.03), SATn (p = 0.01), DBTn (p < 0, 05), PAT (p = 0.03), varDATdb (p = 0.03), varSATd (p = 0.03), varDATn (p = 0.04). During the second examination in group II, significantly more significant dynamics of DMAT indicators were noted: SATdb (p = 0.002), SATd (p = 0.02), DAPdb (p = 0.002), DAPd (p = 0.01), DAPn (p = 0.03), varSATn (p < 0.04), varDATn (p < 0.05), varSATdb (p = 0.0002), varDATdb (p = 0.0001). The dynamics of PAT and midnight SAT were insignificant. 3 months after KE, all mean values of SBP and DBP, as well as PAT, decreased significantly in patients of group II. The expressiveness of changes in SBP indicators during the day, day and night, as well as indicators of SBP variability in group II was more significant. During the third examination, the proportion of patients with a \"dipper\" circadian rhythm increased in the two groups (p < 0.05). In group II, the proportion of patients with an unfavorable type of daily profile \"over-dipper\" significantly decreased (p < 0.001), which did not occur in group I. Conclusions. Surgical treatment of carotid stenoses in patients with and without type 2 diabetes is associated with a decrease in blood pressure in the early postoperative period and is observed for several months after the operation.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":"73 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139207726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.22141/2224-0721.19.7.2023.1325
P. O. Lishchynsky, O. Tovkai
Background. Due to the low sensitivity and specificity of neck ultrasound in the evaluation of the central lymph nodes, it is necessary to find alternative ways to predict central lymph node metastases in patients with papillary thyroid cancer (PTC). The purpose of the study is to develop a prognostic model for assessing the risk of local metastasis of papillary thyroid cancer based on preoperative ultrasound and demographic predictors. Materials and methods. A retrospective monocenter cohort study was conducted. The data of 401 patients who underwent surgery for PTC were processed. The main group included 179 patients in whom central lymph node metastases were detected during histopathological examination. The comparison group consisted of 222 patients without metastases according to the results of histopathological examination. When conducting the analysis, the following signs were considered as risk factors: subcapsular location of the tumor; size; blurred boundaries; the presence of calcification areas (microcalcifications); age of a patient. Inclusion criteria: PTC that was cytologically confirmed at the preoperative stage; surgeries (thyroidectomy/hemithyroidectomy and central neck lymph node dissection). Exclusion criteria: history of neck surgery; multifocal lesions of the thyroid gland. Results. The following logistic equation was obtained using the StatPlus program: y = –1.839 – 0.037 × X1 + 0.097 × X2 + 1.123 × X3 + 1.198 × X4 + + 0.692 × X5, where X1, X2, X3, X4, X5 are age (years), size (mm), subcapsular location (presence), blurred boundaries (presence), calcifications (presence), respectively. The obtained prognostic model provided the following operational characteristics when specifying the threshold value for P, which is equal to 0.44 (the decisive rule X > T): sensitivity — 75.4 %, specificity — 79.3 %, diagnostic efficiency — 75.1 %. To assess the quality of the model, the receiver operator characteristic (ROC) analysis was performed. The following data were obtained: area under the ROC curve = 0.797 (95% confidence interval: 0.753–0.841), which corresponds to the good quality of the model, and Youden index J = 0.5155. Checking the quality of the model on a control group of 100 people gave the following results: sensitivity — 72.2 %, specificity — 76.1 %, diagnostic efficiency — 75.8 %. Conclusions. The application of a prognostic model based on ultrasound data and the patient’s age makes it possible to predict the presence of local metastases of the PTC at the preoperative stage with a diagnostic efficiency of 75.8 %. No prognostic model gives 100% prediction accuracy. When choosing the treatment, additional influencing factors (history of radiation exposure, burdened family history, etc.) for a specific patient should be considered.
{"title":"Ultrasound and demographic predictors of papillary thyroid cancer local metastasis at the preoperative stage: a predictive model","authors":"P. O. Lishchynsky, O. Tovkai","doi":"10.22141/2224-0721.19.7.2023.1325","DOIUrl":"https://doi.org/10.22141/2224-0721.19.7.2023.1325","url":null,"abstract":"Background. Due to the low sensitivity and specificity of neck ultrasound in the evaluation of the central lymph nodes, it is necessary to find alternative ways to predict central lymph node metastases in patients with papillary thyroid cancer (PTC). The purpose of the study is to develop a prognostic model for assessing the risk of local metastasis of papillary thyroid cancer based on preoperative ultrasound and demographic predictors. Materials and methods. A retrospective monocenter cohort study was conducted. The data of 401 patients who underwent surgery for PTC were processed. The main group included 179 patients in whom central lymph node metastases were detected during histopathological examination. The comparison group consisted of 222 patients without metastases according to the results of histopathological examination. When conducting the analysis, the following signs were considered as risk factors: subcapsular location of the tumor; size; blurred boundaries; the presence of calcification areas (microcalcifications); age of a patient. Inclusion criteria: PTC that was cytologically confirmed at the preoperative stage; surgeries (thyroidectomy/hemithyroidectomy and central neck lymph node dissection). Exclusion criteria: history of neck surgery; multifocal lesions of the thyroid gland. Results. The following logistic equation was obtained using the StatPlus program: y = –1.839 – 0.037 × X1 + 0.097 × X2 + 1.123 × X3 + 1.198 × X4 + + 0.692 × X5, where X1, X2, X3, X4, X5 are age (years), size (mm), subcapsular location (presence), blurred boundaries (presence), calcifications (presence), respectively. The obtained prognostic model provided the following operational characteristics when specifying the threshold value for P, which is equal to 0.44 (the decisive rule X > T): sensitivity — 75.4 %, specificity — 79.3 %, diagnostic efficiency — 75.1 %. To assess the quality of the model, the receiver operator characteristic (ROC) analysis was performed. The following data were obtained: area under the ROC curve = 0.797 (95% confidence interval: 0.753–0.841), which corresponds to the good quality of the model, and Youden index J = 0.5155. Checking the quality of the model on a control group of 100 people gave the following results: sensitivity — 72.2 %, specificity — 76.1 %, diagnostic efficiency — 75.8 %. Conclusions. The application of a prognostic model based on ultrasound data and the patient’s age makes it possible to predict the presence of local metastases of the PTC at the preoperative stage with a diagnostic efficiency of 75.8 %. No prognostic model gives 100% prediction accuracy. When choosing the treatment, additional influencing factors (history of radiation exposure, burdened family history, etc.) for a specific patient should be considered.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139208429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-03DOI: 10.22141/2224-0721.19.5.2023.1303
D. Miloslavsky, S. Koval
The role of the stress factor and adjustment disorders among patients of a very high-risk group, namely with hypertension against the background of type 2 diabetes, was examined in the review of domestic and foreign sources of literature from the PubMed database. The authors provide data on the classification and terminology of adjustment disorders in this category of patients, and the contribution of the stress factor and activation of neurohumoral systems in their formation is considered in the historical aspect. The issue of the role of such adjustment disorders as anxiety, depression, sleep disorders, violent behavior in the family, at work is considered separately in terms of the negative course and progression of these dangerous diseases. Data are given on a number of non-modifiable and modifiable risk factors, namely genetic, haemodynamic, neurohumoral, hormonal and cardiometabolic characteristics of patients, prevalence, morbidity and mortality from complications of hypertension and type 2 diabetes in the presence of adjustment disorders; a brief description of diagnostic and preventive approaches to the correction of adjustment disorders among patients at a very high risk are described from a cardiologist’s standpoint.
{"title":"Adjustment disorders, hypertension and type 2 diabetes: a cardiologist’s view (literature review)","authors":"D. Miloslavsky, S. Koval","doi":"10.22141/2224-0721.19.5.2023.1303","DOIUrl":"https://doi.org/10.22141/2224-0721.19.5.2023.1303","url":null,"abstract":"The role of the stress factor and adjustment disorders among patients of a very high-risk group, namely with hypertension against the background of type 2 diabetes, was examined in the review of domestic and foreign sources of literature from the PubMed database. The authors provide data on the classification and terminology of adjustment disorders in this category of patients, and the contribution of the stress factor and activation of neurohumoral systems in their formation is considered in the historical aspect. The issue of the role of such adjustment disorders as anxiety, depression, sleep disorders, violent behavior in the family, at work is considered separately in terms of the negative course and progression of these dangerous diseases. Data are given on a number of non-modifiable and modifiable risk factors, namely genetic, haemodynamic, neurohumoral, hormonal and cardiometabolic characteristics of patients, prevalence, morbidity and mortality from complications of hypertension and type 2 diabetes in the presence of adjustment disorders; a brief description of diagnostic and preventive approaches to the correction of adjustment disorders among patients at a very high risk are described from a cardiologist’s standpoint.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81578508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-03DOI: 10.22141/2224-0721.19.5.2023.1302
T. Bentsa
The review article represents an analysis of sources dealing with the issues of dietary therapy of obesity. The internet resources were used such as PubMed, MedLine, The Cochrane Databases, Google Scholar, Science Direct, Web of Science, and Scopus. Obesity has reached pandemic proportions worldwide, with more than 1 billion adults overweight (at least 300 million of them are clinically obese) and is a major contributor to the global burden of chronic disease and disability. This is a complex multifactorial disease, in which the accumulated excess fat in the body leads to negative impact on health. The main cause of obesity is a long-term energy imbalance between consumed and expended calories. Lifestyle modification remains the cornerstone of obesity treatment. An individually selected diet is recommended, which allows you to achieve a state of negative energy balance and is focused on quality food for health promotion. Most often, recommended diets for the treatment of obesity use the following energy restrictions based on changes in the composition of macronutrients: a low-fat diet, a low-carbohydrate and high-fat diet, a low-carbohydrate and high-protein diet, a paleo diet (with a high protein content). Intermittent fasting is considered an alternative to calorie-restricted diets. After an initial period on a high-protein diet, a Mediterranean diet may be an attractive option for continued treatment of obesity, provided that it is given in an energy-restricted form. This diet has been shown to be associated with lower levels of inflammatory biomarkers and metabolic markers of cardiovascular disease risk. The results of many studies indicate successful weight loss with the help of the Mediterranean diet, not only in the short term, but also in the long term. For the majority of obese patients, a purposeful change in lifestyle with adherence to the principles of dietary nutrition and regular physical activity allows for effective weight loss, adequate control of metabolic disorders, reduced risk of concomitant diseases, and long-term maintenance of body weight achieved in the process of losing weight.
这篇综述文章是对有关肥胖饮食治疗问题的资料来源的分析。使用了PubMed、MedLine、Cochrane数据库、Google Scholar、Science Direct、Web of Science、Scopus等网络资源。肥胖在世界范围内已达到流行病的程度，超过10亿成年人超重(其中至少3亿人为临床肥胖)，是造成全球慢性疾病和残疾负担的一个主要因素。这是一种复杂的多因素疾病，体内积累的多余脂肪会对健康产生负面影响。肥胖的主要原因是摄入和消耗卡路里之间的长期能量不平衡。生活方式的改变仍然是肥胖治疗的基石。建议个人选择饮食，使您达到负能量平衡的状态，并以优质食物为重点，促进健康。通常，治疗肥胖的推荐饮食根据宏量营养素组成的变化使用以下能量限制:低脂饮食，低碳水化合物和高脂肪饮食，低碳水化合物和高蛋白饮食，旧石器饮食(蛋白质含量高)。间歇性禁食被认为是卡路里限制饮食的一种替代方法。经过一段时间的高蛋白饮食后，地中海饮食可能是继续治疗肥胖的一个有吸引力的选择，前提是它是以能量限制的形式给予的。这种饮食已被证明与较低水平的炎症生物标志物和心血管疾病风险的代谢标志物有关。许多研究的结果表明，在地中海饮食的帮助下，成功的减肥不仅是短期的，而且是长期的。对于大多数肥胖患者来说，有目的地改变生活方式，坚持饮食营养原则和规律的体育活动，可以有效地减轻体重，充分控制代谢紊乱，降低伴随疾病的风险，并在减肥过程中长期保持体重。
{"title":"The dietary treatment of obesity","authors":"T. Bentsa","doi":"10.22141/2224-0721.19.5.2023.1302","DOIUrl":"https://doi.org/10.22141/2224-0721.19.5.2023.1302","url":null,"abstract":"The review article represents an analysis of sources dealing with the issues of dietary therapy of obesity. The internet resources were used such as PubMed, MedLine, The Cochrane Databases, Google Scholar, Science Direct, Web of Science, and Scopus. Obesity has reached pandemic proportions worldwide, with more than 1 billion adults overweight (at least 300 million of them are clinically obese) and is a major contributor to the global burden of chronic disease and disability. This is a complex multifactorial disease, in which the accumulated excess fat in the body leads to negative impact on health. The main cause of obesity is a long-term energy imbalance between consumed and expended calories. Lifestyle modification remains the cornerstone of obesity treatment. An individually selected diet is recommended, which allows you to achieve a state of negative energy balance and is focused on quality food for health promotion. Most often, recommended diets for the treatment of obesity use the following energy restrictions based on changes in the composition of macronutrients: a low-fat diet, a low-carbohydrate and high-fat diet, a low-carbohydrate and high-protein diet, a paleo diet (with a high protein content). Intermittent fasting is considered an alternative to calorie-restricted diets. After an initial period on a high-protein diet, a Mediterranean diet may be an attractive option for continued treatment of obesity, provided that it is given in an energy-restricted form. This diet has been shown to be associated with lower levels of inflammatory biomarkers and metabolic markers of cardiovascular disease risk. The results of many studies indicate successful weight loss with the help of the Mediterranean diet, not only in the short term, but also in the long term. For the majority of obese patients, a purposeful change in lifestyle with adherence to the principles of dietary nutrition and regular physical activity allows for effective weight loss, adequate control of metabolic disorders, reduced risk of concomitant diseases, and long-term maintenance of body weight achieved in the process of losing weight.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78506126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-03DOI: 10.22141/2224-0721.19.5.2023.1304
A.M. Urbanovych, M.V. Yuskiv
This article was created on the basis of a literature review in the Web of Science, PubMed and Scopus databases and analyzes information on the prevalence, classification, etiopathogenetic mechanisms of anemia, evaluation of data from clinical studies and meta-analyses on the course of anemic syndrome in thyroid diseases. Anemia and thyroid dysfunction are common phenomena that often occur simultaneously. According to modern recommendations, it is worth evaluating the function of the thyroid gland when investigating anemia. With thyroid dysfunction, normocytic anemia is the most common, and microcytic and macrocytic anemias occur less often. The combination of anemia with thyroid diseases is an important problem for clinicians. Thyroid hormones have a direct effect on the proliferative capacity of the erythroid progenitor, which may be related to the mechanism of erythropoietic dysfunction in human thyroid diseases. Anemia, especially iron deficiency, in turn, affects a decrease in the level of thyroid hormones against the background of weakened thyroid function of the pituitary gland. The most frequent cause of anemia in hypothyroidism is bone marrow suppression due to thyroid hormone deficiency, as well as insufficient production of erythropoietin due to a decreased need for O2. Hyperthyroidism is associated with an increased number of erythrocytes, because there is an excessive need for tissues in oxygen, and therefore, the secretion of erythropoietin is increased. In autoimmune thyroid disease, a high prevalence of vitamin B12 deficiency and, especially, pernicious anemia is observed. Anemia in Graves’ disease resembles anemia of chronic disease and is associated with activation of nonspecific inflammation. Aplastic anemia, which is the result of the thyroid dysfunction, is rare. It occurs as a side effect in patients with autoimmune hyperthyroidism who take antithyroid drugs.
本文基于Web of Science、PubMed和Scopus数据库的文献综述，分析了贫血的患病率、分类、发病机制、临床研究数据的评估以及甲状腺疾病贫血综合征病程的荟萃分析。贫血和甲状腺功能障碍是同时发生的常见现象。根据现代的建议，在调查贫血时，评估甲状腺的功能是值得的。甲状腺功能不全时，常发生正红细胞性贫血，小细胞性和大细胞性贫血较少发生。贫血合并甲状腺疾病是临床医生面临的一个重要问题。甲状腺激素直接影响红细胞祖细胞的增殖能力，这可能与人甲状腺疾病的促红细胞功能障碍机制有关。贫血，尤其是缺铁，反过来又影响甲状腺激素水平的下降，而垂体的甲状腺功能减弱。甲状腺功能减退症中最常见的贫血原因是由于甲状腺激素缺乏导致骨髓抑制，以及由于氧气需求减少导致促红细胞生成素产生不足。甲状腺机能亢进与红细胞数量增加有关，因为组织对氧的需求过度，因此促红细胞生成素的分泌增加。在自身免疫性甲状腺疾病中，维生素B12缺乏症的患病率很高，尤其是恶性贫血。格雷夫斯病的贫血类似慢性疾病的贫血，与非特异性炎症的激活有关。再生障碍性贫血是一种罕见的由甲状腺功能障碍引起的疾病。它是自身免疫性甲状腺机能亢进患者服用抗甲状腺药物的副作用。
{"title":"Peculiarities of the anemic syndrome course with thyroid dysfunction","authors":"A.M. Urbanovych, M.V. Yuskiv","doi":"10.22141/2224-0721.19.5.2023.1304","DOIUrl":"https://doi.org/10.22141/2224-0721.19.5.2023.1304","url":null,"abstract":"This article was created on the basis of a literature review in the Web of Science, PubMed and Scopus databases and analyzes information on the prevalence, classification, etiopathogenetic mechanisms of anemia, evaluation of data from clinical studies and meta-analyses on the course of anemic syndrome in thyroid diseases. Anemia and thyroid dysfunction are common phenomena that often occur simultaneously. According to modern recommendations, it is worth evaluating the function of the thyroid gland when investigating anemia. With thyroid dysfunction, normocytic anemia is the most common, and microcytic and macrocytic anemias occur less often. The combination of anemia with thyroid diseases is an important problem for clinicians. Thyroid hormones have a direct effect on the proliferative capacity of the erythroid progenitor, which may be related to the mechanism of erythropoietic dysfunction in human thyroid diseases. Anemia, especially iron deficiency, in turn, affects a decrease in the level of thyroid hormones against the background of weakened thyroid function of the pituitary gland. The most frequent cause of anemia in hypothyroidism is bone marrow suppression due to thyroid hormone deficiency, as well as insufficient production of erythropoietin due to a decreased need for O2. Hyperthyroidism is associated with an increased number of erythrocytes, because there is an excessive need for tissues in oxygen, and therefore, the secretion of erythropoietin is increased. In autoimmune thyroid disease, a high prevalence of vitamin B12 deficiency and, especially, pernicious anemia is observed. Anemia in Graves’ disease resembles anemia of chronic disease and is associated with activation of nonspecific inflammation. Aplastic anemia, which is the result of the thyroid dysfunction, is rare. It occurs as a side effect in patients with autoimmune hyperthyroidism who take antithyroid drugs.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":"113 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76727397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-03DOI: 10.22141/2224-0721.19.5.2023.1297
V. I. Pankiv
Background. Monotherapy for type 2 diabetes (T2DM) has been found to be effective only for a limited time. At the same time, the rationality of drug combinations remains an important component of successful management of T2DM. In this context, given the complex multifactorial pathogenesis of T2DM, it is optimal to influence various mechanisms of hyperglycemia. The purpose of the study is to determine the effectiveness and safety of additional administration of a combination of metformin and glimepiride in patients with type 2 diabetes with a glycated hemoglobin (HbA1c) level of 8.5–9.5 % who took dapagliflozin alone for at least three months. Materials and methods. Fourteen men (mean age 57.9 ± 8.4 years) and 18 women (mean age 58.2 ± 9.3 years) with T2DM were included in the study. The average duration of T2DM was 9.7 ± 4.2 years. The patients were in a state of decompensation of T2DM (HbA1c over 8.5 %) against the background of dapagliflozin monotherapy in the maximum dose for at least three previous months. In addition to dapagliflozin (10 mg/day), patients were prescribed a combination of metformin and glimepiride (Duglimax tablets, 500 mg/2 mg once a day) for three months. Results. The average level of HbA1c in 32 patients with T2DM was 9.72 ± 0.81 %, fasting plasma glucose was 10.71 ± 1.42 mmol/l. Three months after the start of a combined treatment, the HbA1c level decreased significantly to 7.54 ± 0.46 % (p < 0.05). The average reduction in HbA1c after switching to additional metformin therapy with glimepiride was 1.48 ± 0.38 %. The proportion of patients who achieved HbA1c < 7.5 % was 34.5 % after 3 months (p < 0.05). The effectiveness of the additional administration of metformin and glimepiride is also confirmed by the high percentage of patients (12.5 %) who achieved HbA1c < 7.0 % (p < 0.05). The level of fasting plasma glucose decreased to an average of 7.19 ± 1.06 mmol/l after 3 months. The average decrease reached 3.06 ± 1.08 mmol/l, which in relative terms was 31.4 ± 8.7 % of baseline. No cases of hypoglycemia or other adverse events were registered during the entire study period. Conclusion. The analysis of indicators in 32 patients with type 2 diabetes who had a high level of HbA1c (over 9 %) against the background of dapagliflozin monotherapy allowed us to conclude that it is necessary to intensify the therapy by additionally prescribing a combination of metformin and glimepiride for achieving the target levels of HbA1c. Glucocentric and cardiocentric views on T2DM can be reconciled and integrated by using a combination therapy to address the different etiopathological features of the disease from the very beginning of treatment.
{"title":"Glucocentric and cardiocentric approaches to achieving type 2 diabetes compensation","authors":"V. I. Pankiv","doi":"10.22141/2224-0721.19.5.2023.1297","DOIUrl":"https://doi.org/10.22141/2224-0721.19.5.2023.1297","url":null,"abstract":"Background. Monotherapy for type 2 diabetes (T2DM) has been found to be effective only for a limited time. At the same time, the rationality of drug combinations remains an important component of successful management of T2DM. In this context, given the complex multifactorial pathogenesis of T2DM, it is optimal to influence various mechanisms of hyperglycemia. The purpose of the study is to determine the effectiveness and safety of additional administration of a combination of metformin and glimepiride in patients with type 2 diabetes with a glycated hemoglobin (HbA1c) level of 8.5–9.5 % who took dapagliflozin alone for at least three months. Materials and methods. Fourteen men (mean age 57.9 ± 8.4 years) and 18 women (mean age 58.2 ± 9.3 years) with T2DM were included in the study. The average duration of T2DM was 9.7 ± 4.2 years. The patients were in a state of decompensation of T2DM (HbA1c over 8.5 %) against the background of dapagliflozin monotherapy in the maximum dose for at least three previous months. In addition to dapagliflozin (10 mg/day), patients were prescribed a combination of metformin and glimepiride (Duglimax tablets, 500 mg/2 mg once a day) for three months. Results. The average level of HbA1c in 32 patients with T2DM was 9.72 ± 0.81 %, fasting plasma glucose was 10.71 ± 1.42 mmol/l. Three months after the start of a combined treatment, the HbA1c level decreased significantly to 7.54 ± 0.46 % (p < 0.05). The average reduction in HbA1c after switching to additional metformin therapy with glimepiride was 1.48 ± 0.38 %. The proportion of patients who achieved HbA1c < 7.5 % was 34.5 % after 3 months (p < 0.05). The effectiveness of the additional administration of metformin and glimepiride is also confirmed by the high percentage of patients (12.5 %) who achieved HbA1c < 7.0 % (p < 0.05). The level of fasting plasma glucose decreased to an average of 7.19 ± 1.06 mmol/l after 3 months. The average decrease reached 3.06 ± 1.08 mmol/l, which in relative terms was 31.4 ± 8.7 % of baseline. No cases of hypoglycemia or other adverse events were registered during the entire study period. Conclusion. The analysis of indicators in 32 patients with type 2 diabetes who had a high level of HbA1c (over 9 %) against the background of dapagliflozin monotherapy allowed us to conclude that it is necessary to intensify the therapy by additionally prescribing a combination of metformin and glimepiride for achieving the target levels of HbA1c. Glucocentric and cardiocentric views on T2DM can be reconciled and integrated by using a combination therapy to address the different etiopathological features of the disease from the very beginning of treatment.","PeriodicalId":13962,"journal":{"name":"INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine)","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89608711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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