[Dysglycemia in COVID-19 and Type 2 Diabetes Mellitus: Peculiarities of the Glycemic Profile in Hospitalized Patients and the Role of Steroid-Induced Disorders].

BACKGROUND: There is a lack of data on the features of dysglycemia in hospitalized patients with COVID-19 and concomitant diabetes mellitus (DM) confirmed by continuous glucose monitoring (CGM). AIM: to study the glycemic profile in hospitalized patients with COVID-19 and type 2 diabetes mellitus by continuous glucose monitoring and the role of steroid therapy in dysglycemiadevelopment. MATERIALS AND METHODS: We examined 21 patients with COVID-19 and DM 2 and 21 patients with DM 2 without COVID-19 (control group) using a professional 4-7-day CGM. We also compared two subgroups of patients with COVID-19 and DM 2: 1) patients received systemic glucocorticosteroids (GCS) during CGM and 2) patients in whomCGMwas performed after discontinuation of GCS. RESULTS: Compared with controls, patients with COVID-19 and DM2 had lesser values of glycemic «time in range¼ (32.7 ± 20.40 vs 48.0 ± 15.60%, p = 0.026) andhigher parameters of mean glycemia (p <0.05) but similar proportion of patients with episodes of hypoglycemia (33.3% vs 38.1%, p = 0.75). Patients who received dexamethasone during CGM were characterized by higher hyperglycemia and the absence of episodes of hypoglycemia. In patients who hadCGM after dexamethasone discontinuation, hyperglycemia was less pronounced, but 60% of them had episodes of hypoglycemia, often nocturnal, clinically significant and not detected by routine methods. CONCLUSION: Patients with COVID-19 and DM 2had severe and persistent hyperglycemia but a third of them hadalso episodes of hypoglycemia. During therapy with dexamethasone, they had the most pronounced hyperglycemia without episodes of hypoglycemia. In patients who underwent CGM after discontinuation of dexamethasone, hyperglycemia was less pronounced but 60% of them have episodes of hypoglycemia, often nocturnal, clinically significant and not diagnosed by routine methods. It would be advisable to recommend at least a 5-6-fold study of the blood glucose level (with its obligatory assessment at night) even for stable patients with COVID-19 and DM 2after the end of GCS treatment.

Diagnostic Capabilities of Islet Autoantibodies in Children with New-Onset Type 1 Diabetes Mellitus and Healthy Siblings.

The aim of the study is to determine the diagnostic utility of several islet autoantibodies and their combinations in order to identify individuals susceptible to type 1 diabetes mellitus (T1DM) among healthy siblings in the pediatric population within the scope of the development of a screening program. MATERIALS AND METHODS: A total of 424 children were evaluated, 260 children with new-onset T1DM and 164 healthy children with brothers and/or sisters with T1DM.Blood tests for a complex of autoantibodies to insulin (IAA), tyrosine phosphatase (IA-2A), zinc transporter 8 (ZnT8A), pancreatic ß-cells (ICA), and glutamate decarboxylase (GADA) were conducted in all the subjects with the enzyme immunoassay method. RESULTS: It was found that the diagnostic utility of individual autoantibodies is not equal and varies with age. The optimal age groups for the immunological control of the risks of developing type 1 diabetes in healthy siblings were determined. The highest risks were noted with the combination of GADA, ZnT8A, and IA-2A. CONCLUSION: Islet autoantibodies may serve as prognostic markers of the risk of developing type 1 diabetes in healthy siblings.

[Type 2 diabetic mellitus and prognostically adverse factors].

This 6-year-long study included 73 patients with cardiac disorders (chronic CHD, AH) and type 2 diabetes without myocardial infarction. Control group was comprised of similar patient without DM2. Survival in DM patients was significantly lower than in controls (0.64 (0.58; 0.71) and 0.93 (0.89; 1.01) respectively; p < 0.001). The main prognostic factors were elevated HbA1c level > 8.5%, echoCG changes in the left ventricle, and signs of myocardial ischemia revealed by 24 hour ECG monitoring.

[Development of diffuse toxic goiter in the presence of prior hypothyroidism].

We present a clinical example of a differential diagnostic search for the causes of thyrotoxicosis in a patient with previous hypothyroidism.

[The peculiarities of cardial arrhythmias in patients with type 2 diabetes].

The aim of the study was to clarify the pathogenetic mechanisms of arrhythmias in patients with diabetes mellitus type 2 (DM 2), and the role of diabetic factors in their onset. A comparative analysis of arrhythmias was performed in 212 cardiological patients, 114 of whom had DM 2, and 98 did not. The character of concomitant pathology was similar: the patients had primary arterial hypertension, coronary heart disease, and no myocardial infarction background. The study found that the frequency of more severe and prognostically unfavorable arrhythmias was higher in the DM 2 subgroup; these arrhythmias were associated with the compensation of carbohydrate metabolism according to the level of glycated hemoglobin (HbA(1c), immunoreactive insulin (IRI), and C-peptide. Severe metabolism decompensation (HbA(1c) > 8.5%) was more often associated with ventricular arrhythmias and low IRI and C-peptide levels, whereas relatively low (< 7.0%) HbA(1c) level was associated with supraventricular arrhythmias and elevation of IRI and C-peptide levels. Arrhythmias in DM 2 were also associated with left ventricular geometric anomalies, revealed by means of electrocardiography.

[Disturbances of cardiac rhythm and metabolic control in patients with type-2 diabetes].

Twenty four hour ECG monitoring, registration of ventricular late potentials, and measurement of glycated hemoglobin (HbA1c) were included into examination of 142 cardiological patients (101 with and 41 without type 2 diabetes). Groups of patients with and without diabetes had similar age and severity of cardiac pathology. Patients with diabetes had more prognostically and hemodynamically unfavorable arrhythmias -- paroxysmal and permanent atrial fibrillation, high grade ventricular extrasystoles (HGVE) and their combinations. Atrial fibrillation and HGVE were more often observed in diabetic patients with HbA1c <7 and >8.5%, respectively. Date of registration of ventricular late potentials in patients with diabetes mellitus (QRSTt >110 ms, LAS40 >37 ms, and RMS <23 mcV) possess high informative power not only in prognosis of HGVE but also evidences for bad control of glycemia.