[Blood pressure variability and neuroplasticity in patients with type 2 diabetes mellitus]. / Variabel'nost' arterial'nogo davleniya i neiroplastichnost' u bol'nykh sakharnym diabetom 2-go tipa.

OBJECTIVE: Analysis of the role of blood pressure (BP) variability in the formation of neuroplasticity in patients with type 2 diabetes mellitus (DM). MATERIAL AND METHODS: 100 patients with type 2 DM were examined, which were divided into groups depending on the presence of cognitive impairment (CI), the control group consisted of 25 people. All examined patients underwent a clinical examination, a standard set of biochemical blood tests, plasma osteopontin levels, 24-hour blood pressure monitoring (ABPM) for 24-26 h MRI of the brain (dynamic contrast and arterial spin marks, proton spectroscopy, tractography). RESULTS: Patients with type 2 diabetes and CI had higher body mass index, blood levels of glycated hemoglobin, glucose, alanine aminotransferase, low-density lipoprotein, triglycerides, total cholesterol, osteopontin, and lower levels of high-density lipoprotein (p≤0.05). The level of osteopontin was higher in patients with overweight, hyperglycemia, dyslipidemia, and in patients with CI in patients with BP variability. When assessing 24-hour blood pressure monitoring (ABPM), a significant difference was found in all standard indicators, while patients with type 2 diabetes were referred to as «non-dipper¼, in the presence of CI they noted significantly higher values of the index of time and area of stay in the suprathreshold state. BP and variability in SBP and DBP at night, as well as the risk of occult hypertension. A decrease in cerebral blood flow was revealed according to the data of contrast and non-contrast assessment of perfusion in cortical (especially in the frontal lobe) and subcortical (mainly in the putamen) structures, associated with changes in ABPM parameters. Mean SBP and DBP day and night, as well as the index of BP variability, also affect the integrity of the corticospinal, uncinate, lower longitudinal tracts, and arcuate fasciculus. The same parameters change the metabolism of the hippocampus in terms of choline (Cho), creatine (Cr), creatine phosphate (Cr2), as well as the ratio of N-acetylaspartate (NAA)/Cho, NAA/Cr, Cho/Cr. CONCLUSION: In patients with type 2 diabetes, BP variability contributes to the formation of CI through a pro-inflammatory mechanism (osteopontin), leading to impaired brain vascularization in general, white matter structure, and hippocampal metabolism.

[Brain tractography in type 1 and 2 diabetes and cognitive impairment]. / Traktografiya golovnogo mozga pri sakharnom diabete i kognitivnykh narusheniyakh.

OBJECTIVE: To study conductive white matter pathways in patients with type 1 and type 2 diabetes with- and without cognitive impairment. MATERIALS AND METHODS: The study included 85 patients with type 1 and 95 patients with type 2 diabetes who were divided into those who had normal cognitive functions and those with cognitive impairment. The groups were comparable in age and duration of the disease. Screening of cognitive functions was performed using the Montreal Scale for the Evaluation of Cognitive Function (MoCA-test). Brain MRI was performed on 1.5 Tesla system. All statistical analyses and data processing were performed using Statistica (Statsoft) software (version 10) on Windows 7/XP Pro operating systems. RESULTS: The study revealed the prevalence of mild and moderate cognitive impairment in type 1 diabetes, medium and severe in type 2 diabetes, which were mainly manifested by memory, attention and optical-spatial disorders. Intergroup analysis of the brain tractography did not show any difference in the integrity of tracts in type 1 and type 2 diabetes, but the most significant risk factors of pathway impairment were identified. They include arterial hypertension (H=6.602833, p=0.0368), degree of polyneuropathy (H=15.30420, p=0.0005), degree of nephropathy (H=9.993923, p=0.0068), degree of retinopathy (H=8.445891, p=0.0376) for type 1 diabetes and age (H=7.381742, p=0.0607), (H=8.359127, p=0.0391) for type 2 diabetes. Cholesterol level contributes to the risk in both types (H=4.009380, p=0.0452; H=4.057357, p=0.0440; H=6.454558, p=0.0111). The corticospinal and commissural tracts are most susceptible to damage. CONCLUSIONS: There are no significant differences in axial cerebral tract diffusion in patients with type 1 and type 2 diabetes with- and without cognitive impairment. However, the most important risk factors for white matter structure damage, namely, arterial hypertension, diabetic complications, cholesterol levels and age, are verified.

[Relationship of the I/D-polymorphism of the ACE gene and the T174M-polymorphism of the AGT gene to diabetic microangiopathies in children and adolescents].

The purpose of the study was to examine a role of candidate genes of the renin-angiotensin system in the development of microangiopathies in children and adolescents with type 1 diabetes mellitus (DM) and to systematize the risk factors of development of diabetic microangiopathies in order to substantiate the optimal approaches to prevention and therapeutic correction. A hundred and thirty-eight children (73 boys and 65 girls) with type 1 DM were examined. Their mean age was 13.2±0.3 years. Based on the findings, it may be assumed that patients with type DM who are the carriers of the D allele are genetically predisposed to the development of diabetic nephropathy. An association of the ID polymorphism of the ACE gene with the development of diabetic nephropathy was established in children with type 1 DM in the Siberian population. Allele I of the ACE gene ACE less frequently occurs in DM patients with nephropathy (p > 0.05) and a factor that reduces the risk of its development. The association of the D allele with the development of diabetic nephropathy suggests that the polymorphism of the ACE gene contributes to the regulation of generation of angiotensin-converting enzyme that plays an important role in the pathogenesis of this complication. There was no association of the polymorphism in question with the concomitance of diabetic nephro- and retinopathy in the patient. Analysis of the associations of the T174M polymorphism of the AGT gene with diabetic microangiopathies revealed no statistically significant differences when the distribution of the AGT gene was compared in the groups of patients with and without microangiopathies. There was an association of the T allele of the AGT gene with Type 1 DM, as evidenced by a negative TDT test in with healthy sibs. An association of the T allele with diabetic nephropathy was also ascertained.