[The relation of insulin resistance with the complications of diabetes mellitus type 2 and metabolic parameters].

The aim of our investigation was to study the relation of insulin resistance (IR) with the complications of diabetes mellitus type 2 (DM2) and metabolic parameters. 44 patients with DM2 (mean age - 49,1+/-8,7 years) have been investigated. The parameters of carbohydrate metabolism, HOMA-indices, parameters of lipid metabolism and blood pressure have been determined. I group consisted of 32 patients with high mean value of HOMA-IR (2,6+/-0,8), and II group - 12 patients with lower mean value of HOMA-IR (0,9+/-0,3). The IHD frequency was significantly lower in II group (OR=0,20 (0,40-0,95)); and sum of macrovascular complications was significantly frequent in I group, i.e. in patients with IR (OR=9,71 (1,12-84,30)). In patients with IR serum C-peptide, triglycerides, HDL-cholesterol levels, sistolic blood pressure, body mass index and waist circumference were significantly differed from analogous parameters of patients without IR. IR significantly impact on the development of macrovascular complications of DM2 and significantly worsen the parameters of carbohydrate and lipid metabolism, blood pressure and body mass. Therefore, we conclude that in addition to the good glycemic control the important goal of the treatment of DM2 is the reduction of insulin resistance (introduction of insulin sensitizing agents, physical activity, body mass reduction, the decrease of daily insulin injecting doses).

[The influence of high levels of endogenous and exogenous insulin on the complications of type 2 diabetes and metabolic parameters].

The aim of our investigation was to study the influence of high levels of endogenous and exogenous insulin on the complications of type 2 diabetes and metabolic parameters. 62 patients with DM2 (mean age - 50,2+/-9,7 years) have been investigated. The parameters of carbohydrate metabolism, HOMA-indices, parameters of lipid metabolism, blood pressure, BMI and waist circumference have been determined. I group consisted of 19 patients with high levels of endogenous insulin (C-peptide - 3,3+/-0,5 ng/ml) and daily exogenous insulin doses (65,2+/-17,7 units); II group - 26 patients with moderate levels of endogenous insulin (C-peptide - 1,6+/-0,8 ng/ml) and daily exogenous insulin doses (48,7+/-11,7 units); and III group - low levels of endogenous insulin (C-peptide - 0,4+/-0,4 ng/ml) and daily exogenous insulin doses (36,3+/-5,7 units). The IHD frequency was significantly higher in I group in comparison with II and III [OR=6,00 (1,54-23,30) and OR=5,36 (1,24-23,21), respectively]; and sum of macrovascular complications was significantly frequent in I group [OR=10,20 (2,50-41,39) and OR=8,13 (1,87-35,23)). In patients with high levels of serum C-peptide and daily doses of exogenous insulin HOMA indices, triglycerides, HDL-cholesterol levels, body mass index and waist circumference were significantly differed from analogous parameters of patients of other groups. High values of endogenous and exogenous insulin significantly impact on the development of macrovascular complications of DM2 and significantly worsen the parameters of lipid metabolism and body mass. On the basis of obtained data we conclude that in addition to the good glycemic control the important goal of the treatment of DM2 is the control of insulinemia.

[Relation of serum uric acid levels with basic metabolic parameters in patients with metabolic syndrome during insulin-sensitizing therapy].

The aim of our investigation was to study the peculiarities of serum uric acid (UA) levels in patients with metabolic syndrome (MS) during 6 month therapy with metformin (MF), Rosiglitazone (RG) and their combination. 30 patients with MS (10 males, 20 females, mean age - 35,5+/-9,7 years) have been investigated by all parameters of MS and serum UA levels. Investigated group was divided into 3 subgroups of 10 patients: group 1 - patients on RG; group 2 - patients on MF; group 3 - patients on RG + 850-1000 mg of MF. Results of investigation showed that UA serum levels did not decrease significantly. However, the frequency of hyperuricemia decreased significantly. PPG, basal C-peptide, and HOMA-% IR also decreased significantly. Despite percentage reduction of BMI in group 3 (7,6%), decrease of UA and HOMA-IR was significantly higher in group 1 (18,2% and 37.0%, respectively). Correlation analysis showed that decrease of UA significantly correlated with BMI and HOMA-IR in the whole group (r=0.5674, p=0.001; r=0.5437, p=0.002; respectively); in group 1 - with HOMA-IR (r=0.5753, p=0.016); in group 3 - with BMI (r=0.7821, p<0.001). Obtained results showed that UA levels and hyperuricemia cases significantly decreased during insulin sensitizing therapy.

[The dependence of changes of parameters of metabolic syndrome features on the reduction of degree of insulin resistance during lifestyle intervention].

The aim of our investigation was to study the dependence of changes of parameters of metabolic syndrome (MS) features on the reduction of degree of insulin resistance during lifestyle intervention--balanced diet and moderate exercise. 33 patients with MS have been investigated (mean age--49.1+/-8.7 years). MS was confirmed by WHO definition of 2002. All parameters of MS features have been determined baseline and after 6 months of study initiation. Balanced diet (restriction of easy-digestible carbohydrates and lipids and consumption of products with high cellulose content) and moderate exercise (60 min. walking three times per week) have been prescribed to all patients. After 6 months IR index was decreased from 3.6+/-0.7 to 2.6+/-0.4 (p<0.001). Investigated subjects were divided on two groups: I group consisted of patients HOMA-IR index of whom after 6 months decreased by magnitude less than 1.0 (n=19); and II group--patients HOMA-IR index of whom after 6 months decreased by magnitude greater or equal 1.0 (n=14). In spite of similar reduction of body mass and waist circumference, the parameters of carbohydrate and lipid metabolism in II group decreased significantly sharply than in I group. The more positive changes of metabolic parameters of MS features during lifestyle intervention strongly depend on the degree of reduction of insulin resistance which has to become the main strategic target during MS treatment.

Comparative analysis of blood redox parameters according thyroid function of patients with autoimmune thyroid diseases.

Little is known about various blood parameters of oxidative stress and antioxidant defence patients with various thyroid functional states in autoimmune diseases (ATD). To clarify influence of thyroid metabolic status on blood redox parameters, we performed a complex estimation of patients with ATD (Graves' disease and chronic autoimmune thyroiditis). 50 patients with ATD have been studied: 16 - with hyperthyroidism; 20 - euthyroidism; and 14 - with hypothyroidism. 10 healthy subjects were selected as a control group. In patients with hyperthyroidism has been only observed inverse correlation between ceruloplasmin (CP) and thyroid volume (r= -0,5177, p<0,001); in patients with euthyroidism only inverse correlation between CP and FT4 (r= -0,4970, p<0,001). But in patients with hypothyroidism inverse correlation between Fe(3+)-transferrin and TSH levels (r= -0,6501, p<0,001) and direct correlation between nitric oxide and FT4 (r= 0,5657, p<0,001), and lipid peroxyradicals and FT4 (r= 0,5620, p<0,001) have been established. Thus, according to obtained results oxidative stress occurs at ATD in spite of thyroid status. Our findings about association of the thyroid function and REDOX-system should be considered in the treatment of ATD.

[Levels of uric acid in serum in patients with metabolic syndrome].

The aim of our investigation was to study the peculiarities of serum uric acid (UA) levels in patients with metabolic syndrome (MS) and without it, also correlations between UA and parameters of MS features. 41 patients (mean age - 37,8+/-13,7 years) have been investigated. MS was defined by definitions of WHO (2002), ATPIII and Society of Georgia Endocrinologists (SGE). Exclusion criterion served the gout. Levels of all parameters of MS features and serum UA have been determined. MS was diagnosed in 48,7% of cases. Study group consisted of these patients, and control group - patients without MS. Serum UA levels were significantly higher in the study group in comparison with the control (6,6+/-1,4 vs. 5,4+/-1,3 mg/dl, p=0,007; respectively). In main group the cases of hyperuricemia have been documented significantly frequently than in control (65,0% vs. 33,3%, p=0,043; respectively). Obtained results shown that UA levels significantly higher and hyperuricemia cases significantly frequent at MS, which have to be taking into account during symptomatic treatment of patients.

Effect of metformin therapy on plasma adiponectin and leptin levels in obese and insulin resistant postmenopausal females with type 2 diabetes.

To investigate the relative role of the adiponectin and leptin in the insulin resistance (IR) and obesity we studied plasma levels of these adipocytokines in obese and insulin resistant postmenopausal (PM) females with type 2 diabetes (DM2) during 6 months of Metformin therapy. We recruited 26 PM women, between the ages of 50 and 67 (59,7+/-8,1 years). These women had a BMI of 36,6+/-1,8 kg/m2. After baseline measurements Metformin therapy has been initiated (1700+/-2550 mg per day). Duration of therapy was 6 months. The results of investigations of adipocytokines after Metformin 6 months therapy shown that circulating adiponectin levels were significantly increased (19,1+/-6,0 vs. 16,1+/-3,9 ng/ml, p=0,008) together with significant reduction of BMI (35,9+/-1,9 vs. 36,6+/-1,8 kg/m2, p=0,005) and IR (3,05+/-0,89 vs. 3,96+/-0,70, p<0,001). The magnitude of the change in adiponectin levels positively correlated with the magnitude of BMI reduction (r=0,4784, p=0,013) and IR reduction (r=0,5779, p=0,002). Any significant correlation did not observed between changes of leptin levels and BMI, leptin levels and IR. In summary, our data suggest that hypoadiponectinemia in PM may be explained by only IR because the amelioration of whole-body insulin action by 6-month Metformin therapy leads to increase of plasma adiponectin levels; leptin levels did not significantly change after 6-month Metformin therapy.

[The status of redox system in patients with chronic autoimmune thyroiditis].

The aim of present investigation was to study redox processes and to establish state of blood oxidative and antioxidant systems in patients with chronic autoimmune thyroiditis (CAT). 19 patients with CAT (2 males, 17 females; mean age 35,3+/-14,8 years) have been randomly investigated, of which 3 patients (15,8%) had hypothyroidism, 11 (57,9%) - euthyroidism and 5 (26,3%) - hyperthyroidism. Control group consisted of 10 practically healthy subjects (2 males, 8 females; mean age 41,1+/-11,7 years). The parameters of blood redox-system were investigated by electron-paramagnetic resonance method (EPR). The value of ceruloplasmin in patients with CAT was significantly higher than in control group (20,0+/-2,0 mm/mg vs. 16,0+/-1,1 mm/mg, p<0,001); EPR-signal of Fe3+ - transferrin in main group was also significantly higher (18,5+/-1,3 mm/mg vs. 22,0+/-0,9 mm/mg, p<0,001); values of nitric oxide in both groups were almost identical. EPR-signals of methemoglobin significantly correlated with thyroid volume (r=0,5421, p=0,016). These changes demonstrate possible relationship between CAT and blood redox system. It should be supposed that the introduction of antioxidant preparations will improve CAT pathogenetic therapy.

[The status of redox system in patients with Graves' disease].

The aim of our investigation was studying the redox processes, the establishment of state of blood oxidative and antioxidant systems in patients with Graves' Disease (GD). 19 with diffuse-toxic goiter have been investigated. Control group included 10 practically healthy subjects. The parameters of blood redox-system were investigated by electron-paramagnetic resonance method (EPR). In GD group hypothyroidism was diagnosed in 7 patients (36,8%), euthyroidism - in 7 patients (36,8%) and hypothyroidism - in 5 (26,3%). The value of ceruloplasmin in main group was significantly higher than in the control (18,6+/-1,3 mm/mg vs. 16,0+/-1,1 mm/mg, p<0,001); EPR-signal of Fe(3+)-transferrin in main group was also significantly higher (19,2+/-1,2 mm/mg vs. 22,0+/-0,9 mm/mg, p<0,001); values of nitric oxide in both groups were almost identical. EPR-signals of Mn(2+) ions significantly correlated with thyroid volume (r=0,5461, p=0,016), NO - with antibodies to thyroglobulin (r=0,5750, p=0,010). These changes demonstrate possible relationship between autoimmune diseases and redox-system.

Plasma adipocytokine levels in obese and insulin resistant postmenopausal females with type 2 diabetes.

The objective of this study was to compare plasma levels of adiponectin and leptin in lean (LN), obese (OB) and obese diabetic (OD) postmenopausal females (PMF). We recruited 26 PM women (group 1, mean age - 59,7+/-8,1 years, BMI - 36,6+/-1,8 kg/m(2)). All women had their last menstrual flow more than 2 year before the study (mean duration of PM period was 11,9+/-8,3 years). No woman had received hormones within 3 months of this study. All Women were diabetic patients (mean duration of DM2 was 9,5+/-5,5 years). Ten obese (group 2; mean BMI - 35,9+/-2,3 kg/m(2) and age - 58,1+/-4,7 years) and ten lean (group 3; mean BMI - 22,3+/-1,9 kg/m(2) and age - 56,5+/-5,6 years) PM women were recruited as controls for comparing adipocytokine levels. Adiponectin was significantly decreased and leptin is significantly elevated in OD PMF in comparison with group 1 and 2 (p<0,001 and p=0,003, respectively). There was a tendency for adiponectin levels to be lower in OD PMF as compared with OB individuals (p=0,053). OD PMF were more insulin resistant than OB and LN subjects (p<0,001). Hypoadiponectinemia in PMF may be explained by IR and obesity. Leptin levels in OD PMF are not significantly different from leptin levels of OB subjects, although they significantly differ from leptin levels of LN individuals.

Growth hormone (GH) determinations by RIA and IFA during GH stimulation tests in children with short stature.

Growth hormone deficiency (GHD) as a syndrome comprises multiple pathogenetically distinct entities caused by disorders of secretion or peripherial action of growth hormone (GH). Confirmation of the diagnosis of GH deficiency in children is based on provocative testing for human growth hormone (hGH). Immunofunctional assay (IFA) allows quantitation of only biological active GH forms in circulation. The aim of this study was to compare the results of GH determinations by radioimmunoassay (RIA) and IFA, and to establish cut-off-levels for IFA in insulin tolerance test (ITT). We have investigated 32 children (30 males and 2 females) with short stature. All patients underwent insulin tolerance test (ITT), GH was measured in duplicate by radioimmunoassay (RIA, Seria) and IFA (DSL). Children with peak GH concentration below 10 ng/ml in ITT (by RIA) underwent arginin tolerance test (ATT, arginin 0,5 g/kg). The correlation between the results of growth hormone determination by radioimmunoassay and immunofunctional assay was excellent and cut-off-level in stimulatory test was established for the immunofunctional assay.

[Peculiarities of metabolic characteristics in females of reproductive age with hyperplastic processes of cervix and mammary glands].

The aim of our investigation was the evaluation of character of metabolic disorders in patients with hyperplastic processes of uterine corpus, cervix and mammary glands. 88 patients of reproductive age with several gynaecological complaints have been investigated. 72 patients with hyperplastic processes of endometrium and endocervix (hyperplasia, polyposis), myoma of uterus, fibroadenoms and adenomatosis of mammary glands were selected in main group. Control group consisted of 16 patients without any hyperplastic processes of genital organs. Metabolic syndrome in main group was revealed in 28% of cases, in control--18.8% (chi(2)=3.95, p=0.047); insulin resistance--30.5% and 18.7% (chi(2)=4.01, p=0.046), respectively. In main group in comparison with control group took place the tendency of the increase triglyceride plasma level and the decrease of levels of HDL-cholesterol. b-cell function was significantly increased in patients with hyperplastic processes of uterine corpus and cervix, in subgroup of uterine myoma revealed the tendency. Insulin resistance revealed in patients with hyperplasia of endocervix and pathologies of mammary glands. Our results suggest that metabolic syndrome and its components significantly influences on the formation of hyperplastic processes of uterine corpus, cervix and mammary glands.

[Endocrine-metabolic peculiarities in women of reproductive age with hyperplastic processes of cervix and mammary glands].

The aim of our investigation was the detection of endocrine-metabolic disorders in patients with hyperplastic processes of endomyometrium, uterine cervix and mammary glands. 88 patients of reproductive age with several gynaecological complaints have been investigated. 72 patients with hyperplastic processes in endomyometrium, uterine cervix (hyperplasia, polyposis, myoma) and mammary glands (fibroadenomatosis, adenomatosis) were selected in main group. Control group consisted of 16 patients without any hyperplastic processes of reproductive organs. Metabolic syndrome in main group was revealed in 28% of cases, in control - 18,8% (chi(2)=3,95, p=0,047); insulin resistance - 37,5% and 18,7% (chi(2)=4,59, p=0,033), respectively; obesity - 52,8% and 25,0% (chi(2)=4,05, p=0,045), respectively; dyslipidemia - 52,8% and 0,0%; hypertension - 26,4% and 12,5% (chi(2)=1,88, p=NS), respectively. Blood leptin level in main group was - 13,7+/-10,9 ng/ml, and in control - 5,0+/-2,9 ng/ml (p=0,005). Our results suggest that metabolic syndrome and its components significantly influences the formation of hyperplastic processes of endomyometrium, uterine cervix and mammary glands. Blood leptin level is significantly increased in patients with hyperplastic pathologies.

[Blood adiponectin and leptin levels in menopausal metabolic syndrome].

The aim of our investigation was the study of blood adiponectin and leptin levels in patients with menopausal metabolic syndrome (MMS) and their correlation with the parameters of MMS features. 40 females with menopause have been investigated. In 38 cases diabetes mellitus type 2 has been registered, and in 2 - impaired glucose tolerance. Mean duration of postmenopausal period was 11,1+/-7,4. Control group consisted of 10 females of postmenopausal age. The blood content of adiponectin and leptin was measured by ELISA. For MMS diagnostics WHO classification (2002) was applied. In basic group MMS was revealed in 37 patients, in control group - in 3 cases (chi(2)=19,53, p<0,001). It was not observed significant difference in blood adiponectin levels of basic and control groups (16,4+/-7,6 vs. 16,3+/-6,1, p=NS), but blood leptin level was significantly higher in study group in comparison with controls (166,7+105,3 vs. 60,3+/-51,0, p<0,001). Significant correlations of blood adiponectin and leptin levels with the parameters of MMS features were observed. Obtained results show that blood adiponectin level in MMS does not differ from the values in control group, although blood leptin level is significantly higher than the one among controls. They significantly correlated with the parameters of MMS features.

[The effect of diet and exercise on the parameters of lipid metabolism in the patients with metabolic syndrome and impaired carbohydrate metabolism of various degrees].

The aim of our study was the investigation of the peculiarities of lipid metabolism in the patients with metabolic syndrome and impaired carbohydrate metabolism of various degrees after diet and moderate exercise. We selected 123 overweight patients from Imereti Region. Metabolic syndrome in patients was determined by World Health Organization -2002 classification. Total cholesterol, triglycerides, high density lipoprotein, low density lipoprotein, very low density lipoprotein and atherogenic indices have been measured. Diet and exercise - changes in the life style decreases the risk of metabolic syndrome development and decrease fasting and postprandial glucose. It was also indicated that the parameters of lipid metabolism sharply improved by diet and exercise and the degree of improvement was practically identical in patients with diabetes mellitus type 2 and impaired glucose tolerance.

[Characteristic changes of skin and its accessories in type 2 diabetes mellitus].

The different changes are seen on skin and it's accessories in Diabetes Mellitus, some of which represent the prognostic indicator of complicated diabetes and some directly contribute in development of them. Numerous problems concerned with the diabetic foot could be avoided due to early detection and treatment of these changes. The objective data on foot examination of 195 patient with Type 2 Diabetes Mellitus were analyzed considering the grade of severity of Diabetic Peripheral Neuropathy (DPN). It was revealed that the skin humidity is dependent on DPN, particularly, the DPN 2-4 times raises the dryness of the skin on the foot; the risk of callus development is significantly high in case of painless and complicated DPN, accordingly, the possibility of neuropathy ulcer is also high in this group. The high incidence of onychomycosis and Yellow nails syndrome was noted, accordingly in 28.7% and 39.4% of cases; the Melin's shin spots were found in fourth of the patients, mainly in men; a few cases of rubeosis plantarum and bulbosis diabeticorum were revealed; the cases of necrobiosis were not noted. Thus, the prevalence of the characteristic changes of skin and it's accessories in Type 2 Diabetes Mellitus is sufficiently high and it depends on the severity of DPN, using early detection of them may avoid many problems related to diabetic foot and its complications.

[Parathormone and calcitonin in men suffering from ischemic heart disease]. / Paratgormon i kal'tsitonin u muzhchin, stradaiushchikh ishemicheskoi bolezn'iu serdtsa.

It has been shown that in men with coronary heart disease (CHD), the basal concentrations of parathyroid hormone (PTH) and calcitonin (CT) in blood serum were increased both during an angina pectoris attack and the interparoxysmal period. During an angina pectoris attack, the highest CT concentration was detected in CHD patients with angina pectoris of effort on the day of the anginal attack. In acute myocardial infarction (AMI), the basal PTH level in the patients' blood serum was increased, particularly during the subacute disease stage. The blood serum CT content during AMI depended on the disease onset: in patients with a sudden disease onset, the parameter under study was increased, whereas in AMI patients with a history of angina pectoris, the CT concentration remained within normal. The authors discuss the pathogenetic role of the shifts in the function of the parathyroid glands and C cells of the thyroid during CHD and the possibility of the use of calcium antagonists and CT in the treatment of myocardial infarction.