BACKGROUND: With the development of visceral obesity, against the background of insulin resistance (IR), lipo- and glucose toxicity in tissues progresses, which disrupts the metabolic balance of the body, and is the main factor in the development of type 2 diabetes mellitus (DM2). To date, a growing number of publications highlighting the role of circadian rhythms in the control of gluconeogenesis and lipogenesis. In the context of the development of DM2, the process of rhythm mismatch (desynchronosis) is increasingly mentioned, for the diagnosis of which the calculation of amplitude-phase parameters is used. Thus, the study of circadian rhythm disturbances using amplitude-phase parameters and factors influencing them is of particular interest in individuals with visceral obesity and prediabetes, since the data obtained can be used as markers for preclinical diagnosis of DM2.AIM: To identify significant differences in the parameters (amplitude, acrophase) of circadian rhythms (fasting glycemia, basal body temperature, heart rate) as markers of desynchronosis in groups without carbohydrate metabolism disorders, but with the presence of visceral obesity, prediabetes (impaired fasting glycemia, impaired glucose tolerance test) and DM2 and obesity.MATERIALS AND METHODS: The study was conducted in individuals with visceral obesity, as well as the presence of prediabetes or DM2, with a disease experience of not more than 5 years.In accordance with the study design, every 3 hours during the day, the participants made self-measurements of blood glucose at home (using individual glucometers), basal body temperature (BTT) in the armpit (using a mercury thermometer) and heart rate (HR) ( with the help of an electronic tonometer), with the fixation of the results in self-control diaries. To assess the reliability of the circadian rhythms of the studied indicators, the interpretation of chronobiological parameters (MESORa-Midline Estimating Statistic of Rhytm; amplitude; acrophase) was carried out using a single сosinor analysis.RESULTS: Of the 120 study participants, 73% were women and 27% were men. Mean age of participants was 58.6[52.2;56.7] years, BMI 31.3[29.7;33.9] and presence of visceral obesity WC 100 [93.8;104.7]. When conducting cosinor analysis, the daily rhythms of physiological indicators of fasting glycemia, BTT and heart rate differ from normal already in the group with visceral obesity without carbohydrate metabolism disorders and prediabetes, in the form of a decrease in the amplitude of daily rhythms (p<0.001), with a shift in their acrophases (p <0.001), no dynamics of night BBT decrease (р<0.001).CONCLUSION: Integral amplitude-phase parameters of circadian rhythms of physiological parameters (fasting glycemia, basal body temperature, heart rate), as markers of desynchronosis, can be used in the presence of visceral obesity for preclinical diagnosis of prediabetes and DM2, which will have a preventive focus. This method of chronodiagnostics can be useful in health and prevention centers for people at risk of developing DM2.

BACKGROUND: In medical literature sources, there are data on the relationship of disorders of circadian rhythms (desynchronosis) with the development of type 2 diabetes mellitus (T2DM). Desynchronosis of circadian rhythms of glycemia can be triggered both by external factors (exposure to excessive artificial lighting in the evening, violation of the diet, «sleep-wake»), and internal — from the individual organization of circadian rhythms (chronotype). In this connection, there is an interest in the most detailed study of the influence of individual characteristics of the organization of circadian rhythms on the risk of developing T2DM. AIM: To characterize the individual organization of circadian rhythms in persons without carbohydrate metabolism disorders, with prediabetes and T2DM with obesity and BMI = 30.0–34.9 kg/m2.MATERIALS AND METHODS: Тhe Horn-Ostberg questionnaires were analyzed retrospectively in individuals with visceral obesity without carbohydrate metabolism disorders (n=40), with prediabetes (n=40) and T2DM (n=40). The results of the Horn-Ostberg test were compared with anamnestic anthropometric, laboratory parameters, nutrition diaries, daily rhythms of integral physiological indicators of carbohydrate and energy metabolism.RESULTS: All study participants (n=120) were identical age 56,7 [52,2; 58,6] years, BMI 31.3 [30.7; 33.9] kg/m2, waist circumference (OW) in women 96.54 ± 1.35 cm in men 98.75 ± 2.61 cm Sex distribution: 73% women and 27% men. Persons with morning chronotype made up 24% (29 people), intermediate 63% (75 people) and evening 13% (16 people) . In the groups, the late time for the first breakfast was noted (without carbohydrate metabolism disorders 9:45h, prediabetes 9:31 and T2DM 10:00h), and 20% of the participants missed it (p<0.05). A larger amount of daily energy value was shifted to the afternoon (p<0.05). Late bedtime was observed in all groups: without carbohydrate metabolism disorders 22.50–00.29h, with prediabetes 22.30–00.29h and T2DM 22.45–00.29h with an increase in sleep duration in the prediabetes group (08.14h, 09.00h and 08.38h, respectively). In all groups, morning and evening chronotypes had correlations with the amplitude of the daily rhythm of glycemia (r=-0.7, p=0.002 and r=-0.6, p=0.035), basal body temperature (r=0.4, p=0.046 and r=-0.5, p<0.0001) and daily energy value (r=-0.6, p= 0.041 and r=-0.6, p=0.05), differing only in the strength of the relationship.CONCLUSION: Thus, people with the morning and intermediate types of the morning chronotype, who organize a daily routine and nutrition that do not correspond to the individual characteristics of this given chronotype, can, along with people of the evening chronotype, become vulnerable in the context of the development of type 2 diabetes.

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