In order to identify risk factors and to study alteration of cerebral vessels in patients with type 2 diabetes mellitus and cerebrovascular disease, ultrasound Doppler investigation of extracranial vessels was performed in 67 patients with type 2 diabetes mellitus. Atherosclerotic lesions of the vessels were detected in 67% of patients, depending on age, gender, body mass index, duration of diabetes and hypertension, systolic blood pressure, cholesterol and blood glucose level fluctuations during the day. The number of vessels affected by atherosclerosis and a higher degree of carotid stenosis was significantly higher in patients undergoing brainstroke. Quality of life was significantly lower in patients with diabetes associated with cerebrovascular disease, especially in patients after brainstroke.

INTRODUCTION: The increasing number of patients with diabetes mellitus (DM) and chronic kidney disease (CKD) is one of the most pressing problems of modern medicine. In comorbid pathology a combination of type 2 DM and thyroid hypofunction the negative effect of hypothyroidism on carbohydrate metabolism, lipid metabolism, endothelial function, and glomerular filtration rate (GFR) is a risk factor for the formation and progression of diabetic nephropathy and CKD and requires further study. AIM: To identify risk factors and epidemiological peculiarities of CKD in type 2 DM in combination with thyroid hypofunction and to determine the possibility of using cystatin C levels for the evaluation of the kidney function in this pathology. MATERIALS AND METHODS: The prospective study involved 203 patients with type 2 DM undergoing inpatient treatment in the endocrinology department of the Ryazan Regional Clinical Hospital: group 1 (n = 76), type 2 DM combined with the primary hypothyroidism, and group 2 (n = 127), type 2 DM without thyroid pathology. Carbohydrate, lipid metabolism, albuminuria (AU), thyroid hormone spectrum, adipokines (leptin, plasminogen activator inhibitor-1, interleukin-6, and tumor necrosis factor-) were analyzed. The GFR was calculated using the CKD-EPI formula based on the levels of creatinine and cystatin C. Arterial pressure daily monitoring (APDM) was conducted, and intra-abdominal fat thickness was evaluated by ultrasonography. RESULTS: The incidence of kidney pathology in patients with type 2 DM was 52.22%. In group 1, there was a significant increase in the prevalence of CKD (64.47%, p = 0.006) and of normoalbuminuric CKD (NAU-CKD, 32.89%; p = 0.010). The risk of CKD development in patients with concomitant PH was more than twice that in patients without thyroid pathology with an odds ratio of 2.229 (95% confidence interval (CI) 1.2414.003) and that for NAU-CKD was 2.474 (95% CI 1.2674.833). Significant impairment of several metabolic parameters and individual APDM parameters was revealed in group 1 in comparison with group 2. The dependence of AU and GFR on the body mass index and of AU on the intra-abdominal fat thickness was noted. A negative relationship between GFR and leptin was revealed; in group 1, a correlation of interleukin-6 and thyrotropic hormone was found (r = 0.809, p = 0.001). With concomitant PH, cystatin C values were lower, and the GFR (CKD-EPI-cys) was reliably higher. CONCLUSION: Hypothyroidism is a risk factor for CKD development including NAU-CKD in type 2 DM. Obesity and hormonal activities of the intra-abdominal fatty tissue facilitate AU progression and GFR reduction. The use of cystatin C as a marker of the filtration function of the kidney in patients with hypothyroidism may lead to the underestimation of kidney function; thus, further investigation is required.

Aims. Current study was aimed to identify symptoms and risk factors for depression and anxiety and to estimate quality of life (QoL) in patients with diabetes mellitus type 2 (T2DM) and cerebrovascular disease (CVD). Materials and methods. We examined 73 patients with T2DM. 1st group included 49 patients with T2DM and CVD, 2nd group - 24 patients with T2DM and no cardiovascular pathology. The groups were not significantly different in terms of age, BMI, level of HbAlc, fasting and postprandial glycemia. All patients received antihyperglycemic and antihypertensive therapy. Anxiety and depression were diagnosed with Beck Depression Inventory and Spielberger State and Trait Anxiety Scale (SSTAS). SF-36 questionnaire was used for estimation of QoL. Results. 2nd group showed symptoms of anxiety and depressive disorders in 100% and 75% of cases, respectively. 1st group showed significantly more prominent anxiety and depression symptoms. Risk factors for anxiety and depressive disorders in patients with T2DM and CVD were found to be senior age, obesity and atherogenic dyslipidemia. Conclusion. Cardiovascular comorbidity in T2DM significantly decreases QoL, especially in aspects of physical functioning and vitality. Timely diagnostics of anxiety and depression in patients with T2DM and CVD requires development of screening and rehabilitation programs.

Диагностика, контроль и лечение 1/2012Сахарный диабет жегодно количество пациентов с ожирением ка-тастрофически нарастает во всем мире. Метабо-лический синдром (МС) давно перешел из сферы интересов эндокринологов и кардиологов в общемедицин-скую проблему. Кроме общепризнанных критериев МС активно изучаются и другие его компоненты: синдром по-ликистозных яичников, неалкогольная жировая болезнь печени, гиперурикемия. Немалое влияние на качество жизни больных оказывают депрессивные расстройства и дегенеративно-дистрофические заболевания суставов.Несомненно, инсулинорезистентность -основа развития всех проявлений МС. В развитии инсулино-резистентности лежит абдоминальное ожирение, про-филактика и устранение которого может сократить количество больных с МС. Исследования показывают, что факторами риска перехода предиабета в явный са-харный диабет (СД) являются как раз компоненты МС: артериальная гипертензия (АГ), избыточная масса тела, нарушенная толерантность к глюкозе, отягощенная на-следственность, поликистоз яичников [1]. Как показы-вают исследования, не всегда абдоминальное ожирение является ранним компонентом МС; последовательность появления АГ, нарушений углеводного обмена (НУО), дислипидемии также различна. Согласно популяцион- Особенности развития метаболического синдрома у женщинСоловьева А.В., Дубинина И.И. ГБОУ ВПО

The article presents the results of the study of glycaemia variability, neurological symptoms and electroneuromyography indicators in 33 patients with diabetes mellitus type 2 and diabetic neuropathy, who, at the moment of the study, received various kinds of antihyperglycemic therapy. Significant increase of the glycaemia coefficient after combined perioral therapy was found. Correlation dependency of positive neurological semiology, neurological deficiency and electroneuromyography data (M-response amplitude, propagation rate of activation and residual latency) upon the level of glycated hemoglobin (HbA1c), standard deviation and glycaemia variability coefficient was found.