2. ДИАГНОСТИКА ЗАБОЛЕВАНИЯ ИЛИ СОСТОЯНИЯ (ГРУППЫ ЗАБОЛЕВАНИЙ ИЛИ СОСТОЯНИЙ), МЕДИЦИНСКИЕ ПОКАЗАНИЯ И ПРОТИВОПОКАЗАНИЯ К ПРИМЕНЕНИЮ МЕТОДОВ ДИАГНОСТИКИ 2.1 ЖАЛОБЫ И АНАМНЕЗ 2.2 ФИЗИКАЛЬНОЕ ОБСЛЕДОВАНИЕ 2.3 ЛАБОРАТОРНЫЕ ДИАГНОСТИЧЕСКИЕ ИССЛЕДОВАНИЯ 2.4 ИНСТРУМЕНТАЛЬНЫЕ ДИАГНОСТИЧЕСКИЕ ИССЛЕДОВАНИЯ 2.5 ИНЫЕ ДИАГНОСТИЧЕСКИЕ ИССЛЕДОВАНИЯ 3. ЛЕЧЕНИЕ, ВКЛЮЧАЯ МЕДИКАМЕНТОЗНУЮ И НЕМЕДИКАМЕНТОЗНУЮ ТЕРАПИИ, ДИЕТОТЕРАПИЮ, ОБЕЗБОЛИВАНИЕ, МЕДИЦИНСКИЕ ПОКАЗАНИЯ И ПРОТИВОПОКАЗАНИЯ К ПРИМЕНЕНИЮ МЕТОДОВ ЛЕЧЕНИЯ 3.1 ТЕРАПЕВТИЧЕСКИЕ ЦЕЛИ 3.1.1 Показатели контроля углеводного обмена (индивидуальные цели лечения) 3.1.2 Целевые уровни показателей липидного обмена 3.1.3 Целевые уровни показателей артериального давления 3.2 КОНТРОЛЬ УРОВНЯ ГЛЮКОЗЫ 3.3 НЕМЕДИКАМЕНТОЗНЫЕ МЕТОДЫ ЛЕЧЕНИЯ 3.3.1 Рекомендации по питанию 3.3.2 Рекомендации по физической активности 3.4 МЕДИКАМЕНТОЗНАЯ ТЕРАПИЯ 3.4.1 Общие принципы медикаментозной терапии 3.4.2 Инсулинотерапия 3.5 ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ

Type 2 diabetes mellitus (T2 DM) is often seen in patients with obesity. Bariatric surgery, aimed to decrease body weight, can often help those patientsto improve glycemic status. After some of bariatric operations patients reach normoglycemia in few days, the fact that cant be explained onlyby reduction in weight. Recent trials revealed that the reorganization of gastrointestinal tract provides hypoglycemic effect of such operations. Thisarticle explains the role of proximal and distal gut in pathophysiology of T2 DM.

BACKGROUND: Type 2 diabetes (T2D) is multifactorial disease. NATION epidemiological study may provide the information about the prevalence of T2D and prediabetic state in patients with different risk factor combinations in Russian population. AIMS: To evaluate the prevalence of T2D and prediabetic state in NATION cohort depending on the amount of diabetes risk factors. MATERIALS AND METHODS: NATION is an epidemiological, cross-sectional study, designed to assess the prevalence of T2D in Russian adult population, where HbA1c was used to establish T2D (HbAc6,5%) and prediabetes (5,7%HbA1c6,5%). Patients with T2D were either previously diagnosed or newly diagnosed. Current study presents an additional analysis of NATION cohort focused on the prevalence of T2D and prediabetic state among patients with different risk factor combinations. RESULTS: T2D and prediabetic state prevalence gradually increased among patients with following risk factors (prevalence of T2D and prediabetes respectively): low physical activity (4,3%, 18,3%), rare fruit and vegetable consumption (4,8%, 18,7%), T2D family history (7,7%, 20,3%), age 45 years (9,5%, 31,3%), obesity grade 1 (9,6%, 30,3%), obesity grade 2 (14,6%, 37,8%), obesity grade 3 (20,1%, 39,7%), hypertension (14,7%, 38,2%), history of diabetes during pregnancy (14,1%, 24,7%). Prevalence of T2D with single and multiple risk factors was compared to the prevalence of T2D in young patients (45 years) without additional diabetes risk factors. Age 45 years was associated with 7-fold increase in T2D prevalence; obesity 8,8-fold; family history 5,7-fold; hypertension 10,8-fold (p0,001 for comparisons of every group with patients 45 years of age without other risk factors). When one patient had several risk factors combined, the prevalence of T2D increased progressively: combination of age 45 years and family history led to 10,7-fold rise; combination of age 45 years and BMI30kg/m2 11,2-fold; combination of age 45 years, family history and BMI30kg/m2 15,3-fold; combination of age 45 years, family history, BMI30kg/m2 and hypertension 19,1-fold (p0,001 for comparisons of every group with patients 45 years of age without other risk factors). CONCLUSIONS: Presence of multiple risk factors, such as age 45 years, obesity and hypertension led to progressive increase in the prevalence of T2D and prediabetic state. These data are important to identify patients at the highest risk of T2D among Russian population.

Цель. Оценить распространенность недиагностированного сахарного диабета 2 типа (СД2) среди пациентов с сердечно

Background: At present a lot of attention is paid to the so-called “metabolically healthy obesity”. More than a half of patients with prolonged history of obesity lack any carbohydrate metabolism disorders. Unfortunately, physiological factors forming the foundation of a favorable metabolic profile in such patients are not sufficiently defined. Aims: Evaluation of insulin resistance (IR) degree, the level of insulin secretion by pancreatic β-cells, and the contribution of both these mechanisms to the maintenance of normal carbohydrate metabolism in patients with prolonged history of obesity. Methods: An observational cross-sectional non-blinded selective comparative case-control study was performed. Patients with prolonged history of obesity without carbohydrate metabolism disorders and with type 2 diabetes mellitus (DM2) were included into the study. The following parameters were analyzed: IR parameters (М-index, HOMA-IR); insulin secretion parameters (НОМА-%β and insulinogenic index, glucose disposition index, GDI); body composition indices (total body fat and visceral fat area). Results: 68 patients participated in the study: 34 patients with obesity and normal carbohydrate metabolism («Obesity and NCM» group), and 34 patients with obesity and DM2 («Obesity and DM2» group); both groups were matched by body mass index, known obesity duration, and sex ratio (males/females) in each group. «Obesity and NCM» groups significantly differed from «Obesity and DM2» group by the following parameters: lower IR level (М-index median 4.13 vs 1.52 mg/kg/min, p0.001; HOMA-IR median 4.84 vs 9.94, p0.001); better insulin secretion (insulinogenic index median 28.15 vs 15.24, p0.002; HOMA-%β median 115.63 vs 25.94, p0.001); higher GDI (median 115.63 vs 25.94, p0.001); lower visceral fat area (median 170.00 vs 230.00 cm2, p0.001). Differences in total body fat (%) were not statistically significant. Conclusions: Patients with obesity and NCM compared to patients with DM2 have a less significant IR and a more preserved basal stimulated insulin secretion, which allows to maintain normal carbohydrate metabolism. Low visceral fat grade also contributes to this. Most likely, the most important factor contributing to the “maintenance” of normal carbohydrate metabolism in patients with obesity is preserved insulin secretion, which is confirmed by the high glucose disposal index (almost 4.5-fold higher than that in patients with DM2) characterizing the ability of β-cells to secrete the amount of insulin required to overcome IR.