Pre-diabetes as an interdisciplinary problem: definition, risks, approaches to the diagnostics and prevention of type 2 diabetes and cardiovascular complications

Барбараш, О. Л.; Воевода, М. И.; Галстян, Г. Р.; Shestakova, Marina Vladimirovna; Бойцов, С. А.; Александрова, О. Ю.; Брызгалина, С. М.; Друк, И. В.; Каретникова, В Н; Кашталап, В. В.; Квиткова, Л. В.; Кореннова, О. Ю.; Огарков, М. Ю.; Плотникова, Е. Ю.; Цыганкова, О. В.; Сваровская, А. В.; Чумакова, Г. А.

doi:10.15829/1560-4071-2019-4-83-91

Cited by 15 publications

(10 citation statements)

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“…Любой человек в возрасте старше 45-ти лет или с ИМТ ≥25 кг/м² и хотя бы еще одним из ФР (семейный анамнез СД, гестационный СД или рождение крупного плода в анамнезе, АГ, низкая ФА, холестерин липопротеинов высокой плотности (ЛПВП) ≤0,9 ммоль/л и/или уровень триглицеридов ≥2,82 ммоль/л, синдром поликистозных яичников, наличие ССЗ) или набравший ≥12 баллов по шкале FINDRISC, должен быть направлен на скрининговое обследование с целью диагностики возможных нарушений углеводного обмена. Если у пациента выявлен предиабет, то частота повторного обследования -1 раз в год, если нет -1 раз в 3 года [1]. В настоящее время отсутствуют единые позиции по критериям диагностики предиабета.…”

Section: проблемы диагностики предиабетаunclassified

“…В настоящее время отсутствуют единые позиции по критериям диагностики предиабета. Все экспертные общества и ассоциации относят к предиабету такие состояния как ГГН и НТГ [1]. Правда ГГН при этом трактуется различными ассоциациями по-разному.…”

Section: проблемы диагностики предиабетаunclassified

“…В течение среднего периода наблюдения (12 лет) 33,8% участников вернулись к нормогликемии, 7,2% прогрессировали к недиагностированному диабету, 12,8% прогрессировали к диагностированному диабету и 46,2% оставались предиабетиками [52]. Важно отметить, что исследование крови на HbA1c должно быть выполнено с использованием метода определения HbA1c, сертифицированного в соответствии с National Glycohemoglobin Standardization Program (NGSP) или International Federation of Clinical Chemists (IFCC) и стандартизованного в соответствии с референсными значениями, принятыми в Diabetes Control and Сomplications Trial (DCCT) [1]. НТГ представляет собой сочетание ГГН и недостаточного по своей силе и активности инсулинового ответа на 75г глюкозы на 200-300 мл воды.…”

Section: проблемы диагностики предиабетаunclassified

“…Выявление значений HbA1c 6,0-6,4% пока не является самостоятельным диагностическим критерием и должно быть подтверждено обнаружением ГГН и/или НТГ. Тем не менее, наличие у пациента с предиабетом HbA1c в диапазоне 6,0-6,4% стратифицирует его в группу наибольшего риска развития СД второго типа [1].…”

Section: проблемы диагностики предиабетаunclassified

“…Системы здравоохранения, особенно в развивающихся странах, могут иметь ограниченные экономические и технические ресурсы. Кроме того, большинство участников клинических исследований в последующем снова набирали вес [1]. В настоящее время наряду с немедикаментозными подходами к профилактике СД второго типа закончены крупномасштабные исследования с использованием фармацевтических препаратов.…”

Section: подходы к лечениюunclassified

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Modern Aspects of the Clinic, Diagnosis and Treatment of Prediabetes

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2020

Arhivʺ vnutrennej mediciny

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Prediabetes is a common violation of carbohydrate metabolism, the medical and social relevance of which is due to the negative impact on the incidence of type 2 diabetes mellitus (DM) and cardiovascular disease (CVD). The analyzed literature emphasizes the presence of a close pathogenetic relationship between type 2 DM/prediabetes and CVD. This relationship becomes even more relevant, taking into account, on the one hand, the persistent upward trend in the prevalence of carbohydrate metabolism disorders in the population, and on the other hand, the fact that in patients with dysglycemia it is cardiovascular complications that are the main cause of death. However, while the significance of type 2 DM as a risk factor for CVD is widely known and its presence immediately stratifies most patients to a group of high or very high cardiovascular risk, the contribution of prediabetes to the development of CVD remains underestimated among the therapeutic and cardiological communities. The high prevalence of prediabetes creates prerequisites for a further increase in the incidence of type 2 DM and CVD in the Russian Federation, which requires doctors of various specialties to be wary of early detection of prediabetes, since timely preventive measures can significantly reduce the risk of type 2 DM and its complications in the future. Currently, the effectiveness of both non-drug and drug strategies in preventing the development of type 2 DM in people with prediabetes has been confirmed, more and more data are accumulating about the possibility of effective prevention of CVD in prediabetes. According to modern research, the primary role of measures to actively change lifestyle in the treatment and prevention of prediabetes is emphasized, at the same time, the effectiveness of these measures can be reduced due to insufficient commitment of the patients themselves to their independent long-term implementation. Therefore, the strategy of prescribing metformin for the prevention of type 2 diabetes is absolutely justified if the doctor and patient recognize the inefficiency or inability to follow the recommendations for active lifestyle changes for a long time. The article presents the data on the etiology, epidemiology, diagnosis, and approaches to the management of patients with prediabetes from the standpoint of modern recommendations.

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Section: проблемы диагностики предиабетаunclassified

Section: подходы к лечениюunclassified

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Modern Aspects of the Clinic, Diagnosis and Treatment of Prediabetes

Пырикова

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Полякова

2020

Arhivʺ vnutrennej mediciny

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Insulin resistance and heart failure with preserved ejection fraction. Pathogenetic and therapeutic crossroads

et al. 2022

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Insulin resistance, which is a fundamental pathogenetic factor of prediabetes, is closely associated with abdominal obesity on the one hand and the development of cardiovascular diseases, heart failure (HF), on the other. The pathogenetic role of insulin resistance is multifaceted and consists in the acceleration of atherosclerosis, the formation of left ventricular myocardial hypertrophy, including through mechanisms that do not depend on blood pressure, as well as the development of its diastolic dysfunction. The latter is the starting point for starting HF with preserved ejection fraction (HFpEF).Compared with patients with HF with reduced ejection fraction, the presence of HFpEF determines a higher frequency of hospitalizations not due to decompensation of heart failure, but due to concomitant diseases, such as destabilization of the course of arterial hypertension, decompensation of type 2 diabetes mellitus, curation of which, in general, has a greater impact in terms of improving prognosis. Thus, in patients with prediabetes and HFpEF, the correction of insulin resistance as the underlying cause and trigger of cardiometabolic disorders can potentially improve not only insulin-glucose homeostasis, but also the parameters of myocardial diastolic function. This literature review is devoted to the accumulated experience of using metformin as a «strategic» antidiabetic drug in HFpEF and considering potential new points of its application as a protector of the cardiovascular system.

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The FINDRISC scale as a risk assessment tool for liver fibrosis in patients with nonalcoholic fatty liver disease

et al. 2022

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BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the world, which includes changes from hepatic steatosis and nonalcoholic steatohepatitis to fibrosis and cirrhosis. Attempts to find noninvasive markers of liver fibrosis have led to a variety of scales, diagnostic algorithms, and imaging techniques. Individual studies have analyzed the relationship between the FINDRISC scale and hepatic steatosis and concluded that this questionnaire can be used as part of population screening to identify individuals at risk for hepatic steatosis. However, our review of the literature did not reveal any clinical studies on the use and effectiveness of the FINDRISC in liver fibrosis screening.AIM: To evaluate diagnostic value of FINDRISC for liver fibrosis detection.MATERIALS AND METHODS: The study enrolled patients aged 40–60 years from unorganized outpatient population. The sample of patients was formed randomly according to the inclusion and noninclusion criteria. All patients were assessed with standard anthropometric parameters. The FINDRISC questionnaire was used. All patients underwent transabdominal ultrasound examination of the liver and transient liver elastometry. The degree of steatosis was evaluated using Hamaguchi ultrasound scale. RESULTS: The study included 100 patients. An increased risk of type 2 DM (≥7 points) was detected in 68% of patients using the FINDRISC scale. Liver steatosis was diagnosed in 41% of patients. Median values of hepatic elastic modulus by transient elastometry were 4.50 (4.00; 5.25) kPa. At the same time, liver elasticity modulus values ≥5.9 kPa were registered in 11 (11.0%) patients. When analyzing the array of sensitivity and specificity values using the ROC-curve, it was found that for the FINDRISC scale the maximum LR+ and the minimum LRvalues were observed when the number of points on the indicated scale exceeded 10. At this cutoff, the FINDRISC scale had a sensitivity of 81.8% and specificity of 61.8% for detecting liver fibrosis (liver modulus of elasticity ≥5.9 kPa). The scale was of good diagnostic value (AUC 0.699; 95% CI 0.530–0.815).CONCLUSION: In an unorganized sample of patients aged 40–60 years the FINDRISC can serve as a diagnostic tool for liver fibrosis and steatosis. Sum of FINDRISC scores >10 allowed to diagnose liver fibrosis (liver elastic modulus ≥5.9kPa) with sensitivity 81.8% and specificity 61.8%. The probability of absence of hepatic fibrosis with FINDRISC scale values <10 was 96.5%.

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Pre-diabetes as an interdisciplinary problem: definition, risks, approaches to the diagnostics and prevention of type 2 diabetes and cardiovascular complications

Abstract: .

Cited by 15 publications

References 38 publications

Modern Aspects of the Clinic, Diagnosis and Treatment of Prediabetes

Modern Aspects of the Clinic, Diagnosis and Treatment of Prediabetes

Insulin resistance and heart failure with preserved ejection fraction. Pathogenetic and therapeutic crossroads

The FINDRISC scale as a risk assessment tool for liver fibrosis in patients with nonalcoholic fatty liver disease

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