Vol 19, No 2 (2016)

Epidemiology
The prevalence of type 2 diabetes mellitus in the adult population of Russia (NATION study)
Dedov I.I., Shestakova M.V., Galstyan G.R.
Abstract

Aim. To estimate the prevalence of type 2 diabetes mellitus (T2DM) in Russian adults.

Materials and methods. NATION was a national, epidemiological, observational, cross-sectional study. The sample of adults (20–79 years old) was stratified by age, sex, geographic region and settlement type to obtain a representative sample. Recruitment was performed in public areas with large number of people. T2DM was diagnosed by glycated haemoglobin A1c (HbA1c) levels (diabetes: HbA1c≥6.5%; pre-diabetes: HbA1c≥5.7% to <6.5%). Socio-demographic and anthropometric data were collected.

Results. Blood samples from 26,620 subjects were available. Overall, 5.4% were diagnosed with T2DM (2.5% were previously diagnosed and 2.9% were previously undiagnosed); 19.3% were pre-diabetic. T2DM prevalence increased with age (up to 70 years), and no significant difference was revealed between females and males (5.6% vs. 5.1%). The estimated prevalence of pre-diabetes and T2DM tended to increase with increasing BMI. T2DM prevalence varied by geographic region and was higher in rural areas than in urban areas (6.7% vs. 5.0%, p < 0.001).

Conclusion. Approximately one in five adult Russians had pre-diabetes, 5.4% had T2DM and about half of the diabetic subjects were previously undiagnosed. These results demonstrate the need for new programs in the Russian Federation to predict, prevent and manage T2DM.

Diabetes mellitus. 2016;19(2):104-112
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Validation of the Finnish diabetes risk score (FINDRISC) for the Caucasian population of Siberia
Mustafina S.V., Rymar O.D., Sazonova O.V., Shcherbakova L.V., Voevoda M.I.
Abstract

Aim. A validation of the Finnish diabetes risk score (FINDRISC) was conducted among the Siberian population. FINDRISC was used to study the prevalence of risk factors for type 2 diabetes mellitus (T2DM) and to estimate the incidence of T2DM in high-risk groups during a 10-year observation period. 

Materials and methods. A total of 9,360 subjects aged between 45 and 69 years were enrolled in this cross-sectional, population-based study. FINDRISC was used to group 8,050 people without diabetes according to their risk for T2DM. Statistical analysis was performed using SPSS. 

Results. When a cutoff point of 11 was used to identify those with diabetes, sensitivity was 76. 0% and specificity was 60. 2%. The area under the receiver operating curve for diabetes was 0. 73 (0. 73 for men and 0. 70 for women). More than one-third (31. 7%) of the adult population of Novosibirsk was estimated to have medium, high or very high risk of developing T2DM in the next 10 years. Cases of T2DM estimated to occur during the 10 years of follow-up had significantly higher incidence of risk factors such as BMI ≥30 kg/m2, waist circumference >102 cm in men and >88 cm in women and a family history of T2DM and were more likely to take drugs to lower blood pressure. 

Conclusion. FINDRISC provided good results in our sample, and we recommend its use in the Siberian population. 

Diabetes mellitus. 2016;19(2):113-118
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Genetics
The association of TCF7L2 rs7903146 polymorphism with type 2 diabetes mellitus among Tatars of Bashkortostan
Avzaletdinova D.S., Sharipova L.F., Kochetova O.V., Morugova T.V., Erdman V.V., Somova R.S., Mustafina O.E.
Abstract

Aim. To perform the analysis of the association of transcription factor 7-like 2 (TCF7L2) gene rs7903146 polymorphism with type 2 diabetes mellitus (T2DM) among Tatars of Bashkortostan. 

Materials and methods. In this study, 169 patients with T2DM and 286 controls without clinical symptoms and laboratory signs of diabetes and without diabetes relatives were examined. Amplification of the DNA fragments was performed using real-time polymerase chain reaction (PCR) and TaqMan technique. 

Results. Genotype CT and allele T ratios were higher in the T2DM group than in controls (46. 7% vs. 36. 4%, p = 0. 030; 41. 7% vs. 30. 8%, p = 0. 001 respectively). There was a positive association between allele T and T2DM (OR = 1. 61), and allele C had a protective effect (OR = 0. 62, p = 0,001). Carriers of the ТТ genotype had later onset of T2DM (mean = 59. 5 years old) compared with carriers of the CT and CC genotypes (56. 1 years old, p = 0. 044). Basal C-peptide concentration, lipid levels and body mass index were not associated with TCF7L2 rs7903146 polymorphism. 

Conclusion. TCF7L2 rs7903146 polymorphism is associated with T2DM among Tatars of Bashkortostan. 

Diabetes mellitus. 2016;19(2):119-124
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Phenotypic and genetic characteristics of patients with type 2 diabetes with different responses to metformin therapy in Novosibirsk region
Bondar I.A., Shabelnikova O.Y., Sokolova E.A., Pyankova O.V., Filipenko M.L.
Abstract

Aim: The purpose of this study was to examine the phenotypic and genetic characteristics of patients with type 2 diabetes mellitus (T2DM) with different responses to treatment with metformin (MF) in the Novosibirsk region. 

Materials and methods: We examined 460 patients with T2DM in the Novosibirsk region. Patients were divided into groups according to their HbA1c level: patients who achieved the target HbA1c level during MF therapy (n = 209) and those who did not reach the target HbA1c level (n=251). Genotyping of ATM (rs11212617) was performed using polymerase chain reaction by TaqMan. 

Results: Patients who achieved the target HbA1c level during MF treatment (good response) were older (61. 1±9. 1 years vs. 57. 4±8. 4 years, p=0. 001), had later onset of diabetes (54. 6 ± 10. 1 years vs. 49. 2±8. 5 years, p = 0. 0001) and shorter duration of diabetes (6. 5±5. 9 years vs. 8. 2±6. 1 years, p=0. 03) compared with those who did not achieve the target HbA1c level. There was no statistically significant association between ATM rs11212617 and achieving the target HbA1c level among all patients [odds ratio (OR)=0. 94, 95% confidence interval = (0. 73–1. 23), p=0. 67] or those with MF monotherapy [OR=0. 90, (0. 65–1. 25), p=0. 54] or combination therapy [OR=1. 02, (0. 72–1. 43), p=0. 92]. There was an effect of age on response to MF therapy in all three groups (all patients: p=0. 001, MF monotherapy group: p=0. 04, combination therapy group: p=0. 0009). In the MF monotherapy group, low dose MF was associated with a good response (p=0. 03), and in the combination therapy group, males were more likely to have a good response (p=0. 003). Patients with genotype C/C or A/C for ATM (rs11212617) compared with those with genotype A/A were more likely to have high levels of triglycerides [2. 33 (1. 52–4. 2) mmol/l, 2. 09 (1. 35–3. 0) mmol/l and 1. 99 (1. 49–3. 21) mmol/l, respectively, p=0. 001], coronary heart disease (CHD) (13. 4%, 13. 4% and 9. 6%, respectively, p=0. 009) and myocardial infarction (7. 8%, 3. 2% and 4. 0%, respectively, p=0. 001). 

Conclusion: Patients with T2DM who had a good response to MF therapy were older, more likely to be male and had a later onset of T2DM. Genotype C/C for ATM rs11212617 was associated with high triglycerides, CHD and myocardial infarction. ATM rs11212617 was not associated with response to MF therapy in the Novosibirsk region. 

Diabetes mellitus. 2016;19(2):125-131
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Complications
Factors associated with abnormal cardio-ankle vascular index in patients with type 2 diabetes and prediabetes
Sumin A.N., Bezdenezhnykh N.A., Fedorova N.V., Shcheglova A.V., Indukaeva E.V., Artamonova G.V.
Abstract

Aim: The purpose of this study was to examine the phenotypic and genetic characteristics of patients with type 2 diabetes mellitus (T2DM) with different responses to treatment with metformin (MF) in the Novosibirsk region. 

Materials and methods: We examined 460 patients with T2DM in the Novosibirsk region. Patients were divided into groups according to their HbA1c level: patients who achieved the target HbA1c level during MF therapy (n = 209) and those who did not reach the target HbA1c level (n=251). Genotyping of ATM (rs11212617) was performed using polymerase chain reaction by TaqMan. 

Results: Patients who achieved the target HbA1c level during MF treatment (good response) were older (61. 1±9. 1 years vs. 57. 4±8. 4 years, p=0. 001), had later onset of diabetes (54. 6 ± 10. 1 years vs. 49. 2±8. 5 years, p = 0. 0001) and shorter duration of diabetes (6. 5±5. 9 years vs. 8. 2±6. 1 years, p=0. 03) compared with those who did not achieve the target HbA1c level. There was no statistically significant association between ATM rs11212617 and achieving the target HbA1c level among all patients [odds ratio (OR)=0. 94, 95% confidence interval = (0. 73–1. 23), p=0. 67] or those with MF monotherapy [OR=0. 90, (0. 65–1. 25), p=0. 54] or combination therapy [OR=1. 02, (0. 72–1. 43), p=0. 92]. There was an effect of age on response to MF therapy in all three groups (all patients: p=0. 001, MF monotherapy group: p=0. 04, combination therapy group: p=0. 0009). In the MF monotherapy group, low dose MF was associated with a good response (p=0. 03), and in the combination therapy group, males were more likely to have a good response (p=0. 003). Patients with genotype C/C or A/C for ATM (rs11212617) compared with those with genotype A/A were more likely to have high levels of triglycerides [2. 33 (1. 52–4. 2) mmol/l, 2. 09 (1. 35–3. 0) mmol/l and 1. 99 (1. 49–3. 21) mmol/l, respectively, p=0. 001], coronary heart disease (CHD) (13. 4%, 13. 4% and 9. 6%, respectively, p=0. 009) and myocardial infarction (7. 8%, 3. 2% and 4. 0%, respectively, p=0. 001). 

Conclusion: Patients with T2DM who had a good response to MF therapy were older, more likely to be male and had a later onset of T2DM. Genotype C/C for ATM rs11212617 was associated with high triglycerides, CHD and myocardial infarction. ATM rs11212617 was not associated with response to MF therapy in the Novosibirsk region. 

 

Diabetes mellitus. 2016;19(2):132-140
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Perspectives on reducing mortality attributed to acute myocardial infarction among patients with type 2 diabetes mellitus in multicenter randomized trials
Kakorin S.V., Iskandaryan R.A., Mkrtumyan A.M.
Abstract

A review of the scientific literature was conducted to investigate reducing mortality from acute myocardial infarction (AMI) in patients with type 2 diabetes mellitus (T2DM). This included a review of literature comparing cardiovascular disease (CVD) treatment methods for AMI patients who have T2DM and those with normal carbohydrate metabolism. These treatments increase the life expectancy and greatly improve the quality of life of patients with acute myocardial infarction in both groups of patients. However, the risk of cardiovascular mortality in patients with T2DM compared with people with normal carbohydrate metabolism remains unchanged. The rapidly growing population of patients with T2DM will soon change our attitude towards the possibility of improving the prognosis and treatment of those with CVD. 

Diabetes mellitus. 2016;19(2):141-149
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Reproductive health
The associations of incretin hormone concentration with gestational diabetes mellitus
Saprina T.V., Timokhina E.S., Goncharevich O.K., Budeeva S.V., Prokhorenko T.S., Tashireva L.A., Musina N.N., Dronova I.V.
Abstract

Background: Enteropancreatic hormonal system disorder is a possible reason for β-cell dysfunction and carbohydrate metabolism disorder among pregnant women. However, no information is available about the state of enteroinsulin hormones [glucagon, glucose-dependent insulinotropic peptide (GIP), glucagon-like peptide1 (GLP-1) and GLP-2] during pregnancy. The role of enteroinsulin hormones in the development of carbohydrate metabolism disorder during pregnancy is poorly understood. 

Aim: To quantify and compare incretin hormone secretion in groups of pregnant women with and without gestational diabetes mellitus (GDM). 

Materials and methods: The study included 80 patients, 50 of whom had GDM, and the control group consisted of 30 pregnant women without GDM. All patients underwent an oral glucose tolerance test; glycated haemoglobin (HbA1c) estimation; ferritin, transferrin, basal and postprandial glucagon estimation; GLP-1 and GLP-2 estimation. 

Results: Basal glucagon and GLP-1 levels were significantly higher (p <0. 05) in the group of women with GDM than in the control group. The most significant differences in GLP-1, basal and postprandial glucagon levels were observed during the first trimester of pregnancy. 

Conclusion: High GLP-1 levels in the group of women with GDM may reflect a state of ‘incretin resistance’, which is similar to hyperinsulinemia in the early stages of type 2 diabetes mellitus. 

Diabetes mellitus. 2016;19(2):150-157
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A comparison of the clinical outcomes of induced and spontaneous labour in patients with gestational diabetes
Bettikher O.A., Zazerskaya I.E., Popova P.V., Kustarov V.N.
Abstract

Aim. To evaluate the clinical outcomes of induced and spontaneous labour in patients with gestational diabetes (GD).

Materials and methods. This retrospective cohort study conducted at the Federal Almazov Northwest Medical Research Centre included 251 patients with GD who had given birth during 2014. The patients were divided into the following two groups: one included 210 patients who were treated with diet and the other included 41 patients who were treated with insulin. Clinical outcomes were compared between patients who had induced (n = 43) or spontaneous (n = 188) labour.

Results. Complications of labour, such as dysthyroidism and uterine inertia, were significantly more common (p < 0. 05) in induced labour patients than in those who had spontaneous labour (16. 3 vs. 3. 2% and 7% vs. 0%, respectively). Fetal distress occurred in 10. 6% and 9. 3% of patients during spontaneous and induced labour, respectively. The frequency of ceasarean section after induced labour was not significantly greater than that among patients who had spontaneous labour.

Conclusion. Delivery at 38 to 39 weeks in women with GD has led to an increase in the rate of birth complications, such as uterine inertia and dysthyroidism. Gestational age cannot be considered as a sufficient indicator of labour induction at full-term in the absence of foetus distress or poor maternal glycemic control. 

Diabetes mellitus. 2016;19(2):158-163
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Efficacy and safety of metformin for the treatment of gestational diabetes: a new approach to the problem
Sazonova A.I., Esayan R.M., Kolegaeva O.I., Gardanova Z.R.
Abstract

Historically, the following two methods were used to treat gestational diabetes mellitus: non-medical life-style interventions (diet and increased physical activity) and insulin treatment when other interventions were not effective. The possibility of alternative types of treatment such as oral anti-diabetic drugs has been the source of debate in recent years. Metformin is an oral anti-diabetic drug that reduces insulin resistance, which is common during gestation and is considered one of the main pathways of glucose metabolism alteration during pregnancy.

The main concern is that metformin can cross the placenta and is found unchanged in foetal blood. This is the reason why oral anti-diabetic drugs are contraindicated during pregnancy in many countries, including Russia (according to the 2012 Russian recommendations for gestational diabetes treatment).

In recent years, many studies investigating the safety and efficacy of metformin for maternal and foetal health have been published. We will review recent randomized clinical trials and discuss new international clinical recommendations (FIGO, 2015) and new opportunities for gestational diabetes mellitus treatment. 

Diabetes mellitus. 2016;19(2):164-170
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Detemir potential applications in the treatment of diabetes during pregnancy: proven benefits and perspectives
Ruyatkina L.A., Sorokin M.Y.
Abstract

In recent years there is notable growing prevalence of gestational and overt diabetes in pregnant women while rate of obstetric complications, neonatal morbidity, perinatal mortality in women with diabetes is maintained at the high level as compared with common population. Furhermore no doubt that fetal programming and genetic factors induce the formation of various longterm complications in infants of diabetic mothers.

 

There is a strong evidence that the risk of obstetric complications can be reduced by achieving adequate glycemic control, which is frequently still an elusive goal. Improved pharmacokinetic and pharmacodynamic profiles of the insulin analogs (including minimal action variability) allow to achieve a better glycemic control with lower risk of hypoglycemias compared to human insulin. The clinical benefits of detemir have been confirmed in clinical trials in pregnant women with diabetes. Detemir is the only long-acting insulin analog that has been evaluated in prospective studies in pregnant women and proved a satisfactory safety profile and the ability to achieve a lower level of fasting glycemia and advanced maturity of the fetus at delivery.

Diabetes mellitus. 2016;19(2):171-178
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Obituary
In memory of professor Yury A. Pankov (1930-2016)
 
Abstract

On February 12 2016 we have lost one of the most famous Russian biochemists — professor Yury A. Pankov.

Diabetes mellitus. 2016;19(2):179-180
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News
The interim experts’ counsil resolution on the EMPA-REG OUTCOME trial issues
 
Abstract

The interdisciplinary interim experts’ counsil on March 3, 2016 in Moscow have considered the EMPA-REG OUTCOME trial results and suggested a number of prorositions and remommendations on further empagliflozin’s cardiovascular effects investigation and it’s clinical application in patients with type 2 diabetes at high cardiovascular risk.

Diabetes mellitus. 2016;19(2):182-185
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