Vol 67, No 1 (2012)

SHORT MESSAGES
DIABETES MELLITUS — A DANGEROUS TREAT TO THE MANKIND
Dedov I.I.

Abstract

According to the WHO and the UN definitions, diabetes mellitus is a non-infectious disease that has an epidemic spread rate, this has led to the UN 2006 resolution against diabetes mellitus. A special diabetologic service has been established in Russia which includes Federal and regional diabetes centres, endocrinologic clinics, equipped with modern diagnostic and treatment equipment for diabetes and its vascular complications handling. Planning of diabetologic service functioning is based on State diabetes mellitus register data, according to which nowadays in Russia 3 268 871  patients have been registered. This article contains data from control-and-epidemiological studies from various regions of Russia which have shown real spread of the disease. This article also contains information about innovative technologies of treatment of diabetes mellitus and its complications, international and national foreground studies, as well as discussion of diabetologic service development perspectives.

Annals of the Russian academy of medical sciences. 2012;67(1):7-13
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DIABETUS MELLITUS AND SURGICAL TREATMENT OF CORONARY HEART DISEASE
Akchurin R.S., Vlasova E.E., Mershin K.V.

Abstract

Nearly 40-year experience of surgical treatment of coronary heart disease testifies to higher coronary heart disease (CHD) morbidity and mortality rates among diabetes mellitus patients in comparison to non-diabetic patients. At the same time, comparative study of CHD treatment methods efficacy in diabetes mellitus patients has shown that surgery is preferred to angioplasty, especially in the most severe cases – in presence of coronary occlusion, insulin-dependent diabetes and left-ventricle dysfunction. More inferior results of coronary bypass surgery in diabetic patients in comaparison to non-diabetic were conditional on a more pronounced arterial calcinosis and diffuse distal arterial involvement, as well as more severe aortal ateromatosis, flebopathy and more often wound infection occurrence. In the department of cardio-vascular surgery in Russian cardiologic scientific productive complex a quarter of all patients waiting for the coronary bypass surgery are diabetic. Selection algorithm, preoperation preparation, peculiarities of surgical technique and principles of postoperative supervision of these patients were specially designed. With adequate preparation, remission of diabetes and use of microsurgery, postoperative prognosis for these patients (both stratified and real) is comparative to that for the main group of patients. One-year follow up after the bypass surgery data testifies to the low difference in autovenous and autoarterial shunt patency in diabetic and non-diabetic patients. Long-term (10 years) survival rate is significantly lower in the group of diabetic patients. Proposed cardioprotective postoperative strategy is designed to improve both short and long-term efficacy of surgical revascularization in CHD patients with concomitant diabetes mellitus.

Annals of the Russian academy of medical sciences. 2012;67(1):14-19
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MODERN APPROACH TOWARDS SURGICAL TREATMENT OF CORONARY HEART DISEASE IN DIABETIC PATIENTS
Bokeria L.A., Golukhova E.Z., Sigaev I.Y., Keren М.A.

Abstract

In the recent years there has been registered an increase in diabetes mellitus (DM) morbidity, especially among able-bodied citizens. The steady increase in amount of DM patients inevitably leads to the increase in the amount of diabetic CHD patients – candidates for the surgical myocardial revascularization. This article contains analysis of choice of myocardial revascularization technique in patients with CHD and concomitant DM. It also contains data from the study of endovascular and surgical treatment of CHD results in diabetic patients. This study also included postoperative complications analysis with exposure of complication development predictors and was held in Bakulev Scientific Centre of cardiovascular surgery. Results obtained in the study testify to the fact that DB increases relative risk of cardio-vascular complications (cardiac death, myocardial infarction and restenosis of special-purposed stenosis) development in patients with CHD after percutaneous coronary intervention with stenting. DM is an independent risk factor that increases myocardial infarction development risk, recurrence of stenocardia and shunt failure during the three year follow up after the coronary artery bypass grafting done in CHD patients.

Annals of the Russian academy of medical sciences. 2012;67(1):20-26
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THE PLACE OF VASCULAR SURGERY IN TREATMENT OF DIABETIC PATIENTS
Pokrovskiy А.V.

Abstract

This article is dedicated to diagnostics, prevention and surgical treatment of vascular complications of diabetes mellitus, particularly prevention of ischemic strokes and treatment of critical ischemia of lower limbs. The main tendency in treatment of brachiocephalic artery lesions nowadays is a surgical intervention in the latent stage of the disease. X-ray endovascular surgical techniques are being increasingly used to treat lesions of lower limbs arteries. Limb preservation is impossible without cooperation of many specialists. It’s essential to perform careful out-patient follow up of the patient after vascular reconstructive surgery.

Annals of the Russian academy of medical sciences. 2012;67(1):27-30
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MOLECULAR AND GENETIC ASPECTS OF HEART FAILURE IN DIABETIC PATIENTS
Shlyakhto Е.V.

Abstract

This article deals with peculiarities of development and clinical course of heart failure (HF) in diabetic patients, influence of diabetic cardiopathy on HF formation., role of genetic predictors of diabetes mellitus (DM) and HF formation, also the importance of treatment response predictors, the significance of a more «personalized» exposure in order to optimize treatment. The role of stationary and dynamic genomics was analyzed,
especially molecular visualization that allows the earliest possible intervention. The article also includes examples of molecular visualization use in diagnosis of myocardial dysfunction, disease monitoring, and treatment efficacy assessment. Authors give an analysis of targeted treatment methods on the example of targeted delivery of medications to the target-organ (myocard). Discuss means of anti-ischemic myocardial protection, perspectives of metformin use in order to enhance efficacy of myocardial ischemic pre- and postconditioning mechanisms. Presented perspectives of study of molecular and genetic mechanisms involved in the pathogenesis of HF in diabetic patients, in particular, study of key biological features of stem cells, cell interactions, stem cell plasticity (in vitro direction of differentiation) and their paracrine function evaluation. Given information about identification of genes with partly altered expression due to chronic exposure of mesenchymal stem cells to the high concentration of glucose, and upon decreased ability of mesenchymal stem cells of proangiogenic factors with simultaneous increase of inflammatory markers production (IL8). In whole this article reviews modern state of HF in diabetic patients development mechanisms study with the use of molecular and genetic technologies, and of perspectives of development of this area.

Annals of the Russian academy of medical sciences. 2012;67(1):31-37
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HYPERGLYCEMIA IMPACT ON ANGIOGENIC PROPERTIES OF ENDOTHELIAL AND PROGENITOR VASCULAR CELLS
Parfenova Е.V., Tkachuk V.A.

Abstract

This report contains authors own data about hyperglycemia impact on main functional properties of endothelial cells, mesenchymal stem cells and
circulating progenitor cells, which define their participation in angiogenesis. Obtained data shows that cultivation of endothelial cells in hyperglycemic
conditions leads to decrease of their ability for targeted migration and vascular-like structures formation on matrigel, and to suppression of VEGF
receptors expression in these cells. Mesenchymal stem cells cultivated in hyperglycemic conditions have altered expression profile, decreased ability
to stimulate angiogenesis via paracrine activity. Hyperglycemia in CHD patients with concomitant diabetes mellitus type II most probably lead to
circulating bone marrow progenitor cells mobilisation distortion in response to tissue ischemia and damage to the endothelium, that can infringe upon
their participation in endothelium reparation and angio- and vasculogenesis in the ischemic conditions. Found distortions can be used as targets for the treatment aimed at cardiovascular complications prevention in diabetic patients.

Annals of the Russian academy of medical sciences. 2012;67(1):38-44
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DIABETES MELLITUS AND CHRONIC KIDENY DISEASE: MODERN DIAGNOSTICS AND TREATMENT
Shestakova М.V.

Abstract

Diabetic nephropathy (DN) – is a leading cause of terminal renal failure in the developed countries. Kidney pathology development undergoes several
stages – from preclinical structural changes in the first years of the disease to diffuse or nodular glomerulosclerosis 15-20 years after the diabetes onset. Microalbuminuria is an early marker of DN. Intensive treatment of DN at the stage of microalbuminuria leads to regress and remission of lab parameters of DN in 40 – 50 % of patients after 2 years of treatment. Prognostic factors of DN remission are: tight glycaemia control, arterial hypertension control, especially while treated with renin-angiotensin blockers. Regress of structural changes of kidney tissue In a diabetic patient is possible only after a long-term (>10yrs) normoglycaemia maintenance.

Annals of the Russian academy of medical sciences. 2012;67(1):45-49
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«OTHER TYPES» OF DIABETES: CONTRA-INSULAR HORMONES AND GENETIC PREDISPOSITION, NEW HORIZONS OF DIAGNOSTICS AND TREATMENT
Mel'nichenko G.A., Glinkina I.V., Surovtseva D.M.

Abstract

This article deals with various specific types of diabetes mellitus and other carbohydrate metabolism distortions occurring against the background of different endocrinopathies: hypercorticism, acromegaly, hyperparathyroidism, pheochromocytoma and other. Epidemiology of carbohydrate metabolism distortions as well as pathophysiological mechanisms of hyperglycemia development in various endocrinopathies are included in the article, the necessity of endocrinopathy screening among patients with refractory carbohydrate metabolism distortions is substantiated, objectives and tactics of glucose-reduction-therapy in these patients are defiend. This article also contains data upon prevalence and prevention of long-term complications of diabetes mellitus.

Annals of the Russian academy of medical sciences. 2012;67(1):50-53
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TYPE 1 DIABETES MELLITUS, DIABETIC NEPHROPATHY: TRANSPLANTOLOGY POTENTIAL
Got'e S.V.

Abstract

The review covers the role of transplantology in treatment of patients with type 1 diabetes and the state of its development in the world and in Russia. The results of major multicenter studies, devoted to the influence of simultaneous kidney and pancreas transplantation and kidney transplantation alone on life expectancy and quality of life of diabetic patients are summarized here. Experience in pancreas-kidney transplantation, gained in Academician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs, is described, including surgical technical and postoperative treatment. Also we perform the results of research work, devoted to the influence of pancreas transplantation on different homeostasis parameters, such as: oxidative stress parameters, homocysteine, receptor for advanced glycation endproduct (RAGE), and markers of endocrine function of pancreas transplant.


Annals of the Russian academy of medical sciences. 2012;67(1):54-60
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MODERN ASPECTS OF DIABETIC RETINOPATHY AND DIABETIC MACULAR OEDEMA TREATMENT
Neroev V.V.

Abstract

Main reasons of eyesight deterioration in diabetic patients are diabetic retinopathy (DR) and diabetic macular oedema (DMO). International multicenter studies have shown that retinal laser coagulation in the event of DMO decreases the risk of eyesight loss in 50% , though only in 16% patients it was also possible to improve their eyesight. Use of vascular endothelial growth factor inhibitor – Ranibizumab – have opened a new era in DMA treatment. It’s efficacy and safety have been proven in several international studies. This article contains our own data upon the use of Lucentis in patients with DMO. Intravitreal Lucentis injections and subsequent retinal lasercoagulation in the macular zone were performed on 43 eyes; follow up period – 6 months. Additional injections were required in 19 cases, average amount of injections – 1,4. Mean corrected visual acuity before the treatment was 0,37±0,06, after7 days, 1, 3 and 6 months - respectively 0,41±0,06, 0,49±0,06, 0,51±0,07 and 0,52±0,07 (р<0,05). Mean retina thickness in central zone was 428±25 mkm before treatment, 391±24 mkm 7 days after the last injection 349±23, 313±21 and 308±20mkm (р<0,05) after 1, 3 and 6 months. In addition to that Lucentis use in preoperative period in patients with non-complicated proliferative DR allowed to decrease the risk of hemorrhagic complications. Thereby, intravitreal injections of Lucentis improve functional result of treatment of patients with DMO, increase efficacy and safety of surgical interventions in patients with complicated forms of proliferating DR.


Annals of the Russian academy of medical sciences. 2012;67(1):61-65
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DIABETES MELLITUS AND METABOLIC SYNDROME IN SIBERIA AND IN THE FAR EAST
Nikitin Y.P., Voevoda М.I., Simonova G.I.

Abstract

In Siberia and in the Far East region overall incidence of diabetes mellitus is somewhat lower than in the European part of the country, though these indices reduplicate on average in 10-15 years. The prevalence of both diabetes (both types) and metabolic syndrome among indigenous mongoloid population is lower than among Caucasian.


Annals of the Russian academy of medical sciences. 2012;67(1):66-74
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IMMUNOGENETICS OF TYPE 1 DIABETES MELLITUS — FROM FUNDAMENTAL IDEAS TO MEDICAL PRACTICE
Alekseev L.P., Dedov I.I., Khaitov R.M., Boldyreva M.N., Trofimov D.Y., Peterkova V.A., Kuraeva T.L., Abramov D.D.

Abstract

The review of studies of Russian researchers on theoretical and practical aspects of genetic predisposition to type 1 diabetes associated with immunity: HLA and not HLA genes. Most important for practical public health outcomes are evidence that HLA-genetic predisposition to type 1 diabetes is associated with the DRB1-genotype, consisting entirely of variants DRB1-genes associated with the development of T1D. It was also established that CTLA4 gene has an independent predictive value for T1D.

Annals of the Russian academy of medical sciences. 2012;67(1):75-80
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MOLECULAR GENETICS AND CLINICAL ASPECTS OF MONOGENIC DIABETES MELLITUS
Peterkova V.A., Kuraeva T.L., Prokof’ev S.A., Emel'yanov A.O., Zakharova E.Y., Tsygankova P.G., Grishina D.P.

Abstract

The paper is dedicated to clinical and laboratory aspects of Diabetes Mellitus non-immune forms, such as neonatal Diabetes Mellitus, Maturity Onset Diabetes of young (MODY), DIDMOAD-syndrome, Wolframe syndrome, Alstrom syndrome and its determinating genes. The analysis of proper clinical results are present in this paper.

Annals of the Russian academy of medical sciences. 2012;67(1):81-86
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