Objective: To study the features of cardiac remodeling in patients with diabetes mellitus (DM) depending on the stage of chronic kidney disease (CKD). Design and method: We examined 499 patients with type 1 and type 2 diabetes mellitus older than 25 years. The laboratory examination of the patients included the measurement of serum creatinine, eGFR according to the CKD-EPI equation. An echocardiographic investigation was performed to study structural and geometric heart parameters. Left ventricular hypertrophy (LVH) was diagnosed when the left ventricular myocardial mass index (LVMI) exceeded 115 g/m2 in men and 95 g/m2 in women. Results: LVH was detected in 57.7% of patients with DM, while in the comparison group – in 35.4%. The frequency of LVH increased with a decrease in eGFR and was diagnosed in 100% of cases with CKD 5. In patients with DM, the left ventricular concentric remodeling significantly predominated (29.2%). Multiple linear regression analysis demonstrated the influence of age (ß=0.30, p=0.01) and serum creatinine (ß=0.15, p<0.0001) on the LVMI, independent of other factors, which confirms their independent pathogenetic significance. Conclusions: Patients with DM and CKD have structural and functional changes in the LV myocardium. Regardless of the nitrogen-excretion function of the kidneys, the predominant pattern of LV remodeling is concentric. The study of the features of structural and functional restructuring of the left heart in patients with diabetes should be taken into account in determining the cardiovascular prognosis.

Abstract Background and Aims Diabetic kidney disease (DKD) is one of the fastest growing causes of chronic kidney disease and associated morbidity and mortality. Previous studies have demonstrated the involvement of inflammation in the progression of kidney damage. The aim of our study was to evaluate potential therapeutic approaches using inflammatory biomarkers to assess DKD progression. Method A total of 499 patients with DT1 and DT2, aged 34 to 84 years (60 [60;72]), were examined. All patients underwent standard clinical and laboratory examination, with an assessment of the levels of the inflammatory biomarkers (FGF-23, TNF-α, VEGF-A, hsCRP, Il-6) in baseline plasma samples. Renal function was assessed based on the levels of serum creatinine, eGFR and albumin/creatinine ratio. Control group included 65 people the same age without diabetes. Results We divided all patients into two groups according to the presence DKD. The levels of FGF-23 (p < 0.001), TNF-α (p = 0.014), VEGF-A (p = 0.006), hsCRP (p < 0.001), Il-6 (p < 0.001) were significantly higher in patients with DKD than in control group. A predictive model was developed to estimate the probability of DKD depending on VEGF-A, FGF-23, TNF-α, Il-6, hsCRP, age, duration of diabetes, systolic blood pressure, HbA1c, LDL-C, using binary logistic regression. The resulting regression model was statistically significant (p < 0.001). Based on the value of Nagelkerke R², the model explained 79.5% of the observed DKD variance. 1 pmol/l increase of FGF-23 was associated with 1.921 times increase in DKD odds. 1 pg/ml increase of TNF-α was associated with 1.092 times decrease in DKD odds. 1 mg/ml increase of Il-6 was associated with 1.612 times increase in DKD odds. 1 mg/l increase of hsCRP was associated with 1.496 times increase in DKD odds. Conclusion Our study identifies FGF-23, TNF-α, Il-6, hsCRP as promising targets of novel therapeutic interventions in patients with diabetes, which should be investigated in future clinical trials.

Hyperprolactinemia (HP) is a persistent pathological increase in a prolactin serum concentration amounting to more than 20 ng/ml in males and 25 ng/ml in females and leads to developing the pathological symptom complex of HP primarily from the reproductive system. To confirm the persistent etiology of HP and to eliminate physiological short-term hormone enhancement, a number of recommendations, including Russian and Belarusian, were proposed to make several prolactin measurements. This study included 120 patients with HP (96 females, 78.0 %) and (27 males, 22.0 %) aged 18–50 years who sought medical help at the Health Institution “Minsk City Clinical Endocrinology Center” in the period from December 2022 to September 2023. After catheterizing the vein, a venous cannula was inserted and blood was taken immediately after cannulating (T0), and then in 60 minutes (T1) and 120 minutes (T2). The cannulated prolactin test results were considered positive – with HP remaining in all three samples (T0, T1, T2), questionable – if HP was kept at T0 and T1, and negative if HP was only at T0. When evaluating the cannulated test results, true HP is 36.7 %. Patients with a positive cannulated test had a higher prolactin at T0, which was 888.5 mME/L ( U = 97.0; z = 7.92; p < 0.001). Patients with stress-induced HP (negative test) and patients with true HP (positive test) had no statistically significant differences in age and occurrence frequency of specific and non-specific complaints and symptoms for HP.

Abstract Background and Aims It has been known that cystatin C is a marker for early prediction of renal function. In recent years, studies have shown that cystatin C plays an important role in predicting new or worsening cardiovascular diseases. The aim of our study was to investigate the role of cystatin C in the development and progression of chronic heart failure (CHF) in patients with diabetes. Method A total of 499 patients with DT1 and DT2, aged 34 to 84 years (60 [60; 72]), were examined. All patients underwent standard clinical and laboratory examination, with an assessment of the levels of the natriuretic peptides (BNP and NTproBNP) in baseline plasma samples. Renal function was assessed based on the levels of serum creatinine and cystatin C. Patients were divided into quartiles according to cystatin C levels: Q1 <0.78 mg/l, Q2 0.78-0.92 mg/l, Q3 0.93-1.38 mg/l, Q4 >1.38 mg/l. Results Significant differences in the levels of BNP and NTproBNP were observed in patients with diabetes with cystine C levels ≥0.93 mg/l (32.20 [19.85; 69.35] pg/ml and 104.25 [57.70; 210.08] ng/l, respectively). There were significant correlations between cystatin C and the levels of BNP (r = 0.56, p < 0.05) and NTproBNP (r = 0.58, p < 0.05). Logistic regression analysis showed the prognostic value of cystatin C, and not creatinine, as a predictor of heart failure in patients with diabetes and GFR>60 ml/min/1.73 m2 (1 mg/l increase of cystatin C was associated with 7.085 times increase in CHF odds). ROC analysis revealed that the level of cystatin C ≥0.96 mg/l with a sensitivity of 84% and specificity of 75% predicted increased BNP and NTproBNP in patients with diabetes (ROC AUC = 0.844). Conclusion Cystatin C level could be used as a predictive indicator of CHF in patients with diabetes and GFR>60 ml/min/1.73 m2.

ЦЕЛЬ: оценить взаимосвязь уровней CD26 с маркерами воспаления в зависимости от значения насы- щения крови кислородом (SpO2) у пациентов с Сovid-19 и сахарным диабетом 2 типа (СД2). МАТЕРИАЛЫ И МЕТОДЫ: в исследование включено 46 пациентов с Сovid-19 и СД 2, которым выполне- на оценка показателей общего анализа крови, уровня гликированного гемоглобина (НbА1с), С-реактивного белка (СРБ), интерлейкина 6 (ИЛ6), ферритина, расчетной скорости клубочковой фильтрации (СКФ), SpO2, растворимой формы CD26, степени поражения легочной ткани по данным компьютерной томографии (КТ) легких, экскреции CD 26 в моче. Для достижения цели исследования пациенты были разделены на 2 группы: группа 1 включала пациентов с SpO2 ≥95% (n=20), группа 2 – SpO2 <95% (n=26). РЕЗУЛЬТАТЫ: анализ результатов позволил установить, что у пациентов группы 1 значение HbА1с было на 1,4% ниже (7,5% vs 8,9%; р=0,034), а СКФ – выше (81,2 [71,0;83,0] vs 63 [60,5;71,0] мл/мин/1.73 м2; р=0,0214). Также в группе 2 выявлен больший процент поражения легочной ткани по данным КТ (67,7 [65,0;70,0]% vs 50,3 [40,0;60,0]%, р=0,001). В группе 2 отмечены наименьшие показатели гемоглобина 110 [109,0;117,0] г/л vs 123 [118,0;130,0] г/л (р=0,021); лимфоцитов 7,0 [6,0;9,0]% vs 15,0 [10,0;16,0]% (р=0,017); растворимо- го CD26 (41,16 [32,36;49,18] нг/мл vs 73,96 [54,0;88,95] нг/мл, р=0,001) и наибольшие значения марке- ров воспаления СРБ 67,2 [41,0;71,0] мг/л vs 35,4 [27,0;43,0] мг/л (р=0,002); ИЛ6 – 51,8 [42,0;59,0] пг/мл vs 35,4 [14,5;53,0] пг/мл (р=0,001); ферритина 780,0 [720,0;820,0] нг/мл vs 360,0 [340,0;412,0] нг/мл (р=0,003). Экскреция в утренней порции мочи CD26 в группе 1 была значимо ниже и составила 1,66 [0,92;1,92] нг/мл vs 14,38 [0,91;29,68] нг/мл, р=0,001. Корреляционный анализ позволил определить зависимость между показателями растворимого CD26 и SpO2 (r=0,569), повреждением легочной ткани по данным КТ (r=-0,731), значением лимфоцитов (r=0,419), ИЛ6 (r=-0,491) и СРБ (r=-0,635), экскрецией CD26 в моче (r=-0,473), СКФ (r=0,438) в группе 2. В группе 1, у па- циентов с легким течением инфекции Сovid-19 отмечаются корреляционные зависимости между показате- лями растворимого CD26 и экскрецией CD26 в моче (r=-0,531), ИЛ 6 (r=-0,611) и СРБ (r=-0,523). Привлекает внимание факт несоответствия уровней растворимого CD26 в сыворотке и его экскреции с мочой в группах сравнения: при более высоких значениях растворимого CD26 в группе 1, его экскреция значимо ниже. ВЫВОДЫ: определено, что наряду с повышенным уровнем НbА1с (8,9%), традиционных маркеров воспаления (ИЛ6, СРБ), большим процентом повреждения легочной ткани по данным КТ, снижением SpO2 89,0% и повышение уровня растворимого CD26 и снижение его экскреции с мочой являются факторами, подтверждающими тяжесть течения Сovid-19 у пациентов с СД 2 типа. ФИНАНСИРОВАНИЕ: работа выполнена при финансовой поддержке Белорусского республиканского фонда фундаментальных исследований (Проект М21КОВИД035 «Прогностическая значимость дипепти- дилпептидазы-4 и полиморфных вариантов гена TCF7L2 в развитии осложнений COVID-19 у пациентов с сахарным диабетом 2-го типа»).

Обобщены современные подходы к ведению пациентов с сахарным диабетом 2-го типа, включающие мультифакториальные воздействия, направленные на снижение массы тела, достижение целевых уровней гликемии, артериального давления и липидов. Рассмотрены подходы к выбору оптимальных лекарственных препаратов для коррекции гликемии, гипотензивной и липидснижающей терапии с позиций коррекции кардиоваскулярного риска. Обосновано использование статинов для пациентов с сахарным диабетом 2-го типа. Уделено внимание необходимости использования ацетилсалициловой кислоты. Modern approaches to the management of type 2 diabetes patients are summarized, including multifactorial effects aimed at reducing body weight, achieving target levels of glycemia, blood pressure and lipids. Approaches to the selection of optimal drugs for the correction of glycemia, hypotensive and lipid-lowering therapy from the perspective of cardio-vascular risk correction are considered. The use of statins for patients with type 2 diabetes mellitus is justified. Attention is paid to the necessity of using acetyl-salicylic acid.

Abstract Background and Aims Previous studies suggest that interactions between the heart and the kidney can contribute to the progressive dysfunction of both organs. Recently, there has been an increase in the prevalence of cardiovascular disease (CVD) and chronic kidney disease (CKD) due to increasing diabetes mellitus rate. It is known that fibroblast growth factor-23 (FGF-23) has been found to be related to kidney metabolism especially as a biomarker and a key factor to be used in the kidney field. The aim of our study was to assess potential therapeutic approaches of the use of FGF-23 in clinical settings as a potential circulating biomarker for CVD and CKD. Method A total of 155 patients with DT2, aged 34 to 84 years (60 [60;72]), were examined. Control group included 94 healthy people the same age. All patients underwent standard clinical and laboratory examination, with an assessment of the levels of FGF-23 in baseline plasma samples. Renal function was assessed based on the levels of serum creatinine, cystatin C, eGFR, which was calculated according to the CKD-EPI formula, and albuminuria, which was assessed as albumin/creatinine ratio (A/C). An echocardiographic examination was conducted according to the standard protocol with the calculation of dimensional, volume and speed characteristics. Results The levels of FGF-23 were significantly higher in DT2 patients with CKD 5 in comparison with stages 1–4. There were positive strong significant association between FGF-23 and creatinine (r = 0.71, p<0.001). In both unadjusted and adjusted analyses, probability of decreased eGFR was associated strongly with FGF-23 (COR; 95% CI 1.890; 1.362-2.622, p<0,001). When evaluating the dependence of the probability of decreased eGFR on the FGF-23 using the ROC analysis, the cut-off value of FGF-23 was 0,9 pmol/l. The sensitivity and specificity of the method were 75.3% and 74.5%, respectively (AUC 0.832±0.035 with 95% CI: 0.764-0.901, p<0.001). DT2 patients with left ventricular hypertrophy (LVH) were characterized by higher levels of FGF-23 (2,45 [0,65;7,43] vs 0,57 [0,19;2,19] pmol/l in control group). DT2 patients with LVH and natriuretic peptides levels ≥ 35 pg/ml for BNP and/or ≥125 ng/ml for NT-proBNP had significantly high concentrations of FGF-23 than patients with normal levels of natriuretic peptides (3,22 [1,09;9,55] vs. 0,52 [0,27;1,08] pmol/l, p<0,0001). In order to assess the diagnostic significance of the FGF-23 for predicting left ventricular mass index (LVMI) thickening and increasing the proBNP concentration, a ROC analysis was performed. Thus, at the level of FGF-23 (AUC-0.702) = 0.9 pmol/l, the sensitivity and specificity for LVMI thickening were 66.9% and 67.3%. Conclusion Our study identifies FGF-23 as a promising target of novel therapeutic interventions in cardiorenal syndrome, which should be investigated in future clinical studies.

Introduction. The association of diabetes mellitus (DM) and cardiovascular diseases (CVD) is due to common pathophysiological processes that determine the prognosis and progression of both diseases. We studied the factors associated with the risk of developing cardiovascular pathology to create an algorithm for diagnosing it in patients diabetes mellitus. Patients and methods. A total of 449 patients (126 men and 323 women) with type 1 diabetes (133) and type 2 diabetes (316) were examined. The median age was 63 (53; 70) years. Serum cystatin C, C-reactive protein (CRP), homocysteine, interleukin-6 (IL-6), N-terminal natriuretic peptide (NTproBNP) and brain natriuretic peptide (BNP) levels, fibroblast growth factor (FGF-23) levels, tumor necrosis factor (TNF-α), chemokine MIG, endothelial growth factor (VEGF-A), chemokine RANTES were determined in all patients. Instrumental research methods included echocardiographic examination and ultrasound of the lower extremity and brachiocephalic arteries. Logistic regression and ROC analysis were used to assess the prognostic value of markers. Results. Cystatin C levels ≥0.96 mg/l were associated with increased natriuretic peptides in patients with diabetes and early stages of CKD (with GFR>60), IL-6 levels ≥2.13 mg/ml and FGF-23 ≥0.9 pmol/ l — with the risk of increasing natriuretic peptides, and IL-6 ≥0.9 pmol/l — with the risk of increase in left ventricular mass index. Based on the obtained results, we developed an algorithm for diagnosis of cardiovascular pathology in patients with diabetes mellitus. Conclusions. In the present study, we identified markers associated with the risk of adverse cardiovascular events in patients with diabetes and their diagnostic value.

Objective . To evaluate the role of the T(-344)C polymorphism of CYP11B2 gene in the development of cardiorenal syndrome (CRS) in diabetes mellitus (DM). Materials and methods . 270 patients with type 1 and type 2 diabetes aged over 25 years were examined. All patients underwent molecular genetic analysis using deoxyribonucleic acid isolated from whole venous blood. Results . The TT genotype was associated with the risk of developing CRS manifestations such as left ventricular hypertrophy (odds ratio (OR) 2.64; 95% CI (0.93–4.19), chronic heart failure (OR 4.26; 95% CI (2.26 - 8.06), subclinical atherosclerosis (OR 4.04; 95% CI (1.89 - 8.58), chronic kidney disease (CKD) (OR 10.77; 95% CI (3.56 - 32.61), and the CT genotype (OR 3.28; 95% CI (1.02 – 10.59) with CKD risk.. Conclusion. There are pathogenetic associations between renin-angiotensin-aldosterone system, cardiovascular complications and a decrease of renal function. Further research is needed for a deep understanding of the complex pathogenetic mechanisms of the development and progression of cardiovascular and renal pathology.