ОТНОШЕНИЕ К ЗАБОЛЕВАНИЮ ПАЦИЕНТОВ С САХАРНЫМ ДИАБЕТОМ. РЕЗУЛЬТАТЫ ПИЛОТНОГО ИССЛЕДОВАНИЯМотовилин О .Г

23-24 СЕНТЯБРЯ 2021 Г. СБОРНИК ТЕЗИСОВКонференция по лечению и диагностике сахарного диабета «Фундаментальная и клиническая диабетология в 21 веке: от теории к практике» 98 КОГНИТИВНАЯ ДИСФУНКЦИЯ У ПАЦИЕНТОВ С ЦЕРЕБРОВАСКУЛЯРНЫМИ ЗАБОЛЕВАНИЯМИ НА ФОНЕ САХАРНОГО ДИАБЕТА 2 ТИПА 1 Танашян М .М ., 2 Суркова Е .В ., 1 Лагода О .В ., 1 Антонова К .В ., 1 Наминов А .В .

In recent years, the possibility of using intranasally administered insulin to treat Alzheimers disease and other cognitive disorders has been widely studied. At the same time, the possibility of its use in the treatment of diabetes mellitus is practically not investigated, which is due to the insufficient study of the molecular mechanisms of its action on the hormonal and metabolic status of the organism. The review discusses literature data and the results of our own research on the role of insulin in the central regulation of energy homeostasis, as well as on the experience of using intranasally administered insulin to correct eating disorders and metabolic and hormonal dysfunctions developing under conditions of experimental diabetes mellitus and metabolic syndrome. In studies involving healthy volunteers, various effects of intranasally administered insulin were shown, including effects on cognitive function, eating behavior and weight loss, and the gender specificity of its action was found. In the course of numerous studies of intranasally administered insulin in animal models of diabetes mellitus, not only stabilization of carbohydrate homeostasis was shown, but also a positive effect in the form of restoration of the functional activity of insulin signaling pathways in the hypothalamus and other parts of the brain. We have presented and analyzed data on the systemic effects of intranasally administered insulin in rodents with experimental models of diabetes mellitus, as well as in healthy individuals.

Despite the well-studied effect of insulin in peripheral tissues, its role in functioning of the central nervous system is much less understood. The effects of insulin in the brain are extremely diverse: insulin plays an important role in neuron growth and differentiation, affects higher cognitive functions (in particular, the formation of long-term memory), and also has a neuroprotective effect. Both peripheral and central insulin resistance as well as absolute insulin deficiency impairs the functional activity of neurons and neurogenesis. Several studies have investigated intranasal administration of insulin as a potential way for correction of these disorders. The review presents data on abnormalities of the insulin signaling system in the brain in diabetes mellitus, which is accompanied by cognitive dysfunction of varying severity and is associated with the development of neurodegenerative disorders, including Alzheimer's disease. We analyzed the results of studies on the use of intranasal insulin in animal models with diabetes mellitus, healthy volunteers, and patients with cognitive impairments.

The review considers the current views on the central nervous system (CNS) in diabetes mellitus (DM). It discusses an attitude towards the term diabetic encephalopathy. The data of investigations of cognitive functions in types 1 and 2 DM and the brain structural imaging results obtained using up-to-date technologies are considered. The results of studies of the factors that induce cerebral changes in DM and their associated cognitive impairments are given. There is evidence that hyperglycemia has a more considerable impact on the above processes than hypoglycemia; other possible factors, apart from blood glucose control, are set out. The current views on the function of insulin in the CNS and the relationship of central insulin resistance to Alzheimer's disease are outlined. There are current data on intranasal insulin application that is still exploratory, but, as might be judged from the findings, may by a promising method for the treatment and prevention of cognitive decline in both patients with DM and those without this condition.

Insulin treatment for type 2 diabetes mellitus is challenging in elderly people. Biphasic insulin preparations technically simplify this task, but also increase compliance and facilitate the achievement of therapeutic goals.

Aim. To identify psychological characteristics associated with better glycemic control and higher quality of life (QoL) in patients with type 1 diabetes mellitus (T1DM). Materials and Methods. The study included 140 T1DM patients (47 males) aged 18 to 28 years. Assessment of the QoL and associated emotional state (ES) was performed by validated localized questionnaires, supplemented with the inventories for evaluation of psychological characteristics. Based on the acquired data we performed a trilateral analysis of glycemic control, QoL and ES, followed by testing of these parameters for correlation with certain psychological characteristics, including disease attitude, mindfulness, self-attitude and self-assessment, coping strategies, autoregulation parameters and the locus of control. Results. In the studied sample, better glycemic control was associated with higher QoL and more favourable ES. We also identified several psychological characteristics associated with an improvement in all three primary parameters, namely: higher level of mindfulness, internal locus of control and ergopathic attitude. Conclusion. The diagnostic inventory for QoL and ES evaluation used in the present study may be helpful for psychological testing in patients with T1DM.

Body weight (BW) excess is a characteristic problem for type 2 diabetes mellitus (T2DM) both as its pathogenetic feature and as a side effect of blood glucose lowering therapy. In the latter case reduction of glycosuria and frequent hypoglycemic events are primarily blamed for BW gain, but additional factors like direct effect of insulin on lipogenesis and influence of its supraphysiologic levels on regulation of appetite via CNS structures are also under discussion.Advances of the last years have brought new hope due to introduction of drug classes that do not affect BW. However, fraction of patients dependent on exogenous insulin shows stable trend for growth. Deterioration of beta-cell secretory capacity makes insulin an ultimately indispensable tool in the foreseeable future. As so, insulin therapy modalities with minimal impact on BW are preferable. In this regard human insulin analogues of both rapid and prolonged action have certain advantages.Current article addresses influence of pre-mixed insulin preparation NovoMix 30 (Novo Nordisk, Denmark) on BW. A summary of several studies of substantial duration (up to 3 years) suggests a neutral effect on BW in various categories of T2DM patients (including obese and elder patients).Therapy with pre-mixed preparations is an adequately safe and effective T2DM treatment modality and is advantageous for patients in whom BW gain is particularly unfavorable.

This review discusses publications on the usage of biphasic analogue insulin aspart 30/70 (NovoMix 30) in the treatment of patients with type 2 diabetes mellitus. Data on the clinical and pharmaco-economic advantages of NovoMix 30 versus biphasic human insulin was analyzed. The problems of doctor's clinical inertia and patient's psychological insulin resistance, as well as possible solutions to key problems of insulin therapy with help of biphasic insulin aspart 30/70 were discussed.

Quality of life (QoL) studies are very important in many chronic diseases. Diabetes srongly impacts on QoL because of complex control and treatmentregiments and multiple somatic symptoms (acute and chronic complications). In turn, QoL has a significant impact on the prognosis of the disease.The paper reviws QoL definitions, evaluation approaches in medicine, list of examination tools.

Aim. To elucidate the relationship between glycemic control (assessed by the level of HbA(1c)) and psychological status of the patients.Materials and methods. The study included 115 patients with type 1 diabetes aged 13-27 years. The following tests were used to assess the psychological status of the patients status (emotional state, social relations, attitude toward disease): State-trait-anxiety Inventory (Spielberger C.D., Hanin Y.L), Center for Epidemiologic Studies Depression Scale (CES-D), Social ajustment scale by A.K. Osnizkiy based on Q-Sort Adjustment Scale developed by R. Dymond and C.R. Rogers (1954), Lusher colour test, Colour attitudes test, A.M. Etkind original technique, method for the assessment of attitude toward disease developed in V.M. Bekhterev Research Psychoneurologic Institute, Sankt-Peterburg. The patients were allocated to 3 groups differing in terms of 33.3% percentile of HbA(1c) levels.Results. Patients with good glycemic control (mean HbA(1c) level 7.4%) show the lowest level of social adaptation and emotional well-being. The reason for this phenomenon is the excessive focus of patient on the disease and narrow scope of interests, which suggest psychological dependence on diabetes. Patients with poor glycemic control (mean HbA(1c) level 13.1%) also experience emotional discomfort due to increased anxiety. Despite the fact they exhibit a higher degree of social adaptation than the patients of the above group, the main concern is the low level of communicative autonomy and the feeling of being unable to cope with the disease. Such personal characteristics also create a psychological dependence on diabetes, although of a different type than in the first group of patients. Patients with average glycemic control (mean HbA(1c) level 9.5%) in the sample have the most favorable psychological state in comparison with the other two groups. Their emotional state and social adaptation are significantly better than in the other two groups. These patients tend to psychological autonomy and independence and maintain multifaceted life motivation in terms of diabetes. They perceive the disease as a given, some life condition that allows to maintain a positive psychological state, high daily activity, not to feel overwhelmed with diabetes and at the same time pay attention to diabetes self-management even not quite sufficient.Conclusions. Glycemic control and psychological status in young adults does not coincide with each other, although there is a close relationship among them. Attitude toward the disease is the most important mediator of this relationship. Professional psychological help and educational interventions designed to develop skills of the practical management of diabetes may contribute to improvement of metabolic control, psychological well-being and social adjustment of patients.

Aim. To study quality of life (QL) in young patients with type 1 diabetes mellitus (DM1) depending on clinical characteristics, diabetes-related behaviour,and demographic indices. Materials and methods. The study included 89 patients (25 men aged 18-28 years) with DM1. Exclusion criteria were newly diagnosed DM, terminalstages of diabetic complications, severe concomitant somatic and psychic diseases. The patients filled the socio-demographic questionnaire, theirHbA1c was measured. QL was estimated using the Audit of Diabetes Dependent Quality of Life (ADDQoL) questionnaire and general well-beingbased on the Well-Being Questionnaire 12 (W-BQ12). In addition, the frequency of glycemia self-control was determined as an aspect of the diabetes-related behaviour. Results. Mean age of the patients was 22.3?3.0 years, mean duration of DM 9.6?5.8 years, mean HbA1c level 9.7?2.4%. It was shown that CD1has negative effect on all QL aspects (integrated significance of effect based on all scales -1.8). The most seriously affected aspects were dietaryfreedom (-2.9), professional and physical activities (-2.9 and -2.8 respectively), feeling secure about the future (-2.6). ADDQoL did not reveal a relationshipbetween any of these aspects and the HbA1c level. However, results of W-BQ12 suggest a rise in HbA1c associated with the high frequencyof negative emotions (r=-0.242, p = 0.023) and the low level of general emotional well-being (r=-0.253, p=0.019). Progressive diabetic nephropathyhad negative effect on professional activity (r=-0.317, p=0.025), financial well-being (r=-0.242, p=0.025), ability to move over a distance (r=-0.215,r=0.046), and ability to do something (r=-0.295, p=0.006). The highest QL level was documented in the patients who controlled glycemia 1-2 timesa week (mean over all scales -1.2). Lower or high frequencies of self-control were associated with the general worsening of QL (-2.3 and -2.1 respectively,p=0.005). The highest level of emotional well-being was revealed in the patients who controlled glycemia 1-2 times a week (24.7 W-Q12scores). A higher or lower frequency of self-control was associated with deterioration of emotional well-being (22.5 and 20.5 points respectively,p=0.019). ADDQoL data suggest sex-related differences in QL. In women, DM1 had stronger negative effect on the quality of domestic life (-3.2 comparedwith -2.2 in men, p=0.001), social life (-2.5 and -0.9, p=0.021) and dietary freedom (-3.4 and -1.8, p=0.007). Moreover, women experiencedstronger diabetes-related negative emotions than men (4.1 vs 2.5 points, p=0.007, W-B12).Сахарный диабет Обучение и психосоциальные аспекты44 4/2010Conclusion. DM1 has negative effect on all QL aspects. Dietary freedom, professional and physical activities, feeling secure about the future are moststrongly affected. The most important factors through which these effects are mediated include clinical characteristics (quality of compensation ofcarbohydrate metabolism, diabetic complications), DM-related behaviour (frequency of glycemia self-control), and gender.

Diabetic neuropathy (DN) is one of the most common complications of diabetes mellitus (DM). Most clinical and population studies indicate that its prevailing form is distal symmetric, affecting about 30% of patients with diabetes. The main clinical manifestation of this form of DN is a decrease (up to a complete loss) of sensitivity, which is either not recognized by the patient or is perceived as numbness, loss of any sensations in the lower extremities. At the same time, in a relative minority of patients, the leading symptom in the DN clinical presentation is pain, which, in some cases, reaches high intensity, disrupts working ability, daily activity, and sleep.