RESUMEN
steady increase in the prevalence of carbohydrate metabolism disorders is closely related to overweight and obesity. Obesity is associated with a sedentary lifestyle, poor diet, sleep disturbance, which can lead to dysfunction of circadian rhythms with a decrease in the production of the hormone melatonin. The aim of the study is to clarify the most significant risk factors for carbohydrate metabolism disorders in obese patients from the standpoint of chronobiology. Material and methods. The retrospective study involved 120 patients with obesity (body mass index 31.35±3.80 kg/m2) with early disorders of carbohydrate metabolism (EDCM), type 2 diabetes mellitus (T2DM) and without disorders of carbohydrate metabolism (n=40 in each group). The age of the patients was 40-69 years, of which 75% were women and 25% were men. The patients' food diaries (for 24 hours) and Horne-Ostberg tests were analyzed. Fasting glucose, glycated hemoglobin, leptin, insulin were determined in the venous blood plasma; the insulin resistance index (HOMA-IR) was calculated, anthropometric indicators, basal body temperature (BT) were measured. Results and discussion. Patients of all groups were comparable in age, sex, BMI. The patients had an irrational distribution of the amount of calories consumed during the day, frequent meals, and a tendency to late breakfast (9:30-10:00 h) and dinner (19:00-20:00). In all 3 groups, leptin and insulin resistance was determined. In patients with DM2 leptin and insulin deficiency was revealed, which was confirmed by the presence of negative correlations between insulin concentration and energy consumption (r=-0.817, p<0.001) and carbohydrates intake (r=-0.299, p<0.001), as well as between carbohydrate intake and leptin concentration (r=-0.221, p<0.01) and HOMA-IR (r=-0.257, p<0.005). The duration of sleep averaged 7±1 h per day, and bedtime using artificial illumination, on average, varied in the range of 22:00-23:30, which can lead to circadian mismatch, with the progression of insulin resistance. The decrease in the amplitude of the BT circadian rhythm in patients with EDCM and T2DM, as well as the presence of an inverse correlation between BT and energy consumption (r=-0.531, p<0.0001) and fat intake (r=-0.533, p<0.0001), and a positive correlation between BT and protein consumption (r=0.533, p<0.0001), may indicate the involvement of melatonin in the development and progression of disorders of carbohydrate metabolism. Conclusion. The most significant risk factors for the development of disorders of carbohydrate metabolism, accompanied by circadian dysfunction in the surveyed, include irrational distribution of the energy value of food during the day, frequent meals, late breakfast and dinner; shifting the time of going to bed, shortening the duration of sleep, exposure to artificial lighting in the evening.
Asunto(s)
Metabolismo de los Hidratos de Carbono , Ritmo Circadiano , Diabetes Mellitus Tipo 2 , Ingestión de Alimentos , Resistencia a la Insulina , Obesidad , Adulto , Anciano , Glucemia/metabolismo , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Insulina/sangre , Leptina/sangre , Masculino , Melatonina/sangre , Persona de Mediana Edad , Obesidad/sangre , Obesidad/fisiopatología , Estudios RetrospectivosRESUMEN
We report a progressive disruption of 24-h rhythms in fasting blood glucose (FBG), body temperature (BT) and heart rate (HR) associated with metabolic dysfunction and the development of prediabetes (PD) and type 2 diabetes mellitus (T2DM) in overweight middle-aged (40-69 years old) humans. Increasing BT and HR mean values and declining 24-h BT and HR amplitudes accompany adverse changes in metabolic state. Increased nocturnal BT and a phase delay of the 24-h BT rhythm, deviant 24-h HR profile and a phase advance of the 24-h HR and FBG rhythms are early signs of the PD metabolic state. In T2DM, the 24-h FBG rhythm is no longer detectable, and the 24-h amplitudes of BT and HR are greatly diminished. In addition, lepton and creatinine values were lowered in T2DM. Moreover, positive correlations between FBG and body mass index, BMI, and negative correlations between the 24-h amplitude of FBG and BMI indicate that overweight is an additional factor causing disruption of the circadian rhythms. Further studies on circadian disruption as a consequence of metabolic dysfunction are necessary. The quantitative analysis of changing circadian BT and HR rhythms may provide prognostic markers of T2DM and therapeutic targets for its prevention and correction.
Asunto(s)
Glucemia/metabolismo , Temperatura Corporal/fisiología , Diabetes Mellitus Tipo 2/metabolismo , Ayuno/fisiología , Frecuencia Cardíaca/fisiología , Adulto , Anciano , Ritmo Circadiano/fisiología , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estado Prediabético/metabolismoRESUMEN
Diabetes mellitus is a systemic lesion of the micro- and macrocirculatory bed. We examined a total of 110 people with type 2 diabetes mellitus and lesions of the major vessels of the lower limbs. Of these, 70 patients were found to have microangiopathy combined with nephropathy. Diabetic nephropathy was classified depending on the level of microalbuminuria and the glomerular filtration rate. All patients were subdivided into three groups: diabetic macroangiopathy of the lower extremities with neither diabetic nephropathy nor chronic renal disease, lower-limb diabetic macroangiopathy combined with diabetic nephropathy in stage 1 of microalbuminuria of chronic renal disease and those in combination with diabetic nephropathy in stage 2 of microalbuminuria chronic renal disease. We measured the level of interleukine-6 and interleukine-8, tumour necrosis factor α, fibrinogen and the von Willebrand factor, revealing simultaneous progression of lower limb angiopathy in diabetic nephropathy, with direct interrelation between proinflammatory cytokines and the haemostasis system parameters. A decrease in the interleukine-8 level as nephropathy progresses may be indicative of exhaustion of angiogenesis, which is one of the factors of progression of macroangiopathy in patients with diabetes mellitus.
Asunto(s)
Citocinas/sangre , Diabetes Mellitus Tipo 2/sangre , Angiopatías Diabéticas/sangre , Inflamación/sangre , Biomarcadores/sangre , Diabetes Mellitus Tipo 2/complicaciones , Angiopatías Diabéticas/etiología , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Long-term results were followed up from 3 to 15 years in 649 patients with different morphological forms of the nodular goiter. Postoperative recurrent nodular goiter was diagnosed in 26.8% of the patients. The greater part of recurrences (87.4%) was nodular colloid goiter that was shown morphologically. Main part of the recurrences (69.1%) appeared after operations if the greater part of the thyroid gland was left--resection of a lobe and enucleation of the nodes. No recurrences were registered after thyroidectomy. The results of the investigation suggest that such operations as enucleation of a node and resection of a lobe with a node are thought to be inadequate.
Asunto(s)
Bocio Nodular/cirugía , Neoplasias de la Tiroides/cirugía , Adulto , Biopsia con Aguja Fina , Femenino , Bocio Nodular/patología , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , RecurrenciaRESUMEN
The structure and functions of lymphocyte membranes with characterization of their phospholipid composition, lipid peroxidation intensity (LP), activity of membranous ATPases and a type of the immune status were investigated in patients with insulin dependent diabetes mellitus. The results obtained were indicative of considerable differences (LP) in the lymphocytes of these patients as compared to those of healthy controls. LP intensity showed correlation with change in the ratio of phospholipid fractions and change in ATPase activity. In complicated insulin dependent diabetes mellitus destabilization of lymphocyte cell membranes and disturbance of transmembranous transport were more marked than in uncomplicated disease. The structure and functions of the membranes of immunocompetent cells, a degree of carbohydrate metabolic decompensation and the presence of complications determined an immune response type.