: инсулинорезистентность, метаболический и нормальный фенотип, макро- и микроангиопатии

Patients with Type 1 diabetes mellitus (DM-1) represent a heterogeneous group with different phenotypes, which might include some individuals with genetic predisposition towards insulin resistance (IR) and metabolic phenotype (MPH) development. At present, the IR effects on cardiovascular risk development in DM-1 patients remain an understudied area.

Aim. To assess the prevalence of cardiometabolic risk factors (RF) and micro- and macrovascular complications by phenotype in patients with DM-1. Material and methods. The study included 3371 DM-1 patients from the Altay Region Diabetes Register. All participants were divided into two groups, by the waist circumference/hip circumference ratio: those with normal phenotype (NPH) and those with metabolic phenotype (MPH). Overall and separately in two age groups (under 50 and >50 years), the prevalence of the following characteristics was assessed: overweight, obesity, arterial hypertension, diabetic retinopathy, diabetic nephropathy, diabetic polyneuropathy, acute myocardial infarction, stroke (S), angina, and lipid metabolism disturbances.

Results. MPH was registered in 46,5% of DM-1 patients. Overall, MPH patients were 7 years older than their NPH peers. The percentage of men was higher among MPH participants. Among DM-1 patients with MPH, the prevalence of all clinical conditions was significantly higher (p<0,05), with S as the only exception. The effect of MPH on macroangiopathy development was greater than that for microangiopathy development. MPH participants were characterised by a higher prevalence of hypercholesterolemia and hypertriglyceridemia (p<0,01); however, this difference was less obvious in older patients. In the age group of 50 years and older, the strength of the association between MPH and cardiovascular diabetic complications was different from that in younger patients.

Conclusion. In DM-1 patients, MPH is an additional RF of cardiovascular disease development, which should be taken into account while choosing the appropriate therapeutic strategy

1. Ivashkin VT, Maevskaya MV. Lipotoxicity and metabolic disorders in obesity. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2010; 1:4-13. Russian (Ивашкин В. Т., Маевская М. В. Липотоксичность и метаболические нарушения при ожирении. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2010; 1:4-13).

2. Nathan DM, Cleary PA, Backlund JC, et al. Intensive Diabetes Treatment and Cardiovascular Disease in Patients with Type 1 Diabetes. N Engl J Med. 2005; 353 (25):2643-53.

3. Veglio M, Giunti S, Stevens LK, et al. The EURODIAB IDDM Complications Study Group: Prevalence of QT interval dispersion in type 1 diabetes and its relation with cardiac ischemia. Diabetes Care. 2002; 25:702-7.

4. Dankowski R, Wierzchowiecki M, Naskret D, et al. Association between retinopathy, microalbuminuria and coronary perfusion in young patients with type 1 diabetes mellitus. Kardiol Pol. 2008; 66 (3):212-16.

5. N das J, Putz Z, Fv nyi J, et al. Cardiovascular risk factors characteristic for the metabolic syndrome in adult patients with type 1 diabetes. Exp Clin Endocrinol Diabetes. 2009; 117 (3):107-12.

6. Schwab KO, Doerfer J, Hecker W, et al. Spectrum and Prevalence of Atherogenic Risk Factors in 27,358 Children, Adolescents, and Young Adults With Type 1 Diabetes. Cross- sectional data from the German diabetes documentation and quality management system (DPV). Diabetes Care. 2005; 20:1623-8.

7. Bednarek-Tupikowska G, Stachowska B, Miazgowski T, et al. Evaluation of the prevalence of metabolic obesity and normal weight among the Polish population. Endokrynol Pol. 2012;63 (6):447-55.

8. Chen S, Wu R, Huang Y, et al. Insulin Resistance Is an Independent Determinate of ED in Young Adult Men. PLoS One. 2013; 8 (12): e83951.

9. Ervin RB. Prevalence of Metabolic Syndrome Among Adults 20 Years of Age and Over, by Sex, Age, Race and Ethnicity, and Body Mass Index: United States, 2003-2006. Nat Hlth Stat Rep. 2009; 13:1-7.

10. Kilpatrick ES, Rigby AS, Atkin SL. Insulin resistance, the metabolic syndrome, and complication risk in type 1 diabetes: "double diabetes" in the Diabetes Control and Complications Trial. Diabetes Care. 2007; 30 (3):707-12.

11. Mattsson N, R nnemaa T, Juonala M, et al. The prevalence of the metabolic syndrome in young adults. The Cardiovascular Risk in Young Finns Study. J Intern Med. 2007; 261 (2):159-69.

12. Ferriss JB, Webb D, Chaturvedi N, et al. EURODIAB Prospective Complications Group. Weight gain is associated with improved glycaemic control but with adverse changes in plasma lipids and blood pressure in Type 1 diabetes. Diabet Med. 2006; 23 (5):557-64.

13. McGill M, Molyneaux L, Twigg SM, et al. The metabolic syndrome in type 1 diabetes: does it exist and does it matter? J Diabetes Complications. 2008; 22 (1):18-23.

14. Bertoluci MC, Ce GV, da Silva AM, et al. Endothelial dysfunction in type 1 diabetes Arq Bras. Endocrinol Metabol. 2008; 52 (2):423-9.

15. Solntseva AB. Endocrine effects of adipose tissue. Medical News. 2009; 3:7-11. Russian (Солнцева АВ. Эндокринные эффекты жировой ткани. Медицинские новости. 2009; 3:7-11).