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Assessment achievement of target levels of glycemic control in children with type 1 diabetes.
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DOI: http://dx.doi.org/10.20534/ESR-16-9.10-127-129
Rakhimova Gulnara Nishanovna, Head of the Department of Endocrinology Tashkent Institute
of Advanced Medical Studies, Ministry of Health of the Republic of Uzbekistan E-mail: nasiba_ali@mail.ru Alimova Nasiba Usmanovna, Jr.researcher in Institute of Endocrinology Ministry of Health of Uzbekistan
Assessment achievement of target levels of glycemic control in children with type 1 diabetes, according to the National Register (NR) in Uzbekistan
Abstract: The Register cards included demographic data, duration of the disease, insulin therapy type, fasting glycemia parameters, postprandial glycemia, presence of late vascular complications, date and cause of death. Carbohydrate metabolism compensation parameters were assessed in compliance with ISPAD recommendations (2007). Analysis of carbohydrate metabolism compensation in children with type I diabetes mellitus during the National Register showed that as a whole in Uzbekistan optimum parameters of carbohydrate metabolism (fasting glycemia) were 30.5%. Suboptimal carbohydrate metabolism parameters were found in 14.0% of the children. Fasting glycemia level exceeding 8.0 mmol/l was registered in the majority of the patients (52.4%). When assessing postprandial glycemia optimum carbohydrate parameters in the children were found 38.2%. 40.0% of children had suboptimal carbohydrate metabolism parameters. 16.4% ofchildren were at the decompensation stage, that is, postprandial glycemia was higher than 2.5 mmol/l in these children. As per 2007 National Register the satisfying degree ofcompen-sation was failed to be achieved in 47.6% of children with type I diabetes mellitus that need changes in tactics of management.
Keywords: children, type 1 diabetes, glycemic control.
Type 1 diabetes mellitus (DM) in children is a chronic autoimmune disease, caused by destruction of pancreatic beta-cells and leads to absolute insulin deficiency.
In order to guarantee normal physical and intellectual development of children, to prevent the development of late vascular complications, blood glucose levels should be maintained within compensation rates. It is shown that elevation of the level of glycated hemoglobin (HbA1s) by 1% over 8%, existing for 3 months or more, increases the risk ofvascular events by40-50%. The results of a multinational study carried out recently in several countries, showed that only one third of children with diabetes have HbA1c level ofless than 8%, while the vast majority of young patients are in a state of chronic decompensation. This leads to early onset ofsevere microvascular complications such as diabetic retinopathy, diabetic nephropathy, neuropathy, disability and death in younger patients, as well as to the deterioration of physical health, psychological and social adaptation of children and adolescents, to communication problems with family members and with peers.
Recently, it was shown that the development of complications can occur after only a few years after the onset of the disease, particularly in childhood, which forces to address issues of intensification of treatment in pediatric practice.
It is believed that stable compensation of carbohydrate metabolism achievement is harder in children rather than in adults. The main causes of inadequate compensation are as follows:
1) complete absence of insulin in the body with total dependence on exogenously administered insulin;
2) non-systematic meals;
3) non-permanent physical and school load;
4) The hormonal changes associated with growth and development;
5) behavioral problems associated with psychological difficulties;
6) frequent childhood infections.
In this regard, one of main problems of modern diabetology is the optimization and intensification of therapeutic approaches, which would improve both the therapeutic and cost-effectiveness of the treatment of children with diabetes. The quality of life and life expectance of children with diabetes, should not differ from those of their healthy peers.
The main criteria for the effectiveness of insulin therapy is to achieve and maintain normoglycemia, absence of severe hypoglycemia and episodes ofketoacidosis, as well as the normal rates of physical and sexual development of children. The consensus on the basic principles of the treatment of children and adolescents with type 1 diabetes (ISPAD Consensus for the Management of Type 1 Diabetes Mellitus in Children and Adolescens, 2007) recommends new criteria for the diagnosis and compensation of type 1 diabetes in children and adolescents (Table 1).
Sectiom 6. Medical science
Table 1. - ISPAD Clinical Practice Consensus Guidelines 2006-2007
Ideal (non-diabetic) Optimal Suboptimal High risk (intervention is necessary)
Fasting glycemia mmol/l 3,5-5,0 4,5-7,5 7,5-8,0 >8,0
Glycemia 2 hrs after meal mmol/l 6,5 4,5-9,0 9,0-12,5 >12,5
HbA1c% <6,05 <7,5 7,5-9,0 >9,0
Objective: To evaluate the degree of blood glucose target levels achievement among type 1 diabetes children according to the national register from 2000-2007 depending on the regions in Uzbekistan.
Materials and methods
Maps of the register included demographic data, duration of the disease, insulin regimen, fasting and postprandial glycemia results, the presence oflate vascular complications, date and cause of death. Indicators of compensation of carbohydrate metabolism were evaluated according ISPAD recommendations for 2007.
Comprehensiveness of the National Register (NR) of type 1 diabetes in children is currently made up of 96%, which makes the data representative.
Results and discussion
Currently, WHO recommends evaluation of diabetes compensation by the level of glycated hemoglobin, but in regional centers, these tests are not being conducted. Therefore, compensation eval-
uation was made according to glycemia. 2007 ISPAD Consensus Guidelines were used as criteria for compensation of diabetes in children. According to the guidelines, optimal performance, appropriate clinical and metabolic compensation is considered when fasting blood glucose level is 4,5-7,5mmol/l, suboptimal -7,5-8,0mmol/l and unsatisfactory (decompensation) — over 8,0mmol/l.
Analysis of the level of compensation of carbohydrate metabolism in type 1 diabetes in children for the duration of the register showed that for the whole Uzbekistan optimal carbohydrate metabolism (fasting plasma glucose) in children, amounted to — 30.5%. Suboptimal performance of carbohydrate metabolism was in 14.0% of children. In vast majority of patients (52.4% of children) levels of fasting glucose were over 8.0 mmol/l. A high percentage of children in a state of decompensation observed in Jizzakh — 94.4%, Andijan -63.2%, Tashkent regions -60.0%. Among adolescents in Jizzakh 78.5%, in Tashkent 74%, and in Kashkadarya region 72.5% were decompensated (table 2).
Regions Optimal Suboptimal High risk (intervention is necessary)
4,5-7,5 >7,5-8,0 >8,0
Andijan 17,6 20,6 63,2
Bukhara 8,33 20,8 58,3
Jizzakh 5,56 0 94,4
Kashkadarya 25,8 21,3 52,8
Surkhandarya 6,45 6,45 32,2
Syrdarya 27,7 11,1 55,5
Karakalpak Republic 42,0 2,0 38,0
Tashkent 34,7 6,25 60,0
Fergana 50,0 2,94 47,0
Namangan 21,8 28,1 46,8
Samarkand 52 6,67 42,6
Navoi 36,8 26,3 36,8
Khorezm 22,0 12,0 58,0
Tashkent city 49,2 16,6 34,2
Uzbekistan 30,5 14,0 52,4
Optimal levels of postprandial glycemia of carbohydrate me- glycemia comprised over 12.5 mmol/l in these patients. The high-
tabolism observed in 38.2% of children with diabetes. 40.0% of est percentage of children in decompensation state was observed in
children had suboptimal levels of carbohydrate metabolism. 16.4% Jizzakh region — 94.4%. (Table 3). of children were in state of decompensation, so that posprandial
Table 3. - Achievement of target levels of postprandial glycemia in children with type 1 DM
Regions Optimal Suboptimal High risk (intervention is necessary)
4,5-9,0 >9,0-12, 5 >12,5
1 2 3 4
Andijan 23,5 64,7 11,7
Bukhara 4,17 79,1 4,17
Jizzakh 11,1 27,7 55,5
Kashkadarya 70,7 25,8 3,37
Surkhandarya 19,3 19,3 3,23
Syrdarya 0 5,56 11,1
Karakalpak Republic 24,0 44,0 2,0
Table 2. - Achievement of target levels of fasting glycemia in capillary blood (mmol/l) in children with type 1 DM according to National Register data (%) in 2007 by ISPAD 2007 criteria
Influence modulators of nitric oxide synthesis on the activity of liver enzymes monooxygenase in animals with acute toxic hepatits
1 2 3 4
Tashkent 16,9 28,5 2,68
Fergana 41,1 50,0 2,94
Namangan 15,6 65,6 6,25
Samarkand 45,3 50,6 2,67
Navoi 63,1 31,5 5,26
Khorezm 6,0 30,0 8,0
Tashkent city 40,0 36,4 23,6
Uzbekistan 38,2 40,0 16,4
Thus, 2007 National Register data showed that 47.6% of children with type 1 diabetes had not achieved satisfactory levels of compensation and to change their treatment tactics, especially in Tashkent, Jizzakh, Andijan, Syrdarya, Khorezm and Kashkadarya regions.
Conclusions:
Thus, 2007 National Register data showed that 47.6% of children and 37.9% of adolescents with type 1 diabetes had not achieved satisfactory levels of compensation and to change their treatment tactics, especially in Tashkent, Jizzakh, Andijan, Syrdarya, Khorezm and Kashkadarya regions.
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DOI: http://dx.doi.org/10.20534/ESR-16-9.10-129-133
Sayfullaeva Saida Akromjanovna, Tashkent Medical Academy, Uzbekistan Associate of research laboratory Senior research E-mail: saida_sayfullaeva@mail.ru
Influence modulators of nitric oxide synthesis on the activity of liver enzymes monooxygenase in animals with acute toxic hepatits
Abstract: A nonselective inhibitor L-NAME NOS (eNOS and nNOS) and selective inhibitor 7-NI (nNOS) inhibit, and selective inhibitor iNOS- S-MT, and the donor L-arginine NO- increase the activity of enzymes of the monooxygenase system of the liver. The inhibition of the activity of microsomal liver enzymes by the action of L-NAME statistically correlated with indicators of high activity in microsomesiNOS, content of ONO2-and low activity of eNOS. Under the action of the selective inhibitor iNOS- S-MT stimulation of functional activity of microsomal enzymes is correlated with the induction of eNOS, iNOS inhibition and the content ONO2-. The lack of correlation between the NO in the microsomes and microsomal enzymes in the liver give the reason to believe that an important factor modulating the activity of monooxygenases are isozymes NOS — eNOS, iNOS and the content of ONO2.
