CC BY
14
Н.О. Бейсембинова, А.В. Балмуханова, Л.К. Кошербаева
С.Ж. Асфендияров атындагы К,азац ¥лттыцмедицинаyHueepcumemi
ДИАБЕТТ1К РЕТИНОПАТИЯ НАУЦАСТАРГА ЦОЛДАНЫЛАТЫН МЕДИЦИНАЛЬЩ ТЕХНОЛОГИЯЛАРДЬЩ ТИ1МД1Л1Г1
ТYЙiн: Кептеген жылдар бойы лазерлiк фотокоагуляция диабеттж ретинопатияда кврудi са;тауга арналган жалгыз алтын стандарт болды. Дегенмен, Цазак;станныц офтальмологиялы; орталы;тарында кецiнен ;олданылатын лазерлж фотокоагуляцияныц жэне инъекциялы; (анти-VEGF) немесе стероидтермен аралас ;олданудыц жаца эд^терше ;ол жеткiзiлдi. Лазерлiк фотокоагуляция жаца эд^тершде жэне инъекциялы; дэрi-дэрмектермен немесе стероидтармен ;осымша ;олданган кезiнде жеэтстчктер пайда болуына ;арамастан клиникалы; жэне экономикалы; тиiмдiлiгiн сапалы багалау керек, сонымен ;атар диабеттiк ретинопатияныц дурыс алгашк;ы диагностикасын, жагымсыз эсерiн, уза; мерзiмдi жэне технология эсерлердiц пайдасын назарына алу керек.
ТYЙiндi свздер: диабеттiк ретинопатия, лазерлiк фотокоагуляция, инъекциялы; дэрi-дэрмектер, медициналы; технологиялар багалау.
N.O. Beisembinova, A.V. Balmukhanova, L.K. Kosherbaeva
Asfendiyarov Kazakh National medical university
EFFECTIVENESS OF MEDICAL TECHNOLOGIES USED FOR PATIENTS WITH DIABETIC RETINOPATHY
Resume: For many years, laser photocoagulation of the retina has been the only gold standard for the treatment and preservation of vision in diabetic retinopathy. Currently, this type of treatment is used at the stage of proliferative diabetic retinopathy (PDR). However, progress has been made in new methods of laser photocoagulation and in its combined use with injectables (anti-VEGF) agents and steroids, which are widely used in Kazakhstan's ophthalmological centers. The widespread use of these new technologies and the rapid growth of the prevalence rates of diabetic retinopathy ensures the relevance of the qualitative assessment of the clinical and economic efficiency of these methods, while taking into account the correct preliminary diagnosis of diabetic retinopathy, side effects, long-term and cost-effectiveness of the technology.
Keywords: diabetic retinopathy, pan-retinal photocoagulation, intravitreal administration of inhibitors of angiogenesis, health technology assessment
УДК 616.379-008.64
А^^ Seidinova1, I.A. Ishigov1, Peyami Cinaz2, A.Zh. Abylayuly3
1Internationdl Kazakh -Turkish University named after H.A. Yassawi, Turkestan, Kazakhstan. 2Department of Endocrinology, Gazi University, Ankara, Turkey. 3 Asfendiyarov Kazakh National medical university
ASSESSMENT OF EXECUTIVE FUNCTIONS IN THE FRONTAL LOBE OF THE BRAIN AND THE PRESENCE OF DEMENTIA PATIENTS WITH TYPE 2 DIABETES MELLITUS ON A CONTINUOUS SUBCUTANEOUS INSULIN INFUSION
Background: Cognitive impairment becomes a problem in the 21st century, due to increasing background diseases leading to this problem. It should be noted that the average age of mankind increases, respectively, the executive functions of the brain among the population of the Earth is also getting older. Dementia and cognitive functions of the brain are undoubtedly relevant topics today. Diabetes mellitus is a background factor that leads to dementia and memory impairment [1].
Aim: to study the presence of impaired executive function of the frontal lobes of the brain and dementia among patients with type 2 diabetes mellitus on a continuous subcutaneous insulin infusion and multiple daily insulin injection therapy from 45 to 65 years, according to the experience of diabetes from 5 years and above.
Materials and methods: 210 patients with type 2 diabetes were studied. The main group consisted of patients with type 2 diabetes using the method of treatment as a permanent subcutaneous insulin infusion (n = 105), in the control group there were patients with type 2 diabetes on multiple insulin injection therapy (n = 105). Patients were selected from two study groups according to age: from 45 to 65 years, according to the experience of diabetes were selected from 5 years and above.
The presence of impaired executive functions of the frontal lobes of the brain and presence of dementia were determined using the clock drawing test.
Results: In our research work, the cognitive functions (executive work) of the frontal lobe of the brain and the presence of dementia in patients with type 2 diabetes (n = 210) were studied for two methods of CSII (n = 105) and MII (n = 105) from 45 up to 65 years old and with a disease duration of> 5years and above. In the present study, a clock drawing test (CDT) was used to identify dementia and cognitive impairment of the brain (executive works of the frontal lobe of the brain). The results of the comparative analysis showed that only in patients with type 2 diabetes from 45 to 50years (n = 40) there were significant differences between the compared groups on the effectiveness of treatment (x2 = 11.87, at a significance level of p <0.003) as compared with MII, which means among patients with type 2 diabetes with the method of treatment with CSII, there are less pronounced executive disorders of the frontal lobe of the brain and dementia, compared with patients with the method of treatment of MII. According to the results of the study, patients with type 2 diabetes of the first subgroup with the experience of the disease from 5 to 10 years (n = 114) had significant differences: the number of patients in whom dementia was not detected and cognitive impairments of the frontal lobe according to the PPII treatment were more, 1%), compared with the control group at MII (31.3%). Their difference was-24.8%. That is, manifestations of executive dysfunction of the frontal lobes of the brain and the presence of dementia were less susceptible to patients with the method of CSII.
BecmnuK Ka^HJy №1-2019
Conclusion: it is possible to consider CSH as one of the effective methods of preventing dementia and executive brain dysfunction among patients with type 2 diabetes from 45-50 years old, with an experience of the disease from 5 to 10 years. The remaining subgroups (by the duration of the disease from 11 years and above, as well as by age groups: from 51-55 years; 56-65 years) did not reveal the effect of CSII or MII. The earlier treatment is started with the CSII method, the less the manifestations of executive dysfunction in patients with type 2 diabetes and the development of dementia.
Keywords: dementia, diabetes mellitus type 2, clock drawing test, cognitive function, continuous subcutaneous insulin infusion.
Introduction.
Scientists from the Kaiser Permanente Research Center (California) studied patients diagnosed with type 2 diabetes. Of the 22,852 patients studied, it turned out that dementia was more frequently detected in patients with poor blood glucose control. Also, researchers found that poor blood sugar control increased the risk of dementia to 78% [6]. Researchers from another center found out in their research about the connection between diabetes and Alzheimer's disease. It turned out that among patients who participated in the study during 9 years of observation, even in the pre-diabetes state, the risk of Alzheimer's disease was 77% higher, and the risk of dementia was almost 67% [7].
The aim of the study: to study the presence of impaired executive function of the frontal lobes of the brain among patients with type 2 diabetes mellitus on a continuous subcutaneous insulin infusion (CSII) and multiple injection insulin therapy(MII) from 45 to 65 years, according to the experience of diabetes from 5 years and above. Materials and methods.
In our research work, patients with type 2 diabetes mellitus (type 2 DM) on a CSII in the amount of 105 people were involved, the control group consisted of 105 people with type 2 diabetes on traditional multiple injection insulin therapy. The subject being studied was dementia and the executive functions of the brain (gnostic and executive functions, constructive praxis). To study these data, a clock drawing test was used (Clock Drowing Test, abbr. CDT, was developed in 1920 by the English neuropathologist G. Head to identify dementia in patients) [2]. Features of the selected test is that the test is highly specific in identifying dementia, right-hemispheric lesions and impaired executive function (praxis) in the frontal regions of the brain and has sufficient sensitivity. Interpretation of the clock drawing test results: 10 points - the norm, a circle is drawn, numbers in the right places, the arrows show the set time; 9 points - minor inaccuracies in the location of the arrows; 8 points - errors in the location of the arrows are more noticeable (one of the arrows deviates by more than an hour); 7 points - both arrows show the wrong time; 6 points - arrows do not show time (time is circled); 5 points - wrong arrangement of numbers on the dial (numbers follow in the reverse order, that is, counterclockwise, or the distance between them is not the same);
4 points - the integrity of the clock is lost, some of the numbers are missing or located outside the circle;
3 points - the dial and the numbers are no longer related to each other;
2 points - the patient attempts to complete the task, but without success;
1 point - the patient does not attempt to follow the instructions of the doctor.
The patient is given a pencil and a blank sheet of paper and is asked to self-depict a round clock, put the numbers in the desired positions of the dial and draw arrows indicating the set time. The test result of less than 10 points indicates the presence of cognitive disorders. The performance of this test is impaired in both dementia of the frontal type, and in Alzheimer's dementia and dementia with a primary lesion of the subcortical structures. For a differential diagnosis of these conditions, with the wrong self-drawing, the patient is asked to draw the arrows on the dial already drawn (by the doctor) with numbers. In dementia of the frontal type and dementia with a primary lesion of subcortical structures of mild and moderate severity, only independent drawing suffers, while the ability to locate the arrows on an already painted dial remains. With Algeimer's type of dementia, both independent drawing and the ability to position the hands on the ready-made dial are violated.
Patients with diabetes were approximately comparable to the control group by age, sex, and number. By age, all patients from the main and control groups were divided into 3 subgroups: 1-subgroup: from 45 to 50 years(n=40); Subgroup 2: from 51 to 55 years(n=55); 3-subgroup: from 56 to 65 years(n=115). The age group was chosen taking into account the fact that according to specialists, the risk of developing diabetes increases after 45 years. At the same time, according to the objectives of the study, the choice of patients took into account the risk of dementias and cognitive disorders associated with age-related changes, which increases after 55-65 years. Therefore, the optimal age for our study was 45-65 years.
It has been proven that the duration of diabetes mellitus directly affects metabolic processes [3][4]. Considering this important factor, all patients of the two studied groups were divided into 3 subgroups according to the duration of the disease: 1-subgroup: the experience of the disease is from 5-10 years(n=114); 2-subgroup: the experience of the disease from 11-15 years(n=53); 3-subgroup: the experience of the disease from 16 years and above(n=42).
Criteria for inclusion in research.
1. Age - from 45 to 65 years;
2. Diagnosis: diabetes mellitus type 2 on the insulin period;
3. Disease experience: at least 5 years;
4. Persons residing in the city of Almaty and the Almaty region who are citizens of the Republic of Kazakhstan.
Criteria for exclusion from the study.
1. Age is younger than 45 years, and also is more senior than 66 years;
2. The presence of dementia;
3. Refusal or inability to participate in the study;
4. The experience of the disease is less than 5 years;
5. The presence of the following comorbidities: acute infectious and inflammatory diseases, chronic infectious and inflammatory diseases in the acute stage, allergic, oncological diseases, alcoholic and viral etiology hepatitis, hypothalamic obesity, chronic heart failure according to NYHA IV Art. or cerebral stroke, conditions after severe head injuries and surgeries, taking sedatives, severe dysfunction of the kidneys and liver of any etiology, elaya form of hypertension, mental illness, epilepsy, blood system diseases, feverish conditions.
An open, comparative, prospective study was conducted with an assessment of the presence of dementia in previously undetected patients and the executive functions of the brain between the two groups differing by treatment method.
All patients were informed about testing, their consents for testing and signatures on informed consent were obtained. Data from 210 patients with diabetes were collected, recorded and evaluated using the SPSS 22 statistical program. The study was conducted in a research clinic - the Center for Diabetes at the KazNMU named after SD Asfendiyarov, Kazakhstan, Almaty from 2015 to December 2017. All patients had type 2 diabetes.
This research work was carried out by the ethics committee at KazNMU named after S.D.Asfendiyarov and permission was received to conduct a scientific research in 2015. Results.
Evaluation of the executive functions of the brain in those who were on a permanent subcutaneous insulin infusion determined that among the age group of 45 to 50 years, there was no violation of the executive functions of the frontal lobe of 3/4 of the subjects (76.0%) compared with multiple injection insulin therapy (20.0%).
As can be seen from Table 1 and Figure 1, the quantitative relationship between the variable — the Clock Drawing test and the type of therapy used by patients in the 45-50 age group is reliable, since the critical value of x2 at a significance level of p <0.003 is 11.87. With a score of 0, patients showed a significant
difference between the levels of 76.0% and 20.0% of the two types of therapies by 56.0% (p <0.001). In addition, Kramer's calculated criterion V showed a relatively strong relationship between the nominal variables under study at a level of 0.54. However, in the age groups of 51-55 years and 56-65 years in patients (Table 2-3, Figure 2-3), no reliable statistical
relationship was found between the presented nominal variables (x2 = 1.57-2.15, p>0 , 34-0.45; Kramer's V, 0.14-0.16; That is, the comparative characteristic of the executive functions of the frontal lobe of the brain in patients of the main and control groups did not differ in the effectiveness of treatment methods in the other subgroups (51-55 years and 56-65 years).
Table 1 - Characterization of test results with drawing hours among the 1st age group (45-50 years old) depending on the type of treatment
Clock drawing test(CDT), points
Total
Typeofther apy
CSII
MII
Quantity, abs. number
oftherapy
of CDT
total
Quantity, abs. number
oftherapy
of CDT
total
19
76,0%
8,0%
86,4%
33,3%
47,5%
5,0%
20,0%
26,7%
13,6%
66,7%
7,5%
10,0%
16,0%
33,3%
10,0%
53,3%
66,7%
20,0%
25
100,0%
62,5%
62,5%
15
100,0%
37,5%
37,5%
Total
Quantity, abs. number
oftherapy
of CDT
total
22
55,0%
15,0%
100,0%
100,0%
55,0%
15,0%
12
30,0%
100,0%
30,0%
40
100,0%
100,0%
100,0%
X2- 11.87, p <0.003; Cramer's V - 0.54, p <0.003. The "0" value means that the patient has no cognitive impairment in the frontal part of the brain and there is no violation of executive praxis (corresponding to 10 points in the clock drawing test).
"1" means that the patient has minor cognitive impairment and the beginning of the violation of executive praxis (corresponds to 9 points in the watch drawing test).
"2" patients whose scores were below 8 points on the clock drawing test.
Type of therapy
Figure 1 - Memory level among patients in the 1st age group [45-50 years old) depending on the type of treatment
Note: 0-no violation of executive memory; 1 - there are moderate violations of the executive memory; 2-there are violations of the executive memory.
BecmHUK Kß^HMy №1-2019
Table 2 - Characterization of test results with drawing hours among the 2nd age group (51-55 years) depending on the type of treatment
Clock drawing test(CDT), points
Total
Typeofther apy
CSII
MII
Quantity, abs. number
> oftherapy
> of CDT
total
Quantity, abs. number
oftherapy
of CDT
total
10
37,0%
29,6%
55,6%
57,1%
18,2%
14,5%
28,6%
21,4%
44,4%
42,9%
14,5%
10,9%
33,3%
39,1%
16,4%
14
50,0%
60,9%
25,5%
27
100,0%
49,1%
49,1%
28
100,0%
50,9%
50,9%
Total
Quantity, abs. number
oftherapy
of CDT
total
18
14
32,7%
25,5%
100,0%
100,0%
32,7%
25,5%
23
41,8%
100,0%
41,8%
55
100,0%
100,0%
100,0%
X2 - 1,57, p>0,45; Cramer's V - 0,16, p>0,45.
Type oftherapy
Figure 2 - The memory level among patients in the 2nd age group [51-55 years old) depending on the type of treatment Table 3 - Characterization of test results with drawing hours among the 3rd age group (56-65 years old) depending on the type of treatment
Clock drawing test(CDT), points
0 1 2 Total
Typeofther apy CSII Quantity, abs. number 22 8 23 53
% oftherapy 41,5% 15,1% 43,4% 100,0%
% of CDT 53,7% 34,8% 45,1% 46,1%
% total 19,1% 7,0% 20,0% 46,1%
MII Quantity, abs. number 19 15 28 62
% oftherapy 30,6% 24,2% 45,2% 100,0%
% of CDT 46,3% 65,2% 54,9% 53,9%
% total 16,5% 13,0% 24,3% 53,9%
Total Quantity, abs. number 41 23 51 115
% oftherapy 35,7% 20,0% 44,3% 100,0%
% of CDT 100,0% 100,0% 100,0% 100,0%
% total 35,7% 20,0% 44,3% 100,0%
X2- 2,15, p>0,34; Cramer's V - 0,14, p>0,34.
Type of therapy
Figure 3—Level of executive memory among patients in the 3rd age group [56-65 years old) depending on the type of treatment
As can be seen from Table 4 and Figure 4, the quantitative relationship between the variable — the Clock Drawing test and the type of therapy used by patients in the group for the duration of the disease — 5-10 years is reliable, since the critical value of X2 at a significance level of p <0.02 is 7.37. With a score of 0, patients showed a significant difference between the levels of 56.1% and 31.3% of the two types of therapies by 24.8% (p <0.009). In addition, the calculated Kramer's criterion V showed
an average relationship between the nominal variables under study at a level of 0.25. That is, manifestations of executive dysfunction of the frontal lobes of the brain are less susceptible to patients with the method of PPII treatment. However, in groups by disease duration of 11-15 years and 16 years and above, patients (Table 5-6, Figure 5-6) did not find a reliable statistical relationship between the presented nominal variables (x2 = 0.88-1.79, p > 0.40-0.64; Cramer's V - 0.14-0.18).
Table 4 - Characteristics of the test results with drawing hours among patients for the duration of the disease from 5-10 years
Clock drawing test(CDT), points
0 1 2 Total
Typeofther apy CSII Quantity, abs. number 37 9 20 66
% oftherapy 56,1% 13,6% 30,3% 100,0%
% of CDT 71,2% 40,9% 50,0% 57,9%
Quantity, abs. number 32,5% 7,9% 17,5% 57,9%
MII Quantity, abs. number 15 13 20 48
% oftherapy 31,3% 27,1% 41,7% 100,0%
% of CDT 28,8% 59,1% 50,0% 42,1%
Quantity, abs. number 13,2% 11,4% 17,5% 42,1%
Total Quantity, abs. number 52 22 40 114
% oftherapy 45,6% 19,3% 35,1% 100,0%
BecmHUK Ka^HMy №1-2019
% of CDT 100,0% 100,0% 100,0% 100,0%
% total 45,6% 19,3% 35,1% 100,0%
X2 - 7,37, p<0,02; Cramer's V - 0,25, p<0,02.
Type oftherapy
Figure 4 —The memory level among patients in the group according to the duration of the disease from 5-10 years,
depending on the type of treatment
Table 5 - Characteristics of the test results with drawing hours for the duration of the disease from 11-15 years depending on the type of treatment
Clock drawing test(CDT), points
Total
Typeofther apy
CSII
MII
Quantity, abs. number
> oftherapy
of CDT
jtotal
Quantity, abs. number
> oftherapy
of CDT
jtotal
36,4%
31,8
47,1%
50,0%
14,8%
13,0%
28,1%
21,9%
52,9%
50,0%
16,7%
13,0%
31,8
30,4%
13,0%
16
50,0%
69,6%
29,6%
22
100,0%
40,7%
40,7%
32
100,0%
59,3%
59,3%
Total
Quantity, abs. number
> oftherapy
of CDT
total
17
14
31,5%
25,9%
100,0%
100,0%
31,5%
25,9%
23
42,6%
100,0%
42,6%
54
100,0%
100,0%
100,0%
X2 - 1,79, p>0,40; Cramer's V - 0,18, p>0,40.
Type oftherapy
Figure 5 - The level of memory in patients depending on the duration of the disease [51-55 years) in two groups by type of treatment Table 6 - Characteristics of the test results with drawing hours for the duration of the disease from 16 years and above, depending on the type of treatment
Clock drawing test(CDT), points
Total
Typeofther apy
CSII
MII
Quantity, abs. number
) oftherapy
35,3%
11,8
52,9%
of CDT
50,0%
28,6%
39,1%
)total
14,3%
21,4%
Quantity, abs. number
14
) oftherapy
24,0%
20,0%
56,0%
of CDT
50,0%
71,4%
60,9%
total
14,3%
11,9%
33,3%
17
100,0%
40,5%
40,5%
25
100,0%
59,5%
59,5%
Total
Quantity, abs. number
12
23
oftherapy
28,6%
16,7%
54,8
of CDT
100,0%
100,0%
100,0%
total
28,6%
16,7%
54,8
42
100,0%
100,0%
100,0%
X2 - 0,88, p>0,64; Cramer's V - 0,14, p>0,64.
Type oftherapy
Figure 6 - Memory level according to the test with drawing hours in patients with type 2 diabetes depending on the duration
of the disease in two groups by type of treatment
In the present study, the average level of glycemia— glycated
hemoglobin over the past 6 months — was evaluated in patients
BecmnuK Ka^HMy №1-2019
in both groups differing by treatment method. When evaluating the mean value of glycated hemoglobin in the main group with insulin pump therapy was 7.45%, in the control group it was 9.84%. Glycolized hemoglobin (HbA1c) was analyzed by age and duration of the disease. The average HbA1c in the age group of 45-50 years was lower at the CSII (M ± m - 7.07% ± 0.21%), compared to patients with MII (M ± m 10.20% ± 0.28%) [sixteen]. However, glycated hemoglobin indices in this age subgroup were higher than in patients from 51-55, 56-65 years old.
Evaluation of carbohydrate metabolism showed that patients with a disease duration of 5 to 10 years and from 16 years and above from the control group have higher glycemia rates (M ± m — 10.23% ± 0.26% and M ± m — 9, 45% ± 0.40%) compared with the main group, where the mean value of glycated hemoglobin was subcompensated (M ± m — 7.31% ± 0.14%) in patients with a disease duration of 5-10 years. We also performed a linear regression analysis between HbA1c (glycolized hemoglobin) and the average value of the clock drawing test, however, no Pearson correlation coefficient was found for constant subcutaneous insulin infusion (r = 0.05; p> 0.61); similarly, it was not detected correlation with multiple injection insulin therapy. That is, the disorders obtained from the clock drawing test among patients with type 2 diabetes were not associated with the glycemic level. In connection with this data, we cannot assume that the correction of glycemia was the best indicator of the clock drawing test. Discussion.
In our research work, the cognitive functions (executive work) of the frontal lobe of the brain and the presence of dementia in patients with type 2 diabetes (n = 210) were studied for two methods of CSII (n = 105) and MII (n = 105) from 45 up to 65 years old and with a disease duration of> 5 years and above. In the present study, a clock drawing test (CDT) was used to identify dementia and cognitive impairment of the brain (executive works of the frontal lobe of the brain). The results of the comparative analysis showed that only in patients with type 2 diabetes from 45 to 50 years (n = 40) there were significant differences between the compared groups on the effectiveness of treatment (x2 = 11.87, at a significance level of p <0.003) as compared with MII (Table 1, Figure 1), which means among patients with type 2 diabetes with the method of treatment with CSII, there are less pronounced executive disorders of the frontal lobe of the brain and dementia, compared with patients with the method of treatment of MII. According to the results of other research works, it turned out that poor cognitive work of the brain and the presence of dementia is associated with poor self-control of blood glucose [18] [19]. However, according to the results, ACCORD MIND did not show predominant differences in cognitive function after intensive glycemic control in patients with type 2 diabetes. In our research work, glycated hemoglobin —HbA1c was also studied; the average value from both groups was taken in the last 3 months (CSII was 7.45%, in the control group with MII it was -9.84%.). Such comparative research was carried out in the randomized multicenter research work OpT2mise [22], where the correction of glycemia was better demonstrated on the CSII in patients with type 2 diabetes, which is confirmed in our research work. A linear regression analysis was performed between HbA1c (glycolized hemoglobin) and the average value of the clock drawing test, however, we could not reveal a linear correlation between cognitive impairment, dementia and the average HbA1c (r = 0.05; p> 0.61) in patients
with Type 2 DM at CSII and MII. That is, violations of the clock drawing drawing test among patients with type 2 diabetes were not related to the level of blood sugar in patients with type 2 diabetes in both study groups. In connection with these data, we cannot assume that the correction of glycemia was the best indicator of the clock drawing test in patients aged 45 to 50 years.According to the results of the study, patients with type 2 diabetes of the first subgroup with the experience of the disease from 5 to 10 years (n = 114) had significant differences: the number of patients in whom dementia was not detected and cognitive impairments of the frontal lobe according to the PPII treatment were more , 1%), compared with the control group at MII (31.3%). Their difference was-24.8%(Table 4, Figure 4). Further, in patients with a longer duration of the disease (Table 5-6, Figure 5-6) did not differ significantly among themselves (from 11-15 years (n = 53) and 16 years and above (n = 42)), no significant statistical relationship between the presented methods of treatment (x2 = 0.88-1.79, p> 0.40-0.64; V Cramer's — 0.14-0.18), which means the effectiveness of the CSII for patients with a disease duration from 11 years and above. These results in the subgroups have not been thoroughly investigated, requiring convincing, thorough research including other factors influencing cognitive function and the presence of dementia in patients with type 2 diabetes. According to some researchers, the influence of age, as well as the duration of the disease are important background risks for the development of dementia and cognitive impairment [8], as well as the diagnosis of diabetes mellitus according to scientists (Roberts et al., 2008) with a long period of disease are more closely related with dementia [9]. In other studies, a link was found to have good metabolic control among patients with diabetes and better cognitive performance [11]; [12] and the amount of memory (Lenore et al., 2011). The results of our study showed the opposite, that is, glycemic control did not affect the level of cognitive work and dementia in patients with type 2 diabetes.
In turn, the lack of dementia and cognitive impairment can lead to better control of glycemia in general and other late complications of diabetes, as the patient better understands and accepts external information about his illness. The results of our study confirm that the best indicators of the test results in patients at a relatively young age (45-50 years old) with CSII are associated with several factors: a relatively young age, as well as the least development of cognitive impairment, due to the small history of the disease. According to the results of our research work, we can distinguish the duration of diabetes and age as factors affecting the executive memory of the frontal lobes of the brain and manifestations of dementia. It can be assumed that the introduction of CSII at the earlier stages of the treatment of diabetes in the insulin-dependent period has a positive effect on the state of cognitive functions and the prevention of the development of dementia. Early insulin therapy and good sugar control prevents cognitive dysfunction [15]. In conclusion, it is possible to consider CSII as one of the effective methods of preventing dementia and executive brain dysfunction among patients with type 2 diabetes from 45-50 years old, with an experience of the disease from 5 to 10 years. The remaining subgroups (by the duration of the disease from 11 years and above, as well as by age groups: from 51-55 years; 5665 years) did not reveal the effect of CSII or MII. The earlier treatment is started with the CSII method, the less the manifestations of executive dysfunction in patients with type 2 diabetes and the development of dementia.
REFERENCES
1 AreosaSastre A, Vernooij RWM, González-ColafoHarmand M, Martínez G. Effect of the treatment of Type 2 diabetes mellitus on the development of cognitive impairment and dementia // Cochrane Database of Systematic Reviews. - 2017. - Issue 6. - Р. 86-94.
2 Head H. Aphasia and Kindred Disorders of Speech. - Cambridge, UK: Cambridge University Press: 1926. - 349 р.
3 Moheet A, Mangia S, Seaquist ER. «Impact of diabetes on cognitive function and brain structure» // N Y Acad Sci. - 2015. - Vol. 1353. - P. 60-71.
4 Bhagoji SB, Patil M, Mirje M. «Effect of duration of type 2 diabetes on short term and working memory» // IJMPS. - 2014. - Vol. 4, Iss. 6. -P. 26-30.
5 А.И. Мелехин, Использование теста рисования часов в скрининг-обследовании когнитивного дефицита // Журнал «Национальные приоритеты России». - 2014. - №2(12). - С. 186-198.
6 Lieza G Exalto,Geert Jan Biessels,Andrew J Karter, et al,.Risk score for prediction of 10 year dementia risk in individuals with type 2 diabetes: a cohort study // J.Lancet, Diabetes and Endocrinology. - 2013. - №3. - Р. 88-97.
7 Nicholas T. Vagelatos Guy D. Eslick,Type 2 Diabetes as a Risk Factor for Alzheimer's Disease: The Confounders, Interactions, and Neuropathology Associated With This Relationship // J Epidemiologic Reviews. - 2013. - Vol.35. - Р. 152-160.
8 Wennberg AM1, Gottesman RF2, Kaufmann CN1, Albert MSand etc., Diabetes and cognitive outcomes in a nationally representative sample: the National Health and Aging Trends Study //Int Psychogeriatr. - 2014. - №26(10). - Р. 1729-1735.
9 Roberts RO, et al. Association of duration and severity of diabetes mellitus with mild cognitive impairment // Archives of Neurology. -2008. - №65. - Р. 1066-1073.
10 Lenore J Launer, PhD, Michael E Miller, PhD, Jeff D Williamson, MD, Ron M Lazar, PhD, Hertzel C Gerstein, MD, Ann M Murray, MD,et al. Effects of randomization to intensive glucose lowering on brain structure and function in type 2 diabetes ACCORD Memory in Diabetes Study // Lancet Neurol. - 2011. - №10(11). - Р. 969-977.
11 Naor M, Steingruber HJ, Westhoff K, Schottenfeld-Naor Y, Gries AF. Cognitive function in elderly non-insulin-dependent diabetic patients before and after inpatient treatment for metabolic control // Journal of Diabetes and its Complications. - 1997. - №11. - Р. 40-46.
12 Ryan CM, Freed MI, Rood JA, Cobitz AR, Waterhouse BR, Strachan MW. Improving metabolic control leads to better working memory in adults with type 2 diabetes // Diabetes Care. - 2006. - №29. - Р. 345-351.
13 Bárbara Costa Beber,Renata Kochhann, Bruna Matias, and Márcia Lorena Fagundes Chaves, The Clock Drawing Test: Performance differences between the free-drawn and incomplete-copy versions in patients with MCI and dementia // Dement Neuropsychol. - 2016. -№10(3). - Р. 227-231.
14 Martin R, Jose Jensterle, JanezMlakar Diabets 2 type// J.Dementia and cognitive disorders. - 2018. - Vol. 45. - Р. 326-334.
15 Шоломов И.И., Салина Е.А., Дудко А.Н., Оценка когнитивных функций у больных с хронической ишемией головного мозга и сахарным диабетом 2 типа // Межрегиональная научная конференция, посвящённая 100-летию образования кафедры нервных и душевных и болезней медицинского факультета Императорского Николаевского Саратовского университета: "100 лет саратовской неврологии: достижения и перспективы". - Саратов: 2014. - С. 26-34.
16 Сейдинова А.Ш., Ишигов И.А. Ж.А. Аблайулы,Тезис: «Анализ гликемических данных пациентов с сахарным диабетом 2 типа на инсулиновой помповой терапии и инъекционной терапии» // Республиканский научный журнал «Вестник» ЮКГФА, г.Шымкент, V международная научная конференция молодых ученых и студентов «Перспективы развития биологии, медицины и фармации». - Шымкент: 2017. - С. 21-22.
17 Гацких И.В., Петрова М.М., Веселова О.Ф., Шалда Т.П., Наркевич А.Н., Брикман И.Н. Анализ когнитивного статуса у пациентов с сахарным диабетом 2 типа // Сахарныи диабет. - 2017. - Т.20, №6. - С. 434-440.
18 RBiessels GJ1, Staekenborg S, Brunner E, Brayne C, Scheltens P.Risk of dementia in diabetes mellitus: a systematic review // Lancet Neurol. - 2006. - №5(1). - Р. 64-74.
19 Formiga F, Reñe R, Pérez-Maraver M. Dementia and diabetes: casual or causal relationship? // Med Clin. - 2015. - №144(4). - Р. 176-180.
20 Mohammed Abdul Hannan Hazari, Barra Ram Reddy, Nazia Uzma, Bhaskarpillai Santhosh Kumar, Cognitive impairment in type 2 diabetes mellitus,International // Journal of Diabetes Mellitus. - 2015. - Vol.3, Issue 1. - Р. 19-24.
21 Reznik Y, Cohen O. Insulin pump for type 2 diabetes : use and misuse of continuous subcutaneous insulin infusion in type 2 diabetes // Diabetes Care. - 2013. - №36, Suppl2. - Р. 219-225.
22 Reznik, Y., Morello, R., Zenia, A., Morera, J., Rod, A., &Joubert, M. (2014). Autonomy of Patients With Type 2 Diabetes With an Insulin Pump Device: Is It Predictable? // Journal of Diabetes Science and Technology. - 2014. - №8(4). - Р. 760-765.
А.Ш. Сейдинова1, И.А. Ишигов1, Пейами Джиназ2, А.Ж. Абылайулы3
гХ.А Ясауи атындагы Халыцаралыц цазац-тур1куниверситетi, Туркестан, ^азацстан. 2Гази Университету эндокринология кафедрасы, Анкара, Турция 3С.Ж. Асфендияров атындагы К,азац ¥лттыц медицина университетi, Алматы, %азацстан
УЗД1КС1З ТЕР1АСТЫ ИНСУЛИН ИНФУЗИЯСЫН ЦОЛДАНАТЫН 2 ТИП ЦАНТ ДИАБЕТ БАР НАУЦАСТАРДА БАС МИЫНЬЩ МАЦДАЙ Б6Л1МШДЕП АТЦАРУШЫ ФУНКЦИЯЛАРДЫ ЖЭНЕ ДЕМЕНЦИЯНЬЩ БОЛУЫН БАГАЛАУ
ty^h: Мидыц деменция жэне когнитивт функциялары бупнп куннщ езекл та;ырыптары болып табылады. Кант диабет - бул деменция мен есте са;таудыц бузылуына экелетш фонды; фактор [1]. Зерттеудщ ма;саты узджаз терiасты инсулин инфузиясы ;олданатын 2 тип ;ант диабет бар нау;астар арасында мидыц мацдай бел^ндеп ат;ару ;ызметш жэне деменцияны аны;тау болды. Бiздiц гылыми зерттеу жумысымызда 2 типт ;ант диабет бар 210 нау;ас зерттелдь Непзп топ узджаз терiасты инсулин инфузиясын ;олданатын 2 типт ;антдиабетмен ауыратын нау;астарды ;урады (n = 105), ба;ылау тобында бiрнеше инъекциялы; инсулин терапиясын ;олданатын (n = 105) 2 типт ;ант диабет бар нау;астар болды. Кант диабет уза;тьиы 5 жыл жэне одан жогары адамдар iрiктелдi. Мидыц мацдай бел^ндеп ат;арушы функцияларыныц бузылуы жэне деменция сагат салу тест кемепмен аны;талды.
Зерттеудщ салыстырмалы нэтижелерi керсеткендей, узджаз терiасты инсулиндж инфузия ;олданатын нау;астарда когнитивтк функциялары ба;ылау тобымен салыстырганда 45-50 жас аралыгындагы 2 типт ;ант диабет бар нау;астарда жэне ауру уза;тыгы 5-10 жыл болтан нау;астарда гана жа;сы керсеткштер керсеткен.
ty^híí сездер: деменция, 2 типт ;ант диабету сагат салу тест, когнитивтк функция, узджаз терiасты инсулин инфузиясы
Вестник Ка^НЖУ №1-2019
А.Ш. Сейдинова1, И.А. Ишигов1, Пейами Джиназ2, А.Ж. Абылайулы3
1Международный казахско-турецкий университет им. Х. А. Ясави, Туркестан, Казахстан 2Университет Гази, Кафедра эндокринологии, Анкара, Турция 3Казахский Национальный медицинский университет имени С.Д. Асфендиярова
ОЦЕНКА ИСПОЛНИТЕЛЬНЫХ ФУНКЦИИ В ЛОБНОЙ ДОЛЕ ГОЛОВНОГО МОЗГА И НАЛИЧИИ ДЕМЕНЦИИ У ПАЦИЕНТОВ С САХАРНЫМ ДИАБЕТОМ 2 ТИПА НА ПОСТОЯННОЙ ПОДКОЖНОЙ ИНСУЛИНОВОЙ ИНФУЗИИ
Резюме: Деменция и когнитивные функции головного мозга несомненно актуальные темы на сегодняшний день. Сахарный диабет — это фоновый фактор, который приводит к деменции и ухудшению памяти[1]. Целью исследования являлось изучение наличия нарушении исполнительных функции лобных долей головного мозга и деменции среди пациентов с сахарным диабетом 2 типа на постоянной подкожной инсулиновой инфузии. Были изучены 210 пациентов с сахарным диабетом 2 типа. Основную группу составили пациенты с СД 2 типа использующие подкожную инсулиновую инфузию (п=105), в контрольной группе были пациенты с СД 2 типа на множественной инъекционной инсулинотерапией (п=105). Пациенты были выбраны от 45 до 65 лет, по стажу диабета были выбраны от 5 лет и выше. Наличие нарушении исполнительных функции лобных долей головного мозга и деменция определялись с помощью теста рисования часов.
Результаты нашего сравнительного исследования показали, что когнитивные функции на постоянной подкожной инсулиновой инфузии лучше по сравнению с контрольной группой на множественной инъекционной инсулинотерапии только у пациентов с СД 2 типа от 45-50 лет, со стажем заболевания от 5-10 лет.
Ключевые слова: деменция, сахарный диабет 2 типа, тест рисования часов, когнитивные функции, постоянная подкожная инсулиновая инфузия.
УДК 616.379-008.64
А.Ш. Сейдинова1, Ж. Абылайулы2
1Международный казахско-турецкий университет им. Х. А. Ясави, Туркестан, Казахстан 2Казахскии Национальный медицинскии университет им. С.Д. Асфендиярова,
Алматы, Казахстан
ВЛИЯЕТ ЛИ МЕТОД ИНСУЛИНОТЕРАПИИ НА ИНДЕКС МАССЫ ТЕЛА У ПАЦИЕНТОВ С САХАРНЫМ ДИАБЕТОМ?
В данной статье представлены результаты исследовательской работы, в котором изучались пациенты с сахарным диабетом 2 типа. Был проведен сравнительный анализ индекса массы тела (ИМТ) среди пациентов с СД 2 типа использующие постоянную подкожную инсулиновую инфузию и множественную инъекционную инсулинотерапию. Сравнительная оценка показала, что вид применения инсулинотерапии, как метод лечения не меняет ИМТ у пациентов с СД 2 типа.
Ключевые слова: сахарный диабет 2 типа, индекс массы тела, множественная инъекционная инсулинотерапия, постоянная подкожная инсулиновая инфузия
Введение.
Во всем мире СД 2 типа занимает 90% всех видов диабета [1]. На сегодняшний день, известны риски приводящие к СД 2 типа: неправильное питание с содержанием большого количество углеводов и жиров, избыточный вес, малоподвижный образ жизни, возраст, генетическая предрасположенность, наличие артериального давления, хронический стресс [2]. Наличие сахарного диабета часто усугубляет липидный обмен, влияет на вес тела. Индекс массы тела (ИМТ) - это отношение массы тела к росту, часто использующееся для выявления ожирения и избыточного веса человека [1,6].
Цель исследования: изучить индекс массы тела у пациентов с сахарным диабетом 2 типа от 45-до 65лет, находившиеся на постоянной подкожной инсулиновой инфузии и множественной инъекционной
инсулинотерапии.
Материалы и методы: В нашей исследовательской работе участвовали пациенты с диагнозом сахарный диабет 2 типа на инсулинопотребном периоде, стаж заболевания был от 5 лет и выше, возраст пациентов был выбран от 45 лет и до 65 лет включительно. В ходе исследовательской работы выбраны 105 человек, которые находились на постоянной подкожной инсулиновой инфузии и 105 человек, на множественной инъекционнойинсулинотерапии. Пациенты были разделены по гендерным различиям на мужчин и женщин, по длительности заболевания на три подгруппы: от 5-10 лет, 11 -15 лет, 16 и выше. Так же, не целесообразно было сравнивать ИМТ пациентов с различными возрастами,
поэтому разделили на три подгруппы: 45-50 лет, 51-55 лет и 56-60 лет.
В исследовательской работе изучено влияние двух методов инсулинотерапии на ИМТ у пациентов с СД 2 на постоянной подкожной инсулиновой инфузии, а также на множественной инъекционной инсулинотерапии. ИМТ измерялся по методу Кетле, по следующей формуле: ИМТ=кг/м2. В соответствии с рекомендациями Всемирной организации здравоохранения (ВОЗ)принята следующая интерпретация показателей ИМТ [6]:16 и менее — Выраженный дефицит массы тела;16-18,49 — Недостаточная (дефицит веса) масса тела;18,5-24,99 — Нормальная масса тела; 25-29,99 — Избыточная масса тела;30-34,99 — Ожирение 1 степени;35-39.99 — Ожирение 2 степени;40 и выше — Ожирение 3 степени. Сравнивание производили по среднему значению показателей ИМТ у основной группы с контрольной группой.
Работа проводилась на базе университетской клиники Внутренних болезней, в Центре Диабета при КазНМУ имени С.Д.Асфендиярова в г.Алматы.
Результаты. Среднее значение индекса массы тела (ИМТ) во всех подгруппах соответствовала избыточной массе тела во всех группах. Среди мужчин и женщин средне статистическое значение ИМТ примерно были одинаковыми [Таб.1]. При сравнении средних значений ИМТ в основной и контрольной группах как по полу, возрасту, так и по длительности заболевания не обнаружено достоверной статистической значимости (р > 0.05) (Таблица 1, рисунок 13).
