K.V. Antonova (1), M.M. Tanashyan (1), M.Yu. Maksimova (1), N.V. Shakhparonova (1), T.I. Romantsova (2)1) Scientific Center of Neurology, Moscow, Russia; 2) Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
Background. Cerebrovascular diseases (CVD) are often detected in patients with diabetes mellitus (DM). An increase in the glycated hemoglobin (HbA1c) level is associated with the development of microvascular complications; however, there is no information about a similar relationship in the genesis of acute or chronic forms of CVD. Objective. Evaluation of the role of carbohydrate metabolism parameters in the development of acute and chronic forms of CVD in patients with type 2 diabetes mellitus (DM2). Methods. The study included 167 patients with DM2 and ischemic CVD: group 1 (n=87) included patients with ischemic stroke (IS), group 2 (n=80) included patients with chronic CVD. General and neurological examinations, laboratory tests with determination glycemic and HbA1c levels, duplex scanning of the main arteries of the head (MAH), and neuroimaging (magnetic resonance imaging of the brain) were performed. Results. The development of both acute and chronic forms of CVD in diabetic patients usually occurs against the background of arterial hypertension, atherosclerosis of MAH, and an increase in body mass index on average 5 years after the diagnosis of diabetes. The same frequency of critical stenosis of the internal carotid artery (more than 70%) was detected in both groups – 34 and 37.5% for group 1 and 2, respectively. In patients of group 1 in 63.2% of cases an atherothrombotic subtype of IS occurred, and the incidence of atherosclerosis of MAH had a direct correlation with the duration of diabetes (r=0.26; p=0.02). There was a significantly higher level of glycemia and HbA1c (10.1 mmol/L and 8.4% versus 7.3 mmol/L and 7.6%) in patients with acute cerebral circulatory disorders (CCD) compared with patients with chronic CVD . Conclusion. The severity of carbohydrate metabolism disorders in DM2 patients is associated with the degree of «chronization» of the CVD. Insufficient glycemic control with an increase in glucose level to 10.1 mmol/L and HbA1c level to 8.4% creates favorable conditions for the progression of atherosclerosis with atherothrombosis, which are the leading pathogenetic mechanism for the occurrence of ischemic CVD in DM2 patients.
For citations: Antonova K.V., Tanashyan M.M., Maksimova M.Yu., Shakhparonova N.V., Romantsova T.I. The state of carbohydrate metabolism and the development of cerebrovascular diseases in patients with type 2 diabetes mellitus. Farmateka. 2019;26(4):61–67. (in Russian). DOI: https://dx.doi.org/10.18565/pharmateca.2019.4.61-67
Corresponding author: Ksenia V. Antonova, PhD, Scientific Center of Neurology, Moscow, Russia; e-mail: firstname.lastname@example.org
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