Komarovska I. The prognostic value of the study of adiponectin, resistin and sex steroid binding globulin at various stages of diabetic retinopathy in patients with type 2 diabetes mellitus

The dissertation is devoted to solving the current problem of modern ophthalmology - to increase the effectiveness of diagnosing the progression of diabetic retinopathy in patients with type 2 diabetes and obesity by establishing a predictive value of the study of adiponectin, resistin and sex steroid-binding globulin. The scientific data on the pathogenesis of DRP in patients with T2DM during disadipokinemia is supplemented. It was established that these patients are outside the protector role of adiponectin on the vascular layer of the eye and retina, since its concentration in the blood is significantly reduced by 2.3 times at the minimal and mild stage of nonproliferative DRP compared to subsequent stages with subcompensation of T2DM (Р<0,01) and 2.2 times lower in moderate and severe nonproliferative DRP and in the proliferative stage of DRP with the onset of decompensation of T2DM (Р<0,01). It has been established that in obese patients with T2DM regardless of the stage exists apparent statistically significant direct relationship between the concentration of resistin in serum and the duration of T2DM (Р<0,01), and direct dependence of the serum adiponectin concentration and the age of patients with diabetes mellitus (Р<0,01) and history of diabetes (Р<0,01), in the absence of a statistically significant levels association of adiponectin and resistin among themselves. The scientific data is supplemented as for the role of gender in the implementation of the effect of SSBG on the vascular layer and retina. In the comparison group (obesity), the excess reference values of the SSBG concentration in serum was 17% higher in females (P<0.01), with T2DM - 15% higher due to number of men (P <0.01). For the first time complex research was made over the stage of development of DRP in obese patients with diabetes mellitus, taking into account the content of adiponectin, resistin and SSBG in blood, due to the risk factors for the development and progression of diabetic microvascular complications. Confidence intervals of adiponectin, resistin and SSBG in the blood have been determined, which formed the basis for the development of recommendations for the early prevention of diabetic microvascular complications and mitigating the pathogenic effect of obesity on the onset and development of DRP for all patients with diabetes mellitus and obesity. It is recommended to determine adiponectin, resistin and serum SSBG, as well as the functional reserves of the pancreatic B-cells (QUICKI index) and the state of insulin resistance (HOMA-IR index). A higher concentration of adiponectin in the blood compared to the confidence interval will indicate a positive dynamics of lipid metabolism and an increase in the protective role of adiponectin in the development of DRP, a lower concentration of resistin - about the positive dynamics of the lipid metabolism and the reduction of the pathogenic effect of insulin resistance (hyperinsulinemia) on the development of DRP, and the concentration of SSBG in serum more than 100 nmol / L will have a tread effect on the development of DRP, especially in male patients.