Tkach S. Autonomic neuropathy in patients with type 1 diabetes mellitus: risk factors, course, diagnosis, and treanment.

Object: Autonomic neuropathy in patients with diabetes mellitus (DM). Aim of the study: study the regularities of development of autonomic nervous system (ANS) disorders in DM and develop methods of early diagnosis, pathogenetically grounded treatment and prevention of diabetic autonomic neuropathy (DAN) in patients with type 1 diabetes mellitus. Methods and equipment: clinical, biochemical, instrumental, radiological and roentgenological, statistical methods; ultrasound devices „Toshiba SSA240A" and „Aloka SSD-500", electromyograph „МG 440", X-ray apparatus „Diagnost 75 Plus", electrocardiograph „EК1Т-03М2", radiological apparatus "Radiocirculograph", personal computer with software for analysis of heart rate variability (HRV) and statistical processing of study results. Theoretical and practical results: the regularities of development of ANS disorders and their relationship with motility dysfunction of stomach, with various forms of dyskinesia of extrahepatic biliary ducts and urodynamics changes,the character interrelationship of somatic and autonomic neuropathy, were determined in type 1 diabetes patients. Characterization of stages of diabetic cardiovascular autonomic neuropathy (DCAN) based on a spectral and statistical analysis of HRV are suggested. Early signs of diabetic gastrointestinal autonomic neuropathy (DGAN) and diabetic cystopathy (DC), risk factors of DAN, and risk markers of Charcot osteoarthropathy were determined. Unithiol was shown to have a positive effect on polyol pathway of glucose metabolism, with increasing sorbitol dehydrogenase activity, which prevents an excessive sorbitol accumulation in nerves. Positive effect of unithiol on DCAN, DGAN, DC, of sodium thiosulphate in DCAN, DGAN, of ?-lipoic acid in DGAN were established in patients. Novelty: for the first time, an objective electrophysiological characterization of DCAN stages are developed, based on analysis of HRV, methods of early diagnosis of DGAN and DC, markers of increased risk of development of Charcot osteoarth-ropathy are suggested, unithiol use in the treatment of DAN is pathogenetically grounded, positive effects of unithiol on DCAN, DGAN, DC, of sodium thiosulphate on DCAN, DGAN, and ?-lipoic acid on DGAN are demonstrated. Degree of introduction: the methods were patented, included in the endocrinological guidelines for medical care of patients with diabetes mellitus. Field of application: endocrinology, neurology.