Serhiyenko V. Cardiovascular autonomic neuropathy in type 2 diabetes mellitus: pathogenesis, diagnosis, classification, treatment.

On the basis of a comprehensive examination of patients with type 2 diabetes mellitus at different stages of cardiovascular autonomic neuropathy (CAN) development it was worked out a timely diagnosis algorithm, reasonable strategy of pathogenetic pharmacotherapeutic treatment of functional stage of CAN with the study of biochemical, ELISA, radioimmunoassay and instrumental parameters. For the first time it was proved that ECG-markers of subclinical myocardial damage are highly most informative in early CAN diagnosis. Obtained results expanded insight about CAN pathogenesis (priority of insulin resistance and chronic low-level inflammation process activation), that together with ECG markers allowed to establish the diagnostic criteria and justify the treatment strategy. For the first time it was established that subclinical CAN is characterized by increase of inactive N-terminal fragment of brain (B-type) natriuretic peptide in blood and spatial QRS-T angle, that proves the necessity to include them to the numbers of CAN risk ECG and biomarkers. Subclinical stage of CAN is characterized by increased vascular stiffness that can serve as an indirect predictor of interrelation between macro- and microvascular diabetic complications. For the first time it was showed, that combined prescription of benfotiamine, ?-lipoic acid and ?-3 polyunsaturated fatty acids to patients with type 2 DM and functional stage of CAN is followed by most expressed statistically significant positive changes of hyperinsulinaemia/insulin resistance parameters, lipid profile, chronic low-level inflammation factors, endothelial dysfunction; ECG markers of subclinical arrhythmogenic cardiac damage, arterial stiffness parameters and the state of the autonomic nervous system.