Shevchenko (Cherpita) V. Clinical significance of homocysteine and visfatin in pre- and postmenopausal women with type 2 diabetes in combination with osteoarthritis

This dissertation is devoted to the study of clinical and amnestic features of postmenopausal women with the tracking of changes in the parameters of lipid, carbohydrate, calcium-phosphorus metabolism, with an assessment of the functional state of the knee joints and their structural changes; with the study of clinical manifestations of menopause and determination of estradiol levels; with the study of the content of the adipokine visfatin and homocysteine to find probable new predictors of the occurrence of early osteoarthritis (OA), reproducing the main goal of the work: optimization of diagnosis and treatment of pre- and postmenopausal women with type 2 diabetes mellitus (T2DM) in combined with OA by studying the clinical significance of homocysteine and visfatin. 120 pre- and postmenopausal women with OA and T2DM were subjected to clinical and laboratory examination, of which 20 women were patients with T2DM, 22 women had resolved OA, and 62 patients had combined pathology of T2DM and OA. The control group (CG) consisted of 16 practically healthy pre- and postmenopausal women. As a result of the conducted research, it was found that in women with isolated OA and with T2DM in combination with OA, data were obtained on violations of the structural and functional state of the knee joints, which worsened in the presence of comorbidity. After evaluating the compensation of carbohydrate metabolism, the results were obtained that in patients with isolated DM-2 and the combined course of DM-2 and OA, there was a deterioration of the compensation of carbohydrate metabolism with the addition of OA. The highest levels of insulin were obtained in women of group 3 with comorbid course of T2DM and OA. We determined the presence of metabolic disorders in the body of a pre- and postmenopausal woman under the influence of OA and T2DM, and the obtained results fully confirm the interdependence of overweight, hyperglycemia associated with increased insulin levels, arterial hypertension and dyslipidemia. Signs of diabetic dyslipidemia were clearly seen in women with confirmed T2DM, which was characterized by all indicators of lipid metabolism disorders, namely: an increase in the level of triglycerides (TG), a decrease in the level of high-density lipoproteins (HDL-C) and an excess of low-density lipoproteins (LC LDL), and the highest levels of total cholesterol (TC) were found in the group with a comorbid course of DM-2 and OA. In women of the 1st group, there was a statistically significant decrease in the level of the adipokine visfatin, which had a level before treatment of 5.5 ± 1.0 ng/ml and had a decrease to 5.06 ± 1.0 ng/ml (p<0.001) compared to and after treatment. A statistically significant decrease in the content of visfatin in 1 group with ALA is the result of the activation of a compensatory mechanism aimed at reducing the level of insulin resistance, suppressing the activity of signaling pathways and inflammatory processes, and increasing the sensitivity to endogenous insulin against the background of the use of ALA. The proposed method of therapy using ALA contributed to a statistically significant improvement in the state of adipocytokine balance, namely a statistically significant decrease in the level of the anti-inflammatory and insulin-sensitizing adipokine - visfatin, a decrease in the level of insulin, an improvement in the parameters of carbohydrate and lipid metabolism, as well as an alleviation of the clinical manifestations of OA. The obtained results indicate the expediency of using ALA as an adjunctive therapy to the treatment scheme of women with T2DM in combination with OA in pre- and postmenopause. Thus, the significance of the obtained results lies in the scientific substantiation of the clinical value of visfatin and homocysteine in comorbid conditions in postmenopausal women with T2DM and OA based on the study of the clinical and amnestic features of the patients, assessment of carbohydrate and lipid metabolism, the structural and functional state of the joints, with determination of markers of early OA to increase the effectiveness of diagnosis and therapy of pre- and postmenopausal women with T2DM in combination with OA.