The aim of the study was achieved by examining 120 patients with type 2 diabetes mellitus and 15 practically healthy individuals. At the first stage of the study, patients were divided as follows: group practically healthy individuals (PHI); patients with T2DM with MS and without symptoms of MS were divided depending on the presence of NAFLD: group 1A – patients with T2DM with MS and NAFLD – 40 patients, group 1B – patients with T2DM with MS without NAFLD – 32 patients; group 2A – patients with T2DM without MS but with NAFLD – 26 patients, group 2B – patients with T2DM without MS and without NAFLD – 22 patients. At the second stage, to study the effectiveness of the applied therapy, restorative treatment and rehabilitation, the patients were divided as follows: group 1A1– patients with DM with MS and NAFLD receiving basic therapy, according to the guidelines – 15 patients; group 1B1 – patients with DM with MS without NAFLD receiving basic therapy – 15 patients; group 1A2 – patients with DM with MS and NAFLD receiving the restorative treatment and rehabilitation on the basis of SE “Sanatoriy «Morshynkurort” PrJSC “Ukrprofozdorovnytsia” against the background of basic therapy – 25 patients; group 1B2 – patients with DM with MS without NAFLD receiving restorative treatment and rehabilitation on the basis of SE “Sanatoriy «Morshynkurort” PrJSC “Ukrprofozdorovnytsia” against the background of basic therapy – 17 patients.
When evaluating the clinical peculiairites of the course of T2DM with MS, it was determined that in all examined patients with MS according to the criteria recommended by the IDF, hypertension was observed in 85.8%, abdominal obesity – in 100 % of patients. Most of the patients (85.8%) had dyslipidemia. Among 120 examined patients, 55 % had NAFLD. When analyzing the components of MS in the examined patients, it was found that in the group of patients with DM with MS in combination with NAFLD, 5- or more component MS occurred in 25% compared to the group of patients with DM with MS without NAFLD – 9.4%. It was found that the most severe metabolic disorders were in the group of patients with T2DM with MS and NAFLD: there were the highest numbers of glycated hemoglobin (HbAIc), individual parameters of lipid metabolism, blood pressure, body mass index (BMI), waist circumference. The obtained data confirm the most significant degree of IR in patients with DM with MS and NAFLD: the index of insulin resistance (HOMA IR) was 3.6-fold higher than the index in PHI (p<0.05).
For the first time, daily glucose monitoring (DGM) was evaluated in patients with T2DM depending on the presence of MS and NAFLD. It has been proven that the time in the range of 3.9–10.0 mmol/l (Time in range (TIR) in the groups of patients with DM with MS was significantly lower and was estimated at 50.49±2.94% in patients with NAFLD and 59.09 ±2.3% without NAFLD, compared to patients without MS – 62.26±1.98% and 60.23±2.84%, respectively, which did not meet the latest ADA recommendations (2023) – time in the range of 3.9–10.0 mmol/l should be more than 70% of the study time in all patients with T2DM. Probable higher variability of glycemia was found – 35.44±3.21% and 30.59±0.94% in patients with T2DM with MS compared to patients without MS – 28.83±1.02% and 28.99±1.01%. An indirect correlation relationship of medium strength was determined between HOMA IR and TIR indices (r=-0.31, p˂0.05).The important role of CGM in assessing the effectiveness and safety of treatment, expanding the possibility of assessing glycemic control during the day and providing important data for making clinical recommendations, including the prevention of hypoglycemia, and feasibility for patients with T2DM and MS.
For the first time, the effectiveness of comprehensive restorative treatment and rehabilitation under the influence of natural and preformed physical factors has been convincingly proven, using treatment with diluted mineral water, which is a product of diluted brine water from wells № 3-k and № 2-k of the Nyniv deposit in the village Horishne, Stryy District, Lviv Region, with underground waters of spring № 4 in the State Enterprise “Sanatorium «Morshynkurort”, PrJSC “Ukrprofozdrovnytsia”, on the carbohydrate metabolism, glycemic variability, insulin resistance, dyslipidemia, functional state of the liver, essential trace elements, and quality of life in patients with T2DM with metabolic syndrome.
Key words: type 2 diabetes mellitus, metabolic syndrome, insulin resistance, obesity, non-alcoholic fatty liver disease, glucose variability, continuous glucose monitoring, spa treatment, hydrotherapy. Branch-Medicine.
