Type 2 diabetes mellitus (DM-2) and prediabetes are serious diseases that can lead to early disability and death. DM-2 can remain undiagnosed for many years; therefore, screening is one of the main assistants of a doctor in establishing a diagnosis, allowing to start treatment as early as possible.Research objective: early identification of patients with prediabetes and DM-2 using an online questionnaire.Materials and methods. The study was carried out online using the Google Forms platform, where a questionnaire was created based on Appendix 3 “Form of risk assessment of diabetes mellitus-2” of the Unified clinical protocol of primary and secondary (specialized) medical care “Type 2 diabetes mellitus”, approved by order of the Ministry of Health of Ukraine No. 1118 dated 12.21.2012, as well as additional questions on nutrition and physical activity. As of June 2021, the study involved 209 patients (151 women and 58 men) who did not have a documented diagnosis of DM-2 or prediabetes.Results. Most of the respondents (89 people) were overweight. 51 respondents had grade I obesity, 31 respondents had grade II, and 7 patients had a body mass index > 40 kg/m2, which corresponds to grade III obesity. Only 49 respondents had a healthy weight, which corresponds to a body mass index 18.5–24.9 kg/m2. 29 (19.21%) women had a history of childbirth with a child weighing more than 4 kg. The diagnosis of polycystic ovary disease (a risk factor for the DM-2) was in 34 (22.52%) women. Upon receipt of laboratory tests, we established a diagnosis of prediabetes in 28 (13.40%) patients, and a diagnosis of DM-2 in 17 (8.13%) people.Conclusions. It is necessary to search for new opportunities in communicating with patients during the COVID-19 pandemic, one of which is online questionnaires based on regulatory documents.
Objectives: development of an algorithm for the early detection of comorbid pathology polycystic ovary syndrome (PCOS) in obese women.Materials and methods. The study included 56 women aged 28.02 ± 2.25 years with a diagnosis of obesity who had no history of PCOS. The examination was carried out by a multidisciplinary group of doctors consisting of a family doctor, a gynecologist and an endocrinologist.The patient’s history of life and diseases was studied, an anthropometric еxamination and a survey according to the modified Ferriman–Gallwey scale were performed with a further ultrasound examination and a gynecologist consultation.Results. The majority of patients (55.36%) had acne, hirsutism and seborrhea occurred in 41.07 and 26.76% of women, respectively, and 14.29% of patients had alopecia. Often, the patient had not one, but several symptoms at the same time.According to the modified Ferriman–Gallwey scale, the majority of women (58.92%) had no manifestations of hirsutism along with obesity, 17.8% had moderate manifestations of hirsutism, 16.07 and 7.14% had mild and moderate hirsutism, respectively.The patients had no complaints and did not know whether they had PCOS. PCOS were diagnosed in 31 (55.36%) women after ultrasound examination and gynecologist consultation. It was also found that patients with longer obesity and a higher body mass index were more likely to have a diagnosis of PCOS (ρ = 0.77). The largest number of PCOS patients was among women with a body mass index over 40 kg/m2, i.e. with the III degree of obesity.Conclusions. The algorithm we developed for the diagnosis of PCOS in obese patients allowed us to detect this disease early in 55.36% of cases. We consider it appropriate to recommend screening for PCOS to all obese patients of reproductive age. This tactic will help maintain the fertility of this category of patients.
Today, the prevalence of overweight and obesity is pandemic. This disorder is defined as “a complex chronic disease in which abnormal or excess body fat impairs health, increases the risk of long-term medical complications, and decreases life expectancy”.This article presents evidence-based clinical guidelines for the management of obese patients, as well as excerpts comments on pharmacological treatment.Treatment approaches for overweight and obese patients include behavioral interventions, lifestyle adjustments, etc. One of the methods is pharmacological therapy, based on the following principles: therapy for weight loss can be used starting already at a body mass index ≥ 27 kg/m2 or ≥ 30 kg/m2 with complications associated with excess body fat. As drugs can be used liraglutide, combination of naltrexone + bupropion, orlistat. Pharmacotherapy must be accompanied by lifestyle modification, including if necessary therapeutic diet, increased physical activity on ongoing basis with its mandatory control, and behavioral or cognitive-behavioral therapy. Pharmacotherapy can be used to support the weight loss achieved through lifestyle modifications and to prevent weight gain. It is forbidden to use over-the-counter drugs unless they are approved for weight control. Patients with metabolic obesity should be consulted by specialists to assess the feasibility of bariatric surgery, followed by treatment with this specialist.Every clinician must have sufficient knowledge to diagnose obesity and offer their patients an individualized, long-term, evidence-based weight loss regimen. The success of obesity treatment depends on the patient's trust the doctor and on the doctor's knowledge in this area.
Objectives: to evaluate cognitive functions in middle-aged patients with type 2 diabetes mellitus (T2DM).Materials and methods. The total number of participants was 72 people. The main group included 52 patients with T2DM (25 women, 27 men), the control group included 20 people (11 women, 9 men) without T2DM and without carbohydrate metabolism disorders.Cognitive function was assessed using the following scales: the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Anxiety-depressive disorders were assessed using self-administered questionnaires: the Hospital Anxiety and Depression Scale (HADS) and the Beck’s Depression Inventory scale.Results. In the main group the average duration of T2DM was 8.31 ± 0.53 years, the average HbA1c level was 8.14 ± 0.07%, the fasting glycemia level was 7.07 ± 0.11 mmol/l, average body mass index (BMI) – 28.45 ± 0.60 kg/m2. 18 patients in this group had a normal body weight with an average BMI 23.58 ± 0.26 kg/m2, 12 people had an excessive body weight with an average BMI 28.21 ± 0.43 kg/m2, 22 patients had obesity of various severities with an average BMI 32.57 ± 0.51 kg/m2. The following results were obtained in patients with T2DM according to the MMSE scale: 54% (n = 28) of patients had no cognitive impairment (CI), 46% (n = 24) had various degrees of СІ, of which 27% (n = 14) had mild degree CI, 19% (n = 10) had moderate severity CI. According to the MoCA scale, cognitive deficit was found in 44% of the participants of the main group. According to the Beck’s scale, the following data were obtained: 10 (20%) people had no signs of depression, 34 (65%) of the respondents had signs of subclinical depression, 3 (15%) had signs of clinically expressed depression.Conclusions. We established a direct, close relationship between BMI and HbA1c level according to Spearman’s rank correlation coefficient (ρ = 0.730). When CI is detected, the doctor should review the treatment plan for such patients, avoiding complex management plans that overload patients physically, emotionally, or financially, and will not be implemented to the required extent due to cognitive deficits.
According to recent studies, obesity is associated with genetic variations, iatrogenic conditions, viruses, environmental and behavioral factors. Currently, the treatment of childhood obesity is mainly aimed at limiting energy consumption by changing the child’s lifestyle. Families bear the main social responsibility for raising and educating children. Family sports are an addition to school and play an indispensable role. The object of family sports intervention is not only children, but also parents. In addition, parents’ behavior has a lot of influence on the formation of the views of teenagers. Eating habits and attitudes towards one’s own nutrition are also formed thanks to parental example. This article highlights a clinical example of managing a family with a teenage boy diagnosed with obesity. Diet and physical activity recommendations were given to the patient and his parents. Given that there is already a history of interventions to reduce body mass and the patient did not get the desired result, we suggested to focus on modifying the life of not only the patient, but also the family. Due to a comprehensive approach to lifestyle modification of the whole family, we obtained a positive result, namely: the patient reduced his body weight by 20.5 kg during the year of observation. In addition, a decrease in glycated hemoglobin from 6.0 to 5.48 % was observed, which is a good prognostic criterion for the further possible development of diabetes. The patient himself noted that he had improved relationships in the family and with peers.
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