Currently there are many experimental markers of diabetic nephropathy, but clinical practice focuses mainly on the presence of albuminuria, which usually manifests itself in both adults and children on average 5-7 years after the onset of diabetes. The aim of the study was to study the general clinical and anthropometric parameters in patients with type 1 diabetes mellitus (T1D) depending on the level of albumin in the urine. The study included 78 men and 62 women aged 22 to 26 years with T1D. The control group consisted of 8 healthy men and 13 healthy women of the same age. The level of microalbuminuria was determined in all patients by enzyme-linked immunosorbent assay. The assessment of general clinical (pulse, systolic, diastolic pressure) and anthropometric (height, weight, body surface area, waist circumference, body mass index) indicators was performed. Statistical processing of the obtained results was performed in the license package “Statistica 5.5”, using non-parametric evaluation methods. It was found that angio-, retino- and neuropathy occurred in all patients with T1D. Simultaneously with the increase in albuminuria, the percentage of patients with deeper degrees of these complications increased. It was found that with increasing levels of albumin in the urine in most cases increases the percentage of patients with a correspondingly severe degree of these complications. Thus, in patients with T1D men found: angiopathy of the III degree with normoalbuminuria – 12.5 %, with microalbuminuria – 40.0 %, with proteinuria – 53.8 %; retinopathy of the II-III degree with normoalbuminuria – 0 % and 7.5 %, with microalbuminuria – 4.0 % and 40.0 %, with proteinuria – 100 % and 0 %; II-III degree neuropathy with normoalbuminuria – 65.0 % and 0 %, with microalbuminuria – 92.0 % and 0 %, with proteinuria – 0 % and 92.3 %. In patients with T1D women were found: angiopathy of the III degree with normoalbuminuria – 29.0 %, with microalbuminuria – 13.0 %, with proteinuria – 62.5 %; retinopathy of the II-III degree with normoalbuminuria – 3.2 % and 9.7 %, with microalbuminuria – 4.3 % and 26.1 %, with proteinuria – 87.5 % and 0 %; II-III degree neuropathy with normoalbuminuria – 71.0 % and 0 %, with microalbuminuria – 91.3 % and 0 %, with proteinuria – 12.5 % and 75.0 %. In patients with T1D with normo-, microalbuminuria and proteinuria, the value of systolic, diastolic blood pressure and pulse, in most cases, significantly higher than in healthy subjects (respectively in men by 6.1-18.3 % – 3.6-20.3 % and 4.2-14.7 %; in women – by 5.0-20.0 % – 9.1-22.8 % and 8.0-31.6 %). The value of these indicators increased with the increase in the level of albumin in the urine (respectively in men by 11.4 % – 16.1 % and 10.1 %; in women –- by 13.3 % – 10.0 % and 21.8 %). Patients with T1D had lower values of growth (respectively in men by 4.6-9.2 %; in women – 2.2-4.1 %), weight (only in men by 9.0-26.4 %) and body surface area (respectively in men by 7.2-17.7 %, in women – 4.8 % only in the group of proteinuria). Body mass index in sick men, compared with healthy, was significantly lower only in the group of proteinuria (by 5.5 %); and in women it was higher in the groups of normo- and microalbuminuria (by 10.6 % and 11.2 %). Patients with T1D women compared to healthy women had a larger waist circumference (by 5.5-11.8 %), and in patients with T1D men – on the contrary, this figure was lower in the group of microalbuminuria (by 4.0 %). Thus, the differences in general clinical and anthropometric parameters between patients with T1D with different levels of albumin in the urine and the degree of complications from the vascular and nervous system allow to assess the severity and compensation of the disease, and comparison of these indicators with the control group possibilities of disease development and peculiarities of the pathological process.

Annotation. The aim of the study was to examine the differences in lipid, carbohydrate metabolism and renal function in patients with type 1 diabetes (T1D) with different levels of albumin in the urine depending on the level of cystatin C. The sample was 78 men and 62 women aged 22-26 years, T1D patients. The control group consisted of 8 almost healthy men and 13 almost healthy women of the same age. The level of microalbuminuria and cystatin C was determined in all patients by enzyme-linked immunosorbent assay. Biochemical evaluation of fasting glucose, fasting blood glucose, glucose 2 h after exercise, mean value of glucose, glycated hemoglobin, total cholesterol, triglycerides, GFR according to Cockcroft-Gault, CKD EPI and GFR according to cystatin C. Statistical processing of the obtained results was performed in the license package “Statistica 5.5”, using non-parametric evaluation methods. In T1D patients compared to the control group found significantly higher values – fasting blood glucose, glucose 2 hours after exercise, the average value of glucose, glycated hemoglobin, total cholesterol and triglycerides, cystatin C and lower values – international normal ratio, GFR according to Cockcroft-Gault, GFR by CKD EPI and GFR by cystatin C. With increasing levels of albumin in urine in patients with cystatin C<0.9, there were changes in the following indicators: higher values of total cholesterol in men with proteinuria compared to men with normo- and microalbumin ; and lower values – the international normal ratio in women with microalbuminuria, compared with women with normoalbuminuria; Cockcroft-Gault GFR in men with proteinuria and GFR by CKD EPI in men with proteinuria and microalbuminuria compared to men with normoalbuminuria. With increasing levels of albumin in the urine in patients with cystatin C>0.9 there were changes in the level of the following indicators: higher values – fasting blood glucose and triglycerides in women with proteinuria compared with women with normoalbuminuria, and glycated hemoglobin and total cholesterol compared with and microalbuminuria; international normal ratio in men with microalbuminuria, compared with men with normoalbuminuria; and smaller values – GFR level by Cockcroft-Gault in men with microalbuminuria compared to men with normoalbuminuria; GCF levels by Cockcroft-Gault in women with proteinuria compared to women with microalbuminuria and GFR levels by CKD EPI in women with proteinuria compared to women with normoalbuminuria and microalbuminuria. With increasing levels of cystatin C, a decrease in glycated hemoglobin in men and women with microalbuminuria and triglycerides in women with microalbuminuria, as well as greater values of the international normal ratio in men with normoalbuminuria and GFR on cystatin C in men and women with normoalbuminuria and micro. Thus, the study obtained results that indicate the existence of differences in the studied indicators between healthy and sick subjects, between men and women and between groups of T1D patients’ men or women with different levels of albumin and cystatin C.

Cystatin C improves the risk stratification among people with diabetic nephropathy, the risk of mortality, cardiovascular disease, disorders of the visual organ and nervous system in the preclinical and early stages. The aim of the study was to study the frequency of angio-, retino- and neuropathy, as well as differences in general clinical and anthropometric parameters in patients with type 1 diabetes (T1D) with different levels of albumin in the urine depending on cystatin C. The sample was 78 men and 62 women aged 22-26 years, patients with T1D, who were hospitalized in the therapeutic department №1 and №2 of the Vinnytsia Regional Highly Specialized Endocrinology Center. The control group consisted of 8 healthy men and 13 healthy women of the same age. The level of microalbuminuria and cystatin C was determined for all patients by enzyme-linked immunosorbent assay. The frequency of angio-, retino- and neuropathy, general clinical (systolic, diastolic, pulse) and anthropometric (height, weight, body surface area, waist circumference, body mass index) was assessed indicators. Statistical processing of the obtained results was performed in the license package “Statistica 5.5”, using non-parametric evaluation methods. It was found that in the group of men with cystatin C<0.9, and in women with cystatin C>0.9 with increasing albuminuria, the percentage of patients with more severe microvascular complications of T1D. In patients with diabetes mellitus 1 compared with the control group systolic blood pressure is significantly higher and increases with increasing albumin levels in the urine (with cystatin C<0.9 – in men with normo-, microalbuminuria and proteinuria by 7.14%, 8.1% and 10.8%; in women with normo-, microalbuminuria by 7.5% and 10.0%, with cystatin C>0.9 – in men with normo-, microalbuminuria by 4.9% and 7.2%, in women with proteinuria by 19.5%). Similar changes were found for diastolic blood pressure (with cystatin C<0.9 – in men with proteinuria by 13.0%; in women with normo-, microalbuminuria by 11.4% and 13.4%; with cystatin C>0.9 – in men with microalbuminuria by 9.0%; in women with normo- and proteinuria by 9.5% and 21.5%) and heart rate (with cystatin C<0.9 – in men with microalbuminuria and proteinuria by 18.4% and 12.6%, in women with microalbuminuria by 9.13%; with cystatin C>0.9 – in men with microalbuminuria by 12.0%, in women with normo-, microalbuminuria and proteinuria by 10.1%, 16.3% and 25.3%). In patients with T1D compared to the control group, the length of the body is significantly smaller and decreases with increasing levels of albumin in the urine (with cystatin C<0.9 – in men with normo-, microalbuminuria and proteinuria by 3.6%, 6.7% and 9.0%; women with microalbuminuria by 1.9%, with cystatin C>0.9 – in men with normo-, microalbuminuria by 5.2% and 7.3%, in women with normoalbuminuria and proteinuria by 2.6% and 4.3%). Similar changes were found in men for body weight (with cystatin C<0.9 – with microalbuminuria and proteinuria by 13.6% and 30.1%; with cystatin C>0.9 – with normo- and microalbuminuria by 10.2% and 25.4%) and body surface area (with cystatin C<0.9 – with normo-, microalbuminuria and proteinuria by 5.8%, 10.8% and 18.9%; with cystatin C>0.9 – with normo- and microalbuminuria by 8.2% and 16.2%). The size of the waist circumference in patients with T1D with normoalbuminuria is significantly higher, and in patients of other groups significantly less than in healthy subjects (with cystatin C<0.9 – with normo-, microalbuminuria and proteinuria by 3.8%, 1.2% and 5.2%; cystatin C>0.9 – with microalbuminuria by 5.1%). Compared to healthy women, the waist circumference was significantly higher in sick women (with cystatin C<0.9 – with normo- and microalbuminuria by 11.2% and 10.7%; with cystatin C>0.9 – with normo- and proteinuria by 9.7% and 6.0%). In patients with T1D men with proteinuria compared with the control group, the value of the body mass index was significantly lower by 9.7% (cystatin C<0.9). The value of the body mass index was significantly higher in patients with normoalbuminuria and microalbuminuria – by 11.8% and 17.7% (cystatin C<0.9), respectively, and in patients with proteinuria by 7.2% (cystatin C>0.9) compared with healthy women. Thus, between healthy and patients with T1D with varying degrees of albuminuria, differences in general clinical and anthropometric parameters were found, and they are greater the higher the level of cystatin C.

The use of multi-label biochemical panels is justified by the fact that different markers reflect the severity of various pathological processes (disorders of carbohydrate and fat metabolism), which in their interaction are indicators of decompensation of a single pathology – diabetes in particular. The aim of the work was to study the differences in biochemical parameters in healthy and patients with type 1 diabetes mellitus (T1D) depending on the level of albumin in the urine. 78 men and 62 women aged 22-26 years, patients with diabetes mellitus type 1, who were hospitalized in the therapeutic department в № 1 and № 2 of Vinnytsia Regional Highly Specialized Endocrinology Center and 8 practically healthy men and 13 practically healthy women of the same age were examined. The level of microalbuminuria was determined in all patients by enzyme-linked immunosorbent assay. Fasting blood glucose and 2 hours after a meal were determined by enzymatic, amperometric analysis on a biochemical analyzer Biosen C_Line, manufactured by EKF Diagnostic (Germany). The average value of blood glucose was calculated mathematically. To determine glycated hemoglobin (HbA1c), we used the method of high performance liquid chromatography on a D 10 analyzer, manufactured by Bio-Rad (USA). The International Normal Ratio (INR) was determined using a set of reagents to determine the prothrombin time, prothrombin ratio and international sensitivity index, which is specified in the passport to the set (manufacturer of PC-K-TEST "Granum"). Total cholesterol and triglycerides were determined by colorimetric photometric method (using enzymes) on a biochemical analyzer using standard kits from Olympus AU480 (USA). Statistical processing of the results was performed in the license package "Statistica 5.5", using non-parametric evaluation methods. When comparing the level of biochemical parameters between patients with T1D and normo-, microalbuminuria and proteinuria with healthy men or women, patients found higher values: fasting glucose (in men – by 29.1 %, 30.9 % and 42.0 %; in women – by 29.7 %, 33.2 % and 46.0 %); glucose 2 hours after exercise (for men – by 27.4 %, 30.8 % and 36.1 %; for women – by 30.4 %, 32.4 % and 40.2 %); the average value of glucose (for men – by 26.2 %, 30.8 % and 39.3 %; for women – by 28.7 %, 34.0 % and 43.1 %); glycated hemoglobin (47.8 %, 48.8 % and 45.8 % for men; 27.2 %, 50.2 % and 54.4 % for women). Also, in patients with T1D men and proteinuria and women with normoalbuminuria and proteinuria compared with healthy men or women found higher cholesterol values (17.8 % in men and 7.6 % and 26.0 % in women); and in patients with T1D men with proteinuria compared to healthy men – 31.3 % higher triglyceride levels. When comparing the level of biochemical parameters between patients with T1D in men or women with proteinuria, higher values were found: fasting glucose compared with men with normoalbuminuria by 22.2 % and with women with normoalbuminuria by 30.3 % and microalbuminuria by 23.7 %; the average value of glucose compared with men with normoalbuminuria by 20.8 % and microalbuminuria by 14.0 %; glycated hemoglobin compared to women with normoalbuminuria by 15.9 %; compared with men with normoalbuminuria and microalbuminuria – by 24.8 % and 20.3 %, or with women with normoalbuminuria and microalbuminuria – by 24.9 % and 28.0 %; triglycerides compared with men with normoalbuminuria by 23.0 %. When comparing the sex differences in the level of biochemical parameters between healthy or between patients with T1D and normo-, microalbuminuria and proteinuria in men and women, only higher values of glycated hemoglobin by 14.1 % in women with proteinuria and total cholesterol by 8.3 % in women with normoalbuminuria were found. Thus, between healthy and patients with T1D and different levels of albuminuria there are differences in biochemical parameters, and they are greater the higher the level of albumin in the urine.

Резюме. Наведено Всесвітня організація охорони здоров'я визначи-ла глобальні медико-соціальні проблеми: цукровий діабет (ЦД), рак, серцево-судинні й хронічні легеневі захворювання. Вирішення проблем, пов'язаних із ЦД, відноситься до основних завдань національних систем охорони здоров'я. Це пов'язано не тільки зі зростан-ням кількості хворих на ЦД у всьому світі, в тому числі в Україні, але і з надзвичайно високим ризиком розвитку його хронічних ускладнень, що призводить до втрати працездатності, інвалідизації та смертності хворих.Управління ЦД розпочинається з індивідуальної зацікавленості пацієнта, його відповідальності за само-контроль глікемії. Індивідуальний підхід при лікуванні визначається з урахуванням особливостей пацієнта, прогнозу ефективності й безпеки. Такий підхід потребує чіткого визначення індивідуальних завдань і мети ліку-вання з урахуванням віку, статі, маси тіла, тривалості хвороби, наявності ускладнень, їх тяжкості й тривалості [1, 2].Основою й початком лікування ЦД є здорове хар-чування, що є складовою здорового способу життя. Правильне харчування допоможе знизити, підтрима-ти чи збільшити масу тіла. Але навіть при цьому має бути збалансованим розмір порцій їжі та її склад. Об'єм порції круп, продуктів з вмістом крохмалю або фруктів має дорівнювати об'єму кулака пацієнта. Овочі склада-ють в раціоні стільки, скільки поміститься в обох руках. Порція м'яса та альтернативних білкових продуктів має бути не більшою за площу долоні та завтовшки не більше за мізинець. Об'єм жирів становить не більше за розмір великого пальця. Оцінюючи такі рекомендації, відразу можна зробити висновок про значне зменшення об'єму їжі, і це дасть зниження її калорійності. У багатьох паці-єнтів виникає проблема відчуття голоду. Однак виконан-ня рекомендацій із харчування є основою позитивного лікування в майбутньому. Коли пацієнт правильно хар-чується, він не набирає масу тіла (збільшення маси тіла погіршує перебіг діабету), уникне різних коливань рівня цукру в крові. Однак здорове харчування не означає голодування або відмову назавжди від улюблених страв.Згідно із сучасними рекомендаціями, велике значен-ня має використання в раціоні харчування людей з ожи-рінням харчових волокон, які посилюють перистальтику кишечника, зменшують всмоктування нутрієнтів, від-чуття голоду, знижують глікемічний індекс продуктів, сприяють зростанню нормальної мікрофлори кишеч-ника. У денному раціоні в осіб із надлишковою масою тіла кількість харчових волокон має становити не менше 25-30 г. Пацієнтам із ЦД або порушеною толерантністю до глюкози (ПТГ) та ішемічною хворобою серця реко-мендовано вживати > 40 г/добу клітковини [4].Пацієнтам досить важко забезпечити рекомендо-вану денну норму харчових волокон, дотримуючись лише дієтичних рекомендацій. Забезпечити організм необхідною кількістю харчових волокон можна шляхом додаткового прийому препарату Гуарем (смола гуарова).Гуарем -це харчова клітковина, яка належить до гіпоглікемізуючих препаратів. Смола гуарова значно подовжує випорожнення шлунка, абсорбцію вуглеводів у тонкому кишечнику [3]....

Annotation. The aim of research is to study correlations of biochemical parameters with glomerular filtration rate according to Cockcroft-Gault, CKD EPI and cystatin C in patients with type 1 diabetes (T1D). 78 men and 62 women aged 22-26 years with T1D were examined. The control group consisted of 8 almost healthy men and 13 almost healthy women of the same age. The level of microalbuminuria and cystatin C was determined in all patients by enzyme-linked immunosorbent assay. Biochemical evaluation of fasting blood glucose, glucose 2 h after exercise, mean value of glucose, creatinine, GFR according to Cockcroft-Gault, CKD EPI and GFR according to cystatin C. Correlation analysis between the series of indicators was calculated using Spearman statistics in the license package “Statistica 5.5”. In patients with T1D, there is no significant correlation in normoalbuminuria between urinary albumin levels and GFR by Cockcroft-Gault (in women), CKD EPI and cystatin C (in all study groups). No significant correlations were found between urinary albumin levels and GFR by Cockcroft-Gault, CKD EPI and cystatin C in the proteinuria group. The correlation analysis revealed in the general group and in women with proteinuria an association between the average value of blood glucose and low GFR levels by Cockcroft-Gault, CKD EPI (negative medium strength correlation r = from -0.31 to -0.46) and elevated creatinine (positive strong correlation r=0.62 and r=0.91), indicating an unfavorable role of hyperglycemia in the development of nephropathy in patients with T1D. Higher correlations of cystatin C with GFR by cystatin C (r= -1.0) than by creatinine with GFR by Cockcroft-Gault (r = from - 0.63 to 0.99) and by CKD EPI (r = from -0.73 to -0.99) were demonstrated. The strength of the correlations increases from GFR by Cockcroft-Gault to GFR by cystatin C. Correlations between creatinine and GFR by Cockcroft-Gault and CKD EPI were characterized by sex differences (greater in women) and an increase in their strength synchronously with an increase in urinary microalbumin. At the same time, there is a consistently high identical value (r= -1.0) of correlations of the level of cystatin C with GFR on cystatin C in all comparison groups. Neither the sex factor nor the degree of albuminuria affected the change in their strength. Only men with microalbuminuria had moderate feedback between creatinine and cystatin C (r= -0.46). In all groups of women, in the general group and in men with normoalbuminuria and proteinuria, the correlations are close to zero, which may indicate the absence of a linear relationship between these indicators. When dividing the sample according to the level of cystatin C between the level of creatinine and the level of cystatin C, the following were found: medium feedback (r= -0.37) in the general group with normoalbuminuria and cystatin C>0.9; moderate feedback (r= -0.37) in the general group and in men with proteinuria and cystatin C<0.9 strong feedback (r= -0.90 and r= -0.88). Thus, in the course of correlation analysis it was found: microalbuminuria is not an independent marker of diabetic nephropathy (DN), starting from preclinical and ending with a clinically manifested stage of this complication; for timely and adequate diagnosis of DN it is necessary to measure the level of albumin, creatinine and cystatin C, which are independent markers of renal dysfunction; cystatin C gives a more accurate approximation to the actual values of GFR than creatinine; cystatin C is more sensitive in the early stages, and creatinine is a marker of later stages of DN development; hyperglycemia is the main initiating metabolic factor in the development and progression of DN.

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