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№4' 2018
ENDOCRINOLOGYInternational Medical Journal, Vol. 24., Iss. 4, 2018, P. 66−69.
ABSOLUTE INSULIN INSUFFICIENCY IN DIFFERENT VARIANTS OF DIABETES MELLITUS
V. N. Karazin Kharkiv National University
"Institute of problems of endocrine pathology named after V. Ya. Danilevsky of NAMS of Ukraine", Kharkov, Ukraine
In the conducted study, the importance of determining C−peptide in patients with various types of diabetes mellitus (DM) at the stage of absolute insulin insufficiency (AIN) development was studied. It is important to determine the C−peptide in the differential diagnosis of types 1 and 2 of diabetes, as well as when it is impossible to determine the type of the disease by clinical signs, that is, to distinguish between absolute and relative insulin deficiency. Evaluation of the insulin−producing function of ?−cells according to this indicator will allow to justify the legality of the appointment or cancellation of insulin therapy in patients with diabetes. The aim of the study was to determine the severity of AIN in patients with different variants of the course of diabetes on the basis of the C−peptide study. 168 patients with diabetes were examined: 62 patients with type 1 diabetes, 72 patients with slowly progressive autoimmune diabetes in adults and 34 patients with type 2 diabetes with the development of insulin dependence. The control group was made up of healthy individuals with unceremonious heredity according to diabetes that were representative by sex and age. Considering the results and literature data obtained in the presented study, it should be considered that the determination of C−peptide in patients with diabetes is a reliable criterion by which the functional activity of ?−cells can be assessed, in particular, when prescribing insulin therapy. When studying the indicator, it is necessary to take into account the peculiarities of the course of the disease, including the presence of immunological markers of insulitis, signs of insulin resistance. In doubtful cases, it is necessary to conduct studies of C−peptide in the dynamics of observation, which will allow not only to prescribe an adequate hypoglycemic therapy to the patient, but also to evaluate its effect on the insulin−producing function of the pancreas. The findings suggest that C−peptide is a reliable marker of the functional state of ?−cells. Based on a comparative analysis of fasting C−peptide levels in patients with different types of diabetes at the stage of absolute insulin deficiency, a different degree of decrease in insulin secretion was established. It has been proven that in patients with type 1 diabetes, the severity of absolute insulin deficiency is not the decisive factor in the relatively stable or labile course of the disease. For an objective assessment of the functional state of ?−cells and the effect of hypoglycemic therapy on insulin secretion in doubtful cases, it is advisable to determine the C−peptide over time.
Key words: type 1 and 2 diabetes mellitus, slowly progressive adult autoimmune diabetes, C−peptide, absolute insulin deficiency.