The Relationship between Insulin Resistance and Thyroid Volume in Georgia

Patients with insulin resistance (IR) have a higher thyroid volume therefore the aim of our study is to examine the correlation between IR and thyroid volume in the residents of Georgia.

METHODS

413 patients with a mean age of 37.3 ± and 11.4 years were included in this study. Out of those, 120 were males, and 293 were females who were studied retrospectively. They had hyperinsulinemia and were referred to the clinic from 2017 to 2019. The factors studied were age, sex, body mass index (BMI), clinical signs, thyroid ultrasound, alanine aminotransferase (ALT), aspartate aminotransferase (AST), lipids, fasting insulin, fasting glucose, thyroid stimulating hormone (TSH), Free thyroxine (FT4), and Zinc (Zn).

RESULTS

IR was detected in 252 individuals. The frequency of men with insulin resistance was significantly higher than in the control group - 72.50%, and 56.31%, respectively (F = 9.55, p= 0.0021). Mean thyroid volume in the patients with IR was significantly higher compared to the controls 20.52 + 6.39 cm3 and 15.25 + 6.55 cm3, respectively (p < 0.001). Hyperinsulinemia had a significant positive correlation with Goiter r = 0.445, p < 0.0001. The associated factors for hyperinsulinemia are: Goiter (1) - OR = 5.12 (95% CI:3.02-8.69); Cholesterol - OR = OR = 3.31 (95% CI: 1.54-7.14); Triglycerides - OR = 3.23 (95% CI:1.02-10.28); Obesity (1)- OR = 3.94 (95% CI: 2.23-6.98); Thyroid structural changes (1) - OR = 2.01 (95% CI: 1.12-3.60); ALT/AST-OR = 4.53 (95% CI: 2.33-8.80); Zn decreased Odds Ratio hyperinsulinemia - OR = 0.95 (95% CI: 0.94-0.97).

CONCLUSION

Hyperinsulinemia is the most common cause of diffuse goiter and the heterogeneous structure of the thyroid. The volume of the thyroid gland shows a significant positive association with the characteristics of metabolic syndrome and increased thyroid volume predictors of metabolic syndrome.

Correlation Between Vitamin B12 Deficiency and Autoimmune Thyroid Diseases

BACKGROUND

Autoimmune thyroid diseases (AITD) are the most prevalent organ-specific autoimmune disorders. Vitamin B12 plays an important role in the proper functioning of the immune system. The aim of this study was therefore to investigate the correlation between vitamin B12 deficiency and AITD.

MATERIALS AND METHODS

A total of 306 patients (aged 18-65 years, mean - 37.6 ± 11.3 years and comprising 87 males and 219 females) were studied retrospectively (observational study). Patients were divided into groups: with and without vitamin B12 deficiency, and with and without AITD. Differences between groups were evaluated by Fisher's exact test for qualitative variables and by Student's t-test for quantitative variables. Correlations for quantitative factors were determined by the Pearson correlation coefficient and for qualitative factors by Spearman correlation analysis. The sensitivity and specificity of vitamin B12 deficiency for AITD were calculated by ROC analysis.

RESULTS

The vitamin B12 level was significantly lower in patients with AITD (and 200.70 + 108.84) compared to controls (393.41+150.78 p<0.0001). Patients with vitamin B12 deficiency were characterized by significantly higher mean values of anti-TPO (236.60+455.74) compared to controls (39.51+165.57 p<0.0001). Vitamin B12 levels were inversely correlated to anti-TPO levels (r=- 0.233, p<0.001). Roc analysis of vitamin B12 as a diagnostic test for AITD gave the area under curve as 0.881 (95% CI: 0.839-0.924), a sensitivity of - 0.947, a specificity of - 0.768, and a cutoff value of - 178.9.

CONCLUSION

The vitamin B12 level correlates significantly to AITD. The concentration of vitamin B12 should therefore be determined in patients with autoimmune thyroiditis as a diagnostic test with high sensitivity and good specificity.

Comprehensive study of the rheological status and intensity of oxidative stress during the progression of type 2 diabetes mellitus to prevent its complications

BACKGROUND

Prevention of Type 2 diabetes mellitus (T2DM) requires a modifying effect on the pathological processes inducing the β-cell dysfunction.

OBJECTIVES

the comprehensive study of the violation of rheological parameters in patients with different stages of diabetes and identification of possible links between these alterations with the intensity of the oxidative stress in the patient's body.

METHODS

60 patients with IR, prediabetes, T2DM and healthy volunteers were included. Full range of the rheological parameters of the patients' blood - the indicators of erythrocytes aggregation index (EAI), the relative deformability of the erythrocytes membranes (ERDI), blood plasma viscosity (BPV), and oxidative stress intensity (OSI) were examined.

RESULTS

In patients with insulin resistance (IR), prediabetes, and T2DM the ERDI was statistically significantly lower and BPV - higher compared to control; a significant increase in EAI was detected in the patient group with prediabetes and T2DM compared to the control.

CONCLUSION

The level of rheological disorders in patients increases with the increase of the level of carbohydrate metabolism disorders and intensity of oxidative stress and reaches a maximum during manifested diabetes. Diagnosis of hemorheological disorders and OSI in T2DM can serve as an early marker of target organ damage possibility.

The Effect of Low Doses of Radon on Ghrelin and Glucose Levels in Rats with Multiple Low-Dose Streptozotoccin-induced Type 2 Diabetes Mellitus

AIM: The aim of our research was to identify the ghrelin concentration in experimental animals with type 2 diabetes mellitus (T2DM) and to study the effect of radon hormesis balneotherapy using natural thermal waters of Tskaltubo spring, practically, its effect on ghrelin and glucose metabolism. MATERIALS AND METHODS: To study the effect of radon in balneotherapy, group of experimental animals (multiple low doses streptozotocin-induced T2DM Wistar rats were used) went through the procedure of inhalation of radon by the Tskaltubo mineral water pool, once daily, during 10 days. In animals of the control groups, inhalation with radon was not used. The experimental group and the control group were brought from Tskaltubo to Tbilisi to the Ivane Beritashvili experimental biomedicine center, where the blood of the rats was analyzed. RESULTS: After radon inhalation therapy with Tskaltubo mineral water, a normalization of the ghrelin levels was observed in the experimental group and despite the different body weight, the levels were approximately the same and close to those of the control group. In the experimental group, ghrelin level normalization was accompanied by glycemia normalization. CONCLUSION: This research showed that Tskaltubo mineral water radon inhalation caused hormesis, which consequently decreased ghrelin levels in rodents with T2DM and obesity and the result was stable during 3 months. Ghrelin level stabilization positively influenced on glucose levels. The result of our experiment gives us a stimulus to continue future research to find more specific neurochemical mechanisms participating in radon hormesis processes and positively influencing on glucose levels and T2DM outcome.

The Impact of Obesity Assessed by Different Criteria on the Metabolic Parameters in Children and Adolescents in Georgia

The aim of our study was comparative analysis of anthropometric characteristics in children and adolescents significantly correlated with the parameters of metabolic syndrome. The study group is consisted of 113 children and adolescents (study group) with excessive body weight and obesity (group 1—BMI percentile; group 2—waist circumference; group 3—waist to height ratio). The control group consisted of 113 children and adolescents without. Comparative analysis of obtained data have been carried out by multiple regression analysis. BMI percentile is more an indicator of a generalized obesity; WC and WHR percentiles better describe visceral obesity and metabolic disorders—insulin resistance, hypertension and dyslipidemia. However, the WHR Percentile may be a more useful tool. To assess obesity in children and adolescents, it is necessary to evaluate together BMI, WC, and WHR percentiles. It can be also concluded that these findings indicate the need to continue research in this direction.

Weekly Lonapegsomatropin in Treatment-Naïve Children With Growth Hormone Deficiency: The Phase 3 heiGHt Trial

CONTEXT

For children with growth hormone deficiency (GHD), treatment burden with daily somatropin injections [human growth hormone (hGH)] is high, which may lead to poor adherence and suboptimal overall treatment outcomes. Lonapegsomatropin (TransCon hGH) is an investigational long-acting, once-weekly prodrug for the treatment of GHD.

OBJECTIVE

The objective of this study was to evaluate the efficacy and safety of once-weekly lonapegsomatropin vs daily somatropin.

DESIGN

The heiGHt trial was a randomized, open-label, active-controlled, 52-week Phase 3 trial (NCT02781727).

SETTING

This trial took place at 73 sites across 15 countries.

PATIENTS

This trial enrolled and dosed 161 treatment-naïve, prepubertal patients with GHD.

INTERVENTIONS

Patients were randomized 2:1 to receive lonapegsomatropin 0.24 mg hGH/kg/week or an equivalent weekly dose of somatropin delivered daily.

MAIN OUTCOME MEASURE

The primary end point was annualized height velocity (AHV) at week 52. Secondary efficacy end points included change from baseline in height SD scores (SDS).

RESULTS

Least squares (LS) mean (SE) AHV at 52 weeks was 11.2 (0.2) cm/year for lonapegsomatropin vs 10.3 (0.3) cm/year for daily somatropin (P = 0.009), with lonapegsomatropin demonstrating both noninferiority and superiority over daily somatropin. LS mean (SE) height SDS increased from baseline to week 52 by 1.10 (0.04) vs 0.96 (0.05) in the weekly lonapegsomatropin vs daily somatropin groups (P = 0.01). Bone age/chronological age ratio, adverse events, tolerability, and immunogenicity were similar between groups.

CONCLUSIONS

The trial met its primary objective of noninferiority in AHV and further showed superiority of lonapegsomatropin compared to daily somatropin, with similar safety, in treatment-naïve children with GHD.

"Vitamin D Deficiency Is More Common in Women with Autoimmune Thyroiditis: A Retrospective Study"

BACKGROUND

Vitamin D is a hormone that is mainly produced in the skin upon ultraviolet B radiation exposure and has important influence on various organs. In recent years, data have been collected that vitamin D deficiency plays an important role in the development of various nonskeletal diseases, including autoimmune diseases. Chronic autoimmune thyroiditis (Hashimoto's thyroiditis) is one of the most common organ-specific autoimmune endocrine diseases. It is characterized by increased level of antithyroid peroxidase and/or antithyroglobulin antibodies in blood, which often leads to thyroid dysfunction and structural changes of the gland. There is an opinion that vitamin D deficiency may be considered as an important risk factor for development of chronic autoimmune thyroiditis, but data of various small studies are controversial. Despite the fact that Georgia is a sunny country, vitamin D deficiency is a widespread problem here. Thyroid diseases, including the chronic autoimmune thyroiditis, are also very common in Georgia. The aim of our research was to compare the level of vitamin D between the patients with chronic autoimmune thyroiditis and the healthy subjects.

METHODS

This retrospective study enrolled subjects, who were 18-70 years old and visited the clinics "Cortex" and "National Institute of Endocrinology" in 2018 or in 2019 from mid-spring to mid-summer. Data of thyroid-stimulating hormone, free thyroxine, antithyroid peroxidase antibodies, antithyroglobulin antibodies, thyroid ultrasonography, and 25(OH) vitamin D were retrospectively analysed based on medical history. In total, data of 1295 patients were collected. The statistical processing of data was performed through the SPSS 20 program.

RESULTS

The negative association between thyroid-stimulating hormone, antithyroid peroxidase antibodies, antithyroglobulin antibodies, heterogeneous parenchyma of thyroid gland, and vitamin D was found in women. Statistically significant association was not detected in men.

CONCLUSIONS

Serum vitamin D is lower in women with autoimmune thyroiditis and primary hypothyroidism. Further studies are needed to evaluate the influence of vitamin D supplementation on thyroid autoantibody positivity or primary hypothyroidism.

RESOLUTION OF NATIONAL ADVISORY BOARD

On October 2, 2020, by Novo Nordisk initiative, an expert council was held in Tbilisi, Georgia, dedicated to the problems of introducing innovative insulin therapy on the example of insulin degludek into the clinical practice. The council chaired by prof. R. Kurashvili included seven leading endocrinology experts in Georgia and a specialist in the field of pharmaco-economics from Russian Federation Prof. A. Kulikov. During the expert council, important scientific, clinical and economic emphases were made on the benefits of using insulin degludec associated with its unique structure and mechanism of action. Special emphasis was placed on the difficulty in managing children and adolescents with type 1 diabetes. The meeting provided compelling evidence that insulin degludec reduces the incidence of hypoglycemia and diabetic ketoacidosis, thereby contributing to overall health and the prevention of vascular complications in children and adolescents with diabetes. The members of the council resolved to petition the Georgian Ministry of Health to include insulin degludek in the state program for children and adolescents with diabetes.

RECOMMENDATIONS BY GEORGIAN ASSOCIATION OF SKELETAL METABOLIC DISEASES ON THE INITIATION OF TREATMENT WITH USE OF AGE-DEPENDENT INTERVENTION THRESHOLD BASED ON FRAX IN PATIENTS WITH OSTEOPOROSIS

Treatment criteria based only on bone mineral density do not reflect completely the likelihood of fractures. We reviewed the studies and recommendations on different types of intervention thresholds for the initiation of treatment in patients with osteoporosis. Georgian Association of Skeletal Metabolism Diseases recommends to use age dependent intervention threshold based on 10-year probability of osteoporotic fractures calculated by FRAX algorithm as a diagnostic and treatment criteria for patients with osteoporosis.

OR17-4 Transcon Growth Hormone In The Treatment Of Pediatric Growth Hormone Deficiency: Results Of The Phase 3 Height Trial

TransCon Growth Hormone in the Treatment of Pediatric Growth Hormone Deficiency: Results of the Phase 3 heiGHt TrialBackground TransCon Growth Hormone is a sustained-release recombinant human growth hormone (hGH; somatropin) prodrug in development as a long-acting GH (LAGH) for children with growth hormone deficiency (GHD). In its prodrug form, TransCon hGH is inactive with hGH transiently bound to a TransCon carrier via a TransCon linker. Upon injection and triggered by physiological pH and temperature, unmodified recombinant hGH is sustainably released and thus designed to maintain the same mode-of-action and distribution as daily hGH replacement therapy but with once-weekly dosing. In a 6-month phase 2 trial of TransCon hGH vs. a daily hGH in children with GHD, mean annualized height velocity (AHV) for TransCon hGH was 12.9 cm/y compared to 11.6 cm/y for a daily hGH at an equivalent hGH dose (0.21 mg/kg/wk). The subsequent pivotal phase 3 global heiGHt Trial (ClinicalTrials.gov: NCT02781727) was designed to investigate the safety, tolerability, and efficacy of weekly TransCon hGH versus daily hGH over 52 weeks in treatment-naive prepubertal children with GHD. Methods Subjects were randomized in a 2:1 ratio and received either once-weekly TransCon hGH 0.24 mg hGH/kg/wk or dose-equivalent once-daily Genotropin over 52 weeks. Key baseline demographics variables included age, gender, height standard deviation score (SDS), IGF-1 SDS, peak stimulated GH, and bone age delay. Study endpoints included AHV, IGF-1 response, immunogenicity, and safety. Results At baseline, the mean age of study participants, of whom 82% were male, was 8.5 years. Mean height SDS was -2.93, and mean IGF-1 SDS was -2.04. Mean peak stimulated GH was 5.77 µg/L, and mean bone delay was 2.63 years. The final sample size (n=161) was larger than planned (n=150) which strengthens the study power for noninferiority. Top-line results, including AHV, change in height SDS, serum IGF-1 levels, change in bone age, and adverse events, will be available for presentation at ENDO 2019. Conclusion Only LAGHs based on unmodified hGH have obtained approval in Europe or the United States. By February 2019, all subjects will have completed their participation in this pivotal trial of a LAGH designed to release unmodified hGH, with top-line analyses available in March. The heiGHt Trial was well-powered to demonstrate noninferiority between TransCon hGH and a daily hGH, with baseline demographic variables in the range of recent GH trials.

THE IMPACT OF THE DEGREE OF OBESITY ON METABOLIC PARAMETERS IN CHILDREN AND ADOLESCENTS

The aim of our investigation was to determine the impact of the degree of obesity on metabolic characteristics in children and adolescents with metabolic syndrome. We studied 117 children and adolescents 8-15 years of age with BMI exceeded the 85th percentile for their age and sex and the complaints associated with obesity. Investigated patients were divided according BMI percentiles for age and sex established by the U.S. Centers for Disease Control and Prevention (CDC) as follows: Group 1. Overweight (OW; 85-94.99th percentiles, n=10); Group 2. Obesity of I degree (Ob1; 95-96.99th percentile, n=12); Group 3. Obesity of II degree (Ob2; 97-98.99th percentile, n=51); Group 4. Obesity of III degree (Ob3; >98.99th percentile, n=39). Plasma glucose levels (fasting plasma glucose - FPG, postprandial plasma glucose - PPG) were determined by glucose oxidase method and Serum lipid (total cholesterol, HDL-cholesterol, LDL-cholesterol, VLDL-cholesterol, Triglycerides) levels have been measured. Plasma C-peptide, fasting plasma insulin (FPI), postprandial plasma insulin (PPI) and Leptin levels were determined by Enzyme-linked Immuno-Sorbent Assay kits. Like adults, the children and adolescents in our study were classified as having the MS if they met three or more of the following criteria for age and sex: 1) a WC≥90th percentile or 1a) WC/Height≥0.05, 2) a triglyceride level above the 95th percentile, an HDL cholesterol level below the 5th percentile,3) systolic or diastolic blood pressure above the 95th percentile, and 4) impaired glucose tolerance or insulin resistance. Metabolic syndrome was diagnosed in 68 cases (out of 117; 58.12%). The results of FPG, PPG, FPI, PPI, serum C-peptide and HOMA-IR in groups shows that FPG and PPG have not significant difference in between groups (p=NS). FPI, PPI, C-peptide and HOMA-IR-were significantly increased by the increase of degree of obesity. The values of systolic BP are significantly higher in Ob2 and Ob3 rather that OV and Ob1 groups. It has not been detected significant difference between diastolic BP values. The levels of total cholesterol, VLDL-cholesterol, and Triglycerides are significantly lower in group 1 (OV) than analogous values of other obese groups. HDL-cholesterol was significantly sharply lower only in group 4. Triglyceride and leptin levels are sharply significantly higher in Ob3 group in comparison to others. The degree of obesity in children and adolescents has important clinical implications. Data on the prevalence of severe obesity in children and adolescents do not exist, to our knowledge. Our results show a significant adverse effect of worsening obesity on insulin resistance, glycemia, lipids and blood pressure, underscoring the deleterious effect of increasing BMI percentile.

INSULIN LIKE GROWTH FACTOR 1 POSSIBLE DEPENDENCE IN PATIENTS WITH METABOLIC SYNDROME OF NODULAR PATHOLOGY OF THE THYROID GLAND

Metabolic syndrome and nodular pathology of the thyroid gland is a widespread problem nowadays. Recently there has been a notable coincidence between metabolic syndrome and nodular pathology of thyroid gland. Hence, it is interesting to reveal the connection between these two diseases. It is possible that insulin-like growth factor system (IGF), namely IGF 1 is connecting link between metabolic syndrome and nodular pathology of thyroid gland, because IGF1 stimulates growth and proliferation of cells in the body. We have investigated18-82 years of age 71 patients. group 1 n27- subjects with thyroid nodular disease, and metabolic syndrome, group 2 n31- subjects with thyroid nodular disease and without metabolic syndrome. group 3 n13 - subjects with metabolic syndrome and no thyroid pathology. In all groups were assessed thyroid structural data, defined parameters of carbohydrate metabolism, thyroid function and blood concentration of IGF1. In patients with hyperinsulinemia IGF 1 was noted in normal or reduced concentration. In I group IGF1 was normal in 70,4% (n=19), decreased in 29,6% (n=8), In II group was normal in 77,4 % (n=24), decreased in 22,6% (n=7) and in III group was normal in 76,9% (n=10), decreased in 23,1% (n=3). Increase of IGF 1 in patients with thyroid nodular disease patients was not noted. Statistically significant connection between IGF1 and thyroid nodules was not revealed. For the further investigation of this connection we plan to measure IGF1 in the thyroid histological samples in the future studies.

ADJUVANT (HORMONAL) THERAPY AS A CAUSE OF BONE LOSS IN PATIENTS WITH BREAST CANCER (REVIEW OF LITERATURE)

Adjuvant (hormonal) therapy is the main method of treatment after surgery in hormone (estrogen and/or progesterone) positive breast cancer patients. The goal of above mentioned treatment is to reduce or block the level of estrogen and progesterone. ultiple clinical trials have revealed that hormonal therapy in breast cancer patients affect bone mineral density (BMD). Authors have analyzed data obtained from several clinical trials conducted in several countries (including Georgia). The final conclusion is that selective estrogen receptor modulators (SERMs) have negative effect on BMD in pre-menopausal women and aromatase inhibitors (anastrozole, letrozole, exemestane) are associated with significant bone loss in post-menopausal women. It is recommended to assess BMD during the adjuvant (hormonal) therapy using Dual Energy X-ray Absorptiometry (DXA). Because of significant negative impact of aromatase inhibitors on BMD, it is suggested to involve antiresorbtive treatment in parallel with hormonal therapy.

The Frequency of Langerhans Islets β-Cells Autoantibodies (Anti-GAD) in Georgian Children and Adolescents with Chronic Autoimmune Thyroiditis

Aim. Chronic autoimmune thyroiditis and type 1 diabetes mellitus are organ-specific autoimmune diseases. There is large evidence that autoimmunity against the thyroid gland in patients with type 1 diabetes mellitus is increased, but little is known about anti-islet cell autoimmune status in patients with chronic autoimmune thyroiditis. We evaluated the concentration of antibodies against glutamic acid decarboxylase (GAD) which are widely used as a diagnostic and predictive tool for type 1 diabetes mellitus, in school-aged Georgian children with chronic autoimmune thyroiditis. Methods. The frequency of anti-GAD antibodies was measured in Georgian school-aged children with chronic autoimmune thyroiditis and compared to healthy age and sex matched controls. Results. Of the 41 patients with chronic autoimmune thyroiditis 4 (9.8%) were positive for GAD antibodies. The frequency of GAD positivity in the chronic autoimmune thyroiditis group was significantly higher than in the control subjects (P = 0.036). Conclusion. In the study we found that the frequency of GAD antibody positivity in autoimmune thyroiditis patients was significantly higher (9.8%, P = 0.036) than in the control group. Our findings support the concept that patients with autoimmune thyroid disease may develop type 1 diabetes mellitus in future life.

Hyperleptinemia May Protect From Cardio-Vascular Complications: A Small Georgian Study

BACKGROUND AND AIM: Leptin was assessed to play a coordinating role in obesity and its cardio-vascular complications, however the findings are conflicting and further clinical investigation is required. The aim of the present study was to evaluate the association of serum leptin with cardio-vascular risk factors in different body mass index and age groups.MATERIALS AND METHODS:  One hundred and forty nine female patients were enrolled in the study and divided into groups according to body mass index (BMI) and age. Following measurements were carried out: height, weight, BMI, waist circumference, blood pressure. Venous blood sample was obtained for plasma leptin, insulin, glucose and lipid profile analysis. Insulin resistance index was calculated for each patient. Body fat distribution was measured using Dual energy X-ray Absorbtiometry.RESULTS: The lowest leptin concentration was observed in overweight patients, the highest concentration was seen in obese patients. The difference between leptin levels were not observed in age groups. Leptin positively correlated with high density lipoprotein cholesterol levels in obese and elder patients.CONCLUSION: Leptin might act as a preventive measure for cardiovascular complications only in the presence of sufficient amount of fat mass. Further studies are warranted in order to support these results.

Influence of Testosterone Replacement Therapy on Metabolic Disorders in Male Patient with Type 2 Diabetes Mellitus and Androgen Deficiency

INTRODUCTION: Multiple epidemiological studies have shown that low testosterone levels are associated with and predict the future development of T2DM.AIM: The aim of study was to show the influence of testosterone replacement therapy on anthropometric characteristics, glycosylated hemoglobinlevel level, blood pressure and dyslipidemia in patients with T2DM and Androgen deficiency.MATERIALS AND METHODS:  From 125 male patients with T2DM were randomized 85 subjects with age 49.8 ± 6.74 and BMI from 35.83 ± 3.65 kg/m2 in placebo-controlled study. We divided patients into two groups: 1) Treatment group, where was used testosterone replacement therapy. 2) Placebo group, where was used placebo. In both groups was added Life style modification, but Antidiabetic therapy was unchanged.RESULTS: After six months of treatment we repeated the diagnostic assessments: lipid profile was improved in both groups but in group I it was statistically significant. Free testosterone level increased in all groups but in group I it was statistically significant. HbA1c decreased in both group but in group I we had the best result. Blood pressure was reduced in both groups, results were similar.CONCLUSION: Our study demonstrated that it is possible to regulate blood pressure, lipid profile, HbA1c, BMI - by raising testosterone in diabetic men with androgen deficiency.

Influence of testosterone replacement therapy on metabolic disorders in male patients with type 2 diabetes mellitus and androgen deficiency

Background

Multiple epidemiological studies have shown that low testosterone levels are associated with and predict the future development of type 2 diabetes mellitus and the metabolic syndrome.

The aim of our study was to show the influence of testosterone replacement therapy on obesity, HbA1c level, hypertension and dyslipidemia in patients with diabetes mellitus and androgen deficiency.

Methods

One hundred and twenty-five male patients with diabetes mellitus were screened; 85 subjects aged 41 to 65 years, with BMI from 27.0 to 48.0 kg/m², were randomized in a placebo-controlled study. They also underwent a routine physical examination and selected by free testosterone examination. We divided patients into two groups: 1) treatment group, where we used diet, physical activity, patient’s antidiabetic therapy and testosterone replacement therapy; 2) placebo group, where we used diet, physical activity, patient’s antidiabetic therapy and placebo.

Results

After 6 months of treatment we repeated the diagnostic assessments: lipid profile was improved in both groups but in first group it was clinically significant. Free testosterone level increased in all groups, but in group I was clinically significant. HbA1c decreased in both groups, but in group I we obtained the best result. Leptin level after treatment was approximately the same in both groups. Also, blood pressure was reduced in both groups but results were similar.

Conclusions

Our study demonstrated that it is possible to break this metabolic vicious circle by raising testosterone levels in diabetic men with androgen deficiency. Re-instituting physiological levels of testosterone, as the study has shown, has an important role in reducing the prevalence of diabetic complications.

Apolipoprotein B/apolipoprotein A-I ratio in relation to the metabolic syndrome, its components, total cholesterol and low-density lipoprotein cholesterol in the population of Georgia

The study was designed to assess the association of ApolipoproteinB/ApolipoproteinA-I (ApoB/ApoA-I) ratio with metabolic syndrome, its components, total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) in the population of Georgia. The subjects were 1522 Georgians of Caucasian origin aged 18-80 (653 women and 869 men) without diabetes mellitus. The subjects were divided into two groups. High ApoB/ApoA-I ratio group was defined as gender-specific upper quartile (≥0.88 for women and (≥1.0 for men) and low ApoB/ApoA-I ratio group as the remaining three quartiles (<0.88 for women and <1.0 for men). ApoB/ApoA-I ratio was significantly higher in patients with vs. without MetS (p<.0001). Mean values of ApoB/ApoA-I ratio significantly increased as the numbers of MetS components increased (p<.0001 in both sexes). After adjustment for age and gender, ApoB/ApoA-I ratio was associated significantly with MetS as definition (OR=1.86), IR as definition (OR=9.83), LDL-C (OR=1.99), systolic pressure (OR=3.31), diastolic pressure (OR=1.64), fasting glucose (OR=2.46), triglycerides (OR=2.52), high-density lipoprotein cholesterol (OR=7.08) (all p<0.05).

Association of the apolipoprotein b/apolipoprotein a-I ratio, metabolic syndrome components, total cholesterol, and low-density lipoprotein cholesterol with insulin resistance in the population of georgia

The study was designed to assess the association between insulin resistance (IR) and apolipoprotein B/apolipoprotein A-I ratio (ApoB/ApoA-I ratio), metabolic syndrome (MetS) components, total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) in the nondiabetic population of Georgia. The subjects were 1522 Georgians of Caucasian origin (mean age = 45 years, 653 women) without diabetes who had visited the clinics for a related health checkup between 2012 and 2013. IR was calculated using the computer homeostasis model assessment (HOMA2-IR) and was defined as the upper quartile. MetS was diagnosed using the updated ATP-III definition of the metabolic syndrome. Logistic and multiple regression models were used to estimate the association between IR and other components. IR was positively correlated with age, ApoB, ApoB/ApoA-I ratio, MetS components (excluding high-density lipoprotein cholesterol-HDL-C), LDL-C, fasting insulin, and TC and negatively correlated with HDL-C and ApoA-I in both sexes (all P < 0.001). In the logistic regression models, gender, age, ApoB/ApoA-I ratio, diastolic pressure, HDL-C, LDL-C, fasting glucose, and triglycerides were the covariates significantly associated with IR (OR: 8.64, 1.03, 17.95, 1.06, 0.13, 1.17, 3.75, and 2.29, resp.; all P < 0.05). Multiple regression models demonstrated that these components (except for HDL-C) made an independent contribution to the prediction of HOMA2 (all P < 0.05).

The impact of thyroid diseases on bone metabolism and fracture risk

Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk. One of the leading causes of secondary osteoporosis are thyroid diseases; this fact carries special importance for Georgia because of thyroid disease prevalence in Georgian population. In the present article we discuss the mechanisms, by which thyroid hormones and thyroid stimulating hormone (TSH) act on bone. We also present the data of meta-analysis of large studies, which demonstrate the complex relationship between the thyroid diseases and bone mineral density as well as the fracture risk; namely by overt and subclinical thyrotoxicosis, hypothyroidism and the treatment with the suppressive doses of levothyroxine. Beside that, we review the related data and the possible reasons, why different treatment regimens of Grave's disease: conservative, operative and radioiodine are related to different fracture risks. Finally, we discuss briefly the practical aspects of the treatment of secondary osteoporosis, related with thyroid diseases.

Spectrum of thyroid gland injury during goiter (morphofunctional parallels) in various regions of Georgia

Investigation of the patho-and morphogenesis of TG diseases in the regions of Georgia, on the basis of modern approaches to the questions of classification and treatment, coordinated with the Program of the European Association of Pathologists were carried out. We have examined the surgery material from the patients operated in Tbilisi within the period 2002-2006. The work included also the results of the retrospective pathomorphologic analysis of TG patterns within the period 2001-2007 from the regions of Western (Ajara, Samegrelo, Imerety) and Eastern (Kakheti, Kartli) Georgia. Material included 1248 cases, 63(5,05%) males and 1185 (94,95%) females at the age of 15-70 years old (128 (34,29%) cases of diffuse toxic (DTG), 122 (9,77%) cases of multinodal toxic (MTG) and 667 (53,45%)- nodal euthyroid goiter (NEG), 31(2,48%) cases of recurrent goiter). DTG is mostly characterized by the intensification of the synthetic, transport and energetic processes. The examined patterns of MTG revealed the increase of thyrocyte proliferative activity and basal membrane fibrosis and sclerosis. One of the distinctive signs of NEG is a great frequency of secondary destructive changes in parenchyma. It is noteworthy that the sizes of thyrocytes, cytoplasma and nuclei slightly exceeds those of the persons from the control group, but compared to the types of toxic goiter, they are lower. The number of Hurtle's cells grows in all three types of goiter. The process is especially intensive in NEG - till 40% that significantly exceeds the activity of these cells in other benign pathologies of TG. The analysis of the surgical material of thyroid gland from various regions of Georgia shows that in the patterns from the regions of Western Georgia, these prevails nodular euthyroid goiter with dystrophic-destructive secondary changes in follicles and stroma, morphological signs of colloid stagnation and hypothyreosis. In the patterns of the surgical material from the regions of Eastern Georgia, their prevail toxic types of goiter, in particular multinodular toxic form with a high mitotic activity of thyrocytes, intensive vascularization and signs of autoimmune disease.