The way to prevent the progression of impaired glucose tolerance with the use of local essentuki mineral water type

 

(57) Abstract:

The invention relates to medicine, in particular to endocrinology, and can be used to prevent the development of diabetes at the stage of impaired glucose tolerance with the use of local Essentuki mineral water type. Mineral water Essentuki 4 take 200-250 ml for 15-20 minutes before meals for 30 days. The method allows to normalize the blood glucose curve, to improve the early phase of insulin secretion, improve lipid metabolism. It increases the effectiveness of prevention of the disease. 11 table.

The invention relates to the field of medicine in particular, to the prevention of diabetes at the stage of impaired glucose tolerance with the use of carbon dioxide chloride-hydrocarbonate sodium mineral water of medium mineralization in complex Spa therapy.

As we know from literary sources, disturbed tolerance to carbohydrates occurs 2-3 times more often than overt diabetes (A., Mazowieckie, 1987; I. I. Dedov, 1992) and to prevent its development - task more promising than to achieve success in the treatment of this horizon manifest itself already of the disease.

Previously we had offers is that have a normalizing effect on the disturbed carbohydrate, lipid, protein, water-salt metabolism, indicators of hormonal regulation of glycogenesis and tissue sensitivity to insulin (G M Krasnica, L. A. Botvinov. The matters. kurortol. - 1992. - N 3. - S. 21-24). Found that these mineral waters have expressed insulinotropic effect in the early preabsorption phase insulin secretion, which is a powerful sanogenetic factor (B. G. Kuznetsov et al. 1979, 1987).

Research has identified all the prerequisites for the use of mineral waters as a primary prophylactic agent in patients with very early, actually diagnosed to date manifestations of disorders of carbohydrate metabolism - according to the who classification (1987) - in persons with impaired glucose tolerance (IGT) who have these disorders are diagnosed by oral glucose tolerance test (OGTT). For this stage of diabetes is characterized by reduced or absent early peak of insulin secretion and hyperinsulinemia in the postprandial period, a decrease in insulin sensitivity of tissues to the hormone, dyslipidemia.

In this regard, we have proposed a method of preventing the progression of disorders of carbohydrate metabolism in individuals with IGT were prominences mineral water Essentuki N 4 in 200 ml for 15-20 minutes before meals for 30 days on the background diet (diet 9), receiving carbon-mineral baths in the course of 20 treatments. Control was a group of individuals with IGT who received identical treatment complex, but without the intake of mineral water.

The method is illustrated by the following examples.

1. Patient I., 29 years old were treated in the Essentuki clinic research Institute of balneology with 27.07. on 25.08.1996, Diagnosis: Obesity III senior alimentary-constitutional Genesis, stable stage, IGT. Overweight is celebrated with children's age, the greatest body weight 129 kg with height 171 see Heredity diabetes burdened by the maternal line. Upon receipt of a complaint to increased appetite, weakness, fatigue, irritability, drowsiness, shortness of breath when walking, aching pain in the heart, a tendency to constipation.

During examination: body weight of 114.5 kg, height 171 cm, barely noticeable stretch marks on the abdomen and thighs. Cardiovascular system without pathology, palpation of the abdomen painless, liver and spleen are not enlarged. When conducting OGTT with a glucose load of 50 g/m2the surface of the body, revealed impaired glucose tolerance and hyperinsulinemia with lack of early phase insulin secretion (see tab. A).

Lipid metabolism: odes - 480 g/l, nezhk - 1,17 mEq/ml.

After the treatment with the application of the above method initial complaints disappeared, body weight decreased by 3.5 kg, normalization OGTT and reduction of hyperinsulinemia fasting and in the postprandial period, the emergence of the early peak of insulin secretion (5 and 10 min) (see tab. B).

Improved lipid metabolism: total lipids 400 g/l, triglycerides - 68 mmol/l, total cholesterol of 5.5 mmol/l cholesterol 1.12 mmol/l, LDL - 420 g/l, nezhk - 1,02 mEq/ml When conducting an insulin test increased sensitivity to insulin. Given the positive dynamics of clinical symptoms, normalization OGTT, reduction of hyperinsulinemia, body mass and improve insulin sensitivity patient was discharged with significant improvement.

2. Patient O., 37 years of age, was treated in the Essentuki clinic research Institute of balneology with 8.07 on 31.07.1996, Diagnosis: Obesity Art. I alimentary-constitutional Genesis, stabilant stage STG. Overweight is logged within 10 years, the last increase to 6 kg noted after delivery, the baby's weight at birth 4.5 kg, heredity diabetes is not burdened.

Upon admission to the hospital was concerned about the aja system without pathology, HELL 120/80 mm RT.art., the abdomen is soft, painless on palpation, the liver and spleen are not enlarged. OGTT at the beginning of treatment (see table. C).

Lipid metabolism: General lipid - 600 g/l, triglycerides - 115 mmol/l, total cholesterol - 5,72 mmol/l cholesterol is 0.99 mmol/l, LDL - 550 g/l, nezhk - 1,17 mEq/ml.

After the course of Spa therapy with the use of mineral waters for the initial complaints were not disturbed in body weight lost 3.6 kg, OGTT at the end of treatment normalized the level of IRI decreased, the early phase of insulin secretion is increased (see table. D).

The lipid metabolism by the end of treatment significantly improved: total lipids 520 g/l, triglycerides - 94 mmol/l, total cholesterol - 5,72 mmol/l cholesterol - 1,09 mmol/l, LDL - 480 g/l, nezhk - 1,17 mEq/ml When conducting an insulin test increased sensitivity to the hormone.

The results of the treatment were assessed as a significant improvement.

3. Patient S., 36 years old, was treated in the diabetes branch of the Essentuki clinic research Institute of balneology from 13.12 on 11.01.1996, the Diagnosis of Obesity II senior alimentary-constitutional Genesis, progressive stage, IGT. Increased body weight with de is P CLASS="ptx2">

Upon admission to the hospital was worried about the non-permanent dry mouth, General weakness, fatigue, weight 91 kg with height 160 cm, BP 130/80 mm RT.art., cardiovascular system without pathology, abdominal palpation soft, painless, liver and spleen are not enlarged, OGTT at the beginning of treatment (see table.E).

Lipid metabolism: total lipids 400 g/l, triglycerides - 70 mmol/l, total cholesterol is 5.54 mmol/l cholesterol - 0.6 mmol/l, LDL - 430 g/l, nezhk - 1,17 mEq/ml After a course of Spa treatment with the application of the described method the initial complaints were not disturbed in body weight lost 4,2 kg OGTT at the end of treatment normalized the level of IRI decreased basal to subnormal numbers, increased early phase of hormone secretion (see tab. F).

Lipid metabolism: General lipid - 320 g/l, triglycerides - 60 mmol/l, total cholesterol - to 4.68 mmol/l cholesterol is 0.72 mmol/l, LDL - 400 g/l, nezhk - 1,02 mEq/ml Increased sensitivity to insulin.

Given the dynamics of all indicators, drawn with significant improvement.

Demonstrated clinical examples the proposed method is tested in the Essentuki clinic research Institute, resort examined 30 patients with IGT, which were cures without the use of mineral water (group II). Both groups comparable on the main clinical characteristics: sex, age, weight and height of patients (table. 1).

Symptoms symptoms of pathology in both groups was low (General weakness, fatigue, irritability), the frequency of extinction neurasthenic symptoms by the end of treatment was about the same. The same applies to the average loss of body weight, which in group I was -4,1 0.5 kg, while in the second -3,8 0,4 kg Obvious advantages identified in the appointment of mineral waters patients of group I when conducting OGTT (PL. 2). As can be seen from the table, by the end of treatment in patients of the first group normalization of blood glucose curve and the absence of such dynamics in group II. The level of insulinemia significantly decreased basal to 25.3 2.4 Miu/ml, increased early-phase insulin secretion (0-20 min), before treatment it was : S (area of insulinemia) 0-20 minutes 249,8 32,1, after treatment 524,7 36,8 srvc. ed, (P=0). In the second group and glycemic insulinemic curves had only tended to improve.

When conducting an insulin test, charcterized insulin sensitivity, persons I and II vtoroy. This is confirmed by comparison of the areas under the glycemic curve. In group I S for the entire study period 0 - 120 minutes was -60,25 12,5 and after treatment -147,75 19,1 srvc. units (P=O), (PL. 3), in group II, these figures remained virtually unchanged.

Similar differences were revealed in relation to lipid metabolism: in individuals of group I significant shifts observed for all the studied tests (except total lipids), such dynamics in group II was not observed (table. 4).

Results the overall effectiveness of treatment (table. 5) also confirm the advantage of I medical complex.

The way to prevent the progression of impaired glucose tolerance, characterized in that the mineral water Essentuki N 4 take a dose of 200 ml for 15 - 20 minutes before meals for 30 days.

 

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2 ex, 5 tbl

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