Scientific journal
European Journal of Natural History
ISSN 2073-4972

THE FEATURES OF THE 2ND TYPE DIABETES MELLITUS IN ABORIGINAL POPULATION OF THE NORTH

Sydykova L.A., Gagarin V.I.
In the Republic of Sakha (Yakutia) the 2nd type of diabetes mellitus (DM 2) is the most wide-spread pathology of endocrine system. (P.M.Ignatiev, M.A.Fedorova, 2004). For the last decades DM 2 disease incidence has increased more than 2 times. Considerable and fast growth of DM 2 disease has been observed especially among  aboriginal population of the North. Undoubtedly the spread of this "metabolic" epidemy is closely connected with urbanization of the North, deformation of traditional food of natives and other factors. Nowadays observation of indigenous inhabitants with DM 2 gives us an opportunity to analyze the features of their disease process, compensation, late complications etc.

Materials and methods. We examined 68 Yakuts (49 women and 19 men) with DM 2 who were on hospitalization in endocrinological department of Republican hospital № 2 of Emergency Medical Care Centre during the period 2002 - 2005 (group 1). Average age of patients was 58,16+1,12 years. Diabetes duration was 8,4+1,36 years. For comparison we examined 32 Russian patients (21 woman and 11 men) with DM 2 of the same age (group 2). In this group diabetes duration was 11,8+1,52 years. They were put diagnosis DM 2 on the basis of classification and diagnostic criteria of the WORLD ORGANIZATION OF PUBLIC HEALTH (1999). Anthropometrical parameters of research included weight, growth, dimensions of waist and hips as well as calculation of the index of body weight (IBW) and ratio of waist and hips (W/H). All the patients filled in the form for revealing social data, anamnesis of chronic diseases and uses of medicines. This form also contained questions about food (dietetical interview), physical activity, ischemic disease of the heart heredity and harmful habits (smoking and alcohol). All the patients gave their consents to participate in research, including biochemical analyses conduction.

Laboratory methods of research included:

Definition of blood sugar within a day (glycemia profile) by glucose oxidant method with automatic biochemical analyzer "Eos-bravo" of Hospitax-diagnostics (Switzerland - Italy) in biochemical laboratory of Republican Hospital № 2 (EMCC).  Definition of glycosylated hemoglobin - НвА1с by liquid chromatography under pressure (normal level of 4,5-6,2 %) in a laboratory of polyclinic №1 in Yakutsk. Glycemia and НвА1с were evaluated according to WORLD ORGANIZATION OF PUBLIC HEALTH specifications, 1999.

Definition of lipid spectrum in blood serum by diagnosticum in vitro method(TC, HDL, TRG, LDL, non-HDL, TC/HDL) with the help of standard cartridges on the device CHOLESTECH LDX (USA) after the 14 hours night starvation period and 3 days with no alcohol. Classification АТР III was put on a basis of lipoproteins levels interpretation.

Clinical examination included arterial tension measurement by A.S.Korotkov´s method, electrocardiogram, ultrasonic research of abdominal cavity, echocardiogram.

All patients were examined by internist, oculist, neuropathologist, podiatrician (the expert on diabetic foot) and surgeon.

Statistical data processing was carried out by means of BIOSTAT 3.03 and Microsoft Excel Programs (version 7.0). In cases of distribution close to normal the data are presented as M + SD (M is an average arithmetic, SD - standard deviation). Quality datas are presented as absolute quantity of examinations and percentage (%) of the patient´s quantity according to the sample or the appropriate group. In case of distribution close to normal we applied  Student´s t-criterion for two samples comparison. Distinctions were statistically significant at р < 0,05. The correlation analysis was carried out with the use of Spirman´s rank correlation.

Results and their discussion. The analysis of the basic anthropometrical data in 2 groups has revealed lower parameters of growth and weight in group 1 in comparison with group 2. 23 Yakuts (33,8 %) with DM 2 suffered from expressed obesity (IBW>30kg/m²). The percentage of Russian patients with obesity was a bit higher (53,1 %). According to dietetical interview  35,2 % of people of the group 1 mainly feed on dishes of national kitchen compared to 15,6% of group 2. Most patients (group 1) with obesity (60,9 %) preferred the European meal. More than 30 % of respondents of both groups estimated their physical activity as hypodynamia (35,3 % и31,25 %). According to НвА1 level compensation of DM 2 was observed with 19 people (27,9 %) in group 1 and 10 (31,2 %) in group 2. Decompensation was marked with 24 (35,3 %) patients in group 1 and 11 (34,4 %) in group 2. The comparison of DM duration revealed that more than a half patients of group 1 (76,6 %) had suffered from the disease for less than 10 years, 54,4 % of them - about 5 years. In group 2 the percentage of people suffering from DM for more than 10 years was 43,8%.  Nevertheless, the frequency of late complications in both groups was mainly identical. We found out that  patients had diabetic angioretinopathy (79,4 % and 71.8%), neuropathy (72 % and 71,8), nephropathy (57% and 59,3 %), fat hepatosis (52,9% and 53,1%),  diabetic foot (13,2% and 12,5%) and dislipidemia (60,2% and 68,7 %). 36,7 % of the 1st  group patients and 62,5 % of the 2nd  had ischemic disease of the heart . In the 1st group there were 5 patients with infarct of myocardium, 3 of them had "muted"  form, and  4 had  arrhythmia. 42 % of patients of group 1 and 62 % of patients of group 2 were put a diagnosis aorta atherosclerosis with transition to the base of velum of  aorta and mitral valves. 60% and 65% accordingly suffered from arterial hypertension (Blood pressure > 140/90 mm.Hg). Ultrasonic research of abdominal cavity revealed  signs of pancreatitis with 84 % of the 1st group patients and 61 % of people of group 2. Approximately identical quantity of patients had signs of cholecystitis, gallstone, pyelonephritis, urolithic illness. Biochemical parameters revealed authentic distinctions of lypoproteid level (р < 0,05) of high density (HDL).  The 1st group patients had higher level of HDL (1,42+0,12 ммоль/l) in comparison with parameters in group 2 (0,76+0,13 ммоль/л).

CONCLUSIONS. The examination of Yakuts showed that diabetic microangiopathia of various degrees is diagnosed with the duration of disease up to 10 years. Thus, searches of the various genetic factors providing higher or lower susceptibility of  microvascular bed of target organs to the influence of metabolic factors are proved. As for macrovascular complications, the ischemic deasease of the heart incidents among native people of the North are revealed more rarely than among Russians, possibly due to protective action of high level of high density lipoproteins. Clinical features of ischemic disease of the heart with Yakuts suffering from DM indicate that they have autonomical neuropathy.

The article is admitted to the International Scientific Conference "Modern High Technologies, Medical Sciences", Spain, Tenerife, 2006, November 20-27; came to the editorial 09.10.06