Multimorbidity in the patients with diabetes mellitus and arterial hypertension as basis for difficulties in diagnostics and treatment

Abstract

Aim. Identify multimorbidity triggers in the patients with diabetes mellitus (DM) and arterial hypertension (AH) to optimize the quality of diagnosis, treatment. Patients and Methods: The study involved 81 patients with various combinations of DM (including 5 – with 1st DM) with AH and acute or chronic coronary artery disease (CAD), pathology of the digestive system. Research methods included biochemical, hemostatic, metabolic parameters, cardiac biomarkers, interleukin-10 (IL-10), high sensitive C-reactive protein, auto-antibodies to chaperone 60 (anti-Hsp 60); daily arterial pressure (AP), electrocardiographic monitoring. We used the MiniMed Paradigm Real-Time insulin pump and continuous glucose monitoring system for 1st DM patients. Statistical parametric and nonparametric analysis was made using SPSS v. 13.0. Results: The main predictors of complicated course of CAD in the patients with DM and AH was instability of the glycemic profile, increasing the amount of monocytes and neutrophils above 75% , the index value of leukocytes to the blood cholesterol more than 1,21 conventional union, anti-Hsp 60 over 66,67 ng/ml, IL-10 less than 70 pg/ml (P by ANOVA, Kruskal-Wallis tests <0,05). Diastolic blood pressure and heart rate multiplied by the systolic blood pressure have a direct correlation average force (r=0.645, P=0.0001). AP elevation and hyperglycemia was observed in 84,4% of episodes (P<0.01 by criteria of sign). CONCLUSION: Multimorbidity triggers in the patients with DM and AH are the instability of the glycemic profile, disturbances of lipid metabolism, consumption syndromes of pro-inflammatory and anti-inflammatory, pro-ischemic and anti-ischemic factors. It’s may be basis to optimize treatment, overcoming polypharmacy.