Classical and new atherosclerosis biomarkers in elderly patients with type 2 diabetes mellitus

Strict control of metabolic parameters of the glycemic, cholesteric profiles as well as blood pressure (BP) is an integral part of preventing complications of type 2 diabetes mellitus (DM2), among which cardiovascular ones predominate. However, even such control is accompanied by a residual risk due to poorly studied processes — systemic inflammatory response, carbonyl stress with formation of advanced glication end products (AGEs) determined by skin autofluorescence (SAF). Objective. To identify the current directions of therapeutic correction in hospitalized elderly patients with type 2 diabetes mellitus and in age-comparable patients with multifocal atherosclerosis without diagnosis of type 2 diabetes mellitus in terms of known and new biomarkers. Materials and methods. The study was done in cross-sectional design; the sample consisted of 88 elderly patients aged 60—74.9 years, groups were formed by confirmed diagnoses of DM2 (n=50) and multifocal atherosclerosis (MFA) (n=38); epidemiological indicators, the structure of drug therapy were studied, as well as 39 clinical, laboratory and instrumental variables, including echocardiography parameters and SAF parameter. Results. In the main group of DM2, therapeutic control targets were not achieved in terms of glycated hemoglobin (HbA1c) in 74% of cases, in terms of systolic blood pressure in 96% of cases, and in terms of diastolic blood pressure in 18% of cases; in the MF comparison group, deviations in the parameters of the lipid spectrum and blood pressure, as well as the frequency of achieving target values, were comparable compared with the main group; the KPG index in the DM2 group significantly exceeds the value in the MFA group (p=0.018), and also does not demonstrate a statistically significant correlation with HbA1c; The immune inflammation index in the MFA group significantly exceeds the value in the DM2 group (p=0.022). Conclusion. The majority of elderly patients with T2DM are polymorbid, have polymorphic vascular complications and comorbid conditions, and do not achieve therapeutic control targets for classical atherosclerosis biomarkers. The CPG parameter of elderly patients with T2DM, reflecting long-term «metabolic memory», exceeds the average values in patients with MF, is correlated with the duration of insulin therapy, and has no correlation with HbA1c. The immune inflammation index in patients with MF is higher than in patients with DM2, which may be associated with a higher incidence of chronic heart failure syndrome.