Assessment of metabolic and hormonal shifts in patients at risk of diabetes mellitus

Abstract

Coronary patients and patients with essential hypertension were found to have the highest levels of glycated hemoglobin (gly-Hb), specifically, of its HbAlc fraction, as was shown in screening of 615 subjects. Measurements of blood levels of gly-Hb and gly-albumin, study of pyruvate metabolism, oral glucose tolerance test, and glucose-insulin test in 74 patients with coronary disease and essential hypertension revealed a high prevalence of latent disorders of carbohydrate metabolism in this patient population, with disorders of carbohydrate metabolism manifesting primarily by an increase of blood levels of glycated proteins and by disorders of pyruvate metabolism. Glycation of blood proteins in patients with coronary disease and essential hypertension increases blood viscosity (1.6 ± 0.02), spontaneous platelet aggregation (46.59 + 2.07% vs. 18.1 ± 1.5% in control), reduces fibrinolysis, and is conducive to a parallel increase of the concentration of blood serum lipids. These patients develop disorders of insulin secretion after glucose loading, thyroid function is reduced with the deficit of tri-iodothyronine production (1.46 + 0.07 nmol/liter vs. 1.92 ± 0.1 nmol/liter in health, p < 0.05); hydrocortisone hypersecretion is observed (746.25 ± 49.74 nmol/liter vs. 358.23 + 9.8 nmol/liter in health, p < 0.001); hormonal dysfunction favors the formation of glucose toxicity mechanism in normal glycemia when no clinical signs of impaired glucose tolerance are seen.