RU2467757C1 - Method of treating children suffering decompensated diabetes mellitus - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly paediatrics and endocrinology, and concerns treating decompensated diabetes mellitus. For this purpose, a complex therapy involving the introduction of insulin and lipotropic preparation is added by the introduction of the probiotic Bifiform Baby 0.5 g 1 time a day for 10 days.

EFFECT: method provides lipid metabolism correction that is manifested in normalising triglycerides, total cholesterol and beta-lipoproteins, as well as reduces a risk of formation and progression of fatty hepatosis in the given group of patients.

2 ex, 2 tbl

Description

The invention relates to medicine, in particular to the field of pediatrics and endocrinology, can be used to treat sick children with diabetes in the stage of decompensation.

There is a method of treating sick children with diabetes mellitus in the stage of decompensation using lipotropic drugs (Sergeev Yu.S. Diabetes mellitus // In the book: Pediatrics / Ed. By N.P. Shabalov. - St. Petersburg: SpecLit, 2010. - S. 779-783). However, despite the abundance of drugs, the treatment of diabetes is not always successful, there are complications in the form of persistent triglyceridemia, fatty liver hepatosis.

There is a method of treating lipid metabolism disorders in the elderly with the Normospectrum synbiotic (Amerkhanova AM, Aleshkin A.V., Chulok T.A., Tereshina E.V. et al. Efficiency of the Normospectrum synbiotic in elderly people with lipid disorders exchange // Gastroenterology of St. Petersburg. - 2009. - No. 4. - M1-M2.).

The disadvantage of this method is the lack of data on its use in the treatment of diabetes in the stage of decompensation in children.

The purpose of the invention is the expansion of the arsenal of therapeutic agents for the treatment of diabetes mellitus in the stage of decompensation in children, contributing to the normalization of lipid metabolism, improving the results of treatment of patients with diabetes.

The purpose of the invention is achieved in that, along with traditional methods of treatment (insulin therapy, lipotropic drugs), a probiotic Bifiform Baby is administered orally at a dose of 0.5 g containing 10 ⁹ CFU of Bifidobacterium lactis BB-12 and 10 ⁸ CFU of Streptococcus thermophilus TH-4, 1 time per day for 10 days.

Baby Bifiform is a powder and oil solution for the preparation of a probiotic combination, 1 dose of which, corresponding to 0.5 g, contains 10 ⁹ CFU of Bifidobacterium lactis BB-12 and 10 ⁸ CFU of Streptococcus thermophilus TH-4; excipients are included in the composition; maltodextrin; silicon dioxide; medium chain triglycerides derived from coconut and palm kernel oil.

The method is implemented as follows. For children aged 2-18 years with a verified diagnosis: “Type I diabetes mellitus in the stage of decompensation”, along with conventional medication (insulin therapy, lipotropic drugs) from the first days of hospitalization, a probiotic Bifiform Baby in a dose of 0.5 g containing 10 ^{9 is} prescribed CFU of Bifidobacterium lactis BB-12 and 10 ⁸ CFU of Streptococcus thermophilus TH-4, 1 time per day for 10 days.

The advantage of Baby Bifiform is the presence of the symbiotic probiotic composition Bifidobacterium lactis BB-12 and Streptococcus thermophilus TH-4, the preparation of a liquid form of which immediately before the start of the treatment ensures the preservation of the strains of probiotic bacteria in an active viable state.

We give an example of the practical implementation of the proposed method of treatment.

Clinical example No. 1.

Shaburova Anastasia, 13 years old, was treated at Children's hospital No 1 in St. Petersburg in 2010 (medical history No. 8796) with a diagnosis of diabetes mellitus. Ketoacidosis I. Chronic pyelonephritis. Obesity 2 tbsp. Biliary tract dysfunction on the background of an abnormality of the gallbladder (bile condensation syndrome). Received with progressive complaints of polyuria, polydipsia, lethargy, headache for 2 months. Outpatient hyperglycemia of 17 mmol / L was detected, and therefore was hospitalized.

Heredity burdened by diabetes, obesity, chronic cholecystitis. Upon admission to the hospital, a moderate condition caused by ketoacidosis. Heart sounds are rhythmic, moderately muffled. The breath is hard. The abdomen is soft, painless, revealed an increase in the liver by 2 cm. Sexual formula: AII.PII.MaIII.Me-. Height 161 cm, body weight 74 kg. BP 110/70, PS 90 bpm, BH 20 per min. In a clinical blood test: white blood cells 10.5 × 10 ⁹ / l, ESR 10 mm / hour. Serum glucose 14.6 mmol / L; triglycerides 2.81 mmol / L; cholesterol 6.6 mmol / l; betalipoproteins 85 opt. units The level of glycated HB A _1C is 8.96%. Ultrasound of the gallbladder revealed an excess in the body and neck, the presence of biliary sludge. ECG: metabolic disturbances in the ventricular myocardium. The treatment was carried out: the intensified administration of insulin preparations, methionine 1 table. 3 times a day for 10 days; Bifiform Baby 1 dose 1 time per day for 10 days. To evaluate the effectiveness of therapy, studies were carried out: determination of serum triglycerides, total cholesterol, betalipoproteins (before and after the appointment of Bifiform Baby). Against the background of the therapy, the patient's condition improved, stabilization of the blood glucose level was reached by the 10th day of hospitalization.

The patient’s lipid metabolism normalized during treatment:

1) the content of triglycerides decreased (from an elevated level to normal) - from 2.81 mmol / l to 1.66 mmol / l;

2) the content of total cholesterol decreased (from an elevated level to normal) - from 6.6 mmol / l to 4.9 mmol / l;

3) the content of betalipoproteins decreased (from an elevated level to normal) - from 85 opt. units up to 46 opt. units

Clinical example No. 2 using the traditional method of treatment of diabetes mellitus in the stage of decompensation shows less favorable results.

Akhmedzyanov Alexander, 16 years old, was treated at Children's Hospital No 1 in St. Petersburg in 2009 (case history No. 826) with a diagnosis of Type I diabetes. Ketoacidosis I. Fatty hepatosis. Myocardial dystrophy. Polyneuropathy. Hyropathy. Post-injection lipodystrophy. Chronic cystitis Chronic gastroduodenitis. Received with progressive complaints of polyuria, polydipsia, lethargy, headache. He has been ill with diabetes for 11 years. Glycemia level monitoring is carried out irregularly, often violates the diet, smokes. The last week before hospitalization, hyperglycemia is 25-20 mmol / L. Heredity burdened by diabetes. Upon admission to the hospital, a moderate condition, symptoms of moderate ketoacidosis. Heart sounds are rhythmic, moderately muffled. The breath is hard. The abdomen is soft, painless, a 3 cm increase in the liver is revealed. Sexual development corresponds to 3 tbsp. (according to Tanner). Height 158 cm, body weight 56.4 kg. BP 120/80, PS 120 beats / min, BH 20 per min. In the clinical analysis of blood: white blood cells 5.4 × 10 ⁹ / l, ESR 12 mm / hour. Serum glucose 20.0 mmol / L; 1.85 mmol / L triglycerides; cholesterol 12.3 mmol / l; betalipoproteins 197 wholesale. units The level of glycated HB A _1C is 16.3%. Ultrasound revealed a moderate increase in the liver, an increase in echogenicity. ECG: metabolic disturbances in the ventricular myocardium. The treatment was carried out: the intensified administration of insulin preparations, methionine (1 tablet 3 times a day for 10 days), as well as berlition, phosphogliv, essentiale forte for 10 days. To evaluate the effectiveness of therapy, studies were carried out: determination of serum triglycerides, total cholesterol, betalipoproteins (before treatment and after 10 days). Against the background of the therapy, the patient's condition improved, stabilization of the blood glucose level was reached by the 10th day of hospitalization.

The patient’s lipid metabolism during treatment did not normalize:

1) an increase in the content of triglycerides was noted - from 1.85 mmol / l to 2.57 mmol / l;

2) there was a decrease in total cholesterol - from 12.3 mmol / l to 6.0 mmol / l;

3) a decrease in betalipoproteins was noted - from 197 opt. units up to 75 opt. units

To prove the possibility of industrial applicability of the proposed method, a study was conducted of the results of treatment of insulin-dependent diabetes mellitus in the stage of decompensation in children in a hospital.

In the endocrinology departments of Children's hospital No 1 and Children's hospital No 19 in St. Petersburg, 25 patients from 2 to 18 years old with a verified diagnosis: “Type I diabetes mellitus are in the stage of decompensation” were monitored. Patients were divided into 2 groups depending on the therapy: the experimental group (n = 11) along with insulin therapy and a lipotropic drug (methionine) took the probiotic Bifiform Baby in a dose of 0.5 g containing 10 ⁹ CFU of Bifidobacterium lactis BB-12 and 10 ⁸ CFU Streptococcus thermophilus TH-4, 1 time per day for 10 days; the comparison group (n = 14) received insulin therapy and a lipotropic drug for 10 days.

The effectiveness of the used treatment regimens for patients with diabetes mellitus was evaluated on the basis of a study of the dynamics of biochemical parameters of lipid metabolism in blood serum: triglycerides, total cholesterol, betalipoproteins. In the observed patients, the indicated biochemical criteria were evaluated twice: before the start of therapy and after 10 days. The data obtained were processed statistically.

Table 1 presents the analysis of the dynamics of lipid metabolism in patients with diabetes of the experimental group using Bifiform Baby (n = 11), average age 10.7 ± 5.0 years (M ± σ), before and after treatment.

Assessment of the dynamics of serum lipid metabolism in patients with diabetes of the experimental group showed a significant decrease in triglycerides (from 1.689 to 1.151 mmol / L, P = 0.019), total cholesterol (from 6.251 to 5.272 mmol / L, P = 0.022), betalipoproteins (from 55.667 to 43.889 opt. units, P = 0.019). In addition, positive dynamics in the form of a decrease in serum triglycerides was observed in 100% of children observed during treatment, a decrease in total cholesterol occurred in 90% of patients, a decrease in the level of betalipoproteins in 88.9% of patients.

Table 2 presents the analysis of the dynamics of lipid metabolism in patients with diabetes mellitus comparison group (n = 14), average age 14.1 ± 2.9 years (M ± σ), before and after treatment.

Evaluation of the dynamics of serum lipid metabolism in patients with diabetes mellitus of the comparison group did not reveal a significant decrease in triglycerides: 3.195 mmol / L before treatment and 1.984 mmol / L (P = 0.058) after treatment. At the same time, during the course of observation during treatment of patients, a significant decrease in the increased level of total cholesterol (from 6.736 to 4.95 mmol / L, P = 0.005) and betalipoproteins (from 79.429 to 47.786 opt. Units, P = 0.003) was established. . It should be noted that a decrease in the level of triglycerides in the dynamics during treatment occurred only in 75% of sick children of the comparison group, a decrease in total cholesterol in 85.7%, and a decrease in the level of betalipoproteins in 92.9% of patients.

Thus, the problem of diabetes in children remains extremely relevant. In diabetes, it is known that the risk of cardiovascular disease increases sharply. According to world statistics, among adult patients with type I diabetes, coronary heart disease is 10 times more common than in the population. A rational comprehensive approach to the treatment of diabetes in children, including aimed at eliminating lipid metabolism disorders, helps to reduce the risk of serious complications.

In children with type I diabetes mellitus in the stage of decompensation, against the background of standard therapy with insulin preparations and lipotropic drugs in a hospital, an insufficiently effective correction of lipid metabolism disorders is noted. Secondary hypertriglyceridemia and other combined manifestations of dyslipidemia, due to the severity of endocrine pathology, contribute to the formation and progression of complications of diabetes mellitus, in particular, fatty liver hepatosis. The complex therapy of children with diabetes mellitus in the decompensation stage using the Bifiform Baby probiotic for 10 days provides high-quality rehabilitation due to an adequate corrective effect on lipid metabolism, which is expressed in the normalization of triglycerides, total cholesterol and betalipoproteins, reduces the risk of formation and progression of fatty hepatosis .

Table 1. METHOD FOR TREATING SICK CHILDREN WITH DIABETES MELLITUS IN THE STAGE OF DECOMPENSATION Statistical
kie indicators Triglycerides (mmol / L) Total cholesterol (mmol / l) Betalipoproteins (opt. Units) Before treatment After treatment Before treatment After treatment Before treatment After treatment Average value 1,689 1,151 * 6,251 5,272 * 55,667 43,889 * Dispersion 1,740 0.615 0.644 1,589 159.5 72,611 Observations eleven eleven 10 10 9 9 t-statistic 2,784 1,833 2,948 P (T <-t) two-way
her 0.019 0,022 0.019 t critical two-way
her 2,228 2,262 2,306 * - statistically significant results (P <0.05)

Table 2. Statistical indicators Triglycerides (mmol / L) Total cholesterol (mmol / l) Betalipoproteins (opt. Units) Before treatment After treatment Before treatment After treatment Before treatment After treatment Average value 3,195 1,984 6,736 4.95 * 79,429 47,786 * Dispersion 3,819 0.687 3,143 1,249 1301,495 336,335 Observations eleven eleven fourteen fourteen fourteen fourteen t-statistic 2,145 3,4759 3,599 P (T <= t) two-way 0.058 0.005 0.003 t critical two-way 2,228 2,160 2,160 * - statistically significant results (P <0.05)

Claims (1)

A method of treating sick children with diabetes mellitus in the stage of decompensation by prescribing insulin and lipotropic drugs, characterized in that they additionally prescribe probiotic Bifiform Baby in a dose of 0.5 g once a day for 10 days.