Clinical portrait of a patient with type 2 diabetes mellitus as the basis for the specific course of acute otitis media

Abstract

Introductions: Comorbidity is a current world problem, which has various aspects from the simple combination of etiopathogenetic diseases in one patient to syntropy. This involves the formation and presence of complications that are not usual for the main disease. The influence of comorbidity is particularly increasing with age and also due to the presence of concomitant diabetes and (or) metabolic syndrome. These data and our previous studies (determining the effect of hyperglycemia on the formation of a complicated course of acute otitis media) make the study relevant. Aim: to create a typical "clinical portrait" of a patient with type 2 diabetes on the basis of clinical and laboratory indices, taking into account pathogenetic links of bone resorption. Materials and methods: The study included 45 patients aged 38 to 75 years with type 2 diabetes without acute middle otitis media who underwent examination and treatment at the "V.Y. Danilevsky Institute of Endocrine Pathology Problems" during the period from 2019 to 2021. Patients were included in the study according to the randomized simple sampling method in the order of admission to the hospital and were divided into groups for further analysis according to the level of glucosylated hemoglobin (HbA1c): 1st group – 15 patients with HbA1c up to 7%; 2nd – 21 patients with HbA1c levels of 7-10%; 3rd – 9 patients with HbA1c levels higher than 10%. The examined patients were subjected to clinical examinations of blood, urine, blood glucose level with determination of the average glucemia and its fluctuations, level of glucosylated hemoglobin (HbA1c), total and ionized calcium in the blood, lipidogram, the level of interleukin 6 (IL-6) and tumor necrosis factor (TNF-α), the level of parathormone in the blood. Results: According to the received data, the general portrait of a patient with type 2 CD is as follows: a patient of a certain age group (over 50 years old) with increased body weight (BMI for the whole group was 31.07±0.84 kg/m2 with fluctuations from 22 to 44 kg/m2), with comorbid pathology (the most frequent were metabolism encephalopathy with liquor-venous distension (95.5%), hypertonic disease and polyneuropathy (91.1%), retinopathy (86.7%) and cardiopathy (60%), thyroid pathology and fatty hepatosis (55.6% and 57.8% respectively), obesity and cardiosclerosis (46.7% and 44.4% respectively), and the presence of a diabetes in the family history (62.2%). Laboratory indicators show an increase in blood glucose level (8.15±0.29 mmol/l), glucosyl haemoglobin (8.8±0.29%), significant changes in lipid profile of the blood (an increase in the level of total cholesterol, Atherogenicity coefficient, low lipoproteins, decrease of high lipoproteins), increased levels of proinflamation cytokines (IL-6 and FNP-α) and negative correlation of parathormone and calcium in blood. Conclusions: According to the results of the investigation, we found that the changes in the clinical portrait of patients with type 2 CD indicate the presence of subclinical poliorgan inflammation in each patient. Specified features of homeostasis under certain conditions are also able to cause a latent inflammatory process anywhere, including in the mastoid process during a certain period of time before the occurrence of clinical signs. Taking this into account, further search of general criteria and significance of their combination for diagnostics and treatment of patients with acute otitis media with type 2 diabetes mellitus and metabolic syndrome is relevant.