CLINICAL AND PATHOGENETIC ASPECTS OF THE PURINE METABOLISM STATE IN DIABETES MELLITUS (review of literature and own observations)

In recent years attention has been paid on the state of purine metabolism (PM) in diabetes mellitus (DM) and the possible role of disturbances in the metabolism of uric acid (UA) in the manifestation and progression of this endocrine pathology. Up today it has been proven that the imbalance of UA is a risk factor for the occurrence of such conditions and disorders, which are usually combined with DM, namely: cardiovascular diseases, arterial hypertension, chronic kidney disease and vascular lesions. In addition, hyperuricemia (HUE) is considered as a component of the metabolic syndrome (MS) and the relationship of HUE with insulin resistance is revealed. Despite a significant number of studies on the state of the PM in patients with MS and with type 2 diabetes, there are a number of issues that need to be resolved, and data on the status of the PM in type 1 diabetes are only isolated. Based on a examination of 95 patients with DM, metabolic disorders of UA were detected in 28.42 % of DM patients, including 25.64 % of patients with type 1 DM, 36 % of patients with type 2 DM and 25.81 % of patients with type 2 DM with development of absolute insulin dependence. There are no significant differences in the frequency of imbalance of PM depending on the type of DM and insulin dependence. In patients with DM asymptomatic HUE was observed, so the absence of arthritis is not a criterion for excluding metabolic disorders of UA with diabetes. In patients with type 1 DM metabolic disturbances of UA are associated with complicated forms of the disease, in particular, with the development of diabetic nephropathy and diabetic foot syndrome.