| укр | рус |



No6(4) 2021

Back to the issue

DOI 10.37219/2528-8253-2021-6-14

Pochuieva TV, Filatova IV, Miroshnichenko OS, Filatova GA
Clinical portrait of a patient with type 2 diabetes mellitus as the basis for the specific course of acute otitis media 
Pochuiеva Tatiana V.
Department of Otorhinolaryngology and Pediatric Otolaryngology,Professor
Kharkiv Academy of Postgraduate Education
Email :

Filatova Iryna V.
Department of Otorhinolaryngology and Pediatric Otolaryngology
Kharkiv Academy of Postgraduate Education
Email :

Filatova Anna A.
Department of Otorhinolaryngology and Pediatric Otolaryngology
Kharkiv Academy of Postgraduate Education
Email :

Miroshnichenko Oksana S.
Deputy chief medical officer for treatment
State Institution “V.Danilevsky Institute for endocrine pathology problems National Academy of Medical sciences of Ukraine”
Email :


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.


diabetes mellitus, glucosylated hemoglobin, metabolic syndrome, glucemia fluctuations, comorbid pathology, parathormone, latent mastoiditis, acute middle otitis media, pro-inflamation cytokines.


  1. Assari S. Comorbidity influences multiple aspects of well-being of patients with ischemic heart disease. Int Cardiovasc Res J. 2013;7(4):118-23.
  2. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37-43. doi: 10.1016/S0140-
  3. Belyalov FI. [Treatment of internal diseases in conditions of comorbidity]. Irkutsk: RIO Irkutsk State Medical Academy of Postgraduate Education; 2012. 283 p. [In Russian].
  4. Bonora E, Calcaterra F, Lombardi S, Bonfante N, Formentini G, Bonadonna R, Muggeo M. Plasma glucose levels throughout the day and HbA1c interrelationships in type 2 diabetes: implications for treatment and monitoring of metabolic control.
    Diabetes Care. 2001;24(12):2023-9. doi: 10.2337/diacare.24.12.2023.
  5. Campbell-Scherer D. Multimorbidity: a challenge for evidence-based medicine. Evid Based Med. 2010;15(6):165-6. doi:10.1136/ebm1154.
  6. Carvalho AK, Menezes AM, Camelier A, Rosa FW, Nascimento OA, Perez-Padilla R, Jardim JR. Prevalence of self-reported chronic diseases in individuals over the age of 40 in Săn Paulo, Brazil: the PLATINO study. Cad Saude Publica.
    2012;28(5):905-12. doi: 10.1590/s0102-311x2012000500009.
  7. Caughey GE, Roughead EE Multimorbidity research challenges: where to go from here? J Comorb. 2011;1:8-10. doi:10.15256/joc.2011.1.9.
  8. Caughey GE, Vitry AI, Gilbert AL, Roughead EE. Prevalence of comorbidity of chronic diseases in Australia. BMC Public Health. 2008;8:221. doi: 10.1186/1471-2458-8-221.
  9. Dawes M. Co-morbidity: we need a guideline for each patient not a guideline for each disease. Fam Pract. 2010;27(1):1-2. doi: 10.1093/fampra/cmp106.
  10. Dzyak GV, Khanyukov AA. [Risk stratification of patients with chronic heart failure: comorbidity issues]. Medical newspaper "Health of Ukraine of the XXI Century". 2010; 3: 22-3. [Article in Russian].
  11. Fadeenko GD. [Comorbidity and high cardiovascular risk are the key issues of modern medicine]. Ukrainian therapeutic journal; 2013;1:102-7. [Article in Ukrainian].
  12. Freitas Lima LC, Braga VA. Adipokines, diabetes and atherosclerosis: an inflammatory association. Front Physiol. 2015;6:304.
  13. Genkel VV, Nikushkina KV, Nikonova TI, Shaposhnik II Peripheral arterial disease and indicators of low-grade inflammation in patients with coronary artery disease and type 2 diabetes mellitus. Diabetes mellitus. 2018;21(3):178-185. [Article in Russian].
  14. Gumenyuk AF. [Aspects of rational treatment of cardiovascular patients with polymorbid injuries]. Ukraïnskyĭ medychnyĭ chasopys ; 2009;5(73):25-32. [Article in Ukrainian].
  15. Hrebenyk МV, Honcharuk YV. [Clinical portrait of patients with arterial fibrillation: data of own observations in a cohort of patients with comorbid arterial hypertension and diabetes mellitus]. Achievements of Clinical and Experimental Medicine; 2021;(2):49-53. [Article in Russian].
  16. Kim HS, Shin AM, Kim MK, Kim YN Comorbidity study on type 2 diabetes mellitus using data mining. Korean J Intern Med. 2012;27(2):197-202. doi: 10.3904/kjim.2012.27.2.197.
  17. Klimontov VV, Tyan NV, Fazullina ON, Myakina NE, Lykov AP, Konenkov VI. [Clinical and metabolic factors associated with chronic low-grade inflammation in type 2 diabetic patients]. Diabetes Mellitus; 2016; 19(4): 295-302. [Article in Russian].
  18. Kolomoiets MY, Vashenyak OO. [Comorbidity and polymorbidity in therapeutic practice]. Ukraïnskyĭ medychnyĭ chasopys . 2012; 5(91). [Article in Ukrainian]. Available in:
  19. Kovalenko VM, Bortkevich OP [Comorbidity: identification, possible areas of diagnosis and treatment]. Ukrainian Journal of Rheumatology. 2019; 77(3):33-44. [Article in Ukrainian].
  20. 20. Kozlovsky VL. [Differentiated pharmacotherapy for comorbid anxiety and depression]. St. Petersburg: V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology; 2012. 18 p. [In Russian].
  21. Krishnamurti U, Steffes MW. Glycohemoglobin: a primary predictor of the development or reversal of complications of diabetes mellitus. Clin Chem. 2001;47(7):1157-65.
  22. Lazebnik LB, Konev YV, Drozdov VN, Efremov LI. [Polypharmacy: the geriatric aspect of the problem]. Consillium Medicum. 2007;9(12):29-34. [Article in Russian].
  23. Marengoni A. Prevalence of disability according to multimorbidity and disease clustering: a population-based study. J Comorb. 2011;1:11-18. doi: 10.15256/joc.2011.1.3.
  24. Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, Meinow B, Fratiglioni L. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011;10(4):430-9. doi: 10.1016/j.arr.2011.03.003.
  25. McCartney M, Treadwell J, Maskrey N. Making evidence-based medicine work for individual patients. BMJ. 2016;353:i2452. doi:10.1136/bmj.i2452.
  26. Moroz GZ. [Gout: modern approaches to diagnosis and treatment]. Therapia. 2010;49(7-8). [Article in Ukrainian]
  27. Nesen AO. [Polifactorial diagnostic and treatment approach and cardiovascular risk assessment with regard to comorbidity]. Ukrainian Therapeutic Journal. 2013;(3):33-9. [Article in Ukrainian]
  28. Nobili A, Garattini S, Mannucci P. Multiple diseases and polypharmacy in the elderly: challenges for the internist of the third millennium. J Comorb. 2011;1:28-44. doi: 10.15256/joc.2011.1.4.
  29. Nurullina GM, Akhmadullina GI. Features of bone metabolism in diabetes mellitus. Osteoporosis and Bone Diseases. 2017;20(3):82-9. [Article in Russian].
  30. Ostrovskiy MM, Gerich PR. [To the question of polymorbidity and comorbidity in patients with chronic obstructive pulmonary disease]. Ukrainian Pulmonology Journal. 2011;(4):19-24. [Article in Ukrainian].
  31. Parkhomenko AN, Lutay YM, Danshan N. [Ukrainian Registry of acute myocardial infarction as a fragment of the European Registry: patient’s characteristics, organization of medical care and hospital therapy]. Ukrainian medical journal.
    2011;81(1):20-4. [Article in Russian]
  32. Pochuieva TV, Filatova GA, Filatova IV, Iyevleva VI. [Pathogenetic significance of hyperglycemia in the formation of specifics of the persistence of acute otitis media and its complications]. International Medical Journal; 2021; 4. [Article in Ukrainian].
  33. Prystupyk OM, Bodian MV. [Obesity in patients with type 2 diabetes]. International Journal of Endocrinology. 2018;1(13):33-7. [Article in Russian].
  34. Rasputina LV. [Comorbidity of non-specific diseases of the respiratory system and the cardiovascular system in practice]. Ukrainian Pulmonology Journal. 2011;(4):25-7. [Article in Ukrainian].
  35. Struijs JN, Baan CA, Schellevis FG, Westert GP, van den Bos GAM. Comorbidity in patients with diabetes mellitus: impact on medical health care utilization. BMC Health Serv Res. 2006;(6):84. doi: 10.1186/1472-6963-6-84.
  36. Valderas JM, Starfield B, Sibbald B. Defining comorbidity: implications for understanding health and health services. Ann Fam Med. 2009;7(4):357-63. doi: 10.1370/afm.983.
  37. Voloshin O, Dogolich O, Pashkovska N. [Age and gender aspects of comorbid and concomitant pathology in patients with gout (retrospective study)]. BMH Journal; 2012;16(2):20-3. [Article in Ukrainian].

© 2019, Public Organization «Ukrainian Scientific Medical Society of Otorhinolaryngologists»