Multimodal approach in algorithm of instrumental examination of patients with metabolic syndrome and type 2 diabetes mellitus

Relevance. Currently, metabolic syndrome (MS) occurs in 20–30% of the population. The main age of patients is 20–65 years. The study of this syndrome is genetically determined, which indicates that insulin resistance is genetically determined. The obtained facts allowed us to consider MS as the principle of primary prevention of type 2 diabetes and its complications. MTS affects such vital organs as kidneys, pancreas, etc. Since the topic of the development of CKD in patients with metabolic syndrome is acute, a qualitative diagnosis of this complication is necessary. To date, such a method is non-ionizing contrast-enhanced ultrasound, which is not nephrotoxic and hepatotoxic and can be used in patients with reduced renal function.

Objective. Evaluation of the effectiveness of the multimodal approach in the algorithm of instrumental diagnostics of examination of patients with metabolic syndrome on the background of type 2 diabetes mellitus.

Materials and methods. A study of patients with metabolic syndrome (n = 240) was conducted in 2020–2022. When collecting and analyzing clinical and laboratory data, (n = 67) had metabolically associated fatty liver disease: 22 of them were women (32.8%), 45 men (67.2%), average age 51.0 ± 4.2. All patients were examined according to a single diagnostic algorithm, which included four stages. Stage 1. Examination of patients by specialists, including clinical and laboratory data, with the resolution of the conclusion (n = 67). Stage 2. Ultrasound of the liver with quantitative ultrasound steatometry with determination of the level of the attenuation coeffcient of the ultrasonic wave (n = 67). Stage 3. Conducting dualenergy X-ray absorptiometry (DXA) in the ‘Whole body’ mode (with an assessment of the percentage of adipose tissue, abdominal obesity index) (n = 67). Stage 4. Conducting multiparametric ultrasound of the kidneys in B-mode and colour Doppler mapping (CDC) mode in patients with CKD, followed by contrast-enhanced ultrasound (n = 14). The criteria for inclusion in the study are age over 18 years, metabolic syndrome.

Conclusions. 1. The algorithm of examination of patients with metabolically associated fatty liver disease may include extended ultrasound examination of the kidneys, including contrast-enhanced ultrasound examination of the kidneys as a safe and effective method of assessing chronic kidney disease. 2. Two-energy X-ray absorptiometry in the ‘Whole body’ mode is a highly sensitive method in determining and monitoring the components of the metabolic syndrome. 3. A multimodal instrumental study of patients with metabolic syndrome and type 2 diabetes mellitus makes it possible to identify possible complications at an early stage.