LOW-FREQUENCY ULTRASOUND THERAPY IN COMBINATION TREATMENT OF PATIENTS WITH TYPE 2 DIABETES MELLITUS

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Hypoglycemic therapy used at present in patients with type 2 diabetes mellitus does not always lead to desired result and many patients live in a state of constant decompensation of metabolic processes, with the high levels of glycemia and glycosuria.That is why the search for the optimal treatment strategy that could increase the effectiveness of hypoglycemic therapy, and reduce the risk of complications is one of the most actual problems of modern diabetology.
The continuous search for new methods of diabetes mellitus treatment is recently conducted.A variety of the physiotherapy methods of treatment are traditionally used in our country.The natural and modified physical factors can replace many methods of treat- Оригинальные исследования /Original Researches/ ment.In most cases of chronic disease they become independent agents that have little or no side effects, and are different by low prices comparing with the pharmacological agents [1].At present ultrasound is becoming more common together with hypoglycemic agents for improving their efficiency.
Ultrasound therapy involves the application of mechanical energy fluctuations of an elastic medium with a frequency above 20 kHz.In recent years the low-frequency ultrasound is beginning to be used in medical practice along with the high-frequency ones.It exceeds the physiological and therapeutic effects of the high-frequency ultrasound [2].Low-frequency ultrasound has a universal therapeutic effect, consisting of mechanical miromassage of the cells and the tissues, energy influence of ultrasonic waves on the body tissues, and the physical and chemical actions.The biological effects of ultrasound on the body is to increase an activity of the adaptive and protective mechanisms.The therapeutic effect is expressed as anti-inflammatory, spasmolytic, desensitizing effects, and the stimulation of regenerative processes [3].The human body and its internal organs are acoustically «opaque» for the low-frequency ultrasound, which makes it possible to influence them through the skin areas to which it is projected.The deep-seated human internal organs are voiced with the low-frequency ultrasound (effect depth -10-20 cm) [4].
Currently, the most perfect device of low-frequency ultrasound therapy is the apparatus MIT-11.An ultrasonic impact is performed in a pulse mode of 44 kHz and the amplitude of fluctuations -2 microns.The pulse mode consists in greater softness and the duration of manifested effects.The softness of action is associated with the predominance of physical and chemical influences over the thermal and mechanical ones.This type of impact is most suitable when scoring the endocrine formations sensitive to ultraacoustic energy.The pulse mode is directed to restoring synthesis [6].
It is known that the key factors in the development of hyperglycemia in type 2 diabetes are: functional insufficiency of -cells causing a decrease in insulin secretion; cell insulin resistance and the inability to use glucose as an energy substrate; an increase in hepatic glucose production.The liver is one of the major insulin-sensitive organs involved in carbohydrate metabolism.Affecting with low-frequency ultrasound on the liver, we are acting on the basic links of disease pathogenesis [5].
The purpose of this study was to determine the use of low-frequency ultrasound therapy on cutaneous projection of the liver in patients with type 2 diabetes mellitus.

Materials and Methods
30 patients with newly diagnosed type 2 diabetes mellitus and body mass index (BMI) greater than 25 kg/m 2 were treated by the low-frequency ultrasound therapy.Clinical studies were performed with the con-sent of patients.The ultrasonic effects were conducted in pulsed mode of 44 kHz and an amplitude of fluctuations -2 microns using the apparatus MIT-11 as follows.Effects on the area of liver projection in patients was performed by the immovable technique (method), exposure to a session consisted of 8 minutes.The vaseline oil was used as a contact substance.Additionally influence on segmental area of Th7-Th12 by labile technique for 2 minutes on each plot was used to enhance the therapeutic effect.The course of treatment was 10 sessions.The patients were on a diet, without the use of hypoglycemic agents.The control group consisted of 12 patients with newly diagnosed type 2 diabetes mellitus and excessive body weight (BMI > 25 kg/m 2 ) and who were appointed to conventional (traditional) therapy (diet and exercise).
The patients were examined before and after treatment.The dynamics of clinical symptoms, glycemia and glycosuria, level of glycated hemoglobin was taken into account to assess the effectiveness of low-frequency ultrasound.To assess the degree of insulin resistance content of insulin, C-peptide and glucagon in blood plasma were determined by radioimmunoassay.Fasting insulin, C-peptide, glucagon in blood serum were tested in the morning.The analysis was conducted using the kit for immunoradiometric determination -IMMUNOTECH (Czech Republic).The determination of the insulin level in blood plasma was perform at the same time for patients with type 2 diabetes mellitus and control group with one kit of reagents, which allows to minimize the error of the data obtained.
The statistical processing of tests' results was performed using Student's t test.

The Results and Their Discussion
The beginning of therapeutic effect was observed after 2 procedures of the ultrasound exposure.The maximum effect is appeared after 8-10 treatment sessions.The positive dynamics of complex treatment is improving the general state of health, a disappearance of asthenization, and a decrease in the symptoms of cardiovascular disorders, achieving faster compensation of carbohydrate metabolism.
The course of treatment contributed to the hyperglycemia reduction in patients with newly detected type 2 diabetes mellitus.

Investigated parameters
A normalization of the parameters characterizing the synthesizing insulin function of the pancreas is not observed during the traditional treatment (Table 2).
The use of low-frequency ultrasound therapy to the area of liver projection in patients with newly diagnosed type 2 diabetes mellitus contributes to improve the efficiency of insulin action on tissues (reducing insulin resistance).Low-frequency ultrasound reduces the increased hepatic glucose production, helps to normalize both fasting plasma glucose (glycemia) and postprandial glycemia.The clinical improvement is associated with decreasing counter insulin hormone -glucagon levels, regardless of disease duration.
The data obtained point out an increased efficiency of insulin action on the tissues, suggest the possibility of reducing insulin resistance in patients with newly diagnosed type 2 diabetes mellitus and BMI > 25 kg/m 2 .Inhibiting hepatic glucose production, the ultrasound therapy lowers the fasting glucose and the level of glycosylated hemoglobin.
After ultrasound treatment, the authors noted a positive dynamics of clinical symptoms: an improvement of the general health status, a decrease in fatigue, an improvement of psycho-emotional indices, disappearance of pain in the right upper quadrant, and a decrease in liver size in all the patients under study.

Conclusions
1.The use of low-frequency ultrasound therapy on cutaneous projection of the liver in patients with type 2 diabetes mellitus promotes the normalization both fasting and postprandial glycemia.
2. The effect of low-frequency ultrasound on cutaneous projection of the liver is significantly decreasing parameters that characterize the pancreatic insulin synthesizing function (IRI, C-peptide) in patients with newly diagnosed type 2 diabetes mellitus and a BMI > 25 kg/m 2 .
3. Low-frequency ultrasound reduces the glucagon secretion and thereby positively affects the hepatic gluconeogenesis.