UDC  616.375-008.64-07-053.2

Abstract. Cardiac autonomic neuropathy (CAN) is closely associated with an approximately five-fold increase in the risk of cardiovascular mortality in patients with diabetes mellitus (DM). Impaired autonomic function of the cardiovascular system in DM, which leads to the development of CAN, can be accompanied by coronary artery ischemia, heart rhythm disturbances, “silent” myocardial infarction, severe orthostatic hypotension, and sudden cardiac death syndrome. The article provides an analysis of literature data on the impact of glycemic variability (GV) on diabetic CAN development. This review analyzed the possible relationships between GV in people with diabetic CAN. In particular, the issues related to glycemic control and CAN, the link between GV and CAN in diabetes were analyzed. Unsatisfactory glycemic control and uncontrolled glycemic status are considered the main risk factors for chronic complications of DM, in particular CAN. An increase of GV is associated with a higher risk of chronic complications of DM, cardiovascular risk, all-cause mortality and morbidity. The clinical trial results demonstrated that time in range might be a promising metric for assessing glycemic control and prognosis of diabetic complications. This review is based on a search in PubMed and MEDLINE, Scopus, BIOSIS, EMBASE, Google Scholar and Springer Online Archives Collection. The following keywords were used: glycemic variability, cardiac autonomic neuropathy and diabetes mellitus. Research findings missed by the web search have been identified through a manual search of the bibliography of publications. CAN is one of the frequent long-term complications of DM, and reasonable control of GV may be necessary for its prevention. Determination of GV may have advantages for predicting future complications of DM in clinical trials and practice. The association of autonomic dysfunction and glucose levels, insulin resistance, and HbA1c variability suggest further research to reduce chronic complications development. Further investigation is needed to study the mechanisms of GV and evaluate them as therapeutic targets in the treatment of patients with T2DM.
Keywords: diabetes mellitus; cardiac autonomic neuropathy; glycemic variability

In recent decades, the role of hydrogen sulfide (H2S), a gas mediator and signaling agent, has been studied in the regulation of intercellular signaling and intracellular signal transduction pathways with various physiological and pathophysiological effects in cells and tissues. These cellular pathways are responsible for changes in metabolism, epigenetic, and cellular behavior. There are enzymatic and non-enzymatic pathways of endogenous hydrogen sulfide biosynthesis. Numerous studies have shown the diverse effects of H2S on the physiological processes of neurotransmission in the brain, vascular smooth muscle relaxation in synergy with nitric oxide (NO), apoptosis, autophagy, angiogenesis, aging, inflammation, redox system, manifestations of oxidative stress, protein, as well as bioenergetic effects and systemic bioregulatory effects, including ANS. Recently, it was shown that H2S signaling is often dysregulated in different dysfunctions. The effect of H2S on insulin secretion and protection of the heart, kidneys, and brain from ischemic damage, and hypoxia is known. The availability of H2S as a bioregulator has led to changes in cytoprotection, scavenger’s function, and antiinflammatory activities in the digestive system, as well as it could be a molecular target for the creating new safe hybrid compounds, esp., H2S-realized nonsteroidal anti-inflammatory drugs. Our recent research has shown a cytoprotective effect on the mucous membrane of the esophagus and stomach. Thiosulfate sulfurtransferase (TST, EC 2.8.1.1)-derived H2S plays an important role in maintaining redox balance but its effects on mesenteric integrity in aspects of age-related changes and during stress response or high-carbohydrate diet are still limited.

У Львові 14 жовтня 2022 року за підтримки Львівського національного медичного університету імені Данила Галицького, Лікарської комісії Наукового товариства імені Шевченка, Львівської міської ради та Львівського конференц-бюро відбувся вже 6-й міжнародний симпозіум «SMART LION» Science Medicine Arts Research Translational Lviv International Opportunity Network. Час проведення конференції не випадково збігся з
датою Дня захисника України, якими є військовий медик і науковець, який озброює його знаннями та навичками, що дає змогу рятувати життя на полі бою.
Мета симпозіуму – проаналізувати новий досвід медиків і волонтерів України та країн-союзниць, що з’явився у ході війни росії проти України, напрацювати нові методики у медичній освіті, налагодити тісну співпрацю між військовими медиками, волонтерами та науковцями. Наукова подія відбувалася онлайн через платформу ZOOM. У мережі Facebook на сторінці журналу «Праці Наукового товариства імені Шевченка. Медичні науки» проводилася трансляція для усіх зацікавлених. Понад 20 виступів міжнародних і вітчизняних науковців, висококваліфікованих фахівців в подальшому слугуватимуть науково-практичною основою для розвитку не тільки військової медицини, а й медицини загалом. Дискусії під час конференції виявили потребу системних змін у медичній освіті, доповнення освітніх програм з урахуванням багатого досвіду військових медиків, удосконалення методики викладання.

On October 14, 2022, the 6ᵗʰ International Symposium “SMART LION” (Science Medicine Arts Research Translational Lviv International Opportunity Network) was held in Lviv with the support from Danylo Halytsky Lviv National Medical University, the Medical Commission of the Shevchenko Scientific Society, Lviv City Council and Lviv Conference Bureau. It was no coincidence that the time of the conference coincided with the Day of Defenders of Ukraine,
which include military medical professionals and scientists who equip them with knowledge and skills enabling them to save lives on the battlefield.
The purpose of the symposium was to analyze the new experience of medical professionals and volunteers of Ukraine and its allies, which they acquired during russia's war against Ukraine, develop new methods in medical education, and establish close cooperation between
military medical professionals, volunteers, and scientists.
The scientific event was held online via ZOOM. It was also streamed on the Facebook page of the journal “Proceedings of the Shevchenko Scientific Society. Medical Sciences”. The event featured more than 20 speeches by international and domestic scientists and highly qualified specialists. Subsequently, they will serve as a scientific and practical foundation for the development of both military and general medicine. Discussions during the conference clearly showed the need for systemic changes in medical education, supplementing educational programs taking into account the vast experience of military medical professionals, and improving teaching methods.