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Introduction: With an increase in the prevalence of type 2 diabetes mellitus worldwide, the incidence of visual impairment due to diabetic retinopathy also increases. Aim: Тo systematize and analyze the available data on the clinical, social and economic benefits of introducing screening programs for diabetic retinopathy. Materials and Methods: The search for available publications regarding retinopathy screening in patients with type 2 diabetes mellitus is limited to the last ten years (1 January 2013-1 January 2024) and the PubMed scientific database. Results: One hundred sixty-four studies have been identified, 10 of which were included in this systematic review. Screening for diabetic retinopathy is a crucial step in preventing visual impairment and blindness, which can prove to be costly if left untreated. It is recommended that this screening should be covered by compulsory health insurance as it has been proven to be profitable from the health system perspective. However, annual screening is not necessary for all patients, and screening intervals should be individualized based on patient characteristics and the risk of developing diabetic retinopathy. Using artificial intelligence for screening can be a significant advantage in areas with insufficient access to health services. Efforts should be made to improve the methods for evaluating images obtained during screening, as manual assessment by medical professionals is more labor-intensive but cost-effective. Conclusions: It is necessary to develop national programs to prevent visual damage in patients at risk, such as those with diabetes mellitus. [ABSTRACT FROM AUTHOR]

BACKGROUND: Molecular genetic testing (MGT) is increasingly accessible, improving diagnosis of monogenic diabetes (DM), particularly maturity-onset diabetes of the young (MODY). While most MODY research focuses on pediatric populations, diagnosis is possible after age 18. The Federal Diabetes Registry (FDR) offers unique insights into real-world management of MODY patients.AIM: To analyze the clinical features of DM onset, carbohydrate metabolism, complications, and hypoglycemic therapy (HT) in patients with the main types of MODY based on the FDR data.MATERIALS AND METHODS: A cross-sectional analysis of the FDR was conducted. All patients with registered MODY diagnoses (MODY-1, MODY-2, MODY-3, or other) as of June 1, 2023, were included. The specified MODY type was considered indicative of prior MGT. Direct MGT results are not recorded in the FDR.RESULTS: The study included 640 patients. MODY2 was the most prevalent type (69.4%), followed by MODY1 (18.2%) and MODY3 (12.4%). The median age of DM diagnosis was 19 years for MODY1, 10 years for MODY2, and 14 years for MODY3. The majority of patients (71.4%) were diagnosed with MODY before the age of 18 years.While 61% of MODY2 patients received monotherapy with diet, others received various ADT. Sulfonylureas were commonly prescribed for MODY3 patients (45.8%), and for a smaller portion of MODY1 patients (14.1%). Insulin therapy was more frequent in MODY1 and 3 (35.9% and 31.2%, respectively). The target glycated hemoglobin level was achieved in 82% of MODY2 patients and in 50.7% and 52.9% of MODY1 and 3 patients, respectively.Diabetic complications were observed in 6.04% of MODY2 patients, 23.0% of MODY1 patients, and 22.0% of MODY3 patients. Specific complications included diabetic retinopathy (5.75%, 1.21%, and 3.39% in MODY1, MODY2, and MODY3, respectively), diabetic nephropathy (10.3%, 2.11%, and 11.9%), and diabetic polyneuropathy (14.9%, 4.53%, and 15.3%).CONCLUSION: The FDR analysis revealed real-world practice patterns in MODY management, highlighting a lack of standardized treatment approaches and potentially unnecessary insulin use. These findings, coupled with an expected rise in MODY diagnoses, underscore the need for clinical guidelines for this population.

Sulfonylurea (SU) are an effective class of oral hypoglycemic drugs that have been used in clinical practice for more than 70 years. Despite the common mechanism of action, members of the class have significant intraclass differences in hypoglycemic activity, safety, and the presence of extrapancreatic effects. This review examines the features of gliclazide modified release (MR), its differences from other representatives of the SU and its place in modern recommendations for the treatment of type 2 diabetes mellitus. Gliclazide MR belongs to the modern 2nd generation SU with high hypoglycemic activity, low risk of hypoglycemia due to reversible binding to the SUR1 receptor and no effect on the Epac2 pathway, generally neutral effect on weight, proven nephroprotective properties and cardiovascular safety, which makes it possible to highlight it among representatives of the SU class. International and national clinical guidelines indicate the place of SU when it is necessary to intensify glucose-lowering therapy and glycemic control in patients with type 2 diabetes mellitus.

Diabetic Charcot neuroosteoarthropathy is a manifestation of diabetic foot syndrome, accompanied by a high risk of foot ulcers and amputation. Many aspects of this pathology due to its features remain poorly understood, which leads to difficulties in determining the tactics of treatment of these patients. This review analyzes of anatomical and functional classifications of Charcot foot. The review focuses on the midfoot pathology as the most severe in their consequences. The advantages and disadvantages of different approaches to the description of the X-ray picture of the disease at its various stages are analyzed. The systematization of the literature allows us to conclude that the existing approaches to classification are relatively acceptable mainly when planning conservative treatment. At the same time, detailed anatomical and radiological classifications do not help in choosing the tactics of reconstructive surgical treatment. With the increasing availability of reconstructive surgery for severe deformities due to Charcot’s arthropathy, it seems appropriate to develop classification systems that could become a practical tool for determining surgical tactics in this pathology.

Today, diabetes mellitus (DM) represents a problem on which the attention of endocrinologists, general practitioners, and dentists is focused. Early pathological changes, which manifest themselves in the oral cavity, determine the relevance and social significance of this pathology, because dentists are usually the first to diagnose disorders of carbohydrate metabolism based on the results of the analysis of specific complaints and typical clinical symptoms of damage to the mucous membrane and periodontal tissues. The aim of the work is to find out the pathogenetic characteristics of the reparative component of the post-extraction alveolar socket depending on the time after tooth extraction in experimental diabetes. Materials and methods. In total, 120 sexually mature (age 8–10 months) male Wistar rats, divided into 8 groups of 15 animals each, were used for research. Complex immunohistological, radiographic and biochemical studies were used for the purpose of detailed analysis of the features of the course and mechanisms of development of complications after tooth extraction against the background of DM. In order to assess the state of the innate link of local immunity, the specifics of the course of repair processes at different times of the post-extraction period, the levels of cell proliferation (by expression of Ki-67) and the concentration and content of CD68-positive macrophages in the mucous membrane were determined immunohistochemically. In order to determine the state of the bone tissue of the dental and jaw apparatus and the levels of mineralization of the hard tissues of the molars in the animals of the experimental groups, radiovisiographic images of the right half-mandible were analyzed with determination of the radiographic density. Results. Analysis of proliferative-reparative relationships showed almost no macrophages and very low proliferative activity in the intact periodontium, on the other hand, in DM, initial significant diffuse infiltration by CD68-immunopositive cells with high levels of Ki-67 expression was found. Analysis of X-ray images of the half-mandible revealed that induced DM in rats, even without prior surgical intervention, led to the intensification of resorption processes in bone tissue, which was evidenced by a decrease in radiographic density in the root region of the 1st molar and intraalveolar bone membranes of all three lower molars. Conclusions. In the intact periodontium, there are almost no CD68-immunopositive macrophages and very low proliferation activity in the periodontal soft tissues. In experimental diabetes, on the contrary, initial significant diffuse infiltration by CD68-immunopositive macrophages with high proliferative activity of most fibroblasts is determined. Induced diabetes in rats, even without prior surgical intervention, leads to increased resorption processes in the bone tissue of the mandible and long-term prolongation of the inflammatory process after tooth extraction.

Background and Aim: Laboratory assessment of sialic acid as a marker of microvascular complications can be a diagnostic tool for diabetes mellitus. Microalbumin is an established predictor of diabetic nephropathy. The study was undertaken to evaluate serum sialic acid and microalbumin levels and to correlate it with glycemic control in diabetic nephropathy patients. Material and Methods: Clinically diagnosed diabetic nephropathy patientsvisiting the medicine OPD (outdoor patient department) and NCD (Non-Communicable Disease) were selected for the study. This study included 75 subjectswith diabetes types 2 of which 44 were males and 31were females. Control includes a total of 75 out of which 49 Males and 26 females. Blood samples were analysed for the glucose, C-reactive protein, and sialic acid. Urine sample was analyzed for microalbumin and sialic acid. Results: The mean value of FBS was 161±53.2 mg/dl which was significantlyhigher than controls 81±5.2. The Sialic acid in subjects was 105±21 mg/dl which is higher than controls 51±6 mg/dl. The urine microalbumin level was found to be 96.5±17.2 in subjects, whereas 6.4±1.6 mg/dl was in controls. Serum Creatinine level in subjects was 8.75±2.05 mg/dl which was higher than subjects 0.8±0.3mg/dl. Serum Urea in diabetic nephropathy subjects was 93.5±15.4 mg/dl, which is positively higher than controls 30.8±7.1 mg/dl. Conclusion: Urine microalbumin is established as a potential marker for diabetic nephropathy. The correlation of serum sialic acid, urine microalbumin and serum creatinine proposed serum sialic acid as an accessory diagnostic marker for diabetic nephropathy. Estimation of sialic acid before microalbumin in diabetic patients helps assess glycemic control and identify the risk for nephropathy and other secondary complications of diabetes mellitus, which are the main causes of mortality and morbidity among type-2 diabetes mellitus patients.

Aim. To study the long-term prognosis of patients’ life who have suffered cerebrovascular accident (CVA), and to determine the role of diabetes mellitus (DM) as a possible negative prognostic factor, according to the outpatient follow-up stage in the REGION-M registry.Material and methods. The outpatient part of the REGION-M registry included 684 patients assigned to the Moscow City Polyclinic No. 64, discharged from the hospital in the period from 01.01.2012 to 30.04.2017 with a confirmed diagnosis of CVA, of which 122 patients (17.8%) were diagnosed with DM. The polyclinic stage included three observation points: 2017, 2020, and 2022. Data on the life status of all patients were obtained by telephone survey, if it was impossible to establish contact with the patient or his relatives, a unified medical information and analytical system was used to determine the life status of patients. The study patients were observed on an outpatient basis for more than 5 years (ME 1958 (751; 2555) days), the primary endpoint was death from any cause.Results. Information about the life status was obtained for all 684 patients. By the end of the observation, 415 cohort members had died, and 269 were alive. The average age of patients with DM was significantly higher than that of patients without DM: 71.5±10.9 years vs 68.0±14.7 years (p

BACKGROUND: The results of surgical treatment of rectal fistulas (RF) directly depend on the accuracy of their diagnosis and the detection of a concomitant disease, such as diabetes mellitus (DM). To improve the results of surgical treatment, it is necessary to take into account the mutual influence of RF and DM, which can aggravate each other’s course.AIM: The study of the features of the course of RF against the background of DM and the assessment of their mutually aggravating influence.MATERIALS AND METHODS: 120 patients with RF were studied, which were divided into two groups: the main group (MG) included 60 patients with DM, the control group (CG) also included 60 patients without DM.RESULTS: In both groups, patients with transsphincteric RF dominated: 39 (65.0%) in the MG and 38 (63.3%) in the CG. Recurrent SPC prevailed in patients with DM (30.0% versus 15.0%), which indicates a more complex course of RF against the background of DM. It was found that in 17 (28.3%) patients, the stage of diabetes compensation after the formation of a fistula with a purulent cavity in the pararectal tissue passed into the stage of subcompensation and, due to an unstable decrease in blood sugar levels, it was necessary to replace tableted antidiabetic drugs with injectable insulin, which says about the deterioration of the course of diabetes against the background of chronic purulent inflammation in the pararectal tissue. The results of the study showed the presence of a direct correlation between the course of chronic paraproctitis and the stage of DM (r=0.50552, p

BACKGROUND: Previously, we presented the process of developing a clinical decision support system (CDSS) for adjusting insulin pump (IP) settings in children with type 1 diabetes mellitus (T1D) and assessing the agreement of the recommendations it generates with the expert opinion. The CDSS demonstrated satisfactory forecasting of glucose profile and agreement rates between recommendations CDSS and experts.AIM: To evaluate the effectiveness and safety of using CDSS in children with T1D, testing the hypothesis of non-inferiority (with a limit of -5%) of relative increase of glucose time in range (TIR) over 6 months.MATERIALS AND METHODS: The trial included 80 children with T1D, divided into two comparable groups of 40 children using the minimization method. Patients in the main group received recommendations for adjusting the IP settings from a physician who uses the CDSS; patients in the control group received recommendations from a physician (control group). Patients were observed for 6 months with remote consultations once a month (7 consultations in total) and monitoring of glycated hemoglobin (HbA1c) at 1, 4 and 7 consultations. The primary outcome is the difference in group mean relative changes in TIR (%), secondary outcomes are TIR (%), HbA1c concentration. RESULTS: The trial was completed by 63 patients 32 in the main group, 31 in the control group. The difference in the mean relative increase in TIR at the 7th consultation in the groups was 3.02%, one-sided 95% CI (-4.55%; inf ). Thus, the lower bound of this CI is greater than the noninferiority limit of -5%, and the noninferiority hypothesis can be accepted. There were no statistically significant differences between groups for all outcomes. The dynamics of the indicators were positive in the main group and had a statistical tendency towards positive changes in the control group.CONCLUSION: The use of CDSS was no less effective in terms of the TIR than the management of the patient by a physician. The use of CDSS in clinical practice can help in regular and frequent monitoring of children with T1D, and standardize at a high level the approach to correction of IP parameters, supplemented with CGM.

BACKGROUND: Widely available diabetes devices (continuous glucose monitoring, insulin pump etc.) generate large amount of data and development of an advanced clinical decision support system (CDSS), able to automatically evaluate and optimize insulin therapy, is relevant.AIM: Development of a mathematical model and an CDSS based on it to optimize insulin therapy in children with type 1 diabetes (T1D) and assessment of the agreement between the recommendations of the CDSS and the physician on insulin pump (IP) parameters: basal profile (BP), carbohydrate ratio (CR), correction factor (СF).MATERIALS AND METHODS: Data from 504 children with T1DM were analyzed over the period of 7875 days. The data included glucose, insulin, food, sex, age, height, weight, diabetes duration and HbA1c. We constructed recurrent neural network (RNN) to predict glucose concentration for 30-120 minutes, an algorithm for optimizing IP settings using prediction results. Next, a software product was developed — a CDSS. To assess the agreement of the recommendations of the CDSS and physicians, retrospective data from 40 remote telemedicine consultations of 40 patients with T1D (median age 11.6 years [7; 15]) were used and 960 points of possible adjustments were analyzed. Three degrees of agreement have been introduced: complete agreement, partial agreement, and complete disagreement. The magnitude of the adjustments was also analyzed.RESULTS: The accuracy of glycemic predictions was better or comparable with other similar models. The assessment of agreement for BP, CR and CF, according to the Kappa index, showed slight and weak agreement. The frequency of complete agreement between recommendations for adjusting the ongoing IP therapy between the CDSS and physicians is 37.5–53.8%, and complete inconsistency is 4.5–17.4%. From a clinical point of view, consistency in the frequency of occurrence of the indicator is more important. There were no differences in median IP settings between the CDSS and physicians.CONCLUSION: The CDSS has an acceptable accuracy of glycemic predictions. The CDSS and physicians provide comparable recommendations regarding CSII parameters.

Insulin resistance (IR) and type 2 diabetes mellitus (T2D) represent serious, steadily progressing global epidemics involving millions of people all over the world. IR is associated with numerous concomitant disorders, including T2D that inevitably complicates the course and outcomes of cardiovascular disorders and represents one of the leading causes of death in the population [1]. It is well known that IR leads to hyperinsulinemia, increase in chronic inflammation and oxidative stress, which finally result in the vascular wall morphofunctional alterations and accelerate atherogenesis and arteriosclerosis. Micronutrients, such as selenium (Se) and zink (Zn) that are involved in antioxidant defense and maintaining reparative properties of the endothelium, play an important role in these processes. Furthermore, selenium regulates the immune function and some glucose metabolism processes, which causes interest in their role in the pathogenesis of IR and T2D. The paper provides the analysis of current data on the impact of selenium on the risk of T2D based on the recent studies.

Aim – to develop and provide clinical substantiation of experimental mathematical models for the chronic kidney disease (CKD) progression rate in patients with type 2 diabetes mellitus (T2DM) using the glomerular filtration rate reduction index (RI_GFR) as original diagnostic parameter. Material and methods. A cross-sectional observational study of clinical status indices was performed in a sample of patients with type 2 diabetes. The significant predictors of a high rate of CKD progression were identified by regression analysis, three variants of experimental mathematical models were developed with different combinations of arguments with an emphasis on modifiable factors. Results. The method of one-dimensional logistic regression analysis revealed the indices of clinical status having a significant impact on the rate of CKD progression on the scale of changes in RI_GFR by 1 ml/min/1.73 m2 and on the binary classification of outcomes in the groups of "slow" and "fast" decrease in kidneys filtration function with a threshold value of RI_GFR of 4.21 ml/min/1.73 m2 per year. These indices were age, body mass index (BMI), glycemia and duration of diabetes at the time of visit, history of insulin therapy, acute myocardial infarction in the anamnesis, pulse on the popliteal artery, concomitant retinopathy, hypertension risk group, treatment with sulfonylureas and calcium antagonists. Using multidimensional logistic regression, three types of experimental mathematical models were developed, including various combinations of predictors that demonstrated high values of diagnostic significance. Conclusion. The mathematical modeling of CKD progression in patients with T2DM with the RI_GFR diagnostic index allows for better understanding of the pathology's development patterns. An experimental mathematical model using modifiable drug factors that a doctor can manage during the treatment (administration of sulfonylureas and calcium channel blockers) demonstrated 55.6% sensitivity, 85.3% specificity, AUC 0.76 (0.65; 0.86), which ensured high quality prediction with an accuracy of 77.5%.

Aim. To compare the frequency of cardiovascular events (CVE), to assess the risk of cardiovascular death using the mSCORE and the development of type 2 diabetes mellitus (DM) using the FINDRISC in patients with rheumatoid arthritis (RA) with and without hypothyroidism. Materials and methods. The study included 149 patients (125 women, 24 men) with RA (median age – 57 [52; 61] years). In all patients, traditional factors of cardiovascular risk and glucose metabolism disorders (age, smoking status, total blood cholesterol, blood pressure, overweight, abdominal obesity – AO, heredity burdened by diabetes, insufficient physical activity, the lack of the necessary amount of berries, fruits and vegetables in the daily diet, history of hyperglycemia episodes), the 10-year risk of death from cardiovascular causes according to the mSCORE and the risk of developing type 2 DM according to the FINDRISС were assessed, a history of CVE (myocardial infarctions, and its revascularization, stroke) was recorded. Results. Hypothyroidism was diagnosed in 17.4% of RA patients. Patients with hypothyroidism (group 1) were more likely to have AO and less likely to consume unsufficient dietary fiber than patients with euthyroidism (group 2). Moderate, high and very high risk of development according to the mSCORE and FINDRISC was detected in 61.5% of hypothyroid patients and 48.8% euthyroid patients, according to mSCORE alone – in 30.8 and 44.7%, according to FINDRISC – in 0 and 2.4%, respectively (p0.05 in all cases); 11.5% of patients in group 1 and 6.5% in group 2 suffered from CVE (OR 1.875, 95% CI 0.462–7.607; p=0.63). Conclusion. It is necessary to evaluate the thyroid gland function, especially in patients with AO due to the high frequency of hypothyroidism in RA. Hypothyroidism did not have an independent effect on the severe CVЕ rates, as well as risk assessment according to the score and FINDRISC in RA patients. Theses, with and without hypothyroidism, were predominantly in the moderate, high, very high risk groups according to both scales.

The use of non-steroidal anti-inflammatory drugs (NSAIDs) for a wide range of diseases is increasing, in part due to an increasing elderly population. Elderly patients are more vulnerable to adverse drug reactions, including side effects and adverse effects of drug-drug interactions, often occurring in this category of patients due to multimorbidity and polypharmacy. One of the most popular NSAIDs in the world is celecoxib. It is a selective cyclooxygenase (COX)-2 inhibitor with 375 times more COX-2 inhibitory activity than COX-1. As a result, celecoxib has a better gastrointestinal tract safety profile than non-selective NSAIDs. Gastrointestinal tolerance is an essential factor that physicians should consider when selecting NSAIDs for elderly patients. Celecoxib can be used in a wide range of diseases of the musculoskeletal system and rheumatological diseases, for the treatment of acute pain in women with primary dysmenorrhea, etc. It is also increasingly used as part of a multimodal perioperative analgesia regimen. There is strong evidence that COX-2 is actively involved in the pathogenesis of ischemic brain damage, as well as in the development and progression of neurodegenerative diseases, such as Alzheimer's disease. NSAIDs are first-line therapy in the treatment of acute migraine attacks. Celecoxib is well tolerated in patients with risk factors for NSAID-associated nephropathy. It does not decrease the glomerular filtration rate in elderly patients and patients with chronic renal failure. Many meta-analyses and epidemiological studies have not confirmed the increased risk of cardiovascular events reported in previous clinical studies and have not shown an increased risk of cardiovascular events with celecoxib, irrespective of dose. COX-2 activation is one of the key factors contributing to obesity-related inflammation. Specific inhibition of COX-2 by celecoxib increases insulin sensitivity in overweight or obese patients. Combination therapies may be a promising new area of treatment for obesity and diabetes.

Objective. To consider modern means of monitoring glycemia using a mobile application that allows remote control of diabetes mellitus (DM). The main provisions. The problem of self-control of DM in the modern world does not lose relevance. Recommendations on the management of patients with DM are updated annually. New approaches to self-monitoring of glycemia are being developed, innovative glucose meters are being introduced, which are a system with a mobile application.

The XVII Moscow City Congress of Endocrinologists, "Endocrinology of the Capital – 2024," is one of the most significant medical events in Russia's field of endocrinology. The event brings together leading domestic and international experts in endocrinology to present reports, symposia, and seminars on the latest developments in treatment and personalized therapeutic strategies. Leading Russian experts discussed recent advances in the treatment of type 2 diabetes mellitus. They analyzed the current global trends in combined drug therapy, presented new data on hypoglycemic medication safety and efficacy for pregnant women with type 2 diabetes mellitus, and discussed the significance of non-alcoholic fatty liver disease in carbohydrate metabolism disorders.

Obesity is a complex condition that is associated with various metabolic disorders and has a significant social impact. Weight loss is primarily achieved through dietary changes, such as reducing calorie intake. Therefore, it is essential to provide patients with effective weight loss programs and recommend a low-calorie diet as soon as possible. In addition to drug therapy for metabolic disorders, it is crucial to educate patients about the importance of a healthy diet and encourage them to adopt a low-calorie approach. Numerous studies have demonstrated the effectiveness of low-calorie and very low-calorie diets for treating obesity. However, compliance with these diets can be challenging, as they require careful attention to nutritional value and the balance of macronutrients and micronutrients. Prolonged adherence to reduced dietary regimens can lead to hypovitaminosis, lack of dietary fiber, or decreased protein intake. In 2024, a new product for balanced low-calorie nutrition, OPTIFAST, was introduced on the Russian market by the Nestlé Health Science company in Germany. This product provides patients with all essential nutrients and allows them to manage their daily calorie intake. It also provides a feeling of fullness that is essential for maintaining adherence to a low-calorie diet and ensuring effective and safe weight loss, primarily through adipose tissue reduction.

Recent decades have been marked by a rapid increase in the number of patients suffering from diabetes. The development and progression of complications of the disease have the greatest impact on the life prognosis of patients with diabetes mellitus. One of the common complications of diabetes mellitus is diabetic polyneuropathy. According to expert estimates, diabetic polyneuropathy develops in 50% of patients with diabetes mellitus and in 10–30% of patients in a prediabetic state. In domestic clinical recommendations and algorithms, the treatment of diabetic polyneuropathy is considered only in terms of drugs used to treat the painful form of diabetic polyneuropathy. In the recommendations of international experts, pathogenetically oriented pharmacotherapy (alpha-lipoic acid and benfotiamine) occupies an important place. As part of the review, we examined the use of B vitamins for the treatment of diabetic polyneuropathy. We searched for relevant sources in the PubMed and Scopus information databases, including the time period up to 12.04.2024. Experience with the use of B vitamins shows that their maximum effectiveness is achieved when they are used in combination, which is due to the complementary effect of each individual vitamin. The use of a combination of vitamins B1, B6 and B12 for diabetic polyneuropathy normalizes reflex reactions, helps eliminate sensitivity disorders, increases the speed of conduction along nerve fibers, and has a moderate analgesic effect.

Metformin is a sugar-lowering drug that is actively used in long-term therapy of type 2 diabetes mellitus (DM2). The safety of metformin for different groups of DM2 patients is currently well studied. However, the drug is contraindicated for patients with severe renal impairment and should be used with caution in cases of moderate renal impairment. Since contrast agents as well as metformin are excreted by kidneys, patients with reduced renal function taking metformin require special attention due to the risk of lactic acidosis, a life-threatening condition resulting from functional renal failure and accumulation of metformin in tissues. Numerous studies have shown that the risk of lactic acidosis is relatively low and in most cases is not associated with metformin therapy per se, but rather with comorbidities. Initial versions of clinical recommendations related to the use of contrast agents strictly limited the use of metformin before and after examination, but as data on lactate acidosis and possible causes of this condition expanded, the recommendations gradually became less strict. For emergency contrast studies, they are currently unchanged, but data are gradually accumulating on the safety of continuing metformin in these clinical situations. There is no consensus among contrast manufacturers on whether and in what regimen metformin should be interrupted during contrast studies as well as on a number of other related issues. The best strategy for clinicians is to check the instructions for each specific drug before use.

Proton pump inhibitors (PPIs) are the most effective drugs for treating acid-related diseases. In recent decades, the use of PPIs has increased exponentially. From gastroenterological practice, PPIs are being actively introduced into other specialties, in particular in cardiology and rheumatology, where they are used to protect the mucous membrane of the gastrointestinal tract and prevent gastrointestinal bleeding during long-term antithrombotic therapy and long-term use of non-steroidal anti-inflammatory drugs. For a long time, PPIs were considered completely safe drugs for both short-term and long-term use. However, modern clinical guidelines note that when prescribing PPIs in large doses for a long period, the possibility of side effects should be taken into account. In recent years, a number of foreign reviews have been published that examine the relationship between PPIs and a number of diseases/conditions, including the question of a possible association of PPI use with an increased risk of cardiovascular complications, but note the inconsistency of these data. We searched the PubMed and Scopus information databases for publications on the safety of PPI use, including sources up to 12/01/2023. In this review, we examined the possible cardiovascular risk of long-term use of PPIs. Analysis of publications, despite a number of contradictions, allows us to conclude that the cardiovascular risk with long-term use of PPIs is real and must be taken into account when prescribing PPIs for a long period and to comorbid/multimorbid patients.

BACKGROUND: The relevance of the study is justified by the fact that in recent years, the original insulin preparations have been replaced with biosimilars in the regions of the Russian Federation, but there are currently few studies describing the use of insulin biosimilars in children with type 1 diabetes mellitus (DM1), both in domestic and foreign sources.AIM: To evaluate the efficacy and safety insulin therapy with RinFast® (GEROPHARM LLC, Russia) as bolus therapy in combination with long-acting insulin and as monotherapy in an insulin pump in children with DM1 in real clinical practice.MATERIALS AND METHODS: The dynamics of HbA1c after 3 and 6 months, the change in daily insulin requirements, the fre quency of episodes of postprandial hyper- and hypoglycemia, adverse reactions at injection sites, the number of patients who reached the target values of HbA1c in children with DM1 who received RinFast® at least 6 months after the original analogue of insulin aspart were evaluated.RESULTS: The study was conducted in 50 children with DM1 from 1 to 18 years old (average age 9.8±4.6 years), with a duration of DM1 of more than 1 year (average duration 3.5±2.1 years), who had glycated hemoglobin (HbA1c) at the beginning of follow-up of no more than 9.5% and received biosimilar RinFast® for at least 6 months after the transfer from the original analogue of insulin aspart. Basic bolus insulin therapy in 36 children was carried out using multiple injections of insulin (MII), in 14 — continuous supply of insulin (NPI) using an insulin pump. The study resulted in HbA1c levels comparable to the baseline 3 and 6 months after the start of therapy with the RinFast® biosimilar (p=0.05), no changes in the daily ­insulin ­requirement (p=0.05) and no increase in the frequency of episodes of postprandial hyper- (p=0.05) and hypoglycemia (p=0.05) and adverse events (p=0.05). High adherence to treatment with the RinFast® biosimilar was noted.CONCLUSION: The results obtained indicate the absence of a clinically significant deterioration in glycemic control indicators after the transfer of children with DM1 to therapy with the RinFast® biosimilar, which makes it possible to use it safely and effectively in this category of patients.

Last time there are a lot of date, published systematic reviews and meta-analyses about relationship between eating behavior and incidence type 2 diabetes. It is known that more than 80% of cases of type 2 diabetes are associated with obesity. In this regard, the nutritional factor is of particular importance in the formation of treatment goals for patients with type 2 diabetes. Today, the disease is no longer a sentence, because achieving remission of type 2 diabetes is possible with the help of nutritional correction. The results of studies shown that a significant decrease in body weight is a predictor of remission of type 2 diabetes. However, the question of the best dietary recommendations for patients with type 2 diabetes remains open. Various dietary patterns (Mediterranean, paleo diet, DASH system, etc.) contribute to the improvement of glycemia, however, there is not enough data indicating a regression of symptoms of type 2 diabetes. In all likelihood, achieving remission is possible only with a significant reduction in daily caloric intake. The ketogenic diet, especially popular in recent times, also improves glycemic control. At the same time, according to the results of a meta-analysis, carbohydrates from whole grains and cereal fibers should not be neglected, because this category of products helps reduce the risk of developing diabetes.

BACKGROUND: It is important to evaluate the effect of androgen replacement therapy on glycemic control.AIMS: Assessment of the effect of transdermal testosterone therapy on glycemic control in men with hypogonadism and T2DM.MATERIALS AND METHODS: The prospective, comparative study included 300 men aged 55[49;61] years: men receiving both glucose-lowering therapy (GLT) and transdermal testosterone; and patients receiving only GLT. Observation period 1 year. A medical history, a questionnaire for symptoms of androgen deficiency, and measurement of total testosterone and glycated hemoglobin were carried out. Groups were compared using nonparametric methods.RESULTS: Patients receiving androgen replacement therapy in combination with GLT at both 6 and 12 months from the moment of inclusion in the study, they had a statistically significantly higher level of total testosterone and less severity of symptoms of androgen deficiency. When assessing the magnitude of changes in the studied parameters, it was found that patients receiving testosterone replacement therapy (TRT) were characterized by a statistically significantly more pronounced decrease in the level of glycated hemoglobin (average difference 0,3%). In 29 (20,4% (95% ДИ 13,8–27,0)) men who received only GLT, hypogonadism was eliminated. In 3 patients from the TRT group, a pathological increase in the level of total blood PSA was observed, and therefore TRT was discontinued. An increase in hemoglobin above the reference value (>172 g/l) was detected in 8% and 1,3% of men on TRT and without correction of hypogonadism, respectively, p=0,011.CONCLUSIONS: The combination of transdermal TRT and GLT has a positive effect on glycemic control, which is manifested by a decrease in glycated hemoglobin to a greater extent than when using GLT alone. Normalization of testosterone levels leads to a decrease in the symptoms of androgen deficiency, which is accompanied by an improvement in quality of life. Elimination of hypogonadism only with GLT is possible in a small number of cases.

BACKGROUND: The incidence of diabetes mellitus (DM) both in the Russian Federation and in the world has been steadily increasing for several decades. Stable population growth and current epidemiological characteristics of DM lead to enormous economic costs and significant social losses throughout the world. The disease often progresses with the development of specific complications, while significantly increasing the likelihood of hospitalization. The creation and inference of a machine learning model for predicting hospitalizations of patients with DM to an inpatient medical facility will make it possible to personalize the provision of medical care and optimize the load on the entire healthcare system.AIM: Development and validation of models for predicting unplanned hospitalizations of patients with diabetes due to the disease itself and its complications using machine learning algorithms and data from real clinical practice.MATERIALS AND METHODS: 170,141 depersonalized electronic health records of 23,742 diabetic patients were included in the study. Anamnestic, constitutional, clinical, instrumental and laboratory data, widely used in routine medical practice, were considered as potential predictors, a total of 33 signs. Logistic regression (LR), gradient boosting methods (LightGBM, XGBoost, CatBoost), decision tree-based methods (RandomForest and ExtraTrees), and a neural network-based algorithm (Multi-layer Perceptron) were compared. External validation was performed on the data of the separate region of Russian Federation.RESULTS: The best results and stability to external validation data were shown by the LightGBM model with an AUC of 0.818 (95% CI 0.802–0.834) in internal testing and 0.802 (95% CI 0.773–0.832) in external validation.CONCLUSION: The metrics of the best model were superior to previously published studies. The results of external validation showed the relative stability of the model to new data from another region, that reflects the possibility of the model’s application in real clinical practice.

The article presents the result of our own observation of the patient with a poor control of type 2 diabetes mellitus (DM) for a long period, complicated by obliterating atherosclerosis of the arteries of the lower extremities, Menckeberg’s sclerosis and chronic ischemia threatening loss of the lower extremity (CLLI). A feature of the clinical manifestation are complications associated with potentially regional (angiosomal) ischemia of the foot, as well as variant anatomy, represented by hypoplasia of the vascular lower leg in the patient. The clinical consequences of vascular calcification due to long-term decompensation of carbohydrate metabolism and the development of diabetic distal polyneuropathy (DDP) led to falsely high values of the cuff test in the patient. Disadvantages of non-invasive methods for diagnosing limb ischemia and advantages of the complex application of tests for diseases of the arteries of the lower extremities are discussed. Using WIFI classification according to the degree of ulceration, the degree of ischemia, and the degree of infection on the foot (Wound, Ischemia and Foot Infection), the tactics of managing the patient are presented. The important role of ultrasonic duplex scanning (USDS) in the visualization of the arteries of the legs and feet in patients with DM is substantiated. The importance of a multidisciplinary approach in the management of a comorbid patient with type 2 diabetes and CLTI is emphasized.

AIM: to assess proliferation and migration of keratinocytes at the nonhealing edges of neuropathic wounds.MATERIALS AND METHODS: 25 patients with neuropathic ulcers and 5 patients without diabetes with decubitus were enrolled. Diabetic foot (DF) patients were underwent to standard treatment including debridement, atraumatic dressing, offloading, antibacterial therapy if it needs. Severity of peripheral neuropathy was assessed according to the NDS scale. Histo­logical (hematoxylin and eosin) and immunohistochemical (Ki-67 , α7nAChR markers) examination of wound edge were done during treatment (0, 10, 24 days).RESULTS: All patients have severe neuropathy according to NDSm (>8). The average size of DF ulcers before and on 10th day of treatment was of 4 cm2 and 2,5 cm2, respectively (p

Atypical antipsychotics (novell atypical generation antipsychotics) have entered clinical practice recently, but despite this, they have already managed to occupy one of the leading positions in modern therapy of mental disorders such as schizophrenia and bipolar affective disorder. It is known that treatment with antipsychotics of both generations is associated with a number of side effects. When using atypical antipsychotics, metabolic disorders, including carbohydrate metabolism, occupy a leading place. A number of scientific studies, the analysis of which we are conducting in this review, describe the mechanisms of development of such changes in glucose homeostasis as hyperglycemia and insulin resistance in patients receiving therapy with second-generation antipsychotics (atypical). Another proven side effect is an increase in appetite and an increase in body weight. It is obvious that such metabolic changes have the potential to lead to the development of type 2 diabetes mellitus in the long term. The relevance of the study lies in the fact that the use of atypical antipsychotics is not always among the causes of drug-induced diabetes mellitus. In this regard, not all internists, endocrinologists, general practitioners, and sometimes even psychiatrists consider patients receiving treatment with these drugs to be at increased risk. Consequently, primary and secondary prevention of diabetes mellitus among such patients may not be carried out or may be insufficient. In this review, through meta-analysis, we summarized data on the effect of the main representatives of atypical antipsychotics on the possibility of developing type 2 diabetes mellitus, and also examined in more depth the pathogenesis of carbohydrate metabolism disorders in patients receiving therapy with these drugs.

The article discusses current ideas about the pathogenesis, risk factors, and new methods of diagnosis and treatment of diabetic retinopathy. This disease is a specific microvascular ocular complication of diabetes mellitus and is part of the group of ischemic retinopathies, which are characterized by a significant violation of capillary perfusion, the development of intraocular newly formed vessels and retinal edema. Statistics show that almost 366 million people in the world suffer from diabetes mellitus (IDF Atlas, 2011). According to forecasts, this number is expected to double by 2030, and this global growth will have a huge impact on the prevalence of diabetic retinopathy. Over the past decade, advances in medical technology and the development of new treatment methods have significantly improved the diagnosis and treatment of patients, but nevertheless, diabetic macular edema and proliferative diabetic retinopathy remain the leading causes of vision loss.

Background. Type 2 diabetes mellitus (DM) remains the most common type of DM and is associat-ed with disabling complications, reduced quality of life and reduced life expectancy. Satisfactory control of carbohydrate metabolism remains the key way to manage them. Aim. To perform a retrospective analysis of carbohydrate metabolism (in terms of glycated hemoglobin – HbA1c), the prevalence of complications, and features of hypoglycemic and concomitant therapy in patients with type 2 DM. Materials and methods. The analysis of sex and age characteristics, achieved level of HbA1c, diabetes complications, sugar-reducing and concomitant therapy according to the data of outpatient records of the patients who are on dispensary registration with an endocrinologist in the Endocrinology Department of the Consultative and Diagnostic Polyclinic of the Tomsk Regional Clinical Hospital in Tomsk was carried out. Results. 546 outpatient medical records of patients with type 2 DM were analysed, among which there were 39.6% men (n=216) with a history of type 2 DM 8.0 years [3.0; 13.0] , median age 64.0 years [54.5; 71.0] and 60.4% women (n=330), history of type 2 DM 10.0 years [5.0; 15.0], median age 70.0 years [63.0; 75.0]. The achieved HbA1c level in men was 7.6% [6.3; 9.0] and in women 7.4% [6.4; 9.1]. 19.4% of men and 13.6% of women had an aggravated history of type 2 DM. According to the history, 6.5% of men (n=14) and 3% of women (n=10) with type 2 DM had a history of stroke, and myocardial infarction 12% (n=26) and 1.5% (n=5), respectively. Among the analysed outpatient records of type 2 DM patients, 18.5% of men (n=40) and 12.4% of women (n=41) were found to have diabetic nephropathy. Diabetic retinopathy was reported in 9.3% (n=20) of men and 4.2% (n=14) of women. Diabetic macroangiopathies were detected in 29.6% (n=64) of males and 9.7% (n=32) of females. Among other chronic complications of DM, diabetic neuroosteoarthropathy was recorded in 1% (n=2) of males and 3% (n=10) of females, diabetic polyneuropathy in 25% (n=54) and 21.5% (n=71), respectively. Diabetic foot was diagnosed in 1.9% (n=4) of men and 1.8% (n=6) of women. Among comorbid pathology, obesity was diagnosed in 45.4% (n=88) of men and 69.1% (n=228) of women, dyslipidaemia in 10.2% (n=22) and 10.6% (n=35) respectively, hypertension in 39.8% (n=86) and 32.6% (n=108) of cases. The diagnosis of non-alcoholic fatty liver disease was verified in 3.7% of men (n=7) and 1.8% of women (n=6), chronic heart failure in 7.4% of men (n=16) and 2.4% of women (n=8) registered for type 2 DM. According to the analysed outpatient records, 4.1% (n=23) of patients received diet therapy, 48.3% (n=263) received monotherapy and 47.6% (n=260) received combination therapy for type 2 DM. Metformin was the most commonly used monotherapy for type 2 DM 36.1% (n=197), followed by insulin 6.9% (n=38), sulfonylurea derivatives – 2.7% (n=15). Combination of metformin and dipeptidyl peptidase-4 inhibitors (13.9%) was the most commonly used combination therapy. Conclusion. Analysis of the current situation in the diabetology service will help to identify weaknesses and strengths, which is necessary to optimise existing therapeutic approaches in accordance with current clinical recommendations.

Classical knowledge about the pathogenesis of diabetes and its complications in recent years has been supplemented by ideas about the role of chronic inflammation. It has been established that inflammatory reactions play a role in the beta cell dysfunction, the formation of insulin resistance and remodeling of the vascular wall. Cytokines, soluble low molecular weight proteins and peptides that perform informational and regulatory functions, play central role in the development of inflammation. A wide range of biological activity and involvement in many aspects of pathogenesis make it possible to consider cytokines as promising molecules for diagnosing and predicting the complications. In this review, we summarize data from studies that assessed the role of cytokines as diagnostic and prognostic markers for the development of microvascular diabetic complications. Current data indicate that angiogenic and pro-inflammatory cytokines (VEGF, TNF-α, IL-6, IL-8, IL-15, IL-17, MCP-1, IP-10, INF-γ, PEDF, etc.) are promising biomarkers for proliferative diabetic retinopathy, especially when their local production is assessed (in vitreous, aqueous humor and tears). The role of these molecules as biomarkers of non-proliferative diabetic retinopathy and diabetic macular edema needs further research. Serum proinflammatory and fibrogenic cytokines (primarily MCP-1, IL-6, TNF-α, YKL-40, TGF-β and bFGF) and cytokine receptors (sTNFR1, sTNFR2) are considered as promising diagnostic and prognostic markers of diabetic kidney disease. Urinary excretion of IL-6 and MCP-1 turned out to be a predictor of the progression of diabetic nephropathy. Multi-bead assay and mass spectrometry make it possible to study cytokine panels in small samples of biological material. Combined biomarkers, including several cytokines, may increase the reliability of the prognosis of diabetic complications.

BACKGROUND: Overweight and obesity have a significant impact on the course and results of treatment of many diseases, including cancer. One of the modern types of antitumor therapy is immune checkpoint inhibitors. Taking into account the high effectiveness of immune checkpoint inhibitors for various types of tumors, it seems interesting to study the initial anthropometric data of patients and assess the possible influence of nutritional status on the development of endocrine immune-mediated adverse events.AIM: To compare groups of patients with different starting body mass index (BMI) before the first administration of the immune checkpoint inhibitors drug and analyze the risk of developing endocrine immune-mediated adverse events in the future.MATERIALS AND METHODS: The single-center study included 172 patients who were recommended antitumor therapy immune checkpoint inhibitors at the N.N. Blokhin National Medical Research Center of Oncology and Moscow City Oncology Hospital №62 in 2020–2022. Measurement of height and body weight with further calculation of BMI was carried out before the first administration of the drug immune checkpoint inhibitors.Depending on the subsequent occurrence of immune-mediated adverse events, patients were divided into groups: those with developed immune-mediated adverse events (any, cutaneous, thyroid) and those without immune-mediated adverse events (any, cutaneous, thyroid).RESULTS: According to the results of our study, in 38 patients (37.3%) out of 102, for whom data on the presence/absence of any immune-mediated adverse events were obtained, the following were recorded: thyropathies (n=13, 12.7%), skin lesions (n=13, 12.7%), gastrointestinal toxicity (n=7, 6.9%), hepatotoxicity (n=4, 3.9%), hypophysitis (n=2, 2%), nephritis (n=2, 2%), diabetes mellitus (DM) (n=1, 1%), hematological toxicity (n=1, 1%), pneumonitis (n=1, 1%), Guillain-Barré syndrome (n=1, 1%). At the same time, in most patients only one immune-mediated adverse event was encountered (n=31, 81.6%), two immune-mediated adverse events were detected significantly less frequently (n=7, 18.4%).When conducting a comparative analysis of groups of patients with developed immune-mediated adverse events, including dermatological ones, or their absence, a statistical trend in differences in BMI was obtained. Using ROC analysis, a BMI cut-off point was determined equal to 28.16 kg/m² for all immune-mediated adverse events and 25.39 kg/m² for skin immune-mediated adverse events, below which, contrary to the available data, the risk of developing immune-mediated adverse events increased, but the diagnostic sensitivity (DS) and diagnostic specificity (DS) turned out to be low.CONCLUSION: We identified a statistical trend in the risk of developing immune-mediated adverse events (primarily dermatological) with a lower BMI before the start of antitumor immunotherapy immune checkpoint inhibitors. More research is required to find a more reliable relationship.

Aim. To assess the impact of atherosclerotic plaque (ASP) on the local arterial stiffness of the common carotid arteries (CCA) in patients with stage II hypertension (HTN) in combination with type 2 diabetes mellitus (T2DM). Materials and methods. The study included 37 patients with stage II HTN and T2DM (mean age 60.4 ± 10.7; 66.7 % male). Patients were divided into two groups: 20 individuals with ASP and 6.35 mmol/l (p = 0.036) and independent of age and sex. A greater left CCA diameter of more than 8.59 mm (p < 0.019) and right CCA diameter of more than 8.1 mm (p < 0.0001) increases the OR of ASP by 3.7 times (p = 0.001) and 6.6 times (p = 0.0013), respectively, the factor influence increases after adjusting for elevated total cholesterol levels over >6.35 mmol/l (p = 0.031) and it is also unaffected by age and sex. Conclusions. In individuals with stage II HTN and T2DM, the presence of CA atherosclerosis with stenosis up to 50 % is associated with a significantly increased CCA and ascending aorta diameter, a decreased percentage of AT, and an increased compliance coefficient of plaque-free wall segments.

SCIENTIFIC RELEVANCE. The clinical features of COVID-19 in patients with comorbidities, including diabetes mellitus (DM), have already been discussed in the medical literature. However, the available data on blood glucose levels in patients with DM during SARS-CoV-2 infection and after COVID-19 vaccination are clearly insufficient to estimate the importance of the changes taking place.AIM. The study aimed to show that patients with DM or impaired glucose metabolism need glycaemic monitoring during COVID-19 disease and after COVID-19 vaccination, drawing on the example of a clinical case.MATERIALS AND METHODS. The study analysed the medical records of a 58-year-old male patient newly diagnosed with DM. He received inpatient and outpatient treatment after COVID-19 vaccination and SARS-CoV-2 infection in February–November 2021. In 2014, the patient was diagnosed with impaired glucose metabolism, including fasting hyperglycaemia (≤ 9 mmol/L), which was corrected by diet.RESULTS. After vaccination with Gam-COVID-Vac component 1 in February 2021, the patient developed polydipsia, polyuria, and arterial hypertension. His laboratory findings were as follows: blood glucose, 25 mmol/L; glycated haemoglobin, 10.7%; fasting insulin, 28.4 μIU/mL; calcium, 2.45 mmol/L; and 25-hydroxyvitamin D, 21 ng/mL. The patient was diagnosed with new-onset type 2 DM, admitted to the endocrinology department of a multidisciplinary hospital, and discharged when his condition stabilised after 14 days of treatment. After vaccination with Gam-COVID-Vac component 2, the patient’s glucose levels did not change. In November 2021, the patient was diagnosed with SARS-CoV-2 infection. Even though all symptoms had resolved within 3 days, the virus persisted in the blood for 12 days without clinical manifestations of the disease. This was confirmed by repeated polymerase chain reaction testing. The patient had moderate hyperglycaemia despite antidiabetic treatment; his glucose levels were restored to normal without hospitalisation.CONCLUSIONS. Timely vaccination against COVID-19 in patients with DM, hypertension, and obesity contributes to a mild course of COVID-19 and helps avoid complications in the lungs and other organs. For patients with DM or glucose metabolism disorders, blood glucose monitoring is advisable for detecting and correcting possible hyperglycaemia after vaccination and/or recovery from COVID-19.

Background. Until now, urgent pathology of the abdomen remains in the focus of attention in modern abdominal surgery, which is due to the preservation of a high level of morbidity and mortality. Therefore, it is relevant to search for treatment regimens to optimize the results of treatment, especially in comorbid pathology with diabetes mellitus. The purpose of the study is to establish the effectiveness of metabolic and laser therapy in the correction of homeostasis and microcirculation disorders in the early postoperative period in patients with comorbid urgent pathology of the abdomen with diabetes mellitus. Materials and methods. 38 patients with acute abdominal diseases complicated by peritonitis and diabetes mellitus of both types were studied: the first (n=20) – treatment of patients according to clinical recommendations; the second (n=18) – complex treatment included laser therapy and remaxol. The patients have been operated on. Observation stages 1, 3 and 5 days after surgery. The microcirculation, the level of toxins, the severity of oxidative stress and the activity of phospholipase A2 were evaluated. Results. It was found that in patients who underwent surgical interventions for acute surgical pathology of the abdomen, having diabetes mellitus, significant phenomena of endogenous intoxication occurred in the early postoperative period, which was accompanied by phenomena of oxidative stress and increased phospholipase activity. Patients in the early postoperative period had significant microcirculation disorders. In the group of patients whose treatment included laser therapy and remaxol, homeostasis and microcirculation disorders were less pronounced. It turned out that the number of complications in patients who occurred in the early postoperative period, assessed according to the Clavien-Dindo classification, decreased by 34.7% (p

The prevalence of DM is currently increasing all over the world, including Russia. Kidney damage develops in about one third of patients with type 1 diabetes and in half of patients with type 2 diabetes. Renal tissue and microcirculatory bed damage in patients with DM is associated with the impact of several factors, the most significant are: age, heredity, hypertension, dyslipidemia, prolonged uncompensated hyperglycemia. Despite the numerous researches of DN etiopathogenesis, the mechanisms of its formation and progression have not been fully studied. This review contains updated information about metabolic disorders development in cells and interstitial renal parenchyma. Significant attention is devoted to the glomerular hypertension formation as the cause of glomerular damage and nephrons progressive loss. Understanding of these phenomena essence is the key to development effective treatment methods and prevention of DM complications.

Proton pump inhibitors are the most effective drugs for the treatment of acid-related diseases. In recent decades, the use of PPIs has increased exponentially. For a long time, PPIs were considered completely safe drugs for both short-term and long-term use. However, modern clinical guidelines note that when prescribing PPIs in large doses for a long period, the possibility of side effects should be taken into account. There are no reviews in the domestic literature on the safety of PPIs during long-term use. In this regard, a search was conducted in the PubMed and Scopus information databases for publications on the safety of PPI use, including sources up to November 15, 2023, which showed that long-term use of PPIs is associated with the possible development of numerous side effects. The first publications examined the likely side effects of long-term use of PPIs: the development of infections, increased risk of fractures and kidney pathology, and possible side effects: the risk of cancer and electrolyte disturbances. This review examines the possible cardiovascular risk of long-term PPI use and a number of rare side effects, many of which have been described in recent years. The key to mitigating side effects is judicious use of PPIs at the lowest effective dose and as quickly as possible. If there are clear indications for long-term PPI use, monitoring should be carried out to identify side effects.

Mucormycosis is a serious fungal infection, which increased significantly during the COVID-19 pandemic. We retrospectively analyzed 5 histopathologically confirmed cases of rhino-cerebral mucormycosis, which were diagnosed in patients admitted to Smolensk regional clinical hospital from November 2021 to January 2022. All patients were older than 60 years of age and had a recent history of laboratoryconfirmed severe COVID-19 and were treated in infection hospitals. All patients had decompensated type 2 diabetes mellitus; 80% of patients had concomitant cardiovascular diseases (coronary heart disease, arterial hypertension), 100% of patients received previous treatment with systemic corticosteroids for COVID-19 in hospitals. All patients underwent surgical treatment. Antifungal therapy (amphotericin B) was administered, and one patient received posaconazole due to a lack of efficacy of amphotericin B. The length of hospital stay ranged from 14 to 56 days. The overall 3-month survival rate of patients with rhinocerebral mucormycosis was 80%.

Aim. To determine the incidence of the no-reflow phenomenon in patients with acute coronary syndrome (ACS) undergoing primary percutaneous coronary intervention (PCI), and to study factors associated with its occurrence in the daily work of the City Clinical Hospital.Material and methods. Of the 2090 patients with ACS admitted to N. I. Pirogov City Clinical Hospital No.1 in the period from 01.01.2017 to 01.11.2022 there were 2 groups of patients with PCI: group 1 (n=59) included patients with initial antegrade coronary blood flow TIMI 0 and final blood flow TIMI 0-2 (with the no/ slow-reflow phenomenon); Group 2 (n=149) included patients with initial coronary blood flow TIMI 0 and final antegrade coronary blood flow TIMI 3 (without the no/slow-reflow phenomenon).Results. The no-/slow-reflow phenomenon was observed in 2.8% of cases. Patients with no-/slow-reflow phenomenon more frequently had diabetes mellitus (42.4% vs. 22.8%, p=0.003), a history of stroke (12.1% vs. 3.4%, p=0.016), higher Killip class and "pain-to-balloon" time 7 [3; 16] vs. 4 [2.3; 8.25] hours, p=0.004. Binary logistic regression identified "pain-to-balloon" time as the most significant predictor of no-/slow-reflow phenomenon development [Odds Ratio (OR)=1.03; 95% CI: 0.95-0.996; p=0.02] and the proximal level of occlusion in infarct-related coronary artery. The incidence of in-hospital mortality was 6.1 times higher in the no-/slow-reflow group compared to the normal blood flow group [OR=6.102±0.433; 95% CI: 2.614-14.247; p

Hypertrophic cardiomyopathy (HCM) is a common hereditary disease of the myocardium. Sodium-glucose co-transporter 2 inhibitors are recognized as first-line drugs for the treatment of heart failure, but at the moment there is little known about their use in HCM. The aim. To assess the possibility of using an acute test with empagliflozin in patients with HCM with echocardiographic assessment of left ventricular outflow tract (LVOT) obstruction. Materials and methods. Twenty-six non-obstructive HCM patients were examined. All the patients underwent an acute test with sodium-glucose co-transporter 2 inhibitor using 10 mg of empagliflozin and echocardiographic examination before and 3 hours after administration. Twenty-four patients were included in the further analysis (2 patients were excluded due to arrhythmia). The patients were divided into two groups: group 1 included subjects with an increase in LVOT pressure after empagliflozin (12 patients), group 2 included those without an increase in the gradient (12 patients). Results. During the acute test, an increase in LVOT gradient occurred in 12 patients, and in 6 patients the gradient increased significantly and reached more than 30 mm Hg. The indicator at rest in patients before the test was 11.2 (10.1-19), after the test it was 12.45 (8.9-17) mm Hg (p = 0.042). The indicator at the height of the Valsalva test also increased from 15 (11-29) to 15.45 (10.4-33) mm Hg (p=0.29). Comparative analysis of clinical and echocardiographic data did not show significant difference between the groups. Conclusions. In some patients with HCM without signs of overt or latent obstruction at the baseline, a significant increase in LVOT pressure was noted after acute test with empagliflozin. Conducting an acute test in patients with HCM is appropriate to determine the possibility of the development of LVOT obstruction while taking the drug.

Chronic kidney disease (CKD) is a common complication of diabetes mellitus. It increases significantly cardiovascular risk and decreases the quality of life. CKD requires treatment, and the treatment paradigm for type 2 diabetes has shifted from a glucose-centric approach towards disease-modifying therapy. Attention is being paid to cardioprotective and nephroprotective effects. In patients with type 2 diabetes and CKD, drugs that affect the renin-angiotensin-aldosterone system, as well as sodium-glucose cotransporter type 2 inhibitors (iSGLT2) are widely used. Despite the proven positive effect of these drugs in preservation of renal functions, the pathogenesis of CKD contains links that have not yet been covered. In particular, the activity of fibrosis processes in the renal parenchyma is increased in patients with CKD due to high expression of mineracorticoid receptors. It may be a potential target for nephroprotective drugs. Thus, mineralocorticoid receptor antagonists (MCRA) may influence the residual risk of CKD progression. In particular, the effectiveness of the non-steroid selective AMCR finerenone has been proven in a number of large clinical studies, which confirmed its nephroprotective potential. In this regard, studies aimed at studying the joint effect of known nephroprotective drugs, as well as their combined effect on cardiovascular risk, are highly needed.This review marks the main mechanisms of the combined action of iSGLT2 and finerenone. Discussion of the results of main clinical studies with combined use of standard nephroprotective therapy, SGLT2 and finerenone is also presented.

BACKGROUND: The paper is dedicated to the assessment of the retinal microvasculature in patients with type 1 diabetes mellitus (DM) with various features of the clinical course and different stages of diabetic retinopathy (DR). Automatic analysis of optical coherence tomogram angiograms (OCT-A) was carried out with specially developed software that provides the ability to estimate quantitative vascular parameters.AIM: The purpose of the study was to assess diagnostic accuracy of clinical parameters and imaging biomarkers in type 1 diabetes using a new algorithm for OCT-A analysis.MATERIALS AND METHODS: The study involved 186 people (365 eyes) with type 1 diabetes. The analysis of the OCT-A parameters was performed with a specially developed software. The range of studied parameters included: foveal avascular zone (FAZ), vessel area density (VAD), skeletonized vessel density (VSD), vessel diameter index (VDI), vascular curvature index (VCI) at the level of superficial (SCP) and deep (DCP) retinal capillary plexuses in the macular region. A correlation between the involvement of OCT-A biomarkers and age, degree of DM, increased glycated hemoglobin (HbA1c) level, stage of DR, and maximally corrected visual acuity (BCVA) was analysed.RESULTS: A significant dependence of all quantitative OCT-A parameters on the age of and duration of diabetes (p0.05). The presence of correlation between BCVA and FAZ DCP (K=-0.728, p=0), as well as VSD DCP (K=-0.754, p=0) was proved.CONCLUSION: As a result of a comprehensive analysis of clinical data and imaging biomarkers, a number of patterns that have diagnostic value in diabetic retinopathy were identified.

Introduction. A progressive decrease in the rate of glomerular filtration is an independent risk factor for cardiovascular complications, as well as a marker of an unfavorable prognosis of cardiovascular diseases. Cardiovascular complications arising against the background of end-stage renal failure are the main cause of mortality in patients undergoing renal replacement therapy. The aim of the study was to determine the features and prevalence of cardiovascular complications in patients undergoing renal replacement therapy. Materials and methods. A retrospective study was conducted of 114 medical records of nephrology patients who were treated in the center of nephrology and dialysis of Poltava Regional Clinical Hospital n.a. M.V. Sklifosovsky. Patients were divided into three groups: two experimental and one control group. The first experimental group consisted of 44 (38.6%) patients who were on RRT by the method of programmed hemodialysis. The second experimental group consisted of 21 (18.4%) patients who were also undergoing RRT, but by the method of peritoneal dialysis. The control group consisted of 49 (43.0%) patients with CKD stages I-II. Analysis of laboratory data of traditional risk factors for cardiovascular complications (lipidogram), as well as non-traditional ones (level of calcium and phosphorus) was carried out. The frequency of cardiovascular complications in patients on renal replacement therapy was studied. Results. A statistically significant difference was found between the indicators of the atherogenicity index in the groups GD1 with CG1 (р=0.001) and GD2 with CG2 (р=0.031), PD1 and CG1 (р=0.005) and PD2 with CG2 (р=0.027). When analyzing the correlations between indicators of mineral metabolism in the experimental and control groups, it was found that weak and medium inverse correlations were observed in the experimental groups (GD1: -0.4703, GD2: -0.3219, PD1: -0,2146, PD2: -0.2784, respectively), while in the control groups a direct weak correlation was found (CG1 0.1975, CG2 0.2031, respectively). Chronic heart failure was detected in 75.0% of patients in the GD1 group, in 66.6% – in GD2, and in 100.0% of PD1 and PD2 patients. Valve calcification was observed in 35.0%, 29.1%, 33.3%, and 20.0%, respectively. Conclusions. Studying the features of cardiovascular complications, control of risk factors, which in any case occur in patients on dialysis therapy, is one of the main directions of controlling the underlying disease, reducing the risk of dangerous cardiovascular complications, prolonging life expectancy and its quality.

Background. Diabetes mellitus has been a menace to healthy human condition from antiquity. There has been continuous search for plant medicinal substances for drug development with an aim to managing this ailment with minimal drug side effects. In this research work, effects of fractions of aqueous root-bark extract of Nauclea latifolia on blood glucose, lipid profile and serum liver enzymes in diabetic rats were investigated. Thirty –five Wistar albino rats weighing 164.1 – 171.6 grammes were used for this study involving aqueous root-bark extract fractions A, B, C and D. The rats were divided into 7 groups of 5 rats each. Group 1 was normal non-diabetic control, group 2 was diabetic control and groups 3, 4, 5 and 6 were rats treated with 250 mg/kg body weight of varying root-bark fractions while group 7 was diabetic rats treated with 5mg/kg. body weight of glibenclamide, the standard anti-diabetic drug. Fasting blood glucose levels were determined using digital glucometer (Acuu-chek, Mannheim, Germany). Lipid profile was determined using standard procedures. Serum liver enzymes were determined using assay kits. Fraction A was analyzed using gas chromatography- mass spectroscopy and nuclear magnetic resonance spectroscopy. Results. Fraction A demonstrated the most effective anti-diabetic property compared to fractions B, C and D. It caused significant reduction in blood glucose levels. It also brought about significant decrease in the levels of triacylglycerol, very low density lipoprotein cholesterol and low density lipoprotein cholesterol. Aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase levels were also significantly reduced by it. Fraction A was found to contain catechol as the most abundant active principle. Conclusion. Previous works on catechol show that catechol moiety either exists as a free molecule or a substituent of flavonoids and that it confers on them their anti-diabetic property. Since the catechol containing fraction A caused significant reduction in glucose levels, lipid profile and serum liver enzymes, it therefore has the potential for the management of diabetes mellitus and ameliorating its complications in clinical medicine.

Background. The economic costs associated with chronic kidney disease (CKD) are a significant burden on the health care system. The use of dapagliflozin is a breakthrough strategy in the management of patients with CKD and type 2 diabetes mellitus (T2DM) to slow the progression of the disease and reduce healthcare costs. Aim. To evaluate the clinical and economic efficiency of dapagliflozin in patients with T2DM and CKD in the Russian Federation. Materials and methods. A cost-effectiveness/utility analysis was carried out. The calculation of direct costs was carried out in a model adapted to the conditions of healthcare in the Russian Federation by using Russian cost indicators and characteristics of the patient population. Results. Dapagliflozin in addition to standard therapy compared with standard therapy will provide an additional average of 0.253 life years and 0.219 quality-adjusted life years per patient with stage 2–4 CKD and T2DM during 10 years of therapy. Cost reduction in case of using dapagliflozin and standard therapy compared with standard therapy alone amounted to an average of 49,350 rubles per patient. Dapagliflozin and standard therapy compared with standard therapy alone on the modeling horizon of 10 years allows to extend the stay in the pre-dialysis stages of CKD by an average of 7 months per patient. The use of dapagliflozin in 1000 targeted patients for 10 years will help to avoid 26 hospitalizations for heart failure (NNT – 39), as well as prevent 44 cases of acute kidney injury (NNT – 23) and 51 deaths from all causes (NNT – 20). Probabilistic sensitivity analysis showed the robustness of the results to changes in parameters of cost of therapy, clinical efficacy and usefulness of the studied medical interventions. Conclusion. Intensification of standard CKD therapy with dapagliflozin in patients with T2DM is clinically and economically justified.

Diabetes mellitus (DM) is one of the global problems of world’s healthcare. Systemic vascular complications are the dangerous sequelae of the disease, and chronic hyperglycemia is the leading factor contributing to the disease development. Glycemic control remains an effective strategy to prevent diabetes complications that requires achieving and maintaining metabolic targets throughout the life of the patient. The current guidelines on the selection of personalized treatment goals based on the glycated hemoglobin (HbA1c) levels and the glycemic control methods are discussed. The emphasis is placed on self-monitoring of blood glucose (SMBG), one of the important factors contributing to the efficacy of the ongoing glucose-lowering therapy and hypoglycemia prevention. Proper SMBG is impossible without therapeutic training of DM patients. The current understanding of SMBG implies a certain frequency of the systematic measurement of blood glucose levels depending on the DM type and the type of glucose-lowering therapy. Various glucose meters for measurement of blood glucose levels at home are available. The criteria for choosing the glucose meter include compliance with the relevant accuracy standards, simplicity and ease of use, ease of getting the results by patients, which allow patients of any age to easily measure blood glucose levels. With all the advancements in modern technology, the glucose meters have appeared that significantly expand the possibilities of DM control due to integration with the free mobile application.

Aim. To compare the elastic properties of the common carotid arteries (CCA) in patients with stage II hypertension (HTN) depending on the presence of diabetes mellitus (DM) and atherosclerotic plaque (ASP)

Type 2 diabetes mellitus is a significant concern due to its high prevalence and impact on global health. Ongoing scientific research aims to enhance our understanding of the mechanisms involved in the development and progression of diabetes and devise effective strategies for its treatment. This involves the development of new pharmacological treatments, including novel antidiabetic drugs, and the exploration of individualized approaches to therapy. The mechanisms underlying type 2 diabetes are intricate, involving various aspects of physiology and biochemistry. Gaining insight into the development and progression of type 2 diabetes mellitus through modern laboratory diagnostic methods is crucial for the development of effective treatment and prevention strategies for diabetes. The aim of the study is to identify and analyze a panel of genes, involved in insulin signals transmission in the development of experimental type 2 diabetes mellitus. Materials and methods. The analysis of gene expression involved in insulin signal transmission was conducted using real-time reverse transcription-polymerase chain reaction (RT-qPCR) on the CFX-96 Touch™ system (Bio-Rad, USA). The RT2Profiler™ PCR Array Rat Diabetes kit (QIAGEN, Germany) was employed for this purpose. Results. Based on the study results, the activity of the genes involved in insulin signal transmission can be categorized as follows: genes with low expression compared to the control group of animals, where ∆∆Ct

The purpose of the study was to evaluate the severity of changes in the values of markers-candidates for the differential diagnosis of anemia of chronic diseases in patients with type 1 and type 2 diabetes mellitus. The total number of leukocytes, erythrocyte sedimentation rate, content of C-reactive protein, TNFa, ferritin and hepcidin were evaluated. 50 people with type 1 diabetes mellitus and 81 people with type 2 diabetes mellitus were examined. The diagnosis of anemia was established on the basis of data on the level of hemoglobin, the content of erythrocytes in the blood, ferritin and serum iron. Next, the type of anemic syndrome was determined. The patients were divided into groups: 14 patients with diabetes mellitus and anemia of chronic diseases, 15 people with diabetes mellitus and iron deficiency anemia, 38 patients with diabetes with latent iron deficiency and 64 patients with diabetes mellitus without anemia. The comparison group consisted of 17 healthy volunteers. It was shown that in the general sample of patients with diabetes mellitus anemia of chronic diseases was distinguished only by the erythrocyte sedimentation rate, which was higher than in iron deficiency anemia, latent iron deficiency and in patients without anemia. The severity of inflammation in diabetic patients was analyzed depending on its type. The concentration of hepcidin in the blood of diabetic patients, regardless of type, exceeded its content in the blood of healthy individuals. Elevated serum concentrations of TNFα were characteristic of inflammation in type 1 diabetes mellitus. Diabetes mellitus type 2 was characterized by an increase in: erythrocyte sedimentation rate - relatively healthy individuals; concentrations of C-reactive protein - in comparison with healthy volunteers and patients with type 1 diabetes mellitus; ferritin levels compared with patients with type 1 diabetes mellitus. Taking into account the type of diabetes and the type of iron metabolism disorder, it was found that in type 1 and type 2 diabetes mellitus, only the erythrocyte sedimentation rate in patients with anemia of chronic diseases was significantly higher than in patients with iron deficiency anemia and without anemia. The article discusses the reasons for the difficulties in using inflammatory markers (ferritin and hepcidin) as parameters for verifying anemia of chronic diseases in patients with diabetes mellitus. It is pointed out that it is necessary to take into account the differences in the mechanisms of inflammation development in type 1 or type 2 diabetes mellitus when trying to use cytokines and C-reactive protein as additional diagnostic markers in practice. The rationale is given for the prospects of determining the erythrocyte sedimentation rate, with the recommendation of a certain threshold value, for the detection of anemia of chronic diseases in patients with type 1 and type 2 diabetes mellitus.

Diabetes mellitus (DM) is a common endocrine disease with a large number of acute and chronic complications, among which diabetic ketoacidosis (DKA) is the most frequent and severe, especially in children and adolescents with type 1 DM. Oxidative stress (OS) is a pathological condition that develops due to an imbalance between free radicals formation and inefficiency of the antioxidant system. OS is a strong risk factor for the development of numerous diabetic complications. Recently OS has been considered as an important component of DKA, the pathophysiological mechanisms of which have not yet been fully elucidated. This paper describes hypotheses according to which OS not only triggers and exacerbates manifestations of DKA, but itself represents a severe consequence of DKA, leading to the progression of numerous micro- and macroscopic diabetic complications. The formation of glycation end products, activation of protein kinase C, polyol and hexosamine pathways are considered among the key pathophysiologic mechanisms of OS development in DKA. Achieving a better understanding of OS pathogenesis in DKA will optimize the diagnosis of OS and approaches to DKA correction through timely prescription of antioxidants.

The aim. To study the relationship between β1-, β2-adrenoceptor (β-AR) and LGALS-3 genes polymorphisms with the course of heart failure (HF) in patients with coronary heart disease. Materials and methods. We examined 201 patients with HF on the background of post-infarction cardiosclerosis. Control group included 43 healthy individuals of comparable age and sex. Genotyping was carried out for 4 polymorphisms (rs1801253 and rs1801252 of the β1-AR gene; rs1042714 of the β2-AR gene and rs2274273 of the LGALS-3 gene). Statistical analysis was performed using Statistica 10.0 and SNPStats programs. Results. In patients with HF, the A allele (A/G-A/A) of the rs1801252 polymorphism of the β1-AR was associated with a reduced risk of rehospitalization (RH) within a year (odds ratio [OR] = 0.44 [0.20-0 .98], p = 0.036, dominant inheritance model). The data on the reduction of the risk of RH in patients with HF in the presence of the A allele of the rs1801252 polymorphism of the β1-AR gene were also confirmed in the log-additive (OR = 0.44 [0.20-0.96], p = 0.027) and, mainly, in excessively dominant (OR = 0.48 [0.21-1.06], p = 0.059) inheritance models. The analysis showed a higher frequency of allele A of the rs1801252 polymorphism of the β1-AR gene in the group of patients with HF who did not have RH due to decompensation during the year, compared to patients with RH (14.9% versus 7.0%, respectively; χ2 = 4.304; p = 0.039). The A allele of the specified gene polymorphism was also associated with a reduced risk of persistent atrial fibrillation (AF) (OR = 0.34 [0.14-0.84], p = 0.018, dominant inheritance model). This regularity was confirmed in the overdominant (OR = 0.27 [0.11-0.69], p = 0.0048) and in the codominant (OR = 0.28 [0.11-0.72], p = 0.0081) inheritance models. The A allele (A/G-A/A) of the rs2274273 polymorphism of the LGALS-3 gene was associated with an increased risk of AF in patients with HF (OR = 6.63 [1.31-33.53], p = 0.032, codominant inheritance model). Data on the increase in the risk of AF, provided that the A allele of the aforementioned polymorphism is present, were also confirmed in the recessive (OR = 5.12 [1.08-24.24], p = 0.017) and log-additive (OR = 2.11 [1.13-3.94], p = 0.015) inheritance models. The risk of RH in patients with HF and concomitant diabetes mellitus increased in patients with heterozygous (G/C) polymorphism rs1801253 of the β1-AR gene (OR = 3.91 [1.03-14.87], p = 0.0041). Conclusions. The course of HF was associated with genetic differences β1-AR, in particular: the A allele of the rs1801252 polymorphism of the specified gene reduced the risk of RH within a year (14.1 % vs. 27.0 %; OR = 0.44; p = 0.036, dominant inheritance model) and AF (18.3 % vs. 39.5 %; OR = 0.34; p = 0.018, dominant inheritance model). The risk of RH of patients with HF and accompanying diabetes mellitus was higher with heterozygous (G/C) rs1801253 polymorphism of the β1-AR gene (24.4 % vs. 11.1 %; OR = 3.91; p = 0.0041). The A allele of the rs2274273 polymorphism of the LGALS-3 gene was associated with an increased risk of AF in patients with HF (20.0 % vs. 4.7%; OR = 6.63, p = 0.032, codominant inheritance model). No probable association of the rs1042714 polymorphism of the β2-AR gene with the course of HF was found.