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Коморбидное течение сахарного диабета и сердечно-сосудистых заболеваний является одним из патологических состояний, с которым часто встречаются в своей практике врачи терапевтического профиля всех звеньев. Ассоциируясь, заболевания отягощают друг друга, приводят к более быстрому и тяжелому поражению органов-мишеней, сердечно-сосудистым осложнениям, инвалидизации и смерти и требуют современных медикаментозных подходов к лечению. В статье приведены данные касательно основных положений современных рекомендаций по лечению сердечно-сосудистых заболеваний, протекающих в сочетании с сахарным диабетом, основанные на последних документах европейских и американских экспертов в области диабетологии и кардиологии.

This review presents the applications of artificial intelligence for the study of the mechanisms of diabetes development and generation of new technologies of its prevention, monitoring and treatment. In recent years, a huge amount of molecular data has been accumulated, revealing the pathogenic mechanisms of diabetes and its complications. Data mining and text mining open up new possibilities for processing this information. Analysis of gene networks makes it possible to identify molecular interactions that are important for the development of diabetes and its complications, as well as to identify new targeted molecules. Based on the big data analysis and machine learning, new platforms have been created for prediction and screening of diabetes, diabetic retinopathy, chronic kidney disease, and cardiovascular disease. Machine learning algorithms are applied for personalized prediction of glucose trends, in the closed-loop insulin delivery systems and decision support systems for lifestyle modification and diabetes treatment. The use of artificial intelligence for the analysis of large databases, registers, and real-world evidence studies seems to be promising. The introduction of artificial intelligence systems is in line with global trends in modern medicine, including the transition to digital and distant technologies, personification of treatment, high-precision forecasting and patient-centered care. There is an urgent need for further research in this field, with an assessment of the clinical effectiveness and economic feasibility.

Background We present the results of the pilot study of a multinational “Diabetes Know‐Me” project investigating knowledge regarding diabetes of medical students. This is the first collaborative project of the ISPAD JENIOUS group. Methods Students of the final year of medical studies from six countries answered a 25‐question survey regarding basic knowledge concerning diabetes (1091 surveys handed out, response rate 86%). Results Among the responders (58% female) 90% confirmed attending diabetology classes; 11% planned to specialize in diabetology. There were significant differences between countries in the median score of correct answers ranging from 10/25 to 22/25. Attending diabetes classes (20 vs. 13/25, p

Introduction. Adherence to physician recommendations and the principles of healthy lifestyle is the key to avoid diabetic complications. Daily physical activity, a healthy diet and adherence to drug therapy can delay the development of the disease and its complications, leading to an increased life expectancy. The aim of the study was to evaluate the adherence to physician recommendations among patients with diagnosed diabetes mellitus type 2 (DM2). Material and methods. We studied 57 patients, including 27 women (47.4%) and 30 men (52.6%) diagnosed with DM2. The patients were hospitalized in the Department of Diabetology and Internal Diseases at the Independent Public Central Clinical Hospital in Warsaw in April–August 2019. The average age was 57 years in women and 58 years in men. We analyzed the answers obtained from the respondents in response to the original questionnaire developed by the authors. Results. We found that 70% of respondents did not follow dietary recommendations, 52% regularly consumed fast foods, 82% consumed sweets, 15% consumed the recommended amount of vegetables, 92% consumed meat at least once a day, and 39% were physically inactive. Among those declaring any physical activity, the most commonly reported type of activity was walking (32 patients or 56%). Conclusions. The adherence to physician recommendations in patients with diagnosed DM2 is unsatisfactory. The available solutions lack cooperation within multi-specialist teams.

Zusammenfassung. Die Initiative für die Arbeiten, welche in Toronto 1921 zur Entdeckung des Insulins führten, ging von Frederik G. Banting aus. Er arbeitete unter der Leitung von John J. R. Macleod im Institut für Physiologie der Universität Toronto. In seinem Versuchsprogramm unterstützte ihn der Student Charles H. Best. An Hunden mit experimentellem Diabetes demonstrierten sie den blutzuckersenkenden Effekt von Pankreasextrakten. Dank Zusammenarbeit mit Macleod und James B. Collip, einem Biochemiker der Universität Alberta, der in Toronto ein Sabbatical absolvierte, waren die Arbeiten rasch von Erfolg gekrönt und erste klinische Anwendungen der Extrakte wurden anfangs 1922 möglich. Bereits 1923 erhielten Banting und Macleod den Nobelpreis für Physiologie oder Medizin. Banting teilte seine Hälfte des Preises mit Best, während Macleod seine Hälfte mit Collip teilte. Dass gerade ihre Untersuchungen von Erfolgt gekrönt waren, dürfte zu einem grossen Teil auf Bantings Fähigkeiten als Chirurg, Bests Enthusiasmus als Student, Collips Fähigkeiten als Biochemiker und Macleods Umsicht, die Gruppe zusammenzubringen und mit den notwendigen Ressourcen auszustatten, zurückzuführen sein. In den nächsten zwei Jahrzehnten wurden erste Depotinsulinpräparate verfügbar. In den 1950er Jahren gelangen in der Insulinforschung wichtige Fortschritte, welche die weitere Forschung in der Diabetologie beflügeln sollten. Dies betraf zum einen die Klärung der Insulinstruktur und zum andern die Möglichkeit der Insulinmessung im Blut. Diese beiden Entdeckungen wurden mit dem Nobelpreis für Chemie ausgezeichnet (siehe Kasten 1). In den 1960er und 70er Jahren entwickelten die Insulinhersteller immer bessere Reinigungsmethoden, die schliesslich zu Präparaten mit sehr guter Verträglichkeit und nur sehr seltenen Allergien führten. Später, in den 1980er Jahren, führte die Möglichkeit der biotechnologischen Herstellung von Insulin zu einer immer stärkeren Verbreitung des Humaninsulins. Auf der Grundlage derselben Technologie wurden in den 1990er Jahren und dann im neuen Jahrtausend Insulinanaloga hergestellt, die sozusagen als «Designer-Insuline» neue, klinisch interessante Wirkprofile ermöglichten. Die heutige Vielfalt der verfügbaren Insuline, moderne Formen der Insulinapplikation (Insulinpens, Insulinpumpen) sowie die Blutzuckerselbstkontrolle beziehungsweisen das kontinuierliche Glukosemonitoring bilden heute die Grundlage der modernen intensivierten Insulintherapie.

Introduction. The history of recommendations by the Polish Federation for Education in Diabetology dates back to 2006, when guidelines for nurses/midwifes working with diabetic patients were first drawn up. However, the development of nurses and midwifes? competences requires stronger actions that foster a transition from experience-based towards evidence-based practice. Aim. The aim of this publication is to present a set of procedures describing nursing interventions in diabetes care, including currently available scientific evidence and clinical experience of specialists involved in the care of diabetic patients. Material and methods. The study involved a literature review of selected areas of nursing practice in diabetes care. When compiling the material, the priority was to use data from (in order of significance): randomized controlled clinical trials and their meta-analyses, observational studies and other studies with an adequate scientific status. Results. This joint study yielded 11 procedures describing selected aspects of nursing interventions in diabetic patients. Each of the procedures details key recommendations on diabetes care, arranged in accordance of the significance ascribed to the scientific evidence analyzed. Conclusions. The 2020 PFED guidelines on nursing and midwifery diabetes care are the effect of the evaluation of the previous versions and comprise a considerably more extensive, comprehensive and evidence-based set of practices. The major asset of these guidelines is their interdisciplinarity, reflected in the fact that the final version of the publication was approved by consultants in numerous nursing fields, a consultant in diabetology, and the President of the Polish Federation for Education in Diabetology, who all represent the medical community. The authors experience gained during work on international recommendations (New Insulin Delivery Recommendations) played an important role when formulating the present guidelines.

Aim/background To assess the effectiveness of mobile SMS as a tool for behavior and life style modification in management of diabetes. Methods This interventional study was conducted from July 2014 to April 2015 at Baqai Institute of Diabetology and Endocrinology (BIDE). Demographical and clinical information of subjects (patients and relatives) along with their knowledge and beliefs regarding diabetes was recorded using questionnaire. In Short Message Service (SMS) and non-SMS groups, education regarding diabetes was given. Two messages per day were sent to SMS group for two months. Results Total 648 subjects, SMS (n = 376) and non-SMS (n = 276) groups, were included in study. Mean age of patients and relatives was 45.41 ± 15.13 and 34.58 ± 11.91 in SMS group, while 47.06 ± 14.83 and 31.02 ± 11.51 in non-SMS group, respectively. No significant difference regarding level of knowledge and beliefs among both groups was observed at baseline. After SMS intervention, level of knowledge (p ≤ 0.0001) and beliefs (p ≤ 0.0001) were found to be significantly higher in SMS groups Non-SMS group. Conclusion Mobile SMS are an effective tool to deliver behavior and lifestyle modification advice and support for better management of diabetes and its prevention in people who are at high risk. Education intervention through SMS is found to be an important variable which enhances the knowledge and beliefs of the subjects.

In modern clinical practice, the assessment of the state of blood microcirculation and the diagnosis of microcirculatory disorders are extremely relevant in a variety of diseases: in cardiology, diabetology, oncology, dermatology, dentistry, surgery and resuscitation. Microcirculatory disorders are very diverse both in their pathogenesis and in clinical manifestations. Therefore, in the pattern of various diseases and extreme conditions, as well as in the correction of microcirculatory disorders the methods are needed for both operative assessment of the state of blood flow at tissue level and for its long-term monitoring. The interest in the study of the microvascular bed of the circulatory system is sparked by the significant role of capillaries in the implementation of the basic processes of the body's vital activity, in the trophic support of organs and their direct participation in tissue and cellular respiration. The health and life expectancy of a person depend on the coordinated work of the heart, large blood lines, and microcirculation vessels. The authors have studied modern optical methods for diagnosing microcirculation. The feasibility of using the speckle imaging method for noninvasive rapid assessment of the state of the microvasculature of human surface biological tissues has been substantiated. To implement the speckle-visualization method, methodological and software have been developed. The processing parameters that are most optimal from the point of view of the ratio of spatiotemporal resolution and computation time have been experimentally substantiated. The purpose of this work is the experimental testing of the developed methodological and hardware speckle imaging for the diagnosis of microcirculation of human surface biological tissues. The authors have carried out the studies of the state of microcirculation in the superficial blood vessels of the skin during physiotherapeutic procedures and in the imitation of pathology. The results of the studies have proved the feasibility of using the developed software for a high-quality diagnosis of the state of microcirculation of human surface biological tissues: primary changes in microcirculation are revealed, further changes to occur during physiotherapeutic procedures are visualized.

To assess the health-related quality of life of Pakistani adolescents with type 1 diabetes mellitus and their parents. This cross-sectional study of adolescents with T1DM and their parents was conducted at Baqai Institute of Diabetology and Endocrinology, a tertiary care hospital, Karachi Pakistan from April 2017 to September 2018. Diabetes Quality of Life for Youths (DQOLY) questionnaire (assess possible problems in six dimensions of impact) and WHO QOL-BREF instrument was used to assess quality of life of adolescents with type 1 diabetes and their parents respectively. The data was entered and analyzed using IBM Statistical Package for Social Sciences version 20. Adolescents with T1DM had adverse impact on their quality of life (QOL); overall QOL score was found 20.76 ± 0.83, the maximally reported adverse impact was related to symptoms of diabetes 24.35 ± 1.92 and impact of treatment 24.59 ± 2.12. Females had more adverse impact on QOL score, i.e. 22.49 ± 1.2 (p value = 0.015). Adverse effect on QOL score is strongly correlated with increasing age (p value = 0.006). Overall QOL score of parents/care takers was 56.3 ± 0.98. The worst overall QOL score was noted to be of care takers 53.75 ± 3.4 followed by mothers 54.52 ± 1.25 and fathers 60.56 ± 1.61 respectively (p value = 0.015); the environment domain was associated with statistically significance adverse impact on QOL of mothers (p value = 0.008). It is imperative for health care professionals to be aware of the effect of diabetes on QOL as timely screening is important for better health care outcomes.

The aim of this paper is to present the most relevant clinical applications of positron emission tomography/computed tomography, scintigraphy and single photon emission tomography with different radiotracers allowing to visualize e.g. glucose metabolism, amino acids metabolism, receptor density or inflammation and infections in diabetology.

Introduction. Due to high prevalence of diabetes mellitus all over the world it is essential for students who will become doctors of different specialties to possess a basic knowledge of it in this field. This pilot surveybased study was designed to assess diabetes related knowledge among faculty of medicine students from all of the medical universities in Poland. Materials and methods. Students were invited to fulfill the questionnaire during Students’ Diabetology Conference and via the Internet (social media). The survey consisted of questions about respondent’s age and personal history of diabetes and diabetes related knowledge (etiology, symptoms, risk factors, complications and treatment of diabetes mellitus and additionally a section concerning gestational diabetes). Results. A total number of 1200 medical students from Poland (70% women; mean age [SD] 22.12 [1.83] years of age) completed the survey. Mean test result was 66.62%. The best score was observed in the group of students enrolled in the 5th and 6th year of study, and those with diabetes mellitus type 1. Conclusions. The study outcome proves that knowledge about diabetes mellitus among surveyed medical students in Poland is insufficient, therefore persistent improvement in transmitting it during the course of medical education is essential.

Introduction COVID-19 pandemic suddenly affected all countries and health care systems from different perspectives including severe disruption of chronic disease services including diabetes. Diabetes is a serious condition and highly present in Bosnia and Herzegovina population, so provision of diabetes care is a important part of good control. Countries had different responses to adopt diabetes care under new circumstances as well as Bosnia and Herzegovina. Aim To investigate and evaluate the impact of the COVID-19 pandemic on the provision of diabetology care in Bosnia and Herzegovina from the perspective of patients and diabetologists. Methods Online survey for diabetologists and patient organizations have been developed with adopted question for different perspectives. The survey has been conducted online early September 2020. Collected data were analyzed in SPSS software for descriptive statistics. Results 25 diabetologists and 24 diabetes patient organizations responded. 72% of diabetologists believe that pandemic has partially altered work with patients and 56% believe that the organization of diabetes care has successfully responded to the new circumstances but 80% believe that the diabetes care system should change. 75% of patient organizations thought that the organization of diabetes care did not adequately respond and 87.5% believe system should change. Conclusion No significant differences found between RS and FBiH when it comes to majority of questions. Both diabetologists and patients consider that system of diabetes care in Bosnia and Herzegovina should be improved in future. It has been also found that diabetologists in Bosnia and Herzegovina responded and adopted their practices similar to other countries.

Hypertension and diabetes are, after smoking, obesity and hypercholesterolemia, the most important cardiovascular risk factors. It is common for these diseases to coexist, which leads to a poorer prognosis. There are differing medical association guidelines regarding the values of blood pressure when treatment should start, but instructions are consistent with the goals of treatment for diabetic patients. The guidelines published in 2017 by the American College of Cardiology/American Heart Association (ACC/AHA) suggest a value of 130/80 mm Hg for both diagnosis and starting treatment. The European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines published in 2018 recommend a value of 140/90 mm Hg when we should start therapy, with the goal of treatment below 130/80 mm Hg, but only if drug tolerance is good. The exception is patients aged over 65, for whom we should maintain systolic blood pressure in the range 130–140 mm Hg. The new Polish 2019 guidelines from the Polish Diabetology Association (PTD, Polskie Towarzystwo Diabetologiczne ) and the Polish Society of Hypertension (PTNT, Polskie Towarzystwo Nadciśnienia Tetniczego ) have been adjusted to align with the ESC/ESH guidelines. In this article, we look at changes in the guidelines over the last 20 years. We also look back at the clinical trials which have had the biggest impact on the guidelines. We describe the optimal treatment of hypertension in diabetic patients. Among all the hypotensive drugs recommended as a first choice are angiotensin-converting enzyme inhibitors or angiotensin AT 1 receptor blockers, together with calcium channel blockers and/or diuretics. There is increasing evidence regarding the positive influence of diabetic drugs on blood pressure, especially sodium-glucose cotransporter 2 inhibitors.

First and last of my vivid memories of Fred Whitehouse are actually tied to Davida Kruger. Shortly after I moved to Detroit in 1986 to establish a comprehensive diabetes center at Wayne State University and the Detroit Medical Center I made an appointment to see Fred to pay him homage as the giant of diabetology. Upon my entrance he stopped my compliments and said, with his usual dry humor, “Oh, I don’t really do anything here. My job is just to hold the doors open so Davida does not run into closed ones….” More sadly, it was on 1 March 2019, while flying to Houston for a meeting, when Davida, who happened to sit next to me on the plane, received the call about Fred’s passing. She was clearly shaken by that awful news. Ironically, the night before, at the meeting of the Endocrine Club of the Michigan chapter of the American Association of Clinical Endocrinologists (AACE), the past officers of AACE took a picture together to deliver it to Fred upon learning that he was in a local hospice. Another classic “Fred” recollection: We were caught in the epic snowstorm of 2003 at the Washington, DC, Mandarin Oriental Hotel (where we were preparing educational efforts for the anticipated approval of insulin glulisine) and the nation’s capital was shut down. All airports were closed, our flights canceled, and streets became impassable with the huge amount of snow. Fred approached me and said, “Let’s go and see if the Freer Art Gallery is open.” And so we went out into the blizzard, trudging the half mile through more than a foot of snow, the only crazy ones out in the street. I had a hard time keeping up with his long strides, but we made it and were the only people …

Aims Type-2 diabetes mellitus (T2DM) is a common health condition which prevalence increases with age. Besides lifestyle modifications, passive heating could be a promising intervention to improve glycemic control. This study aimed to assess the efficacy of passive heat therapy on glycemic and cardiovascular parameters, and body weight among patients with T2DM. Methods A systematic review and meta-analysis were reported according to PRISMA Statement. We conducted a systematic search in three databases (MEDLINE, Embase, CENTRAL) from inception to 19 August 2021. We included interventional studies reporting on T2DM patients treated with heat therapy. The main outcomes were the changes in pre-and post-treatment cardiometabolic parameters (fasting plasma glucose, glycated plasma hemoglobin, and triglyceride). For these continuous variables, weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated. Study protocol number: CRD42020221500. Results Five studies were included in the qualitative and quantitative synthesis, respectively. The results showed a not significant difference in the hemoglobin A1c [WMD −0.549%, 95% CI (−1.262, 0.164), p = 0.131], fasting glucose [WMD −0.290 mmol/l, 95% CI (−0.903, 0.324), p = 0.355]. Triglyceride [WMD 0.035 mmol/l, 95% CI (−0.130, 0.200), p = 0.677] levels were comparable regarding the pre-, and post intervention values. Conclusion Passive heating can be beneficial for patients with T2DM since the slight improvement in certain cardiometabolic parameters support that. However, further randomized controlled trials with longer intervention and follow-up periods are needed to confirm the beneficial effect of passive heat therapy.

Summary The capacity of the brain to elicit sustained remission of hyperglycemia in rodent models of type 2 diabetes following intracerebroventricular (icv) injection of fibroblast growth factor 1 (FGF1) is well established. Here, we show that following icv FGF1 injection, hypothalamic signaling by extracellular signal-regulated kinases 1 and 2 (ERK1/2), members of the mitogen-activated protein kinase (MAPK) family, is induced for at least 24 h. Further, we show that this prolonged response is required for the sustained antidiabetic action of FGF1 since it is abolished by sustained (but not acute) pharmacologic blockade of hypothalamic MAPK/ERK signaling. We also demonstrate that FGF1 R50E, a FGF1 mutant that activates FGF receptors but induces only transient hypothalamic MAPK/ERK signaling, fails to mimic the sustained glucose lowering induced by FGF1. These data identify sustained activation of hypothalamic MAPK/ERK signaling as playing an essential role in the mechanism underlying diabetes remission induced by icv FGF1 administration., Graphical abstract, Highlights • FGF1 action in the brain induces remission of diabetic hyperglycemia • FGF1 induces sustained activation of hypothalamic MAPK/ERK signaling • Blockade of hypothalamic MAPK/ERK signaling abolishes the antidiabetic action of FGF1 • FGF1 increases hypothalamic astrocyte-neuron interaction by transcriptomic analysis, Molecular biology; Molecular neuroscience; Diabetology

Introduction: The DBLG1 Hybrid Closed-Loop system improves time in range and glycemic control in adults. However, the efficacy and safety of the system had not yet been evaluated in children. Objective: of this study is to evaluate the non-inferiority of the DBL4K (Diabeloop for Kids) hybrid closed-loop system (Kaleido pump + Dexcom G6 = CL) compared to a Dexcom G6 sensor augmented pump (open loop = OL) in prepubescent children. Materials and Methods: Multicenter open-label randomized controlled trial in 3 pediatric diabetology centers, 2 of which are French. The CL and OL are allocated for 4 days in hospital, followed by 6 weeks at home for the French centers. Results: Seventeen patients (mean age: 8.3+/- 1.6 years) were included for evaluation at 6 weeks at home between March and December 2019. The percentage of time spent in range (0.7-1.8 g/L) was significantly higher in the CL group during the 6 weeks at home (66.19% in CL vs. 58.68% in OL, p Conclusions: The DBL4K Closed-Loop System is suitable for prepubescent children. It is not inferior to sensor augmented pump therapy in children. Just as in adults it improves the time in range while decreasing the time spent in hypoglycemia. It could allow for better long-term glucose control in children with diabetes. Disclosure D. Kariyawasam: None. C. Morin: None. K. Casteels: None. C. Le Tallec: None. C. Godot: None. A. Sfez: None. N. Garrec: None. M. Polak: Other Relationship; Self; AMMTeK. G. Charpentier: Other Relationship; Self; Diabeloop. S. Franc: Advisory Panel; Self; Diabeloop SA. Board Member; Self; Novo Nordisk. Research Support; Self; Merck Sharp & Dohme Corp. Stock/Shareholder; Self; Diabeloop SA. Other Relationship; Self; Abbott Diabetes. J. Beltrand: None.

Background: The prevalence of diabetic retinopathy (DR) is expected to increase. This will put an increasing strain on health care resources. Recently, artificial intelligence-based, autonomous DR screening systems have been developed. A direct comparison between different systems is often difficult and only two such comparisons have been published so far. As different screening solutions are now available commercially, with more in the pipeline, choosing a system is not a simple matter. Based on the images gathered in a local DR screening program we performed a retrospective comparison of IDx-DR and Retinalyze. Methods: We chose a non-representative sample of all referable DR positive screening subjects (n = 60) and a random selection of DR negative patient images (n = 110). Only subjects with four good quality, 45-degree field of view images, a macula-centered and disc-centered image from both eyes were chosen for comparison. The images were captured by a Topcon NW-400 fundus camera, without mydriasis. The images were previously graded by a single ophthalmologist. For the purpose of this comparison, we assumed two screening strategies for Retinalyze—where either one or two out of the four images needed to be marked positive by the system for an overall positive result at the patient level. Results: Percentage agreement with a single reader in DR positive and DR negative cases respectively was: 93.3%, 95.5% for IDx-DR, 89.7% and 71.8% for Retinalyze strategy 1, 74.1% and 93.6% for Retinalyze under strategy 2. Conclusions: Both systems were able to analyse the vast majority of images. Both systems were easy to set up and use. There were several limitations to the current pilot study, concerning sample choice and the reference grading that need to be addressed before attempting a more robust future study.

Introduction: Post-pancreatitis diabetes mellitus is one of the most common types of secondary diabetes. The pharmaceutical armamentarium in the field of diabetology can be broadened if the design ...

The epidemiology of diabetes mellitus (DM) is a section of diabetology that includes the study of the basic laws of the formation of the epidemiological situation and the epidemiological conditions in relation to this disease, as well as environmental, social and biological factors that determine the dynamics of its main epidemiological characteristics. The end points of the epidemic process are the prevalence of cases of the disease, their frequency and mortality of patients with diabetes. Each of these characteristics is determined by many factors that can change their importance, priority and even lose it over time. The epidemiological approach to solving a number of diabetological problems is based on the same principles as the epidemiology of other noncommunicable diseases: cardiovascular, oncological and some others. The main ones: the object of study is the population (population); the study of the disease is carried out in vivo of its development and course; in the researcher’s field of vision, the whole set of factors that can be associated with the fact of the development of the disease.

In July 2019 the American Board of Internal Medicine published a position statement in which a new sub-specialty alongside a new training curriculum was proposed: cardiometabolic medicine. This new sub-specialty is a natural advance in the collaboration between two twinned medical specialties: diabetology and cardiology. The links between the two specialties are more evident as a continuous body of evidence is building regarding a long set of inter- connections. For a long time the links between the two specialties were considered merely based on the macro-vascular complications arising in patient with Type 2 Diabetes Mellitus (T2DM); in the early era of diabetes knowledge it was hypothesized that the macro-vascular complications arisen mainly due to an improper glycemic control associated to the presence of T2DM. Nowadays, the paradigm is progressively changing, and the arising evidences are pointing to common pathogenic pathways between T2DM, atherosclerotic cardiovascular diseases or heart failure.

The scientific-practical conference Dietoogy In Practice Of Endocrinologist was held during the VIII Russian diabetology congress with international participation Diabetes Mellitus XXIth Century Pandemia. It was chaired by Academician of RAS M.V. Shestakova (Moscow), Professors L.A. Ruyatkina (Novosibirsk ) and L.A. Suplotova (Tyumen). The expediency of this event was dictated by the necessity to create a unified national regulated guidelines for the diet therapy of obesity and associated diseases for the medical community and patients. The program of the meeting included a discussion about the formation of a healthy diet and its effect on the body, starting from the pregnant women, fetal development, the breastfeeding period, in the period of perimenopause and postmenopause, in the presence of concomitant pathology of heart and kidneys.

Koncatinovocievna arteriova ischemicka choroba (periferne arteriove ochorenie dolných koncatin - PAO DK) je doležitou manifestaciou systemovej aterosklerozy a iných arteriových chorob cievneho systemu. Cim nižsi je clenkovo-ramenový tlakový index, tým vacsie je riziko vzniku zavažných akutnych instabilných organovaskularnych prihod (napr. akutneho infarktu myokardu, nahlej cievnej mozgovej prihody). V praci sa rozobera komplexna prevencia a liecba koncatinovocievnej arteriovej choroby. Angiologia/vaskularna medicina je najrýchlejsie sa rozvijajucou specializaciou internej mediciny.

Published information on diabetes in Pakistani youth is limited. We aimed to investigate the demographic, clinical, and biochemical features, and HLA-DRB1 alleles in new cases of diabetes affecting children and adolescents

Summary Circulating tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) levels are reduced in patients with cardiovascular disease, and TRAIL gene deletion in mice exacerbates atherosclerosis and inflammation. How TRAIL protects against atherosclerosis and why levels are reduced in disease is unknown. Here, multiple strategies were used to identify the protective source of TRAIL and its mechanism(s) of action. Samples from patients with coronary artery disease and bone-marrow transplantation experiments in mice lacking TRAIL revealed monocytes/macrophages as the main protective source. Accordingly, deletion of TRAIL caused a more inflammatory macrophage with reduced migration, displaying impaired reverse cholesterol efflux and efferocytosis. Furthermore, interleukin (IL)-18, commonly increased in plasma of patients with cardiovascular disease, negatively regulated TRAIL transcription and gene expression, revealing an IL-18-TRAIL axis. These findings demonstrate that TRAIL is protective of atherosclerosis by modulating monocyte/macrophage phenotype and function. Manipulating TRAIL levels in these cells highlights a different therapeutic avenue in the treatment of cardiovascular disease., Graphical Abstract, Highlights • Monocytes are a significant source of TRAIL in the normal circulation • Monocyte TRAIL expression is reduced, concomitant with plasma levels in CAD • TRAIL-expressing monocyte/macrophages attenuate atherosclerosis • Macrophages lacking TRAIL are dysfunctional, Pathophysiology; Molecular Mechanism of Behavior; Diabetology; Immunology; Immune Response

Cardiovascular disease (CVD) is one of the most global threatened diseases; particularly coronary artery disease (CAD) is a major deadly attack around the world. Diabetes mellitus (DM) is associated with a 2 to 4-fold increased mortality risk from heart disease. Diabetes related microvascular complication is seemed to be a hazardous factor for cardiovascular system and likely to cause coronary arteries disease, hypertension, peripheral arteries, and carotid vessels, especially seen in the type 2 DM populations. The severity of cardiovascular complications are related to prolong hyperglycemia and the control of dysglycemia. Thus, effective glycemic control is one of the imperative aspects of the management for the prevention of CVD in diabetes. In addition, different kinds of antidiabetes agents have different mechanism of actions that has impacted to cardiovascular outcome.

In den vergangenen zehn Jahren gab es in der Diabetologie eine Vielzahl neuer Ergebnisse aus evidenzbasierten Forschungsprogrammen — negative wie auch positive. Wichtig ist nun, diese Erkenntnisse in der Praxis umzusetzen.

Canada’s largest national obstetric and diabetology organizations have recommended various algorithms for the screening of gestational diabetes mellitus (GDM) over the years. Though uniformity across recommendations from clinical practice guidelines (CPGs) is desirable, historically, national guidelines from Diabetes Canada (DC) and the Society of Obstetricians and Gynaecologists of Canada (SOGC) have differed. Lack of consensus has led to variation in screening approaches, rendering precise ascertainment of GDM prevalence challenging. To highlight the reason and level of disparity in Canada, we conducted a scoping review of CPGs released by DC and the SOGC over the last thirty years and distributed a survey on screening practices among Canadian physicians. Earlier CPGs were based on expert opinion, leading to different recommendations from these organizations. However, as a result of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study, disparities between DC and the SOGC no longer exist and many Canadian physicians have adopted their recent recommendations. Given that Canadian guidelines now recommend two different screening programs (one step vs. two step), lack of consensus on a single diagnostic threshold continues to exist, resulting in differing estimates of GDM prevalence. Our scoping review highlights these disparities and provides a step forward towards reaching a consensus on one unified threshold.

Introduction Both hyperglycaemia and hypoglycaemia in hospitalized patients have been shown to be associated with a longer length of stay, higher readmission rates, and higher rates of morbidity and mortality. With 25%‐30% of all hospitalized patients carrying a diagnosis of diabetes, it is important to optimize glycaemic control. Current guidelines for care of inpatients with diabetes now suggest consulting a specialized diabetes team for all patients when possible. Aim This study was a retrospective cohort study to evaluate the impact of an inpatient diabetology consult within 48 hours of admission on patients’ length of stay. Methods All patients admitted to the general medicine service between 2013 and 2018 with a diagnosis of diabetes in their medical record were included, which consisted of 11 477 inpatient stays. We looked at the effect of an inpatient diabetology consultation within the first 48 hours on length of stay, complications and 30‐day readmission rates. Results We found that patients whose care included a diabetology consult within 48 hours of admission had a statistically significant shorter length of stay by 1.56 days compared to the remainder of the group. There was no difference in complications or 30‐day readmission rates between the groups. Conclusion Among general medicine patients with a diagnosis of diabetes, timely diabetology consultations reduced patients’ length of stay and have the potential to improve their care and lessen the economic impact., This is a retrospective cohort study of 11 477 patients over 5 years at an academic institution that examined the impact of an inpatient endocrinology consult for patients with diabetes on their length of stay. We found a statistically significant shorter length of stay by 1.56 days among patients who received an inpatient endocrinology consult within 48 hours of admission compared to the remainder of the patients.

Diabetes is a complex pathology both for the affected patients and for the medical specialists who follow them. Furthermore, since diabetes is a pathology with a high prevalence and incidence, it is essential to intervene effectively in therapeutic actions through the application of common guidelines. Therefore, in order to improve the management of the diabetic patient, the aim of the work is to define a Diagnostic Therapeutic Assistance Pathway (PDTA). A questionnaire-based approach is adopted for data collection from 136 patients at the Clinical Dermatology Unit of the University Hospital “Federico II”. In most cases (64%) the diagnosis was made by the General Practitioner, 15% of patients obtained the diagnosis at the ASL and 12% at the Polyclinic of Naples AOU “Federico II” and the remaining part from the diabetologist specialist. The second access is generally carried out at the “Federico II” AOU (66%), followed by the ASL (17%), by a doctor specialized in diabetology (12%) while no patient has turned to the General Practitioner for the treatment of diabetes. The final visit is carried out at the “Federico II” AOU in almost cases. The data obtained follow the Italian guidelines: the patients get the diagnosis from the Family Doctor and then they are addressed either to ASL or to diabetologists specialists. For the subsequent visits, most of them prefer to turn to the “Federico II” AOU, especially when they have complications associated with the diseases as they are followed in a more careful and satisfying manner.

The advanced and performing technologies of glucose monitoring systems provide a large amount of glucose data that needs to be properly read and interpreted by the diabetology team in order to make therapeutic decisions as close as possible to the patient’s metabolic needs. For this purpose, new parameters have been developed, to allow a more integrated reading and interpretation of data by clinical professionals. The new challenge for the diabetes community consists of promoting an integrated and homogeneous reading, as well as interpretation of glucose monitoring data also by the patient himself. The purpose of this review is to offer an overview of the glycemic status assessment, opened by the current data management provided by latest glucose monitoring technologies. Furthermore, the applicability and personalization of the different glycemic monitoring devices used in specific insulin-treated diabetes mellitus patient populations will be evaluated.

Background and Objectives:Currently, diabetes is becoming a very serious challenge in medicine, type 2 diabetes mellitus (T2DM) is referred to as a noncontagious epidemic of the 21st century. The aim of the study is to assess the lifestyle of patients with type 2 diabetes, in particular eating habits, physical activity, and tobacco smoking, and to compare the obtained values with the latest recommendations of the Polish Society of Diabetology. Materials and Methods: The study group was comprised of 460 patients with type 2 diabetes, treated in the Diabetes Outpatient Clinic (n = 299) and the Clinical Department of Internal Medicine (n = 166). The study was conducted using a questionnaire, which included the Food Intake Frequency Questionnaire, 24h dietary recall, and the International Physical Activity Questionnaire. Results: Abnormal excessive consumption of saturated fatty acids and salt and insufficient intake of dietary fiber was observed in the study group. Physical activity was insufficient in over 50% of the study group. In the study group, 17% of patients were smokers and the mean number of pack-years was 23. Conclusions:In the study group, excessive fat consumption (i.e.,saturated fatty acids) and dietary fiber deficiency were found in the daily diet.

Summary Infants of diabetic mothers are at risk of cardiomyopathy at birth and myocardial infarction in adulthood, but prevention is hindered because mechanisms remain unknown. We previously showed that maternal glucolipotoxicity increases the risk of cardiomyopathy and mortality in newborn rats through fuel-mediated mitochondrial dysfunction. Here we demonstrate ongoing cardiometabolic consequences by cross-fostering and following echocardiography, cardiomyocyte bioenergetics, mitochondria-mediated turnover, and cell death following metabolic stress in aged adults. Like humans, cardiac function improves by weaning with no apparent differences in early adulthood but declines again in aged diabetes-exposed offspring. This is preceded by impaired oxidative phosphorylation, exaggerated age-related increase in mitochondrial number, and higher oxygen consumption. Prenatally exposed male cardiomyocytes have more mitolysosomes indicating high baseline turnover; when exposed to metabolic stress, mitophagy cannot increase and cardiomyocytes have faster mitochondrial membrane potential loss and mitochondria-mediated cell death. Details highlight age- and sex-specific roles of mitochondria in developmentally programmed adult heart disease., Graphical Abstract, Highlights • Fetal exposures disrupt mitochondria, bioenergetics, & cardiac function at birth • First, bioenergetics & function improve until greater reliance on OXPHOS with age • At 6MO, poor respiration incites biogenesis & mitophagy, and then functional decline • Fetal exposures cause faster mitochondria-mediated cell death in aged adult hearts, Biological Sciences; Physiology; Animal Physiology; Molecular Biology; Diabetology; Cell Biology

Currently, diabetes mellitus remains a global unsolved problem, and its prevalence continues to grow steadily, running rampant. This is especially true for type 2 diabetes mellitus, which belongs to the “diseases of civilization”, the development of which is more associated with lifestyle. Type 2 diabetes mellitus leads to the development of severe micro- and macrovascular complications, which are the main causes of disability and mortality in these patients. Moreover, type 2 diabetes mellitus is extremely often combined with already formed cardiovascular diseases, which significantly worsens the prognosis in patients. The article presents the main principles of modern recommendations for examination, stratification of cardiovascular risk, treatment and prevention of cardiovascular diseases in patients with type 2 diabetes mellitus based on the latest documents of European and American experts in the field of diabetology and cardiology., В настоящее время сахарный диабет остается глобальной и нерешенной проблемой, а его распространенность продолжает неуклонно расти, принимая характер пандемии. Особенно это касается сахарного диабета 2-го типа, который относится к «болезням цивилизации», развитие которых в большей степени связано с образом жизни. Сахарный диабет 2-го типа приводит к развитию тяжелых микро- и макрососудистых осложнений, которые и являются основной причиной инвалидизации и смертности этих больных. Более того, сахарный диабет 2-го типа чрезвычайно часто сочетается с уже сформировавшимися сердечно-сосудистыми заболеваниями, что значительно ухудшает прогноз больных. В статье приведены основные положения современных рекомендаций по обследованию, стратификации кардиоваскулярного риска, лечению и профилактике сердечно-сосудистых заболеваний у больных сахарным диабетом 2-го типа, основанных на последних документах европейских и американских экспертов в области диабетологии и кардиологии., На сьогодні цукровий діабет залишається глобальною і невирішеною проблемою, а його поширеність продовжує неухильно зростати, приймаючи характер пандемії. Особливо це стосується цукрового діабету 2-го типу, що відносять до «хвороб цивілізації», розвиток яких більшою мірою пов’язаний зі способом життя. Цукровий діабет 2-го типу призводить до розвитку тяжких мікро- та макросудинних ускладнень, які і є основною причиною інвалідизації і смертності цих хворих. Більше того, цукровий діабет 2-го типу надзвичайно часто поєднується з вже сформованими серцево-судинними захворюваннями, що значно погіршує прогноз хворих. У статті наведені основні положення сучасних рекомендацій з обстеження, стратифікації кардіоваскулярного ризику, лікування і профілактики серцево-судинних захворювань у хворих на цукровий діабет 2-го типу, які базуються на останніх документах європейських та американських експертів у галузі діабетології та кардіології.

Ultrasound is increasingly used in daily clinical practice to improve the efficiency of the clinical examination. In this article, we reviewed its various possible uses in the field of diabetology. The ultrasonic evaluation of the carotid arteries (plaques and intima media thickness) allows improving the assessment of the cardiovascular risk. Steatosis can be detected relatively easily on liver ultrasound. Ultrasound also allows a more sensitive detection of lipohypertrophy resulting in glycemic fluctuations and thus increasing the risk of hypoglycemia than the clinical examination. Finally, muscle ultrasound appears to be a promising tool to assess the nutritional status and its consequences (e.g., falls).

To explore the association of Ramadan fasting with symptoms of depression, anxiety, and stress in people with diabetes.This observational study was conducted at Baqai Institute of Diabetology and Endocrinology between May-July 2017. Informed consent was taken from each study participant. Demographic and baseline data was recorded. DASS-21 scale was used to assess symptoms of depression, anxiety, and stress pre and post Ramadan.A total of one hundred and fifty people with diabetes participated in this study. 100 people were in fasting group and 50 were in non-fasting group. In fasting group pre-Ramadan depression, anxiety and stress symptoms were present in 45%, 45%,49% of people which improved to 23%, 26%, 35% post Ramadan (p-value0.0001,0.0001, 0.001) respectively. In non-fasting group pre-Ramadan depression and anxiety symptoms were present in 34%, and 50% of people, which improved to 30% and 40% post Ramadan (p-value 0.625, 0.227) respectively, while no improvement was observed in stress symptoms.There is significant improvement in symptoms of depression, anxiety, and stress in people with diabetes post-Ramadan fasting.

In order to assess β cell secretory capacity after islet transplantation, standardized mixed meal stimulation tests are often used. But these tests are cumbersome and the effect of exogenous insulin on the test results is unclear. The aim of our study was to determine to what extent fasting glycemic indices can estimate stimulated β cell function in islet transplant recipients with and without basal insulin. In total 100 mixed meal stimulation tests, including 31 with concurrent basal insulin treatment, were performed in 36 islet transplant recipients. In a multivariate model, fasting C‐peptide and fasting glucose together estimated peak C‐peptide with R 2 = .87 and area under the curve (AUC) C‐peptide with a R 2 = .93. There was a larger increase of glucose during tests in which exogenous insulin was used (+7.9 vs +5.3 mmol/L, P, Fasting C‐peptide and glucose can accurately estimate stimulated β cell function during a mixed meal tolerance test in islet transplant recipients, irrespective of concurrent basal insulin use.

The Covid-19 pandemic confronted us with unknown clinical pictures, also in diabetology and endocrinology. Sharing clinical experiences is therefore of enormous importance. Actually, information about the care given in the Covid-19 ward (in contrast to that provided in the Emergency Room/ICU) is still sparse. The last weeks we built experience and gathered knowledge while giving hospital care to patients who had a pre-existent endocrine disease (and diabetes; most patients suffered from a type two diabetes). In our contribution we presented our insights obtained from this intensive period obtained in the Covid-19 ward.

Type 2 diabetes mellitus (T2DM) portends high risk of atherosclerotic cardiovascular (CV) events and of CV mortality; moreover, this group of patients has a very high probability of developing heart failure (HF). In this review, we discuss new advances in pharmacological treatment both in CV prevention and in HF management with a special focus on T2DM patients. A large number of randomized clinical trials and meta-analyses provided strong evidence about therapeutic strategies acting on glucose metabolism, such as GLP-1 RA and SGLT2i and about lipid-lowering treatment, such as PCSK9i and icosapent ethyl. Moreover, SGLT2i demonstrated strong evidence of benefit particularly in HF management both in diabetic and non-diabetic patients. The pathophysiological bases of multiple mechanisms of benefit of this class of drug explain the unexpected and remarkable results demonstrated both by prevention trials and by trials dedicated only to HF (like DAPA-HF). These, new drugs in the CV therapeutic armamentarium are establishing a new comprehensive approach from prevention to therapy of HF, giving more emphasis on HF classification in four stages (A→D). New therapies, which are on the horizon, promise to further reduce CV mortality and morbidity in HF patients irrespective of diabetic status.

Summary Myc has emerged as a pivotal transcription factor for four metabolic pathways: aerobic glycolysis, glutaminolysis, polyamine synthesis, and HIF-1α/mTOR. Each of these pathways accelerates the utilization of sugar. The BCG vaccine, a derivative of Mycobacteria-bovis, has been shown to trigger a long-term correction of blood sugar levels to near normal in type 1 diabetics (T1D). Here we reveal the underlying mechanisms behind this beneficial microbe-host interaction. We show that baseline glucose transport is deficient in T1D monocytes but is improved by BCG in vitro and in vivo. We then show, using RNAseq in monocytes and CD4 T cells, that BCG treatment over 56 weeks in humans is associated with upregulation of Myc and activation of nearly two dozen Myc-target genes underlying the four metabolic pathways. This is the first documentation of BCG induction of Myc and its association with systemic blood sugar control in a chronic disease like diabetes., Graphical Abstract, Highlights • T1D has insufficient aerobic glycolysis; this causes insufficient sugar utilization • BCG vaccine lowers blood sugar levels in T1D by augmenting aerobic glycolysis • BCG-induced shift to aerobic glycolysis is associated with Myc activation • Host-microbe BCG interactions through Myc activate sugar-regulating genes in T1D, Immune System; Diabetology; Transcriptomics

An on-chip transducer, for monitoring noninvasively the insulin bio-availability in real time after administration in clinical diabetology, is proposed. The bioavailability is assessed as insulin decrease in situ after administration by means of local impedance measurement. Inter-and-intra individual reproducibility is enhanced by a personalized model, specific for the subject, identified and validated during each insulin administration. Such a real-time noninvasive bioavailability measurement allows to increase the accuracy of insulin bolus administration, by attenuating drawbacks of glycemic swings significantly. In the first part of this paper, the concept, the architecture, and the operation of the transducer, as well as details about its prototype, are illustrated. Then, the metrological characterization and validation are reported in laboratory, in vitro on eggplants, ex vivo on pig abdominal non-perfused muscle, and in vivo on a human subject, using injection as a reference subcutaneous delivery of insulin. Results of significant intra-individual reproducibility in vitro and ex vivo point out noteworthy scenarios for assessing insulin bioavailability in clinical diabetology.

Aims Our study aimed to review the impact of COVID-19 pandemia in children and adolescents with type 1 diabetes mellitus, to analyze the clinical characteristics of the infection and to propose clinical practice recommendations from the Italian Society for Pediatric Endocrinology and Diabetology (ISPED). Methods A literature search was carried out in the guideline databases, Medline and Embase and in Diabetes Societies websites until May 21st, 2020 for guidelines and recommendations on type 1 diabetes mellitus management during COVID-19 pandemic. Results COVID-19 infection in pediatric patients seems to be clinically less severe than in adults; children have so far accounted for 1–5% of diagnosed cases, with a median age of 6.7 years (1 day–15 years) and better prognosis. Clinical manifestations include mild, moderate, severe disease up to critical illness. There is currently no evidence suggesting a higher risk of COVID-19 infection in children with diabetes than unaffected peers. Besides general recommendations for pediatric patients, ISPED has proposed specific measures for patients with diabetes. Conclusion COVID-19 outbreak modified type 1 diabetes management, and telemedicine has been demonstrating to be an effective new tool for patients care. Moreover psychological aspects deserve attention and future researchs are mandatory.

Background and aim Diabetic ketoacidosis (DKA) is a serious medical emergency once considered typical of type 1 diabetes (T1DM), but now reported to occur in type 2 and GDM patients as well. DKA can cause severe complications and even prove fatal. The aim of our study was to review recent international and national guidelines on diagnosis, clinical presentation and treatment of diabetic ketoacidosis, to provide practical clinical recommendations. Methods and results Electronic databases (MEDLINE (via PUB Med), Scopus, Cochrane library were searched for relevant literature. Most international and national guidelines indicate the same accurate flow chart to diagnose, to evaluate from clinical and laboratory point of view, and treat diabetic ketoacidosis. Conclusion Prompt diagnosis, rapid execution of laboratory analysis and correct treatment are imperative to reduce the mortality related to diabetic ketoacidosis. These recommendations are designed to help healthcare professionals reduce the frequency and burden of DKA.