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Artificial hypoglycemia (Munchausen syndrome) is a condition caused by low blood glucose due to the deliberate taking of insulin or oral hypoglycemic drugs. Artificial hypoglycemia remains one of the problems that endocrinologists face in their practice; a diagnostic search for its etiological factor can lead to expensive and unnecessary studies. Diagnosis of artificial hypoglycemia in patients with diabetes mellitus on insulin therapy seems to be a labor-intensive task, since unlike most factitious disorders, which may be indicated by atypical manifestations of the disease or conflicting medical information about the patient, in patients with diabetes mellitus hypoglycemic syndrome is an expected unwanted event due to insulin therapy. Therefore, deliberate insulin administration is often not diagnosed until self-induced hypoglycemia becomes recurrent and/or severe. If artificial hypoglycemia is suspected, a number of authors currently recommend testing С peptide and a combination of two methods for quantitative determination of insulin in the blood using different analyzer systems. Active collaboration between clinical and laboratory specialists is the key to successfully solving such a diagnostic problem.This article presents a clinical case of Munchausen syndrome in a 28-year-old patient with type 1 diabetes mellitus with recurrent hypoglycemia during 21 years, repeated severe hypoglycemia, including loss of consciousness, and proven intentional administration of an insulin analog drug during hospital stay; the complex diagnostic path passed before making the correct diagnosis is described.

Due to its effect on insulin resistance, ease of administration and favorable safety profile, metformin has been included in the recommendations of foreign medical communities for the management of pregnant women with hyperglycemia since 2008. However, in Russia, the use of any oral hypoglycemic agents during pregnancy is still contraindicated. However, recent studies demonstrate the safety and positive effects of metformin on pregnancy in patients with pregestational diabetes mellitus, polycystic ovary syndrome and gestational diabetes mellitus. In 2023, the Federal Service for Surveillance in Healthcare of the Ministry of Health of Russia updated the instructions for the medical use of Glucophage® and Glucophage®Long: pregnancy was excluded from the “Contraindications” section and moved to the “With caution” section. This resolution is intended to evaluate studies of the effectiveness and safety of metformin, as well as to study the experience of foreign colleagues and Russian legal aspects of prescribing metformin in the stages of preparation for pregnancy, during it and in the post-gravid period.

According to the decision of the WHO, therapeutic education (TE) of patients is an independent branch of medicine and an essential component of the treatment of chronic diseases, primarily diabetes mellitus and obesity. TE is implemented through the creation of “Schools for patients with diabetes mellitus” and “Schools for patients with overweight” (“Schools”) as a structural unit of a medical institution. On April 25–26, 2022, the First All-Russian Forum «Therapeutic Education in Endocrinology» was held online, organized by the Public Organization «Russian Association of Endocrinologists», which was attended by leading experts in this field. As a result of its work, this Resolution was adopted by the experts. It discusses the methodological and pedagogical foundations of TE, it is proposed to make changes related to the organization of the work of «Schools», tariffing in the obligatory health insurance system, and training of personnel, including nurses.

At the beginning of the XXI century, with the advent of technical capabilities and new methods of genes sequencing, the attention of researchers to the study of the human metagenome has significantly increased. The interaction between changes in the qualitative and quantitative composition of the gut microbiota (GM) and various diseases is being actively studied, a search for specific metabolites and genes of microorganisms that may be associated with the development, in particular, of immune-mediated diseases is underway. In recent years, a lot of new data have been published on the possible contribution of gut flora dysbiosis to the development of Type 1 Diabetes Mellitus (T1DM), while the first assumptions were put forward as far back as 1970s. The search for pathogenetic mechanisms of GM influence on the development and progression of T1DM is becoming an increasingly relevant objective, since in recent years the incidence of T1DM is rapidly increasing, which is a serious health problem throughout the world.This review discusses the current ideas about the role of GM in the immunopathogenesis of T1DM, new data on the near-term prospects in the study of the human macrogenome, current ideas about the role of GM in the immunopathogenesis of T1DM, and the possibility of applying this knowledge by the practitioner.

Slowly developing immune-mediated diabetes, often called latent autoimmune diabetes in adults, is characterized by the presence of autoantibodies (ATs) to glutamic acid decarboxylase (GADA), the patient's age at the onset over 35 years, and the absence of the need for insulin therapy for 6-12 months to 6 years from the moment of diagnosis, according to the WHO classification of 2019, refers to hybrid forms of diabetes mellitus (DM). In this article, we present a case history of slowly developing immune-mediated diabetes in a 14-year-old boy who was transferred from metformin monotherapy and a diet with restriction of digestible carbohydrates to the intensified insulin therapy only 4 years after the onset of diabetes mellitus with a glycated hemoglobin (HbA1c) level of less than 6.5% throughout the disease. As a result of the studies, the patient was found to have a homozygous genotype highly predisposing to the development of Type 1 Diabetes Mellitus (T1DM), as well as increased levels of ATs to GADA and tyrosine phosphatase (IA-2A). The initially preserved level of basal C-peptide and the clinical course of the disease in this patient do not allow us to classify this case as a classic variant of the course of Type 1 Diabetes Mellitus.