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Alogliptin, a dipeptidylpeptidase-4 inhibitor, is an oral hypoglycemic agent approved in many countries for the treatment of patients with type 2 diabetes, including the United States, Europe, and Japan. The drug is effective both as a monotherapy, and as an additional or combined treatment of type 2 diabetes. Alogliptin is well tolerated by patients, including the elderly, as well as those suffering from kidney and / or liver failure or having a high risk of cardiovascular events. The low risk of hypoglycemia, weight gain, acute pancreatitis, and side gastrointestinal events. During treatment with alogliptin has been demonstrated in both long-term (up to 4.5 years) studies and in actual clinical practice. Alogliptin increases postprandial levels of the glucagon-like peptide-1, which leads to insulin secretion and normalization of glucose homeostasis. Treatment with alogliptin is associated not only with improved glucose metabolism, but also with a decrease in blood pressure and arterial rigidity in patients with arterial hypertension and diabetes, as well as normalizing the lipid profile. In patients with diabetes mellitus who have recently undergone acute coronary syndrome and received alogliptin, the frequency of serious adverse cardiovascular events does not increase. Experimental data show that alogliptin reduces ventricular hypertrophy, interstitial fibrosis, and diastolic dysfunction. Alogliptin has a number of unique properties. It is assumed that it can increase the number of circulating endothelial progenitor cells that play an important role in endothelial repair and neovascularization. Alogliptin preserves the functionality and structure of the mitochondria of cardiomyocytes. The drug may be a potential treatment for patients with MODY1 diabetes at an early stage of the disease, when residual insulin secretion is preserved. Treatment with a fixed combination of Alogliptin + Metformin results in better glycemic control than monotherapy and is well tolerated. There is evidence that treatment with alogliptin is not associated with an increased risk of pancreatitis or pancreatic cancer.

The most common causes of diabetes insipidus are neurosurgical operations on the pituitary gland due to its defeat by benign and malignant tumors, the neoplasms themselves, lymphocytic hypophysitis. Much less is known about the development of metastatic lesions of the pituitary gland by primary tumors of the lung, breast and kidneys. Even less common is diabetes insipidus caused by leukemia, lymphoma, xanthogranulomas, germinomas, HIV infection, pituitary hemorrhage, drug-induced, combined with neurofibromatosis, as well as diabetes insipidus during pregnancy. The review describes the predictors of the development of diabetes insipidus during surgical interventions, the frequency of development and prognosis in various neurosurgical operations. The article focuses doctors of various specialties on timely diagnosis, prevention and treatment of diabetes insipidus, including its atypical forms.

Diabetes therapy in elderly patients is a complex task due to their heterogeneous population, high risk of hypoglycemic conditions, the development of life-threatening arrhythmias and cardiovascular diseases, dementia, and the presence of a large number of comorbid diseases. The number of elderly patients in the world is growing rapidly, however, the algorithm for the treatment of elderly patients has not yet been developed and preference is given to an individual approach to the therapy of violations of carbohydrate metabolism. There are no therapeutic goals in elderly patients depending on their clinical and functional characteristics, the recommended level of glycated hemoglobin varies in a wide range from 7 to 9%. Priority is the problem of preventing hypoglycemia, which can lead to fatal consequences. The requirements for the use of oral hypoglycemic drugs in elderly patients with diabetes mellitus are also reduced to the absence of nephro-, hepatoand cardiotoxicity, as well as their lack of interaction with other drugs and ease of use. Such conditions are answered by incretin therapy represented by agonists of glucagon-like peptide-1 and inhibitors of dipeptidyl peptidase-4. It is also possible to use ultra-long-acting insulin. It is undesirable to use sulfonylureas and intensive insulin therapy in elderly patients. In the absence of contraindications, the use of metformin and pioglitazone is permissible, with the caution the use of SGLT-2 inhibitors is recommended. Treatment with any medicinal hypoglycemic drugs is possible in elderly patients who lead an active lifestyle and are capable of self-monitoring of carbohydrate metabolism, but in patients with low social adaptation it is desirable to limit the incretin therapy.

In economically developed countries, cirrhosis is one of the six leading causes of death at the age of 35–60 years and ranges from 14 to 30 cases per 100000 population. In the world 40 million people die of cirrhosis each year. At 6% of the population of the Russian Federation there is a diabetes mellitus. The combination of diabetes mellitus in patients with cirrhosis of the liver is a common comorbid pathology. Diabetes mellitusis a risk factor for the development of liver cirrhosis, and the incidence of combination of both diseases is quite high, although the frequency of occurrence varies. About 80% of patients with LC may have impaired glucose metabolism, and 30% have diabetes mellitus. Prospective studies have shown that diabetes is associated with an increased risk of developing hepatic complications and death in patients with cirrhosis of the liver. Diabetes mellitus increases the risk of complications of liver cirrhosis of any etiology (varicose veins of the esophagus, hepatic encephalopathy, hepatic-cell insufficiency) and subsequent survival. The incidence, frequency of hospitalizations and mortality from this combined pathology are very high. There are common mechanisms that provoke metabolic and autoimmune disorders in the development of chronic hepatitis and cirrhosis, leading to steatosis, insulin resistance, impaired glucose tolerance and the development of diabetes mellitus. There are certain features of the evaluation of the compensation of carbohydrate metabolism in patients with cirrhosis of the liver, anemia and impaired protein metabolism. Effective control of glycemia can have a beneficial effect on the treatment of these patients. However, few studies have evaluated the efficacy and safety of antidiabetic drugs and the effect of diabetes treatment on morbidity and mortality in patients with cirrhosis. Previously it was believed that in the presence of cirrhosis the only treatment remains insulin. At present, in connection with the emergence of modern groups of hypoglycemic drugs, as well as new approaches to the treatment of type 2 diabetes, this concept has radically changed. Unfortunately, the issues of correction of carbohydrate metabolism in patients with cirrhosis of the liver are practically not covered in the world literature. This article deals with the correction of carbohydrate metabolism in patients with cirrhosis and hepatocellular insufficiency of insulin analogs, biguanides, drugs with incretin effect — dipeptidyl peptidase‑4 inhibitors, agonists of glucagon-like peptide‑1, inhibitors of sodium-glucose cotransporter 2 diabetes. Particular attention is paid to the development of hepatocellular insufficiency and portal hypertension in patients with cirrhosis and type 2 diabetes, as well as processes for their prevention and insulin alternative correction methods.

Diagnosis and treatment of functioning and non-functioning neuroendocrine tumors is a challenging task. Surgeru remains the only radical method of treatment of these tumors, but tumors often are diagnosed at the stage of metastasis, when only palliative treatment is possible. Octreotide in patients with neuroendocrine tumors remains a drug with proven efficacy that can suppress the clinical symptoms of carcinoid syndrome and has antiproliferative activity, which can improve the quality of life and prolong survival.

Aim. To study testosterone undecanoate effects on some modifiable cardiovascular risk factors in men with metabolic syndrome (MS).Material and methods. Androgen status screening (anthropometry, total and free testosterone level measurement) was performed in 35-75-year-old men with cardiovascular disease (CVD). In 50 MS patients, a double-blind, randomized, placebo-controlled trial of testosterone undecanoate was performed, focusing on hypogonadism clinics, erectile function (EF), quality of life (QoL), lipid profile (LP), inflammatory markers: C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha), and interleukin-6 (IL-6).Results. In men with CVD, clinical and laboratory androgen deficiency was observed in 67,8%, more often in those with visceral obesity. By Week 30 of testosterone treatment, androgen deficiency became less manifested clinically; EF, QoL, and LP also improved. Baseline levels of inflammatory markers pointed to elevated CVD risk. Testosterone undecanoate therapy was associated with significant, 2-fold reduction in CRP concentration, and 1.2-fold decrease in TNF-alpha and IL-6 levels.Conclusion. In men with CVD, hypogonadism was widely prevalent; testosterone level was age-independent in combined pathology. Testosterone level normalization facilitated improvements in LP and QoL. Testosterone undecanoate therapy was safe and well-tolerated.

Among patients with somatic diseases the most of those who had had the history of femoral neck fracture suffered from cardiovascular diseases. The consulting room for osteoporosis was established in the Moscow out-patients' clinic. More than 87% of patients with somatic diseases had the risk factors for osteoporosis. Low BMD was found in more than 72% of these patients. Thus, the consulting room for osteoporosis based on out-patients' clinic let us to diagnose and treat osteoporosis in proper time as well as to prevent the development of osteoporosis in patients with different somatic diseases.

The presence of risk factors for osteoporosis has been found in 87,1% of investigated patients with somatic diseases. Osteoporosis was diagnosed more frequently in males with somatic diseases, than in females with somatic diseases. Moreover, males had lower BMD versus females. The prevalence of osteoporosis depended on age for men, but did not for women. The presence of somatic disease and/or the risk factors for osteoporosis are the most important factors in the development of osteoporosis without any dependence on sex.

Цель. Оценить применение препаратов тестостерона при андрогенном дефиците у мужчин с сахарным диабетом 2 типа. Материалы и методы. В исследовании приняли участие 92 пациента, 46 (1-я группа) из которых получали ?Андрогель? (трансдермальная форма тестостерона) в дозе 5,0 мг. 46 пациентов (2-я группа) получали тестостерон ундеканоат (небидо?) по 1000 мг за инъекцию. Определяли уровень тестостерона, парралельно исследовали уровень глобулина, связывающего половые стероиды (ГСПС). Для исключения гипогонадотропного гипогонадизма определяли уровни ЛГ, ФСГ и эстрадиола в сыворотке крови. Тяжесть ЭД определяли по Международному индексу эректильной функции. Всем пациентам выполнено трансректальное УЗИ предстательной железы. Результаты. Независимо от получаемой терапии у всех пациентов отмечено улучшение сексуальной активности, повышение либидо, снижение общей массы тела и процента жировой ткани. Средний уровень PSA в 1-й группе незначительно возрос. Отмечены позитивные сдвиги в липидном спектре и уровне гликированного гемоглобина. Индекс эректильной функции увеличился и составил в среднем в 1-й группе 20,1?5,3, а во 2-й группе ? 19,8?5,8 балла. Выводы. Для лечения андрогенного дефицита у больных СД 2 типа могут с успехом применяться оба препарата тестостерона. Они позитивно влияют на липидный спектр, массу тела, компенсацию СД, остеопороз, сексуальную функцию и настроение. В обязательное исследование больных СД 2 типа необходимо включить определение уровня тестостерона. Пациенты, получающие терапию гелем тестостерона, должны иметь более серьезную мотивацию.