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An erratum on « Insufficiency/deficiency of vitamin B12 in patients in the endocrinological practice» by Natalya G. Mokrysheva, Marina V. Shestakova, Alexander S. Ametov, Mikhail B. Antsiferov, Igor G. Bakulin, Tatiana V. Vavilova, Gagik R. Galstyan, Tatiana Y. Demidova, Fatima K. Dzgoeva, Tatiana L. Karonova, Elena A. Lukina, Ashot M. Mkrtumyan, Rodion V. Ponomaryov, Natalia A. Suponeva, Olga Y. Sukhareva, Minara S. Shamkhalova (2024). Diabetes mellitus. 27(3). doi: 10.14341/DM13181An error was made in the list of authors: Nina A. Petunina was not indicated as author of this article. The correct list of authors: Natalya G. Mokrysheva, Marina V. Shestakova, Alexander S. Ametov, Mikhail B. Antsiferov, Igor G. Bakulin, Tatiana V. Vavilova, Gagik R. Galstyan, Tatiana Y. Demidova, Fatima K. Dzgoeva, Tatiana L. Karonova, Elena A. Lukina, Ashot M. Mkrtumyan, Nina A. Petunina, Rodion V. Ponomaryov, Natalia A. Suponeva, Olga Y. Sukhareva, Minara S. Shamkhalova.The identifier in the ORCID system for F.K. Dzgoeva was also indicated incorrectly. The correct link is: https://orcid.org/0000-0002-0533-7652.The editorial board apologize for this error and state that this does not change the scientific conclusions of the article in any way.The original article has been updated.

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.

AIM: To assess the prevalence of chronic kidney disease (CKD), clinical and demographic characteristics and therapy profile in patients with type 2 diabetes admitted to multidisciplinary hospitals. CREDO (Cardio-REnal Diabetic cOmplications) trial was initiated for this purpose.MATERIALS AND METHODS: in a prospective observational multicenter study for the period from August 2022 to April 2023, data from 445 patients with type 2 diabetes hospitalized in multidisciplinary hospitals of the Moscow Department of Health were analyzed. The data was collected on a single visit. The design of the study did not involve any interventions in routine clinical practice, including the choice of a diagnostic or treatment method.RESULTS. The study included 445 patients with the main inclusion criteria — type 2 diabetes, age over 50 years, duration of diabetes more than 3 years. The prevalence of CKD was 90%, while in 43% the diagnosis of CKD was confirmed, in 43% it was detected for the first time, and in 7% the disease progressed. Patients with stage C2 and C3 (a and b), as well as with levels of A1 and A2 albuminuria, were most often identified. The percentage of patients in whom the albuminuria was not performed remained high — 46.2%. The highest incidence of CKD was observed in patients with inadequate glycemic control, having an HbA1c level of ≥9%. In the group with newly diagnosed CKD, sodium-glucose co-transporter-2 inhibitor (iSGLT-2) was received by 31.1% of patients, glucagon-like peptide-1 receptor agonists (GLP-1 RA) — 7.9% of patients. In the group with confirmed CKD — 30.7% and 9.4%, respectively.CONCLUSION: it has been shown that patients over the age of 50 with type 2 diabetes with a disease duration of more than 3 years are at a high risk of developing CKD — 90%. The results obtained convincingly confirm the possibility of detecting CKD and initiating nephroprotective therapy at the hospital stage.

On March 20, 2024, an interdisciplinary meeting of the Expert Council on the current problem of B12 insufficiency/deficiency and the prevalence of this condition among endocrine patients was held at the Endocrinology Research Centre (Moscow). The purpose of the meeting was to assess the role of B12 deficiency in reducing the quality of life of patients of different groups and to outline a strategy for the management of patients with vitamin B12 insufficiency/deficiency by endocrinologists.The resolution of the expert council was developed by leading specialists in various specialties.

BACKROUND: Heart failure (HF) is in the first place in the structure of cardiovascular death in patients with type 2 diabetes mellitus (T2D). One of the factors determining the prognosis of patients with this pathology is hospitalization. The difficulties of managing patients are related to the heterogeneity of the population. In some cases, HF in patients with T2D remains undiagnosed, and data on the true frequency of HF in patients with T2D and their clinical and laboratory characteristics in real clinical practice remain limited.AIM: To assess the prevalence of HF, clinical and demographic characteristics and therapy profile in patients with T2D admitted to multidisciplinary hospitals.MATERIALS AND METHODS: A prospective observational multicenter study was conducted at the city clinical hospitals of the Moscow. For the period from August 2022 to April 2023, data from patients with T2D were analyzed. Data collection was carried out at one visit. The study design did not involve any intervention in routine clinical practice, including the choice of diagnostic method or treatment.RESULTS: The study included 445 patients in accordance with the main inclusion criteria - T2D, age over 50 years, duration of T2D more than 3 years. The incidence of HF in patients with type 2 diabetes at discharge was 76.6%. The diagnosis of HF was confirmed in 48.7% (n=217), newly diagnosed HF occurred in 27.9% (n=124) of cases, in 12.6% of patients (n=56) the diagnosis of HF was withdrawn, in 10.8% (n=48) of cases the diagnosis of HF was not established. The frequency of prescribing drugs at discharge was iSGLT-2 — 77.3% (n=344), statins — 86.7% (n= 386), MRAs — 23.1% (n=103), diure­tics — 46.1% (n=205).CONCLUSION: 76.6% of patients with T2D admitted to multidisciplinary Moscow hospitals were diagnosed with HF at discharge. The results obtained confirm the possibility of detecting HF and initiating cardioprotective therapy at the hospital stage, using inpatient clinical diagnostic examination, and patients with type 2 diabetes lasting more than 3 years and aged over 50 years can be classified as a high risk group for developing HF.

Features of the functional state of the enteropancreatic hormonal system in pregnant women with gestational diabetes mellitus© Fatima O. Ushanova1*, Tatiana Y. Demidova1, Tatiana N. Korotkova21Pirogov Russian National Research Medical University, Moscow, Russia2Federal Research Centre of Nutrition, Biotechnology and Food Safety, Moscow, RussiaBACKGROUND: The prevalence of gestational diabetes mellitus (GDM) is growing rapidly, along with which the typical portrait of a pregnant woman with this disease is changing. Frequent detection of GDM in the early stages of pregnancy causes a high interest in the study of new mechanisms of its development.AIM: Evaluation of the state of the incretin response based on the analysis of the secretion of GLP-1, glucagon, insulin and c-peptide in pregnant women with different periods of GDM development.MATERIALS AND METHODS: A single-center prospective comparative uncontrolled study that included pregnant women with GSD, divided into 2 groups depending on the duration of the disease: group 1 — pregnant women who were diagnosed at

Chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) is one of the most important medical and social problems associated with significant risks for patients and a burden on the national healthcare system. There are significant unmet diagnostic and therapeutic needs of CKD in T2D patients in Russia relating to problems of underdiagnostics of CKD and substantial residual cardiorenal risks in these patients in spite of therapy with registered renoprotective medications. Finerenone is the first selective non-steroidal mineralocorticoid receptor antagonist which targets different from other drugs pathways involved in the pathogenesis of CKD in T2D. It has a significant potential to reduce residual renal and CV risks, and therefore addresses the existing therapeutic unmet need. According to the results of recent clinical studies, the cardio- and renoprotective effects of finerenone were apparent throughout a wide range of CKD C1-C4 in T2D patients, regardless of the severity of kidney dysfunction, the level of HbA1c and other drug therapy. This document summarizes the main results regarding the efficacy and safety profiles of finerenone and determines its place in treatment of CKD in T2D patients.

BACKGROUND: The problem of metabolic syndrome is considered a demographic catastrophe. According to WHO experts,«by 2025, the prevalence of metabolic syndrome (MS) in the world will amount to more than 300 million people, and in the next 25 years it is expected to increase by 50%.» The pathophysiological mechanisms of MS formation and the role of unhealthy diet on the development of intestinal dysbiosis, mitochondrial insufficiency remain unclear.AIM: To study the effect of unhealthy diet on the state of the intestinal microbiota and the development of metabolicmitochondrial insufficiency in the formation of a multi-organ metabolic syndrome, evaluation of ways of correction.MATERIALS AND METHODS: Clinical picture assessment, anthropometric data (body mass index), laboratory results (glucose, cholesterol and fractions) were carried out in patients with MS, triglycerides, aspartate aminotransferase, alanine aminotransferase, C-reactive protein, lipid peroxidation indicators: malondialdehyde, diene conjugates, schiff bases, hydroperoxides, catalase, superoxide dismutase, succinate dehydrogenase (ASDH), α-glycerophosphate dehydrogenase (α-AGFDH). Hemorheological parameters were evaluated by the apparent viscosity of blood, the yield strength, the aggregation coefficient of erythrocytes and platelets. The microbiota and microbiome of the intestine were evaluated by species, strain composition and the level of metabolites-propionic, butyric, acetic acid, lipopolysaccharides, peptidoglycans. A questionnaire was conducted to study the nature of nutrition.RESULTS: The study included 128 patients with MS and 25 healthy individuals. According to medical outpatient records from anamnesis, questioning of each patient, complaints and clinical picture, 26.2% of patients had type 2 diabetes, 3.74% of men had erectile dysfunction, 7.5% of women had polycystic ovaries, 15.1% had night apnea syndrome, 8.7% hyperuricemic syndrome, 96.5% of patients had metabolic fatty liver steatosis. According to the results of the survey, it was revealed that 99.8% of patients adhered to an unhealthy and unbalanced, high-calorie diet, 46.4% of patients had a low level of physical activity, 48.7% had an average. The revealed disorders of lipid, carbohydrate metabolism, microbiota and intestinal microbiome were associated with increased lipid peroxidation, decreased levels of antioxidant defense enzymes, indicators reflecting mitochondrial function against the background of hemorheological disorders.CONCLUSION: In multi-organ MS, unhealthy diet can be considered as a targeted risk factor triggering pathophysiological mechanisms at the level of the intestinal microbiota, followed by a cascade of metabolic disorders in the form of activation of lipid peroxidation with inhibition of antioxidant defense enzymes, the development of multi-organ mitochondrial insufficiency and the development of latent hemorheological syndrome. The revealed metabolic complex obviously constitutes a multiorgan morphological cluster underlying the development of multi-organ metabolic syndrome. Based on the identified disorders, pathogenetically justified correction of MS should include a balanced diet with mitochondrial protective therapy.

It has now been established that the intestinal microbiota (CM) is one of the 11 links in the pathogenesis of type 2 diabetes mellitus (DM2). Th e fact is that when the composition of BM is disrupted and the concentration of its active metabolites changes, the processes of synthesis and secretion of incretin hormones are disrupted, the homeostasis of carbohydrates and fats in the body is disrupted, the processes of central regulation of appetite change, chronic infl ammation and insulin resistance of peripheral tissues develop. Th is review discusses possible ways of impairing the synthesis of incretin hormones and the incretin eff ect in patients with T2DM through the prism of BM and its active metabolites, and discusses possible ways of correcting the altered composition of BM with incretin drugs.A systematic literature search was carried out using the Scopus, PubMed, Web of Science databases.

This literature review focuses on the association of prediabetes with cardiovascular disease (CVD). Recently, much attention has been paid to the study of prediabetes due to its extremely high prevalence and strong association with a high risk of developing serious complications that worsen the quality of kife of patients. Prediabetes is not only a metabolic condition with a high risk of developing type 2 diabetes mellitus (T2DM), but also CVD and death from all causes. This association is true for both patients who do not yet have CVD and those with a history of CVD. Also during the COVID-19 pandemic, attention is drawn to the fact that people with prediabetes have a higher risk of a severe course of infection, complications and a worse prognosis of the disease. This is associated with hyperglycemia, the presence of chronic systemic inflammation of a low degree of activity, impaired immune response mechanisms and a procoagulant state in patients with prediabetes, although these disorders are less developed than in patients with T2DM. Therefore, early screening of early disorders of normal metabolism. Since active early intervention at the stage of prediabetes helps to prevent the development of type 2 diabetes and CVD.

The widespread prevalence of non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM), as well as their combination, determines the need for a targeted analysis of this pathology in order to optimize approaches to the diagnosis and treatment of patients with NAFLD and T2DM. As components of the metabolic syndrome, these two diseases have largely similar mechanisms of development and progression, simultaneously increasing the risk of adverse outcomes in comorbid patients. Despite the common pathophysiological mechanisms, the question of the development of NAFLD and T2DM remains significant.Upon conducting literature analysis, two main theories have been identified: alimentary and metabolic. According to the alimentary theory, the primary link in the pathogenesis is obesity and the associated excessive accumulation of free fatty acids and triglycerides in the liver, which subsequently leads to insulin resistance and the development of T2DM. In contrast, the metabolic theory considers diabetes-related insulin resistance as the first hit, which, regardless of obesity, creates preconditions for liver damage. In addition, the review focuses on the consideration of the new concept of Metabolic associated fatty liver disease (MAFLD) as a hepatic manifestation of the metabolic syndrome and considers the clinical phenotypes identified within this pathology. In conclusion, pathogenically based treatment goals in patients with NAFLD and T2DM are overcoming insulin resistance, correcting atherogenic dyslipidemia, and restoring the structures and functions of liver cells.

BACKGROUND. Type 2 diabetes mellitus (T2DM) is an independent risk factor for adverse clinical outcomes in patients with Covid-19. There is currently insufficient data evaluating the efficacy and safety of drugs for the treatment of COVID-19, especially in patients with T2DM.AIM. The aim of study was to identify an associative relationship between the drugs used and the clinical outcomes of patients with Covid-19 and T2DM.MATERIALS AND METHODS. A retrospective analysis of the clinical outcomes of 1753 patients with COVID-19 who were hospitalized to the redesignated departments of multidisciplinary city clinical hospital in the period from 23.03.2020 to 01.06.2020.RESULTS. The total number of patients is 1,753, of which 311 (17.7%) are patients with DM2. 92.6% of patients received treatment for COVID-19. At the same time, 91.4% of patients received antibiotics (a/b), 61.5% — bronchodilators, 56.6% — injectable anticoagulants (a/c), 45.2% — hydroxychloroquine, 6.3% — antiviral drugs, 5.4% — oral a/c, 4.6% — glucocorticosteroids (GCS), 1.9% — Tocilizumab.Decrease of risk of death among patients with COVID-19 was as the therapy of a/b (OR 0.07, 95% CI 0.05–0.11, p

Hyperglycemia in T2DM is based on three main mechanisms: insulin resistance, progressive β-cell dysfunction, and excess glucose production by the liver.The onset of T2DM is usually preceded by a long period of insulin resistance. Prescribing sugar drugs that affect different links of pathogenesis, reducing a steady decrease in glycemia. To date, in clinical practice, various combinations of hypoglycemic drugs are used, the choice of which is determined by the characteristics of the course of diabetes in the patient, the presence of concomitant diseases and complications of diabetes, as well as the dominant clinical problem. This resolution provides an expert council opinion on the feasibility of using a combination of alogliptin and pioglitazone in patients with type 2 diabetes.

Diabetes mellitus (DM) is a well known risk factor for osteoporosis and an increased risk of fractures. A lot of data has been published about the relationship between diabetes and bone health. DM type 1 and DM type 2 have different effects on bone mineral density (BMD). The central link in pathogenesis of bone fragility in patients with DM type 1 is a violation of the activity and gifferentiation of osteoblasts. On the contrary, hyperinsulinemia in DM type 2 activates the division and gifferentiation of osteoblasts and contributes to an increase in BMD. However, Higher BMD values in patients with DM type 2 are combined with slowdown in bone metabolism. As the result, high-quality bone remodeling does not occur. And bone strength decreases despite the high BMD. Despite the differences, DM type 1 and DM type 2 have common pathogenic pathways, that lead to increased bone fragility. For example, non-enzymatic glycation of bone matrix collagen and increase in concentration of sclerostin, which blocks the Wnt signaling pathway. In this review, we will analyze current data about epidemiology and pathogenesis of osteoporosis in DM and discuss the practical issues of the clinic, diagnosis, stratification of fracture risk and treatment. Special attention will be paid to the effects of glucose-lowering and anti-osteoporotic drugs on bone tissue.

Gut microbiota (GM) is a set of bacteria which colonize the gastrointestinal tract. GM and its active metabolites take part in intestinal and hepatic gluconeogenesis, in the synthesis of incretin hormones, and affect the regulation of appetite. Thus, GM and its metabolites participate in the homeostasis of carbohydrates and fats. An imbalance in the set of the intestinal flora and a disturbance of the production of active metabolites sharply increases the risk of developing obesity and type 2 diabetes. There are conflicting data in the literature on the role of specific microorganisms in the development of metabolic disorders. Research is needed to identify specific types of bacteria and their active metabolites which affect the development of obesity and type 2 diabetes.

The review presents an analysis of studies on the role of the intestinal microbiota and microbiome in lipid metabolism and the development of dyslipidemia, atherosclerosis and cardiovascular diseases. The role of the intestine as a metabolic organ with a multifactorial strain evolution, involved in lipid metabolism, cholesterol homeostasis and enterohepatic circulation is shown. The influence of microbial imbalance on the development of dyslipidemia and atherosclerosis is considered. Special attention is paid to preventive therapy with hypolipidemic probiotics. It is shown that the use of probiotics with hypolipidemic properties and consisting of a mixture of such strains asLactobacillus plantarumCECT7527, CET7528 and CECT7529, mixtures ofLactobacillus acidophilusLa-5,Bifidobacterium lactisBB-12,Bifidobacterium animalis lactisBB-12 contribute to reducing the level of LDL-C, CCS, TG, are safe and well tolerated, can be used as an adjuvant non-drug therapy in combination with hypolipidemic drugs for dyslipidemia, multifocal atherosclerosis.

Diabetes mellitus (DM) is a serious medical and social problem. The prevalence of diabetes has been steadily increasing in all countries, where 95% are patients with type 2 diabetes. According to the International Diabetes Federation, in 2014, the number of patients with type 2 diabetes was 387 million, or every 12th inhabitant of the planet. By 2035, the number of patients with type 2 diabetes could increase to 592 million people [1]. Global trends in diabetes incidence rates are also observed in Russia. According to the national register, there are 8 million diabetic patients in Russia, or approximately 5% of the total population, whereas 90% of them are patients with type 2 diabetes. By 2025, the number of patients is expected to increase to 13 million people. The number of registered patients is usually 2-3 times less than the real number. [2, 3] The greatest input in the number of diabetic patients is made by the increase in the number of type 2 diabetes patients in older age groups.

One of the most common diseases of the thyroid gland is nodular goiter. The widespread use of modern diagnostic methods (ultrasound, computed tomography, magnetic resonance imaging) helps to identify a huge number of thyroid incidentalomas. This, in turn, requires clear and clinically substantiated guidelines for the diagnosis and treatment of nodular goiter. Such guidelines are being developed by both Russian and foreign endocrinologists, which are the same across the main provisions but have some differences as well. Advancements in diagnostic methods and accumulation of clinical experience result in a regular update of the recommendations. Examination of patients with nodular goiter focuses on ruling out malignant thyroid. Among nodular abnormalities, thyroid cancer is detected in 4,7--5,0% of cases.

Subclinical hyperthyroidism occurs when the serum TSH is below the lower limit of the reference range and the free T4 and T3 concentrations are normal. Тhe clinical significance of subclinical hyperthyroidism is much debated. Subclinical hyperthyroidism has been associated with several biological effects on cardiovascular system, such as increased heart rate, left ventricular mass. Observational studies have reported an association between subclinical hyperthyroidism and coronary heart disease, incident atrial fibrillation, and cardiac dysfunction.