[Pituitary disorders in patients with end-stage chronic renal failure].

Disorders in the kidneys lead to disturbance of homeostasis. As the glomerular filtration rate decreases, the metabolism of numerous biologically active substances, including pituitary hormones, decreases. The article presents an overview of pituitary dysfunction in patients with chronic kidney disease (CKD) and discusses the possible reasons of the pathogenetic mechanisms. Particular focus is being given to the assessment of changes in the concentration of pituitary hormones in patients with end-stage chronic kidney disease (CKD) and discusses the pathogenetic mechanisms of their formation. Particular attention is paid to the assessment of changes in the concentration of pituitary hormones in patients receiving renal replacement therapy (RRT). CKD leads to an increase in the level of prolactin, luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Concentrations of growth hormone (GH), isulin-like growth factor-1 (IGF-1), thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH) and vasopressin may remain within normal values or increase in this group of patients. RRT does not reduce the levels of prolactin, LH, FSH, while the concentration of growth hormone, IGF-1, TSH tends to normalize. The content of ACTH and vasopressin may remain unchanged or decrease. Kidney transplantation in most cases corrects hormonal disorders. Correction of hormonal changes can improve the clinical outcome and quality of life of patients with end stage CKD.

[Adipocytokines: modern definition, classification and physiological role].

Adipose tissue is an endocrine organ which produces a large number of secretory bioactive substances also known as adipocytokines affecting directly insulin resistance (IR), glucose and lipid metabolism, angiogenesis and inflammation. The studies show a close connection between the imbalance of adipocytokines formed as a result of excessive deposit of adipose tissue in the course of the development of type 2 diabetes mellitus and cardiovascular diseases. In the present review, we summarize current data on the effect of the adipocytokines on the liver, skeletal muscles, adipose tissue, endothelial cells and inflammatory processes, as well as attempt to define the term «adipocytokines¼ and classify adipocytokines according to their influence on metabolic processes and pro-inflammatory status. Some of adipocytokines (adiponectin, omentin, leptin, resistin, tumor necrosis factor-α and interleukin-6) are divided into two groups: adipocytokines reducing IR, and adipocytokines increasing IR.

[Resolution on the results of the first working meeting of the Scientific Advisory Board «Actual problems of glycemic variability as a new criterion of glycemic control and safety of diabetes therapy¼].

June 19, 2018 the meeting of the Scientific Advisory Board took place in Moscow, chaired by Professor G.R. Galstyan, (co-chair - A.V. Zilov) devoted to the discussion of the possibilities of improving the results of treatment of diabetes mellitus (DM) by consideration of «variability of glycemia¼ (VG) as an additional criterion of the glycemic control effectiveness (especially of insulin therapy) as well as one of the goals of treatment in patients with unstable glycemia. The purpose of the working meeting was to develop a strategy for the introduction of VG as a predictor and an additional criterion in assessing the effectiveness and safety of hypoglycemic therapy to improve the pharmacotherapy of diabetes and reduce cardiovascular and total mortality. Aims: - to conduct a comprehensive data analysis of the relationship between VG and adverse DM outcomes, such as hypoglycemia, micro-and macrovascular complications, cardiovascular and total mortality; - to accumulate and analyze published data and the experience of decrease of VG and improving outcomes of diabetes on the background of different versions of insulin therapy; - to compare existing methods of glycaemia monitoring and VG assessment, their validity and availability in real practice in the context of limited budget; - to analyze the informativeness, clinical and prognostic significance of various parameters of VG assessment and determine their reasonable «minimum¼ for a comprehensive assessment of VG as a criterion for evaluating the effectiveness of treatment of DM and predictors of negative diabetes outcomes. The following reports were heard during the discussion: Glycemic variability: clinical and prognostic value. Types of glycemic variability. (Alexey V. Zilov, MD, PhD in Medicine, Assistant Professor). Methods of assessment of variability of glycemia in clinical trials and routine practice (Tatiana N. Markova, MD, PhD in Medicine, Professor). Current international and national recommendations on glycemic monitoring (Gagik R. Galstyan, MD, PhD in Medicine, Professor). Peculiarities of glycemic variability and its evaluation among children and adolescents (Alisa V. Vitebskaya, MD, PhD in Medicine).

[Analysis of cardiovascular safety of novel glucose-lowering medications].

In 2008 the Food and Drug Administration has revised approval process for new antidiabetic agents and introduced a requirement to demonstrate the cardiovascular safety in an international multicenter trial. Currently cardiovascular outcome trials of dipeptidyl peptidase-4 (DPP-4) inhibitors (SAVOR-TIMI53, EXAMINE and TECOS), sodium-glucose cotransporter 2 inhibitors (EMPAREG, CANVAS), glucagon-like peptide-1 receptor agonists (ELIXA, EXSCEL LEADER and SUSTAIN-6), ultralong-acting and insulin (DEVOTE) have been completed. The trials confirmed cardiovascular safety of these glucose-lowering medications, and in addition, EMPA-REG OUTCOME (empagliflozin), CANVAS (canagliflozin) and LEADER (liraglutide) have also demonstrated cardioprotective effect of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists. These data led to the changes of clinical guidelines for the management of type 2 diabetes.

[Efficacy of metformin in abdominal obesity].

AIM: To study the effect of metformin on metabolic parameters, body weight (BW), and waist circumference (WC) in patients with abdominal obesity (AO). SUBJECTS AND METHODS: The results of using metformin 2000 mg daily for 3 months in 46 patients with AO. The comparison group consisted of 50 people. BW, WC, and blood pressure (BP) were measured; lipid profile parameters and blood insulin concentrations were determined; and Homeostasis Model Assessment (HOMA) estimates were calculated. Metabolic syndrome (MS) and AO were judged by the 2005 International Diabetes Federation (IDF) criteria. RESULTS: The study and comparison groups showed were reductions in BW by 4.2 and 1.7 kg and in WC by 4.2 and 1.1 cm, respectively. Metformin used in the patients with AO contributed to a more significant improvement in the lipid profile than in those who received no medication. A decrease in the HOMA index was observed only in the metformin group. The effects of the drug were more pronounced in MS and insulin resistance. The use of metformin in the patients with AO decreased lower BW and HOMA index and improved lipid metabolism even in the absence of MS. CONCLUSION: The trial has demonstrated that the people with AO may take metformin could be used in to reduce BW and WC and to treat and prevent MS.

[Hormonal aspects of the development of obesity and metabolic syndrome in ethnic groups (by the population of the Chuvash Republic)].

AIM: To study the specific features of the hormonal status in the development of obesity and metabolic syndrome (MS) in different ethnic groups. MATERIALS AND METHODS: The prevalence of obesity and MS was studied in Russian and Chuvash people, the relationship of MS to body mass index (BMI), the levels of insulin, dehydroepiandrosterone sulfate (DHEAS), and testosterone, and insulin resistance (IR) was assessed. RESULTS: The prevalence of obesity and MS depends on ethnicity and gender (these are more common in the Russians than in the Chuvashes, in the women than in the men). Overweight and obesity versus normal weight are characterized by the higher rate of MS, hyperinsulinemia, and low DHEAS concentrations. The obese men have decreased testosterone levels. The lower DHEAS levels are associated with the presence of MS (association factor +0.36) rather than with the development of obesity (association factor +0.07). In the Russians versus the Chuvashes, the development of MS is more frequently associated with the fall of DHEAS levels and less frequently with the development of IR. CONCLUSION: The incidence of MS increases with higher BMI, accompanies by IR and hyperinsulinemia. MS in the Russians is associated with the lower DHEAS concentration.

[Adaptive systems of the body in metabolic syndrome].

The aim of the work was to study the state of adaptive systems in patients with metabolic syndrome. This cross-sectional randomized trial included 99 women and 32 men. The measured variables were blood levels of dehydroepiandrosterone sulfate (DGEAS), cortisol, total T3 and T4, lymphocyte count, and muscle endurance (number of squats/min). 43 patients presented with metabolic syndrome (MS) and 88 without it. MS was associated with decreased blood DGEAS and T3 levels, increased lymphocyte count, reduced activity of sympathetic nervous system and muscle endurance.

[The prevalence of eating behavior disorders in patients with overweight and obesity].

The prevalence of food behavior abnormalities among people with overweight and obesity. The AIM OF INVESTIGATION: To estimate characteristics of food behaviour among people with overweight and obesity. MATERIALS AND METHODS: We examined 188 human of Chuvashia. Anthropometric data was estimated, bodyweight index and waist-hip index were calculated. Infringements of food behaviour were evaluated according to T.G. Voznesenskoj's recommendations. THE RESULTS AND CONCLUSION: Food behavior abnormalities appeared more often among people with overweight and obesity than among people with normal weight. The prevalence of food behavior abnormalities depended on the presence of abdominal obesity. The frequency of all types of food behavior abnormalities rose among individuals with overweight and obesity. The groups with overweight and obesity turned out comparable in prevalence and structure of food behavior abnormalities.

[Main causes of hyperuricemia in diabetes mellitus]. / Osnovnye prichiny giperurikemii pri sakharnom diabete.

AIM: Investigation of hyperuricemia (HU) causes in diabetes mellitus (DM). MATERIALS AND METHODS: Purin, lipid and carbohydrate metabolisms, renal excretion of uric acid (UA) were examined in 535 patients with DM. Non-insulin-dependent DM (NIDDM) and insulin-dependent DM (IDDM) were diagnosed in 369 and 166 patients, respectively. RESULTS: Hyperglycemia and glucosuria in DM enhance renal excretion of UA. However, HU in DM occurs significantly more frequently than in the population (22.5 +/- 3.0% in IDDM and 29.9 +/- 2.5% of cases in NIDDM). CONCLUSION: In NIDDM, HU genesis is strongly related with renal lesions. In IDDM, HU genesis is associated with metabolic factors (high activity of xantinoxidase, lipid peroxidation, obesity). However, combination of factors is, as a rule, involved in HU development: renal dysfunction and hyperproduction of UA.

[Hyperuricemia as a risk factor for noninfectious diseases in the inhabitants of Chuvashia]. / Giperurikemiia kak faktor riska nekotorykh neinfektsionnykh zabolevanii zhitelei Chuvashii.

The relation of hyperuricemia with obesity, arterial hypertension, hyperlipoproteinemia, high intensity of lipid peroxidation, hyperinsulinemia, diabetoid carbohydrate disturbances (abnormal tolerance to carbohydrates and type-II diabetes mellitus) has been investigated in an epidemiological survey of a random population. The study covered 594 citizens of Chuvashia aged 16-65 years (mean age 39.4 +/- 0.5 years). Hyperuricemia is shown to be related with hyperlipidemia, arterial hypertension, obesity, high activity of lipid peroxidation and hyperinsulinemia. It is evident that on the population level hyperuricemia may serve an indicator of hormonal-metabolic athero-, diabetogenic shifts.