[Management of a patient with diabetes mellitus after total pancreatectomy. Case report].

In modern diabetology, the most important condition for a personalized approach to patient management is to determine the type of diabetes mellitus. Particular attention is drawn to a large, but at the same time insufficiently studied group of patients with diabetes mellitus due to diseases of the pancreas or as a result of surgical interventions on the pancreas, in particular, patients who, for a number of vital indications, undergo total pancreatectomy and the mechanism of development of impaired glucose homeostasis have not been studied in these patients. To date, there are no specific algorithms for managing this category of patients. This clinical example emphasizes that the management of glycemia in patients with diabetes mellitus as a result of total pancreatectomy is an extremely difficult task that requires a multidisciplinary approach in the treatment of this category of patients, the participation of an endocrinologist at all stages of patient treatment.

[Parkinson's disease and type 2 diabetes mellitus: interrelation of pathogenetic mechanisms and general therapeutic approaches]. / Bolezn' Parkinsona i sakharnyi diabet 2-go tipa: svyaz' mekhanizmov patogeneza i obshchie terapevticheskie podkhody.

The review article discusses the epidemiological, clinical and pathophysiological aspects of the relationship between Parkinson's disease (PD) and type 2 diabetes mellitus (DM2). DM2 increases the risk of PD, correlates with the rate of its progression and severity of motor and cognitive deficits. The key link in the pathogenesis of both diseases can be insulin resistance that occurs in peripheral tissues in DM2 and in the brain in PD. In this regard, the use of antidiabetic drugs as neuroprotective agents opens up the possibility of developing a new strategy for targeted therapy that modifies the course of PD.

[The problem of vitamin B12 deficiency: relevance, diagnosis and targeted therapy (based on materials of an interdisciplinary expert council with international participation)]. / Problema defitsita vitamina B12: aktual'nost', diagnostika i targetnaya terapiya (po materialam mezhdistsiplinarnogo soveta ekspertov s mezhdunarodnym uchastiem).

Deficiency of vitamin B12 occurs much more often than it is commonly believed and leads to a wide range of various disorders, the emergence of primarily neurological manifestations, while there is a lack of awareness among clinicians in the field of its causes, nonspecific manifestations, diagnostic methods and effective therapy. The conference «The problem of vitamin B12 deficiency and the experience of use in Germany¼ was devoted to this urgent clinical problem, within the framework of which an interdisciplinary council of experts, at which the most pressing issues were considered, associated with B12 deficiency.

[Empagliflozin and heart failure: position paper of the experts on the results of the online meeting and discussion of the EMPEROR-Preserved Trial].

At an international online expert meeting held on September 16, 2021, the results of the empagliflozin research program EMPA-REG Outcome, EMPEROR-Reduced and EMPEROR-Preserved were reviewed. We analyzed cardiovascular and renal outcomes during the treatment with empagliflozin in patients with chronic heart failure, regardless of the presence of type 2 diabetes mellitus. The positive results of the EMPEROR-Preserved study are updated and their significance for clinical practice is discussed. Several proposals have been adopted that will accelerate the introduction of empagliflozin therapy into practice in patients with heart failure and overcome clinical inertia.

[The agreed experts' position of the Eurasian Association of Therapists on tactics of management of patients with comorbid pathology infected with SARS-Cov-2].

The agreement of experts of the Eurasian Association of Therapists (EAT) discusses pathogenesis and treatment of COVID-19. Modern data on the characteristics of cardiovascular, kidney, respiratory damage in SARS-infected CoV-2 are presented. The tactics of managing patients initially having cardiovascular diseases, diabetes mellitus, chronic obstructive pulmonary disease, bronchial asthma, chronic kidney disease are discussed in detail. The article presents data on drug interaction of drugs.

[The pharmacogenetics of hypoglycemia and the glycemic variability at the patients ith type 2 diabetes mellitus].

AIM: To investigate the link between the hypoglycemia (registrated accurately by the professional Continuous Glucose Monitoring CGM; severe hypoglycemia at home) and the hetero-/homozygote carriage of single nucleotide polymorphisms (SNP) of cytochrome systems geneCYP2C9(rs1799853CYP2C9*2 иrs1057910CYP2C9*3) at the patients with Type 2 Diabetes Mellitus (T2DM) used sulphonylurea (SU). MATERIALS AND METHODS: In Study Case-Control 120 T2DM-SU-patients genotyped by SNPs of geneCYP2C9(using PCR-RT) had been done the professional CGM (System iPro2, Medtronic) recorded Time in Range of Hypoglycemia (TIR-HYPO), level of Minimal CGM-hypoglycemia (MinGl) and standard CGM-parameters of Glycemic Variability. Severe hypoglycemia at home was recorded from visit to visit. The odds ratio (OR) of metabolic disturbances had been assessed for carriage SNPs in comparison with wide alleles. RESULTS: The Study established that carriage of SNPsrs1799853andrs1057910geneCYP2C9at T2DM-SU-patients associated with rising of Glycemic Variability and frequency of CGM-hypoglycemia (MinGl decreasing, increasing of TIR-HYPO and number of Glycemia Excursion 4 mmol/L/h), as well as increasing severe hypoglycemia at home (p0.05). Thus, OR at the carriage ofrs1799853andrs1057910respectively equaled: for CGM-hypoglycemia 7.78 (3.0220.01) and 5.80 (0.23145.87); number of Glycemia Excursion 4 mmol/L/h 5.76 (2.2914.43) and 4.44 (1.4313.76); MinGl3.9 mmol/L 4.39 (1.7910.75) and 6.26 (1.8421.30); CV40% (vs30%) 3.63 (1.0412.62) and 15.22 (0.59393.94);p0.05. CONCLUSION: At the real clinical practice the assessment of carriage of SNPs of geneCYP2C9before inclusion of SU to glucose-lowering scheme of T2DM-therapy it necessary to carry out for the detecting patients with a higher risk of hypoglycemia and rising of Glycemic Variability.

[The сardiometabolic assessment of the glycemic variability in patients with diabetes mellitus: the role of the glucocardiomonitoring].

Aim To study quantitatively the two-way relationship between parameters of glycemic variability and development of cardiovascular events in patients with type 2 diabetes mellitus (DM) on chronic sulfonylurea (SM) therapy by synchronous, professional glucose and cardiac monitoring.Material and methods The study included 421 patients with type 2 DM on SM therapy. A 5-day synchronous glucose and cardiac monitoring was performed for these patients in a retrospective mode using an iPro2 (Medtronic, USA) continuous glycemia monitoring (CGM) system and Holter monitoring. Glycemic endpoints (CGM-parameters of glycemia variability and integral indexes) and cardiological endpoints (ventricular rhythm disorders (VRD), ST segment depression (dST), and corrected QT interval (QTc)) were evaluated.Results Clear correlations were found between the ST segment depression and the increase in TIR-HYPO index and the length of QTc. The strongest correlation was observed for VRD and the increase in TIR-HYPO. Moderate correlations were observed between VRD and the decrease in TIR-NORMO and between increased variabilities of glycemia (increases in SD and number of glycemia excursions >4 mmol/l/h) and integral indexes (mean CGM-level of glycemia and HbA1c). Elongation of the QTc interval was associated with increased TIR-HYPO, decrease in maximum glycemia, and development of dST.Conclusion The glucose and cardiac monitoring confirmed the close interrelation between the quality of glycemic control and cardiovascular disorders and should be recommended for a wider use in real-life clinical practice for determining the cardiometabolic status of patients and personalization of hypoglycemic therapy.

[Glycemic variability and oxidative stress in patients with type 2 diabetes mellitus during combined glucose-lowering therapy]. / Variabel'nost' urovnia gliukozy v krovi i okislitel'nyi stress u bol'nykh sakharnym diabetom 2-go tipa na fone kombinirovannoi sakharosnizhaiushchei terapii.

AIM: To evaluate the impact of intensified glucose-lowering therapy on carbohydrate metabolic indicator, such as glycated hemoglobin, fasting blood glucose level (BGL) (FBGL), postprandial BGL (PBGL), and glycemic variability (GV) in patients with type 2 diabetes mellitus (T2DM) during metformin monotherapy before and 3 months after therapy intensification. SUBJECTS AND METHODS: The investigation enrolled 51 patients with T2DM treated with metformin 1000 mg twice daily, who failed to achieve satisfactory glycemic control. During randomization, the treatment was intensified by addition of sitagliptin 100 mg/day in Group 1 (n=25) or gliclazide MB 60 mg/day in Group 2 (n=26). Before and 3 months after the treatment, carbohydrate metabolic indicators were investigated, 24-hour BGL monitoring (continuous glucose monitoring system (GMS)) was performed, and the body's antioxidant status was examined by determining the total antioxidant capacity of blood plasma (overall sound pressure levels (OASPL)). RESULTS: During 3-month treatment, Group 1 had a significantly reduced FBGL compared to that before the therapy; in Group 2 this index did not change significantly. Both study groups showed a significant decrease in PBGL and glycated hemoglobin (HbA1c). The mean amplitude of glycemic excursion (MAGE) was significantly decreased in the sitagliptin intensification group. In both groups, the standard deviation (SD) reduced significantly by 26% in Group 1 and by 38% in Group 2. Both groups also displayed a significant increase in blood OASPL (p<0.05). CONCLUSION: The addition of sitagliptin significantly affected the change in the indicators of both the standard carbohydrate metabolism (FBGL, PBGL, and HbA1c) and GV (MAGE, SD), whereas that of gliclazide MV altered some studied parameters. OASPL significantly increased in both groups.

A New Chemiluminescent Method for Evaluation of the Functional Activity of Neutrophils in Patients with Type 2 Diabetes Mellitus.

Functional activity of neutrophils was evaluated by the chemiluminescent method with successive double stimulation by soluble stimuli with different mechanisms of action: phorbol-12-myristate-13-acetate (PMA) and phormyl-methionyl-leucyl-phenilalanine (fMLP). The study was carried out in 26 patients receiving oral sugar-reducing therapy. In addition to the functional activity of neutrophils, the levels of TBA reactive products, inflammation markers, blood clotting values, and biochemical parameters were measured. The results showed mainly reduction of the granulocytic component of the immune system in the patients.

Kinetic Chemiluminescence as a Method for Oxidative Stress Evaluation in Examinations of Patients with Type 2 Diabetes Mellitus.

We propose a new approach to evaluation of oxidative stress based on kinetic chemiluminescence: measurement of antioxidant and pro-oxidant activities of the plasma. The study included 50 patients with type 2 diabetes mellitus receiving peroral hypoglycemic therapy. In addition to the above parameters, the levels of TBA-reactive products, inflammation markers, clotting parameters, and biochemical values were studied. The new method provides information on oxidative stress in patients with type 2 diabetes mellitus irrespective of the clinical and laboratory values. The use of this method in complex with the clinical, laboratory, and instrumental studies allows comprehensive evaluation of patient's status for the diagnosis and choice of therapy.

[Type 2 diabetes mellitus: Clinical aspects of genetics, nutrigenetics, and pharmacogenetics]. / Klinicheskie aspekty genetiki, nutriogenetiki i farmakogenetiki sakharnogo diabeta 2-go tipa.

The review gives modern knowledge of the genetics, pharmacogenetics and nutrigenetics of type 2 diabetes mellitus. The knowledge of genetic determinants can refine our understanding of the pathogenesis of this disease and introduce pharmacogenetic and nutrigenetic approaches to its effective therapy and prevention.

[Effect of dipeptidyl peptidase-4 inhibitors on lipid metabolism in patients with type 2 diabetes mellitus].

AIM: To evaluate the effect of sitagliptin in combination with metformin on glucose toxicity and lipotoxicity in patients with type 2 diabetes mellitus. SUBJECTS AND METHODS: . Eighty-two overweight and dyslipidemic patients (mean age 55.3 +/- 9.1 years) who had not achieved the goal levels of glycated hemoglobin (HbA1c) (mean level 8.3 +/- 1.6%) during metformin therapy and dietotherapy were examined. Group 1 patients received sitagliptin 100 mg/day in combination with metformin 2 g/day; Group 2 took metformin 1.5-2 g/day. The levels of fasting plasma glucose (FPG) levels, postprandial glycemia (PPG), HbA1c, body weight, body mass index, waist circumference, and waist-to-hip ratio, blood lipid composition, and the levels of insulin, leptin, adiponectin, HOMA-IR, and HOMA-beta were estimated at baseline and 6 months later. Visceral fat (VF) magnetic resonance imaging (MRI) was carried out. RESULTS: Following 6 months, both groups showed positive changes in FPG, PPG, and HbA1c levels. HbA1c decreased from 8.3 +/- 1.6 to 6.6 +/- 1.24% in Group 1 and from 8.35 +/- 1.75 to 7.62 +/- 1.39% in Group 2. PPG and FPG reduced by an average of 2.67 and 3.3 mmol/l in Group 1 and by 2.1 and 1.8 mmol/l in Group 2. HOMA-beta increased by 23.4. conventional units (CU) in Group 1 and by 4.8 CU in Group 2. HOMA-IR was noted to display positive changes in both groups. The level of adiponectin rose by 1.9 ng/ml in Group 1 and by 0.49% ng/ml in Group 2 and that of leptin fell by 7.37 and 1.21 ng/ml, respectively. There were significant differences between the groups in anthropometric changes. MRI revealed a significant VF drop by 20.6 +/- 13.5 cm2 (7.5%) in Group 1 and by 5.7 +/- 3.75 cm2 (1.76%) in Group 2. CONCLUSION: Combined therapy with sitagliptin and metformin caused reductions in glucose toxicity and lipotoxicity.

[Cardioprotective effects of glucagon-like peptide 1 receptor agonists].

In this paper we discuss pathogenetic mechanisms of cardiovascular risk reduction in patients with type 2 diabetes mellitus by glucagon-like peptide 1 (GLP-1) receptor agonists. Results of experimental studies and randomized clinical studies are presented, and perspectives for using GLP-1 agonists in patients with diabetic cardiovascular complications are described.

[The contribution of current investigations to understanding the nature of type 2 diabetes mellitus, and treatment perspectives].

The paper discusses the key issues of modern diabetology: a concept of pathogenesis, genetic aspects, novel drugs and devices for the therapy of diabetes mellitus, and its treatment perspectives.

[Nonglycemic effects of dipeptidyl peptidase-4 inhibitors].

The review considers the major nonglycemic effects of dipeptidyl peptidase-4 inhibitors commonly used in diabetological practice, by using as an example sitagliptin, the first and most investigated representative of this class.

[Erectile dysfunction and obesity].

The review considers the relationship between obesity and erectile dysfunction (ED). Obesity is associated with the high prevalence of ED; however, the pathophysiological link between these conditions has yet to be adequately investigated. Visceral obesity leads to the enhanced activity of inflammatory responses and, thus, endothelial dysfunction and decreased plasma testosterone levels, which favors the development of hypogonadism and increases the risk of vascular diseases. Endothelial dysfunction and androgen deficiency in turn give rise to ED.

[Evaluation of the efficiency and safety of therapy with a combination of sulfonylurea derivatives and insulin sensitizers for type 2 diabetes mellitus].

AIM: To evaluate the efficiency and safety of early combination therapy with sulfonylurea derivatives (SUD) and insulin sensitizers in patients with type 2 diabetes mellitus (T2DM). SUBJECTS AND METHODS: Forty patients (31 women and 9 men; mean age 57.7 +/- 0.9 years) with decompensated T2DM (HbA(1c), 8.16 = +/- 0.27%), a mean body mass index of 32.7 +/- 0.27 kg/m2, who received glimepiride, were examined. The duration of T2DM was 3.3 +/- 0.4 years. The patients had concomitant cardiovascular diseases (CVD). Coronary heart disease and hypertensive disease (HD) were treated; the doses of the agents were not adjusted during the study. For T2DM compensation, all the patients were given insulin sensitizers (rosiglitazone 4 mg) in addition to glimepiride. The treatment lasted 24 weeks. Carbohydrate and lipid metabolic parameters, insulin resistance, body weight, structural and functional parameters, and heart rate were estimated before and after the treatment. RESULTS: During the combination therapy, there were decreases in the level of HbA(1c) from 8.16 +/- 0.27 to 6.84 +/- 0.15%, fasting blood glucose from 8.89 +/- 0.35 to 6.77 +/- 0.16 mmol/l, postprandial blood glucose from 8.66 +/- 0.24 to 7.761 +/- 0.20 mmol/l, HOMA index from 5.88 +/- 0.70 to 3.75 +/- 0.44. The rate of hypoglycemic reaction reduced. Sugar-lowering therapy was observed to have, on average, a positive impact on blood lipid composition and cardiovascular parameters in the group. Echocardiography (EchoCG) identified a group of patients with negative cardiac structural and functional changes. CONCLUSION: The combination therapy with SUD and insulin sensitizers was stated to be effective in maintaining the reached blood glucose level, reducing the risk of hypoglycemic reactions, and positively affecting lipid metabolism. The therapy resulted in cardiovascular improvement only in patients without obvious signs of CVD while it caused negative EchoCG changes (transformation of concentric to eccentric left ventricular hypertrophy) in patients with a long-term (more than 7 years) history of HD and pronounced cardiac structural and functional alterations.

[Diabetes mellitus is an independent risk factor for cardiovascular disease].

Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases, the incidence of which tends to grow steadily. The great social importance of diabetes mellitus is determined by disability and deaths from late vascular events. So the risk for cardiovascular disease (CVD) and the cardiovascular safety of glucose-lowering therapy for T2DM are a multidisciplinary and multi-faceted problem. Its solution requires a comprehensive approach to controlling the risk factors of CVD and assessing hypoglycemic therapy in the context of cardiovascular safety. The paper shows the bases of CVD pathogenesis and contains the results of numerous international clinical trials evaluating the efficiency and safety of current glucose-lowering therapy (metformin and cardioprotective drugs, the action of which is based on their incretin effect).

[Glycemic control and psychoemotional alteration in patients with different clinical characteristics of diabetes mellitus].

AIM: To determine the pattern and changes of psychoemotional states in 94 patients with diabetes mellitus (DM) and to study their relationship to glycemic values in its different clinical characteristics. SUBJECTS AND METHODS: Ninety-four patients (63 women and 31 men) with type 1 (n=20) and type 2 (n=74) DM who had received a course of planned hospital treatment in the Vladikavkaz Endocrinology Dispensary in the period 2006 to 2010 were examined. The psychodiagnostic procedure "GSAM" to evaluate their general state, activity, and mood and the Luscher color test were used. RESULTS; Determinants of the psychoemotional pattern were identified in the patients with DM. These included: 1) age that determined general state and mood; 2) glycemia that affected the evaluation of general state and activity in middle-aged patients; 3) the type of DM that affected the evaluation of general state; 4) insulin dependence that determined mood. The activity factor related to the mechanisms of development of hyperglycemia was separated out in the very pattern of a psychoemotonal state. CONCLUSION: The low self-rating of general state, activity, and mood among diabetic patients is most common in elderly patients who have type 2 DM and receive sugar-lowering drugs.

[Acute coronary syndrome in patients with type 2 diabetes mellitus].

According to evidence obtained from large epidemiological studies, an incidence rate of acute coronary syndrome (ACS) in diabetics is 2-3 times higher than in general population. Relevant invalidity and mortality is much higher than in patients free of diabetes. In type 2 diabetes mellitus a high risk of an unfavourable course and outcome of myocardial infarction was registered both within 30 postinfarction days and 1-3 years of follow-up. Poor prognosis persists despite adequate and early treatment. The results of the attempts to correct MI prognosis in diabetics by means of carbohydrate metabolism correction (multicenter trials DIGAMI-1, DIGAMI-2) are reviewed.