Pharmateca

Primary hyperaldosteronism (PHA) as the most common cause of secondary arterial hypertension (AH), and accounts for 10–15% of cases according to the literature. However, the true prevalence of PHA is underestimated due to the lack of clear, understandable diagnostic algorithms for primary care physicians and incorrect interpretation of results. This is especially true for “mild” forms of the disease. Despite the lack of a clear clinical picture, PHA is associated with a higher risk of adverse cardiovascular events and metabolic disorders compared with essential AH, even when blood pressure target levels are achieved. Understanding the new pathogenetic aspects of PHA, in particular the connection between the clinical form of the disease and somatic mutations of ion channels that accumulate with age, is intended to make the diagnosis of PHA more convenient for everyday clinical practice and, thus, increase the effectiveness of treatment and the quality of life of patients.

Thyroid diseases occupy one of the central places in clinical endocrinology. Iodine and the amino acid tyrosine are the main components for the synthesis of thyroid hormones. Studies conducted in the 21st century indicate a certain effect of other microelements and vitamins the on metabolism and function of the thyroid gland.

We searched for publications devoted to the study of the influence of trace elements selenium, zinc, vitamins A, E, C on the physiology and pathology of the thyroid gland. The search was carried out in the PubMed and Scopus information databases, and included sources up to March 25, 2024. It has been shown that adequate intake of selenium and zinc along with vitamins A, E, C contributes to normal metabolism of the thyroid gland.

The change in the status of the microelements selenium and zinc, vitamins A, E, C in the aspect of the most common diseases of the thyroid gland – diffuse toxic goiter (Graves disease), primary hypothyroidism, autoimmune thyroiditis, thyroid cancer – is considered.

To normalize the function of the thyroid gland, supplements of the microelements selenium and zinc are used, both individually and together, as well as with the addition of vitamins A, E, C, which have antioxidant activity. Their addition as a means for adjuvant therapy increases the effectiveness of basic therapy with thyreostatics for hyperthyroidism and levothyroxine for hypothyroidism.

A preliminary analysis of the initial level of microelements and vitamins seems appropriate for better selection of patients in need of replacement therapy using vitamin-mineral complexes.

Objective. Evaluation of the modern means of glycemic monitoring using a mobile application that allows for more effective, including remote diabetes mellitus (DM) management.

Basic provisions. Diabetes control is impossible without self-monitoring by the patient, which remains relevant in modern conditions. Recommendations for the management of patients with diabetes are updated annually, more modern approaches to self-monitoring of glycemia are developed, and innovative glucometers represented by systems with a mobile application are introduced.

Acromegaly is a rare severe disease characterized by excess production of growth hormone in individuals with closed growth plates, associated with a number of comorbid conditions, high levels of disability and mortality. Surgical, radiation and drug methods are used to treat acromegaly. The emergence of new drugs makes it possible to improve the results of treatment of acromegaly and reduce the severity of associated diseases, which helps reduce mortality and improve the quality of life of patients. Pegvisomant is a growth hormone receptor blocker and is currently the most effective drug for acromegaly treatment. Most often, the drug is used as a second-line treatment for patients with resistance to somatostatin analogues. Pegvisomant may be the drug of choice for monotherapy in patients in whom the severity of the disease requires rapid normalization of the insulin-like growth factor 1 (IGF-1) level, as well as in cases where diabetes mellitus is not stable due to the positive effect of the drug on carbohydrate metabolism and a decrease in insulin resistance. Combination therapy with growth hormone receptor antagonists and somatostatin analogues is a promising direction due to the increased effectiveness of treatment with the combined action of drugs, especially in terms of reducing the tumor mass of the pituitary gland, as well as reducing the cost of treatment by reducing the dosage of pegvisomant.

Bisphosphonates (BPs) are the first-line treatment for osteoporosis and are prescribed to the majority of patients with this disease. However, worldwide concern among osteoporosis practitioners is the lack of initiation and adherence to this class of drugs. One of the reasons for this is the most common side effect that occurs when taking this group of drugs – acute phase reaction (APR), or influenza-like syndrome. The article presents the results of scientific studies and meta-analyses aimed at assessing the clinical characteristics of this side effect, its prevalence, as well as those factors that may influence the reduction of its frequency and severity. The data obtained during the studies must be taken into account in clinical practice when prescribing drugs of this group, which will help increase adherence to treatment and achieve a reduction in the number of osteoporotic fractures.

Objective. Evaluation of the effectiveness of dulaglutide in real clinical practice for patients with type 2 diabetes mellitus (DM2) in Moscow.

Methods. To assess the main indicators of DM2 patients using dulaglutide in therapy, a sample was formed from the Moscow segment of the Federal Register of Diabetes Mellitus (FRDM) as of 02/14/2024. To assess the effectiveness of dulaglutide therapy over a 5-year follow-up period, an additional sample of patients from the Moscow segment of the FRDM who began treatment with dulaglutide in 2018 was formed.

Results. When assessing the dynamics of carbohydrate metabolism control indicators over a more than 5-year follow-up period (2018–02/01/2024), a trend towards a decrease in HbA1c levels from 7.3 to 7.0% was noted (p>0.05). In the subgroup of patients who did not receive insulin therapy, a statistically significant decrease in HbA1c levels from 7.3 to 6.7% was demonstrated (p=0.04); there was no statistically significant change in HbA1c levels on insulin therapy (7.5±1.1 versus 7.7±1.1%; p>0.05). When assessing the dynamics, a statistically significant decrease in body weight from 102.9±21.8 to 98.4±19.6 kg, a decrease in body mass index (BMI) from 35.6 to 33.5 kg/m² (p<0.05) primarily in patients who did not receive insulin therapy (p<0.05) was noted. In patients on insulin therapy, there were no statistically significant differences in the dynamics of body weight and BMI.

Conclusion. The use of dulaglutide in real clinical practice demonstrates long-term maintenance of glycemic control indicators within or close to target values and a statistically significant reduction in body weight and BMI. The greatest effectiveness in achieving glycemic control, reducing body weight and BMI was achieved in a cohort of DM2 patients not receiving insulin medications.

Background. Among all diseases of the endocrine system, type 2 diabetes mellitus (DM2) has the highest prevalence, the risk of developing vascular complications and its impact on prognosis. However, among the wide range of complications of diabetes, functional changes in the intestine are not sufficiently represented and studied.

Objective. Prospective evaluation of the clinical and anamnestic characteristics of patients with irritable bowel syndrome (IBS) in combination with DM2 compared with individuals with IBS without diabetes.

Methods. 107 patients were followed-up, 42 (39.3%) men and 65 (60.7%) women aged from 36 to 66 years (mean age – 48.9±9.4 years) with DM2 and the presence of clinical manifestations of IBS, in addition, 52 patients with IBS without diabetes, including 21 (40.4%) were men and 31 (59.6%) women (mean age – 43.7±6.8 years). There were no differences in gender and age between the groups (P>0.05). The study subjects were represented by patients with a combination of IBS and DM2, as well as isolated IBS, whose complaints and anamnesis were assessed, and standard objective and laboratory examinations were performed in accordance with modern recommendations. The severity of clinical manifestations of IBS was assessed using the GSRS questionnaire, and a survey for the presence of psycho-emotional stress, previous gastrointestinal infection and COVID-19 was conducted. In a number of patients, fibrogastroduodenoscopy and fibrocolonoscopy were performed, followed by a morphological examination of biopsy specimens, and the presence of antibodies to gliadin and tissue transglutaminase was determined.

Results. Among diabetic patients, IBS with diarrhea (IBS-D) was represented in 45.8% of cases, patients with IBS with constipation (IBS-C) accounted for 33.6%, 12.2% had mixed (IBS-M) and 8.4% – undifferentiated (IBS-U) form of IBS. Compared with the group of IBS patients without diabetes, those with DM2 more often had IBS-D and IBS-M variants, in the absence of significant differences when examining histological biopsies of the colon mucosa. In diabetic patients with IBS, compared with the group of patients without diabetes and IBS, the frequency of gastrointestinal manifestations, which were associated with overweight, obesity and metabolic syndrome, chronic stress, anxiety, and previous COVID-19 infection, was significantly higher. An increase in the proportion of IBS-D, IBS-M and undifferentiated IBS (IBS-U) was also found in patients with previous severe psycho-emotional stress, acute gastrointestinal infection, taking non-steroidal anti-inflammatory drugs, antibiotics, as well as a previous COVID-19 infection, while the connection between smoking and hypothyroidism and IBS was observed much less frequently.

Conclusion. Diabetic patients with IBS have a number of clinical and anamnestic features that distinguish them from patients with IBS without diabetes, which should be taken into account when choosing the optimal treatment tactics.

Background. Modern methods of treating gestational diabetes (GD) are aimed at preventing excessive fetal growth and the development of complications through lifestyle modification and diet therapy, and, if ineffective, insulin therapy. Taking into account the research data of recent years, different subtypes of GD based on the predominance of the pathological mechanism – β-cell defect, insulin resistance (IR) or a combination of these factors – are identified. Determining the subtype of GD can be of extreme clinical importance, since the choice of treatment tactics for patients and, as a result, their achievement of target blood glucose values may depend on the mechanisms underlying the pathogenesis of carbohydrate metabolism disorders.

Objective. Evaluation of the effectiveness of modern treatment methods depending on the GD subtype.

Methods. 130 pregnant women without a history of carbohydrate metabolism disorders were examined (an oral glucose tolerance test with 75 g of glucose and an additional determination of fasting insulin during the test). The subjects were divided based on the examination results, as well as calculation of the Matsuda index: group I – 45 pregnant women with GD and β-cell dysfunction, group II – 43 pregnant women with GD and IR. Additionally, all study participants were surveyed using a specially developed questionnaire. Statistical analysis was carried out using comparative analysis. Data are presented as medians and interquartile ranges of quantitative indicators in groups. Data were considered statistically significant at p<0.05.

Results. All patients achieved target glycemic values. In the GD group I, 29 (64.4%) patients received only non-drug therapy, while 16 (35.6%) used diet therapy in combination with insulin administration. In the GD group II, 16 (37.2%) patients received only non-drug therapy, 27 (62.8%) pregnant women used diet therapy in combination with insulin therapy. In the GD II group, patients were significantly less likely to use whole grain products in their diet compared to pregnant women in the GD group and β-cell defect: 6 (14%) patients versus 12 (27%), p=0.03, more often consumed foods with added sugar: 14 (33%) versus 4 (9%), p=0.04 in the GD group I.

Conclusion. Patients with GD and β-cell dysfunction more often achieve GD compensation with non-drug treatment, while patients with GD and IR more often require insulin therapy.

Background. Along with increasing life expectancy, the prevalence of age-associated diseases and geriatric syndromes is increasing. Sarcopenic obesity (SO) is one example of pathological changes in body composition associated with aging. However, the relationship of this pathology with bone density in elderly people has not been fully studied.

Objective. Evaluation of the relationship between SO and bone density in elderly people.

Methods. The study included 568 elderly people (mean age 66.5±5.6 years) with obesity who signed informed consent to participate. Complaints and medical history were collected for all study participants, and anthropometric indicators (height, weight, body mass index [BMI]) were determined. Body composition was determined by bioimpedance analysis, bone mineral density [BMD] was determined by the bone mineral density (BMD) criterion using dual-energy x-ray absorptiometry (DEXA), and hand grip strength was determined using hand dynamometry. Walking speed over a distance of 4 meters was measured using standard methods. Patients were divided into two groups: with SO and without SO. Osteosarcopenic obesity (OSO) was defined as a combination of SO and low BMD.

Results. Participants with SO (197 people, 34.7%) were significantly older (p<0.001), predominantly female (51.6 vs 48.4%), with higher BMI (p<0.001), higher fat mass (p= 0.015) and a higher proportion of fat mass (p<0.001). People with SO had lower values of BMD (p<0.001) and BMD/height ratio (p<0.001) compared to people without SO. The SO group included more participants with low BMD (47.3 vs. 25.9%) than the non-SO group. Logistic regression analysis revealed a 2.5-fold higher risk of low BMD (HR=2.57; 95% CI: 2.17–3.04; p<0.05) in the SO group. The association persisted after adjustment for age, weight, and fat mass proportion, reflecting an almost twofold higher risk of low BMD in the presence of SO (HR=1.92; 95% CI: 1.60–2.31; p<0.05). 93 (16.4%) participants had OSO.

Conclusion. Osteosarcopenic obesity in our study occurred in 16.4% of patients. Sarcopenic obesity was associated with low bone mineral density (RR=2.57; 95% CI: 2.17–3.04; p<0.05). To form an individual complex of treatment, preventive and rehabilitation measures for elderly patients with obesity, it is necessary to conduct a study of the body composition and bone mineral density.

Background. Decreased muscle mass and bone mineral density are interrelated processes that often occur in rheumatoid arthritis (RA). Damages to the gastrointestinal tract may also occur, leading to impaired absorption and digestion of food, as well as a deterioration in protein and energy metabolism in the body, which also results in changes in the body composition.

Objective. Evaluation of associations of osteoporosis, sarcopenia and osteosarcopenia with the nutritional status and physical condition of women with RA.

Methods. The cross-sectional study included 157 women with RA, who underwent clinical, laboratory and instrumental examinations (densitometry); nutritional status and physical activity were assessed.

Results. 37.6% of the individuals examined had osteoporosis, sarcopenia, or osteosarcopenia. Differences in assessing nutritional status using the MNA questionnaire and the amount of calcium intake from food between groups were revealed. Associations were established between the presence of osteosarcopenia and the frequency of intense physical activity <2 days per week (odds ratio [OR]=3.38 [95% CI: 1.04; 10.87], p=0.042), with assessment of nutritional status according to the MNA questionnaire (OR=1.39 (95% CI: 1.03, 1.85), p=0.029), dietary calcium intake less than 500 mg/day (OR=4.02 (95% CI: 1, 28; 12.61), p=0.018).

Conclusion. Osteosarcopenia was associated with nutritional status assessed by the MNA questionnaire, low dietary calcium intake and low frequency of intensive physical activity.

Background. Among the various types of pancreatogenic diabetes mellitus, the greatest difficulties in glycemic control arise in patients after total duodenopancreatectomy (TDPE). This is associated to the presence of an absolute deficiency of insulin secreted by β-cells and a lack of glucagon secreted by α-cells of the pancreas.

Objective. Evaluation of the safety of using the Guardian Connect continuous glucose monitoring (CGM) system in the early postoperative period in patients after TDPE.

Methods. A retrospective assessment of glucose values recorded in the electronic medical record of 28 patients after TDPE who were followed-up in the clinic from 2020 to 2023 was carried out. In group 1, 13 patients were monitored for glycemic control using the Guardian Connect CGM system (in parallel with the use of a glucometer). In group 2, 15 patients underwent glycemic control only using a glucometer.

Results. Intravenous insulin therapy: glucose levels in group 1 were statistically significantly more likely to be in the target range of 5.6–10.0 mmol/L (p = 0.005) and in the range from 4.3 to 11.6 mmol/L (p=0.001). When assessing the number of hypoglycemia episodes below 3.9 mmol/l, the frequency of this side effect was statistically significantly lower in group 1 (p<0.001). The results of the analysis of episodes of severe hypoglycemia showed a lower frequency in group 1 (p>0.05), but the results were not statistically significant. Subcutaneous insulin therapy: glucose levels in group 1 were statistically significantly more likely to be in the target range of 5.6–10.0 mmol/l (p=0.017) and in the range from 4.3 to 11.6 mmol/l (p = 0.017) compared to group 2. When assessing the number of episodes of hypoglycemia below 3.9 mmol/l, no statistically significant differences were found between groups (p<0.112). There were no episodes of severe hypoglycemia in both groups.

Conclusion. The results of our study demonstrate the safety of use of the CGM system in patients in the early postoperative period after TDPE.

Diabetes mellitus (DM) is a polygenic and multifactorial disease. It can also be caused by certain diseases. The article presents clinical cases of the manifestation of DM during treatment or after the disease. The use of a number of drugs, for example corticosteroids, is often accompanied by hyperglycemia, which is not always transient and after discontinuation of therapy the diagnosis of diabetes is verified. In the first clinical case, during treatment of hemolytic anemia, the patient was diagnosed with hyperglycemia, which was later verified as diabetes. Scientific papers describe cases of the onset of diabetes after a viral infection. For example, the manifestation of diabetes after rubella, as demonstrated in the second clinical case. The features of glycemic correction in this category of patients and the possibility of intensifying glucose-lowering therapy using insulin degludec are described. The effectiveness of therapy was assessed based on self-monitoring of glucose with assessment of self-monitoring diaries, glycated hemoglobin levels, data from continuous glucose monitoring using Libre sensors, followed by assessment of indicators through the LibreView application. After correction of hypoglycemic therapy using insulin degludec, achievement of target glycemic values with a minimal risk of hypoglycemia was recorded. These clinical examples emphasize the importance of an integrated approach to the examination and treatment of patients.