No 3 (2009)

Liraglutid is the first representative of human glucagon-like peptide-1 (GLP-1) analogs. The article presents data for the mechanisms of liraglutid action and review of studies on the efficacy and safety of its use in patients with type 2 diabetes mellitus (type 2 diabetes). Based on the research results, liraglutid administration in doses of 1.2/1.8 mg once daily resulted in significant and sustained glycemic control improvement, and also was accompanied by a number of additional effects, such as a persistent decrease in body weight, clinically significant decrease of systolic blood pressure level and improvement of of beta-cells function. Thus, new class of human GLP-1 analogs provides a unique opportunity in the treatment of type 2 diabetes mellitus, providing pathogenetic influence on progressive reduction of beta-cell function, and factors of cardiovascular risk.

Diabetes mellitus type 2 (CD2) is often accompanied by cardiovascular disease (CVD), having identical mechanisms of development. Risk factors for rapid development and progression of CVD include hypertension, noncompensated DM, and dyslipidemia. Therefore it is of critical importance that the modern drugs used in diabetes management not only had a high therapeutic activity in relation to glycemia, but also had effect on blood pressure (BP) and dyslipidemia. These drugs include incretinomimetic exenatide (Byetta), which has pancreatic and extrapancreatic mechanisms of action. Exenatide has glucose-dependent insulinotropic effect on beta-cells of pancreas, improving two-phase insulin secretion. It also reduces the secretion of glucagon by the alpha-cells of the pancreas, resulting in decreased production of glucose by the liver, especially in the postprandial period. The extrapancreatic effects of the drug include: delayed gastric emptying, appetite suppression, decrease of blood pressure level, increase of high-density lipoprotein level and decrease of cholesterol, triglycerides, and low density lipoprotein levels, and decrease in body weight. Exenatide administration open new possibilities in the treatment of type 2 diabetes and allow avoiding the development of CVD.

Diabetes mellitus (DM) has a leading position among socially significant diseases and remains a major health problem worldwide. Infectious complications are great health hazard to patients with DM. Just infectious complications such as diabetic foot syndrome are the leading cause of hospitalization of patients with diabetes. Practice shows that the level of native doctors knowledge in the treatment of diabetic foot infection does not correspond to the proper provision of experienced and specialized medical care. The article discusses the etiology of foot infections in diabetic patients, recommendations for adequate diagnosis, and the problems of antibacterial therapy of this pathology.

We consider the criteria for diagnosis of congenital hypothyroidism (CH) and discuss the possible reasons of this disease. The necessity of screening for CH is justified; the principles and stages of its holding are presented. We give the recommendations for the treatment of CH and discuss the typical errors allowable during the screening. As a whole, 18-year screening of newborns for CH has allowed to specify the prevalence of the disease (1:4000), revealed about 8 thousand children with CH, and eliminated cases of cretinism caused by late diagnosis of CH. Screening is spent today in all regions of Russia with coverage of 92-95 % of newborns.

One way to glycemic control improvement in patients with type 1 and type 2 diabetes mellitus (CD) is the creation and introduction of new insulin preparations with improved pharmacokinetic and pharmacodynamic properties. Since 2005, in daily clinical practice long-acting analog of insulin Lantus (insulin glargine) became a regular used. The Lantus® administtration as a basal insulin can significantly improve glycemic control in patients with type 1 diabetes and type 2 diabetes not only in the short term treatment, but in long-term care. Clinical effectiveness and advantages of Lantus ® have been demonstrated in many studies, in most of whom insulin glargine was compared with NPH insulin. However, registers, allowing exploring and evaluating the use of the drug in the daily lives of large groups of patients, provide the most valuable information about the drugs from a clinical point of view. The data for LAUREL (LAntus Utilization in REal Life) register, whose main goal was to evaluate the effectiveness of insulin glargine in patients with type 2 diabetes, are presented. Register was created based on database of Russian clinics with the participation of 366 endocrinologists. The results of register showed the benefits of treatment of patients with type 2 diabetes with insulin glargine (Lantus) with available titration algorithms. Using Lantus ® in type 2 diabetes can improve glycemic control and reduce the frequency of hypoglycemic states in real clinical practice.

The results of the study, including 200 patients with type 1 and type 2 diabetes mellitus (type 1 diabetes and type 2 diabetes) complicated by diabetic peripheral neuropathy (DPN), which assessed changes in quality of life of patients before and after treatment with medication alpha-lipoic acid - Tiagamma- are presented. Use of Tiagamma in the treatment of DPN in patients with type 1 diabetes and type 2 diabetes in outpatient practice leads to a significant decrease in DPN symptoms, improvement of characteristics of carbohydrate and lipid metabolism, reduction of depression manifestations, and improvement of quality of life.