No 16 (2011)

Effective management of type 2 diabetes mellitus (DM2) is one of the most topical problems of modern diabetology. This is determined by progressive nature of the disease and treatment complications (hypoglycemia and weight gain), which develop on the background of a number of oral glucose-lowering drugs and have significant effect not only on treatment compliance of DM2 patients, but also on risk of cardiovascular diseases. In this regard, strict requirements for efficiency and safety of modern pharmacotherapy of type 2 diabetes mellitus are required. Saxagliptin - dipeptidyl peptidase-4 inhibitor - meets these criteria. Saxagliptin belongs to a new group of antidiabetic drugs; its glycose-dependent action is based on the effect of incretins. Clinical studies have confirmed the efficacy and safety of saxagliptin in DM2 patients both as monotherapy and in combination with other antidiabetic drugs.

The article is dedicated to the role of sulfonylureas (SU), primarily gliclazide (Diabeton MR) in the treatment of type 2 diabetes mellitus (DM2), discusses their effects on the cardiovascular system. Data supporting the benefits of gliclazide in front of so-called old SU (glibenclamide, etc.) are presented. It is shown that in addition to pronounced hypoglycemic action gliclazide has an antioxidant property, ability to prevent development of micro- and macrovascular complications of DM2, including myocardial infarction and stroke. The antioxidant properties, the lack of effect on apoptosis provide gentle action of this drug on β-cells, that is also a undeniable advantage of gliclazide.

Relevance of evaluation of pathogenesis and the search for effective treatment of diabetic gastroenteropathy is determined by high frequency of gastrointestinal tract disorders and severity of functional changes affecting the course of diabetes mellitus (DM). Treatment of gastrointestinal complications with diabetes requires a differentiated approach taking account of the pathogenesis and clinical manifestations of this disease.

The article considers new potentials for prevention of vertebral and nonvertebral fractures, which are mainly attributable to postmenopausal and glucocorticoid-induced osteoporosis. In this context, the combination of bisphosphonates (BP, especially alendronate) and D-hormone analogs is of considerable interest. The theoretical basis of the complementary actions of alendronate and D-hormone analogs is discussed; data on the effects of BP and D-hormone analog on the falls, bone mineral density and fracture risk in various forms of osteoporosis are presented. The data on the safety of this combination are considered. It is emphasized that the combined use of active vitamin D metabolites with BP (for example, alfacalcidol with alendronate) demonstrates greater efficacy compared with monotherapy because of the different mechanisms of action, complementing each other (complementary or synergistic effect), that makes this combination valuable alternative for the treatment of osteoporosis.

In old age, the prevalence of type 2 diabetes mellitus (DM2) increases progressively, reaching 20 % among people older than 70 years. Elderly DM2 patients are a heterogeneous group with multiple comorbidities, high risk of hypoglycemia and susceptibility to side effects of drug therapy, which greatly complicates the treatment of this complex patient population. The risk of development of severe hypoglycemia, probably, is the most difficult problem in the treatment of elderly patients with diabetes mellitus. Incretins, including glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1), are the hormones released in the intestinal mucosa in response to a meal; they provide glucose-dependent stimulation of insulin secretion and suppression of postprandial glucagon secretion. Therapy based on incretins, including GLP-1 analogs and dipeptidyl peptidase-4 (DPP-4) inhibitors, can be considered as reasonable choice for older patients. These drugs are characterized by good tolerance, high efficacy and low risk of hypoglycemia. Recently, several meta-analyses on evaluation of the effectiveness and risks of treatment of elderly patients by DPP-4 inhibitor vildagliptin in monotherapy and in combination were published. The article analyses the published data on the use of Galvus (vildagliptin) and Galvus Met (vildagliptin + metformin) in a population of elderly patients.

The article presents the modern principles of drug therapy of the metabolic syndrome; main groups of drugs used for the treatment of this disease are presented. The application of the cardioselective β-adrenergic blockers for the treatment of arterial hypertension in metabolic syndrome is justified; the features of bisoprolol are discussed; the results of studies confirming its metabolic neutrality and efficiency are reported. Data for the use of the drug Bisogamma® (bisoprolol) for the treatment of arterial hypertension against the background of metabolic syndrome are presented.

The article considers the definition, epidemiology, etiopathogenesis and differential diagnosis of incidentalomas and hormone-inactive tumors (HIT) of adrenal glands. The existence of differences between incedentalomas and HIT is emphasized. It is shown that term "incidentaloma" is collective concept and indicates that the identified (usually by accident) tumor has not led to typical clinical picture of endogenous hypercorticism, primary hyperaldosteronism, phaeochromocytoma, and feminizing or virilizing tumor. This diagnosis should be considered only as provisional diagnosis; therefore, physician should focus on a particular set of tests for clinical diagnosis and treatment-management of the patient (surgery, observation).

The article considers the reasons for the occurrence of episodes of hypoglycemia in pregnant women with type 1 diabetes mellitus. A comparative analysis of relief of hypoglycemia by pills d-glucose (dextrose), or by receiving the typical foods with high glycemic index are presented, clinical examples are given. The efficiency of dextrose in increasing of blood glucose level in 15 minutes after its reception during hypoglycemia without rebound hyperglycemia in 60 minutes is proved.

The article discusses the problem of timely diagnosis of neuroendocrine tumors of the lung. The results of study aimed to analysis of the data obtained in the diagnosis of this type of tumors and based on the integrated application of radiological methods with account of morphological (histological, electron microscopic, immunohistochemical) data are presented.