No 16 (2013)

The article discusses the problem of diseases associated with disturbances of metabolic processes in the body. The well-established at present time major pathogenetic mechanisms of metabolic syndrome, and their significance in the development of type 2 diabetes mellitus are presented. Alpha-lipoic acid preparations are considered as a basis of pathogenetic therapy. The results of studies on the effectiveness of the use of Espa-lipon in the treatment of metabolic syndrome in diabetic patients are demonstrated.

The article considers the properties of canagliflozin and dapagliflozin, the first representatives of a new class of antidiabetic drugs: oral sodium - glucose cotransporter type 2 inhibitors (SGLT2), recently approved for use in the U.S. and Europe, respectively. SGLT2 inhibitors decrease blood glucose level by insulin-independent reduction of glucose reabsorption in the proximal renal tubuli, ie stimulate its excretion in the urine. Efficiency of canagliflozin and dapagliflozin in patients with type 2 diabetes mellitus has been demonstrated in controlled clinical trials. It is emphasized that their place in the treatment of diabetes mellitus should be determined by the results of further clinical and pharmacoepidemiological studies.

The article presents the results of retrospective analysis of electronic medical records of 65 patients from Moscow registry of patients with acromegaly for 2011-2013, conducted to evaluate the efficacy of monotherapy with lanreotide and combination therapy with lanreotide and cabergoline in patients with acromegaly previously treated with octreotide. At the time of the last visit, a significant decrease in the insulin-like growth factor-1 (IGF-1) level in comparison with the data at the time of transfer was revealed; in 12 of the 50 initially decompensated patients, normalization of IGF-1 level was occurred. Decrease in the size of adenomas according to results of magnetic resonance imaging in the period after the transfer was observed in 12 patients, and normalization of biochemical parameters and a decrease in adenoma size were registered in 3 patients. In some patients, transfer from octreotide to lanreotide increased the long-term efficacy of treatment.

The article describes the features of management of patients with arterial hypertension (AH) and type 2 diabetes mellitus (DM2). The pathogenic role of insulin resistance (IR) and endothelial dysfunction (ED) in the development of hypertension, as well as possible ways for their correction in patients with AH and DM2 are discussed. The results of own research on the effects of combined antihypertensive drug Ekvator on IR and ED in patients with AH and DM2 are presented. It is shown that the use of the fixed combination of amlodipine and lisinopril for 12 weeks resulted in a significant improvement in endothelial function and carbohydrate metabolism in patients with AH and DM2. Reducing the severity of IR and ED against the background of combination therapy with Ekvator is associated with improvement of status of target organs: heart, kidneys, and blood vessels.

The progressive nature of diabetes mellitus type 2 (DM2) and complex pathogenesis of the disease make it necessary to intensify treatment and widespread use of combination therapy in clinical practice to achieve glycemic targets. The use of fixed combinations in the treatment of DM2 may be associated with benefits of therapy as a convenient mode of administration of the drug, increased treatment compliance, and as a consequence - the improvement of metabolic and clinical outcomes of DM2. The emergence of a new fixed combination of saxagliptin and modified-release metformin, the drug Komboglyze Prolong, offers new treatment options for DM2 patients, providing more comfortable treatment regimen for the doctor and the patient. The advantage of this combination is associated not only with a single dose of the drug per day, but with complementary mechanisms of action of saxagliptin and modified-release metformin, effectiveness for all parameters of glycemic control, safety, including lower risk of hypoglycemia, the absence of adverse effects on body weight, and the absence of the risk of increasing the frequency of cardiovascular diseases.

The article raises the question on cardiovascular complications in the structure of mortality in patients with type 2 diabetes mellitus (DM2). Diabetes mellitus increases stroke risk by 25 times, and mortality is 2.8-4.0 times higher in DM2 patients compared with patients without DM2; DM2 determines more severe course of stroke, more pronounced brain swelling, and higher mortality. The importance of vascular lesions in DM2 includes the development of diabetic macroangiopathy, which greatly increases the risk of cerebrovascular disease, aggravates its course and prognosis, increasing mortality and disability. It is emphasized that in diabetic patients more attention should be given not only to focal lesions of the brain, but the development of cognitive impairment due to metabolic or dyscirculatory encephalopathy. The high efficiency of neuroprotective drug Actovegin in the treatment of complications of DM2 and cerebrovascular disease is demonstrated.

The article considers important aspects of diagnosis and prevention of neuroendocrine dysfunctions (NEDs) in schizophrenic patients receiving neuroleptic therapy. Much attention is paid to the analysis of various risk factors for NEDs and the problems of their diagnosis. Practical recommendations for the diagnosis and therapeutic approaches to minimize the manifestations of NED are presented.