No 5 (2014)

The article presents the results of evaluation of the effect of combination therapy on body weight and fat distribution in 70 patients with type 2 diabetes mellitus (DM2) with abdominal obesity, using magnetic resonance imaging to visualize the visceral adipose tissue. The main group consisted of 40 patients, for whom therapy with metformin to compensate for carbohydrate metabolism was added by drug vildagliptin 100 mg/day. The comparison group included 30 patients, for whom treatment with metformin was added by drug glibenclamide at a dose of 3.5 to 7.5 mg/day. It has been shown that combination therapy with metformin and vildagliptin (Galvus Met) is optimal because it synergistically enhances the therapeutic effects, affects all major pathogenetic mechanisms of DM2 with minimal risk of side effects, and promotes slowing of progression of DM2.

In the history of diabetology, there were many treatment methods that, when studied more extensively, turned out to be not sufficiently safe: synthalin, phenphormin, the list can be continued. The last story with rosiglitazone made the FDA implement new unprecedented requirements for the evidence base for hypoglycemic pharmacological agents being registered on the territory of the USA. The huge study SAVOR, which results were published in September 2013, became the first reliable confirmation of the safety of a DPP-4 inhibitor available on the Russian market. Saxagliptin was studied in a double-blind placebo-controlled study on 16 492 type-2 diabetes mellitus patients with high cardiovascular risk and wide HbA1c range (6.5-11.9 %). After two years of follow-up, the primary endpoint’s cardiovascular risk ratio was 1.00 (95 % CI 0.89-1.12). Thus, in Russia currently saxagliptin is the DPP-4 inhibitor with the most confirmed cardiovascular safety.

The article is devoted to the etiopathogenesis, clinical presentation and diagnosis of central diabetes insipidus. Pharmacological characteristics of the desmopressin are presented. The approaches to replacement therapy are described. Particular attention is given to the intranasal spray Vazomirin. The rapid onset of antidiuretic effect is emphasized. It is concluded that nasal spray is not only the most convenient but also cost-effective form of desmopressin. Its main advantages include high precision dosing, rapid achievement of effect and convenient form of release.

The article presents the results of evaluation of effect of taurine in the combined treatment of chronic heart failure (CHF) on carbohydrate and lipid metabolism, insulin resistance, heart rate variability, systolic and diastolic function of the heart and vascular elastic properties and parameters of microcirculation (MC). The high frequency of heart failure and type 2 diabetes mellitus (DM2), poor prognosis and poor quality of life determine the relevance of the issue of selection of optimal therapy. In diabetes, prevention of target organ damage, including microcirculatory vessels and large arteries, is one of the main goals of treatment. The study included 60 patients of both sexes in the early postinfarction period with functional class (FC) II-III CHF (NYHA) and concomitant DM2. All patients were randomized into two groups of 30 people : Group 1 has received standard therapy of heart failure and standard antidiabetic therapy, and Group 2 has additionally received taurine at the dose of 500 mg twice a day. The effects of 16-week treatment with taurine on FC heart failure, structural and functional cardiac parameters, carbohydrate and lipid metabolism, heart rate variability and MC, elastic properties of the main vessels in CHF patients with concomitant DM2 were evaluated. Inclusion of taurine in the combined treatment of CHF and DM2 has statistical trend to reduce the blood levels of brain natriuretic propeptide, significantly increase the left ventricular ejection fraction, decrease the fasting blood glucose levels and glycosylated hemoglobin levels, decrease the insulin resistance, reduce the LDL and triglyceride levels, leading to normalization of the autonomic cardiac function in particular reduces the number of patients with hypersympathicotonia , promotes clinically significant reduction in stiffness of the vascular wall of the large arteries and significantly improves endothelial function. Against the background of use of taurine, statistically significant increase in the proportion of normocirculation hemodynamic type of microcirculation in patients with CHF and DM2 occurs, attributable to the reducing of the occurrence of spastic type of hemodynamics. Thus, the inclusion of taurine in the combined treatment of patients with CHF and DM2 is justified in early postinfarction period.

The article presents the data on the prevalence, pathogenesis, clinical features, diagnosis and treatment of the most common form of diabetic neuropathy - symmetric distal sensorimotor polyneuropathy.

The article considers the features and effectiveness of self-control for patients with type 2 diabetes mellitus not receiving insulin therapy. International clinical studies have demonstrated efficiency and the need for a structured self-control. It is emphasized that structured self-control is an integral part of a comprehensive treatment of patients with type 2 diabetes mellitus.

Diabetes mellitus (DM) is associated with a high risk of prenatal, obstetric and vascular complications in women. For the improvement of pregnancy outcomes, DM women need to have rigid limits of glycemic control. The target blood glucose levels during pregnancy can be achieved only through an integrated approach to treatment, which includes multiple self-control of blood glucose level and self-control of ketonuria, functional insulin therapy, the use of insulin pump therapy, split meals with the exception of carbohydrates with a high glycemic index and rich in dietary fiber, and graduated exercises.