No 5 (2015)

Progressive course of type 2 diabetes mellitus, the lack of an «ideal» drug for the treatment of this disease are a key factors for the searching of new opportunities for effective management of blood glucose. The emergence of a new class of oral antidiabetic drugs is always an outstanding event in the modern diabetology The appearance of sodium-glucose co-transporter type 2 inhibitors and their introduction into clinical practice open a new era in the treatment of diabetes. Dapagliflozin is the first representative of this class, registered in Russia. With the best risk/benefit ratio and unique insulin-independent mechanism of action, dapagliflozin provides new opportunities to control not only the level of glycemia, but body weight without increasing the risk of hypoglycemia both foe physicians and patients.

Currently, much attention is paid to the quality of life of the patient as one of the indicators for assessing the effectiveness of different modes of treatment of diabetes mellitus. The main factor that reduces the quality of life of patients receiving insulin therapy, is the fear of hypoglycemia. Fear of hypoglycemia leads to severe psychological and social maladjustment and reduces adherence to the treatment. Thus, when selecting regimen of insulin therapy, not only the incidence of hypoglycemia, but its impact on quality of life, including fear of hypoglycemia, should be considered.

The article provides an overview of research on the role of adipokines (leptin, adiponectin, resistin) - proteins secreted by adipose tissue, which are associated with weight gain, insulin resistance, atherosclerosis and the development of cardiovascular diseases.

This review is dedicated to the current problems of pharmacotherapy of acromegaly. The mechanisms of antisecretory and antiproliferative action of somatostatin analogues, as well as the use of clinical and laboratory predictors for prognostication of effectiveness of a primary or secondary pharmacotherapy are discussed. The results of a meta-analysis and some clinical studies on this subject are presented.

The article highlights the issues of diagnosis and treatment of polyneuropathy, a widespread disease of the peripheral nervous system. The types and forms of polyneuropathy, the main pathogenetic mechanisms leading to its development are described in detail. Particular attention is paid to the main groups of diseases in which the neuropathy develops as a comorbidity. The criteria for choosing the drugs for the treatment of diabetic polyneuropathy, formulated at an international conference in Sao Paulo (Minnesota, 1994) are presented. As pathogenetically substantiated and effective for the treatment of diabetic polyneuropathy, preparation of thioctic acid is considered.

The article presents the results of comparative analysis of adherence to the diagnosis of osteoporosis (OP) in St. Petersburg residents: women aged more than 50 years and men aged more than 60 years with ability of independent walking, in two equal time periods -November to April 2009-2010 and 2012- 2013. It was found that the proportion of patients, coming from emergency stations to policlinic of RSRITO n.a. R.R. Vreden for free expert advice on OP, has only slightly increased for 3 years: from 31 to 35.9%. However, the proportion of patients who choose commercial dual energy X-ray densitometry after consulting, has been significantly increased (p<0.01) more than by two times, from 44.2 to 95.1%. Low adherence of patients to diagnosis of systemic OP is primarily due to their low awareness of this systemic skeletal disease and associated risk for life and health. The important task of raising such awareness and motivation of patients with low-energy fractures to the diagnosis of OP should belonges to traumatologists and orthopedists, who are often the first and only physicians faced such patients.

Fractures of the ankle are low-energy fractures in 20-30% of patients, and they occur in elderly and senile age. The prospective controlled randomized trial (52 patients) was aimed to the demonstration of the possibility of improving the results of surgical treatment of osteoporotic fractures of the ankle using strontium ranelate at a dose of 2 g daily for 12 months in the postoperative period. 42 patients had completed the study (group A - control [18 patients], B - main [24 patients]). All patients underwent surgery during the first 48 hours after injury in accordance with clinical guidelines. In postoperative period, both groups had received calcium supplement of 1500 mg/day, cholecalciferol 1,200 lU/day until metal structures were removed. Group B had received strontium ranelate (2.0 g once a day). Metal structures were removed in 350±15 days. According to the results of study, the use of strontium ranelate 2 g daily for a year in the postoperative period improves the functional state of the operated ankle. Subject to the conditions of use, strontium ranelate improves bone structure in the area of regenerating bone. There were no registered side effects and complications associated with the administration of strontium ranelate in this study.