No 5 (2017)

Achievement of satisfactory glycemic control in children and adolescents with type 1 diabetes mellitus keeps on to be one of the most difficult task of modern diabetology. The usage of a new generation basal insulin, insulin degludec with ultra-long action and the lowest variability of hypoglycemic activity, opens the new opportunities for achieving high quality of treatment in pediatric patients. It allows a significant improvement of the main parameters of glycemic control with a low risk of hypoglycemia, and has a good profile of tolerability and safety, as well as a convenient treatment regimen. The article presents the results of treatment of 27 type 1 diabetic patients aged 5-17 years using insulin degludec, including the dynamic of the main parameters of glycemic control depending on the age and the particulars of switching to the new insulin product and its titration.

Modern hypoglycemic therapy requires mandatory self-management of glycemia (SMG). The use of modern glucometers taking into account the human factor in carrying out the SMG will increase the result of hypoglycemic therapy and will be an effective measure in the prevention of the development and progression of diabetic complications.

Osteoporosis (OP) is a serious medical and social problem, which is attributable with the high prevalence of this disease. The main clinical manifestation of OP and one of the leading risk factors for subsequent fracture is a bone fracture after minor injury. Currently, there are effective treatments of OP, combining non-pharmacological approaches with the use of modern antiosteoporotic drugs. Timely medical interventions can reduce the risk of osteoporotic fractures and improve the quality of life of the patient. Teriparatide is high effective bone anabolic drug that increases bone mineral density in patients with high risk of low-energy fractures and provides new opportunities for solving the main goal of treatment of the disease - reducing the risk of fractures of various localizations.

Acromegaly - invalidusername multi-organ disease, the treatment efficiency of which depends on timely diagnosis. Given the low detectability of acromegaly in the Russian population, it was decided to develop and test the algorithm for detection of acromegaly in patients with concomitant somatic pathology. The Russian non-interventional study Acroscreen included 1249 patients, and as a result of the diagnostic search, 9 patients with newly detected acromegaly (2 men and 7 women) were revealed. A clinical case of one of the patients included in the study is presented; it illustrates the practical importance of an active search strategy acromegaly. It is emphasized that the careful examination of patients at risk will significantly increase the efficiency of detection and search of acromegaly, helping to improve the quality of life and life time.

This review presents the results of studies showing the need for wider use of angiotensin II receptor blockers in the treatment of socially significant diseases such as type 2 diabetes mellitus, arterial hypertension, cerebrovascular diseases, and chronic kidney disease. The advantages of this class of antihypertensive drugs in relation to their impact on the functional and structural change of the target organs in hypertensive patients are discussed.

The article is devoted to the metabolic syndrome - a combination of various metabolic disorders and/or diseases, which are a risk factor for the early development of atherosclerosis. Insulin resistance and compensatory hyperinsulinemia are the key link in the pathogenesis of this syndrome. The imbalance of adipokines - adiponectin, leptin, resistin, etc. - can lead to the development of insulin resistance. In this review article, the metabolic syndrome is discussed from the perspective of its influence on the development and course of cardiovascular diseases.

The increase in the life expectancy of people has led to an increase in the prevalence of some «age-related» diseases, including osteoporosis (OP), a systemic disease of the skeleton, accompanied by brittleness of bones. The development of OP is closely related to vitamin D deficiency. On the basis of natural vitamins D2 and D3, their active metabolites and synthetic analogues, a significant amount of vitamin products and drugs has been created in various dosage forms that are widely used to prevention and treatment not only OP but also other diseases. This article considers the potentials for the clinical use of the active metabolite alfacalcidol, a prodrug, which is activated in the liver and bone tissue with formation of D-hormone after intake. Alfacalcidol is more effective than native vitamin D, it increases the bone mineral density and its strength, regardless of calcium absorption and inhibition of parathyroid hormone activity. It is shown that this drug reduces the incidence of falls in elderly patients. Alfacalcidol has therapeutic and prophylactic effects in various forms of OP and can be used both as monotherapy and in combination with other anti-osteoporotic drugs.

The pathology of the thyroid gland is the second most common pathology among all endocrine diseases. The lack of thyroid hormones affects many functions and processes in the body. One of the manifestations of hypothyroidism is the metabolic-hypothermic syndrome with moderate obesity. In turn, obesity is a component of the metabolic syndrome and is often accompanied by insulin resistance. This review article presents information on the relationship between insulin resistance and thyroid function.