No 16 (2017)

The article presents an overview of modern approaches to the treatment of type 2 diabetes mellitus (DM2). The algorithm for the choice of hypoglycemic therapy according to the Russian Algorithm of specialized care for diabetic patients is discussed in detail. It is noted that according to the accumulated modern clinical experience, hypoglicemic monotherapy is usually effective in the first few years of the disease, but it is necessary to use combinations of various hypoglycemic agents in order to achieve and maintain the target blood glucose levels in most DM2 cases. It was concluded that modern fixed-dose combinations of hypoglycemic agents are an integral part of the DM2 pharmacotherapy.

The review article discusses the problem of polymorbidity through the example of metabolic syndrome. The data of recent years on the features of the combination of components of the metabolic syndrome with diseases of the cardiovascular system, respiratory organs, gout, thyroid pathology, etc. are presented.

The article presents the results of clinical studies, including real-world data trials, on a new analogue of long-acting insulin glargine 300 IU/ml (Toujeo SoloStar®) in patients with type 2 diabetes mellitus. Increase in glargine concentration per unit volume with the formation of a small-volume subcutaneous depot led to a change in the pharmacokinetic properties of the drug: glargine 300 IU/ml compared with glargine 100 IU/ml is more slowly released from the subcutaneous fat depot, which provides more regular and long-acting effect. That led to a change in properties of the drug, which is clinically manifested in the form of achieving comparable glycemic control with less risk of hypoglycemia and less pronounced influence on body weight compared with insulin glargine 100 U/ml.

Insulin degludec/aspart (IDeg/Asp) is the first soluble combination of the ultralong-acting human insulin analogue degludec (70%) and the fast-acting prandial human insulin analogue aspart (30%) in one injection. The unique pharmacodynamic profile of IDeg/Asp provides a stable effect of basal insulin (>24 hours), as well as effective prandial control, which does not affect on the basal effect. In patients with type 2 diabetes mellitus, the use of IDeg/Asp once and twice a day provides effective glycemic control with a lower risk of overall and nocturnal hypoglycemia compared to conventional premix and basal-bolus insulin therapy. Furthermore, when required patients can flexible change the injection time of IDeg/Asp compared with the conventional premix insulins. In patients previously received insulin therapy, the switch to IDeg/Asp is a simple helpful choice of optimization and intensification of insulin therapy, which allows to maintain a more stable glucose level during the day, to achieve individual glycemic target without increasing the hypoglycemia risk and adverse weight gain, and also is a well-tolerated. These clinical advantages give possibility to recommend IDeg/Asp as a simple and safe strategy of insulin therapy, including in patients previously received insulin but did not achieve glycemic control.

The article presents the results of a 6-month prospective comparative evaluation of the efficacy of two treatment options for patients with signs of hyperthyroidism on the background of diffuse toxic goiter. First group received traditional therapy with thiamazole and ß-blocker, the second group additionally received an angiotensin-converting enzyme inhibitor and ethylmethylhydroxypyridine succinate. The additional efficacy of combined therapy with the use of these agents for correcting clinical manifestations of hyperthyroidism with a positive effect on the morphometric and hemodynamic parameters of the functioning of the cardiovascular system is shown. The authors give an overview of the literature data, justifying the need for study and correction of cardiovascular pathology against the background of traditional thyrotropic therapy in cases of hyperthyroidism.

The article considers the most frequently occurring alterations of the skin and oral mucosa in patients with diabetes mellitus, their causes, and some features of their prevention.