No 4 (2018)

This article presents data on a novel glucagon-like peptide-1 receptor agonist, exenatide once weekly (EQW), which is an extended-release formulation of exenatide. To create an extended-release formulation of exenatide, a Medisorb® microspheres technology was used, which ensure the gradual release of exenatide into the blood plasma. The drug is indicated for treatment of type 2 diabetes mellitus in combination with metformin, sulphonylurea, thiazolidinedione or their combinations in adults who have not achieved adequate glycaemic control on maximally tolerated doses of these oral therapies. In addition to stable safe glycemic control, the drug has a number of non-glycemic effects, including weight loss, blood pressure lowering, protective effect on pancreatic β-cells. The article discusses the main results of the clinical trial program of exenatide QW DURATION, as well as the data of the cardiovascular outcome trial EXSCEL.

Acromegaly is a severe chronic neuroendocrine disease, accompanied by such concomitant conditions as diabetes mellitus, cardiovascular, respiratory, and musculoskeletal disorders, and an increase in the number of neoplasms. Development of these conditions is associated with an increase in the growth hormone and insulin-like growth factor 1 levels. Therefore, the pathogenetic treatment of acromegaly, namely the use of somatostatin analogues, remains the main method of treatment and prevention of concomitant diseases. Nevertheless, in a number of cases, additional symptomatic treatment is necessary in persisting symptoms and controlled course of the disease.

Euthyroid status is a necessary optimal condition for a favorable outcome of pregnancy in women with diffuse toxic goiter (DTG), which is considered as the most common cause of thyrotoxicosis during this period, and has a negative effect on the course and outcome of pregnancy. Different opinions existing in the scientific literature about the tactics of pregnancy management in women with DTG determine the relevance of this topic. Methods. The results of a study on the use of thyreostatic therapy in 67 pregnant women with DTG are presented. The main methods of evaluation in the study included thyroid echography in women throughout pregnancy and in newborns on the 4th-7th day of life, as well as determination of the thyroid-stimulating hormone (TSH), free thyroxine (Free T4) and TSH receptor antibodies (anti-TSHR) levels in the blood of pregnant women and in umbilical cord blood. Results. The results indicate a higher incidence of complications of pregnancy (early toxicosis - 83%, threatening miscarriage - 94%, placental insufficiency - 55%, gestosis -100%, fetal hypotrophy - 88%) and childbirth (premature delivery - 33%, fetal hypoxia - 44%) in women with thyrotoxicosis. The high incidence of goiter in newborns (more than 83%) is associated with the negative effect of transplacental transfer of thyreostatic drugs and anti - TSHR on the volume and functional status of thyroid gland in newborns. An important factor determining the need to optimize the doses of thyreostatic drugs is the high risk of developing neonatal hypothyroidism (in 53% of newborns). Conclusion. The high incidence of subclinical hypothyroidism in newborns (53%) from mothers with DTG requires the optimization of thyroid doses prescribed for the treatment of DTG during pregnancy.

Despite the optimal drug provision for children with type 1 diabetes mellitus (DM1) in the Sverdlovsk Region with human insulin analogues, selfmonitoring tools and insulin pumps, the problem of achieving and maintaining compensation for carbohydrate metabolism still remains. The emergence of the innovative insulin analogue Degludec (Deg) in clinical practice offers prospects for improving DM1 compensation. Purpose of the study: to evaluate the efficacy and safety of the use of Deg in DM1 children in real-life clinical practice. Methods. In 12 DM1 children (mean age 14 [12.5-15] years, mean duration of DM1 3 [2-3.5] years) who did not achieve optimal glycemic control (glycated hemoglobin - HbA1c> 7.5%) on the previous basal bolus therapy with insulin analogues or with a high mean daily amplitude of plasma glucose level (DAPG >7 mmol/L) and/or hypoglycemia ≥1 times per week). The dynamics of HbA1c levels, fasting plasma glucose (FPG) levels, plasma glucose levels before sleep, DAPG, as well as changes in the average daily dose of insulin, the average frequency of all episodes of hypoglycemia, night hypoglycemia and severe hypoglycemia (per 1 week), the number of children experiencing hypoglycemia, and the proportion of children who achieved HbA1c <7.5% after transferring to Deg were analyzed. The efficacy and safety of therapy was assessed in 1, 2, 4, 8, 12 and 52 weeks. Results. By the end of the follow-up period, a significant decrease in HbA1c by 1.59%, and an increase of 66% in the proportion of children reaching HbAn <7.5% was observed. A significant decrease in the FPG level from 8.7 to 6.5 mmol/l, a significant decrease in DAPG by 4 mmol/l, a significant reduction in the incidence of diurnal hypoglycemia by 88% with the disappearance of episodes of night hypoglycemia, as well as a statistically significant reduction in the dose of basal insulin by 14 % were revealed. During the whole period of observation, there were no one episode of severe hypoglycemia, ketosis, and other side effects. Conclusion. In real-life clinical practice, switching to Deg from other basal insulin analogues in children with DM1 helps to achieve the most effective glycemic control with an optimal safety profile against a background of a reduction in the dose of basal insulin; this allows to recommend Deg for a wider use in clinical practice for the treatment of DM1 in children.

Type 2 diabetes mellitus (DM2) is an actual modern medical and social problem. The review article discusses the pathogenesis of the disease. The important role of insulin resistance as a key link in the development of DM2 is emphasized. Details of the mechanism of action of metformin, its glycemic and extra-glycemic effects, the place of the drug in modern diabetes therapy are considered.

A clinical case of primary hyperparathyroidism (PHPT), which was manifested by a severe bone disease, is presented. Based on these data, the variety of clinical symptoms of PHPT is shown, and the difficulties of early diagnosis in out-patient settings are emphasized. The necessity of increasing the skillfulness of specialists in diagnostics of the HPT is substantiated. For patients with combined pathology in the form of ulcerative lesions of the gastrointestinal tract and cholelithiasis, musculoskeletal disorders (osteoporosis, osteodystrophy, bone deformation, fractures) and recurrent nephrolithiasis, the determination of the calcium and parathyroid hormone concentrations to detect primary hyperparathyroidism is indicated.