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No 11 (2018)
- Year: 2018
- Articles: 16
- URL: https://journals.eco-vector.com/2073-4034/issue/view/7078
Articles
VSTUPITEL'NOE SLOVO KURATORA
Pharmateca. 2018;(11):4
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NEWS OF MEDICINE
Pharmateca. 2018;(11):5-7
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Potentials for the management of cardiovascular risk in diabetic patients on insulin therapy
Abstract
Diabetes mellitus (DM) contributes to the development of a number of severe vascular complications and a significant increase in cardiovascular risk, which leads to early disability and premature death of patients. The evaluation of cardiovascular safety of both new and traditionally used for many years hypoglycemic drugs and their combinations contributes to the development of more effective therapeutic strategies and recommendations for the prevention of adverse cardiovascular events and improve the prognosis of diabetes. The article presents a comparative analysis of the safety of basal insulin analogues for DM2 patients in relation to the risk of developing severe hypoglycemia and cardiovascular safety. Analysis of data from randomized clinical trials, databases of real-life clinical practice, as well as the largest study of cardiovascular safety of insulin analogues to date, DEVOTE study, makes it clear that insulin degludec, possessing sugar-lowering efficacy and cardiovascular safety comparable to other basal insulin preparations, has several advantages, namely a lower risk of developing severe hypoglycemic episodes, a greater likelihood of achieving target levels of fasting glycemia, as well as the possibility of a more flexible regimen of drug administration.
Pharmateca. 2018;(11):8-16
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Alogliptin in the treatment of type 2 diabetes mellitus: an evidence base for the clinical use
Abstract
Type 2 diabetes is a serious disease associated with the development of severe complications. The current treatment, including the use of drugs based on the “incretin effects", and the mechanism of action of dipeptidyl peptidase-4 inhibitors are discussed. The results of clinical studies of the efficacy and safety of alogliptin are presented.
Pharmateca. 2018;(11):17-25
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Carcinoid syndrome in the practice of the endocrinologist
Abstract
Neuroendocrine tumors (NETs) are a heterogeneous group of tumors derived from neuroendocrine cells of the embryonic intestine. Functioning NEO, secreting biologically active peptides, may be accompanied by the development of a complex of pathognomonic symptoms, the so-called. carcinoid syndrome (CS), which makes it possible to suspect a serious diagnosis in a patient with a high probability. The review provides detailed information about the epidemiology of the NETs and the CS, the pathophysiology and the clinical picture of the CS (hot flashes, diarrhea, carcinoid heart disease). Criteria for diagnosis of CS and NETs are discussed. General approaches to the treatment of CS and NETs are presented; the leading place among them is occupied by the use of somatostatin analogues, such as octreotide and lanreotide, including slow-release preparations. Management of patients with NETs requires a multidisciplinary team of specialists, which should necessarily include therapists, endocrinologists, gastroenterologists, surgeons, oncologists, and pathomorphologists. Close cooperation of specialists with each other is needed in order to make an accurate diagnosis, make a consensus treatment decision and develop an individualized treatment plan.
Pharmateca. 2018;(11):26-33
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Apelin: biological and pathophysiological effects
Abstract
Adipose tissue is a source of secretion of various biologically active substances - adipokines, which affect all types of metabolism. This article focuses on apelin, one of the understudied adipokines. The biological and pathophysiological effects of this peptide, its effect on carbohydrate metabolism, pathology of the cardiovascular system and atherosclerosis are discussed. In addition, data on the prospects for the use of apelin for therapeutic purposes in cardiovascular pathology are presented.
Pharmateca. 2018;(11):34-38
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Features of glycemic control in patients with type 2 diabetes mellitus and chronic heart failure
Abstract
The article discusses the issues of glycemic control in a rapidly growing population of patients with type 2 diabetes mellitus (DM2) and chronic heart failure (CHF). The authors consider this problem in detail, taking into account the results of national epidemiological studies on diabetes mellitus (NATION) and CHF (EPOCH-CHF), analyze the pathogenetic mechanisms of CHF development in diabetes. A detailed review of studies published in recent years and devoted to the evaluation of the effect of the existing groups of oral antidiabetic drugs (OADDs) on cardiovascular outcomes in DM2 patients is presented. The benefits and potential side effects of various classes of OADDs are discussed. The therapeutic strategies for the management of diabetes mellitus aimed at preventing cardiovascular pathology and improving its prognosis are considered.
Pharmateca. 2018;(11):39-47
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Prevention and treatment of osteoporosis and vitamin D deficiencyof in adults. Focus on alfacalcidol
Abstract
The article provides information about the role of vitamin D, the main causes of deficient states and the metabolic features of the native and active forms of vitamin D, including in persons over age of 45 years. It is emphasized that despite the similar safety profile, alfacalcidol due to the lack of renal metabolism demonstrates greater clinical efficacy compared with native vitamin D in the treatment of primary and secondary osteoporosis (OP), deficient conditions, prevention of falls and fractures. Monotherapy with alfacalcidol is included in the clinical guidelines for the treatment of OP, unlike the native vitamin D, because it demonstrated a more pronounced effect on increasing bone mineral density, reducing the risk of falls, reducing the risk of fractures and a significant reduction in pain. The wide possibilities of selecting individual doses of Alpha D3®-Teva (alfacalcidol) can minimize the risk of side effects, which contributes to improving the quality of life of patients of all ages, along with the prevention of new fractures, the elimination of pain syndrome and the improvement of physical activity.
Pharmateca. 2018;(11):48-55
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Problem of detection and pharmacological correction of anxious and depressive disorders in patients with type 2 diabetes mellitus
Abstract
Background. Depression and anxiety are frequent companions of chronic somatic diseases. The most acute question is about the pharmacotherapy of these conditions in type 2 diabetes mellitus (DM2), when, due to the similarity of the clinical symptoms and manifestations of anxious disorders, they are difficult to differentiate, and treatment compliance is violated. The presence of anxiety and depressive disorders contributes to the progression of the underlying disease and its complications. Objective. Evaluation of the incidence of anxiety and depressive disorders in DM1 and DM2 patients during planned hospitalization. Methods. Filling EQ5D5L and HADS questionnaires by patients (DM1 - 50 patients, DM2 - 47 patients) of School of Diabetes. Results. Subclinical and clear signs of depression and/or anxiety were detected in all DM2 patients, while these indicators were within the normal range in DM1 patients. DM2 patients assessed their own quality of life significantly lower than DM1 patients. Conclusion. DM2 patients have a high incidence of anxious and depressive disorders identified during screening. The timely detection and pharmacological support of such patients with such disorders can help to improve their quality of life and the effectiveness of glucose-lowering therapy due to their greater adherence to treatment.
Pharmateca. 2018;(11):56-59
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Initiation of insulin therapy in patients with type 2 diabetes mellitus according to the Federal Diabetes Register in Moscow
Abstract
Background. Insulin therapy (IT) occupies an important place in the treatment of patients with type 2 diabetes mellitus (DM2). According to the Federal Diabetes Register (FDR) in Moscow on 05/01/2018, 66.2 thousand DM2 patients received glucose-lowering therapy using insulin preparations (21% of the total number of DM2 patients). According to the Russian part of the CREDIT study, in 2009, for initiation of insulin therapy in DM2 patients, basal insulin (BasalIns; 66.2%) was most often used; less often - basal-bolus IT (17.9%) and mixed insulin (MixIns; 4%) and very rarely (1.1%) - only bolus insulin (BolusIns). IT initiation was carried out at an average level of HbA1c of 9.7±1.8% [2]. Objective. To determine the most commonly used schemes for initiating IT in DM2 patients. Methods. Based on the FDR in Moscow, the analysis of the database of DM2 patients who were assigned to receive IT for the first time in 2017 was carried out. The structure of initial IT in these patients has been determined. Results. Analysis of FDR in Moscow has identified 7020 DM2 patients with initiation of IT in 2017. There were 2,780 men (39.6%) and 4,240 women (60.4%). The average age of patients was 63.9±11.8, the average disease duration was 8.5±6.8 years. BMI was 31.2±6.5 kg/m2, the average НЬА1с level was 8.4±1.8%. Most often IT initiation was carried out using BasalIns (51.6%) or basal-bolus IT (34.4%). The combination of 2 (46.3%) and 3 glucoselowering drugs (38.8%) was most often used. In 78.9% of cases, IT initiation was performed using insulin analogues. In patients with newly diagnosed DM2, basal-bolus IT (48.0%) and BasalIns (40.4%) for IT initiation are mainly used, with the combination of 2 (60.0%) and 3 (21.9 %) sugar-lowering drugs. Conclusion. There is a change in the structure of the newly prescribed IT in DM2 patients com pared with the results of the CREDIT study (2009). Thus, according to the FDR in 2017, IT initiation in DM2 patients was carried out 2 times more often using the basal-bolus scheme (34.4 /s. 17.9%), and less frequently using BasalIns (51.6 /s. 66.2%), MixIns (12.3 /s. 14.4%).
Pharmateca. 2018;(11):60-65
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Adiponectin and metabolic parameters in patients with type 2 diabetes mellitus and hypothyroidism
Abstract
Background. Currently, there is an increase in the number of patients with a combination of type 2 diabetes mellitus (DM2) and hypothyroidism. These diseases are associated with overweight, dyslipidemia, insulin resistance. A decrease in thyroid function has an additional negative effect on carbohydrate and lipid metabolism in DM2 patients, contributing to the earlier development of its micro- and macrovascular complications. Objective. Analysis of the relationship between the adiponectin level, carbohydrate and lipid metabolism in women with diabetes mellitus, hypothyroidism, and their combination. Methods. Three groups of women were examined. The first group included 42 women with primary symptomatic hypothyroidism, the second group - 38 women with type 2 diabetes mellitus. The third group consisted of 39 women with a combination of DM2 and hypothyroidism. As a control group, the results of a survey of 35 apparently healthy women, divided into older and younger groups, were used. All surveyed women underwent anthropometric examination, evaluation of the indicators of lipid and carbohydrate metabolism, as well as adiponectin level. Results. In women with DM2 and its combination with hypothyroidism, pronounced insulin resistance with compensatory hyperinsulinemia was revealed. In the group of women with hypothyroidism, a decrease in insulin sensitivity was observed. Atherogenic dyslipidemia and hypoadiponectinemia were detected in all three groups. Conclusion. The minimum adiponectin level was detected in the group of patients with a combination of DM2 and hypothyroidism
Pharmateca. 2018;(11):66-73
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Type 1 diabetes mellitus in Moscow -2018 (according to the Moscow segment of the Federal Diabetes Register)
Abstract
Background. Type 1 diabetes mellitus (DM1) to date remains one of the most difficult endocrine diseases, not always amenable to quality management. A large amount of information about the disease necessary for patient, the need for high-quality insulin preparations, the necessity of frequent self-control, the need for psychological support create difficulties in achieving compensation for the disease. The Federal Diabetes Register (FDR) provides an opportunity to assess the quality of treatment for diabetic patients, the level of glycemic control, the presence and severity of complications. Objective. To evaluate the clinical and metabolic parameters in the dispensary group of DM 1 patients in Moscow in 2018: the level of glycated hemoglobin (HbA1c), the incidence of complications and concomitant diseases, the variants of insulin therapy used. Tasks. To form a sample of DM1 patients from the Moscow segment of the FDR, to perform among them a statistical analysis of the main demographic indicators, the level of disease control, the frequency of complications and comorbidities, and the options for the therapy used. Methods. The analysis of the data of DM1 patients included in the FDR was carried out: the number of patients, sex composition, age, HbA1c level, the presence of complications, approaches to insulin therapy. Conclusion. As of September 1, 2018, 17,839 adult DM1 patients were registered at the FDR in Moscow; there were 9704 (54.4%) men and 8135 (45.6%) women. The average age of patients was 42.1±14.4, the average duration of the disease was 16,0±11.7 years. Presence of complications was noted in 9824 (55.1%) patients. The most common complications included diabetic neuropathy (DNeuP), retinopathy (DRP) and nephropathy (DNephP). More than 50% of DM1 patients with DRP had a non-proliferative stage of complication. The proliferative stage was recorded in 10% of patients with DRP. Of the total number of patients with DNephP, 2.9% of patients had stage 2, 6.9% of patients - stage 5. A direct correlation between the number of detected complications and the duration of the disease (r=0.49; p<0.01) and the age of the patients (r=0.35; p<0.01) was found. More than 40% of DM1 patients had a disability, in half of the cases - severe disability; 4.2% of DM1 patients (743 people) used an insulin pump in therapy.
Pharmateca. 2018;(11):74-79
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Application of Cocarnit in complex treatment of patients with diabetic polyneuropathy in outpatient practice
Abstract
Background. Diabetes is one of the global problems of modern healthcare. Diabetic distal symmetric polyneuropathy occurs among 30-80% of diabetic patients, is accompanied by severe pain syndromes, reduces quality of life, and is associated with increased mortality. Blood glucose control is not enough to prevent the development and progression of diabetic polyneuropathy (DPN). The search for new drugs for the treatment of DPN is relevant. Objective. Evaluation of the effect of complex therapy, including the drug Cocarnit, on the course of DPN. Methods. The study included 20 patients with type 2 diabetes mellitus complicated by DPN of varying severity. Cocarnit was administered once a day intramuscularly at a dose of 2 ml for 9 days as part of complex therapy. Results. All patients had neuropathic pain of varying severity, which was confirmed by assessment using TSS, NSS and NDS scales. Against the background of the therapy, a significant decrease in pain and improvement in the quality of life was noted. After treatment, according to electroneuromyography, conduction along the motor and especially sensory nerves has improved. Conclusion. Cocarnit is an effective drug for the treatment of patients with diabetic distal sensorimotor polyneuropathy. The use of cockarnit, containing B vitamins, as well as triphosadenine and nicotinamide, is pathogenetically substantiated and effective in the complex treatment of patients with diabetic neuropathy.
Pharmateca. 2018;(11):80-84
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Clinical features of axonal-demelinizing diabetic polyneuropathy
Abstract
Objective: to compare the clinical features of axonal and axonal-demyelinating distal symmetric diabetic polyneuropathy (DPN). Methods. Observational cohort study. The pathogenetic variant of DPN was diagnosed using electroneuromyography; based on its results, all patients were divided into 2 groups of 26 people each - with axonal and axonal-demyelinating polyneuropathy. The somatic and neurological status of the patients was examined; the severity of DPN was assessed on the basis of neurological symptom score (NSS, for subjective symptoms) and neuropathy disability score (NDS, for objective symptoms). Results. A total of 52 patients with DPN were examined. The group of patients with axonal-demyelinating variant of polyneuropathy demonstrated statistically significant differences with the group of axonal DPN: a high incidence of decompensation of diabetes mellitus (61.5 and 15.4% of patients, respectively, p<0.04), a higher NSS score (5,5±2.4 and 3.6±2.3, respectively, p<0.04) and NDS score (17.7±8.4 and 8.5±7.0, respectively, p<0.005), a greater frequency of additional symptoms of polyneuropathy (paresis, ataxia, muscular atrophy, 69.2 and 23.1% of patients, respectively, p<0.04). Conclusion. The axonal-demyelinating variant of DPN is associated with a more severe course of diabetes mellitus and a greater severity of polyneuropathy.
Pharmateca. 2018;(11):85-89
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Role of copper in the development of cardiovascular pathology in patients with diffuse-toxic goiter
Abstract
Objective. To evaluate the contribution of the copper status in the progression of thyrotoxicosis severity and the development of cardiovascular complications in patients with diffuse toxic goiter. Methods. The study included 113 women with diffuse toxic goiter aged 25 to 60 years; 61 (54.0%) of them had moderate thyrotoxicosis, 52 (46.0%) - severe thyrotoxicosis. Duration of the disease was 1 to 5 years. The control group included 37 women aged 25 to 60 years without pathology of the thyroid gland and cardiovascular system. Blood thyroid-stimulating hormone (TSH) level, free thyroxine (fT4) level, the thyroid-stimulating hormone receptor antibody (anti-THSr) levels, as well as hair copper concentration, were assessed. All patients underwent ultrasound examination of the thyroid gland, echocardiography, and 24-hour Holter ECG monitoring. Results. At baseline, all patients achieved subclinical thyrotoxicosis against the background of thyroostatic therapy. With moderate thyrotoxicosis, the mean TSH level was 0.07 (0.03-0.13) lU/l at baseline; fT4 - 18.5 (16.0-19.5) pmol/l; with severe thyrotoxicosis - 0.06 (0.03-0.12) lU/l (p=0.70), and 18.0 (16.7-19.0) pmol/l (p=0.40), respectively. With moderate severity of diffuse-toxic goiter (DTG), all patients (61 [100.0%]) had an increase in the hair copper level to 21.0 (17.0, 23.0) pg/g was revealed. In majority of patients with severe DTG -40 (76.9%) - reduced hair cooper level 7.0 (5.5-8.0) pg/g was revealed. In the comparison group, the indicators of 4 (10.8%) patients were 13.0 (11.1-15.5) pg/g (p=0.01). Hair copper deficiency in chronic heart failure (CHF) was detected in 40 (76.9%) patients, in atrial fibrillation - in 21 (67.7%) patients. Conclusion. The data obtained allow to consider that copper deficiency contributes to the progression of thyrotoxicosis severity and increases the probability of development of AF and CHF in patients with severe DTG.
Pharmateca. 2018;(11):90-96
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Diabetic foot: clinical presentation and treatment options
Abstract
The article is devoted to such a severe complication of diabetes mellitus, such as diabetic foot, which occurs among 15% of diabetic patients and represents a serious problem, since it leads to a deterioration in the quality of life of patients and their disability. The article discusses the etiology, pathogenesis and clinical picture of diabetic foot, and also provides an overview of the principles of treatment of this pathology. Particular attention is paid to the topical treatment and modern dressing materials.
Pharmateca. 2018;(11):97-103
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