Vol 26, No 4 (2019)

The article presents the scientific data on the prevalence, classification, mechanisms of development and main clinical manifestations of diabetic autonomic neuropathy. Particular attention is paid to the primary diagnosis of cardiac, gastrointestinal and urogenital autonomic neuropathies. The possible solutions to the problem and the main approaches to the treatment of autonomous neuropathy are discussed. It has been shown that one of the most popular modern treatment methods is the use of а-lipoic acid preparations; its effectiveness has been fairly well proven in the treatment of diabetic peripheral neuropathy, but good results have also been obtained in the treatment of autonomic neuropathy. Based on the data of scientific literature and his own previously published work on the diagnosis and treatment of autonomic neuropathy, the author presents his own view on the problem under discussion.

Background. The number of patients with type 2 diabetes mellitus (DM2) is growing steadily both in the whole world and in the Russian Federation. Dapagliflozin is a selective type 2 sodium-glucose cotransporter (SGLT2) inhibitor, which blocks glucose reabsorption in the proximal tubule of the kidney and thus promotes glucosuria. Objective: to describe changes in key glucose metabolism parameters and other clinical and laboratory characteristics against the Background of the use of dapagliflozin in the Russian patient population. Methods. The GLORIA study is an observational, retrospective, multicenter study that included 922 diabetic patients who started therapy with dapagliflozin. Dynamics of the glycated hemoglobin (HbA1c) level was assessed as the primary endpoint. Additionally, the clinical characteristics of patients treated with dapagliflozin were evaluated, as well as the proportion of patients with a decrease in HbA1c level by 0.5% or more, the proportion of patients who reached the target HbA1c value (<7.0%), and the dynamics of fasting blood glucose level, body weight and blood pressure (BP). Results. A history of macrovascular complications was registered in 338 (36.7%) patients. When evaluating the clinical efficacy of dapagliflozin, a significant decrease in HbA1c level by 0.9% compared to the initial value was observed. The dynamics of fasting blood glucose level was -1.95 mmol/L. The target Hb1Ac value of <7.0% was reached in 357(40.1%) patients. In patients taking dapagliflozin, a significant decrease in body weight was observed: the median difference of this indicator was 3.0 kg. Dapagliflozin administration was accompanied by a significant decrease in systolic and diastolic blood pressure: the median difference between the initial and final values was 6.5 and 4.5 mm Hg, respectively. 260 side effects occured in the study. Only 12 of them, however, were established to have a causal relationship with the fact of taking the drug. Mild hypoglycemic episodes occurred in 2 (0.2%) patients. When using regression equations to assess the associations between the clinical characteristics studied and taking dapagliflozin to achieve target HbA1c values, it was found that using the drug both as monotherapy and in combination with metformin increases the chances of achieving target HbA1c values. Conclusion. The use of dapagliflozin in the Russian patient population is accompanied by a significant decrease in HbA1 level, fasting plasma glucose level and other indicators of the effectiveness of therapy, as well as a favorable safety profile.

Background. Despite the progress achieved in the diagnosis and treatment of metabolic syndrome (MS), its significant prevalence remains. The heterogeneity of MS indicates the need for the use of complex therapy based on a personalized approach. Currently, the protective role of vitamin D in relation to human health is shown, but the question of its relative importance in MS is still open. Therefore, this study was conducted to understand the additional mechanisms that affect the pathogenesis of MS and, accordingly, the effectiveness of therapeutic measures. Objective. Improvement of the effectiveness of therapeutic measures in metabolic syndrome (MS) and vitamin D deficiency. Methods. The study was conducted in 2014-2015 with the inclusion of 60 patients with MS and vitamin D deficiency (50% women, 50% men) aged 20 to 45 years. Patients in the control group (n=30) were recommended to have diet therapy and the use of metformin at a dose of 1700 mg/day for 6 months. Cholecalciferol at a dose of 2000 IU/day was recommended to patients of the comparison group (n=30) in addition to the above mentioned therapy. Results. Only patients of the comparison group have achieved a more pronounced effect of treatment. Conclusion. Achievement of an optimal vitamin D level in patients with MS with the use of cholecalciferol a t a dose of 2000 IU/day in combination with diet therapy and the use of metformin increases the effectiveness of treatment, has a positive effect on abdominal obesity, insulin resistance and systemic inflammation.

Background. Cerebrovascular diseases (CVD) are often detected in patients with diabetes mellitus (DM). An increase in the glycated hemoglobin (HbA1c) level is associated with the development of microvascular complications; however, there is no information about a similar relationship in the genesis of acute or chronic forms of CVD. Objective. Evaluation of the role of carbohydrate metabolism parameters in the development of acute and chronic forms of CVD in patients with type 2 diabetes mellitus (DM2). Methods. The study included 167 patients with DM2 and ischemic CVD: group 1 (n=87) included patients with ischemic stroke (IS), group 2 (n=80) included patients with chronic CVD. General and neurological examinations, laboratory tests with determination glycemic and HbA1c levels, duplex scanning of the main arteries of the head (MAH), and neuroimaging (magnetic resonance imaging of the brain) were performed. Results. The development of both acute and chronic forms of CVD in diabetic patients usually occurs against the background of arterial hypertension, atherosclerosis of MAH, and an increase in body mass index on average 5 years after the diagnosis of diabetes. The same frequency of critical stenosis of the internal carotid artery (more than 70%) was detected in both groups - 34 and 37.5% for group 1 and 2, respectively. In patients of group 1 in 63.2% of cases an atherothrombotic subtype of IS occurred, and the incidence of atherosclerosis of MAH had a direct correlation with the duration of diabetes (r=0.26; p=0.02). There was a significantly higher level of glycemia and HbA1c (10.1 mmol/L and 8.4% versus 7.3 mmol/L and 7.6%) in patients with acute cerebral circulatory disorders (CCD) compared with patients with chronic CVD . Conclusion. The severity of carbohydrate metabolism disorders in DM2 patients is associated with the degree of «chronization» of the CVD. Insufficient glycemic control with an increase in glucose level to 10.1 mmol/L and HbA1c level to 8.4% creates favorable conditions for the progression of atherosclerosis with atherothrombosis, which are the leading pathogenetic mechanism for the occurrence of ischemic CVD in DM2 patients.

Type 2 diabetes mellitus (DM2) is a metabolic disease that develops as a result of insulin secretion dysfunction or reduced tissue sensitivity to insulin action (insulin resistance). DM2 patients often suffer not only from the symptoms of elevated blood glucose levels, but also from the manifestations and complications of comorbidities that dictate the need for prescribing drug therapy. As a result, diabetic patients have a high risk of polypragmasy, which can cause a serious complication - hypoglycemia. The article provides a brief overview of some pharmacokinetic and pharmacodynamic interactions of glucose-lowering drugs, including with food and biologically active supplements.

Achievement of the optimal long-term glycemic control without increasing the risk of hypoglcemic conditions remains the goal of treating type 2 diabetes mellitus. According to the new recommendations, the drug for the treatment of a patient with diabetes mellitus and cardiovascular pathology should primarily have cardiovascular safety. SGLT2 inhibitors belong to this group of glucose-lowering drugs. The article discusses the glycemic and non-glycemic effects of SGLT2 inhibitors, and presents data from clinical studies on assessment of the safety and efficacy of therapy using various representatives of this class of drugs.

Among the proven risk factors for the development of non-communicable diseases and mortality from them, obesity has a special role due to a chronic recurrent nature of the course and a high prevalence among all segments of the population, regardless of gender and age. Currently, obesity-associated diseases include more than 10 nosologies, such as type 2 diabetes mellitus (DM2), cardiovascular and oncological diseases, polycystic ovarian syndrome, obstructive sleep apnea syndrome, and many others, but cardiovascular diseases and DM2 undoubtedly play a leading role. It has now been proven that the treatment of obesity can slow down the development of prediabetes and is one of the key factors in the treatment of DM2. Along with lifestyle changes, pharmacotherapy is an essential step in the management of obese patients. It has been convincingly proven that the use of Reduxin® and Reduxin®Met in patients without contraindications is effective and safe regardless of the presence of polymorbid pathology and the use of various concomitant therapies.

Background. The duration of an increase in the growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels directly correlate with the mortality rates in acromegaly that’s why complete biochemical remission of this disease remains the treatment goal. Description of the clinical case. Clinical observation of 38-year-old patient L. is presented The diagnosis of «acromegaly» was established in 2007 (at the age of 27 years), and a course of telegrammatherapy was conducted. From 2008 to 2009, he received a short-acting octreotide analogue, from 2010 to 2016 - a prolonged somatostatin analogue, with pronounced improvement in general condition, but without achievement of laboratory remission. Since 2016, he receives long-acting somatostatin analogue. In the spring of 2018, he was admitted to the hospital for the assessment of the effectiveness of therapy and examination for the detection of complications. Clinical and laboratory compensation of the disease was revealed, and therefore it was recommended to continue drug therapy in the same regimen. Conclusion. Against the background of therapy with long-acting somatostatin analogue, patient with acromegaly achieved clinical and laboratory remission (GH <2.5 ng/ml, IGF-1 - within the reference range), thus, the stabilization of the disease can be expected. Since acromegaly, regardless of the activity of the process, serves as a factor that increases the cardiovascular risk significantly, all patients with this disease must be monitored by a cardiologist with the timely prescription of HMG-CoA reductase inhibitors (statins), if necessary.