Vol 27, No 4 (2020)

Сахарный диабет можно считать одной из серьезнейших глобальных проблем, с которыми сталкивается человечество. Именно поэтому в начале 2020 г. представителями ФГБОУ ДПО РМАНПО был подписан договор о создании сетевой кафедры ЮНЕСКО, которая будет заниматься продвижением результатов современных научных исследований, относящихся к биоэтике сахарного диабета. Руководителем кафедры является доктор медицинских наук, профессор Александр Сергеевич Аметов.

A brief review presents the results of studies conducted to identify a possible relationship between the vitamin D level in the body of a pregnant woman and the development of gestational diabetes mellitus. It seems possible and appropriate to use vitamin D to prevent the development and treatment of gestational diabetes mellitus, including its severe complications. Currently, however, there are no convincing data on the safety of prolonged use of drugs for mother and fetus, and threshold vitamin D levels for reasonable pharmacological correction have not been determined. The development of pharmacotherapeutic strategies requires carefully planned experimental and clinical studies.

Among 9 classes of antidiabetic drugs used, dipeptidyl peptidase-4 (IDPP-4) inhibitors were firmly established in medical practice about 14 years ago. To date, drugs of this group are confidently prescribed as the first-line therapy for type 2 diabetes mellitus. Features of drugs of this class allow the use of DPP-4 inhibitors in various groups of patients, especially requiring close attention. These include the older age group, patients prone to hypoglycemia, and suffering from end-stage renal disease, when the possibilities for choosing hypo-glicemic therapy are extremely limited. Furthermore, the safety of the use of most drugs of this group in the presence of cardiovascular pathology is also important, and it allows them to be used in the vast majority of patients with type 2 diabetes mellitus.

Background. The combination of type 1 diabetes mellitus (DM1) and autoimmune thyroiditis (AIT) is quite common and varies in frequency from 20 to 35% among DM1 children. The literature data indicate a negative effect of the combination of these diseases on the control of DM1, frequent hypoglycemia, and a deterioration of the lipid profile in children with hypothyroidism in the AIT outcome. Objective. Evaluation of the effect of AIT on the compensation of carbohydrate metabolism and the development of microvascular complications in DM1 children regardless of the functional state of the thyroid gland. Methods. A cross-sectional study with analysis of medical records of children undergoing inpatient treatment at the Regional Endocrinology Center of the Regional Children’s Clinical Hospital with a diagnosis of autoimmune polyglandular syndrome type 3 (APS 3: DM1 + AIT) were conducted. Data on the date of manifestation and the duration of the disease, the revealed complications, the glycated hemoglobin (HbA1c), TSH, cT4, anti-thyroid peroxidase antibody (anti-TPO) levels and the results of ultrasound, as well as the presence of chronic complications (diabetic retino-, nephro-, polylineuro- and chiropathy) were recorded. The distribution into subgroups was carried out according to the TSH level: euthyroidism (ET): 0.4-5.0 цЮ/L; subcompensated hypothyroidism (SCHT): 5.0-10.0 цЮ/L; drug-compensated hypothyroidism (DCHT): 0.4-5.0 цЮ/L on sodium levothyroxine; and analysis of AIT catamnesis. Results. The main group included 112 children diagnosed with APS 3. According to the functional state of the thyroid gland, ET was observed in 38.4% of cases (n=43), SCHT - in 42% (n=47), DCHT - in 19.6% (n=22). In general, in children with APS 3, regardless of the thyroid function in the outcome of AIT, the HbA1c level was significantly higher compared to the control group (n=77; 9.8 versus 8.7%; p=0.001), including with ET - 9.7%, with SCHT - 9.5%, and with the greatest differences with DCHT - 10.3%. The frequency of diabetes complications in the groups did not differ, but in the main group, diabetic nephropathy was significantly more often diagnosed, as well as the presence of several complications at once. The highest complication rate was found in the DCHT group - 68.2% (n=15), in the subgroups of children with ET and SCHT - 39.5% (n=17) and 46.8% (n=22), respectively. Children with DCHT had a higher incidence of nephropathy. Hyropathy was rare in both groups, however, was observed 6 times more often in the group with combination of DM1 and AIT. Conclusion. Children with a combination of DM1 and AITare at high risk for decompensation of carbohydrate metabolism and the development of chronic DM1 complications regardless of the functional state of the thyroid gland. Selective screening for AIT (TSH, anti-TPO and thyroid ultrasound) in DM1 children is necessary already at the stage of diabetes manifestation. Further dynamic monitoring of children with APS 3, regardless of the initial functional state of the thyroid gland, should be carried out taking into account the established risks, more carefully, with annual monitoring of TSH level and screening for chronic complications.

Background. Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that leads to irreversible damage and deformation of the joints and is associated with an increased risk of death from cardiovascular disease. Metabolic disorders, manifested by changes in lipid and carbohydrate metabolism, and vascular manifestations of systemic inflammation contribute to the development of obesity in RA patients. Sarcopenia (SP) in RA is considered as another comorbid condition that develops against the background of a chronic inflammatory process, limitation of physical activity and the use of glucocorticoids, which can also worsen the prognosis of the disease. Objective: Evaluation of the frequency of pathological body composition phenotypes (obesity, SP, and sarcopenic obesity) in women with RA. Methods The study included 91 women aged 40-75 years with confirmed RA. All patients underwent clinical and laboratory examination and dual-energy X-ray absorptiometry to assess body composition. Results. Obesity was revealed in 72.5% of the examined individuals according to the results of absorptiometry, and only in 28.6% - by a body mass index of >30 kg m2. In 18.7% of patients, the body composition phenotype was without pathological changes, while 53.8% of RA women had obesity without SP, 8.8% - non-obese SP, and 18.7% - sarcopenic obesity. Women with sarcopenic obesity had a significantly longer duration of RA (p=0.02) and a higher disease activity score DAS 28 (p=0.04). Inverse correlations were established between fat and muscle mass and the of C-reactive protein level and cumulative dose of glucocorticoids, positive correlation - with the serum creatinine and uric acid levels and the mineral bone density of the spine and hip. Conclusion. Our study showed a high frequency of pathological body composition phenotypes in RA patients. Only 18.7% of the examined individuals had no abnormalities in the composition of the body, while 53.8% of the patients were obese, and another 18.7% had sarcopenic obesity. Densitometry for assessing body composition is advisable for identifying SP and more accurate diagnosis of obesity in order to conduct preventive measures both to prevent locomotor disorders and to reduce cardiovascular risk in RA patients.

Given the growing number of patients with type 2 diabetes, one of the tasks of modern medicine is to take measures to reduce the prevalence of this disease. In particular, it is necessary to reduce the frequency of obesity and overweight among the population, since obesity is the main predisposing factor for the development of type 2 diabetes. This article discusses the epidemiology of diabetes and obesity, the causes of the diagnosis of these diseases in both children and adults. Attention is paid to nutrition, the psychological aspects of obesity, the role of physical inactivity and socio-economic factors in the process of weight gain. Possible measures for the prevention of obesity and, as a result, type 2 diabetes mellitus are considered.

Hypoglycemia, i.e. a decrease in blood glucose level below normal is a frequent and dangerous violation of the most important part of homeostasis: energy metabolism. The frequency of hypoglycemia is attributable to the fact that it not only complicates many diseases and syndromes, but also performs the function of a physiological regulator of energy metabolism. The glycopenia hazard is that glucose is actually the only source of energy for nerve structures and a lack of glucose leads to their damage. The lecture discusses the definitions of hypoglycemic syndrome, the typology of hypoglycemic syndrome from the point of view of causes and mechanisms of development, and the issues of the clinical picture and diagnostics. An algorithm for the treatment of hypoglycemic coma and diagnostic schemes for the main pathogenetic variants of hypoglycemic syndrome are presented.

Psoriasis is a chronic inflammatory, immune-mediated skin disease that affects 2-3% of the population worldwide. Psoriasis is often associated with metabolic diseases such as diabetes mellitus, obesity, dyslipidemia, metabolic syndrome and non-alcoholic fatty liver disease. The presence of concomitant diseases is of great importance in the choice of therapy for patients with psoriasis. On the one hand, the rational therapy of psoriasis should stop the exacerbations quickly enough, and on the other, maintain the duration of remission. Some drugs used for the treatment of psoriasis, however, can adversely affect concomitant diseases, determining a more careful selection of therapy for such patients. The article discusses modern methods of topical therapy for psoriasis and describes the clinical experience with the use of Kartalin cream in patients with psoriasis occurring against a background of metabolic disorders.

Background. Almost half (47.8%) of patients with type 2 diabetes mellitus (DM2) do not reach glycated hemoglobin (HbA1c) levels of less than 7% and, accordingly, are at high risk for chronic complications of this disease, including macrovascular complications and mortality from them, because HbA1c is one of the most significant predictors of myocardial infarction and acute stroke among DM2 patients. Despite success in treating patients with DM, the issue of long-term and sustainable compensation for diabetes remains relevant. In 2018, a fixed combination of the basal insulin analogue glargine 100 U/ml and the prandial glucagon-like peptide type 1 receptor agonist (GLP-1RA) lixisenatide became available in Russia. As shown in the LixiLan-O clinical study, a fixed combination of insulin glargine and lixisenatide allows 74% of patients who have not previously reached treatment goals with oral antidiabetic drugs to achieve an HbA1c level of less than 7%. Description of the clinical case. This publication presents a clinical case of successful long-term (more than a year) use of this drug by DM2 patients who did not reach the target glycemic values with oral antidiabetic drugs. Conclusion. On the example of DM2 patient, it was shown that the fixed combination of the basal insulin analogue glargine and arGPP-1 lixisenatide in real clinical practice demonstrates the efficacy and safety parameters previously shown in clinical trials.