Vol 30, No 12 (2023)

Type 2 diabetes mellitus (T2DM) is a serious disease

Objective. Discussion of the results of a meta-analysis that was conducted to evaluate the effectiveness of sulodexide treatment of diabetic nephropathy.

Results. Sulodexide is a heterogeneous group of sulfated glycosaminoglycans; which mainly consists of low molecular weight heparin. Clinical studies have shown that sulodexide is able to reduce urinary albumin excretion in patients with type 1 and type 2 diabetes mellitus (DM). A meta-analysis was conducted to summarize the clinical results of all prospective clinical studies on the clinical efficacy and safety of sulodexide in diabetic patients with nephropathy. In general; sulodexide therapy was accompanied by a significant decrease in urinary protein excretion. In the sulodexide group; 220 patients (17.7%) achieved a reduction in albumin excretion of at least 50% compared with 141 (11.5%) in the placebo group. The odds ratio in patients with therapeutic efficacy between the sulodexide and placebo groups was 3.28 (95% confidence interval: 1.34–8.06; P=0.01).

Conclusion. These data indicate the renoprotective effect of sulodexide in diabetic patients with microand macroalbuminuria and may be the basis for the treatment of diabetic nephropathy with sulodexide; in particular; the prevention of end-stage renal disease associated with DM [1].

In December 2019; there was an outbreak of a new coronavirus infection (NCI) COVID-19 in China; which then developed into a pandemic. Almost immediately after the advent of NCI; it became apparent that the presence of chronic diseases; such as diabetes mellitus (DM); plays a key role in the outcome of the disease for infected patients. Based on the results of numerous studies; we concluded that the risks of complications and death in NCI with the presence of diabetes increase significantly. Scientists have shown that; a persona-lized approach; which consists of selecting an optimal treatment regimen for diabetes during the period of NCI; creating the necessary conditions for the prevention of NCI; and developing a strategy for general vaccination of the population is required for the successful management of patients in this cohort.

Objective: to determine an effective strategy for the treatment and prevention of NCI in comorbid patients based on an analysis of domestic and foreign studies.

Methods. In the process of searching for information; articles that were published over the last 4 years (2019–2023) were studied. A review of more than 90 scientific papers including systematic reviews; meta-analyses; and articles was conducted.

Conclusion. NCI is a serious infectious disease; which; in the presence of comorbid conditions such as diabetes; occurs with an increased risk of mortality and severity of the patient’s condition. To reduce the consequences of the pandemic and effectively prevent new outbreaks; the development of new treatment algorithms and their implementation in clinical practice; early routine monitoring and determination of subsequent vaccination tactics are required.

Pathology of the thyroid gland (TG) has become widespread in Russia and the world in recent years. The most common diseases associated with the presence of iodine deficiency include diffuse and diffuse-nodular endemic goiter; autoimmune thyroid pathology (autoimmune thyroiditis and diffuse toxic goiter); as well as benign and malignant thyroid tumors. The review given in the article covers modern aspects of the treatment of thyroid diseases. A study on the effectiveness and reduction of side effects of radiation therapy for hyperthyroidism through the introduction of complex treatment of thyrotoxicosis with herbal drugs and their derivatives with thyrostatic agents was conducted.

The presented scientific and analytical article discusses the modern scientific literature data on structural and physiological changes in nervous tissue in patients with diabetes mellitus. A complex of mechanisms leading to disruption of antioxidant protection; changes in protein structure and activity of enzyme systems; leading to hypoxia; the development of axonal degeneration and demyelenation of nerve fibers; has been analyzed. The multicomponent nature of metabolic disorders has been identified as the main problem that needs to be solved; which dictates the need to find and use means with not just precise; but also complex effects. Analysis of data on the presentation of domestic drugs with complex effects on the Russian pharmaceutical market drew our attention to a drug containing inosine +nicotinamide+riboflavin+succinic acid.. Pharmacokinetics of Cytoflavin allows it to simultaneously influence several pathophysiological mechanisms; providing to predict the complex effect on metabolic processes in nervous tissue. Currently; one of the most promising areas for using this drug is in the treatment of diabetic neuropathy.

Diabetes mellitus (DM) is one of the most common chronic diseases that require constant monitoring of glycemic levels. In recent years; modern methods for assessing glycemia which significantly improve the quality of life of patients and facilitate the management of their disease have been developed and implemented. Glycemic self-monitoring (GSM) is an integral part of diabetes management and is essential for achieving optimal blood glucose control. Modern self-monitoring techniques; such as the use of advanced glucose meters; allow patients to quickly and accurately measure their blood glucose levels; which helps them make informed decisions about next steps in managing their disease. GSM also allows patients to track the effectiveness of their treatment and identify factors that may affect blood glucose levels; such as diet; physical activity and stress. GSM allows patients to prevent possible complications associated with low or high blood glucose. The use of 24-hour glucose data is an important tool for effective diabetes management. This data can help patients identify glucose peaks and valleys; as well as identify patterns that may be related to certain factors such as diet; physical activity and stress. Using this data; patients can make more informed decisions about their treatment. Overall; the use of 24-hour glucose data allows patients to more accurately monitor their disease; make individualized treatment decisions; and effectively manage diabetes.

Background. The prevalence and severity of complications of gestational diabetes (GD) remain a significant problem worldwide. The desire to improve pregnancy outcomes; as well as an understanding of carbohydrate metabolism disorders; has led to studies demonstrating the presence of various pathogenetic subtypes of GD. Thus; studies have already demonstrated that pregnant women with GD and severe insulin resistance (IR) not only have more unfavorable prognoses; but also differ phenotypically and biochemically. Identification of biochemical markers of different GD subtypes has the potential to improve early diagnosis of a specific subtype and personalize treatment depending on the predominant pathogenetic factor.

Objective. Determineation of the biochemical markers for the diagnosis of various GD subtypes in pregnant women.

Methods. A single-center; observational; prospective; uncontrolled study included 130 pregnant women undergoing outpatient examination between March 2020 and March 2022. Based on the results of an oral glucose tolerance test with 75 g of glucose; 88 patients were diagnosed with GD: 43 were diagnosed with GD subtype with impaired β function-cells (GD I); 45 had the GD subtype with predominant IR (GD II); 42 patients formed the control group. Additionally; insulin was determined at three points to calculate the Matsuda index; fasting levels of total cholesterol (TC); triglycerides (TG); high and low density lipoproteins (LDL); apolipoprotein A (Apo-A); apolipoprotein B (Apo-B); adiponectin; leptin and omentin were examined

Results. Pregnant women from the GD II group had statistically significantly higher TG values (P=0.01 when compared with the GD I group; P<0.001 when compared with the control group); the total cholesterol and LDL levels were higher compared to those in patients from other groups; but these changes were not statistically significant. The (Apo-A) level was significantly higher in patients with GD (P<0.001 when comparing both GD groups with the control group) and did not differ when comparing different GD subtypes; in contrast to the Apo-B level; which was significantly higher in pregnant women from the group GD II compared with that in pregnant women from the other two groups (in both cases P=0.02). When studying adiponectin; leptin and omentin; statistically significant differences were detected only in the level of adiponectin (the lowest level in pregnant women from the GD II group compared with participants in other groups; P<0.001 when compared with the GD I group; P=0.004 – with the control group ). It was not possible to detect significant differences in omentin and leptin levels within the study.

Conclusion. High levels of Apo-B; TG; and low levels of adiponectin can be used as potential biomarkers in scientific and clinical practice to verify the pathogenetic subtype of GD with severe IR; most unfavorable factor regarding the prognosis according to previous studies.

Background. Diabetes mellitus (DM) in patients with COVID-19 is known to be a risk factor for severe disease and death. Hyperglycemia in hospitalized patients with diabetes and COVID-19 is corrected by insulin therapy (IT) in most cases. Studying the effectiveness of IT; the features of IT regimens during hospitalization and the selection of glucose-lowering therapy before discharge of DM2 patients hospitalized with coronavirus infection is relevant.

Objective. Evaluation of the features of compensation of carbohydrate metabolism in hospitalized DM2 patients with coronavirus infection who initially did not receive IT.

Methods. A retrospective study of DM2 patients hospitalized with coronavirus infection who were not receiving IT initially (n=86) was conducted The first group consisted of patients receiving IT in a hospital (n=63); the second group included patients compensated with hypoglycemic non-insulin drugs (n=23). In the study groups; anamnestic; clinical; laboratory and instrumental parameters; and indicators of carbohydrate metabolism were assessed. Additionally; groups receiving glucocorticosteroid (GCS) therapy (n=56) and without it (n=30) was compared.

Results. In inpatient settings; 73.3% of patients were prescribed IT; 38.4% received IT only; 34.9% received IT in combination with other glucose-lowering drugs. Among discharged patients; IT was recommended in 18.8%. Patients receiving IT in the hospital had higher lactate dehydrogenase levels on admission (259.3 vs. 223.8 U/L; P=0.006); and a higher proportion of cases with lung damage greater than 25% (42.9 vs. 13.0%; P=0.011); severe COVID-19 (28.6 vs. 4.4%; P=0.018) and transfer to ICU (19.1 vs. 0.0%; P=0.031). Patients of the first group were characterized by a high level of fasting glycemia on the first (9.6 vs 6.9 mmol/l; P<0.001); third (9.8 vs 7.9 mmol/l; p=0.030) and 7th days (10.4 vs 7.4 mmol/l; p=0.021); the maximum daily dose of insulin was 0.40 (0.19–0.62) U/kg on the 3rd day. The frequency of use of IT in the hospital in patients receiving GCS was 87.5%; in the group without GCS therapy – 46.7% (p<0.001); upon discharge from the hospital – 26.0 and 6.7% (P=0.070); respectively.

Conclusion. In DM2 patients hospitalized with coronavirus infection who did not receive insulin initially; transfer to IT was carried out in 73.3%; at the time of discharge from the hospital; 18.8% needed continued IT. Patients prescribed insulin had severe COVID-19 and worse glycemic control. The use of GCS increased the chance of transfer to IT (87.5%); however; even in patients who did not receive GCS; every second was prescribed IT to compensate for carbohydrate metabolism; which indicates the direct influence of SARS-CoV2 on the development of hyperglycemia in the acute period of coronavirus infection; regardless from the use of GCS.

Background. Thromboembolic complications are the one the factors that plays a significant role in the increase in mortality and disability of the population. The main role in their treatment and prevention belongs to anticoagulants; incl. oral anticoagulants (OACs); which include rivaroxaban; apixaban and dabigatran. OACs have gained particular importance in the context of the novel coronavirus infection (COVID-19) pandemic.

Objective. Evaluation of the consumption of OACs in hospitals in the Russian Federation for the period from 2017 to 2022 and the characteristics of their consumption during the COVID-19 pandemic.

Methods. The database of OOO Cursor Marketing LLC was used as a data source. Data on contracts concluded between 01/01/2017 and 12/31/2022 were analyzed. Data published by WHO from March 1; 2020 to December 31; 2022 were used as a source of data on morbidity and mortality from COVID-19. Consumption was calculated based on DDD (Defined Daily Dose) data presented on the WHO Collaborating Center website.

Results. Total for the period 2017–2022. 57;866 records were entered into the Cursor databases; of which 47.38% of records contained an indication that the purchased drug was rivaroxaban; 26.51% – dabigatran and 26.11% – apixaban. There was a drop in the number of contracts in 2022; from 2017 to 2021; their number grew; with the increase being more pronounced for apixaban and the least significant for dabigatran. Similar dynamics were observed for the volume of contracts; expressed in the number of packages and DDD; 97% of all contracts were concluded for a period of one year. For all analyzed time series; the presence of seasonality was found. The number of packages purchased and the DDD of rivaroxaban (P<0.05) and apixaban (P<0.001) purchased were correlated with rates of new illness and death from COVID-19.

Conclusion. The problem of studying the dynamics of OAC consumption is of significant practical interest. The number of requests for the purchase of OACs in Russian hospitals is increasing; and the COVID-19 pandemic has had a significant impact on the procurement structure.

Treatment of type 2 diabetes mellitus (DM2) is an important task of modern medicine against the background of the inexorable spread of the disease. Recently; the possibilities of glucose-lowering pharmacotherapy have significantly expanded due to a deepening of understanding of the pathophysiological mechanisms of the disease. The importance of the incretin system in the regulation of carbohydrate metabolism; a target for incretin-directed therapy; is discussed. The class of dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors; gliptins) refers to drugs with incretin activity. The mechanisms of action of DPP-4 inhibitors are revealed; and the advantages of drugs in this group are emphasized. Several DPP-4 inhibitors are registered in the Russian Federation: alogliptin; vildagliptin; gemigliptin; gosogliptin; linagliptin; saxagliptin; sitagliptin; evogliptin. The article is devoted to the selection of the optimal drug from the DPP-4 group. The appearance on the market of a new Russian drug from this group of DPP-4 inhibitors; evogliptin; will make it possible to provide DM2 patients with modern; effective; affordable and high-quality treatment. The results of clinical studies of the effectiveness and safety of evogliptin are presented.

Limited contraindications for use; lack of stimulation of insulin secretion; weight gain and an extremely low risk of hypoglycemic episodes determine the relevance of the use of metformin as a first-line drug in the treatment of type 2 diabetes mellitus (DM2). The potential of metformin is not limited to its use in DM2. Numerous studies determining the pleiotropic effects of metformin have expanded the range of use of this drug. The article presents various metabolic properties of metformin; which have a beneficial effect on the pathogenesis of various pathological conditions; a new coronavirus infection.

The article discusses a clinical case of intensification of glucose-lowering therapy with insulin degludec in a patient with type 2 diabetes mellitus (DM2); who did not achieve glycemic control goals despite the use of a combination of three glucose-lowering drugs: metformin; empagliflozin and semaglutide. Fasting and postprandial glycemia was more than 10 mmol/l; the glycated hemoglobin level was 10.4%. In addition; the time above the target range was 85%; and no hypoglycemic conditions were recorded. After intensifying hypoglycemic therapy with insulin degludec; a significant improvement in glycemic control was noted: fasting glucose was 5.4–6.2 mmol/l; postprandial – up to 10 mmol/l; the time in the target range; according to flash data. monitoring was 99%; no hypoglycemic conditions were noted.

Metabolic processes in the liver are closely related to the work of the thyroid gland. In this regard; it is necessary to exclude the pathology of the thyroid gland with an increase in the transaminase level for an unknown reason. It is known that diffuse toxic goiter is the leading cause of thyrotoxicosis. In patients with newly diagnosed hyperthyroidism; biochemical abnormalities in the blood test; indicating liver dysfunction; are recorded quite often; while clinical manifestations; as a rule; may not be expressed. The article discusses the issues of diagnosing hepatopathy in patients with thyrotoxicosis; the need to differentiate true thyrotoxic damage from concomitant liver diseases of a viral and autoimmune nature; drug-induced liver damage. The authors present a clinical case of acute toxic hepatitis caused by thiamazole in a patient with diffuse toxic goiter.