No 16 (2010)

The article is dedicated to the modern potentials for use of dipeptidyl peptidase-4 (DPP-4) inhibitors, which recently were introduced in clinical practice. The main mechanism of action of these drugs is based on the increase of activity of incretin hormones by blocking the DPP-4 enzyme. Currently, the DPP-4 inhibitors are considered along with metformin as first-line agents for the treatment of type 2 diabetes mellitus (glycated hemoglobin level 6.5-7.5%) and as drugs for combination therapy in all phases of the continuation of therapy. To date, two drugs in this group are registered in the Russian Federation: Vildagliptin (Galvus, and its combination with metformin Galvus Met) and Sitagliptin (Januvia). Combined medication vildagliptin with metformin (Galvus Met) is available in different doses (50/500, 50/850 and 50/1000 mg), that helps to select the optimal daily dose and increase the patient's compliance. One of the advantages of these drugs is the possibility of their use in groups of elderly patients, patients with cardiovascular risk, arterial hypertension, and moderate renal dysfunction.

Diabetes mellitus (DM) remains one of the most serious chronic diseases that lead to disabling complications. Pilot clinical studies have actively studied thiaminpyrophosphate (thiamine and benfotiamine) for the prevention of complications of diabetes. The results of 4 randomized, blind clinical studies have confirmed the efficacy of benfotiamine in the treatment of diabetic polyneuropathy. A number of experimental studies have shown prospects of benfotiamine for the treatment of diabetic nephropathy, retinopathy, and cardiomyopathy in DM. Thus, the benfotiamine has multiphasic effects in the treatment of DM, and opens new possibilities for pathogenetic treatment of vascular complications.

The article is dedicated to the modern methods of insulin administration; main advantages of continuous subcutaneous insulin pump infusion over regimen of multiple injections of insulin are discussed. The results of clinical studies demonstrating the effectiveness and advantages of insulin pump therapy, namely the elimination of dawn phenomenon, decrease in diurnal variability of glycemia, reduction of level of glycated hemoglobin, decrease in insulin requirements, lower incidence of hypoglycemia and ketoacidosis, are presented. Main correctable and non-correctable factors supporting chronic decompensation of diabetes are described. It is emphasized that lack of participation of the patient, as well as lack of his awareness about the disease and the performance of device leads to poor compensation of diabetes.

Type 2 diabetes mellitus (DM2) is disease caused by insulin resistance and relative insulin deficiency. The article is dedicated to the modern principles of treatment of DM2 and hypoglycemic agents. One of the frequently used hypoglycemic agents is metformin, which can be combined with sulfonylureas in the case of ineffectiveness of treatment of DM2. The potentials for the use of Glucovance, combined tableted drug consisting of metformin and glibenclamide are discussed. Micronised form of glibenclamide in the Glucovance ensures the safety of the drug with high efficiency. This drug has less effect on β-cells, does not increase the fasting plasma insulin concentration, and reduces the risk of hypoglycemia. Affordability of Glucovance is important.

The article presents the results of study aimed to evaluation of relationship between leptin, insulin, testosterone, and sex hormone binding globulin (SHBG) levels, Caro's index, lipid profile, and anthropometric parameters in 65 patients with pubertal adolescent's dispituitarism. The trend toward lower leptin level against the background of hyperinsulinemia, insulin resistance, and lower levels of testosterone and SHBG was noted in this category of patients.

Currently, drugs for correcting free-radical-mediated oxidative stress (OS) are widely used in the treatment of patients with diabetes mellitus (DM). One of these drugs is Dibicor containing active substance taurine. Taurine directly affects the antioxidant system of cells through the formation of N-chlorotaurine, which inhibits superoxide radicals, reduces the production of tumor necrosis factor and peroxylnitrite, and stimulates the formation of superoxide dismutase. For the purpose of evaluation its influence on the activity of other antioxidant enzymes and content of oxidatively modified proteins (OMP), the author have examined 34 patients with type 2 diabetes mellitus (DM2). Patients were divided into two groups: one group of patients (n = 20) received Dibicor at dose of 1 g/day within 2 months against the background of basic antihyperglicemic therapy, patients of the other group (n = 14) received only the basic antihyperglicemic therapy. It was shown that use of Dibicor against the background of basic antihyperglicemic therapy led to statistically significant increase in catalase activity and decrease in different fractions of OMP. The tendency to increased levels of nitric oxide metabolites in patients treated with Dibicor was noted, that can be considered as a positive attempt to correction of endothelial dysfunction in patients with type 2 diabetes mellitus against the background of reduction of OS. Given the positive trend in the correction of endothelial dysfunction in these patients, the use of Dibicor should be prolonged.

Due to the insufficient number of endocrinologists, especially in rural areas, patients with diabetes mellitus (DM) are treated by primary care physicians and general practitioners. In these regions, the level of compensation in diabetic patients is extremely low; doctors often prescribe insulin, mainly due to low awareness of modern trends in therapy of diabetes. To improve the quality of medical and preventive care for diabetic patients in rural areas, employees of FSI Endocrinological Research Center of Ministry of Public Health and Social Development RF with the support of Novo Nordisk have developed the "Medical ambitions" project, in which training program "Modern approaches to diagnosis and treatment of type 2 diabetes mellitus" was prepared and implemented. This program was aimed to raising awareness of type 2 diabetes mellitus from primary care physicians and general practitioners and the intensification of therapeutic approaches to this disease. The program included two seminars (more than 120 doctors were trained), and their effectiveness was evaluated in 3 regions (Moscow Region, Tver Region, Khabarovsk Territory) by two criteria: the structure of antihyperglycemic therapy and the level of compensation of carbohydrate metabolism in patients with type 2 diabetes mellitus (n = 620) before and 12 months after the start of the project. The number of patients receiving peroral antihyperglycemic drugs (PAD) as monotherapy has decreased from 44.7 to 34.2%, and number of patients receiving insulin therapy increased from 18.4 to 23.3%. The doses of PAD and insulin have significantly increased, and intensification of insulin therapy was observed (the proportion of patients on premixed insulin increased from 22.4 to 33.3%, on insulin analogues - from 31.9 to 51.2%). Significant decrease in the average level of glycated hemoglobin (HbA1c) from 8.5 ± 2.8 to 7.4 ± 1.9% was noted, and the proportion of patients achieving target levels of HbA1c have increased from 15.4 to 50.2%.