№ 3 (2011)

Modern pharmacotherapy of type 2 diabetes mellitus (DM2) should be directed not only to achievement and maintenance a target level of glycemia, but also to adequate control of blood pressure and correction of hyperlipidemia for the purpose of reduction of risk of development and progression of DM2-assosiated complications and mortality (including cardiovascular mortality). Incretin hormones, especially glucagon-like peptide-1 (GLP-1), play an important role in the homeostasis of glucose metabolism. In humans, GLP-1 causes glucose-related stimulation of insulin secretion by β-cells in the pancreas, as well as the suppression of glucagon production, thereby provides maintenance of normoglycemia. In addition, GLP-1 stimulates insulin biosynthesis, improves peripheral insulin sensitivity, promotes the active absorption of glucose by the liver, muscle and adipose tissue, delays gastric emptying, reduces food intake, which leads to a decrease in body weight, and provides cardio-vascular and neurotrophic action. The article presents the results of randomized clinical trials aimed to evaluation of efficacy of liraglutide (Victoza) - the first long-acting analogue of human GLP-1, whose appearance opens new prospects in the treatment of DM2. Currently, Victoza is the strongest non-insulin hypoglycemic agent.

The article is dedicated to the significance of ACE inhibitors in the treatment and prevention of diabetic nephropathy. Administration of ACE inhibitors in diabetes mellitus (DM) is closely reasoned by pathophysiology. Positive effect of this class of drugs on the prognosis of type 2 diabetes combined with arterial hypertension was confirmed by controlled trials, including high-risk patients. Evidences of effect of ACE inhibitors on microalbuminuria have been obtained in clinical studies, which used lisinopril. Considerable experience of use of lisinopril in patients with DNP allow to consider the drug as a priority ACE inhibitor used for treatment and prevention of kidney damage in diabetes mellitus, especially type 2 diabetes mellitus. Well-tested medications of lisinopril, which are characterized by favorable cost/effectiveness ratio, include, in particular, Lizigamma manufactured by pharmaceutical company Wörwag Pharma (Germany).

The article discusses the problems associated with type 2 diabetes mellitus (DM2). Data for medical and social consequences of DM, etiology and factors contributing to the development of this disease are presented. Treatment algorithm of DM2, adopted by the EASD and ADA in 2008 is considered. This algorithm provides effect on the basic components of pathogenesis of DM2, such as insulin resistance and dysfunction of β-cells of the pancreas and contributes to effective glycemic control.

Mechanisms of action and potentials for use of dipeptidyl peptidase-4 (DPP-4) inhibitor vildagliptin (Galvus) and its combined form with metformin (Galvus Met) in type 2 diabetes mellitus (DM2) are discussed. The article presents the results of numerous clinical trials that have proved efficacy of DPP-4 inhibitors, primarily Galvus and Galvus Met, in improvement of glycemic control without increasing body weight and frequency of hypoglycaemia. They can be used in combination with all oral hypoglycemic agents and insulin (vildagliptin) that expands the range of use due to different groups of patients with DM2.

The article is dedicated to the current concepts of epidemiology, etiology, diagnosis and treatment of central diabetes insipidus (CDI). The experience of Endocrinological Dispensary of Department of Health in the treatment of CDI with drug desmopressin is presented. Against the background of administration of intranasal form of the drug (Presinex), good clinical effect, providing long-term compensation of disease, was observed.

The article presents the results of examination of effectiveness of intravenous and subcutaneous insulin therapy in 76 patients with type 2 diabetes mellitus (DM2) in acute cerebrovascular accident. The data indicate the need for intensive intravenous insulin therapy in patients with diabetes mellitus and ischemic stroke on admission to the intensive care unit in order to rapid normalization of glicemia and maintenance of blood glucose level within the required range, that allow reducing the degree of neurological deficit and disorders of consciousness, and stabilizing the somatic status of patients.