Nº 3 (2012)

The article considers the mechanisms of action and potentials for use of dipeptidyl peptidase-4 inhibitor sitagliptin in different variants of diabetes mellitus (DM). It is emphasized that sitagliptin is the most studied drug of gliptin class, allowing control of glycemia at low risk of hypoglycemia, with neutral effect on body weight and good tolerability. Its use is pathogenetically substantiated not only in the early stages of DM2, but also in long-term experience of the disease, including those against the background of insulin therapy. Pleiotropic effects unrelated to effects on glycemia, and tolerability of sitagliptin (potential cardioprotective effects, immunomodulatory effects) offer the prospects for its use in special groups of patients - with cardiovascular diseases, DM1 and post-transplantation diabetes.

Currently, the prevalence of type 2 diabetes mellitus (DM2) progressively increases. Along with the progression of diabetes mellitus, need for insulin inevitably arises in connection with the deterioration of β-cell function. Insulin therapy allows to maintain more stringent target levels of blood glucose, but is associated with some side effects, the most serious of which are hypoglycemia and body weight gain. They significantly reduce the quality of life of patients and limit their daily activities. In addition, it was shown that hypoglycemia is independent predictor of high risk of cardiovascular mortality and morbidity. The most difficult problem in the treatment of DM2 patients receiving insulin is the risk of severe hypoglycemia. Therapy based on incretinomimetics, which include dipeptidyl peptidase-4 inhibitors (vildagliptin, etc.), can be considered as pathogenetically substantiated choice for these patients. Drugs of this group are characterized by favorable tolerability and high efficacy, their use is associated with lower risk of hypoglycemia. The results of studies on evaluating the efficacy and safety of vildagliptin added to insulin therapy in DM2 patients are presented.

The article considers the modern views on the pharmacotherapy of type 2 diabetes mellitus (DM2). The mechanisms of action of metformin and sulfonylureas from the standpoint of the pathogenesis of the disease are discussed. Particular attention is paid to the combined therapy of DM2. The results of comparative studies of efficacy and safety of fixed combinations of metformin with different sulfonylureas are presented. By the example of drug Amaryl-M, high efficacy of fixed combination (glimepiride + metformin) is shown, which is achieved due to the effect on two major pathogenetic defects in DM2. The potentials for use of this drug in patients of various categories are discussed.

The article considers the variants of the start of insulin therapy in patients with type 2 diabetes mellitus (DM2), which failed to reach target glycemic control against the background of uses of oral hypoglycemic drugs and lifestyle modifications. The features of different types of basal insulins are discussed. The advantages of use of long-acting insulin analogue glargine for the initiation of insulin therapy in DM2 patients are described. Simple algorithm for titration of doses, convenient mode of administration (once a day), and reduction of the risk of hypoglycaemia, improvement of glycemic control, improvement of health and quality of life allow to recommended insulin glargine for the start of insulin therapy in these patients.

The article discusses the current data on the characteristics and gender differences of pain syndromes (PS) of different origin. The potentials for use of calcitonin in analgesic therapy of osteoporosis are considered. 127 case records of patients with verified osteoporosis were analyzed for the purpose of definition of features of disease in men and women, presence of PS and options for its treatment. The results of use of domestic drug calcitonin (Veprena) in the group of 23 men and women with osteoporosis are presented. It is shown that the Veprena (calcitonin) is a safe and effective drug for the treatment of PS in men and women with osteoporosis. The analgesic effect of the drug Veprena develops after the first intranasal administration, stable therapeutic effect is achieved within 3 months.

The article is dedicated to the role of taurine in the human body, the possibility of therapeutic use of Dibicor ®, a taurine-based drug, including diabetic patients. The results of use of Dibicor ® in the complex therapy of patients with type 2 diabetes mellitus (DM2) and metabolic syndrome (MS) are presented. Study involving 40 patients has shown that inclusion of Dibicor ® at a dose of 0.5 g 2 times daily in the treatment regimen has contributed to the decline in body mass index, lower waist and hips circumferences and improvement of carbohydrate and lipid metabolism (significant reduction in glycated hemoglobin, fasting glucose, total cholesterol, triglyceride and low density lipoprotein cholesterol levels) in patients with DM2 and MS.

According to the register of patients with acromegaly in Moscow region and other international epidemiological studies, acromegaly predominates among women aged 50 years and over. The article presents the results of evaluation of 34 postmenopausal women with acromegaly. All women of represented group experienced various gynecological diseases. The prevalence of hysteromyoma was 77.8%; high incidence of urogenital disorders (51.8%) was observed. The severity of the climacteric syndrome was assessed using the Green Scale; it was found that menopausal symptoms are similar to the clinical manifestations of acromegaly (eg, headache, fatigue, muscle and joint pain, tachycardia, night sweats, rough breathing). For this reason, Green Scale for the assessment of severity of climacteric syndrome, probably, is not suitable for women with acromegaly.