Nº 11 (2018)

Type 2 diabetes is a serious disease associated with the development of severe complications. The current treatment, including the use of drugs based on the “incretin effects", and the mechanism of action of dipeptidyl peptidase-4 inhibitors are discussed. The results of clinical studies of the efficacy and safety of alogliptin are presented.

Adipose tissue is a source of secretion of various biologically active substances - adipokines, which affect all types of metabolism. This article focuses on apelin, one of the understudied adipokines. The biological and pathophysiological effects of this peptide, its effect on carbohydrate metabolism, pathology of the cardiovascular system and atherosclerosis are discussed. In addition, data on the prospects for the use of apelin for therapeutic purposes in cardiovascular pathology are presented.

The article provides information about the role of vitamin D, the main causes of deficient states and the metabolic features of the native and active forms of vitamin D, including in persons over age of 45 years. It is emphasized that despite the similar safety profile, alfacalcidol due to the lack of renal metabolism demonstrates greater clinical efficacy compared with native vitamin D in the treatment of primary and secondary osteoporosis (OP), deficient conditions, prevention of falls and fractures. Monotherapy with alfacalcidol is included in the clinical guidelines for the treatment of OP, unlike the native vitamin D, because it demonstrated a more pronounced effect on increasing bone mineral density, reducing the risk of falls, reducing the risk of fractures and a significant reduction in pain. The wide possibilities of selecting individual doses of Alpha D3®-Teva (alfacalcidol) can minimize the risk of side effects, which contributes to improving the quality of life of patients of all ages, along with the prevention of new fractures, the elimination of pain syndrome and the improvement of physical activity.

Background. Insulin therapy (IT) occupies an important place in the treatment of patients with type 2 diabetes mellitus (DM2). According to the Federal Diabetes Register (FDR) in Moscow on 05/01/2018, 66.2 thousand DM2 patients received glucose-lowering therapy using insulin preparations (21% of the total number of DM2 patients). According to the Russian part of the CREDIT study, in 2009, for initiation of insulin therapy in DM2 patients, basal insulin (BasalIns; 66.2%) was most often used; less often - basal-bolus IT (17.9%) and mixed insulin (MixIns; 4%) and very rarely (1.1%) - only bolus insulin (BolusIns). IT initiation was carried out at an average level of HbA1c of 9.7±1.8% [2]. Objective. To determine the most commonly used schemes for initiating IT in DM2 patients. Methods. Based on the FDR in Moscow, the analysis of the database of DM2 patients who were assigned to receive IT for the first time in 2017 was carried out. The structure of initial IT in these patients has been determined. Results. Analysis of FDR in Moscow has identified 7020 DM2 patients with initiation of IT in 2017. There were 2,780 men (39.6%) and 4,240 women (60.4%). The average age of patients was 63.9±11.8, the average disease duration was 8.5±6.8 years. BMI was 31.2±6.5 kg/m2, the average НЬА1с level was 8.4±1.8%. Most often IT initiation was carried out using BasalIns (51.6%) or basal-bolus IT (34.4%). The combination of 2 (46.3%) and 3 glucoselowering drugs (38.8%) was most often used. In 78.9% of cases, IT initiation was performed using insulin analogues. In patients with newly diagnosed DM2, basal-bolus IT (48.0%) and BasalIns (40.4%) for IT initiation are mainly used, with the combination of 2 (60.0%) and 3 (21.9 %) sugar-lowering drugs. Conclusion. There is a change in the structure of the newly prescribed IT in DM2 patients com pared with the results of the CREDIT study (2009). Thus, according to the FDR in 2017, IT initiation in DM2 patients was carried out 2 times more often using the basal-bolus scheme (34.4 /s. 17.9%), and less frequently using BasalIns (51.6 /s. 66.2%), MixIns (12.3 /s. 14.4%).

Background. Type 1 diabetes mellitus (DM1) to date remains one of the most difficult endocrine diseases, not always amenable to quality management. A large amount of information about the disease necessary for patient, the need for high-quality insulin preparations, the necessity of frequent self-control, the need for psychological support create difficulties in achieving compensation for the disease. The Federal Diabetes Register (FDR) provides an opportunity to assess the quality of treatment for diabetic patients, the level of glycemic control, the presence and severity of complications. Objective. To evaluate the clinical and metabolic parameters in the dispensary group of DM 1 patients in Moscow in 2018: the level of glycated hemoglobin (HbA1c), the incidence of complications and concomitant diseases, the variants of insulin therapy used. Tasks. To form a sample of DM1 patients from the Moscow segment of the FDR, to perform among them a statistical analysis of the main demographic indicators, the level of disease control, the frequency of complications and comorbidities, and the options for the therapy used. Methods. The analysis of the data of DM1 patients included in the FDR was carried out: the number of patients, sex composition, age, HbA1c level, the presence of complications, approaches to insulin therapy. Conclusion. As of September 1, 2018, 17,839 adult DM1 patients were registered at the FDR in Moscow; there were 9704 (54.4%) men and 8135 (45.6%) women. The average age of patients was 42.1±14.4, the average duration of the disease was 16,0±11.7 years. Presence of complications was noted in 9824 (55.1%) patients. The most common complications included diabetic neuropathy (DNeuP), retinopathy (DRP) and nephropathy (DNephP). More than 50% of DM1 patients with DRP had a non-proliferative stage of complication. The proliferative stage was recorded in 10% of patients with DRP. Of the total number of patients with DNephP, 2.9% of patients had stage 2, 6.9% of patients - stage 5. A direct correlation between the number of detected complications and the duration of the disease (r=0.49; p<0.01) and the age of the patients (r=0.35; p<0.01) was found. More than 40% of DM1 patients had a disability, in half of the cases - severe disability; 4.2% of DM1 patients (743 people) used an insulin pump in therapy.

Objective: to compare the clinical features of axonal and axonal-demyelinating distal symmetric diabetic polyneuropathy (DPN). Methods. Observational cohort study. The pathogenetic variant of DPN was diagnosed using electroneuromyography; based on its results, all patients were divided into 2 groups of 26 people each - with axonal and axonal-demyelinating polyneuropathy. The somatic and neurological status of the patients was examined; the severity of DPN was assessed on the basis of neurological symptom score (NSS, for subjective symptoms) and neuropathy disability score (NDS, for objective symptoms). Results. A total of 52 patients with DPN were examined. The group of patients with axonal-demyelinating variant of polyneuropathy demonstrated statistically significant differences with the group of axonal DPN: a high incidence of decompensation of diabetes mellitus (61.5 and 15.4% of patients, respectively, p<0.04), a higher NSS score (5,5±2.4 and 3.6±2.3, respectively, p<0.04) and NDS score (17.7±8.4 and 8.5±7.0, respectively, p<0.005), a greater frequency of additional symptoms of polyneuropathy (paresis, ataxia, muscular atrophy, 69.2 and 23.1% of patients, respectively, p<0.04). Conclusion. The axonal-demyelinating variant of DPN is associated with a more severe course of diabetes mellitus and a greater severity of polyneuropathy.

The article is devoted to such a severe complication of diabetes mellitus, such as diabetic foot, which occurs among 15% of diabetic patients and represents a serious problem, since it leads to a deterioration in the quality of life of patients and their disability. The article discusses the etiology, pathogenesis and clinical picture of diabetic foot, and also provides an overview of the principles of treatment of this pathology. Particular attention is paid to the topical treatment and modern dressing materials.