Nº 5 (2016)

To date, accumulated data suggest that the use of glycemic parameters in conjunction with the glycated hemoglobin levels and other traditional risk factors can improve the accuracy of prediction of the development of vascular complications and hypoglycemia in diabetes mellitus (DM). Assessment of glycemic variability is the most promising approach to the evaluation of the effectiveness of diabetes control, and its reduction can be considered as one of the important therapeutic targets in the treatment of DM [34]. As a consequence, more and more attention is paid to the evaluation of impact of various glucose-lowering drugs on the parameters of glycemic variability, in particular dipeptidyl peptidase-4 inhibitors, which have glucose-dependent effect on the function of pancreatic β- and alpha-cells.

Osteoporosis - is a chronic disease of the skeleton, leading to bone fragility and fracture and requiring long-term treatment. The article deals with the modern principles of pathogenetic therapy of osteoporosis, summarizes data on the effectiveness of the main groups of drugs.

The article discusses the features of the course of diabetes mellitus (DM) in elderly patients, hypoglycemic therapy in which has its own characteristics. The use of antidiabetic drugs with a minimum dose frequency during the day and a low risk of side effects - nephrotoxicity, hepatotoxicity and hypoglycemia - is an important principle of treatment of such patients. Prospects of use of dipeptidyl peptidase-4 inhibitor saxagliptin in elderly patients with type 2 diabetes are considered. Currently, there are 6 international, placebo-controlled studies of efficacy and safety of this drug in DM2 patients over age 65 years. Their results suggest that the therapy with saxagliptin and combination of saxagliptin+metformin in elderly DM2 patients is is sufficiently safe and effective in relation to the risk of hypoglycaemia and cardiovascular events.

Effective pharmacotherapy for type 2 diabetes mellitus is one of the main problems of diabetology. Empagliflozin - an sodium-glucose cotransporter type 2 (SGLT2) inhibitor preventing the reabsorption of glucose in the proximal renal tubules and not allowing glucose already filtered by the kidneys to fall back into the blood stream and accelerating its excretion in the urine at different stages of disease therapy; its application makes the achievement of long-term glicemic control and reduction of cardiovascular risk as a very real purpose, and is crucial for improving the prognosis of type 2 diabetes mellitus.

Recently, glucagon-like peptide-1 agonists (GPP-1-a) are actively applied in the treatment of type 2 diabetes mellitus (DM2). To assess the effectiveness of exenatide treatment, multicentric international studies were conducted that have proven highly effective addition of the drug to metformin, sulfonylureas, and combinations thereof. A clinical experience of exenatide for the intensification of DM2 treatment, which showed that exenatide can be recommended for DM2 patients with overweight, glycated hemoglobin levels >7%, in case of ineffectiveness of the previous combination therapy.

The article presents the results of a comparative clinical study conducted for a year among two groups of patients (48 and 47 women, respectively) aged over 50 years with extra-articular fractures of the proximal femur against the background of severe involutive osteoporosis (OP); patients received surgical treatment (osteosynthesis using PFN fixators) or combined surgical and antiosteoporotic treatment with two different drug regimens. It was established that the severe OP with X-ray densitometry T-test values below the threshold level (less than -3,3 SD) can be considered as a risk factor for osteosynthesis complications associated with the implant, and risk is increased by 23.6 times. In such patients, drug therapy of involutive OP using only calcium and vitamin D3 is useful, but does not prevent a significant reduction in bone mineral density after 6 months after the surgery. Antiosteoporotic therapy with the addition of strontium ranelate in calcium and vitamin D allows almost stabilize the rate of bone mineral density by the deadline at the level marked in the period of implementation of the osteosynthesis operation. Complex treatment of patients with extra-articular fractures of the proximal femur on the background of involutive OP with osteosynthesis using PFN fixators and 6-month therapy with calcium, vitamin D3 and strontium ranelate using tested scheme provides better functional outcomes one year after surgery compared with similar groups of patients, receiving only calcium and vitamin D3, and not receiving specific antiosteoporotic therapy.

The economic component of insulin pump therapy (IPT) is a major factor for the lack of use of insulin pumps in Russia. Since the introduction of insulin pumps into practice in different countries, clinical and economic analysis of their use was carried out. Targeted search in the available sources, including MedLine/PubMed, has revealed 9 foreign pharmacoeconomic studies, 2 domestic pharmacoeconomic studies, and 4 foreign research reviews. Analysis of the sources detected by their content allowed to determine the general trend of research and their special aspects. Most economic studies of IPT came to the conclusion about economic justification of IPT, despite the higher cost of the insulin pump and its accessories. The use of continuous subcutaneous insulin infusion in certain subgroups of patients with type 1 diabetes mellitus is the most cost-effective.