Volume 11, Nº 3 (2025)

Diabetes mellitus (DM) is one of the most common socially significant chronic infectious diseases. Treatment of hyperglycemia in hospitalized patients with previously known or newly diagnosed DM or with stress hyperglycemia is a complex and challenging task. Experts from the European Federation of Internal Medicine (EFIM) analyzed and critically assessed existing clinical guidelines concerning issues related to hyperglycemia in hospitalized patients of different age, on the basis of which recommendations for the management of this category of patients were developed. There were suggested 75 recommendations, focused on 5 common clinical scenarios: target glycemic values, management of patients with comorbidities and elderly patients with low level of consciousness or dementia receiving irregular meals or parenteral/enteral nutrition, special cases of hyperglycemia (stress hyperglycemia, treatment with corticosteroids, fasting) and hypoglycemic therapy upon discharge from the hospital. This article is devoted to the discussion of the key provisions of the critical review of EFIM guidelines.

Due to the high socio-economic significance of obesity (OB), it is necessary to improve the provision of medical care to that category of patients, which requires representative data on the real clinical practice concerning management and characteristics of patients with OB in Russia.

The aim: to assess the costs of the healthcare system for the management of patients with OB based on a retrospective analysis of primary medical documentation.

Material and methods. An analysis of outpatient records of 1000 patients over 18 years of age, observed for 1 year by a general practitioner or endocrinologist in outpatient medical and preventive institutions in 8 regions of Russia, was performed. Diagnosis of OB was made for them at least a year before inclusion in the study.

Results. Final analysis included 801 patients (55.2% male, 44.8% female individuals), average age of them was 55 [45; 62] years. Most of them had stage 1 OB at the beginning of the study. In 94.4% of them the degree of the disease did not change or increased over 1 year of observation. Arterial hypertension (82.3%) and type 2 diabetes mellitus (33%) prevailed in the structure of comorbid pathology. The frequency of clinical, laboratory and instrumental examination methods, as well as the frequency of dispensary observation, did not comply with clinical recommendations. During observation period, 32% of patients were hospitalized, most often due to cardiovascular diseases (43.5%) and diabetes mellitus (28.5%). About 21% of examined individuals received drug therapy (DT) for OB during the year of observation, but the frequency of drug prescriptions did not comply with the standard. The average cost of managing 1 patient with OB in 2022 was 70,450.53 rubles per year. The share of DT in the cost structure from the state’s perspective was only 9.46%, and the maximum costs were for outpatient care (24%), hospitalizations (26%) and disability payments (18.5%). When recalculating the cost of drug therapy for patients with OB in 2024, taking into account the use of semaglutide, a significant decrease in this index is shown –15,507.93 rubles per year per patient versus 21,748.71 rubles per year in 2022.

Conclusion. The real practice of managing patients with OB in the Russian Federation differs significantly from clinical recommendations. As a result, 1-year therapy for OB does not lead to a significant decrease in body weight. Low coverage of patients with subsidized drug provision may be one of the reasons for non-compliance with recommendations for DT in outpatient settings.

Obesity is an important medical problem that significantly worsens the prognosis for life and health of the population. However, among obese individuals, there is a group that does not have metabolic complications and is characterized by moderate cardiometabolic risks. This phenotype is called “metabolically healthy obesity” (MHO). Studies of individual obesity phenotypes, MHO in particular, seems to be important in terms of optimizing approaches to the prevention and treatment such kind of patients.

The aim: to study MHO peculiarities among the population aged 45–69 in the Ryazan region.

Material and methods. Analysis included the data from 255 individuals aged 45 to 69 years with no chronic non-communicable diseases. It consisted of 78% female and 22% male patients. NCEP ATP III criteria were used to determine the metabolic health condition. MHO was assessed as a combination of body mass index ≥ 30 kg/m² and less than three criterion indexes.

Results. The prevalence of MHO according to NCEP ATP III criteria among the selected group was 101 individuals (39.6%). From them, 30 were male (53.5% among obese males) and 71 female (35.7% among obese females) individuals. MHO was fixed 1.5 times more often among male persons, p < 0.05. Among MHO individuals, two components of metabolic health disorder were found more common (84.2%) than one (15.8%). No differences were found in the frequency of occurrence of metabolic health disorder components between male and female groups (p> 0.05), as well as in the prevalence of various degrees of obesity (p > 0.05). Differences in the age groups of male and female patients are statistically insignificant (p > 0.05).

Conclusion. The data we obtained indicate a fairly high prevalence of MHO in the population, which promotes interest for a more detailed study of this group of individuals. Detailing MHO phenotype can be useful for risk stratification and personalization of approaches to prophylaxis among obesity patients with.

Infection caused by SARS-CoV-2, seriously affects the cardiovascular system, which is manifested by changes in electrocardiogram (ECG).

The aim: to study the ECG of patients survived from COVID-19.

Material and methods. 352 patients with COVID-19 underwent ECG upon admission, during treatment in hospital and before discharge. Heart rate (HR), cardiac electrical axis position, cardiac rhythm, extrasystoles, bundle branch block, ST segment and T wave (ST) abnormalities, ischemic events, and presence of acute myocardial infarction were estimated.

Results. Patients with COVID-19 were mostly admitted to the hospital with a normal heart rate. Sinus tachycardia was more often detected in females upon discharge and in male patients upon admission; sinus bradycardia was more often detected upon discharge than upon admission. This tendency was typical for both female and male individuals. Supraventricular and ventricular extrasystoles were rare. Atrial fibrillation and atrial flutter were twice as common in male, and first-degree atrioventricular blocks were found in female patients. No patients had incomplete left bundle branch block (LBBBi). Complete left bundle branch block (LBBBc) upon admission and discharge was registered in 3 male individuals. LBBBc, LBBBi and left anterior superior fascicle block were observed equally often both at admission and at discharge. Ischemic myocardial abnormalities were rare. cST and T anomalies were equally often verified both at admission and at discharge, they were almost 3 times more in females. Acute myocardial infarction was not diagnosed in any patient either at admission or at discharge.

Conclusion. Changes in ECG pattern of patients survived from COVID-19 are slightly different from those in individuals without this pathology.

Type 2 diabetes mellitus (T2DM) and chronic heart failure (CHF) are multidisciplinary diseases associated with an extremely unfavorable prognosis and high mortality. In presence of T2DM, the course of CHF is characterized by greater severity, early disability and an increased frequency of hospitalizations, which often leads to premature mortality. Large clinical studies dealing with cardiovascular outcomes (CVOT) assessing have demonstrated significant organ-protective properties of sodium-glucose cotransporter type 2 inhibitors in patients with T2DM. For the first time these studies revealed the possibility of reducing overall and cardiovascular mortality, as well as hospitalization due to CHF in patients with and without T2DM. Expansion of indications for the use of sodium-glucose cotransporter type 2 inhibitors marked a significant breakthrough in the treatment of heart failure, which, in its turn led to the formation of a new therapeutic paradigm covering all patients with CHF, regardless of the etiology, stage of the disease and the value of the left ventricular ejection fraction. This resulted in the achievement of a clinically significant improvement in the prognosis and an increase in life quality of patients. Now it is officially reflected in the updated clinical guidelines of the world’s leading cardiological societies, including the European Society of Cardiology, American Heart Association and Russian Society of Cardiology.

The first opinion of the possibility of primary prevention of myocardial infarction by salicin derivative – acetylsalicylic acid (ASA), was published back in 1950. Current specialized review provides updated information on the role of ASA in primary and secondary prevention of cardiovascular diseases, as well as some information on the direction in which such kind of prevention could be developed.

The aim of the review: to highlight the role of ASA in the modern real clinical practice of a therapist.

Material and methods. An adaptive version of the literature search is proposed, when it is carried out for each section of the review separately. The following keyword groups were searched in PubMed (MEDLINE), Scopus, eLibrary, and CyberLeninka databases: *acetylsalicylic acid, *aspirin, *mechanism of action, *pharmacokinetics, *pharmacodynamics, *placebo-controlled studies, *efficacy, *safety, *combined forms, *magnesium hydroxide. In Russian-language databases, the query was compiled using the same algorithm and similar terms in Russian. Literature review included 61 sources.

Conclusion. Taking into account the large volume of evidence of efficacy and safety, low-dose ASA should continue to be used as an antithrombotic agent for the prevention of cardiovascular mortality. In modern clinical practice, it is unlikely to be displaced by currently available P2Y₁₂ inhibitors due to the inconclusive demonstration of their superiority over low-dosed ASA.

Progress in the treatment of vascular complications of diabetes mellitus (DM) has not solved the problem of timely diagnosis of diabetic retinopathy (DR), which is detected in most cases at an advanced stage of DM. DR is a common microvascular complication of DM and the leading cause of preventable blindness in people of working age. The presented clinical case demonstrates a patient with complete loss of vision in the first 6 years from the onset of type 2 DM. Despite multiple attempts of anti-VEGF therapy, proliferative retinopathy in this case was complicated by corneal dystrophy, rubeosis of iridis, terminal glaucoma, and development of blindness in both eyes. Due to the risk of rapid progression of DR, annual examination by ophthalmologist is critical to preserve patients’ vision and improve their quality of life. The article considers potential risk factors for severe DR, and discusses methods for early diagnosis and prevention of this complication.

Various forms of polyneuropathies are frequent extraglandular manifestations of Sjogren’s syndrome and disease. Article describes a clinical case of Sjogren’s disease, in which polyneuropathy became the first clinical symptom of the disease, three years before the main diagnosis was made. In patients with polyneuropathy, complaints and anamnesis should be carefully assessed and the necessary diagnostics should be carried out in order to exclude Sjogren’s syndrome and disease.

Peculiarity of modern hypoglycemic therapy is the effect on multiple pathogenetic targets and presence of a wide range of glycemic and non-glycemic effects, opening up new opportunities in achieving long-term results in type 2 diabetes mellitus (T2DM) treatment. An innovative group of drugs in T2DM treatment are glucagon-like peptide-1 receptor agonists, some of which are registered for the treatment of obesity. Thus, the effect of semaglutide combines high efficacy in terms of metabolic control and weight loss with serious cardio- and nephroprotective effects, as well as an effect on increasing life expectancy in patients with T2DM and obesity. The study of the pleiotropic properties of glucagon-like peptide-1 receptor agonists is actively ongoing, and new data allow us to specify focus groups and principles of a personalized approach to prescribing drugs in this group.

The risk of cognitive impairments (CI) in patients suffering from cerebrovascular diseases (CVD) significantly increases in the presence of comorbid pathologies. The influence of carbohydrate metabolism disorders at the formation of CI has been studied the best, but obesity and thyroid dysfunction have recently been considered to be coequally important risk factors. The article describes the pathophysiological mechanisms leading to decrease of cognitive functions in patients with such common pathological conditions as obesity, diabetes mellitus and dysthyroidism. Understanding the stages of CI development in patients with CVD in the presence of metabolic disorders is the basis for the development of personalized strategies for their correction. An analysis of scientific publications devoted to neuroprotection is presented. A description of our own clinical experience in the treatment of cognitive dysfunction in CVD comorbid patients is given.