No 4 (2015)

The increased prevalence of diabetes mellitus (DM) type 2 exceeds all forecasts. The complex pathogenesis of the disease dictates the need for combination therapy. In 2009 a DPP-4 inhibitor with metformin in addition included in the recommendations of the American Association of Clinical Endocrinologists and the American College of Endocrinologists (AACE/ACE) as the first-line treatment of type 2 diabetes (when the level of HbA1 c 6.5-7.5%) and further at all stages of continued therapy as a drug combination therapy. As a result, the set of studies proved the efficacy and safety of saxagliptin and metformin in monotherapy and in combination. Currently, Russia applies a fixed combination of metformin and saxagliptin MB - Kombogliz Prolong. The advantage of this combination is not only a single dose of the drug per day, but with complementary mechanisms of action of saxagliptin and metformin.

The literature review examines approaches to the treatment of diabetic angiopathy. The macroangiopathies multifactorial therapy often overlooke feature of diabetic dyslipidemia - hypertriglyceridemia. The positive effect of carbohydrate control for all microangiopathy proved. On the other hand the effectiveness of the blood pressure control and statin therapy proved for nephropathy only. The review analyzes pathogenetic features of the diabetic microvascular complications reduction in the FIELD study in response to therapy with fenofibrate. The possibilities of the drug in the treatment of diabetic vascular complications considered except its effect on hypertriglyceridemia.

Article reviews the results of the largest multi-center study evaluated the efficacy and safety of sulfonylurea (SU) drugs. The data from meta-analysis showed a high efficacy of SU among all oral hypoglycemic drugs. Along with efficiency, according to a number of clinical studies SU preparations have high cardiac safety. Despite the increased likelihood of hypoglycemic events, in routine clinical practice, the use of drugs with the SU is not associated with very high risk of hypoglycemic reactions. The risk can be minimized by pre-determination of the individual glycemic targets and the recommendations of the fractional diet and dosed physical activity. The listed lets SU-preparations to be considered as effective and fairly safe drugs, that remain relevant today.

Hypothyroidism, despite the high prevalence, easy diagnosis, a well-known and simple algorithm for the treatment, is accompanied by a high percentage of decompensated patients that can be associated with a wide variety of causes. According to various authors, both foreign and Russian, their share is 20-40%. The reasons for considering the low compliance of patients, their psychological state (in particular, depression), change of the brand of levothyroxine, accompanying chronic diseases (e.g., atrophic gastritis and celiac disease) and inadequate recommendations. Various measures to overcome these reasons are offered including the establishment of registers of patients with active mandatory supervision, the accounting quantity of the accepted pills, consult a psychologist for the correction of psycho-emotional disorders, assessment of bioavailability of levothyroxine after the change of the brand. This article describes the main mistakes therapists and endocrinologists committed in the diagnosis and treatment of hypothyroidism.

The article presents the lessons learned and the achievement of the leading experts in the field of diabetology and obstetrics in treatment of diabetes in pregnant women. The major differences in the classification criteria of gestational diabetes in the version of the World Health Organization, and in the version approved by the leading experts of the Russian Association of Endocrinologists and Obstetricians were considered and highlighted. Detailed description of the main stages of the diagnosis of gestational diabetes in pregnant women, and key indicators of self-control are presented. Classification of insulin preparations that are assigned in the absence of compensation glucose. Attention is drawn to the need to re-reclassification diagnosis 6-12 weeks after childbirth.