Diabetes mellitus is a most serious socio-medical and economic problems facing health authorities throughout the world. A major threat is vascularcomplications of the disease. The currently available diagnostic tools, up-to-date means for monitoring glycemia, introduction of innovative insulinpreparations and hypoglycemic agents, development of high-technology therapeutic modalities may greatly improve disease prognosis, reduce the frequencyof chronic complications, related disablement and mortality rates. The targeted control of major risk factors, viz. hyperglycemia, hypertension,and dyslipidemia, during the patients lifetime starting from the onset of diabetes remains the most promising strategy for the prevention of diabeticcomplications. An indispensable condition for efficacious management of diabetes is the elaboration of active screening programs for the early diagnosisof complications and optimal organization of the clinico-diagnostic process in the framework of multidisciplinary approach.

Renin-angiotensin-aldosterone system (RAAS) is a major system of the human body playing a key role in the regulation of most physiological andpathological conditions, such as vascular tone, AD level, myocardial and vascular wall remodeling, development of atherosclerosis, glomerulosclerosis,and other pathologies. The discovery of local (tissue) RAAS in the late XX century gave evidence of direct synthesis of all components of this system,from renin to aldosterone, in target tissues and organs. Activation of tissue RAAS was shown to play a leading role in the evolvement of diabetic complicationsincluding cardiovascular diseases, diabetic nephropathy (DN), and retinopathy. Recent studies revealed the presence of RAAS componentsin fat and pancreas. This system is involved in the development of visceral obesity, pre-diabetes, and Type 2 diabetes. These findings are confirmedby a reduced risk of CDM2 in subjects receiving long-term therapy with RAAS blockers.

Aim.
Comparative assessment of the prevalence of diabetic complications (DC) and the main metabolic indices in adult patients with DM1 and DM2 in the periodfrom 2003 to 2009.
Materials and methods.
The study based on the Diabet Tsentr mobile module was designed to perform screening (2003) and rescreening (2009) for DC in severalregions of the Russian Federation. Laboratory analyses included measurement of blood HbA_1c, creatinine, urea, total cholesterol levels, and albumin in singlevoidurine samples. The patients underwent fundoscopy, evaluation of all forms of sensory responsiveness, measurement of arterial pressure, and ECG. The resultswere treated with the use of Statistica 6 software. They are presented as median, 25th and 75th percentiles (Me[25%;75%]). The difference between the groups wasregarded as statistically significant at p<0.05.
Results.
The prospective study reveled a significant decrease in the prevalence of diabetic cataract from 36.8 to 33.7%, diabetic retinopathy from 41.4 to 31.8%,nephropathy from 39.6 to 30.6%, arterial hypertension from 68.9 to 65.3, angina from 28.8 to 20.5%, myocardial infarction from 7.5 to 5.2% (=<0.05) amongadult patients. Mean HbA_1c level dropped by 0.8 and 0.5% in DM1 and DM2 patients respectively. Mean systolic pressure decreased by 10 and 2 mmHg in thetwo groups. The number of DM1 and DM2 patients with decompensate carbohydrate metabolism decreased by 12.5 and 7.3% respectively. The number of DM2patients in need of insulin and combined therapy increased up to 18.2 and 7.7%.
Conclusion.
Controlled epidemiologic studies are indispensable for obtaining reliable information about the prevalence of DM and its complications and for updatingregister data. Comparative assessment of the efficiency of diagnostic and therapeutic aid to the patients revealed positive dynamics of morbidity characteristics.

Type 1 diabetes mellitus (DM1) is associated with compromised (defective) immunologic tolerance to autoantigens and selective destruction of pancreatic B-cells by CD4+ (effector) and CD8 (cytotoxic) lymphocytes. The mechanisms of autotolerance involve CD4+CD25+high T-regulatory cells (Treg) whose suppressor activity depends on the expression of the FoxP3 gene. Aim. Detection of quantitative and functional alterations at the level of regulation of immunity in subjects at risk of DM1 and patients with different duration of DM1. Materials and methods. 116 patients (67 men and 49 women) with different duration of DM1. The risk group was comprised of 33 subjects (10 men and 23 women), control group included 16 subjects. In all cases, HLA genotyping was performed, autoantibodies to GDC, insulin and tyrosine phosphatase, islet cell antigens were determined, subpopulation composition of CD3+, CD4+, CD8+, CD38+, HLA DR+, CD25+, CD4+25+ lymphocytes and their functional activities (FoxP3 gene expression) studied, C-peptie and HbA1c levels measured. Results. A tendency toward a rise in Cd25+ and CD4+25+ T-lymphocytes and a decrease in FoxP3 expression was documented in the risk group compared with control (p0.05) but their functional activity was lower (p

Diabetes mellitus (DM) is frequently associated with disturbances of the sexual function underlain by hypogonadism and neuropathy. These pathologicalconditions are successfully managed by androgens, alpha-lipoic acid, and phosphodiesterase type 5 inhibitors, besides compensation of carbohydratemetabolism. This paper reports results of evaluation of different methods for the treatment of erectile dysfunction in DM patients basedat Endocrinological Research Centre. Their combination ensured higher than 90% efficiency of therapy.

Aim.
To study the role of vascular endothelial growth factor (VEGF-A) in the fluid of the anterior chamber of the eye (ACE) in the evolvement ofdiabetic retinopathy (DR) and the outcome of cataract surgery.
Materials and methods.
The study included 120 patients with diabetes mellitus (DM) operated for the removal of cataract. 16 patients received treatmentfor DR-related neovascular glaucoma (NG). The control group comprised 22 subjects without DM. VEGF-A and glucose levels were measuredin the ACE fluid prior to surgery.
Results.
Patients with DM were not significantly different in terms of VEGF-A, fasting glucose, and HbA_1c levels on the day of surgery excepting DMpatients without DR. VEGF-A and glucose levels in AEG increased in proportion to DR severity. VEGF-A concentration was minimal in the absenceof DR (22.75 pg/ml [10.78; 63.36]) and amounted to 336.6 pg/ml [232.3; 410.74] in patients with DM and DR (P<0.0001). In DM combined withNG the VEGF-A level increased to 1634.01 pg/ml [610.69; 2657.33] (17 times the level in control subjects). Visual acuity in the late postoperativeperiod gradually decreased to the preoperative values 12 months after surgery for severe DR. Thereafter, 7.6% of the patients developed NG. 40% ofthe patients were treated by retinal laser coagulation; postoperative complications were absent only in 52.4% of the cases.
Conclusion.
High VEGF-A level in the ACE fluid (above 137.4 pg/ml) greatly contributes to the development of NG after removal of cataract and increases9.62-12.3 times the risk of NG.

Aim.
To consider technical aspects of antihyperglycemic injection therapy in patients with type 1 and type 2 diabetes mellitus.Methods.
The analysis included 200 adult patients (60 men and 140 women) receiving injection therapy for at least 6 months. They filled a 40-iremquestionnaire designed to estimate socio-demographic parameters, the use of different devices for insulin injection, and the most frequent mistakesmade by the patients. Their mean age was 51.7?15.1 years, duration of DM 11.9?9.1 years, mean HbA_1c level 8.4?1.5%.
Results.
130 (65%) patients used semiautomated injection pens, 39 (19.5%) disposable syringes, 31 (15.5%) both devices. Most patients (122, 61%)used 8 mm needles, 32 (16%) used 12.7 mm needles, 31 (15.5%) 10 mm, 28 (14%) 12 mm, 19 (9.5%) 6 mm, 18 (9.0%) 5 mm. 64 (32%) patientsused needles of different length, 25 (12.5%) could not give a definitive information about the needle length they used. Location of injection sites variedconsiderably in individual patients. 87 (43.5%) made injections within a single anatomic regions (62 into the anterior abdominal wall, 19 into theanterolateral surface of the thigh, 5 into shoulders, and 1 into buttocks. 113 (56.5%) patients made injections into two or more regions. 83 (41.5%)developed lipodystrophy at injection sites, 42 (50.6%) continued to use them for injections (12 did it on a regular basis and 30 occasionally). HbA_1clevels were 9.5 and 8.2% in patients who made injections into affected sites and who had no lipodystrophic changes respectively (p=0.02). Over halfof the interviewed patients (106 or 53%) were informed about correct subcutaneous injection technique by the attending endocrinologist, 60 (30%)were taught by the nursing staff while staying in a hospital or visiting an endocrinological dispensary, 28 (14.%) were educated at Diabetes schools,9 (4.5%) when seeing the local therapist, and 19 (9.5%) by non-professionals.
Conclusion.
Many patients make serious mistakes when self-administering insulin. Incompliance with the guidelines on insulin injections leading tothe impairment of carbohydrate metabolism, the technical aspects of injections must be in the focus of attention of any practitioner. New (2010) internationalguidelines on the injection technique are overviewed.

This paper reviews key aspects of hypoglycemia in patients with diabetes mellitus. The description and classification of hyoglycemias are presented inconformity with criteria of American Diabetes Association, European Agency for Evaluation of Medicinal Products, Canadian Diabetes Association,and Russian Algorithm of specialized care for diabetic patients. The main factors responsible for the development of hypoglycemia and its clinicalpicture are considered. A detailed characteristic of abnormal sensitivity to hypoglycemia is given. Psychological aspects of the effects of hypoglycemiaon the quality of life and achievement of target parameters of glycemic control are analysed.

Aim.
To study efficiency and safety of hydroxizine (H) and tofisopam (T) therapy in DM patients with generalized organic anxiety disorders and subsyndromicanxiety the overall prevalence of which among diabetic patients amounts to 45-50%.
Materials and methods.
This open prospective randomized comparative study included 60 DM patients with anxiety disorders (AD) of whom 95%presented with arterial hypertension. The medicines were prescribed at mean therapeutic doses for 3 months followed by 1 month withdrawal period.The efficiency of anxiolytics was estimated from dynamic patterns of reactive anxiety (RA), personal anxiety (PA, Spielberger scale), somatic anxietysymptoms (Giessen questionnaire), HbA_1c level, systolic and diastolic AP (SAP, DAP), heart rate.
Results.
Therapy with anxiolytics for 3 months resulted in the decrease of the HbA_1c level from 7.9?1.4 to 7.4?1.4%, total somatic anxiety scorefrom 38.0?13.2 to 31.5?12.2, PA from 52.5?9.7 to 47.1?8.8, RA from 32.3?9.0 to 25.5?9.3, SAP from 141.4?12.4 to 129.8?13.5 mmHg,DAP from 82.3?7.4 to 77.8?8.6 mm Hg, HR from 76.3?9.5 to 72.7-5.6 (in all cases p<0.05). Subgroups treated with H and T had similarclinical, laboratory, and psychological characteristics before and after therapy. However, H caused a more pronounced fall in PA scores than Twhereas T reduced DAP and HR to a greater degree than H. Termination of therapy was not accompanied by clinical symptoms of withdrawal syndrome.All the above parameters remained stable within 1 month after treatment excepting DAP in the subgroup given T (a rise from 76.5?5.6 mmHg 3 months after the onset of therapy to 81.0?8.3 mm Hg 1 month after its withdrawal (p<0.05). By the end of the treatment period, 7 patientsfrom the H subgroup and 6 from the T subgroup dropped out of the study including 1 and 0 ones respectively who discontinued presumably due to thedrug-related adverse events.
Conclusion.
1. Anxiolytic therapy of AD in patients with DM significantly reduces intensity of chronic anxiety; this effect persists within 1 month afterthe termination of therapy. 2. Simultaneously, manifestations of major risk factors of vascular disorders (glycated hemoglobin, AP) decrease. 3. Meantherapeutic doses of atarax and grandaxin are well tolerated and safe for DM patients who do not develop withdrawal syndrome after the terminationof therapy. 4. Despite comparable, on the whole, results of therapy with atarax and grandaxin, the former agent appears to have greater effect on thepsychological component and the latter on the somatic (vegetative) component of AD.

This paper reports results of the DIA-DA observation program designed to study the efficacy and safety of the DPP-4 inhibitor sitagliptin added tometformin therapy in different regions of the Russian Federation. The study included 923 patients with DM2 (mean duration 4.5 years) uncontrolledby diet and metformin monotherapy. They were transferred to the combined treatment with sitagliptin and metformin during 6 months. The mainend-points assessed in the study were hypoglycemic efficiency, frequency of side-effects, and satisfaction of patients and physicians with the treatment.The target HbA_1c level <7% was achieved by the end of therapy in 71% of the patients with a low incidence of hypoglecemic episodes (1.2%) andother side-effects (0.5%). Most patients and their doctors expressed content with the results of the treatment. These data give reason to recommendthe sitagliptin-metformin combination starting from the onset of DM2.

Aim.
To elucidate therapeutic effect of metformin-sitaglitin combination on the dynamics of indices of insulin resistance and functional activity of pancreaticbeta-cells, lipid metabolism and body weight in patients with type 2 diabetes mellitus (DM2) and obesity.
Materials and methods.
The study included 32 patients treated by a combination of metformin (500-2550 mg/day) and sitagliptin (100 mg) for18 weeks. Standard parameters of carbohydrate and lipid metabolism, body mass index (BMI), blood adiponectin and leptin levels were measured, indices of insulin resistance and functional activity of pancreatic beta-cells were calculated.
Results.
Therapy with metformin-sitagliptin combination ensured compensation of fasting and postprandial hyperglycemia, reduced HbA_1c level, increasedfunctional activity of beta-cells, decreased peripheral insulin resistance and BMI, had beneficial effect on lipid metabolism and hormonalactivity of adipose tissue.
Conclusion.
Metformin-sitagliptin combination can be recommended as a clinically efficacious modality for the treatment of patients with diabetesmellitus and obesity.

The author analyses recent publications supporting the ability of metformin to decrease the risk of cancer morbidity and mortality in patients with type 2diabetes mellitus. Pre-history of the problem (including the use of biguanides for metabolic rehabilitation of oncological patients), the role of DM as a riskfactor of cancer morbidity and mortality, mechanisms and targets of metformin anticancer effects, and potential use of this agent in non-diabetic patientsare discussed. The need for the search of the markers of sensitivity and resistance to metformin to be used in oncological practice is emphasized.

Diabetes mellitus (DM) is a stably growing pathology leading to micro- and macrovascular complications. Despite high potential of medicamentaltherapy for DM its efficacy needs to be further improved. Uncompensated postprandial hyperglycemia is known to be responsible for many diabeticcomplications. Moreover, it by itself aggravates disturbances of insulin secretion through the toxic effect of glucose. Insulin therapy remains a principaltool for the treatment of DM. Its efficiency was greatly improved with the advent of fast-acting insulin analogs obtained by reducing stability of hexamers.Insulin glulysine (Apidra) is the fastest-acting analog licensed for the treatment of DM1 and DM2 in adult patients in 2004 (FDA, EMEA) andin children above 6 years in 2008 (EMEA). A characteristic feature of this analog is the absence of Zn2+ in its molecule that substitutes polysorbate-20 acting as a surfactant and providing additional protection of monomers from denaturation.

The paper deals with the main aspects of pathogenesis of cardiovascular diseases in patients with disturbed carbohydrate metabolism. Results of theADVANCE study are presented that confirm the importance of intensive control of glycemia for the reduction of the overall risk of diabetic complicationsand death from cardiovascular pathology.

Metformin is a major antihyperglycemic agent used for the treatment of DM2. Analysis of the mechanism of its action is presented. Cardioprotectiveand anticancer activities of metformin are discussed. Results of multicentre studied of metformin are described.

Type 2 diabetes mellitus is a most serious medical problem throughout the world. Traditional hypoglycemic agents do not ensure long-term control ofglycemia and fail to affect the natural course of DM. An ideal hypoglycemic medicine must be efficacious, safe, and convenient to use for the preventionof progressive deterioration of beta-cell function during prolonged therapy; also, it should have positive effect on the outcome of DM. The use of incretinsin the recent decade is a new promising approach to the management of DM2. The group of incretins includes gastrointestinal hormones released inresponse to food intake to stimulate insulin secretion. Dipeptidyl peptidase-4 (DPP-4) inhibitors, a new class of hypoglycemic agents, have been inuse in this country for over 3 years. Vildaglyptin (Galvus) is a representative of DPP-4 inhibitors and GalvusMet is the sole combination of DPP-4inhibitor with metformin registered in Russia. The advent of incretin mimetics necessiatate revision of national and international guidelines for DM2therapy. Results of international clinical studies show that Galvus and GalvusMet are efficacious and safe, they ensure adequate control of glycemiafree from complications and side effects. An important advantage of these preparations is the possibility of their use by elderly patients with arterialhypertension and moderate renal dysfunction and by those at risk of cardiovascular disorders. The evidence-based Galvus information is highly convincing.The advantages of Galvus over traditional agents give reason to recommend it as a medicine of choice for the initiation of DM2 therapy. Approvedcombinations of Galvus with other hypoglycemic agents may be used at all stages of intensive therapy of DM2.

Obesity associated with the enhanced risk of cardiovascular disorders plays a key role in the evolvement and progression of type 2 diabetes mellitus(DM2). Incretin mimetics are the sole class of hypoglycemic agents that not only effectively correct hyperglycemia but also reduce body weight. Exenatide(Byetta) is the first drug of this class approved for the use as monotherapy. This paper presents a detailed review of the available data on thescope of exenatide effects and the results of its clinical studies that confirm high efficiency of Byetta used for both monotherapy and combined therapyof DM2.

The first human glucagon-like peptide-1 analog (liraglutide) was registered in Russia in May 2010. This review contains data on the results of randomizedclinical studies of this preparation applied to the treatment of patients with DM2 as monotherapy and in combination with traditional hypoglycemicagents (LEAD 1-6 program). Liraglutide is shown to have advantages when used by patients with an excess body mass and obesity, those atrisk of cardiovascular diseases and prone to develop hypoglycemia. Patients treated with liraglutide (1.8 mg) more frequently achieved the desired efficacyendpoints (НbА1с < 7%, reduced body mass and AP control) of than those using traditional therapy (24 vs 3-14%).

Current therapeutic strategies of type 2 diabetes mellitus are aimed at reducing the risk of acute and late vascular complications by means of normalizationof glycemia, improvement of life quality and expectancy, minimization of socio-economic losses. The adequate glycemic control should besupplemented by screening for and correction of risk factors of cardiovascular disorders; it may help to prevent or delay the development of macrovascularcomplications.

A review of the main stages of investigation undertaken by Novartis Pharmaceuticals in search of a new molecule for the treatment of type 2 diabetesmellitus, dipeptidyl peptidase-4 (DPP-4) inhibitor (Vildaglyptin). The data on specificity and selectivity of the action of this molecule are presentedalong with the results of its comparison with another agent of this group (sitagliptin).

The management of chronic lesions in DM patients implies a multifactor approach, its important component being the adequate treatment of thewound bed. The new hydrosurgical technology for the purpose based on the VersaJet system poses a number of technical problems and requires assessmentof its applicability and efficiency in patients with different forms of diabetic foot syndrome. Results of the work with this system (62 patients)revealed its advantages, such as reduction of treatment duration and the number of repeat treatments, higher probability of wound healing at sitesdifficult to access (heel, tendon projection regions, etc.). It is concluded that the VersaJet system may be recommended for the use in surgical departmentsproviding specialized medical aid to patients with DM and pyonecrotic foot lesions.

Aim.
Clinical assessment of the use of dressing materials based on the lipid-colloid technology for the local treatment of diabetic foot syndrome (DFS).
Materials and methods.
The study included 24 patients with DM1 and DM2 and neuropathic or neuroischemic forms of DFS in the absence of pronounced leg ischemia (ankle-brachial index >0.7). Duration of the observation period was 8 weeks, the patients were examined once in 2 weeks. The dressing materials used in the study were based on the Cellosorb NA, Cellosorb Ag, Urgotul S Ag. technology (Laboratories Urgo). Efficacy and safety of the dressing materials were estimated from the wound size, degree of exudation, characteristics of the wound bed and the surrounding tissues. The data obtained were treated using Statistica v. 7.0 software (StatSoft Inc.).
Results.
Efficacy of local therapy was assessed based on the Pressure Ulcer Scale of Healing (PUSH). Neither local nor systemic adverse events related to the use of the above dressing materials were registered during the follow-up. Cellosorb NA and Cellosrb Ag hydrocellular dressings showed high absorption activity and atraumatic properties. Most patients especially those using Cellosorb Ag were free from local infection.
Conclusion.
Dressing materials based on the lipid-colloid technology are safe and meet all requirements for the means of local treatment of chronic wounds.

Aim.
To identify profibrogenic mediators, markers of endothelial dysfunction and hemostasis in patients with diabetes mellitus (DM) and chronickidney disease (CKD).
Materials and methods.
The study included 120 patients with DM and 20 age-matched normotensive subjects without DM showing the glomerularfiltration rate (GFR) > 60 ml/min/1.73 m3. Four groups of patients were distinguished: 1 - DM2 patients without renal pathology (n=33), 2 - DM2 patients with diabetic nephropathy (n=24), 3 - DM2 patients with ischemic nephropathy (IN) (n=33) verified by contrast visualization techniques(multispiral CM of abdominal aorta and renal arteries, abdominal angiography of renal arteries or MR angiography of renal arteries and abdominal aorta), 4 - DM1 patients with DN (n=30). Clinical examination included assessment of complaints, analysis of medical history of the main diseaseand concomitant disorders, determination of the main clinical and biochemical characteristics of blood and urine, measurement of НbА1с and 24-hralbuminuria (AU) by standard methods, estimation of GFR by the MDRD formula, ECG, echocardiography, 24-hr AP monitoring, counseling bycardiologist and ophthalmologist (fundal examination by ophthalmoscopy). Standard kits were used to detect profibrogenic mediators and markersof endothelial dysfunction including transforming growth factor-beta (TGF-b), angiotensin II (AT II), monocyte chemoattractant protein (MCP-1),regulated on activation normal T cell expressed and secreted (RANTES), adhesion factors (intracellular adhesion molecule (ICAM-1), vascular celladhesion molecule (VCAM-1) vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), asymmetric dimethylargnine (ADMA), homocysteine(HCYST), metalloproteinases (MMP), von Willebrand factor (vWF), plasminogen activator inhibitor (PAI-I).
Results.
DM patients with CKD had elevated blood profibrogenic cytokine (MCP-1, TGF-1b, IL-6) and extracellular matrix degradation factor(MMP-9) levels compared with patients without CKD and healthy subjects. These changes were unrelated to the type of diabetes or the cause ofnephropathy, which suggests their contribution to renal pathology through the universal mechanism of tubulointerstitial fibrosis. Activation of profibrogeniccytokines in DM patients with CKD was closely associated with endothelial dysfunction manifest as enhanced production of blood adhesive angiogenic, thrombogenic factors (FW, PAI, VICAM, sICAM, VEGF), and endothelium-affecting factors (ADMA, homocysteine). Mediators of inflammationand fibrogenesis in these patients negatively correlated with GFR and positively with AU, the main markers of renal dysfunction. Hyperuricemia,TGF-1b, ADMA, and MCP-1 are considered to be the risk factors of impaired renal filtration function.
Conclusion.
The level of profibrogenic cytokines and ndothelial dysfunction factors in DM patients with different renal lesions reflects severity of tubulointerstitialfibrosis. It may be used for the purpose of prognostication and substantiation of intensification of secondary prophylaxis of renal insufficiency.

Adequate glycemic control remains an unresolved problem for children and adolescents with type 1 diabetes mellitus. The use of new insulin analogsand intense insulinotherapy does not always permit to achieve the target levels of glycemia and HbA_1c. To-day insulin pump therapy is considered tobe the most efficacious tool for the improvement of glycemic control.Aim.
To estimate results of glycemic control in children and adolescents treated by insulin pump therapy.
Materials and methods.
The study included 173 patients aged 1.5-22 years having the disease for 0.5-20 years. MiniMed 508, MiniMed 712,MiniMed 722, Accu Check Spirit, Accu check D-Tron, Dana Care IIs pumps, ultrashort-acting insulins aspart and lispro were used. The patientsperformed self-control of glycemia 4-8 times during 24 hours. HbA_1c was measured before and 12, 24, 36, 48 months after the onset of therapy. Thefrequency of DKA and severe hypoglycemia was recorded.
Results.
The HbA_1c before the onset of therapy was 9.8 ?2.0% and dropped to 8.6; 8.7; 8.7; 8.9 and 9% 12, 24, 36, 48 months after it respectively.DKA was diagnosed in 20 (2.4%) and severe hypoglycemia in 5 patients. All patients in the CSII group were content with the use of the pumps, theabsence of injections and flexible day regimen.
Conclusion.
One year after the beginning of therapy the level of HbA_1c significantly decreased. However, it increased again during a follow-up of5 years probably because of impaired compliance. This fact implies the necessity to regular repeat patient education for raising awareness of and motivationfor self-management.

Despite substantial progress in the treatment of type 1 diabetes mellitus achieved by the end of the last century due to the advent of human insulins,intensive insulinotherapy, means of glycemia self-control, and active patient self-management education, compensation of the diseases in childrenand adolescents remains a challenging problem. This paper is focused on the use of insulin analogs in these patients and main difficulties encounteredby pediatricians in the correction of therapy.