Aim. To estimate the prevalence of and risk factors for low-traumatic fractures in patients with type 2 diabetes mellitus (T2DM).
Materials and methods. We questioned 214 patients with T2DM from a single outpatient clinic located in Moscow to evaluate the prevalence of and risk factors for low-traumatic fractures, the duration of and complications from TD2M and HbA1c levels.
Results. Of 214 patients, 65 reported low-traumatic bone fractures. Patients with a history of low-traumatic fractures reported falls in the previous year (28%), whereas only 13% of patients without fractures reported falls. The difference was statistically significant, with an odds ratio of 2.34 (1,14–4,76), P=0,022. Men reported fractures more frequently than women (43.3% vs. 24.7%, respectively, P = 0.01). Patients with bone fractures had a lower body mass index (P = 0.022); however, a multivariate analysis revealed that a history of falls and male sex were the most significant risk factors for fracture.
Conclusion. Around 30% of patients with T2DM from a Moscow outpatient clinic reported bone fractures. The most significant risk factors for fracture were a history of falls in the previous year and male sex.

The extent of damage to the nervous, vascular and microcirculatory systems in diabetic patients determine the regulation of physiological events that lead to the formation of chronic wounds, reduction of patient quality of life and increase of the financial value of medical care. Successful physiological repair is impossible without the successive phases of inflammation, proliferation and wound healing. Keratinocytes are the major cellular barrier components of the epidermis. These cells play an important role in physiological repair, as suggested by recent research, with many cells able to secrete steroid hormones de novo. Damage to the integrity of the skin leads to keratinocyte activation, triggering a cascade of reactions that contribute to changes in epidermal cell phenotype and lead to their proliferation and migration, analogous to changes in cellular adhesion and configuration of the cytoskeleton. An open question remains as to how the keratinocyte cell cycle, which is altered under conditions of hyperglycemia, and neurotransmitter metabolism during different stages of physiological repair are regulated. Understanding these processes will provide a scientific basis for the development of new targets for pharmacotherapies.

Aim. To determine the relationships between bone remodelling markers and bone mineral density (BMD), metabolic parameters and total body composition (TBC) in postmenopausal women with type 2 diabetes (T2D).

Materials and methods. The study included 140 women who were diagnosed with T2D more than five years prior. The control group included 20 postmenopausal nondiabetic women with normal BMD. The BMD and TBC parameters were assessed by dual X-ray absorptiometry. Based on their T-scores, T2D women were divided into the following groups: normal BMD (n = 50), osteopenia (n = 50) and osteoporosis (n = 40). Serum levels of bone formation markers [osteocalcin and type 1 C-terminal collagen propeptide (CICP), osteoprotegerin (an inhibitor of bone resorption), parathyroid hormone (PHT) and urinary excretion of C-terminal telopeptides of type 1 collagen (alpha-CrossLaps, or CTX-I; a bone resorption marker)] were determined by ELISA.

Results. Osteocalcin levels were decreased in all groups of T2D women (all P < 0.0002), without any differences between groups. Osteoprotegerin levels were reduced in all patient groups but was significantly lower in diabetic women with osteoporosis and osteopenia compared to those with normal BMD (P = 0.003 and P = 0.01, respectively). Women with osteoporosis had higher urinary CTX-I excretion than control and diabetic women with normal BMD (P = 0.01 and P = 0.01, respectively). CICP levels did not differ between groups. PHT concentrations were increased in diabetic women (P < 0.0001), without any differences between groups. After multiple regression analysis, BMI, age and CTX-I excretion were all associated with lumbar BMD (R2 = 0.38, P = 0.0007), whereas age, BMI, osteoprotegerin levels and CTX-I excretion were all predictive of BMD at the proximal femur (R2 = 0.44, P = 0.00003). There was no relationship between bone remodelling markers and HbA1c, lipid metabolism or TBC.

Conclusions. In postmenopausal T2D women, osteoporosis is associated with decreased serum osteoprotegerin levels and enhanced urinary CTX-I excretion. The data do not support the existence of an interrelationship between bone remodelling markers, metabolic parameters and TBC in postmenopausal women with T2D.

Type 2 diabetes mellitus (T2DM) increases the risk of cardiovascular disease that is based on endothelial dysfunction (ED). Currently, conventional diagnostic methods are unreliable, especially at early stages of disease.

Aims. The aim of this work was to assess endothelial function in men with T2DM without clinical signs of cardiovascular disease.

Materials and methods. The study included 100 patients (mean age, 54.3 ± 5.3 years) with a T2DM duration of less than 10 years and without signs of cardiovascular disease. The patients were divided into two groups: group 1 consisted of 60 patients with a T2DM duration of less than five years. Group 2 included 40 men with a history of diabetes between 5 and 10 years. Endothelial function was assessed by the levels of nitric oxide (NO), endothelial NO synthase type 3 (eNOS3), ICAM-1, VCAM-1, E-selectin, P-selectin, resistin and C-reactive protein and the arterial vasoreactivity of the brachial artery (BA) using the D. Celermajer method.

Results. Results revealed decreases in levels of both eNOS3 by 2.5 fold (P = 0.0005) and NO by 1.9 fold (P = 0.043) in group 2 patients, compared to those in group 1 patients. When the duration of diabetes was greater than five years, levels of VCAM-1, resistin and C-reactive protein increased by 12.1% (P = 0.048), 62% (P = 0.01) and 45.6%, respectively. Additionally, the time until maximal BA vasodilatation during reactive hyperemia was observed to be higher in group 2 [105 (90; 180) seconds] than those in group 1 [90 (60; 120) seconds].

Conclusions. Biochemical and imaging signs of ED begin to appear in the first five years of T2DM, long before clinical manifestations. The earliest symptoms are decreases in eNOS3 and NO levels, increases in VCAM-1 and resistin concentrations and increased time until maximal BA vasodilatation during reactive hyperemia.

The treatment of diabetes mellitus generally involves genetically engineered human insulin (GICH) or genetically engineered analogues of human insulin (AIC). Compared to GICH, AIC better physiologically mimics endogenous insulin functionally. It would thus be logical to assume that long-term (multi-year) application of AIC leads to a lower incidence of diabetic angiopathy compared to GICH. To date, however, no long-term comparisons of both classes of insulin preparations (in terms of efficacy of glycemic control or incidence of microvascular complications in patients with type 1 diabetes) have been performed.

Aims. To retrospectively compare the efficacy of glycemic control and incidence of microvascular complications (nephropathy and retinopathy) in patients with type 1 diabetes treated for at least 10 years with either GICH or AIC.

Materials and methods. Based on data from electronic databases (diabetes registry) from several regions within the Russian Federation, the following patient samples were examined (n=260): group 1 received GICH for 10 years (n = 130) and group 2 received AIC for 10 years (n = 130). Patients in both groups underwent pairwise matching for baseline clinical characteristics (sex, age of diabetes onset, duration of disease and HbA1c level). All patients were observed by endocrinologists in the clinic.

Results. After 10 years of follow up, HbA1с levels declined more significantly in group 2 than in group 1 (1.30% vs. 0.81%, respectively, P < 0.05). By the end of the observation period, the presence of diabetic retinopathy (any stage) increased in both groups and was not significantly different between groups; the presence of diabetic nephropathy was also increased in both groups, but the increase was significantly lower in group 2 than in group 1 (20.5% vs. 33.9%, respectively, P < 0.05). Overall, the risk of microvascular complications was significantly higher in group 1 than in group 2 [HR (hazard ratio): 1.84; 95% CI: 1.37–2.48), specifically, the risk of diabetic retinopathy (HR: 1.37; 95% CI: 0.98–1.90).

Conclusions. A 10-year retrospective analysis of patients treated with AIC for type 1 diabetes in the clinic showed a significantly more effective reduction in HbA1c levels and a lower incidence of diabetic nephropathy, compared with patients treated with GICH.

Improved prognoses of patients with type 2 diabetes are primarily determined by the extent of blood glucose control (correction of both hyper- and hypoglycemia and normalization of blood glucose levels). The proper identification and timely correction of abnormal blood glucose levels require frequent blood glucose monitoring by the patient. Currently used methods for the self-monitoring of blood glucose have significant drawbacks that limit their use. The most significant problems with these methods include insufficient accuracy, invasiveness and high cost, leading to noncompliance and difficult assessment of disease status. Such factors underscore the need for a noninvasive, cost-effective and highly accurate method to measure blood glucose levels. There are several different approaches for the noninvasive measurement of blood glucose levels, including optical analysis, ultrasound and bioimpedance. The concept of a noninvasive glucometer was launched more than 30 years ago. Nevertheless, most noninvasive technologies are still in early stages of development and are not used in clinical practice. This review describers the most promising developments in this area.

For patients with coronary artery disease (CAD), in combination with diabetes mellitus, diffuse multivessel coronary artery lesions are common. Such patients are prone to a more rapid progression of atherosclerosis, significantly increasing the need for myocardial revascularization. The choice of an optimal approach determines the prognosis and course of CAD. The results of randomized trials show that the use of percutaneous coronary interventions with drug-eluting stents is appropriate for patients with one or two coronary artery lesions, but that coronary artery bypass graft surgery is preferred in cases of multivessel disease and significantly reduces the risk of long-term adverse events. It should also be noted that the use of modern generations of stents allows the achievement of comparable results in terms of long-term mortality, which was most convincingly demonstrated in patients with one or two vascular lesions.

Diabetes mellitus is a chronic disease that not only affects the lives of patients but also influences their social interactions, including driving. Driving a motor vehicle is a complex process, requiring good visuospatial function, rapid information processing, vigilance and high decision-making skills. Potential causes of driving impairment associated with diabetes include hypoglycemia and its effects on unawareness, retinopathy, neuropathy and ischemic heart disease. The effects of hypoglycemia can lead to dangerous and life-threatening events for both the driver and others on the road. Research data confirm that impairments from hypoglycemia affect driving performance. Many trials and meta-analyses have revealed that not all drivers follow precautions such as measuring blood glucose levels before driving; therefore, this problem remains quite relevant. In Russian Federation, the process of a person with diabetes obtaining a driver’s license is not uniformly regulated, even though this issue is related to road safety.

Joseph Davidovich Levit – a well-known Soviet endocrinologist; a disciple of the founder of the Russian school of endocrinology, Vasily Gavrilovich Baranov; and an outstanding thyroidologist whose name is firmly established in the history of medicine.

Dr. Joseph Levit was among the pioneers of the field. Not only did he meticulously research the endemic problems of goiter and its various forms, but also showed a clear inverse relationship between autoimmune thyroiditis (AIT) and endemic iodine deficiency.

He was one of the first in the Soviet Union to open a hormone laboratory built to the highest standards at the time, and put into practice the prevention and treatment of various forms of goiter. He saved tens of thousands of patients from the necessity of surgical intervention, was categorically against the extirpation of the thyroid gland in AIT patients, a common practice in those days.

A brilliant organizer, he founded from scratch the endocrine service in the Chelyabinsk region, considered one of the best in the USSR.Trained countless experts – endocrinologists, post-graduates and doctors of sciences.

Dr. Levit authored over 100 scientific papers, the monograph “Autoimmune Thyroiditis”, and numerous innovations. He held a strong belief in the possibility of bringing autoimmune diseases into remission and was far ahead of his time proving it in practice.

The main works of Dr. Joseph Levit, as well as his scientific biography may serve not only as a source of useful information, but also as an incentive for independent research for both the younger generation and the seasoned experts in various fields of medical science.