BACKGRAUND: The need to create a national questionnaire for screening the population for disorders of carbohydrate metabolism.

AIMS: Develop a highly specific and sensitive questionnaire-calculator of the risk of prediabetes (PreD) and diabetes mellitus type 2 (DM2T) based on depersonalized data of individuals who have these diagnoses confirmed in the national epidemiological study NATION.

METHODS: The express method of prediabetes (PreD) and diabetes mellitus type 2 (DM2T) risks has been created, validated and proposed for clinical usage for the first time in the Russian Federation, it was based of NATION epidemiologic study database (more than 26 000 participants). The following mathematical instruments have been used: mathematic modelling, main components methodology, binary variables, correlation analysis and single-factor analysis of variance.

RESULTS: Highest coefficients of logistic regression for PreD (p<0.05) were identified for age — ≥52 years old for women and ≥59 years old for men (1,48); body mass index ≥31 (0.75); waist circumference ≥100 сm for women and ≥112 cm for men (0.90). In the same time coefficients for DM2T were for for age — ≥52 years old for women and ≥59 years old for men (1,24); body mass index ≥31 (1,19), high blood fasting glucose analysis in the past (1,37); waist circumference / hip circumference ratio ≥0.85 for women and ≥0.92 for men (1,05), high blood pressure (0.69). Correlation coefficients were taken into account and score has been used for specialized questionnaire creation. Sensitivity and specificity for PreD were 83,8% and 59,3% accordingly, for DM2T — 85,4% and 73,6% accordingly. DM2T may be suspected when total score of questionnaire is 11 and higher, and PreD — when total score will be ≥7 and <11.

CONCLUSIONS: The calculator based on questionnaire (DIARISK) allows to separate of potential patient for PreD and DM2T confirmation during first examination or dispanserization. A patent for innovation has been issued.

BACKGROUND: The number of patients with chronic metabolic disorders such as obesity, type 2 diabetes mellitus (T2D) and non-alcoholic fatty liver disease (NAFLD) is growing at an alarming rate worldwide in both developed and developing countries. In the world, the prevalence of NAFLD is approaching 25%. Among patients with T2D, 70–80% are diagnosed with NAFLD. Insulin resistance (IR) is recognized as one of the main pathogenetic factors in the development of the most common chronic liver disease — NAFLD.

AIM: Our search work was aimed at determining the contribution of the degree of IR to the progression of NAFLD; compare the gold standard for the determination of IR (clamp) and the mathematical model (HOMA-IR).

METHODS: An observational one-stage open comparative study was conducted on the basis of the case-control principle. The objects of the study were overweight and obese patients who had not previously been diagnosed carbohydrate metabolism disorders, without secondary causes of fat accumulation in the liver. During the examination, clinical and laboratory studies were carried out, IR indices (M-index, HOMA-IR index) were obtained, a diagnosis of carbohydrate metabolism disturbance (or its absence) was made, a liver biopsy was made, morphological and clinical diagnoses were made.

RESULTS: The analysis included information about 60 patients, they are divided into 3 groups: without NAFLD (7 people), with steatosis (18 people), with non-alcoholic steatohepatitis (NASH) (35 people), groups are comparable by age, gender, and body mass index (BMI), glycated hemoglobin. When assessing the degree of IR using the hyperinsulinemic euglycemic clamp test, 19 showed a severe degree of IR, 28 had a moderate degree, 8 had a mild degree, and 5 had no IR. In the three studied groups, the median IR corresponded to an average degree and did not significantly differ. When comparing the gold standard for determining IR and the mathematical model (HOMA-IR) in the studied groups, an negative significant correlation was revealed (p = 0,0001).

CONCLUSIONS: In the course of our study, no correlation was found between the degree of IR and the severity of NAFLD. This result allows us to think about other pathogenetic factors that affect the progression of NAFLD.

BACKGROUND: Type 2 diabetes and osteoporosis are widespread diseases in the middle-aged and elderly people. Most studies of osteoporosis in patients with type 2 diabetes have been performed in women; meantime risk factors for lowering bone mineral density (BMD) in men have been little studied.

AIMS: to identify risk factors for decreased BMD at the lumbar spine, femoral neck and forearm in men with type 2 diabetes.

METHODS: Eighty two men from 50 to 75 years old, with duration of diabetes for at least one year, were included in the study. Individuals with known risk factors for secondary osteoporosis were not included. Twenty-three men with normal BMD having no diabetes or obesity were acted as control. The T-score at the lumbar spine, femoral neck and forearm of a non-dominant arm, as well as body composition parameters, were evaluated by dual-energy X-ray absorptiometry. The levels of hormones that affect bone metabolism (parathyroid hormone, free testosterone, 25-OH vitamin D) were measured in blood serum by ELISA. Risk factors for reducing BMD were identified using multivariate regression analysis and receiver operating characteristic (ROC) curves.

RESULTS: Among patients with diabetes, 49 individuals had normal BMD and 33 showed decreased T-score values (<-1 SD). Free testosterone <5.92 pg/ml was predictor for decreased BMD at the lumbar spine (OR=4.4, p=0.04). For femoral neck, the risk factors were body weight <95.5 kg (OR=2.8, p=0.04), total fat mass <27 kg (OR=3.3, p=0.03), truncal fat mass<17.5 kg(OR=4.5, p=0.006), android (central abdominal) fat mass <3.2 kg(OR=4.0, p=0.01), gynoid (hip) fat mass <3.5 kg(OR=3.3, p=0.02), and lean mass <59 kg(OR=3.0, p=0.04). Risk factors for reduced BMD at the forearm were diabetes duration>15.5 years (OR=3.7, p=0.03) and HbA1c <8.15% (OR=3.8, p=0.03). Parathyroid hormone and 25-OH-vitamin D did not predict BMD independently.

CONCLUSIONS: In men with type 2 diabetes, low free testosterone is a risk factor for decreased BMD in the lumbar spine, and diabetes duration is a risk factor for decreased BMD in the forearm. The presence of obesity is associated with an increase in BMD in the femoral neck; a high HbA1c is associated with an increase in BMD in the forearm.

BACKGROUND: Due to the high rate of growth in the incidence and burden of cardiovascular complications, type 2 diabetes mellitus (T2DM) is a significant medical problem in the world. Even in the absence of cardiovascular disease (CVD), patients with T2DM are classified as high and very high risk. In addition to glycemic control, an extremely important aspect of managing this group of patients is prevention of cardiovascular complications. T2DM and hyperlipidemia determines the target group for statins. At the same time, little is known about the frequency of administration of this class of drugs among people with T2DM.

AIM: To study prescribing frequency and adherence to statins in outpatients with T2DM and comorbid cardiovascular diseases.

METHODS: 156 patients with type 2 diabetes (87.2% — women, average age — 65.2 years) were examined as part of an outpatient appointment with an endocrinologist at the city polyclinic ofTomsk. We used a standard questionnaire compiled on the basis of adapted international methods, including information on cardiac pathology, medications, income level, and Morisky-Green test. Anthropometric parameters, fasting plasma glucose, glycated hemoglobin, lipid spectrum parameters were measured. Methods of parametric and nonparametric statistics were used for comparisons.

RESULTS: Statins were prescribed to 45.0% of the surveyed, and 47.0% of them were constantly taking statins. In 41 and 39% of cases, statins were prescribed by an endocrinologist and a cardiologist, respectively. Those taking statins were characterized by a more severe functional class of angina pectoris (p=0.03), a higher prior myocardial infarction rate (p=0.01). For other concomitant diseases, and also indicators of carbohydrate metabolism, differences between the groups were not revealed. One third of patients were adherent (3–4 points), 2/3 were not adherent to treatment (0–2 points), respectively. Patients with incomes between 1 and 2 cost of living took statins more often than the rest (p=0.021).

CONCLUSION: An insufficient frequency of prescription and adherence to statin therapy in patients with T2DM was revealed. In most cases, statins were prescribed by an endocrinologist or cardiologist. Functional class of angina pectoris, prior myocardial infarction and moderate income were associated with more frequent use of statins. To increase the coverage of patients with T2DM with statin treatment, more attention needs to be paid to the issues of CVD prevention from both medical professionals and patients.

BACKGROUND: It is known that the so-called “rocker” outsole helps to reduce the load on the forefoot and toes. Such an outsole is available in ready-made orthopedic shoes of some Russian manufacturers, however, an objective assessment of their impact on the load distribution under the foot during walking has not been carried out.

AIMS: To study the pressure distribution inside the off-the-shelf orthopedic shoes“Sursil-Ortho” in comparison with the load inside the shoes used by patients on a daily basis.

METHODS: We studied 20 patients (40 feet) with a high risk of diabetic foot syndrome. According to clinical data, a risk regions were determined on the plantar surface of the feet. In-shoe pedography (pedar, novel,Germany) was performed in shoes usually worn by the patients, and in orthopedic shoes“Sursil-Orto”(Moscow). The maximum peak pressure (MPP) was calculated. Criterion of efficiency: MPP in the risk region<200 kPa or reducing it by 25% or more.

RESULTS: There was a significant decrease of the median MPP in the forefoot and in the risk region. The percentage of feet with MPP >200 kPa in the risk region decreased from 58% to 30% (p=0,014), in any area of the forefoot — from 63% to 30% (p=0,04). The increase in MPP under the midfoot and hindfoot did not exceed +14% (ns). Tested footwear was effective in 71% of cases. Predictors of the insufficient effect were: higher initial MPP in the risk region, risk region on the hallux or in the lateral part of the forefoot.

CONCLUSIONS: Shoes with a rigid rocker outsole significantly reduce the pressure under the forefoot and under the toes during walking. The degree of load reduction varies: the lateral part of the forefoot and 2-5 toes are most unloaded, and the hallux and medial forefoot are slightly less.

BACKGROUND: The «gold standart» for surgical treatment of patients with proliferative diabetic retinopathy (PDR is vitreoretinal surgery. However, the question of the timing of the removal of primary cataract in this category of patients remains open.

AIM: To evaluate the efficacy of phacoemulsification of primary cataract by the second stage after vitreoretinal surgery of PDR patients

METHODS: 67 cases of surgery treatment of patients with PDR and complicated primary cataract were enrolled. This patients were divided into two groups depending on the treatment tactics. In the 1st group patients were subjected to a two–step surgical procedure: vitreoretinal surgery with silicone oil tamponade performed as the 1st step in their treatment; followed by the 2d step, phacoemulsifi tion surgery and silicone oil removal, and the IOL implantation, respectively. In the 2d group phacoemulsifi tion performed simultaneously with vitreoretinal surgery: phacoemulsification, IOL implantation, vitreoretinal surgery with silicone oil tamponade. The second step differed in the removal of silicone oil from the vitreous cavity.

RESULTS: Visual functions improved in 88.6% of cases in group 1, and in 68.7% in group 2.

CONCLUSIONS: Outcomes of the preliminary studies suggest that it is more viable to perform phacoemulsification surgery sometime later along with silicone oil removal on PDR patients with complicated primary cataract. This sequence of treatment procedure ensures a more gentle approach to the anatomic structures of the eye during the first stage (vitreoretinal surgery) and contributes to the reduction in the number of intraoperative and postoperative complications.

The clinical picture of primary hyperparathyroidism (PHPT) which caused by parathyroid neoplasms often includes metabolic syndrome leading to the development of cardiovascular diseases. According to clinical studies, an increased incidence of diabetes mellitus, insulin resistance, obesity, dyslipidemia, hyperuricemia and other disorders that signifi tly affect the life span and quality are observed in patients with PHPT regardless of the form and the severity of the underlying disease. Basic research shows the potential nonclassical effects of high levels of parathyroid hormone and calcium on adipose tissue, pancreas, gastrointestinal tract and kidneys. However, the pathogenetic mechanisms of impaired carbohydrate and other types of metabolism in patients with parathyroid hyperfunction remain unclear because of the lack of relevant experimental models and the heterogeneity of patient groups. Besides, the effect of surgery on metabolic abnormalities is also controversial. Nowadays a deeper understanding of this issue is required, which can subsequently help in the creation of optimal approach to diagnosis and treatment of patients. This review covers different aspects of metabolic disorders in patients with PHPT, as well as potential key factors of their development.

The purpose of this review is to analyze existing data on the molecular genetic features of the development of type 1 and type 2 diabetes mellitus, gestational diabetes and specific types of diabetes (maturity onset of diabetes of the young, neоnatal diabetes) and to assess the possibility of precision therapy.

The etiology of diabetes is heterogeneous, and a genetic predisposition plays a significant role in its development. Genetic studies, conducted in the past few decades, allow us to identify a number of genes that directly affect the development of diabetes. The genetic prerequisites indicate high levels of predictability for the occurrence of type 1 diabetes. The only personalized treatment that is known to date for such patients is insulin therapy. For monogenic specific types of diabetes, genetic testing is a diagnostic factor which allows to prescribe adequate therapy. The molecular genetic characteristics of the development of type 2 diabetes and gestational diabetes are very complex and ambiguous, however, the existing rich data will become the basis for future recommendations for the prevention, diagnosis and personalized treatment.

Type 2 diabetes mellitus (T2DM) is the cause of the development of diabetic nephropathy — a complication that determines the high degree of disability and mortality of such patients. Until recently, approaches to normalizing glucose levels did not have a significant possibility of influencing the outcome of kidney damage in diabetes. Type 2 sodium glucose cotransporter inhibitors (SGLT2) are a new class of glucose-lowering drugs that improve glycemic control due to an insulin-independent mechanism of action associated with increased urinary glucose excretion. The review provides an analysis of the results of studies on the assessment of nephroprotective actions — one of the pleiotropic actions of this drugs group. These materials show the properties of SGLT2 inhibitors to reduce the risk of developing and the progression of albuminuria, to save glomerular filtration rate, to reduce the frequency of end-stage renal disease and the need for renal replacement therapy in patients with T2DM. The article gives and analyzes the currently existing hypotheses of the mechanism of action of these glucose-lowering drugs. The risk of the most common renal complications with the use of SGLT2 inhibitors is considered. The practical aspects of the use of SGLT2 inhibitors in modern algorithms for the care of patients with T2DM are indicated, as well as the prospects for new randomized clinical trials.