BACKGROUND: The poor outcomes of chronic hepatitis C (CHC) and type 2 diabetes determine the socio-economic significance of the combined pathology since they lead to premature death. The proportion of patients with type 2 diabetes with markers of viral hepatitis (VH) in the Russian Federation is not known, which does not allow us to estimate the burden for the state of this medical problem.

OBJECTIVE: Assessment of the prevalence of concomitant pathology, HCV infection and type 2 diabetes, as well as the proportion of severe liver damage in its structure, according to the analysis of the primary medical records of four Moscow hospitals.

MATERIALS AND METHODS: A retrospective analysis of the medical records of patients with HCV infection and diabetes mellitus, who admitted at different periods to four hospitals in Moscow, was carried out, as well as a total examination for the presence of anti-HCV in the blood of all patients with diabetes who were admitted within a certain period to the endocrinology department of a multidisciplinary hospital. Additionally, to determine the proportion of patients with liver cirrhosis (LC), an additional examination of patients with this combined pathology was carried out in accordance with the standards for the diagnosis of hepatitis C.

RESULTS: In total, according to data from 4 hospitals in Moscow, over a certain period, 2% (105/5298) of diabetes patients with anti-HCV in their blood were identified. Sex ratio for men: women = 54 (51%): 51 (49%). Patients aged 50–69 years prevailed — 70% (74/105). Seroprevalence of HCV in cohorts of patients with type 2 diabetes according to the analysis in 3 health facilities: 0.9% (20/2196), 1.9% (8/432), 1.9% (28/1500). A significant drawback was revealed that did not allow assessing the true seroprevalence of HCV: not all patients were hospitalized with the results of a VH test, and not all of them were assigned an examination for VH markers if it was not performed before hospitalization. The proportion of type 2 diabetes patients with anti-HCV in the blood according to the results of total screening (3.7%; 16/432) became comparable to the proportion of type 2 diabetes patients among patients with CHC admitted to an infectious hospital (4.2%; 49 / 1170). The proportion of patients with LC according to the analysis of the medical records of the infectious hospital is 65% (32/49), in the group of endocrinological patients with additional examination it is 18% (13/71).

CONCLUSION: For the first time in the Russian Federation, data were obtained on the prevalence of HCV infection in combination with type 2 diabetes. The results of the study indicate the need to develop effective screening programs to detect active HCV infection in the group of patients with diabetes, as well as patients among them with severe hepatic fibrosis for the timely conduct of highly effective antiviral therapy, which will prevent poor outcomes in a separate perspective.

Background: In establishing the diagnosis — type 2 diabetes, there is a trend of multiple increases every year, which is a health issue. According to the state register, the statistics of patients with diabetes in Russia is about 17% of the total population of the country. The prevalence of diabetes is steadily increasing every year. Today, diabetes mellitus is the leader among the prevalence of non-communicable diseases after cancer, cardiovascular diseases, often leading to disability and death.

Aim: To study the relationship between oxidative stress and the «proteinase-inhibitor» system in diabetes mellitus 2.

Materials and methods: An observational single-center single-stage sample study was conducted with the participation of patients with type 2 diabetes mellitus and a control group (practically healthy individuals). the activity of elastase-, trypsin-like proteinases, α1-proteinase inhibitor, the content of bityrosine as an indicator of oxidative modification of proteins and the state of lipid peroxidation were determined by spectrophotometric method in all subjects in blood plasma: the concentrations of TBK-active products and antioxidants-the activity of superoxide dismutase, catalase.

Results: It was shown that in type 2 diabetes mellitus, the content of TBA of active products (an indicator of lipid peroxidation) increases by 2.34 times and the concentration of bityrosine — an indicator of oxidative modification of proteins, which was negatively dependent on the activity of a proteinase inhibitor (-0.79, p=0.03) increases by 7 times. A decrease in the activity of the proteinase inhibitor (by 23%) was accompanied by an increase in the activity of elastase — and trypsin-like proteinases, respectively, by 1.2 and 2.3 times, compared with practically healthy individuals. The activity of antioxidant enzymes, superoxide dismutase and catalase increased by 8.2 and 6.4 times, respectively.

Conclusion: An increase in oxidative stress and oxidative modification of proteins is accompanied by a decrease in the activity of the proteinase inhibitor and an increase in the activity of elastase-, trypsin-like proteinases, as well as antioxidant enzymes.

Children did not escape the COVID-19 pandemic. Although, in general, the course of viral infection in children is mild, the question of the long-term effects of COVID-19 on a child and adolescent, in particular, on pancreatic beta cells, remains unclear.

Аim: Тo study the characteristics of children with diabetes mellitus identified after COVID-19 infection.

Materials and methods: This article presents the preliminary results obtained from children and adolescents hospitalized at the RSSPMCE clinic with the newly diagnosed diabetes mellitus after COVID infection, as well as a systematic review of 61 clinical cases (case series study).

Results: Of the 120 children hospitalized at the RSSPMCE clinic with newly diagnosed diabetes, 15 were diagnosed with diabetes after COVID-19 infection, all in a state of diabetic ketoacidosis. Only 20% of children knew about the previous COVID-19 infection, the course of the disease was mild, in 80% of children the infection was asymptomatic. At the time of diabetes onset, all children had a high level of HbA1c - above 10%, a low level of vitamin D, high levels of antibodies to SARS-CoV-2 (IgG), and the need for insulin was above the average.

Conclusion: The SARS CoV-2 virus could be the direct cause of the development of diabetes mellitus in children, even with the asymptomatic course of the viral infection. However, the question remains about the exact classification of diabetes after COVID-19 in children. It is necessary to inform the population about the first signs and symptoms of diabetes mellitus in order to timely consult a doctor for the diagnosis of diabetes mellitus.

A dangerous viral disease COVID-19, caused by a new RNA coronavirus SARS-COV-2, has been actively spreading in the world since December 2019. The main manifestations of this disease are bilateral pneumonia, often accompanied by the development of acute respiratory syndrome and respiratory failure. Patients with diabetes mellitus (DM) are at high risk of infection with the SARS-COV-2 virus, severe illness and death.

Maintaining of target glycemic levels is the most important factor in a favorable outcome of COVID-19 in both type 1 and type 2 DM. The choice of antihyperglycemic therapy in a patient with DM in the acute period of COVID-19 depends on the initial therapy, the severity of hyperglycemia, the severity of the viral infection and the patient’s clinical condition.

The article presents the recommendations of the board of experts of the Russian Association of Endocrinologists on glycemic control and the choice of antihyperglycemic therapy in patients with type 2 DM and COVID-19, and also on the use of glucocorticosteroids used in the treatment of COVID-19 in patients with type 2 DM.

Diabetes mellitus stays an important medical, economic and social problem worldwide. Infectious diseases in people with diabetes mellitus are often more severe with an increased frequency of hospitalizations and complications. The presence of chronic hyperglycemia leads to decreased immune function and an increased predisposition to infections. Infections lead to uncontrolled hyperglycemia, which worsens the course of infections, thus forming a vicious circle of violations.

Mass vaccination with an emphasis on people belonging to the high-risk group reduces the number of infected and, hospitalized people, and also has clear economic advantages. However, in many countries the proportion of vaccinated remains low.

Vaccine prophylaxis in Russia is regulated by a number of regulatory legal acts, of which the main one is Federal Law No. 157-FZ of September 17, 1998 (edited on July 2, 2021) «About Immunoprophylaxis of Infectious Diseases». Each country has a National Vaccination Schedule, which shows a routine vaccination schedule at a specific age against infections that are widespread and / or pose a serious threat to health and life), as well as a National Epidemic Indication Vaccination Schedule. In Russia, these documents are approved by Order of the Ministry of Health of the Russian Federation of March 21, 2014 N 125n «About the approval of the national calendar of preventive vaccinations and the calendar of preventive vaccinations for epidemic indications.»

This article discusses vaccination against the most socially significant infections associated with a high worldwide prevalence and increased risk among people with diabetes.

RATIONALE. Over the past 20 years the prevalence of type 2 diabetes in Russia has more than doubled and reached 4.43 million people in 2020, while the growth rate keeps increasing. Most patients with T2DM are at a higher risk of developing major adverse cardiovascular events (MACE) associated with significant mortality. There is a strong evidence base that the drugs belonging to GLP-1RA class contribute to reducing the risk of cardiovascular events and renal outcomes. At the same time, the current prescribing rates of these treatments in Russia are quite low - only about 0.1% of patients are prescribed GLP-1RAs, according to Diabetes Registry data.

AIM. Review the results of several randomized clinical trials (RCTs) concerning effects of GLP-1RA treatments on prevention of primary and secondary cardiovascular events and estimate the number of diabetic target population.

MATERIALS AND METHODS. We examined the data from clinical trials on GLP-1RA treatments registered in Russia and used in routine clinical practice (ELIXA, EXSCEL, LEADER, SUSTAIN-6 and REWIND) and data from two meta-analyzes published as of December 1, 2020. The task was to evaluate the inclusion criteria, patient profile, and the clinical efficacy and safety profiles of  the studied therapies. Also, the analysis of clinical information from the Diabetes Registry (DR) was performed to estimate the number of target T2DM patients meeting RCTs inclusion criteria that could benefit from prescribing of GLP-1RAs.

RESULTS. The reviewed clinical trials demonstrated a statistically significant reduction (p <0.05) in the risk of serious cardiovascular events in patients treated with Liraglutide [RR 0.87 (95% CI, 0.78-0.97)], Semagltuide [OP 0.74 (95% CI 0.58-0.95)] and Dulaglutide [RR 0.88 (95% CI 0.79-0.99)]. Meta-analyzes utilizing data from 6 RCTs with the total number of 56,004 T2DM patients, also, confirmed a statistically significant reduction in the risk of developing MACE (by 12%) in the studied population, and a 17% reduction in the risk of combined renal outcomes [RR 0.83 (95% CI 0.78-0.89), p <0.0001]. The DR patient population that met the RCTs inclusion criteria amounted to 538.6 thous. subjects in case of REWIND and 432.4 thous. in case of LEADER and SUSTAIN-6. The key differences between FDR patients and patients engaged in RCTs included gender and age characteristics. The DR patients were generally older and the bulk of them were women, which has to do with overall Russian demographic trends. The proportion of DR patients with established CVD was 26%, which closely matched the profile of patients from REWIND study (31.5%). According to DR data, the number of patients in whom the treatment was intensified following prescription of basal insulin was 7612 per year, which is close to a potential cohort eligible for alternative treatment with GLP-1RAs.

CONCLUSION. All the drugs belonging to GLP-1RA class are clinically effective in reducing the risk of cardiovascular and renal outcomes, while demonstrating a favorable safety profile including with respect to lower risk of developing hypoglycemia. The decreased risk of complications was recorded both in patients with existing cardiovascular risks and patients with established CVD. Of all GLP-1RA treatments available in Russia at this point, the greatest clinical effectiveness is achieved by Liraglutide, Semaglutide and Dulaglutide. The estimated patient population from DR, meeting RCTs inclusion criteria and matching RCTs patient profile was over 500, 000 people with the largest number of patients meeting the REWIND criteria. The target population of patients with T2DM who may potentially benefit from the administration of GLP-1RAs is over 500, 000 people. Out of that number at least 7.5 thousand are patients, whose treatment is intensified following prescription of basal insulin (with an aim of improving glycemic control, but without consideration of cardiovascular risks).

Currently, if we take the real world clinical setting in Russia, the number of patients receiving GLP-1RA treatments is substantially lower than the estimated figures (less than 1%), which requires reconsideration of the approach toward their prescribing as is recommended by state-of-the-art clinical guidelines prioritizing prevention of cardiovascular risks.

Gestational diabetes mellitus (GDM) is characterized as hyperglycemia, first detected during pregnancy, yet not meeting the criteria for “manifest” diabetes mellitus. GDM is one of the most common gestational complications. This pathology is associated with many adverse pregnancy outcomes, both on the part of the mother and the fetus. The problem of identifying GDM has acquired particular relevance and significance for the healthcare system at the moment due to the steady increase in the prevalence of such risk factors of GDM as obesity and late pregnancy. The history of screening and diagnosis of GDM has undergone a number of significant changes in a short time. Currently, different clinical guidelines offer different approaches to GDM screening, thus, a unified approach to identifying this pathology has not yet been formulated and adopted. The purpose of this review was to discover the current clinical guidelines for the detection of GDM at 24–28 weeks of pregnancy, including historical context of their origin and development, to describe these approaches, as well as to critically evaluate them with a discussion of the main advantages and disadvantages of each of them.

Mutations in the GLIS3 gene encoding the GLIS3 transcription factor are cause of a rare syndromic form of neonatal diabetes mellitus (NDM) with congenital hypothyroidism. Additional features include congenital glaucoma, hepatic fibrosis, polycystic kidneys, developmental delay and other anomalies. This disease in foreign literature is called NDH-syndrome (Neonatal diabetes and Hypothyroidism syndrome).

We present the description of a patient with this syndrome with novel homozygous GLIS3 mutation.

Our patient is a female, who was born with a weight of 1680 gr, length of 44 cm to consanguineous parents. She developed diabetes on 2 day after birth, requiring continuous intravenous insulin. On day 5 of life hypothyroidism was identified. ­Thyroid anatomy was normal on ultrasound scan. NDH syndrome was suspected.

Genetic analysis revealed a novel homozygous mutation c.1836delT, p.Ser612ArgfsTer33 in exon 5 in GLIS3 gene.

To date, the patient is followed up for 4 years in total. Currently, growth retardation, psychomotor and speech development persist. Carbohydrate metabolism and thyroid profile has been subcompensated against the background of replacement therapy. No other components of the syndrome have been identified.

In this report, we have demonstrated the features of the neonatal diabetes mellitus in a patient with a defect in the GLIS3 gene. Early genetic verification of the diagnosis contributes to the timely starting of personalized therapy, can improve the quality of life of such patients, and, given the nature of inheritance, is necessary for medical genetic counseling of the family.

MODY10 is a rare subtype of MODY diabetes, which caused by heterozygous mutations in the insulin gene INS. There are single descriptions of families with MODY-INS or MODY10 in the literature, its clinical course is not well understood. We present a case of MODY10 in a boy with a history of diabetes mellitus (DM) in three generations (father and paternal grandmother). Proband was diagnosed with diabetes mellitus at the age of 7 years. The glycaemia at the onset of the diabetes was 10.2 mmol/l, HbA1c — 7.6%, islet cell autoantibodies (ICA), insulin autoantibodies (IAA), glutamic acid decarboxylase antibodies (GADA) and islet tyrosine phosphatase 2 (IA2) antibodies (IA2) were not detected. According to the results of the oral glucose tolerance test, fasting blood glucose was 6.5 mmol/l, in 120 minutes 10.3 mmol/l, which corresponded to the diagnosis of impaired glucose tolerance. Diet with restriction of easily digestible carbohydrates was recommended, than gliclazide was added to the therapy, which the proband received for 3 years. At the age of 10, a deterioration in the parameters of carbohydrate metabolism was noted, which insulin therapy was added. Examination at the age of 12 revealed a decrease in C-peptide secretion. The child’s father has a similar phenotype — slowly progressive disorders of carbohydrate metabolism from 6 years old, from 10 years old — insulin therapy. A genetic test was provided, in the child and his father was detected a previously undescribed heterozygous mutation in the INS p.C31W. Thus, in our clinical case, MODY10 was characterized by a milder course than T1DM, but eventually leading to the development of insulin demand, which distinguishes it from the most common forms of MODY. Currently, there is no specific therapy, and the detection of a mutation in the INS gene does not affect therapeutic tactics, however, a correct genetic diagnosis makes it possible to predict the course of diabetes and provide genetic counseling to the family.