INTRODUCTION. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are the treatment options with comprehensive action on different aspects of type 2 diabetes. Due to its peptide nature GLP-1 RAs, until recent time the delivery of these agents into patients’ organism was via injectable devices. In 2019, the first time in history oral semaglutide was registered based on the results of PIONEER clinical trial program, since 2021 this drug is available in Russia. However, the pathophysiology of type 2 diabetes and local treatment approaches may differ in different populations; this can lead to the differences in the efficacy and safety of newly registered drug. Therefore, it is necessary to evaluate the response in different populations. In this paper we report the result of subanalysis of efficacy and safety of oral semaglutide in Russian patients.

OBJECTIVE. The aim of this analysis is to evaluate efficacy and safety of oral semaglutide in Russian patients, who participated in semaglutide clinical development program, as well as to evaluate consistency and applicability of the results obtained from global population in that program.

MATERIALS AND METHODS. Patients from PIONEER 1, 2, 3 were included in the analysis: 150 patients from Russian, 1956 — the rest patients from these trials. Reductions in HbA1c and body weight were analyzed in both cohorts, and treatment differences were tested for interaction. Similarly, the rate of adverse events was analyzed.

RESULTS. Reduction in HbA_1c in oral semaglutide arms in both cohorts showed numerically similar and consistent result. Interaction test showed statistical difference in PIONEER 1 data (p=0.0268) — the effect was due to diminishing influence of substantial response in placebo arm in Russian cohort. In longer-term trials (PIONEER 2 and 3) this finding was not confirmed (p=0.7459 and p=0.4906, respectively). In regard to body weight reduction there were more numerically pronounced results in Russian cohort compared to global population; although statistical significance were not reached in any of the trial (p>0.05). There was lower rate of reported adverse events in Russian patients compared to the rest cohort.

CONCLUSION. This analysis showed similar efficacy and safety of oral semaglutide in Russian patients compared to global population of patients from clinical program.

BACKGROUND: The prevalence of Type 2 diabetes mellitus (T2DM) has reached epidemic proportions and it is estimated to affect over 400 million people worldwide. Moreover, the incidence of diabetes is expected to continue to rise and it is projected to affect nearly one of the three individuals by the year 2050. These alarming projections suggest that there is an urgent need for the development and implementation of novel prevention and treatment strategies to combat the rise in T2DM.

AIM: To study the possibility of using polymorphisms of genes SLC30A8 and MC4R as markers for predicting the development of T2D in the population of Novosibirsk.

MATERIALS AND METHODS: On the basis of prospective follow-up of a representative population sample of residents of Novosibirsk (The HAPIEE Project), 2 groups were formed according to the “case-control” principle (case — people who had diabetes mellitus 2 over 10 years of follow-up, and control — people who did not developed disorders of carbohydrate metabolism). T2D group (n = 443, mean age 56.2 ± 6.7 years, men — 29.6%, women — 70.4%), control group (n = 532, mean age 56.1 ± 7.1 years, men — 32.7%, women — 67.3%). DNA was isolated by phenol-chloroform extraction. Genotyping was performed by the method of polymerase chain reaction with subsequent analysis of restriction fragment length polymorphism, polymerase chain reaction in real time. Statistical processing was carried out using the SPSS 16.0 software package.

RESULTS: Genotype TT rs13266634 of the SLC30A8 gene was associated with the risk of developing T2D (relative risk — RR 1.51, 95% confidence interval — CI 1.11–2.05, p =0.008). The CC genotype rs13266634 of the SLC30A8 gene was associated with a protective effect against T2D (RR 0.57, 95% CI 0.35–0.92, p=0.026). No significant effect of rs17782313 of the MC4R gene on the risk of developing T2D was found.

CONCLUSION: The rs13266634 polymorphism of the SLC30A8 gene confirmed its association with the prognosis of the development of T2D, which indicates the possibility of considering it as a candidate for inclusion in a diabetes risk score. The association between polymorphisms rs17782313 of the MC4R gene and the prognosis of the development of T2D was not found.

BACKGROUND: Low muscle mass increases the risk of developing type 2 diabetes mellitus (DM 2) and prediabetes. Nutrition is an important factor in the study of the relationship between low muscle mass and the development of glucose metabolic disorders.

AIM: The present study was conducted to assess the relationship between prediabetes and low muscle mass on the basis of serum creatinine levels, taking into account patient nutrition.

MATERIALS AND METHODS: The study included 551 patients aged 18–69 years without DM 2. The glucose level was determined based on fasting glucose and after an oral glucose tolerance test (OGTT). Hyperglycemia is assessed according to the classification of the World Health Organization. The MedDietScore questionnaire was used to assess the nutritional factor, which determines the adherence of patients to the Mediterranean diet. In order to assess odds ratios (OR) and 95% confidence interval (CI), a binary logistic regression was performed.

RESULTS: The prevalence of prediabetes in the group with the lowest and highest blood creatinine level was 31.9% and 17.5% respectively (p=0.016). As a result of the conducted regression analysis, a statistically significant relationship was found between low creatinine levels and the chances of having prediabetes (crude OR 2,07, 95% CI 1,21; 3,56), which persisted after adjusting for socio-demographic, anthropometric factors, stress level and physical activity as well as muscle strength. After adding the data on MedDietScore to the statistical model, the revealed relationship was lost (p = 0.187).

CONCLUSION: Low serum creatinine increases the chances of the presence of prediabet regardless of gender, age, body weight index, the volume of the hips, the ratio of the volume of the waist to growth, as well as physical activity, the level of stress and muscular power. However, the chances of the presence of prediabet do not differ in persons with low creatinine blood depending on the commitment to the Mediterranean diet among the population of those living in the Turkestan region.

BACKGROUND: Observation of changes in the volume and size of the pancreas has a long history, however, the results of studies are still not unambiguous, the specific causes of changes in pancreatic volume, as well as their consequences, are not clear. According to some data, the decrease of pancreas volume in life expectancy is 35–45% in the population of patients with a long history of type 1 diabetes, and about 20–25% during the first year of the disease. Interestingly, in T1D in 20–45% of cases, the development of exocrine pancreatic insufficiency is noted, one of the manifestations of which is pancreatic atrophy, leading to a decrease in life expectancy.

AIM: Assess the volume and size of the pancreas, as well as factors that can influence on their changes.

MATERIALS AND METHODS: The study included 78 patients with type 1 diabetes mellitus, the control group consisted of 23 people without previously identified disorders of carbohydrate metabolism, comparable in age and anthropometric parameters with the study group. RESULTS: The volume and dimensions of the pancreas were statistically significantly less in patients with T1D than in the control group. In addition, the influence of the duration of T1D and the age of onset of the disease on these indicators has been proven.

CONCLUSION: The volume and size of the pancreas in patients with T1D is less than in healthy individuals. It is necessary to  study the effect of these changes on the function of the pancreas.

BACKGROUND: Oxidative stress may be one of the mechanisms for the development of complications in DM and many forms of CKD. However, the influence of this factor on the metabolism of sialoglycoconjugates, which actively participates in the regulatory processes of the body, is unknown.

AIM: comparative study of the effect of lipoic acid on the parameters of liver sialoglycoconjugate metabolism in rats with alloxan diabetes mellitus.

MATERIALS AND METHODS: Studies were conducted on white male rats weighing 180–220 grams. The animals were divided into three groups: in the animals of the first and second groups, alloxan diabetes mellitus (DM) was caused by a single subcutaneous injection of alloxan tetrahydrate (AT). Animals of the second group received lipoic acid intramuscularly; the third group consisted of intact rats. On 5, 10, 20, 30 and 40 days after the injection of AT, a comprehensive examination of the animal’s condition was performed: 1) determination of the level of glycemia; 2) assessment of the degree of development of oxidative stress by the content of TBK-active products in the liver; 3) study of the dynamics of the exchange of sialoglycoconjugates in the liver (free, oligo-and protein-bound sialic acids, sialidase activity).

RESULTS: The study was conducted on 106 rats, each experimental group had 48 animals, control — 10. It was found that the administration of α-lipoic acid to rats with alloxan diabetes leads to a decrease in the level of glycemia. The introduction of lipoic acid in experimental animals did not reduce the sialidase activity and the content of all sialic acid fractions in the liver, although it reduced the degree of oxidative stress in the body.

CONCLUSION: Supplementation of lipoic acid in experimental animals did not significantly decrease sialidase activity and content of the sialic acid fractions under study in the liver, although it did reduce the degree of oxidative stress development in the organism. The increased rate of sialic acid metabolism in the liver of alloxan-diabetic rats may indicate a restructuring of hepatocyte metabolism to adapt the whole organism to prolonged hyperglycemia under insulin deficiency conditions.

Diabetes mellitus type 1 (T1D) develops as a result of the interaction of genetic and environmental factors. Genetic predisposition to T1D turns into clinical reality only in half of hereditary cases, which indirectly indicates the importance of external factors, the significance of which is periodically reviewed. Retrospective and prospective clinical foreign and national studies were included. PubMed, Medline and eLibrary were searched. Modern ideas about the possible impact of the main prenatal and postnatal environmental factors on the development of autoimmune response against insulin-producing islet cells and T1D were discussed. The risk of developing type 1 diabetes is determined by the complex interaction of environmental factors and genetic predisposition. The mechanisms of their influence remain rather unknown. Further research is needed to determine strategies of primary and secondary prevention of T1D.

Heart failure (HF) is a pressing public health problem. According to the literature, the presence of diabetes mellitus (DM) significantly increases the risk of repeated hospitalizations and the length of hospital stay in patients with heart failure. The proportion of HF remains high due to increased life expectancy, higher prevalence of risk factors and improved survival rates. Currently, advances in the treatment of coronary heart disease (CHD) and valvular disease have significantly improved survival rates, but the prognosis for heart failure remains extremely poor. Among the most important medical problems, heart failure occupies a special place in patients with type 2 diabetes. DM contributes to the onset of HF through a variety of mechanisms, including a complex of specific structural, functional, and metabolic changes in the myocardium called diabetic cardiomyopathy. Despite the active study of the causes of cardiomyopathy, the search and implementation of new approaches in assessing the risk of developing this pathological phenomenon in patients with heart failure remains relevant. This review examines current hypotheses for the development of diabetic cardiomyopathy, such as insulin resistance, endothelial dysfunction, fibrosis, lipotoxicity, and energy disorders.

In today`s therapy of type 2 diabetes mellitus, SGLT2 inhibitors have taken their rightful place both due to their positive hypoglycemic and outstanding cardiorenometabolic effects. Recent randomized clinical trials, such as DAPA HF, EMPEROR-Reduced and EMPEROR-Preserved, show the benefits of their use in the treatment of patients with chronic heart failure without regard to the status of type 2 diabetes mellitus and so significantly expands the range of use of SGLT2 in the practice of doctors of various specialties. This review presents not only the results of the most significant studies of SGLT2 inhibitors, but also the main approaches to the starting therapy with this class of drugs in various clinical situations, both inpatient and outpatient. In addition, potential adverse events and limitations associated with the use of SGLT2 inhibitors are discussed in detail, which must be taken into account when prescribing in particular patient. The practical aspects of SGLT2 inhibitors` prescription are considered separately through the prism of their safe use in the perioperative and postinfarction periods, as well as during other special conditions. Particular attention is paid to the monitoring of physical and general examination data and laboratory instrumental tests, the consideration of which will minimize adverse events and best benefit for many cardiological, endocrinological and nephrological patients.

The review article describes modern approaches to hypoglycemia in diabetes mellitus (DM) patients, its clinical and laboratory diagnostics, and its current classification. Hypoglycemia has the highest impact on cardiovascular morbidity and mortality, including stroke. Cerebral damage in neuroglycopenia, as well as neurological aspects in this group of patients, are discussed. The authors describe glycopenia’s influence on cerebral metabolism, counter-regulatory response, and impaired hypoglycemia recognition, as well as modern neuroimaging techniques that may enhance differential diagnostics in complex cases. The epidemiology of neurocognitive disorders in DM patients and their association with hypoglycemic conditions is outlined, together with psychosocial aspects of its consequences — both for the patient and relatives and for the medical professionals. The search for ways to reduce the burden of hypoglycemia from the standpoint of an effective and safe strategy for treating patients with type 2 diabetes does not lose its relevance, and therefore data on the prevalence of hypoglycemic conditions of varying severity when using certain classes of hypoglycemic drugs are presented. A therapeutic approach that maximizes metabolic control while reducing hypoglycemia to a minimum may determine further possibilities for personalized DM management.

According to the decision of the WHO, therapeutic education (TE) of patients is an independent branch of medicine and an essential component of the treatment of chronic diseases, primarily diabetes mellitus and obesity. TE is implemented through the creation of “Schools for patients with diabetes mellitus” and “Schools for patients with overweight” (“Schools”) as a structural unit of a medical institution. On April 25–26, 2022, the First All-Russian Forum «Therapeutic Education in Endocrinology» was held online, organized by the Public Organization «Russian Association of Endocrinologists», which was attended by leading experts in this field. As a result of its work, this Resolution was adopted by the experts. It discusses the methodological and pedagogical foundations of TE, it is proposed to make changes related to the organization of the work of «Schools», tariffing in the obligatory health insurance system, and training of personnel, including nurses.