Dear Colleagues!

We are glad to present the 12th Edition of the Standards of Specialized Diabetes Care.

These evidence-based guidelines have been designed to standardize and facilitate diabetes care in all regions of the Russian Federation.

The Standards are regularly updated to incorporate new data and relevant recommendations from national and international clinical societies, including World Health Organization (WHO), the Russian Association of Endocrinologists (RAE), the International Diabetes Federation (IDF), the European Association for the Study of Diabetes (EASD), the American Diabetes Association (ADA), the American Association of Clinical Endocrinologists (AACE), the International Society for Pediatric and Adolescent Diabetes (ISPAD), as well as the results of completed randomized clinical trials in patients with DM.

The number of people with diabetes in the world has increased threefold over the past 20 years. In 2024, according to the International Diabetes Federation (IDF Atlas, 11th Edition, 2025), the number of people with diabetes in the world was 588.7 million people, 40% of whom were not diagnosed in time. More than 1 billion people have prediabetes (impaired glucose tolerance and/or impaired fasting glucose). Like many other countries, Russian Federation experiences a sharp rise in the prevalence of DM. According to the data of the Endocrinology Research Centre, obtained on the basis of the analysis of the “Clinical and Epidemiological Monitoring Database” (https://www.diaregistry.ru/) there were 5,463,982 people with DM in our country (3.5% of the population) on 01.01.2025: 92.4% (5,046,037) – type 2 diabetes, 5.5% (298,919) – type 1 diabetes and 2.1% (119,026) – other types of diabetes, including 10,010 women with gestational diabetes.

However, these data underestimate the real number of patients, because they consider only registered cases of DM. Results of the Russian epidemiological study (NATION) confirmed that 54% of type 2 diabetes cases were undiagnosed. Thus, the real number of patients with diabetes in the Russian Federation is at least 11-12 million people (about 7% of the population). This represents an extreme threat. The most dangerous consequences of the global epidemic of diabetes are systemic vascular complications – nephropathy, retinopathy, coronary artery disease and peripheral vascular disease. These complications are responsible for the majority of cases of diabetes-related disability and death.

This edition preserves the individualized approach to the selection of treatment goals in patients with diabetes and the choice of antihyperglycemic therapy.

The most important updates:

• Methods of glucose control. The list of actually used continuous glucose monitoring (CGM) systems has been updated, conditions are listed when the use of CGM is inappropriate.
• Targets of lipid control. The SCORE2-Diabetes scale of the European Society of Cardiology has been taken into account (further relevant for determining individuals with a high risk of ASCVD in the section “Personalization of the choice of antihyperglycemic agents depending on the patient’s dominant clinical problem”).
• Prevention of type 1 diabetes. This section is presented for the first time. The advisability of determining autoantibodies in first-degree relatives of patients with type 1 diabetes has been clarified.
• Diabetes mellitus in children and adolescents. Type 1 diabetes mellitus. Glycemic control goals in childhood have been adjusted (ISPAD, 2024). The specifics of using CGM have been clarified.
• Type 2 diabetes mellitus. Treatment.

– A new class of drugs for type 2 diabetes is presented – dual GIP/GLP-1 agonists. The position of tirzepatide in type 2 diabetes treatment has been determined.

– The position of combination therapy when initiating type 2 diabetes treatment has been strengthened.

– Information on the comparative efficacy, advantages and disadvantages of antihyperglycemic agents has been updated.

– The section on personalizing the choice of antihyperglycemic drugs has been updated: the use of the SCORE2-Diabetes scale has been proposed for patients with a high risk of atherosclerotic cardiovascular diseases (ASCVD); the ranking of drugs in patients with CKD has been changed (taking into account the results of the FLOW study, semaglutide has been classified as a first-line drug); priority drugs for the treatment of type 2 diabetes in NAFLD have been identified.

• Acute complications of diabetes mellitus. The section on diabetic ketoacidosis has been significantly updated.
• Diabetic nephropathy. The possibility of using cystatin C for diagnostics has been clarified. Information on the use of antihyperglycemic drugs at various stages of CKD has been adjusted.
• Diabetes mellitus in pregnancy. The possibility of using metformin in patients with type 2 diabetes during pregnancy planning (before pregnancy) has been clarified. The positions of possible use of metformin during pregnancy have been determined.
• Non-alcoholic fatty liver disease in diabetes mellitus. This section is presented for the first time. The main diagnostic issues are briefly outlined, and the preferred antihyperglycemic agents for use are determined.
• Diabetes mellitus in the elderly. The possibility of selecting more stringent treatment goals when used in an elderly patient in the case of using agents with a low risk of hypoglycemia is determined.
• Menopausal hormone therapy in diabetes mellitus. The section is presented for the first time.
• Contraception in diabetes mellitus. The section has been significantly revised.

“Standards of Specialized Diabetes Care” have been a reference book for almost a quarter of a century not only for endocrinologists, but also for a wide range of doctors of other specialties. The advantages of the “Standards” are a concise, structured and visual presentation of information, and due to regular updates, every 2 years, a quick presentation of the most relevant data. This is the result of the work of a large team of authors and therefore allows us to cover a wide range of problems of patients with such a heterogeneous disease as DM.

The working group draws attention to the fact that the information contained in the “Standards of Specialized Diabetes Care” reflects the key positions of approved clinical guidelines, but at the same time the “Standards” are not regulatory legal documents mandatory for execution in the territory of the Russian Federation, but are generally informational and advisory in nature. Legally binding documents that have priority are the current versions of the relevant clinical recommendations posted in the rubricator of the Ministry of Health of the Russian Federation (https://cr.minzdrav.gov.ru).

On behalf of the Working Group