Dear Colleagues!

We are glad to present the 12th (revised) 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 5,814,928 people with DM in our country (3.9% of the population) on 01.01.2026: 92.3% (5,366,995) — type 2 diabetes mellitus, 5.3% (308,605) — type 1 diabetes mellitus and 2.4% (139,328) — other types of diabetes, including 20,982 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:

• Type 2 Diabetes Mellitus remission criteria. Information on ICD-10 code E11.A has been added to indicate remission of type 2 diabetes in patients without complications.
• Type 2 Diabetes Mellitus. Treatment.
  • Information on drugs available in the Russian Federation has been updated.
  • In patients with ASCVD, tirzepatide (a dual GIP/GLP-1 receptor agonist) is considered as one of preferred options (based on the results of the SURPASS-CVOT study, which assessed the effect on cardiovascular risk compared to dulaglutide).
  • The section on insulin therapy examines the possibilities of its deintensification; comments are provided for clarifying the role of concentrated insulin forms and ultra-rapid-acting insulins.
• Monitoring of patients with T2DM. HbA1c monitoring may be reduced to once every 6 months in patients who have consistently achieved target glycemic control (in patients without hypoglycemia or factors that could potentially distort HbA1c).
• Prevention of T2DM. A fasting plasma glucose level ≥ 6.1 mmol/L has been added as a criterion for the greater expected efficacy of metformin as the agent for pharmacological prevention.
• Diabetic nephropathy in T2DM. In antihyperglycemic therapy, SGLT2 inhibitors are prioritized due to their proven benefits in reducing the risk of CKD progression and cardiovascular events.
• Diabetic neuropathy. Visual materials with methods for assessing tactile and vibration sensitivity have been added.
• Diabetes and Heart Failure. Information has been added on the use of GLP-1 RAs (GLP-1 /GIP RAs) in patients with type 2 diabetes, obesity and heart failure.
• Diabetes mellitus and dyslipidemia. This section is presented as a separate part of manuscript for the first time. The feasibility of testing lipoprotein (а) levels for all patients to clarify cardiovascular risk once during life once during life has been determined. The position of bempedoic acid has been clarified for the first time. Approaches to the treatment of hypertriglyceridemia have been updated.
• Diabetes mellitus in children and adolescents. Type 1 diabetes mellitus. Glycemic targets have been revised according to ISPAD, 2024.
• Epidemiological data on diabetes mellitus in the Russian Federation have been updated.
• Some inaccuracies have been corrected.

“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