Current document presents a coherent viewpoint of Russian Association of Endocrinologists and Russian Association of Obstetriciansand Gynaecologists on diagnostic criteria of gestational diabetes mellitus (GDM) and other glycemic disorders during gestation. Currentapproach is based on analysis of high-profile multinational study HAPO (Hyperglycemia and Adverse Pregnancy Outcomes Study),which included more than 23 000 pregnant women. This project was repeatedly reviewed on workgroup sessions and presented orallyon 6th Russian Congress of Endocrinology with international participation, as well as Russian interdisciplinary educational congressGestational Complications and Premature Delivery.

77 male patients (mean age 47?7.4 years) without ischaemic heart disease were tested for metabolic syndrome factors, risk for developmentof type 2 diabetes mellitus (T2DM) according to FINDRISK questionnaire, following with assessment of intracellularmetabolism parameters of neutrophils. Increased risk for T2DM positively correlated in these patients with myeloperoxidase activity,level of hydrogen peroxide within neutrophils and BMI. We observed elevation of oxygen-dependent metabolism in neutrophils formpatients with morbid obesity, accompanied with decrease in antioxidant factors, which is suggestive of oxidative stress.

Aims.
To assess contribution of therapeutic training, blood glucose self-monitoring and general improvement of glycemic control on development ofchronic heart failure (CHF) in patients with type 2 diabetes mellitus (T2DM).
Materials and methods.
We conducted a prospective, open-label, non-controlled before/after study. 80 patients with T2DM took part in this trialafter initial hospitalization for decompensation of both CHF and diabetes (НbА1с>=8.0%). Therapeutic training as well as provision of tools and consumablesfor self-monitoring was arranged for all patients. Therapeutic goal was set to lowering НbА1с for?1% by the end of 12 months of follow-up.
Results.
We observed lowering of НbА1с values from 9.3% [8,4-10,6] to 8.8% [7,6-10,0] (р<0.001), while number of patients with regular hypoglycemicexperience decreased from 25 (35%) to 10 (14%), р=0.003. 28 patients (39%) reached the therapeutic goal. CHF progression was observedin 9 patients (32%) from this subgroup, as compared with 25 patients (57%) from the subgroup which failed to reach the therapeutic goal (p=0.04).
Conclusion.
Therapeutic training and regular self-monitoring are effective in improvement of glycemic control in patients with T2DM and CHF.Decrease in НbА1с for?1% by 12 months results in deceleration of CHF progression in patients with T2DM.

Aims.
To study influence of combined treatment with human insulin analogues (insulin aspart and insulin detemir) on glycemic control,insulin resistance and development of ischaemic heart disease (IHD) in patients with type 2 diabetes mellitus (T2DM) and frequenthypoglycemic events in comparison with that of human insulins (soluble and isophane).
Materials and methods.
54 patients (mean age 61.2?0.7) with T2DM and IHD participated in this study. All included patients experiencedfrequent mild and moderate hypoglycemic events (3+ episodes per week). We analyzed frequency and severity of hypoglycemia,parameters of glycemic and lipid metabolism, number of ischaemic episodes per day, duration and depth of ST depression, circadianindex, incidence of different types of arrhythmia and conduction abnormalities as measured by Holter ECG monitoring.All patients were subdivided into two groups by random sampling: 21 patient (first group) carried on with human soluble insulin andisophane in an optimized basal-bolus regimen. In 33 patients, comprising second group, treatment was changed for combination ofinsulin aspart (NovoRapid?, Novo Nordisk, Denmark) and insulin detemir (Levemir?, Novo Nordisk, Denmark). Follow-up periodwas set to 6 months.
Results.
In patients with frequent hypoglycemic experience different types of arrhythmia and heart conduction abnormalities wereobserved in 75.9% of cases. Most patients had complex types of arrhythmic disorders (70.4%) with ventricular extrasystole being themost common one. Signs of myocardial ischaemia were registered in 48.1% of patients.After 6 months of follow-up patients from the second group demonstrated a statistically significant decrease in fasting and postprandiallevels of glycemia (p=0.000001). Both groups also had a significantly lower rate of hypoglycemic events. Moreover, in the second groupall episodes of hypoglycemia were mild and occurred only in 36.4% of cases. Additionally, after 6 months of treatment with humaninsulin analogues ventricular extrasystoles were registered only in 24.2% of patients, while rate and duration of ischaemic episodesdropped to 4.25?1.51 (p=0.012, comparing with first group).
Conclusion.
Treatment with human insulin analogues NovoRapid? and Levemir? is associated with 1.6% decrease in HbA_1c levels.Mild hypoglycemia was 72.2% less frequent, as compared with rates in the group on human soluble and isophane insulin, while moderateand severe hypoglycemic events were not observed at all. In turn, decrease in frequency and severity of hypoglycemia was associatedwith substantial improvement in cardiovascular status due to lower number and duration of ischaemic episodes (including painlessvariant) and lower frequency of heart rhythm disorders.

Aims.
To analyze basic clinical characteristics, inhospital therapeutic approaches and outcomes in patients with acute coronary syndrome(ACS) and diabetes mellitus (DM).
Materials and methods.
Patients were included in this study according to the protocol, established for Russian ACS Registry (RECORD),based on data from 18 hospitals operating in 13 Russian cities.
Results.
796 patients took part in the current study. 15.6% reported diagnosis of DM at admission. We observed positive correlationbetween initial glycemic levels and presence of DM (r=0.43; р<0,001). Patients with DM were elder and more often had othercardiovascular risk factors, signs of chronic heart failure and increased GRACE score at admission. However, therapeutic approachdid not significantly differ between patients with and without DM, while hospital mortality rate was substantially higher in diabeticpatients as compared to non-diabetic (16.9% and 5.2%, respectively; p<0,0001). We determined a certain dependence of outcomeson the aggressiveness of treatment. In particular, we show that percutaneous coronary intervention and clopidogrel were more effectivein patients with DM, who suffered from ST-elevation ACS (STEACS).
Conclusion.
Patients with ACS and DM comorbidity tend to have worse prognosis, and diagnosis of DM is an independent predictor oflethal inhospital outcomes. Nevertheless, treatment tactics remains similar between patients with DM and without it.

Aims.
To determine popularity and variants of blood glucose self-monitoring in patients with type 2 diabetes mellitus (T2DM) as wellas its correlation with efficiency of antihyperglycemic therapy.
Materials and methods.
Current study was carried out within the framework of mobile diabetes centre project. We analyzed 545 patients,assessing their clinical status, laboratory test results (including HbA_1c levels) and self-monitoring frequency.
Results.
49% of patients reported regular self-monitoring, while 25% conducted monitoring of both fasting and postprandial bloodglucose levels. Percentage of patients performing self-monitoring was found to be independent of age and length of diabetes experience,but correlated with insulin therapy and rating of chronic diabetic complications. Self-monitoring was associated with lower rate ofdiabetic decompensation and was much more common among patients on insulin therapy, being associated with statistically significantreduction of HbA_1c levels.
Conclusion.
Self-monitoring is associated with greater efficiency of antihyperglycemic treatment in patients with T2DM on insulintherapy, as well as in those receiving oral agents only.

Due to progressive nature of diabetic nephropathy (DN) and limited effectiveness of therapeutic efforts at clinically overt stages, diagnosisof pre-clinical (and, therefore, potentially reversible) DN is especially important. To date, however, test for microalbuminuriaremains the only technique applicable for early diagnostics of DN. Current review addresses search for potential markers of pre-clinical stage of DN in patients with type 1 diabetes mellitus and embracesdata from latest experimental and clinical studies in this area.

Aims.
To assess differences in blood formed elements aggregation activity in patients with type 1 (T1) and type 2 (T2) diabetes mellitus(DM).
Materials and methods.
We studied blood samples from 88 patients with T1 and T2 DM. Platelet aggregation activity was assessed bymeans of ?Biola? aggregometer; we also determined platelet-lymphocyte and leucocyte-erythrocyte adhesion intensity.
Results.
We show that spontaneous platelet aggregation is markedly increased in patients with T1DM but remains normal or slightlyelevated in case of T2DM. In blood from patients with T2DM platelet aggregation in response to ADP, epinephrine, ristomycineand contact with collagen was generally increased, whereas in T1DM we often observed its secondary reduction. Data on plateletlymphocyteadhesion in T1DM is controversial, but in T2DM this process seems to be significantly suppressed. Quantity of leucocyteerythrocyteaggregates was sharply increased in both T1DM and T2DM.
Conclusion.
We've determined significant difference in blood formed elements aggregation activity between patients with T1 and T2 DM.

Current review addresses diagnostic issues and treatment of patients with diabetes mellitus (DM) and pyoinflammatory diseases ofENT organs. We discuss etiologic and pathogenetic factors affecting course of pyoinflammatory processes in ENT organs of diabeticpatients

Diabetes mellitus type 2 remains one of the most significant chronic diseases. More than 552 million individuals (one of every teninhabitants of the planet) are estimated to have diabetes mellitus to 2030. Early incapacitation and high mortality rates resulting fromlong-term diabetes complications constitute social significance of carbohydrate metabolism disorders. Despite modern advances intreatment, most diabetic patients are not adequately compensated, requiring intensification of insulin therapy. Pre-mixed insulins areone of the most advanced options of treatment intensification.

Arterial media calcification is a common finding in diabetes mellitus (DM) and is associated with distal symmetric neuropathy. Arterialcalcification also emerges as a complication of chronic kidney disease and is considered to be a risk factor for cardiovascular andgeneral morbidity. "Calcification" is actually not an accurate term, because morphologic alterations also include bone tissue formationor "ossification". Both processes are complex and exist in tight connection with bone homeostasis. Connection between distal symmetricneuropathy and arterial calcification suggests that neuropathy may be an independent risk factor for cardiovascular morbidity.

It is now well established that clinical use of statins for primary and secondary prevention of cardiovascular complications in patientswith diabetes mellitus (DM) increases life expectancy. At the same time, meta-analysis of major randomized trials shows statins to increaseglycemic levels and incidence of diabetic symptoms, especially in patients at risk for developing glycemic disorders. However,comparison of positive and negative effects of statins suggests prevalence of clinically beneficial factors.

At present time four groups of medications are used to correct dyslipidemia: bile acid sequestrants, niacin, fibric acid derivatives andstatins. During last years statins' potential to increase risk of type 2 diabetes mellitus (T2DM) is actively discussed, though no commonopinion about the possible mechanism of such effect has evolved as yet. Insulin desensitizing effect as a class feature of statins remainsa disputable question.Position of statins as a first-line therapy for severe hyperlipidemia seems undoubted; however they do not improve insulin sensitivity.Moreover, several studies reported increased risk of T2DM. It is feasible to consider combined treatment (including metformin) inpatients from risk groups for development of T2DM, receiving statins

Current article presents commentary on official inclusion of cardiovascular prophylaxis in indications for Diabeton MR therapy. The paper features extensive review of data from ADVANCE (Action in Diabetes and Vascular Disease: PretarAx and DiamicroN Modified Release Controlled Evaluation) trial and its comparative analysis with other major randomized studies of intensive glycemic control in patients with type 2 diabetes mellitus.

Current review analyzes pharmacological and clinical aspects of glimepiride from perspective of the evidence-based medicine. We aimedto determine position of glimepiride within modern antihyperglycemic dialectics of safety and efficacy. We also address cardioprotectiveproperties of glimeperide due to its anti-atherogenic activity, capacity to correct endothelial dysfunction and hemostatic system, as wellas absence of inhibitory effect on ischemic preconditioning.

We present two atypic clinical cases of ?middle? proliferation in patients with proliferative stage of diabetic retinopathy. Both patientsunderwent hospitalization in Department of diabetic retinopathy and ophthalmic surgery of Endocrine Research Centre, Moscow.We conducted full-scale endocrine and ophthalmologic examination, including A/B scanning.?Middle? proliferation in diabetic retinopathy should be considered a severe disorder and managed in conjunction of endocrine andophthalmologic approaches. Adequate and timely compensation of diabetes mellitus combined with vitreoretinal surgery may substantiallyimprove prognosis in such patients and reduce the risk of incapacitation.