Aim.
To evaluate epidemiological situation with respect to diabetes morbidity in the Omsk region during 2002-2008.
Materials and methods.
This prospective cohort study used official statistical reporting forms № 12. A total of 1398 Acts of medical and social assessment,Statistical cards (form № 25), Minute books of medico-social examination commissions, and Collected information-statistical materials ondisability situation in the Omsk region were available for analysis.
Results.
A stable trend toward reduction of unfavourable outcomes of diabetes mellitus (DM) (complications, physical disability and mortality) hasbeen documented despite overall enhancement of DM morbidity in the region.
Conclusion.
The study revealed improved rehabilitation records among disabled diabetics.

Aim.
To analyse frequency distribution of alleles and genotypes of -23 HphI, a polymorphic marker of the INS gene, for evaluation of its associationwith DM1.
Materials and methods.
The study included two group of subjects: healthy ones and DM1 patients. Genotyping was performed by real time amplification.
Results.
Comparative analysis demonstrated association between -23 HphI polymorphic marker of INS gene, and type 1 diabetes mellitus.
Conclusion.
The use of the case-control method revealed association of -23 HphI, a polymorphic marker of the INS gene, with type 1 diabetes mellitus.

This review was designed to evaluate mechanisms of adaptive immunity in DM1. Special attention is devoted to such immunological concepts as antigen,long-term immunological memory, central and peripheral tolerance. Current views of the role of interleukins in DM1 are discussed.

Aim.
To evaluate effectiveness of different modes of per os therapy of painful diabetic peripheral polyneuropathy with alpha-lipoic acid.
Materials and methods.
This work is a prospective open randomized comparative clinical study including 4 parallel groups of patients. Group 1(n=31) comprised patients given 600 mg ALA daily (two 300 mg tablets at a time), group 2 (n=28) 600 mg ALA daily (two 300 mg tablets in succession),group 3 (n=35) 900 mg ALA daily (three 300 mg tablets at a time in the morning), group 4 (n=27) 900 mg ALA daily (three 300 mg tablets in succession30-40 min before meals). Active treatment lasted 3 months.
Results.
Beneficial effect of 3 ALA tablets on neurologic symptoms estimated by NTSS-6 and 9 scales was significantly more pronounced than that oftwo 300 mg tablets taken either once or twice a day. The groups were analysed in terms of the number of patients who achieved or failed to achievethe end point of therapy (responders, n=86 and non-responders, n=29). The HbA_1c level and the degree of sensory deficit were shown to begood predictors of therapeutic efficiency. There was moderate correlation between HbA_1c level (>8%), NIS LL and NIS LL-sensory function points,and frequency of response to ALA therapy (r=0.251; p=0.007 // r=0.32; p=0.00077 // r=0.32; p=0.0015 respectively). Patients having HbA_1c<7.0% showed maximum dynamics of NTSS-6 and 9 points.
Conclusion.
Intake of ALA tablets (300 mg thrice daily) causes marked reduction of neurologic symptoms estimated by NTSS-6 and 9 scales. Thefrequency of pain relapses depends on the initial HbA_1c level rather than on the previous scheme of ALA therapy. High HbA_1c (>8.0%) and severedisturbances of sensory function (e.g. monofilament resistance) may be used as predictors of therapeutic efficiency.

Aim.
To evaluate clinical efficiency of sulodexide (glycosoaminoglycan) for the treatment of patients with type 2 diabetes mellitus (DM2) and diabeticnephropathy (DN) at the stage of microalbuminuria (MAU).
Materials and methods.
A total of 30 patients with DM2 and MAU were examined 15 of whom were given sulodexide (200 mg daily) for 6 months.The following parameters were measured before, 3 and 6 months after the onset of therapy: HbA_1c level, biochemical characteristics, highly sensitiveCRB, MAU in morning urine samples, soluble intercellular and vascular cell adhesion molecules-1, blood coagulation and anticoagulation factors(PTI, fibrinogen, thrombin time, coagulation factors VII, VIII, X, Willebrand factor), tissue plasminogen activator, and its inhibitor.
Results.
Sulodexide produced significant positive effect on albumin excretion in urine. It exerted antithromotic and profibrinolytic action and improvedendothelial function. Taken together, these properties of sulodexide give reason to recommend it as a protector of different vascular segments.
Conclusion.
Significant positive effect of sulodexide on albumin excretion in urine coupled to its multifactor activity, convenience of therapeutic application,low risk of complications, good tolerability, and safety in aged patients with DM2 permit to consider it as a promising tool for the treatmentof DM2 with MAU.

Цель. Изучение влияния терапии классическими и атипичными антипсихотическими препаратами (АА) на динамику толерантности к глюкозе и некоторых показателей липидного обмена. Материалы и методы. Обследовано 50 больных с развившимся впервые в жизни психотическим эпизодом, отвечающим критериям па- раноидной шизофрении (МКБ ? 10). В первую группу вошли больные, получающие галоперидол, вторую группу составили пациенты, по- лучающие атипичные антипсихотические препараты (АА). Использовались биохимический, антропометрический, статистический методы. Результаты. У 12% пациентов, получавших АА, выявлено нарушение толерантности к глюкозе на 8 неделе терапии, у 4% больных ? сахарный диабет (СД). Заключение. Терапия с использованием атипичных антипсихотических препаратов оказывает существенное влияние на состояние уг- леводного обмена у больных параноидной шизофренией по сравнению с галоперидолом.

Aim.
To study association between obesity and renal pathology in patients with type 2 diabetes mellitus (DM2).
Materials and methods.
The study included 106 patients with CD2 (41 men and 65 women) of mean age 60.0?7.0 years. Exclusion criteria wereduration of DM2 less than 5 years and manifest diabetic nephropathy (DN) (glomerular filtraton rate (GFR) below 60 ml/min/m2, albuminuria over2 g/24 hr). Anthropometric parameters measured included body mass index (BMI). Serum creatinine, uric acid, lipid spectrum, hormones of adiposetissue (leptin and adiponectin) were determined. Severity of renal pathology was estimated from GF and albumin excretion in urine. The patients were categorized into 2 groups: with obesity (BMI>=30 kg/m2) and without it (BMI<30 kg/m2).
Results.
Occurrence of microalbuminuria and proteinuria increased with the degree of obesity (p<0.05). Patients with BMI>=30 kg/m2 more frequently presented with disturbed intrarenal dynamics (hyperfiltration), elevated arterial pressure, and reduced LVLD level than patients with BMI<30 kg/m2. Leptin levels increased with BMI. All patients with proteinuria showed hyperleptinemia. 89% of the DM2 patients had hypoadiponectinemia. Adiponectin levels dropped in DN at the stage of microalbuminuria compared with control. Patients with DN at the stage of proteinuria exhibiteda rise in adiponectin.
Conclusion.
Patients with DM2 and obesity (BMI>=30 kg/m2) more frequently develop renal pathology than in the absence of obesity. It suggests anindependent role of obesity in the development of DN in addition to specific mechanisms of renal pathology intrinsic in DM. This effect of obesity ismediated through the enhancement of hemodynamic and metabolic disorders coupled to the negative influence of adipose tissue hormones.

Aim.
To evaluate effectiveness of unloading immobilization bandages manufactured from Soft Cast and Scotchcast materials.
Materials and methods.
The study included all patients (n=39) with diabetic foot ulcers treated with the use of total-contact cast technology (TCC)from 01.10.2007 to 01.03.2009. 31 patients presented with neuropathic foot ulcers and 8 with neuroischemic ulcers (in the absence of critical foot ischemia).26 and 13 were managed using non-removable and removable casts respectively. All were given standard local treatment of ulcers, supplementedby antibacterial therapy in 20 patients.
Results.
Treatment resulted in the healing of ulcers in 31 (79%) patients during 40.5?32.9 days (M?SD) (median 27, min 7, max 11 days). In 28(72%) of them, healing required 12 weeks to complete. TCC had to be removed in 8 (21%) patients because of low efficiency or complications. Newulcers or abrasions related to the use of TCC developed in 10 patients but treatment was discontinued only in one of them. We distinguished a subgroupof 12 patients comparable in terms of major characteristics (plantar stage 1A and 2A neuropathic ulcers according to Texas University classification)and unloading method (non-removable cast throughout the treatment period) with patients included in earlier randomized studies. In this subgroup,healing of 100% ulcers was completed within 12 weeks (median 22 (13-74) days).
Conclusion.
1. Efficiency of TCC in our practice is comparable with that in earlier publications. 2. The use of TCC is indicated not only for thetreatment of uninfected plantar neuropathic ulcers but also in some cases of neuroischemic and non-plantar ulcers. 3. Skin lesions from TCC is oflittle clinical significance and can be avoided by specialized education of the medical personnel involved in TCC manufacture.

High prevalence of arterial hypertension and related cardiovascular complications dictates the necessity of preparations possessed of markedorganoprotective activity and good tolerability. The currently available data suggest advantages of iACE and ARB as preparations for the treatmentof cardiovascular diseases such as ability of iACE to improve clinical picture and outcome of therapy of cardiac insufficiency, left ventricle dysfunction,and myocardial infarction. Large-scale prospective studies demonstrated effectiveness of these agents in the treatment of CHD, stroke, diabetes, renalpathology and revealed their additional advantages attributable to inhibition of angiotensin II secretion other than those related to reduction of AP.These studies gave evidence of a more pronounced decrease in the frequency of cardiovascular events under effect of ARB in high-risk patients. However,protective action of ARB on the cardiovascular system compared with that of iACE and combination of ARB+iACE awaits an in-depth study.

Aim of this study was to investigate the effect metformin to carbohydrate, lipids metabolism and leptin level in impaired glucose tolerance (IGT)patients.Methods.
16 patients with IGT were studied. Age of participant was 55.1?8.2 yrs. All patients was divide into two groups: treatment group (bagomet1700 a day and diet) and control group (only diet). Effect of therapy was access in HbA_1c, fasting glucose (FG), HOMA, lipids, liver glucose production(LGP) and leptin, which investigate in intravenous glucose tolerance test (IVGTT).
Results.
Normalization of carbohydrate metabolism was discover in 37.5% in treatment group and in 12.5% in control group. HbA_1c was decreasefrom 6.4 to 5.9 % (р<0.05), LGP was decrease from 4.6?1.3 mmol/l to 3.0 ?1.7 mmol/l and HOMA also was decrease in treatment group. We foundout significant decrease low-density lipoprotein and triglyceride levels in treatment group. We didnt find a change leptin level in treatment group.
Conclusion.
The therapy of bagomet leads to normalization of carbohydrate metabolism in 37.5% persons with IGT.

Diabetes mellitus (DM) is believed to be the third most frequent direct cause of death after cardiovascular and oncological diseases. Therefore, solutionof DM-related problems is a major challenge facing health authorities in many countries. No doubt, strict control of glycemia is an indispensablecondition for the reduction of the frequency of diabetic complications. Indeed, many strategies developed in the recent years allowed metabolic controlin DM patients to be significantly improved. Basic and clinical research of the last decade provided a basis for the development of highly promisingtrends in the treatment of CD2, such as the use of incretins. Inhibitors of dipeptylpeptidase-4 (DPP-4) including Galvus (vildagliptin) and GalvusMet (vildagliptin + metformin) have been available in this country for the last 2 years. International studies showed high efficiency and safety of bothagents. They help to achieve adequate glycemic control in the absence of side effects and complications. Galvus significantly reduces daily variabilityof glycemia that is known to be a risk factor of severe vascular complications of DM. Another advantage of these drugs is they can be used by agedpatients at risk of cardiovascular disorders suffering hypertension. An example of combined therapy using Galvus Met in a DM2 patient is presenteddemonstrating markedly improved glycemic control, blood glucose dynamics, and quality of life. Galvus and Galvus Met can be prescribed as aninitial treatment in combination with all traditional oral hypoglycemic agents and insulin.

Aim.
To identify risk factors of macro-microvascular lesions at different stages of pathological process in patients with type 1 diabetes mellitus andmicrogiopathy of different severity.
Materials and methods.
Comprehensive analysis of parameters of metabolism, hemogram, platelet and plasma hemostasis in 121 patients (67 menand 54 women of mean age 28.2?10.7 years) with type 1 diabetes mellitus and angiopathy of different severity.
Results.
All patients had hyperglycemia along with dysproteinemia and altered lipid spectrum. Mean platelet volume and aggregation activity increasedwhile activated partial thromboplastic time decreased compared with control subjects regardless of the presence and severity of microangiopathy.
Conclusion.
Morphological and functional characteristics of platelets and activated partial throm-boplastic time are differently related to metabolicchanges.

Aim.
To elucidate changes in the immunity status of patients with type 1 and 2 diabetes mellitus (DM) and pyelonephritis (PN).
Materials and methods.
The study included 48 patients with type 1 and 2 diabetes mellitus and acute pyelonephritis and 15 ones with pyelonephritiswithout DM. Bacteriological study of urine in the acute phase of the disease was supplemented by evaluation of phagocytic activity, NBT test, measurementof circulating immune complexes, T and B-lymphocyte populations and subpopulations (CD3, CD4, CD8, CD16, CD19, CD95), HLA-DR,determination of lymphocyte immunoregulatory index and serum IgA, G, M, E levels. All patients were given identical antibacterial, anti-inflammatory,and detoxication treatment.
Results.
Patients with DM and PN suffered more pronounced disturbances of phagocytosis, humoral and cellular immunity than those with PN withoutDM. Immunity changes in DM1 and DM2 patients were similar, but the former had smaller phagocytic reserve and lower CD8, CD19, IgM, and IgElevels than the latter. Immunity status in DM1 and DM2 patients with PN was related to the duration of diabetes.
Conclusion.
Greater changes in the immune system of DM (especially DM1) patients with PN account for the enhanced frequency of upper urinarytract diseases.

Aim.
To study Actovegin efficacy in oxidative stress (OS) correction at diabetic polyneuropathy (DPN) in patients with diabetes mellitus type 2 (DM2)and arterial hypertension (AH).Materials and Methods.
51 patients (24 women and 27 men) aged 53.4?0.7 with the average duration of DM2 5.6?0.2 years, DPN - 4.9?0.2years and AH - 6.0?0.2 years were examined. Daily albuminuria, glomerular filtration rate (GRF) were evaluated, standard methods for diagnosisof DPN were used. 26 patients took Actovegin therapy during 6-8 weeks, the rest 25 patients were in the control group. Parameters of the OS werestudied.
Results.
The increase of total oxidative capacity, the decrease of total antioxidant capacity and the rise of levels of antibodies to oxidated LDL wererevealed in patients with DM2, DPN and AH. Antioxidant and anti-hypoxic effects of 400 mg/day of Actovegin were established in this group of patients.Conclusions. Actovegin impacts oxidative stress parameters and improves the clinical manifestation of diabetic polyneuropathy.

Aim.
To compare different methods for surgical treatment of cataract in patients with diabetes melli-tus (DM) and substantiate the choice of its optimalmodality.
Materials and methods.
Analysis included data on 209 patients (221 eyes) treated from January 2008 to December 2009 in the Department ofRetinopathy and Ophthalmosurgey, Endocrinological Research Centre. Diabetic cataract was managed using UNIVERSAL-II, LEGACY EVEREST,and INFINITI phacoemulsifiers. Parameters studied included time of ultrasound (US) ex-posure, US power, and retinal characteristics in the earlypostoperative period. In addition, analysis included data on the location of lens opacity in 1047 patients (1897 eyes) with diabetic cataract.
Results.
Relatively low corrected and uncorrected visual acuity in the early postoperative period was attributable to concomitant DM-related retinalpathology. Analysis of lenticular opacity showed that it in the first place affected collagen fibers beneath the posterior capsule. The use of torsional USin INFINITI for cataract phacoemulsification produced almost 4-fold reduction in the exposure time of ocular tissues. As a result, the postoperativeoedema was significantly smaller than in patients undergoing combined treatment (AQUALASE hydromonitoring and OZIL ultrasound system).
Conclusion.
Combination of ultrasound and hydromonitoring phacoemulsification for the treatment of cataract in DM patients reduces exposure timeof ocular tissues and postoperative oedema which creates prerequisites for faster recovery of visual acuity after surgery. Functional results of surgicaltreatment of diabetic cataract can be further improved by early diagnosis of lens opacity and the use of US and hydromonitoring phacoemulsificationtechniques.

Aim.
To study effect of duration of diabetes mellitus on the prevalence of diabetic retinopathy (DR) in patients with type 2 diabetes (DM2) andmetabolic syndrome (MS) or without it.
Materials and methods.
The study included 115 patients with type 2 diabetes and metabolic syndrome and 45 patients with DM2 without MS (controls).Of 115 MS patients and of 45 control ones, 42 and 17 respectively presented with different forms of DR. Ophthalmological examination was performedby generally accepted methods including visiometry, tonometry, biomicroscopy, ophthalmoscopy, and fluorescent angiography.
Results.
The study revealed a well-apparent tendency toward an increase of DR occurrence in MS patients with duration of DM2 (10.0%, 53.1%,82.6% during 0-4, 5-9, and 10 or more years respectively). Significant difference between DR incidence was recorded in MS patients having DM2for 0-4 and 5-9 years (p<0.001, FET). Similar difference was documented in MS patients with the duration of DM2 5-9 and 10 or more years(p<0.01, FET). Analogous tendency was observed in control group (20.8%, 53.8% and 62.5%). The difference between DR incidence in control patientswith DM2 0-4 and 5-9 years in duration was statistically significant (p<0.01, FET) unlike the difference between DR incidence in DM2 of 5-9 and over 10 years (p >0.05, FET). Correlation between occurrence of DR and HbA_1c levels failed to reach statistical significance (r bs = 0.023,p>0.05 in MS patients and r bs = 0.064, p>0.05 in controls).
Conclusion.
Occurrence of DR increases with duration of DM2 with and without MS but fails to correlate with HbA_1c levels in either condition.

Aim.
To evaluate efficiency of Gemaza used to treat hemophthalmia of different severity and localization.
Materials and methods.
Gemaza (5000 IU) was admnistered parabulbarly to 75 patients (78 eyes) with diabetes mellitus (DM) after dilution in0.5 ml of 0.9% sodium chloride solution. Each patient received 10 daily injections during baseline hypoglycemic therapy. Control group was comprisedof 20 patients (20 eyes) with hemophthalmia, treated by traditional drug therapy (emoxipin, dicinon, ascorutin, actovegin).
Results.
Gemaza proved a highly efficient agent showing hemoresorptive and fibrinolytic activities; it improved visual acuity in 51.3% of the patientsfrom day 5 after the onset of therapy.
Conclusion.
It is recommended to administer Gemaza soon after hemorrhage, prior to the development of proliferative processes in the vitreous bodyand retina.

In this systematic review the analysis of hypoglycemia and cardio-vascular events was analyzed due to therapy by SU and other secretagenes. Accordingto more then 1400 publications from 1984 to 2009 there is no clear data of increasing hypoglycemia and cardio-vascular events by using micronisedglibenklamide (glyiburide) in comparison to other medications.

Aim.
To compare efficiency of two regimes of basal therapy with human insulin analogs glargin (Lantus) once daily and detemir (Levemir) twicedaily based on their hypoglycemic action (HbA_1c<7%) and the absence of verified symptomatic hypoglycemia.
Materials and methods.
The study included patients aged 40-75 years with DM2 and poor control of glycemia (7%?HbA_1c?10.5%) under stabletherapy with oral hypoglycemic agents (OHA) in the absence of previous insulin therapy. They were randomized (1:1) into two groups one treatedwith glargin (at supper or at bedtime), the other with detemir (at breakfast and before supper). Dose titration continued until the plasma glucose (PG)level of 5.6 mmol/l was reached before breakfast in both groups and before supper (in group 2, detemir). Previous therapy with tiasolidindions waswithdrawn while therapy with secretagogues (sulfonylurea and glinids) was either continued or discontinued at the investigators discretion. Metformintherapy continued at a constant dose throughout the 24 week study period.
Results.
A total of 973 patients were randomized between group 1 (glargin, n=486) and group 2 (detemir, n=487). Mean age of the patients was58.4?8.3 yr, men to women ratio 54.7/45.3%, mean HbA_1c level 8.7?0.9%, duration of DM 9.9?5.8 yr. 130 (27.5%) patients in group 1 and121 (25.6%) in group 2 achieved the primary end point (HbA_1c<7%) in the absence of verified symptomatic hypoglycemia (95% CI [-3.78%, 7.48%]); HbA_1c<7%: 44.1% in group 1 and 47.8% in group 2 (p=0.254);HbA_1c<6.5%: 22.7% in group 2 and 16.5% in group 1 (p=0.017). Mean HbA_1clevel after completion of the study was 7.2?0.9% in group 1 and 7.1?0.9% in group 2. In both groups it was lower than the initial value (-1.46?1.09% and -1.54?1.11%). The intergroup differences were insignificant (p=0.149). Advantages of therapy were equally well-apparent with respectto selected secondary end points.
Conclusion.
Viewed from the pharmacoeconomic standpoint, results of the study show that glargin and detemir are equally efficacious in terms of hypoglycemiceffect and safe in terms of the risk of hypoglycemia but the former analog has some advantage over the latter because it permits to achievethe targeted level of glycemia after single daily injection at a lower dose

Treatment of patients with diabetic foot syndrome (DFS) is a major medico-social problem facing public health services. One of its important aspectsis high cost of the treatment. In connection with this, not only medical but also economic issues pertinent to DFS have recently been widely discussedin different countries. Clinico-economic analysis of the use of new medicinal products, therapeutic modalities, and established medical technologiesis of primary importance for making decisions concerning allocation of available financial resources. The present review of foreign publications focuseson the studies providing additional arguments in favour of modern efficacious methods for the management of DFS. The review is intended to motivateclinicians and health officials to revise current approaches to the treatment of DFS patients in this country.