Aims.
To conduct an analysis of modern antihyperglycemic prescription patterns in type 2 diabetes mellitus (T2DM).
Materials and methods.
Russian DM State registry was studied.
Results.
We obtained absolute and comparative data on use of insulin analogues, dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 agonists in treatment of T2DM.
Conclusion.
Percentage of DPP-4 inhibitors and GLP-1 analogues in T2DM treatment patterns remains nominal and does not exceed0.2%, which is significantly lower than in the majority of other countries. Insulin analogues are prescribed considerably more frequentlyand currently appear to be the most promising agents for treatment of T2DM.

Aim. To study prevalence and incidence of type 2 diabetes in the young population of Tyumen region. Materials and methods. The study included 201 adult patient with type 2 diabetes mellitus (DM). The first group included 99 patients with disease onset before 35 years, while the second group included 102 patients with disease onset after 40 years. We have used a Tyumen regional diabetes register data, covering last 10 years period. We assessed the prevalence and incidence of type 2 DM and its vascular complications. Results. The prevalence of type 2 DM in patients with disease manifest before 35 years increased by 2,7 times and the incidence ? by 2,1 times during last 10 years. We noted predominance of retinopathy and nephroopthy in the structure of vascular complications in this group. Conclusion. Patients with type 2 DM onset before 35 years are characterized by increasing prevalence and incidence during last 10 years, as well as rapid development of late diabetic complications with a predominance of microangiopathy.

AIMS: In order to study type 1 diabetes mellitus associations, we conducted a comparative analysis of allele and genotype frequencydistribution of polymorphic markers rs41295061 and rs11594656 of IL2RA gene, which encodes α-chain of interleukin-2 receptor, - and rs2069762, a marker of IL2, gene, encoding interleukin-2.

MATERIALS AND METHODS: Experimental group included 451 patients with type 1 diabetes mellitus (DM); control group consistedof 306 healthy subjects (both groups were represented by ethnic Russians). Alleles and polymorphic markers were identified byreal-time amplification method.

RESULTS: A comparative analysis of patients with type 1 DM and healthy control group did not show statistically significant differencesfrom the viewpoint of allele and genotype frequency distribution of polymorphic markers rs41295061, rs11594656 and rs2069762. This makes Russian patients considerably different from European ones where markers in question show substantialassociation with type 1 DM.

CONCLUSIONS: A comparative analysis of allele and genotype frequency distribution of IL2-RA and IL2 genes polymorphic markersshowed population differences in association of these markers in Russian and European patients.

Aims.
Development of assessment model for type 2 diabetes mellitus (DM) patient stratification for painless ischemic heart disease(IHD).
Materials and methods.
258 patients with DM type 2 participated in this study (109 male and 149 female) of mean age 58.4?8.5 withDM experience of 7.9?6.1 years. All participants were subdivided into three groups: first - DM type 2 without history of painless IHD(138 individuals); second - DM type 2 with diagnosed painless IHD (50 individuals); third - DM type 2 with painful myocardialischemia. We assessed "classic" risk factors for IHD, immediately connected with DM comorbidity, as well as "additional" risk factors,potentially capable of provoking both painless and painful IHD. In addition, we screened our patients for structural abnormalitiesof heart by means of echocardiography. Painless IHD was diagnosed by treadmill-tests or Holter monitoring with submaximal exercise.Accumulated data was statistically processed with the use of Spearman's rank correlation, as well as binary logistic regression method.Results were deemed statistically significant at р<0,05.
Results.
At the first stage all risk factors were analyzed according to Spearman's rank correlation coefficient. We identified 21 parameterwith average (r=0,5-0,7) and high (r>0,7) correlation strength. Next we isolated 11 independent variables with highest predictivevalidity for painless IHD. Based on binary logistic regression method we calculated prediction coefficients and developed a specialmodel, valid for prediction of painless IHD. After adjustment with account of type I and type II errors (with 50/50 ration), predictivevalidity of our model reached 76% with confidence limit of 95%.
Conclusion.
Only 11 of all assessed risk factors ("classic", "specific" and "additional") showed to have high predictive validity fordevelopment of IHD. Based upon our data, we offer an assessment model suitable for identification of patients at high risk of IHDdevelopment in everyday clinical practice.

Hypoglycemia is a frequent event in patients on insulin therapy. Current clinical and experimental evidence shows hypoglycemia tobe a cause of arrhythmia and, possibly, a link to increased mortality risk in patients with diabetes mellitus. This review addressesprobable mechanisms and pathogenic factors of arrhythmia development due to hypoglycemic events. We adduce data accumulatedon rates of hypoglycemia, as well as their correlation with cardiovascular and general mortality according to ACCORD, ADVANCEand VADT trials.

Aim.
To reveal the role of inflammatory markers (homocystein (HC), interleukin-6 (IL-6)), components of hemostatic mechanism ofcoagulation in the development of diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM).
Materials and methods.
A total of 240 patients with T2DM and DN were examined.
Results.
Negative correlation between HC level and glomerular filtration rate (GFR) (r= -0,38) and positive correlation between IL-6and fibrinogen (r=0,55) were observed.
Conclusion.
Inflammation and changes in mechanism of coagulation have influence on development and progression of DN in patientswith T2DM.

Aim.
To compare efficacy of special structured program for type 1 diabetes mellitus (DM) group education between users of an integratedreal-time (RT) continuous glucose monitoring (CGM)/continuous subcutaneous insulin infusion (CSII) systems and patientson CSII and self-monitoring of blood glucose (SMBG).Methods.
This 4 months trial included 39 adults (18 male, age 27 [24,0;35,0] years) with type 1 DM (duration of diabetes 12[8,0;18,0] years). All subjects were randomized to study groups: 20 in the CSII/SMBG arm and 19 in the RT-CGM/CSII arm. Allparticipants were provided with special structured program for group education of diabetes patients on insulin pump therapy. Qualityof life (QoL) was assessed with questionnaire SF-36.
Results.
Both groups were not significantly different in HbA_1c, BMI and QoL at baseline. After 4 months HbA_1c was significantly lowerin both study groups without increase in rate of hypoglycemia. Improvements in QoL were observed in psychic health score in the CSII/SMBG arm and in physical health and psychic health scores in the RT-CGM/CSII arm. There was no significant difference in HbA_1c,BMI and QoL between groups.
Conclusion.
Transfer to CSII during group training under special structured program for patients with type 1 DM significantly improvesglycemic control regardless of glucose monitoring method. Both RT-CGM+CSII and SMBG+CSII amend several aspects of QoL.Finally, transfer to CSII during group training considerably reduces total consumption of trainers time without loss of training quality.

Endothelial dysfunction and aberrations of haemostasis play an important part in development of cerebrovascular disorders in patientswith diabetes mellitus. Such factors as hyper- and hypoglycemia, hyperinsulinism, insulin resistance and excessive weight affect progressionof microcirculation deficiency and cerebral ischemia. Transcranial Doppler ultrasound examination is useful as a noninvasivemethod of hemodynamic assessment.

During latest decade, as threat of acute complications of diabetes mellitus was surmounted, cardiovascular complications became leadingcause of death. Clinical manifestation of coronary, brachiocephalic and renal atherosclerosis is quite dramatic in diabetes mellitus,which determines extent of dissemination and intensity of lesions. Combination of these mutually confounding conditions is a characteristicproblem of patients with diabetes mellitus. Presence of 2+ risk factors (one of which is diabetes mellitus in itself) requiresactive examination in order to rule out coronary, brachiocephalic, peripheral and renal artery lesions. Aggressive care is necessaryin order to control progression of disease and administer adequate conservative and endovascular treatment with account of high riskof combination of lesions.

Aims.
To evaluate combination and manifestation sequence of metabolic syndrome (MS) components, as well as cardiovascular riskfactors in women.
Materials and methods.
We examined 100 female subjects with MS. We assessed anthropometric parameters, glycemic control andlipid metabolism. We also conducted cardiac ultrasound in all participants.
Results.
44% of patients developed abdominal obesity after pregnancy, 48% - in perimenopausal period and in 8% of studied casesobesity manifested in combination with arterial hypertension 10 years before menopause (at the average). Family history of type 2diabetes mellitus and obesity, elevation of LDL and TG characterized post pregnancy abdominal obesity. Postmenopausal obesity wasassociated with significantly lower levels of HDL. HDL concentration was also lower in cases of histerectomia and early age of surgicalmenopause.
Conclusion.
Manifestation of MS in females is associated with periods of hormonal imbalance. Cardiovascular risk positively correlateswith number of pregnancies, duration of abdominal obesity experience, and negatively - with HDL level and age of surgical menopause.Complete form of MS (with all 6 components present) is found more frequently in women with postmenopausal manifestation.

Prevalence rate of diabetes mellitus worldwide and in Russian Federation is epidemic in its nature. Prospective studies have shown thatmaintenance of glycemic target reduces risk of late vascular complications. In turn, strict glycemic control requires modern approach tointensification of glucose lowering therapy. Randomized clinical trials prove capacity of modern insulin analogues to improve glycemiccontrol while decreasing risk of hypoglycemic events and weight gain. Current paper presents initial data on 9342 patients, participatedin multicenter prospective 52-week observational study A1chieve, conducted in order to assess efficiency and safety of treatment withinsulin analogues Levemir?, NovoMix? and NovoRapid? (Novo Nordisk) in daily management of patients with type 2 diabetes mellitus,who never received that treatment before.

Diabetes mellitus is a serious medical and social problem in many countries. Nowadays it is well known that most of therapeutic goalscan hardly be reached without patients willingness to take active part in the process of treatment. Thus therapeutic training in diabetesself-management is a necessity. Today different new options in the field of therapeutic education are developing rapidly. Amongthem are training via internet and other telecommunication systems, electronic diaries, various dose calculators, wizards and?simulators?. Many of such approaches show their clinical and economic effectiveness, thus indicating need for further developmentof this sphere.

We report a case of diabetes mellitus, manifested against the background of hormone replacement therapy after treatment of Cushingdisease.

Renal allotransplantation is the most effective and safest mode of renal replacement therapy in patients with diabetes mellitus (DM),and currently is recognized as method of choice for patients with end-stage renal disease. Due to variety of factors damaging transplantedkidney in patients with DM, issues of long-term survival of the graft constitute a serious problem. Therefore, special attentionshould be directed at correction of rejection risk factors in order to prolong graft survival - and prevent development and progressionof chronic allograft nephropathy.