Aim.
To assess main epidemiological characteristics (prevalence, morbidity, mortality) of type 1 diabetes mellitus (DM1) in children of the RussianFederation and its federal okrugs (districts) in 2001-2008.
Materials and methods.
The research was based on questionnaries designed in the Pediatric Endocrinology Institute of Endocrinology Research Center.
Results.
There were18,028 children aged 0-14 years with DM1 as per 01.01.2009. As many as 2,789 new caseswere diagnosed in 2008. The meanprevalence as per 01.01.2009 was estimated at 72.28 (24.88-90.63), morbidity 11.25 (3.39-14.06), mortality 0.07 (0-0.26) per 100,000 childrenspopulation.The absolute increment in morbidity from 2001 to 2008 was 1.69, growth rate 117.7%, accession rate 17.7%, mean annual rate for the8-year study period 2.2%. Morbidity is predicted to reach 13.2 per 100,000 in the next 5 years (2013). The highest morbidity recorded in the Uralokrug (14.73/100,000) exceeded that in the North-West okrug (13.63/100,000 as per 01.01.2009) where it was maximum in the preceding years.Morbidity in the Privollzhsky, Far East and Siberian okrugs remained unaltered (11.06, 7.3, 10.6 respectively), decreased in the Southern okrug(8.0) and increased in the Central okrug from 13.3 in 2007 to 14.3/100,000 in 2008. The overall prevalence of DM1 among children in Russia increasedfrom 54.6 to 72.28 per 100,000.
Conclusion.
The main tendentious in DM1 epidemiology in children in RF are comparable with those worldwide.

The risk of type 1 diabetes mellitus (DM1) depends in the first place on the presence of predetermining HLA DR haplotypes, DQ genes, and specific autoantibodies.Aim.
Prospective observation of DM1 risk groups (healthy sibs of DM patients) for the elucidation of the role of genetic and autoimmune abnormalities in thedevelopment of DM1.
Materials and methods.
Predetermining and protective haplotypes (HLA-DRBI, DQ genes) in combination with immunological markers (autoantibodiesto cytoplasmic structures of betbeta-cells (ICA), anti-insulin autoantibodies (IAA), anti-glutamate decarboxylase autoantibodies (GAD)) were studied in healthysibs of mean age 11.9?5.8 years selected from 143 discordant families of patients with DM1. In addition, a random sample of 599 DM1 patients (mean age7.5?6.2 years) was enrolled for molecular genetic studies (HLA-DRBI-DG genes). The control group comprised 200 subjects.
Results.
DQAI*0501-DQB1+0201 (DQ2) and DQAI*0301-DQBI*0302 (DG8) haplotype heterozygosity creating the highest risk of DM1, the healthy sibswere divided into 3 risk groups. The high risk group 1 (DQ2/DQ8) included 23 (13.5%) subjects, moderate risk group 2 (DQ2/X, DQ8/X) 85 (59.7%), andlow risk group 3 (X/X; X - any haplotype besides DQ2, DQ8) 63 (36.8%). The frequency of autoantibodies (AB) of 2 or 3 species in group 1 was higher thanin groups 2 and 3 (26.1, 14.1, 11.1% respectively, p>0.05; 8.7, 2.4, 0%, p<0.05). A single AB species also occurred more frequently in group 1 than in groups2 and 3 (52.1, 27.6, 26.2%). GAD were more frequent in DQ2/DQ8 group compared with groups 2 and 3 (65, 37.9, 18% respectively, p<0.05). The same istrue of IAA (19, 12.9, 3,7%, p1.3<0.05).There was no significant difference in the ICA occurrence between the groups. Manifestation of DM1 during the 11-year observation period was documented in 11 (6.4%) subjects, in agreement with the DM1 risk estimates for healthy sibs obtained in early population studies.The disease was diagnosed in 8.7% of the sibs in group 1, 8.0% in group 2, and 3.3% in group 3. 82% of the new patients expressed high-risk haplotypes(DQ2/DQ8 genotype occurred in 18.2%, DQ2/X and DQ8X in 63.6% cases, and only18.2% patients had no predisposing haplotypes). 73% of the new patientswere AB-positive and 27% AB-negative. Sibs from group 1 were AB-negative 1-5 years before manifestation of DM1 when 85.7% and 100% of the sibs fromgroups 2 and 3 were AB-positive. ICA were detected in 16.7%, GAD in 66.6%, and CAD+ICA in 16.7% of the cases in group 2; ICA at significant titers occurred in 100% of the cases in group 3. The absence of AB in the newly diseased sibs from groups 1 and 2 can be accounted for by the wave-like character of the autoimmuneprocess or the destruction of most betbeta-cells (decrease in antigenic determinants responsible for immune reactions on their surface).
Conclusion.
The study confirmed that the presence of DQ2,DQ8 haplotypes in healthy sibs increases the risk of DM1 while their absence do not reliablyguarantee protection from the disease

Patients with diabetes mellitus (DM) are predisposed to diffuse and rapidly progressing forms of atherosclerosis which significantly increasesthe probabilityof surgical revascularization of myocardium. However, unique pathophysiological features of atherosclerosis in DM patients are responsiblefortheirunusual reaction to an arterial injury associated with percutaneous coronary intervention (PCI).Numerousstudies showed that DM is an independentrisk factor of restenosis following successful balloon angioplasty or stenting of coronary arteries and significantly increases the need forsecondary myocardial revascularization that compromises the outcome of the treatment.Preliminary data indicate that the use of drug-releasing stentsdecreases the need for repeat interventions in both diabetic and non-diabetic patients without negative effect on certain clinical end-points, such asmyocardial infarction and mortality. Any surgical intervention causes less pronouncedimprovement of the clinical picture or prognosis in patients withfunctional class I or II angina of effort compared with optimal medicamental therapy. Surgical revascularization, PCI and aortocoronary bypasssurgery (ACB) is indicated to patients that remain symptomatic despite adequate conservative therapy. The choice of an optimal revascularizationstrategy is of primary importance for DM patients with multiple lesions in the coronary system. Randomized studies comparing multivascularPCI withballoon angioplasty and holometallic stents demonstrated the advantage of ACB for DM patients who showed a higher survival rate, lower frequencyof infarctions and secondary revascularization. Certain authors demonstrated that ACB surpasses PCI even when drug-releasing stents are used.It may be hoped that the ongoing randomized studies comparing the two modalities will help to develop the optimal strategy for myocardial revascularizationindiabetic patients.

The frequency of diabetic complications remains high despite the development of improved therapeutic modalities. Macroangiopathy continues to bethe predominant complication while coronary heart disease is the main cause of mortality.This paper considers clinical features of diabetic patientswith coronary heart disease and critical limb ischemia; various aspects of optimal drug therapy, preoperative examination and diagnostics precedingvascular non-cardiac surgery; preoperative risk assessment; indications for coronary angiography and myocardial revascularization. The authors emphasizethe importance of development of algorithms for the treatment of patients with diabetes, critical limb ischemia, and coronary heart disease.

The modern algorithm of hypoglycemic therapy for patients with type 2 diabetes mellitus (DM2) has been designed to effectively reach the ?target?blood glucose and HbA_1c levels associated with the lowest mortality rate.The most popular scheme is combined treatment with metformin andsulfonylureasthatmakes possible the achievement of the ?target? metabolic indices in the majority of DM2 patients. However, specific cardiovascular efficiency ofthis therapy is a matter of controversy. The safest modalities of combined therapy are discussed based on the analysis of relevant epidemiological data.

Aim.
To study psychologic and neurologic characteristics and their interrelationship in patients with type 2 diabetes mellitus (DM).
Materials and methods.
The study included 167 women aged 54.2?0.4 years with DM2 9.9?0.51 years in duration. Severity of DM was estimatedfrom the presence of late complications and labile clinical course of the disease. Diabetic peripheral polyneuropathy was diagnosed basedon clinical symptoms, NSS and NDS scales. The psychological status was studied by the Spielberger-Khanin method with the assessment of reactive(situational (PX-1) and personal (PX-2) anxiety.
Results.
Most CD2 patients presented with moderate (NDS) and severe (NSS) polyneuropathy. It became aggravated as DM duration increased,with subjective symptomatics prevailing over objective one. The psychologic status of the patients was characterized by moderate depression andfrequent anxiety episodes in which personal anxiety prevailed over situational one. The latter was associated with macroangiopathy and thelatter with severe polyneuropathy. Depression most frequently occurred in patients with CHD, obesity, and decompensated carbohydrate metabolism.
Conclusion.
The above peculiarities of psychologic and neurologic status of DM2 patients should be taken into account when planning their outandinpatient treatment and education.

Aim.
To study quality of life (QL) in young patients with type 1 diabetes mellitus (DM1) depending on clinical characteristics, diabetes-related behaviour,and demographic indices.
Materials and methods.
The study included 89 patients (25 men aged 18-28 years) with DM1. Exclusion criteria were newly diagnosed DM, terminalstages of diabetic complications, severe concomitant somatic and psychic diseases. The patients filled the socio-demographic questionnaire, theirHbA_1c was measured. QL was estimated using the Audit of Diabetes Dependent Quality of Life (ADDQoL) questionnaire and general well-beingbased on the Well-Being Questionnaire 12 (W-BQ12). In addition, the frequency of glycemia self-control was determined as an aspect of the diabetes-related behaviour.
Results.
Mean age of the patients was 22.3?3.0 years, mean duration of DM 9.6?5.8 years, mean HbA_1c level 9.7?2.4%. It was shown that CD1has negative effect on all QL aspects (integrated significance of effect based on all scales -1.8). The most seriously affected aspects were dietaryfreedom (-2.9), professional and physical activities (-2.9 and -2.8 respectively), feeling secure about the future (-2.6). ADDQoL did not reveal a relationshipbetween any of these aspects and the HbA_1c level. However, results of W-BQ12 suggest a rise in HbA_1c associated with the high frequencyof negative emotions (r=-0.242, p = 0.023) and the low level of general emotional well-being (r=-0.253, p=0.019). Progressive diabetic nephropathyhad negative effect on professional activity (r=-0.317, p=0.025), financial well-being (r=-0.242, p=0.025), ability to move over a distance (r=-0.215,r=0.046), and ability to do something (r=-0.295, p=0.006). The highest QL level was documented in the patients who controlled glycemia 1-2 timesa week (mean over all scales -1.2). Lower or high frequencies of self-control were associated with the general worsening of QL (-2.3 and -2.1 respectively,p=0.005). The highest level of emotional well-being was revealed in the patients who controlled glycemia 1-2 times a week (24.7 W-Q12scores). A higher or lower frequency of self-control was associated with deterioration of emotional well-being (22.5 and 20.5 points respectively,p=0.019). ADDQoL data suggest sex-related differences in QL. In women, DM1 had stronger negative effect on the quality of domestic life (-3.2 comparedwith -2.2 in men, p=0.001), social life (-2.5 and -0.9, p=0.021) and dietary freedom (-3.4 and -1.8, p=0.007). Moreover, women experiencedstronger diabetes-related negative emotions than men (4.1 vs 2.5 points, p=0.007, W-B12).Сахарный диабет Обучение и психосоциальные аспекты44 4/2010Conclusion. DM1 has negative effect on all QL aspects. Dietary freedom, professional and physical activities, feeling secure about the future are moststrongly affected. The most important factors through which these effects are mediated include clinical characteristics (quality of compensation ofcarbohydrate metabolism, diabetic complications), DM-related behaviour (frequency of glycemia self-control), and gender.

Aim.
To study the prevalence and structure of anemia syndrome in patients with type 1 diabetes mellitus (DM1) in Tatarstan.
Materials and methods.
Population-based screening studies for decreased blood Hb level were carried out in the cities of Kazan, Nabereznye Chelny,Chistopol and in the Arsk district. A total of 567 DM1 patients were involved; medical histories of 846 patients (54% of those registered in Kazan)were analysed. All patients were examined to elucidate the causes behind the reduced Hb level.Results and conclusions. Two screening techniques revealed anemia in 27 and 34% of the patients compared with 20% in the general population. Itsfrequency was estimated at 13% in the Arsk district. Anemia occurred more frequently in women than in men. The blood Hb level was directly relatedto GFR and inversely related to the presence of chronic renal disease and DM1 duration. Anemia of chronic disease (ACD) and iron deficiency anemia(IDA) prevailed in the structure of anemia syndrome in DM1 patients. These conditions accounted for 85.5% of all cases of anemia). IDA predominatedin patients without clinical manifestations of DN and in those with DN and preserved renal function while ACD associated with DN and impairedrenal function. Almost every third case of anemia was a combination of ACD and IDA. Folic acid deficiency was unrelated to the renal function

Aim.
To analyse factors hampering the achievement of compensation of carbohydrate metabolism in patients with type 2 diabetes mellitus treated for3 months with diabeton MB at a daily dose of 90-120 mg under real practical conditions.
Materials and methods.
This open study included 70 patients with type 2 diabetes mellitus given gliclazide MB-based hypoglycemic therapy(90-120 mg/day); their HbA_1c level was measured before and 3 months after the onset of therapy.
Results.
The treatment resulted in a significant decrease of the HbA_1c level especially pronounced in patients capable of following the rational therapeuticstrategy. At the closing visit, each patient was prescribed a pathogenetically sound regime of combined hypoglycemic therapy.
Conclusion.
Poor efficacy of hypoglycemic treatment in real clinical practice is attributable to frequent prescription of monotherapy, untimely onsetof insulin administration, its correction and intensification to meet changing requirements

Type 2 diabetes mellitus is rising at an epidemic scale throughout the world. Up to a certain moment, DM2 develops as a latent pathology which accounts for its late diagnosis and onset of therapy. Hence, the high frequency of vascular complications, early disablement and mortality. Therefore, the improvement of screening studies is of primary importance for the detection of metabolic disorders. At present, HbA1c determination is the most informative and cost-effective tool for the purpose. The choice of the method for measuring HbA1c is a paramount consideration. It must be standardized against a reference technique (high performance liquid chromatography) in conformity with the results of DCCT and UKPDS studies

Current trends in conservative therapy of chronic wounds associated with diabetes mellitus are discussed along with results of original studies aimedto assess efficacy of different methods for unloading the affected leg in patients with the neuropathic form of diabetic foot syndrome and diabeticnephropathy. Effects of collagen-containing dressings on the wound-related factors (matrix metalloproteinases 2 and 9, collagenolytic activity) andwound epithelization rate are described.

This paper is focused on the main aspects of pathogenesis of diabetic osteoarthropathy (DOAP) underlain by motor and sensory neuropathies, injuries(including microfractures and joint disintegration), and inflammation accompanied by enhanced cytokine expression. The role of osteopenia andbone resorption-formation decoupling at different stages of DOAP is discussed. Modern methods of DOAP treatment are considered with special referenceto immobilization, drug therapy, surgical and orthopedic care

This review of current foreign literature is focused on the analysis of different variants of pancreas and kidney transplantation in patients with terminalrenal insufficiency resulting from diabetic nephropathy. Most authors consider combined pancreas and kidney transplantation to be the method ofchoice for patients with this pathology. Given the adequately functioning pancreas implant, this operation ensures excellent engaftment of the kidneyimplant and survival of the recipient. An alternative method is isolated transplantation of a kidney from a live donor with subsequent transplantationof the pancreas. Isolated transplantation of a cadaveric kidney results in transplant and recipient.

Aim.
To study excretion of amine nitrogen and ammonia in urine of pregnant women with type 1 diabetes mellitus depending on gestational ageand albuminuria level.
Materials and methods.
A total of 60 pregnant women with type 1 diabetes mellitus were examined. Proximal and distal tubular function was estimatedfrom daily excretion of amine nitrogen and ammonia respectively.
Results.
Daily excretion of amine nitrogen and ammonia in urine of pregnant women with type 1 diabetes mellitus was lower than in healthycontrols in the 2nd trimester regardless of albuminuria and in the 3rd trimester in patients with microalbuminuria (MAU) and proteinuria (PU).Ammonia excretion was twice lower than normal in the 2nd trimester in women with MAU and PU, and in the 3rd trimester in patients with PU.Healthy pregnant women showed significant correlation between ammonia and amine nitrogen excretion throughout pregnancy (r?0.833,p<0.05). In women with normal albuminuria strong correlation was recorded in the 1st and 2nd trimesters (r?0.7, p ?0.02); it was somewhatweaker (r=0.555, p=0.5) in the 3rd trimester. In the MAU group strong correlation (r=0.818, p=0.03) was documented in the 1st trimester andmoderate (r=0.574, p=0.033) in the 2nd trimester. No correlation between daily excretion of ammonia and amine nitrogen was found in the PUgroup.Conclusion: Renal tubular dysfunction increases with gestation age and severity of nephropathy.

Diabetes mellitus (DM) is a leading cause of renal insufficiency in developed countries. Most cases of chronic renal disease in DM patients are dueto diabetic nephropathy. The impairment of renal function at later stages of diabetic nephropathy is accompanied by complicated changes in the regulationof carbohydrate metabolism most of which require hypoglycemic therapy to be corrected

Aim.
To evaluate the importance of insulin pump therapy for the achievement of DM1 compensation in children of different age.
Materials and methods.
The study included 36 patients aged 5-18 years with DM1. Efficiency of insulin pump therapy was assessed from the resultsof clinical and metabolic monitoring; the data obtained were treated with the use of the Statistica 6.0 program.
Results.
The use of insulin pump therapy permits to achieve compensation of carbohydrate metabolism in children and adolescents with type 1 diabetesby modeling therapeutic schemes for individual patients. The basal regime of insulin administration at a minimal rate is indicated to young childrentaking into account their generally low background requirement for insulin. Adolescents need a stepwise regime of insulin delivery with an increasedrate of administration inearly morning and evening hours.
Conclusion.
The continuous regime of subcutaneous insulinadministration ensures the freedom of choice of the character of physical activity and simplifiescontrol of diabetes in children and adolescents engaged in sports activities.

Aim.
To elucidate age and sex-related differences in the time of manifestation of type 1 diabetes mellitus and its chronic complications in childrenfrom the analysis of developmental patterns and age of the patients for the substantiation of improved methods of their early diagnostics.
Materials and methods.
Analysis of the results of comprehensive clinical and instrumental examination of 246 children with DM1 representative ofthe population of diabetic children in the Tver region (as per 01.01.2009).
Results.
Critical periods of DM1 manifestations are identified. The physical development of the childrenis shown to be a function of the duration ofDM1 and the number of its chronic complications while the time of their manifestations depends on the age and sex of the patients.
Conclusion.
The time of DM1 manifestations depends on the age and sex of the patients. and the quality of diabetes compensation which dictates thenecessity to optimize screening forthese complications in children.

This article is the answer to the letter sent by Gorbachev to the editor. It deals with problems and difficulties encountered by diabetic patients using insulin pumpsand systems for continuous glucose monitoring in real time are considered. Most of them are of purely technical character and may be reduced to a minimum bycompliance with medical advice. Nevertheless, it needs to be emphasized that insulin pump therapy implies a scope of immediate knowledge and imposes requirementson the users health self-care behaviour. Those patients who forget about diabetes relying on the effect of insulin pump therapy alone are unlikely to benefit fromit. This therapy provides a high-technology tool for the treatment of diabetes that may help the majority of patients to achieve almost ideal compensation of carbohydratemetabolism, but it requires specialized education. Many patients have very poor knowledge of insulin pump therapy and continuous glucose monitoring in real time.