The current update of the consensus algorithm of initiation and intensification of the antihyperglicemic therapy in treatment of the patients with type 2 diabetes mellitus (2015) is based on the preliminary document issued by the Russian Association of the Endocrinologists in 2011.
The update was needed due to new data on the safety of the traditional therapeutic options, availability of the new class of the antidiabetic medications, and necessity to add chapter about initiation and intensification of the insulin therapy.
The patient-centered approach remains the absolute priority at any stage of diabetes care as it ensures the efficacy and safety of antihyperglycaemic treatment.

Patients with diabetes mellitus (DM) have a 2- to 4-times higher risk of developing cardiovascular complications compared with non-diabetic controls. Hyperglycemia activates pathophysiological mechanisms that damage the endothelium. According to the current views, circulating progenitor cells derived from bone marrow repair the damage. These cells, known as endothelial progenitor cells (EPCs), maintain endothelial homeostasis and contribute to the formation of new vessels. Many clinical studies have reported that EPC population is dysfunctional and declines in numbers in patients with type 1 and type 2 DM. In addition, bone marrow doesn?t respond adequately to mobilizing stimuli in DM. Therefore, EPC alterations might have a pathogenic role in the complications of DM. In this review, EPC alterations will be examined in the context of macrovascular and microvascular complications of DM, highlighting their roles and functions in the progression of the disease.

The review highlights the problem of stress-induced hyperglycaemia (IT). The study of this condition is in demand because there is an association between IT and increasing number of complications and mortality among patients in critical state. In the review pathological and physiological mechanisms of stress-induced IT syndrome and its components are shown. These are acute IT, insulin resistance and hyperinsulinemia. The range of critical states, in which development of stress-induced IT is more probable and the IT negative impact on different organs and systems are described in the article.
Clinical significance, influence on treatment and complications development of stress-induced IT are considered. It has been shown that adequate control and correction of IT are leading to improvement in critically ill patients state. Much attention in the review is paid to early diagnostics of any carbohydrate abnormalities in critical care medicine, as well as to prevention and optimal correction of IT. The variety of IT correction methods, target glucose levels and various therapeutic methods of hyperglycaemia correction are discussed. Dealing with hyperglycaemia in intensive care units is described in details.

Aim.
Sulfonylureas (SU) are widely used in everyday clinical practice in treatment of patients with type 2 diabetes mellitus (T2DM). There is a considerable variability in SU effects, which may be caused by psychological, social, biological and genetic factors. The aim of the study was to investigate the association between rs5219 KCNJ11 gene and rs757110 ABCC8 gene polymorphism and long-term response to SU-drugs of second and third generation in the Novosibirsk region.
Materials and Methods.
326 patients with type 2 diabetes in the Novosibirsk region were examined. Patients were divided into 2 groups, depending on HbA_1c level. The first group included patients with target HbA_1c levels on SU monotherapy. The second group included patients who did not reach target HbA_1c levels on the highest dose of SU. Genotyping of KCNJ11 (rs5219) and ABCC8 (rs757110) was performed by TaqMan real-time PCR (ICBFM SB RAS, Novosibirsk, Russia).
Results.
Patients with type 2 diabetes with a good response to SU-therapy compared to the group of patients with a poor response to SU-therapy were older (65.8?9.1 years vs. 61.6?7.9 years, p<0.01), had later onset of type 2 diabetes (59.7?9.2 years vs. 48.3?9.3 years, p <0.01), shorter duration of type 2 diabetes (6.1?4.8 years vs. 13.2?7.3 years, p<0.01) and weak insulin resistance: fasting insulin 9.7?6.9 mU/ml vs. 13.6?12.7 mU/ml (p<0.05), HOMA-IR 3.1?2.2 vs. 6.2?6.0 (p<0.01), triglycerides 1.76?0.83 mmol/l vs. 2.42?1.97 mmol/l (p <0.01). Statistically significant differences between KCNJ11 (rs5219) and ABCC8 (rs757110) genotypes and response to SU-therapy was not found. The frequency of risk allele T polymorphism rs5219 KCNG11 gene in patients with a good response to SU was 0.38 and in the patients with a poor response to SU -0.38 (?²=0.02, р=0.89). The frequency of the risk allele G polymorphism rs757110 ABCC8 gene in patients with a good response to SU was 0.40 and in the patients with poor response to SU -0.37 (?²=0.34, р=0.56).
Conclusion.
Patients with type 2 diabetes, who showed poor response to SU-therapy had a longer duration of diabetes, earlier diabetes onset, stronger insulin resistance compared to patients with a good response to SU-therapy. No correlation between rs5219 KCNJ11 gene and rs757110 ABCC8 gene polymorphism and long-term response to SU-therapy in T2DM patients in the Novosibirsk region was found.

Psychosocial factors play a significant role in the management of young type 1 diabetes mellitus (T1DM) patients who may have difficulties in coping with their condition. DM can lead to discrimination and changes in social relationships. It may also have a negative impact on academic and professional performance. We aimed to highlight the influence of psychosocial factors on metabolic control and health of the patient as a whole, and to attract the attention of medical professionals to the variety of psychosocial problems existing in young patients with T1DM. This article reviews the results of recent clinical studies and discusses methods of psychological screening.

High prevalence and insufficient efficacy of medical treatment in type 2 diabetes mellitus (T2DM) poses a major challenge for medical care. Generally, only 30% of patients reach therapeutic goals, while remission occurs only in the minority of patients. In the obese (BMI>35 kg/m2), bariatric surgery provides an alternative to pharmacological treatment of T2DM, boosting remission/compensation rate up to 76.8%. A few recent clinical studies explored the anti-diabetic effect of ileal transposition (IT). This type of surgery targets restoration of incretin balance by proximal transposition of ileal segment. In this review, we discuss the salutary mechanisms of IT in T2DM based on the analysis of the pioneering clinical trials.

Aim.
To determine the relationship between bone mineral density (BMD) and total body composition in postmenopausal women with type 2 diabetes.
Materials and Methods.
The study included 78 women, from 50 to 70 years of age (median 63 years). Twenty women had normal body mass index (BMI), 29 ones were overweight and 29 had obesity. The body composition and BMD was studied by dual-energy X-ray absorptiometry.
Results.
Women with normal BMD had higher BMI, total and truncal fat mass, as well lean mass as compared to women with osteoporosis and osteopenia (all p <0.05). Patients with osteoporosis had a lower fat mass at the hips, compared with those with normal BMD. Total and truncal fat mass, as well as lean mass were positively correlated with BMD in the lumbar spine and proximal femur, femoral neck and radius. In multivariate regression analysis fat mass was an independent predictor for total BMD, after adjusting for age, BMI, duration of menopause, HbA_1c, glomerular filtration rate and other total body composition parameters.
Conclusions.
In postmenopausal type 2 diabetic women BMI and fat mass is associated positively with BMD.

Aims.
To evaluate long-term efficacy of CSII for treating type 2 diabetes patients. To make an attempt to predict which patient would be more likely to reduce HbA_1c levels (success) on CSII.
Methods.
18 Type 2 diabetes patients who began insulin pump therapy in our institute were included. All patients were previously treated by insulin with a mean duration of 54.9?51.4 months.
Results.
Mean duration of follow-up with CSII was 42.2?27.0 months. No significant changes were seen in HbA_1c in total cohort (p=0.064), but fasting plasma glucose was reduced from 10,5?2,9 to 7,6?1,9 mmol/l, p=0.007. No weight gain and no severe hypoglycemia were noted. All patients were divided to three groups according to their HbA_1c levels: those whose treatment was successful (A), failed (B) or neutral (C), (5, 8, 5 patients respectively). A difference was found in insulin/weight (IWR) ratio within the group A: 0.81?0.29 U/kg before vs. 0.41 ?0.12 U/kg on CSII, p=0.043. There was a difference in IWR on CSII in group A compared to group B (0.41 ?0.12 U/kg vs. 0.93?0.6 U/kg respectively, p=0.011). We also noted a trend of weight reduction in the group A vs. weight gain in the group B.
Conclusions.
CSII is a viable tool in insulin ? requiring type 2 diabetes persons, since the insulin dosing and release it provides are much more physiological. CSII is safe and effective for improving glycemic control, but not in all diabetes patients. We suggest IWR reduction may serve as an early predictor of success on CSII. This work may serve as a "proof-of-concept" study, demonstrating once again the fundamental role of strict weight control in type 2 diabetes. More studies are needed to explore and confirm our experience.

The article reviews the available data on investigations in the field of electrolyte (calcium, magnesium), hormonal (insulin, leptin) and hemostasis disturbances in term newborns from women with gestational diabetes; possible mechanisms of their development are also highlighted. The review describes changes in blood glucose concentration in term newborns from women with gestational diabetes, and their impact on the child's condition. In addition to already known factors causing macrosomia and other metabolic disorders in term neonates, the role of leptin (peptide hormone that regulates energy metabolism) is quite discussable. Low leptin levels lead to the development of obesity. It is also confirmed, that leptin influences brain development of the newborn, leading to later cognitive deficits in children from women with GDM.
The aim of the review is to summarize the available data on investigations in the field of electrolyte (calcium, magnesium), hormonal (insulin, leptin) and hemostasis disturbances in term newborns from women with gestational diabetes.

Aim.
To compare kidney disease markers: glomerular filtration rate (GFR), calculated upon creatinine and cystatin C, urinary cystatin C, collagen type IV and albumin in type 2 diabetic patients with normal and moderately reduced renal function.
Materials and methods.
56 patients, aged 43?70 years, and 16 healthy controls, aged 40-72 years, were included in the study. GFR was calculated by equations based on creatinine (CKD-EPI_creat), cystatin C (CKD-EPI_cys) or both markers (CKD-EPI_creat-cys). Serum and urinary cystatin C was measured by immunoturbidimetric method, urinary albumin, albumin excretion rate (AER) and collagen type IV excretion was determined by ELISA. The body composition was investigated in 24 patients by dual-energy X-ray absorptiometry.
Results.
In diabetic patients serum cystatin C level correlated positively with age (r=0.37), GFR calculated by CKD-EPI_creat (r=-0.43) and fat mass percentage (r=0.55). There was a positive correlation between GFR calculated by the CKD-EPI_cys and GFR by CKD-EPI_creat (r=0.48). In multiple regression analysis the percentage of body fat influenced the GFR calculated by CKD-EPI_cys or CKD-EPI_creat-cys. No correlation between urinary cystatin C and serum cystatin C level, GFR and AER was found. Collagen type IV excretion was increased in patients with decreased GFR, compared to those with normal GFR (p=0.002). Urinary collagen type IV correlated with both GFR and AER (r=-0.28 and r=0.47).
Conclusion.
The measurement of serum cystatin C with calculation of GFR by CKD-EPI_cys and CKD-EPI_creat-cys, in addition to the CKD-EPI_creat, increases the accuracy of CKD diagnostics in type 2 diabetic patients. However, obesity and particularly body fat mass affect the results of estimation of GFR based on cystatin C. The increase in urinary collagen type IV, but not in cystatin C excretion, is related to GFR decline and AER elevation in these patients.

Aim.
To evolve the association between cardiac autonomic function and arterial stiffness in children and adolescents with type 1 diabetes mellitus (T1DM).
Materials and methods.
72 T1DM patients aged 7?18 years without history of macrovascular complications or renal disease, including microalbuminuria, were involved in the study. Cardiac function was assessed by the cardiovascular tests and 24-hour ECG monitoring with automatic calculation of QT interval and heart rate variability (HRV) parameters. Artery stiffness was assessed by measurement of pulse wave velocity (PWV) and augmentation index (AI) obtained from arterial blood pressure monitoring for 24 hours.
Results.
Estimated prevalence of cardiovascular autonomic neuropathy (CAN) was 31,9%. CAN+ patients had significantly higher PWV and AI than those without CAN. A negative correlation between PWV and AI with some cardiovascular tests and HRV parameters was observed. In multivariable analysis, AI was independent predictor of autonomic dysfunction defined as number of positive cardiovascular tests, HRV parameters below normal values and prolongation of QT interval (?.
=0,18; p=0,035).
Conclusion.
Cardiac autonomic function is an independent predictor of arterial stiffness, in children and adolescents with T1D without macrovascular and renal complications. The presence of cardiovascular risk factors and arterial stiffness in children and adolescents with T1DM may contribute to the increased cardiovascular morbidity and mortality in adulthood in patients with CAN.

In this review we discuss ten promising biological targets of interest for treating type 2 diabetes mellitus, obesity and metabolic syndrome. Namely, we address current experimental and clinical data on several new compounds that affect SGLT2, 11b-HSD1, PTP1B, SCD1, Il-1?.
, fructose-1,6-bisphosphatase, glycogen phosphorylase, SIRT1, DGAT-1 and GPR119. The body of data shows potential of these substances to become effective antidiabetic agents.

We present a case of a teenage boy with a Rabson-Mendenhall syndrome. There are only few recent publications on the topic of Rabson-Mendenhall syndrome in medical literature. This syndrome appears with a same frequency in both sexes. The disease prevalence is still unknown due to many undiagnosed cases linked with high mortality in early childhood. There are no prenatal screening for this disease till now, but it is clear, that in case of positive diagnostic tests, abortion should be recommended.
The typical clinical symptoms of Rabson-Mendenhall syndrome are the following: physical development delay, loss of subcutaneous fat, teeth and nails abnormalities (premature teeth eruption, teeth number doubling, nails thickening). The earliest signs of the syndrome are skin hyperpigmentation and hyperkeratosis at neck, armpits and groin, which are typical for insulin resistance.
Children with Rabson-Mendenhall syndrome usually have early manifestation of diabetes mellitus, characterized by labile disease course and frequent ketoacidosis state.
The present clinical case might be interesting regarding a long follow-up of the child.

24.02.2015 the Conference ?Endocrinology: from the very beginning to 21st century technologies? dedicated to 90th anniversary of Russian Association of Endocrinologists and foundation of State Institute for Experimental Endocrinology and 25th anniversary of Endocrinology Research Centre took place.
The introduction speech was held by the president of Russian Association of Endocrinologists and chief of Endocrinology Research Centre, academician Ivan Dedov. The highly discussed topic was creation of National Endocrinology Centre with the main goal of implementation of modern technologies and association of endocrinology with closely related specializations such as immunology and neurology. Within the Conference their talks had the vice-president of Russian Association of Endocrinologists, academician Galina Melnichenko, scientific Secretary of Russian Association of Endocrinologists Marina Shestakova and the Board team member of Russian Association of Endocrinologists Valentina Peterkova.

On March, 17th, 2015 professor Andrey A. Alexandrov, the chief of functional cardiology department at Endocrinology Research Centre passed away. Andrey A. Alexandrov graduated from 2nd Moscow Medical Institute in 1971. In 1979 finished his PhD and in 1989 his doctoral research on topic ?Hormonal regulation and carbohydrate metabolism in patients with heart attack?. From 1999 to present time was the Chief of cardiology department at Endocrinology Research Centre.
Alexandrov is the author of more than 420 publications, he supervised 13 PhDs and 1 doctoral research. We will remember him as a high level professional, great scientist, talented teacher and charming person.
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