The diagnosis of maturity onset diabetes of the young (MODY) has high clinical significance in young patients (no absolute need for exogenous insulin; normoglycaemia in most patients achieved by dieting or taking oral hypoglycaemic agents) and their relatives (high probability of first-degree relatives being carriers of mutations, which requires a thorough collection of family history and determination of the parameters of carbohydrate metabolism).

Aim. This study aimed was to determine the clinical characteristics of different subtypes of MODY in a Siberian region.

Materials and Methods. We performed an examination, biochemical and hormonal blood tests, ultrasound and molecular genetic testing of 20 patients with a clinical diagnosis of MODY.

Results. Four subtypes of MODY were verified: MODY2 in 11 patients, MODY3 in two, MODY8 in one and MODY12 in two. Eleven patients (69%) exhibited no clinical manifestations of carbohydrate metabolism disorders, and one patient showed weight loss during early stage of the disease. Comorbidities included dyslipidemia, thyroid gland disorders and arterial hypertension. One patient (6%) exhibited diabetic nephropathy; two (13%), diabetic retinopathy and three (19%), peripheral neuropathy of lower legs. All patients achieved the target carbohydrate metabolism; the level of C-peptide was within the reference range.

Conclusion. Four different subtypes of MODY (2, 3, 8, 12) were diagnosed in the present study, which differed in their clinical characteristics, presence of complications and treatment strategies. Our knowledge of monogenic forms of diabetes is expanding with the development in molecular genetics, but several aspects related to them require further study.

Aim. We analysed the main epidemiological characteristics of diabetes mellitus (DM) in the Russian Federation (prevalence, incidence, mortality and mean life span), degree of diabetes control, and prevalence of diabetic complications (retinopathy, nephropathy, and diabetic foot syndrome and macrovascular pathology) according to the federal DM registry.

Materials and methods. The database of the federal DM registry of 79 regions was included using the online system until 31.12.2016.

Results. TThe total number of patients with DM in the Russian Federation on 31.12.2016 was 4.348 million (2.97% of the population), comprising 4 million patients with DM2 (92%), 255,000 with type 1 diabetes (T1DM) (6%), and 75,000 with other types of DM (2%). DM prevalence per 100,000 population was as follows: T1DM, 164.19/100,000; type 2 diabetes (T2DM), 2637.17/100,000; and other types of DM, 50.62/100. The incidence per 100,000 population was as follows: T1DM, 16.15/100,000; T2DM, 154.9/100,000; and other types of DM, 8.65/100,000. Mortality per 100,000 population was as follows: T1DM, 2.1/100,000; T2DM, 60.29/100,000; and other types of DM, 0.57/100,000. Mortality decreased in patients with T1DM by 6.6% and with T2DM by 3.6%. Mean life span in patients with T1DM was 50.3 years for men and 58.5 years for women. Mean life span in patients with T2DM was 70.1 years for men and 75.5 years for women. Glycated haemoglobin A1c (HbA1c) levels in T1DM was <7% in 33.4%, 7%–7.9% in 28.3%, 8%–8.9% in 16.2%, and ≥9.0% in 22.1% of patients. HbA1c levels in T2DM was <7% in 52.1%, 7%–7.9% in 29.1%, 8%–8.9% in 10%, and ≥9.0% in 8.7% of patients.

Conclusions. This study evaluated the increase in DM prevalence in the Russian Federation in 2016 and in the dynamics of 2013–2016, which was mainly due to T2DM. An increase in patients with a target HbA1c level <7% and a decrease in the proportion of patients with severe uncontrolled DM was observed; however, the treatment effectiveness of this key indicator was unsatisfactory, i.e. less than a third of the patients with DM. In the dynamics of 2013–2016, an increase in mean life span for patients with T2DM and mortality reduction in patients with T1DM and T2DM was observed. The frequency of diabetic complications varied widely, which may reflect differences in the quality of specialised care in different regions.

Diabetic nephropathy (DN) is a severe complication of diabetes mellitus associated with the progressive deterioration of renal function. Although microalbuminuria is considered as a gold standard for DN diagnosis, it has limited predictive powers and specificity as a diagnostic tool for the early stage of DN. Therefore, new biomarkers are required for the early detection of DN. Studies using in vitro and in vivo models of DN have revealed an important role of microRNAs (miRNAs), short non-coding RNAs that modulate physiological and pathological processes by inhibiting target gene expression, in DN development. Recent studies have shown that the dysregulation of miRNAs, which is associated with the key features of DN, such as the mesangial expansion and accumulation of extracellular matrix proteins, is related to fibrosis and glomerular dysfunction. Thus, the up- and downregulation of miRNA expression in the renal tissue or biological fluids, including urine, may represent new biomarkers for the diagnosis and monitoring of DN progression. In this review, we highlight the significance of miRNAs as biomarkers for the early detection of DN and emphasise their potential role as a therapeutic target.

Nenets are Samoyedic people belonging to Ural contact minor race, with combined anthropological signs of both Caucasoid and Mongoloid races. In this population, the occurrences of type 1 diabetes mellitus (T1DM) were registered during 30 years.

Aim. The study aimed to investigate the incidence of human leucocyte antigen (HLA)-haplotypes in Nenets compared with those in the Russian population.

Materials and Methods. HLA-typing was performed in 61 healthy Nenets subjects residing in the Arkhangelsk district, 341 Russian subjects from Moscow and natives from the Vologda district.

Results. DRB1*04-DQA1*0301-DQB1*0302 was similar in all the three study populations: 11.5%, 8.5% and 11.6% for Nenets, Moscow and Vologda populations, respectively (p > 0.05). However, the incidence of the second most important high predisposed haplotype DRB1*17(03)-DQA1*0501-DQB1*0202 was significantly lower in Nenets (1.6%) than in the Moscow and Vologda populations (10% and 7.4%, respectively) [(p1.2 = 0.03 (x2 = 4.42); p1.3 = 0.12 (x2 = 2.46)]. The incidence of DRВ1*01-DQA1*0101-DQB1*0501 haplotype specific for both Russian populations was also significantly lower in Nenets (3.3%) than in the Moscow and Vologda populations (11% and 12.4%, respectively) [(p1.2 < 0.05 (x2 = 3.34); p1.3 < 0.05 (x2 = 3.85)]. The incidence of protected haplotypes (DRB1*11-DQA1*0501-DQB1*0301 and DRB1*13-DQA1*0102-DQB1*0602/8/DRB1*13-DQA1*0103-DQB1*0602) was significantly higher in Nenets than in the Moscow and Vologda populations: 32.8% versus 12.5% and 9.1%, respectively [(p1.2 < 0.001 (x2 = 13.48); p1.3 < 0.001 (x2 = 17.3)] and 16.4% versus 8.5% and 11.1%, respectively [(p1.2 = 0.07 (x2 = 3.14); p1.3 = 0.3 (x2 = 0.97)]. The incidence of some neutral haplotypes was also significantly higher in Nenets: haplotype DRB1*12-DQA1*0501-DQB1*0301 was detected in 29.5% of Nenets compared with 2.5% and 1.2% of the Moscow and Vologda populations, respectively [(p1.2 < 0.001 (x2 = 42.43); p1.3 < 0.001 (x2 = 37.66)]; haplotype DRB1*09-DQA1*0301-DQB1*0303 was detected in 14.8% of Nenets compared with 1% and 2.5% of the Moscow and Vologda populations, respectively [(p1.2 < 0.001 (x2 = 21.9); p1.3 < 0.001 (x2 = 10.04)].

Conclusions. According to preliminary evidence, the incidence of predisposed haplotypes was significantly lower and that of protected haplotypes was significantly higher in Nenets than in the Moscow and Vologda populations, which probably play a role in the very low incidence of T1DM in Nenets.

Aim. To study the quantity of endothelial progenitor cells (EPCs) and levels of vascular endothelial growth factor A (VEGF-A) in patients with type 2 diabetes mellitus (T2DM) after endovascular interventions on coronary and peripheral arteries.

Materials and methods. We observed 68 patients with stable angina pectoris and critical limb ischaemia, admitted for elective percutaneous coronary intervention and endovascular revascularisation of the lower extremity. The number of CD34+VEGFR2+CD45- and CD34+CD133+CD45- cells and levels of VEGF-A were determined before endovascular intervention and 2–4 days after the surgery.

Results. We found that in patients without diabetes, the levels of EPCs increased significantly after endovascular interventions (CD34+VEGFR2+CD45-cells, p < 0.0001; CD34+ CD133+CD45-cells p = 0.041). The levels of EPCs in the peripheral blood of patients with T2DM before and after endovascular interventions did not significantly differ. The analysis of VEGF-A showed a statistically significant increase after intervention in both groups. In addition, in patients with an HbA1c level of <8% and duration of diabetes of <10 years, the levels of EPCs significantly increased (p = 0.001 and 0.005, respectively). In patients with an HbA1c level of ≥8% and duration of diabetes of >10 years, the levels of EPCs before and after endovascular interventions did not significantly differ.

Conclusions. Patients with diabetes exhibited impaired EPC mobilisation after endovascular interventions. Poor glycaemic control and a long duration of diabetes are among the risk factors of EPC mobilisation.

Aim. To evaluate the efficacy and safety of the novel combined laser treatment technology compared with those of the conventional laser photocoagulation in diabetic macular oedema management.

Material and methods. Fifty eyes of 44 patients with clinically significant diabetic macular oedema were enrolled. Patients of the main group (25 eyes) underwent combined laser treatment, whereas patients in the control group (25 eyes) underwent modified ETDRS (mETDRS) focal/grid photocoagulation.

Results. Mean central point thickness (CPT) in the main group decreased from 411.24 ± 126 µm to 359.86 ± 120.4 µm (p < 0.05), with a subsequent increase in the mean best-corrected visual acuity (BCVA) from 0.52 ± 0.2 at baseline to 0.71 ± 0.2 (p < 0.05) at the 12-month follow-up. The mean central retinal sensitivity (RS) improved from 11.27 ± 3.8 dB to 13.24 ± 3.2 dB (p < 0.05). In the control group, our results showed similar improvement in BCVA and CPT values at the 12-month follow-up (from 0.59 ± 0.12 to 0.72 ± 0.23 and from 424.17 ± 68.12 µm to 387.51 ± 93.45 µm, respectively, p < 0.05). The RS value, on the contrary, decreased from 12.32 ± 0.90 dB to 10.14 ± 0.71 dB (p < 0.05).

Conclusions. The combined laser technology is a safe treatment technique that allows to minimise the extent of laser-induced chorioretinal complex damage due to the contribution of subthreshold micropulse laser photocoagulation. The efficacy of this novel technology is comparable with that of the mETDRS technique in the resolution of macular oedema and BCVA increase. This technology also provides an advantage of RS improvement and the possibility of safe and repetitive treatment sessions.

Empagliflozin, an inhibitor of sodium–glucose symporter type 2 (SGLT2), is a new class of antidiabetic agents with numerous pleiotropic effects. The review summarises data on the influence of empagliflozin on the structural and functional changes in the kidneys of the models of diabetes mellitus (DM) and of patients with DM. A literature search was conducted using the databases of Medline/PubMed, Scopus, Web of Science, ClinicalTrials.gov and eLibrary. The experimental results showed a decrease in the blood glucose level, blood pressure, glomerular hyperfiltration and overexpression of proinflammatory and fibrogenic factors in the kidneys under the influence of empagliflozin. Most clinical studies have demonstrated the albuminuria-lowering effect of empagliflozin in patients with type 2 DM. The EMPA-REG OUTCOME study has demonstrated slowing of the chronic kidney disease progression, decrease in the incidence of end-stage renal failure and death from renal causes in patients with type 2 DM undergoing the empagliflozin treatment compared with those receiving placebo. The mechanisms of the nephroprotective effect of empagliflozin included systemic and renal effects. The decrease in hyperglycaemia, blood pressure and body weight; reduction in glomerular hyperfiltration; enhancement of sodium excretion and suppression of inflammatory and fibrogenic signalling pathways in the kidneys may help slow the development of diabetic kidney damage under the influence of empagliflozin. The possibility of extrapolating the confirmed properties of empagliflozin to other SGLT2 inhibitors needs further investigation.

Background. Gestational diabetes mellitus (GDM) is a common complication of pregnancy. It can cause significant problems for the mother and offspring, such as caesarean delivery, birth trauma and the development of type 2 diabetes mellitus (T2DM) in the future. The identification and correction of modifiable risk factors for GDM will provide a possibility to prevent these complications.

Aim. This study aimed to identify the most significant lifestyle parameters affecting the risk of developing GDM.

Methods. The study included 680 pregnant women who underwent oral glucose tolerance test at 24–32 weeks of pregnancy and responded to a questionnaire comprising the following sections stratified in a semi-quantitative manner: the consumption of major food groups and drinks and the amount of physical activity and smoking before and during pregnancy. A logistic regression analysis was performed to identify lifestyle parameters that influence GDM development. GDM was diagnosed according to the IADPSG criteria.

Results. GDM was diagnosed in 266 women; the other 414 women formed the control group. The most significant dietary risk factor for developing GDM was the consumption of sausage(s), dried fruits and fresh fruits. Eating sausage(s) more than thrice a week during pregnancy increased the risk of developing GDM by 2.4 times [95% confidence interval (CI), 1.5–3.8; p < 0.001] and so did the consumption of dried fruits more than thrice a week during pregnancy [odds ratio (OR), 6.5; 95% CI, 2.5–16.8; p < 0.001)] compared with the risk of GDM by less consumption of these food groups. A regular consumption of fresh fruits more than 12 times a week during pregnancy reduced the risk of GDM (OR, 0.5; 95% CI, 0.3–0.8; p = 0.015). The habit of climbing at least four floors per day during pregnancy also reduced the risk of GDM (OR, 0.7; 95% CI, 0.5–1.0; p = 0.069).

Conclusions. The recommendations for GDM prevention should include limiting the consumption of sausage(s) and dried fruits, increasing the consumption of fresh fruits and introducing regular physical activities, such as climbing stairs.