Aim. To study the association between polymorphic genetic markers, tumor necrosis factors and their receptors (rs 1800629 TNFα, rs 909253 Ltα, rs 767455 TNFR1, rs 1061624 TNFR2) and the development of type 2 diabetes (T2D) among the population of the Central Black Earth Region of Russia.

Materials and methods. The results obtained from 544 patients, of which 236 were already diagnosed with T2D and 308 were healthy control individuals, were analysed. All the loci were analysed by DNA synthesis using PCR TaqMan probes. The statistical analysis of the frequency distribution of genotypes was performed using contingency tables and the χ2 test, with p ≤ 0.05.

Results. A case-control analysis showed that genotype GG rs 909253Ltα was a risk factor for T2D (OR = 2.36, p = 0.01). Also, individuals with genotype AA rs 767455TNFR1 had significantly earlier age of T2D manifestation than that of patients with genetic variants AG and GG (p = 0.01).

Conclusion. This study demonstrated the involvement of polymorphic markers of tumor necrosis factors and their receptors in the development of T2D among the residents of the Central Black Earth Region of Russia.

Background. Recently, insulin resistance (IR) has been actively investigated by experts in various fields. Here we aim to study the effect of stress on the development of IR.

Objective. To study the associations between IR and personal stress moderators (self-attitude, locus of control and coping strategies) as well as the related performance lifestyles.

Methods. The study included 63 patients (16 men; mean age, 48.2 ± 11.7 years). Of these participants, 26 were diagnosed with type 2 diabetes mellitus, 10 with impaired glucose tolerance, 6 with impaired fasting glucose and 21 with normal glucose tolerance. The levels of HbA1c and IR ratio were determined using HOMA. Well-known psychological assessment questionnaires were used to assess the effect of personal stress moderators.

Results. There was a significant relationship between IR and personal stress moderators. A positive self-attitude was associated with a lower risk of IR (p < 0.05), which can be explained by a decrease in the risk of developing stress. Assertive coping strategies were most pronounced in subjects with a low level of IR (p < 0.05). Personal characteristics also determined an individual’s lifestyle, which may have an impact on the increase in IR. There was an association between high levels of IR and unhealthy alimentary preferences (p < 0.05). Such preferences were also associated with personal characteristics, such as external locus of control, less positive self-attitude and passive coping strategies (p < 0.05). People with high IR rarely engage in a regular physical activity; there was a direct correlation between the frequency of physical activity and assertive coping strategies (p < 0.01). Married participants had high levels of IR (p < 0.05).

Conclusion. There were significant relationships between IR and personal stress moderators, such as self-attitude and coping strategies. Besides the direct effects on stress levels, personality traits may also indirectly increase the risk of IR by influencing the individual’s lifestyle. There is a need to investigate the fact that married people have higher levels of IR.

Currently, diabetes mellitus (DM) is the most common metabolic disorder, which is manifested by hyperglycemia and leads to vascular and cognitive impairment. Mechanisms of cognitive dysfunction in patients with DM remain highly unclear, thus complicating the search for effective strategies for the prevention and treatment of dementia. Recently, scientists have discussed the issues regarding the relationship between DM and Alzheimer’s disease (AD), such as risk factors that trigger the cascade of pathological reactions. Patients with DM show an increased risk of developing AD. Similarly, patients with AD have been shown to have impaired insulin and glucose metabolism. Both these diseases have common nosology, pathology and biochemical basics, including oxidative stress, formation of advanced glycation end products, dysregulation of glucose metabolism and altered insulin signaling pathways. The microtubule-associated tau protein is involved in one of the causative mechanisms underlying the development of AD. We provide an overview of the major domestic and foreign data analyses regarding tau protein and the development of cognitive disorders in experimental DM.

Diabetic cardiovascular autonomic neuropathy (DCAN) is a diabetic complication characterised by early dissemination of sympathetic and parasympathetic, small-fibre neuronal degeneration. DCAN is the most dangerous and insidious complication that influences the clinical course and mortality rate of diabetes; however, it is often underestimated and not recognised by practitioners. Medical history and a physical examination are not sufficient for diagnosing DCAN. Laboratory diagnosis and the instrumental methods used to evaluate DCAN are time-consuming and not always available. Early detection of DCAN in diabetic patients is important for the early implementation of therapy. Today, there is no uniform diagnostic algorithm for DCAN in patients with various disorders of carbohydrate metabolism. This is due to the insufficient number of clinical trials and limitations of current protocols.

This review presents an overview of the clinical and experimental studies of DCAN. The epidemiology, clinical manifestations, risk factors and underlying pathogenesis of DCAN are considered. The advantages and disadvantages of conventional and new diagnostic methods are discussed.

Background. The mechanisms underlying the close relationship between diabetes mellitus (DM) and coronary artery disease (CAD) have not been fully understood. The pathophysiological processes of vascular inflammation that accelerate and enhance the development of atherosclerotic vascular lesions and their complications warrant further study.

Aims. To compare lipid profiles and inflammatory markers in patients with CAD and stable angina in the presence and absence of type 2 DM.

Materials and methods. A total of 169 patients were examined: Group 1 included 123 patients with CAD but without DM; Group 2 consisted of 46 patients with CAD and DM. The biochemical parameters were estimated before coronary angiography.

Results. The lipid profile in both groups of patients revealed elevated levels of atherogenic markers (TС, LDL, VLDLP and TG). Patients in Group 2 had significantly increased levels of vascular inflammatory markers (hs-CRP, homocysteine, IL-1β), TNF-α, MMP-9 and endothelin-1 compared to those in Group 1.

Conclusions. Our results indicate that the vascular inflammatory response was more pronounced in patients with CAD and DM and that they have an increased risk of developing adverse vascular complications.

The prevalence of morbid obesity is on the rise. Surgical intervention for the treatment of morbid obesity has been shown to provide high metabolic efficiency, acquiring a special role in the treatment of type 2 diabetes mellitus. Various surgical procedures are used in treating morbid obesity. These include gastric-bypass surgery and biliopancreatic bypass diversion (BPD), each with various advantages of its own. In recent years, BPD (also referred to as the Scopinaro procedure) has evolved and been modified into the single anastomosis duodeno-ileal (SADI) procedure. Like other types of BPD, the SADI procedure effectively reduces excess body weight and promotes normalisation of carbohydrate and lipid metabolism, leading to a reduced frequency of insulin therapy and use of antidiabetic drugs. The potential benefits of the procedure include reduced operative time and a reduced incidence of internal hernias. Studies have also shown that the SADI procedure results in fewer early and late post-operative complications. Given the effectiveness of the procedure, it is necessary to increase the number and duration of observations made to enable further insight into the long-term efficacy and use of the SADI procedure.

In modern algorithms for the treatment of type 2 diabetes, metformin is positioned as a first-line drug, which, when the disease progresses, is universally combined with other groups of hypoglycemic drugs, including insulin. Review of literature demonstrates the multifaceted effects of metformin with its efficacy and extensive safety range, allowing the drug to be used not only for glycemic control but also for the management of cardiovascular risk factors. Here we present a retrospective study of whether cardiovascular safety of hypoglycemic drugs should be assessed, on the basis of which the idea of a “vulnerable patient” in the presence of diabetes can be formulated, and the necessity of joint management of such patients by an endocrinologist and cardiologist can be postulated. The mechanisms of macrovascular protection by the drug demonstrated in the UKPDS with the phenomenon of “metabolic memory” are analysed along with a discussion regarding their lipid-lowering and antisclerotic effects using modern analytical reviews. The features of the action of long form of the drug (Glucophage Long) are considered. The pleiotropic possibilities of metformin, the expansion of the present indications and the prospects of application as well as new hypotheses about its mechanism of action are discussed. The possible effects of the drug on the components of the “gastrointestinal tract–brain–liver” axis are discussed, and the effects of metformin on homeostasis due to the effect on the microbiota are presented.

For the purpose of exploring the development, pharmacology and clinical trial program related to dulaglutide, we conducted a nonsystematic review of dulaglutide, focusing on the AWARD (Assessment of Weekly Administration of LY2189265 [dulaglutide] in Diabetes Assessment) program of randomized, phase 3 studies. Dulaglutide is a glucagon-like peptide 1 (GLP-1) receptor agonist that causes a variety of antidiabetogenic actions by acting on the incretin system. Steady-state plasma concentrations of dulaglutide are achieved between 2 and 4 weeks following a once-weekly administration. The AWARD 1–6 studies were conducted in patients with different treatment needs, ranging from patients with mild diabetes who can be treated with diet management and exercise to patients for whom target glycemic control cannot be achieved with conventional insulin treatment. Changes in HbA1c from baseline to the primary endpoint assessment (primary efficacy outcome) with dulaglutide were generally dose-dependent and significantly greater than those of active comparators and placebos (AWARD 1–5) or non-inferior to the comparators (AWARD 6). The results of secondary outcome measures demonstrated that glycemic control attained with dulaglutide was sustained for long-term and that a greater proportion of patients treated with dulaglutide achieved a target HbA1c level of <7.0% compared with placebo and/or active comparators. Reduction in fasting serum glucose, glucagon levels and body weight after dulaglutide treatment were noted in most AWARD studies. Although treatment-emergent adverse events were common with dulaglutide, the incidence was similar to that of active comparators in most AWARD studies, and serious adverse events were generally infrequent, except in patients with more severe disease or with prolonged therapy. Hypoglycemic and immunogenic events were also infrequent.

In patients with type 2 diabetes, dulaglutide improves glycemic control and leads to clinically useful reduction in body weight in a range of treatment settings.

On June 5 2017 we have lost one of the most famous Russian endocrinologists member of Diabetes Mellitus journal Editorial board – Professor Sagdulla A. Abusuev.

Type 2 diabetes prevalence is growing in Russia and worldwide. To date disease is considered as the leading cause ofmortality in many countries. To date, there is a need to develop integrated program of type 2 diabetes and prediabetes early detection and care. Within Advisory council experts developed recommendations regarding program plan including activities on type 2 diabetes early screening, prevention and care. The Public Screening Program for Adult Population is currently being implemented in Russia and should be considered as a background for activities on type 2 diabetes early prevention.