BACKGROUND: The progression of incidence and prevalence of type 1 DM among children worldwide is undeniable and is a priority problem for healthcare systems of all countries.

AIM: assessment of changes in the main epidemiological data on type 1 diabetes mellitus (DM1) in children living in the territory of the Luhansk People’s Republic (LPR) over the past 10 years.

MATERIALS AND METHODS: assessment of the dynamics of regional epidemiological indicators (incidence, prevalence and mortality) in type 1 diabetes in children and adolescents over the time period from 2010 to 2021. The data were studied on the basis of the cardio rheumatology department with endocrinological beds of the Luhansk Republican Children’s Clinical Hospital of the LPR by colleagues of the Department of Pediatrics of Additional Professional Education and Propaedeutic of Pediatrics of the Luhansk St. Luke State Medical University of the Ministry of Health of the Russian Federation. The object of the study was the database of the regional register of the state statistics service.

RESULTS: the final total quantitative indicator of children and adolescents with DM 1 as of 01.01.2023 was 328 people, of which 130 girls (39.7%) and 104 boys (31.7%) entered the first age group (0-14 years), in the second statistical age group (15–17 years) there were 42 girls (12.8%) and 52 boys (15.8%). In just ten years, the prevalence of DM 1 increased by 1.7 times in the first age group, and in the second, the increase was 1.2 times. Morbidity rates increased 1.6 times in both age groups over the same period.

CONCLUSION: the analysis of the results of the study indicates that a protracted armed conflict has a negative impact as a significant stress factor on the development, prolongation, and decrease in the control of type 1 diabetes mellitus in children and adolescents.

BACKGROUND: Research aimed at creating and validating models of diabetes plays an important role in the development of new treatments for this disease. Large animal models may bridge the gap between basic research and clinical trials of new technologies for the treatment of insulin deficiency. At the moment, the most popular model is streptozotocin-induced diabetes. However, different species and breeds of animals respond differently to streptozotocin. Thus, although models already exist in different breeds of pigs, verification of the Wiesenau pig model of streptozotocin-induced diabetes is an important task, since this breed has not yet been used, and it is also one of the most accessible breeds of laboratory pigs in the world. Russia.

AIM: To reproduce the model of streptozotocin-induced diabetes in Wiesenau pigs with correction of hyperglycemia by insulin therapy and evaluate its stability and compliance with the experimental model of type 1 diabetes.

MATERIALS AND METHODS: The study was performed on 6 Wiesenau pigs. Diabetes was induced by intravenous administration of streptozotocin (150 mg/kg). Blood glucose concentration was determined with a glucometer and a continuous glucose monitoring system was used. The content of insulin in the blood was determined by enzyme-linked immunosorbent assay (Cloud-clone corp). The success of diabetes induction was confirmed by a glucose tolerance test. Seven days after the injection of STZ, insulin therapy was initiated and continued for three months. Insulin therapy was carried out for three months. 3 months after induction, a histological and immunohistochemical study of the condition of the pancreatic islets was carried out.

RESULTS: A study in Wiesenau pigs showed that a dose of 150 mg/kg streptozotocin was safe and effective in inducing diabetes in 67% of cases. An optimal individual insulin therapy protocol was selected, which successfully reduces blood glucose levels to normal values. This model of streptozotocin-induced diabetes in Wiesenau pigs is stable for 90 days and can be used to study new antidiabetic agents.

CONCLUSION: A model of STZ-induced diabetes has been established in Wiesenau pigs. The stability of the model has been confirmed under conditions of glucose toxicity alleviation through insulin therapy.

BACKGROUND: Latent autoimmune diabetes in adults (LADA) is considered an intermediate form between type 1 (T1DM) and type 2 diabetes mellitus (T2DM). However, the molecular mechanisms underlying its unique clinical and pathogenetic features remain insufficiently studied. Identifying differentially expressed genes (DEGs) in LADA compared to T1DM is essential for developing more personalized diagnostic and therapeutic approaches.

OBJECTIVE: To identify DEGs in peripheral blood mononuclear cells (PBMCs) of patients with LADA compared to those with T1DM, and to evaluate differences in DEGs between these patient groups and healthy volunteers.

MATERIALS AND METHODS: The study included 60 participants (23 T1DM patients with disease duration of up to 1 year, 15 LADA patients with disease duration of up to 5 years, and 22 healthy volunteers). The median age of LADA patients was 40 [34; 45] years, and for T1DM patients, 26 [21; 31] years. This was a single-center, cross-sectional observational study. PBMCs were isolated from all participants, and single-cell RNA sequencing (scRNA-seq) was performed. Differential gene expression analysis was conducted using a pseudo-bulk approach (pyDEseq2, p<0.05 adjusted for multiple comparisons, |log2FoldChange| ≥0.5). Statistical analyses employed nonparametric tests (Kruskal–Wallis, Mann–Whitney).

RESULTS: In LADA patients, reduced expression of HLA-G, SPARC, and C20orf204 and increased expression of AC002460.2 were observed compared to healthy volunteers (p<0.05) in CD4+ Naive T-cells. In the T1DM group, the most significant differences were identified in CD4+ Central memory T-cells (IFIT1, CASP3, LAMP3, HIST1H2BN). When comparing LADA to T1DM, only one transcript, C20orf204, showed statistically significant differential expression (p<0.05) in CD4+ Naive T-cells.

CONCLUSION: The findings indicate that LADA and T1DM share similar molecular patterns, with LADA exhibiting moderate changes in the expression of genes associated with immune regulation and inflammation. The minimal differences between these forms of diabetes highlight their pathogenetic similarity.

BACKGROUND. To investigate the heterogeneity of autoimmune diabetes mellitus (DM) in adults and identify factors associated with delayed initiation of insulin therapy in real-world clinical practice.

MATERIALS AND METHODS. A retrospective analysis was conducted on clinical and laboratory data from 717 patients with DM onset after the age of 18 who were tested for antibodies against β-cell antigens (GAD, IA-2, ICA, ZnT8, insulin) at the National Medical Research Center for Endocrinology (NMRCE) between 2017 and 2022. Data were obtained from the electronic medical records of the NMRCE database and questionnaires from the nationwide clinical and epidemiological diabetes monitoring system in the Russian Federation. Patients with elevated vs normal antibody titers were compared, as well as patients with autoimmune DM based on the timing of insulin therapy initiation.

RESULTS. Elevated antibodies to β-cell antigens were identified in 370 patients (51.6%). A combination of two or more antibodies at DM onset was found in 63.7% of cases. The most frequently elevated antibodies were ZnT8, GAD, and IA-2. There was no significant difference in age at onset between patients with positive and negative antibodies; however, those with positive antibodies had lower body mass index (BMI), a higher incidence of ketoacidosis, and lower levels of C-peptide, uric acid, and triglycerides at disease onset. Among antibody-positive patients, 36.8% did not require insulin therapy until at least 6 months after disease onset (median: 2 [1; 3] years). During onset and the first 5 years, these patients demonstrated higher BMI, triglycerides, and C-peptide levels. Notably, 8.9% of patients with elevated antibodies were managed exclusively with oral glucose-lowering agents and/or glucagon like peptide 1 (GLP-1) receptor agonists for a median of 3 [2; 7.5] years after disease onset, maintaining an HbA1c level of 6.7 [6.2; 7.75]%.

CONCLUSION. Autoimmune DM in adults demonstrates heterogeneity in the rate of β-cell function decline and the development of insulin dependence. Later initiation of insulin therapy in autoimmune DM is associated with older age at onset, higher BMI, triglycerides, and C-peptide levels at diagnosis and during follow-up. The use of oral antidiabetic drugs and/or GLP-1 receptor agonists may be considered for patients with preserved C-peptide levels, provided that carbohydrate metabolism and C-peptide levels are regularly monitored. Nonetheless, insulin replacement therapy remains the primary pathogenetic treatment for autoimmune DM.

BACKGROUND: A comprehensive assessment of biomarkers involved in the development of systemic inflammation in patients with long-term type 1 diabetes mellitus (T1D), accompanied by the development and progression of cardiac and renal pathology, may allow stratification of patients according to specific inflammatory activity and help in the search for new therapeutic prevention and treatment options.

AIM: To evaluate markers of inflammation, fibrosis, endothelial dysfunction, and podocytopathy in patients with prolonged course of T1D (≥ 20 years).

MATERIALS AND METHODS: The study consisted of 2 stages. In the first stage, a single-center, cross-sectional study of 133 patients was conducted. Of these, 87 patients with 10-year data available were included in the second stage of the study with dynamic assessment of parameters. All patients were examined and treated at the Endocrinology Research Centre of the Ministry of Health of Russia from 2011 to 2024. Patients were divided into several groups: without chronic kidney disease (CKD) and with CKD at different stages. In addition to standard laboratory parameters, the levels of matrix metalloproteinase-9 (MMP-9), brain natriuretic hormone (NT-proBNP), transforming growth factor beta-1 (TGF-β1), asymmetric dimethylarginine (ADMA), monocyte chemotactic factor-1 (MCP-1), osteopontin, and tumor necrosis factor receptors type 1 (TNFRSF1A) and type 2 (TNFRSF1B), cystatin C in blood, nephrin, podocin in urine were studied using commercial kits in accordance with manufacturers’ recommendations. Based on the values of the regression coefficients, the estimated glomerular filtration rate (eGFR) showed an inverse relationship with the development of chronic heart failure (CHF), while podocin exhibited a positive relationship with acute kidney injury (AKI). The risk of CHF decreased with every 1 mL/min/1.73 m² increase in eGFR, OR=1.12 (95% CI: 1.02–1.22, P=0.015). The risk of AKI increased with every 1 ng/mL increase in podocin level, OR = 1.43 (95% CI: 1.01–2.03, P=0.047).

RESULTS: According to the criteria of CKD, preserved kidney function was observed in 43.2% of patients (n=54), the rest were at various stages of CKD. The prevalence of late complications of diabetes among the examined patients was high and increased as renal dysfunction progressed. Individuals with CKD showed increased levels of ADMA (P<0.005), TNFRSF1A and TNFRSF1B (P<0.001) and decreased levels of TGF-β1 (P<0.006) compared with those without CKD. In the dynamic control group (n=87), statistically significant increases in the levels of TGF-β1, nephrin, podocin, a decrease in the estimated glomerular filtration rate (eGFR) (P<0.001), and a statistical trend towards an increase in cystatin C during the follow-up period against the background of progression of renal and cardiovascular pathology were detected. In the same group, an inverse correlation (strong and noticeable) was determined between eGFR and TNFRSF1A and TNFRSF1B, ADMA.

CONCLUSION: In individuals with a long history of T1D, a significant role of factors of endothelial dysfunction, inflammation and fibrosis, podocytopathy in the development and progression of CKD with involvement of the cardiovascular system in the pathological process has been determined.

BACKGROUND: Dialysis treatment is a risk factor for the development of carbohydrate metabolism disorders (CMD) and glycemia variability (VG) in patients with chronic kidney disease (CKD).

AIM: To analyse the impact of renal replacement therapy (RRT) on the development of CMD in patients with CKD without a history of diabetes mellitus (DM).

MATERIALS AND METHODS: 90 patients were examined with CKD without DM in the history (60 patients with CKD on RRT using program hemodialysis (pHD) and continuous ambulatory peritoneal dialysis (CAPD) and 30 patients with CKD 3–5 (without RRT)). Patients were collected anamnesis, measured the level of glycated hemoglobin (HbA1c), fasting plasma glucose (FPG) and capillary blood glucose at 5 points in the HD and advanced CKD stages groups and at 9 points in the CAPD group. Indices of VG and dynamics of the glucose median for Friedman in all groups were evaluated. Patients with impaired fasting glycemia (IFG), impaired glucose tolerance (IGT), IGT and FPG, with first diagnosed DM were included in the CMD.

RESULTS: In the total group (n=90), the median HbA1с was 5,1 [4,9; 5,4] %, median FPG was 5,2 [4,72; 5,94] mmol/L, and median postprandial glycemia (PPG) was 6,0 [5,5; 6,8] mmol/L. 32,2% (n=29) patients of the total group had CMD: first-diagnosed DM — 2,2% (2 patients), IFG and IGT — 3,3% (3 patients), IFG — 17,8% (16 patients), IGT — 8,9% (8 patients). The prevalence of CMD in the total group was higher according to FPG and/or PPG level than according to HbA1c value (31,3% vs 10%, p<0,001). 33,3% of patients on RRT had CMD; in the group with CKD without RRT, CMD was detected in 30% of patients (p=0,025). CMD were more frequent in patients on CAPD than in patients on pHD (46,7% vs 20%, p=0,028), mainly due to IFG. Patients with CKD on pHD, compared to patients on CAPD, showed a propensity for hypoglycemia as measured by the LBGI index (0,67±0,17 vs 1,66±0,67), p<0,001.

CONCLUSION: A high prevalence of CKD was found in patients with CKD — 32,2%. Patients with CKD on RRT, compared to the group with advanced stage CKD without dialysis, have a higher incidence of CMD due to IFG and are prone to hypoglycemia development (group on pHD). A high VG within the groups was revealed regardless of the type of RRT, presence of advanced stages of CKD, day of dialysis.

BACKGROUND: Currently, much attention is paid to the search for highly informative and non-invasive methods for screening the progression of non-alcoholic fatty liver disease (NAFLD) through the stages of «steatohepatosis-steatohepatitis-fibrosis». Such non-invasive methods include tests based on serum markers and/or biometric indicators. The differences in cut-off diagnostic thresholds for some fibrosis indices and the use of a point scale, which includes the presence/absence of diabetes or other carbohydrate metabolism disorders (CMDs) in calculating other indices (NAFLD-LFS, BARD, NFS) make the issue of the applicability of these indices in a cohort of patients with prediabetes and T2DM relevant.

AIM: To study clinical and laboratory associations of liver steatosis and fibrosis indices in overweight and obese patients depending on CMD, and to evaluate the diagnostic significance of individual steatosis and fibrosis indices in this cohort of patients.

MATERIALS AND METHODS: All patients underwent a comprehensive clinical and laboratory examination, liver fibrosis screening by ultrasound liver fibroelastometry, and liver MRI in IDEAL-IQ mode. The steatosis index FLI and fibrosis indices FIB-4, APRI, BARD, and NFS were calculated. Statistical processing of the results included comparative analysis, frequency analysis, correlation — and ROC analysis.

RESULTS: The study included 114 patients with overweight or obesity divided into groups depending on the CMD: group 1 — without CMD (n=52), group 2 — prediabetes (n=34), group 3 — newly diagnosed T2DM (n=28). We verified significant differences depending on CMD only for the NFS index: in individuals with T2DM, the NFS index was significantly higher than in individuals with impaired glucose tolerance (IGT) and significantly higher than in the group without CMD. In IGT patients, the NFS values significantly exceeded those in the group without CMD. According to the APRI and FIB4 assessment, no cases of advanced (≥F2) fibrosis were found in the obtained sample. The APRI index demonstrated sufficient informative value regarding F2 fibrosis (area under the curve=0.687; p=0.008) in the cohort of obese and overweight patients without taking into account the CMD.

CONCLUSION: Non-invasive tests have potential for detecting liver fibrosis, but require further study regarding applicability to a cohort of patients with CMD.

BACKGROUND: Chronic brain dyscirculation (CBD) is a common type 2 diabetes mellitus (DM) complication that leads to the cognitive dysfunction. Glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter type 2 inhibitors (SGLT-2i) can reduce the stroke risk but their effect on CBD is not fully studied.

AIM: To study and to compare the effect of SGLT-2i of various selectivity and GLP-1RA on the biochemical and functional parameters of CNS damage in patients with type 2 DM.

MATERIALS AND METHODS: Type 2 diabetic patients with target HbA1c level on metformin monotherapy were included in “MET” group (n=43), with non-target HbA1c were divided into groups: “MET+EMPA”, n=47, (empagliflozin therapy), “MET+CANA”, n=41, (canagliflozin therapy), “MET+GLP-1RA”, n=66 (therapy with injectable GLP-1RA). The “Control” group (n=23) consisted of healthy volunteers. In “Control” and “MET” groups at baseline, in the rest groups also after 3 and 6 months neuron-specific enolase (NSE), neurofilament light chains (NLC) levels and cognitive status were determined.

RESULTS: NSE was increased in all DM patients. GLP-1RA therapy did not lead to NSE decrease. NSE decreased in “MET+EMPA” group after 3 months and in “MET+CANA” group after 6 months. NLC levels were elevated in patients with non-target HbA1c compared to “Control”. Both SGLT-2i caused a more pronounced decrease in LCN than GLP-1RA after 3 months; after 6 months NLC in all treatment groups did not differ from “Control” group. At baseline all DM patients had impaired cognitive function according to MOCA and MMSE. Empagliflozin treatment resulted in the improvement, but not normalization, of cognitive status by MOCA scale. Canagliflozin led to cognitive function normalization after 3 months and retention of the effect. GLP-1RA use was associated with mental function normalization after 6 months. Satisfactory glycemic control was achieved in all groups.

CONCLUSION: Type 2 DM is characterized by CNS damage even with satisfactory glycemic control. GLP-1RA and SGLT-2i have a protective effect in CBD in DM; the protective potential of low-selective canagliflozin is probably more pronounced, as it manifests in biochemical and functional parameters improvement. The neurotropic effect of GLP-1RA and SGLT-2i is not due solely to their effect on the glycemic profile.

OBJECTIVE. To evaluate the therapeutic efficacy and safety of the new fixed-dose combination of alogliptin and pioglitazone, in patients with type 2 diabetes mellitus, in real-world clinical practice.

MATERIALS AND METHODS. A multicenter, observational, non-interventional, prospective study of the only fixed-dose combination of alogliptin and pioglitazone, available under the brand name «Incresync», was conducted in the Russian Federation. The study included two dosage regimens (25 mg+15 mg and 25 mg+30 mg, respectively) of the medication (PROsperity). The study included 1,999 patients who were observed in 52 research centers in the Russian Federation over a period of six months (24 weeks). Inclusion criteria: patients aged 18 or older with newly diagnosed type 2 diabetes mellitus or who had not achieved glycemic targets with previous treatment, and exclusion criteria: contraindications to using alogliptin or pioglitazone. Study design: Initially, after 3 and 6 months of incresync therapy, researchers recorded the target and current levels of HbA1c, fasting and post-prandial glycemic indices, as well as a wide range of cardiorenal-metabolic markers, including assessments of lipid profile, renal function, blood pressure, cardiovascular risk factors, concurrent medication, insulin resistance (HOMA-IR), and anthropometric measurements such as body weight and waist circumference, on the background of treatment. Two key glycemic indicators were chosen as the primary endpoints for evaluating the efficacy of T2DM treatment: 1) changes in HbA1C after 3 and 6 months of incresync treatment; 2) the proportion of patients who achieved individual HbA1c targets after 6 months. Secondary endpoints included assessment of other glycemic and non-glycemic markers, including the dynamics of these markers. In the case of combined therapy, the dosage regimens and duration of nternational nonproprietary name (INN) treatment were recorded for all hypoglycemic drugs.

RESULTS. The average duration of the disease was 68.4±62.0 months. At the end of the study, after 6 months, the average decrease in HbA1c levels was -1.3%, compared to the initial level of 8.2%. This decrease was statistically significant (p<0.001). In the group of patients who started with a dose of 25+30 mg HbA1C reduction was more pronounced, amounting to -1.5% compared to baseline levels of 8,2% (also statistically significant p<0.001). The maximum reduction in HbA1C (-2,8%) was seen in patients with baseline HbA1C >9,0% (n=300, which is 15% of the total sample). Overall, 70,2 % of patients achieved goal HbA1C (<7,0%), including 80,1 % of those treated with Incresync 25 mg+30 mg (n=915, which is 46% of the total sample). Also, improvements of blood lipids, reduction of insulin resistance, systolic blood pressure and body weight were seen during 6 months of Incresync treatment. The use of Incresync was characterized by a favorable safety profile: 23 adverse events (~1%) were registered during the study period, which were mainly mild and non-specific and did not require discontinuation of therapy. After end of the study, 94% of patients remained on Incresync therapy, and 94% of physicians rated it as “very effective” or “effective”.

CONCLUSION. The results of the multicenter, observational, non-interventional «PROsperity» study confirm the high efficacy and safety of Incresync. This allows the new combination to be considered the next step in the treatment for all groups of patients with type 2 diabetes mellitus who have not reached the target glycemic control on previous therapy.

Sodium glucose cotransporter-2 inhibitors (SGLT2is) are now widely used to treat diabetes, but their effects on nonalcoholic fatty liver disease (NAFLD) remain to be determined. We aimed to evaluate the effects of SGLT2is on the pathogenesis of NAFLD. A multicenter, randomized, controlled trial was conducted in patients with type 2 diabetes with NAFLD. The changes in glycemic control, obesity, and liver pathology were compared between participants taking ipragliflozin (50 mg/day for 72 weeks; IPR group) and participants being managed without SGLT2is, pioglitazone, glucagon-like peptide-1 analogs, or insulin (CTR group). In the IPR group (n = 25), there were significant decreases in hemoglobin A1c (HbA1c) and body mass index (BMI) during the study (HbA1c, -0.41%, P < 0.01; BMI, -1.06 kg/m2, P < 0.01), whereas these did not change in the CTR group (n = 26). Liver pathology was evaluated in 21/25 participants in the IPR/CTR groups, and hepatic fibrosis was found in 17 (81%) and 18 (72%) participants in the IPR and CTR groups at baseline. This was ameliorated in 70.6% (12 of 17) of participants in the IPR group and 22.2 % (4 of 18). of those in the CTR group (P < 0.01). Nonalcoholic steatohepatitis (NASH) resolved in 66.7% of IPR-treated participants and 27.3% of CTR participants. None of the participants in the IPR group developed NASH, whereas 33.3% of the CTR group developed NASH. Conclusion: Long-term ipragliflozin treatment ameliorates hepatic fibrosis in patients with NAFLD. Thus, ipragliflozin might be effective for the treatment and prevention of NASH in patients with diabetes, as well as improving glycemic control and obesity. Therefore, SGLT2is may represent a therapeutic choice for patients with diabetes with NAFLD, but further larger studies are required to confirm these effects. (Hepatology Communications 2022;6:120-132) .

Sodium glucose cotransporter-2 inhibitors (SGLT2is) are now widely used to treat diabetes, but their effects on nonalcoholic fatty liver disease (NAFLD) remain to be determined. We aimed to evaluate the effects of SGLT2is on the pathogenesis of NAFLD. A multicenter, randomized, controlled trial was conducted in patients with type 2 diabetes with NAFLD. The changes in glycemic control, obesity, and liver pathology were compared between participants taking ipragliflozin (50 mg/day for 72 weeks; IPR group) and participants being managed without SGLT2is, pioglitazone, glucagon-like peptide-1 analogs, or insulin (CTR group). In the IPR group (n = 25), there were significant decreases in hemoglobin A1c (HbA1c) and body mass index (BMI) during the study (HbA1c, -0.41%, P < 0.01; BMI, -1.06 kg/m2, P < 0.01), whereas these did not change in the CTR group (n = 26). Liver pathology was evaluated in 21/25 participants in the IPR/CTR groups, and hepatic fibrosis was found in 17 (81%) and 18 (72%) participants in the IPR and CTR groups at baseline. This was ameliorated in 70.6% (12 of 17) of participants in the IPR group and 22.2 % (4 of 18). of those in the CTR group (P < 0.01). Nonalcoholic steatohepatitis (NASH) resolved in 66.7% of IPR-treated participants and 27.3% of CTR participants. None of the participants in the IPR group developed NASH, whereas 33.3% of the CTR group developed NASH.

Conclusion: Long-term ipragliflozin treatment ameliorates hepatic fibrosis in patients with NAFLD. Thus, ipragliflozin might be effective for the treatment and prevention of NASH in patients with diabetes, as well as improving glycemic control and obesity. Therefore, SGLT2is may represent a therapeutic choice for patients with diabetes with NAFLD, but further larger studies are required to confirm these effects. (Hepatology Communications 2022;6:120-132) .

BACKGROUND: This study uses the AHA Risk Calculator to initiate empagliflozin in diabetic patients at risk of cardiovascular disease by comparing the threshold to current guidelines.

AIM: The purpose of this study is to use the American Heart Association’s Cardiovascular Risk Calculator to initiate empagliflozin in patients at cardiovascular risk and to determine an appropriate threshold for initiation of this drug compared to current European and American guidelines for the treatment of diabetes mellitus.

MATERIALS AND METHODS: Information was collected on 800 patients with type 2 diabetes mellitus aged 40 to 79 years and aged 40 to 79 years in the city of Kerman. Patients with indications to start empagliflozin were identified in accordance with the latest European and American guidelines. Using the American Heart Association’s 10-year Cardiovascular Disease Risk Calculator, the patients’ scores were calculated.

RESULTS: Of the 800 patients, 435 patients had indications for empagliflozin as recommended. Patients who were recommended to initiate treatment with this medication exhibited a notably elevated likelihood of developing cardiovascular disease. The incidence of risk factors for cardiovascular issues was assessed, with nephropathy, retinopathy, and stroke being the most closely linked to the commencement of empagliflozin as per recommendations in diabetes management guidelines.

CONCLUSION: The American Heart Association calculator can be used to start empagliflozin with a threshold of 6% in women and 6.5% in men.

BACKGROUND: Diabetes Mellitus significantly impacts the quality of human resources and substantially increases healthcare costs. Good adherence to diabetes treatment can control blood sugar levels and minimize hospitalization.

AIM: To determine the medication adherence profile in patients with diabetes mellitus and the influencing factors.

MATERIALS AND METHODS: A cross-sectional study was used in Kalinyamatan Primary Health Center, Central Java, Indonesia, involving 90 patients with type 2 diabetes mellitus. Primary data was collected using pretested questionnaires. This research used a total sampling technique to recruit participants. To determine the factors influencing medication adherence in patients with diabetes mellitus, we conducted a logistics regression analysis.

RESULTS: The study showed that medication adherence indicated low in 22 individuals (24.4%) and high in 68 individuals (75.6%). Four factors were significantly influencing medication adherence in patients with diabetes mellitus: age (p-value 0.007), education (p-value 0.048), occupation (p-value 0.012), and family support (p-value 0.002). However, two factors, namely gender (p-value 0.259) and duration of illness (p-value 0.547), were found to have no significant impact on medication adherence.

CONCLUSION: Healthcare professionals should have to motivate patients with Diabetes Mellitus to ensure adherence to their prescribed treatment regimen.

Oncological diseases are one of the leading causes of mortality in the world. Despite the intensive search for new methods to increase the efficacy and safety of antineoplastic therapy and to reduce resistance to it by malignant tumors, treatment issues still remain unresolved in clinical oncology. This review analyses experimental data on the antineoplastic effect of sodium-glucose cotransporter 2 (SGLT2) inhibitors: the reasons why SGLT2 inhibitors can be used for the treatment of malignant tumors are presented, class-specificity and dose-dependence of the antineoplastic effect of the drugs are determined. Possible mechanisms of antitumor effect of glyflozins are described in detail, among which, in addition to reduction of glucose entry into tumor cells, inhibition of Wnt/β-catenin signalling pathway, enhancement of AMP activated protein kinase activity with subsequent change of lipid profile of tumor cells and inhibition of mTOR protein kinase (mammalian target of rapamycin), disruption of DNA and RNA synthesis in malignant tumor cells, etc. play a significant role. Considerable space is devoted to the pro-oncogenic effect of SGLT2 inhibitors, previously undisputed and now disproved, as well as to the interaction of this class of antidiabetic agents with other antitumor treatment in the context of efficacy, safety and therapeutic resistance.