BACKGROUND: Diabetes mellitus (DM) is a dangerous challenge to society and high-priority goals for health systems worldwide due to the severity of diabetic complications leading to disability and premature mortality in this category of patients.

AIM: To carry out an analysis of epidemiological, clinical and therapeutic characteristics of DM control in the Russian Federation (RF) according to the strategy goals of the World Health Organization (WHO) by 2030 (diagnosis of DM; control of glycemia, blood pressure in DM patients; assignment of statins to DM patients; ensuring the availability of insulin and means for self-monitoring of the level of glycemia) based on the «Database of clinical and epidemiological monitoring of DM in the territory of the Russian Federation (RF)».

MATERIALS AND METHODS. The research performed on the basis of the de-personalized "Database of clinical and epidemiological monitoring of DM in the territory of the RF", certificate of state registration database №2020622447 (http://diaregistry.ru, register of DM), which included 87 regions of the RF. Data are presented as cross-sectional study in 01.07.2024.

RESULTS: According to the Database of clinical and epidemiological monitoring of DM in the territory of the RF, the target HbA1c<7% is achieved in 29% of patients with type 1 DM (T1DM) and 42% of patients with T2DM. Effective blood pressure control in people with diagnosed DM is achieved in 84% of patients with T1DM and 60% of patients with T2DM. The proportion of patients receiving statins aged 40 and over is 14.1% for T1DM, 15.9% for T2DM. All patients with T1DM (100%) and T2DM on insulin therapy are provided with insulin under the program of state guarantee of drug provision, of them insulin analogues in T1DM — 84,8%, in T2DM — 60,9%, the rest — recombinant human insulins. Self-monitoring devices (glucometers and test strips for them) are provided to 100% of patients with DM. Since 2023, patients with T1DM under 18 years old are provided by continuous glucose monitoring systems.

CONCLUSION: Common diabetes monitoring system based on "Database of clinical and epidemiological monitoring of DM in the territory of the RF" at the national level allows to assess the effectiveness of programs to achieve the WHO targets. The data analysis identifies priority areas for the most effective and achievable interventions to strengthen and monitor diabetes control. Providing timely, reliable and sustainable national information on risk factors, epidemiology and clinical data of DM, access to medical drugs and modern technologies of control requires coordinated work by health professionals.

Type 1 diabetes mellitus (T1DM) in childhood is one of the most important social and medical problems, given the growing incidence and negative impact on the duration and quality of life. The onset of the disease in childhood associated with significantly reduced life expectancy, largely due to micro- and macrovascular complications, and background pathological processes may occur from the T1DM onset due to suboptimal glucose control. Large registers data indicate that less than half of children with T1DM achieve target glycemic control, and adolescence is characterized by the worst glycemic control among all age groups. In recent years, modern treatment tools have been widely adopted in children with T1DM: insulin pumps, continuous glucose monitoring and automatic insulin delivery systems, which has become possible due to their increased availability, convenience and proven effectiveness. These technologies not only reduce the burden of the disease, but also improve the effectiveness of treatment of T1DM in children, consequently reducing the risks of diabetic complications protecting the health for the upcoming adult life.

Therapeutic education for patients with diabetes mellitus (DM) has become an important and mandatory component of the comprehensive management of this disease. This approach integrates several disciplines such as medicine, pedagogy and psychology, making it a unique field aimed at improving the health and quality of life of patients. The goal of therapeutic education is not only to provide information about the disease, but also to teach the patient self-management skills, proper nutrition, self-adjustment of insulin doses, and recognizing the signs of possible complications.

Effective management of DM is impossible without the patient’s participation. Continuous monitoring of glucose levels, timely adjustments of insulin doses and compliance with dietary recommendations require the patient’s informed and active participation in the treatment process. Therapeutic education helps patients to better understand their condition, recognize the importance of self-management and improve their disease management skills. Thus, education becomes an integral part of treatment, ensuring the achievement of long-term goals for maintaining optimal glycemia levels and preventing the development or progression of complications.

Since the end of the 20th century, Russia began to develop its own school of therapeutic education for patients with diabetes mellitus. Various programs were created, including courses for patients and their relatives, seminars with doctors. These programs have proven to be effective in the long term, as evidenced by the improvement of carbohydrate metabolism compensation indicators in patients with diabetes, as well as a reduction in the frequency of hospitalizations and complications.

Thus, therapeutic education within the framework of comprehensive diabetes treatment not only contributes to the improvement of individual health indicators of patients, but also has a positive impact on the overall efficiency of the health care system.

This article addresses contemporary issues in endocrine cardiology. The main content of the work is an analysis of the history of medications used in diabetology, ranging from the first animal-derived insulins to modern sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors) and glucagon-like peptide-1 receptor agonists (GLP-1 RA), which possess pronounced cardioprotective activity. Studies demonstrating their effectiveness in influencing the cardiovascular system in patients with type 2 diabetes mellitus (T2DM) are analyzed. Particular attention is paid to multicenter clinical trials that studied the effect of hypoglycemia on cardiovascular outcomes in patients with T2DM. The article also summarizes the scientific and practical experience of using SGLT2 inhibitors in patients with various cardiac arrhythmias, including those that are life-threatening for patients with T2DM.

Chronic kidney disease (CKD) is a supranosological concept, defined as a disorder of the structure and/or function of the kidneys for 3 months or more that leads to health consequences. CKD develops in 20–40% of patients with diabetes mellitus (DM). Dynamic analysis of epidemiological indicators of CKD in patients with diabetes mellitus points to the prevalence increase of this pathology in the Russian Federation in 2010–2022. Improved quality of diagnostics of earlier stages complications, a decrease in the risk of cardiovascular events (the leading cause of death) and end-stage renal failure at a later age and with a longer duration of diabetes are noted as well. The development of tools for predicting the risk of the pathology progression and its complications has made it possible to improve patient monitoring and routing. Current international and domestic recommendations emphasize a comprehensive approach to the treatment of CKD, including lifestyle modification, evidence-based pharmacological treatments aimed at preserving organ function, and improving cardiovascular prognosis. An optimal model of care for patients with diabetes and CKD, aimed at multidisciplinary care and adapted according to the severity of CKD, will lead to the best outcomes for the individual patient and society.

Lesions of the lower extremities in diabetes mellitus are a complex and urgent problem of modern medicine. The high prevalence of diabetes mellitus, significant difficulties in timely diagnosis, differential diagnosis and the choice of therapeutic tactics to preserve the supporting function of the limb determine the difficulties in managing diabetic patients. Over the past decades, significant changes have occurred in the structure of specialized medical care for diabetic foot patients which has significantly reduced the number of high amputations, improved the quality and life expectancy of patients. The article presents the results of the long-term experience of the Diabetic Foot department in the treatment of diabetic foot patients.

BACKGROUND: Diabetic retinal involvements as proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME), revealed in most cases of PDR, are main causes of best corrected visual acuity (BCVA) loss in diabetic patients. PDR represents late diabetes mellitus (DM) complication, in severe cases it requires vitreoretinal surgery (VRS). Given high risk of vision loss and comorbidity of PDR patients, optimal choice of ophthalmological treatment strategy is still actual.

AIM: to compare clinical guides’ recommendations accomplishment and real clinical practice, analyze main retinal diabetic involvement diagnosis and management problems, on diabetic patients, presented to Endocrinology Research Center of the Ministry of Health of the Russian Federation for VRS.

MATERIALS AND METHODS: Study subjects: data of medical records and endocards (Endocrinology Research Center diabetic patients clinical statistical registration cards) of 252 patients (260 eyes) with type 1 (n=168) and type 2 (n=84) DM, undergoing VRS from 2019 to 2023. We analyzed reasons for PDR deterioration, VRS results, frequencies of cardiovascular (CV) and diabetic complications, that heighten risks of cardiovascular events (CVE), such as atherosclerotic diseases, ischemic heart disease (IHD), chronic heart failure (CHF), cerebrovascular accident (CVA), chronic kidney disease (CKD), and diabetic foot syndrome (DFS). Inclusion criterion was presence of PDR complication, requiring VRS, irrespective of its severity. Standard ophthalmological investigation, ultrasound B-scan of the eyes, retinal optical coherent tomography (OCT), and fundus photography were carried out. BCVA evaluation was made before VRS and one month after the procedure. Proliferative process stabilization was checked up in one month to five years.

RESULTS: Median age of patients with T1DM/T2DM was 39/63 years, DM duration before VRS was 19/17 years, females constituted 63%/57% of patients, respectively. In 258 eyes of 260 (99,2%) retinal photocoagulation (PC) before VRS procedure was not accomplished or was not performed at all. In all patients one month after procedure BCVA grew higher, but it strictly depended on baseline BCVA, which was determined by PDR complication severity. Before/after VRS in 76 eyes (29%) it constituted between light perception with projection and 0,05/0,01–0,08; in 68 eyes (26%) — 0,06–0,1/0,08–0,3; in 62 eyes (24%) — 0,2–0,3/0,3–0,5; in 54 eyes (21%) — 0,4–0,8/0,5–1,0 in decimals, respectively. Concurrent conditions frequencies among DM1/DM2 patients were for atherosclerosis — 47%/67%, for IHD — 9%/32%, for CVA — 4%/9%, for CHF — 5%/30%, for CKD — 71%/63% (including CKD stage C5 24,7%/13,6%), for DFS — 29%/17%, for amputations — 13%/17% of cases, respectively.

CONCLUSION: In the studied cohort of patients with severe PDR, frequent concurrent conditions and high CVE risks in 99,2% of cases retinal PC extent was improper, that lead to complications and need for VRS. In patients with PDR and comorbidities panretinal PC should be carried out without delay, as it is required by clinical guidelines. To avoid severe visual loss panretinal PC must be the treatment of high priority.

OBJECTIVES. Dapagliflozin is a glucose-lowering drug of the class of type 2 sodium-glucose cotransporter inhibitors (iSGLT-2) that also has cardio- and nephroprotective properties. Its efficacy in improving cardiovascular and renal outcomes in patients with type 2 diabetes mellitus (T2D) is well studied in international randomized clinical trials, but there are no data on the effectiveness of the drug in real clinical practice in Russian patients. The CARDIA-MOS observational study was conducted to investigate this issue using data from the Moscow segment of the diabetes registry and UMIAS electronic outpatient records. In addition to the previously published results, updated data for the 6-year follow-up period are presented.

OBJECTIVE. To study the impact of dapagliflozin on clinical outcomes and mortality rates of patients with T2D in real clinical practice in Moscow.

MATERIALS AND METHODS. To assess outcomes, we retrospectively collected data from the main and control groups, each consisting of 499 patients with T2D who met the selection criteria. Patients in the main group initiated dapagliflozin therapy in 2017; the control group comprised patients matched for baseline characteristics but who did not receive iSGLT-2 before inclusion in the study and during the follow-up period.

RESULTS. The majority of patients in the main and control groups were women (58.9%), the mean age was about 63 years, and the duration of T2D history was about 9 years. Administration of dapagliflozin as an add-on therapy of patients in the main group was associated with relative risk (RR) reduction of death from any cause by 42% (RR=0.58; 95% CI 0.43–0.78; p<0.001), risk of death from heart failure (HF) by 66% (OR=0.34; 95% CI 0.16–0.72; p<0.001), risk of death from cardiovascular disease (CVD) by 72% (OR=0.28; 95% CI 0.17–0.47; p<0.001), and risk of major adverse cardiovascular events (MACE) by 49% (OR=0.51; 95% CI 0.40–0.67; p<0.001) after 6 years of follow-up. Also, the dapagliflozin group showed a decrease in HbA1с from 8.53% to 7.92%, a decrease in body weight, and a slower decrease in glomerular filtration rate (GFR) compared to the control group.

CONCLUSIONS. Long-term treatment with dapagliflozin significantly improves clinical outcomes in patients with T2D, including a reduction in the risk of death from any cause, the risk of death from HF and CVD, and the risk of developing MACE compared with standard therapy without iSGLT-2. Along with high effectiveness profile of the drug in terms of improvement in glycemic control parameters, the use of dapagliflozin in routine practice also led to a decrease in body weight and the rate of progression of chronic kidney disease (CKD).