Review article is devoted to the main directions of prevention of diabetes, which remains one of the main causes of death and disability in most countries of the world. Prevention of 2 type diabetes requires a modifying effect on the pathological processes leading to diabetes in order to slow down, stop or reverse the development of p-cell dysfunction and insulin resistance of the tissues. In the absence of a clinical effect from non-drug methods of prevention, it is advisable to use drugs that reduce insulin resistance and dysfunction of p-cells. The results of research indicate that biguanides, а-glucosidase inhibitors, orlistat, thiazolidinediones reduce the risk of developing T2D to varying degrees. Metformin has the largest evidence base, and its prolonged form is a registered indication in the Russian Federation as a drug therapy for patients with prediabetes. For other drugs we need to consider cost, side effects and long-term efficacy. The questions about the possibility of personalization of treatment-and-prophylactic measures based on algorithms, including phenotypic, genetic and microbiome features of patients with prediabetes, are discussed now.

The prevalence of T2D is steadily increasing annually, which resulted in an active search for a way to control the disease. The last decade has seen a rise in the number of new groups of glucose-lowering drugs, which not only proved effective in the management of hyperglycemia and safe against hypoglycemia, but also joined the ranks of the drugs of the first-line therapy. Among them is incretin-active agents - type 4 dipeptidyl peptidases inhibitors (IDPP-4, glyptines). Sitagliptin was the world's first approved IDPP-4, and began to be used successfully in Russia since 2007. The review presents data on the efficacy, safety (including cardiac safety) of sitagliptin use and accumulated experience of its use in the treatment of patients with type 2 diabetes.

Aim. Comparison of the influence of mono- and combined lipid-lowering therapy on lipid profile and glycemia in patients with T2DM.

Methods. A comparative assessment of lipid profile dynamics in patients with type 2 diabetes from the group of high and very high risk of cardiovascular diseases depending on lipid-lowering therapy - atorvastatin in increasing doses (group 1), or by a combination of low doses of rosuvastatin and ezetimibe (group 2) was carried out.

Results. It was found that at baseline comparable lipid metabolism in the study groups, after completion of therapy in both groups there was a significant decrease in total cholesterol, low-density lipoprotein cholesterol, and triglycerides. In group 2 after completion of treatment triglyceride levels were significantly lower than in group 1. At the same time, after completion of hypolipidemic therapy course with atorvastatin, there was a significant increase in the level of both basal and postprandial glycemia, as well as glycated hemoglobin. In the group of combined therapy the level of postprandial glycemia and glycated hemoglobin after completion of the course of treatment was significantly lower than the baseline. As a result, by the end of 6 months of treatment in group 2 was significantly lower level of basal glycemia and glycated hemoglobin compared to group 1.

Conclusion. Combined lipid-lowering therapy with rosuvastatin and ezetimibe is significantly more effective than monotherapy with atorvastatin. This is expressed in a more pronounced lipid-lowering effect of this combination on the background of almost neutral effect on carbohydrate metabolism. At the same time, there was a negative effect of atorvastatin therapy on carbohydrate metabolism. The results require further research to clarify the mechanisms of this effect.

Type 2 diabetes mellitus is a serious disease associated with the development of severe complications. Recent advances in diabetology are related to hormone therapy. The mechanism of action of DPP-4 inhibitors is discussed. The results of clinical studies of the efficacy and safety of gosogliptine are presented.

It is obvious that glycemia self-monitoring during management of diabetes mellitus (DM) is important and beyond argument due to increasing prevalence of diabetes throughout the world. Careful self-monitoring may make it possible to achieve target glycemia during 24 hours, the onset and intensification of glucose-lowering therapy. Self-monitoring implies monitoring blood glucose by patients using portable medical devices for in vitro diagnosis (glucometers). Innovative glucometers are easy to use and have a new accuracy level of measurements, which allows patients to effectively manage their disease, increase commitment to self-monitoring and, therefore, actively participate in the prevention of diabetes complications.

Over the past decade, the number of people with type 2 diabetes mellitus (T2DM) has more than doubled globally. For 2040, it was estimated by the International Diabetes Federation that 642 million people will have diabetes. According to the Federal Register of Diabetes Mellitus as of January 01.2019, more than 4.5 million patients with diabetes are registered in Russia, of which 4,238,503 are people with type 2 diabetes. However, these data are incomplete, as problems with timely diagnosis and active detection of glucose metabolism disorders continue to exist. Due to late diagnosis of T2DM, high rates of glycemia in the onset of the disease, as well as pronounced decompensation in association with oral hypoglycemic drugs during a long course of the disease, require the transfer of patients to injection therapy. The head of Diabetic Foot Department of the Research Center for Endocrinology of the Ministry of Health of the Russian Federation, Dr. of Sci. (Med.), Professor Gagik Radikovich Galstyan talks about the therapeutic possibilities of modern combined injection therapy.

Interview with Gagik Galstyan

The paper presents the new paradigm for assessment the glycemic control at the patients with the type 2 diabetes (T2DM), which consists of the combined detection from the professional continuous Glucose Monitoring CGM data: 1) coefficient of variation CV and 2) corrected Glucemic Monitoring Index GMIc. This approach was tested with 510 T2DM CGM records and it allows to correct the aimed glycated haemoglobin level HbA1c in combination with the reduction of the glycemic variability for the routine endocrinological practice, and to assess the safety and the efficacy of the current sugar-rescue therapy, and to increase the technical compliance of the patient with T2DM.

Hyperglycemia is one of the main risk factors for the development of microvascular complications in patients with T2D. However, the main reason of their deaths remain diseases such as myocardial infarction, chronic heart failure, stroke. Although all of the current glucose-lowering drugs are very effective for the correction of hyperglycemia, studies of the last decade proofs that some of them can additionally decrease cardiovascular risk on patients with T2D. So, the influence of empagliflozin, pioglitazone, liraglutide, semaglutide and canagliflozin was characterized as statistically significant positive to the frequency of development of macrovascular complications in patients with T2D. However, nowadays a convincing reduction in cardiovascular mortality in patients with T2D, who took empagliflozin and liraglutide was demonstrated only in two clinical studies - EMPA-REG OUTCOME and LEADER.

In the following review there are going to be analyzed the significant results of these studies and the peculiarities of the action of these drugs, which, possibly with joint application, have additive effects in reducing cardiovascular risk in patients with T2D.

Diabetic neuropathy and neuropathic pain worsen the quality of life of patients with diabetes. Clinical recommendations are not uniform and, often, do not consider alternative treatment options. The goals of treatment for diabetic painful neuropathy should be individualized. The choice of drug for the treatment of painагд DPN depends on the effectiveness, safety profile and existing or potential comorbid pathology.

The aim of the study was to assess the 10-year risk of fractures (FRAX®), taking into account the values of bone mineral density (BMD) and trabecular bone index (TBI) in a population sample of women over 55 years of age with type 2 diabetes mellitus (DM2).

Materials and methods. The study was carried out on the material of the population cohort of the international project HAPIEE (Novosibirsk). The design of the study is «case-control». Random groups of women aged 55-84 with and without DM2 were formed in combination with the presence or absence of fractures in the history (n = 103, group 4). Standardized questionnaires, anthropometry, densitometry (dual energy X-ray absorptiometry, DEXA), TBI and FRAX® fracture risk determination were performed on all people.

Results. Women with DM2 who reported a history fracture (group 1) had lower T-criteria in the femoral neck than women with DM2 without fracture (group 2), p = 0.039. However, the history of fracture in women with DM2 was accompanied by higher T-criteria values (by 0.3-0.5 SD) in the vertebrae and hips compared to women without DM (group 3). We did not get a significant difference in the TBI parameter between all 4 groups studied. We also found no difference in the risk of repeated fracture among women with and without DM2 using FRAX® without densitometry and TBI-adjusted FRAX® (p = 0.841, p = 0.094, respectively). In group 1 with DM2 and fractures, the risk for FRAX with T-test was lower than in group 3 without DM with fractures (p = 0.034 for the main fractures, p = 0.002 for the hip).

Conclusion. In the studied population groups «case-control» of women aged 55-84 years with diabetes mellitus and fractures in their history, the risk of FRAX® fractures is lower with regard to DEXA and does not differ significantly in terms of TBI in comparison with women without DM2 fractures. The data obtained reflect the difficulties in diagnostics and the need to search for additional methods of early diagnosis of increased risk of fractures in patients with DM2.

The mechanisms of mutual influence of fat tissue and the hypothalamo-pituitary-adrenal (HPA) axis include the regulation of the metabolism of adipocytes by adrenal cortex hormones, on the one part, and the effect of adipocytes and adipocytokines on secretion, metabolism and action of steroid hormones in target cells - on the other part.

Glucocorticoids contribute to the differentiation of preadipocytes into mature adipocytes; brown fat tissue transforms into white under the effect of GC. Mineralocorticoids are also involved in the process of adipocyte differentiation, regulate adipokine expression, and induce oxidative stress in fat tissue. There is evidence that suggest that circulating dehydroepiandrosterone sulfate (DHEAS), obesity, insulin sensitivity are associated with the presence of cardiovascular diseases.

Orexigenic neuropeptides and inflammatory mediators, which trigger the synthesis of corticotropin-releasing hormone (CRH) in the hypothalamic paraventricular nuclei, are considered as possible mechanisms of (HPA) axis activation in obesity. Expression of 1ip-hydroxysteroid dehydrogenase type 1 (11P-HSD1) in fat tissue and the formation of cortisol from cortisone at the tissue level can be considered as one of the factors involved in development of insulin resistance. The autocrine and paracrine regulatory effect of these hormones on adipocyte function is the consequence of aldosterone production and aromatization of androgens by fat tissue.

Over the past 40 years, much attention has been paid to the condition of muscle tissue and its function in older people, which is associated with an increased risk of falls and fractures in this population of people. The term «sarcopenia» was proposed in 1989 to denote a decrease in the weight and strength of skeletal muscles in the process of aging, and in 2010 European Working Group on Sarcopenia provided a definition and diagnostic criteria for this condition. In 2016, sarcopenia was assigned a code M62.84 to designate it as a muscle disease in the ICD-10. The article introduces readers to the classification, risk factors and methods of diagnosis of the disease, provides updated criteria for its diagnosis, and defines the concept of «osteosarcopenia». Possible methods of prevention and treatment to improve the quality of life of patients suffering from sarcopenia and osteosarcopenia are described.

The formation of the MS cluster starting from insulin resistance (IR), visceral obesity, dyslipidemia, arterial hypertension and carbohydrate metabolism disorders (CMD) against the background of estrogenic deficiency defines postmenopause as a risk factor for type 2 diabetes mellitus (DM2) and increased cardiovascular risk. The TyG index (logarithmic ratio of triglyceride and fasting plasma glucose levels) is proposed for surrogate evaluation of IR, reflecting an integrated approach to metabolic disorders.

Aim: To assess the relationship between the TyG Index and HOMA2-IR and its informativeness in predicting the risk of DM2 in women in postmenopause.

Materials and methods: TyG and HOMA2-IR indices (C-peptide) were determined in 94 postmenopausal women 58.02 ± 5.88 years of age, evaluated according to NCEP ATP III criteria and divided into groups: 1st - DM2, 2nd - prediabetes, 3rd - without CMD (HbAlc 7.3 ± 1.0; 6.2 ± 0.2 and 5.5 ± 0.4%, respectively). By means of SPSS (version 17) we evaluated ME (25-75%); intergroup differences by Mann-Whitney criteria; we performed correlation and ROC-analysis.

Results: TyG correlates with HOMA2IR in group 2 (R = 0.61; p = 0.013) and 3 (R = 0.60; p = 0.001). In the process of ROC-analysis cut-off for TyG was revealed, reflecting the chance of presence of DM2 in groups 2 and 3: 7.5 (sensitivity 0.938 and specificity 0.813) and 8.0 (sensitivity 0.894 and specificity 0.810), respectively.

Conclusion: TyG index allows predicting the development of dysglycemia in women in postmenopause with the signs of MS through the phenomenon of lipoglucotoxicity.

Obesity is becoming increasingly common and is becoming a risk factor for many non-communicable diseases. Over the past decades, considerable information has been gathered on the relationship between obesity and the risk of certain malignant neoplasms, particularly the gastrointestinal tract and the female genital system. This review article discusses the reliability of available statistical data, the impact of the type of tumor, age and gender peculiarities on cancer risk, highlights traditional and prospective hypotheses about the possible role of obesity in oncogenesis. The data on the influence of obesity on the course of developed oncopathology and the role of weight loss in reducing cancer risk are presented in a concise form.

In modern society, the problem of osteoporosis and diabetes mellitus (DM) is the most relevant one and covers the majority of the world's elderly population. One of the severe consequences of this pathology is a fracture that occurs when falling from a height of one's own growth or spontaneously. Due to growing comorbidity, elderly people with diabetes have an additional range of potential risk factors for falls. In this review, we will consider the impact of risk factors for DM-related falls in the context of osteoporotic fractures.

The risk of type 1 diabetes mellitus (T1DM) combined with epilepsy is significantly higher in people with this disease than in people without it, which may indicate a genetic predisposition for this combination. The issue of the relationship between diabetes and epilepsy has not yet been fully understood. The article is concerned with a clinical case of type 1 diabetes mellitus combined with Graves' disease in a 37-year-old patient with epilepsy. The combination of two autoimmune diseases can be taken as part of type 2 or 3 autoimmune polyglandular syndrome (APS). APS affects multiple glands in the endocrine system. The chronic adrenal cortex insufficiency is a characteristic sign for the most studied type 1 or 2 APS. Type 3 APS is defined by the presence of an autoimmune thyroid disease and other autoimmune diseases, both endocrine (excluding adrenal and parathyroid gland insufficiency) and nonendocrine. The autoimmune nature of T1DM and Graves' disease is beyond dispute in the considered case; the possibility of considering epilepsy as part of the autoimmune process (like type 3 APS) is not to be irrelevant. The article presents the differential diagnosis of convulsive conditions and comparison of clinical manifestations of hypoglycemia and epileptic seizures, and focuses on the prescription of anticonvulsant therapy in patients with type 1 diabetes. Thyrotoxicosis, which developed against the background of diabetes, leads to high variability of glycemia, increased need for insulin, metabolic decompensation, which requires correction of insulin therapy. Patients with polymorbid conditions should be considered from the perspective of single pathogenesis, and they should be followed-up. If a patient has polyendocrinopathy, the variability of the clinical picture, and pharmacokinetic and pharmacodynamic interaction of the prescribed drugs needs to be taken into account due to mutual influence of pathological processes.